I'm Dr. Andrew Weil,
the founder and director of the University of Arizona
Center for Integrative Medicine, and I want to talk to you this morning
about the future of healthcare and the role of integrative medicine
in healthcare systems of the future. A number of speakers at this conference have mentioned the fact that healthcare
is a responsibility of governments. It is in the interest of governments
to keep citizens well and healthy and to improve wellbeing. But the economic challenge
of healthcare today is so serious and growing that it threatens
the stability of governments. I want to use the example
of the United States which I'm most familiar with, because the crisis in healthcare
that's happening there is beginning to develop
in most other advanced nations. The US is now spending 18%
of its gross domestic product on healthcare. And that is going up,
it's predicted to reach 20% in the next few years.
That's unsustainable. At the same time,
our health outcomes are worse than those of other developed countries. The World Health Organization
rank the United States 37th in health outcomes on a par with Serbia, and that's, any way you look at it,
infant mortality, longevity, rates of chronic disease. So something is very wrong
with this picture. We're spending more
and more on healthcare, and we have worse and worse outcomes. So clearly the message is that
we're spending money in wrong ways. Now I would argue that we do not
have a healthcare system in America. We have a disease management system that's functioning very imperfectly
and getting worse by the day. And the sad fact is that the diseases
that we're trying to manage are mostly diseases rooted
in lifestyle choices. They have to do with
how people are eating, their lack of physical activity, how they handle stress
or don't handle it, all these factors that are really apart from purely
looking at the physical body. And it is a truth that modern
high-tech medicine is unable to manage
these diseases very well. The classic diseases
that we're seeing of this sort are obesity, hypertension,
type 2 diabetes. All of these are now epidemic
in the United States especially among young people. The obesity epidemic
in children in the US should be a flashing red light telling us that we're
doing something very wrong. Experts on type 2 diabetes are closely watching
the epidemic of type 2 diabetes follow this development
of an obesity epidemic in children. When I was in medical school
in the late 1960s, type 2 diabetes
was called adult onset diabetes, then we changed the name to adolescent onset diabetes. Now we're seeing this disease develop
in children as young as 3 and 4 preceded by massive obesity
at ages 1 and 2. So something is very wrong
with what we're doing in our society. And also experts on diabetes tell us that the cardiovascular complications
of that disease typically appear 15 to 20 years
after diagnosis. So that means that we can begin
to see an epidemic of coronary artery disease
in young men, something that we've never
had to deal with before. Also when I was in medical school, I was taught that if you see a young man
in an emergency room with acute chest pain, you don't have to worry
about doing an extensive workup because the chance that this
is something very serious is small. Now if you see a man
in his twenties or early thirties with chest pain in an emergency room, you have to consider the possibility
that this is a heart attack. This is a great change
in patterns of disease that we've seen in our culture. The great challenge we face, I think, is how do we turn this system
of disease management into a system of health promotion
and disease prevention? And that is a great challenge
for our society. The forces that are impacting
healthcare in America are building in all other countries, I'd say all other developed countries. And the reasons are first of all
that people are living longer. We are seeing a greying of populations. Japan is ahead of the United States
in this change, but this is rapidly happening
in other advanced cultures. The oldest old are the fastest growing
segment of the population, and as people become older, they become sicker and begin to drain
the resources of healthcare systems. Secondly, we are trying
to manage these diseases of lifestyle by applying the methods
of high-tech medicine. Conventional allopathic medicine
is very reliant on technology. I include pharmaceutical drugs
in that category. And the methods of high-tech medicine
are very successful in dealing with trauma,
with medical crises, with acute conditions of all sorts. They are much less successful
at managing the chronic diseases that are now becoming epidemic
in our societies. So I think a fundamental change
in the nature of medicine is required in order to meet the challenge
that we're seeing of escalating healthcare's cost, and at the same time, deteriorating health outcomes. Integrative medicine is one solution
I think to the problem, and this is what I have
dedicated my career to, and through the center
at the University of Arizona, we have begun to train physicians
in a new model of medicine that is not simply focused
on the physical body. Let me review for you the fundamental
principles of this new system. First, integrative medicine
places great emphasis on the human organism's potential
for self-regulation and healing. This is not a new idea; this was enunciates by Hippocrates
in the 5th century BC, who said that we should revere
the healing power of nature. But that idea has been lost
in our enthusiasm for technological solutions
to all problems. To me, the most marvelous fact
of human biology is that our bodies
have the ability to know when they have been injured
or damaged. They have the ability
to regenerate tissue to re-establish new equilibrium, to adapt to injury and loss, and that should be
where good medicine begins. When I sit with a patient, always at the back of my mind, I'm thinking why is healing
not happening here? What can I do from outside
to facilitate that process? Are there obstacles to healing
that I can remove? Is there a way that I can give
more energy to that system? Here's an example
that I often use in teaching students; if you have a patient acutely ill
with bacterial pneumonia, you put them in a hospital, give them intravenous antibiotics, and 48 hours later,
they're out of danger. It's very easy to interpret
what happened as the antibiotics caused the cure. I would ask you to interpret
that differently. What antibiotics do in that circumstance is reduce populations of germs to a level where the
immune system can take over and finish a job that it could not do
because it was overwhelmed. And to me, that's a model for how all
of our treatments work when they work. They don't work directly,
they work indirectly by impinging on the internal mechanics
and mechanisms of healing that we're all born with. As I said, it seems to me
that good medicine begins with emphasizing this fact that the human organism
has a tremendous potential for healing, and that's
where we should start. That's the first principle
of integrative medicine. The second principle is that human beings
are not just physical bodies; we are also mental emotional beings, spiritual entities, community members. And in order to understand
health and disease, those other dimensions of human life
have to be taken into account. At the moment, conventional
medicine is dominated by the biomedical model which assumes that all physical disease has physical causes, and restricts its scope
of analysis and treatment to the physical body, and in doing so, it restricts its vision and ignores often the true sources
of health and disease which can be only understood
by taking a more comprehensive view. So this is one of the most important
aspects of integrative medicine. You might call it
whole person medicine that is breaking out of the restrictions
of the biomedical model and instead using a bio psycho
social spiritual model, and interestingly enough, it is a bio
psycho social spiritual model that has been an essential aspect
of many traditional forms of medicine around the world, including
traditional Chinese medicine, Ayurvedic medicine,
traditional Islamic medicine, Native American medicine, and other systems which have had a more
complete view of the human being. A third principle
of integrative medicine is that we look
at all aspects of lifestyle in trying to understand
health and illness. That means inquiring
about how people eat how they handle stress, the nature of their physical activity, how they rest, how they sleep, the nature of their relationships
and so forth. And it is only through a careful
taking of a lifestyle history that we're often able to understand
the causes of illness and able to make recommendations
that can help people remain healthy. I think this emphasis
on lifestyle medicine puts integrative medicine
in a very strong position to offer real prevention
and health promotion, which conventional medicine
is unable to do because doctors have not been trained to analyze lifestyle choices
of patients, or to present them
with practical advice. A forth principle
of integrative medicine is that the interaction between
the physician, health practitioner and the patient is all important
to eliciting a healing response. One of the great tragedies
of modern medicine, and I see this very clearly
in the United States, is that as medicine has become
incorporated into for profit systems, the time allotted for physician-patient
interactions has diminished. It is not impossible, but it's unlikely that if you only have
5 or 10 minutes with a patient, that you can form the kind
of therapeutic relationship that fosters healing. So healthcare systems of the future must
allow for a much greater interaction between patients and practitioners. And then finally, the final aspect
of integrative medicine is that we are willing
to look around the world and take from traditional
systems of medicine anywhere we find them treatments
that we feel to be useful, and as long as they don't cause harm, and we have reasonable
evidence for efficacy, to incorporate them
into the medicine that we practice. So an integrative
treatment plan for a patient might include, always
includes recommendations for dietary change, information about exercise, use of dietary supplements, use of natural remedies
including herbal remedies, referral to practitioners
of other systems like Chinese medicine
or Ayurvedic medicine, mind-body therapies;
this is a whole range of therapies, everything from hypnosis
to visualization to guided imagery, to take advantage of the connection
between the mind and the body. Conventional medicine
ignores that connection, and again, only looking at the physical
body does not see the great potential of using the mind to access
the healing potential of the organism. So, an integrative treatment plan
is much broader than what conventional doctors
would give, but it does not exclude
conventional treatment. If drug therapy
is the appropriate therapy, if surgery is the appropriate therapy, of course integrative medicine
will recommend that, but in addition to that, these other
therapies will be recommended to make them more effective, to reduce
toxicity of conventional therapies, to improve general health,
to improve outcomes. I mentioned to someone
as I was coming into the conference that a few years ago I was in Beijing, and was taken to a very large hospital, Guang An Men hospital. The entire hospital is dedicated
to integrative medicine. It's a modern hospital that looks
as modern as any hospital that I know in America
or other Western countries. The largest department
in that hospital was oncology. Every cancer patient in that hospital
gets surgery, chemotherapy, radiation, as needed, in addition, very sophisticated
nutritional therapy acupuncture, massage therapy, and most importantly,
very sophisticated herbal therapy designed to reduce the toxicity
of the conventional treatments, to increase their efficacy, to improve general quality of life
and improve outcomes. I saw a number of patients
who were presented to me there. Their outcomes were very good. It made me sad to think
that in my country, so few cancer patients are able
to access that kind of care. And when cancer patients
do ask oncologists about the use of dietary supplements
or herbal therapies often, they're just reflexively told
not to do it, that it'll interfere
with conventional treatment. So, again, I think there is in oncology
as in many other specialties of medicine there's an enormous need
to broaden our model, and I believe integrative medicine
is the way of the future. In the US, it appears that we might see a complete
unravelling of the healthcare system. As you know, there was an attempt
to try to improve it under the last
presidential administration, and that effort... there's now
an attempt to undo it completely. Patients are extremely unhappy,
doctors are extremely unhappy. It is not clear where this is going, but it's not going in a good direction. It is possible that
the conventional healthcare system and conventional healthcare institutions will not be there
10 years in the future, and it's interesting to speculate
about what might take their place. I'd like to give you one vision
that I have. It seems to me that conventional
allopathic medicine, high-tech medicine which I've said is very good at dealing
with trauma, with medical crises, with medical and surgical
emergencies and so forth, that this might become a specialty, and the practice of it
will be restricted to large urban medical centers, which are the only ones that
are going to be able to afford all the technological hardware, and many smaller and community
hospitals may simply disappear. In their place, I would hope new kinds of healthcare institutions
might come into being. One of them that I envision
I would call a healing center, and I see this as something
between a spa and a hospital. This would not be
for the treatment of severe illness, critical illness, terminal illness, but they'd be places where you could go if you were not yet sick where you could have
your lifestyle analyzed. It could also be places
where you could go for the management
of routine complaints; back pain, headaches, allergies, autoimmune diseases,
a whole range of conditions which are not well managed
by conventional medicine. And I would see these centers
as being under the direction of integratively trained physicians, but there would also be a team
of allied health professionals that would include practitioners
of Chinese medicine, of Ayurveda, of Islamic medicine, of mind-body medicine. I would also see this as places
where you could stay, say you stay there for 3 days
or 5 days a week, and when you came out,
you'd know more than you went in about how to live,
about how to eat, perhaps how to cook,
perhaps how to grow some of your food, how to handle stress. You would learn practical information that would enable you to go out
and live in a better way to reduce the chances of disease
and optimize health. And very important, I would see stays in these centers being reimbursed in whole
or in part by insurance. And this is a great stumbling block
at the moment for integrative medicine, because as dysfunctional
as our current healthcare systems are, they are generating
a great deal of money, and that money is going
into very few pockets. It's the pockets of the big
pharmaceutical companies, the manufacturers of medical devices,
and the big insurers. And those vested interests
do not want to see anything change. At the moment, as I said,
we at our center graduate physicians who are highly trained
in integrative medicine. We have now graduated over
1500 physicians from all specialties, from these intensive two year trainings
in integrative medicine, but then they go out into a world where the priorities
of insurance reimbursement are stacked against them. We happily reimburse for giving drugs,
for doing procedures. We don't pay a doctor
to sit with a patient and give them advice about diet, give them advice about exercise,
teach them methods of managing stress. That's what has to change, we have to change
these priorities of reimbursement. I think that can only be done by convincing the people
who pay for healthcare that it is in their interest to pay
for this kind of treatment, that in fact doing
this sort of treatment and emphasis on prevention
and health promotion in the long run will save them money. For example, I said that one of our key points
is that there has to be sufficient time for a doctor and a patient to interact. At the moment, it's the physician's time
that is the most inelastic element, economic element in healthcare. So when you try to talk to someone
who pays for healthcare, about allowing an hour
for a first visit, they stop listening. They can't imagine how that could work. Our contention is that by taking
that amount of time at the beginning, you will save money down the road because there will be
lowered utilization of practitioners, lowered costs of treatments of so forth. But that has to be demonstrated. And there is an enormous need
at the moment for effectiveness and outcomes research in which integrative treatment can
be compared with conventional treatment head to head to see how the two compare. And the way that I would do this
is to pick disease conditions that now absorb most
of our healthcare dollars. Things like chronic back pain
for example, allergies. Pick forms of arthritis in which we think that integrative
medicine would shine. You take matched pairs of patients, matched for age, gender,
medical diagnosis. One of each pair goes
to conventional treatment, one goes to integrative treatment, and then you want to compare outcomes in terms of medical outcomes, cost outcomes, patient satisfaction. And I am quite sure that if we did this, we can produce data
that's very convincing that integrative medicine
will be more successful and more cost effective
than conventional medicine. But it is not easy
to get these studies done. They require large populations, they're expensive to do, and it's
not clear who's going to pay for them. I think it is... I would hope
that perhaps corporations which are now hobbled
by healthcare costs perhaps in collaboration
with governments could organize at least
some pilot studies of this sort in which we can look and do
this kind of comparative study of effectiveness and outcomes, in order to guide the way
that we reimburse for healthcare. But I thought I might
give you an example of a treatment
that I use very frequently, a recommendation in my own practice that to me is an example of the kind of
thing that integrative medicine can find and bring into mainstream practice. I've become known
as one of the few doctors who places a great emphasis
on breathing. And in my own experience, I have found that regulation
of the breath could be an extremely powerful
medical intervention that is utterly simple,
that requires no technology. It's free, and produces remarkable changes
in physiology. And I'd like to teach you
a simple breathing technique that I have found to be really
the single most effective remedy in all of my explorations
of alternative treatments. All of these breath work,
if you look around the world, at areas where emphasis
is placed on breathing whether it's martial arts, systems of meditation,
athletic performance, natural childbirth, and you try to find where
did this information come from, all roads point to ancient India. This is, I think,
a true experiential science that developed thousands
of years ago in India, and has diffused all over the world. The theory of breath work
is that breathing is the only function that we can do completely consciously
or completely unconsciously. It's run by two different sets
of nerves and muscles by voluntary nerves and muscles and involuntary nerves and muscles. So the theory is that
by imposing certain rhythms on breath with your voluntary system, gradually, you can induce those rhythms
into the involuntary nervous system, and breath thus provides you
with a window through which you can influence
the functioning of the involuntary nervous system. Otherwise, we don't have access to that. Many common health conditions
are rooted in unbalanced functioning of the involuntary nervous system. That's true of high blood pressure, of many gastrointestinal complaints, circulatory problems and so forth. So this breathing technique
is I think a specific antidote for the imbalance that's most common
in our societies today, and that problem is that the tone
of the sympathetic nervous system, the sympathetic division
of the autonomic nervous system, the one that prepares us
for emergencies, for fight or flight responses is set too high. And we'd like to reduce that and increase the tone of the
parasympathetic nervous system which is the one
that has the opposite effects; the relaxing effects. And this is a specific technique
to do that. So I'm going to describe
this breathing technique to you, then I'm going to demonstrate it to you, and then I'd like us to do it together. So let me first tell you how it's done. In this exercise, you're going
to breathe in quietly through your nose, and you're going to exhale
forcibly through your mouth, blowing air out like... and making a sound as you do so. So the exercise begins by letting
all the air out through your mouth, then you close your mouth,
breathe in quietly through your nose, to a count of four. Hold your breath for a count of seven, and blow air out through your mouth
to a count of eight, and then you repeat this
a total of four breath cycles. It takes almost no time,
about 30 seconds. So let me demonstrate this to you, and then we'll do it together
and I'll count for you at a rate that I think
will be moderate. This is what it looks like. That's all. It's a little hard for me to come back and talk to you
after I do that because this produces a very pleasant
altered state of consciousness that I would rather stay in. You may not experience that
the first time you do it, but it is one of the rewards
of practicing this technique. Do not do more than 4 breaths
at one time. You can however repeat the exercise
as often as you like. After a month,
if you're comfortable with it, increase to 8 breath cycles, and then that's the absolute maximum. So then the practice is 8 breath cycles,
a minimum of twice a day. After the physiological changes
of doing this become apparent after, I would say usually 6 weeks
of doing this regularly, and after a month or so, try using this exercise for things. If someone cuts you off in traffic, if somebody says something
to you that angers you, before you react,
do the breathing technique. This is a very useful way
to deal with cravings for any habits that you want to stop, whether it's a cigarette,
a piece of chocolate, when you have the craving,
do the breathing exercise. By the time you get back,
the craving will be gone. But the most interesting changes are
the ones that happen physiologically. I have had patients who've
had cold hands all their lives who now have warm hands just as a result of doing this. Cold hands in a normal
temperature environment are a sign of overactive sympathetic
nervous system activity because the sympathetic nervous
system constricts blood vessels on the surface of the body
to divert more blood to the brain. So, a manifestation
of a parasympathetic response is increased circulation
to the surface of the body and warm hands. I have people who've had
chronic digestive problems that have resisted
all sorts of treatment who now are fine simply as a result
of doing the breathing exercise. I have 5 cases of people
who've stopped atrial fibrillation by doing this breathing technique, something I wouldn't
have thought was possible. This is also the most effective
anti-anxiety measure I've ever found. It makes the drugs that we use
for treatment of anxiety disorders look pathetically weak by comparison. And interestingly, the subjective experience
in an anxiety attack or a panic attack is of being out of control. If you treat this by giving
the person a sedative drug, like a Benzodiazepine, it reinforces the idea that the locus
of control is outside of you. But if a person learns that
they have within them the controls that can stop anxiety, it's very empowering, and this technique becomes
more powerful with repetition, whereas when you use
a drug from outside, the effect becomes less powerful and often there's a need
for increasing doses, which leads to dependence. So, I will just offer this as an example
of one of the kinds of things that we in integrative medicine can find that's not really even on the radar
of conventional medicine. and we can bring this
into conventional treatment. And think of how many adverse
drug reactions could be avoided, or how much money could be saved just by teaching people
this simple breathing technique. I've taught this to all the people that
come through our fellowship training. Many of them are now
using this with patients in all sorts of clinical settings, and in all sorts of specialties both in acute surgical cases,
in emergency rooms, with pediatric autoimmune diseases, and reporting great
clinical success with it. So to me, this is a prime example
of what I mean by an integrative treatment that broadens our approach
both conceptually and practically. But I'd just like to leave you
with this thought. In English, the literal meaning
of the word "conspiracy" is to breathe together. So that by doing this, we have
been engaged in a conspiracy I hope for better health, and better healthcare in the future. Thank you.
