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November, 2009 - VOL. 15, NO. 6 | |
November, 2009 |
| Putting Healing Into Healthcare Reform: Will Physicians and Healthcare Practitioners Lead? |
| Wayne B Jonas, MD; David P. Rakel, MD |
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William James, founder of modern psychology, was one of the most brilliant scientific thinkers of the last century. As professor of Psychology at Harvard University, he continuously showed both the curiosity and the courage to evaluate new and emerging concepts and discern their importance. A favorite quote from William James made over 100 years ago is the following:
Round about the accredited and orderly facts of every science there ever floats a sort of dust-cloud of exceptional observations, of occurrences minute and irregular and seldom met with, which it always proves more easy to ignore than to attend to. . . . Anyone will renovate his science who will steadily look after the irregular phenomena, and when science is renewed, its new formulas often have more of the voice of the exceptions in them than of what were supposed to be the rules.
To modern-day biomedicine, the importance of “healing” and “caring” have remained in Dr James’ dust cloud. Is it possible that “healing” and “caring” could emerge from that cloud and sow the seeds of true healthcare reform? Could they become the rules?
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November, 2009 - VOL. 15, NO. 6 | |
November, 2009 |
| Lifestyle Medicine: Treating the Causes of Disease |
| Mark A. Hyman, MD; Dean Ornish, MD; Michael Roizen, MD |
| Recently, at a small gathering in Martha’s Vineyard in support of the Robert F. Kennedy Center for Justice and Human Rights, Larry Summers, PhD, economist and director of the White House’s National Economic Council, spoke about our narrow escape from economic depression. Dr Summers also addressed the even larger impending risks to our economy if the costs of healthcare are not successfully addressed now. He was asked how we could control these costs without tackling the root causes of the problem, the fact that most of the chronic diseases that affect 160 million Americans and account for 78% of our healthcare costs are caused by lifestyle and environmental factors—namely our diet, sedentary lifestyle, smoking, chronic stress, and environmental toxins.
But most believe that doctors don’t “do” lifestyle. Dr Summers dismissed “lifestyle” as a community and public health issue that was already included in the current plan. He didn’t understand that physicians can and must practice clinical lifestyle medicine to effectively treat disease and dramatically reduce healthcare costs. Lifestyle factors leading to chronic diseases such as heart disease, diabetes, obesity, and cancer are the domain of doctors and not merely a “public health problem.”
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November, 2009 - VOL. 15, NO. 6 | |
November, 2009 |
| Yoga for Chronic Low Back Pain in a Predominantly Minority Population: A Pilot Randomized Controlled Trial |
| Diana Cullum-Dugan, RD, LDN; Larry Culpepper, MD, MPH; Roger B Davis, ScD; Russell S Phillips, MD; Robert B Saper, MD, MPH; Karen J Sherman, PhD, MPH |
| Background: Several studies suggest yoga may be effective for chronic low back pain; however, trials targeting minorities have not been conducted.
Primary Study Objectives: Assess the feasibility of studying yoga in a predominantly minority population with chronic low back pain. Collect preliminary data to plan a larger powered study.
Study Design: Pilot randomized controlled trial.
Setting: Two community health centers in a racially diverse neighborhood of Boston, Massachusetts.
Participants: Thirty English-speaking adults (mean age 44 years, 83% female, 83% racial/ethnic minorities; 48% with incomes =$30 000) with moderate-to-severe chronic low back pain.
Interventions: Standardized series of weekly hatha yoga classes for 12 weeks compared to a waitlist usual care control.
Outcome Measures: Feasibility measured by time to complete enrollment, proportion of racial/ethnic minorities enrolled, retention rates, and adverse events. Primary efficacy outcomes were changes from baseline to 12 weeks in pain score (0=no pain to 10=worst possible pain) and back-related function using the modified Roland-Morris Disability Questionnaire (0-23 point scale, higher scores reflect poorer function). Secondary efficacy outcomes were analgesic use, global improvement, and quality of life (SF-36).
Results: Recruitment took 2 months. Retention rates were 97% at 12 weeks and 77% at 26 weeks. Mean pain scores for yoga decreased from baseline to 12 weeks (6.7 to 4.4) compared to usual care, which decreased from 7.5 to 7.1 (P=.02). Mean Roland scores for yoga decreased from 14.5 to 8.2 compared to usual care, which decreased from 16.1 to 12.5 (P=.28). At 12 weeks, yoga compared to usual care participants reported less analgesic use (13% vs 73%, P=.003), less opiate use (0% vs 33%, P=.04), and greater overall improvement (73% vs 27%, P=.03). There were no differences in SF-36 scores and no serious adverse events.
Conclusion: A yoga study intervention in a predominantly minority population with chronic low back pain was moderately feasible and may be more effective than usual care for reducing pain and pain medication use.
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November, 2009 - VOL. 15, NO. 6 | |
November, 2009 |
| A Complementary and Alternative Medicine Workshop Using Standardized Patients Improves Knowledge and Clinical Skills of Medical Students |
| Charles H. Griffith, III, MD, MSPH; Steven A. Haist, MD, MS; Andrew R. Hoellein, MD, MS; Michelle J. Lineberry, MA; John F. Wilson, PhD |
| Objectives: As the use of complementary and alternative medicine (CAM) has increased in the general population, so has the interest in CAM education among medical students and medical educators. The purpose of this study is to determine the impact of a CAM workshop using standardized patients (SP) on knowledge and clinical skills of third-year medical students.
Design: A 4-hour CAM workshop was developed as part of a new curriculum for a required third-year 4-week primary care internal medicine clerkship. The CAM workshop and 3 other novel workshops were randomized for delivery to half of the rotational groups. The CAM workshop incorporates 4 SP cases representing different clinical challenges. All students in every rotation group are assigned CAM readings. At the end of the rotation, all students take a 100-item written exam (7 CAM items) and 9-station SP exam (1 CAM station) including a post–SP encounter open-ended written exercise. Scores on the written exam CAM items, CAM SP checklist, and CAM open-ended written exercise of workshop participants and nonparticipants were analyzed with simple means, standard deviations, and multiple regression approaches.
Results: The CAM workshop was delivered to 12 of the 24 rotation groups during the 2004-2005 and 2005-2006 academic years. Ninety-two students participated in the workshop, and 94 did not. Workshop participants performed significantly better than nonparticipants on the CAM-specific SP checklist items (58 vs 36.6%, P<.0001), post–SP encounter written exercise (76.9 vs 63.3%, P<.0001), and 7 CAM written exam items (84.8 vs 76.3%, P<.0001).
Conclusions: Students participating in a 4-hour SP workshop exhibit superior CAM knowledge as assessed by SP checklist, open-ended exercises, and multiple choice items. It appears that practice with SPs assists in acqusition and application of CAM knowledge and deferential counseling skills.
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November, 2009 - VOL. 15, NO. 6 | |
November, 2009 |
| Temporal Bone Misalignment and Motion Asymmetry as a Cause of Vertigo: The Craniosacral Model |
| David Christine, CST |
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Objective: To describe dysfunction of the craniosacral system, particularly temporal bone motion asymmetry, as a cause of vertigo and to suggest a new perspective on research, diagnosis, and treatment.
Data sources: A database search was conducted using MEDLINE, CINHAL; Health Sources: Nursing/Academic Edition; and the Internet. Keywords: vertigo diagnosis and treatment, craniosacral therapy, temporal bones, cranial bone mobility, Upledger, and temporomandibular disorders.
Study selection: Articles that most clearly described a relationship between cranial bone misalignment and vertigo were selected for review.
Conclusion: Clinical experience suggests that craniosacral therapy is a powerful evaluative and treatment modality for vertigo patients who have not found relief from medical treatments. A narrative review of the literature describes and supports a theoretical link between dysfunction of the craniosacral system and vertigo. Dysfunction of the craniosacral system may include osseous, dural membrane, and fascial restrictions leading to asymmetric temporal bone movement and hence vertigo. Clinical trials are necessary not only to verify that craniosacral therapy is an effective treatment but also to determine the full range of symptoms and medical diagnoses for which craniosacral therapy is beneficial.
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November, 2009 - VOL. 15, NO. 6 | |
November, 2009 |
| Lomi Lomi as a Massage With Movements: A Conceptual Synthesis? |
| Pawel Lizis, PhD; Paul Posadzki, PhD; Toby O. Smith, MSc |
| This article narratively reviews the evidence of 2 therapeutic modalities, massage and passive movement. The authors suggest that these 2 treatment techniques may be combined as 1 treatment to be used in a variety of clinical settings. We present the rationale through which the concept of massage with movement (MWM) has been developed and constructed from the principles of passive movements with gentle massage during Lomi Lomi massage. It is hypothesized that through further investigation and empirical studies, this concept may allow bodywork and movement therapists, nurses, physiotherapists, and occupational therapists to combine the positive effects of passive movements with those of massage for patients’ health benefits, most notably through enhanced relaxation. |
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November, 2009 - VOL. 15, NO. 6 | |
November, 2009 |
| Clinical Research in Anthroposophic Medicine |
| Harald Johan Hamre, Dr med; Gunver S Kienle, MD; Jean Kijek, RN, PhD |
| Anthroposophic medicine includes special medications and special artistic and physical therapies. More than 200 clinical studies of varying design and quality have been conducted on anthroposophic treatment. Half of these studies concern anthroposophic mistletoe therapy for cancer. Clinical effects of mistletoe products include improvement of quality of life, reduction of side effects from chemotherapy and radiation, and possibly increased survival.
Apart from cancer therapy, the largest studies of anthroposophic treatment have been 2 naturalistic system evaluations: In German outpatients with mental, musculoskeletal, respiratory, and other chronic conditions, anthroposophic treatment was followed by sustained improvements of symptoms and quality of life. In primary care patients from 4 European countries and the United States treated for acute respiratory and ear infections by anthroposophic or conventional physicians, anthroposophic treatment was associated with reduced use of antibiotics and antipyretics, quicker recovery, and fewer adverse reactions; these differences remained after adjustment for relevant baseline differences.
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November, 2009 - VOL. 15, NO. 6 | |
November, 2009 |
| Benjamin Kligler, MD: Advancing the Cause of Healing-oriented Medicine |
| Frank Lampe; Suzanne Snyder |
| Benjamin Kligler, MD, is vice chair of the Department of Integrative Medicine, Beth Israel Medical Center, New York. He is associate professor of Family and Social Medicine at Albert Einstein College of Medicine and Research Director of the Continuum Center for Health and Healing, an integrative medicine practice that opened in May 2000. Additionally, Dr Kligler is co-director of the Beth Israel Fellowship Program in Integrative Medicine, which accepted its first fellows for training in January 2002, and teaches in the Beth Israel Residency Program in Urban Family Practice. Dr Kligler is the author of Curriculum in Complementary Therapies: A Guide for the Medical Educator, a monograph distributed by the Society of Teachers of Family Medicine, and co-editor of Integrative Medicine: Principles for Practice (McGraw-Hill, 2004). He is also co–editor in chief of the peer-reviewed journal Explore: The Journal of Science and Healing. Dr Kligler is certified in Ericksonian hypnotherapy and acupuncture and incorporates these and the use of botanical medicines into his primary care practice at the Center for Health and Healing.
Alternative Therapies in Health and Medicine (ATHM): What were the influences in your life that led you to medicine and, specifically, to integrative medicine?
Dr Kligler: Medicine in general was more or less ordained for me. My dad was a pediatrician. He had an office in our basement at home, and I grew up watching him take care of kids and families. I had periods when I thought that wasn’t what I would I do, but I know it was in my mind from when I was young.
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