Recently I was fortunate to speak with Karlo Berger, Founder of the New England based Integrative Medicine Alliance, regarding the exciting and growing fields of holistic (integrative) healthcare, and complementary and alternative medicine (CAM).

The Integrative Medicine Alliance has done excellent work in bringing integrative health into public awareness. The IMA is a network of people, organizations, and associations, and their primary mission is to foster networking, dialogue, education and collaboration between conventional and complementary/alternative medicine practitioners and deepen the quality of the experience in human healthcare.

The IMA is helping create a healthcare system which embraces diverse healing practices, supports relationships, and invites people to actively participate in self-care. Their ultimate vision is a healthcare system that integrates appropriate conventional, complementary and alternative healing practices for care of the whole person; and one in which practitioners and providers recognize that the healing manner in which those tools are applied is essential.

In 1999, Karlo Berger founded the IMA. Doing this work Karlo has learned the ins and outs of America's holistic health sector as no one else has. Karlo's personal network of hundreds of colleagues is unparalleled.

Over the years, Karlo has worked extensively in the fields of integrative healthcare, community development, education, international security, and the environment. Karlo currently works as Harvard University Health Services' shiatsu therapist.

He now lives in Providence, Rhode Island with his wife Annie Gjelsvik and daughter Astrid.

Paul (P): Why don't we start by discussing your advocacy work and your work with the IMA.

Karlo Berger (KB): There are a lot of integrative medicine networks, alternative caregivers, holistic networks but they are mostly oriented around business to business support. What they do is network to get clients and they learn about different approaches. That’s nice but our approach is different. We want the healthcare system to change. We want to walk the walk. And, we care about balance in the individual and harmony and healing, but it also has to be happening on the societal level because our society’s really a wreck. That requires the healthcare system to heal itself, and part of that is what we see as the mission of the IMA. Part of that is to deepen the quality of the human experience in healthcare, and, part of the way we do that is by promoting dialogue and collaboration sort of bridge building between all the different caregivers.

P: To me what seems important is to make it more client-centered or person-centered.

KB: Definitely, that’s what we mean by relationship-based care. It’s about people, not about the medicines themselves, or certainly not about the insurance corporations, or the pharmaceutical corporations or the AMA – it’s about people. That’s the Hippocratic Oath.

So, yes, I am interested in the social dimensions of this, the big public health questions like the Avian Flu or PTSD among returning Gulf War vets. Or, how does this relate to minority communities, or low-income communities, or people that are disabled? How do we bring these great approaches into society? It’s not just about, "How can I get more clients?" Those are the issues I love to talk about.

P: Have you had any experience or interaction with the big integrative medicine programs? I know it is way out west, but say for example, the University of Arizona integrative medicine program with Dr. Andrew Weil?

KB: Well, Andrew Weil is on our board of advisors but he has agreed to be there as a name. But the experience I have had is in New England. There are a lot of different integrative medicine centers and hospitals in Boston: there is the Zakim Center, the Marino Center on Mass Ave, the Dana Farber, the Osher Institute at Harvard Medical School. I know people at all those schools. There’s the program at Lesley University. So we’ve really got our finger on the pulse on the programs in Boston and around New England.

P: Let’s switch gears a bit. I know you are interested in social issues, can you discuss how poverty and low-income have affected people with their healthcare, and whether or not they interested in alternative treatments? As the founder of a health advocacy organization, what experience have you had with this topic?

KB: Certainly poverty is to a large extent bad for your health. Affluence can also be bad for your health, too in some ways. I guess moderation or moderate income is the best way perhaps. I am not a public health expert; however, my wife actually is. I know that people who are poor eat a diet that can result in obesity, which is certainly not good for your heart with heart disease being a leading cause of death in the United States. It also can lead to Type II Diabetes. Those are clear examples of how low-income can be injurious to you.

In terms of low-income communities and their interest in complementary/alternative medicine it is actually very interesting. There are two ways to answer that: One is that the biggest barrier to many of these communities against the use of techniques like acupuncture or massage is not, from what I've gathered, to be lack of interest - it's lack of income. These [alternative] therapies aren't covered by insurance, of course, and they've taken some degree of disposable income to explore. And I think that's borne out by the number of low-income clinics around the country. For example, we have clinics in the Boston area. There is the Pathways to Wellness Program based in the South End that offers acupuncture, and possibly chiropractic as well as shiatsu to people regardless of cost. Interest is very strong, there is a lot of interest when it's made more economically acceptable..

P: That's excellent.

KB: It's really not surprising. A lot of people come to alternative therapies not because they are necessarily innately attracted to them. I suspect that most people don't do acupuncture because they've read about it, they're fascinated by it, they've read about Chinese civilization, or because they love the idea of having needles stuck into their bodies.

P: Yes, I would guess they are disillusioned.

They've got recurring headaches, the pills don't seem to work, or they don't like the side-effects, or their doctor says, "Well you should take these pills" and, [patient reply:] "Well, they aren't working”, [doctor's reply:]"Well you should take stronger pills...”

Someone tells you about it, you read about something somewhere, or someone says "Hey, well, maybe you should try acupuncture." And that's why you go to acupuncture. And a lot of acupuncturists can help people, the word gets out and it starts to spread. And all people get migraines. It's not just limited to middle class people getting migraines. On the contrary. There are a lot of reasons to get headaches if you're poor. There's more stress... your more likely to have a job where you are exposed to toxic substances where at the very least can give you a headache and irritate you. If anything, you might make a case that in a society where there was more access, there might even be more use of these therapies by lower-income populations. It's hard to say.

The second way of answering the question though - which is just as interesting - is that a lot of low-income communities actually already have complementary and alternative medicine; but it's usually not seen that way. In particular, immigrant communities have their traditional ways of healing that aren't the kind of ones you will find at a holistic center in the suburbs.

P: Do you mean folk remedies?

KB: Yes folk remedies. Particularly herbal medicine is a big one, but there are also lots of forms of hands-on healing. For example, in the Boston area I am talking about the traditional African Diaspora...modalities like faith healing, and Santeria, and Voodoo tradition from Haiti, and some other ones. And there are many herbal remedies in the Islamic communities. There's a traditional Islamic form of healing that involves prayer and fasting, and I think herbal medicine. But there's clearly a lot there. For those of us who are in those kind of white middle class scenes, we don't typically think of the forms of traditional medicine as alternative. But they are also alternative.

In some cases it's very quiet because many of the practitioners are afraid they will be shut down. For example, in some of the traditional African Diaspora practices it involves sacrificing a chicken or something similar, and they get concerned and wonder if the ASPCA is going to come down on these practitioners for being cruel to animals. You know that the people in these communities know this is going on. I was involved. I helped organize a tour for mainly doctors and nurses to access some of these traditional approaches. And, it was amazing; we went to this one place that was a Haitian botanica, which meant it was a place where Haitian-Americans went to get healing supplies – Voodou balms, and things like that. And it was just down the street from the Codman Square Health Center. But, if you didn't know that this was what this shop was about, you'd never know. It didn't have a big sign on the front that said "HOLISTIC CENTER” it just said 'Groceries'; it was so low-key you'd never know. I thought it was ironic that it was just down the street from the health center.

So, in other words I think that's a great testament to how the power of healing manifests itself in so many ways in humanity. There's a lot of suffering in humanity. And the folk healing is going on whether or not there's money available. And certainly if there is money available, that's better, but it's going on either way. I mean people are bartering or something like that; regardless of whether it has the approval of the mainstream medical system or the white establishment that we are part of. That is I think a perspective we need to remember when we think about alternative medicine in that it's going on in these communities. That they hurt too, and they could use alternative care too.

P: Well that brings me to some of the areas I have been looking into regarding complementary and alternative medicines; for example, the National Institute for Health (NIH) and the Center for Alternative Medicine there (NCCAM). Part of it is that people get involved in, or they move to alternative practices because they are disillusioned with the traditional healthcare system - many times but not always. And now there's money being spent on research in alternative areas. But as one might expect, there is a lot of controversy now that there is more money involved; and the traditional medical establishment doesn't want to give up a big chunk of their market of the pharmaceutical companies and of the HMO's over to the alternative therapy providers, to the supplement companies, and other related organizations and networks.

KB: Yes, there is to some degree, particularly if by establishment you mean the actual power brokers, like the associations and organizations like that. However, the rank and file physicians and nurses are a lot more open than that - they just want people to get better. There's an important distinction to be made.

P: Yes, well I would agree. But it does depend upon what physician you are talking about. Because some are just diehard "give out the drug prescription" types, wouldn't you agree?

KB: The new generation is less so in my experience. The great thing about it is that you don't have to choose one or the other, you can do both.

P: With the IMA's main area of focus in the New England area, I am wondering if you are in touch with any of the research that's being done in New England on alternative medicine?

KB: I can't give you a comprehensive answer; but, I can tell you what I know is going on, and I can tell you over the past years what is going on. The big area for research for people is lower back pain and I think it's partly because it's been an area where so many modalities have had some success like chiropractors, acupuncturists, and massage therapists. It's an area where they all intersect. And these are the three most widely accepted forms of alternative care. It's also an area where so many people have gotten sick: people suffer from low-back pain. I think the majority of Americans in their lives have had this problem at some point, I am not sure of the number though.

Consequently, there's a lot of insurance money involved. So if it can be proven that massage can help with lower back pain, then it's something that the insurance industry can say "well we will approve paying for your massage for back pain because if a fifty dollar massage will help reduce the chances of fifty thousand dollar back surgery, then great." I know Harvard has been involved in lower back pain research over the years and I think some other places might have been too. Lower-back pain has been a big starting point over the years. In addition to that I know Dana Farber did research on low-back pain a couple of years ago. And, I should mention research in this area has only been going for the past five years.

P: Wow! really?

KB: It's because the growth in the budget for alternative medicine has not been growing enormously over the past couple of years. But, from mid-nineties to like 2000 it had been growing by leaps and bounds. I think even the George Bush budget for research hasn't diminished, which is surprising because the research in a lot of other areas has. I don't know if that's because prayer is considered a form of CAM and there's been some studies looking at prayer and spirituality and health.

P: Yes, this may have to do with George Bush's fundamental Christian views.

KB: But in terms of other research, Dana Farber was doing research on chi gong for cancer. I think it was about its relationship to the immune system, though I am not sure about that. There's also some very interesting work going on affiliated with the Mass. General Hospital using the MRI to measure the effects of acupuncture. I think they are looking at medications too: they look at the physiological changes that happen when you are in a medicated state or when acupuncture points are used; and, what I've heard is that certain points will stimulate parts of the brain and clearly it's not just haphazardly pressing on any point. Each point has special impact. But I haven't really followed these things too closely. I would say the big areas of research are going on at Harvard and at Mass General Hospital. Also they are doing research at the Brigham and Women's Hospital regarding yoga and insomnia.

P: I assume these are connected with local universities.

KB: Yes. Well, these institutes are all very interrelated particularly Harvard University, Dana Farber, and Beth Isreal Deaconness, Mass. General Hospital, Brigham and Women's, and Children's Hospital. Most of them have some affiliation with Harvard Medical School. The Osher Institute's website is a great website for looking at what's going at Harvard.

P: Yes, David Eisenberg is leading that.

KB: Another good site for looking at research is the NCCAM website.

P: Yes, with the NIH

KB:The NCCAM site is in database form. You can look up what research they are currently funding and what state it's in, and who's involved in it.

P: Yes that is a great site. You had mentioned the newer phase of doctors is more open to complementary and alternative medicines. Obviously you have been involved in-depth in this field for quite some time. Overall, in the whole field, how do you see the trends from the time that you've entered it, regarding CAM's integration into the traditional system? Have you seen a real substantial change or is it still minimal?

KB: In terms of its integration, or in terms of its acceptance by doctors?

P: What I mean is we know that there is a lot of alternative medicine going on. There are a lot of people taking herbs and vitamins and those types of things; but, from a big picture perspective of the whole healthcare industry, and what's commonly accepted in Universities and major hospitals and medical doctors and psychiatry, do you see a major shift occurring there?

KB: Again, I need to make a distinction between the institution and the individual. Because I think there's a difference between the two and I think that difference - I think I would even say disconnect, at times - is part of what the problem with conventional medicine is. People over all these years have been feeling we are in a healthcare crisis, and I think most Americans and most doctors and nurses also think that. And, part of that crisis is what doctors want from healthcare and nurses want from healthcare is not how the healthcare system is. It's run by almost oppressive institutions. I mean doctors, nurses, and practitioners have seen budgets slashed terribly. The poor doctors can only go see their patients for about ten minutes, it's crazy.

P:Maybe what you're saying is that even if doctors may not be as up to date on the newest integration of medicine, nevertheless, the concern is for the patient anyway.

KB: YYeah, I was going to say in a way it's very hard for a doctor in the current institutional circumstances to be holistic even if he or she wanted to - and some do. It's ironic. I will give you an example: I met a doctor the other night at a networking meeting down in Rhode Island who setup with her husband, -they're both relatively recent doctors - they setup a practice (they're family medicine doctors), it's called "Yestermorrow Medicine." They call it Yestermorrow because it's where yesterday meets tomorrow. And they do family practice healthcare, general style, but are outside of the insurance system, which certainly limits them. Well, they don't see poor people. It limits them to people who are basically financially well-off, the doctors can say, "pay us $200 a month and we'll be your doctors." She was telling me the first intake visit they could spend up to three hours talking all about their health. And they are doing it generally from a conventional medicine way but, are you ever going to see intake like that in a hospital? - three hours? But that's how it used to be, doctors a century ago. And in a way that is more holistic. The doctor wants to know about their whole life, and to know about their emotional life, and they want to look at them as a human being.

P: Yeah, I was at your site recently (the IMA website) and I had seen an article by one of the IMA directors who had written an article about "time" [or, the time taken by a practitioner with her/his patient]. I can't remember the name of the author.

KB: , that was Dr. Zarren. He's president of the IMA's Board of Directors

P: I thought that article was great.

KB: I mean it's sort of ironic, to be holistic you don't have to necessarily practice Chinese medicine. But, certainly the way it's being done in hospitals is not holistic.

P: For example, in psychology and counseling Carl Rogers was the one who started client-centered psychotherapy and to me a lot of the idea behind that is putting the person back at the center of healthcare - the whole person - just as you had said last week when we talked.

KB: Yes, I am getting a little off track, but I wanted to basically make that point. Institutionally it's been very uneven in terms of alternative medicine. For most of the years there wasn't acceptance. It was considered ridiculous. And then about in the late Nineties it sort of paralleled the dotcom era - and I am not sure what that means - but in the late Nineties there was a lot of interest in hospitals and integrative centers. But, I think that maybe the reason it connected with dotcom was that some of that interest on the institutional level was like "Oh right, people want to have acupuncture, so wouldn't it be great if we can have it in our hospital. All we need is to setup a treatment room and we'll make a lot of money." And yet they didn't make a lot of money.(laughs) But because hospitals are so obsessed with money and they weren't making tons of money, the accountants began thinking, "if we put an MRI machine here we will make this much. And if we put an acupuncturist we will make this much." And, the truth is you make more money with an MRI machine. But, you don't have as much comprehensive care if you don't have integrative treatments like acupuncturists to provide a different angle on health. But that was the limit of their thinking.

So, a lot of centers got up and then they sort of retracted and many of these hospitals and healthcare centers were going under financial crunches. I was working at Harvard Vanguard doing shiatsu. They had maybe four managers because the managers were all losing their jobs. It wasn't because they were incompetent or anything, I mean the first manager was incredibly competent. They just kept carving away at the administrative staff because they were trying to save money. And, by the time this was all done we didn't have that many allies. And today, the Harvard Vanguard program just basically rents space. You know they just basically pulled away from integrative medicine altogether.

P: I guess part of what you are talking about is humaneness. I don't think it really matters what part of the corporate world we are talking about. Nevertheless, people would think that if it was healthcare it would be different than the typical corporate bottom-line attitude. However, it's not necessarily so.

KB: Yes, it's shameful. It's all about meeting a bottom line. Even if you realize that in the long-run if people are exercising preventive care, which holistic care is good with, that patients will be less sick. But, it is a sick thing: the hospitals are actually making money when patients are sick. So part of their bottom line is about you being sick. It's totally gross!!

P: So, much depends upon the value systems of the people involved, I guess?

KB: What I've noticed is that there was interest [in complementary medicines], and in the last few years there's been a bit of a contraction and less enthusiasm.

And, I would like to just finish the other thing. In the other way of how's things have changed - in terms of individuals, I think there has been a growing acceptance among medical professionals. And that I think has to do with the fact that doctors get mysterious back pains, too - and their friends say, or their husbands and wives say: "Why don't you go to an acupuncturist honey." And then they go and they are helped and they say, "Oh my god, it worked!"

I really see sort of three generations out there: There are doctors that are older than baby boomers and they were pre-counterculture- they never had any exposure to alternative care at all. They had home remedies but that was pooh poohed on, "Well, that was just old wive's tales" people would say.

Then there's the baby-boom generation, which is definitely more interested. Maybe it's partly because they are a little older and have been around the block but they've seen things work and seen things fail. It’s hard to tell in alternative medicine if the practitioner is going to help, because they could just have some ridiculous ideas that aren't going to work. Or, alternatively, an alternative practitioner could have things that are going to be lifesaving. It’s a little hard to tell unless you're really in the field sometimes.

And third are the young doctors. I've met young doctors, people now in there twenty or thirties. The acceptance is much, much, much higher; they're of the impression, "of course it works." Their whole generation has been brought up that it works. A lot of them had massage when they were eighteen years old even before they thought about being a doctor, and they were just signed on.

It's really funny, too, in the medical community you will hear things like "Well, we need more evidence and we need more studies." but it's not as important on the institutional level. Yet when it comes to actually what is it that convinces a doctor that something works - it has so much more to do with personal experience. And that's why I have had so many conversations with medical providers about this stuff. And the way the conversation usually goes when I explain what I do is either, they look at me like they don't know what to do with me like "OH??" - They're just not processing it. These are people who have not had a personal experience with alternative medicine. Then there are the ones that are suddenly interested and say, "Oh, that's really interesting and what do you do?" And inevitably they'll say "Oh!! You know I went to an acupuncturist" or "Oh!! You know my wife was really helped by a chiropractor." So, it's not about science, what it comes down to is if they or someone they care about had a positive experience. If you've had a positive experience, suddenly it's valid. If you haven't, its not. So they say its science, but its not.

P: Yes, I think a lot of it is empirical. It's experience because if you're suffering, people can tell you someone is a quack, but if you're suffering and a remedy or therapy helps you, you'll know it, you'll remember it, and you'll believe it.

KB: Right, that's why the IMA has the mobile clinic. We've set our mobile clinic up partly for that very reason. We started focusing on medical students, we want to get as many medical students to experience reiki and experience acupuncture as possible.

P: How often do you go out and where do you go?

KB: We've done it on and off over the years. We've done it with different intensities, but this year we're hoping to do it two places. Harvey Zarren is organizing something in the Spring with Tufts Medical School. They have a student integrative medicine group which wants to sponsor and organize, and invite other med school students from Harvard and BU. We think this is ideal - this is the next generation. We've had clinics like this before and people have had some profound experiences.

The other one we are doing is at the American Public Health Association gathering in November of this year (2006). It's going to be in Boston, a massive convention.

Well I guess we should wrap up the interview now Karlo. I have one last question, and it is regarding your own personal involvement in integrative health. How long have you personally been involved with alternative medicine and what has been your primary involvement?

KB: Well I founded the IMA in 1999. Prior to that, my direct experience has been practicing shiatsu therapy. And I graduated from the Boston Shiatsu School in 1998. And before that I think it all began with my interest in tai chi. I started practicing tai chi in 1985 and I've been doing it ever since.

P: LMT. Does that stand for Licensed Massage Therapist?

KB: Yes. ABT stands for Asian Bodywork Therapist. My professional background is that I went to shiatsu school and I'm a member of the American Organization of Bodywork Therapies of Asia (AOBTA).

P: Well, I think it's commendable you have taken such an interest in complementary health promotion. I've seen have a lot of activism - such as environmental or other types of social activism. Perhaps there is a lot of activism in the health field (or, in complementary health promotion) but it seems kind of new to me. Would you say that healthcare activism is new to social activism?

KB: It is. And I think it's very powerful when these groups get together. What I want to say in closing is that the activist groups that you mention like environmental, anti-racism, poverty, and others are all about social transformation, or, societal transformation. Alternative therapy is about personal transformation. I think it's about time that we brought together social transformation and personal transformation. Because if you bring the two together that's incredibly powerful!

P: I agree. And the Internet can be a really powerful medium. If your website inspired one student (such as myself), than it surely has the potential to inspire many others. Regarding your comments about the division in activism between the social and the individual, people tend to want to separate things, for, example, the different aspects of our beings such as body, mind, and spirit, and their connections to healing. But I think the goal of integrative medicine is, obviously, to integrate the various aspects of our lives and our worlds. Just because a person is interested in self-improvement shouldn't mean they have to sacrifice or neglect their community. It should be quite the opposite, actually. It sounds like a basic concept but it's not.

KB: We are society; and, society is us. We are Earth and planet; and the Earth is us.

We need to be healthy, and the planet needs to be healthy, and society needs to be healthy. It's different levels, and we've got to work on all these different levels.

P: Well Karlo I must say it's been an enlightening conversation. I realize you are doing this on your own time and do greatly appreciate your help. I look forward to our speaking again. Thank you again!

KB: You're quite welcome.