| ||Positive Side-Effects: Evidence of Prevention & Health Promotion via Integrative Clinical Practices from Ornish, Cherkin-Sherman, Seely-Herman & Gaby||
Summary: An integrative medicine colleague challenged me on the evidence-base for arguing that integrative practices deserve to be highlighted in the National Prevention (and Health Promotion) Strategy. Here are some morsels from 2010 from Dan Cherkin-Karen Sherman, Dean Ornish and Dugald Seely-Patricia Herman and Alan Gaby. The Surgeon General and her Council would serve us all in examining these. If NIH NCCAM fully wakes to the potential societal benefit from focusing research dollars on these health-enhancing practices, we may yet have a chance to "shift the nation," as the draft Strategy declares in its first sentence, "from a focus on sickness and disease to one based on wellness and prevention."
In the days leading up to the January 13, 2011 closing of the comment period on the draft National Prevention (and Health Promotion) Strategy, an integrative medical doctor engaged me in an e-dialogue that went something like this:
WARNING: Clinical dispensing of these agents causes positive side-effects
Me: The point the integrative practice community needs to make is that whole person approaches are by nature primary preventive and health promoting. They bridge the historic chasm between reactive, disease-focused clinical medicine and population-based prevention and health promotion strategies
This argument would become the focus of my response to the draft strategy. My integrative medical doctor friend responded:
IM doctor: The problem is that we don't have much evidence that CAM is health promoting.
The perspective startled me. I go back 27 years in this work. Historically, holistic doctors and the diverse disciplines reduced to the title "CAM practitioners" boasted health-enhancing outcomes from what they do. Yet anyone suckled on the first decade of output of the NIH National Center for Complementary and Alternative Medicine could easily believe that these practices don't even have a health-promoting intent.
I made a few notes on this theme during my review of 2010 Integrator content for that year's Top 10 lists. Three articles in particular yield exceptional guidance for my integrative MD colleague, for the NIH NCCAM leadership, and for the National Prevention, Health Promotion and Public Health Council charged with developing the nation's strategy.
1. Cherkin & Sherman at Group Health
Research Institute: "Unanticipated benefits ..."
Cherkin: "positive outcomes not captured"
The paper from the top-flight health services research team of Dan Cherkin, PhD, and Karen Sherman, PhD at Group Health Research Institute is entitled "Unanticipated benefits of CAM therapies for back pain: an exploration of
patient experiences." The researchers' goal was "to provide insight into the full range of meaningful outcomes experienced
by patients who participate in clinical trials of complementary and alternative
medicine (CAM) therapies." The findings:
"Our analysis identified a range
of positive outcomes that participants in CAM trials considered important but
were not captured by standard quantitative outcome measures. Positive outcome
themes included increased options and hope, increased ability to relax,
positive changes in emotional states, increased body awareness, changes in
thinking that increased the ability to cope with back pain, increased sense of
well-being, improvement in physical conditions unrelated to back pain,
increased energy, increased patient activation, and dramatic improvements in
health or well-being. The first five of these themes were mentioned for all of
the CAM treatments, while others tended to be more treatment specific.
Cherkin and Sherman concluded that "standard measures used to assess the outcomes of CAM treatments fail to
capture the full range of outcomes that are important to patients." They add: "In order to
capture the full impact of CAM therapies, future trials should include a
broader range of outcomes measures."
2. Dean Ornish in the New York Times: " ... the only side-effects are good ones"
Ornish: Not merely reversing atherosclerosis
The year 2010 was a banner year for Dean Ornish, MD and the Preventive Medicine Research Institute. After two decades and significant, repeated research, Ornish's whole person,
multi-practitioner, multi-modality lifestyle-oriented integrative programs for
reversing cardio-vascular disease gained acceptance for coverage by Medicare. Four months earlier, Ornish published a letter to the editor of the New York Times (Plan to Widen Use of Statins Has Skeptics), in which he writes that "the only side-effects to comprehensive lifestyle changes are good
ones." He ticks off a few:
"These include reversing heart disease and Type 2 diabetes, reductions in
LDL cholesterol comparable to what can be achieved with statins, and
improvements in gene expression like turning off genes that promote
inflammation, prostate cancer and breast cancer."
3. Seely & Herman with Canada Post: " ... secondary outcomes"
Seely: many positive secondary outcomes
In August 2010, Canadian College of Naturopathic Medicine research director Dugald Seely, ND and health services researcher Patricia Herman, MS, ND, PhD reported preliminary outcomes of a multi-factorial,
nutritional and mind-body, integrative intervention for employees of Canada Post, the Canadian postal service. The team examined the potential of an individualized whole person naturopathic intervention in reducing cardiovascular risk. The principal findings were of reduced risk and $1025 per employee in
projected cost savings.
In addition, these naturopathic physician researchers chose to examine the kinds of outcomes Cherkin and Sherman recommend. The "secondary outcomes" garnered through patient self-report via MYMOP included positive changes in numerous areas related to:
" ... fatigue, sleep, weight, stress, allergic
symptoms, hypertension, coffee consumption, musculoskeletal problems, etc."
The first of the 3 reports noted here is from arguably the top health services research team in the "CAM" arena. The second is from the pioneering leader of the best-known and well-researched, lifestyle-focused integrative intervention. The third is from probably the most significant, ongoing employer-integrative care partnership in the integrative practice arena.
I wrote to my integrative medicine doctor friend that the evidence to back what integrative, whole person-oriented practitioners have historically claimed was emerging. I added that the best news is that in its 2011-2015 draft strategic plan, the NIH NCCAM appears to be beginning to respect the paradigm-shifting potential in these approaches. The NCCAM authors write that their ...:
" ... strategic planning process forged a
realization that although half of CAM use by Americans is aimed at
improving general health, most CAM research to date has focused on the
application of CAM practices to the treatment of various diseases and
We do not need to continue this chasm between reactive, disease-focused clinical practices and pro-active health promotion and primary prevention interventions. I offered the evidence of these 3 studies to Surgeon
General Regina Benjamin, MD, MBA on January 13, 2011, the last day they accepted public comments. I might have added comments from nutritional medicine maven Alan Gaby's MD in his 1374 page textbook, Nutritional Medicine:
Gaby: "side-effects are positive ..."
"Many of the 'side-effects' reported by patients
who follow a nutritional program are positive, such as more energy,
better mood, fewer cravings, better mental concentration and less aches
Hopefully in its second decade NCCAM will make a name for itself, and for integrative practices, through prioritizing real world research that explores how health-focused integrative practices may be the clinical bridge to "shift the nation," as the National Prevention (and Health Promotion) Strategy declares in its first sentence, "from a focus on sickness and disease to one based on wellness and prevention."
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