CAMLAW: Complementary and Alternative Medicine Law Blog

Acupuncture assessed; integrative health program suggests health coaches

Scientists discuss acupuncture, while integrative medicine enthusiasts promote health coaching.

The Washington Post says that Millions Embrace Acupuncture, Despite Thin Evidence:

A study published in December by the National Center for Complementary and Alternative Medicine (NCCAM), a part of the National Institutes of Health, found that 3.1 million adults and 150,000 children used acupuncture in 2007, seeking relief from ailments including headache or back pain, insomnia and attention-deficit disorders. That was about 1 million more adults than in 2002, when the last NCCAM survey was done. "In the consciousness of the American public, acupuncture has become white bread," said Joseph M. Helms, a physician who trains medical doctors in acupuncture techniques.

The people who go regularly for treatment swear by it. Some wouldn't miss a week. Others scoff that it's complete hokum and that you would get just as much help from a nap.

The American Medical Association takes no position specifically on acupuncture; the AMA groups it with other alternative treatments, saying "there is little evidence to confirm the safety or efficacy of most alternative therapies." It says "well-designed, stringently controlled research" is needed to evaluate its efficacy.

Then a bunch of scientists who know nothing about chi give their opinions about what acupuncture does to the brain.

Yes, there's neuroscience, and then there's energy.

Stress sucks. So try some alternative remedies:

'While it is perfectly normal to feel 'stressed out' throughout the year, millions of Americans are suffering from increased stress and tension due to the downturn in the economy,' said Dr. Deborah Baldemor, family practice physician and Integrative Medicine Fellow with Cigna Medical Group.

Baldemor goes on to day, 'The good news is that there are ways to regain control and manage the added stress in your life.'

Dr. Baldemor offers the following tips as ways to regain control and manage stress:

Stick to a financial plan.
Slow down and simplify your life
Exercise to maintain energy and reduce stress, including yoga
Maintain healthy sleep habits
Eat healthy, drink in moderation; too much alcohol has depressant generating effects
Don't get caught up in "gloom and doom" discussions
Identify what's making you feel stressed, and then focus on what you can control

Patients are bargaining down their hospital bills, reports the NY Times.

Charges for lab work can be exorbitant. But, as with hospital bills, the numbers you see on your statement may not reflect what most insurers actually pay, according to Dr. Woodson C. Merrell, chairman of the department of integrative medicine at Beth Israel Medical Center in New York.

Negotiate just as you would with your doctor or hospital. Quest Diagnostics, the largest clinical laboratory in the country, for instance, offers a six-month interest-free payment plan, as well as financial assistance for those with real hardship.

Cross-cultural psychiatry resembles integrative medicine in bridging healing modalities. It's being used to help monks who have been beaten, heal from PTSD:

The Western diagnosis was post-traumatic stress disorder. But Dr. Michael Grodin of the Boston University School of Public Health has treated Tibetans for 15 years and knew better than to limit himself to Western concepts. He added a Tibetan diagnosis: "Srog-rlung," an imbalance of the "life-wind," and added Eastern treatments to the Western antidepressants he prescribed.

"Whatever works," Grodin said.

These days, Togden can smile again, even occasionally laugh, and though his heart remains in Tibet with his people's struggle for greater freedom from China, he said the treatment has helped him to feel and meditate better.

In a paper published today in the journal Mental Health, Religion, and Culture, Grodin and his colleagues at Boston Medical Center's refugee health center describe the East-West treatment he tailored for Togden and seven other Tibetan monks in Boston. It included Taoist breathing, musical bowl-playing, and Eastern movement practices such as Tai Chi and Qigong, along with Western-style talking therapy and medications.

Today's study is the first published paper to describe attempts to integrate Western and Tibetan medicine to help traumatized monks, said Grodin, also a professor of human rights, psychiatry, and community medicine at Boston University School of Medicine.

Grodin's efforts fit into a growing field called cross-cultural psychiatry, which aims to offer more culturally sensitive mental health care to immigrant groups. It entails efforts to understand and work with foreign medical interpretations, such as the Tibetan belief that many ills can stem from problems with the "life-sustaining wind" that controls the body's health and harmony.

Some are urging that 'health coaches' be more active to help people with health prevention and promotion:

Real health care reform requires revamping the medical hierarchy, opening the field for health coaches, nurse practitioners, naturopathic doctors and allied health professionals.

Global Health Media
FOR IMMEDIATE RELEASE
(415) 785-7987

By Dr. Meg Jordan, PhD, RN

(SAN FRANCISCO)--Most of the Congressional debate for health care reform revolves around ways to extend reimbursement for sick care. However, paying for more of the same fragmented, costly care isn't reform, it's madness.

The $2.2 trillion health care system, the costliest in the world, requires a new top-to-bottom vision, and although the 600 doctors and health professionals gathered at the Institute of Medicine's Summit on Integrative Medicine last month didn't agree on everything, they reached a resounding consensus about the need for Americans to change their health habits. Yet how can that best be accomplished?

With a primary shift toward health promotion, disease prevention and wellness, a revamped health care system could put the brakes on the disastrous trajectory predicted for 2012, in which total health care costs would equal 20% of the Gross Domestic Product (GDP). Providers, employers, and even insurance companies finally concede that the US would fall behind the world's nations in every imaginable sector if one out of every dollar of our productivity went toward health care costs.

For over 30 years, the National Wellness Institute has been reporting that 8 out of 10 Americans suffer from chronic ailments derived from unhealthy lifestyles: poor diet, inadequate physical activity and unmanaged stress. Yet the difficult task of behavior change has always fallen on individuals, without much support from the medical system or their doctors.

In addition, cultural support has been lacking for the most at-risk populations, often minorities with higher rates of diabetes and obesity. At present, there are more obese Americans than overweight ones--an almost unthinkable statistic.

Cultural support for healthy lifestyles starts with community activists demanding bike paths, public parks, safe streets, farmers' markets, fresh food options and more from their local governments. Together with cooperation from industry, government, health care, and public health officials, pressure can be placed on developers to build environments that provide opportunities for physical activity. Teachers, parents and consumers can demand that Big Food stop advertising cheap, non-nutritious, calorie-dense, processed foods to kids and young adults. Schools can offer nutrition and PE classes again, and lunch programs can teach kids about healthy choices--and provide them!

Should Your MD Get Paid to Teach Wellness?

"Lose weight, stop smoking, start exercising, and cut down on your stress--and I'll see you next year for your physical." Everybody knows that the once-a-year admonition from your doctor rarely translates into new health habits.

A new tier of health coaches can supply the support and encouragement needed for Americans to begin their journey towards maximizing personal health. Health coaches should be part of every public clinic, medical office and hospital wellness center. They should be reimbursed by insurance companies, or be part of the first-access tier of Medicare, Medicaid, private insurance companies and corporate wellness programs. Even Dr. Mehmet Oz suggested that health coaches should be considered a central part of health care reform to CNN's medical reporter Dr. Sanjay Gupta.

Instead of medical doctors expecting to be reimbursed for providing health promotion and wellness services (at rates exceeding $200/ hour), health coaches could easily provide this service at one-fifth the cost. They would also present a more friendly, accessible, peer-support approach to individuals. The specialized training of medical doctors is best directed to complex cases, whether acute or chronic.

The entire continuum of care needs to be re-examined and opened up to include reimbursement for health professionals that investigate the foundational causes of chronic illness, and who understand and have specialized skills in countering the ill effects of unhealthy lifestyles--professionals such as Nurse Practitioners, Naturopathic Doctors, and Traditional Chinese Medicine doctors, Homeopathic doctors, and Chiropractors.

For too long, there has been an active collusion barring the advancement of these professions by certain medical organizations with insurance companies, and the public has suffered as a result.

When these allied health professionals spoke up, demanding inclusion at the reimbursement table at the Summit on Integrative Medicine, a few medical doctors such as Dean Ornish, MD, championed this democratizing of the medical landscape, but others kept insisting that their own practices could accomplish wellness services, if only they were properly reimbursed.

However, reimbursement for lifestyle counseling should not have to include the major overhead encountered by medical doctors, including their clinical offices, costly tuition loans, high-tech equipment, numerous staff and billing clerks.

It's been said that the US health care system is neither healthy nor much of a system. I believe it's always darkest before the dawn of a new era, and these dark days of an ailing system must mean the light is about to break over the horizon.

Bringing health coaches into the US health care system can address the colossal "elephant in the middle of the room"--that the burden of disease and related health costs can be dramatically lowered through healthy behavioral change. Learning to move more, eat well and less, and de-stress often, is not only a prescription for a better life, it's an Rx for US health care reform.

# # #


Meg Jordan, PhD, RN, is Dept. Chair and Professor of Integrative Health Studies, California Institute of Integral Studies, San Francisco. She is a medical anthropologist, specializing in behavioral medicine and integrative health. Reach her at mjordan@ciis.edu

Meg Jordan, PhD., RN
Sausalito, CA
Phone : 415-785-7987

The author teaches in this program:

Integrative Health Studies is a two-year, nonclinical master's degree program (40 units) that prepares graduates to enter the innovative field of integrative health and medicine, which blends modern medicine with time-honored perspectives on mind-body-spirit wholeness, traditional healing, and complementary/alternative modalities.

At the intersection of science and spirituality, integrative health is an exciting field that attracts students interested in deepening their holistic self-care practices, as well as professionals who have a variety of licenses and certificates in allied health professions.

CIIS is a WASC-accredited institution of higher learning that embodies spirit, intellect, and wisdom in service to individuals, communities, and the Earth.

Graduates of the program work successfully as:

Integrative health practitioners in private practice
Integrative wellness coaches
Integrative medicine clinics administrators
Integrative health practitioners in hospitals
Wellness program managers and coaches in corporations
Spa managers and owners
Practitioners in wellness clinics
Holistic health educators
Mind-body healing practitioners in physicians offices
Directors of international nongovernmental organizations
Our unique and leading-edge program captures the essence of CIIS integral education through intellectual rigor, applied learning, and embodied practice.
Students build skills that align with personal and professional goals by selecting electives that complement the foundational courses in the curriculum.

Stamford (not Stanford) discusses adaptogens:

The concept of adaptogens dates back thousands of years to ancient India and China, but modern study did not begin until the late 1940s. Adaptogens are natural herb product that are said to invigorate, and allow the body to counter adverse physical, chemical, or biological stressors.

Joe Feuerstein, MD, Director of Integrative Medicine, Center for Integrative Medicine & Wellness at Stamford Hospital, Instructor in Clinical Medicine at Columbia University Medical School. Training directly under Dr. Andrew Weil, Dr. Feuerstein has completed a Fellowship in Integrative Medicine at the University of Arizona, and is board certified in Holistic Medicine and Family Medicine.

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