The Definition of Integrative Medicine

Integrative medicine or integrative health is a relatively new term and used in various ways by various people. Some use the term in a very limited way to describe a new and different approach to a clinical condition that in fact has nothing to do with integrating anything. Others use the term to mean complementary and alternative (CAM) services, and nothing more.

At the Marino Center, we believe that integrative medicine has a much deeper and comprehensive meaning that is in concert with the definitions promulgated by the Bravewell Collaborative, The Consortium of Academic Health Centers for Integrative Medicine, and the National Institutes of Health – National Center for Complementary and Alternative Medicine (NCCAM). These definitions are presented below:

Bravewell Collaborative:

Integrative Medicine has the following characteristics:

1. Patient-centered care and focuses on healing the whole peson – mind, body, and spirit in the context of community;
2. Educates and empowers people to be active participants in their own care, and to take responsibility for their health and wellness;
3. Integrates the best of Western scientific medicine with a broader understanding of nature of illness, healing, and wellness;
4. Makes use of all appropriate therapeutic approaches and evidence-based global medical modalities to achieve optimal health and healing;
5. Encourages partnerships between the provider and patient, supports the individualization of care; and
6. Creates a culture of wellness.

The Consortium of Academic Health Centers for Integrative Medicine:

"Integrative medicine is 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."

National Institutes of Health – National Center of Complementary and Alternative Medicine:

"Integrative medicine combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness."

Regardless of how integrative medicine is defined and delivered, the true test of its value is how it effects the health status of patients (quality) and the impact on the consumption of health care resources (cost). If it improves the health and well being of patients and uses resources economically, it’s a winner! The Marino Center is committed to finding out the answer to the quality and cost questions and to be a leader in the health care reform movement.

Health Care Reform and the Yin and Yang of Health Care

A health care reform plan is being crafted in Washington that would require all Americans to carry health insurance and would help families making less than $88,000 pay the premiums. Employers would also have to pay into the system. President Barack Obama said the final legislation must:

Rein in costs
Guarantee choice of health plans and medical providers
Ensure that all Americans have access to affordable coverage

Accomplishing the choice and access to affordable coverage is relatively easy compared to reining in costs. Legislating provisions of public and private health plans to guarantee choice and eliminating discriminatory practice that exclude certain individuals, and providing government subsidies are all very doable . But the cost part is much trickier and here is where the Yin and Yang of health care takes over.

The focus on health care reform is on the health care system. However, the power force behind the health care system is the health care industry. The system and the industry represent the yin and yang of health care. The health care industry consists or the many organizations that provide health care related products and services. Each of these organizations, under the free enterprise system that we so cherish in America, work very hard to grow revenues and profits. As these organizations achieve their revenue growth targets, their collective success adds to the cost of the health care system. To put in succinctly, every dollar of cost to the health care system is a dollar of revenue to the health care industry. In essence, the health care industry collectively will do everything in its power to preserve and defend its revenue flow. The key question to ask when one hears that costs will be reduced is who will see a reduction in revenue?

There is a lot of vested interest by the collective players that comprise the health care industry in the unregulated status quo. Its going to take a lot of clout to move this very powerful and entrenched force. We will see in the coming months how this issue will be dealt with.

Integrative Medicine: A Vital Part of The New Health Care System

There is a lot of momentum for major reform of our health care system at the federal and state levels. Cost, quality, and access issues have reached a tipping point and the convergence of political, economic, social forces have virtually assured that health care reform will happen now.

The Marino Center and its integrative care delivery model have been ahead of its time with a focus on prevention, wellness, and treating the whole person. Some aspects of the coming reform will move the whole system toward the Marino model.

On February 26th, Senator Kennedy convened a hearing on integrative medicine. This hearing was held at the same time as the Institute of Medicine’s Summit on Integrative Medicine. Those testifying before Senator Kennedy’s committee included Andrew Weil, M.D., Mehmet Oz, M.D., Mark Hyman, M.D., and Dean Ornish, M.D.

The statement offered by Senator Kennedy provides a succinct summary of how and why Integrative Medicine is a vital part of the future of health care in America. His statement is presented below in its entirety:

Statement of Senator Kennedy, February 26, 2009:

"The American health care system urgently needs repair and reform. Today as a nation, we spend 16% of our gross domestic product on health care, more than any other country in the world. Yet health outcomes of Americans are ranked 37th in the world by the World Health Organization. Our system is often called a "sick care" system, not a health care system, because it is designed to treat diseases and illnesses, instead of promoting good health and wellness over the lifespans of our people.

Genuine health reform therefore requires a major transformation in our national mindset on how we care for ourselves and others. It must incorporate and encourage disease prevention activities and lifestyle changes that promote long-term health and well-being. The current incentives in our health care system that lead to over-treatment and mistreatment must be changed to promote high-quality, appropriate, and coordinated health care. The nation’s alarmingly high and growing rates of obesity and chronic disease today are a clear call to action. By preventing diseases before they start and adopting a broader approach to medicine, we will actually reduce costs in the long run, and we will extend and improve the quality of life as we do it.

To achieve this fundamental shift in our nation’s health care mindset, it will be necessary to reform how medicine is practiced. Low-cost or even free health screenings and vaccinations will encourage individuals to take part in preventive medicine. Patient-centered and coordinated care that addresses the whole person – from genetic predispositions, to life-style choices to potentially harmful conditions – is essential for treating acute diseases and managing chronic conditions.

We must also adopt a more integrated approach to medicine, through health care that addresses the mental, emotional, and physical aspects of the healing process in order to improve the depth, breadth, and patient choice in clinical practice.
Further, we must incorporate prevention, wellness, and more patient-centered approaches as fundamental components of medical education and the training of health providers. In order to reach the patient effectively, integrative practices must be accepted throughout our health care system, and especially in the education of health care providers and the consumers who will benefit.

Finally, we can look beyond the traditional health care system to the community itself – to local environments, where we can build sidewalks and bike lanes; to workplaces, where wellness programs can help employees include healthy nutrition and exercise in their lives; and to schools, where we can provide preventive screenings and lay a strong foundation for students to lead healthy lifestyles from and early age.

Americans deserve a health care system that provides this kind of high-quality, patient-centered care, and encourages individuals’ choices and control over their health. The result, as I have said, of this new focus on prevention and health promotion will be lower health care costs and longer, healthier lives.

I commend Senators Harkin and Mikulski for their continuing leadership and this important issue, and I look forward to working closely with my colleagues on the HELP and Finance Committees and with President Obama to achieve or fundamental goal of improving the quality of health care, expanding access to such care for all our people, and reducing the financial burden of such care."