Brief History of Medicine:Brief History of Medicine:

A patient goes to his doctor and he says,

"Doc, I have an earache."

In 1000 B.C., the doctor replies,

"Here, eat this root."

In 1000 A.D., the doctor replies,

A patient goes to his doctor and he says,

"Doc, I have an earache."

In 1000 B.C., the doctor replies,

"Here, eat this root."

In 1000 A.D., the doctor replies,

"That root is heathen. Say this prayer."

In 1850 A.D., the doctor says,

"That prayer's superstition. Drink this potion."

In 1950 A.D., the doctor says,

"That poison is snake oil. Swallow this pill."

In 2000 A.D., the doctor says,

"That pill is artificial. Here, eat this root."

"That root is heathen. Say this prayer."

In 1850 A.D., the doctor says,

"That prayer's superstition. Drink this potion."

In 1950 A.D., the doctor says,

"That poison is snake oil. Swallow this pill."

In 2000 A.D., the doctor says,

"That pill is artificial. Here, eat this root."

Integrative OncologyIntegrative Oncology

COMPREHENSIVE CANCER CARECOMPREHENSIVE CANCER CARE

Integrating Alternative, Complementary and Conventional Therapies

for

Integrating Alternative, Complementary and Conventional Therapies

for

•Complementary medicine = used together with conventional medicine

•Alternative medicine = used in place of conventional medicine

Integrative medicine = combines

•Complementary medicine = used together with conventional medicine

•Alternative medicine = used in place of conventional medicine

Integrative medicine = combines Integrative medicine = combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.

Integrative medicine = combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.

Integrative medicine

•combines conventional medicine, which primarily investigates and treats physical symptoms, with complementary practices that include the inner healing processes of mind and spirit

Integrative medicine

•combines conventional medicine, which primarily investigates and treats physical symptoms, with complementary practices that include the inner healing processes of mind and spiritof mind and spirit

•supports the body’s healing abilities through nutrition, physical activity, relaxation, and social and spiritual connections

CTCA

of mind and spirit

•supports the body’s healing abilities through nutrition, physical activity, relaxation, and social and spiritual connections

CTCA

Exploratory Survey Among Cancer Patients at the

UP-PGH Cancer Institute – Use of CAM

•Including prayer/ psychosocial support,

99% of the patients use CAM,

Exploratory Survey Among Cancer Patients at the

UP-PGH Cancer Institute – Use of CAM

•Including prayer/ psychosocial support,

99% of the patients use CAM, 99% of the patients use CAM,

with an overlap use 2-3 CAM types

•Excluding prayer/ psychosocial support, 81% use CAM

•The patients’ demographic or clinical profile showed no

correlation with CAM use

•36% of the patients consulted a CAM provider

99% of the patients use CAM,

with an overlap use 2-3 CAM types

•Excluding prayer/ psychosocial support, 81% use CAM

•The patients’ demographic or clinical profile showed no

correlation with CAM use

•36% of the patients consulted a CAM provider

Why Patients Use CAM - Results of a National Study

John A. Astin, PhD

JAMA. 1998;279:1548-1553.

Conclusion:— Along with being more educated and reporting poorer health status, the majority of CAM users appear to be doing so not so much as a result of

Why Patients Use CAM - Results of a National Study

John A. Astin, PhD

JAMA. 1998;279:1548-1553.

Conclusion:— Along with being more educated and reporting poorer health status, the majority of CAM users appear to be doing so not so much as a result of users appear to be doing so not so much as a result of being dissatisfied with conventional medicine but largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life.

users appear to be doing so not so much as a result of being dissatisfied with conventional medicine but largely because they find these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life.

Filipino Cancer Patients’ Perception of Filipino Cancer Patients’ Perception of CAM vs CONV Cancer TreatmentCAM vs CONV Cancer Treatment

Weighted meansWeighted means pp--valuevalueCONVCONV CAMCAM

Prevents spread of cancerPrevents spread of cancer 4.524.52 2.982.98 0.000.00

Cures cancerCures cancer 4.484.48 3.133.13 0.000.00

Relieves symptomsRelieves symptoms 4.324.32 3.143.14 0.000.00

Assists body’s natural forces to healAssists body’s natural forces to heal 4.224.22 3.643.64 0.000.00

Complementary Medicine Use

Among Filipino Cancer Patients

(UP-PGH Medical Oncology Study Group, 2005)

Assists body’s natural forces to healAssists body’s natural forces to heal 4.224.22 3.643.64 0.000.00

Easy to understand how they workEasy to understand how they work 4.104.10 3.413.41 0.280.28

Prevents recurrence of cancerPrevents recurrence of cancer 4.094.09 3.253.25 0.000.00

Gives feeling of selfGives feeling of self--control over cancercontrol over cancer 3.723.72 3.423.42 0.000.00

SafeSafe 3.703.70 3.693.69 0.950.95

Improves quality of lifeImproves quality of life 3.703.70 3.563.56 0.280.28

Weakens body’s natural reservesWeakens body’s natural reserves 3.643.64 2.872.87 0.030.03

Have side effectsHave side effects 3.573.57 2.892.89 0.000.00

Boosts immune systemBoosts immune system 3.343.34 3.523.52 0.000.00

Reduces chance that the other therapy will Reduces chance that the other therapy will workwork

3.083.08 2.872.87 0.130.13

Rank Mean Filipino Cancer Patients’ Reason for CAM Use

3.37 To stabilize present condition

Complementary Medicine Use

Among Filipino Cancer Patients

(UP-PGH Medical Oncology Study Group, 2005)

4.00 To boost immune system

4.14 To aid conventional treatment

4.18 To treat cancer

4.31 To improve quality of life

4.64 To have a control over life

5.19 To treat side effects of conventional medicine

6.29 To compensate for failed conventional medicine

answers the patients’ question

“What else can I do?”

answers the patients’ question

“What else can I do?”

important role of

SELF CARE

in cancer care. ..

important role of

SELF CARE

in cancer care. ..

•38% of the patients disclosed to their doctors that they

were using a CAM remedy

•Among these doctors:

•20% advised their continued use

•25% advised possible adverse effects from CAM use

Reason for NonReason for Non--disclosure to disclosure to PhysiciansPhysicians

%%

The doctor did not askThe doctor did not ask 7474

Patient is not sure if CAM will help at Patient is not sure if CAM will help at allall

2020

The doctor may prohibit use or may The doctor may prohibit use or may disagree with patientdisagree with patient

99

The doctor may not understand The doctor may not understand patient’s usepatient’s use

88

The doctor may stop treating patient The doctor may stop treating patient 44

As Oncologists, As Physicians to these Cancer Patients –

We must be enlighten more than our patients…

to be able to understand…

to be able to Prescribe or Not Integrative Medicine….

Cancer Treatment Centers of America offers the most sophisticated forms of surgery, radiation, and chemotherapy in combination with complementary therapies that include; nutrition, spiritual support, mind-body medicine, and naturopathic medicine…

Mission

Cancer Treatment Centers of America

CTCA is the HOME of integrative and

Mission

Cancer Treatment Centers of America

CTCA is the HOME of integrative and CTCA is the HOME of integrative and compassionate cancer care.

We never stop searching for and providing powerful and innovative therapies to

treat the whole person, improve quality of life and restore hope.

CTCA is the HOME of integrative and compassionate cancer care.

We never stop searching for and providing powerful and innovative therapies to

treat the whole person, improve quality of life and restore hope.

Naturopathic

MedicineSurgical Oncology

Pastoral careMedical Oncology

Integrative Care Model

Patient and

Radiation Oncology

NutritionMotion for Life

Mind-Body

Medicine

Patient and

Family

Planned Team Interaction

Team Cases Review 3x weekly

Surgical, Medical, Radiation Oncologists

Medical Specialists

Naturopathic Physicians

NutritionistsNutritionists

Mind-Body Medicine Therapists

Physical Therapists

Pain Specialists

Nurse Case Managers

Pastoral Care/Social Services

CAM Modalities Used by Filipino Cancer PatientsCAM Modalities Used by Filipino Cancer Patients %%

Prayer by self, prayer by others, vitamins, exercisePrayer by self, prayer by others, vitamins, exercise 7474--100%100%

Herbal, vegetarian diet, cleansing/ detoxifying dietHerbal, vegetarian diet, cleansing/ detoxifying diet 5050--64%64%

Toning or pyramid power, iridology, vacuum cupping, Toning or pyramid power, iridology, vacuum cupping, reflexology, therapeutic massage,reflexology, therapeutic massage, acupunctureacupuncture

3838-- 48%48%

Vegan/ macrobiotic diet, psychotherapy, tai chi, Vegan/ macrobiotic diet, psychotherapy, tai chi, hypnosis, pranic healing, shark cartilage,hypnosis, pranic healing, shark cartilage, acupressure, acupressure, music therapymusic therapy

1515--30%30%

Chiropractic/ osteopathic, journaling, melatonin, Chiropractic/ osteopathic, journaling, melatonin, immune therapy, bioelectromagnetic, chelationimmune therapy, bioelectromagnetic, chelation

<10%<10%

Clinical Nutrition:

That "food is the best medicine" is a cornerstone of naturopathic practice.

Clinical Nutrition:

That "food is the best medicine" is a cornerstone of naturopathic practice.

Naturopathic Doctors use diet, natural hygiene, fasting, and nutritional supplementation in their practice.

Naturopathic Doctors use diet, natural hygiene, fasting, and nutritional supplementation in their practice.

Why should we integrate NUTRITION?Why should we integrate NUTRITION?

It has a tremendous effect on patients well being and quality of lifeIt has a tremendous effect on patients well being and quality of lifebeing and quality of life

It may affect their ability to tolerate treatment side effects

They have the tendency to change their diet and have demonstrated a willingness to make significant changes

being and quality of life

It may affect their ability to tolerate treatment side effects

They have the tendency to change their diet and have demonstrated a willingness to make significant changes

Why should we integrate NUTRITION?Why should we integrate NUTRITION?

An important component of the holistic approach to cancer care.

It may affect the tumor’s response to treatment and thereby affect treatment

An important component of the holistic approach to cancer care.

It may affect the tumor’s response to treatment and thereby affect treatment treatment and thereby affect treatment outcome.

It is important in cancer prevention. Obesity is a risk factor for cancer, regardless of the content of one’s diet.

Caution against baseless and potentially harmful alternative diets for cancer patients.

treatment and thereby affect treatment outcome.

It is important in cancer prevention. Obesity is a risk factor for cancer, regardless of the content of one’s diet.

Caution against baseless and potentially harmful alternative diets for cancer patients.

Oriental Medicine:

An important understanding of the unity of

the body and mind and adds to the Western understanding of physiology

Oriental Medicine:

An important understanding of the unity of

the body and mind and adds to the Western understanding of physiology

Acupuncture provides a method of Acupuncture provides a method of Acupuncture provides a method of

treatment that can unify and harmonize the

imbalances present in disease conditions,

which in turn stimulates the immune system

and the healing response

Acupuncture provides a method of

treatment that can unify and harmonize the

imbalances present in disease conditions,

which in turn stimulates the immune system

and the healing response

Acupuncture- pain control

nausea/vomiting (11 RCT’s)

fatigue

immunomodulation

radiation induced xerostomia

Acupuncture- pain control

nausea/vomiting (11 RCT’s)

fatigue

immunomodulation

radiation induced xerostomiaxerostomia

hiccups

anxiety

xerostomia

hiccups

anxiety

Ginger- reduces nausea/vomitingGinger- reduces nausea/vomiting

Qi gong- reduces fatigue

increases immunity

Qi gong- reduces fatigue

increases immunity

Mind-Body-Spirit Interventions

Uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms.

Some techniques have become mainstream (e.g., patient support groups and cognitive-behavioral

Mind-Body-Spirit Interventions

Uses a variety of techniques designed to enhance the mind's capacity to affect bodily function and symptoms.

Some techniques have become mainstream (e.g., patient support groups and cognitive-behavioral patient support groups and cognitive-behavioral therapy).

Other mind-body techniques - meditation, prayer, mental healing, and therapies that use creative outlets such as art, music, or dance.

patient support groups and cognitive-behavioral therapy).

Other mind-body techniques - meditation, prayer, mental healing, and therapies that use creative outlets such as art, music, or dance.

MindBodySpirit Medicine

is the HEART of Cancer Care

Regardless of the kind or stage of illness, the human being who has cancer is CENTRAL

MindBodySpirit Medicine

is the HEART of Cancer Care

Regardless of the kind or stage of illness, the human being who has cancer is CENTRAL

It is a crucial part of the cancer patient’s answer to “What else can I do?”

Importance of acting on one’s own behalf

It is a crucial part of the cancer patient’s answer to “What else can I do?”

Importance of acting on one’s own behalf

Mind Body connection Cancer and the Mind

Psychoneuroimmunology

Mind Body connection Cancer and the Mind

Psychoneuroimmunology

“ I found in the (cancer) patients a clear pattern of great

crises, grave depressive afflictions, profound mourning, and all the sad emotions which have prolonged repercussions…you can see in the patients prolonged

“ I found in the (cancer) patients a clear pattern of great

crises, grave depressive afflictions, profound mourning, and all the sad emotions which have prolonged repercussions…you can see in the patients prolonged repercussions…you can see in the patients prolonged and silent sorrow without the release of sobs and tears.”

– E. Foque, MD 1931

repercussions…you can see in the patients prolonged and silent sorrow without the release of sobs and tears.”

– E. Foque, MD 1931

Woody Allen’s wisdom

In the movie Manhattan, he has just been dumped by his girlfriend, Diane Keaton, who started a relationship with his best friend.

Woody Allen’s wisdom

In the movie Manhattan, he has just been dumped by his girlfriend, Diane Keaton, who started a relationship with his best friend.

Keaton: “Why don’t you get angry so that we can get it out in the open? “Keaton: “Why don’t you get angry so that we can get it out in the open? “

Allen: “ I don’t get angry, OK? I mean, I have a tendency to internalize. That’s one of my problems. I—I grow a tumor instead.”

Allen: “ I don’t get angry, OK? I mean, I have a tendency to internalize. That’s one of my problems. I—I grow a tumor instead.”

Testing Woody’s Hypothesis

CAN THE MIND PLAY A ROLE IN CANCER RISK?

5 of 9 prospective studies show significant link between

Testing Woody’s Hypothesis

CAN THE MIND PLAY A ROLE IN CANCER RISK?

5 of 9 prospective studies show significant link between 5 of 9 prospective studies show significant link between non-expression of emotions and cancer risk

Only 2 of 9 reveal association between depression and cancer

5 of 9 prospective studies show significant link between non-expression of emotions and cancer risk

Only 2 of 9 reveal association between depression and cancer

Social factors and life events identified in 3 studies:

Social isolation

Lack of parental affection in childhood

Poor “relationship potential’

Social factors and life events identified in 3 studies:

Social isolation

Lack of parental affection in childhood

Poor “relationship potential’Poor “relationship potential’

Maternal death in childhood

Strongest data is for non expression or repression of emotions

Poor “relationship potential’

Maternal death in childhood

Strongest data is for non expression or repression of emotions

Basis: Psychoneuroimmunology, Psychobiology

Stress, ANS and Cancer

Basis: Psychoneuroimmunology, Psychobiology

Stress, ANS and CancerStress, ANS and Cancer

Perception influences Neurophysiology

Emotions influence Neurophysiology

Stress, ANS and Cancer

Perception influences Neurophysiology

Emotions influence Neurophysiology

Mind Body Spirit approaches:

Self Awareness- expressive writing, drawings, movement and dance

Relaxation- music therapy, hypnosis, guided

Mind Body Spirit approaches:

Self Awareness- expressive writing, drawings, movement and dance

Relaxation- music therapy, hypnosis, guided Relaxation- music therapy, hypnosis, guided imagery

Meditation- concentrative, awareness, expressive

Group Support

Relaxation- music therapy, hypnosis, guided imagery

Meditation- concentrative, awareness, expressive

Group Support

Group Support

the research is as good as that for many standard treatments

other supports:

individual counseling

family and friends

Group Support

the research is as good as that for many standard treatments

other supports:

individual counseling

family and friendsfamily and friendsfamily and friends

“One of the most difficult of all things to endure for a

crow, a raven, a wolf, or a human is to feel alone and

separated from one’s own kind. A sense of belonging is

one of the most universal of all feelings.”

-Lawrence Kilham, 1989

“One of the most difficult of all things to endure for a

crow, a raven, a wolf, or a human is to feel alone and

separated from one’s own kind. A sense of belonging is

one of the most universal of all feelings.”

-Lawrence Kilham, 1989

Prayer and Spirituality-

remote, intercessory prayer, distant healing

Prayer and Spirituality-

remote, intercessory prayer, distant healing

“A sense of spirituality can help you realize that you’re not alone, and that you can turn to a larger force for help, support or comfort.”

“A sense of spirituality can help you realize that you’re not alone, and that you can turn to a larger force for help, support or comfort.”

Should we integrate the Biologically Based Therapies?Should we integrate the Biologically Based Therapies?

•Vitamins (A,C,E)

•Minerals (selenium)

•Hormones (melatonin)

•Enzymes

•Vitamins (A,C,E)

•Minerals (selenium)

•Hormones (melatonin)

•Enzymes

•Phytonutrients: garlic, green tea, grape seed extract, flavonoids, isoflavones, resveratrol, chorella, spirulina, mushroom extracts

•Essential fatty acids

•Probiotics, amino acids

•Accessory nutrients (co Q10, whey prot, bee propolis, shark liver oil)

•Phytonutrients: garlic, green tea, grape seed extract, flavonoids, isoflavones, resveratrol, chorella, spirulina, mushroom extracts

•Essential fatty acids

•Probiotics, amino acids

•Accessory nutrients (co Q10, whey prot, bee propolis, shark liver oil)

It is important to distinguish – between:

•Complementary therapies that are used alongside conventional medicine for symptom management &

QoL versus

•Alternative therapies that are used instead of oncologic therapy for the purposes of cancer cure

It is important to distinguish – between:

•Complementary therapies that are used alongside conventional medicine for symptom management &

QoL versus

•Alternative therapies that are used instead of oncologic therapy for the purposes of cancer cure

SUPPORT/ COMPLEMENTARY/ INTEGRATIVE

NOT

THERAPEUTIC/ ALTERNATIVE FOR CURE

SUPPORT/ COMPLEMENTARY/ INTEGRATIVE

NOT

THERAPEUTIC/ ALTERNATIVE FOR CURE

ALTERNATIVE CANCER CURES – DISPROVENVickens, A (Memorial Sloan Kettering Cancer Center).

CA Cancer J Clin 2004; 54:110-118

ALTERNATIVE CANCER CURES – DISPROVENVickens, A (Memorial Sloan Kettering Cancer Center).

CA Cancer J Clin 2004; 54:110-118

•Livingston-Wheeler

•Di Bella Multitherapy

•Antineoplastons

•Livingston-Wheeler

•Di Bella Multitherapy

•Antineoplastons

•Mega Vit C

•Hydralazine sulfate

•Laetrile

•Psychotherapy

•Mega Vit C

•Hydralazine sulfate

•Laetrile

•Psychotherapy

Supplement Contraindications and Drug Interactions:

•Folic acid vs Methotrexate- activity depends on reduced

folates to damage DNA

•Soy genistein vs Paclitaxel- may interfere with drug

efficacy

Supplement Contraindications and Drug Interactions:

•Folic acid vs Methotrexate- activity depends on reduced

folates to damage DNA

•Soy genistein vs Paclitaxel- may interfere with drug

efficacyefficacy

•High dose Vit E vs Doxorubicin- may increase drug

uptake and toxicity

efficacy

•High dose Vit E vs Doxorubicin- may increase drug

uptake and toxicity

Manipulative and Body-Based Methods

based on manipulation and/or movement of one or more parts of the body;

include chiropractic or osteopathic manipulation, and massage.

Manipulative and Body-Based Methods

based on manipulation and/or movement of one or more parts of the body;

include chiropractic or osteopathic manipulation, and massage.

“May the work of your hands be a sign

of gratitude and reverence to the human

condition”

– Mahatma Ghandi

“May the work of your hands be a sign

of gratitude and reverence to the human

condition”

– Mahatma Ghandi

Research on Massage

Quality of Life- improved mood and sense of well

being

Anxiety and Pain- relaxation, reduced pain

Post Surgery and Massage- less anxiety, depression,

less pain medication, improved bowel

function, sleep, shorter hospital stay

Research on Massage

Quality of Life- improved mood and sense of well

being

Anxiety and Pain- relaxation, reduced pain

Post Surgery and Massage- less anxiety, depression,

less pain medication, improved bowel

function, sleep, shorter hospital stayfunction, sleep, shorter hospital stay

Side effects of Chemotherapy- decreased nausea

and vomiting, diarrhea, less fear, greater

sense of control

function, sleep, shorter hospital stay

Side effects of Chemotherapy- decreased nausea

and vomiting, diarrhea, less fear, greater

sense of control

Research on Massage

Coping with cancer

Depression- improved mood, decreased depression

Research on Massage

Coping with cancer

Depression- improved mood, decreased depressionDepression- improved mood, decreased depression

Fatigue

Lymphedema

Depression- improved mood, decreased depression

Fatigue

Lymphedema

“Massage therapy is not contraindicated in cancer

patients, massaging a tumor is – but there is great deal

more to a person than their tumor.”

-Bernie Siegel, MD

“Massage therapy is not contraindicated in cancer

patients, massaging a tumor is – but there is great deal

more to a person than their tumor.”

-Bernie Siegel, MD

Cautions and Contraindications:

Blood clots (DVT)

Cautions and Contraindications:

Blood clots (DVT)Blood clots (DVT)

Thrombocytopenia

Avoid fragile or broken skin

Don’t do deep traumatic massage

Not on the site of the tumor

Not near radioactive implants

Blood clots (DVT)

Thrombocytopenia

Avoid fragile or broken skin

Don’t do deep traumatic massage

Not on the site of the tumor

Not near radioactive implants

Energy Therapies

Involve the use of energy fields, the normal self healing capacity of the body

Biofield therapies

Examples include qi gong, Reiki, and

Energy Therapies

Involve the use of energy fields, the normal self healing capacity of the body

Biofield therapies

Examples include qi gong, Reiki, and Examples include qi gong, Reiki, and Therapeutic Touch

Bioelectromagnetic-based therapies

Examples include qi gong, Reiki, and Therapeutic Touch

Bioelectromagnetic-based therapies

Research:

RCT’s for Healing Touch and Therapeutic Massage

Non randomized controlled study for Reiki

Effects on: Quality of Life

Research:

RCT’s for Healing Touch and Therapeutic Massage

Non randomized controlled study for Reiki

Effects on: Quality of Life

Pain

Vitality

Physical Functioning

Fatigue

Anxiety/Stress/Relaxation

Pain

Vitality

Physical Functioning

Fatigue

Anxiety/Stress/Relaxation

Integration into Clinical Practice…WHY?

Improved patient well being during

treatment

Increased acceptance of treatment

Integration into Clinical Practice…WHY?

Improved patient well being during

treatment

Increased acceptance of treatment

Increased patient satisfaction Increased patient satisfaction

Exercise

A. Measurable Benefits: Improve mood and QOL

Enhance Immunity

Reduce symptoms

Increase Longevity

Exercise

A. Measurable Benefits: Improve mood and QOL

Enhance Immunity

Reduce symptoms

Increase LongevityIncrease Longevity

Decrease Risk

B. Immeasurable Blessings:

Moving beyond self limiting

thoughts

Getting back to your life

Increase Longevity

Decrease Risk

B. Immeasurable Blessings:

Moving beyond self limiting

thoughts

Getting back to your life

Talking with patients about Integrative Medicine:

Concentrate

Getting Better vs. Feeling Better

Talking with patients about Integrative Medicine:

Concentrate

Getting Better vs. Feeling BetterGetting Better vs. Feeling Better

Acknowledge the emotion

Explore, validate, empathize

Never argue with the patient

Getting Better vs. Feeling Better

Acknowledge the emotion

Explore, validate, empathize

Never argue with the patient

ITEM MINUTES PRICE

Nutrition initial consult 85 $175

follow up consult 55 $125

Guided Imagery 50 $60

Yoga 50 $75

Qi Gong 50 $100Qi Gong 50 $100

Massage Deluxe 80 $100

Full 50 $75

Hot Stone 80 $120

Lymphatic 80 $120

“Complementary medicine is here to stay.

It is no longer an option to ignore it or treat it as something outside the

“Complementary medicine is here to stay.

It is no longer an option to ignore it or treat it as something outside the something outside the normal processes of

medicine and science. “

- Wayne B. Jonas, MD

Journal of American Medical Association

Formerly of the National Institutes of Health

something outside the normal processes of

medicine and science. “

- Wayne B. Jonas, MD

Journal of American Medical Association

Formerly of the National Institutes of Health

Medical spa

comprehensive medical and wellness care in an environment which integrates spa services, as well as conventional and complementary therapies and treatments

Medical spa

comprehensive medical and wellness care in an environment which integrates spa services, as well as conventional and complementary therapies and treatments