In 2002, the World Health Organisation (WHO) predicted that by 2020, two thirds of all disease worldwide would be the result of chronic diseases, most of them strongly associated with diet .
Were they right?
It’s looking that way. According to the latest Global Burden of Disease study, sixty percent of the global burden of disease in 2015 was due to chronic conditions, also known as non-communicable diseases (NCDs) .
To a certain extent, these numbers are the inevitable result of an ageing population. But as many as 15 million premature deaths in 2015 were attributed to NCDs, representing 27% of total deaths that year . Obesity, a known risk factor for a number of chronic diseases, including Type 2 Diabetes, Cardiovascular Disease and some cancers, has tripled since 1975. According to the WHO, a staggering 39% of adults globally were overweight in 2016, and 13% obese. Over 340 million children and young adults globally in 2016 were overweight or obese . Type 2 Diabetes, traditionally seen in adulthood and associated with excess weight, is increasingly being diagnosed in children and young adults. And it’s not just physical health either. WHO has reported that disability associated with mental health is on the rise, estimating that by 2020, should current trends continue, depression will be second only to heart disease in its global disease burden .
Attempts to tackle these problems at a public level are rarely enough. Well-meaning nutrition campaigns are often tainted or undermined by the food industry and its media influence. Which, I might add, does not necessarily have the best interests of the public’s health at heart. Besides, healthy public policy is only one aspect of health promotion. The rest centre on the individual, their immediate environment, and available local health services.
So where do we go from here?
The problem with lifestyle related disease is that there simply isn’t always the time and resource, in the general practice setting at least, to get to the bottom of the issue. Because too often, the issue is intertwined with the society in which we live. In an attempt to combat this, a one size fits all approach ensues, addressing the biological markers of chronic disease with medication. That’s not to say that medication is never necessary or that we should stop adhering to expert medical advice and taking medications as prescribed. But it doesn’t necessarily tackle the underlying root causes of chronic disease – essentially a lifetime of ingrained beliefs, emotions, thoughts, reactions and choices. In turn, the inevitable effect these have on our habits and behaviours as the way we live our daily lives.
They may manifest as physical problems, but the drivers of modifiable chronic disease risk factors are rooted deep in our minds.
Time for a paradigm shift? It may have already begun. Recent years have seen a growing interest in a new approach to medical care, known as Integrative Medicine. Integrative Medicine combines traditional medical approaches (including medication and surgery), lifestyle medicine (attention to nutrition, exercise, sleep and stress management), with, where relevant, access to appropriate complementary therapies (including Osteopathy, Massage, Acupuncture, Reflexology, Aromatherapy, Mindfulness Meditation and Yoga). The Integrative approach requires acceptance of the fact that in order to truly address the majority of chronic health issues we face in the 21st century, the therapeutic relationship needs to involve more than just pharmacodynamics.
Is it a radical new form of alternative medicine that dismisses decades of scientific advance? Certainly not. It is intended to complement, not to replace. The whole person is treated, rather than the part fixed. Attention is paid to subjective as well as objective symptoms. Patients are active rather than passive recipients in their care. Health maintenance is as important as disease management: self care, nourishment, relaxation therapies including massage and mindfulness, attainment of peace, purpose, joy, community, sustainability and belonging. Perhaps most importantly, patients are encouraged and inspired to understand and take responsibility for their own health – past, present and future.
Pioneered by physicians in the US, Integrative Medicine is steadily growing this side of the Atlantic. We now have three Integrative Medicine centres here in the UK: The Royal London Hospital for Integrated Medicine, The National Centre for Integrative Medicine (Bristol), and the NHS Centre for Integrative Care (Glasgow). Medical School programmes are increasingly including the study of complementary medicine, as well as lifestyle and nutritional approaches to treating disease. GPs across the country are slowly but surely incorporating integrative approaches within their practices, and have been for some time . There now exists a British Society of Lifestyle Medicine. Recent changes in GMC referral guidelines allow doctors to refer to complementary therapy practitioners regulated by the Complementary and Natural Healthcare Council. A growing number of doctors, nurses and physiotherapists now offer Medical Acupuncture alongside traditional medical treatment. The use of Complementary Therapies as an adjunct to medical treatment has become well established within the Palliative Care and Oncology settings. They are also increasingly sought by patients in a number of other specialties. In fact, research suggests that around 44% of the English population may have used complementary medicine in their lifetime .
The House of Lords Select Committee on Science and Technology produced a report on Complementary Medicine in 2000, acknowledging that even then, the use of complementary therapies in the developed world was widespread and increasing .
In response to this, they highlighted the need for regulation, evidence, and high standards of training. The result was to categorise therapies in terms of their aims, evidence base, regulatory status, and likelihood of NHS provision. Three groups resulted. Group I (Osteopathy, Chiropractic, Acupuncture, Herbal Medicine and Homeopathy), the most organised and regulated, principally complementary, with an established research base, individual diagnostic approach, and used within the NHS. Group II (including Aromatherapy, Nutritional Medicine, Meditation, Reflexology and Yoga), voluntarily regulated, principally complementary, needing further research, not attempting to diagnose or cure, and showing some use in the NHS. Finally Group III (principally alternative, voluntarily regulated, with an individual diagnostic approach) was separated into IIIa (including long established healing traditions such as Traditional Chinese Medicine and Ayurveda), and IIIb (including lesser known therapies for which there is little to no evidence base).
Integrative Medicine complements medical management by incorporating, if relevant, the most appropriate complementary therapy for the condition concerned, with clear and realistic aims of treatment, subject to available evidence and regulation of practitioner.
Is Integrative Medicine truly a new concept? Not really. Global ancient healing traditions, such as Traditional Chinese Medicine and Ayurveda, have embodied the concept for centuries. They share one common goal: to heal the specific person of their nonspecific illness. The goal of modern Medicine on the other hand: to cure the nonspecific person of their specific illness. When it comes to acute illness and infectious disease, modern medicine has certainly triumphed. An incredible advance to be cherished.
But this isn’t the whole story. Because when it comes to lifestyle related disease and mental health, the modern medical paradigm is failing. People aren’t living any healthier, and they aren’t getting any happier. Medication and surgery alone simply aren’t enough to fix this. Why? The answer is simple. Curing and healing are not necessarily the same thing. It’s just as possible to be cured without being healed as it is to be healed without being cured. Modern medicine does not always achieve, nor does it always seek to achieve, the ability to heal. Complementary therapies do not necessarily achieve, nor do they necessarily seek to achieve, the ability to cure.
The interpretation of our various symptoms is truly unique. A culmination of our cumulative knowledge, personality, early experiences and deepest fears. What we do to help us cope can either be healthful or harmful; the choice is ours. Which begs the question: Given that we find ourselves subject to near constant media bombardment promoting an array of poor lifestyle choices, is it acceptable to be permanently firefighting the inevitable result of those choices? What’s more, is it sustainable?
Integrative Medicine, incorporating Lifestyle and Complementary Medicine, may well offer a solution to the growing gap we face. Lifestyle Medicine approaches that focus on coaching patients to achieve proper nutrition, manage stress and undertake sufficient physical activity, are already being adopted with success in the NHS for diabetes prevention. Complementary therapies, particularly those that focus on relaxation and mindfulness, potentially have much to contribute in tackling the stress epidemic. Yet historically, the concept has been met with resistance within the medical profession. Why?
It comes down to what we’re trying to achieve with treatment, and how we measure health outcomes in medical research. Most complementary therapies aim to improve general wellbeing, not diagnose or cure. How do you accurately and objectively measure a sense of wellbeing, and the improved self-esteem and self-efficacy that goes with it? How do you accurately and objectively measure the potential benefit this then has for self-motivation and subsequent lifestyle choices? How about the long-term effects of those healthier lifestyle choices on chronic disease risk? This isn’t as simple as intervention versus placebo. The result? Insufficient randomised controlled trials (RCTs) demonstrating efficacy for objective outcomes. A vicious cycle really, given that the funding necessary for such trials is rarely available. Even if it were, this type of study would be the wrong fit. To put it simply, they are running in a totally different race.
What’s more, the very originators of the evidence based medicine concept did not design it to be used in this way. They did not intend for RCT results to eclipse clinical expertise, experience and patient preference. Indeed they themselves later warned of the dangers of the concept being widely misinterpreted through almost exclusive use of RCTs to guide clinical decision making .
With lifestyle-related chronic disease now the leading cause of death worldwide, infection is (for now at least), no longer our ultimate threat. As society becomes ever more advanced and isolated, so does the potential for chronic disease to avalanche. Lifestyle Medicine offers a solution to this unfolding disaster, by addressing the root causes of the problems, before they get out of control.
The same goes for the stress epidemic. Long term stress contributes to chronic disease. We can’t the take stressors away, but we can learn to deal with them better. This means to address the psychological, social and spiritual, not just the physical. It means, ultimately, to heal. Most Complementary Therapies do not aim to diagnose or cure, but they may help to heal. They do not aim to replace or compete with traditional medical treatment, but to work alongside it. Achievement of peace, relaxation and general wellbeing are as necessary for long term holistic health as proper hygiene, good nutrition and regular exercise. The physiological mechanisms behind them are complex; their attainment in the modern world both an art and a science.
integrated medicine is not just about teaching doctors to prescribe herbs instead of drugs. It is about restoring core values which have been eroded by social and economic forces. Integrated medicine is good medicine, and its success will be signalled by dropping the adjective. The integrated medicine of today should be the medicine of the new millenium.
– REES & WEIL, 2001 
Medicine shouldn’t be an eternal firefighting exercise. Health care should be just that – care of our health. Individualised motivation, inspiration, and education on how to better take care of ourselves as we journey through life. What better way to do that than with an integrated approach that pays attention to nutrition, exercise, stress management, rest and wellbeing, acknowledging all that makes a person unique? Learning to understand, nurture and nourish our bodies in ways that maximise our potential.
Modern medicine, Lifestyle Medicine and Complementary Therapies blend together as Integrative Medicine. The healthcare system of the future must adopt this approach if it is to succeed in doing what it first set out to do. Integrative Medicine offers a valuable cog in an increasingly resource-deplete healthcare system. It’s time to embrace it. Because to be healed as well as to be cured is to experience the art and science of Medicine at its harmonious best.