13 steps to health

A whole person approach to wellness care:

1) Breathing

2) Sleep, rest, & relaxation

3) Mindfulness & Meditation

4) Prayer & spiritual connection

5) Proper Diet/Eating Hygiene

6) Exercise & Stretching & Bodywork/Massage

7) Self-understanding & Mental Health care

8) Faith, Hope, & Love

9) Feng Shui

10) Body-mind integration (Yoga, Qi-Gong)

11) Herbs, supplements, medications, and homeopathy

12) Holisitic Interventions (Acupuncture, Chiropractic, Energy Medicine)

13) Western Medical Interventions (Surgery)

The Functional Spectrum of Wellness and Disease

Dr. Len Saputo, M.D. from his book A Return to Healing, has another great tool to asses health and wellness. The Functional Spectrum of Wellness and Disease



0% - 25% - 50% - 75% - 100%
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When working with clients, the goal is to help clients move closer to 100%. Any increase in health toward 100% is success. Whether it it something small like reducing smoking from 3 packs to 2 packs, or something large like heart surgery, movement towards 100% is what healthcare and wellness care is about. Keep in mind, however, 100% is different for everyone. 100% for one person may appear as 25% for another. Anything below 50% is where symptoms begin to surface and functionality becomes impacted.

So what is the best way to move a patient towards ideal health? Dr. Len Saputo has also developed a hierarchy of treatment modalities.

1) Lifestyle strategies such as diet, sleep, exercise, stress reduction, weight control, reduction of toxic chemicals, balance, etc.

2) Noninvasive complementary and alternative (CAM) services such as acupuncture, herbal medicine, chiropractic, massage and bodywork, homeopathy, counseling, health coaches, and energy medicine.

3) Natural-medicine approaches such as orthomolecular medicine, functional medicine, bioenergetic research, and advanced testing.

4) Very careful and sparing use of pharmaceutical drugs, surgery and other invasive strategies as a last line of defense.


Seems to me to be a reasonable, cost-effective, patient empowering model of healthcare. It starts with prevention and self care, supplemented with trained medical professional help to encourage and promote the natural healing process. When prevention and support does not work, targeted testing and individualized medicine determines what is going wrong and what needs to be done to move the patient towards a more functional wellness. The use of pharmaceutical drugs, surgery, and advanced procedures in this context can then be used to finally tip the scales towards health and wellness when the disease or condition is unmanageable without further intervention.

Healing Circles- A Novel Treatment and Diagnosis Method

Imagine you as a patient have searched for years, maybe even decades, for the answer to why you always feel unwell. You have gone from doctor to doctor, and have tried everything from medications to energy healing. Some things help temporarily. At best most things don't do anything and often new treatments make it worse. You have a few doctors or practitioners that you like and you go to see them somewhat regularly, but they certainly have no interest in coordinating your care. You simply see one for the pain, another for information, and another for a medication, and so on.

Dr. Len Saputo has developed a novel way of diagnosis called the Healing Circle. It brings together a team of 3-8 physicians and practitioners from different fields to sit down with a patient in a 2 hour session. The patient shares his/her history (medical, social, spiritual, emotional, etc) with the group and the group subsequently works together to find a treatment plan that is honest about what each field of medicine can and cannot do, is complementary to all healing practices involved, and supports the whole person.

The Healing Circle was developed and born out of more than 15 years of collaboration with the Health Medicine Forum and his subsequent integrative health practices in San Franscisco, CA.

Watch this video of a circle:



To learn more about Healing Circles, visit www.doctorsaputo.com or you can read Dr. Saputo's many books, including A Return to Healing: Radical Health Care Reform and the Future of Medicine

Major Trends and Health Care Industry Outlook

The philosophy and substantive development of an Integrative Health Care model has been evolving over the past few decades. According to Clement Bezold in his article Evolving Demands and Demographics in Health Care, “90% of the variance in premature death in modern society is related to factors other than the lack of health care. Currently, the vast majority of morbidity and mortality is associated with lifestyle, genetic, and environmental factors.” According to the Center for Disease Control:

• 7 out of 10 deaths among Americans each year are from chronic diseases. Heart disease, cancer and stroke account for more than 50% of all deaths each year.
• In 2005, 133 million Americans – almost 1 out of every 2 adults – had at least one chronic illness.
• About one-fourth of people with chronic conditions have one or more daily activity limitations.

Many of these chronic diseases are preventable through simple diet, exercise, and healthy lifestyle choices. Clearly, there is a need for our health systems to shift from infection and acute and emergency trauma care towards medical and wellness care targeted at our 21st century health problems. While this does not call for an elimination of our evidence-based biomedical health care, it does call for an integration of biomedicine into health systems designed to address lifestyle modification and reduce environmental and genetic risk factors. According to the Institute of Medicine in their February 2009 Summary Report of Integrative Medicine and the Health of the Public, “the interactions between an individual’s social, economic, psychological, and physical environments, and his or her biological susceptibility to illness and responsiveness to treatment; the nature of the care process, as well as its content; and the often greater health benefit to be had from certain “lower tech” interventions, rather than more costly approaches” are part of a bigger picture needed to create this new health care system. Unfortunately, these factors are often overlooked in our current health care system, which are necessary when working with chronic and preventable disease. The tools needed to move our health care system towards one that addresses lifestyle, environment, and genetics and takes into account environmental factors, biological susceptibility and responsiveness, the care process, and lower tech inventions are already at our finger tips. We have the technology to detect early risk factors, know the best preventative measures and lifestyle interventions needed, have a rich array of health care practices and theories of medicine, and we understand the motivations and interventions need to modify human behavior on both an individual and community wide scale.

The factors needed to refocus our health systems, however, are at times in direct conflict with major trends in health care. In an effort to address them as quickly as possible, often the most effective answer is considered too difficult to achieve (for reasons such as finances or logistics) or is simply missed because the patient interactions with the environment, biological susceptibility and responsiveness, the care process, and “lower tech” interventions are not utilized in solution assessments. Trends in individualized medicine, for example, tends to focus on complex and expensive treatment plans, when often a patient just wants an extra few minutes with the doctor, or just wants the pain to stop which could potentially be managed more effectively with greater cost savings with a service such as acupuncture. Patient demand for maximum level of care, again, also trends towards complex and expensive treatments. Ultimately, a patient wants to be heard and wants the problem to be fixed, and without addressing the root cause and instead focusing on fixing the problem once it has become broken, medical costs and frustration with ineffective and/or slow treatment results become common when treatment and interventions don’t work immediately. Direct consumer advertising of health care interventions and treatment options is also driving up costs because patients are demanding these products and services advertised and providers are at times under pressure to utilize certain products and services. When both provider and patient are under pressure to utilize the same products and services, the result is treatments that may not be the most effective and may be more costly, especially since direct consumer advertising focuses on new innovations and technology which are inherently more expensive. Since current health care financing control is not driven by price and patients are often unaware of the costs of products and services, the trend in direct consumer advertising has few checks and balances. Comprehensive disease management, however, is fortunately a trend that integrative health excels at addressing and this, perhaps, is one of the biggest factors in the growth of integrative health care.

Integration of Complementary and Alternative Medicine is a critical aspect of creating an integrative health care facility; however, the integration of CAM into contemporary western medical facilities, as if they were a few extra silos in the bunch, is not a viable model. CAM is unique is its delivery of care because care encompasses diet and nutrition, spiritual connections, social support, and exercise, just the pieces needed to support this new health care model. The use of CAM modalities without comprehensive wellness and positive lifestyle factors makes these modalities limited. This limited use results in the exclusion of many of the primary reasons CAM is so popular in the first place, ie: patient empowerment and effective treatments from practitioners willing to take the time to listen to their patients. In inclusion of CAM into conventional medical systems often highlights a variety of additional strengths, such as it provides minimalist, non-invasive approaches to early-stage and chronic health conditions, which often confounds the medical industry in an effort to effectively treat without high costs. Many aspects of CAM also meet criteria for safety, efficacy and cost-effectiveness. In addition, CAM is useful in addressing many of the leading trends of healthcare in the United States. CAM, thus, can enter the health care scene as a way to fill in holes that an integrative health system that is focused on lifestyle interventions, environmental factors, and genetic/biological factors, without reinventing the wheel. Looking forward, integrating CAM into current health care systems, therefore, requires a reassessment of our current strengths and weaknesses as a system, and will seek to develop a model where CAM and Biomedicine are complementary. This kind of synthesis, fortunately, is flexible and adept at addressing the complexity of today’s healthcare and health care cost challenges.

Segmenting the Broader Health Care Industry

There are a variety of segments in the health care and wellness industry

Conventional Health Care Industry
• Health care financing
• Physician and Nurses services

Wellness Industry
• Complementary and Alternative health services
• Fitness
• Diet & nutrition

Support Industries
• Public education
• Professional education
• Research & technology innovation
• Institutional services (environmental services, security, design, management, ordering, etc)
• Input factors (natural resources & land, labor, and capital goods)

Health care financing through third party payers and the physician and nurses services that they finance are 18% of the United States GDP, which equals roughly $2.5 trillion dollars. The health care is growing due to a pending increase in health insurance coverage across the nation, population growth, and the aging of the population. Services tend to be clustered in urban and metropolitan areas with use primarily from insured individuals. 83% of the U.S. population is insured in some way. 59% of those insured under the age of 65 are employer insured and 19% under the age of 65 are insured through some sort of government sponsored program such as Medicare, Medicaid, or military health services. All individuals over the age of 65 are eligible for Medicare insurance. Most health services addresses chronic disease and according to the Centers of Disease Control and Prevention, it is estimated that health care costs for chronic disease treatment account for over 75% of national health expenditures. There is a high demand for quality service that is individualized and competition is plentiful. Services are primarily conducted in English and Spanish.

The size of the wellness industry is not as well known. In a 2007 report by the US Department of Health and Human Services, approximately $34 billion dollars was spent on Complementary and Alternative Health (CAM) care, which includes not only visits to CAM practitioners (only 1/3 of money spent) but also CAM products, classes, and materials. This equates to just over 11% of all out of pocket health expenses and to 1.5% of total health care expenditures in the United States. Like the health care industry, the wellness industry is clustered in urban and metropolitan areas but those who frequent these services tend to be wellness and fitness oriented, seeking preventative services, or suffering from chronic illness. According to the US Department of Commerce, nearly 1 in every 2 Americans has a chronic illness, so the wellness industry is certainly not limited to a small percentage of Americans. Based on the amount of growth over the past two decades, and projections for the demand of healthcare services, it is estimated that wellness services, especially CAM, is expected go grow at a fast pace over the next decade. The use of self-care practices has also been on the rise and growth is expected, as wellness and lifestyle interventions become a greater part of healthcare services.

Along with the growth of the health and wellness industries, the growth of support industries will also expand in order to accommodate and support the health and wellness industries. The need for more public education and better professional health care education will support the evolution of health systems towards comprehensive lifestyle interventions that encompass environmental and biological/genetic factors. Research and technological innovations will continue to drive health care practices, knowledge, and care. Currently, the United States spends approximately $100 billion on medical research alone and is not expected to decline. Technology innovations have always been a hallmark of American health systems, and that trend will not likely stop either. The need for institutional services, essentially, all the pieces of administration and business that keeps health organizations working, will also expand. As more health facilities are established to accommodate growing demands for health services, more people will be employed to design, manage, and upkeep the systems. More health services and facilities will also require more natural resources and land, labor, and capital resources.


Within the Conventional Care Industry, the continuum of care from cradle to grave encompasses 15+ different realms of medicine. These include:

1) Pre-natal care
2) Infant/neo-natal care
3) Pediatric
4) Adult care/primary care
5) Internal medicine
6) Specialists (ie: Oncologists, Urologists, Cardiologists, Endocrinologists, etc)
7) Critical Care & Emergency Care
8) Geriatrics
9) Long-term care
10) Mental Health
11) Behavioral Medicine
12) Environmental Medicine
13) Occupational medicine
14) Rehabilitation
15) Preventative Health (includes wellness care, self-care, and lifestyle management)

The wellness industry fits almost entirely into the last category. Support industries mirror the same set of realms of medicine.

The challenge of health care today is managing systems that streamline delivery of the entire continuum of care. 30 years ago, medicine went in the direction of institutionalized delivery of care. The entire industry became institutionalized. However, in the 80’s, the American health system entered into a transition phase attempting to demystify and deinstitutionalize health systems. This has produced a staggering array of delivery systems. To a large degree, we are still in this transition period trying to find effective delivery systems that address the complexity of health in American society. Some of these delivery methods are:

1) The “Medical Home” or “Health Home”
2) Integrative Health
3) Functional Medicine
4) Community Clinics & Satellite Hospitals
5) Conventional biomedical “silo system”
6) Home Health Care
7) Patient Centered

The diversity in Integrative Health systems, in part, is a result of Integrative Health combining different delivery systems together to produce new ideas and results.

Factors that Drive the Health Care Industry

The health care industry is the largest and easily the most complex industry in the United States. Every person at one point in their lives is touched by the system. Political factors, environmental and ecological issues, economics, social factors, and technology all play a huge role in the industry, often creating cycles of patterns or directing attention towards or away from trends and information.

Perhaps more than any other factor, and often the most overlooked, the environment and the ecological niches in which we live in have the biggest impact. Humans are more attuned to the rhythms of the earth than many of us would like to believe. Despite our modern society, these deep associations play a huge role. Weather patterns trigger cycles of aches and pains; the full moon guarantees the maternity ward will be packed solid; the seasons will cause the Emergency Department to code red because of influenza patients in the winter or injuries and accidents from kids breaking their arms and families in car accidents during their vacation in the summer. As drought and heat waves, ice storms and hurricanes sweep the nation each year, medical service crisis’s always follows. Beyond the natural environment, the ways in which we alter our environment are also challenging our health systems. Pollution chokes asthma patients and chemicals from pesticides and building materials wreak havoc on our bodies. Over-sterilization and over use of antibiotics are creating superbugs which make infection rates skyrocket. Hospitals and health systems are designed to operate at near capacity, which results in facilities that are chronically over-utilized and maxed out. Each day and week brings unpredictable challenges that simply cannot be ignored, even if our society is removed from the natural cycles of the earth.

Politics, on the other hand, is not so unpredictable; rather it is a constant battle that must be met. Legislation can change health systems and their futures of success or failure literally overnight once the dust settles after the long, hard fight. Federal legislation in particular can create and obliterate entire markets and professions. The 1996 HIPAA and 2010 Affordable Care Act both have had a deep effect on the nature of health systems. A large majority of large health facilities in the United States also participate in the Medicare system, which is constantly being reworked. Thus, health systems must always keep abreast of recent developments and plan extensively in order to ensure success of their businesses. Regulatory bodies and government policies on all levels of government, as well as the private sector, place significant limits on heath care too. Party politics and power struggles between the Republican and Democrats creates cyclical change in support of programs and funding. And an ever expanding number of lobby groups constantly work to keep things moving smoothly between government and the industry. Internationally, shifts in populations, immigration, global health epidemics, and terrorist threats all put a huge burden on the system.

Since health care in the United States is essentially big business, the economy impacts on health care can be both devastating and extremely profitable. Even though the United States health system is a reactionary system and largely removes choice when a patient is in need of services, when the economy is slow, health systems struggle to make ends meet. In hospitals, 80-90% of admissions come from the ER, so when the ER is low, hospital beds become empty. During a recession, for example, people travel less and thus have fewer car accidents. Sports funding also goes down and so fewer kids are getting sports injuries. Elective surgeries get put off and operations get delayed because patients cannot afford the co-pay. Sometimes people choose to travel to other countries for medical services instead because they are cheaper. Since most hospitals also get capital funding from endowments or bonds, both of which are interest based investments, equity can be severely impacted during recessions as well. The market also cycles with a constant new stream of drugs, research studies, and technologies. When it comes to distribution of services, there is a huge gap between wealthy communities and poor communities. Hospitals and clinics supported by insured and wealthy patients have more services, more doctors, and better equipment. The lack of insurance or quality insurance significantly impacts reimbursement rates for health systems, with the resulting cash flow problems significantly impacting services.

Societal trends are perhaps the most diverse and difficult to manage. American lifestyles are isolated, sedentary, fueled by a poor diet and lack of sleep, and are increasingly dependent upon mental energies rather than physical work. Combined, these factors put Americans at high risk for dozens of chronic diseases and mental and behavioral health challenges. As populations are aging, growing, and shifting, access to healthcare can be stressed because the services of the local health systems no longer fit the demographics of the area. Our society has a “fix it NOW” mentality and often has no time for wellness care, self care, or preventative care. Those who have chronic health conditions tax the system the most. Nearly 80% of health care resources are used to manage chronic health conditions, yet a vast number of Americans with chronic health conditions don’t even have health insurance and access to medical care. These patients not only tax the system, also rely on self-care and out-of-pocket services to manage their health. Preventative medicine, however, is opening new doors in choices about health care spending. Consumers who are insured tend to use primary care when they get sick. But those who are uninsured tend to wait until they are so sick that they need to go to the ER. Ethnic and religious factors can also impact service and care. Different cultures and ethnicities often have a different perspective and values on care and the course of treatment. Some cultures value large families, so in turn, when a family member ends up in over night care, accommodations for larger families must be made. Language barriers, companions, and interpreters can all complicate easy and speed of service. Religion, at times, can also create logistical nightmares when the need for kosher food, last rights, or specific protocols for handling the deceased for burial is at odds with normal protocol.

The media at times can also impact the system with constant updates of new studies, lawsuits, or stories of when something screwy happens, like a sponge is sewed into a patient. Fortunately, the media does not play as important of a role in health care decisions as other national issues because most people place a higher value on personal experience and opinions of family and friends. Despite this, most major health facilities will have a designated public information officer to play as intermediary with the press. Over the past few decades, health care has increasingly been branded. At one time, it was considered unethical to advertise health services. But with a change in laws, hospitals and major health facilities play off their strengths against competitors to increase revenues and retain patients. Hospitals have become highly competitive and heavily use billboards, radio and TV ads, and print media to get their message and brand image out. The increasing direct consumer advertising for medications and services further brings health decisions into the everyday lives of Americans. The increasing use of advertising, however, adds to healthcare costs, which requires an increase in patient volume, which means stronger pushes for consumer loyalty through advertising and branding.

Last, but not least, technology makes an impact on our health systems in many ways. Competing technology developments constantly produce innovations in drugs, treatments, equipment, design, and robotics. Despite intellectual property rights on drugs, treatments, and biological units like genes, which limits access, Health systems are under a lot of pressure to keep up with innovations. Ultimately, however, what makes the difference is not the innovation, but whether or not health facilities choose to embrace innovations. Those who do often see better outcomes in care and more accurate diagnosis which then leads to lower risk. It is often faster, more efficient, creates better access and communication, and precision. The replacement of technology, however, and the innovation of new solutions creates a chronic problem. How often do you upgrade? And at what point does it become a liability if you don’t? And sometimes, technology is too good. For example, imaging can now pick up micro cysts in breast tissue during mammograms that are part of the normal tissue and not necessarily a health risk. This begs the question, how early should intervention be when intervention itself may be more risky than the cyst that may or may not actually become a health risk? The actual technological innovations of healthcare are not the only technologies that affect the industry. There are a variety of technologies associated and dependent upon the health care industry, such as clinical information systems, imaging, and health billing and accounting operations. The recent and growing transition to electronic health files is somewhat “revolutionary” in the field. Many systems are struggling to make this transition. But, clinical info is critical to care and electronic records makes diagnosis and medical oversight easier and more efficient. As a benefit, electronic systems allow patients to access their own files on the internet or their doctors via a simple email.

Fields within Integrative Medicine

Integrative Medicine is a whole person approach to medicine that integrates conventional evidence-based medicine (ie: Western Medicine) with CAM. Integrative Medicine is the clinical application and integration of Integrative Health. The following are examples, but certainly not a complete list of therapies. Many can actually placed in more than one category.


Conventional Western Medicine

This type of medicine is what you will find when you go to your primary care physician or the Emergency Room at the hospital. It is sometimes called “Allopathic Medicine”, “Biomedicine” or “Evidence-Based Medicine”. The majority of the American Healthcare system is composed of this type of medical system. Doctors, nurses, and other healthcare providers diagnose and treat based on rigorous scientific evidence and utilize medications and surgery to address illness and disease. There are many specialties such as Cardiology, Dentistry, Oncology, Endocrinology, Infectious Disease, etc. This is a highly regulated field in all states and requires a high level of education to practice.

- Primary Care Physicians/Family Medicine
- Acute Care & Emergency Care
- Specialties (Oncology, Cardiology, etc)
- Hospice
- Laboratory & Imaging
- Surgery


Alternative Medical Systems

These alternative medical systems are built upon an independently complete system of theory and practice and can stand alone as an entire medical discipline. Many have a rich historical tradition that is thousands of years old and are considered pre-modern medical systems. They often incorporate aspects of manual medicine, energy medicine, natural medicine, and body-mind techniques. In most states, these alternative medical systems are highly regulated and require a high level of education to practice.

- Homeopathy (including Bach Flower Remedies)
- Naturopathy
- Traditional Chinese Medicine & Acupuncture


Manual Medicine/Bodywork

This is a part of the traditional CAM (Complementary and Alternative Medicine) field and is composed of several unique disciplines, but not entire medical systems. Manual Medicine is the practice of manual manipulation of the body. It encompasses some of the oldest medical traditions from around the world and in some cases predates many alternative medical systems such as TCM and Ayruveda. There are also many newer bodywork disciplines that have been incorporated into conventional evidence-based medical systems. This field is regulated in most states and requires moderate to high educational requirements to practice.

- Massage Therapy
- Chiropractic
- Applied Kinesiology
- Cranial Sacral


Energy Medicine

This is also is a part of CAM and incorporates many different disciplines. There are two major categories in the Energy Medicine field. The first is biologically produced energy fields, known as Biofields and commonly referred to as Subtle Universal Energy. The second category is Bioelectromagnetic medicine which uses measurable waves such as in magnetism, light, and electricity. Energy Medicine, especially the use of Biofields, was used as a form of primary healthcare in ancient and traditional cultures, predating the formation of alternative medical systems. In many cases, the use of Energy Medicine became an integral part of ancient traditional medical systems such as Traditional Chinese Medicine and Ayruvedic Medicine. Many aboriginal and other traditional cultures still use Energy Medicine as a part of their primary healthcare system. This field is largely unregulated in the United States. In most cases there are relatively low educational requirements to practice these disciplines, outside being taught them.

- Qi-gong
- Reiki
- Therapeutic Touch
- Polarity Therapy
- Magnetic Therapy
- Light Therapy


Biological/Natural Medicine

This is also a CAM field and refers to the use of natural substances for health. For most Americans exploring complimentary and alternative health practices, this is the first thing they are exposed to. Most natural medicine is available to the consumer at the grocery market or over the counter at pharmacies. Examples include healthy food choices, vitamin supplements, and using herbs to maintain good health. Occasionally it is useful to see a practitioner or advisor when putting together a diet or herbal regimen. There is a significant amount of federal and state regulation on the quality of food, vitamins, supplements, and herbs. Practitioners and advisors vary in the amount of education required to advise but in most cases do require a moderate amount of education. Regulation of herbal and nutritional advisors and practitioners vary by state.

- Herbology
- Nutritional Therapy
- Vitamin Therapy
- Aromatherapy


Body-Mind Medicine

This is also a CAM discipline and includes the use of techniques to boost mental abilities to control the body. Many Americans are familiar with body-mind techniques which include guided imagery, meditation, and prayer. This is the second most common form of complimentary and alternative medicine that Americans are exposed to. Some techniques require a moderate to high amount of training to practice or advise in but in most cases educational requirements are low to none. There is no regulation for practitioners of body-mind medicine.

- Biofeedback
- Guided Imagery
- Hypnotherapy
- Trauma Touch Therapy
- Somatic experiencing
- Rapid eye desensitization
- Emotional freedom technique
- Trauma release exercises
- Meditation
- Prayer, Spirituality & Religion
- Yoga
- Breath/Breathing Therapy
- Behavioral Therapies (CBT, DBT)
- Autogenics
- Progressive Muscle Relaxation