New York State Governor Spitzer Focuses on "Patient-Centered" Care, Guts CAM Office: What's Up?
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.
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.”
Apparently 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.
Send your comments to
for inclusion in a future Your Comments article.
Apparently 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.]
