I started Dignity Integrative Health & Wellness a little over a year ago because, after 25 years as an emergency medicine doctor, I became convinced that the chronic problems facing our nation’s healthcare system needed a different approach. I focused my practice around four pillars of healthspan: sleep, nutrition, movement, and mental resiliency.
Today, it seems talk of those four pillars of health is everywhere, including in conventional medicine. Today, nearly everyone accepts the fundamental centrality of eating well to your long-term health. Nearly everyone recognizes how important sleep and exercise are to your well-being. And, after a lengthy pandemic put unprecedented stress not just on our health system, but on our individual mental wellbeing, talk of strengthening mental resiliency and addressing a mental health crisis is everywhere.
In other words, integrative medicine has arrived fully into the mainstream. Today, oncologists won’t hesitate to recommend meditation to patients battling cancer. Primary care physicians will have lengthy discussions with their patients about diet and nutrition. And talk about how to get better sleep and why it’s important has moved well beyond the realm of Ted talks.
It’s just a matter of how we talk about it. Call it a focus on nutrition and sleep, or call it an integrated approach to health and well-being, but one thing is clear, the integrated medicine approach is now baked into how we all think about health and wellness.
One thing is clear is that it no longer seems appropriate to call this approach alternative medicine, because focusing on the food we eat, getting better sleep, movement, and mental resilience is no longer an alternative to anything. Similarly, the term functional medicine is now largely synonymous with integrative medicine, except that I think integrative medicine is just a better descriptor for the kind of medicine I’m practicing.
So, what drove this growth? It’s clear the pandemic accelerated it, especially since the challenge of long COVID really begs for an integrated approach. But in fact, the real driver of recent growth in integrative medicine was probably the opioid epidemic.
What drove growth in integrative medicine?
Looking back at my decades as an emergency medicine physician, I had a front-row seat to every stage of the opioid crisis. In the 1990s, doctors were encouraged to view pain as the “fifth vital sign.” Then, influenced by misleading marketing campaigns and distorted studies, doctors began prescribing ever-more-powerful opioids to treat chronic pain. Of course, we now know that drug companies did everything they could to obscure opioids’ highly addictive nature and tout their benefits as a pharmacological response to a chronic societal problem.
With newer and more-powerful opioids, deaths from overdose began to accelerate. We in emergency medicine recognized that overuse was now its own very serious problem, and put in place programs to restrict over-prescribing.
In 2016, the opioid epidemic reached an inflection point. The CDC put out a public comment period as it sought to create “Guidelines for Prescribing Opioids for Chronic Pain.” The response from the mainstream medical community sent a clear message: our insurance and payments system needed reform to incentivize other, non-pharmacological approaches to pain management.
If opioid prescriptions were the only response to pain doctors would get reimbursed for, that was the response you’d get. We needed alternatives. Virtually every major medical professional organization chimed in asking for payments reform. The AMA wrote, “Non-pharmacologic therapy and non-opioid pharmacologic therapy are preferred for chronic pain.” An article in JAMA published at the end of 2016 summed up the shift: “As Opioid Epidemic Rages, Complementary Health Approaches to Pain Gain Traction.”
What the opioid epidemic clearly demonstrated was that treating a societal-wide chronic health problem only with pharmacological interventions did not work. In fact, doing so led to a nationwide crisis of overdose and death that persists to this day. It was an opening for everyone, the mainstream medical community included, to begin looking at alternative, integrated approaches.
Growth in Integrative Medicine
Because integrative medicine, functional medicine, and complementary medicine are so wide in their meanings, it is difficult to track precise growth in the industry. I know that in the communities surrounding Rockville, Maryland (including Olney, Germantown, Gaithersburg, and Bethesda), where Dignity Integrative is located, there are more than a dozen integrative health clinics, including holistic medicine practitioners, nutritionists, acupuncturists, and more.
Maryland is also home to the Maryland University of Integrative Health. And, the University of Maryland’s School of Medicine now has a Center for Integrative Medicine. As I said, integrative medicine is now mainstream.
One of the few reports I was able to find that predicted the growth in integrative medicine says the industry will grow 22 percent a year, eventually becoming a more than $400 billion market by 2028. According to the report, integrative medicine “has witnessed a significant expansion in its consumer base in recent years owing to the benefits and philosophies that have the potential to attract customers.”
The benefits of better nutrition, sleep, movement, and mental resiliency are now clear and widely accepted. That’s why practices like mine are growing. Meanwhile, the philosophy is simple: the purely pharmacological approaches that came before haven’t worked, and we need an integrative approach to health and wellness-focused on preventing disease, rather than treating the end results of years of neglect.