Institute of Medicine's Names Planning Team for Integrative Medicine Summit: Snyderman to Chair

Summary:  The Institute of Medicine (IOM) of the National Academy of Sciences has announced a 12-person planning committee which will oversee development of the February 25-27, 2009 National Summit on Integrative Medicine and Health of the Public. The IOM is sponsoring the Summit in partnership with the Bravewell Collaborative of philanthropists. Here is a look at the 12 member team, chaired by Ralph Snyderman, MD, plus some musing on their not very integrated mix. Nine are MDs, suggesting that to the IOM, "integrative medicine" is an MD franchise.

Institute of Medicine of the National Academies

The Institute of Medicine (IOM) of the National Academy of Sciences announced in March that the Bravewell Collaborative of philanthropists and the IOM have "

Ralph Snyderman, MD (Chair)
Chancellor Emeritus
Duke University

Dame Carol M. Black, MD, FRCP
Chair
Academy of Medical Royal Colleges

Elizabeth Ann Goldblatt, PhD, MPA/HA
Vice President, Academic Affairs
American College of Traditional Chinese Medicine

Erminia Guarneri, MD, FACC
Founder and Medical Director
Scripps Center for Integrative Medicine

Michael M.E. Johns, MD
Chancellor
Emory University

Richard P. Lifton, MD, PhD
Sterling Professor and Chair
Department of Genetics
HHMI Investigator
Yale University

Bruce S. McEwen, PhD
Alfred E. Mirsky Professor and Head
Harold and Margaret Milliken Hatch Laboratory
of Neuroendocrinology
The Rockefeller University

Dean Ornish, MD
Founder, President & Director
Preventive Medicine Research Institute

Victor S. Sierpina, MD
WD and Laura Nell Nicholson Family Professor of Integrative Medicine
Professor of Family Medicine
University of Texas Medical Branch

Esther M. Sternberg, MD
Director, Integrative Neural Immune Program
National Institute of Mental Health

Ellen L. Stovall
President & CEO
National Coalition for Cancer Survivorship

Sean Tunis, MD
Director
Center for Medical Technology Policy

Summit's financial backers

The planning team make-up provokes a few observations:

• MDs uber alles  

Okay, this is the Institute of Medicine. Filling the team with 9 medical doctors out of 12 members (75%) is a strong message that the IOM views "integrative medicine" as an MD franchise. The Bravewell's Mack pointedly stated that "this is not (about) CAM" on the Charlie Rose Show. This is unfortunate. There is of course no such thing as "CAM." The acronym and the words represented are nothing more than a useful, if misleading, bundling of diverse therapies and whole systems of care which are not conventional medicine. Many of these whole systems have been "integrative" mind-body practices for millenia. Can we have reform of clinical care in this country if MDs don't realize they have something to learn by integrating others into their decision processes - including meta-processes like this? It's time we end the era of segregation in the "integrative" dialogue. Here is hoping that the IOM team includes the richness of these disciplines in the Summit itself.

• Bravewell connections 
  

Three of the members have had their work honored by Bravewell. Snyderman won the $100,000 Bravewell award for leadership in integrative medicine in 2003. Two years later, Guarneri was one of the nominees for the Bravewell's second award. When Bravewell  named six as "Pioneers in Integrative Medicine" in 2007, Ornish was among them, picking up a $25,000 prize.

• Academic consortia represented 
  

Two academic consortia are represented here, through their chairs. Sierpina is the chair of the Consortium of Academic Health Centers for Integrative Medicine, with 41 member medical schools, which was founded through significant Bravewell support. Goldblatt is chair of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC). ACCAHC includes among its membership the councils of colleges of the licensed complementary healthcare disciplines. Inclusion of Goldblatt is the IOM's first formal recognition of the extensive infrastructure created by the licensed complementary healthcare disciplines. ACCAHC actively sought representation on the planning team. (*)

• Low presence of licensed CAM disciplines
  

Other than Goldblatt, the licensed complementary and alternative healthcare fields are not present. However, because Goldblatt chairs ACCAHC, the case might be made that all of the licensed disciplines whose councils of colleges are ACCAHC members.

• Specialist versus family medicine 
  

With two cardiologists (Guarneri and Ornish) and just one family medicine practitioner(Sierpina), the team has a tilt toward inpatient care. See my separate commentary which touches on how conventional medicine's inpatient bent and tertiary care power center has tended to take complementary and alternative health care out of the outpatient environment from which it principally emerged.

• No nurses 

Given the role of nurses, particularly in managing and delivering in-patient complementary healthcare services, and the recognition of holistic nursing as a boarded specialty by the American Nurses Association, this oversight is unfortunate.

• NIH presence 

Sternberg, based in the NIH, was a name mentioned as a potential candidate for the directorship of the NIH National Center for Complementary and Alternative Medicine before that position was filled last January. Sternberg has research experience in the relationship between stress and emotions and health.

• National Summit with international connection 

The Bravewell's close links with England - including having the Duchess of York Sarah Ferguson (aka "Fergie") as Mistress of Ceremonies for the 2005 Bravewell event, and the relationship with the Prince's Foundation for Integrated Health, comes through again with the inclusion of the chair of the Academy of Medical Royal Colleges.

• The newbies/experienced mix
  

As seems the practice with these national gatherings, those with background in complementary or integrative medicine are matched by a strong subset of individuals with little or no connection to the field prior to their appointments.

Ralph Snyderman, MD, planning committee chair

Background of Snyderman - academic and entrepreneur

Snyderman's participation in "integrative medicine" has always been intriguing. By lending his name to the movement, the former chair of the council of deans of the American Association of Medical Colleges has been perhaps the most useful credibility-builder and namedrop for academic leaders in integrative medicine, other than the IOM itself. He has also been the figurehead for a significant integrative medicine program at Duke, funded largely by the Macks and directed by long-time academic IM leader Tracy Gaudet, MD.

Known for his work at Duke, Snyderman's other hat in recent years is as health care entrepreneur. He serves as a venture partner with investment firm NEA.  He serves on the board of Proctor and Gamble and of XDx, Inc. The latter is a firm which seeks to "

Snyderman promotes a version of integrative thinking which he calls "prospective care." The approach is "emergent" rather than reductive. An article on the approach is available here.

Bravewell's Christy Mack

How to stay tuned

The IOM's website on the Summit can be found here. Some of the initial thinking about the Summit's directions are hopeful.  For instance, there is reference to "