Last November, I was sitting in the Grand Ballroom of the Grand Hyatt Hotel next to Grand Central Station. Self-consciously, the reiterated adjective defines the space. Six hundred people, in black tie, grouped at little tables, guests of a philanthropic society, The Bravewell Collaborative. Our role in this public event was as witnesses to the honoring of our esteemed executive editor, Larry Dossey, as well as Jim Gordon, MD, Jon Kabat-Zinn, PhD, Dean Ornish, MD, Rachel Naomi Remen, MD, and Andrew Weil, MD, for the contributions they had each made as pioneers of integrative medicine (IM)—“integrative” being the latest modifier replacing “complementary and alternative medicine” (CAM), which itself replaced “holistic.”
The awards were certainly well deserved. The only person missing in my personal constellation of heroes being Gladys McGarey, MD, who introduced me, son of an anesthesiologist and a nurse, to this view of healthcare in 1965. And, as we ate well-prepared healthy food, and people talked in twos and threes, there came a moment when the conversation at my table died, and in that zone of silence within the room's noise, I looked out across the ballroom and realized a moment of significant transition was taking place. It took me a moment to work it out what it was.
One-by-one, I went through a litany. Was it that the evening was happening at all? Or that it was happening in a major New York venue? Or was it the audience made up of many leaders in the IM movement, some with friendships going back 30 years or more? No. What struck me as the important question was, who had paid for all this, and the daylong sessions that had preceded the dinner? As it happened, I was seated next to someone who I thought would know, and asked. Morgan Stanley, I was told, had paid for the lunch; Goldman Sachs, and the Arthur Vining Davis Foundations had paid for other things. At that moment, in the glare of media lights, as Charles, Prince of Wales, gave his video greeting signaling his support, I understood that the zeitgeist had changed. I understood that this was a public embrace by the A-list of American philanthropy acknowledging the mind-body role in healthcare and the therapies that encompass this perspective.
Even as I listened to Mehmet Oz—who was acting as MC—as I thought about this, I was suddenly back in 1970. We were living in Washington, DC, then, when my eldest daughter, Katherine, was born that year. Her mother and I wanted a Lamaze natural childbirth. Accomplishing this, today a simple request, became such a saga that I wrote an 8,000 word piece on it at the request of an editor at The Washington Post, who had followed the story. Sitting in the ballroom, I could still remember the smell in the conference room of The Washington Hospital Center, where I argued my case for being present at the birth of my child before a Hospital Review Board, made up of a group of mostly disdainful and grumpy ob-gyns. The fusion of the two moments made me comprehend viscerally how much things have changed.
On the scale of how long a social process like this takes, the IM transition is happening pretty much consistent with other comparable transformations, and I think it is realistic to believe it will probably take the rest of this generation to complete. The German physicist Max Planck frames the essence of why this is true, observing, “A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it.”1
Look at it this way. If you are 44 or older—I date this to the signing of the Civil Rights Act of 1964—in your lifetime race relations between whites and blacks have changed, and you can see that clearly. When I was in my 20s, I was marching to help African Americans to vote. Now, I may well vote for one, and any observer of the present American scene cannot help but notice that most of American culture icons are black—Oprah Winfrey, Colin Powell, Tiger Woods, Michael Jordan, and on and on. If you are aged 43 or less, you have seen only the West slope of this mountain. The civil rights stories that once had such immediacy are, to those in their 20s and 30s, antique. They live in a different world. It takes about 50 years.
In half a century, we have also changed a social habit that, from the planting of the first tobacco by the colonists of Jamestown, Virginia, in 1619, each year had grown in popularity each year for the next three centuries. If you are 50, or older, you can remember when doctors endorsed cigarettes. Today, the movie Thank You for Smoking is instantly recognized as comedy.
The only social transformation I can think of quicker than the IM transition is Prohibition and the Volstead Act. Enacted in October 1919 as the enabling legislation for the Eighteenth Amendment, Minnesota Representative Andrew Volstead's National Prohibition Act authorized the mechanism of Prohibition. It wrought its havoc only 14 years. Early in 1933 it was rescinded, at the same time as the Twenty-first Amendment was passed to obviate the Eighteenth Amendment. Thus ended Prohibition, leaving us with organized crime and a cautionary tale on why it is a really, really, bad idea to use the Constitution as the mechanism for imposing “values” politics on the country.
All through the evening, I kept coming back to the idea that the zeitgeist had shifted, and then to the realization that, almost certainly within a year, one of Malcolm Gladwell's tipping points would occur, and the momentum symbolized in this social event could—I stress the conditional—become the new norm.
No matter who takes the White House, but most particularly if the Democrats do, a great opportunity is going to open up for IM: the illness-profit health system model is recognized, even by the most conservative, as a failure. Something will happen, because a consensus for change has been reached.
That evening showed me we are in transition. Research tells me that trends in disciplines as diverse as biology, medicine, and physics are converging, driven by gathering evidence about both local processes such as placebo response, and nonlocal, such the therapeutic intention.
As this transition continues, the leverage point will shift from a struggle over defending the allopathic fort (denying that IM has any contribution to make in healthcare) to a debate over whether we are to have a new variant of the original, or a new architecture. This is the point where the least amount of focused intention on the part of the IM community can produce the maximal effect.
In my last column, “The Beingness Doctrine,” I described the Eight Laws of Social Change that I see in the historical record. With no more than a year before the healthcare debate erupts, driven onto the stage by the universally acknowledged crisis in America's health system, IM forces should be shaping their intention now and preparing plans as to how to express what they have to contribute.
Issues like posttraumatic stress disorder immediately present themselves as opportunities. Prevention is going to look much more desirable, particularly from an economic consideration. What is the right aikido move would be a way of putting what I am trying to say. Reach out. Who do you know in the political process? Who does your colleague know? Will they introduce you? Maybe after talking to you, they'll go with you. This is a once-in-a-generation opportunity. Things are in maximum crisis; therefore, they are at maximal lability.
Also remember that many vectors are converging in support of the IM point of view. From biology to physics, change is occurring. Other scientists, for their own reasons, from their own research, are finding links, even as all of this is being incorporated into the larger transition involving the acceptance of nonlocality. It may be incremental in each discipline, but in aggregate, powerfully significant. When the tipping point happens, it is no longer a struggle over worldview and becomes a discussion over technique within the new perspective. What we call “normal” places everything else outside the pale and anomalous.
We are always trapped in models. Ways of looking at reality. It is what allows us, out of an infinitude of choices, to see a pattern. What could the universe be but the Buddhist nothingness without the reference of a model to bring some part of that infinitude into focus? The next two years are a time when what you do—as an individual clinician, or practitioner—will really matter.
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