William J. Arnold, M.D., 51, is executive vice president and medical director of Advanced Bio-Surfaces, Inc. (ABS), Minnetonka, Minn. Arnold has been involved on the local and national level with the Atlanta-based National Arthritis Foundation, where he now chairs a task force on complementary medicine. He grew up on the South Side of Chicago, where for 40 years his father was chief pharmacist at Little Company of Mary Hospital. His daughter Erin is a physician in her second year residency in internal medicine at the University of Chicago. Another daughter Katie is a healthcare risk management consultant with CNA Insurance Co. His wife Cele is an artist. Dr. Arnold is a rheumatologist and has been on staff at Lutheran General Hospital in Park Ridge, Ill., for 20 years, the last 11 of them as chairman of the department of internal medicine. He is on the President's Council of the Park Ridge Center and was interviewed by Daniel Cattau of the Bulletin.

Q: Tell me a little bit about your formative experiences in medicine?

A: After my rheumatology fellowship at Duke, I spent two years in the Army, right at the end of Vietnam. I was at Brooke Army Hospital in San Antonio, Texas, one of the major hospitals that cared for the returning prisoners of war. I was tremendously affected by caring for these brave men and hearing their stories. A physician held prisoner in Hanoi for over seven years awakened me to the suffering caused by our government's decision to intervene in Vietnam. This experience taught me a basic distrust of institutions. Maybe that's one of the reasons that I relate so well with people who use complementary therapies because they do often say, "Organized medicine is just trying to hide things." I'm probably more predisposed to say, "Well, let's listen to individuals. Let's hear what they have to say."

William Arnold

Q: Where did the interest in complementary medicine come from?

A: My patients. Honest to God. My patients.

Q: Any specific ones? Or any specific case where you went, " ah hah."

A: Nothing dramatic, although I think it was a gradual awakening due to an understanding of the needs of people with a chronic disease. I found myself saying in the last five or 10 years, at the end of my visits, "I'll pray for you." It was spontaneous. The majority of times it was very welcomed.

Q: Tell me how you got involved in the Arthritis Foundation and what you're doing with the complementary medicine task force?

A: The National Arthritis Foundation is the single lay organization devoted to finding a cure for arthritis. It is analogous to the American Heart Association and American Cancer Society. As chair of the task force, I was both asked to cover the specific area of spirituality and to coordinate the contributions of other authors on a variety of complementary therapies for the care of arthritis patients. Where did the foundation's interest in complementary therapies come from? The Arthritis Foundation's primary constituency are patients, who on their own have been pursuing alternative or complementary therapies. I prefer to call them complementary, I think it's less pejorative. We know from a New England Journal of Medicine article in 1993 that people in our country spend more in general on complementary therapies then they do on visits to their primary care physicians. Our patients tell us that — because of the chronic nature of arthritis, because of the pain, and the reduction in quality of life and the fact that we have curative therapies for only two of the some 100 causes of arthritis — they want something else, something they can control, something to give them hope.

As a rheumatologist, I realize that my ability to treat arthritis in the traditional Western scientific sense is limited. Arthritis and cancer are two groups of illnesses that lend themselves to the use of complementary therapies. When patients come to me requesting advice on complementary therapies I most often say: Number One, don't quit what you're doing. Stay on your medication. Stay on your basic regimen. Number Two, make sure you understand the risk of complementary therapies, and one of the risks is an economic risk to you. Don't get fleeced. If you stay on your basic regimen, if you understand the risk to you, go ahead. For example, patients try to exclude dairy products or tomatoes from their diets. They try green lip muscle extract, copper bracelets, or vitamin therapy. I let them know that I'll be there if they need help.

Q: Magnets are another therapy.

A: Magnets. Sure. And you know what complementary therapies do? They give a patient with a chronic illness hope. Why? I think it's because they restore some sense of control. [Joseph] Cardinal Bernardin said it very well, "People have to have hope." Among faith, hope, and love, the greatest of these is love. I don't think this is completely true if you're sick. As your physician, I need to treat you lovingly, but what you want me to give you is hope — that's what complementary therapies do. If you have arthritis, you're in pain every time you move, you often can't get out of bed, it can be a hopeless situation. By finding something you can do for yourself, something you can choose and control, patients can restore hope.

Q: With complementary medicine, how do you weigh the issues of evidence and proof? Are they applicable at all to complementary therapies and how?

A: Scientific evidence is important to establish not only the effectiveness of a treatment, but also the trust or predictability in the relief that it offers. Most often, this evidence comes from clinical trials. How did physicians get the idea in the first place to start a clinical trial? How did physicians get the idea that aspirin works for pain, or that beta blockers work for heart disease, or that insulin works for diabetes? You know where they get the idea from? Most often, it comes from anecdotal observations. An anecdote is the observation of a single case or instance of a response to a treatment, often by chance. Louis Pasteur said, "Chance favors the prepared mind." However, you should be suspect when the observer doesn't proceed past the anecdote. A charlatan typically uses the anecdote as scientific evidence and glamorizes one or two instances of apparent response far past their individual significance. In my experience, this is the single most reliable indicator of a quack or charlatan.

Q: How has your own view changed about the spiritual role of the physician? Do you have any particular religious affiliation?

A: I still identify strongly with the Roman Catholic church, my heritage. I certainly am not what you would call a strictly practicing Catholic. My mother was a devout Catholic. My own spirituality grew during my time at Lutheran General and after my father's death. My mother's death was so sudden — she died of a heart attack when I was 23 years old. My father died from Parkinson's disease in 1993. I learned a lot from him. I learned about praying. Another important factor is when I went to Lutheran General Hospital, I found I could live my faith, allowing me to express my feelings toward faith and spirituality in a setting of caring for patients and educating medical students and residents. The philosophy of human ecology forced us on a regular basis to confront issues other than simply fixing broken bodies. We must do that plus deal with the issues of the mind and spirit that accompany every illness. When dealing with issues that involve your health, the discussion is incomplete without talking about your faith. I particularly have a debt to Mr. George Caldwell (one of the founders of the Park Ridge Center). He is why I became involved in the Center.