photo by Chris Hildreth

hen talking about whole-person health care, the terminology itself can be confusing, misleading, and laden with New-Age stigmas. But use a different word--integrative. Integrative medicine combines the best in traditional health care. It seeks to treat illness with medication and/or medical procedures, with non-traditional research- and outcome-based therapies that fall into a category commonly called complementary/alternative medicine, or CAM.

The idea behind integrative medicine is not for people to forego the appropriate traditional treatments in favor of CAM therapies, says Tracy Gaudet, director of the Duke Center for Integrative Medicine (DCIM), but to complement these treatments with techniques that address the multiple components of whole-person care--including body, mind, nutrition, movement, and spirit.

This philosophy clearly rings familiar with many Americans: Nearly half have pursued CAM therapies at one time or another. And for this, Gaudet cites two primary reasons: first, because there are therapies and approaches that have been proven beneficial in helping people prevent and fight illness, but have fallen outside mainstream medicine; and second, because "a large cultural shift is afoot in which people want to be seen as more than just diseased body parts--they want to be understood and treated as the whole entities they are."

Duke has long been known for its scientific and technological advances in health care--as Duke Health System CEO Ralph Snyderman, says, "The practice of medicine has benefited tremendously from its marriage to science and technology over the last fifty years." However, he adds, "the concern is that although that marriage is vital--and will continue to drive Duke--it is insufficient, because there are limitations, as well as benefits, to science and technology. Unfortunately, much of today's delivery of health care fails to acknowledge the components of health care that go beyond science alone."

	Taken to Heart
	The Point of Treatment

For example, although much of science-and-technology-driven medicine is straightforward, a woman whose cancer results in the removal of a breast "has needs beyond thinking of her own chances for a cure," Snyderman says. "In a way, she and all patients facing serious illness become different people, with new questions, needs, concerns, and priorities." In other words, cognitive and spiritual issues.

The problem lies in the modern Western tradition of medical education. While many health-care providers are trained to treat the body, few are trained to address matters of the mind and soul--components that are arguably as critical as the physical when it comes to staying and getting well. And the fact that so many consumers are now looking beyond body-only health care makes it even more important for the medical community to be in the know about integrative medicine.

"It's as though there are now two distinct health-care systems in our country--conventional and 'alternative'--and because they're not integrated, patients are stuck in the middle, getting mainstream advice from their doctors and CAM advice from others," says Gaudet. "Because many people aren't telling their doctors about their interest in CAM therapies for fear the doctors won't be knowledgeable and supportive, cancer patients are seeking medical advice from health- food store clerks."

As a leading institution in the field of integrative medicine, Gaudet says, Duke has a responsibility to educate both patients and health-care professionals. "First and foremost, we at Duke are advocates of the best medicine, and our knowledge of and receptivity to CAM enables us to help patients separate what's safe and legitimate from what's not--and then look at CAM therapies that might benefit them."

Think of integrative medicine, which evolved centuries ago and began appearing in health-care settings in the 1970s, as three overlapping circles, says Jeff Brantley, director of Duke's mindfulness-based stress reduction (MBSR) program. MBSR incorporates hatha yoga, breathing techniques, and meditation to help reduce stress or stress-related symptoms. "The left one represents traditional Western medicine, the one in the middle symbolizes CAM therapies, and the circle on the right are mind-body-spirit techniques--things like mindfulness, that people can do themselves to promote health and well-being."

While most of the techniques represented by the left and middle circles require an expert to do something with or to us, Brantley says, those represented by the right circle "are the internal experiences that are vital to health and healing. There's growing evidence that clarifies the link between how we experience stress and how that stress affects our bodies' reactions to things. Our immune systems in particular are greatly impacted by stress, which can have serious health implications.

"Mindfulness is a quality we've already got. It's about paying attention to what's here, inside and out, right now, and being open-heartedly aware of what's going on in the present without thinking or judging. Out of that undistracted awareness comes a heightened appreciation for life and a strong recognition of habits, choices, and options. It starts with being fully present--for good things and bad."

But Brantley echoes the warnings of other Duke medical professionals when it comes to CAM: "People must never stop taking their prescribed medications or foregoing necessary procedures in favor of CAM therapies like MBSR," he says. "If you have concerns about your care, become a better partner with your physician and try to gain skills that will make you more aware of what's going on inside. That combination is very empowering--and is what really does help us to be our own best healers."

Whether as part of MBSR or on its own, yoga is one component of stress control and integrative medicine. A practice that evolved some 5,000 years ago, whose name means to join or yoke together, yoga "focuses on breathing techniques, physical postures, and meditation to teach us to bring our bodies back into a state of balance and quiet so that we're better able to deal with daily stressors from a place of clarity," says Linda Smith, yoga expert and DCIM director of programs. "A system of awareness and rebalancing that's easy to learn and can be practiced at many different levels, yoga is successfully used in the prevention and treatment of many chronic conditions."

Because the goal of yoga is to tone, strengthen, and develop flexibility and balance within one's body, Smith says it isn't only for people in excellent physical condition. "Most everyone, regardless of their state of health, can breathe, meditate, and move their bodies. The key is to develop awareness and sensitivity to what's going on in your body and learn to listen to its limitations."