Joanna Hill on Integrative Medicine, Integrated Healthcare and her Life's Mission

for the Ageless interview on Integrative Medicine & The Bagnall Centre (Chesham, UK) by Joanna Hill.

1. In your opinion, what is integrated healthcare and how important is it today?

Our national healthcare system is facing ever-increasing demand and ever more expensive diagnosis and treatment possibilities. But despite huge financial investment in research, and rapid technological progress in medical diagnosis and treatments, the profligate use of antibiotics in farming and medicine has resulted in killer superbugs, drug research is less and less fruitful, there is a growing epidemic of chronic long term health conditions, and overall health outcomes in the UK are not improving.

I believe that the way to reverse the upwards trend in the total cost of the NHS, and to radically improve overall health outcomes in the UK, is to focus less on searching for cures and more on investing in prevention, on focussing on the whole person holistically rather than isolated elements of disease and to be curious about and investigate the benefits of less conventional and more holistic approaches to health and healing.

To me, integrated healthcare means bringing together orthodox and complementary medical approaches, alongside educating and empowering individuals and inspiring personal commitment to a healthy lifestyle, to form one seamless medical system. Our national healthcare system, preoccupied as it is with diagnosing and treating an increasing number of sick people with conventional medicine and surgery, must focus far more effort and resources on preventing those ailments that are preventable. This approach should entail the education of the importance of adopting healthier lifestyles and the use of a wide range of complementary approaches, which our medical doctors are not taught about, such as nutritional therapy, acupuncture, osteopathy, chiropractic, bodywork, homeopathy, mindfulness, meditation and yoga - these are just a few examples.

2. What sort of impact can it have?

I believe that expanding the training and toolsets available to support our healthcare professionals in preventing and treating chronic conditions, and moving to a less medicalised model of increased personal responsibility for personal health, will greatly reduce demand on the NHS, and the unnecessary drain on the economy caused by preventable and reversible chronic conditions such as obesity, diabetes, heart disease, digestive problems, chronic fatigue, depression, stress, back problems and a number of immune system conditions. The NHS budget of over £100bn pa could then be more favourably weighted towards improving the management and treatment of acute conditions.

Encouragingly, there is a national movement towards merging the health and social care activities of clinical commissioning groups and county and district councils into county-wide Accountable Care Systems with a more strategic view of healthcare needs, delivery and optimisation: with luck this will provide an opportunity for innovation.

3. There are so many natural health disciplines… is there anyone out there who can see the bigger picture of health or is this a collective challenge?

Trained naturopaths, who can be described as natural health general practitioners, probably see the bigger picture of natural health better than any general practitioner, and they can signpost the patient to different natural healing modalities as well as being skilled in some of those modalities themselves. They do, however, face the same challenge as the orthodox general practitioner - the need for constant training, education and research in order to stay abreast of developments in their field, the new modalities and methods available, and their benefits and applications. The combined general medical practitioner and naturopath, practicing a synergy of both orthodox and natural medicine, is a very rare breed, but numbers are increasing as more medical doctors are becoming frustrated by the limitations of the drugs and surgery medical model, particularly in the treatment of chronic conditions, and more training in this combined approach is being developed and offered.

I believe we must all collectively rise to the challenge, look for links and consistencies between the different natural healing modalities we encounter, and trust in the power of these commonalities (and the blurred boundaries between modalities) rather than attempt to mimic our current medical/surgical model and find a ‘one size fits all’ fixed prescription/treatment for every specific illness or condition. We should remember that prescribers often try several drugs on a patient before they find the one which is most effective/has least side effects, and surgery is often ineffective – so whilst a similar trial and error approach to natural therapies might at first glance seem overly risky and uneconomic, this may not be the case when drug and surgery costs over the lifetime of a health issue are calculated, and considering that the risks and downsides of natural therapies - most significantly lifestyle change - are considerably less. It is time to add back patient instinct and gut feel into the equation, to empower the patient to explore a range of healing modalities: and learn that those modalities which work best for them in the moment are very likely to work well for them in the future, not least because of the power of the continuing therapeutic relationship with the practitioner.

4. Are we taking more ownership of our health as years go by?

On the contrary, we are increasingly suffering from physical and mental degeneration which modern medical models cannot dependably combat. Diabetes diagnoses in the UK have increased by more than one third in six years and it is estimated that obesity will double by 2030, affecting half of the UK adult population. We are told that cancer will soon directly affect 1 in 2 of the population.

Meanwhile, according to the WHO, deaths from cancer, heart disease/stroke and Type 2 diabetes are strongly influenced by four main behavioural risk factors: tobacco use, insufficient physical activity, harmful use of alcohol, and unhealthy diet. Dementia, Alzheimer’s, depression, allergies, arthritis and many chronic neurological and behavioural conditions have variously been linked to a number of significant lifestyle factors such as physical inactivity, lack of sleep or sunlight, deprivation of minerals and nutrients, stress, overload of pharmaceuticals, and exposure to environmental poisons such as cosmetic/food additives, industrial chemicals and agrochemicals.

And yet we insist on relying solely on doctors, medicine and surgery to fix us when these degenerations happen, rather than looking at the likely causes and for clues as to how we ourselves can avoid and remedy them.

5. You are not a healthcare practitioner. What made you want to devote your life to improving the health of others?

When my mother, who was a conventional nurse, was told that conventional medicine and science could not treat her cancer, I looked outside conventional medicine and science for an answer to why cancer happens and how to avoid and reverse it. I found part of the answer in therapeutic nutrition and the work of the German medical doctor Max Gerson in reversing human degeneration using nutrition and detoxification. Once I had understood the principles of his work I resolved to communicate this information to as many people as possible, in order to give them another option in combatting disease, and I am committed to finding a way to give therapeutic nutrition greater credibility in the medical world. To this end, my ultimate goal is to create a clinical facility within the medical school network where doctors will be taught how to use nutrition to improve health. Meanwhile, I have created The Bagnall Centre for Integrated Healthcare in Chesham Buckinghamshire, where we teach and practice nutrition, exercise and relaxation alongside many complementary therapies; we aspire to be a platform and catalyst for change in the health system.

6. Tell us more about what makes the Bagnall Centre for Integrated Healthcare unique.

There are many wonderful holistic centres which teach and deliver exercise, relaxation and complementary therapies in varying combinations. What makes us unique is our strong focus on therapeutic nutrition, our beautiful teaching kitchen and range of healthy cookery classes, our scale (exercise studio, rehabilitation gym, classroom, teaching kitchen, client showers, plus eight therapy rooms), our personal trainers qualified in GP referral and specialisms such as cardiac issues and cancer, and our WIN (Wellbeing is Natural) lifestyle change programme which is about to be piloted as part of the national Diabetes Prevention Programme second wave (a combined programme of nutrition/healthy cookery, exercise and stress reduction as an intervention in diabetes). We are extremely proud to be working with the Buckinghamshire Clinical Commissioning Groups and County Council, with the aim of delivering lifestyle change programmes on prescription and lifestyle change education and training to both medical professionals and patients.

7. What do practitioners say are the very best colleges or universities for integrated healthcare and Integrative Medicine out there?

The virtual College of Medicine (and Integrated Health) led by Dr Michael Dixon, encourages health organisations, practitioners and patients to work in equal partnership to champion health creation and health creators, and to share evidence and experience that inspires future health creation. It offers a two-day Foundation Course and many educational events involving both orthodox and complementary practitioners. The College is collaborating with Bristol’s Portland Centre to deliver a two-year part time postgraduate diploma course in Integrative Medicine for medical professionals which embraces conventional approaches as well as other modalities centred on lifestyle and mind-body techniques like mindfulness and nutrition.

The College of Naturopathic Medicine, led by Hermann Keppler, has several physical colleges in London and throughout the UK. The principles of Naturopathy were first used by the Hippocratic School of Medicine in about 400 BC which believed in viewing the whole person to find the cause of disease, and using the laws of nature to induce cure. The college provides training in Naturopathy, and specialist natural therapies such as Nutrition, Herbal Medicine, Acupuncture and Homeopathy. It also delivers training for Natural, and Vegan Natural, Chef qualifications.

The British College of Integrative Medicine is headquartered in Bath. Led by Dr Rosy Daniels, it offers a Postgraduate Diploma in The Study of Integrative Medicine, to educate the healthcare professionals of the future to develop IM services and inspire individuals, families and communities to take a proactive approach to the care of their health. Rosy believes that the true Integrative Medicine provider is open to the value of all healthcare approaches and will evaluate their benefits with equal rigour based upon the unique medical and personal needs of each individual at the differing stages of their illness journey, and the best evidence available.

The BBC’s Doctor in the House, GP Dr Rangan Chatterjee, is a partner with fellow NHS GP Dr Ayan Panja in the new LOBE training organisation (Lifestyle Optimisation By Education). In association with the Clinical Education Group, LOBE is planning to deliver its first one day Prescribing Lifestyle Medicine course in London in January 2018. This will provide science based lifestyle medicine training for doctors, teaching practical skills which can be applied in the surgery to reduce follow-ups, referrals and drug prescribing, going beyond basic diet and exercise advice, to understanding biologic systems and how they relate to symptoms, and how a doctor can get to the root cause of many common presentations quickly.

The following organisations are not educational establishments but are authoritative sources of information:

The British Holistic Medical Association, led by Dr William House, is a virtual educational resource (website, journal and collaborations) which exists to educate doctors, other healthcare professionals and the general public in the principles and practice of holistic medicine.

The British Society of Integrated Medicine, led by Dr Julian Kenyon, is a virtual professional membership organisation for medical doctors which champions the principles, practice and development of integrated medicine within the United Kingdom. It believes that Integrated Medicine is an approach to health and healing that provides patients with individually tailored health and wellbeing programmes designed to address barriers to healing and provide the patient with the knowledge, skills and support to take better care of their physical, emotional, psychological and spiritual health.

8. How do you see the future of integrated healthcare?

The most visionary, strategic and open minded complementary practitioners and medical professionals will increasingly come together in an atmosphere of mutual acceptance and respect, to learn from each other and drive forward the necessary changes in our national health system - to prioritise wellbeing and disease prevention through personal responsibility and accountability, and to embrace a wider portfolio of healing modalities beyond drugs, surgery and CBT.

Significantly more effort will be put into researching, avoiding and remedying the causes of the degenerations which result in non communicable diseases - into preventative and restorative healthcare.

Our combined health and social care systems will work to identify and remove the obstacles - both real and perceived - which prevent individuals from improving their lifestyles and their health: lack of education, motivation, responsibility and accountability, poor prioritisation, and limited resources and support. It is of note that in our modern, pressured society, even medical professionals may be in need of adopting more positive lifestyle changes themselves, this surely in part as a result of inadequate training, resources and incentive to lead by example?

It will become common knowledge that we may not eat and drink whatever we wish, be physically inactive and overstressed, smoke, and rest too little - and still expect technology to save us from degeneration - because it cannot.

9. What is the ultimate lesson you’ve learned from this, your passion?

I have above all learned (in the words of my wonderful friend and GP Dr Mark Chambers) ‘None of us know as much as all of us’. We must never stop learning from others, being curious, being open to different perspectives and contexts, having empathy, respect and humility, being ready to question ourselves, to embrace change and move forwards - otherwise we stagnate, we abandon holism and become reductionist in our thinking, fulfilling our desire (ego) to be differentiated as an expert, thus limiting our horizon, scope and reach, our ability to collaborate, and our value to the community.

On a personal level I have learned that, similar to the above, in personal health and wellbeing, as in running your own business, it is impossible to get it all right, it is a continuous singular journey of improvement rather than a destination, and you can never assume or expect anyone else will share your own perspective, knowledge, expectations, ideals, experiences or challenges, strengths, weaknesses, motivations and limitations - or you theirs.

Through my work with The Bagnall Centre, I am absolutely dedicated to continuing to educate people as to the range of options available to them in terms of all aspects of healthcare, empowering people to make positive lifestyle changes and encourage everyone to make health their lifestyle choice.

I would like to finish with a brilliant quote from a book written by my friend Toby Murcott, a well respected medical journalist - “The Whole Story - Alternative Medicine on Trial?” (Macmillan, 2005), in which he invites conventional medicine to drop its prejudices and investigate these treatments rigorously in pursuit of powerful new approaches to healthcare.

The book ends with a quote from Professor Sir Iain Chalmers (renowned medical researcher, randomised controlled trials expert, and of Cochrane Review fame) in 1998:

”…the most important resource required to promote the concept of integrated health care is likely to be humility among those whose practices will be put to the test, within both orthodox and complementary medicine.”