Integrative medicine may not be covered by your insurance plan, but the practice is gaining momentum in the industry and it mirrors a tenant of health-care reform: patient-centered, well-dialogued care.

Advocates describe Integrative Medicine (IM), also called complementary or alternative medicine, as a practice that focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, health-care professionals and disciplines to achieve optimal health and healing. Integrative care combines conventional Western or allopathic medicine with treatments like herbal medicine, acupuncture, massage, biofeedback, yoga and stress reduction techniques.

More than 30 years ago, it was rare for hospitals to offer IM, but research funded by the National Institute of Health [NIH] has done much to prove its effectiveness and safety. This testing has fostered tremendous growth in the hospital community and at hospitals in academic medical centers.

According to the American Hospital Association’s most recent statistics, approximately 21% of community hospitals reported inclusion of IM therapies in 2008, up from almost 9% in 1999.

Also, today, many medical schools are offering electives in integrative therapies. Since 1999, the Consortium of Academic Health Centers for Integrative Medicine has grown from eight institutions to 46, according to Executive Director Janet Polli.

The Emergence of IM Practices

The Duke Center for Integrative Medicine, a consortium member, was established at Duke University in 2008.

“We needed to include the full breadth of health care and healing,” says spokeswoman Isabel Geffnerd. At Duke, health care teams of doctors, nurses, nurse practitioners and health coaches work with participants to customize long-term health plans, further healing following a major medical or life event and support healthy lifestyle changes.

Duke’s leadership explored what an integrative practice would look like, both its infrastructure and its physical space. “We wanted something to model the transformation of health care and translate our work and advocate for its efficacy to policy makers and insurance and health care providers to prove that it is translatable to larger systems," says Geffner.

The public, however, was already convinced.  But public demand does not necessarily equate with safety or effectiveness.

Dr. Robert Saper, a research faculty member at Boston Medical Center’s family medicine department, noted, for example, that some eastern medications, among them some drugs from India, are not safe because of their elemental components of lead, mercury and arsenic.

 Dr. Tom Delbanco, a Harvard Medical School professor who practices at Beth Israel Deaconess Medical Center, is angered by public exposure to unsafe medicines or practices reinforced by the danger of holistic practitioners “promising things that are not backed by real fact.”

Saper adopts a more moderate view: “We cannot look at these approaches with simplistic eyes. A careful, skeptical approach is necessary in both alternative and traditional therapies.”

IM is often helpful when used with mainstream medicine, not as a replacement, Saper says. In fact, research has proved that tai chi can improve chronic back or fibromyalgia pain, decreasing the reliance on medication and the costs associated with it. Massage can relieve pain and fatigue, and acupuncture, which is also used by the military in the field, according to Geffner, can help nausea for cancer patients.

 “It’s unlikely that any of these treatments will cure a disease; however, they may play an important role in alleviating symptoms,” according to Saper. “These therapies can also improve stress or foster compliance to difficult treatment regimens and are helpful adjuncts to pharmacological therapy.”

Cost matters

But IM therapies are generally not covered by insurance and often extract a high cost, particularly because they require repetition and regularity for effectiveness. Critics like Delbanco contend that they are accessible mainly to the wealthy.

“I tell people to submit cost for therapies like Reiki and other alternate practices to insurance,” says Geffner. Eventually usage may inform policy.

While Saper shares Delbanco’s concern that barriers to treatment exist particularly for the urban underserved, Saper said Boston Medical Center, also a consortium member, is targeting research on minority populations. “If it [IM] is going to be offered to middle income populations we believe it should be offered to people with less discretionary income.” A current undertaking involves providing yoga as a treatment for back pain to a control group of Boston residents whose gross family incomes are less than $20,000.

IM  a top strategic initiative

Meanwhile, in New Jersey, Atlantic Health System is also democratizing IM at its four residential community locations. “We knew we were making strides when we received the recognition and support of our cardiac surgery team, who acknowledged that their patients were getting relief,” says Emilie Rowan, manager of integrative health at Atlantic Health.  “The docs started to refer patients to us.”

Atlantic Health continues to evolve its program, focusing on a health and wellness program that reaches out to people in the community, improving, nurturing and allowing local residents to “experience at an affordable cost a different relationship with their hospital.”



The positive placebo

Rowan touts the benefits of human touch and contact that patients receive from IM.

“Those components alone help a person feel or do better. Yes, it’s the placebo effect, when you feel better because you believe that something will heal you. There’s considerable research on the benefits of that.

“Then, too, with massage or Reiki we can work on someone with a high level of pain and in 20 minutes that person will be asleep. That kind of sleep is a great gift for patients.”