High-Tech, High-Touch: Reconciling Technology and Integrative Medicine Lawrence D. Rosen, MD “At best, technology supports and improves human life; at its worst, it alienates, isolates, distorts and destroys.”1 —Author and Futurist John Naisbitt V is medicatrix naturae. Latin, from Greek, originally attributed to Hippocrates, translated as “the healing power of nature.”2 One of the core principles of the integrative med- icine philosophy. We value nature and natural healing. We strive for homeostasis, for balance. We laud the healing powers of our planet and lament the erosion of her natural resources. Ecologically sustainable medicine— buzz words we use to cham- pion the necessary greening of medicine— recognizes not only the impact of the en- vironment on health but the impact of the practice of healthcare on the environ- ment. We cheer recently published re- search documenting the positive effects of green spaces on human health.3 We strive to be models of health for our patients, adopting yoga or meditation or other practices designed to simplify our lives and harness the power of the mind-body connection for optimal healing. Yet we live and practice in an increas- ingly technology-driven society. E-mail and texting are default methods of com- munication, and our patients request that we “friend” them on Facebook and follow health advice delivered in brief 140-char- acter bursts on Twitter. In fact, in a 2008 survey conducted by the Commonwealth Fund, nearly 90% of respondents indi- cated that they wanted their physicians to communicate electronically.4 Patients want high-tech doctors. But they also want more face-to-face time, more personal connections. The onslaught of high-tech has been blamed for rising disconnection and depersonalization in our communi- ties. We worry about the impact on chil- dren’s minds and about the very nature of human interaction. In the increasingly complex world we inhabit, how do we rec- oncile our high-touch values with our high-tech realities? Communication, I believe, is the key shared value. Integrative Medicine pro- motes healing relationships and open communication as cornerstones of our philosophy. Indeed, as defined in 2004 by the Consortium of Academic Health Cen- ters for Integrative Medicine, integrative medicine “is the practice of medicine that reaffirms the importance of the relation- ship between practitioner and patient, fo- cuses on the whole person, is informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare profes- sionals and disciplines to achieve optimal health and healing.”5 It is notable that this statement emphasizes the importance of the relationship in healing. Regardless of the modalities a practitioner employs— drugs or herbs, surgery or acupuncture needles—it is the very nature of the con- nection between practitioner and patient that begins to define integrative medical care. It is the foundation of our work. In fact, we have research to support this common-sense contention. In a landmark 1987 study published in the British Med- ical Journal, Dr KB Thomas reported on his experiences with 200 patients in general practice.6 All patients presented with phys- ical symptoms (eg, cough, sore throat, ab- dominal pain, headache) but demon- strated “no abnormal physical signs” and no definitive diagnosis could be made at that time. Patients were divided into two main groups: half were given a “positive” consultation (given a firm diagnosis and told confidently that they would be better in a few days) and half were given a “neg- ative” consultation (told that it was uncer- tain was what wrong). In both groups, half were offered treatment (a placebo) and half were offered no specific treatment. When asked how they felt, two weeks after consultation, a significantly greater per- centage of those given a positive consulta- tion reported feeling better than those given a negative consultation (64% vs. 39%, P ! .01). Whether or not patients received prescribed treatment made no difference. The outcomes were predomi- nantly predicated on communication be- tween doctor and patient. Connection is crucial, therefore, to the practice of integrative medicine. Many of our tried-and-true healing remedies em- phasize the power of human contact. In the most ancient, basic, and perhaps most poorly understood (from a conventional, scientific perspective) modalities, this in- volves touch. Hands-on therapies such as osteopathy, chiropractic, and massage are just a few of the many practices that rely on human touch for healing. The power of touch is tremendous. Even those prac- tices that involve energy fields (eg, acu- puncture, reiki) incorporate person-to-per- son contact as a core element. Sadly, this element of healthcare practice—the “touch” in healing touch— has become more and more removed from modern medical care. Practitioners and patients alike mourn the loss of face-to-face com- munication time. This is the mechanism by which, historically, we have established healing relationships. Especially in pri- mary care, relationships that develop through 1:1 time spent together over many years are crucial to both patient and practitioner satisfaction. The previously cited Commonwealth Fund report points out that “our fragmented system rewards 138 EXPLORE May/June 2011, Vol. 7, No. 3 Guest Editorial GUEST EDITORIAL high-cost, intensive medical intervention over higher value primary care, including preventive medicine and the management of chronic illness.” But there are opportu- nities in these challenges, for, as Ralph Waldo Emerson wrote, “Our strength grows out of our weakness.”7 We must learn how to leverage our interest and proficiency in technology as a means to facilitate communication and, therefore, connection and the de- velopment of relationships. The rise of social networks like Facebook highlights our society’s desire to reconnect and share stories, and information, in new and interesting ways. Practitioners who have embraced this technology are now able to address not only the individual information needs of a single patient but can deliver messages instantaneously to an entire community. For example, I estab- lished a Facebook page for my practice, The Whole Child Center.8 Although we are physically located in Northern New Jersey, we have “fans” from many coun- tries. I share many different kinds of infor- mation. Recent examples include notices of public speaking events, health articles of note in the news, a video about how to make your own natural hand sanitizer, and a request for gently used car seats for a family struggling with financial difficul- ties. The opportunities for connection— and for action—are endless in this new world of doctor-patient communication. For those of us that desire to advocate change on a larger scale, there is perhaps no better method available to do so. Just as then-candidate Barack Obama used Web 2.0 technologies to engage voters and help vault him to the Presidency in 2008, so can we adopt these methods to promote integrative medicine as a trans- formative model of healthcare. The importance of communication also extends to dialogue among practitioners. The 2008 Commonwealth Fund report notes, “We can no longer afford, nor should we tolerate, the outcomes of our fragmented healthcare system. We need to move away from a cottage industry in which providers have no relationship with, or accountability to, one another.” Communication among providers and co- ordination of healthcare services is abso- lutely a key principle of integrative medi- cine. The Consortium urges us to make “use of all appropriate therapeutic ap- proaches, healthcare professionals and disciplines to achieve optimal health and healing.” In order for care to be truly inte- grated, it is crucial that we encourage and support communication between various types of healthcare practitioners. In the most local sense, this may occur in clinics and hospitals, but practically, many prac- titioners across a wide distance care for the same patient. Coordination of therapies and dialogue across disciplines is a key in- gredient in ensuring the success of an in- tegrative model. Communication tech- nologies may, in fact, offer us the best way to connect with each other to best serve our patients, no matter where we live. Al- though person-to-person e-mail is most commonly utilized, newer technologies may, in fact, be more robust and secure. For example, inexpensive, password-en- abled, Web-based solutions now allow au- diovisual chats among groups of provid- ers. Documents and images can be shared for viewing and commentary. Geographi- cal distances are no longer barriers, as voice and video are streamed through the internet. On a more global scale, on-line networks have developed to allow practi- tioners to discuss clinical, research, educa- tional, and advocacy ideas. One such model is the International Pediatric Inte- grative Medicine Network,9 which I started in January 2004. Based on the free Yahoo Groups format, the International Pediatric Integrative Medicine Network now links over 400 practitioners from countries across the world with the ex- pressed mission to connect pediatric inte- grative medicine practitioners and organi- zations via a moderated, secure electronic network. In an age where attendance at medical conferences is dwindling and practitioners are looking for new ways to connect, professional listservs provide technological solutions to the challenges of connecting practitioners. There are numerous challenges in pa- tient and practitioner education, as well. As attendance at conferences has dwin- dled, the use of technological solutions for health education has skyrocketed. Ironi- cally, forward-thinking nonprofit organi- zations founded on the principles of supporting nature and ecological sustain- ability have adopted Web-based solutions to promote their missions. Joel Kreisberg’s Teleosis Institute coordinates an on-line course, “Introduction to Leadership In Green Health Care,”10 which has included participants from as far away as Nepal. Richard Louv’s Children and Nature Net- work features a blog, Field Notes from the Future, on their informative Website. One post discusses “Techno-Naturalists,” pro- moting the use of gadgets that might en- courage children (and quite a few adults) to get outdoors.11 Many people believe that technology is the antithesis of nature. Here’s an alternate view. A fishing rod is tech- nology. So is that fancy backpack. Or a compass. Or a tent. When boomers my age ran through the woods with play guns (as distasteful as that might be to some people), they were using technology as an entry tool to nature. Today, the family that together goes geo-caching or wildlife photo- graphing with their digital cameras, or collecting pond samples, is doing something as legitimate as going fish- ing; both involve gadgets that offer an excuse to get outside. Young citi- zen naturalists are bound to have a different attitude about technology from many older people—and that could be an advantage. There are even potential ecological advantages inherent in the use of tech- nology. Electronic medical record sys- tems reduce the use of natural resources like paper. Educational webinars reduce travel-related energy expenditures. Al- though social networks and on-line courses cannot replace human face-to- face interaction, they can create and sus- tain relationships that otherwise would not form or survive. One of the ecological advantages of integrative medicine is the promotion of self-care. In their seminal article, “Inte- grative Medicine: Bringing Medicine Back to Its Roots,” Ralph Snyderman and Andrew Weil implore us to “involve the patient as an active partner in his or her care, with an emphasis on teaching each patient the best way to improve his or her health.”12 Mind-body medicine skills, easily taught to children and adults alike, are one such set of self-care tools that can help patients cope with stress and pain. Biofeedback, a mind- body practice that uses monitors to feed back to patients biophysical data of which they are typically unaware, has undergone a revolution with respect to 139Guest Editorial EXPLORE May/June 2011, Vol. 7, No. 3 home use through the development of less expensive, more mobile hardware and software. This is just one example of an integrative medical modality made more accessible and useful through tech- nological advancement. Over the years, I have delivered many versions of a presentation I call, “Back to the Future.” The concept is that the use of many modalities we now include in integrative medicine— herbals, acupunc- ture, massage, and so on— goes back thousands of years in some cultures. The future of healthcare, which I firmly be- lieve is rooted in the principles and prac- tices of integrative medicine, is in fact dependent on reemphasizing time- tested, old-school values like practitio- ner-patient and practitioner-practitioner relationships through the use of modern communication tools. If we are to move forward, it must towards a hybrid high- tech, high-touch system that does not shun the use of technology but instead embraces the challenge of mindfully utilizing our best new technologies to best achieve the goals of integrative medicine. REFERENCES 1. “Naisbitt Questions the Future of Tech- nology.” Available at: http://findarticles. com/p/articles/mi_m1571/is_22_17/ai_ 75435164/. Accessed June 8, 2010. 2. “Vis medicatrix naturae—Wikipedia, the free en- cyclopedia.” Available at: http://en.wikipedia. org/wiki/Vis_medicatrix_naturae. Accessed June 8, 2010. 3. McCurdy LE, Winterbottom KE, Mehta SS, Roberts JR. Using nature and outdoor activity to improve children’s health. Curr Probl Pediatr Adolesc Health Care. 2010;40: 102-117. 4. “Organizing the U.S. Health Care Delivery System for High Performance—The Com- monwealth Fund.” Available at: http:// www.commonwealthfund.org/Content/ Publications/Fund-Reports/2008/Aug/ Organizing-the-U-S--Health-Care-Delivery- System-for-High-Performance.aspx. Accessed June 15, 2010. 5. “About Us—AHC—Consortium of Aca- demic Health Centers for Integrative Med- icine.” Available at: http://www.ahc.umn. edu/cahcim/about/home.html. Accessed June 8, 2010. 6. Thomas KB. General practice consulta- tions: is there any point in being positive? Br Med J (Clin Res Ed). 1987;294:1200-1202. 7. “V. Essays. Compensation. 1841. Emerson, Ralph Waldo. 1909-1914. Essays and Eng- lish Traits. The Harvard Classics.” Avail- able at: http://www.bartleby.com/5/105. html. Accessed June 15, 2010. 8. “Facebook/The Whole Child.” Available at: http://www.facebook.com/thewholechild, accessed June 15, 2010. 9. “IPIM-NETWORK: The IPIM Network.” Available at: http://health.groups.yahoo. com/group/IPIM-NETWORK/. Accessed June 15, 2010. 10. “Teleosis Institute: Green Health Care— Environmental Health Education Pro- grams.” Available at: http://teleosis.org/ ghcp.php. Accessed June 15, 2010. 11. “TECHNO-NATURALISTS: Field Notes from the Future.” Available at: http:// www.childrenandnature.org/blog/2010/ 05/20/techno-naturalists/. Accessed June 15, 2010. 12. Snyderman R, Weil AT. Integrative medi- cine: bringing medicine back to its roots. Arch Intern Med. 2002;162:395-397. Lawrence D. Rosen, MD, is the Founder of The Whole Child Center in Oradell, NJ and may be con- tacted via email at lrosen@wholechildcenter.org 140 EXPLORE May/June 2011, Vol. 7, No. 3 Guest Editorial http://findarticles.com/p/articles/mi_m1571/is_22_17/ai_75435164/ http://findarticles.com/p/articles/mi_m1571/is_22_17/ai_75435164/ http://findarticles.com/p/articles/mi_m1571/is_22_17/ai_75435164/ http://en.wikipedia.org/wiki/Vis_medicatrix_naturae http://en.wikipedia.org/wiki/Vis_medicatrix_naturae http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2008/Aug/Organizing-the-U-S--Health-Care-Delivery-System-for-High-Performance.aspx http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2008/Aug/Organizing-the-U-S--Health-Care-Delivery-System-for-High-Performance.aspx http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2008/Aug/Organizing-the-U-S--Health-Care-Delivery-System-for-High-Performance.aspx http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2008/Aug/Organizing-the-U-S--Health-Care-Delivery-System-for-High-Performance.aspx http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2008/Aug/Organizing-the-U-S--Health-Care-Delivery-System-for-High-Performance.aspx http://www.ahc.umn.edu/cahcim/about/home.html http://www.ahc.umn.edu/cahcim/about/home.html http://www.bartleby.com/5/105.html http://www.bartleby.com/5/105.html http://www.facebook.com/thewholechild http://health.groups.yahoo.com/group/IPIM-NETWORK/ http://health.groups.yahoo.com/group/IPIM-NETWORK/ http://teleosis.org/ghcp.php http://teleosis.org/ghcp.php http://www.childrenandnature.org/blog/2010/05/20/techno-naturalists/ http://www.childrenandnature.org/blog/2010/05/20/techno-naturalists/ http://www.childrenandnature.org/blog/2010/05/20/techno-naturalists/ mailto:lrosen@wholechildcenter.org