About the first thing one is taught in medical research is that there are hierarchies of evidence and that the “RCT” (randomized controlled trial) sits on the Iron Throne. What the integrative user of multimodal, individually-tailored approaches immediately feels is estrangement and resentment at rules that seem form-fit for pharma. Can integrative even get an audience in such a court? Now the American College of Lifestyle Medicine (ACLM) and the True Health Initiative led by Yale public health, integrative, and lifestyle medicine leader David Katz, MD, MPH have published a model that seeks to take the RCT’s down a notch. It’s a diversity play. They recommend a “systematically weighted approach” involving multiple research models that “(increase) the weight and thereby validity of evidence specially applied to lifestyle interventions.” I reached Katz for an interview in which he spoke to the model’s relationships to integrative whole system research models and of the “tyranny of the RCT”. He shares intriguing political, strategic and tactical dimensions to lifestyle medicine’s Hierarchies of Evidence Applied to Lifestyle Medicine (HEALM).
The blog post to which my attention was called was entitled When Big Brother Went High Tech. The news from energy medicine author Lynn McTaggert jerked attention of the integrative community to a story I’d long anticipated: Google’s censors turned their attention to the still wild political-economical-medical frontier of “alternative medicine”. Osteopath and internet businessman Joseph Mercola reported that 99% of the traffic to his sometimes pugnacious mercola.com “natural health” website was killed. “Integrative medicine” was not spared. Visits to the much more tame Dr. Weil site from that field’s godfather dropped 66%. In an August 2019 e-blast to his list of Minnesota holistic practitioners on Google’s incendiary actions, an integrative leader of 40-years Bill Manahan, MD writes: “”I think you will find it pretty scary for those of us in the integrative, alternative, and functional medicine fields.”
Two decades ago, James Gordon, MD was the chair of the top US government effort to examine integrative medicine policy. In an August 20, 2019 blogpost, the integrative psychiatrist shared how 50 years ago he traveled with crisis intervention nurse Sharon Curtin and singer Joan Baez to Woodstock where he treated hundreds of hallucinating attendees through a co-caring model. His August 9, 2019 letter to the New York Times challenged the Trumpian portrayal of mass-shootings motivated only by mental illness. Gordon described himself this way: “Though my professional work is devoted largely to trauma healing for survivors of such mass murders — and of wars, state-sponsored torture and climate-related disasters — I have known and treated a number of violent extremists, including mass murderers.” Trauma is us. On September 10, 2019, trauma hot-spots healer Gordon has a new book coming out on the transformation needed. I reached him for a brief interview.
The idea that “the first is the last and the last the first” was a value in my liberal Protestant upbringing. It likely had some noblesse oblige in it too. The concept can be challenged as an entrapping promise that good will come of waiting. Regardless, in some the call to work with the least-cared-for becomes a guiding mission. Self-preservation of the integrative field may be another motivator of such a mission. A past head of the NIH agency that researches integrative practices has challenged the main body of clinical research as un-generalizable due to the research being on upper income, well-educated, white, female patients. For a multitude of reasons, Integrative Medicine for the Underserved (IM4US) has emerged as the leading edge of the movement for integrative health.