Monday, August 29, 2011

Providers Treating Providers

The past several days I noticed many people posting about a study reporting the increasing popularity of acupuncture and other CAM among healthcare providers over the general population. Shock? Nope. I see my fair share of MDs, RNs, NPs, DPTs, PharmDs, LMTs and folks who work in the healthcare administrative arenas. They, more than anyone else, see the end effects of poorly managed chronic illness and reactive rather than proactive self-care. Contrary to popular opinion, they often make the best patients . . . and even joke about how bummed out they are that this stuff actually works!

My only gripe with the CAM classifications in the study is they include self-administered therapies like nutrition (which is an alternative to what, exactly, starving?) and exercises like pilates and yoga. I do not think anything that is diet, exercise, or rest related is complementary or alternative - you either do those things or you drop dead of something. Overall it was well done and I am glad to see an increase in acceptance that a patient's report of relief is a reliable resource, with or without an impressive postscript after their name!

Discussion Excerpt:

This study provides the first population-based description of CAM use by U.S. health care workers. Our analyses reveal that, overall, health care workers are significantly more likely to use CAM therapies, particularly mind-body therapies, than the employed U.S. population. This is not surprising as health care workers, particularly those in ambulatory care settings, are more exposed to these methods, and exposure is probably correlated with higher use. Our results are also consistent with findings of previous studies documenting a high prevalence of CAM use in narrowly defined health care worker populations. For example, one study found that 63 percent of nurse practitioners in Connecticut reported personal use of CAM (Hayes and Alexander 2000), whereas another reported 96 percent of critical care nurses across the United States had personal experience with CAM (Lindquist, Tracy, and Savik 2003). Studies of physicians reveal a lower prevalence of personal CAM use. One study reported that 24 percent of physicians in Denver had personally used CAM (Corbin Winslow and Shapiro 2002), whereas another found that 49 percent of primary care clinicians in Kentucky reported personal use of CAM in the past year (Flannery et al. 2006). A high percentage of health professions faculty report CAM use, with 83 percent of primary care faculty at one medical school having ever used CAM (Levine, Weber-Levine, and Mayberry 2003) and 100 percent of nursing faculty in another university having personally used a CAM therapy (Halcon et al. 2003).

Read More
Johnson, P. J., Ward, A., Knutson, L. and Sendelbach, S. (2011), Personal Use of Complementary and Alternative Medicine (CAM) by U.S. Health Care Workers. Health Services Research. doi: 10.1111/j.1475-6773.2011.01304.x

Tuesday, August 23, 2011

Engineering Explanations

Lately I have noticed my usual answers to the common questions "how does acupuncture work? I mean, what do the needles really do?" have not been working for the folks who want an explanation in 20 words or less. Although I provide excellent literature on theory, a few months ago I jettisoned my TCM explanation and shortened it to "the needle sensation helps direct the release and flow of endorphins to stimulate the body's self-healing processes." This seems to satisfy those who find things like Qi and meridians either too esoteric or too hippy dippy to accept as viable healthcare.

As it turns out, my simple explanation has evidence-based research to back it. The Columbia University electrical engineering department and University of Hong Kong medical faculty of the collaborated on a study published in the June 2011 issue of The European Journal of Physiology to explain how acupuncture works. Needling acupuncture points sends slow-moving acoustic waves into the muscles. This triggers a flow of calcium that interacts with white blood cells and produces endorphins which can relieve pain and nausea throughout the body. Accuracy and point selection are important. Correct placement generates a 6-8 centimeter wave whereas incorrect placement up to 1 centimeter generates only a 3-4 centimeter wave. This finding may help explain why sham acupuncture can have a therapeutic effect even if delivered via toothpick (as I have been saying as nauseam!).

Here is the abstract:
This article presents a novel model of acupuncture physiology based on cellular calcium activation by an acoustic shear wave (ASW) generated by the mechanical movement of the needle. An acupuncture needle was driven by a piezoelectric transducer at 100 Hz or below, and the ASW in human calf was imaged by magnetic resonance elastography. At the cell level, the ASW activated intracellular Ca2+ transients and oscillations in fibroblasts and endothelial, ventricular myocytes and neuronal PC-12 cells along with frequency–amplitude tuning and memory capabilities. Monitoring in vivo mammalian experiments with ASW, enhancement of endorphin in blood plasma and blocking by Gd3+ were observed; and increased Ca2+ fluorescence in mouse hind leg muscle was imaged by two-photon microscopy. In contrast with traditional acupuncture models, the signal source is derived from the total acoustic energy. ASW signaling makes use of the anisotropy of elasticity of tissues as its waveguides for transmission and that cell activation is not based on the nervous system.

Link to Study

Tuesday, August 16, 2011

The "Other" Provider: It's Time to Talk

Despite most intake forms including a section for vitamin, supplements, and other therapies, many people keep complementary and alternative treatments from their primary care provider. Sometimes this is because of a lack of knowledge that a particular health behavior is an actual therapy, that it has the potential to interfere with conventional treatment, or that it should be reported. Providers neglecting to ask,  lack of time to bring up the topic, and concern of provider disapproval or embarrassment over what they might think also contribute to underreporting. Although we are moving to a partnership model of healthcare, many of those in the "greatest," "boomer," and even "X" generations in the US are more comfortable with the paternalistic paradigm. The National Center for Complementary and Alternative Medicine, a division of the National Institute of Health, launched a program called "Time to Talk" for providers, patients, and organizations to foster communication and improve care coordination. The site provides a variety of material to help get the discussion started. I am especially impressed that it reassures providers they are not expected to be CAM experts and encourages them to refer patients to available evidence-based education materials rather than, as I have seen, run into their office to Google an herb or supplement to fein expertise.

asktell.gifCheck out the program at Time To Talk

What People 50 and Older are Using and Discussing with Their Physicians