NPR interviews Dr. Elana Rios, president of the National Hispanic Medical Association (NHMA), on the onethird of Hispanics in the U.S. who are uninsured. She says the reasons are cultural as well as economic “Hispanics have health beliefs that are unique, lots of traditional ways of taking care of disease with teas and herbs and other things. And so families dont send their children or young adults to doctors. Another reason is other Hispanics come from other countries where their government provides health insurance.” She also points to problems with trust “Hispanics cannot entrust these authority figures, and let alone government, because we have mixed families with undocumented grandparents who dont want to be deported back to where they come from.”

Rios says affordable health insurance would help solve the problem, along with “lots of education and outreach of the importance of purchasing health insurance.” The NHMA “agrees with President Obama to have this health care reform system be changed for American citizens and those eligible to participate for health reform, and that does not include illegal and undocumented” (Morning Edition, Wertheimer, 9/23).

NPR also interviews Yvette Roubideaux, director of the Indian Health Service (IHS), on “what the rest of the country can learn” from the program. The IHS was started in 1955 and provides care for “about half of this countrys 4.3 million AmericanIndians and Alaskan natives” with a network of more than 600 hospitals and clinics located on or near reservations. Roubideaux says that historically, the program has “had difficulty meeting the needs and the growing demands of the patients it serves with the limited budget that it has.” It has also “had difficulty recruiting doctors to work in rural and remote areas.”

The IHS is not a singlepayer system Roubideaux explains that at some facilities, more than half of the total budget comes from billing to Medicare, Medicaid and private insurance. She adds that the quality of care from IHS is “sort of a mixed picture. If you look at the quality of care over time, since 1955, there are some areas where weve made great improvements. Weve been able to reduce mortality for some conditions and especially in the area of diabetes, weve been able to reduce care to the point to where I think its actually better than what people did in the general U.S. health care system.” But, “sometimes the budget doesnt stretch far enough for us to do more of the preventive practices,” she explains (Tell Me More, Martin, 9/23).

Related KHN column The Indian Health Service Paradox

This information was reprinted from kaiserhealthnews.org with kind permission from the Henry J. Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives and sign up for email delivery at kaiserhealthnews.org.

© Henry J. Kaiser Family Foundation. All rights reserved.

A journey that started with a bad back and the threat of a major operation is about to culminate in a study tour to a leading American medical facility for a researcher at The University of Queensland.

Research scholar Jon Wardle has received a UQ TransPacific Fellowship worth almost $10,000 to meet experts in the field of complementary medicine at the University of Washington.

Mr Wardle will talk to his Seattle counterparts about the role of complementary medicine in rural general practice during a 10week stint in the US early next year.

“It is a very exciting opportunity,” Mr Wardle said.

“The NorthWest Pacific region is the complementary medicine research capital of the USA. The amount I can learn there is amazing.”

Mr Wardle said he became interested in complementary medicine when he hurt his back while working as a nursing student and assistant nurse at the age of 21.

Instead of going for an operation to have a rod inserted in his back, he decided to try acupuncture and naturopathy.

“I was on pain killers and could not get out of bed some days. I was freaking out about having a rod in my back,” he said.

“I was quite young and it was a scary proposition. I went looking for other options.”

When the pain disappeared and Mr Wardle recovered using the complementary medicine therapies, he decided to become a naturopath.

Since then, he has completed a Master of Public Health at UQ and become a director of NORPHCAM, a collaborative network established to encourage international public health and health services research focusing on complementary and alternative medicine.

Mr Wardle said one in six Australian people used complementary medicine as their first option for treating illness or injuries, making it important to have plenty of research in the field.

Acupuncture has been used in EastAsian medicine for thousands of years to treat pain, possibly by activating the bodys natural painkillers. But how it works at the cellular level is largely unknown.

Using brain imaging, a University of Michigan study is the first to provide evidence that traditional Chinese acupuncture affects the brains longterm ability to regulate pain.

The results appear online ahead of print in the September Journal of NeuroImage.

In the study, researchers at the UM Chronic Pain and Fatigue Research Center showed acupuncture increased the binding availability of muopoid receptors (MOR) in regions of the brain that process and dampen pain signals specifically the cingulate, insula, caudate, thalamus and amygdala.

Opioid painkillers, such as morphine, codeine and other medications, are thought to work by binding to these opioid receptors in the brain and spinal cord.

“The increased binding availability of these receptors was associated with reductions in pain,” says Richard E. Harris, Ph.D., researcher at the UM Chronic Pain and Fatigue Research Center and a research assistant professor of anesthesiology at the UM Medical School.

One implication of this research is that patients with chronic pain treated with acupuncture might be more responsive to opioid medications since the receptors seem to have more binding availability, Harris says.

These findings could spur a new direction in the field of acupuncture research following recent controversy over large studies showing that sham acupuncture is as effective as real acupuncture in reducing chronic pain.

“Interestingly both acupuncture and sham acupuncture groups had similar reductions in clinical pain,” Harris says. “But the mechanisms leading to pain relief are distinctly different.”

The study participants included 20 women who had been diagnosed with fibromyalgia, a chronic pain condition, for at least a year, and experienced pain at least 50 percent of the time. During the study they agreed not to take any new medications for their fibromyalgia pain.

Patients had position emission tomography, or PET, scans of the brain during the first treatment and then repeated a month later after the eighth treatment.

Notes
Additional authors JonKar Zubieta, M.D., Ph.D., David J. Scott, Vitaly Napadow, Richard H. Gracely, Ph.D, Daniel J. Clauw, M.D.
Funding Department of Army, National Institutes of Health
Reference Journal of NeuroImage, Vol. 5, No. 83, 2009

Source
Shantell M. Kirkendoll

According to a new report based on a government survey in 2007, in the previous 12 months Americans had spent a total of $33.9 billion out of their own pockets on complementary and alternative medicine (CAM).

The report was compiled by Dr Richard L. Nahin of the National Institutes of Healths National Center for Complementary and Alternative Medicine (NCCAM) and colleagues and was published in the 30 July issue of the US Centers for Disease Control and Prevention (CDC) National Health Statistic Report.

For the purpose of the report, CAM was defined as a diverse group of medical and health care systems, practices and products that are not generally considered to be part of conventional medicine for instance herbal supplements, chiropractic, acupuncture and meditation.

According to sources cited by a recent National Institutes of Health press release, CAM accounts for around 1.5 per cent of the $2.2 trillion that the US spends on healthcare every year, and around 11.2 per cent of outofpocket expenditures (where people pay for it themselves as opposed to the state or insurance scheme).

For the report, Nahin and colleagues used data from the Complementary and Alternative Medicine Supplement of the 2007 National Health Interview Survey (NHIS), which is conducted by the CDCs National Center for Health Statistics.

The survey data came from 3,393 completed interviews with sample adults aged 18 years and over.

The authors used a statistical software package called SUDAAN to calculate estimates and standard errors. The package is designed to tackle the sample complexity of surveys like the NHIS so that the results are reprensentative of the US civilian, noninstitutionalized population aged 18 years and over.

The results showed that in 2007Adults in the US spent a total of $33.9 billion out of pocket to visit CAM practitioners and buy CAM products, classes and materials.
Nearly twothirds of this total went on selfcare purchases of CAM products, classes and materials ($22.0 billion).
The remaining third ($11.9 billion) was spent on practitioner visits.
Despite the greater amount spent on selfcare therapies, 38.1 million adults made an estimated 354.2 million visits to CAM practitioners.
About three quarters of the total number of CAM practitioner visits and out of pocket expenditure on CAM practitioners was linked to manipulative and bodybased therapies.
44 per cent of the total out of pocket expenditure on CAM (about $14.8 billion) was spent on nonvitamin, nonmineral, natural products.To put these figures in to context, £14.8 billion spent on spent on nonvitamin, nonmineral, natural CAM products is about one third of the total out of pocket expenditure spent on prescription medicine. And the $11.9 billion spent on seeing CAM practitioners is about one quarter of the total out of pocket expenditure spent on visiting “conventional” physicians.

Nahin, who is acting director of NCCAMs Division of Extramural Research, told the media that

“These data indicate that the US public makes millions of visits to CAM providers each year and spends billions of dollars for these services, as well as for selfcare forms of CAM.”

“While these expenditures represent just a small fraction of total health care spending in the United States, they constitute a substantial part of outofpocket health care costs,” he added.

While there is no previous exact survey with which comparisons can be made, the authors did discuss how these results compare with a broadly similar survey covering much the same set of CAM therapies that was done about 10 years ago by DM Eisenberg and colleagues and published in the Journal of the American Medical Association in 1998.

The greatest contrast between the surveys appears to be that Americans today spend most of their out of pocket total CAM expenditure on selfcare products, classes and materials than on consulting practitioners, whereas 10 years ago it was the other way around

“The present observation that about twothirds of CAM costs were associated with selfcare therapies contrasts with the findings of Eisenberg et al, who reported that the majority of CAM costs resulted from consultations with healthcare professionals offering CAM services,” wrote the authors.

“Costs of Complementary and Alternative Medicine (CAM) and Frequency of Visits to CAM Practitioners United States, 2007.”
Richard L. Nahin, Patricia M. Barnes, Barbara J. Stussman, and Barbara Bloom.
US Centers for Disease Control and Prevention.
National Health Statistic Report, Number 18, July 30, 2009 (PDF download).

Additional source NIH/National Center for Complementary and Alternative Medicine.

Exercise and electroacupuncture treatments can reduce sympathetic nerve activity in women with polycystic ovarian syndrome (PCOS), according to a new study. The finding is important because women with PCOS often have elevated sympathetic nerve activity, which plays a role in hyperinsulinemia, insulin resistance, obesity and cardiovascular disease

The study also found that the electroacupuncture treatments led to more regular menstrual cycles, reduced testosterone levels and reduced waist circumference.

Exercise had no effect on the irregular or nonexistent menstrual cycles that are common among women with PCOS, nor did it reduce waist circumference. However, exercise did lead to reductions in weight and body mass index.

“The findings that lowfrequency electroacupuncture and exercise decrease sympathetic nerve activity in women with PCOS indicates a possible alternative nonpharmacologic approach to reduce cardiovascular risk in these patients,” said one of the researchers, Dr. Elisabet StenerVictorin of the University of Gothenburg, Sweden. The findings regarding menstrual cycles and decrease in testosterone levels in the lowfrequency electroacupuncture are also of interest, according to the researcher.

The study, “Lowfrequency electroacupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome” was conducted by Elisabet StenerVictorin, Elizabeth Jedel, Per Olof Janson and Vrsa Bergmann Sverrisdottir, all of the Sahlgrenska Academy, University of Gothenburg, Sweden and the Karolinska Institute, Stockholm, Sweden. The study is in the online edition of the American Journal of PhysiologyRegulatory, Integrative and Comparative Physiology, published by The American Physiological Society.

Common endocrine disorder

Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders, affecting an estimated 10% of women of reproductive age. Among the problems associated with the condition are elevated levels of androgens (such as testosterone, the male hormone found in both sexes), ovarian cysts, irregular menstrual cycles and infertility.

PCOS is associated with increased sympathetic nerve activity in the blood vessels, part of the fight or flight response that results in blood vessel constriction. Chronic activation of the sympathetic nervous system increases the risk of diabetes, high blood pressure, heart attack and stroke.

The Swedish researchers had previously found that PCOS is associated with increased sympathetic nerve activity and said it may arise from the elevated testosterone level that is characteristic of PCOS.

Three groups

The researchers wanted to find a longlasting treatment for PCOS that would have no adverse side effects, and so they looked at whether acupuncture or exercise could decrease the sympathetic nerve activity in women with PCOS. The study included 20 women, average age of 30 years, divided into the following groups

lowfrequency electroacupuncture (9)
exercise (5)
untreated controls, (6)

The acupuncture group underwent 14 treatments during the 16week study. Acupuncture points were located in abdominal muscles and back of the knee, points thought to be associated with the ovaries. The needles in the abdomen and leg were stimulated with a lowfrequency electrical charge, enough to produce muscle contraction but not enough to produce pain or discomfort.

The exercise group received pulse watches and were told to take up regular exercise brisk walking, cycling or any other aerobic exercise that was faster than walking but that they could sustain for at least 30 minutes. They exercised at least three days per week for 3045 minutes, maintaining a pulse frequency above 120 beats per minute.

The researchers instructed the control group in the importance of exercise and a healthy diet, the same instructions the experimental groups received, but were not specifically assigned to do anything differently.

Key Findings

The researchers measured the muscle sympathetic nerve activity before and after the 16week study. Following treatment, the study found the following

Both the acupuncture and exercise groups significantly decreased muscle sympathetic nerve activity compared to the control group.
The acupuncture group experienced a drop in waist size, but not a drop in body mass index or weight.
The exercise group experienced a drop in weight and body mass index but not in waist size.
The acupuncture group experienced fewer menstrual irregularities but the exercise groups irregularities did not change.
In the acupuncture group, there was a significant drop in testosterone. This is an important indicator because the strongest independent predictor of high sympathetic nerve activity in women is the level of testosterone.

“This is the first study to demonstrate that repeated lowfrequency electroacupuncture and physical exercise can reduce high sympathetic nerve activity seen in women with PCOS,” according to the authors. “Furthermore, both therapies decreased measures of obesity while only lowfrequency electroacupuncture improved menstrual bleeding pattern.”

The study has some limitations, including a small sample size, so further research is necessary, the authors wrote. To find the full study, go here.