White Paper: Acupuncture’s Role In Solving The Opioid Epidemic

Acupuncture’s Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management—White Paper 2017


The United States (U.S.) is facing a national opioid epidemic, and medical systems are in need of nonpharmacologic strategies that can be employed to decrease the public’s opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture’s cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose.

Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfill these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, and neonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.

Acupuncture’s Role In Solving The Opioid Epidemic

Multivitamin Is An Insurance Policy

A daily multivitamin is a great nutrition insurance policy. True, a healthy diet should provide nearly all the nutrients you need. But many people don’t eat the healthiest of diets. That’s why a multivitamin can help fill in the gaps, and may have added health benefits.

Of course, there can be too much of a good thing. It’s important not to go overboard with vitamins. While a multivitamin and a vitamin D supplement can help fill some of the gaps in a less than optimal diet, too much can be harmful.

  • In general, stick close to standard recommended doses in a multivitamin. And since your multivitamin will likely contain all the folic acid you’ll need, stay away from cereals, protein bars, and other foods that are super-fortified with folic acid.

Read enough nutrition news, and you’ll see that not all scientists agree on multivitamins. Some say that there’s not enough proof that multivitamins boost health, so they don’t recommend them. Other scientists point to studies that seem to show a link between multivitamin use and increased risk of death.  But those studies are flawed. Looking at all the evidence, the potential health benefits of taking a standard daily multivitamin seem to outweigh the potential risks for most people.

The Harvard T.H. Chan School of Public Health

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Your bottled water may contain unsafe levels of arsenic, Consumer Reports says

Updated: 2:09 PM, Apr 21, 2019

By: Mark Charter

TUCSON, Ariz. — Bottled water is sold almost everywhere but do you really know what’s in it? Take Starkey Spring Water, a bottled water brand owned by Whole Foods. In late 2016 to early 2017, more than 2,000 cases were recalled because they contained arsenic levels higher than the federal government allows.

“So after the recalls, the company’s own test results show Starkey Spring Water still has arsenic levels at eight parts per billion, which is federally compliant but above what some states, health officials and Consumer Reports considers safe,” says Consumer Reports investigative reporter Ryan Felton.

The federal limit for arsenic in bottled water is ten parts per billion, but Consumer Reports says that limit should be changed to no more than three parts per billion. A CR review of public records and its own independent tests found Keurig Dr Pepper-owned Penafiel had water that tested above the federal limit with arsenic levels at 17 parts per billion. It has since told CR it stopped production at its manufacturing plant to improve arsenic filtration. The CR review also found several other popular brands, including Crystal Geyser Alpine Spring Water and Volvic, sell bottled water that is federally compliant but above what growing research suggests may be unsafe to drink.

“Arsenic is a heavy metal that, with chronic exposure over time, can cause serious health problems including cancer and cardiovascular disease,” Felton says. “It really makes no sense that consumers can purchase bottled water that is less safe than tap water.”

That’s because municipal tap water is heavily regulated by both federal and state governments. CR reached out to all of the bottled water companies mentioned in this story. Companies that responded said they adhere to government standards and that arsenic can be naturally occurring. So how can you make sure your water is safe, with arsenic levels below three parts per billion? If you drink bottled water, look for the company’s water quality report online, or call and ask for a copy.

Click here to see the full list of the 11 brands CR says have detectable amounts of arsenic on our website, along with a link to the full results from Consumer Reports.

How air pollution is doing more than killing us

The air we breathe could be changing our behaviour in ways we are only just beginning to understand.

  • By Melissa Hogenboom / Images by Emmanuel Lafont

16 April 2019

In the future, police and crime prevention units may begin to monitor the levels of pollution in their cities, and deploy resources to the areas where pollution is heaviest on a given day.

This may sound like the plot of a science fiction movie, but recent findings suggest that this may well be a worthwhile practice.

Why? Emerging studies show that air pollution is linked to impaired judgment, mental health problems, poorer performance in school and most worryingly perhaps, higher levels of crime.

These findings are all the more alarming, given that more than half of the world’s population now live in urban environments – and more of us are travelling in congested areas than ever before. Staggeringly, the World Health Organization says nine out of 10 of us frequently breathe in dangerous levels of polluted air.

Air pollution kills an estimated seven million people per year. But could we soon add murder figures into this too?

BBC Future considers the evidence.

Watch our animated version on BBC Reel: How dirty air is polluting our minds

It was in 2011 that Sefi Roth, a researcher at the London School of Economics was pondering the many effects of air pollution. He was well aware of the negative outcome on health, increased hospital admissions and also mortality. But maybe, he thought, there could be other adverse impacts on our lives.

To start with, he conducted a study looking at whether air pollution had an effect on cognitive performance.

Roth and his team looked at students taking exams on different days – and also measured how much pollution was in the air on those given days. All other variables remained the same: The exams were taken by students of similar levels of education, in the same place, but over multiple days.

He found that the variation in average results were staggeringly different. The most polluted days correlated with the worst test scores. On days where the air quality was cleanest, students performed better.

“We could see a clear decline [of performance] on days that were more highly polluted,” says Roth. “Even a few days before and a few days after, we found no effect – it’s really just on the day of the exam that the test score decreased significantly.”

To determine the long-term effects, Roth followed up to see what impact this had eight to 10 years later. Those who performed worst on the most polluted days were more likely to end up in a lower-ranked university and were also earning less, because the exam in question was so important for future education. “So even if it’s a short-term effect of air pollution, if it occurs in a critical phase of life it really can have a long-term effect,” he says. In 2016 another study backed up Roth’s initial findings that pollution can result in reduced productivity.

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These insights are what led to Roth’s most recent work. In 2018 research his team analyzed two years of crime data from over 600 of London’s electoral wards, and found that more petty crimes occurred on the most polluted days, in both rich and poor areas.

Although we should be wary of drawing conclusions about correlations such as these, the authors have seen some evidence that there is a causal link.

Wherever the cloud of pollution travels, crime increases

As part of the same study, they compared very specific areas over time, as well as following levels of pollution over time. A cloud of polluted air, after all, can move around depending which direction the wind blows. This takes pollution to different parts of the city, at random, to both richer and poorer areas. “We just followed this cloud on a daily level and see what happened to crime in areas when the cloud arrives… We found that wherever it goes crime rate increases,” he explains.

Importantly, even moderate pollution made a difference. “We find that these large effects on crime are present at levels which are well below current regulatory standards.” In other words, levels that the US Environmental Protection Agency classifies as “good” were still strongly linked with higher crime rates.

While Roth’s data didn’t find a strong effect on the more serious crimes of murder and rape, another study from 2018 has shown a possible link. The research, led by Jackson Lu of MIT examined nine years of data and covering almost the entire US in over 9,000 cities. It found that “air pollution predicted six major categories of crime”, including manslaughter, rape, robbery, stealing cars theft and assault. The cities highest in pollution also had the highest crime rates. This was another correlational study, but it accounted for factors like population, employment levels, age and gender – and pollution was still the main predictor of increased crime levels.

Further evidence comes from a study of “delinquent behaviour” (including cheating, truancy, stealing, vandalism and substance use) in over 682 adolescents. Diana Younan, of the University of Southern California, and colleagues looked specifically at PM2.5 – tiny particles 30 times smaller than the width of a human hair – and considered the cumulative effect of exposure to these pollutants over a period of 12 years. Once again, the bad behaviour was significantly more likely in areas with greater pollution.

To check the link couldn’t simply be explained by socioeconomic status alone, Younan’s team also accounted for parental education, poverty, the quality of their neighbourhood, and many other factors, to isolate the effect of the microparticles compared to these other known influences on crime.

Younan says that her findings are especially worrying as we know that how an individual behaves during adolescence is a strong predictor of how they will behave as an adult. Delinquent individuals are more likely to perform worse at school, experience later unemployment and are more prone to substance abuse. This means that an intervention at an early age should be a priority.

Exposure to various pollutants can cause inflammation in the brain

There are many potential mechanisms that might explain how air pollution affects our morality.

Lu, for instance, has shown that the mere thought of pollution can influence our psychology through its negative associations.

Naturally, the researchers were unable to physically expose participants with pollution, so they took the next best (ethically approved) step. They showed both US and Indian participants photos of an extremely polluted city, and asked them to imagine themselves living there. “We made them psychologically experience the effects of pollution,” Lu explains. “…then asked them to really imagine living in this city, and how they would feel and how their life would be living in this environment, to make them psychologically experience air pollution versus a clean environment.”

He found that the participant’s anxiety increased, and they became more self-focussed – two responses that could increase aggressive and irresponsible behaviours. “As a self-protection mechanism we all know that when we are anxious we are more likely to punch someone in the face, than when we are calm,” says Lu. “So, by elevating peoples’ anxiety, air pollution can have a detrimental effect on behaviour.”

When we are anxious we are more likely to punch someone in the face, than when we are calm

Across further experiments, the team showed that participants in the “polluted” conditions were more likely to cheat on several tasks and overrate their performance in order to get rewards.

This research is just the start, and there could be many reasons for these effects besides the increased anxiety and self-focus that Lu describes – including physiological changes to the brain. When you breathe in polluted air, for example, it affects the amount of oxygen you have in your body at a given moment – and that in turn, can result in reduced “good air” going to your brain. It can also irritate the nose, throat, cause headaches – all of which can lower our concentration levels.

It’s also clear that exposure to various pollutants can cause inflammation in the brain and can damage brain structure and neural connections. “So what could be happening is that these air pollutants are damaging the pre-frontal lobe,” says Younan. This is the very area important for controlling our impulses, our executive function and self-control.

Besides elevating crime, that might also bring about a serious decline in mental health. A March 2019 study even showed that teenagers exposed to toxic, polluted air are at a higher risk of psychotic episodes, such as hearing voices or paranoia. Lead researcher Joanne Newbury, from King’s College London, says she cannot yet claim that her results are causal, but the findings are in line with other studies suggesting a link between air pollution and mental health. “It does add to evidence linking air pollution to physical health problems and air pollution link to dementia. If it’s bad for the body, it’s to be expected that it’s bad for the brain,” she says.

Those in the field say that there now needs to be greater awareness of the impact of pollution, along with the well-established effect on our health. “We need more studies showing the same thing in other populations and age groups,” says Younan.

Fortunately, we do have some control over just how much pollution we are exposed to day-to-day. We can be proactive and look up the air quality around us on a given day. Monitors highlight the days it is most dangerous, and when it is lowest. “If it’s dangerous I wouldn’t suggest going for a run outside, or do your work indoors,” says Younan.

While many countries are waiting for stricter legislation or government intervention to curb pollution, some places have taken positive steps. Take California, where regulation has resulted in less pollution, and interestingly, also less crime. Though promising, Younan stresses that we don’t yet know if this is coincidence or not. Meanwhile in London, from 8 April 2019 there will be a new “ultra low emission zone” which has stricter emission standards with an additional £12.50 ($16.30) daily charge for “most vehicle types” on top of the existing £11.50 congestion charge. A greater number of greener busses are also being phased in under the “cleaner air for London” initiative.

“We are doing a fairly good job in cutting pollution in many countries, but we should do more,” says Roth. “It’s not necessarily just government. But it’s also you and I. When we think about what we want to buy, how to get to places, we all affect the environment and we need to be more aware of that and make more informed decisions of what we do.”

Roth remains hopeful that rising pollution is something that is in our control to solve, but until we do we need to make people more aware of the issues.

If we all begin to monitor pollution levels ourselves, we then might start making it a habit to avoid certain activities, like outdoor sports, or even commuting on the most polluted days. Our bodies, brains, and behaviours will benefit.

Melissa Hogenboom is editor of BBC Reel. Her film on the same topic can be seen here, she is @melissasuzanneh on Twitter.

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White Paper: Complementary and Integrative Healthcare

White Paper:  Complementary and Integrative Healthcare – How it Fits in the Healthcare System

Executive Summary

The ever evolving healthcare system will see significant changes coming in the future. Complementary (CAM) and integrated medicine will continue to grow as major players in how Americans treat medical problems. CAM is defined as a “ group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine…“The Complementary medicine” refers to use of CAM together with conventional medicine, such as using in addition to usual care to help lessen pain.

Most use of CAM by Americans is complementary. “Alternative medicine” refers to use of CAM in place of conventional medicine. “Integrative medicine” combines treatments from conventional medicine and CAM for which there is some high-quality evidence of safety and effectiveness. It is also called integrated medicine.” (National Center for Complementary and Alternative Medicine


Article: Sound Health

Article: EPA’s Report on the Environment

“Indoor air quality” refers to the quality of the air in a home, school, office, or other building environment. The potential impact of indoor air quality on human health nationally can be considerable for several reasons:

  • Americans, on average, spend approximately 90 percent of their time indoors,1 where the concentrations of some pollutants are often 2 to 5 times higher than typical outdoor concentrations.2
  • People who are often most susceptible to the adverse effects of pollution (e.g., the very young, older adults, people with cardiovascular or respiratory disease) tend to spend even more time indoors.3
  • Indoor concentrations of some pollutants have increased in recent decades due to such factors as energy-efficient building construction (when it lacks sufficient mechanical ventilation to ensure adequate air exchange) and increased use of synthetic building materials, furnishings, personal care products, pesticides, and household cleaners.

Pollutants and Sources

Typical pollutants of concern include:

  • Combustion byproducts such as carbon monoxide, particulate matter, and environmental tobacco smoke.
  • Substances of natural origin such as radon, pet dander, and mold.
  • Biological agents such as molds.
  • Pesticides, lead, and asbestos.
  • Ozone (from some air cleaners).
  • Various volatile organic compounds from a variety of products and materials.

Health effects associated with indoor air pollutants include:

  • Irritation of the eyes, nose, and throat.
  • Headaches, dizziness, and fatigue.
  • Respiratory diseases, heart disease, and cancer.
The link between some common indoor air pollutants (e.g., radon, particle pollution, carbon monoxide, Legionella bacterium) and health effects is very well established.

Article: America Ranks Last

A harrowing report was put out by the Commonwealth Fund in 2014. Out of 11 industrialized countries, the United States came in dead last for its health care system. It was not one issue that led to its embarrassingly low ranking. America placed 5th for quality care, 9th for access to care, and 11th in each of three categories: efficiency, equity, and “healthy lives”. Healthy lives takes into account infant mortality, preventable deaths, and overall life expectancy for people at age 60.

What do those other countries have that we don’t?

Universal health care.

The point in all this? The AHCA still has to pass the Senate before it becomes the law of the land. No matter which law prevails, the ACA or AHCA, private insurers will find some way to use it to their advantage and turn a profit.

As long as they hold those reigns, actual patient care will come second place to dollars and cents.

Without change, our American health system will continue to rank low compared to other industrialized nations. If we are trying to make America great again, we need healthy citizens to get us there.

This begs the question: Can we revamp our current healthcare system to decrease the power of the almighty insurance company? Or is it time for the United States to turn to a single payer system, i.e. universal healthcare?

Let the debate begin.

by Tanya Feke, MD

Article: America’s Tap Water

If you live in the United States, there is a nearly one-in-four chance your tap water is either unsafe to drink or has not been properly monitored for contaminants in accordance with federal law, a new study has found.

In 2015, nearly 77 million Americans lived in places where the water systems were in some violation of safety regulations, including the 1974 Safe Drinking Water Act, according to the report released on Tuesday from the Natural Resources Defense Council, a New York-based environmental advocacy group.

It’s not only that some tap water has high levels of lead, nitrates, arsenic or other pollutants, said Mae Wu, a senior attorney with the council’s health program. It is that too often, a lack of reporting means residents cannot be sure whether their drinking water is contaminated or not.

The issue is not new; tap water safety violations across the United States have been reported again and again and again. The new study is an attempt to tell the big-picture story, Ms. Wu said, as a backdrop to the piecemeal reports coming out of towns and cities across the country.

The council’s report found that there were around 80,000 reported violations of drinking water safety regulations in 2015. Of those, more than 12,000 were “health-based” violations, or cases that involved actual contamination problems. In addition, the N.R.D.C. said, “repercussions for violations were virtually nonexistent. Nearly nine in 10 violations were subject to no formal action.”

Ms. Wu said that data is “not sexy,” making it hard to use in pushing for meaningful actions like investment in national infrastructure maintenance. “For drinking water infrastructure, like the pipes and the mains, it’s out of sight, out of mind — until the main breaks outside your house, and you can’t drink your own water,” she said.

She added that part of the difficulty in fixing these problems comes down to a complicated regulatory system, in which the responsibility to monitor adherence to federal laws falls largely to states. The report, which relied on data collected by the E.P.A. itself, includes a list of 12 states with the most water safety violations based on population; it is topped by Texas, Florida, Pennsylvania and New Jersey.