I haven't looked yet, but I am hoping to find the recipes for all the magical food we had last night! Thank you everyone for an interesting and enjoyable semester!
If you have time this is a great place to take family and friends for a day trip: http://www.copia.org/content/node/972
All month long …celebrate the spirit of the holidays at COPIA
The holiday season brings a special magic to COPIA. Scents of gingerbread and spices fill the air as our chefs create holiday confections, rare vintages and festive sparkling wines flow and the gardens glow with pomegranates and persimmons. This is the time to put your busy life on simmer for a few hours, and come to COPIA. Create a wreath to welcome guests to your home, catch up with friends and family at our Holiday Teas, learn to make latkes or shop Cornucopia for the best in unique holiday gifts. Slow down, enjoy, indulge. This is our holiday gift to you.
Every Day in December
Pomegranates: Nutritious and Delicious
Learn why this amazing and beautiful fruit is becoming so popular—as well as a few easy ways to enjoy it at home.
Children’s Tea with Mrs. Claus
Saturday, December 16 and Sunday, December 17, 1:00 - 2:30 pm
Mrs. Claus presides over an old-fashioned holiday tea the whole family will love! We’ll serve a delicious assortment of child-friendly baked goodies and tea sandwiches, as well as a choice of tea, hot cider or hot chocolate. Keep the memory warm with a family holiday photo in Santa’s sleigh. (Photos available for purchase separately.) $35 per adult, $20 per child (incls admission)/Members: $25 per adult, $15 per child. Teas sell out quickly; please call 707.259.1600 for reservations.
Why not make it an afternoon with the family and stay for the VOENA children’s choir concerts? See below (ticketed separately).
Tempting Hanukkah Treats
Wednesday, December 20 and Saturday, December 23, 1:00 - 2:00 pm
Learn about luscious latkes, decadent donuts and other traditional Hanukkah treats with Culinary Instructor Jill Hough. Trade stories, share holiday memories and have a nosh! Included with admission.
Concerts
VOENA Holiday Concert
Saturday, December 16 and Sunday, December 17 – 3:00 pm (two matinees)
VOENA (Voices of Eve & Angels) is the internationally acclaimed, multi-ethnic children’s choir that combines inventive a cappella vocal arrangements with percussion, dance and theatrical elements. The choir is a joy for the eyes, ears and heart, and one you won’t want to miss. $25 (incls admission)/$22.50 member.
The Kinsey Sicks: Oy Vey in a Manger
Thursday, December 21, 8:00 pm
For the fourth “straight” year, The Kinsey Sicks—America’s Favorite Dragapella Beautyshop Quartet—turn their considerable talents to revamping holiday cheer at COPIA. Come see what all the fuss is about!
$25 general/$22.50 member. This program contains adult material and is not recommended for children.
Sumptuous Meals at Julia’s Kitchen - Celebrate the holidays with sumptuous prix fixe menus created for the Twelve Nights of Christmas and annual New Year’s Eve fête. Check the website for details: www.juliaskitchen.org. Reservations: 707.265.5700 or www.opentable.com.
Thursday, December 14, 2006
Tuesday, December 12, 2006
H O P E
At MUSC, we teach the HOPE method of taking a spiritual history because of its ease of use and the way it smoothly transitions from social support to spiritual topics (Anandarajah and Hight, Amer Fam Phys 2001). The HOPE questions, can be seen at on the web at www.aafp.org/afp/20010101/81.html, or summarized below:
H addresses the person’s basic spiritual resources, such as sources of Hope, without immediately focusing on religion or spirituality. Using this method allows for meaningful dialogue with patients of diverse backgrounds, including those whose spirituality lies outside the boundaries of traditional religion or those who have been alienated in some way from their religion. It also allows those for whom religion, God or prayer is important to volunteer this information.
O focuses on the importance of Organized religion in patients' lives.
P focuses on the specific aspects of their personal spirituality and personal religious practices. If patients relate meaningful experiences at this point, then the interviewer can proceed with more specific questions regarding religion and personal spirituality. If not, then one can ask open-ended follow-up questions to open the door for patients to discuss important spiritual concerns they may have.
E focuses on the Effects of a patient's spiritual and religious beliefs on medical care and end-of-life issues. These questions help re-direct the discussion back onto clinical issues and medical-decision-making.
H addresses the person’s basic spiritual resources, such as sources of Hope, without immediately focusing on religion or spirituality. Using this method allows for meaningful dialogue with patients of diverse backgrounds, including those whose spirituality lies outside the boundaries of traditional religion or those who have been alienated in some way from their religion. It also allows those for whom religion, God or prayer is important to volunteer this information.
O focuses on the importance of Organized religion in patients' lives.
P focuses on the specific aspects of their personal spirituality and personal religious practices. If patients relate meaningful experiences at this point, then the interviewer can proceed with more specific questions regarding religion and personal spirituality. If not, then one can ask open-ended follow-up questions to open the door for patients to discuss important spiritual concerns they may have.
E focuses on the Effects of a patient's spiritual and religious beliefs on medical care and end-of-life issues. These questions help re-direct the discussion back onto clinical issues and medical-decision-making.
Spirituality and Medicine
Why is it important to attend to spirituality in medicine?
Regardless of their own belief system, physicians should not allow their own bias to blind them to the appreciation of the possibility that religion and spiritual beliefs play an important role for many of their patients. When illness threatens the health, and possibly the life of an individual, that person is likely to come to the physician with both physical symptoms and spiritual issues in mind. An article in the Journal of Religion and Health claims that through these two channels, medicine and religion, humans grapple with common issues of infirmity, suffering, loneliness, despair, and death, while searching for hope, meaning, and personal value in the crisis of illness.[6]
Persons may hold powerful spiritual beliefs, and may or may not be active in any institutional religion. Spirituality can be defined as ". . . a belief system focusing on intangible elements that impart vitality and meaning to life's events."[7] Many physicians and nurses have intuitive and anecdotal impressions that the beliefs and religious practices of patients have a profound affect upon their experiences with illness and the threat of dying. It is generally accepted that religious affiliation is correlated with a reduction in the incidence of some diseases such as cancer and coronary artery disease. For patients facing a terminal illness, religious and spiritual factors often figure into important decisions such as the employment of advance directives such as the living will and the Durable Power of Attorney for Health Care. Considerations of the meaning, purpose and value of human life are used to make choices about the desirability of CPR and aggressive life-support, or whether and when to fore-go life support and accept death as appropriate and natural under the circumstances.
spacer spacer
How should I take a "spiritual history"?
In courses such as the "Introduction to Clinical Medicine," medical students learn the various components of the doctor-patient interview, often beginning with a history of the present illness, a psycho-social history, and a review of systems. Students-in-training are often hesitant to ask questions regarded as intrusive into the personal life of the patient until they understand there are valid reasons for asking about sexual practices, alcohol use, the use of tobacco or non-prescription drugs. Religious belief and practice falls into that "personal" category that students-in-training often avoid, yet when valid reasons are offered by teachers and mentors for obtaining a spiritual history, students can learn to incorporate this line of questioning into the patient interview.
Often, the spiritual history can be incorporated into what we may now want to call the "psycho-social-spiritual" patient history. Students are taught to make a transition by simply stating something like the following: "As physicians, (or, as physicians-in-training,) we have discovered that many of our patients have strong spiritual or religious beliefs that have a bearing on their perceptions of illness and their preferred modes of treatment. If you are comfortable discussing this with me, I would like to hear from you about any beliefs or practices that you would want me to know as your care giver." If the patient responds affirmatively, follow-up questions can be used to elicit the information. If the patient says "no" or "none" it is a clear signal to move on to the next topic.
In my experience as a tutor, students learning the patient interview have returned from a patient interview on many occasions with a sense of excitement and gratification in discovering that this line of questioning opened a discussion with the patient that disclosed the patient's faith in God as a major comforting factor in the face of a life-threatening illness. Some patients have described their gratitude to their church community for bringing meals to their family while at least one parent was at the hospital with a sick child. Others spoke of a visit from a priest, a rabbi, or a minister during their hospitalization as a major source of comfort and reassurance. One patient, self-described as a "non-church-goer," described his initial surprise at a visit from the hospital chaplain which turned into gratitude as he found in the chaplain a skilled listener with a deep sense of caring to whom he could pour out his feelings about being sick, away from home, separated from his family, frightened by the prospect of invasive diagnostic procedures and the possibility of a painful treatment regimen.
Todd Maugans offered a mnemonic in the Archives of Family Medicine as a technique to assist students in framing an approach to spiritual history taking:
S Spiritual Belief System
P Personal Spirituality
I Integration and Involvement in a Spiritual Community
R Ritualized Practices and Restrictions
I Implications for Medical Care
T Terminal Events Planning (advance directives)
The mnemonic is of course suggestive of a broader line of questioning that may follow from open ended questions organized around the topics identified above.
How can respect for persons involve a spiritual perspective?
The emphasis on listening to the patient and learning of the patient's beliefs and values as well as the signs and symptoms of illness is timely. A variety of features related to cost containment seem to work adversely against the patient's needs. The typical office visit grows shorter and more curtailed as physicians are pressured to see more patients within a working day. In managed care organizations the physician is responsible for a pool of patients, not just the individual patient who is standing before the physician at this particular moment. Increasingly, the physician is the "gatekeeper" in terms of referral to specialists and to expensive diagnostic procedures or hospitalization decisions. These pressures toward economy have been created by the upward spiraling of health care costs. However, they must not come at the sacrifice of respect for persons, a fundamental moral obligation in the profession of medicine.
The principle of respect for persons leads to actions designed to safeguard the autonomy of the patient, to limit the risks of harm while providing a medical benefit, and to treat persons fairly in the allocation of health care resources. Such respect for persons is a guiding principle of the healing profession and flows from the professions fundamental ethical commitment in serving the sick and injured. This principle is reinforced for the physician with a religious perspective, who in most religions, views the patient as a part of the creation of God. Likewise, it is reinforced in religious hospitals where the mission is to care for persons individually and equally as "children of God."
How should I work with hospital chaplains?
It is heartening to know that the physician is not alone in relating to the spiritual needs of the patient, but enjoys the team work of well trained hospital chaplains who are prepared to help when the needs of the patient are outside the competence of the physician. Consultation frequently may involve clergy serving the patient and his family. The onset of serious illness often induces spiritual reflection as patients wonder, "what is the meaning of my life now?". Others ponder questions of causation, or "why did this happen to me?". Still others are concerned as to whether the physician's recommendations for treatment are permissible within the faith community of the patient. Practical questions concerning the permissibility of procedures such as in vitro fertilization, pregnancy termination, blood transfusion, organ donation, or the removal of life supports such as ventilators, dialysis, or artificially administered nutrition and hydration, arise regularly for persons of faith. In many cases, the chaplain will have specialized knowledge of how medical procedures are viewed by various religious bodies. In each case, the chaplain will first attempt to elicit the patient's current understanding or belief about the permissibility of the procedure in question.
The chaplain is also a helpful resource in providing or arranging for certain rituals that are important for patients under particular circumstances. Some patients may wish to hear the assurances of Scripture, others may want the chaplain to lead them in prayer, and still others may wish for the sacrament of communion, baptism, anointing, or the last rites, depending upon their faith system. The chaplain may provide these direct services for the patient, or may act as liaison with the patient's clergy person. In one case, the surgeon called for the chaplain to consult with a patient who was inexplicably refusing a life-saving surgical procedure. The chaplain gently probed the patient's story in an empathic manner, leading the patient to "confess" to a belief that her current illness was God's punishment for a previous sin. The ensuing discussion revolved around notions of God's forgiveness and the patient's request for prayer. In this case, the chaplain became the "embodiment" of God's forgiveness as he heard the patient's confession, provided reassurance of God's forgiving nature, and offered a prayer acknowledging her penitence and desire for forgiveness and healing. In another case, the neonatologist summoned the chaplain to the NICU when it became apparent that a premature infant was not going to live and the parents were distraught at the notion that their baby would die without the sacrament of baptism. In this case, the chaplain was able to discuss the parents beliefs, to reassure them that their needs could be met, and to provide an infant baptism service with the parents, the neonatologist and the primary nurse all in attendance. The chaplain also notified their home town pastor and helped make arrangements for the parents to be followed back home in their grieving process.
spacer spacer
What role should my personal beliefs play in the physician-patient relationship?
Whether you are religious, or areligious, your beliefs may affect the doctor-patient relationship. Care must be taken that the nonreligious physician not underestimate the importance of the patient's belief system. Care must be taken that the religious physician who believes differently than the patient, not impose his or her beliefs onto the patient at this time of special vulnerability. In both cases, the principle of respect for the patient should transcend the ideology of the physician.
It is clear that religious beliefs are important to the lives of many physicians. Some physicians attest to a sense of being "called" by God to the profession of medicine, a definite sense of vocation in the religious sense of a calling. In fact, in a much earlier time in the history of the world, the priest and the medicine man were one and the same in most cultures, until the development of scientific medicine led to a division between the professions. Modern physicians wonder whether, when and how to express themselves to patients regarding their own faith.
In one study reported in the Southern Medical Journal in 1995, physicians from a variety of religious backgrounds reported they would be comfortable discussing their beliefs if asked about them by patients.[8] The study shows that physicians with spiritual beliefs that are important to them integrate their beliefs into their interactions with patients in a variety of ways. Some devout physicians shared their beliefs with patients, discussed the patients beliefs, and prayed either with or for the patient. These interactions were more likely in the face of a serious or life-threatening illness and religious discussions did not take place with the majority of their patients.
Four guidelines are offered for physicians regarding religious issues:
* physicians may enter such a dialogue, but they are not obligated to do so.
* the dialogue must be at the invitation of the patient, not imposed by the physician.
* physicians must be open and nonjudgmental in claiming that their beliefs are personally helpful, without claiming ultimate truth
* the guiding principle should be "do no harm," the purpose of the dialogue should be burden-lifting, not burden-producing.[9]
Some physicians find a number of reasons to avoid discussions revolving around the spiritual beliefs, needs and interests of their patients. Reasons for not opening this subject include the scarcity of time in office visits, fear of imposing upon the patient, lack of familiarity with the subject matter of spirituality, or the lack of knowledge and experience with the varieties of religious expressions in our pluralistic culture. On the other hand, some physicians do incorporate spiritual history taking into the bio-psycho-social-spiritual interview, and others find opportunities where sharing their own beliefs or praying with a particular patient in special circumstances has a unique value to that patient. Certainly issues in modern medicine raise a host of questions such as whether or not to prolong life through artificial means, whether it is licit to shorten life through the use of pain medications, or what duty one has to a new born with fatal genetic anomalies. These and a myriad of other questions have religious and spiritual significance for a wide spectrum of our society and deserve a sensitive dialogue with physicians attending to patients facing these troubling issues.
How can I approach spirituality in medicine with physicians-in-training?
In one approach at the University of Washington School of Medicine, the course "Spirituality in Medicine" goes beyond teaching the spiritual history taking. The purpose of the course is to provide an opportunity for interactive learning about relationships between spirituality and the practices in medicine and health care. Some of the goals of the class are as follows:
* To heighten student awareness of ways in which their own faith system provides resources for encounters with illness, suffering and death.
* To foster student understanding, respect and appreciation for the individuality and diversity of patients' beliefs, values, spirituality and culture regarding illness, its meaning, cause, treatment, and outcome.
* To strengthen students in their commitment to relationship-centered medicine that emphasizes care of the suffering person rather than attention simply to the pathophysiology of disease, and recognizes the physician as a dynamic component of that relationship.
* To facilitate students in recognizing the role of the hospital chaplain and the patient's clergy as partners in the health care team in providing care for the patient.
* To encourage students in developing and maintaining a program of physical, emotional and spiritual self-care which includes attention to the purpose and meaning of their lives and work.
Until recently, there were all too few medical schools that offered a formal forum to discuss humanistic aspects of medicine for medical students and residents. This situation is changing. Like the University of Washington, some thirty medical schools around the country have recently added new courses addressing spirituality in medicine. Increasingly, residency programs, particularly those with a primary care focus, are also incorporating this view in the training of residents. In addition, CME has been offered to practicing physicians through three annual conferences on "Spirituality in Medicine," the first of which was hosted by Harvard Medical School with Herbert Benson, MD, as facilitator.
http://depts.washington.edu/bioethx/topics/spirit.html
Regardless of their own belief system, physicians should not allow their own bias to blind them to the appreciation of the possibility that religion and spiritual beliefs play an important role for many of their patients. When illness threatens the health, and possibly the life of an individual, that person is likely to come to the physician with both physical symptoms and spiritual issues in mind. An article in the Journal of Religion and Health claims that through these two channels, medicine and religion, humans grapple with common issues of infirmity, suffering, loneliness, despair, and death, while searching for hope, meaning, and personal value in the crisis of illness.[6]
Persons may hold powerful spiritual beliefs, and may or may not be active in any institutional religion. Spirituality can be defined as ". . . a belief system focusing on intangible elements that impart vitality and meaning to life's events."[7] Many physicians and nurses have intuitive and anecdotal impressions that the beliefs and religious practices of patients have a profound affect upon their experiences with illness and the threat of dying. It is generally accepted that religious affiliation is correlated with a reduction in the incidence of some diseases such as cancer and coronary artery disease. For patients facing a terminal illness, religious and spiritual factors often figure into important decisions such as the employment of advance directives such as the living will and the Durable Power of Attorney for Health Care. Considerations of the meaning, purpose and value of human life are used to make choices about the desirability of CPR and aggressive life-support, or whether and when to fore-go life support and accept death as appropriate and natural under the circumstances.
spacer spacer
How should I take a "spiritual history"?
In courses such as the "Introduction to Clinical Medicine," medical students learn the various components of the doctor-patient interview, often beginning with a history of the present illness, a psycho-social history, and a review of systems. Students-in-training are often hesitant to ask questions regarded as intrusive into the personal life of the patient until they understand there are valid reasons for asking about sexual practices, alcohol use, the use of tobacco or non-prescription drugs. Religious belief and practice falls into that "personal" category that students-in-training often avoid, yet when valid reasons are offered by teachers and mentors for obtaining a spiritual history, students can learn to incorporate this line of questioning into the patient interview.
Often, the spiritual history can be incorporated into what we may now want to call the "psycho-social-spiritual" patient history. Students are taught to make a transition by simply stating something like the following: "As physicians, (or, as physicians-in-training,) we have discovered that many of our patients have strong spiritual or religious beliefs that have a bearing on their perceptions of illness and their preferred modes of treatment. If you are comfortable discussing this with me, I would like to hear from you about any beliefs or practices that you would want me to know as your care giver." If the patient responds affirmatively, follow-up questions can be used to elicit the information. If the patient says "no" or "none" it is a clear signal to move on to the next topic.
In my experience as a tutor, students learning the patient interview have returned from a patient interview on many occasions with a sense of excitement and gratification in discovering that this line of questioning opened a discussion with the patient that disclosed the patient's faith in God as a major comforting factor in the face of a life-threatening illness. Some patients have described their gratitude to their church community for bringing meals to their family while at least one parent was at the hospital with a sick child. Others spoke of a visit from a priest, a rabbi, or a minister during their hospitalization as a major source of comfort and reassurance. One patient, self-described as a "non-church-goer," described his initial surprise at a visit from the hospital chaplain which turned into gratitude as he found in the chaplain a skilled listener with a deep sense of caring to whom he could pour out his feelings about being sick, away from home, separated from his family, frightened by the prospect of invasive diagnostic procedures and the possibility of a painful treatment regimen.
Todd Maugans offered a mnemonic in the Archives of Family Medicine as a technique to assist students in framing an approach to spiritual history taking:
S Spiritual Belief System
P Personal Spirituality
I Integration and Involvement in a Spiritual Community
R Ritualized Practices and Restrictions
I Implications for Medical Care
T Terminal Events Planning (advance directives)
The mnemonic is of course suggestive of a broader line of questioning that may follow from open ended questions organized around the topics identified above.
How can respect for persons involve a spiritual perspective?
The emphasis on listening to the patient and learning of the patient's beliefs and values as well as the signs and symptoms of illness is timely. A variety of features related to cost containment seem to work adversely against the patient's needs. The typical office visit grows shorter and more curtailed as physicians are pressured to see more patients within a working day. In managed care organizations the physician is responsible for a pool of patients, not just the individual patient who is standing before the physician at this particular moment. Increasingly, the physician is the "gatekeeper" in terms of referral to specialists and to expensive diagnostic procedures or hospitalization decisions. These pressures toward economy have been created by the upward spiraling of health care costs. However, they must not come at the sacrifice of respect for persons, a fundamental moral obligation in the profession of medicine.
The principle of respect for persons leads to actions designed to safeguard the autonomy of the patient, to limit the risks of harm while providing a medical benefit, and to treat persons fairly in the allocation of health care resources. Such respect for persons is a guiding principle of the healing profession and flows from the professions fundamental ethical commitment in serving the sick and injured. This principle is reinforced for the physician with a religious perspective, who in most religions, views the patient as a part of the creation of God. Likewise, it is reinforced in religious hospitals where the mission is to care for persons individually and equally as "children of God."
How should I work with hospital chaplains?
It is heartening to know that the physician is not alone in relating to the spiritual needs of the patient, but enjoys the team work of well trained hospital chaplains who are prepared to help when the needs of the patient are outside the competence of the physician. Consultation frequently may involve clergy serving the patient and his family. The onset of serious illness often induces spiritual reflection as patients wonder, "what is the meaning of my life now?". Others ponder questions of causation, or "why did this happen to me?". Still others are concerned as to whether the physician's recommendations for treatment are permissible within the faith community of the patient. Practical questions concerning the permissibility of procedures such as in vitro fertilization, pregnancy termination, blood transfusion, organ donation, or the removal of life supports such as ventilators, dialysis, or artificially administered nutrition and hydration, arise regularly for persons of faith. In many cases, the chaplain will have specialized knowledge of how medical procedures are viewed by various religious bodies. In each case, the chaplain will first attempt to elicit the patient's current understanding or belief about the permissibility of the procedure in question.
The chaplain is also a helpful resource in providing or arranging for certain rituals that are important for patients under particular circumstances. Some patients may wish to hear the assurances of Scripture, others may want the chaplain to lead them in prayer, and still others may wish for the sacrament of communion, baptism, anointing, or the last rites, depending upon their faith system. The chaplain may provide these direct services for the patient, or may act as liaison with the patient's clergy person. In one case, the surgeon called for the chaplain to consult with a patient who was inexplicably refusing a life-saving surgical procedure. The chaplain gently probed the patient's story in an empathic manner, leading the patient to "confess" to a belief that her current illness was God's punishment for a previous sin. The ensuing discussion revolved around notions of God's forgiveness and the patient's request for prayer. In this case, the chaplain became the "embodiment" of God's forgiveness as he heard the patient's confession, provided reassurance of God's forgiving nature, and offered a prayer acknowledging her penitence and desire for forgiveness and healing. In another case, the neonatologist summoned the chaplain to the NICU when it became apparent that a premature infant was not going to live and the parents were distraught at the notion that their baby would die without the sacrament of baptism. In this case, the chaplain was able to discuss the parents beliefs, to reassure them that their needs could be met, and to provide an infant baptism service with the parents, the neonatologist and the primary nurse all in attendance. The chaplain also notified their home town pastor and helped make arrangements for the parents to be followed back home in their grieving process.
spacer spacer
What role should my personal beliefs play in the physician-patient relationship?
Whether you are religious, or areligious, your beliefs may affect the doctor-patient relationship. Care must be taken that the nonreligious physician not underestimate the importance of the patient's belief system. Care must be taken that the religious physician who believes differently than the patient, not impose his or her beliefs onto the patient at this time of special vulnerability. In both cases, the principle of respect for the patient should transcend the ideology of the physician.
It is clear that religious beliefs are important to the lives of many physicians. Some physicians attest to a sense of being "called" by God to the profession of medicine, a definite sense of vocation in the religious sense of a calling. In fact, in a much earlier time in the history of the world, the priest and the medicine man were one and the same in most cultures, until the development of scientific medicine led to a division between the professions. Modern physicians wonder whether, when and how to express themselves to patients regarding their own faith.
In one study reported in the Southern Medical Journal in 1995, physicians from a variety of religious backgrounds reported they would be comfortable discussing their beliefs if asked about them by patients.[8] The study shows that physicians with spiritual beliefs that are important to them integrate their beliefs into their interactions with patients in a variety of ways. Some devout physicians shared their beliefs with patients, discussed the patients beliefs, and prayed either with or for the patient. These interactions were more likely in the face of a serious or life-threatening illness and religious discussions did not take place with the majority of their patients.
Four guidelines are offered for physicians regarding religious issues:
* physicians may enter such a dialogue, but they are not obligated to do so.
* the dialogue must be at the invitation of the patient, not imposed by the physician.
* physicians must be open and nonjudgmental in claiming that their beliefs are personally helpful, without claiming ultimate truth
* the guiding principle should be "do no harm," the purpose of the dialogue should be burden-lifting, not burden-producing.[9]
Some physicians find a number of reasons to avoid discussions revolving around the spiritual beliefs, needs and interests of their patients. Reasons for not opening this subject include the scarcity of time in office visits, fear of imposing upon the patient, lack of familiarity with the subject matter of spirituality, or the lack of knowledge and experience with the varieties of religious expressions in our pluralistic culture. On the other hand, some physicians do incorporate spiritual history taking into the bio-psycho-social-spiritual interview, and others find opportunities where sharing their own beliefs or praying with a particular patient in special circumstances has a unique value to that patient. Certainly issues in modern medicine raise a host of questions such as whether or not to prolong life through artificial means, whether it is licit to shorten life through the use of pain medications, or what duty one has to a new born with fatal genetic anomalies. These and a myriad of other questions have religious and spiritual significance for a wide spectrum of our society and deserve a sensitive dialogue with physicians attending to patients facing these troubling issues.
How can I approach spirituality in medicine with physicians-in-training?
In one approach at the University of Washington School of Medicine, the course "Spirituality in Medicine" goes beyond teaching the spiritual history taking. The purpose of the course is to provide an opportunity for interactive learning about relationships between spirituality and the practices in medicine and health care. Some of the goals of the class are as follows:
* To heighten student awareness of ways in which their own faith system provides resources for encounters with illness, suffering and death.
* To foster student understanding, respect and appreciation for the individuality and diversity of patients' beliefs, values, spirituality and culture regarding illness, its meaning, cause, treatment, and outcome.
* To strengthen students in their commitment to relationship-centered medicine that emphasizes care of the suffering person rather than attention simply to the pathophysiology of disease, and recognizes the physician as a dynamic component of that relationship.
* To facilitate students in recognizing the role of the hospital chaplain and the patient's clergy as partners in the health care team in providing care for the patient.
* To encourage students in developing and maintaining a program of physical, emotional and spiritual self-care which includes attention to the purpose and meaning of their lives and work.
Until recently, there were all too few medical schools that offered a formal forum to discuss humanistic aspects of medicine for medical students and residents. This situation is changing. Like the University of Washington, some thirty medical schools around the country have recently added new courses addressing spirituality in medicine. Increasingly, residency programs, particularly those with a primary care focus, are also incorporating this view in the training of residents. In addition, CME has been offered to practicing physicians through three annual conferences on "Spirituality in Medicine," the first of which was hosted by Harvard Medical School with Herbert Benson, MD, as facilitator.
http://depts.washington.edu/bioethx/topics/spirit.html
Auras and Discharges
Perhaps the most specific model for the bioenergetic field is some special form of electromagnetism. Advocates claim that measurable electromagnetic waves are emitted by humans. In the Journal of Advanced Nursing, Patterson relates "spiritual healing" to the belief that "we are all part of the natural harmonious energy of the universe." Within this universal energy field is a human energy field "that is intimately involved with human life, often called the 'aura.' " [13]
Some self-described psychics claim that they can "see" a human aura. The claim has not been substantiated. [14]
Indeed, humans have auras that can be photographed with infrared-sensitive film. However, this can be trivially identified as "black body" electromagnetic radiation. Everyday objects that reflect very little light will appear black. These bodies emit invisible infrared light that is the statistical result of the random thermal movements of all the charged particles in the body. The wavelength spectrum has a characteristic smooth shape completely specified by the body's absolute temperature. As that temperature rises, the spectrum moves into the visible. The sun, for example, radiates largely as a "black body" of temperature 6,000 K, with a broad peak at the center of the visible spectrum in the yellow. At their much lower body temperatures, humans radiate mostly in the infrared region of the spectrum that is invisible to the naked eye but easily seen with infrared detection equipment.
The inability of the wave theory of light to explain the black body spectrum led, in 1900, to Planck's conjecture that light comes in bundles of energy called "quanta," thus triggering the quantum revolution. These quanta are now recognized as material photons. It is somewhat ironic that holists find such comfort in quantum mechanics, which replaced etherial waves with material particles.
Surely black body radiation is not a candidate for the bioenergetic field, for then even the cosmic microwave background, 2.7K radiation left over from the big bang, would be "alive." Black body radiation lacks any of the complexity we associate with life. It is as featureless as it can be and still be consistent with the laws of physics. Any fanciful shapes seen in photographed auras emanating from humans can be attributed to optical and photographic effects, uncorrelated with any property of the body that one might identify as "live" rather than "dead," and the tendency for people to see patterns where none exist.
Stefanatos [15] tells us that the "electromagnetic fields (EMF) emanating from bacteria, viruses, and toxic substances affect the cells of the body and weaken its constitution." So the vital force is identified quite explicitly with electromagnetic fields and is said to be the cause of disease. But somehow the life energies of the body are balanced by bioenergetic therapies. "No antibiotic or drug, no matter how powerful, will save an animal if the vital force of healing is suppressed or lacking." [16] So health or sickness is determined by who wins the battle between good and bad electromagnetic waves in the body.
Now it would seem that all these effects of electromagnetic fields in living things would be easily detectable, given the great precision with which electromagnetic phenomena can be measured in the laboratory. Physicists have measured the magnetic dipole moment of the electron (a measure of the strength of the electron's magnetic field) to one part in ten billion, and calculated it with the same accuracy. They surely should be able to detect any electromagnetic effects in the body powerful enough to move atoms around or do whatever happens in causing or curing disease. But neither physics nor any other science has seen anything that demands we go beyond established physical theories. No elementary particle or field has been found that is uniquely biological. None is even hinted at in our most powerful detectors.
Besides the infrared black body radiation already mentioned, electromagnetic waves at other frequencies are detected from the brain and other organs. As mentioned, these are often claimed as "evidence" for the bioenergetic field. In medicine, they provide powerful diagnostic information. But these electromagnetic waves show no special characteristics that differentiate them from the electromagnetic waves produced by moving charges in any electronic system. Indeed, they can be simulated with a computer. No marker has been found that uniquely labels the waves from organisms "live" rather than "dead."
Kirlian photography is often cited as evidence for the existence of fields unique to living things. For example, Patterson [17] claims that the "seven or more layers within an aura, each with its own colour," have been recorded using Kirlian photography.
Semyon Davidovich Kirlian was an Armenian electrician who discovered in 1937 that photographs of live objects placed in a pulsed high electromagnetic will show remarkable surrounding "aura." In the typical Kirlian experiment, an object, such as a freshly-cut leaf, is placed on a piece of photographic film that is electrically isolated from a flat aluminum electrode with a piece of dielectric material. A pulsed high voltage is then applied between another electrode placed in contact with the object and the aluminum electrode. The film is then developed.
The resulting photographs indicate dynamic, changing patterns, with multicolored sparks, twinkles, and flares. [18] Dead objects do not have such lively patterns! In the case of a leaf, the pattern is seen to gradually go away as the leaf dies, emitting cries of agony during its death throes. Ostrander and Schroeder described what Kirlian and his wife observed: "As they watched, the leaf seemed to be dying before their very eyes, and the death was reflected in the picture of the energy impulses." The Kirlians reported that "We appeared to be seeing the very life activity of the leaf itself." [19]
As has been amply demonstrated, the Kirlian aura is nothing but corona discharge, reported as far back as 1777 and completely understood in physical terms. Controlled experiments have demonstrated that claimed effects, such as the cries of agony of a dying leaf, are dependent on the amount of moisture present. As the leaf dies, it dries out, lowering its electrical conductivity. The same effect can be seen with a long dead but initially wet piece of wood. [20]
Once again, like the infrared aura, we have a well-known electromagnetic phenomenon being paraded in front of innocent lay people, unfamiliar with basic physics, as "evidence" for a living force. It is nothing of the sort. Proponents of alternative medicine would have far fewer critics among conventional scientists if they did not resort to this kind of dishonesty and foolishness. [21]
THE AFRICAN ROOTS OF TRADITIONAL CHINESE MEDICINE
http://www.blackherbals.com/african_roots_of_traditional_chinese_med.htm
TARIQ SAWANDI, M.H.
Before discussing the principles of Traditional Chinese Medicine, I think it would be interesting to the readers and students of African holistic medicine to know of the African influence of ancient Chinese healing theory.
The African role in early Asian civilization has been submerged and distorted for centuries. Asia's African roots are well summarized in "African Presence in Early Asia" by Ivan Van Sertima/Runoko Rashidi, and "African Presence in Early China" by James Brunson. The original oriental people were Black and many of them still are Black - in southern China and Asia. The earliest occupants of Asia were "small black (pygmies)" who came to the region as early as 50,000 years ago. In "The Children of the Sun", George Parker writes "....it appears that the entire continent of Asia was originally the home of many black races and that theses races were the pioneers in establishing the wonderful civilizations that have flourished throughout this vast continent." Reports of major kingdoms ruled by Blacks are frequent in Chinese documents. Chinese historians described the Fou Nanese people of China as "small and black". The Ainus, Japan's oldest known inhabitants have traditions which tell of a race of dark dwarfs which inhabited Japan before they did. Historians Cheikh Anta Diop and Albert Churchward saw the Ainus as originating in Egypt! There is archaeological support for this. In addition, ancient Egypt and Mesopotamia records the "Anu" (Ainu). The Anu are the same people who occupied Egypt for thousands of years. These same people are recorded to have made large migrations to the Asian continent taking with them thousands of years of African-Egyptian knowledge and influence.
This explains the existence of man-made pyramids in China and Japan! China's pyramids are located near Siang Fu city in the Shensi province. The Chinese do not know how they got there, but it is believed that Africans of the Nile Valley were the builders. (J. Perry: The Growth of Civilization, p. 106, 107).
African Development of Ancient Chinese Medicine
Ancient Chinese medicine dates back to the Shang Dynasty founded by the African-Mongolian King T'ang, or Ta. (1500-1000 B.C.). The Shang (or Chiang) and Chou dynasties were credited with bringing together the elements of Chinese medical theory. The Shang were given the name of Nakhi (Na-Black, Khi-man). Under this Black dynasty, the Chinese established the basic forms of a graceful calligraphy that has lasted to the present day. The first Chinese emperor, the legendary Fu-Hsi (2953-2838 B.C.) was a woolly haired Black man. He is said to have originated the I Ching, or The Book of Change, which is the oldest most revered system of prophecy. It is known to have influenced the most distinguished philosophers of Chinese medicine and thought.
Many of the great concepts of Chinese medical science which was compiled during the Shang period were later developed during the Han Dynasty (168 B.C. to 8 A.D.). During this period, medicine reflected the philosophical ideas associated in the earlier Chou and Shang period. The Han began to fuse Shang medical concepts with outlooks from the philosophical ideas of Confucius (551-479 B.C.). Toward that end, they generated a scheme which explained all phenomena in relation to the whole. Under this system, all natural phenomena including the human body and the organs were organized within the system of "Yin" and Yang" and the "five elements", or what is also called the "five phases" theory.
Han Dynasty physicians created great classic works, such as the Pen-ts'ao and the Nei Ching, or Yellow Emperor's Classic of Internal Medicine (3rd Century B.C.), drawing its inspiration from more ancient sources rooted in Afro-centric thought. (See Diagram 1.)
DIAGRAM 1.
The Nei Ching, The Yellow Emperor's Classic of Internal Medicine, a medical book reportedly written in the second century, B.C. before the birth of Hippocrates, the co-called father of Western medicine. According to Chinese legend, the Nei Ching was created through a dialogue between the legendary ruler Huang-Ti and his court physician, Chi Po. From the Nei Ching, thousands of books have been written about Chinese medicine.
Given these considerations, Chinese medicine echoes the logic of the Ancient Egyptians, which viewed the universe as process-oriented in which there are no boundaries between rest and motion, time and space, mind and matter, sickness and health. The Chinese looked at reality as a unified field, an interwoven pattern of inseparable links in a circular chain called the Tao. From the Tao flowed all things and events in nature: seasons, color, sound, organs, tissue, emotion, climate, matter and energy. (See Diagram 2.)
DIAGRAM 2
According to the Tao Te Ching, out of the One came the duality of Yin and Yang, and the immaterial breath (Chi), from which all physical matter and energy was created. This idea by Chinese philosopher, Lao Tzu was borrowed from the earlier ancient Egyptian concept of "Nu" (formless water)", the duality of Shu and Tefnut, and the Nahab Kau (Tree of Life).
Yin/Yang Theory and the Concept of Chi
Chinese medicine places primary emphasis on the balance of "Chi" (Qi, or Ki), or Life energy constantly flowing throughout the body. There are 12 major meridians, or pathways for chi, and each is associated with a major vital organ or vital function. These meridians form an invisible network that carries chi to every tissue in the body. In health, it is properly balanced, but if it becomes unbalanced, the result is disease. It is the job of the Chinese doctor to restore the balance using diet, acupuncture, and herbal formulas.
The Life energy comes in two, but complementary parts: Yin and Yang. The Yin nature includes the earth, moon, night, fall and winter, cold, wetness, the feet, the female sex, tissue growth and a passive temperament. The Yang counterparts are the heavens, the sun, day, spring and summer, heat, dryness, light, the head, the male sex, tissue breakdown, and an aggressive temperament. All individuals have both male and female polarities which consist of the combinations of Yin and Yang, requiring the Chinese doctor to tailor treatments to the individual's needs. (See Diagram 3.)
DIAGRAM 3.
The Chinese Five-element system was heavily influenced by the ancient Egyptian's four-element conception. Each element relates to one season, one color and two organ systems, and they interact in subtle, and complicated ways through the energy of chi.
An important part of the Chinese doctor's evaluation is the overall relationship between the Yin and Yang balance in the patient's body. This is "Chi". Furthermore, we must bear in mind that Yin and Yang are complementary and not contradictory. There is no such thing as "good" and the other "bad". Rather, one seeks to find a harmony between the two energies. The ancient Egyptians first put forward this idea, explained in terms of "Shu" and "Tefnut", the dual complementary energy that flows in the universe. It was later adopted by the founders of Chinese medicine to distinguish between the Yin and Yang qualities of a person's character, or the constitution of one's illness.
The application of Yin and Yang is an important step in the process of making a traditional diagnosis and treatment.
Treating Conditions Through Chinese Medicine
Based on the assessment of Yin and Yang energy imbalance, the Chinese herbalist looks for patterns of distress in the patient's pulse, as well as tongue, face, and physical characteristics. The pulse system is highly developed in Chinese medicine, and consist of six positions on each wrist, and various pulse beats can be determined by the trained practitioner. According to Traditional Chinese medical text, the pulse corresponds to different organ networks, areas of the body, meridians or energy channels, and physiological processes like breathing, digestion and elimination. These are thought to function in phase with Yin and Yang principles and also the energies represented by the five elements: Earth, Metal, Water, Wood, and Fire. Some general diagnostic correspondence are:
YIN
YANG
Interior
Exterior
Front
Back
Lower section
Upper section
Bones
Skin
Inner organs
Outer organs
Blood
Chi (Life energy)
Chronic
Acute
Deficiency
Excess
In general, the basic treatment principles are to tonify or stimulate in a case of deficient Yin or Yang energy, and to sedate or disperse when the energy pattern is one of excess. Herbal formulas are then tailored to fit the individual's need, or designed to fit the overall condition of the patient.
Special herbal formulas have been traditionally used for thousands of years by Chinese herbalists for such ailments as fever, colds and flu, headaches, infections, menstrual problems, ulcers, high blood pressure, cancer, infertility, and diabetes to name a few.
For example, "Gan Mao Ling", a two thousand year old formula, has been traditionally used for symptoms such as runny nose and scratchy throat. By taking six tablets of this formula every three hours, one can stop a cold in its tracts before it can take root. Chinese remedies are very effective and versatile. You can purchase Chinese herb formulas in many forms such as pills, tablets, extracts, or bulk to overcome numerous conditions and diseases.
Today more than ever, Western doctors are bearing witness to the effectiveness of Traditional Chinese Medicine and are just beginning to realize that the Chinese masters understood profound aspects of the human mind and body without the aid of technology or sophisticated medical devices. China is heir to the secret healing arts which has been passed down by ancient Khemit. I feel that it is time that the Afrocentric roots of Chinese medicine be made public which has been ignored for too long. This and future articles seek to correct this oversight.
References
1. The Destruction of Black Civilizations, Chancellor Williams.
2. The Missing Pages of History, Indus Khamit Kush
3. The Five Lost Books of Africa, Dr. Khallid Al-Mansour.
4. The Children of the Sun, George Parker.
5. African Presence in Early Asia, Ivan Van Sertima/Runoko Rashidi
6. The Way of Herbs, Michael Tierra
7. Chinese Herbal Medicine: Formulas and Strategies, Dan Bensky and Randall Barolet.
8. African Medicine: A guide to Yoruba divination and Herbal Medicine:, Tariq M. Sawandi
(in press).
9. Chinese-Planetary Herbal Diagnosis, Michael and Lesley Tierra.
Monday, December 11, 2006
interesting to know the other side - but what bitterness.....
Why Health Professionals Become Quacks
William T. Jarvis, Ph.D.
It is especially disappointing when an individual trained in the health sciences turns to promoting quackery. Friends and colleagues often wonder how this can happen. Some reasons appear to be:
Boredom. Daily practice can become humdrum. Pseudoscientific ideas can be exciting. The late Carl Sagan believed that the qualities that make pseudoscience appealing are the same that make scientific enterprises so fascinating. He said, "I make a distinction between those who perpetuate and promote borderline belief systems and those who accept them. The latter are often taken by the novelty of the systems, and the feeling of insight and grandeur they provide" [1] Sagan lamented the fact that so many are willing to settle for pseudoscience when true science offers so much to those willing to work at it.
Low professional esteem. Nonphysicians who don't believe their professions is sufficiently appreciated sometimes compensate by making extravagant claims. Dental renegades have said "All diseases can be seen in a patient's mouth." Fringe podiatrists may claim to be able to judge health entirely by examining the feet. Iridologists point to the eye, chiropractors the spine, auriculotherapists the ear, Registered Nurses an alleged "human energy field," and so on. Even physicians are not immune from raising their personal status by pretension. By claiming to cure cancer or to reverse heart disease without bypass surgery, general physicians can elevate themselves above the highly trained specialists in oncology or cardiology. By claiming to heal diseases that doctors cannot, faith healers advance above physicians on the social status chart (physicians are normally at the top of the chart while preachers have been slipping in modern times). Psychologists, physicians, actors, or others who become health gurus often become darlings of the popular press.
Paranormal tendencies. Many health systems are actually hygienic religions with deeply-held, emotionally significant beliefs about the nature of reality, salvation, and proper lifestyles. Vegetarianism, chiropractic, naturopathy, homeopathy, energy medicine, therapeutic touch, crystal healing, and many more are rooted in vitalism, which has been defined as "a doctrine that the functions of a living organism are due to a vital principle ["life force"] distinct from physicochemical forces" and "the theory that biological activities are directed by a supernatural force." [2,3] Vitalists are not just nonscientific, they are antiscientific because they abhor the reductionism, materialism, and mechanistic causal processes of science. They prefer subjective experience to objective testing, and place intuitiveness above reason and logic. Vitalism is linked to the concept of an immortal human soul, which also links it to religious ideologies [4].
Paranoid mental state. Some people are prone to seeing conspiracies everywhere. Such people may readily believe that fluoridation is a conspiracy to poison America, that AIDS was invented and spread to destroy Africans or homosexuals, and that organized medicine is withholding the cure for cancer. Whereas individuals who complain about conspiracies directed toward themselves are likely to be regarded as mentally ill, those who perceive them as directed against a nation, culture, or way of life may seem more rational. Perceiving their political passions are unselfish and patriotic intensifies their feelings of righteousness and moral indignation [5]. Many such people belong to the world of American fascism, Holocaust deniers, tax rebels, the radical militia movement, and other anti-government extremists who would eliminate the FDA and other regulatory agencies that help protect consumers from health fraud. Liberty Lobby's newspaper The Spotlight champions such causes and also promotes quack cancer cures and attacks fluoridation.
Reality shock. Everyone is vulnerable to death anxiety. Health personnel who regularly deal with terminally ill patients must make psychological adjustments. Some are simply not up to it. Investigation of quack cancer clinics have found physicians, nurses, and others who became disillusioned with standard care because of the harsh realities of the side effects or acknowledged limitations of proven therapies.
Beliefs encroachment. Science is limited to dealing with observable, measurable, and repeatable phenomena. Beliefs that transcend science fall into the realms of philosophy and religion. Some people allow such beliefs to encroach upon their practices. While one may exercise religious or philosophical values of compassion, generosity, mercy and integrity (which is the foundation of the scientific method's search for objective truth), it is not appropriate for a health professional to permit metaphysical (supernatural) notions to displace or distort scientific diagnostic, prescriptive or therapeutic procedures. Individuals who wish to work in the area of religious belief should pursue a different career.
The profit motive. Quackery can be extremely lucrative. Claiming to have a "better mousetrap" can cause the world to beat a path to one's door. Greed can motivate entrepreneurial practitioners to set ethical principles aside.
The prophet motive. Just as Old Testament prophets called for conversion and repentance, doctors have to "convert" patients away from smoking, obesity, stress, alcohol and other indulgences [6]. As prognosticators, doctors foretell what is going to happen if patients don't change their way of life. The prophet role provides power over people. Some doctors consciously avoid it. They encourage patients to be self-reliant rather than dependent, but in doing so they may fail to meet important emotional needs. Quacks, on the other hand, revel in, encourage, and exploit this power. Egomania is commonly found among quacks. They enjoy the adulation and discipleship their pretense of superiority evokes.
Psychopathic tendencies. Studies of the psychopathic personality provide insight into the psychodynamics of quackery. Dr. Robert Hare who investigated for more than twenty years, states, "You find psychopaths in all professions. . . the shyster lawyer, the physician always on the verge of losing his license, the businessman with a string of deals where his partners always lost out." [7] Hare describes psychopaths as lacking a capacity to feel compassion or pangs of conscience, and as exhibiting glibness, superficial charm, grandiosity, pathological lying, conning/manipulative behavior, lack of guilt, proneness to boredom, lack of empathy, and other traits often seen in quacks. According to Hare, such people suffer from a cognitive defect that prevents them from experiencing sympathy or remorse.
The conversion phenomenon. The "brainwashing" that North Koreans used on American prisoners of war involved stress to the point that it produced protective inhibition and dysfunction. In some cases, positive conditioning causes the victim to love what he had previously hated, and vice-versa; and in other cases, the brain stops computing critically the impressions received. Many individuals who become quacks undergo a midlife crisis, painful divorce, life-threatening disease, or another severely stressful experience. The conversion theory is supported by a study of why physicians had taken up "holistic" practices. By far the greatest reason given (51.7%) was "spiritual or religious experiences." [8]
Many people -- including far too many health professionals, law enforcement officials, and judges -- exhibit a cavalier attitude toward quackery. Although most reject the idea that quackery is "worth a try" for a sick person [9], it is important to reinforce and mobilize those who understand quackery's harmful potential.
http://www.quackwatch.org/01QuackeryRelatedTopics/quackpro.htmlSCIENCE AND PSEUDOSCIENCE
http://biochemistry.louisville.edu/education/CAMover.htm
A SCIENTIFIC LOOK AT ALTERNATIVE MEDICINE
OVERVIEW; SCIENCE AND PSEUDOSCIENCE;
HEALTH FRAUD AND QUACKERY
* Barnes, P.M. et al. (2004) “Complementary and Alternative Medicine Use Among Adults: United States, 2002.” CDC Advance Data, No. 343, May 27 [pdf file]
Druss, B.G. and Rosenheck, R.A. (1999) “Association Between Use of Unconventional Therapies and Conventional Medical Services” JAMA 282, 651-656 [abstract]
Barrett, S. (2004) "Be Wary of 'Alternative' Health Methods"
Barrett, S. (2004) “Miniglossary of ‘Alternative’ Methods”
Raso, J. (1998 "Dictionary of Metaphysical Healthcare: Alternative Medicine, Paranormal Healing, and Related Methods" (130-page dictionary describing 1169 methods)
Bandolier, “Complementary and Alternative Therapies”
Vogel, R.A. et al. (2005) “Integrating Complementary Medicine Into Cardiovascular Medicine.”J. Am. Coll. Cardiol. 46, 184-221. pdf file (38 page document) [contains reviews of many methods as applied to cardiovascular medicine]
Berman, J.D. and Straus, S.E. (2004) “Implementing a Research Agenda for Complementary and Alternative Medicine” Annu. Rev. Med. 55, 239-254 [abstract]
United States Senate Special Committee on Aging: Hearing on Swindlers, Hucksters and Snake Oil Salesmen: The Hype and Hope of Marketing Anti-Aging Products to Seniors, Sept. 10, 2001:
(critiques of trends in alternative medicine and dietary supplements)
Mooney, C. (2002) “Science Fiction” Washington Monthly, April (“After spending half a billion taxpayer dollars, alternative medicine gurus still can’t prove their methods work...”)
Sampson, W.I. (1998) “The Braid of the ‘Alternative Medicine’ Movement”
Walker, L. (1999) “Mysticism and/or Rigor: Can Science and Alternative Medicine Shake Hands?” 21stC, issue 3.4
Astin, J.A. (1998) "Why Patients Use Alternative Medicine: Results of a National Survey" JAMA 279, 1548-1553 [abstract]
American Academy of Pediatrics (2001) “Counseling Families Who Choose Complementary and Alternative Medicine for Their Child With Chronic Illness or Disability” Pediatrics 107, 598-601 [abstract]
Eisenberg, D.M. et al. (1993) "Unconventional Medicine in the United States: Prevalence, Costs, and Patterns of Use" New Eng. J. Med. 328, 246-252 [abstract] (see critique, next item)
Gorski, T. (1999) “The Eisenberg Data: Flawed and Deceptive” [critique of 1993 study]
Eisenberg, D.M., Davis, R.B., Ettner, S.L. et al. (1998) “Trends in Alternative Medicine Use in the United States, 1990-1997. Results of a Follow-up National Survey” JAMA 280, 1569-1575l [abstract]
Wolsko, P.M., Eisenberg, D.M., Davis, R.B., Ettner, S.L., Phillips, R.S. (2002) “Insurance Coverage, Medical Conditions, and Visits to Alternative Medicine Providers” Arch. Intern. Med. 162, 282-287 [abstract]
Astin, J.A., Pelletier, K.R., Marie, A. and Haskell, W.L. (2000) “Complementary and Alternative Medicine Use Among Elderly Persons: One-Year Analysis of a Blue Shield Medicare Supplement” J. Gerontol. 55A, M4-M9 [abstract]
Overview - sympathetic to alternative methods
Kaptchuk, T.J. and Eisenberg, D.M. (2001) “Varieties of Healing. 1: Medical Pluralism in the United States” Arch. Intern. Med. 135, 189-195 [abstract with link to pdf file of full text]; “Varieties of Healing: 2. A Taxonomy of Unconventional Healing Practices” Arch. Intern. Med. 135, 195-204 [abstract with link to pdf file of full text]
National Center for Complementary and Alternative Medicine
• “Expanding Horizons of Health Care: Strategic Plan 2005-2009"
• Video Lectures (registration required)
Atwood, K.C. (2003) “The Ongoing Problem with the National Center for Complementary and Alternative Medicine” Skeptical Inquirer, Sept/Oct, 23-29
Chesney, M.A. and Straus, S.E. (2004) “Complementary and Alternative Medicine: the Convergence of Public Interest and Science in the United States” MJA 181, 335-33
Education
Gabriel, B. (2001) “To Teach or Not to Teach: The Role of Alternative Medicine in Medical School Curricula” AAMC Reporter, July
Marcus, D. (2001) “How Should Alternative Medicine Be Taught to Medical Students and Physicians?” Acad. Med. 76, 224-229 [abstract]
Kligler, B. et al. (2004) “Core Competencies in Integrative Medicine for Medical School Curricula: A Proposal” Acad. Med. 79, 521-531 [abstract]
Science and pseudoscience, critical thinking
* Barrett, S. and Herbert, V. (2002) "More Ploys That May Fool You"
* Beyerstein, B. (2003) "Why Bogus Therapies Often Seem to Work"
Lett, J. (1990) “A Field Guide to Critical Thinking” Skeptical Inquirer, Winter
Schwartz, J. and Barrett, S. (2001) “Some Notes on the Nature of Science”
Imrie, R. and Ramey, D.W. (2000) “The Evidence for Evidence-Based Medicine”
Complementary Therapies Med. 8, 123-126 (refutes the myth that only 10-20% of medical procedures are evidence-based)
Coker, R. (2001) “Distinguishing Science and Pseudoscience”
Alcock, J. (2001) “‘Alternative Medicine’ and the Psychology of Belief”
Nahin, R. and Straus, S. (2001) “Research into Complementary and Alternative Medicine: Problems and Potential” BMJ 322, 161-164
Sterne, J.A.C., Egger, M., and Smith, G.D. (2001) “Investigating and Dealing with Publication and Other Biases in Meta-Analysis” BMJ 323, 101-105
Smith, G.L. (1997) "Common Questions About Science and 'Alternative' Health Methods"
Stenger, V.J. "'Postmodern' Attacks on Science and Reality"
Stalker, D.F. (1995) "Evidence and Alternative Medicine" Mt. Sinai J. Med. 62, 132-143 [abstract] [Discusses prior probabilities of hypotheses being correct]
Ioannadis, J.P.A. (2005) “Contradicted and Initially Stronger Effects in Highly Cited Clinical Research” JAMA 294, 218-228 [abstract] [found that in about one-third of highly cited studies showing effectiveness of an intervention, subsequent studies found no effect or weaker effects]
Sense About Science (2005) “I Don’t Know What to Believe...: Making Sense of Science Stories” article with link to pdf file [aimed at the lay person, explaining the peer review process]
Health fraud and quackery - generalPolevoy, T. Healthwatcher site Focus is on developments in Canada, but contains many general articles and links.
Lee, P. The Quack-Files “‘Alternative’ Medicine, Quackery, Health Fraud: The Other Side of the Coin”
Anti-Quackery Ring Contains links to many sites
Kurtzweil, P. (1999) “How to Spot Health Fraud” FDA Consumer 33(6), 22-26
“Top Health Frauds” (based on FDA listing, 1989; updated by S. Barrett, 1999)
Barrett, S. "Quackery: How Should It Be Defined?"
Jarvis, W.T. "How Quackery Harms Cancer Patients"
Jarvis, W.T. and Barrett, S. (2005) "How Quackery Sells"
Barrett, S. (2005) “Promoters of Questionable Methods”
Media
FTC Press Release (June 14, 2001) “‘Operation Cure.All’ Wages New Battle in Ongoing War Against Internet Health Fraud”
Barrett, S. (2003) "Web Site Evaluation Index"
Walji, M. et al. (2004) “Efficacy of Quality Criteria to Identify Potentially Harmful Information: A Cross-sectional Survey of Complementary and Alternative Web Sites” J. Med. Internet Research 6(2), e2
Barrett, S. (2004) "Nonrecommended Periodicals"
Barrett, S. (2004) “Nonrecommended Books”
Organizations
National Council Against Health Fraud
Scientific Review of Alternative Medicine
American Association for Health Freedom (formerly “American Preventive Medical Association”; promotes alternative methods and "health freedom" legislation)
Barrett, S. (2005) "Questionable Organizations: An Overview"
Legal issues
Barrett, S. (2001) "Strengths and Weaknesses in Our Laws"
Barrett, S. (2001) “Pro-Quackery Legislation”
Cohen, M.H. and Eisenberg, D.M. (2002) “Potential Physician Malpractice Liability Associated with Complementary and Integrative Medical Therapies” Ann. Intern. Med. 136, 596-603[abstract with link to pdf file of full text]Cohen, M.H. et al. (2005) “Emerging Credentialing Practices, Malpractice Liability Policies, and Guidelines Governing Complementary and Alternative Medical Practices and Dietary Supplement Recommendations” Ann. Intern. Med. 165, 289-295 [abstract]
Cohen, M.H. and Kemper, K.J. (2005) “Complementary Therapies in Pediatrics: A Legal Perspective” Pediatrics 115, 774-780 [abstract]Ethical issues
Adams, K.E., Cohen, M.H., Eisenberg, D. and Jonsen, A.R. (2002) “Ethical Considerations of Complementary and Alternative Medical Therapies in Conventional Medical Settings” Ann. Intern. Med. 137, 660-664 [abstract with link to pdf file of full text]
Miller, F.G., Emanuel, E.J., Rosenstein, D.L. and Straus, S.E. (2004) “Ethical Issues Concerning Research in Complementary and Alternative Medicine” JAMA 291, 599-604[abstract]
Cohen, M.H. et al. (2005) “Pediatric Use of Complementary Therapies: Ethical and Policy Choices” Pediatrics 116, e568
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