1. Integrative Medicine What is it? Why do we care?

2. A Rose by Any Other Name...

3. “Alternative Medicine” o Implies this is being used instead of traditional/allopathic approaches o Potential for harm, if potentially effective treatment is not considered

4. “Complementary” Medicine o Implies it is used to “complement” traditional/allopathic approaches o Implies it is secondary, of less importance or effectiveness

5. “Integrative Medicine” o “The practice of medicine that 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 approaches, healthcare professionals, and disciplines to achieve optimal health and healing. o The Consortium of Academic Health Centers for Integrative Medicine

6. “Integrative” Medicine = Good Medicine o Focus on wellness as well as disease management o Integrates the best of all the available modalities o More options for effectiveness o More options to minimize toxicity o More options to meet patient preferences/provide patient-centered care o A little comment on my own journey...

7. So What Do You Integrate? o The Classic Biopsychosocial Model that Family Medicine adheres to... i.e. addressing the whole patient in their social and family context. And using an expanded toolkit....

8. The Expanded Toolkit o Allopathic and osteopathic approaches o Medical o Surgical o Manipulative o Mind-Body (and Spirit?) o Nutritional Medicine/Functional Medicine o Herbal Medicine o Modalities from other cultures: o Acupuncture o Ayurveda o And More?....

9. Why here and now? o My own opinion: it is the face of medicine to come because it works. o Mainstream medicine is failing in chronic disease management o It is “sexy” – attractive to patients and to prospective residents o It is the reality of what our patients are doing and we might as well offer them some guidance

10. Some Teaching Points for Discussing Integrative Medicine with Residents...

11. Keep your mind open, but not so open that all your brains fall out.... The same evidence-based approach that we use for evaluating any intervention applies to these Caveat: there may only be small or older studies because of research funding priorities/profit motives

12. Physician, Heal Thyself o Most of the chronic diseases we are treating are lifestyle diseases o We cannot be good lifestyle coaches to our patients if our lifestyles are not healthy o Medical training promotes a toxic lifestyle ⁂ Resident wellness will be a part of the curriculum we offer

13. The Rules of Tacks o If you are sitting on a tack, it takes a lot of aspirin to make the pain go away. o If you are sitting on 2 tacks, removing one does not lead to a 50% improvement in symptoms. -Syd Baker, M.D. This is helpful to guide resident thinking as well as to help with patient education about the impact of their own behaviors on their illnesses.

14. And a Side Note on Functional Medicine o Science-based o Personalized medicine that deals with primary prevention and underlying causes instead of symptoms for serious chronic disease o Environmental inputs - diet, nutrients (including air and water), exercise, and trauma are processed by one’s body, mind, and spirit through a unique set of genetic predispositions, attitudes, and beliefs

15. Principles of Functional Medicine o Biochemical individuality o Note applications in pharmacotherapy o Patient-centered medicine o emphasizes "patient care" rather than "disease care" "It is more important to know what patient has the disease than to know what disease the patient has.” Sir William Osler o Dynamic balance of internal and external factors. o Web-like interconnections of physiological factors o E.g. immunological dysfunctions can promote cardiovascular disease o Dietary imbalances can cause hormonal disturbances o Environmental exposures can precipitate neurologic syndromes such as Parkinson’s disease. o Health as a positive vitality – not merely the absence of disease. o Promotion of organ reserve as the means to enhance health span.

16. Core Clinical Imbalances o Hormonal and neurotransmitter imbalances o Oxidation-reduction imbalances and mitochondropathy o Detoxification and biotransformational imbalances o Immune imbalances o Inflammatory imbalances o Digestive, absorptive, and microbiological imbalances o Structural imbalances from cellular membrane function to the musculoskeletal system

17. Psychological and Spiritual Equilibrium Hormone and Neurotransmitter Regulation Detoxification and Biotransformation Structural/Boundary/ Membranes Immune Surveillance and Inflammatory Process Digestion and Absorption Oxidative/Reductive Homeodynamics © Copyright 2008 Institute for Functional Medicine _____________________ _____________________ _____________________ Antecedents (Predisposing) __________________ __________________ Triggering Events (Activation) __________________ __________________ __________________ The Patient’s Story Retold ____________________ ____________________ ____________________ ExerciseNutrition StatusBeliefs & Self-CareSleepRelationships Date: ____ Name: ___________________ Age: _____ Sex:______ Chief Complaints: ____________________________________ FUNCTIONAL MEDICINE MATRIX MODEL™