Health Medicine: What, Why And How?
by Len Saputo

INTRODUCTION
We have witnessed a silent revolution in health care that is now completed! Many of us haven't appreciated what has happened, because we have not yet felt the final effects of its impact. What is this revolution, and what does the future hold for conventional medicine?

In this new emerging era, Americans are reclaiming control of their health care choices, and are re-defining good health. The strengths and weaknesses of all health care disciplines are being weighed in an effort to extract the best from each, in an effort to create a new and better system. The merging of modern technology and ancient healing wisdom is giving birth to a new kind of medicine that has widespread popular appeal. In some ways we are "going back to the future".

While there is great awe for the incredible accomplishments of conventional medicine, there is considerable dissatisfaction with its limitations. We appreciate that we are living longer than ever before, that childhood illnesses have largely been conquered, and that we are on the verge of solving the human genome. Yet we are also aware that there is a pandemic of chronic diseases, that their costs are no longer affordable, and that their treatment often has severe consequences. Americans are "looking for a better way," and they are doing this with their pocketbook.

Harvard Medical School's David Eisenberg, MD, has documented that health care in America is undergoing a major transformation. Heís published two landmark articles, one in the NEJM in l993 (1) that shocked both the American Public and conventional medical practitioners, and its sequel, in the November 11, 1998 issue of JAMA (2), that verifies a powerful, sustained progression of this process.

According to this widely discussed Harvard Study, "Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient." Dr. Eisenberg goes on to report: "Extrapolations to the US population suggest a 47.3% increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary care physicians." Further, "Total out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $27 billion, which is comparable with the projected 1997 out-of-pocket expenditures for all US physician services."

Although the paradigm shift in health care in America has already occurred, its destiny is in its infancy. There is still time to analyze what has really happened, to adjust to these changes, and to step forward with a solution that merges the best of both worlds. If we continue as we are, and David Eisenbergís documented trend continues, conventional medicine will soon become an alternative to the "new medicine".

WHAT IS THE PROBLEM WITH CONVENTIONAL MEDICINE?
Americaís health care industry is a consumer driven business, and we all know that "the consumer is always rightî. When the American Public became convinced that modern medical technology could improve its health, it supported this approach with both its heart and pocketbook.

The philosophy that modern medicine could triumph over nature through science became believable, and we soon learned to depend upon this approach. Because of its highly complicated, high tech nature, it fostered a God-like quality to medical practitioners and researchers. The "we can take care of you, even if you donít take care of yourself, and you can leave the treatment to us" attitude that developed, eventually led to a situation that brought patients into a more or less dependent and powerless relationship with their physicians.

This arrangement was acceptable as long as we believed that it worked. However, statistics published in the November 13, 1996 issue of JAMA (3) documented that in 1987 there were 90 million Americans with at least one chronic disease, and that 9.2 million were unable to carry on their major activity. 25% of our youth under the age of 18, 66% of Americans between 45 and 65, and 88% over the age of 65 had at least one chronic disease, meaning that nearly every family in America is directly affected by this pandemic. The cost of managing these chronic diseases was estimated to be $425 billion in 1990. Because of this state of affairs, Americans are rapidly losing confidence in conventional medicine and are switching to alternative approaches.

This situation may actually be the good news! The bad news is that much of America does not even have access to health care because it cannot afford health insurance, and that skyrocketing health care costs have affected our countryís economy severely. Corporate America is having great difficulty competing in foreign markets because of the staggering costs of health care that are usurping over 50% of their pre-tax income dollars. Medicare is on the verge of bankruptcy. Managed care is cutting costs, but is also cutting services, and neither the consumer nor the physician feels satisfied. Physicians are being put into a conflict of interest predicament where they are rewarded by seeing too many patients, making fewer referrals, and spending less money (4). Unfortunately, HMO medicine is profit driven first, and service oriented second.

The safety of conventional medical therapy is another factor that is attracting public attention. Recent studies published in the April 15, 1998 issue of JAMA projected that there are over 2 million hospitalizations in the US and more than 100,000 deaths every year (for the past 30 years) from the expected "side effects" of synthetic pharmaceuticals (5). This combined with previously documented information that takes into account the mistakes and misuse of synthetic drugs, brings this number to over 5 million hospitalizations, and more than 250,000 deaths annually in the US alone. Our treatment then is the third most common cause of death in the US, behind only arteriosclerotic heart disease and cancer!

WHAT IS THE "NEW MEDICINE?"
Three years ago, an organization called the "Health Medicine Forum" (HMF) was formed with the purpose of developing a health care system that is based upon what Americans have been demanding. Over this period, more than 1700 health care practitioners have attended one or more meetings to explore what this system might look like. We call it "Health Medicine."

Basically, Health Medicine is built upon four principles:

1. Integrative Practice
2. Appreciation of the Inseparability of Body, Mind and Spirit
3. Patient Centered Care
4. Focus primarily on a "Health Care" rather than a "Disease Care" paradigm

Integrative Practice
There is a great public demand to create a dialogue between health care practitioners of different disciplines. This is not easy when the relationship between traditional and alternative practitioners is dysfunctional. All too often, it has been based on a premise of independence, isolationism, and competitiveness and, consequently, has too often been adversarial. There is inadequate collaboration, and far too little knowledge of disciplines other than that which each practitioner is formally trained.

There is a pressing need for a new breed of physician who is open to learning, willing to question the principles of his formal training, committed to stretch and synthesize improved methods of restoring and maintaining health, and in preventing disease. Health Medicine practitioners operate with this philosophy. Leadership for this movement on a larger scale is most likely to emerge from individuals such as Andrew Weil, David Eisenberg, James Gordon and Rachel Naomi Remen, all MDís who are trusted and credible in both conventional and alternative medicine.

The HMF has developed a system wherein 5-10 practitioners of different disciplines are brought together at the same table, and at the same time, with an appropriate patient for a 2 hour panel session. This year over 50 patients have gone through this process, and our initial impression is that our patients benefit greatly. The setting encourages an honest exchange of information, and ultimately transcends from information exchange to interconnectedness.

Holism: The Inseparability of Body, Mind, and Spirit
Our tendency to operate from a science-based, reductionistic, high-tech approach has resulted in our looking at the body as a machine that can be repaired much like a broken car. The additional constraints imposed by the superimposition of capitated care on this approach have all but eliminated attention to our psycho-spiritual nature.

When we are ill, we want to get well. Our most immediate concern is to secure relief from our symptoms, and to be "curedî. We want to operate with a perfect body, and want to feel good, and we actively seek out health care practitioners who promise to deliver these services. There is nothing inherently wrong with this approach, so long as we donít consider this the whole story. We are ultimately responsible for the choices we make, and must abide by their consequences. Curing the body does not in itself heal the soul.

If there is meaningful interconnectedness of everything in the universe, then there is meaning for illness too. Illness, then, can be viewed from a deeper perspective that considers more than simple physical misfortune and psychological challenge. It relates to who we are, and is considered in the context of our entire life story, and how our life interrelates with the all that exists in the universe. It can be valued as a transformative opportunity that presents the possibility of evolving further on our spiritual path. This is what "healing" is about. Even though curing the body and healing the soul are not the same, they can occur simultaneously, and certainly are not mutually exclusive. We should settle for nothing less.

Patient Centered Care
As author John Robbins has so aptly written, Americans are reclaiming their power to make decisions regarding their health care choices (6). Promoting patient self empowerment through the development of a deep, caring, personal relationship, wherein the health care professional is an active and sensitive listener, makes it possible to create a "sacred space" in which the healer and the patient can coexist. Relationships that embody effective communication and education encourage the possibility for the patient and the healer to develop changes in attitude and behavior that can lead to a healing process. The concept of treating a "set of symptoms" with a "bag of tools" is being complemented with a philosophy of "being with" rather than "doing to" our patients.

The derivation of the word physician is from the Greek word for "teacher," and that is just what Americans are beginning to look for. They are wanting to take personal responsibility for their health care choices, and are looking for education, not authoritative unilateral decisions. Health Medicine encourages a partnership between practitioner and patient, wherein the practitioner is willing to be involved and vulnerable.

"Health Care Paradigm" vs "Disease Care Paradigm"
We have become so preoccupied with fighting disease, that we have forgotten about prevention and about supporting and maintaining wellness. Less than 3% of the NIH budget is allocated to prevention, which reflects our general inattention to this important perspective. As we look towards curing arteriosclerosis and cancer, the leading causes of death in America, we are learning a lot. But this knowledge has not solved these problems. It is impractical to treat the 42% of the population that will get cancer at some time during their life, and, very often the treatment doesnít help or even makes things worse. Despite the tremendous achievements in research and technology, arteriosclerosis remains the leading cause of death in modern civilization.

There is a big difference in orientation between managing disease and supporting wellness and prevention. Our state of health can be viewed as a spectrum that extends from an ideal pole where there is perfect functionability of body, mind and spirit, to the opposite pole, where death exists. In between these two extremes lies a place where symptoms of dysfunction have not quite yet surfaced, but where we have lost some of our perfect functionability. In most health care paradigms, including conventional medicine, there is no serious effort to restore perfect functionability of body, mind and spirit unless symptoms have clearly developed. We are busy putting out the fire of rampant disease, which is easy to understand.

The value of fighting disease is easy to appreciate, especially when we are sick. But the most ideal situation would be that diseases never occur, and that we remain in perfect health. Approaches like eating a healthy diet, exercising on a regular basis, reducing our levels of stress by adopting a healthier life style, and finding meaningful purpose in life are all simple, effective and inexpensive factors that promote good health. We all know about these approaches, but find ourselves ignoring them. Why?

CULTURAL IMPEDIMENTS TO OPTIMAL HEALTH CARE
Before creating a health care system it is important to know what good health is, and to have a clear conceptualization of what its objectives are. Conventional medicine has operated from the premise that good health exists when there is no detectable disease. But there is far more to good health than simply not being ill. This is much more complex than what appears at first glance. A truly comprehensive health care system should be designed to facilitate achieving our purpose in life, physically, mentally, and spiritually.

An optimal health care system should be designed with the intent of maintaining perfect functionability of body, mind, and spirit in a way that is congruent with our pursuit of fulfilling the meaningful purpose in our lives. But, in order to be able to develop a system that can support fulfilling this end, we need to know what our purpose in life is.

Through birth, our gift is the embodiment of mind and spirit. Our bodily senses empower us with the ability to experience life by communicating with the world we live in, and the potential to develop relationships that bring fulfillment into our lives. Teleologically then, this is our purpose in life, and what our health care system should support.

How we go about developing meaningful relationships in our lives depends on the values that we learn from our role models. If we learn to operate from fear and greed, we will be based on a materialistic paradigm that is oriented to accumulating wealth and power. Unfortunately, our culture has a long history of such an orientation. It has been centered primarily in materialism, not in service. We tend to disconnect from the universe by thinking of ourselves as separate, isolated, and individualistic, which encourages a self-centered attitude. The lonely struggle that ensues pits us against the universe.

If we are more fortunate and learn values that are oriented to finding pleasure through giving and graciously accepting love, we will be more oriented to valuing and developing loving relationships with ourselves, with each other, and with the entire universe. We were created in love, and can live in this perfect state by allowing it to pass freely to and from us.

The most serious and fundamental impediment to our quest to find meaningful purpose in life, stems from our profound lack of knowledge and appreciation of who we are. Ideally, as children we should be learning who we are, and to love and respect what we have become. And, this is the knowledge that our own children need in order to be able to present themselves to the world with vulnerability, compassion, and love. The blissful loving feeling that results from this attitude, fuels our passion to connect with others and to share. It is what creates community.

Another serious flaw in our culture is that we donít look deeply enough into the reasons why disease develops. We are fixated on the limitations that result from disease, rather than the reasons for their development. In striving to suppress them we have spent billions of dollars looking for magic bullets to achieve this, and have all but ignored their possible psycho-spiritual meaning.

We feel a sense of urgency in addressing our symptoms. This is very understandable, as no one wants to be sick! However, once symptoms are no longer an issue, we quickly forget that they were ever present, and we then fail to explore their underlying causes or potential deeper meaning. In a busy world where we are constantly preoccupied with a materialistic life style, this is precisely what we should expect. In fact, it is what we have demanded. However, now that it is becoming clear that there is meaning to everything in life, we are becoming more motivated to find meaning in illness too.

WHAT DOES THE FUTURE HOLD?
The paradigm shift in Americaís health care system has economic and political ramifications that demand our immediate attention if we are to preserve stability and prevent turmoil. As health care professionals, it is our responsibility to respond to its challenge with novel and innovative approaches that support the integrative, holistic, and patient centered nature that is being demanded.

The entire health care industry has been challenged to work together as one team and invent solutions that will inspire the merging of the best from all disciplines. It is both arrogant and naive to operate from the premise that any single discipline can solve all the problems that are seen in clinical practice. They never have. It is the American Public that is leading the way, demanding that bridges be constructed between disciplines that can support the contributions of each disciplinary approach.

There is a deeper context that is appreciated by the "new medicine" that reflects its great respect for the total health care needs of its patients. We are beginning to realize that while a certain, at least minimal, level of materialism is important in our lives, there are higher values that are coming into focus. If we are to come back into harmony with ourselves, with each other, and with nature, it is vital that we remember that we are a part of a greater whole, and that a service orientation is more rewarding than an attitude that is self-centered and separated from nature. Loving relationships are more nourishing than a neurotic dependence upon wealth and power. Our most powerful weapon to instigate these changes is education, especially for our children.

Prevention and wellness are now being appreciated as the most realistic answer to skyrocketing costs and avoiding diseases. While there is an ever increasing appreciation for the potential value of these approaches, there is an easy to understand resistance to shift our economic resources from disease care to health care. It will take time to adjust to the lost income from the disease care industry, as well as from the change in power that will affect how health care will be governed as we move our focus and dollars from disease care to health care.

With the advent of the Internet, the possibility for an even faster evolution of our health care system is becoming apparent. There is abundant information that is readily available and easy to access. Thousands of web sites are furnishing free information that is highly technical and uncensored. Surveys have documented that more and more patients are now commonly relying upon health care information via the Internet and often feel that they are getting information that is more accurate, varied, and often even more personal than from their own physicians (8). However, at times it is difficult to be sure that the information offered is indeed accurate and appropriate for an individual situation. As both patients and practitioners become more Internet savvy, this powerful resource will become an ally rather than a source of argument.

WHAT YOU CAN DO TO GIVE YOUR PATIENTS BETTER CARE
Notice the state of affairs of our health care system, and imagine what needs to be done to make it better. Keep an open mind, your way is not the only way that has value. Stretch yourself beyond the limits where your professional training stopped. Be willing to question the principles of your discipline and assess the possibilities offered by the varied approaches of other disciplines. Explore the opportunities offered by developing a dialogue with whatever practitioners are appropriate for your patientís needs.

Consider the unique nature of every patient, and look for possible solutions that are realistic for that special person. Evaluate the meaning of illness in the context of the whole patient, his entire life story, and as part of a universal wholeness.

Be willing to acknowledge that "not knowing" what is needed to solve a situation is okay. Be vulnerable and form an alliance with your patients in a way that they feel empowered. It is in this setting that transformations become possible, and new insights emerge that may offer the opportunity for a healthier and more meaningful life.

References

1. Eisenberg DM, Kessler RC, Foster C, et al. "Unconventional Medicine in the United States," NEJM 1993; 328:246-52.
2. Eisenberg DM, Davis RB, Ettner SL, et al. "Trends in Alternative Medicine Use in the United States, 1990-1997. JAMA 1998; 280:1569-75.
3. Hoffman C, Rice D, Hai-Yen Sung. "Persons With Chronic Conditions: Their Prevalence and Costs." JAMA. 1996; 276:1473-79.
4. Grumbach, K, et al. "Primary Care Physicianís Experience of Financial Incentives in Managed- Care systems." NEJM Nov. 19, 1998; 339:1516-21.
5. Lazarou J, Pomeranz B, Corey P. "Incidence of Adverse Drug Reactions in Hospitalized Patients." JAMA April 15, 1998, vol. 279, no. 15.
6. Robbins, John. "Reclaiming Our Health." 1996. Published by H. J. Kramer Inc. ISBN 0- 915811-69-3.
7. Murray MT. "The Time Is Right for Natural Medicine." Natural Medicine Journal; 1998;vol 1, number 1:1-7.
8. Ferguson, Tom, MD. "E-patients prefer e-groups to doctors for ten of twelve aspects of health care." The Ferguson Report, the newsletter of consumer health information and online health. ISSN 1520-5487. E-mail address doctom@doctom.com.