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.

Claire Johnson, DC, MSEd

1.  Claire Johnson, DC, MSEd: Evidence of inclusivity and great consciousness about health

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"

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.