Complementary and integrative medicine a modern healthcare revolution

Photo Cred: Drew Beamer/Unsplash

By Bill Reddy, LAc, DiplAc, Bill Reddy, LAc, DiplAc, Bill Reddy, LAc, DiplAc, Bill Reddy, LAc, DiplAc, Bill Reddy, LAc, DiplAc

The integrative healthcare field is working toward a genuine revolution in healthcare. All practitioners must act as leaders to bring about such monumental change, but it helps greatly to have people in positions of power willing and able to move complementary and integrative medicine practices toward mainstream acceptance.

 In this regard, practitioners may be familiar with the name and work of Helene Langevin, MD, director of the National Institutes of Health (NIH) National Center for Complementary and Integrative Health (NCCIH).

The non-integrative approach to healthcare that remains predominant in the United States has many negative consequences of which we have all heard. Presentations abound at medical conferences identifying the U.S. as having the highest healthcare spending per capita on the planet but ranking a dismal No. 37 by the World Health Organization among their member states. The U.S leads in deaths associated with iatrogenic causes, opioids, murder/gun-related deaths, and suicide disproportionately to other countries – including infant mortality. 

For those intimately involved in integrative health practice, it’s not a matter of “if” integrative medicine will take hold within the U.S. healthcare system, but “when.” One of the lesser-known tenets of the Affordable Care Act is health promotion and disease prevention—a noble concept, but difficult to execute in a fee-for-service environment. Conceptual shifts toward the “Triple Aim” of patient experience/satisfaction, population health, and lower cost are reflected in current healthcare policy, but implementation is ineffective and inconsistent. 

Complementary and integrative medicine concepts can improve all aspects of the Triple Aim. In fact, the new Department of Veterans Affairs (VA) Whole Health program is demonstrating just that. This program began as a pilot program at 18 of the VAs 1,243 locations, designated as Whole Health Flagship Sites, and the department has now secured funding to expand to additional health facilities. Tracy Gaudet, MD, executive director of the Veterans Health Administration’s (VHA) National Office of Patient Centered Care and Cultural Transformation, shifted their healthcare paradigm from “what’s the matter with you?” to “what matters to you?”

Integrative practitioners can’t do it all by themselves, and so the work of NIH’s NCCIH is very good news indeed. Langevin fully recognizes the importance of whole health. In an Integrative Health and Wellness Congressional Caucus briefing in November 2020, she expressed her concern that the research world is missing the keys to optimal health through reductionist thinking and that thought process bleeds into healthcare delivery, or vice-versa.

In the briefing, Langevin noted that the U.S. life expectancy has declined for three years in a row due to opioid overdoses and suicide of those suffering from chronic pain, compounded by chronic disease, obesity, diabetes, and novel coronavirus (COVID-19) infection. She said that our healthcare system lacks integration and is designed to predominately treat disease of separate organ systems as if they are independent from one another.

Researchers’ preoccupation with analyzing organs and organ systems, right down to the cellular level, is why we attempt to treat pathology with pharmaceuticals that miss the point of whole-person integration. She provided an example of a middle-aged woman presenting with a high body mass index (BMI), diabetes, high blood pressure, and knee pain as well as suffering from anxiety and insomnia. Her chief complaints were managed with drugs, which create problems of their own, eventually leading to a downward spiral of polypharmacy. 

The major problem, which is reflected globally in the U.S. healthcare system, is that she was treated using a fragmented, disease-focused model. Langevin emphasized studying the biopsychosocial aspects of patient care and her values are reflected in the top five priorities listed in the NCCIH FY 2021 to 2025 strategic plan:

• Advance fundamental science and methods development.
• Advance research on the whole person and on the integration of complementary and conventional care.
• Foster research on health promotion and restoration, resilience, disease prevention, and symptom management.
• Enhance the complementary and integrative health research workforce.
• Provide objective, evidence-based information on complementary and integrative health interventions.

Implementation science is of particular interest at the NCCIH, to help move from test-tube to treatment table in a more expeditious manner.

A new model for healthcare research

Researchers must work in baby steps, usually using an in vitro model, asking “Does the intervention work at the tissue level in a controlled environment?” Then on to in vivo in an animal model, and finally, if the previous data is promising, in human clinical trials.  From there, researchers do their best to keep the maximum number of variables constant and only vary the intervention versus a control group. The results measure the efficacy of the drug or therapy. 

Changing the paradigm to evaluate effectiveness, such as testing the intervention in more realistic circumstances, will provide hospital administrators, legislators, and decision-makers a more accurate picture of the intervention being evaluated. Langevin is attempting to move in that direction through pragmatic studies and facilitating the transition of proven integrative practices to healthcare delivery

A vision of the future

The most accurate and succinct definition of integrative health, developed by the Integrative Health Policy Consortium, is “a collaborative, comprehensive, person-centered approach to health creation and disease care that addresses all factors impacting health, including social determinants, and embraces all evidence-informed disciplines, both conventional and complementary, in order to achieve optimal well-being.” With that definition in mind, our broken healthcare system leaves significant room for improvement.

Take, for example, a 44-year-old female accountant suffering from migraines, TMJ, and dysmenorrhea schedules an appointment at a local integrative health clinic. A nurse navigator refers her to the acupuncturist on staff whose treatment plan is twice a week for three weeks. In addition to supplementing with transdermal magnesium, and ergonomic changes to her computer workstation, the nurse navigator suggests she receive craniosacral therapy (CST) from a chiropractor, massage therapist, osteopath.

She chooses an osteopath at the practice who performs CST as well as visceral manipulation of her abdomen/uterus and recommends calcium lactate as needed for her cramping. She also decides to follow the nurse’s advice to see a nutritionist to help her identify any food triggers that may be contributing to her migraines and a meal plan to help lose a few stubborn pounds. The synergy of this approach will lead her to go back to swimming and playing tennis and having a more positive attitude toward her health and body image. 

In the example above, the accountant is under the care of multiple practitioners who are in communication and coordinating her care plan, and she’s playing an active role in her healing path. Compare this to how the NIH, including the NCCIH, currently studies individual interventions in a vacuum. That approach is insufficient to apply to actual use and reflect real world application. America’s often disappointing marginal outcomes reflect these shortcomings.

Similar in concept to the “Blue Zones”¹ introduced by Dan Buettner, NCCIH researchers should perform a survey of 1,000 healthy octogenarians and disseminate that data as a basis for a dietary and lifestyle model that can be emulated by Americans and promoted by physicians. Similarly, there can be a study of “anti-cancer lifestyles” as well.  Advancing studies in resilience and well-being would also provide value in a country plagued by anxiety, depression, and ADHD.

Langevin is looking for synergism by opening lines of communication between NCCIH and other non-disease focused institutes such as child health and human development, and the National Institute on Aging. Health promotion and disease prevention are the key elements in shifting our outrageously expensive sick care system into one that provides person-centered, integrative care to encourage positive lifestyle changes that will eventually reduce the burden of chronic disease in the U.S. We are lucky to have an ally in NIH leadership willing to advance the revolutionary vision that CIH practitioners aim to achieve every day in our practices.

References

Buettner, D. (2012) The Blue Zones: 9 lessons for living longer from the people who’ve lived the longest.