The Power of Adaptation and Health Care Policy

The recent health care debate and subsequent bill demonstrated that the focus of public policy is squarely on the delivery system of health care and not on the content of delivery. Though meetings took place among several luminaries in integrative medicine and the writers of the legislation, from what it appears, there has been little attention given to the basic problem—a medical approach that rewards illness care and ignores the usefulness of integrative medicine, including acupuncture, to prevent chronic disease.

To reduce costs and improve outcomes, health policy discussion must focus on the person who has the disease and not the disease alone. This idea is found in the Nei Jing, which discusses the terms zien and bien, translated as author and book. If we are content to solely read the "book" of symptoms without knowing the author, then we are resigned to disease management and not preventive and integrative care. Even if alternative therapies are included in the treatment plan, whether it be acupuncture, botanicals, vitamins, or manipulative therapy, it is not enough if there is no attempt to understand the person and his/her body-mind-spirit nature.

In the Five Element acupuncture paradigm, for example, symptoms are seen as guideposts to understanding the underlying constitutional diagnosis leading to a whole-person approach. ¹ Focusing on the person who has the disease frequently leads to greater insight into the emotional, spiritual, and social roots of a problem. It provides the patient appreciation of the changes that need to be made to prevent chronic disease. Acupuncture treatment, focusing on the constitutional energy, can be deeply transformative and facilitate these changes. Challenging as it may be to work in this way, when patients change "from within," and report feeling "like themselves again," I truly feel honored to have done this kind of work

One way to understand these whole-person shifts is to look at the science of adaptation. Life is always challenging us to adapt to changing circumstances. Our patients who are able to do this well are less likely to develop chronic disease. When a person becomes maladapted, it leads to elevation of cortisol and other stress hormones and consequences such as obesity, insomnia, depression, diabetes, hypertension, and cancer. Current neuroscience research has shown that once a person experiences an extended period of stress, the midbrain, including the amygdala, hippocampus, and locus coerelleus, remodels and maintains elevated cortisol levels even in the face of resolution of the initial events. This has been termed allostatic load, defined as the price paid by the body in response to chronic stress. ²

Functional magnetic resonance imaging (MRI) studies have confirmed these midbrain changes as well as showing that acupuncture and psychotherapy have the ability to assist in remodeling the brain and reverse allostatic load. ³ If we have a means of changing a person's maladapted patterns, whether through acupuncture, therapy, or enhanced self-awareness, we truly reduce the likelihood of chronic disease. Enhancing adaptation and reducing the stress response is at the basis of primary prevention.

In my experience, providing the information to improve the adaptive abilities unique to each of the Five Element patterns and encouraging patients to use additional techniques such as mindfulness meditation, tai chi, yoga, and an adaptive dietary approach can lead to reduction in cortisol levels and improved well-being. How can we reduce health care costs if we don't teach people the root of primary prevention, which is improved adaptation? The Nei Jing gives us insight into what is possible in our practices: “The Great Acupuncturist will help you to disengage, by yourself, from your illness. He will reach the root of life where aliveness and newness arrive from moment to moment.” ⁴ It is up to all of us who have been fortunate to study acupuncture and integrative medicine to bring this message to our patients, and to policy makers, if we hope to see a healthier future for American medicine and the people it serves.