Integrative Medicine: The Hopkins Perspective

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
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
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
Is the practitioner integrative, or disintegrative?
Engage the patient as an active participant
Provide education about health, symptoms, and
Counsel in appropriate nutrition practices and
supplement use
Discuss evidence-based pharmacologic and mindbody 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
 Limit your alcohol intake
 Stop smoking
 Raise the head of your
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 antireflux 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
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
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 longterm management strategy
Discuss evidence-based
Answer questions about the use
of supplements
Determine if stress is a trigger
for symptoms and identify
strategies for addressing stress
Dickman, R. et al. Aliment Pharmacol Ther 2007. 26: 1333–1344
Fennel seed
no scientific evidence… yet
Apple Cider Vinegar
Conventional care
Massage Therapist
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 faceto-face time, mind-body therapies
Conventional practitioners lack knowledge about
evidence-based healing practices and practitioners,
and how to identify them

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