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Transition from allopathic to integrated model

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Dr. Cady presented this presentation at the World Link Medical seminar in Salt Lake City, UT on January 27 for the 2012 Medical Seminar Series - Mastering the Protocols for Optimization of Hormone ...

Dr. Cady presented this presentation at the World Link Medical seminar in Salt Lake City, UT on January 27 for the 2012 Medical Seminar Series - Mastering the Protocols for Optimization of Hormone Replacement Therapy, Part 1. It will be presented twice more for World Link Medical in 2012.

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  • Health care provider and “consumer”
  • The politicians are constantly told that MD ’s in the US are making too much. This is a graph from one of the consultants for one of the government policy making. This is for family medicine.
  • Beneficiaries going up; workers going down to support them.
  • First thing politicians have to do is serve their constiuents – to “maintain the current perceived benefit of the structure.” Next priority is taxes – “You will protect your constituency.” Republicans want tax cuts for everybody. Democrats – protecting their constituency. “Tax the rich” Both see the same problems. Their solution is different. Next, doctors will fight with the hospitals and organizations for reimbursements.
  • This represents a disconnect between the AMA and physicians.
  • In the 1960 ’s and 1970’s – when it was known that someone’s child was becoming a doctor, it was viewed as a great accomplishment.
  • Giuseppe Mazzini (22 June 1805 – 10 March 1872), nicknamed "Soul of Italy,"[1] was an Italian politician, journalist and activist for the unification of Italy. His efforts helped bring about the independent and unified Italy[2] in place of the several separate states, many dominated by foreign powers, that existed until the 19th century. He also helped define the modern European movement for popular democracy in a republican state. [ citation needed ] – Source - Wikipedia
  • The incidence of drug abuse was compared in 56 medicated ADHD patients, 19 non-medicated ADHD patients, and 137 non-ADHD control subjects [Biederman 1999 pe21] Non-medicated ADHD patients were at a significantly higher risk for substance abuse than controls or medicated ADHD patients [Biederman 1999 pe22-23] There was no significant difference between medicated ADHD patients and controls (chi-squared=3.7, P =0.15) [Biederman 1999 pe22-23] Medication is associated with an 85% reduction in the risk of substance abuse in ADHD patients [Biederman 1999 pe22-23] Poor compliance is often a more significant problem than addiction [Garland, 1998 p 387-388]

Transition from allopathic to integrated model Transition from allopathic to integrated model Presentation Transcript

  • Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute Adjunct Professor – University of Southern Indiana Adjunct Clinical Lecturer – Indiana University School of Medicine Department of Psychiatry Child, Adolescent, Adult & Forensic Psychiatry – Evansville, Indiana How to Transition from Traditional Allopathic Practice to a Holistic and Integrated Medical Model This presentation is © Louis B. Cady M.D. and may not be reproduced or used without permission. World Link Medical is authorized to reprint/duplicate it for 2012 syllabi. (c) 2012 Louis B. Cady, M.D. - all rights reserved
  • Louis B. Cady, M.D. – historical statement of support, conflict of interests… [>/=2 years]
    • Abbott Laboratories
    • Bristol-Myers Squibb (Serzone)
    • Celltech (Metadate CD)
    • Cephalon (Provigil)
    • Elli Lilly (Prozac)
    • Forest Pharmaceuticals (Celexa, Lexapro, Namenda, Viibryd)
    • Glaxo-SmithKline (Wellbutrin, Paxil)
    • Janssen (Concerta, [Reminyl]/ Razadyne)
    • McNeil (Concerta)
    • Pfizer-Roerig (Zoloft, Pristiq)
    • Sanofi~aventis (Ambien)
    • Sepracor (Lunesta)
    • Searle Pharmaceutical (Ambien)
    • Shire Pharmaceuticals (Adderall, Daytrana, Vyvanse, Intuniv)
    • Shionogi & Co., Ltd. (Kapvay)
    • Takeda Pharmaceuticals (Rozerem)
    • Wyeth-Ayerst (Effexor, Pristiq)
    Note: Today’s presentations are CME and are sponsored by World Link Medical.
  • “ The mind, once expanded to the dimensions of larger ideas, never returns to its original size.” - Oliver Wendell Holmes
  • H - “ There are two objects of medical education: to heal the sick and to advance the science.” - Dr. Charles H. Mayo, MD “ The glory of medicine is that it is always moving forward, that there is always more to learn.” - Dr. William J. Mayo
  • Ethics and financial/logistical practicalities of these lectures
    • Nothing is more important than taking care of the patient.
    • “ The needs of the patient come first.” (Dr. Will Mayo, MD)
    • The current “medical model” is at variance with what is ethical, moral, and factual.
    • If the physician is not stable and financially secure, the system implodes.
    • If the system implodes, the patient suffers.
  • Background
  • Death Optimal Health Traditional Medicine Hormone Modulation No Disease = Health Diet, Exercise Nutritional Supplementation “ Wellness [integrated] Medicine” Diagnose and Treat Disease New Drugs New Surgical Techniques Forestall and PREVENT Disease – Optimize Function
  • “ But my patients don’t know about this and aren’t asking for it….”
    • “ It’s not the consumers’ job to know what they want.”
    • - Steve Jobs
  • Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity.  -  World Health Organization
  • American Journal of Health Promotion; November/December, 2002 19% of those surveyed were completely healthy with high levels of both physical and mental health and a low level of illness . 18.8% completely unhealthy, defined as having low levels of health with high levels of illness. Two-thirds of the adults reported some degree of mental or physical illness that kept them from being completely healthy. “ Incompletely healthy.” HEALTH continuum DEAD OPTIMAL 66% “ Incompletely healthy”
  • Outline
    • Overview of concepts
    • My bias – a practice model
    • Current state of allopathic medicine
    • Microchip as disruptor and disintermediator
      • (“Change or die”)
    • Current state of patients and society
    • What’s your model? Chloraseptic or PCN?
    • How to start changing….
  • The evolution of my practice
    • Sidetracked in high school, two degrees in music (’ 77 and ’ 79) and learned piano tuning
    • 1976 – 1989 – piano tuning (through pre-med and med school). “fee for service”
    • 1989-1993 – conventional allopathic psychiatry residency at Mayo Clinic
    • 1993 – start practice. 1995 – l-tyrosine and EFA’s
    • 2002 – first IFM conference
    • 2003 – Cenegenics training
    • 2005 – founded Cady Wellness Institute
    • 2010 – 2011 – Neil Rouzier, MD & WorldLink
    • 2012 – rTMS (Transcranial Magnetic Stimulation)
  • May 2002: 9 th Annual IFM Conference
  • The Functional Medicine component Dead Doctors Don ’t Lie - Joel Wallach, DVM, ND
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  • Cady Wellness Institute – July 2005 The Reasons:
    • Conventional medical practice had failed me twice.
    • A lot of “psychiatric cases” WEREN’T “psychiatric.”
    • Nobody was integrated.
    • Nobody was looking at ALL of the peer-reviewed literature.
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  • Current socioeconomic state and allopathic (“conventional”) medicine – DISRUPTIVE NOTIONS
    • CONVENTIONAL Allopathic medicine = symptom focused, reactive, “taught,” unthinking, uncreative, PRACTICALLY non-informed by peer-reviewed medical literature.
      • Commoditized. No variability. “ Providers. ”
    • Wellness medicine: individualized. Can’t get it elsewhere. Not a commodity. Scientific. Informed by peer-reviewed literature.
      • Concept of “information brokering” (example: THYROID)
  • Healthcare “Reform” Today
    • Today: Patient Protection and Affordable Care Act (P.L. 111-148) – includes amendments from the Health Care and Education Reconciliation Act of 2010 (H.R. 4872)
    Available at http://voices.washingtonpost.com/capitol-briefing/2009/07/gop_accuses_democrats_of_censo.html Slide courtesy of John Adams, MBA – CEO, Cenegenics
  • What the feds see & their lust for “cost control” Example: salaries for Family Medicine Adapted from http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/. Accessed April 3, 2010. US $1000 Slide courtesy of John Adams, MBA – CEO, Cenegenics
  • Medicare–Workers per Beneficiary http://facts.kff.org/chart.aspx?ch=383. Accessed April 3, 2010. Year Millions SOURCE: Kaiser Family Foundation based on the 2009 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. Slide courtesy of John Adams, MBA – CEO, Cenegenics
  • The Future of Medicare
    • “ Medicare is going bankrupt. The Medicare Trustees estimate that the program will run short of money starting in 2017.”
    • Rep. Bobby Scott, Senators Jim Webb and Mark Warner
    http://www.congress.org/congressorg/bio/userletter/?id=3181&letter_id=4747883751. Accessed April 3, 2010. Slide courtesy of John Adams, MBA – CEO, Cenegenics
  • http://www.ama-assn.org/amednews/2011/11/21/gvsd1121.htm
  • Healthcare Reform–Physicians Perception of Medicine Over the Next Few Years http://www.athenahealth.com/index.php?open=26. Accessed April 3, 2010. Slide courtesy of John Adams, MBA – CEO, Cenegenics
  • Are the Best and Brightest Staying in Medicine?
    • “ 60% of physicians would not recommend medicine as a career to their children.”
    • – The Physicians ’ Foundation
    http://www.mayorswellnesscampaign.org/wp-content/uploads/2009/05/merritt-hawkins-survey.pdf. Accessed April 3, 2010. Slide courtesy of John Adams, MBA – CEO, Cenegenics
  • http://marketing-images.ubmmedica.com/Insights/2011/2011_GAP_Survey.pdf Accessed 01 21 2012 “ Although American doctors feel stressed, overworked, and uncertain about the future, they’re generally happy with their career choices and the state of their lives (???), despite practicing during one of the greatest periods of tumult in the modern history of US healthcare.” “ The results also suggest strongly that physicians wish they had more control of their careers… and time.”
  • Current US Physicians’ Attitudes
    • Mean respondent – 51 yoa
      • 43% primary care; 57% specialty
    • 31% owners of private practice
    • 96% - at least somewhat happy to be docs
    • 65% - plan to remain in practice at least 5 years
    • Note – no “n” cited.
    Great American Physician Survey – July 31, 2011 – UBM Medica – cf: http://marketing-images.ubmmedica.com/Insights/2011/2011_GAP_Survey.pdf referenced 01 21 2012
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  • “ The Great Crossover” – the microchip cf: Dan Sullivan www.strategiccoach.com
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  • Accessed 1 21 2012
  • Current status of patients and society
  • CURRENT PRACTICE OF MEDICINE: What a patient had to say about her “specialists”:
    • “ They just monitor my degeneration.”
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  • Consultations with “ complementary and alternative ” practitioners
    • US, 2004 . 36% of US adult >18 yoa
      • National Center for Complementary and Alternative Medicine survey, 2004.
        • http://altmedicine.about.com/od/alternativemedicinebasics/a/CAMuse.htm
    • Canada – 1.2 million adults, or 13% of the population of Ontario . N = 32,598 surveyed.
      • Williams, Kitchen, e al. Alternative health care consultations in Ontario, Canada. BMC Complementary and Alternative Medicine 2011, 11:47
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  • What causes oxidative stress?
    • Environmental Toxins
      • Heavy metals – including Mercury (fillings!)
      • Pesticides/herbicides
      • Preservatives
      • PCB ’s, Dioxins, Phthalates
    • Toxins produced in the body
      • Yeast and bacteria
      • Products of cellular metabolism
    • Emotional Stress
      • Anxiety/Tension
      • Fear
      • Anger
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  • February 26, 2009 6 a.m.
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  • Today ’s Medical Practice Challenges
    • Obesity, diabetes, auto-immune, inflammatory and chronic diseases increasing
    • Inflammatory triggers increasing
    • Novel viruses and infective organisms
    • Unresponsive/resistant infections
    • Weakened immune systems
    • GI decline/inflammation
    • Poor quality /foods/nutritionals
  • A change from the allopathic model?
  • Socioeconomic/disruptive forces with two models
    • Allopathic
    • Disease and sickness focused
    • Short appointments
    • Commoditized
    • Compartmentalized
    • Doctor as priest
    • Uninformed patient
    • Sicker patients
    • Either practice ignorantly or with guilty conscience
    • Worry/poor satisfaction
    • Wellness/ fxnl med
    • Integrated and whole person model
    • Bill for time
    • Non-commoditized
    • Collaborative
    • Informed patients willing to “pay for expertise”
    • Practice per peer-reviewed literature; No crises (pl) of conscience
    • INTENSE satisfaction
    CHANGE AGENTS
    • Microchip/internet
    • Increase in chronic disease
    • “ boomers”
    • Job/socio-economic pressures
  • Divergence of focus of two models
    • Allopathic
    • Relief of symptoms
    • Organ specific
    • Aggressive. “magic bullet”
    • Rules, practice guidelines
    • Patient as uninformed protoplasm.
    • Tied to medico-pharmaco-industrial complex
    • Use of synthetic, patented, not-from-nature substances
    • Wellness/ fxnl med; “complementary/alternative”
    • CAUSE of symptoms, prevention
    • SYSTEMS focused
    • Gentle, methodical.
    • Creative. What works?
    • Patient as integral part of team. Questions/participation encouraged.
    • Focused on health and optimization with natural, bio-identical methods
    • Use of PROVEN botanicals and natural hormones (as well as conventional RX).
    Adatped from “Alternative Medicine: Why so popular? By Hans R. Larsen, MSc ChE. International Health News, Sept 1999, issue 93 http://www.yourhealthbase.com/alternative_medicine.htm accessed 1 21 2012
  • “ Slumber not in the tents of your fathers. The world is advancing. Advance with it.” - Giuseppe Mazzine
  • Some interesting thoughts:
    • “ The war situation has developed not necessarily to Japan’s advantage..”
-  Japanese Emperor Hirohito after the atomic bombing of Hiroshima and Nagasaki, announcing Japan’s surrender to the Allies
    • “ A naïve analysis of stability is derived from the absence of past variations” (or “The Turkey Problem”)
      • Nicholas Taleb, author of The Black Swan
  • What does integrated, holistic medicine “look like?” A quick dip in the literature
  • % U.S. Women with inadequate quantities of nutrients Arab L, Carriquiry A, Steck-Scott S, Gaudet MM. Ethnic differences in the nutrient intake adequacy of premenopausal US women: results from the Third National Health Examination Survey. J Am Diet Assoc 2003; 103:1008-14.
  • = 2 apples (fruits) & 3 - 4 vegetables – per CDC
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  • % Mineral depletion from the soil during the past 100 years, by continent Source: UN Earth Summit Report 1992 North America 85% South America 76% Asia 76% Africa 74% Europe 72% Australia 55%
  • Cf: http://www.veganforum.com/forums/showthread.php?t=3532
    • 16,103 people – 1994 – 1996.
    • ZERO got 100% of all required vitamins and nutrients
    • - Highest – B12 =- 82.8% got enough
    • 66.8% - had adequate folate
    • Lowest – Zinc – only 26.6% got enough .
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  • “ Take homes”: Low folate is associated with elevated homocysteine, which is associated with neuronal damage.
  • “ Take homes”: If you smoke, and if your FA levels are not optimum, “homozygous” [double SNP] 5MTHFR mutated individuals are at higher risk of elevated homocysteine
  • “ Take homes” [this slide and following]: Elevated homocysteine is definitely not good for you!
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  • Wang X et al. Homocysteine induces cardiomyocyte dysfunction and apoptosis through p38MAPK-meidated increase in oxidant stress. J Mol Cell Cardiol. 2011 Dec 29. Epub. Accessed 1 21 2012. “ Hcy may increase the risk for CVD not only by causing endothelial dysfunction , but also by directly exerting detrimental effects on cardiomyocytes. ”
  • Factors trapping physicians
    • “ Doing it, doing it, doing it.” (Michael Gerber, The E-Myth )
    • Already time-pressured –
      • Minimal time to think or plan
      • PROBABLY ADRENALLY DEPLETED ALREADY, perhaps with suboptimal thyroid and sex hormones
      • Tip – GET YOUR LABS CHECKED!!
    • Must “make overhead.”
    • Can’t “take chances.”
    • Trapped by “provider panel” arrangements, including cut rate fees. (Alcoa story)
  • The Baby Boomers & Their Expectations The first time the entire Baby Boom generation is impacting a single market ALL at the same time!
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  • Let’s look at the logic. How would you take care of a classic? “ Chronic diseases affect at least 125 million Americans & cost more than $500 billion last year.” Centers for DiseaseControl – Dec 2003
  • “ Age management” “Conventional practice” There are fuel additives we can use to keep our cars burning cleaner and preserve engines. No fuel additives should be used. They are unnatural. Gas is all that is required. We should use optimal quality of gas. Cheap gas causes “pinging” which is hard on the engine. The quality of the gas is irrelevant. Anything that the motor will burn is adequate. We should take our car in for preventive maintenance before anything breaks. Preventive maintenance? This is silly! Wait until something breaks, then have the car towed in so the mechanic can really tell what is wrong.
  • Modern Medicine ’s Paradigm: Two Standard Deviations – “if you are not sick, then you must be well.” “ NORMAL” OPTIMAL? OPTIMAL
  • Definition of “normal labs”:
    • “ When your lab values are as crappy as everyone else’s.”
    • - Neil Rouzier, MD (World Link Medical Seminar II – Spring 2011)
  • MAKING THE TRANSITION
    • Must DECIDE
      • Must have INFO (e.g., this weekend)
      • Must INTROSPECT
    • Must have something LEGITIMATE to offer
    • Start SMALL – both with interventions and logistics/financial
      • E.g, ¼ grain Armour, or Cytomel 5 MICROgrams, or Cortef 5 mg twice daily, or FDA approved testosterone for guys
      • E.g. – ½ day per week – “hormones”
    • Get EDUCATION
      • Teachers – Rouzier, World Link Medical
      • AAMG, A4M
    • Find a mentor (s) – start here
  • Marketing & Practice Development
    • Maintain excellence in allopathy
      • (knowledge base, prescribing, surgery)
      • (“Be able to debate the great issues.” – Jim Rohn)
    • Give CME talks and paper over their objecting mouths with references.
    • Know your [new] stuff!
    • Do not badmouth the competition. (Chris Lord example).
    • Spiritual and ethical clarity – see following…
  • Quick examples of powering through objections and overwhelming with literature Note – don’t get bogged down. Get the idea of HOW TO PRESENT the data.
  • A Scientific (& FUN!!!) Review of Vitamin Supplementation & Essential Nutrients Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute Adjunct Professor – University of Southern Indiana Adjunct Clinical Lecturer – Indiana University School of Medicine Department of Psychiatry Child, Adolescent, Adult & Forensic Psychiatry – Evansville, Indiana Presented 2 27 2010 – Oliver Headache and Pain Clinic CME seminar – Evansville, IN
  • Trends in Pharmacological Sciences (2008) Jul; 29(7):351. Epub 2008 Jun 4
    • Mitochondrial diseases are due to impairment of chemical reactions.
    • A reasonable theory is oxidative stress.
    • Few studies have actually been done on this.
    • Glutathione deficiency is known in mitochondrial disease.
    • Biosynthesis of glutathione depends on cysteine availability.
    • “ Our findings reinforce the notions that in mitochondrial disease, oxidative stress is important and can be reduced by administration of a cysteine donor.”
  • Zoned, Stoned and Blown: The Emotional Tsunami of Psychiatric Disorders Coupled with Pain Disorders & Chemical Dependency Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute Adjunct Professor – University of Southern Indiana Adjunct Clinical Lecturer – Indiana University School of Medicine Department of Psychiatry Child, Adolescent, Adult & Forensic Psychiatry – Evansville, Indiana Also Presented 2 27 2010 – Oliver Headache and Pain Clinic CME seminar – Evansville, IN
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  • Pharmacotherapy Significantly Reduces Substance Abuse in Adults with ADHD Biederman J, et al. Pediatrics. 1999;104:e20-e25. 40 30 20 10 0 % of study population Unmedicated ADHD Medicated ADHD Control 32 12 10 P <0.001 (N=56) (N=19) (N=137) 3-fold!
  • Business philosophy citations follow … END EXAMPLES…
  • “ You can have everything in life you want, if you just help enough other people get what they want.” - Zig Ziglar
    • What do patients want?
    • To be treated with respect
    • To not have to wait!
    • To FEEL BETTER
    • To HAVE HOPE.
    • To not be doped up.
    • To NOT have their money wasted.
  • $5,000 worth of wisdom on one page – from Jay Abraham
    • Risk reversal
    • “ USP” – unique selling proposition
    • Defining the buying criteria
    • Three ways for more profit:
      • Higher price
      • More frequency
      • Additional items (supplements, etc.)
  • Evansville Courier & Press : May 29, 2006 References: www.pharmanexmd.com ; www.slideshare.net/lcadymd ; Dr. Oz show on YouTube: http://www.youtube.com/watch?v=rX4oxxGWi_8
  • My position on supplements
    • “ The needs of the patient come first.” – W Mayo
    • Unique and patented. (Otherwise GNC is fine).
    • Guaranteed (risk reversal).
    • Measurable changes
    • NO STOCKING or inventory.
  • Jay Abraham References (recommended) www.amazon.com
  • Building CWI - what has worked
    • Being nice to patients
      • (on time, polite, compliment on questions, don’t be a jerk or abrasive, put yourself into their shoes, etc.)
    • Be good and get results. BE THE BEST!
    • Be TRANSPARENT – give’em their labs.
      • Write on them. Draw pictures. Take time (and BILL FOR IT).
      • Cenegenics model
    • Be appropriately self-protective of your time and talents.
  • MARKETING – what has and hasn’t worked
    • Worked
    • Word of mouth
    • Public seminars
    • Web site
    • Going to MD’s/DO’s offices PERSONALLY
    • Free stuff – PR opportunities
    • Going to places and NETWORKING
    • Hasn’t worked
    • Paid advertising (TV, print, magazines)
    • What I HAVEN’T tried:
      • Marketing consultants
      • Radio ads
    • New initiatives:
    • Proprietary, paid websites
    • “ SEO” – search engine optimization (Willie Sutton principle)
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  • Additional resources
    • “ The 10 Commandments of Marketing a Medical Practice” – Cady (handout, free)
    • Cady White Paper on the Biophotonic Scanner
    • Practice Transformation Seminar – June 2012 at Cady Wellness Institute
      • (for any of these, e-mail me at [email_address] or give me your card)
    • Sign up for physician newsletter on www.cadywellness.com
    • “ Errors in judgement” - High glycemic eating, no exercise, poor nutrition, lousy/no supplementation, no hormones, high stress practice.
    • “ Good disciplines” – appropriate diet, supplementation, exercise, hormones. Stress management. Decent practice and lifestyle.
    Success and Failure (Jim Rohn) What about you? You’ ve only got one body.
  • Perhaps the ability not only to acquire the confidence of the patient, but to deserve it, to see what the patient desires and needs, comes through the sixth sense we call intuition, which in turn comes from wide experience and deep sympathy for and devotion to the patient , giving to the possessor remarkable ability to achieve results. ...William J. Mayo, 1935
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  • Contact information: Louis B. Cady, M.D. www.cadywellness.com www.indianaTMS-cadywellness.com Office: 812-429-0772 E-mail: [email_address] 4727 Rosebud Lane – Suite F Interstate Office Park Newburgh, IN 47630 (USA)