Future of medical care lies in support groups and self-care

In 1989, Stanford University psychiatrist David Spiegel published a landmark article in the prestigious British medical journal "Lancet" documenting that women with advanced breast cancer who participated in supportive group therapy lived on the average twice as long as those who didn't. Ironically he had undertaken the study with the hypothesis that group support and self-hypnosis for pain control would improve the quality of life, but have no effect on quantity.

In his book, "Living beyond Limits," he notes, "Never at any time had we told our patients that what we were doing would have any effect on their survival time. Our focus had been on facing death, detoxifying fears of dying, living as fully as possible. We tried to teach these women not to control their cancer, but to control their lives and their treatment.

"The result-that the women lived longer-reminded me of the Zen parable of the archer. If he focuses on the target, he misses it. If he focuses on the relationship between the bow and arrow, he gets a bull's-eye." These unexpected results have been confirmed by other researchers, and cancer support groups are now a standard part of therapy at most major cancer centers, including here at the University.

A similar approach was used by cardiologist Dean Ornish to reverse coronary artery disease in the Lifestyle Heart Trial. Group therapy, combined with yoga, meditation and a low-fat diet, resulted in a decrease in coronary artery stenosis, as well as a decrease in anginal symptoms and an increase in well-being. At the Duke Center for Living a similar opportunity for lifestyle change is offered to cardiac patients in the Healing the Heart Retreat Program.

In his presetation at the medical center last month, health care futurist Leland Kaiser predicted a managed care scenario in the near future where health care systems would thrive based not on the number of coronary bypass surgeries performed, but rather on the number of patients prevented from having these expensive procedures. He emphasized the importance of self-care by noting that he pays for weekly massages for his own employees because stress management makes good business sense from a bottom line perspective.

At the First Annual Integrating Mind, Body and Spirit in Medical Practice Conference last fall, Jon Kabat-Zinn described how his mindfulness meditation program at the University of Massachusetts provides useful self-care skills for patients with a variety of medical problems. Such skills become particularly important in the managed care setting where primary care physicians have limited time to deal with many stress related symptoms. This kind of patient education can be offered in an after-hours group with the goal of empowering individual patients and providing a healing sense of community in a society where unhealthy isolation is the norm.

Mother Teresa, when asked to describe the worst illness she had encountered during her ministry, responded that it was "the loneliness and isolation in the West." Our culture is a breeding ground for hostility which behavioral medicine researcher Redford Williams has shown results in a high incidence of stress related illnesses such as hypertension. Recently these observations have led him to set up anger management groups in the Sanus system designed for high-utilizers of managed care services.

Our best hope of thriving and not merely surviving in the current economic climate lies not in expensive medical technology, but in simple mind-body interventions that emphasize group support and self-care. Mindfulness meditation clinics patterned after Kabat-Zinn's successful model are springing up at major medical centers around the country, and it is anticipated that there will be one at the University in the near future. Ideally these programs will eventually be decentralized to provide services on-site at the primary care practices.