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 ...

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 Integrator referenced 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 here commenting 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

"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

Linda Bark, RN

4.    Comments on Iowa voters wanting licensed CAM practitioners in basic benefits

"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

"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

Regular Integrator columnist Michael Levin noted the Integrator report that less than 1% of the budget of the NIH National Center for Complementary and Alternative Medicine is supporting research on the cost-effectiveness of complementary and alternative medicine.

"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