Summary: Correction: Dr. Roger Rogers after whom the Dr. Rogers Prize is named is alive ... Bill Manahan, MD on pain treatment, CAM and the IOM pain blueprint ... Janet Kahn, PhD on key Integrated Healthcare Policy Consortium language in the National Prevention Strategy ... Ann Fonfa comments on sham acupuncture in the IOM blueprint ... Jean Keating, PharmD speaks up for independent pharmacists ... Glenn Sabin offers an informed patient's view on Freedman's Atlantic article ... Jim Winterstein, DC speaks to a value in the term "alternative medicine" ... Jennifer Olejownik, PhD on the current state of integration ... Chris Foley, MD and Stephen Bolles, DC on "patient-centered care" and "code-centered care" ... Michael Levin of Health Business Strategies on the characteristics of Primary Care 2025 ... Lon Jones, DO and Common Sense Medicine weigh in on the future of primary care ... Lisa Rohleder, LAc offers a useful rant against protective guild behavior ...
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Namesake Roger Rogers, MD is alive
1. Correction: Dr. Rogers of the Dr. Rogers Prize is Alive and Well!
In a recent Integrator Round-up (since corrected) I stated that Roger Rogers, BA, BSW, MD, OBC after whom Canada's Dr. Rogers Prize for integrative health was named, was deceased. He is alive. My apologies to Dr. Rogers and his family. Meantime, the 2011 Dr. Rogers Prize event, funded through the John and Lotte Hecht Foundation, will be in Vancouver, BC on September 23, 2011.
Bill Manahan, MD
2. Bill Manahan, MD: Failure to provide CAM to pain patients is one of medicine's most unfortunate practices
Integrator adviser Bill Manahan, MD responded to the Integrator Resource: Inclusion of IM/CAM in the IOM Pain Blueprint. Manahan is a Minnesota-based, long-time leader in holistic and integrative medicine. He was particularly struck, in that article's comment field, by an unattributed remark questioning how new the IOM perspective is.
"I agree with this statement regarding the pain
blueprint:
I hate to say it but the document does not really say all that much. They
just can't get their collective mind around the fact that much of the treatment
and management of pain requires good hands and a good exam, and that most docs
are simply afraid of pain. Thus, they seize up and default to prescriptions and
referrals.
"My take on this - as an M.D. - is that allopathic medicine practitioners
are, in general, incredibly uninformed about almost any types of
treatments beyond pharmaceuticals for helping in pain
management. The treatment of pain is similar to how we allopaths
treat most chronic problems. Our pharmaceuticals are often very
good for treating the acute pain problems but frequently not
very helpful for managing chronic pain. This is similar to how our
pharmaceuticals are great for infections and many other acute, single
factor problems. But when we try to use pharmaceuticals for
osteoporosis, arthritis, type 2 diabetes, heart disease, chronic
musculoskeletal problems, gastroesophageal reflux, and other chronic
complex problems, we are often doing our patients a real disservice.
"Why would we not use less expensive, safer types of treatments before
going to pharmaceuticals (especially narcotics) for treatment?
Hypnotherapy, yoga, massage, exercise, osteopathic
manipulation, structural integration, Qigong, Reiki, healing touch, meditation,
guided imagery, sound therapy, acupuncture, biofeedback, and a host of
mind/body therapies could be SO helpful to so many people with
pain. I believe that the lack of patients being
prescribed CAM therapies for pain is truly one of the most unfortunate
practices we have occurring in healthcare today. Many people are
suffering needlessly because of the reluctance of medical doctors to learn
a broader approach to pain management." Bill Manahan, MD
Comment: Manahan's response is useful, especially in the context of comments by both Glenn Sabin and Jim Winterstein, below. Regarding the former, Manahan alludes to the harm actually committed by lack of referral: "I believe that the lack of patients being
prescribed CAM therapies for pain is truly one of the most unfortunate
practices we have occurring in healthcare today." Manahan also manifests an "allopathic" viewpoint that would not seem possible given Winterstein's view of medical doctors.
3. Janet Kahn, PhD: National Prevention Strategy used IHPC language to define "integrated health care"
"Thanks for your summaries. Life has been busy and I have
not yet read the Prevention Strategy, but I will now, as your quotes from it
included a 'quote' of sorts from IHPC. Their definition of integrative
healthcare in the opening line of what you lifted from their page 22 sounded so
familiar I went and reread what we had submitted to the Surgeon General.
Turns out it was word for word. See attached. SO thanks for a first thing
in the morning reminder that there is some traction being gained."
Kahn shared a March 24, 2011 letter IHPC sent to Surgeon General Regina Benjamin, MD, MBA, in which the multidisciplinary consortium listed its core perspectives relative to a national prevention and health promotion strategy. The letter's second paragraph includes this language:
"As you may be aware, IHPC is a broad coalition of clinicians,
patients, healthcare educators and organizations committed to public policy that
ensures all Americans access to safe, high quality healthcare, including the
full range of qualified conventional, complementary and alternative healthcare
professionals. Integrated
health care describes a coordinated system in which healthcare professionals
are educated about one another's work and collaborate with one another, and
with their patients, to achieve optimal well-being for the patient.
Integrated healthcare, of course, provides for the population's full health
needs from primary prevention through acute illness and trauma care to
palliation and compassionate end of life care. Its hallmarks, however, are a focus on health promotion and patient
engagement through strong relational care." [bold added)
Comment: A distinct pleasure to read Kahn's comment: " ... a first thing
in the morning reminder that there is some traction being gained." Kahn and the rest of the IHPC team have done a great deal on not much for many years. Helping land this definition in this document must be satisfying. Consider how many will read this passage in their first attempt to grok a meaning of "integrated health care" that goes beyond having an electronic health record shared between doctors.
Ann Fonfa
4. Consumer advocate Ann Fonfa: IOM is right to say sham is inappropriate acupuncture control
Ann Fonfa is a long-time organizer and advocate for healthcare choice. She writes in response to comments on the IOM's Pain Blueprint relative to sham acupuncture. Her Annie Appleseed Project annually promotes a conference that brings patients together with clinicians in the area of integrative oncology.
"Lots of interesting tidbits in this information,
thanks for gathering it. I am concerned, as I have been for years, about
sham acupuncture. In this report it is used to point to acupuncture being
no more effective than sham. Has anyone looked at brain function (MRI) to
compare sham to correct acupuncture? I agree with the bolded section
from NIH below, that sham is not really ineffective and thus not an appropriate
comparison. My interest is in treatments for those with cancer, or preventive
methods. Ann F.
NIH stated: "A commonly used
control group is sham acupuncture, using techniques that are not intended to
stimulate known acupuncture points. However, there is
disagreement on correct needle placement. Also, particularly in the studies on pain,
sham acupuncture often seems to have either intermediate effects between the
placebo and 'real' acupuncture points or effects similar to those of the 'real'
acupuncture points. Placement of a needle
in any position elicits a biological response that complicates the
interpretation of studies involving sham acupuncture. Thus, there is
substantial controversy over the use of sham acupuncture in control groups.
This may be less of a problem in studies not involving pain".
"Research on
acupuncture has been controversial. Of interest, a systematic review of 23 clinical trials found
moderate evidence that acupuncture and sham acupuncture are, in roughly equal
measure, more effective than no treatment for chronic low back pain (Yuan et
al., 2008). This finding is consistent with evidence from a rigorous German
study (Haake et al., 2007). The success of sham acupuncture, in which needles
are inserted in the body but not at acupuncture points and usually not with
stimulation, has led to debates among researchers and clinicians about the
value of placebos (Berman et al., 2010) (see the next section). Some critics of
studies finding a lack of efficacy for acupuncture contend that the study
findings are based only on criteria of Western medicine, not those of
traditional Chinese medicine (Chiang et al., 2010)".
Comment: In a patient-centered world, such as Fonfa inhabits, judgment of acupuncture based on distinguishing effective sham needles from effective educated needles is a side-show in a researcher-centered world.
Glenn Sabin
5. Glenn Sabin: Patient's perspective on "The Triumph of New Age Medicine"
Comment: Self-described cancer "thriver," integrative center consultant and new Integrator adviser Glenn Sabin sent a note following the Integrator article David
Freedman's Atlantic Monthly Feature on Alternative
Medicine and the Holy
Trinity of Patient-Centered Outcomes. Sabin writes his own blog at FON Therapeutics. He shared that he had posted a piece entitled A Patient's Perspective on The Triumph of New Age Medicine. Sabin's piece includes 34 short bullet points that together amount to an eclectic, fetching potpourri. Like Freedman's own piece, these will surprise any reader who comes to the article with biases. Sabin's choice of content and variation of perspectives is aligned with Freedman's own atypical approach to the subject matter.
One gripe. Sabin repeats a view, propounded by mainstream-based observers that puts the accent on the negative around "alternative medicine." Sabin distinguishes "alternative" from "integrative," writing: "Alternative medicine is used in lieu of conventional, allopathic therapies and can be quite dangerous." Why not: "Conventional medicine is often used in lieu of alternative medicine and can be quite dangerous." I'd bet my house that patients have experienced a good deal more harm from conventional practitioners failing to refer for alternatives than alternative practitioners failing to refer appropriately for conventional treatment. That said, take a read. It's quite an interesting assemblage.
Jim Winterstein, DC
6. Jim Winterstein, DC: Reclaiming "alternative medicine"
Jim Winterstein, DC, president of National University of Health Sciences read the articles on Freeman's Atlantic piece and sent an email in which he used one of my comments as his subject line: "Maybe it's time to reclaim 'alternative medicine'?" Freedman chose to use "alternative medicine" repeatedly. Winterstein, a regular contributor, wrote:
"I liked your comment [in the subject line]. Personally, I never had a problem with the
term 'alternative medicine,' because it is an a priori assumption - it makes
sense. There are times when the best 'alternative' for a patient is the
allopath, times when the best alternative is the naturopath, and times when it
should be the chiropractor, or the acupuncturist etc. etc.
"The real 'crux' here
is that the allopath NEVER sees him/her self as the 'alternative' but rather as
the 'only choice' for the patient. The terms 'complementary medicine' and 'integrative medicine' are allopathic efforts to include what they know the
public is seeking without conferring the associated practice authority to those
of the so-called CAM professions. "We can integrate them and allow them to 'complement what we do,'" - but the reverse is never true!
"Some members of the chiropractic profession did not and do not like the term 'alternative medicine' because they believe it automatically casts them as 'outside the norm,' but if all of us could accept that we are 'all alternative'
depending upon the needs of the patient, then we would all be ok! It is no
different than saying 'what is the best choice in this instance?' If we truly
want to place the patient at the center of all our efforts and intentions, then
we are 'all alternative.'"
Jim Winterstein, DC, President
National University of Health Sciences
Comment: First, it is not true that "the allopath NEVER sees him/her self as the alternative." Witness the comments of Bill Manahan, MD, above. Manahan's not the rule, but we have enough openness across a broad spectrum of medical doctors for us to support the positive in each and no longer polarize. How does the saying go: Some of my best friends are integrative medical doctors who are quite willing to co-manage with others. Winterstein's basic point remains a good one. All practitioners are "alternatives" just as each can be a "complement" to another. My own attraction to reclaiming "alternative" is that the problem we face in our system requires something as profoundly different as the term "alternative" suggests. It would indeed be an "alternative" for US healthcare to be re-ordered with significant attention to lifestyle issues first and the least invasive therapeutic course second.
Jennifer Olejownik, PhD
7. Jennifer Olejownik, PhD: Communication and collaboration are barriers Jennifer Olejownik, PhD writes in response to a quote in the Integrator from nursing educator Polly Bednash, PhD, RN, FAAN, regarding the inclusion of CAM in interprofessional education initiatives. (See article here.) Olejownik holds a PhD in Cultural/Somatic Studies in Education from the Ohio State University
and her doctoral research focused on "the paradigmatic tensions of opposing
healing systems as told through the lens of the alternative practitioner."
She is currently a research partner at Diversified Data, a consulting
firm that provides data-based services to organizations.
"Since the early 1990s biomedicine's relationship with CAM has
passed through several phases from condemnation to reassessment to integration.
"Although we are currently in an integration phase, much
effort has focused on exploring the efficacy of CAM practices and
procedures. While scholarship of this kind elicits useful information for
the medical profession, little research has been conducted on the process of
integration that privileges the perspective of CAM practitioners working in
integrative environments.
"From the scarce
research that has been conducted on integration, it is evident that
communication and collaboration are two of the biggest barriers thwarting the
integrative process.
"From my own experience launching an investigation into this
arena, there has been very limited research exploring how conflicting healing
philosophies affect the operative practice of CAM in an integrative
environment. Given that a paradigm clash exists between biomedicine and
CAM, as Ian Coulter describes, it seems that both sets of practitioners need to
negotiate, or at least dialogue, their healing philosophy for the sake of
integration.
"In the applied sense, what does each group gain and/or lose
in the process of integrating? How do these divergent practices blend
together? What are the philosophical and paradigmatic tensions
practitioners negotiate as these processes unfold? Is the dominant
medical model being reinforced or is something new emerging as a result of this
newly forged dialogue?
"Findings from the field seem to indicate that while the US is
moving back toward a more pluralistic model of medicine, it is doing so in a
very superficial manner since the voices of CAM practitioners appear to be
marginalized both in theory and in practice."
Comment: Olejownik's comments speak to the distinction between "integrative" and "alternative" discussed in Sabin's letter in this Reader Comment issue. While "integrative medicine" proposes a more healing-oriented paradigm, that IM is dominated by medical doctors sometimes means that "the voices of CAM practitioners appears to be marginalized both in theory and practice."
Lisa Rohleder, LAc
8. Lisa Rohleder, LAc: A welcome rant against turf wars and why they are, quaintly, "sinful"
Lisa Rohleder, LAchas
been a thorn in the side of the leadership of the acupuncture and
Oriental medicine (AOM) profession since she began analyzing the
professional leadership and economics of the AOM world. Rohleder promotes
the potential for reaching clientele, and employing acupuncturists, in
the community acupuncture practice led by the Community Acupuncture Network which she co-founded. On hearing that some leaders of the
AOM community seek to protect acupuncture needles for
licensed acupuncturists via a position paper on trigger point dry
needling, Rohleder offers a scathing critique in a\her CAN blog of all guild behavior:
"So from the perspective of the real world of acupuncture practice,
these arguments are laughable. But making them in this way isn't funny,
because it's also just wrong. Immoral. I know I'm quaint in this regard,
but I'm going to revert back to my working class Catholic upbringing
and say that turf warfare is a sin. Because that's what I really think
about it. That's the summary, soup to nuts, I don't care if we're
talking about PTs or DCs or MDs, it's all BS. And it's a sin. For those
of you who managed to avoid years of CCD (that's what they called
Catholic Sunday school when I was a kid, only it wasn't on Sunday), sins
are sins because they harm your relationship with God, your
relationship with others, and your relationship with yourself. I'm going
to leave God out of it, but the other two categories do apply here ...
Turf warfare doesn't just harm our relationship with others, it harms others, period."
Comment: I am reminded of the quote from novelist Upton Sinclair that is a favorite in understanding the insane economics of US medicine and of guilds, in particular: "It is difficult to get a man to understand something when his salary depends on his not understanding it." To extrapolate, it would seem to be not difficult but impossible to get an entire profession, of any kind, to understand income-reducing logic; or, to extrapolate a bit further, income-reducing science.
Chris Foley, MD
9. Exchange between Chris Foley, MD and Stephen Bolles, DC on "code-centered care"
Chris Foley, MD is an integrative medicine doctor who runs the clinic Minnesota Natural Medicine. Foley began one of the nation's first health system-based integrative clinics. He has more than once expressed his opposition to any affirmative engagement with the current payment system. Foley writes in response to an Integrator column from Stephen Bolles, DC entitled Stephen Bolles, DC Re-Writes the Trends for Integration to Capture the Marketplace and Consumers. Foley begins with "... you have not become too irrelevant for me to keep reading as you can see," then adds:
"But Steve gets one thing right: The 'Patient Centeredness' BS we hear from mainstream folks is just
that. The Medical Home is something I built more than 11 years ago, but I threw out the coding system. IOWs, the currency is what REAL marketplace
currency is: time and money. I give away some extra time, but patients agree
to certain fees that are non negotiable. It works, we are busy, and I suffer very little interference from IOM type of corruption. If Steve were
really harmonic with the 'marketplace', he would understand that the ICD9,
CPT, and DSM matrix entangles care to a point where it cannot possibly be 'patient centered'. It is absolutely 'code-centered', and no amount
of philanthropic/academic adoption will ever get past that. I can't wait to go to the office every day."
Stephen Bolles, DC
I sent Foley's comment to Stephen Bolles, DC to see if he had a reply. Bolles, a former vice president at Northwestern Health Sciences University who also played a major role in some early integrative clinic developments in the Twin Cities, responded:
"Chris
was certainly a pioneer in understanding that group-delivered care had some
real benefits in terms of patient engagement, and had appealing aspects as a business
model, too. It's unfortunate he did not get support for the model from the
system he was part of at the time, but he has continued to be a pioneer.
"My
lack of condemnation of the current coding system may or may not be evidence of
'harmonic dissonance.' I simply didn't cite the issue, but Chris is absolutely
right: the current coding system is part of the problem. It forces providers to
reduce the complexity of a patient/consumer encounter--whether or not they see
that complexity as important to acknowledge or embrace--to a very
one-dimensional representation of an individual. It's simply not
defensible.
"It
may not still be true, but one of the more startling revelations to me while
working at UnitedHealth was that their data system was often only set up to
capture one diagnosis coding field. One. So no additional codes for anything
resembling a context for the primary diagnosis was even captured, let alone
appreciated. So the coding system is fundamentally inadequate and flawed--even
for its minimal utility in compensating providers for transactions.
"And
even with that, quite a bit more could be challenged, critiqued and condemned.
But my comments were aligned with how you portrayed the trends."
Stephen Bolles, DC
Comment:It occurs that the MD antagonism toward 3rd party payment can look to someone from the typically less-covered world rather like a meal which a patron rejects back to the kitchen looks to a street kid looking for a bite.
Sara Firman
10. Sara Firmin: Regarding integrative health, karass, granfalloon and Vonnegut
"I found your
post around the question of 'karass' or 'granfalloon' very
thought-provoking - I have not read Vonneguts's Cat's Cradlebut shall
now. Perhaps the clue is to be found in true community being formed
'often unknowingly'. How can we say what is 'cosmically significant' or
'spiritual destiny'? And when something dies (like your CHRF) can we say it
failed or that it served its purpose along the way? How we see all this might
indicate what we think 'health' really is.
"I live in a 1000 acre forest which at first glance seems to be defined by the
trees but recently I learned that the trees are all connected underground by a
web of mycorhizae (fungi) without which they could not live. Likewise,
each of us is populated invisibly by hosts of bacteria without which we could
not live. The ebb and flow of these hidden relationships, in response to
environmental stresses, leads to varying visible states of health.
"In Flow (The Anatomy of Consciousness), Csikszentmihalyi suggests that,
as regards human consciousness, 'The shape and content of life depend on how
attention has been used. Entirely different realities will emerge
depending on how it is invested....' This suggests to me that the
shift from 'granfalloon' to 'karass' will come when we truly understand
'health' as a dynamic and complex process rather than fixed and distinct event.
"I suspect that our best teacher and model will be the natural world.
Csikszentmihalyi went on to say that 'Traditional Melanesian sailors can be
taken blindfolded to any point of the ocean within a radius of several hundred
miles from their island home and, if allowed to float for a few minutes in the
sea, are able to recognize a spot by the feel of the currents on their
bodies....' That level of atunement could be applied in all settings but
is lost on most of us.
"'Because attention determines what will or will not appear in consciousness
... it is useful to think of it as psychic energy.' Attention is like
energy .... We create ourselves by how we use it.' So, perhaps the
contemplation Vonnegut and now you and your friends have raised about what
creates real and healthy/healing community is a good place to focus our
attention. A shamanic practitioner introduced me to the idea that healing can
include dying, life and death together.
"Through my interest in the spa world (which you do not mention in your post but
which as an 'industry' is become very interested in organized integrative
'corporate health care') I notice that even as all things natural are
celebrated, there remains the anxious drive to live forever, never aging.
Rarely is it asked what purpose and part natural decline plays in the cycle of
life. 'Karass' it seems to me is about our humanity, while 'granfalloon'
describes our hubris.
Thanks again for making me think about my own perspective on what integrative
community is or could be.
Integratorcolumnist Michael Levin of Health Business Strategies responded to the Integrator call for comments on the Institute for Alternative Futures' Kresge-funded the Primary Care 2025 project. Levin, a consultant, has held executive positions in natural products, pharmaceutical and medical device firms. Levin offered these comments to IAF then shared them with the Integrator. (A first set of Reader Responses on the topic was already posted.)
"Overall Comment: Changing demographics, morbidity
trends, technology and economics will drive changes in primary care delivery
& focus. These will combine to focus and reward prevention, rather than
treatment, in an effort to reduce national healthcare costs by improving the
public health. This is both a preferred and likely future, primarily driven by
economic imperative.
"1. Payment Form & Primary
Care:Comment: Conspicuous in its absence
are shared-risk components of the integrated and semi-integrated payment
schemes. Under shared-risk arrangements, payer networks contract for
population-specific outcome goals over a long time period, during which
payments are made based under negotiated benchmarks. If benchmarks are
favorably exceeded thus reducing the longitudinal planned costs of care, the
increased savings are shared by an between all stakeholders. This incentivizes
patient, practitioner and administrator alike to exceed outcome expectations.
This is a preferred future and, if carefully constructed, a likely future, as
it improves public health while lowering costs. A win-win-win."
Forecasts for Specific Aspects of
Primary Care 2025
"7: Focus on Behavioral Change I've slogged through the
healthcare cost-containment world since the phrase first emerged in the
mid-70s. I'll language this comment as a separate forecast, to elevate it's
criticality:
"Forecast: Economic rewards and
punishments will be effectively used to create healthy lifestyle and behavior
changes. Recognizing that the most
common drivers of disease are lifestyle choices, behavior change programs will
be integrated with primary care delivery. Home biometric monitoring,
web-mediated coaching, and the use of economics to encouragement engagement
will be the norm, not the exception. Consumers will become painfully educated
about the costs of their misbehavior to society. The days of "fish and
loaves" for disease treatment ("fix me doc, at whatever cost, even
though I did this to myself") will end. An era of personal accountability
will begin."
"11. Precision Medicine: Again, conspicuous in its absence is the impact interactive technology will
have on primary care, in terms of both locus and types of intervention. Maybe I
missed something. My point is this: we already have remote technologies in
place that reduce costs of anticoagulation therapy (coumadin) through which INR
measurements are transmitted to a doc who titrates the dose of coumadin which
is automatically dispensed at the patients home thru robotic delivery devices,
thus assuring medication compliance while relieving the costs of patient clinic
visits. In the future, we will have a broad array of at-home, low-cost,
diagnostic technologies that will empower primary care folks with the ability
to better manage chronic diseases at far lower costs. Asthma, diabetes,
anticoagulant therapy, IV antibiotic therapy and (yes) sleep apnea quickly come
to mind as high-cost, high-impact areas for remote management. These types of
cases will be managed by primary care practitioners (be they PAs, RNs, NDs,
RPhs) and referred upwards to specialists only on an as-needed basis. Doing so
gets "under the costs" in several meaningful ways. And driving
engagement with remote, internet-mediated technology tools using economic
incentives will clearly reduce costs while improving outcomes in several major
ways.
"15. Integrative Medicine: As QOL
measures and longitudinal economic outcome measures accrue and mature, the role
for integrative medicine will become increasingly valued and embraced. In
particular, the role of nutritional medicine will expand at the expense of
Pharma. The economic arguments for the use of nutritional supplements &
lifestyle changes first, before drugs, will become so compelling as to change
FDA claims restrictions regarding dietary supplements, just as the laws for
generic drugs were passed over the strong objections of Pharma in the 80s (see
niacin, st johns wort and fish oil as economic examples that can, on an
annualized basis, reduce annualized and growing direct drug spending by
$1-2B/year)."
Michael Levin Health Business Strategies
PMB
585 12042
SE Sunnyside Road Clackamas,
OR 97015
503-753-3568
(direct)
Comment: I always find interesting Levin's strongly held position that tough personal markers should be, or, in this forecast, will become, standard practice. Feels harsh and yet feels appropriate for a time of reckoning after a period of great decadence, which this era in the U.S. will certainly be considered. In addition, Levin's linkage of integrative medicine's future to the evolution of research measures supports a favorite personal view. That is: We serve ourselves to push the research agenda toward one with more expertise in, and respect for, outcomes and QOL.
Lon Jones, DO and partner Jerry Bozeman
12. Lon Jones, DO: Common Sense Medicine should guide primary care
Integrator reader Lon Jones, DO is an advocate for what he and his partner Jerry Bozeman call Common Sense Medicine. Like Levin, he wrote in response to the call for perspectives on Primary Care 2025. Jones is based in Plainview, Texas.
"Following are my
comments on what I would like to see for the future.
"At Common Sense
Medicine we see many of the problems in terms of the old paradigm of
Humoral medicine upon which our current practices are built. Any time
symptoms become the primary focus of therapy we are at risk of
practicing humoral medicine. We argue for the need to switch to biological
medicine where we ask why symptoms are expressed. The simple answer is that
they provide a survival advantage to one side or the other in our
ongoing game with the invaders in our environment. If the advantage is ours
the symptoms are defenses. Our washing defenses provide the best
example: diarrhea washes our GI tract and rhinorrhea our upper
respiratory tract; and blocking those defenses, as is currently done with a
variety of drugs, is not in our best interest since it robs us of their
survival advantage.
"If, on the other hand, the advantage goes to the other
side and the symptoms we have actually help the opponent (as in
the fever and prostration that make people with malaria easy meals for
hungry mosquitoes, or in the profuse watery diarrhea of cholera that
spread the bacteria widely) then the symptoms are called manipulations.
Defenses need to be honored and supported since they give us the advantage.
Manipulations need to be blocked, most easily with mechanical means
like bed nets, good sanitation, and hand washing.
"There are also
ways, largely ignored, to assist our defenses. Oral rehydration has a
40 year track record of helping to make our GI
tract's cleaning safe and effective. The use of xylitol orally
has a similar track record in
preventing tooth decay and used nasally a 10 year record of optimizing our
nasal defenses.
"Recognizing our
defenses would help change our practices; honoring and supporting them
would save millions; optimizing them would save billions. We hope this
shift in thinking is a part of our future.
Lon Jones D.O."
Common Sense
Medicine
Comment: Here's a second to Jones' hope. All of technology's horses and technology's men will continue to stare at broken pieces if we don't organize healthcare to maximally work with the body-mind-spirit when that is appropriate. The value is not only in this being good, commonsense medicine. The value is also in teaching people to pay attention. Doctoring as teaching. Great idea.
13. Jean Keating, PharmD: Include the role of the independent pharmacist
"I read your June blog
and wanted to make a comment. I only saw a small reference to
pharmacy. As a pharmacist, I believe that pharmacists should be included
in any integrative teams for health and wellness. I work in a family
owned independent pharmacy and we are trying to promote health and
wellness as an option for patients.
"I agree that patients
should be treated more holistically, and a team approach would be a lot more
effective. Medication therapy is a necessary piece of
modern healthcare that will never go away, and a pharmacist is
the medication expert who carefully and thoughtfully focuses on drugs
and their effects and interactions. No other part of the healthcare
team is trained to focus and solve medication issues.
"This is the only blog
that I have read, so I'm not sure if you have included pharmacy in the
past. I saw your reference to Jill's list and that is how I came across
this article.
"As an independent
pharmacist I am becoming more involved in trying to promote our profession as a
valuable health care resource. Thank you for your time."