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SEVAMED EDITORIAL

Integrative Medicine – the Future of World Healthcare

Integrative medicine is the combination of the practices and methods of Complementary and Alternative medicine (CAM) with conventional medicine.  Integrative medicine offers nutritional and preventive treatment programmes customized for each patient  to promote wellness and intrinsic healing in the whole person - body, mind and spirit for a healthy and vibrant life. After complete health assessment, a physician directed wellness plan of therapies is provided for optimizing one’s health or treating chronic medical conditions
            As per WHO report, CAM is used by 40 - 70% of population globally in different countries with highest in UK, North Ireland, Belgium, Chile with as much as 70% while 40% of population in USA, France and Australia. Most CAM therapies globally used are for chronic diseases such as Neuromuscular disorders, Life style disorders, allergies, arthritis and insomnia, HIV/AIDS, cancer and so on. The main topics covered of the 3rd European Congress for  Integrative Medicine in December 2010 were cancer, pain, mental disorders, atopic diseases, patient and physician relationship and placebo, primary care, education and various other topics.
            National centre for Complementary and Alternative Systems of Medicine has classified CAM as (1) Alternative Medical Systems (Ayurveda etc.); (2) Mind-Body Interventions (meditation, prayer, music etc.); (3) Biological Based Therapies (herbal medicine, special diet etc.); (4) Manipulative and Body-Based Methods (Chiropractic approaches) and (5) Energy Therapies (Qi gong (‘chee gung’) etc.).
            38% of U.S. adults aged 18 years and over (about 4 in 10) and 12% children (about 1 in 9) use some form of CAM in US.  Recent statistics on CAM costs in the United States showed  83 million adults spent $33.9 billion out-of-pocket on CAM (2007). Pediatric Expenditures on CAM visits and remedies were $127M and $22M respectively (Yussamn, Ambul Pediatr, 2004).  In 2007,  37% of US hospitals have one or more alternate therapies available. Massage, Acupuncture, Therapeutic touch, guided imagery are most common being (Health Forum Survey, 2007).
            A consortium of 44 medical schools who have support of their Deans have a mission to help transform medicine and healthcare through rigorous scientific studies, new models of clinical care, and innovative educational programs that integrate biomedicine, the complexity of human beings, the intrinsic nature of healing and the rich diversity of therapeutic systems. Majority of US universities (Harvard, UCSF, Maryland, Duke, Georgetown, Columbia, etc.) and three Canadian universities (Alberta, Calgary, Laval, McMaster) are associated in this mission (A. Prasad, YOGism Symposium, 2010).
            In 2007, National Health Interview Survey found that yoga is one of the top 10 CAM modalities used among U.S. adults. An estimated 6 percent of adults used yoga for health purposes in the previous 12 months. Hatha yoga, the most commonly practiced in the United States and Europe, emphasizes two of the eight limbs: postures (asanas) and breathing exercises (pranayama). Some of the major styles of hatha yoga include Ananda, Anusara, Ashtanga, Bikram, Iyengar, Kripalu, Kundalini, and Viniyoga. The 2007 NHIS survey found that more than 13 million adults and 1.5 million children used yoga for a variety of health conditions including anxiety disorders or stress, asthma, high blood pressure, and depression. People also use yoga as part of a general health regimen—to achieve physical fitness and to relax (A. Prasad, YOGism Symposium, 2010).
            In the Summit on Integrative Medicine & the health of the public Washington DC, Feb 2009, Senator Harkin says “We don’t have a health care system in America, we have a sick care system.”  We spend about 3% of our healthcare dollars for prevention and 45 million Americans do not have health insurance. The summit states that the disease – driven approach to care has resulted in spiraling costs as well as fragmented health system that is reactive, episodic, inefficient and impersonal. The integrative approach puts the patient as the centre addressing not just symptoms but the real causes of illness. It is care that is preventive, predictive and personalized.  The health care “should account for differences in individual conditions, needs and circumstances, and engage the patient as a partner in addressing all the factors that shape wellness, illness and restoration of health”.  The progression of many chronic diseases such as cardiac disease and cancer can be reversed and sometimes even completely healed by making lifestyle modifications.  There are some success stories in Yoga. Dean Ornish proved that Yogic way of life, vegetarian diet and stress management showing reduction in angina and coronary risks but also angiographically proved the reversal of blockages in the coronary arteries. (Published in JAMA in 1995).  A new era has started in the management of coronary heart disease with Saaol Heart Program. Dr. Dean Ornish is Advisor to the President of USA.
            Based on Vipassana (Buddha’s technique for self realization) and Yognidra (Yogic Practice), Mindfulness (non judgment moment to moment awareness) was first developed in 1979 by Dr. Kabat – Zinn and is being practiced under Mindfulness Based Stress Reduction Programme (MBSR) in over 200 hospitals in US and is currently the focus of a number of research studies funded by NCCAM. Mindfulness meditation has been clinically shown to be effective for the management of stress, anxiety, chronic pain, depression and a wide array of medical and mental health related conditions.
            The Yoga Research in US suggests that yoga might (1) Improve mood and sense of well-being; (2) Counteract stress; (3) Reduce heart rate and blood pressure; (4) Increase in lung capacity; (5) Improve muscle relaxation and body composition; (6) Help with conditions such as anxiety, depression, and insomnia and (7) Improve overall physical fitness, strength, and flexibility.  Research studies supported by NCCAM have been investigating yoga's effects on Blood pressure, Chronic low-back pain, Chronic obstructive pulmonary disease, Depression, Diabetes risk, HIV, Immune function, Inflammatory arthritis and knee osteoarthritis, Insomnia, Multiple sclerosis and Smoking cessation (A. Prasad, YOGism Symposium, 2010). 
            In India AYUSH of Central Health Ministry has identified  Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy for research and development.
            The concept of Body, Mind and Soul is the very basis of Yoga. Yoga is oldest and time tested holistic system for mind-body fitness.  Yoga & Naturopathy aim at purification of mind (mental) and body (physical) i.e. removing negativity of mind and helps in  detoxification of body. Yoga way of Living (YOGism – live Simple, live Spiritual and live to Serve) is strongly preventive and therapeutically effective in reversing Life style health problems in early stages. There is need for integrative research on Yoga in India.  Presently Swami Vivekananda Yoga Anusandhana Samsthana (SVYASA, Bangalore); Dev Sanskriti Vishwavidyalaya, Gayatrikunj, Hardwar; Patanjali Yogpeeth, Hardwar; All India Institute of Medical Sciences, New Delhi and The Yoga Institute, Santacruz, Mumbai and many more are involved in Yoga research.
            Meditation (Vipassana, Yognidra or Mindfulness) have become important component of mind-body medicine for promotion of optimal health and showing beneficial effects in reduction of stress, hypertension, anxiety, depression etc. Goal of mind-body techniques has been to activate the relaxation response and reduce the stress response. When relaxed, the immune system becomes more efficient improving resistance to infection.
            Supportive laboratory evidence for beneficial effects of Yoga has shown that meditation could bring down raised cortisol in stress, elevate brain biochemicals GABA and serotonin levels in anxiety and depression and boosts innate immunity as shown by increase in NK cells and resistance to infection.
            In researches abroad, supportive laboratory evidence for beneficial effects of yoga are (1) Therapeutic intervention in diet, lifestyle, stress care, exercise and psychological support changed the expression of over 500 genes in men with early stage prostate cancer.  (2) Oncogenes associated with breast & prostate cancer, heart disease, oxidative stress and inflammation were down regulated & protective genes are “turned on” by Life style changes. (3) Acupuncture and mind-body practices helped in reduction of lower back pain, with significant reduction in pain medication intake (Ford Motor company – corporate study). (4) In Corporate employee health program in preventive cardiology, smoking cessation, stress management, weight management – decreased medical costs on employees.  (5) In research trials by Health Insurance companies – Therapeutic Yoga & Meditation reduced health care costs.
            Wellness Institute of Cleveland Clinic has started Life style 180 programme for a fee of $1500 addressing 25 million Americans with chronic disease, to reclaim their health and vitality by making positive changes in their life style under guidance of experts on nutrition education, exercise and stress management with specific achievable goals. 

           

There is urgent need in India for health research and educating public and conventional medical practitioners on the beneficial effects of Yoga & Naturopathy by  (1) Research in Life style diseases and publications from Yoga & Naturopathy colleges; (2)  Collaboration with allopathic practitioners with joint publications; (3) Support of research protocols for multi – centric trials in management of Life style health problems in collaboration with allopathic practitioners and (4) Staging the health problems (Hypertension, Obesity, Diabetes, Heart disease, Back pain etc.) and therapeutic intervention with Yogasana, Naturopathy, Nutrition, Exercise, Meditation etc.

March 10, 2011                                                                 Prof. B.C. Harinath

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