The Science

One of the principal themes of the summit was the need to move from treating acute symptomatic disease to the earlier identification of risks for developing disease, as well as use of lifestyle and biomedical interventions to slow or preclude progression to disease.

Dean Ornish, MD, briefly reviewed literature demonstrating the negative impact of stress and depression on physiological factors such as blood flow, immune function, inflammation, brain volume, cardiovascular disease, and even gene expression. Changes in lifestyle activities can greatly ameliorate negative states.

"It really captures peoples' imagination to know that if you change your lifestyle, you can actually change your genes, at least to some degree," said the University of California San Francisco (UCSF) researcher. It can be a useful counter to the sense of "genetic nihilism, that there is nothing I can do."

"Pain can be a powerful catalyst to transformation," Dr. Ornish said. "Sustainable choices in lifestyle changes are based on joy and pleasure, not on risk factor reduction.... What is sustainable is pleasure, and joy, and fun."

He noted that illness begins with "I," wellness with "we." The core of integrative medicine gets the person out of the self and into the group, he said.

"The ability to make lifestyle changes and engage in healthy lifestyles is very much patterned by our social status," said his UCSF colleague Nancy Adler, PhD. There is almost a 5-fold difference in health status between the top and bottom quintiles of income; "this is a huge effect."

"Lower socioeconomic status accelerates the aging process," she said. "Things that change with aging — higher blood pressure, higher [body mass index], greater abdominal fat acquisition, a drop in cortisol — happen at earlier ages among those lower on the social ladder. We can see it even at the cellular level."

The National Institutes of Health's Esther Sternberg, MD, said that 10 to 15 years ago there was skepticism about stress as an illness. Today, "Nobody is questioning that chronic stress can make you ill." Researchers can trace how interventions can shift dopamine, endorphin, and immune function signaling pathways, she said.

"It is hard to do that with belief. We can stress an animal and stress a person and measure something. It is really hard to tell a person, believe and we are going to measure something; it is impossible to do that to a rat."

Dr. Sternberg is working to identify the complex mix of biomarkers that form "a signature, an individualized pattern of health or disease that tells us what this individual needs to do to help them maintain health or reverse disease."

Drawing blood to analyze these biomarkers can affect things such as levels of stress. Her research team has developed a patch that gathers sweat for analysis of markers. "There is a very, very tight correlation between what we could measure in sweat and in plasma," she said.

"Women who had a history of depression had an elevation of proinflammatory cytokines.... Their stress response shifted away from the vagally mediated relaxation response toward a sympathetic adrenaline-mediated response. These patients were asymptomatic." Dr. Sternberg hopes the patch approach might eventually be moved into the clinic so that patients might take the information and modify behavior before disease symptoms develop.

"I think the biggest challenge we have in organized medicine today is that we are not asking the right questions anymore," said Mehmet Oz, MD, the holder of joint positions with Oprah and Columbia University in New York City. "If you cannot fund the trial, you are not going to ask the question."

The level of evidence for making decisions is another concern. The randomized controlled trial is a superb tool for answering reductionist questions, but is less useful when trying to assess more complex, intermodal interventions.

"About 95% of heart disease is preventable today with diet and lifestyle," Dr. Ornish said. The evidence is that unless one is having a heart attack, angioplasty and bypass surgery don't prevent heart attacks or prolong life, yet the US continues to devote $100 billion a year to those procedures. The evidence suggests that the number of these procedures should decline, but they have not, he said.

Dr. Ornish concluded, "Let's take an evidence-based approach and apply it across the board, and not just to so-called integrative medicine."