Yale Integrative Medicine: A Story of Growing Acceptance from Medical Leaders

Summary: Those who have followed the short history of integrative medicine will know that the Yale name has been associated with an integrative clinic for nearly a decade. Yet it was only two months ago that a website at the Yale School of Medicine affirmed that conservative institution's participation in integrative medicine. This article describes the process over the past decade of a public health medical doctor, a Planetree hospital, a medical student and a series of naturopathic physicians quietly "tearing down an Iron Curtain." How? That conservative institution discovered that forms of integrative medicine already existed within its walls. On April 2, 2008, Yale will sponsor an "Inaugural Scientific Symposium" which is expected to significantly advance that academic health center's involvement with the field. More ...

1.    Introduction: Moving  from "Carve Out" to Integration

In its first phase, the integration of complementary and alternative healthcare with conventional medicine in the United States followed fundamentally non-integrated models. Hospitals developed so-called "integrative clinics" then placed them over there, where they weren't too involved with the hospital's core business. The insurers or managed care firms which "integrated" non-conventional services into benefits plans typically did so through methods called a "carve out." This pricing strategy guaranteed that the money spent would not be mixed with the real money in a core benefit plan.

Leadership endorsed IM involvement in 2006

So it was at Yale University School of Medicine when a high visibility member of the faculty began to express his personal interest in integrative medicine through professional pursuits a decade ago. A unique clinical model was created in which medical doctors and naturopathic physicians worked side-by-side. The model caught the attention of Oxford Health Plans then a darling of the managed care world. Through James Dillard, MD, DC, CA, then Oxford's integrative healthcare leader, Oxford piloted coverage of these integrated services.

That early integration activity with which the Yale name was associated was all the more interesting for its leadership. The clinic operated as part of one of 28 Prevention Research Centers (PRC) established through a g

tentatively scheduled for April 2, 2008. To all accounts, this change was fostered largely by the passion and quiet persistence of one medical student, Rachel Friedman.

2.   In which a cardiologist, a medical student and a bookstore employee create a "coat hook" for integrative medicine at Yale

Medical student Rachel Friedman - credited with organizing the Yale IM initiative

"It's gaining momentum," reflects Friedman, thinking back on how integrative medicine has begun to be accepted at Yale. She adds: "The real tipping point will be the conference."

That Inaugural Scientific Symposium will showcase what she, two years ago, anticipated she would find when she began quietly organizing. "There were things going on. A lot of mind-body research. A drug researcher looking at the pharmacology of Chinese herbs. There were research and clinical models. My job was to bring people out of the wood work. There needed to be something to latch onto, a coat hook."

3.   "A flag planted in virgin territory ... "

"Yale is a bastion of conservative thinking," says David Katz, MD, MPH, who continues to head up the Yale effort. "Yale has a strong commitment to evidence-based medicine. What Rachel (Friedman) has done is identify all the things in the University that are connected (to integrative medicine). She's found activity in medicine, in pharmacology, in nursing. We have ours in public health. She's said, 'look, we have a lot going on.'"

David Katz, MD, MPH - Yale's IM pioneer

I asked if it hadn't made some difference that the other university with a similar pedigree as Yale has been closely associated in the public mind with exploration of alternative medicine. After the consumer survey by

Fostering an MD-ND co-directed model

The so-called Yale-Griffin integrative medicine center was born

Ather Ali, ND, MPH - co-chairing the innaugural symposium

Yet while the Yale name is attached, via the Yale School of Public Health and the CDC Prevention Research Center, and while some medical students have observed care at the clinic, Yale medical school still does not have a formal relationship with the Griffin-based integrative clinic.

Still, Katz believes that the existence of the clinic continuously prodded Yale toward more involvement: "In some ways for integrative medicine here, Yale's involvement at Griffin was the mouse that roared."

5.   A sense of the breadth of Yale's integrative medicine activity

disciplines. When it comes to such disciplines, acupuncturists and massage therapists are typically more acceptable to the conservative MDs than are  chiropractors and NDs. It did not help that the naturopathic medical program at Bridgeport, while maturing, was hardly the naturopathic profession's version of Yale or Harvard. On top of this, the naturopathic licensing act in Connecticut hadn't been modernized and still read like an old-time drugless healers act.

Whatever human and historic elements created that MD-ND linkage with Yale's name attached, Katz has clearly kept pushing the envelope. When Yale joined CAHCIM, Katz appointed Ali, a naturopathic physician, to serve as Yale's representative to CAHCIM's clinical working group. Ali was the first ND to attend CAHCIM's annual working conference. Ali is also high profile with Yale's upcoming Inaugural Scientific Symposium, for which he is serving as co-chair.

"We get some push back," acknowledges Katz, adding: "But there is less-and-less as people meet Ather.  Ather is such a beautiful representative of his profession. He's not starry-eyed." W