For medicine to change, culture must change.

 -Roger Mignosa, DO

Integrative medicine and traditional medicine share the common goal of applying the truth and benefiting all parties involved. How can we create a comprehensive model of medicine that helps everyone? It is my belief that we must find the common truths in medicine and stop labeling one branch as integrative and one as traditional.

In our current medical system, there is a separate medical insurance for the body, the eyes, and the teeth. Medicine is so accustomed to separation and specialization that we don’t question the logic behind our strategy to enhance health and healing.  A logical approach to enhance health is to support a model of rehabilitation, education, and collaboration in every field. This model of medicine would address the connections within the body that constitute health. This is the true value of an integrative approach to medical care.

Working in the field of integrative medicine for over a decade has convinced me of two very important factors that are critical to the advancement of integrative medicine in terms of culture and scholarship.

First, the culture of medicine must adapt to the current evidence of medicine. It is well known that the modalities within integrative medicine are effective at treating and preventing disease, but integrative medicine is viewed as separate from traditional medicine. ^{1,2, 3} Interestingly, the acute rehabilitation unit (ARU), although within a hospital, is seen as a separate unit. In the ARU, medically stable patients receive care that restores the highest level of function. Physical medicine and rehabilitation (PM&R) utilizes an integrative model of medicine throughout academic health care institutions and the culture of medicine is moving toward lifestyle interventions.^4,5,6,7,8,9 My PM&R residency program had an integrative pain clinic that included physiatrists, neurologists, psychiatrists, psychologists, acupuncturists, and manual medicine therapists that were supported by comprehensive education programs for pain, mental health, nutrition, and self-care. The culture of PM&R is the culture of integrative medicine.

Second, scholarship includes the full spectrum of academics from original research to education. Academia has embraced Boyer’s model of scholarship to include discovery (original research), integration (the synthesis of information across disciplines), application (the sharing of expertise with peers), and teaching and learning (sharing of information for public application).^10,11 The University of Arizona Center for Integrative Medicine has been the epicenter of integrative innovation within the United States. The leaders from this institution such as Dr. Andrew Weil and Dr. Tieraona Low Dog are masters of integration, application, and teaching. Advocacy work for integrative medicine is needed to advance this field into the next stage of evolution.

In order for medicine to advance the culture of medicine must stop separating medicine into compartments and seek common truths in all fields. In educating the future generations medicine must use the current available evidence and focus on the full spectrum of scholarship including discovery, integration, application, and teaching and learning. This is the rock on which I stand.

There is promise that culture is changing. In 2017 Susan and Henry Samueli donated $200 million dollars to UC Irvine to advance the way medicine is practiced systemically in medical training and practice. UC Irvine is working to advance medicine to a more perfect version of the truth, without separation. This has the potential to systemically prevent disease, reduce the cost of medicine, and enhance the quality of life of the patients and providers involved. This movement will come with many challenges. But if nothing changes, then nothing changes. That is something that we cannot afford.

References:

1. Lin YC, Wan L, Jamison RN. Using Integrative Medicine in Pain Management: Evaluation of Current Evidence. Anesth Analg. 2017 Dec;125(6):2081-2093.
2. Razavi M, Fournier S, Shepard DS, Ritter G, Strickler GK, Stason WB. Effects of lifestylemodification programs on cardiac risk factors. PLoS One. 2014 Dec 9;9(12):e114772.
3. Sagner M, Katz D, Egger G, Lianov L, Schulz KH, Braman M, Behbod B, Phillips E, Dysinger W, Ornish D. Lifestylemedicine potential for reversing a world of chronic disease epidemics: from cell to community. Int J Clin Pract. 2014 Nov;68(11):1289-92.
4. Hillinger MG, Wolever RQ, McKernan LC, Elam R. Integrative Medicine for the Treatment of Persistent Pain. Prim Care. 2017 Jun;44(2):247-264
5. Wolever RQ, Caldwell KL, McKernan LC, Hillinger MG, Integrative Medicine Strategies for Changing Health Behaviors: Support for Primary Care. Prim Care. 2017 Jun;44(2):229-245.
6. Katz DL, Frates EP, Bonnet JP, Gupta SK, Vartiainen E, Carmona RH. Lifestyle as Medicine: The Case for a True Health Initiative. Am J Health Promot. 2017 Jan 1:890117117705949.
7. Pojednic R, Frates E. A parallel curriculum in lifestyle medicine. Clin Teach. 2017 Feb;14(1):27-31.
8. Egger G, Katz D, Sagner M, Dixon J, Stevens J. The art and science of chronic disease management come together in a lifestyle-focused approach to primary care. Int J Clin Pract. 2014 Dec;68(12):1406-9.
9. Frates EP, Moore MA, Lopez CN, McMahon GT. Coaching for behavior change in physiatry. Am J Phys Med Rehabil. 2011 Dec;90(12):1074-82.
10. Bowden, R.G. 2007, ‘Scholarship Reconsidered: Reconsidered’, Journal of the Scholarship of Teaching and Learning 7.2, pp. 1–21.
11. Boyer, E.L. 1990, Scholarship Reconsidered: Priorities of the Professoriate. Special Report, Carnegie Foundation for the Advancement of Teaching. New York: Jossey-Bass.