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

Integrative Medicine and Integrated Healthcare Round-up: October 1-15, 2008

Summary: MGMA says some MDs turning to alternative medicine, supplement sales, for business reasons ... Naturopathic specialty board established to promote aesthetic medicine ... American Acupuncture Council promotes programs to get acupuncturists and chiropractors to explore anti-aging medicine ... NCCAM names NIH veteran Jack Killen, MD as Deputy Director ... Institute of Medicine announces agenda for its February 2009 National Summit on Integrative Medicine, not yet much sign of "integration" ... New American Hospital Association report finds 37% of hospitals offering some CAM, a 40% increase in the percent since 2005 ... Yale-Griffin integrative medicine center in new 27,000 square foot cancer facility ... Donna Karan's Urban Zen initiative brands "new category of integrative practitioner" ... Thumbs up for natural childbirth in Milbank study, and article by obstetrician Bethany Hays, MD ... USA Today features Pentagon's exploration of alternatives ... Plus, Annie Appleseed, patient-centered integrative cancer conference  ... Integrative Medicine Alliance practitioner-centered weekend ... Three of Calabrese's mentees earn NIH awards ... 
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Professions & the Business of Medicine

Alternative methods for making bucks
Alternative Medicine as "Ancillary Services" for Primary Care MDs

A recent Medscape article on "Ancillary Services in Primary Care" (October 7, 2008) begins by noting that "m
any of today's physicians are battling declining reimbursements by bringing ancillary services into their practices."  The source is the Medical Group Management Association (MGMA) 2008 annual Cost Survey Report, which found a 3-year increase in physician use of ancillary services. Physicians are exploring a series of services that primary care doctors might explore to enhance their practices. These range from new diagnostics (treadmills, etc.) to botox and other cosmetic services to "alternative and holistic treatments (eg, acupuncture, massage)." Cited is one Bruce Johnson, JD, an attorney and medical practice expert with the international law firm of Faegre & Benson in Denver, Colorado who is also a consultant to the MGMA. Johnson also suggests sales of nutritional supplements. The paper goes into detail on some options, though not on these. Overall, Johnson recommends that medical doctors "figure out which services complement your practice and what makes sense from a patient care standpoint."
Comment:  Lou Sportelli, DC, who went this link to me, sent it with this comment: "You see this is the kind of mindset that erects barriers [between the medical doctors and distinctly-licensed disciplines]: the use of all things as 'add on's' and often for economic reasons. When medical physicians consider the CAM community as peers, and then allow those who can do the service best to do the service, we will have made huge gains in integration."
Naturopathic doctors promote aesthetic medicine specialty board 

The Naturopathic Physicians Board of Aesthetic Medicine (NPBAM) was founded as an independent, not-for-profit organization in 2006 to "help Naturopathic Physicians who incorporate aesthetic medicine in their practices, to reach an entirely new demographic of patient." The organization, run by Deborah Mainville-Knight, a long-time administrator in the naturopathic profession, will offer certification at 3 levels after which the ND can call his or her self a "Specialist in Aesthetic Medicine," according to an October release. The focus of a recent release from the organization is on practice-building a reaching new sets of patients. The next training is in Arizona in January. 

Practice building for DCs and LAc
Acupuncture, chiropractic and anti-aging medicine

On December 11-12, 2008, the American Acupuncture Council, a malpractice insurance provider for licensed acupuncturists, is offering a co-located seminar in Las Vegas with the the American Academy of Anti-Aging Medicine (A4M). The goal of the program is to teach LAcs and DCs "how to implement anti-aging to complement" acupuncture and chiropractic practices. AAC's Hubert Chang, DC (who says he will sit for his acupuncture licensing in early 2009) said that roughly 25 DCs and 25 LAcs had signed up as of mid-October. Chang notes that it's this $72-billion market, expected
to reach $115 billion in the next two years, "is a niche market" which AAC and its chiropractic affiliate want to open to these practitioners. The 11 sessions in the two days of the acupuncture program each focus on anti-aging uses of various parts of the AOM toolkit, plus how to get paid for the services.. , you will receive the education and information you need to dramatically impact your practice and serve your patients on a new level. Chang says those attending for the $199 price will have access to the broader A4M conference, which costs $895.
Comment: These 3 stories seem to be of a family, each bringing out the pecuniary sides of the a discipline's practice modalities: MD, ND, DC and AOM.


Oregon AOM groups unify

Some positive downstream effect of the unification, two years ago, of the two national acupuncture and Oriental medicine associations into the American Association for Acupuncture and Oriental Medicine (AAAOM) is a similar merger in Oregon, according to a September 2008 release.
The new organization's name is the Oregon Association of Acupuncture and Oriental Medicine (OAAOM). The new organization will focus on positioning the profession in Oregon's new health planning. Congratulations are in order. One of my operating assumptions is the when few dollars are available and power is limited, unity is usually useful. Thanks to PK Melethil, LAc for the notice.

Kick-starting a federal presence
AAAOM announces national lobbying priorities for acupuncture profession

As a lead-up to its national meeting in Chicago October 16-20, the American Association of Acupuncture and Oriental Medicine (AAAOM) announced a Town Hall Meeting entitled "Working to Create National Presence in DC."  The priorities are:

  • Expanding patient access to acupuncture
  • Protection of your access to herbs
  • Achieving acupuncture coverage for the elderly who depend on Medicare, federal employee, military & VA benefits.

An October 8, 2008 invitation from the AAAOM stated that the association is seeking to "acquire a lobbyist for the profession" to move this agenda. Lloyd Wright, LAc serves the AAAOM as national legislative chair.
Comment: The historic struggle and dis-unity in the AOM profession has kept it from seizing the many opportunities that are available to it. Compared to the other two major "CAM" professions, chiropractic and naturopathic medicine, AOM has much lower "negatives," in the political sense, in the mind of collective mind of the mainstream. The openness is there, but the profession needs to show up. One suggestion: It wouldn't hurt if the AAAOM had at least one area of stated interest that spoke to interests which were larger that the guild itself. How about a support of initiatives for moving the system toward a health and wellness focus? Another direction might be to take a position promoting research which looks at the whole practices represented by AAAOM members: needles plus herbs plus Tuina plus the practitioner-patient relationship, and more. My bias is that it is smart, for many reasons, to have parts of any discipline's agenda be designed to connect outside of the guild.

Federal Affairs

Jack Killen, MD, NCCAM's new Deputy Director
Killen named Deputy Director of NCCAM

The NIH National Center for Complementary and Alternative Medicine has finished a lengthy search by naming Jack Killen, MD as Deputy Director. In an NIH NCCAM press release, NCCAM director Josephine Briggs, MD explained the decision this way: "[Killen] has a deep interest in CAM, particularly mind-body modalities, and the exploration of their potential for improving health. I look forward to continuing to work with Dr. Killen in his new role as Deputy Director." She also underscored his role in managing multidisciplinary research projects. Killen has been with the NIH for 27 years. 
Comment: While Killen has received numerous awards for his services to the NIH, he is viewed as a less than ideal selection by some in the integrative medicine community. Killen may have developed an interest in mind-body medicine; it is not reflected in his pre-NCCAM resume. Killen was the subject of an extensive, researched critique that was submitted to the Integrator by homeopathy advocate and former NIH Office of Alternative medicine staffer Beth Clay (see Past NIH Staffer Clay: Who Is NCCAM Deputy Killen and Why Is He Demeaning Homeopathy in Newsweek? March 18, 2008.) I would have preferred to have seen Briggs, a newcomer to integrative medicine, coupled with a deputy who is known to have a grasp of integrative medicine. Examples would be Margaret Chesney, PhD, former deputy director, or Adi Haramati, PhD, the integrative medicine leader at Georgetown. For now, I am looking forward to learning what Briggs will make of her tenure. I am hopeful and look forward to a scheduled interview with her next week. More soon.
Fighing for expansion of chiropractic in the military
Congress expands chiropractic program in the military

An October 9, 2008 release from the American Chiropractic Association is boldly headlined: "Congress orders further expansion of military chiropractic program."  The provision, which orders expansion to 11 new facilities, was incorporated in the
massive National Defense Authorization Act (NDAA) following lobbying by the ACA and the Association of Chiropractic Colleges. The measure was cleared for the White House on Sept. 27, 2008 and reportedly "mirrors a similar-sized incremental expansion as was approved in 2005." The release framed the lobbying as a "fight against competitors" in a hostile environment in which the Department of Defense fought the measure. Especially thanked were House Armed Services Committee Chair Ike Skelton (D-Missouri), Committee Ranking Member Duncan Hunter (R-CA), Rep. Neil Abercrombie (D-HI), and Rep. Mike Rogers (R-Alabama).

USA Today features Pentagon exploration of alternative medicines

An October 7, 2008 article in USA Today (Pentagon researches alternative treatments) underscores that military leaders are "
seeking new ways to treat troops suffering from combat stress or brain damage by researching such alternative methods as acupuncture, meditation, yoga and the use of animals as therapy." The need is huge. According to the article, "about 300,000 Iraq and Afghanistan war veterans suffer from PTSD or major depression, and about 320,000 may have experienced at least a mild concussion or brain injury in combat, according to a RAND Corp. study released this year." The Integrator recently focused on military-related projects of the Samueli Institute, some of which are indirectly referenced in the USA Today account . (See From Research to Practice: Samueli Institute's Work on Integrative Medicine in the Military.

Hospital Integration

New survey shows CAM offerings rise
American Hospital Association reports 37.5% of hospitals have some CAM

Health Forum, a subsidiary of the American Hospital Association, has reported that, according to its 2007 survey, 37% of US hospitals currently offer some sort of complementary and alternative health care. The Cincinnati Business Courier provided a brief report based on a September 15, 2008 release from the Health Forum. Its a 40% increase in the percentage of hospitals with at least some CAM services compared to the 2005 survey. Said
AHA President and CEO Rich Umbdenstock: "Complementary and alternative medicine has shown great promise in supporting and stimulating healing. It's one of the many tools hospitals look to as they continue to create optimal healing environments for the patients they serve." The AHA is sending the Integrator a copy of full report for a deeper look at the findings. Thanks to adviser Sita Ananth for her assistance.

Yale-Griffin integrative services become tenant of "serene" new cancer center

The headline in the October 3, 2008 issue of the New Haven Register is "New cancer center a hub of healing." The article regards
Griffin Hospital's new $27-million, 49,000 square foot building which includes a "healing garden filled with flowering plants, and features stone walls, a reflecting pond and a small waterfall." Among the tenants of the new center is the Integrative Medicine Center which features a unique MD-ND combination of services, led by David Katz, MD, MPH and Ather Ali, ND, MPH who also are part of the leadership team for Integrative Medicine at Yale.  According to Griffin president Patrick Charmel, "a hilly area was blasted to create the picturesque vista, which will be visible to patients undergoing chemotherapy treatments." The combination of heroic measures and complementary treatments that will be co-housed at the facility would appear to recapitulate the sites own history.
Education and Academics

Posts summit agenda
IOM publishes agenda for National Summit on Integrative Medicine

The Institute of Medicine of the National Academies has published the agenda for its National Summit on Integrative Medicine and the Public Health (formerly " ... and the Health of the Public") which is sponsored through a $445,000 grant from the Bravewell Collaborative. The only speakers specifically mentioned are Harvey Fineberg, MD, president of the IOM, and Ralph Snyderman, MD, chair of the Summit Planning Committee. The themes range widely: vision, models, science, workforce and economics. Each will have a panel of presenters. Some "Breakout Groups" will support the process. The site also notes that two new members have been appointed to the Planning Committee: Reed Tuckson, MD, senior vice president of United Health Group and Sir Cyril Chantler, MD, of the King's Fund, United Kingdom. Of the 14 members, 11 are medical doctors, one a conventionally-based researcher, one a representative from a consumer organization and one, Elizabeth Goldblatt, a PhD educator in the AOM field.
Comment: One might wonder, from what is available here, how much "integration" will actually make it into this "integrative medicine" event. So far, it's almost all MDs visible on the site. Given the riches of complementary and alternative medicine in the non-MD fields, from holistic nursing through chiropractic and AOM and naturopathy to massage and Yoga therapy, which together helped birth the consumer movement which was later dubbed "integrative medicine" when centered around an MD practice, one hopes that this Summit will honor this base. A good sign of potential for pluralism is that instead of single talking heads, each theme will have a keynoter and a group of 5 panelists. Here's hoping that Snyderman and his mostly MD team will have the courage, wisdom and humility to break down the historic pattern of exclusion. Don't patients want collaboration? Isn't patient-centered care among the themes? Isn't medical dissing of nurses and other professionals part of what we need to transform in the "new medicine" which Bravewell wishes to establish? Hopefully, Snyderman's choices will be good modeling for all of health care.
Designer Donna Karan's founded Urban Zen
Donna Karan/Urban Zen aim to brand "new category of healthcare practitioner"

The Urban Zen Foundation, founded by designer Donna Karan, has announced a new 500 hour "Integrative Therapist Program." Such a therapist will have yoga skills and also the ability to counsel individuals on complementary therapy techniques, according to information on the Urban Zen site. The program was developed by Rodney Yee, Colleen Saidman Yee and others. The training includes "
Yoga therapy, Aromatherapy, Reiki, Nutrition and Contemplative End-of-Life Care ... providing broad knowledge and expertise to practitioners and preparing them to use these integrative therapies in a variety of healthcare settings." Urban Zen is reaching out to yoga practitioners, physical therapists, massage therapists, nurses and "other allied health professionals." The programs are registered through the Yoga Alliance. Two businesses, Gaiam and Young Living Essential Oils are sponsoring the program.

Farmer's markets and integrative care - take #2: Tai Sophia Institute

The July 16-31, 2008 Integrator Round-up noted that new services from the integrative medicine program at Wake Forest include an onsite farmers markets. More recently, Tai Sophia Institute announced that its Student Chapter of the American Association of Acupuncture and Oriental Medicine will be running information tables and booths at several of the Maryland/Tri-State's largest farmers’ markets in late October and early November. Perhaps the integrated care movement is finally planting itself in the culture. (While linking to the Institute's site, I noted that Mary Jo Kreitzer, RN, PhD, will be presenting at the Institute on optimal healing environments on October 29, 2008.)

Charting the Mainstream

Natural childbirth rules (if evidence does)
Natural childbirth boosted in Consumer Reports, Milbank study

Morgan Martin, ND, LM, chair of the naturopathic midwifery program at Bastyr University sends news of a report entitled Evidence-Based Materinity Care: What It is, What it Can Achieve. The report, produced through a partnership of the Milbank Memorial Fund, Childbirth Connection (est. 1918), and the Reforming States Group, takes on the turn to high-tech procedures, and shows that "non-invasive measures can mean better outcomes for both the baby and the Mom."
The authors recommend going back to basics. The Reforming States Group is a voluntary association of state-level health policymakers.
Comment: I have been meaning to note the exceptional article by Bethany Hays, MD entitled "Is There Still a Place for Normal Birth?  (Integrative Medicine: A Clinician's Journal; Aug-Sept. 2008). Hays, an obstetrician and medical director of True North Center (the Decision Circle for which is featured in this recent Integrator article), provides an excellent short synopsis of childbirth issues and data. I joke, above, that "integrative medicine" will be grounded when we have more connection to farmers' markets. Shared advocacy for quality natural childbirth, whether in home or birth centers, will also put a foundation under us.

Patient advocate Ann Fonfa, organizing cancer conference
Annie Appleseed Projects produces second significant integrative cancer conference

The Annie Appleseed Project, led by sometimes Integrator commentator Ann Fonfa, is a leading, independent, not-for-profit resource on CAM, natural and integrative cancer therapies "from the patient perspective." The Project has announced its 2nd Annual Evidence-based Complementary/Alternative (CAM for Cancer) conference, January 8-10, 2009 West Palm Beach, FL. The focus is on cancer patients/advocates from diverse communities around the US, as well as nurses, dietitians, and various oncology professionals. Among these are Keith Block, MD, Tina Kaczor, ND, FABNO, president of the Oncology Association of Naturopathic Physicians, Ralph W. Moss, PhD, board certified holistic nurse Georgia M. Decker APRN-BC, ANP, CN, AOCN, Penny Block, PhD, Susan Luck, RN, and patient advocates Lynne Farrow and Charlotte.

Boston's Integrative Medicine Alliance holds retreat for practitioners

The Boston-based Integrative Medicine Alliance, one of the nation's most significant regional integrative medicine networks, is sponsoring Hope in Healthcare Retreat: Rediscovering the Joy in Practice for healthcare professionals, October 31-November 2, 2008. IMA president Harvey Zarren, MD, will be among the featured participants.

Carla Calabrese, ND, MPH
Three young researcher awards go to Calabrese's mentees

The Integrator note on the Bernard Osher/NIH NCCAM grants for CAM researchers stimulated a (rightful) note of pride from veteran naturopathic medical researcher and one of my favorite teachers, Carlo Calabrese, ND, MPH. He shared that this past year three young researchers with whom he has been working have received NIH development awards: an
Osher program award to Helane Wahbeh ND, for work on the mind-body and immune system; an NIH K23 award to Gene Bowman ND, for work on nutrient combinations in dementia; and an NIH F32 grant to Kim Tippens ND, MSAOM, LAc, who is looking at CAM, disparities and metabolic risk. It's an impressive group of young researchers. Take a look. The first two are primarily associated with Oregon Health & Science University; all are associated with Helfgott Research Institute at National College of Natural Medicine, Calabrese's base. Meantime, Calabrese, a past member of the NIH National Advisory Council for Complementary and Alternative Medicine, continues his own work of 20 years to promote receptivity for new paradigm research that looks at whole practices.

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