The Continuum Center for Health and Healing an initiative of Beth Israel Medical Center is located at 245 Fifth Avenue at 28th Street in New York City. The Center provides fully integrative care, employing safe and effective conventional and complementary therapies in a specially designed healing environment. The Center’s vision is comprehensive, including clinical services, educational offerings, research studies and outreach efforts.

The Department of Integrative Medicine
The Department of Integrative Medicine at Beth Israel Medical Center was launched in 2007 to bring the benefits of integrative medical care to patients throughout Beth Israel. Under the leadership of Dr. Woodson Merrell, Chairman, the Department is launching new clinical, research and educational programs as well as coordinating integrative services already offered through other Beth Israel departments.

The Department builds upon the success of the Continuum Center for Health and Healing, the outpatient center of Beth Israel, which has become an international leader in integrative care, research and education. The Center serves as the administrative and leadership core of the Department.

The Mission of the Department of Integrative Medicine is to promote a holistic, patient-centered approach to medical care throughout BIMC. We will serve this mission by 1) offering expanded healing approaches to hospital inpatients and outpatients through inter-departmental collaboration; 2) providing educational opportunities and resources on these practices to patients, employees and the community; and 3) conducting research that will demonstrate the effect of these practices in a hospital environment. Our vision is to become a model for other healthcare organizations, demonstrating the value of humanistic, wellness-oriented and holistic care within traditional hospital environments.

Philosophy of the Center
The Continuum Center for Health and Healing is part of a fundamental change in the way health care is delivered and serves as a national model for integrative medical care. We will contribute to this evolution through collaborative clinical care practice, professional education programs and scientific research. The Center will work to broaden the meaning of healing and preventive health care by providing the best of Western scientific medicine with the most effective complementary therapies. The Center’s staff is committed to relationship-centered care and a collaborative working environment. This approach considers the individual’s physical, psychosocial, spiritual and cultural needs in order to support healing on all levels.

The Center and the Evolution of Integrative Medicine

The Integrative Community

“What is integrative medicine? Ask me in a few years. We’re defining the field!” offers Dr. Benjamin Kligler, the Center’s first Medical Director. “This is an exciting time in health care, as we can look to a wider array of choices about what forms of treatment can help our patients. Our concern is to do that creatively and responsibly. Integration means understanding the different philosophies and treatments and selecting the one most in tune with the person’s needs and inclinations.”

“Health care is fundamentally about caring, about offering a compassionate open presence,” says our Director of Clinical Services, Barbara Glickstein, RN, MPH, MS. “People live and thrive in communities because that’s where they find nurturing and healing.” Promoting an atmosphere of trust and dialogue is an essential component of a healing community. “Creating a new model is an ongoing process.”

Well-being is grounded in being real, contends the Medical Director, Dr. Roberta Lee. “Let’s face it, finding a balance in your life style is a challenge for everyone in the 21st century, including practitioners,” Lee points out. “We have to live this, too.” For physicians, integration is about “translating a new body of material into practice. That’s what makes the difference between a good doctor and a great doctor.”

The voices of healers, physicians, patients and their families are joining together at Beth Israel’s Center for Health and Healing. Our hope is to “make integrated health care the standard of practice within the next five years”, says Executive Director Merrell.

Wellness Partnerships

The Center is involved in creating wellness partnerships with many different communities: academic, hospital-based, governmental, religious/spiritual, and community-based groups.

We are involved in ongoing collaboration with a number of other Integrative Health Care Programs in the northeast. We have organized the Northeast Regional Consortium of Academic Complementary and Alternative Medicine Centers at the Continuum Center for Health and Healing which meets periodically to address areas of collaboration in research, education and clinical programs.

One outgrowth of this is a partnership with six consortium members in a multi-center CDC (Center for Disease Control) funded program coordinated by Griffin Hospital in Connecticut (a Yale affiliate) to study the efficacy of integrative approaches to selected health problems.

In addition the Center is co-sponsoring educational initiatives with Omega Institute. Founded in 1977, Omega is a pioneer in holistic studies, hosting conferences, retreats and an extensive teaching program for the public and health professionals. The Center developed a CME (Continuing Medical Education) course on integrative approaches to wellness held at Omega Institute in September 2001.

Representatives from the Center are part of the Albert Einstein College of Medicine working group on integrative curriculum reform. Under the leadership of Albert Einstein College of Medicine Dean of Education, Albert Kuperman, this group is seeking to incorporate integrative approaches in all four years of medical school education.

The Center is a member of the national Consortium of Academic Medical Centers for Integrative Medicine. This consortium is comprised of 42 major medical schools in the U.S. and Canada that have active integrative programs and whose dean of medical school is committed to incorporating integrative approaches into medical education.

In addition to our professional partnerships the Center for Health and Healing is also deeply committed to learning about and incorporating the diverse perspectives and beliefs of those we serve. Our relationships with our patients, our patients’ communities, and other health care practitioners are central to the health care we provide. Our commitment to these relationships is the foundation of our community outreach. We are building connections with religious communities, educational institutions, community health centers and the business world. Together, we can heal ourselves and our communities.

What is Integrative Care?
Our Center is committed to integrative and holistic health. In our approach, we treat the person, not the disease. With detailed questionnaires and extensive one-on-one interaction, we try to discern the patients’ values, beliefs and philosophic orientation towards health and life, so that we can work together to design a program aligned with them. We incorporate the best wisdom from a wide and diverse base of healing modalities.

In integrative health care, we assess the impact of lifestyle on health, affirming the innate potential for self-healing in everyone. Lifestyle changes in nutrition, exercise and stress management are offered in conjunction with a range of gentle therapies. We use holistic therapies because they are often lower risk and less toxic forms of treatment and disease prevention. In our approach, they can be used either in place of or in conjunction with the best available biomedicine. “Our goal is to practice good medicine,” says Executive Director, Dr. Woodson Merrell, “And that means finding what is gentlest, safest, and most effective. We have enough information now to use a wide range of therapies.” These include:

Traditional medicines such as Traditional Chinese Medicine

Plant-based medicines, including herbal medicine and aromatherapy

Optimized nutrition for detoxifying, improving digestion, and eliminating food sensitivities

Nutritional supplementation

Manual therapies such as chiropractic, massage, and cranial therapy

Energy medicines, like homeopathy, Reiki and therapeutic touch

Relaxation techniques, such as meditation, biofeedback, hypnotherapy and guided imagery

Conventional medicine

How did complementary medicine develop in the US?
Health is an issue that concerns everyone — deeply affecting our loved ones and ourselves. That is why after nearly a century of conventional medicine, consumers have reopened the question of what constitutes the best treatment. No longer satisfied with one-size-fits-all approaches, over the course of the last 20 years people have sought a new level of quality and caring in health care. According to the 1998 Eisenberg study published in the Journal of the American Medical Association, 42% of Americans use some combination of complementary/alternative therapies in conjunction with conventional medicine. In Europe and Australia, where there is a longer history of integrating conventional medicine with other modalities, even higher proportions of the population use complementary/alternative treatments.

Eisenberg Research Highlights, Harvard Medical School

The Eisenberg study showed that the number of Americans using an alternative therapy rose from about 33% in 1990 to more than 42% in 1997. Some researchers estimate that the number may currently be as high as 70%.

People reported using the following therapies most often: relaxation techniques, herbal medicine, massage, and chiropractic.

In addition, Americans spent more than $27 billion on these therapies in 1997, exceeding out-of-pocket spending for all U.S. hospitalizations.

Patient visits exceeded those to primary care physicians and patients did not inform their physicians.

Until recently, people have initiated the movement toward integration on their own. Now, in response, biomedical systems have joined this movement to quality, integrative health care. At our Center, physicians and practitioners have devoted decades to the study and practice of a wide assortment of complementary and biomedical specialties. They have developed an understanding of the many ways a health condition can be approached and how to help their patients decide on the most appropriate treatment options.

About Biomedicine
Conventional medicine, also called biomedical science or allopathic medicine, is the prevalent medical system in the U.S. today. It is a little known fact that it only attained wide public acceptance in the early 20th century. One important emphasis was on emergency care, which evolved out of a triage model for treating wartime injuries during World War I. With a corresponding concept of “battling” disease, this medical model excelled in surgery, treatment of trauma and in addressing acute, infectious diseases.

However, we now recognize that the techniques of biomedicine, while excellent for some applications, are limited in their ability to address others. The crisis treatment model, for instance, does not adequately address the needs of those who suffer from chronic illnesses. We have found that complementary treatments can be very helpful in the treatment of arthritis, lower back pain, digestive distress and many other chronic disorders. When it comes to prevention, complementary modalities have a wider array of tools, although biomedical diagnostic procedures are vital.

The Mind-Body Connection
Two decades ago when Bernie Siegel, MD, addressed cancer patients’ emotional needs in order to promote healing, he was ridiculed. Now, he’s considered a wise elder. The mind-body connection, though long outside the radar of biomedical science, resonated too profoundly with people’s experience to be discounted. Research has been a key factor in “proving” what people already know. Studies on the “relaxation response”, begun in the 1970’s by Herbert Benson, MD, showed that patients trained to meditate could reduce the impact of stress on blood pressure and other autonomic responses. The use of meditation along with lifestyle and dietary changes was shown to reverse heart disease in studies done by Dean Ornish, MD. More recent research confirms the influence that relaxation has upon lowering the secretion of hormones associated with stress and the so-called “fight or flight” response. Mind-body approaches are now being studied as “self-control strategies” which people can use to modify their mood, behavior and responses. Harnessing the mind-body connection has been shown to powerfully influence health outcomes for a wide range of disease processes as well as to improve quality of life.

Research by neuroscientist Candace Pert has shown that emotions, transmitted throughout our bodies by neuropeptides, influence us on a molecular level. Current studies demonstrate that prayer and intention can heal, even over distances of time and space. This research indicates that a strictly mechanistic view of the human organism is too limited. Our complexity and our corresponding potential for healing is vaster than previously assumed. Holistic health care providers have evolved sophisticated means for accessing this profound connection.

Holistic Nursing
Holistic nurses were present at the forefront of the new wave in health care, placing the simple act of caring at the center of their professional practice. Over 20 years ago, at the Beth Israel Department of Nursing and at other medical centers throughout the country, nurses were the first to translate the conceptual framework of physics into medicine. Biomedical science, originating in the 19th century, is based upon Newtonian physics which describes how matter acts and reacts in time and space. But the accepted science of modern physics reveals that all matter in the universe, including ourselves and our bodies, is made up of energy and that energy is primary over matter. Therapeutic touch, biofeedback and other modalities of self-care and empowerment utilized by holistic nurses treat the totality of the person as a feeling, conscious energy system, connected to a universal energy field. By introducing these practices into a hospital setting, holistic nurses awakened both patients and physicians to expansive opportunities for healing.

Healing Physicians
Visionary physicians, including Larry Dossey, Andrew Weil, Deepak Chopra, Herbert Benson, Dean Ornish, Bernie Siegel, James Gordon and many others, first began to question and then to expand the horizons of the health care system. Beyond that, they expanded our understanding of who we are as people, appreciating our depth and integrity as beings of body, mind and spirit. Many other physicians, in family practice and other specialties, began to look towards wellness, prevention and other treatment models. In the face of limitations on doctor-patient interaction imposed by managed care, these physicians moved resolutely towards a fuller involvement with their patients. Reaffirming their vocation as healers, these physicians, along with many others, began in-depth studies and practice of complementary modalities. Vanguard physicians have also questioned the self-imposed limitations that blocked science from the spirit of full and open inquiry, thereby opening the door for a transformation of our scientific knowledge base that is fundamental to the ongoing health care revolution.

Medical Research
With the rise of pharmaceuticals and high technology interventions, conventional biomedicine moved away from approaches that we now consider alternative and complementary, such as herbal medicine and massage which were the major components of medicine a hundred years ago. This produced consequences for scientific research in this field.

Because much of the research in the last decades has been funded in large part by pharmaceutical companies who do not economically benefit from non-patentable interventions, such as commonly available herbs or practices like meditation, the financial wherewithal to study the effectiveness of these therapies has been lacking.

In addition, medicine at this time ignored the role of the mind in health because of a focus on the physical body and interest in objective, quantifiable information. Cognitively- and spiritually-based therapies, such as imagery and meditation, were viewed as unscientific because they involved mental processes that were not directly observable. Therefore there was a lack of scientific study on efficacy and safety that has resulted in part in conventional medicine’s mistrust of complementary/alternative approaches.

In 1998 the Journal of the American Medical Association, which publishes peer reviewed medical research, placed complementary/alternative medicine third on its list of topics vital to address. Over the last years, numerous studies of these modalities have been undertaken. In addition, research scientists are questioning whether the same, costly studies needed for toxic synthetic substances are necessary to determine the effectiveness of gentler treatments. Research currently being done includes outcome studies in addition to randomized clinical trials.

The Beth Israel Center for Health and Healing is currently developing a research agenda under the direction of Samuel Shiflett, Ph.D., who has directed numerous studies in this arena. We hope to make a significant contribution towards confirming the efficacy of specific modalities for specific conditions, and to advancing positive synergies while avoiding negative interactions. Providing a solid scientific evidence base for complementary treatments encourages both consumers and practitioners in using successful approaches. This is a cornerstone of integrative health care. In addition, as the efficacy and cost effectiveness of holistic treatments and remedies are statistically proven, health insurance companies can create a cost basis for their coverage.

The Government Response
Over the last decade, governmental agencies have stepped in to fund this needed research. In 1992, the U.S. National Institutes of Health (NIH) established the Office of Alternative Medicine, which in 1998 was upgraded to the National Center for Complementary and Alternative Medicine (NCCAM). The NCCAM has a $68.7 million budget (in 2000) to stimulate, develop, and support this needed research. The NIH has also supported the creation of 11 centers to explore the safety, efficacy, cost and mechanism of action of complementary therapies.

A White House Commission on Complementary and Alternative Medicine Policy, headed by mind-body physician and author Dr. James Gordon, will study issues regarding research, training and certification of complementary/alternative practitioners, insurance coverage, and other alternative medicine issues. We maintain an ongoing dialogue with leaders in the field who are working together to better our understanding of how to use all approaches.

Medical Database Coverage
Medical databases, which provide an infrastructure for identifying, organizing, and evaluating the scientific literature, have increased their coverage of complementary medical practices in response to the growing demand for this information by scientists, researchers, practitioners, and the public. A significant number of new journals and newsletters have been launched. Indexes and electronic databases have increased their coverage of the field. In addition, new, publicly funded databases created by the federal government, such as the CAM Citation Index and the IBIDS database (International Bibliographic Index to Dietary Supplements) now make quality information readily available.

Insurance Coverage
HMO’s may have the greatest influence on the evolution of complementary health care in the U.S., as coverage makes it possible for more people to use such treatment. Currently, consumer use of complementary therapies is driving insurance providers to cover these treatments, with two thirds of HMO’s providing coverage of at least one form of complementary therapy. According to a 1999 Landmark Healthcare survey, HMOs and consumers agree on the levels of future consumer demand for alternative care with nearly three-fourths of HMO’s (74%) expecting it to be moderate or strong. In addition to consumer demand, legal requirements for coverage are another important inducement to HMO coverage, with 38% of HMO’s providing coverage due to legal mandate. In the future, as the effectiveness and cost efficiency is demonstrated, insurers will have additional incentives to cover these treatments.

Medical School Courses and National Conferences
Seventy-five out of 117 U.S. medical schools offer elective courses in complementary/alternative medicine or include these topics in required courses, according to an article published in 1998. In addition, post-graduate residencies and fellowships in complementary medicine are being established and continuing education courses for physicians are being offered. Medical education and training is an important component of the Center, with courses for professionals as well as fellowships and residencies for medical students starting in January 2002.

Conclusion
As medical centers, insurers, medical educators, and scientific researchers follow the public trend to holistic and integrative care, our goal at the Center for Health and Healing is to help set the standard for care. At each step of the way: when we are consulting with an individual or family on their health concerns; when we are researching or studying the evidence for a form of treatment; when, through our active education program, we are sharing the evolving knowledge base with our professional colleagues throughout the U.S. Our goal is to create a model that others can follow. With biomedical physicians and complementary practitioners working side by side and in collaboration, we will discover and work with you to create the kind of health care that is in the best interest of each individual in order to move towards a more complete healing on all levels.

References:
1. Interview with Dr. Woodson Merrell, Center for Health and Healing, August, 2000.

2. Interview with Dr. Benjamin Kligler, Center for Health and Healing, August, 2000.

3. Interview with Barbara Glickstein, Center for Health and Healing, August, 2000.

4. Interview with Jeanne Anselmo, Center for Health and Healing, August, 2000.

5. Interview with Dr. Lewis Mehl-Medrona, Center for Health and Healing, August, 2000.

6. Interview with Dr. Roberta Lee, Center for Health and Healing, August, 2000.

7. Interview with Aurora Ocampo, Center for Health and Healing, August, 2000.

8. Interview with and notes from Marsha Handel, Center for Health and Healing, August, 2000.

9. National Center for Complementary and Alternative Medicine web site: www.altmed.od.nih.gov.

10.Continuum Health Partners Press Kit.

11.Astin J, et al. “The construct of control in mind-body medicine: implications for healthcare.” Alternative Therapies in Health and Medicine. 5(2):42-47, March 1999.

12.Barnes J, Abbot NC, Harkness EF, Ernst E. “Articles on complementary medicine in the mainstream medical literature: an investigation of MEDLINE, 1966 through 1996.” Archives of Internal Medicine. 159 (15): 1721-1725, Aug. 9-23, 1999.

13.Barrett B, et al. “Bridging the gap between conventional and alternative medicine.” Journal of Family Practice. 49(3): 234-239, March 2000.

14.Fontanarosa PB and Lundberg GD. “Complementary, alternative, unconventional and integrative medicine: Call for papers for the annual coordinated theme issues of the AMA journals.” Archives of General Psychiatry. 55(1): 82-83, Jan. 1998.

15.Eisenberg DM, Kessler RC, Foster C, et al. “Unconventional medicine in the United States — Prevalence, costs and patterns of use.” The New England Journal of Medicine. 328 (4): 246-252, 1993.

16.Eisenberg DM, Davis RB, Ettnet SL, et al. “Trends in alternative Medicine Use in the United States, 1990-1997: Results of a follow-up national survey.” Journal of the American Medical Association. 280(18):1569-1575, 1998.

17.Weil A. “The significance of Integrative Medicine for the future of medical education.” Association of Professors of Medicine. 108: 441-443, April 1, 2000.

18.Gaudet T. “Integrative Medicine: the evolution of a new approach to medicine and to medical education.” Integrative Medicine. 1(2):66-73, 1998.

19.Pert C. “Candace Pert, PhD: Neuropeptides, AIDS and the science of mind-body healing.” Alternative Therapies in Health and Medicine. 1(3):70-76, July, 1995.

Who Comes to the Center and Why?
Typically patients who come to the Center fall into one of three groups.

The first group are those seeking ongoing primary care with a medical doctor, a nurse practitioner or a physician assistant who has a holistic, integrative perspective on health care.

The second group are those who come to us, whether self-referred or at the suggestion of their health care provider, for consultation on a specific health problem, or for a “wellness” consultation. These will be people who already have a primary care provider but are looking for information beyond the area of expertise of that particular practitioner.

The third group of patients are those who will come directly to one of our complementary/alternative practitioners. Again, some of these will be self-referred or referred by an outside provider. In these cases we will ask that by the third visit with the complementary/alternative provider, patients provide us with some documentation that their own health care provider is aware that they are undergoing treatment with us. If patients prefer not to do this, we will ask them to see one of our conventional providers for a brief screening visit to ensure that no significant medical problems are being overlooked.

What makes a healing experience? — our patients speak for themselves.

“Peaceful, lovely, thoughtful flow of space; promotes healing; good lighting; beautiful plants and ceramic pots. We haven’t see the doctor yet, but I feel more relaxed and positive regarding the visit. I feel hopeful that we are in the right place with the right health practitioner. Thank you.”

“I love the decor, the ambience, the care-giving approach one gets here.”

“This is my third visit here and the peacefulness/serenity that is evoked is wonderful. Not usual upon awaiting a doctor’s appointment — it becomes an internal healing… thank-you.”

“Today is the first day of the rest of my life — what a start — coming here. It’s a great place, relaxing, peaceful atmosphere, wtih a very welcoming and inviting feel. I love the waiting area and the library — what a great idea and concept at a ”doctors“ office. It makes the wait worthwhile.”

“Here I am — a half hour after my acupuncture treatment — and not eager to leave this very revivifying office! I hope you will continue to be able to keep the welcoming, relaxed feeling in your office. It’s as important to me — or almost as important- as the excellent people — doctors, chiropractors, nurses — here to treat one.”

And about our Resource Library:

“The library and its eclectic books bring hope to those of us having pain. As a psychotherapist, I believe that the spiritual is often left out of our work — I’m glad to see it’s not left out of yours.”

“It is extremely helpful to have access to these resources — meets my needs for support and learning. Thank you!”

“Very relaxing, lots of wonderful information — truly enjoyable!”

“What a wonderful place to relax in the center of the business district. I enjoy the interesting articles you have here.”

“The Resource Library Center is a welcoming center for those who make use of it. It is very informative, inspirational and relaxing. Thank you for the use of this center while we wait.”

“Thanks a million for your library — it’s so helpful — more than you can ever imagine — it’s unexplainable.”

“I had to wait over two hours for my husband to pick me up — what a great way to spend time. It reminded me to slow down and take time for myself.”

Content last modified on Nov 9, 2009