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Readers Respond: First Professional Doctorate, IOM Report, New Nominations for the 2009 Top 10, Plus PDF Print E-mail
Written by John Weeks   

Readers Respond: First Professional Doctorate, IOM Report, New Nominations for the Top 10 in 2009, Plus

Summary: Frank Ervolino, ND, LAc reviews issues on the "first professional doctorate" for the acupuncture and Oriental medicine field ...  Lou Sportelli, DC on how NCCAM needs to research the way practitioners operate ...  Roger Jahnke, OMD's shares his letter to US Senator Barbara Boxer promoting wellness and integrative practice ... Glenn Sabin of FON Therapeutics comments on whole systems research in the IOM's report on the National Summit on Integrative Medicine and the Health of the Public ... Late nominations for Top 10 People from 2009: Harry Pruess, MD nominates Gretchen LeBeau; Emily Kane, ND, LAc nominates the head of the Coalition for Patients Rights; and the head of the Wapello, Iowa, County Medical Society indirectly nominates chiropractor Charles Coram, DC ... 
Send you comments to
for inclusion in a future Integrator.


Image
Frank Ervolino, ND, LAc
1. Frank Ervolino, ND, LAc: Academics and practicing acupuncturists not aligned on "first professional doctorate"


Frank Ervolino, ND, LAc has a unique position relative to the first professional doctorate(FPD) issue that has divided the acupuncture and Oriental medicine(AOM) community. Ervolino was a member of the 2005 task force on the FPD in his capacity as a member of the Federation of Acupuncture and Oriental Medicine Regulatory Agencies, and specifically, as a member of the Florida State Board of Acupuncture. Ervolino has come to oppose the FPD "at this time." His perspective is useful as a summary, if from an individual presently opposed. Along with his clinical practice at Jupiter Medical Center, Ervolino is on the faculty at Palm Beach State College and is involved with producing continuing education course work.
Ervolino sent me this in late January 2010. 
"This my latest on the FPD:

"Recent discussions on the First Professional Doctorate (FPD) for acupuncture produced a wealth of commentary in a google group established for this purpose. Contributors were varied and included the director of ACAOM and former professional association AAAOM leaders as well as former FPD task force members. Discussion in the various threads was in essence a snapshot of the state of acupuncture as a profession today.

   
"[In discussions there was] a view
shared by many that during these
rough economic times we should
be concentrating on the health of
our constituents already in practice."
 

 
"There is no widespread consensus in the acupuncture community in favor of the FPD. This is because there is a general feeling that the educational arm of acupuncture has made it's goals a priority over ideas that would be in the best interest of the acupuncture community as a whole. There was a view shared by many that during these rough economic times we should be concentrating on the health of our constituents already in practice and that the FPD is a direction that will take at least 10 years to implement on an educational and state legislative level.

"There was also concern that the move to an entry level doctorate would also run into opposition from other professional organizations and state legislators. The Little Hoover Commission and the state of California was mentioned as a precedent.

"There was not so much open opposition to the FPD as there was a frustration with the lack of planning ahead for actual execution of the program. It seemed that the planning went no further than implementation on a school level. No one wanted to talk about state legislation or resistance to establishing acupuncturists as doctoral level graduates. It seemed that those in favor were for field-testing the degree. There was discussion about what this degree would mean for all the existing practitioners out there with lower degrees than the FPD. It was pointed out that the various organizations participating in the FPD all derive their operating budgets from money gathered directly or indirectly from the existing practitioners and there was already widespread dissatisfaction with the professional organization, the board certification organization and the schools support of the existing practitioners.

"It was pointed out that there has been no efforts by these organizational groups to bring public
   
  "It was pointed out that there
has been no efforts by these
organizational groups to bring
public awareness to the already
high quality of skill and education
already attained by present
practitioners."


awareness to the already high quality of skill and education already attained by present practitioners. A licensed masters level acupuncturist has a 4 year degree specializing in acupuncture whereas other professions offer 400-800 hour pathways to entry into acupuncture. If they cannot market this degree in a manner similar to the way competing professional organizations market their constituents to the public, why back a degree that would further hamper an existing practitioners ability to be a viable business entity? The response to this concept was disappointing.

"There was a call from some to concentrate on ways to improve the awareness of the high quality product that comes from the twenty thousand practitioners already out there. Marketing our existing practitioners to make them stronger would be a more prudent direction to go in at this moment. The fact that the leadership of acupuncture professional organizations seems to respond to crisis within the profession with educational solutions was brought up. This seemed to be met with frustration by those who were in favor of the FPD. There was more frustration with the unanticipated negative response  to the FPD than there was acknowledgement that the dissenters were willing to address the larger problem of low average income and poor levels of product recognition by the public for acupuncture.

   
"All in all there was a general
frustration with professional
organizations in acupuncture
offering the same old 'more
education' response to the
professions problems."

 
"One young but growing organization called the Community Acupuncture Network got involved heavily in the discussion. This group emphasizes basic business skills for acupuncturists and they advocate a higher volume/lower cost acupuncture model. Their rationale is that most acupuncture fee schedules are not affordable to most of the population in the U.S. This model more closely relates to the way acupuncture is practiced in China. In the discussion group it was apparent that the CAN people were widely misunderstood and viewed as rogues. They handled themselves well and much of the criticism leveled at statements made by members seemed to result from CAN being a more transparent organization were members can participate in open discussion more easily that can members of the professional organization for acupuncture.

"In the end this discussion revealed that several prominent acupuncturists were not in favor of the FPD, several members of the discussion seemed more interested in gaining levels of respect and participation in the conventional medical establishment, and there was a call towards a three tiered degree structure in acupuncture. This would consist of an entry level degree that would cost less and be a quicker entry into the field. Graduates from this degree program would have less debt and be schooled more in basic business skills. The next degree level would be the FPD and this would be geared more towards those who want to be involved with the conventional medical community. The last degree level was the DAOM [Doctor of Acupuncture and Oriental Medicine] which would be a true post-graduate doctorate and those interested in attaining a high level of specialization could pursue this degree.


"The entry level degree proved interesting in that one proponent pointed out that those who graduated from this level would have less debt, more money to use for practice establishment, a business model already field tested in the CAN model and an ability to garner a larger share of the populace as clients. This could in turn add more money to the professional organizations coffers which could be used for lobbying which in this political climate seems to be the way to go for the next decade as a true path to gain ground as a profession.


"All in all there was a general frustration with professional organizations in acupuncture offering the same old 'more education' response to the professions problems.
"

Frank Ervolino

Jupiter, Florida
Comment: The latest from the Accreditation Commission for Acupuncture and Oriental Medicine, following a February 2010 meeting and Ervolino's note, is that the accrediting body is planning to go ahead with the FPD. Those who care about this profession are rightfully concerned about the internal strife that may yet be ahead. Ervolino's commentary lays out the dividing lines very well.


Image
Lou Sportelli, DC
2. Lou Sportelli, DC on NCCAM's direction: A way Briggs' can be "truly transformative"  


Lou Sportelli, DC, president of NCMIC Group, an Integrator sponsor, and I recently spoke about some of the Integrator work relative to the 2011-2015 strategic plan of the NIH National Center for Complementary and Alternative Medicine. The conversation was provoked by a statement of NCCAM director Josephine Briggs, MD on back pain. He wrote back this, which I cleared for publication here:
"I was thinking after our conversation the other day.  We talked about Josephine Briggs, MD and her view of NCCAM. My comments back to you relative to her discussion on back pain (and the guidelines to which she alludes that include spinal manipulation, are accurate but remember they only go so far.

   
"If Briggs keeps this (real world) focus,
who knows there might be health care
reform occurring in spite of Congress
."

 
"Chiropractic, naturopathy and some of the other CAM professions need to be aware of critical issues which could come back to bite all the professions. What seems to always be missed (by researchers) for these professions is that the DC and ND physicians treat the patient. They do not just manipulate the back or prescribe herbs or nutrition.

"These guidelines and nearly ALL research studies study single modality approaches. Sorry, practice never works like that. One cannot separate the spine from the patient, nor the doctor from the treatment provided. Healing or helping a patient to heal is a process and an interaction – not a single intervention.

"As long as the allopathic profession persists in this erroneous approach to a question, and researchers do not recognize that this is not the approach that can provide the best patient outcomes, we will never get legitimate or complete answers. The only researcher who did it differently was Meade (despite some criticism of his approach) and there the answers were clear – including chronic back pain and long term improvement.  (In this case) the researchers did not care so much about what was done, but rather the entire approach and then the outcomes and satisfaction were measured. 

"
Dr. Briggs seems to be looking at all of these issues and not simply discarding them because the 'establishment' does not agree. If she keeps this focus, who knows there might be health care reform occurring in spite of Congress. We need to see if Dr. Briggs can come around to this way of thinking with NCCAM. That will be truly transformative."
Comment: Virtually all of the professional organizations representing the integrative practice fields are aligned with Sportelli. Yes, it is a challenge for researchers to get out of their single agent comfort zones. It's time to pry them out so that we can finally learn a good deal about these practices.


Image
Roger Jahnke, OMD
3. Health Action's Roger Jahnke, OMD shares letter to US Senator Barbara Boxer: "Wellness can save $2 Trillion/yr
..."

Author and integrative health consultant Roger Jahnke, OMD, founder of Health Action, responded to the recent Integrator Alert on supporting "integrative practice" by sending a letter to US Senator Barbara Boxer. Jahnke combined his own message with the sample letter (italics) provided in the Integrator article. It is included here to provoke a few more of you to respond!
"Dear Senator Boxer,
 
'Over 70% of disease and medical office visits are preventable. We waste nearly $3 trillion annually treating preventable diseases.

"To create meaningful change in U.S. healthcare, pay attention to  health promoting, the savings are immense.  Prevention happens at home and at school. The cost is minimal! This could ultimately save nearly $2 trillion annually — its a bailout.

"In addition, I urge you to protect and advance the presence of licensed integrative practitioners, integrative practices and prevention based initiatives in any upcoming health legislation.

"When citizens are informed and inspired about wellness they naturally desire treatment options from the practitioners of more natural healing methods - acupuncture, naturopathy, etc. The foundation of Integrative Medicine is wellness and low cost natural treatments.

"In the reform efforts of the last year, these licensed integrative practitioners and approaches gained inclusion in multiple sections of pending health reform.


"Brilliant, forward thinking members of Congress included licensed complementary and alternative practitioners and integrative practitioners in workforce planning. A representative from this practice community is required on the Board of the institute for comparative effectiveness research. Community health care teams and medical homes must include integrative practitioners under these drafts.

"In addition, a measure included in drafts which requires non-discrimination among licensed provider types by health plans is critical to allowing these new care teams, approaches and practitioners to function optimally in promoting health in the individuals they treat.


"I also urge you to support the creation of the National Prevention, Health Promotion and Public Health Council. This Council's goals are aligned with the health promoting approaches that attract patients to these integrative practitioners and practices.


'These measures will each assist us in moving toward effective disease care and wellness approaches that will get us out of the cost spiral. Please support the inclusion of integrative practitioners and practices in healthcare legislation which reaches your desk."


Sincerely,

Dr Roger Jahnke, OMD
Health Action
Santa Barbara, CA
Comment: Linking "integrative practice" with wellness and with prevention is always good placement. Sending letters to your member of Congress and US Senators takes all of 10 minutes. I did it. The sample letter and links to addresses are here.
 


4.  Glenn Sabin of FON Therapeutics on the support of whole systems research in the IOM Report

Glenn Sabin of FON Therapeutics wrote in response to the Integrator article on the IOM book on the National Summit on Integrative Medicine and the Health of the Public. Sabin write a blog here via his site.
"Good post re the Integrative Healthcare Summit. The following is the single passage [from the book] that resonated with me the most:
'Integrative health care is derived from lessons integrated across scientific disciplines, and it requires scientific processes that cross domains. The most important influences on health, for individuals and society, are not the factors at play within any single domain - genetics, behavior, social or economic circumstances, physical environment, health care - but the dynamics and synergies across domains.  Research tends to examine these influences in isolation, which can distort interpretation of the results and hinder application of results.  The most value will come from broader, systems-level approaches and redesign of research strategies and methodologies.' 
"Whole systems research was the theme of this year's Society for Integrative Oncology conference, but the truth is, Dean Ornish is the only one who has executed anything close to a whole system study (for prostate cancer and heart disease), and for obvious reasons commercial interest to support this area is quite limited, if non-existent.

"Whoever is successful in getting the first five dollars of support from our federal government in support of whole systems research will help pave the way for a new paradigm in scientific research exploration.  I believe that there are ways to design these studies to also address the review boards' needs for a solid reductionism component that will enable such designs to pass the IRBs at any major institution, including NIH, and this is where I am focusing my energies." 

Glenn Sabin
FON Therapeutics Inc.
Silver Spring, MD 20905 USA
Comment:  In fact, there has been over $5 committed by NCCAM for whole systems research, but not much. And there are others besides Ornish, though not so many. One reason is that the lack of funding for this non-traditional research has meant that few have invested in developing whole systems research skills. NCCAM needs to jump start this initiative by making a planned, multi-year commitment. If it needs a reason, it might listen to how much its leading stakeholders are outspoken in favor of this type of research. What is required to respect this level of interest is methodology summits, researcher training, reviewer training, a series of special program announcements and selection of experts in whole systems onto the advisory council.
.

_______________________

More Top 10 People in 2009 Nominees

On December 28, 2009, the Integrator posted a Top 10 People for 2009. That list included a call for readers to nominate individuals not on the list. A first set was published on January 13, 2010. These nominations came in subsequently.

Image
Gretchen Dubeau
5.  Harry Pruess, MD: nominates Gretchen Dubeau of the Alliance for Natural Health


Harry Preuss, MD, a past member of the board of the American Association for Health Freedom, the predecessor organization to the Alliance for Natural Health, and a Georgetown University
"I would like to nominate Gretchen DuBeau for the 10th position in your Top 10 People from 2009 in Integrative Health Care and Integrative Medicine. Gretchen DuBeau joined the Alliance for Natural Health-USA (formerly the American Association for Health Freedom) as Executive Director in 2008. Under Gretchen's direction, the Alliance for Natural Health has gone from strength to strength and has become a unifying force in within the integrative medical community.  Gretchen works collaboratively and has brought together key industry leaders to create meaningful change for integrative medicine. Key achievements include:
  • Modifying the senate healthcare bill to ensure that the Comparative Effectiveness Research (CER) program includes integrative medicine practitioners on the board and advisory panel. This marks the first inclusion of integrative medicine in any federal program and will provide integrative medicine a voice in determining important areas of research, such as the role of dietary supplements in prevention and treatment
  • Mobilizing our Grass Root Activists to send over 300,000 emails to public legislatures on important integrative health issues
  • Filing three lawsuits against the FDA in support of the natural products industry and their right to speak freely to consumers about the science behind their products
  • Collecting over 50,000 signatures on our Reform the FDA petition
  • Working to introduce the Free Speech about Science Act in the House of Representatives that will permit industry to cite peer-reviewed scientific research in support of product health benefits
  • Working in partnership with Praktikos Institute to create www.naturalhealthsciencenews.org, which aggregates natural-health science news and reports daily.
"A lifelong environmentalist and devotee to natural health and healing, Gretchen has found the perfect culmination of her interests in the Alliance for Natural Health International where she directs US policy.  She is an attorney and practiced environmental law and policy for five years before joining ANH to work on natural and sustainable health issues."

Harry G. Preuss MD, MACN, CNS
Professor of Physiology, Medicine, & Pathology
Georgetown University Medical Center
6.  Emily Kane, ND nominates Maureen Shekleton for the Coalition for Patients Rights

Emily Kane, ND, LAc, a practitioner in Juneau, Alaska and Hawaii, wrote a simple note, referencing my comment that the Integrator Top 10 People was dominated by women: "Hi John. Another woman:  Maureen Shekleton, PhD, RN, FAAN, director of Coalition for Patient Rights (CPR)" (CPR). CPR was formed to oppose the AMA's Scope of Practice Partnership, an effort to limit other professions. Kane referenced a letter, signed by Shekleton and sent to President Obama on behalf of CPR. In the letter, Shekleton argues for full inclusion in healthcare reform for the non-MD practitioners represented by the CPR's 35 organizational members.
Comment: CPR made a past Top 10 list in 2006. This letter to Obama, covered in this Integrator article, was an unusual act of coalition this year since it moved to the federal level from state action that is the focus of scope of practice expansion.

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Charles Coram, DC
7.  "Dr. Charles Coram, Physician, posted by his friend and patient, Dr. Marc Hines"
The following nomination came in under that heading. The nomination is for a chiropractor, Charles Coram, DC, by a medical doctor Marc Hines, MD, the head of the local Wapello County, Iowa medical society. The message was forwarded by Coram's office. The language is apparently from a prior honoring of Coram.
"Dr. Coram has so altered the conversations in our community hospital that they have moved from a rigid pharmacological/surgical paradigms toward teams of therapists, community activists, patients, employers, employees, physicians, chiropractors, acupuncturists, massage therapists, religious leaders, nutritionists, and many others banding together.

"He is similar to many truly effective leaders, organizing and guiding but often letting others assume the credit. When conversations were initiated it was always Dr. Coram behind the introduction of change. He was driven. He would not put
the topic down. He had serious resistance. He had patients and his own convictions as his allies. He had all of the arrayed rigidity of a small Midwestern conservative community, hidebound by tradition, enveloped by its distance from the centers of change and with the certainty of a righteous indignation of the truth of its position, allayed against him. He continued anyway. I think it was his patients' needs and the angles of his better nature. He has a lot of angles and a lot of better nature, and you guessed it, it is hard to get in to see him.

"What does our community want most for Charles Coram? Cloning, Seriously. I have discussed this often with him, we need to train young doctors. Dr. Coram begins with the dysfunctions of spirit, of hope, of dignity of knowledge of what personhood could mean in the patients he sees. He does this gently as he massages and stretches and repositions a few facets. In an hour spent talking to a patient while really caring for their needs he learns their needs, their worries and fears. He was a nurse before being a chiropractor before being an integrative medicine physician. When he continues to care for and about his patients he leads them to new insights of their potential. How much more likely are we to listen when we are relaxed? How about when we feel we have been able to express ourselves in the important worries of health, family and what motivates us? I have found Dr. Coram's patients returning to me stating what could be called unintended testimonies. They express new-found strengths physically and emotionally. I wish I could send every patient to him (he is just too busy). So many actually begin to follow the advice received. This is a change in listening.

"This is real change. I, as a physician, listen better and more completely.

"What scuttles our barely floating lives when we feel we are paddling as hard as we can? Often it is a lack of faith that there is another way; it begins with renewed belief in our power to change. Breaking dependence may be the very most disabling agenda in a life. Dependencies can be toward others, habits, harmful realms of thought. It seems Charles incorporates example, sincerity and his message of people realizing purpose they must find. Some patients seem to have epiphanies. Some patients are not ready for these messages, but they still receive benefit.

"Let me give my final and greatest accolade (surely you think I have said it all). When Christ returns to the Passover feast he washes the disciples feet. He shows us by example one last time what he seems to expect of mere human beings like Charles, like myself. I have the great comfort of having Charles Coram as my Dr. and friend. My wish for you, and for everyone, is that we can train more young people to be like this man. I sincerely wish a great gift for you: may you have a Charles Coram in your life."

Sincerely,

Marc E. Hines MD, President

Wapello County Medical Society
CommentThis note was sent by Brenda Coram, Dr. Coram's spouse.

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