Forum on the IOM Summit: Holistic Primary Care's Erik Goldman and JMPT's Claire Johnson
Written by John Weeks
Forum on the IOM Summit: Holistic Primary Care's Erik Goldman and JMPT's Claire Johnson
Summary: The Integrator is honored and pleased to present two submissions from editors of leading publications in the field, relative to their experiences at the recent Institute of Medicine Summit which each attended. Claire Johnson, DC, MSEd is editor of Elsevier's Journal of Manipulative and Physiological Therapeutics, the leading peer-reviewed journal in the chiropractic profession. Johnson ticks off key principles listed by IOM president Harvey Fineberg, MD and notes that "integrative healthcare" was an "inclusive" term, increasingly used, aligned with these key principles. Goldman, a past Integrator contributor, offers a different take altogether, a kind of run-and-gun, hopeful-skeptical, guerrilla warfare dispatch of field notes from an event that often left him wondering. Goldman, a former ureau chief for Elsevier's International Medical News Group, edits Holistic Primary Care, which reaches over 100,000 primary care offices of MDs, DOs, DCs and NDs with each publication. Enjoy the diversity of perspectives from two respected colleagues.
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This is the first of a series of articles with perspectives on the historic IOM Summit on Integrative Medicine and the Health of the Public, February 25-27, 2009. Anyone interested in
viewing the events, a full video webcast of the IOM Summit is available
at this link. The IOM has done a beautiful job of laying out all the content. Written summaries are also available via the same link.
Claire Johnson, DC, MSEd
1. Claire Johnson, DC, MSEd: Evidence of inclusivity and great consciousness about health
If one looks at the editorial board for theJournal of Manipulative and Physiological Therapeutics, one sees a which is a virtual who's who of top researchers in chiropractic over the last 3 decades, from Scott Haldeman, MD, DC, PhD and Reed Phillips, DC, PhD to the next generation with the likes of William Meeker, DC, MPH, Christine Goertz, DC, PhD, Cheryl Hawk, DC, PhD, and NIH NCCAM program officer Partap Singh Khalsa, DC.Claire Johnson, DC, MSEd guides the publication as editor via her position as director of publications and editorial review and as a faculty member at one of chiropractic's anchor institutions, National University of Health Sciences.
I attended the Institute
of Medicine Summit on Integrative Medicine held February 25-27, 2009. It was an
interesting 3 days of presentations and conversations about integrative
healthcare. The conference was opened by [IOM president] Dr. Harvey Fineberg, who did
a wonderful job in his opening speech. He stated that there are
many facets to integrative care and that there is a wide variety
of opinions joining together at this conference. He synthesized a list of
characteristics of integrative healthcare in his opening talk that included:
1. Integrative
medicine/healthcare is similar to the World Health Organization definition of
health, in that health is not just the absence of disease but the health of
physical, mental, emotional, and spiritual components.
2. Integrative
healthcare is the integration across all phases of care, from prevention, to
treatment, to rehabilitation and to recovery, in that there is a need for
continuity of care across intervention levels.
3. Integrative
healthcare is the coordination of care across services and approaches to
patient care.
4. Integrative
healthcare focuses on the patient, and that patient-centered care is
timely, equitable, and efficient.
5. Integrative care is
open to multiple modalities of care, both conventional and unconventional.
He ended with the
statement that "We need to apply the same standard of evidence to what
will or will not work in healthcare." Thus, implying that all healthcare
needs to be evaluated using the same standards, including traditional methods.
There were many
instances when the language was modified from 'medicine' (exclusive) to
'healthcare' (inclusive) and from 'patient' (sick) to 'person' (healthy).
- Johnson
As you will see in the
conference notes posted on the IOM website, only a few people were using the
term IM to replace CAM, and that many are looking beyond absorbing modalities
and professions. Instead, many people are using the broader definition of
integrative healthcare (similar to the 5 characteristics listed above) and are
focusing more on the health of patients and populations. There were many
instances when the language was modified from 'medicine' (exclusive) to
'healthcare' (inclusive) and from 'patient' (sick) to 'person' (healthy). This
suggests to me that, at least for those in the room, there is
greater consciousness that an evolution is taking place in how we think
about health.
As I understand it, additional reports will be published and available later
this year. I hope that you will find this information as informative and
interesting as I have.
Claire Johnson, DC, MSEd
2. Holistic Primary Care's Goldman: "Not quite sure what to make of the whole thing"
I first encountered Erik Goldman in roughly 1990 when Goldman was New Yoprk Bureau Chief for International Medical News Group (Elsevier). I was then serving as executive director for the American Association of Naturopathic Physicians with media flack as one of my responsibilities. Goldman called to do a story. It was an astonishing encounter: an objective assessment of an "alternative" profession in the conventional medical media. I think it was a first. Years later, Goldman began reporting the early Harvard/Eisenberg conferences, and we reconnected. He and Meg Sinclair, publisher, began Holistic Primary Care roughly a decade ago.
We
were at the IOM meeting in DC, and thought of you many times, as did many other
attendees I talked to. As it went on (and on and on) I kept wondering,
"Would Weeks be pleased with this or would he be searching for the nearest
bushel of rotten tomatoes?"
I'm
not quite sure what to make of the whole thing.
To
be sure, it was great to see everyone in one place---truly some of the nation's
best, brightest and most (com)passionate. The august surroundings made it all
the more rich..... and surreal.
Inspiration from the IOM Dome?
"Ages and Cycles of Nature In
Ceaseless Sequence Moving"
sayeth the dome's central inscription.
It's
all there, literally hovering
over their data-driven little heads.
IOM
has a beautiful central hall, adorned with arcane astrological/alchemical
gold-leaf paintings on its domed ceiling. I got to thinking that if the writers
of the IOM white paper really want to understand the essence of
holistic/integrative medicine, they really ought to get together after hours,
smoke a doobie (OK, that might not be such a good idea seeing as IOM is right
across the street from the State Department), lie on the floor, and stare at
that stunning dome for a while. Hildreth Meiere's paintings are all about the
four elements, the mysteries of transformation, the cycles of the zodiac, the
ever-turnings of the natural world ("Ages and Cycles of Nature In
Ceaseless Sequence Moving" sayeth the dome's central inscription). It's
all there, literally hovering over their data-driven little heads.
Anyway,
many good things were said by many wonderful people throughout the three days.
Prevention is the answer, love is they key. Allopathy must be balanced by the
many other healing arts. The needs of people/patients must once again become
the central focus of the healthcare endeavor. We need evidence, but we also
need to re-think/re-frame what constitutes evidence and recognize the
limitations of the RCT. And the evidence based standard needs to be applied to
allopathic practice as rigorously as it is to "CAM." A healthcare
reform bill will happen this year, and wellness/integrative med will be a part
of it (Hearken unto Harkin).
So
that was all good to hear.
On
the other hand, it was VERY hard to
stomach Reed Tuckson, EVP of
UnitedHealthGroup---one of the most
rapaciously greedy corporations in the
world, talkin' bout the need for a revolution.
But, hey, don't get mad.
He's just
keepin' it real, Nowamsayn?
On
the other hand, it was VERY hard to stomach Reed Tuckson, EVP of
UnitedHealthGroup---one of the most rapaciously greedy corporations in the
world, whose former CEO Bill McGuire was nailed in a Dept. of Justice
investigation for timing his $1.6 billion worth of options in his own
company---talkin' bout the need for a revolution. In one of the weirder
persona switches I've ever witnessed, Mr. Tuckson doffed the button-down
insurance exec demeanor he projected on Day One, and took on this "tellin'
it like it is," fight the powwa soul brotha attitude for Day Three. As he
called for revolution, he also said that we damn well better have our
evidence-based shit together if we think we're ever gonna convince Corporate
America to pay for integrative medicine. But, hey, don't get mad. He's just
keepin' it real, Nowamsayn?
Picking
up Tuckson's point and twisting it a few times was Tom Donohue, head of US
Chamber of Commerce, who told everyone something along the lines of, 'Ahh,
you're all just a bunch of petitionuhs! You just want the biznisses to suppawt
yaw practissses!" Gee, Mr. Donohue, you say that like it's a bad thing!
And what about all those corporate chieftains begging for taxpayer dollars to
keep themselves afloat? That's not petitioning?
Anyway,
those were among the livelier talks. Some of the other speakers were
unsurpassed in their talent for taking interesting subjects and turning 'em
into the most mind-numbing blather.
Until we speak plainly about
who's benefiting from the
status quo
(and someone
is clearly benefiting), we'll
never really get anywhere.
I
came away thinking that this was all very nice as far as it went, but that
wasn't nearly far enough. Until we really start talking about WHY the current
system behaves as it does, why it rewards who it rewards and excludes who it
excludes, until we speak plainly about who's benefiting from the status quo
(and someone is clearly benefiting), we'll never really get anywhere.
The
systems science guy in me is saying that before we go on a wild reform spree
('member as a kid, when someone would throw a big handful of baseball cards up
in the air on the playground, and everyone would kill each other trying to grab
'em? That's what Obama's promise of big dollars for health care is starting to
feel like.), we really ought to study the existing system carefully and dispassionately,
and understand its patterns and behaviors. As Deep Throat told Woodward &
Bernstein, "Follow the money." Not with the aim of laying blame (Ok,
maybe just a little blame-layin???), but with the goal of better understanding,
lest we make a screwed up situation even worse.
Throughout
the summit, a number of us tried to raise thorny issues (Insurance co's are in
the biz of money, not healthcare. Can't really get to good healthcare reform
w/o
But
by and large, it felt like
there was a lot of dancing to
entertain and amuse
the 800 lb gorilla. Which I
suppose is safer than provoking
him, though not
nearly
as interesting.
agri/energy/eco reform. Insurance coverage does not automatically equal HC
access. If everyone's so "evidence-based" how come so many unproven
allopathic things still get covered? Howcome there's all this talk about how to
change physicians' practices and how to make people more
responsible...er...make that "empowered," but no talk about how to
change insurance executive behavior?).
But
by and large, it felt like there was a lot of dancing to entertain and amuse
the 800 lb gorilla. Which I suppose is safer than provoking him, though not
nearly as interesting.
But,
you know me and my ever so slightly cynical view of things.
Comment: Somehow, one holds both of these perspectives: the evidence of greater inclusiveness (Hallelujah!) and, at the same time, a kind of disarray about next steps. The Bravewell, as Johnson notes, has plans for publication. The question is, will their focus go beyond marketing to actual organizing? Who else will step up?
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for inclusion in a future Integrator.