Your Comments Forum: ND, Yoga Therapist, MD, RN, 2 DCs, Massage Educator and a Business Strategist
Written by John Weeks
Your Comments Forum: ND, Yoga Therapist, MD, RN Health Coach, 2 DCs, Massage Educator, Integrative Cancer Advocate and a Health Business Strategist
Summary: Reed Phillips, DC, PhD on the "CAM ghetto" ... Michael Levin on the importance of the NCCAM cost-effectiveness initiative ... Julie Chinnock, ND, MPH on who is a "medical doctor" ... Massage educator Cathy Ayers on the new curriculum on integrated care at the Potomac Massage Research Institute ... Bill Manahan, MD, on the Medicaid pilot and the extent of savings he would anticipate from cost explorations of integrative care for other conditions ... Ann Fonfa, Linda Bark, RN and Jim Winterstein, DC, on the Iowa poll results showing interest of voters in licensed CAM practitioners being included in basic benefits ... Yoga therapist Janet Carpenter on why Yoga therapy is a "third path" toward health ...
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Reed Phillips, DC, PhD
1. "CAM ghetto" article stimulates reflection on civil rights demonstrations
Reed Phillips, DC, PhD, has been a leading educator and
researcher in the chiropractic field for 4 decades. The column on the
"CAM ghetto" stimulated his response.
"After
reviewing the article on the 'CAM Ghetto' in your Wednesday, 29 Aug issue of
the Integrator Blog, I felt moved to make a few comments –
for what it may be worth.
"While I am no historian, I have an interest in post
civil war history, especially in the US. The slaves were freed by Lincoln as an outcome of
the Civil War but the Civil Rights demonstrations of the 60’s were evidence
that freedom had not brought the anticipated change hoped for. Even with the
demonstrations, prejudice tended to rule in decision-making in many social
circles. It was not until a coalition of various organizations in the African
American community came together that the demonstrations began to have an
effect on the social order. Much has changed since the 60’s, partly the result
of a collaborated effort, but much remains to be accomplished.
"In order for the CAM professions to accomplish what the African-American
community has accomplished since the 60s will require the same collaborative
effort. If that puts us in a CAM ghetto, so be
it."
- Reed Phillips, DC, PhD
"In
the 70’s, chiropractors filed an anti-trust suit against the AMA and many of the AMA's collaborators. The final decision handed down in 1990 found the AMA guilty
as charged. The chiropractors saw this law suit as a coming together of the
various factions in chiropractic for a common good. It really created some
strange bed-fellows. Since the decision, the drive to eliminate chiropractic
(and probably other CAM providers) has become
less open but much of the same prejudices remain.
"In order for the CAM professions to accomplish what the African-American
community has accomplished since the 60s will require the same collaborative
effort. If that puts us in a CAM ghetto, so be
it. We need to establish where we are before we can set a direction of where we
want to go and how to get there. We don’t all have to think alike or dress
alike but we do have to work together for a common goal, the better health of
our patients.
"No
one in the CAM community is so far removed
from the 'CAM Ghetto' that they can absolve themselves of a responsibility to
work for the good of all.
"My
two cents."
Reed
Phillips, DC,
PhD VP
Foundation for Chiropractic Education and Research
2. Massage program adds integrated healthcare course, taught by ND
A recent Integratorreferenced the addition of a medical doctor to the Tai Sophia Institute's clinical program. Cathy Ayers, CMT, education director at a leading massage school sent a note. Ayers was last seen herecommenting on a changed definition of "integrative medicine."
"Thanks for sending the blog. I love reading it.
"Potomac Massage Training Institute has a 3.5 hour integrated health care class as part of the
basic curriculum in our professional training program. It is taught by a
naturopathic physician and is based on the materials from the National Education Dialogue conference
and the textbook Fundamentals of Complementary and Integrative Medicine
by Marc Micozzi, MD, PhD.
"The purpose is to give the students a little exposure to what is
currently considered Integrated Medicine or Integrated Health Care and how
massage fits in."
Cathy M. Ayers, CMT
Director of Education
Potomac Massage Training Institute Washington, DC 20016
3. Integrator language wrong to distinguish NDs from "medical doctors"
Julie Chinnock, ND, MPH, sent a note regarding an editorial choice I
repeatedly make, to refer to MDs as "medical doctor," as distinguished
from naturopathic physicians/naturopathic doctors (NDs). I asked her if
I could go ahead and publish her note which she okayed. Chinnock is an investigator associated with the Helfgott Research Institute. Chinnock was
last seen herecommenting on ND fees in a managed care plan.
"I am a big semantics person especially when it comes to the political and
social aspects of medicine. It may have been something I learned in medical
school, in learning how to speak to patients and explain details.
"That being
said, I would like to clarify that NDs are medical doctors. It is a
common misconception that I often see in print and in conversation. We are
naturopathic medical doctors and MDs are allopathic medical doctors. It may
seem minor, but when you spend a good part of your time and your job defending
your education and your profession, it is something that you find makes a world
of difference. From government forms to qualifying for loan reimbursement programs,
the clarification is important.
"I understand your point of the distinction, but
I offer to you that this 'detail' is worth it to change the climate
of how NDs are viewed in the medical world."
Julie Chinnock, ND, MPH
Portland, Oregon
Comment: Chinnock's request is challenging. I know that in
Arizona, the NDs have the right, granted by the state, to use NMD - naturopathic medical doctor - or ND as their title. Naturopathic doctors clearly are increasingly granted responsibility
and status of "medical doctors" in some jurisdictions.
The term "allopathic" is not widely used in our culture, thus a challenge for those wishing to communicate. More important, the term allopathic does not appropriately capture all that a good family practice or integrative physician does. The term's origin, to distinguish conventional medicine from homeopathic medicine, is not unlike the uncomfortable corner "complementary and alternative medicine" practitioners are painted into by the term CAM. Interestingly, like "allopathic," "CAM" was also coined as a negative. Each was created by the "other" to distinguish what one field of medicine was not.
I am not disposed to always use "allopathic" before "medical doctor." So here I am exercising a double standard. I use CAM - though complementary and alternative healthcare more typically - but I am not using allopathic. How about "integrative allopathic medical doctor" (IAMD). Now there's an acronym as lousy as CAM. In short, I am
not sure how to honor Chinnock's point editorially. Any ideas?
Linda Bark, RN
4. Comments on Iowa voters wanting licensed CAM practitioners in basic benefits
The coverage of thepoll of Iowa voters
by CodeBlueNow! which found that 68% wanted licensed CAM practitioners covered in basic
benefit under health reform, stimulated responses from Linda Bark, RN,
who runs a holistic coaching program, AsOne Coaching.
"This is definitely good
news that CAM is becoming a player in health care.
"However, how
can this work so that the insurance companies are not controlling CAM
practice—deciding how much and how many and to whom? As a business coach, I work with some CAM
professionals who want to deal with the challenge of needing to write off as
much as 30-40% of their fees because insurance will not cover them.
"This is a complicated issue involving patient
expectations of insurance coverage, CAM professionals' desires to do what is right for their
patients and insurance cost control/profit margins.
"I see insurance coverage for CAM as a very
mixed blessing. How could it be
different from what we have now?"
Linda Bark, RN
AsOne Coaching
James Winterstein, DC
James Winterstein, DC, president of the multi-disciplinary National University of Health Sciencesin
Chicago took a similar tack in comments. He has concerns that any kind
of coverage of complementary and alternative medicine not harm these natural healthcare disciplines in the way
that chiropractic has been carved up by coverage. Winterstein references the current status of chiropractic under Medicare, which allows up to 12 visits for acute low back pain.
"Thanks for bringing this
information [about the voter survey] to us. This is heartening. Yet
what concerns me is that any attempt to include alternative care would
be subsumed in a 'Medicare' type program which would effectively crush
any real care by CAM practitioners.
"Let me explain. The way Medicare currently works for chiropractic, the DC will end up doing only one
thing – spinal manipulation - and will effectively not be allowed to do
anything else simply because of the mandate that the patient pay for all other
services. I see this as a real conundrum in any
kind of nationwide Medicare type program.
"This is complicated but worth understanding to show what constraints may come if complementary practitioners are included. At the present time, an
MD may choose to be part of the Medicare system or not. If not, the MD may bill
the patient but not Medicare. At the same time, the MD is then not controlled
by Medicare. The MD may choose to charge reasonable fees for a straight cash
practice.
"My point is that I believe the CAM community must be very careful to look at
all issues when it comes to any kind of nationalized health care system."
- James Winterstein, DC
"DCs are part of Medicare and may not opt out. If they see a
Medicare patient, the DC must bill for whatever the DC does. However, the DC may collect from
Medicare only what Medicare pays for (spinal manipulation). The DC must bill the
rest as cash BUT cannot offer any care for a reduced fee if it is a covered
item (spinal manipulation) because it is then considered 'inducement.'
"So, if
the DC simply wanted to have a cash practice outside of Medicare and charge
reasonable fees that a patient could afford to pay, that is not allowed because
the DC may not opt out of the Medicare program. If then, we had a 'Medicare for
all' kind of program, the DC could be in a heck of a spot in my opinion.
"My point is that I believe the CAM community must be very careful to look at
all issues when it comes to any kind of nationalized health care system. We
should be very careful what we ask for and at the very least, we must insist on
the right to opt out of the system altogether."
James Winterstein, DC, President
National University of Health Sciences
Ann Fonfa
Integrative cancer advocate and organizer Ann Fonfa, from the Annie Appleseed Project, also offered a short comment.
"No group cares more
passionately about coverage of CAM than people with cancer. Many go into
bankruptcy just to pay for covered treatment. Studies show 60-80% of
people with cancer are interested in CAM. Many use it even though it adds
to the heavy financial burden that a cancer diagnosis brings.
"We support the right to
healthcare coverage for all licensed CAM practitioners."
Ann Fonfa Annie Appleseed Project
Mike Levin
5. Clinical outcomes without cost is incomplete at best - NCCAM take note
"Clinical outcomes research that does not include a cost-effectiveness component is incomplete at best, and a waste of time and money at
worst. That so few NCCAM-funded studies address economic outcomes represents
an unfortunate series of expensive, missed opportunities. Until proved
otherwise, payers will presume CAM interventions will only increase - not
offset - healthcare costs. Going forward, and for CAM to become truly
integrated, all clinical research should include economic outcomes analysis and
quality of life (QOL) components.
"Over the years, I've known many brilliant scientists,
inventors and researchers who simply didn't consider the practical implications
of their groundbreaking research (ie, how much will this cost and who's going
to pay for it?). In those cases, their innovative, intellectual exercise had no
practical value whatsoever.
"The good folks at Alternative Medicine Integration Group understand this and have made,
through their published research, incalculable contributions towards the
advancement of integrative medicine. They understand that the winning formula
has three components: clinical outcomes, reduced costs, and QOL (patient
satisfaction, which is increasingly important in an era of consumer-directed
healthcare).
"Hopefully, others, including NCCAM, will follow their
lead."
Michael Levin Health Business Strategies
Bill Manahan, MD
6. Medicaid pilot finding of 25% cost savings probably low compared to other conditions
Speaking of the AMI model, Integrator advisor Bill Manahan, MD, read Part 1 of the Integrator report on the Medicaid pilot which AMI is managing in Florida. He wrote.:
"Nice article,
John. For those of us who for many years have practiced both Western
medicine and CAM/holistic/integrative medicine, we are not surprised that
integrated programs are going to generally be less expensive and have better
results than using allopathic treatments alone. The 25% cost savings in
the integrative pain program is about what I would have guessed.
"And I suspect that with
some diseases and problems such as otitis media, migraine headache, asthma,
mechanical low back pain, and irritable bowel syndrome, I would not be
surprised if the savings were closer to 50%. We need many more studies
similar to the Florida one so insurers can no longer continue to ignore what is
so possible."
Bill Manahan, MD
Past President, American Holistic Medical Association
Janet Carpenter
7. Bio-Darwinian view of the Future of Yoga Therapy
One
of the beauties of an online publication is that all of the back issues
can be readily available. Yoga therapist Janet Carpenter accessed the Integrator
series on the Future of Yoga Therapy, sponsored by the International
Association of Yoga Therapists. She then offers an interesting look at
her own family background in medicine and service, before offering more
detailed observations on the future of Yoga Therapy.
"I argue the position that non-structural Yoga Therapy has its
best opportunity to create positive change by using the 'third path' model for
its future development.
"I am a thirty-plus year yoga practitioner, a twenty-plus year
meditator and a fifteen-plus year yoga teacher and yoga therapist. My background: I was brought up by a medical malpractice insurance defense
attorney who helped institute pre-operative informed consent documents and
hospital self-insurance in answer to the malpractice lawsuit crisis in the
medical industry. I was married for eighteen years to a neurobiology researcher
and computer imager who helped to develop pre-operative medical imaging
software to increase accuracy and effectiveness of surgery in the operating room.
"My father-in-law helped to establish the public health division
of the Brown U.
School of Medicine
and to develop and administer a vaccine for schistosomiasis to reduce the
devastating effect of this spirochete-borne disease in developing countries like
Kenya and Brazil. My ex-husband’s great-grandfather was a Baptist minister and
financial advisor to John D. Rockefeller; he was instrumental in influencing
him to use his vast wealth to establish hospitals, medical schools and
universities in order to improve life in early-1900’s USA.
"Given a background of social consciousness and public service, I
have watched with morbid fascination and dismay as our
medical-insurance-pharmaceutical-legal conglomerate has increasingly shifted
focus from public health to private profit.
"Part of the reason the medical industry has taken this
unfortunate course, I argue, lies in the basic developmental structure of the
human brain, and is thus beyond repair using a business-as-usual model of
operation.
"Part of the reason the
medical industry has taken
this
unfortunate course, I
argue, lies in the basic
developmental structure
of the
human brain, and
is thus beyond repair using
a business-as-usual model
of
operation."
- Janet Carpenter,
Yoga therapist
"The human brain develops using competition among developing
neurons. From observing my husband’s lab research on baby mice, I have
learned that there are too many neurons in the brain to start with. The
ones that do not receive reinforcement through nerve and/or sensory input die
back. This experience affects the foundational promptings inherent in all
behavior.
"In our current healing modality, we support the weak and
ineffective within our social structure. We go against the primal
instinct of survival which is hard-wired into our brain’s physical
structure. The more efficient our medical industry becomes at this
process, the more it creates an abnormally high level of weak or underutilized
elements (people) in our society.
"This
creates a society burdened with elements that require
higher than normal levels of money, time, effort and concern in order
to keep
societal problems at a manageable level. It creates moral quandaries.
When is it appropriate to remove this support, if the person being
supported
will surely die without it?
"Therefore, the entire premise of Western allopathic medicine
needs a shift toward a focus that creates a more practical end result.
"I am not saying that Yoga Therapists should become less
interested in helping people who are sick. What I am saying is that
non-structural Yoga therapy has a golden opportunity to help focus the Western
medical industry toward a sustainable, workable goal.
"Yoga therapy definitely needs to adopt a 'third path'
approach: Assist and teach people to develop practices and habits that
maintain health, productivity, balance and sanity. Wellness maintenance incorporated into our social structure, I
argue, gives us the best possible chance to foster and support functional,
productive citizens that can help support and further our society’s structures
and goals.
"How can Yoga Therapy accomplish this?
"Yoga is the practice of transcendence. Through
therapeutic, meditative yoga, breathwork and meditation, a person moves beyond
slavish adherence to the urges of the physical makeup."
- Carpenter
"Yoga is the practice of transcendence. Through
therapeutic, meditative yoga, breathwork and meditation, a person moves beyond
slavish adherence to the urges of the physical makeup.
"This includes the physical structure of the brain, which creates
competition as the basis for all activities. A yoga practitioner
transcends the limits of the physical brain, and enters the realm of the mind.
"For a healing modality to create a positive
societal result, its leaders must be able to transcend the limits of
competitive, self-motivated thinking. They must be able to perceive the
bigger picture and to envision a healing industry whose individual elements fit
together to create a constructive, functional end result. "For the reasons I just laid out, Yoga Therapy is an appropriate 'third path' toward achieving that happy end within our lifetime.
"Thank you for your time and for this opportunity."
Janet Carpenter
Yoga therapist
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