Donna Karan welcomes everyone into the vast, raw space of her late husband’s former sculpture studio in downtown New York. Gathered round tables, seated on pillowed platforms, and lunching on healthy gourmet cuisine, a divergent group of leading integrative physicians, visionary thinkers, holistic nurse practitioners, media personalities, Buddhists, and yoga teachers, (along with corporate and foundation sponsors) engages in a daily dialogue, brainstorming, and sharing to determine key initiatives for Karan and her allies’ ongoing efforts to bring Integrative Medicine to the forefront of American health care.
At the forum’s daily panel, and in conversations over meals and in breaks, there’s enthusiasm and urgency. Along with Donna, practitioners and patients seek ways for medicine to rediscover the lost art of caring. Some people envisage a whole new medical landscape, one focused on the totality of patients’ needs — physical, emotional, and spiritual.
In conversations between the forum audience and panel members, practitioners on the frontlines cite rising insurance costs, medical errors, and nursing staff shortages, among other key indicators that our health system is seriously ailing.
“It’s having a heart attack,” said Dr. Dean Ornish, Founding President of the Preventive Medicine Research Institute, who chaired a panel on “Caring for the Patient.” “Companies’ health costs exceed their profit margins. The system isn’t sustainable.”
“Our health care system is focused on sickness, not on wellness.” Senator Hillary Clinton tells the gathering in a taped message, “Lifestyle issues are central to well-being. We need to develop programs to serve as new models.”
“Integrative medicine is about patient-centered care,” explains Christy Mack, President of the Bravewell Initiative, which funds systemic change in medicine. “If you’ve had a heart attack, let’s help you prevent another one. Let’s keep you well when you are well.”
But insurance covers costly procedures rather than lifestyle programs that reduce the need for procedures. Both patients and doctors offering low-tech approaches encounter obstacles from conventional administrators, governmental regulators, and insurance bureaucracies.
“Whether it’s changing your diet or changing the system, change is hard,” says Ornish.
When Ornish applied for NIH (National Institutes of Health) funding for a Medicare study on his clinically successful cardiac disease prevention program, governmental gatekeepers demanded proof that “it was safe to get old people to eat veggies, meditate, and walk,” Ornish recalls as participants laugh in familiar exasperation.
The tipping point for moving beyond these gatekeepers, Ornish believes, are large companies, like Safeway, who have lowered health care costs by incentivizing lifestyle approaches. “Labor and management can get together on this one,” Ornish believes.
“Let¹s re-define success in health care,” Dr. Woodson Merrell, Director of Integrative Medicine at New York’s Beth Israel Medical Center proposes. A guided imagery study with cardiac surgery patients showed improved quality of life measures, Merrell tells the forum. But his conventional colleagues pooh-poohed the results because a conventional walking pace test indicated no improvement.
“Quality of life isn’t meaningful to them. But what’s more important while you await a heart transplant?” Merrell asks, “How far you can walk, or how good you feel?”
“Misguided approaches are like victimless crimes until patients vote with their feet,” offers Dr. Mehmet Oz, Professor of Surgery at the Columbia University College of Physicians and Surgeons and a bestselling author. “Things won’t change when both parties agree to it,” says Oz. “When patients in droves say, “Hell no, we won’t go,” the system will be forced to change.”
“Hospitals are competitive.” Ornish points out, “No one wants to be the first to change, but no one wants to be last, either.”
“I feel an urgency to bring this change on,” Dr. David Shulkin, the President and CEO of New York’s Beth Israel Medical Center asks participants. “How can we create a better environment for people now?”
“I’ve seen it happen in fashion, ” Karan recalls. “One designer does short skirts, and then everyone’s doing it.”
“Health care affects everyone. This has to be a socio-political movement,” Dr. Barrie Cassileth, Chief of Integrative Medicine at the Memorial Sloan-Kettering Cancer Center in New York offers. “But it’s not ‘alternative.’ Let’s call it ‘integrative’ or something else.”
“How about just calling it ‘good medicine?’” suggests Ornish.