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New York State Governor Spitzer Focuses on "Patient-Centered" Care, Guts CAM Office: What's Up? PDF Print E-mail
Written by John Weeks   

New York State Governor Spitzer Focuses on "Patient-Centered" Care, Guts "CAM Office" - What's Up?

Summary: In the best of all worlds, or even a reasonably acceptable one, the consumer-driven movement toward use of alternative, complementary and integrative medicine approaches might be included in any effort to promote "patient-centered" care. But within the course of a week last month, New York State Governor Eliot Spitzer first announced his vision for the former. Then he put the leaders of an emerging New York State "CAM Office" on notice that they had a week to clean out their desks. Here is the story of the departed. The Integrator has contacted Governor Spitzer's budget office but hasn't yet a response on his actions. This will be added here later ...

The budget plans and priorities for
New York State Governor Eliot Spitzer (D), who took over on January 1, include a focus on "putting patients first" and "patient-centered care" according to a March 5 release.

Image
New York Governor Hugh Spitzer (DE)
But Spitzer's vision for New York's healthcare future apparently does not link complementary, alternative and integrative approaches with patient-centered approaches. Two days after Spitzer's press conference promoted patient-centered care, a deputy director in the state's department of regulatory affairs who had been exploring the role of complementary and alternative medicine (CAM) in numerous venues sent out a letter declaring that the New York State "CAM Office" was to be shut down.

The note the Integrator received was from Leslie Botta, DC. Botta held the title of Deputy Director, Governor's Office of Regulatory Reform Complementary & Alternative Medicine Project. She stated:

"It is with great disdain that I write to inform you of the elimination of the NY State Office of Complementary and Alternative Medicine and termination of all staff.  Despite serious efforts to raise the new administration's awareness and understanding of CAM and its benefits (as well as risks), it has chosen to dispose of an office that would factor very favorably into an agenda for 'putting patients first' and focusing on 'treatment and more importantly prevention of chronic disease.'"
The statements which Botta cites are from the above-mentioned March 5, 2007, press release from Spitzer. In that release, representatives of numerous blue-chip, disease-specific associations (diabetes, cancer, heart, etc.) endorse a Spitzer initiative to make health care "patient-centered." States Spitzer:
“I am proud to stand shoulder to shoulder with those who know that state health care spending should be patient-centered. Our ability to effectively treat – and more importantly prevent – chronic diseases means we must invest in new public health programs, such as cancer screenings, obesity prevention programs, and anti-tobacco initiatives.”
ImageApparently Spitzer didn't view complementary and integrative medicine as part of the patient-centered mix, at least as advocated through the state's "complementary and alternative medicine project." [Note: The Integrator has contacted Spitzer's budget office and will update this article when a response comes back.]

A "CAM Office" or a Build-Out of Department Head Passions?

In truth, the so-called "CAM Office" existed largely as a hopeful idea of Botta and her boss,
Margaret Buhrmaster, the director of the Office of Regulatory Reform for the New York State Department of Health. Buhrmaster served on Institute of Medicine's Committee on complementary and alternative medicine which produced the 2005 IOM Report.

Botta explains that in 2000,
the New York State Office of Regulatory Reform, "originally created to support the [prior] Governor's regulatory reform agenda and facilitate a more effective regulation processing system, now also serves as a resource for the most current and reliable information and research on CAM, and as a facilitator/mediator on a number of interdisciplinary projects." 

Botta,
who joined the regulatory reform staff in April of 2006, adds that "what started as a narrow focus project has now grown into a major resource for both government and the private sector." What projects? Botta's March, last-minute appeal included a long list of potential values and specific projects.
__________________________________

Resources, Real and Potential, of the Gutted new York State CAM Office

- Leslie Botta, DC
former Deputy Director, New York State Department of Health,
Office of Regulatory Reform


Values from a CAM Office

  • Develop information files, resource materials and data bases
  • Track CAM policies/activities within federal government and other states
  • Collaborate and facilitate DOH CAM projects
  • Collaborate with other NYS agencies, the legislative and the executive branches
  • Collaborate with health care providers, educators, health care organizations at state and national levels
  • Research special public health issues related to CAM
  • Identify possible CAM grants for NYS
  • Assist in policy development
Current CAM Issues/Projects
  • CAM Use Surveys - AIDS patients, Hospitals,  Insurance Companies on both state and national levels
  • Legislation - resource file on state and federal laws, regulations, proposed legislation
  • Botanical (herbs) - maintain reliable database, information on uses, clinical trials, current efficacy and risk information
  • Dietary Supplements - continue research of potentially harmful weight loss, sports supplements, personal enhancement products; marketing frauds, statistical data
  • Licensing/Certification/Registration of CAM Practitioners and/or Training Institutes - developing files on other states, collaborating with State Education Department, Legislature, and CAM Therapy Representative Associations
  • Physicians Scope of Practice - communicating with Office of Professional Medical Conduct on CAM practice issues
  • Insurance Coverage - collecting information on independent insurance coverage plans, looking for cost benefit information/data collection formats
  • Medical Education and CAM practitioner education - reviewing current curriculum and serving as a resource for Albany Medical College on expansion of CAM program
  • Consumer Education - working with other DOH units on public information issues, for example, informational brochures on CAM
  • Hospital and Nursing Home CAM Programs - serve as a resource for interested facilities
  • Kids & CAM - completed first phase of a research project designed to study the use of CAM for specific childhood diseases and wellness programs
  • Chronic Diseases and CAM treatments and prevention
  • Trauma and its role in Chronic Disease
  • Revitalization of NY’s historic mineral spas
  • Women’s Health
  • Minority Health
  • Aging
  • Environmental Health
  • Insurance/Medicaid/Child
  • Autoimmune Diseases

__________________________________________

The extensive document released to the Integrator by Botta and later by Roberta Gilgore, a consultant to the office, underscores just how ambitious the nascent "office" was becoming. Kilgore notes specific work on "two innovative projects." One of them was exploring CAM in a Trauma Demonstration Program and the second a more general exploration of renovating New York's "historic mineral spas."

Both Botta and Kilgore argue that the loss is significant to New York. Here are Kilgore's words, referring only to the two projects with which she was associated:

"Both these projects would have had an enormous impact on reducing the health and economic burdens associated with chronic disease while improving the health and economic well-being of communities, especially in upstate New York."
Comment:  The irony in the announcement of Spitzer's decision last month was that the very existence of the so-called "CAM Office" probably became known to all of you only through the announcement of its demise. I had an excellent phone interview with Botta and Buhrmaster as part of their information gathering late in 2006 - set up through Integrator sponsor and adviser, Tino Villani, DC.

   
Isn't it ironic, but
somehow emblematic
of CAM and our culture
that we only have a
chance to learn about
this initiative after
its demise.

 
I found the existence of the work fascinating. No other state has a "CAM Office" of which I am aware. I wished to report it but didn't when it became clear that the work they were doing was under the radar. I later had a chance to support a request from Botta for information gathering on the economic case for integration.

Isn't it ironic, but somehow emblematic of the still precarious political-economic position of alternative, complementary and integrative medicine, that we only have a chance to learn about this initiative after its demise.

I will follow-up when I hear more from Spitzer's office about the decision, and the Governor's views of on CAM, and particularly their relationship to patient-centered care. I have a suspicion though that the termination of the so-called "office" may be framed as a dismantling of a favored project of the Democrat's predecessor, a Republican. And my guess is that the budget-cutting had more to do with differing views of "regulatory reform" than with the only barely visible, until the end, CAM-related activity. Let's see.

Meantime, the list of possible projects and potential value is reminiscent of the visionary components of the White House Commission on CAM Policy. The potential for value touches many areas of health. But it's hard to grab that value if one can't announce what that value might be out loud.

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