July 2006

Introducing ...

A member of the International Scientific Advisory Panel

When David Jackson, DC; Matthew McCoy, DC; and Robert Blanks, PhD founded Research & Clinical Science (RCS), they realized that the credibility and validity of the program would rely in great part on the quality of researchers chosen to analyze the data collected by chiropractors around the world.

They sought out a world‑class group of respected scientists with unimpeachable credentials and proven expertise in health care research. The result of their efforts was the RCS International Scientific Advisory Panel, a multi‑disciplinary group charged with overseeing the collection of, and analyzing, data compiled on hundreds of thousands of volunteers and chiropractic patients across the globe.

Each month during this special series, The Chiropractic Journal profiles one member of this prestigious panel.

Margaret Ames PhD

This month's featured International Scientific Advisory Panel member is Margaret Ames, PhD, who is a health behavioral psychologist of considerable acclaim, and expert in the fields of health promotion and disease prevention, biomedical and behaviors, maternal and child health, Complementary and Alternative Medicine (CAM) and a number of disease entities including diabetes, cancer, nutritional co‑therapy, cardiovascular disease, and AIDS.

Dr. Ames developed an early interest in woman's health and in particular the pregnancy and delivery process. No doubt some of these interests resulted from her father being an obstetrician/gynecologist. She fondly remembers that her dad was always saying that "each and every delivery allows you to witness a miracle."

Unfortunately, the lifestyle of an obstetrician is notoriously disrupted, and there were many missed family and social obligations in order to deliver babies. Nevertheless, she was still fascinated by the physiological and psychological aspects of the birth process.

She pursued these interests and received her Bachelors of Science degree in Psychology (with Honors) from Trinity College, Hartford Connecticut in 1979 and then went on to earn her PhD in Behavioral Medicine from the Uniformed Services University of the Health Sciences, Bethesda, Md (1985).

Her training in psychology demonstrated that birthing and other stressful events, in general, share a number of psychological events (social support, conditioning, distraction, etc.).

Her experimental background gave her the idea to examine how prenatal expectations for delivery affect postpartum outcomes. The research involved gathering data from women before and 6 weeks following delivery. She evaluated anticipated vs. experienced pain on questionnaires; expectation for fathers involvement; expectation for type of delivery, vaginal vs. cesarean‑section, etc. and a number of clinical outcome measures.

Results indicated that when the prenatal expectations were not met, the outcomes of the birth were perceived very negatively and, conversely, when the prenatal expectations were met the birthing outcome measures were vastly improved.

What was perhaps a more important conclusion from the research was, when there was a mismatch in expectations vs. the actual birthing experience, the new moms' did not blame the hospital, staff or others, they actually blamed themselves. Clearly, one way to improve patient outcomes, was to develop new strategies for management of patient expectations. Subsequently, many studies have confirmed these relationships.

During her graduate studies, Ames sharpened her clinical and research skills serving as Director of Research for the Birth Education Center of Washington DC. Following graduation she served as medical psychologist, for Kappa Systems Inc, also in Washington and later as Associate Executive Director for the American Society for Psychoprophylaxis in Obstetrics and Lamaze (Arlington, VA).

Her PhD studies allowed her to put into effect clinical protocols to help manage patient expectations and thereby promote healthier outcomes. The most successful programs were patient education, Lamaze birth training, and early determination of the patient's expected role in the process. It was important to determine if the patient chose to be relatively passive or active (as a partner) with the health professional team.

The most successful preventative measures was early patient education and monitoring about health risks and compliance (ban on smoking, alcohol, over‑the‑counter drug and substance use; weight management; prenatal nutrition; weight‑gain during pregnancy; exercise; lots of clean water.). One might think that these measures would be routine in primary care settings today, but there is much room for improvement to optimize the health of pregnant women and their newborn children.

Over the next six years, Ames held senior management positions for two private research and development companies (R.O.W. Sciences, Inc, and IQ Solutions, Inc.) in Rockville, Md. As a recognized health expert, Ames was invited to join numerous panels to develop health practice guidelines in conjunction with the National Heart, Lung and Blood Institute and later the National Cancer Institute at the National Institutes of Health.

A major landmark of her early career was her co‑authored paper on "The 1988 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, Arch. Int. Med. 148:1023‑38, 1988. She continued research and policy work in this area over the next 5 years.

In 1994, the National High Blood Pressure Education Program Working Group published the Report on Hypertension in Diabetes and another volume for high blood pressure in the elderly were published with Ames as one of the co‑authors. A change in emphasis and her position with the Public Health Service, led her to assist with the publication in 1996 of a number of health practice guidelines for breast, colorectal, gastric, pancreatic, non‑small cell lung, small cell lung, prostate and esophageal cancers, each representing the culmination of months of literature review and expert panel testimony and discussions.

Throughout her policy and guidelines work Ames continued to publish research articles on her own areas of research including a number of seminal studies on the status on woman's health, research on the components of a wellness health care practice, male sexual vitality, type 2 diabetes in children and female infertility. These studies were published in journals such as the International Journal of Integrative Medicine, Natural Medicine Review, and popular media such as Health Smart Today.

In 1996, her career brought her to California where she served as Director, Wellness Research Center, Body Wise International (Tustin, CA) a large nutritional supplement company. Under her capable leadership of the next 6 years, she expanded the wellness research department of this group to include 4‑6 major continuing education programs per year for health professionals including chiropractors, physicians, and dentists. During the majority of this time (1998‑2002), she was on the research faculty in the Department of Anatomy and Neurobiology, University of California Irvine, College of Medicine.

Ames' career then took another important turn that brought her back to Washington DC to assume several very responsible positions with the Department of Health and Human Services. Which agency cannot be mentioned because of Federal Guidelines and, consistent with this policy, her role on the International Scientific Advisory Panel is strictly as an individual and not as a member of the federal government. In her current capacity she is responsible for health program assessment, analysis and policy, which she thoroughly enjoys.

On a personal level, Ames sees herself as a "health information junky." She wants to know everything about her health care and that of her family. She states that "no single body system works in isolation, and one needs to look at the body holistically. If patients want to be involved, then they need to work closely with their health care provider." Unfortunately, she acknowledges that the opposite may be true.

Even if this is true, and "they don't want to get involved, they still need to communicate this information to their doctor." Either way, the health professional has a much better understanding about the patient's health beliefs, values and behaviors, making it easier to communicate effectively and manage their expectations and patient outcomes.

 Ames points out that the new director of the National Institutes of Health has proposed a new vision for the health system in the United States, centered on what he calls the four‑p's: Predictive, Personalized, Preemptive, Participatory.

An aggressive health research agenda and evidence‑based medicine promotes the predictive nature of health outcomes. Personalized and Preemptive strategies should be a shared responsibility of the patient and a responsive health service delivery system.

However, the last "P" ‑‑ Participatory‑ is largely the responsibility of the patient. The patient must responsible for their health by maintaining a healthy lifestyle to insure health and wellness. Needless to say, Ames agrees entirely with the health objectives of the chiropractic lifestyle, summarized as "In addition to specific care of the spine, chiropractors usually suggest therapeutic exercises, general fitness recommendations and advice on nutrition, vitamins, weight loss, smoking cessation, and relaxation techniques." (Hawk and Dusio, JMPT, 1995).

Finally, the NIH director also talks about a fifth "P" and this is "Payable." The health care system must be affordable and this is the responsibility of all concerned... citizens by following a healthy lifestyle, and the health system, private sector and government by carefully managing its health resources.

Ames believes that a preventative (wellness) approach is the only rational strategy to address the current health care crisis. She points to the need to examine wellness globally across physiological, psychological, social, spiritual and environmental domains of health and to come up with educational strategies and health policies that are effective.

People need to know that they are responsible for their health, that this involves compliance with all aspects of a healthy lifestyle, and health professionals need to adopt effective educational and preventative strategies to detect, analyze and correct risk factors before they develop into clinical disease.

There is a now famous story about "The 100th Monkey" that perfectly characterizes human dynamics when confronted with the need to change. As a health behavioral psychologist, Ames likes to quote this story because it talks about the challenge of converting our current national policy of disease management, into a rational prevention and health promotion policy. The shift from sickness care to wellness perspective is "like the 100 monkeys living on the island."

Clearly, change is slow but it only takes a small number of committed individuals to make the difference. Ames sees herself as one of these wellness pioneers and this is why she is so excited about working with the other members of the International Scientific Advisory Panel to advance the culture of evidence‑based chiropractic. It is the strong emphasis on wellness promotion (vs. sickness care and back pain) that drew her to support the sweeping research agenda of RCS. And, she sees that the research concept of conducting practice‑based health outcomes research and developing sophisticated electronic clinical records as the logical first step to advancing this wellness agenda.

When asked about her hopes and dreams for the future, she simply replies...."That we succeed in bringing the 100th monkey successfully into the new wellness health agenda"