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Bridging the Gap: Integrative Medicine Meets Population Health

  Happy International Integrative Health Day !  Let's dive into a high-level solution for transforming healthcare by building our practices around population health and value-based care.

What is Integrative Medicine? Past History & Legacy


What is Integrative Medicine?


Where did Integrative Medicine in the US come from?
…A brief history
 
  • Forty years ago (’70s to ’80s) the Holistic Medicine movement saw a need for healthcare to address mind, body, and spirit with patient-clinician relationships rooted in compassionate care.
  • Thirty years ago (‘80s to ’90s) there was talk in the medical community of many patients using Alternative Medicine instead of standard treatments.
  • Twenty years ago (‘90s to ‘00s) the talk was about defining the newer term, Complementary and Alternative Medicine (CAM). The landmark Eisenberg JAMA study confirmed widespread US public use of alternative medicine for self-care.
  • Fifteen years ago (‘00s) the term Integrative Medicine rose to popularity, as medicine encompassing both holistic care and the appropriate use of evidence-based complementary therapies (alongside standard care). The term “Alternative Medicine” was considered antiquated in expert circles by the late 2000s. 
  • Five years ago (late 2014) the National Center for Complimentary & Alternative Medicine (NCCAM) was renamed the National Center for Complimentary & Integrative Health (NCCIH), reflecting the more widespread use of integrative approaches and complimentary treatments with focus on overall health. 
Integrative Medicine Legacy & History in the US

Holistic Medicine in the 20th century began with like-minded clinicians trying to find a better way to help chronically ill patients who were not getting better using conventional treatment methods. A example is Dr. Norm Shealy, a founder of what was once called The American Holistic Medical Association. A comprehensive holistic (mind, body, spirit) approach often involved exploring “alternative” therapies not widely studied or accepted by Western Medicine. 
Let’s not forget there are world medicine systems that have been delivering holistic care for thousands of years, such as Traditional Chinese Medicine and Ayurveda. Botanical medicine, spiritual practices, and home remedies were interwoven as healing arts into various cultures across time and geography.  
Perhaps, our 20th century society recognized something obvious was lacking in what was termed “Modern” or “Western” medicine? History has shown the actual interest in Alternative Medicine started with the general public, not the medical community. The movement essentially was consumer-driven at its core. Healthcare executives were forced to pay attention when they uncovered a multi-billion dollar industry. Medical scientists and clinicians were forced to pay attention when they discovered patients used treatments with little to no scientific evidence and tended not to disclose this at their medical visits. The term “Complimentary Medicine” was tagged on to characterize the use of unconventional therapies in combination with Western medicine, not in place of it.
A desire was sparked within the medical research community to rigorously study the safety and efficacy of these treatments by the accepted central tenet of modern medicine, the scientific method. The scientific method is brilliant but limited in its scope when dealing with therapies that often work by placebo effect in and of themselves. The methodology also faced challenges in developing “sham” or “control” groups for interventions like acupuncture. The US government funded the Office of Alternative Medicine at National Institutes of Health, which was later renamed NCCAM and, most recently, the NCCIH. The studies over the years have given the medical research community insight into best practices for studying non-pharmacological therapies, medical diets, and supplements (dietary, herbal, etc.). Studies have both proven and disproven the efficacy of certain CAM interventions. The knowledge of disproven and/or unsafe therapies continues to be important for patient consumers faced with disinformation from false product claims and “quacks” posing as medical experts. The focus on Complimentary & Integrative research further was strengthened by the call to find effective non-pharmacological treatments for chronic pain in light of the opioid epidemic of the 2010s. 
Along with emphasis on CAM research came education and training for medical professionals faced with a changing healthcare environment. A small number of medical schools starting teaching about CAM in the 1990s. The American Medical Student Association (AMSA) partnered with NCCAM in the early 2000s to fund leadership training for medical students to develop and implement education programs at their schools. By the late 2000s CAM/Integrative Medicine education (in some form or another) was present in the majority of medical schools.
Dr. Andrew Weil, MD was an integral figure in defining Integrative Medicine (IM) and envisioning what it could mean for the future of healthcare. He created the first IM fellowship at the University of Arizona in 1997, and the fellowship quickly grew from a small residential teaching fellowship to a large two year 1,000 hour distance learning program combined with in-person experiential weeks. Other academic medical centers created their own IM fellowships and programs. Following these events, the term IM began to replace CAM, as it was more inclusive of holistic healthcare. 
The American Holistic Medical Association (AHMA) created a board certification in Holistic Medicine in 1996. Eventually, it was renamed The American Board of Integrative Holistic Medicine (ABIHM) in 2008 and then discontinued altogether in 2014 when Integrative Medicine became a recognized specialty by the American Board of Physician Specialties. The AHMA and ABIHM became the Academy for Integrative Health & Medicine (AHIM) in 2014. 
Both academic and privately owned healthcare organizations launched IM centers and service lines. High-profile academic IM institutions convened in 1999 for "The Consortium on Integrative Medicine" which grew to become what in now the Academic Consortium for Integrative Medicine and Health.   This included well-respected institutions, such as Harvard University, who had established their own IM medical services. This vision for preeminent academic IM was largely achieved via funding from philanthropic organizations, such as the Osher and Bravewell collaboratives and the Samueli Foundation. For this reason, the most well-known IM practices are in academic medical centers, combining research, clinical care, and teaching. There has been and remains issues with insurance reimbursement and accessibility of these services to the patient population as a whole. 
IM continues to evolve with new questions about the current state of it’s role in healthcare and it’s future viability. This article series will include past, present, and future perspectives on Integrative Medicine. Stayed tuned for upcoming articles in the series!
© 2020 Danielle Zelnik, MD. 

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