Impact of Integrator, White, Emily Kane, ND, LAc on Dialogue over $1-1 Billion Comparative Effectiveness Research

Summary: Integrator writer Daphne White, CHTP, wrote two April 2009 features on Obama's $1.1 billion comparative effectiveness research (CER) initiative which Obama's budget director Peter Orszag believes is a key to reforming our medical system. White's insightful piece spoke of the "Kabuki Play" in the first "listening session" on the initiative. This article details the impact of White's work as both journalist and an advocate for the integrative practice community playing a role in this dialogue. Noted here are links to the inclusion of White's testimony in a government report of the meeting, a letter to the Coordinating Council from Integrator reader Emily Kane, ND, LAc, and the linking to White's articles by Stanford Wellsphere, the Association of Clinical Research Organizations and others.

Writer-practitioner Daphne White, CHTP

When the Federal Coordinating Council for Comparative Effectiveness Research was named in mid-March to oversee Obama's $1.1-billion comparative effectiveness research (CER) initiative, the Council quickly made plans to gain input from medicine's stakeholders. The task is huge: Obama's budget director Peter Orszag believes CER is a key to reform of an industry in which up to 50% could be waste, and much of that harmful.

Integrator writer Daphne White attended the first "listening session" in which panels of stakeholders spoke. As she reported in

CRO features White's article

The Association of Clinical Research Organizations

"If CER is viewed as an attempt by payers to control costs, "doctors, patients and the public at large are likely to resist the concept." "Every player in the current system understands the potential harm that could come from comparative effectiveness research," says Daphne White on the Integrator Blog. Quoting Julie Rovner from National Public Radio, she contends that the real battle "in health reform [is] not rationing . [it's] redistribution. Every time you take one of those dollars and give it to someone else, the donor is going to yelp and hire a lobbyist." Her description of the "listening session" conducted by the Federal Coordinating Council for Effectiveness Research on April 14th underscores the complex mix of politics, science and money at the heart of the CER debate."

The Integrator article continues to be linked on their back issues site.

White piece was also picked up by Stanford Wellsphere, a health and wellness site created from the community of individuals at Stanford University. Health World Online's Healthy.Net newsletter also included White's work in successive editions of their newsletter which goes out to 120,000 individuals. 

Direct testimony make the record: White and Integrator reader Emily Kane, ND, LAc

Readers may recall that part of White's interest in attending the listening session was to see whether anyone from the integrative practice community would show up. Finding no one did, White took off her reporter's cap and offered quickly drafted testimony during an open comment section. The gist of White comments were included in the Coordinating Council's report of the meeting:

"The Council should consider complementary and alternative medicine (CAM). Some CAM interventions can have a positive effect that is approximately equal to conventional medicine. However, more research is needed to know what kind of modalities work best for what kinds of conditions."

April 30, 2009

Dear Sirs and Madams,

I am a Naturopathic Physician, trained at Harvard and Bastyr Universities, and have been in clinical practice as a wellness-oriented primary health care provider for over 15 years.  I understand you are accepting input for developing a system to study the clinical effectiveness of a wide array of modalities both established and relatively obscure (at least to the eye of a strictly conventionally trained doctor). 

Emily Kane, ND, LAc

Established therapies are largely assumed, often erroneously, to be effective, such as arthroscopic knee surgeries for meniscus tears, or proton-pump inhibitors for heartburn.  Relatively less known therapies, such as Rolfing, or Therapeutic Touch, or Naturopathic Medicine, all of which require varying degrees of training and licensure maintenance, may be quite effective.  In general, the low-tech, low-risk, high-touch approach of CAM modalities pose significantly less risk of pesky to lethal side effects than "conventional" therapies.  Besides being safer, CAM modalities may also be very effective, at a fraction of the cost.

Why is that?  Because many CAM modalities address the patient as a whole person.  Most CAM practitioners are "generalists", not specialists, and do not view the patient's illness as separate from the entirety of the patient's physical, mental and social reality.  As a Naturopathic Physician, my aim is to educate my patients to take care of their own health.  I typically spend 60 to 90 minutes at a patient visit (for the same price my MD colleague would offer a 7-12 minute visit) and so I have time to perform a thorough physical exam, organize appropriate labs/radiology if necessary, and comprehensively investigate the dietary and hygiene habits of my patient.  Often my MD colleagues are trapped by the clock:  frequently, all they have time for in a patient encounter is offer a pharmaceutical prescription.

As an example, a Rolfer might help adjust the imbalance in tension between muscles at the front (quadriceps) and back (hamstrings) of the leg which attach to the knee, thus relieving pressure on the meniscus and allowing innate healing.  This is likely to be as effective as arthroscopic surgery, from my clinical experience, without the risk and expense of surgery.

	I applaud the concept of investigating the effectiveness of therapies because there is clearly a great deal of waste in the way "health care" is delivered today.  I urge your committee to look beyond the AMA and the pharmaceutical and insurance lobbyists when determining the foci of your investigation.  - Emily Kane, ND, LAc

In another example, a Naturopathic Physician would address "heartburn" not as a problem of excess stomach acid but as inappropriate pressure against the lower esophageal sphincter and delayed stomach emptying.  Stomach acid is critical to optimal digestion, not to speak of sterilizing our food.  It is, in many senses, the primary defense against ingested potential pathogens penetrating more deeply into the body.  The Naturopathic Physician (see www.naturopathic.org for access to our 4 plus year post graduate training and licensure requirements) would evaluate and educate the patient on potentially offending foods, would treat the likely hiatal hernia causing the reflux with simple manual therapy which the patient can learn to self-administer, and offer a short-course of natural therapeutics, such as aloe juice, to cure the patient of this ailment.  Long term dependency on anti-acids does not address the underlying cause of the ailment, and, more importantly, puts the patient at risk for nutritional deficiencies over the long term -- because hydrochloric acid is critical for optimal protein digestion.  Food is not assimilated optimally unless it is thoroughly digested first.

According to some accounts, over 70% of North Americans have used CAM therapies in the past decade.  The CAM industry continues to grow: something must be working.  Today's consumers are less enchanted with drugs and surgery as the only options in our so-called health care system.  Because it is increasingly evident that the current system is actually a disease management system. 

Imagine prioritizing our citizens' wellness as a national goal, with the weight of the federal budget behind this concept! 

I applaud the concept of investigating the effectiveness of therapies because there is clearly a great deal of waste in the way "health care" is delivered today.  I urge your committee to look beyond the AMA and the pharmaceutical and insurance lobbyists when determining the foci of your investigation.  Thank you for your important work.

Sincerely,

Dr. Emily A. Kane
www.DrEmilyKane.co

"Thank you for speaking up for CAM modalities and need for research.  It would be interesting to open the minds of people to see how much $$ they can save by using side effects free healing CAM modalities.  We do not need to push drugs in healthy people's body.  CAM modalities are great for prevention and management for chronic diseases."