‘How Healing Works’ Author Dr. Wayne Jonas Explains His Approach

Mark Masselli (00:04)
Our guest believe modern medicine is overly focused on seeking cures rather than taking the time to support
healing and quality of life.

Dr. Wayne Jonas (00:12)
The data is very clear that most of actual health does not come from going to your doctor and, and getting a
diagnosis or a treatment.

Margaret Flinter (00:21)
Dr. Wayne Jonas is an expert in integrative health and whole person care delivery, and a widely published
scientific investigator.

Dr. Jonas (00:29)
I learned that they were using things that I had never heard of before. such as an herb for depression, the number
one prescription item for depression. St. John's War acupuncture was routinely used for pain and pain
management.

Margaret (00:44)
This is Conversations on Healthcare.

Mark (00:57)
Dr. Jonas, welcome to Conversations on Healthcare.

Dr. Jonas (1:00)
Thank you. It's, great to be here, especially, to talk to, folks like you who have built a tremendous community
health centers that deliver whole person care, the topic we're gonna talk about. So glad, so glad to be able to talk
to you.

Mark (01:16)
Well, you, you are the bestselling author, so we, we know many are familiar with your views, but let, let's just
start out by, out by asking, when you're talking about integrative health and whole health, are you referring to
acupuncture, mindfulness, and nutritional interventions, or, or what else is covered under that umbrella?

Dr. Jonas (01:36)
So, whole Health is a much broader concept than integrative medicine or lifestyle medicine or functional
medicine or, any of those other terms you might hear. It does incorporate, those things when there's good
evidence, you know, to show that there are value, in those areas. But it, it's, it's a broader concept really, that
harks back to sort of the continuity primary care, that, the specialty of family medicine really was born after,
Born out of, I'm a family physician and was inspired by those early founders that took the, the bio-psychosocial
model as it was, talked about at that time, which was really a holistic model, developed, a way of caring for
people that addressed all the core aspects, mindbody, social and spirit, and had the ca capability to do that with
expert generalist care. and, and that, and then tested it, tried it out and tested it, and, proved that it actually
improved health lowered costs, and people liked it a lot better.

Margaret (02:43)
Well, you're singing, from our songbook when we, think about not just family medicine, but primary care and
Barbara Star Starfield and those original tenants, and certainly all the work that community health centers were
built upon with community and social determinants, but, but back to your book, how Healing Works. you wrote
about four, decades of experience, and research, that led you to say that 80% of healing occurs organically,
outside of the actual healthcare system. So, talk with us about how you describe how one activates the healing
process and what steps, particularly can the patient take with or without the guidance of the healthcare provider.

Dr. Jonas (03:25)
Well, I think, you know, the data is very clear that to most of actual health does not come from going to your
doctor and, and getting a diagnosis or treatment, although that is important, in those areas. so how do you
activate that healing? Well, just think about it for a minute. you wouldn't be around unless your body was
continually healing, because we are bombarded by stresses, by traumas, by infections, by, you know, all kinds
of, things that, wanna break us down once we're born. And if we didn't have a robust inherent healing and repair
capacity, and the ability to kinda reintegrate, come back to coherence, you know, we wouldn't be around. So the
idea, this concept is captured in the, in the term that I like to use. It was originally, developed by a psychologist,

but I broaden it to medicine in general. It's called salutogenesis. So we all, know what pathogenesis is, right?
Okay. The disease productions, processes, I studied in medical school from the textbook of pathology and
pathogenesis. but in parallel with that, simultaneously always going on is the repair of that process, the
reintegration, the reordering of those comp- the return to wholeness, as I like to say. And, and so this salutogenic
process, we haven't studied, we've studied, there's a lot of data on it, but we haven't incorporated it into our day-
to-day practice. And we can talk about how you can do that in very simple and easy ways.

Mark (05:06)
One of the challenges, Margaret, we see in our practices is around pain. and, you know, research shows that, a
hundred million Americans suffer from chronic pain. I'm wondering, do you recommend that healthcare
providers start treatment with non-pharmacological approaches? we often hear patients really want medication,
in some ways, because the standards were, we always asked about pain. but tell us, how you, handle this
particular area.

Dr. Jonas (05:38)
Yeah. So, let me give you an example of that. I see patients in a, a whole person or integrative chronic pain
management clinic within a family medicine training program. And these are pa So we see a lot of patients who
have had the standard approaches to pain. Many of them are on medications, have had lots of procedures, et
cetera. I'll give you an example of one fellow by the name of Joe had chronic back pain, very common, problem,
a very costly type of thing, creates a lot of suffering. And he'd had, lots of injections. He'd been on and off
opioids. He had medications, physical therapy. he had a couple surgeries actually, for his back, and yet he still
had chronic back pain. Each of those things would give him some relief, sometimes temporarily, sometimes a
bit. but his chronic pain persisted. And so we sat down with him and we asked him, okay, what are the inherent
healing processes that you do? We didn't exactly term it that way. I simply asked him, first of all, what matters
to you? Why do you actually want to get engaged in the treatment of your own pain? He was very clear. the pain
prevented him from driving several hours down to see his grandchildren and getting down on the floor and
playing with 'em. He couldn't do that, and he wanted to do that. This was the driver. This is what mattered to
him. So that's number one. Number two, we needed to, be able to tap into things that helped him do that on his
own, his inherent healing capacity. So we asked him a couple questions about that, and as it turns out, he found
that heat and stretching, actually worked quite a bit, but again, it worked temporarily, and he'd go to physical
therapy, and, he didn't have a way of actually engaging in heat. So we, we had to actually set up a system
whereby he could begin to do this at home. He got a, a hot tub that he got into, and he did some stretching
exercises, but we needed more than that. We needed to get his core function, working so that he could get down
on the floor and play with his grandchildren. That's the primary what he, what he wanted to do. So we, we ran
him up to the physical therapist. I took him up there personally, and we sat down with a physical therapist and
said, you know, we're not here to treat his back pain. We're to get him able to get up and down off the floor.
Now that hurt, all right? But he was motivated to do that. So we adjusted the core exercises. He went and started
to do those along with the heat. Now he had some other things. He had sleep issues, he had stress management
issues, et cetera. And so we had to help support those processes that now we know, facilitate healing and, can
mitigate chronic disease and chronic pain, including that. He did that for about six or seven weeks. He started to
get better, and about eight weeks later, okay, he came in to see me, and he said, Hey, doc, guess what? I just
drove down and I got down on the floor, and, I played with my grandchildren. He was ecstatic, okay? Now, it
was hard for him. He had to go through, you know, a lot. But he was willing to do it because this was what was
important, for him in his life. And it was different from all the pain treatment procedures he'd had over the last
15 years. Now, he was hooked, he was motivated, he was engaged in his own self-care, his own he self-healing
capacity had been tapped into that. He saw the results of that. And then he, he said, what else do you got, doc?
What else can you do to improve my healthcare in those areas? So that's an example, where we tapped into his
own inherent healing capacity, gave him a stimulus that then, you know, actually engaged that in those areas.
but mostly we developed a relationship with him that allowed us to understand and him to understand what was
most important in his life, and then seek to get at those goals in our healthcare plan. And that's whole person
care.

Margaret (09:35)
Well, that is a, great example of listening to the patient, making sure you know what the problem is from their
point of view. And also bringing in the physical therapy, people who are such great members of the team. I
wanna talk about a, a situation that often, just throws people right into a spin. And that's the diagnosis of cancer,
really any kind, of cancer. And you're the co-author of Healing and Cancer, A Guide to Whole Person Care, that
certainly emphasizes lifestyle and emotional wellbeing along, of course, with, traditional treatments. tell us
about this work and, and how would you like people to understand this interaction?

Dr. Jonas (10:13)
Well, I had the great opportunity to partner with a oncologist who works in the VA, Alyssa McManamon,
general oncologist, beautiful individual, very holistic in thinking and, and caring for her patients. And so we
partnered up to really look at the data, okay, look at the evidence about how people improve their quality and
their length of life when they're diagnosed with cancer in those areas. And we know from what are called the
hallmarks of cancer, which is the biological drivers of cancer, huge amount of, of science that has emerged over
the last 20 years in those areas, that the underlying drivers are multifactorial and they involve basic wellness
components, okay? Inflammation, the microbiome immunity, which is now a, an exploding area in terms of the
treatment of cancer. But when somebody gets diagnosed with cancer, and then they go in and see their
oncologist and oncology team, the entire thing is almost all focused on killing the cancer cells. And yet, we
know that those cancers emerge in that microenvironment in the macro environment around that. So, really care
for the cancer person, the person with cancer, and the cancer itself requires, we pay attention to the, the person,
the whole person, not just kill the cancer cell, yes, do that, but make sure we pay attention to that. For example,
exercise. you know, who, when's the last time your oncologist, if you've had cancers, had said, well, tell me
what you're doing for exercise. Or maybe if they were really enlightened, they'd just give you a pamphlet and
say, well, you do need to keep active, okay. In those areas. but people need support and specifically customized
exercise for their stage and endpoint in cancer. And it's now been shown that exercise has huge impact on both
quality and length of life. Social support, the same thing. Social support mitigates stress, that alters
inflammation, inflammation, modifies the drivers in the tumor microenvironment. they also help people, you
know, feel better in those areas. so social support is very important. And if you compare cancer patients with
high social support compared to low social support, there's a 25% mortality difference in that. Okay. But who
asks, do you have social support in those areas? We should all be asking that, bringing our teams together to get
those who do not have good social support up, and they will do better in those areas. So, that's what the book is
about. It outlines a lot of those, those underlying drivers of Whole Person Care. we have those tools available,
in, in, in, especially in in academic centers or larger medical centers. But even in community centers, there are
often tools available using supportive care, what's called supportive care, palliative care, psycho-oncology,
physical therapists we just talked about in those areas that are properly trained, stress management, sleep
management, et cetera. And so these things need to be routinely incorporated into cancer care, and that's what
the book is about. and it actually gives step-by-step guides on how teams can provide that kind of care.

Mark (13:25)
Well, I wanna pull the thread on, how teens can provide the care. I wanna go back to Joe and his grandchild and
wondering if he made the second and third, maybe the fourth trip down there, or did he get thrown off and
then…

Dr. Jonas (13:37)
Oh, no, he was hooked.

Mark (13:39)
…and then maybe about the team, because you needed a willing patient, but you needed a willing team to work
together, big academic centers, but a lot of medicine is delivered in rural parts of the, of the world. How, how
are you thinking about the spread of this training that next generation, certainly as Margaret said earlier, family
practice, dear to our hearts, but not everybody's a family practitioner. so walk, walk us through how this model
is gonna scale up and what you're doing, through your book and, and your talks about helping train that
generation of teams that, can, can really engage those willing patients like Joe.

Dr. Jonas (14:21)
Yeah, you're absolutely right. This isn't just about primary care. This kind of whole person care is needed in
every specialty across, the spectrum in those areas. And there's some great examples, your example of pain
management where orthopedic systems, orthopedic, clinics actually are embedding now whole person care, you
know, before they do surgery, for example, in pain management, knee replacements, hip replacements, things
like that. And their patients do much better with that. So there's lots of examples on that. So how do these teams
get trained up in that? Well, there's several examples of how to do that, guides on how to do that and how to
spread it. again, in primary care, the National Academy of Sciences and Medicine had a report came out in
2021, called Implementing High Quality Primary Care Primary. And it described in detail how to do Whole
Person Care and what the teams look like, what the payment issues look like, what the training issues, the
technology components that are required for that. And they're gradually implementing that. and, you know, in
the nation, I, I hope, I hope CMS and others are paying close attention to it, because it, it was a very detailed
description. Another example is what's going on in the VA, and I mentioned my co-author of, in, in the, in, in
the, the, the, of the, the cancer book. there is a program, that's spreading in the VA called Whole Health. Which

takes this kind, these kinds of frameworks, as is now delivering it across specialties within the VA at Centers of
Excellence, and rolling it out even into a remote kind of clinical centers that the VA provides care for in those
areas. And that was summarized in another National Academy of Medicine report called Achieving Whole
Health. And it described what was happening in the VA, and then it showed examples that were going on
around the country, and even around other places in the world of how this was happening. So it is out there and
available, and we now need to drive the entire system to begin to do more of that. So we tested some simple
tools out that anybody in a rural setting or an individual practice can, can utilize immediately. They're on our
website. We adapted some of them from the VA. We tested them out in, 16 community, health centers, and
some specialty centers, in a, in a subsequent test, 13 oncology centers around the country, in a learning network
where these tools were brought in and began to be implemented. Some of these tools are very simple. They're on
our website. There's, there's, technologies that allow you to do them and get them into the electronic medical
record. One is called the Personal Health Inventory. Okay? This is a simple two-page, questionnaire you give to
patients ahead of the visit, and it asks them, number one, what's important in their life. Like, you know, Joe
found out what was important to him, and what are the underlying drivers that he is ready for, that he's, he's, he's
ready to engage in that can facilitate these inherent healing capacities. And then those then become part of the
plan, okay. They become of the healthcare plan. Then they become integrated into those areas. And, those 16
centers showed that they could be done within large centers, small community centers, even individual
practices, if they organize their services around that, and actually began to embed them in their practice
improvement processes. So, that's what we recommend to people.

Margaret (17:52)
Wow. Well, I'm so glad, that you referenced the whole health program and Veteran Affairs. We're speaking
about that just a few moments ago. I have, a dear colleague, a nurse practitioner colleague who's engaged in that
work in one of the centers. And what was so interesting to me in discussing it is that the Veteran Affairs folks
are really taking advantage of the full continuum: mindfulness, meditation, breathing, reiki, chiropractic,
nutrition, everything that patients need. And, you know, one might say it's a stereotype, but if ever there was a
group of people I might not have thought would be amenable to mindfulness-based meditation or breathing, it
might have been, our Veterans.

Dr. Jonas (18:33)
Veterans. Yeah.

Margaret (18:34)
Tell me, tell me, how you, how you think in this institutional setting in veteran affairs, such an important part of
our healthcare system. Whole Health has been able to take root at the institutional level, the training level, the
service level, and the research level, in a way that maybe not so much beyond Veteran Affairs yet. What what is
unique about Veteran Affairs that you think has been able to make such progress?

Dr. Jonas (18:59)
Well, I happen to know a bit about the history of this. So I was involved in it. there was a lot of this going on
already within the VA because, people that take care of patients over, you know, periods of time and have a
philosophy, have a concept that they need to take care of the whole person, which the VA had, you know, this is
not just, you know, treating them, but the system does. They were already starting to do this. And, the, the, the
institute that I ran, foundation that I ran for several years, was, facilitating calls and discussions across the VA
and many of these areas every month for about three years in order for them to talk to each other, learn what was
going on, seeing what the critical mass is. And they began to talk to, you know, those in policy Congress, and
the people that control the budget and the, the leadership within the VA and say, you know, we need to, to, to
enhance this. We need to make sure we put in more salutogenic resources in those areas. And so, actually, there
was a federal law that said, let's create these whole Health Centers of Excellence. And embedded into that was
the support for salutogenic services that any, you know, veteran and any healthcare team could access. And then
on top of that, the tremendous research capability that the VA already has, right. And has had for years to be
able to track that and look at that, as well as the practice and improvement component. So by inserting those
concepts into that and providing some additional salutogenic support, they were able to actually build this
program and spread it now across the VA.

Mark (20:45)
Well, we've been talking about the VA you mentioned earlier, CMS, there are eight a, let's see, we're eight
months into, or six months into a new administration. What are your thoughts about how the VA's leadership is
shaping up and also the leadership at CMS? And certainly we have a, a, a powerhouse and Secretary Kennedy
and, HHS, who's got a lot of things on his mind. And, what, how, how are you framing this up, in the, in the

context of the work that you're doing, in the work that you're trying to promote? Are you seeing kindred spirits
there, or, have they taken a U-turn?

Dr. Jonas (21:25)
Well, I think, I think the language is very aligned with what we're talking about. you know, there is a philosophy
and a language that says we need to reduce chronic disease. we need to take care of whole people. we need to,
tap into things that aren't just of corporate interest, for example, that might make money for the, for the industry,
but actually facilitate the healing. So the concepts are there. We haven't yet seen the policies that would actually
drive this across the country. I think there are ways to do that. I, you know, I think there's examples. We've
talked about some of those in those areas, but we haven't seen those core processes for tapping into the inherent
healing capacity, which does this Okay. Access yet we're, they're still looking at a variety of things in the
environment. And, you know, trying to go after, you know, reducing, you know, costs in pharmaceuticals,
reducing, you know, the food industry influences type of thing, all of which were laudable, but they're not
getting at those five core things, sleep, exercise, you know, nutrition, stress management and social support, and
the spiritual component yet that are these inherent drivers that we've just been talking about here in those areas.
And so, structuring, coverage, you know, go back to CMS structuring coverage that allows models, these types
of models within community settings, and then tracking their ability to, improve health, reduce chronic disease
and capture costs. That redesign of the healthcare system, which we have lots of examples on, and then putting
some resources, shifting resources, is what we still have to see. We supported our foundation, that I run right
now, healing Works Foundation supported another study in the National Academy of Medicine on how you
would shift investments to drive that spread, okay. Beyond the, it is called valuing America's Health. And it
went through a detailed examination of where are we putting money that's not creating health, and where is
there good evidence? If we put more investment, it would drive health along a whole person framework. And so
that's a great guideline. and I, if I would recommend one thing to 'em, I'd say take a look at that and use that as a
blueprint, for, where you’d like to see CMS go.

Mark (23:55)
But if, if it's not gonna come out of the federal government, will states be the engine of innovation here? Where,
where will this happen? Because it's really important to keep the momentum. The feds may be seeding this to
the states. Do you see anything that suggests that we have, some enlightened state leaders.

Dr. Jonas (24:14)
We do have a, a number of enlightened state leaders. I just got off the phone, yesterday actually with the
National Association of State Policy folks who are tracking and working with states to do this. And there are a
number of states around the country, that have been doing this for quite a long time in different ways, in
different models. And I, I think that the, the, if federal government just pulls out of this rather than, you know,
trying to enhance it, we're gonna see them step up. They're gonna have to step up to take care of their own, their
own healthcare and their populations. It is a state federal thing, and this, they're not, you know, even if the
federal government says, we don't wanna be the ones providing all the support in this area, they're still always
gonna be a major player, okay. In those areas. So state and feds have to get together and begin to work out how
are we gonna, reduce chronic disease and make America healthy again to, to use their term.

Margaret (25:10)
Well, you know, I, you referenced the, national Academy report towards implementing high quality primary
care. Couldn't agree with you more. One of the seminal documents, and and core in it to that team was the
presence of the community health workers, and particularly their role in helping to address the social
determinants of health. And if you wanna talk about stress sending you into a tailspin, I think we can all imagine
not enough food to feed your kids, no way to get to the job because the car broke down. You don't have money
to fix it. losing your housing, all of these things, are stress at an immense level. I'm curious about your
foundation now, in terms of the research you're doing. Are you looking at the con contribution of the social
determinants of health to stress and poor health outcomes in the same way you've looked at, the other factors,
you know, diet, sleep, nutrition, et cetera. It just, it seems like this is such a pervasive challenge in our society
right now.

Dr. Jonas (26:06)
Yeah, no, absolutely. This is, this is key. And if we can't do it in and with populations that, that don't have those
resources, it's very, very difficult to do it across the nation. So we've been working for a number of years now
with a safety net hospital system up in Queens, New York, called the Jamaica Medical Health System. It's the
major safety net hospital within Queens. lots of people with social determinant challenges, as you can imagine,
Medicare, Medicaid, or no, insurance is mostly what they take, care of 133 languages. They have to be

responsible for translating for the patients that they care for. And we've been working with them to help them
build a whole person care approach. Like, just like we've talked for those patients, and especially identifying
those at the highest risk, for chronic illness and high costs in those areas. And they've created an advanced,
primary care system ambulatory system that they've tested out now, using these same principles. If social
determinants are a key issue, they integrate with the community to provide those things, if that's what arises to
the top and what matters, most important to that particular patient. So they have this coordinated, integrated,
service component that works closely with the community. They've trained their health navigators to be health
coaches and community health workers. Many of them are already community health workers in those areas to
provide community ambulatory care for these high, high-risk patients. And they have shown, even in a, in a
matter of, of a, of a year and a half-marked reductions in emergency room use, specialty use, chronic disease,
and chronic costs, they've stayed close to $15 million in a relatively, small population by providing this type of
risk-based whole person care.

Mark (28:01)
You know, I think our listeners would be interested in your journey. We only have a few minutes here, but h
how did you pivot to include this integrative whole health approach? And, maybe just tell, tell us a little bit
about, the storyline.

Dr. Jonas (28:15)
So I, I was a standard trained, family physician, working in the military. I had a scholarship and I did my
residency in the military. And then I, I worked for 20 years in the military, where the philosophy is not just treat
the disease, but keep our service members and their families functional, right? Human performance
optimization. So I had to pay attention, to the health promotion and the prevention components, and did a lot of,
a lot of things within that system during my career in that area, including run clinics that would, that could do
this type of thing. And, so while I was doing that, I was running a small, hospital in, Germany for the military
folks during my assignment. And it, we had to work closely with the German, medical community. 'cause they
did our transportation, our, our ambulance transportation, for those that we needed. 'cause we were quite remote.
and, I learned that they were using things that I had never heard of before. such as an herb for depression, the
number one prescription item for depression, St. John's war acupuncture was routinely used for pain and pain
management, homeopathy, which I thought, this is crazy. What is that? Okay. But, I remember one physician
gave me a homeopathic cream, said, Hey, try this out on your next patient with back pain. I, I gave it to him.
They tried it, it worked, said, oh God, I need to find out about this. Okay. so they had a bigger medical bag than
I did. All right. And most of those fit into the so-called complementary medicine or integrative medicine
category. And that got me interested in the science and the research event eventually led me to Walter Reed to
do research training, train others in research, and then to the NIH, where we looked at the so-called
complementary alternative components, those research components. And now, I'm glad to say many of those,
you know, have emerged as effective and others have been shown not to be effective.

Margaret (30:16)
Arnica is in all of our backpacks.

Dr. Jonas (30:18)
So we now can draw from that and begin to incorporate that, into, into care. And that's now called integrative
practice. But you gotta go beyond that to the social determinants, to bio-psychosocial components, as we just
discussed, to really do whole person care.

Margaret (30:34)
Well, thank you so much Dr. Jonas, for joining us today. And thank you to our audience for being here. Just a
reminder to be sure to subscribe to our videos on YouTube, find us on Facebook and x, and share your thoughts
and comments about this program. We'd love to hear from you. Take care, and be well.

(30:55)
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