There are countless opinions regarding how to improve health care in the United States, but many experts agree on one fact: “Our current health-care system is mainly a sick-care system,” says Adam Perlman, executive director of the Institute for Complementary and Alternative Medicine at the University of Medicine & Dentistry of New Jersey. In the past, Western medical schools did not emphasize teaching lifestyle changes to keep patients healthy; instead they focused on treating patients once they were ill. “The old thinking was, You’re broken—now we’ll fix you,” says Kevin Barrows, clinical director of the Osher Center for Integrative Medicine at the University of California School of Medicine, San Francisco. But things are changing.
What Is Integrative Medicine (IM)?
This practice combines conventional Western medicine with nontraditional practices—including acupuncture, herbal treatments, massage, mind-body approaches, nutrition, and stress management—to keep patients in good health. And though its advocates are growing (according to the 2007 National Health Interview Survey, 42.8 percent of women, 33.5 percent of men, and nearly 12 percent of children under the age of 18 had used some kind of complementary and alternative medicine), integrative medicine by no means abandons its conventional counterpart.
"Western medicine has many strengths and has made incredible advances," says Victoria Maizes, executive director of the Arizona Center for Integrative Medicine, in Tucson, and a family- and integrative-medicine specialist. "People used to die of infections, and now we have antibiotics. They used to die of heart disease, and now we have bypass surgery." An integrative doctor—whether a primary-care physician, an ob-gyn, or an oncologist—enlists Western approaches when appropriate and then complements them with other treatments. An IM doctor won’t go as far as taking a picture of your aura, but don’t be surprised if she supplements your medical prescription with one for a daily walk around the neighborhood. Similarly, a cancer patient receiving chemotherapy might also be getting acupuncture, doing yoga, and practicing meditation for stress reduction.
A few important distinctions: An IM doctor is not the same as an osteopathic or naturopathic doctor, although all three share similarities. A doctor of osteopathic medicine (or DO) gets conventional medical training but with additional instruction on the structure of the body in relation to how it functions; treatment protocol may involve physical manipulation of your body with his hands to diagnose injury or illness and help the body function efficiently. A naturopathic doctor (or ND) gets Western-style medical training but also learns about botanicals, nutrition, and Eastern therapies. "It’s a bit of ‘buyer, beware’ for this specialty," says Tracy Gaudet, executive director of Duke Integrative Medicine, in Durham, North Carolina. "There are quality, accredited programs for naturopathic medicine, but people can also get an online degree and call themselves an ND with very little education."
What Can I Expect From a Visit With an IM Doctor?
The first thing you’ll notice is how long you’re in the office—not in the waiting room reading magazines but actually meeting with your physician. "I spend an hour and a half with a new patient," says Maizes. After discussing your medical history, diet, and what medications and supplements you’re taking, an IM doctor also throws out some lifestyle-related questions. For example, Barrows asks whether patients were raised in a particular religious tradition to determine "whether they have a source of strength and inspiration they turn to in challenging times." He also discusses how connected they are to family, friends, and their community and asks about hobbies. "We place a great deal of emphasis on enhancing the quality of interaction between patient and practitioner," says Barrows. "And that in itself is therapeutic."
Depending on the type of integrative physician you’re seeing, you’ll get many of the same tests that a traditional doctor performs, including a cholesterol screening, a Pap smear, a physical exam, and blood work. The main difference is what the doctor "prescribes" for a chronic condition or for maintaining health. "We spend a lot of time trying to figure out the underlying causes," says Tanya Edwards, medical director of the Center for Integrative Medicine at the Cleveland Clinic Wellness Institute. Instead of giving a patient who comes in complaining of fatigue, insomnia, constipation, and headache prescriptions to treat each symptom, an IM doctor might recognize that the patient has signs of a magnesium deficiency and then prescribe a supplement.
The IM approach also includes ongoing support for incorporating changes into your life. Many doctors are available by e-mail. And Duke Integrative Medicine is launching professional training in integrative-health coaching. "It’s like a life coach, but for your health," says Gaudet.
What Complementary Treatments Can I Expect My IM Doctor to Suggest?
Nutritional counseling and physical activity are two often employed—and powerful—tools. Indeed, the largest diabetes-prevention trial, completed in 2001, found that lifestyle intervention, including diet, exercise, and behavior modification, reduced by nearly 60 percent the chances of developing type 2 diabetes in those at high risk. In comparison, drug therapy (with Metformin) produced only a 31 percent reduction.
Acupuncture is also widely used for a variety of conditions, including nausea (from chemotherapy or pregnancy), infertility, fibromyalgia pain, arthritis, PMS, and menopausal symptoms. It has the backing of many randomized, controlled trials, and "the National Institutes of Health concluded that there is promising evidence for using acupuncture in specific conditions," says Gaudet. Herbal medicines, a counterpart to acupuncture in Chinese medicine, have less scientific backing but much practical evidence. (Note: Because herbs are so effective, don’t self-prescribe them. "You need to be guided by a doctor who is well trained in integrative medicine," warns Gaudet. Otherwise you risk bad drug interactions, and serious medical complications can arise.)
Mind-body therapies, such as meditation, relaxation techniques, yoga, and hypnosis, also show promise. "There have been studies on meditation that show, regardless of condition, many people get a reduction in anxiety and depression from it," says Barrows. Support for the efficacy of hypnosis is growing, too. "There is evidence that using it before surgery can decrease the need for more anesthesia," says Gaudet.
How Can I Get an IM-Like Experience With My Current Doctor?
Many mainstream doctors are already adopting some IM practices, particularly the ones that have hard science backing them. "It’s not that we’re not open to IM," says Jacques Saunders, a family physician outside of Baton Rouge, Louisiana. "It’s just that traditional doctors were trained in a more cautious atmosphere. Western therapies are more widely studied."
To integrate some IM into your own life, "be your own advocate," says Roberta Lee, vice chair of the department of integrative medicine at Beth Israel Medical Center, in New York City. First educate yourself by reading up. Lee recommends Eight Weeks to Optimum Health, by Andrew Weil, a top integrative doctor in the United States, and doing research on credible websites (such as nccam.nih.gov, the site of the National Center for Complementary and Alternative Medicine). Then talk to your doctor. If you have back pain, ask her if she thinks acupuncture might help. Chances are, if you have a doctor you love, she is someone who listens to you, is open-minded, and doesn’t automatically rule out complementary treatments. "Give her the opportunity to research with you and be involved," says Lee.
Does IM Cost More?
It’s true that in many cases complementary treatments are not at present covered by insurance. But if you see an integrative doctor who is also a primary-care physician, office visits and medical testing may be covered, and other therapies may fall under your insurance. "Don’t just assume it’s not covered," says Maizes. "There’s tremendous variation by state and insurance company, so it’s worth checking." And even treatments that aren’t covered may qualify for reimbursement under the rules of your company’s limited health-care flexible-spending account.
So Is IM the Future of Medicine?
Integrative doctors hope so. In fact, they hope to lose the "integrative medicine" label altogether. As more doctors emerge from medical-school programs that incorporate integrative training, and existing doctors learn from patients and research, Maizes says, "I think IM will lose its separateness and just become the medicine we practice." When you walk into many high-tech fertility clinics or cancer centers and see brochures for acupuncturists, massage therapists, and yoga teachers, that’s a sign of just how close this is to reality.
To find a qualified integrative physician in your area, visit the website of the Consortium of Academic Health Centers for Integrative Medicine (imconsortium.org). This organization has a state-by-state directory of integrative health centers; many list their doctors, too.