Naturopathic Medicine Saves Money

Last summer, a landmark study was published in the Canadian Medical Association Journal. It found that naturopathic medicine reduced the risk of cardiovascular disease when added to conventional medical care. In the study, the group that received naturopathic care saw its incidence of metabolic syndrome fall nearly 50%, and their likelihood of suffering a cardiovascular event (a fancy word meaning heart attack, stroke, clot, or other issue) was about a third lower than the group that received only conventional care. To put this in plain English, Naturopathic Medicine makes people healthier and saves lives.

However, the study authors weren't done there. In addition to investigating the healthcare benefit, the authors wanted to answer the question: Does naturopathic medicine save money?

Specifically, the researchers were asking this question: If an employer invests in naturopathic medicine, do they see a return on their investment? To find out, the full cost of the naturopathic program was assessed, and this was then compared against total per employee healthcare spending and differences in employee productivity.

The results were published recently, and they are clear: Employers who invest in naturopathic medical care for their employees see significant healthcare cost savings, as well as increases in productivity. You can read the exact figures in the article itself, but the rough findings were that naturopathic care helped employers save about $1000 dollars per employee in healthcare costs, and that those employees were more productive, to the tune of about $1400 per year. As a per-employee benefit, that's notable, and it scales up very quickly into even more significant cost savings in a large company.

While this is only one study, it does accord with earlier unpublished findings that naturopathic medicine reduced healthcare costs and improved productivity at the Vermont Auto Dealers' Association (VADA). The findings were so significant in Vermont, in fact, that the VADA changed its position on insurance coverage for naturopathic services, and helped Vermont to pass legislation that mandated insurance coverage for naturopathic care.

Whether the new study will push insurance coverage in any states is not clear, but in any case, employers should strongly consider providing naturopathic care to their employees, not only to help their employees live healthier lives, but to save money as well. I'm even imagining a slogan: Go Green To Save Green With Naturopathic Medicine.

Let's get out there and make this happen.

How Many Mets Is That?

About a month ago, the Freakonomics radio show asked the question "What's The 'Best' Exercise?" in their weekly episode. This is a tough question, because there are many criteria you could use to assess this question. Does "Best" mean the one that works the largest variety of muscles? The one that we can do starting when we are young and continue until we are very old? Is it the one that provides the most cardiovascular benefit? Is it the one that provides optimal health benefit for the least input? Or is it the most enjoyable? As you can see, this is a hard question to answer.

In some ways, the answer to this question is: The "Best" form of exercise is the one that you will do regularly. Exercise is a habit, and hard work and persistence are more important than scientifically proven results. A "beach-ready" body that you have one summer when you are 24 is less valuable than the more moderately toned one you maintain for decades. Thus, the exercise that you find enjoyable enough to engage in regularly is the "Best" one. By far.

That said, there is some interesting research out there on the "value" of some forms of exercise as opposed to others, and the best way to quantify this is by using the MET as a unit of measure. MET stands for Metabolic Equivalent, and is a way to quantify the amount of energy burned by a given activity. 1 MET, for example, is roughly equivalent to sitting quietly, whereas walking at a slow pace has a MET value of 2, or twice that of sitting quietly. The higher the MET value, the greater the energy expenditure for a given activity.

But how do we use this information? What are various activities "worth"?

Well, Freakonomics would direct you to this document, produced by the CDC, which gives some examples of moderate and vigorous activity. You might find this helpful, or you may find it a bit difficult to navigate. I'd refer you instead to this website, which provides lists of all kinds of activities, grouped into categories such as Bicycling, Dancing, Home Repair, and Sports. Just about any activity you can think of has been measured and updated over the past 20 years.

While some of this information is what you already know - e.g. basketball requires more energy than billiards - it's still helpful for those who are considering picking up a sport for health benefits. But again we come back to the important question of what kind of exercise you will stick with. Running at a 10 minute/mile pace has a higher MET value than basketball, but the social reinforcement of a team sport is likely to keep you engaged over a long period of time. So take the information with a grain of salt. One form of exercise may burn more calories than another, but if you won't do it, is it worth investing in?

After all, what do you want to do to keep active?

Old Wive's Tales?

The legislative effort continues in Maryland, and in the past week, I have testified to both the Maryland Senate Education, Health, and Environmental Affairs Committee, and the Maryland House Health and Government Operations Committee on the topic of naturopathic licensure. What a week it's been! If you're a Maryland resident and are interested in contacting your representatives about naturopathic licensure, click this link and you'll be brought to a page with simple instructions.

Meanwhile, I was sent this charming infographic by a friend of mine. I can't say I agree with everything it presents (the lack of citations makes it hard to verify info), but this is a great starting point for a conversation. Naturopathic medicine is often maligned as a collection of "old wives' tales," but nothing could be further from the truth. Naturopathic doctors are actively involved in research efforts, and of course pay attention to the latest news from around the scientific world. So which of the following are old wives' tales? Ask a naturopathic doctor to find out!

The Legislative Effort Continues

This week, naturopathic doctors from around Maryland came to Annapolis to talk with legislators about the importance of licensing and regulating the practice of naturopathic medicine. This is the fourth year that the MDANP has been at work in its legislative effort, and in honor of the effort, I'm posting a map showing the US states and territories that currently license naturopathic doctors (in green) and those that will be debating the issue in 2014 (in yellow). Currently, a third of states license naturopathic doctors, and many more will consider doing so in 2014. While I work in a profession characterized as fringe, I hope this map makes clear the fact that naturopathic medicine has moved into the mainstream. And really, why wouldn't it? With a clear focus on prevention, treatments that offer cost savings, and an extremely low incidence of malpractice or harm, naturopathic doctors offer the nation something important at a time when it's needed more than ever before. If you haven't before, take a minute this week to find out what the naturopathic professional organization in your state is up to; you might even pitch in!

Simple Pleasures

Simple recipes are often the most difficult. While large ingredient lists are imposing and can offer the logistical challenge of managing a massive number of ingredients and preparation, a long list of spices often brings with it a strong-enough flavor that it can cover up sub-par technique and preparation. It's ironic, but true. It's easier to get results with complicated recipes. In contrast to that, I'm offering a simple but sublime recipe adapted from Claudia Roden's The Food of Spain. Rather than a curry with a list of 15 spices alone, this is a simple dish prepared from a few ingredients and spiced only with garlic and paprika, and yet the results are fantastic.

1 cup dried chickpeas soaked overnight or 1 15 oz can chickpeas
Salt
1/4 cup olive oil
A whole head of garlic
1 cup dried raisins, soaked in water for 20 min
1 teaspoon sweet paprika
5 cups chicken stock
2 1/2 cups arborio rice

Drain the chickpeas, and bring to a boil in fresh water. Reduce heat to low and simmer for 1 hour, adding 1 tsp salt.
Preheat your oven to 400 degrees.
Peel and chop the garlic cloves, and drain the raisins.
Heat the oil in a medium size pot or casserole that can go in the oven. Stir fry garlic and raisins in the oil for 2-3 minutes, until the aroma arises from the garlic. Add paprika and stir well, then add chickpeas, stock and another teaspoon of salt. Bring the mixture to a boil and add the rice. Stir well to achieve a consistent mixture.
Bake in the oven for 30 minutes, until the rice is al dente.

Simple, yes. Wholesome, yes. Sublime, yes as well. This is a great, filling Spanish delight that will surprise you with its fantastic taste and elegance. It's as well suited to a dinner party as it is a simple family meal. Enjoy.

The 50th Anniversary of an Important Moment

Fifty years ago this week, the Surgeon General of the United States, Luther L. Terry, released Smoking and Health: Report of the Advisory Committee to the Surgeon General, an important milestone in the effort to control tobacco as a public health hazard. While studies from the early 1950s had already indicated that smoking caused lung cancer, and prior studies had shown correlations between smoking an risk of premature death, the report of the Surgeon General made it the opinion of the United States government that smoking was a significant health hazard, and should be controlled by legal means. In that time, we've seen efforts to restrict the purchase of tobacco, the act of smoking, and many, many taxes levied on tobacco, all in an effort to reduce smoking and tobacco consumption.

I won't belabor the point here, so I'll simply point out that the Journal of the American Medical Association has devoted its entire issue to the anniversary of this important event, and also note two studies published in JAMA this month.

The first study found that since the publishing of the Surgeon General's report in 1964, an estimated 8 million smoking-related premature deaths have been prevented in the United States. While lifespan has increased overall since 1964, smoking restriction has added 2.3 years to life expectancy for men, and 1.6 years to life expectancy for women. My own conclusion is that it's been no small potatoes.

The second study found that global smoking rates have decreased for men from 41% in 1980 to 31% in 2012, and for women from 11% in 1980 to 6% in 2012. While this is excellent news - it means that global smoking rates have decreased by over a third - the total number of smokers has actually increased as the global population has increased, so we still have lots of work to do.

As we move forward into the second 50 years of tobacco restriction, and especially as we now see the rise of legalized marijuana consumption, let's not ignore the important work that still must be done, while we celebrate that this global effort has had excellent success.

Vitamin E Surprises Me

Most of the articles written here are meant to be free-standing, so that anyone who happens across them will be able to benefit, but regular readers of my blog will benefit from their experience in reading my blog post today.

To set the scene: Three weeks ago, I made an off-hand comment about the rise and fall of vitamins, mentioning specifically vitamin E. Vitamin E was the focus of a lot of attention many years ago, when it was believed that use of high doses of the antioxidant vitamin might prevent cardiovascular disease. Since then, however, it has fallen out of favor, and is now believed by many to have been over-hyped. Further studies of vitamin E have failed to verify the benefit, and so I tend not to recommend it much, or at least not to patients with cardiovascular disease. In my most cynical moments, I dismiss vitamin E as a fad of a prior time.

Then, two weeks ago, an editorial in the Annals of Internal Medicine came out slamming vitamins in general and vitamin E in particular. I deconstructed that article and argued that it was riddled with problems, but as it relates to today's posting, the editorial suggested that vitamin E was ineffective for, just about anything, and was also probably unsafe.

It turns out that I was wrong to dismiss vitamin E, and so was the Annals of Internal Medicine. Just two days ago, an article was published in the Journal of the American Medical Association that found that vitamin E may provide benefit as an adjunct treatment in Alzheimer's disease. Further confirmation is necessary, but the findings were significant and worthy of attention because of their clinical utility - researchers posited that vitamin E delayed progression of symptoms by about 19% per year in Alzheimer's patients. Additionally, no ill effects were noted over a mean follow-up time of about two years.

I'm not going to discuss the results of the study here, however. Rather, I'm going to make an important point about research. The editorial published in the Annals of Internal Medicine was rash in its suggestion that physicians stop recommending supplements, consumers stop buying supplements, and researchers stop investigating supplements. I argued that broad, blanket statements like this one rarely, if ever, hold up to scientific scrutiny, and less than two weeks after publication, we've already started chipping away at the editorial by way of a peer-reviewed study published in a major medical journal. Broad statements that do not take into account nuances, or indeed evidence, are bound to fail, though they may be partnered with major media campaigns.

The second point is this - clearly I was wrong too. Medicine, despite its attempts to pursue neutrality and evidence, is subject to fads - treatments of all kinds come in and out of favor, and it's not uncommon for clinicians to discount older therapies in favor of newer ones. And lo, I was guilty as charged. Though the evidence for vitamin E in cardiovascular disease remains weak, I was wrong to dismiss the supplement altogether as a fad that lost favor. Vitamin E may indeed hold promise as an effective treatment for other conditions, and I'll now continue to keep an eye out for research.

The point is this: It does no one any favors to close doors in medicine. When we do so, we're inevitably proven wrong. While evidence may lead us away from going to a certain treatment for a certain condition, we should never discount that treatment entirely. I hope we've all learned our lesson today.