Archive for the ‘Science’ category

Four ways to improve access to Integrative Medicine Practices

November 13th, 2017

Licensure, regulation, medical evidence, and funding are four sure ways to speed up the process needed to allow integrative medicine practices to be embraced. If we begin with the assumption that money has a lot to do with everything medical in the United States, then we must look at the winners and losers and the WIFM’s?  (What’s in it for me?)  If you’re a practicing surgeon, and acupuncture or chiropractic care results in the patient not needing a surgery, that can be a financial threat to you. Let’s be fair, that probably doesn’t happen that often, but sometimes it does, and when it does, that’s money lost to your practice.

 

If you’ve spent four years in undergraduate school, four years in medical school, four or five years in a residency, and your educational debts amount to hundreds of thousands of dollars, the last thing you need is a clinical study demonstrating through medical evidence that thousands of patients won’t need your services, and your skills will become exponentially less in the demand.

 

On the other hand, if, like ophthalmologists who surround their practices with optometrists, orthopods did the same with chiropractors and acupuncturists, could that not create a steady stream of referrals for their practices?

 

Let’s face it, there is a role for all three of those professions, and there are skill levels in every profession and duties relegated to each that both overlap and potentially conflict. So, wouldn’t it be better to have the three practice as a team of professionals working together to help you?

 

“There’s not enough medical evidence”  has been the hue and cry of the uninformed for years. Ironically, once traditional medical evidence is thoroughly interrogated, it’s not unusual to find numerous flaws in even the most accepted medical practices. We’ve seen slanted reporting in even the furthermost prestigious journals where various drugs, procedures, and devices have been proven to be ineffective years later.

 

There are over 19,000 papers that have been written and submitted to medical journals in which acupuncture has been endorsed and proven to be effective, but there never seems to be enough medical evidence for the naysayers.

 

Credentialing is a very challenging area as well.  Not unlike the highly skilled surgeon with her medical degrees from the Sorbonne in Paris that is not permitted to practice medicine in the United States, there are sometimes economic and political reasons to limit the number of practitioners allowed in the United States. In my experience, by creating a hospital-based credentials committee that specializes in integrative medicine, the nay-sayers ability to discredit highly trained practitioners with different skills will become more limited.

 

Regulation may be the most difficult challenge in this discussion because, as we have come to know very well, political power can come from political contributions, and when it comes to regulations, those with the gold have more clout than those without. That is not to say that our politicians can be encouraged to be more flexible because they can.  All it takes is for hundreds of constituents to stand in front of a Congressional office to encourage change to occur.

 

So, what are we really dealing with here?  In 1910, the AMA put out a request for proposal to determine what should be taught in the medical schools of Canada and the United States and no physician would accept that assignment.  Consequently, a Ph.D., Abraham Flexner, did, and his approach was to eliminate everything that wasn’t already proven science.  From there we have evolved to a “heal to the pill” mentality where words like root cause and placebo have been dropped from the vernacular.

 

Finally, funding is the key. It has been proven time and again that integrative medicine practices can reduce health care costs exponentially. With that in mind, every bill that comes out of Washington ignores that fact, and funding for many of these well-documented practices is not present. There were over 5000 codes in the Affordable Care Act that were intended to fund such practices as acupuncture, but when the FAQ initially was released, it said, in essence, “Don’t worry about paying these codes.”

 

If you go almost anywhere in Europe and Asia and you will see integrative practitioners thriving because their value is acknowledged and embraced. Of course, we’re not professing that a massage therapist performs open heart surgery, but we do know that Integrative medicine can help to reduce costs across the board.

 

There are many good things that can come from Integrative medicine. You just need to be open-minded.

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Living the Dream – Southwest Florida Global Research Institute

January 30th, 2012

Greetings From Florida - Southwest Florida Research Institute - Nick Jacobs, FACHEI’ve been on a blog hiatus — the longest since I began writing this back in 2005, but for good reason. Another former trumpet player, Kevin Taylor and I have been working on the creation of a research institute in Southwest Florida.  It will embrace an ambitious research mission, academic excellence and become the biotech engine of what could become the future of Southwest Florida’s clinical research, environmental, aging research, behavioral health and translational medicine efforts for the region.

The structure of the not-for-profit arm of this project and the strategic direction of this new 501(c)3 corporation will be the Southwest Florida Global Research Institute.

The initial primary services outlined in this plan are to outfit and set up a tissue repository. From this hub, numerous spokes will emanate that will include opportunities for faculty-student involvement from the Florida Gulf Coast University and other Florida universities, as well as research opportunities for organizations that will eventually feed other related organizations such as an incubator and an accelerator.

It is our intent to focus on the various ideas, concepts, and programs that have been embraced by the leadership of all of the local organizations with whom we have interacted during this effort to include health systems, universities, the private and public pharmaceutical and research communities, environmental science, public health officials and political leaders.

In the financial summary of a business plan, it is evident that the revenue from programs, grants contributions, sponsorships and subsidies must initially be the fiscal drivers behind all of the suggested work at SFGRI with a clear goal of having financial streams in place by year four of the operation to allow the organization to not only survive but also to thrive. With all relevant guidelines, requirements, restrictions, and recommendations in mind, let us begin with an analysis of each suggested area of concentration.

Southwest Florida Regional map - Nick Jacobs FACHE - HealingHospitals.comThe Southwest Florida Global Research Institute tissue repository is a key to growth for both research and biotech efforts in the region. Physician, faculty, staff and community involvement will all determine the degree of success that will ultimately emanate from this key research component, but the ultimate determinant for the success of this repository will come from professional guidance and initial oversight provided through the Clinical Breast Care Project’s Windber Research Institute Tissue Repository.

It is imperative that this program carries the most immediate gain for the overall success and future of the institute. The very essence of this initiative revolves around not only equipment and space, but also quality tissue derived through comprehensive protocols. In time, this effort could lead to an ongoing stream of funding that will help to meet the myriad fiscal needs of the other aspects of this project.

Equipment for setting up this program is relatively inexpensive, but expertise and recommendations for the actual business model are not and it is our recommendation that these efforts should be led through a consulting assignment with the Clinical Breast Care Project’s Windber Research Institute. In order to activate a comprehensive program such as this, highly skilled PhD’s and techs will be needed. Having contributed to the design of the numerous other programs and centers, we would recommend the researchers and employees at the Windber Research Institute as consultants to assist in this effort.  Under their direction, they have successfully put together and managed a similar program that has been identified by the National Cancer Institute as the only platinum quality tissue repository in the United States. They also have world-class experience in data management for the control of the tissue, as well as expertise in accounting, staffing, billing, and management systems that allow for the comprehensive management of the collected tissue.

Windber Research Institute - Image by PlanetRussell.netThe timeline for this program can be relatively immediate, but the overall effort must be seen as neutral and independent from all of the participating organizations. This tissue repository will contribute to biotech research which will enrich physician recruitment opportunities, for profit biotech spin-offs and training experiences for students in the schools of arts and science, business and public health at the local universities.`

In summary, the Southwest Florida Global Research Institute will be the centerpiece for what will become the vision of this region; care for aging, preventative medicine, auto-immune and diseases of the brain while spinning off companies to address all of these maladies and meeting these challenges. It will become part of a world-wide effort based in Southwest Florida with a singular goal —  to improve the health of humanity on many different levels.  That will be the mission of the Southwest Florida Global Research Institute.

Learn more:

Chico's in Lee County, near Ft. Myers, FL

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Coffee and Cancer

May 19th, 2011

Several years ago, at the Clinical Breast Care Project’s (CBCP) offsite retreat with the physicians from Walter Reed Army Medical Center, our biomedical informatics group had prepared a demonstration for the CBCP’s Scientific Advisory Board, a group of distinguished scientists, breast cancer consultants and physicians.

Colonel Craig D. Shriver, MC Director, Clinical Breast Care Project Program Director and Chief, General Surgery Walter Reed Army Medical Center

COL Craig D. Shriver, MC Director, Clinical Breast Care Project (CBCP), Program Director & Chief of General Surgery, Walter Reed Army Medical Center

As the 7:00 PM meeting time approached, it was obvious that there was not going to be a quorum present to start the formal meeting.  The two additional members had called in and we sat waiting patiently for the remainder of this august body to join us; fifteen minutes passed, then twenty and finally at about 7:25 PM, the group burst apologetically into the conference room to begin the call.

In case you’re wondering what would have caused such a delayed response from an otherwise very prompt group of individuals, it was the introduction provided by the biomedical informatics group of how this data repository’s capabilities could be explored.  The advisory group was so captivated by the power of this tool that they literally became lost in the excitement of the demonstration.

This form of science was fascinating to me, because having trillions of pieces of data available from thousands of women allowed the queries to be guided by the data itself.  When this power was coupled with the normal questioning generated by the intellectual curiosity of the individual scientists, the outcomes were beyond fascinating.

For example, you could ask the question, “How many of you drink coffee?” The thousands of participants whose biopsies – both malignant and benign – were being stored in the tissue repository at our research institute had agreed to answer over 500 demographic questions relating to their very personal and now anonymous lives. A graph appeared showing the proportion of women who were coffee drinkers. When I then asked, “How many cups a day do you drink?”a new graph appeared with that information as well. My final question was, “How many of you were diagnosed with breast cancer?” This resulted in an interesting fusion of information. The women who consumed the most coffee had the least amount of breast cancer. Of course, that general assumption needed to be researched, confirmed and proven in numerous ways, but there it was, way back in about 2005.

A report that touched on this topic was released during the second week of May, and it was fascinating. It was a Harvard study that followed almost 50,000 male health professionals for more than two decades.  Over 5,000 of the participants got prostate cancer – 642 of them the most lethal form. “For the men who drank the most coffee, their risk of getting this bad form of prostate cancer was about 60 percent lower compared to the men who drank almost no coffee at all,” says Lorelei Mucci, an epidemiologist at the Harvard School of Public Health and an author of the study. The same group reported about a 50 percent reduced risk of dying from prostate cancer among men who took two or three brisk walks a week. As a part of our funding, similar studies performed by the Preventative Medicine Research Institute under the direction of Dr. Dean Ornish also confirmed this exercise theory of risk reduction for prostate cancer.

The new study shows that a 60 percent reduction in risk of aggressive prostate cancer requires at least six cups a day. However, men who drank only three cups a day still had a 30 percent lower chance of getting a lethal prostate cancer, and that’s not bad. Earlier research also suggests coffee reduces the risk of diabetes, liver disease and Parkinson’s.

But here is best part of this story. Just last week, Swedish researchers reported that women who drink at least five cups of coffee a day have nearly a 60 percent lower risk of a particularly aggressive breast cancer that doesn’t respond to estrogen.

Epidemiologist Mucci says more research is needed before officially urging people to drink coffee for its health benefits. Meanwhile, she says, “there’s no reason not to start drinking coffee.

So, all of these years later, the National Cancer Institute is using about 200 of these CBCP biopsies from that same tissue repository to map the Human Breast Cancer Genome, and everyday new reports are emerging that confirm the value of this research. All of this from a little coal mining town in Western Pennsylvania – the location of the research institute and hospital where I served as President and CEO – just three seconds in air miles from where Flight 93 went down.

Now that’s a story.

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What’s Different About a Teenage Brain?

May 1st, 2011
Montogomery County MD band students

L-R: Senior Niraj Raju (trombone), junior Andrew Simmons (tuba) and senior Julia Maas (violin) of the Montgomery County, MD Youth Orchestra - http://www.mcyo.org

Back in the 1970’s, I made a discovery that seemed unique to me. As a young teacher, musician, band, orchestra and Jazz ensemble director, it was my unexpected pleasure to discover that junior high and middle school aged students had an unbelievable capacity to learn and to excel. This discovery was recently confirmed in an article which appeared in a special edition of U.S. News and World Report, “Secrets of Your Brain,” by Nancy Shute entitled, “How to Deploy the Amazing Power of  the Teen Brain.

Early on in my teaching career, I discovered a mystery of life that, until Nancy’s article, seemed rather extraordinary to me, but I had no scientific evidence to back it up. Before the use of MRI’s beginning in the 1990’s, it was impossible to know what nuanced changes were occurring in the brains of teenagers, but that is not the case today. Of course, the neurologists still don’t understand all of the myriad details of change that appear to be occurring, but they can make certain not so speculative statements about these changes. According to the article, what they found astonished them. The brain’s gray matter, which forms the bulk of the structure and processing capacity, grows gradually throughout childhood, peaks around age 12, and then furiously prunes underused neurons.

Because these changes begin in the back of the brain and move forward, sensory and motor skills mature first followed by the prefrontal cortex which is responsible for judgment and impulse control. According to the scientists at the NIH, the prefrontal and cortex isn’t done until the early 20’s or later in men. The following quote from the article, however, should be the basis for all of the arts education in the United States, “Neurons, like muscles, operate on a ‘use it or lose it’ basis: a teenager who studies piano three hours a day will end up with different brain wiring than someone who spends that same time shooting hoops or playing video games. “Eureka!”

 Grown-Up Brain - USNWR - Nick Jacobs, FACHE - HealingHospitals.com

When we consider that during the teenage years, emotion and passion also heighten attention and tramp down fear, teenagehood turns out to be the perfect time to master new challenges. According to Frances Jensen, a neurologist at Children’s Hospital in Boston, “They can do things now that will set them up later in life with an enhanced skill set.” Of course, the 70’s in semi-rural America did not harbor all of the challenges that we face now for our teenagers, but challenges did exist. What I had discovered in my work was by treating the teenagers more closely as peers than subservient children, while still maintaining control, by allowing them to work with you to select and enumerate their goals, and finally by encouraging them along the way, their passions and intensity would take the music and their performances to heights that would have seemed otherwise incomprehensible.

Music arranged for teenaged performing groups was typically watered down and lacked both emotion and challenge. Because of that, it was my choice to make musical scores available to them that would have been considered too mature, too challenging and too far beyond their comprehension. The trade off, however, was that we were careful never to let them hear any of those “too hard” descriptors. The results were stupefying. The kids worked endlessly and tirelessly to make sure these musical scores were mastered. Because their parents were, in many cases, second generation immigrants, they worked to ensure that the kids had: 1.) Plenty of sleep 2.) Healthy foods 3.) No drugs or alcohol.

The U.S. News article concluded with something that was instinctive to me: “Nature had a reason to give adolescents strong bodies, impulsive natures, and curious flexible minds.” It was the stuff from which scholars, great artists and future leaders were made, and to all of my former students who have been so incredibly successful…I hope you’ve tried to give your children these same experiences!

Nick Jacobs speaks to youth on the future of healthcare

Health 2.0 Leadership (1 of 2) from Nick Jacobs, FACHE on Vimeo.

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