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Guest Column: Georgetown Law Professor Sherman Cohn on How Far We Have Come in Integrating Care PDF Print E-mail
Written by John Weeks   

Guest Column: Georgetown Law Professor Sherman Cohn on How Far We Have Come in Integrating Health Care

Summary:  The Integrator article on the Florida Medicaid Integrative Therapies Pilot prompted Georgetown law professor Sherman L. Cohn, JD, to think of the many signs of the advance of integrated care, from actions of his local hospital to interest in a course he teaches to the treatment received by his grand daughter. Cohn, a former Watergate lawyer, wrote up his comments and sent them to me. As the self-appointed honorary chair of the why have we only come this far club, I find Cohn's column a good reminder. I've decided to take the afternoon off. What do you think?
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integrative medicine, CAM, complementary medicine, Medicaid
Sherman Cohn, Georgetown Law Professor
The day job Sherman L. Cohn holds is professor of law at Georgetown University School of Law. Working in the nation's Beltway, Cohn from time to time has opportunities for deep engagement in national policy. Case in point: 34 years ago Cohn was part of the legal team that took on the Executive Office malfeasance that became known as Watergate.

Meantime, following other interests, Cohn has played a number of leadership roles in the advance of integrated healthcare. He presently is board chair of the Tai Sophia Institute, president of the National Acupuncture Foundation
and a board member of the Integrated Healthcare Policy Consortium. Cohn was also one of the individuals with knowledge of complementary health care who was unceremoniously dumped after being originally selected to advise the Institute of Medicine when it began the exploration that became the 2005 report on Complementary Medicine in the United States. (The IOM's reason for the purge was that having advisers who were deeply experienced in complementary medicine institutions and practices might bias the report. Now, if the IOM is looking at a subject relative to the heart, would the IOM ban cardiologists?

While no stranger to the cynical policies and practices which can define life in the Beltway, a recent Integrator article stimulated Cohn to
affirm positively just how far we have come in opening the dialogue over what is in, and what is out, of the mainstream of medical care in the United States. Cohn, who was most recently in the Integrator in comments on the FDA's CAM Guidance, sent me these reflections on October 26, 2007. What do you think?

How far we have come in a very short period of time

- Sherman L. Cohn, JD

"In the most recent special report of The Integrator Blog you reported on the Florida Medicaid Integrative Therapies Pilot.  This is truly an exciting project for various reasons.  First, because, at least on the surface, it seems to be a carefully designed study without the biases that we believe has existed in so many others, and it follows upon other well designed studies such as those of Brian Berman, MD, at the University of Maryland Medical School.  Second, because of the results that it may show concerning the financial value of CAM, at least in some situations. And third because it is financed with the cooperation of the State of Florida and the Medicaid people. While many believe that the various smaller studies have pointed the way toward showing the efficacy of CAM, this much larger study could have earth-moving effects.

"While all of these factors are very significant, I believe that the most important factor is the recognition that there is enough legitimacy in CAM therapies to investigate in a serious manner.  This should make all of us sit up and take notice. Whether we trace the beginnings of the shift of attitude to David Eisenberg’s studies of the last decade on the use of CAM, as I believe, or whether one finds some other beginning, the point should be clear to all of us: attitudes have changed.

"The point was brought home to me a few weeks ago in the form of a dramatic contrast.  I team-teach a course at the Georgetown University Law Center on the Legal Issues of Complementary, Alternative, and Integrative Medicine.  In a recent class, we studied the case of State v. People, a 1911 Colorado case in which a practitioner of healing touch was convicted of the crime of practicing medicine without a license. As I was preparing for that class, I received in the mail the consumer newsletter of Suburban Hospital, which lies literally in the shadow of NIH in Bethesda, Maryland. This newsletter (New Directions, Fall 2007) had an article the headline of which reads: 'Healing Touch:  New Integrative Medicine Program To Benefit Mind and Body.' The article reported on the use of Healing Touch in the hospital. It stated:  '"This therapeutic practice is based on the idea that the human body has an energy field that extends outward,"explains Beverly Pierce, Suburban Hospital’s new director of integrative medicine services and a certified healing touch practitioner.'  I took the newsletter into class to point out how much things have changed. 

"I then noted your blog dated October 18, 2007: 'Integrative Clinics & Academic Medicine:  The Theme Is Expansion – in Clinics, Integration and Clinical Services.' Following that I read the news item in the most recent (September/October 2007) issue of Explore: 'Integrative Medicine Consult Service Established at the NIH Clinical Center' – for the good of patients and staff.  And Tai Sophia Institute in Maryland announced that it had added a physician to its professional clinic of acupuncturists and herbalists.

"It is very easy to focus
on how far we still have
to go to truly integrate
CAM with conventional
therapies and to have
CAM therapies accepted. 
Yet, it is important to
realize how far things
have changed in just
one short decade."

- Sherman Cohn, JD

"My last item is a personal one:  my 11-year old granddaughter injured her wrist.  X-ray and MRI did not show a fracture.  The orthopedist, saying that there might be a hairline fracture too thin to see, put on a splint and suggested:  'If this does not work in two weeks, try acupuncture; several of my patients have reported success with acupuncture treatments.'

"It is very easy to focus on how far we still have to go to truly integrate CAM with conventional therapies and to have CAM therapies accepted.  Yet, it is important to realize how far things have changed in just one short decade.  The number of medical schools that teach their students about CAM keeps expanding.  The number of hospitals that have integrative therapies is exploding faster than we can count.  True, it usually begins tentatively, perhaps one acupuncturist, and perhaps he or she on a part time basis.  And it often begins for mercenary reasons.  But as the CAM therapy proves itself in actual clinical use, it expands.  More and more conventional therapists are convinced through personal observation – which is what science is really about – that there is truly value.

"When Georgetown Medical School was beginning to teach about CAM, it did a survey of incoming first-year medical students and found that 70 percent already used some form of CAM.   To these medical students, the study of CAM was not strange, but the study of what they were already using.  These young doctors have a very different attitude toward CAM and integrative medicine from the attitude of a generation and two before.

"Today, Georgetown Medical School offers an M.S. degree in CAM, the enrollment in which keeps expanding.  And a growing percentage of those students take the Law center course on the Legal Issues of CAM (the course in cross listed).  The number of law students registering keeps expanding each year.  This year for the first time, with both law and M.S. students, we reached the maximum that the room will hold – and then admitted a few more who begged to be able to take the course.

"While I do not urge that complete acceptance has been reached – we have a long way to go – let us recognize how far we have come in a very short period of time. The Florida pilot program that you reported on is only the latest in a long string of such evidence."

Sherman L. Cohn, Professor of Law
Georgetown University Law Center

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