by Brian Lawenda, MD

Modern medicine has evolved to an extent that would have been difficult to imagine, even twenty years ago. Advanced imaging technologies have given radiologists the ability to ‘see' the metabolic activity and location of pee-sized tumors, anywhere in the body. High-tech pharmacology research has led to the development of a vast array of drugs that can be prescribed for almost any named medical condition. And, nearly every day we learn of new genetic discoveries that have been associated with various cancers, heart disease, diabetes, depression, and other health problems.

However, the overall picture of modern medicine is far from perfect... The cost of healthcare, in the United States, is reaching unsustainable levels and, if not adequately addressed in the near future, will lead to an even more troubling state for our nation's health and economy. Highlighting this point, medical bills have become the leading cause of personal bankruptcy, in the U.S. Compared to other industrialized countries, the U.S. spends most of all on health care. Nonetheless, the U.S. ranks relatively low on health care indicators.

Access to healthcare is limited to those fortunate enough to be able to afford it. Preventive care (i.e. counseling and screening) is not always reimbursed and thus limits the ability of providers to offer this essential service. Individuals who have limited access to primary care providers, often do not seek medical attention until their problem has escalated into a serious condition. As a result, our nation's, emergency departments and urgent care clinics unfortunately serve as the healthcare entry point for the majority of individuals who cannot afford primary care. Even when a patient has access to primary care, they may only be allotted a few minutes to focus on one or two of their issues- obviously, this is not conducive for managing complex medical problems (let alone, preventive care counseling.)

Coordination of care between multiple specialty providers is often too time-intensive for primary care providers who are already overburdened. The ability for providers to document and communicate medical information is hindered by the lack of standardized electronic medical record systems, significantly increasing the risk of medical errors and the inefficiency of each encounter. These issues are not simple and will require a paradigm shift in our healthcare system. The new system must focus on an integrated approach to health care, one that addresses the whole person: body, mind and spirit. This is the essence of ‘integrative medicine.' Increasing timely and affordable access to primary care providers is essential in this model. Preventing disease and improving wellness will be financially incentivized in this new system, as opposed to only rewarding providers for offering expensive therapies and procedures. The best of evidencebased conventional and non-conventional therapies are combined in integrative medicine. Whenever there is a choice between equally effective therapies, selecting the least costly and least invasive/toxic option should be offered. This was the focus of the "Summit on Integrative Medicine and the Health of the Public", held at the Institute of Medicine (IOM), in February, 2009.

Traditional Chinese medicine (TCM) is one of many whole health systems (i.e. Ayurvedic medicine, Native American medicine, Tibetan medicine, etc.) that embodies the concept of integrative medicine. A variety of TCM modalities (i.e. acupuncture, tui na, qi gong, herbal formulas, etc.) have been shown to reduce stress, improve fitness and flexibility, decrease pain and inflammation, improve sleep, modulate hormone levels, and improve various quality of life outcomes (physical and psychological.) These dynamic and complex parameters have been associated with numerous disease processes (i.e. cardiovascular disease, diabetes, cancer, depression, etc.).

TCM is one of the first healthcare systems to emphasize the importance of promoting wellness and preventing disease through healthy eating habits, nutrition, exercise, and meditation. The role of TCM in integrative medicine looks very promising. A quick search on MEDLINE demonstrates thousands of studies employing TCM modalities. These studies vary significantly in their quality and reliability. Increasingly, TCM studies

have been more closely adhering to the rigorous design criteria expected in peer reviewed, conventional medical journals (i.e. randomization, thoughtful selection/omission of controls, statistical power calculations, the use of validated assessment instruments, etc.). Collaborative research among investigators of varying

backgrounds (between physicians, chiropractors, TCM practitioners, statisticians, pharmacologists, etc.) can be helpful in designing high-quality trials to study the efficacy, safety, and cost-effectiveness of TCM practices within the integrative medicine model.

OM