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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 to...
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