Nancy Gahles, DC, CCH, RSHom(NA) discusses the current state of integrative medicine after attending last month’s Integrative Healthcare Symposium in New York City. Add your perspective… 

by Nancy Gahles, DC, CCH, RSHom(NA)

The Integrative Healthcare Symposium held recently at the Marriott Marquis was one more in a series of yearly presentations of the various specialties within the CAM community.  Once again, we were regaled with the promise that each profession holds for restoring health to the sick. Indeed, that is the highest calling of each and every one of us who toil in the field of health care.

Each year there are one or two presentations about creating an integrative practice.  I myself offered tips on how to do so at the end of my presentation on homeopathy and Irritable Bowel Syndrome.  The practical reality of doing same is one I would like to open up for continuing discussion.

I have been in practice for 28 years, as a chiropractor first, and in an ever- evolving journey as a healthcare provider, became a yoga instructor, mediator, wellness educator, and homeopath. The needs of my patients were the driving force behind my evolution. There would be clinical cases where, despite my best efforts employing all the techniques I knew at the time, the patient did not achieve the desired state of wellness that was expected by both of us. Let me amend that to the desired state of wellness that I envisioned. I have a higher expectation than most patients. Generally speaking, they will be satisfied with the alleviation of the pain they experience in the moment and consider that “cured”.

In my search for “something else” I discovered several modalities that are now called Complementary and Alternative. At that time in history, there was not a retinue of practitioners in these fields and so I undertook the study of those therapies that I resonated with and that complemented my practice in an effort to provide whole person healing.  I became my own integrative healthcare center.

Time marches on and all things change and so we arrive at a point in time where CAM professions have schools that educate them and grant degrees or certificates of proficiency. They have national organizations that unify them and promote standards of ethics and practice.

In 2006, the Duke Center for Integrative Medicine and The University of North Carolina held a symposium on “The New Medicine”, thus called for its “ranging discussion on mind-body medicine, patient-centered care, whole person healing, the patient-provider relationship, and how integrative medicine is changing the future of health care.  The late Dana Reeve hosted a documentary called “The New Medicine” which aired on PBS in 2006.  It explored a burgeoning movement taking place in hospitals and clinics across the country integrating the best of high tech medicine with a new attitude that recognizes it is essential to the healing process to treat the patient as a whole person not a cog in an assembly line.” (News release UNC 2/16/06).

That being said, it is now 2008.  Where is the new medicine being practiced in local communities? A few hospitals in the New York area where I practice have had CAM programs offered to patients with cancer that include yoga classes and occasionally some form of relaxation classes. The ones I know of are hard pressed to stay afloat because they can’t sustain themselves if they lose their funding and several have closed because of this.

I do not see the “burgeoning movement” taking place to integrate the best of both worlds. I do not see these hospital programs willing to integrate chiropractic or homeopathy in to their programs. My question to those of you who work in these areas/institutions is where is the integration taking place? Where is the education of the practitioners in these facilities necessary to make appropriate referrals to other specialties in the CAM arena?

How do you reach the goal of whole person healing if the modalities that address the whole person are excluded? The subject of my presentation at this year’s symposium was the treatment of people with irritable bowel syndrome using homeopathy. In my quest for a healing modality that addressed the whole person, I discovered homeopathy. The art and science of a system of healing that takes into account the whole person by treating the totality of symptoms the person presents with, including those of the mental, emotional realm along with the physical ones. Rather than belabor the audience with a classroom Homeopathy 101 style presentation, I elected to present real cases of patients healed from bowel pathologies ranging from benign (spastic colon) to severe  (Crohn’s disease). Case studies have been a traditional form of learning from time immemorial. In settings where there are varying specialties represented they offer an experiential picture that can pique interest in the profession for further investigation.

The questions that were posed to me at the end were the most telling. One reason that physicians seemed unable to refer was because they do not understand what to refer for. After a thorough explanation of how homeopathy addresses the whole person through a consultation that elicits the totality of symptoms they asked questions like, “What type of conditions do I refer for?” and “What other ailments does homeopathy  treat?” The concept of mechanistic/reductionist medicine needs to be addressed. We are imbued with the idea that treatment of a person is about what body part is ailing them. What will it take to educate physicians to think outside this box?  Is it practical? Is it likely to happen? What are the obstacles to this?

The concept of whole person healing in the paradigm of “new medicine” is one that must be addressed.  How do medical doctors address this with their patients when making referrals? Or do they? Either address it or make referrals?

The discussion following the questions was about understanding when to refer. My answer was and is that you refer your patient when what you are doing isn’t working or when you have nothing to offer for the person who is suffering from a certain condition.  In a local community practice, the opportunity presents itself very often when a patient is suffering from a viral syndrome and is told that “It’s a virus, there is nothing to do for it.” Literature and research is replete with documentation of efficacy of herbs, homeopathy, body-work, acupuncture and other forms of CAM that do indeed stimulate the body to heal itself and offer the patient decreased duration of suffering. What are the factors that prohibit a doctor from referring to a CAM practitioner?

Cost, lack of insurance, safety and ignorance as to the therapies are a few of the reasons I have heard bandied about. Dr. James Gordon addressed one of these in a past keynote at a CAMExpo when he called the new healthcare, self care and exhorted us all to educate patients and ourselves to the fact that people need to pay for their own care. They need to be educated to take personal responsibility for their healthcare. Do we, as practitioners, explain to our patients the viability of accepting responsibility to pay for care that would benefit them if insurance doesn’t cover it? Do we explain health plans that include options such as Flex Spend and Health Savings Accounts that allow provisions for the proactive patient to plan for their yearly care outside of allopathic needs?

Belief systems may play a role here as well. One dictionary definition of integration defines it as “equal access for all. The process of opening a group, community or organization to all regardless of race, ethnicity, religion, gender or social class.” I might add, regardless of an MD license or evidence-based research.

When I started practice as a chiropractor in 1980, medical doctors were not allowed to refer to chiropractors. Radiologists were not allowed to accept referrals for x-rays from a chiropractor.  Most of our CAM modalities are not licensed practices. Most of those proven therapies do have certifying bodies that offer credentialing that can be trusted. The Council on Homeopathic Certification, for example, offers a rigorous model of preparation and testing analogous to the medical and chiropractic certifying exams that I took prior to licensing. One simply needs to Google that organization to find a competent practitioner. If integration means equal access to all and it is a process of opening up to these “others”, where are we in that process? What are the dominant belief systems that either inhibit us from referring or encourage us to do so?

Economic factors play a role in referral as well. In my community, a patient was begrudgingly referred to me by her pediatrician only after she demanded that he do something else after 13 years of suffering with irritable bowel syndrome with no relief. Knowing of my reputation in the community, he agreed that she could see me.  Thankfully, she recovered very well with homeopathy and after I sent him a report he congratulated me on the outcome of the case but bemoaned the fact that he doesn’t see the patient in his office anymore. As President of the National Center for Homeopathy, I recently had the opportunity to speak with a member of the British health cabinet. Homeopathy, long a standard in the national health system has recently come under attack.  She said that basically, there are only so many dollars in the pot to go around and everyone is vying for a piece of that.

What part does ego play in our reluctance to refer? Is the bottom line of keeping the patient for economic reasons a realistic one? Is this a prevalent belief?

The standards that we held for assessing efficacy of a treatment modality are often used as a reason why one cannot refer to a CAM practice. They say that there is lack of evidence that it works. We do know that in many cases such as homeopathy and acupuncture there exists hundreds and thousands of years of clinical evidence of effectiveness.  We also know that technology evolves slowly and the fact that there may not exist, at the present time, the technology to assess pathways of function doesn’t mean it isn’t there. NCCAM clearly states that this is the case and is working toward granting funds to research that is apart from the double blind, placebo controlled studies that are presently the gold standard but which do not apply to many CAM therapies.

Researchers such as Iris Bell, MD and Rustum Roy, PhD have done groundbreaking cutting edge research in complex systems theory and structure theory respectively, that point to a dynamic of whole systems healing. This information is available to any practitioner willing to educate themselves about the alternatives that are available to facilitate the healing of their patients.  To what extent do we value this opportunity? How willing are we to take the time to educate ourselves so that we can provide informed information?

Lastly, acceptance into the community, the process of becoming an accepted member of a group or community is a final factor in the willingness to be an integrative practitioner. If we are to truly be unified around the common goal of integrative medicine, we must agree to accept other systems of healing, other ways of thinking and treating.  The new medicine that treats the whole person must cure us as well, of a system of healing that falls far short of the goal of cure.

I wish to express my gratitude to the powers that be who hold this vision of integrative healthcare and who provide a forum every year for us to be in each other’s presence. This is how acceptance begins, how ideas germinate and how the continuing community online yields the fruits of cooperation.  Many Blessings!

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