The decision of the Cleveland Clinic to start a Center for Functional Medicine was big news. That the $9-billion system gave the initiative significant visibility suggested arrival for functional medicine. A few hurdles still existed. Cleveland Clinic’s new partners needed to clarify and create a clinical model that could be measured. That was the caveat. This Center was a bet – a pilot based on a largely untested belief that functional medicine could outperform regular medicine, and at lower cost. Most in the field assumed this would prove a slam dunk. Care from a team of functional medicine physician/nutritionist/health coach and then behavioral specialist became the unit for which outcomes would be measured. Now in a publication in JAMA Network, the first results are in. The headlines were positive – but what do the data really say?
The polarization between reductive biomedical science and a whole person integrative model obscures deeper differences relative to human nature. The top-down, fix-it mode of the former is grounded in a fundamental belief that people (a.k.a. “patients”) either do not want to change or simply can’t. Meantime, the time-consuming, get-in-there-and-partner focus of lifestyle-oriented integrative practitioners assumes that the presenting human being arrives with seeds of change seeking ground for germination and growth. A recent Harris poll on perceptions of self-care among conventional medical doctors and their patients that was funded by the Samueli Foundation and led by its integrative health director Wayne Jonas, MD describes the chasm that has opened between the two parties. The patient is seeking an integrative model for self care amidst the present predication of medical delivery on the skeptical view of human nature.
Cast a net for papers on “innovations in group-delivered services” and what do you get? Guest editor Maria Chao, DrPh, MPA summed up the nearly 40 submissions this way: “Our editorial team was struck by the heterogeneity of integrative group visits for a range of health conditions, serving diverse patients across the life course and implemented in varied healthcare settings. A unifying theme is the potential for integrative group visits to address unmet needs of underserved and vulnerable patients. In many ways, group visits serve as a critical model towards integrative health equity.” The commentaries and research articles in the JACM Special Focus Issue on Innovation in Group Delivered Services make a potent case for an expanded role for groups not just for those who can pay cash but for all populations in a transformed healthcare system. All the articles are in open access until August 25, 2019.
Spoiler alert. The title of a recent column marking the 10th anniversary of Triple Aim efforts to move medical payment and delivery from volume toward value makes no bones about the effort’s shortcomings. This report card from the Triple Aim’s top cheer-leader is meaningful to the high touch, human-intensive movement for integrative health and medicine for one important reason: the field’s potential uptake is pegged to advance of the values orientation. Success is more broadly meaningful because the values-based war against the forces in the industry that causally associate it with 250,000 medical deaths each year – effectively medicine’s white walkers in Game of Thrones terms – is the bullseye point of reference on what is at stake.