Category Archives: Wayne B Jonas, MD

SI Experts And Partners Publish Article On SEaRCH Process For Evidence-Based Care

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On a quest to discover which healthcare practices are the most effective and nominal in cost, leaders from Samueli Institute’s Scientific Evaluation and Research of Claims in Healthcare (SEaRCH) Program have published an article on how to get evidence-based medical practices into mainstream care. We have found that expert panels from SI and partnered organizations are the best option to guide the research process.

Who’s Involved?

Samueli Institute’s SEaRCH program has several expert panels which include article co-authors Wayne Jonas, MD and Senior Psychologist, Pamela Elfenbaum. The Clinical Expert Panel (CEP), Research Expert Panel (REP), the (PoEP) which is designed for policy and the PaEP which is for patient experts. Partners of SI are also closely involved in streamlining evidence-based patient care:

National Institute of Health (NIH) Consensus Panels -Since 1977, the panel has been congregating on occasions to answer standing questions on how to resolve the controversies surrounding data management.

Institute of Medicine (IOM)- The IOM summarizes the medical evidence into reports to make the data more clear and more readily available to be used by practitioners.

RAND Expert Panel– RAND focuses on clinical experts rather than scientific experts to add diversity to the evidence. RAND’s Ian Coulter, PhD is working closely with SI’s SEaRCH.

Consciousness and Healing Initiative (CHI)- Director of the initiative, Dr. Shamini Jain has partnered with SEaRCH for this article.

The article titled, SEaRCH expert panel process: streamlining the link between evidence and practice, is published in the journal BioMed Central.

3 Opportunities for Integrative Medicine

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headshot of Dr. Jonas

Wayne B. Jonas, MD, President and CEO, Samueli Institute

In his interview with the Natural Medicine Journal, an electronic peer-reviewed journal and open access website dedicated to the field of integrative medicine, Wayne B. Jonas, MD, describes three opportunities for the field of health and wellness and how Samueli Institute and others are working to make progress in these areas.

1. Establish an evidence base

Providers and patients are constantly faced with claims about therapeutic and healing practices. Trying to sort out what works and what does not is often done in a haphazard and unreliable manner—or the information is not available at all.

The evidence gap poses a challenge to health professionals, educators, funders and patients seeking to establish whether a health claim is supported by valid clinical evidence. Over the last decade Samueli Institute researchers have tackled the evidence gap for these and other topics:

  • Breast Cancer: A review uncovered specific interventions (i.e., pharmacological, behavioral, psychological, complementary and alternative medicine, multi-modal) aimed at mitigating the fatigue-sleep disturbance-depression symptom cluster in breast cancer patients and survivors.
  • Resilience in the Military: Samueli Institute rigorously assessed the quantity, quality, effectiveness, and safety concerns on multi-modal, biopsychosocial training programs used for the self-management of emotional stress.
  • Supplements: Samueli Institute’s reviews have uncovered how supplements can improve performance and sustain health for omega 3’s, melatonin for sleep, and others.

As more non-traditional health care treatments are accepted, this research becomes even more important to inform providers, guide policy and empower patients.

2.  Incorporate healing practices into large systems

hands_forblogMerely having the evidence is not enough. Most patients undergoing surgery still cannot access post-surgical acupuncture more than a decade after it was deemed effective. Ensuring that large hospital systems are successfully able to integrate these evidence-based practices into standard care is needed to move the field forward.

Complementary and integrative practices like acupuncture, massage, manipulative therapies, and education on diet, nutrition, and other self-care approaches are not very integrated, with conventional medicine or themselves. They are not part of normal medical training, are usually delivered in silos of practice, often aren’t found in the same place, are not part of a patient centered medical home, are not incorporated into national guidelines and are not paid for by insurance. Therefore, integrative practices tend to operate in isolation.

The need to improve quality of care is fueling Samueli Institute’s work in the Chronic Pain Breakthrough Collaborative. Health care systems and clinics receive consultative support in process improvement to integrate care which results in better outcomes for both patients and providers.

3. Show impact on the bottom line

Dr. Jonas discusses the need to demonstrate how complementary and integrative practices are cost effective within large health care systems.

Progress can only be achieved by knowing the return on investment of wellness behaviors and programs, and the success rates of traditional health interventions like medications and surgeries and how they compare with alternative treatments.

When Valley Hospital in Ridgewood, New Jersey decided to train their nursing staff in using holistic integrative care – for themselves and with their patients, a look at the operating margin of 9.64%, nine times the average for New Jersey confirmed that the decision to incorporate integrative, holistic care was clearly on target.

More success stories like this will provide a powerful financial driver for wellness.

Listen to the full interview to hear the biggest advances and future predictions for the field of Integrative Medicine.

Podcast – An Interview with Dr. George Isham

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George Isham, MD, Chief Health Officer of HealthPartners, a nonprofit health provider that covers more than 1.5 million lives in Minnesota and Wisconsin, joins Samueli Institute President and CEO Wayne Jonas, MD, this week for a podcast interview on the future of healthcare.

Clinical Care Accounts for Only 20% of Health

In a 20 minute interview, Isham and Jonas discuss the groundbreaking work of Dr. David Kindig, who argued that clinical care is responsible for as little as 20 percent of overall health. The vast majority of factors influencing health, he said, come from social determinants, such as socioeconomic factors, the environment, and the health behaviors of individuals.

It is through this lens of the importance of what happens outside the doctor’s office that Jonas and Isham consider the future of care and wrestle with real world questions of promoting health within a system that reimburses prescriptions, procedures and clinical treatments.

“If you change the way that people are paid such that you reward the outcomes, then doctors are free to figure out based upon good science what works and what they should begin to do,” explained Isham.

“This will increase satisfaction not just in patients, but in clinicians as well. People are highly motivated when you have a mission that is larger than self. That’s why doctors went to medical school and why nurses trained to be nurses.

Should You Go Under the Knife? A Review of Sham Surgery

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Patients dealing with chronic pain and obesity have a difficult decision to make when facing surgery or minimally invasive procedures. With the help of their doctors, patients weigh the risks of the procedure including infection, cost, and the side effects, including those of anesthesia. However, a recent study by researchers showed that in some cases, surgery is no better than placebo, and in other cases that doctors and patients may not have all the information they need to make proper decisions.

Some Procedures No Better than Placebo

Researchers from Samueli Institute, National Institutes of Health, Harvard Medical School, Houston Methodist Hospital, the University of Maryland and the University of Munich, Germany systematically reviewed 55 studies comparing patient outcomes from actual surgical procedures to outcomes after “sham” procedures. Sham procedures mimic the ritual and process of surgery without actually performing the procedure.

The review encompassed more than 3,500 patients and showed that outcomes for surgery were about the same as placebo in the included procedures for pain, and marginally better in cases of obesity.

The results of the systematic review, which was published this month in the journal BMJ Open, have implications for clinical research and practice by arguing against the continued use of ineffective, invasive procedures—especially in the field of chronic pain – until more rigorous research is done on these procedures. Continue reading “Should You Go Under the Knife? A Review of Sham Surgery” »

Veterans Success, National Success

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A person’s ability to heal and fully recover after stressful and traumatic experiences is powerful, but also completely normal. There is no place in the United States where this is as evident as it is among our veteran and military service members. This is the message we should all hear on this Veterans Day.

Most of the discussion you hear in the nation about veteran’s health is focused on the struggles of a few. We read about veteran homelessness, post-traumatic stress disorder (PTSD), traumatic brain injury, chronic pain and drug use, and the need for education and employment. But these very serious problems are prevalent in a small minority of the 25 million veterans alive today.

Continue reading “Veterans Success, National Success” »

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