Acupuncture for Ford Motor Company Employees: Challenges in Mounting an Pilot Project
Written by John Weeks
Acupuncture for Ford Motor Company Employees: Challenges in Mounting an Integrative Medicine Pilot Project
Summary: Ford Motor Company is offering acupuncture to a limited group of employees suffering from low back pain as part of a pilot project at their Kentucky Truck Plant. Walter Talamonti, MD, Ford's corporate medical director, has a sterling group of partners for the project. First, he developed it through the Corporate Health Improvement Project directed by Kenneth Pelletier, PhD, MD (hc). Pelletier helped him bring in top clinical trialist for acupuncture, Brian Berman, MD, from the University of Maryland. The plan was simple enough: run 100 employees through the program then go to the NIH for a larger project. Only, as Talamonti shared with attendees of the recent conference of the Institute for Health and Productivity Management (IHPM), something is happening on the way to the forum. Linking a major employer and its unions with an academic health center in a state which did not yet license acupuncturists created some unexpected obstacles.
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In the current, third phase of the Corporate Health Improvement Project (CHIP) over a dozen large corporations are exploring the potential value of integrative medicine benefits in the health and productivity of their employees. One especially important study that CHIP, led by Kenneth Pelletier, PhD, MD (hc) and based at the University of Arizona Program in Integrative Medicine, has developed is a pilot with Ford
Motor Company. Ford is offering acupuncture for back pain for employees in its Kentucky
plant.
Walter Talamonti, MD, MPH, corporate medical director, Ford Motor Company
The project, which required only 100 participant in its pilot phase, seemed a slam dunk. Pelletier, an Integrator adviser, brought in his colleague Brain Berman, MD, and his integrative medicine group at the
University of Maryland. Berman is arguably the top acupuncture
trialist and the nation's best-funded integrative medicine researcher. The two-stage plan is to take data from the pilot to make the case with the National Institutes of Health for funding for a broader trial. Think of the big bonanza for acupuncture if a trial on Ford employees showed positive outcomes. Such a project could speak powerfully to those who control the purse-strings in health care.
What developed, however, is an instructive story about how the historically estranged cultures of large employers, academic medicine and treatment by acupuncturists may find themselves with some challenges that no one anticipated.
Walter Talamonti, MD, MPH, medical director of clinical operations at Ford Motor Company, was originally scheduled to present on the findings of the pilot at the October 17-19, 2007 meeting of the Institute for Health & Productivity Management. Instead, attendees of Talamonti's talk during the Complementary and Integrative Medicine Track were treated to a fascinating journey through uncharted territory. Began Talamonti: "We found ourselves with a clash of academics and workplace issues.” The short story is that recruitment
has been a nightmare.
Talamonti ticked off 6 obstacles.
#1: An Institutional Review Board Meets the Americans for Disabilities Act
First, Maryland’s Institutional Review Board told Ford
they needed to ask all possible women participants if they were pregnant. “I
said we can’t – that would be a violation of the rights of workers under the
Americans for Disabilities Act. We can’t ask women if they are pregnant.”
Talamonti later shared that had U Maryland had staff on site in Kentucky to do
the interview, it would have been okay. The issue was that the interview was
being conducted by a Ford employee. The study couldn’t use University of Maryland to interview and treat. So,
bingo, all women – the most likely to be interested - were excluded from the
study.
#2: Finding an acupuncturist in a state without licensing
The second compounding factor was that in the state of
Kentucky there was no licensing for acupuncturists. So they needed to find an
MD-acupuncturist. They found one – and then just when it was time for the
project to ramp up, the MD left the project. They had to recruit another. Subsequently, the state passed a licensing law for acupuncturists. A licensed acupuncturist is currently
being used. This does raise interesting questions about outcome variation between the two types of acupuncturists –
especially since the “acupuncture” intervention also includes a 10 minute
“traditional Chinese medicine massage treatment.”
Piloting an integrative medicine approach
#3: Economic slowdown suspends recruitment
The 3rd confounding issue was all on the
employer side. In the midst of the study, there was a slow down in the auto
industry and the plan was put on furlough. All recruitment was suspended.
#4: Are you experimenting on me with some lesser medicine?
The 4th confounding issue was one I
encountered in Seattle in 1995 when the King County Council decided to fund a public
health-based natural medicine clinic. An African-American county councilman, remembering the shameful experiments on African-Americans in Tuskegee, wondered aloud if giving “alternative medicine” to clients of community clinics was merely an
effort to make guinea pigs of the underserved. (The council member wasn't aware that some of the most significant such natural medicine "experiments" in the United States are among upper middle class people in hospitals built to pander to them.) Talamonti shared that some
representatives of the United Auto Workers were concerned that Ford was
experimenting on them. Said Talamonti: “We lost a pile of potential participants due to the
suspicion that was spread.”
#5: Oops, time for the project's champion to retire
Then, after all these delays, recalled Talamonti, "the lead physician who had
supported the project retired at the end of the year.” Anyone who knows the
importance of champions in the development of integrative medicine projects will greet this news with a
sympathetic grimace.
#6: Is randomization discrimination?
Talamonti closed with an additional issue which grew of the concern of the clash of academic and corporate culture. He notes that employers are not allowed to
discriminate in treatment of employees. Then Talamonti tossed out a very practical rhetorical
question: “How do you run a randomized controlled trial if you can’t
discriminate between employees?” Hey, the people who got the acupuncture did better. Why
didn’t I get the acupuncture, boss?
Talamonti concluded his talk at the IHPM meeting with the reassuring news that the project is moving ahead. The pilot needs 50
subjects to have sufficient power that the results might attract significant NIH support for a major research project.
Talamonti says that the current time frame for completion is Winter-Spring 2008.
Comment: Perhaps one reason why people don't often get out of their boxes is that they are likely to find themselves in other boxes, entangled in another set of codes, qualms and qualifications. All would seem to be teaching them to stay home and not venture out again. Good for Talamonti, Ford, Pelletier, Berman and the University of Maryland for hanging in with this project. It will indeed be an a-typical moment in the young history of integrative medicine if news breaks one day that acupuncture proved very useful to creating health in a large automobile maker's employees.
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