— Reinhold Niebuhr

One of the most frequent questions I’m asked by non-physician practitioners of various therapies in the field of complementary/alternative/integrative medicine (CAM) is how they can crack into the circles of conventional medicine.  Do I know a physician willing to partner, mentor, or collaborate with them?  Am I aware of a hospital that might grant them privileges to practice their art?  These questions reveal a painful fact:  Much of the conventional medical world regards CAM practitioners as outsiders, and they want to keep them that way.

What is the price paid by these CAM practitioners because of their outsider status—being shut out, shunned, marginalized, and rejected by the larger healthcare family?  The cost goes beyond damage to financial income.  Being considered an outsider gnaws at the heart.  It causes pain — literally.

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Banishment and exile — having one’s ties with others dissolved — were a common form of punishment in tribal peoples worldwide.  By preventing any physical connection with one’s spouse, children, friends, and community, severe psychological and emotional damage was inflicted.  In ancient Greece, exile was considered a fate worse than death.

There are analogs of exile in everyday life.  They take the form of ostracism and exclusion.  I’ll bet a lot of you recall the pain during childhood of being passed over when sides were chosen for games, or being shunned because you were not strong enough, pretty enough, or smart enough. I recall the remorse of sitting on the sidelines; it was so keen it often brought tears and was worse than physical pain.

Researcher Naomi Eisenberger and her colleagues at UCLA decided to explore what happens in the brain during social exclusion, which can be viewed as a mild form of banishment and exile.^[1] They performed functional magnetic resonance imaging (fMRI) brain scans on thirteen volunteers who were engaged in an experiment in which they were socially snubbed.The study involved a ball-tossing game on a computer that was programmed so that the two virtual participants eventually ignored the live subject and continued to pass the ball between themselves.  “It was heartbreaking,” said Matt Lieberman, one of the researchers.  “[The live subjects] keep indicating they are ready to be thrown to.  This really affects the person afterward.  They report feeling social distress.” As the real  subjects were shut out of the game, a part of their brain lit up on fMRI — the anterior cingulate cortex — which is the same brain area activated during actual physical pain.

Reflecting on this experiment, neuropsychologist Jules B. Panksepp, of Ohio’s Bowling Green University, says, “Poets have long waxed lyrical about the pain of a broken heart.  We now have an explanation for the feeling of physical pain that accompanies emotional loss — whether that be the loss of a loved one, rejection of one’s social group, or the distress of separation experienced by young animals.”^[2]

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The pain of rejection that is experienced by CAM practitioners is not sentimental or “merely psychological”; it jolts the brain like physical pain.  It is an echo of the biological drive to come together, to congregate and form community, because that is how living things have learned to survive.

Biologists tell us that the need for acceptance is written in bone, blood, and gene.  “No animal or plant lives alone or is self-sustaining,” said renowned biologist George Gaylord Simpson.  “All live in communities, including members of their own species and also a number, usually a large variety, of other sorts of animals and plants.  The quest to be alone is indeed a futile one, never successfully followed in the history of life.”[3]  The eminent geneticist Theodosius Dobzhansky agreed, saying, “A solitary individual wholly independent of others is largely a fiction.  In reality, most or even all living things exist in more or less integrated communities….”[4]

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This issue transcends CAM, of course, and involves all forms of prejudicial exclusion, including those based on race, ethnicity, religion, sexual preference, political affiliation, gender, and religion.

Fortunately conventional medicine is now more receptive to CAM. practitioners than a decade ago, but in far too many areas of healthcare unreasonable, capricious barriers still exist.  One of our missions at EXPLORE is to work for a truly integrative form of healthcare in which practitioners and therapies are judged on empirical evidence for efficacy and safety.  We believe in a system that excludes no one by setting up a razor-wire perimeter of prejudice.

~  Larry Dossey, MD, Executive Editor

The reason why compassion matters in healing can best be seen at the bedside.  My favorite example is an event that took place in the life of Sir William Osler (1849-1919), who is often called the “Father of modern medicine.”  At Johns Hopkins Hospital in Baltimore, he revolutionized the teaching of medicine by bringing students out of the lecture hall for bedside clinical training, and created the first residency program for specialty training of physicians.

After revolutionizing how medicine was taught and practiced in the United States and Canada, in 1905, at the peak of his fame, he was lured to England where he became the Regius Professor Medicine at Oxford.  One day he went to graduation ceremonies at Oxford, wearing the impressive academic robes that are a feature of the occasion.  On the way he stopped by the home of his friend and colleague, Ernest Mallam.  One of Mallam’s young sons was desperately sick with whooping cough.  The child would not respond to the ministrations of his parents or nurses and appeared to be dying. Osler loved children greatly and had a special way with them.  He would often play with them, and children would invariably admit him into their world.  So when Osler appeared in his dramatic ceremonial robes, the little boy was captivated.  Never had he seen a human like this!  After a brief examination Osler sat by the bed, peeled a peach, cut and sugared it, and fed it bit by bit to the enthralled, speechless patient.  It was his first nourishment in days.  Although recovery was unlikely, Osler returned for the next forty days, each time dressed in his magnificent robes, and personally fed the child. Within a few days the tide had turned and the little boy’s recovery was assured.

That’s compassion.  Osler had the ability to enter so fully into the mind of the little boy that he knew how to entice him to take food.  He understood how to evoke a healing response in someone who was dying, all without the use of drugs or high-tech interventions.  Osler was the intervention.  Only someone who understands compassion is capable of such things.

Osler was noted for his ability to convey caring at the bedside of his hospital patients on brief visits.  He cared greatly not only for his patients, but also for the young physicians under his tutelage. He wanted his tombstone to say only, “He brought medical students into the wards for bedside teaching.”  His most famous saying was, “Listen to your patient, he is telling you the diagnosis.”

Some say compassion is out of date.  These days, physicians have only minutes to spend with patients in most medical settings.  No physician can make a house call on a single patient for forty days in a row, as Osler did.  But that is not the entire story.  Compassion can be conveyed in moments; it is not proportional to time.

Compassion is not antiquated.  It remains a crucial factor in healing and will never go out of date.   It is always available for any healthcare professional who is wise enough to claim it.

~ Larry Dossey, MD

 Executive Editor

Explore:  The Journal of Science and Healing

www.explorejournal.com

Sources:

Bliss M.  William Osler:  A Life in Medicine.  Oxford, UK: Oxford University Press; 2007.

Golden RL.  William Osler at 150.  An overview of a life.  JAMA. 1999; 282(23): 2252-2258.

Western science has had remarkable success in explaining the functioning of the material world, but when it comes to the inner world of the mind, it has very little to say. And when it comes to consciousness itself, science falls curiously silent. There is nothing in physics, chemistry, biology, or any other science that can account for our having an interior world. In a strange way, scientists would be much happier if minds did not exist. Yet without minds there would be no science.

This ever-present paradox may be pushing Western science into what Thomas Kuhn called a paradigm shift — a fundamental change in worldview.

This process begins when the prevalent paradigm encounters an anomaly — an observation that the current worldview can’t explain. As far as the today’s scientific paradigm is concerned, consciousness is certainly one big anomaly. It is the most obvious fact of life: the fact that we are aware and experience an internal world of images, sensations, thoughts, and feelings. Yet there is nothing more difficult to explain. It is easier to explain how the universe evolved from the Big Bang to human beings than it is to explain why any of us should ever have a single inner experience. How does all that electro-chemical activity in the physical matter of the brain ever give rise to conscious experience? Why doesn’t it all just go on in the dark?

The initial response to an anomaly is often simply to ignore it. This is indeed how the scientific world has responded to the anomaly of consciousness. And for seemingly sound reasons.

First, consciousness cannot be observed in the way that material objects can. It cannot be weighed, measured, or otherwise pinned down. Second, science has sought to arrive at universal objective truths that are independent of any particular observer’s viewpoint or state of mind. To this end they have deliberately avoided subjective considerations. And third, there seemed no need to consider it; the functioning of the universe could be explained without having to explore the troublesome subject of consciousness.

However, developments in several fields are now showing that consciousness cannot be so easily sidelined. Quantum physics suggests that, at the atomic level, the act of observation affects the reality that is observed. In medicine, a person’s state of mind can have significant effects on the body’s ability to heal itself. And as neurophysiologists deepen their understanding of brain function questions about the nature of consciousness naturally raise their head.

When the anomaly can no longer be ignored, the common reaction is to attempt to explain it within the current paradigm. Some believe that a deeper understanding of brain chemistry will provide the answers; perhaps consciousness resides in the action of neuropeptides. Others look to quantum physics; the minute microtubules found inside nerve cells could create quantum effects that might somehow contribute to consciousness. Some explore computing theory and believe that consciousness emerges from the complexity of the brain’s processing. Others find sources of hope in chaos theory.

Yet whatever ideas are put forward, one thorny question remains: How can something as immaterial as consciousness ever arise from something as unconscious as matter?

If the anomaly persists, despite all attempts to explain it, then maybe the fundamental assumptions of the prevailing worldview need to be questioned. This is what Copernicus did when confronted with the perplexing motion of the planets. He challenged the geocentric worldview, showing that if the sun, not the earth, was at the center, then the movements of the planets began to make sense. But people don’t easily let go of cherished assumptions. Even when, 70 years later, the discoveries of Galileo and Kepler confirmed Copernicus’s proposal, the establishment was loath to accept the new model. Only when Newton formulated his laws of motion, providing a mathematical explanation of the planets’ paths, did the new paradigm start gaining wider acceptance.

The continued failure of our attempts to account for consciousness suggests that we too should question our basic assumptions. The current scientific worldview holds that the material world — the world of space, time and matter — is the primary reality. It is therefore assumed that the internal world of mind must somehow emerge from the world of matter. But if this assumption is getting us nowhere, perhaps we should consider alternatives.

One alternative that is gaining increasing attention is the view that the capacity for experience is not itself a product of the brain. This is not to say that the brain is not responsible for what we experience — there is ample evidence for a strong correlation between what goes on in the brain and what goes on in the mind —only that the brain is not responsible for experience itself. Instead, the capacity for consciousness is an inherent quality of life itself.

In this model, consciousness is like the light in a film projector. The film needs the light in order for an image to appear, but it does not create the light. In a similar way, the brain creates the images, thoughts, feelings and other experiences of which we are aware, but awareness itself is already present.

All that we have discovered about the correlations between the brain and experience still holds true. This is usually the case with a paradigm shift; the new includes the old. But it also resolves the anomaly that the old could not explain. In this case, we no longer need scratch our heads wondering how the brain generates the capacity for experience.

This proposal is so contrary to the current paradigm, that die-hard materialists easily ridicule and dismiss it. But we should not forget the bishops of Galileo’s time who refused to look through his telescope because they knew his discovery was impossible.

TO READ MORE OF PETER RUSSELL’S WORK, PLEASE VISIT: www.peterrussell.com/

The study, “Education on Death: A Study on the Building of the Concept of Death in Children Aged Between 8 and 12 at School,” sampled 288 children between 8 and 12 years, including their parents and teachers. The researchers analyzed how adults’ understanding of the concept of death affects children’s attitudes, fears, beliefs, and approaches to death.

The psychologists concluded that children generally believe in life after death, have had some degree of experiences related to death, and that they remain concerned about it. Girls more commonly believe in life after death than boys, they found.

Only 20 percent of teachers said that death was ever mentioned in the school curriculum.

An appropriate approach to death is vital for children’s health and personality development, the researchers stated. They consider it is essential to provide death education “as a way to value life, and an instrument to end the misguided and unreal idea [of death] transmitted by the media. Such education would provide children with the appropriate strategies and resources to approach death during their lives, avoiding any slight or severe negative impact on their physical or psychological health,” they said. “If death were introduced in the educational system, children would have a more real and intense approach to life, and many of the problems derived from the mourning process in adulthood would be prevented.”

The study found that a high level of education among parents prevents negative attitudes such as fear of death and avoiding the topic.

The study will be published soon in a book devoted to the subject.

Can the implications of this study find traction in the United States? Perhaps in private schools, but it is difficult to imagine how “death education” could enter the public school curriculum. The concept of death and the afterlife differ greatly among the various faiths. Just as sex education and school prayer have proved contentious in public schools, death education would likely evoke similar responses. For this reason, education about death from parents, not teachers, seems the most reasonable approach in our society.

The exploration of death and the afterlife is no longer just a matter of religious beliefs and convictions. An empirical database has been building for years around the phenomenon of near-death experiences or NDEs. Explore will feature articles related to NDEs in the January 2011 issue.

Larry Dossey, MD
Executive Editor
Reference:

University of Granada. People with a university degree fear death less than those at a lower literacy level, Spanish study finds. December 2, 2010. ScienceDaily. Retrieved December 3, 2010, from http://www.sciencedaily.com­ /releases/2010/12/101202124209.htm.

Rochester, VT:  Inner Traditions; 2010

$18.95, paperback

Chris Carter is a man with a mission.  An Oxford-trained philosopher who is firmly grounded in the physical sciences, he is well equipped for the task he has set himself — to examine, in the course of three books, the evidence surrounding parapsychology and related subjects.  This field, also called psi, rests on the premise that information may be acquired from, and may be inserted into, the environment without mediation by the physical senses.

Many individuals have risen to the defense of parapsychology, but few have done so with the meticulous, full-throated enthusiasm that is Carter’s métier.  The first book in his trilogy, Parapsychology and the Skeptics:  A Scientific Argument for the Existence of ESP, established his credentials as a Rambo-like, one-man wrecking crew for the wearisome, perennial, often flimsy arguments of so-called skeptics — “so-called” because their tactics often depart from healthy, open-minded skepticism, which is an invaluable factor in science; and because their objections frequently embody not skepticism but distortion, dissembling, bigotry, prejudice, and pseudoscientific dogmatism.  As one such scientist sneered, “This [psi] is the sort of thing I would not believe in even if it existed.”   And as psi denouncer Ray Hyman, a psychologist, concedes, “The level of the debate [about psi] during the past 130 years has been an embarrassment for anyone who would like to believe that scholars and scientists adhere to standards of rationality and fair play.”

Science and the Near-Death Experience:  How Consciousness Survives Death, the second book in Carter’s trilogy, examines evidence suggesting that some aspect of human consciousness may survive the death of the physical body.  Carter’s focus is on the near-death experience, described in recent years by psychologists Raymond Moody,  Kenneth Ring,  and Erlendur Haraldsson;  psychiatrists Bruce Greyson  and Peter Fenwick,  radiation oncologist Jeffrey Long,  cardiologists Michael Sabom  and Pim van Lommel,  pediatrician Melvin Morse;  researcher Karlis Osis,  and others.   Surveys reveal that around 13 million Americans have experienced near-death experiences, not including children.  The essential components of the near-death experience are remarkably consistent in western cultures. They include a sense of peace and joy, an out-of-body sensation, entering a tunnel or darkness, encountering a light, meeting deceased individuals or guides, a life review, and encountering an unearthly realm.  These features may be experienced in whole or part.  On regaining consciousness and returning to daily life, NDEers typically experience a major shift in values, worldview, and a sense of serenity and peace.  The fear of death generally disappears, and life takes on a deeper sense of meaning and purpose.

Science and the Near-Death Experience gets my vote for one of the best books to date on the near-death experience, and I think you’ll agree.

For more information about author Chris Carter and Science and the Near-Death Experience, visit his Web site at:

www.scienceandtheneardeathexperience.com

— Larry Dossey, MD

Executive Editor, Explore

But it is becoming increasingly difficult to be a materialist these days.  We now know that 90 percent of the matter in the universe is “dark” matter — invisible and of unknown composition and behavior.  This poses problems for materialists.  It’s as if I said to you, “I want to be your doctor, but I am unfamiliar with 90 percent of the organs in your body.”  Lots of scientists want to be our materialists, but they don’t know anything about 90 percent of their subject matter.  Why should we believe or trust any claim they make about the material origins of consciousness?

Since dark matter is said to comprise the vast majority of the matter in the universe, materialism is literally in the dark.   I propose that we re-name the field “dark materialism.” And let’s call those who hold this view “dark materialists.”  This would be an honest recognition of our appalling level of ignorance about the entire material world.

Materialism arose during periods in history when we thought we knew what matter actually is. That certainty no longer exists.   By all rights, the recognition of dark matter should put on hold the materialistic views of mind, consciousness, and will, at least until matter is better understood.

This might make possible a resurgence of the idea that mind, consciousness, and will are fundamental in their own right, not just brain in disguise.

Larry Dossey, MD

Executive Editor

Explore:  The Journal of Science and Healing

[1] Sagan C.The Dragons of Eden. New York:  Random House; 1977:7.

[2] Crick F.  The Astonishing Hypothesis. New York, NY:  Scribner; 1995: 3.

by Larry Dossey, MD

You may think there is enough disease in the world already, and that no one would want to add to the diseases that we humans must deal with.  But there is a powerful industry in our society that is working overtime to invent illnesses and to convince us we are suffering from them.

This effort is known as “disease mongering,” a term introduced by health-science writer Lynn Payer in her 1992 book Disease-Mongers: How Doctors, Drug Companies, and Insurers Are Making You Feel Sick.  Payer defined disease mongering as “trying to convince essentially well people that they are sick, or slightly sick people that they are very ill.” This strategy has also been called “the corporate construction of disease” by Ray Moynihan, Iona Heath, and David Henry in the British Medical Journal. “There’s a lot of money to be made from telling healthy people they’re sick,” they say.

“Pharmaceutical companies are actively involved in sponsoring the definition of diseases and promoting them to both prescribers and consumers.”

Disease mongering got rolling in 1879 with the invention of Listerine, which was originally considered a surgical antiseptic.  It was named for the famous English surgeon Joseph Lister, who performed the first antiseptic surgical procedure.  Soon, however, Listerine’s inventors, Dr. Joseph Lawrence and Jordan W. Lambert, were selling it in concentrated form as a floor cleaner and as a treatment for gonorrhea.  In 1895 they began to market it to dentists for oral care, and in 1914 it became the first over-the-counter mouthwash marketed in the United States.  By the 1920s, the Lambert Pharmacal Company, Listerine’s maker, was confident they had found a cure; now all they needed was a disease.  So they made one up:  “halitosis.” Before that time, halitosis was an obscure medical term that almost no one had heard of.  Advertisers began to promote Listerine as a cure for this condition, which, they said, could blight anyone’s chances of succeeding in romance, marriage, and work. Soon, people all over America were suffering from halitosis.

The trick was to inflate a common, everyday condition to the level of pathology, which, if not attended to, could blight one’s prospects for personal happiness and success.  The ads the Listerine marketers crafted were mini-soap operas, in which people risked social shame and failure unless they used the product.

The Listerine marketers refined the marketing techniques that were pioneered by the patent-medicine makers of the 19th century.  Novelist Henry James was so vexed by these hucksters he called them “nostrum-mongers.” His brother, Harvard psychologist William James, who is considered the father of American psychology, was also exasperated by them, saying that “the authors of these advertisements should be treated as public enemies and have no mercy shown.”

Payer identified several disease-mongering tactics.  Among them:
• taking a normal function and implying that there’s something wrong with it and that it should be treated
• describing suffering that isn’t necessarily there
• defining as large a proportion of the population as possible as suffering from the “disease”
• defining a condition as a deficiency disease or as a disease of hormonal imbalance
• recruiting doctors to spin the message
• using statistics selectively to exaggerate the benefits of treatment
• promoting the treatment as risk free
• taking a common symptom that could mean anything and making it sound as if it is a sign of a serious disease

Healthcare watchdogs are now blowing the whistle on the major pharmaceutical companies who are engaged in this activity, and they have identified several “illnesses” as current examples of disease mongering.  They are not saying these conditions don’t exist — they are indeed problematic for some people — but that their incidence and relevance is wildly exaggerated in the pursuit of corporate profits.  Among these “illnesses” are erectile dysfunction, female sexual dysfunction, bipolar disorder, attention deficit hyperactivity disorder (ADHD), restless legs syndrome, osteoporosis, social shyness (also called social anxiety disorder and social phobia), irritable bowel syndrome, and balding.

Why should we be concerned about disease mongering?  There is a huge psychological burden in thinking of ourselves as diseased when we are not.  Beyond the psychological cost, there are financial costs, both personal and social.  Treating these “illnesses” with pharmaceuticals is not cheap.  Moreover, no tax-funded healthcare system can sustain the cost of drug treatment for all the risks for which the drug companies would like to treat the population. That’s why London physician Iona Heath urges politicians to wake up to “the increasing capacity of this industry to bankrupt [tax-funded] health-care systems.”

Reversing disease mongering won’t be easy.  There is a near-limitless amount of money to be made from marketing pharmaceutical remedies for diseases that exist mainly in the imagination, and there are powerful economic, political, and professional interests who desperately want this process to continue.

The way forward may be in immunizing ourselves psychologically against the messages from Big Pharma that invade our lives on every hand.  We have to learn to stop being suckers.

How? Heath believes our fear of suffering and death make us susceptible to disease mongering. Today, because the comforts of religion are no longer real for many people, death seems more final, resulting in a panicky rush to use anything that offers better health and increased longevity. So it may be that the best way to resist disease mongering is not to beat our heads against the fortress of Big Pharma, but to develop the psychological and spiritual maturity that makes us resistant to their efforts to instill fear and dread in our lives.

It’s been said that one of the main ways we humans differ from other creatures is in our desire to take a pill.  The pharmaceutical companies know that.  Yet our health is determined mainly not by the pills we choose to swallow, but how we choose to live our lives — the ways we eat, exercise, work, play, love, and relate to others.  Realizing that, we can outsmart the efforts of the disease mongerers to pathologize every moment of our existence.

Reference Liist:
L.  Dossey.  Listerine’s long shadow:  disease mongering and the selling of sickness.  Explore. September 2006; 2(5): 379-385.

R. Moynihan, I. Heath I, D. Henry. Selling sickness: the pharmaceutical industry and disease mongering. British Medical Journal. 2002;324:886–891. Available at: http://bmj.bmjjournals.com/cgi/content/full/324/7342/886 <http://bmj.bmjjournals.com/cgi/content/full/324/7342/886> .

L. Payer. Disease-Mongers: How Doctors, Drug Companies, and Insurers Are Making You Feel Sick. New York, NY: Wiley & Sons; 1992.

Listerine. Wikipedia. Available at: http://en.wikipedia.org/wiki/Listerine <http://en.wikipedia.org/wiki/Listerine> .

Special Collection on Disease Mongering.  Public Library of Science (PloS Medicine). http://www.ploscollections.org/article/browseIssue.action?issue=info%3Adoi%2F10.1371%2Fissue.pcol.v07.i02.

In April 2010, a case was reported in which a 13-year-old Croatian girl awoke from a coma speaking fluent German.  The girl, from the town of Knin in the Dalmatian hinterland, has just begun studying German at school and had been reading German books and watching German television to improve her skills, her parents said, but she was by no means fluent.  But on awakening from coma, she was unable to speak her native Croatian, but was able to communicate perfectly in German.  Various experts who examined her are baffled about what caused the flip in language.[ii]

It is likely that when these cases are fully investigated, conventional explanations will be found that relate to disturbances in the brain’s anatomy and physiology.  But other challenges to the assumption that the brain is the controller of consciousness are really serious.  In an article provocatively titled, “Is Your Brain Really Necessary?” British neurologist John Lorber questions whether an intact cerebral cortex is needed for normal mentation.  Lorber did CT scans on hundreds of individuals with hydrocephalus.  He found that many of them had normal or above-normal intellectual function even though most of the skull was filled with cerebrospinal fluid instead of brain tissue.  Humans normally have a cerebral cortex measuring four and one-half centimeters thick, containing around 15 to 20 billion neurons.  In one patient, however, a college mathematics student who was referred to him because his physician suspected that his head was slightly enlarged, the brain scan revealed a cerebral cortex only one millimeter thick.  Functioning with only a tiny rim of cortical brain tissue of around 2 percent normal thickness, this student proved to have an IQ of 126.  He was not only gifted intellectually, he was normal socially as well. [iii]

One of our missions at Explore is to question the conventional assumptions about the nature of consciousness.  We frequently publish rigorous, peer-reviewed scientific studies dealing with the remote, nonlocal actions of consciousness that often referred to as parapsychology or psi. These often involve human intention, and frequently are relevant to healing.  We believe neuroscience is far from an understanding of the origins and nature of consciousness.  Others agree, such as physicist Nick Herbert, who says, “Science’s biggest mystery is the nature of consciousness.  It is not that we possess bad or imperfect theories of human awareness; we simply have no such theories at all.  About all we know about consciousness is that it has something to do with the head, rather than the foot.”[iv] And as the theoretical biologist and complex-systems researcher Stuart Kauffman puts it, “Nobody has the faintest idea what consciousness is….  I don’t have any idea.  Nor does anybody else, including the philosophers of mind.”[v]

Follow Explore as we probe the mysteries of consciousness.

~ Larry Dossey, MD
Executive Editor, Explore

References

Jones, Tim. Girl’s bump cures mirror writing. London Times, December 7, 1995. Also: Mirror writing flips after bang on the head. Fortean Times. May 1996; 86:6.
Croatian teenager wakes from coma speaking fluent German. Telegraph.co.uk. http://www.telegraph.co.uk/news/worldnews/europe/croatia/7583971/Croatian-teenager-wakes-from-coma-speaking-fluent-German.html. April 12, 2010. Accessed April 13, 2010.
Lorber J. Is your brain really necessary? Science. 1980; 210:1232-1234.
Herbert N. Quantum Reality. New York, NY: Anchor/Doubleday; 1987: 249.
Kauffman S. God enough. Interview of Stuart Kauffman by Steve Paulson. Salon.com. http://www.salon.com/env/atoms_eden/2008/11/19/stuart_kauffman/index1.html. Accessed January 30, 2010.

Many people worked to educate policy makers and ensure prevention and wellness became part of the national healthcare agenda.  Among the most notable efforts from within the integrative medical community were:

• The Bravewell Collaborative’s sponsorship of the Institute of Medicine’s Summit on Integrative Medicine and the Health of the Public, held in February 2009, which drew national attention to the promise of integrative medicine.  It ended up being the largest event ever convened by the IOM.  Serving on the planning committee and faculty were Ralph Snyderman, MD (chair); Mimi Guarneri, MD; Victor Sierpina, MD; Elizabeth Goldblatt, PhD; Dean Ornish, MD; and Ester Sternberg, MD, among others.

• The Senate Committee on Health, Education, Labor and Pensions held two hearings in February 2009. The hearings were sponsored by Senator Edward M. Kennedy with Senators Michael B. Enzi, Tom Harkin and Barbara Mikulski. During the session, Integrative Care: A Pathway to a Healthier Nation, testimony about the benefits of an integrative approach to care and the importance of lifestyle choices was given by Dean Ornish, MD, Mark Hyman, MD; Mehmet Oz, MD; and Andrew Weil, MD.  Testifying for the Principles of Integrative Health: A Path to Health Care Reform hearings were: Cathy Baase, MD; Robert Dugan, MA; Sister Charlotte Rose Kerr, RN, MPH; James Gordon, MD; Wayne Jonas, MD; Mary Jo Kreitzer, RN, PhD; Herbert Benson, MD; Brian Berman, MD; Kathi Kemper, MD, MPH; Simon Mills; and Ron Goetzel, PhD.

• The creation and dissemination of the Wellness Initiative for the Nation (WIN), an effort spearheaded by Wayne Jonas, MD, President and CEO of the Samueli Institute.  Created in collaboration with the Integrated Healthcare Policy Consortium, the Systems Wellness Advanced Team, and others, the summary document recommended the creation of a Wellness Initiative for the Nation focused on the promotion of health through lifestyle change and integrative health practices.  It further recommended that WIN be a government wide, trans-agency initiative.  The creation of the National Prevention, Health Promotion and Public Health Council and the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health contained in the Patient Protection and Affordable Care Act are a direct result of the WIN proposal and the efforts of other organizations such as Trust for America’s Health.

In all three activities, prevention and wellness were stressed.  “The importance of prevention in the emerging initiatives on healthcare can be glimpsed in Policy and Action for Cancer Prevention, a report prepared by the World Cancer Research Fund and the American Institute for Cancer Research in 2009, “ said Larry Dossey, MD.  “This report states that better eating habits and more physical activity could prevent a third of all cancers in the United States, and that smoking cessation could prevent another third.  This means that a behavioral, non-drug approach to cancer prevention could eradicate two-thirds of the cancers in America.”

Dr. Dossey also noted that the recent EPIC Study (Healthy Living is the Best Revenge: Findings from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study, Archives of Internal Medicine.  2009: 169(15): 1335-1362) found that adherence to a four-pillar approach such as the one contained in WIN has remarkable benefits.  “If the American public embraced a healthier lifestyle — which includes social integration, stress management, a balance of exercise and rest, and appropriate exposure to a clean environment including no smoking, no or moderate alcohol consumption, and not being exposed to toxic chemicals or a poor diet—93% of diabetes, 81% of heart attacks, 50% of strokes, and 36% of all cancers could be prevented.”

Next Steps

“The inclusion of the National Prevention, Health Promotion and Public Health Council, with its associated Advisory Council, as section 4001 of the Patient Protection and Affordable Care Act is an important step toward actualizing the philosophy of the WIN document to which so many have contributed,” said Jonas.  “The Council has the potential to be a powerful voice for integrative health care in the United States given its mandates, which include providing coordination and leadership at the Federal level, developing a national strategy, and providing recommendations to the President and Congress on pressing health issues and Federal policies to achieve national wellness, health promotion and public health goals.  There is also tremendous opportunity for the Council and its Advisory Council to have significant influence over the framing and execution of many other provisions of the Act — an opportunity that becomes apparent as one maps the Council to wellness and integrative health care action items across the bill.”

“The Council and its mandates are a positive first step but it will be a challenge to ensure that integrative health care is strongly represented in the Council’s proceedings.  Now, vigilance and pro-activity are very important as HHS moves toward the Federal rulemaking phase,” added Jonas.

One way for health care providers can stay informed about the bill’s implementation is through the Integrated Healthcare Policy Consortium (IHPC) Online Action Network (http://capwiz.com/ihpc/mlm/signup/).  Members of the Network receive updates, are afforded opportunities to communicate directly with Congress and the Obama administration, and are asked provide critical feedback on strategy, priorities, and the direction of this work.

Another aspect of the bill, the support of comparative effectiveness research, could prove vital in getting the true benefits of an integrative approach recognized.  “CER was prominent in last year’s stimulus package ($1.1 billion allocated) and important again in the health care bill passed last week,” explained Brain Berman, MD, president of the Institute for Integrative Health,  ”With the move toward CER, the fields of integrative and complementary medicine now face an unprecedented opportunity to demonstrate their value to support high-quality health care in the U.S.”

To this effect, the Institute for Integrative Health has organized an online symposium to discuss CER and provide input on this matter.  To join the discussion or read previous sessions, go to http://www.groupjazz.com/tiih-cer/

The Department of Health and Human Services (HHS), which has oversight for implementation of the bill, has created a web site about health care reform, which is at: http://www.healthreform.gov/.  Related grant notices will be posted on http://www.grants.gov/.

The Patient Protection and Affordable Care Act (HR 3590), which was signed into law (No. 111-148) in April 2010, provides many opportunities for the integrative medicine community.  Perhaps most important is that the new law specifics the creation of a national prevention strategy and provides $15 billion dollars in funding for a public health and prevention fund.  The Act also contains other “calls to action” that address prevention and wellness, patient centered care and the management of chronic disease, all areas in which integrative medicine can make a significant contribution.

Most of the opportunities center around helping to shape prevention and wellness strategies through participation in advisory groups or providing input to these groups, and increased funding for demonstration projects and research.

“Prevention and wellness are now firmly embraced within the national health agenda,” said Larry Dossey, MD, executive editor for EXPLORE: The Journal of Science and Healing.  “This is a huge step forward.”

While there are others, important items contained in “Title IV: Prevention of Chronic Disease and Improving Public Health” that provide opportunities for integrative medicine are:

• Subtitle A: Modernizing Disease Prevention and Public Health Systems
• Subtitle C: Creating Healthier Communities
• Subtitle D: Patient-Centered Outcomes Research

SUBTITLE A

Modernizing Disease Prevention and Public Health Systems

Section 4001

Perhaps the most important mandate, this section requires the establishment, within the Department of Health and Human Services, of the National Prevention, Health Promotion and Public Health Council and the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health. The Council’s Chairperson, the Surgeon General, is tasked to develop a national prevention, health promotion, and public health strategy.

The law states that the Council will be composed of the Secretary of Health and Human Services;
 Secretary of Agriculture;

 Secretary of Education;

 Chairman of the Federal Trade Commission;

 Secretary of Transportation;

 Secretary of Labor;

 Secretary of Homeland Security;

 Administrator of the Environmental Protection Agency;

 Director of the Office of National Drug Control Policy;

 Director of the Domestic Policy Council;

 Assistant Secretary for Indian Affairs;

 Chairman of the Corporation for National and Community Service; and

 the head of any other Federal agency that the chairperson determines is appropriate.

This Council is directed to “provide coordination and leadership at the Federal level, and among all Federal departments and agencies, with respect to prevention, wellness and health promotion practices, the public health system, and integrative health care in the United States, and to develop a national prevention, health promotion, public health, and integrative health care strategy that incorporates the most effective and achievable means of improving the health status of Americans and reducing the incidence of preventable illness and disability in the United States.”  It will provide “recommendations to the President and Congress concerning the most pressing health issues confronting the United States and suggest changes in Federal policy to achieve national wellness, health promotion, and public health goals, including the reduction of tobacco use, sedentary behavior, and poor nutrition.”

The Advisory Group on Prevention, Health Promotion, and Integrative and Public Health — which will inform the Council— is directed to be “composed of not more than 25 non-Federal members to be appointed by the President.

” In appointing members, the President is advised to ensure that “the Advisory Group includes a diverse group of licensed health professionals, including integrative health practitioners who have expertise in worksite health promotion;

 community services, including community health centers;

 preventive medicine;

 health coaching;

 public health education;

 geriatrics; and

 rehabilitation medicine.”

The Advisory Group will “develop policy and program recommendations and advise the Council on lifestyle-based chronic disease prevention and management, integrative health care practices, and health promotion.
”

The appointment process for this Advisory Group has not been determined yet.

Section 4002

This section establishes a Prevention and Public Health Fund to be administered through the Department of Health and Human Services, Office of the Secretary. This fund will provide for “expanded and sustained national investment in prevention and public health programs to improve health and help restrain the rate of growth in private and public sector health care costs.”  Five billion will be appropriated between 2010 and 2014, with $2 billion appropriated each fiscal year thereafter.  Funded programs will be focused on prevention and wellness.

Section 4003

This section reauthorizes the Preventive Services Task Force as an independent task force that reviews the scientific evidence related to the effectiveness, appropriateness, and cost-effectiveness of clinical preventive services for the purpose of developing recommendations for the health care community that will be published in the Guide to Clinical Preventive Services.  This Guide will be directed to “individuals and organizations delivering clinical services, including primary care professionals, health care systems, professional societies, employers, community organizations, non-profit organizations, Congress and other policy-makers, governmental public health agencies, health care quality organizations, and organizations developing national health objectives.”

According to Nicholas Papas at HHS, “the process for selecting task force members is as follows: Open calls for nominations are posted annually in the Federal Register. Nominations are sought from clinicians in disciplines including pediatrics, obstetrics-gynecology, internal medicine, family medicine, nursing and behavioral counseling.  The members are named by the Director of AHRQ to four-year terms, with one or two year extensions possible. Nominees are evaluated on the basis of: 1) Expertise in critical appraisal of evidence; 2) Knowledge about prevention in primary care; and 3) Primary care experience.”

Section 4004

In this section, the Secretary of Health and Human Services is directed to provide for the planning and implementation of a national public-private partnership for a prevention and health promotion outreach and education campaign to raise public awareness of health improvement across the life span. Among other items, the campaign is directed to disseminate information that encourages healthy behaviors linked to the prevention of chronic diseases, and to address proper nutrition, regular exercise, smoking cessation, and obesity reduction.

A competitive bid process will be utilized to award the contracts connected with this campaign, which will include the use of television, radio, Internet, and other commercial marketing venues as well as a website that will provide science-based information on guidelines for nutrition, regular exercise, obesity reduction, smoking cessation, and specific chronic disease prevention.

Section 4103

This section calls for Medicare reimbursement for an “Annual Wellness Visit” that will include the creation of a personalized prevention plan that includes (1) a health risk assessment; (2) the establishment of, or an update to, the individual’s medical and family history; (3) a list of current providers and suppliers that are regularly involved in providing medical care to the individual (including a list of all prescribed medications); (4) a measurement of height, weight, body mass index (or waist circumference, if appropriate), blood pressure, and other routine measurements
; (5) detection of any cognitive impairment; (6) 
the establishment of, or an update to a screening schedule for the next 5 to 10 years, as appropriate; (7) a list of risk factors and conditions for which primary, secondary, or tertiary prevention interventions are recommended or are underway, including any mental health conditions; and (8) a list of treatment options and their associated risks and benefits.

SUBTITLE C:

Creating Healthier Communities

Section 4201

This section requires the Director of CDC to award grants to state and local governmental agencies and community-based organizations for the implementation, evaluation, and dissemination of evidence-based community preventive health activities in order to reduce chronic disease rates, prevent the development of secondary conditions, address health disparities, and develop a stronger evidence base of effective prevention programming.

A series of “Community Transformation” grants will leverage existing evidence-based disease prevention programs, such as those that promote healthier eating and increased physical activity, and establish new programs in areas that currently do not receive funding. To be eligible to receive a grant, an entity must be a state governmental agency;

 a local governmental agency;

 a national network of community-based organizations;

 a state or local non-profit organization; or

 an Indian tribe.

Activities within the plan may focus on but are not limited to (1) creating healthier school environments, including increasing healthy food options, physical activity opportunities, promotion of healthy lifestyle, emotional wellness, and prevention curricula, and activities to prevent chronic diseases;

 (2) creating the infrastructure to support active living and access to nutritious foods in a safe environment;

 (3) developing and promoting programs targeting a variety of age levels to increase access to nutrition, physical activity and smoking cessation, improve social and emotional wellness, enhance safety in a community, or address any other chronic disease priority area identified by the grantee;

 (4) assessing and implementing worksite wellness programming and incentives;

 (5) working to highlight healthy options at restaurants and other food venues; 

(6) prioritizing strategies to reduce racial and ethnic disparities, including social, economic, and geographic determinants of health; and 

(7) addressing special populations needs, including all age groups and individuals with disabilities, and individuals in both urban and rural areas.

Information on the Community Transformation Grants will be made available on the HHS website in the comings months.

Section 4206

This section requires the HHS Secretary to establish a pilot program to test the impact of providing at-risk populations who utilize community health centers with individualized wellness plans that are designed to reduce risk factors for preventable conditions. Up to 10 community health centers will be funded under this section. An individualized wellness plan may include one or more of the following as appropriate to the individual’s identified risk factors:
 nutritional counseling; a physical activity plan; alcohol and smoking cessation counseling and services.
; stress management; and dietary supplements that have health claims approved by the Secretary.

Section 4305

This section directs the Institute of Medicine to convene a Conference on Pain that will increase the recognition of pain as a significant public health problem in the United States;

 evaluate the adequacy of assessment, diagnosis, treatment, and management of acute and chronic pain in the general population;

 identify barriers to appropriate pain care;

 establish an agenda for action in both the public and private sectors that will reduce such barriers and significantly improve the state of pain care research, education, and clinical care in the United States.

Additionally, the Director of NIH is encouraged to expand, through the Pain Consortium, an aggressive program of basic and clinical research on the causes of and potential treatments for pain

The Secretary is charged with establishing an Interagency Pain Research Coordinating Committee that will coordinate all efforts within the Department of Health and Human Services and other Federal agencies that relate to pain research.  In addition to the seven voting Federal representatives appointed from agencies that conduct pain care research and treatment, 12 additional voting members will be appointed.  Six will be chosen from among leading scientists, physicians, and other health professionals,
 and six members shall be appointed from members of the general public who are representatives of leading research, advocacy, and service organizations for individuals with pain-related conditions.

SUBTITLE D

Patient-Centered Outcomes Research

Section 6301

This section requires the Patient-Centered Outcomes Research Institute to identify priorities for, and establish, update, and carry out, a national comparative outcomes research project agenda and creates the Patient-Centered Outcomes Research Trust Fund.

The Patient-Centered Outcomes research Institute was created by the Patient-Centered Outcomes Research Act of 2009 as a private, nonprofit corporation to assist patients, clinicians, purchasers, and policy makers in making informed health decisions by advancing the quality and relevance of evidence concerning the manner in which diseases, disorders, and other health conditions can be prevented, diagnosed, treated, monitored, and managed through research and evidence synthesis.

The new law provides funding for the Institute and the Agency for Health Research and Quality to disseminate research findings of the Institute, as well as other government-funded research; to train researchers in comparative research methods; and to build data capacity for comparative effectiveness research.

The Institute is directed to identify national priorities for research, taking into account factors of disease incidence, prevalence, and burden in the United States, with emphasis on chronic conditions.  It is further directed to consider the potential for new evidence to improve patient health, wellbeing, and the quality of care.

To do this, the Institute will establish a research project agenda.
 Contracts for conducting such research will be available to appropriate agencies and instrumentalities of the Federal Government as well as appropriate academic research, private sector research, or study-conducting entities.

The section also requires the creation of a Methodology Committee to be composed of not more than 15 members. Members appointed to the methodology committee shall be experts in their scientific field, such as health services research, clinical research, comparative clinical effectiveness research, biostatistics, genomics, and research methodologies.  This committee will work to develop and improve the science and methods of comparative clinical effectiveness.

Other Provisions

Under Section 399MM, to expand the utilization of evidence-based prevention and health promotion approaches in the workplace, the Director is instructed to provide employers with technical assistance, consultation, tools, and other resources in evaluating such employers’ employer-based wellness programs.

Under section 10408, the Secretary shall award grants to eligible employers to provide their employees with access to comprehensive workplace wellness programs. The Secretary is directed to develop program criteria for comprehensive workplace wellness programs that are based on and consistent with evidence-based research and best practices.

Download the Act

The entire bill, as passed, can be downloaded at:  http://democrats.senate.gov/reform/patient-protection-affordable-care-act-as-passed.pdf