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A Return to Healing:
Radical Health Care Reform and the Future of Medicine
by Dr. Len Saputo and Byron Belitsos
Origin Press; ©2009; $21.95

This is an immensely important book at this time of national debate on the future of health care in America.

While Dr. Saputo may be rushing into a political melee where even angels fear to tread, he is certainly no fool. An internal medicine practitioner for 40 years, he began to see another side of medicine when medical science failed his wife, condemning her to a downward spiral of drugs and steroids. In desperation, they began to research and employ alternative therapies, and she was eventually able to regain her health.

When Dr Saputo shared his results with his medical colleagues, their reactions ranged from indifference to hostility. This was a major wake-up call to someone who had dedicated himself to being a healer. How could these doctors turn their collective backs on treatments that could relieve suffering? They had all learned medical ethics, yet they closed their minds to a promising treatment protocol just because it was not part of conventional medical practice. Dr. Saputo embarked on a mission to put the wellness of his patients ahead of the orthodoxy of the system and to offer them the best healing practices from both conventional and alternative medicine.

 In order to do that, he had to create a new model of "health care" radically different from the "disease care" practiced today. To do so, he faced the censure of his colleagues, the state medical board, and even legal challenges. All he wanted to do was to offer his patients a choice regarding their own health care. (Sound familiar?)

The first part of the book cites chapter and verse about the incestuous relationship between the drug companies and doctors, researchers and politicians; it describes how hospitals and health insurance companies have morphed from service industries to profit-driven corporations, and all of them together have created the failed system we have today. He quotes one hair-raising fact after another from sources like respected medical journals, the Congressional Record, the World Health Organization, and the National Institutes of Health:

• Medical mistakes are the leading cause of death in US.
• No more than 15% of medical interventions are supported by reliable scientific evidence.
• The FDA approved bad drugs like Vioxx and Lupron, which cost tens of thousands of lives, but 90 studies showing that vitamin D from sunshine reduces cancer risk by 50% have been suppressed.
• Half of all bankruptcies in America are due to medical bills.
• By 2017, $1 out of every $5 spent will be on health care.
• The US spends more money per capita than anyone, but ranks 37th in health outcomes in the world, just above Slovenia and Cuba.

Dr. Saputo has created a group practice through considerable trial and error that offers a fascinating model which could revolutionize health outcomes and patient and doctor satisfaction, and still be more economical than the current system. He calls it "Integral Health Care," adapting the Integral Theory of philosopher Ken Wilber. Depending on the needs of his patients, Dr. Saputo wants to shift the priorities from disease management focused on drugs, expensive diagnostics, and surgery to health management, starting with prevention and health education, then the greater use of gentler alternatives like herbs, chiropractic, acupuncture, and guided imagery, with drugs and surgery as options of last resort.

His practice has pioneered the use of Healing Circles that include the patient, his/her health champion (the lead practitioner), and a panel of other complementary practitioners relevant to the particular case. Both patient and doctor satisfaction have soared with this approach. The problem is that the insurance companies will not cover much of it, even though it is cheaper and more cost effective, so this kind of enlightened health care is only available to those who pay out of pocket or pro bono.

Dr. Saputo thinks that a single-payer insurance system would be a big step forward. The present system is untenable. It is as bad for patients and doctors as it is for the economy and the national deficit. It is time for an informed public to pressure the politicians, who seem to be paralyzed by the fear of losing campaign funding from Big Pharma and the rest of the medical-industrial complex.

This book needs to be read by every politician, medical practitioner, and citizen. It is a manifesto for what health care should be, and what it can be with honest and intelligent reform.

EXCERPT

Chapter Eight
Creating an Integrative Medical Clinic

• An "integral medical practice" is a practice that makes room for the entire panoply of effective treatments.
  – Ken Wilber
  
  
• An integrative medicine approach seeks to discern multiple perceived origins  of a disease process and address them all. Integrative medicine also assumes that  an individual has the potential for healing at the spiritual level,  even when physical healing does not take place.
  – Andrew Weil, MD

The first integrative clinic based on Health Medicine was born almost literally amid the flames of a real fire. In September 2001, the building in which I was practicing medicine suddenly burned to the ground. This strangely timed conflagration had synchronicity written all over it. A fire had now been lit under me to create a center for health medicine. It was as if the old medicine had gone up in smoke, and the universe was shouting, "It's time to begin the work you've long dreamed about!"

It had been a long time coming. The Health Medicine Forum (HMF) had been founded in 1994 and spent seven years exploring how the principles of health medicine could be applied in clinical practice; it was high time to test the model that I had helped pioneer.

Within a few weeks, I secured an office that would become the new home for a clinical center, a research institute, and the meetings of the Forum itself. We named it the Health Medicine Institute (HMI). Waiting in the wings was an investor, Bob Leppo, and a CEO that Bob recruited, Kay Sandberg. They almost immediately came on board to help initiate the new venture. The three of us brought all the vision, management expertise, and capital needed to start up the ambitious project. We opened our doors by November 2001, less than two months after the fire!

HMI's founding practitioners included a bodyworker specializing in post-traumatic stress therapy, a Chinese-medicine practitioner, a registered nurse with expertise in energy medicine, a psychologist, a naturopath, a chiropractor with side specialties in homeopathy and applied kinesiology, and myself, a board-certified physician in internal medicine. This diverse team soon found itself creating integrative health care solutions for many patients, notably those who had been going from doctor to doctor without much success.

Because this was such a novel experience for all of us, building camaraderie among our practitioners was a primary goal from the beginning. HMI sponsored retreats where we cooked, ate, worked, and played together. We explored visions of the new medicine, shared about our disciplines, and worked through the nuances of our personal and professional relationships with one another. Gradually, we evolved into a trusting family of healers that was able to collectively guide our patients through recovery. 

One of our first patients was Jason. He came to HMI because he had heard about our photonic stimulation device and our integrative pain management program, which rarely uses medications to control pain (introduced in chapter 3). At age 32, he was considering suicide because of intense, unrelenting pain and the negative effects it was having on his marriage, employment, and quality of life. He had suffered through two failed back surgeries for lumbar disc disease that left him in constant pain despite the use of narcotics, antidepressants, anti-inflammatory drugs, and muscle relaxants. He had become a "walking zombie" who could not find any position where his pain would relent. He was on total disability, his marriage had crumbled, and pain and depression had become a way of life.

Our HMC team of practitioners met and created a collaborative plan of treatment, and I assumed the role of Jason's health guide. His insurance was minimal, of course, so most of the care he received was gratis. I still wonder how much of his recovery was related to the fact that, out of compassion, we gave our time without concern about compensation.

Jason's initial treatment with the new photonic device in whose use we are pioneers provided his first break from pain in nearly four years. Within a few weeks of starting his full treatment program—which also included acupuncture, bodywork, chiropractic, and guided imagery—he was able to discontinue all medications. He began taking walks and could now sleep through the night without pain. He soon joined a gym and regained much of his lost muscle strength. Within a few months, Jason took up his interest in golf again, was looking for work, and had become socially active. Today, about eight years later, Jason visits us about once a month for a light treatment and a chiropractic adjustment. As he now puts it, "I have my life back!" 

We soon learned that synergy is an essential part of the clinical practice of integrative medicine. Working in the same location, and often together at the same time, can be far more effective than coordinating care with practitioners in independent offices, which causes a patient's health care to be fractured into pieces managed by several specialist physicians or independent CAM practitioners. Indeed, without the structured collaboration provided by an integrative clinic, the patient is forced to do the overall coordination! It can't be stated often enough: Long experience and simple logic show that integrative medicine under one roof is far superior to the fragmented care provided by either standard mainstream medicine or CAM therapies alone, or by diverse approaches blended in an ad hoc manner without professional coordination.

Over the course of our initial five years at HMI, we branched out even further in our integrative methodology. We attracted and worked with practitioners from a wide range of disciplines aside from our core group. Additional healing options beyond those mentioned above included Native American shamanism, Reiki, yoga, Qi Gong, marriage counseling, nutritional counseling, many styles of chiropractic, women's health, guided imagery, and movement therapies, as well as frontier technologies such as photonic stimulation, breast thermography, bioenergy testing, heart-rate variability testing, vascular stiffness testing, HeartMath, and dark field microscopy. A marvelous blend of what might be called high-tech and high-touch health care was evolving. And this was the beginning of the Healing Circles process that I have carefully developed over the years in collaboration with my colleagues, which I present later in this chapter.

Practical challenges to our first integrative clinic
As the patient load increased, I discovered what a joy it was to work in a team setting that had the capacity to treat the whole person. It had been a long time in the making, and it was working as well as we had hoped. But one problem deeply troubled all of us. While it was very satisfying to help people who could afford our services, there were far too many who could not. There were a few like Jason that we simply did not have the heart to turn away, but we also knew we could not afford to see the vast majority of people if we wanted to keep our doors open. We were running into the deep prejudice against CAM and the integrative model that to this day plagues government policy and the private health insurance business.

Eventually we ran into other problems—everyday business issues that will always afflict integrative health care clinics as long as we must operate against the grain of the current paradigm.

For example, we found it difficult to recruit CAM practitioners who already had full and successful practices. Put simply, they were reluctant to bring their clientele with them. Why should they? They were content with being in solo practice, where they could call their own shots while at the same time enjoying financial security. They were providing competent care, no doubt, but from our perspective they were also becoming entrenched as just another species of the fragmentation of health care delivery in a time of competing paradigms and poor government coordination. They too were not ready for the integrative model of the future. Plus, most were forced to operate among the affluent; they were occupying the finite market of those wealthier patients who could pay out of pocket.

On the other hand, for those CAM practitioners just starting out (or who perhaps were not as strong at marketing), things were different. Again, unfair discrimination against CAM by policymakers and insurance providers limits their reach in the market. Thus, unlike mainstream physicians, few CAM practitioners have full practices. Competition for patients can be fierce, leaving them with little incentive to refer patients to fellow CAM practitioners for fear of losing them and the income they generate. We consequently discovered an abundance of alternative practitioners looking primarily for work; they would work anywhere they could make an income. But they weren't motivated by a compelling interest in practicing collaborative Health Medicine.

In addition, although it was a responsibility of HMI practitioners to bring in patients and be willing to share them, many that we retained on staff were reluctant to recruit on behalf of the whole center. While a few were skilled at marketing, most were either unable or unwilling to build their practices in a collaborative way; they were far more comfortable waiting for patients to show up on their doorstep or come through referrals from within HMI. Competition for patients even among practitioners at HMI was a serious issue that did not lend itself to quality integrative health care. Several practitioners felt sufficiently insecure about their limited practice size that they left and took the patients they acquired while working at HMI. We just let them go; it was not worth bothering to enforce the noncompete clauses in their contracts.

But the biggest problem of all, again, is that CAM services are largely nonreimbursable under the coverage rules of conventional health insurance companies. It can't be emphasized enough that this reality limits Health Medicine to those who can afford to pay for services in cash, thus collapsing the potential market. Even so, the CAM sector is still greater than the size of the out-of-pocket portion of the mainstream medical market, as noted earlier.

In any case, this insurance dilemma represents a serious inequity; it means that the playing field is not level between mainstream physicians and CAM practitioners. The mainstream enjoys a substantial competitive and strategic edge—even within Medicare and Medicaid —largely through the force of insider politics, the inertia of the health care system we have inherited, and the distraction of an unresolved conflict of paradigms.

This is a tragic situation for the American people. We HMC practitioners know from our experience that the integrative, holistic, preventive, and highly personalized model of Health Medicine is demonstrably more effective in solving even the most complex health care problems, and it is also clearly less expensive than mainstream health care. Yet, insurance companies—in the thrall of the monopolistic practices of the mainstream—dare not support integrative medicine wholeheartedly.

Some employers and insurance companies now offer FSAs—flexible savings accounts—allowing a certain number of dollars each year to be dedicated to any CAM service that the insured desires. Another version of this concept is the health savings account (HSA). These two approaches form the core of the emerging consumer-directed insurance plans, which impose greater cost sharing on enrollees but permit some tax savings plus broader choices than the HMO plans of the managed care era. However, these approaches are underutilized and are beset with difficulties in practice.

We at HMI were up against an entrenched and at times hostile system, and before long, our seed money ran out. We simply could not attract enough people willing to pay out of pocket for enough of their health care, even in our affluent location. And we also had the kinds of operational problems that business pioneers always face. By October 2007 we were forced to close HMI's doors and reorganize our business plan.

Starting over again with an improved clinical model
Undaunted, I immediately opened a new incarnation of HMI that was scaled down in size and ambition; I had learned to accept the fact that an integrative center will never be as profitable as any mainstream medical clinic as long as monopolistic forces are arrayed against us. We named it the Health Medicine Center (HMC), and it is still operating in Walnut Creek, California.

The administrative and marketing aspects of HMC's business plan are substantially different from HMI's, yet the concept (of what I now call integral-health medicine) remains the same. We relocated from an upscale 5,000-square-foot building to one that is about 1,000 square feet. In this strategically designed smaller space, we are still able to accommodate 12 health care practitioners (who operate in shifts) and thus are still able to provide all the specialized tests and services that were offered at HMI.

In HMC's new model, practitioners are not expected to bring in new business; they primarily see patients who are referred from my internal medicine practice. As in the earlier model, the practitioners have continued to work together closely, meeting regularly to review treatment plans for our patients and conducting Healing Circles when needed. Cross-referrals often occur, and typically our patients will see several of us simultaneously.

We're continually evolving; even now we are examining the applicability of the new integral model of medicine to clinical practice. Overhead expenses for this operation are considerably lower than HMI's, but the quality and nature of care has not changed. HMC offers each practitioner a contract for services that include office space, supporting staff, making appointments, and providing the basic activities required to conduct each specific practitioner's business. The major difference between the HMI contract and HMC's is that we no longer require practitioners to build their practices; they are free to manage the size of their practice as they see fit. We have found that this updated model works well and believe it will be financially sound when the playing field is leveled; we further believe it has the potential for replication. However, we'll need to wait until that day when the insurance industry begins reimbursing for CAM services fairly.

Because of broad popular demand, there are a rapidly growing number of integrative health care clinics in the U.S. Most major medical facilities, such as large mainstream clinics, hospitals, and teaching centers, purport to offer CAM services; in general, however, they offer merely token services with limited, uncoordinated access to a few disciplines such as acupuncture, chiropractic, and massage—primarily window dressing designed to attract market share from the more enlightened consumers.

Healing Circles: a key innovation
The concept of Healing Circles evolved directly out of the Health Medicine movement, and has been fully explored by its pioneers at HMI and currently at HMC.

Patients best suited for Healing Circles are those with chronic diseases of such severity that they interfere with the patients' ability to enjoy healthy, functional lives. Typically, these patients have consulted numerous health care practitioners over periods of years; some have all but given up hope that recovery is possible. Many have traveled great distances or spent enormous sums of money trying a myriad of CAM therapies hoping to find a solution to their problem.

The Circles are composed of three to eight practitioners from a variety of disciplines, plus the patient. Everyone meets in a designated room, sitting together in a circle for approximately two hours. Before convening, the patient meets with a health guide for the purpose of determining which practitioners to invite. While it is preferable that the patient's primary care practitioner act as the health guide, outside practitioners with a broad knowledge of health care disciplines and CAM—such as a holistically oriented nurse or a broad-minded psychologist—can be trained to serve as the health guide.

Years of experience with Circles have shown that patients receive a number of benefits from them:

• First of all, patients usually receive immediately practical information in regard to resolving their illness from the point of view of several disciplines.

• Second, they often feel more empowered to delve into their psychospiritual problems—which are, after all, at the root of most diseases. In other words, patients receive excellent technical information that is offered from varied points of view, while they also feel supported to dive deeper into the meaning of their illness.

• But more important, perhaps, is that Circles usually witness a shift from information exchange to profound group interconnectedness. Powerful healing often emerges from the nature of the relationship between practitioners and the patient, and even from the practitioners' contact with one another. We have found that as each person becomes more authentic within a Circle, something like a descent into the soul occurs: All the connections deepen. This leads to a heightened awareness of the meaning of the illness in question and usually reveals the strategic approach most suitable in light of that deeper connection. 

Practitioners who have participated in our Healing Circles include physicians of many mainstream disciplines, such as internists, psychiatrists, oncologists, family practitioners, neurologists, cardiologists, and surgeons. Complementary practitioners have included acupuncturists, chiropractors, herbalists, bodyworkers, homeopaths, nutritionists, naturopaths, Ayurvedic practitioners, indigenous healers, and many others. Although the composition of Healing Circles nearly always includes at least one conventional medical practitioner, it emphasizes the inclusion of all practitioners the patient has chosen to work with.

As integrative medicine becomes more mainstream and as the benefits of Healing Circles are better known, I believe that Circles will soon see participation from an even broader range of specialists and will involve into new forms and new applications, opening up even more options for healing for many patients.

How Healing Circles work in practice
Before participating in a Healing Circle, patients are asked to describe in writing why they are requesting a panel and what they hope to gain from the experience. They also are required to write an autobiography of their physical, emotional, and spiritual life since birth. Each panelist carefully reviews this information before the meeting convenes.

Our Circles always convene in a quiet, relaxing, and private setting. The health guide continues to take the lead, acting as moderator; the guide also concludes the session by providing a summary of each practitioner's input, including the recommended treatment strategies and goals.

After introductions, the process usually begins with the patient describing why he has requested a Circle, what his health issues are, and what he hopes to achieve. Practitioners are then encouraged to address their remarks directly to the patient whenever possible. Patients are assured that they are not expected to respond to questions that they feel are invasive.

In the Circle setting, health care professionals partner to support a single patient. The responsibility to help the patient is shared by all practitioners. This allows individual practitioners to feel less pressure to find a solution to the patient's problems. Not knowing becomes a more acceptable option, which permits the possibility for no action as an approach.

But does the decision for no action with a sick patient make sense? All too often, a one-on-one clinical setting carries with it the obligation to come up with a treatment, almost any treatment, so that at least "something" is seemingly being done. But in reality, not taking action can be far better than interventions that have little chance of helping, may give false hope, may be dangerous, or could lead to patient disappointment, frustration, anger, or even lawsuits. In fact, holding open the option for no action can be a blessing. It allows for a kind of gentleness and wise forbearance not usually found in disease care medicine, with its invasive, know-it-all posture.

Once this kind of wisdom has been invoked, we have found that the best approach is to change the focus from curing to healing. In a Circle, this means supporting psychospiritual needs rather than forcing a treatment plan that has little chance of resolving what may be an impossible physical challenge. Happily, not much is required to carry out this subtler mission, since the group process of a Circle almost inevitably transforms itself from information exchange into heartfelt connection. In the right context, the human heart naturally shifts to regarding and treating the whole person rather than just curing disease or its symptoms.

Years of experience have shown us that the active and sensitive listening we practice in our Circles creates a sacred space in which patients feel deeply heard and cared for. While curing symptoms is still a high priority in most cases, Healing Circles also create a rich opportunity to explore the meaning of illness in the context of who the patient is—in relation to her entire life story, including her family, her culture, her lifework, and her total environment; in other words, they stimulate an integral approach to healing and evoke the entire spectrum of possibilities in the integral-health medicine model.

With the health guide still moderating, the practitioners hold a brief post–Healing Circle meeting without the patient. Its purpose is to review the group process, assess the strengths and weaknesses of the Circle, and receive full input from each practitioner for the final treatment plan, unless of course the no-action option has been chosen. The health guide writes a summary of the plan, sends it back to each practitioner for final edits, and then forwards it to the patient.

Each Healing Circle is unobtrusively recorded and transferred to a CD, with a copy stored for future reference. We recommend that patients listen to the CD as well as carefully review the written treatment plan summary. They usually gather a different set of insights from listening to the recording than those they received while in the hot seat.
Finally, the health guide meets with the patient within two weeks of the Healing Circle. In this important meeting, the two review the Circle's overall outcome, reconsider its written recommendations, and refine the treatment plan. Periodically, additional sessions may be held, depending on the patient's needs and wishes and on the health guide's judgment.

The following story is a representative example of a Healing Circle recently held at HMC.

At a high point of enjoying her life at age 67, "Sally" discovered a lump in her left breast and came to our clinic. We performed a mammogram that indicated the likelihood of a cancer. Sally agreed to have it biopsied, which revealed a 1-centimeter invasive carcinoma. After consultation with her surgeon and two oncologists, I notified her that she might need surgery and perhaps chemotherapy and radiation, in combination with CAM therapies. Sally was, quite understandably, overwhelmed and terrified.
Over the next few weeks, she and her husband, Roger, began a frantic Internet research project and found their situation more challenging than they had anticipated. Their research also included consultations with a naturopath who had advanced experience with cancer treatments, a psychologist, and a specialist in interactive guided imagery—all members of our Health Medicine Center staff. Sally and Roger now felt better educated, but they explained to me that they were getting conflicting messages from this myriad of specialists regarding the best treatment; they felt confused, upset, and even a bit disempowered as to how to make the right decisions about treatment. They were also quite apprehensive about conventional cancer therapy. To resolve this complex situation, so typical with the difficult disease of cancer, I offered to bring her entire team of practitioners together, including her surgeon and lead oncologist, into a Healing Circle with both Sally and Roger present. Everyone agreed to participate.

Over the two-hour session, all of the practitioners had the opportunity to present their point of view to Sally and Roger. It was interesting to learn about the practical and realistic advantages, limitations, and problems of each approach in Sally's case. As her health guide, I chaired a wide-ranging discussion about how the varied styles of therapies could come together in a personalized treatment program that would meet Sally's unique needs.

By the conclusion of the session, the group had shifted from information exchange to genuine connection. We watched as Sally became filled with the sense of how fully she was supported by the entire group. The Circle arrived at the common ground needed for creating a treatment approach that would best meet Sally's physical, emotional, and spiritual needs and preferences. Based on our recommendations, she opted for a simple mastectomy followed by a five-year course of Arimidex (a drug that would block the effects of estrogen on any tumor that might remain in her body) from conventional oncology, but she decided to hold off on radiation treatment. Sally and Roger also chose to work on supporting her wellness with lifestyle measures that included exercise, a low-carbohydrate diet, plenty of sunshine and vitamin D supplements, immune support, and a regular detoxification program. Eight years later, Sally is still cancer free and is delighted with her outcome. She recently told me, "Without my Healing Circle and the loving support Roger and I received, I don't know how we could have found peace in the decisions we made."

Practitioner responses to Healing Circles
You may be surprised to find that no fees are paid to Circle practitioners for their participation; our firm policy is that all such services are pro bono. This may sound impractical at first, but we have discovered that the joy of giving and the profound sense of connection experienced by everyone in Circles is usually more than enough payment. We even find that some practitioners, once they've been part of a Circle, engage in them as often as twice a month. In fact, it has been rare for invited practitioners to refuse Circle participation for any reason, including lack of compensation. And many practitioners feel that their experience is a wake-up call that something very important is missing from both mainstream and CAM practice—giving.

I see Circles as offering their own reward. They're a reminder that the joy of giving and of graciously accepting love is supremely satisfying. After all, many of us have come to believe that it is love that heals at the deepest level.

Additional incentives for practitioners to participate include the more "practical" benefit of assisting their own patients in developing advanced treatment plans based on multiple perspectives in an integrative setting. Practitioners also further their own professional expertise through observing the rich responses from a diverse group of colleagues to a difficult case. The overall impression of both patients and practitioners has been that Healing Circles are a deeply touching as well as cost-effective method of resolving what had been irresolvable illnesses.

Finally, Healing Circles have the potential to do more than help patients and practitioners. They could also bring substantial relief to our financially overburdened system. We used to charge $500 for each Circle—a small expense when compared, for example, with the costs of many high-tech diagnostic tests. But we changed this policy because we have come to believe that they have a greater impact when services are pro bono. Circles may even avert a hospitalization that can cost more than $150,000.  

Of course, formal Healing Circles are not always indicated. We have discovered many pragmatic variations on how their principles can be utilized in a genuine integrative setting.
"Linda," for example, never had a Circle, but each of her practitioners at HMC spent considerable time discussing how to best serve her. Sometimes we did this in Linda's presence, and at other times we met without her—thus illustrating one of the many advantages of working together in the same building in common offices.

Linda was gifted with the talent to be one of the world's top tennis players. Even when she was a teenager, her unusual skills were obvious. I recall how the rest of the pack of ordinary tennis players marveled at her talent; we considered her a phenom. As a junior tennis player, she won the national women's 18-year-old clay championships, with victories over Tracy Austin and Pam Shriver. She also won the U.S. Open Junior Championships. However, Linda soon discovered that she did not enjoy being on the women's professional tour because of the grueling travel schedule. She chose to become a teaching professional and live a "normal" life. Yet she still loved playing tennis, although by now I had lost track of her.

Linda had suffered from numerous minor injuries over the past 20 years, but in 2001 she was badly injured in an auto accident, suffering a fractured right arm and severe, unrelenting pain in her neck and back. Over the next couple of years, the pain spread to her entire back as well as her arms and legs. Consultations with a series of physicians led to the conclusion that Linda was suffering from fibromyalgia. Although she was treated aggressively with a variety of drugs to relieve her intractable pain, nothing worked. In fact, the drugs interfered with her ability to function because of their side effects.

Then, in fall 2008, our paths crossed. Once a year she returned to the Berkeley Tennis Club to play in an exhibition pro-am tennis tournament, but this time she wasn't sure she could participate. She called and asked me if I'd test her to see if she could play. Linda told me of her misfortune and of how it had so radically changed her life. We played great tennis for about 20 minutes, and her form looked just as perfect as it had been 20 years earlier. However, her pain was soon too great and she had to stop. While still at the club, I examined her neck and low back, and it was clear that she was in severe pain. I was amazed that she could play at all. We went directly to my office, where I did a diagnostic scan of her neck and back with the photonic stimulator.

Now, Linda's personality had always been confident and positive, and she was a tough competitor. Although fibromyalgia was a possible diagnosis, somehow I knew that it did not match with the Linda I had known 20 years before. To my surprise, her scan clearly diagnosed that she had a severe problem with discs in her neck and back.

After our many conversations, HMC practitioners treated Linda over the course of the next several weeks with photonic stimulation, chiropractic adjustments, imagery, and bodywork. As of this writing, about six months later, her pain has been reduced by about 75 percent. She's able to do some of her normal activities with only minor discomfort, and she is no longer on pain medications. Linda and I are looking forward to a day when we can hit a few balls once again.

Linda's story is a good example of how important it is to know the whole person. It is critical to listen carefully to each person's story and evaluate all aspects of who she is—body, mind, emotion, and spirit—in the context of her entire life story. One must especially question a diagnosis arrived at when the previous practitioner did not take the time to know a patient in all domains. The collaborative consultations we carried out at HMC were also critical in resolving Linda's symptoms.

Can mainstream and CAM practitioners work together?
I realize that Healing Circles are futuristic—probably even far ahead of the standards of collaborative practice in most integrative centers. The fact that this exciting clinical technique has evolved only in the San Francisco Bay Area is probable evidence of the uneven progress in the acceptance of the new medicine nationwide. Still, the general shift from a conventional practice to one that is integrative has been agonizingly slow for large portions of the public and certainly for CAM practitioners. Ironically, the shift has been too fast for the mainstream medical industry and its political supporters, whose paradigm and income are at stake. By virtue of their fundamentalist training and separatist orientation, most physicians are not open to working together in clinical settings as a collaborative force that operates from the standpoint of multiple healing perspectives. And almost no encouragement for change is coming to them from medical schools or from government.

Given the steadfast demand for CAM or integrative approaches from the public over several decades, this seems highly maladaptive. Today's health care industry is not adjusting to undeniable market realities, even as it continues to enrich itself on disease care practices. As we will see in the final chapter, elements in the industry collude to politically delay the promotion of preventive policies, the funding of CAM research, and legislation to support integrative solutions and create universal health care insurance—all of which are favored by a majority of Americans.

But the ethical question remains. Does the spirit of the Hippocratic Oath permit a doctor to abandon further efforts to help a patient if there is no hope from the standpoint of a single discipline? For example, should mainstream oncology physicians send their cancer patients home to die just because there are no answers from within their own paradigm? Physicians in this setting usually tell their patients that there is nothing more that modern medicine can do and that it is not worth looking elsewhere for help. Of course, many alternative practitioners make this same fatal error.

I believe such attitudes no longer work with the educated lay public. Is there anyone who is seriously ill and not getting better who would turn down a healing council where many disciplines came together to consider what might be possible from the perspective of each? In my experience, although many CAM practitioners have some resistance to truly partnering with other health care modalities to create a higher synthesis, physicians have much more resistance. The result has been a fruitless turf war waged at the expense of patients dealing with difficult health care issues.

Resolving this situation takes special people—pioneers who are willing to stretch to explore new approaches that are beyond their own training. This is what we should expect from true healers. Without the willingness of practitioners to work as a community of healers, new possibilities will never be tested and brought forward into clinical practice.

In the end, what everyone wants is "good" medicine. It doesn't make any difference whether it comes from the mainstream or CAM, or from the East or the West. We just want the best treatment for our health problems. I find it tragic that health care practitioners from different disciplines have not found more ways to work together to provide the best care possible, especially given that no discipline by itself has found an effective way to treat any of our epidemic chronic diseases. I do acknowledge that there are many understandable reasons for this resistance. Disciplines such as Chinese medicine, homeopathy, energy medicine, and western medicine each bear radically different assumptions and technical languages; some are based on traditional Newtonian science, others on quantum physics, and still others on ancient cosmologies. Yet I believe we can and will learn to collaborate—I've seen it happen in practice at my own integrative clinics. And in time, we will overcome the chronic disease epidemic. Through the firm intention for radical reform of health care, combined with the embrace of a broader and deeper model of medicine, we can get there.

Miriam Knight
New Consciousness Review
www.ncreview.com