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October, 2009 - VOL. 8, NO. 5 | |
October, 2009 |
| The Path Ahead: Twenty-first Century Medicine |
| Joseph Pizzorno, ND |
| When I wrote the professional/trade book reviews in my last editorial, I decided to delay the mention of 1 particular book until this issue as I wanted to give it more space. Over the past years, many of us have given considerable thought as to how we can develop a healthcare system that works a lot better than our current one and that will also incorporate the many important concepts we address in this journal. Fortunately, some of us write down these thoughts. David Jones, MD, president of The Institute for Functional Medicine (IFM); Laurie Hoffman, MPH; and Sheila Quinn, a former IFM employee and cofounder of Bastyr University; have written a marvelous monograph, 21st Century Medicine: A New Model for Medical Education and Practice. This 90-page book, published by The Institute for Functional Medicine in Spring 2009, deeply considers the causes behind the strengths and failings found in our current healthcare system and makes thoughtful recommendations about how the functional medicine paradigm would solve many of the problems. It is available for free download at www.functionalmedicine.org. |
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October, 2009 - VOL. 8, NO. 5 | |
October, 2009 |
| News and Analysis: The Health of CAM: The Eisenberg Report vs NCCAM. . . and more |
| John Weeks |
| The big, bold numbers in the National Institutes of Health (NIH) National Center for Complementary and Alternative Medicine (NCCAM) analysis of 2007 survey data from the US Centers for Disease Control and Prevention are significant enough not to be dismissed. The July 2009 report was led by NCCAM’s Richard Nahin, PhD, MPH, who is acting director of the Division of Extramural Research and senior advisor for Scientific Coordination and Outreach. The report states that 38% of US citizens used CAM, spending $33.9 billion out of pocket that year. Of this, $11.9 billion was spent on 354-million visits to practitioners such as chiropractors, massage therapists, and acupuncturists, among others. The gross expenditures on CAM represent 11.2 percent of all out-of-pocket expenses for healthcare services in 2007.1
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October, 2009 - VOL. 8, NO. 5 | |
October, 2009 |
| Abram Hoffer, PhD, MD, RNCP: In Memoriam, 1917-2009 |
| Merrily Manthey, MS |
| Abram Hoffer, MD, PhD, RNCP, a powerful yet gentle giant and a catalyst and mentor in orthomolecular psychiatry, died May 27, 2009, at the age of 92 in Victoria, Canada, after a brief illness. He is survived by his son, John; his daughter, Miriam; and his extended family.
Mentally sharp and working on his next book, the Canadian physician recently sent e-mails to colleagues indicating his strong belief that the long-overdue adoption of orthomolecular protocols by mainstream medicine lay just around the corner. Dr Hoffer often maintained that 40 years had to pass for a radically new and effective idea to take hold in medicine.1 If the pattern holds, his ideas will be ratified soon, as it was 4 decades ago when the psychiatric world first read of his landmark research using a nutritional approach—orthomolecular psychiatry—to treat schizophrenia. His leadership produced the first double-blind, placebo-controlled studies ever conducted in North American psychiatry, and the results set him on a path of helping patients get well.
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October, 2009 - VOL. 8, NO. 5 | |
October, 2009 |
| Why I Brought Spirituality to My Medical Practice |
| David Mokotoff, MD |
| “How are you doing Henry?” I asked my elderly cardiac patient at the start of a routine office visit.
“I’m doing okay, doc, but how are you doing? I bet no one ever asks you that, do they?”
Nodding my head, I answered “all right” without even thinking. In actuality, though, I was doing anything but all right. My wife was an active alcoholic who was dying from liver failure, and we had just separated. I was as busy finding live-in nannies for my young daughter as I was practicing cardiology and taking call.
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October, 2009 - VOL. 8, NO. 5 | |
October, 2009 |
| Clinical Assessment and Management of 6 Common At-risk Nutrients in the Older Person (Reprint) |
| Sonya Brownie, ND; Stephen Myers, PhD, BMed, ND |
| Older people in Western communities are the single largest demographic group at risk from inadequate diet and malnutrition. Their nutritional status is associated with increased hospital admissions, and it is an important determinant of morbidity. This risk is disproportionate in comparison to other age groups and needs to be a primary consideration in determining the appropriate management of the older person. Chronic illness, heavy use of medication, and periods of lengthy hospitalization are often underlying causes of nutritional deficiency. In addition lifestyle factors, immobilization, isolation, and physiological factors associated with aging compound the risks and affect the ability of the older person to meet nutritional needs or to digest, absorb, utilize, or excrete nutrients that are ingested. Improvements in healthcare, nutritional status, and living standards have resulted in more Americans living to an older age. In order for the gains in life expectancy to be viewed as a positive demographic feature, the additional years need to be quality years with attention focused on approaches that can retard the losses associated with aging. Of specific interest is the role nutrition may play in attenuating these losses and promoting functional independence and optimal wellness in an aging population
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October, 2009 - VOL. 8, NO. 5 | |
October, 2009 |
| Reforming the US Healthcare System: Implementing an Effective Approach to Chronic Disease |
| Jeffrey S Bland, PhD |
| It is widely acknowledged that the future of our US healthcare system is challenged with the rising prevalence of chronic disease:1 The cost of healthcare per capita is increasing, but there is evidence that children born today will have, on average, a shorter life expectancy than their parents due to the rising incidence and subsequent burden of chronic disease.2 Thus, the US healthcare system is facing a looming crisis and medicine is in need of a new healthcare model that sensibly incorporates recent breakthroughs in the origins of chronic disease.
Fortunately, the last few decades have brought about alterations in the healthcare delivery system that provide more effective preventive care and chronic disease management.3 This article looks at the need to develop reimbursement procedures for prospective, functional interventions that provide support for assessment, patient education, and therapy to reduce the burden of chronic disease.
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October, 2009 - VOL. 8, NO. 5 | |
October, 2009 |
| Nutrigenomics: The Potential to Optimize Phenotype with SNP-Based Dietary Recommendations |
| Lara Pizzorno, MDiv, MA, LMT |
| In the individual, diet/nutrient-gene interactions are significantly impacted by common DNA sequence variations called single nucleotide polymorphisms (SNPs). SNPs alter the expression or activity level (ie, the Michaelis constant, KM) of gene products, resulting in altered metabolism of and altered dietary requirements for nutrients, and can increase disease risk. However, whether one's genetic potential for health or harm will manifest as a phenotype is decided by the interplay among genes, diet, and lifestyle. Genes determine the range of possibilities, but nutrition and lifestyle choices significantly impact which genetic options are expressed, and thereby influence whether individuals attain the optimal, normal, or detrimental potential in their genetic inheritance.
Nutrigenomic profiling can already identify SNPs that underlie individual variations in key nutrient requirements, as well as the likelihood of a positive response to specific dietary interventions. This article provides an introduction to several SNPs with well-documented effects on nutrient requirements and suggests how clinicians might begin to utilize the available data in this rapidly developing field to meet patients' unique needs.
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October, 2009 - VOL. 8, NO. 5 | |
October, 2009 |
| Mind-Body Techniques to Reduce Hypertension’s Chronic Effects |
| Erica B Oberg, ND, MPH |
| The physiologic impact of the mental-emotional state is well illustrated in hypertension. In this review, the mechanisms by which stress hormones interact with the vasculature to contribute to hypertension are discussed. Also discussed are the general adaptation syndrome theory of stress and several evidence-based mind-body techniques to reduce blood pressure. Examples include progressive muscle relaxation, biofeedback, meditation, mindfulness-based stress reduction, and positive thinking. Reductions in systolic blood pressure from these techniques range from 2 mm Hg to 12 mm Hg. These techniques can be readily taught to patients and will benefit healthcare practitioners themselves. |
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October, 2009 - VOL. 8, NO. 5 | |
October, 2009 |
| Patient Handout: Achievable Blood Pressure Reductions From Lifestyle and Mind-Body Techniques |
| Erica B Oberg, ND, MPH |
| Controlling high blood pressure is important to reduce the risk of health problems related to the blood vessels, including heart disease, stroke, vision loss, kidney damage, erectile dysfunction, and—less serious but still bothersome—problems such as varicose veins. The maximum recommended blood pressure for most people is less than 140/90; for people with diabetes or existing heart or kidney disease, blood pressure should not be above 130/80. Most people with high blood pressure need to try a combination of approaches to bring their blood pressure down. You can try as many of the techniques below as you want and combine them as you wish. |
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October, 2009 - VOL. 8, NO. 5 | |
October, 2009 |
| Green Medicine Tips: Preventative Medicine: Taking an Environmental History |
| Joel Kreisberg, DC |
| How often do you take an environmental history? If your answer is rarely or never, please read on.
An integrative practice requires the practitioner to consider the whole person—including chief complaints, a full health history, and the patient’s social and psychological make-up—along with still having the time to determine a prescription and give proper guidance. In particular, environmental health is an important topic that should be included in a full health history.
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October, 2009 - VOL. 8, NO. 5 | |
October, 2009 |
| BackTalk: Understanding Healthcare Reform in 5 Easy Lessons |
| Bill Benda, MD |
| Ah, healthcare reform. After decades of inattention, our current medical paradigm has begun to mimic many of the chronic illnesses it was created to address. Initially there were symptoms of vague discomfort and weakness, followed by an examination, then diagnosis of failure to thrive, and subsequent denial once we found out how much a cure was going to cost in terms of money and requisite changes in behavior. Eventually the pain became too great to bear, and we bit the bullet and called in expensive specialists to begin the complex, lengthy process of resuscitation, if at all still possible. |
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