Comments: A DC, an MD, an MSW, an RN, and a PhD on Bolles, Managed Care, NCCAM, Cultural Authority and More

Summary: Bob Sager, MD wanted integrative MD questions in the CodeBlueNow! voter surveys ... Wellpoint fraud expert Howard Levinson, DC comments on the state of managed care ... Former holisitic nurses association leader Sonja Simpson, RN, AHN-BC believes commentator Beth Wooton, ND was spot on regarding practitioner education ... Researcher Lyn Freeman, PhD has some suggestions about new routes to project funding that are not NCCAM dependent ... Lisa Yater, LCSW, on how the structure of conventional care delivery limits the opportunity for inclusion. More ...

Bob Seger, MD

1.   Bob Sager, MD: More information on MD practices would have been good

Bob Sager, MD, is an integrative medicine doctor. He comments on the Integrator article on the findings of the CodeBlueNow! survey of voters ("Do Republicans or Democrats Most Want Prevention and Licensed CAM Practitioners in Covered Benefits?" March 12, 2008)

"I found this interesting and the results expected. I wish this could be done countrywide for voters, politicians and Presidential candidates. I have posted something about this post to my blog with a link back to yours.

"What was missing in the question about coverage for CAM was mention of physicians using CAM and what types of CAM they use.  Overall a great idea for a pilot survey ad I hope more is done on this topic."

Bob Sager, MD
www.drsager.com

"I am a chiro working within the fraud/abuse area of WellPoint primarily involved in chiro/pain mgt./phys med issues. Bolles is on target. I opined a bit of a more optimistic article in March and April issues of JACA on-line, but the facts remain that although we were early in the MCO arena, we have not and probably never will be, a 'valued' member of a payors healthcare delivery team. And this, despite some good research and favorable studies such as the IL AMI [Alternative Medicine Inc.] study.

"We are coming to the party way too late. Thanks for running this informative website."
 
Howard Levinson, DC, CFE, AHFI
Clinical Investigations
Wellpoint

Sonja Simpson, RN, MS, AHN-BC

3.    Sonja Simpson: On the comments of Beth Wooten, ND, on education strategies

Sonja Simpson, RN, MS, AHN-BC focuses her comments on prior commentary from Beth Wooton Pimentel, ND, an educator in naturopathic medicine.

"I really enjoyed the comments by Dr. Beth Wooten regarding the “current educational paradigm does not support the kind of experiential learning that may be more conducive to integrative medicine”.

"She is so 'right on' about the 'neglect of the vessel through which the m\medicine will be practiced.' She expresses so clearly the importance of relationship and connection in healing. As I put it, at first the person needs to connect with self and be clear about the fact that healing is not so much about doing but 'being' and then connect with the client to form a  relationship within which healing can occur.

"Thanks for your interesting blog….always food for thought."

Sonja Simpson RN MSN AHN-BC
Former President, American Holistic Nurses Association

Lyn Freeman, PhD, LPC

4.   Lyn Freeman: NCCAM is not the only option for research funding

"I have read with interest your recent articles on NCCAM.  I would like to point out an issue that I think should be addressed more fully in the Integrator.  NCCAM is not the only institute at NIH that supports research on CAM.  In fact, the other centers and institutes combined actually spend more money on CAM research than does NCCAM.

"I will give my situation as one example.  In 2005, I was funded by NCI (National Cancer Institute) to perform imagery research with breast cancer survivors. The research and its publications were completed in 2007.  I was not funded through a university, but through my small business, Mind Matters Research.  The outcomes of that trial were quite good, and results from that study are being published this year in peer-reviewed oncology journals.  I have recently submitted for Phase II funding.

"My grant was funded by SBIR funds (i.e., small business innovation research), a funding mechanism intended specifically for the business community.  You must not only demonstrate the quality of the research you intend to do, but you must also create a business plan to show how you will make your ‘product’ available to the public, if your outcomes are good.  NIH has recognized that the best research in the world is of little value, if what is learned is not made available to the public. That is why the SBIR grant mechanisms exist. I would really encourage readers of the Integrator to consider applying for grant funding, using this mechanism.

"I am not suggesting that it is easy to get funding—far from it-- but simply that it is certainly possible to do so, if those in the business community want to pursue CAM research.  There are three keys to success in this regard:  a great deal of planning, teaming with more experienced and recognized researchers who can advise and add to your research, and a willingness to listen carefully to critique, and respond in constructive ways.

"There is also another mechanism—STTR—which I am not as familiar with, but one worth reading about on the NIH website.  This mechanism  requires much more direct involvement with universities.

"As always, thank you so much for bringing the voice of the Integrator to these issues.  Perhaps I am just an uncontrollable optimist, but I do get a sense that we will see a new level of support from NCCAM in the near future."

Lyn Freeman, PhD, LPC
Mind Matters Research

Lisa Yater, LCSW

5.    Lisa Yater: The challenge is the "structure" of current delivery

Lisa Yater, LCSW, has been a community organizer as well as holistic practitioner. Yater, whose networking business was the subject of an early Integrator article, offers some poignant thoughts on the challenges of practical integration of integrating into existing structures.

"I had the luxury of speaking to you and emailing at the beginning of The Integrator Blog. Now you and the blog are going full blast and it is one of my favorite web oases.

"I was able to scan the article sent out recently about DCs and cultural authority. Many good thoughts from reading this. After working in the inpatient psych unit at a rural hospital here in West Texas, I got a new eye-ful of healthcare. It came to me that the problem with CAM, integration, conventional care, etc, wasn’t in the realm of ideals – despite clashing paradigms. It was in the realm of STRUCTURE. In everything we did for patients in our unit, we barely had time for the stuff we provided. Everyone showed up and fit in their piece just right or the day moved on. The result was damn good a lot of the time. Even if it was miraculous in efficacy, where were we going to fit a new different form of healing?

"This has been a back-burner thought as I’ve returned to direct care practice. Despite my ability to sneak in CAM within the context of psychotherapy, I still wonder about structure and how this angle can explain some of the struggle without the thin-air philosophizing.

"How the heck are CAM therapies going to structure themselves when actually delivering services and stay linked to reality? Certainly 'cultural authority' gives services and institutions time, place, structure, income by its very nature."

Lisa Yater, LCSW
West Texas