Browsing Posts published in August, 2010

    Allergies, asthma, and autoimmunity are the most prevalent immune disorders and affect millions
    of people worldwide.
    The role of prevention of these immune disorders at the level of infancy and early childhood has become an important emphasis of recent research.
    The proper development of the growing infant’s immune system provides a promising avenue into prevention of these disorders. Breast milk has long been acknowledged as the optimal source of nutrition for infants, and emerging research points to its profound effect on the immune development of infants.
    Immune disorders like asthma, allergies, and autoimmunity have become predominant issues in both pediatric and adult healthcare. An estimated 300 million people worldwide suffer from asthma, with 250,000 annual deaths attributed to the disease.Allergic diseases affect as many as 40 to 50 million Americans.Autoimmune diseases include more than 70 different disorders and affect approximately 5 percent of the U.S. population, or an estimated 23.5 million Americans.3 Early intervention as a means of preventing immune disorders later in life has become the subject of abundant research in recent years. Special attention must be paid to the infant’s developing immune system in order for this type of prevention to be a success. The infant is born with an immature immune system that doesn’t fully develop until several years after birth.
    Mounting evidence shows that breast milk is not only an excellent source of nutrition, but it also has a profound influence on the development of the immune system and thus, the pathogenesis of asthma, allergies, and autoimmunity. This paper will focus on immune development in infants and the use of breast milk as a potential prevention of immune disorders. We will briefly review the workings of a healthy, mature immune system before discussing the developing immune system of an infant and how breast milk best promotes its proper development. Although our knowledge of the system is always advancing, the immune system in healthy adults has several distinct arms: Th0, Th1, Th2, Th3, and Th17. The T helper cells 0 (Th0) refer to mature T cells that have yet to encounter an antigen. When these naпve Th0 cells encounter an antigen, they differentiate into Th1 or Th2 cells depending on the cytokine environment. The T helper cells 1 (Th1) are recruited in response to infection and are the predominant cells used against bacterial and viral infections. T helper cells 2 (Th2) are responsible for allergic responses and responses to parasites.
    Cytokines are secreted proteins that stimulate most of the biological effects in the immune system, such as the cell-mediated immunity seen in infections, predominately driven by Th1, and allergictype responses, predominately driven by Th2. These cytokines inhibit the opposing immune reaction, so a robust Th1 response to an infection inhibits a Th2 response and vice versa. Immune tolerance is characterized by a Th3 response, which involves T regulatory cells (Treg cells) and the cytokine, transforming growth factor-beta (TGF-beta). Treg cells play a major part in the regulation of immune responses, sustaining immunological self-tolerance and immune homeostasis.6 They also play a crucial role in the control of auto-reactive T-cells, making them a necessary combatant against autoimmune reactions. A Th17 immune response is associated with autoimmune conditions and the cytokine secretion of various interleukins: IL-17, IL-12 and IL-23 IL-17 is produced by Th17, which comes from a different lineage than Th1 and Th2 cells but can also stimulate the secretion of TNF-alpha and IL-1.Th17 and Treg cells have taken center stage in the discussion of autoimmune conditions.
    A new category of cells named Th22 was recently discovered. Th22 enables innate epithelial immune responses.Allergies, asthma, and autoimmune conditions are associated with unresolved inflammation that contributes to the pathogenesis of these conditions. The immune system contains this system of checks and balances with responses like Th3 so that the immune system stays plastic without ever becoming stuck in one particular immune response.

    Patients who forgo medications for both diabetes and chronic pain appear to be influenced primarily by economic pressures, whereas patients who cut back selectively on their diabetes treatments are influenced by their mood and medication beliefs. Our findings point toward more targeted strategies to assist diabetic patients who experience CRN.

    Prescription drug spending in 2007 was >750 USD per capita in the U.S., of which patients must pay a growing share through medication copayments. Nine of 10 older adults use prescription medications, and those with Medicare Part D take five prescriptions per month on average. Even among low-income patients, most take their medications despite copayments; however, one-fifth or more of all patients may cut back because of cost concerns. Cost-related nonadherence to medications (CRN) has been associated with increased rates of serious adverse events, emergency department visits, hospitalizations, and poorer health.

    Empirical studies have implicated financial, attitudinal, mood, and provider influences in CRN, although their relative effects are not well understood. Most of the variance in patients’ reports of CRN remains unexplained by financial measures. Although economic pressures drive these decisions, noncost factors appear to modify the effect of medication cost at a given level of ability to pay.

    Most survey-based studies of CRN have used a single global question to ascertain adherence and, therefore, could not discern whether patients cut back uniformly across their medications or selectively. Studies using administrative data indicate that patients vary in their adherence across medications, but these studies could not explore fully the influences of factors such as patients’ mood and medication-related beliefs.

    Building on our theoretical model of factors that influence patients’ elasticity of demand for prescription drugs, in the present study we explored further how cost and noncost factors influence patients’ adherence to prescription medications for two chronic conditions: type 2 diabetes and chronic pain. We hypothesized that although some patients would cut back on medications for both conditions, others would cut back selectively, and sought to understand the factors associated with these behaviors.

    These analyses are important for clinical care because most efforts to address CRN have targeted patients’ ability to pay exclusively, for example, through government assistance (e.g., Medicare Part D), pharmaceutical industry programs, and prescribing of less expensive therapeutic alternatives. Physicians are now called upon to incorporate discussions of medication cost pressures into their routine patient interactions. Because insufficient time may be the greatest barrier to such provider-initiated discussions, it is essential that we distinguish patients for whom ability to pay, as opposed to other factors, constitutes the dominant challenge to adherence.

    Helfgott employs experienced faculty in the fields of nutrition, psychology, immunology, whole systems research, and acupuncture, among other natural medicine research faculty, to carry out natural medicine clinical trials. Further, Helfgott faculty work with conventional biomedical researchers, using groundbreaking technology to study ancient traditions. A donation from Don Helfgott has helped fund the state-of-the-art basic science laboratory, as well as the resources to carry out clinical research.
    Dedicated to the advancement of natural medicine, Helfgott was founded with the goals of training students and faculty interested in conducting research, collaborating with other research institutes and organizations, and conducting research specifically on naturopathic and Chinese medicine. At Helfgott, scientists from the fields of naturopathic medicine, Chinese medicine, acupuncture, immunology, and nutrition work together to apply their expertise to the study of natural medicine. “Our philosophy is that every study is a collaboration,” notes Zwickey, emphasizing the importance of collaborative research at Helfgott. Studies at Helfgott almost always involve external organizations, which “not only strengthens the study, but those relationships are what ultimately get natural medicine accepted in some of these more mainstream places.” Current faculty research projects at Helfgott include grants directly funded by the National Institutes of Health’s National Center for Complementary and Alternative Medicine.
    In addition, Helfgott participates in several collaborative grants with Oregon Health & Sciences University as well as with other Western biomedical and naturopathic schools. In addition to working with external health organizations nationwide, Helfgott is largely involved in the local community as well. “One of the things that we’ve been doing is being the conduit for people in Portland to learn about who’s in their community and what type of research they’re doing,” says Zwickey. Helfgott is active not only at the local level, but at national and international levels as well.
    “We envision Helfgott as the premier natural medicine research institute. Our vision includes a consortium of researchers from naturopathic medicine, Chinese medicine, Ayurvedic medicine, physical medicine, energy medicine, and other natural medicine disciplines. We envision an institute based on health rather than disease. We see a think tank that develops new innovative approaches to healthcare, and clinical floors where these approaches can be piloted. We see the development of research moving away from treating symptoms, and moving toward promoting health.” —From Helfgott Research Institute’s vision

    Chronic diseases like heart disease, stroke, cancer,respiratory disease, and diabetes are the leading cause of mortality in the world, causing 60% of all deaths, according to the World Health Organization. Of the 35 million people who died worldwide from chronic disease in 2005, half were under age 70. These numbers emphasize the intense need for research related to chronic disease. In America, chronic disease is replacing infectious disease as the primary health concern, further highlighting the need for research related to its complex nature. At the Helfgott Research Institute in Portland, Ore., healing chronic disease is one of the manygoals of researchers. Established in 2003 at the National College of Natural Medicine (NCNM), Helfgott is a professionally independent, nonprofit research institute whose mission is to conduct rigorous, high-quality research on the art and science of healing, specifically working to understand natural forms of medicine. Although chronic illness can sometimes be effectively treated by pharmaceutical medicine alone, it often requires a more comprehensive approach due to its complex nature.

    Lifestyle, nutrition, and behavioral changes all affect chronic disease, so Helfgott employs traditional approaches combined with natural medicine such as herbs, homeopathy, hydrotherapy, and acupuncture in order to prevention and treatment. One of the unique aspects of Helfgott’s research is the way clinical trials are conducted. “We are committed to studying natural medicine the way that it’s practiced,” says Heather Zwickey, PhD, director of research at Helfgott and dean of research at NCNM. “When a naturopath sees a patient, they don’t ever give just one thing. They always address the diet, and the lifestyle, and may provide some herbs, and maybe a homeopathic; it’s never one thing. If that’s what naturopaths are doing in practice, then that’s what we ought to be studying.” Instead of studying medicines individually or in a manner that would reduce an herb to its constituent components, Helfgott researchers look at a combination of herbs being administered. Zwickey continues, “Part of our mission is to study whole systems of medicine; we try to do as little with isolated components as possible.” The need for evidence-based research and clinical studies to evaluate and confirm the safety and effectiveness of natural medicine continues to grow.

    Just as pharmaceutical medicine undergoes clinical trials, natural medicine is researched and studied through clinical trials. Helfgott employs experienced faculty in the fields of nutrition, psychology, immunology, whole systems research, and acupuncture, among other natural medicine research faculty, to carry out natural medicine clinical trials. Further, Helfgott faculty work with conventional biomedical researchers, using groundbreaking technology to study ancient traditions. A donation from Don Helfgott has helped fund the state-of-the-art basic science laboratory, as well as the resources to carry out clinical research.