integrative medicine and women's health

7/28/2019 Integrative Medicine and Women's Health

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Integrative Medicine andWomens Health

Anastasia Rowland-Seymour, MDFellow, Program in Integrative Medicine

University of Arizona

Priester National Extension Health ConferencePhoenix, AZ

April 22, 2003


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Health Issues for Women Heart Disease

Cancers Lung Cancer number one for deaths per year

Breast Cancer number one for diagnoses per year

Stroke

Diabetes

Asthma

Osteoporosis HIV/AIDS

Domestic Violence


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Chronic Diseases Women report a higher number of

chronic conditions and have higherrates of disability and activitylimitations than men.

While 67% of women between the

ages of 18 and 64 reported theirhealth as excellent or very good,only 36.9% of women aged 65 andover did so.


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So how can we make adifference for Women even if

money is an issue?


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Nutrition 1996 Data from the USDA indicate that

9% of US women over the age of 20 ateless than one serving of vegetables perday, and only 47% of women consumedat least 2 servings of vegetables a day.

Only 26% of adult women ate two fruitserving daily, and nearly half of U.S.women received less than one serving offruit per day.


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Physical Activity Preliminary data from early 2001 show

that 36% of women aged 18-24 reported

exercising regularly, with the proportioncontinually decreasing with advancingage.

Among persons 18-64 years and 75 yearsand older, men were more likely thanwomen to participate in regular exercise.


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Mental Health Depression and anxiety disorders

disproportionately affect women.

12% of women reported havingbetween 3-7 poor mental healthdays as compared to 9% of men.

5% of women reported being in poormental health for the entire month.


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Integrative Medicine DefinitionIntegrative Medicine is healing-orientedmedicine that takes account of the

whole person (body, mind and spirit),including all aspects of lifestyle. Itemphasizes the therapeutic relationship

and makes use of all appropriatetherapies, both conventional andalternative.


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Integrative Medicine CAMIntegrative Medicine seeks to combinethe best ideas and practices of

conventional and alternative medicineinto cost-effective treatments that willbe in the best interest of patients and

that aim to stimulate the bodys naturalhealing potential. It neither rejectsconventional medicine nor embracesalternative practices uncritically.


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Principles of Integrative Medicine

1. The conviction that it is better to preventdisease than to have to treat it later.

2. Recognition of the interaction between body,mind, spirit, and environment.

3. A desire to integrate the best of conventionaland unconventional medicine.

4. The belief that bodies respond uniquely, sotreatment must be customized.5. A belief in the innate healing powers of the

body.


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The doctor of the future will giveno medicine, but will interest hispatients in the care of the humanframe, in diet, and in the cause andprevention of disease.

Thomas A. Edison


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Prevention Oriented It is safer, cheaper, and more effective to

prevent disease before it starts.

Innumerable studies illustrate the health-protective effects of good food, plenty ofwater, regular exercise, and stress reduction,even vitamins (JAMA 2002).

Focus on education about lifestyleinterventions that improveand maintainhealth.


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2. Recognition of the interaction betweenbody, mind, spirit, and environment.


4. The belief that bodies respond uniquely, sotreatment must be customized.5. A belief in the innate healing powers of the

body.


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Environmental Factors No health problem exists in isolation.

Environment can be defined in so

many ways, physical, cultural, mental,spiritual, etc.

There are many studies looking at

cultural competency in medicine andits importance in providing effectivehealth care.


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Interaction between body,

mind, spirit, and environment Role of the environment in illness and healing: how the

patient eats, if they exercise, how they relate to theirenvironment, what stressors are present and how onereacts to them

Knowing the importance (and having the time) to notjust look at symptoms but also to listen for deeperissues that might be contributing to an illness

Dealing with issues of mind and spirit, recognizing thatMedicine and Spirit are not incompatible, thatcombining one with the other creates potential forhealing that goes far beyond the potential of eitherone used independently


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2. Recognition of the interaction betweenbody, mind, spirit, and environment.

3. A desire to integrate the best ofconventional and unconventionalmedicine.

4. The belief that bodies respond uniquely, sotreatment must be customized.

5. A belief in the innate healing powers of thebody.


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Integrate the best of conventional

and unconventional medicine An Integrative Physician is conventionally trained

An Integrative practitioner employs a wide-ranging set oftools:

Conventional: vaccines, antibiotics, pain medications,diagnostic tests, and surgeryUnconventional: mind/body techniques, botanicals,nutritional interventions, manipulation, massage,movement therapies, homeopathy, and other alternatives

Embrace technology, understand its usefulness,understand its limitations, and use it when appropriate

Antibiotics for Sepsis, Surgery for Acute Injury, etc.

Other Modalities for Viral Illnesses, Autoimmune disorders,etc.


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Not every alternative therapy iseffective!

Consider that 43% of Americans spent $21.2 billion in1997 on unconventional therapies, such aschiropractic, massage, herbal remedies, and dietarysupplements, and the majority of these patients didnot disclose this info to their physicians.

The concern is that not every modality used iseffective, there isnt evidence to support a good

number of the therapies being used.

We recommend therapies for which there is goodevidence.


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2. Recognition of the interaction between body,mind, spirit, and environment.3. A desire to integrate the best of conventional

and unconventional medicine.4. The belief that bodies respond uniquely,

so treatment must be customized.5. A belief in the innate healing powers of the

body.


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Patient Centered Customized

Treatment Many conditions have different triggers in

different people, so it makes sense thatdifferent people may need differentapproaches to healing- e.g. asthma.

People vary in their biochemistry, genetics,

digestion, hormonal levels, attitudes, values,age and gender, all of which can influencewhat works and what doesnt - e.g.idiosyncratic reactions.


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Genetic Polymorphisms

A small study published in the Lancet studied 57patients on Coumadin looking for the presence ofgenetic variants of the CYP2C9 allele and its effect

on elevated INRs. In the low dose coumadingroup 29 of 36 (81%) had one or more variantalleles. 20 of the 36 patients had an elevated INR.

3-10% of Caucasians are deficient in CYP2C9.

CYP2C9 is responsible for 15% of drug metabolismtherefore increased susceptibility to Accolate,Diclofenac, Ibuprofen, Losartan, Phenytoin,Warfarin, etc.


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Drug Metabolism Even the types of foods that we eat can

affect our metabolism.

Weve all heard about grapefruit and how we

shouldnt eat it with many drugs because itdecreases metabolism of many drugs andraises drug levels.

Additionally, liver metabolism is improved by

in Phase I by milk thistle and cruciferousveggies, and in Phase II by cruciferousveggies, green tea, fish oils, folic acid,vitamins B6, B12, and C, glutathione andselenium.


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Adverse Drug Events It is well documented that there are

detrimental outcomes from the right drugat the right time to the right person.

In 1998, JAMA published a meta-analysisof studies about inpatient adverse drug

events that estimated in 1994 more than1 million Americans were hospitalized dueto adverse drug events, accounting for4.7% of all admissions.


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Adverse Events Last week lead article in New England

Journal of Medicine on Adverse DrugEvents in Ambulatory Care.

Of 661 patients who responded, 162(25%) had adverse drug events. Of therespondents 66% were women.

Drugs most often involved: SSRIs, B-blockers, ACEs, Ca channel blockers,Corticosteroids, NSAIDs, Non-narcoticanalgesics.


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2. Recognition of the interaction between body,mind, spirit, and environment.


4. The belief that bodies respond uniquely, sotreatment must be customized.5. A belief in the innate healing powers of

the body.


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Homeostasis

In grade school biology we learnabout the bodys ability to

maintain constant conditions -homeostasis.

We seek to help re-establish andmaintain homeostasis.


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Innate healing power of the body

Healing comes from within (not outside) the patient.

The body is designed with an excellent system of

defense.

Integrative physicians attempt to work with and supportthis natural healing capacity.

Goal: to strengthen and enhance the functioning of apersons innate healing capacity, not take over for it.


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So What Modalities Might WeRecommend?

Nutritional Interventions

Mind-Body Medicine

Manual Medicine Movement Therapies

Traditional Chinese Medicineacupuncturealone or plus herbs

Supplements

Homeopathy

Energy Medicine


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So Where Do We Find ThisApproach?

Fellowship Programs at:


Albert Einstein-Continuum CenterUniversity of Maryland

Harvard

ColumbiaScripps Medical Center


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Medical School Education

JAMA study in 1998 looked at CAMelectives in medical schools.

Of 125 medical schools 117 replied tosurvey.

Of those 75 (64%) offered an elective

in Med School curriculum.


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The Consortium of Academic HealthCenters for Integrative Medicine includes:


UCLA

UCSF Columbia

Duke

Albert Einstein

Georgetown Harvard

University of Hawaii

Thomas Jefferson

University of Maryland

U Mass University of Minnesota

UMDNJ

U Penn

University of Pittsburgh U Texas Medical Branch

U Washington


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References

Womens Health USA 2002. U.S. Department ofHealth and HumanServices. http://mchb.hrsa.gov/data/women.htm.

KM Fairfield, et al. Vitamins for Chronic Disease Prevention in Adults.JAMA2002;287:3116-3126.

D Eisenberg, et al. Trends in Alternative Medicine Use in the UnitedStates, 1990-1997: Results of a Follow-up National Survey. JAMA1998;280(18):1569-75.

GP Aithal, et al. Association of polymorphisms in the sytochrome P450CYP2C9 with warfarin dose requirement and risk of bleedingcomplications. Lancet1999;353:717-9.

T Gandhi, et al. Adverse Drug Events in Ambulatory Care. NEJM

2003;348:1556-64. J Lazarou, et al. Incidence of adverse drug reactions in hospitalized

patients: a meta-analysis of prospective studies. JAMA1998;279(15):1200-1205.

MS Wetzel, et al. Courses Involving Complementary and AlternativeMedicine at US Medical Schools. JAMA1998;280:784-787.
http://mchb.hrsa.gov/data/women.htmhttp://mchb.hrsa.gov/data/women.htmhttp://mchb.hrsa.gov/data/women.htm

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