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  • How to control health benefit costs
    In a few years, the average Fortune 500 company may be spending as much on health benefits as it earns in profits. Something’s got to give.
    FEBRUARY 2004 • Lynn Dorsey Bleil, James Kalamas, and Rayman K. Mathoda
  • We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative.
    About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
  • Source: Mercer's National Survey of Employer-Sponsored Health Plans; Bureau of Labor Statistics, Consumer Price Index, U.S. City Average of Annual Inflation (April to April) 1988-2008; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey (April to April) 1988-2008.
  • http://www.grantthornton.com/portal/site/gtcom/menuitem.a8ee697a92b73ac9b217bfae633841ca/?vgnextoid=b17acbbdad9c4010VgnVCM100000368314acRCRD&vgnextfmt=default
  • That's the tagline for the 2008 Health Confidence Survey published by the Employee Benefits Research Institute (EBRI), released October 7.
  • http://www.iom.edu/CMS/28312/52555/62252.aspx
  • http://www.iom.edu/CMS/28312/52555/62252.aspx
  • Would you like to be hospitalized tomorrow, even if it’s at the best hospital in the world?
    Do you want to be sick tomorrow?
  • Would you like to be hospitalized tomorrow, even if it’s at the best hospital in the world?
    Do you want to be sick tomorrow?
  • Pain - Average pre-massage score 5.3 (range 4-9)
    Average post-massage score 1.85 (range 0-5)
    Average 3.45 point decrease
    Tension - Average pre-massage score 4.95 (range 0-10)
    Average post-massage score 1.15 (range 0-4)
    Average 3.8 point decrease
    Anxiety - Average pre-massage score 4.65 (range 0-8)
    Average post massage score 1.25 (range 0-9)
    * one patient reported a two point increase
    Average 3.4 point decrease
  • Lead aprons
  • AHi Evran U, Kirsehir Turkey
  • AHi Evran U, Kirsehir Turkey
  • The underlying changes in biological processes that are associated with reported changes in mental and physical health in response to meditation have not been systematically explored. We performed a randomized, controlled study on the effects on brain and immune function of a well-known and widely used 8-week clinical training program in mindfulness meditation applied in a work environment with healthy employees
  • Means SE antibody rise from the 3- to 5-week to the 8- to 9-week blood draw in the Meditation and Control groups. The ordinate displays the
    difference in the log-transformed antibody rise between the 3- to 5- and the 8- to 9-week blood draws derived from the hemagglutination inhibition
    assay
  • Synergy:
    “The interaction or cooperation of two or more…agents to produce a combined effect greater than the sum of their separate effects”
    New Oxford Dictionary of English
  • N = 30 men w/ prostate cancer
    Telomerase enzymatic activity
    Start 3 months
    2.00 2.22 p = 0.031
    Decr. LDL p = 0.041
    Decr. in psychological distress p = 0.047
    “Comprehensive lifestyle changes significantly increase telomerase activity”
  • (10% of calories from fat),
    , low in refined carbohydrates
    20 The diet was supplemented with
    soy (one daily serving of tofu plus 58 g of a fortifi ed soy
    protein powdered beverage), fi sh oil (3 g daily), vitamin E
    (100 IU daily), selenium (200 μg daily), and vitamin C
    (2 g daily).21,22 Participants were provided with all of their
    food during the intervention period. A registered dietician,
    exercise physiologist, clinical psychologist, nurse, and
    stress management instructor were available for education
    and counselling. Adherence was assessed with selfreported
    questionnaires which were used to compute a
    mean adherence score.16–18 The decision to use a 3-month
    duration was arbitrary and was based on the resources
    available.
  • handout two

    1. 1. Spa and Integrative Medicine:Spa and Integrative Medicine: The Future of Health and WellnessThe Future of Health and Wellness Brent A. Bauer MDBrent A. Bauer MD Director, Complementary andDirector, Complementary and Integrative Medicine ProgramIntegrative Medicine Program Mayo ClinicMayo Clinic Department of MedicineDepartment of Medicine
    2. 2. Learning ObjectivesLearning Objectives • Understand the evolution of CAM and theUnderstand the evolution of CAM and the emergence of “Integrative Medicine”.emergence of “Integrative Medicine”. • Be able to communicate the evidenceBe able to communicate the evidence from Integrative Medicine and how thatfrom Integrative Medicine and how that science validates Spascience validates Spa • Prepare strategically for thePrepare strategically for the opportunities where Spa and IM meetopportunities where Spa and IM meet
    3. 3. Quotable quoteQuotable quote ““The greatest opportunity to touch theThe greatest opportunity to touch the lives of the greatest number of peoplelives of the greatest number of people with a lifestyle that promotes wellnesswith a lifestyle that promotes wellness and health is where Spa and Integrativeand health is where Spa and Integrative Medicine meet”Medicine meet” Brent A. Bauer MD,Brent A. Bauer MD, 2009 ISPA CONFERENCE2009 ISPA CONFERENCE
    4. 4. Scope of the IssueScope of the Issue • United States AdultsUnited States Adults – 2/3 are overweight or obese2/3 are overweight or obese – 1/2 have a chronic disease1/2 have a chronic disease ⋅ e.g. heart disease, stroke, diabetes, cancere.g. heart disease, stroke, diabetes, cancer – One in four have heart diseaseOne in four have heart disease – One in three have high blood pressureOne in three have high blood pressure – 24 million Americans have type 2 diabetes24 million Americans have type 2 diabetes Trust for America’s HealthTrust for America’s Health (www.healthyamericans.org)(www.healthyamericans.org)
    5. 5. Source: Behavioral Risk Factor Surveillance System, CDC. Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
    6. 6. 1988-2008; Bureau of Labor Statistics, Seasonally Adjusted Data from the1988-2008; Bureau of Labor Statistics, Seasonally Adjusted Data from the Current Employment Statistics Survey (April to April) 1988-2008.Current Employment Statistics Survey (April to April) 1988-2008.
    7. 7. Barnes, 2008Barnes, 2008
    8. 8. Househol 13 5 4 30 6 27 32 0 20 40 60 80 100 Yoga/Tai Chi Acupressure Hypnosis/Guided Imagery Herbs/DietarySupps Acupuncture Massage Therapy Chiropractic Percentage
    9. 9. Integrative MedicineIntegrative Medicine ““The practice of medicine that reaffirmsThe practice of medicine that reaffirms the importance of the relationshipthe importance of the relationship between practitioner and patient,between practitioner and patient, focuses on the whole person, isfocuses on the whole person, is informed by evidence, and makes use ofinformed by evidence, and makes use of all appropriate therapeutic approaches,all appropriate therapeutic approaches, healthcare professionals and disciplineshealthcare professionals and disciplines to achieve optimal health and healing."to achieve optimal health and healing." Consortium of Academic HealthConsortium of Academic Health Centers for Integrative MedicineCenters for Integrative Medicine
    10. 10. Institute of MedicineInstitute of Medicine • Integrative Medicine:Integrative Medicine: – ““Orienting the health care process to createOrienting the health care process to create a seamless engagement by patients anda seamless engagement by patients and caregivers of the full range of physical,caregivers of the full range of physical, psychological, social, preventive, andpsychological, social, preventive, and therapeutic factors known to be effectivetherapeutic factors known to be effective and necessary for the achievement ofand necessary for the achievement of optimal health”.optimal health”. www.iom.eduwww.iom.edu
    11. 11. Institute of MedicineInstitute of Medicine • “…“…to explore issues, opportunities, andto explore issues, opportunities, and approaches for shifting our health careapproaches for shifting our health care system to a focus on efficient, evidence-system to a focus on efficient, evidence- based prevention, wellness, and patient-based prevention, wellness, and patient- centered care that is personalized,centered care that is personalized, predictive, preventive and participatory.”predictive, preventive and participatory.” www.iom.eduwww.iom.edu
    12. 12. Time for a change?Time for a change? • ““If no oneIf no one wantswants to be hospitalized andto be hospitalized and no oneno one wantswants to be sick, then it’s time toto be sick, then it’s time to establish a health care system that notestablish a health care system that not only treats sickness, but also focuses ononly treats sickness, but also focuses on keeping people healthy”.keeping people healthy”. Denis Cortese, M.D.,Denis Cortese, M.D., CEO emeritus, Mayo ClinicCEO emeritus, Mayo Clinic Mayo Clinic Health Policy CenterMayo Clinic Health Policy Center
    13. 13. Time for a change?Time for a change? • Taking charge of your health.Taking charge of your health. – Eat a healthy dietEat a healthy diet – Get regular exerciseGet regular exercise – Don’t use tobaccoDon’t use tobacco – Actively manage stressActively manage stress ““These practices will keep you healthier,These practices will keep you healthier, happier and more productive”happier and more productive” Denis Cortese, M.D., Mayo ClinicDenis Cortese, M.D., Mayo Clinic
    14. 14. Massage Therapy – Mayo ClinicMassage Therapy – Mayo Clinic Pilot trialPilot trial – 58 cardiac surgery patients58 cardiac surgery patients – Massage therapy vs. quiet relaxationMassage therapy vs. quiet relaxation – DecreasedDecreased ⋅ PainPain ⋅ AnxietyAnxiety ⋅ TensionTension Bauer, Comp. Therap.Clin. Practice, SubmittedBauer, Comp. Therap.Clin. Practice, Submitted
    15. 15. Anxiety LevelAnxiety Level VV AA SS Massage Therapy after CV SurgeryMassage Therapy after CV Surgery
    16. 16. Massage Therapy after CV SurgeryMassage Therapy after CV Surgery VV AA SS Pain LevelPain Level
    17. 17. Massage Therapy – Mayo ClinicMassage Therapy – Mayo Clinic • Randomized, controlled trialRandomized, controlled trial – 113 cardiac surgery patients113 cardiac surgery patients – MT therapy days 2,4 vs. quiet relaxationMT therapy days 2,4 vs. quiet relaxation – Decreased painDecreased pain p <0.001p <0.001 – Decreased anxietyDecreased anxiety p <0.001p <0.001 – Decreased tensionDecreased tension p <0.001p <0.001 – Increased relaxationIncreased relaxation p <0.001p <0.001 Bauer, Comp. Therap. Clin. Practice, In pressBauer, Comp. Therap. Clin. Practice, In press
    18. 18. Massage Therapy – CRSMassage Therapy – CRS 5.3 1.85 4.95 1.15 4.65 1.25 0 1 2 3 4 5 6 7 8 9 10 Pain Tension Anxiety Pre Post N = 20
    19. 19. Massage Therapy – Mayo ClinicMassage Therapy – Mayo Clinic • Randomized, controlled trialRandomized, controlled trial – 130 cardiac pts going to invasive procedure130 cardiac pts going to invasive procedure – MT x 20” prior vs. quiet relaxationMT x 20” prior vs. quiet relaxation – Decreased painDecreased pain p <0.001p <0.001 – Decreased anxietyDecreased anxiety p <0.001p <0.001 – Decreased muscle tensionDecreased muscle tension p <0.001p <0.001 – Improved satisfactionImproved satisfaction Bauer, submittedBauer, submitted
    20. 20. Massage Therapy – Mayo ClinicMassage Therapy – Mayo Clinic • EchocardiographersEchocardiographers – 45 full-time cardiac-sonographers45 full-time cardiac-sonographers – 30” chair massage each week vs. stretching30” chair massage each week vs. stretching – Modest impr. in work-related discomfortModest impr. in work-related discomfort – Marked increase in satisfactionMarked increase in satisfaction Bauer, submittedBauer, submitted
    21. 21. Massage Therapy – Mayo ClinicMassage Therapy – Mayo Clinic • Cardiac Cath Lab personnelCardiac Cath Lab personnel – 50 staff members (MD’s, RN’s, technicians)50 staff members (MD’s, RN’s, technicians) – On-site, table massage, 30” x 10On-site, table massage, 30” x 10 – Outcomes: pain, fatigue, anxietyOutcomes: pain, fatigue, anxiety – PreliminaryPreliminary ⋅ Positive feedbackPositive feedback Bauer, analysisBauer, analysis
    22. 22. Massage Therapy - MSKCCMassage Therapy - MSKCC • Memorial Sloan-Kettering Cancer CenterMemorial Sloan-Kettering Cancer Center – 1,290 patients treated over 3 yr period1,290 patients treated over 3 yr period – Pre- and Post-therapy sxs recordedPre- and Post-therapy sxs recorded ⋅ PainPain ⋅ FatigueFatigue ⋅ Stress/AnxietyStress/Anxiety ⋅ DepressionDepression ⋅ NauseaNausea Cassileth, J Pain Symptom Manage. 2004
    23. 23. Massage Therapy - MSKCCMassage Therapy - MSKCC • Results:Results: SymptomSymptom ImprovementImprovement PainPain 40%40% FatigueFatigue 41%41% AnxietyAnxiety 52%52% NauseaNausea 21%21% DepressionDepression 31%31% Cassileth, J Pain Symptom Manage. 2004
    24. 24. Massage and FibromyalgiaMassage and Fibromyalgia • Clinical Trial, N = 50 women w/ FMSClinical Trial, N = 50 women w/ FMS – Manual lymph drainageManual lymph drainage = 25= 25 – Connective tissue massage = 25Connective tissue massage = 25 – 5X/week for 3 weeks5X/week for 3 weeks – ImprovedImproved ⋅ Pain intensity, pain pressure threshold, HRQoLPain intensity, pain pressure threshold, HRQoL ⋅ AM tiredness, anxiety, FIQ better with MLDAM tiredness, anxiety, FIQ better with MLD Ekici, J Manip. Physiol Ther 2009Ekici, J Manip. Physiol Ther 2009
    25. 25. Massage and FibromyalgiaMassage and Fibromyalgia SiteSite YearYear RandomRandom NN OutcomeOutcome U of MiamiU of Miami 19961996 YY 3030 U Hospital, UppsalaU Hospital, Uppsala 19991999 YY 4848 U of MiamiU of Miami 20022002 YY 2424 Ohio State UOhio State U 20062006 NN 1010 Ahi Evran U, TurkeyAhi Evran U, Turkey 20092009 YY 5050
    26. 26. CAM and the Relaxation ResponseCAM and the Relaxation Response • Therapies with good efficacy/ low riskTherapies with good efficacy/ low risk – MassageMassage - Meditation- Meditation – AcupunctureAcupuncture - Music Therapy- Music Therapy – YogaYoga - Hypnosis- Hypnosis – SpiritualitySpirituality - Tai chi- Tai chi – Guided imageryGuided imagery - etc.- etc.
    27. 27. Relaxation ResponseRelaxation Response • RCT N = 41, U of WisconsinRCT N = 41, U of Wisconsin – Meditation vs. wait list controlMeditation vs. wait list control – 8-wk program > vaccinated8-wk program > vaccinated – Meditators hadMeditators had ⋅ Measurable change in brain electrical patternMeasurable change in brain electrical pattern ⋅ Higher antibody titersHigher antibody titers “…“…meditation may change brain and immunemeditation may change brain and immune function in positive ways”function in positive ways” Davidson, Psych Med 2003Davidson, Psych Med 2003
    28. 28. Davidson, Psych Med 2003Davidson, Psych Med 2003
    29. 29. Davidson, Psych Med 2003Davidson, Psych Med 2003
    30. 30. ISPAISPA ““Spas offer…a time and place to…Spas offer…a time and place to… recharge your mind, body and spirit. Therecharge your mind, body and spirit. The opportunity to bring your physical,opportunity to bring your physical, mental, emotional and spiritual selvesmental, emotional and spiritual selves back into alignment”.back into alignment”. http://www.experienceispa.com/spa-goers/why-spa/http://www.experienceispa.com/spa-goers/why-spa/
    31. 31. Ruth Stricker Spa and WellnessRuth Stricker Spa and Wellness AwardAward • Created in 2008Created in 2008 • First recipient - Dr. Jen SedaFirst recipient - Dr. Jen Seda ““Our research is designed to show theOur research is designed to show the biological, emotional, and mentalbiological, emotional, and mental benefits of a typical spa experience”benefits of a typical spa experience”
    32. 32. Ornish, Lancet Oncology 2008Ornish, Lancet Oncology 2008
    33. 33. ““Comprehensive lifestyle modification”Comprehensive lifestyle modification” • Lifestyle modifications included: – Low fat, whole foods, plant-based diet – Mod. aerobic exercise (walking 30”/d, 6 d/wk) – Stress management (gentle yoga stretching, breathing, meditation 60”/day, 6 d/wk) – 1-h group support session once per week. Ornish, Lancet Oncology 2008Ornish, Lancet Oncology 2008
    34. 34. Questions???Questions??? bauer.brent@mayo.edubauer.brent@mayo.edu

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