According to a report by the Common Wealth
Fund:
In
2013, the U.S. spent far more on health care than these other countries. Higher
spending appeared to be largely driven by greater use of medical technology and
higher health care prices, rather than more frequent doctor visits or hospital
admissions. In contrast, U.S. spending on social services made up a relatively
small share of the economy relative to other countries. Despite spending more
on health care, Americans had poor health outcomes, including shorter life
expectancy and greater prevalence of chronic conditions.”
I’ve been researching on the various reasons
why our nation has such poor outcomes compared to other industrialized nations. Last week, I discussed that
the sole reliance on treatments with high risks for adverse events may be one factor that contributes to this. Other factors, which will be expanded on
in a future blog, include issues with test validity, reliability, and the
over-use of medical technology.
Another major issue has been the division of
the body and the mind. This week, I’m going to report on several recent studies
which provide evidence of the power of the mind. Science is now validating that
what lies between our ears may, in fact, be one of our most important, and
least invasive health tools we have.
How
the Relaxation Response Could Help Health Care
The following abstract discusses a controlled cohort
observational study that compared patients who used the Relaxation Response Resiliency
Program (ERP) to controls on healthcare utilization outcomes. The results
provided evidence that mind-body interventions could “reduce stress and build resiliency”
resulting in decreased use of health care.
Abstract
Background
Poor
psychological and physical resilience in response to stress drives a great deal
of health care utilization. Mind-body interventions can reduce stress and build
resiliency. The rationale for this study is therefore to estimate the effect of
mind-body interventions on healthcare utilization.
Objective
Estimate
the effect of mind body training, specifically, the Relaxation Response
Resiliency Program (3RP) on healthcare utilization.
Design
Retrospective
controlled cohort observational study. Setting: Major US Academic Health
Network. Sample: All patients receiving 3RP at the MGH Benson-Henry Institute
from 1/12/2006 to 7/1/2014 (n = 4452), controls (n = 13149) followed for a
median of 4.2 years (.85-8.4 yrs). Measurements: Utilization as measured by
billable encounters/year (be/yr) stratified by encounter type: clinical,
imaging, laboratory and procedural, by class of chief complaint: e.g.,
Cardiovascular, and by site of care delivery, e.g., Emergency Department.
Subgroup analysis by propensity score matched pre-intervention utilization
rate.
Results
At one
year, total utilization for the intervention group decreased by 43% [53.5 to
30.5 be/yr] (p <0.0001). Clinical encounters decreased by 41.9% [40 to 23.2
be/yr], imaging by 50.3% [11.5 to 5.7 be/yr], lab encounters by 43.5% [9.8 to
5.6], and procedures by 21.4% [2.2 to 1.7 be/yr], all p < 0.01. The
intervention group’s Emergency department (ED) visits decreased from 3.6 to
1.7/year (p<0.0001) and Hospital and Urgent care visits converged with the
controls. Subgroup analysis (identically matched initial utilization rates–Intervention
group: high utilizing controls) showed the intervention group significantly
reduced utilization relative to the control group by: 18.3% across all
functional categories, 24.7% across all site categories and 25.3% across all
clinical categories.
Mind body interventions such
as 3RP have the potential to substantially reduce healthcare utilization at
relatively low cost and thus can serve as key components in any population
health and health care delivery system.
Why Washing Dishes Is Good for Your
Health
The good news is, you
can find relaxation as close as the dirty dishes in the sink:
This study sought to investigate whether washing
dishes could be used as an informal contemplative practice, promoting the state
of mindfulness along with attendant emotional and attentional phenomena. We
hypothesized that, relative to a control condition, participants receiving
mindful dishwashing instruction would evidence greater state mindfulness,
attentional awareness, and positive affect, as well as reduce negative affect
and lead to overestimations of time spent dishwashing. A sample of 51 college students
engaged in either a mindful or control dishwashing practice before completing
measures of mindfulness, affect, and experiential recall. Mindful dishwashers
evidenced greater state mindfulness, increases in elements of positive affect
(i.e., inspiration), decreases in elements of negative affect (i.e.,
nervousness), and overestimations of dishwashing time. Implications for these
findings are diverse and suggest that mindfulness as well as positive affect
could be cultivated through intentionally engaging in a broad range of
activities.
Being Mindful May Fight Fat
According to Health
Day, mindfulness may also assist with the obesity epidemic:
Being self-aware may help reduce your risk of
obesity, a new study contends.
Researchers looked at more than 400 people in New
England and found that those with higher levels of what is known as dispositional
mindfulness — an awareness and attention to current feelings and thoughts —
had less belly fat. They were also less likely to be obese than those with
lower levels of such mindfulness.
The
Healing Words of Docs Before Surgery
Few
moments in life are more daunting than those just before a surgery. But a new
study finds that some reassuring words from a doctor just before an operation
begins may be more effective than drugs in easing patient anxiety.
Placebo Effect Grows in U.S.,
Thwarting Development of Painkillers
Stronger
placebo responses have already been reported for trials of antidepressants and
antipsychotics, triggering debate over whether growing placebo effects are seen
in pain trials too. To find out, Mogil and his colleagues examined 84 clinical
trials of drugs for the treatment of chronic neuropathic pain (pain which
affects the nervous system) published between 1990 and 2013.
Based
on patients’ ratings of their pain, the effect of trialled drugs in relieving
symptoms stayed the same over the 23-year period–but placebo responses rose. In
1996, patients in clinical trials reported that drugs relieved their pain by
27% more than did a placebo. But by 2013, that gap had slipped to just 9%. The phenomenon
is driven by 35 US trials; among trials in Europe, Asia and elsewhere, there
was no significant change in placebo reponses. The analysis is in press in the
journal Pain.
The Power of Placebo Explained in
Depression, Study
A recent study found
the mechanism in which placebo may effect depression outcomes:
Conclusions and Relevance These data demonstrate
that placebo-induced activation of the µ-opioid system is implicated in the
formation of placebo antidepressant effects in patients with MDD and also
participate in antidepressant responses, conferring illness resiliency, during
open administration.
Now, I want to hear what you think with all these latest findings? Will you make some time for minding your health?
Sources:
The Common Wealth
Fund. U.S. Health Care from a Global Perspective: Spending, Use of Services,
Prices, and Health in 13 Countries.2015.http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective/
ABIM. About. Choosing
Wisely. org. 2015. Available at: http://www.choosingwisely.org/about-us/
Deardoff J. What’s
normal for bloodwork? How blood test ‘reference ranges’ are calibrated, why
they may vary from lab to lab. Chicago Tribune.November 21, 2011.
Available at:
http://articles.chicagotribune.com/2011-11-21/a-z/sc-health-1123-bloodwork-20111121_1_labs-range-glucose
Mayo Clinic. Mayo School of Health. Medical
Laboratory Sciences. May 8, 2015. Available at: http://www.mayo.edu/mshs/careers/laboratory-sciences
Relaxation Response
and Resiliency Training and Its Effect on Healthcare Resource Utilization. PLOS
One. October 13, 2015. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0140212
This Could Cut Your
Health Costs by $25,000 a Year, Study Finds: Time. October 13, 2015. http://time.com/4071897/stress-relief-healthcare-costs/
Mindfulness. October 2015, (6)5: 1095-1103
Being Mindful May
Guard Against Belly Fat. Health Day. Oct. 21, 2015 (Journal Link:
http://link.springer.com/article/10.1007%2Fs12529-015-9513-z)
Surgeon’s Calming
Words May Ease Stress of Surgery. Oct. 27, 2015. Health
Day News.
Scientific
American. October 7, 2015. http://www.scientificamerican.com/article/placebo-effect-grows-in-u-s-thwarting-development-of-painkillers/
Link to journal: http://journals.lww.com/pain/Abstract/publishahead/Increasing_placebo_responses_over_time_in_U_S_.99737.aspx
JAMA Psychiatry. Published
online September 30, 2015. doi:10.1001/jamapsychiatry.2015.1335
