Integrative Medicine: The Hopkins Perspective

JHI Partners Forum, 2012

Linda A. Lee, MDJohns Hopkins Integrative Medicine & Digestive CenterDivision of Gastroenterology and Hepatology

Johns Hopkins Integrative Medicine & Digestive Center

Primary location at Green Spring Station Consultative services also available at the Hospital Staff

Four physicians (internist, GYN, GI, rheumatologist)

Two acupuncturists (TCM)

Four licensed massage therapists

Two psychotherapists – hypnotherapy, CBT, guided imagery

One nutritionist – individual consultations and group classes

Goals

To create an inviting, comfortable, safe environment

Allow lengthy appointments so there is more time to understand the multiple dimensions of illness, to educate the patient, and discuss the full range of evidence-based therapies

Offer services within the Center that would be readily accessible to patients as well as referring providers

Johns Hopkins Integrative Medicine & Digestive Center

4000 visits to the Center in FY12 Open Mon-Sat, evening hours until 9

pm 6 examination rooms, all

multipurpose Staff offer personal, concierge-type

service Is the only integrative medicine

center in the US based in gastroenterology

JHIMDC: Our Patient Programs

www.hopkinsintegrative.org

Finding practitioners

What training or education did she receive? Is the practitioner licensed in the state? Is certification by a professional

organization required for state licensure? (e.g. NCCAOM)

What clinical and research experience does she have?

Is the practitioner integrative, or disintegrative?

Integrative Medicine Approach: Principles

Engage the patient as an active participant

Provide education about health, symptoms, and diseases

Counsel in appropriate nutrition practices and supplement use

Discuss evidence-based pharmacologic and mind-body therapies

The patient-provider interaction is a vital part of the healing process

An example: Gastroesophageal Reflux

Conventional Strategy

Medical therapy Additional testing Lifestyle changes

Low fat diet Avoid caffeine Avoid carbonated

beverages Limit your alcohol

intake Stop smoking Raise the head of your

bed

Trends in usage of antacid and gastroprotective agents over 5 years

Gastroesophageal reflux: cause

Stress and esophageal hypersensitivity

Esophageal hypersensitivity has been implicated as a cause of reflux symptoms

Psychosocial factors are known to mediate both peripheral and central hypersensitivity and play a role in symptom perception among patients with GERD

Behavioral medicine techniques (CBT and hypnotherapy) may be a useful adjunct to other anti-reflux therapy in those who experience increased symptoms during stressMcDonald-Haile, J, et al. Gastroenterology, 1994;107(1):61-9

Van Peski-Oosterbaan, AS, et al. Am J Med 1999; 106: 424–9Miwa, H et al. J Neurogastroenterol Motil, Vol. 16 No. 4 October, 2010

The Integrative Medicine Approach

Understand and treat the symptoms in the context of the patient’s home and work life

Educate the patient as to why GERD occurs

Discuss weight loss as a long-term management strategy

Discuss evidence-based acupuncture

Answer questions about the use of supplements

Determine if stress is a trigger for symptoms and identify strategies for addressing stress

Medical therapy Additional testing Lifestyle changes

Low fat diet Avoid caffeine Avoid carbonated

beverages Limit your alcohol

intake Stop smoking Raise the head of your

bed

PLUS THIS:

Acupuncture for persistent reflux symptoms

Dickman, R. et al. Aliment Pharmacol Ther 2007. 26: 1333–1344

Traditional Remedies for reflux

no scientific evidence… yet

Fennel seed

Licorice

Apple Cider Vinegar

PhysicianConventional care

Acupuncturist

Psychotherapist

Nutritionist

Massage Therapist

Physician

JHIMDC

Is integrative medicine cost-effective?

Cost savings could be realized by Decreasing utilization of expensive

medical interventions such as pharmaceuticals, or reducing trips to the ER

Reducing provider visits by offering group interventions, such as stress reduction, nutrition education, and mind-body skills training

If nothing changes and the current trends continue…

By the year 2022, 80% of the US population will be overweight or obese (currently 66%)

Projected healthcare spending related to overweight and obesity by the year 2020 is estimated to be $437.6 billion (was $81.5 billion in 2000)

Yang, F. et al Obesity (2008) 16 10, 2323–2330

Challenges to Integrative Medicine

Current healthcare reimbursement favors procedures and pharmaceuticals over education, adequate face-to-face time, mind-body therapies

Conventional practitioners lack knowledge about evidence-based healing practices and practitioners, and how to identify them