Renowned Integrative Physician Shares Stewardship Message at Turner Farm
Since 2013, Dr. Sian Cotton has served as the Director of the University of Cincinnati College of Medicine’s Center for Integrative Health and Wellness as well as UC Health’s Integrative Medicine program.
The center promotes integrative medicine, which combines conventional medicine with evidence-based complimentary therapies, including mindfulness, nutrition, acupuncture and stress reduction techniques.
By embedding integrative medicine in the UC Health system, Dr. Cotton and her team have helped make these complimentary therapies more accessible to patients, including those seeking pain treatment in an era of increased scrutiny because of the opioid addiction epidemic.
Among the supporters of the Center is Turner Farm. As an homage to its founder, the Turner Farm Foundation created the Bonnie Mitsui Integrative Health and Wellness Fund. The gift is being used to support the overall development of the center.
Last year, the farm also remodeled an existing barn to house a state-of-the-art Teaching Kitchen. The kitchen is used for educational programs on healthy living, including nutritional literacy, self-care, mindfulness and personal responsibility for healthy.
Every month, Dr. Cotton coordinates visits to the farm from medical students, nurses, physicians and other health care students and professionals. The focus on the five-hour training events is “food as medicine” and the role of healthy eating in disease prevention.
Dr. Cotton recently sat down with us in the Teaching Kitchen to talk about the role of integrative medicine in modern health care and the success of the student visits to Turner Farm.
How did the Center for Integrative Health and Wellness get started?
The University of Cincinnati has four health colleges—medicine, nursing, allied health and pharmacy. Around 2009, I started to look around to see who was talking about prevention and wellness in an integrative way. Is anybody doing acupuncture with veterans? Who is talking about food and nutrition to prevent diabetes?
Someone informed me that there was a larger collegiate medical school consortium called the Academic Consortium of Integrative Health, so I joined on UC’s behalf. At the time, there 46 member schools of 150 medical schools across the country. The “big dogs” were all members. Duke, Harvard, Stanford, the Cleveland Clinic. They all had either clinical programs and/or they were training students to treat patients with nutrition, movement, biofeedback, mindfulness, stress reduction and the like.
What kind of pushback did you receive against your efforts to establish an integrative health presence at UC?
From the beginning, I’ve had much less pushback than I anticipated. In less than seven years, we have support from the highest levels of leadership at UC, the dean of the College of Medicine and even the new and previous presidents of the university.
But it still must be difficult to integrate into the existing framework of such a large program.
By their nature, medical schools and healthcare systems move very slowly. Even in 2017, there is slow uptake of this approach to medicine. It’s not as if our clinical program is seeing 25,000 patients, for example. But I’m being approached by doctors who will say they are at the end of their rope because their patients are in pain, we’re ground zero in a terrible nationwide opioid epidemic, and there is nothing left in the traditional toolbox that hasn’t been tried. Others will speak to me about depressed patients who aren’t being helped by traditional means. So many healthcare providers, especially physicians, get it. They understand that conventional medicine and conventional healthcare do not have all of the answers.
Are patients receptive to the integrative approach? It’s one thing to talk about mindfulness with a yoga teacher, but are patients ready to hear about it from their primary care doctor?
The patients are the ones who are most excited. Of all the medical initiatives, none have been more publicly driven than integrative medicine. You have a growing number of patients who are saying that the current system isn’t working. There is a strong desire to learn more about integrative, preventive approaches and to incorporate these methods into the more well-known methods.
Let’s be honest. We have a healthcare industry heading toward a cliff. We’re going broke fixing people using expensive therapies that many people cannot afford. Our system works well for stabilizing acute issues. If you have an acute medical problem, you’re in the right country. But if you’re problem is one of the chronic diseases that is tanking our healthcare system—obesity, diabetes, hypertension, chronic pain—our healthcare system is not optimized for you.
And an integrative approach can push back against this tide?
Yes, it’s my belief that this is exactly the true benefit and value of integrative medicine. One of the tenants of integrative medicine is that we turn the ship early on through preventive measures and education.
In the political battles over healthcare now, preventive measures and personal responsibility seem to be a new third rail. A politician who recently asserted that part of the trouble is that individuals aren’t prioritizing their own health as much as their choice of cell phone.
I don’t care. It’s the right thing. We must do everything within our power to convince as many doctors, nurses, healthcare professionals and patient. This is about personal responsibility. For you, your children and your grandchildren. This one body we are given.
Obviously, you aren’t talking to the 40-year-old man who was just diagnosed with ALS or the thousands of others being treated for diseases that are more or less un-preventable.
No because they aren’t going to bankrupt the healthcare system. The diseases pushing us over that cliff are the major ones like the one in three cancers caused by lifestyle choices. Or obesity, hypertension and diabetes, which are all related to lifestyle.
You’ve chosen a tough battle. There seems to be a lot of factors lined up against you.
Yes. Behavior change is hard, individually and at a societal level. Just look at our schools, where you have vending machines and chicken nuggets providing nutrition to children. There is less gym class time and physical activity. There’s nothing being taught to children in terms of stress reduction. These are indicative of problems like diabetes, obesity and mental health issues down the road.
These problems can be addressed by prevention. As adults, we need to model it. We need to practice stewardship at the individual level to create societal change.
This belief in stewardship of the body dovetails well with Turner Farm’s mission to increase stewardship of the land and, through diet, the body as well.
It’s a big reason why bringing out students in our medical programs for daylong educational events has been so successful. It’s a brand new initiative and we already have a waiting list. The students are hungry for this. They love it. They average around age 25 and they tell us that they go into medicine to help and heal people, not just give them medication.
What can they gain in only a day?
I recently attended a Teaching Kitchen Collaborative event with some of the farm’s leadership. One of the speakers was talking about the different types of programming. One was called a “spark,” meaning it is designed to spark interest which will lead to further investigation. The other was called “immersive,” which is 6-8 weeks. The UC visits to Turner Farm are “spark” opportunities. Just five hours on a Saturday. But they see this beautiful place. They stroll the grounds of this farm and learn to cook something that has been grown there. They’re introduced to food as medicine, mindfulness and sustainability. They really soak it up. Most of them ask how they become more involved. Nobody has left and then said, “That was a waste of my time.”
Does that surprise you?
No. That’s why we started the visits. We knew it would be transformative. How can it not? The farm is an unbelievably inspiring place.
What comes next? Do you see the program evolving?
Our medical programs require a balancing of priorities. I believe these “spark” classes are all we can do for now. But we are putting thought into a more immersive class for those students who would be interested. Perhaps it could be a summer program.
We’re also developing a wellness education series at the farm, bringing in faculty members from the College of Medicine to teach integrative medicine classes. For instance, we have doctors who might teach a class on yoga or tai chi or Dr. John Sacco would teach about integrative nutrition for cancer patients. These classes would be both open to the public and available for CME (Continuing Medical Education). These lectures would raise the educational platform of the community.
It seems as if the tide might be turning.
Remember, when I joined the Academic Consortium of Integrative Health on UC’s behalf in 2009, there were only 46 of 145 medical schools as members. Now there are 71. Nearly half. In five more years, I’d love to see us get to the point where we don’t even say integrative health. We want to break down the barrier between conventional and integrative and say, “It’s just healthcare. It’s all a part of what we do because patients deserve access to these tools.”