Daniel A. Anderson / UCI
A Picture of Health
Doctors and researchers share snapshots of how communication, lifestyle, data, innovation and scientific evidence are changing healthcare as we know itBy Anna Iliff
How does one visualize something as complex as integrative health? Just look to some of the individuals who practice it.
At UCI, that includes an assistant physician who sees her patients as more than their diseases or ailments; a researcher determined to put technology to work for the greater good of human health; and a pharmacologist who longs for a day when people can live their longest, best lives free of the debilitating side effects associated with some prescription drugs.
A central component of integrative health is incorporating the best care science has to offer, whether that means using conventional medicine for diabetes or pioneering technology to help cure a rare disease. But it’s also an understanding that one size does not fit all when it comes to health and that patients sometimes need more than a traditional doctor visit can provide.
“One of the surprising things about healthcare is how much we don’t know and how much we need evidence,” says Dr. Josephine Briggs, director of the National Center for Complementary & Integrative Health, part of the National Institutes of Health. “That includes practices outside the mainstream – but also practices that are very much part of the mainstream.”
Across the UCI campus, physicians and researchers from a wide range of disciplines are investigating ways to enhance health via plants and botanicals, biomedical engineering, cardiology, mind-body practices, information and computer science, radiology and neurology. While their individual expertise varies, each has the same intent: to make meaningful strides in medicine, therapies and healthcare delivery.
The Doctors Will See You Now
When you first walk into Dr. Anna Monique Halbeisen’s office, you’re greeted by a kind face and a cup of tea. Rather than sitting on a cold table in a paper gown under harsh fluorescent lights to get a quick diagnosis, you sit in a comfy chair and have an open, honest and eye-level conversation with a doctor who’s listening intently.
Halbeisen, an assistant physician in UCI’s Department of Medicine with her own practice, makes an effort to get to know her patients on a deeper level. She doesn’t poke and prod and write a prescription right off the bat. She won’t even wear a white coat if she can help it.
“That’s how you really earn your patients’ trust,” she explains. “You have to get to the heart of the problem. You can’t just hope they miraculously respect you and open up to you.
“Every person is unique, and they all come in with different mindsets of what they think will work for them. I try to be open and receptive to that.”
Halbeisen practices neuromusculoskeletal/osteopathic manipulative medicine with an eye toward integration, working with a team of highly qualified health professionals to empower her patients to take a proactive role in their own care, particularly when it comes to managing stress.
“I don’t see a single patient with low back pain that doesn’t deal with stress,” she says. “But we all hold stress differently in our bodies, depending on our life experiences and our injury patterns. When times get tough, usually that’s when we see a lot more physical manifestations of issues. You really cannot separate the mind and spirit from the actual physical body.”
Most of her patients come to her after a string of bad experiences with other health professionals. She’s found that taking time to get to the root of an ailment – whether it’s an aching back or gastroesophageal reflux disease – and treating patients with compassion and respect can change lives.
“People want to be heard; they want to be listened to,” Halbeisen says. “Half the time, they know what’s wrong when they walk into the office, but they just need to be in a comfortable setting to process their problems and come up with an active solution.”
Integrative practitioner Dr. David Kilgore says he tries to expose patients to lifestyle choices that can make a profound difference in their overall wellness. “We help them manage stress, eat and sleep better, and be more active – all while ordering the necessary tests and putting them on recommended medications,” he says.
At the UCI Family Health Center in Santa Ana, Kilgore sees many patients from low-income areas. He has found that they’re prone to stress caused by disruptive home environments and a lack of family support and access to resources, such as healthy food, fitness centers and transportation to regularly visit the doctor.
“Food is medicine, exercise is medicine, mind-body balance is medicine,” says Kilgore, UCI clinical professor and vice chair of family medicine. “These have real effects in reducing complications in chronic disease.”
The clinic offers free yoga and cooking classes, manages a healthy food pantry and hosts wellness workshops. The aim is to teach healthy behaviors and instill a sense of community, decreasing isolation and stress and the problems that accompany them.
“Integrative health addresses some of the fundamental needs of patients living in our underserved communities,” Kilgore says. “It is not fluffy add-on therapy but powerful, evidence-based medicine that is critical in disease prevention.”
Ramesh Jain, Donald Bren Professor of Information & Computer Sciences and director of the UCI Institute for Future Health, sees fertile ground when it comes to making advances in human health and healthcare delivery. With the advent of smartphones and wearable devices, he’s working on developing a one-of-a-kind technology to make health monitoring as common as checking your email.
“We should be focused on health 24/7,” Jain says. “Current healthcare evolved in days when we did not have technology. It evolved in a time when infectious diseases were predominant. Those two things have changed. When you start dealing with chronic diseases, you have to rethink the healthcare system completely.”
That’s why he and his students are creating Health Butler, a mobile application that can measure and collect data on a variety of health markers, make real-time recommendations and provide assistance in times of distress.
Just as a thermostat works to keep a room at a comfortable 72 degrees, Health Butler constantly monitors a person and his or her external environment to maintain optimal health. The technology is based on cybernetics, the science of communications and automatic control systems in both machines and animals.
“Human bodies have very well-designed cybernetic systems,” Jain says. “It’s what we commonly call homeostasis.”
He envisions a world in which he could order from a menu and his Health Butler would digitally communicate with restaurant staff to prepare the correct portion, ensuring that he’s satiated but doesn’t overindulge. Jain also sees the application as a repository of health data – including blood pressure, heart rate, insulin and hormone levels, and sleep quantity and quality – that has the potential to alert a person to an impending heart attack so he or she can call for help.
“Technology is important, but we have been poor about adopting it or using it. Technology can change healthcare.”
To accomplish this feat, he says, society must be willing to embrace technology and its capabilities to revolutionize life as we know it. “Technology is important, but we have been poor about adopting it or using it,” Jain says. “Technology can change healthcare.”
Matters of the Heart
UCI’s Dr. John Longhurst was skeptical when he first began investigating acupuncture more than 25 years ago. On a trip to China in 1992, he met with traditional Chinese medicine practitioners who seemed unconcerned with the lack of scientific evidence to back up the observed healing powers of the ancient treatment.
“They would say, ‘We don’t really need to worry about that. It’s been around for so long. We just know it works.’ Well, that’s not how I practice medicine,” Longhurst says.
It wasn’t until he collaborated with Dr. Peng Li of Shanghai Medical University that the cardiologist had a change of heart. Li, now a project scientist at UCI, had published acupuncture-affirming findings in reputable scientific journals.
Decades of research later, Longhurst and his team have discovered that electroacupuncture – in which a weak electrical current is passed through the needles – can lower blood pressure in patients with mild to moderate hypertension.
Recently, their clinical study of 65 hypertensive patients found that 70 percent of those who had received electroacupuncture at particular spots on their inner wrists and below each knee experienced a drop in their blood pressure.
Now the lab is examining auricular acupuncture, which stimulates different points of the ear, to determine its effects on pain and hypertension. The team also is looking into how electroacupuncture might benefit menopausal women.
“Acupuncture is just one of many forms of therapy that activate our body’s own ability to heal itself,” Longhurst says. “It triggers endorphins, enkephalins and dynorphins – opiates that we produce naturally. We can demonstrate how acupuncture works down to the cellular level. When we do that, it changes people’s notions about it.”
Procedures With Precision
In the 1980s, before Joyce Keyak finished her Ph.D. and became a professor of radiological sciences at UCI, her cousin was diagnosed with breast cancer. She had to undergo radiation targeting tumors that had grown in the bone of her spine. The stakes were high. If something went wrong and the adjacent spinal cord received too much radiation, she risked nerve damage and even paralysis.
“That stuck in my mind,” Keyak says. “Traditional therapy requires multiple visits for external beam radiation. It could mean going to a facility five times a week for several weeks. And on top of that, there’s nausea, vomiting, diarrhea, lethargy and the general misery that comes with it.”
In 2007, while studying the strengthening capabilities of bone cement in the hip and femur, she and Harry Skinner, now-retired chair of orthopedics at UCI, had a breakthrough. Mixing radioisotopes with bone cement and injecting it into a patient’s bone could precisely treat cancerous tumors while fortifying weakened or fractured bones.
“You can have this procedure and be done with it,” Keyak says. “And you can do it when the tumors are smaller and it’s easier to prevent bone damage.”
Theoretically, she says, the method wouldn’t have the same side effects as traditional radiation therapy. Because the injection directly targets the tumor, radiation doesn’t pass through other organs, such as the intestines or stomach, which is what causes the uncomfortable aftermath. Research on bone cement without radiation also has revealed that it can immediately reduce pain in the spine, potentially getting patients off strong opioid medications that could carry further side effects, Keyak says.
The Flowers of Youth
Mahtab Jafari, UCI professor, Chancellor’s Fellow and vice chair of pharmaceutical sciences, may have found the elusive flowers of youth.
Her inquiry into how to extend lifespan and improve overall health led to an unbiased screening of pharmaceuticals, botanicals and additional natural products to see which could reduce mortality without negatively affecting important biological systems in fruit flies – a species that shares 75 percent of disease genes with humans.
The results? Two spices – cinnamon and curcumin (found in turmeric) – plus a beautiful rose species and Rhodiola rosea outperformed all other supplements, including pharmaceuticals.
“Fruit flies don’t lie,” Jafari says. “The plants did better.”
Rhodiola rosea, a golden flowering plant that grows in the Arctic and subject of her research for over a decade, extended the lifespan of fruit flies by nearly 25 percent.
She hopes to eventually run clinical trials on humans to determine if the plant can increase not only lifespan, but “healthspan.”
“When you slow the aging process, you slow the progression of disease,” she says. “The goal is to not just extend life, but improve quality of life.”
One might assume that a professor of pharmacology would be a staunch advocate for the medical marvel of drugs. But Jafari says she has learned better from her past life running the Cholesterol Clinic at UC Irvine Medical Center and serving as a clinical pharmacist at UCI and UCSF. She often would encourage lifestyle changes, natural remedies and alternative medical modalities.
“I used to ask my clinic patients with high cholesterol, ‘Do you want to take a pill and have all of these side effects, or do you want to adopt a more plant-based diet and walk 30 minutes a day and be on a lower dose?’”
Today her research findings prompt her to tell her students to be open-minded to their patients’ needs, whether they desire to use natural remedies, conventional medication, meditation or a combination of all three.
“If you have pneumonia, I’m not going to say, ‘Let’s go meditate and hope that your infection will go away’ – you could die. If you have pneumonia, I’m going to recommend you antibiotics, but maybe you can meditate to get through it,” Jafari says.
Brain and Brawn
At the UCI Institute for Memory Impairments and Neurological Disorders, a clinical trial launched in February is investigating whether exercise can slow the progression of cognitive impairment in seniors. The local effort, led by UCI MIND’s Dr. Aimee Pierce, is part of the 18-month, national EXERT Study.
Previous observational research has found that older adults who engage in aerobic exercise have a lower chance of developing Alzheimer’s dementia, the sixth-leading cause of death in the U.S. But the EXERT Study is the first large-scale, randomized clinical trial of its kind.
“If you have pneumonia, I’m not going to say, ‘Let’s go meditate and hope that your infection will go away’ – you could die. If you have pneumonia, I’m going to recommend antibiotics, but maybe you can meditate to get through it.”
The EXERT Study is the result of research conducted by Carl Cotman, UCI professor of neurology, who discovered that aerobic exercise triggers the production of brain-derived neurotrophic factor, a protein that shields brain cells from injury or death and improves learning and memory.
Currently, there are no effective medications for mild cognitive impairment, Pierce notes. But exercise holds promise due to its multifaceted ability to stimulate insulin sensitivity, release endorphins, reduce inflammation, increase production of BDNF and protect against the development of diabetes.
Ultimately, the study aims to equip doctors to make the right recommendations for their patients, with a focus on prevention and intervention.
“Prevention is crucial,” Pierce says. “It’s not enough to just vaguely say, ‘You should exercise.’ We want to be able to prescribe a specific type of exercise delivered at the right dose.”
Pathway to Wellness
So how does one become the picture of health? While our individual paths to wellness may differ, it’s clear that research and innovation will pave the way.
“Scientific curiosity is often a very good reason to do research,” says Briggs, of the NIH center. “Sometimes the practical applications are farther down the road, but just learning about ourselves as humans can lead to new ways of solving some of the worst health problems.”
The key, she says, is integration.