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<<   作成日時 : 2010/05/13 21:42   >>

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 不妊、慢性疼痛、うつ、更年期障害などの症状のために多くの人が鍼治療を受けており、保険外で自己負担であるにもかかわらず、増加し続けている。
 NIHの代替医療部門の調査によれば、2002年には210万人だったが、2007年には310万人が鍼治療を受けた。鍼治療が効果的とする研究成果が出ている疾患には、慢性頭痛、骨関節炎、妊娠うつ、腰痛がある。しかし、保険業者は鍼治療のカバーを渋っている。まれには一定の条件下で支払うことがある。
 ニューヨーク州で鍼療法を行うライセンスを取るために、4,050時間の授業コースと、650時間の臨床トレーニングをし、250人の患者を治療し、国家資格試験に合格しなければならない。
 いくつかの病院では痛みや不安に対して入院患者に鍼治療を提供し始めた。薬物より副作用が少ない。マンハッタンのベス・イスラエル・メディカルセンターの患者は無料で鍼治療を受けられる。
 しかし、ほとんどの人は有料である。鍼療法師によっては300ドル請求する場合もあるが、一般的には約65〜120ドルである。ほとんどの病気で少なくとも3回の治療が必要であり、関節炎のような慢性病は隔週や毎月の治療が必要となる。(2010-05-01 NYT)

-------------------------
 ゲイツ国防長官は土曜日、米軍でPTSDの治療にアロマテラピー・鍼療法の研究をしており、有望だと言った。(2010-5-08 Reuters)

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Acupuncture Is Popular, but You’ll Need to Pay
By LESLEY ALDERMAN
Published: May 1, 2010
http://www.nytimes.com/2010/05/08/health/08patient.html

画像WHEN Divya Kumar was having trouble getting pregnant four years ago, she meticulously tracked her menstrual cycles and found something was amiss. She was ovulating late, on Day 22, instead of on the more normal Day 14.
Ruby Washington/The New York Times

Some acupuncture schools, like the Pacific College of Oriental Medicine in Manhattan, offer treatment by supervised students for discounted rates. Holly Crafts-Calasanti works on a fellow student, Patrick Kelley.


Ms. Kumar, then 29, went to see an obstetrician-gynecologist for help.

“The doctor said there wasn’t anything she could do for me because I was under age 35 and had been trying to conceive for less than year ― even though it was clear something was not quite right,” Ms. Kumar explained. “She said, ‘come back in a year.’ ”

Ms. Kumar, who has a master’s degree in public health and lives in Jamaica Plain, Mass., decided to try an alternative. She went to see an acupuncturist who said, “I can help; give me 12 weeks.”

Because her insurer, like most, did not cover acupuncture, Ms. Kumar had to pay for the $70 weekly treatments she hoped would put her cycle on a more normal schedule. After the first few treatments, that seemed to be working. Two months later, Ms. Kumar was pregnant. There is no way of knowing for sure whether it was the acupuncture or the gynecologist’s keep-on-trying advice that helped Ms. Kumar conceive.

But a growing number of people are turning to acupuncture for help with conditions including infertility, chronic pain, depression and menopause symptoms. And they are turning to it even though financially it remains a largely out-of-pocket form of health care.

In a 2007 survey, 3.1 million adults reported using acupuncture in the previous 12 months, up from 2.1 million in a 2002 survey, according to the government’s National Center for Complementary and Alternative Medicine, a unit of the National Institutes of Health.

The center’s Web site is mainly neutral on the question of acupuncture’s effectiveness, and it urges people to go to a medical doctor ― not an acupuncturist ― to have a medical condition diagnosed. Acupuncture can have a powerful effect on your system, but serious ailments typically require a dose of Western medicine, like a course of antibiotics, a prescription-strength pain killer or even surgery.

Still, there are a handful of well-respected studies indicating that acupuncture can be an effective treatment for a range of conditions, like chronic headaches, osteoarthritis, depression in pregnancy and low back pain.

Western doctors are beginning to embrace it, sometimes sending their patients to acupuncturists for specific conditions. And the federal Food and Drug Administration takes it at least seriously enough to regulate acupuncture needles for use by licensed practitioners.

But insurers have been reluctant to cover acupuncture. And even in the relatively rare instances when insurers do, they might pay for only a few visits or a specific condition.

Ms. Kumar was able to get a financial break by using money from her flexible spending account at work. “It was expensive,” she said, “but probably not as expensive as infertility treatments would have been.”

When she was ready to have a second child, she again went to her acupuncturist, Claire McManus, and became pregnant within months.

Proponents say that acupuncture, in addition to helping treat existing conditions, can also help prevent problems from occurring in the first place. Some devotees of acupuncture even say they believe treatments keep them healthy and out of the doctor’s office, potentially saving them money.

“We’re seeing a small but growing number of clients come to our clinic for wellness tune-ups,” said Angela Grasso, director of clinical services at the Pacific College of Oriental Medicine in Manhattan, which is accredited by the Accrediting Commission of Career Schools and Colleges and trains students to become licensed acupuncturists.

To receive a license to practice acupuncture in New York State, one must have completed 4,050 hours of course work, done 650 hours of clinical training and treated 250 patients. Once students have completed those requirements, they must pass a national certification examination in acupuncture.

Marcus Berardino, 41, a massage therapist and yoga instructor in Brooklyn, swears by the acupuncture treatments he receives regularly. “Combined with other natural remedies like biking, healthy eating and a little daily meditating,” he said, “it keeps me healthy and fairly balanced.”

Some hospitals are beginning to offer acupuncture to inpatients for pain and anxiety.

“When patients receive acupuncture before or after surgery, their anxiety is less, and their pain is reduced,” said Arya Nielsen, director of the acupuncture fellowship program at Beth Israel Medical Center in Manhattan. “They need less pain medication and so have less side effects from the medication.”

Beth Israel patients receive their acupuncture treatments free through the postgraduate fellowship program run by Dr. Nielsen, who has doctorate in the philosophies of medicine.

But for most people, money is a consideration. Sessions with an acupuncturist run about $65 to $120, depending on where you live (and some leading acupuncturists charge as much as $300). Most ailments require at least three treatments, while some chronic issues like arthritis might require biweekly or monthly sessions, depending on the situation.

If you want to try acupuncture, but are concerned about the cost, here are some suggestions:

CHECK YOUR COVERAGE Call your insurer and ask whether your policy covers acupuncture. If it does, press for details.

Find out how many sessions a year it allows and whether a doctor’s prescription is needed. Check whether it allows coverage for only certain conditions. Some policies, for instance, might cover acupuncture only for chronic pain.

TRY A SCHOOL If you must pay yourself, consider discount treatment by an acupuncturist-in-training. Most acupuncture schools have clinics where you can be treated by supervised students at discounted rates of $40 or so for one to two hours. To find a school, go to the American Association of Acupuncture and Oriental Medicine’s Web site.

Barbara Andisman, who was told she had multiple sclerosis two years ago, has been going to the clinic at the Pacific College of Oriental Medicine in Manhattan once a week for more than a year. She says the treatments help with her balance and energy.

“I have a type of M.S. for which there are no medications; the treatments have been incredible and helped keep me stable,” said Ms. Andisman, 52, who lives in Brooklyn. “If I miss a few sessions I notice a difference. I feel kind of sluggish.”

COMMUNITY ACUPUNCTURE If your problem is not serious or complicated ― say you are suffering from stress or headache pain ― consider visiting a community acupuncture setting, where fees can be as low as $15 a session.

You receive a brief assessment and then are treated, fully clothed, in an open room with other patients. It is the acupuncture equivalent of a chair massage.

To locate a clinic near you, see the Web site of the nonprofit Community Acupuncture Network.

USE FLEX SPENDING Even if your insurer will not reimburse you, your flexible spending account might ― if you have one. Using flex-spending dollars to pay for treatments can reduce the cost by 20 percent or so, depending on your tax bracket. Look on your employer’s list of approved expenses to see whether acupuncture is included.

HAVE SOME PATIENCE Acupuncture often has a cumulative effect. If you have a simple cold or headache, you might feel better after one session. But it might take three sessions before you start to notice an improvement in a muscle strain, according to Ms. Grasso, who is also a licensed acupuncturist.

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Pentagon tries aroma therapy to ease combat stress
FORT RILEY, Kansas
Sat May 8, 2010 8:31pm EDT
http://www.reuters.com/article/idUSTRE64802D20100509
FORT RILEY, Kansas (Reuters) - The U.S. military is experimenting with aroma therapy, acupuncture and other unorthodox methods to treat soldiers traumatized by combat experiences, Defense Secretary Robert Gates said on Saturday.

He said the experiments showed promise.

Gates touted possible treatments for post-traumatic stress disorder (PTSD) during a meeting with the wives of servicemen at Fort Riley, Kansas, when one woman asked him to explain why chiropractic and acupuncture therapies were not covered under her military health care plan.

"We have an experimental unit ... treating soldiers with PTS (post-traumatic stress) and using a number of unorthodox approaches, including aroma therapy, acupuncture, things like that, that really are getting some serious results, and so maybe we can throw that into the hopper as well," Gates said.

The Pentagon has seen a sharp increase in the number of soldiers suffering from post-traumatic stress disorder during and after long deployments in Iraq and Afghanistan.

The disorder can cause flashbacks, edginess and emotional numbness. The risk depends on the type of traumatic events a person is exposed to.

A report in the New England Journal of Medicine in January found that U.S. combat soldiers in Iraq who received a shot of the painkiller morphine within an hour of being wounded were less likely to develop the post-traumatic stress disorder.

(Reporting by Adam Entous; editing by Todd Eastham)

---------------------------------------------------
NEJM Volume 362:110-117, January 14, 2010 Number 2
Morphine Use after Combat Injury in Iraq and Post-Traumatic Stress Disorder

Troy Lisa Holbrook, Ph.D., Michael R. Galarneau, M.S., Judy L. Dye, M.S., R.N., A.N.P., Kimberly Quinn, B.S.N., and Amber L. Dougherty, M.P.H.

ABSTRACT

Background Post-traumatic stress disorder (PTSD) is a common adverse mental health outcome among seriously injured civilians and military personnel who are survivors of trauma. Pharmacotherapy in the aftermath of serious physical injury or exposure to traumatic events may be effective for the secondary prevention of PTSD.

Methods We identified 696 injured U.S. military personnel without serious traumatic brain injury from the Navy--Marine Corps Combat Trauma Registry Expeditionary Medical Encounter Database. Complete data on medications administered were available for all personnel selected. The diagnosis of PTSD was obtained from the Career History Archival Medical and Personnel System and verified in a review of medical records.

Results Among the 696 patients studied, 243 received a diagnosis of PTSD and 453 did not. The use of morphine during early resuscitation and trauma care was significantly associated with a lower risk of PTSD after injury. Among the patients in whom PTSD developed, 61% received morphine; among those in whom PTSD did not develop, 76% received morphine (odds ratio, 0.47; P<0.001). This association remained significant after adjustment for injury severity, age, mechanism of injury, status with respect to amputation, and selected injury-related clinical factors.

Conclusions Our findings suggest that the use of morphine during trauma care may reduce the risk of subsequent development of PTSD after serious injury.


Source Information

From the Naval Health Research Center (T.L.H., M.R.G, J.L.D., K.Q., A.L.D.) and EPI-SOAR Consulting (T.L.H.) ― both in San Diego, CA.

Address reprint requests to Dr. Holbrook at the Naval Health Research Center, 140 Sylvester Rd., San Diego, CA 92106-3521, or at troy@epi-soar.com.

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