Impact of Medication-Related Harm in Older Adults Following Hospital Discharge

Total Page:16

File Type:pdf, Size:1020Kb

Impact of Medication-Related Harm in Older Adults Following Hospital Discharge IMPACT OF MEDICATION-RELATED HARM IN OLDER ADULTS FOLLOWING HOSPITAL DISCHARGE NIKESH PAREKH A thesis submitted in partial fulfilment of the requirements of the University of Brighton and the University of Sussex for the degree of Doctor of Philosophy October 2018 DECLARATION I, Nikesh Parekh, declare that the research contained in this thesis, unless otherwise formally indicated within the text, is the original work of the author. The thesis has not been previously submitted to these or any other university for a degree, and does not incorporate any material already submitted for a degree. Nikesh Parekh TABLE OF CONTENTS ACKNOWLEDGEMENTS .........................................................................................................6 LIST OF ABBREVIATIONS .......................................................................................................7 LIST OF TABLES......................................................................................................................9 LIST OF FIGURES .................................................................................................................. 12 ABSTRACT ........................................................................................................................... 14 CHAPTER 1. ......................................................................................................................... 15 INTRODUCTION .................................................................................................................. 15 1.1 STATEMENT OF INTENT ................................................................................................. 16 1.2 IATROGENIC ILLNESS ...................................................................................................... 16 1.3 CHANGING PATTERNS OF DISEASE AND MEDICINE USE ................................................. 18 1.4 DEFINING MEDICATION-RELATED HARM ....................................................................... 21 1.5 OLDER ADULTS ARE A HIGH-RISK POPULATION .............................................................. 22 1.6 TRANSITIONS OF CARE ARE A HIGH-RISK TIME ............................................................... 24 1.7 NATIONAL POLICY LANDSCAPE AROUND MEDICATION-RELATED HARM ........................ 25 1.8 STRUCTURE OF THIS THESIS ........................................................................................... 28 CHAPTER 2. ......................................................................................................................... 29 THE EPIDEMIOLOGY OF MEDICATION-RELATED HARM IN OLDER ADULTS FOLLOWING HOSPITAL DISCHARGE: A SYSTEMATIC REVIEW .................................................................. 29 2.1 INTRODUCTION ............................................................................................................. 31 2.2 METHODS ...................................................................................................................... 34 2.2.1 SEARCH STRATEGY ....................................................................................................... 34 2.2.2 SELECTION CRITERIA..................................................................................................... 35 2.2.3 OUTCOMES................................................................................................................ 37 2.2.4 STUDY SELECTION ........................................................................................................ 37 2.2.5 DATA EXTRACTION....................................................................................................... 38 2.2.6 QUALITY ASSESSMENT .................................................................................................. 38 2.2.7 DATA SYNTHESIS ......................................................................................................... 38 2.3 RESULTS ........................................................................................................................ 39 2.3.1 STUDY SELECTION ....................................................................................................... 39 2.3.2 KEY STUDY CHARACTERISTICS ......................................................................................... 41 2.3.3 PARTICIPANT RECRUITMENT .......................................................................................... 44 2.3.4 PARTICIPANT FOLLOW-UP ............................................................................................. 44 2.3.5 DEFINITION OF MRH ................................................................................................... 44 2.3.6 DATA COLLECTION ....................................................................................................... 45 2.3.7 ASSESSMENT OF CAUSALITY ........................................................................................... 45 2.3.8 CRITICAL APPRAISAL .................................................................................................... 45 2.3.9 INCIDENCE OF MRH .................................................................................................... 49 2.3.10 SEVERITY, PREVENTABILITY AND RISK FACTORS ................................................................. 51 2.4 DISCUSSION ................................................................................................................... 53 1 2.4.1 HEALTHCARE COSTS ASSOCIATED WITH MRH .................................................................... 54 2.4.2 DEFINING MEDICATION-RELATED HARM ........................................................................... 54 2.4.3 DATA COLLECTION ...................................................................................................... 55 2.4.4 RISK FACTORS ............................................................................................................. 56 2.4.5 LIMITATIONS .............................................................................................................. 56 2.5 CONCLUSIONS ............................................................................................................... 57 CHAPTER 3. ......................................................................................................................... 58 MEDICATION-RELATED HARM: A QUALITATIVE EXPLORATION OF THE OLDER PERSON’S LIVED EXPERIENCE .............................................................................................................. 58 3.1 INTRODUCTION ............................................................................................................. 60 3.2 METHODS ...................................................................................................................... 63 3.2.1 DISEASE VERSUS ILLNESS: THE IMPORTANCE OF LIVED EXPERIENCE .......................................... 63 3.2.2 SETTING AND ETHICS .................................................................................................... 64 3.2.3 CONCEPTION AND DESIGN ............................................................................................. 64 3.2.4 PATIENT AND PUBLIC INVOLVEMENT ................................................................................ 65 3.2.5 DEFINITION ................................................................................................................ 65 3.2.6 RECRUITMENT ............................................................................................................ 66 3.2.7 HOUSEBOUND PARTICIPANTS ......................................................................................... 66 3.2.8 AMBULATORY PARTICIPANTS ......................................................................................... 67 3.2.9 DATA COLLECTION APPROACH ....................................................................................... 68 3.2.10 THEMATIC ANALYSIS .................................................................................................. 69 3.2.11 REFLEXIVITY ............................................................................................................. 70 3.3 RESULTS ........................................................................................................................ 71 3.3.1 EXPERIENCES OF THE HEALTHCARE SYSTEM ....................................................................... 73 3.3.1.1 Communication ............................................................................................... 74 3.3.1.2 Inappropriate prescribing ................................................................................ 77 3.3.1.3 Hospital discharge ........................................................................................... 77 3.3.2 PRACTICALITIES OF USING MEDICINES .............................................................................. 79 3.3.2.1 Formulation, Packaging and instructions ......................................................... 79 3.3.2.2 Side-Effects ...................................................................................................... 81 3.3.3 MANAGEMENT OF MEDICATION PROBLEMS ...................................................................... 81 3.3.3.1 Information and Support.................................................................................. 82 3.3.3.2 Non-Adherence ................................................................................................ 82 3.3.4 PARTICIPANT BELIEFS ..................................................................................................
Recommended publications
  • Overdiagnosis and Overtreatment Over Time
    University of Massachusetts Medical School eScholarship@UMMS Family Medicine and Community Health Publications and Presentations Family Medicine and Community Health 2015-6 Overdiagnosis and overtreatment over time Stephen A. Martin University of Massachusetts Medical School Et al. Let us know how access to this document benefits ou.y Follow this and additional works at: https://escholarship.umassmed.edu/fmch_articles Part of the Community Health and Preventive Medicine Commons, Diagnosis Commons, Family Medicine Commons, Preventive Medicine Commons, and the Primary Care Commons Repository Citation Martin SA, Podolsky SH, Greene JA. (2015). Overdiagnosis and overtreatment over time. Family Medicine and Community Health Publications and Presentations. https://doi.org/10.1515/dx-2014-0072. Retrieved from https://escholarship.umassmed.edu/fmch_articles/318 Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License. This material is brought to you by eScholarship@UMMS. It has been accepted for inclusion in Family Medicine and Community Health Publications and Presentations by an authorized administrator of eScholarship@UMMS. For more information, please contact Lisa.Palmer@umassmed.edu. Diagnosis 2015; 2(2): 105–109 Opinion Paper Open Access Stephen A. Martin*, Scott H. Podolsky and Jeremy A. Greene Overdiagnosis and overtreatment over time Abstract: Overdiagnosis and overtreatment are often Introduction thought of as relatively recent phenomena, influenced by a contemporary combination of technology, speciali- In recent years, an increasing number of clinicians, jour- zation, payment models, marketing, and supply-related nalists, health service researchers, and policy-makers demand. Yet a quick glance at the historical record reveals have drawn attention to the problems of overdiagnosis that physicians and medical manufacturers have been and the overtreatment that it so often engenders [1, 2].
    [Show full text]
  • BOOKTIVISM: the Power of Words
    BOOKTIVISM: The Power of Words Book•ti•vi•sm(noun). 1. The mobilization of groups of concerned citizens produced by reading books offering powerful analyses of social or political issues. 2. A call to action based on the sharing of knowledge through books. 3. Books + activism = “booktivism.” 4. A term first used at the SellingSickness, 2013: People Before Profits conference in Washington, DC, see www.sellingsickness.com. Read. Discuss. Be thoughtful. Be committed. Here are some more suggestions to get you started: 1) Set up a reading group on disease-mongering among interested friends and colleagues. If you do The books included in BOOKTIVISM celebrate recent contributions to the broad topic of disease- not already have a group of interested readers, post a notice in your workplace, library, community mongering, especially as they examine the growing prevalence and consequences of overtreatment, center, apartment building, etc. Once you have a group, decide where to meet. Book clubs can overscreening, overmarketing, and overdiagnosis (see Lynn Payer’s 1992 classic, Disease-Mongers: How meet anywhere – at homes, in dorms, in pubs, in coffeehouses, at libraries, even online! Decide on Doctors, Drug Companies, and Insurers Are Making You Feel Sick, for an introduction to timing and format. Will you meet monthly/bimonthly? You’ll need time to prepare for the sessions, disease-mongering). but not so much time that you lose touch. Circulate the reading guide. It is usually best if one person leads each discussion, to have some questions at the ready and get things rolling. Although the challenge to disease-mongering is not unprecedented (the women’s health movement of the 1970s was another key historical moment), these books represent an impressive groundswell OR, maybe you’d like to of amazing, powerful, brilliant, and often deeply unsettling investigations by physicians, health scientists, 2) Set up a lecture/discussion group.
    [Show full text]
  • National Cancer Institute University of Oxford
    SEPTEMBER 1-3, 2015 CO-SPONSORED BY NATIONAL CANCER INSTITUTE Division of Cancer Prevention UNIVERSITY OF OXFORD Centre for Evidence-Based Medicine NATCHER CONFERENCE CENTER National Institutes of Health | Bethesda, Maryland USA NOTICE OF PHOTOGRAPHY & FILMING Preventing Overdiagnosis 2015 is being visually documented. By your attendance you acknowledge that you have been informed that you may be photographed and recorded during this event . Images taken will be treated as property of Preventing Overdiagnosis and may be used in the future for promotional purposes. These images may be used without limitation by any organisation approved by the Preventing Overdiagnosis scientific committee and edited prior to publication as seen fit for purpose. Images will be available on the Internet, accessible to Internet users throughout the world including countries that may have less extensive data protection laws than partnering organisation countries. All films will be securely stored on the University of Oxford servers. Please make your- self known at the registration desk if you wish to remain off camera. Thank you for your cooperation. CONFERENCE PARTNERS The Dartmouth Institute Bond University, Centre for Research in Evidence-Based Practice The BMJ Consumer Reports University of Oxford, Centre for Evidence-Based Medicine The views expressed in these materials or by presenters or participants at the event do not necessarily reflect the official policies of the U.S. Department of Health and Human Services, the National Institutes of Health, the National Cancer Institute, or any NIH component. TABLE OF CONTENTS WELCOME 2015 Scientific Committee 4 KEYNOTES BIOS 6 PROGRAMME 16 KEYNOTE ABSTRACTS 32 WORKSHOP ABSTRACTS 34 SEMINAR ABSTRACTS 48 PANEL SESSION ABSTRACTS 61 POSTERS 66 NOTES 67 MAPS WELCOME We are pleased to welcome you to the 3rd Preventing Overdiagnosis conference, held in Bethesda, Maryland on the campus of the US National Institutes of Health.
    [Show full text]
  • People Before Profits February 21 - 22, 2013
    Selling Sickness, 2013: People Before Profits February 21 - 22, 2013 bringing together ACADEMIC MEDICAL REFORMERS, CONSUMER ACTIVISTS, AND HEALTH JOURNALISTS to examine the current scope of disease mongering and to develop strategies and coalitions FOR CHANGE Hyatt Regency Washington on Capitol Hill Washington D.C. Floorplan REGENCY D REGENCY B REGENCY C GOOD NEWS EXHIBIT HALL Ballroom Level 2 Selling Sickness 2013: People Before Profits - Washington D.C. Table of Contents Conference Floorplan ............................................................................. 2 Welcome from Leonore and Kim ............................................................ 4 Special Thank Yous ............................................................................... 5 Disease-Mongering, defined.................................................................. 6 Call To Action On Disease Mongering ................................................... 7 Booktivism ............................................................................................. 9 Schedule-at-a-glance, Thursday, 2/21 ................................................... 10 Schedule-at-a-glance, Friday, 2/22 ........................................................ 11 Conference Program ............................................................................. 12 Wednesday, Registration, Social Hour .............................................. 12 Thursday morning sessions and break ............................................. 12 Thursday lunch .................................................................................
    [Show full text]
  • Preventing Overdiagnosis: How to Stop Harming the Healthy
    MEDICALISATION bmj.com � BMJ blog: Elizabeth Loder on tackling unnecessary treatment in the US: This time “it feels diff erent” � Des Spence: The psychiatric oligarchs who medicalise normality (BMJ 2012;344:e3135) � Research: Overdiagnosis in publicly organised mammography screening programmes (BMJ 2009;339:b2587) Preventing overdiagnosis: how to stop harming the healthy Evidence is mounting that medicine is harming healthy people through ever earlier detection and ever wider definition of disease. With the announcement of an international conference to improve understanding of the problem of overdiagnosis, Ray Moynihan , Jenny Doust , and David Henry examine its causes and explore solutions edicine’s much hailed ability to help the sick is fast being challenged by its propensity to harm the healthy. A burgeon- ing scientifi c literature is fuel- M ling public concerns that too many people are being overdosed, 1 overtreated, 2 and overdiag- nosed. 3 Screening programmes are detecting early cancers that will never cause symptoms or death, 4 sensitive diagnostic technologies iden- tify “abnormalities” so tiny they will remain benign, 5 while widening disease defi nitions mean people at ever lower risks receive permanent medical labels and lifelong treatments that will fail to benefit many of them. 3 6 With estimates that more than $200bn (£128bn; €160bn) may be wasted on unnecessary treatment every year in the United States,7 the cumulative burden from overdiagnosis poses a signifi cant threat to human health. Narrowly defined , overdiagnosis occurs when people without symptoms are diagnosed with a disease that ultimately will not cause them to experience symptoms or early death.3 More broadly defi ned, overdiagnosis refers to the related problems of overmedicalisation and subsequent overtreatment, diagnosis creep, shift ing thresholds, and disease mongering, all processes helping to reclassify healthy people with mild problems or at low risk as sick.
    [Show full text]
  • Adopting the UNESCO Ethics Model to Critique Disease Mongering Barbara Postol
    Duquesne University Duquesne Scholarship Collection Electronic Theses and Dissertations Spring 1-1-2016 Adopting the UNESCO Ethics Model to Critique Disease Mongering Barbara Postol Follow this and additional works at: https://dsc.duq.edu/etd Recommended Citation Postol, B. (2016). Adopting the UNESCO Ethics Model to Critique Disease Mongering (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/1496 This One-year Embargo is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. ADOPTING THE UNESCO ETHICS MODEL TO CRITIQUE DISEASE MONGERING A Dissertation Submitted to the McAnulty College and Graduate School of Liberal Arts Duquesne University In partial fulfillment of the requirements for the degree of Doctor of Philosophy By Barbara A. Postol May 2016 Copyright by Barbara A. Postol 2016 ADOPTING THE UNESCO ETHICS MODEL TO CRITIQUE DISEASE MONGERING By Barbara A. Postol Approved April 5, 2016 ________________________________ ________________________________ Henk ten Have, MD, PhD Gerard Magill, PhD Director, Center for Healthcare Ethics Vernon F. Gallagher Chair for Professor of Healthcare Ethics Integration of Science, Theology, (Dissertation/Project Chair) Philosophy and Law Professor of Healthcare Ethics (Committee Member) ________________________________ ________________________________ Joris Gielen, PhD Henk ten Have, MD, PhD Assistant Professor of Healthcare Ethics Professor of Healthcare Ethics (Committee Member) (Center Director) ________________________________ James Swindal, PhD Dean, McAnulty College and Graduate School of Liberal Arts Professor and Dean of McAnulty College (Dean) iii ABSTRACT ADOPTING THE UNESCO ETHICS MODEL TO CRITIQUE DISEASE MONGERING By Barbara A.
    [Show full text]
  • Disease Mongering (Pseudo-Disease Promotion)
    DIRECTORATE GENERAL FOR INTERNAL POLICIES POLICY DEPARTMENT A: ECONOMIC AND SCIENTIFIC POLICY Disease Mongering (Pseudo-Disease Promotion) NOTE Abstract Disease mongering is the promotion of pseudo-diseases by the pharmaceutical industry aiming at economic benefit. Medical equipment manufacturers, insurance companies, doctors or patient groups may also use it for monetary gain or influence. It has increased in parallel with society's 'medicalisation' and the growth of the pharmaceutical complex. Due to massive investments in marketing and lobbying, ample use of internet and media, and the emergence of new markets, it is becoming a matter of concern, and policy makers should be aware of its perils and consequences. IP/A/ENVI/NT/2012-20 November 2012 PE 492.462 EN This document was requested by the European Parliament's Committee on Environment, Public Health and Food Safety and produced internally in the Policy Department for Economic and Scientific Policy. AUTHORS Dr. Marcelo SOSA-IUDICISSA Dr. Purificación TEJEDOR DEL REAL RESPONSIBLE ADMINISTRATOR Dr. Marcelo SOSA-IUDICISSA Policy Department A: Economic and Scientific Policy European Parliament B-1047 Brussels E-mail: Poldep-Economy-Science@ep.europa.eu LINGUISTIC VERSION Original: EN ABOUT THE EDITOR To contact the Policy Department or to subscribe to its newsletter please write to: Poldep-Economy-Science@ep.europa.eu Manuscript completed in November 2012. Brussels, © European Union, 2012. This document is available on the Internet at: http://www.europarl.europa.eu/studies DISCLAIMER The opinions expressed in this document are the sole responsibility of the authors and do not necessarily represent the official position of the European Parliament.
    [Show full text]
  • Outstanding Medical Research Scientist Award for Basic Biomedical Research
    MDA-126 NEW LEGISLATION TO REGULATE MDAdvisor UPDATE FROM THE NEW JERSEY DEPARTMENT PERSPECTIVES ON HEALTHCARE FROM THE 2 011 OUT-OF-NETWORK BENEFITS OF BANKING AND INSURANCE EDWARD J. ILL EXCELLENCE IN MEDICINE HONOREES NOW MEDLINE INDEXED Daniel B. Frier, Esq., Commissioner Tom Considine Janet S. Puro, MPH, MBA and Mohamed H. Nabulsi, Esq. Spring 11PRINTER:Layout14/8/1110:17AMPage This publication is sponsored by MDAdvantage ™ Insurance Company of New Jersey. F R D T C H S O 201 T O O I O O S E U E E N P A S N R T 1 A D H T E O R S S C V E E T R I A N B A R L I T A F N U G N H I N C C . E T N I H E L R I D M O S C O I A I W S I P S P N N A N C R O Y L L G Y E I R T A R , E A M D M N N E I N D T E S T , E G S D M I A I T B R C A A C A W H L A R V O D L U M E 4 • I S S U E 2 • S P R I N G 2 0 1 1 MDA-126 MDAdvisor Spring 11 PRINTER:Layout 1 4/8/11 10:18 AM Page 2 “When you’re committed to helping achieve excellence in all areas of healthcare, you must begin by recognizing it.
    [Show full text]
  • UNNECESSARY CARE Is Profit Driven Healthcare to Blame?
    OVERTREATMENT bmj.com News: Experts consider how to tackle overtreatment in US healthcare UNNECESSARY CARE (BMJ 2012;344:e3144) doc2doc Overdiagnosis: do we know when to stop? Discuss at doc2doc Is profit driven bmj.com/multimedia Jeanne Lenzer healthcare to blame? (pictured) investigates the harms of overtreatment A newly launched movement led by prominent doctors is challenging the basic assumption in US healthcare that more is better. Jeanne Lenzer reports t 8 am on her first day as an Medicare recipients alone each year. Overall, Medicaid Services; and Harvey Fineberg, presi- intern, Diane Meier attended the unnecessary interventions are estimated to dent of the Institute of Medicine, which co-hosted resuscitation of an 89 year old man account for 10-30% of spending on healthcare the meeting. with end stage congestive heart in the US, or $250bn-$800bn (£154bn-£490bn; Participants poured out examples of ram- failure. The staff shocked the man’s €190bn-€610bn) annually.2 pant overtreatment, ranging from the overuse heartA repeatedly. They tried four times to place of screening tests and imaging technology to an a central line. They injected pressors directly Signs of change epidemic of questionable surgery (tonsillectomies into his heart, stuck his femoral artery for blood Earlier in the year, Meier, along with more than alone increased by 74% from 1996 to 2006). gases, and performed chest compressions for over 130 prominent doctors from the US, Canada, Rita Redberg, a cardiologist and editor of the an hour before finally pronouncing him dead. and the UK participated in a two day conference Archives of Internal Medicine, told the gathering Two decades later, after witnessing similar pre- on avoiding avoidable care, the first in the US to that many interventions need to be challenged, death rituals countless times, Meier published focus exclusively on overtreatment.
    [Show full text]
  • Expanding Disease and Undermining the Ethos of Medicine
    Expanding disease and undermining the ethos of medicine Bjørn Hofmann PhD 1,2 1. Department for the Health Sciences at the Norwegian University of Science and Technology (NTNU) at Gjøvik, Norway 2. Centre of Medical Ethics at the University of Oslo, Norway Corresponding author: Bjørn Hofmann, Centre for Medical Ethics University of Oslo PO Box 1130, Blindern N‐0318 Oslo, Norway b.m.hofmann@medisin.uio.no Expanding disease and undermining the ethos of medicine Abstract: The expansion of the concept of disease poses problems for epidemiology. Certainly, new diseases are discovered and more people are treated earlier and better. However, the historically unprecedented expansion is criticised for going too far. Overdiagnosis, overtreatment, and medicalization are some of the challenges heatedly debated in medicine, media, and in health policy making. How are we to analyse and handle the vast expansion of disease? Where can we draw the line between warranted and unwarranted expansion? To address this issue, which has wide implications for epidemiology, we need to understand how disease is expanded. This article identifies six ways that our conception of disease is expanded: by increased knowledge (epistemic), making more phenomena count as disease (ontological), doing more (pragmatic), defining more (conceptual), and by encompassing the bad (ethic) and the ugly (aesthetic). Expanding the subject matter of medicine extends its realm and power, but also its responsibility. It makes medicine accountable for ever more of human potential dis‐eases. At the same time it blurs the borders and undermines the demarcation of medicine. Six specific advices can guide our action clarifying the subject matter of medicine in general and epidemiology in particular.
    [Show full text]
  • Quaternary Prevention, an Answer of Family Doctors to Overmedicalization Marc Jamoulle*
    http://ijhpm.com Int J Health Policy Manag 2015, 4(2), 61–64 doi 10.15171/ijhpm.2015.24 Perspective Quaternary prevention, an answer of family doctors to overmedicalization Marc Jamoulle* Abstract Article History: In response to the questioning of Health Policy and Management (HPAM) by colleagues on the role of rank Received: 30 November 2014 Accepted: 2 February 2015 and file family physicians in the same journal, the author, a family physician in Belgium, is trying to highlight ePublished: 4 February 2015 the complexity and depth of the work of his colleagues and their contribution to the understanding of the organization and economy of healthcare. It addresses, in particular, the management of health elements throughout the ongoing relationship of the family doctor with his/her patients. It shows how the three dimensions of prevention, clearly included in the daily work, are complemented with the fourth dimension, quaternary prevention or prevention of medicine itself, whose understanding could help to control the economic and human costs of healthcare. Keywords: Physicians, Family; Preventive Medicine; Physician’s Role; Medicalization; Ethics, Clinical Copyright: © 2015 by Kerman University of Medical Sciences *Correspondence to: Citation: Jamoulle M. Quaternary prevention, an answer of family doctors to overmedicalization. Int J Health Marc Jamoulle Policy Manag 2015; 4: 61–64. doi: 10.15171/ijhpm.2015.24 Email: marc.jamoulle@doct.ulg.ac.be rom Health Policy and Management (HPAM) eyes, The doctor’s knowledge, true or false, cross the thoughts, family doctors are rank and file healthcare providers. true or false, of the patient. By his/her training, the doctor In a recent paper in this journal, Chinitz and Rodwin drags irresistibly the patient towards the disease.
    [Show full text]
  • Nutrition and Lifestyle • Research • Reviews
    Summer/ Volume 13 Issue 2 Autumn 2016 ISSN 1743-9493 JOURNALOF holistic healthcare Food as Medicine conference Healthy farming = healthy food An ethical approach to obesity Do doctors underestimate patient’s interest in lifestyle change? Lifestyle medicine Kitchen on prescription Ayurvedic perspectives on self-care Are we medicalising normal human experience? Medical student resilience symposium Plus Nutrition and lifestyle • Research • Reviews IN COLLABORATION WITH THE COLLEGEOF MEDICINE JOURNALOF holistic healthcare Contents ISSN 1743-9493 Editorial . 2 Published by Doctors can only tackle chronic disease with the right tools. Teach them nutrition. 3 British Holistic Medical Association West Barn, Chewton Keynsham Jerome Burne BRISTOL BS31 2SR Good nutrition begins in the soil. 6 contactbhma@aol.co.uk www.bhma.org Patrick Holden An ethical approach to obesity. 9 Reg. Charity No. 289459 Robyn Toomath Editor-in-chief Do we doctors underestimate our patients’ interest in lifestyle David Peters change and willingness to collaborate to improve health?. 12 petersd@westminster.ac.uk David Unwin Editorial Board Lifestyle medicine . 15 Peter Donebauer Rob Lawson Ian Henghes Dr William House (Chair) Social prescribing in action: Professor David Peters Bristol’s Kitchen on Prescription Alliance . 20 Dr Thuli Whitehouse Helen Cooke & Elizabeth Thompson Dr Antonia Wrigley Nurturing health with traditional herbal medicine. 25 Production editor Sebastian Pole Edwina Rowling edwina.rowling@gmail.com Self-care and self-cultivation: the necessary foundation to heal. 30 Thuli Whitehouse Advertising Rates 1/4 page £130; 1/2 page £210; Diagnosis: are we medicalising human experience? full page £400; loose inserts £140. A radical review . 33 Rates are exclusive of origination Vinay Mandagere where applicable.
    [Show full text]