Leslie Smith, MD, is a Western-trained physician who prefers acupuncture needles to scalpels and herbs to pharmaceuticals. At her busy practice in Chicago, she rarely prescribes medications, relying instead on gentler modalities from Asian medicine as well as osteopathic release techniques and nutritional counseling. She also teaches courses on acupuncture, and on complementary and alternative medicine, to medical students at the University of Illinois Chicago College of Medicine. She serves on the board of the American Academy of Medical Acupuncture.
After watching Smith’s talk at the Integrate Chicago conference, I became interested in what led this highly trained physician—in addition to her medical degree, she holds masters degrees in physiology and biophysics, and medical education and leadership—to immerse herself in the world of acupuncture. Here, we talk about her journey, from an aspiring surgeon since the age of four to an acupuncturist at the forefront of modern holistic medicine.
Sara Calabro: What led you to acupuncture?
Leslie Smith, MD: I was always interested in integrative medicine, but when I was in med school, there was absolutely no exposure to anything that was not mainstream, allopathic medicine. My first experience with acupuncture came in the fourth year of my training as a general surgeon, when I developed a repetitive stress injury called radial tunnel syndrome from doing laparoscopic procedures on people’s abdomens. It evolved over several months, to a point where I woke up and my right hand would not move at all. It was completely swollen and immobilized. I remember that it was Friday the 13th, in November of 2008.
This was a very, very dark time for me. I was 37 then, and since I was four years old, I wanted to be a surgeon. So after 33 years of working toward something, it was becoming clear that it wasn’t going to happen. I was put in wrist splints for six weeks and prescribed physical therapy, narcotics, and anti-inflammatories. None of it was working for my pain. I couldn’t even turn the page in a book because the pressure on my hand was so bad. Someone finally said to me, “Why don’t you try acupuncture?”
At the time, I was living in a relatively small town in central Illinois where there was one acupuncturist. I went and was kind of blown away. I had not let myself cry for several years, and I had a huge emotional release the first time I laid down on the table. Acupuncture really worked for my pain.
How did that personal experience with acupuncture lead you to shift your professional focus in that direction?
After my pain started improving, I was able to go back and run the trauma service as a resident, but it was clear that I wasn’t going to be able to operate. The first time I went into the OR, I thought I was going to die—it was so painful. I needed to switch to something else, and I couldn’t bear the thought of going back and starting residency all over again. I started studying acupuncture. The acupuncturist who I went to suggested that I read The Web The Has No Weaver by Ted Kaptchuk. I was fascinated. It just really resonated with me.
In my surgery residency, particularly in the ICU, I frequently had very strong intuitive insights into what was going on with patients, especially those who were unconscious. I would frequently get written up for not having a more definitive way to explain why I wanted to administer a medication or take a particular course of action. The first couple of times that it happened, I didn’t really have a good understanding of how to verbalize the cascade of events that I saw unfolding. After my predictions were right a few times, my colleagues started listening to me a little more. But aside from one attending who totally got it, everyone was very dismissive.
My intuition was a handicap in Western medicine. With acupuncture and Chinese medicine, I felt that I would be able to harmoniously engage both my scientific brain and my intuitive grasp of what’s going on with people. It would allow me to maintain my scientific filter while permitting me to be a little more fluid when it comes to interpreting deeper causes of disease, such as childhood trauma and emotional factors.
I investigated one of the acupuncture courses that’s offered to physicians, but when I didn’t have a great experience with that, I decided instead to go to acupuncture school. I’m so glad I did, because if I hadn’t, I wouldn’t know as much about Asian medical theory. I wouldn’t know about herbs. I wouldn’t know about Chinese nutrition. Physician courses focus on the acupuncture part and less on the entire scope of Asian medicine.
It sounds like you feel it is important for physicians to go to acupuncture school. Is that correct?
While it is safe for medical doctors to perform acupuncture—and there are a lot of good physician acupuncturists out there—I think they would get a more well-rounded education by going to acupuncture school. I think we should have a system that’s more like the one they have in China, where everyone goes to medical school and acupuncture is a residency, in the same way that cardiology is a residency.
Without learning hospital medicine, acupuncturists are only getting half of medicine. And without learning the subtleties of Chinese nutrition therapy, herbs, and zang fu diagnosis, medical doctors get a limited education as well. Both professions are reasonable and viable the way they currently stand, but I think it would be better if we combined the two into one unit.
Did you encounter challenges when you went back to school for acupuncture as a physician?
Doctors, generally, are the type As of the type As. And surgeons are the type As of the type As of the type As. In the beginning of acupuncture school, I would keep raising my hand in frustration and confusion, wanting to understand what these concepts meant from a perspective I could relate to. It was difficult at first, but my teachers at Yo San were so kind to me. They would just smile and explain how in Chinese medicine, we look at things through a different lens.
Overtime, it became less difficult. I realized that the two perspectives are not really that different. For example, in Western medicine, when someone has a headache, we don’t limit it to just saying the person has a headache. We characterize it as a cluster headache or a migraine headache or a tension headache. In Eastern medicine, we look at the etiology of the headache to determine whether it is caused by Liver Fire Rising, stagnation of the channels, or an issue in the Gall Bladder channel. It is just different vocabulary. There are some things that we don’t have concepts for in Western medicine, and there are some things that we don’t have concepts for in Eastern medicine.
How would you describe your practice today?
I’m an acupuncturist. I occasionally put my friends’ thumbs back on if they cut them off in the kitchen—I’ve done that a couple times, including my own thumb—but I don’t really do any Western medicine on a daily basis. I practice an amalgamated style of acupuncture that combines all the different traditions I’ve learned into a style that’s uniquely my own. I also have an herbal pharmacy and recommend herbs for about 75 percent of my patients. On rare occasions, I prescribe Western medications, but generally I do not.
You’re on faculty at the University of Illinois Chicago College of Medicine. Have you noticed attitudes about therapies like acupuncture changing in Western medicine, especially among younger doctors?
Absolutely. I am on staff in the family medicine department and the department of medical education, so just the fact that I’m there is a sign of progress. I teach acupuncture to medical students as well as a class about the scope of complementary and alternative medicine. I have had medical students rotate through my clinic. The University of Illinois Chicago College of Medicine is currently working on integrating a lot more complementary therapies into the medical school curriculum. When I graduated from med school in 2004, there was nothing. That was only 12 years ago, so we’ve come a long way.
Another positive sign: I just started an acupuncture pilot program with an acupuncturist colleague of mine, Maria Mulcahy, at one of the big hospitals in Chicago. In speaking with the various departments within the hospital, they were all very, very excited about having this program there. We are treating some very sick patients in the hospital and getting spectacular results.
Why do you think the tides are shifting in regard to receptivity to acupuncture?
Some of it is that patients don’t want to take pharmaceuticals. Ironically, when the FDA allowed pharma companies to market directly to consumers, patients became aware of the side effects of the medications they’re being prescribed. The push back to that has been really strong. Patients are also pushing back on surgery, because they go online and read about the side effects. They are looking for solutions that are gentler to their systems.
Because patients are interested in alternative solutions, physicians are becoming curious. Physicians are also patients, and they very well know the side effects of medications and surgical procedures. I’m in kind of an isolated environment in the sense that the people who come to see me are people who don’t want pharmaceuticals and surgery—but it’s a lot of people. My practice is very full.
This isn’t an indictment of Western medicine. If my appendix bursts, I want my appendix taken out by a Western doctor. But for many conditions, there are ways we can treat people that don’t have the side effects of pharmaceuticals and surgery. That’s the real power of acupuncture. It gets rid of the underlying root problem so that all the branches—the headaches, the insomnia, the high blood pressure, the digestive issues, the back pain—go away. When the root gets cleared up, you don’t need medication anymore because all of these symptoms are coming from the same underlying problem.
The current gold standard in medical research—the randomized controlled trial—doesn’t work very well for studying acupuncture. What are your thoughts on acupuncture research and how it needs to evolve?
The gold standard exists the way it does because of the pharmaceutical industry. With randomized controlled trials, we assume that if we take two people with high blood pressure, both cases of high blood pressure have a common etiology. We can then either put a pharmaceutical band-aid on it and lower their blood pressure, or not if they’re getting a placebo. But acupuncture doesn’t assume that all cases of high blood pressure have a common etiology—and therefore, not everyone gets the same treatment.
This makes it very difficult to prescribe and track outcomes for a particular set of points. There are certainly acupuncture points that are indicated for high blood pressure, or headache, or back pain, but that doesn’t mean that they’re appropriate for each individual person. What we can do is compare acupuncture to no treatment, to pharmaceutical treatment, and to surgical treatment and see where the outcomes are better.
When we do comparison trials, the evidence-based medicine is absolutely clear that acupuncture is superior to placebo and, in many cases, to treatments such as pharmaceuticals and surgery. Acupuncture is not a religion or a belief. I don’t need someone to believe in my ability to help them in order to help them. It always makes me giggle when people say they “believe in acupuncture.” It’s just science.