Preventive Integrative Medicine, the Ideal Approach to Care

How could this have been prevented? This is a question I have been asked hundreds of times throughout my training and over the course of my career. As a resident learning about surgical procedure as pertains to obstetrics and gynecology, I clearly recall thinking beyond the surgery to how the need for the surgery may have been prevented. It was during this time that I decided to switch my concentration to family medicine, which would allow me to further focus on prevention.

Preventive Integrative Medicine to address the widest array of appropriate options that are both safe and effective

While practicing family medicine and treating significant cases of hypertension, heart disease and diabetes, my passion for preventing or delaying these health issues continued to grow. I pursued a Fellowship in Integrative Medicine, which allowed me to further move from traditional reactionary medicine and embrace core prevention strategies.

Prevention/Preventive Medicine

Primary.Prevents disease before it occurs, addresses risk factors. Examples: immunization, clean water, nutrition, diet, exercise.
Secondary.Measures that lead to early diagnosis. Example: finding/removing a colon polyp to prevent colon cancer.
TertiaryTreatments to reduce chronic effects of a health problem. Example: treatment of hypertension or cardiac disease using cardiac rehab or medications to prevent further disease.
Quaternary.A newer concept that attempts to protect patients from medical harm, over medicalization, over testing and over treatment. Example: women were prescribed hormone replacement therapy in the hopes of preventing heart disease, but this not only failed to reduce cardiovascular risk, but resulted in an increase in the number of breast cancers, stroke and thromboembolic events (blood clots).
Primordial Prevention.Prevents developing risk factors by minimizing health hazards. Example: avoiding childhood obesity with diet and exercise, or the onset of smoking, which leads to risk of disease in adults.

Unfortunately, many physicians find themselves concentrating primarily on tertiary prevention, managing chronic disease with medications, which often leads to side effects and, subsequently, the need for additional medication. This is a frustrating prospect, as I recognize the opportunity for prevention through diet and lifestyle.

Earlier this year I attended a conference on cardiometabolic health in an effort to further explore ways to prevent, diagnose, and reverse disease. However, during the three days of lectures, which focused primarily on heart disease, diabetes, kidney disease, hypertension, and obesity, the majority of the lectures addressed medical management of established and severe disease. Only three lectures addressed diet, nutrition, and risk factors. Of course, there is plenty of work to be done in the area of medical management, and I am thankful for the physicians who specialize in this area, as it requires complex and difficult work. However, I was reminded of the critical need to focus on prevention.

Eventually, we all will succumb to disease (statistics point to cardiovascular disease or cancer), but delaying the onset of disease by staying functional and healthy, and experiencing compression of morbidity, or a shorter period of illness and disability, will lead to more time feeling able bodied and vital.

The issue is this: Although disease can be treated easier or even reversed if physicians catch it early, people rarely seek a doctor for prevention. They aren’t of the mindset that the removal of a polyp can save their life, or that by the time they experience elevated blood pressure, cholesterol or blood sugar, the onset of disease has already begun. Perhaps this is due to the fact that prevention is not as personalized as it could be. There is exciting work in genetics (Harvard’s Preventive Genomic Center is researching polygenic risk calculation and scores) and other research in early biomarkers (indications of inflammation and damage) that can certainly change or even reverse disease if detected early enough.

Integrative medicine offers the promise of more expansive means to achieve the desired ends of preventive medicine.

Preventive Integrative Medicine as the ideal approach to care.

Integrative medicine offers the promise of more expansive means to achieve the desired ends of preventive medicine. So it may come as no surprise that I see the overlap of the two, Preventive Integrative Medicine, as the ideal approach to care. Its philosophies include healthy behavioral, diet, exercise and lifestyle choices, many that demonstrate the ability to improve functionality, reduce morbidity, improve the quality of life and directly influence–perhaps even reverse–the disease process. This is how I live my life, so by “walking the walk” I feel confident about counseling others on making healthy lifestyle choices. Adapting and maintaining a healthy lifestyle are also key components of the vision of Dr. Andrew Weil, with whom I studied.

We need to be careful to maintain focus on disease prevention and health promotion with scientifically-sound, continued standard preventive measures that are expansive, not divisive. It is through Preventive Integrative Medicine that we can address the widest array of appropriate options that are both safe and effective, and allow us to live optimally.

Worth Reading

Ali, A., Katz, DL, Disease Prevention and Health Promotion: How Integrative Medicine Fits, NCBI/2015

Carmona, Richard, Liponis, Mark, Integrative Preventive Medicine, Weil Integrative Medicine Library/2017.

Dudbridge, Frank, Power and Predictive Accuracy of Polygenic Risk Scores. PL0S/2013