Ten Years After: Reflecting on Holistic Primary Care’s First Decade


hpc10yrvictorWe started this publication 10 years ago with a simple “mission:” to provide lively, balanced coverage of the emerging field of holistic or “alternative” medicine as it converges with mainstream practice. The basic premise was that physicians --and their patients--would benefit from a better understanding of the principles and practices of holistic medicine.

The need seemed obvious enough: the fragmentation and hyper-specialization of health care was escalating costs yet doing little to stem the tide of chronic diseases crippling and bankrupting the country. Millions of Americans were experimenting with alternative approaches about which their physicians knew little. Healing disciplines long marginalized by mainstream medicine--naturopathy, homeopathy, midwifery, nutrition counseling, traditional Chinese medicine, Ayurveda and others—were asserting their worth, bolstered by growing public interest.

With Holistic Primary Care, we hoped to build an information bridge between the medical mainstream and these holistic disciplines in the interest of fostering interdisciplinary collaboration and, ultimately, a more health-centric approach to health care.

An Upward Look

Over the years, many have asked why we chose the word “holistic,” with it’s ‘touchy-feely’ ‘60s connotation, rather than a newly minted, emotionally-neutral term like “integrative” or “complementary.” The answer is pretty simple: ideas like “integrative” and “CAM,” are about politics and economics, and the existing health care system’s struggle to come to terms with disciplines formerly outside it’s purview. They say nothing descriptive about those healing disciplines themselves.

On the other hand, “holistic,” derived from the Greek “holos,” actually points to an ideal, a way of seeing characteristic of the healing arts that evolved outside the walls of conventional drug-based medicine. It is a mode of perception that views an individual entity, be it a cell, an organ, a human being or a nation in the context of the larger systems of which it is a part. It implies an upward look along a vertical scale, from constituent part to larger system.

The antithesis of “holistic” is not---as many believe--“allopathic” or “Western”; it is “reductionistic.” The reductionistic mode of perception tries to understand any entity in terms of its constituent parts. The holistic mode tries to understand how any entity functions as a constituent part of a larger system.

In reality, for a sane mind and a sane world, we need both.

The problem is that allopathy, with it’s tendency to seek explanations by drilling downward from people to organs to cells to genomes, and it’s economic imperatives to patent “specific” therapies with “discrete” effects, became wholly wedded to reductionistic ways of seeing. Other views of health and illness—and the therapeutic options to which they lead---were excluded.

Imagine a young child who takes apart a radio, and then, encouraged by the glowing smiles of proud parents, he takes apart the parts. And nobody tells him that ultimately he needs to put it all back together. The results of our collective imbalance toward reductionistic ways of interacting with life, our unwillingness to recognize interconnections, are everywhere to be seen.

What Have We Become?

In so many ways, the world was a different place in October 2000, when the first issue of HPC rolled off the presses. Bill Clinton was still president, the federal government had a budget surplus, the Dow Jones Industrial Average was just under 12,000 points and on it’s way up to its ultimate crest of over 14,000. National unemployment was 4%--less than half of what it is today. The price of a postage stamp was 33 cents; the average cost for a gallon of regular gas was just over $1.50.

In the year 2000, most of us didn’t know what a gigabyte was. The iPod was still a year in the offing. Dell was busy putting low-cost PC’s in the hands of a whole generation, and rumors abounded that a failure to account for “Y2K” in our computers’ operating systems was going to crash our brave new cyber world.

In the year 2000, you could still show up at the airport 20 minutes before your flight and check in at the gate, and you didn’t have to take your shoes off. The worst act of terror most Americans could recall was the 1995 Oklahoma City office bombing, or arguably, the Columbine High School shootings.

In the Fall of 2000, there were still two glittering 110-story towers standing at the southernmost tip of Manhattan island, seven blocks from HPC’s “headquarters.”

Flash forward 10 years, through the millennium madness of hanging chads and swift boats, hybrid automobiles and International Space Stations, Medicare Part D donut holes, iPhones, YouTube, Myspace, Gameboys, Playstations, Napster, Enron, Freddie & Fannie, Ashcroft & Rummy, Monica & Kenny. Wizz past all the default settings and default credit swaps, Homeland Security, Shock & Awe, the toppling of Saddam Hussein, the ascendancy of Barack Hussein, Viagra, Vioxx & Vitamin D, anthrax, West Nile and Bird Flu, Katrina, Deepwater Horizon, right on through all the patriot acts, the hopeful audacities and inconvenient truths, past Scooter, Sarah, Tiger, A-Rod, J-Lo, Miley, Eminem, GaGa, Google, and GoDaddy.

What have we become?

A nation of corporations too big to fail, and working people to small to matter---despite their vast numbers or growing median girth. A country of Supersized me’s with high-speed DSL & low-interest mortgages. A land of over-fished waters & underfunded schools where the three ‘Rs are now Readin’, Ritin', and Ritalin. A high tech, lo-cal, aspartame-addled nation that can send robot probes to Mars and decode the human genome but can’t---make that, won’t---come up with a viable alternative to fossil fuels.

We’re a nation with a two-front war that’s blundered on for more than 9 years----more than twice as long as WWII---with no clear goal, no obvious progress, and no exit strategy. Somehow, though, the costs of war never figure as “government spending” when pundits howl for small government and big tax breaks.

We’re a land of caloric excesses and attention deficits, where FaceBook is the only book some kids read, and the “blackberries” they know do not contain antioxidants. A place of SAD diets comprised of HappyMeals. A country where some Madoff like bandits, while others discovered that while wealth occasionally trickles down, woe reliably comes in waves—tidal waves. Sure, we had problems 10 years ago, but they Palin comparison with what’s happening now.

As a nation seemingly obsessed with youth and health, how is it that one in three Americans is obese and at least one in four kids under 10 is on at least 1 prescription drug? How is it that in a country spending $2.5 trillion a year on health care, one out of every two adults has at least one chronic disease and our basic national health stats rank us 50th among nations?

How is it that potentially preventable diseases account for 7 out of every 10 American deaths? Why are prevention-focused primary care doctors struggling to keep their clinics open despite the fact that, according to a recent CDC report, two-thirds of all adults believe our health care systems should emphasize preventive care?

The answer to this is also quite simple. As Dr. Mark Hyman points out in our 10 year retrospective (see Crisis & Creation: Ten Years On the Road to Healthier Healthcare), nearly one-third of our economy is based on making people overweight and ill, and then treating them for the resulting problems. To quote a wise attendee at a health care policy meeting several years back, “All that excess spending everyone is talking about is somebody’s profit.”

The Wolves in the Henhouse

Despite the health care crisis, despite the fact that millions of Americans have lost their jobs and health care benefits in the last 2 years, Aetna—one of the nation's four biggest health insurers--reported that its second-quarter profits rose 42% since the same time last year. The percentage of premium dollars Aetna spent on medical care fell substantially. And Aetna’s not alone.

Numbers like that stoke the ire of patients and physicians alike. The American Medical Association, it’s own questionable virtue aside, rightly points out that 94% of the country's insurance markets are "highly concentrated," ie, near-monopolies, according to Justice Department guidelines. This leads to roiling costs to patients and purchasers, and fat profits for insurers. Average premiums rose more than 87%, from 2000-2007. Profits at ten of the largest publicly traded health plans more than quadrupled in that period.

Insurance leaders say their industry is being unfairly maligned. They contend that on average, health plans turn very modest yearly profits in the range of 3-6%--a pittance compared to Exxon’s average margin of around 9%, Johnson & Johnson’s 21%, and Wal-Mart’s whopping 25% (thanks to Robert Glen Fogarty at the Destiny in Technology blog (www.lockergnome.com/swordofdestiny) for the number-crunching).

According to a 2009 report by WellPoint, an independent licensee of Blue Cross Blue Shield plans, 87 cents of every premium dollar paid into health care plans, “is spent on providing medical services to members: physician services, hospital costs (inpatient and outpatient costs), drugs and other medical services…and only 3% represents insurers’ profits.”

WellPoint goes on to argue that 33 cents of every premium dollar goes to physicians, with 20 cents going to inpatient care, while only 3 cents goes to the insurers’ profit line. Sounds like finger-pointing to me, and if it was true, how  come none of my doctor friends are getting rich?

The hidden factor, of course, is that the health plans’ posted profit margins are calculated after payroll, expenses, and operating costs. Given what the industry’s CEOs see fit to pay themselves, that payroll line item is pretty big. According to a 2009 report on FierceHealthcare (www.fiercehealthcare.com), a news site for health care executives, Aetna’s Ron Williams took home a cool $24.3 million in 2008. CIGNA’s H. Edward Hanaway earned $12.2 million, and WellPoint’s Angela Bray earned $9.8 million. None of that’s counting stock options, private company jets, and other perks.

Down at the bottom of the heap was UnitedHealth Group’s Stephen Hemsley, who brought home a mere $3.2 million in 2008. Of course, that was AFTER his company was forced to settle an $895 million Securities and Exchange Commission lawsuit brought against UHG executives for back-dating their company’s stock options to their own advantage.

The industry feeds its attack dogs pretty well, too. The Washington Post reported that Karen Ignagni, CEO of America's Health Insurance Plans (AHIP), the industry’s DC-based trade association, earned a total of $1.58 million in 2007, the last year for which data are on file. This includes $700,000 in base salary, $370,000 in deferred compensation and a bonus. According to the National Journal’s “Under the Influence” website (www.undertheinfluence.nationaljournal.com), six of the largest health insurers, all members of AHIP, quietly ante’d up between $10 and $20 million last summer to kill the “public option” and otherwise obstruct the original Obama Administration reform proposal. The money was solicited by AHIP.

The Power of Our Purchases

Now, I don’t believe for a minute that if you stripped the top brass of their gold and dumped it back into the common pot it would substantially change life and health on the ground for many people. The point, though, is that the insurance and drug industries are carefully l calibrated to do just what they do: generate massive rewards for those in executive positions, and nice steady returns for share-holders. Everything else they do---pay doctors and hospitals, cover health services, discover and disseminate new therapies—is simply the means.

None of that will change substantially under the health care reform plan. With its stated goal of providing insurance coverage—which is not necessarily synonymous with health care---for all, and its mandate that all Americans must purchase insurance (or have it purchased for them), the plan basically amounts to putting more hens in the hen-house; don’t expect it to do much to control the wolves.

That’s life in the corporate capitalist fast-lane, and I’m not going to debate the morality of it. What’s hard to understand is why so many Americans who profess to hate bureaucratic red tape, egregious spending, and restriction of choice were so quick to defend a form of corporate socialism and for-profit bureaucracy just because someone cleverly calls it “private,” instead of “public.”

When was the last time anybody got to vote on what’s covered by their insurance? Is it really better to have a corporate bureaucrat decide what you can and can’t have instead of a federally-employed one?

Rage & Renewal

The pubic outrage manifesting as the Tea Party Patriot movement is understandable. But it is seriously misdirected. If the patriot crowd is serious about health and health care, they’d make a much stronger statement by organizing a “ Say No to Fast Food” week, or a March on Washington to demand an end to federally subsidized corn syrup. But that’s not nearly as much fun as brandishing guns, shouting about “death panels,” and calling the President a communist.

As Dr. Mary Jo Kreitzer, of the University of Minnesota’s Center for Spirituality & Healing stated so beautifully at the 2010 Integrative Health Care Symposium, what the country really needs is “Green Tea Parties.” And you know what? They’re already happening.

Despite all the ways it has been coopted and corrupted, capitalism works both ways. The sellers sell what they sell because the buyers are buying it. Everything we purchase is a vote on our values. And as difficult, dangerous and depressing as this last decade has been, it was also marked by many hopeful signs that people are buying into new, more humane and healthier systems.

I see it in the rapid growth of the organic food movements; the marketability of the Prius; the stellar growth of the natural products industry; the evolution of socially conscious “triple bottom line” investment funds; the patient advocacy groups and empowered parents networks learning all they can about health; the wider availability of eco-friendly building materials, clothing and cleaning products; the locovore, slow food, and raw food trends.

It’s proudly on display in the rapid rise of non-insurance based, direct-pay primary care models (see Despite Recession, Concierge Practices Show Brisk Growth, Excellent Outcomes); the gradual but steady integration of holistic therapies into conventional clinics and mainstream medical training; the continued evolution of naturopathy, chiropractic, health coaching and other holistic disciplines.

It’s in the rising demand for fair-trade, sustainably harvested foods, and the spectacular growth of “speciality” food lines catering to people with gluten sensitivity and other common allergies.

Doctors in Massachusetts are now sending patients from poor communities into local farmer’s markets with “prescriptions” (and coupons) for fresh produce. The website for Triscuit crackers has a “Home Farming” section all about rooftop vegetable patches and backyard crops (www.kraftbrands.com/homefarming). Organic Valley (www.organicvalley.coop) a coop founded by seven organic farmers in 1988, and still farmer-owned, now has organic dairy and juice products in tens of thousands of grocery stores creating livelihood for thousands of independent farm families.

For those seeking healthier ways of life, there have never been more options. Is there any sizeable community in this country without a yoga studio or health food store? Is there anyone who doesn’t have at least one vegetarian friend?

All of these trends reflect a thriving impulse toward health and holistic thinking that’s being stoked by the billions of daily values-based purchases made by millions of people who are tired of the way things have been and willing to seek---and sometimes create—something better. Let us celebrate, nurture and protect that impulse. It may be our last best hope!