1 a transition from allopathic to integrated medical practice

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Update on Dr. Cady's presentation on transition from conventional allopathic to functional and integrated practice. Current state of medicine, socio-economic variables, and demographics reviewed. Mental posture toward how you want to practice reviewed. Presented 8/17/2012 in Salt Lake City for CME lecture of World Link Medical

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1 a transition from allopathic to integrated medical practice

  1. 1. How to Transition from Traditional AllopathicPractice to a Holistic and Integrated Medical Model 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 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
  2. 2. 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.
  3. 3. “The mind, onceexpanded to thedimensions of largerideas, never returnsto its original size.” - Oliver Wendell Holmes
  4. 4. 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. – “No margin, no mission.” - Steven R. Covey• If the system implodes, the patient suffers.
  5. 5. Background• Listen for IDEAS• MINDSET is important.• WHY to make the change is more difficult than HOW to make the change. (Strategy vs. tactics).• Listen for personal relevance – if it’s important to you, it’s important to your patients.• Relax for use of COLOR.• Relax for data – you’re getting access.
  6. 6. Attention class!!www.slideshare.net/lcadym d
  7. 7. www.slideshare.net/lcadymd
  8. 8. Tech Rules…. Please turnyour phones ON (just silenced).• Shoot photos!• Tweet! ( @LouisCadyMD )
  9. 9. “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
  10. 10. “Wellness [integrated] No Disease = Health Medicine” Forestall andDiagnose and PREVENT Disease –Treat Disease Optimize FunctionNew Drugs HormoneNew Surgical Modulation Techniques Diet, Exercise Nutritional Supplementation
  11. 11. Health is a state ofcomplete physical, mentaland social well-being, andnot merely the absence ofdisease or infirmity.- World Health Organization
  12. 12. American Journal of Health Promotion; November/December, 2002 18.8% 66% 19% of those “Incompletely healthy” surveyed were completely completely unhealthy, d healthy with efined as high levels of having low both physical levels of health and mental with high Two-thirds of the adults health and a levels of reported some degree low level of illness. of mental or illness. physical illness that kept them from being completely healthy. “Incompletely healthy.” OPTIMALDEAD HEALTH continuum
  13. 13. 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….
  14. 14. 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”(Med School finished 1989)• 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)
  15. 15. May 2002: 9th Annual IFM Conference
  16. 16. The Functional Medicine component Dead Doctors Don’t Lie - Joel Wallach, DVM, ND
  17. 17. 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.
  18. 18. Current socioeconomic state andallopathic (“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)
  19. 19. 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) Slide courtesy of John Adams, MBA – CEO, Cenegenics Available at http://voices.washingtonpost.com/capitol-briefing/2009/07/gop_accuses_democrats_of_censo.html
  20. 20. What the feds see & their lust for “cost control” Example: salaries for Family Medicine Average Sweden Finland Australia France Canada Switzerland United Kingdom United States $0 $50 $100 $150 $200 US $1000Adapted from http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/. Accessed April 3, 2010. Slide courtesy of John Adams, MBA – CEO, Cenegenics
  21. 21. Medicare–Workers per Beneficiary Millions YearSOURCE: Kaiser Family Foundation based on the 2009 Annual Report of the Boards of Trustees of the Federal HospitalInsurance and Federal Supplementary Medical Insurance http://facts.kff.org/chart.aspx?ch=383. Accessed April 3, 2010. Trust Funds. Slide courtesy of John Adams, MBA – CEO, Cenegenics
  22. 22. 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 Warnerhttp://www.congress.org/congressorg/bio/userletter/?id=3181&letter_id=4747883751. Accessed April 3, 2010. Slide courtesy of John Adams, MBA – CEO, Cenegenics
  23. 23. http://www.ama-assn.org/amednews/2011/11/21/gvsd1121.htm
  24. 24. SOURCE: Mary Meeker, Partner – Kleiner, Perkins Caulfield &Byers – “Internet Trends” Slide deck – D10 conference, released
  25. 25. SOURCE: Mary Meeker, Partner – Kleiner, Perkins Caulfield &Byers – “Internet Trends” Slide deck – D10 conference, released
  26. 26. Healthcare Reform–Physicians Perception of Medicine Over the Next Few Yearshttp://www.athenahealth.com/index.php?open=26. Accessed April 3, 2010. Slide courtesy of John Adams, MBA – CEO, Cenegenics
  27. 27. Are the Best and Brightest Staying in Medicine? “60% of physicians would not recommend medicine as a career to their children.” http://www.mayorswellnesscampaign.org/wp- content/uploads/2009/05/merritt-hawkins-survey.pdf. • – The Physicians’ Accessed April 3, 2010. Foundation Slide courtesy of John Adams, MBA – CEO, Cenegenics
  28. 28. “Although American doctors feel stressed, overworked, anduncertain about the future, they’re generally happy with theircareer choices and the state of their lives (???), despitepracticing during one of the greatest periods of tumult in themodern history of US healthcare.” “The results also suggest strongly that physicians wish they had more control of theirhttp://marketing- careers… and time.”images.ubmmedica.com/Insights/2011/2011_GAP_Survey.pdfAccessed 01 21 2012
  29. 29. 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.pdfreferenced 01 21 2012
  30. 30. Note: new slide
  31. 31. “The Great Crossover” – the microchipcf: Dan Sullivan www.strategiccoach.com
  32. 32. Accessed 1 21 2012
  33. 33. CURRENT STATUS OFPATIENTS AND SOCIETY
  34. 34. CURRENT PRACTICE OF MEDICINE:What a patient had to say about her “specialists”:“They just monitor my degeneration.”
  35. 35. 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/CA Muse.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
  36. 36. 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
  37. 37. 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
  38. 38. A CHANGE FROM THEALLOPATHIC MODEL?
  39. 39. Socioeconomic/disruptive forces with two models Allopathic Wellness/ fxnl med• Disease and CHANGE • Integrated and whole sickness focused AGENTS person model• Short appointments • Microchip/inter • Bill for time• Commoditized net • Non-commoditized• Compartmentalized • Increase in • Collaborative• Doctor as priest chronic disease • Informed patients• Uninformed patient • “boomers” willing to “pay for• Sicker patients • Job/socio- expertise”• Either practice economic • Practice per peer- ignorantly or with reviewed literature; pressures No crises (pl) of guilty conscience• Worry/poor conscience satisfaction • INTENSE satisfaction
  40. 40. Divergence of focus of two models Wellness/ fxnl med; “complementary/alternative”Allopathic• Relief of symptoms • CAUSE of symptoms, prevention• Organ specific • SYSTEMS focused• Aggressive. “magic bullet” • Gentle, methodical.• Rules, practice guidelines • Creative. What works?• Patient as uninformed • Patient as integral part of team. protoplasm. Questions/participation encouraged.• Tied to medico-pharmaco- • Focused on health and optimization industrial complex with natural, bio-identical methods• Use of synthetic, patented, • Use of PROVEN botanicals and not-from-nature substances natural hormones (as well as conventional RX).Adatped from “Alternative Medicine: Why so popular? By Hans R. Larsen, MScChE. International Health News, Sept 1999, issue 93http://www.yourhealthbase.com/alternative_medicine.htm accessed 1 21 2012
  41. 41. “Slumber not inthe tents of yourfathers.The world isadvancing.Advance with it.” - Giuseppe Mazzine
  42. 42. 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
  43. 43. What does integrated, holistic medicine “look like?” A quick dip in the literature
  44. 44. % U.S. Women with inadequate quantities of nutrientsArab L, Carriquiry A, Steck-Scott S, Gaudet MM. Ethnic differences in thenutrient intake adequacy of premenopausal US women: results from theThird National Health Examination Survey. J Am Diet Assoc 2003;103:1008-14.
  45. 45. = 2 apples (fruits) & 3 - 4vegetables – per CDC
  46. 46. 4 – 13 servings of fruits andvegetables per day, dependingon energy needs
  47. 47. % Mineral depletion from the soilduring the past 100 years, by continent North America 85% South America 76% Asia 76% Africa 74% Europe 72% Australia 55% Source: UN Earth Summit Report 1992
  48. 48. Cf: http://www.veganforum.com/forums/showthread.php?t=3532
  49. 49. Source: Jerry Brunetti – www.agri-
  50. 50. 16,103 people – 1994 – 1996.ZERO got 100% of all required vitamins andnutrients- Highest – B12 =- 82.8% got enough- 66.8% - had adequate folate- Lowest – Zinc – only 26.6% got enough.
  51. 51. 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)
  52. 52. The Baby Boomers & Their Expectations The first time the entire Baby Boom generationis impacting a single market ALL at the same time!
  53. 53. 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
  54. 54. “Age management” “Conventionalpractice”fuel additivesThere are No fuel additives shouldwe can use to keep our be used. They arecars burning cleaner and unnatural. Gas is all thatpreserve engines. is required.We should use optimal The quality of the gas isquality of gas. Cheap gas irrelevant. Anything thatcauses “pinging” which is the motor will burn ishard on the engine. adequate.We should take our car in Preventive maintenance? Thisfor preventive is silly! Wait until something breaks, then have the carmaintenance before towed in so the mechanic cananything breaks. really tell what is wrong.
  55. 55. Modern Medicine’s Paradigm:Two Standard Deviations – “if you are not sick, then you must be well.” “NORMAL” OPTIMAL? OPTIMAL
  56. 56. 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)
  57. 57. 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
  58. 58. Marketing & Practice Development• Maintain excellence in allopathy or (traditional osteopathy) – (knowledge base, prescribing, surgery) – (“Be able to debate the great issues.” – Jim Rohn)• Know your [new] stuff!• Do not badmouth the competition. (Chris Lord example).• Give CME talks and paper over their objecting mouths with references. (examples follow next)• Spiritual and ethical clarity.
  59. 59. 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.
  60. 60. A Scientific (& FUN!!!) Review of Vitamin Supplementation & Essential NutrientsLouis B. Cady, MD – CEO & Founder – Cady Wellness Institute Adjunct Professor – University of Southern Indiana Adjunct Clinical Lecturer – Indiana University School of Medicine Department of PsychiatryChild, Adolescent, Adult & Forensic Psychiatry – Evansville, Indiana Presented 2 27 2010 – Oliver Headache and Pain Clinic CME seminar – Evansville, IN
  61. 61. Trends in Pharmacological Sciences (2008) Jul; 29(7):351. Epub 2008 Ju
  62. 62. • 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.”
  63. 63. Zoned, Stoned and Blown: The Emotional Tsunami of Psychiatric Disorders Coupledwith Pain Disorders & Chemical DependencyLouis B. Cady, MD – CEO & Founder – Cady Wellness Institute Adjunct Professor – University of Southern Indiana Adjunct Clinical Lecturer – Indiana University School of Medicine Department of PsychiatryChild, Adolescent, Adult & Forensic Psychiatry – Evansville, Indiana Also Presented 2 27 2010 – Oliver Headache and Pain Clinic CME seminar – Evansville, IN
  64. 64. Pharmacotherapy SignificantlyReduces Substance Abuse in Adults with ADHD 40 32 3- P<0.001% of study population 30 fold! 20 12 10 10 0 Unmedicated Medicated Control ADHD ADHD (N=137) (N=19) (N=56) Biederman J, et al. Pediatrics. 1999;104:e20-e25.
  65. 65. …END EXAMPLES…Business philosophy citations follow
  66. 66. “You can have everything in life you want, if you just help enough other people get what they want.” - Zig ZiglarWhat 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.
  67. 67. $5,000 worth of wisdom on one page – from Jay Abraham• Risk reversal• “USP” – unique selling Focus: “Be able proposition to treat your• Defining the buying clients (or criteria patients) as dear• Three ways for more and valued profit: – Higher price friends.” - Jay Abraham – More frequency – Additional items (supplements, etc.)
  68. 68. Evansville Courier & Press: May 29, 2006References: www.pharmanexmd.com ;www.slideshare.net/lcadymd;Dr. Oz show on YouTube:http://www.youtube.com/watch?v=rX4oxxGWi_8
  69. 69. 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• Be a doctor and not a stock boy or inventory clerk.
  70. 70. Jay Abraham References (recommended) www.amazon.com
  71. 71. 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. “If they show up, bill’em.” – Dan Kennedy.
  72. 72. Be Awesome!Note: NEW reference. Grab it.
  73. 73. MARKETING – what has and hasn’t workedWorked Hasn’t worked• Word of mouth • Paid advertising (TV,• Public seminars print, magazines)• Web site• Going to MD’s/DO’s • What I HAVEN’T tried: – Marketing consultants offices PERSONALLY – Radio ads• Free stuff – PR opportunities New initiatives:• Going to places and •Proprietary, paid websites NETWORKING •“SEO” – search engine optimization (Willie Sutton principle)
  74. 74. Additional resources – handouts down front at end of lecture• “The 10 Commandments of Marketing a Medical Practice” – Cady (handout, free)• Additional resources handout sheet• Practice Transformation Seminar – to be scheduled 2013 - at Cady Wellness Institute
  75. 75. Contact information: Louis B. Cady, M.D. www.cadywellness.com www.indianaTMS- cadywellness.com Office: 812-429-0772 E-mail: lcady@cadywellness.com 4727 Rosebud Lane – Suite F Interstate Office Park Newburgh, IN 47630 (USA) Download fromiTunes or Android App store now!
  76. 76. A personal close:How do you want to age?
  77. 77. Success and Failure (Jim Rohn) What about you? You’ve only got one body.• “Errors in judgement” - High glycemic eating, no exercise, poor nutrition, lousy/no supplementation, high stress practice.- “Good disciplines” – appropriate diet, supplementation, exercise, hormones. Stress management. Decent practice and lifestyle.
  78. 78. Perhaps the ability not only to acquirethe confidence of the patient, but todeserve it, to see what the patientdesires and needs, comes through thesixth sense we call intuition, which inturn comes from wide experience anddeep sympathy for and devotion tothe patient, giving to the possessorremarkable ability to achieve results. ...William J. Mayo, 1935
  79. 79. BREAK!!

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