“… and of these one and all, I weave the song of myself.”
Walt Whitman

This past week I participated in a series of meetings and discussions in which leaders of distinct integrative practice organizations explored the potential for shared policy action.

The venue was the annual convention of the American Association of Naturopathic Physicians (AANP) with which the American Holistic Medical Association (AHMA) participated. Integrative policy advocate Bill Benda, MD moderated a panel and a follow-up luncheon session between leaders of these two organizations and five others representing practitioners, academic healthcare and natural products.¹

Benda, who will be moderating a similar dialogue at the Integrative Healthcare Symposium in New York City on February 20, 2009, began by collecting mission statements from each organization. Each articulated interest in transforming the current medical system. The discussions were fruitful. More on this will be forthcoming in upcoming Integrative Practitioner content. As a starting place, shared mission as a cornerstone of an enduring alliance appears to exist.

On my return to Seattle, I shared this action with a long-time colleague and advocate for health system integration, Dominican Sister and health system leader Diana Bader. Bader, who has promoted integrative care in numerous Catholic healthcare systems, suggested that we could benefit from an additional cornerstone for collaborative policy action. Wouldn’t it be good to have better awareness of the diverse contributions which have brought us to this point?

Most of us have witnessed how one profession or organization within its separate silo will tend to express a self-centered view of historical importance. Gathering in our own tribes, we are all winners. We are the heroes of our own stories. Each profession or organization builds up its own role while down-playing the contributions of others, if only by ignorance or neglect.

Yet how rich are sources, streams and underground wells from which this integrative practice movement is rising. How broad are the rivers we can form if the “us” from whence we have come forms as a shared movement. The depth of our common origins in time, culture and consumer interest are suggested by the following grouping of professional and organizational action during a decade from the late1970s through the late 1980s.

• The bio-psychosocial model of primary care was defined in 1977, inserting whole person and whole system thinking into the dominant, reductive medical monologue.
• In 1978 and 1979 the American Holistic Medical Association and American Holistic Nurses Association were established, respectively, to support the move to holistic practice among members of these mainstream disciplines.
• In 1978, the nearly dead 100-year-old naturopathic medical profession took significant steps into rebirth when both Bastyr University (then John Bastyr College of Naturopathic Medicine) and Canadian College of Naturopathic Medicine (then the Ontario College of Naturopathic Medicine) were founded, bringing to 3 the number of such educational institutions in all of North America.
• In 1978, a patient, Angelica Thieriot, upset with the increasingly technological and dehumanized experience of medical care in US hospitals, formed the Planetree organization which created and advanced the idea of patient-centered care.
• In 1979, the American Chiropractic Association took the gutsy path of filing an anti-trust suit against the American Medical Association’s (AMA) determined effort to suppress any non-conventional disciplines.² The ACA’s victory a decade later in this grassroots legal campaign forced the AMA to discontinue its direct suppression of other fields. (The decision’s impact was felt again this year when an organization of nurses waived it in front of the AMA to ward off a prospective AMA action.)
• In the late 1970s and early 1980s, Jon Kabat-Zinn, PhD, Dean Ornish, MD, Herbert Benson, MD, Eileen Stuart, RN, PhD and others began publishing studies which became the evidence pillars of the integrative medical movement which was to emerge a decade later in US medical schools. They showed that the mind was, indeed, connected to the body and that mindfulness and meditation intervention, alone or coupled with other natural health interventions (nutrition, group support, exercise) could positively impact medical outcomes.
• In 1982, the American Herbal Products Association was established, to promote the interests of an industry infused with new consumer interest in medicinal herbs.
• The American Association of Acupuncture and Oriental Medicine and the American Association of Naturopathic Physicians were each established in the early 1980s.
• In 1983, New Hope Communications was incorporated. The publishing and exposition business give a modern face and support to the organic food and supplement industry which was beginning to thrive amidst growing consumer interest in healthy food and natural living.
• In 1985, major employers in the United States, concerned about the escalating cost of employee benefits plans, established the Wellness Council of America to identify and advance a new proactive orientation toward health creation among major medical purchasers.
• In 1985, the Organic Trade Association was established to support development of the organic food industry.
• In 1987, members of the naturopathic medical profession and who had established schools and standards of education and then an independent accrediting agency, the Council on Naturopathic Medical Education, secured the recognition of this agency by the US Department of Education.
• In 1987, members of the AOM profession who had established a growing number of schools and standards of education and then an independent accrediting agency, Accreditation Commission for Acupuncture and Oriental Medicine, secured the recognition of this agency by the US Department of Education.
• In 1988, the American Botanical Council was created to provide quality information on herbs for consumers, practitioners and researchers.
• By the late 1980s, licensing and insurance coverage efforts were under way or already successful in scores of states by members of the AOM, naturopathic medicine, chiropractic, massage therapy and direct-entry midwifery professions and their activist patient and clients. Together there significantly expanded access to licensed natural healthcare practitioners by consumers across the United States.

All of this robust activity between the late 1970s through the 1980s has flourished, comingled and energized a broad, cultural movement to shape medicine differently. This grassroots action was captured by David Eisenberg and others in his landmark consumer survey, carried out in 1990, which showed that, despite rabid disapproval from conventional medicine, over a third of US citizens were using some form of non-conventional care and over $13-billion was being spent out of pocket on these services.³ These data on consumer practices stimulated the entrance of the National Institutes of Health, major medical schools and hospitals and health systems and other major stakeholders into this expanding arena.

Contrary to what we may tell each other in gatherings of our individual tribes, no single practice or profession or organization or individual led or leads this movement. If anything, the movement is and was patient-centered and patient-driven. Individual leaders may act as exponents of a profession or an industry. Yet most are consumers of the new health care. They are motivated by personal experience of something healthier than medicine as the conventional system was delivering it. This shared experience is another cornerstone of our mutual history.

The multiple forces in the emergence of integrative practice call to mind the words of poet Walt Whitman in his “Song of Myself.” I adjust them for our situation: “… these tend inward to each profession or organization, and what each of us accomplish tends outward to others/ and such as it is to be of these, more or less we are/ and of these one and all, we weave the song of ourselves.”⁴

If we begin to see our own histories as profoundly inter-mingled and our advances dependent on those of others, perhaps we can more easily act in connected ways to engage the challenges and opportunities in front of us.

References:

1. Involved were leaders of the AANP, AHMA, AHNA (holistic nurses), American College for the Advancement of Medicine (ACAM), the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM), and the Natural Products Association (NPA). I was involved as executive director of ACCAHC.
2. Wilk vs. the AMA
3. Unconventional Medicine in the United States -- Prevalence, Costs, and Patterns of Use. NEJM, January 28, 1993.
4. “And these tend inward to me, and I tend outward to them/And such as it is to be of these more or less I am/And of these one and all I weave the song of myself.” Walt Whitman, Song of Myself, part 15.