On the Hidden/Real Costs of Healthcare/Insurance: NY Times Article

I avoid getting political in matters relating to my practice, which would include on this blog. In the case of universal health care, the political relates to my practice, and I find myself no longer able to restrain my urge to speak out.

I suppose first off I should straight out say that I am emphatically for universal health care because it is the humane and compassionate thing to do. With the advances in western medical technology causing health care costs to rise astronomically, I can not see any reason why the so called 'most advanced nation on earth' does not provide health care/insurance for all members of it's society. The notion of not providing health care to all, and rather only providing it to the 'haves', is medieval, IMO.

On the day that Obama will address the nation regarding providing universal health care for all, the New York Times has published an article regarding the hidden costs of health care, which it reports has risen annually to $7,500/person, $15,000/household. Up 5x the cost, from about $1,500/person, in 1960. KB

Mahatma Gandhi Kitcharee: Rice & Grain Dish Works Well for Poor Appetite

In TCM (Traditional Chinese Medicine) we often prescribe a rice porridge called congee for those with poor appetite or difficult digestion, esp. for chronic illness, cancer or chemotherapy. Congees are traditionally made with rice, although any grain can be uses. They are cooked with lots of water (8:1 water: rice) and cooked for a long time (4-8hr: a crock pot is often used). Herbs, meats, dried fruits, sweeteners and nuts are added for flavor and medicinal effect. A respected teacher of mine gave accounts of bedridden patients with cancer brought back from the precipice through the use of congee.

In India, they make a traditional dish called kitcharee, which is similar to the medicinal effect of congee, but less water and cooking time is involved. Kitcharee works well for those who can eat solid foods, but have poor appetite. It's an Indian comfort food. I also think it's a spiritual food, being merely rice and dal (lentils), which may explain why Gandhi enjoyed this simple, nourishing dish.

2:1 rice to dal (yellow lentils)

Any long-cooking rice can be used: basmati, jasmine. I suggest long-grained rice. Being as this is an Indian dish, traditionally basmati rice is used. With loose stools use white rice, with hard or difficult stools use brown.

1: 1 1/2 rice & dal (pre-soaked): water/stock. I suggest soaking the rice for 24h in advance to make it more digestible. According to Paul Pitchford, author of "Healing With Whole Foods" soaking grains for 24h helps to prevent fatigue.

1:2 - 2 1/2 rice/grain: water/stock Use this proportion when using unsoaked grains.

I suggest using 50/50 water & stock (vegetable, beef or chicken). For vegetarians & meditators use vegetable stock. I believe eating a meatless diet aids the transcendence to the spiritual realms. You'll find many spiritual peoples - Buddhists, hindis - eat a vegetarian diet.

Example: 1C long-grain rice: 1/2C dal (yellow lentils). 1 1/2C rice (soaked)/dal: 2 1/4C water/stock or 1 1/2C rice (unsoaked)/dal: 3 - 3 3/4C water/stock.

+ salt (1/2t) I suggest sea salt because it is high in valuable trace minerals. I like to add a few sprigs of fresh parsley.

Pressure cook 15min (low pressure) with soaked rice, longer (30-40min) unsoaked grain. If you are not using a pressure cooker, cook it longer: 40m-1h, until lentils are soft and all the water is absorbed. (First bring to a boil, then turn down to a simmer and cook).

Here's the special favor enhancer:

As soon as the grain has finished cooking heat some high heat oil (1T - olive, sunflower) in a small frying pan on medium heat. As soon as the oil is hot (just a few minutes on a gas stove) add cumin seeds (1/2t) and let them fry for 10 seconds until the aroma arrives and they are foaming. Immediately lift the lid on the grains and pour in the fried cumin seeds, and quickly replace the lid. Let them sit in the pot for 1 minute or so. Then stir and serve. I like to garnish with fresh, chopped parsley or pesto.

Kitcharee can be eaten for any meal - breakfast, lunch or dinner. You can make up a larger quantity and reheat it at meal time. It travels well for brown bagging. KB

Dangers of Using Cellphone While Driving, NY Times Article

The New York Times is running a series on the dangers of using cellphones while driving. This article tells the heart wrenching story of a young man who caused a deadly auto accident because he never saw the red light while engaged in a cell phone conversation.

According to the NY Times research, studies show cell phone drivers have an equal crash risks as a drunk driver. The article cites a 2003 Harvard study asserting that "cellphone distractions caused 2,600 traffic deaths every year, and 330,000 accidents that results in moderate or severe injuries."

"Five states and the District of Columbia require drivers who talk on cellphones to use hands-free devices, but research shows that using headsets can be as dangerous as holding a phone because the conversation distracts drivers from focusing on the road."

"Last year, the federal agency dealing with road safety, the National Highway Traffic Safety Administration, published a study, based on researchers’ observations of drivers, suggesting that at any time during daylight hours in 2007, 11 percent — or 1.8 million drivers — were using a cellphone.
And in a survey of 1,506 people last year by Nationwide Mutual Insurance, 81 percent of cellphone owners acknowledged that they talk on phones while driving, and 98 percent considered themselves safe drivers. But 45 percent said they had been hit or nearly hit by a driver talking on a phone. "

"Seven years ago, when cellphones and services like texting were less common, federal researchers estimated that drivers using cellphones caused about 1,000 fatalities and played a role in 240,000 crashes. (In 2007, drunken driving caused 13,000 fatalities.) "

"University of Utah, Professor Strayer has spent a decade studying driver distraction.
Mr. Strayer’s research, showing that multitasking drivers are four times as likely to crash as people who are focused on driving, matches the findings of two studies, in Canada and in Australia, of drivers on actual roads."

"The highway safety administration estimates that drivers using a hand-held device are at 1.3 times greater risk of a crash or near crash, and at three times the risk when dialing, compared with others who are simply driving. The agency based its conclusions on research from the Virginia Tech Transportation Institute, which placed cameras inside cars to monitor drivers for more than a year. The study found cellphones to be the most common cause of driver distraction.
Research also shows that drivers conversing with fellow passengers do not present the same danger, because adult riders help keep drivers alert and point out dangerous conditions and tend to talk less in heavy traffic or hazardous weather. "

"July 2003, researchers at the National Highway Traffic Safety Administration . . . in a proposed draft of a cellphone policy for the agency as a “a significant body of research worldwide.”
The draft policy said: “We are convinced that legislation forbidding the use of handheld cellphones while driving will not be effective since it will not address the problem. In fact, such legislation may erroneously imply that hands-free phones are safe to use while driving.”
The agency’s current advice is that people should not use cellphones while driving and that hands-free devices do not eliminate the risks of distracted driving. "


"the big device companies even offer warnings [of the dangers of cellphone driving] that remind them of labels on cigarette packs. Verizon Wireless, for instance, posts instructions on its Web sites not to talk while driving — with or without a headset."

". . .Some states have overcome opposition to pass restrictions. Joe Simitian, a state senator in California, managed to get his hands-free legislation, an effort he began in 2001, passed in 2006. . .his bill requiring use of headsets while driving took effect in July 2008. In the first six months the California law was in effect, a preliminary California Highway Patrol estimate showed that fatalities dropped 12.5 percent — saving 200 lives. "

KB

Studies Show Childhood Stress & Trauma Increase Risk For Auto Immune Diseases & Asthma

There have been some interesting studies published recently showing a positive correlation between childhood stress & trauma and auto immune diseases and asthma. Deepak Chopra has been discussing the findings of one of these studies on auto immune diseases on various news channels lately. I have pasted abstracts from a few of these studies published in Psychosomatic Medicine below for your perusal.

As an acupuncturist, this information has peaked my interest.

There are a couple of reasons I wanted to learn more about these findings. First, as a holistic medicine (meaning one that treats the whole: mind/body/spirit, and considers the organism to be inseparable or part of its surrounding environment) Traditional Chinese Medical (TCM) theory has long recognized the relationship between emotions and diseases. In fact, TCM considers the 7 emotions (joy, grief, sorrow, anger, worry, fright, fear) to be a direct cause of disease and pathology in the body. Trauma (coming from the exterior environment) would involve fright, fear, anger, sorrow, grief and worry all of which bind qi (prevent energy in the body from circulating smoothly) causing disease processes to set in: when qi, and hence blood & fluids (it takes qi or energy to move blood & fluids) do not flow smoothly, pain arises, growths (tumours) develop, phlegm accumulates (causing allergy & asthma symptoms) and so on. So a top priority in TCM treatment of any disease is to keep the qi (and hence blood and fluids) flowing smoothly.

The 7 emotions cause qi (blood & fluids) to stagnate (slow down or stop moving). I'll demonstrate this idea with anger: when we get angry we get tense and tighten up. This tightening prevents qi from moving smoothly. Likewise grief and sorrow result in emotional and physical depression, meaning qi slows down or stops moving. With fear & fright we stop, or freeze. Animals demonstrate this physically when they realize there is a predator near. When worrying, we get stuck in a feedback loop, going over and over the same thoughts: like an eddy in a river. The river of qi swirls around itself rather than moving forward with the current.

The studies mentioned here have focused on pediatric factors, but the implications are not limited to childhood trauma. The results can be extrapolated to include adult traumas & stresses as well, according to TCM theory of the 7 emotional causes of disease.

Secondly, I find it interesting that the recent study showed a high correlation between autoimmune diseases and stress & traumas. Let's explore this idea for a moment.

With autoimmune diseases, the immune system is attacking itself. It misidentifies it's own tissues, marking them as foreign bodies (pathogens) that must be attacked and neutralized. Deepak Chopra's interpretation of the study's results is that in the case of abuse or trauma, esp. for a child, one's boundaries begin to blur regarding who is friend and foe: most often the abuser is a family member. The confusion is registered in the body's immune system.

I would postulate that when under stress, this effect is amplified. We feel we are under attack by the outside force who's interaction with us becomes stressful, and due to that stress, we begin an inner dialogue which may in someways be self-abusive. We ruminate, are fearful, depressed and in perpetuating and nurturing these adverse emotions we are attacking ourselves, impeding our own inner peace and harmony. Thus our immune system identifies ourselves (physically) as a pathogen, or a disease causing agent. In a way, in the case of those who have a positive correlation between compromised immunity and high stress or trauma, the immune system can be seen as doing it's job by diagnosing/identifying ourselves (emotions & thoughts) as the disease pathogen, and it then goes on with its mission to attack and destroy the offending agent.

Maybe the lesson here with immune disorders (or any disease process for that matter) is to see if there is something we are doing in mind or lifestyle that is detrimental to the homeostasis of our well being and if so address it.

I realize that I am going out on a limb here with this extrapolation of the study findings. I am not suggesting that all autoimmune diseases can be cured merely by correcting poor life habits and state of mind. Or even that all autoimmune disease are correlated with stress & trauma in every case. What I am saying is that in TCM we know that lifestyle and emotions are a causative factor in the formation of diseases, and that an important component of any treatment plan is to address the role of these adverse factors in the disease process. KB

Psychosomatic Medicine 71:243-250 (2009)
© 2009 American Psychosomatic Society

ORIGINAL ARTICLES

Cumulative Childhood Stress and Autoimmune Diseases in Adults

Shanta R. Dube, PhD, MPH, DeLisa Fairweather, PhD, William S. Pearson, PhD, MHA, Vincent J. Felitti, MD, Robert F. Anda, MD, MS and Janet B. Croft, PhD

From National Center for Chronic Disease Prevention and Health Promotion (S.R.D., W.S.P. R.F.A., J.B.C.), Centers for Disease Control and Prevention, Division of Adult and Community Health, Atlanta, Georgia; Department of Environmental Health Sciences (D.F.), Bloomberg School of Public Health and Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and the Department of Preventive Medicine (V.J.F.), Southern California Permanente Medical Group (Kaiser Permanente), San Diego, California.

Address correspondence and reprint requests to Shanta R. Dube, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Adult and Community Health, 4770 Buford Highway, N.E., MS K-50, Atlanta, GA 30341-3717. E-mail: skd7@cdc.gov

Objective:

To examine whether childhood traumatic stress increased the risk of developing autoimmune diseases as an adult.

Methods:

Retrospective cohort study of 15,357 adult health maintenance organization members enrolled in the Adverse Childhood Experiences (ACEs) Study from 1995 to 1997 in San Diego, California, and eligible for follow-up through 2005.

ACEs included

• childhood physical
• emotional
• or sexual abuse
• witnessing domestic violence
• growing up with household substance abuse
• mental illness
• parental divorce
• and/or an incarcerated household member.

The total number of ACEs (ACE Score range = 0-8) was used as a measure of cumulative childhood stress.

The outcome was hospitalizations for any of 21 selected autoimmune diseases and 4 immunopathology groupings:

• T- helper 1 (Th1) (e.g., idiopathic myocarditis)
• T-helper 2 (Th2) (e.g., myasthenia gravis)
• Th2 rheumatic (e.g., rheumatoid arthritis)
• and mixed Th1/Th2 (e.g., autoimmune hemolytic anemia).

Results:

Sixty-four percent reported at least one ACE.

The event rate (per 10,000 person-years) for a first hospitalization with any autoimmune disease was 31.4 in women and 34.4 in men.

First hospitalizations for any autoimmune disease increased with increasing number of ACEs (p < .05).

Compared with persons with no ACEs, persons with 2 ACEs were at a

• 70% increased risk for hospitalizations with Th1,
• 80% increased risk for Th2,
• and 100% increased risk for rheumatic diseases (p < .05).

Conclusions:

Childhood traumatic stress increased the likelihood of hospitalization with a diagnosed autoimmune disease decades into adulthood.

These findings are consistent with recent biological studies on the impact of early life stress on subsequent inflammatory responses.

Key Words: childhood abuse • traumatic stress • autoimmune diseases • stress • inflammatory response

Abbreviations: ACE = adverse childhood experience; AD = autoimmune disease; Th1 = T-helper 1; Th2 = T-helper 2; CRP = C-reactive protein; CRH = corticoid releasing hormone

---

Psychosomatic Medicine 71:243-250 (2009)
© 2009 American Psychosomatic Society

Cumulative Childhood Stress and Autoimmune Diseases in Adults

Shanta R. Dube, PhD, MPH, DeLisa Fairweather, PhD, William S. Pearson, PhD, MHA, Vincent J. Felitti, MD, Robert F. Anda, MD, MS and Janet B. Croft, PhD

^{From National Center for Chronic Disease Prevention and Health Promotion (S.R.D., W.S.P. R.F.A., J.B.C.), Centers for Disease Control and Prevention, Division of Adult and Community Health, Atlanta, Georgia; Department of Environmental Health Sciences (D.F.), Bloomberg School of Public Health and Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland; and the Department of Preventive Medicine (V.J.F.), Southern California Permanente Medical Group (Kaiser Permanente), San Diego, California.}

Address correspondence and reprint requests to Shanta R. Dube, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Adult and Community Health, 4770 Buford Highway, N.E., MS K-50, Atlanta, GA 30341-3717. E-mail: kd7@cdc.gov

^{http://www.psychosomaticmedicine.org/cgi/content/abstract/71/2/243}

---

Psychosomatic Medicine 71:243-250 (2009)
© 2009 American Psychosomatic Society

ORIGINAL ARTICLES

Received August 5, 2008
Returned for revision November 20, 2008

Double-Exposure to Acute Stress and Chronic Family Stress is Associated With Immune Changes in Children With Asthma

Teresa J. Marin , MA, Edith Chen , PhD, Jennifer A. Munch , BA, Gregory E. Miller , PhD

Address correspondence and reprint requests to: Teresa J. Marin, MA, E-mail: teresamarin@psych.ubc.ca.

	Abstract

Objective: To understand how psychological stress heightens risk for asthma flare-ups, we examined the relationship between acute stress, chronic family stress, and the production of asthma-related cytokines. Methods: Seventy-one children with asthma and 76 medically healthy children completed interviews regarding life stress, and peripheral blood samples were collected. After mononuclear cells had been mitogenically stimulated, production of the cytokines interleukin (IL)-4, IL-5, IL-13, and IFN- was measured. All measurements were repeated every 6 months for 2 years. Children reported on their asthma symptoms for 14 days after each study visit. Results: Children with asthma who had higher levels of chronic family stress showed increased production of IL-4, IL-5, and IFN- at times when they had experienced an acute event compared with times when they had not. These stress-related changes did not occur in asthmatic children with lower levels of chronic family stress, or in healthy controls. The combination of acute and chronic stress was also associated with increased asthma symptoms. Conclusion: These findings suggest that acute negative life events have a particularly strong impact among a subgroup of children with asthma who are under high chronic family stress. The heightened inflammatory profile in this group suggests an explanation for why children experiencing life stressors are at greater risk for asthma exacerbations.

Psychosom Med 2009, doi:10.1097/PSY.0b013e318199dbc3

© 2009 by American Psychosomatic Society


Psychosomatic Medicine 70:1035-1043 (2008)
© 2008 American Psychosomatic Society

ORIGINAL ARTICLES

Childhood Adversity, Early-Onset Depressive/Anxiety Disorders, and Adult-Onset Asthma

Kate M. Scott, PhD, Michael Von Korff, ScD, Jordi Alonso, MD, PhD, Matthias C. Angermeyer, MD, Corina Benjet, PhD, Ronny Bruffaerts, PhD, Giovanni de Girolamo, MD, Josep Maria Haro, MD, PhD, Ronald C. Kessler, PhD, Viviane Kovess, MD, PhD, Yutaka Ono, MD, Johan Ormel, PhD and José Posada-Villa, MD

From the Department of Psychological Medicine (K.M.S.), School of Medicine and Health Sciences, Otago University, Wellington, New Zealand; Center for Health Studies (M.V.K.), Group Health Cooperative of Puget Sound, Seattle, Washington; Health Services Research Unit (J.A.), Institut Municipal d'Investigacio Medica (IMIM) and CIBER en Epidemiologia y Salud Publica (CIBERESP), Barcelona, Spain; Center for Public Mental Health (M.C.A.), Gösing am Wagram, Austria; National Institute of Psychiatry (C.B.), Calzada Mexico Xochimilco, Mexico City, Mexico; Department of Neurosciences and Psychiatry (R.B.), University Hospital, Gasthuisberg, Leuven, Belgium; Regional Health Care Agency (G.G.), Emilia-Romagna Region, Bologna, Italy; Sant Joan de Deu-SSM (J.M.H.), RETICS RD06/0011 REM-TAP, Barcelona, Spain; Department of Health Care Policy (R.K.), Harvard Medical School, Boston, Massachusetts; Fondation MGEN pour la Santé Publique (V.K.), Université Paris 5, Paris, France; Health Center (Y.O.), Keio University, Tokyo, Japan; Department of Psychiatry (J.O.), University Medical Center, Groningen, Netherlands; and Colegio Mayor de Cundinamarca University (J.P.-V.), Bogota, Colombia.

Address correspondence and reprint requests to Kate M. Scott, Department of Psychological Medicine, School of Medicine and Health Sciences, Otago University, Wellington, PO Box 7343, Wellington South, New Zealand. E-mail: kate.scott@otago.ac.nz

Objectives: To investigate a) whether childhood adversity predicts adult-onset asthma; b) whether early-onset depressive/anxiety disorders predict adult-onset asthma; and c) whether childhood adversity and early-onset depressive/anxiety disorders predict adult-onset asthma independently of each other. Previous research has suggested, but not established, that childhood adversity may predict adult-onset asthma and, moreover, that the association between mental disorders and asthma may be a function of shared risk factors, such as childhood adversity.

Methods: Ten cross-sectional population surveys of household-residing adults (>18 years, n = 18,303) assessed mental disorders with the Composite International Diagnostic Interview (CIDI 3.0) as part of the World Mental Health surveys. Assessment of a range of childhood family adversities was included. Asthma was ascertained by self-report of lifetime diagnosis and age of diagnosis. Survival analyses calculated hazard ratios (HRs) for risk of adult-onset (>age 20 years) asthma as a function of number and type of childhood adversities and early-onset ( for current age, sex, country, education, and current smoking.

Results: Childhood adversities predicted adult-onset asthma with risk increasing with the number of adversities experienced (HRs = 1.49–1.71). Early-onset depressive and anxiety disorders also predicted adult-onset asthma (HRs = 1.67–2.11). Childhood adversities and early-onset depressive and anxiety disorders both predicted adult-onset asthma after mutual adjustment (HRs = 1.43–1.91).

Conclusions: Childhood adversities and early-onset depressive/anxiety disorders independently predict adult-onset asthma, suggesting that the mental disorder-asthma relationship is not a function of a shared background of childhood adversity.

Key Words: asthma • childhood adversity • comorbidity • depressive disorders • anxiety disorders

Abbreviations: CIDI = Composite International Diagnostic Interview; HR = hazard ratio; WMH = World Mental Health; HPA = hypothalamic-pituitary-adrenal; CI = Confidence Interval.

Chinese Medicine Explained in Video

A couple of lovely young ladies who are recent grads from my acupuncture college, Pacific College of Oriental Medicine (PCOM) and now fellow North Carolinians have put together this thoughtfully written & produced video, called School Me, to explain about Chinese Medicine's history & theory, including herbal medicine, and the educational level of a Licensed Acupuncturist. It's a 30min video, but I'm sure those interested in learning more about the topic will find it complete and interesting. KB


http://www.vimeo.com/5403390