Archive for the ‘Systems Medicine’ category

Kennedy and Oz

January 10th, 2025

Before transitioning from music to healthcare, as a student, we learned about the works of composers like Igor Stravinsky, Arnold Schoenberg, and Bela Bartok. These men contributed uniquely to the evolving musical landscape with their creative works. Schoenberg, for example, revolutionized music by developing atonality and the twelve-tone technique. Not unlike what was happening with visual artists like Picasso, they were breaking new ground, moving away from tradition and accepted norms.

The traditionalist and the audiences did not consider their work to be acceptable. Schoenberg faced harsh criticism. His music was called incomprehensible, and the public often condemned it. Due to its radical rhythms and dissonance, Stravinsky’s “The Rite of Spring” (1913) caused a riot at its premiere.

Over time, their work gained widespread recognition as groundbreaking.

Now that the United States political dust has settled and the reality of the next four years is upon us, the question of what Dr. Mehmet Oz and Robert Kennedy Jr will potentially bring to the picture of healthcare reform is very much up in the air.

If confirmed as Secretary of Health and Human Services (HHS), Robert F. Kennedy Jr. would oversee the CDC, FDA, and NIH. As Secretary of HHS, Kennedy would manage a $1.7 trillion budget. He has indicated that his agenda includes challenging Big Pharma and its current practices, reforming dietary guidelines, and dealing with chronic diseases through stricter food and pesticide regulations.

While his positive focus on transparency and chronic disease prevention resonates with many, his other controversial stands face scientific and political opposition.

Dr. Oz’s potential appointment to head the Centers for Medicare and Medicaid is also controversial. As a heart surgeon, a communicator, and a champion of wellness and prevention, Dr. Oz receives high praise. He also believes he can eliminate waste from the $1 trillion CMS budget.

The challenges faced by Oz and Kennedy might be similar to those of the musicians mentioned above in the sense that they will be potentially maneuvering upstream through white water. A primary difference is that they will be rocking a multi-trillion-dollar healthcare boat funded by lobbyists representing organizations from Big Pharma, Agri-food, Alcohol, Tobacco, the Fast Food industry, and even oil and additive companies that sell dyes and preservatives, all contributors to the food industry in this country.

The science has been strong against many of the methodologies and advertising techniques employed by these industries in the United States. So much so that the European Union, and even countries like India, China, and Japan have banned foods that are a large part of our culture.

In 2001, the Institute of Medicine, an affiliate of the National Academy of Science published “Crossing the Quality Chasm,” a report created by dozens of independent experts who sought answers to how to improve America’s healthcare system. The report concluded that our healthcare system is so convoluted and fragmented, that it wasn’t a system at all. It further concluded that it could not be fixed by merely tweaking parts of the system in isolation. It suggested that a payment system based on the quality of patient outcomes would go a long way to correcting its current design flaws.

One primary goal would be to engage practitioners who have proven track records in wellness and prevention. Thousands of these practitioners have offered a multitude of therapeutic interventions that can quantify and demonstrate patients’ return to a healthy state. We know that diet, exercise, stress management, and social support can reduce the need for polypharmacy intervention.

Chronic diseases account for 90% of U.S. healthcare expenditures, while end-of-life care represents about 25% of Medicare spending annually. At some point, change seems to be inevitable. If they survive their tenure in government, maybe someday they too will be acknowledged for contributing to a better future.

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Posted in Boomers, Current Affairs, Healthcare, Hospital, Hospital Administration, Hospital Blog, Hospitals, Integrative Health, Leadership, Medicare, Medicine, Music, Nutrition, Systems Medicine, Wellness

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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Posted in Boomers, Communication, Current Affairs, Disability, Energy, Family, Future, Healthcare, Hospital, Hospital Administration, Hospital Blog, Hospitals, inspiration, Integrative Health, Leadership, Medicare, Partnerships, patient-centered care, Public Health, Public Policy, Science, Sports, Systems Medicine, Uncategorized

Knowing Enough About Systems to be Dangerous

May 30th, 2008

From the age of about eight until 20 years ago, my entire life was immersed in music, education, the arts and, in a very pure way, people in general.  It was a complex world that required a deep, intuitive understanding of the human condition on multiple levels.  In a very general way, that life, (pre-health care management) was all about systems.  

Obviously, it was never just about one or two individuals, and it was not about life and death, but it was magnificently complex in its own way. It involved working with  people to do something that was extremely challenging, that required incredible hand/eye co-ordination, and an ensemble mindset of co-operativeness that was paramount to success.  Most importantly, it required them to listen intently to each other so as to find the perfect balance, blend and intonation. 

The nuances of taking a systemic approach to the creation of music through the efforts of an ensemble in many ways have escaped our world of healing, at least until now. 

At a recent visit to my dentist, he and his hygienist were talking about the fact that the doc had just taken a continuing medical education course.  When he was asked if anything new had evolved from his class, he smiled and said, "Well, for the first time in 28 years of practice, they admitted that the mouth is connected to the body."  He went on to elaborate about the fact that each and every day he sees the destruction caused by inflammatory disease of the gums, and then told me about his attempts to communicate that information to a physician friend several years ago.  "It just didn't register," he said. 

What little we know about inflammatory disease has us dutifully brushing our dog's teeth to prevent a heart condition, yet we still do not have direct lines of communication between our primary or cardiac physicians and the the dentists who see these problems as they manifest themselves in our body.  

Someone once told me that Descartes' Treatise of Man played a major role in the imposed medical and emotional separation of the brain from the body, as it clearly took the stand that "Hospitals and physicians should take care of the body while the church takes care of the mind and the soul."

One of our scientific collaborators, Dr. Lee Hood, is famous for his work in Systems Biology.  Another collaborator, Georgetown University, is involved in the creation of a medical school program revolving around Systems Medicine, and finally, our Optimal Healing Environment collaborator, the Samueli Institute, is focused on Systems Wellness.  In spite of these wonderful leaps into what would have to be considered common sense approaches to health and life, we still sometimes miss the ensemble approach.

My recommendation? 

Maybe it would help our healers to take their place on the podium, look at every one of the 30 plus lines of music on the score, raise the baton and begin to direct their way through every nuance, inflection, and harmonious signature present in a score of music with the appropriate rhythm, intonation and accents just to remind themselves that; we human beings are basically all made up of systems as well, and those systems will not function smoothly if one is completely out of sync with the other." 

This is something that we all know intuitively.  Maybe immersing ourselves in that world for a while will help bring that concept totally back into focus.  It's all about harmony, balance and nature's perfection, and a disjointed approach to health is as potentially harmful as a disjointed approach to life.   

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Posted in Hospital, Integrative Health, Music Education, Systems Medicine