The Epidaurus Project

The opening of the new Walter Reed National Military Medical Center (WRNMMC) in September 2011 marked a new era of holistic medicine in the U.S. military health system. An inspiring example of the “hospital of the future,” its whole-person approach to patient-care and state-of-the art facilities were informed by the Epidaurus Project, an initiative spearheaded by Institute Scholar Fred Foote, MD, to create a model healing environment for Wounded Warriors of the Iraq War as well as other service members. 

Envisioning a Model for Holistic Care

Launched in 2001, the Epidaurus project brought together civilian and military thought leaders to identify the core principles of patient-centered care and define the physical environment that would facilitate it.

Measuring Its Impact

A barrier to the widespread adoption of holistic or integrative medicine has been the lack of metrics to directly measure the whole-body effects of such interventions. As the Epidaurus principles were coming to life through the construction of WRNMMC, Dr. Foote turned his attention to evaluating the impact of the innovative care that Wounded Warriors and veterans would receive there.

With support from the Nova Institute (then The Institute for Integrative Health), in 2010, he convened a group of experts, including Scholar Dr. David Lary, to develop a set of scientific metrics for this purpose. Drawing on genomics, systems biology, and complex systems science, the working group developed five metrics, which Dr. Foote describes in an article published in Global Advances in Health and Medicine:

1. The first metric (Esther Sternberg, MD, and Julian Thayer, PhD) combines heart rate variability, salivary cortisol, and neuroimmune biomarkers into a single expression to give a broader measure of allostatic load. Advanced mathematics, using successive mean difference and multilevel regression models, will be required.
2. The second metric (Herbert Benson, MD, and colleagues) involves whole-genome transcriptional analysis to identify changes in gene expression associated with holistic therapies. In civilian populations, these investigations have shown meaningful changes in gene expression with mind-body medicine practice, including progressive activation as one moves from non-practitioner to novice to expert. Genes regulating mitochondrial energy utilization and immune processes are among the complexes involved.
3. The third metric, Natural Language Processing (Ann Berger, MD, and Perry Skeath, PhD), uses artificial intelligence to analyze syntax and content of patient stories and self-reports to determine feeling states and propensities to action. Useful findings have been reported in various settings, including advertising and the analysis of suicide notes.
4. The fourth metric, “star glyphs” (Jim Deleo, PhD), involves plotting patient indices as diameters on a circle, with the patient’s score represented as a dot on the line. Connecting the dots produces a geometric shape. Specific disease states may have characteristic shapes. Progression toward a “normal” shape, or fluctuation in a patient’s personal norm, can be captured by combining multiple time-sequenced glyphs into a film.
5. The fifth metric, machine-based learning (David Lary, PhD), presents large data sets to an artificial intelligence program to identify nodes of meaning not apparent to the human observer. Our initial intent is to analyze de-identified records of patients with traumatic brain injury and post-traumatic stress disorder to establish more valid sub-groupings for these conditions. Afterward, “before/after” testing of specific holistic interventions can be pursued.

Putting the Metrics To Work

The Green Road Project is using three of the Epidaurus metrics to evaluate the healing effects of spending time in nature—specifically, on a woodland path traveled by Wounded Warriors and their families at Naval Support Activity Bethesda, home of WRNMMC. This wheelchair accessible route allows people to cross campus through a tranquil sylvan area rather than on busy roads.

The project team hopes to scientifically demonstrate the positive impact of encounters with nature on human health. Objective evidence will advance the case for increasing community green space and making exposure to nature a therapeutic mainstay.

LEARN MORE

Article: Holistic Care in the US Military I – The Epidaurus Project: An Initiative in Holistic Medicine for the Military Health System, 2001-2012. Frederick O. Foote, MD; Roger J. Bulger, MD; Susan B. Frampton; PhD, and Edmund D. Pellegrino, MD. Global Advances in Health and Medicine. May 2012.

Article (abstract): The Epidaurus Project: Holism in Department of Defense Health Facilities. Frederick O. Foote, MD. Military Medicine. January 2012.