Meeting Report

A Review of a Historical Summit on Integrative Medicine

Dana Ullman

Homeopathic Educational Services Berkely California USA

The US Institute of Medical sponsors a lsquolsquoSummit on Integrative Medicine and the Health of thePublicrsquorsquo on February 25ndash27 2009 A prestigious body of speakers and attendees created adynamic conference in which the content and discussions provided vital information for trans-forming the US health care system Topics included patient-centered care the scientific basisof integrative medicine health care financing reform and value-driven care and mind-bodyrelationships and health

Keywords mindbody medicine ndash healing ndash patient-centered care ndash health care reform ndashcost-effectiveness ndash wellness

The Institute of Medicine (IOM) is considered Americarsquospreeminent body of physicians scientists and academi-cians interested in health and medical issues It is apart of the United States National Academies whichalso includes the National Academy of Sciences TheIOM produces independent recommendations andpolicy reports by enlisting various experts to addressthe scientific and technical aspects of some of societyrsquoshealth problemsOn February 25ndash27 2009 the IOM convened a

lsquoSummit on Integrative Medicine and the Health of thePublicrsquo at its headquarters in Washington DC Approxi-mately 600 people participated in this historic meetingwhich included a wide variety of experts in integra-tive medicine as well as people in leading positions ingovernment industry and academia This summit wasco-sponsored by the Bravewell Collaboration a founda-tion composed of leading philanthropists dedicated totransforming the culture and delivery of health careThe summit content and discussions provided vital

information for transforming the US health caresystem Topics included patient-centered care the scien-tific basis of integrative medicine health care financingreform and value-driven care and mindndashbody

relationships and health Prior to the conference theIOM commissioned several papers to provide back-ground information on integrative medicinersquos perfor-mance in prevention and wellness patient-centered careresearch public education professional education andeconomics and policy

The Players

The speakers at this summit included many of the move-mentrsquos high profile leaders including Dean OrnishMehmet Oz and Kenneth Pelletier Evidence of the inter-est in the broad field of integrative medicine was theinclusion of the program of Thomas Donahue (the CEOof the US Chamber of Commerce) George Halvorson(chairman and CEO Kaiser Foundation Health Plan)Senator Tom Harkin (Iowa) Bill Novelli (CEO AARP)and Reed Tuckson [Chief of Medical Affairs UnitedHealth Group a major health maintenance organization(HMO) and former Senior Vice President AMA] Otherspeakers included Mimi Guarneri (cardiologist andmedical director of the Scripps Center for IntegrativeMedicine) David Katz (internist and founder of YalersquosPrevention Research Center) Victor Sierpina (Universityof Texas) Victoria Maizes (University of Arizona)Tracy Gaudet (Duke University) and Josephine Briggs(Director NIHrsquos National Center for Complementaryand Alternative Medicine) The chairperson of the

For reprint and all correspondence Dana Ullman MPH PresidentHomeopathic Educational Services 2124 Kittredge St Q BerkeleyCA 94704 Tel +1-510-649-0294 Fax +1-510-649-1955E-mail danahomeopathiccom

Advance Access Publication 31 August 2009 eCAM 20107(4)511ndash514

doi101093ecamnep128

The Author 2009 Published by Oxford University Press All rights reserved For permissions please email journalspermissionsoxfordjournalsorg

planning committee for the conference was the eminentRalph Snyderman Chancellor Emeritus Duke UniversityPerhaps most impressive of all was the audience itself

who consisted of many health and medical experts whooften serve as keynoters at health conferences includingJeffrey Bland Jon Kabat-Zinn Larry Dossey WoodsonMerrill and Wayne Jonas as well as dozens of professorsof medicines who teach at leading medical schools nat-uropathic nursing acupuncture and chiropractic colleges

The Presentations

Harvey Fineberg the president of the IOM welcomedattendees and acknowledged that integrative medicine isa bit like a Rorschach blot test because it meaning seemsso variedRalph Snyderman gave the opening address expressed

concern about the state of medicine today He assertedlsquono other industry holds its customers in such high dis-regard except perhaps the airline industryrsquo He describedhealth care today as uncoordinated disease-orientedreactive physician-directed not personalized or safeand extremely expensive Snyderman expressed hisstrong appreciation for modern medical science but hehumbly acknowledged that most drugs and technologieshave not been proven efficacious and that at best it mayonly impact 25 of modern health concernsReed Tuckson who represents one of the large HMOs

warned attendees that we all may want health carereform but whatever changes we want must have evi-dence of benefit He urged scientific inquiry as well asevaluation of demonstration projects He however alsonoted that lsquothe enemy of the good is the perfectrsquo and wecannot wait until all of the evidence is in or that there iswide consensus before we begin to make serious changesTuckson also reminded the audience that virtually everypatient wants every treatment that they receive to becovered by their insurance and yet third party payerswill always insist upon seeing lsquoevidencersquo of benefitbefore allowing coverage This requirement is not onlyreasonable but also necessary and yet later discussionnoted the great number of conventional medical interven-tions that are both very expensive and do not haveadequate evidence of benefitKenneth Pelletier echoed a similar viewpoint by assert-

ing lsquotrust in God but everyone else must present datarsquoPelletier noted that we may not necessarily need newmonies in health care but just better allocation of presentresources Because so many high-tech methods presentlyused have not yet been proven efficacious there are greatsavings to be obtained by no longer providing reimburse-ment for questionably effective (and expensive) healthinterventions Pelletier has served as a consultant tomany major American corporations who have developedvarious disease prevention and health promotion

programs for their employees He noted that 62 of 63studies of cost-effectiveness cost benefit and return oninvestment have shown positive results (1) Accordingto his review of this research a return on investmentfor health programs usually takes only 325 yearsFurthermore evidence-based return on investmentranges from $350 to $490 for every $100 investedBill George a professor of Business Management at

Harvard Business School was the CEO President andChairman of the Board at Medtronic Inc the largestmedical technology company in the world that beganby creating heart pacemakers His wife Penny Georgewas past President of the Bravewell Collaborationco-sponsor of this Summit and the George FamilyFoundation has been a leading supporter of manyBravewell efforts Bill George spoke about his personalexperience at Medtronic during his presentationHe insisted that it was important for employers toreward good healthy behaviors rather than punish badones He noted that his company gave employees$50month ($600year) for complying with some healthybehaviours He also noted that a gym is not a perk of anoffice but is a necessary component of it

The Most Powerful Presentation

Dean Ornish made what many attendees considered to bethe most powerful presentation of the summit as wasevidenced by the largest number of people in attendancegiving him a standing ovation for a prolonged periodof time He described his and many others researchthat showed significant changes in the health status ofpeople suffering from many of the leading causes of mor-tality in the USA Ornishrsquos own research has shownthat significant changes in dietary and exercise were sub-stantially effective in improving health status in peoplesuffering from cardiovascular disease and prostatecancer Furthermore he noted that the minor dietaryand exercise recommendations of the American HeartAssociation and the National Cancer Society weresimply inadequate to create significant positive resultsthereby leading to poor compliance due to the smallhealth improvementsOrnish noted that the World Health Organization

ranked the US health care system in 2000 first in bothresponsiveness and expenditure but 37th in overall per-formance (2) This ranking suggests that simply spendingmore money on what we are doing now or making minorchanges in health reform will not provide the realimprovements that Americans want and need todayOrnish also made reference to one study in which curcu-min (an active ingredient in the herb turmeric) wasfound to have 2000 increase in bioavailability andtherefore significant better health benefits when usedwith a type of pepper used in curries Ornish sought to

512 Historical Summit on Integrative Medicine

warn attendees to avoid looking at studies that testsimply one ingredient Many recent studies for instancehave found little or no results from using vitamin C or Eor a single type of multivitamin when in fact mostnutritional-oriented physicians and practitioners do notlimit themselves to such single ingredient treatmentsOrnish also discussed several mindndashbody treatment pro-

grams including certain meditative visualization andyoga practices to improve health status and quality oflife for people suffering from a host of serious ailmentsHe also noted their importance for soldiers as they returnfrom combat operations usually suffering from post-traumatic stress disorders Many speakers made referenceto the challenge in health care today in which physiciansand other primary care clinicians do not have the time orexpertise to be their patientsrsquo lsquohealth coachrsquo There seemsto be a real need for a person on the health care teamwho works personally with the patient to help enactbehavioral changes that are health enriching Some atten-dees thought that psychologists might fill this role othersthought nurses may be best and others wondered if anew type of health professional was neededFurthermore Ornish reported on genetic research on

telomeres a gene associated with long life Ornishrsquosresearch published in Lancet Oncology discovered thatsignificant dietary changes had direct effects on telo-meres thereby verifying that our genetic heritage canbe influenced and changed (3) While our genes mayindeed have powerful effects upon our health and lifesuch influences are not in stone but can be transformedOrnishrsquos expansive message also included reference to

the provocative notion that a vegetarian diet is not onlyhealthier for people but also for our planet He notedthat livestock production leads to more global warmingeffects than all transportation sources combined

A View to and from the Hill

In recognition of the potential significance of the IOMSummit on Integrative Medicine two hearings on inte-grative medicine were held 2 days before the summitand on one of the days of the summit itself TheSenate Sub-committee on Health Education Labor andPensions held a hearing chaired by Maryland SenatorBarbara Mikulski and heard testimony from WayneJonas James Gordon Sister Charlotte Kerr Mary JoKreitzer and Cathy Baase corporate medical directorfor Dow Chemical Company Senator Harkin chairedthe second hearing of this same sub-committee withwhat some of us referred to as the lsquointegrative healthdream teamrsquo including Dean Ornish Andrew WeilMehmet Oz and Mark HymanThe third day of the summit began with a rousing

presentation from Senator Tom Harkin Harkin reportedon these Senate hearings noting that just that week

President Obama had asserted that health reform was a

major priority for him and for the American people and

that prevention and wellness programs have to have an

important place in this health reform President Obama

has also designated that over US$1 billion would be

devoted to outcomes evaluation for health and medical

treatment programs to begin to be evaluated to determine

what really works Harkin asserted lsquoAmerican always do

the right thing after they have tried everything elsersquo

Indeed Harkin has been a long-term advocate for inte-

grative health (although he originally expressed interest

and support for lsquointegrative medicinersquo an attendee sug-

gested to him what others at this Summit had previously

expressed lsquointegrative healthrsquo is more comprehensive

a term than lsquointegrative medicinersquo within the remaining

time of the QampA session with Harkin he referred to

integrative health) Harkin was the primary sponsor

that created the Office of Alternative Medicine as well

as the National Center for Complementary and Alterna-

tive Medicine Harkin also noted that the status quo

(which he also called the lsquostagnant quorsquo) has reimburse-

ment and incentive priorities in the wrong place Harkin

promised to make certain that these priorities be

changed

Personal Thoughts

The very concept of lsquointegrative healthrsquo is quite compre-

hensive and yet with respect to getting the biggest bang

for the buck we must honor the Hippocratic tradition

that asserts lsquoFirst do no harmrsquo How this translates into

health improvements is that we should explore and

exhaust safer methods first before resorting to the big

(and expensive) guns of medicine and medical technol-

ogy Also there is general recognition that we need to

move our thinking about health care where the physician

is at the center to where the lsquoPersonrsquo is at the centerSeveral speakers at this summit expressed the need and

the demand for lsquodatarsquo During audience participation

moments at this summit I voiced my concurrence but

I also voiced a warning In homeopathic and naturo-

pathic thought and practice there is a profound respect

for the lsquowisdom of the bodyrsquo If we set up clinical trials

that simply evaluate whether a treatment is effective in

getting rid of a symptom we may be discovering that this

treatment is effective but only in suppressing a symptom

and sometimes creating a more serious chronic ailment

rather than enacting a true cureWe therefore need to have clinical trials but they must

not only evaluate specific symptoms but also overall

health status They must not ignore side effects because

such new symptoms are not side effects at all they are

usually the direct result of a drugrsquos toxicity or its ability

to suppress the disease to deeper and more serious levels

eCAM 20107(4) 513

Furthermore when we seek lsquoevidencersquo we should notonly evaluate evidence obtained from randomizeddouble-blind trials but we should also evaluate evidencefrom outcome studies cost-effectiveness studies andwhen possible and appropriate basic science trials Weneed to remember that we today accept most surgicalpractices even though the vast majority of them havenot been proven to be effective based on double-blindplacebo-controlled trials Few people consider surgeryto be lsquounscientificrsquo just because it is not viable to conductplacebo-controlled trials And yet many physiciansscientists and health policy analysts assume certainthat some alternative treatment methods are unscientificbecause they too cannot be evaluated in placebo-controlled trials (how does one give a placebo meditationor a placebo yoga posture)Likewise many treatments that lsquointegrative practi-

tionersrsquo use comprise a lsquopackage of treatmentsrsquo thatinclude various dietary changes vitamin and mineralsupplements herbal remedies homeopathic medicinesyoga practice stress management methods and so onEvaluations of the outcomes of such packages of treat-ment are truly necessaryAt this summit there were several professors of genetics

and other basic sciences who discussed the most recentscientific discoveries in their fields However I was a bitsurprised at the casual reference to lsquogenetic causesrsquo ofillness and to new (and old) infective agents that lsquocausersquothis or that disease My concern here is that becauselanguage is so important it is necessary that we drawfrom systems biology and systems thinking to realizethat it is more accurate to say that these influences arelsquoco-factorsrsquo to diseases not causes of them The conceptof causality tends to be linear when in fact cause israrely so simple The susceptibility of the host alwaysinfluences whether infective agent leads to disease ornot and as Dean Ornish and others have now notedeven genetic status of an individual can be alteredFinally we must be more humble in how we all make

use of the words and concepts of lsquoscientific medicinersquoAn IOM special report lsquoInforming the Future CriticalIssues in Healthrsquo (published in 2007) noted that one-thirdof Americans today take five or more medications Andyet even if all of these drugs have been proven lsquoscienti-ficallyrsquo to work each drug was tested individually not incombination with one or two let alone five drugsFurthermore most of the studies conducted have notbeen on children or the elderly and yet the high quan-tities of drugs are prescribed them Still further discon-certing is that most medication is tested for very short

periods of time even though many drugs are used overyears or decades While such evaluations are complex anddifficult to conduct these issues simply mean that wemust remain humble in our sense of which drugs workwhen and for whomA report from the IOM on this summit is expected to

be published in late 2009 Because President BarackObama has placed health care reform as a major priorityof his administration the timeliness of this summit issignificant though it is uncertain what role integrativehealth thinking and practices will become a part ofObamarsquos initiatives Obama did however give us someinsight into his present thinking when in May 2009he responded to a question about acupuncturersquos role inhis health care reform plans Obama said lsquo[m]y attitudeis that we shouldmdashwe should do what works So I thinkit is pretty well documented through scientific studies thatacupuncture for example can be very helpful in relievingcertain things like migraines and other ailmentsmdashor areat least as effective as more intrusive interventions I willlet the science guide mersquo (4)

Important Online Links

To see agenda and presentation slides of the IOMSummit to watch the web cast of the summit and toaccess the commissioned papers that were availableprior to the start of the summit please visit httpwwwiomeduID=52555The US Senate hearing on integrative medicine by the

Committee on Health Education Labor and Pensionsin which testimony was provided by Dr Andrew WeilDr Mehmet Oz Dr Dean Ornish and Dr MarkHyman can be watched at httphelpsenategovHearings2009_02_262009_02_26html

References1 Pelletier K The Economics Institute of Medicine Summit on

Integrative Medicine and the Health of the Public February25ndash27 2009 Retrieved from httpwwwiomeduCMS28312525555992463468aspx (last accessed 19 August 2009)

2 World Health Organization Assess the Worldrsquos Health System PressRelease WHO44 21 June 2000 Retrieved from httpwwwphotiuscomrankingswho_world_health_rankshtml (last accessed19 August 2009)

3 Ornish D Lin J Daubenmier J et al Increased telomerase activityand comprehensive lifestyle changes a pilot study Lancet Oncol200891048ndash57

4 Obama Positive Toward Acupuncture Acupuncture Today 200910Retrieved from httpwwwacupuncturetodaycommpacmsatarticlephpid=31983 (last accessed 19 August 2009)

Received March 11 2009 accepted August 3 2009

514 Historical Summit on Integrative Medicine

planning committee for the conference was the eminentRalph Snyderman Chancellor Emeritus Duke UniversityPerhaps most impressive of all was the audience itself

who consisted of many health and medical experts whooften serve as keynoters at health conferences includingJeffrey Bland Jon Kabat-Zinn Larry Dossey WoodsonMerrill and Wayne Jonas as well as dozens of professorsof medicines who teach at leading medical schools nat-uropathic nursing acupuncture and chiropractic colleges

The Presentations

Harvey Fineberg the president of the IOM welcomedattendees and acknowledged that integrative medicine isa bit like a Rorschach blot test because it meaning seemsso variedRalph Snyderman gave the opening address expressed

concern about the state of medicine today He assertedlsquono other industry holds its customers in such high dis-regard except perhaps the airline industryrsquo He describedhealth care today as uncoordinated disease-orientedreactive physician-directed not personalized or safeand extremely expensive Snyderman expressed hisstrong appreciation for modern medical science but hehumbly acknowledged that most drugs and technologieshave not been proven efficacious and that at best it mayonly impact 25 of modern health concernsReed Tuckson who represents one of the large HMOs

warned attendees that we all may want health carereform but whatever changes we want must have evi-dence of benefit He urged scientific inquiry as well asevaluation of demonstration projects He however alsonoted that lsquothe enemy of the good is the perfectrsquo and wecannot wait until all of the evidence is in or that there iswide consensus before we begin to make serious changesTuckson also reminded the audience that virtually everypatient wants every treatment that they receive to becovered by their insurance and yet third party payerswill always insist upon seeing lsquoevidencersquo of benefitbefore allowing coverage This requirement is not onlyreasonable but also necessary and yet later discussionnoted the great number of conventional medical interven-tions that are both very expensive and do not haveadequate evidence of benefitKenneth Pelletier echoed a similar viewpoint by assert-

ing lsquotrust in God but everyone else must present datarsquoPelletier noted that we may not necessarily need newmonies in health care but just better allocation of presentresources Because so many high-tech methods presentlyused have not yet been proven efficacious there are greatsavings to be obtained by no longer providing reimburse-ment for questionably effective (and expensive) healthinterventions Pelletier has served as a consultant tomany major American corporations who have developedvarious disease prevention and health promotion

programs for their employees He noted that 62 of 63studies of cost-effectiveness cost benefit and return oninvestment have shown positive results (1) Accordingto his review of this research a return on investmentfor health programs usually takes only 325 yearsFurthermore evidence-based return on investmentranges from $350 to $490 for every $100 investedBill George a professor of Business Management at

Harvard Business School was the CEO President andChairman of the Board at Medtronic Inc the largestmedical technology company in the world that beganby creating heart pacemakers His wife Penny Georgewas past President of the Bravewell Collaborationco-sponsor of this Summit and the George FamilyFoundation has been a leading supporter of manyBravewell efforts Bill George spoke about his personalexperience at Medtronic during his presentationHe insisted that it was important for employers toreward good healthy behaviors rather than punish badones He noted that his company gave employees$50month ($600year) for complying with some healthybehaviours He also noted that a gym is not a perk of anoffice but is a necessary component of it

The Most Powerful Presentation

Dean Ornish made what many attendees considered to bethe most powerful presentation of the summit as wasevidenced by the largest number of people in attendancegiving him a standing ovation for a prolonged periodof time He described his and many others researchthat showed significant changes in the health status ofpeople suffering from many of the leading causes of mor-tality in the USA Ornishrsquos own research has shownthat significant changes in dietary and exercise were sub-stantially effective in improving health status in peoplesuffering from cardiovascular disease and prostatecancer Furthermore he noted that the minor dietaryand exercise recommendations of the American HeartAssociation and the National Cancer Society weresimply inadequate to create significant positive resultsthereby leading to poor compliance due to the smallhealth improvementsOrnish noted that the World Health Organization

ranked the US health care system in 2000 first in bothresponsiveness and expenditure but 37th in overall per-formance (2) This ranking suggests that simply spendingmore money on what we are doing now or making minorchanges in health reform will not provide the realimprovements that Americans want and need todayOrnish also made reference to one study in which curcu-min (an active ingredient in the herb turmeric) wasfound to have 2000 increase in bioavailability andtherefore significant better health benefits when usedwith a type of pepper used in curries Ornish sought to

512 Historical Summit on Integrative Medicine

warn attendees to avoid looking at studies that testsimply one ingredient Many recent studies for instancehave found little or no results from using vitamin C or Eor a single type of multivitamin when in fact mostnutritional-oriented physicians and practitioners do notlimit themselves to such single ingredient treatmentsOrnish also discussed several mindndashbody treatment pro-

grams including certain meditative visualization andyoga practices to improve health status and quality oflife for people suffering from a host of serious ailmentsHe also noted their importance for soldiers as they returnfrom combat operations usually suffering from post-traumatic stress disorders Many speakers made referenceto the challenge in health care today in which physiciansand other primary care clinicians do not have the time orexpertise to be their patientsrsquo lsquohealth coachrsquo There seemsto be a real need for a person on the health care teamwho works personally with the patient to help enactbehavioral changes that are health enriching Some atten-dees thought that psychologists might fill this role othersthought nurses may be best and others wondered if anew type of health professional was neededFurthermore Ornish reported on genetic research on

telomeres a gene associated with long life Ornishrsquosresearch published in Lancet Oncology discovered thatsignificant dietary changes had direct effects on telo-meres thereby verifying that our genetic heritage canbe influenced and changed (3) While our genes mayindeed have powerful effects upon our health and lifesuch influences are not in stone but can be transformedOrnishrsquos expansive message also included reference to

the provocative notion that a vegetarian diet is not onlyhealthier for people but also for our planet He notedthat livestock production leads to more global warmingeffects than all transportation sources combined

A View to and from the Hill

In recognition of the potential significance of the IOMSummit on Integrative Medicine two hearings on inte-grative medicine were held 2 days before the summitand on one of the days of the summit itself TheSenate Sub-committee on Health Education Labor andPensions held a hearing chaired by Maryland SenatorBarbara Mikulski and heard testimony from WayneJonas James Gordon Sister Charlotte Kerr Mary JoKreitzer and Cathy Baase corporate medical directorfor Dow Chemical Company Senator Harkin chairedthe second hearing of this same sub-committee withwhat some of us referred to as the lsquointegrative healthdream teamrsquo including Dean Ornish Andrew WeilMehmet Oz and Mark HymanThe third day of the summit began with a rousing

presentation from Senator Tom Harkin Harkin reportedon these Senate hearings noting that just that week

President Obama had asserted that health reform was a

major priority for him and for the American people and

that prevention and wellness programs have to have an

important place in this health reform President Obama

has also designated that over US$1 billion would be

devoted to outcomes evaluation for health and medical

treatment programs to begin to be evaluated to determine

what really works Harkin asserted lsquoAmerican always do

the right thing after they have tried everything elsersquo

Indeed Harkin has been a long-term advocate for inte-

grative health (although he originally expressed interest

and support for lsquointegrative medicinersquo an attendee sug-

gested to him what others at this Summit had previously

expressed lsquointegrative healthrsquo is more comprehensive

a term than lsquointegrative medicinersquo within the remaining

time of the QampA session with Harkin he referred to

integrative health) Harkin was the primary sponsor

that created the Office of Alternative Medicine as well

as the National Center for Complementary and Alterna-

tive Medicine Harkin also noted that the status quo

(which he also called the lsquostagnant quorsquo) has reimburse-

ment and incentive priorities in the wrong place Harkin

promised to make certain that these priorities be

changed

Personal Thoughts

The very concept of lsquointegrative healthrsquo is quite compre-

hensive and yet with respect to getting the biggest bang

for the buck we must honor the Hippocratic tradition

that asserts lsquoFirst do no harmrsquo How this translates into

health improvements is that we should explore and

exhaust safer methods first before resorting to the big

(and expensive) guns of medicine and medical technol-

ogy Also there is general recognition that we need to

move our thinking about health care where the physician

is at the center to where the lsquoPersonrsquo is at the centerSeveral speakers at this summit expressed the need and

the demand for lsquodatarsquo During audience participation

moments at this summit I voiced my concurrence but

I also voiced a warning In homeopathic and naturo-

pathic thought and practice there is a profound respect

for the lsquowisdom of the bodyrsquo If we set up clinical trials

that simply evaluate whether a treatment is effective in

getting rid of a symptom we may be discovering that this

treatment is effective but only in suppressing a symptom

and sometimes creating a more serious chronic ailment

rather than enacting a true cureWe therefore need to have clinical trials but they must

not only evaluate specific symptoms but also overall

health status They must not ignore side effects because

such new symptoms are not side effects at all they are

usually the direct result of a drugrsquos toxicity or its ability

to suppress the disease to deeper and more serious levels

eCAM 20107(4) 513

Furthermore when we seek lsquoevidencersquo we should notonly evaluate evidence obtained from randomizeddouble-blind trials but we should also evaluate evidencefrom outcome studies cost-effectiveness studies andwhen possible and appropriate basic science trials Weneed to remember that we today accept most surgicalpractices even though the vast majority of them havenot been proven to be effective based on double-blindplacebo-controlled trials Few people consider surgeryto be lsquounscientificrsquo just because it is not viable to conductplacebo-controlled trials And yet many physiciansscientists and health policy analysts assume certainthat some alternative treatment methods are unscientificbecause they too cannot be evaluated in placebo-controlled trials (how does one give a placebo meditationor a placebo yoga posture)Likewise many treatments that lsquointegrative practi-

tionersrsquo use comprise a lsquopackage of treatmentsrsquo thatinclude various dietary changes vitamin and mineralsupplements herbal remedies homeopathic medicinesyoga practice stress management methods and so onEvaluations of the outcomes of such packages of treat-ment are truly necessaryAt this summit there were several professors of genetics

and other basic sciences who discussed the most recentscientific discoveries in their fields However I was a bitsurprised at the casual reference to lsquogenetic causesrsquo ofillness and to new (and old) infective agents that lsquocausersquothis or that disease My concern here is that becauselanguage is so important it is necessary that we drawfrom systems biology and systems thinking to realizethat it is more accurate to say that these influences arelsquoco-factorsrsquo to diseases not causes of them The conceptof causality tends to be linear when in fact cause israrely so simple The susceptibility of the host alwaysinfluences whether infective agent leads to disease ornot and as Dean Ornish and others have now notedeven genetic status of an individual can be alteredFinally we must be more humble in how we all make

use of the words and concepts of lsquoscientific medicinersquoAn IOM special report lsquoInforming the Future CriticalIssues in Healthrsquo (published in 2007) noted that one-thirdof Americans today take five or more medications Andyet even if all of these drugs have been proven lsquoscienti-ficallyrsquo to work each drug was tested individually not incombination with one or two let alone five drugsFurthermore most of the studies conducted have notbeen on children or the elderly and yet the high quan-tities of drugs are prescribed them Still further discon-certing is that most medication is tested for very short

periods of time even though many drugs are used overyears or decades While such evaluations are complex anddifficult to conduct these issues simply mean that wemust remain humble in our sense of which drugs workwhen and for whomA report from the IOM on this summit is expected to

be published in late 2009 Because President BarackObama has placed health care reform as a major priorityof his administration the timeliness of this summit issignificant though it is uncertain what role integrativehealth thinking and practices will become a part ofObamarsquos initiatives Obama did however give us someinsight into his present thinking when in May 2009he responded to a question about acupuncturersquos role inhis health care reform plans Obama said lsquo[m]y attitudeis that we shouldmdashwe should do what works So I thinkit is pretty well documented through scientific studies thatacupuncture for example can be very helpful in relievingcertain things like migraines and other ailmentsmdashor areat least as effective as more intrusive interventions I willlet the science guide mersquo (4)

Important Online Links

To see agenda and presentation slides of the IOMSummit to watch the web cast of the summit and toaccess the commissioned papers that were availableprior to the start of the summit please visit httpwwwiomeduID=52555The US Senate hearing on integrative medicine by the

Committee on Health Education Labor and Pensionsin which testimony was provided by Dr Andrew WeilDr Mehmet Oz Dr Dean Ornish and Dr MarkHyman can be watched at httphelpsenategovHearings2009_02_262009_02_26html

References1 Pelletier K The Economics Institute of Medicine Summit on

Integrative Medicine and the Health of the Public February25ndash27 2009 Retrieved from httpwwwiomeduCMS28312525555992463468aspx (last accessed 19 August 2009)

2 World Health Organization Assess the Worldrsquos Health System PressRelease WHO44 21 June 2000 Retrieved from httpwwwphotiuscomrankingswho_world_health_rankshtml (last accessed19 August 2009)

3 Ornish D Lin J Daubenmier J et al Increased telomerase activityand comprehensive lifestyle changes a pilot study Lancet Oncol200891048ndash57

4 Obama Positive Toward Acupuncture Acupuncture Today 200910Retrieved from httpwwwacupuncturetodaycommpacmsatarticlephpid=31983 (last accessed 19 August 2009)

Received March 11 2009 accepted August 3 2009

514 Historical Summit on Integrative Medicine

warn attendees to avoid looking at studies that testsimply one ingredient Many recent studies for instancehave found little or no results from using vitamin C or Eor a single type of multivitamin when in fact mostnutritional-oriented physicians and practitioners do notlimit themselves to such single ingredient treatmentsOrnish also discussed several mindndashbody treatment pro-

grams including certain meditative visualization andyoga practices to improve health status and quality oflife for people suffering from a host of serious ailmentsHe also noted their importance for soldiers as they returnfrom combat operations usually suffering from post-traumatic stress disorders Many speakers made referenceto the challenge in health care today in which physiciansand other primary care clinicians do not have the time orexpertise to be their patientsrsquo lsquohealth coachrsquo There seemsto be a real need for a person on the health care teamwho works personally with the patient to help enactbehavioral changes that are health enriching Some atten-dees thought that psychologists might fill this role othersthought nurses may be best and others wondered if anew type of health professional was neededFurthermore Ornish reported on genetic research on

telomeres a gene associated with long life Ornishrsquosresearch published in Lancet Oncology discovered thatsignificant dietary changes had direct effects on telo-meres thereby verifying that our genetic heritage canbe influenced and changed (3) While our genes mayindeed have powerful effects upon our health and lifesuch influences are not in stone but can be transformedOrnishrsquos expansive message also included reference to

the provocative notion that a vegetarian diet is not onlyhealthier for people but also for our planet He notedthat livestock production leads to more global warmingeffects than all transportation sources combined

A View to and from the Hill

In recognition of the potential significance of the IOMSummit on Integrative Medicine two hearings on inte-grative medicine were held 2 days before the summitand on one of the days of the summit itself TheSenate Sub-committee on Health Education Labor andPensions held a hearing chaired by Maryland SenatorBarbara Mikulski and heard testimony from WayneJonas James Gordon Sister Charlotte Kerr Mary JoKreitzer and Cathy Baase corporate medical directorfor Dow Chemical Company Senator Harkin chairedthe second hearing of this same sub-committee withwhat some of us referred to as the lsquointegrative healthdream teamrsquo including Dean Ornish Andrew WeilMehmet Oz and Mark HymanThe third day of the summit began with a rousing

presentation from Senator Tom Harkin Harkin reportedon these Senate hearings noting that just that week

President Obama had asserted that health reform was a

major priority for him and for the American people and

that prevention and wellness programs have to have an

important place in this health reform President Obama

has also designated that over US$1 billion would be

devoted to outcomes evaluation for health and medical

treatment programs to begin to be evaluated to determine

what really works Harkin asserted lsquoAmerican always do

the right thing after they have tried everything elsersquo

Indeed Harkin has been a long-term advocate for inte-

grative health (although he originally expressed interest

and support for lsquointegrative medicinersquo an attendee sug-

gested to him what others at this Summit had previously

expressed lsquointegrative healthrsquo is more comprehensive

a term than lsquointegrative medicinersquo within the remaining

time of the QampA session with Harkin he referred to

integrative health) Harkin was the primary sponsor

that created the Office of Alternative Medicine as well

as the National Center for Complementary and Alterna-

tive Medicine Harkin also noted that the status quo

(which he also called the lsquostagnant quorsquo) has reimburse-

ment and incentive priorities in the wrong place Harkin

promised to make certain that these priorities be

changed

Personal Thoughts

The very concept of lsquointegrative healthrsquo is quite compre-

hensive and yet with respect to getting the biggest bang

for the buck we must honor the Hippocratic tradition

that asserts lsquoFirst do no harmrsquo How this translates into

health improvements is that we should explore and

exhaust safer methods first before resorting to the big

(and expensive) guns of medicine and medical technol-

ogy Also there is general recognition that we need to

move our thinking about health care where the physician

is at the center to where the lsquoPersonrsquo is at the centerSeveral speakers at this summit expressed the need and

the demand for lsquodatarsquo During audience participation

moments at this summit I voiced my concurrence but

I also voiced a warning In homeopathic and naturo-

pathic thought and practice there is a profound respect

for the lsquowisdom of the bodyrsquo If we set up clinical trials

that simply evaluate whether a treatment is effective in

getting rid of a symptom we may be discovering that this

treatment is effective but only in suppressing a symptom

and sometimes creating a more serious chronic ailment

rather than enacting a true cureWe therefore need to have clinical trials but they must

not only evaluate specific symptoms but also overall

health status They must not ignore side effects because

such new symptoms are not side effects at all they are

usually the direct result of a drugrsquos toxicity or its ability

to suppress the disease to deeper and more serious levels

eCAM 20107(4) 513

Furthermore when we seek lsquoevidencersquo we should notonly evaluate evidence obtained from randomizeddouble-blind trials but we should also evaluate evidencefrom outcome studies cost-effectiveness studies andwhen possible and appropriate basic science trials Weneed to remember that we today accept most surgicalpractices even though the vast majority of them havenot been proven to be effective based on double-blindplacebo-controlled trials Few people consider surgeryto be lsquounscientificrsquo just because it is not viable to conductplacebo-controlled trials And yet many physiciansscientists and health policy analysts assume certainthat some alternative treatment methods are unscientificbecause they too cannot be evaluated in placebo-controlled trials (how does one give a placebo meditationor a placebo yoga posture)Likewise many treatments that lsquointegrative practi-

tionersrsquo use comprise a lsquopackage of treatmentsrsquo thatinclude various dietary changes vitamin and mineralsupplements herbal remedies homeopathic medicinesyoga practice stress management methods and so onEvaluations of the outcomes of such packages of treat-ment are truly necessaryAt this summit there were several professors of genetics

and other basic sciences who discussed the most recentscientific discoveries in their fields However I was a bitsurprised at the casual reference to lsquogenetic causesrsquo ofillness and to new (and old) infective agents that lsquocausersquothis or that disease My concern here is that becauselanguage is so important it is necessary that we drawfrom systems biology and systems thinking to realizethat it is more accurate to say that these influences arelsquoco-factorsrsquo to diseases not causes of them The conceptof causality tends to be linear when in fact cause israrely so simple The susceptibility of the host alwaysinfluences whether infective agent leads to disease ornot and as Dean Ornish and others have now notedeven genetic status of an individual can be alteredFinally we must be more humble in how we all make

use of the words and concepts of lsquoscientific medicinersquoAn IOM special report lsquoInforming the Future CriticalIssues in Healthrsquo (published in 2007) noted that one-thirdof Americans today take five or more medications Andyet even if all of these drugs have been proven lsquoscienti-ficallyrsquo to work each drug was tested individually not incombination with one or two let alone five drugsFurthermore most of the studies conducted have notbeen on children or the elderly and yet the high quan-tities of drugs are prescribed them Still further discon-certing is that most medication is tested for very short

periods of time even though many drugs are used overyears or decades While such evaluations are complex anddifficult to conduct these issues simply mean that wemust remain humble in our sense of which drugs workwhen and for whomA report from the IOM on this summit is expected to

be published in late 2009 Because President BarackObama has placed health care reform as a major priorityof his administration the timeliness of this summit issignificant though it is uncertain what role integrativehealth thinking and practices will become a part ofObamarsquos initiatives Obama did however give us someinsight into his present thinking when in May 2009he responded to a question about acupuncturersquos role inhis health care reform plans Obama said lsquo[m]y attitudeis that we shouldmdashwe should do what works So I thinkit is pretty well documented through scientific studies thatacupuncture for example can be very helpful in relievingcertain things like migraines and other ailmentsmdashor areat least as effective as more intrusive interventions I willlet the science guide mersquo (4)

Important Online Links

To see agenda and presentation slides of the IOMSummit to watch the web cast of the summit and toaccess the commissioned papers that were availableprior to the start of the summit please visit httpwwwiomeduID=52555The US Senate hearing on integrative medicine by the

Committee on Health Education Labor and Pensionsin which testimony was provided by Dr Andrew WeilDr Mehmet Oz Dr Dean Ornish and Dr MarkHyman can be watched at httphelpsenategovHearings2009_02_262009_02_26html

References1 Pelletier K The Economics Institute of Medicine Summit on

Integrative Medicine and the Health of the Public February25ndash27 2009 Retrieved from httpwwwiomeduCMS28312525555992463468aspx (last accessed 19 August 2009)

2 World Health Organization Assess the Worldrsquos Health System PressRelease WHO44 21 June 2000 Retrieved from httpwwwphotiuscomrankingswho_world_health_rankshtml (last accessed19 August 2009)

3 Ornish D Lin J Daubenmier J et al Increased telomerase activityand comprehensive lifestyle changes a pilot study Lancet Oncol200891048ndash57

4 Obama Positive Toward Acupuncture Acupuncture Today 200910Retrieved from httpwwwacupuncturetodaycommpacmsatarticlephpid=31983 (last accessed 19 August 2009)

Received March 11 2009 accepted August 3 2009

514 Historical Summit on Integrative Medicine

Furthermore when we seek lsquoevidencersquo we should notonly evaluate evidence obtained from randomizeddouble-blind trials but we should also evaluate evidencefrom outcome studies cost-effectiveness studies andwhen possible and appropriate basic science trials Weneed to remember that we today accept most surgicalpractices even though the vast majority of them havenot been proven to be effective based on double-blindplacebo-controlled trials Few people consider surgeryto be lsquounscientificrsquo just because it is not viable to conductplacebo-controlled trials And yet many physiciansscientists and health policy analysts assume certainthat some alternative treatment methods are unscientificbecause they too cannot be evaluated in placebo-controlled trials (how does one give a placebo meditationor a placebo yoga posture)Likewise many treatments that lsquointegrative practi-

tionersrsquo use comprise a lsquopackage of treatmentsrsquo thatinclude various dietary changes vitamin and mineralsupplements herbal remedies homeopathic medicinesyoga practice stress management methods and so onEvaluations of the outcomes of such packages of treat-ment are truly necessaryAt this summit there were several professors of genetics

and other basic sciences who discussed the most recentscientific discoveries in their fields However I was a bitsurprised at the casual reference to lsquogenetic causesrsquo ofillness and to new (and old) infective agents that lsquocausersquothis or that disease My concern here is that becauselanguage is so important it is necessary that we drawfrom systems biology and systems thinking to realizethat it is more accurate to say that these influences arelsquoco-factorsrsquo to diseases not causes of them The conceptof causality tends to be linear when in fact cause israrely so simple The susceptibility of the host alwaysinfluences whether infective agent leads to disease ornot and as Dean Ornish and others have now notedeven genetic status of an individual can be alteredFinally we must be more humble in how we all make

use of the words and concepts of lsquoscientific medicinersquoAn IOM special report lsquoInforming the Future CriticalIssues in Healthrsquo (published in 2007) noted that one-thirdof Americans today take five or more medications Andyet even if all of these drugs have been proven lsquoscienti-ficallyrsquo to work each drug was tested individually not incombination with one or two let alone five drugsFurthermore most of the studies conducted have notbeen on children or the elderly and yet the high quan-tities of drugs are prescribed them Still further discon-certing is that most medication is tested for very short

periods of time even though many drugs are used overyears or decades While such evaluations are complex anddifficult to conduct these issues simply mean that wemust remain humble in our sense of which drugs workwhen and for whomA report from the IOM on this summit is expected to

be published in late 2009 Because President BarackObama has placed health care reform as a major priorityof his administration the timeliness of this summit issignificant though it is uncertain what role integrativehealth thinking and practices will become a part ofObamarsquos initiatives Obama did however give us someinsight into his present thinking when in May 2009he responded to a question about acupuncturersquos role inhis health care reform plans Obama said lsquo[m]y attitudeis that we shouldmdashwe should do what works So I thinkit is pretty well documented through scientific studies thatacupuncture for example can be very helpful in relievingcertain things like migraines and other ailmentsmdashor areat least as effective as more intrusive interventions I willlet the science guide mersquo (4)

Important Online Links

To see agenda and presentation slides of the IOMSummit to watch the web cast of the summit and toaccess the commissioned papers that were availableprior to the start of the summit please visit httpwwwiomeduID=52555The US Senate hearing on integrative medicine by the

Committee on Health Education Labor and Pensionsin which testimony was provided by Dr Andrew WeilDr Mehmet Oz Dr Dean Ornish and Dr MarkHyman can be watched at httphelpsenategovHearings2009_02_262009_02_26html

References1 Pelletier K The Economics Institute of Medicine Summit on

Integrative Medicine and the Health of the Public February25ndash27 2009 Retrieved from httpwwwiomeduCMS28312525555992463468aspx (last accessed 19 August 2009)

2 World Health Organization Assess the Worldrsquos Health System PressRelease WHO44 21 June 2000 Retrieved from httpwwwphotiuscomrankingswho_world_health_rankshtml (last accessed19 August 2009)

3 Ornish D Lin J Daubenmier J et al Increased telomerase activityand comprehensive lifestyle changes a pilot study Lancet Oncol200891048ndash57

4 Obama Positive Toward Acupuncture Acupuncture Today 200910Retrieved from httpwwwacupuncturetodaycommpacmsatarticlephpid=31983 (last accessed 19 August 2009)

Received March 11 2009 accepted August 3 2009

514 Historical Summit on Integrative Medicine

Submit your manuscripts athttpwwwhindawicom

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Hindawi Publishing Corporationhttpwwwhindawicom Volume 2014

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Immunology ResearchHindawi Publishing Corporationhttpwwwhindawicom Volume 2014

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Parkinsonrsquos Disease

Evidence-Based Complementary and Alternative Medicine

Volume 2014Hindawi Publishing Corporationhttpwwwhindawicom