In the News

IOM Summit Provides Models for Health Reform

Calcium Associated With Lower Risk of Cancer in Women

B Vitamins and Folic Acid May Reduce Risk of Age-related Vision Loss

Mediterranean Diet Associated With Lower Risk of Cognitive Impairment

NIHSeniorHealth Adds Complementary and Alternative Medicine Information

IOM Summit Provides Models for Health Reform

Before one of the largest and most diverse audiences ever assembled at the Institute of Medicine (IOM), the Summit on Integrative Medicine and the Health of the Public held this week brought forth emerging strategies for addressing some of the major problems inherent in our current healthcare system. The goal: improved care for less cost.

As Congress and the Obama Administration tackle issues related to escalating healthcare costs and the rising incidence of chronic disease, distinguished scientists, leading clinicians, top policy experts and industry leaders articulated principles and practices from integrative medicine that could form the basis for effective healthcare reform.

Integrative medicine is an approach to healthcare that places the patient at the center of care, focuses on prevention and wellness, and attends to the physical, mental, and spiritual needs of the person. “What we have now is a ‘sick care’ system that is reactive to problems,” said Ralph Snyderman, MD, Chancellor Emeritus, Duke University School of Medicine and Summit Chair. “The integrative approach flips the system on its head and puts the patient at the center, addressing not just symptoms, but the real causes of illness. It is care that is preventive, predictive and personalized.”

The 600-plus participants at the Summit discussed how advancing technology is finally allowing health professionals to understand the mechanisms by which many integrative medicine interventions, such as mind-body medicine and nutrition, actually work. “Genomics and advanced imaging technologies such as MRI are validating the mechanisms for integrative healthcare approaches that were difficult to prove before,” said Mimi Guarneri, MD, Founder and Medical Director of Scripps Center for Integrative Medicine. Consequently, the new evidence is compelling.

The Summit articulated the following important factors to be considered in upcoming healthcare reform:

• The progression of many chronic diseases can be reversed and sometimes even completely healed through lifestyle modifications. Lifestyle modifications programs have been proven to mitigate cardiac disease and prostate cancer, among other chronic conditions.
• Genetics is not destiny. Recent research by Dean Ornish, MD, and others has shown that gene expression can be turned on or off by nutritional choices, levels of social support, stress reduction activities such as meditation and exercise.
• Our environment influences our health. Mounting evidence suggests that the environment outside one’s body rapidly becomes the environment inside the body.
• Improving our primary care and chronic disease care systems is paramount. Participants widely agreed that our primary care system is in danger of collapse and that we must retool how both primary and chronic disease care is delivered. The new system must focus on prevention and wellness, and put the patient at the center of care.
• The reimbursement system must be changed. The Summit grappled with the current reimbursement system that rewards procedures rather than outcomes and urged changes that would incentivize physicians to focus on the health outcomes of their patients.
• Changes in education will fuel changes in practice. Implementation of an integrated approach to healthcare requires changes in provider education. All healthcare practitioners should be educated in the importance of compassionate care that addresses the biopsychosocial dimensions of health.
• Evidence-based medicine is the only acceptable standard. Researchers and practitioners alike concurred that healthcare should be supported by evidence and urged further research and testing to expand the evidence base for integrative models of care.
• A large demonstration project is needed. Because funding for research on the effectiveness of specific models of care is difficult to obtain from standard grant channels, participants voiced support for pursuing a demonstration project funded by the government that would fully demonstrate the effectiveness of the integrated approach to care.

“If we fail to seize this unique opportunity to adopt a pragmatic, integrative approach to healthcare it will constitute a failure and we must not fail,” said Senator Tom Harkin, D-IA. “It is my intention to change our health system and to place integrative healthcare at the heart of the reform legislation we will pass this year.”

Calling attention to the fact that the healthcare issues facing the United States are actually global issues facing the world, representatives from the Prince’s Foundation for Integrated Health in the United Kingdom added their voice to the call for reform. A letter from HRH The Prince of Wales to Summit participants urged both nations to support the creation of a healthcare system that places a greater emphasis on treating humans as whole beings—mind, body and spirit—and on prevention, as well as the cure, of illness and disease.

The Summit’s leadership believes that the integrated approach to healthcare could provide the basis for our nation’s health reform. “We intend to broadly share ideas expressed at this Summit for transforming healthcare; our key audiences are the Obama Administration and the Department of Health and Human Services,” said Judy Salerno, MD, MS, Executive Director of the IOM.  “The Bravewell Collaborative looks forward to receiving the formal summary report of the IOM Summit and the Health of the Public on November 4, 2009,” said Bravewell Executive Director, Diane Neimann. “There will be a major event in Washington, DC, to mark the release of the report.”

“Immediately following the Summit, we will begin work with our Summit Coalition partners in consultation with the IOM on two major points of merging consensus,” said Christy Mack, Bravewell’s President. “We endorse Bill Novelli/AARP’s call for a national campaign for health and wellness and will explore the potential for a public/private partnership to make it happen. We will also encourage demonstration models that will test the efficacy of the philosophy and approach to healthcare addressed through this historic Summit.”

Video recordings of all Summit presentations will be available at www.imsummitwebcast.org after March 4, 2009.

Calcium Associated With Lower Risk of Cancer in Women

Women with higher intakes of calcium appear to have a lower risk of cancer overall, and both men and women with high calcium intakes have lower risks of colorectal cancer and other cancers of the digestive system, according to a recent report in Archives of Internal Medicine.

Calcium is known to benefit bone health. Because of this, the Institute of Medicine recommends 1200 mg of calcium for adults aged 50 years and older, and the 2005 dietary guidelines for Americans recommend 3 cups per day of low-fat or fat-free dairy products. Studies of dairy products, calcium intake, and cancer have revealed different results for different cancer sites.

Yikyung Park, ScD, of the National Cancer Institute, Bethesda, Maryland, and colleagues analyzed data from 293 907 men and 198 903 women who participated in the National Institutes of Health-AARP Diet and Health Study. Participants completed a food-frequency questionnaire when they enrolled in the study between 1995 and 1996, reporting how much and how often they consumed dairy and a wide variety of other foods and whether they took supplements. Their records were then linked with state cancer registries to identify new cases of cancer through 2003.

Over an average of 7 years of follow-up, 36 965 cancer cases were identified in men and 16 605 in women. Calcium intake was not associated with total cancer in men but was in women—the risk decreased in women with intake of up to 1300 mg per day, after which no further risk reduction was observed.

According to the authors, dairy food and calcium intakes were inversely associated with cancers of the digestive system in both men and women. The one-fifth of men who consumed the most calcium through food and supplements (about 1530 mg per day) had a 16% lower risk of these types of cancer than the one-fifth who consumed the least (526 mg per day). For women, those in the top one-fifth of calcium consumption (1881 mg per day) had a 23% lower risk than those in the bottom one-fifth (494 mg per day). The decreased risk was particularly pronounced for colorectal cancer. Calcium and dairy food intake was not associated with prostate cancer, breast cancer, or cancer in any other anatomical system besides the digestive system.

Calcium has been shown to reduce abnormal growth and induce normal turnover among cells in the gastrointestinal tract and breast. In addition, it binds to bile and fatty acids, potentially reducing damage to the mucous membranes in the large intestine.

B Vitamins and Folic Acid May Reduce Risk of Age-related Vision Loss

Taking a combination of vitamins B6 and B12 and folic acid appears to decrease the risk of age-related macular degeneration (AMD) in women, says a recent report in Archives of Internal Medicine.

AMD  is a leading cause of vision loss in older Americans. Treatment options exist for those with severe cases of the disease, but the only known prevention method is to avoid smoking. Recent studies have drawn a connection between AMD and blood levels of homocysteine. High levels of homocysteine are associated with dysfunction of the blood vessel lining, whereas treatment with vitamin B6, vitamin B12, and folic acid appears to reduce homocysteine levels and may reverse this blood vessel dysfunction.

William G. Christen, ScD, of Brigham and Women’s Hospital and Harvard Medical School, Boston, and colleagues conducted a randomized, double-blind clinical trial involving 5442 women aged 40 years and older who already had heart disease or at least 3 risk factors. Of these, 5205 did not have AMD at the beginning of the study. In April 1998, these women were randomly assigned to take a placebo or a combination of folic acid (2.5 mg per day), pyridoxine hydrochloride (vitamin B6, 50 mg per day), and cyanocobalamin (vitamin B12, 1 mg per day). Participants continued the therapy through July 2005 and were tracked for the development of AMD through November 2005.

Over an average of 7.3 years of treatment and follow-up, 137 new cases of AMD were documented, including 70 cases that were visually significant (resulting in a visual acuity of 20/30 or worse). Of these, 55 AMD cases, 26 visually significant, occurred in the 2607 women in the active treatment group, whereas 82 of the 2598 women in the placebo group developed AMD, 44 cases of which were visually significant. Women taking the supplements had a 34% lower risk of any AMD and a 41% lower risk of visually significant AMD.

Beyond lowering homocysteine levels, potential mechanisms for the effectiveness of B vitamins and folic acid in preventing AMD include antioxidant effects and improved function of blood vessels in the eye, the authors noted.

Mediterranean Diet Associated With Lower Risk of Cognitive Impairment

Eating a Mediterranean diet appears to be associated with less risk of mild cognitive impairment—a stage between normal aging and dementia—or of transitioning from mild cognitive impairment into Alzheimer's disease, says a study in a recent issue of Archives of Neurology.

Previous studies have shown a lower risk for Alzheimer’s disease among those who eat a Mediterranean diet, characterized by high intakes of fish, vegetables, legumes, fruits, cereals, and unsaturated fatty acids; low intakes of dairy products, meat, and saturated fats; and moderate alcohol consumption.

Nikolaos Scarmeas, MD, and colleagues at Columbia University Medical Center, New York, calculated a score for adherence to the Mediterranean diet among 1393 individuals with no cognitive problems and 482 patients with mild cognitive impairment. Participants were originally examined, interviewed, screened for cognitive impairments, and asked to complete a food-frequency questionnaire between 1992 and 1999.

Over an average of 4.5 years of follow-up, 275 of the 1393 who did not have mild cognitive impairment developed the condition. Compared with the one-third who had the lowest scores for Mediterranean diet adherence, the one-third with the highest scores for Mediterranean diet adherence had a 28% lower risk of developing mild cognitive impairment, and the one-third in the middle group for Mediterranean diet adherence had a 17% lower risk.

Among the 482 with mild cognitive impairment at the beginning of the study, 106 developed Alzheimer's disease over an average 4.3 years of follow-up. Adhering to the Mediterranean diet also was associated with a lower risk for this transition. The one-third of participants with the highest scores for Mediterranean diet adherence had 48% less risk, and those in the middle one-third of Mediterranean diet adherence had 45% less risk than the one-third with the lowest scores.

The Mediterranean diet may improve cholesterol levels, blood sugar levels, and blood vessel health overall or reduce inflammation, all of which have been associated with mild cognitive impairment. Individual food components of the diet also may have an influence on cognitive risk. For instance, potentially beneficial effects for mild cognitive impairment or mild cognitive impairment conversion to Alzheimer's disease have been reported for alcohol, fish, polyunsaturated fatty acids, and lower levels of saturated fatty acids.

NIHSeniorHealth Adds Complementary and Alternative Medicine Information

Older adults are frequent users of complementary and alternative medicine (CAM), which includes products such as vitamins and herbal supplements and practices such as chiropractic manipulation, acupuncture, meditation, and massage. According to a new nationwide government survey, 41% of adults in the United States aged 60 to 69 years use some form of CAM. They and other consumers can learn about these approaches in "Complementary and Alternative Medicine," the latest topic on NIHSeniorHealth, the National Institutes of Health (NIH) website designed especially for older adults.

Older adults who go to http://nihseniorhealth.gov/cam/toc.html will find easy-to-understand information on the basics of CAM, as well as useful tips on how to be an informed consumer, choose a CAM practitioner, and talk candidly with their doctors about CAM use.

One of the fastest growing age groups using the Internet, older Americans increasingly turn to it for health information. In fact, 68% of online seniors look for health and medical information when they go online. NIHSeniorHealth is a joint effort of the National Institute on Aging and the National Library of Medicine. The site is based on the latest research on cognition and aging. It features short, easy-to-read segments of information that can be accessed in a number of formats, including various large-print type sizes, open-captioned videos, and an audio version. Additional topics coming soon to the site include dry eye and substance abuse among older adults.

Josephine P. Briggs, MD, director of the National Center for Complementary and Alternative Medicine, part of the NIH, reminds users that it is important to inform their healthcare providers about any CAM therapies they use.