Kenneth R. Pelletier, Ph.D., M.D.(hc) -- clinical professor of medicine in the Department of Medicine and professor of public health at the University of Arizona School of Medicine, and clinical professor of medicine in the Department of Family and Community Medicine and in the Department of Psychiatry at the University of California School of Medicine, San Francisco (UCSF) -- is one of many doctors on the forefront of changing the way medicine operates today, in the interest of optimizing its functionality and ability to heal people successfully. His book, New Medicine, is not only a road map for those interested in learning about integrative medicine but is also a blueprint for the medicine of the future. I was delighted to have the opportunity to speak with Ken recently. Here are excerpts from our conversation.
Michael Finkelstein: What is the idea behind New Medicine?
Ken Pelletier: The basic model of New Medicine is to look at roughly 300-400 common conditions and ask, "What does conventional medicine do, and do really well?" If conventional medicine works well for a certain condition, there is no reason to go any further. However, if conventional medicine does not resolve the condition, the book lays out all the other options to consider, such as meditation, chiropractic, herbal medicine, and all the other integrative medicine and evidence-based health strategies that a person can use. The idea behind the book was to operationalize, or make a very practical, the integrative medicine model.
MF: What do you envision as the future of medicine?
KP: I see it as integrative medicine and the evidence-based fusion of conventional and alternative medicine -- the common ground being evidence-based. Much of what we do in conventional medicine, as you know, is not evidence-based. Much of what we do in integrative medicine or alternative medicine has as good, if not better, evidence base. So we need to recognize our bias and move forward to get the two systems working together.
MF: While the conventional medical culture is beginning to accept an integrative medicine model, it still seems to be applying a reductionist understanding of how healing works -- namely that one therapy should result in one outcome. What are your thoughts?
KP: We still have the dominance of the reductionistic, randomized clinical trial. That is the gold standard of science. The problem is, it's not a systems approach. Instead, you isolate a single factor responsible for an outcome. That is really an erroneous model, even in conventional medicine.
There was a study that was conducted with acupuncture and irritable bowel syndrome*, published about six years ago. The study involved setting up six acupuncture points for treating irritable bowel, vs. allowing the practitioners to use whatever acupuncture points there might be in a flexible, clinical model. The study looked at outcomes.
At six months, the outcomes were virtually identical between the fixed intervention and the flexible intervention. What was so remarkable, however, was that at the one year mark, virtually all of the individuals in the fixed model acupuncture intervention had regressed. They all had developed further symptoms and needed further treatment. In the flexible acupuncture model, virtually none of the patients developed the need for further intervention.
We need to realize that we need a longer-term view. We need a slower model of healing, because systems don't change overnight. You don't take an aspirin and get rid of your headache within 30 minutes. Headaches are persistent. It may take weeks of changes that take place. So it's a slower, more systemic approach, but the result is a healthy system.
The objective is not an end to a particular symptom, although that symptom will resolve in process. Instead, the approach is to modify the entire system, not just to address a particular symptom.
MF: The slow medicine model teaches that the wellness we are seeking is not just in the physical body. If we don't include the other pieces of our experience -- mental, emotional, psycho-spiritual, social, and so on, then we leave out a lot of material that is probably part of the underlying dysregulation or imbalance that leads to symptoms. What are your thoughts on this model?
KP: I think we have to include these additional variables. We hear about social media and social support and interconnectedness. Research makes it clear that individuals who have a social support system heal more readily. This social support system can be a community, a single friend, a spouse, a group of friends, an animal, or even a plant
We live in an intangible, psychological, social web. When it is intact and vital, we have health. When it is broken -- when people are homeless and impoverished, when their emotional system is eroded -- that's when we get the receptor site for ill health. The definition that I came to for "health" is basically a life fully and well lived. Independently, whatever the limitations might be, physical or psychological, the person's life is optimally expressed and optimally lived.
MF: What are some of the changes you have seen in medical culture in recent years, indicating that we are heading in the right direction of pulling from the best of conventional, complementary, and alternative medicine?
KP: I'm seeing more and more of a systemic approach in medical clinics. In the same practice, you'll have chiropractors, herbalists, nurse practitioners, physicians, and physical therapists, and they really do work together. Each of them appreciates and defers to the competence and expertise of the other. It isn't a physician-dominated group of people that work under medical doctors. Instead, they really are all working together collaboratively. To me, that's an optimistic model for the future of medical care.
*Lim B, Manheimer E, Lao L, Ziea E, Wisniewski J, Liu J, and Berman BM, "Acupuncture for treatment of irritable bowel syndrome" (Review), The Cochrane Collaboration, NY: Wiley & Sons, 2008 - Issue 4: 1-39
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