the Changing Landscape of Medicine
Is there a better way to do healthcare, and what does it look like for Australia?
Moving from a disease management based model of care and toward a patient-centred model of care Functional Medicine is able to treat disease at its root cause, rather than merely managing symptoms. Integrative Medicine is practiced by many practitioners around the world who hold a core understanding of treating the whole person, not just their diagnosis. Let’s take a peek at both these models and our existing model of healthcare, both globally and here in Australia.
I was first introduced to Functional Medicine in 2013 when I was a student at the Institute for Integrative Nutrition in New York. The school had gathered some of the top minds in medicine and nutrition and delivered what i liked to call 'essence classes' with them. We heard from Walter Willett, Fredrick John Stare Professor of Epidemiology and Nutrition at Harvard Public Health who studies the effects of diet on the occurrence of major diseases. Publishing over 1700 original research papers most notable on how diet greatly impacts on our chronic health and disease status. Medical Students in the US receive an average of 23.9 hours of nutrition curriculum in their overall degrees. When Nutrition is at the seat of our overall health and wellbeing - this figure is iniquitous. Its not that different in Australia, as Professor Caryl Nowson from Deakin University explains:
“Currently, medical graduates are ill-equipped to identify and appropriately manage nutritional issues of patients, which contributes to increased complication rates and hospitalisation time,” Professor Nowson said. “The inclusion of nutrition within medical degrees across Australia at present is haphazard and uncoordinated, and course infrastructures do not support the delivery of a sustainable nutrition curriculum within courses.”
Looking at human health from a wide lens. The IFM’s Functional Medicine Tree
Although Walter Willet was not the one that informed me about Functional Medicine, he did point the finger in the direction of this thought: better care is needed if we want to call our health services - 'health care'. It was Dr Mark Hyman, that lectured on several occasions that ignited the love of Functional Medicine in me and I have been waiting, very patiently, to see it arrive on our shores here in Australia.
Not to be confused with Integrative Medicine, Functional Medicine is a scalable, trackable and repeatable operating system that doctors can use to take their healthcare from a disease management based model to a health-creation based model. Integrative Medicine can mean different things to consumers and practitioners - Sometimes it's the way a Physician practices using additional modalities and sometimes it's who they refer to. Although they most likely adhere to a similar philosophy, there is currently no specific operating system under which IM practitioners in Australia all work.
AIMA explains this well - Integrative medicine is a philosophy of healthcare with a focus on individual patient care and combining the best of conventional western medicine and evidence-based complementary medicine and therapies within current mainstream medical practice. Integrative Medicine reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing. It takes into account the physical, psychological, social and spiritual well being of the person with the aim of using the most appropriate, safe and evidence-based treatments available. Functional medicine shares this philosophy and adds a system by which to disseminate this understanding into practical application and measurable outcome.
Dr Penny Caldicott, Director of AIMA -
Australasian Integrative Medicine Association
Above: James Maskell - Functional Medicine and the Micropractice, Sydney March 2017. Presented by AIMA
video credit/copyright AIMA
Welcome to this Special Feature episode of pregnancy birth and beyond; The Changing landscape of Medicine around the world and how Australian physicians and consumers are inspired to ask better questions about our healthcare system. I have been facinated by and folowing Funcitonal Medicine for the past four years since i first heard about it and recently had the opportunity to meet with one of its biggest internatioanl advocates, James Maskell. This facination has opened the door to a wider discussion about healthcare. Medicine and science are evolving at a breakneck speed and yet chronic disease is on the rise, global antimicrobial resistance threatens to destroy some of scinece’s most notable achievements and the cost of healthcare in an ailing and aging society may very well be digging us all into a early grave.
The two part article features several passionate trailblazing figures in the move towards changing the way healthcare is delivered, both globally and locally. The first part looks at some of the overarching issues within the current medical system and the new emerging model of care seeking to correct and create significant primary healthcare reform around the world. In the second part we take a cloer look at Functional Medicine and what we can all do to create better outcomes for ourselves as cnsumers and practitioners.
We hear from James, an international speaker, founder of Functional Forum and The Evolution of Medicine and author of a compelling book with the same title. We also tap into the wisdom of Dr Penny Caldicott, President of the Australasian Integrative Medicine Association and founder and director of Invitation to Health. Championing Integrative Medicine, Penny walks among those leading a new era in Australian healthcare. Reine duBois, Clinical Director of the Health Lodge in Byron Bay also features discussing her passion, experience and how she makes it work in her practice. I also speak to Sally Cusack who is NSW Branch President of Maternity Choices Australia and has significant experience navigating the Australian healthcare system and understanding the unique needs of healthcare consumers. There will be a few sound bites form the AIMA conference in Sydney; Functional Medicine and the Micropractice.
“Each patient represents a unique, complex, and interwoven set of environmental and lifestyle in uences on intrinsic functionality (their genetic vulnerabilities) that have set the stage for the development of disease or the maintenance of health”
Interviewees.
Dr Penny Caldicott, BMed, FRACGP
-Director of AIMA & founding member of Invitation to Health
Dr Caldicott is the founder and a director of Invitation to Health. She has helped to create a nurturing environment in which the team offers patient treatment that respects and integrates the best of evidence based conventional and complementary medicine.She is particularly focused on understanding the journey that has contributed to illness, which helps her to guide and facilitate the path to well being. She values deep listening and spends time to develop a trusting relationship with each patient. Treatment modalities will be different for each individual and will often include the support and participation of other practitioners.
Penny is passionate about Integrative Medicine (IM) and has been involved with a number of organisations to champion IM to other health practitioners, to the government and in the public space. She believes that the IM focus on prevention of disease can play a significant role in turning back chronic disease in Australia. She is currently the President of the Australasian Integrative Medicine Association.
James Maskell
-Founder of Functional Forum and Evolution fo Medicine
-Author of the Evolution of Medicine and The Community Cure
James has been looking for levers to create significant positive change in healthcare for a decade. Following education in healthcare economics, James has played a part in building a number of successful businesses in the integrative medicine space.James has lectured to audiences of physicians on three continents, including four years on faculty of “Heal Thy Practice”, Integrative Health Symposium and George Washington University’s Metabolic Medicine Institute.
James has been featured on platforms at diverse at TEDMED, Huffpost Live, TEDx and more, as well as writing for blogs like Huffington Post, KevinMD, thedoctorblog and MindBodyGreen. He sees a unique aperture to help fuse the massive potential of digital health and functional approaches to accelerate the evolution of medicine.
Reine duBois
-Clinical Director at the Health Lodge
To her patients Reine is a medical detective with a passion for finding the underlying causes of disease to create real changes in health and wellness. To the medical community, she is a true pioneer of Integrated Medicine with more than 17 years experience in the field and a history of lecturing in this powerful model of modern day medicine. She specialises in uncovering complex health conditions and coordinating treatment plans for chronic health concerns.
Sally Cusack
Sally is NSW President of Maternity Choices Australia, Australia’s peak maternity consumer represnting body. Sally has been a consumer advocate in the area of Maternity for over 7 years. She is the founder of Pregnancy, Birth and Beyond radio and works tirelessly supporting mothers and their families in her local community and communities across Australia for better outcomes in healthcare.
Definitions.
The Australian Healthcare System. Below is an excerpt from a great article attempting to define our Aussie healthcare. I highly recommend reading it to better understand the services that this unique system offers!
"For most people their first contact with the Australian health system when they become ill is a visit to a general practitioner (GP). The GP may refer them to a specialist or a public hospital, order diagnostic testing, write them a prescription or pursue other treatment options. But patient and clinical care are just 2 components of a much broader and complex network that involves multiple providers working in numerous settings, supported by a variety of legislative, regulatory and funding arrangements." Click HERE for the full article.
Functional Medicine. Functional Medicine addresses the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership. It is an evolution in the practice of medicine that better addresses the healthcare needs of the 21st century. By shifting the traditional disease-centered focus of medical practice to a more patient-centered approach, Functional Medicine addresses the whole person, not just an isolated set of symptoms. Functional Medicine practitioners spend time with their patients, listening to their histories and looking at the interactions among genetic, environmental, and lifestyle factors that can influence long-term health and complex, chronic disease. In this way, Functional Medicine supports the unique expression of health and vitality for each individual. IFM
Integrative Medicine. Integrative medicine is a philosophy of healthcare with a focus on individual patient care and combining the best of conventional western medicine and evidence-based complementary medicine and therapies within current mainstream medical practice. AIMA
Citations, Links & Resources.
Functional Medicine
>IFM - Institute for Functional Medicine
https://www.functionalmedicine.org
>Applying functional Medicine free resources for practitioners
21st Century Medicine; A new model for medical education and practice
https://www.functionalmedicine.org/functiona-medicine-in-practice/applying/
Integrative Medicine in Australia
>Australasian Integrative Medicine Association
https://www.aima.net.au
James Maskell
>Evolution of Medicine
>The Evolution of Medicine book
>Functional Forum
>Functional Forum meet ups in Australia (scroll down the directory for current events)
http://meetup.functionalforum.com/directory/
Mayo Clinic research
https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-researchers-demonstrate-value-of-second-opinions/
36 holes in the roof
>Article summarising some recent studies including 36 holes and a few others
https://www.clinicaleducation.org/resources/reviews/36-holes-in-the-roof-the-dawn-of-the-era-of-treatable-and-preventable-alzheimers-disease/
>Reversal of cognitive decline; A novel therapeutic approach (the study)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4221920/
Australia’s health care services explained
>For consumers:
http://ourhealth.org.au/rep-support/consumer-reps-guide-australias-health-system/parts-health-system#.WTyt38ZL3xo
>Preventive care programs in Australia
Department of health - education & prevention
http://www.health.gov.au/internet/main/publishing.nsf/Content/Education+and+Prevention-1
>AIHW
http://www.aihw.gov.au/home/
>AIHW Corporate plan 2016-17 - 2019-20
http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129556352
>Australian Atlas of Healthcare Variation
https://www.safetyandquality.gov.au/atlas/
>Chronic disease management
https://www.humanservices.gov.au/customer/services/medicare/chronic-disease-management-plan
Physician health and wellbeing
>Preventing doctor suicide (US website)
https://afsp.org/our-work/education/physician-medical-student-depression-suicide-prevention/
>ABC News - AMA calls for national approach to help doctors deal with physical and mental health
http://www.abc.net.au/news/2017-05-16/ama-calls-for-national-focus-on-doctors-mental-health/8529202
Doctor-patient relationship
>Healing relationships study
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2478496/
Evidence-based healthcare dissemination
Book: How to implement evidence based healthcare / Trisha Greenhalgh (2017)
Why change is difficult for some and easier for others
https://www.ted.com/talks/jonathan_haidt_on_the_moral_mind?language=en
Antimicrobial resistance
>Harvard Medical School demonstration of antimicrobial resistance
http://news.harvard.edu/gazette/story/2016/09/a-cinematic-approach-to-drug-resistance/
>World Health Organisation
http://www.who.int/antimicrobial-resistance/en/
>Australia’s Antimicrobial Resistance strategy 2015-2019
http://health.gov.au/internet/main/publishing.nsf/Content/1803C433C71415CACA257C8400121B1F/%24File/amr-strategy-2015-2019.pdf
>The Australian Atlas of Healthcare
Key Findings and recommendations
Excerpt: Australia has very high overall rates of community antimicrobial use compared with some countries.
In 2013–14, more than 30 million prescriptions for antimicrobials were dispensed. Many of these were unnecessary because antimicrobials are frequently used to treat infections for which they provide little or no benefit.
On Research
>AIMA ethics in research reading
https://www.aima.net.au/research-in-cam/
>Ben Goldacre: Battling bad science
https://www.ted.com/talks/ben_goldacre_battling_bad_science#t-871608
Author
Annalee Atia is a Coach, Producer and Consultant. Broadcaster for Pregnancy, Birth & Beyond Media she is passionate about birth, wellbeing and community engagement. Mother of two, she lives and works out of the Northern Rivers in New South Wales, Australia.
This content was produced by Annalee for PBB Media incorporated and first published on the Pregnancy, Birth & Beyond podcast and the PBBM website on Jun 16, 2017.
