Complimentary & Alternative Medicine

stevenlamer@gmail.com (Steven D. Lamer DC DO) — Mon, 16 Jan 2006 04:45:00 +0000

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

3. Traditional Chinese Medicine, Kampo and Tibetan Medicine

stevenlamer@gmail.com (Steven D. Lamer DC DO) — Fri, 10 Nov 2006 21:06:00 +0000

In this chapter we will explore some of the oldest known healing traditions in the world, the healing practices of the Far East: from China and its rich history of herbal medicine and its commitment to energy flows in the body; to Japan and its adaptation of Chinese medicine; and finally to Tibet and the development of a deeply based spiritual practice founded in Buddhism with influences from both India and China.

These practices extend back as far as 5,000 years and are rooted in a respect for Mother Nature and are deeply committed to establishing harmony both in the body and in its relationship to the universe. These are all practices that use the abundance that the earth has provided for us and can be adapted to assist us in bringing about a state of improved health. These are healing modalities that use only organically grown plants and naturally derived substances in their approach to healing. They look for the state of disharmony in the patient and seek, through a variety of ways, to reestablish balance and harmony, as imbalance is the source of disease or dis-ease.

As a western trained physician, I have found little of these ancient healing traditions and philosophies in my training. As western research techniques begin to verify the validity of many of the claims for healing, physicians, like me, find this comforting in enhancing the possibilities for the patients that we treat.

1. Traditional Chinese Medicine

Perhaps the oldest system of healing in the world is the field known as Traditional Chinese Medicine, or TCM. Elements of this broad field are more that 4,000 years old and span the known history of the Chinese civilization. This field encompasses therapeutic interventions that were based on pathophysiologic concepts derived from the scientific thinking of the time and is a comprehensive system of medical thinking. TCM is an all natural healing modality that encompasses and array of over 6,000 herbal remedies and other products for not only the treatment, but also for the prevention of disease. This healing art has spread from China to now include Japan, Korea and parts of Southeast Asia and as such these practitioners have made their way into the United States as a distillation of these various approaches in their general practice.

To truly understand TCM one must have an appreciation for the philosophical base out of which this healing tradition emerged. At the heart of TCM is an awareness or understanding that the same forces that govern the universe also regulate the human body. TCM attempts to assist the individual patient to eliminate imbalances within themselves and thus allow for a free interaction with their environment. This interaction is from a state of wholeness, from which the current “holistic” movement in the world is believed to be derived. The TCM approach has it roots in the Daoist tradition, which is an approach to life, just as TCM is to healing arts. I will not attempt to define Daoism as this has been the source of discussion from some of the great philosophical thinkers from China for many millenniums. A simplified definition for our purposes is that a power envelops, surrounds and flows through all living as well as non-living things. That Dao, or power, regulates natural processes and also seeks and nourishes balance in the body, like it nourishes balance in the universe. TCM believes that by restoring this energy flow, or power, a balance is brought about that will assist in bringing the patient into closer harmony with the universe and thus to a state of health and well being.

TCM as it is practiced in the US has 4 main components: acupuncture, herbal medicine, tui na and qi gong. Herbal medicine is a system of healing that utilizes various formulas that are designed to treat a variety of symptoms and disease processes. Despite its age, herbal medicine includes in its practice fields that resemble our current practices of internal medicine, pediatrics, gynecology and as well as treating a variety of diseases in the field EENT, or eyes, ears, nose and throat. Tui na is a Chinese medical theory that utilizes massage and manipulation techniques to help maintain or restore the flow of energy that travels through the body in specific channels or meridians. This energy flow is called Qi or Chi and through restoration of this process the body heals itself naturally. Qi gong is another philosophic approach that utilizes Qi, or energy flow, and is a system of physical training, various aerobic exercises, isotonics, isometrics, meditation and relaxation techniques to help us gain control over these very life forces that radiate through our bodies via these meridians. Acupuncture is also a system of healing that utilizes these energy meridians, focusing on the disruption of these channels, which they believe are instrumental in causing disease. Acupuncturists insert needles into these meridians to assist in opening any blocks that might be present and thus restore a healthy flow of qi into areas that are suffering from a disease state.

Herbal Medicine

Herbal medicine is the oldest known healing art in the world. It is over 4,000 years old and much of what we enjoy in our current healthcare system was derived from folklore as handed down from generation to generation. Even today many of our drugs used in allopathic medicine are herbally derived and approximately ¼ of our prescription drugs dispensed today contain an active ingredient from a plant. While many of our other prescriptions written in the West do not contain plant ingredients they do contain synthetic substances that mimic plant compounds.

Even today, an estimated 80% of the world’s population uses herbal remedies for parts of their health care regimen. There is not a single culture known to man that does not utilize herbal plants and herbs as part of their healing arts. While the oldest known culture to record the use of herbs was China, this practice is found in every indigenous peoples approach to healing from around the world. Ayurvedic Herbalism came from India; the herbalism we practice in the United States, that is not rooted in the practices of the indigenous people of North America, came to us from Rome and Greece. The World Health Organization or WHO, states that there are over 100 plant derived pharmaceuticals and that over 70% of these are used exactly like the traditional uses of native cultures.

A good example of a Chinese herbal medicine that is still in use today is ephedra; this herb is rumored to be over 5,000 years old and is known in Chinese medicine as Ma huang. Ephedra is also an herb that was placed under FDA restrictions because of its use by those individuals trying to lose weight or enhance athletic performance. Yet despite this, the herb Ma huang is still utilized safely by herbalists, acupuncturists and practitioners of oriental medicine. Much like the field of medicine, these compounds need to be prescribed by individuals trained in the appropriate fields of endeavor. Another good example that is more current than ephedra, yet still old by today’s standards, is the herb foxglove. Foxglove, or digitalis as those of us practicing medicine would call it, is an herb that has been used to treat a variety of heart diseases since 1775. To this day digitalis, also called digoxin or lanoxin, is used to treat congestive heart failure and is used as an adjunct therapy in the condition known as atrial fibrillation. In the hands of skilled practitioners this is an excellent tool, yet when an overdose of this herb occurs it is usually severe and frequently fatal.

In a recent study done in Taiwan, Republic of China, a Chinese mushroom called Ganoderma tsugae was assessed for efficacy in treating inflammation of the bronchoalveolar system, also known as the lungs. This approach, utilizing current laboratory standards used to assess physical changes, found a reduction of inflammation, as well as possible assistance into therapeutic applications for allergic asthma (1). In another study conducted at the Department of Chemical Pathology, The Chinese University of Hong Kong, Shatin, Hong Kong, China, 2 herbal formulas, (San Ju Yin and Yu Ping Feng San), were used to assess whether TCM could assist in the treatment of SARS (severe acute respiratory syndrome). Their conclusions were promising in the treatment of viral infections including SARS and merit further research (2). In another study looking at localized skin irritation the herbal extract Wu-Zhu-Yu, a substance derived from the berry fruit of Evodia rutaecarpa, was found to have a powerful anti-inflammatory effect when applied topically to human skin (3).

The potential applications and implications for herbal medicine are tremendous and likely underused by us practitioners of allopathic medicine. On a promising note the National Institute of Health (NIH) is sponsoring research on herbs and other modalities to assist in the treatment of diseases from cancer to depression. All of this points to a renewed interest in natural modalities that should assist in lowering health care costs and lessening the potential side effects of many of our currently used drugs.

Tui na

Tui na is the ancient art of Chinese massage and manipulation of body tissues to promote the flow of Qi through improved lymph drainage and muscle rejuvenation. This process uses a variety of techniques with the hands to massage the soft tissues of various body areas, as well as acupressure points being directly stimulated to assist in the flow of Qi throughout the body. The ancient art of bone-setting, seen in today’s world as Chiropractic or Osteopathic manipulative medicine, is undertaken to realign various musculoskeletal relationships. Tui na may also employ the use of external agents in the form of salves, poultices or compresses to help assist in this process, these being done to aid in the promotion of unimpeded flow of Qi in the body.

Inside of Tui na itself are several philosophical approaches including ones that focus on soft tissue injuries which involve themselves with muscle strains and ligamentous sprains. Another school that focuses on acupressure meridian points to assist in the treatment of internal disorders, and another school focuses on the regeneration of depleted energy systems in the body. The manipulation of the joints to promote better alignment of the musculoskeletal system is the focus of another school, concerning itself with nerve like pain and joint injuries. On an interesting note, Tui na is now catching wider acceptance into western schools of massage and its slow incorporation into the western culture is now being seen.

Tui na is a difficult modality to measure as so much of what has been reported is subjective. In a study reviewed in the Journal of Alternative and Complimentary Medicine; May 2006, Vol. 12, No 4:395-399, Tui na was used in conjunction with acupuncture and qigong and while there did appear to be some subjective improvement in improving depression and quality of life, there was no improvement in overall motor scores in treating Parkinson’s disease patients.

Much of the ongoing research is being conducted in China and references are found in their journals, one of which is the journal called “Clinical Observations”. Massage or Tui na is used in conjunction with a variety of other modalities and anyone interested should peruse these studies. This is a difficult area to do any of the western double blind studies because much of the end result is a subjective feeling of better health from the recipient, yet in the west many of the medicines we prescribe are given for the express purpose of symptom reduction, which we assume leads to the patient feeling better.

Qi gong

Qi gong is an ancient Chinese practice of body movements coupled with different breathing patterns and postures to promote the movement of Qi in the body. Qi gong also utilizes meditation that assists one to develop the skill of attracting vital energy. Qi gong utilizes visualizations to help enhance this mind/body connection and to assist in the healing process. There are 460 different movements to be learned in this approach and a variety of breathing techniques as well. Qi gong is a self healing technique and is an acquired skill that anyone can master.
At the heart of Qi gong is a state of mental relaxation, controlled breathing and physical movements. Studies are being done world wide that focus on this therapeutic approach. In one interesting study from India, this approach was utilized to see if blood pressure could be modified, and a temporary fall in blood pressure was found after only one session. (4). In a study trying to improve the quality of life in cardiac patients it was found that progressive relaxation coupled with Qi gong did indeed improve the quality of life along certain physiologic and psychologic parameters, reaffirming the previous studies of the positive effect of Qi gong on the psychologic dimension (5).

Exercises in controlled breathing have been found to be beneficial in patients suffering from multiple sclerosis (6). In a study in Taiwan Qi gong it was found that a common side effect of chemotherapy, a decrease in white blood cell count, called leukopenia, could be counteracted in breast cancer patients.(7). In a study reported in the Townsend Letter it was found that blood pressure improved greatly, as did pulmonary function, in a study of 58 volunteers. This study revealed adrenaline levels (epinephrine and norepinephrine), fell significantly, which could account for the drop in blood pressure (8). In an article published in the American Journal of Chinese Medicine, Winter 2001 a surprising and statistically significant change was observed in the immune system’s white blood cells, polymorphonuclear cells, or PMN’ and their increase in phagocytic activity after undergoing Qi therapy by a Qi master. What this means is that our white blood cells (PMN’S) were potentially more adept at doing their job of detaining and removing pathogens, or those substances that could harm us, from our bodies. Qi gong has shown some very interesting results in people suffering from heroin withdrawal and a reduction in symptoms utilizing this approach (9). In another study Qi gong had a positive effect on blood pressure, as well as having an efficacious effect on producing an improved lipid profile as well (10), 11).

All this points to a therapy that is underutilized, I suspect because it is misunderstood. There are no known side effects from this treatment and all signs seem to point to its potential as a powerful adjunctive treatment modality whose inclusion into a western practice can only have a beneficial impact, not only on the patient but also for the physician and its subsequent benefit towards lowering health care costs. Further research on this is worthy of merit and by all appearances this could easily have a profound effect on many areas of health.

Acupuncture

Acupuncture is probably the most well known Chinese healing modality in the west. It is over 2,500 years old and it too is based on the belief that there are energy flows, called qi throughout the body, and that the disruption of this energy will produce disease. These flows traverse through systems called meridians which are anatomically consistent, residing just below the surface of the skin. Correct stimulation, through a variety of techniques, can promote a reduction of a disease state and lead to better health.

While the most recognizable technique is through the use of a thin solid needle that is placed in very specific areas corresponding to various organs systems, laser type treatments can be used to stimulate these points, as well as acupressure. If the needles are used there can be either manual manipulation or even stimulation by an electrical current as part of the therapy.

The acceptance of acupuncture in the west grows by the day as over 5,000 individuals in the U.S. alone incorporate this modality for the treatment of pain relief, pain prevention and for a host of medical conditions. These practitioners include physicians, dentists, chiropractors and acupuncturists and as such the FDA has now classified the needles used by acupuncturists as surgical devices and imposes upon them the same stringent restrictions it does on any surgical device to restrict the transmission of disease.

Acupuncture has been in wide use in the U.S. since the 1980’s and due to this the National Institute of Health conducted a conference in 1997 for a general review of the literature and studies known to that time. After thousands of such studies were reviewed it was found that acupuncture was superior for the treatment of nausea resulting from chemotherapy as well as post-operative nausea. It appeared to also have excellent efficacy in post-operative dental pain as well. The conference concluded with the recommendation that further research needed to be undertaken, as acupuncture also showed promise in not only the painful conditions noted above, but also in such diverse conditions as asthma, arthritis, stroke rehabilitation, fibromyalgia and menstrual cramps. Many of these recommendations are currently underway under the direction of the NIH.

There has been a fair amount of basic science research done in the field of acupuncture with ongoing research as we speak. In a study from the late 1980’s electroacupuncture was found to have a pain reducing action through a mechanism that appears to be opioid in nature (12). There appeared to be a release of the bodies own natural painkillers or endorphins in response to the acupuncture intervention. In another study using advanced radiological techniques known as functional MRI, a correlation between acupuncture points and eye disorders was found. This is similar to the correlations found in the oriental literature between activation of specific areas of the brain and acupuncture points (13). In another study corroborating this activation of specific brain areas it was found that the same effect could not be found if attempting the same stimulation on non-acupuncture points (14). For those individuals less likely to follow the more metaphysically based meridian theories of qi manipulation, a study was reported that showed that either acupuncture or acupressure seemed to be producing a neuroelectric stimulation for the gene expression of neuropeptides (15). This study further concluded that this process could be easily taught to physicians and that it was a useful tool for the modulation of pain as well as a variety of other conditions.

Many of the studies are at least thought provoking to say the least. Studies showed that acupuncture would not only decrease heart rate and pulse rate, but would also seem to cause relaxation, calmness as well as reduce feeling of tension and distress when a particular site was stimulated (16). Vasomotor symptoms, or hot flashes, like those that are experienced by menopausal woman, as well as both breast and prostate cancer patients undergoing chemotherapy, have been found to be ameliorated or lessened, by using specific acupuncture points (17). Acupuncture has been found to be useful in Crohn’s disease (18), radial nerve paralysis as well as aggressive and obsessive behavior (19) and has a beneficial effect on the gastric mucosa, or lining of the stomach (20). These are just a few of the studies that are available for perusal for anyone truly interested in investigating this healing approach.

Of all the modalities to be found in Traditional Chinese Medicine, acupuncture is by far the most researched, recognized and accepted of these various treatments, perhaps because there is a tangible entity that is being utilized, i.e. the needle. Anyone interested in this approach could easily find both the disease process and the therapeutic intervention that would be used in the treatment of that same disease. For anyone new to these fields, and filled with any degree of skepticism, I would recommend starting with acupuncture and then venturing into the other fields as their comfort level grows with these ancient and still practiced healing arts.

2. Kampo

To truly understand Kampo from a historical perspective one has to appreciate our last subject, Traditional Chinese Medicine (TCM). The actual word Kampo comes from the 2 Chinese characters Kan, which means “from China” and po, meaning “way”. Kampo is the Japanese adaptation of TCM. Several thousand years ago there were numerous texts present in China for the use of herbs for healing. The Japanese practitioners found this to be too cumbersome so they simplified this vast array of knowledge into a system that would be more efficient and thus easily standardized. Out of this distillation process Kampo was born and is still practiced to this day. It should be noted that the number of herbal formulas used dropped from roughly 17,000 to only 365, one for each day of the year.

For the most part Kampo is almost entirely plant based in its approach with only fossilized bone and some shells used in the formulas. Yet this is not the only departure from western based medicine. In the west we use a diseased based diagnostic system, where we attempt to find a specific cause for the illness and attempt to eliminate this as the basis for our therapy. In Kampo, like most of the eastern based medicines, the emphasis is on what they call patient based diagnosis, where the emphasis is on finding the state of disharmony in the patient that is causing the illness, and then using herbs, either singly or in unison, to help bring about a harmonious state back and thus a resolution of whatever illness the patient is suffering from.

Kampo, like TCM, also balances the essential life force, qi (ki in Japanese). It is the flow and balance of this qi that is the determining factor in the health of the patient. Kampo further believes that the food we consume is instrumental in absorbing qi from the environment. Kampo utilizes plants and herbs in their therapeutic approach to correct the imbalance. The life force that is being harnessed in the particular herb or plant goes directly to the target organ to bring about the balance required to correct the state of disease that is present.

Kampo survives to this day, despite numerous attempts to bring an end to the therapeutic modality, such as the incursion of western thinking from the Portuguese in 1590 and the Spanish in the early 1600’s, as well as the Dutch in 1639. In the early years of the 20th century Kampo staged a resurgence and today the Japanese Ministry of Health, Labor and Welfare have approved 148 Kampo formulas for coverage and reimbursement in their national health insurance plan. Kampo is now deeply integrated into the health care system with approximately 75% of the Japanese physicians prescribing Kampo formulas on a regular basis.

There has been an enormous amount of research into Kampo, primarily in Japan, and likely due to its inclusion into the Japanese system. An entire book could be written just on Kampo research so I will only highlight some of the more interesting studies underway so as to give the reader a chance to see that this is not an unscientific healing modality, but a viable and powerful adjunct to any practice of the healing arts.

In a recent study the Kampo extract Saiboku-to was found to have beneficial effects toward asthma as well as anxiety (21). In the elderly, there is a condition known as chronic subdural hematoma (CSDH), a condition where an accumulation of blood arises in the head, which can occur spontaneously with no known cause and little to no symptomotology present. By using the Kampo medicine known as gorei-san-ryo there has been shown to be a fairly rapid resolution of the hematoma without surgical intervention (22). This approach appears fairly promising as surgical evacuation has all the requisite complications as with any surgery, and in addition the hematoma would frequently come back even after the surgery. In only one case studied using the Kampo intervention did the patient need to go to surgery to remove the hematoma.

Recent research into the roll of hange-kobotu-to on patients with functional dyspepsia is very promising (23). Dyspepsia is the medical term for indigestion and is a frequent diagnosis in western medicine. By utilizing this Kampo medicine there was found to be a significant reduction in the symptoms surrounding dyspepsia and that these results suggest that this is through the process of gastric emptying. Anyone suffering from delayed gastric emptying of diabetes, also known as diabetic gastroparesis, would find this study enlightening to say the least.

Whether it be an adjunct in the treatment of chronic fatigue (24), or providing assistance in memory enhancement (25), Kampo shows promise as a viable modality. With the increased prevalence of strokes and TIA’s (transient ischemic attacks) an interesting study utilizing “chotosan”, a Kampo medicine, showed very interesting results for reducing the transient induced learning impairment after an ischemic event. Ischemia is where a part of the body has a decreased blood flow to that area, since blood carries the oxygen on the red blood cells this can lead to damage to that area, when that event happens in the brain, but blood flow resumes we call that a TIA, when blood flow is not restored we call that a stroke.

In a very interesting study looking at threatened abortion in early pregnancy, when the traditional Kampo herbal remedy known as xiong-gui-jiao-Al-tang was used, there was found to be a beneficial effect in stabilizing the pregnancy (26). In western medicine we have no real adjunct to assist in stabilizing threatened abortion during the early phases of pregnancy. Yet we also have the postpartum period, the time after the delivery of the baby, where we frequently see depression.. In this time period there can be wild mood swings in the mother where she can even harm her baby while in this debilitated state. In a study using the Kampo herbal remedy xiong-gui-tiao-zui-yin there appeared to be a stabilizing effect of the psychological state with improved mental health (27). There are even studies to improve the physical condition of the postpartum woman (28).

The purpose of this section was not to give all the research based evidence available for the efficacy of Kampo, but rather to give the reader a sense of the scope of the evidence available. There appears to be fairly overwhelming amount of data available for even the most skeptical of individuals to see that this is a healing modality that was not only founded in antiquity, but still holds up well to the scientific inquiry of the day. I would suggest that anyone interested in finding out more about this healing approach start reading on their own and they too will be amazed at how thorough the evidence for this healing art truly is.

3. Tibetan Medicine

The actual origins of Tibetan medicine as a distinct entity, much like all the modalities in this chapter, are obscured by the passage of time. It would be a safe assumption to say that this healing art is at least 2,000 years old and possibly 2,500 years old. There does appear to be a strong influence from India in the Ayurvedic traditions but also some influence is present from Chinese medicine as well.

In the 7th century A.D. King Gampo of Tibet adopted Buddhism in Tibet as the religion and under his auspices he called for a medical convention. Physicians from many neighboring countries attended, including doctors from India, China, Nepal, Persia as well as the Byzantium Empire. The free flow of acquired knowledge and ideas that were exchanged were responsible for the assemblage of the texts that became the framework of the medical system and approach that comprises Tibetan medicine to this date. The most gifted of the physicians were invited to stay and assist the king in his attempt to put into writing all of this material so that it could be taught and shared by anyone interested in this field of endeavor.

This phenomenal body of literature has in it the oldest known written system on psychiatry as well as a storehouse of knowledge on the use of herbs in the treatment of a variety of diseases, both physical and psychological. The physicians who practice Tibetan medicine function under a code of ethics that hold them to the highest standards possible, it is believed that they operate on more than the physical and emotional level, but also on the spiritual level as they minister to their patients. The feeling amongst these physicians goes to the heart of the Buddhist tradition: that there is an inherent relationship between the mind and the body, and that by maintaining the patient’s connections to the natural world through spirituality there will an affect on the health of the patient and minimize illness.

At the heart of Tibetan medicine is what is known as the four Tantras. These were teachings that were taught by the Buddha himself and all Tibetan physicians study these 4 texts as the basis for their practice.
1. The First Tantra: this is called the Root Tantra and is contains an explanation for all diseases.
2. The Second Tantra: this book has 31 chapters and it explains the anatomy and physiology of our bodies, as well as the events of both birth and dying.
3. The Third Tantra: this book has 92 chapters and deals with the cause, nature and treatment of diseases as well as their classification.
4. The Fourth Tantra: this book has 25 chapters and has in it 18 different methods of diagnosis, pharmacology and treatments available.
The Buddha gave these teachings for the benefit of sentient beings and for the physicians to help assist their patients in being healthy and living a long life, for them to learn to walk in a life of spirituality, to be happy and even to accumulate richness. This has been misinterpreted to mean monetary wealth when in actuality what is meant is “the essence of immortality”. The practitioners of this healing art are those who in their hearts are truly interested in learning both the material, emotional and spiritual essence and will not only themselves learn, but will also impart these teachings to their patients.

Even to this day Tibetan medicine and the practitioners of this field are held in high esteem in Tibet and Asia, and what they dispense is believed to be directly received from the Buddha himself. The overall concept of well being comprises the mind, body and spirit and when these are in balance and harmony, then will there be the most effective and comprehensive healing possible. Health is actually believed to be a state of balance between the physical, psychological and spiritual elements of ones life.

The overall qualities that are sought for in a physician to practice effective Tibetan medicine are outlined in the Root Tantra and these are:
1. An analytical mind with intuitive qualities
2. Must possess a good heart and be able to show compassion
3. Have respect for medical ethics and be committed to their profession
4. Have no qualms about seeing body fluids
5. Understand that all medicines and medical scriptures are wish fulfilling jewels
6. Be able to have patience in body, speech and mind
7. Always have a desire to learn and gain experience
8. Be gentle of manner, be contented and have a desire to assist the destitute
9. Know by heart the causative factors of diseases and the appropriate treatment
The physician will frequently recite prayers and or mantras during the preparation of the medicines to enhance the potency of the treatment along all lines possible, be they psychological or spiritual.

In an interesting article the Tibetan medicine Padma 28 was found to have beneficial effects in intermittent claudication (29), or pain in legs from activity due to peripheral artery disease. This study was also duplicated in a larger review of the literature from Switzerland. (30). In an other study looking at sepsis, or overwhelming infection, the Tibetan herb Artemisia vestita was found to have an anti-sepsis activity and may be beneficial in treating shock, one of the devastating consequences that accompany this condition(31). In spinal cord injury patients a common complication present is constipation. By using the Tibetan medicine Padma Lax this potentially debilitating condition was relieved (32). This was a patient who was paralyzed from the mid neck down; had his life significantly improved, and this could also be very useful in the general population for constipation as well.

With the rise on chronic inflammatory diseases, like rheumatoid arthritis and atopic bronchial asthma the use of the Tibetan medicine Taban-Arshan would be a welcome adjunct as it appears to have a beneficial effect in normalizing the inflammatory cascade (33). As we see the increased use of a variety of medicines used to treat these diseases, including bronchodilators, steroids and immunosuppressive medicines, certainly a safe and seemingly non-toxic approach would be a welcome adjunct to any practitioners or lay person’s pharmacy. Padma 28 has been shown to have beneficial effects on limiting atherosclerosis, or hardening of the arteries (34) as well as a skin-repairing quality for the same herb (35).

Much of the research is along a basic science, or cellular level, with certain herbs showing antioxidant activity (36) as well as some showing a protective quality towards our own DNA, but also the very unique DNA that makes up our mitochondria. 70% of the fuel that our bodies run on, ATP, is made in the mitochondria so protecting this vital component our cells is of paramount importance (37).

These finding represent just a portion of the research being done the field of Tibetan medicine, but they do show a profound correlation between the information passed down through the millennia and its verifiability through current scientific methods. All of this points to exciting inclusion of many of these formulas into the practice of western medicine; with a host of benefits and without all of the deleterious side effects that many of our current medicines seem to bring with them.

Conclusion:
It is difficult for us to ignore the deep spiritual connection that all of these healing modalities have not only towards the patient but for the practitioner as well. From the practitioner of TCM to the Tibetan physician there is an appreciation for the forces that govern the universe, our connection to these same forces and the need for harmony with both the internal and external environment. I also found myself enthralled with the overwhelming body of evidence supporting many of the ancient claims of these practices. I saw the need for further research to substantiate the further inclusion of these practices in the west to assist in healing, but also to alleviate the apprehensions of the skeptics who resist new ideas or change, no matter how new or different these ancient ideas seem. I only listed a few of the studies available for perusal, but would encourage anyone interested to delve into any of the areas just delineated in this chapter to assist them in allaying any fears they may have about these healing modalities.

1. Int Immunopharmacol. 2006 Feb;6(2): 241-51.
2. Am J Chin Med. 2006;34(1): 13-21.
3. J Dermatol Sci. 2006 Apr;42(1): 13-21.
4. Complement Ther Med. 2006 Jun;14(2): 120-6.
5. J Altern Complement Med. 2006 May;12(4): 373-8.
6. Arch Phys Med Rehabil. 2006 Apr;87(4) :468-73.
7. Cancer Nurs. 2006 Mar-Apr;29(2): 149-55.
8. Townsend Letter Feb-March, 2005.
9. Altern Ther Health Med. 2002 Jan-Feb;8(1): 50-4, 56-9.
10. Int J Neurosci. 2004 Jul;114(7): 777-86.
11. Zhong Xi Yi Jie He Za Zhi. 1989 Sep;9(9): 543-4, 516.
12. Brain Res 1988 Jun 14;452(1-2):227-31 & 232-6.
13. Proc Natl Acad Sci USA. 1998 Mar 8;95(5): 2670-2673
14. Neuorimage 2002 Aug: 16(4): 1028-37.
15. South Med J 1998 Dec;91(12): 1115-20.
16. Am J Chin Med. 2006;34(1):23-36.
17. Acupunct Med. 2005 Dec;23(4):171-80.
18. Digestion. 2004;69(3):131-9.
19. Acupunct Med. 2005 Dec;23(4):190-5.
20. World J Gastroenterol. 2005 Nov 7;11(41):6472-6.
21. Eur J Intern Med. 2005 Dec;16(8):621.
22. No Shinkei Geka. 2005 Oct;33(10):965-9.
23. Phytomedicine. 2005 Nov;12(10:730-4.
24. J Altern Complement Med. 2005 Oct;11(5):895-901.
25. Biol Pharm Bull. 2005 Oct;28(10:1886-91.
26. Am J Chin Med. 2006;34(5):731-40.
27. Am J Chin Med. 2005;33(1):117-26.
28. ibid 2003;31(3):437-44.
29. Atherosclerosis. 2006 Nov;189(1):39-46.
30. Forsch Komplementarmed 2006 Feb;13 Suppl 1:23-7.
31. Int J Mol Med. 2006 May;17(5):957-62.
32. Forsch Komplementarmed. 2006 Feb;13 Suppl 1:31-2.
33. Patol Fiziol Eksp Ter. 2005 Jan-Mar;(1):23-5.
34. Vasa. 2005 Feb;34(1):11-7.
35. J Invest Dermatol. 2005 Mar;124(3):524-9.
36. Zhongguo Yi Xue Ke Xue Yean Xue Bao. 2004 Aug;(4):364-7.
37. Environ Mol Mutagen. 2006 Aug 31;

Brief Discussions on NIH/CAM Modalities

stevenlamer@gmail.com (Steven D. Lamer DC DO) — Mon, 16 Jan 2006 04:46:00 +0000

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.

Healthcare Today by Cindy Reed, RN, ThD, PhD

webmaster@medrounds.org (MedRounds Publications) — Wed, 18 Jan 2006 15:17:00 +0000

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

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

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

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

Tufts Managed Care Institute. (1998). The Healthcare System in the United States: Integrating Costs and Quality [Data file].Tufts University. Retrieved June 10, 2004 from http://www.thci.org/downloads/USHealthSystem.pdf

Healthcare can be cured: Here’s how. (2004). Time Magazine, 164, p. 53.

Dean, C., Null, G., Feldman, M., Rasio, D., & Smith, D. (2003, October). Death by Medicine. Retrieved April 22, 2004, from http://www.newmediaexplorer.org/sepp/Death%20by%20Medicine%20Nov%2027.doc

Bartlett, D. & Steele, J. (2004) Critical condition: How Healthcare in America became Big Business—and Bad Medicine. New York: Doubleday, p. 50.

Pilzer, Paul Zane. (2001).The Next Trillion. Lake Dallas, Texas: VideoPlus Inc. Edition, p. 10.

Lemonick, M. K. (2004). America's Obesity Crisis. Time, 163, 57-113.

Starfield, B. Primary Care 21st Century Challenges to Quality. Paper presented at the May 2002 Primary Healthcare Conference, Wellington, New Zealand. Retrieved February 12, 2003 from http://www.moh.govt.nz/moh.nsf/Files/bStarfieldpdf/$file/bStarfield.pdf. pv(' http://www.moh.govt.nz/moh.nsf/Files/bStarfieldpdf/$file/bStarfield.pdf ','1', 600)

Tufts Managed Care Institute. (1998). The Healthcare System in the United States: Integrating Costs and Quality [Data file].Tufts University. Retrieved June 10, 2004 from http://www.thci.org/downloads/USHealthSystem.pdf

Goran, M. (2004). The Health Care Cost Crisis; Can it be Managed?. Retrieved June 10, 2004, from http://www.bryancave.com/FILES/tbl_s23News/PDF118/783/goran,%20ingrams.pdf
McKnight, J. (1995). The Careless Society: Community and its Counterfeits. New York: Basic Books.

Complimentary and Alternative Medicine

stevenlamer@gmail.com (Steven D. Lamer DC DO) — Mon, 16 Jan 2006 04:44:00 +0000

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.

2. Mind-Body Medicine

stevenlamer@gmail.com (Steven D. Lamer DC DO) — Sat, 11 Feb 2006 15:31:00 +0000

The overall concept of there being an interplay between the mind and body in a state of health is not a new one. As far back as ancient Egypt healing as a modality was addressed on all levels; whether it is the body, mind or spirit. The Egyptians realized that treating the person as an integrated individual carried the greatest potential for a cure of any illness, and this still holds true today. In their world the healing process was an integration of elements of the mind, which may have involved prayers, incantations or spells, and it involved the purification of the body through bathes, herbs and special diets. But always it was the priest and his influence over the mind of the patient that carried the greatest possibility for a cure.

There are basically 3 distinct schools of thought regarding this interplay of the mind, body and spirit;
1. Material - in this state mind and matter are of one nature and arise and exist together.
2. Cartesian dualism - in this state mind and matter exist together in a substantial relationship, but they arise separately.
3. Fundamental mind - mind and matter arise separately but are intimately related.

In the material state the mind is said to function only on a physical level, where thoughts are reduced to chemical reactions and the only things of substance are the hormones and neurotransmitters that are produced. In other words everything that exists only exists because it has a physical reality and the mind is a byproduct of the body. The mind and body work according to the same principles that govern non-organic matter and everything is reducible to its component atoms and such.

Cartesian dualism is the brain child of Rene Descartes, who coined the phrase "I think, therefore I am". Cartesian Dualism, or Mind-Body dualism, is the basis for science and medicine and their separation of mind and body that lingers to this day. This concept is not new by any means, and has been found amongst ancient concepts in the Greek culture where body and mind were found to be of an entirely different essence. Yet is was Descartes who drew a strict distinction whereby the mind was responsible for things like imagination, feelings, will and all forms of rational thought and body was of the material realm. Descartes believed that the mind could cause the body to act and the body could cause the mind to have a variety of sensations. To Descartes the mind had a reality apart from the body while at the same time is was substantially united with the body and therefore had an impact on the physiological state. While he admitted that this approach left many things unexplained he persisted in spreading this philosophy to all who would listen. This type of approach exists in western, or what we call allopathic medicine, to this day due to the persuasiveness of Descartes. Inroads into breaching this philosophy have existed for generations and currently this philosophy is under considerable assault from the field of quantum mechanics. This approach however supports a distinction between physical phenomena and those of a mental or emotional nature.

The third philosophical approach, or the fundamental mind, is well over 2,000 years old and has its roots in ancient Buddhism, yet continues to this day. In this view mind and matter arise separately but are related in much the same way as a rider may mount a horse for a journey. In this approach there is the acknowledgement of a profound connection between the mind and body. Mind and body are seen to have functions that are cooperative as well as having the potential for a profound influence on each other's states. This particular connection is detailed in the latest book by the Dalai Lama "The Universe in a Single Atom" and is well worth the read. The Dalai Lama makes a compelling argument, often times elegant in its grandeur and simplicity, regarding current discoveries in the field of quantam mechanics, and the inability to separate the observer from the observed as distinct entities, as evolving explanations for theories that Buddhist monks have espoused for over a thousand years.

While you can see that this has been a topic of discussion for many millenniums, the discussion continues and is evolving while we speak. Dating back over 4,000 years in ancient Egypt, thru traditional Chinese and Ayurvedic medicine, thru Hippocrates and up the 20th century with the work of Walter Canon, and his documentation of the relationship between stress and neuroendocrine responses in animals, this model of a mind-body relationship has persisted, despite some very dogged opposition at the hands of very skilled and articulate detractors. Even Dr. Henry Beecher, and his use of placebos during World War II when there was a morphine shortage, showed how powerful the mind could be controlling pain.

However the past 30 years has shown a tremendous amount of research in the field of mind body medicine and even before that, in the mid 1960's, Dr Elmer Green began his pioneering research into what eventually became popularized as biofeedback. Dr Green began his career as a physicist and later got his PhD in biopsychology for the University of Chicago and this launched a 40 year career in the field of mind-body medicine. Dr Green has left his mark on the field with his work in the field of biofeedback and psychophysiologic self-regulation. But in reality his work is a combination of his own research and that of Oskar Vogt, the brain physiologist at the Brain Neuro Biological Institute in Berlin. Dr. Vogt noticed that some patients could put themselves in a self-hypnotic state which would have positive effects on their recuperation and could also, independent of this work, relieve many stress related symptoms and diseases.

Biofeedback as field of research goes back over at least 100 years, but it was Dr. Elmer Green who was granted the first NIH grant for research in this field and deserves much of the credit for helping to gain a greater understanding of biofeedback. His work in disseminating this body of information to the general public has helped it gain a much wider acceptance as well. Dr. Green was the father of autogenic biofeedback training and developed his techniques while at the Menninger Clinic with his wife, Alyce Green and with colleague Dale Walters as they studied EEG biofeedback as well as the process of meditation. Elmer and Alyce Green co-authored a wonderful book "Beyond Biofeedback" in 1977 which is a must read for people interested in this field. Dr. Green is well into his 90's and continues to write and research in this field.

Another leader in this field is Dr. Herbert Benson, from Harvard University, who has studied meditation, relaxation and the physiologic response that occurs. Much of his work goes hand in hand with that of Dr. Green and both are to be congratulated for looking outside the box of western allopathic medicine to help bring these healing modalities into the forefront of the healing arts. Dr. Benson explained in his book "The Relaxation Response" how meditation can be an excellent antidote for stress as it has a positive effect on lowering heart rate, decreasing the respiratory rate, decreasing blood pressure, decreasing muscle tension and decreasing oxygen consumption. A classic paper was printed in Psychiatry 1974 which shows demonstrable changes with such mind-body practices as meditation, yoga, autogenic training and hypnosis.

Even as far back as the early 20th century, Dr. Ivan Pavlov demonstrated a conditioned response in a dog. This work won him the Nobel Prize and has been used as a model for changing behavior since. His classic book "Conditioned Reflexes" continues to be used as a basis for modifying behavior to this day.

The list of contributors to this field of endeavor is quite large and the purpose of this discussion is to provide a history perspective and to allow one to see that this is not a new approach to healing. The opposition to Mind-Body medicines is pervasive today so I thought a brief historical perspective was in order. The essence of this approach is that it stresses an interconnection of physical, chemical, emotional, mental and spiritual properties. There are many modalities, and the purpose here is to open a debate and pique the interest of the reader to delve into other areas if he or she so desires. Although there are many modalities to be explored, we will discuss the following:
1. Biofeedback
2. Relaxation training
3. Autogenic training
4. Psychosynthesis
5. Meditation
6. Guided Imagery
7. Spiritual Healing
8. Prayer
9. Logotherapy
10. Gestalt Therapy

1. Biofeedback:
Biofeedback has evolved, due to various discoveries over the years, into a system where the individual practitioners have been able to control a variety of physiologic responses in the body. In what was originally thought to be under autonomic control (control through the unconscious mind), it has been found that various functions in the body could be altered through the exertion of mind and will. It has now been proven the the ability to control certain "automatic" body functions such as blood pressure and heart rate, amongst others, is an innate ability and even laboratory animals have been able to change the body temperature of various parts of their body in order to receive a food reward. Migraine headache sufferers can short circuit a headache simply by changing the temperature of their hands, and these techniques can be taught in just a few short weeks. Pain responses can be blocked for such conditions as colitis and neuritis as well as constipation.

In an article in Gut, biofeedback showed positive results in obstructive constipation and the results lasted for over 6 months, with later studies showing good results in chronic constipation in general. Researchers in Taiwan(1) were able to show positive results with neck pain and spasm using biofeedback in conjunction with cervical traction. Alan Brauer M.D., in a relatively thorough review of biofeedback and anxiety, walks through much of the research of the time surrounding biofeedback. This article, found in Psychiatric Times, Feb. 1999, Vol XVI, Issue 2 gives an excellent treatise for the efficacy of biofeedback and should help to dispel any fears one may have revolving around this healing approach.

2. Relaxation Training:
The heart of this approach is detailed in Dr. Herbert Benson's book, "The Relaxation Response", but for a brief review of the actual technique I will detail for you his 6 steps to the relaxation state.
1) Sit quietly in a comfortable position.
2) Close your eyes.
3) Deeply relax all your muscles, beginning at your feet and progressing up to your face. Keep them relaxed.
4) Breathe through your nose. Become aware of your breathing. As you breath out say the word, "ONE", silently to yourself. For example, breathe IN...OUT, "ONE," ...OUT, "ONE", etc. Breathe easily and naturally.
5) Continue for 10 to 20 minutes. You may open your eyes to check the time, but do not use an alarm. When you finish, sit quietly for several minutes, at first with your eyes closed and later with your eyes opened. Do not stand up for a few minutes.
6) Do not worry about whether you are successful in achieving a deep level of relaxation. Maintain a positive attitude and permit relaxation to occur at its own pace. When distracting thoughts occur, try to ignore them by not dwelling on them and return to repeating "ONE". With practice, the response should come with little effort. Practice the technique once or twice a daily, but not within 2 hours after any meal, since the digestive processes seem to interfere with the elicitation of the Relaxation Response.
- The Relaxation Response, Herbert Benson, M.D.

The number of studies undertaken to investigate the various physical processes impacted are too numerous to elucidate at this time. Researchers continue to discover how controlling basic functions through relaxation can modify things like heart rate dynamics(2) or in playing a role in modifying certain brain chemicals like nitric oxide (NO) (3), which itself plays a very intricate roll in stress related diseases as well as immunological, cardiovascular and neurodegenerative/mental disorders. In the journal Neuroreport(4), where functional MRI was utilized, specific areas of the brain were identified that were active during a simple form of meditation. These areas are numerous and are involved in attention and control of the autonomic nervous system. The relaxation response has been shown to assist in improvement of sleep in the insomniac(5). The treatment of pain is both costly and frustrating for all involved but it has been shown that this too can be impacted through the person's own control of their physiologic processes. The overall complexity of the pain syndrome is multifactorially influenced involving behavioral patterns, socioeconomic factors, belief systems and family dynamics as well as many physiologic and mechanical components. However, with the interjection of behavioral modification techniques(6), like relaxation training, decreasing in the need for visits to the doctor, for pain management, could yield a projected savings of $23,000 per patient by the second year. For economic reason alone we need to consider this mode of treatment and certainly the patients themselves would do better if there was a decreased dependency on the physician for pain management.

Whether for assistance in cancer patients and the relief of their psychological distress(7), to improved hemodynamic functioning in middle aged adults(8), or an impact on the blood pressure of youths at risk for hypertension(9), the roll of the relaxation response has been shown to be of enormous benefit. I have given only a few of the various ways that this technique has been of benefit to a variety of disease states, but this should provide the impetus for further investigation to anyone interested in utilizing this as a tool in their approach to healthy living.

3. Autogenic Training:
Autogenic training, which actually means 'self origin', was devised by Johannes Schulz in the 1930's and was a discipline where the mind provides directions and the body follows. Dr. Schulz was a respected psychiatrist and neurologist who also became interested in the work of Oskar Vogt and was attempting to expound on some of his earlier research. This particular technique is described in Dr. Schulz's book "Autogenic Therapy" and gives in excellent detail both the training and descriptions of the six autogenic states utilized in this approach today. Dr. Schulz was attempting to find a way to switch off the "fight or flight" system of the body and thus bring about a healthier state in the body. The Autogenic process is one that involves progressive relaxation of various body parts and organs and is carried out in a state of passive concentration. Dr Schulz described 6 autogenic states and they are as follows:
a) focus on heaviness in the arms and leg
b) focus on warmth in the arms and legs
c) focus on warmth and heaviness in the heart area
d) focus on breathing
e) focus on warm in the abdomen
f) focus on coolness in the forehead

An essential feature to this approach is that it is carried out in a state of passive concentration, with no direct attempt at an outcome by the conscious mind. There are many similarities to the work by Dr. Jon Kabat-Zinn and his "Mindfulness Meditation" as well as the Buddhist work on mindfulness as a meditative approach. This form of relaxation therapy, and others in this mind-body approach, has been shown to be effective in treating a variety of disorders as was reviewed in the International Journal of Molecular Medicine(10). This approach also encourages a healthier lifestyle. The list of disorders that can aid by this approach is quite numerous and further research into this area is well justified.

4. Psychosynthesis:
Psychosynthesis, whose development was brought about by Roberto Assagioli, the Italian psychiatrist, is known as an approach to human development where an individual is focusing on a blending, or coming together, of all the various aspects of an individual’s personality into a more cohesive unit. It is believed that through this action a person's life can be more authentic and therefore more fulfilling. Psychosynthesis further asserts an affirmation of the higher or transpersonal self, which is a spiritual dimension and therefore a source of wisdom, unconditional love and inspiration that can lend a meaning to our life. Psychosynthesis has been deeply involved in the movement for increasing human potential due to its basic tenet that we live in an orderly universe and that it is structured to enhance the evolution of consciousness. This process helps an individual discover his or her owns purpose and meaning to their life.

Psychosynthesis is considered one of the most coherent and effective frameworks of transpersonal psychology and as a whole this approach addresses the entire spectrum of the human experience from the aspect of prepersonal consciousness into the development of a healthy personality and beyond into higher states of consciousness. There are numerous steps that one goes through from ego-death to the emergence of an expanded sense of one's self, both from an individual perspective to a universal one. This movement is one that espouses the belief that there is a natural tendency towards a progression of unfoldment, an evolution if you will, not only on the individual level, but on the universal level as well. This movement is one that aids in that evolution by assisting the individual to go inwards, to find that connection of the physical, emotional, mental and spiritual essences that exist inside of our consciousness and then help one become aware of the self as an active and directing agent on the journey towards living is a state of unconditional love. To experience love, compassion and many other wonderful emotions as one evolves into a state of universal consciousness.

There are 2 basic stages of Psychosynthesis: a) the personal level and b) the transpersonal level. At the heart of this process is the recognition that each person is an individual with the experience manifesting each time in a unique way.

In personal psychosynthesis there is an integration of the personality that revolves around assisting the individual in attaining a healthy functioning in both his relationships and in his work. This approach utilizes such things as guided imagery, training of the will and goal setting, toward the development of intuition and imagination while using meditation and dreamwork as well as other techniques to help facilitate the process. This approach treats the individual as a whole and any one session of psychosynthesis work may involve only one aspect to be integrated or many. The overall focus is on an integration of mind, body and feelings to help the individual see this as an ongoing and creative process with the ultimate goal of a joyful and harmonious life.

In transpersonal psychosynthesis one takes these lessons and transforms them to a larger scale where one sees such things as altruistic love and enhanced social responsibility as achievable things. Where one can visualize a greater spirit of cooperation, not only on an individual level but on the level of nations as well to bring about a grander global perspective of collaboration.

Psychosynthesis is a blending of western analytic depth psychology (e.g. Freud) and eastern meditative psychology into an approach that intended to enhance both human growth and development. Its intent is to assist us on the personal level to recognize when a temporary feeling like anger can cause us to distort our true perspective and to help us to recognize when we are simply responding to a particular situation because that is the way we may have always responded or perhaps we saw a parent respond that way. Dr. Assagioli called this a pre-programmed routine and much of the basic work in this approach is to recognize these false identifications and harmonizing them so we are no longer controlled by them but can bring them under our conscious direction. This technique helps us to find our path to our true identity, which is a center of awareness and will.

5. Meditation:
There are numerous types of meditation, many of which are involved in the healing modalities all over the world. Here we are going to discuss their implications for those of us going about our daily lives, as well as for physicians that practice in the world of allopathic medicine. Meditation as a process is one where you are attempting to alter your state of consciousness by quieting your busy mind. The attempt here is to get the mind to stay in the present moment and to have the mind be in the center of feelings of peace and calmness.

The varieties of approach to the field meditation include; Inner Light Meditation, Mindfulness Meditation, Relaxation Meditation, Energy Healing Meditation, Color Healing Meditation and many more. All of these techniques seem to embody the same basic intent, although th approaches vary. Many of these techniques have their origins in antiquity, like Mindfulness which has been portrayed as having been taught by Buddha to his followers over 2,500 years ago. Dr. Jon Kabat-Zinn has been instrumental in helping to bring this approach to non-buddhist people, and the Dalai Lama, in his recent book, "The Universe in a Single Atom" stated emphatically that this is a practice that is not only deeply steeped in Buddhist tradition but continues to be practiced today. For anyone interested in the audio book version of this book, I would highly recommend the heartfelt version as read by the actor and practicing Buddhist Richard Gere, and this can be purchased easily at audible.com.

But how does this impact health? There is a fairly large volume of research that can be found on this subject. In the area of aging there appeared to be not only a retardation of aging but also its reversal(11). There was also a healthy form of regeneration that not only had anti-aging properties, but also one that was antagonistic to oncogenesis or the formation of tumors. This recent information is groundbreaking in its implications and has helped us to identify a host of molecular mediators including DHEA, various interleukins and especially melatonin. Given our earlier discussion on the need for sleep it is interesting how melatonin, a hormone released by the pineal gland and is used to help induce sleep, now has been shown to be released while utilizing meditation. Meditation has been shown to be a powerful tool in conjunction with other non-pharmacologic interventions to assist in the anti-aging process, as well to having properties that are antagonistic to tumor formation meditation.

But what of those that have advanced in years, those of us who have reached the retirement age? In a sweeping review of research into meditation and spirituality over the past 25 years, as found in the journal Geriatric Nursing(12), these practices were beneficial in improving physical health, reduceing pain, enhanced immune response and an improvement in emotional well being. This practice helped to foster spiritual growth and could be easily taught to the elderly and even enhanced the life of those with dementia. These practices promoted social and emotional benefits for those in social isolation with specific benefits for those in nursing homes. This article recommended further investigations were indicated for nursing home residents and, with the growth of the portion of the population entering retirement, could well go a long way towards reducing the staggering health care costs that accumulate in the last few years of a person’s life, as well as improving the quality of life.

In the field of mental health one of the most frustrating areas is the field of suicide and people harboring suicidal thoughts. I have been involved in emergency medicine for going on 13 years and have seen an untold number of people who visit the emergency room because life’s frustrations and disappointments have become too great and the only solution for some people is to take their life. It is difficult to portray to you the sense of urgency one feels when somebody comes through your ER after having overdosed on any one of a variety of things. The Journal of Clinical Psychology(13) cited meditation and its usefulness as intervention towards preventing recurrence of suicidal behavior. Anyone who works in this field, or anyone who has a friend, family member or loved one who has attempted or contemplated suicide should read this article and give it serious thought.

The implications of this modality are not the sole dominion of aging, the elderly or even mental health. All of these were mentioned to encourage an active investigation into this field. Research has shown that this need not be a practice that is restricted to any one religious practice(14), as was shown in a Korean study, but rather one that can expand your faith in your own religious practice. It has been shown to assist in the recovery from disease in this same study as well as stabilizing ones physical, psychological and social daily living. Meditation was shown to be a path for discovering one's true self through a process of entering a religious discipline, embodying religious discipline, self-accomplishing religious faith and recovering mind-body health. I have only touched on a portion of the data and research in this field, but I hope that all can see that this is a powerful healing modality that is little utilized and can have powerful effects in all areas of health and healing.

6. Guided Imagery:
Guided imagery is a healing modality that uses the creative imagination of the patient to create positive images or affirmations to bring about a better state of health. So what is guided imagery? Guided imagery is a relaxation technique that is promoting the easing of stress; it promotes an incorporation of the power of the mind to assist the healing of the body. All this through an involvement of an emotional connection between the mind, body and spirit. Guided imagery uses the power of the mind as a powerful resource to help bring about changes in your life on all levels. It helps bring about a balance between all 3 levels by relaxing the mind and helping the mind is more open and receptive to new information.

While there have been many books written on this subject the one I found to be very practical in its approach was written by Steven Covey in his book "Seven Habits of the Most Effective People" which describes a guided imagery process that he calls the 5 basic ingredients of a good affirmation:
a) It's personal
b) It's positive
c) It's present tense
d) It's visual
e) It's emotional
Dr. Covey does and excellent job of portraying just how powerful this adjunct can be in changing your life through this simple practice. As he quotes in his book "We are what we repeatedly do. Excellence, then, is not as act, but a habit." - Aristotle. I would highly recommend this book to anyone looking for a practical way to integrate this practice into ones life.

Guided imagery has been utilized from open heart surgery with success(15), assisting in the cessation of smoking(16), to having effects for the elderly in simple things like balance and attention(17). In many studies a noticeable change occured in both stress levels and mood improved as well as health status(18). Better sleep and decreased nightmares were found to be present(19) and guided imagery provided some assistance in depression and post-traumatic stress.

As one can glean from all this information, this modality has implications at nearly every level of life. The implications are not just for the medical practitioner, but for anyone looking to have a happier, healthier and more successful life.

7. Spiritual Healing:
What is spiritual healing, or better yet what is spirituality? Spirituality is at the core of virtually all of our belief systems whether it is Buddhism, Christianity, Muslim, Hinduism or the Jewish system. But spiritual healing is the involvement of subtle energies that are only just starting to be recognized in the western world. However these energies are well recognized in a host of other medical systems, and are called "Qi or Chi" in traditional Chinese medicine, "Prana" in Ayurvedic medicine and as such are related to one's consciousness. Some of the more common practices for a spiritual healing include; prayer, visualization, channeling of spiritual energy or spirit guides and teachers as well as psychic abilities.

Spiritual healing has at its source a deeply spiritual recognition and acceptance of a Universal Consciousness and that this consciousness can provide inspiration, joy, peace of mind and guidance in the healing process. This may involve a caring touch, kind words or even just listening to the patient. This type of healing can be practiced through prayer, either individually or in groups, but if done when the person is not present is called distant healing. In any event this process is described as a channeling of energies being transferred to the patient, with the caveat that the healing does not come from the channeler, but rather the healing comes from the source of Universal Consciousness.

So much of what the research into this area is anecdotal by our modern standards, as we in the west have come to be dependent on the double blind testing methods as the gold standard. Scientists believe that all testing should adhere to very strict principles or it is invalid. Yet simply because something cannot be quantified does not mean it does not exist, it may mean that we simply lack the ability or technology to measure it. Given the fact that we are not able to fully understand how some medicines work, yet use them anyway, does not mean they should not be utilized. This is especially true of drug therapy in the field of mental health where a lot of their chemical interactions are based on conjecture and hypothetical models.

In the handbook called, "Comprehensive Handbook of Psychotherapy and Integration", by Robert N. Sollod describes a most fascinating model whereby spiritual healing could be folded into a typical psychologists practice with no compromising of standard psychotherapeutic models. He poses very interesting questions as to how such a model could emerge. This is a field of endeavor that is still in its infancy in the west and it will be a model that could easily emerge in the decades to come.

It is easy to speculate how such an effect could be made by looking at the field of quantum mechanics. As early as the 1920's Dr. Niels Bohr described a theory that later became known as the Copenhagen interpretation, or what is known as the Observer Effect, in where he postulated that the event and the observer were inseparable on a quantum level. In actuality there is no effect or phenomenon until it is observed. He found that at a quantum level things exist as a wave, but through the direction of consciousness these subatomic waves become a particle. This effect implies that the physical universe is a direct result of consciousness whereas our western science implies that human consciousness is the result of the inner physical workings of the human brain. Further research into modern physics has found that the observer actually determines the nature of the subatomic matter and that when they look for them as particles they show up as particles and when looking for them as waves they show up as waves, which makes the role of consciousness even more implicit.

So how does all this relate to spiritual healing? What if on a subatomic level the healer is producing change via his interaction with the healed? What if there is a rearranging of matter at this subatomic level that is conducive to a healing state, or a state of enhanced well being? I throw all this out for conjecture because, like you, I am looking for answers.

8. Prayer:
The general discussion of prayer is an area that does not lend itself well to the scientific approach. Prayer in and of itself has always been in the domain of a variety of belief systems. In this area people feel that they are seeking communion with God, through prayer. This has been described as a communication between their mind and that of God. So how prevalent is prayer? According to Self magazine as reported in an April 1994 survey, 88% of people in the USA pray and 59% of them meditate, while 89% believed in some sort of God or a higher consciousness. Clearly prayer is not an isolated or rare event. But does prayer belong in medicine and does it make a difference?

A lot of the early research was anecdotal, due to the extreme difficulty in quantifying prayer in the field of scientific research. Rupert Sheldrake PhD, in his paper "Prayer-A Challenge for Science", discusses how since ancient times a strong belief exists that consciousness is not limited to the physical body and that prayer is an access point to this realm. Dr. Sheldrake gives insight into the mechanistic mindset of the scientist and the difficulty that science has in evaluating something that is not easily quantified. Many of the researchers have difficulty separating the mind from something that exists inside of the brain.

One of the first studies utilizing the scientific approach, the double blind study, the cardiologist Randolph Byrd M.D. looked at the use of prayer in a cardiac care unit(20). He found that the use of prayer had a statistically significant benefit for those that received prayer. This study was criticized by in mainstream medicine. The best assessment of this study from the perspective of a non-partial point of view was by a fellow cardiologist, the respected Larry Dossey, M.D., in his book "Healing Words", he explains the strengths and weaknesses of this study, but congratulates Dr. Byrd for the courage in both performing and bringing out this study. Dr. Dossey concludes that there have been no conclusive studies done on human subjects on the power of prayer that would meet the guidelines of double blind studies.

Does this mean that prayer does not work or does it indicate that we perhaps lack the means to study it adequately? There is a difference between something not existing and being incapable of proving the non-existence of a thing. From the standpoint of current scientific thinking if a thing cannot be proved it does not exist. To say that something does not exist because we cannot proves its existence represents a metaphysical position rather than a scientific one and it would be more scientific to continue to accumulate empirical data and to keep our minds open. In science we take our empirical data and form our conclusions. If we attempt to form a conclusion and them make the empirical data fit that conclusion then that would be like trying ro reform our feet to fit our shoes as the Dalai Lama so aptly stated.

Perhaps the answer to this will indeed come from the field of quantum mechanics. Dr. David Bohm makes a compelling argument in his book, "Wholeness and the Implicate Order" that all things are connected on a subatomic level. As we learned earlier the observer can have an effect on the observed simply by his conscious interaction and the actual nature of matter at the subatomic level would change by virtue of this interaction. Is prayer simply the insertion of a conscious stream of intention that alters the health state of the person being prayed on?

The thoughts of one of the greatest minds of the 20th century perhaps ring truer now than ever before: Albert Einstein stated; "Now, even though the realms of religion and science are clearly marked off from each other, nevertheless there exist between the two strong reciprocal relationships and dependencies. Though religion may be that which determines the goal, it has, nevertheless, learned from science, in the broader sense, what means will contribute to the attainment of the goals it has set up. But science can only be created by those who are thoroughly imbued with the aspiration towards truth and understanding. This source of feeling, however, springs from the sphere of religion....The situation may be expressed by an image: Science without religion is lame, religion without science is blind."

9. Logotherapy:
Logotherapy, according to it founder Dr. Viktor Frankl, is based on the belief that all life has meaning and the focus of therapy was to assist the patient in their quest to find meaning in life’s daily activities; as well as to help them live a responsible and meaningful life, irregardless of the circumstances they found themselves in. Dr. Frankl described logotherapy as "a psychology in spiritual terms"; however this was not intended to be a religious based endeavor. But rather that it was the spirit of the will of the human being which could affect health, the capacity for love, the imagination and even enhance personal religious faith at the same time. At the heart of this approach is the search for meaning, however, and not the search for God.

Dr. Frankl has espoused 3 basic tenets of his therapy:
1) Life has meaning under all circumstances or meaning of life
2) our main motivation for living is our will to find meaning in all things in life or will to meaning
3) we have freedom to find meaning in what we do and experience or free will.
Dr. Frankl believed that each person exists in 3 dimensions; the body, the mental or mind and the spiritual and that these 3 components comprise a totality or a unit and could not be broken down to their individual parts but must be treated as a whole. Dr Frankl believed that is was this spiritual component that was unbreakable and that it remained intact in even the worst of conditions, be they physical or mental.

The basic tenets of logotherapy were developed as early as the 1920's, while Viktor Frankl was still in his teens. Yet it was in the concentration camps of Nazi Germany that he got to see first hand how his theories were supported by his personal experience and observation. After spending 3 years total in Auschwitz and Dachau, he observed that those individuals whose focus was on the future and a meaning to life were the ones most apt to survive. This experience stands alone in the field of psychotherapy where the therapist had the opportunity to test his theories under such extreme circumstances.

Dr. Frankl believed that if this search for meaning was not at the heart of ones being that we would exist in a state of emptiness and that it would be evidenced as boredom. He believed that this was as a by product of industrialization, the breakdown in the family and the rampant dehumanization of individuals, as he personally experienced. This feeling of meaninglessness in today’s world in what Dr. Frankl called the mass neurotic triad, in other words depression-addiction-aggression.

The 4 main techniques are:
a) paradoxical intention - the patient is encouraged to do or wish to happen the very thing they fear
b) dereflection - patients are asked to redirect their attention away from what is bothering them to more positive things going on their lives. This method is used to help them transcend themselves as see themselves as being more creative
c) modification of attitudes - in this approach the patient is taught to reframe many of the negative attitudes to positive ones. Help them to see the beneficial aspects to whatever the current situation is.
d) The appealing technique - in this approach the actual appeal is to the human spirit inside of everyone and through the power of suggestion; the therapist expresses belief in the dignity, the ability to accept responsibility, the inner drive of the human spirit to seek meaning and the potential for change that the patient possesses.

In a study at Hamamatsu University(21), School of Medicine, Health Administration Center in 2003 both DHEA and cortisol were studied in conjunction logotherapy and loxoprofen sodium (a non-steroidal anti-inflammatory drug like aspirin). This study revolved around low back pain and it found that by utilizing logotherapy there was a discernable difference in the release of beneficial hormones in the body and there was an active mechanism in stimulating human brain function. Logotherapy has been found to be beneficial in the treatment of alcoholics(22), as well as new approaches are being utilized at Sloan-Kettering Cancer Center(23) in their psychotherapeutic interventions at the end of life. Further research on cancer and logotherapy was undertaken in Japan reported in 2006(24) and its role in spiritual care. In an article reported in Journal of Mental Health Counseling, Vol. 26, 2004 Robert G. Blair reported promising results using logotherapy in the treatment of depression in older adolescents.

Perhaps at its heart, logotherapy espouses the philosophy of its founder, Dr. Viktor Frankl. Dr Frankl argued that the spiritual dimension needed to be added to the physical and mental dimensions because ultimate meaning exists and is a unique to each person and experience. He believed that this meaning to life was accomplished through 3 ways:
1) Creativity, to give something to the world, by way of our talents, through the process of self expression, whether it is gifts or through the type of work we do.
2) Experiencing, through the process of receiving via relationships, our culture or various interactions with nature or the environment.
3) Change in attitude, we always have control over our attitude towards any situation and that it is up to us to develop a way of transcending ourselves to find the deeper meaning of things, even in the face of suffering.
He felt that meaning was meant to be discovered, recognized and fulfilled and that even in the worst of situations something meaningful could be found if one had the courage.

10. Gestalt Therapy:
Gestalt therapy was born out of the existential movement that sprang up in Germany in the 1920's. The collaboration of Frederick Perls M.D., and his work in the field of psychoanalysis under the direction of Wilhelm Reich studying brain injured soldiers from WWI, and his wife Laura Perls Ph.D. and her work with the noted existential philosopher Martin Heidegger were the beginnings of this approach. Existentialism focuses on the direct experience of relationships of pain, joys, suffering as experienced through our interaction with others and that through this process we are always discovering not only ourselves but are also capable of remaking ourselves in the process.

After having fled Nazi Germany to the safer confines of South Africa both of the Perl's were exposed to Jan Smuts who later became the prime minister of South Africa and started to espouse what Mr. Smuts called "holism". This blending of Gestalt psychology, existential philosophy and psychoanalysis helped Dr.'s Perl to formulate a new approach to the field of psychiatry and psychology that embodied a holistic approach that they termed Gestalt Therapy. Dr. Perls was trained as a Freudian psychoanalyst but he felt that Dr. Freud was too dogmatic in his approach and that a much larger picture would emerge through the patients acknowledgement of personal responsibility for their actions, through an understanding that there are choices that everyone has in creating their personal existence and through forming what he called an existential dialogue. He felt that the emotions and feelings that were present in every moment needed to be dealt with and that only through gaining an awareness of these processes could true mental health be achieved.

In an elaborate book by Gary Yontef, Ph.D. "Awareness, Dialogue and Process" and later in his collaboration with James S. Simkin, Gestalt therapy was described as a process where enhanced awareness was the goal. This was not to be accomplished through the interpretation of an analyst, but rather through the perceptions and feelings of the actual patient. Through enhanced awareness, insight is gleaned and this type of awareness could only be achieved through a present-centered approach, or living in the moment, not in the past or the future. Gestalt therapists believe that through this awareness, and the insight that is garnered, patients can not only change those things about themselves that are harming them in some ways, but that they can learn to accept and value themselves in the process.

Awareness has 5 distinct qualities:
a) Contact - Where are we in relation to the world we live in or relative to our environment. This describes not only our interaction with other people but anything that is different from what we may think, feel or experience as being from ourselves or us.
b) Sensing - Includes a variety of things like body sensations, emotions, thoughts or even dreams, but is essentially the very nature of awareness. This process involves being aware of ourselves, our environment and how we are interacting within that environment.
c) Excitement - This covers both the physiological as well as the emotional response we may go through when we encounter something in our environment. This may involve an increased heart rate, a flush of memories or a rush of anxiety or dread or any of a myriad of things.
d) Figure formation - This describes the very way that awareness is both shaped and developed. Figure formation is the process whereby we give shape and organization to the things we interact with, or contact, in our environment. With figure formation we use every part of ourselves be it the mind, the heart, the body, the soul, the intellect or the mind. This is what is known as a gestalt formation.
e) Wholeness - "The whole is greater than the sum of its parts" is in the most famous phrase of Gestalt psychology and embodies the thinking of current Gestalt therapy to this day.

At the Los Angeles Jewish AIDS Service(25) this approach was found to be of benefit in HIV - related therapy and in a study in Japan (26) general neurotic symptoms were found to be reduced by this approach. Researchers have found that using this approach also helps in the field of nursing (27) by allowing nurses to explore their creativity and to improve the professional practice. In an interesting article(28) discussing chronic or life-threatening illnesses, Gestalt therapy was found to be of benefit and in the field of schizophrenia(29) Gestalt theory was felt to be a viable therapy and underutilized if not forgotten.

Perhaps one of the most exciting things to come out of Gestalt therapy is Neurolinguistic Programming (NLP). In NLP, communication impacts and is impacted by sensory experience. NLP is a model for how language influences mental states, and was developed by John Grinder and Richard Bandler in the 1970's. NLP utilizes the work of Fritz Perls and others to construct a model for communication and how thinking and mental states are related to physiology. NLP stresses how important our mind is as a healing tool, how powerful our subconscious is as an engine that powers our lives and how intimately they are involved with health and well being. This field of endeavor has been utilized in Russia on people with acute coronary syndrome with excellent results (30).

Gestalt therapy believes that it is through the integration of all the various aspects of our essence and through conscious awareness of ourselves that we will be best able to function in a healthy manner. The practitioners in this field believe that there is a constant element of change within us and that by staying in the moment and staying aware, we are best suited to fully participate in life and all it has to bring.

Conclusion:
As the reader can appreciate the field of Mind-Body Medicine is wide ranging and encompasses many theories and disciplines. This body of knowledge and experience has engaged some of the best minds of many generations from the fields of philosophy, science and spirituality. Each of these areas alone comprise a rich body of knowledge and insight gleaned from some of the best thinkers of the last 100 years, however, it is through the integration of these various approaches that we will come to understand how to improve and maintain our health.

References:
(1). J Biomech Eng. 1996 Nov;118(4):597-600.
(2). Int J Cardiol. 2004 May;95(1):19-2.
(3). Med Sci Monit. 2002 Jun;8(6)RA103-118.
(4). Neuroreport. 2000 May 15;(7):1581-5.
(5). Behav Modif. 1993 Oct;17(4):498-509.
(6). Clin J Pain. 1991 Dec;7(4):305-10.
(7) Gen Hosp Psychiatry. 2001 Sep-Oct;23(5):272-7.
(8). Psychosom Med. 1999 Jul-Aug;61(4):525-31.
(9). Am J Hypertens. 2004 Apr;17(4):366-9.
(10). Int J Mol Med. 2005 Oct;16(4):621-30.
(11). Ann N Y Acad Sci. 2005 Dec;1057:28-29.
(12). Geriatr Nurs. 2005 Nov-Dec;26(6):372-7.
(13). J Clin Psychol. 2006 Feb;(2):201-10.
(14). Taehan Kanho Hakhoe Chi. 2005 Oct;35(6):1025-35.
(15). Ann Thor Surg. 2006 Jan;81(1):201-5.
(16). J Nurs Scholarsh. 2005;37(3):245-50.
(17). Aging Clin Exp Res. 2005 Jun;17(3):223-8.
(18). BMC Complement Altern Med. 2005 Dec 20;5-21.
(19). Behav Sleep Med. 2005;(3):151-7 .
(20). South Med J. 1988 Jul;(7):826-9.
(21). Seishin Shinkeigaku Zasshi. 2003;105(4):459-67
(22). Int J Addict. 1979 Aug;14(6):847-53.
(23). Can J Psychiatry. 2004 Jun;49(6):366-72.
(24). Support Care Cancer. 2006 Jan;14(1):65-70.
(25). Focus. 1997 Mar;12(4):1-4.
(26). Sehshin Shinkeigaku Zasshi. 2003;105(5):589-92.
(27). Rev Bras Enferm. 1999 Apr-Jun;52(2):283-92.
(28). J Clin Psychol. 2002 Nov;58(11):1361-73.
(29). Am J Psychol. 2004 Summer;117(2):259-77.
(30). Klin Med (Mosk). 2000;78(6):16-20.

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

stevenlamer@gmail.com (Steven D. Lamer DC DO) — Sun, 22 Jan 2006 04:21:00 +0000

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.