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Excerpt from: "A Return to Healing: Radical Health Care Reform"

by Len Saputo, MD with Byron Belitsos


Chapter 6, excerpted by permission from A Return to Healing: Radical Health Care Reform and the Future of Medicine (Origin Press, September, 2009), by Len Saputo, MD, with Byron Belitsos
See: http://www.areturntohealing.com

Wellness, Prevention, and Healing: The New Direction for Medicine

Health is a state of complete physical, mental, and social well-being
and not merely the absence of disease or infirmity.

—World Health Organization

The biggest problem with the U.S. health-care system is that it has
long been designed to respond to illness rather than prevent it.

Time, “America’s Health Checkup,” December 1, 2008

When we’re sick, most of us will do whatever it takes to get rid of our symptoms; our disease care system is, after all, built around capitalizing upon this simple impulse. The implicit trajectory of today’s medical technology and pharmaceuticals is to one day fulfill this desire, overcoming all of our symptoms and every disease.

Such fanciful science-fiction logic would probably be valid if human health were an advanced engineering problem, the solution to which paid out with the highest net profit.

Yet it’s not surprising that most Americans accept this approach, for some things in life really are that simple and mechanical: Experience a difficulty; buy a service or product that solves it and reward the provider with riches. We’re the land of the technological quick fix. We should expect our scientists and physicians to come up with tricks to relieve our suffering, right? After all, no one wants to feel sick.

Unfortunately, human biology is not that simple. Feeling better in the moment is only one part of what an ideal health care system should provide.

Let’s take a look at what an advanced health care system should accomplish when it has put a priority on a return to healing.

Getting acquainted with the wellness buffer

The point of fighting disease is easy to appreciate. But the ideal, of course, is that diseases never occur in the first place—and that we remain in optimal health by regularly pursuing healthy lifestyle practices.

We all know about the simple, effective, and inexpensive factors that promote good health through prevention, and we all agree with them, yet we often find ourselves ignoring them. After all, as Time magazine reported in the article cited above, “If you’re like 67 percent of Americans, you’re currently overweight or obese. If you’re like 96 percent of the population, you may not be able to recall the last time you had a salad, since you’re one of the hundreds of millions of Americans who rarely eat enough vegetables. And what you do eat, you don’t burn off—assuming you’re like the 40 percent of us who get no exercise.” What’s worse, if we look closely, we discover that our current health care system reinforces this ignorance and laziness—in fact, profits from it. We’ll also discover that the infrastructure needed to support wellness and prevention simply isn’t present in the United States; the commercial interests that drive today’s medical care have little to gain from building such an infrastructure.

On the other hand, there’s nothing to stop smart businesspeople from also capitalizing on what might be called the wellness impulse: the inner urge many of us have to achieve peak health. In his 2002 book The Wellness Revolution, economist Paul Zane Pilzer outlined an emerging $200 billion industry he called “the wellness business.”(1) The latest edition of the book, The New Wellness Revolution (2007), claims that the natural medicine and wellness industry has grown to $500 billion, providing ever-increasing entrepreneurial opportunities in natural health, integrative medicine, prevention, nutrition, and much more.

It appears that the worldview clash at the heart of America’s health care dilemma facing America has led to a clash of industries. But what if there were a way to bridge the gap between the two in a single concept?

Consider this: Picture your state of health as a spectrum that extends from one pole on the left—where there is (theoretically) perfect functioning of body, mind, and spirit—to the opposite pole on the right, where death exists. In between these two extremes lies a place where symptoms of dysfunction have not quite yet surfaced but where we have lost some of our perfect functionality. I call this critical zone our wellness buffer.

In conventional medicine, this place is usually not on the map. Disease care doesn’t get involved in the issue of wellness unless symptoms have developed. Restoring a well-functioning of body, mind, or spirit is irrelevant until a person has lost the cushion of his wellness buffer, and when a good bit of remediation is now required.

In today’s medicine, the gold standard for diagnosing good health is the act of documenting the absence of signs and symptoms of disease—that is, it’s in the business of exploring only 50 percent of the total spectrum! Optimal health is not under investigation; a “clean bill of health” simply means that nothing is severe enough to show evidence of symptoms during a physical examination or abnormal findings in routine laboratory testing. Such measures don’t identify the magnitude or extent of the patient’s wellness buffer or how close they may be to theoretic perfect function; nor do they show the patient explicitly how to move toward optimal function once symptoms have disappeared.

It’s a matter of paradigm: Today’s diagnostics are geared to detect diseases from the middle to the far right end of the spectrum, where the horse is already out of the barn—maladies such as cancer, diabetes, and heart disease. These tests accurately measure the biochemical and physiological function of many organ systems; many sensitively assay the total function of such organs as the heart, lungs, and kidneys. However, as long as the results of these analyses are within the so-called normal range with no overt symptoms present, nothing more will be done.

For example, the ability of the heart to pump blood can be measured by a number called the ejection fraction, where “normal” values are those between 50 and 62 percent. Most people can function quite well at 50 percent, but it is not as ideal as 62 percent—which indicates more advanced wellness. Physicians are not inclined to treat a patient with an ejection fraction at the low end of “normal,” in part because drugs and surgery—the only remedies at hand—have the potential to cause severe side effects. Lifestyle strategies in these cases can be very helpful in promoting prevention and increased wellness, but physicians are not trained to deliver this aspect of health care.

The same is true when measuring lung function. Some of these tests are highly sophisticated, and they do in fact measure all the way up to ideal total lung physiology. Again, however, unless there is sufficient loss of function such that lifestyle is impaired, no concentrated effort is made to restore lung function to optimal levels.

To restate: Science has learned that our body’s organs have remarkable reserves that protect us from the symptoms of disease, and we can measure the extent of these reserves all the way up to theoretical perfect function. Our functional reserves let us remain symptom free across a good part of the spectrum. All may appear well in our general health right up to the point where we’ve lost as much as 50 percent of an organ’s total reserve function. Until we reach this point of loss, we may have no idea that we’re dangerously near the edge of a cliff. To put it numerically: If we are scoring 100, we’re perfect in function and in peak health. At 90 or 80 we’re not too bad. But if we fall between, say, 70 and 55, we’re in danger of losing our remaining buffer and falling off the edge into disease.

We have all heard stories that illustrate this issue. These are the tragic tales about people who had recently gone to their doctor for a routine checkup, including an EKG and routine lab work, and were told they were in good health. Seemingly out of nowhere, within hours to days, they suffered a heart attack and were hospitalized or even died. Do you really think these people were in good health one day, yet seriously ill or even dead the next?

Let us not be fooled by the large but hidden middle ground that spans the distance from perfect functioning to the onset of symptoms. Instead, we should all be working to maintain the optimum amount of reserve protection in our organs. Our most potent defense is a good offense, one based on living a healthy lifestyle.

The Pete Wilson and Tim Russert stories

Pete Wilson was a well-known and treasured ABC news anchor and radio broadcaster in the San Francisco Bay Area for more than 30 years. In July 2007, Wilson was scheduled for elective hip replacement surgery at a well-known medical facility in the San Francisco Bay Area. He passed his physical examination, EKG, and routine laboratory work with flying colors. To make a sad story short, Wilson died of a heart attack on the operating table. How could this have happened?

First of all, this story is not that unusual. And yes, he did have state-of-the-art medical screening at a university hospital with an outstanding reputation. You might wonder why his physicians didn’t consider that they were dealing with someone over the age of 60 who was a bit overweight, was under considerable stress and anxiety, and was possibly at high risk for heart disease—and therefore delay a major surgical procedure until more in-depth screening tests could be completed.

Wilson must have had an intuition that all was not right with his level of wellness. During the last hour of his final radio broadcast, the day before his surgery, he talked about his worries concerning the surgery with fellow radio talk show host Gene Burns and invited callers to recount their own surgical experiences. It was reported later, after his death, that Wilson had had severe anxiety about his upcoming surgery and had gone to the emergency room the night before, because of it.

Yet everything was pronounced “normal,” and the deadly surgery was performed the following day.

Wilson had received from a prestigious medical center the standard of care expected by the Medical Board of California. But did he really get the care he needed and deserved? At least two inexpensive and safe, Medicare-approved tests could have been done to screen for occult (i.e., hidden) heart disease. In his case, chances are that both a heart-rate variability test and a test for vascular stiffness would have come out abnormal, as these tests are measures of organ functionality that expose disease when it falls well within the range of the wellness buffer (at the left side of the spectrum). This might well have led to uncovering his underlying critical heart problems and to the proper preventive treatment that had the potential to save him from his destined fatal heart attack. Even so, these are still not standard tests in cases like that of Pete Wilson.

In addition, sending anyone to surgery—especially an elective surgery—when in a state of extreme anxiety seems imprudent. This, of course, points to yet another blind spot in the current mechanistic paradigm—the inextricable role of the mind and emotions in health. If this commonsense factor—well understood these days in the emerging scientific field of mind-body medicine—had only been recognized, then Wilson would ideally have been referred for preoperative interactive guided imagery. An extensive literature indicates the benefits of positive imagery before surgery, documenting that when it is employed, there is less blood loss during surgery, less pain afterward, faster healing, and certainly less anxiety throughout the entire process. Nancy Huddleston’s book and audiotape titled, Prepare for Surgery, Heal Faster, featured nationwide on PBS-TV and now recommended by several leading hospitals, explains how to use relaxation to calm preoperative jitters and to create the biochemistry that enhances healing. It also guides the patient in using visualization and healing imagery, mobilizes the healing power of a support group of family and friends, and even creates a healing role for the anesthesiologist. Ongoing research has shown the efficacy of this system, yet it remains too little known among surgeons trained in the old reductionistic paradigm.

While “routine” testing may work for the majority of patients as screens before surgery, the case of Pete Wilson shows that it obviously does not suffice for all. The art of medicine requires that physicians take time to know each patient as a whole person and use their experience and judgment to determine when the standard one-size-fits-all workup is insufficient.

A second instance is the tragic Tim Russert story. Russert, another beloved broadcast journalist, died at age 58 of an unexpected fatal heart attack while at work, then in his 16th year as moderator of NBC’s Meet the Press. Russert’s physician stated that he had ruptured plaque in a major coronary artery that led to its abrupt closure and his sudden demise. Yet he had passed a stress EKG test just a couple of months earlier.

Russert was overweight, was under considerable stress, and had an enlarged heart. It was known that he had asymptomatic arteriosclerotic heart disease (meaning that he was still in the wellness buffer zone). He was being treated with drugs and exercise, a conventional approach that in retrospect was clearly insufficient. Suppressing symptoms without dealing with the underlying causes is unfortunately the standard of “good” medical practice in this setting.

I wonder how many additional risk factors Russert had for premature coronary artery disease and what his doctors might have learned, had he been given a heart-rate variability test and a vascular stiffness test. And what if he had been more aggressively treated for his weight and high stress levels with intensive nutritional counseling and more effective stress-reduction strategies?

The upshot is that if we are to prevent these scenarios, it is important to measure the reserve function of our organ systems—a superior approach compared with simply screening for symptoms of advanced disease without taking preventive action to reverse silently progressing and potentially lethal health problems.

This new style of medicine, called functional medicine, exists today and is available as part of the repertoire of the new medicine. Want to guess why it is not routinely practiced? The above examples indicate that the disease care model has little interest in addressing and dealing with wellness and prevention.

It should now be clearer why good health means much more than simply not having symptoms of disease; nevertheless, we still find ourselves waiting to get sick before seeking medical attention. Today’s HMO medicine aggravates this problem by putting pressure on physicians to treat only the physical symptoms of disease, not the underlying health and lifestyle problems that lead us to getting sick—and it gives only lip service to our deeper human needs. In this setting, physicians are rewarded for evaluating and treating us as quickly as possible and with as little support from their specialist colleagues as they can.

And prevention, of course, is not on the agenda.

While functional medicine is an effective way to diagnose and prevent the very early onset of disease, it is generally nonreimbursable by insurance entities like Medicare and HMOs. Amazingly, Medicare does not even have diagnostic billing codes for most preventive medical services. It states that these kinds of tests or practices are “not indicated.” Yet there are often simple and inexpensive ways, as in the cases of Pete Wilson and Tim Russert, to avoid the progression of diseases that can result in very expensive hospitalizations, not to mention death.

One of the most crucial changes needed in today’s medical care is reimbursement for preventive, integrative, and wellness strategies from the health care insurance providers. At today’s rate of change, it may take a virtual revolution to get it.

Differentiating curing and healing

Let’s now revisit a closely related issue that we have only lightly touched upon: the distinction between curing and healing. By our definition, curing is focused on eliminating symptoms. Yet curing symptoms is just the beginning of healing. Genuine healing moves us along toward peak health—not just in organ function, but in all functions of body, mind, emotion, and spirit. Healing addresses all aspects of our being—just as if these too are “organs” that deserve peak function and, in a real sense, have their own wellness spectrums.

Consider: If there is a purpose or a reason for everything that happens in the universe—as I believe there is—then what would be the value in restoring physical health without learning from the experience of being sick? From this point of view, curing the symptoms of disease alone could be looked upon as having a negative impact on a patient’s opportunity for emotional, intellectual, and spiritual growth. If the stimulus to learn is removed with an external fix and we are no longer suffering, how many of us would still seek to learn why we got sick in the first place? That’s why the deepest responsibility of an ideal health care system includes guiding us as human beings to ultimate healing as one feature of a spiritual path—a path of personal growth in wisdom and self-knowledge.

Throughout history, ancient healing traditions have always encompassed the responsibility of guiding patients through their life challenges, especially illness; poor health in this context offers insights into the whole person that might otherwise be difficult or even impossible to learn. Illness itself, then, can be regarded as a teacher of wisdom. And wisdom, in turn, teaches us that we must act to prevent illness in the first place through living a life of virtue and loving-kindness that includes healthy lifestyle practices.

The virtuous life in this sense allows us to maintain an optimal position, or homeostasis, in the domain of the wellness buffer, with the goal of evolving toward perfection in body-mind-spirit health. No wonder we are witnessing a massive revival of the ancient traditions of healing and the CAM practices that are often derived from them: They teach us that the needs of the whole person are central to the mission of true healing.

Focusing on the whole person is nearly impossible in the current model

Now, let’s contrast genuine healing with today’s medicine. In our single-minded quest to identify and overcome the symptoms of illness alone, the practice of medicine has become almost unimaginably technical, complicated, impersonal, and fragmented. The myriad of subspecialties, such as cardiology, neurology, gastroenterology, nephrology, and endocrinology, make it nearly impossible for any single person—even a physician specializing in a particular area—to be fully versed in her own field, let alone all fields. No wonder general-practice physicians are often overwhelmed. The managed care system gives them very limited time and resources to figure out which treatments are best, let alone teach patients how to understand what is happening to them and why it is necessary that they receive a given treatment. It becomes tempting to defer to the expertise of the subspecialist most concerned with a particular malady, especially considering his lifetime of devotion to learning the intricacies of his field.

But remember our earlier conclusion: It is not just the amount of knowledge or technique that an expert commands that makes the difference; rather, it’s the way knowledge and wisdom are applied that determines the best outcome. And this is a function of the humility of the practitioner, her spiritual attainment as an individual, and her ability to be authentically present with the patient—that is, to address the needs of the whole person for healing, not simply curing the symptoms. That’s a crucial lesson I’ve derived from my experience of four decades of clinical practice.

And here we’ve come full circle. The services of any given specialist usually cannot be reflexively applied for best results, for genuine healing, without consideration of what is needed by the whole person in its most encompassing context. Each specialist’s service must be woven into the fabric of a comprehensive treatment program that often involves several other specialists, some whose services are so technical that a personal relationship with the patient is not even considered because it is not possible or practical. Further, all of the specialties one is struggling to coordinate still exclude many of the issues we have identified as crucial to the whole health of a given individual—physical, biochemical, bioenergetic, emotional, environmental, cultural, and spiritual.

The emerging integral medicine does, of course, encompass these things. When practicing this new medicine with a goal of providing true healing in such situations, quarterbacking and team-building is crucial. At least in theory, the core responsibility of the primary care physician becomes one of educating and guiding his patients through a complex decision-making process that can involve a multitude of disciplines and specialists.

What about the patient? We are all different, and making the “right” decision often has a lot to do with who we are, what we prefer, and what we can afford, as well as our unique medical and personal situation. To get at that decision, we want to partner with our health care practitioners, all of them. And we want our health care practitioners to partner with each other too.

Many primary care doctors would love to pursue collaborations and explorations of this kind. But we have learned in previous chapters that the current system is simply not designed for this. Physicians are generally far too busy to carefully review the medical situation at hand and negotiate a treatment plan with each patient—even within the disease care paradigm. Partnering is critical, but it is rarely possible in clinical settings regulated by a managed health care system that typically offers only ten minutes for each patient visit, and focuses on drugs and surgery to manage symptoms of disease.

Many patients and their families are highly motivated and capable of participating in their own medical research and sharing in the decision-making process that leads to the best and most appropriate treatment options and choices. The Internet has had a tremendous impact on the availability of medical information for physicians and for patients and their families. And this new age of readily accessible highly technical information is leading to an even greater desire by patients for a new, collaborative, and person-centered approach to medicine.

But as the saying goes, we don’t always get what we want.

Public surveys reveal what Americans want from medicine

While most Americans have great respect and even awe for the amazing technology of modern medicine, they are considerably dissatisfied with its lack of success in treating chronic diseases, the safety issues of its drugs and surgeries, its inequities of access, its rising cost, and its depersonalized nature. Americans appreciate that we are living longer than ever before, that some epidemics of childhood diseases have largely been eradicated, and that we are close to bringing the potential wonders of stem cell transplants and gene therapy into clinical practice. Medical technology has accomplished what were once regarded as impossible feats. It would be foolish to discard these brilliant advances. And while Americans are moving toward something—still incompletely defined—that transcends the dire problems of the old disease care model, they still want to include its best features in the new medicine that is evolving.

More than a decade ago, Harvard Medical School’s David Eisenberg, MD, documented that health care in America was indeed entering such a new era, the era that some call integrative medicine, the predecessor of integral-health medicine. In his two landmark articles—one published in 1993 in NEJM, which shocked the medical world, and its 1998 sequel in JAMA—he verified a powerful, sustained progression of change.(2, 3)

According to his widely discussed 1998 report, “Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient.” He went on to report, “Extrapolations to the US population suggest a 47.3 percent increase in total visits to alternative medicine practitioners, from 427 million in 1990 to 629 million in 1997, thereby exceeding total visits to all US primary care physicians [emphasis added].” Further, “Total out-of-pocket expenditures relating to alternative therapies were conservatively estimated at $27 billion, which is comparable with the projected 1997 out-of-pocket expenditures for all U.S. MD services.” Here are additional facts that emerged from this stunning research:

• Total visits to CAM providers (629 million) exceeded total visits to all primary care physicians (386 million) in 1997.

• Out-of-pocket expenditures for herbal products and high-dose vitamins in 1997 were estimated at $8 billion.

• An estimated 15 million adults in 1997 took prescription medications concurrently with herbal remedies and high-dose vitamins.

• The majority of CAM therapy users perceived the combination of CAM and conventional care to be superior to either alone (79 percent).

• The majority of CAM therapy users typically saw a medical doctor before or concurrent with their visits to a CAM provider (70 percent) and did not disclose their CAM therapy to their medical doctor (63 to 72 percent).

More recent studies, though not as broad in scope, have confirmed the trend. The National Center for Complementary and Alternative Medicine at the NIH released a survey in May 2004 showing that 36 percent of U.S. adults use some form of alternative remedy. Their definition of CAM practices included acupuncture, meditation, the use of herbal supplements, and prayer. When prayer used specifically for health reasons is included in the definition of complementary and alternative medicine, the number of U.S. adults using complementary and alternative medicine rises to 62 percent, the report stated.(4)

A February 2006 New York Times article said that the billions that U.S. residents spend annually on alternative and complementary medicine provide the “most telling evidence of Americans’ dissatisfaction with traditional health care.” According to the Times, an estimated 48 percent of U.S. adults used at least one alternative or complementary treatment in 2004, compared with 42 percent in 1994, and health care experts maintain that the rate continues to increase “for reasons that have as much to do with increasing distrust of mainstream medicine and the psychological appeal of nontraditional approaches as with the therapeutic properties of herbs or other supplements.” Americans who use CAM treatments often have a “sense of disappointment” or “betrayal” related to a “misdiagnosis, an intolerable drug, failed surgery, even a dismissive doctor,” and “[h]aggles with insurance providers, conflicting findings from medical studies and news reports of drug makers’ covering up product side effects all feed their disaffection,” according to the Times.(5)

There can be no doubt that conventional medicine is steadily losing market share in the health care business, and Americans are demanding this new medicine with their pocketbooks. We are now spending out of pocket far in excess of $30 billion a year for CAM services, according to the National Center for Complementary and Alternative Medicine. Yet we cannot afford to lose the technological brilliance of modern medicine.

Although this emerging paradigm shift in America’s health care is impressive, its institutional formation is only in its infancy. Fortunately, there is still time to analyze what has happened, adapt to these changes in consumer preference, and step forward with a solution that can creatively merge the best of both conventional and CAM worlds, providing a greater choice of options to prevent disease as well as restore and maintain good health, all across the entire spectrum of health and disease. The story of my own attempt at such a merger begins in the next chapter.

Patients and their families demand integrative care

Most of the public now knows that mainstream medicine can’t provide all the right answers. If it did, we would not be so sick, our health care institutions would not be so dysfunctional and costly, and our system of delivery would not be rated behind those of Colombia, Morocco, Chile, and Costa Rica. On the one hand, there is immense pressure for radical reform of health care delivery; and on the other, there’s a massive interest in new models of health and healing itself, especially through choices that could involve CAM alone or in conjunction with mainstream strategies.

This new era will bring a new breed of health care practitioners who are open to learning, willing to challenge traditionally accepted principles, and committed to exploring eclectic, integrative, or integral approaches for treatment. Many physicians are beginning to embrace this style of practice, and my colleagues and I have been experimenting with these ideas since 1994 through a nonprofit educational foundation, the Health Medicine Forum, in Northern California. I have also brought this style of health care into clinical practice at the Health Medicine Center in Walnut Creek, California.(6) The next chapter tells our story.

Nevertheless, despite patients’ massive interest in CAM services, integrative services are institutionalized in clinical practices only in isolated cases. At the moment, the most expedient way to obtain an integrative strategy is to work independently of the mainstream physician, if one is in charge or involved!

Indeed, it is common for patients to work with CAM practitioners without ever informing their primary care physician. They want the services of both and, understandably, do not want to create an adversarial stance with either. Even if the conventional primary care physician were aware of the patient’s use of CAM, resulting in a great deal of CAM input and information from the patient and CAM practitioner, it is simply not practical for physicians working in managed care to deal with all the additional issues or perspectives being raised. Bear in mind that conventional medical training today still barely touches upon CAM approaches.

A good example of this dilemma is the treatment of most cancers. Abundant data published in mainstream medical journals documents the fact that the majority of people with advanced cancer search for CAM approaches in addition to their mainstream cancer treatment. This alone strongly suggests that the public has lost considerable confidence in many conventional cancer therapies that essentially limit their focus to the use of surgery, radiation, and chemotherapy. Anyone in this situation, especially if their conventional treatment was not working, would want to know if there were alternative therapies outside of mainstream medicine that might help him. But it is almost impossible to find mainstream physicians who have deep knowledge in both conventional and CAM treatments for cancer. Obviously there is a very large need to coordinate care for these patients through collaboration. Indeed, a great deal is at stake for the patient!

Take, for example, the known effectiveness of surgery and chemotherapy for breast cancer. And let’s assume for the sake of argument that these conventional treatments extend life on the average by about 25 percent—though one could make a good case that they are less effective than that. Now compare this with a startling finding published in the Journal of Clinical Oncology in June 2007. In a study of about 1,500 women who had been treated conventionally for breast cancer an average of two years earlier, the researchers found that women who stuck to a healthy diet consisting of lots of fruits and vegetables and were moderately active with physical exercise had a 44 percent lower risk of dying within a ten-year period.(7, 8)

On the prevention side, one study published June 8, 2007, in the American Journal of Clinical Nutrition reported that use of vitamin D supplements is associated with a 60 to 77 percent lower risk of cancer.

Combine this with the results of a study that David Spiegel from Stanford Medical Center published in the Lancet in 1989.(9) In it, he compared the longevity of stage-four breast cancer patients who were treated with imagery, support groups, and emotional support, as well as conventional medical treatment, with that of patients who received only the conventional medical treatment. Women in the latter, control group, who had no further cancer treatment options, lived the expected 19 months. Those in the former treatment group lived an average of 37 months. This is a nearly 100 percent increase in survival!

Despite the fact that we need further research to more precisely clarify the role that imagery, group therapy, and psychotherapy play in treating patients with cancer, Spiegel remained convinced that it is “very clear” that support groups provide benefits to cancer patients and should be an important part of their treatment. Doesn’t this information make you wonder why the medical profession has not focused on the use of lifestyle strategies primarily, and the use of all other medical treatments secondarily, when managing patients with cancer?

It would therefore also seem like a no-brainer that having a team of health care practitioners from a wide range of disciplines work together with patients would be the most ideal way to support them. However, it is most unusual for mainstream and CAM practitioners to work side by side as partners and collaborate with one another. Can you imagine how satisfying it would be for patients to openly meet with their surgeon, oncologist, CAM practitioners, social worker, psychologist, bodyworkers, and others—sometimes even in the same room at the same time? And to have a single person act as the quarterback, or guide, to coordinate the work of all these disciplines? In the next chapter I present an innovation that permits this very process, which I call Healing Circles.

The urgent need for the birthing of a new paradigm of medicine

The American public is without a doubt demanding a “new medicine.” The health care they seek is integrative, holistic, person-centered, and focused on prevention and wellness—a medical model in which nutrition, natural therapies, a healthy lifestyle, a clean environment, a less stressful work environment, and a meaningful purpose in life are cornerstones.

We also want and need a personal relationship with our physicians. It is not acceptable that physicians focus on treating symptoms with technology alone or that they do not work in collaboration with other modalities of healing. The emerging new style of health care also requires that physicians spend enough time with us to develop a sacred space within which we can be deeply heard and develop an honest, personal connection. Further, we want our health care practitioners and health care system to put much more emphasis on prevention, including the building of an infrastructure to support a culture of prevention, wellness, and the pursuit of peak health.

Today we want genuine physician-healers. We want them to be authentic. We prefer that they be vulnerable and be willing to accept that not knowing how to solve difficult health issues is okay with us. And we want to be included in their decision-making processes that will affect the way we experience and manage our illness.

We also realize that it takes time to find the deeper meaning in illness. We are interested in addressing more than the simple physical misfortune and psychological challenge imposed by illness. We want to know more about why we became ill in the first place, how it affects our whole life, and any spiritual lessons that may be related to our particular disease.

We are beginning to understand the difference between curing and healing, and we want to address both. We care about curing our symptoms because we do not want to suffer. Yet simply curing the body’s symptoms does not in itself heal the soul. Healing involves a consideration of who we are, how our illness relates to our life story, and how our life interrelates with our society and culture, and with everything in the universe.


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