Is Integrative/Holistic Medicine more patient-centric than mainstream medical care?

Yes, but with a very big “If”:

If we regain and retain the truly holistic principles upon which Integrative Medicine began,

if we focus on what truly helps us become healthier, and

if we keep our eyes wide open to the growing corrupting influences that are threatening to lead Integrative Health to the same un-patient-centric ends in which mainstream medicine is so deeply entangled.

One of the primary “selling points” and attractions of Integrative, CAM (Complementary/Alternative Medicine), or Holistic-oriented healthcare approaches has been the suggestion that it values the customer better than the mainstream system of care.  Indeed, countless articles and essays from the skeptical side of mainstream medicine for the past thirty years have promoted the idea that the success of CAM is due to patients/consumers receiving more attention and therefore having higher rates of satisfaction rather than CAM interventions having any particular merit as treatments.  Mainstream medicine has been portrayed (often accurately) as a corrupt, uncaring, money-grubbing behemoth that will rape your pocketbook and maybe even kill you with drugs and procedures.  The extremely large footprint of Big Pharma has been the easiest boogey-man to target, and CAM has been promoted as the safe, patient-centered, pure-of-heart alternative option.  Value-based healthcare consumers need to be aware that the same corrupting influences that have helped create an often dysfunctional, unhealthy, inefficient and bankrupting mainstream medical system now threaten the world of Integrative and Holistic Medical Care.

Some forty years ago the main thrust of the alternative/holistic medicine movement began. Evarts Loomis, MD had been writing and practicing medicine with alternative treatments and attitude for over a decade. Physicians Gladys and Bill McGarey and Norm Shealy started the American Holistic Medical Association (now a part of the Academy of Integrative Health and Medicine, the AIHM). Over the next decade leaders such as Larry Dossey, MD and Bernie Siegel, MD would release groundbreaking books introducing concepts of spirituality, love and non-local connection into the realms of physical mainstream medicine. Others such as Deepak Chopra, MD and Dean Ornish, MD would soon follow, continuing to inject the roles of stress, diet and our spiritual connectedness into the health conversation.

The common thread and driver for these new approaches was the recognition that something in our mainstream medical system of care was ailing. The system itself was becoming sicker. With the onslaught of information that exploded in the latter half of the 20^th century, medicine and healthcare became ever more compartmentalized. Specialists began to appear for smaller and smaller niches of the physiologic landscape of human beings.   It became increasingly difficult to practice generalized medicine with competency in multiple arenas. Consequently the traditional western lens of categorizing our human system as separate body sections became ever more hardened. Further, attention and care to the other aspects of our existence – our mental, emotional and spiritual lives – became further and further relegated to separate silos of expertise – the psychologist and the pastoral counselor/minister/priest. (Certainly the spiritual/physical break had come much earlier with Cartesian duality of mind and body, but that split shifted into higher gear as compartmentalization took over.)   The holistic medicine movement was born of the growing observation of these trends and the recognition of what was getting lost in the process:  the essential, irreducible whole that is a human body, being and existence. Compartmentalization tends to destroy connection, connection among the parts of our physiology, the aspects of our humanity, and with other human beings and the cosmos. The founding of the American Holistic Medicine Association (AHMA, now AIHM) was primarily to address this core loss. Its stated goal was to restore Heart to the practice of medicine, to take a stand that Love was not only relevant, but life’s most powerful healing force.  It’s goal was to restore a sense of connection.

The other primary trend in medicine was the impact of the treatment of infectious diseases brought about by antibiotics in the first half of the 1900s. The capacity to treat so many conditions that had previously led to untold misery and death was life-changing for the planet. We can argue about the merits of the approach amid our current crises with antibiotic-resistant organisms, but at the time it was a powerful boon for the perspective of mainstream western medicine. A significant effect of this shift was that the model of health involving a single cause of disease coupled with a single specific ‘magic bullet’ treatment began to dominate thinking about human suffering. This framework began to shape how we approached every human illness, a search for the “it” that was causing the suffering and the “it” that would fix it. Enter the obsession with the right “diagnosis”. Enter the realm of drugs and surgery as the primary tools in this battle and thus an even smaller micro-compartmentalization in our thinking. Here also enters the foundations of pharmaceuticals and surgical hardware as the places to put our money. Forty years later, by the ’70s and ’80s, those industries were highly developed and were not just serving the landscape of healthcare but shaping its process and future. Another significant founding principle of the Holistic Medicine movement was push-back against these tools as the only (or sometimes the best) approaches to health as well as against the corruptive influence of big money. Love and connection are free. Drugs and surgery certainly aren’t.

So where are we another fifty years later? Certainly much has changed. In the ’70s when the AHMA first began, its members were mostly physicians who were hiding in the shadows, trying new approaches, and trying to stay off the radar of the medical boards, who regarded them as dangerous charlatans and apostates. Medical schools would go nowhere near serious conversations on these topics. Holistic practitioners needed others to talk to, others who shared their experience. So, they banded together in order to have a place to connect.

Fast forward to today: we have an  Academy Consortium for Integrative Medicine and Health, the collective body of Integrative Medicine Programs at the premier Medical Institutions in the country. It currently has 63 members, including Harvard, Duke, Yale, Stanford, Vanderbilt and the Mayo Clinic. Approaches to healthcare that were once punishable by fines or the loss of a medical license are now studied, pursued and sanctioned as viable approaches by the top medical schools in the world. We have a section of the National Institutes of Health (NIH) for the study of Alternative and Complementary Medicine with funding from Congress. Hanging one’s shingle out as a holistic or integrative medicine physician is not only no longer dangerous, it’s cool. Studies on vitamins, herbal treatments, acupuncture, yoga, and the like are being conducted at major medical institutions and appear regularly in the most prestigious medical journals, such as JAMA and the New England Journal of Medicine. A significant (and often appropriate) degree of skepticism is present, but the conversation has changed dramatically in the last fifty years.

Are we healthier and more connected as a result? That’s a tougher call. While the prominence of the integrative conversation has been a huge step in the right direction, we unfortunately have come to see the same compartmentalizations and corrupting money influences significantly impact the world of Integrative Medicine. As someone who was involved in holistic thinking and approaches starting in the 1980s, during my pre-med years in college, I have watched the ensuing decades with a mixture of elation and deep disappointment. My first introductions were connection with the AHMA as a student and being blessed with a mentorship and friendship with one of the pioneers of the movement, Dr. Larry Dossey. At that time I watched what happened to physicians who spoke out. There was a hunger for the message at the grassroots level of many in the patient population, but the response from the medical system wasn’t pretty. There was risk, and folks like Larry took the brunt of the system’s backlash that enabled doctors like me to have it relatively easy now. I am eternally grateful for that. Unfortunately, what has also transpired over the past twenty years has been the growing influence of big money and compartmentalized thinking that threaten to choke out the very foundational principles with which Holistic Medicine began. The world of Nutraceuticals has become every bit as corrupt as the world of Pharmaceuticals. Alternative medicine practices are often just as compartmentalized and non-holistic as mainstream approaches ever have been. Our cultural appetite for quick, easy fixes continues to drive the market toward the same single-cause, single-bullet treatment approaches as that of the past. We’ve just traded a shelf full of drugs for a shelf full of vitamin bottles.  While many might applaud that as a step in the right direction, I’m not on board with that. It’s the same mentality we had before just dressed up differently. I see many patients who come in seeking help and the only difference in the conversation is what vitamin, herb, or hormone shot will alleviate their misery as opposed to which drug. The thinking and approach are exactly the same. What’s still missing is connection. What’s still missing is the holistic shift that recognizes the core drivers of how we live each minute of the day – what we ingest, how we move, what we feel, our sense of safety, how we honor the need for rhythm and balance – their deep interpenetration with each other, and their roles as the primary determinants of our daily suffering or experience of joy. Connection to ourselves and connection to others – these are what matter the most in how we feel. The world of nutraceuticals and alternative treatments has become a multi-billion dollar industry and lots of people are making lots of money. And, yet, I see just as many miserable people toting a bag full of supplements with them as a bag of drugs. They’ve been to practitioner after practitioner and spent thousands of dollars (often in one day) on the bottles, the treatments, the expensive tests and aren’t one whit less miserable.

What’s most needed is the focus back on “how am I living my life?” The holistic movement began as way of addressing the loss of heartfelt connections and their role in health, and it is still just as sorely needed. We have to recognize that alternative does not mean holistic, and the vast majority of what will alleviate our suffering as human beings is increased self-awareness, changing our behaviors, and pursuing loving connection with our lives. We have a mainstream healthcare system that provides very little supportive structure for these goals. Changing how we interact with ourselves and the world means going against our most entrenched habits. It takes focus and support. You can’t get that in a 7-minute doctor’s visit. While the integrative/holistic health conversation has taken flight over the past decades we have simultaneously seen the progressive decimation of the most important component of healthcare delivery: time spent with patients. The ability to spend time helping and supporting someone’s health journey has been systematically stripped out by the effects of big money and third-party payer systems. We can’t get people better if we can’t help them change, and we can’t help people change if we can’t spend time with them.

We’re at the beginnings of this shift, but it’s in its infancy. Medicare, for instance, has introduced Chronic Care Management Services (CCM), a way of establishing reimbursement to medical practices (or their surrogates) for increased contact and support with patients, but it is a pittance and there’s a long way to go. The monetary system of reimbursement has to fundamentally change from doing things to people to spending time with them, and the philosophical perspective of the healthcare system has to shift to how we spend that time. In our culture saturated with bigger, better, faster and a million temptations for attention literally at our fingertips, we have to learn to slow down. Huge sections of the system are arrayed against that. How can a doctor in such a rush that they hardly sit down, never let the patient speak, and have one hand on the doorknob ever be effective in helping the patient slow down? The healthcare delivery system most often models illness not health. We have to take time to pay attention differently. We have to take the time to connect.

Despite the progress toward Integrative Health over the past decades, holism is needed now as much as it ever was. This is a call to action. First, take stock of your own life and health. Are things in rhythm? Are you taking time to actually pay attention to yourself and what you need for health? Are attending to connection? Be honest about those things and have the courage to take some steps on your own behalf. Next, what avenues of healthcare delivery are you choosing? Admittedly, it can be slim pickings out there sometimes for someone on the practitioner side who will take time and listen. Don’t stop looking though, and don’t allow yourself to settle for bad service. If you decide that where you are receiving care is not at all meeting your needs, find something else. And, just as importantly, let the place you are leaving know in an honest communication why you are leaving. If the consumer demand keeps growing, then things change. Great resources for patient-centric providers can be found through truly holistic organizations such as the aforementioned Academy of Integrative Health and Medicine (AIHM) and the Institute for Functional Medicine (IFM).

There are also multiple new frameworks for healthcare delivery that are better attempts to address these issues and move the needle back to more patient-centric care, such as Patient-Centered Medical Home and arguably the best approach, the Direct Patient Care Model (DPC).  These models support more holistic care, more time spent with patients, strengthening of the patient-provider relationship, and a shift toward reimbursement for healthy outcomes rather than high dollars just for doing stuff to people. Take a look at the links and familiarize yourself with these concepts. You will be hearing more about them, and you can then look for providers that are utilizing these models.  Here is a link to a Finder Directory that can help you locate practices of multiple different patient-centered models. Educate yourself about the system, the politics inside healthcare and outside, and exercise your right to opt for and support those measures that will actually enhance and support your journey to better health.