I guess I had a vague notion of what “integrative medicine” is, but Dr. Perlman set me straight on what it is and what it isn’t. It is a combination of Western “scientific” medicine and Complimentary Alternative Medicine. More and more medical schools, hospital and individual physicians have embraced integrative medicine over the last two decades. A 1993 study published in the New England Journal of Medicine gave integrative medicine a big boost and revealed that about a third of the American population had resorted to alternative treatments: acupuncture, massage therapy, yoga, nutrition, fitness, meditation, mindfulness retreats, journaling, chiropractic to name only a few.
Since then about 60 academic health centers have formed the Academic Consortium for Integrative Medicine and Health. Duke University has played an important role in giving this movement impetus and has built a state of the art facility for the practice. Other prominent members of the Consortium include Johns Hopkins, Georgetown, and Mayo Clinic. Trained in Boston, Adam Perlman came to Duke in 2011 as Executive Director of Duke Integrative Medicine and also leads the Duke Diet and Fitness Center as well the Duke Health and Fitness Center. Toward the end of the program, Jim Leak in his usual exuberant manner testified to the effectiveness of the Health and Fitness Center. One would never believe that Jim once weighed in—if I heard him correctly—at 235 lbs. One can only imagine the costs of the new wardrobe, but worth every penny!
Perlman contends that health is not just the absence of disease in which medicine strives to get measurements of blood pressure or glucose levels back to normal. Integrative medicine attempts to develop a sense of well-being often depending on diet but also can have spiritual and emotional dimensions. It emphasizes prevention rather than treatment.
The major health costs in this country—70%–go for diabetes, heart disease, asthma, high blood pressure and depression. And each of these is potentially preventable through changes in diet, exercise, cessation of smoking, good sleep, moderate alcohol consumption.
Integrative Health affirms the development of a sound relationship between provider and patient. The pop in-pop out practice that we traditionally experience doesn’t lead to meaningful relationships. The leading complaint by patients is not having enough time to discuss their health concerns. The typical encounter between patient and provider in integrative medicine is from 30 to 60 minutes. Beyond that, openness between provider and patient is also important. Integrative medicine encourages patients to share in decisions about their health.
The Q&A session led to some interesting and sometimes amusing moments. In a question about herbal medicines, Perlman said they can help but the body doesn’t really recognize the difference between them and manufactured medicines. What diet is most effective? Perlman says he uses a modified Mediterranean diet but lifestyle modification is important. In a light moment, a visiting physician whose name and whose age did not diminish his nimble mind said he saw a lot of women during his practice who presented with stomach complaints. The cause, it turns out, is that their husbands were about to retire! I don’t suppose there is a better example of what integrative medicine can expose.
Submitted by Allen Cronenberg