IOM’s Summit onIntegrative Medicine

Noble words were spoken—let’s hope they’re no bull.

ByErik Goldman

According to the Senator Tom Harkin (D-IA), the Obama administration will move on healthcare reform later this year, and wellness-focused, prevention-centered care will be at the center of their proposal for increasing access, improving quality and reducing cost.

“For those of us who have been working for years to promote wellness, our time has come,” said Sen. Harkin, at the Institute of Medicine’s (IOM) recent Summit on Integrative Medicine & the Health of the Public. He added that President Obama himself “gets it” as far as the importance of prevention, the value of nutrition, and the need to shift the focus of the healthcare endeavor from late-stage disease treatment to health promotion and disease prevention.

“It’s not enough to talk about how to extend insurance coverage. It makes no sense to try to figure out how to pay the bills on a system that’s broken and unsustainable. If we pass healthcare reform without infrastructure for health and wellness and prevention, we will have failed America,” the nutraceuticals industry’s favorite legislator told the roughly 700 people who gathered in Washington for the three-day summit.

Leading Minds in Integrative Medicine Speak to Washington

Among the delegates were some of the leading lights in holistic medicine, nutrition, prevention, public health, healthcare financing and policy-making, including: Dean Ornish, Mehmet Oz, Mark Hyman, Jeffrey Bland, Dana Ullman, Mary Jo Kreitzer, Mimi Guarneri, Don Berwick, Tracy Gaudet, Bill Novelli, Arnold Milstein, Ken Pelletier, Vic Sierpina, Adam Perlman, Reed Tuckson, Ralph Snyderman and Harvey Fineberg.

The purpose of the summit, held in the patrician Washington, D.C., headquarters of the IOM, was to clarify what, exactly, “integrative medicine” really means, and how it fits into the public health equation.
The presentations and discussions swung between “hopeful” and “wishful,” with some underscoring the clear and glaring need for major changes in American healthcare and the new windows being opened by a new administration, while others catalogued the daunting difficulties inherent in making those changes: institutional inertia, entrenched Big Pharma/Big Food/Big Insurance interests, lack of coherence among “integrative” practitioner groups, lack of definitive data showing clinical effects and cost savings, reluctance or even resistance from other industries and lawmakers.

The summit was sponsored by the Bravewell Collaborative, a private philanthropy dedicated to furthering the evolution of integrative medicine, founded several years ago by Penny and Bill George (former CEO of Medtronic) and Christy and John Mack (CEO of Morgan Stanley).
The meeting provided an opportunity for leaders in the field to make the case for a wide range of practices that engender a culture of wellness and personal empowerment that could help people—especially young people—prevent or at least greatly delay the development of diabetes, obesity, heart disease, chronic pain syndromes, depression and many of the other chronic diseases that threaten the physical and fiscal health of the nation.

The speakers touched on gritty issues such as the need for new research models that go beyond the limitations of the drug-oriented randomized controlled trial; the many challenges of trying to finance new models of care in a contracting economy; the difficulties of burying historical enmity and creating cross-disciplinary working relationships among diverse practitioner groups; the sticky question of whether holistic practices ought to be covered by conventional health insurance and/or government programs (Medicare & Medicaid); and the challenges of defining who’s “in” and who’s “out” in any future “reformed” healthcare system.

The Need for a Healthcare Revolution

Some of the rhetoric was quite bold. Dr. Ralph Snyderman, chancellor emeritus of Duke University, and head of the summit’s planning committee, said the time is right for, “a new revolution in healthcare.” Genomics, proteomics, metabolomics, systems biology and nutrition science are converging to create a much better understanding of how gene expression—and disease development—are driven by environmental and lifestyle factors.

“We’re moving away from the belief that disease is caused by a (single) factor and that your job (as a doctor) is to find that factor and fix it. This reductionist approach has its place, but it is not sufficient. We should not be thinking simply of preventing disease, we ought to be talking about enhancing health and well-being,” Dr. Snyderman said.

But Duke’s Dr. Snyderman wasn’t the only one calling for a healthcare revolution. Reed Tuckson, MD, executive vice president and chief of medical affairs for UnitedHealth Group (UHG), also uttered the “R” word, declaring that “we’re all in this together,” and promising that UHG is committed to forwarding evidence-based, wellness focused healthcare. Not mincing any words, he said basically that we’re all dreaming if we think big insurers—and the large employers who pay the premiums—are going to cover anything new without reams of good outcomes data.

He also had some biting criticism for America’s healthcare gluttony. “Everybody wants everything all the time. The person who’s sick wants it all, and they want it now. The doctors want it all. The tech people want it all. And you should see what’s rolling down the hill from the geneticists.”

His points were true enough, but such chastisement was hard to take from a guy who heads one of the most rapaciously greedy insurance corporations in the world, a company whose former CEO, Bill McGuire, was taken down in a Dept. of Justice investigation for timing his $1.6 billion worth of options in his own company. While there was much talk throughout the summit about how patients, doctors, researchers and politicians need to change, there was surprisingly little overt mention of egregious profiteering by insurance companies, the layers of administrative cost they add to the healthcare equation, or the dangerous entwinement of the insurance industry with the rest of the financial sector.
Dr. Mehmet Oz, the holistically-minded Columbia University cardiac surgeon who’s become Oprah’s right hand man on all things health-related, stressed that the “balkanization” of medicine into subspecialties and ever-narrowing research and practice interests only engenders conflict and mistrust, which in turn leads to unnecessary public suffering, and tremendous fiscal waste. Practitioners and hospitals have been too focused on their own needs and narrow interests, and not enough on their patients’.

He believes it is up to well-informed patients to re-set their practitioners’ priorities, and he called for the creation of a national “Health Corps,” similar to the Peace Corps, which could recruit energetic young people to demonstrate and promote healthy living in poor, disease-plagued communities.
Proceedings of the integrative medicine summit will be boiled down into policy recommendations to be issued by IOM later this year.

The Supplement Industry is a No Show

Throughout the three days, representatives of a very broad range of professions and positions voiced their ideas, experiences and concerns. Glaringly absent from the speakers’ roster and attendee list, however, were representatives of the supplement industry, despite a widely broadcast public invitation many months prior to the event.

This was surprising, given how much the industry stands to gain—or lose—in the next few years. Sen. Harkin’s words about wellness-centered health reform were encouraging. But he was also very frank about the entrenched financial interests of conventional medicine and the pharma/device industries, which will likely oppose any major changes.

With so much at stake, you’d think nutrition/supplement industry leaders would want to at least participate in the dialog. I guess everybody was too busy preparing for Expo.

The IOM Summit received wide, glowing coverage within the integrative medicine community. Many participants and observers seemed almost starry-eyed that the event itself actually occurred, and that so many leaders of the movement were invited to the mainstream table, at least for the weekend. The Institute of Medicine, which issues formal recommendations to guide national health policy is historically very conservative, and not exactly welcoming of “alternative” thinking.

To be sure, the gathering had tremendous symbolic significance, and it was wonderful to see many of the best minds and hearts of our movement together in one place. At the same time, some of us—this writer among them—felt a deep frustration that it has taken epidemics of largely preventable diseases and the near-bankruptcy of our nation’s medical systems, before the leading institutions and financiers of mainstream medicine would entertain the possibility of a serious dialog with people who think there’s more to healthcare than drugs and surgery.

Should we be pleased that discussions that should have happened 20 or 30 years ago are finally taking place? I suppose so.

But somehow my gratitude was diminished by a sense that until we really take a serious, impartial and untempered look at why the existing healthcare system behaves the way it does—until we study its matrix of incentives and disincentives, its flow of currency—we will continue to have polite but impotent dialogs about whether to call it “integrative” or “integrated” medicine, without making much real impact.

What the Future Holds

We’ll continue to convene and converse about “what if’s,” all the while kids will continue to be drugged for ADHD, young adults will continue to develop type 2 diabetes at ever-earlier ages, people will continue to die of preventable diseases, practitioners will continue to struggle to keep their practices alive, Big Food will continue to profit by selling nutritionally worthless, health-destroying crap, the drug and device companies will continue to profit from the ensuing diseases, and the insurers will continue to make book by processing the transactions.

Sen. Harkin and several other speakers very rightly pointed out that we cannot have truly meaningful healthcare reform without truly meaningful reforms in agriculture, energy production, education and environmental policy. Of course this doesn’t mean we should sit with our hands folded and wait. We need to get real about what’s driving the diseases crippling our nation. And we must be resourceful, intelligent and diligent in designing real solutions.

The Institute of Medicine has a beautiful central hall, adorned with beautiful gold-leaf paintings of astrological, mythological and alchemical images on its domed ceiling. I got to thinking that if the leaders of the Summit really wanted to understand the essence of holistic/integrative medicine, they should have gotten together after hours, laid down on the floor of the main hall, and pondered the visions on that stunning dome for a while. Hildreth Meiere’s paintings are all about the four elements, the mysteries of transformation, the cycles of the zodiac, the ever-turnings of the natural world.

“Ages and Cycles of Nature In Ceaseless Sequence Moving” says the dome’s central inscription. It was all there, literally hovering over our policy-pecked, data-driven little heads.

Editor’s Note: Holistic Primary Care is holding its first conference, called “Heal Thy Practice: Transforming Primary Care,” at the Westin La Paloma in Tucson, AZ, June 5-7, 2009. The conference will explore viable business models that support and sustain the practice of holistic medicine. For more information about Holistic Primary Care or the “Heal Thy Practice” conference, visit www.holisticprimarycare.net or E-mail erik@holisticprimarycare.net.