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Integrative Medicine and Integrated Healthcare Round-up: Nov. 30-Dec. 31, 2008 PDF Print E-mail
Written by John Weeks   

Integrative Medicine and Integrated Healthcare Round-up: Nov. 30-Dec. 31, 2008

Summary: New CDC report shows CAM use at 38%, but over 50% among our indigenous ... AARP, US Chamber and Prince's Foundation join Bravewell-led coalition to promote health-oriented reform ... More on Dasche/Obama community discussions from Jonas'/Samueli gathering, Hawaii Consortium, ND group in Connecticut, a Reiki leader and the ACA ... URAC names first accredited wellness programs ... Institute for Functional Medicine leader David Jones, MD leads Integrative Practitioner discussion on the role of the randomized controlled trial ... Naturopathic physician-run wellness program for automobile dealers earns Vermont Gold Medal award for 3rd straight year ... Oprah opens a page to homeopathy ... Former American Whole Health integrative medicine director and SCNM founder Michael Cronin, ND takes board roles at National University of Health Sciences and the AANP ... Samueli Center and Arizona Center offer CME programs ... Nursing site lists top 100 herb-related blogs ...

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Landscape

ImageNew CDC data suggest CAM use at 38% but over 50% for indigenous populations

Some 38% of adults and 11% of children are users of alternative medicines according to 2007 data recently reported out of the Center for Disease Control and Prevention. The report is available here and an NCCAM page is available here. The results in the abstract are worth a read in full:
Results:  In 2007, almost 4 out of 10 adults had used CAM therapy in the past 12 months, with the most commonly used therapies being nonvitamin, nonmineral, natural products (17.7%) and deep breathing exercises (12.7%). American Indian or Alaska Native adults (50.3%) and white adults (43.1%) were more likely to use CAM than Asian adults (39.9%) or black adults (25.5%). Results from the 2007 NHIS found that approximately one in nine children (11.8%) used CAM therapy in the past 12 months, with the most commonly used therapies being nonvitamin, nonmineral, natural products (3.9%) and chiropractic or osteopathic manipulation (2.8%). Children whose parent used CAM were almost five times as likely (23.9%) to use CAM as children whose parent did not use CAM (5.1%). For both adults and children in 2007, when worry about cost delayed receipt of conventional care, individuals were more likely to use CAM than when the cost of conventional care was not a worry. Between 2002 and 2007 increased use was seen among adults for acupuncture, deep breathing exercises, massage therapy, meditation, naturopathy, and yoga. CAM use for head or chest showed a marked decrease from 2002 to 2007 (9.5% to 2.0%).
The widely covered report (including LA Times on 12/10/08 and Washington Post on 12/11/08) included a note, in the Associated Press (AP) article from author and blogger Michael Cohen. He notes "surprise that adult use didn't rise more, given other trends." Adult use was at 36% in similar CDC data from 2002. Cohen includes a lengthy section of the AP story and some commentary on his CAMLaw Blog. Thanks to Hillary Davis, vice president for former Integrator sponsor Triad Healthcare for the heads-up on this report.
Comment: Note the use by American Indian and Alaska Native adults. The is hardly the profile of the upper class, white, higher-educated "CAM users" which has framed the dialogue on integration to date. Credit the CDC team, and NIH's NCCAM's Richard Nahin, MPH, PhD, for bringing this information out. It can partucularly be useful especially in integration strategies for serving the under-served and lowering disparities.
 
Coalitions

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Key partner in Bravewell-led coalition
Bravewell announces AARP, US Chamber, Prince's Foundation are part of growing, pro-active coalition promoting a health orientation


A December 2008 newsletter from the Bravewell Collaborative reported that "the Collaborative has been forming a coalition that will carry the work of the (IOM's Nation Summit on Integrative Medicine)  into the future and translate it into social change." According to the newsletter coalition "will investigate new health care delivery models, press for new health care legislation, and educate both the public and professional sectors to shift from disease-oriented approaches to a more integrative, whole person approach to medicine." The lead partner with Bravewell is the AARP, whose CEO Bill Novelli underscored the wellness focus of the coalition: “AARP is participating in the Summit because the focus of health care should not just be on getting you better; it should be about keeping you healthy. Especially at this time of great economic uncertainty, we cannot afford to keep a broken health care system.” The US Chamber of Commerce and the Prince’s Foundation for Integrated Health in the United Kingdom also joined the coalition during the fall of 2008. Christy Mack, the Bravewell's co-founder and president, described the Bravewell's role "as that of catalyst and convener, bringing key people, groups and institutions together in support of this important cause.” A Bravewell note on the relationship with the Prince's Foundation is here.
Comment: While I have significant issues with some of the Bravewell's choices on who is in or out of the acceptable "people, groups and institutions," one can only laud the ambition, steadfastness and perseverance the Collaborative has shown since it was founded in 2002. This coalition is a pretty cool move. Hope it has legs!

Policy


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Obama: stimulating grassroots action
More on the Daschle/Obama Health Care Discussions


Integrator reader and sometimes commentator Taylor Walsh writes that he plugged "integrative medicine" into the search function at Obama's www.change.gov site, which has over 250 position papers. He got this response: "We found 0 results for 'integrative.'" That may begin to be remedied by recent grassroots action, if not by hte Bravewell. Early word from the December 29th Daschle/Obama Health Care Community Discussion hosted by Wayne Jonas, MD and the Samueli institute is that the Institute's phone lines were jammed for sign-up. Over 100 people reportedly joined on the call. Thanks to reader Beth Rosenthal for taping the meeting for me.

I have heard from a few others who have had events. Daphne White reports 15 or so people at her D.C.-area discussion. Josh Levitt, ND and his partners at Whole Health Connecticut also held a discussion, attracting visitors to a greenhouse, where the meeting was held during the cold spell.
The Hawaii Consortium for Integrative Healthcare hosted two meetings on December 27th and 28th. Laura Crites, executive director, set up the discussion in an email to her list with this statement: 
"We will focus on the question of the role of integrative medicine in healthcare reform at these two meetings. Throughout the discussions on healthcare reform in Hawaii and nationwide, there has been little or no mention of the potential role of integrative medicine-how can complementary and alternative medicine (CAM) be part of the solution?  Although there is much mention of wellness and prevention as part of a healthcare reform approach, it is unclear whether the conventional medical professions will be expected to shift their focus or whether those licensed CAM professionals who are already trained to focus on prevention and wellness will be actively engaged in providing for the healthcare needs of Americans."
A couple of practitioner and therapy groups spent some energy urging their members to participate in such meetings, and briefed them for it. In a note to her list, Pamela Miles, the unstoppable promoter of Reiki through her Reiki in Medicine site, urged readers to familiarize them  selves with the NCCAM backgrounder on Reiki (which Miles had a hand in crafting). The American Chiropractic Association used the last 2008 issue of it's Week in Review (December 18, 2008) to urge its members to hold meetings in their communities. The ACA prepped member by linking them to the association's Issue Brief on Healthcare Reform. The ACA also is piloting with 400 of its doctors a "Chiropractic Advisory Network" which it plans to use for lobbying the Obama administration. Meantime, the American Association of Naturopathic Physicians urged their members to join Doctors for Obama.

Walsh sent along another quick noted that on December 11, 2008, in a speech accepting Obama's nomination as HHS secretary,
Daschle said that one of the objectives for changing the health care system is "investing in prevention and wellness."


Employers


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Wellness accreditor acts fast
Accrediting Wellness: URAC names first firms to make the grade


The Integrator recently reported that URAC, the accrediting agency, has promulgated accreditation standards and measures for Comprehensive Wellness programs. URAC has been busy. The accrediting agency recently announced the first firms to make the grade.
The companies that have achieved URAC Comprehensive Wellness accreditation are the American Institute for Preventive Medicine, Healthyroads, Healthways, SHPS Health Management Solutions, and Health Management Corporation. In addition, six other firms are in process of application. Alan P. Spielman, URAC's president and CEO makes the pitch for the value of such accreditation: "Accredited companies must demonstrate a comprehensive approach--that they use evidence-based tools and interventions, that they support consumers with information they need, and that they have the ability to integrate services, a necessary component in today's environment."
Comment: I continue to track this development to stimulate more awareness among those in "wellness oriented" integrative practices about what a wellness program means to large payers. English, as it turn out, has varying meanings for identical words. We serve ourselves to see how the "them" of the "employers" is "us."
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Naturopathic doc Noe (l) with Governor Douglas and VADA client Miller
Naturopathic physician's wellness program receives 3rd straight Vermont Gold Standard Award


Bernie Noe, ND, president of Green Mountain Wellness Solutions and Marilyn Miller, executive director of the Vermont Automobile Dealers Association (VADA) once again received the Gold Standard Award for Continued Excellence in Work Site Wellness from Vermont Governor James Douglas. The VADA program, designed and implemented by Noe, has received the governor's top worksite wellness award for large businesses for the last three years in a row. Noe shared details of the program's strategies and first year outcomes in this prior Integrator report.


Research


Integrative Practitioner features IFM's David Jones, MD in discussion on whether the RCT is a "gold standard"

David Jones, MD, president of the influential Institute for Functional Medicine, lobbed a fine discussion topic to the 5600 members of Integrative Practitioner Online (membership is free and open to all):
"Is the randomized control trial truly a gold standard or simply a good experimental design for some circumstances and that's all?"
The roughly 20 responses include this conclusion from sometimes Integrator commentator Chuck Simpson, DC: "In the meantime, CAM researchers and CAM clinicians must collaborate to devise questions and develop research strategies that are rigorous, valid and able to put to rest the notion that if an intervention cannot be put through the RCT sieve, it cannot suffice as evidence that can help clinicians and their patients make appropriate decisions about health care."

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Stimulating few discussion through David Jones, MD
Jones thoughtfully reviewed many of the submissions then concluded with: "So the next question might be: 'Is the RCT the most appropriate experimental methodology for single molecule queries, but inadequate to the multivariable, complex, networked nature of whole systems research?”  Should we consider tearing down the artificially constructed hierarchy of research methodologies and consider rather the appropriateness of methodologies that suit the nature of the question at hand. I do not think it reasonable to acquiesce to the notion that “some things” in our clinical universe of important “things” simply cannot be measured (the nihilistic position); rather the question may be 'how best to measure?'"
Comment: This Integrative Practitioner discussion is a good one - as is Jones' direction. Maybe it is time for the NIH NCCAM to focus some more energy on unearthing and building-out some of its past methodology conferences and, more important, take guidance from the findings. Here's a vote for non-acquiesence and for "tearing down" the non-reasonable, forced uses of the RCT construct and building one that works with "the multivariable, complex, networked nature of whole systems research."

Personnel


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Michael Cronin, ND
Former AWH integrative medicine director Cronin selected to boards at National University and AANP


The decade of the 1990s saw Michael Cronin, ND in two very important roles in the integrative practice movement. One continues to significantly offer thousands of consumers more healthcare choices. The other didn't fare so well. Cronin became known to many in the integrative medicine community when he served from 1997-2000 as director of integrative medicine for American WholeHealth (AWH). AWH was the most significant, venture capital-funded venture in US history, which sought to spread a network of integrative clinics nationally. Cronin took the job after spearheading the creation of Southwest College of Naturopathic Medicine for which he served as the first president. At AWH, Cronin and the AWH team created many sustainable clinics with some top-notch clinicians. They couldn't, however, find enough margin to pay the corporate overhead and feed the venture-capitalist hunger for ROI. AWH shut down, sold off or gave back the clinics. Cronin consulted with Ric Scalzo and Gaia Herbs then turned inward for a few years and grew a busy practice in Phoenix. Now he's venturing back out on the national stage and has made 2 choices. He was appointed to one board, at National University of Health Sciences, and elected to another, with the American Association of Naturopathic Physicians. I asked Cronin about his choices:
"Our children are not inheriting the "Age of Aquarius", quite the contrary. We can improve quality of life by affecting healthcare policy and improving access to our naturopathic solutions.  Our Earth is getting smaller and the rapidly changing environment will have many casualties. How well we plan and adapt to these challenges and the "Greening of Healthcare" will affect the health of our children and their opportunities for health optimization on the positive side and lower the body count on the negative side. The AANP is in a great position to affect change. We have a great organization, situated in Washington with leadership and membership from all the states. I look forward to participation in guiding that process. Going on the board for National University of Health Sciences has a different  meaning. My path as a health care professional has been greatly affected by the good work of many chiropractors as mentors and friends. I hope to give back some of that by assisting the NUHS and the Naturopathic program in whatever way possible. I also look to stimulate more collaboration with the chiropractic profession regarding these upcoming opportunities and challenges in the "Greening of Healthcare".
Side Comment: A side note here. John Reed, MD, Cronin's long-time friend and colleague from Phoenix and with American Whole Health (AWH) has left the firm that purchased AWH, Healthways, to go to Harvard Divinity School. I am looking forward to learning what Reed will be doing next.


Professions

AHNA to honor top holistic nurse or program to be honored - ideas?

The American Holistic Nurses Association's (AHNA) is sponsoring a new Excellence in Holistic Nursing Education Award for schools, programs, or departments of nursing that offer an undergraduate or graduate degree in nursing and demonstrate a strong commitment to holistic nursing. The deadline to submit a nomination is January 30, 2009. Contact Jeanne Crawford at


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Making Yoga therapy info more accessible
IAYT's Yoga therapy publications online and searchable, Diefe new editor


The International Association of Yoga Therapists has announced to members that they can now search and find articles from the International Journal of Yoga Therapy (back to 2002), as well as all issues of Yoga Therapy in Practice (YTIP). The e-news from IAYT executive director John Kepner, MBA notes that IAYT is using a professional service provided by "MetaPress, a leading provider of scholarly electronic management, hosting, and delivery services" to provide the service.  Says Kepner: "Electronic hosting also makes this work easily accessible to individual Yoga teachers, Yoga therapists, healthcare professionals and researchers worldwide." In related news, IAYT notes that Julie Deife will begin in 2009 as the new editor-in-chief of the increasingly robust YTIP. Kelly McGonigal, PhD, founding YTIP editor, will remain Editor in Chief of IAYT's International Journal of Yoga Therapy.  

Oprah opens page for homeopathy

Homeopathy Nancy Gahles, DC, CCH, RSHom (NA) president of the National Center for Homeopathy, send a note that homeopathy has "finally arrived." The measure: A page on the Oprah.com website. Gahles credits the public relations work of Peter Gold for the placement. Gold was also the fellow behind the widely reported debate on homeopathy at the University of Connecticut Medical School not long ago.



Conferences

Samueli Center: healthy aging

The Susan Samueli Center for Integrative Medicine at UC Irvine is hosting a conference entitled Healthy Aging: Integrative Medicine Throughout a Lifetime. The conference will be held in Orhgange County from February 28-March 1, 2009. Wade Najm, MD, MSEd is course director.

Arizona Center: nutrition & health

A note from Heather Bradley at the Arizona Center for Integrative Medicine sought this notice that the Center is hosting their 6th Annual Nutrition and Health Conference in Chicago, May 10-14, 2009. Odd that they should hold it the week of the North American Research Conference on Complementary and Integrative Medicine. Different audiences, I suppose.


Miscellaneous


Top herbal blogs (including the Integrator ...)


Kelly Sonora writes that NursingDegree.net has posted an article entitled "Back to Nature: Top 100 Herbal Medicine Blogs."  The selections are helpfully broken into roughly ten difference categories, with a brief explanatory phrase behind each. For instance, among the nine in a category called "Health Experts" is a listing that goes: "The Integrator:
Learn about the business of integrated medicine from this blog." Most are more directly focused on herbs. Take a look.

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