At the age of 100, Xing Yi Master Wang Ji Wu Describes His Principles of Living a Healthy Life

This gem was brought to my attention by licensed acupuncturist and tai chi teacher Robert Martinez of New York City. Thanks Robert! It has wonderful words of wisdom for anyone interested in health, and for doctors and martial artists in particular.

I believe it may have been taken from this book, Xing Yi Nei Gong.

The Heart is Calm, Quiet as Still Water
My own history is from the end of the Qing Dynasty, through the period of the republic to the People's Republic, already a hundred years. My life has seen its share of ups and downs, times of poverty and hardship, honor and dishonor, the changes of the seasons, all of which have left a deep impression on me. After the founding of the People's Republic, my life became stable, but with the Cultural Revolution, disaster once again overran the country and I was forced out of business. All of these events served as a means of cultivating my spirit, and afforded me the opportunity to practice the "gong fu" of living in the world.

One must always maintain a calm heart even when influenced by the Seven Emotions; joy, anger, happiness, worry, sadness, fear, and surprise. The heart must remain as calm as still water, never allowing any personal desires to stir up a ripple of disturbance. My thoughts are pure; in spirit I seek to forget myself and transcend the common affairs of the world, keeping my life simple and my desires few. With a clear heart, I do not contend with others or make demands upon the world, but rather seek to contribute what I can for the benefit of all, aiding those in need and protecting those in danger.

Without desire one is strong, without desire one is quiet, without desire one may return to that which is natural, without desire one returns to the Original State. With a heart like still water, from the extreme stillness will spring action, from the Void comes that which is alive, yin and yang are in harmony and the qi flows unimpeded. With a heart like still water, the qi is sufficient and the spirit full. When the qi is sufficient and the spirit full, the Organs function normally, the blood is nourished, the meridians, nerves, digestion, and circulation are all healthy and the metabolism stimulated. When the factors that prevent aging are all strong, one may prevent illness and live a long and healthy life.

Humans are holistic beings which are possessed of a certain vitality. The spirit and flesh are inseparable and form a complicated entity. The human vitality supports, influences, and is responsive to the person as a whole, while the spirit is the leader and controller, the "commander-in-chief" of the being as a whole. Under certain circumstances, it can be said that the spirit, "pulls one hair and the whole body follows," or, at the slightest stirring of the spirit the whole being responds, and each movement of the spirit has a real effect on the individual. Therefore, I put special emphasis on the spirit as leader, ever strengthening my resolve to cultivate the spirit, maintain calmness of heart, and become as pure as light without a speck of dust. This is akin to the Song Dynasty poet who wrote "to understand the highest virtue" applied to the present time. Better yet, this cultivation of the spirit and heart will improve the physical constitution of the people, protect their health, and contribute to a long and healthy life.

Live an Enthusiastic Life, Serve the Public Good
I have traveled the long road of life, experiencing hardship, difficulty, and I know the sentiment of man is often as thin as paper. I have seen corruption and those whose only concern is realizing their own desires. Because of this, I have striven even harder to live a practical life, willing to sacrifice even more for the good of the people. After the founding of the Republic, I spent my time working in the streets as a doctor, treating anyone who came to me for help with wholehearted enthusiasm. When one finds happiness in serving others, one will be full of the spirit of life, seeing things as they are with a calm heart. Thus, one may reach the state where the spirit is preserved within, the body is healthy and the spirit full, the intellect wise, decisions made adroitly and reactions made spontaneously. Consequently, the life energy will be strengthened and increased while promoting the health and longevity of the body.

Happy Thanksgiving everyone!

Fitting That It's Shaped Like A Frown

Hello! My name is Menaflex.

Is it a rainbow? No.
Is it a broken piece of pottery? No.
Is it part of one of those thingies that go on the inside lid of jars? No.

Is it an orthotic for shoes? Not quite... but that's a little closer.

This, my friends, wins an award for Most Anger-Inducing Thing Of The Day.

Further deteriorates my already sour view of politics.

Health Care Reform

Famous ancient Chinese physician Hua Tuo

If you follow the news at all, you've heard something about this "health care reform" thing people seem to be all excited about. You've read the editorials, you've seen the politicians speechifying. Maybe you've seen the video clips of people shouting things like "We are ALL afraid of Obama" and crying things like "I want my country back!" (What does this have to do with health care? I don't know either.) You've heard the phrases "death panels" and "public option".

So far the debate seems to be framed as "Health Care For All - For or Against?" People on both sides loudly declare the other side stupid, or evil. I'd like to point you towards a voice that asks us to focus on a different aspect of this whole debate - the very nature of the medicine that people either want to extend or not extend to the whole country.

But what's missing, tragically, is a diagnosis of the real, far more fundamental problem, which is that what's even worse than its stratospheric cost is the fact that American health care doesn't fulfill its prime directive -- it does not help people become or stay healthy. It's not a health care system at all; it's a disease management system, and making the current system cheaper and more accessible will just spread the dysfunction more broadly. -Dr. Andrew Weil: The Wrong Diagnosis at the Huffington Post

This is an extremely important point. The health care system is broken, and getting the last 40 or 50 million uninsured Americans into this same system is not going to improve the health of our nation.

It reminds me of a story I heard during my TCM (traditional Chinese medicine) education. There was a doctor in ancient China who became famous for saving lives. He could cure diseases in their most advanced state, when a patient was near death. Everyone called him a genius, some even said he had magical powers.

The doctor laughed when people praised him. "My skill is actually quite low. I can only cure disease when it has gone nearly out of control, and I have to use severe herbs and acupuncture techniques. I have two older brothers who are much better at medicine than I am."

Of course people went in search of these brothers. When they found the middle brother he said "I'm still not very good at medicine. I can only catch diseases in their initial stage. I still have to feel the pulse and look at the tongue before prescribing mild herbs and acupuncture. If you want to know real medical skill, you should find our eldest brother."

Of course the people went to search for this wonder-worker. When they found him he said "When people come to me I use neither acupuncture nor herbs. I do not feel their pulse or look at their tongue. I diagnose them by observing the color of their face and the tone of their voice. I tell them how to eat in accord with the seasons and their locations, and sometimes I give them some simple exercises to do. However, if they could sit quietly every day and listen to the natural wisdom of their own body they would not even need my advice."

The eldest brother was the only one practicing real health care - the other two were doing different forms of disease management. Of course we can't abandon those who are already in advanced disease states, but we should put equal and perhaps even more emphasis on encouraging health - what the chinese call 養生 Yang Sheng or "nourishing life."

HR 646: Acupuncture For Everyone!

Obama's 8 Principles for Health Care Reform

Read the Bill, also known as The Federal Acupuncture Coverage Act

How HR 646 can support Obama's Plan

Act now to help make it happen!

We Need A Better Health Care System

I just spent over four hours waiting to get an annual reproductive health examination, and I was one of the fortunate ones who had an appointment scheduled. I couldn't believe it.

The waiting room was full of 20-somethings, men and women, all uninsured. Some people had waited over two hours just to pee in a cup, and were still waiting after I left!

I emphatically commend the low-cost health care providers of this country. They have to handle such an incredible work load, with so much paperwork and bureaucracy, it's ridiculous.

National Health Care Day of Service, June 27th

Get out and volunteer this Saturday! It's a great opportunity to help your neighbors, educate yourself, and find out first-hand how our current health care system functions.

Volunteer options include letter writing, donating blood, open house and teach-in events, and even fresh yard fruit collection for donation.

Here's a list of activities within 75 miles of Mar Vista.

Swine Flu, Concerned Parents, Western Medicine and Chinese Medicine

Yesterday I got an email from my dad. I've been sick for the past few weeks, but what with finals and the end of school, I only got serious about treating it last Friday, when I went to see Dr. Yuhong Chen at the Yosan clinic (scroll down to read her bio). I had two acupuncture treatments and she wrote a kick-ass herbal formula, and five days later I'm back to 100%.

My main symptom was sore throat, persisting for three weeks, plus fatigue, and at various points during that four weeks I had body aches, slight fever, night sweats, thick sticky green phlegm streaked with blood, thin white phlegm, and probably something else too. It sounds bad when I write it all out, but it didn't bother me too much. All those symptoms didn't occur at the same time, and when they did occur they only lasted a day or so. The only thing that persisted was the sore throat.

In a phone conversation last weekend, my dad suggested that I go get a throat culture and, if it turned out to be strep throat, take antibiotics. I told him that I was fairly sure it wasn't strep, and even if it was, I'd rather take Chinese medicine. Like many Americans, I don't have health insurance, and my last trip to the ER cost me nearly $1000.

Then the swine flu media panic got out of control over the weekend, and I had the email exchange reproduced below with my dad. I guess I was a little defensive about Chinese medicine - after all, I just spent four years studying this completely different, completely effective system of medicine, and now my dad wants me to take antibiotics and Tamiflu? Sheesh.

But I think it's instructive about the way a lot of people feel about Chinese medicine - that's it's good for mild symptoms, but if it's "something serious," then you absolutely have to "go see a doctor," which means an M.D. The fact is, Chinese medicine can treat everything. Let me say that again: Chinese medicine can treat everything.

And now, without further ado...

>>>>>>>>>>>>>>>>>>>>>>>>>>>
11:54 AM (22 hours ago)
(My Dad)
to me

Hey Jonah,

Not sure if your symptoms fit this profile, but if they’re in the ballpark I would urge you to go to a clinic or even a hospital ER somewhere to get a test. This has public health implications – the only way the CDC can track what’s happening is by monitoring test results – but more important the health networks are well stocked with anti-virals (tamiflu and another one whose name I forget) that so far have been effective if the result turns out positive. So no need to panic, but also no reason not to be proactive. From the news reports it looks as if this could get serious down the line. As you have probably been reading, the group most at risk from this outbreak are healthy young adults in the 20-40 age range.

Love,

Dad



From: Lisa
Sent: Sunday, April 26, 2009 7:29 PM
Subject: IMPORTANT UPDATE! Swine Influenza Outbreak.
Importance: High

Fellow Employees:

The World Health Organization (WHO) and Center for Disease Control (CDC) have confirmed an outbreak of the Swine Influenza A/H1N1 (swine flu) in Mexico with now twenty (20) confirmed cases in the United States. Swine Influenza is a respiratory disease found in pigs caused by type A influenza that regularly causes outbreaks of influenza among pigs. CDC has determined that this swine influenza A (H1N1) virus is contagious and is spreading from human to human. However, at this time, it not known how easily the virus spreads between people.

The symptoms of swine flu in people are similar to the symptoms of regular human flu and include fever, cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people. Like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions.

Spread of this swine influenza A (H1N1) virus is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

Your health and the health of your family is greatly important. Please take some general precautions during this time.

Since influenza is thought to spread mainly person-to-person through coughing or sneezing of infected people, there are many things you can to do preventing getting and spreading influenza:

Everyday actions:

· Cover coughs and sneezes with tissues or by coughing into the inside of the elbow. Throw the tissue in the trash after you use it.

· Wash your hands often with soap and water for 20 seconds, especially after you cough or sneeze. Alcohol-based hands cleaners are also effective.

· Avoid touching your eyes, nose or mouth. Germs spread that way.

Try to avoid close contact with sick people.

· Limit close contact (within 6 feet) with others when possible.

· Stay away from places where there are large groups of people.

· If you get sick, CDC recommends that you stay home from work and limit contact with others to keep from infecting them.

All offices remain open at this time. However, we would like to recommend that business travel to/from Mexico be delayed/re-scheduled. In lieu of travel, please consider conducting conference calls and/or video conferences.

The following link is the CDC’s Q&A which provides the detail regarding when to contact your health care provider, especially for children or someone with pre-existing health issues. http://www.cdc.gov/swineflu/swineflu_you.htm

We will continue to send you updates on any important information as it becomes available. Please contact your HRBP or the Benefits Team if you have any other questions or concerns.

Regards,

Lisa
Vice President, Human Resources

--------------------------------------------------
1:23 PM (21 hours ago)
Jonah Ewell
to (My Dad)

Hey Dad,

I appreciate your concern! But I'm getting much better. Chinese medicine is much much more effective for any kind of influenza than drugs. When SARS broke out in China, they used herbal medicine. If Chinese medicine were in wider use in the Americas, swine flu would be much easier to contain. Obviously, to treat the root of the problem you need to stop having factory farming and crowding huge amounts of pigs together, which concentrates effluvia (aka pigshit!) and breeds disease. Until that happens, Chinese medicine, handwashing, and rest are the best way to recover from a flu.

I'm currently taking a Chinese herbal prescription which consists of 15 herbs. Some of the key herbs, such as 茵陳蒿 Yin Chen Hao (a type of artemisiae) and 山豆根 Shan Dou Gen (a type of sophora root) have been proven in laboratory testing to have broad-spectrum antiviral and antibacterial actions. No need to worry, Chinese medicine is on the case!

love,
Jonah
------------------------------------------------

1:53 PM (20 hours ago)
(My Dad)
to me

OK, sounds good. But do you know whether you have the particular virus that’s in the news?

Love,

Dad

---------------------------------------------------------

2:35 PM (19 hours ago)
Jonah Ewell
to (My Dad)

In the framework of Chinese medicine, it's unimportant what exact microbe or virus is causing you problems. Western science and medicine is reductionist, always looking for that ONE THING that they can point to and say is the cause of illness. When you find the exact bacteria or virus, all you have to do is kill it, or remove it, or block it, or any of the other things Western medicine does. This is a relatively recent development, hinging on the invention of advanced microscopes. Thanks to these instruments, we have made incredible advances in being able to look at and detect these small microbes and viruses, which has helped the world deal with serious health problems. However, as we are seeing, looking for the one microbe and trying to eliminate it is a textbook case of missing the forest for the trees.

What causes disease? Why do some people get sick and others don't? If the swine flu was really so contagious, why haven't more people become sick and died? According to what I've heard on the radio and read in the newspapers, less than 10% of people with swine flu have died. Over 90% recover. Think of fruit in a basket. If you leave it for awhile, you might find that one piece of fruit has mold on it. Another piece of fruit, sitting right next to it and even touching it, cheek-by-jowl, is unaffected. Why is that?

Louis Pasteur, the father of modern bacteria studies (the process of pasteurization was named for him) was said to have renounced bacteria-based medicine on his deathbed, saying "Terrain is everything." Terrain means our bodies, our immune system, our environment. If you have a strong immune system (what the Chinese call 卫气 wei qi, or defensive qi) without underlying deficiencies, and live in harmony with your environment, you will not become sick.

Chinese medicine has, over the course of 2000-3000 years of recorded history, developed a number of powerful diagnostic systems that, properly applied, can cure nearly everything. Modern medicine has a place, and it adds to the world's knowledge. But it doesn't replace Chinese medicine.

Chinese medicine looks at the totality of a person and treats the person, not the disease. The herbal formula I'm taking was written exactly for me, taking into account all my body systems, my constitution and my presenting symptoms. This is what good medicine is. Simply telling millions of people, young, old, tall, short, skinny, fat, to go dose themselves with Tamiflu is ridiculous.

If you have an epidemic situation, in Chinese medicine it falls under the general classification of 温病 wen bing, or warm disease. There are many subcategories within it, but one of note is called 杂气 za qi, or miscellaneous qi. This is a type of qi that arises under special circumstances and is outside the realm of the ordinary system of Chinese medicine, which holds that there are six types of exogenous pathogens. This seventh type of qi was discussed by 吴有性 Dr. Wu Youxing in his work the 温疫论 Wen Yi Lun in 1642 A.D., many centuries after the main classics of Chinese medicine were written but two centuries before Dr. Pasteur made his discoveries in the area of germ theory.

In other words... don't worry!

love,
Jonah

--------------------------------------------------

6:05 PM (16 hours ago)
(My Dad)
to me

In principle I can see your point, but the 1918 flu pandemic killed millions of people in a single year before it ran its course, and the treatments that have been developed since then to combat viruses of this type are pretty specific and pretty effective once the agent has been identified. Not sure of the details, but I think that anti-virals are different from antibiotics, which are less specific and also ineffective against viruses. Also, according to the NYT article on it yesterday, what makes this particular virus so deadly is not so much what it does directly as the immune reaction that it triggers, literally drowning the patient as the body tries to activate its natural defenses to meet a perceived but not well understood threat. Viruses (which are basically small free-floating pieces of genetic code) are tricky, and developing an effective anti-viral agent on the molecular level seems mostly to be a matter of strategy. So maybe the most appropriate medical text for this kind of threat would be the Sunzi…

Anyway, my 2 cents for what it’s worth.

Love,

Dad

-------------------------------------------------------

10:03 PM (12 hours ago)
Jonah Ewell
to (My Dad)

Sunzi is used as a medical text, but antiviral medications are a far cry from the wisdom of Sunzi. One of Sunzi's basic tenets is to follow the laws of Heaven and Earth. In medical terms, that means the exterior and the interior, the environment and the body. Viruses are highly adaptable, which is why getting a flu shot is such a crap shoot. They have to guess which flu strain is going to go around, and a lot of times they get it wrong, so all these old folks are immunized against something which poses no threat, and they have no defense against the flu strain that actually does come around.

They would be far, far better off to do the basics: light exercise daily, eat foods in accordance with the seasons, and have a stable emotional life. Add handwashing, proper clothing for the weather, and there's your natural flu vaccine. It's easy to tune out because it's so basic. The basics are hard! Huaching Ni says that having a normal life is actually quite difficult, and that few people ever achieve it. Instead of focusing on the basics, everyone's looking for the magic pill or injection which is going to allow them to continue with their bad habits.

The CDC is doing their job by telling people to wash their hands (http://www.cdc.gov/swineflu/), but that doesn't get picked up by the media. Everyone's looking for a vaccine or treatment. As the Neijing says, treating an illness after it has started is like digging a well when you get thirsty, or forging weapons after the battle has begun.

There is an "attacking school" or "detoxification school" of Chinese medicine that concentrates on using harsh, bitter, cold herbs to drive pathogens from the body (攻邪学派 Gong Xie Xue Pai). It's one of the four famous schools of medical thought from the Jin-Yuan period. Most modern western medicine can be thought of as an extreme example of the attacking school. Antibiotics, antivirals, chemotherapy, radiation, are all very effective if used correctly (big if) but they absolutely destroy your body and leave it open to further attack. This mode of thought is just one of many overlapping theories that are used concurrently in Chinese medicine, and certainly not a dominant one.

love,
Jonah

-----------------------------------------------------
10:34 PM (11 hours ago)
Jonah Ewell
to (My Dad)

You're correct in that strategy is important, but if the only time you apply strategy is in a quest to find the best anti-viral medication, that's a misapplication of strategy. Everyone is looking through the microscope, which is fine, but if the virus is underneath a microscope that means it's not in a human body. At the same time as you bend over the microscope, you also have to step back and look at what's going on in a real live sick person, and then step back again to look at where that person lives, the state of the environment in which he or she lives, and all the people around them, sick or not. The strength of Chinese medicine is that we deal with living systems in their natural environments.

Modern machinery is great - who wouldn't want an MRI machine to peer inside the body? - but it doesn't replace the basics of the four examinations - palpation, listening/smelling, observation, and questioning. When you add blood tests, X-rays and scopes to that, you have a some very powerful diagnostic tools. If you rely too much on the machines and lab reports, as many modern doctors tend to do, you can very easily be misled. Western medicine, until very recently, made good use of palpation, physical exam, and the verbal investigation to form a complete diagnosis. Nowadays, it's just testing. Some of my patients in the clinic get sent for test after test after test. Some of these tests are very invasive, and at the end of it the doctors say, "we can't find anything wrong. It must be psychological." Well, they're looking in the wrong place, with the wrong tools, and the wrong mindset.

Medicine In The News

While reading the New York Times yesterday, I couldn't help but notice the increasing number of articles about health care. Could it be that all this talk of health care reform is forcing people to look at what needs to be reformed? The ideas of conflict-of-interest and professional integrity have always come up in regards to medical care versus the medical industry. I feel that the growing discontent with the current mainstream medical system has finally reached a point of some kind of public vigilante justice, bent on shaming the perpetrators into following the rules of medical ethics and propriety.

Two articles in particular had stood out: Prosecutors Plan Crackdown on Doctors Who Accept Kickbacks, and Harvard Medical School in Ethics Quandary. Interestingly enough, both of these articles did not make their appearance in the Health section of the Times, but rather in the Money & Policy section and Business section respectively.

The first article describes how federal prosecutors are going to start enforcing laws that make it illegal for medical doctors to accept gifts from industry. They have already been going after the pharmaceutical companies that engage in such practices, but have found that even increasing fines is not enough of a deterrent, as some of them already set aside money for fines that they know they'll need to pay for breaking these laws. Now, they're going after the medical doctors.

[...] federal health officials are forcing a growing number of drug and device makers to post publicly all payments made to doctors who serve as consultants or speakers.

That means that information about the companies that illegally market their goods as well as the doctors who they bribe will be made completely public and searchable.

The second article discusses industry influence on education. The problem that a lot of medical schools face is that a good proportion of their funding comes from private companies, and a lot of star faculty act as consultants for companies to increase the marketability of their products. But what kind of education would future doctors be getting if their instructors were all on the payroll of big pharmaceutical companies? Some would argue that it wouldn't affect their jobs as teachers, but I suspect there must be a huge bias with the dissemination of information.

Harvard medical students, as part of the American Medical Student Association, have worked to make it a requirement that all professors and lecturers disclose their industry ties in class. They are the first and only medical school to do that, which is appropriate in this age of reform because they are ranked one of the lowest in terms of transparency and control of industry money.

Here is where I would normally tie this blog post to Chinese medicine somehow... for today, I think it would be sufficient to simply say that I hope all this reform of the health care system in its final incarnation will include low-cost, low-risk, highly effective therapies - such as Chinese medicine - into the grand plan of taking care of each other.

Consumers Turn to Herbs over Prescription Medications

Kristen Kemp, right, gives her 1-year-old son Soren some black elderberry extract at their home in Montclair, N.J. Kemp uses home remedies and herbal medicine for her kids’ sore throats and colds instead of prescription medications to cut costs.

According to this story from the Associated Press, more and more consumers are turning to herbal remedies over prescription medications, in part to save money in this down economy.

“The doctors are so much higher (in cost), the insurance isn’t paying as much,” said the 61-year-old self-employed bookkeeper and notary. Her husband, a retired dispatcher, has high blood pressure and seizures. Recent changes in their health insurance coverage resulted in $1,300 in monthly premiums, double what they used to be.

The story also points out an important safety factor: most people who use herbs are self-medicating. While herbs themselves are quite safe, people may end up hurting themselves if they use them without guidance. Most of the time this comes from taking something long-term that is only meant to be taken for a short period of time.

For instance, many people know Yin Chiao as the product to take when they feel the first symptoms of a cold (银翘解毒丸 Yin Qiao Jie Du Wan). This herbal remedy works so well that some of my friends started to take it all the time, thinking that it would work as a sort of herbal prevention. A daily dose of Yin Chiao is actually indicated for people with herpes, to prevent outbreaks. Taking Yin Chiao when you're not sick at all can lead to a chronic stuffy nose.

The best way to take Chinese herbs safely? Consult a licensed acupuncturist (L.Ac) - nearly all of us have extensive herbal training. Hate needles? Ask them for an herbal consultation, sans acupuncture. Most will be happy to oblige.

Health Insurance for Everyone

Health insurance companies seemed to have had a change of heart, announcing today that they would accept all applicants for insurance regardless of their previous health history. This would include any and all pre-existing medical conditions, such as cancer, chronic illnesses like diabetes, autoimmune diseases, and disabling injuries.

Is there a catch? Of course there is!

Insurers are pushing for mandatory coverage for everyone. In order for them to be able to handle the costs of accepting all applicants, those who are healthy should also be required to buy insurance to cover the costs of those who are not.

Universal health care is the direction we seem to be heading in, and it's about time in my opinion. The problem I see with this proposal is that mandatory purchases of insurance policies does not guarantee that the services and care I want would be covered. It also does not guarantee that individuals who need more care will necessarily get adequate coverage even if they are accepted under an insurer's plan. Also, as the cost goes up for insurance companies that accept high-cost patients, the cost of insurance coverage will go up all around. Even if the companies wouldn't incur a loss because of the increased number of individuals buying in through a mandatory insurance policy, I wouldn't put it past them to use that high-risk cost factor as an excuse to have to raise policy prices anyway.

It just seems impossible for the government to enforce mandatory purchasing of health insurance.

Regulation of prices and the enforcement of regulations are subjects that have not been mentioned much during the last two years of dueling health care plans. Politicians have given a lot of lip service to changing the state of the system, and it's a mystery how it's all going to go down in the next few years. Most insurance companies do not cover acupuncture as part of their policies, even in California where acupuncturists are considered primary care providers. As an aspiring acupuncturist, I'm concerned with what the revised health care system will include, and whether or not our role as primary care, pain management and preventative care specialists will be upheld.

The Cost of Diabetes

• $218 billion spent in the last year by government and the public - this includes direct medical costs, from insulin and pills for controlling patients' blood sugar to amputations and hospitalizations, plus indirect costs such as lost productivity, disability, and early retirement

• $218 billion is about 10 percent of all health care spending

• estimated cost of people not yet diagnosed: $18 billion

• estimated cost of gestational diabetes: $636 million

• estimated cost of those who are considered pre-diabetic: $25 billion

• average number of diabetes medications prescribed per patient rose from 1.14 in 1994 to 1.63 in 2007

• yearly patient visits for diabetes increased from 25 million to 36 million between 1994 and 2007

• 17.9 million Americans are diagnosed with diabetes

• cost for those with Type 1 diabetes total $14.9 billion

• Type 1 diabetes, which generally begins in youth and is genetically linked, accounts for only 6 percent of those diagnosed

• cost for those with Type 2 diabetes total $159.5 billion

The information above was taken from an article published by the Associated Press today. Some notable quotes from that article:

Diabetes has not seen a decline or even a plateauing, and the death rate from diabetes continues to rise

The numbers just keep going higher and higher, and what we want to say is, 'It's time for government and businesses to focus on it'

Drugmakers such as Novo Nordisk also see diabetes as an important — and lucrative — disease.

Jamaica, Diabetes, and Its Youth

Jamaica's National Diabetes Week is this week, and its focus is on children and adolescents.

...the Ministry is taking a proactive approach to educating all children and their families about healthy food options and the importance of daily exercise, through various healthy lifestyle initiatives in schools and communities.

It is reported that 2 percent of those between 15 and 19 have been diagnosed with diabetes, but that the number could be as high as 17 percent. The story of Ryan Dwyer describes how being diagnosed with diabetes affected aspects of his social life and education:

"I woke up with two IVs in my arm and when I came to my senses the doctor told me I had diabetes," he said. "I started crying. I said diabetes is for old people like my grandmother and I am no where near being a grandfather."

For him, back then having diabetes was like a death sentence as he was discriminated against by his schoolmates.

"Nobody wanted to be my friend. I couldn't play the games that I wanted to play anymore," said Dwyer who is now a mixologist. "I got a separate chair in class and I had to write on the ground because I didn't have a desk."

This story made me think about how illness and disease is perceived so differently across cultures and communities. Diabetes is known to be a non-communicable disease. It seems strange that even at school a kid diagnosed with diabetes can be openly discriminated against. With a public stigma against the diagnosis, it's no wonder there is difficulty in finding out what the prevalence of diabetes is amongst teens there.

I did a Google search to try to find Chinese medical physicians in Jamaica, and only found two business listings: Daling Chinese Acupuncture & Moxibustion, and Shortwood Dental & Acupuncture Center, both in Kingston. According to the website for Anhui College of TCM in China, there is a TCM school in Jamaica called the Jamaican Cultural Center of Chinese Medicine, but I couldn't find a website for it.

Lowering Blood Sugar, Increasing Risk of Death?

Below is an article published in the New York Times earlier this year about a study conducted on diabetes and cardiovascular health. The results raised a lot of questions about how the current medical understanding of the disease views blood glucose levels as a primary factor when determining the patient's prognosis. Clearly, meeting some numerical requirement alone isn't the answer when it comes to health care. I've highlighted some of the interesting parts for your reading pleasure.

Diabetes Study Partially Halted After Deaths
By: Gina Kolata
Published: February 7, 2008

For decades, researchers believed that if people with diabetes lowered their blood sugar to normal levels, they would no longer be at high risk of dying from heart disease. But a major federal study of more than 10,000 middle-aged and older people with Type 2 diabetes has found that lowering blood sugar actually increased their risk of death, researchers reported Wednesday.

The researchers announced that they were abruptly halting that part of the study, whose surprising results call into question how the disease, which affects 21 million Americans, should be managed.

The study’s investigators emphasized that patients should still consult with their doctors before considering changing their medications.

Among the study participants who were randomly assigned to get their blood sugar levels to nearly normal, there were 54 more deaths than in the group whose levels were less rigidly controlled. The patients were in the study for an average of four years when investigators called a halt to the intensive blood sugar lowering and put all of them on the less intense regimen.

The results do not mean blood sugar is meaningless. Lowered blood sugar can protect against kidney disease, blindness and amputations, but the findings inject an element of uncertainty into what has been dogma — that the lower the blood sugar the better and that lowering blood sugar levels to normal saves lives.

Medical experts were stunned.

“It’s confusing and disturbing that this happened,” said Dr. James Dove, president of the American College of Cardiology. “For 50 years, we’ve talked about getting blood sugar very low. Everything in the literature would suggest this is the right thing to do,” he added.

Dr. Irl Hirsch, a diabetes researcher at the University of Washington , said the study’s results would be hard to explain to some patients who have spent years and made an enormous effort, through medication and diet, getting and keeping their blood sugar down. They will not want to relax their vigilance, he said.

“It will be similar to what many women felt when they heard the news about estrogen,” Dr. Hirsch said. “Telling these patients to get their blood sugar up will be very difficult.”

Dr. Hirsch added that organizations like the American Diabetes Association would be in a quandary. Its guidelines call for blood sugar targets as close to normal as possible.

And some insurance companies pay doctors extra if their diabetic patients get their levels very low.

The low-blood-sugar hypothesis was so entrenched that when the National Heart, Lung and Blood Institute and the National Institute of Diabetes and Digestive and Kidney Diseases proposed the study in the 1990s, they explained that it would be ethical. Even though most people assumed that lower blood sugar was better, no one had rigorously tested the idea. So the study would ask if very low blood sugar levels in people with Type 2 diabetes — the form that affects 95 percent of people with the disease — would protect against heart disease and save lives.

Some said that the study, even if ethical, would be impossible. They doubted that participants — whose average age was 62, who had had diabetes for about 10 years, who had higher than average blood sugar levels, and who also had heart disease or had other conditions, like high blood pressure and high cholesterol, that placed them at additional risk of heart disease — would ever achieve such low blood sugar levels.

Study patients were randomly assigned to one of three types of treatments: one comparing intensity of blood sugar control; another comparing intensity of cholesterol control; and the third comparing intensity of blood pressure control. The cholesterol and blood pressure parts of the study are continuing.

Dr. John Buse, the vice-chairman of the study’s steering committee and the president of medicine and science at the American Diabetes Association, described what was required to get blood sugar levels low, as measured by a protein, hemoglobin A1C, which was supposed to be at 6 percent or less.

“Many were taking four or five shots of insulin a day,” he said. “Some were using insulin pumps. Some were monitoring their blood sugar seven or eight times a day.”

They also took pills to lower their blood sugar, in addition to the pills they took for other medical conditions and to lower their blood pressure and cholesterol. They also came to a medical clinic every two months and had frequent telephone conversations with clinic staff.

Those assigned to the less stringent blood sugar control, an A1C level of 7.0 to 7.9 percent, had an easier time of it. They measured their blood sugar once or twice a day, went to the clinic every four months and took fewer drugs or lower doses.

So it was quite a surprise when the patients who had worked so hard to get their blood sugar low had a significantly higher death rate, the study investigators said.

The researchers asked whether there were any drugs or drug combinations that might have been to blame. They found none, said Dr. Denise G. Simons-Morton, a project officer for the study at the National Heart, Lung and Blood Institute. Even the drug Avandia, suspected of increasing the risk of heart attacks in diabetes, did not appear to contribute to the increased death rate.

Nor was there an unusual cause of death in the intensively treated group, Dr. Simons-Morton said. Most of the deaths in both groups were from heart attacks, she added.

For now, the reasons for the higher death rate are up for speculation. Clearly, people without diabetes are different from people who have diabetes and get their blood sugar low.

It might be that patients suffered unintended consequences from taking so many drugs, which might interact in unexpected ways, said Dr. Steven E. Nissen, chairman of the department of cardiovascular medicine at the Cleveland Clinic.

Or it may be that participants reduced their blood sugar too fast, Dr. Hirsch said. Years ago, researchers discovered that lowering blood sugar very quickly in diabetes could actually worsen blood vessel disease in the eyes, he said. But reducing levels more slowly protected those blood vessels.

And there are troubling questions about what the study means for people who are younger and who do not have cardiovascular disease. Should they forgo the low blood sugar targets?

No one knows.

Other medical experts say that they will be discussing and debating the results for some time.

“It is a great study and very well run,” Dr. Dove said. “And it certainly had the right principles behind it.”

But maybe, he said, “there may be some scientific principles that don’t hold water in a diabetic population.”

Yes We Can!

There was a comparison of the two candidate's health care plans, written by the organization Doctors for Obama, highlighting the differences between them in terms of diabetes care. To tell you honestly, I didn't read the McCain part because it's written by a partisan group and probably not entirely accurate. I did read the Obama side because this is the plan that would ideally be put in place some time in the next four years. I feel like the most significant differences, and the most valuable if Barack Obama and his team can really make this happen, are payment for preventative health services and the inability for insurance companies to penalize patients with chronic illnesses - such as diabetes - with higher costs for coverage.

Everyone in San Francisco Has Health Care

Healthy San Francisco is an innovative program designed to ensure that everyone in the city and county of San Francisco, regardless of income, has access to a basic level of medical care.

Unfortunately the program doesn't cover acupuncture at this time. But if San Francisco hired just five full time acupuncturists to deliver Chinese medicine care to program participants, I guarantee you that people would be getting better faster and staying healthier longer. Everyone knows acupuncture is excellent for pain. But Chinese medicine also gets excellent results with a whole host of problems that affect public health: diabetes, addiction issues, mental health, asthma, and on and on.

What Does Acupuncture Treat?

In 2003, the World Health Organization published "Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials". This report (here is a summary and the full report in PDF form), often cited on acupuncturist's websites, lists the following:

Diseases, symptoms or conditions for which acupuncture has been proved-through controlled trials-to be an effective treatment:

• Adverse reactions to radiotherapy and/or chemotherapy
• Allergic rhinitis (including hay fever)
• Biliary colic
• Depression (including depressive neurosis and depression following stroke)
• Dysentery, acute bacillary
• Dysmenorrhoea, primary
• Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm)
• Facial pain (including craniomandibular disorders)
• Headache
• Hypertension, essential
• Hypotension, primary
• Induction of labour
• Knee pain
• Leukopenia
• Low back pain
• Malposition of fetus, correction of
• Morning sickness
• Nausea and vomiting
• Neck pain
• Pain in dentistry (including dental pain and temporomandibular dysfunction)
• Periarthritis of shoulder
• Postoperative pain
• Renal colic
• Rheumatoid arthritis
• Sciatica
• Sprain
• Stroke
• Tennis elbow

Your acupuncturist can tell you that this list is far from complete. Traditional Chinese Medicine is a complete medical system in and of itself, which can effectively treat nearly any condition. As research progresses, traditional medicine and bacteriological medicine are becoming partners in delivering the best health to people the world over.

As a patient, you should look for health care practitioners who have a broad-minded approach to medicine. Ideally you'll want not only an M.D. who is open to Chinese medicine, but a Chinese medicine practitioner who knows about your condition from both Western and Eastern perspectives. Tell your doctor about your acupuncturist! Tell them how much it helps you. If you have a serious condition like cancer, your doctor and your acupuncturist must coordinate your care for the best results.