Disease Management Update
Volume V, No. 32
December 11, 2008

Dear Healthcare Intelligence Network Client,

According to the HHS, U.S. healthcare costs could amount to $4.3 trillion by 2017. To avoid this, the healthcare community is seeking alternatives to conventional medicine and healthcare. As of 2004, 36 percent of U.S. adults used some form of complementary and alternative medicine (CAM), and this week's DM Update showcases one such alternative therapy used for headache relief.

Your colleague in the business of healthcare,
Laura Greene
Editor, Disease Management Update

Please pass this along to any of your colleagues or, better yet, have them sign up to receive their own copy at http://www.hin.com/freenews2.html where you can also learn about our other complimentary news services.

Table of Contents

  1. Acupuncture Offers Headache Relief over Medication
  2. Disease Management Q&A: Holistic Health & DM
  3. HealthSounds Podcast: Integrative Health Coaching — Addressing Body, Mind, Spirituality and Community
  4. Ginkgo Biloba Shows No Effect in Preventing Dementia
  5. Survey of the Month: Tobacco Cessation and Prevention
  6. Evidence-Based Medicine and Managed Care

1. Acupuncture Offers Headache Relief over Medication

Acupuncture is more effective than medication in reducing the severity and frequency of chronic headaches, according to a new analysis conducted by Duke University Medical Center researchers. Researchers analyzed data from only randomized controlled trials evaluating acupuncture for adults with chronic headaches and were conducted for more than four weeks. The studies included nearly 4,000 patients who reported migraines (17 studies), tension headaches (10 studies) and other forms of chronic headaches with multiple symptoms (four studies). In 17 studies comparing acupuncture to medication, the researchers found that 62 percent of the acupuncture patients reported headache relief compared to only 45 percent of people taking medication. These acupuncture patients also reported better physical well-being compared to the medication group. In 14 studies that compared real acupuncture to sham therapy, 53 percent of acupuncture patients responded to treatment compared to 45 percent receiving sham therapy.

The Duke team looked at studies that compared traditional acupuncture to either medication or a control group who received sham acupuncture. Similar to traditional acupuncture, the sham therapy entails inserting needles into the skin but the acupuncturist avoids meridians or areas of the body that Chinese medicine teaches contains vital energy associated with achieving balance needed for good health.

"Acupuncture has been practiced for thousands of years but only recently has started to become more accepted as an alternative or supplement to conventional therapies," explains Tong Joo Gan, M.D., a Duke anesthesiologist who lead the analysis. "One of the barriers to treatment with acupuncture is getting people to understand that while needles are used it is not a painful experience," Dr. Gan says. "It is a method for releasing your body's own natural painkillers." Gan also has conducted research to determine the effect of acupuncture on post-operative pain, nausea and vomiting. His research has found that acupuncture can significantly reduce pain and the need for pain medications following surgery. He also found that acupuncture can be as effective as medication in reducing post-operative nausea and vomiting.

To learn more about this research, please visit:

2. Disease Management Q&A: Holistic Health & DM

Each week, a healthcare professional responds to a reader's query on an industry issue. This week's expert is Michael Thompson, a principal with PricewaterhouseCoopers.

Question: What impact can alternative medicines and an overal holistic health approach have on DM?

Response: (Michael Thompson) A holistic health perspective has great potential for optimizing DM and behavioral modification outcomes. This approach must be enabled through leadership, cultural change, process integration and collaboration across the value chain. Only then can we adapt this optimal approach to unique issues within a population to maximize effect.

For more details on coaching to change behavior and raise self-efficacy, please visit: http://store.hin.com/product.asp?itemid=3573

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HealthSounds Podcasts delivers a free weekly audio interview with a healthcare innovator to your e-mailbox. Listen to thought leaders answer key questions about the most pressing issues and trends in healthcare — impact of retail clinics, implications of Web 2.0 for healthcare, medical home models and much more.

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3. HealthSounds Podcast: Integrative Health Coaching — Addressing Body, Mind, Spirituality and Community

Integrative medicine includes the best of conventional medicine but expands the definition and focus of health to the person's body, mind, spirituality and community, explains Ruth Wolever, Ph.D., clinical health psychologist and director of research at Duke Integrative Medicine. Central to Duke's integrative health coaching program is mindfulness training and the "Wheel of Health" — a key to defining health and assessing the individual's readiness to change. Encouraging health coaches to implement their own personalized health plans allows them to "walk the talk" and empathize with the client's position.

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4. Ginkgo Biloba Shows No Effect in Preventing Dementia

The dietary supplement ginkgo biloba was found to be ineffective in reducing the development of dementia and Alzheimer's disease in older people. Researchers conducted the trial known as the Ginkgo Evaluation of Memory (GEM) study at four clinical sites over eight years. GEM is the largest clinical trial ever to evaluate ginkgo's effect on the occurrence of dementia.

Study participants were followed for an average of approximately six years (maximum of just over seven years). During the study, 523 participants were diagnosed with dementia, 246 in the placebo group and 277 in the ginkgo group. Thus, ginkgo showed no overall effect for reducing all types of dementia or Alzheimer's disease. In addition, in analyzing safety data, the GEM study did not find significant adverse effects from ginkgo; in particular, there was no evidence for increased bleeding risk in persons taking ginkgo.

"While this study revealed that ginkgo does not have an effect on reducing dementia in the study population, it does provide us with important information about how to design and conduct large dementia prevention trials in older adults," said Dr. Jeff Williamson, a geriatrician and principal investigator of the GEM Clinical Coordinating Center at Wake Forest University. "Future analyses will provide us with additional information on ginkgo's possible effects on cardiovascular disease, cancer, depression and other age-related conditions. We are especially grateful to the more than 3,000 older adults who dedicated many hours to helping us answer the important questions addressed by GEMS."

To learn more about this research, please visit:

5. Survey of the Month: Tobacco Cessation and Prevention

A CDC report released last month found that from 2000 to 2004, at least 443,000 people in the U.S. died prematurely each year as a result of smoking and exposure to secondhand smoke, an increase from 438,000 deaths annually for 1997-2001. This report also found that smoking costs the nation $193 billion per year in healthcare expenditures and productivity losses — up from a previous estimate of $167 billion — and that smoking results in 5.1 million years of potential life lost in the United States each year. What is your organization doing in the area of tobacco cessation and prevention? Complete HIN's Survey of the Month on tobacco cessation and prevention by December 31 and you’ll get a free executive summary of the compiled results.

To participate in this survey and receive its results, please visit:

6. Evidence-Based Medicine and Managed Care

There is growing pressure on managed care plans to increase access to all providers while also reducing health costs and improving outcomes. Its strategies and tactics are under the microscope resulting in high levels of tension with providers and increased scrutiny from regulators. The promise of managed care — to provide comprehensive care inclusive of prevention, chronic and acute while controlling costs via a pre-payment methodology — is being questioned in many circles. In many circles, managed care is synonymous with restricted care. Managed care has an image problem in most circles because it is seen as a barrier to evidence-based care rather than promoter.

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Contact HIN:
Editor: Laura M. Greene, lgreene@hin.com;
Sales & Marketing Coordinator: Deirdre McGuinness, dmcguinness@hin.com;
Publisher: Melanie Matthews, mmatthews@hin.com

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