It’s no surprise that the first talk is the
science of connection because at the end of the day, it’s all about love. It’s my honor
to do Dr. Lee Lipsenthal’s talk this morning. Hopefully, I’ll make it through it. The Cartesian Model
I didn’t know this, but Lee told me that the model of health care that we practice is called
the Cartesian Model of Health Care. Has anyone else ever heard this before? Am I just the
only one? OK, a lot of smart people out there. I guess I’m just the only one who never heard
of it. Of course, this is the model we learned in medical school, the model that works really
well for acute life threatening emergencies. As you’ll see in a few minutes, everyone has
to agree, it’s based on a disease care system. It’s certainly not effective for treating
or preventing the chronic diseases that we see, many of us, every day in our practice. 1910 – Abraham Flexner
It all began, I think, in 1910, when Abraham Flexner was commissioned to come up with a
paper that said what should go into medical schools, how should we accredit medical school,
so on and so forth, what do we do with medical education in the United States and Canada.
This report was actually commissioned for the Carnegie Foundation for the Advancement
of Teaching. Right there, we hit, for the first time, in
1910, a reductionist approach to health, because what made it into that paper, and what didn’t
make it into that paper, were totally separated forever, until things are starting to come
back now through holistic integrative medicine. Things like homeopathy were really battered.
Chiropractic survived by hanging on by their nails.
It was truly a start of a reductionist approach, limiting what we do and when we do it. The
Great Depression/The War Against Disease Then we had the Great Depression. And, the
Depression led to one good thing, perhaps, which was, let’s get all Americans covered
in their old age so they don’t have to worry about, in their golden years, being sick and
not having health care. That led, ultimately, to Medicare. The problem with that is Medicare
led to, “We’ll pay for this, and we won’t pay for that.”
Again, we hit this reductionist approach, saying, “We’ll pay for your surgery, we’ll
pay for some drugs, we’ll pay for physical therapy, but we’re not going to pay for your
exercise, your nutrition, your acupuncture, your homeopathy, and so on.” We ended up with this very big, what they
call the “war against disease.” Money started to pour in. After the advent of penicillin,
money started to pour in for scientific research. Again, that’s not a bad thing. Medical education
was really focusing on the basic sciences, because at the time everyone believed that
you can cure one thing with a magic bullet. They didn’t realize that this is about microbiology
and microbes. It’s not necessarily about complex human beings. But that led to this big focus
on the basic sciences, the founding of penicillin, the magic bullet mentality toward illness.
We’re going to fix everything with one thing. This was a real big hit for holism. It was
a huge hit, because we went on this path of, “Let’s keep identifying disorders and drugs,
disorders and drugs.” The growth of the industry
At the end of the day, we ended up with insurance companies. For those of you who were in our
pre con yesterday, you heard a lot about the evils of insurance companies. We ended up
with third party payers, huge growth of hospitals, rapid increase in research which was OK and
a lot of money being spent on health care. One thing we weren’t seeing along the way
was necessarily improved outcomes. Managed Care
When it started to become too expensive, the concept of managed care came in. If there’s
anything that’s going to battle the concept of treating the whole person, it’s probably
managed care, which came in to say, “Let’s slim it down,” leading, again, to a further
reduction in services. Artificial Nature of Diagnostic Categories
For 100 years, if we look at the history of medicine, we ended up with the elimination
of therapies and treatments. We ended up with a reduction of services offered and paid for.
We ended up devaluing time with the practitioner. Now, they say you can code for your extra
15 minutes of time. We ended up putting high tech and pharmaceuticals on a platform, and
we started to just label things. It had to have an ICD 9 code to be billed,
and therefore we would get paid for it. And, that’s the model that has happened.
Strengths of Western Medicine Some of you know this, but I trained as an
Interventional Cardiologist. I used to put 700 stents in a year. Obviously, I’m not one
to bash Western medicine. This is where we’re gray. Truthfully, if you have a heart attack,
a stroke, you need a diagnostic or a surgical procedure, that’s maybe not the time that
you want to start aromatherapy. You might, for relaxation, but you certainly want to
do it in a trauma center, right? This is where we’re good. This is what happened to us over time. Now
all of you know this, we were trained…What’s our first question? “What is your chief complaint?”
Right away that implies you’re coming to me sick. You’re broken, something’s not right.
The good news about the way we were trained in the acute care model, it gets us right
to the diagnosis and treatment. We go, “chief complaint, history, diagnosis and treatment.”
Somebody comes in with chest pain, want to make the diagnosis of “heart attack,” want
to get the aspirin, nitro, stent, angioplasty and everything in place. That’s how we were
trained to practice. So we arrive at the diagnosis very quickly.
It begins in the acute setting, leads to rapid treatment. These are all the good things.
We lock down the issue, come up with a plan and away we go. That’s good for acute care.
You can’t breathe, we probably want to do that. The problem becomes when we take this
model and we apply it to prevention. That certainly doesn’t work there and we try to
apply it for chronic long term health issues. We end up with it looking like this, somebody
comes in, they say, “I’m depressed” or “I’m feeling blue.” We make the diagnosis, “They’re
depressed. I know what to do.” “I’m going to give Effexor.” “I’m going to give Prozac.”
“I’m going to give something.” We make the diagnosis. We have an ICD9 code
and we think we’re ready to go. The Challenge
We get paid for the diagnosis, but I will tell you this, the biggest learning curve
I had when I was sitting where you’re sitting, in the year 2000, was when I took my first
ABIHM Board exam. I had to make this transition from the “ill to the pill,” the quick jump.
“Oh, depression? Prozac.” “High cholesterol? Lipitor.” “High blood pressure? ACE Inhibitor.”
I had to make this transition to asking the question, “Why?”
“Why is someone depressed?” Just because you name it does not mean you know how to treat
it. Is the depression because they’re sitting in the dark all day? Is it because they have
vitamin D deficiency? Is it because their dog just died? Is it situational?
You don’t treat people who need light therapy with Prozac, right? Getting to the underlying
cause, asking why someone’s diabetic, why someone’s hypertensive. This does not come
out of our Western Allopathic model. We truncate the story, “chief complaint, history of present
illness, diagnosis and treatment.” The Story is Truncated
What about the human being that’s sitting there? What about this person’s family history?
What about what they’re eating? What about the supplements that they’re taking? Where
are they emotionally, mentally, spiritually? My fellows do something like this. This is
their presentation. “65 year old man…the echo shows.”
“The echo shows”? What happened to the whole person in between the “65” and the “echo machine”?
It’s gone and one of my fears with…I’m not against technology, but if we start approaching
people like that, we’re missing the big picture. The Results of Using the Acute Care Model
We make a diagnosis by the organ system. Little attention is paid to the story, beyond the
chief complaint and the history of present illness. The patient’s whole story is not
understood and each issue becomes a billable diagnosis in isolation from all the others.
You guys know what I’m talking about. You have reflux, you have depression, you
have diabetes, you have hypertension and by the way, none of these just happen to be connected.
That’s a problem. It looks like this. We have the “ill to the pill.” Here it is. You have
Irritable Bowel Syndrome, you get Hyoscyamine. You have arthritis, you get an NSAID. You
have a migraine, you get a Triptan. You have high cholesterol, you get a Statin. You have
reflux, you get an H2 blocker. You’re depressed, you get an SSRI.
This is where we’re at. What’s really striking is we spent $308 billion last year on what?
Pharmaceutical therapies. The United States, North America, consumes about 50 percent of
all the pharmaceuticals made for the entire world. What did we just learn, Scott? $14.6
billion on anti psychotics, $10 billion on antidepressants, $13 billion on statins, and
$10 billion on PPIs, protein pump inhibitors which, by the way, we’re giving to infants
and children, and I have a problem with that. Think about it. The United States of America
is psychotic, depressed, has high cholesterol and heartburn. Now, some people are looking
at me, they’re giving me a hard time energetically, but this is where it’s at.
Conventional : Holistic/IM This is my list that I thought about a number
of years ago. I said conventional medicine, holistic integrative medicine, how did they
really differ, for me, personally, as a cardiologist? I was taught to be reactive you’re having
a heart attack, get your stent, your nitro, your Effient, everything you need. I was not
at all taught to prevent heart disease, the concept of being proactive.
I was born in a disease driven model, not a prevention model. I was taught to treat
the heart people are shocked when I’m asking them about their life, who they live with,
what they eat. They say, “Aren’t you the heart doctor?” I say, “Yeah, but it’s all connected.”
Treating the whole person was not something I was really taught to do. I was taught to
treat symptoms again, if you have high blood pressure, here’s your pill for high blood
pressure. I wasn’t taught to get to the underlying cause.
These are shifts I’ve made over the last 10 years. Now, if somebody comes to me with high
blood pressure, the first two things I’m thinking how much Campbell’s soup are they eating,
how stressed are they, where’s the salt coming from, are they exercising, are they overweight?
What’s the underlying cause of the problem? How do we motivate people by feeling good?
Fear is not a motivator. We’re all going to die. It is not a motivator. Feeling good is
a motivator, no doubt about it. One of the areas that really took a big hit
during managed care medicine is the concept of spirituality being connected to health.
I remember, when I arrived at Scripps, I was told they’d just fired or they no longer were
going to have chaplains. They also got rid of the psychiatrists, too, because I guess
they kept it at the same ilk, because they decided they didn’t make money. All they wanted
to do was take the physical body and cut out the spiritual and so on.
Also, one of the things I’ve learned to really focus on is quality of life. I can keep people
alive in the ICU on tubes and catheters forever, but quality of life, what I’ve learned from
my patients, is what they really want. From the ABIHM & AHMA
This is going to be a different week for you guys. When’s the last time you went to a medical
conference and people are saying, “All you need is love”?
The 10 Principles of Integrative Holistic Medical Practice
In case you haven’t noticed, this is going to be a different kind of week, because all
of the board and the people who practice integrative holistic medicine recognize that we have to
care for the whole person body, mind, and spirit. We recognize that the emotional, mental,
and spiritual aspects of healing cannot be separated from the physical. It’s not possible.
One of our key focuses is on prevention how do we keep people healthy in the first place?
As an integrative holistic practitioner, we hope that you will consider focusing on health,
prevention of illness, and raising awareness of disease in our lives rather than just merely
managing the symptom. How do we do it? We do it by looking at contributing
factors that are leading to illness. How do we modify them? How do we enhance someone’s
life to optimize their future wellbeing? How do we get people to be whole, or as whole
as they’re ready to be? Tree of Life
This is the way I put it to my patients. I tell my patients, “If you have a sick tree,
if your tree is sick, what are you going to do with it?” They say, “More water, better
soil, all sorts of things. Put it in the sun. Give it plant food.” Then, why, in medicine,
do we label our branches things like “heart disease” and “diabetes”? Then we go up and
we bypass the branches, and we cut them off or we drug them.
This is the way I teach it to my patients now. I say, “If you want to have healthy fruit,
you need to think about micro and macro nutrition, physical activity, sleep, getting toxins out
of your life. You need to look at where you are emotionally, mentally, spiritually, how
you’re connected to community, how you’re connected to the planet, what is your purpose
in life.” These are all the things that interact with your genes imagine this is your DNA that
lead to either sick or healthy fruit. The leap you make this week is you go from
treating up here to looking down here, because every lecture you will hear this week will
be focusing on these various aspects of health and healing.
One of our goals in holistic integrative medicine is optimal health. This is what we want to
have for our patients. I like this pyramid as well, as a little bit
of a diagram, because it reminds us what is really important for optimal health. It’s
not drugs and surgery. We need them when we need them, but at the end of the day, we’re
humans. We need clean air. We need clean water, proper nutrition, love, touch, spirituality,
and so on. We need to think about it a little bit differently.
Optimal Health=Happiness When I think about the research you’re going
to hear this research all week. You’re going to hear how important it is to deal with the
emotional and mental aspects of health, because there’s a lot of research that tells us that
anger makes you sick. 70 to 90 percent of visits to health care providers are from stress
related disorders. Yes, 70 to 90 percent. Being socially connected. You know, what Sachidananda
said: The “i” in illness is “isolation.” The “we” in wellness is “we.”
Are we physically active? Where are we at spiritually? What the research shows is that
people who have a connection to a higher power have much less issues with cortisol, higher
levels of DHEA, and have healthier behavior patterns.
All of these things are important in healing. This is something I learned on my journey.
All life experiences, including birth, joy, suffering, and the dying process, are learning
opportunities for patients and health practitioners. I wasn’t taught that in medical school. I
was taught to run away from the dying process as fast as I could. I never was comfortable
with it. My goal was to keep people alive. That’s what
I do. Reality is healing is different from curing. I’ve had to learn that all of these
events major life events, in my life and my patient’s lives, are all part of our opportunity
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