This is the keynote lecture of the series of three lectures that Dr. Cady presented to the World Link Medical seminar in Salt Lake City, Utah on June 1, 2012.
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Transition from allopathic to integrated medical practice
1. How to Transition from Traditional Allopathic
Practice to a Holistic and Integrated Medical Model
Louis B. Cady, MD â CEO & Founder â Cady Wellness Institute
Adjunct Professor â University of Southern Indiana
Adjunct Clinical Lecturer â Indiana University School of Medicine
Department of Psychiatry
Child, Adolescent, Adult & Forensic Psychiatry â Evansville, Indiana
This presentation is Š 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. Louis B. Cady, M.D. â 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: Todayâs presentations are CME and
are sponsored by World Link Medical.
3. âThe mind, once
expanded to the
dimensions of larger
ideas, never returns to
its original size.â
- Oliver Wendell Holmes
4. Ethics and financial/logistical
practicalities of these lectures
⢠Nothing is more important than taking care of the
patient.
⢠âThe needs of the patient come first.â (Dr. Will
Mayo, MD)
⢠The current âmedical modelâ is at variance with
what is ethical, moral, and factual.
⢠If the physician is not stable and financially secure,
the system implodes.
â âNo margin, no mission.â - Steven R. Covey
⢠If the system implodes, the patient suffers.
8. Tech RulesâŚ. Please turn
your phones ON (just
silenced).
⢠Shoot photos!
⢠Tweet! ( @LouisCadyMD )
9. âWellness
Traditional [integrated]
Optimal Health
No Disease = Health
Medicine Medicineâ
Forestall and
Diagnose and PREVENT Disease â
Treat Disease
Death
Optimize Function
New Drugs Hormone
New Surgical Modulation
Techniques
Diet, Exercise
Nutritional Supplementation
10. âBut my patients donât know about
this and arenât asking for itâŚ.â
âItâs not the
consumersâ
job to know
what they
want.â
- Steve Jobs
11. Health is a state of complete
physical, mental and social
well-being, and not merely
the absence of disease or
infirmity.
- World Health Organization
12. American Journal of Health Promotion;
November/December, 2002
66% 19% of those
18.8%
âIncompletely healthyâ surveyed were
completely
completely
unhealthy,
healthy with
defined 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 low level of
illness. degree of mental
illness.
or physical
illness that kept them
from being completely
healthy.
OPTIMAL
âIncompletely healthy.â
DEAD
HEALTH continuum
13. Outline
⢠Overview of concepts
⢠My bias â a practice model
⢠Current state of allopathic medicine
⢠Microchip as disruptor and disintermediator
â (âChange or dieâ)
⢠Current state of patients and society
⢠Whatâs your model? Chloraseptic or PCN?
⢠How to start changingâŚ.
14. The evolution of my practice
⢠Sidetracked in high school, two degrees in music (â77 and
â79) and learned piano tuning
⢠1976 â 1989 â piano tuning (through pre-med and med
school). âfee for serviceâ
⢠1989-1993 â conventional allopathic psychiatry residency
at Mayo Clinic
⢠1993 â start practice. 1995 â l-tyrosine and EFAâs
⢠2002 â first IFM conference
⢠2003 â Cenegenics training
⢠2005 â founded Cady Wellness Institute
⢠2010 â 2011 â Neil Rouzier, MD & WorldLink
⢠2012 â rTMS (Transcranial Magnetic Stimulation)
20. Cady Wellness Institute â July 2005
The Reasons:
⢠Conventional medical practice had failed me twice.
⢠A lot of âpsychiatric casesâ WERENâT âpsychiatric.â
⢠Nobody was integrated.
⢠Nobody was looking at ALL of the peer-reviewed
literature.
21.
22. Current socioeconomic state and
allopathic (âconventionalâ) medicine â
DISRUPTIVE NOTIONS
⢠CONVENTIONAL Allopathic medicine = symptom
focused, reactive, âtaught,â unthinking, uncreative,
PRACTICALLY non-informed by peer-reviewed
medical literature.
â Commoditized. No variability. âProviders.â
⢠Wellness medicine: individualized. Canât get it
elsewhere. Not a commodity. Scientific. Informed
by peer-reviewed literature.
â Concept of âinformation brokeringâ (example: THYROID)
23. Healthcare âReformâ Today
â˘Today: Patient Protection and Affordable Care Act (P.L. 111-148) â includes amendments from
the Health Care and Education Reconciliation Act of 2010 (H.R. 4872)
Slide courtesy of John Adams, MBA â CEO, Cenegenics
Available at http://voices.washingtonpost.com/capitol-briefing/2009/07/gop_accuses_democrats_of_censo.html
24. What the feds see & their lust for âcost controlâ
Example: salaries for Family Medicine
Average
Sweden
Finland
Australia
France
Canada
Switzerland
United Kingdom
United States
$0 $50 $100 $150 $200
US $1000
Adapted 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 â CEO, Cenegenics
25. MedicareâWorkers per Beneficiary
Millions
Year
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. http://facts.kff.org/chart.aspx?ch=383. Accessed April 3, 2010.
Slide courtesy of John Adams, MBA â CEO, Cenegenics
26. The Future of Medicare
âMedicare is going
bankrupt. The Medicare
Trustees estimate that
the program will run
short of money starting
in 2017.â
â˘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 â CEO, Cenegenics
30. Healthcare ReformâPhysicians 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 â CEO, Cenegenics
31. Are the Best and Brightest
Staying in Medicine?
â60% of physicians
would not recommend
medicine as a career
to their children.â
http://www.mayorswellnesscampaign.org/wp-
⢠â The Physiciansâ
content/uploads/2009/05/merritt-hawkins-survey.pdf.
Accessed April 3, 2010.
Foundation
Slide courtesy of John Adams, MBA â CEO, Cenegenics
32. âAlthough American doctors feel stressed, overworked, and
uncertain about the future, theyâre 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.â
âThe results also suggest strongly that physicians wish
they had more control of their careers⌠and time.â
http://marketing-images.ubmmedica.com/Insights/2011/2011_GAP_Survey.pdf
Accessed 01 21 2012
33. Current US Physiciansâ Attitudes
⢠Mean respondent â 51 yoa
â 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 â no ânâ cited.
Great American Physician Survey â July 31, 2011 â UBM Medica â cf:
http://marketing-images.ubmmedica.com/Insights/2011/2011_GAP_Survey.pdf
referenced 01 21 2012
43. CURRENT PRACTICE OF MEDICINE:
What a patient had to say about her âspecialistsâ:
âThey just monitor my
degeneration.â
44.
45. Consultations with âcomplementary
and alternativeâ practitioners
⢠US, 2004. 36% of US adult >18 yoa
â National Center for Complementary and Alternative
Medicine survey, 2004.
⢠http://altmedicine.about.com/od/alternativemedicinebasics/a/CAMus
⢠Canada â 1.2 million adults, or 13% of the
population of Ontario. N = 32,598 surveyed.
â Williams, Kitchen, e al. Alternative health care consultations in Ontario,
Canada. BMC Complementary and Alternative Medicine 2011, 11:47
46.
47. What causes oxidative stress?
⢠Environmental Toxins
â Heavy metals â including Mercury (fillings!)
â Pesticides/herbicides
â Preservatives
â PCBâs, Dioxins, Phthalates
⢠Toxins produced in the body
â Yeast and bacteria
â Products of cellular metabolism
⢠Emotional Stress
â Anxiety/Tension
â Fear
â Anger
48.
49.
50.
51. Todayâs 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
53. Socioeconomic/disruptive forces
with two models
Allopathic Wellness/ fxnl med
⢠Disease and CHANGE AGENTS
⢠Integrated and whole
sickness focused person model
⢠Short appointments ⢠Microchip/intern ⢠Bill for time
⢠Commoditized et ⢠Non-commoditized
⢠Compartmentalized ⢠Increase in ⢠Collaborative
⢠Doctor as priest chronic disease ⢠Informed patients
⢠Uninformed patient ⢠âboomersâ willing to âpay for
⢠Sicker patients ⢠Job/socio- expertiseâ
⢠Either practice economic ⢠Practice per peer-
ignorantly or with reviewed literature;
pressures No crises (pl) of
guilty conscience
⢠Worry/poor conscience
satisfaction ⢠INTENSE satisfaction
54. Divergence of focus of two models
Wellness/ fxnl med;
âcomplementary/alternativeâ
Allopathic
⢠Relief of symptoms ⢠CAUSE of symptoms, prevention
⢠Organ specific ⢠SYSTEMS focused
⢠Aggressive. âmagic bulletâ ⢠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 âAlternative 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
55. âSlumber not in
the tents of your
fathers.
The world is
advancing.
Advance with it.â
- Giuseppe Mazzine
56. Some interesting thoughts:
⢠âThe war situation has developed not
necessarily to Japanâs advantage..â- Japanese
Emperor Hirohito after the atomic bombing of Hiroshima and Nagasaki,
announcing Japanâs surrender to the Allies
⢠âA naĂŻve analysis of stability is derived from the
absence of past variationsâ (or âThe Turkey
Problemâ)
â Nicholas Taleb, author of The Black Swan
57. What does integrated, holistic
medicine âlook like?â
A quick dip in the literature
58. % 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.
59. = 2 apples (fruits) & 3 - 4 vegetables
â per CDC
60. 4 â 13 servings of fruits and
vegetables per day, depending on
energy needs
61.
62. % Mineral depletion from the soil
during 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
66. 16,103 people â 1994 â 1996.
ZERO got 100% of all required vitamins and
nutrients
- Highest â B12 =- 82.8% got enough
- 66.8% - had adequate folate
- Lowest â Zinc â only 26.6% got enough.
67.
68. Factors trapping physicians
⢠âDoing it, doing it, doing it.â (Michael Gerber, The
E-Myth)
⢠Already time-pressured â
â Minimal time to think or plan
â PROBABLY ADRENALLY DEPLETED ALREADY,
perhaps with suboptimal thyroid and sex hormones
â Tip â GET YOUR LABS CHECKED!!
⢠Must âmake overhead.â
⢠Canât âtake chances.â
⢠Trapped by âprovider panelâ arrangements,
including cut rate fees. (Alcoa story)
69. The Baby Boomers & Their Expectations
The first time the entire
Baby Boom generation
is impacting a single market
ALL at the same time!
70.
71. Letâs look at the logic.
How would you take care of a classic?
âChronic diseases
affect at least 125
million Americans
& cost more than
$500 billion last
year.â
Centers for DiseaseControl â Dec 2003
72. âAge managementâ âConventional practiceâ
There are fuel additives No fuel additives should
we can use to keep our be used. They are
cars burning cleaner and unnatural. Gas is all that
preserve engines. is required.
We should use optimal The quality of the gas is
quality of gas. Cheap gas irrelevant. Anything that
causes âpingingâ which is the motor will burn is
hard on the engine. adequate.
We should take our car in Preventive maintenance? This
for preventive is silly! Wait until something
breaks, then have the car
maintenance before
towed in so the mechanic can
anything breaks.
really tell what is wrong.
73. Modern Medicineâs Paradigm:
Two Standard Deviations â âif you are not
sick, then you must be well.â
âNORMALâ
OPTIMAL?
OPTIMAL
74. Definition of ânormal labsâ:
âWhen your lab
values are as
crappy as
everyone elseâs.â
- Neil Rouzier,
MD (World Link Medical Seminar II
â Spring 2011)
75. MAKING THE TRANSITION
⢠Must DECIDE
â Must have INFO (e.g., this weekend)
â Must INTROSPECT
⢠Must have something LEGITIMATE to offer
⢠Start SMALL â both with interventions and
logistics/financial
â E.g, Âź grain Armour, or Cytomel 5 MICROgrams, or Cortef 5 mg
twice daily, or FDA approved testosterone for guys
â E.g. â ½ day per week â âhormonesâ
⢠Get EDUCATION
â Teachers â Rouzier, World Link Medical
â AAMG, A4M
⢠Find a mentor (s) â start here
76.
77. Marketing & Practice Development
⢠Maintain excellence in allopathy or (traditional
osteopathy)
â (knowledge base, prescribing, surgery)
â (âBe able to debate the great issues.â â 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.
78. Quick examples of powering
through objections and
overwhelming with literature
Note â donât get bogged down.
Get the idea of HOW TO
PRESENT the data.
79. A Scientific (& FUN!!!) Review of Vitamin
Supplementation & Essential Nutrients
Louis B. Cady, MD â CEO & Founder â Cady Wellness Institute
Adjunct Professor â University of Southern Indiana
Adjunct Clinical Lecturer â Indiana University School of Medicine
Department of Psychiatry
Child, Adolescent, Adult & Forensic Psychiatry â Evansville, Indiana
Presented 2 27 2010 â Oliver Headache and Pain Clinic
CME seminar â Evansville, IN
81. ⢠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.
⢠âOur findings reinforce the notions that in
mitochondrial disease, oxidative stress is
important and can be reduced by
administration of a cysteine donor.â
82. Zoned, Stoned and Blown: The Emotional
Tsunami of Psychiatric Disorders Coupled
with Pain Disorders & Chemical Dependency
Louis B. Cady, MD â CEO & Founder â Cady Wellness Institute
Adjunct Professor â University of Southern Indiana
Adjunct Clinical Lecturer â Indiana University School of Medicine
Department of Psychiatry
Child, Adolescent, Adult & Forensic Psychiatry â Evansville, Indiana
Also Presented 2 27 2010 â Oliver Headache and Pain
Clinic CME seminar â Evansville, IN
83.
84. Pharmacotherapy Significantly
Reduces Substance Abuse in Adults
with ADHD
40
32
3-fold! P<0.001
% of study population
30
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.
86. âYou can have everything in life
you want, if you just help
enough other people get what
they want.â
- Zig Ziglar
What do patients want?
â˘To be treated with
respect
â˘To not have to wait!
â˘To FEEL BETTER
â˘To HAVE HOPE.
â˘To not be doped up.
â˘To NOT have their
money wasted.
87. $5,000 worth of wisdom on one page
â from Jay Abraham
⢠Risk reversal
⢠âUSPâ â unique selling Focus: âBe able to
proposition
treat your clients
⢠Defining the buying
(or patients) as
criteria
dear and valued
⢠Three ways for more
friends.â
profit: - Jay Abraham
â Higher price
â More frequency
â Additional items
(supplements, etc.)
88. 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
89. My position on supplements
⢠âThe needs of the patient come first.â â 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.
91. Building CWI - what has worked
⢠Being nice to patients
â (on time, polite, compliment on questions, donât be a
jerk or abrasive, put yourself into their shoes, etc.)
⢠Be good and get results. BE THE BEST!
⢠Be TRANSPARENT â giveâem their labs.
â Write on them. Draw pictures. Take time (and BILL
FOR IT).
â Cenegenics model
⢠Be appropriately self-protective of your time and
talents. âIf they show up, billâem.â â Dan
Kennedy.
92. MARKETING â what has and hasnât
worked
Worked Hasnât worked
⢠Word of mouth ⢠Paid advertising (TV,
⢠Public seminars print, magazines)
⢠Web site
⢠What I HAVENâT tried:
⢠Going to MDâs/DOâs
â Marketing consultants
offices PERSONALLY
â Radio ads
⢠Free stuff â PR
opportunities New initiatives:
⢠Going to places and â˘Proprietary, paid websites
NETWORKING â˘âSEOâ â search engine
optimization (Willie Sutton
principle)
93.
94. Additional resources â handouts
down front at end of lecture
⢠âThe 10 Commandments of Marketing a
Medical Practiceâ â Cady (handout, free)
⢠Additional resources handout sheet
⢠Practice Transformation Seminar â to be
schedule 2013 - at Cady Wellness Institute
95. 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 â Suite F
Interstate Office Park
Newburgh, IN 47630 (USA)
Download from
iTunes or Android App store now!
98. Success and Failure (Jim Rohn)
What about you? Youâve only got one body.
⢠âErrors in judgementâ - High glycemic eating,
no exercise, poor nutrition, lousy/no
supplementation, high stress practice.
- âGood disciplinesâ â appropriate diet,
supplementation, exercise, hormones. Stress
management. Decent practice and lifestyle.
99. 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
100. 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 â Suite F
Interstate Office Park
Newburgh, IN 47630 (USA)
Editor's Notes
Health care provider and âconsumerâ
The politicians are constantly told that MD âs 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 â to âmaintain the current perceived benefit of the structure.â Next priority is taxes â âYou will protect your constituency.â Republicans want tax cuts for everybody. Democrats â protecting their constituency. âTax the richâ 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 âs and 1970âs â when it was known that someoneâs child was becoming a doctor, it was viewed as a great accomplishment.
Giuseppe Mazzini (22 June 1805 â 10 March 1872), nicknamed &quot;Soul of Italy,&quot;[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 ] â 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]