. Johnson found the Integrator support for this movement "disturbing." His reasons ranged from questions about science to views on the role of a physician and what he views are the economic challenges coaching can put on a successful physician-level integrative practice. Johnson's perspective stimulated these responses from integrative care consumer, editor and policy leader Sheila Quinn, and from Oregon chiropractor Jamey Dyson, DC.

Sheila Quinn

1.  Sheila Quinn: "The physician's role is not to take over the healing process ..."

Sheila Quinn's work in holistic health care, naturopathic medicine, functional medical and integrative practice extends over 40 years. Her positions have included senior editor at the Institute for Functional Medicine, founding chair of the Integrated Healthcare Policy Consortium, a kitchen-cabinet crafter of language used in the NIH NCCAM legislation and co-founder of Bastyr University. Quinn, an Integrator adviser, was last seen commenting on the not-unrelated topic of employer incentives for habit change.

"My response to Dr. Chris Johnson's opposition to coaching as part of an integrative medical team:

• "I disagree that the scientific literature is of little or no value in helping clinicians understand how to guide their patients toward healthier lives. I have read widely in the literature and written extensively on this subject. I believe there is indisputable evidence that the effects of environmental exposures and lifestyle choices on genetic vulnerabilities are responsible for most chronic disease. True, the literature is heavily epidemiological, but there are many excellent clinical studies as well, and the evidence base grows stronger over time.

"The idea that people make poor lifestyle decisions because they are sick seems ludicrous to me.

• "The idea that people make poor lifestyle decisions because they are sick seems ludicrous to me. Not that illness doesn't affect our abilities-certainly it does, and it can be difficult to self-activate when one is ill (even nearly impossible if one is very ill). But we don't become sick and then choose unhealthy lives! Each of us has a unique response to lifelong exposures to toxins, poor diet, sedentary jobs, chronic stress, and other unhealthy influences that, over time and conditioned by our genetics and epigenetics, create our own personal trajectory toward disease; our therapies need to address those influences in order to create lasting improvement.

• "The role of a physician or other health practitioner is to help the patient-not to take over the whole healing process. As patients, we are more effective on our own behalf if we are partners in our care. We need to be educated and supported in making healthy changes. The clinician is vital, of course, not only to identify our underlying problems but to help us understand how we got there, and to recommend appropriate interventions and monitor their effects. Some therapies are as straightforward as taking a pill or avoiding a certain food. Others are far more difficult; a good coach-taking the time that most physicians cannot-can provide expertise, encouragement, and feedback, all extremely helpful factors in the struggle to achieve lasting change.

"The role of a physician or other health practitioner is to help the patient-not to take over the whole healing process."

• "I do agree that there's no one right answer to most health problems. However, there's nothing inherent in the coaching discipline that dictates a uniform approach to all patients! On the contrary, clinicians and coaches (at least the best ones) do not take a one-size-fits-all approach; they individualize the therapeutic regime to the particular patient, taking into account their genetics, environment, lifestyle, and readiness/ability to change. As one who has struggled to make healthy changes, I can say unequivocally that a well-trained integrated team with health coaching available would be a tremendous boon!

"I am glad that Dr. Johnson's approach has helped so many patients. However, ALL clinicians tend to overestimate their successes and underestimate their failures-perhaps accounting for the fact that most primary care practitioners in ANY field report seeing a lot of other people's failures! Just because Dr. Johnson doesn't appear to need an integrative team (including coaching) for his own patients doesn't mean that many other practices and patients wouldn't reap great benefit from these services. I think there is very convincing evidence that most of us would benefit enormously."

Sheila Quinn
Freelance medical Writing and Services
Gig Harbor, Washington
sheilaquinn@medwriter.comcastbiz.net

Jamey Dyson, DC, CCWP

2.  Jamey Dyson, DC: "Patients just don't know how to get themselves to be healthy ..."
 
The website for the practice of Jamey Dyson is titled Advanced Chiropractic: A Licensed Eat Well, Move Well, Think Well Center. The clinic's name pretty well announces Dyson's view of the importance of health coaching which he describes here. Dyson is also a Certified Chiropractic Wellness Practitioner (CCWP), a program of the International Chiropractic Association.  

"The opinions of Chris Johnson, ND are quite disturbing to me also.  I wonder if he represents a large part of the naturopathic profession.  His opinions appear to be rooted in a lack of understanding of the cause of disease, a lack of understanding in the power of lifestyle change, and a lack of understanding how to deliver coaching services in a profitable way.

The opinions of Chris Johnson, ND are quite disturbing to me also.  "I wonder if he represents a large part of the naturopathic profession."

"First of all, it should be well known among most health care providers that the cause of disease and illness is STRESS.  This concept was developed by the late Hans Seyle, MD in the 1940s and describes how any living organism will enter pathological states of function when under prolonged stress.  What is stress?  We can say that stress comes in 2 forms: toxicity and deficiency.  Simply too much or too little of something.  It is easy to think of toxicity/deficiency examples relating to nutrition, but this concept applied holistically, must also include the areas of movement and thought patterns. 

"So we can say that stress in the form of toxicity and deficiency in the way we eat, move and think, is the primary cause of most states of human pathology.  The research is clear that 8 out of 10 deaths in western society are being caused by genetically incongruent lifestyle choices.  Industrialized humans are not living according to their genetic needs and it has everything to do with lifestyle.

"The human body has an amazing ability to heal and regenerate with the proper changes in lifestyle.  Dean Ornish, MD has shown us with his research that it is possible to reverse not only heart disease, but also prostate cancer with simple lifestyle change.  In fact, the literature shows that the simple effects of eating more fruits & veggies and walking 30 mins a day are more powerful than any drug on the planet for preventing heart disease and cancer.  Why wouldn't a physician want to focus on helping his patients develop those behaviors?

"The lifestyle change we need should be based on what our species requires for health.  Very simple.  All wild animals on the planet innately act out the lifestyles they require for health.  Humans are the only animals who have the ability to choose a lifestyle which differs from our innate genetic requirements for health.  When we live an incongruent lifestyle, it acts as a chronic stressor, gradually pushing us into varying pathological states of chronic illness.  Herein lies the problem of chronic disease in industrialized and developing countries.

	"I have found that the ONLY effective way to help a person change their lifestyle is through coaching. "Yes, they can look up how to eat and exercise on the internet, but they still don't know how to get themselves to change."

"I have found that the ONLY effective way to help a person change their lifestyle is through coaching.  Yes, they can look up how to eat and exercise on the internet, but they still don't know how to get themselves to change.  This is a new, emerging science - the science of human lifestyle change.  We have to effectively work with the complex nature of the human mind if we are going to have any hope.  We know that to effectively change a person's behaviors, we must first change their belief systems at a deep enough level.  If you do not change belief systems, there will be no long-term behavior change.

"Every patient wants to be healthier... they just don't know what to do, why to do it, how to do it, and most importantly - how to get themselves to do it.  They need coaching by a lifestyle wellness expert.  They need someone to hold their hand through the process of learning about healthy lifestyle and learning how to change their belief systems about lifestyle, which will result in their behaviors changing for a lifetime.
 
"I hope other practitioners out there agree with what I have written here."

Jamey Dyson, DC, CCWP
Advanced Chiropractic & Wellness
a licensed Eat Well Move Well Think Well® Center
Salem, OR  97304