Dr Robert London

Self-Care Strategies - NYTimes.com

Readers discuss a doctor’s call for expanded use of mind-body techniques for both financial and health reasons.

To the Editor:

Many economists believe that health care costs will continue to rise. Even more distressing, the Affordable Care Act will likely reinforce current practice, which dictates surgical and pharmacological interventions that can be expensive, inappropriate, burdened by side effects and, often, ineffective.

Forty years ago, as a researcher at the National Institute of Mental Health, I began to study inexpensive self-care strategies — then called “alternative therapies” — that might address the underlying biological and psychological imbalances that contribute to chronic conditions. These included nutrition, exercise and “mind-body” techniques like meditation, guided mental imagery and biofeedback.

Since then, research has demonstrated that mind-body approaches reduce stress and improve mood and immunity. They decrease blood pressure in hypertensives, blood sugar in diabetics and pain. Dietary modification can play a major role in preventing breast, prostate and colon cancer, as well as in diabetes and heart disease. And exercise, which can help prevent all of these, can also alleviate depression.

We spend about twice as much as many other industrialized nations on health care, often with inferior outcomes. Three-quarters of that spending is on chronic conditions, including heart disease, diabetes, cancer, arthritis, depression and chronic pain — exactly the ones for which self-care is best suited. Comprehensive programs that offer self-care in a supportive group are even more promising, for both treatment and prevention. This approach is also proving effective for psychological trauma.

What was unexamined and alternative 40 years ago is now well researched. It should be fundamental. If we are going to reduce our ruinous costs and improve our declining national health, we must make self-care and group support central to all care.

Washington, May 12, 2014

The writer, a psychiatrist, directs the Center for Mind-Body Medicine and was chairman of the White House Commission on Complementary and Alternative Medicine Policy appointed by President Bill Clinton.

Readers React

I agree with Dr. Gordon that alternative therapies can be very useful, cost-effective approaches to successful care. As a psychiatrist, I have used and taught medical hypnosis, often classified as alternative therapy. Medical hypnosis, an old and well-studied therapeutic tool with a lot of good science behind it, when combined with certain behavior modification strategies, can help patients stop smoking and lose weight. Hypnosis is also a tool that can be used to address deeper issues, including anxiety, high stress and insomnia. Conquering those kinds of problems, in turn, can have a positive effect on physiological illnesses such as cardiovascular disease and metabolic disorders.

Unfortunately, neither hypnosis nor other alternative therapies are readily taught in medical training programs. These programs need to incorporate alternative and adjunctive care with the recognition that these techniques can be an important component of a well-rounded therapeutic plan, never losing sight of the great medical and surgical treatments that cure illnesses, prevent disease and improve our quality of life.

New York, May 14, 2014

The writer is on the faculty of NYU Langone Medical Center.