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How to Transition from Traditional Allopathic
Practice to a Holistic and Integrated Medical Model
     Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute
             Adjunct Professor – University of Southern Indiana
      Adjunct Clinical Lecturer – Indiana University School of Medicine
                          Department of Psychiatry
     Child, Adolescent, Adult & Forensic Psychiatry – Evansville, Indiana
  This presentation is © Louis B. Cady M.D. and may not be reproduced or
       used without permission. World Link Medical is authorized to
                     reprint/duplicate it for 2012 syllabi.
                     (c) 2012 Louis B. Cady, M.D. - all rights reserved
Louis B. Cady, M.D. – historical statement of
          support, conflict of interests… [>/=2 years]
•   Abbott Laboratories
•   Bristol-Myers Squibb (Serzone)
•   Celltech (Metadate CD)
•   Cephalon (Provigil)
•   Elli Lilly (Prozac)
•   Forest Pharmaceuticals
    (Celexa, Lexapro, Namenda, Viibryd)
•   Glaxo-SmithKline (Wellbutrin, Paxil)
•   Janssen (Concerta, [Reminyl]/ Razadyne)
•   McNeil (Concerta)
•   Pfizer-Roerig (Zoloft, Pristiq)
•   Sanofi~aventis (Ambien)
•   Sepracor (Lunesta)
•   Searle Pharmaceutical (Ambien)
•   Shire Pharmaceuticals (Adderall, Daytrana, Vyvanse,
    Intuniv)
•   Shionogi & Co., Ltd. (Kapvay)
•   Takeda Pharmaceuticals (Rozerem)
•   Wyeth-Ayerst (Effexor, Pristiq)      Note: Today’s presentations are CME and
                                          are sponsored by World Link Medical.
“The mind, once
expanded to the
dimensions of larger
ideas, never returns to
its original size.”
 - Oliver Wendell Holmes
Ethics and financial/logistical
      practicalities of these lectures
• Nothing is more important than taking care of the
  patient.
• “The needs of the patient come first.” (Dr. Will
  Mayo, MD)
• The current “medical model” is at variance with
  what is ethical, moral, and factual.
• If the physician is not stable and financially secure,
  the system implodes.
   – “No margin, no mission.” - Steven R. Covey
• If the system implodes, the patient suffers.
Background
Attention class!!

www.slideshare.net/lcadymd
www.slideshare.net/lcadymd
Tech Rules…. Please turn
your phones ON      (just
       silenced).




• Shoot photos!
• Tweet! ( @LouisCadyMD )
“Wellness
    Traditional                                     [integrated]




                                                                       Optimal Health
                             No Disease = Health
     Medicine                                        Medicine”
                                                     Forestall and
    Diagnose and                                   PREVENT Disease –
    Treat Disease
Death



                                                   Optimize Function

        New Drugs                                     Hormone
        New Surgical                                  Modulation
         Techniques


                               Diet, Exercise
                       Nutritional Supplementation
“But my patients don’t know about
  this and aren’t asking for it….”
                  “It’s not the
                  consumers’
                  job to know
                  what they
                  want.”
                  - Steve Jobs
Health is a state of complete
physical, mental and social
well-being, and not merely
the absence of disease or
infirmity.
- World Health Organization
American Journal of Health Promotion;
                 November/December, 2002

                                    66%                 19% of those
          18.8%
                            “Incompletely healthy”     surveyed were
        completely
                                                         completely
         unhealthy,
                                                         healthy with
          defined as
                                                        high levels of
          having low
                                                        both physical
       levels of health
                                                          and mental
           with high        Two-thirds of the adults     health and a
           levels of            reported some             low level of
            illness.         degree of mental
                                                            illness.
                                 or physical
                            illness that kept them
                             from being completely
                                    healthy.




                                                                    OPTIMAL
                            “Incompletely healthy.”
DEAD




                          HEALTH continuum
Outline

•   Overview of concepts
•   My bias – a practice model
•   Current state of allopathic medicine
•   Microchip as disruptor and disintermediator
    – (“Change or die”)
• Current state of patients and society
• What’s your model? Chloraseptic or PCN?
• How to start changing….
The evolution of my practice
• Sidetracked in high school, two degrees in music (’77 and
  ’79) and learned piano tuning
• 1976 – 1989 – piano tuning (through pre-med and med
  school). “fee for service”
• 1989-1993 – conventional allopathic psychiatry residency
  at Mayo Clinic
• 1993 – start practice. 1995 – l-tyrosine and EFA’s
• 2002 – first IFM conference
• 2003 – Cenegenics training
• 2005 – founded Cady Wellness Institute
• 2010 – 2011 – Neil Rouzier, MD & WorldLink
• 2012 – rTMS (Transcranial Magnetic Stimulation)
May 2002: 9th Annual IFM Conference
The Functional Medicine component




  Dead Doctors Don’t Lie - Joel Wallach, DVM, ND
Cady Wellness Institute – July 2005
                The Reasons:
•   Conventional medical practice had failed me twice.
•   A lot of “psychiatric cases” WEREN’T “psychiatric.”
•   Nobody was integrated.
•   Nobody was looking at ALL of the peer-reviewed
    literature.
Current socioeconomic state and
allopathic (“conventional”) medicine –
        DISRUPTIVE NOTIONS
• CONVENTIONAL Allopathic medicine = symptom
  focused, reactive, “taught,” unthinking, uncreative,
  PRACTICALLY non-informed by peer-reviewed
  medical literature.
   – Commoditized. No variability. “Providers.”

• Wellness medicine: individualized. Can’t get it
  elsewhere. Not a commodity. Scientific. Informed
  by peer-reviewed literature.
   – Concept of “information brokering” (example: THYROID)
Healthcare “Reform” Today
•Today: Patient Protection and Affordable Care Act (P.L. 111-148) – includes amendments from
            the Health Care and Education Reconciliation Act of 2010 (H.R. 4872)




      Slide courtesy of John Adams, MBA – CEO, Cenegenics
  Available at http://voices.washingtonpost.com/capitol-briefing/2009/07/gop_accuses_democrats_of_censo.html
What the feds see & their lust for “cost control”
    Example: salaries for Family Medicine
                       Average
                       Sweden
                        Finland
                     Australia
                         France
                        Canada
                 Switzerland
         United Kingdom
              United States

                                      $0                     $50                    $100                    $150                  $200
                                                               US $1000
Adapted from http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/. Accessed April 3, 2010.


                         Slide courtesy of John Adams, MBA – CEO, Cenegenics
Medicare–Workers per Beneficiary
 Millions




                                                            Year
SOURCE: Kaiser Family Foundation based on the 2009 Annual Report of the Boards of Trustees of the Federal Hospital Insurance
and Federal Supplementary Medical Insurance Trust Funds. http://facts.kff.org/chart.aspx?ch=383. Accessed April 3, 2010.
                       Slide courtesy of John Adams, MBA – CEO, Cenegenics
The Future of Medicare

   “Medicare is going
   bankrupt. The Medicare
   Trustees estimate that
   the program will run
   short of money starting
   in 2017.”

   •Rep. Bobby Scott,
   Senators Jim Webb and Mark Warner

http://www.congress.org/congressorg/bio/userletter/?
id=3181&letter_id=4747883751. Accessed April 3, 2010.



                         Slide courtesy of John Adams, MBA – CEO, Cenegenics
http://www.ama-assn.org/amednews/2011/11/21/gvsd1121.htm
SOURCE: Mary Meeker, Partner – Kleiner, Perkins Caulfield & Byers –
“Internet Trends” Slide deck – D10 conference, released 5/31/2012
SOURCE: Mary Meeker, Partner – Kleiner, Perkins Caulfield & Byers –
“Internet Trends” Slide deck – D10 conference, released 5/31/2012
Healthcare Reform–Physicians Perception of
     Medicine Over the Next Few Years




http://www.athenahealth.com/index.php?open=26. Accessed April 3, 2010.
               Slide courtesy of John Adams, MBA – CEO, Cenegenics
Are the Best and Brightest
  Staying in Medicine?


            “60% of physicians
            would not recommend
            medicine as a career
            to their children.”
            http://www.mayorswellnesscampaign.org/wp-

             •        – The Physicians’
            content/uploads/2009/05/merritt-hawkins-survey.pdf.
            Accessed April 3, 2010.

             Foundation
         Slide courtesy of John Adams, MBA – CEO, Cenegenics
“Although American doctors feel stressed, overworked, and
uncertain about the future, they’re generally happy with their
career choices and the state of their lives (???), despite practicing
during one of the greatest periods of tumult in the modern history
of US healthcare.”
    “The results also suggest strongly that physicians wish
     they had more control of their careers… and time.”
http://marketing-images.ubmmedica.com/Insights/2011/2011_GAP_Survey.pdf

Accessed 01 21 2012
Current US Physicians’ Attitudes
                                     • Mean respondent – 51 yoa
                                          – 43% primary care; 57%
                                            specialty
                                     • 31% owners of private
                                       practice
                                     • 96% - at least somewhat
                                       happy to be docs
                                     • 65% - plan to remain in
                                       practice at least 5 years
                                     • Note – no “n” cited.
Great American Physician Survey – July 31, 2011 – UBM Medica – cf:
http://marketing-images.ubmmedica.com/Insights/2011/2011_GAP_Survey.pdf
referenced 01 21 2012
“The Great Crossover” – the microchip
cf: Dan Sullivan www.strategiccoach.com
Accessed 1 21 2012
Current status of patients and
society
CURRENT PRACTICE OF MEDICINE:
What a patient had to say about her “specialists”:




“They just monitor my
    degeneration.”
Consultations with “complementary
   and alternative” practitioners
• US, 2004. 36% of US adult >18 yoa
  – National Center for Complementary and Alternative
    Medicine survey, 2004.
      • http://altmedicine.about.com/od/alternativemedicinebasics/a/CAMus


• Canada – 1.2 million adults, or 13% of the
  population of Ontario. N = 32,598 surveyed.
  – Williams, Kitchen, e al. Alternative health care consultations in Ontario,
    Canada. BMC Complementary and Alternative Medicine 2011, 11:47
What causes oxidative stress?
• Environmental Toxins
  –   Heavy metals – including Mercury (fillings!)
  –   Pesticides/herbicides
  –   Preservatives
  –   PCB’s, Dioxins, Phthalates


• Toxins produced in the body
  – Yeast and bacteria
  – Products of cellular metabolism

• Emotional Stress
  – Anxiety/Tension
  – Fear
  – Anger
Today’s Medical Practice
            Challenges
• Obesity, diabetes, auto-immune, inflammatory and
  chronic diseases increasing
• Inflammatory triggers increasing
• Novel viruses and infective organisms
• Unresponsive/resistant infections
• Weakened immune systems
• GI decline/inflammation
• Poor quality /foods/nutritionals
A change from the allopathic
model?
Socioeconomic/disruptive forces
              with two models
    Allopathic                                 Wellness/ fxnl med
•    Disease and           CHANGE AGENTS
                                               •   Integrated and whole
     sickness focused                              person model
•    Short appointments   • Microchip/intern   •   Bill for time
•    Commoditized           et                 •   Non-commoditized
•    Compartmentalized    • Increase in        •   Collaborative
•    Doctor as priest       chronic disease    •   Informed patients
•    Uninformed patient   • “boomers”              willing to “pay for
•    Sicker patients      • Job/socio-             expertise”
•    Either practice        economic           •   Practice per peer-
     ignorantly or with                            reviewed literature;
                            pressures              No crises (pl) of
     guilty conscience
•    Worry/poor                                    conscience
     satisfaction                              •   INTENSE satisfaction
Divergence of focus of two models
                                          Wellness/ fxnl med;
                                      “complementary/alternative”
Allopathic
•   Relief of symptoms                 •   CAUSE of symptoms, prevention
•   Organ specific                     •   SYSTEMS focused
•   Aggressive. “magic bullet”         •   Gentle, methodical.
•   Rules, practice guidelines         •   Creative. What works?
•   Patient as uninformed              •   Patient as integral part of team.
    protoplasm.                            Questions/participation
                                           encouraged.
•   Tied to medico-pharmaco-           •   Focused on health and optimization
    industrial complex                     with natural, bio-identical methods
•   Use of synthetic, patented,        •   Use of PROVEN botanicals and
    not-from-nature substances             natural hormones (as well as
                                           conventional RX).
Adatped from “Alternative Medicine: Why so popular? By Hans R. Larsen, MSc ChE.
International Health News, Sept 1999, issue 93
http://www.yourhealthbase.com/alternative_medicine.htm accessed 1 21 2012
“Slumber not in
the tents of your
fathers.
The world is
advancing.
Advance with it.”
 - Giuseppe Mazzine
Some interesting thoughts:
• “The war situation has developed not
  necessarily to Japan’s advantage..”- Japanese
  Emperor Hirohito after the atomic bombing of Hiroshima and Nagasaki,
  announcing Japan’s surrender to the Allies



• “A naïve analysis of stability is derived from the
  absence of past variations” (or “The Turkey
  Problem”)
   – Nicholas Taleb, author of The Black Swan
What does integrated, holistic
   medicine “look like?”

   A quick dip in the literature
% U.S. Women with inadequate quantities of nutrients




Arab L, Carriquiry A, Steck-Scott S, Gaudet MM. Ethnic differences in the
nutrient intake adequacy of premenopausal US women: results from the Third
National Health Examination Survey. J Am Diet Assoc 2003; 103:1008-14.
= 2 apples (fruits) & 3 - 4 vegetables
– per CDC
4 – 13 servings of fruits and
vegetables per day, depending on
energy needs
% Mineral depletion from the soil
during the past 100 years, by continent


           North America             85%
           South America             76%
           Asia                      76%
           Africa                    74%
           Europe                    72%
           Australia                 55%
           Source: UN Earth Summit Report 1992
Cf: http://www.veganforum.com/forums/showthread.php?t=3532
Source: Jerry Brunetti – www.agri-dyanmics.com
16,103 people – 1994 – 1996.

ZERO got 100% of all required vitamins and
nutrients
- Highest – B12 =- 82.8% got enough
- 66.8% - had adequate folate
- Lowest – Zinc – only 26.6% got enough.
Factors trapping physicians
• “Doing it, doing it, doing it.” (Michael Gerber, The
  E-Myth)
• Already time-pressured –
   – Minimal time to think or plan
   – PROBABLY ADRENALLY DEPLETED ALREADY,
     perhaps with suboptimal thyroid and sex hormones
   – Tip – GET YOUR LABS CHECKED!!
• Must “make overhead.”
• Can’t “take chances.”
• Trapped by “provider panel” arrangements,
  including cut rate fees. (Alcoa story)
The Baby Boomers & Their Expectations
   The first time the entire
    Baby Boom generation
is impacting a single market
    ALL at the same time!
Let’s look at the logic.
How would you take care of a classic?

                         “Chronic diseases
                         affect at least 125
                         million Americans
                         & cost more than
                         $500 billion last
                         year.”
         Centers for DiseaseControl – Dec 2003
“Age management”           “Conventional practice”
There are fuel additives    No fuel additives should
we can use to keep our      be used. They are
cars burning cleaner and    unnatural. Gas is all that
preserve engines.           is required.
We should use optimal       The quality of the gas is
quality of gas. Cheap gas   irrelevant. Anything that
causes “pinging” which is   the motor will burn is
hard on the engine.         adequate.
We should take our car in   Preventive maintenance? This
for preventive              is silly! Wait until something
                            breaks, then have the car
maintenance before
                            towed in so the mechanic can
anything breaks.
                            really tell what is wrong.
Modern Medicine’s Paradigm:
Two Standard Deviations – “if you are not
     sick, then you must be well.”

                               “NORMAL”


                             OPTIMAL?

                                OPTIMAL
Definition of “normal labs”:
            “When your lab
            values are as
            crappy as
            everyone else’s.”
                        - Neil Rouzier,
            MD (World Link Medical Seminar II
                               – Spring 2011)
MAKING THE TRANSITION
• Must DECIDE
   – Must have INFO (e.g., this weekend)
   – Must INTROSPECT
• Must have something LEGITIMATE to offer
• Start SMALL – both with interventions and
  logistics/financial
   – E.g, ¼ grain Armour, or Cytomel 5 MICROgrams, or Cortef 5 mg
     twice daily, or FDA approved testosterone for guys
   – E.g. – ½ day per week – “hormones”
• Get EDUCATION
   – Teachers – Rouzier, World Link Medical
   – AAMG, A4M
• Find a mentor (s) – start here
Marketing & Practice Development
• Maintain excellence in allopathy or (traditional
  osteopathy)
   – (knowledge base, prescribing, surgery)
   – (“Be able to debate the great issues.” – Jim Rohn)
• Know your [new] stuff!
• Do not badmouth the competition. (Chris Lord
  example).
• Give CME talks and paper over their objecting
  mouths with references. (examples follow next)
• Spiritual and ethical clarity.
Quick examples of powering
    through objections and
  overwhelming with literature
   Note – don’t get bogged down.
      Get the idea of HOW TO
        PRESENT the data.
A Scientific (& FUN!!!) Review of Vitamin
  Supplementation & Essential Nutrients
Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute
        Adjunct Professor – University of Southern Indiana
 Adjunct Clinical Lecturer – Indiana University School of Medicine
                     Department of Psychiatry
Child, Adolescent, Adult & Forensic Psychiatry – Evansville, Indiana


  Presented 2 27 2010 – Oliver Headache and Pain Clinic
  CME seminar – Evansville, IN
Trends in Pharmacological Sciences (2008) Jul; 29(7):351. Epub 2008 Jun 4
• Mitochondrial diseases are due to impairment of
  chemical reactions.
• A reasonable theory is oxidative stress.
• Few studies have actually been done on this.
• Glutathione deficiency is known in mitochondrial
  disease.
• Biosynthesis of glutathione depends on cysteine
  availability.
• “Our findings reinforce the notions that in
  mitochondrial disease, oxidative stress is
  important and can be reduced by
  administration of a cysteine donor.”
Zoned, Stoned and Blown: The Emotional
 Tsunami of Psychiatric Disorders Coupled
with Pain Disorders & Chemical Dependency
Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute
        Adjunct Professor – University of Southern Indiana
 Adjunct Clinical Lecturer – Indiana University School of Medicine
                     Department of Psychiatry
Child, Adolescent, Adult & Forensic Psychiatry – Evansville, Indiana



  Also Presented 2 27 2010 – Oliver Headache and Pain
  Clinic CME seminar – Evansville, IN
Pharmacotherapy Significantly
Reduces Substance Abuse in Adults
           with ADHD
                        40
                               32
                                           3-fold!            P<0.001
% of study population




                        30


                        20
                                             12                         10

                        10


                         0
                             Unmedicated   Medicated                    Control
                             ADHD          ADHD                        (N=137)
                              (N=19)        (N=56)

                                               Biederman J, et al. Pediatrics. 1999;104:e20-e25.
…END EXAMPLES…

Business philosophy citations
           follow
“You can have everything in life
   you want, if you just help
 enough other people get what
         they want.”
          - Zig Ziglar

What do patients want?
•To be treated with
respect
•To not have to wait!
•To FEEL BETTER
•To HAVE HOPE.
•To not be doped up.
•To NOT have their
money wasted.
$5,000 worth of wisdom on one page
        – from Jay Abraham
• Risk reversal
• “USP” – unique selling   Focus: “Be able to
  proposition
                           treat your clients
• Defining the buying
                           (or patients) as
  criteria
                           dear and valued
• Three ways for more
                           friends.”
  profit:                  - Jay Abraham
  – Higher price
  – More frequency
  – Additional items
    (supplements, etc.)
Evansville Courier & Press: May 29,
          2006




References: www.pharmanexmd.com ; www.slideshare.net/lcadymd
;
Dr. Oz show on YouTube:
http://www.youtube.com/watch?v=rX4oxxGWi_8
My position on supplements

• “The needs of the patient come first.” – W
  Mayo
• Unique and patented. (Otherwise GNC is
  fine).
• Guaranteed (risk reversal).
• Measurable changes
• Be a doctor and not a stock boy or inventory
  clerk.
Jay Abraham References
    (recommended)




    www.amazon.com
Building CWI - what has worked
• Being nice to patients
  – (on time, polite, compliment on questions, don’t be a
    jerk or abrasive, put yourself into their shoes, etc.)
• Be good and get results. BE THE BEST!
• Be TRANSPARENT – give’em their labs.
  – Write on them. Draw pictures. Take time (and BILL
    FOR IT).
  – Cenegenics model
• Be appropriately self-protective of your time and
  talents. “If they show up, bill’em.” – Dan
  Kennedy.
MARKETING – what has and hasn’t
              worked
Worked                    Hasn’t worked
• Word of mouth           • Paid advertising (TV,
• Public seminars           print, magazines)
• Web site
                          • What I HAVEN’T tried:
• Going to MD’s/DO’s
                              – Marketing consultants
  offices PERSONALLY
                              – Radio ads
• Free stuff – PR
  opportunities         New initiatives:
• Going to places and   •Proprietary, paid websites
  NETWORKING            •“SEO” – search engine
                        optimization (Willie Sutton
                        principle)
Additional resources – handouts
     down front at end of lecture
• “The 10 Commandments of Marketing a
  Medical Practice” – Cady (handout, free)

• Additional resources handout sheet

• Practice Transformation Seminar – to be
  schedule 2013 - at Cady Wellness Institute
Contact information:
                                                       Louis B. Cady, M.D.
                                              www.cadywellness.com

                                   www.indianaTMS-cadywellness.com

                                                       Office: 812-429-0772
                                           E-mail: lcady@cadywellness.com
                                              4727 Rosebud Lane – Suite F
                                                       Interstate Office Park
                                              Newburgh, IN 47630 (USA)




         Download from
iTunes or Android App store now!
A personal close:
How do you want to age?
Success and Failure (Jim Rohn)
  What about you? You’ve only got one body.




• “Errors in judgement” - High glycemic eating,
  no exercise, poor nutrition, lousy/no
  supplementation, high stress practice.
- “Good disciplines” – appropriate diet,
  supplementation, exercise, hormones. Stress
  management. Decent practice and lifestyle.
Perhaps the ability not only to acquire
the confidence of the patient, but to
deserve it, to see what the patient
desires and needs, comes through the
sixth sense we call intuition, which in
turn comes from wide experience and
deep sympathy for and devotion to
the patient, giving to the possessor
remarkable ability to achieve results.
           ...William J. Mayo, 1935
Contact information:
                Louis B. Cady, M.D.
              www.cadywellness.com

  www.indianaTMS-cadywellness.com

                 Office: 812-429-0772
     E-mail: lcady@cadywellness.com
        4727 Rosebud Lane – Suite F
                 Interstate Office Park
        Newburgh, IN 47630 (USA)

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Transition from allopathic to integrated medical practice

  • 1. How to Transition from Traditional Allopathic Practice to a Holistic and Integrated Medical Model Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute Adjunct Professor – University of Southern Indiana Adjunct Clinical Lecturer – Indiana University School of Medicine Department of Psychiatry Child, Adolescent, Adult & Forensic Psychiatry – Evansville, Indiana This presentation is © Louis B. Cady M.D. and may not be reproduced or used without permission. World Link Medical is authorized to reprint/duplicate it for 2012 syllabi. (c) 2012 Louis B. Cady, M.D. - all rights reserved
  • 2. Louis B. Cady, M.D. – historical statement of support, conflict of interests… [>/=2 years] • Abbott Laboratories • Bristol-Myers Squibb (Serzone) • Celltech (Metadate CD) • Cephalon (Provigil) • Elli Lilly (Prozac) • Forest Pharmaceuticals (Celexa, Lexapro, Namenda, Viibryd) • Glaxo-SmithKline (Wellbutrin, Paxil) • Janssen (Concerta, [Reminyl]/ Razadyne) • McNeil (Concerta) • Pfizer-Roerig (Zoloft, Pristiq) • Sanofi~aventis (Ambien) • Sepracor (Lunesta) • Searle Pharmaceutical (Ambien) • Shire Pharmaceuticals (Adderall, Daytrana, Vyvanse, Intuniv) • Shionogi & Co., Ltd. (Kapvay) • Takeda Pharmaceuticals (Rozerem) • Wyeth-Ayerst (Effexor, Pristiq) Note: Today’s presentations are CME and are sponsored by World Link Medical.
  • 3. “The mind, once expanded to the dimensions of larger ideas, never returns to its original size.” - Oliver Wendell Holmes
  • 4. Ethics and financial/logistical practicalities of these lectures • Nothing is more important than taking care of the patient. • “The needs of the patient come first.” (Dr. Will Mayo, MD) • The current “medical model” is at variance with what is ethical, moral, and factual. • If the physician is not stable and financially secure, the system implodes. – “No margin, no mission.” - Steven R. Covey • If the system implodes, the patient suffers.
  • 8. Tech Rules…. Please turn your phones ON (just silenced). • Shoot photos! • Tweet! ( @LouisCadyMD )
  • 9. “Wellness Traditional [integrated] Optimal Health No Disease = Health Medicine Medicine” Forestall and Diagnose and PREVENT Disease – Treat Disease Death Optimize Function New Drugs Hormone New Surgical Modulation Techniques Diet, Exercise Nutritional Supplementation
  • 10. “But my patients don’t know about this and aren’t asking for it….” “It’s not the consumers’ job to know what they want.” - Steve Jobs
  • 11. Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. - World Health Organization
  • 12. American Journal of Health Promotion; November/December, 2002 66% 19% of those 18.8% “Incompletely healthy” surveyed were completely completely unhealthy, healthy with defined as high levels of having low both physical levels of health and mental with high Two-thirds of the adults health and a levels of reported some low level of illness. degree of mental illness. or physical illness that kept them from being completely healthy. OPTIMAL “Incompletely healthy.” DEAD HEALTH continuum
  • 13. Outline • Overview of concepts • My bias – a practice model • Current state of allopathic medicine • Microchip as disruptor and disintermediator – (“Change or die”) • Current state of patients and society • What’s your model? Chloraseptic or PCN? • How to start changing….
  • 14. The evolution of my practice • Sidetracked in high school, two degrees in music (’77 and ’79) and learned piano tuning • 1976 – 1989 – piano tuning (through pre-med and med school). “fee for service” • 1989-1993 – conventional allopathic psychiatry residency at Mayo Clinic • 1993 – start practice. 1995 – l-tyrosine and EFA’s • 2002 – first IFM conference • 2003 – Cenegenics training • 2005 – founded Cady Wellness Institute • 2010 – 2011 – Neil Rouzier, MD & WorldLink • 2012 – rTMS (Transcranial Magnetic Stimulation)
  • 15. May 2002: 9th Annual IFM Conference
  • 16. The Functional Medicine component Dead Doctors Don’t Lie - Joel Wallach, DVM, ND
  • 17.
  • 18.
  • 19.
  • 20. Cady Wellness Institute – July 2005 The Reasons: • Conventional medical practice had failed me twice. • A lot of “psychiatric cases” WEREN’T “psychiatric.” • Nobody was integrated. • Nobody was looking at ALL of the peer-reviewed literature.
  • 21.
  • 22. Current socioeconomic state and allopathic (“conventional”) medicine – DISRUPTIVE NOTIONS • CONVENTIONAL Allopathic medicine = symptom focused, reactive, “taught,” unthinking, uncreative, PRACTICALLY non-informed by peer-reviewed medical literature. – Commoditized. No variability. “Providers.” • Wellness medicine: individualized. Can’t get it elsewhere. Not a commodity. Scientific. Informed by peer-reviewed literature. – Concept of “information brokering” (example: THYROID)
  • 23. Healthcare “Reform” Today •Today: Patient Protection and Affordable Care Act (P.L. 111-148) – includes amendments from the Health Care and Education Reconciliation Act of 2010 (H.R. 4872) Slide courtesy of John Adams, MBA – CEO, Cenegenics Available at http://voices.washingtonpost.com/capitol-briefing/2009/07/gop_accuses_democrats_of_censo.html
  • 24. What the feds see & their lust for “cost control” Example: salaries for Family Medicine Average Sweden Finland Australia France Canada Switzerland United Kingdom United States $0 $50 $100 $150 $200 US $1000 Adapted from http://economix.blogs.nytimes.com/2009/07/15/how-much-do-doctors-in-other-countries-make/. Accessed April 3, 2010. Slide courtesy of John Adams, MBA – CEO, Cenegenics
  • 25. Medicare–Workers per Beneficiary Millions Year SOURCE: Kaiser Family Foundation based on the 2009 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds. http://facts.kff.org/chart.aspx?ch=383. Accessed April 3, 2010. Slide courtesy of John Adams, MBA – CEO, Cenegenics
  • 26. The Future of Medicare “Medicare is going bankrupt. The Medicare Trustees estimate that the program will run short of money starting in 2017.” •Rep. Bobby Scott, Senators Jim Webb and Mark Warner http://www.congress.org/congressorg/bio/userletter/? id=3181&letter_id=4747883751. Accessed April 3, 2010. Slide courtesy of John Adams, MBA – CEO, Cenegenics
  • 28. SOURCE: Mary Meeker, Partner – Kleiner, Perkins Caulfield & Byers – “Internet Trends” Slide deck – D10 conference, released 5/31/2012
  • 29. SOURCE: Mary Meeker, Partner – Kleiner, Perkins Caulfield & Byers – “Internet Trends” Slide deck – D10 conference, released 5/31/2012
  • 30. Healthcare Reform–Physicians Perception of Medicine Over the Next Few Years http://www.athenahealth.com/index.php?open=26. Accessed April 3, 2010. Slide courtesy of John Adams, MBA – CEO, Cenegenics
  • 31. Are the Best and Brightest Staying in Medicine? “60% of physicians would not recommend medicine as a career to their children.” http://www.mayorswellnesscampaign.org/wp- • – The Physicians’ content/uploads/2009/05/merritt-hawkins-survey.pdf. Accessed April 3, 2010. Foundation Slide courtesy of John Adams, MBA – CEO, Cenegenics
  • 32. “Although American doctors feel stressed, overworked, and uncertain about the future, they’re generally happy with their career choices and the state of their lives (???), despite practicing during one of the greatest periods of tumult in the modern history of US healthcare.” “The results also suggest strongly that physicians wish they had more control of their careers… and time.” http://marketing-images.ubmmedica.com/Insights/2011/2011_GAP_Survey.pdf Accessed 01 21 2012
  • 33. Current US Physicians’ Attitudes • Mean respondent – 51 yoa – 43% primary care; 57% specialty • 31% owners of private practice • 96% - at least somewhat happy to be docs • 65% - plan to remain in practice at least 5 years • Note – no “n” cited. Great American Physician Survey – July 31, 2011 – UBM Medica – cf: http://marketing-images.ubmmedica.com/Insights/2011/2011_GAP_Survey.pdf referenced 01 21 2012
  • 34.
  • 35.
  • 36. “The Great Crossover” – the microchip cf: Dan Sullivan www.strategiccoach.com
  • 37.
  • 38.
  • 39.
  • 40.
  • 42. Current status of patients and society
  • 43. CURRENT PRACTICE OF MEDICINE: What a patient had to say about her “specialists”: “They just monitor my degeneration.”
  • 44.
  • 45. Consultations with “complementary and alternative” practitioners • US, 2004. 36% of US adult >18 yoa – National Center for Complementary and Alternative Medicine survey, 2004. • http://altmedicine.about.com/od/alternativemedicinebasics/a/CAMus • Canada – 1.2 million adults, or 13% of the population of Ontario. N = 32,598 surveyed. – Williams, Kitchen, e al. Alternative health care consultations in Ontario, Canada. BMC Complementary and Alternative Medicine 2011, 11:47
  • 46.
  • 47. What causes oxidative stress? • Environmental Toxins – Heavy metals – including Mercury (fillings!) – Pesticides/herbicides – Preservatives – PCB’s, Dioxins, Phthalates • Toxins produced in the body – Yeast and bacteria – Products of cellular metabolism • Emotional Stress – Anxiety/Tension – Fear – Anger
  • 48.
  • 49.
  • 50.
  • 51. Today’s Medical Practice Challenges • Obesity, diabetes, auto-immune, inflammatory and chronic diseases increasing • Inflammatory triggers increasing • Novel viruses and infective organisms • Unresponsive/resistant infections • Weakened immune systems • GI decline/inflammation • Poor quality /foods/nutritionals
  • 52. A change from the allopathic model?
  • 53. Socioeconomic/disruptive forces with two models Allopathic Wellness/ fxnl med • Disease and CHANGE AGENTS • Integrated and whole sickness focused person model • Short appointments • Microchip/intern • Bill for time • Commoditized et • Non-commoditized • Compartmentalized • Increase in • Collaborative • Doctor as priest chronic disease • Informed patients • Uninformed patient • “boomers” willing to “pay for • Sicker patients • Job/socio- expertise” • Either practice economic • Practice per peer- ignorantly or with reviewed literature; pressures No crises (pl) of guilty conscience • Worry/poor conscience satisfaction • INTENSE satisfaction
  • 54. Divergence of focus of two models Wellness/ fxnl med; “complementary/alternative” Allopathic • Relief of symptoms • CAUSE of symptoms, prevention • Organ specific • SYSTEMS focused • Aggressive. “magic bullet” • Gentle, methodical. • Rules, practice guidelines • Creative. What works? • Patient as uninformed • Patient as integral part of team. protoplasm. Questions/participation encouraged. • Tied to medico-pharmaco- • Focused on health and optimization industrial complex with natural, bio-identical methods • Use of synthetic, patented, • Use of PROVEN botanicals and not-from-nature substances natural hormones (as well as conventional RX). Adatped from “Alternative Medicine: Why so popular? By Hans R. Larsen, MSc ChE. International Health News, Sept 1999, issue 93 http://www.yourhealthbase.com/alternative_medicine.htm accessed 1 21 2012
  • 55. “Slumber not in the tents of your fathers. The world is advancing. Advance with it.” - Giuseppe Mazzine
  • 56. Some interesting thoughts: • “The war situation has developed not necessarily to Japan’s advantage..”- Japanese Emperor Hirohito after the atomic bombing of Hiroshima and Nagasaki, announcing Japan’s surrender to the Allies • “A naïve analysis of stability is derived from the absence of past variations” (or “The Turkey Problem”) – Nicholas Taleb, author of The Black Swan
  • 57. What does integrated, holistic medicine “look like?” A quick dip in the literature
  • 58. % U.S. Women with inadequate quantities of nutrients Arab L, Carriquiry A, Steck-Scott S, Gaudet MM. Ethnic differences in the nutrient intake adequacy of premenopausal US women: results from the Third National Health Examination Survey. J Am Diet Assoc 2003; 103:1008-14.
  • 59. = 2 apples (fruits) & 3 - 4 vegetables – per CDC
  • 60. 4 – 13 servings of fruits and vegetables per day, depending on energy needs
  • 61.
  • 62. % Mineral depletion from the soil during the past 100 years, by continent North America 85% South America 76% Asia 76% Africa 74% Europe 72% Australia 55% Source: UN Earth Summit Report 1992
  • 64. Source: Jerry Brunetti – www.agri-dyanmics.com
  • 65.
  • 66. 16,103 people – 1994 – 1996. ZERO got 100% of all required vitamins and nutrients - Highest – B12 =- 82.8% got enough - 66.8% - had adequate folate - Lowest – Zinc – only 26.6% got enough.
  • 67.
  • 68. Factors trapping physicians • “Doing it, doing it, doing it.” (Michael Gerber, The E-Myth) • Already time-pressured – – Minimal time to think or plan – PROBABLY ADRENALLY DEPLETED ALREADY, perhaps with suboptimal thyroid and sex hormones – Tip – GET YOUR LABS CHECKED!! • Must “make overhead.” • Can’t “take chances.” • Trapped by “provider panel” arrangements, including cut rate fees. (Alcoa story)
  • 69. The Baby Boomers & Their Expectations The first time the entire Baby Boom generation is impacting a single market ALL at the same time!
  • 70.
  • 71. Let’s look at the logic. How would you take care of a classic? “Chronic diseases affect at least 125 million Americans & cost more than $500 billion last year.” Centers for DiseaseControl – Dec 2003
  • 72. “Age management” “Conventional practice” There are fuel additives No fuel additives should we can use to keep our be used. They are cars burning cleaner and unnatural. Gas is all that preserve engines. is required. We should use optimal The quality of the gas is quality of gas. Cheap gas irrelevant. Anything that causes “pinging” which is the motor will burn is hard on the engine. adequate. We should take our car in Preventive maintenance? This for preventive is silly! Wait until something breaks, then have the car maintenance before towed in so the mechanic can anything breaks. really tell what is wrong.
  • 73. Modern Medicine’s Paradigm: Two Standard Deviations – “if you are not sick, then you must be well.” “NORMAL” OPTIMAL? OPTIMAL
  • 74. Definition of “normal labs”: “When your lab values are as crappy as everyone else’s.” - Neil Rouzier, MD (World Link Medical Seminar II – Spring 2011)
  • 75. MAKING THE TRANSITION • Must DECIDE – Must have INFO (e.g., this weekend) – Must INTROSPECT • Must have something LEGITIMATE to offer • Start SMALL – both with interventions and logistics/financial – E.g, ¼ grain Armour, or Cytomel 5 MICROgrams, or Cortef 5 mg twice daily, or FDA approved testosterone for guys – E.g. – ½ day per week – “hormones” • Get EDUCATION – Teachers – Rouzier, World Link Medical – AAMG, A4M • Find a mentor (s) – start here
  • 76.
  • 77. Marketing & Practice Development • Maintain excellence in allopathy or (traditional osteopathy) – (knowledge base, prescribing, surgery) – (“Be able to debate the great issues.” – Jim Rohn) • Know your [new] stuff! • Do not badmouth the competition. (Chris Lord example). • Give CME talks and paper over their objecting mouths with references. (examples follow next) • Spiritual and ethical clarity.
  • 78. Quick examples of powering through objections and overwhelming with literature Note – don’t get bogged down. Get the idea of HOW TO PRESENT the data.
  • 79. A Scientific (& FUN!!!) Review of Vitamin Supplementation & Essential Nutrients Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute Adjunct Professor – University of Southern Indiana Adjunct Clinical Lecturer – Indiana University School of Medicine Department of Psychiatry Child, Adolescent, Adult & Forensic Psychiatry – Evansville, Indiana Presented 2 27 2010 – Oliver Headache and Pain Clinic CME seminar – Evansville, IN
  • 80. Trends in Pharmacological Sciences (2008) Jul; 29(7):351. Epub 2008 Jun 4
  • 81. • Mitochondrial diseases are due to impairment of chemical reactions. • A reasonable theory is oxidative stress. • Few studies have actually been done on this. • Glutathione deficiency is known in mitochondrial disease. • Biosynthesis of glutathione depends on cysteine availability. • “Our findings reinforce the notions that in mitochondrial disease, oxidative stress is important and can be reduced by administration of a cysteine donor.”
  • 82. Zoned, Stoned and Blown: The Emotional Tsunami of Psychiatric Disorders Coupled with Pain Disorders & Chemical Dependency Louis B. Cady, MD – CEO & Founder – Cady Wellness Institute Adjunct Professor – University of Southern Indiana Adjunct Clinical Lecturer – Indiana University School of Medicine Department of Psychiatry Child, Adolescent, Adult & Forensic Psychiatry – Evansville, Indiana Also Presented 2 27 2010 – Oliver Headache and Pain Clinic CME seminar – Evansville, IN
  • 83.
  • 84. Pharmacotherapy Significantly Reduces Substance Abuse in Adults with ADHD 40 32 3-fold! P<0.001 % of study population 30 20 12 10 10 0 Unmedicated Medicated Control ADHD ADHD (N=137) (N=19) (N=56) Biederman J, et al. Pediatrics. 1999;104:e20-e25.
  • 86. “You can have everything in life you want, if you just help enough other people get what they want.” - Zig Ziglar What do patients want? •To be treated with respect •To not have to wait! •To FEEL BETTER •To HAVE HOPE. •To not be doped up. •To NOT have their money wasted.
  • 87. $5,000 worth of wisdom on one page – from Jay Abraham • Risk reversal • “USP” – unique selling Focus: “Be able to proposition treat your clients • Defining the buying (or patients) as criteria dear and valued • Three ways for more friends.” profit: - Jay Abraham – Higher price – More frequency – Additional items (supplements, etc.)
  • 88. Evansville Courier & Press: May 29, 2006 References: www.pharmanexmd.com ; www.slideshare.net/lcadymd ; Dr. Oz show on YouTube: http://www.youtube.com/watch?v=rX4oxxGWi_8
  • 89. My position on supplements • “The needs of the patient come first.” – W Mayo • Unique and patented. (Otherwise GNC is fine). • Guaranteed (risk reversal). • Measurable changes • Be a doctor and not a stock boy or inventory clerk.
  • 90. Jay Abraham References (recommended) www.amazon.com
  • 91. Building CWI - what has worked • Being nice to patients – (on time, polite, compliment on questions, don’t be a jerk or abrasive, put yourself into their shoes, etc.) • Be good and get results. BE THE BEST! • Be TRANSPARENT – give’em their labs. – Write on them. Draw pictures. Take time (and BILL FOR IT). – Cenegenics model • Be appropriately self-protective of your time and talents. “If they show up, bill’em.” – Dan Kennedy.
  • 92. MARKETING – what has and hasn’t worked Worked Hasn’t worked • Word of mouth • Paid advertising (TV, • Public seminars print, magazines) • Web site • What I HAVEN’T tried: • Going to MD’s/DO’s – Marketing consultants offices PERSONALLY – Radio ads • Free stuff – PR opportunities New initiatives: • Going to places and •Proprietary, paid websites NETWORKING •“SEO” – search engine optimization (Willie Sutton principle)
  • 93.
  • 94. Additional resources – handouts down front at end of lecture • “The 10 Commandments of Marketing a Medical Practice” – Cady (handout, free) • Additional resources handout sheet • Practice Transformation Seminar – to be schedule 2013 - at Cady Wellness Institute
  • 95. Contact information: Louis B. Cady, M.D. www.cadywellness.com www.indianaTMS-cadywellness.com Office: 812-429-0772 E-mail: lcady@cadywellness.com 4727 Rosebud Lane – Suite F Interstate Office Park Newburgh, IN 47630 (USA) Download from iTunes or Android App store now!
  • 96.
  • 97. A personal close: How do you want to age?
  • 98. Success and Failure (Jim Rohn) What about you? You’ve only got one body. • “Errors in judgement” - High glycemic eating, no exercise, poor nutrition, lousy/no supplementation, high stress practice. - “Good disciplines” – appropriate diet, supplementation, exercise, hormones. Stress management. Decent practice and lifestyle.
  • 99. Perhaps the ability not only to acquire the confidence of the patient, but to deserve it, to see what the patient desires and needs, comes through the sixth sense we call intuition, which in turn comes from wide experience and deep sympathy for and devotion to the patient, giving to the possessor remarkable ability to achieve results. ...William J. Mayo, 1935
  • 100. Contact information: Louis B. Cady, M.D. www.cadywellness.com www.indianaTMS-cadywellness.com Office: 812-429-0772 E-mail: lcady@cadywellness.com 4727 Rosebud Lane – Suite F Interstate Office Park Newburgh, IN 47630 (USA)

Notes de l'éditeur

  1. Health care provider and “consumer”
  2. The politicians are constantly told that MD ’s in the US are making too much. This is a graph from one of the consultants for one of the government policy making. This is for family medicine.
  3. Beneficiaries going up; workers going down to support them.
  4. First thing politicians have to do is serve their constiuents – to “maintain the current perceived benefit of the structure.” Next priority is taxes – “You will protect your constituency.” Republicans want tax cuts for everybody. Democrats – protecting their constituency. “Tax the rich” Both see the same problems. Their solution is different. Next, doctors will fight with the hospitals and organizations for reimbursements.
  5. This represents a disconnect between the AMA and physicians.
  6. In the 1960 ’s and 1970’s – when it was known that someone’s child was becoming a doctor, it was viewed as a great accomplishment.
  7. Giuseppe Mazzini (22 June 1805 – 10 March 1872), nicknamed &amp;quot;Soul of Italy,&amp;quot;[1] was an Italian politician, journalist and activist for the unification of Italy. His efforts helped bring about the independent and unified Italy[2] in place of the several separate states, many dominated by foreign powers, that existed until the 19th century. He also helped define the modern European movement for popular democracy in a republican state. [ citation needed ] – Source - Wikipedia
  8. The incidence of drug abuse was compared in 56 medicated ADHD patients, 19 non-medicated ADHD patients, and 137 non-ADHD control subjects [Biederman 1999 pe21] Non-medicated ADHD patients were at a significantly higher risk for substance abuse than controls or medicated ADHD patients [Biederman 1999 pe22-23] There was no significant difference between medicated ADHD patients and controls (chi-squared=3.7, P =0.15) [Biederman 1999 pe22-23] Medication is associated with an 85% reduction in the risk of substance abuse in ADHD patients [Biederman 1999 pe22-23] Poor compliance is often a more significant problem than addiction [Garland, 1998 p 387-388]