The Integrator Top 10 list ten years ago honored the work of what is now the University of Arizona Andrew Weil Center for Integrative Medicine. I apologized then for the oversight in not honoring their leadership earlier. In truth, I might have done so virtually every year. The simple fact of the matter is that, while one might cringe at any part of a collaborative movement being characterized as the “epicenter” – as University of Arizona’s president characterized the Center recently – the Center has clearly earned the title if what we are talking about is the expansion of “integrative” in academic medicine. Through its 1855 Fellows, through its Integrative Medicine in Residency partners in 99 medical schools, through graduates promoting the integrative paradigm and practice in dozens of nations, and via government-funded projects involving multiple integrative professions, the Center founded by Andrew Weil, MD in 1994 is the gift that keeps on giving. I reached Weil and the Center’s long-time executive director Victoria Maizes, MD, to take a look at the program, its accomplishments, challenges, and what’s ahead.

The long road to recognition inside the University

I first asked the two what, looking back, has been the biggest surprise. Weil was quick to respond: “How long it took the university to embrace us.” The statement reminded me of something Weil said at our first encounter, in October of 1996. He was working with the then NIH leader for the awakening movement, Wayne Jonas, MD. Weil’s nascent “Program in Integrative Medicine” was co-hosting a symposium with two federal agencies. Jonas’ day-long symposium was a rare jump out of the scientific community’s reluctant engagement in researching controversial “alternative and complementary” practices. The day would instead focus on the dynamism at the time in the implementation of real world integration strategies. (I’d been invited to present a paper on insurance and coverage models.) Weil, the sometimes entrepreneur who would later co-found the successful True Food Kitchen restaurant chain, made one statement that both declared for his abiding passion, and for the stuckness of the academic medical center against the Program’s ideas: “We can’t even get them to put healthy food in the cafeteria.”

 Recognized by Time, then finally by the University via Robbins

Turns out, neither making the cover of Time magazine in 1997 nor again in 2005 helped do the trick that common sense had failed to accomplish. It took the institution more than the 20 years of a Rip Van Winkle-like stony sleep before someone got it. Said Weil: “It was only when we got a new president.” He was referring to the previously quoted Robert Robbins, MD, the cardiac surgeon and former NIH investigator who took over University of Arizona leadership in July of 2017.

I pushed back on Weil: “It might have helped the president to come around that you made a $15-million commitment to the Center …” That donation brought to $20-million Weil’s total donations. I had last interviewed Weil about this philanthropic investment, made possible due to the success of his True Food venture. The gift led to the operation being re-named the Andrew Weil Center. It turned out that Weil’s donation wasn’t until 2 years after Robbins had been on the job. Weil was quick to correct me, and give credit where it was due:

No, his support was way before that. The president made a point to speak with me before he was even officially in his position. We sat down together. He immediately got it. He couldn’t believe that the University hadn’t recognized what a jewel they had. It’s been great ever since.

The University of Arizona Fellowship: setting standards and spreading the word

The second positive surprise was volunteered by Maizes: the “incredible growth and impact” of their pioneering Fellowship in Integrative Medicine. She chimed in:

We have now graduated nearly 2000 Fellows. Right now its 160 a year, in two groups. The most recent entering class was of 91. They were originally mainly in family medicine and pediatrics and primary care. Now we’ve had fellows in virtually all medical specialties – neurosurgery, cardiology, psychiatry – you name it. We’ve expanded from medical doctors and osteopaths to take dentists, pharmacists, advanced practiced nurses, and physicians assistants. We’ve just opened to naturopathic physicians. Our alumni are out there working everywhere in healthcare systems, other academic health centers and many other places. We’re in partnership discussions with numerous people around the globe. An insurance company in Ireland wants a whole batch of our Fellows. We have a waiting list. Even in COVID times it has continued to grow. The impact has been remarkable.

So it has. From the period that began in 2005 with the Bravewell Fellowships, conceived by long-time Center philanthropic partner Colby Jones, the Center’s fellowship became the de-facto standard for education of most of the medical doctors who are presently being hired in hospitals, large medical delivery organizations, and academic centers. The then burgeoning yet untamed field of medical doctors with wildly varying levels of education on complementary and integrative practices and practitioners who were adopting the “integrative” title began to be judged against an increasingly accepted measure. The standard was fixed when the Center began collaborating in 2011 with the American Board of Integrative Holistic Medicine and others to create the Board Certification in Integrative Medicine through the American Board of Physician Specialties.

Multiple other organizations now offer fellowships. The most significant is that of the Academy of Integrative Health and Medicine. I asked Maizes about differences with AIHM’s program. She noted that one area is the breadth of practitioners who qualify to enter the AIHM program which includes, for instance, acupuncturists and dieticians: “We took a different tack and chose to set up a separate interprofessional program, our Integrative Health and Lifestyle Program (IHeLp) for clinicians with varied backgrounds in education.”

The transformation tool-box: Integrative Medicine in Residency, plus …

In the early days of academic integration, Maizes was a principal co-author on the ground-breaking Core competencies in integrative medicine for medical school curricula: a proposal published in the Association of American Medical College’s esteemed Academic Medicine. The focus of the emerging field was on the strategies to begin to transform medical education from its disease centered model and embed any of these competencies in the already over-stuffed curricula.

What becomes clear to anyone skimming the website, reading their handy chronology, and talking, as I was, to the principals, is that they have chosen to, in some fashion, produce virtually every good education program and resource idea anyone has had. In combination with the other programs already mentioned, picture the following as a tool-box for the transformation of medical education and practice. (These bullets do not include all the resources they have created.)

• Integrative Medicine in Residency (IMR), in 99 sites and five specialties with more than 1,300 present residents. The program counts 1400 graduates.
• The short form, specialist-specific, Integrative Medicine Skills in Residency curriculum for residency programs in Emergency Medicine, Anesthesia, Surgery, and OB/GYN.
• My Wellness Coach, a free online tool “designed to result in wellness for underserved patient communities.”
• CanHEAL: Cancer Health Empowerment, Advocacy, and Learning pilot project, a “free, in depth, online patient-centered toolkit for integrative cancer care.”
• The interprofessional Health Resources Services Administration (HRSA) funded National Center for Integrative Primary Healthcare (NCIPH).
• Multiple one-time or annual conferences.
• Integrative Pain Management program.
• Integrative Health Team Training.
• The Institute on Place, Wellbeing & Performance led by the Center’s research director since 2012, NIH scholar and renown architecture expert Esther Sternberg, MD. The Institute is a “collaboration between the Center, the College of Medicine, and the College of Architecture, Planning and Landscape Architecture.

The set of tools allows the Center to do for the transformation of conventional medical education and care delivery what a good integrative practitioner does in the clinic: meet the “patient” where they are with the right prescription that can get them on a transformative path. One client is the US Veterans Administration. Maizes notes that in the VA’s work to implement the Whole Health model, the VA has “trained many of their site leaders in our fellowship, and purchased parts of our programs including the Foundations in Integrative Health modules, our Integrative Pain Management program, and our Integrative Medicine in Residency-Psychiatry.”

The tool box is growing. Appreciating the changing nature of the upcoming “digital natives,” more attention is being focused on targeting the learning and interactive styles of these learners. Maizes notes that they anticipate development of more direct-to-patient programs and resources. One major step in that direction was their decision to create and jointly co-host their consumer-and-practitioner facing Body of Wonder Podcast. The promise is to:

… dive into ideas that are changing medicine, hear compelling stories, and explore age-old wisdom backed by modern science. We discuss the latest research and how it has a powerful effect in our lives.

The podcasts are freely available on their site. Among featured guests have been (with their podcasts available via the link): Paul Stamets, the mushroom guy; author Deepak Chopra; Dr. Roger’s Prize micronutrient researcher Bonnie Kaplan, PhD;  and their very own associate director of the Fellowship, the trailblazing naturopathic physician Lise Alschuler, ND who was lead author on the Center’s influential Integrative Considerations During the COVID-19 Pandemic paper.  One unanticipated consequence of our reconnecting during the interview was an invitation to participate in a 2021 Body of Wonder podcast. Stay tuned via their newsletter sign-up on the site.

Ireland? An insurance company? What?

Another partner, in the works, is with the insurer in Ireland that Maizes mentioned when ticking through the evidence of the reach of the Fellowship. When I followed up, Maizes explained that “one of our goals is to grow through partnerships.” An unanticipated opportunity arose when the Voluntary Health Insurance Board in Ireland that insures 25% of the nation’s population decided that, to meet its goals related to health and costs, it would get into the business of not just covering but also delivering care. Sort of a reverse HMO.

They decided to move from being just an insurer to being a provider of care. They wanted to do it with an integrative medicine model. We are still working on the details. They want us to train 50 doctors, and a large number of other providers through IHeLp and through our health coaching.

IHeLp is an interprofessional, all online, 6-month, certificate program. It can be a means of fulfilling prerequisites for the latter, their Integrative Health and Wellness Coaching certification program. VHI is the first group to use a new Center program, the Integrative Health Team Training, now enrolling its second cohort with 18 participants. Maizes notes that conversations are under way with multiple prospective global partners. That with VHI is only the most advanced.

Challenges in Clinical Services Delivery: Pivot to a Virtual Network?

An area where the Center is nowhere near the “epicenter” for academic integrative medicine is in the delivery of clinical services. Asked to identify leaders in that arena, Weil and Maizes point to places like Northwestern and University of California San Francisco, and the unfortunately now shut down center in New York City formerly operated through Continuum Health in association with Albert Einstein University.

The Center faces an obstacle in Arizona because state law there dictates that the university cannot directly offer clinical services. Weil and his team worked around this with a major pilot center in Phoenix that was developed in partnership with District Medical Group (DMG). Weil forecast that at the Center’s outpatient integrative center “our findings will help change priorities of reimbursement and ultimately affect how health care is delivered on a national level.” Unfortunately, they got the same treatment as the Continuum Center, where the multi-billion Mt. Sinai Medical Center brushed it away like a gnat off an elephant’s back. The Phoenix pilot meant as little to the Banner Healthcare executives as it took over the smaller DMG in a merger. The Phoenix operations was summarily shuttered in 2016. No data have been published to prove or dis-prove Weil’s postulate.

The COVID era’s stimulus to online services has given birth to a new clinical idea that could potentially lead to a virtual national and even global network via the Center. Here is Weil:

We are now thinking of shifting to telemedicine as a center of clinical care. Now with roughly 2000 clinicians graduated and with our health coaches, practitioners trained at multiple levels, and with our many online programs, we are thinking of telehealth as a post-pandemic model. An article in Harvard Business Review has just forecast that up to 50% of the virtual services begun during COVID will remain virtual. Think of it like MD Anderson’s advertisements that, wherever you are, let them provide a second opinion on your cancer. In the wildest expression, this could be the future for us. Telemedicine can work very well for us. It could make very good sense as a wonderfully distinct clinical network. This can serve the patients, it can be work for the providers, and serve as a way of broadening the field’s impact. Of course, there are all kinds of regulatory issues. But it could be a win-win-win.

I could picture the television advertisements – beyond what Cancer Treatment Centers of America did some years ago when their ads on television and places like the New Yorker promoted their naturopathic and other integrative services. Here there would be the familiar face of Weil, perhaps with the original 1997 Time cover re-purposed from question to assertion: This integrative care network can help make you healthy!

Concluding Comments

The Center’s mission statement is a blunt promise: “The University of Arizona Center for Integrative Medicine is leading the transformation of healthcare by training a new generation of health professionals and by empowering individuals and communities to optimize health and wellbeing through evidence-based, sustainable, integrative approaches.” Their promotional materials suggest the on-the-ground magnitude of the present success: “Center graduates are now guiding more than 8 million patients to take a greater role in their health and healing.”

One thing known for sure about the Center’s future is that, as part of the Weil philanthropy, the multiple teams will before long be working out of a new Andrew Weil Center building that is being designed and developed in coordination with Sternberg. Any future dreams, planning and project development behind their profound and expanding national and now global influence will not be constrained by dark, cramped, confined, and unhealthy spaces.

“Our building,” Maizes shares, “will be in 3 sections: mind – where most of us will work; body – a teaching kitchen and space for things like yoga and Tai chi; and spirit – a relatively small and lovely meditation space where you can look at the light and view.”  Maizes says they are targeting the ribbon cutting for Weil’s 80th birthday, in 1.5 years. It is good to imagine the “mind” behind these parts of the global integrative movement nourished by such an environment. From day one, Weil has advocated for the healing power of nature.

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