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Integrator Forum: A Dozen of Your Voices on Diverse Integrative Medicine Topics PDF Print E-mail
Written by John Weeks   

Integrator Forum: 13 of Your Voices on Diverse Integrated Care Topics

Summary:  Correction on article about AANP ... Manahan on Gerberding's call for "schools of health" ... Yoga therapist/PT on integration challenges ... Kidder adds observations on the legacy of former NCCAM director Straus  .... Heads up on alt-med interests of New York Lieutenant Governor David Paterson ... A South African actuary on the influence of coding on DC/ND practices ... Hammerly suggests a method for CAM/integrative practitioners to participate in the health reform dialogue ...  A prospective student weighs MD and ND school  ... A query-response on data on the cost of ND services ... plus more
Send your comments to
for inclusion in a future Forum/Your Comments article.

1.    Correction on Notice re Bill Benda, MD, Joining Board of ND Organization


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Correction on Integrator report on bylaws changes
After running the interview with Bill Benda, MD, on his work to bring into collaboration the leadership of the American Holistic Medical Association, American Holistic Nurses Association and the American Association of Naturopathic Physicians, I heard back from Jane Guiltinan, ND, AANP president, with clarification on an AANP process. Guiltinan was last seen here reflecting on the accomplishments and wish-list from her term in office. My apologies for the mis-statement.
"Nice article on Bill and his work with our groups.  There is an inaccuracy however, that should be corrected.

"You stated: 'Last summer, the AANP changed its bylaws to allow a medical doctor to sit on its board. The change was made for Benda.'

"Actually, the by-laws were changed to allow for non-ND's at least 7 years ago.  It was not done for Bill, it was done because the Board at the time decided it was important to provide space for perspectives other than ND's on the board so we could deliberate our future direction with a wider lens.  I think it was a really wise decision, and am glad that Bill is on our board.  Additionally, the first non-ND to be elected to our board was Astrid Berg, known as Ozzie.  She is currently in the second year of her first term, and is running for re-election for a second term this year.  She has extensive experience on boards, as an executive director for a non-profit, and as a consumer who uses naturopathic medicine.

"I'd appreciate a correction in your next edition. Hope you are well, thanks for your work." 

Jane Guiltinan N.D.

President, American Association of Naturopathic Physicians 
2.    On Gerberding's "Schools of Health," plus LAc in Hospitals

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Bill Manahan, MD
The career of Integrator advisor Bill Manahan, MD, includes deep involvements in both academic medicine and holistic medicine. He responded to the Integrator article on the call from Julie Gerberding, MD, the head of the Center for Disease Control, which suggested that we need to establish "schools of health" if we truly wish to transform medicine as we know it.
"Regarding Julie Gerberding's Schools of Health in which some of the various disciplines would train together, I think it is a fabulous idea but probably 20 or 40 years ahead of its time.  I believe the most difficult part would be figuring out WHO (meaning which disciplines) should be training together.  It would be quite complicated, I believe."

[on another topic]


"I loved the piece you did on home birth and especially your personal experience.  Great writing.  I think you should publish that in Mothering magazine so many more people could have access to it.
 

"You asked about places where acupuncture is being done in hospital settings.  Abbott Northwestern Hospital in Minneapolis has the Institute for Health and Healing.  They are doing a large number of acupuncture treatments on inpatients every month.  They have six practitioners of acupuncture.  For details, the director of the program is Lori Knutson, last year's holistic nurse of the year."

Bill Manahan, MD
Minneapolis

3.   Holistic Leader Cruises the Integrator ...

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AHMA board member Kjersten Gmeiner, MD
Kjersten Gmeiner, MD
is a member of the board of the American Holistic Medical Association. We'd met via the phone in 2005 before meeting face-to-face in June 2007. She met the Integrator shortly thereafter ...

"Just a piece of fan-mail.  I spent the last hour or so cruising around your blog (my first ever, sad-to-say, but also exciting) and wanted to let you know how cool I think it is.  I got the first half of the ND at Bastyr in 1995/6 and my MD from UMn in 1998, joined the AHMA in 2004 and am now on the board, and it does my heart good to see such a comprehensive forum for the diverse world of integrated health care."

Kjersten Gmeiner, MD
Seattle, Washington

4.   
Examining Multiple Substances, Causes and Treatments

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Ann Fonfa of the Annie Appleseed Project
Ann Fonfa
runs the Annie Appleseed Project, a cancer advocacy program which supports integrative approaches, was taken with the Integrator interview with David Barnes, PhD, director of research with Standard Process, on the need for whole practice nutritional approaches. Fonfa recently participated in the NIH National Center for Complementary and Alternative Medicine "Stakeholder Dialogue," in which she urged non-reductionist approaches.

"The concept whose time may finally have come - the study of how multiple health approaches will heal the whole person. I run a cancer patient advocacy organization whose mission is to inform, educate and advocate around complementary and alternative approaches. We see the need to combine therapies, to focus on the person's health and well-being and NOT the disease specific.

"We totally support the idea of examining multiple substances, multiple 'causes', multiple treatments and just stated that at the recent NCCAM meeting in Bethesda (June 20, 2007).

"I have argued against the reductionist approach in many posters in the last few years - accepted and displayed at mainstream medical/scientific/research meetings.  I estimate that if we wait until each mechanism is explored in each individual 'active' ingredient or element, it may take 40,000 years or so.  Maybe less but a LONG time.

"Back in 2000 I proposed the Patient Track, where studies are done on what people actually do, in combination."

Ann Fonfa
President, The Annie Appleseed Project
 
5.    The Role of Stephen Straus, MD (1947-2007) Former NCCAM Director

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Stephen Straus, MD - 1947-2007
Susie Kidder, PhD
is an integrative medicine gadfly and connector who I met years ago through her connector friend and colleague Robb Scholten.  She says her current "passion is around moving our discussion on the universal healthcare system we will adopt in this country in a direction that can take us both forward and backwards – forward into models of medicine and care delivery that we can only begin to imagine, and backwards to re-establish the kinds of relationships across all of healthcare that we take for granted in the Integrative world." She responds to the Integrator forum on the legacy of Stephen Straus, MD, the recently deceased founding director of the NIH National Center for Complementary and Alternative Medicine (NCCAM).
"I read the memorials on Steve Strauss in a previous issue with interest. My reaction when I first heard him speak was that he might be driving integrative medical research in a direction that concerned me a little.  I felt as though he was suggesting some approaches that, for lack of a better description, sort of flattened and constrained some of the very multi-dimensional aspects of the medicine that actually provided a lot of its potential power.

"Over time I came to appreciate the role he played.  I believe it's difficult to measure the extent of the gift he gave our medicine by running interference while we grew up and came of age.  He protected us against what could otherwise have been a concerted effort to kill off (defund) any and all research into a model of medicine and an approach to care that were completely antithetical to the prevailing culture at NIH.  That more than compensates for a few studies that might have been a little more successful.

"It was stunningly obvious in Edmonton back in May of 2006 just how far Integrative Medicine had come.  Yes, there was a lot of serious mechanism of action work that was being done in research models that were indistinguishable from mainstream medical bench science.  And some, taken equally seriously, was totally amazing.  I attended the most interesting exploration into potential research models in which one could investigate the effects of non-contiguous and non-co-located phenomena that appeared, against all rational explanation, to affect each other.  And I attended a number of presentations on the delivery of clinical care in which the research protocols, data collection, and analyses had all the scientific rigor one might wish .... wrapped around a care model being delivered by a group of extraordinary human beings ... straight from their hearts.

"We're grown into a model of medicine in which there is a growing body of serious research, and we have done so without losing either our collective heart or soul.  Now that's what medicine is supposed to be, and some of the freedom in which that could happen was a gift from Steve Strauss."

Susie Kidder, PhD
Cambridge, MA

6.    Article on New York Governor Prompts Info on Lt. Governor David Paterson

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NY Lt. Governor David Paterson
Cindy Perlin, LCSW
came across the Integrator piece on the decision of New York Governor Eliot Spitzer to shut down the  government oversight operation which housed a budding office of complementary medicine.

"I just came across your blog entry on the dismantling of the Office of CAM in the New York State Department of Health and found it very disconcerting.  As an alternative medicine practitioner in NYS (biofeedback practitioner), I have been taking Spitzer at his word about his commitment to patient-centered, preventive and primary care and have been planning to launch a lobbying effort aimed at insurance coverage for biofeedback.

"I thought you might be interested in the attached article on our Lt. Governor David Paterson and his commitment to alternative medicine."

Cindy Perlin, LCSW

Note: The article on Paterson was in LE Magazine, October 2006, was entitled "Campaigning for a New Culture of Health.'" Paterson, a former state senator who is legally blind, began learning about natural therapies as a patient of Eric Braverman, MD. He has become a public advocate for promoting Braverman's vision of a "culture of health."

7.   South African Actuary on Discussion of CPT Shaping ND & DC Practices

This one fits in the category of sometimes it's just plain interesting to see what the Internet can do, relating to connectivity. The writer, Heather MacLeod, is a South African actuary who is involved with complementary and alternative medicine exploration for the International Actuarial Association.

"I spoke to you some time ago about the work we would attempt to do on TM/CAM from the International Actuarial Association. I apologise but I still do not have a document for you on the programme of action - although we have had a session recently at the IAA conference in Cape Town, South Africa.

"I sent the message below with an extract from your blog to the group that has expressed interest in working on integration issues here in South Africa. There are some international members of that group as well.

"I have set up a TM/CAM section on my web-site and will focus primarily on integrating TM/CAM from an actuarial and policy perspective. Much of the focus will be on Africa and South Africa, but I have put key links for other parts of the world, including your blog on the "TM/CAM" / "North America" page.

I want to start a page on coding issues and would like to put the attached file there for down-load, acknowledging your blog as the source. May I do so?" [I told her yes ...]

Heather McLeod

www.hmcleod.moonfruit.com
South Africa

Subject: TM/CAM and CPT and ICD coding

Dear Colleagues

John Weeks writes extensively in the USA on the business of the integration of CAM and allopathic medicine. You can access and subscribe to his regular blog at http://www.theintegratorblog.com

I attach an extract of a discussion in the USA on the impact of CPT and ICD coding on naturopathic practice. John Weeks comments at the end that this is underscored by comments from chiropractors and that "practice tends to conform to payment patterns, regardless of what is in the best interest of the patient."

Warm regards

Heather
Professor Heather McLeod
Visiting Associate Professor
Department of Public Health and Family Medicine
University of Cape Town Extraordinary Professor
Department of Statistics and Actuarial Science
University of Stellenbosch

8.    Method for Involvement in Healthcare Reform Dialogue


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Milt Hammerly, MD
Milt Hammerly, MD
, vice president for medical operations and integrative medicine for Catholic Health Initiatives, a 19 state hospital system, is an Integrator advisor. He offers this opportunity for involvement in the healthcare reform dialogue.

"I thought this link might be of interest.  
"This seems an opportunity for CAM/Integrative practitioners to contribute to the dialogue on health care quality and safety and perhaps also something that might be mimicked by creating a parallel wiki environment specifically for collaboration of CAM/integrative practitioners.

"Another powerful tool is available that could even facilitate clinical collaboration of a virtual team of practitioners.  Access Grid provides inexpensive (or expensive if you want all the high-end bells & whistles) tools that take us from the current point-to-point model of telemedicine & video conferencing into a new model with multipoint-to-multipoint interfaces.

"Although dysfunctional public policies and lobbying by powerful organizations may perpetuate inequities and inefficiencies in health care we may find the use of emerging technologies to be a great equalizer ..."

Milt Hammerly, MD
Denver, Colorado
9.    This Being a Dialogue on Going to MD School or ND School

A prospective medical student from Ontario who just goes by "ZF"
( ) read articles in the Integrator discussion of incomes in the naturopathic medical field. He is evaluating going to naturopathic or conventional medical school. This was our exchange.
Prospective Student: I just read your article on Feb 2007, about the ND income vs MD how NDs do on the market after graduation. As a prospective career changer, I heart-fully want to study ND, but the disadvantages are too many and risky and scary. No recognition, no chance of surviving financially, but job satisfaction is there. Of course for me it is more important to have job satisfaction but also as important is to be able to make a reasonably decent living.  (If I became) an MD, I don't know if I can practice as an ND , seeing patients as long as I want and this profession has its negatives too, a lot. So I am thinking both MD and ND are a bad choice. With all the info I have gathered from media and practitioners, I'm very confused and can't see clear a thing. Could you tell me what do you think?

Integrator:  Tough calls.
Many NDs survive financially and do just fine. Do you have an entrepreneurial spirit? That is the biggest deal in the ND world. There are very few salaried positions available. So you need to create your patient flow. Many ND graduates have fine clinical minds but lack the biz and entrepreneurial sense and can’t make it. Yes, there are downfalls to MD biz models as well. Again, a strong entrepreneurial spirit might allow you to create something out of the mold.

Prospective Student
: I am very passionate about the clinical medicine, but I might not have the entrepreunial biz spirit. I think I am very scared when facing such huge risk...and afraid to get a 80,000K loan and not be able to make it. It is a scary thought. In Canada, I have seen most MDs seeing patients for 10-15 min, not doing much nutrition or counselling, and billing the Medicare. They are able to make enough if they see 4 patients an hour, the same as what an ND will bill. But, I saw a small minority going in private practice, billing Medicare for what is covered and then billing patients out of pocket for what is not covered  ... I was thiking of that what if I could get in med school, and complete my MD then after residency complete the ND school (with advanced standing, I might be able to finish in 2 years), then I can practice the way I want, maybe with a mix model of private and public billing?

IntegratorMy only additional thought: You may not want more school when you get out of MD school and residency! You may also have had your current opinions and views of value drilled out of you. This happens. That said, if your plan stays intact, you would be among the first MDs from the US to have completed legitimate ND schooling. There are a dozen who have done ND school first, then MD school.
10.   A Thanks and an Integrator Plug

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Holistic coach Linda Bark, RN
Linda Bark, RN, AHN-BC
, sent a note after reading in Issue #29 of the Integrator Blog News & Reports.

"Thanks for this issue in particular. I especially loved reading about David Cundiff [and the charge of economic bias at the Cochrane Collaboration] and Alison Rose Levy's report [on the Donna Karan-initiated Urban Zen initiative]. I hope your distribution is growing. I send info about this blog to all my students and hope they are signing up. This is really extraordinary information."

Linda Bark, RN
AsOne Coaching

11.   
Regarding the Series on Yoga Therapy

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Matt Taylor, Bridging Yoga and PT
Mathew Taylor, PT, PhD, RYT
is a physical therapist and Yoga therapist who now sits on the board of the International Association for Yoga Therapists (IAYT). He responses to the Integrator series which was developed under a grant from IAYT. My apologies, Matt, for my delay in posting this!

"Thanks for all the work you do to initiate these important discussions. As a 'recovering' physical therapist, I still ride this fence day in and day out ... its complex without easy answers.

"As an expert legal witness for yoga based injuries there is some 'bad' karma developing that our own culture will craft through our legal systems/liability insurance to legislation etc. etc. that will be a system-generated reality if we aren't much better at keeping our yamas from bunching up in the yoga world .... ; )

"Leslie's argument falls apart from 'listening to a tune' to potentially blowing out another's cardiovascular system ....somewhere there is a middle ground and wishing everyone would behave won't get us there anytime soon cuz the few that aren't behaving will create everyone else's reality. A conundrum but one that requires skillful action vs wishful thinking. Wish it wasn't so, but we live in a land with more lawyers than doctors and the lawyers write the law....yikes."
 
Matthew J. Taylor, PT, PhD, RYT
Dynamic Systems Rehabilitation
10213 N 92 Street  Suite 102
Scottsdale, AZ  85258
12.    Query on Data on Insurance Coverage for CAM Services

From 1993-1999, my primary focus in integrated health care was on coverage issues. From time-to-time, I receive a query on the topic via the Integrator. This was one, from Karina Wickland, RD, ND, and my response to her.

"I'm a naturopathic doctor in Canada and I'm doing a project for my professional association around increasing naturopathic coverage for extended health care plans.  The goal is to complete a package that we can present to employers and unions emphasizing the benefits of naturopathic medicine and the potential for cost savings.  To avoid re-inventing the wheel, I have been checking in with a few other associations to find out what work has already been done.  A doctor in Oregon directed me to your site as this is an area you have written about (I read a couple of the articles you wrote about Dr. Bernie Noe)

"I was wondering if you could direct me to any resources - written or human - that would be helpful to me in this project.  I am looking for examples of naturopathic medicine saving employers money, any studies that have been done, any innovative insurance programs OR if you know anyone who had completed a similar project or presentation. Much appreciated."

Karina Wickland, RD, ND
Vancouver, BC

Response: I shared two links at the Integrator site, under CAM resources in PDF. There are two coverage-related long documents which you will find useful, my paper on coverage issues for the  National Institutes of Health and my White House Commission Testimony. The former is an exploration of the challenges in thinking about coverage, while the latter includes 40 tables that look at coverage models and cost issues.
13.   What about your language ...

Jodi Vingelen
is a naturopathic student or physician (I am not sure which) associated with Bastyr University.
Vingelen:  I was wondering why you choose not to use the words, "Naturopathic Medicine"?  Instead, you use CAM and Integrative Medicine.  Morgan Martin sent your blog on your telling of your son's birth to me. Thanks for sharing your story.

Integrator: I don't include massage or AOM or chiropractic or holistic nursing or herbal industry or etc. either. It's awkward, but I attempt to umbrella the others with 'integrated health care.' Good query.

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