Integrative Medicine and Integrated Healthcare Round-up: September 1-15, 2008
Written by John Weeks
Integrative Medicine and Integrated Healthcare Round-up: September 1-15, 2008
Summary: CCAOM backs move in the acupuncture profession toward "First Professional Doctorate" ... IAYT reports data on the emerging Yoga therapy field ... ND students set quality standards for nutraceutical partners ... Hopkins opens integrative clinic with gastro-intestinal focus ... Hawaii Consortium for Integrative Healthcare begins monthly television program ... New ACOEM guidelines for chronic pain elevate role of acupuncture, yoga ... Employer group, IHPM, begins worksite metabolic health initiative ... American Specialty Health receives awards ... Standard Process' president Charlie DuBois joins board of chiropractic research group ... Council for Responsible Nutrition selects naturopathic physician Douglas MacKay, ND as vice president for regulatory and scientific affairs ... Changes at the top for American Association for Health Freedom ... U.S. need for primary care to be aggravated by disappearing interest in general medicine among med school grads ... plus more
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Professions & Associations
Acupuncture college organization backs move from Masters to "entry-level doctorate"
An at times divisive issue inside the licensed acupuncture and Oriental medicine (AOM) profession recently saw a remarkable step toward unity. The issue concerns the "entry level doctorate" or "first professional doctorate." In the 1980s, the profession's educators chose to target a Master's level degree program as the profession's basic educational standard. Some in the profession pushed for the entry-level doctorate, in part by reference to the stature of AOM practitioners as doctors in other
countries. The Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM) subsequently engaged a national process to re-open the issue. (See outcomes of
the ACAOM's survey of the AOM profession on the subject here.)
With the two motions below, from the most recent meeting of the Council of Colleges of Acupuncture and Oriental Medicine (CCAOM), the CCAOM both endorsed the ACAOM direction and stepped in to help with
consensus building. The CCAOM makes a special point of pledging to support their smaller members which are likely to have more difficulty in meeting the higher standards. The transition is expected to take at least 5-10 years.
Motion No. 1:
The Council of Colleges of Acupuncture and Oriental Medicine supports the
offering of first-professional doctoral education in Oriental medicine and in
acupuncture with appropriate standards of accreditation. The Council will
continue to review and forward to [Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM)] recommendations regarding ACAOM’s draft
of first-professional doctoral standards. The Council affirms its
commitment to providing resources and support to its members during this
period. The Entry-Level Standards Committee and the Core Curriculum
Committee will take the lead on this, with support from the Faculty Development
Committee, the Research Information Committee, and the Libraries
Committee. The Council will initiate a dialogue toward building consensus
with members of the profession regarding issues of the first-professional
doctorate and its implications for the profession of AOM.
Motion No. 2: The Council of Colleges of Acupuncture and
Oriental Medicine requests that ACAOM renew its review of the
first-professional doctoral standards.
Note: The move toward the entry-level or first-professional doctorate is distinct from the existing Doctor of
Acupuncture and Oriental Medicine (DAOM) programs, currently accredited through ACAOM standards. These clinical doctorates were introduced in the last half-decade by a half-dozen schools. Comment: The move, when fully implemented, will be clarifying. In a few states, acupuncturists already have a doctoral-type recognition in their title rights under their licensing statutes. In Florida, for instance, the title is "Acupuncture Physician" (AP). In New Mexico, licensed acupuncturists use the title "Oriental Medical Doctor" (OMD). With success in this shift, the field will also most likely get more attention from the American Medical Association's "scope of practice partnership" (AMA-SOPP) which is seeking to limit scope expansions in other fields. (See AMA SOPP Escalates Campaign Against Nurses, Chiropractors, Naturopaths, Midwives and Others , June 21, 2008.) Perhaps in preparation for this, the American Association of Acupuncture and Oriental Medicine has already joined the Coalition for Patients Rights which was organized by nursing to oppose the AMA's move. Yoga therapy group, IAYT publishes data on survey of members
The International Association of Yoga Therapists made public its "findings of it first membership assessment." The organization also made visible data charts from all of the questions, a fine bit of transparency. Roughly 500 members responded, a 20% response rate on a list that would be just short of 2500. A quick snapshot includes the following.
Notably, IAYT's recent efforts to publish research, bring the profession into broader dialogues and explore standard setting in education also received high levels of agreement.
Statement
Agree or
strongly agree
It would be helpful if IAYT would emphasize or
publicize “best practices”, “exemplary practices” and/or
“evidenced based practices” in our field.
76%
IAYT’s service of supporting the establishment of a
Council of Schools to develop training standards for
Yoga therapists is important to me.
79%
IAYT’s service of supporting and publicizing research
in the field of Yoga therapy is important to me.
95%
IAYT’s service of providing an organized professional
voice for Yoga in public policy decisions, integrative
medicine and complementary and alternative health
care is important to me.
91%
In recent years, the IAYT, under the leadership of executive director John Kepner, MA, MBA and board chair Matthew Taylor, PhD, PT, has partnered with the NIH, joined the Academic Consortium for Complementary and Alternative Health Care, become a Participating Sponsor for the North American Research Conference on Complementary and Integrative Medicine, begun convening a council of schools and even partnered with the Integrator for a series on the future of Yoga therapy. In a note to members with the report on the survey, Taylor wrote: "What you told us is that for the most part we are on target for providing the support
you expect from your membership. Thank you for that validation!" The members seem to like hte direction. Most significantly, at least 66% were willing to consider a dues increase.
Naturopathic Medical Student Association sets polocy on relationships with supplement firms
Aware of the pharma issues noted below (see Media) surrounding the problems from too-close relationships between conventional medicine and Big Pharma, the Naturopathic Medical Student Association
has developed the "NMSA Vendor Association Policy." NMSA's policy "recognizes the 'slippery slope' of accepting monetary sponsorship
from nutraceutical companies." The
group is pushing for "mutualistic relationships" and pledges to only
accept sponsorship from companies if they:
Independently test raw materials for
heavy metals, product authenticity, bacteria/yeast/mold, potency and
chemical contamination.'
Manufacture by cGMPs for dietary supplements
Ensure proper quality control and storage of products
Test end products for label claim potency.
The NMSA move was stimulated in part by the PharmFree campaign of the American Medical Student Association (AMSA) with which NMSA is affiliated.(See MD and ND Student Associations Form Formal Ties, April 21, 2008.) The motto for the AMSA campaign is "reclaiming the ethics of medicine by removing conflicts of interest, and restoring the sanctity of the patient-physician relationship."
Comment: The NMSA policy is not specific on the challenging issues of how
such quality standards would be clarified and enforced. That said, it
is good to see the consciousness of potentially negative pharma influence in these emerging leaders of their disciplines. AAAOM conference to feature Cohn, Briggs, others
Staff for the American Association of Acupuncture and Oriental Medicine (AAAOM) share that sign-up for the AAOM's October 16-19 conference in Chicago is well above that in recent years. Among the presentations for attendees will be one by Josephine Briggs, MD, director of the NIH National Center for Complementary and Alternative Medicine, Five Element acupuncture master Judy Worsley, and sometimes Integrator commentarist Sherman Cohn, JD. Cohn, who has held numerous key roles in the acupuncture community for nearly 30 years, will be sharing some history which he is writing of the profession's emergence in the United States.
Reiki leader on NCCAM: "Big step toward establishing the values of truly integrative medicine"
A note from Reiki leader and publicist Pamela Miles honors recent action at NIH NCCAM. Miles notes that NCCAM recently posted updated Reiki content. She adds: "I was honored to be asked to review and comment on the previous version of the
Reiki backgrounder. NCCAM made some important edits that addressed the errors
of fact and logic. We now have a credible introduction to Reiki available to
the public and to health care providers." She adds: "And having a government agency acknowledge a lay practitioner as reviewer
is a big step toward establishing the values of truly integrative medicine.
Comment: Personally, I like this openness. I imagine it will be fodder for the anti-NCCAM bloggers out there.
Integrative Practices Johns Hopkins opens integrative clinic with GI focus
The Washington Post rolled out the tired headline "Alternatives Enter the Mainstream: Alternative medicine wins some converts" as a way of announcing the September 2, 2008 opening of the Johns
Hopkins Integrative Medicine and Digestive Center. The center includes
gastroenterologist Linda Lee, MD, "among the 12 specialists, including
acupuncturists, nutritionists, massage
therapists and a psychotherapist who uses hypnosis and touch therapy."
The writer focuses on the financial play that such a clinic is for
Hopkins, underscoring that "the center is a way to capitalize on a
burgeoning patient
base." Says Lee: "I can't tell you the number of patients who come in
and say they've been getting acupuncture for 10 years." The article
also notes integrative clinic offerings at the University of Maryland and George
Washington University. Comment: Googling this story, I came upon a comment on the clinic by naturopathic physician Gina Nick, ND. Nick focuses on the connection to gastro-intestinal issues, noting the close link to gut issues in much of naturopathic theory and practice.
Hawaii Consortium's Crites produces monthly "integrated health" TV program
The Hawaii Consortium for Integrative Healthcare has kicked off the first of a monthly series of program on Integrated Health. Each month will focus on integrative approaches to a challenging condition. The first month takes on cancer, with Diana Thompson, MD, a psychiatric oncologist at Queens Cancer Center moderating and naturopathic physician Michael Traub, ND, FABNO and licensed acupuncturist Joni Kroll, DAc on the panel. The series is produced by Laura Crites, the Consortium's executive director.
New Occ-Med guideline elevates role of acupuncture and yoga in chronic pain
An article in the October 2008 issue of Acupuncture Today describes the heightened place of acupuncture in the new Occupational Medicine Practice Guidelines
for chronic pain of the American College of Occupational and
Environmental Medicine. The article describes the way acupuncture is
described in the text as well as the chief conclusion: "Acupuncture is recommended for select use for treatment of chronic
moderate to severe neck pain, chronic trigger points/myofascial pain,
chronic LBP, and osteoarthrosis of the knee or hip as an adjunct to
more efficacious treatments."The article also notes that Yoga is recommended for chronic low back pain. Bielkus and daughters open Body-Mind-Spirit Reengineering Center" on Cape Cod
Bielkus, 2nd from right, with daughter team at B1 Community
Ryma
Bielkus, an early consultant and promoter of health coaching as a core modality in the integrative practice models, announces that she and her daughters, Aida, Laisvyda,
Sigita and Sara (all Bielkus) have opened B1 Community, LLC, on Cape Cod. The "Body Mind Spirit Re-Engineering Center" combines yoga and coaching and uses the Wellness Inventory promoted by Jim Strohecker the co-dounder and CEO of Health World Online.
Bielkus
has developed coaching programs and consulted with various integrative
medicine programs. The Bielkus team also offers retreats. The next will be
October 30-November 2, 2008.
Employers & Managed Care
IHPM holds "consensus conference" on workplace metabolic health
Looking at worksite metabolic health initiatives
The Institute for Health and Productivity Management (IHPM), has announced that it is holding a September 24, 2008 invitational "consensus conference" on best practices in metabolic health management. IHPM, an Integrator sponsor, is working to define the domain of metabolic health, testing the
best strategies for managing metabolic health and disease, and
measuring and reporting the outcomes to the provider and employer
communities. The meeting is part of IHPM'sWorkplace Center for Metabolic Health which it established with the support of founding sponsor Abbott. The consensus conference program will explore: the prevalence and financial impact of metabolic disease and its significance for employers in the workplace; lifestyle behavior changes to reduce the impact of metabolic risks; how to measure the success of metabolic health initiatives; pharmacy management to improve adherence and clinical outcomes;and best practices in metabolic health management. Comment: The initiative would appear to be an exceptional place for integrative practice interests to seek to participate and integrate new options in this meeting for "employers and providers."
More employers offering onsite primary care
A September 3, 2008 story in the Philadelphia Inquirerexplores the continuing growth of on-site health care provision by large employers. Notably, a motivator is realizing that many employees have no primary care on their own, and wait around and end up in emergency rooms. (See related story on primary care, below.) The article notes that Johns Hopkins, which is just opening its first integrative center, "runs about 50 clinics, most of them staffed by nurse
practitioners and physician assistants, at seven large national
companies" such as Pepsi. Most of the care noted in the article is conventional. The employer clinic profiled which has a significant wellness component is the Showboat Casino and Hotel in Atlantic CityNotably, the movement toward greater investment in onsite care comes as a report on employer practice concluded that 59% of businesses plan to limit their financial exposure via health benefits through such mechanisms as requiring higher co-payments from their employees. American Specialty Health and CEO DeVries receive awards
George DeVries
The company that complementary and alternative healthcare practitioners most love to hate, American Specialty Health (ASH), has recently secured a series of awards from the clients the firm serves, if not from the practitioners off which it makes most of its money. Most recently, the San Diego Business Journal named ASH CEO George DeVries a "healthcare (management) champion." The firm's management strategy typically includes low payments to practitioners, often leading to challenges in filling practitioner panels. Yet ASH is clearly pleasing some of its constituencies. The firm recently received
a "Best Employers for a Healthy Lifestyle" award from the
National Business Group on Health, an employer group, and was named one of the 15 fittest companies
in America by Men's Fitness
magazine. The firm has a significant employee wellness program. Last year, the firm also received an award from URAC, the accrediting firm, for reducing variation in X-ray examinations among its contracted providers. Over
the past decade, ASH transitioned from
a California-based chiropractic management firm to a national roll-out featuring a loss-leader discount program for
CAM services which successfully undercut ASH's less-capitalized competitors, to the "health improvement organization" it styles itself
as today.
Charting the Mainstream
Antibiotics send 140,000/year to ER - why aren't we researching integrative strategies?
Some 140,000 emergency room visits per year are linked to "popping antibiotics" according to a Centers for Disease Control and Prevention report reported here at MSNBC. Loren Israelson of the LDI Group sent the link to his list, adding that "this is yet another reason
to encourage the appropriate use of supplements and natural health products to
minimize the need for antibiotics and to reserve them for extreme cases when
they are indeed lifesaving." Why aren't we researching the potential of these important public health applications of integrative practices?
Non-$$ incentives play bigger role in nurse hiring and retention
A Washington Post article notes that hospitals are using working conditions rather than wages to lure nurses. While allowing nurses to perform or receive complementary health services is not mentioned, this trend is aligned with the known integrative practice strategy noted by the Samueli Institute and others in looking for a business model for integration. (See The Business Case for Integration: Perspectives from the 5th Annual AHA/Health Forum Conference, May 3, 2007.) A hospital's return on investment in adding complementary health services is often measured in terms of nurse attraction and retention. Many nurses like both performing the services, and having them available for their own care. The cost of replacement of a nurse is put at $50,000 to $100,000.
Pharma influence scrutinized, but "no one suggesting anything drastic"
The influence of Big Pharma on medicine is the subject of a Kaiser Network daily report in which, Catherine DeAngelis, MD, the editor of JAMA notes: "The influence that the pharmaceutical companies, the
for-profits, are having on every aspect of medicine ... is so blatant
now you'd have to be deaf, blind and dumb not to see it. We
have just allowed them to take over, and it's our fault, the whole
medical community." But no big changes are expected according to a Houston Chronicle article: "No one is suggesting anything as drastic as cutting off
industry funding for academic research on new drugs," as those
"billions help pay lab and other expenses at virtually all U.S.
teaching hospitals, medical schools and affiliated practices, while
giving the drugs' developers the cachet of having big-name academic
researchers running their studies." Comment: The blindness of our banks and financial houses to the collapse this week has me wondering whether this refusal to separate from pharma represents a similar level of institutional denial in the awful situation in our medical system. No dear, this direction is not evidence based: 2% of med students choose primary care
Okay, if we know that health outcomes are better in regions with more primary care, and that cost is lower in those regions, it stands to reason that we will see a significant growth in primary care, right? A September 10, 2009 Washington Post story notes that just 2% of medical students are choosing primary care residencies this year. This is 75% lower than the early 1990s "crisis in primary care" when the percent fell to what was then viewed as an almost unimaginably low 9%. Foreign medical graduates have been making up the slack in the declining numbers, creating shortages in their own nations. This structural failure of the US medical education system to make sure we have a robust system for outpatient care is a useful reference point for those who wonder why the mostly outpatient complementary and integrative medical practices are poorly up-taken by the system. How would the integrative practice dialogue be going if our nation had a more appropriate level of investment in outpatient care?
Personnel
Standard Process founder DuBois on chiropractic research organization's board
Charlie DuBois, Standard Process' CEO
The Foundation for Chiropractic Education and
Research (FCER) announced in a September 12, 2008 release that Charles DuBois, president of Standard Process has been elected to the not-for-profit's board. Dubois is quoted as saying: “I am pleased to join FCER’s Board of Trustees. Scientific evidence is becoming
an essential tool for all chiropractors. Being given the
chance to be involved first-hand in efforts that will provide chiropractors
with evidence-based research and the expertise to use this research in daily
practice is very exciting.” Standard Process is a major contributor to research and educational advances in chiropractic and integrative medicine.
Brenna Hill leaves exec position at the American Association for Health Freedom
Brenna Hill, the executive director of the American Association for Health Freedom (AAHF) over the past half decade has left her position. AAHF is one of the few lobbying voices in Washington, DC representing the integrative practice community. In a note on September 8, Hill stated that she will remain with AAHF as a senior fellow but will take time for "personal initiatives." As noted in this Integrator article,
Hill led the 501C4 lobbying organization through
significant growth with an influx of capital from a source that was not
publicly shared. No successor has been named. Hill shared that the organization has also a change at the head of its board: Hunter Lewis is taking a position that has been held by Shari Lieberman, PhD, CNS, FACN. Council for Responsible Nutrition names ND to serves as VP for scientific affairs
The Council for Responsible Nutrition consists of most of the better-heeled players in the dietary supplements industry. Founded in 1973, CRN positioned itself as a more conservative voice in Washington, DC. So it was an interesting step when the organization announced on September 9, 2008 that a naturopathic physician, Douglas MacKay, ND, has joined CRN’s team of
scientists as vice president for regulatory and scientific affairs. CRN said he will "complement
the expertise of John Hathcock,
PhD, Andrew Shao, PhD, and consultant and former CRN president, Annette Dickinson, PhD." McKay is an ex-executive of Nordic Naturals and a former adviser to Thorne Research. McKay served as a senior editor for the peer-reviewed Alternative Medicine Review whic Thorne publishes. Comment: CRN's choice is may mark a small piece of cultural authority gained by MacKay's discipline. CRN is choosing to have an ND be the face of the organization, and the industry. On the face of things, the decision makes sense: the naturopathic profession has the most thorough, required didactic and clinical training in therapeutic nutrition and the inclusion of nutraceuticals of any discipline. Yet cultural prejudices have tended to lead organizations to favor spokespeople with conventional professional degrees. Perhaps this marks a coming out of NDs in the United States. Notably, a naturopathic physician has in the past headed up the natural products regulatory arm in Canada. This is now slightly less unimaginable possibility here in the more medically-predjudiced States.
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An at times divisive issue inside the licensed acupuncture and Oriental medicine (AOM) profession recently saw a remarkable step toward unity. The issue concerns the "entry level doctorate" or "first professional doctorate." In the 1980s, the profession's educators chose to target a Master's level degree program as the profession's basic educational standard. Some in the profession 
Yoga therapy group, IAYT publishes data on survey of members
Aware of the pharma issues noted below (see Media) surrounding the problems from too-close relationships between conventional medicine and Big Pharma, the 
