Take As Directed Oct 3, 2013

by RICK RADER, MD * EDITOR-IN-CHIEF

It's a scenario as old as medicine itself. Patient presents his or her pains, complaints, concerns and fears. The physician questions, pokes, prods and probes. The physician scribbles on a slate, parchment, paper or touch screen and offers, "Take this, it will help."

Ah, the prescription. Panaceas, bromides and elixirs. Early on it was plants, herbs, roots, bark and soil. Molds and spores were de rigueur. Opium, morphine, black henbane, harmal, peyote, and psilocybin were the drugs of choice to soothe the body and were not only taken recreationally but were eventually responsible for the need to regulate the dispensing of certain drugs "by prescription only."

Up until the early 20th century, a prescription merely meant "a doctor's written advice or recommendation and prescriptions were not limited to just pharmaceutical drugs. In fact, it was not uncommon for doctors to give their patients written prescriptions for bed rest, or a set of shoes one size bigger etc." The fact that the prescriptions were "written" is noteworthy since they became popular when only one or two percent of the population knew how to read and write. The actual law restricting the use of certain drugs by physicians had its origins in trying to inform consumers about the drug. The 1938 Food, Drug and Cosmetic Act required that every drug bear a label adequately instructing the consumer in the safe use of the product. It said nothing about prescriptions. They soon realized that some drugs were inherently so unsafe that no adequate label cold be written.

And so it fell to the physician to "prescribe" drugs. And prescribe they do; in doctor's offices alone, to the tune of 2.6 billion prescriptions. Throw in another 500 million scripts written in hospital outpatient department visits and emergency rooms. The physicians have quite a lot to prescribe. The FDA has about 800 approved drug ingredients and there are over 100,000 drug products derived from them. We need this armamentarium. According to the World Health Organization's International Classification of Diseases (ICD), there are probably near 20,000 diagnoses that exist within biomedicine. WHO distinguishes 12, 420 disease categories. So in revisiting the scenario that introduced this article it's quite a dance. Patient presents with one (or more) of a possible 20,000 different, funky things happening to his/her body and the physician selects one of 100,000 different concoctions to meet the funk head on.

In the case of the disorders, conditions and syndromes that constitute the field of developmental disabilities, we're outliers. There are no "prescriptives" specifically for most of the funks that are negotiated daily by readers of Exceptional Parent (EP) Magazine. We certainly are big time generators and recipients of multiple drugs from multiple therapeutic classifications but we never hear, "Take this, it will help," only, "Take this."

Till now.

One prescription that should be extensively written by clinicians for their patients with intellectual and developmental disabilities is to "engage in Special Olympics."

As a therapeutic regimen it has no peer. It's safe, effective, readily obtainable, renewable, easily titrated for changes in physical status, many options for delivery, affordable, easy to administer, requires no refrigeration, provides almost immediate improvement, completely systemic, can be taken with or without food, unrestricted indications, has no adverse side effects and readily crosses the blood brain barrier. Much to their collective energy, resources and frustration, Merck, Pfizer, Roche and GlazoSmithKline continue to research the discovery of drugs that boast those attributes. Like all high potent drugs, "The Special Olympics" does require FDA approval. However, here, we are not referring to the Federal Drug Administration—but to Families, Direct (care staff) and Advocates. That is the FDA that impacts on the lives of individuals with intellectual and developmental disabilities; and they have "approved" Special Olympics since its inception.

Barry Blackwell, writing in the New England Journal of Medicine (1973) offered that, "Too often a prescription signals the end to an interview rather than the start of an alliance." In the case of "prescribing" engage in Special Olympics the "alliance" is initiated, encouraged and developed over the life of the Special Olympics athlete.

Pioneers in the use of "prescribing of Special Olympics" to patients with intellectual and developmental disabilities are the medical practitioners at the Orange Grove Center in Chattanooga, Tennessee (where I have the privilege of serving as the Director of the Habilitation Center). While Orange Grove has been long supporters and participants in Special Olympics as an athletic program providing enjoyable activities, opportunities for socialization and personal accomplishments, we began to view it as a bona fide health and wellness endeavor. The literature is robust as to the myriad attributes that regular physical activity provides to the neuro-typical population (with recent inclusion regarding benefits for patients with dementia and seizures), and so we were motivated to do more than simply display posters of Special Olympic athletes competing.

A collaborative equation was developed, which included the Orange Grove Center's Department of Health Care Services, the Orange Grove Department of Therapeutic Recreation, and the Morton J. Kent Habilitation Center. Thus, the key players included the clinicians, the coaches and the innovators. Under the leadership of Dr. Randy Heisser, Dr. Graham Parker, Nurse Practitioner Latosha Walker, Therapeutic Recreation Specialist Lizzy Cheek and myself (someone has to get the coffee) we created a strategy that led to the necessary interdisciplinary team that such an initiative demands.

Conceptually the program begins with the clinician writing an actual prescription advising the patient to "engage in Special Olympics" which leads them to a meeting with Lizzy. An assessment is made that reveals their interests, experience, skills and motivation. Lizzy conducts multiple trial opportunities to ascertain the best Special Olympic sport that would meet the individual's needs. This is done in consultation with family members and other members of the "circle of support" (teachers, direct support professionals, job coaches, physical/occupational therapists, behavioral professionals and, often, close friends). Lizzy then sets ups a schedule for practice, smiles and announces, "Let the games begin!" The clinicians record the participation with Special Olympics in their clinical and progress notes and use it as "talking points, encouragement and tracking health indicators."

Dr. Graham Parker, the Director of Orange Grove's Health Care Services remarked about the vision behind the initiative, "Setting the standard for comprehensive, patient-centered care, Healthcare Services' 'prescription' for Special Olympics participation innovatively integrates the fields of Healthcare and Developmental Disability. More than simply promotion of a 'program' to benefit individuals with disabilities, this decision punctuates the vital leadership role of Healthcare Services in enhancing physical and psychosocial outcomes for the individuals we serve."

To Blackwell's observation that "too often a prescription signals the end to an interview rather than the start of an alliance," we can simply say that by having clinician's "prescribe" engage in Special Olympics, the alliance elevates the potency of the formula tenfold; leading to enhanced health outcomes that exceed the goals of the U.S. Department of Health and Human Services' "Healthy People 2020."

Finally we have something that will enable us to say, "Take this, it will help."

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