Prescription for Change: On the Construction of a True Integrative Health Model

In a health care environment marked by raging turf battles that pit one profession against another, positive change will require—as a start–introspection and self-criticism by providers from different disciplines.

I am trained as a chiropractor, and have practiced my craft for almost 30 years. But the dominance of the allopathic medical profession has forced me to work in isolation. Chiropractors have been excluded from hospitals, marginalized by insurance companies, and subjected to ridicule by the American Medical Associations PR wing.(1)

To survive, we have upheld a holistic philosophy and championed effective treatment. As a result, chiropractic has become the most powerful and popular of the “alternative” modalities. At the same time, the pressure to work on our own in solo practices has tended to separate us from practitioners in the other healing arts.

Chiropractors are not alone in this isolation. Medical doctors are educated to believe that theirs is the only effective treatment for most illnesses. As a result, they refer patients almost exclusively to other MDs or providers under MD control. A family practitioner or a general internist will not hesitate to send a patient to a neurologist, a gastroenterologist or a physical therapist; but to a chiropractor, a naturopath, or an acupuncturist? Not so fast.

Variations on this theme can be seen across the healing arts spectrum.

This isolation is a contributor to the inefficiency of our health care system. The remedy is integration. And it has to start with care providers—on all levels—opening their minds to the efficacies of alternative treatment modalities.

Building an educational foundation for change

During a recent visit to the Southern California University of Health Sciences (SCU), I met with its President, John Scaringe, DC, EdD.

The University took its present form in 2000 when the Los Angeles Chiropractic College (LACC), which had been founded in 1911, expanded to include a Licensed Acupuncture degree as well as massage therapy and Ayurvedic (a wellness system from India) certification programs. SCU is also developing and working with the appropriate accreditation agencies to launch a Physicians Assistant (PA) program in 2016.

When SCU grew out of LACC, chiropractic was elevated as a practice–as were acupuncture, massage, and Ayurveda. All became parts of something larger than they’d been individually: a true integrative medicine. Chiropractic is a highly effective, hands on, drug free treatment for musculoskeletal conditions, particularly for problems related to the spine. Acupuncture and herbal medicine are relatively safe alternatives for the treatment of metabolic disorders and pain. Massage therapy can reduce physical and emotional stresses and strains that cause pain and dysfunction. And Ayurveda, an ancient South Asian science, prescribes diet, exercise, and bodywork to support healing.

When you throw into the mix a PA program, which is fully grounded in allopathic medicine, you have a solid educational foundation for constructing a truly integrative medicine.

“SCU exists to advance health and wellness by providing patient-centered integrative care,” said Dr. Scaringe.

He described the structure of the program: Chiropractors, acupuncturists and physician’s assistants take core foundational courses together. They then go off to take specialized courses in their respective disciplines, and come together again to work side by side in a clinical setting. By studying and practicing together, students develop both an understanding and a respect for each other’s professions.

“SCU’s goal,” said Scaringe, “ is to train practitioners who will take their place in a newly evolving health care system but also to train leaders who will shape that system. It is clear that the future of health care is integrated health care and we want our students to be at the forefront of this movement.”

Meanwhile, at the California Institute of Integral Studies (CIIS), students are getting Masters Degrees in Integrative Health Studies. Meg Jordan, PhD, a nationally recognized expert in the emerging field of wellness, and the program director, has designed a course of study to prepare students to enter a work world just coming into being.

“Students will have an historical, cultural, and practical understanding of health care and healing,” said Jordan. As part of their training they become certified health coaches and upon graduation are qualified to enter the corporate or not-for-profit business world as coordinators of newly developed wellness departments.

Jordan emphasized that the CIIS curriculum is focused on “transforming health care from its current, ongoing crisis intervention model to one that emphasizes the use of preventive strategies in wellness and health promotion.” Many new positions will open up, she observed, as our society shifts from “sick care” to real health care”.

Industry stands ready

It has become clear that pharmaceutical and surgical disease “management” of chronic/preventable disease is an unnecessary drain on our health care system.

As health insurance premiums continue to spiral upward, industry will bear the brunt of these rising expenses. Corporate America stands ready to experiment with alternative health care delivery models.

Some large companies, like Apple and Google, have already decided to minimize dependence on health insurance companies. They’ve constructed full integrative medical clinics on site, emphasizing wellness and prevention.

For smaller companies that seek the same benefits, start-ups like Mevident have come into being. (Full disclosure: I am on its advisory board.)

Mevident, founded by Asako Tsumagari, MBA, provides consulting services to determine the needs of particular companies and then can customize on site integrative care clinics for those businesses. Asako observes that “today’s health care industry is set up in every way to deter consumers away from engaging in wellness.” She believes that “most chronic conditions are caused by mind, body and work-life issues and the key driver for each individual is different. Through a combination of technologies and hands-on treatment, industry can promote health and wellness, create a positive work environment, and save money at the same time.”

Paradigms shifting

Thomas Kuhn, in his seminal work “The Structure of Scientific Revolutions”, described the process by which paradigms shift. Paradigms are slowly abandoned when they no longer respond to the needs of the society that they had served. But when an old paradigm breaks down, a new one can grow—providing relevant answers to a population badly in need of new solutions.

A new health paradigm is under construction. The pieces are in place: a theoretical framework as well as real structures that will test that theory. All that is needed is for thought leaders to make the leap into the new world.

Progressive CEOs, insurance providers and consumers must learn that there is a better, more rational way to deliver and receive health care. Providers must place their egos on hold, admit the benefits and limitations of various therapies, and work together.

The culture of health care is changing, its tired old paradigm imploding. But it’s good when worlds collapse. That’s how new ones are born.

1 This point has been confirmed through a lawsuit in Federal Court (Wilk vs. AMA—7th Circuit 1990)

Dr. Ricky Fishman has been a San Francisco based chiropractor since 1986. In addition to the treatment of back pain and other musculoskeletal injuries, he works as a consultant in the field of health and wellness with companies dedicated to re-visioning health care for the 21st century.

Copyright 2014 Ricky Fishman