Our CEO: Integrative Medicine Conference Interview

The Co-op captured the following interview with CEO, Cindy Marteney after attending the Integrative Medicine Conference in San Diego (January 2004).

Q: You attended the Integrative Medicine for Healthcare Organizations conference in San Diego in January. What are the top themes you took away?

"On an optimistic note, I was definitely struck by the number of physicians who talked about dreams that, in their lifetime, there would no longer be a distinction between traditional and alternative medicine, that all medicine would be integrative.

One OB/GYN from the East Coast talked about her traditional practice paying the bills, while she put in long, uncompensated hours as the director of a new integrative medicine center.

Another physician, who completed a fellowship in integrative medicine at the University of Arizona (Dr. Andrew Weil's program), was clearly part entrepreneur in getting an integrative medicine program going in the Midwest. He expressed envy about the way the state of Washington structures reimbursements for health care (for example, massage and acupuncture are regularly integrated into traditional treatment programs, without crazy discussions about what code can be used to cover such treatments)."

Q: How is "integrative medicine" defined?

There are many definitions. Some emphasize combining mainstream medicine with complementary or alternative medicine. Here, treatments include herbs, supplements, and acupuncture. A more inclusive definition includes medicine -- the best of East and West, both ancient and modern -- but also mind/body wellness more generally.

There's good, hard science that proves that enlisting positive emotions can profoundly affect medical outcomes. Humor, optimism, self-confidence, a sense of belonging -- these emotional states all are highly correlated to health and resilience. So I would prefer to talk about a discipline that aims to "integrate the best of medicine and mind/body wellness."

Q: Doesn't that fit with the poster you presented?

"Yes, my poster was "An Ontological Approach to Healing: Supporting Both Practitioners & Patients Alike." Now I'm sure you want a definition of "ontological," so here it is. It's the study of being, the nature of how we are being in the world. The focus was on how healers can extend beyond doing "to" or "for" a patient or client and move toward "working with" the whole person, from a place of relationship, and within the context of that person's history of experiences and interpretations about what is possible.

The poster emerged from my other work, as an executive coach partnering with physicians, nurses, and other healing professionals."

Q: Back to the conference. Any areas you wished had been covered in more detail?

"Sure. The information on and knowledge of nutritional supplements was still woefully rudimentary. While my vision for integrative medicine would include a lot more focus on the mind, emotions, and healing relationships, it's easier to start with things that look and feel like more traditional "treatments."

I would have liked to see a much more serious supplements education program, especially given the need to assess interactions among various supplements and drugs. Physicians are hungry for good information, asking questions like, "How do we assess quality?" and "What are the best resources for understanding the science behind supplementation strategies?"

The only presentation on supplements, titled "High Utilization Herbs and Supplements," was by a PharmD from the Natural Standard. The presenter confessed to being fairly cautious, which is fine, but in reviewing ten herbals (ranging from Black Cohosh to Valerian), Saw Palmetto was the only herb rated an "A" (for benign prostate hyperplasia). The presentation had an attached "Interactions Table" highlighting potential hepatoxic, hypotensive/hypertensive, SSRI, MAOI, and other properties of concern.

My objection was that supplements with outstanding scientific support were missing altogether. Where was the discussion on glucosamine for osteoarthritis and whether the latest research indicates that glucosamine increases insulin resistance and blood glucose levels (important questions for diabetics)? What about helping physicians understand that any patient on statin drugs should be taking coenzyme Q-10 (even the CoQ-10 patent holders knew that statin drugs deplete the body of CoQ-10)?

You get the picture. The good news is that more and more physicians are getting exposed to alternative therapies. The bad news is that we're really just at the beginning of the education process."

Q: What is the biggest challenge for physicians who are open to integrative medicine once they get back to their offices?

"Not enough time, lack of support from insurance companies, lots of obvious things. Something that got my attention was how important it is for healing professionals outside of medicine to communicate with physicians, including consultation letters and discussion around charting approaches."

Q: Anything that Co-op members can share with their own physicians?

"The material I appreciated most detailed the cost-effectiveness of complementary and alternative medicine, otherwise known as "CAM." Dr. Brian Berman -- Director for the Center for Integrative Medicine at the University of Maryland School of Medicine -- spoke about evaluating the evidence for CAM therapies, with some very encouraging data to support CAM therapies.

The most powerful nugget came on a slide titled, "Is the evidence for conventional medicine more conclusive?" Net-net, CAM therapies are clearly comparable to conventional medicine and the so-called difference in standards of evaluation are not as great as many CAM skeptics have assumed!"

Q: Do you have any specific statistics you can share?

"Hold on, let me get my folder out. Yeah, here are some great statistics from the presentation:

Only 22.5% of conventional medicine interventions have evidence from systematic reviews demonstrating a clearly positive effect (Ezzo et al, 2001)
The quality of systematic reviews in CAM were found to be comparable to reviews in conventional medicine (Moher et al 2002)
"The quality of medical information generally and in particular, the evidence for many clinical interventions is quite poor. The difference in standards of evidence for orthodox and complementary therapies may not be as great as generally assumed." (Furnham 2003)

Q: Hmm. Any more good pieces of data?

"Here are a few, but there are more interesting things to talk about!

It wasn't so long ago that "alternative medicine" was indexed in Medline as "therapeutic cults." "Alternative medicine" only made it into the Medline thesaurus in the early 1990s.
The percentage of U.S. hospitals offering CAM therapies doubled in only four years (between 1998 and 2002 -- going from just 8% to over 16%).
Massage therapy, stress management, yoga, relaxation techniques, acupuncture, and biofeedback topped the list of CAM therapies offered at hospitals or wellness centers.
CAM treatments with clear benefit that are not being extensively used in hospitals included nutritional supplements.

I laughed out loud at the idea of calling "alternative medicine" a variety of "therapeutic cults." You would think this was ancient history, but it's really quite recent. Sad, isn't it? I was also surprised that supplements were not being used more often in integrative medicine strategies.

Nutrition/nutritional supplements were missing on the top CAM therapies in use at hospitals and wellness centers. Again, we have a long way to go!"

Q: What else was presented on the cost-effectiveness of CAM therapies?

"Great question. I loved hearing Dr. David Sobel speak about "The Health and Cost-Effectiveness of Mind/Body Medicine." He talked about the "somatization of suffering," which is more or less the expression of stress through the body.

He noted that surgeons often spend more time cleaning their hands than preparing patients for surgery emotionally.

With respect to living with chronic disease, Dr. Sobel distinguished between "managing the illness," "managing the daily activities," and "managing the emotions." Of interest, in an arthritis program, patients that felt more confident and in control had the best outcomes, even over those who changed their behavior (taking meds, diet, exercise, etc.)."

Q: Any other highlights?

"Visiting the new Scripps Center for Integrative Medicine was inspiring. What a hot ticket they have in the cardiologist-turned-integrative-medicine-champion, Dr. Erminia Guarneri. Her vision is ambitious and heartening. I think everyone in attendance hoped that such a center would be available to all of us someday.

Q: Nothing on cats or pets or humor?

"Funny you should mention that. Dr. Sobel also did a presentation on "Healthy Pleasures: The Benefits of Sensuality, Optimism, and Altruism." In it, he mentioned that heart attack patients "treated" with 30 minutes of humor videos had fewer irregular rhythms, lower blood pressure, less medication, and one-fifth the rate of recurrent heart attack.

He also said that after a heart attack, pet owners had one-fifth the rate of recurrence; that depression in coronary patients is a better predictor of future cardiac events than the severity of coronary heart damage; that men taking naps were 30-50% less likely to have heart attacks; and that taking frequent annual vacations was associated with a 30% reduction in cardiovascular risk.

Such pleasures were more important than the traditional risk factors, such as smoking, hypertension, hyperlipidemia, and physical inactivity.

The gist was that we spend far too much time on risk reduction and not enough time on healthy pleasures. I'm sure the kat would be delighted to hear these statistics repeated more often!"

If you are interested in contacting Cindy Marteney, please feel free to write to her at marteney@ourhealthcoop.com