Archive for the ‘Uncategorized’ category

Follow the Pharma Money

May 16th, 2018

President Trump indicated at his press conference on the pharmaceutical industry that a “tangled web of special interests” has conspired to keep drug prices high at the expense of American consumers.

Today I received an email reflecting the latest information about pharmacy costs for emergency rooms in the United States. The information was collected by IBM Watson’s Health Redbook which contains product information on more than 200,000 prescription and non-prescription drugs plus 8 of the 10 most frequently used emergency department drugs.

As a former hospital CEO, one of my most challenging aspects of budget season was predicting drug costs for the following year. Well, as most of us in the business know and Watson confirmed, within the past ten years, emergency department drugs have seen price increases of 50 percent or more.

Because I am neither a physician nor a pharmacist, many of these drugs mean little or nothing to me in terms of use or frequency of use, but as you will see, some of the more recognizable ones that are the most often used have had significant increases. Here’s just a few of them.

Ketoralac: 153 percent price increase (oral)

Morphine: 77 percent increase (injectable)

Albuterol: 69 percent increase

Hydromorphone: 81 percent increase (injectable)

Acetaminophen/Oxycodone: 90 percent increase

Lidocaine: 59 percent increase

Besides these drugs, another significant change has occurred that impacts thousands of patients annually. Depending on the manufacturer and quantity ordered, intravenous sodium chloride has increased in price by a whopping 162 to 328 percent.

What’s happening?

The pharmaceutical industry is a for-profit participant in what can only be described as the medical-industrial complex, and when you query them, they indicate that they have increased costs in producing their drugs, hence their higher costs to us, but their recent profits have been excellent.

I am also not an expert in the healthcare supply chain, but when it comes to things like IVs of saline solution increasing exponentially in cost, my head says, “Follow the money.” And following the money usually leads to lobbyists and politicians.

We know that drug companies have made billions of dollars by literally pushing opioids on our population. We consume 80 percent or more of the world’s production of these addictive pain meds. We also know that some of the most prominent supply chain companies were complicit in the illegal distribution of these drugs and were given only a financial slap on the wrist by our government for their involvement.

The current system of getting a new drug to market costs about a billion dollars, and the citizens of the United States are covering much of those research and development costs by paying more for drugs than any other country in the world. Is it a coincidence that the United States allows direct-to- consumer advertising for pharmaceuticals?

Follow the money.

In a private meeting, a top scientist from one of the pharmaceutical companies said to me, “You don’t understand the drug industry in the United States. We’re like the movie industry. We only want the blockbusters, a pill you have to take from age 5 until death that never makes you better.”

The big hammer the United States possess that could control these prices is the purchasing power of the federal government, something President Trump promised to enforce during his campaign. The U.S. government buys more drugs than any other entity in the world, but the President’s pharmacy speech touched on about 50 alternatives to that idea. He never came close to offering to bring that federal clout to the table.

In the EU, drug manufacturers are not permitted to set their own prices.

As securities analyst Ronny Gal, from Sanford C. Bernstein & Company said, “The President’s speech was very, very positive to pharma.” And he added, “We have not seen anything about that speech which should concern investors” in the pharmaceutical industry.

Follow the money.


Childhood Trauma

April 19th, 2018

Nadine Burke Harris, MD, a San Francisco based physician, made a presentation that captured both my attention and my concern, and I’d like to share some of the information from that presentation. Let’s be clear, these are her words, not mine, but if you take a deep dive into her work, it may be a little like the kid who saw his reflection in the water because many of us grew up in an era when several of the “conditions” mentioned in this description were considered normal.

In the mid-1990’s, a discovery was made that exposure to one thing contributed to the cause of seven of the ten most likely causes of death in the United States.  This discovery was known to impact Brain Function, the Immune System, the Hormonal System, and even DNA function. People who were exposed to it had a 20-year difference in life-expectancy with triple the amount of heart disease and lung cancer.  Now, that was a blockbuster discovery, but physicians are still not trained in even the most routine screening for this diagnosis let alone for its treatment.

What was this amazing discovery?  It was Childhood Trauma. The short list of things that fall into this category are abuse, neglect, and dealing with a parent who struggles with Drug and Alcohol Abuse or Mental Illness.

The discovery came from a paper written by Dr. Vince Felitti of Kaiser and Dr. Bob Onda from the Center for Disease Control. It was titled “Adverse Childhood Experience Study,” and over 17,500 adults who were exposed to these adverse experiences were interviewed for this study.  It became known as the ACE study.  This study included people who had been exposed to emotional or sexual abuse, physical or emotional neglect, parental mental illness, substance abuse or dependence, incarceration, separation, or divorce, or domestic violence.  That’s a list that many people can absolutely relate to on many levels.

For every YES checked off on that list, the participants got one point on the ACE score, and then the physicians compared them to health outcomes.  Of those interviewed, 67% of the population had at least one on the ACE score, 12.6% had four or more ACES.

Here’s the discovery. There was a direct response relationship between ACE (Adverse Childhood Experiences) and health outcomes.  The higher the score, the greater the risk and the worse the health outcomes.  Depression was 4.5 times more likely to be present, 3.5 higher risk for lung cancer, and a  3.5 times more likelihood of getting heart disease, but the most dramatic prediction was the incidence of suicidality, this suicide or attempted suicide statistic was 12 times higher.

There are real neurologic reasons why folks who were exposed to childhood diversity were more likely to engage in high-risk behavior, but even if they weren’t engaged in that behavior, they were still more likely to get heart disease or cancer.  You see, when you’re exposed to stress, the body’s stress response system that governs your flight or fight response mechanism ignites, and if that stress is coming at you every day, it evolves from being adaptive and life-saving to maladaptive and health damaging.

The most likely reason this “discovery” hasn’t become more highly promoted within the medical community may be because of something that is not directly evident. The information generated from these 17,500 people may have been marginalized because, as Dr. Harris points out, people may have just thought, “It’s those kids from those neighborhoods.”  The reality, however, is that the participants in the study were 70% Caucasian and 70% college educated. Maybe the study hasn’t been more widely embraced because it truly is “too close to home.”

This is an issue that touches many of us, and it’s easy to look away.  The very real courage must come from our ability to acknowledge this is a real problem and then in taking the steps necessary to deal with it through a multi-disciplinary treatment team that works to reduce impact of adversity through care coordination, counseling, attention to nutrition, holistic interventions, and, when needed, medicine.


Birthday Thoughts

April 5th, 2018


When I was on that gurney in the ER at age 38 with a ruptured esophagus or was having stents placed at ages 49, 50, 58, and 67, or even at age 17 when the car full of my high school buddies was hydroplaning and spinning out of control on Route 51, I never thought I’d make it this far.

But as I look back over the past 70 years, I know for sure there have been accomplishments, successes, and joys that my parents would have been incredibly proud of and would have enjoyed sharing with me. I miss my family and friends very much.

Of course, I’ve made mistakes, plenty of them and would have done some things completely differently, but we can’t live a woulda, coulda, shoulda life either. We can’t change yesterday, and we don’t have tomorrow yet. All we have is, today, and we must make the most of it that we can.

But there is one thing that I really do know. The best part of my life started about fifteen years ago when a baby named Jude was born. After Jude came Nina, Lucy, Laura, Zoey, and Pete, and nothing, absolutely nothing has been more perfect than having had the opportunity to be their grandfather. The joy that I’ve experienced from having those kids in my life was magnitudes greater than I ever thought possible.

Do not get me wrong, I adore my kids and would give my life for them any day of the week, but when you have your own kids they come with a lot of responsibility. You’re not only responsible for feeding, clothing, housing. and educating them, it’s your job to make sure they grow up to be productive world citizens and that responsibility comes with a lot of angst and concerns.

Yeah, it all worked out great, but there were plenty of frightening days and nights during that journey. These grandkids, though, well, they clearly are not my responsibility, and what a relief that has been. It’s freedom, happiness, joy, and unlimited, unconditional love. There’s nothing like it.

However, my second shift of babies are growing up, my journey is once again changing, and I find myself searching for ways to continue to remain relevant. People ask me about my bucket list, but it’s pretty much empty because I’ve gotten to experience things that I never dreamed possible. No, I’m not wealthy, I’m not a TV star or a celebrity, and I’m not famous, but I’ve been very lucky with absolutely the most important thing life can offer, a wonderful family and the knowledge of having lived a purpose driven life.

It’s been almost 10 years since I’ve had to wear a suit and tie every day to work, since I’ve had to answer to a board of directors, since I’ve been on call 24/7 365 with the responsibility of hundreds of lives to protect and support. Truth be told, I don’t miss that part of my life very much. Sure, I miss the interactions with friends and co-workers, the banter at lunchtime, the challenges of building, growing, and maintaining something, but there’s a lot to be said for my life now.

I recently heard a student of Stephen Hawking talk about his passing from an astrophysics perspective. She said, ”When a large heavenly body dies, it explodes into many pieces and produces lots of stars.” That’s the legacy I hope to leave behind.”

So, where does it go from here? I’m not afraid of death, but I’m in no hurry to get there. That’s in the hands of a higher power, but when grandparent’s day rolls around, count on the fact that this poppa will be floating higher than a Snoopy balloon at the Thanksgiving Day parade because my legacy will live on six different ways through six amazing, wonderful, beautiful stars, my grandchildren, and that’s enough for me.


“One Small Step for Man and One Giant Leap for Microbes” a quote from Dr. Dan Handley

March 29th, 2018
F. Nicholas (Nick) Jacobs. FACHE

F. Nicholas (Nick) Jacobs. FACHE

Implementing programs in Integrative Medicine and Wellness plus Precision Medicine and Pharmacogenomics

By: Nick Jacobs

This story could easily have had several other titles including: “Our skin has as many ecosystems as the landscapes of the Americas,” but the reason I selected the moon landing one is, according to Dr. Dan Handley, our presence there didn’t just leave a footprint. There are trillions of Earthlings that took that first step on the moon. The Apollo 11 astronauts were just two out of two trillion Earth inhabitants that took that “first step for mankind.”

We always knew that our bodies had microbes, but we didn’t know that the microbes numbered in the trillions, or that we are totally dependent on them and they on us. According to Alanna Colleen, author of the book “10% Human,” “We are superorganisms of collective species living side by side and co-operatively running the body that sustains us.”

It was difficult to figure out which microbes had what functions, but a few years ago, the equipment that was invented to map genomes became available to map our microbes as well. Previously, scientists could only study what microbes they could grow in the laboratory. Most microbes won’t grow under laboratory conditions, but with gene sequencing equipment, we can directly sequence the genomes of these microbes. We can discern what microscopic life lives on us and within us. And microbes outnumber our own cells at least 5 to 1, and their genes outnumber ours about 100 to 1.

Over the years we discovered the bugs that cause smallpox, cholera, and polio. We also discovered antibiotics like penicillin, and we reduced hospital infections and deaths through medical hygiene. Now that we can analyze these microbes, the scientific world is in a gold rush to understand the role these microbes play in both disease and health. Most of the microbes that inhabit us are either completely benign, or essential to our health. These microbes do many positive things including producing essential vitamins and bolstering our immune systems.

We have already discovered there are very specific links between the types of microbes that inhabit our bodies and autism, obesity, asthma, autoimmune diseases such as Type 1 diabetes, multiple sclerosis, irritable bowel syndrome, and eczema, as well as nut and wheat allergies and a myriad other 21st century ailments.

We also know that, because our intestinal tract is only one cell thick, it can leak, become distended and bloated. It also appears that our bodies, due to a lack of infectious diseases, may have begun to turn on themselves.

Microbes can also impact our psychological health and moods. For example, Whipple’s disease, caused by the bacterium Tropheryma Whipple, causes aggression, lack of communication and loss of certain inhibitions. We also know that gastrointestinal symptoms are surprisingly common in people with mental and neurological conditions.

Cats can carry a parasite called Toxoplasma gondii, and humans can be infected from their litter boxes or from a scratch. When a man is infected, he becomes less pleasant and more aggressive, disregards societal rules, becomes suspicious, jealous and insecure. Women, on the other hand, become more easy-going, warm-hearted, and trusting. Being infected by this microbe makes you three or four times more likely to have an automobile accident.

Many of us have had loved ones who developed something called Clostridium difficile or C.diff. When a patient receives too many very strong antibiotics, the good bacteria in our intestines are killed, allowing these marauders to take over. C. diff infections are serious and can be life-threatening. Current research has shown that a patient’s ecosystem can, however, be restored, with a transplant of microbes from a healthy donor. The unfortunate name for this is a fecal microbial transplant, where a donor’s stool is liquefied and placed into the recipient’s intestines. It’s a virtual microbial miracle, and the trillions of microbes that help sustain our lives can get back to work doing just that.

Microbes don’t live in us, we live in them


Become compassionate caregivers

March 8th, 2018
Last week it was my privilege once again to attend the Lake Nona Impact Forum. One of the most important sessions was a panel discussion by some of the top thought-leaders in the medical community on the opioid addiction crisis. Speaking on this panel moderated by Dr. Sanjay Gupta were people such as Dr. Toby Cosgrove, former CEO of the Cleveland Clinic; Tim Ryan, Ohio Congressman; and Dr. Tom Mayer, Medical Director of the NFL Players Association.

Earlier in the week, Dr. David Nicholson, former Chief Executive of the National Health Service in England, and Dr. Mark Britnell, Chairman and Partner of Global Health Practice for the accounting firm KPMG, referred to the opioid crisis in the United States as a blight on our country.

What did we learn? Although we have about 4.4 percent of the world’s population, we’re consuming 80 percent or more of the world’s opioid production.

Opioid addiction is the leading cause of accidental death in the United States. From 2001 until now, opioids have produced over a trillion dollars in losses to the American economy. But money isn’t everything, or is it?

The panel agreed that the manufacturing, marketing, and distribution of these opioid products was in part attributable to pharmaceutical and distribution companies misleading the physicians and patients regarding the addictive nature of these drugs.

When OxyContin was introduced, the marketing line was, “OxyCotin is safe and controlled pain relief all day and all night.” One of the speakers pointed out that the only word in that sentence that was true was the word and.

Of course, there was some casual culpability placed on pain control requirement guidelines, compounded by the emphasis placed on the reimbursable HCAHPS scores that impact health systems and physicians financially.

We do know that 80 percent of the individuals using heroin today started with prescription drugs. I spoke with a pharmacist last week who confirmed to me that they are selling far fewer opioid prescriptions but can’t keep hypodermic needles in stock.

One sad fact that has come out of this epidemic is that only one in 10 addicted individuals seek treatment, and this is primarily because of the shame inflicted upon the users by our society. Rather than seeing addiction as a sickness, the media, and we individually, continue to portray these addicts as sub-quality human beings.

Numerous steps can be taken to help control the national tragedy, many of which were delineated during the discussion. We can, of course, stop stigmatizing the individuals who have become addicted. We can provide transparency through primary care, and according to Congressman Ryan, we can change the arcane Medicaid reimbursement of thirty days and you’re back on the street. This was the typical cure for alcoholics, but drug users need more time to rid their system of these killers.

Dr. Cosgrove of the Cleveland Clinic would like to see a publicly visible daily clock showing exactly how many individuals have overdosed and died each day in the United States from opioid abuse. We’re fast approaching the number of people killed in total during the Vietnam war each year with opioid deaths.

With less than 3percent of emergency room physicians prescribing opioid meds, we know there are numerous other ways to control pain, and we must educate all physicians as to what these methods can be.

Of course, this would not be a Nick Jacobs article if I didn’t endorse the use of mindfulness training, acupuncture, massage, biofeedback, osteopathic and chiropractic manipulation and several more world treatments that are not drug-based.

Final warning, in some states, even marijuana has been laced with fentanyl and carfentanil, originally a weapon of mass destruction and now used for elephant sedation. It’s 5,000 times as potent as a unit of heroin and instantly fatal.

Bottom line? Clean out your medicine cabinets and become compassionate caregivers. This must end.



March 1st, 2018

Over the past two months, I’ve become an ardent follower of National Geographic Fellow and New York Times bestselling author, Dan Buettner. He is the founder of the Blue Zones and Blue Zones, LLC. Dan has spent the last 15 years or so studying the five places in the world where people simply forget to die. They live into their late 90s and early 100s and include places like Sardinia, Italy; Loma Linda, California; Okinawa, Japan; Nicoya, Costa Rica; and Ikaria, Greece.

In his original book, Dan found that only 10 to 20 percent of longevity is dictated by genes. In those areas where people lived longer it was not because of diets, treadmills or supplements. “Long life was not something they pursued. It was something that ensued.”

These long-lived people had a great sense of purpose to their lives, were nudged into movement about every 20 minutes by their geography, were completely energized by being in what he described as “Like-tribes” that help keep people on the right track, and were facilitated by living in the right community. They lived in interconnected, mutually supportive clusters of behavior allowing them to do the right thing long enough not to get disease.

He then changed his focus slightly to attempt to determine where the happiest places were in the world. What he found might throw some of you for a loop, but for many of us, it’s that not so common, common sense that our grandparents, parents and friends have shared with us throughout our lives.

Mike Norton from Harvard asked this question on three continents: Do you think life is short and hard or long and easy? The people who selected long and easy were always happier, and they were also more civic-minded and generous. In fact, they were 40 percent happier, 30 percent more likely to vote, and 60 percent more likely to donate money. So when you have your next fundraising event, invite only generous, civic-minded, happy people.

Dan Buettner worked with Google, Gallup and the University of Pennsylvania and discovered that the 50 billion Google searches they analyzed were more predictive of happiness than either age or income. They found, for example, that people who own dogs are happier than people who own cats. People who like action movies or comedies are happier than those looking for romance movies.

From his world studies, he found that gender equality is important. In fact, it makes the men happier when women are treated equally. (Read that again, guys.) Education for both men and women is an important key to happiness, not Ph.D education, but at least a high school education because educated girls become educated mothers and produce better everything.

They found that healthcare–not America’s sick care, but genuine health care which includes prevention and wellness–is a great predictor of happiness, and countries where there is complete healthcare equality is where the happiest people live.

Happy people place their values on family, some type of belief system, face to face conversations, walking to the church, market and friends’ homes, laughter, and seven hours of sleep a day. They also take all their vacation days, try new things and have some type of intimate relations at least twice a week.

So, own a dog, socialize, stay married if you can, pick a job you love over money, give something back, and most importantly, pick where you live because that is the single most important happiness indicator. If you live in an unhappy place and move to a happy one, you will be exponentially happier within a year.

He also recommends meditation, financial security over consumption, big windows for lots of light, a front porch, and having a best friend at work. Armando Fuentes said, “Eat without gluttony, drink without drunkenness, love without jealousy, argue but don’t go to bed mad, and occasionally, with great discretion, misbehave.”

Check off your happiness boxes, and make some changes.


Knowing when to change

January 14th, 2018


There are certain times in our lives when we know that something is over, and we’ve just had it. We don’t always know exactly why it’s over, but we’re absolutely sure that, for whatever reason, “It’s over.”

For example, do you remember the very last time as a young two or three year old you dedicated in your pants as a child? Maybe it was because of the awful smell, the embarrassment, the discomfort of carrying that extra load around, or just the fact that you wanted to be more like your parents or older siblings. It doesn’t really matter. Something just clicked, and you said, “That’s it. I’m done.”

It’s like the scene in “A Christmas Story” when Ralphie has had it with the bully, Scut Farkus, and he decided that it was over and, regardless of the potential outcome, he’d had enough.

Some of us have lost our jobs over moments like this. Lots of people lose significant others. Some folks stopped smoking or drinking or, if they’re really lucky, stopped taking drugs. It’s a sort of cold turkey, abrupt cessation, a sudden withdrawal that can happen once we’ve reached a breaking point, a specific limit, a so-called red line that we won’t cross.

The Amish have an explicit terminology for the social rejection version of this phenomena. It’s called shunning. It’s a formal decision by the congregation to formally cease interaction and to ostracize an individual. When we decide to stop doing something, it’s a little like Mr. Wonderful, Kevin O’Leary, on “Shark Tank” when he says, “You are dead to me.”

One of my personal challenges has been knowing when to pull the plug. I’m sure that my tolerance for people lasts way beyond what both my brain and my gut tell me is correct. As a young teacher, I spent 10 years working with teenagers. The difference between a teenager and an adult is that sometimes teenagers actually change.

Because I witnessed these miraculous changes with kids over and over again, I embraced it as something that essentially was normal. But when I became an administrator and gave the same benefit of the doubt to adults, I was simply dealing out of a fool’s deck because it’s a rare thing when a leopard changes its spots. Time after time, I’d give the adults chance after chance after chance, and it was a fool’s journey.

So, what do you think makes us change? Those professionals who study change say that even when it’s a life and death situation, people respond negatively to change 90 percent of the time. They’d rather die than change.

Well, for one thing, people have to know why change is necessary. They need an awareness of the depth of the problem and a desire to change. Then they need to be offered solutions, and they need to be coached as to how to make the change. They also have to be assured they will be able to change and will receive the resources necessary to make that change. And while the change is occurring, it’s up to their sponsors to ensure it will actually happen by measuring, correcting mistakes, and rewarding success.

Just to keep this real, I’ve followed all of those steps above and was still chewed on by those darn leopards who had no desire to change. It’s human nature that at least 10 percent of people will fight change in the workplace to the bitter end.

So, in those cases, it’s important to understand that some people just get used to carrying an extra heavy load in their pants, and no one can alter that. On the other hand, sometimes they find that red line and decide they will not cross it, and they do it on their own.

With all of this in mind, let’s work together this year to make the world a better place, and to unify for the common good. It’s really worth it.


Advice for a longer life

December 6th, 2017




Back in 1997, I was given a death sentence. OK, it wasn’t one that was exactly spelled out by a judge, but it was provided to me by my ancestors in the form of genetics. You see, I failed a stress test at age 49 and ended up in a cath lab. I’ve been there four more times over the next two decades, but it was primarily because my first set of stents were not medically coated and Mother Nature doesn’t like that.

After this medical crisis slapped me directly in the face, I went to the most progressive physician I knew and asked her what was going on in heart care that was not common knowledge at the time. She told me about a researcher, Dr. Dean Ornish, in San Francisco. I called him, and he invited me to come to a retreat for heart patients in Sausalito, California. Over a five-day period, I learned about yoga, meditation, stress management and group support.

Clearly, my biggest personal challenge was managing stress, and unfortunately, I didn’t get good at that until I left day-to-day healthcare administration in 2009. But the real eye-opener that occurred during this retreat was something called PET Scans. Dr. Ornish introduced us to several heart patients who had been given their own death sentences 20 years earlier, and during their introductions, he showed us their before and after PET Scans. It was at those sessions where I saw that the human body is capable of healing itself. All you have to do is give it a chance and some tender loving care.

Their blockages literally opened up, and in some cases disappeared. Since that retreat back in the nineties, I’ve experienced a similar reversal of a blockage that is lovingly referred to in the healthcare world as a “widow maker.” So, diet, exercise, stress management and group support were the key. It wasn’t cheeseburgers, and one more pack of cigarettes a day that would do the trick.

Turn the clock ahead to October 25, 2017, in San Diego, California, where physician Dr. Daniel Amen presented information from his new book, Memory Rescue, about the human brain. Guess what? Once again, it was demonstrated that epigenetics can supersede genetics. He showed slide after slide of SPECT scans of individual’s brains that had reversed damage caused from head injuries, poor circulation and horrendous American diets. Yes, it was another life-changing event for me as well

Dr. Amen has written about 20 books that address brain health, but I’d highly recommend that you buy this one. He talks about the essentials of brain health that include blood flow, continuous learning, managing inflammation, epigenetics, head trauma, toxins, mental health, infection, diabetes and sleep. I’m sure that’s an overwhelming list for many of you, but let me boil it down in this way. Diet, exercise, stress management, and group support.

If you care enough about yourself, here’s a list: limit fat and fatty foods, walk several minutes a day, stimulate your brain by reading and learning, seek out people who provide you with love and support, and cut back on alcohol, caffeine, and head-butting. Finally, if you work to drop your belly fat and try to stay away from sugars and lots of alcohol, your brain will actually heal itself. Brain damage can be reversed.

Of course, sadly, if things are too far gone as with advanced Alzheimer’s, nothing will do much good, but generally, he has seen the reversal of serious brain function loss when his patients begin to eat healthy fruits and vegetables, drop unnecessary weight, stop eating junk and fried foods, stop zoning on television and actually read, perspire to eliminate toxins by exercising regularly and sleep. Oh, and take fish oil because none of this can hurt you.


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.


Opioid addiction terrorizes U.S.

September 18th, 2017

Can you imagine a tragedy equivalent to the number of deaths on 9-11 occurring in this country every three weeks? How would we, as a society, endure the loss of nearly 3000 lives every 21 days due to terrorist attacks? Would we dedicate trillion dollars to addressing this issue?

Now try to imagine that there was no end to these attacks, that they would simply go on and on and on forever. Okay, let’s add a level of complicity to these deaths that did not exist in the 9-11 attacks.  Let’s suppose that trusted members of our communities were literally coerced into participating as somewhat guiltless bystanders by large companies that benefited financially by their complicity.

How about another level of complication? Let’s say that friends and relatives who either through what they perceived to be compassion or through stupidity also contributed significantly to these deaths by participating either knowingly or unknowingly in this involvement.

Now we’re honing in on why this situation exists.  Physicians, nurse practitioners, and physician assistants pressed by heavy marketing techniques employed by Pharmaceutical companies and relatives leaving their unused bottles of meds unchecked or knowingly giving these drugs to other relatives have contributed to a massive opioid problem in our country.

Approximately, 140 Americans are dying every day in their homes and on the streets due to this new type of drug terrorism, and this terrorism is opioid addiction.  Each year, we see the equivalent of nearly 20 times 9-11 in the number of Americans dying of drug overdoses.  This does not include the number of drug dealers, police, and bystanders killed by gang activities related to drug sales.

In many cases, the drug addiction emanates from what we have come to describe as chronic pain.  More than 100 million Americans categorize themselves as suffering from chronic pain, that’s approximately 1/3 of the population of the United States. In fact, the citizens of the United States represent 4.6% of the world’s population but consume more than 80% of the world’s available painkilling drugs and 99% of the world’s hydrocodone. That equates to about 110 tons of addictive opiates each year treating chronic pain at an overall cost of $2000 per U.S. citizen.

In the United States, pain is graded by an intensity of pain scale where one denotes very mild pain and ten refers to an unspeakable level of pain.  Back pain is the leading cause of disabling pain among Americans under 45 years of age. Interestingly, only one in seven people complain of chronic pain internationally, down significantly from the one in three in the United States.

What’s contributing to so much pain in the United States?  It could be inactivity, obesity, a lack of appropriate diet, exercise, and stress management as well as a lack of societal attachment, and absence of understanding as to what pain really is in our lives.

For many that prescription of opioid drugs can become an addictive dose, and because heroin and fentanyl are less expensive, the addiction then moves to unregulated street drugs.

The traditional path to treating chronic pain is with surgery, injections, opioids, occupational and physical therapy. It is a rigid adherence to these treatment methodologies that has often proven to be incomplete. World health has always taken a broader approach to pain management by utilizing additional treatments.  Per Circa Interactive, complimentary treatment options include acupuncture, natural products, deep breathing, yoga/Tai Chi/Qi Gong, chiropractic techniques, meditation, massage, special diets, homeopathy, progressive relaxation, and guided imagery.

With over two-thirds of our physicians admitting to inadequate knowledge of pain treatment and opioid dependency management, it is time to focus on both physician and patient education and also on complementary opportunities to address chronic pain. We are being terrorized by a lack of knowledge, greed of big business, and lack of open mindednesses.

If not now? When?

Otherwise, it’s 911 forever.