A marriage of conventional Western medicine with other healing modalities, including complementary and alternative medicine (CAM), integrative medicine (IM) neither rejects conventional medicine nor uncritically embraces alternative therapies. Rather, IM can be described as a practice that "cherry picks" the best and scientifically supported therapies of both systems. This article offers a look into IM and what it means for the future of health care.
In this Article:
- What is Integrative Medicine?
- What are the principles of integrative medicine?
- Who practices integrative medicine?
- What is an IM session like?
- How popular is integrative medicine?
- What does this mean for the future of medicine?
When it comes to improving health care in the United States, one fact seems fairly undisputed: “What we have now is a ‘sick care’ system that is reactive to problems,” says Dr. Ralph Snyderman, MD, Chancellor Emeritus at the Duke University School of Medicine. According to Dr. Ka-Kit Hui, MD, founder and director of the UCLA Center for East-West Medicine and the Wallis Annenberg Professor in Integrative East-West Medicine, “current health care works by waiting until symptoms of disease arise, as opposed to spending more time and effort on disease prevention so that those problems do not occur in the first place.”
Dr. Hui describes a health-disease continuum, with “feeling great”, “wellness/absence of disease”, and “minor symptoms” on one hand, and “multiple/chronic symptoms”, “acute/advanced disease” and “terminal stage/death” on the other. “The biomedical model of health care, or modern Western medicine, emphasizes a reductionistic approach that focuses on the physical and objective basis of disease. With the help of groundbreaking medical research and life-saving surgical procedures, modern Western medicine has been successful in treating the right-hand side of the spectrum,” says Dr. Hui. “Its inadequacy, however, lies in how it tends to the left-hand side of the spectrum – the maintenance of health and promotion of wellness – seen in part by the tremendous number of patients who have turned to alternative methods because of dissatisfaction with current care.”
Indeed, in recent years, it has been acknowledged by health care leaders, politicians, and socioeconomic analysts alike that one major flaw of the U.S. health delivery system is its focus on acute and episodic care, an emphasis that neglects other fundamental health issues underlying the prevalence of chronic disease. According to the Centers for Disease Control and Prevention (CDC), 70 percent of all deaths are due to chronic disease, and the cost of chronic care exceeds $1.5 trillion a year, or 75 percent of all medical expenses. Only a fraction of our budget is spent on prevention and health promotion, despite evidence that prevention can do much to reduce the burden of chronic disease. According to Dr. Hui, “not only have the accelerating costs been under scrutiny, questions are also being raised about the paradigm that leans heavily upon high-tech and invasive crisis intervention. Decades of debates have finally reached the historical juncture when major reforms to our healthcare system are now urgently needed.”
The proposed solution? Integrative medicine. Emerging as a cost- effective remedy to the epidemic of chronic diseases that continue to tax the economy, integrative medicine is being recognized as a strategy that can patch up holes in the current health delivery system while keeping medical costs at bay. But proponents of the system see it as more than just a way to alleviate health care costs: “The integrative approach flips the system on its head and puts the patient at the center, addressing not just symptoms, but the real causes of illness. It is care that is preventive, predictive and personalized,” says Dr. Snyderman.
According to the Consortium of Academic Health Centers for Integrative Medicine, a collaborative alliance of 46 academic health centers dedicated to the advancement of integrative health care, “integrative medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing.”
Dr. Andrew Weil, MD, director of the Program in Integrative Medicine at the University of Arizona, and the world’s leading proponent of integrative medicine, insists that integrative medicine, despite popular misconception, is not synonymous with complementary and alternative medicine (CAM). CAM refers to the use of nonconventional modalities and therapies, such as acupressure, or alternative medical systems, such as traditional Chinese medicine, either alongside conventional Western medicine (“complementary”) or in place of conventional Western medicine (“alternative”). To be clear, “complementary medicine” suggests the addition of other healing practices to conventional medicine, in which those modalities would otherwise only have a secondary role, while “alternative medicine” implies the use of healing practices that altogether replace conventional biomedical treatments. CAM-based therapies are traditionally excluded from conventional Western medicine, since the mechanisms underlying many are not well understood by the scientific community. Although successful clinical outcomes and insights into CAM-based therapies (such as acupuncture and nutritional supplementation, to name a few), have led to significant acceptance in the West, the mechanisms behind other nonconventional therapies remain to be better elucidated.
According to the NIH’s National Center for Complementary and Alternative Medicine (NCCAM), what makes integrative medicine different from CAM is its synthesis of both conventional and CAM treatments “for which there is evidence of safety and effectiveness.” A marriage of conventional medicine with other healing modalities, including CAM, an integrative practice neither rejects conventional medicine nor uncritically embraces alternative therapies; rather, integrative medicine can be described as a practice that “cherry picks” the best and scientifically supported therapies of both systems. The ultimate goal: to get the patient better, through the use of safe, effective, less-invasive interventions whenever possible.
According to Dr. Weil, “integrative medicine is healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship [between patient and physician] and makes use of all appropriate therapies, both conventional and alternative.” Dr. Weil lists the following as defining principles of integrative medicine:
- Patient and practitioner are partners in the healing process.
- All factors that influence health, wellness and disease are taken into consideration; including mind, spirit, and community as well as the body.
- Appropriate use of both conventional and alternative methods facilitates the body’s innate healing response.
- Effective interventions that are natural and less invasive should be used whenever possible.
- Integrative medicine neither rejects conventional medicine nor accepts alternative therapies uncritically.
- Good medicine is based in good science. It is inquiry-driven and open to new paradigms.
- Alongside the concept of treatment, the broader concepts of health promotion and the prevention of illness are paramount.
- Practitioners of integrative medicine should exemplify its principles and commit themselves to self-exploration and self-development.
An integrative medicine (IM) practitioner is a healthcare professional who embraces and practices the principles of integrative medicine. An integrative medicine practitioner is often a doctor with a Doctor of Medicine (MD) degree, Doctor of Osteopathic Medicine (DO) degree, or Doctor of Naturopathic Medicine (ND) degree, or nurse practitioner who emphasizes a whole-person approach and patient-centered care, and utilizes both conventional medicine and nonconventional medicine to optimize the patient’s health and healing process.
However, an IM doctor is not necessarily the same as an osteopathic or naturopathic doctor, although the three share several similarities. Unlike MDs, while a DO also receives conventional medical training, he or she receives additional instruction on osteopathic manipulative medicine, which involves a wide variety of techniques applied to the musculoskeletal system. Treatment from a DO may involve manual manipulations of the body in the diagnosis and/or treatment of injury or illness. Meanwhile, an ND receives Western-style medical training with additional instruction on botanicals, nutrition, and Eastern therapies. However, one area of controversy regarding this profession arises from the lack of qualifications and education of many naturopathic practitioners. A major concern is that many naturopaths have only completed minimal training before they are certified, while some practitioners of naturopathy have no formal training at all.
According to Dr. Roberta Lee, MD, Vice Chair of the Department of Integrative Medicine at Beth Israel Medical Center in New York, an IM practitioner, like a conventional MD, has pharmaceutical and surgery-based interventions at his or her disposal; these options, however, will be weighed in the context of the other therapeutic choices, including CAM-based therapies, and together these interventions are prioritized according to the level of benefit, risk, potential toxicity, and cost. In Integrative Medicine: Principles for Practice, Dr. Lee states, “The use of any intervention is weighed in context of the wishes of the patient, the objective of the visit, and the depth of the problem/disease that may or may not be present...Because much of the context of the integrative approach is oriented toward prevention, more time and effort is devoted to identifying lifestyle interventions that can lead to disease prevention, or at least to reducing the rate of progression of an established chronic condition.”
The key word is prevention: “It is important to understand that if you take good care of the body/mind and help it stay healthy, there is little need for more expensive and sometimes toxic or invasive interventions,” says Dr. Hui.
Techniques that are both safe and effective – taken from biomedicine/ allopathic (conventional) medicine and other healing therapies – can be used as tools in the integrative approach. Healing therapies include techniques used in traditional medical systems (such as traditional Chinese medicine), manual medicine (osteopathy, massage), lifestyle changes (nutrition, exercise), and mind-body therapies (yoga, Tai Chi).
Yet integrative medicine is much more than just a system endowed with a wider variety of tools that are generally available to conventional practitioners. “Patient education and self-help are central to an IM session,” says Dr. Hui. Integrative practitioners see physicians as educators of their patients, in which “physicians are basically the patient’s health advocate and coach.” Hui uses acupressure as an example of how patients can be taught techniques that can lead to daily maintenance of health and improvement of certain chronic problems, such as back and neck spasms. “Sometimes, rather than taking a pill for the pain, a massage at the right pressure point could accomplish the same thing – not to mention do a whole lot more in terms of rooting out the underlying problem.”
The integrative visit, according to Dr. Lee, is just as much about “a time for the practitioner to get to the know the patient as it is about understanding the disease.” Dr. Lee states that since integrative practitioners are interested in the full spectrum of health and being – mind, body, and spirit – ”understanding the nuances of each of these facets provides a rich context for understanding how and why they came to be where they are.” Integrative doctors often provide many of the same tests that a conventional doctor performs, from basic physical exams and blood work, to Pap smears and cholesterol screening. However, it’s the emphasis on prevention and maintenance of health that’s different; and, in the opinion of integrative practitioners like Dr. Hui, whose clinic sees around 13,000 patient visits a year, it’s a difference that really counts.
According to Dr. Hui, the practitioner seeks a patient-centered approach at the get-go “by studying their patient’s history, examining their psychosocial situation, understanding their diet and exercise habits, looking at the way they cope with stress, and seeing what kind of chemicals or prescription drugs they have been exposed to.” The goal, he says, is to look at the big picture: “When you spend a little bit more time understanding the patient, you can understand them as a person and understand what is bothering them.” Consider sleep disorders: patients who complain of not being able to sleep, possibly due to stressors arising from work or family, may only receive sleeping pills when treated the conventional way. “That is not good medicine,” argues Dr. Hui. “You can send people home with pills, but the underlying problems, such as stress activation and all the problems that come with it, don’t go away. Alternatively, you can talk with people and teach them skills to deal with stress, whether it is yoga, stretching, deep breathing exercises... You can teach them how to eat and exercise according to their body size and physical needs, and restore the body’s own chemistry in the right direction through modulating the autonomic nervous system and putting it back into the right balance.” Dr. Hui’s goal for his patients is to provide the safest, most effective, least invasive, and most accessible tools to keep them well.
It’s no surprise that as a practice driven initially by consumer demand, integrative medicine continues to grow in popularity, both in its users and in its practitioners. CAM itself has become increasingly popular in recent years: a report released by the Institute of Medicine (IOM) in 2005 estimated that total annual visits to CAM providers exceed visits to primary-care physicians. According to the NIH NCCAM, based on a nationwide government survey released in December 2008, approximately 38 percent of U.S. adults aged 18 years and over use some form of CAM, and the numbers are growing. According to the IOM, integrative medicine is increasingly being accepted in many settings, from hospitals and private physician practices, to leading cancer treatment centers such as the University of Texas MD Anderson Cancer Center, and even insurance companies.
Integrative health care models are currently being explored. UCLA itself has been a pioneer in the field, with the Collaborative Centers for Integrative Medicine (CCIM) leading the way through its multidisciplinary group of clinicians and researchers who have dedicated themselves to a new vision of health care. CCIM’s mission is to “build a 21st century model of medicine and health promotion that integrates state-of-the-art science with traditional healing principles of compassion, community interaction, and self-regulation.” Dr. Hui’s Center for East-West Medicine and the clinical program, the Pediatric Pain Program (PPP) at the Mattel Children’s Hospital led by Dr. Lonnie Zeltzer, MD, are both part of the CCIM and successful models of integrative health care.
At the national level, the field has made prominent strides with The Patient Protection and Affordable Care Act (HR 3590), which was signed into law in April 2010, and is said to provide opportunities for integrative health care. Most prominently, the new law specifies the creation of a national prevention strategy, providing $15 billion dollars in funding for a public health and prevention fund. Chief among its provisions, the Act calls for the development of a national prevention, health promotion, and public health strategy through the National Prevention, Health Promotion and Public Health Council and the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. Another section requires the Department of Health and Human Services Secretary to establish a pilot program with up to ten community health centers to test the impact of providing individualized wellness plans to at-risk populations. These wellness plans are designed to reduce risk factors for preventable conditions, providing nutritional counseling, physical activity plans, alcohol and smoking cessation counseling services, stress management and dietary supplement advice.
For Dr. Hui and his colleagues at the Center for East-West Medicine, these are steps in the right direction. However, for integrative medicine to flourish, changes will need to be made systematically, and “will require the concerted efforts, ingenuity, and collaborative spirit of the scientific and medical communities, policymakers, the business community, and the public.” Dr. Hui encourages open- mindedness and transformative ways of thinking that will heal both the broken health care system and its patients. According to Dr. Hui, “by rebalancing the focus of the health care system between treatment of disease and maintenance of health, the future paradigm will bring us closer to the achievement of the goals of medicine: to promote health and wellness, prevent diseases, ease human suffering, and improve quality of life in a cost-effective and timely manner.”
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Click here to view the original article published in the Winter 2011 issue of Total Wellness Magazine.
By Elizabeth A. Wang, B.S./B.A., M.D. Candidate ’17, UC Davis School of Medicine