The Soul Of A New Medicine
An integrative approach may be changing the future of health care in the United States
By Andrea M. Girman, MD, MPH
Jane Roberts leans forward to tell me her story. She is 32 years old and has been struggling since her teens with chronic health problems. Speaking quickly, she recounts a lifetime of complex health experiences in a matter of moments. Jane, who has asked that we change her name to protect her privacy, says she is happy to be at Beth Israel Medical Center's Continuum Center for Health and Healing in New York City—and thankful that her insurance plan includes primary-care doctors who take a holistic approach to medical care.
I smile, tell Jane that I'm glad she's here, and apologize for being unable to keep up with her hurried narrative. "This is your first visit to the center, and we have an hour and a half together," I say. "Why don't you start again from the beginning, so I'll better understand how I might be able to help you?" With that, Jane inhales deeply, sits back in her chair, and says with a quiet smile of her own, "No doctor has ever said that to me before."
It's a novel experience for me as well. But as a physician training in the emerging field of integrative medicine, it seems as if every day in clinical practice involves unfamiliar territory. Although our work together as partners in health has just begun, I believe our journey will help Jane and me understand better how it is that we achieve healing and how it is that we feel whole. It is an amazing experience to be standing with her at this new medical frontier.
The Rise Of Integrative Medicine
In 1993, a team of physicians at Harvard Medical School, led by David M. Eisenberg, MD, stunned the medical establishment by reporting that Americans made more visits to providers of complementary and alternative medicine (CAM) than to primary care physicians—in 1990 spending an estimated $10.3 billion out-of-pocket to do so. And in the nearly ten years since the study was published, use of CAM therapies as well as out-of-pocket spending on CAM therapies has continued to increase (Journal of the American Medical Association, 1998, vol. 280, no. 18).
Although dissatisfaction with conventional care is often cited as a reason for the continued trend toward nontraditional CAM therapies, a recent national survey suggests otherwise. As reported in the Annals of Internal Medicine (2001, vol. 135, no. 5), nearly 79 percent of adults using both alternative and conventional Western medical therapies said they perceived the combination to be a superior therapeutic approach as opposed to using either approach alone.
Integrative medicine (IM) is the term used to describe this melding of complementary and alternative medicine with conventional Western medicine. Popular perception of integrative medicine often limits it to the needs of the physical body: Will acupuncture be helpful in alleviating nausea in patients receiving chemotherapy? Can eating soy products ease hot flashes in menopausal women? Will meditation help lower high blood pressure? But as a vision for health care's future, IM goes much further than the biological by also taking into account the psychological, sociological, and spiritual factors that impact every person's health.
To get a better understanding of how IM has evolved in recent years, I spoke with five visionary practitioners who stand at the leading edge of a movement that promises to transform the way health and healing are viewed in this country. These doctors imagine a health care system that focuses on prevention and emphasizes the wellness and healing of the entire person. They teach and practice a caring, interactive patient-physician relationship. This is IM's promise. It is because of doctors like these that after ten years of medical training and practice, I have spent this past year as a fellow at Beth Israel learning a new way of offering clinical care. It is why Jane Roberts came to see me.
The Nurse Turned Doctor: Alice McCormick, DO
Alice McCormick, DO, knows a lot about training. A nurse for eight years before beginning osteopathic medical school, McCormick is now an associate fellow studying with the University of Arizona's Program in Integrative Medicine. This two-year "virtual" program, in which students spend three one-week visits in Tucson, Arizona, and the rest of the time participate in the curriculum via the Internet, is teaching McCormick to incorporate IM philosophies and techniques into her busy practice at the Center for Integrative Medicine at Inner Harmony in Clarks Summit, Pennsylvania, where she is acting medical director.
"If integrative medicine is to be fully embraced by the medical profession, medical education will need to change. How can you teach others to experience health if your training has never encouraged you to be healthy?" McCormick's interest in IM first arose after she was diagnosed with a chronic illness that was not well managed by traditional Western medicine. A friend recommended a nutritional supplement that provided immediate physical relief. "This experience made me see that possibilities other than conventional medicine can work," says McCormick, "even though initially it seems they shouldn't."
McCormick believes that IM is the future of medicine—and that to get there we need to reform medical education. She describes her initial medical training as years filled with limited sleep and exercise, poor nutrition, and minimal room for emotional, spiritual, and physical healing. Her experience with the University of Arizona has been remarkably different. "The program's first goal has been to teach me how to get healthy myself," says McCormick. "It has challenged me to look deeply at my approach to food, water, and exercise, and at my emotional health." Finally, she says, the healer is healing herself.
The Holistic Pediatrician: Lawrence B. Palevsky, MD, FAAP
It's hard to imagine a more circuitous path to integrative medicine than the one Lawrence B. Palevsky, MD, FAAP, has taken. After training in pediatrics, the 41-year-old pediatrician practiced for nine years in New York City in the most rigorous medical settings, including pediatric and neonatal intensive care units, emergency departments, and hospital inpatient floors. You might expect that an immersion in such crisis-driven, conventional arenas would have fostered a conventional view toward the medical care of children. Not so, says Palevsky.
"Children are ideal candidates for integrated therapies because they are so responsive physically, mentally, and emotionally." Now a pediatrician at the Continuum Center for Health and Healing in New York City, Palevsky explains that his intense medical experiences taught him the principles on which he now bases his holistic pediatric and adolescent medicine practice. He learned, he says, that the personal connection between the health care provider and the patient is one of the most important links to health (in addition to the link between parent and child). He also believes that children have an innate ability to heal, irrespective of intervention by health care practitioners. "They have not had years of exposure to environmental factors that create and deepen illness in the body," he explains.
Working closely with children and their families, Palevsky spends a lot of time reframing the meaning of health and illness, presenting them as dynamic rather than static processes. Integrative medicine, he believes, offers patients the chance to see symptoms of illness as a possible road to healing. "Integrative medicine," he says, "provides an opportunity for patients to use health problems to learn, grow, possibly heal, and take charge of their own lives."
The Private Practitioner: Howard Morningstar, MD
Howard Morningstar, MD, is finishing a busy day at Morningstar Healing Arts, his private clinical practice in Ashland, Oregon. Although now a doctor, Morningstar is an herbalist at heart: He studied with well-known herbalist and author Rosemary Gladstar from 1980 to 1985 and was a village herbalist while living in the mountains of rural Oregon. He decided to become a physician after realizing he wanted to know more about healing than plants alone could teach him. After medical school at Yale, residency training at Brown, and four years of public health service in rural Florida, Morningstar returned to Oregon to establish a clinic where patients could come for primary medical care, use their conventional insurance, and have the widest range of therapeutic options available.
Ideally, the future of medicine is one in which people are able to access the widest array of good therapies without concern for political or economic barriers." Over the years, Morningstar has developed relationships with a variety of health and wellness practitioners in the Ashland community, giving him and his patients the flexible treatment choices he considers crucial to his vision. Unfortunately, although visits to his primary-care practice are covered by most insurance, his referrals for chiropractic care, acupuncture, massage, or other complementary therapies usually are not. Morningstar laments that this is in part due to the powerful economic and scientific interests that keep the medical system from undergoing changes, that keep its focus on pharmaceuticals, surgery, and intensive medical intervention rather than on wellness and preventive care.
These same vested interests, Morningstar believes, propagate misconceptions about IM, which in turn hinder its core acceptance among doctors. "Many medical professionals dismiss integrative medicine, saying it's not safe, or it isn't scientific, or it's all placebo," he says. "They often do this without having good first-hand knowledge about herbs, supplements, or other therapies that we use in an integrated medical practice. Addressing these misconceptions is critical. Educating people is a large part of what I do on a daily basis."
The Academic Internist: Roberta Lee, MD
Roberta Lee, MD, spends time talking with colleagues and patients about her vision of the future of medicine. After all, as medical director of New York City's Continuum Center for Health and Healing and co-director of the center's new integrative medicine fellowship training program, it's her job. But it's also her passion.
"I don't see integrative medicine as a separate field of conventional medicine. I see its values—those of a patient-centered care and a science-based approach to health care that spans the mind, body, spirit and community—incorporated into every field of medical practice." After five years in public health service in Micronesia, Lee joined—and then left—a busy internal medicine practice Stateside. Why? An opportunity arose she couldn't pass up: to become one of the first fellows to work under the tutelage of Andrew Weil, MD, at the University of Arizona's Program in Integrative Medicine. During that training, Lee, an ethnobotany enthusiast, learned how to integrate the plant-based medicinal practices of indigenous cultures with conventional Western therapies. Even more important, this training built on the appreciation she had first gained in Micronesia for the close healer-patient relationship.
Lee believes that a wider embrace of IM will require redefining the traditional Western doctor-patient relationship. An integrative approach means doctors must take more time with the people they treat and thus see fewer patients—and perhaps reap fewer financial rewards. "This is labor-intensive medicine," says Lee, adding that interacting with patients on a more personal level requires the physician to let down his or her guard. Although energized by the work she's doing, she admits it's more demanding of her on all levels. What makes it all worthwhile, she says, is the "great increase in joy and personal satisfaction."
The Cancer Specialist: Jeremy R. Geffen, MD, FACP
Board-certified medical oncologist Jeremy R. Geffen, MD, FACP, fully understands the commitment needed to create a technologically and scientifically proficient cancer center that is wholly integrative in its approach. As founder and director of the Geffen Cancer Center and Research Institute in Vero Beach, Florida, he has spent more than 15 years listening to and working with people with cancer. Geffen's integrative approach is chronicled in his recent book, The Journey Through Cancer: An Oncologist's Seven-Level Program for Healing and Transforming the Whole Person (Crown Publishers, 2000).
As a young man, Geffen had a powerful desire to know more fully who he was spiritually. His quest led him to immerse himself in diverse spiritual and healing traditions practiced throughout the world.
"Creating a medical model that is committed to helping others heal and transform at the deepest levels requires that we as caregivers have a deep and genuine commitment to our own healing and transformation as well." This cross-cultural knowledge, he says, has made it easier for him to recognize the crucial shift that IM is helping to facilitate. Doctors must move beyond questions of what they are going to do in their practice, into a deeper understanding of who caregivers and patients are as human beings—mentally, emotionally, and spiritually, as well as physically. He believes that personal exploration by health care providers translates into better patient interactions and improved patient experiences. "This exploration of how conventional, complementary, and alternative medicine might be interwoven into a truly integrative model is an important and historic opportunity," he says. "If pursued openly and sincerely, it will generate a greater understanding of what is possible for us to experience in our lives."