To celebrate its 15-year anniversary, Samueli Institute invited guests to gather and share stories of the positive impact the Institute’s research has had in helping patients, policymakers, service members and veterans find evidence-based alternative, complementary and integrative treatments for chronic pain and illness.
In 2001, Henry & Susan Samueli launched Samueli Institute to explore the science of healing and expand the evidence base for complementary and integrative medicine. In the ensuing decade and a half, Institute researchers published more than 700 peer-reviewed articles and hosted scientific conferences of global experts, developed programs for pain, stress and performance for the military and supported healthy communities across the United States.
Now, after 15 years of service to the integrative health, healthcare, and military communities, Samueli Institute will cease research and programmatic operations in 2017.
“I am enormously proud of the work that Samueli Institute and all of its staff, fellows and grantees have accomplished. And I am grateful to Henry and Susan Samueli for their investment in time, money and expertise in supporting the work of the Institute,” said Wayne Jonas, MD, Samueli Institute President & CEO.
Samueli Institute has long supported the exploration of how healing happens. But exploring the linked question—how preventable disease happens—is also a priority. Diseases don’t merely pick and choose individuals. They arise when our continuous healing processes breakdown.
Scientists are searching for an answer to the question of why some people are affected by diseases like addiction, diabetes and cancer, while others are not. What’s the interplay between genes, behavior, social determinants of health and perhaps as of yet unknown factors? Could we prevent chronic illnesses if we could track and enhance how the body operates to keep us free of them?
Current statistics suggest that white Americans are more susceptible to certain diseases like breast cancer and addiction, according to the Department of Health and Human Services. Individuals who are African American, Mexican American, American Natives, or Asian American and Pacific Islander are more likely to suffer from Diabetes (Type II), Hypertension, Heart Disease and Stroke. Race/ethnicity is only one of the many factors that contribute to one’s chances of contracting diseases. The issue is that no one knows what the definitive factors are and why they matter.
To finally find an answer, the White House has launched the Precision Medicine Initiative (PMI), a new research effort to improve the American healthcare system. The initiative will include studies, infrastructure building, and health policy efforts to streamline preventative healthcare measures and uncover the many determinants of health.
The PMI, which President Obama first announced in 2015, was launched in response to the upsurge of preventable disease in the country. Obama stated that the idea of there being an “average patient,” is unrealistic and that “one size does not fit all,” when it comes to both preventative care and treatment for disease. The PMI study will be one of the first studies to look at disease prevention in such a broad way.
One cohort that has emerged as a result of Obama’s PMI, is a series of studies conducted by the National Institutes of Health (NIH), who have contributed $55 million to the study of disease prevention that focuses on the genetic and biological differences in humans. Perhaps this part of PMI should be called Precision Prevention.
“This range of information at the scale of one million people from all walks of life will be an unprecedented resource for researchers working to understand all of the factors that influence health and disease. Over time, data provided by participants will help us answer important health questions, such as why some people with elevated genetic and environmental risk factors for disease still manage to maintain good health, and how people suffering from a chronic illness can maintain the highest possible quality of life. The more we understand about individual differences, the better able we will be to effectively prevent and treat illness.” –NIH Director, Francis S. Collins, M.D., Ph.D.
Previously, large studies like the Human Genome Project (HGP) discovered that it was possible to activate and deactivate genes by changing lifestyle. This means that the pre-existing genes for conditions like obesity can be redirected by nutrition and exercise. The question that the PMI cohort seeks to answer that the Genome project did not is, does this remain true when factors like ethnicity, location and culture are brought into the equation?
The widespread belief is that these differences do contribute to health. But so far, the only issue researchers have looked into is health disparities associated with ethnicity and income.
Creating Human Flourishing
At Samueli Institute we acknowledge health disparities as issues that can, for the most part, be solved with health policy change and through advocacy, and multi-sector involvement in the promotion of health and wellbeing. Also, through integrating more holistic and integrative practices into everyday care, more Americans can be resilient and remain healthy throughout their life. Most of our work in this area falls under one important initiative, Wellbeing in the Nation (WIN).
Wellbeing in the Nation (WIN)
The Institute has gathered leaders from all levels of the public and private sectors to write recommendations for improving the health and wellbeing of the nation. This includes fusing health with determinants like socioeconomics, providing recommendations for leadership and deciding which healthcare costs are essential and which can be eliminated with preventative health measures.
The Creating Wellbeing Leadership Group, which oversees WIN, not only identifies the key problems with the American healthcare system but also recommends ways to improve it. Part of that is through advocating for evidence-based research for individualized care.
What is Precision Medicine?
The White House has described precision medicine as “healthcare tailored for you.” This description is important, as it recognizes people’s unique characteristics, which often contribute to their health and wellbeing.
NIH hopes to draw participation from various agencies in the federal government to ensure its success. The PMI study will begin in late 2016 and is expected complete by 2020.
We at Samueli Institute are pleased that our continued priority of health prevention and healthcare improvement are priorities of the White House as well. When patients receive individualized, patient-centered care in a health system in which preventative health measures are just as important as the treatment of disease, we will all prosper.
Each day more than 50 people in the U.S. die from prescription pain relievers. When you add the deaths related to heroin, that number jumps to 80 per day.[i] Last week Congress passed legislation that hopes to reduce those figures. The Comprehensive Addiction and Recovery Act (CARA), S. 524 was passed by the Senate in a nearly-unanimous (92-2) vote. Having been previously passed by the House, it was recently signed by President Barack Obama.
Update: President Obama signed the Comprehensive Addiction and Recovery Act of 2016 on July 22nd. Read the White House press release.
In these days of bipartisan politics, passage of the act shows the depth and breadth of the opioid crisis. No one is safe from the opioid epidemic as it crosses both racial and socio-economic lines.
What New Opioid Legislation Means for Pain Care and Integrative Medicine
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
Merely 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.
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.”