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THE THERAPEUTIC MOUNTAIN
âIâve taken my child to so many doctors, Iâve lost count,â Helen began. âThe pediatrician put him on antibiotics to prevent any more ear infections, but the medicines gave him diarrhea and a yeast infection. The chiropractor said that adjusting his neck would help, but I didnât think it helped much, and I didnât like all the X-rays. The naturopath recommended some herbs and vitamins, but my insurance wouldnât pay for them. None of these doctors thought the other ones did any good. They all seemed more interested in promoting their own particular therapy than in working with each other to help my child. Iâm frustrated and confused. How can the best, the safest, and most effective of all available treatments be combined for my child?â
Helenâs story from 1994 epitomizes many familiesâ complaints about the health care system. Back in the 1990s, my friend at Harvard, Dr. David Eisenberg, published research on the use of complementary and alternative medical (CAM) therapies in the prestigious New England Journal of Medicine and the Journal of the American Medical Association. His research showed that the percentage of Americans using CAM therapies increased from about 30 percent to over 40 percent in less than 10 years. And that was ignoring the use of prayer and multivitamins, which were used by a majority of Americans to improve health.
These publications grabbed the attention of leading academic medical centers, which started offering courses in CAM. A group of visionary philanthropists created the Bravewell Collaborative. The Collaborative funded leadership training and awards, education, clinical care, and research at major academic health centers, and then formed the Academic Consortium for Integrative Health and Medicine. By 2015, the Consortium boasted over 60 members across North America.
The Consortium collaborated with the International Society for Complementary Medicine Research to sponsor international research symposia from North America to Europe to Asia, building the groundwork for integrating complementary therapies into conventional settings internationally. There have been enormous growth and change in this field in the last twenty years.
Dr. John Astin published papers describing why CAM became so popular. He found that many people sought CAM care because it relied on values and worldviews that were more consistent with their personal beliefs than the disease-focused, high-tech, pharmaceutical industryâdominated world of modern medicine. These values include autonomy and interdependence, a respect for nature and the human capacity for health and healing, and a preference for humanistic, relationship-based care.
Dr. Wayne Jonas wrote about salutogenesis (the process of restoring health and well-being, which is the opposite of pathogenesis, the process of becoming sick) and optimal healing environments. He was appointed the first director of the National Institutes of Healthâs Office of Alternative Medicine, which is now the National Center for Complementary and Integrative Health.
In 2004, a small group of integrative pediatricians gathered in St. Paul, Minnesota, to discuss the future of pediatric integrative medicine. That meeting spawned a new Section on Integrative Medicine within the American Academy of Pediatrics, as well as an international online discussion group among pediatric professionals, a series of journal articles, a new textbook, and the emergence of residency and fellowship training programs in integrative pediatrics. The group, which included several next-generation pediatricians, met again in 2015, seeking input from diverse non-physician clinicians and thousands of parents to pave the way for the next ten years of pediatric integrative medicine.
Over the years, the many different kinds of health professionals who care for childrenâwhose backgrounds, theories, and therapies often differâhave advanced from hostility and competition to a greater emphasis on cooperation, teamwork, and patient-centered care. An increasing number of insurance companies cover therapies previously considered alternative, like acupuncture and massage. The U.S. Department of Defense created a program called Total Force Fitness, a care model for healthy warriors and their families. Today there are integrative pediatricians in every specialty, and the most common question is not, âDoes this work?â but rather, âHow do we get this paid for so our patients have access to it?â Integrative medicine has become mainstream.
Helenâs experience from the 1990s has become much less common in the twenty-first century, as leading medical institutions have adopted a more holistic, integrative care model, focusing on patient-centered care. Integrative, holistic care has simply become the best kind of health care!
WHAT DO WE MEAN BY HOLISTIC HEALTH CARE?
In 1948, the World Health Organization defined health as âa state of complete physical, mental, spiritual, and social well-being and not merely the absence of disease or infirmity.â Holistic care is based on this definition. It means caring for the whole personâbody, mind, and spirit in the context of family, culture, and community.
WHAT DO WE MEAN BY INTEGRATIVE HEALTH CARE?
Integrative care is holistic care based on a respectful relationship between patients and clinicians. It is informed by evidence, and uses all appropriate therapeutic approaches, health care professionals, and disciplines to achieve optimal health and healing. It is not simply combining complementary and alternative medicine with conventional medications to treat diseases. Instead, it emphasizes articulating and achieving health goals, in the context of respectful relationships, and a common approach to health built on healthy habits in a healthy habitat. The reliance on respectful relationships also suggests the vital role of clinician compassion and loving-kindnessâprofessionalsâ desire and behavior to relieve suffering and extend good will, not to make money or increase oneâs power over others or inflate oneâs ego, but simply to enrich the human community by serving others.
Ideally, both professionals and parents lay aside their personal concerns when faced with an ill child. The focus should be on the childâs and familyâs goals for wellness and healing. Health goals can be thought of in several ways.
WHAT ARE HEALTH GOALS?
In conventional medicine, health goals are typically divided into curing, preventing, managing, or rehabilitating from a disease or injury. Table 1.1 shows examples of these different health goals.
In conventional care, we define or diagnose a condition, and then dispense a treatment (often, but not always a medication) to cure, prevent, manage, or rehabilitate it. I refer to this as the âdiagnose and dispenseâ model of care.
When I began doing research on therapies like acupuncture, music, and Therapeutic Touch, I realized that many of these therapies were not aimed at a specific disease or condition, but on the whole person. When the whole person felt better, she was more resilient and able to recover from and resist a variety of conditions. Integrative care means choosing the therapy that best helps the patient achieve his or her goal. It can include both models of care, depending on the patientsâ goals and needs.
MODELS OF CARE
Conventional Care (Diagnose and Dispense)
Holistic Care
A person doesnât have to be sick to feel better after a massage, a loving dinner with family and friends, or a good nightâs sleep.
As I began writing Mental Health Naturally, I realized that there was a lot written on mental disorders like depression, but very little written on mental health and how to achieve health goals (as opposed to using antidepressant medications). So, I began asking my patients what their health goals were. This goal-oriented approach is most useful when considering an ongoing or chronic health situation.
Table 1.2 shows a few examples of common health goals.
An individualâs health goals can change over time and with life circumstances. Goals set a positive direction. When we consider our health goals, rather than just our diagnoses, we often think more creatively and effectively about the strategies we can use to achieve those goals.
For example, if we just focus on a diagnosis like depression, the first remedy most physicians consider is an antidepressant medication (based on the âdiagnose and dispenseâ model). But if we want to become more consistently cheerful, we may look at the literature on happiness and consider volunteering to help others; donating to a cause we believe in; caring for a pet ...