ABIHM: Hello and welcome. I recently came across your policy piece, “The Case for Commons Healthcare” in the January edition of the journal, Explore. In the paper and your more detailed Commons Health Care Blog, you weave together disparate issues such as climate change, food, anchor institutions and integrative practices into a forceful argument for a new healthcare framework.  Can you distill your thinking about how these issues fit together?

Harvie: Thanks, Scott. It may be helpful to provide some context.  For the past 14 years, I worked with colleagues to insinuate an environmental agenda within western medicine. We achieved considerable success.  Hospitals have eliminated mercury thermometers and PVC IV bags, stopped incinerating medical waste, and have implemented other environmentally friendly strategies.  Yet, there was an unspoken acknowledgement, that though green hospitals are good, wouldn’t the ideal be far fewer hospitals? What if our vision as a society was optimal health, and as a result, lowered or eliminated our need for hospitals?  How would we get there? With approximately 20% of our economy invested in our current treatment model, change is difficult, and we are vexed by healthcare reform.  But it is even harder to change without a vision of what we might imagine as a new health delivery system.  There is a general consensus that our existing model is broken and in transition, but no one seems to know exactly where it is going. A commons healthcare framework attempts to provide some direction; the idea is to create the future health system, instead of fixing the old one. Moreover, it offers some concepts about key allies and drivers that can affect a transition more rapidly when properly aligned.  Of course, this model is neither simplistic nor perfect, but it represents a vantage point that will only be strengthened by debate, discussion, and trial.

ABIHM: So can you explain these linkages?

Harvie: Consider key drivers of disease or ill health. We know that our global healthcare system is crumbling under a burden of primarily diet related chronic diseases.  The IPCC (Intergovernmental Panel on Climate Change) has highlighted an impending public health crisis because of climate related impacts such as heat stress, infectious disease, and natural disasters. The International Agriculture Assessment, a global report funded by multiple UN agencies, has determined that our current industrial agriculture model has led to a host of social and environmental impacts that jeopardize our ability to both grow food for future generations and maintain social stability. Moreover, the UN Millenium Report describes major global ecosystems at imminent collapse.  Hospitals and clinicians in an already overburdened healthcare system will be at the receiving end of these predicted impacts.  Our food system represents one third of climate emissions (greater than transportation); healthcare treatment represents about 80% of healthcare climate emissions (versus 20% for energy use). Our industrial food model promotes social inequity and negative environmental impacts. If we want to be healthy on a healthy planet, we will need to look for multiple benefits solutions (and we have limited time to do so).  As a result, a health care commons model will necessarily require a “systems” mindset with primary prevention as its focus.

ABHIM: So is this where the commons comes in?

Harvie: This is where we recognize the interrelationship between community and the commons. The commons are what we all share. They are both what we inherit and what we create together. Think of air, water, food, libraries.  So at one level, the commons are used to reflect common drivers of good health and to highlight community ownership.  Hippocrates, Florence Nightingale, and others have long recognized that clean air, water,  and food are at the heart of prevention and good health.  They would never have imagined that food (through genetic engineering), water (through privatization), or natural remedies including yoga postures might one day by privatized. But this can extend to the enclosure of research, education and more.

Commons is at root of “community” so it is about rebalancing the relationship between individual and community. This is implied in healthcare reform – more people and resources in the “pool” beyond healthcare delivery. We know that a sense of connectedness, or “community” improves health outcomes. In the UK, where they’ve been giving considerable thought to this, the NHS Roadmap describes a transition from institution led health to community based social and health care.  This concept is also central to the health care commons model in which the community takes ownership for its health. It parallels the tremendous work the integrative community has done to educate and empower patients to take control of their own health, just at a different level. Interestingly, the important work that the integrative community is advancing at the clinical and political levels parallels the work of many community and environmental advocates.  There is a deep caring, passion, and soulfulness that is woven through these cultures. If we can understand this, and see the connectedness in our work, I believe we can create important linkages, leverage our work and generate more co-creators and catalysts.

ABHIM: This sounds exciting, but what does this mean in practice, for our clinical community? What might next steps be?

Harvie: At the present time, there’s no obvious roadmap, but we can co-create the next steps. It  is important to articulate a new primary prevention framework, especially one that works towards multibenefit solutions.  Moreover, it must extend beyond clinical medicine throughout the lives of fellow clinicians, patients and communities, such that the interconnections feel obvious.  I suspect that many of your Diplomates are already involved in some way. At the heart of your training and practices are the understanding of environmental toxins, clean water, nutrition and spirituality. The broad thinking systems model I’ve been talking about typically feels intuitive to integrative holistic practitioners.

More than likely, the same old institutions are not going to provide the answers. If we invite the same guests to the party we’ll have the same conversations. In the UK, they’ve created  DEFRA,  a new Department of Environment, Food and Rural Affairs. This is an exciting way to engage new and inspiring discussions. We are beginning to see this philosophy through the establishment of ACO’s (accountable care organizations).  We have to remember that we have about 17% of the economy invested in a treatment model.  This is a lot of entrenched power that will resist change.  So things won’t just “happen”.  What will this mean in practice? It will require future health professionals to promote consumption of healthy foods from agro-ecological production models, not only at the patient level, but to be advocates within the community for agro-ecology because this production and management method has the potential to improve social determinants of health, mitigate ecological impacts, and reduce the burden of chronic disease.  Implicit in this approach is support for community approaches to resource management. In practice, this means prohibiting GE Foods or requiring labeling, and no bottled water.

Physicians and other staff can call on their hospitals to set up farmers markets, facilitate CSA drop-offs, support food literacy initiatives, or teach cooking skills. Much of the groundwork has already been laid by facilities who have committed to these practices. Clinicians can work with community members and challenge their hospitals to support Baby Friendly hospital guidelines, a hospital commitment to purchase local sustainable food, and to stop selling sugar sweetened beverages.  In Cleveland, the community has helped develop a hospitals and universities supported worker-owned laundry. Clinicians can join with community members to highlight social disparities and support economic policies that support safe working conditions and livable wages. These are ultimately connected to socioeconomic health. This is why anchor institutions are included in the Commons Health Framework.

Researchers might also include the development of a multi-benefit research agenda.  The Bravewell Collaborative published a wonderful paper, The Efficacy and Cost-Effectiveness of Integrative Medicine.  Much of the cost effectiveness was due to a reduced need for pharmaceutical interventions. Because there are significant climate and other ecological/human impacts associated with the lifecycle of pharmaceuticals, we should intentionally highlight and explicitly link these benefits in research back to the health of individuals, communities and the planet.  If we understand this, it might help us be more judicious and intentional when pharmaceutical interventions are considered.

At the same time, this model requires taking responsibility at the personal and community levels. Integrative clinicians have been good at “empowering” patients to take control of their health.  With ACOs, we’ll start to have a better handle on community based costs of treatment. This transparency may help communities make more informed choices about how and where they invest their “health” dollars. In her wonderful short video, “The Story of Stuff”, Annie Leonard reminds us that much of our consumer oriented economic model is based on making us feel lonely and unhappy.  The commons health care community might raise the idea of including a “happiness” index“ as a community health benchmark, and maybe even replace a strict economic indicator, such as the GDP.

The weight of a community driven approach does not have to be shouldered by clinicians alone, though their moral authority is helpful in engaging business and community leaders. In so doing, communities can begin to take ownership of their health resources  in the same way that patients are asked to take responsibility for their health.  This agenda is really about de-siloing and weaving many areas of policy and practice with community at the center, and shifting power in decision making from the institution to the community.

ABHIM:  This is tremendous food for thought.  Thank you for sharing your vision and for providing so many useful links and resources for this work.

“The doctor of the future will give no medicine, but will interest his patients in the care of the human frame, in a proper diet, and in the cause and prevention of disease.”

This quote is by Thomas Edison (1847-1931), inventor of the light bulb, the phonograph, and with over a thousand patents for inventions. The innovative, creative Edison was my childhood hero. I read every available book in the Phoenix Public Library on his life and work.  Edison’s futuristic vision for the evolution of medicine was a noble one that I have held like a lamp during my career. I have amended it to say “will give some medicine,” and of course to clarify that no longer are all doctors solely represented by “his” as in his day and we thankfully have just as many “hers” in the field.  With so much talk about health and the health care system these days, I want to share some predictions. I reported on these in 2009 to the Institute of Medicine’s Summit on Integrative Medicine.   The “doctor of the future” will include the following characteristics:

1. Patient centered

2. Team-based and outreach oriented

3. High tech AND high touch

4. Genomic individualization of care

5. Prospective, preventive, behavioral science-based change methods

6. Focus on self-healing and homeostasis

7. Utilize natural treatments: nutrition, botanicals, lifestyle, mind-body therapies

8. Integrative: using both conventional and complementary therapies

This doctor of the future will gradually evolve along with society into acknowledging the increased importance (and cost-effectiveness) of lifestyle medicine, nutrition, and natural remedies, while using the best evidence from personalized genomic science. Attention will be placed on prevention and on supporting the ability of the body to heal itself. He and she will reach into the community using teams of skilled healthcare providers from multiple disciplines.  The doctor of the future will also need to look beyond the individual patient. He will be a systems thinker to include:

1. Health system navigator

2. Multidisciplinary/collaborative

3. Conscious designer of healing environments

4. Systems biology/complexity theory methods expert

5. Quality and outcomes focused, evidence-based manager

6. Empowering patient education through web-based resources and health coaching

7. Community based/patient advocate/activist

8. Social/environmental /policy change exponent

9. Teaching self-care strategies

The doctor of the future will stress system change, support patients in navigating the healthcare labyrinth, and become a leader in improving quality outcomes of care. He and she will closely collaborate with other professionals, nurses, nutritionists, physical and occupational therapists, complementary practitioners, health coaches, and researchers. The doctor of the future will be at the leading edge of systems biology and the understanding of health and the human condition as a holistic, dynamic, and personalized complexity science as well as a sophisticated human art. He and she will work to make healing spaces more inviting and patient friendly, to improve access, and continually advocate for ethical patient care.  The ABIHM is doing its part to grow the doctor of the future. Join us!

In a New York Times Op-ED by Theresa Brown on March 15th entitled Hospitals Aren’t Hotels, she clearly articulated the company line regarding the new patient centered care requirements being imposed upon hospitals by previously the Bush and now the Obama administrations through CMS.   Although Ms. Brown is most probably a world class nurse, she echoes the sentiment being expressed by many healthcare leaders regarding the realities of current thinking in hospital care.  In her op-ed, she writes that “A lot of what we do in medicine, and especially in modern hospital care, adheres to this formulation.  We hurt people because it is the only way we know to make them better.”

Having been in senior management in healthcare for over twenty years as an officer and for the last dozen years prior to my retirement as a CEO, this type of rationalizing was a constant symphony.   My experience was very different because it was from the patient’s point of view.   Almost ironically, prior to entering the healthcare field, I was the CEO of a Convention and Visitors Bureau, and I saw firsthand what could be done in healthcare.   The irony for me was that, once I was in a position to introduce a more patient centered environment in hospitals, the push back was relentless and unending.  That was until I became a CEO and took an unmovable stand on this issue.  You see, this is not a situation where patient centered care resulting in higher acceptance wouldn’t work; it is a situation as so aptly described by Ms. Brown where “We hurt people because it is the only way we know to make them better.”

Once while observing a young child being treated in the Emergency Room I heard blood curdling screams.  After the treatment was complete, we brought that team of care givers together to discuss what had happened.  During that conversation, we asked if any type of topical pain killer could have been used.  Their response was, “Yes, of course, we just never did it that way.”  It was done that way from that day forward.    What we are missing here can best be described by reading the poem “Calf Paths,” by Sam Walter Foss in which he describes a walk taken by a medieval calf that ended up being the foundation laid for what later became a road, then a primary street through a medieval town and finally a major highway.  Healthcare is based on conservative tradition, and it is well known that, as stated by a seasoned VA nurse at a presentation that I gave, “We are famous for eating our young if they don’t follow the traditional path set out for them by our healthcare ancestors.”

Our hospital offered massage, stress management, music, aroma, pet and all other types of therapy.  We had 24 hour visiting, beds for our visitors beside their loved ones and double beds in the OB suites.  We baked bread in the hallways, had popcorn machines and live music in the lobbies, but most importantly, we provided our employees classes in emotional intelligence and sensitivity.   We provided them with the knowledge that every aspect of what we did we did as a Good Samaritan.  We embraced the philosophy of “Doing unto others what we would have others do unto us,” and then we capped that with a commitment to provide unconditional love to our patients and their families.   The result?  This hospital had the lowest restraint, readmission, lengths of stay and infection rates of it 18 peer hospitals.  But most importantly, even though the patients came from the same pool of humanity, we had the lowest mortality rates. But here’s the real irony for this lesson, our employee and patient satisfaction rates were in the highest possible percentages.  Treat people with kindness, love and respect.  Explain to them when they will hurt and why and then respect their needs.  That’s not a hotel.  It is a center for healing.

In the movie, “City Slickers” Jack Palance mystically told Billy Crystal that the secret to life was finding “one thing.” Finding the cryptically un-named “one thing,” is a metaphor for our individual journey and the values that guide us.

At his Stanford University commencement address in 2005, Steve Jobs advised graduates: “”Stay hungry. Stay foolish”.’”  He told them, “Your time is limited, so don’t waste it living someone else’s life.” He knew then that he had a potentially fatal cancer certain to shorten his life.

On a flight this week from one island, Galveston to another, Kauai, I watched a bio-video of Jobs, founder of Apple, now the world’s largest company. Having just read his biography by Walter Issacson. I was intrigued how this focused genius changed not one but five major industries: personal computing, animated movies, cellphones, portable computing, and finally the textbook.

He seemed to have done this with attention to “one thing” at a time by demanding the highest blend of artistry, technology, and excellence from himself and his team.

These days, when people ask how I am doing, instead of the generic, “Fine” or “OK,” I offer a new and personally motivating response:  “Living the dream!”  This means I am grateful for the life I have, where I live, and what I can give to others. Some find this response upsetting, as it breaks away from the expected non-answer in social situations. Others sadly report they are living a nightmare.

Finding and living our unique dream is what brings true health, energy, vitality, and creativity to our lives no matter our age. Living in this magnetic pull to the center of our being, this discovery of who we really are, of what we were created to do in the world, is the true measure of health. I am reminded of so many of my precious patients over the years. One, a retired professional over 90, teaches me regularly about new natural therapies.   She is in better health than many 60 year olds.  She has lived and continues to live her dream and it keeps her younger than her years. The recent movie, “The Big Year” is another example that will inspire our Galveston birders and many others to follow their dreams and keep it all in balance. It astounds me how so many creative artists live to ripe old ages, productive, creative, expressing their soul nature.

To thrive, not just survive requires having purpose and meaning in life as Viktor Frankl taught in his classic, “Man’s Search for Meaning.” Earl Nightingale defined success as ““… the progressive realization of a worthy ideal.” Unfortunately, some folks seem to have little hope, vision, or ambition for a better future or even an ideal next moment. As a result, they are fatigued, depressed, often with multiple aches, pains, medical complaints, and anxieties.

Your “one thing” can be one of many things, depending on your nature, beliefs, and personality. Find that one thing and you will bring prosperity and health to yourself and those around you. It could happen TODAY.

1. Change my breakfast
2. Choose to move
3. Hydrate
4. Connect with nature
5. Make my sleep a priority
6. Embrace the power of touch
7. Give myself the gift of silence

The next national Wellness Week will take place March 19-25.

Dr. Friedland has generously agreed to share the following full transcript of his inspiring speech. For more information about Dr. Friedland’s work, see http://danielfriedland.com/blog.

Daniel Friedland, MD – Wellness Week talk on Capitol Hill 2.9.12

We’re in the midst of a healthcare revolution and I can think of no better place to speak briefly about this than here on Capitol Hill.

Our sickness focused healthcare system of care has been buckling under immense costs. Just consider: 75% of the $2.6 trillion U.S. healthcare spend goes to treating chronic diseases, which research shows can largely be prevented through lifestyle changes and a focus on wellness.

So what you are seeing now is a much-needed revolution into wellness. This revolution is reflected in the Patient Protection and Affordable Care Act where Wellness is mentioned 98 times.

This revolution is also reflected in the rise of complementary and alternative care. More than 40% of individuals and more than 40% of U.S. hospitals engage in complementary and alternative medicine.

But this revolution goes beyond wellness, it reaches into wellness empowerment. More and more patients want to be able to make their own choices and drive their care toward their destination of health and well-being.

But for any revolution to be successful we need to have a clear vision. We need to be clear on what is this destination of health.

When I went through medical training in the late 80’s and mid 90’s I was taught that health is the absence of disease –this is the sickness model perspective.

A major part of this revolution is reframing this definition of health.

As you’ll see when we reframe this it invites everyone to play or role including in a major way the spa industry.

So I’m going to ask you a question. “What is the root of the word health?”

If you don’t you you’re in great company. In my talks to thousand of physicians around the country hardly any of them know…and we’re in the healthcare business.

The root of the word “health” does not come from Greek or Latin. It comes from the old English, H A squiggle L, HAL, which means wholeness. It’s “wholeness.”

What’s the root of the word “patients”? The patients we are or care for? This does come from Latin. It means to suffer.

So patients suffer from fragmentation of mind, body and spirit and our role as healer, same root word, is to support their essential wholeness, their health and wellness both before and after they get sick. That’s the journey.

But here lies the challenge in travelling to this destination. How do we best help patients getting there? There are big obstacles to navigate. Healthcare providers and patients alike are overwhelmed by scientific information, the complexities of the healthcare system and stress and uncertainty that fragment our sense of wholeness each and every day.

One of the solutions is evidence-based medicine. I wrote one of the first textbooks on this in 1998. It’s the way all doctors are now trained to navigate scientific information to make decisions on what works. Evidence-Based Medicine is also referenced multiple times in the Affordable Care Act.

But this is not enough we still need a vision on how to best incorporate Evidence-Based Medicine to empower patients in their wellness.

So three years ago, I created a website called SuperSmartHealth to offer a vision and tools to empower healthcare providers and patients to more fully partner in the pursuit of health and wellness.

The vision is framed by 4 principles:

1)  You are the CEO of your health.

2)  As the CEO you get to decide on your mission statement and definition of health and wellness.

I serve on the board of the ABIHM and offer for your consideration the definition the board uses. Think if you could live with this:

Optimal health – or wellness – is the conscious pursuit of the highest level of functioning and balance of the physical, environmental, mental, emotional, social and spiritual aspects of human experience, resulting in a dynamic state of being fully alive.

This definition enables us to experience wellness in both the presence and absence of disease.

It also invites participation from broader group of stakeholders than the traditional medical system – including the spa industry that that has also had a long history of investing health seekers in their rejuvenation, vitality and wellness.

3)  The third principle of SuperSmartHealth is that you are able to recognize resources to support your mission statement of health and wellness.

Here you recognize the value of the traditional medical system as well as complementary and alternative medicine, the intersect of which is known as integrative medicine.

But both within integrative medicine and beyond it, core to wellness is good air and water, health food, exercise, sleep, love and compassion, and a connection with nature and whatever you define as your deepest source of inspiration.

Which makes wellness week and the wellness week pledge so very important here today.

4)  The 4^th and final principle of SuperSmartHealth is that you are empowered to harness these resources toward your definition of wellness.

3 key skills are needed to do so:

1) You need to know how to navigate science to know what’s likely to work.

2) You need to know how to navigate the health and wellness system to get support to implement what works, and

3) You need to know how to turn inwards to find meaning motivation and purpose to take action on what works.

If you know how to do all 3 you have thoroughly mastered wellness empowerment.

With the vision and support of Susie Ellis, President of SpaFinder and Sallie Fraenkel, the Spa Industry has endeavored to empower all the of these areas.

When it comes to navigating science here’s where knowing how to access the evidence-based medicine resources that doctors use are very important to make decisions.

Last year I had the great pleasure of working with Susie and Dr. Ken Pelletier and Dr. Marc Cohen to create first ever evidence-based portal for the spa industry. It’s called SpaEvidence.com. It brings together the scientific research from trusted sources to make evidence-based decisions so you can know what’s likely to work around the most commonly used spa-related wellness therapies.

When it comes to navigating the broader wellness system, Wellness week invites you to explore the range of service the spa industry offers to provide you the support to implement what works.

Finally, when it comes to inspiring you to take action on what works, we have the wellness Week pledge – 7-simple, powerful and evidence-based steps to empowering your mission statement for optimal health, well-being and vitality!

And Mariel Hemingway will be sharing this with you in just a moment.

It’s been a great pleasure and privilege to be here with you today.

I wish you well. Thank you!

Healing Young Minds: Helping Children Thrive in a Stress-Filled World

A five-year-old boy begins kindergarten.  He goes to school from 8:15 till 3:15, which seems an eternity.  After lunch, he longs for a nap, or at least some time to glide back and forth on the swings.  Instead, he sits and copies words from a text onto her notebook.  The arrangement of letters makes no sense to him.  The teacher encourages him to sound out the words, but he can’t.  He envies his younger sister, who gets to stay home.  When he climbs into the car most afternoons, his sister gaily tells him what she and “my mommy” have done in his absence. Sometimes his jealousy swells so painfully within his chest, he has to hit his sister in order to breathe again.  Even though he knows this action will provoke his mother to yell at him, he can’t control the impulse.  Just after Thanksgiving, he develops chronic stomachaches.  His mother takes him to the doctor, who can finds nothing wrong.

A teenaged girl notices her long, red hair comes out in handfuls when she showers or brushes her hair.  Otherwise, her health is good.  Her grades are excellent.  She plays varsity sports.  Teachers and peers like her.  Between the demands of academics and athletics, she often stays up late finishing her homework.  The pediatrician can’t find anything wrong, nor can the dermatologist.  [xx maybe cut this one.yy]

A previously well-adjusted eight-year-old boy has taken to chewing the cuffs of his shirt sleeves, sweaters, and jackets.  His expression is pinched and anxious.  He seems to always have a cold.  Smaller than most of the other kids in his class, he is a common target of teasing and bullying.  Lately, he has been making excuses to stay home from school.  He has trouble sleeping.  He cries when either of his parents leaves on a business trip.  He admits that he fears they might die and not return.

An eleven-year-old girl’s parents divorce.  She spends weekdays with her mother and weekends with her father.  Her parents do their best to get along with each other and to make things easier for their daughter.   Despite their efforts, their daughter’s grades begin to fall.  She has trouble concentrating on her studies.  As she sits at her desk, she snacks on crackers or candy and listens to her stereo.  When her jeans become uncomfortably snug, she takes to wearing sweat pants.  Her friends stop calling.  At home, she rarely leaves her room, except to eat meals or watch television.  She feels tired all the time.  Her mother has trouble getting her up for school, even though she sleeps ten hours a night.

A ten-year old boy is sent to the school psychologist because he repeatedly gets into fistfights on the playground and refuses to follow the teacher’s instructions.   He lives with his mother and an older brother and sister.  His father left when he was so young he doesn’t remember what he looked like.  His mother works as a secretary at the newspaper.  Sometimes she works evenings.  When she does, the boy’s older sister is supposed to look after him.  Sometimes she takes him to parties, where he sees kids making out and drinking.  Sometimes she takes him to movies, movies that are typically laden with sex and violence.  Sometimes the two of them just hang out and watch TV.  Sometimes she leave him home alone.  He doesn’t mind.  That way, he can watch cartoons and the Disney station without his sister calling him a baby.

Although the children described above have different stories, they all have one thing in common: they are under stress.  More to the point, excessive stress has overwhelmed their abilities to cope.  As a result, they have developed symptoms: depression, anxiety, anger, poor concentration, weight change, sleep disturbance, headaches, stomach aches, hair loss, and combative and defiant behavior.

If you are a parent or anyone who works with children, you are probably well aware children today have to deal with too much stress too soon in their young lives. They have too much homework and too little after-school supervision.   If their parents are still married, it’s likely that both of them work.  Diets have grown thin on critical nutrients, even as the childhood obesity rate has skyrocketed to 15 percent.  Kids get neither enough exercise, nor sufficient sleep.  Unstructured time has practically become an endangered species.  Musical lyrics have become darker.  Music videos are often X-rated.  Many kids don’t feel safe in their schools and neighborhoods.  In addition to books, some kids keep weapons, drugs, and alcohol in their lockers.  It’s enough to make the kids who don’t very nervous.  Hardly a week goes by, without headlines of a kid maiming or killing someone, without headlines of a child being abducted or abused.  Hardly a week goes by when the media neglects to remind us of the eminent threat of terrorist attack.

As stress has mounted, so have rates of childhood mental illness.  So many kids have attention deficit disorders, anxiety disorders, depression, and bipolar disorder that school administrators have had to take on the task of doling out medications.  Visit any summer camp, and you likely see long lines forming outside the nurse’s office when it’s time for the morning and evening medications.

As a child psychiatrist, I have seen an increase in both the number of kids who come to me showing clear symptoms of stress, and the number of kids with symptoms of depression, bipolar disorder, anxiety disorders, attention deficits, and hyperactivity.  A few decades ago, many of these illnesses were uncommon or practically unheard of in children.

What has accounted for this increase?  Genetics can contribute to mental illness, but it’s not as though the country’s gene pool has changed much over the past several decades.  Certainly, we have become better at recognizing mental illness, but increased awareness can’t explain everything.  I believe there’s a link between the increased burdens placed on kids and the rise in mental illness.

We have propelled kids into dealing with adult problems before they’re able.  As a result, they’re developing physical and psychological ailments previously relegated to adulthood.  Kids have obesity, diabetes, and high blood pressure.  And they have symptoms of stress, many of which mimic those of several psychiatric conditions.  Depending upon the child, stress can diminish concentration, increase activity, darken mood, increase anxiety, and provoke aggression.

Not only can stress produce symptoms that mimic mental illness, but it can activate mental illness.  Every child possesses certain vulnerabilities, and stress erodes any native resistance to these susceptibilities.  It undermines a child’s ability to cope and to maintain health.  Stress can cause one child to develop recurrent colds, another to develop migraine headaches, another to become depressed, anxious, inattentive, or hyperactive.

How has childhood stress gotten so out of hand?  I like to think that we adults are neither negligent, nor cruel.  Rather, a number of less sinister factors explaining why well-meaning parents miss signs of stress.  We’ve become so inured to our culture’s fast pace and ambiance that we have accepted the way we tear madly about as normal.  We may be so busy and overwhelmed ourselves as to fail to notice that our children are struggling.  Or we may chalk up our children’s behaviors as part and parcel of a developmental stage.  Oh, we think, he’s just going through the terrible twos, or the terrible teenage years.  Or our children may hide their problems from us.  Or they may only be able to describe the physical symptoms such as headache or stomach upset.  Or we may recognize that there are problems (academic demands out of proportion to the child’s abilities or an unsafe neighborhood or school bullies) but not know what to do about them.

Indeed, many parents do fret that their kids are struggling to cope with too much too soon.  Both in my clinical practice and at social gatherings, the main topic on other parents’ minds is their kids’ struggles.  What to do about the mean girls who won’t let their daughter sit with them, what to do about their sons’ angry outbursts, what to do about poor focus and hyperactivity…

And although many parents, educators, and mental health professionals are rightly concerned with the issues of violence, sex, drug use, and other disturbing trends, we often let more peripheral debates sideline us.  We discuss whether to put metal detectors in schools or whether to randomly test kids for drugs or whether safe sex discussions belong in the classroom or whether we should allow our 2^nd grader to watch pg-13 movies because all the other kids are doing it.  There’s no question that modern life stresses kids and we have to begin to do something about it.  Nevertheless, we have to ask more important questions about why kids commit violent acts, engage in premature and promiscuous sex, and take drugs.

Many of us are worried about these things, but don’t know how to help our children.  How, you may well wonder, can you change the school system, disarm your entire neighborhood, throw a monkey wrench in the whirring gears of American culture?  You can’t.  That is, you can’t precipitate widespread social revolution. Of course, you can take steps to rectify some of the stresses (turn off the TV, establish reasonable bedtimes, feed your child healthy food).  You can alter your child’s perception of stress and help him manage it.  In fact, many small improvements in your child’s life can go a long way toward healing his mind.

For the unavoidable slings and arrows your child will encounter, you can armor your child against them.  Those defenses are the skills of resilience.  Many of us take our children’s “resilience” for granted.  Compared to us adults, they still show a remarkable ability to bounce back from adversity.  However, their innate resilience may not always be up to the task of cope with the myriad modern stressors.  It’s up to us adults to be aware of the pervasive effects of stress on our children and to enhance their resilience.  I’ll devote several chapters to giving you practical ways to give your child the lifestyle habits, thinking habits, emotional skills, social skills, and spiritual cushioning that will help him recover from small disappointments and major disasters.

Of course, your child may develop a problem of sufficient severity that you need professional help.  Sadly, your child may not get the kind of help he really needs.  For one, the doctor may not realize that the underlying problem is stress.  For another, the trap physicians and parents alike have fallen into is to restrict treatment to correcting the child’s behavior or eliminating symptoms.  Doing those things is certainly important.  Unfortunately, we often neglect to get to the root of the problem.  In the case of stress, we either need to remove it or help the child learn to cope with it.

Regardless of whether symptoms are those of stress overload or of stress-activated mental illness, the standard medical practice of treating symptoms with a pill falls short.  Because misdiagnosis is not uncommon, the prescribed drug may fail to do good and may even do harm.  For example, I often see kids misdiagnosed with attention-deficit disorder whose problem is stress overload.  In such cases, stimulant medications like Ritalin only serve to aggravate symptoms and don’t help the child solve the underlying problem.  Even if the diagnosis is correct, drug treatment alone addresses the symptoms while ignoring the stress that underlies the disorders.

Granted, medications are sometimes lifesavers for kids with psychological difficulties.  But I think it’s a mistake to stop there.  While drugs offer symptom relief, they are at best a half-measure, a finger in the dyke.  If we want our children truly to heal, we must look at the child in all her wonderful complexity and devise a treatment plan that works with that child’s strengths and weaknesses.

In Healing Young Minds, I’ll show you the many other healing therapies I use to help kids get better.  Fortunately, a whole array of options exists.  In my practice, I employ everything from dietary changes to yoga, psychotherapy to acupuncture, vitamin and herbal supplements to medications.  Some of these therapies are so simple and inexpensive you can employ them yourself.  For others, you’ll need to work in partnership with a mental health specialist.  But at least you’ll know how to go about doing so.

On a bright note, children have a natural drive toward health.  Their brains, minds, and spirits are amazingly resilient.  All most kids need is for someone to remove the roadblocks and they will spontaneously heal body, mind, and soul.  Believe me, I’ve seen hundreds of kids recover, even children who have suffered horrible trauma.  I look forward to telling some of their stories and to sharing with you the things that have helped them mend.

This book is an autobiography of the soul of Dr. Lee Lipsenthal in which he describes both his living and dying. Lee was a well known holistic physician whose life work evolved from being an internist in private practice, to being a researcher with Dean Ornish’s prevention programs, and finally an internationally known presenter on creating a balance in a medical professional life.

He died a few months ago from advanced adenocarcinoma of the esophagus at age 53. His diagnosis was a mystery and shock to many as Lee had in many ways epitomized a wellness-oriented life.  He truly practiced and taught focusing on balance, prevention, good diet, exercise, meditation, and other ingredients we all would prescribe for optimizing their and our physical-mental-spiritual being.

Despite his early transition from this life, Lee left a profound impact on the holistic and integrative medicine community in which he was a recognized leader. As a former President of the American Board of Integrative Holistic Medicine, his work, his heart, and his soul reached out to touch many lives, friends, patients, and many other souls.

One way he continues to touch lives is through Enjoy Every Sandwich in which he reminds us to be mindful of and to enjoy each and every moment. A poignant turning point in his life was when he had a problem swallowing while eating a sandwich. As a physician, he immediately knew the potential differential diagnosis. His “cancer story” started at that moment. His story follows an amazing, winding road as he leads us through the psychology of his childhood, his deep, intimate marital and family life with wife and physician, Kathy and their kids, and with many patient stories of healing and of mystery.

Dr. Lipsenthal further guides us skillfully through his own spiritual path, through transpersonal psychology, through dreams, images, prior life remembrances, and psychic premonitions. In all of this journey, he evolves and we evolve as the subtitle of the book “Living Each Day As If It Were Your Last” dawns slowly then brilliantly. He continues, as he had done all his life, to teach us how to be mindful, grateful, joyful even when faced with doubt, despair, and anguish. He died peacefully in the warm embrace of family and spiritually connected with thousands of friends.

To conclude, I’d like to cite integrative oncologist, Don Abrams, MD who wrote in praise of this book, “At once playful and profound, Enjoy Every Sandwich serves up a delicious double-decker. Lee gifts us with gracious guidelines not only for those facing death but for everyone seeking to live life the fullest. Should be required reading for all!”

“When men lack a sense of awe, there will be disaster.”

Lao Tsu

In a recent issue of Academic Medicine, editor Steven L. Kanter, MD, spoke about the value of “case studies that are analytic, penetrating, that illuminate fundamental precepts and concepts, and that reveal new avenues for research or theory development, and have the potential to broaden and deepen knowledge and understanding in  a way that might not be available otherwise.” (1)

The editorial decision made  in April 2011by Academic Medicine, the most prestigious of academic medical journal to start including case studies in their future issues  brought to mind a book I have just read Stories of Healing: A Family Doctor’s Journal by Robert A . Anderson, MD . (2)

Dr. Anderson is a dear and long time friend and colleague and one of the founders of the American Holistic Medical Association and of the American Board of Integrative Holistic Medicine. His life and work as a family doctor has always been on the leading edge of holistic practice. In this short and easy to read book, he documents an amazing series of patient encounters/case studies over his 40 years of practice. These “stories of healing” serve to explore the real mystery and wonder of medicine as a path to continual self-discovery, lifelong learning, the power of observation, and the mystery of the human condition.

In the all too brief 160 pages, he skillfully leads us through new learning in multiple areas. Section headings include  such topics as Vital Nutrients, Infections, Our Toxic World, Allergies and Sensitivities, Lifestyle Practices, Attitudes and Emotions, Cancer, What’s the Source of Healing?, and the final section, Mysterium.  Bob presents these topics in a charmingly fresh and succinct way. Often the lesson to be learned from each chapter is disarmingly simple, e.g., think of dairy allergy for patients with recurrent joint or urinary problems, notice the power of belief and attitude in encouraging healing, listen deeply and communicate your truth  gently but firmly, look beyond the appearance of things, and don’t be afraid to challenge the medical status quo.

I strongly recommend this book as an excellent synopsis of the field of holistic and integrative medicine.  As organized around real life examples and case histories, it gives the “feel” of whole-person, patient-centered practice in a robust way without being disconnected with day to day practice. Further, it works quietly to extend our awareness of the incredible  depth and beauty available  to us in the practice of medicine.

As the Lao Tsu quote at the beginning reveals, we must continuously cultivate a sense of awe and wonder for our lives to be truly vibrant and alive. In this book, Dr. Robert Anderson brings us back full circle to the mystery and surprises that are before us every day as we care for patients. We need only use our eyes to see, our ears to hear, our hearts to feel, and our souls to breathe in the miracles around us.

1. Kanter, Steven L. Case Studies in Academic Medicine. Academic Medicine. April 2010;85 (4), 567.

2. Anderson, Robert A. Stories of Healing: A Family Doctor’s Journal . Everett, WA: Starseed Publications, 2011. ISBN 978-0-9837422-1-0.

Our society doesn’t really contribute to healthy sleep. Our staccato, frenzied pace, overstimulation with media, caffeine, and nocturnal lights all break the natural rhythms of the body that are conducive to good sleep. Many health conditions can contribute to poor sleep such as pain, obstructive sleep apnea, many respiratory and cardiac conditions, GERD, anxiety, depression, urinary problems, restless legs syndrome, fibromyalgia, hot flashes, and more.  Increasingly recognized is that poor sleep itself increases the risk of heart disease, diabetes, obesity, strokes, viral infections, and auto accidents. Studies among house staff found that staying up for 30 hours created decreased function and reaction time equivalent to a blood alcohol level of 0.1, legally drunk in all states. Sleep and dream debt cause dangerous mental smog and daze.

We may actually be suffering from a darkness deficiency. LAN (light at night) undermines life’s fundamental rhythmicity. Rush hour, prime time, happy hour, late night TV, drugs, alcohol, and incessant web-browsing, texting, and  e-mail all interfere with the yin and yang of natural sleep and wakefulness.

Because of these factors, taking a sleep history is an essential part of the integrative consultation process. In addition to past history, dietary and exercise patterns, and other lifestyle issues, identifying sleep problems is essential though often overlooked or underappreciated.  Yet, even when a patient complains of insomnia, our tendency is to reach for a prescription sleep aid without more exploration.

Insomnia comes in several varieties: 1) problems falling asleep, 2) problems staying asleep, 3) premature wakening, 4) poor quality of sleep. Each requires a different approach.

Here are some basics to an integrative approach. First, take a good sleep history, including a patient sleep diary if appropriate. Emphasize good sleep hygiene which ought at a minimum emphasize avoiding overstimulation such as stimulant medications, substances, or exercise prior to sleep. Encourage rhythmicity, ritual, and regular patterns much as we do with children with sleep issues. Sleep experts recommend using the bed as a place for sleep or sex but not other activities such as watching TV. Especially for the elderly, avoid daytime naps. Identify contributing medical or psychiatric issues, painful conditions, stimulant prescription medications, e.g. decongestants, beta blockers, calcium channel blockers, thyroid, anti-depressants, anti-convulsants, bronchodilators, steroids, among others.

Treatment always begins with education about healthy sleep patterns and sleep hygiene, e.g., if not asleep in 20 minutes, get up and do something for awhile before returning back to bed. Eliminate worrying or problem solving at night. Resolve anger before going to bed. Keep the room to be dark, cool, and quiet. Avoid watching the clock.

Mind-body therapies to improve sleep include meditation, relaxation and breathing techniques, body scan, imagery, progressive muscle relaxation, or alpha wave training are all useful. Multiple herbs and supplements may be useful and ought to be considered before use of medications as they are less likely to disturb slow wave sleep or be habit forming. These include valerian (1000mg at bedtime), melatonin (2-6mg), St John’s Wort, chamomile, hops, passion flower, kava, lavender, lemon balm, and skullcap.

In some cases, psychotherapy or hypnosis may be helpful and of course, some patients really need medications. In addition to popular prescriptions such as Lunesta, Sonata, Ambien,  and in some cases benzodiazepines, I have often found tricyclics like Elavil, especially for those with neuropathic pain and/or anxiety; trazodone and analgesics can also contribute to a good night’s sleep.

Remember that homeostasis requires rhythm, repetition, regularity and routine.  Rhythms rule our world and are powerful and healing. Rhythmic activities of our body and mind include our hormones, circulation, indigestion, brain waves, and states of consciousness. The question of why we spend a third of our lives asleep likely has to do with our need to allow our immune system to do its work effectively, to allow our brains to process, integrate, and sort out life through dreams and images, to re-establish our biorhythms, as well as the benefits of physical rest.

So, in conclusion, remember to take a good sleep history. Recognize the essential role of sleep to a happy, healthy life. And develop a broad range of methods and a mindful, consistent approach to managing sleep and sleep disorders in yourself and your patients.  Finally, remember the old proverb, “One hour of sleep before midnight, is worth two after.”

Summarized from a presentation at the American Board of Integrative Holistic Medicine Annual Review Course, St Petersburg, FL, November 9, 2011.

To begin:
Dave Rakel, MD, in his lecture, “The Clinician Effect” challenged us with the statement that “The practitioner is more powerful than the pills we prescribe.” In a study that Rakel and his colleagues conducted in 2009, both the duration and severity of the common cold were reduced in patients who meaningfully perceived their physicians’ empathy, in comparison to those who didn’t.

In another study performed by Hojat and colleagues, diabetic patients who rated their physicians with high empathy scores experienced better control of blood sugar and lipids, compared to those who didn’t rate their physicians as highly empathic. The results suggest that physician empathy is a very important factor as related to clinical competence and patient outcomes.

Though the results of these studies are not particularly surprising, they underscore the vital importance of the art of delivering quality healthcare, and remind us of one of the basic principles of the ABIHM: The Healing Power of Love: Integrative holistic physicians strive to relate to patients with grace, kindness and acceptance, emanating from the attitude of unconditional love as life’s most powerful healer.

Mitch Gaynor, MD, taught us in his lecture “Integrative Oncology” that certain compounds have specific properties as they relate to cancer:
Compounds which prohibit cancer cell proliferation directly: Bee propolis, turmeric, epigallocatechin gallate (EGCG), genistein, resveratrol, vitamin E, selenium
Compounds that act indirectly to inhibit cancer progression: Vitamin C, anthocyanidins, proanthocyanidins
Compounds which stimulate the immune system: Maitake/shitake mushrooms, l-glutamine, melatonin, ginseng

Furthermore, Dr. Gaynor explained that a diet rich in omega 3 fatty acids improved the effectiveness of chemotherapy and radiation in the setting of breast cancer, and that supplementing the diet with omega 3 fatty acids represents a nontoxic and simple way to improve outcomes.

Finally, true to an emergent theme that was discernible throughout the entire conference, higher glucose levels, insulin resistance, and obesity are all poor prognostic indicators of cancer outcomes, suggesting an adverse effect on tumor biology with these risk factors.

If you attended the conference, please take a moment to add the pearls that you learned that you believe are worth sharing!