In 1972 President Richard Nixon traveled to the People’s Republic of China to initiate detente and successfully changed the course of the Cold War. In advance of this visit, American journalist James Reston also visited China and, while there, had appendicitis. His postoperative pain was successfully treated with acupuncture. The article he wrote for The New York Times describing his experience triggered another sea change, this one in health care. The American Holistic Medical Association was formed that decade. By 1990 the National Institutes of Health formed the Office of Complementary and Alternative Medicine, and in 1998 expanded funding to form the Center for Complementary and Alternative Medicine.
Integrative medicine is the medical specialty that evolved from these early roots. The field strives to bring together the best of modern medicine and traditional healing arts combined with a culturally sensitive, whole-patient approach. The Hawaii Consortium for Integrative Healthcare was formed in 1999 to facilitate research, education and clinical models in the field. Over the years, its membership has included hospitals, insurance companies, professional associations, government organizations and the academic sector. The Academic Consortium for Integrative Medicine, a national organization formed in 2001, now has a membership of 55 medical schools.
The Accountable Care Act, the centerpiece of health care reform, was designed to provide care to millions of Americans who are without adequate health insurance. It was also created to improve the quality of care. Critical to the success of health care reform is that costs come under control.
Integrative medicine is well suited to make a profound contribution to this process.
Cost efficiency and quality care depend on a collaborative team-based approach, the foundation of integrative medicine. Conventional medicine historically centers care on the physician. However, this has proved to be costly and inefficient. Physician education focuses on understanding mechanisms of disease, diagnosis and treatment. Doctors are generally ill equipped to handle administration, process change or work flow redesign. Physicians are also the most expensive members of the care team.
The strongest care team might include nurse practitioners, physician’s assistants, mental health providers, acupuncturists and nutritionists. The broader team is well equipped to offer patient education, preventive care, health promotion and wellness. Integrative medicine focuses on diet, lifestyle, adequate physical activity and psychosocial well-being.
Collaborative integrative care teams can also offer centers of excellence for chronic disease such as obesity, diabetes, pain and for end-of-life care.
Integrative medicine is not only about who is on the care team, but also how the team works together. Effective multidisciplinary care requires active communication, conducive work flows and a passionate team spirit that is supported over time.
The sea change in health care today is unprecedented and of even greater impact than the creation of Medicare in 1965 or the implementation of managed care in the ’80s. During the 40 years since Reston described his experience with acupuncture in The New York Times, integrative medicine has evolved and matured. It may now make its most profound impact yet on American health care.
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Ira Zunin, M.D., M.P.H., M.B.A., is medical director of Manakai o Malama Integrative Healthcare Group and Rehabilitation Center and CEO of Global Advisory Services Inc. Please submit your questions to info@manakaiomalama.com.
