Health Care: New & Improved
A new generation of patients and doctors is changing the face of American medicine. It's about more than curing disease now—it's health for the whole person.
By Emma Seppala
Stacy Brindise, 30, was eager to have children. But after trying for several years to conceive, she and her husband, Mike, were still childless. Like millions of couples, the Brindises were faced with what doctors refer to as "unexplained infertility."
Couples diagnosed with unexplained infertility are typically active, health-conscious people of childbearing age who find themselves—for no apparent reason—without a crib or a bottle in the house. Like many, the Brindises followed a familiar route, first consulting doctors who recommended hormone treatment, which Stacy reluctantly decided to try. The arduous six-cycle program involved daily medications, self-administered hormone shots, and monthly intrauterine insemination with a catheter.
But the Brindises still couldn't get pregnant.
Physicians next suggested that Stacy try in vitro fertilization. It would involve doses of medication, a considerable price tag (starting at $12,000), and increased chances of her having twins—factors that gave the couple considerable pause.
Nothing had worked and it was time, Stacy decided, to change her approach.
"When people have a medical problem, everybody seems to jump right to drugs as the solution," she says. "I wanted to see if improving my overall health and well-being would increase our chances of getting pregnant naturally."
Stacy is not alone in her gut feeling that first addressing her overall health and well-being—before investing in more invasive solutions—might be a key element in her health care. High-tech, high-cost approaches clearly have their place, and modern medicine can boast many silver-bullet solutions. But millions of Americans feel that's not enough. They spend more than $30 billion a year out of their own pockets for alternative treatments, according to data compiled by the National Center for Complementary and Alternative Medicine. Funding for NCCAM—the U.S. government's "lead agency for scientific research on complementary and alternative medicine"—hit $128 million in 2012, a 156% increase since its inception in 1999.
"Complementary and alternative" is the federal government's current label for approaches that lie outside the mainstream. However, a nationwide survey shows that approximately 38% of U.S. adults aged 18 years and over use some form of complementary and alternative medicine—anything from acupuncture to meditation. That's starting to look pretty mainstream, which is one reason many doctors prefer the term "integrative" health care.
In 2010, 600 health care professionals assembled in Washington, D.C., for a summit on integrative medicine. It was sponsored by the Institute of Medicine, which defines integrative medicine as "health care that addresses together the mental, emotional, and physical aspects of the healing process for improving the breadth and depth of patient-centered care and promoting the nation's health."
The doctors who champion integrative approaches are not simply proposing "alternatives." They advocate an updated model of health care that integrates mind and body, promotes more interaction and communication in the doctor-patient relationship, puts the patient at the center, and encourages self-care.
Florence Strang's successful battle with breast cancer is a prime example of integrative medicine—of taking care of the whole person while trying to cure a disease. She is alive today because of radiation, chemotherapy, and surgery. But Strang also attended a mindfulness retreat led by an oncologist, and she credits mindfulness and awareness practices with helping her cope with the suffering that came with those life-saving treatments.
"I was undergoing a lot of lengthy, painful, and uncomfortable treatments and procedures," she says. "In one year I had six rounds of chemo, 25 radiation treatments, three surgeries, and I would not be able to tell you how many difficult tests and procedures."
Strang is a registered psychologist who works as an elementary school guidance counselor. She knew the chemotherapy treatments were helping her fight cancer. But in the process, her body was weakening and suffering profoundly. By her second round of chemo, she knew that if she was going to get through it, she needed to stay focused on the positive.
"The most important thing I did is what I would call mindfulness of healing," says Strang. "Instead of fighting against these treatments, which left me feeling in such misery, I just observed and accepted what was happening. And I would think to myself, 'Chemotherapy is my friend. It's going to save my life.'
"If I observed the treatment from a place of being kind and healing to myself, rather than looking at the treatment as some horrible thing that was happening to me, it made it easier. Bringing mindfulness and kindness to your care gives you a different perspective."
This is when Strang came up with what she calls her "survival plan," which took—and continues to take—her own body and mind into account. To help focus her mind on the positive, she started a blog, www.perksofcancer.com, which chronicles her approach to dealing with the disease.
Strang's way of coping with her cancer reflects the approach that integrative health care doctors take, according to Dr. Margaret Chesney, director of the Osher Center for Integrative Medicine at the University of California-San Francisco. Chesney emphasizes that the best way to enhance health and heal illness is often a combination of conventional medicine and healing methods that "address the person as a whole, that see where they are in their lives from the point of view of mind, body, spirit, and community." For a patient at the Osher Center who wants to prevent heart disease, for example, the treatment plan might include an appointment with a cardiologist for appropriate testing but also a stress-management program such as yoga, meditation, or massage.
Richard Low served for 16 months in Iraq as an officer in the 4th Battalion of the 23rd Infantry Regiment. He didn't think of himself as the sort of person who needed yoga to round out his life and help him heal. He wasn't even sure he needed healing, but he volunteered anyway to be part of the Veterans' Wellness Study at the Center for Investigating Healthy Minds in Madison, Wisconsin.
"During the study, I learned a lot about what PTSD was and just how much I had been affected," Low now says. He also learned how to use a yogic breathing technique called sudarshan kriya, which has been found to be particularly effective for trauma sufferers. With trauma usually comes agitation, and that makes most meditation techniques difficult. It's hard for people with traumatic thoughts to sit still and relax, but breathing techniques give them a way to feel their body and find relaxation there.
Low came to some realizations. "I really numbed myself out after returning from Iraq," he says. "I was disconnected, but I didn't really know it."
Other family members noticed, though. His dad, for one.
"We were out deer hunting," says Richard. "We were talking about the study and my dad said, 'I can see that you're you now—the you from three or four years ago.' I was happier, joking around again, relaxed."
Standard treatments for post-traumatic stress include therapy and medication. However, recent studies have shown that both therapeutic and drug treatments have high dropout rates, and of veterans who do complete treatment, only about half experience a reduction in symptoms.
Shad Meshad, founder of the National Veterans Foundation, was instrumental in bringing attention to post-traumatic stress disorder before it was a clinically acknowledged diagnosis. He is internationally renowned for his work with trauma and was asked by the U.S. government to train critical-incident and trauma teams after the 9/11 attacks. Meshad uses a technique called TFT, in which a practitioner asks the patient to recall a traumatic event, then helps them tap different parts of the body known as meridian points (mostly on the face) in order to release the trauma. This practice is often coupled with breathing practices.
Combat veterans in particular are often averse to talking about their trauma to a stranger. "The great thing with this method," says Meshad, "is that they don't have to go into the details that distress them. They just need to describe the moment that led to the trauma and what haunts them, and then we go through the procedure. I ask them to rate their anxiety on a scale of 1 to 10. If they are at 10, my goal is to get them to 1.
"People think I'm a miracle worker, but I know this stuff works. I've watched a decorated combat vet laughing or crying with joy like he won the lottery because he feels free. It's freedom, a release from the imprisonment of the brain, a release from hell."
The power of integrative medicine doesn't just lie in techniques. According to Dr. David Spiegel, director of the Center on Stress and Health at Stanford University, part of what's powerful about any integrative approach is that it helps patients feel more involved, more in control and responsible for their own health care. It also allows for more time with a medical practitioner. "The average doctor," says Spiegel, "spends seven minutes per patient and the average integrative practitioner spends 30 minutes."
"The medical care system in this country is broken," says Dr. Jeffrey Brantley, director of Mindfulness-Based Stress Reduction at Duke Integrative Medicine in Durham, North Carolina. "One of the ways it's broken is that both people in that seven-minute exchange—the patient and the doctor—are being short-changed. Many factors weave together to create this problem: our medical culture, our national view of health, our reimbursement models."
The fee-for-service reimbursement approach is a cornerstone of the U.S. health care system. It pays doctors for services supplied. It does not evaluate the quality of their care, as measured by the health of their patients. This approach stems from a health care system that responds to health problems more than it prevents them from occurring in the first place. "Disease management" tends to outweigh "health care" in such a model.
But change is afoot. "The system is shifting," says Dr. Adam Perlman, executive director of the Duke Center for Integrative Health. "We're seeing much more emphasis on prevention and lifestyle. It's an exciting time for integrative health."
It was a friend of Stacy's who helped the Brindises solve their unexplained infertility. She was a nurse in an obstetrician's office and she told Stacy that she had met many women who had used acupuncture successfully when they were trying to get pregnant. Despite some misgivings about the little she knew about acupuncture—namely, that it involved a lot of tiny needles—Stacy booked an appointment at the Acupuncture and Chinese Medical Center in Edina, Minnesota.
"My first surprise was that the doctor spent a good hour and a half with me," Stacy says. "She asked me detailed questions about my eating habits, stress levels, and lifestyle. She took the time to get to know all of my habits so I could make choices that were more conducive to pregnancy. Her assessing my overall well-being made me feel really comfortable and taken care of."
The acupuncturist advised once-a-week acupuncture sessions and dietary adjustments. Five weeks later, Stacy got her second surprise: She was pregnant. Stacy and Mike welcomed a healthy baby boy into the world in November.
Emma Semmpala is associate director of the Center for Compassion and Altruism Research and Education at Standford University and a research scientist and honorary fellow with the University of Wisonsin-Madison's Center for Investigating Healthy Minds.