An Automated 3D Mapping process (courtesy NPHG technology).  

Recent results of a new technology for spatial medical cartography that I developed, requiring minimal engagement at the IT developer’s end, including an elimination of time requirements related to the development of videos

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We are in the initial stages of implementing GIS for managed care based population health monitoring.  There are a number of software programs out there than enable you to include maps in the displays or presentations you develop as part of the monitoring process of your workstation.  As leaders in the field, the production of “dashboards”, “scorecards” and “reports” have enabled us to increase our understanding of the population we serve and develop the knowledgebase needed to better manage the various types of healthcare programs we provide.

Surveillance is a major reason to establish as GIS workstation that has specific public health and population health and safety related metrics defined.  Most of the uses of GIS to date have been for research purposes, with a few projects actually evolving into standard intervention, health safety, health security and even cost effectiveness reviews of our programs.

There are literally thousands of conditions, events, diagnoses that fit the description of being important to national health security concerns.  Aside from the hundreds or more zoonotic and rare infectious diseases,  there are culturally linked and bound health conditions for which the knowledge of their notations in the EHR or EMR should lead to the raising of a “red flag.”

Included in these issues are those related to domestic violence, spouse or child related mistreatment, malnutrition, unsanitary living conditions, criminal activities, illegal or immoral seclusion to an inside home-setting, etc. etc.    This particular event is one of the most controversial to appear in the US EMR/EHR data.  Its controversy in part related to its reasons for practice, as well as its reasons for continuous practice in spite of international laws passed prohibiting it from being performed.

This new technology enables spatial analysts to define the sociological or sociocultural “hot spots” in health related issues.  The recent re-eruption of measles, the in-migration of mosquito-born diseases like zika, the possible planting of new forms of food-spread antibiotic resistant bacteria in certain parts of the U.S., the increasing density of certain culturally-linked genetic disease traits due to cultural growth, combined with the ongoing forming of you families with shared genetic traits, set the stage for the development of a medical GIS by all managed care institutions.  When such an HIT-GIS station is developed in association with the local public health program activities utilizing spatial health analytics tools, we develop a better understanding of our local population health, and can more quickly use this knowledge to monitor, survey and even predict the health changes expected for a region.

Genetic Disease Carriers, for a very common malady within a heavily populated urban setting.  Note: this was not performed using a GIS, but a simple set of SQL-SAS algorithms

Fortunately, technology does catch up with some of the programs I write.  One of those programs in the combined SQL and SAS needed to automate reporting for managed care companies.

The limiter to producing an automated ‘MAPP’ Program, as I call it (Mine-Analyze-Produce-Present) is the amount of work you put your system through.

My first attempt to go through this process entailed a production of about 3500 popualtion pyramids for most of the major ICD9 disease classes, many broken into specific age groups, in order to determine the highest risk gender-age groups in one year increments for very special social disease patterns, such as anorexia, wife beating, pyromancy, infibulation, and the varous forms of child abuse.  This evaluation took me nearly a half-year to complete, b ut inspired me to automate my processes some more for producing more effective products, more quickly.

My second attempt entailed evaluating regional disease patterns.  To accomplish this, I broken the US down ultimately into about 25 regions.  It seemed the NCQA, NIH, US Census and USGS ways of breaking the US population and states down into regions, based on income and/or expeditures and insurance related patterns, wasn’t exact enough to demonstrate the varying family sizes I noted for unique areas, in more unique parts of this country.  The Midwest and Great Lakes areas for example, I divided into north-south and east-west and combined N-S-E-W quadrant patterns to determine where the most statistically significant differences existed across state line/regional or subregional borders.  That project fortunately took only a week or two to perfect, and led me to develop the grid mapping of the entire United States, in detail.

Picture2

Over the past five years, the status of Medical GIS as practiced within the Managed Care profession has remained at a 5.50-5.75 level.  We don’t use GIS to improve our HEDIS results, nor event to routinely monitor the HEDIS requirements, or event the Obamacare “Meaningful Use” requirements.  There are numerous programs underway to try to convince managers to implement some form of spatial monitoring process.  But due to disinterest, and/or lack of knowledge for this form of research and exploration, this more productive form of Health Information Technology (HIT) management has not become a standard part of any managed care system.  It remains, in what I like to call, an “Experimental Use” category for HIT.

My grid mapping algorithms begin with the zip code mapping style, in which two kinds of maps are developed.  The first is a raw data related zip code choroplethic or 3D columnar like demonstration of where the distributions exist for each particular metric.  These metrics are, like before, of diseases and disease groups based upon ICD9, but also included evaluations of human behavioral patterns like late refills on necessary chronic disease prescriptions, or incidence/prevalance rates for some of the more classical population based disease distributions.

My second way of 3D mapping uses the grid modeling, of one or more resolutions.  I tends towards the “best resolution” models determined using standard comparison analyses of the ability of different grid cell sizes to cluster series of adjacent cases to each other, producing the best fit half-bell curve of smoothly changing frequency distribution half-bell graphs.    Each have their values when used to produce 3D mapping of large regional health care statistics.

My recent years have been spent applying these processes to local disease mapping.  In particular, larger urban areas were needed to test the models that were produced.  This allows the cartographer to test outcomes, and then to quantify the utility of each process relative to the spatial-temporal distribution patterns of diseases or measured events.  Some processes work incredibly rare on rare disease events.  Some appear to be under representative of high density patterns, like diabetes, obesity, hypertension, atrial fibrillation.

The use of prevalence incidence metrics for the spatial grid modeling technique is still very important to work with.  But in too many cases (about one third of the time), this traditional use of “rates” as determined by demographers, epidemiologists, and public health specialists to be the chosen method, are unrealistic and useless at the business level.  It would be a tremendous waste of company money to direct your spending to the higher prevalence/incidence places, which some of these values relate to low population counts, not any true need to healthcare facility or products and care management development.

DemogMedGIS.png

There are several essential ways to develop your EMR data for automating the managed care population health reporting process.  With the proper use of macros, you can develop the programming needed to make these calculation processes happen.  Most importantly, this methodology doesn’t require the introduction of new software and work station settings to the system.

Granted, these standards to evaluating populations will be around for a while, and unfortunately, they distract from the directions in which more effective evaluations need to be made.  The standard Cognos, Sharp and other systems out there are productive, but too slow.  These processes evolved from the processes I developed are a great deal more productive, and produce lengthy detailed reports, on a daily basis if you wanted.

In the past year, the following algorithms were developed, tested, utilized and produced into report-producing programming end products:

  1. Population pyramid and standard barchart graphical depictions, for detailing standard metrics (demographies, diseases, costs, savings per member, cost, predicted costs, etc.)
  2. Age-Gender Population Pyramid produced statistical comparisons of matched or comparable regions, for any health-related metric
  3. Race-Ethnicity defined grouped data and regrouped data (binomial grouped) differential analytics, per metric
  4. Religion and Health regrouping algorithm used to compared traditional and various non-traditional religion and religion-health profiling methods for evaluating areas, regions, neighborhoods, in relation to treatment patterns, refusal for care, disease outbreak patterns, and performance of preventive care programs.
  5. A method for defining the least healthy patients in any program or population
  6. A method for defining the most important (highest numbers, incidence, costs)  ICD groups for a given population, based upon race, ethnicity, etc.
  7. A method for applying and then combining or merging the three major risk scoring formulas into a single population-area health analysis methodology, specific down to the 1-year age increments for assigning a risk score, for each patient, and then reporting the summary of these data at the age-gender depicting race, ethnicity, religion, regional, program-defined, facility-defined levels [8 x 3 x 10 x n1 regions x n2 insuranceprograms or insured groups (MCD, CHP, MCR, COM, etc.)].
  8. A method for mapping these data (numerically, or fraction/ratio related):
    1. institutionally
    2. facility or office/provider based
    3. by network types (MCD, MCR, CHP, COM, BCBS, Obamacare)
    4. by industry distributions (urban hierarchical modeling processes)
    5. by socioeconomics data, race, ethnicity, and religion
    6. by specific disease classes (ICD, V and E codes)
    7. by specific human behavior patterns (based upon criminal or consumer data)
    8. by potential investor types

Demog_VPRetc

We expect some of what we see on the above diagram.  As people get older, they potentially get sicker and require more care.  Those who are the sickest experience increases in care related needs, relative to their number of chronic disease patterns.  Visits include all visits to doctors, hospitals, labs, referrals, ERs, counselors, anytime you walk into a place and are billed for that visit. Procedures are actions taken by whom you isit, like your lab tests, your annual x-ray, PET, MRI or mammography, your routine drug levels screening for seizure control, your monthly drug urinalysis.  VPR is Visits to Patients (per patient) ratio, per 1 year increment of age. ProcVR is the procedures to Visits ration; expected to increase as you get older and more procedures need to be peformed for more reason.  ProcPtR is Procedure Patient Ratio, which is a product of ProcVR and Visits to Patient ration of average visits per patient, by age increments (1 year).  The left column is for all standard office visit procedures; the middle column for Emergency Visits only; the third is of a population with a specific medical history using the ER for a specific reason.  What is most important to note  is the flate VPR that exists throughout the ER visits, relative to age.  Younger people come in for different reasons, but that seems to balance out with the newer reasons that lead older people to come into ER for in order to receive care.  The small spike at 0-2 years of age is for post-delivery problems, that often cause deaths in some children.

 

Stats1

A review of this website performance over the past 11 months suggests, as expected, the academic year is an indicator of visitors.  Both winter and summer breaks define the lulls for its use.

As of July 4th, more than 360,000 visits were documented at this site since 2009.  It is currently receiving about 90,000 visits per year, representing about 60,000 visitors. The most visited site is page one.

Stats2

A review of the monthly reporting for pages visited demonstrated there are repeats for certain pages as being the most visited for the month.  Tabulating this data produced a table of 24 most visited sites.  The two that stood out the most during the past year are my detailed review of the first US Census maps of disease and the historical medical geography article on an outbreak at Martha’s Vineyard in 1763.

Stats4

If the ratio of visitors and views relative to the views of these Top 24 sites are calculated, the following numbers are generated based on these three monthly sums.

Stats3

There are approximately 925 more pages that can be viewed at this site.  Therefore, a review of these percentages was made relative to total visitors for all pages.

This produced the following percentages of visits that each of the 24 sites represents, on a monthly basis.

Stats5

A closer view of the lower values is provided:

Stats6

 

From these results we can determine the most popular topics in historical medical geography and historical medicine.

PortraitLines

My site is saturated with coverage of the history of Colonial medicine, centering on the New York area, and so may of these pages pertain to that subject

  • Small Pox and the Cree
  • Throat Distemper in Kingston, 1735 (early Diphtheria?)
  • The Diagnosis of James River Ringworm (Slavery and disease, Thomas Jefferson’s estate; a disease never before evaluated in the historical literature)
  • 1763 – the Extraordinary Disease
  • Revol War Doctor,
  • Jane’s [Colden] Plants . . . ,
  • Valentine Seaman,
  • the Fowler [initiators of Phrenology] Estate,
  • Divine Psychiatric Truth [religion, philosophy and psychology]).

Midwestern and Far West exploration and development are also reviewed extensively, those pages  being:

  • Cholera on the Oregon Trail (my 2000 MS thesis)
  • Plants along the Trail (Oregon Trail medicine)
  • 1808 May’s Lick Kentucky (an early geographic interpretation of the Midwest)
  • 1851-1917 Cattle Drives and Texas Fever

Historical Mapping

  • Valentine Seaman (the first ever disease maps, of NYC yellow fever)
  • The diagnosis of James River Ringworm
  • Yellow Fever revisited . . . again
  • 1851-1917: Cattle Drives and Texas Fever
  • 1890 – The Census disease maps
  • Four Prussian Disease maps (1890s map)

Several cultural topics received a lot of attention, especially:

  • Small Pox and the Cree
  • Medicine (Prayer) Stick (Indian medical philosophy)
  • Chicle: The History of Chewing Gum (an important Hispanic Heritage study I did from 1988 to 1992)

A stand alone piece I produced was on the history of the late 1890s-1930s ammunitions seller, Francis Bannerman and Bannerman’s Island, which I have family photos and relics from, an important piece of Hudson Valley history

Another important standalone topic is my work on combining qualitative and quantitative research practices for more thorough cultural reviews of community and population health (my current occupation).

This leaves the mention of hexagonal grid modeling, a technique I developed in GIS and applied in winter 2003/4 (unemployed), for mapping environmental chemical exposures in the state of Oregon.  I developed the math and theory behind this after beginning work for Medicaid/Medicare in Denver Colorado in 2004.  I posted it on this site in late 2009 or early 2010.  The popularity of this page immediately jumped to the top of my lists of pages visited.

Stats7

Due to the increase popularity of this topic, I produced the DOWNLOAD page for students to access the excel I used in 2004 to produce my hexagonal grids. (newer versions of this are perhaps due for release; I have an SQL/SAS related version as well developed.)  This method of modeling continues to rise in popularity.

Stats8

Based on number/percent of visitors to it for downloading the excel file, it continues to increase, with primary interest perhaps being expressed by students enrolled in GIS and/or urban planning and development programs.  Based on the feedback I get, most of the support for hex grids remains mostly a practice of western European spatial analysts; for the Americas, its frequent visitors and users appear to be Canadian.

(Time for US urban planners and spatial analysts to catch up!)

MedicalGeographers

PhysicalCulturalGroupSubclasses2

Over the past few weeks I have been ranting about the fact that the current managed care system has advanced little over the past 10 to 15 years.  In fact, the first articles on the barriers to developing an electronic medical records system so essential to the managed care environment were published fifteen years ago.  Today, many of these problems remain.  The only thing that has changed is that information technology software programs and packages have improved, the amount of data that a data warehouse can store has increased significantly, and the speed at which ‘Big Data’ analyses can be carried out has improved substantially.

When you turn to the LinkedIn posting on IT, you’re left with the impression that this is a rapidly advancing field, with the ability to bring US health care programs to the next generation of due to progress.

Well, if you take a look at the accomplishments of most programs, you are more than likely going to see managed care programs still struggling to demonstrate success with their programs.  Should this success be in the form of highly successful meaningful use measures, or important changes in population health features, there had better be a few of these “accomplishments”.  After all, a typical program is evaluating between 50 and 150 metrics to document its accomplishments.  Only some of these are reported.  None of these programs (to my knowledge over the past 4 years) produces a thorough ‘Quality of Care’ or ‘Quality Improvement’ analytic program, measuring all or many of the accomplishments of the past years worth of healthcare efforts, and then maps the most significant of these findings.  (Such is a reasonable goal, and product, for a HIT-GIS program.)

Knowing how to program your system to make such measurements is 90% of the work; its focus should be on the quality of care/quality of service (QOC/QOS) process for a majority of disease patterns in the region.   The reasons such steps are not taken relate mostly to poor planning and administration.  These processes could have been decided upon, planned, implemented, expanded and made more efficient in 2005, the year that the content of a valuable meaningful use program could be defined, a time when such a program referred to as a quality improvement [QI] program became a requirement.

There are several reasons managed care programs have not implemented a data warehouse setting in such a way that a spatial analysis technique can be applied, or added to an institution’s QI program with full scale implementation of a GIS.

First, there is no official policy or recommendation that was ever put into place for the implementation of spatial analysis techniques as part of a new meaningful use, quality improvement program.

Second, the skillset for implementing such a program is lacking at the leadership and administrative level.  This lack is because directors, managers and administrators failed to hire the type of human resource needed to implement such an innovative program.

Third, even if individual exist in a healthcare system whom are capable of producing highly useful monitoring and intervention maps, the know-how for implementing a new program based upon these findings is also lacking, a blame we may once again lay on the administrators.

So meanwhile, as the Health Information Technology [HIT] departments at most institutions struggle to make old and new outcomes match, and develop a database that is not only consistent but highly worthwhile for monitoring managed care population health, it is best for those already working in their system to take on the next most important research question in managed care.

Can religion be used to evaluate population health, and if so, how do we make use of this unique form of datum?

Religion provides us with equally valuable if not more insight when compared with ethnicity and race data.  Ethnicity can be used to search for social inequality and language related barriers involving the most predominant patient ethnic group in the United States.  Race provides us with insights into how socioecononic status/poverty, and race and race-linked genetics can impact a populations health features.

What religion tells us can serve as a further clarification of race-related findings for illness and disease.  Religion also adds to the insights we receive from the ethnicity  work engaged in.

I have identified 9 physical science, 7 social science and 5 behavioral science and/or mental health topics that are closely linked to diseases and the medical disorders people are diagnosed with, in such a way that if these lists were related to the therapeutic processes engaged in for any ICD-defined medical/health state, the results of this interpretation of each ICD should enable us to define those which are most linked to a particular religious culture.

Elsewhere on the web, I have identified the various types of cultural disease patterns that exist, based on the current ICD systems.  There are well defined culturally bound diseases, rarely mentioned culturally-linked disease patterns, frequently mentioned culturally-related health conditions and disease patterns involving the physical body.

Specific religious groups infrequently overlap with their disease patterns in United States cultural settings.  There is the majority of diagnoses that are ubiquitous to population health, which individuals of all race, culture and religion experience.  But there are also specific diagnoses and health problems that occur due to culturally-related human behavior habits.  These are the topic of this review.

Using the standard research theory models, like Health Belief Model, to understand how people react to a medical condition, the above figure can be related to that model and the primary dimensions, subclasses and behaviors linked to a disease can be identified. Then a more effective and thorough intervention program may be developed and specifically targeted.

A “meaningful” managed care system assesses the entire population for all of its healthcare needs.  This model enables planners to develop a balanced program devoted to physical, behavioral, mental and social care processes.   It can be used to define when and where focus groups are needed, what populations to target with a survey, where to look for unexplored ICD related topics for you particular population, and how to improve the intervention planning process for conditions that aren’t effectively treated at the moment.

Consider each of these elements a question that has to be explored in order to fully understand the causes for certain non-physical, behavioral, social and cultural behavioral disorders and/or disease patterns.

MiddleEastInmigration

Introduction

With the migration of settlers from the Middle East, Arabic medicine will soon be impacting Western medicine or allopathy.  This influence will be in the form of Unani-Tibbs medical practices.

To understand this impact of a newly arriving medical belief, consider the impact that Asian migration has had on the U.S healthcare system since 1830.  Whereas there was plenty of migration between the mid-1800s and late 1800s, it wasn’t until well established oriental communities were formed in urban settings, with enough local consumers, in the form of Asian families, available to support a growing medical business devoted to traditional Chinese medicine.

uscubachinamalaysia_01b1

From an older essay comparing these three programs

Oriental Medicine in the US

Within western cultural settings, there have been several stages when parts of the oriental philosophies came to be common practice by western doctors.  Most of these methods tried and accepted required some form of western philosophical paradigm to improve their likelihood for  acceptance and integration into Western Medicine practice.  The most recent examples of these many non-Asian United States citizens are aware of, like the practice of acupuncture and acupressure, the use of ginseng for strengthening the body, ginkgo for the mind.

Yet there are parts of the Oriental philosophy which we struggled to develop philosophical interpretations for.  One of the earliest Oriental practices noted and almost accepted in western European writings was the use of moxi, a smoldering stick consisted of pressed sage leaves that maintained the fire but not the flame—its purpose: to heat a specific area of the skin, add energy or chi, and improve the vitality of the body there, assist in the flow of its energy from one part of the body to the next, through this area that served as a node or place where such flow could be strengthened.

greekcupping

The acceptance of moxi, more as a curiosity noted in the earliest oriental travelers recounts, initiated as early as 1650.  To make sense of it in the traditional four humours paradigm of western medical philosophy, the writers termed it a way to add fire to the four elements that needed to be in balance within.  Yet, there were other theories that could be used to explain how Oriental medical practices made sense, many based on the observations made about electricity and the body.

The other practice sometimes reviewed by writers in their recounts of China was acupuncture.  To understand acupuncture required a knowledge fo the how the body was shaped, and then how these particular moxi points were distributed across the body surface, and how without heat, but only through the use of a very thin needle, these points could be changed with a barely visible perforation of the skin.  This view of the acupuncture needle process seemed counter to the much cruder, more injuring practice of lancing the body, in order to let the blood flow, in the form of the practice of bleeding or bloodletting.

The Western paradigm stated that a certain amount of blood had to be removed, to remove the bad humours within and give room for newer, more healthy humours to form and fill this empty space in the vessels. That philosophy was much easier to visualize and understood, and was accepted as true by Western Doctors, whereas the acupuncture theory that was suggestive of energy flow rather than fluid blood flow, had less evidence to base itself upon.  Lanced blood was more convincing than theoretical energy released and allowed to flow freely elsewhere in the living body.

pulsetherapy

When electrotherapy had its first discoveries, the similarity of these early phenomena to the claims linked to moxi-generated heat and acupuncture-generated energy could be equated with parts of the western medical theory for electric cure.   The first form of electricity this related to was equivalent to the concept of the battery, with energy stored in the form of static electric change, stored and held by the Leyden jar, an early form of the capacitor.  If one grasped the right wire atop the Jar, a shock was felt, an electric charge, that could in theory “revitalize” the body, and in the realest sense, recharge a heart that has stopped beating.  The witnessed evidence that leyden jar and static electric charge production and discharge could revitalize a living thing, was the use of static electric generators to cause a muscle to twitch, to make a seeming dead muscle in a young child paralyzed by a disease like spinal meningitis contract again, offering help to the crippled child and his parents.

acupuncture

The Oriental philosophy of how energy worked in the body, the power of Chi, wasn’t exactly equivalent to the Western medical paradigms upon which certain regimens were discovered and then added to the philosophy at hand. It wasn’t until the 1830s that later stages in the development of the use of electricity, in particular in the form of stored galvanic electricity, led to another rendering of the use of acupuncture to help patients.  The acupuncture needle became a medium through which energy flowed, out and across the chi pathway in the sense of oriental methods for its use, from the energy source into the body in the allopathic electric cure sense.

The other forms of Chinese medicine that came to be popular were mostly related to herbs.  Ginseng was mostly worth what it was to the Chinese people.  But similar tonics could be found in United States treatments that were akin to the Chinese tonic medicines.  The occasional overlap between Chinese medicine and Allopathic medicine did happen in the early 19th century, but its impact on the acceptance of traditional Chinese philosophy in general was minimal.  Oriental medicines like the Ailanthus glandulosa (Tree of Heaven) became popular because its stench worked against the miasma, not due to an energy it helped to generate in the body to help heal the patient and strengthen a patients defense again sickness.  The Chinese ginseng had its American equivalents, but they cost the price of a great medicine, not an aged root worth more than its weight in gold due to its form, age and twisting spiraling nature.  A root was simply a root in Western medicine.  The purest whitest powder of a starchy Smilax tuber was appreciated due to the nature of it starchy content and its value in preparing formulas, not its symbolic purity.

“Modern” Philosophies and Traditions

The latest rebirths of Oriental medicine, (there were several) came in much the same manner that other forms of “alternative medicine” have come to be practiced.  There was this tremendous dissatisfaction with the standard allopathy for the time—people were in need of safer and more trustworthy methods of treatment and cure.  During the late 1890s and early 1900s, Oriental medicine was practiced heavily in American office, by Oriental practitioners, sometimes in association with American non-allopathic MDs.  The bacterial theory had caused a major eruption in heathcare, enabling non-allopathics to briefly get a hold of the reins once again.  If it weren’t for improvements in licensure laws at that time, many of these philosophies might have been here to stay.

But many medicine philosophies were put to the test by the regular medical profession around 1900s.  The 1906 Food Act helped further this attitude about health, as did the 1915 Food and Drug Act, which effectively got rid of unfounded or unsupported over the counter drug based remedies (i.e. over the counter opium in treatments for teething babies).  Since then, many of the 19th century allopathy skills have since vanished from the medical books.  The allopathic standards of leeching, blistering, and bloodletting were the first to go, followed by the excessive use and reliance upon rubefacients and other irritants that in theory were working as “counter irritants”.  There was also the reliance upon unusual tools such as the baunscheidtismus contraption, mean to apply the equivalent of many irritants, numerous lances, all in one spot.  This elimination of the serious irritant, however, did not completely eliminate the perceived value of the acupuncture needle from Oriental medicine.

When Mao Tse Tung showed the world that acupuncture could be used to perform Open heart surgery in his primary teaching hospitals, the United States and United Nations observers of this practice were not only stunned, they were amazed, and convinced of its success.  Chinese medicine has ever since had its periods of acceptance and then rejection by western practitioners, until recently, when allopathy finally decided to include it in the possible treatment paths for  specific therapeutic pathways they were unable to be successful with—alcohol abuse, drug abuse being the most prominent, but the treatment of certain chronic diseases like ileal paralysis, chronic back pain and HIV or AIDs infection.

Unani_heisthehealer

 

Middle Eastern Unani-Tibbs Medicine

Are the same things that happened with Traditional Chinese Medicine and United States medicine about to happen with Unani-Tibbs medicine?

More than likely yes, but for different reasons.

As the number of families from the Middle East increase, those devoted to practicing their own unique forms of medicine known as Unani-Tibbs will become the standard (if it isn’t already the standard for some community settings).  It is possible that the transition of small social settings from western the Sharia Law will provide insights into where these transitions will first take place, and where they will first have their impacts on patients receiving both Unani-Tibbs and Allopathic forms of medical care.

The most important parts of these other forms of medicine that may become a standard in some western medical-integrated healthcare systems are the ways in which some diseases are interpreted, etiologically explained, and then treated.  What we learn from how Chinese medicine was introduced into Western Medical practice paradigms may relate to how we should view, study and interpret what events are happening as Unani-Tibbs medicine becomes more popular, and more common.

Like Chinese medicine, Unani-Tibbs medicine does have its own unique way of interpreting the cause of disease, the meaning of diseases, the developmental processes responsible for disease onset, and how to treat and eliminate the disease. Like Chinese medicine, Unani medicine has its more direct, and perhaps reliable and trustworthy applications, at the cultural level, treating behavioral health and psychologically related or induced states, by basing these treatments upon traditional cultural paradigms.

But what about diseases that are mindbody-like in their behavior, those which during the 1940s and 1950 (and even 1960s) we called “psychosomatic diseases”?   Irritable Bowel Disease and Fibromyalgia are two very common examples of this.  Might other versions of treatment for these long-lasting chronic conditions be beneficial to some patients?

One of the best examples of these conditions which has a very social and cultural definition attached to its seriousness and meaning is Epilepsy.  Epilepsy is a prime example of a disease that has different interpretations across different cultures, and perhaps even requires different methods of treatment depending upon the source of the paradigms that guide the lives of specific patients diagnoses with epilepsy.

Imam_Ali_and_the_Jinn

Djinn, or Jinn

Epilepsy Causality

Like the theory of humours, epilepsy has this long history of definition and redefinition of its cause and treatment over the millennia.  Western medicine, Asian medicine, and Middle Eastern medicine have been involved in how we developed our current perceptions of the patient with epilepsy, especially in his or her uncontrollable or intractable state.

roth_1898_theophilusborden_vitalism_pp138-9

Vitalism – – the Western Medical theory of life energy in 1800 +/- 10 yrs

In the past, western medicine has dealt with the notion that epilepsy is related to some “invasion of spirit concept”.  Hippocrates taught that to us, as well as Chinese and Native American doctors and healers.  The unexplainable nature of the seizure, and the appearance of the invasion of other beings or demons into the human body, is a cross-cultural paradigm assigned to explaining certain seizure types.  The New Testament attests to many examples healed by numbers of healers during their pre-sanctification phase or existence.  This same story, so common to most leading religious writings, is curiously absent from the Koran, the reasons for which are in dire need of a professional theological and medical review and the publication of any intense speculation that may arise due to this research by the best scholars in the world.

But until then, we have to deal with the reality of epilepsy—that it exists, and that it impacts Muslims probably as much as it impacts most other populations.  If epilepsy is an unusual example of culturally-bound disease pattern, like some of my past writings have suggested, it exists because western medical philosophy allows it to exist, allows for its related behaviors to happen, be interpreted the way they are, and then diagnosed as expected.

As a historian, I always though it curious as to how and why past forms of epilepsy are different from the standards we believe in today.  The hysteric convulsion, the French diagnostic categories of seizures were very different from those we believe in right now.  They seem to be mostly presentation and symptoms based, relying heavily upon the patient’s appearance and affect during the seizure episode.  And when you read some of the severest events as they happen, you have to wonder why they were more often considered a form of sleep walking or somnambulism, or some sort of hallucinatory state like those induced by medicines, or those initiated by the animal spirit in the human body, its emotional system and emotional reaction to the stimuli at large in life, home and society.

OLYMPUS DIGITAL CAMERA

Islamic “Treatment of Spirits” (Djinn)

Middle East Interpretations

With patients from the Middle East, they have a unique spiritual and physical medicine interpretation of epilepsy that must be adequately approached by the western physician or neurologist unaware of Islamic beliefs and faith regarding the seizure.  That will likely not happen, unless the primary care giver is Islamic himself or herself.

The primary reason a child is brought to the doctor for possible epilepsy, is that the family and closest associates need to know if it is of djinn origins or physical origins.

At first, this seems a very easy problem to deal with.  The provider has to convince the parents that the seizure is what s/he (the allopath) thinks or believes it to be.  But try to convince a different culture that this interpretation is true.

There is a transition going on in Unani-Tibbs medicine just like there was when Oriental medicine was put under the lens during the late 1800s.   We will see transformed Unani-Tibbs trained MDs who are convinced that this traditional path does provide unique opportunities to better a patient’s life.  We will also see Unani-Tubbs trained physicians who have moved away from the traditional philosophy and try to lay to rest the fears that riddle the families receiving western medical care who are so concerned about the roles and reasons related to the “evil” forms of disease onset that they experience, and yet no other culture does, in terms of how they interpret it.  We will also see traditional MD allopaths, perhaps even of Middle Eastern descent, who haven’t any training in the philosophies of these cultural scientists and medical leaders.

In a recent review of epilepsy cases and their care practices performed in large urban settings, I found that there was a growing number of Middle Eastern parents with children adding to the health care system due to their greater numbers of visits to the provider for children, about their concern that the child might have epilepsy.

By reclassifying the religions noted in their EMR data, I was able to merge the data enough produce classes of religion that could then be used to five major religious groups to each other, and then to several smaller religious or religious-like belief systems that are increasingly popular, and can impact the way patients chose to seek out medical care or not. The final group I defined was the “Unknown” group, patient who had no religious affiliation listed.

Rhazes_Inoulation

Inoculation discovered – Al Rhazes

Findings

A review of ten groups in terms of the numbers of kids with parents concerned about epilepsy, with the epilepsy ICD in their electronic medical records database, showed that mostly the Middle Eastern families were highly concerned for their child’s welfare when it comes to diagnosing and treating epilepsy for a child who is under the age of 4.  They are the only group demonstrating early peaking in visits for this ICD for the one and two year old children, demonstrating aggregate visit rates that more than twice those of any other religious class in the U.S.  The summation of these visits for kids by the time the child reached eight years of age, was much greater than the other classes, in particular at the visits and procedures levels.  This means that not only were the patients evaluated for possible epilepsy higher in Middle Eastern groups, but also underwent considerable more visits to determine their diagnostic state and many more procedures to confirm the final findings or claims made about a diagnosis.

Equally important to note for this study is that the peak age for children seeking out help or assistance about a possible epilepsy condition is closer to the 8 to 12 year range than the 0-5 year range, like it is with Middle Eastern families.  This implies that the non-Middle Eastern families have a wait and see attitude that prevents them from seeking out possible insight into their child’s state, assuming that child even experienced an event that would make the parents be so concerned about epilepsy.

IbnSina

Commentary

The needs for childcare visits for epilepsy for children so young in Middle Eastern families suggests there is a culturally attached belief system feeding into this watching and waiting attitude, avoiding it as much as possible.  This could be because the Middle Eastern concerns and judgments about a person who is diagnosed with epilepsy have a much greater impact on that person’s life and the life of his or her family.

One final observation about this Middle Eastern behavior related to seizure related visits and procedures involving very young children is the gender asymmetry of this pattern, with boys receiving this care more than girls.  In other cultures, the two genders have equal representation for the most part, with boys sometimes slightly more than girls in early childhood, but with female related visits and procedures performed far outnumbering male visits and procedures for most of the decades to come.

This difference in patients, visits and procedures data for epilepsy related visits, by these ten groups I defined and evaluated for approximately thousands of cases, suggests that this topic is in need of a much more detailed analysis.  As the numbers of Middle Eastern patients increase in the years to come, we will most likely see the influences of Unani-Tibbs medicine and philosophy come into play in highly multicultural healthcare settings, in particular the managed care programs.

If the institutions in charge of some managed care system aren’t ready for this change, this could result in less communication between patient and provider in the traditional allopathic healthcare system.  We don’t want to see the influx of new cultures lead to the development of another set of new healthcare providers in the United States, not effectively monitored, because the current allopathic system is unable to make the accommodations necessary for this new way f dealing with and interpreting medical history at home, in the doctor’s office, and in the in-patient setting.

HakimMohuammedUnaniUNESCO

From my Pinterest slides on this topic

Recommended Searches to review:

https://www.google.com/search?num=20&espv=2&q=unani+altonen&oq=unani+altonen

https://www.google.com/search?num=20&espv=2&biw=1580&bih=840&q=islamic+epilepsy

https://www.pinterest.com/altonenb/international-health/

 

 

 

May2016Spike

 

About twice a year I get these huge spikes in people visiting my site.

What does it mean?

The first time this happened, I had about 3000 hits in 24 hours.  Totally unexpected, it led me to contract the company that provides the place where my site and information are housed.  Their response . . . . normal traffic, due likely to a recommendation to visit my site by a place with regular visitors or a list of subscribers.

At times, there is no telling why these people visit.  If I am lucky, I can link the surge in visitors to a single page and topic.  One day, a few years ago, I was able to find a web page indicating that a conference was being held at the moment, and my site was possibly referred to as an example of what is out there.  The topic . . .  medical GIS.

 

Feb092016_MyActivityHistory

 

Several times I have been able to link the masses of visitors to a specific topic or course related to medical GIS.  My hexagonal grid mapping is the most common page frequented now by medical GIS students.  Interestingly, it also suggest that professors and practitioners in the field of medical GIS have yet to adopt this new methodology.

SquarevsHexagonGridCircleErrorZones

 

My illustration for the math behind hexagonal grid mapping.

 

There are some things that the health profession cannot do.  They cannot treat everyone perfectly.  They cannot prevent the most basic iatrogenic illnesses and surgical mistakes from happening.  The evolution of new disease and illness, due to the clinical setting, are natural events–the profession’s decision to focus on just the insured at the risk of ignoring the uninsured is the reason we are having immunizable disease outbreaks.  relying upon false assumptions and grandiose conclusion drawn about the success of your 98% effective immunization program, is like turning your back to the plank fence blocking your view of all those poorer communities you have missed.

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The recent resurgence in in-migrating vectored diseases is an indication that public health and the world health were taken by surprise by the ability of old diseases to travel to new places.  Why the errors?

ForeignDiseases_4x7

Understaffing at the WHO level, and those whom were employed weren’t experts at all compared to some of the leaders in this field, and the questionable ability of United States, CDC, and even NIH leaders to even successfully managed its small pox labs and anti-terrorism teams.  We do not know if AIDS was ever borne due to corporate lack of control, but we do know that Anthrax made its way into the public setting due to poor management and leadership, or that old vials of forgotten test samples of small pox could be found, where they were never supposed to  be stored these past 50 to 60 years.

Fortunately, what few open minds that there are for new discoveries, are mostly found in the student populations of public health programs.

In just a few months, any system can design a means to managed its population using just five basic query paths for its EMR.  This means that while systems struggle to make their EMR systems perform and function at the clinical level, quality improvement teams working on their own at the corporate or institutional level can produce a system that makes more effective use of their data at one or two thousand times the other teams’ productivity level.

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Meaningful use has some meaning.  But it tells us little about the prevalence of genetic diseases, the amounts of illegal care practices being performed such as childhood female circumcision, the amount of spousal abuse engaged in by specific religious groups, the amounts of poor nutrition and malnutrition related conditions suffered by low income communities, the amounts of MVAs experienced by kids riding ATVs, the numbers of people who refuse to have their kids immunized and locations of their clusters, the age at which boys are least likely to see a doctor, the kinds of developmental disorders that are surging in certain ethnic groups.

We can brag about about MU attempts and the results of a few of those 40 or 50 measures we’re focused upon.  Yet throughout all the hours spent trying to get a perfect outcomes and report generated, we miss nearly 99% of the population still in need of the same type of care and managed care improvement processes.

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This latter reason is the primary reason Medical GIS has to be implemented as a core part of all managed care programs.  But as the evidence shows regarding those that visits my pages devoted to Medical GIS, such a change is perhaps another generation or two away from happening.  Leadership, management, directors and VPs are still struggling, trying to make progress about a subject that should have been resolved nearly a decade ago, when medical GIS was ready to become a standard.

 

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History of Medicine Trephining in Ancient Peru (Small)

“letting out the bad spirit” caused by a head wound with an adz while in battle

From a teaching collection.  See http://www.trowbridgegallery.com.au/john-gould/trephining-in-ancient-peru

I finally reached the point where I have been able to analyze religious philosophy and relate it to health and medicine practices.  Religion is not a single philosophy or even a set of philosophies of similar form and content.

Religions vary because their philosophies are different.  But just because two religions are distinct from each other doesn’t mean the way they look at health is different from each other.  Alternatively, when two religions are in the same major belief system, using the same books or sacred writings, basing their philosophies on the same mystics, saints and writers who produced these books, this also doesn’t mean they think identically.

Religions have a topology or distinction from each other, and the ability to merge together to form similar groups with seemingly quite different theological ideologies, because certain features of their philosophy and discipline relate them to each other.  Fundamentalists in the major religious sects of the work, for the most part, belief in some of the same things as each other, enough to lead them to have  similar experiences about being ill, and about how that illness can be made to dissipate or go away.

Similar, people who are completely devoted to the science of health, in either the physical and or behavioral science way, believe in theories that are used to describe how the health of a patient comes to be.  There are certainly differences between the purely physical science idealist, and the behavioral science only idealist (you are or become what you think).

With regard to religion, if you don’t belief in religion, but believe in something akin to some of the beliefs of religion, such as this higher power, your “religion” is what I have termed natural theological.  You belief is some higher power, but not so far out on the edges that it isn’t religion at all that your are thinking.  Two prime examples: Quakerism and Shakerism.

To some writers of religious philosophy, out pragmatism makes us become who and what we need to become, and many of our thought processes relate to this process of behavior and personal development.  We become whom and what we are for a reason.  That belief is very much akin to religion, with the exception that we place the total responsibility for who and what we are on ourselves first, and nature second, and the effects that nature has on us, either as some truly scientific form of nature, or as a nature with this possible “force” that we must learn to control to help define and determine out own long term fate.  This kind of religion I call “natural theology” because the “universal concept” it depends upon is that universal power, energy, being, or field of change and existence.

The universal energy belief that is attached to certain religions is a simple, less anthropomorphic version of the extracorporeal God concept.   For example, the “God within” that we allow to exist, we decide to accept as being potentially useful, and usually approachable, with the hopes of gathering it enough to produce a consequence.  The individual who believes in the Godlike power of prayer, universal energy, waving the cross over the head of a “possessed child”, but without abiding by a traditional global religion based version of this philosophy, is one of those universalists who pay heed to universal power, which in turn is interpreted as the “universal god”.

There is also a slightly less universal-minded philosophy that approaches more the physical science, neurochemical interpretation of the mind, and God as a state of that mind.  This religious group, although we hear about it quite a bit, doesn’t seem to pop up in the medical records as much as a new researcher of religion in the local community appears to exist.  Only the big groups tend to show up in the medical records it seems.  Patients are still quiet about their universal energy ideology borne by the religion of Scientology or Christian Science.  We know they exist, but may not be indicated as such in the medical documents.  A modern term for these beliefs, and their reliance on “logic” is philosophical realism.  Belief is everything, no matter how many parts the brain has and how they are divided from each other.

Religion is also defined by culture, and culture in turn is defined by countries or nations, and nations and countries often have relationships to the majority of people within that nation.  So a nationally-definable single religion does not exist, but certain religions do seem to relate to specific cultures, and those cultures in turn to specific countries.

Even though a single religion in related countries is not universally the same across all those countries, there are some culturally defined life patterns and personal, family and community behaviors that define the roles that a particular religion may play in producing, supporting or helping an individual’s health.  Asian cultures are quite different from each other, and the religions harbored by certain parts of the world vastly different from each other in when they were born, who their founders were, how they interpret disease and discuss it via the religion writings, and how they react to disease, feed the child, treat the very sick, tend to the very poor and needy.   Buddhism, Hinduism and Bahai faiths are very different.  Yet their attentiveness to self, relatives, family, neighbors, community, foodways, beverage consumption, cooking practices, sleeping and prayer techniques, hope and prayer for the ill, are very similar in how they impact the ill person, because the families tend to display the same human reaction to poor health, in spite of their religious and cultural upbringing differences.  What brings them together into a single group is my observation that these followers often place more trust in the self and the philosophy this other culture is teaching them.  With the exception of one Caribbean group, the bulk of these beliefs systems are Asian or Asian derivatives.  The reason to group them together pertains mostly to the faith that they hold in their traditional beliefs, not primarily the teachings and philosophy of Western medicine.

So, beginning with approximately 160 religious types, after a few days of thinking and analysis, mostly reflecting back upon the years of readings I engaged in about religious philosophy and the meaning of disease, I developed three classification systems for religion, and in the end, for now, allow the following to be used and evaluated in relation to how disease, state of illness, religious behaviors, personal religious philosophy and community or family belief practices, play into the health and well being of each individual, at the preventive health level as well as with the recovery process and exceptional cure (“Miracle”) process of recovery.

For now, the following ten religions are used to analyze the interplay of health, religion and culture/ethnicity or race on how patients survive and experience their diagnoses.

  1.  Catholicism
  2.  Christianity
  3.  Christian Sects
  4. Judaic or Jewish
  5. Islamic or Muslim
  6. Natural Theological
  7. Cultural (the Chi, the higher power)
  8. Contemporary Spiritualists (higher power is scientific; i.e. Xian Sci, Scientology)
  9. Modern and Postmodern (atheists, agnostics)
  10. The undefined (no answer given)

In the next few months I hope to see relationships between certain disease and health states, and the entry within medical records that defines your personal ideology or philosophy.

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