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Dr John Pan 簡介:

	Director, Center for Integrative Medicine
	Expert of integrative medicines
	Has been voted as one of the Best 100 Doctors in the DC area
	Taught and practiced at George Washington University (GWU) hospital for over 20 years
	Clinical Professor, Dept. of Obstetrics & Gynecology at GWU Medical Center

Summary of Dr John Pan's Presentation

Topic: How to live healthier and longer

Preview
n Disease Care
n Health Care
n Break
n Integrative Care

State of US Disease-care
n Most $$$ spent
§ Patient care
§ NIH budget
n World ranking in health status

Disease care
n Diagnosis
§ Differential diagnosis
§ Expensive work-up
n Treatment
§ Based on diagnosis
§ Standard protocol
n Chronic disease

Diagnosis
n Dis-ease to disease

§ Fallen off the cliff
§ Outside a defined set of parameters
o Based on a statistical majority on a average patient
o Not based on race/gender/culture
o Not updated
§ Not recognized as a continuum

Diabetes II
n Screening test
§ Fasting blood sugar
§ Hg A1-C
n Diagnostic test
§ Glucose tolerance
n Drugs/Insulin
n 2 Hr Glucose/Insulin challenge test
n Diet – Exercise - Supplement

Treatment Principle
n What works for what
§ Evidence based medicine
§ Single intervention with single outcome
§ Disease as a biochemical malfunction
o Biochemical intervention
§ Defined protocol
§ Not individualized

Drug based culture
n Patient
§ Immediate response – just a little water
n Doctor
§ How long does it take to write a Rx
n Insurance Co
§ An easy 10% off the top
n Drug company
§ Laughing all the way to the bank

Statins - Cholesterol
n HMG Co enzyme inhibitor
§ Reduces the production by the liver
n The lower the better – NOT true
n Prevents heart disease – NOT because of lower cholesterol
n Good for everyone – NOT true
n Good drug - TRUE

Anti-acid
n H-2 Blocker & Proton Pump Inhibitor
§ Blocks production of gastric acid
n Normal gastric pH = 1-2
n Proper digestion
n Anti-bacterial - sterilize food
n Designed for short term use

Health Care
n What is Health?
§ Absence of disease?
§ Optimal function in mind/body/spirit?
n Preventing Disease
§ How do you know what worked
n Optimizing Function
§ No standardized measure

Health Reserve
n Capacity to heal


Taking care of your reserve
n Avoid filling up with toxic stuff
n Try to neutralize
n Your reserve is full
§ Feels lousy all the time
§ Takes longer to recover from flu
§ Frequently ill
n Overflowing
§ Chronic disease – sick all the time

Disease Prevention
n Inflammation
§ Anti-inflammatory
n Free Radical
§ Antioxidant

INFLAMMATION - followed by some images

Anti-inflammatory
n Plant based diet
n Omega 3 fatty acids
§ DHA and EPA – fish oil
§ ALA – flax seed oil
n Avoid sugar

OXIDATIVE STRESS -
Imbalance between FREE RADICALS and ANTIOXIDANTS

Free Radical
n Free radical is a cluster of atoms one of which contains an unpaired electron in its outermost shell of electrons
n Oxygen, nitrogen & sulfur
§ Reactive Oxygen Species (ROS)
n Sources
§ Ionizing radiation – Air pollutants – Tobacco smoke – Alcohol - Fried foods - Stress

ROS - Formation
n Interaction of ionizing radiation
n Natural bi-product of cellular respiration
§ Electrons passing “down” the respiratory chain leak away from the main path
and directly reduce oxygen molecule to superoxide anion
n Synthesized by enzymes in phagocytic cells – neutrophils & macrophages

ROS - Damage
n Cell Membrane
§ Fatty acid side chain
o Deformed fatty acid chains – damage cell membrane function
o Mitochondria – directly exposed during cellular respiration
n Mitochondrial mutation
§ Cumulative accelerated degradation of mitochondrial fucntion
§ Premature aging, cancer, neurodegenrative diseases

Antioxidants - Endogenous
n Endogenous
§ Super Oxide Desmutase – SOD
§ Glutathione peroxidase
§ Catalase

Antioxidants - Vitamins
n Vitamin-A – Retinol – 900mcg/700mcg
§ Toxicity – Liver & Teratogenic
§ Preformed (animal) & Carotenoids (veg)
n Vitamin-C – Ascorbate
§ Oral dose – plasma concentration – sigmoidal
§ Saturated at 400mg/day – entire absorbed dose excreted above 500mg/day
n Vitamin-E – Tocopherols & Tocotrienols
§ Alpha, beta, gama & delta
§ Lipid domain of the body – cell membrane - LDL

Antioxidants - Mineral
n Zinc
n Copper
n Manganese
n Selenium

Antioxidants - Phytonutrients
n Flavonoids
§ Proanthcyanidins – Quercitin - Citrus bioflavenoids – Rutin –
Green tea polyphenols-EGCG
n Carotenoids
§ Beta-carotene & alpha-carotene – Lycopene – Zeaxathin - Lutein
n Co Q-10
n Alpha Lipoic Acid

Optimize Function
n Vitamins
§ Organic nutrients essential of cell health
n Minerals
§ Inorganic nutrients critical in biochemical and physiologic functions
n Phytonutrients
§ Optimize but not essential

Nutritional Supplement Guide
n Dosing
§ More is not better
§ Twice daily
n Form
§ Natural VS Synthetic
§ Vit-D & Vit-E
n Formulation
§ Updated
§ Calcium/Magnesium
n Bioavailable
§ Amino-chelation
§ Dissolution
n Integrity
§ Meet standard
§ Safety

Summary
n From regular to extended life light bulb
n System of disease care not health care
§ Annual physical
§ Early diagnosis
§ Not prevention
§ Drug dependent
§ Shared guilt: patient-doctor-insurance-drug
n Blind leading the blind

Health Reserve
n Capacity to heal
n Healing depends on
§ YOU
§ YOU are responsible
§ YOU have TOTAL control
n Doctor
§ Facilitator
§ Guide

True Health Care
n Prevent disease
§ Anti-inflammatory & Antioxidant
n Optimize function
§ Vitamins, Minerals & Supplements
n Diet & Exercise
§ Only you can do it
n Mind & Spirit
§ Ultimately the most important


Center for Integrative Medicine - Founded 1998
George Washington University Medical Center

MISSION:
Our mission is to deliver collaborative and integrative health care principled in science and tradition, engage our students and faculty in a learning environment to expand our knowledge, open our minds and stimulate scientific research.

Education
n Students
§ 1st year - Integrative Medicine Track – 4 year program
§ 3rd year primary-care rotation
§ 4th year electives
n Residents - Electives
n Practitioners – CME/CEU lectures & courses open to CAM practitioners
n Public – Lectures & classes

Research
n Government Grants
§ R-01 Grant : Acupuncture Treatment of CTS – NIH-NCCAM
§ FIPSE-DOE : Medical School Curriculum
n Foundation
§ MS Society : Integrative Treatment MS
n Industry
§ Smoke reduction

Patient Care
n Primary Focus
n Implementation of Integrative Medicine
n Financial viability
n Explore beyond the boundaries of conventional medicine
n Facility
§ 2,500 sq ft
§ Next to Medical School & Hospital

Clinical Tracks
n Quality of Life Programs
§ Cancer – A comprehensive adjunctive care program to support the patient
§ MS – Improve function, reduce symptoms
§ Pain Management – A multi-modality approach to the treatment of chronic pain
§ Healthy Weight – Optimum weight achieved through optimum health
§ Prepare for Procedure – Mind-body approach to improve surgical outcome

n Women’s Health
§ Healthy Aging for Women – A whole health program for peri- & post menopausal women
§ PreConception – A total health approach to pregnancy planning
§ IVF-Prepare for Procedure – Multi-modality approach to enhance outcome

Integrative Medicine
n Integrative Medicine is the practice of medicine that reaffirms the importance of the relationship between practitioner and patient, focuses on the whole person, is informed
by evidence, and makes use of all appropriate therapeutic approaches, healthcare
professionals and disciplines to achieve optimal health and healing.

HOW IS INTEGRATIVE MEDICINE DIFFERENT?

REDEFINE
n Disease
n The management path
n The relationship between healthcare provider and patient

Antecedents
n Genetic make-up – Hard wired
n Emotional Heritage – Soft wired
n Environmental Heritage

Triggers
n Toxins
– Environmental/ Pollutions: Air/Water/Radiation
– Iatrogenic: Drugs/Vaccines/Amalgam/others
n Food
– Contaminants & Additives
– Nutrients
n Life events
– Stress
– Physical Injuries & Illness
Milieu
n Health Reserve
– Nutritional status
– Emotional well being and balance
– Functional level of your organ systems
n Disease Vessel
– Disease burden
– Capacity to resist illness
– The Final Drop

Disregulation
n Biochemical Mediator
– Inflammatory cytokines
– Bacterial toxins
– Brain chemical
– Hormones
n Cellular
– Cancer – Tumor
n Functional
– Type II Diabetes
– Obesity
– Pain – Neuro-skeletal-muscular

REDEFINING MANAGEMENT PATH
When you get sick: WHAT, How, Why?

WHAT
n Patient:
– What do I do? What can I do? What should I do?
n Healthcare provider:
– Identify the disease and intervene
– What works for what?
n Disengages the disease from the patient and the healthcare provider
HOW
n Allopathic
– Biomedical industrial complex
n CAM
– What else may work. Try it out.
n Integrative Medicine
– What is that?
WHY
n Explore the full relationship between the patient and the disease
– Antecedent
– Trigger/Milieu
– Root cause
– True healing
n Fully engages the disease to the patient and the healthcare provider

REDEFINING PROVIDER PATIENT RELATIONSHIP

HEALTHCARE PROVIDER

Innate Healing

Patient Centered

Partnership

-> Patient as student -> PATIENT

Innate Healing

n Universal innate ability to heal

n Innate ability to distinguish good or bad

n Enhance that ability

n Spontaneous healing – Placebo effect

Patient Centered

n Traditional Chinese Medicine model

n Whole person – Mind, Body & Spirit

n Unique and Individual

Partnership

n Ask not what I can do for you, but what you can do for yourself

n Healthcare provider as facilitator

n Patient as self-healer

n Balancing intervention and self-healing


Integrative Medicine
n Healthcare practice that chooses the best healing path for the patient
– Disease beyond the dysregulation
– Engages both the patient & provider with the disease
– Redefined relationship
n Practice of Integrative Medicine
– Defined by the role the healthcare practitioner play in relationship the patient’s disease
– Not defined by skill or training
n It is medicine that we all can and should practice – GOOD MEDICINE

John C. Pan M.D.
n Center for Integrative Medicine
908 New Hampshire Ave. NW, Suite-200
Washington, DC, 20037
Tel : 202-833-5055
Fax : 202-833-5755
E-mail : jpan@mfa.gwu.edu
Web: IntegrativeMedicineDC.com