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Lions Roar : January 2011
SHAMBHALA SUN JANUARY 2011 60 then has a series of appointments with other specialists, such as a nutritionist or a health psychologist, and receives complemen- tary therapies like massage, acupuncture, or reiki. every patient is also introduced to the concept of mindful- ness and the body–mind relationship. “Mindfulness is at the core of everything we do,” brantley says. “We believe that the more mindful people can be as they face health challenges, the health- ier they will be.” the center also offers mindfulness-based stress reduction classes to health care professionals, and all of their care providers and health coaches are trained to bring mindfulness into their interactions with patients. before the end of the immersion, the full team of core and complementary care providers meets to chart a plan individually tailored for the patient. the patient walks away not only with a list of recommendations for supporting his or her own health, but with established relationships with a team of health profes- sionals. Health coaches follow up with patients by phone on a monthly basis to support their progress. “It’s not just about ex- perts giving information and advice,” brantley says. “the power of the individual to shape the trajectory of their own health is one of the main principles at Duke. It’s a core shift in paradigm. We partner with patients to help them be the single most impor- tant element in their own health and healing.” can We afford it? ford says yes Programs like Duke Integrative Medicine are incredibly appeal- ing—who wouldn’t prefer a dedicated team of medical profes- sionals, and a full spectrum of complementary care, instead of a ten-minute rushed appointment with an overworked physi- cian that ends with a single prescription and a lot of unanswered questions? but in debates about the practicality of integrative medicine, one question always comes up: Is integrative med- icine—which requires more time, more health care providers, and a broader scope of services—financially feasible in a health care system that is straining to contain costs? kenneth Pelletier, MD, is on a mission to answer that ques- tion. as director of the university of arizona’s corporate Health Improvement Program (cHIP), Pelletier helps companies evalu- ate and implement a range of integrative health interventions in the workplace. the cHIP program is designed to address two of the most common objections to integrative medicine: one, it’s too expensive, and two, there’s not enough evidence that it works better than standard care. Pelletier started cHIP in 1980 as a small health promotion project with IbM. When that program was bought by Johnson & Johnson, a light bulb went off for Pelletier. “I realized corpora- tions have a vested interest in health. they need high-perform- ing, healthy people. their products depend on it. If you want to demonstrate the clinical and cost-effectiveness of an approach, this is the place to do it.” thirty years later, even in the midst of health care reform, large companies recognize they are still going to be on the hook for their employees’ health care. this, Pelletier says, makes them very open to preventive and integra- tive interventions. “It does not matter to them if something is conventional or alternative medicine. once these companies see something that works, they act, very decisively.” one such company is ford Motor. a few years back, its medi- cal director came to cHIP with a very specific problem. ford was spending eighty to ninety million dollars a year managing back pain. In addition to the cost of covering employees on disability, ford was running its own fully-staffed health clinics in plants across the u.s. the company estimated that the cost of employ- ees’ back pain alone was adding $400 to the price of every car ford sold; medical costs in total were adding $2300. since this was far more than foreign competitors like toyota were spend- ing, back pain had become a major barrier to remaining com- petitive. so the medical director asked cHIP: Is there a way ford could better manage back pain that would cost less? cHIP helped ford implement an integrative approach to back pain at a randomly selected engine assembly plant in kentucky. the approach included the usual care offered at ford’s clinics, plus onsite clinical acupuncture, mindfulness-based meditation and body mechanics training, and referral to chiropractic services when appropriate. Pelletier wasn’t sure how blue-collar assembly line workers would respond to the less conventional therapies. “When we first went to louisville, we had to meet with the unions and ford’s medical team. the very first person said, ‘What’s this acupuncture?’ and I thought, we’re in trouble. but the good news about companies is that they are agnostic. they want to get people healthy and back to work, so they can save money. they’re very practical, and they set aside bias. they’re not against any form of medicine as long as it is safe, effective, and cost-effective.” the good news about corporations is that they’re very practical and they set aside bias. If you want to demonstrate the clinical and cost-effectiveness of an approach, this is the place to do it. Dr. kennetH PelletIer