JHI Partners Forum, 2012 Linda A. Lee, MD Johns Hopkins Integrative Medicine & Digestive Center Division of Gastroenterology and Hepatology

 Primary location at Green Spring Station  Consultative services also available at the Hospital  Staff  Four physicians (internist, GYN, GI, rheumatologist)  Two acupuncturists (TCM)  Four licensed massage therapists  Two psychotherapists – hypnotherapy, CBT, guided imagery  One nutritionist – individual consultations and group classes

 To create an inviting, comfortable, safe environment  Allow lengthy appointments so there is more time to understand the multiple dimensions of illness, to educate the patient, and discuss the full range of evidence-based therapies  Offer services within the Center that would be readily accessible to patients as well as referring providers

 4000 visits to the Center in FY12  Open Mon-Sat, evening hours until 9 pm  6 examination rooms, all multipurpose  Staff offer personal, concierge-type service  Is the only integrative medicine center in the US based in gastroenterology

 What training or education did she receive?  Is the practitioner licensed in the state?  Is certification by a professional organization required for state licensure? (e.g. NCCAOM)  What clinical and research experience does she have?  Is the practitioner integrative, or disintegrative?

 Engage the patient as an active participant  Provide education about health, symptoms, and diseases  Counsel in appropriate nutrition practices and supplement use  Discuss evidence-based pharmacologic and mind- body therapies  The patient-provider interaction is a vital part of the healing process

 Medical therapy  Additional testing  Lifestyle changes  Low fat diet  Avoid caffeine  Avoid carbonated beverages  Limit your alcohol intake  Stop smoking  Raise the head of your bed

 Esophageal hypersensitivity has been implicated as a cause of reflux symptoms  Psychosocial factors are known to mediate both peripheral and central hypersensitivity and play a role in symptom perception among patients with GERD  Behavioral medicine techniques (CBT and hypnotherapy) may be a useful adjunct to other anti- reflux therapy in those who experience increased symptoms during stress McDonald-Haile, J, et al. Gastroenterology, 1994;107(1):61-9 Van Peski-Oosterbaan, AS, et al. Am J Med 1999; 106: 424–9 Miwa, H et al. J Neurogastroenterol Motil, Vol. 16 No. 4 October, 2010

 Understand and treat the symptoms in the context of the patient’s home and work life  Educate the patient as to why GERD occurs  Discuss weight loss as a long- term management strategy  Discuss evidence-based acupuncture  Answer questions about the use of supplements  Determine if stress is a trigger for symptoms and identify strategies for addressing stress  Medical therapy  Additional testing  Lifestyle changes  Low fat diet  Avoid caffeine  Avoid carbonated beverages  Limit your alcohol intake  Stop smoking  Raise the head of your bed PLUS THIS:

Dickman, R. et al. Aliment Pharmacol Ther : 1333–1344

no scientific evidence… yet Fennel seed Licorice Apple Cider Vinegar

Physician Conventional care Acupuncturist Psychotherapist Nutritionist Massage Therapist Physician JHIMDC

 Cost savings could be realized by  Decreasing utilization of expensive medical interventions such as pharmaceuticals, or reducing trips to the ER  Reducing provider visits by offering group interventions, such as stress reduction, nutrition education, and mind-body skills training

 By the year 2022, 80% of the US population will be overweight or obese (currently 66%)  Projected healthcare spending related to overweight and obesity by the year 2020 is estimated to be $437.6 billion (was $81.5 billion in 2000) Yang, F. et al Obesity (2008) 16 10, 2323–2330

 Current healthcare reimbursement favors procedures and pharmaceuticals over education, adequate face- to-face time, mind-body therapies  Conventional practitioners lack knowledge about evidence-based healing practices and practitioners, and how to identify them