Moving A Nation From Sick Care

Toward Wellness Care With Integrative Medicine

WASHINGTON (AP) — Popping a pill can cut your cholesterol. But did the doctor also prescribe cutting the stress that’s eroding your immune system? Or teach you how to exercise without worsening painful joints?

Think three P’s: Good health care is preventive, predictive, and personalized, a rarity today in a crisis-oriented care system far better at treating disease than keeping it at bay. To help change that, one of the nation’s top medical groups started a major push this week for what patients might call whole-body wellness care.

“Health is more than the absence of disease,” says Dr Ralph Snyderman, who heads a three-day meeting of the prestigious Institute of Medicine to get onto Congress’s radar this health-promotion approach, what jargon-loving doctors call “integrative medicine.”

What does that mean? Basically, it’s going beyond standard disease-of-the-day care to involve a range of extra factors — physical, lifestyle habits, mind-body interaction — that play a role in preventing illness, and helping people stick with recommended changes long enough to see a benefit.

“Not enough attention is paid to wellness,” says AARP chief Bill Novelli, who worries that’s lost in the coming health care reform movement.

“The doctor says, ‘Lose weight, exercise, see you in a year.’ We know that doesn’t work,” adds Dr Tracy Gaudet, an obstetrician/gynecologist who heads integrative medicine at Duke University Medical Center.

But how to pay for keeping people well is a barrier. Even though preventing disease is cheaper overall than treating it, it’s not clear where the upfront investment would come from, a big part of the Institute’s debate.

Still, a growing number of respected academic medical centers are adopting integrative medicine in different ways. At Duke, specially trained health coaches help patients implement a personalized care plan that complements treatment prescribed by their regular physicians, extra care that patients often pay for out-of-pocket.

But these centers must straddle a line between adopting some nonmainstream therapies that seem to at least help a patient’s quality of life, while avoiding unproven “alternative therapies,” even outright quackery.

“We’re extremely wasteful in health care in America because we don’t respect what the patient can bring to the table, the healing properties of the body itself, the use of lower-technology routes to healing,” says Dr Donald Berwick, a Harvard health-quality expert who heads the nonprofit Institute for Health care Improvement.

Yet Dr Berwick planned to issue the IOM meeting a strong warning: “Evidence matters.”

There is some evidence. Medicare funded a Duke study of 154 middle-aged people at high risk of heart disease. In ten months, people who received health coaching were exercising 3.7 days a week —two days a week more than when they started — and had an average ten-point drop in cholesterol.

That equaled a small but significant drop in their overall heart risk, while people who got standard checkups barely budged.

Another example: A chronically stressed brain orders release of hormones and other chemicals that tamp down the immune system so it can’t fight off disease or speed healing, says Dr Esther Sternberg of the National Institute of Mental Health.

Too much stress even ages us faster. But regular exercise, a healthy diet, and stress-relieving techniques such as meditation or yoga have been shown in scientific studies to help battle stress’s bad effects.

That doesn’t mean replacing medication or other treatment, Dr Sternberg cautions.

“We’re saying do it together with the space-age advances in medicine,” she says. “That will allow your body to receive that treatment and respond optimally to that treatment which otherwise it might not.”

In Derby, Conn., the Integrative Medicine Center at Griffin Hospital (IMC) positions itself to bridge the gap between conventional and alternative medicine for a broad range of medical conditions.

Since the Planetree medical facility is founded on principles of patient-centered care and evidence-based medicine, each patient is provided with evaluations that are holistic (consider the whole person) and involve a conference of five on-site experts — medical doctors (MD) specializing in internal and preventive medicine, a nurse practitioner, and two naturopathic physicians (ND) with expertise in a wide array of natural, complementary, and alternative therapies.