Focus On...

Integrated Medicine Gaining Proponents

Marc Kennedy

Once met with indifference, scorn or ridicule in conventional medical circles, integrative medicine has entered the health care mainstream on a wave of curiosity and demand by patients desperate for remedies for conditions that allopathic modalities alone have not satisfied. Now, there are scores of highly trained, highy educated and highly motivated physicians eager to learn how to meet this demand and expand their own capabilities to fulfill their roles as healers.


Author Affiliations: Special to WMJ

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Nun Study Leads to New Medical Center

Marc Kennedy

As integrative medicine gains acceptance, more evidence is emerging concerning its success. And in Wisconsin, a study involving 35 nuns at the Congregation of St. Agnes in Fond du Lac not only demonstrated the value of an integrative medical approach, it also helped to launch a new clinic devoted to integrative medicine.


Author Affiliations: Special to WMJ

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Editorials

CAM Use on the Rise; Physician Perceptions Changing

Thomas C. Meyer, MD, WMJ Medical Editor

This issue of WMJ is designed primarily to provide us with sufficient background relating to CAM that we can decide whether to look further into the practices for our own benefit.


Author Affiliations: WMJ Medical Editor

Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800

Blastomycosis is a Serious Disease, But Let’s Not Raise Fears Without Conclusive Data

Richard A. Proctor, MD FACP

Two articles appear in this issue of the WMJ concerning Blastomycesdermatitidis. Mudey et al present a case of acute repiratory distress syndrome from blastomycosis.

Author Affiliations: Doctor Proctor is a Professor of Medicine and Medical Microbiology/Immunology, University of Wisconsin Medical School, Alexander von Humboldt Distinguished Researcher.

Corresponding Author: Reprint requests to Richard A. Proctor, MD FACP, 407 SMI, Dept of Medical Microbiology & Immunology, University of Wisconsin Medical School, Madison, WI 53706; 608.263.5591, e-mail rap@facstaff.wisc.edu

Original Research

Complementary and Alternative Medicine

Bruce Barrett, MD, PhD

A number of health-related interventions--from widespread therapies such as acupuncture, herbal medicine, homeopathy and yoga, to less well-known modalities such as Feldenkrais, iridology, reflexology and reiki--have increasingly come under the general heading of complementary and alternative medicine (CAM).

Author Affiliations: Doctor Barrett is with the Department of Family Medicine, University of Wisconsin Medical School

Corresponding Author: Please address correspondence to 777 S. Mills, Madison, WI 53715; 608.265.9041; e-mail bbarrett@fammed.wisc.edu

Provider Attitudes and Use of Alternative Medicine in a Midwestern Medical Practice in 2001

Brenda Rooney, PhD; Guy Fiocco, MD; Peter Hughes, MA: Susan Halter, MD

Objective: To determine the current level of use, referral and desire for service of different complementary and alternative (CAM) therapies among Gundersen Lutheran Medical Center providers.

Methods: A survey was conducted in January of 2001 of all medical and associate staff. Results: The response rate was 70%; 55% reported using 1 or more of 18 therapies for themselves. Over 25% of providers used nutritional supplements, herbal medicines, or hydrotherapy with a patient. Over half of providers had referred a patient for biofeedback or chiropractic care. Over half of providers would like to offer acupuncture, biofeedback, chiropractic care, hydrotherapy, nutritional supplements, or massage to patients in the future. Associate staff, female staff, primary care providers, and those who had personally used CAM therapies were more likely to have used, referred, or wish to offer more therapies in the future. There was little support for aromatherapy, magnetic field therapy, naturopathic medicine, or ethnic healing methods.

Conclusions: Use of and desire for complementary therapies at Gundersen Lutheran was higher than expected by the Integrative Medicine Oversight Committee. Health care organizations should consider having process in place to manage the increasing demands for complementary and alternative therapies.



Author Affiliations: Authors are with Gundersen Lutheran Medical Center, La Crosse, WI.

Corresponding Author: Reprint requests to Brenda Rooney, PhD, 1836 South Ave, La Crosse, WI 54601; 608.782.7300.

Use of Imported Folk Remedies and Medications in the Wisconsin Hmong Community

Mark A. Wener, PhD; Lynda M. Knobeloch, PhD; Theresa Erbach; Henry A. Anderson, MD

The Marathon County Health Department and the Wisconsin Division of Public Health evaluated several imported drugs and folk remedies that were being used by 2 Hmong families. These included a powdered blend of folk remedies that had been purchased in California and 5 packets of medication that had been imported from Thailand. The powdered folk remedy contained arsenic sulfide as a principal ingredient. The drug packets contained acetyl aspririn, acetaminophen and chloramphenical. The purity of these drugs was not assessed, and their dates of manufacture could not be determined. To discourage use of folk remedies and imported drugs, the county health department issued a press release that was published in a Hmong community newsletter. Despite these efforts, many Asian immigrants may continue to use these products.



Author Affiliations: Doctors Werner and Knobeloch are toxicologists in the Bureau of Environmental Health, Wisconsin Division of Public Health, Wisconsin Department of Health and Family Services. Ms. Erbach is a public health nurse in the Marathon County Health Department. Do

Corresponding Author: Reprint requests to Mark A. Werner, PhD, Wisconsin Division of Public Health, PO Box 2659, 1 W Wilson St, Madison, WI 53701-2659.

Self-Rated Health Status

Linda N. Meurer, MD, MPH; Peter M. Layde, MD, MSc; Clare E. Guse, MS

Self-reported health status ratings depend on whether one references health problems or health behaviors. Pessimistic health perceptions may indicate underlying emotional distress or predict mortality. This study explores the association between a single-item health status question and self-reported health problems or behaviors among women in a Wisconsin family medicine clinic. All women who present for health maintenance complete a health history form that includes a single item health status rating; health status ratings from 251 randomly selected records were compared with certain reported demographics, health behaviors (e.g. smoking, exercise), health concerns, depression and anxiety symptoms, vital signs and body mass index. Health status ratings of fair or poor were found to be associated with race, marital and employment status, obesity, exercise, and depressive symptoms. Smokers were 4.22 times more likely to report a less favorable health category than non-smokers. Implications for future research are discussed.



Author Affiliations: Authors are with the Department of Family and Community Medicine, Medical College of Wisconsin.

Corresponding Author: Reprint requests to Linda N. Meurer, MD, MPH, Assistant Professor, Family and Community Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwukee, WI 53226; 414.456.5720, e-mail lmeurer@mcw.edu.

Acute Respiratory Distress Syndrome form Blastomycosis: A Case Report

Kavita Mundey, MD; Basil Varkey, MD; Jerome VanRuiswyk, MD; Fan Yang, MD, PhD; Ralph M. Schapira, MD

Blastomyces dermatitidis. The most heavily endemic areas in the world are in the United States. These include the Mississippi and Ohio River Valleys and around the Great Lakes and extends to northern Wisconsin and northern Minnesota. Fungal growth occurs in nitrogen-rich soil close to streams, rivers and lakes, and aerosolization is facilitated by rain, excavation or other disturbance of a site with contaminated soil. Except for rare cases of direct inoculation into soft tissue, the lung is the portal of entry and the site of the primary disease. About one half of those infected are asymptomatic, and in others, the symptoms vary in severity. Rarely, blastomycosis causes a severe and fulminant pneumonia that presents as acute respiratory distress syndrome (ARDS) with dyspnea, tachypneak, diffuse pulmonary infiltrates, severe hypoxemia and respiratory failure. This case report describes the features of such a presentation and highlights the diagnostic aspects.



Author Affiliations: Authors are with the Medical College of Wisconsin. Doctor Mundey is a senior Fellow in the Division of Pulmonary and Critical Care Medicine; Dr Varkey is a Professor of Medicine, and Drs. VanRuiswyk and Schapira are Associate Professors, Dr. Yang is an As

Corresponding Author: Address correspondence to Ralph M. Schapira, MD, Pulmonary & Critical Care Section, Milwaukee Veterans Affairs Medical Center (CC-111E), Milwaukee, WI 53295-1000.

Blastomycosis More Evidence for Exposure Near One’s Domicile

Dennis J. Baumgardner, MD; Daniel P. Paretsky, DVM

Our previous publications on the epidemiology of blastomycosis suggested that the etiologic organism, Blastomyces dermatidis, may be acquired at home, however this view was challenged in an editorial.

Author Affiliations: Doctor Baumgardner, Professor of Family Medicine, University of Wisconsin Medical School, is Campus Director of the Family Medicine Department. Doctor Paretsky is with Eagle River Animal Hospital in Eagle River, WI.

Corresponding Author: Reprint requests to Dennis J. Baumgardner, MD, Aurora Health Care, 2801 West KK River Pkwy, Ste 175, Milwaukee, WI 53215; 414.649.7909; e-mail dbaumgar@fammed.wisc.edu.

Your Practice

Ethics Network Offers Support When Making Difficult Decisions

Michael J. Dunn, MD, Dean, Medical College of Wisconsin

The Midwest Ethics Committee Network (MECN) within the Center for the Study of Bioethics at the Medical College of Wisconsin exists to help physicians and health care providers make these difficult decisions regarding their patients.


Author Affiliations: Dean, Medical College of Wisconsin


Corresponding Author: Please address correspondence to the Wisconsin Medical Society at 608.442.3800