Duke University Integrative Medicine Center- Opinion on Obama Care


Dr. Adam Perlman Shares Reflections on Implications of the Supreme Court Decision


In a landmark decision, the Supreme Court has upheld the Patient Protection and Affordable Care Act.  There are many complex subtleties to this legislation and many points on which lively and spirited conversation will continue to unfold.  From our perspective at Duke Integrative Medicine and from the larger perspective I now hold as Associate Vice President of Health and Wellness at the Duke University Health System, there is no doubt that significant benefits will at last be realized in many important areas that support enhanced quality of care and preventive services for patients.

Here are some highlights of the areas of change about which we are most interested:

Systemic change:

  • An independent, non-profit group known as the Patient-Centered Outcomes Research Institute has been formed to study treatments and determine which is the best both from an economic perspective and from a quality of care perspective.

Insurance benefits:

  • Children under 19 will not be charged more due to pre-existing conditions, and they can remain on their parents’ health insurance until age 26.
  • Insurers will no longer be able to drop clients once they are sick, nor can they charge more for clients with pre-existing conditions or for those who are sick.
  • Insurance coverage may no longer be dropped due to patient’s age (no more lifetime limits).
  • Insurers must inform clients of everything they are charging (random fees must be thoroughly explained).

Patient Care:

  • Doctors will be reimbursed on the basis of their quality of care, not on the number of patients they see.
  • Preventive care, not just “sick care,” will be included in coverage plans
  • Medicare will be expanded to include care delivered in smaller clinics and hospitals

Given the breadth, scope and complexity of the Act and the politically polarized culture that we live in, it is no surprise that there will continue to be heated conversation about the legislation. However, it is hard to argue that something needed to change with our current system, and that something has to include more emphasis on improving quality, increasing access, and decreasing the cost of care. In addition, we need greater emphasis on prevention and healthy lifestyle. Hopefully with the Supreme Court decision behind us, we can begin to focus on what’s most important: improving the health and wellbeing of our community, our state and our nation.




(NIH/NHLBI funded)

The Awareness Study is looking for healthy non-smoking volunteers (aged 30-65) to participate in a research study comparing the effectiveness of a mindfulness-based meditation intervention with personalized health planning to support and guided education in reducing psychological stress and blood sugar. The study includes 22-week group sessions and 3 laboratory visits with compensation up to $350. To participate you must be prediabetic. For more information, please contact Tracey Hawkins or Sarah Rowe at 919-684-8667 or awareness-study@mc.duke.edu. You can view more information about the study HERE  

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The Perfumes from Arabia

Some of the earliest descriptions of aroma therapy can be found in records from Egypt, Alexander the Great, and the Old Testament.  Incense has long had a spiritual role in carrying man’s gifts and prayers to the gods. Arabian frankincense and myrrh already had a reputation 2,000 years before the time of classical Greece. The Greeks and Romans used “aromata ” ( incense, perfumes, spices, and drugs ) for healing which were often imported from the South Arabian coast and the Horn of Africa. They came to the Mediterranean countries by way of caravan over the Incense Route. Many of the perfumes were obtained from herbs, shrubs, and tree resins, gums, and balsams. Frankincense and myrrh comes from tree resins and gums. Myrrh and other resins, sometimes mixed with wine, were used on burns and wounds. These resins have been found to have antiseptic and pain relieving properties. Mastich obtained from a shrub was the chewing gum of the ancients.  Cinnamon ( known to be germacide ) came from India and Cassia from North Vietnam and southern China along the Cinnamon Route.  Resins and balsams         ( balms ) are still used by tribes in South America as antiseptics.  Brazilian Indians treat their wounds with copaiba.  The balsam of Tolu is used by the Indians of Colombia, Venezuela, and Peru.  Indians in Central America use tree bark containing cinnamate and vanillin.  The Russians use a very successful wound salve made of resin, mineral, and bismuth.  Aromatherapy ( the use of essential oils for healing ) is becoming popular in the contemporary West.

Chiron- The Wounded Healer

Chiron of Greek mythology was a famous healer, surgeon, herbalist, astrologer, and mentor to the generation of great heroes of the Helenic age of ancient Greece;  Jason, Heracles, and Achilles as well as of Asclepius, the Greek god of medicine.  He was taught medicine by Apollo.  He was accidently wounded by a poisoned arrow but despite his wound that never completely healed,  he continued to heal and teacher others.  Chiron was the son of Cronus, when he had taken the form of a horse and the nymph Philyra.  He was a centaur– half man, half horse, neither truly man nor truly animal.  Unlike other centaurs who were known to be rowdy and rough,  Chiron was learned and gentle.  Chiron’s story is the story of all healers, as healers are usually wounded themselves and learn how to heal others through healing themselves.  Chiron’s story is also the story of all humanity, as we all live with our animal as well as human nature.

Greek Roots of Western Medicine

Records of medicine in Greece go back to 400 BC, the time of Hippocrates.  Some terms that are found in these records, such as arthritis, asthma, dysenteria, sepsis, pleuritis, hypochondria, rheuma, epidemic, and crisis, are still in use today.  Hospitals were called iatreion.  Diseases that originated in our present day hospitals are called iatrogenic diseases.  From these records we know that surgical instruments, tubes used to both inject fluid and remove fluid, bandages, and tourniquets were used.  Drugs were made from plants; oils such as frankincense and myrrh; metals such as copper, lead, zinc, and alum; salt; vinegar; nuts; and honey.  Wine and vinegar were used as antiseptics.  Wine and probably opium were used for pain.  Illnesses and injuries that were commonly treated were infection, gangrene, peritonitis, cuts, and dislocation of the shoulder.  Carpentry on the skull was not uncommon.  Methods of healing usually revolved around bleeding, starving, and purging.  The Greeks talked about the four humors;  blood, phlegm, yellow bile and black bile.  When they describe these four humors as corresponding with the four winds, four tastes, four states of matter, and four temperatures,  they sound not unlike the four directions honored by the North and South Native  Americans and the five elements of Chinese Medicine.

Smoking Cessation

Go alternative to quit smoking

I can think of plenty of great reasons to quit smoking — and I can think of just as many fruitless ways to try to achieve that goal.

From dangerous drugs to worthless patches, it’s easy to get frustrated when you think you’ve tried “everything,” but still find yourself puffing away on your cancer sticks.

Don’t give up, because a new study shows that some of the safe and natural anti-smoking therapies I recommend all the time are far more effective than anything the mainstream has to offer.

Researchers say their review of 14 studies finds that both acupuncture and hypnosis are more effective than going cold turkey with no treatment. In some cases, the acupuncture patients had triple the success rate of those who didn’t get any help quitting.

The new analysis doesn’t offer a direct comparison of either acupuncture or hypnosis to nicotine patches and gums, but a 2008 study on laser acupuncture found that 55 percent of those who received the treatment were not smoking within six months.

That’s remarkable — because up to 93 percent of smokers who try nicotine replacement therapies such as patches and gums are either back to smoking or still smoking six months later.

That makes the acupuncture eight times more effective.

Surprised? Not me — I see it all the time. I have a terrific acupuncturist on my staff who has helped plenty of my patients kick butts for good.

And if any of my patients smoke but aren’t trying to quit, they hear it from me every time they walk in.

It’s not that I want to be a nag. It’s that in addition to the obvious risks — cancer emphysema, chronic obstructive pulmonary disease, smoker’s cough, bad breath, and more — smokers face a number of other serious health concerns.

Cigarettes expose smokers — and those around them — to toxic heavy metals such as lead and cadmium. Cigarettes from tobacco grown with certain fertilizers can also contain polonium, a radioactive element.

And let’s not forget all the other dangerous chemicals and additives deliberately put into cigarettes. I’ve seen estimates that there are up to 4,000 chemicals in each cigarette.

That’s a lot of toxins gathered in one place, all headed into your body every time you inhale.

You don’t want that. Quit now — while you still can.

Asclepius, God of Healing

My research has brought me to Asclepius, the god of medicine, healing, rejuvenation,and physicians in ancient Greek religion.  He represented the healing aspect of the medical arts.  He carried a serpent entwined rod.  This symbol has continued to be the symbol for medicine although it is usually seen with two snakes entwined up the rod.  Asclepius ( or Aesculapius in Roman ) was the son of Apollo and Coronis.   She was killed pregnant or died in childbirth and he was cut from her womb by Apollo.    Apollo carried the baby to Chiron, the centaur who raised Asclepius and instructed him in the art of medicine. Asclepius married Epione.  They had six daughters:  Hygieia ( the goddess of health, cleanliness, and sanitation ), Iaso ( the goddess of recuperation from illness ), Aceso  ( the goddess of the healing process ), Panacea ( the goddess of universal remedy ), Meditrina ( the serpent-bearer ), and Aglaea/Egle    ( the goddess of beauty, splendor, glory, magnificence, and adornment.)  Their names each reflect an aspect of the overall theme of “good health.”  After Asclepius’ death,  Zeus placed his body among the stars as the constellation Ophiuchus ( The Serpent Holder.)

Making love to Hippocrates

I spent most of my weekend as usual….. doing research for my book.  I am working on the history of Western medicine.  As the lives of these historical figures unfolded,  I began to feel this intimate connection with them, especially with Hippocrates.  I knew he was the “Father of Medicine.”  I knew that from my nursing days.  But I never knew why.  Apparently he was considered the greatest physician of all time.  Now I understand.  He founded the first known school of medicine on a Greek island named Cos.  This school produced over 50 books as well as a system of medical methodology and ethics which is still honored today.  Upon being granted their M.D. degrees,  new doctors still recite a modification of the original “Hippocratic Oath” which swears to practice ethically.  Hippocratic medicine was known for its strict professionalism and discipline.  A physician was expected to be “well-kempt, honest, calm, understanding, and serious.”  Hippocrates rejected the views at that time that believed illness was due to possession of evil spirits and disfavor of the gods.  He believed that illness had a physical explanation and taught the importance of a physical examination, clinical observations, diagnosis, and prognosis.  Even though he is credited with the quote, “First do no harm,”  some of his other beliefs are not commonly known.  He believed in gentle treatments that included rest, a good diet, fresh air, and cleanliness which “balanced the four humors of the body.”  He was reluctant to administer drugs or do aggressive procedures.  The original version of the Hippocratic Oath swears to “prevent disease whenever I can, for prevention is preferable to cure.”  I wonder if those are in the modern version said by physicians today.

Aging Gracefully…..sort of

That is my theme these days. I’ve always felt like I have had an identity of seeming younger than my biological age. So, as I have moved through my 60’s, I have prided myself on being a youthful “60’s are the new 40’s” kind of person. Then I went to my 45th college reunion. First I was excited about seeing my nursing school classmates and my ATO Brothers. Then the craziest thing…….I started worrying about how I looked, my weight, my hair, my skin, what clothes to take. Suddenly I noticed that my teeth were not like the pearly white ones I see on TV. I’m 7 pounds heavier than I feel good at. My hair, which has always been thin and fine, is really thin and fine. Too many facial lines. For the 6 weeks before the trip to Duke I tried to address all these issues, but by the time I went, I don’t think anything was too different. I started to realize that I had fallen into how I saw the world in my 20’s. External validation was the only thing that was important. As I had moved into my 60’s I had prided myself on finally finally having become comfortable in my own skin. I liked saying what I really think and no longer caring what others think of me. I fancied myself one of those little ole ladies hitting people over the head with my umbrella. Yet, here I was dragging around ( and paying extra for ) a huge suitcase because I didn’t know what outfits to wear.

In some ways the reunion was delightful. Re-uniting with my fellow nursing school classmates was extra special. I realized I had disowned a very important part of my life and myself when I jumped ship from Western Medicine to Chinese Medicine. Being with a group of women I have so much respect for allowed me to re-own that part of my history and myself. The hardest part of the whole thing was the thing that we probably all dread at reunions….not being recognized by a couple of people.

I returned home having sobered up from whatever that 20 year old mentality was that had taken over pre-reunion. I have to admit I was fighting off some bits of depression and fear.  Thoughts like, “Am I going to die a lonely old cat lady?”  were sneaking up into my mind.  That is the shadow side of the thinking of us “mature adults” I guess.   The 20 year old perceptions of the importance of external validation had disappeared at least.  And there is something really refreshing about the awareness that more of my life is behind me than in front of me…even if I meet my current goal of 104.  Every day feels much more important than it ever did…..every moment does!  My relationships are more valuable than ever.  I take better care of my body than I ever have.  I don’t have to search for spirituality in my life.  It has now become so much a part of who I am.   I’m still sensitive to judgments from others.  I won’t deny that.  But what I think about myself is so much more important than what anybody else thinks.  It has been a long road, but I realize I have grown to like myself.   And through liking myself,  I like others.  I don’t need that umbrella after all!

Outrage over Acupuncture Evidence Attacks NIH

Doctors from the University of Maryland School of Medicine, Baltimore and the University of Vermont College of Medicine, Burlington published a case vignette in the New England Journal of Medicine recommending acupuncture for the treatment of lower back pain. The article cites that patients with lower back pain account for over $90 billion in annual health care expenses in the US. The doctors conclude that acupuncture is an effective means for treating lower back pain based partly on a recent study of 6,359 patients published in Spine1. For the lower back pain patient in the case study presented, 10-12 acupuncture treatments over an 8 week period are recommended.

The doctors cite physiological phenomena that measure the effects of acupuncture. Local anesthesia at needle insertion sites block the the analgesic effects of acupuncture showing that acupuncture is dependent upon neural innervation2. Acupuncture has been proven to cause the release of endogenous opioids in brain-stem, subcortical, and limbic structures3,4. Acupuncture has also been proven to induce the secretion of adrenocorticotropic hormone and cortisol from the pituitary gland thereby creating a systemic anti-inflammatory response5. Functional MRI studies in humans reveal that acupuncture stimulates limbic and basal forebrain areas involved in pain processing6. PET scan MRIs (positron-emission tomography) show that acupuncture increases opioid binding potential in the brain for several days7. Acupuncture has also been proven to mechanically stimulate connective tissues8, release adenosine at the site of needle stimulation9, and increase local blood blow10. The doctors then cite clinical trials showing the efficaciousness of acupuncture in the treatment of thousands of patients10-15.
Despite this overwhelming evidence proving the mechanisms of action and efficaciousness of acupuncture, skeptics were outraged at the publication of an article supportive of acupuncture in the venerable New England Journal of Medicine. An article recently posted in the Forbes “science business” section stated that the article is “embarrassing” and that acupuncture “infiltrates” the University of Maryland Medical School. In the article, the author calls acupuncture “pseudoscience” and states that it is based on “magical thinking of non-existent life-force.” The skeptic author’s only proof of his theory is that one of the many studies cited in the article found that acupuncture was only 47.6% effective for the treatment of lower back pain and that sham acupuncture was 44.2% effective. Therefore, the author concludes that using “toothpicks” randomly on the human body will have the same pain relieving effects as acupuncture. What the author fails to mention in the Forbes attack article is that conventional western medicine therapy (a combination of drugs, physical therapy, and exercise) was only 27.4% effective in that very same study. Should we therefore abolish western medicine by MDs and call it pseudoscience? Acupuncturists have noted that the success of sham acupuncture noted in that particular study of 1,162 patients in Germany reveals that poorly placed acupuncture needles also derive benefit for the patient.
The author in the Forbes article does have an agenda, he calls for the elimination of the NCCAM (National Center for Complementary and Alternative Medicine), a division of the NIH (National Institutes of Health). He states that since acupuncture is poorly supported by research, the NCCAM should be abolished. The authors of the New England Journal of Medicine article contend that more research needs to be conducted on the efficacy of acupuncture based on existing and promising research. The authors suggest continuing acupuncture education and research as a means to better serve the public with quality medicine.



HO’OPONOPONO, Dr.Ihaleakala Hew Len

Email of a conversation with Dr. Len by Joe Vitale,

Author of “The Attractor Factor”

Two years ago, I heard about a therapist in Hawaii who cured a complete

ward of criminally insane patients–without ever seeing any of them. The

psychologist would study an inmate’s chart and then look within himself to

see how he created that person’s illness. As he improved himself, the

patient improved.

When I first heard this story, I thought it was an urban legend. How

could anyone heal anyone else by healing himself? How could even the best

self-improvement master cure the criminally insane? It didn’t make any

sense. It wasn’t logical, so I dismissed the story.

However, I heard it again a year later. I heard that the therapist had

used a Hawaiian healing process called ho ‘oponopono. I had never heard of

it, yet I couldn’t let it leave my mind. If the story was at all true, I had

to know more. I had always understood “total responsibility” to mean that I

am responsible for what I think and do. Beyond that, it’s out of my hands.

I think that most people think of total responsibility that way. We’re

responsible for what we do, not what anyone else does–but that’s wrong.

The Hawaiian therapist who healed those mentally ill people would teach me

an advanced new perspective about total responsibility. His name is Dr.

Ihaleakala Hew Len. We probably spent an hour talking on our first phone

call. I asked him to tell me the complete story of his work as a therapist.

He explained that he worked at Hawaii State Hospital for four years. That

ward where they kept the criminally insane was dangerous. Psychologists

quit on a monthly basis. The staff called in sick a lot or simply quit.

People would walk through that ward with their backs against the wall,

afraid of being attacked by patients. It was not a pleasant place to live,

work, or visit.

Dr. Len told me that he never saw patients. He agreed to have an office

and to review their files. While he looked at those files, he would work on

himself. As he worked on himself, patients began to heal.

“After a few months, patients that had to be shackled were being allowed

to walk freely,” he told me. “Others who had to be heavily medicated were

getting off their medications and those who had no chance of ever being

released were being freed.” I was in awe. “Not only that,” he went on,

“but the staff began to enjoy coming to work. Absenteeism and turnover

disappeared. We ended up with more staff than we needed because patients

were being released, and all the staff was showing up to work. Today, that

ward is closed.”

This is where I had to ask the million dollar question: “What were you

doing within yourself that caused those people to change?”

“I was simply healing the part of me that created them,” he said. I didn’t

understand. Dr. Len explained that total responsibility for your life means

that everything in your life – simply because it is in your life – is your

responsibility. In a literal sense the entire world is your creation.

Whew. This is tough to swallow. Being responsible for what I say or do is

one thing. Being responsible for what everyone in my life says or does is

quite another. Yet, the truth is this: if you take complete responsibility

for your life, then everything you see, hear, taste, touch, or in any way

experience is your responsibility because it is in your life. This means

that terrorist activity, the president, the economy or anything you

experience and don’t like – is up for you to heal. They don’t exist, in a

manner of speaking, except as projections from inside you. The problem isn’t

with them, it’s with you, and to change them, you have to change you.

I know this is tough to grasp, let alone accept or actually live. Blame

is far easier than total responsibility, but as I spoke with Dr. Len, I

began to realize that healing for him and in ho’oponopono means loving

yourself. If you want to improve your life, you have to heal your life.

If you want to cure anyone, even a mentally ill criminal you do it by

healing you.

I asked Dr. Len how he went about healing himself. What was he doing,

exactly, when he looked at those patients’ files?

“I just kept saying, thank you and I love you over and over again”, he


“That’s it?”

“That’s it.”

Turns out that loving yourself is the greatest way to improve yourself,

and as you improve yourself, you improve your world.

Let me give you a quick example of how this works: one day, someone sent

me an email that upset me. In the past I would have handled it by working on

my emotional hot buttons or by trying to reason with the person who sent the

nasty message.

This time, I decided to try Dr. Len’s method. I kept silently saying, “Thank you and I love you”, I didn’t say it to anyone in particular. I was simply

evoking the spirit of love to heal within me what was creating the outer


Within an hour I got an e-mail from the same person. He apologized for his

previous message. Keep in mind that I didn’t take any outward action to get

that apology. I didn’t even write him back. Yet, by saying “Thank you, I love you”, I somehow healed within me what was creating him.

I later attended a ho’oponopono workshop run by Dr. Len. He’s now 70 years

old, considered a grandfatherly shaman, and is somewhat reclusive. He

praised my book, The Attractor Factor. He told me that as I improve myself,

my book’s vibration will raise, and everyone will feel it when they read it.

In short, as I improve, my readers will improve.

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