PCM1: Introduction to Integrative Medicine Eugene Lee, MD, RYT Assistant Professor Loyola Department of Family Medicine

Objectives Define and differentiate Integrative Medicine from Complementary and/or Alternative Recognize the approach of Integrative Medicine Discuss the impact of Integrative Medicine on society and in medicine Learn some skills for yourself Derive Enjoyment at least once in the next hour

Outline Define Integrative Medicine Application of Integrative Medicine Fundamentals of recommending a technique or product Effects of Integrative Medicine in Medicine Social Implications and Challenges

Definitions: Old terminology Alternative Medicine: “instead of” Complementary Medicine: “in addition to”

Defining Terms: Current terminology “Integrative Medicine and Health reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic and lifestyle approaches, healthcare professionals and disciplines to achieve optimal health and healing.” Academic Consortium for Integrative Medicine & Health

What does Integrative Medicine Include? National Center for Complementary and Integrative Health (NCCIH): Whole Medicine Systems Mind-Body Medicine Biologically Based Practices Manipulative and Body Therapies Energy Therapies

1: Whole Medical Systems Homeopathy Naturopathy Traditional Chinese medicine Ayurveda Shamanism More

2: Mind-Body Medicine Meditation Prayer Art/dance/music therapy Hypnosis / Guided imagery Biofeedback Yoga Cognitive-behavioral therapy Journaling More

3: Biologically Based Practices Dietary supplements (vitamin and minerals) Herbal/animal supplements Probiotics

4: Manipulative and Body-Based Practices Spinal manipulation (both chiropractic and osteopathic) Craniosacral therapy Massage Rolfing Zero Balancing Trauma Releasing Exercises More

5: Energy Therapies Qigong Reiki Therapeutic touch Healing Touch Quantum Touch Electromagnetic therapy More

Recent NCCIH Taxonomy 2 subgroups Natural Products – biological based practices Mind and Body Practices – mind body medicine + manipulative therapies Recognizes “Other Health Approaches” – Whole Medical Systems + Energy therapies

POP QUIZ! Everyone take out a piece of paper and number it 1-10.

Mind Body Exploration - Breathwork Diaphragmatic Breathing

Breath work 4-7-8 breathing

Outline Define Integrative Medicine Application of Integrative Medicine Fundamentals of recommending a technique or product Effects of Integrative Medicine in Medicine Social Implications and Challenges

Options available in Integrative Care

What is an integrative approach? The VA example - Whole Health

Whole Health/Integrative Medicine addresses 70% Health Care alone = 10% Whole Health/Integrative Medicine addresses 70% Sandra Braunstein, and Risa Lavizzo-Mourey 2011

Maximizing the Mind-Body Connection

The Good (Placebo), the Bad (Nocebo), the Ugly (Lying?) Ted Kaptchuk – Harvard Researcher who does open label placebo research Kam-Hansen S, Jakubowski M, et.al. “Altered placebo and drug labeling changes the outcome of episodic migraine attacks.” Science Translational Medicine. 2014 Jan 8;6(218):218ra5

The Power of You Rakel DP, Hoeft TJ, et.al. Practitioner empathy and the duration of the common cold. Family Medicine. 2009 Jul-Aug;41(7):494-501 A empathetic clinician correlated with 1 day shorter cold duration and less severe symptoms.

Outline Define Integrative Medicine Application of Integrative Medicine Fundamentals of recommending a technique or product Effects of Integrative Medicine in Medicine Social Implications and Challenges

ECHO Efficacy Cost Harm Opinion

Experiential: Body awareness

Why care about integrative medicine? Define Integrative Medicine Application of Integrative Medicine Fundamentals of recommending a technique or product Effects of Integrative Medicine in Medicine Social Implications and Challenges

Use of Health Care <- Petterson, et.al Jan 2018

Most recent Blood Pressure Treatment Guidelines -> Integrative Medicine Becomes Standard of Care Medicine Most recent Blood Pressure Treatment Guidelines -> When did the American Heart Association add “lifestyle habits” and “nonpharmacological therapies” to the Guidelines?

In 2017, about 1 out of every 8 people you meet do yoga and meditation

Difficult to treat conditions via traditional medical models seem to respond well. www.bravewell.org, 2012

Resources to learn about Integrative Medicine Integrated Medicine for the Underserved (IM4US) Academic Consortium for Integrative Medicine and Health VA: Whole Health University of Wisconsin Integrative Health Program University of Arizona: Center for Integrative Medicine National Center for Complementary and Integrative Health

Outline Define Integrative Medicine Application of Integrative Medicine Fundamentals of recommending a technique or product Effects of Integrative Medicine in Medicine Social Implications and Challenges

Good Research Barriers

Is there anything wrong with these photos?

Experiential

Resources www.fammed.wisc.edu/integrative http://www.fammed.wisc.edu/mindfulness-meditation-podcast-series/ tinyurl.com/uwmindfulpodcast VA website http://projects.hsl.wisc.edu/SERVICE/main_login.php Natural Standards Database https://naturalmedicines.therapeuticresearch.com/ Consumerlab.com tinyurl.com/KPHealthJourneys

References Petterson S, McNellis R, Klink K, Meyers D, Bazemore A. The State of Primary Care in the United States: A Chartbook of Facts and Statistics. January 2018.