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Moving Nation From Sick Care Toward Wellness Care

Moving Nation From Sick Care Toward Wellness Care

This handout photo provided by Debbe Geiger/Duke University Medical Center, taken in Nov. 2008, shows Roberta Cutbill, 68, exercising at the hospital in Durham, N.C. (AP Photo/Duke University Medical Center, Debbe Geiger)

Lauren Neergaard / AP

February 23, 2009

WASHINGTON – Popping a pill can cut your cholesterol. But did the doctor also prescribe cutting the stress that’s eroding your immune system? Or teach you how to exercise without worsening painful joints?

Think 3 Ps: Good health care is preventive, predictive and personalized, a rarity today in a crisis-oriented care system far better at treating disease than keeping it at bay. To help change that, one of the nation’s top medical groups starts a major push this week for what patients might call whole-body wellness care.

“Health is more than the absence of disease,” says Dr. Ralph Snyderman, who heads a three-day meeting of the prestigious Institute of Medicine to get onto Congress’ radar this health-promotion approach, what jargon-loving doctors call “integrative medicine.”

What does that mean? Basically, it’s going beyond standard disease-of-the-day care to involve a range of extra factors — physical, lifestyle habits, mind-body interaction — that play a role in preventing illness, and helping people stick with recommended changes long enough to see a benefit.

“Not enough attention is paid to wellness,” says AARP chief Bill Novelli, who worries that’s lost in the coming health care reform movement.

“The doctor says, ‘Lose weight, exercise, see you in a year.’ We know that doesn’t work,” adds Dr. Tracy Gaudet, an obstetrician/gynecologist who heads integrative medicine at Duke University Medical Center.

But how to pay for keeping people well is a barrier. Even though preventing disease is cheaper overall than treating it, it’s not clear where the upfront investment would come from, a big part of the Institute’s debate.

Still, a growing number of respected academic medical centers are adopting integrative medicine in different ways. At Duke, specially trained health coaches help patients implement a personalized care plan that complements treatment prescribed by their regular physicians, extra care that patients often pay for out-of-pocket.

“If I didn’t have coaching, I would have given up,” says Roberta Cutbill, 68, of Cary, N.C., whose cardiologist referred her to the program in hopes that better nutrition and exercise could lower her cholesterol enough to avoid medication.

But these centers must straddle a line between adopting some non-mainstream therapies that seem to at least help a patient’s quality of life, while avoiding unproven “alternative therapies,” even outright quackery.

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