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Coming of the Light: Integrator Top 10 from 2009 for Integrative Medicine/Integrated Health Care PDF Print E-mail
Written by John Weeks   

Coming of the Light: Integrator Top 10 from 2009 for Integrative Medicine/Integrated Health Care

SummaryOn or about the winter solstice, the Integrator announces a Top 10 from the previous year which will support the coming of the light for integrative practice in the New Year. Here is the 2009 Integrator Top 10 for integrative policy, practice, research and professional activity. Just 9 are listed. What are your suggestions for #10? Thanks to the individuals behind the good work. Happy reading, and reflecting, on the year that was as we look ahead.
Top 10 from 2006 - Top 10 from 2007 - Top 10 from 2008 

What are your reflections on the year that was?
What action do you think should be included here?

Send your ideas for the Top 10 to
for inclusion in a future Integrator.

ImageEach dark time of year since the electronic Integrator was first published, I have offered a reflection on events integrative from the previous calendar year in the form of a Top 10. The object of the exercise is to locate the light from the past year that will help illuminate the road ahead.
Not surprisingly, this year the Top 10 focuses  on policy. As in prior years, I ask you to help out with #10. What deserves recognition that is not here? What are the beacons?

Image1. Light amidst the quagmire of Congressional health reform

The consuming effort to reform U.S. healthcare recalls the legislative adage that you know that you have legislation that is ready for passage once everyone hates it. Yet the effort has been meaningful for the integrative practice world in many ways. Early months brought a venting and discussion of exciting new directions for health care delivery, including the image of a wellness society, that reflect the values in integrative care. While current proposals have regressed to a coverage-focused mean, a few handholds and footholds for new inclusion of integrative care and wellness appear on their way to creation. Meantime, the quagmire of U.S. medical and healthcare policy reminds us that we needn't take personally the shortcomings of our own efforts to move medicine toward a health creation paradigm. Congress' action and inaction provide an exceedingly gray and foggy backdrop against which to measure our progress.

IOM's summary report
2. Advancing Integrative Health Care via the Institute of Medicine Summit

The integrative healthcare reform drama within the broader reform drama was a February 25-27, 2009 production called the National Summit on Integrative Medicine and the Health of the Public. This event was followed 8 months later with IOM's publication of a Summary book on the gathering. The Summit was celebrated in the IOM book and as the largest and most diverse and inclusive of any meeting in the IOM's history. The 600 souls onsite made a piece of that history as it became clear that
"integrative health care" was believed to be a more fitting title for the movement than "integrative medicine." While the IOM published no specific recommendations, the summary text effectively advocates for much in this vision of a reformed health system as an aspirational future for US medicine.  

Considering how to spend $600-million
3.  Stakeholder input, including Congress', on NCCAM's next strategic plan

In mid-year, the NIH National Center for Complementary and Alternative Medicine engaged development of its 2011-2015 strategic plan. Like the IOM process, this is a drama inside the larger health reform drama. Themes of effectiveness, comparative effectiveness, medical costs and the role of research in reform are on the table. NCCAM leaders opened their process for stakeholder comment in October. Since then, a flurry of leading integrative healthcare professional and academic associations weighed in for more attention to pragmatic, real-world, effectiveness approaches. An Integrator analysis of the mandate from Congress suggests that an NCCAM more closely aligned with these recommendations would better comply with Congressional intent than past NCCAM priorities. Happily, NCCAM shows signs of responsiveness to the national trends and to its stakeholders, including the direction Congress originally set. NCCAM promises additional loops of stakeholder input in the year ahead. Stay tuned. And stay involved. At stake, for stakeholders, is the fate of some $600-million in government investment.   

MAMA campaign promotes homebirth and Certified Professional Midwives (CPMs)
4. The MAMA Campaign for access to homebirth midwifery

One shocking surprise in the integrative care dialogue is how little
birth practices are considered or examined. This year the MAMA Campaign hit the scene for the first time nationally to inject natural child birth, at home, into the reform debate. This coalition of organizations supporting Certified Professional Midwives (CPM) went to Washington, DC to gain inclusion of CPMs as providers and homebirths as services. The MAMA Campaign hired a lobbyist, sponsored a fly-in lobby day, worked with staff of Congressman Henry Waxman (D-CA) to deliver a cost-analysis to the Congressional Budget Office based on Washington State Medicaid data, held a high-level meeting with top Medicaid and Medicare officials and raised over $140,000 for lobbying to make it happen. MAMA achieved a partial victory when Senator Maria Cantwell (D-WA) inserted a provision in the Senate bill that will, if passed, require Medicaid to pay provider fees to CPMs attending births in birth centers. Not all that MAMA wants, but an exceptional start for a profession with only 1500 certified practitioners and regulation in just 26 states making its first appearance on the national scene.

SIO: promoting the value of whole systems and inter-disciplinary practice
5. Society for Integrative Oncology examines inter-disciplinary and whole system treatment

The 6th conference of the Society for Integrative Oncology (SIO) held in New York in November was entitled "Revitalizing Cancer Care: Comprehensive Interdisciplinary Programs and Whole Systems Research." This was the first major meeting in the integrative practice field to focus on these central themes. (The treatment of what chronic condition could not benefit from a similar exploration?) Over 300 attendees examined
acupuncture and Oriental medicine, Ayurveda, homeopathy, naturopathy and other systems, evaluating particularly the potential contributions of each for treating cancer patients. SIO's speakers sought to identify gaps in research in each system relative to cancer care. Content also focused on practical strategies for integrating whole systems care into oncology settings. From its founding, the SIO has demonstrated a commitment to interdisciplinary practices, with a board that includes MD, ND, PhD, LAc, RN and other titles. It is no wonder that SIO would take this lead in examining how best to use each other in a whole system of treatment for patients. SIO would seem to be perched for additional advances during the term of its incoming president, author and integrative medicine leader Donald Abrams, MD.

The god-father of CER is cost
6. Obama's stimulus to comparative effectiveness research (CER)

One valuable teaching from the endless healthcare punditry of 2009 is that virtually everyone knows that, compared to other nations, the cost of the US medical system is awful and the outcomes horrendous, given the costs. Yet as the evidence of this mess has grown over the last 30 years, the U.S. research establishment has basically shrugged and said: Not my problem. We're focused on other, more important things. Happily, the Obama stimulus plan elevated
a movement toward comparative effectiveness research (CER) which will help reset our research course via an exceedingly stimulating $1-billion of grant awards. The ascending CER movement would appear to be particularly favorable toward integrative practice fields. After all, the main claims to value from these practitioners have been that, compared to conventional treatment, inclusion of their services will make care more effective and cost effective. Notably, the director of NIH NCCAM co-chairs a trans-NIH committee on CER and a new institute in integrative health led by NCCAM's most-funded researcher (see #8) devoted its first significant symposium to the topic.

IFM: Taking a leap into the spotlight with a fine white paper
7. The Institute for Functional Medicine and its white paper 21st Century Medicine

Many advocates perched in one or another of the branches of the integrative healthcare tree readily make claims for how much better the world will be if consumers had more of what they've got. Yet rarely has a case been so thoughtfully built by an interest group as that for functional medicine in 21st Century Medicine: A New Model for Education and Practice.
This white paper from the Institute for Functional Medicine (IFM), developed by David Jones, MD, Laurie Hoffman, MPH, and Sheila Quinn, provides excellent short synopses of other, progressive models for re-shaping clinical medicine. The authors then explore the overlap and alignment of functional medicine with these clinical reform efforts. They artfully argue that functional medicine is not only of similar stuff as these more conventionally-accepted emerging models, but the functional medicine approach also includes some beneficial extras. The IOM book (#2 above) and this white paper are exceptional primers for grounding students and newcomers in the broader context of emerging models of integrative care.

IIH: Off to a good start in changing the healthcare conversation
8. The founding of the Institute for Integrative Health

The Institute for Integrative Health stepped into the integrative practice landscape this year
with quite an agenda. According to its website the Institute would, among other things, "challenge conventional thinking on health and healthcare, reframing the conversation, nurturing creative solutions, and exploring cutting-edge ideas." Daunting ambition. Yet the prior accomplishments of the Institute's founding team of Brian Berman, MD, Aviad (Adi) Haramati, PhD, Margaret Chesney, PhD and Susan Hartnoll Berman make one sit up and pay attention. The Institute's first significant event did not disappoint. IIH convened top federal policy and integrative health leaders to explore comparative effectiveness research and its relationship to integrative practice. The organization's website and related SpeakHealth.org blogging and tweeting further open opportunities for influence. Here's hoping IIH continues to find funding amidst what the founders call "a unique opportunity at this point in time to improve our healthcare system through an integrative approach that values mind, body, and spirit and blends complementary and conventional medicine."

Image9.  NARCCIM draws 810 to Minneapolis

In May, 810 professionals from 24 countries gathered in Minneapolis for the second North American Research Conference on Complementary and Integrative Medicine (NARCCIM). The first was Edmonton in 2006; that conference made the 2006 Top 10. The 2009 NARCCIM was as multidisciplinary as it was multinational. Under the steady hand of Adi Haramati, PhD, the
overall organizer and founding vice-chair of the sponsoring organization, the Consortium of Academic Health Centers for Integrative Medicine, NARCCIM was an even more outrageous demonstration of the plenitude of research flowing from these allied fields. The only complaint was how little of the bounty one attendee could directly experience. These conferences are on a 3-year cycle. The next is scheduled for May 15-18, 2012 at the Portland Marriott Downtown Waterfront. Be there!

10.   And What Is It That You Would Add?

My Top 10 turns around the inter-related fields of policy and research. I have certainly left much out. Send me a note with your thoughts! A future Integrator will include your ideas about top action from 2009 as we move forward.


CodaIntegrator Sponsors

I have additional action for which I am particularly thankful. The Integrator relies on the generosity and commitment of a few dedicated executive teams and businesses with which they are associated. These were the Integrator sponsors in 2009.

Thank you Sponsors and thank you all! Enjoy your holidays.

Send your ideas for the Top 10 to
for inclusion in a future Integrator.

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