Doctors move wellness care onto the radar

Medical institute pushing Congress on investment

Roberta Cutbill, 68, joined a wellness program in hope of lowering her cholesterol level enough to avoid medication. Roberta Cutbill, 68, joined a wellness program in hope of lowering her cholesterol level enough to avoid medication. (Duke University via AP)
By Lauran Neergaard
Associated Press / February 24, 2009
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WASHINGTON - Popping a pill can cut your cholesterol. But did the doctor also prescribe cutting the stress that is eroding your immune system? Or teach you how to exercise without worsening painful joints?

Think 3 P's: Good health care is preventive, predictive, and personalized, a rarity today in a crisis-oriented care system far better at treating disease than keeping it at bay. To help change that, one of the nation's top medical groups starts a major push this week for what patients might call whole-body wellness care.

"Health is more than the absence of disease," says Dr. Ralph Snyderman, who heads a three-day meeting of the Institute of Medicine to get "integrative medicine" onto Congress's radar.

Integrative medicine means going beyond standard disease care to involve a range of factors - physical, lifestyle habits, mind-body interaction - that play a role in preventing illness and helping people stick with recommended changes long enough to see a benefit.

"The doctor says, 'Lose weight, exercise, see you in a year.' We know that doesn't work," adds Dr. Tracy Gaudet, an obstetrician-gynecologist who heads integrative medicine at Duke University Medical Center.

But how to pay for keeping people well is a barrier to integrative medicine. Even though preventing disease is cheaper overall than treating it, it is not clear where the upfront investment would come from.

Still, a growing number of respected academic medical centers are embracing integrative medicine in different ways. At Duke, specially trained health coaches help patients implement a personalized care plan that complements treatment prescribed by their regular physicians.

"If I didn't have coaching, I would have given up," says Roberta Cutbill, 68, of Cary, N.C., whose cardiologist referred her to the program in hope that better nutrition and exercise could lower her cholesterol enough to avoid medication.

But centers must straddle the line between adopting nonmainstream therapies that may improve a patient's quality of life while avoiding unproven alternative therapies.

"We're extremely wasteful in healthcare in America, because we don't respect what the patient can bring to the table, the healing properties of the body itself, the use of lower-technology routes to healing," says Dr. Donald Berwick, a Harvard health-quality specialist who heads the nonprofit Institute for Healthcare Improvement.

Yet Berwick intends to issue a strong warning to the institute's meeting: "Evidence matters."

There is some evidence. Medicare funded a Duke study of 154 middle-age people at high risk of heart disease. In 10 months, people who received health coaching were exercising 3.7 days a week, two days a week more than when they started, and had an average 10-point drop in cholesterol. That equaled a small but significant drop in their overall heart risk, while people who got standard checkups barely budged.

Another example: A chronically stressed brain orders release of hormones and other chemicals that tamp down the immune system so it can't fight off disease or speed healing, says Dr. Esther Sternberg of the National Institute of Mental Health. But regular exercise, a healthful diet, and stress-relieving techniques such as meditation or yoga have been shown in studies to help battle the bad effects of stress.

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