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September, 2009 - VOL. 15, NO. 5 | |
September, 2009 |
| Healthcare Reform |
| David Riley, MD |
| The debate on healthcare reform is in full swing, with wildly inaccurate charges and countercharges on issues ranges from cost to access and rationing. We have invited 3 physicians practicing integrative and holistic medicine, actively engaged in this healthcare policy debate, to share their unique vantage points. Please welcome Drs Mark Hyman, Karen Lawson, and Lawrence Rosen.
It seems clear that if we continue down the path of healthcare delivery we current practice in this country, even if it is practiced a bit more efficiently, we will have failed. We will bankrupt this country, and the health of our citizens will continue to decline. We cannot continue to do what we have been doing for most of the last century and expect a different result, and what we are doing now is not sustainable. Our current system is run by private insurers, the pharmaceutical industry and hospitals trying to maximize profits by focusing on those who are healthy (often younger patients) and avoiding the sick (often older patients). We need a comprehensive system that looks for the most efficient and rational use of our resources, moving beyond disease management and beginning to focus on optimal health, wellness, and prevention—all measures of the self-healing capacity of the body.
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September, 2009 - VOL. 15, NO. 5 | |
September, 2009 |
| Integrative Pediatrics: The Future Is Now |
| Lawrence D. Rosen, MD |
| “The life and health of every infant are, both economically and morally, of paramount importance to society.”
— Dr Abraham Jacobi, 1872
The world is at a crossroads. At no point in our collective lifetimes have we witnessed comparable social and economic challenges. Healthcare transformation is no longer a luxury wish-list item; it has become an absolute imperative. The good news? Central to the debate is a growing recognition that true wellness care—primary preventive medicine—must be a cornerstone of any successful plan to resurrect our failing disease-care system. Witness the buzz generated by the Institute of Medicine’s February 2009 Summit on Integrative Medicine and the Health of the Public.1 At long last, public officials charged with operationalizing healthcare system change have acknowledged the value of integrative medicine as part of the solution.
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September, 2009 - VOL. 15, NO. 5 | |
September, 2009 |
| Could Health Coaching Build a Bridge to a New System of Healthcare? |
| Karen Lawson, MD |
| “In order to change, we must be sick and tired of being sick and tired.”
— Author Unknown
The talk of healthcare reform has been growing in intensity and urgency among consumers, healthcare providers, administrators, and our nation’s leaders. When planning a journey, or building a bridge, it is critical to know where you want to go and from where you are starting. So . . .
FUTURE SCENARIO, 2040
Children are raised with adult modeling of self-care and responsibility for their own health as well as social and environmental health. Our system of formalized education focuses not just on intellectual and sometimes physical intelligence, but also on emotional and social intelligence. There is recognition and valuing of multiple ways of knowing, of diverse cultural mores, and of the spiritual core of all purposeful human life. In our schools, there is attention to creating functional educational environments that are healing spaces, with nutrition that nurtures the body and senses as well as the intellect. Children are raised to be aware of the manifestation power of their own consciousnesses. Mind-body skills and practices are cultivated in the classroom from children’s first years in school. Self-care is a right and responsibility that children grow up to accept and expect.
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September, 2009 - VOL. 15, NO. 5 | |
September, 2009 |
| Finding the Money for Healthcare Reform |
| Mark A. Hyman, MD |
| The elephant in the room in healthcare reform is this: If we pay for “producing a higher-quality product” in healthcare—namely good health—then we will have more than enough money for comprehensive healthcare reform. If not, we will be simply re-arranging deck chairs on the Titanic. Not only will our nation’s health and healthcare system decline, but our nation will fall to the bottom of the global sea of failed nations as 34% of our gross domestic product (GDP) and 75% of all federal spending will be consumed by Medicare and Medicaid by 2040, according to the President’s Council of Economic Advisors.
Conspicuously absent in proposals for health reform policies from the White House, Senate, and Congress, aside from programs for community wellness and prevention, is any mechanism for payment for services that not only better prevent, reverse, and treat the major disease and cost drivers, but actually creates better health—in other words, a healthcare system that creates increased value: unit of health purchased per dollar spent.1 By improving the quality of our health and focusing on health creation and improved health outcomes, the sinking ship of healthcare can be righted, and the behaviors of physicians and healthcare institutions will shift from doing more things (volume), to doing the right things (quality).
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September, 2009 - VOL. 15, NO. 5 | |
September, 2009 |
| Factors Associated With Potential Medication-Herb/Natural Product Interactions in a Rural Community |
| Susan J. Blalock, PhD; Leigh F. Callahan, PhD; Philip J. Gregory, PharmD; Joanne M. Jordan, MD, MPH; Linda L. Norton, PharmD; Rajul A. Patel, PharmD, PhD |
| Objective: To examine the use of both herbs/natural products and conventional medications in a rural community, examine the prevalence of potential interactions between herbs/natural products and conventional medications, and identify factors associated with exposure to such interactions.
Design: Population-based epidemiological study.
Setting: Data for this paper were collected between 1999 and 2004 as part of the Johnston County Osteoarthritis Project.
Participants: Limited to civilian, noninstitutionalized, white or African American residents, age 45 years or older, of Johnston County, North Carolina. Data used in this paper are from 2523 individuals who completed face-to-face interviews.
Main Outcome Measures: Prevalence of herb/natural product use and exposure to potential interactions between these products and conventional medications.
Results: Nineteen percent (n=488) of participants used at least 1 herb/natural product. Among those who used both conventional medications and herbs/natural products, more than 1 in 5 (97 [21.9%]) were using a combination of products associated with a potential interaction. Odds of exposure to a potential interaction were lower among people who had health insurance and increased with the number of products used.
Conclusions: Many people are exposed to potential interactions between herbs/natural products and conventional medications. Research is needed to better understand the effect such interactions may have on patient care.
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September, 2009 - VOL. 15, NO. 5 | |
September, 2009 |
| Effects of Yoga on Inner-city Children’s Well-being: A Pilot Study |
| Deborah L. Berger, MD; Ellen Johnson Silver, PhD; Ruth E.K. Stein, MD |
| Objective: To examine yoga’s effects on inner-city children’s well-being.
Methods: This pilot study compared fourth- and fifth-grade students at 2 after-school programs in Bronx, New York. One program offered yoga 1 hour per week for 12 weeks (yoga) and the other program (non-yoga) did not. Preintervention and postintervention emotional well-being was assessed by Harter’s Global Self-Worth and Physical Appearance subscales, which were the study’s primary outcome measures. Secondary outcomes included other measures of emotional well-being assessed by 2 new scales: Perceptions of Physical Health and Yoga Teachings (including Negative Behaviors, Positive Behaviors, and Focusing/relaxation subscales). Preintervention and postintervention, physical well-being was assessed by measures of flexibility and balance. Subjective ratings of yoga’s effects on well-being were evaluated by an additional questionnaire completed by the yoga group only.
Results: Data were collected from 78% (n=39) and 86.5% (n=32) of potential yoga and non-yoga study enrollees. No differences in baseline demographics were found. Controlling for preintervention well-being differences using analysis of covariance, we found that children in the yoga group had better postintervention Negative Behaviors scores and balance than the non-yoga group (P<.05). The majority of children participating in yoga reported enhanced well-being, as reflected by perceived improvements in behaviors directly targeted by yoga (eg, strength, flexibility, balance).
Conclusions: Although no significant differences were found in the study’s primary outcomes (global self-worth and perceptions of physical well-being), children participating in yoga reported using fewer negative behaviors in response to stress and had better balance than a comparison group. Improvements in well-being, specifically in behaviors directly targeted by yoga, were reported. These results suggest a possible role of yoga as a preventive intervention as well as a means of improving children’s perceived well-being.
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September, 2009 - VOL. 15, NO. 5 | |
September, 2009 |
| Shiatsu as an Adjuvant Therapy for Schizophrenia: An Open-label Pilot Study |
| Shany Edelman, MA; Uriel Heresco-Levy, MD; Pesach Lichtenberg, MD; Hamutal Ptaya; Agnes Vass, MD |
| Objective: To determine if shiatsu can provide clinical benefit to individuals diagnosed with schizophrenia.
Design: An open-label pilot study.
Setting: An inpatient psychiatric ward at Herzog Memorial Hospital, Jerusalem, Israel.
Patients: Twelve hospitalized patients with chronic schizophrenia.
Intervention: Shiatsu treatment provided in a course of eight 40-minute biweekly sessions over 4 weeks.
Main Outcome Measures: All subjects were evaluated at baseline, 2 weeks, 4 weeks (end of treatment), and 12 weeks (follow-up). The tools used for assessment included the Clinical Global Impression (CGI), the Brief Psychiatric Rating Scale (BPRS), the Positive and Negative Syndrome Scale (PANSS), the Hamilton Rating Scale for Depression (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A), and the Nurses’ Observation Scale for Inpatient Evaluation (NOSIE). Side effects were measured using the Simpson-Angus Scale for Extrapyramidal Symptoms (SAS) and the Abnormal Involuntary Movement Scale (AIMS).
Results: On all scales of psychopathology and side effects, the subjects showed a statistically and clinically significant improvement by the end of treatment. This improvement was maintained at the 12-week follow-up. These findings, while encouraging, must be considered preliminary and require confirmation and cross-validation in larger-scale controlled studies. |
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September, 2009 - VOL. 15, NO. 5 | |
September, 2009 |
| Integrative Approaches to Pediatric Mood Disorders |
| Scott Shannon, MD |
| Pediatric mood disorders (depression and bipolar disorders) represent common, serious, and recurrent medical illnesses. According to the World Health Organization, major depression now constitutes the number-one cause of illness related impairment in developed countries worldwide.1 Naturally representative data from 15- to 17-year-olds in the United States indicate a prevalence rate of about 5% for major depression. The number of children and teens with milder forms of depression is probably about 8% to 10%.2 Rates for pediatric bipolar disorder are much less clear but may represent about 1% of the teenage population.3 A 2007 study showed that the rates of pediatric outpatient bipolar diagnosis rose 40-fold between 1994 and 2003.4 Before puberty, the rates of mood disorder are higher in boys; after puberty, girls experience about twice the rates found in boys. Suicide rates for older teenagers represent a leading cause of death and an alarming tragedy. |
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September, 2009 - VOL. 15, NO. 5 | |
September, 2009 |
| Migraines and Mood Disorders: Nutritional and Dietary Intervention Based on Laboratory Testing |
| Alexander Bralley, PhD; Stephanie Kaplan, ND; Cass Nelson-Dooley, MS |
| Current conventional treatments for migraine headache, depression, and mood disorders often fail to address the underlying cause(s) of these conditions and therefore usually require long-term medication without hope for cure or, in many cases, adequate symptom relief. Previous studies have shown that amino acids,1-7 neurotransmitters,6,8-16 and allergenic foods17-23 may be involved in the pathogenesis of depression and migraine headache. This case report examines plasma amino acids, urinary neurotransmitter catabolites, and serum food antibodies in a patient with chronic depression and migraine headache before and after nutritional and dietary interventions. |
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September, 2009 - VOL. 15, NO. 5 | |
September, 2009 |
| Recurrent Miscarriage Syndrome Treated With Acupuncture and Allergy Elimination and Desensitization Technique |
| Rita Stanford, DAOM, LAc, Dipl Ac, Dipl CH |
| In December, 2001, a 33-year-old female—“SC”—gravida 2, para 0-0-2-0, came in with the chief complaints of repeated miscarriage, pain, recent weight gain, circulation problems, feeling cold, premenstrual syndrome, and food and environmental allergies. She had been diagnosed with allergies to dust, mold, ragweed, cats, and sage, a minor reaction to dogs, and also reported that fast foods and milk were difficult to digest. She had frequent ear infections as a child. She complained of fatigue, sinusitis, sinus congestion and sinus pain, dry skin and eyes, frontal headaches, frequent sneezing, stuffy nose, postnasal drip, and phlegm in her throat. |
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September, 2009 - VOL. 15, NO. 5 | |
September, 2009 |
| Susan Frampton, PhD: Expanding the Reach of Patient-centered Care |
| Frank Lampe; Suzanne Snyder |
| Susan Frampton, PhD, president of Planetree, a nonprofit organization in Derby, Connecticut, works with a growing network of hospitals and health centers across the United States, Canada, Europe, Japan, and Brazil that have implemented Planetree’s unique patient-centered model of care. Prior to her work with Planetree, Dr Frampton spent more than 20 years at several hospitals in the New England area. Her work focused on community education, wellness and prevention, planning and development of integrative medicine service lines. Dr Frampton received both masters and doctoral degrees in medical anthropology from the University of Connecticut and has numerous publications, the most recent including a series on patient-centered care in the American Journal of Nursing and the newly released second edition of Putting Patients First (Jossey-Bass Publishing, 2008). The first edition of Putting Patients First (Jossey-Bass Publishing, 2003) won the American College of Healthcare Executives (ACHE) Hamilton Book of the Year Award in 2004. In addition to speaking internationally on culture change, patient-centered design, and health care consumerism, Dr Frampton has presented keynotes on designing patient-centered practices in acute care, continuing care, and ambulatory medicine settings for the Healthcare Design Symposium, Veterans Health Administration, and World Health Organization. She was invited in May 2009 by the Saudi Arabian Ministry of Health and the International Medical Center in Jeddah to present the keynote address at the “Paradigm Shift in Healthcare” symposium. She was recently appointed to The Joint Commission’s Expert Advisory Panel on culturally competent patient-centered care standards, the National Quality Forum’s Care Coordination Steering Team, and the Institute of Medicine’s review panel for its upcoming publication on integrative medicine.
Alternative Therapies in Health and Medicine (ATHM): I read on the Planetree website that Planetree was started when your founder, Angie Thieriot, was disheartened and concerned by the lack of personalized care that she received when she was in the hospital. She was concerned about how it overshadowed the benefits of the technology that fuels modern medicine. She formed Planetree in 1978, vowing to improve patient-centered care in hospitals. What kind of changes have you seen over the past 20 years in regard to patient-centered care?
Dr Frampton: There have been a number of substantial changes, fueled in part by access to the Internet. The increased access to information about healthcare has resulted in a demystification of medicine. Some well-informed consumers probably know as much as if not more than their physicians about their specific conditions.
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