Insured, but Bankrupted by Health Crises

http://www.nytimes.com/2009/07/01/business/01meddebt.html?ref=business

Above is a link about the U.S. healthcare problems faced by millions of Americans.
As health care fix is being investigated by the Obama administration, I hope that it will consider the suffering of its people and come up with a viable solution.

How Safeway Is Cutting Health-Care Costs

http://online.wsj.com/article/SB124476804026308603.html

Above is an article published by the Wall Street Journal written by the CEO of Safeway.

By all accounts, our health care is in deep trouble. The US spends the most of money in health care only to claim 37th in the world right after Costa Rica. There are growing population of the US, more than 48 million people, who does not have insurance. More and more businesses are not able to afford providing insurance to the employees.

The article points out how we can learn from the auto industry. Provide financial incentives for health associated behaviors and provide financial disincentives for illness associated behaviors. It's pretty simple really. When people realize preventive measurements such as blood pressure, cholesterol, and weight result in increased premiums, they have a tendency to want to self correct the behavior.

Safeway implemented this policy and found that they can save 40%. Perhaps, the rest of the U.S. can learn from this experience.

Cost-Effective Ways to Fight Insomnia

http://www.nytimes.com/2009/06/06/health/06patient.html?_r=1&scp=1&sq=insomnia&st=cse

Dalai Lama said "Sleep is best meditation." I agree.
Lack of sleep can easily account for many of the chronic illnesses in the U.S. While, I cannot say that lack of sleep or chronic sleep deprivation causes illnesses, it can contribute to the ill effects of chronic illnesses.

I find that sleeping problems are often the most sensitive indicator of overall health and wellness. Often times, sleep disturbances will precede an episode of illness or a bout of depression or anxiety.

A good sleep resets our body and mind and renews our spirit. I find good sleep to be most cost effective ways for wellness. Integrative Medicine is a wonderful asset to help people to restore a good sleep.

Dr. Rubin Naiman, a faculty at Dr. Weil's faculty, suggest below suggestions for improving sleep:

Recommended Lifestyle Changes for Insomnia Treatment:

from Dr. Weil's website: http://www.drweil.com/drw/u/ART02004/insomnia

The following are some of the best possible insomnia remedies:

• Establish a consistent bedtime routine. This is one of the most important factors in insomnia treatment and maintaining good sleeping habits. Routines may include taking a warm bath or a relaxing walk in the evening, or practicing meditation/relaxation exercises as part of your regular nighttime routine.
• Try to go to bed at the same time every night, and get up at the same time each morning. This includes weekends.
• Get plenty of exercise during the day. Studies have shown that people who are physically active sleep better than those who are sedentary. The more energy you expend during the day, the sleepier you will feel at bedtime. Just be sure not to engage in vigorous exercise too close to bedtime as that can make it more difficult to fall asleep.
• Reduce your intake of caffeine, particularly in the evening.
• Avoid stimulants like caffeine and limit alcohol. Both, even when consumed early in the day, can affect sleep and inhibit insomnia treatment.
• Use your bed only for sleeping and sex. Don’t use it to do work or watch TV.
• Avoid large meals late in the evening.
• If you can’t fall asleep within half an hour of going to bed, get up and read or do something calming until you feel sleepy.
• Learn and use a relaxation technique regularly.Breathing exercises, meditation and yoga are not insomnia cures, but do lead to a state conducive to sleep.
• Use “white noise” devices to block out surrounding environmental noise.
• Take a hot bath before bedtime. Try a few drops of relaxing oil of lavender in the water.
• Short naps are good. Try to get into the habit of napping for insomnia treatment: ten to twenty minutes in the afternoon, preferably lying down in a darkened room.
• Spend some time outdoors as often as you can to get exposure to bright, natural light. If you are concerned about harmful effects of solar radiation, do it before ten in the morning or after three in the afternoon or use sunscreen.
• Try to give yourself some time - up to an hour - in dim light before you go to sleep at night. Lower the lighting in your house and bedroom and if other members of the household object, wear sunglasses.
• The two best natural sleep aids are valerian and melatonin. Valerian is a sedative herb, used for centuries. You can find standardized extracts in health food stores and pharmacies. Take one to two capsules a half hour before bedtime. Melatonin is a hormone that regulates the wake/sleep cycle and other daily biorhythms. Try sublingual tablets (to be placed under the tongue and allowed to dissolve); take 2.5 mg at bedtime as an occasional dose, making sure that your bedroom is completely dark. A much lower dose, 0.25 to 0.3 mg, is more effective for regular use.
• Don’t obsess about not sleeping. Not surprisingly, studies have shown that individuals who worry about falling asleep have greater trouble dropping off. It may help to remind yourself that while sleeplessness is troublesome, it isn’t life-threatening and there are insomnia remedies.

If All Doctors Had More Time to Listen

http://www.nytimes.com/2009/06/07/health/07health.html?_r=1&em

Above is an article in NY Times on If All Doctors Had More Time to Listen.

I feel priviledged to be part of the team at Georgia Integrative Medicine. We make the time to listen to our patients. Patients have ready access to Dr. Kim. Patients spend about one hour being treated for each visit. For complex patients, we spend up to four hours performing a comprehensive evaluation known as the team visit.

We have patients who are choosing us over their regular physicians and over other integrative medicine physicians because we choose to listen to our patients. Even our growth is managed to ensure that our existing patients have a ready access to Dr. Kim.

At Georgia Integrative Medicine, we understand that our patients are the experts on their bodies and in order to help, we have to listen and understand to their healing journey. Carl Rogers was a humanistic psychologist who understood the importance of "client-centered" therapy. He understood the importance of listening mindfully to what his clients had to say. At Georgia Integrative Medicine, we honor the Rogerian tradition and perform that mindful listening to the best of our ability.

Jeanne Bowers
Clinic Manager

Helath Benefits of Omega 3 Fatty Acids

http://en.wikipedia.org/wiki/Omega_3_fatty_acids

Above is a link for Omega 3 fatty acids from Wikipedia.
Omega 3 fatty acids is all the rage these days. So, what is omega 3 fatty acids?

First of all, omega 3 fatty acids are essential fatty acids. That means our body is not capable of making them ourselves. We have to obtain it from our nutrition or supplements.

Below are from the Wikipedia article:

• The benefits of omega 3 fatty acids were discovered in the 1970s by researchers studying the Greenland Eskimos. The Greenland Eskimos consumed large amounts of fat from seafood, but displayed virtually no cardiovascular disease. The high level of omega-3 fatty acids consumed by the Eskimos reduced triglycerides, heart rate, blood pressure, and atherosclerosis.
• On September 8, 2004, the U.S. Food and Drug Administration gave "qualified health claim" status to eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) n−3 fatty acids, stating that "supportive but not conclusive research shows that consumption of EPA and DHA [n−3] fatty acids may reduce the risk of coronary heart disease." This updated and modified their health risk advice letter of 2001 (see below). Currently regulatory agencies do not accept that there is sufficient evidence for any of the other suggested benefits of DHA and EPA other than for cardiovascular health, and further claims should be treated with caution.

• The Canadian Government has recognized the important of DHA omega-3 and permits the following biological role claim for DHA: "DHA, an omega-3 fatty acid, supports the normal development of the brain, eyes and nerves."
• The 18 carbon α-linolenic acid has not been shown to have the same cardiovascular benefits as DHA or EPA. Currently there are many products on the market which claim to contain health promoting 'omega 3', but contain only α-linolenic acid (ALA), not EPA or DHA. These products contain mainly higher plant oils and must be converted by the body to create DHA and therefore considered less efficient. DHA and EPA are made by microalgae that live in seawater. These are then consumed by fish and accumulate to high levels in their internal organs. If a person is concerned about mercury and oceanborne contaminants in fish, DHA can be produced directly from microalgae as a vegetarian source.
• Some benefits have been reported in conditions such as rheumatoid arthritis and cardiac arrhythmias.
• Some research suggests that fish oil intake may reduce the risk of ischemic and thrombotic stroke. However, very large amounts may actually increase the risk of hemorrhagic stroke (see below). Lower amounts are not related to this risk, 3 grams of total EPA/DHA daily are considered safe with no increased risk of bleeding involved^[and many studies used substantially higher doses without major side effects (for example: 4.4 grams EPA/2.2 grams DHA in 2003 study).

At Georgia Integrative Medicine, the correct use of omega 3 fatty acids form an important part of the treatment protocol. Most plant sources yield ALA not EPA or DHA. Therefore, the preferred sources are from marine animals including Krill, Anchovies, Sardines, and Salmon. One potential problem taking marine based EPA/DHA is the exposure to heavy metal contaminants which can cause health problems. This can be avoided by buying from a reputable producer of omega 3 fatty acids with molecular distillation and asking to see the certificate of analysis.

Letting the Patient Call the Shots

http://www.nytimes.com/2009/06/04/health/04chen.html?em

Above is an article on the NY Times about the idea about collaborative approach to health care. As a physician in training, I was taught that physicians were the authority figure in health care. I also remember when I was providing primary care that I was taught to deny the patient "unnecessary" prescription of antibiotics.

Today, given the information revolution, I am not sure that a physician, even a specialist, can know better than a motivated patient who is well-read on the subject. I often share with patients that I can provide the perspective, knowledge, and experience. Patients provide the context and subjective experience of how their condition is affecting their life.

I view integrative medicine as not just a combination of Eastern and Western medicine. Rather, it is a transformative way of practicing medicine in a collaborative approach with patients being of assistance to them. Also it is about honoring patients' experience of their suffering of their ill-ness and guiding them back to well-ness. I recall Dr. Bernie Siegel, who helped me through the development of my career, stating that [as physicians], we are a privileged listener.

Medical bills prompt more than 60 percent of U.S. bankruptcies

http://www.cnn.com/2009/HEALTH/06/05/bankruptcy.medical.bills/index.html

• Story Highlights
• Study: More than 60 percent of bankruptcies are linked to medical bills
• Three-quarters of people with a medically-related bankruptcy had health insurance
• Researcher: "You're one illness away from financial ruin in this country"
• Situation likely to worsen: study was done a year before recession

Above link is an article featured on CNN focusing on the the importance of medical health insurance issues in the U.S. We currently have the dubious honor of being the first in medical expenditures with health care results being rated 37 in the world after Costa Rica.

Above article states that we are all one illness away from financial ruin in the U.S. As we are discussing universal health care for the U.S., I invite everyone to be active in participating the development. The first step of participating is knowing what is being proposed and understanding how it affects you.

Study: Alzheimer’s Drugs May Raise Death Risk in Elderly

NY Times has published that Anti-psychotic drugs commonly used to treat Alzheimer's disease may double a patient's chance of dying within a few years, suggests a new study that adds to concerns already known about such medications.

I am not surprise at the finding. Western medicine has outstanding tools for acute problems such as trauma, heart attack, and stroke. However, my sense is that integrative medicine has much better handle on chronic degenerative illnesses such as Alzheimer's disease. The basis of all degenerative disorders involve abnormal inflammation. There are highly effective nutritional protocols that can be of help to reduce inflammation. In addition, there are mycomedicinal products that have been shown to have stimulation of nerve growth in-vitro.

At Georgia Integrative Medicine, we have used natural approaches to Alzheimer's disease successfully using all of above approaches. We also treated successful dementia resulting from other causes including Parkinson's disease.

Major Flu Strain Found Resistant to Leading Drug, Puzzling Scientists

NY Times has reported that virtually all the dominant strain of flu in the United States this season is resistant to the leading antiviral drug Tamiflu, and scientists and health officials are trying to figure out why.

Western scientific breakthroughs in microbiology has led the scientific methods to become the core of medicine. Drs. Pasteur and Koch demonstrated how illness was caused by microorganisms. Then, the discovery of anti-biotics have changed the treatment options.

About one hundred years ago, people died of diseases related to infectious diseases. The whole society had to mount a comprehensive approaches including public health advances.

We have found with antibiotics we can benefit many people dying of infectious illness. Last century ended with HIV virus and Avian Flu virus reminding us of our vulnerabilities to infectious diseases.

Integrative approach to infection still have anti-biotic, anti-fungal, and anti-viral as central role. Many patients who develop Shingles receive anti-viral medication at Georgia Integrative Medicine. However, in addition, we also use Chinese herbs that support immune functions with scientific evidence. In addition, we also use anti-inflammatory nutrition to decrease possibility of post-herpetic neuralgia. Also, medicinal mushrooms can be helpful to shorten the duration of illness.

I believe that flu pandemic is just a matter of time and that most of our measures will not likely to be successful for treating a viral illness. Integrative medicine, I believe, can provide important tools for developing next generation of fighting microorganisms causing death & pestilence.

Wall Street Journal: Alternative Medicine is Mainstream

JANUARY 9, 2009

Wall Street Journal has published an opinion written by Drs. Chopra, Ornish and Weil.

Below is my submission to the letters to the editor:

Dear Editor: The article by Chopra et. al summarizes my journey as a physician. I chose family medicine as my first specialty. The reactive nature of primary care where the system was overwhelmed with treating symptoms of patients precluded the possibility of providing a systematic proactive approach focusing on prevention.

I pursued further training through preventive medicine residency which included a master's degree in public health. The additonal training provided me with a valuable systems perspective. Our current health care model is largely based on social conditions prevailing in the early part of last century where infectious causes of diseases were most frequent. Today, the disease frequency has shifted to chronic illnesses where therapeutic lifestyle change has been shown to work.

As part of my residency, I also worked at Kaiser Permanente's Preventive Medicine Department and Positive Choice Wellness Center where health appraisal program identified individuals with high risk of developing chronic illnesses and therapeutic life style change was prescribed by physicians and implemented by nurses and counsellors. Another benefit of the preventive medicine training was academic training of evaluating evidence. The difficult part of evaluation of evidence is not evaluation but education of professionals and public of complexity of conditional truths rather a simple generalizable truth. I have written several review papers evaluating the effectiveness of acupuncture and other modalities for treating medical condition. The result is complex. While acupuncture does not appear to be effective as a sole therapy for addiction, there is a solid evidence for acupuncture for treating knee pain due to osteoarthritis.
Complexity is compounded by professional researchers who are not experts in the modality and experts in the modality who are not researchers collaborating.

After the preventive medicine residency, I was fortunate to be accepted to the residential integrative medicine fellowship program at University of Arizona founded by Dr. Andrew Weil. The program provided hands-on clinical training and academic training from evidence based medicine and complexity theory to total quality control. Since graduation, my attempts to help a healthcare system implement integrative medicine has been challenging. Most systems want a cosmetic integrative medicine program benefiting marketing position of the system. I have not yet found a system willing to use integrative medicine to revolutionize health care outcome.

Today I practice integrative medicine where I provide mindful choices to medicine. Patients needing medications are prescribed, patients needing specialists are referred, and the majority of patients needing healing are assisted with making the therapeutic life style change. To put it simply, it is common sense that we treat patients with cheaper and safer treatment modalities before exploring more expensive and risky procedures.

The quality of health care in the US has been deteriorating despite growing costs of health care. The burden on people are increasing and the access of healthcare is decreasing. We are in a desperate need for an overhaul of the system. The new system needs to take account of the fact that we need a new model based on current prevalence of chronic illnesses. I view the current economic crisis and the new administration a dangerous opportunity (characters combined meaning crisis in Chinese) for creating a model health care for the world in this century. Is there enough courage and political will to do so? For all of our sake, I hope so.

Yoon Hang "John" Kim, MD MPH FAAMA
Director
Georgia Integrative Medicine

click to read the article