1. Nutrition and Lifestyle: Diet, Exercise, Sleep and Stress Management

The purpose of this section is to help bring about a better understanding of the interplay between a lifestyle that promotes health and the role of nutrition while leading your everyday lives. It is to help bring about an awareness of how diet, exercise, proper sleep and stress management can have a positive effect on your daily living and how it can have a beneficial impact on health, longevity and an overall better quality to your life. While the interplay between these may be subtle they tend to weave themselves into a rich tapestry that provides the basic mechanism for how we lead our daily lives and interact with our environment.

a) Diet:
Nutrition and diet as a basis for health is not a new concept, with ancient Chinese physicians emphasizing food selection and even proper cooking techniques as therapeutic modalities. During the Dhou dynasty, dating back from 1,000-400 BC, the classic "The Yellow Emperors Guide to Internal Medicine" described the use of nutrition and the use of foods as medicines which many traditional physicians in China use to this day. In the country of India, those practicing in the Ayurvedic tradition use what is known as "rasas", or the 6 basic tastes which make up a part of Ayurvedic medicine. Even Hippocrates wrote that we should let food be our medicine and medicine be our food.
So with all this being said, where do we start when discussing the role of nutrition in health and disease? In the 1990's less than 1/4 of the medical colleges in the United States had a course on nutrition in their core curriculum despite a general understanding that the use of food and eating habits to promote health and both treat and prevent disease has been well documented. There has been a vast amount of research that shows what people eat in their regular day can have an influence on their likelihood of developing chronic illnesses like heart disease and diabetes.
In 2 separate studies by DeLorgeril et al, the first in the prestigious British medical journal Lancet in 1994 and the second in the journal Circulation in 1999, he and his team described how a Mediterranean diet had a 70% reduction of dying from cardiac death or suffering a heart attack and if you had a heart attack and started this diet there was a reduction in the risk of both cardiac death and another heart attack. This was coupled with decreased incidence of having angina (chest pains), a stroke, congestive heart failure and a blood clot, as well as a 47% reduction in hospital admissions. The Harvard University School of Public Health discovered variations on the diet, depending on the region of the Mediterranean where the diet was derived, but many key components had a common basis. The diet contained an abundance of fruits and vegetables, usually locally grown and were consumed either raw or minimally processed. They noted that olive oil was the principal oil that was utilized and, given current research that appears to show that this oil will actually raise HDL (good cholesterol); this may be part of the cardiac protection noted in the research. There was low to moderate consumption of dairy products and little use of animal protein in the diet. A regular exercise program was part of the regimen and alcohol, usually wine, was consumed in moderation.
Another landmark study, authored by T. Colin Campbell PhD, in what may be the most comprehensive study every conducted in the field of nutrition called "The China Study", described the role of animal proteins in our diet and the devastating effects they have on nearly every aspect of our health. Dr. Campbell described the interplay between animal proteins and heart disease, cancer, obesity, autoimmune diseases and a variety of other disorders. Dr. Dean Ornish called Campbell’s' book one of the most important books on nutrition ever written. Nobel Laureate Robert C. Richardson, PhD stated it was a story which needs to be heard. Sushma Palmer, PhD, former Executive Director Food and Nutrition Board, U.S. National Academy of Sciences stated it described the fallacies of the modern diet and lifestyle and was a compelling rationale for a diet to promote health and reduce disease.
In the DASH (Dietary Approaches to Stop Hypertension) Study reported in the New England Journal of Medicine in1997, which also had a diet with it, there was a marked reduction in high blood pressure and in the second DASH study reported in the journal Clinical Cardiology in 1999; there were even greater reductions in hypertension. In this diet there were recommendations that were similar in many ways to the Mediterranean Diet and if followed had many of the same risk reduction and disease prevention benefits. So what does all this mean? Nutrition in the United States is at a critical state with over 60% of Americans now overweight. The American Journal of Clinical Nutrition stated in 2003 that the current trend in America of eating a diet high in saturated fats has a high correlation of leading to diabetes and obesity. According to a Yale study, published in the New England Journal of Medicine in 2002, 25% of obese children are already glucose intolerant and at high risk for developing diabetes. In what was previously thought to be a disease of the elderly these children face a future of coronary heart disease and kidney failure just to name a few complications. In the past decade obesity in the United States has risen 30% and there are now over 20 million Americans with diabetes. These are staggering numbers that can be directly attributed to poor nutrition and lack of exercise. Many contributing factors can be isolated; amongst them is a greater caloric intake. We in the United States now consume on an average 500 calories more a day that we did just a decade ago. There has been an increase in the intake of calorie dense foods as evidenced by the proliferation of fast food establishments and higher soft drink consumption. Research continues to find more metabolic and digestive disorders from our consumption of trans-fatty acids, refined foods and low fiber intake. Currently our fast food industry is over 100 billion dollars in revenues a year and shows little likelihood in decreasing. Interestingly enough Harvard researchers found that in a 3 year period between 1996-1999 the number of children who ate meals outside the home doubled which corresponded with an increase in childhood obesity. An article in Lancet 2005 detailed how people who frequently eat in fast food restaurants gain more weight and are more likely to develop insulin resistance than those who don't. It is estimated that more than 10% of the food consumed by children is fast food, with a corresponding weight gain. The data is in and well known to researchers in this field, but there has been appalling lack of dissemination of this information to the public and the fast food industry has shown an equally appalling lack of desire to change their habits and dismantle what has become for them a cash cow business.

b) Exercise:
Exercise is slowly becoming one of the most underutilized modalities to help combat disease, despite being widely recognized as beneficial in the fight against obesity, diabetes, coronary artery disease and degenerative joint diseases. In addition, it improves the overall quality of life, controls both blood pressure and helps to maintain a more balanced cholesterol. In a study reported in the Journal of the American Medical Association in 1989 it was noted that regular exercise reduced both the risk of cardiac death and helped to lower cholesterol; despite this, billions of dollars are spent each year on cholesterol medicine alone. Paffenbarger et al reported in JAMA in 1999 that having poor cardiorespiratory fitness was a strong indicator for cardiovascular disease(CVD) and was equal to diabetes as a predictor of CVD. Regular exercise reduced the risk of cardiac death by 50%, more than many of the other drug therapies used to control blood pressure and cholesterol. In Social Science Medicine 2005 it was noted that if a a physician mentioned overweight or obesity to a patient, there was a reduction in the calories consumed and an increase in the probability of utilizing exercise as a means for weight control by the patient. The amount of exercise recommended is conservative and can be tailored to overall physical condition and stamina. At the Heart and Vascular Institute, located at the Cleveland Clinic in Cleveland, Ohio, there are basic recommendations for both aerobic exercise, like jogging or a treadmill and anaerobic exercise like weight lifting. The standard recommendations are to subtract your age from 220 and maintain this heart rate for at least 30 minutes with an adequate warm up and cool down period, but this can be adjusted if lack of conditioning is prevailing at the beginning of your training program. This can for as little as 3 times a week or even daily if desired. All of the requisite information can be found at the site for the Cleveland Clinic @ www.clevelandclinic.org

c) Sleep:
We live in a fast paced world, all of our own creation, and in the process manage to deny ourselves one of the most basic things our bodies need. Most people don't even recognize the necessity of sleep, yet without it we suffer in ways not easily recognizable. In an early article printed in Psychophysiology in 1981, the cumulative effects of sleep deprivation of only 1 hour a night stretched over 1 week showed the equivalent of a full night without sleep. If only 1.3 to 1.5 hours of sleep was missed in 1 night alone there was as much as a 32% decrease in daytime alertness, as noted in the journal Sleep in 1995 . Further research into sleep deprivation was noted in Sleep 2003 which showed that cumulative sleep deprivation revealed both cognitive disruption as well as behavioral changes that were largely unrecognized by the individuals who were suffering the sleep loss. Sleep loss has always felt to be benign yet this loss of sleep comes at a neurobiological cost that not only accumulates over time but causes overall performance lapses in our everyday life. Even our children are at risk for sleep deprivation which further research documented in Sleep as far back as 1981, which showed that they would require up to 36 hours after a single sleep deprivation incident to return to a baseline.

d) Stress and Stress Management:
The purpose of this section is to open a dialogue into what we are putting into our bodies, the effects that these compounds may play in not only increasing the stress on our bodies but also the deleterious effects that these same compounds may have on the developing brains and minds of our children. We are all familiar with the recognizable forms of stress, whether it be a deadline at work, a school project that is due or even the drive through traffic to get to work, but the real question is are we recognizing all the forms of stress and do we have a reasonable approach to managing these stressors. One of the early pioneers in the field of stress and stress management was Hans Selye MD. Dr Selye recognized that unmanaged stress, which frequently was just the process of poor adaptive processes would manifest in what he called General Adaptation Syndrome (GAS). Dr. Selye was an endocrinologist by training so his interest was in the area of hormonal response to stress and the effects that these hormones had on the body. Dr. Selye understood that stress played a significant role in the development of all types of disease. Dr Selye described 3 distinct phases of stress which he named; alarm, resistance and exhaustion. Dr. Selye further described stress as anything that puts a demand of the body and not just the "nervous stress" that we have all come to recognize. The alarm phase is what we call the "fight or flight" phase where the body is preparing it self for whatever the stimulus is that is coming in. No one can stay in this phase for long and we quickly go into the phase where resistance to the stress is built. The final stage is one of exhaustion or the aging process where we are worn down due to wear and tear.
Recognizing this and having a mechanism in place to deal with this is critical if ones health is to be maintained. In the Journal Psychiatry in 1974 and in a course currently offered as continuing education through Harvard Medical School, Dr. Herbert Benson described the physiological changes that can be elicited through simple practices like meditation, yoga, hypnosis and autogenic training. A body of evidence demonstrates a host of beneficial responses all designed to reduce the overall stress on the body. In this type of response, which is the opposite of the "fight of flight" process described by Dr. Selye, which is a sympathetic nervous system approach, the relaxation response, as it has been coined by Dr. Benson, has been shown to reduce anxiety and pain, decrease muscle tension has a positive effect on a host of other diseases with a more beneficial health outcome ensuing. Even in the medical literature, where much of the information is to assist medical students as they enter training, there has been shown to be a process of improvement in the immune system, decrease in the depression and anxiety states, an increase in both spirituality and empathy for patients, an improvement in their overall level of sensitivity, greater coping skills, enhanced ability to resolve conflicts and a much better understanding of stress itself. This article found in Academic Medicine 2000 should be a must read not only for every student entering medical training, but also the essence of the information should be dispensed to everyone looking to decrease their own stress of to establish better coping skills for handling stress.
But what about the stresses that are hidden, those that we don't think about or don't even know about? Are there stressors that are in our daily foods, those things we consume that we assume are safe for us yet may be causing irreparable harm to our children and even causing changes in how we deal with our everyday environment? In a landmark book "Excitotoxins: The Taste That Kills", the brilliant neurosurgeon Russell Blaylock MD describes an almost frightening process where NutraSweet (aspartame) has been linked to brain tumors, brain cell damage as well as Alzheimer's and Parkinson's Disease. He describes numerous scientific studies including one by Shephard et al in Food and Chemical Toxicity 1993, Sorg et al in Neuropsychopharmacology 1998, Trocho et al in Life Sciences 1998 and Hardcastle et al in Prostaglandins, Leukotrienes and Essential Fatty Acids in 1997 as concrete evidence that aspartame is a dangerous chemical that needs considerable more scientific investigation before it is allowed to used by the general unsuspecting public. For the download of a very revealing expose on aspartame which is free I would recommend going to aspartamekills.com, while the download is somewhat choppy the access to other material is well worth the acquisition if you or any loved one is suffering from any type of a neurological disorder. In what will probably be groundbreaking research in the correlation between aspartame and cancer researchers in Bologna Italy found a direct correlation between aspartame and cancer to be present. But what is more frightening is the rise in attention deficit disorder (ADD) and the attention deficit hyperactivity disorder (ADHD). A basic understanding of the molecule aspartame is in order here; aspartate-methanol-phenylalanine is how it looks and it appears that the problem arises when this molecule is broken down. Many of the research articles illustrate how the individual components may cause problems since the body easily breaks down aspartame to its components, and as much of this starts as soon as the chemical is ingested in the mouth. If for example you are a diabetic, and these chemicals accumulate in areas that are already under assault from the effects of, say, diabetic neuropathy, then further progression of your nerve damage is almost a given. In an easy to read article that gives some good references, doctors at Birth Defects Research for Children Inc. give some interesting insight into how many of the components could elicit a problem. In a breathtaking review of literature from around the world John V Dommisse MD reveals the relationship between many substances and ADHD. MSG is another additive that has been permissively allowed to be used without an adequate disclosure of the potential health risks. In a host of research dating back to the 1950's and up to more recent research by researchers in Hirosaki Japan, evidence has been found linking MSG to damage to the retina. While many of the mechanisms may not be readily understood, the empirical data seems to be accumulating as accounted for by Meldrum as long ago as 1993.
If these compounds are indeed producing ADHD, as many researchers and authors claim, then it lends even more concern when recent findings in the field of radiology revealed that actual damage was found in the brains of children with ADHD and the area of damage was intimately involved with emotional processing and hyperactivity. As chilling as all these findings may be we believe that they are a call to action to not only protect ourselves but also the lives of our children

Conclusion:
An incredible amount of information was just presented with numerous things to be considered. So let’s try to distill all of this data down to a few caveats to be put into place in our everyday lives. We have just learned how important our food is in our daily lives, more than just fuel to keep our basic metabolism afloat, but rather a source of nutrients that can help to prevent heart disease, diabetes, obesity and hypertension amongst others. We have learned how food additives can have a profound deleterious effect on our brains and the brains of our children. We have also discovered that these same chemicals can effect the very formation of the developing brains of our children and produce aberrent behaviors, as well their being implicated in various degenerative disorders like Alzheimers and Parkinson’s Disease and recent links to cancer and retinal damage. We have further learned that something as simple as exercise for just 30-45 minutes a day 3 days a week not only has a profound effect on things like hypertension, obesity and diabetes, but also minimizes the risk of heart disease or heart attack. The role of sleep and the need for a good nights rest cannot be overlooked and the management of stress should play a central role in our daily lives.
For most of us, considering this information will necessitate a major change in how we eat and what chemicals we allow in our food. I suspect, despite the increased hassle of reading labels for what is in our food, all of us who take our health seriously will become more astute as to what we are putting in our bodies and the bodies of our children. The hope is that this information will lead to an active search by lay people and an active dialogue by people in the healing arts fields to pursue a more healthy lifestyle for themselves and their loved ones.

Healthcare Today by Cindy Reed, RN, ThD, PhD

The state of American health is declining, and the healthcare system is in crisis. Healthcare in the United States, while touted by Americans as the best in the world, is dysfunctional, costly, and a burden on the economy that threatens to bankrupt us. We need new solutions to the problems and issues that are outside the widely accepted medical model, solutions that take advantage of advances in other areas such as science and spirituality. Health is not an isolated physical condition, as depicted by the current medical model, but is an intertwined and interdependent blend of physical, emotional, social, spiritual, and environmental determinants. Health is an issue that is critical not only to the well being of our citizens, but to our economy and our way of life as well.

THE COST OF HEALTHCARE

Currently healthcare costs comprise one sixth of our national economy and consumed 15.4% of our Gross National Product in 2003, a higher percentage than any other major industrialized nation, and up from 7% thirty years ago. In contrast, education spending as a percent of the Gross National Product has remained steady during that same time period at 6%. In 2003, 45% of the costs of healthcare were borne by public programs like Medicare and Medicaid, which is predicted to increase to 49% by 2014. Another 40% of the cost of healthcare is borne by business: General Motors reportedly spends $1,400 per vehicle to provide healthcare for its employees and retirees, more than the cost of the steel. Some predict that in nine years, by 2014, we will spend 3.6 trillion dollars on healthcare, or 19% of the U.S. economy. As of the mid-1990’s, the federal government was spending 20% of its budget on healthcare. Still, a large part of the problem, identified by the Tufts Managed Care Institute, is the healthcare systems’ increasing capacity to provide care, which is not necessary or beneficial, and is of marginal utility.

The system that costs so much is also the leading cause of death in America: iatrogenesis, not heart disease or cancer, kills more of us than anything else. Bartlett and Steele explain how we spend more money and have less to show for it than other developed countries:

"We don’t adequately cover half of the population. We encourage hospitals and doctors to perform unnecessary medical procedures on people who don’t need them, while denying procedures to those who do. We charge the poor far more for medical services than we do the rich. We force senior citizens with modest incomes to board buses to Canada to buy drugs they can’t afford in America. We clog our emergency rooms with patients because they can’t get in to see their doctors. We spend more money treating disease than preventing it. We are victims of rampant fraud and over billing. We stand a good chance of dying of a mistake if we are admitted to a hospital, and we kill more people with prescription drugs than with street drugs like cocaine and heroin. We have an endless choice of healthcare plans, but most people have few real choices. We are forced to hold bake sales, car washes, and pancake breakfasts to pay the medical bills of family members when a catastrophic illness strikes."

It is a complicated, multi-interest system where the business incentives are aligned to keep people unhealthy. People are beginning to seek alternatives to the current system, and utilizing their own resources to improve their health. According to Paul Zane Pilzer:

"Approximately 1.4 trillion dollars a year is dedicated to the “healthcare industry”, while another 200 billion this year will be spent on what are commonly referred to as wellness products. It is projected that by 2010, the “wellness industry” will be an additional 1 trillion dollars of our US economy. Yet, 85% of individuals finance their medical care through a system of insurance that absolves them in large part from any direct responsibility for their medical expenses while disallowing any preventative services for reimbursement."

Healthcare costs to employers are skyrocketing in this system, and the proliferation of HMO’s and managed care, as a way to control costs, has been the beginning of the end of the free-for-all system of care. Health insurance plans attempt to control costs by restricting access to providers, eliminating costly treatment benefits, requiring pre-approval for care that meets medical necessity criteria, restricting access to certain medications through “approved formularies”, charging higher deductibles and co-payments for services, as well as increasing health insurance costs to the employee. These have all failed to impact the rising cost of care.

Paradoxically, as technology advances and systems of care proliferate, as interest in maintaining and improving health increases, and the appeal of complementary and alternative medicine grows, the health of our nation seems to be declining instead of improving. In June of 2004, Time Magazine reported that one of the latest health epidemics to strike the American people is the ‘Epidemic of Obesity’. Despite the proliferation of nutrition and exercise information, as well as health risk information available, in 2004 over one half of all adults in the U.S. are overweight, and one half of those are officially obese. By 2005, only 30% of Americans identified themselves as overweight or obese, while the Health and Human Services Department of the Federal Government classified 64% of Americans as overweight or obese. Starfield found 40% of the American population — 100 million people — to be suffering from serious chronic disorders. While some, such as Tufts Managed Care Institute and current political candidates tout the healthcare system of the United States as offering the highest quality of care in the world, the reality is that 15% of Americans have limited or no access to healthcare because they are uninsured. In addition, the United States falls behind other industrialized countries in population based healthcare measures such as life expectancy and infant mortality. Iatrogenesis is now the leading cause of death in the United States. In their definitive reviews of medical journals and government health statistics, Null, Dean, Feldman, Rasio, and Smith found:

"…that American medicine frequently causes more harm than good. The number of people having in-hospital, adverse drug reactions (ADR) to prescribed medicine is 2.2 million. Dr. Richard Besser, of the CDC, in 1995, said the number of unnecessary antibiotics prescribed annually for viral infections was 20 million. Dr. Besser, in 2003, now refers to tens of millions of unnecessary antibiotics. The number of unnecessary medical and surgical procedures performed annually is 7.5 million. The number of people exposed to unnecessary hospitalization annually is 8.9 million. The total number of iatrogenic deaths is 783,936. It is evident that the American medical system is the leading cause of death and injury in the United States. The 2001 heart disease annual death rate is 699,697; the annual cancer death rate, 553,251."

Yet, our research dollars, institutions of higher learning, the government, and private organizations do not focus on finding a ‘cure’ for the sickness that is our healthcare system, but instead concentrate on diseases like cancer and heart disease. Overall, therefore, while there is lots of care being produced, it seems to be making us worse, not better. Clearly a change is needed if we are going to stay healthy and not bankrupt the country. But where to start?

THE PROBLEM

There are five principal parties in the healthcare system: consumers (clients), government, insurers, providers, and the legal system. Each plays a key role in maintaining not only the dis-ease of the system, but of our declining health as a nation. Though we call it an industry, the healthcare system it is really not structured like the other industries in a free market economy. In a free market economy, consumers and sellers of a product come together with the benefit of competition. In health care, the consumer is not really the purchaser. There are two purchasers of healthcare: employers, who purchase health care insurance from payors, and the government, which purchases care for its Medicare and Medicaid programs from providers. Employers and the government provide coverage for 85% of the population. The government mandates the price it will pay providers, based on complex formulas that providers can’t understand. Payors (who provide coverage to employers), who understand that the government prices are the lowest that providers will accept, try to negotiate prices as close to the governments rates as possible. The providers have no ability to negotiate with the government on pricing or scope of services covered, but they do negotiate with payors individually. Of course, providers, who have no option but to accept government prices, want to increase prices to the payors, so that they can maintain profit margins. The providers set charges for their services; however, the payors negotiate discounts on the charges. In reality, the only people who actually pay what the providers charge are the 15% of the American population with no insurance. The purchasers of healthcare (employers) are precluded from negotiating collectively with providers (the rules and regulations of the healthcare system make it cost prohibit for employers to do this), which means the payors have significant control. As long as the payors can charge purchasers more than they pay providers, they have little incentive to invest in new methods of health care provision. Providers, who are receiving discounted fees from payors, and deeper discounted fees from the government, also have little incentive and few resources to improve efficiencies or contain costs.

Managed care has attempted to control costs through capitation arrangements, in which providers are given lump sums to provide care for a group of people or for a set of services to a group. In theory, this gives providers an incentive to control the direction and costs of care. However, consumers now have an entitlement mentality because they have been taught that their insurance will pay for whatever they need. Consumers are insulated from the costs of care and have been trained by the system to expect that they can have whatever services they need while their insurance coverage lasts. This has begun to change recently, as employers have had to cut benefits or implement cost sharing strategies (such as deductibles, co-pays, and co-insurance) to attempt to deal with the rising cost of healthcare. However, consumers continue to demand what they perceive to be high quality in health care, much of which they learn about from television, advertising, and the internet. This puts providers in the position of explaining to consumers what is truly needed from a medical perspective and what is not. Yet providers have been trained to make treatment recommendations based on what a consumer’s insurance would pay for, and have not risen to the challenge of managed care: that providers would actually manage the care of the consumer. The interesting thing is that in our healthcare system, the definition of quality healthcare actually comes from the healthcare system itself. Pharmaceutical companies, insurance companies, healthcare systems and their suppliers, and powerful professional organizations through their advertising campaigns and lobbying of the public and legislature(s), all define quality healthcare in terms that protect their own parochial interests and profits.

In our system, if a consumer perceives that quality services were not rendered, s/he can turn to the court system and use legal recourse to make the provider, insurance company, or health institution pay monetarily for the perceived mistake. Thus, the legal system and lawyers in particular are also beneficiaries of the structure of our healthcare system. Healthcare has provided a growth opportunity in the legal specialty of malpractice. Malpractice also provides additional business for insurance companies, as now providers must protect themselves against the consumers they treat, while consumers use this avenue of problem resolution to protect themselves from incompetent providers. This avenue of recourse for consumers has encouraged providers to give consumers the most healthcare possible, in an effort to avoid prosecution. This then increases costs to the payors (insurance companies), who, in order to maintain profit margins, increase prices to employers. The government does not respond to the same price increases, though it must be aware when its funding level puts the service delivery system out of business. Institutions that are primarily funded by the government have a very difficult time making a profit.

John McKnight, in his book The Careless Society: Community and Its Counterfeits, goes beyond the typical analysis of healthcare system failure to identify the roles that all the parties play in maintaining a system that is diseased itself. McKnight asserts that the problem is not that we have ineffective service producing systems, but that our systems are too powerful, and our communities too weak. He believes that:

"The most significant development transforming America since World War II has been the growth of a powerful service economy and its pervasive service institutions. Those institutions have commodified the care of the community and called the substitution a service."

McKnight believes that physicians, and the institutions that have grown up around healthcare systems, are exemplary models for professionals seeking imperial prerogatives. At the core of our healthcare system is a paradigm for modernized domination, which functions through the propagation of a therapeutic ideology. The basic creed of the ideology is: “1) the basic problem is you, 2) the resolution of your problem is in my professional control, and 3) my control is your help”. The essence of this is to mask the control that the healthcare system wields behind the smokescreen of therapeutic help.

Obviously, our healthcare crisis begs for reform of the system. Unfortunately, healthcare reforms perpetuate the dis-eased system, as the healthcare systems themselves define both the problem and the solution. Rather than significantly changing the system to benefit those it attempts to serve, each reform is a new growth opportunity for the system to exert control and expand its influence. McKnight views the current reforms in Table 1 as advancing medicine’s hegemony:

Table 1 . Healthcare Reforms and Their Result.

Reform

Result

1. Effort to ensure equal access to medical care (supporting doctors in underserved areas, programs to increase the number of healthcare workers, regulatory systems allocate beds based on medical need). 2. Focus on improving the quality of healthcare (increased professionalization and review processes are supported by federal, state and medical practitioners). 3. Attempts to deal with costs (comprehensive prepaid systems, HMO’s, Medicare/Medicaid and the national health insurance discussion represents efforts to conquer the medical systems’ growing capacity to consume the gross national product). 4. The effort to involve “health consumers” in the system (government and medical industry gradually enabling non-professionals to participate in the decision making processes of the system). 5. The increase concern over ethical issues posed by modern medicine (organ transplants, abortion, life extension technologies provide new crises and new public and professional policies). 6. The preventative healthcare movement (provides policy alternative to “get at the root of the problem”, calling for continuing check ups, screenings, and outreach plans designed to encourage and enable more people to use the system).

1. Achieving equal access broadens clientele base and establishes the right to consume services as a central issue, while litigation establishes the ‘right to treatment’. 2. The guarantee of quality services reinforces the popular belief that that health care professionals know what health is, while the critical issue is making the professionals produce “it”. 3. Cost control ensures a rationalized guarantee of the medical systems income, with the central issue being how to extend the system while lowering or stabilizing the price. 4. Consumer participation co-opts potentially disruptive citizens by providing participation in medicine as a substitute for political action that might affect the system. 5. Ethical reform could limit medical hegemony by concluding that such issues are not medical prerogatives, however, theologians and clergy have been co-opted by expanding their trade and becoming counselors for decisions 6. “Preventative” medical care can make every person a client everyday of his life—medicalized prevention tells us that we need the medical system precisely because we do not perceive a need.

Note: From McKnight, L. (1995). The Careless Society: Community and its Counterfeits. New York: Basic Books p.56-60.

Health care reform to date has not only promoted the growth of the system, but has had political implications as well. In our economy, the expansion of healthcare systems creates new markets, new income opportunities, and forestalls unemployment, all disguised as help. Expanding medical systems also require the manufacture of need, and as each need is created, citizens have an increased sense of deficiency and dependence. To meet the ever-growing demand, we have to have more trained professionals. McKnight believes that an essential function of professional training is to increase the capacity of the trainee to define others as deficient while decreasing their capacity to cope. Also, as physiological health diminishes while medical resources increase, political energies are increasingly consumed with healthcare system reform, which reinforces the need for and the dependence on the healthcare system. Medical care then becomes a placebo for political action. Almost half the patients seen in the U.S. are classified by physicians as being seen for non-physiological problems. When asked why, physicians identify a host of cultural, social and economic problems that might be addressed by political action if patients were not being taken care of in the healthcare system. As public belief in the need for medically defined services expands, people act less like citizens and act more like clients—people who believe that they are going to be better because someone knows better.

Looking at one of our latest epidemics in healthcare, the epidemic of obesity, 88% of those surveyed thought the government was doing too little or the right amount. Only 8% thought the government was doing too much, and 4% were unsure. Curiously, the Time magazine poll indicated respondents thought that the top two causes of obesity were not getting enough physical exercise (86%) and poor eating habits (84%). Lack of information as a cause for the epidemic was at the bottom of the list. This suggests that McKnight is on the right track with his ideas about how the current system of care keeps the public dependent and despondent: the top two causes are well within individual control, however, 88% of the respondents wanted the authorities to continue or increase addressing the problem.

Healthcare, through its processes and institutions, has had the unintended side effect of making health and healing mysterious, to the point of commodifying the service so that people consume it, even if they don’t understand it. The system clearly appears to be set up to serve those who run it. We have all been co-opted as consumers and/or players in the system services. As McKnight points out:

"Many people encounter a life interruption, call it a disease, and take it to a doctor or a hospital where it is treated un-understandably by people who speak in mystifying tongues. The result is for the “person” to become a “patient” in the face of the malady. The malady becomes a commodity of the medical profession, and health becomes a consumable as citizens become “health consumers”. There is, of course, no possibility that health can be consumed. [The] health consumer….is a medically engineered mythical being has entered the fantasy life of modern society and emerged as a client…[which] is the necessary commodity to meet the needs of the medical system. Thus health becomes a new medium for converting citizens into clients who consume the systems commodities in order to achieve well being."

The fact that 15% of the population has no health insurance and thus limited access to the system might just save their lives. McKnight quotes the motto placed on bottles of famous medicine maker, Eli Lilly, in his early days: “a drug without side effects is no drug at all”. In fact, McKnight asserts that the negative side effects of the healthcare system are now manifest at multiple levels of our everyday lives, so much that we hardly notice the program to perpetuate dis-ease running in the background. In the future we will see increasing public awareness of the abdication of our power as individuals within the healthcare system, the ways in which we unwittingly participate in advancing the growth of the system, and the steps we can take to reclaim what is actually our health.

REFERENCES

1. Healthcare can be cured: Here’s how. (2004, October 11). Time Magazine, 164, p. 50.


2. Numbers. (2005, March 7) Time Magazine, 165, p. 25.


3. Health, United States, 2001(on line). Available from http://www.cdc.gov/nchs/products/pubs/pubd/hus/heexpend.pdf; accessed 24 November 2001.


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Brief Discussions on NIH/CAM Modalities

The following information is a byproduct of a large collaboration thru the National Institute of Health and American Medical Student Association and its plans for educational development in the field of Complimentary and Alternative Medicine (CAM).

1. Nutrition and lifestyle: diet, exercise, sleep and stress management.
While a lot of this should be common sense, not enough is given to these subjects, especially since lifestyle covers nutrition, physical fitness, hygiene, sleep and stress management. Social adjustment, worldview, culture and personal choices are all determining factors. Even Hippocrates, considered the father of modern medicine and over 2,500 years ago, wrote about the roll of food as medicine and modern nutritionists stress that food choices and eating habits may promote health and prevent disease. Exercise has long been recognized for its roll in decreasing the incidence of diabetes, obesity, coronary artery disease and arthritis, but is still woefully underutilized as a means to improve the quality of life. Chronic stress and improper handling of stress has been shown to be harmful to the body and can impact adversely virtually every disease known to man. Sleep deprivation of even 1 or 2 hours in a single night has been shown to decrease daytime alertness by as much as 32%.

2. Mind-body Medicines
Mind-Body medicine has its roots in modern medicine with the work of Elmer Green and his work with biofeedback and by the work of the Harvard researcher Dr. Herbert Benson, through his studies of meditation and relaxation. Mind-body medicines stress the interconnectedness of the physical, chemical, mental and spiritual components that make up a healthy individual. There are numerous techniques that stress these modalities that include biofeedback,relaxation training, meditation, spiritual healing, guided imagery and prayer with many more too numerous to list. There are literally thousands of scientific articles that show the effects of mind on body and vice versa.

3. Traditional Chinese Medicine, Kampo, Tibetan Medicine and Acupuncture
Traditional Chinese medicine (TCM) is a system of healing that developed over a period of 4.000 years and is the oldest system of healing known to man. TCM has 4 main components; 1) acupuncture, a system of healing based on the theory that there are energy flow patterns (qi) that are essential to health and that the disruption of these lead to disease, 2) herbal medicine, consists of specific compounded formulas for a specific syndrome or group of syndromes, 3) tui na, this is a form of chinese massage to promote lymph drainage and rejuvenate muscles and 4) qi gong, which is a practice of energy movement in the body through specific physical movements. Kampo is Chinese herbal medicine therapy that was adopted and modified by the Japanese, Kampo is now accepted by many health care coverage systems in Japan. Tibetan medicine is an adaptation of Ayurvedic medicine with influence from Chinese medicine and has its roots in Buddhism as it is practiced in the areas around Tibet.

4. Yoga and Ayurveda
Yoga is a Sanskrit word that describes a process of uniting the body to the mind and they are then joined together with the soul, or the union between the individual self and the higher self. Yoga as a healing philosophy is over 2,000 years old and is described as a mechanism where the thought process is restrained and the mind becomes serene. Ayurveda is the Sanskrit term for "knowledge of life" and is a comprehensive system of traditional care that stresses the interconnectedness between body, mind and spirit. Ayurveda seeks to restore and individuals innate harmony. Hand in hand these disciplines function where Yoga is a spiritual tradition from which Ayurveda has emerged as a healing modality.

5. Homeopathy and Flower Essence Therapy
Homeopathy as a healing modality is over 300 years years old and is a medical approach that uses minute doses of substances for the purpose of stimulating a healing response. They describe a process of "like cures like" and might for example use heat on the body for the purpose of breaking a fever. But they will also use a variety substances in microdose quantities to assist in the natural healing response. Flower essence therapy describes plants and flowers as having unique vibrational qualities where if used properly can have a positive impact of balancing both emotional and physical imbalances.

6. Bioenergetic Medicines
Bioenergetic medicines, also known as energy medicine, utilizes subtle energies known by many names, amongst them are vital force, qi and prana. Numerous healing modalities utilize these energies including, Reiki, magnet therapy, qi gong and therapeutic touch. The 2 main categories of Bioenergetic Medicine are 1. Bioelectromagnetic therapies and 2. Biofield therapies. A TENS unit (transcutaneous electrical nerve stimulation) is a good example of a bioelectromagnetic therapy. Whereas Biofield therapies uses the body's own subtle energies for medicinal purposes. These subtle energy techniques are utilized in every medical system in the world except western, which espouses an allopathic approach. These subtle energies are called by a variety of names' innate intelligence by Chiropractic, prana in Ayurvedic medicine, qi in chinese medicine and reiki in the Japanese Usui system as well as many more.

7. Herbal Medicines
Herbal medicine may well be one of the oldest forms of healing known to man. Many of our current medicines in allopathic medicine used today are synthetic derivations of naturally occuring compounds. Herbal medicine is often call botanical medicine or natural medicine and as such utilizes plants and a variety of their residues to provide support for physiological systems and to assist in the healing or prevention of a variety of diseases. Herbal products are frequently known as phytomedicines and phytoestrogens are currently being touted for their non-carcinogenic side effect while still providing adequate support for menopausal women, just to site an example. Aromatherapy relies primarily on the essential oils of plants and has 2 main components. The first may involve preparations for internal or external usage. The second involves an inhalation process from various compounds to achieve a desired effect. Naturopathy is a healing system that emphasizes prevention and utilizes plants and natural substances for a variety medical conditions.

8. Nutrition, Dietary Supplements, Vitamins/Minerals
This area flows seamlessly with the #1 section (Nutrition and Lifestyle) as here we are supplementing our basic diet with various nutrients for both the prevention and treatment of diseases. We are using foods (macronutrients) and various supplements (micronutrients) to help provide an optimal environment for health. An illustration of this is the action of British sailors, known later as "limeys", and their use of limes while at sea to prevent scurvy. They did not realize at the time that the Vitamin C in limes prevented disease, in fact the Vitamin C molecule had not even been discovered, but they understood empirically that by eating the limes they stayed free of scurvy, which is a disease of Vitamin C deficiency. In much the same way 50 years of accumulated scientific evidence has shown us that foods and supplements have a powerful influence on treating disease and maintaining health. This field of endeavor is little recognized by western allopathic medicine despite huge contributions by many leading scientists, including Nobel laureate Linus Pauling and his colleague Dr. Jeffery Bland.

9. Chiropractic and Osteopathy
The commonality of these 2 approaches is that they both espouse the use of manipulation of the musculoskeletal system to affect a change in the overall health of the body. They both believe that there is a structure/function relationship and that by removing interference the body will re-establish its inherent ability to heal itself. They also believe disease will ensue when there is an interference/abnormality present. Osteopathy has its roots in an allopathic physician, A.T Still MD, who became disgruntled with the treatment of disease in the mid 19th century. He felt that the treatment was frequently worse than the disease, for example the use of mercury compounds to treat a variety of diseases. On the basis of this he started exploring a more holistic approach that included manipulation of the musculoskeletal system and refraining from the use of the more toxic medicinals of the time. Chiropractic was founded some 20 years later under the leadership of D.D. Palmer, a self-educated healer in Davenport, Iowa. The principal focus of chiropractic in its inception was the manual manipulation of the spine for the treatment and prevention of disease. Chiropractic to this day maintains its independence from mainstream medicine, although many branches now extend manipulation to outside the spine. Osteopathy, on the other hand, has become more integrated into an allopathic mode of practice, despite OMT (osteopathic manipulative therapy) being taught to every osteopathic medical student. Hence little OMT is utilized in private practice today by practicing osteopathic physicians.

10. Massage
Massage therapy has at its core a systematic approach of manual or mechanical manipulations of the soft tissues of the body for the purpose of promoting better blood flow, lymph drainage, muscle relaxation and relief from pain. All of these are felt to promote a restoration of metabolic balance and benefit both the physical and mental processes. In this massage therapy carries at its core many of the original principles as espoused by A. T. Still MD when he proposed osteopathy as a new approach to healing. Massage as a healing approach can trace its roots back to ancient Egypt, Babylon, China and India and murals of massage are seen on the walls of pyramids in Egypt. Current massage schools can be generally grouped into 4 main categories; 1) relaxation, 2) structural/physiological change, 3) kinesthetic awareness/somato-emotional repatterning and 4) oriental massage. Currently massage therapy is one of the top 3 CAM modalities utilized today with at least 89% of the people utilizing this technique believing there was some therapeutic benefit.

Table of Contents

The National Institute of Health in its subsection called Complimentary and Alternative Medicine, now called NIH/CAM came up with 10 generalized headings that I will now list. In the coming months we will be discussing all these modalities in more detail, but for the sake of brevity I will name them at this juncture.

Table of Contents

- Introduction

- Healthcare Today by Cindy Reed, RN, ThD, PhD

- Complimentary and Alternative Medicine

1. Nutrition and Lifestyle: diet, exercise, sleep and stress management
2. Mind-Body Medicines
3. Traditional Chinese Medicines, Kampo, Tibetan Medicine and Acupuncture
4. Yoga and Ayurveda
5. Homeopathy and Flower Essence Therapy
6. Bioenergetic Medicines
7. Herbal Medicine
8. Nutrition, Dietary Supplements, Vitamins/Minerals
9. Chiropractic and Osteopathy
10. Massage

Complimentary and Alternative Medicine

My name is Steven D. Lamer DC DO. I am board certified in both family practice and emergency medicine. I am currently working in a Level II trauma center in the emergency medicine department but have been involved in all forms of health care since I got my degree in Chiropractic over 20 years ago. I am in the process of evolving several sites on www.medrounds.org with my good friend Andrew Doan MD PHD. We are interesting in all forms of healing from around the world and our sites will be around both integrative medicine and all the forms of complimentary and alternative medicine as determined by the National Institute of Health. I would welcome any insights and comments that any of my fellow bloggers have regarding these thoughts and I would welcome any potential authors to submit your thoughts on these matters to me stevenlamer@gmail.com. Despite having spent over a decade in allopathic medicine, I am still convinced that there are numerous other healing modalites that need to be explored and nurtured.