HAWAIIMEDICAL

JOURNALNovember 2001 Volume 60. No. 11 ISSN: 001 7-8594

I

Special Issue on Alternative Medicine —

Part II

comes

Dr. Lynn Stuart Ashby is Board Certified in Neurology and PalliativeMedicine. Special interests mclude neuro-oncology and general neuioiogical care. Received Doctorate of Medicine at l’Jorthwestern UniversityMedical School. Chicago, IL. Neurology residency at St. Josephs Hospitaland Medical Center, Phoenix, AZ. Fellowship in neuro-oncology at TheBarrow Neurological Institute, Phoenix. AZ. She is also the Neuro-oncologyConsultant for the Gamma Knife Center of the Pacific.

ORTHOPEDIC SURGERYDr. Michael Reyes’ special interests include joint replacement surgery,arthroscopy/sports medicine, trauma and general orthopedics. ReceivedDoctorate of Medicine from University of Pennsylvania School of Medicine,Residency at University of Southern California Department of OrthopedicSurgery. Fellowship in Adult Reconstruction/Joint Replacement Surgery atthe University of Southern California Department of Orthopedic Surgery

RADIOLOGYDr. Kryss Kojima is Board Certified in Diagnostic Radiology Specialinterests include body imaging, magnetic resonance angiography magrietiresonance coil design and computers. Received Doctorate of Medicinefrom Oregon Health Sciences University School of Medicine. DiagnosticRadiology Residency at Oregon Health Sciences University Fellowship inbody imaging at Stanford University

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Editorial fl Letter to the Editor

Norman Goldstein MDEditor, Hawaii Medical Journal

Special Issue on Alternative Medicine -

Part II

\\: eunt.ine.e our sect’s a nape-rs. p rc.scm.e at t.h.e Suauh Paundahon

Sen.sinai.s on Comphme.ntary and .Alternative Medicine (CA.Mj.

Part I appeared in the Oct oher 2001 issue of the Journal,

ad a.‘ati r. at’ the . a’pO 0 ant e ot rAM Ott John a BSt ms School

at Me-ucea:e is plannine to start a l.)ettartntetn ma Inteorat, se AlcOa

e;ac ttccmanossnpt “Inteerato e Medicine: .-\n Academic Disco

ph n.e.?” is also published in this Special Is sne, .Mahalo to T. Samuel

Shen.raker, M.D,. J.D.. Vice Dean for Acade.mic Affairs in. oar

tTl5ihICt’tl school 4.*.m.t‘‘“ Dr. Shomnaker notes that Coneress

ret lt/tntt tttat CoD has taeeonte a natot rieatth tsuc in Itte Putted

States has create-h a Patistual. Center r55 (:aitctrhtoettuir’ :tnd Alter’

nad.ve Medicine iN CCA.M p The .J oho A. Barns a chool of Me.dicine

helievesit is important to train our medical stude,.nts ahout all the

therames their ptttents wtl.l recec.ee. There is no doubt that we d..o,.1 “t.,,.-....,.,,, %K,.tL..t,

I Lit , IL. I, s L.

us. :sstjr’ ttco tnclurtes a hoot res:tess Meditation Niedietne or

Dhaooa Si ogh Kltalsa and Cameron Startth, Mahato to Charle.s, Dc

Metsa, M,P.PP, an e.nvirontoental s.c ience instructor, for this’ review,

A te.xthook hoof dealine with (SM’ s:s rec.en tlv released: The

a I 55tt a

one. ha St. John Dtatuond. M.D. te-anail: ordcrsth’crcpt’ess.cata

The list or monthly publications decline with CAM con.tinoes to

expand ctnd ioci.udes alternad.ve Medicine .A.lert and Alternoh’e

therapies in Women’s. He::tlth (e-mail:

if lame/ann if

‘ibis. lariat riepiets the :t’tdqurr i—l.:tsvaiian “haprsr face’’ spider

Box Jellyfish in Waikiki

We applatid the work, oh Thomas et al, which a.ppeared in the ?..pril

2001 is:suc oh your joumal. In this atctir:le they pres:ent erarefully

planned :atd antIs /ed data on tIre anal ucsic et’l’cet of hot and sold

H 5 s ,,,s Into ,.h5 Itt tat

he:.ss sen tt:c use at an aent as tnhthttrn s prrs’enttng dtseharcc’ ol

utthired.nern.atocy st adhering to the vic.tini’ s skin and pain relief Thc-

puhhc. and many physlcitrns forget this: dishrction. It frdlow’s f.h.at th.e

clinical rrnportrtne e of inhihihot. the ruptttre of anfhed nentatocysts

a 1 5tet’crtd upon thetr nttnther and the incremental effect of addtna

theit se notn rmto the p-ain .tlreaam sntferet.i hs’ the patient. In most,

cases we thin.k. this w’ould he small.

We 1.ave (ound that cold pac.ks. are of marginal us:e in sea nettle.

mat imo itt I so to tod I at th, dtsal ott

rt sntait child a “chill”, Heat appitcatimi a as unintpressis e.

On one’ occasion one of us tJB’t stunc his tot’eartn with the’ s\tlcttttte

c.oa:.O Pot-mn.guesc memo’ rro.r tentacles and rapidly im.m.ersed that

arert ft.om wrtstto elbow in a42.°C constant ho’t water hath for 15 olin,

Thmt svas all the thermal therapm he cttuld tolerate. Ta o-miontes

alter retorts irtc the im’n’tphanciric streaks appeared ott the ttpper am:,

this practice’ a a.s discontinued. Such ,tn cc-sot did not ctppear at

the’ presettt work proha.bly because. less heat was applied.

A. minor point to he reviewed is: the ose of vinegar as’ a oematocvst

inhibitor. It is an etThctive solutiott against the microscttpic firing of

,Atlatttcc’ test Pit ontii’mt orcaneIIc in. the lahorators, it is applied as

a Orst aid trteasnrc cvctt though it’s ehitticmd benefit is prohahi’e

toarginal. Phase/ia atrtett/us, P/twa/ia p/t co/is and a larger fortit at

the later otuhiteotacu.lar aoitnal can he f’ouod in Queensland waters,

P ttter,ar applicate arrests netnatocyst discharge in the first tsvo

tell fts[t httt appears to stiotnltttc Ortnc rtt the organclic itt tltc latter:

ntedus.ac. Bccctrtsc ssvtrnoiers and hifeunards. do too has c rimm’ttor

the’ opportunity ttt alwam s idettttfy the otfeodtng species recono

toeaded in reference 6 of the Thonias et al. paper to withhold vinegar

from Australian patic.nts ltas made. It is thus s:alc to .:av that we do

nIt knr.ss whether vnccar should he r’ecrtntmcnded tar use itt

Fi, tsr-Pt—c st_thi,ee-t tar these autnors also tsr st rtd’\ -

WI Burnett. .15 aateweons Pj rennet

.:.sca.toe tszr.esrtsnt Lais’erti.a .t.’ tterylsnn’ St. edimel B’o:en. 40 Sri. Redwood t:.t. Bo.ltiwortt u-a

Cover art by Dietoich Varez, ‘Volc.ar.o, H.avs’ah. All niehtt:.

mesersed hy tM. artist.

278

o__Book Review

Meditation As Medicine, Oharma SinghKhalsa, M.Da and Cameron Stauth, New

York: Pocket Books, 2001, 284 pp

Ti. the. United State.s, the num.her of people turning to alternativepraetnlouem has e heeu raaehiue record uumhers in i ‘AU ah ac.Ameriemts made no estimated 4f5 miii on 5 iNitS to aiternaus e erepractitioners.: compared. with iSf million visits to prim.ary carephvsieiaas The ruajoriry sought rem.edies for long-term ptihlemslike ohesits, ehomie pain. anx’et\ suhstattee nhuse and ,teressonwhile. few soueot treatmeats Ca hfe-ti.treareuing, couditi.rms such as:cancer and AIS. App.roxim.ataly $14 hdhon is spent annuadv iCralternative care treatment in the Luited States This data puhitsitetin the New England Journal of Meate’tue riuring 199k tttdteatcu thateoove.utioual nwdieine m.ight not tttways provide the “magic. hullet”for some inrlividuals and that n..anv haheve thalt alternative or nonmaiuteream practices seemed and eouttuLie to hare saiuaole-, therapeutic henetit.

Integrating certain form of alternative therapy with standard,medical treatment mac he more effective than appli ing the conventional. isolated approach. in Meditation as Medteiue Dharma SlnhKhaisa, MD. and Cameron Stauth explained hosv medical meditatiou—-kundali.ni yoga ar.d advanced meditativa techniquas—-eouldhe eumhined with customers’ treattrtem to tare.et and ailc tateafflictions raneine from arthritis to high hloorl pre’isrtre to cancer.Each medical meditattun was specific tor each different medicale.onditiot.. or illness, It was th.is specificity that separate.d it from.other forms iT meditation practice

The authors introduce Meditation as Medicine a deserthiue towadvau.eed meditation. and. yoga a era actually secrets ut syiritualuowar once guarded hy ancient yoga masters and personally pr.ssedm trom master to student for centttrie-. In 9t*. hoe .\.e.r iOa’i

Bhajan-—-the worlds leadine authority on yoga and meditation——

relocated to A.me.riea and. re.vealed the se.etets of .Medcal Meditationti) aasoue is [to had a sincere interest. Dr. Khalsa apolted andeonnuues to aptslv the teehnietu afthi atteieut eteuee in, a en detchttic.al setting. Since the applieatiou is.: relatively ness, d.yere haveheen few s:tu is thi.:t derrtonstrate its effeetive.uess, Some of thes.tr. iL5 ease ii:0ieukn han’ MeJ.ea1 Meditation ii as utore

s.s fn]. that other foi:tti of rrtes . int.t i Ofl inc tni.t In. theti.iOst scle.atlf ic-ally examined fhrm in vs’e.st.ern eultureTrartsceadeut:al Muditrtaoia Evidentlya more studies are required to assessthe aceuraes tad va]tdtty a thu lindtttes.

The hook.f.: irtte.uded thr th.e eeneral pupa att.im, is uass to ri.ad. andincorporates practical iafornsatiou such its; hreathiug rmdconeeu.trahuta teeltniqtt.es.. o,stures/it.iox.:enteuts stud spe.ethe mantrits. .a:his.;t:..

can he used ri.’r me,ittntion. Drawitta etC s.ttttpIe atreetitits ateincluded.

The auihors; descrihed how .Medical Medi.tatiun wa.ss’aceessi’ttlhe-cause it tnriaene.e,1 hoth the rhi slea]. and etherent; ntiltea ot: ourhoWe-s. [ftc physical nh] en tne]adea sge:e;Ie hodv parts.i:y::tems and. glands, while the ctheral. milieu included the ehakaits(centers.: of consciousness and communication). ritdis ienepav con-

e,itittee’ttog i;hti rats i and tattwns tthe eemtplete relattoashiphetss..eert ;t persian’ s.. eita.kras and ita ,.t. Both tniiiees recipri.aeali\:in. .fluenead health, aa.d halaace mustt h.e itchieved throug,h five, keyitttrihutes of t’ledice,t Mediti.ttion—hreathine patterns, exact pns:i -

tiinti.Oe of hands and fineers. focus ot ennuenan tiO n. taa:utt n.post rtres.,..:movett.teots. The Medical. i..de.ditations: v,ere ate’ant to openup channels.- of com.tnunication that ex:isted hetween mind and hodyhe ehan ing the profile of enrii.ieri ne. uearotrnnsmitter an.d hormonal secretions. This is as heltesed to relax ttn mdts idnal tocitlm, healin.g state.

“laleditation as I. Udicine” should lie rettd hy persons: a:’ho areinterested in ads. anee meditatis e techniques attd yuan and those

wttit n,ltematts e fortnsot rhet-apy itiet.udmgstudents and health care practi.tioners.

“Meditation as Medicine” provides a wealth of ie.form.atiota andiitsi1tht into the ase- of ttteditatton as tin adanetise n’,,’,,tt\.

Choa.rles: i)rafe.sa MPH

tar:nr;Ar jaantaas... e’eii ‘iii: 5O:.VLt tees.279

D_Special Contribution

IntegratIve Medicine:An Academic Discipline?

T Samuei Shomaker MD JDVice Dean, Academic Affairs, University of Hawaii

John A Burns School of Medicine

Is eamplemeatarviaiternattve medicine U.AMt a saitahle academic

ttoiA Sc Johns F ‘is :Hvne Pert’orataa t

sold over the counter, has heea widely toated in the pepoiar n.serla.t

as a rreatment for cimical depression, aicl.ong.h its ei.fectiveness h.as

not been. e.stabhshea a contrtdle..o ch.niL al triais and there. is: little‘, 5” 0 in ,,,

-

S

c.yctasponn. a drop nsed to prevent transplant reiecthn,5 were

markedly reduced in patients taking St. John’s Wort, An FDA

pnhi ic health adv:isory svarning concladed th.at St. John’s Woo

md aces. the evtoehro ate P45P s\:stem 5.. fl’ut ‘V .r the

asat t: mans otesertotion drees, ar,cia,la’ tnose asect t,a treat

d:is.ease, der.session. nnvitv’s ‘‘ 5Oifl —;eV’s ,;,

pregnancy (oral contraceptives ,t. The ss’arnng concl.uded that the

fhe.rapentic effects:: of these drops conld he markedly rednced h

c.oaeonsttrtnt administration of St. John’ s Wort,ad a’ as a peope acreess tee United St;e,tes nosy

tt.neiv rise coaotslementary and a.iternscisc theranies, the h,et:

that Ii tt Ic •ereJi hle se ttt.te t nto.rraatt. on exists. th reeani to the

effectiveness a:nd satdtv e,f noanv of these. therapies. The. controversy

snrroundme, St. John’s Wortis an example of a s:i.tntttion in which

inaoeetnate in s’estieati.on ot a sa idel as ailahle health esre prodact

There Ps no den in that CAIvI has heeorne. his’ tausiness, A I.

report estimated that over 42 percent of Americ.ans wiere osinccomplementary and akemadve. therapies$ Furthermore, another

seer” as . omot,cted in i (572 ca:aclnrled that oatotCpocket exnend i

fdr oil U(S, physician seavices, Furthermore, the aamher ssf annaai

vi.sits to alternative healers nov..: exceeds the nntnhcsr of total visits to

US. primary ca.r.e phvsician.s.I C

sat cioae:d hv the Unìtest States boaeres.. svtscn tt cx andest ‘he tJtttce

telectieiae, it estt:Jhiisi’cst cit the

of Health fri i 991 to e:retste. thei’

fe.nter tor comtsternen.tars

aed alternative Medic inc (NCCAM),5a c.enhcr eferrged ha conduct

import sic resa Ten to ( Jteeo ness ide sot art in

V ‘V 5

the NICCJ.,M.

History teac.h.es th.ttt sonse aiternati.ve an.d complementary th.erm

in ss’idestsread as.e htts’e beneficial effe.cts on the treatment os

pres canon ot disease, ‘\ceitnatu.re. a a esamole, ts widely cm-

the searld ass i.eehtteiae’ ‘or toe t.T’.a naeetrient ,stsdatn..

e\.nomhe.r ol’ important nsc-dicati.rass, including digitalis, quinine.

colchi.cine, an.d nsorphine, are plant derivatives: that have. hec.n.kuoss:t.t to h.erhali.sts a.nei trtiditiontsl lsetdcrs for man. yea.rs,5 Whatother riiani ha sad ot’ tsoie,nets has s’ s.ast,a.ithie’ thet’a.oeaticerssoerties.(

S ,, ‘— I I

inc-se and mans other aee’stionc Ofl’iItt fl

itwait am’s’ers. Then. thttere are th.c. polics: questions, many of which

have heen mnadequate.iy dehate.d and studied, FUr exansple. w’hy are

peo tng5sT n. a r t tepto rtnat il eripa ‘sth

or t.t,sc iridn.ine afwesteit’e trt s’stcot tts Shoittd t’e’t’o nscdic,,tion.s he

sa’riteetto- f-U’s cerr,ti.eat.tonjtaet.tt,attis Fir sa.t’et.v at ad etticacy or as

“natural” products: she old th.ey he ex.empt?

Gi sen these question.s: ttnd tlsc’ir insport:snc.e to the health ttnd weh

b51, dot /rt’ t stnpoc ‘teh ‘ìdxC\’lor n mit

a’ the Jahrt A.. hones School ot’S ic’dicirte ‘t’the. e, s’ersttr sf Hassc,i:

(JABSIJ&l: we’ hehc’yc’ that it is: incunshent upon the’ se’hsxsl. to

conduc.t research in areas of. particular i.nterest to H.awaii and the

Pacific .Re.gion, In. adtfition, sve have the responsibility Far educatint’

t.he next srenerat ion ssf ehvsir: ions that wi 1.1. mitre fin t.he people of omtr

cultrtres an.d ethrucities, tnany healing traditions, srtmc of’ ancient

origin, are represen.ted herc in o:ur i.slands, Dur local citizens mak:e

use of these herd.ing’ arts freque.ntly, and often in unusual conshina0, . iSV t.tost 5:eon ci se’where . T1s is trases: eha lenc i’ tee dilensm as fist

po.tetci.rte s7hs sicte,n> ‘eat ani.uac researcle, i.Ttatcut5unitie tier

is an ideal lahatratory for the s,trtdy o,f the’ use.. eflieacy an.d sa.fUty oil”

alteo.tativc- the.rapies. Given the lack of gciod scientific. infdsmnsatiott

about n.an.v I .f th.es:e therapies . J,.&BSfJM rese.ar::hers can play’ at:

Ic “5 aoine cr’ dilaic ctenttt c evattmt ions. s’t the altet’

rlsemani,e’s rtsod a our ci’ttteartntts. .1A RSfJM can aiso e.xstisae

tts’ ot(pia.tsi. ca_tract:5and rotter natat’at srthstances as potential. lent

as yet anknosvn, tlserapies:. Thesc spadies can g.ive patients infornsa

tion to nsake informed rJecisions about fhe.rapeutic optioni.: available

tO V Ta ea’V set ip thet i salle u pr l an ‘tee r rtuntt

h i.. also trrtt.5.srtant, for JABSGM’s edsteat:ion.ai respoass.ihiiities to

teacls ntedi.cai students ahout tlse poten.tiads and risks of altern.ative

dset.soaie.s, as well. as the:ir imspacnon conve.ntional svestern dmug.s and

themanies, It is: iteeporta tat that o.’e- take an e.sidence-hasc’d stpproach

svdh thssns th5 ase of a: nomjuderaenati :ipproaei: tta patients usitte

alte.rt:ad.ve tf.erapies so that patient trust and confidence in westemtt

physieian.i: is nsrtintained,‘5ithi rtht less’ ro,eetic al s:choosis lasso’ s cst es:tt:thlislscd rlepartmertt.s

cotst.tstentctit,it’r’ rr:esttc’t:tie’ 5;is: treoOis’,e’ a. tasatot’ natal ti

issue fUr the Ltstied Stones, Conuncss Isass recognixed this fact by’ the

t o in isP on p

280

Guest Editorial

Theresa Danao MDStraub Cflnic & Hospital

Coionieioentnrs and Alternate, e Nieslienie

of he-tdioe either a.s a eomp-lemen t to. or analternative to western medicine.

The Hasvad State Con.sortiom for integrativeHealth Care has been established in response tothe ine.reased interes.t in tdoo. Iementaev and

Alternative Medieine. Tt1-’ isbn 01: tim eonosnnna i’ that thepeeple ot ilawio \tli cmos increased nno timely access to nil tormsor health care that mar beof benefit, inei.odioc traditional ss sisms

ofheoling, wit approprIate scope and :standardsof praettee, andren iborsmcm In it 1% 5 tahtr t sr patteot t ess sdet and p er

The Reeareh insesticators Meeting held nt the Hilton I lass atirm‘n September 15. flEeT) sr-es heid in an ettort to deset he the

state of research into inteerasss:e medieoe-c-: orrent s— tahane plae.ei nthe:. State of H.awah, Ove-r htsrtto-five phvstcians and oth.e.r healtheare

ote-ss.onal attenrled the meeting.

The morning session inclnded 5 res-eareb presentations of topicsas diverse as Tibetan Medicine to the ose of Comple’ni entery

1 a f

acnpnnemre services and an 05cm: iew of the Hawaiian he:alingteehnsqoe of Paola.

The abstracts inclnde.d in. this isstne- provide a repres-eatativestnn:phnp. of the- topics that were presented a-t the-’ nte:e-ting. it is hopedthat this forom. for p-rese:r.Itinft enrtent research in the field of

event aoOr itt rein to advance toe sttow mace

SOLUTIONS TH AT SAV E

TIME & MDNEY[bgii no

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281

Are Heart Transplant RecipientsReceiving Cellular Memories from Their

Donated Organ? A Heuristic StudyPaC Ka’ikena Pearsafl, PhD

PresHent ano CEO Ho aa Hou ChncH Pro essor Jnlversdy of Hav’ai at Manna

bnck p enooo.h if you cp ye one s.i.nole croi.•v

to be white.Wii.ibmi.. Janucc

A lIft rear old male heart transplant recipientark akened n a cold sweat the nicht after his

operation. He told his nurses that he kept dreanu

ing that he was failing down a .flight of stai.rs. He.

had reported no m.ore pre—transplant anxiety than. m.ost recipie.nts.

and no consultatjon from a s\ chiatrist or clergy xv as sought prior to

his operation orthat cx enintn \Vhen the ‘arne thing happened on the

second and th rd n ght , a chaplain was cal led xx ho n turn requested

a psychiattic consultation. The psychiatrist reported that the patient

was only bothered that he could not sleep well and attributed no

particularsignificance tothe dream. The patient reported that he had

net er himselt fallen down sm irs and xxxix not aware of anyone xvhn

had. However, the clinical team was, in the words of the reporting

ps\ chiatrist, “a hit unnerved, because them knerx the source of the

heart.” ft had come from a cried who had passed out drunk in an

upstairs hedroorn at a fraterr.ity party When she awoke still intoxfi

cared. she had fallen down a flight of stairs to her death.

This case. like many ,,t those reported by heart transplant rcctpi

cnr. cannot be considered evidential of “cellular memories.” There

are many po”xihilitics that could explain this report, including but

not limited to chance correlat.io.n of the dream with a current event,

possible i.nformation leaked to th.e. rev.ipient on a conscious or

subconscious level through telex ision, newspaper accounts. or hos

peal staff. disrupted slc-ep or brain atterns related to rnedication

and mniunosuppresxant drue’.. c-motional stress, or ‘.oine pre

cab. ring pscchopatholoyv or forgotten trau.ma- But are there

plau ble hypothesesift has been assu.med th.at Iearn.ing primarily involves the nervous

and immune systems and that the heart is merely a pump. Newlm

dcx ciopine theories and research related to encrec cardioloem.r J

heart. Livi.nr systems theory suecests that al.l dvnamnie.al s.vstem by

definition c:onta.i.n rec.urrent feedback loops that store in .firmation

and energy to various degrees that could relate to some fbrm. ot

mcnoivI’ \licrotuhnlc mew’ rv mx also jixv(,lve so me

form of SSSICN mex ‘rv proce

Based on evera] published cases 4 heart transplant ieetpients

e.xpe.riencinr various kinds and levels, of associations with their

dom us turthvr yr idc H he plausibi no of sonic type of Ccl lular

memory manifestine in these patients seems xvarranted. In the most

recently published set of cases of heart transplant/donor association.

two to five parallels per case were observed between changes

following surgery and the history of the donorH’ These cases.

mx olved transertpts of audio taped interviews quoted verbatim and

correlated with interviews with transplant recipients. recipient fami

lies or friends, and donor families or triends. Parallels included

changes in food, music, art, sexual, recreation and career pretbo

ences, and specific instances of perceptions of names and sensory

experiences related to the donors. (e.g. one donor xvas killed by agun

shot to the face: the recipient had dreams of seeing hot flashes ofiielcr

in hts face. The total ‘.et of findings. spanninrz the ten caxe appear

to indicate that coincidence or ihc statistical chance hypotheses mat

he insufficient to explain these phenomena.

Further study of the issue of cellular memory is difficult. Because

of fear of ridicule and/or being; seen as psychiatrically disturbed.

recipients: are often iv luctant to share their stories. When them report

them to me. it is often done xvith a sense of embarrassment and with

the strictest assurance of confidentialitm . When cases are reported at

scientific meetings, they are often greeted not with appropriate

skepticism and requests for more study bitt with cynicism, mockery.

and utiwillirietiess to consider possible explanations.

The limited number of cases this author has reported and their

sporadic and clinical anecdotal nature do not allow conclusions

regarding the cellular memorm hypothesis. The true incidence of

cardiac transplant patients associations with their donor is not

known, hut stress, illness, surgery, confrontation of niortalitv,

:mmuno-.suppi’cssant drugs, and tatistieal coincidence scent insut

fic ienm to frtllv explain the 74 cases this author has reported to date.

A few anecdotes are collection of stories, but many comparable-

anecdotes carefully collected and recorded over time become data

worthy of examination. If cellular memory or any kind of veritied

association to an unknovvn donor is occurring in only sonic trans

ri ant patie’nt’.. xx hr this group/ [s it possible that tt is not the

transplant, the ot’eat itself, or cellular memorm that are tainted tx

these stories but ‘.onmc intensified consciousness crn.ucctioit brought

about or facilitated by the. traumn.a of near death a.nd the sudde.n

m.i.rae.le of ti’ie gift of a new ii.fe? It see.ms wort.h the time and attention

of open-minded scientists to take a cleser look at the whtte crows,

282

Energy Fields in Conventional andIntegrative Medicine

Frank L. Tabrah, MDProfessor of Physiology and Emeritus Professor of Community Health, John A, Burns School ofMedicine University of Hawaii at Manoa Medical Affairs Department Straub Clinic & Hospital

\laiznatic ield’ n ii eslicine zn hack t\le’mer.a Part an alms harmontca—plal intl eihicenthcentury raccal vho, dressed in brtght \ inletrobes, developed a magnificent practice in hisp.arlor, treati.ng hysterica.l women with. bar magnets and iron-laced water. The final measure ofhi’ succe’ t as his death m 1 15 as a pauper.and the soniev hat doubtful metamorphosis oflis earne’t hut mtseuided work. into ps\ chin—

.Far from t.h it’ dubious legacy, present .legtimat.e. maun.etotherapyuses specially gen.e.rated magnetic fields,2while spurious futi.l.e commercial applications still exploiting Mesmer’s placebo efFects,

I, I 1 it 1 1 it on n ,

turc-s,.\ few basics:

There are electrostatic fields—witness the sparks whe.n you .strokea dry cat—and there. are eiect.ro-magneti.c fields, produced bycurrent fl.owing through a wi.re or a coi.l—the heart of all electric

otors Onts th tom LI F field si onk it Ii s nm in

elation in tlcsuc, appeals to have an’; measurable clinical elfrcts.‘these result (roam winced current, s1U1ittllleli in Faraday’s lea

1 I

produced ha static. magnets—those in the mattresses, discs. bars,horseshoes, earrings, bracelets and other widely marketed configurations, despite their popularity, have no explicable interaction,ken versel a eiectri. macnets.. Ph thai. a moOre fields driven ha

a current in the acne 5 p jar to the snecitic was Oorm discovered by ]Fukada when he. physically stressed hone matrix. in hisplezLeie..ctric studies of erystaisb’8

\pp’e moith neipie 5t z 11101 1 11 i2v ikii hour still i f eM cx [(‘

:111115 .50 ado stat Ii ive its-Pit) tie a open aiter . 05. ““mf.

found in the t.reated arms.Comparable e.ffea.ts have bee 11 reported in ma.ny anmmai. modelsP

as well as in worldwide fracture the.rapy . Although. the exac.t bone.enhancine ineeharns.ni unknown, these eonsmstent I esu.lts suceest

1 1 1

Ai.thou.gb most chniea.l. applications of oscillating magnetic fieid.sused Ct was 1ev s ‘sell b ow iOn ii ‘1 ,i it i) p luss I mx.cnt

clinical des elopment ut concentrated fields of Ad F’s1’’ I os er20.U(hi gauss has made possible mo new clinical uses. one, the SO’

successful ti-eatment of’ maior depression st ithout classical electroshock therapy, using induction through the skull,2aitd another, thetreatment of urinary incontinence patients by stimulation of pelvicstructures (nerves and musculature) by a series of “induced” Kegelexercises at 50 I-F’ seth liz thea ale comfortable seated in the treatment chair, Stx[v—hve percent iii patients report marked impros t’—

tnent or cure alter the prescribed treatment course.’In contrast to the quantifiable eFfects 01’ the relatively high energy

time-varying Odds long used in conventional medicine, there ext sisa .separate and tt.nreiate’d world of magnetic “therapy,” “aura manipuiatiotg” unexplained “body forces.” and “energy fields” that baseno demonsn’ahie basis n ratIonal chemis.trs. phvstcs. or phvsiologsother than possthle ps\ chosomatic ef’focts. Controt,led studtcs IC

peatedla debunk ihe m stietsm on 55 inch minI 01 tliee therapeutic“s:s.tenm..’’ ride—n.one, better, for exa.mple. than the work that haspun.etured the prolife.ration. of Kirlian photography, and. Emi.lyR.osa’s ian.dnaPk 4° grade science proies. 1 published in JA.M.A.P

The astonishing popularity oF’ stuail static magnets that are a tin,walked .sn ill a nili”n shoe’ slept oil, and revered an tinsends. cleltcnttuil’ demonstrate’ time oiurnph ‘iiflarl’t’1211e a

flot)c or er reason,S tatic .m.agnets ccntactmn.g the body have no more effe.ct (In. 0111’ s

ph.ysiolog,y than refrigerator door magt..et.s have on tim-. fond fru.:ide,Maenc-.tic beuhlet.’ tray satisfy. htit on.lv by their presene.e, Br

atisfact.ion, perhaps. thc’ve air t.he,’keep however: cur-t ‘- —‘ F

ad urPon i: im. [in inc ‘ itsi 0511 nias. i’ no wince’ abielv ne am’ it doe..s, in the range 01 one ten i.stiionth ol’ theelectrical and ttermal en.ergies in tissues

Cle’ariy’ it is the responsihilit.’ of the seien.tificafly iterat.e t.oa ontin.uouslx c’larify, uuantmfy, tamP document m.e.ch.ani.sms a.nd oui-

1 ,_—

— I

u’s

283

Introduction/Statement of theProblemLow hack pain is an almost universal human

condition. It has affected man throughout most

ol recorded histor . It is a motor contributor to

human suHer inst and disability and has enor

moos associated social costs. Chronic disabil

ity associated with low hack pain has reached

epidemic proportions despite advances inknowk

edge and greater resources.T Persons suffering from ba hack pain

represent two distinct populations. In approximately NU’ ot per

sons afflicted with loss back pain, the pmblem seems to resolve ni

matter what type ot care is pros ided while the remaining 20% of

persons with low hack pain seem destined to a life of chronic pain

and disability regardless of the t\ pe of care providend It is this latter

croup of mdi iduaic that is associated a ith the enormous financial

and societal costs of ow hack pain in aestern societies.’

I-iistoricall . low back pain has been operatiunalized into two

hroad categories—acute low hack pain and chronic loss hack pain

disahility. Various studies have identifi.ed several factors th.at .may

he associated with the occurrence of acute low haek pain including

smoking obesity.’ socioeconomic status ioperationai ized by ioh

classification i: and certain ps chological traits deprcssion. type -\

h-ehsis or, and hr pochondria i \iost. if not all ot these studies of

acute low hack pain have heen conducted on adult populations.

However, recent investigation has suggested that incident (acute)

bow back pain may he occurring in early adolescence rather than

adulthood as prevouslv assumed. Thms fmnding mar resjui re future

studies investigating risk factors for acute low back pain to include-

adolescents as a eli as adults in their samples.

On the other hand. Waddell describes chronic pain, chronic

di.sahil.i.ty, and ch.roni.c i.I[iess behavior assoc.iated •with low hack

pain ,is a dissociation from the physical hack problem. There is

usually liule es ide-nec of remaining tissue dauiacc in patients ‘ith

chronic low hack pain disabi tv, Enoiional distress, depression.

and disease conviction become incrcasnigiy asociated a ith the

pai.n. Chroni.cpain usually hecomes sel.f’sustai.ning and. does not

respond well to traditi.onal .medical m.anager.aent. Vari.ou.s psycho

logical states and traits are thought as the main prouioters of ehroni

boxy hack pain disability. Psvehuboical condttions that have beensuggetecl as p scibic detcrmnants ot cbs OiC low hock pat disabi I

i.ty inciudt. depression. l...ypochondriasis and hysteria, inappro-

pri it coping str tegis s md being mit mntcrcd moos

forms of abuse may also play a role as a determinant of chronic low

hack pain disability. Females with a history of being hattered h)

their partner were found to heat greater risk for development of Post

Traumatic Stress Disorder. depresssion. chronic pain, and substance

abuse, Chronic pain and depression may be consequences of past

chidhood sexual abue as well Alcohol abuse has also beers

suggested as a possible determinant o[ chronic low hack pam

disability. - Nommedicab factors such as being on workers’ com

pensation henefits and pending litigation have been found to he

predictors of chronic Ion hack pai disahil itv,2° Finally, ineffective

or inappropriate medical care has also been inphcated as a possible

determinant of chronic low hack pain disability,

NuN Hypothesis1. Individuals with acute low hackpain and proxdisposing psycho—

logical risk factors develop chronic bow hack pain disabihtr

the same rate and trequcncr regardless of the type of healthcarc

prolcssional inedical physician sersus chiropractor providing

care for their boa back pain.

2. Low hack pain sufferers who seek tim services of medical

physicians versus chiropractors do nor differ demographically.

Their sex erity of injury (pain intensity and pschobogical

profiles are homogeneous.

MethodsThis study will he carried out prospectively, focusing on outcome

data, Acute bow hack pain patients will he fobboss ed over a 3-month

period. Anxiety, depression. functional capacits. general health

status, work disabibmtv, and pain ntensim\ a ill be the main outcomes

sarisblcs measured as curie Into the studx mid at 3 months folioss -

up. so-oodeinoeraphic information wi.i I ait.’o he collected at entry:,

Patients treated hy medical phy-sicians svi.l.l he compars.d with

patients treated by chmropractors. This comparison will pm’ovide

niorsnation on outcou e cffccix cuess between these Ia 0 pr;-dei

A sample si/c of 4mm participants, 2U0 from chiropractic clinics

and 200 froni. various med.ic.al faci.li.tiet.: will. he utilh..,ed.. Participants:

will he adults (18 years or older), residin on the island of Oahu.

seekmny the sets ices of a chiropractic or medical provider n-ith a

pi’mmiary complains oi’acnie loss back pain not mote than to 3i..i das

duration, with am least a ne ear loss’ back psi-lrc’e stOte prior To tile

most .recen.r episode) of muscuboskeietal ortgn.Patients xx ith low hack pain, secondary to organ ic• dysfunction or

Chronic Low Back Pain Disabilitya Modern-Day Epidemic

(Doctoral Research Proposal)Robert C. Hirokawa, DC, MPH

Doctoral Graduate Student, John A. Burns School of Medicine; Department of Public Health

Sce ces ao Epdem o ogv LIOlve s at Ha a a Manoa

284

malignancy, patients with pending litigation associated xx ith the lowhack pain (MVA. slip/fall), or patients being treated for depressionwill he excluded from the study.

The Beck’s Depression in’, entor\ - Oswestrv Questionnaire ( lunc—non). Short Form 12 (general health status), anxiety scale (not etchosen), and Visual Analog Scale (pain intensity) will he the indicesused to measure outcomes of the two pros ider types.

Each site chiropractic and medical xx ill he gis en a predeterminednumber of packets survey instruments and consent lorms 1 to hehanded out to prospective participants that fit the selection criteriartime one). The enrollment period will continue until all of thepackets are handed out and completed. The purpose of the stud \x illhe explained to each propeetive participant verhall h\ the receptionist/nurse. -S written explanation xx ill also be provided. Intormedconsent will be obtained, Confidentiality will be assured. Paruci—pants will be able to complete the surveys in approximately 10-15in in ute s.

hoc h prtrlicIpIult xx ill he mailed a second packet deutical surs cvinstruments contained in the first packet, time iwo) 3 months afterenterin the study. Participants who fill out and return the surveyswill he compensated for their efforts.

Statistical analvs is will include calculations of descriptive statistics of sample demographics. correlation coefficients of coxariates,logistical regression, and multiple linear regression. The mainindependent variable will he provider type. The main dependantvariables will in lade depressix esv mptoins, anxiety, general healthstV(tlis. pain intensit\. functional capacity and work disability

ConclusionIt is hoped that this outcome study will shed at least a “glimmer oflieht” into this complex public health crisis—the chronic low backpain disability eptdemic. Ohvioulv. tlii stud is attemptine tounderstand only a very small part of this serious societal burden, Itis by’ no means an attempt at a major “breakthrough”. Nevertheless,information garnered froru this studs will add to our knoss ledgebase

References

‘6 Ac ncc”J 9i5’M P ter’tnT rani C HaS Pr v fit” a t a”dn k ip yOrl 11 flora oa , a w,ttr ch oni Hw b ck p oq,rot d eoy P in 1° i 4 11 I 1

1, H n ‘a F B’ “ en hrcl M id a , a M&oh Pt on lit6 I” Has pots n09 With a n4ha”t aWbac’ p in Sp 19 O 7 6 22

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‘0 5 ‘P Pa’ (ci v’ 7 T ,d0np at r7 t a p t” a ‘ ‘‘ r ‘ .‘ H a a S0 ,S”’c ‘I”’ -‘

‘c—I ‘—,, ‘c’, -c

a ,, it’ S ‘ a an 0) 1 r 1 5 r t I S be I, ‘so Sn 5 b 151 ‘ it wShfiS” p i, n ‘ “ Mc’d 64’ 14” 4

AL’UN1\L. FLKU1-GOC)RA,. CR1,, Notary Public

Slarcus & Associates, inc.$flXi 691-3847 Dl’

595’ I 539-71-sO Ext 307aiain.aff3 marcusreal.ty,co.n.a

d’n.ta.l ptotcZ’SSIO.rlS

x’leoebar .--. (.o’i. o,Hi of i’sident ii Seen alis.ts

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“Serving you it. the .Spi.rit of Al.oha”

285

The Emerging Field of Yoga Therapyv Ca e S

L.ea MErn Der, Yoga Cornmnee, (AM vrossonai Brancn, Hawaii State ConsorTium tar ntegr

Flea Ith Care; instructor, Yoga n Nature Retreats, Kapa’au, HawaU

Y:a h-py i 1iisJ [)y ..i\1.ng nu--hei oi nhij rfli IIcaitI-I iit i pDsUic a*r> hind

.iiiU inpani a UI ie1ve tchnius tri i!I1. h ng:

t1L I 1 O i

_

I . n Ik i. 1 u u

hypertenslon tfld cmot.iona di.tre.ss to chronic back ast.h.ma presu.re-. menta.I functioning increas ci fI.ex.ih.iIit and

and d lnLLs ‘ ‘ haia a id’tioa ii oa r ad at ta hn n mjscit slrclgtri and th rtr afuring n tha tissuc ad suortrg

beina an i.n.ten.t.c.d. nindbod.y s\..stem. inteactin.g with ()ute.r niu.;cuIoskeieta.I .tein of bodv’ Hath.a oaa also picanotes

-

- r ‘ I

I _-z HC —

pI

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aLd \1 t rLs ing n nt d t t adu i a th i Ii i in S ii i a, B n iv I i a in

that lead one to he.[th.v. Ii.ighe.r state.s ofconsci.ouness . and ultimate I 9 Other re.earJi centers include Kivalyadlinrma in Lonavia.

awa.reness ofon.e’ s pure, free. non.ntfL..ring nature. Y.ga :hare: ft,. tou.nde.d in I 9 24. Tn the Wea. the Yona Research and EduL.ti(.)n

origins with Avur\eLa. Idia’ nrd’.c natun:pathic i.cience. and Cente.r ‘tREC) i.e (.Liifornia. estahiis dv Fenerstein,

theiuR‘. iie\’ di:i tIne ChOiJI. (i;eote ersein reaairc hir ieeaJers and techer.. Iiere n !f..o ad. iheI j N O — ‘

arid nch.nique. vith ‘iVe.swrn ne.dicaI an.d psychological kn.owL coinnittee within ds Cd..... 4 .Branei to ex.plt.ae the

cdhL p(ih’1iL 01 medic es.an i in vog i cli og edi.n.ation

I hL O C it. ol Tk. i1th lillios tior th. nion im.chn a. ‘ md ham na iii t Lncrap

(.)f th human .s.sIein otten rccoenii in the West, in ‘.‘ ea. health Becker sum.maritcd a numhei of nidicai :tudies on voee in a

.- . I . ‘- I ‘- -

coo soirilua cencrs. in addition ci .tadLs documcoa . eft4ctive role the saL u: adinnet neat

i I

the body-mind eomp.lex. Health is both a by-product of and a means .nd.roiier to ast.hma,1 diabetes,9 cardiac dysfuneion5 seir are.s,

to ird via i s t anscenu t g us H th oa lbs. ss ssCfl of tad h eps. tension

cIs. insi picetics lisriy i invsical , ss.s i”. is and b ith’ng Ss.h a a c 9 a i7) ft r impas. nd a sub intial c 1i s.tion

S ., I 0 1 t . rio ( s.Ti

— ‘ S L

There are see era] eurren I cpn.roae hes to hath a saga a the We ‘ ‘lo ie i. ndi’ id aoL for up to 54 nina ibs, who had

a h dad Jot cc s ha i hci apea a. pois.nt i The’. inc u’.is. mu dis a oiicp out in s 0 ii a.nin Thes sri sss.d i ‘if,,Pt

a in a ha Kr p a yt Wos.nix Ri na S ha InLeT cc Saa i signilis. ri” imorose ads.flt in i 1051 I ip speed ic P ir alls.ts.a. md

Thei r md’ r 5 oc ha Fs.uu i’. it p or I in is.’ act n the I ILO ilior n CT i 19931 1 i oct i

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ST iO_ , ..

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rd ii iguti’. rs. S in’ a. is.as.Ou ( i Li 1 o 1 Ini ii ainin4 th ma .us. m ha Lih

Maui, has also explore.d the therapoutie ases of yoga, and has individuals,1314

authored a hook on yoga therapy. In Cal.ifornia. the Yoga Research .Despite the numberof d.ocumnente.d research studie.s. investigators

i ion in C umi i ‘a c bass. I ‘.4 eL d sen s p0 ‘ii ci 1ha I ii ‘. idma a

S — - S

oh Ins. iJ to’. gays.’. hots. -. on ft ii 11mw’. iss.t ad o’t’. 1or’. i pi lets, fly m t rts i I as. re’s. 1,_I

ra Ps.i[’s.ts. n ins a. as. ha 9th th”oagh e oru,nats.d It tJ body 1’ a this. dirlia.ilu s nohas.u in obtani mes. ha gs. onsaJs.nt impi’.

movements and breath.ing coder the qui.e.t meditative ftcus of the s izel potential bias through the effect of individual yoga instructors

286

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OAHU: 941-4411NEIGHBOR ISLANDS TOLL-FREE:

1-800-362-3585Free Hotline 24 Hours a Day.

POISON CENTER TIPS

• Keep the number of the HawaU Poison Center onor near your telephone.

if you suspect a poisoning, do not wait for signsand symptoms to develop. Call the Hawaii PoisonCenter immediately.

• Always keep ipecac Syrup in your home. (This isused to make a person vomit in certain types ofpoisoning.) Do not use Ipecac Syrupunless advised by the Hawaii PoisonCenter.

• Store al) medicines, chemicals, and householdproducts out 0f reach and out of sight, preferablylocked up.

• A good rule to teach children is to “always askfirst” before eating or drinking an thing—-don’ttouch, don t smell, don’t taste.

Donate to help us save lives.Mail checks, payable to:

Hawaii Poison Center1319 Puncfou Street, Honolulu, Hi 96826

The Use of Pulsed ElectromagneticFields (PEMF) in Osteoarthritis (OA) of

the Knee Preliminary ReportTheresa Danao-Camara. MD, FACP. FACR

Staff Rheumatologist, Straub Clinic & Hospital: Chief. Division of Internal Medicine Subspecialities.Straub Clinic & Hospital

andFrank L. Tabrah. MD

Professor of Physiology and Emeritus Professor of Community Health.John A. Burns School of Medicine, University of Hawaii at Manoa; Medical Affairs Department.

Straub Clinic & Hospital

Magnets are widely used by arthritic patients forsymptom control. Clinical benefits have beenreported from the intermittent application 01

pulsed electromagnetic fields to osteoarthriticjoi nts.’ However. puhl shed trials have usedcomplex electromagnetic fields generated beumhersomeexpensiveequipment. limiting trueportability and widespread use. We reportcomparable beneficial effects using a continu

ous sine ave input to 1-Ielmholz coils run onstandard household eleetricit\.

Fifteen patients with osteoarthritis of at leastone knee as defThed by Altman4 were drawnfrom the outpatient Adult Rheumatology practice of one of the authors (TDC). Patients had tobe older than 18 years and symptomatic in the

subject knee for at least one year. Pain had to be incompletelyrelieved by analgesics. nonsteroidal antiinliammatory drugs(NSAIDs) and phsical therapy. No new treatments intra—artieularinjection into the subject Joint. PT. NSAIDs were allowed ss ithin amonth of. and during the study. Stable regimes were continued.Pregnant and premenopausal women not using contraception wereexcluded, as were patients with pacemakers or medical problemsjudged unstable.

Subjects applied the supplied magnet to the designated knee for

three hours daily for thirty days. They then returned to the clinic forreevaluation, and to receise the second magnet, which was thensimilarly applied at home,

Of the pairs of magnets sequentially used by each patient, onemagnet (hereinafter referred to as the “active magnet”) consisted of1-Ielmholz coils delivering a 0,4 milliTesla. peak to peak. electro

magnetic field at 60 Hi. in a sine wave configuration (Fig I. i. Theother magnet appeai-ed identical in all respects. hut the fieldsaffecting the ioint s crc the earth’s magnetic field onl\ . plus ss hates er stray fields the individual might encounter in daily life ‘‘mac—to. e magnet. Subjects were assigned randomly to receive either

magnet first.

The folloving data were collected at baseline, at 3t) day’ tend oftreatment period \ Oh the first magnet. and at 60 days end of

treatment period with the second magnet patients assessment of

pain, and the patient’s assessment of function on a ten centimetervisual analog scale (VAS), minutes of morning stiffness of thesubject knee, range of motion. tenderness on an ordinal scale ofOto4 (0 no tenderness, 4 = withdrawal), swelling on an ordinal scale

of (3 to 4, knee circumference in cm, and time in seconds for thepatient to walk 50 feet, Neither the assessing physician nor thepatient knew which magnets were act is e or not.

Of the fifteen patients enrolled and randoniiied. there were tourcurly withdrasn als from the eroup that receis ed the inact is e mac—

net—one at three days and two at one week for lack of patient—

(,(,ItoIueJ ni .00

Figure 1 .— Clinical variables at baseline, after one month of activemagnet treatment and after one month of inactive magnet treatment.

Baseline Active InactiveMagnet Magnet

Pain VAS 2.4 3.1

Function VAS iPt: 4.3 6.7 4.8

Function VAS iMD 5.1 6.7 5.2

MornIng Stiffness m:nutes 33.5 6.0 21.5

Loss of FROM tdegreest 5.4 2.0 5.2

Tenderness )0’3) 0.8 0,4 1.2

Swelling (0-3) 0.9 0.9

Circumference )cmt 39.4 40,3 40,3

50 ft walk time seci 15,0 14.3 15.6

Abbreviatons. useo in table: VAS — vsuai anaog scale’ Pt — patient assessment:MD— ohyslcIan assessment: FROM — ra’ge of motcn.

288

Complementary Medicine Techniques toHelp Reduce Muscular Pain in the

Pediatric Rheumatic IllnessesDavid K. Kurahara. MD

Medical Director of Fediatric Rheumatology. Kapiolani Children’s Specialty Center:Assistant Professor of Pediatrics, John A. Burns School of Medicine, University of Hawaii at Manoa

Complementary medicine techniques may hehelpful in the treatment of some of the pediatricpain syndromes. it is important to view thesetechniques as complementing standard medicalcare for these illnesses, as there still is a requirement for antiint’lammator\ and immunosup—pressant medications to combat the cripplingeffects ot these illnesses. However. cei’tain

techniques like massaee therapy. biofeedback. and acupuncturema’s he helpful in relies ins’ some of the pain associated with these‘vndromes from muscular spasm and joint contracture,

Two of the more common illnesses, which cause pain in children,include Juvenile Rheumatoid Arthritis (iRA) and Myofaseial PainSyndrome (MPS). These illnesses represent sides of a spectrum ofillnesses seen in a Pediatric Rheumatology clinic. JRA representsone of the more common intlammatorv rheuiTiatic illnesses inchildren, whereas MPS represents one of the most common causesof muscular pain . .Somne patients with iRA develop secondar MPSfroni postural problems and muscular spasm. and can he debilitatedtrom this condition. It is important to recognize this possibility sothese patients are not prescribed increasingly powerful immunosuppressants. when in realit, it is the secondary MPS which is

causing them the increase of pain.One complementary technique we have used in our clinic with a

significant amount of success is massage therapy. This technique isespecially helpful in MPS. as it relieves muscular spasm, contraclure, and is helpful in elongating shortened mvofascial segments.Other complementary techniques used in this population of patientsincludeacupuncture and trigger point injections: It can not hestressed enough that attention must be paid to what activit’v causedthis muscular knotting in the first place Appropriate counseling anda stretchingistrengthening pi’ogmm should then he given.

Massage therapy has been helpful in the literature in iRA. Anintensive studs showed impressive results from massage therapy ofchildren by’ their parents. The parents gave their children a dailymassage for 30 days. A control group received relaxation techniques. The massage therapy group with JRA had marked decreasesin subjective pain, observed pain, and tender trieger points after the30 dais. all with statistically significant resull. The pain se a’cpcciallv relics ed at night. I his t’indinmz is probablL attributable tothe observation that many iRA patients develop secondar\ NIPS.I Ii bnJit II om mass ic thu ips is must li kLl\ du is d ti oni

decreasing muscular spasm and contracture around inflamed joints.Also from relieving muscular spasm in the hacks of these JRApatients which is caused by awkward gaits and disrupted posture dueto the pain in their joints.

With each complementary technique. sse as responsible healthcare pmovidei’s need to study and insure that these methods providerelief and are safe for our patients. Each technique should heelegantly studied, using many indicators to measure health outcome.We need to he careful that our patients do not discontinue neededantiinllammatorv!immunosuppressant medications. The combination of respected standard medical therapy and some complementary techniques like massage therapy may be useful to give thesepatients with chronic arthritis an increased amount of relief.

References1. Rachtn ES Mvcfascia!PaInandFbromyaigia. TriggerPo’ntManagemend St. Lcus MO. MosbyYear

Book. Inc 19940 Ned T Hernadez-Re M. Se1gma S K’asnegor J S.jns5ne W J.,,eOe Rheu”,atc d A’thnts:

Benehts Iron Massage The’apy. J Pad Psycfr 1997225r6OT-6’2.0 Nagata 09, TsiL V Myoterapy A New Aop’oach to Os Treatment at Muscx Pm’ Sydrorces. J

Manual& Manipi2a9ve Therapy. t995(2i:87-90.

11000W MEDICAL .JOLJP,NAL VOL. 60, 102106.66 2001289

11

Until There’s a Cure,

There’s the

American Diabetes

Association

Ginko, Vioxx and Excessive Bleeding

Possible Drug-Herb Interactions:

Case Reportlamar Hoffiman, MD

A 69 r a old Chinese man with hisyor’ of mild

diabetes, hype.rtension and arthritis presented to

medical .rre’Feb 2000 comnlaining. of riyht leetee tie anti UI tejt_t’ ‘tilt . slat

tO neuu with a haseheib There

was hiss of consciousness. H.s medieatinn’

included Zest.ril, Glyhuride. and Vioxx. [Ic was

not taking A •Tfri a. History of supplement use

was not ohtaned,Examination confirmed rieht sided weakness and unsteady trait.

utuer abnormalits identtfied. [zmeseenes CT sean of head

revealed a laree ‘ubacute Iett subdural hesaitonia. CRC, PT’ A PTT

were B NL Bleedine Ti me was not stone. hnicreencv es

of the hernato.ma was performed and we.l.l tolerated, no evidence

excessive bleeding intra - or post o’peratively. The patient recov

ered and his weakness resolve.d, Follow-up CT scan was obtained

2 m nths postoperatively and revealed 3 mew small subdural he—ii in i J ikint T s ‘ ill iFti lU

hi stOl ofcxeesovc bleedine tendenes I listors ulsuppiemems use

was ehtaned patient has been using the toilun inc supplements “tom

years”: Ginkgo Biioha-253,4 mg daily (Ibr memory). .Siheriari

Ginseng - ‘i 62 mg daily, Fish oil, tablets- 1000 n.rr daily, Vit E-30 J

daily and multivitamins, He was not taking any Garlic or Ginger

suppleme nts. Hi cx amtnation am \VL,t here as no neural detteit

and no evidence if ecchvinusis. Lab revealed ebnommai Bieedt n

Time ttl’S nisif CRC. PT & P iT - W\L, All supplements and

Vioxx were discontinued, and patient was ouservea c.onservatively.

One a eek. later Bleedin Time re.tu.mned to norrr.al.. and remai.ned

normal upon re.suming, low dose Vioxx (7.5 mc daily). Patient has

remained neurolocically stable. to this date, repeat CT was. not done

Discussion(jinkco Biloha contains several, active. i.neredien.ts i.nc.iudintr

Ginkgoiide.s, which have. a variety of pharmacological actions.

Ginkgpi.ide B is a pote.nt inhibitor of Platelet svctivatlnp bac.tor)’

One t dv do erdi hone r ieta, itir Ii ( 1ttkei

itt i’iltUi c,aeuiautin narametets ine!udine Bleedina lime. -There have been several menorts of e xeessit’e bleedine asoeiated

U tt t (i nt toi lone. “‘ tm together ye i. A Aspirin. “ or itt in ad

Th.e question arises whe.ther Gin..kgo by itse.If, or in combination with

Vioxx c.ontributed to the occurrence of the traumatic as well at.’ the.

re.curment., spontaneous, suhdu.ral hernatonras

290

Aloha Laboratories. 1nc

When results count

CAP accredited laboratoryspecializing in Anatomic

PathologyQLlahitv and Service

David M Amberger, M.DLaboratory Directory

Phone: (SOSi 832-6600Fax: t808’ 838-0663

[OMail: resultsbr ti]ohaIabscomhttp:/!wwwaiohaIa’hsatorn

Patient Characteristics and Satisfactionfor Members Using Acupuncture

ServicesDebara.:: ft SaD

an t71

5. \Jiocii.paiti Di rea-tur, Care Mangenaeat, H awa i€sa icC Service Association,

Coesnmer demand for tn.tegratmg: e:ompie.n enter alternat.ive care

wi.rh idiopathic medicine has been growi.ng, In ft:ict. e.x.pen.ditt.tresh trcompierncatarv care have risc-n from 51, 50 h in 1990 to 521 0billion in 1997.

In into nUn the l—Iawi i \lcntcai tiers icc [n’> ‘cOnan Hf lS>-\

ci scn’ant ttn ‘wan itt iv as iasca it a: arnttr.shinitinart: 1—Ia-lit wire iii’ ii’ fli’ii ,fli’ f.cit.nttnT;’a’ tat!

a apntements. a ad with Antcrican Spech Its Health. Nets sirks Inrovtde massace therapy and fitness me-mhcrships. As part ni the

agreement. acopnncrrtrists provide-d aMSA with a. hsit of nsers on amonthly basis from inly 1999 to lone 2000.

The- goals of this stndy were to:• Sx-arnitw -tiac characteristics of HMSA enrollees who nscd

f’nmn-a rc sat i ihctiott with a - rtn:.ahi c sara i. ces. for non anacinand anti a sers rtw na data trnm the iirfl Nd ember S-ic i fcc—

MethodsA total of- 788 nniqne member identification nrtnrhe-rs were sobmitted to HMSA he acnpnnc.tnris;ts. of -which 2.17 t-vere nnmrnehahle toenrollment fibas dna tat incomplc:te- or incrirrect: ide-ndfic cOon itam—

i 01 199 iii tn, 442 th s i29 itud in Ito itt

H 1-i S A \lt-t mt-Ocr Sah sfact i’ ‘a S arc-cs. t5n l - tact ahcrs w ha

Sa,tis.tac-t.in-a

Results

The mean ace a-f awaponctare c cars (5 -ei.irs. aatgc 18 trt 315. t: i-oassi adlar trt nnans,e-rs who resnt:-aded to the trtcirther satislitct-ioosnrvey. Sixty-sO perc.e’nt n-f acapnnc-tone nsert-: tv-c-re female, compared svith 60% of nonnsie-rs who responded to th a sorvey. Ac-op-nactare nse-rs wore atore like-la’ tt 1-e c:rtrtcrts:i.tta aid Hi-swadan titant-tnansers, [tan call--report- health atatas of acananctare asers -was

I tea c.xpcr a ace . =h . ifal 55:L’rc,ri:;s i—eec lit t no tt fl;it ttc rare nsa is aatti

nonnsers. Despite similan’ s-aria-faction scores, enshert- who nsedacop-nnctnre were. le-ss I i-kely to say thc’s vs’onld. recora ti-tend theirpbs’ t thin to i ee’ I ware o=to

to report that the- svnnld :saek help ara.ti a front the’ir lty5ai au (81 SfVs So-: p99.05).

Limitations

foiinw itta: critet,-ia:

t-t/ti-’5/;5 05-caSe ,ttjn I-cut. - 50-t tic-. t-ttit5t t;tt;tt it its.:-

Ls-en aaac-,ec:cre .a.Se;2tit. fin ccc i-Si’ fia_tt-c c;afl:

-

rats.goat “°

oovr40%

Fiç ore 0— -Seek help paN-n

* -Used ac-anc: ::t at-a -a=i 2% -- ri- - if cat cse Ic. t. c--i

40%

20% t tr taas

0%-

Yea ra-ahattv yea Pre.b.ablc a--n N-ia;

291

* FIMSA enrollee

• Useable ID number submitted to HMSA

• Had a physician visit during 1999• Received and reponded to a member satisfaction srir cv in 1999

• Visited an acupunclunst who ‘ oluntarilv submitted member iden—

ti ficai on numbers to HMSAThus, the study population includes only a small fraction of acu

puncture users in Hawaii. Because the member satisfaction sur\ ey

was only sent to members who had visited a physic ian in 1999. the

sample is biased toward less healthy members. Also, becausesubmiss ion of member identification numbers to HMSA by provid

ers was voluntary, we have an incomplete list of FIMA members who

used acupuncture services.

ConclusionThis study found that acupuncture users were less likely than non—

risers to be in good health and to be Caucasian or part-Hank atian.

While there were no differences in pittient ratings of access or office

experience, acupuncture users nn crc less likel\ to recommend or to

seek help again from their doctor. This suggests that some needs of

acupuncture users are not being met by traditional physician ser

vices,

Future studies. which link acLipuncture use with administrative

(claims) data. are needed to determine the uti lixation patterns of

acupuncture users (Inpatient. outpatient. drug. and physician ser

vices) and to examine the disease profiles of acupuncture users.

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Guest Editorial

Martina L. Kamaka, MDCoordinator of Faculty andCurriculum Development

University of Hawai’iJohn A Burns School of Medicine

Native Hawaiian Center of ExcellenceVice-President of ‘Ahahui o nã Kauka

Improvine the health ot Nato e Has ailans depends largeR onnnpro inc early access to diagnosis and care. which, in turn, relicsOfl a system of culturally competent providers who are attuned to thevalues and health beliefs of their Hawaiian patients. On August 9-I 3d’, 2000, a group of 23 physicians traveled to the island ofKaho’olawe to partake in an innovative conference entitled, “Increasing Cultural Competency in the Native Hawaiian Physician”The Straub Foundation, the Native Hawaiian Center of Excellenceand the ‘Ahahui o nd Kauka (Association of Native HawaiianPhysicians) designed the cumcuium that centered on the issue ofcultural competency, with a twist, The physicians would take part inan intense cultural experience, and the cun’iculum would he delivered in that context. Conference planners hoped to show that sncla roram would help to bridge the cap that exists between the\\ estern trainine of the physicians and traditional approaches toNato e Ha anan health and healing. The underlying premise wasthat coupling a cultural competenc program with a cultural immer

sion e\perience would enhance the success of the curriculum, Theph sician pirticipants had the t’ollowmg hackcrounds:s ixteen ‘acreNative I—law ailan ( Kthtaka Mao/n, one was \Iaori. one was Filipino.one \\ as Native American Comanche, two were Asian and twovs ei’e Caucasian, All physicians had an interest in Native Hawaiianor Pacific Islander health,

Historical BackgroundThe island of Kaho’olawe is theeighth largest island in the Hawaiianarchipelago. In times of old, it was home to dryland farmers, adzeworkers and fishing families, Ancient navigators studied the channels, winds and clouds atop Pu’u Moaulaiki, and master craftsmanset up work-shops near the adze quarry at Pu’u Mdiwi, In the l9

centurr it was used as a penal colony tar Hawaiians who violatednew (‘hrRtian moralities, before being used by cattle, sheepand goatrancher’. In 9$,, it was appropriated hr the l..S government andused a’ a target rans’c for military exercises. Alter a long anddifficult political struggle spearheaded hr the crass’oots ProtectKahn ‘olass e ‘Ohana. President George Bush ordered the military tostop using the island for bombing and tirget practice in October of1992. In 1993, the Lnited States Concrcs voted to return the titleof the i1and to the State’ at’ Hawaii and authorized the funding toclean lip the u next oded ordnance. (.)n \l,ir

“.

1994, the deedreturning the island tothe p.eopleofI law ai ‘i vs a signed. Kaho’olawcnow sei vCs as a “cultural resers c’ and i being held m trust tar the[uturc “o\ creign native Hass auian cfllit\

. term or settlement of the original lawsuit provides monthlyaccess to the island by’ the Protect Kaho’olawe ‘Ohana (hereafter

referred to as the ‘Ohana) t’or educational, scientific, cultural andreligious purposes ,,As a part of the experience, participants aretaught the history of the island, visit archaeological and culturalsites, and aid in ecological restoration projects Restoration work is

crucial since severe erosion has occurred as a result of the 50 yearsof honihing and earlier grating by goats, sheep and cattle. Lnfortunatelv. it appears that it vs ill be impossible to clear the land of all tlteirdnance in spite at an onion nc niultim ill ion—dollar clean up hr

military contractors. The island has become a symbol of hope. at theland and of the Native 1-law auian people. By helping to healKaho ‘olasve. Klinaka Maoi heal themsek cX’.

Cultural Immersion ActivitiesActivities enabled phr sicians attending the conference to experience traditional Native Hawaiian values. The values of aloha tolove, care for), mgi/ama (to take care of), ‘imi’ike (to seek knowledge), loko maika’i (to share. lao//ma (many hands working together), kbkua (to help out), ‘ohana (family living) and olakinomaika’i (to he healthy) were incorporated into the cultural immersion experience.

Facilities on Kaho’olawe are limited, There is no electricity oi’running vvater, The camp consisted of a field kitchen, two portabletoilets and traditional style hale lid/dual (meeting house) built hrmembers of the ‘Ohana. All food. vs ater, supplies, and camping gearvs crc hrought over by boat. The group was dropped off outside ol thesnrliine and then staved in the vs ater passing ear into shore I hisi’eqnired cooperation .a.s lines had to he formed n the water to enablean efficient system of passine ill gear and supplies trom one toanother, i’his same assembly line system was eiYiplo\ed at theairport. at the hotel, and getting on and off the buses and the boats.The group stood out l’rom the other visitors because their ‘‘luggage’’was all vs aterproored in a triple layer of 3-mi Ilime-ter black carhagebags sealed off with duct tape

Before participants could set fm t on the island, they had to chanta request for permission to land . .\nother chant was required uponleavi tig the island, The sun rising over [{aleakald was also erectedwith a chant, There were times set aside for prayer and reflection.All meals were communal with everyone helping with cooking andcleaning.

Hikes were of varying lengths and difficulty, and cultural andarchaeological sites were pointed out along the trails, No plantingis done in August. so the groups’ ecological restoration workconsisted of filling bags of mulch to he used as erosion darns,Of course, at the end of the dir .aftcr cleansing in the ocean, eatinghealthr meals, and opemng es err ones minds with cti mulatinglectures. i vs as time for kaiiila;pi/a ‘a ith ‘un/c ‘music i and /u/a.

The CurriculumThe thi’ee—dav curriculum included traditional Native Hawaiauhealer’, Lectures were given hr Richaid K. Pachnawan. MS\\ . amaster practitioner of Ila’’,wpo,’io’. the traditional Hass auianpHictice of conflict resolution, and Roland ‘Bula’ l.,oan. a pract I-

‘ncr otIa roil, an1 (Hiss ai ian n ias -age techniques t and Id’uii 1(100 ‘(111

Ilawadan herbal healing. I(thnobotanist Lr. Isabella Aona Abbott.prolcsur emeritus, talked about specific plants, their use- andpreparation methods emplor ed hr herbal healers-, Dr. KekunB lai sdell, professor of medicine and mentor to many of the phr si

MEIOCAL I002NAL,. 002, 00, N010M800 200.1

293

cians in attendance, discussed the historical and cultural aspects ofKanaka Maoli health. The role of traditional diet in Native Hawaiianhealth was the topic of Dr. Claire Hughes’ lecture, Dr. Ken Ratima.Dr. Das id Rico and Mr. Ed Oshiro. MPH discussed culturallycompetent public health practices from a more global perspective.Specifically. they discussed their experiences in health care delHerbr the \laori. Native American, as ss cli as certain Asian and Africanpopulanon. Dr. \athan \Vone talked about how culture affects the

ph\ sieian—patient relationship and the conterence ended hr sharinuthe lessons learned and reeommendation for future action. At tilestart ol the last session. Die Blaisdell reminded all ol the phr sicianspresent oltis e km oints to remember in the iourney toward cultural

coinpetelier

Our Ki7uota tlnoir patients and then’ hcaitl needs come first,

e make this commitment to them hr heine’ here.2. The term “doctoti” means teacher. We need also to teach

ourselves by listening to, and earning from, our patients, ourcolleagues and our students.

3. As weste.rn-trained k.ai..ka (doctors), outlask.is to bring the bestof Western. Science to the bedside. But we are a].so Kanaka.Monk, so we r.eed to hri.ng effhcti cc tradition.ai .t<an.a.ka Maoiihealing was to our pat.ien.ts as well,

4. We nand always to have fun no matter how har.d the wor.k. Thatis. we need to “play hard” as did our ancestors.

5. There. must be a reason. wh we all are here at this special placeand at this special time. As vs e learned at aurbnefing, Kaho’olaweehoe Us, We ale here because of out aneestor. ‘she hate arcsponsibhtr trom thertt to heal ourselves. Our people. our

nation and our descendants totes er in t . the Tutu re - We have’ noother

in the re\ lesv session, the trlr-sic’ian shared with each other vs—hat

‘‘=‘tr’’’a’ about beconnue more ,,.alturalt,\ o’Innernrit anti flat

the a’. ericose ui the- ‘neekend meant to the-na With rernndto

nitutitl con netenc , me then-es t,lit scinciuded; inc

aware of one’s self and culture’ first, learnina anout and supportinc

the role traditional medicine can. play in tsician practices, reaiiz-

lug the importance. of networking and sharing experiences with each

otner, work n.g to abolish the cultural stereotypes that exist in

medjeat schools and communities. rememhermg that the ‘dma.(land) can he a powertcd teacher, being role. models and teachers intheir resoeet.ive comnaunities and families, becoming more involvedin community issues and realizing that flartic.pat.ng in t.his conihr

is ends just a small step toward becontin culturally competent.

Summarythe ‘ \51t11 ationc of the eon era’ tee me e’xee lle.nt and t lie

- I fl5’T’., eOtItfliO[1t5. eer-ttJreJ on this’ arcs tininfiSi itt

-—thj ts, 550 otna’ Has’. anan enlt.o.maI vetoes to datlv ttvtne

routines—promotes learn”ing on several levels. Culture is learned. hut alsofelt-physically, emotionahir and spiritually. Theresult i’ a eroup of providers who are more culturally attuned to Hawaiianalum and hopefully. bet

ter able to care for the nec-ds.of the kanjika .llosth,

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55,-an isut of the rniddcci

DAMERICAN ACADEMY OF DERMATOLOGY

The Impact of Disease on Hawai’i’sHistory

The matrix heaith,disease and rutre of the Kanaka laoli peoplecovers four eras: i from time mmemorial of Pd to the 1 77S returnot Lnsr chance arrival t the trst Europeai e\plorers: 2 theperiod of macrn and eastern contact and colonialism a ith collapse

tln d K ,.a th5 S 11953 L’S lfaii\ e 1—lawaitans Stu77 ( lnliniscf,iI md ttSS P Cia MaoReoort: and —i current healine af a wounded people throucheoliectt\ e Kanaka Maoit caitural res italization and cdt-determinetion.

Prom urnulipo (dark source). with the mat.i.ne of Wd.kea skyfather and Papa earth mothe.r, all in the cosmos were derived inorderly sequence at.; living, conscious and communicating. Afterkalo, was horn Hdioa, the common ancestor of all .Kdnaka. Overcenturies via canoe, Kdnaka settled the dispersed islands of KaMoananui (Pacified In Ka Pae1iina. c 1(X) AD, Kdnaka embodied‘ohana and aloha dma in evaivine ahu ua’a, the basic eeomrraphic.self-sufficient eeanomic, socmal and political ecosystem repLilatedhr kdndwai natnra.l lass mb maintain pono.

c 1200 AD. Kdnaka proliferated over the next 500x ears in healthyisolation from emimious epidemic infections elsea here. attainina’a thrivi nit peak population of edO ).000—800.00( . N la.i n ailmentswere trauma. deitenerative disnrders, aropa. focal inlect;ons, rarecancer, ‘ama excess, mild plant poisoning,” uncommon mentalillnesses and congenital defects.

Balanced nutrition, vigorous physical activity, strict san.itation.,refined medical practices, cooperative producttcn of food. andshelter. cross-iteneration education an.d arts were based on timelessspiritual concepts: iOk.ahi, pono. mnana, pklua, kinolau. authäkua,piko ‘ekolu. Km. maul.i, ‘uhanc. ole. svailua and ea. These promotedholistic mel nes and disease pres entmon Hemeu hodla heelinittenip)e crc centers ot rcsearell, education arid spce;ait\ care.Becinninc a oh Cook s “‘‘L’nimi landing irt 1778. a eslern

eastern contact initmated tire interrelated, inimical. and cmntinu;nL’i K I 1\h.

. dmnmn;aatin: 1 cx.rinratlm: 3; cultural c’ntct:

native aequ i 0 ti on of harm.fu i re. cm : and 5 dom i it ant .societv

reelect and malice..initia.l decimation he.ginning. in 1 778-1779 was due to gonorrhea.

syphilis, respi.ratory infections, tuhe.rculosis, alcohol.. and firearmThcm 1804 infectious diarrheas t 824 a ughs 1826 oughs mdcongestIon: 1 832 coughs and measles; 1.877 mumps, 1 540 leprosy,1848 measles, pei-tussis, diarrhea and influenza: 1.8Sf) con hs: and1853-1881 )dursmallpoxepidcmnics.Survivin.g in 1881 were c45,000nat4 e—. cli (ti tO Chinese and c3.Otth a noes

lSSO founding of Queens Hospital for K(mnaka \laoli failed tostemn the devastation. Theme followed in 1 870 searlatina, I SXSpertuscms. I NN9 measles. ml senters and 1 NOt diphtheria.

Meanwhmle, the onset cit Fznru-Anermean I N I cattle ranehmne.1520 whalinc. 1826 LS-toreed Sandalwood Treaty. 1835 suarlan tat ii1S. 1 840 Haa aim an K i nedom consti tomb na I monarchs and

I 54(1—1 X50 \ldheie land prms anzauon alienated rmlore than 7tt5KLinaka NIanli from their sacred dlina (lands.

[S rrmissionaries in I SIt) began coercive assimilation which exacerbated Kanaka Maoli cultural conflict. Kdnaka acquired perniuous is well as benefice ml foreign lifestyle a is while colonialeconomic aggression accentuated Kanaka Maoli despair. WhenKdnaka Maoli refused sugar plantation work in a 1841 strike, thehaole oligarchy initiated I 547 vagrancy laws and importation ofChinese contract laborers in 1852, Japanese in 1868, Koreans in

I ‘503 and Filipinos in 1906.1875 LS-Ka Pae’iiimma Reeiprncmtc Treaty’s largess otrisine sugar

pmofit tiehtened haole ecommomnmc. political. socmo—cultural dornina—tjcn, Kaldkauas reassertion’, of Kanaka Manlm culture and posseracme res crscd hr the hanie-imposed 1887 Ba onet Consntutmon.

In I 503, haole hu’-inessmnen a ith the support of L’S naval troopsioppled Lmlm’uokalani, proclaimed a Provisional Gos ernment and. tn1594. a Republic of Hasvai 1. US forced annexation of Ka Pae’dmnain 1805 and took 1.8 million acres of Kanaka \laoli crown andgovernment lands.

Honolulu cholera epidemic in 1895 and Chinatown huhonicplague in 1899 refl.e.cte.d. crowded unsanitary commdition.s.By 1900. Kdnaka Maoli had declined to a nadir of 37,656. and theewere mmutnumhered hr 61,Ill Japanese. 25.767 Chinese and 28.8.19ohmic torelitners.

Under the new 1,75 Territory f Hawai ‘m.aithoneh Kfmnaka Nlm1eamned ballot ci.lntmli of the fer’islature and elected Kanaka RobertKc.ianm Wilcox as delegate_nm_Congress, the US pmccmrlent appomnted

am in 1 u 4 — a-, otine.

In 190Q, Governor Walter Freer privatized Qoeens Hospttai andts.rniinaied free me..d.icai c:.Ire for indig.ent sick and disahi.ed KdnakaMaoli. H.aole ph flciamis and husine.ssmen. aequi.red control of

ipi. ‘o i.a.n.i .Mate.mnity Home from wdh.in.e (fe.mna.lei K.an.a.ka Maoi.m ofthe .Ho’dla Llihui Society.

191 8 influenza, 192.8 meningtis, 1936. m.eat.de.s were major fatalacute enid emics wit.h highest rates fhr Kdnak.a Maoi i. then Att:ian immierants and iowet:t. for hank:,

cm1 5 Hmaa’imn Elnmne’. Commn1ss;mmm -Sm mt .mide 2003t01

295

Richard Kekuni Blaisdeil, MDProfessor c.f Medicine, University of Hawai’i, John A. Burns

University of Hawai’i at ManoaSchool of Medvtn

acres of arid “ceded’’ US—stoleni Kanaka NlaoIi lands for 5(Y4blood—quantum Kanaka Nlaoli homesteadinc, to protect haole—leased sugar lands. Os er the sLibseqrient 70 years. less than 7.0(10

Kanaka Maoli families s crc awarded less than 25ff of these lands.

Niore than 20.OO() eligible Kdnaka Maoh remained on the waitinglist, while 70% of the lands were assigned to non-Kanaka Maoli,

such as the military.In the l930s, heart disease, stroke and cancer began to replace

tuberculosis, pneumonia and gastro—intestinal affections as leadingcauses ot death. However. Kdnaka Maoli continued to have thehighest morbidity. mortality and shortest life expectancy.

1931 Pearl Harbor bombinu tocused World \\ ar II on Ka Paeffiina

and the Pacific. Mar ial law, expandinu military bases, and masses

of immigrant defense ss orkers from the US continent further Amencainzed the island economy, politics and culture and marginalizedKdnaka Maoh Pot—ss ar economic boom. rise of Asian (ii bill—educated island professionals. 1959 statehood, tourism, Korean and

Vietnam wars aggmasated displacement of less-educated K3nakaMaoli from jobs and from rural k7puka (enclaves). US civil rightsactivism inspired modern Kanaka Maoli kh’d (protest) movement.1971 Kalama Valley eviction, 1972 ALOHA reparations demands,1976 Kahoolawe occnpation, 1978 HOkfile’a voyage, KanakaMaoli music, hula, languace resurgence and creation of OHA as astate agency culminated in 1983 Native Hass aiians Study Commission Report to US Congress. Reaaen appointees Nlajorit\ Report

concluded no U S responsibilitr for the I 893 us erthro\s of the

Hawaiian monarch\ Kanaka Maoli Nlinoritm Report stronglm

disagreed and recommended reparations.1975 UH medical school graduated first class ol 62 NIDs. includ

inc four Khnaka \laoli.985 E Ola Mau Health Needs Srudm Report detailed worst health

profile for Kfinaka Xlaoli. Causal historical—societal—ens ironmen—

ml. as well as individual lifestm Ic. factors were cited Ads ocatedss crc holistic cultural healinc. collective Kanaka Maol i sell—respon

sibility, self—snfficienc v, self—determination and return of Kanaka

Maoli lands.1988 US Congress Native Hawaiian Health Care Act authorized

Papa Ola Ldkahi and five Native Hawaiian Health Care Centers

(Systems), Emphasis was on health promotion, disease prevention

and primary care. with involvement of traditional practitioners and

cultural health educators. Health Protessions Scholarship Program

funded western professional training.1993 US Congress Apoioc Resolution PL lu3 — I 5u acknuss I—

edeed: US 1893 armed invasion: l S role in overthrow of Kinedrimi:

US violation of treaties and international law: US suppression ofKanaka Maoli inherent sovereicnt\ and nicht to self—determination:Kanaka Maoli health and well—being tied to their lands: economic

and social changes des astating to health and well—being of Kdnakt

Maoli: Kdnaka \laoli never relinquished their claims to their nher—

ent sovereignty or over their national lands to the US: Kdnaka Maoli

are determined to preserve, develop and transmit to future generations their ancestral territory and their cultural identity with theirown spiritual and traditional beliefs, customs, practices, languageand social institutions.

In 1999, UH School of Medicine Native Hawaiian Center ofExcellence reported a total of 201 Kanaka Nlaoli MDs: 137. ‘t$ UH

graduates: 43, 5ff- of island 2500 licensed MDs: 59, 28%. in

continental US: 60% in primary care, 40% specialists: 50ff urban

and 50% rural. Thus, Ui-I had sicnifieantlv increased the number of

practicing Kanaka Nlaoli MDs. and half were in rural areas where

there are more Kinaka Maoli in need.

1,200

Ka Pae’ãina Resident Population by Ethnicity, 17784990

1,000

800

600

400

200

0

E 994Hc S t2f&i 1992

1990Year

296

HooponoponoRichard and Lynette Paghnawan

c Co c Resobet o flracttloners Kaha’j u Ha° ai

Hcipiupon s a E{awaaa a ‘:, a a’ rcols e i erpersonal cuntlctsi’nc lanwv me.mhere, Handed down frito generation to genera

tion, it acts and continues to he a surv i cal toolWhen the ea.rly Hawaiians settled in these islands tfey hroug.ht

their values with them whi.c.h evolved to suittteirnew life i.n. the newlandoArnong these. were the beliefs in the importance of fam.ilv,netny p .rsons work.ing. together fhr the common ood, m intai.ningharmony, the importance of higher powers who controlled life anddeath, the existence of these powers in a myriad 01 envi.ronmentalforms, love and respect for extended faniv to name a few. After themigrations ceased, and the big ocean voyaging ca.noes ceased toexist. these inhabitants were fbrced to develop systems that ad

scsi the rnajntenancc of their limited environmental and human

The earliei recordings Han ii i and t’ people indicate thepresence tastrict kapu svsten reuurce nianacement tools nnlatincd olant “d animal use. conset ation penods and interpersonal hehas tom.

\khn s 4, arrived in these islands. the ‘was an estimatediulJ,ii(tt) pecmle who could not leave these islands and who weretorcesi to aeveton systems tin healing and setting alon, Thus, theKh,huna applied the arts of psvchoioaical and emotional healingbefore beginning any physical healing.

One ‘uch s stem, ho’oponopono. is a method with definedprocedures and processes that emphasize positive hea.hng within thecontext of the nuci.ear and extended laini iv. When used to restoreharmony aniong re.latives, the mana or the spiritual, psychological,

physical. intellectual recources and efl\ ronmental resources of eachperson is brought to bear on the situation. It is used to straighten out.to correct, to resolve the conflict or rehabilitate the persons in need.Sometimes there is only a partial horoponopono in that there is noresolution hut members of the family are made aware of all of ihecircumstances surrounding the situation and where the key participants stand, Thus this enables others to move on and not feed intothe problem matrix,

Ho’oponopono is the opportunity for family members to pooltheir collective strengths to focus on aiding the one who is hurtingand is needy. Members respect each other’s needs to be heard whiletalking in ways that encourage listening rather than turning outothers. Therefore. communication is verr important. All verhalitatons are directed to the leader rather than each other because it is a

de ice br maintaining personal internal controls. especially intami lyeontcxts whei’e the communication stc Ic is verbally e.\pbo—‘ave and physical. Thor are required to engage in self-rellectiun ofacts ofcommission and omis’,ion that contributed to the problem andto understand and he sensitive to the ramifications oh these acts onothers in physical. psychological, and emotional ssavs. And fina]lrto humble oneselt through pLiblic apolog\ for those deeds. Apologyand forgi eness are mutuall reciprocal between the injurer andinjured parties.

When those ways of conduct are part oh their life style, the familyand its members are armed with survival tools that will sustain the inthrough all the cycles of family life, its growth and development.

PaolaMchae Chun

Han ai.Lu based hand’ ‘n theraps med to reduce the paine\a’r:c!tve [—‘ta*’/,a is translated to mean ‘‘quick hcaiine’ ‘. It wabeds c.l trout the ancient. Hanat ian a ermine art of /nn and loot i/otto

This heaitng art “a” a a’ pascd Joan through severala tamit,v on F{asvat

The mana’o’’ in p/lola to intcgl ate the tao sides of the braininc the mdi’ tduai’s”man.a’’to f/on through the rain and allow

tornitia’diatcreiieT, Thenractiti ncruc\ ariahlehandpressurennt.ri iteer nO nts on the. body and verbal comma u iii cati ons to guide theclient’ mental processes, Pain relief s. immediate, and long-termresults car depending on t.he. origin ‘f the. pain, mental crisis oranatomical d isorder,

P5t treatments i’e’ults include relaxation, reduction of pain.impro\ ed ranee of motion Ion en an sietr lor els and sleep. \\ henPliola i’ utilized on patients in intensive ‘ire units changes in vitaltunctions are visible on the no mitors. no statistics to validate this

PTla therapy i” hiehic tntiuenced b Hawaiian cultural concepts,uch as. Hoolono. Lbkahi. Hon manawanui. ‘Ohana. 1—lena. H/i.Hiki nib Kaona. etc. The practitioner has the understanding of thebipolar nature of hem. ciii and aug. He has the ability to detachhis personal prejudices and beliefs n lien smorking: that is a orkmngo ith “no mind”.

Pdola includes the Chinese meridian model, shiatsu, left brainright brain operation and meditation techniques.

297

The Problenr. A favorite subject for Hawanans is “food”. However. during the last tew decades of the 20’ century. our food suppl\

could be characterized as a nutritionist’s worst nightmare. There are

excesses of all kinds. Across the U.S.. we are eating excesses of

food, sugar. tat. protein and drinking excesses of alcohol. Resultingfrom these excesses, are health problems that run the gamut horn

caries in our teeth and low nutrient reserves, to gross obesity, early

aging and early death.Public health data (BRFSS, Behavioral Risk Factor Surveillance

Study, CDC) show that Native Hawaiian dental caries, obesity,chronic disease and smoking rates are higher than others in ourstatewide community. In I 9)8. more than 53(/ of Native Flaw ananswere overs eight. up from about —1-00’ in the I 980c., And, when these

risks factors arc high. it follows that our rates of illness and death are

high. The unfortunate thing i. that when Hawaiians look around and

see that more than half of their famil and friends are overweight.

obesity becomes the communit norm. We need to change that

perception.Working within ourcommunities, it is clearthat Native Hawaiians

do not know that:• gaining excessive weight is dangerous to the health;• food fat is an enemy, and that there are ways to determine the fat

and sugar content ot favorite foods:• nitrates that preserve canned meats, bacon. sausages are carcino

genic when consumed in large quantities dail• omega 3 oils are best, and mono and poE unsaturated oils are next

best:• phytochemicals from vegetables and fruit have an importantdaily dietary role in fighting cancer, cardiovascular disease, etc.,

andchanging our diet is critical to assure the health and survival of ourchildren and families.

What Works: \Ve have found that dietar change for Natixe

Hawanans i’ possible. and that the “traditional Hawaiian Diet’’

1rrrams are an acceptable methodology, Sustaining dietary changeis a challenge, but car he done.

Getting the buy-rn needed for successful research is possible.Emmett Aluli was the first to use a culturalls -appropriate methodology to get Native Hawaiians on Moloka’i to enlist in the 1985 and1987 research studies, the Moloka’i Heart Study and Moloka’i DietStudy (MDSc aher overtures by UHresearchers had failed, Emmettcs ent door-to-door. beginning s ith c onlmunit\ kiiptina and leaders.to ask tor support. I-Ic promised to keep the communitr mb rmed on

the study procedures and progress. and that the communities ould

hear the study results first. Emmett demonstrated a willingness to

be ace ountable to the communityThe successful MDS, communil\ THDs and receilt ‘‘Warrior

Diet” has taught us important lessons on impartinc health and

mon vation lessons. These are:• traditional Hawaiian diet THDi. foods. cookino’ and 100 fat diei

yields best results;• ‘ohana building via participants eating daily works;• k’hkdkSkS sessions are critical for information exchange/teaching

about culture and health:• teaching about the traditional culture builds pride and confidence,

and• learning the spiritual meanin of the food and diet N siess ed as

important by the diet piirticipcnats.The “Warrior Diet”, conducted in Mas by the Denartment no’

Health, has brought new understanding about the efficae’ of building and strengthening muscle, increasmnc’ flexihilits and aerobiccapacit\. benefits of lomilomi and building spiritual orientation,

As health professionals and elders, it is important for us to “walkthe talk and not just talk the talk” about leading healthy lifestyles.W’e need to set the example for our patients and communities.

Office of Cancer Communications

Kaho’olawe: Traditional Hawaiian Diet(THD) and Health

Claire K. Hughes, DrPH, RDDirector and Nutritionist, Office of Health Parity, Hawai’i State Department of Health

Honolulu, Hawai’i

National Cancer Institute

A4%d jZv

Pap tests can help find cervica cancer at anearly stape — while it’s still easier to cure.

Cad the Natio-nai Cancer Os rirure’s0. tormar,cw -.,r

1-800-4-CANCER (1’800-422-62371.

Visit NCI’s website at http://www.ncinih.gov

298

Medical School Hotline

Student ProfiIe Class of 2005John A. Burns School of Medicine

(JABSOM)

Satoru Izutsu PhDSenior Associate Dean

Chair, Admissions Committee

The School of Medicine’s Admissions Committeejust completed itsfinal selection of62 first year students forthe 35th entering c lass. Thefirst day of class was August 2001. To welcome the students, a\\ hite Coat Ceremony was conducted in v hich craduate’, of theCia’.-. of lOst) pre’.ented sshite coats to each ‘.tudent. members of theHawan \ledical A’. sociation eas e each student a stethoscope. andthe Robcrt \\ ood Johnson Foundation donated the hook, “OnDoctoring to all students.

There were 1, 75 applicants for this freshman class, Of thisnumber, 197 were residents of the State of Hawaii and 975 were out-of-state applicants. Residenc status for admission purposes isdetermined b 5 taetors (legal residene\ . birthplace, parents’ resideuce, high school and collece or professional school attended andthe applicant must have a minimum of three ot the five to becon’.idered a resident of Hawaii. Candidates for interviews areselected on the basis of academic scores, honor awards during theundergraduate years, extra-curricular acti ities and employment inhuman services, Of the total number of applicants, 226 qualified tohe interviewed by two interviewers and the Chair of the AdmissionsCommittee. The final selection included 56 in—state and 6 out—of—state applicants.

The Admissi€ ui’. (Soinmittee met 21 times between September.20)Ju. and May, 20(11 to tate the applicants. The e1e en—membercommittee consRted of 6 men and 5 women, There \\ere eightclinicians, one basic scientist and two social scientists, The Committee members represented the major ethnic groups in Hawaii aswell as varied age levels, The final rating for each applicant was bysecret ballot and submitted to the registrar ss ho averaged the scoresthat were ranked at the conclusion,

Documc-nts esamned by the Admission’. Committee v crc: GradePoint Averaces GPA . Medical College AdmissionsTest ( NICATr:ntcr\ ie\\ rs repoits. applicant’s essays on the topics “\Vh\ Mcdi-

cine’?” and “Why (the interest in) the John A. Burns School ofMedicine’.”. letters of recommendations, transcripts of undergraduate courses, and a biographical sketch that included experiences inproviding human services, The final median scores of the enteringclass are: Cumulative GPA. 3,46; Science GPA, 3,55: MCAT total,30 ‘v’crh d Re isoning 6 Phystal Sctenccs 10 ‘v\ riting S unpleP; and, Biological Sciences, 10,

JABS()Nl is proud that it is the s orld’s most cthnicallr dis ct-seschool. 1 his year’s class includes: 15 Japanese. 14 Chinese. 7Filipino. 7 Other Asians. 6 Hawaiians. 5 Caucasians. 3 Koreans. 2\ietnamc’.c. I Mexican—American/Hispanic. and I Other Pacilicislander.

Nineteen are graduates of the Uni’ersity of Hawaii at Manna: 2from Hawaii Pacific University; 1 from Chaniinade University,Honolulu, and I from University of Hawaii— Iblo. Thirty-nineobtained their undergraduate degrees from mainland colleges thatinclude 1’nisersitv of Calil’ornia -——— San Diego. Berkeley and LosAngeles. lr me, Riverside. Davis. and Santa Barbara: University ofPenns\ Ivania: University of Washington—Seattle: Columbia k’nis ersity. Ness 5iork; Stanford University; Duke University: GoníagaUniversity-. Massachusetts Institute of Technology; NorthwesternUniversity; Princeton University; Seattle Unix ersity: St, LouisUniversity: University of Denver: University of Idaho; Universityof Portland: and Unisersitv of Southern California.

All students have Baccalaui’eate degrees and 5 have Mastersdegrees. Their college majors include: 21 in Biolog. 2 in each ot’the following—Anthropology. Biochemistry. Biologv-Phartnacologs. Pi’e-Medicine. Pvvchology. andone I )inthelollowing lields—--—Accounting, Biochemistry/Economics. Biochemistry/Neuroscience,Bioengineering, Biology/combined with Dance, Ecotiomics, EthnicStudies, Japanese, Liberal Studies. Genetics, Physiology, PublicHealth, and. Biomedical Engineering. Biomedical Sciences. Cell &Molecular Biology. Public Health. Ecology & Evolution Biology.English—Landscape .-\rchitect. Human Biolog . Interdisciplinar\Studies. Lit’e Science/P’.vchologv. Mathematics. Neuro Science.Neurobiolog —Phvsiologv—Behavior—\eurosc ience, Nutrition.Oceanograhy. Physiology. Psychobiology. Science Technologyand Socio/Biological Science, and Zoology.

Students were chosen from hundreds of their peers and identifiedas those with the best potentials of becoming competent, culturallysensitive phsicians. The\ are on an exciting ourney that ss illchance their own lis es and others lores cr. The will undoubtedlyhear -—-- throuchout their journey ot becoming physicians - theadvice of Dr. Arnold P. (mId, sponsor of the White Coat Ceremony.ss ho said. “ . . - work hard. care, and nc er forget human sutftrinv,”

Until there’s a cure, there’s the American Diabetes Association.

Until there’s a cure, there’s the American Diabetes Association.

299

Integiuin ,e Pledaine: An -teadem,e !315r i/Pale:’ raiitinne,l iron, ;‘

i eatio of the CCAM. JABSOM h Ii sin, that it in h a lv

in the United Stat and intL rnatlonall\ in the i dihie ierit,l

study oi altei nati\ e and enmplementarn therapie—. I Iii therm n e

I ABSO\I belies Cs that it is important to educate in died -tud i-

about th th epic the the patient ue u s-s hi h in iv u mci

i et I oti Oni n on I a I pat c in ci thi t n

s-ic h lies-c it i’ iii portent ti’ ste t a Dep rtnk n of 1111 i its

\ledie inc it the John A Burn- School ot \Iedi i

ReferencesI •1

1I -

1 -

--‘LI -

II T ‘

lije Lr (Paired L/eerrnnagirerir Pie/Jr PLAJJ or ()srer,rrrrhrui

(VA) ci the Knee Peelinn/noes.: Repr ct ‘eonnnued loon p 2815

perceived effect Another withdrawal seas. for trave.l Ten patients

completed the studsRe-cu Its obtained for the mon ti aed pa mmmc in are su ni ran sed

Table I. Thirt.y iJavs of ictive. rnaCne.t use. improved pai.n, perception

of function, and the range of motion of the joint, while reducing th.e

duration of mornine stiffness in the knee and. increasune the ranee

mono n s 0 eites--t wa-’ noted on otnt ‘s c-lone reuniterence. cit

tone needed toss- of eelCartilace, like hone, has pie.zoe.l.ectffe properties leading to elec

trical outputs thought to he capahl.e of stimulating chondroe.yte.

synthesis of matrix components Similar electrical changes

occur thrrsueh Faradas induction from apgiied t me-vats nc electro

magnetic fields. Co,nple. chemreai responces ore detectable- s-s

dx hours of PUMP exposureJ’

Although pun mommy sutfness Intl r snge of mm in u-’pe m to

he beneficially affected by the active field used in this study, further

sainplins s-situ appropriate statdtieal evaluation is nccesrcar\ sIt

s alid njuantitatis- e coneluslvr,s Es-tended studtes ‘hould he desiened

to histologicalls deterunne whether PUMP exposure has true chon

droproteetive or repair potential in the intact joint, or both.

-i ic flea it Transplant Ris iplents Raced inc Ce//ri/ui lie In, ‘i/to dr ‘In

Their Dniuircd Vr,n ; 1 Hcurisnr- Studs. i “nt/nm,! lion, p. Cd-?

References1 Communication received from peychiathst Dr. Charles Bruce Greyson Univervty of Virgin:a as

towiarded to author U Dr Gary E. Schwartz Department of Psychology and Medicine Univershy atAszona Jury 5 2000

2 For eeampe see Lode CT Psycb’at’r Corotea: or’s of Hear Tr”,’,m’u c’ Pain a:’:

3 See ado iron WF era. Psvo5ooati-ooav ‘ Heat’ Trsrsoam Caro-ovres a‘9987223-228.

4, Schwartz BEEt Ruseel LBS Do At Dynamtcai Systems Have Memory: Irpicahoun of the SystemicMemory Hypothesis for Science and Society In: Pribrsm KH Ed. Brain and Values: /s a Biological

Sc/ence of Va/ues Possible Hilesdale New Jersey: Lawrence Erlbaum Associates: 1998Harer I SR Pen P Orch t d Re r ‘ Ga — “ Cd e a’ B a LI cr0 A

Caob-ioc,e. MA’Tve ‘‘1 PEss 1320

p P , — ,, -.-. — —

News-un NY Broaowe, BooRs, tel.7. Pearsalt P Schwartz GER Russek LBS C/ranges in Hear: Transpiunl Recipients the Parsi. iii the

Personalities of Their Donors Jot tntegrahve Med Fat. 2000.

lOt a s I relt a (our otional ti,e In i ‘ne leco in , ‘ riot no 0

noiu/ 8

o -au ‘11 2 AJ Ii ,: n, ,lo H b

ci Au’s-y c I, s I- —‘l,rO -‘b -— L II - r

-a,,:,, , or or II p r ji ,j r ,, a- n d I p “ ‘ ‘ or ‘o B I

I ‘1

0’ ‘ — : , ‘ ‘ - ‘

References

4,,y I H F

I’ a I.

l’(’)I ,,

,

300

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Classified Notices

Assistant Researcher

ASSISTANTASSOCIATE FULL PROFESSOR OFMEDICINE, M3M4 M5. one gosition. Pos;tion No.0082790T. Deans Office Geriatric Medcne Program.UHJnhnA Br Srnooln floacne oat5meotime, 11 month. non-tenurable, temp general funds,NTE 06/30/02, renewable depending on performanceand!orfunding, to begin approximately December2001.pending position clearance and availability of funds.The John A. Burns School of Medicine atthe Universityof Hawaii seeks a board certified or board eligibleinternist or family practitioner to serve as a physician atthe Hawai; State Hospital in Kaneohe. Hawaii Thesuccessful apphcant will be a physician who by academic standing and appropriate expenence is qualified for an appointment to the medical school faculty atthe Assistant Associate Professor evel. Duties: Workunder the direct supervision of the Director of MedicalServices and provides direct clinical services for inpatients of the Hawaii State Hospital and is the primaryback-up physician to cover for absences of othermedical services physicians because of vacation, sickleave or other approved absences. Will also serve asa member of appropriate hospital committees. Will beon the regular faculty of the medical school and will beexpected to undertake teaching and scholarly activities commensurate with the academic rank. MinimumQualifications: (Assist) MD or DO degree; BoardCertified or Eiigiblei by the Amer:can Board of InternalMedicine or Amercan Board c-f Family Practice, eligible for Hawaii license and demonstrated ability inteaching: (Assoc) Same as Assistant plus four yearsat the rank of Assistant Professor or equivalent combination of teaching and experience: ABIM or ABFPboard-s in a subspecialty as appropriate: and provenabiiity in teaching. research and programs administration: (Prof) Same as Associate plus tour years at therank of Assocate Professor or arty eouivaient comb;nacn of teacnng and experience. Desirable Qualifications: Interest an-c exOerience in worKing svrth

o 5c a o ca e a’-” a cu., H0 aaD o a a -“o e C 0 r’

team: nterestano experence in mecica scnoo: teachng as a clincal or reouiar faculty member. Minimum

(Assist: $78,924:Assoc).$92.340; (Prot;:.: $99,876. Salary com-mensu

rate- with experience. To apply: Send updated CV.bibiiography, letter of application, and five names ofreference to Patricia lano-ie Bianchette. iAD, MPH,

jo’” A Bum S -‘no o 1 lodic no 3*- 0 Kaen;- HPhI-9. Hoocue H 96817 3085228a6.”

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• iai mcd that the deaur Li led mincer the oiandard cii care he not procI I T L I I uIl a PDR ida scd

‘rho tebc d.atin dry tt incimuct patients to wear dark glasses, andavoid driving or opematina daoeerous machinery after the eyes crc dilated.The doctor stated. thm his staff routinely advises pti.ents about lightsensitivity and blurred vision alone with dil..ating drops snfl isioers thepat.ient dark classes before leaving the office, Howe.ver, the pat.ient did notrequest them .and iggg.±TPctagi,on was made in th.e. record that the dark.glasses wereoftered. Considering’ the above, thedefe.nsegroup felt it wouldbc di I ticult to dvt0n t S w ttl0d md h0 duct w a nt to thc dathank where. they make deposits hut not withdrawals.

Elsie! Please Use The ContainerS It Was The Herd ShotRound The WorIdAn exciting, development to aid in the diagnosis of “mad. cow disease” hasbeen c.iaimed by Israeli scientists, A. urine test ‘fob detect the renegadeproteins, called pLow , which are believed to cause the disease, Schentistso laim the. test is straightforward, and can be quickie confirme.d, At thepresent time the on.iy method of diag,nosis is at autopsy whe.re. the spongiformencephalopath.y is evide.nt. In Britain, about 11.30 pe.ople have died from thehuman variant, Creutzfeidt iakoh Disease. Researchers have been desperate to find a simple diacntistic test in order to sav’e cattle hertls when. aninfected animal is discos’ered. investig.aturs have been able to detect thecondition a oh bSht accut mc in a double blind test performed on 52 Britishcows. It has not been pn en that the condition can he transmitted withblood, hut restnctlons has c been impoced. The test couldhelp safeguard theblood supply also, much a Inch is exported front Europe to the U. S.

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