Latest / Becker’s Healthcare - Clinical Leadership Podcast / Tieraona Low Dog, MD, ABOIM, Founding Director of the Integrative and Functional Medicine Fellowship & Shaista Malik, MD, PhD, MPH, Vice President of Integrative Health at UCI Health

Transcript

Tieraona Low Dog, MD, ABOIM, Founding Director of the Integrative and Functional Medicine Fellowship & Shaista Malik, MD, PhD, MPH, Vice President of Integrative Health at UCI Health · Becker’s Healthcare - Clinical Leadership Podcast

• 0:02
  - There's a small circle of people who truly
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  - visit beckershospitalreview.com
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  - Hi. My name is Paige Twenter. I'm an
• 0:53
  - editor here at Becker's Healthcare. Thank you all
• 0:55
  - so much for tuning in to the Becker's
• 0:57
  - Healthcare podcast.
• 0:58
  - I'm joined today by two
• 1:00
  - extraordinary leaders at UC Irvine
• 1:03
  - in integrative health. We'll start with, Doctor. Malik.
• 1:06
  - Can you please introduce yourself and tell us
• 1:08
  - about your role at UC Irvine?
• 1:12
  - Thank you, Paige.
• 1:13
  - Absolutely. I'm Shay Simalek. I'm a cardiologist by
• 1:16
  - training,
• 1:17
  - and I serve as the founding executive director
• 1:20
  - of the Susan Samuele Integrative Health Institute at
• 1:23
  - UC Irvine,
• 1:24
  - vice president of integrative health for UCI Health
• 1:26
  - and
• 1:27
  - founding associate vice chancellor for integrative health at
• 1:30
  - the Samuelelli College of Health Sciences.
• 1:33
  - My role is essentially to build the academic
• 1:36
  - and clinical
• 1:37
  - infrastructure for whole person health across the academic
• 1:41
  - health system.
• 1:42
  - What that means is that,
• 1:45
  - we integrate,
• 1:47
  - and create programs
• 1:49
  - in oncology,
• 1:51
  - GI, cardiology,
• 1:52
  - pain and primary care,
• 1:54
  - a research portfolio with more than $12,000,000
• 1:56
  - in active funding, including NIH supported work,
• 2:00
  - and education
• 2:01
  - from,
• 2:03
  - where medical students learn about nutrition
• 2:06
  - all the way through to fellowship training for
• 2:08
  - practicing clinicians.
• 2:10
  - Last, fiscal year, we surpassed 123,000
• 2:14
  - integrative health visits,
• 2:16
  - which is 24
• 2:17
  - growth in two years.
• 2:19
  - And the fellowship that Doctor. Lodog leads
• 2:22
  - sits at the education end of that, and
• 2:24
  - it's one of the best and clearest expressions
• 2:27
  - of what we're trying to do. And,
• 2:30
  - I'll let her describe it because she built
• 2:32
  - it.
• 2:34
  - Yes. Thank you, Paige. Thank you for the
• 2:35
  - invitation and that warm,
• 2:37
  - that warm introduction,
• 2:39
  - doctor Malek. I'm Triony Lodog. I'm,
• 2:42
  - the founding director for the integrative and functional
• 2:45
  - medicine fellowship program at the UCI Susan Samuelli
• 2:48
  - Integrative Health Institute. I know that's a mouthful,
• 2:51
  - but it it
• 2:52
  - it it almost needs to be that big
• 2:54
  - to describe everything that doctor Malek just described
• 2:57
  - what we do. Right?
• 2:59
  - I'm also
• 3:00
  - a clinical
• 3:01
  - professor in the department of medicine, at UCI
• 3:04
  - as well in health sciences.
• 3:06
  - You know, I've been
• 3:08
  - I've been involved in integrative medicine for
• 3:11
  - a little more than thirty years now. So
• 3:13
  - this is my third fellowship that I've led
• 3:16
  - in integrative medicine. I was at the University
• 3:18
  - of Arizona for many years and then the
• 3:20
  - Academy of Integrative Health and Medicine.
• 3:23
  - And now I'm I'm at the flagship, really,
• 3:25
  - program,
• 3:26
  - in integrative medicine in the country,
• 3:29
  - one that really does education, research, and clinical
• 3:33
  - care.
• 3:34
  - My piece of that is education, but it
• 3:36
  - really feeds into the other pieces as well.
• 3:38
  - We use research to,
• 3:41
  - help inform our fellows and train them in
• 3:44
  - clinical medicine.
• 3:45
  - And then in the clinical setting, we generate
• 3:48
  - hypotheses of what's working and what doesn't work
• 3:50
  - so that we can better care for our
• 3:52
  - patients.
• 3:53
  - This is the first time
• 3:55
  - in an academic setting that integrative and functional
• 3:58
  - medicine have bought... Been brought together under one
• 4:01
  - roof.
• 4:02
  - We...
• 4:03
  - For so long,
• 4:05
  - integrative medicine, which really really whole person care.
• 4:08
  - I mean, that was what its,
• 4:11
  - sort of foundation was built upon and also
• 4:13
  - being open to many evidence informed
• 4:16
  - therapies and approaches. Right? So understanding what acupuncture
• 4:20
  - can do, you know, learning about, systems that
• 4:23
  - have been here for a very long time.
• 4:26
  - Functional medicine really has its roots in systems
• 4:29
  - based biology,
• 4:31
  - and
• 4:32
  - it takes the approach of really trying to
• 4:36
  - look upstream
• 4:37
  - at... To see what's driving any particular
• 4:40
  - problem.
• 4:41
  - And when I say that, I mean, three
• 4:43
  - people can have depression,
• 4:45
  - but all three of those people could have
• 4:47
  - something very different driving
• 4:49
  - that mood state.
• 4:51
  - And so taking one approach to treat everybody
• 4:54
  - that comes in with major depression
• 4:56
  - is a fairly outdated way of thinking
• 4:59
  - about that one particular diagnosis.
• 5:02
  - So bringing the integrative and functional medicine pieces
• 5:05
  - together
• 5:06
  - allows our fellows
• 5:08
  - to have
• 5:09
  - sort of a more systems based biology
• 5:12
  - lens
• 5:13
  - that can be enveloped within a whole person
• 5:16
  - way of of looking at the individual who's
• 5:19
  - sitting in front of them. So it's really
• 5:21
  - exciting, and, I couldn't think of a better
• 5:23
  - place to do it than here at, at
• 5:26
  - our center at UCI.
• 5:29
  - Doctor Lodock, why
• 5:31
  - combine integrative and functional medicine together at... In
• 5:34
  - a fellowship at UCI?
• 5:36
  - Well, for a long time,
• 5:38
  - these were very different philosophical systems that set
• 5:42
  - apart from each other. Right? So my own
• 5:44
  - background was,
• 5:45
  - deeply enveloped in the integrative medicine world,
• 5:49
  - as I directed these programs.
• 5:52
  - Yet I saw probably back in 2008,
• 5:54
  - 2009,
• 5:55
  - the real growth of functional medicine.
• 5:57
  - I also began to see it evolve as
• 5:59
  - a field. Integrative medicine, we've done a lot
• 6:02
  - of the work to to earn our legitimacy,
• 6:05
  - if you will.
• 6:06
  - We've developed fellowship competencies. We've published those competencies.
• 6:10
  - We just republished those competencies,
• 6:13
  - updating them.
• 6:14
  - We have an American Board of Integrative Medicine,
• 6:17
  - certification
• 6:18
  - through the ABPS. I mean, so we've really
• 6:21
  - done the work.
• 6:22
  - Functional medicine
• 6:24
  - has been growing outside
• 6:26
  - of that kind of,
• 6:28
  - framework.
• 6:29
  - But they have come to a place now
• 6:31
  - where they have really enhanced their rigor,
• 6:35
  - deepened their commitment to education and evidence. And
• 6:39
  - I felt this is the time that we
• 6:42
  - should really be bringing these two complementary
• 6:45
  - philosophies together. And that's really what they are.
• 6:47
  - They're very complementary. They're not antagonistic
• 6:50
  - to one another. I think that
• 6:53
  - functional medicine for me without the whole person
• 6:55
  - lens and without really talking about
• 6:58
  - how mind body medicine or how
• 7:01
  - acupuncture,
• 7:02
  - for which we have a lot of data
• 7:04
  - for,
• 7:05
  - how these can also influence and impact human
• 7:08
  - health,
• 7:09
  - that it's missing that piece. I also think
• 7:11
  - integrative medicine for all the wondrous things that
• 7:14
  - we do in whole person care and
• 7:18
  - opening our
• 7:19
  - our clinical lens, having a wider aperture, if
• 7:22
  - you will, to,
• 7:24
  - to many systems and approaches that have evidence
• 7:27
  - for them,
• 7:28
  - we lack the system based biology
• 7:32
  - approach that really can change the trajectory of
• 7:35
  - where somebody's health is going.
• 7:37
  - So for me, it has seemed for a
• 7:40
  - number of years now that these were,
• 7:42
  - these were logical companions. To bring these two
• 7:45
  - together would really allow
• 7:47
  - our fellows to have a much broader,
• 7:51
  - way of looking at the patient that's sitting
• 7:53
  - in front of them. And I also just
• 7:55
  - wanna say,
• 7:56
  - our fellowship
• 7:57
  - trains
• 7:58
  - clinicians that are already trained in western
• 8:02
  - biomedicine.
• 8:03
  - And as I tell them, as I reminded
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  - them last night, we don't leave that training
• 8:07
  - behind. That's that's gold. That's that's gold kind
• 8:10
  - of training,
• 8:11
  - that we get. I I treasure my training,
• 8:14
  - my medical training.
• 8:16
  - So we're not trying to make...
• 8:18
  - Diminish that in any way. We're just trying
• 8:20
  - to make the world bigger. We're trying to
• 8:22
  - have a wider angle lens instead of just
• 8:25
  - a zoom lens,
• 8:27
  - when we're taking care of our patients.
• 8:30
  - It's more holistic,
• 8:32
  - like, the butter
• 8:34
  - term.
• 8:35
  - Holistic is an interesting one for somebody like
• 8:38
  - me because holistic medicine was what we called
• 8:40
  - this, you know, thirty, forty years ago. It
• 8:43
  - was alternative medicine, then it was complementary and
• 8:46
  - alternative medicine, then it was holistic medicine, sometimes
• 8:48
  - with a w h, sometimes just with an
• 8:51
  - h.
• 8:52
  - And I wanna be thoughtful because while that
• 8:55
  - while that name means something to me that
• 8:57
  - is very,
• 8:59
  - beautiful and warm, I would also just say
• 9:02
  - that can have baggage.
• 9:03
  - You know, kind of a a a look
• 9:06
  - backwards,
• 9:07
  - almost nostalgic. And what I'd say is that
• 9:09
  - we're also very cutting edge. We're we're using
• 9:13
  - a lot of very new technologies,
• 9:16
  - and and I think the future
• 9:18
  - is going to be
• 9:20
  - wise use of technology and evidence in a
• 9:23
  - deeply
• 9:24
  - human centric,
• 9:26
  - type of practice. So,
• 9:28
  - I I love the term holistic. I just...
• 9:30
  - I'm thoughtful how I use it over being
• 9:33
  - in this field for so long.
• 9:35
  - Yeah. Totally totally understand. And
• 9:38
  - on the kind of timing, you you mentioned,
• 9:40
  - you you know, cutting edge technologies. I wanna,
• 9:43
  - tap on doctor Malik now. Can you kinda
• 9:45
  - speak
• 9:46
  - about
• 9:47
  - the essence of time here? Like, why
• 9:50
  - now, you know, when AI is further and
• 9:53
  - further,
• 9:55
  - you know,
• 9:56
  - entering health
• 9:57
  - care, genomics, and biomarker testing, changing what clinician...
• 10:00
  - Clinicians
• 10:01
  - need to learn.
• 10:03
  - I'd love to hear your thoughts.
• 10:05
  - Yeah. No. Thank you, Paige. And I'm gonna
• 10:07
  - build on what doctor Lodog was, you know,
• 10:09
  - talking about,
• 10:10
  - in terms of using things like AI and
• 10:12
  - data.
• 10:13
  - Really two things have converged.
• 10:16
  - The first is data.
• 10:18
  - You know, over a decade ago,
• 10:20
  - I'm a NIH funded researcher and my very
• 10:23
  - first R01 was on the genomics of heart
• 10:25
  - disease.
• 10:26
  - And I remember sitting in the clinic trying
• 10:29
  - to pull things from research
• 10:31
  - and trying to build, you know, a genomic
• 10:33
  - risk score for a patient by hand.
• 10:36
  - And, it didn't go very far, but today,
• 10:39
  - you know, clinicians can order genomics, metabolomics, advanced
• 10:43
  - biomarkers.
• 10:44
  - They can track their patients' continuous glucose data.
• 10:47
  - You know, I have a lot of patients
• 10:50
  - that wear,
• 10:51
  - rings and watches where we can see what
• 10:54
  - they're doing in their sleep and their heart
• 10:56
  - rate variability.
• 10:57
  - None of that existed in the training of
• 11:00
  - most practicing physicians.
• 11:02
  - And that gap isn't
• 11:05
  - the access to the test anymore.
• 11:07
  - It's the interpretive framework,
• 11:10
  - knowing which test actually changes management for this
• 11:14
  - patient,
• 11:15
  - what the evidence supports,
• 11:17
  - and then what to do with a number
• 11:19
  - that's abnormal, but the patient feels well and
• 11:22
  - healthy.
• 11:24
  - So, you know, it's really the data coming
• 11:27
  - to us in droves now.
• 11:29
  - The second is AI, which is going to
• 11:32
  - take over a lot of that retrieval and
• 11:34
  - pattern matching work.
• 11:36
  - And that shifts the value of a clinician
• 11:39
  - towards exactly the things that this training, Doctor.
• 11:42
  - Lodog mentioned, builds, which is synthesizing
• 11:46
  - across systems, right? That whole idea of systems
• 11:48
  - biology,
• 11:50
  - understanding the lifestyle and environmental drivers behind a
• 11:53
  - lab value,
• 11:55
  - and doing the behavior change work with a
• 11:58
  - patient, you know, sitting with a patient, figuring
• 12:01
  - out,
• 12:03
  - where and
• 12:04
  - where there are gaps in their care, why
• 12:06
  - they can't sleep.
• 12:08
  - And so the timing isn't
• 12:11
  - a coincidence.
• 12:12
  - As medicine becomes
• 12:14
  - more personalized,
• 12:17
  - you know, as Doctor. Lowdaug was mentioning, you
• 12:19
  - can have one condition,
• 12:21
  - but very many different paths to it,
• 12:24
  - and many different drivers.
• 12:26
  - And so as we become more data rich,
• 12:29
  - you really do need a systems based framework
• 12:32
  - to organize that information.
• 12:34
  - Otherwise,
• 12:35
  - you know, you just have more tests and
• 12:38
  - the same fifteen, twenty minute visit.
• 12:41
  - Yeah.
• 12:42
  - Yeah.
• 12:43
  - I think, you know, I I... And and
• 12:46
  - doctor Melek is an amazing researcher, and so,
• 12:48
  - you know, some... Which is such a rare
• 12:50
  - gift for us also to have
• 12:53
  - leadership that's heavily invested
• 12:55
  - in clinical
• 12:56
  - research and education. And when I think about,
• 13:01
  - when I think about where we've come from,
• 13:04
  - I I think one of our... One of
• 13:07
  - the biggest changes I've noticed, it's not a
• 13:09
  - trend, but it's a change,
• 13:11
  - is that our field has really gone from
• 13:14
  - the margins
• 13:15
  - to mainstream.
• 13:17
  - And and that changes the job. I mean,
• 13:20
  - so in many ways, at the margins,
• 13:23
  - you know, you're just you're just fighting to
• 13:25
  - be seen. Right? That was us in the,
• 13:27
  - you know, twenty years ago.
• 13:29
  - And now,
• 13:30
  - you know,
• 13:32
  - I'd say in the mainstream, we have to
• 13:34
  - prove that we deserve to be here. And
• 13:36
  - I I think that's
• 13:38
  - that's a hard reality, but it is it
• 13:40
  - is true. And
• 13:42
  - visibility...
• 13:44
  - Our increasing visibility brings so much opportunity, but
• 13:47
  - it also brings scrutiny.
• 13:49
  - Right? So I I love that today,
• 13:53
  - we have found that science is catching up
• 13:57
  - in many ways
• 13:58
  - to what
• 14:00
  - I'd say even people who came long before
• 14:03
  - us have understood that nutrition
• 14:06
  - matters and that,
• 14:07
  - you know, how we manage our stress and
• 14:10
  - how we sleep,
• 14:11
  - our metabolic health, that all of these things
• 14:13
  - are important, that the body
• 14:16
  - is a network,
• 14:18
  - not a collection of parts.
• 14:20
  - And an integrative is... And systems biology really
• 14:25
  - leverages that. So, I mean, I couldn't have
• 14:28
  - told you when I was in medical school
• 14:29
  - that the microbiome
• 14:30
  - had anything to do with much of anything.
• 14:32
  - I mean, that is that is new and
• 14:34
  - that's science driven. Right?
• 14:37
  - So I I just think that,
• 14:40
  - I think that,
• 14:41
  - you know, AI is changing the map.
• 14:45
  - I think the future is going to be
• 14:46
  - very powerful. I think the question is, will
• 14:48
  - it be wise? And can we be wise
• 14:51
  - in how we apply,
• 14:53
  - these things? Because right now, AI can help
• 14:56
  - us with
• 14:57
  - data collection, sorting, retrieval,
• 15:00
  - and diagnostics.
• 15:02
  - But also we can see in the lay
• 15:04
  - community
• 15:05
  - out and TikTok, and we can see in
• 15:08
  - in the Internet
• 15:10
  - a lot of false information
• 15:12
  - and a lot of information that,
• 15:15
  - appears to be accurate or evidence informed, but
• 15:18
  - they're kind of... You know, they're inaccurate. So
• 15:21
  - I'm very optimistic about the future of AI.
• 15:23
  - Don't get me wrong. I am. I just
• 15:25
  - always question, you know, no question we're gonna
• 15:27
  - have a powerful technology, and let's just hope
• 15:30
  - that we can also use it in a
• 15:32
  - way that's very, very wise to help people
• 15:35
  - and and and the planet.
• 15:37
  - You talked a little bit about,
• 15:39
  - the shift from margins to mainstream
• 15:41
  - for integrative
• 15:43
  - medicine.
• 15:44
  - There are obviously still pockets of skepticism
• 15:47
  - from, like, parts of academic medicine. Doctor Malek
• 15:50
  - or Doctor Lohdau, whoever wants to take this
• 15:53
  - question first. How would the, you know, extra
• 15:56
  - visibility?
• 15:57
  - How are you approaching
• 15:58
  - leadership of the program and
• 16:01
  - the fellowship?
• 16:02
  - So I could start.
• 16:04
  - You know, I'd say skepticism is a very
• 16:07
  - healthy thing.
• 16:08
  - We treat it as a design requirement rather
• 16:11
  - than a public relations problem.
• 16:14
  - A few concrete things. First, the program
• 16:17
  - sits inside,
• 16:18
  - a University of California
• 16:20
  - academic health system.
• 16:21
  - So it's subject to the same academic oversight
• 16:25
  - as any other program
• 16:27
  - we have.
• 16:29
  - Faculty are UCI faculty.
• 16:31
  - The content is, you know, peer reviewed internally.
• 16:36
  - Second, we teach the evidence, including where it's
• 16:39
  - thin.
• 16:40
  - Fellows are taught to grade the quality of
• 16:43
  - evidence behind an intervention,
• 16:45
  - to distinguish, you know, mechanism
• 16:48
  - from clinical outcome,
• 16:51
  - and to see plainly
• 16:53
  - where something is plausible, but unproven.
• 16:57
  - Most of what we teach, nutrition,
• 17:00
  - exercise, sleep, stress reduction,
• 17:03
  - botanical medicine is well supported.
• 17:06
  - Where the data are weaker, we say so.
• 17:10
  - And
• 17:11
  - lastly, this part, I think,
• 17:13
  - matters most for an academic
• 17:15
  - institution.
• 17:17
  - You know, we study it ourselves.
• 17:19
  - Doctor. Lodock mentioned that earlier.
• 17:21
  - Our investigators
• 17:22
  - run clinical trials on acupuncture and hypertension,
• 17:27
  - on integrative approaches to pain,
• 17:30
  - on nutrition
• 17:31
  - interventions.
• 17:32
  - We measure our own clinical outcomes,
• 17:35
  - including
• 17:36
  - on cost savings,
• 17:38
  - and publish them.
• 17:40
  - A program that only teaches and never generates
• 17:42
  - evidence
• 17:43
  - hasn't really earned
• 17:45
  - that academic
• 17:47
  - standing.
• 17:48
  - And honestly,
• 17:50
  - some skepticism
• 17:51
  - has been deserved historically.
• 17:53
  - The way that you answer is with data,
• 17:57
  - and not with volume.
• 18:02
  - Yeah.
• 18:04
  - Growth is not just,
• 18:06
  - that's not the only thing you... You know?
• 18:07
  - Growth doesn't necessarily mean that that you've done
• 18:10
  - something well or good. It just means that
• 18:12
  - it's grown.
• 18:13
  - And, I love the research.
• 18:15
  - I I love I love the research, and,
• 18:17
  - actually,
• 18:19
  - you know, our institute is part of a
• 18:21
  - larger network
• 18:23
  - of research institutions
• 18:25
  - that are working in this. And so we...
• 18:27
  - Maybe, Doctor. Malek, you just like to mention
• 18:29
  - BRAVENET. I just... I think it's wonderful.
• 18:33
  - Yeah. You know, we're part of and lead,
• 18:36
  - the BRAVENET,
• 18:38
  - consortium, which is a practice based
• 18:40
  - research consortium.
• 18:42
  - And it's now over 30
• 18:44
  - institutions
• 18:45
  - in The US and internationally.
• 18:48
  - And, you know, the desire is to pool
• 18:51
  - our data
• 18:52
  - and look at what works and what doesn't.
• 18:55
  - And I think that is something
• 18:57
  - that we're trying to bring into integrative health
• 19:01
  - is EquiPost.
• 19:02
  - Right?
• 19:03
  - Having the ability to say, well, you
• 19:06
  - know, does this really improve outcomes
• 19:08
  - over and above what we do in standard
• 19:11
  - care?
• 19:12
  - Yeah.
• 19:13
  - And I love that. And and, you know,
• 19:15
  - a lot of my work actually and one
• 19:16
  - of my passions is,
• 19:18
  - is ethnobotany
• 19:20
  - and botanicals. That's always been... That's... A lot
• 19:22
  - of my work was at the United States
• 19:25
  - Pharmacopeia
• 19:26
  - and, even with National Geographic. So I love
• 19:29
  - that.
• 19:30
  - And and it's interesting because people ask me
• 19:33
  - a lot about,
• 19:35
  - you know, well, that was used for thousands
• 19:37
  - of years. That's its own kind of evidence.
• 19:39
  - And I said, I I do. I believe
• 19:41
  - that that... That's... That is a type of
• 19:43
  - evidence. And I don't think that evidence,
• 19:46
  - and research is the enemy of tradition.
• 19:49
  - I think it's... In many ways for me,
• 19:50
  - it's been one way that we honor what
• 19:53
  - tradition has carried forward. I have to say,
• 19:55
  - I don't know that acupuncture would be as
• 19:57
  - popular as it is or finding its way
• 20:00
  - into health systems
• 20:02
  - if we didn't have the body of research
• 20:04
  - that's that's going on looking at it. I
• 20:06
  - think that
• 20:07
  - traditional knowledge,
• 20:09
  - which which
• 20:10
  - I am,
• 20:12
  - I am very deeply respectful of,
• 20:15
  - gives us generations of careful observation.
• 20:18
  - And science lets us ask new questions
• 20:21
  - about that.
• 20:23
  - Like, who does it work for? What's the
• 20:25
  - mechanism by which it works?
• 20:27
  - What's its safety? You know? And if it's
• 20:29
  - a botanical, what would the dose be? Right?
• 20:31
  - I I actually think neither is complete today
• 20:35
  - in modern times
• 20:36
  - without the other.
• 20:37
  - And and I always tell the fellows, unlike
• 20:40
  - strong evidence gives us permission to speak clearly,
• 20:44
  - and limited evidence
• 20:46
  - asks us to speak carefully. And I think
• 20:49
  - both of those are forms of honesty and
• 20:51
  - and clarity for our patients. Yeah.
• 20:55
  - My last question, since we're coming up on
• 20:58
  - time,
• 20:58
  - I'll start with doctor Lodog and then Doctor.
• 21:00
  - Mallick, I'd love to hear your thoughts as
• 21:02
  - well.
• 21:04
  - Doctor. Lodog, you mentioned,
• 21:06
  - you know, kind of building off the
• 21:09
  - generations of tradition and, you know, having
• 21:12
  - body of research to support,
• 21:16
  - such as,
• 21:18
  - botanical medicine and acupuncture.
• 21:20
  - When we're talking about the next generation of
• 21:22
  - clinicians,
• 21:24
  - what advice would you give to other leaders
• 21:28
  - like yourself,
• 21:29
  - you know, really
• 21:30
  - supporting the pipeline of next... Of, you know,
• 21:33
  - future clinicians?
• 21:36
  - Yeah. Clinicians,
• 21:38
  - I see also as leaders. Right? I see
• 21:41
  - whether we're the leader in our clinic or
• 21:43
  - the leader in our community.
• 21:45
  - And so for me, I think legacy
• 21:47
  - is
• 21:48
  - really important. We mentioned growth a moment ago.
• 21:50
  - Right? Growth can tell you how big you've
• 21:52
  - become, but I think that legacy
• 21:55
  - tells you what happened because of the way
• 21:58
  - you grew.
• 21:59
  - And, I I think I think that's what's
• 22:01
  - important here. What,
• 22:03
  - you know, my advice to clinicians
• 22:06
  - and to leaders in general is to build
• 22:08
  - what endures.
• 22:10
  - Right? Legacy is the outcome. It's it's how
• 22:13
  - you make decisions when no one's watching you.
• 22:16
  - Right? So, like, the claim you don't make
• 22:19
  - because the evidence isn't there, even though it
• 22:21
  - might be popular. Right?
• 22:24
  - Hold rigor and humanity together. That's a huge
• 22:26
  - thing. You know, you have to be able
• 22:28
  - to hold the science and hold humanity together
• 22:31
  - because all the science in the world will
• 22:32
  - not help you when that 27 year old
• 22:34
  - woman asks why her two year old has
• 22:37
  - cancer. I I mean,
• 22:39
  - so there's an art to what we do.
• 22:41
  - And,
• 22:42
  - you know, I just I just would say
• 22:45
  - mentor the future.
• 22:46
  - I... For me, that's a big part of
• 22:48
  - what I do, mentor the future. The next
• 22:50
  - generation is watching, you know, what we do
• 22:52
  - and what we reward.
• 22:54
  - And I hope that years from now,
• 22:56
  - when people ask what endured, they find
• 22:59
  - that, you know, we told the truth.
• 23:01
  - We cared for what was entrusted to us
• 23:04
  - by our patients, and that we left them,
• 23:07
  - you know,
• 23:09
  - we left them with a better way to
• 23:11
  - practice medicine,
• 23:12
  - for themselves and for others. Yeah.
• 23:17
  - And I'll just build on that.
• 23:19
  - You know, I think
• 23:21
  - training
• 23:24
  - for the questions clinicians
• 23:26
  - actually face. So for, you know, health leaders
• 23:29
  - who are overseeing a system,
• 23:32
  - to offer curricula
• 23:34
  - that can help,
• 23:36
  - support clinicians.
• 23:38
  - Because for most of the patients that walk
• 23:40
  - into the clinic,
• 23:41
  - it's a chronic disease issue driven by nutrition,
• 23:45
  - movement, sleep, stress, environment.
• 23:47
  - And if physicians are graduating without real training
• 23:51
  - in those, we've prepared them for the wrong
• 23:53
  - century. Right? And
• 23:56
  - the second is to build infrastructure,
• 23:59
  - not just programs.
• 24:01
  - Programs depend on a champion and leave when
• 24:04
  - that person does.
• 24:06
  - So ask about delivery model, the data, the
• 24:08
  - payment pathway,
• 24:10
  - not just whether, you know, an idea is
• 24:12
  - good.
• 24:14
  - And think about scale from the very beginning.
• 24:17
  - The opportunity
• 24:18
  - isn't building
• 24:20
  - a boutique program
• 24:21
  - for a few patients.
• 24:23
  - Is determining how approaches that work become part,
• 24:28
  - a part of the bigger health system.
• 24:31
  - And I'll close by saying, you know, in
• 24:33
  - terms of advice,
• 24:35
  - be patient, but be persistent.
• 24:38
  - I started my very first, you know, program,
• 24:43
  - in preventive cardiology,
• 24:46
  - seventeen years ago. And ideas that felt marginal
• 24:50
  - then are mainstream now.
• 24:53
  - Change in
• 24:54
  - academic medicine is slow,
• 24:57
  - but the leaders,
• 24:59
  - who can make it happen
• 25:01
  - are the ones that,
• 25:02
  - stay with it and are persistent.
• 25:06
  - And patients want it.
• 25:08
  - Your patients are asking for it. So, you
• 25:11
  - know, if you wanna really
• 25:13
  - save cost,
• 25:15
  - help change the trajectory of health in this
• 25:17
  - country,
• 25:18
  - it will not be built on the back
• 25:21
  - of an acute
• 25:22
  - care disease based model.
• 25:25
  - That has been a wonderful model for us
• 25:27
  - for many years. We're just now moving to
• 25:29
  - the next evolution of this. It's a natural
• 25:31
  - progression of where we were
• 25:33
  - to optimization,
• 25:35
  - right?
• 25:36
  - Health optimization
• 25:37
  - for our people. And
• 25:39
  - and doctor Malek is so true. I think
• 25:41
  - one of the biggest things fellows say when
• 25:43
  - they come in at the beginning and when
• 25:45
  - they leave
• 25:46
  - is,
• 25:48
  - wow. I I didn't know any of this.
• 25:50
  - I didn't know any of this, and it
• 25:52
  - makes sense. And it's all evidence driven.
• 25:55
  - They just...
• 25:57
  - You know,
• 25:58
  - we need to bring more of it into
• 25:59
  - medical schools. We need to have more of
• 26:01
  - it in residencies, but there's probably always going
• 26:03
  - to be a place for fellowship.
• 26:05
  - I I believe that because there's so much
• 26:07
  - to learn in medical school or nursing school
• 26:10
  - or whatever school you're in. You still have
• 26:12
  - to learn all of that. And so we
• 26:14
  - need to integrate more of this, but for
• 26:16
  - those who really wanna specialize,
• 26:18
  - there's probably, at least for the next ten
• 26:20
  - to fifteen years, gonna be a place for
• 26:22
  - fellowships
• 26:22
  - until we can change the educational infrastructure
• 26:26
  - to be the model that we're looking for
• 26:28
  - for the next twenty years. I don't think
• 26:30
  - anybody wants to practice the medicine of ten
• 26:32
  - years ago or twenty years ago. We're wanting
• 26:34
  - to practice the the medicine of tomorrow.
• 26:39
  - K. Well, thank you all so much for
• 26:41
  - your time today. I really, really appreciate it.
• 26:46
  - So just thank you. You're welcome.