Taking Charge of Your Health

>>Dr. Sandra Charles:
Good morning, everyone. And thank you for being here. I’m Dr. Sandra Charles of the
Library’s Health Services, and the Library’s Physician. And I welcome you to this joint
program with Dr. Tomoko Steen from Science, Digital
Technology Division of our library services. And today’s lecture is what
we’ve been looking forward to. We actually started this thought
process along these lines last Wednesday when we had our
Family Health and Wellness Day and featured different
alternative approaches to pain management
and emphasized a lot of our alternative
medicine practices then. So this is very timely. And it’s in sync with our theme,
which I think will continue for some time, being
that pain management and alternative medicine
as such, topical items. So, we have with us today. Dr. Hakima Amri, from
Georgetown University. And the she will be leading
us along, and guiding us, and giving us all the various
options as well as the latest in the light of alternative
and complementary medicine. And you know, as a
physician, we generally, at least the traditional
schools are trained in traditional practices. But complementary and
alternative medicine definitely over the past I’d
say 10, 20 years, maybe even longer have captured
the imagination, and rightly so, of many of people who are
having different ailments. And so much so that NIH has
been conducting certain research into different practices. And certain ones, such
as acupuncture have become mainstream. And actually covered by
many of our insurance plans. So, it is not a fly-by-night. Any of you who grew up
outside of the city know that there be many
practices that were used when you had a cut or an
ailment, or a bump on the head. And myself, having
grown up in the islands, I always thought
it was fascinating. If you had a really
bad bump on your head, they would give you some super
sweet sugar and water to drink. And I really didn’t understand
it but learning medicine. When you have head trauma to reduce increased
intracranial pressure, you’re given 50%
glucose solution to prevent the swelling. Somewhere along the line,
there was a connection made. Now, whether or not the
oral intake is equivalent to the intravenous is a
whole different story. But nonetheless, it was
going along those lines. And of course there are
many teas, and salts, and lotions that were used then. So, it’s always been
a fascination and something that
we’re open to. And I think 21st-century
medicine is a combination of traditional, and
complementary, and alternative medicine. Hence the term integrative
medicine. So I’m going to ask Dr. Steen
to introduce her speaker. And then we will sit back
and get to learn something. So, thank you so
much for being here.>>Tomoko Steen: It is wonderful
to have the more audience today. But last Wednesday I had 130
people stop by for the tea and the health, you know,
lecture and discussion, I had. We had many tables you
know thinking about how to manage pain and
health in general. So, I’m so delighted to have
my dear friend and expert in the field, Professor
Hakima Amri coming. And she is a professor at the
Department of Biochemistry and Serum Molecular
Biology in the Division of Integrative Physiology. That’s the department she is in. And she holds a master’s
and doctorate degree on reproductive physiology,
and steroid biochemistry from the Pierre and Marie Curie
University in Paris, France. And she is a co-founder
of the CAM program at the Georgetown
Medical School. And that she has been
raising experts from 2003. So, you know we have more
young people learning about this topic. And her approach is
scientifically approaching you know traditional medicine
and how to access them. And that’s a wonderful, you know
her background is biochemistry. So this is a wonderful
way of doing it. And we have some books
from you know, my division and my colleague Ashely Coffier
[assumed spelling] fixed up and that’s include a book just
published by Professor Amri and so that is focusing on
Greek or Arabic medicine, is it? Yeah. And linking the
21st-century biomedicine to Hippocrates. And maybe I’m pronouncing
it wrong. Anyway. Without further ado, please join me welcoming
Professor Amri. [ Applause ]>>Hakima Amri: Thank you. Thank you, for this very nice
introduction from the leadership and from my colleague Dr. Steen. I’m very delighted
to be here today and sharing some of
my work with you. And speaking here at this
very prestigious institution. So, thank you very much. Today’s talk, I think you
made the ground for me. You are making my
talk very easy now. It’s about integrative medicine. And we are going to
discuss a few points, in addition to what
has been said. Actually I was going to
say, I wish I was here for the tea party, the real
tea party from last week. So, today we are going to
talk about complementary and alternative medicine,
and integrative medicine. Define that field of medicine. Review the history of
integrative medicine. We try to do that very briefly. So we have more time
for discussion. We are going to examine the
role of integrative medicine in the management
of chronic diseases. I think that’s the focus of this
month, or this week topics here at the Library of Congress. And then, discuss its
emerging role in healthcare. We will try to save time
for questions and answers. Okay so, let’s start by
the first point here, which is defining complementary,
and alternative medicine, and integrative medicine. Here we are noticing already,
that is a mouthful actually. So, how are we going to define
this complementary alternative medicine and integrative
medicine? So, before I go to my next
slide, just to the raise of hand, how many of you have
already heard of complementary and alternative medicine,
or integrative medicine? Very good. And if I ask you to tell
me a little bit what it is, any volunteer who can
tell me what that is? Yeah? Okay, I don’t meant
to put anybody on the spot, but just to be interactive. Okay, so what it is really
the definition is very simple. And I always get that
look on my student’s faces when I say okay the
definition is simple. Because they don’t expect it. Complementary and alternative
medicine is the therapies that are not usually
taught in medical schools. That’s all. Are not generally practiced
or available in US hospitals. So, that was the definition
from back in the ’90s. So, that’s a question on the
test for the students actually. So the definition is very
literal to the wording of it. It is complementary
when it’s used together with conventional medicine. Makes sense, right. It’s complementary when
it’s used in addition to antibiotics, or
to painkillers. So, that’s complementary. And then it’s alternative,
because it’s an alternative, it’s used instead of
the other medicine. So, instead of taking a
blood thinner, for example, the patient will start
taking ginkgo biloba, for example, right. Which is known as
a blood thinner. So that’s alternative. We don’t want that to happen. So, and this is integrative, when it’s basically used
together, when it’s combined to a conventional medicine. But those therapies
that are combined to call it integrative medicine
have to be supported by science. So, that’s when it’s
integrative. So basically, as it
was mentioned before, acupuncture has been studied a
lot for the past now 20 years. And science has shown that acupuncture works
for pain management. So now, acupuncture
is incorporated in the medical treatment
for pain, for example. It is reimbursed by many
health insurance companies. So that’s real integration. Acupuncture is supported by
the evidence, by the science. Are we clear on that? If we’re clear on
that we can proceed. You have questions, I can
go through that again, okay. Clear. Okay so, these are
the basic definitions. And the latest consensus that
to define really this field came from the National
Center for Complementary and Alternative Health,
which is a center at the National Institutes
of Health. And I want you to keep in
mind that that’s the authority on all published on the science
behind integrative medicine. So, if you have a
question about any aspect of integrative medicine
go to the NIH website, and specifically the National
Center for Complementary and Integrative Health. That’s the authority. So their definition, “The
National Center of Complementary and Integrative Health, generally uses the term
complementary health approaches when we discuss practices
and products of nonmainstream origin. We use integrative
health when we talk about incorporating
complementary approaches into mainstream health and these
complementary approaches are the ones that have been
supported by science.” Okay, so that’s their
definition. And that’s what has been
actually put out there and that’s what the
people should follow. The scientists, the educators, the private organizations,
and all that. So they divide integrative
medicine into different categories,
or different domains. And there are five domains
for integrative medicine. The biologically-based
therapies or practices, and that’s when you
are using herbs. How many of you are using just
supplements, herbs for health? Yeah, so these are the
biologically-based practices. Herbal products fall
under that category. Mind-body medicine practices
or mind-body medicine. How many of you are
doing MBSR, or yoga, or? Yeah. These practices fall
under the mind-body medicine. Energy medicine, that’s where
it gets a little bit murky. Now, I’m just saying that
because energy medicine depends who you are talking to,
but here we are talking about energy medicine like
biofeedback, Tai Chi, Chi Gong, where they really,
these practices call on the inner energy of
the body to heal itself. And then, manipulative,
and body-based practices. And those, how many of
you go to see an osteopath or a chiropractor,
massage therapist, yes. So, these are the manipulative
and body-based practices. Osteopathy, chiropractic
care, massage therapy, where they basically
manipulate the body. And then, you see
under that circle, the whole medical systems. That’s the fifth category. The whole medical systems
are those medical systems that are used by 80% of the
population on the planet. And those are traditional
Chinese medicine, it’s a system. Ayurveda is a medical system. Unani medicine, or [inaudible]
medicine is a medical system. So, the people around the
globe are using these other medical systems. And they’re part of
their healthcare. n China, for example,
you walk into a hospital and you have the conventional
medicine, what we call by our definition conventional,
which is conventional, which is maybe unconventional
in other countries. So you can see the
conventional physicians and next door is the
traditional practitioners, in the same institution. So, it’s really integrated
into the medical system. So, into the medical
healthcare system. It’s the same thing in India. So, in India you have the
conventional medical system which is similar to
ours here in the US. And also you have
the Ayurvedic doctor and then the Unani doctor. So, it’s all handy working
together in parallel and in collaboration, of course. So these are the
whole medical systems. These are the five
categories of that medicine. And this is just another
figure to show you what it is. So now we know right. So it’s practices like
the yoga, massage, chiropractic, all those. Then, there are other
definitions by private organizations. So, if I tell you today that
1/3 of our medical schools, our health medical
centers are part of the consortium that’s
called the consortium of academic health centers
for integrative medicine. So, we have what, we have
about 150 medical schools. About now 70 of those
medical schools are part of that consortium. The consortium includes all the
17 medical schools in Canada and the medical school
in Mexico. Guadalajara University
Medical School is part of that consortium. So, and they define,
they the lead on that and the consortium is
really very active. And you can check
also their website. They have a lot of
information there. And they define integrative
medicine as follows: “It’s the practice of medicine
that reaffirms the importance of the relationship between
practitioner and patient.” Very important. “Focuses on the whole person,
is informed by evidence, and makes use of all appropriate
therapeutic approaches, healthcare professionals
and disciplines to achieve optimal
health and healing.” Optimal health and healing. Very important. We come back to that. So, that’s the definition
by the consortium. Now, any questions so far
on that first section? Okay? At the end? Okay, she is the boss. So, wait until the end. A brief history of
integrative medicine now. So, what really feed or
trigger a change if I ask you. What really triggers a change? If you think about, yes? [ Inaudible Audience Comment ] That’s, yeah. Herb Benson’s book from Massachusetts
University is about medication. Yeah. So, that the science. And then also the people
who know about these things. So, what triggers
really a change, you need grassroot
movement, right. So, in the ’90s people
were ready to really take control
of their health. So that’s the grassroots
movement. And then it takes
also the science prove that this medicine works or is
used by the American population. And also, it takes politics. Without the politics
we cannot do much. And without the money
we cannot do much. We know that. So part of the history
that I’m going to share with you is basically
these three elements that were happening
in the ’90s until now and really coalesced together
to create that field, if you, of integrative medicine. So, the science. In the ’90s there were surveys
that were published from a group at Harvard University. And they showed that when
they surveyed the population, they showed that more than 1/3
of the people surveyed used one or more complementary and
alternative medicine therapies. So, 1/3 of the population
was already using it. That study also showed
that the visits to the CAM providers
exceeded the visits to the primary care physicians. Yes, and they estimated the
out-of-pocket expenditures to exceed $27 billion. So, that’s the science. And so, the people were ready
and the science were showing it. So, who are these 1/3
of the population? It’s mainly the segment
between 50 and 70 years old. They are the most who have
been using this practices. But you can see, I mean it goes, it’s all different
segments of the population. So, here, yeah. And if you look at that
was published in the ’90s. So when you look at this segment of the population it’s basically
the baby boomers who wanted to take charge of their health. Okay. Then these
studies also show that these people
didn’t necessarily reject conventional medicine. But they found it really
congruent with their beliefs and with their philosophies
towards health and life. One of the major points also
that were shown in this paper is that less than 40% of the CAM
therapies used weren’t disclosed to a physician. So the patients were
going to their physicians and not telling them of
what they were doing. And even today, I think many
patients are not disclosing what they’re doing with their
primary care physicians. And that’s where
the danger lays. It’s that if the patient is
taking as I mentioned before, blood thinners and in
addition they’re thinking that ginkgo biloba is good for
them because it improves memory and blood circulation. They’re adding on top of the
blood thinner another element that might cause problems. That’s why it’s very important
to know, or very important that the patient
disclose this information with their practitioners. But back then in the ’90s there
was no training whatsoever of our physicians
on these things. So, even when the patient goes
very well-informed and knowing about all these practices
and all that. The doctor doesn’t
necessarily know what to say. So, they start really
mocking the patient and not answering the patients
and ignoring the patients. And that created a big issue in the doctor-patient you
know satisfaction outcomes. Okay, so that’s just to show
you in diagrams who are those who answered yes or no, who
reported to the practitioner or not, their use of
for these therapies. And how they heard about it. So you can see here that
the patients are the ones who talk about it most. They know, they’re
very informed. And it’s around 25% they hear
about it from a practitioner. So, as I said, our physicians
are not trained in this field, at least until a few years ago. So, that’s science. Now, the politics. We need the politics
to make things happen. So, in October of 1991, the
US Congress passed legislation that provided $2 million in
funding to establish an office at the National Institutes
of Health to investigate and evaluate promising
unconventional medical practices. So, $2 million sounds
a lot, right? No. For research and for
do it nothing, right. So, they started, it start
at least it started somewhere and they created the Office of
Alternative Medicine back then, and they gave them
this $2 million. When you think that the budget for the National Cancer
Institute is in the trillions, so this is really nothing right. So, and this was
facilitated by Senator Harkin from Iowa, who was instrumental. He was the chair of the Appropriations
Committee back then. And he had a very good
experience using bee pollen for his allergies. So he was like okay,
let’s try it. You see when the
politics meet the science. So, that’s how it started. He took bee pollen
and it worked for him. He has been suffering of
allergies for many, many years. He’s like okay, let’s study it. Let’s go to NIH and see if we
can bring the evidence to that. So, that’s what happened
at NIH after the Office of Alternative Medicine was
opened, or launched in 1991, then a few years later,
it changed from an office to a center which is
already a good progress. And it was called the National
Center for Complementary and Alternative for many years. And then, they started
acting as a center, they created the
council, advisory council. And they started
giving grants out and doing research and all that. And in 2007, the
clinical center. You know that NIH has a
hospital trains protocols and they see patients
and all that. So they started this
integrative medicine consult at the medical center. And Dr. Berger is
the one leading that. So at NIH, they’re giving
some of these therapies. People don’t know about that. NIH is giving some of
those therapies inside NIH. And in 2015, the
center changed name, because the word alternative
is not really a good fit for this medicine. We don’t want anything
alternative to our conventional medicine. We want complementary. We want integration,
but no alternatives. So, the name changed
to the national Center for Complementary and
Integrative Health in 2015. See, this is just to give you
an idea about what’s going on. So, they do lot of research at
NIH, in their intramural labs, through their intramural
funding. And they are studying a
pain and natural products. There is a new director who
just joined this January 2019. So, she’s an acupuncture
researcher. And we are hoping that we will
see more research in that field. And so if you want
authoritative information about integrative medicine,
please visit the website of NIH. That’s the website
we have to go to. Now, outside of that. So, now we have the politics, we have the grassroots
movement, we have the science. Things are happening. But what has been happening also
in other, you know organizations and other academic institutions. So, for the past two decades, so
we created the National Center of Complementary and
Alternative Medicine. But also, I don’t know if
maybe you know that already, President Clinton called the
commission it’s called the White House Commission on
Integrative Medicine, so he called the commission to
really inform the politicians about integrative medicine. Is called the White House
Commission on CAM Policy. The consortium as I
mentioned before, was created and also another consortium
on policy in particular. So that was happening
around 2000. There was another
academic consortium for the allied health colleges. And the VA started
offering chiropractic care to veterans way back
then in 2004. Of course, the Institute of Medicine also wrote
a report on that. And the conclusion was like integrative medicine is
here and is going to stay. So, you better get together and make it you know
a practiced right. More, also on that. So, conferences, research
conferences taking place. And there was as I mentioned
before, the NIH clinic that opened around that time. The other organizations
also started. Like the WIN, which is
the Wellness Initiative. There was also a
national movement. The second IOM report,
the second report from the Institute of Medicine. And a lot of things
happening at this, you know throughout these years. All the way to 2019. Where, as I said, the
new director for NCCIH. Okay. The VA has always
been ahead, it seems. So, early in 2004, they
started offering benefits for chiropractic care. And now they are leading the
way by creating this health and wellness at the VA. They’re offering more
now; acupuncture. They have battlefield; they developed actually
a protocol called the Battlefield Acupuncture. That’s offered on
the battlefield to manage pain, and yeah. So, they’re really
ahead of the game. And they are really
working on this model where the patient
is at the center. That’s me, the patient. And then, it’s the
patient should take care of his or her health. Take care that, you know, really
be in charge of their health. So, self-care, then
professional care. They think that the workplace
should be also favorable to develop, to have
you know this wellness. And of course, the community. Very important to
have family support and community support
for better health. So, they’re trying to develop
this model which I think, the way I teach it
to my students, it’s called the biopsychosocial
model of health. And I mean I have been
following this movement now for the past 20 years. Being you know really
in the middle of it. We are moving from
the biological model to the biopsychosocial model,
which is more comprehensive. And the VA is following that. So, the other player in
this are the hospitals. And there was a survey
that was sent to many hospitals, around 2010. And they were asking if they
have any integrative medicine practice in the hospital. So in 1998, only 8% of our
hospitals were offering one or more of these
care modalities. Then this number started
increasing and in 2011, 42% of the hospitals around
the country are offering one or more of these modalities. And I’m sure by now, which
is almost 10 years later, this number is even
higher, I’m assuming that because I see the change. Unfortunately, there
haven’t been any new surveys for the past 10 years. So that’s what’s happening. And the key reasons,
the key reasons is the grassroots movement. Patients are asking for it. Patients are demanding
to have choices, to have an interdisciplinary
approach to their health. And then the other reason is that there is clinical
effectiveness. People who are practicing
it, or doing you know, adding these other
modalities to their health or to their health programs
are seeing an effect. It’s effective. And of course there’s always
the economic component. Hospitals are doing it
to attract more patients. Okay. Integrative medicine
and the management of pain. Chronic diseases is a big
issue in this country. Six in ten adults in the
US have a chronic disease. And four in ten adults in the
US have two or more of them. And this has been really
an issue for our country. And that range from
heart disease, to cancer, to chronic lung disease, to
stroke, Alzheimer’s, diabetes, chronic kidney disease. And I would add to
that list obesity. Obesity is also big
issue in our country. So here, this graph shows the
years lived with disability, that’s in 2013 in the United
States by cause and age. These are the age segments. And here it’s the
percentage of years lived in less than ideal health. So, people who are living with
moving around in some kind of, all kinds of illnesses. So, you can see here, the green
is chronic respiratory disease. The red is diabetes, urogenital,
blood, and endocrine problems. The yellow is the mental and
substance abuse disorders. And the blue is the
musculoskeletal disorder, the pain basically. The lower back pain,
the shoulder pain, the osteoarthritis pain. So, these are the
musculoskeletal diseases. And here, you see that
the mental health early in age is prevalent, but then it
switches to these pain problems. Okay, so the chronic
diseases are going to increase until 2030, this is the
estimate until 2030. And in parallel, our
spending of course on healthcare is
going to increase. Because these are
debilitating issues. And healthcare needs
to spend on that. So, the healthcare spending
here also increasing. And it’s going to reach of
our, I think we’re going to meet somewhere
our GDP [laughter]. The surveys, I mentioned
the survey from the Harvard University, but the CDC also conducted
two surveys which were bigger than the study from Harvard. They conducted a survey in
2002, and a survey in 2007. The difference between
the two is that in 2007 they
included children. And integrative medicine
used by the parents, you know on their children. And why I want to
share this with you is that pain is the major
condition that was reported by these polled people. So, back pain, neck pain,
joint pain, and arthritis. These are all pain
and disability. Okay. Pain and debilitating
diseases. The survey in 2007, independently showed
the same trend. Back pain, neck pain,
joint pain, arthritis. The major four issues. What is used? They use natural products,
deep breathing, yoga, Tia Chi, Chi Going, chiropractic, or
osteopathic manipulation, meditation, massage, all
these other modalities. That’s what the survey showed. Now, do we have any
idea what’s the share of this integrative medicine
in our healthcare spending. So, this is back in
2012, our spending for 2018 was 3.65 trillion. So back in 2012 when this was
done, it was 2.82 trillion. This is the share of the pie for integrative medicine,
very small. But it still in millions. And the blue part here
is the conventional out-of-pocket expenditures. So people are willing to pay
out-of-pocket to feel better. That’s what it is. So, if we if we increase
that part here, then you see where it goes. To the complimentary
practitioner visits, 14.7 billion. Self-care purchases 2.7 billion. Non-vitamins, non-mineral,
natural products, 12.8 million. So, that’s the share
of the market. So, there is also this
global movement of wellness which has also big share
of the economy here in the United States and
around the world, actually. So the global wellness
economy is 4.2 trillion market. And the industry is
growing really fast. In three years from
2012 to 2015, just in two years it
grew over 12%, right. So that is all that is also
happening in our country. This is just to show you
what are these key sectors. And I’m going to focus
on healthy eating, nutrition, and weight loss. There is a lot happening
there for our wellness. People are willing to spend
out-of-pocket to feel good. That’s the message. So what are the key
points so far? Let’s recapitulate. What have we learned so far? That integrative medicine is
used by the American people and not only disclosed
to the physicians. That government agencies are
incorporating integrative medicine in the healthcare
program and we see that at NIH and at
the VA, right. The third point is that
private organizations and academic health
centers are promoting and teaching integrative
medicine. As I said 70 of the 150 medical
schools here, and Canada, and Mexico are the teaching some
kind of integrative medicine. So, we are trying our best. And Georgetown is part
of that consortium, I forgot to mention that. We have the highest expenditure
on healthcare in the world. And yet we are the
sickest nation. So, yet, pain and the use of painkillers are not
adequately managed. We know that. The opioid epidemic is
ravaging and we need to do something about it. So let’s switch gears a
little bit now to talk about the management
and the best practices. This is a report that
just came out of the HHS. And it was called, of course, from the leadership
there, from the HHS. They put together an interagency
commission to look into how to manage pain and how to put
their best guidelines for it. So NIH was part of it, the
FDA, of course the HHS, ARC. All these organizations were
part of that commission. And the recommendations came out
a few weeks ago, few months ago. What does it say? So, they have this long report. And of course, what are the
alternatives to the opioids? You can read the report if
you are interested in that. So, they have in section 2.5, the behavioral health
approaches. And these are some, they kind
of intersect a little bit with integrative medicine. Because it behavioral therapy, instead of giving the magic
bullet to stop the pain, maybe direct people,
or the patients to do some behavioral therapy. Cognitive behavioral therapy, biofeedback, relaxation
training. So looking into other
alternatives rather than the magic bullet. Okay. Now, section 2.6,
they have a section 2.6 on complementary and
alternative medicine and integrative medicine. And they list acupuncture,
massage, and manipulative therapies, mind-body stress
reduction, yoga, Tai Chi. So, they’re listing some of those modalities,
which is great right. So it’s under the
radar for the HHS. The way it was written, though,
is like yeah, they are there, they exist, but more
research is needed. More proof that they
work is needed. So basically, that’s how it
has been for the past 20 years. We need more research. We need more research. Although there are so many
studies that have been showing that these modalities
are working, okay. Now, what is the evidence? We talked about acupuncture. Acupuncture has been shown
in many, many studies that it’s efficient in
reducing postsurgical pain, when they compare it
to sham acupuncture, when they compare it
to other controls. And it’s also effective in
reducing the side effects of opioids; reducing
the intake of opioids and the side effects
from opioids. So this has been
studied and shown, that acupuncture is
effective in acute pain. Even in the emergency
department. When people go with
the shooting pains, you know to the extremities and
that, they have been managed through the acupuncture, in
the emergency department. Acupuncture has been shown to
be superior to sham and control for chronic pain like
osteoarthritis of the knee, neck pain, shoulder pain, nonspecific back
pain, low back pain. And these are the studies,
if you’re interested in that you can go and
check the literature. So, the evidence is there. We know that there is evidence. Is it getting to the
right policymakers? We don’t know. So we are trying our best to really make these
studies known out there. So this is, I mentioned the
consortium at the beginning. The consortium is very active. So there is already a
response to that draft, contrast from the consortium. And the response is that there
is the science behind it. There are studies. There are systematic reviews. There are clinical trials that have been showing the
effectiveness of acupuncture. So, I’m focusing
here on acupuncture, because it’s the most studied. But there are also studies on
biofeedback for headache pain, biofeedback for anxiety. So there are other studies
for other modalities as well. You guys, very good,
there is a whole field of science of yoga out there. Actually, we offer a course
for our students on the science of yoga, where they go and
look at the literature. And it’s taught by
a PhD, actually. The science of yoga,
who’s a Yogi herself. So there is a lot out there. The other obstacle I think
to really talking freely, or incorporating 100%
integrative medicine, are the insurance companies. The insurance companies are
following the guidelines that come from the government,
right from the HHS and all that. So if the HHS is reluctant, of course the insurance
companies are not necessarily going to go on their own and start covering
all these modalities. Acupuncture is the most covered
by many insurance companies. Some massage therapist,
some companies cover that. If it’s specified, coded
for the right you know, patient and the right code. Under pain, muscular pain,
or something like that. Then it’s covered
by some insurance. So here, so what if
acupuncture were covered by insurance for
pain management. This is a cross-sectional
study for cancer patients. It’s a big study. And the conclusion was that one in two cancer patients
was willing to use insurance coverage
acupuncture for pain. So, again the grassroots
people are willing to use it, if it’s covered,
if it’s available, if you know the politics follow. There is another study,
which analyzed also, the state of insurance coverage
for nonpharmacologic treatment of low back pain as recommended
by the American College of Physicians Guidelines. So when all this opioid
epidemic you know came to light and all that, many of these
organizations became very active and wanted to really help
on managing this crisis. So the American College
of Physicians came out with a number of
guidelines on how to do it. But nothing was taken
into consideration. Now, it has been a few years
and nothing has been happening. So, what are the conclusions are that essential health benefits
are routinely excluding nonpharmacological therapies. So they still believe that
the magic bullet works better. We don’t necessarily send the
patients to anxiety management, or to behavioral therapy,
or, we don’t do that. Insurance coverage discourages
multidisciplinary therapies for chronic pain. And of course, they make
their guidelines so ambiguous that nobody can read or
understand what they cover and what they don’t cover. And they have many restrictions on ongoing complementary
therapies. This is what we need is really
to have enlightened EHB coverage to really help alleviate
this opioid crisis. So we need to be very active
and bring our two cents to the table each time, whenever
we have the location to do it. What is the take-home message? Integrative medicine considers
the body as a whole unit and not as independent parts. So it’s true, we are the
most sophisticated machine. We are body’s most incredible
machine, one can design. And the way we have
been really looking at that body is in parts. If you have chest pain,
you go to a cardiologist. If you have knee pain, you
go to a rheumatologist. If you have, I don’t
know diabetes you go to an endocrinologist. So we kind of divided the body
into these different parts. But in fact, the heart could
be affected by the mind. It’s that easy, we
need to treat the mind so the heart can feel better. So we need to think
of the body as a unit. And that’s what I
mentioned earlier, the biopsychosocial model where all the components
should work together. I designed this model
a couple years ago. I adopted it from
the HHS services. And so, the patient
should be at the center. It doesn’t matter, I
think, that’s my opinion. It doesn’t matter which
therapy you’re going to get, or which practitioner. As long as these doctors are
putting you at the center. You are the central focus. And the main goal is to
make you feel better. You are at the center
of this model. And then, you have the MD,
you have the osteopath, you have the chiropractor, you
have the natural path helping. What we need to do with our
healthcare system is move from this very siloed medicine to a comprehensive,
integrative medicine. Where the patient
is at the center. And then all the
physicians and practitioners and the allied health
providers are working together to make you, the
patient, us the patients, to make us feel better. And we are the center
of their focus. That’s what we want. And maybe we’ll get
there one day. In conclusion, integrative
medicine offers a multidisciplinary patient
centered approach to treatment by focusing on the mind
and the body together. It promotes complementary
modalities in addition to pharmacological. So integrative medicine, what
I want you to really keep in mind is not to reject
our conventional medicine. It’s to integrate it to
our conventional medicine. And please don’t think that
if it’s natural, it’s safe. That’s the biggest mistake. Natural doesn’t mean safe. As I mentioned ginkgo biloba, which is natural is
not necessarily safe if you are taking other drugs. Because the drug herb production
could be really detrimental. So, these are the two messages
today, take-home messages. So, the other thing is
integrative medicine treatments have been shown to
be cost-effective. And there’s a few studies
on the cost-effectiveness of these therapies with
insurance coverage. And they are way cheaper. We need to teach integrative
medicine in medical schools. I think we got to a
point where we want to go to an informed physician who
can make informed decisions about the referrals,
where to send you. If you have back pain and
you go to a physician, maybe surgery is not
the first option, right. Maybe you need to ask
your physician, okay, let’s do some imaging
to remove all kind, you know, of other issues. But if it’s musculoskeletal,
or as it is the case in many patients, let’s maybe go to explore other options
before we go to surgery. So, you need to see
an informed physician. And this cannot happen unless
we teach these modalities in our medical schools. So if we do all that,
it could contribute to providing a better
quality of care. That’s what we want. Before I end, here, I
want to make you aware that you have a program
at Georgetown University that I launched 15
years ago, already, on integrative medicine. So, my goal is to train a
new generation of physicians who look at health care, the
patients, with different eyes. So, that’s the goal
of that program. And it’s really to educate
open-minded healthcare providers and scientists who are
eager to explore the state of the evidence in
areas of complementary and integrative medicine
with objectivity and rigor. As a scientist, always you know,
after objectivity and rigor. So, that’s what we need. We need the science to support
this integrative medicine. And this is the quiz. Don’t think you are you going
to leave without the quiz. Taking the quiz. Okay, so let’s see,
what is this one? Echinacea. And it’s used for? Yeah, for cold. Yeah. Mild cold, right, don’t
wait until for it to happen and then start taking echinacea. Start taking echinacea. Next one, that’s an easy one. That’s ginkgo biloba, yeah. It’s used for memory and
because it works for blood, it improves blood circulation. Then this one. Very easy, yeah. Good for digestion, right. Oh yeah, we cannot
miss that one. Cholesterol reduction,
blood pressure. Very good. This one. it looks
like chamomile, no. No, it’s not. It’s yellow like chamomile. Okay, let’s go to the
next one, we’ll come back. Ginger, digestion also. Some here are some
wellness products. Okay. Yeah, turmeric, cumin, yeah absolutely,
star anise, yes. Star anise. And this is cardamom
I think too. Okay, so these are
some spices and herbs. The picture is too small
I think to see that. So, let’s go back to this one. This is St. John’s wort,
yeah, and it’s used for mild, not all depression, used
only for mild depression, that’s what the studies
have shown. It cannot be used for
severe depression. Okay. St. John’s wort. Like St. John, the Saint John. It’s called St. John’s wort
because it really it blooms, it flowers, it blooms on
the St. John day in June. That’s the reason, I think
around the 20th of June. It’s called St. John’s wort. Okay, this one here, is ginseng. And you see a lot of drink,
and tea you know using ginseng. But what they don’t tell you is that ginseng is only
effective, if it’s really old. If it’s a young ginseng,
it has no effect. So, just be careful when
you go by ginseng ask for how old is the root. For this one, for example,
which is a 300-year-old, it was sold for $400,000. So, you can see it’s
very expensive. And all this tea that you see
around, I don’t think it’s from that batch [laughter]. Okay with this, I thank you and
I’m happy to take questions. [ Applause ] Questions? Yes, ma’am. [ Inaudible Audience Question ] The leadership is
here, ask them. You have it. Okay, very good. Yeah, absolutely, it’s
very important because you, I mentioned; the question
is to encourage exercise and movement as part of health. And it should be part
of health absolutely. So, there are two fields of
medicine that deal with that. Osteopathic medicine and
chiropractic medicine. And they are both really focused
on the alignment of the spine with the brain, basically,
with the head. And they think that this
alignment is very important in maintaining health. So, it is. And we should all
promote that, absolutely. I don’t know if you
know the difference between chiropractic
and osteopathic. They are two different
fields of medicine. Although, osteopathic
schools now, they don’t want to consider themselves
as alternatives. They are really,
they’re operating as conventional medical schools. So, chiropractic really focuses
on the alignment of the spine with the head, you know. And osteopathic medicine, they tend to expand a little
bit to the musculature. So, it’s the musculoskeletal
alignment. They are very close. They were also founded
around the same time, here in the United States. So, these are two
fields of medicine that have their origin
here in the US. And we don’t know, you know
when we talk about it like oh, it coming from different planet. No. Chiropractic and
osteopathic were founded here in the United States, as well
as naturopathic medicine. Founded here in the
United States. And I’m glad you mentioned
the islands before. There is also use of
integrative medicine in these practices among
the Native Americans and the Alaskans. So they can still use the
traditional approach to health. Okay, other questions? Yes, ma’am. [ Inaudible Audience Question ] Yeah, absolutely. You all heard the question. Okay, oh for the camera, yeah. So, the question is what is the
regulation of herbal products. How do we know about the
quality of the herbal? The quality, and safety, and
efficacy of the herbal products. Very good question. In the United States, the herbal
products are not regulated as drugs. So if they’re not drugs,
they’re regulated as foods. So, if they’re not drugs,
they don’t really fall under the same scrutiny
as a pharmaceutical drug. And that’s what’s
creating all this confusion who is controlling the
safety and efficacy and all. So the drugs, this is
different than other countries. For example, in Germany
they have a book called the Commission E, “The
German Commission E” and there it’s basically
a repertoire of all the plants that they use. And all the amount,
the content, you know, the scientific name; everything. How it should be taken,
the dosage and all that. So, that’s called “The
German Commission E.” In Japan it’s regulated
as [inaudible]. yeah. It’s very well regulated. Here, in the United States,
it’s a little bit different. So, it’s regulated as food. And there is a regulation
that went through the regulatory bodies
called the [inaudible]. I don’t know if you are
interested in reading about that, where they
tried to regulate it. So, the pharmaceutical
companies didn’t want herbs to be regulated as
pharmaceutical drugs, which is maybe not a bad idea. But there isn’t much
money in it. The pharmaceutical drugs
are surviving because; I mean surviving, they’re
making lot of money because any compound they
create, they patent it and they make a lot of
money out of that patent. But herbal products,
you cannot patent it, it’s part of nature, right? So, that’s why there
is no interest really, there is no money in doing
these big clinical trials, multicenter clinical
trials with herbal products. The standardization
is getting there. For example, if you go to
buy ginkgo biloba, again, I will stay with that example,
it should be standardized to an active element
in the mixture. Ginkgo biloba, I think
it’s standardized to 24% of ginkgolides. So, ginkgolides are chemicals
inside and every batch has to have at least 24% of that. And I think 2% of
bilobalides or something, something, or [inaudible]. And so, every herbal product
has to be standardized to a certain chemicals inside. And that’s when you
know the quality. So when you go to
buy your product, you need to read the
small print standardized to so-and-so percentage
of the active ingredient. The standards are put
by the science, yeah. I mean the standards
are by the manufacturers and the manufacturers are
standardizing to that. So, what you need to do is
to go to the NIH website, and say okay the standard
for ginkgo is 24% of this, and for echinacea,
it’s the high percent. So, we need to look for
this active ingredient. If it contains the right
percentage and all that. Yes? [ Inaudible Audience Comment ] I agree with that. There were even worse cases than you know just
misleading the labeling. There were cases of
[inaudible] of the products. I don’t know if you
want to read about that. It’s called the SP
SPES, sorry the PC SPES, which was a compounded mixture
that was funded by the NIH to do clinical trials
for prostate. And they found that
it was [inaudible] by pharmacological drugs. So there is, out
there, there’s a lot to you know sift
through absolutely. Yeah, thank you.>>Tomoko Steen: Every
good thing comes to an end. And we thank you very much. It was absolutely a
good thing [applause].

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