This philosophy to care is not new, but I find that it is far more unfamiliar to healthcare consumers than I might have appreciated. More recently, the practice manager, Jeremy Gooden, and I were working with a graphic artist - an very intelligent woman, Purdue graduate, and it was clear that integrative medicine was a newer or maybe even completely unfamiliar concept to her. This made me question if my tagline was potentially foreign to most people, as I am well aware that functional medicine is already a new concept.
Unfortunately many have overlooked #integrativemedicine simply because the pendulum of accepted medical care disciplines tends to swing from one extreme to another. It seems though the pandemic has caused many, if they weren't already, to begin to recognize the benefits of combining the external, physical, and technological successes of curing with the internal, non-physical exploration of healing.
Aristotle (384-322 BC) is said to be one of the first truly integrative practitioners as he appreciated that every person was a combination of both physical and spiritual properties with no separation between mind and body. Interestingly, sometime around the 1600s, concern arose that if we continued down a path of recognizing the healing power of the conscious mind that potentially we would be vulnerable to manipulation and even control. Certainly there was also concern within the church that healing powers would undermine or displace their own role within the community. Effort to separate mind and spirit was then a priority, particularly within the #church, thus leaving science to dissect the physical body.
Reductionists or the reductionish movement shaped our worldview of health in that similar to a clock, we could best understand time by reducing our view to the inner workings of each individual parts within the clock. Reductionists offered us great discoveries, but clinicians weren't offered many tools for treating dis-ease. In the early 20th century, science transformed into #medicine and ultimately, we discovered allopathic medicine and the triad of research, education, and clinical practice. We certainly have learned a significant amount of pathophysiology, which I teach at the graduate level today. We have subspecialties thanks to this approach - practitioners who focus on the pieces and even a society who appreciates that these specialities are the key for fixing their problems. What seems a fairly significant oversight however, is that we aren't really improving chronic disease. Our body systems are interconnected, so simply repairing a part without addressing the underlying causes provides only temporary relief and a false sense of security. We have an exceedingly expensive healthcare system do to this approach with very little success for offering optimal health to our consumers.
Technology has become Our Golden Calf
The health care market grows when more attention is focused on single diseases that can be treated with drugs or procedures to the tune of about $10K each year, per resident of the United States. Financial rewards increase when we have more subtypes of disease to which treatments can be matched. In just ten years (2003 to 2013), spending on medications in the United States more than doubled, from $180 billion to $271 million. The system encourages healthcare consumers to believe that tools are the answer to their physical woes and discourages them from paying attention to the interplay of the mind, community, and spirit. We don't have the patience for digging into the underlying root cause or correcting lifestyle habits. Technology is the gold calf. We are dependent on it and we overuse it so much so that it's become a barrier between the client and the clinician. There is no more rapport, gestalt, intuition, or laying on of hands - or those who do are ostracized and deemed pseudoscience practitioners.
The fix became managed care rather than prioritizing true healing. This new model reduced excessive costs but further eroded the relationship between clinician and client. We were expected to see more clients each day while also increasing our administrative work. Clinicians lost a great deal of autonomy and clients are aware that their needs aren't being met, or even heard.
Chronic disease is at an all-time high and we really have very few systems in place to treat these well, and essentially none for preventing them. The evaluation and treatment of #diabetes, heart disease, irritable bowel disease, #depression, chronic fatigue, chronic pain and the list goes on and on requires much more than focusing on a single organ. I do believe consumers are becoming more aware that they need more attention paid to health and healing - wellness. They want optimal health for as long as they live.
Integrative Medicine is the Preference
Consumers drive change and the deterioration of the client-clinician relationship, the overuse of technology, and the inability of the medical system to effectively treat chronic disease has lead to a rising interest in complementary and alternative medicine, otherwise known as CAM therapies. More visits were made to CAM providers in the early 1990s than to all primary care physicians and interestingly, these visits were paid for out-of-pocket. This trend has continued and clients are demanding less and less aggressive forms of therapy, most especially fewer pharmaceutical drugs.
Sadly, data has shown us that adverse drug reactions were the sixth leading cause of death in hospitalized patients in 1994 so it is no surprise that botanicals were the largest growing area of retail pharmacy that same year. People find complementary approaches to be more aligned, per the research, with "their own values, beliefs, and philosophical orientations toward health and life." If I am blunt, this means that the layman, the public, realized that health and healing involved more than pills and surgery even before the medical establishment did. No wonder our trust in the healthcare system is lacking.
Integrative medicine *integrates* more traditional treatments such as nutrition, #botanicals, manipulation, meditation, massage, #yoga, talk therapy, energy medicine, homeopathy, magnet therapy, prayer, and a multitude of other modalities that are too often neglected within conventional medicine, but are now being rediscovered with great enthusiasm.
The popularity of CAM therapies did grow so that the National Institute of Health (NIH) now has an office called the National Center for Complementary and Integrative Health (NCCIH). The NIH definition of integrative health can be found here. Here is the mission and vision of the NCCIH.
The University of Arizona offered the first fellowship program in integrative medicine, led by Andrew Weil, and this has grown to more than 62 medical schools across the United States and Canada. More than 40 percent of schools now, in some way, address integrative health concepts in their curriculums, although the Institute of Medicine (IOM) has recommended that all health profession schools incorporate sufficient information about CAM to enable licensed professionals to advise their clients. I am lucky enough to be part of the Integrative and Wellness graduate program at the University of Maryland.
Integrative medicine reaffirms the importance of the relationship between the practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and life-style approaches, health care professionals, and disciplines to achieve optimal health and healing (Rakel, 2012, p 4).
Changing Medical Culture
Integrative medicine is supported by really good research yet still these practitioners sit on the outskirts of their profession, often referred to as pseudoscience practitioners. Practitioners within the conventional model will go to great lengths to harass and ostracize holistic clinicians... oh, let me count the ways I have been bullied within my own career... it's truly exhausting and disheartening beyond articulation. However, a greater peace lies in knowing you are doing the right thing even if it isn't the social norm. People need clinicians who will listen to them and truly dig into the underlying cause.
The term complementary and alternative medicine really isn't the best fit and sort of supports this concept of this being a second class speciality, yet consider that nutrition and spirituality are part of #CAMtherapies. Eliminate these and we have obesity, diabetes, and substance abuse. In fact, conventional medicine has largely ignored these needs and we are facing the worst chronic health epidemic in our history.
Labeling therapies as CAM allows conventional medicine to ignore them, further fragmenting care and of course, when they are within the label of CAM and not within the treatment plan of specialists, third party payers don't have to cover these treatments. You'll find more and more treatment centers and academic programs transitioning their name away from integrative medicine and more towards integrative health, or as our own practice has done: "integrative and functional wellness," because the effort is to create an approach that is all-inclusive, rather than simply add another specialty to the fragmented mix currently dominating our healthcare infrastructure. Sadly, these professional organizations also recognize the poor treatment of clinicians who have been coined "alternative" and "complementary."
This controversy, and because academic programs were not properly preparing clinicians to utilize holistic care in their programs, ultimately motivated The American Board of Physician Specialists to create a board certification for those who wanted to be identified as integrative providers. The American Board of Integrative Medicine (ABIOMM) graduated its first class in 2014.
It seems healthcare is a large part of the political argument each election and I do sit and think how we could truly fix our system. Interestingly, the Institute of Medicine (IOM) has concluded that the U.S. healthcare system was so flawed it could not be fixed and an overhaul was required. A few years later the American College of Physicians stated that "primary care, the backbone of the nation's healthcare system, is at grave risk of collapse due to a dysfunctional financing and delivery system." Our current system undermines that relationship between clinician and consumer which is why so many integrative and functional medicine practitioners are self-employed and cash-based. We are working to create a new system for our clients that truly prioritizes their unique needs.
The IOM Summit summary stated that, "This disease-driven approach to care has resulted in spiraling costs as well as fragmented health system that is reactive and episodic as well as inefficient and impersonal." Integrative medicine is the superior approach.
Defining Integrative Medicine
Consider that in the 1970s, we had holistic medicine which turned into "complementary and alternative medicine" in the 1980s, or CAM treatments. The 1990s brought us integrative medicine which then transitioned into integrative health in 2000. It's anticipated that into the future we will see terms more in line with "health and healing-oriented systems." Ultimately, the mindset of integrative medicine is healing-oriented and emphasizes the centrality of the client/provider relationship. We prioritize the least invasive, least toxic, and least costly methods for optimizing health and integrating allopathic and complementary therapies as they may enhance the individual wellness plan. We also seek to not just support clients in getting well, but also in staying well.
Healing is different to curing however. We can cure a condition such as hypertension with a pharmaceutical product without actually healing the client. Healing would facilitate changes that reduce stress, improve diet, promote exercise, and increase the person's sense of community. When we create a wellness plan that ultimately helps the client find balance, the body can heal itself which may result in the resolution of further need for a specific pharmaceutical or reduce their need. Many, many times I have witnessed this in clinical practice, particularly for anxiety, thyroid disease, and diabetes.
It is interesting to me, as a crazy-plant-lady, that when plants are ill, we look to the environment. We check the soil, their sunlight, their water, what they are fed, even the noise they live within and we know that if a limb breaks on a plant that is dying, it will likely not heal itself. However, when a limb breaks on a plant that is vibrant, happy, and growing, we trust it will likely recover with ease. In conventional medicine however, when someone breaks an arm, we rarely question their vitamin D status, their overall bone health, their balance, core strength and mental health. Rather, we cast and send on their way. Integrative medicine changes the focus in medicine to one of health and healing rather than simply dis-ease.
Conventional medicine is focused on the immediate visit while integrative providers focus on a continual healing relationship. Professional autonomy drives conventional medicine while care is customized according to the client's needs and values in integrative clinics. Professionals control the care in conventional medicine, while the patient is the source of control in integrative medicine. Conventional medicine is more secretive about care and advice, maintaining information in a closed record while integrative practices see decision making as a mutual endeavor, knowledge is shared, information flows freely, and decisions are evidence-based. In conventional medicine, we react to needs, but in integrative medicine, needs are anticipated. The bigger challenge though, may be in switching the financial rewards to health rather than dis-ease.
The integrative approach emphasizes prevention, health maintenance and early intervention, and utilizes all appropriate, evidence-based and personalized therapeutic approaches to achieve optimal health and wellbeing across one's lifespan. It is whole person care.
It is much more important to know what sort of patient has a disease than what sort of disease a patient has - Sir William Osler