LOCAL Houston | The City Guide APRIL 2015 | Page 49

Local April.qxp_002houston 3/23/15 2:15 PM Page 49

LORENZO COHEN

If it’s on the exam it will be in the curriculum. A big effort for the Academic
Consortium for Integrative Medicine and Health has been to change the board
exams and that’s not an easy process.
So what is the point of conducting all of this research if it’s not being applied?
LC: To change the standard of care it is essential to have the evidence on what
matters to prevent disease and increase health of out nation. But the evidence is
not sufficient to create change. We need to change the incentives of the system,
because preventing disease doesn’t make money.

LC: But who’s incentivized to do it? The incentives in this country are to treat disBut at the end of the day it would?

ease once it has developed. But it looks like the incentives are finally changing.
The folkloric history from traditional Chinese medicine was that the Chinese medicine doctor was paid when the patient stayed well. If the patient got sick, he
wasn’t paid anymore. So the incentive was to keep the patient healthy. Our system uses an illness model. And doctors are paid when someone comes in and
they are sick and they fix them or try to fix them.
AC: And the sicker they are, the more things they have to do, the more money the
medical system makes.
LC: I am somewhat optimistic for our country and the role of prevention and real
integrative care, because there is hope that the incentives are changing. MD

Anderson, not necessarily today, but in a very near future is going to be incentivized to try and do less. To try and get the same medical return on less intensive
interventions. We are already in some sense testing this with head and neck cancer patients. They are experimenting with essentially a bundle payment (this was
written up in the Wall Street Journal because we are one of the few hospitals
that are doing this kind of experiment right now in the area of cancer), the head
and neck group have mapped out in the last five years, down to the dollar, what
is spent on different things and came up with what they think is the appropriate
target for what we should be paid for treating a head and neck cancer patient.
And if it costs us a lot more money to treat a specific patient, then we are going
to lose money and there won’t be profits. But if we can do it for less, we are
going to save money and put some money in the bank.

AC: It has helped and hurt. On one hand, yes, there is more interest in IM. But on
Has the whole eating clean, juicing, organic movement helped the IM area?

the other hand, there are a lot of things that are under IM that are not evidencebased. In fact there are probably more non-evidence-based things out there that
people are doing than evidence-based. I think there needs to be more research.
You just can’t make claims.
LC: Ultimately the science is going to speak for itself. Literally every couple of
weeks there is a high impact publication showing the role of lifestyle factors and

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