Health Medicine

Abstract

For almost two centuries, disease-treatment medicine has dominated healthcare. This has resulted in many benefits, especially for acute infections, injuries, acute life-threatening disease, congenital malformations, etc. However, we have also seen a parallel and relentless increase in chronic disease. In fact, we now suffer the highest burden of virtually every chronic disease in every age group ever in human history. Why? It is not because disease-treatment medicine is wrong, but rather because it is incomplete. Today’s healthcare is missing health care and is focused almost solely on disease. Through recorded history, there has been an ongoing philosophical dynamic between treating disease vs promoting health. Dominance by either side is insufficient. This editorial explores Health Medicine and why embracing this concept is critical for solving our healthcare crisis. It is organized as follows: a brief review of history, the rationale for “Health” medicine, what defines it, why organizing under it is important, how an optimal system could be organized, and the potential response of conventional medicine.

Some History

Most everyone is aware of the adage, “History is written by the victors.” Since conventional medicine became dominant almost 200 years ago, the history of medicine became only the history of disease-treatment medicine.ⁱ Sadly, the history of health promotion medicine has been almost totally neglected until recently. I have discussed in several IMCJ editorials these parallel paths of healthcare. They can be simplified as health promotion vs disease treatment. These are summarized in my editorial for the 100th issue of IMCJ (100th IMCJ: The Untold/Hidden History of Western Medicine–Part 1, IMCJ 18.3 June/July 2019). In the many editorials and articles I’ve written or solicited, we have worked to reveal the full history of medicine, not just the story promoted by the currently dominant school of medicine.

We now suffer the highest burden of chronic disease in every age group ever in human history, a progressively increasing incidence of epidemics and pandemics, an alarming percentage of children who are obese, suffer diabetes and/or are chronically taking antibiotics, and out of control healthcare costs that threaten to bankrupt society—the list of problems is long and growing relentlessly.¹ More and more, leaders in medicine and politics are sounding the alarm. Why are we in such a severe crisis? The answer is not that disease medicine is wrong; rather, that it is incomplete. Another way of differentiating these approaches: the interventionist sees the body as a victim needing to be saved; the health-oriented practitioner sees the body as an empowered entity capable of healing and works to remove obstacles.²

In two chapters in the Textbook of Natural Medicine 5th Ed (Elsevier 2020), George W. Cody, JD, MA and Heidi Hascall, MA, trace the history and concepts of the many professions, some ephemeral, that have discovered and advanced the foundational concepts of health promotion medicine.

George Cody continued this historical unveiling through many articles³ in IMCJ and has systematically uncovered the origins of this philosophy by many names. I found especially interesting his documentation of the many times that conventionally trained MDs worked to advance the concepts of Health Medicine by various names. These MDs became frustrated with conventional medicine’s inexplicable blinders. After trying unsuccessfully for years and even decades to change the system from within, these courageous pioneers, often at great personal and professional cost, left the conventional medicine umbrella to advance insights which had been systematically blocked.

This medicine has been known by many names (and I am sure some readers will know of others that I’ve not included—please write a Letter to the editor). There are many examples from the 19th century of pioneers working to understand the causes of disease and exploring ways to restore health. Examples include (alphabetically): dietotherapy, Eclecticism, Grahamism, homeopathy, hydropathy, hygienic medicine, Kneipp cure, massage, nature cure, physical culture, sanatoriums, suggestive therapeutics, and Thomsonianism. In the 20th century, we saw the emergence of anthroposophical, chiropractic, ecological, functional, holistic, integrative, massage, naprapathy, naturopathic, orthomolecular, and osteopathic (as originally conceived) medicine.ⁱⁱ And when we consider other countries, Chinese, Ayurvedic, and Unani medicine are but a few of the most prevalent. Many different names, many different diagnostic criteria, and many diverse therapeutic approaches were created—but one foundational concept persisted: belief in the body’s innate ability to be healthy. The naturopaths call this the Vis Medicatrix Naturae—the Healing Power of Nature. Diet, therapeutic nutrition, detoxification, exercise, spinal realignment, meditation, balancing the meridians, herbalism, and other tactics were advanced in order to pursue this fundamental principle.

What do/did they have in common? A belief the body can become healthier, stronger, more resistant to disease, etc. if provided better inputs. In many ways, the only thing that really differentiates these practitioners is the path they took, the interventions that most attracted them, and what they called themselves. While historically important, are these differentiations necessary now?

No one owns this medicine. But some professions, like naturopathic medicine, have fully committed to the broadest and most rigorous manifestation of health promotion medicine. It is not surprising that naturopathy had so much opposition, since it was the most directly confrontational and comprehensive alternative to the drug model.

One hundred years ago, the founders of naturopathic medicine wrote broadly that if acute disease is treated with “suppressive medicine,”ⁱⁱⁱ chronic disease would increase.⁴ Their prediction is exactly what happened. Medicine did not address the actual causes of disease but instead became enamored by the illusion of success of symptom alleviation. Yes, this is overstated a bit since obviously there are many examples of curative conventional care. Nonetheless, this truly describes the vast majority of how medicine is actually practiced.

A deep and unmovable understanding of this persists in the public mind. While not technically healthcare professions, there are widespread public movements promoting health such as organic farming, fitness gyms, environmental activism, etc. Clearly, huge portions of the population understand the need to promote health. They continue trying to do so independent of the dominant medical profession.

IMCJ

When Bonnie Horrigan approached me in 2001 to start a new journal in integrative medicine, I was intrigued. As founding president of Bastyr University, I had at that time worked over 2 decades to help reestablish naturopathic medicine and document the scientific support for this way of thinking about patients. During this time, I also joined Jeff and Susan Bland’s initiative to create functional medicine and engaged with many leaders in holistic and orthomolecular medicine. I was watching with great interest Andy Weil’s creation of integrative medicine. I soon realized many in the field were using my Textbook of Natural Medicine as a foundational resource for their practices.^iv Seeing the many parallels—though each with their unique characteristics—I realized a journal fully embracing these movements would be an important resource for advancing the field. A quick perusal of the Associate Editors and Editorial Board of IMCJ will show the broad intellectual leadership from the many professions in this field.

Having now published over 100 editorials and recruited hundreds of Commentaries on key issues, IMCJ has explored most areas of the philosophy of Health Medicine. These editorials and articles have compared the strengths and weaknesses of the disease treatment vs health promotion models.

What Do We Call This Medicine?

The public is no longer willing to passively accept progressively declining health and the increasing burden of disease and costs. They are taking a more active role in looking for solutions to take control of their health. They are looking for health. They are finding us—the readership of IMCJ. But who is “us?”

One of our challenges has been naming our medicine more succinctly. For over 4 decades now, I have been trying to determine a name or acronym that embraces all of the professions practicing health promotion. I’ve suggested several terms, but none resonated in informal conversations—including the term “Health” medicine, which I first tried a decade and a half ago. I’ve many times said “Naturopathic, Integrative, Functional and Environmental Medicine,” but long sequences of names are awkward and not scalable. In frustration, I’ve used the term “This” medicine in many editorials, but This has of course felt incomplete and weak. Last year, I tried FINE Medicine (Functional, Integrative, Natural, Environmental) as an acronym and had some success. But while it sounded good, it didn’t resonate with enough people.

We need something instinctual, obvious, and comprehensive—something that captures our underlying philosophy in a way that is immediately salient to the majority of people. It should be simple. And I continue to feel “Health” is the clearest, easiest way of accomplishing this. So, starting about 2 years ago, I returned to “Health Medicine”—and this time, I finally got some traction.

I was very impressed when Erminia Guarneri, MD, led the merger with other non-AM A professional organizations in founding AIHM—Academy of Integrative Health & Medicine—and insisted on inclusion of the term “Health.” As far as I know, they were the first major organization dedicated to healthcare professionals that intentionally included “Health.” Unfortunately, the impact was diminished by widespread adoption of the AIHM acronym. Virtually no one I’ve recently asked to define AIHM got the H right. Nonetheless, this was a big step in the right direction. So, let’s take this to the next step:

I propose we clearly define this philosophical divide into Disease Medicine and Health Medicine. An optimal healthcare system fully embraces—and funds and researches—both.^v

Let’s define Health Medicine a little more.

What Is Health Medicine?

Simply stated, Health Medicine is about the patient, not the disease. It is about promoting the health of each unique individual rather than statistical disease models in generic populations. It is fundamentally about nurturing first and intervening second.

The Figure shows the complex interaction between diet, environment, and genomics. Looking at only one aspect can lead to suboptimal, even erroneous, care. An example: for most of the population, arsenic levels in the water supply are below the toxicity threshold. Yet, nutrient deficiencies and/or genomic susceptibility can dramatically—especially when combining synergistically—lower the safe threshold for arsenic exposure.

Figure.

The Complex Interaction of Diet, Environment, and Genomics

Nurturing with needed nutrients works fine at lower arsenic levels for most people. However, with worse exposures or more genetic susceptibility, more aggressive intervention will be required. A comprehensive Health Medicine approach understands this. Conventional medicine typically takes an intervene-only approach. This is often suboptimal. Yet, we must also recognize that nurturing has its limits. I think an important reason that practitioners of Health Medicine get into trouble is that they don’t adequately appreciate when to make the transition from nurturing to intervention. This concept is more fully discussed in my editorial “Thoughts on a Unified Theory of Disease.”⁵

Another example distinguishing Health Medicine from Disease Medicine is our approach to genetics. The conventional approach is to view genetics fatalistically, using it to predict disease risk. In contrast, Health Medicine reconceptualizes the genomics revolution as an important tool for leading a person to optimal health.⁶ Rather than looking for disease risk in genetics, we instead look at what these polymorphisms mean in terms of addressable enzyme dysfunctions. For example, a person’s genome or epigenetics may indicate increased need for specific nutrients—such as a vitamin D receptor (VDR) polymorphism indicating an above average need for vitamin D—or higher priority for avoiding particular toxins that could more likely disrupt their unique physiology.⁷

Yet another way to differentiate the current dominant healthcare system from Health Medicine is philosophy of practice. In my opinion, one of the greatest vulnerabilities of conventional medicine—and a key reason it has missed so much of importance—is the lack of a cohesive philosophy. In my many debates/conversations with conventional doctors, they commonly assert that the disciplines under the possible rubric of Health Medicine are limited by their philosophy. My response is that conventional medicine is limited by its lack of philosophy. They then argue that they do have a philosophy: the scientific method.^vi Yet, science alone without conceptual guidance does not ensure the right questions are being asked and that the right measures are being used. For example, if the question is only, “What is the best treatment to lower a patient’s elevated blood pressure?” then many drugs can be easily shown to be very effective at achieving this. Unfortunately, this also leads to adverse drug reactions (ADRs) and lifelong dependence on antihypertensives since the causes are not addressed. If the question is instead, “Why does this person have elevated blood pressure and what can we do to reestablish normal function?” then many more measures must be considered than numerical blood pressure alone. In this way, Health Medicine brings guiding principles to using science more effectively. Understanding the body’s innate healing capacity allows us to consider the whole person, their diet, nutritional status, toxic load, lifestyle, etc. This leads to scientific intervention far different from prescribing a drug—and it requires more from the patient than simply taking a pill (no matter how natural). The typical side effects of a holistic approach are improved health and function.^vii

What can be confusing and easily used to discredit Health Medicine is the diversity of tactics for advancing health promotion. Each profession—and each practitioner within that profession—adopts the assessments and interventions they find to be most effective for patients. For example, a patient with gout might see a practitioner skilled in diet who recommends reduction of dietary purines; or an expert in therapeutic nutrition who recommends high dose folate; or another who is knowledgeable in environmental medicine who assesses body arsenic, lead, and perfluorooctanoic acid (PFOA) loads and recommends tactics to decrease elevated levels.⁸ Each method is founded on a similar strategy of supporting the body’s healing capacity, but the tactics are diverse.

Health Medicine also has critical implications for public health. When we think of Health Medicine, we must realize this is not only about direct patient care. We also need to be leaders in the passive determinants of health. Many examples include:

• Restoring the healthfulness and integrity of the food supply⁹

• Aggressively supporting protection of the environment from the metals and chemicals poisoning the population and becoming primary drivers of disease¹⁰

• Doing public affairs work to stop government subsidies for disease-promoting processed foods

• Working to ensure underserved populations have access to health-promoting primary care

• Doing public affairs work to fund Health Medicine research as much as Disease Medicine research is funded.

If Health Medicine were respected as much as disease medicine, would we have allowed the severe decline in minerals and phytonutrients in our food supply and the poisoning of our environment due to the high phosphate fertilizers and pesticides used in conventional agriculture?

The Table illustrates the many differences between Health Medicine and the current dominant paradigm of treating disease.

Disease Treatment	Health Promotion
Generic care	✓ Personalized care
Symptom relief	✓ Treatment of underlying causes
End-stage pathology	✓ Physiological optimization
Secondary prevention	✓ Primary prevention
Dependence on doctors	✓ Education & self help
Dependence on drugs	✓ Vis medicatrix naturae
Environmental pollution	✓ Decreased toxin release into the environment
Nutritional deficiencies	✓ Public and farmer education to increase food nutrient density
Excessive costs	✓ Prioritization of health promotion as much as expensive end stage care

Why Is Unifying Under Health Medicine Important?

We need to join together under a clear banner. It is fine to have various flavors and approaches. Yet, we all must work together to advance our shared fundamental philosophy. It is time to fully embrace that we are colleagues and we will benefit greatly from collaborating. Fear of competition and protection of one’s turf is not only unnecessary, but it limits our ability to seize low-hanging fruit. Society is rife with examples of chronically ill and soon-to-be chronically ill people. Our populace is so sick that there is far more need for our services than any of separate profession can provide. Meanwhile, our lack of collaboration confuses the public and undermines our success.

Let’s rally under the banner of Health Medicine.

Those who have access can watch the videos of Amy Mack, CEO of The Institute for Functional Medicine (IFM), where she discusses Health Medicine in her introduction to the 2021 AIC (Annual International Conference). They can also watch Mark Hyman, MD, and me interview Laurie Hofman, MPH, to discuss her receiving IFM’s highest honor, the Linus Pauling Award. During this interview, I several times address the importance of a healthcare system that balances Health Medicine with Disease Medicine.

Before becoming overwhelmed by the complexity of dealing with so much diversity and vested interests, we should ask if this is even possible. Conventional medicine also had historic schisms and schools of thought. The surgeons, druggists, radiationists, psychiatrists, etc. all had separate origins. Conventional medicine figured out how to merge these diverse groups into a unified profession. We can do the same.

What Is An Optimal Healthcare System?

In order to advance this medicine, I think it is critical we understand what we are trying to achieve. What is an Optimal Healthcare System? I addressed this in an editorial over a decade ago (before IMCJ was in PubMed) suggesting fully embracing the strengths of the complementary roles of public health, primary care, and tertiary care. In the succeeding decade, my understanding and ideas have continued developing. In particular, I sheepishly realized I left out the patient! Without full engagement and empowerment of the patient, only an interventionist healthcare system is possible.

Accordingly, the first leg is the patient. Only by empowering the patient—by awakening the physician within (as one of my students once astutely said)—can an optimal healthcare system develop. If we do not inspire self-determination in our patients, we require they treat us as their interventionists instead of their teachers.

The second leg is primary care, which should be primarily Health Medicine. This is focused on understanding and helping to remove each patient’s barriers to optimal health. Of course, some acute disease care medicine is needed.^vii For example, antibiotics are sometimes needed to treat infections the body has failed to fight, or steroids may be needed to treat intense eczema flare—but why these failures occurred must also be identified and addressed. Repetitive or chronic drug use suggests effective root cause analysis has not occurred. I leave to the reader to think through the many examples where disease medicine is needed for an acute problem, but its continued use at the expense of Health Medicine results in chronic disease.

Please be clear, I am NOT saying primary care is only non-MD medicine. Most MDs are attracted to medicine because of their desire to heal people. Many, many times I have heard from MDs who have said that reading my Textbook and studying integrative and functional medicine gave them back their love of medicine. So many already want this, which is why they have embraced this field of Health Medicine with its many names. Rather, our reconceived model of primary care emphasizes the unaddressed importance of health over disease.

The third leg is tertiary medicine, where the conventional intervene-first approach is so incredibly effective. Drugs and surgery are the appropriate treatment for many acute, serious conditions for preventing morbidity/mortality. Even here, however, we must realize that many diseases which are currently only treated with drugs will be more effectively alleviated, and with fewer ADRs, when Health Medicine is incorporated. For example, few clinicians seem to realize that many adverse effects of drugs are due to the induction of nutrient deficiencies.¹¹

The fourth leg is aggressive public health. I see public health as more than just contagion control—it needs to include full collaboration with farmers to produce food that is nutrient rich and low in toxins. It also means much more aggressive work to decrease the release of toxic metals and chemicals into the environment. Opportunities with big payoffs abound in a broader view of public health.

What Will Conventional Medicine Think?

Everyone realizes we are on an unsustainable path. The population is becoming progressively sicker and is ever more susceptible to widespread infections. Why? One reason is that nutritional deficiencies are rampant.¹² Who knows better how to increase population nutrient levels than our nutritionists and farmers? The huge and growing body load of environmental toxins has become an even worse cause of disease.¹³ And who knows detoxification better than the naturopathic doctors, those practicing Ayurvedic medicine and environmental medicine specialists? Everyone knows that poor lifestyle drives ill health and disease burden. Who better than physical therapists and health coaches to help people to move from the disease path to the health path? Who more important than the patient to accomplish this?

Conventional medicine knows the country can’t keep increasing healthcare costs alongside worsening disease burden, so they’ve got to stop the ever-increasing flood of illness. Yet, they apparently don’t know how. Their focus has been on improving healthcare delivery, rationing health services, or optimizing drugs—as if doing more of the same will accomplish fundamental change. The point of diminishing returns for this approach was reached long ago. Disease medicine has become so big it is devouring its host.

Meanwhile, Health Medicine is already slowing down the disease train and picking up some of the overflow. Health Medicine can help cap the disease flow so that disease medicine practitioners can keep their lucrative model. The public can, if not fully recover, at least greatly improve health and prevent disease. I think conventional medicine as a whole will welcome this. My many conversations with primary care providers reveal frustration and weariness with patients coming back with ever worsening disease; patients who are in desperation are asking them questions about natural health products that they can’t answer; and a model which yields ever decreasing satisfaction. They are still devoted to their patients and fully support the disease diagnosis and treatment model. But the context has to change because the existing model is unfulfilling and unsustainable and is leading to ever worsening control by bureaucrats and lobbying groups that do not have patients’ best interests at heart. Primary care providers would really rather stick to what they know and are good at—but want a context that produces better results and provides patients pathways to better health and less need for endless services. Health Medicine would be a boon since it can help make the medical model sustainable by allowing it to focus on what it does best and not be overwhelmed with the relentless increase in disease burden.

How Does This Happen?

The obvious inclination is to try to change the dominant healthcare system. After all, this is where all the authority, money, and prestige lie. But WE HAVE BEEN TRYING TO DO THIS FOR MORE THAN 200 YEARS! Look at the many sects and branches of medicine listed above. What impact have they actually had on the dominant healthcare system? Eclectic medicine, functional medicine, holistic medicine, homeopathic medicine, integrative medicine, orthomolecular medicine—how have they actually changed how establishment medicine is practiced? A medical school named after Hahnemann, some elective courses on integrative medicine in some medical schools, a clinic here and there in a hospital system, an editorial here and there mouthing the need for change—and 99% of medicine as actually practiced still follows the same limited disease model. Some might say that now everyone realizes not just the benefits of the disease model, but also its substantial and serious limitations, so change is now finally possible. Really? Does anyone think a highly profitable, vested system developed over a century and representing 20% of the economy is going to change its model?

Let’s contrast this with what has happened outside of the disease model. Over half the public is either seeing a non-disease treatment-oriented healthcare professional or is self-treating with natural health products. The public spends more out of pocket for health promotion than for subsidized drugs to manage disease. The revolution in medicine is already happening—readers of IMCJ are at the forefront. But we are disorganized, the public is confused, and there is no clear collaboration to fully represent and advocate for why we are important.

Some might still think we can get conventional medicine to adopt Health Medicine as a specialty. How? Most of the MDs who would be receptive have already left the disease model and joined integrative and functional medicine. They would be faced with the decision of going back under the conventional umbrella as second-class citizens or being leaders in the Health Medicine revolution. If this sounds like hyperbole, please consider the income of primary care or preventive medicine MDs compared to specialists. We are not talking about a small percentage here or there—a cardiac surgeon makes 4 times as much as a family doctor, and an emergency medicine doctor makes three times as much as a doctor practicing preventive medicine. Why should these primary/preventive MDs have loyalty to disease medicine? Their political bodies have prosecuted and persecuted those who chose to not follow the drug model. It has gotten so bad that about half the states had to pass laws prohibiting the medical disciplinary boards from persecuting MDs for practicing nutritional medicine. I remember during a televised debate that dental pioneer Hal Huggins, DDS, and I had with Victor Herbert, MD, JD, when he bragged about having “27 notches on his gun belt” for the MDs he had gotten delicensed. Some were friends of mine.

What Next?

The time has come for the leadership of the major non-AMA medicine associations and organizations to meet to find common ground and work together to advance healthcare reform that fully embraces the critically needed Health Medicine. The economic, legislative, and community environments have never been better for fully establishing our medicine as an integral part of healthcare.

Conclusion

Disease medicine has produced huge benefits for our society. But it is an incomplete solution. The best medicine fully embraces both health promotion and disease treatment. The revolution is already happening—the public is fully on our side for the first time in history. Let’s work together to create a true healthcare system. Disease medicine keeps its vested benefits, Health Medicine becomes an integral part of healthcare, and the public enjoys greater wellness and decreased disease burden.

Win-Win-Win

Up to you dear reader. What do you think? Email me at mail2@drpizzorno.com

Biography

Joseph Pizzorno, ND, Editor in Chief, IMCJ; co-author, Textbook of Natural Medicine; Founding President, Bastyr University; Chair, Board of Directors, Institute for Functional Medicine.