The theme of the annual American Public Health Association (APHA) conference was "Public Health Without Borders." Held in San Diego Oct. 25-29, the meeting attracted more than 13,000 attendees from throughout the country and signaled the APHA's desire and willingness to expand the paradigm of community and global health to include approaches that focus on the body, mind, and spirit.
Three former U.S. Surgeons General addressed conference attendees in a plenary session titled "Becoming the Healthiest Nation." M. Joycelyn Elders, David Satcher and Richard Carmona discussed their roles and vision in expanding public-health consciousness during their respective tenures as "America's doctor." Their contributions at the session included warning the public about tobacco use, advocating for mental health and proposing strategies to address youth violence. Although their ideas were sometimes controversial, their perspectives on broadening the traditional focus of public health have likely inspired a new generation of leaders.
The APHA is a broad-based group that includes health and policy specialists in a variety of fields such as epidemiology, environmental concerns, nutrition and occupational health. In the past 10 years, however, a nascent group of individuals who are involved with integrative health formed the Alternative and Complementary Health Practices (ACHP) group. Consisting of practitioners, researchers, administrators and academics, this group focuses on CAM and self-care approaches as part of public-health practice.
The ACHP attracts individuals who are involved with Asian medicine and acupuncture, yoga, ayurvedic care, homeopathy, bodywork, and herbal medicine, as well as other disciplines. By integrating these forms of health and wellness into the fabric of public health, ACHP members are dedicated to increasing access to these types of care.
The ACHP designed a "conference within a conference" that included over 100 presentations and roundtable discussions focused on CAM. Presentations were clustered into the following themes: health promotion and disease prevention; health practices; developing CAM curriculum in medical schools and the health professions; educating and training CAM providers; evidence-based research; and mind/body/spirit in public health. Topics of interest at this year's conference included ayurvedic management of uterine polyps, integrating massage into hospital care, use of CAM in rural Appalachia, recovery from trauma for war veterans of Iraq and Afghanistan, and equine-assisted programs for youth.1
Acupuncture has always been well-represented in ACHP, and this year's conference highlighted a variety of areas of interest to our community. Alexandra York, of the Samueli Institute, presented a poster on evaluating a procedure-specific acupuncture training program. She works in a unique collaborative environment that brings together acupuncture researchers and the U.S. military. Her presentation focused on the pain treatment procedure called "battlefield acupuncture," developed by Richard Niemtzow, MD. His five-point auricular approach uses the following points: cingulate gyrus, thalamus, shen men, point 0 and omega-2. This procedure was developed to treat headache in pilots and has been used at Walter Reed Army Hospital.
Calen Huang and colleagues gave a brief overview of using traditional Chinese medicine in Taiwan to treat people living with HIV/AIDS. Based in Taiwan at the national Yang Ming University School of Public Health, Nicole Huang discussed how Taiwanese physicians integrate Western medicine and Huang discussed how Taiwanese physicians integrate Western medicine and TCM. Jun Wang, who is involved in Health Education at San Francisco State University, discussed the role of Chinese herbalists in health promotion in a Chinese-American community. Researchers at Morgan State University in Baltimore described variations in the use of acupuncture by adults with chronic diseases. This work was presented by Joy Nanda, a naturopath and doctoral candidate in the School of Community Health at Morgan State.
Jason Jaggers, of the University of South Carolina, discussed the effects of acupuncture on oral markers of emotional distress in HIV-infected African-Americans. He and his team surveyed CAM users, as well as individuals who receive acupuncture treatment. Their innovative work examines the level of cortisol in saliva and tracks the decrease in stress hormone levels following treatment.
Linda Wardlaw DrPH, grant-writer and evaluator for the Charlotte Maxwell Clinic in Oakland, Calif., presented work from her clinic on promoting access to complementary care for underserved women who are living with cancer.2 Wardlaw commented, "It is gratifying to see complementary medicine getting the attention it deserves in the discussion about our national health care needs. Those who can afford CAM approaches are turning increasingly toward these modalities because they are less invasive and more personal; taking the whole person into consideration. Access to healing should not limited to those who can afford it. Universal access to care is a high priority for public health and CAM should be an integral part of our vision for comprehensive care."
In a presentation describing the national recognition Pathways to Wellness received from the Agency for Healthcare Quality and Research, Beth discussed the innovations in CAM that Pathways has addressed.3 Areas of equity, patient-centeredness and treatment effectiveness are of particular interest. The concept of equity refers to promoting access to care, which is implemented in a variety of ways including the "share the care" model that utilizes a sliding-scale concept. Patient-centeredness includes the variety of ways in which cultural and linguistic needs of clients are addressed, as well as having an ongoing commitment to cultural competency. Through ongoing evaluation, effects of treatment and clinical outcomes can be monitored as part of quality assurance and improvement.
A dynamic international panel presented a discussion on the use of herbal medicine. Blanca Ramos, LSW, and colleagues discussed how herbal approaches are used in urban areas of northern Peru. Chamomile, anise and mint are commonly utilized for their effects on gastritis and ulcerative conditions. A research team headed by Juan Carlos Belliard, PhD, at Loma Linda University's School of Public Health, surveyed first-generation Mexican immigrants in San Bernardino, Calif., about their use of herbs. Frank Snyder, MS, and colleagues at Oregon State University examined the use of herbal supplements and the potential for herb-drug interactions in a population of senior citizens in southeast Idaho. C.J. Allen, MAc, LAc, Dipl. CH, a faculty member of the New England School of Acupuncture, presented a case series examining users of a Chinese herbal medicine clinic based in an urban, inner-city health center.
Allen focused on the clinic's success in treating a variety of acute and chronic conditions, and he shared some of his thoughts related to the need for continued studies. The APHA conference inspired him to continue his research in order to advance the practice of Chinese herbal medicine in the U.S. Describing his response to the variety and quality of CAM presentations at the conference, Allen noted, "Questions and discussions that followed the presentations were supportive, not confrontational, with requests for clarification or expansion on themes." He was particularly impressed when an MD approached him after his talk and asked about the use of Chinese medicine to treat autism. Allen told us, "It was an honor and a privilege to be selected to make an oral presentation. Participating in national meetings like APHA provides a platform for information exchange between the medical and public health communities."
In addition to the two and a half days of presentations, acupuncture was actively promoted in the exhibition hall. Interns from the San Diego branch of Pacific College of Oriental Medicine provided sample acupuncture and bodywork treatment for conference-goers. Organized by Stacy Gomes, EdD, and Greg Sperber, LAc, DAOM, interns were able to provide mini sessions to more than 100 people each day. Several interns staffed the event and were excited by the variety of people interested in trying treatment. Because many of the attendees had never had an opportunity to receive a sample acupuncture treatment or experience bodywork, the exhibition hall provided a unique venue to be able to promote this exciting work.
As AOM continues to permeate the very health care fabric of the U.S., we are seeing unprecedented interest and enthusiasm for integrating this approach into wellness care. ACHP's motto, "Health care that includes wellness is a right, not a privilege," continues to advance the national health care agenda and profoundly influence providing care without borders.
References
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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