Integrative Medicine Conference News

I just returned from the Integrative Medicine Conference for Health Care Organizations held April 12-14, 2007, in San Diego, CA. This was a very interesting three days attended by healthcare professionals and directors of integrative medicine clinical programs, academics, economists and researchers.

There were several presentations from integrative medicine leaders who are now showing successful models of integrating natural medicine into conventional hospital and clinical settings. Especially encouraging is the emerging research showing better patient outcomes.

Most thought-provoking for me were the lectures by Jennifer James, PhD, and Martin Merry, MD. Dr. James is a cultural anthropologist from Seattle who has been studying the cultural transformation underlying the huge public movement towards natural/integrative/holistic approaches to healthcare. She made several strong points that were insightful for me:

1. The current chaos in healthcare, while unpleasant for both practitioners and patients, creates the opportunity for fundamental change. But, while many may appreciate and welcome the new ideas, they do not want to let go of what they have learned and do not want to be made to feel they were "wrong" in the past.
   
   This helped me understand why many dedicated conventional healthcare professionals seem to find it so hard to accept well-documented natural therapies when this might imply that the pharmaceuticals they have used for so long are possibly not be as good and more dangerous.


2. We cannot expect healthcare change to come from the federal level as there is no strong political leadership, and too many vested interests resist any real change. The solutions will come at the state level.
   
   This was encouraging to me since this means local action by dedicated activists has the best chance to develop models that can then be evaluated and adopted more widely when they are shown to be effective.


3. As cultures advance, they become more kind. Healthcare is kindness-manifested. I liked this one! It resonated deeply with me, and I could see the same sense of appreciative self-understanding in others in the audience. Caring about others' health is the source and core of what I do.


4. Flattening of the hierarchy gives patients greater involvement in their own health care decisions. This is consistent with my perspective that each patient is his or her own best doctor.

Dr. Merry has been involved in healthcare quality improvement programs for almost 30 years. His message focused on the causes of the unacceptably high level of medical error and the necessary solutions.

He believes that most errors are due to "First Curve" or "physician-centered" thinking. This is manifested by our current healthcare system. Merry asserts that the old model of centering systems on the expert craftsman, which worked so well in the past, no longer works in our modern world. Increased complexity, increased amounts of information and broader patient access to information and technology that were once reserved to the specialist, all result in demands for a different way of functioning.

First curve care, even when optimally practiced, still yields what is called "4 sigma error," i.e., about 6,000 deaths due to errors for every 1 million patient interventions (and this does not include patient injury, which according to some studies may be as high as 25% of interventions1). The goal, of course, is to have no injuries or deaths due to medical errors.

Merry believes this is simply not possible in a physician-centered system. According to published research, most medical errors in hospitals are due to lack of communication amongst the professionals involved in a patient's care. As long as the system is physician-centered, these communication errors will continue to happen.

The "second curve" model is centered on the patient. All involved in providing care are fully engaged and regularly communicating. The hierarchy is flattened, and the needs of all involved are met, not just the primary doctor or the patient, and a culture of safety and excellence pervades the organization.

Merry presented a most interesting example: currently in the first curve medical system: When a woman goes to see her doctor because of the possibility of breast cancer, it takes 1 to 8 weeks before she knows the result of the biopsy. These are defined as the "sleepless nights." There is no real reason for the delay other than the long string of communications that have to occur before the patient is finally informed. In a second curve system, the patient is informed in 2 hours. Yes, the same day after a short delay, not endless days of worry later.

Merry believes that integrative medicine has already moved a long ways into the second curve model and is the future of healthcare. Nice to hear a non-IM physician recognize the importance of our movement!

Conclusion. This conference was a very positive experience, documenting the great strides this new medicine is making.

¹ Gandhi TK, et al. Adverse drug events in ambulatory care. BMJ. 2003;348:1556-64

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Technorati Tags: integrative medicine, healthcare, complementary medicine

New Diet and Exercise Guidelines for Cancer Survivors

The American Cancer Society (ACS) has updated its 2003 guidelines on the use of diet, exercise, and nutritional supplements by cancer survivors. These guidelines, often cited as the official statement of the conventional cancer community on complementary and alternative (CAM) therapies, could be improved.

FULL STORY:

The ACS diet and exercise recommendations continue to be authoritative but not as helpful as they could be.

The diet recommendations describe whole foods diets high in fruits, vegetables, and whole grains; low in saturated fat; and low in refined sugars. These are important recommendations as a huge body of research shows that a whole foods diet low in processed foods is one of the most effective ways to prevent cancer.

The ACS exercise recommendations push aerobic exercise for nearly every cancer survivor, consistent with evidence showing improved quality of life during cancer treatment with regular exercise. We would like to see more emphasis on strength training.

The disappointing aspect of the new recommendations is their complete dismissal of the growing body of research showing specific nutritional supplements can help with some of the symptoms cancer survivors face. The official statement argues that because antioxidant supplements could potentially prevent chemotherapy from having full treatment effect, all nutritional supplements should be avoided.

The most striking problem with this generalization is that not all nutritional supplements are antioxidants. L-glutamine, often used for the prevention of neuropathy, and vitamin B6, used for the prevention of hand/foot syndrome, are two examples of the many well-researched non-antioxidant nutritional supplements of potential benefit to cancer survivors. Many more clinical pearls of this nature could and should be part of future versions of these guidelines.

Read the full text of the ACS Guidelines.

References:

1. Doyle C, Kushi LH, Byers T, et al. Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin. 2006 Nov-Dec;56(6):323-53.
2. Vahdat L, Papadopoulos K, Lange D, et al. Reduction of paclitaxel-induced peripheral neuropathy with glutamine. Clin Cancer Res. 2001 May;7(5):1192-7.
3. Fabian CJ, Molina R, Slavik M, et al. Pyridoxine therapy for palmar-plantar erythrodysesthesia associated with continuous 5-fluorouracil infusion. Invest New Drugs. 1990 Feb;8(1):57-63.

Related Topics:

• WebMD Video: Cancer and Exercise
• Nutrition to Help You Fight Cancer

Technorati Tags: integrative medicine, supplements, antioxidents, cancer, diet, exercise, health-and-wellness

Flu Season

This week, we find ourselves right in the peak of flu season. Luckily, it looks as though the particular strains of flu going around this year are fairly mild.

Of course, if you are currently suffering through the body aches, respiratory problems, and gastrointestinal symptoms of the flu, it may not feel like a mild flu season. Here are a few recommendations to help get you back to health if you are feeling down.

FULL STORY:

If you develop flu-like symptoms and are concerned about your illness, especially if you are among those at high risk for complications of the flu, it's best to check with your doctor. People at high risk for complications include those who are 65 years or older, those who have chronic medical conditions, pregnant women, and young children.

Tests can determine if you have the flu - if you're tested within the first 2 to 3 days of illness.

A doctor's exam can also identify whether you have the flu or a more serious complication. Flu can often be complicated by pneumonia, and when it is, it should be treated aggressively. When secondary bacterial infections, such as pneumonia, are not present, antibiotic therapy is of no help in the treatment of the flu, and should be avoided. You should also never give aspirin to children or teenagers with the flu, as serious side effects could potentially occur. If fever spikes uncomfortably high, Tylenol or cool sponge baths should help.

It is particularly important to drink lots of liquids to maintain hydration during acute illness, especially if diarrhea or vomiting occur. Many people use sugary sports drinks or fruit juice for this purpose; I prefer a nourishing clear vegetable broth or minimally sweetened vitamin and mineral drinks like Emergen-C.

Many traditional herbal treatments have been shown to be effective to treat acute infection. Elderberry syrup, sold in the U.S. as Sambucol, is one of my favorites, especially for children, who enjoy the flavor. Researchers have found it to be both safe and effective. Take one tablespoon four times daily, one and a half teaspoons four times daily for children. Start at the first sign of illness for the best results.

If you have a sore throat, try boiling 4 tablespoons marshmallow root (you can buy this in bulk from many healthfood stores) in 2 quarts of water for a half-hour or until the liquid gets thick and syrupy. Cool, strain, and mix with 4 tablespoons of honey. Use 1 teaspoon at a time as needed until your symptoms improve.

Keep in mind that you can spread infection from the day before symptoms start until about five days after getting sick. Obviously, you can't do much about the day before symptoms start, but try to minimize social interaction and get plenty of rest in the period after getting sick. The extra rest should get you back up and running in a matter of days.

Related Topics:

• CDC recommendations on influenza
• Germ Warfare: Common Cold & Flu Culprits

References:

1. Kinmonth AL, Fulton Y, Campbell MJ. Management of feverish children at home. BMJ. 1992 Nov 7;305(6862):1134-6.


2. Zakay-Rones Z, Thom E, Wollan T, Wadstein J. Randomized study of the efficacy and safety of oral elderberry extract in the treatment of influenza A and B virus infections. J Int Med Res. 2004 Mar-Apr;32(2):132-40.


3. Basch E, Ulbricht C, Hammerness P, Vora M. Marshmallow (Althaea officinalis L.) monograph. J Herb Pharmacother. 2003;3(3):71-81.

Technorati Tags: colds, flu, integrative medicine, natural remedy