Crisis & Creation: Ten Years on the Road to Healthier Healthcare

The occasion of Holistic Primary Care’s 10th anniversary offers a special opportunity to look back on the trials and triumphs of the holistic medicine movement over the last decade. In it’s role as a chronicle of the field, HPC has had the privilege of highlighting the work of thousands of dedicated clinicians, researchers, and policy-makers engaged in the much-needed task of transforming American medicine. Some are working publicly and visibly on the national level, others are quietly reshaping health care in their own communities. Still others are behind the scenes, at academic centers and research institutions where new practitioners are trained and new ideas are explored.

All are committed to putting health back into health care, and we celebrate their continued efforts.

As part of our 10th year retrospective, we’ve asked members of this vital community to share their thoughts on the trends, achievements and setbacks that shaped the last decade in holistic medicine. They also share predictions on what’s to come in the next 10 years. We think you’ll find their insights as inspiring, provocative and transformative as holistic medicine itself!

No Longer a Voice in the Wilderness

Leo Galland, MD

There is the growing awareness within the broader medical community that what we have been saying for decades is true: that people with chronic illness need an integrated approach that includes nutrition, environmental management and mind-body therapies, and that sustainable health care must be based on lifestyle change, not drugs.

The growth of scientific research on nutritional supplements, from vitamins to phytochemicals, now allows them to be used with the same level of precision that has been claimed for pharmaceuticals. I've been particularly excited by the research on positive drug/supplement interactions: the many ways in which supplements diminish side effects or enhance efficacy of drugs.

Integrative medicine will continue to become more science-based, which will allow it to have more of an impact. When a mainstream journal like the Archives of Internal Medicine initiates a series called "Less Is More", which starts by warning against irresponsible overuse of acid suppressive drugs, and the Annals of Internal Medicine runs a study that demonstrates the failure of physicians to individualize treatment based upon patients’ personal characteristics, I don't feel like a voice crying out in the wilderness any more!

But while “personalized medicine” is receiving a great deal of lip service these days, no one with regulatory authority has any idea what it really means. Attempts to control the high cost of medicine are likely to increase depersonalization.

Leo Galland, MD, is an internist and practitioner of integrated medicine, with a special interest in digestive disorders and other “difficult to treat” chronic problems. He is director of the Foundation for Integrated Medicine (www.mdheal.org), a clinic and educational institution in New York City. He is the author of several popular health books, including “Power Healing,” and “The Fat Resistance Diet.” Dr. Galland was the 2000 recipient of the Institute for Functional Medicine’s Linus Pauling Award.

Functional Medicine Meets “Pharmageddon,”

Mark Hyman, MD

Over the last 10 years, we’ve been moving toward a truly integrated concept of how we can help people with chronic disease find a pathway that deals with underlying causes rather than just symptoms. Integrative physicians are shifting out of a peripheral role to a more central one.

You see this in things like the (patient centered) medical home (PCMH)…I don’t know if I’m a “believer,” but I think it is manifesting the need to reorganize health care and rethink how we follow and treat patients. Functional Medicine is a bridge. It uses Western biomedical language to explain whole-systems concepts, and provides an over-arching map for managing underlying causes and imbalances.

We’re at a watershed moment. For the first time, we’ll be able to look at whole systems approaches to chronic disease. Dean Ornish’s lifestyle program for reversing heart disease was just approved by Medicare. That’ll change reimbursement. When you change reimbursement, you change practice. Large corporations, the Veterans’ Administration, and some insurers are seeing that we can shift the way we do things. Big food service providers are looking at buying local, organic, healthy foods for institutions, schools and hospitals. There’s a sea change in thinking that’s going to move health care forward in a quantum way in the next 10 years.

The obstacle is, simply, the entrenched medical-industrial complex, that includes the food and drug industries. Right now, 30% of our economy is founded on making people fat and sick…and then treating them. But we’re entering an era of what I would call “Pharmaggedon.” Pharma companies are recognizing the end of the “blockbuster drug” era. They’re looking for other avenues to make revenue. There’s a need for new models to drive economic growth. When we move to an economy that supports creation of health and wellness, we’ll be able to move past the obstacles we currently see.

Mark Hyman, MD, is a board-certified family physician in Western Massachusetts. A widely respected teacher, he is founder of the popular UltraWellness programs (www.ultrawellness.com ), and author of New York Times bestsellers, “UltraPrevention” and “UltraWellness.” Dr. Hyman is on the board of directors of the Institute for Functional Medicine.

A Crash, Then a Boom

Decker Weiss, NMD

We are set for a crash followed by a boom, and both give me hope. As the collapse of the conventional medical economic system continues, more MDs are starting to learn from natural practitioners. This, in turn, will decrease the number of prescriptions written. The Catch-22 for the drug industry is that the wealthier, more educated populations with the top insurance plans (and drug coverage) are increasingly seeking natural options, while the poor, less educated crowd is lining up for $4 Wal-Mart generics. The term “brand new drug” used to mean “breakthrough” or “blockbuster.” Now it can mean “class action lawsuit.”

The deflation of new drug sales will reduce the direct and indirect subsidies that Big Pharma puts into medical schools, government lobbies, and doctors’ offices, which will lessen it’s overall influence on health care policy. This is, in effect the end of the old system, which I believe, will ultimately give rise to a rebirth of sanity in health care; people will become accountable for their own health and able to make real choices for their treatment. 

Of course, it is still true that the majority of Americans will choose subsidized medicine, even if it is less effective, sometimes life-threatening, or degenerative in its effects. But high insurance costs and rising deductibles have forced more Americans to find the most efficient system, which is the natural healing paradigm. It is an exciting time for natural practitioners as the playing field is leveling quickly. We, as natural healers, are ready. This is our time. We have stood up to bullying and manipulation for years, being called quacks and charlatans, only to watch those same people now going for massages, doing detox programs, or seeking hugs from their healers.

Decker Weiss, NMD, is a naturopathic physician/cardiologist, and founder-director of the Better Heart, Better Life clinic in Scottsdale, AZ. He is the first naturopathic physician to complete a residency in the Columbia Hospital System, and the first to serve on the staff of a conventional cardiovascular center, the Arizona Heart Hospital. He is Assistant Professor of Medicine at the Southwest College of Naturopathic Medicine, Tempe, AZ. 

Kicking Our Drug Habit

Grace Keenan, MD

As a nation, we are very dependent on prescription drugs, which is a major problem. The Western approach to medical training has become so prescription and procedure-oriented that doctors come into the field thinking their first response to every problem should be drugs or procedures, when there are clearly less costly, less aggressive options.

The overall demand from patients for the integrative approach, and the robust growth in the field over the past 10 years, is incredible. We need to continue to promote these less costly and preferable measures as strategies to be tried first, before using aggressive drugs and procedures. More conventionally trained providers need exposure to the integrative approach, because there still seems to be a lot of ignorance about the field. 

As a nation, we face a number of problems like obesity and diabetes, conditions that can be prevented and controlled with lifestyle and diet change. While we are taking small steps in the right direction, we need to be much more concerned about additives in processed foods, and to increase the amount of organic foods purchased. We have to focus on lowering trans fats found in processed foods. There needs to be a tremendous change of focus at the national level. 

Grace Keenan, MD, is founder and medical director of NOVA Medical Group (www.novamedgroup.com), a 4-site integrative group practice in Northern Virginia. Over the last decade, NOVA has emerged as one of the nation’s most successful integrative models, providing everything from urgent care and conventional primary care to guided fitness, naturopathic medicine, and medical spa services. Dr. Keenan is board certified in internal medicine and holistic medicine. She was chairwoman for HPC’s first Heal Thy Practice conference.

Leaving a Broken System Entirely

William “BJ” Lawson, MD

My primary concern is that control has gradually been shifted from physicians empowered and encouraged to take care of their patients, to centralized bureaucracies managed by large corporate interests that are not accountable and not particularly interested in advancing the doctor-patient relationship.

There are a lot of problems in American health care, and we desperately need reform. But the reform recently passed in Washington emphasizes the worst aspect of the existing system—reliance on 3rd party payers as middlemen to ration care and limit access and choice. This is the opposite of true health care freedom, patient choice, and physician empowerment.

However I’m very optimistic that, given the amount of oversight, heavy-handed enforcement and frank abuse physicians are now enduring, that more doctors-- especially in primary care--are discovering the power of contracting directly with patients. They’re simply leaving a broken system entirely.

When doctors realize that we can take back the care of our patients and give them the best possible care for less than the cost of their cell phone bills every month, we have an opportunity to eliminate tremendous waste and inefficiency, and focus on what really matters: health and well-being. While it’s challenging, we do have opportunities to fix the system, regardless of what’s happening at the legislative or corporate levels.  Doctors have a reputation for being risk-averse and wanting stability, but more are beginning to realize that continuing to play within the current system is not an option. The greatest risk is doing nothing.

William “BJ” Lawson, MD, is a physician and software engineer in Raleigh-Durham, NC. Following training in neurosurgery at Duke University, Dr. Lawson founded MercuryMD, a medical information systems company now owned by Thomson Reuters. An outspoken advocate for independent practice, small government, and libertarian principles, Dr. Lawson is running for US Congress as a Republican, on the core themes of Peace, Prosperity and Liberty (www.lawsonforcongress.com).  

Empowered Patients vs. Entrenched Interests

Bill Manahan, MD

The most significant development in this past decade is the emergence of a more informed consumer aided by high-speed Internet and Google. There has been a dramatic change, I believe, in just the past five years. Patients have become much more assertive about what they want and need. This is key, if we are to ever change the system.

The biggest challenges are the power and money of those in power—the pharmaceutical, insurance, and biomedical device companies, and the hospital-clinic industry. They do not want to give up any power or money, so the changes are difficult to implement. But ultimately, we are headed toward a more collaborative system characterized by a new respect for other modalities and healers beyond drugs and MDs, and better cooperation among all practitioners and patients.

Bill Manahan, MD, is the co-founder of the Wellness Center of Minnesota. He is a Past-President of the American Holistic Medical Association (www.holisticmedicine.org), and a founding member of the American Board of Integrative Holistic Medicine (www.holisticboard.org).  He is an Emeritus Professor of Family Medicine and Community Health at the University of Minnesota Medical School. 

Read more reflections on the last 10 years from thought leaders in the holistic health care field on HPC editor Erik Goldman's blog. And don't forget to add your own comments. Click here.