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Integrative Medicine and Integrated Health Care Round-up: July 1-15, 2008 PDF Print E-mail
Written by John Weeks   

Integrative Medicine and Integrated Health Care Round-up: July 1-15, 2008

Summary: Commonwealth Fund reports double cost, horrible outcomes of US medicine ... Expansion of low-cost community acupuncture models featured by AAAOM and in Philadelphia weekly ... Alaska's Native-owned, community-focused, team-oriented healthcare approach approach shows huge cost savings, increased practitioner satisfaction through a relationship-centered approach ... Ian Coulter, PhD offers insight into strengths and shortcomings of health services research as the "holy grail" for integrative practices ... Holistic board requires self-care knowledge in re-certification ... AHMA celebrates 30th birthday ... Chiropractic organization and NCMIC clarify manipulation/stroke evidence for 16,600 neurologists ... Cohen and Dumoff combine for webcast seminars on legal issues for integrative clinics and spas.

This ongoing feature captures some top developments in the previous 2 weeks (or events which arrived on my desk in this time frame). You are my news service. Send information!

Health Reform - Payment and Access

Report blasts US (non) system
Down with Bullies
: Commonwealth Funds Reports US Spends Twice as Much for Worse Outcomes

As I sit to write, a new New York Times article features a new Commonwealth Fund report on the horrendous outcomes of medicine as we know it (While the U.S. Spends Heavily on Health Care, a Study Faults the Quality, July 17, 2008). The US spends twice as much as nearly all industrialized countries, yet achieves last place outcomes. As I noted in the June 15-30 Round-up, key explanatory factors noted here were identified by leaders at the Institute of Medicine in a February 2009 JAMA editorial" in which they estimate that perhaps a trillion dollars each year (yes, $1,000,000,000,000) is utter waste. And harmful at that. (Is it gratuitous here to note that on July 14, 2008, the Los Angeles Times ran an article on the decision of the Joint Commission on Accreditation Health Care Organizations to establish a standard against bullying doctors? See Hospital group issues alert on bullying by doctors, other workers to curb medical errors) Here's a hope that the planners of the IOM's National Summit on Integrative Medicine don't shy away one bit from the role of integrative practice in facing these challenges. Down with bullies!

Community Acupuncture Network logo
Community Acupuncture model featured as access expands

Affordable acupuncture at $15-$35 per visit? The key health reform issue of access to services is directly addressed by the revolutionary Community Acupuncture Network (CAN) model of acupuncture delivery. The model received a significant write up in the Philadelphia City Paper (Sticking Together: Two West Philly Needlers make hte case for community-based acupuncture, July 9, 2008). The West Philly operation was the site of an East Coast training for Portland, Oregon-based CAN. In addition, the Spring 2008 issue of the American Acupuncturist, the publication of the American Association of Acupuncture and Oriental Medicine, features an interview on the model, with Jordan Van Voast, LAc, whose clinic, CommuniChi, located in Seattle's chief Latino community center, has been appreciatively used by this writer's spouse and daughter. The model focuses on service and access. The Philadelphia Community Acupuncture clinic sees 120 patients a week and Van Voast says he and his partner are seeing 250 patients a month. Why aren't more hospitals and community health clinics adopting this model?

Image Alaska Native integrative community ownership model shows huge savings

Outcomes show a 40% drop in urgent care and emergency department utilization, 50% in specialist utilization and 30% in hospital days. At the same time, clinical quality jumped significantly as did access and staff satisfaction. The "whole system transformation" of medicine at the Alaska Native-owned Southcentral Foundation (SCF) since 1999 is responsible for these results. The primary care "is delivered with integrated care teams that fully incorporate tribal doctors or traditional healers as well as chiropractors, massage therapists and acupuncturists" and a variety of behavioral health services. There are no "patients," only actual "customer-owners." In a Family Practice Management article, available for download at this link Transforming Your Practice: What Matters Most, the writers credit the outcomes to a focus on their customer-owners, on community and on practitioner teams. "In the SCF system," the authors assert, "the core product is relationships." 

This transformation was predicated on an economic shift to ownership. How can we create such connectivity in our other communities where such direct ownership is not possible? The work on practitioner-patient, practitioner-practitioner and practitioner-community aspects have a road map in the Pew-Fetzer's groundbreaking 1994 report on Relationship-Centered Care. Yet the economic outcomes of this success do suggest that "transformation," in most communities, will not come without war.  Note that oxes will be gored right and left through such savings. And the American Hospital Association seems to be girding for such a war, sowing fear of change through sending out a press release on their job creation. See my column: Should the Military and Hospitals Celebrate Their Economic Contributions to Communities? It is not hospital jobs but outcomes from models like this that deserve celebration. Thanks to David Rakel, MD, for forwarding this article to me.

Researcher Ian Coulter, PhD
Coulter looks beyond health services research for the best understanding integrative practice

A useful look at the strengths and weaknesses of health services research in the integrative practice field is featured in the July-August issue of Alternative Therapies in Health & Medicine (Is Health Services Research the Holy Grail of Complementary and Alternative Medicine Research?  Lead author Ian Coulter, PhD, whose job-portfolio presently includes positions with the Samueli Institute, the Rand Corporation and Southern California University of Health Sciences, takes as his launching place an article led by economist and naturopathic physician Patricia Herman, MS, ND, PhD (cand.) which promotes a health services prioritization of funding (Are Health Services Research a Match for CAM? ATHM 2006; 12(3):78-83).

Coulter opens with agreement on Herman's basic argument. He quietly skewers the current direction of investigation: "To the extent that science is supposed to be about discovery and then explanation, it often seems that the research community and funding agencies have it reversed." Then he steps even further away from the randomized controlled trial (RCT) box that pharmaceutical medicine has deified in medical research. Coulter, who has significant expertise in research on chiropractic, notes that some of the very best research in exploring any integrative practice has been the sociological and anthropological rather than health services or RCT looks at chiropractic. He noted that soc/anthro explorations conclude that chiropractic is typically a holistic practice, whereas even health services research is likely to present chiropractors as little more than limited specialists. This is fascinating guidance, especially for anyone who has come to believe that transforming medicine (see policy note, above) requires turning our priorities in funding research upside down. When will NCCAM begin a program to retrain reductive CAM/IM researchers?

Professions and Organizations

Image ABIHM requires physician self-assessment for re-certification

Physician health thyself
has always been problematic in either conventional medical world in which residents have 100 hour weeks or in integrative practice in which many practitioners are also involved in multiple professional or educational efforts to increase visibility and value of their new way of doing things. The American Board of Integrative and Holistic Medicine (ABIHM) recognizes the issue with more than lip service in materials related to its re-certification program. Applicants are asked to fill out a 3 page self-assessment document which grades them from "surviving" to "optimal health." The download is available under Certification Maintenance. How do you measure up? Kudos to ABIHM for focusing on this subject. Now, time for me to work on bettering my own outcomes ...

ImageSamueli Institute identifies "key stone" areas following June retreat

The Samueli Institute, led by Wayne Jonas, MD, has some additional clarification of the focal points of its robust agenda following June 2008 feedback from various members of the integrative health community.
The Institute focuses work in a handful of areas (Hospital/Optimal Healing Environments, Military Health, Brain-Mind-Healing, Integrative Medicine). A series of “key stones towards which each of these initiatives could be applied" have now been identified, according to Jonas. The five "key stones" are:

  • stress and stress management
  • pain and the trauma response
  • educational and knowledge translation activities around the components of Optimal Healing Environments within health care systems
  • developing methodologies for the evaluation of complementary and integrative medical practices
  • the theoretical and functional foundation for moving towards a wellness system that integrates the best of healing practices with the best of scientific information technology and measurement. 

Jonas notes that the Samueli Institute will "be working on continuing to fill in the evidence base and translate knowledge along the lines of these five 'key stone' areas to explore their potential impact as transformative factors in healthcare."

ImageACA and NCMIC inform send neck pain document to 16,600 neurologists

The American Chiropractic Association (ACA) announced July 9, 2008 that it has mailed copies of a report issued by the Task Force on Neck Pain and its Associated Disorders to more than 16,600 neurologists across the country. The report is the result of a 7-year, international, multidisciplinary study and was published in the journal Spine. ACA notes that the goal of the distribution is to "help health professionals apply the best available evidence to prevent, diagnose and manage neck pain."
Among other findings, the report noted that risk of stroke following chiropractic visits appears to be about the same as that following visits to family practice doctors. ACA worked closely with Integrator sponsor NCMIC, the nation’s leading provider of chiropractic malpractice insurance for doctors of chiropractic, in distributing the report.

ImageAmerican Holistic Medical Association (AHMA) completes 30th year of service

A July 2008 note from
the American Holistic Medical Association (AHMA) states that the organization has "officially competed its 30th year of service to the holistic community: "We turned 30 on July 10 and have a special fundraising campaign underway to raise $30,000 in 30 weeks in honor of that 30th anniversary. Our members will be enjoying a 30th Anniversary Dessert Reception as we celebrate together in Phoenix on August 14."  It's been a tough year, with the AHMA Board working, successfully to all accounts, to re-direct an organization which, at its founding, was mainly a large support group for MDs and DOs who were venturing into holism. Times have changed. AHMA members will gather in conjunction with the annual conference of the American Association of Naturopathic Physicians. (See Integrator article with comments from AHMA and AANP leaders.)


Michael Cohen, MA, JD
Cohen & Dumoff partner on web-available IM legal issues programs

I received a call from attorney Michael Cohen, JD, MA while writing this. Cohen, based now in the Bahamas but working throughout the US, has been a prolific writer, blogger, and adviser to many for all the years of the "integrative medicine" movement. He notes that his work with legal issues around integrative teams and program has expanded lately to include more spa business: "
The clinical care teams of an integrative medicine center share common legal issues with care teams put together in spas (and particular medical spas).  Of course, integrative medicine focuses more on clinical care and the spa more on ‘aesthetic medical services,’ but each will have to deal with common legal issues such as licensure, credentialing, and scope of practice boundaries.”

Alan Dumoff, JD, MSW
Alan Dumoff, MSW, JD
, another attorney-writer-practitioner who has been instrumental in clarifying the legal foundation for this movement, works with Cohen in an of counsel capacity. Together the two recently gave a continuing education webcast, sponsored by West LegalEd Center, entitled "Medical and Physician Spa Practices: A Practical Guide in Avoiding Costly and Regulatory Mistakes.” In September they will offer a second, entitled “When Patients Insist on Complementary and Alternative Medicine: 4 Ways to Help Legally Protect Your Clinical Practice or Hospital.”
Cohen noted some of the wild legal realities that continue to demarcate the boundaries for integrative care. He adds: "The good news is that we are seeing more and more regulatory activity that acknowledges the shift from conventional care alone, toward encompassing a broader range of healing modalities.

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