Thursday, January 21, 2016

Integrative medicine

Integrative medicine is hard to define, but just as American English is distinct from British English, integrative medicine is different from medicine a generation ago. The federally funded National Center for Complementary and Integrative Health defines it as “bringing conventional and complementary approaches together in a coordinated way.”

“The old [medical] model was ‘find it and fix it,’” explains Dr. Scott Schwantes, associate medical director at Gillette Children’s Specialty Healthcare and head of the hospital’s neuropalliative and integrative care unit. “The new model is ‘mind and body.’”

Peek into Minnesota’s leading hospitals, health care systems, doctor’s offices, and psychiatry practices today and you’ll see hundreds of examples of integrative medicine. At the Mayo Clinic Healthy Living Program, throat cancer survivors learn new cooking methods and cardiac patients fill yoga classes led by yogis specializing in Reiki, an energy-based healing therapy. At PrairieCare Hospital and Clinics, the fastest-growing acute mental health care chain in the state, suicidal teens have access to a mental health coordinator who focuses on spiritual growth and exploration. At the three Twin Cities Mother Baby Centers, state-of-the-art Neonatal Intensive Care Units, lactation consultants, aromatherapy consultants, and groovy low-light spa-like rooms coexist so that new moms can sleep and heal before and after childbirth. At The Waters, a senior care center that now has six Twin Cities locations, residents participate in spiritual, emotional, and physical programs in collaboration with the University of Minnesota’s nationally leading integrative think tank, the Center for Spirituality & Healing.

How did a state best known for icy winters and politely wary emotional engagement become the leader in something so darn soft? The reasons are varied. “Minneapolis is a green, outdoorsy, progressive community. No one here seems to be held down by traditions, and they aren’t afraid to try something new,” says Dr. Stefan J. Friedrichsdorf, medical director of the Department of Pain Medicine, Palliative Care, and Integrative Medicine at Children’s Hospitals and Clinics of Minnesota. “It is just something that seems to be in the DNA of the city. What takes the rest of the world 17 years to adapt to comes here very fast.” Friedrichsdorf should know. He was born in Germany, where he was a pediatric resident before moving to Sydney, Australia, for his fellowship at a children’s hospital. He was then recruited to Minneapolis, and today he runs North America’s largest pain and palliative care training seminars for health professionals—so that Minnesota’s integrative care advances can be used in the wider world. “There are some people for whom [integrative medicine] intuitively makes sense,” Friedrichsdorf says. “That Western medicine is good, it’s great, but it’s not the end. If people combine the best of Western medicine with the best evidence-based results from other traditions, the results will be better.”

Friedrichsdorf makes a convincing case for integrative medicine in the various studies he’s led and published in journals such as the Journal of Palliative Medicine (palliative medicine being a specialized care approach for people with serious illnesses). One study showed that children with fatal cancer who received palliative care, such as massage and whole-family counseling, lived with a better quality of life, had more meaningful happy experiences, and suffered less fatigue, diarrhea, seizures, and pain—and saved their insurers an average of $275,000 for home-based palliative care. That insurance savings—and the fact that insurers are now covering more complementary medical therapies—is certainly another reason integrative care is on the rise in Minnesota and around the country (according to a federal survey released in 2015, close to a third of U.S. health care consumers used complementary therapies with traditional medicine between 2002 and 2012).

“A thing they call ‘the triple aim’ is the holy grail of health care these days,” explains Penny George, the visionary philanthropist who funded a good part of the local integrative movement (read her story on page 29). George describes the triple aim as improving patient satisfaction, clinical outcomes, and cost savings, and she says integrative health medicine delivers on all three. Imagine, George continues, 100 elderly people in a hospital, and none of them can sleep. If 100 get a sleeping pill, some will have drugs in their systems that could cause them to fall in the bathroom and hit their heads, costing the hospital tens—if not hundreds—of thousands of dollars. But what if instead those people are lulled to sleep in a quiet room with acupressure, the smell of lavender, and a nurse using “narrative therapy”—talking to them and understanding their wants and needs and calming their minds? Everyone’s happier.

Dr. Deborah Rhodes, an internist at the Mayo Clinic, emphasizes that wellness goes beyond soothing white robes and pretty smells. “If you want to optimize cancer outcomes based on true data, we don’t see anywhere to go but with integrative medicine,” she says. “Weight, inactivity, stress, poor diet—that’s what brings on so much disease and so much recurrence. Learning to relax and eat well is the embodiment of all our best advice accrued from giving medical care. But every doctor knows telling someone to make exercise a priority and actually getting them to change are different things. . . . The missing piece is turning our best advice into action that patients want to take.” That’s why there are now life coaches, nutrition coaches, masseuses, acupuncturists, and yogis on staff at Mayo Clinic.

Integrative medicine may be hard to define at first, but, like a new language, you begin to recognize it when it’s pervasive. Listen for words like resilience, mindfulness, sleep, listening, purpose, community, and wellness. And don’t be surprised that people from Europe and the Middle East are jetting to Minnesota to learn mindfulness and how to eat well. “There’s just been a belief in Minnesota that we can always do things better,” says Dr. Henry Emmons, a psychiatrist known for his work in resilience...

In the 1980s, they used to do open-heart surgery on infants without anesthesia,” explains Dr. Stefan Friedrichsdorf, with the rapid and unhappy air of someone who has repeated something horrible a number of times and still finds it appalling... “They would do a little something to paralyze the muscles, then strap them down and start cutting. There was a crazy belief that babies did not feel pain. I can tell you that cancer pain is the same for a 3-year-old as it is for a  30-year-old.” Friedrichsdorf has devoted his life to moving the needle—quite literally—on children’s pain.

He went on to discover a variety of techniques to help children cope with their pain. One such method has pediatric patients blowing bubbles, which calms their breathing and distracts them from pain when, say, a needle stick is coming. Friedrichsdorf says we take common needle pokes of childhood far too lightly. He says the proper procedure for all shots and blood draws should be to apply Lidocaine or something to numb the skin, then engage the child in an age-appropriate distraction technique (blowing a pinwheel or, for babies, a dose of sugar water). Allow the child to have some control, he adds. “Do you want to sit in mommy’s lap or do you want to sit alone?” explains Friedrichsdorf, who has worked with thousands of children throughout his career and has three of his own, ages 7, 8, and 10. “One out of four Americans is needle-phobic,” he adds. “Seven percent of Americans don’t vaccinate because they don’t want to deal with their child’s pain. I’ve seen five children die of measles. Will that make us take pain seriously?” In the next few years we will see changes to Minnesota’s needle-stick protocols based on Friedrichsdorf's methods. He predicts the changes will spread to the rest of the country. “There should be no needless pain, no unaddressed pain. This isn’t voodoo,” he adds. “If there is less pain from vaccination, there will be less dying from measles.” Although pain from a needle prick might not seem comparable to an infant not getting anesthesia for surgery, the philosophy is the same: Kids’ pain, no matter the source, is serious and should be treated as such.

1 comment:

  1. Postier A, Chrastek J, Nugent S, Osenga K, Friedrichsdorf SJ. Exposure to home-based pediatric palliative and hospice care and its impact on hospital and emergency care charges at a single institution. J Palliat Med. 2014 Feb;17(2):183-8.



    Pediatric palliative care (PPC) aims to promote quality of life for children and their families through prevention and relief of physical and psychosocial symptoms. Little is known about how PPC/hospice services impact health care resource utilization in an uncertain financial landscape.


    The study objective was to compare pediatric hospital health care resource utilization before and after enrollment in a home PPC/hospice program.


    The study was a retrospective administrative data analysis.


    The study took place in a pediatric multispecialty hospital. Data were analyzed for 425 children ages 1-21 years who received home-based PPC/hospice services between 2000 and 2010.


    Hospitalization and emergency room (ER) administrative data were examined to determine whether or not there were changes in total number of hospital admissions, length of stay (LOS), and hospital billed charges before compared to after PPC/hospice exposure.


    There was no change in average total number of admissions pre-/post-PPC/hospice exposure; however, we found a significant increase in hospital/ER admissions for children with cancer diagnoses with longer exposure to PPC/hospice services. There were statistically significant reductions in LOS and total charges for hospital-based care; reductions were more pronounced in the noncancer group. Noncancer patients with at least six months of PPC exposure showed a significant decrease in total LOS from pre- to post-program admission by an average of 38 days, and an average decrease in total hospital charges of nearly $275,000.


    Enrollment in home-based PPC/hospice was associated with lower hospital and ER LOS and total hospital charges as compared with the period prior to enrollment for children with noncancer diagnoses.