By SIMON YU, MD, COL, USA (Ret)
Dr. Tom Frieden, former director of the Centers for Disease Control and Prevention (CDC), opened up a new front in the Coronavirus War by saying we don’t just need to treat the acute disease, we need to treat the underlying conditions that make people more susceptible to serious disease progression. He focused on heart disease, and managing mitigating risk factors such as CVD, diabetes, hypertension and smoking in order to increase people’s odds for recovery. The initial focus has been pneumonia and acute respiratory distress syndrome (ARDS), with risk factors including asthma, chronic obstructive pulmonary disease, and emphysema.
Dr. Frieden calls for better
management of people’s underlying health problems to help mitigate the impact
of COVID-19. I would take this one step further and say we need to go beyond
managing chronic diseases, and find and treat the pathogens that underlie and
fuel their pathologies. Why?
In 2001, my work as an Army
Reserve medical officer took me to Bolivia to treat 10,000 Andes Indians with
parasite medications. Not only did this resolve their parasite problems, but
many reported it helped them overcome a range of additional chronic health
problems. When I returned to St. Louis, I began to dig deeper with my chronic
disease and “mystery disease” patients and treat some of them for parasite
problems, and saw many improve. I expanded this “search and destroy” mission
with my patients to fungal and dental infections, as I learned many such
infections – often overlooked in medicine today – are overlapping, synergistic,
and can present as chronic illness.
By AMITA NATHWANI, MA
This week’s impeachment hearings show what a crisis of trust we live in today. 69% of Americans believe the government withholds information from the public, according to recent findings by Pew Research Center. Just 41 % of Americans trust news organizations. We even distrust our own health care providers: Only 34% of Americans say they deeply trust their doctor.
One important way doctors can regrow that trust is to become educated about the types of medicine their patients want, including alternative therapies.
People are seeking new ways to care for their health. For instance, the percentage of U.S. adults doing yoga and mediating—while still a minority– rose dramatically between 2012 and 2017, according to the CDC’s National Center for Health Statistics. Likewise, the number of Americans taking dietary supplements including vitamins, minerals and natural therapies like turmeric, increased ten percentage points, to 75% in the past decade, according to the Council for Responsible Nutrition. As Americans increasingly seek out non-pharmaceutical ways to address wellness, they need doctors who can talk to them about such alternatives.
Unfortunately, this is rare. As a provider of an holistic approach to health called Ayurvedic Medicine, I often see people who tell me their physician dismissed them when they asked about treatments they’d read about on the internet. In many cases, clients tell me their doctor has actually chastised them for entertaining an alternative approach to their existing illness. This leaves them disempowered. They wanted to make choices to improve their own health, but found they were not acknowledged, supported or even understood by the doctor.
Mohammad Al-Ubaydli: Let’s just start from the beginning. Tom, can you please give us an introduction about yourself and your background?
Thomas Tsang: I’m a general internist by training. I practiced internal medicine in New York City, first at a small community hospital where I predominantly worked with residents and medical students and mostly taught principles of outpatient medicine, ambulatory care and interviewing techniques.
Then I was recruited by the Charles B. Wang Community Health Center. That’s when I got to use some of the public health knowledge that I had acquired: I worked on various public health initiatives for the community in New York City. The health center itself served a predominantly Asian population. It had four sites and one of the things that I did in the beginning was implement an electronic health record. That work led to my involvement with the Board of Health of New York City, which, in turn led to my work in Congress.
I was then selected for the Robert Wood Johnson Foundation/IOM Health Policy Fellowship on the Committee on Ways and Means-Subcommittee on Health and worked on some of the policies that led to the creation of ACO’s, i.e., Value-Based Purchasing, Pay for Performance and so on. I was fortunate enough to actually help implement some of the policies that I worked on! It’s a long answer to your question, but that’s the route I took.
Mohammad: It’s perfect. It’s really interesting to learn. Among the many things under your belt, it sounds like you have a successful electronic health record deployment, which is good–so well done! Tell me and our readers a bit about Accountable Care Organizations. What is an ACO and what is the point of it?
Thomas: The ACO is not a very new concept. It was a term that was coined by Elliott Fisher from Dartmouth Medical School, who is the director of Center for Health Policy and Clinical Practice. I hate to use the word HMO, but in a way, it’s almost like an HMO. It’s not really an HMO because it is actually a provider-led organization, not an insurance-led one.