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Chinese Medicine Coming of Age for Healthcare In the New Millennium

Chinese Medicine Coming of Age for Healthcare In the New Millennium. Ka-Kit Hui, MD, FACP Wallis Annenberg Chair in Integrative East-West Medicine Professor & Director Center For East-West Medicine David Geffen School of Medicine at UCLA. Clinic-Based. Community. Primary Care.

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Chinese Medicine Coming of Age for Healthcare In the New Millennium

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  1. Chinese Medicine Coming of Age for Healthcare In the New Millennium Ka-Kit Hui, MD, FACP Wallis Annenberg Chair in Integrative East-West Medicine Professor & Director Center For East-West Medicine David Geffen School of Medicine at UCLA

  2. Clinic-Based Community Primary Care Trends in Medicine 20th Century 21st Century Acute Diseases Chronic Illnesses CAM Biomedicine Hospital-Based Acute & Advanced Stage Crisis Care Prevention& WellnessHome/Self Care

  3. The Status Quo in US Healthcare: Expenditure Total Expenditure on Health Per Capita ($ PPP) Source: OECD Health Data 2003, a comparative analysis of 30 countries • In 2005 American spent close to $1.9 trillion on healthcare, about 16% of the GDP • The US ranks 1st in health expenditures per capita, but 37th in overall health system performance • Source: WHO world health report 2000, June 2000 Hong Kong

  4. The Status Quo in US HealthcareAttitudes to Current Healthcare System 56% of the public, 46% of physicians, 48%of employers, 50% of health plan managers, and 51% of hospital managers felt that the healthcare system required “radical change” Harris Interactive Health Care Research. Health Care News 2002, Aug 21; 2(17) “But in spite of all the money spent for medical care, education, and research, no one – whether patient, provider, or purchaser – seems satisfied with the status quo.” John K. Iglehard New England Journal of Medicine January 7, 1999 Hong Kong

  5. Healthcare System Transformation Efforts • No Toyota yet, but a start. A cadre of providers seeks to transform an inefficient industry--before it's too late. • Berwick D, et al. Mod Healthc. 2005 Jan 31;35(5):18-9. • Redefining Health care: Creating Value Based Competition on Results • Michael Porter and Elizabeth Teisberg.2006 Hong Kong

  6. Hong Kong

  7. THE CHINESE MEDICAL MODEL NATURE SOCIAL ENVIRONMENT BODY MIND Hong Kong

  8. Integrative East-West Medicine Model Chinese Medicine Western medicine “Flip” shades provide a complementary view of medicine. Neither lens by itself is sufficient to see all aspects of the spectrum of health. Combining components of Western Medicine and Traditional Chinese Medicine together to benefit patients. Hong Kong

  9. Minor health complaints Multiple/ chronic health complaints Acute/ Advanced disease Wellness/Absence of disease Feeling Great Acute crisis/ terminal stage Death Traditional Chinese Medicine Modern Western Medicine

  10. TCM’s Approach to Health and Disease • Systems perspective • Central role of homeostasis • Importance of a normal flow of an adequate amount of energy • Optimal interaction of man and the natural/social environment • Inseparable nature of body and mind • Focus on process and function over structure Hong Kong

  11. In Search of the Mighty Label • Step 1: Collection • Step 2: Formulation Clinical evaluation: Collection of subjective and objective data Formulation of diagnostic Hypothesis ZHENG Pathophysiological Pattern DISEASE Hong Kong

  12. Therapeutic Goals of TCM • Restore normal balance and flow • Individualization • Focus on enhancing the body’s endogenous resistance (homeostatic reserve) to disease • Less emphasis on specific causal factors Hong Kong

  13. Prevention • The heightened focus on health promotion and disease prevention has opened a new window of opportunity for TCM Hong Kong

  14. Primary Care • The integration of complementary therapies in Australian general practice: results of a national survey. • Cohen MM, et al. J Altern Complement Med. 2005 Dec;11(6):995-1004 • Providing Complementary and Alternative Medicine in primary care: the primary care workers' perspective. • Van Haselen RA, et al. Complement Ther Med. 2004 Mar;12(1):6-16 • Primary care physicians and complementary-alternative medicine: training, attitudes, and practice patterns • Berman BM, et al. J Am Board Fam Pract. 1998 Jul-Aug;11(4):272-81. Hong Kong

  15. Acupuncture and Oriental Medicine in the US • California was the first state to license acupuncture • In 2004, South Carolina and Illinois join more than 30 states in the U.S. that now allow acupuncturists to treat patients without a referral from a physician • About 36 states have established acupuncture committees or government agencies to control and regulate the practice of acupuncture. Source: www.acupuncturetoday.com Hong Kong

  16. Licensed Acupuncturist in the US • Total: 16129 • California: 6569 • Florida: 1339 • Colorado: 650 • Texas: 648 • Oregon: 641 • New York: 557 • Massachusetts: 546 • Other states: 5179 http://www.acupuncturetoday.com/list/info/aculocatorzip/ Hong Kong

  17. Acupuncture Usage: pain management • Clinical trials have documented the efficacy of acupuncture for pain management • Fibromyalgia • Headache • Neck pain • Shoulder Pain • Low Back Pain • Osteoarthritis Pain • Cancer related pain Hong Kong

  18. Headache • Acupuncture for chronic headaches--an epidemiological study. • Melchart D, et al. Headache 2006 Apr;46(4):632-41 • Conclusion: headache patients reported clinically relevant improvements after receiving acupuncture. Randomized trials performed in parallel to this study confirm the relevant overall effect, however, the effect may largely be due to potent unspecific needling and placebo effects. • A randomized, controlled trial of acupuncture for chronic daily headache • Coeytaux RR, et al. Headache 2005 Oct;45(9):1113-23. • Conclusion: Headache-specialty medical management alone was not associated with improved clinical outcomes among our study population. Supplementing medical management with acupuncture, however, resulted in improvements in health-related QoL and the perception by patients that they suffered less from headaches. • Acupuncture in patients with tension-type headache: randomised controlled trial • Melchart D, et al. BMJ, 2005 Aug 13;331(7513):376-82. • Conclusion: The acupuncture intervention investigated in this trial was more effective than no treatment but not significantly more effective than minimal acupuncture for the treatment of tension-type headache. Hong Kong

  19. Neck Pain • Acupuncture for patients with chronic neck pain • Witt CM, et al. Pain 125(2006):98-106 • Conclusion: Treatment with acupuncture added to routine care in patients with chronic pain was associated with improvements in neck pain and disability compared to treatment with routine care alone • Cost-effectiveness of acupuncture treatment in patients with chronic neck pain • Willich SN, et al. Pain 125(2006): 107-113 • Conclusion: Acupuncture is a cost-effective treatment strategy in patients with chronic neck pain • Efficacy and safety of acupuncture for chronic uncomplicated neck pain: a randomised controlled study • Vas J, et al. Pain 2006 July • Conclusion: Acupuncture is more effective than the placebo treatment and presents a safety profile making it suitable for routine use in clinical practice. Hong Kong

  20. Low Back Pain • Acupuncture in patients with chronic low back pain: a randomized controlled trial • Brinkhaus B, et al. Arch Intern Med. 2006;166: 450-457 • Conclusion: Acupuncture was more effective in improving pain than no acupuncture treatment in patients with chronic low back pain, whereas there were no significant differences between acupuncture and minimal acupuncture. • A randomised controlled trial of acupuncture care for persistent low back pain: cost effectiveness analysis • Ratcliffe J, at al. BMJ Sept. 15, 2006 • Conclusion: a short course of traditional acupuncture for persistent non-specific low back pain in primary care confers a modest health benefit for minor extra cost to the NHS compared with usual care. Acupuncture care for low back pain seems to be cost effectiveness in the longer term. Hong Kong

  21. Osteoarthritis Pain • Acupuncture for peripheral joint osteoarthritis: a systematic review and meta-analysis • Kwon YD, at al. Rheumatology 2006;45:1331-1337 • Conclusion: Shan-controlled RCTs suggest specific effects of acupuncture for pain control in patients with peripheral joint OA. Considering its favourable safety profile, acupuncture seems an option worthy of consideration particularly for Knee OA. • Effectiveness of acupuncture as adjunctive therapy in osteoarthritis of the knee: a randomized, controlled trial. • Berman BM, et al. Ann Intern Med. 2004 Dec 21;141(12):901-10. • Conclusion: Acupuncture seems to provide improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee when compared with credible sham acupuncture and education control groups. Hong Kong

  22. Acupuncture Usage: Oncology • The potential of a person-centered approach in caring for patients with cancer: a perspective from the UCLA center for East-West medicine • Hui KK, et al. Integr Cancer Ther. 2006 Mar;5(1):56-62 • Acupuncture care for breast cancer patients during chemotherapy: a feasibility study. • Price S, et al. Integr Cancer Ther. 2006 Dec;5(4):308-14. • The use of complementary and alternative medicine by cancer patients undergoing radiation therapy. • Swarup, et al. Am J Clin Oncol. 2006 Oct;29(5):468-73. Hong Kong

  23. More Coverage of Clinical Use of Chinese Medicine • Integration and reimbursement of complementary and alternative medicine by managed care and insurance providers: 2000 update and cohort analysis. • Pelletier KR and Austin JA. Altern Ther Health Med. 2002 Jan-Feb;8(1):38-9, 42, 44 passim • Insurance coverage and subsequent utilization of complementary and alternative medicine providers. • Lafferty WE, et al. Am J Manag Care. 2006 Jul;12(7):397-404 Hong Kong

  24. Insurance Coverage on the Rise: a survey released by the Kaiser Family Foundation and Health Research and Educational Trust. • 47 percent of all employers surveyed offered acupuncture as a covered health benefit, up from 33 percent in 2002. • 52% of the POS plans covered acupuncture; 47% of the PPO plans offered coverage; 44% of conventional plans included an acupuncture benefit; and 41% of HMO plans provided coverage. • 50% of all large firms (those with 200 or more employees) surveyed offered coverage for acupuncture, compared to 41% of small firms (those with between 3 and 199 employees). The highest percentage of large firms offering acupuncture coverage were those that used point-of-service plans (60 percent). Hong Kong

  25. Insurance Coverage on the Rise: A survey from Mercer Human Resource Consulting • In 2003, 13% of large employers covered massage therapy in their largest medical plans; 7 percent covered homeopathy; and 7 percent covered biofeedback. • A 10% increase in the number of employers offering coverage for acupuncture, from 17% in 1998 to 27% in 2003. Hong Kong

  26. The Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) • http://www.imconsortium.org/ • The membership currently includes 36 highly esteemed academic medical centers. • Curriculum In Integrative Medicine: A Guide for Medical Educators • Core Competencies in Integrative Medicine for Medical School Curricula: A Proposal • Kligler B, et al. Acad Med. 2004 Jun;79(6):521-31 Hong Kong

  27. UCLA Collaborative Centers of Integrative Medicine • Center for East-West Medicine • Center for Human nutrition • Center for Neurovisceral Sciences and women’s health • Cousins Center for psychoneuroimmunology • Mindful Awareness Research Center • Pediatric Pain Program • Stiles Program in Integrative oncology • Ted Mann Family Resource Center • eCAM Hong Kong

  28. Urgent Need for Disseminating CM Knowledge to the West with Appropriate English Texts and other vehicles Hong Kong

  29. Urgent Need for Better Models of Clinical Care, Research Design and Health Policy Hong Kong

  30. Clinical Research Health Professionals/ Providers Clinicians Health educators Information Others Government/ Non-Profit Policy Makers Health Regulators Business Health Care Orgns Herbs Drug Equipment Information Others Public Patients Family Work environment Community Others Education Integrative Health Paradigm Effective Affordable Safe Accessible Meeting Public/Patient Health Needs

  31. UCLA Center for East-West Medicine “All forms of medicine aim to ease human suffering and improve quality of life; they differ only in their approaches to the realization of this goal. The blending of Eastern and Western approaches to health and healing can maximize the safety and effectiveness of care in an accessible and affordable manner.” -- Ka-Kit Hui, MD, Director and Professor Clinic Telephone: (310)998-9118 Website: http://www.cewm.med.ucla.edu E-mail: cewm@mednet.ucla.edu Hong Kong

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