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Integrative Medicine and Integrated Health Care Round-up: April 2010 PDF Print E-mail
Written by John Weeks   
Friday, 02 April 2010

Integrative Medicine and Integrated Health Care Round-up: April 2010

Summary: What integrative practice associations are saying about healthcare overhaul ... CMS/Medicare nominee Berwick and his principles for integrative medicine ... Patient outcomes from Penny George Institute inpatient integrative care ... Ground-breaking Healthpoint expands integrative model in community health; Breed comments ... NCH's Gahles reports on meeting of top homeopathic researchers with NCCAM team ... Anti-NCCAM bloggers take invite from NCCAM's Briggs ... Outcomes of Medicare chiropractic demonstration project confusing, under examination by ACA ... Ford pilot shows lowered use of drugs by acupuncture and mind-body group ... Merrell and integrative medicine featured as cost-saving in NYT ... Update on action at Wake Forest integrative medicine ... First inpatient acupuncture fellowship at New York's Beth Israel ... Maizes clip highlights decade plus of changes at Arizona Center for Integrative Medicine ... Western States Chiropractic College becomes University of Western States ... Tri-State Acupuncture College publishes white paper on inter-professional education ... Ornish challenges thinking in New York Times piece ... Bravewell leaders in Vanity Fair ... Acupuncture positively portrayed in Wall Street Journal ... Robust SPARC/OCIM gatherings in Portland, Oregon ... Massage Therapy Foundation receives $30,000 NCCAM conference grant ... Educators Schwartz and Lowe team for online education business ... Caldwell heads AHMA ... O'Connell to exec post with ACA ... Naturopathic doctor Cronin in the cover of Phoenix Magazine "Best Doctors" issue ... Marchiori selected as new Palmer chancellor ... Huggins elected to AHPA presidency, plus more ...    
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Policy

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Health reform impacts on integrative practice fields
Integrative practice stakeholders on perceived gains, losses from the healthcare overhaul


Later this month, the Integrator will publish a Special Report on the Obama-backed and Pelosi-driven healthcare overhaul legislation and its impacts on integrative practices. Meantime, here are some links to what integrative practice stakeholders are saying:


Comment:
Whatever one thinks about the legislation that passed, there is no question that all of the licensed integrative practice disciplines are more specifically in the game than they have ever been in the past. If these professions connect the dots between the various levels of inclusion in workforce planning, comparative effectiveness research, wellness and health promotion, medical homes, community health teams and the critical non-discrimination clause, a constellation clearly emerges of a new presence for integrative practice in federal US healthcare policy. More soon.

integrative medicine, CMS, principles, IOM
Berwick: Up for CMS post
Berwick, speaker at IOM Summit on Integrative Medicine, to be asked by Obama to direct CMS

A March 27, 2010 article in the New York Times indicates that Barack Obama plans to appoint Donald Berwick, MD, MPP, FRCP, as director of the Centers for Medicare and Medicaid Services. Berwick is the founder and director of the influential Harvard-based Institute for Health Improvement, through which he led the 100,000 Lives Campaign to clean up medical errors in US hospitals. Berwick considers himself an "extremist" advocate for patient-centered care, partly based on his own troubling experience with the system as a patient. Some have challenged Berwick for the CMS position based on his lack of experience in running a large agency. Others highly laud Obama for his choice. Berwick was among the presenters at the February 25-27, 2009 Institute of Medicine (IOM) National Summit on Integrative Medicine and the Health of the Public.
Comment: This potential appointment is extraordinarily on target. Anyone who supports patient-centered care and integrative practices would be smart to do all they can to make sure the appointment is not held up. Consider, merely from the integrative practice community, that he not only showed up for the IOM Summit, he also made a significant, thoughtful contribution. Here are the "Principles for Integrative Medicine" Berwick offered attendees.

Berwick's Principles for Integrative Medicine
  1. Place the patient at the center.
  2. Individualize care.
  3. Welcome family and loved ones.
  4. Maximize healing influences within care.
  5. Maximize healing influences outside of care.
  6. Rely on sophisticated, disciplined evidence.
  7. Use all relevant capacities - waste nothing.
  8. Connect helping influences with each other.
Berwick is quoted in the report on the IOM meeting as concluding this way: "The sources of suffering are in separateness and the remedy is in remembering that we are all in this together. Integration, if it is to thrive, is the name of a duty to contribute what we can to a troubled and suffering planet." This is wisdom, a rare treat in a leader of a huge bureaucracy. The United States will be lucky to have him in this critical moment.

Integrative Services

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Integrative care inpatient programs produce positive outcomes
George Institute/Allina Hospital publishes outcomes on patients who receive integrative, inpatient care

A study conducted by Jeffrey Dusek, PhD, and including a top-notch team of Michael Finch, PhD, Gregory Plotnikoff, MD and Lori Knutson, RN, BS-HN examined the results of integrative inpatient care on 1837 patients. Of these, 66% had never before used integrative services they received. The researchers are all part of the inpatient care team of the Penny George Institute for Health and Healing that is part of Allina Hospitals and Clinics. Results were published in the Journal of Patient Safety as "The Impact of Integrative Medicine on Pain Management in a Tertiary Care Hospital." Here is the conclusion:
"The formal provision of inpatient integrative medicine had a significant impact on pain scores for hospitalized patients, reducing self-reported pain by more than 50%, without placing patients at increased risk of adverse effects. This was true in all 6 settings. Age, previous use of complementary therapies, and sex did not affect results. Future research must define the appropriate dose of the intervention, the duration of the relief, and the identification of patients most likely to respond to these nonpharmacological treatments. Additionally, future research using the electronic health record will allow quantification of any reduction in total costs, pain medication usage, and adverse events."
Following a query from the Integrator, Knutson confirmed that this is the patient population on which the team has estimated there was a $2000 average savings per patient which Knutson had previously reported. The savings were linked to decreased length of stay.
Comment: The robust George Institute inpatient initiative, which has delivered over 60,000 inpatient integrative visits, would optimally have a full-time staff of a half-dozen researchers and support staff continuously slicing and dicing that experience. It is clearly the most significant demonstration opportunity in the country, if yet limited in its service offerings. This is one of the best settings to help answer the question US Senator Tom Harkin posed to NCCAM when he charged NIH NCCAM in 1998, in Section C of the NCCAM mandate, to "study the integration of alternative treatment, diagnostic and prevention systems, modalities, and disciplines with the practice of conventional medicine as a complement to such medicine and into health care delivery systems in the United States." To this point, this focal interest of the Senator and his colleagues has been poorly engaged at NCCAM. Here's hoping that the NCCAM advisory council and staff will place fulfilling on this charge near the center of NCCAM's investment in the 2011-2015 strategic plan in development.
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Integrated community health model expands
Healthpoint, formerly Community Health Centers of King County, continues with integrative services in new facility; Breed featured in interview


In 1996,
Community Health Centers of King County, now Healthpoint, began the first government-funded integrative services program in the United States. The widely reported initiative, under the direction of CEO Tom Trompeter, MHA, chose to continue offering the services after the subsidy expired. The homepage begins with this unusual descriptor: "Welcome to HealthPoint. We provide medical and dental care, as well as complementary and alternative services, at 12 King County locations." Healthpoint stayed this course when it recently moved its Kenmore clinic into a new facility in Bothell, Washington. There, employee Christopher Crumm, ND, LAc offers both naturopathic medical and acupuncture services each Wednesday. (He also works 3 days a week at Healthpoint's Eastside Redmond facility.) Cindy Breed, ND, Healthpoint's "lead provider for Natural Medicine program" is the subject of the audio interview in the March 2010 issue of Natural Medicine Journal. Breed is affiliate clinical faculty and residency director for the Bastyr University Residency Program which HealthPoint also supports. Employed natural health practitioners are on staff in all 8 clinical facilities.
Comment: Credit Trompeter for holding the vision and maintaining the model through a tremendous roller-coaster of budget cycles and funding challenges for all community clinics. Breed, interestingly, has also been there since the beginning. Let's hope the services are still there after the current, crushing cycle of funding retraction.

Research


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Gahles: NCH president set up the NCCAM meeting
International homeopathic team meets with NCCAM: Nancy Gahles, DC reports


Top homeopathy researchers recently met with NIH NCCAM leadership to explore NCCAM's relationship with the field. The meeting was organized by Nancy Gahles, DC, CCH, RS Hom(NA), president of the National Center for Homeopathy. The topic: "Homeopathy Research - State of the Science & Future Recommendations." Gahles' top-flight international team included Iris Bell, MD, and Molly Punzo, MD, who were with her at the NIH and, via teleconference, Martin Chaplin, Rustum Roy, Stephen Baumgartner, Harald Wallach, Klaus von Ammon, Peter Fisher and Claudia Witt (via slides). NCCAM's director Josephine Briggs, MD, deputy director Jack Killen, MD, Richard Nahin, PhD, MPH and 3 others filled out the NCCAM team. Gahles team began by presenting NCCAM with a "6-inch binder of research."

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Bell: Top researcher onsite as part of NCH team
Gahles, in a report to the Integrator, assessed that the meeting went "very well." In Gahles assessment, a presentation by Chaplin and Roy on chemistry and "
slides that showed activity of homeopathic remedies on basophils and IgG" seemed to be particularly compelling to the NCCAM team as far as showing mechanism of action. Gahles underscored that conventional bio-markers seemed to be key in stimulating interest. On the other hand, a presentation on quantum physics and energy medicine appeared to be less useful in making the case for more research investment. At one point, an NCCAM team member who found the presentation "powerful" asked what the community of top scientists thinks. Those in the meeting responded: "We are the leading scientists in the field." The NCH team reiterated key points they had made in a submission on the NCCAM 2011-2015 strategic plan, urging representation on the NCCAM advisory council, more research, and specifically more "real world" research. Gahles considers the next steps in the relationship with NCCAM challenging, but is actively involved in gathering CVs to submit for the advisory council. Her conclusion was that the group "will continue to build on the inroads we have made."
Comment: One of the perverse pleasures that comes from the disposition of the NIH to hire NCCAM leaders who have no prior experience in alternative or integrative medicine is to consider the resulting challenges to move from the comfort zone of drug research on botanical medicines into the far reaches of of "alternative medicine" such as homeopathic theory and practice represent. In fact, forms of energetic thinking are infused throughout the "CAM" universe. It is probably good that Briggs' extensive and admirable self-education process of the last 2 years preceded this meeting. The culture shock may have been too much had it been in her first months. Credit Gahles for her gumption in pulling her field into this meeting and the NCCAM team for taking it. 
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Novella: In the office he'd like to shut down
Anti-CAM blogging trio that wants to shut NCCAM invited to meet with NCCAM team

A trio of anti-CAM bloggers who have called for de-funding and shutting down NCCAM recently held a meeting with an NCCAM team that included director Josephine Briggs, MD and deputy director Jack Killeen, MD. In a blog posting entitled "Our Visit with NCCAM,"the meeting is reported by one of the attendees, Steven Novella, MD, a member of the faculty at the Yale School of Medicine. Briggs reportedly requested the meeting, which included Novella and his colleagues David Gorski, MD, PhD and Kimball Atwood, MD. One area of concern for the bloggers is NCCAM "putting the cart before the horse" by doing pragmatic trials prior to mechanism and efficacy research. They report that
Briggs "defended the utility of pragmatic studies but also acknowledged our concerns." The bloggers then pressed a favorite issue, urging that NCCAM not even consider funding of homeopathy research. The reported answer: "Dr. Briggs response was that in the last two years (under her directorship) the NCCAM has not funded any studies of homeopathy, which is true. However, they still accept applications for homeopathic research, but none have made it through the review process and been awarded funding." Novella then pressed NCCAM on his view that NCCAM's website effectively validates therapies and approaches. He notes that "the one concrete result of the meeting was an offer to have experts from SBM review NCCAM material before it is published. We, of course, agreed to offer our services."
Comment: Josephine Briggs, MD, deserves the Obama Big Tent award for her proven interest in sitting down with everyone, no matter which party affiliation or belief. (Some have said this was proven in early 2008 when Briggs met with me.) Arguably, Briggs takes her openness to dialogue further than the President. While Obama keeps arms length from those calling for the demise of the USA, Briggs invited a meeting with those who have been lobbing bombs at her professional home for years, calling steadily for its destruction. Briggs' offer of review of content is disconcerting. For instance, has the director of NIH's National Heart Lung and Blood Institute asked Julian Whitaker, MD or the chelation doctors with American College for the Advancement of Medicine to review their content on their site?

I am intrigued by Briggs actions, as I am with Obama's strategy. At the same time, just as I often want Obama to play to the progressives that got him elected, I want Briggs to respond above all to the wishes of the practitioners, patients and other stakeholders who actually offer, cover, include or receive integrative services. That said, what would have been especially interesting is if Briggs' scheduler crossed wires and the bloggers and homeopaths had showing up for the same meeting time.


Costs


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Chiropractic demonstration findings raise questions
Major Medicare demonstration project on expanded chiropractic coverage finds huge variation on key "cost neutrality" measure


In 2003, the American Chiropractic Association (ACA) took a bet with Medicare that expanded coverage of chiropractic services would be at least cost neutral for the agency. In January 2010, HHS Secretary Kathleen Sibelius submitted her final report to Congress on the 2005-2007 demonstration project that Medicare began following the Congressional mandate. Patients rated the pilot highly across the board. Yet cost results were radically different, based on location. In the demonstration's New Mexico, Maine and Virginia sites, the expanded coverage was cost-neutral or better for the global neuromuscoluskeletal (NMS) costs that were measured. But in the 4th site of Northern Illinois, where 2/3 of the dollars were spent, Medicare showed losses of $50-million. Now Medicare is looking to recoup $50-million through a lowering of reimbursement rates for chiropractors. ACA formed a team including health services expert Christine Goertz, DC, PhD and the ACA's Medicare coverage expert Susan McClelland to explore the huge variances between sites. The biggest question: Why is the Chicago area such a costly outlier? There is no indication now when the ACA examination will be complete. Meantime, ACA is opposing the reimbursement decrease. An Integrator article including interviews with Goertz, McClelland and others is published here. The ACA maintains a resource page on the project here.
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Goertz: Part of ACA team
Commen
t: The lessons and process here may be of interest to any integrative practice interests who believe all they need is a demonstration project to guarantee rapid adoption into the healthcare payment and delivery system. One salient feature: Like the mandate to the NIH to establish the National Center for Complementary and Alternative Medicine, this demonstration also came from Congress rather than from within the affected agency.

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Talamonti: Ford leader backed pilot
Pilot at Ford plant indicates integrative acupuncture, mind/body, chiropractic reduces back pain medication use and costs


A pilot study conducted with assembly workers at the Ford Motor Company in Louisville, Kentucky utilizing acupuncture and mind/body therapies in conjunction with conventional medicine provided the same outcomes as conventional back pain therapies, but reduced the use of pain medications among participants by 58%. The findings were published in a letter to the Journal of Occupational and Environmental Medicine as An Integrative Medicine Intervention in a Ford Motor Company Assembly Plant. In the study, one group received conventional pain management therapies, including pain medications. The second group utilized integrative therapies, including acupuncture and relaxation/meditation CDs. Both of the groups received treatments over a six-week period, with a 12-week follow-up. Kenneth R. Pelletier, PhD, MD(hc), a co-principal investigator on the study commented, in a release from HealthyRoads the provider of the CDs, as follows: "While the sample size was insufficient to adequately estimate the effect of the integrative medicine intervention on disability or absenteeism, the results have very positive implications for employers looking to manage their pharmacy costs associated with low back pain." Back pain is estimated to cost employers as much as $100 billion a year in direct medical expenses, lost workdays, reduced productivity, compensation payments and legal charges. A release on the project is published here.
Comment: The leader at Ford, Walter Talamonti, MD, offers an insightful look at the challenges one can face in doing research in the onsite, employee-employer environment in this Integrator story.
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Merrell: Promotes integrative medicine as cost saving
“Integrative medicine” included as doctor-led cost cutting solution in New York Times article

The headline across the page of the New York Times on March 27, 2010 ran “Doctors Offer Thoughts on Cutting Healthcare Costs.” There followed 9 short statements of 100-200 words each from a diverse set of medical doctors. Examples: “Change Malpractice Law,” "Insure Catastrophes Only,” and “Rely on Evidence.” Then, prior to “Stop Overtreating” and “Restore the Humanity” was this: “Use ‘Integrative Medicine.’” The author, Woodson Merrell, MD, is the chair of the department of integrative medicine at New York’s Beth Israel Hospital (NYBI). Merrell referenced a Beth Israel study that found that breast cancer patients using hypnosis cost the hospital $772 less overall compared to those who didn't. Said Merrell:“That’s an example of how a simple technique can help patients and reduce costs.”
Comment: These outcomes, from hypnosis, appear to be huge. Of course, the question begged here is whether any hospital sees this "savings" as a benefit or as a loss of income. Somebody got paid less. As Duke's dean emeritus Ralph Snyderman, MD stated in a recent JAMA editorial in which he referenced his experience with an integrative strategy, incentive structures can hamper adoptions of cost-saving approaches. (Snyderman's statement was covered here in the Integrator.) Regardless, it was nice to see Merrell and integrative medicine elevated to meaningful here.

Employers


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Pelletier: CHIP hits 25th anniversary
Pelletier's Corporate Health Improvement Program, presently focused on integrative medicine, celebrates 25th year


The Corporate Health Improvement Program (CHIP), the longest-standing research program between major medical schools and Fortune 500 corporations, this year celebrates its 25th anniversary. CHIP was founded by Kenneth R. Pelletier, PhD, MD(hc). According to a release from the Arizona Center for Integrative Medicine where it is housed, CHIP's mission is to "respond to the need for creative solutions to an unchecked rise in medical-benefits costs incurred by businesses nationwide." The release notes that the organization's research and publications "have been a major driving force in demonstrating the clinical - and more recently, integrative medicine - cost value of prevention." The program is a collaboration between the academic health center and 15 major corporations, including Canyon Ranch Resorts, American Specialty Health, Ford Motor Company, Dow, Thomson/Reuters, Corning, Prudential, IBM, Mercer, Pepsi, NASA, Pfizer, and Walgreens. One outcome of CHIP's work is the integrative medicine for back pain pilot at the Ford Motor Company noted in this issue of the Round-up. Other CHIP projects include: work with NASA to develop an objective assessment tool of worksite stress; and a research project with Prudential that is designed to prevent the conversion from short-term disability to long-term disability.
Comment: Pelletier, an Integrator adviser, was and remains one of the few voices to trumpet the potential value of bringing health promoting integrative practices with the health-creating and productivity interests of the employer community. As a sometimes organizer, I particularly appreciate Pelletier's success with the challenge of holding together a shifting but always significant set of dues-paying members for this period of time.

Academics


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Kemper: Wake Forest IM leader
Update: Wake Forest University's Center for Integrative Medicine


Since 2006, the Integrator has tracked various developments at the Center for Integrative Medicine (CIM) at Wake Forest University Baptist Medical Center (WFUBMC). CIM's co-sponsorship of the Society for Acupuncture Research 2010 International Conference
in March 2010 prompted this update. CIM is partnering with the Maya Angelou Center for Health Equity (MACHE) also at Wake Forest and the Claude Pepper Older Americans Independence Center on pilot research projects. According to Lauren Azevedo, the program manager with CIM, the pilots focus on "cancer disparities, cancer and aging, and integrative medicine with cancer patients or assistance with their caregivers." In addition, the WFUBMC Department of Nursing and Caregiver Stress Task Force developed a program entitled "Healing Touch Therapy: Caregiver to Patient/Family." The program includes policies and procedures "to reduce stress and promote healing in caregivers, patients and families, and to ensure consistency in Healing Touch practice." Azevedo adds that the Wake Forest School of Medicine began offering Integrative Awareness Training (IAT) to medical students in 2009. The program, says Azevedo, "focuses on learning mind-body skills that promote self-awareness, self-reflection and self-care." In addition, Mental Health, Naturally authored by center director Kathi J. Kemper, MD, MPH, FAAP was published in March by the American Academy of Pediatrics. A prior Integrator look at massage services is here. The center's newsletter is available to those who wish by contact Azevedo at

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Nielsen: Directs inpatient acupuncture fellowship
First inpatient fellowship for licensed acupuncturists begins at New York's Beth Israel hospital

Nearly 20 licensed acupuncturists have taken advantage of the nation's first inpatient fellowship for licensed acupuncturists which began in September 2008. The program is based out of the
department of integrative medicine at NYBI (see above) that is associated with the Continuum Center for Health and Healing, one of the nation's largest integrative clinics. The yearlong fellowships are led by Arya Nielsen, PhD, LAc and Ben Kligler, MD, MPH. They benefit from a close relationship with an integrative medicine program for medical doctors which Kligler runs. Participants have at least 2 4-hour shifts each week, and have an additional 3 hours per week of typically interactive, didactic training. A research component is also included. The cost: $3500. For details, see this longer article.
Comment: As becomes clear, this exceptional opportunity, thanks to the work of Nielsen, Kligler and Merrell (noted in the costs article this issue of the Round-up), is still largely possible only as a labor of love. Nielsen notes that some fellows think they should be getting paid, and Nielsen agrees. Yet the business model of the hospital has the acupuncture services provided for free. Thus, there is no income to justify the expense. My estimate is that the fellows are generating between $100,000 and $200,000 of value to the hospital's patients, depending on whether the inpatient services are valued at $20 or $40 each treatment. At $60, we're talking $300,000. It would be nice to see this work made sustainable on something more than heart.
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Maizes: Video of IM leader provides short history of influential Arizona program
University of Arizona's
Victoria Maizes, MD, MPH in short video on the evolution of the nation's most robust academic integrative medicine program

Anyone curious about the evolution of the program in integrative medicine, founded by Andrew Weil, MD in 1998 at the University of Arizona, into the Center for Integrative Medicine that it is today, will find this 5 minute video illuminating. The video features the Center's executive director, Victoria Maizes, MD, MPH. Maizes succinctly summarizes twelve years of work on the Center's fellowship and integrative medicine in residency programs.
Comment: Sometimes people find the perfect work. I am thinking Maizes must feel that way about landing her job at what is now the Center for Integrative Medicine, after being one of the former Program in Integrative Medicine's first residential fellows. Credit Weil for the vision, his ongoing financial backing, and his wisdom in hiring the likes of Maizes. While other academic centers have made significant contributions, imagining the development of academic integrative medicine without the influence of the Arizona Center for Integrative Medicine is to view a very different, less mature, less holistic and less ambitious entity. Take a listen. The contributions are remarkable.
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Brimhall: Leads college to university status
Western States Chiropractic College becomes University of Western States


The only college of chiropractic medicine in the Northwest of the United States quietly shifted its profile to reflect its actually status early this year. Western States Chiropractic College became the University of Western States (UWS). Joe Brimhall, DC, the university's president, shares that “the board decided about three years ago to pursue University status and we’ve been working on it since then.” Besides chiropractic, the university offers a massage therapy program and is now rolling out a masters degree in sports and rehabilitation. Brimhall, who led the transition, is an accreditation expert. He is past president of the Council on Chiropractic Education, a commissioner of the Northwest Commission on Colleges and Universities and chair of the Accrediting Agency Special Interest Group of the Academic Consortium for Complementary and Alternative Health Care. UWS is already regionally accredited.


Tri-State College of Acupuncture publishes report on interdisciplinary professional education


The newborn Center for Acupuncture Educational Research and the Tri-State College of Acupuncture have jointly published a 20-page report entitled "Integrative Medicine and Interdisciplinary Professional Education (IPE): A Report on Theories, Practices, Trends and Funding Opportunities." The document may be the first significant focus on IPE to come directly the acupuncture and Oriental medicine community. Anya Kaplan-Seem, a research assistant at Tri-State, wrote the report. Kaplan-Seem provides an exceptional introductory review of key reports relative to AOM and other integrative practice educators, including the seminal 1994Pcew-Fetzer document on relationship-centered care, the National Education Dialogue to Advance Integrated Health Care (published by the Integrated Healthcare Policy Consortium), the competencies for integrative medicine endorsed by the Consortium of Academic Health Centers for Integrative Medicine and recent IPE research.

Comment: I take it as a sign of maturity that a component of the AOM community, which has an advanced tendency to stick inside its own silo, is focusing on IPE. Under my hat as director of the Academic Consortium for Complementary and Alternative Health Care, where bettering care through IPE is core mission, I particularly salute Tri-State for this useful publication. Here's hoping they can find what they need to take the Center from idea to established force in the AOM community. The document is not presently internet available. Email me if you have an interest in seeing it.  

Media


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Ornish: Challenging the therapeutic approach
Tolle causam: Ornish letter urges better way of thinking about reducing statin use


The April 3, 2010 New York Times letters-to-the-editor included a submission from Dean Ornish, MD which frames the journalist and policy task in a health promoting light. Referencing a March 31, 2010 front page story “Plan to Widen Use of Statins Has Skeptics,” Ornish writes: “The wrong question is being asked. It’s not 'Should Crestor be given to reduce inflammation?’ It should be: ‘What is the cause of chronic inflammation and what can be done to address the causes?’” Ornish notes the he and others have shown that a variety of lifestyle changes can reduce chronic inflammation. Ornish then adds the kicker outcome of health-oriented, lifestyle interventions: “The only side effects of comprehensive lifestyle changes are good ones.” Ornish's letter was re-printed here in the Huffington Post.


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Magazine honors Bravewell trio
Vanity Fair features 3 women who lead the Bravewell Collaborative


Page 108 of the April 2010 edition of Vanity Fair includes a photo of the 3 women who have led the Bravewell Collaborative: Christy Mack, current president, Penny George, founding president, and Diane Niemann, executive director. According to readers who saw the article, the 3 women are featured in designer raincoats in a section entitled "Hall of Fame." Mehmet Oz, MD offered what one reader called "a fine nominating statement." Oz nominated them for their role in advancing integrative medicine.
Comment: The question of the day is: Which most advances integrative medicine: a) the New York Times' inclusion of the approach as a doctor-recommended cost-saving solution? (see related article under "Cost" in this Round-up); or b), this Bravewell trio being highlighted in Vanity Fair? 
Internet videos, radio on integrative practice

Recently a number of integrative practice interests sent links to videos related to their work.


Portland Tribune offers pro-con feature on growing use of naturopathic doctors as primary care in Oregon

"Paging Dr. Alternative: State pushing naturopaths to fill shortage in primary care" is the title of the April 2, 2010 article in the Oregon-based Portland Tribune. The article offers a portrait of the emerging use of naturopathic physicians as primary care practitioners in the state. A chart from the article, below, points out that the state has more naturopathic doctors per person than any other state.
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Source: Portland Tribune, April 2, 2010
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The article includes a medical doctor who expresses concern about potential safety issues:
“To my mind, it’s like if we had a shortage of pilots, then we’d hire people who practice levitation." Integrative medical doctor Anne Nedrow, MD is quoted in counterpoint. She speaks to what she has experienced among the NDs with whom she has worked as "understanding of anatomy, physiology and chemistry similar to that of many MDs." Nedrow adds: “I don’t think there will be any doubt that we will need them" in meeting the primary care needs. The article closes on a sober note for NDs. Scott Ekblad, the director of the Oregon Office of Rural Health Care, says that lack of insurance coverage for naturopathic care is "one of the major hurdles keeping naturopaths from providing primary care where the need is greatest — in rural areas of the state." The issue is principally Medicare, which doesn't reimburse for naturopathic care. (Thanks to reader Karma Carpenter for sending me the link.)

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Positive look at acupuncture
Wall Street Journal examines science in acupuncture; 93% of readers give practice thumbs up


The feature is called "Decoding an Ancient Therapy." The subhead: "High-Tech Tools Show How Acupuncture Works in Treating Arthritis, Back Pain and Other Ills." Melinda Beck, the writer of this March 22, 2010 Wall Street Journal feature takes a favorable stance toward the therapy. Her focus is on bridging acupuncture theory with Western medical thinking. For instance:
"Several meridians track major arteries and nerves. 'If people have a heart attack, the pain will radiate up across the chest and down the left arm. That's where the heart meridian goes,' says Peter Dorsher, a specialist in pain management and rehabilitation at the Mayo Clinic in Jacksonville, Fla. 'Gallbladder pain will radiate to the right upper shoulder, just where the gallbladder meridian goes.'"
Among the types of condition Beck reports as scientifically supported for acupuncture treatment are arthritis of the knee, headaches, lower back pain, cancer, infertility and treatment of addiction. She writes: "After decades of cynicism, Western medical experts are using high-tech tools to unravel the ancient mysteries of how acupuncture works." Of 256 respondents as of April 8, 2010 to a poll on whether one believes "acupuncture works," 93.4% weighed in with a yes. (Thanks to Jan Schwartz, MA, for sending the link.)


Conferences

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Portland integrative practice group in lively set of activities
April 15-17: SPARC and the OCIM (as in "awesome") integrative network of Portland, Oregon


During April 15-17, 2010, hundreds of professionals from diverse fields will participate in the most robust community, multidisciplinary integrative care initiative in the nation. Portland, Oregon is the home of the annual Symposium for Portland Area Research on Complementary and Alternative Medicine (SPARC) conference. That such a meeting is hosted annually is possible through the confluence of energy from programs in 4 institutions that train MDs, NDs, DCs, AOM professionals, nurses and massage therapists. These are united as partners in the Oregon Collaborative for Integrative Medicine, led by Anne Nedrow, MD, integrative medicine leader with Oregon Health Science University. SPARC is produced through the Helfgott Research Institute at one of the OCIM institutions, National College of Natural Medicine, where Heather Zwickey, PhD directs research. This year the weekend events kick off with a Thursday evening OCIM-sponsored distinguished lecture from Aviad "Adi" Haramati, PhD, integrative medicine leader at Georgetown University. A program Friday, April 16, will focus on disseminating to librarians at CAM health professions schools information on the important role librarians can play in enhancing an evidence-informed institutional culture. That content for librarians continues into Saturday. Friday evening, SPARC hosts a dinner leading up to the Saturday, April 17 conference keynoted by Dan Cherkin, PhD and Karen Sherman, PhD, MPH. The conference is entitled "Research in Clinical Practice."
Comment: Actually, this is an apology, for not noting this series of events earlier. I am planning to attend under my ACCAHC hat and meet with the rich network of integrative practice educators in that metropolitan area. If you can't make it this year, keep an eye out for SPARC 2011.
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Thompson: Chairs MTF conference that received NCCAM award
$30,000 NIH NCCAM grant supports May 13-15 Massage Therapy Foundation conference


The Massage Therapy Foundation announced in late February that its May 13-15, 2010 conference in Seattle, entitled
"Highlighting Massage Therapy in Complementary and Integrative Medicine (CIM) Research," received a $30,000 conference grant from the NIH National Center for Complementary and Alternative Medicine (NCCAM). Diana Thompson, MTF's immediate past president and conference chair states: "This NCCAM grant is an important demonstration of support-support of massage therapy's presence in integrative medicine and support of the Massage Therapy Foundation's role in bridging research and massage therapy practice." The conference targets massage and manual therapy practitioners, educators, researchers, allied health professionals, and others interested in massage research. Among the keynote speakers is NCCAM director Josephine Briggs, MD. Conference details are available here.

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Celebrates 30th year
30th Annual AHNA Conference coincides with International Year of the Nurse
 

The American Holistic Nurses Association (AHNA) is holding their 30th Annual Conference, Re- Visioning Environment: Creating a Habitat for Healing, June 3-6, 2010 in Colorado Springs. AHNA's conference coincides with the celebration in 2010 of the International Year of the Nurse. AHNA executive director Jeanne Crawford explains: "We are celebrating a pivotal moment in nursing. As the demand for whole-person/patient-centered care grows, AHNA celebrates 30 years. We are proud to be a 2010 International Year of the Nurse event, in recognition and support of the eight U.N. Millennium Development Goals." Attendees will learn about holistic health therapies and reflective practice from nursing and health experts.

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Knutson: Overseeing unique conference on inpatient integrative care
Penny George Institute/Allina offers unique conference on hospital-based integrative health care


On July 26-29, 2010, the Penny George Institute for Health and Healing will sponsor a conference entitled "Hospital Based Integrative Health Care Conference: Transforming Health Care Practice" in Minnesota. The objectives are stated up front, and practical. For instance, participants will have, according to a flier: gained new skills to help patients manage stress, anxiety and pain; practiced skill building techniques in the areas of massage, aromatherapy, relaxation, breathing, guided imagery, meditation; understand the operational aspects of creating a hospital-based integrative health department; and learn about research that is happening throughout the integrative health community.
Comment: If any entity can claim rights to a knowledge base in this area, the George Institute with their Abbott Northwestern/Allina inpatient initiative with its 60,000+ inpatient integrative care visits can. The team, under the direction of Lori Knutson, RN, BC-HN, views its work as a pilot project for the nation. The team has been exceptionally helpful in sharing important information and strategies at a number of conferences since the program got up and running in 2004. (Note that this issue of the Round-up includes information about publication of a research paper on patient outcomes in the inpatient program.) This is a not-to-be-missed opportunity for those interested in inpatient integrative services.
Joint AHMA/ICIM meeting a prelude to a 4-association integrative conference in 2011

The American Holistic Medical Association and the International College of Integrative Medicine joined together for a March 18-21, 2010 conference in Nashville that drew 200 attendees, and 41 exhibitors. “Not bad when it’s only 4 months after the AHMA’s 2009 conference and 5 months after ICIM’s fall event,” states former AHMA executive director Donna Nowack, who worked closely with Wendy Chappell, her ICIM counterpart, to put on the conference. The conference, entitled “Healthy Brain, Healthy Body,” was co-chaired by David Forbes, MD, AHMA president and Jeannette Soriano, MD, his counterpart with ICIM. The event was described by Forbes as “the first truly joint conference venture between two predominantly physician-based organizations in integrative/holistic medicine. The conference workload was split, as was the revenue and expenses 50/50.”  He credits the two executive directors and states: “We finished with deeper bonds between the two organizations.” The organizers believe that the outcome bodes well for a planned April 6-10, 2011 event to be called “iMOSAIC” - Integrative Medicine Offering Science-based Alternatives in Collaboration. Co-hosts will include AHMA and ICIM plus the American Academy of Environmental Medicine (AAEM) and American College for Advancement in Medicine (ACAM). The hosts are targeting 750-1000 participants.


Reader Comment

Integrative psychiatrist reader challenges Round-up article on Newsweek's feature on anti-depressants


The March 2010 issue of the Integrator Round-up included information on questions about anti-depressants based on a Newsweek article on the topic. New York City physician Karen Hopenwasser, MD, who saw the Round-up as republished via Integrator sponsor Integrative Practitioner, writes:
"I am writing to express my concern about some of the content of the newsletter I receive through email from the Integrative Practitioner. I have been practicing integrative psychiatry for many years and there is absolutely no doubt in my mind that western anti-depressant medication saves lives and improves the quality of life for many individuals who do not respond to other treatment. The current news about anti-depressants is just as biased as are the many negative articles about supplements and herbs. The ethics of the pharmaceutical industry may be in question, but not the efficacy of the medication. The industry that manufactures supplements and herbs is just as motivated by profit as anyone else. I approach both with caution and skepticism. I expect more from a newsletter that is truly about integrative health."
Comment: The antagonism toward anti-depressants about which Hopenwasser complains came directly from the writer and headline writer at Newsweek who called the feature The Depressing News about Anti-Depressants and a Huffington Post piece by one of the researchers behind the Newsweek piece who spoke of them as "the Emperor's new drugs." On reflection, some of my interest in re-publishing this information may be a sort of polarized pleasure in seeing these evidence holes in the platform on which the billions of anti-depressants have been over-sold. Each brick of that touted platform was certainly a "gold-standard" randomized controlled trial. That said, a nod to Hopenwasser. Some of my best friends claim benefits from those pills and, while this is outside my expertise, would seem to have their role in integrative practice.

People

American Chiropractic Association chooses William O'Connell to head up operations

The American Chiropractic Association (ACA) has hired William K. O'Connell, MBA, MPA as its new executive vice president.
Most recently, O'Connell served as executive director of government affairs at the National Safety Council. O'Connell has also served as a senior executive with the American Board of Anesthesiology, the American Osteopathic Association and the American Dietetic Association The release from the ACA noted O'Connell's ability to "forg(e) partnerships in coalitions of like-minded organizations to advance shared legislative interests" as a key characteristic. O'Connell earned a bachelor's degree in cultural anthropology from the University of California, Berkeley, an MBA from the University of San Francisco and an MPA from Northern Illinois University. O'Connell succeeds Kevin Corcoran, who left the association in May 2009. The ACA release is here.

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Schwartz: Teams with Lowe for online education business
Lowe and Schwartz form Educational Training Solutions to develop online curriculum

Long-time integrative health educators Whitney Lowe and Jan Schwartz announced in early March that they have created Education and Training Solutions LLC. The venture, according to the release, will "set a new bar for online course development and design." The two foresee significant "innovative opportunities for moving into this exciting new option in education" which is the fastest growing sector in education today. The group offers a free consultant via their website, phoning 888-689-4445 or emailing   Schwartz, who has significant background in accreditation and as an executive in a national education firm, is co-chair of the Education Working Group of the Academic Consortium for Complementary and Alternative Health Care on which Lowe, a well-known author and educator in the massage field also serves.

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Cadwell: Taking the helm for holistic doctors
Steve Cadwell new exec for holistic medical doctors


In a March 2010 release, the American Holistic Medical Association announced that
Steve Cadwell will be the organization's new executive director. The decision followed a 5-month search about which president David Forbes, MD writes: "Steve brings to us a solid Executive Directorship history, a dedication to our core principles and philosophies, a commitment to the continued growth of the AHMA, and a huge heart. He wants to see us continue to solidify our reputation and credibility as a central voice for holism, increase our financial sustainability, and serve our key mission of transforming healthcare to a more holistic model." The release is laudatory, but short on details about Cadwell's past work life. He replaces Donna Nowack who has helped turn around the organization from a position of near bankruptcy two years ago and took a lead in engaging the AHMA in a series of alliances and collaborations.

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Marchiori: New Palmer chancellor
Palmer College has a new chancellor in Denny Marchiori, DC


Palmer College has selected former faculty member Dennis "Denny" Marchiori, DC, PhD, DACBR as its new chancellor. According to a release from the college, the selection followed a lengthy national search. Marchiori earned his doctorate from the University of Iowa in 2005 in policy, planning and leadership.
He has had faculty appointments at Palmer in research, diagnosis and radiology with administrative responsibilities that include department chair, dean, vice president of academic affairs for the Davenport Campus, and vice chancellor for academics for the 3-campus Palmer College system. Marchiori replaces William Wilke, a longtime board member and local businessman who has served as interim chancellor since 2008.

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Huggins: Elected to presidency of AHPA
Katie Huggins elected to chair board of American Herbal Products Association


The American Herbal Products Association announced in a March 18, 2010 press release that Katie Huggins, vice president of quality control with Traditional Medicinals, has been elected to chair the organization's board of directors. In a note to the Integrator, Katia Fowler, AHPA's director of communications states that the trade association "is consistently impressed by Katie’s thoughtfulness, expertise and willingness to dedicate her time and energy to the association, as demonstrated by her receipt this year of the AHPA Herbal Hero award. AHPA is thrilled to have Katie in this important role." AHPA's mission is to "promote and protect the responsible commerce in herbal products."

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Cronin: ND graces cover of Best Doctors issue
Naturopathic physician Michael Cronin, ND featured on cover of Phoenix magazine


Michael Cronin, ND, a clinician in Phoenix, Arizona, was selected to grace the cover of a "Best Doctors" issue of Phoenix Magazine, apparently a first for a naturopathic doctor anywhere. Cronin, the founding president of Southwest College of Naturopathic Medicine and past director for integrative medicine for American Whole Health, was subsequently told by a colleague, via Facebook, that the honor would have been better were it the swimsuit edition. Cronin replied to a number of permutations of this comment with:
"Thanks guys. I'm not so sure about this swimsuit thing, could set legislation back 10 years. It's interesting, and it has been a lot of fun with patients as well. They also seem to appreciate a sense of validation in their decision to use naturopathic medicine, typically responding 'It's about time you guys got some notice.'" Alas, Cronin, though tops in naturopathic medicine, didn't make the list of the "Fantastic Five" of physicians in a related feature in the issue.

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Last Updated ( Monday, 12 April 2010 )
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