Pulse Diagnosis​

Integrative Medicine and Public Health

The Institute of Medicine (IOM) convened the Summit on Integrative Medicine and the Health of the Public, Feb. 25-27 in Washington, D.C., in order to advance the science and progress of integrative medicine in the United States. The summit brought together educators, policy-makers and health care providers from multiple sectors to present challenges and opportunities for integrative medicine to improve U.S. health care. IOM President Harvey V. Fineberg, MD, PhD, framed the discussion on integrative medicine as “orienting the health care process to engage patients and caregivers in the full range of physical, psychological, social, preventive, and therapeutic factors known to be effective and necessary for the achievement of optimal health.”

Primary support for the Summit was provided by the Bravewell Collaborative, which is a foundation of philanthropists dedicated to transforming the culture and delivery of health care. Support also came from the Prince’s Foundation for Integrated Health, a London-based nonprofit that champions an integrated approach to health, and the American Association of Retired Persons (AARP). The three groups formed an international alliance supporting the summit and the advancement of integrative medicine.

Many dimensions of integrative medicine were brought forward during the conference. The discussion was about creating seamless engagement by patients and caregivers in the full range of physical, psychological and preventive factors for achieving optimal health. In summary: integrating health care approaches and systems.

However, as Ralph Snyderman, Chancellor Emeritus and professor of medicine at Duke University School of Medicine, stated at the summit: “We have no system for navigating the system.”

Mehmet C. Oz, MD, of “Oprah” fame, spoke on evidence integration. Oz, a professor of surgery at Columbia University, spoke on evidence-based medicine, essentially reframing the matter in terms of what we would tell our families. This is the litmus test he uses. “Not additive knowledge, but stretching what healing means. We must ask: ‘Is this the evidence we are looking for? If you can’t find a trial, the question won’t be asked.'”

However, as Ralph Snyderman, Chancellor Emeritus and professor of medicine at Duke University School of Medicine, stated at the summit: “We have no system for navigating the system.”

This brings us to several questions about evidence. Who determines what quality evidence is? Who decides who determines what evidence is and how it is gained? Oz further distinguished forms of inquiry centered upon, “Does this or this work better,” as opposed to, “Does this work, or does nothing work?” These are very different questions, leading to distinctly different outcomes.

President and CEO of the Institute for Healthcare Improvement (IHI), Donald M. Berwick, is one of the nation’s leading authorities on health care quality and improvement issues. He serves as a clinical professor of pediatrics and health care policy at Harvard Medical School. Berwick identified a triple aim of integration related to population health, experience of care and per-capita cost.

Nancy Adler discussed the role of socioeconomic status in health care. As director of the MacArthur Foundation Research Network on Socioeconomic Status and Health, she coordinates research spanning social, psychological and biological mechanisms by which socioeconomic status influences health. Adler presented the pathways of socioeconomic status connections between health and illness. If we are to see a change, we must track the redistribution of wealth in the social systems. The socioeconomics define the social gradient, stress, impact of early life events on health, social exclusion and unemployment related health conditions.

According to Berwick, integration requires the globalization of medicine. Our economic situation is global, but in medicine, we remain provincial. Every industrialized country except the U.S. has universal health care. This is complicated by physician shortages, which are increasing. By 2025, there could be as many as 200,000 too few doctors.

It was clear that conditions appear to be favorable for allied health professions in general, and acupuncture in particular. I made brief comments during the meeting to this effect: “The practice of integration occurs in many strata, from cognitive processes of practitioners to delivery systems to state and federal policy-making institutions. Integration at the policy making level will only occur when all classes of licensed health care providers are at the policy-making table, including acupuncturist.”

In the words of Reed Tuckson, executive vice president and chief of medical affairs at UnitedHealth Group: “We are all in this together and it’s time for a revolution.”

June 2009