Kelly McGonigal's Articles on Lion's Roar

It’s caring, it’s cost-effective, and it works. Is integrative medicine the future of health care? A report by Kelly McGonigal, PhD. In 1998, Jeffrey Brantley, MD, was knocking on colleagues’ doors, trying to raise the visibility of a new project. He had just launched a Mindfulness-Based Stress Reduction program at Duke University Health System, the beginnings of what would become Duke Integrative Medicine. He laughs when he tells the story of the reception he got from some physicians. One prominent gastroenterologist eagerly agreed with Brantley about the importance of the mind–body connection, and described the role of stress in many of the cases he saw every day. “Let me show you something,” he told Brantley, pulling a book on holistic healing out of a filing cabinet. “I have to hide this book, because if my colleagues saw it, they’d think I was crazy.” More than a decade later, fewer physicians feel the need to hide in the mind–body closet, and more medical centers around the country are embracing a holistic approach. Last year, more than six hundred health care professionals packed a standing-room only Summit on Integrative Medicine, held at the Institute of Medicine in Washington, DC. The first of its kind, the summit brought together a range of experts to explore the practice of integrative medicine, its scientific basis, and its economic and policy implications. To many, integrative medicine has become the one bright spot in a struggling health care system. It promises to control costs, prevent or reverse many chronic conditions, improve quality of life, and even return the idea of “health” to what is better described as a disease care system. But integrative medicine faces many challenges. Some conventional Western health care providers criticize integrative medicine for bringing what they view as unsupported and unscientific therapies into an evidence-based field. Others worry that its comprehensive approach to health and healing, while ideal, is too expensive to implement on a large scale. But the leaders in this emerging field are ready to tackle those challenges and prove that the U.S. is ready for a new kind of medicine. What is Integrative Medicine Integrating? The words “integrative medicine” may bring to mind holistic approaches such as acupuncture, massage therapy, and stress reduction. Although these can be important parts of an integrative approach, the field does more than merely integrate alternative and conventional medicine. The Consortium of Academic Health Centers for Integrative Medicine defines integrative medicine as “the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, health care professionals, and disciplines to achieve optimal health and healing.” Key to this definition is integrative medicine’s embrace of any therapy that supports health and healing, regardless of its origins. Treatment for cancer, for instance, might include everything from surgery and chemotherapy to diet, spiritual counseling, and yoga. Integrative medicine also strives to integrate every aspect of the health care system, from self-care and primary care to urgent care and hospital care. This requires a level of communication and cooperation rare in modern health care. Integrative medicine also acknowledges the many resources a patient has outside of the medical system, including the body’s innate capacity for healing, the support of family and friends, cultural or religious beliefs, and the ability to find meaning within illness and suffering. Finally, integrative medicine reflects a return to a core value of medicine—the power of the therapeutic relationship. This is easily overlooked in the modern, technology-driven culture of health care, but in integrative medicine, the time spent and the trust built between caregiver and patient is considered the foundation of effective health care. Health Is More Than the Absence of Disease. Health, says Christiane Northrup, MD, is a vibrant thriving that includes pleasure, joy, and meaning. It is not simply the absence of disease. Northrup is a leading advocate for women’s health and the winner of the 2010 Integrative Health Care Visionary Award. Part of Northrup’s vision is a world in which every individual recognizes his or her own capacity to create health. “True health care,” she says, “is often not found in hospitals—that is disease care,” she says. “They have a role, but your role in your own health is far more potent than hospitals, doctors, and insurance companies.” Northrup says that even what medicine calls “health promotion” is usually just disease screening. “At a health fair, you can have your blood pressure taken, your cholesterol measured, and get a mammogram.” These tests can detect a problem, but they do little to create health, and by spending so much time and energy searching for what is wrong with the body, we miss opportunities to care for the body, mind, and spirit. Northrup recommends broadening our view of health care to include the things that create health and joy on a daily basis, whether it’s dancing the tango, reading a good book, or spending fifteen minutes a day in natural sunlight. “Begin to think about your health care as a program that you are in control of,” she says. “It includes your thoughts and beliefs and the people you spend time with. It includes turning off the news and getting massages regularly. Just being present with another human, being present in the moment, ramps up your circuitry of health.” Moreover, Northrup says, true health care is possible even in the presence of pain, grief, or illness. Illness can provide the catalyst for learning how to be with yourself in a compassionate way, and focus your attention and energy on what matters most. “When you move toward that which is most fulfilling, pleasurable, and life-enhancing, healing follows, regardless of what your physical health is like in that moment.” A New Kind of Medical Practice. What if a visit to the doctor left you feeling replenished, rejuvenated, and motivated to make changes in your life? What if you belonged to a health care practice that understood every aspect of your well-being—physical, emotional, and spiritual? That’s the invitation on the website of Duke Integrative Medicine, part of Duke University’s world-class medical system. This promise of integrated care draws more than five thousand patients to the Duke center each year. They come for help with chronic conditions such as high blood pressure, cardiovascular disease, and diabetes, or to seek a holistic approach to cancer recovery or pain management. Some come simply to invest in themselves and their health. A visit to the center is called a “health immersion,” and patients can choose to spend half a day, a full day, or a week at the center. For local patients, the center offers a flat-fee annual membership that provides unlimited consultation with an integrative physician, ongoing personal support, gym membership, cooking classes, stress reduction programs, and more. Whatever the health challenge or goal, and no matter how short the visit, every patient at Duke Integrative Medicine has their own core team of health care providers, including a physician, nurse, and health coach, who will help the patient select the services and specialists that meet their needs. The patient’s health immersion begins with an intake that might last ninety minutes and assesses all areas of the patient’s life. The patient then has a series of appointments with other specialists, such as a nutritionist or a health psychologist, and receives complementary therapies like massage, acupuncture, or reiki. Every patient is also introduced to the concept of mindfulness and the body–mind relationship. “Mindfulness is at the core of everything we do,” Brantley says. “We believe that the more mindful people can be as they face health challenges, the healthier they will be.” The center also offers mindfulness-based stress reduction classes to health care professionals, and all of their care providers and health coaches are trained to bring mindfulness into their interactions with patients. Before the end of the immersion, the full team of core and complementary care providers meets to chart a plan individually tailored for the patient. The patient walks away not only with a list of recommendations for supporting his or her own health, but with established relationships with a team of health professionals. Health coaches follow up with patients by phone on a monthly basis to support their progress. “It’s not just about experts giving information and advice,” Brantley says. “The power of the individual to shape the trajectory of their own health is one of the main principles at Duke. It’s a core shift in paradigm. We partner with patients to help them be the single most important element in their own health and healing.” Can We Afford It? Ford Says Yes. Programs like Duke Integrative Medicine are incredibly appealing—who wouldn’t prefer a dedicated team of medical professionals, and a full spectrum of complementary care, instead of a ten-minute rushed appointment with an overworked physician that ends with a single prescription and a lot of unanswered questions? But in debates about the practicality of integrative medicine, one question always comes up: Is integrative medicine—which requires more time, more health care providers, and a broader scope of services—financially feasible in a health care system that is straining to contain costs? Kenneth Pelletier, MD, is on a mission to answer that question. As director of the University of Arizona’s Corporate Health Improvement Program (CHIP), Pelletier helps companies evaluate and implement a range of integrative health interventions in the workplace. The CHIP program is designed to address two of the most...

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