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The Integrator Blog. News, Reports and Networking for the Business, Education, Policy and Practice of Integrative Medicine, CAM and Integrated Health Care. - Berwick Bad for Integrative Care: Comments of Chris Foley, MD, Ron Hoffman, MD & Cindy Krueger, MPH
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Berwick Bad for Integrative Care: Comments of Chris Foley, MD, Ron Hoffman, MD & Cindy Krueger, MPH PDF Print E-mail
Written by John Weeks   

CMS' Berwick Will Be Bad for Integrative Practice: Comments from Chris Foley, MD, Ron Hoffman, MD and Cindy Krueger, MPH

Summary: The Integrator advocacy of the controversial Donald Berwick, MD for director of the Centers for Medicare and Medicaid Services (CMS) sparked outspoken pushback from 3 readers: Minnesota-based integrative clinic leader Chris Foley, MD, former American College for the Advancement in Medicine president Ron Hoffman, MD and consultant Cindy Krueger, MPH. Opposition tended to break on ideologic lines. Is support of Berwick out of touch with the integrative practice community? Interestingly, Berwick's nomination is blasted by a leading anti-alternative medicine blogger. I give their push-back a little pushback. There is evidence that Big Government can be quite friendly to inclusion of integrative practices. Do you think Berwick will be bad for integrative care?
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for inclusion in a future Integrator.

For past Integrator content on Berwick:

Berwick: Will his tenure be bad for integative practices?
The Integrator column supporting Obama appointee Donald Berwick, MD to head the Centers for Medicare and Medicaid Services stimulated 3 strongly opposing
responses. (See Obama's Embattled Nominee Berwick's Integrative Medicine Smarts Emblematic of Why He's Right for CMS, June 16, 2010.)

My support for
Berwick is based on his work organizing health systems to stop hospital-caused deaths and his radical views on patient-centered care. In addition, Berwick's perspective on integrative medicine is on record via his presentation at the February 2009 IOM Summit on Integrative Medicine and the Health of the Public. There, Berwick, the founder of the Institute for Healthcare Improvement (IHI), elucidated his "Basic Principles for Integrative Medicine."

Since the Integrator column was published, President Barack Obama avoid what was expected to be a drawn out appoiuntment battle by offering Berwick the job as a "recess appointment." Daniel Henninger, a writer for the Wall Street Journal has opined that Berwick's appointment is "Bigger than Kagan" - a reference to prospective Supreme Court Justice Elena Kagan. Writes Heningger: "Dr. Berwick's ideas on the design and purpose of the U.S. system of medicine aren't merely about change. They would be revolutionary." (The column is available at Henninger: Berwick Recess Appointment Is Bigger Than Kagan - WSJ.com.)

Chris Foley, MD
1.  Chris Foley, MD:  "Berwick is a healthcare rationer par excellence ..."

Chris Foley, MD led one of the first health system-sponsored integrative clinics, partnering with the HealthEast system in Minneapolis in the mid-1990s. He continues to practice integrative medicine at Minnesota Natural Medicine. Foley sent the link to the Wall Street Journal column noted above. He was last seen in the Integrator commenting on Andrew Weil's health reform plan.
"Berwick's 'patient centeredness' is very nice and a noble goal to which I aspire on a daily basis. 

"But, his means to achieve that end is euphorian and centrist/statist. He simply adores the NHS [British National Health Service] and is a healthcare rationer par excellence. His algorithmic past belies his patient-centered world methinks, and I would fear him above all as the emperor who finally eliminates the capacity of any MD to privately contract with a patient.

"You need to reread The Cancer Ward.  [Author Alexander] Solzhenitsyn teaches us that the paternalism of the State ultimately defiles the most sacred of human relationships outside of marriage and children -- that between physician and patient. You cannot be 'patient centered' while telling the principles in the relationship what they can and cannot do or treat nor dictate what their time and value is worth.  He's headed there and reeks of it."
Comment:  First, I urge Foley to look at the case Berwick makes regarding patient-centered care. In his What Patient-Centered Care Should Mean: Confessions of an Extremist, he elevates individual interests above controlling protocols. Berwick's is not garden-variety lip-service to patients. He directly challenges algorithm medicine. That said, it will be curious to see what sort of balance he will strike when his hands are on the wheel.

Ronald Hoffman, MD
2.  Ron Hoffman, MD:  "Don't take for granted your constituency buys in ..."

Integrative medicine pioneer, author and radio host
  Ron Hoffman, MD is a past president of the American College for Advancement in Medicine. His practice is in New York City where he has hosted Health Talk on WOR Radio since 1987. Hoffman sent along his comment with a side-note of "thanks for offering to dialogue on this issue."
"I just don't know how you can shill for Donald Berwick, who represents health care rationing at its worst. 

"Don't take for granted that your constituency buys into tokenistic inclusion of some 'holistic' modalities when the thrust of Obamacare is to crush individualistic, private practice physicians who are the backbone of the iconoclastic grassroots pushback against standard care.

"You really have to suspend disbelief and engage in magical thinking to believe we'll make progress under his regime. Limiting choice is always going to be bad for CAM."

Comment: First, an important note on "constituencies." One of the fascinating aspects of work in these fields is the diversity of the political philosophies one encounters. The former CAM Caucus in the US House was co-chaired by a right-winger, Dan Burton (R-IN) and a left-winger, Dennis Kucinich (D-OH). In the Senate, the leaders were not quite as diametrically opposed but certainly separated by a huge chasm: Orrin Hatch (R-UT) and now deceased Ted Kennedy (D-MA). Strange bed-fellows.

What are the full views of the Integrator's constituency?

Now, regarding what Hoffman calls my "magical thinking ... that we can make progress under this regime." Of course, no one can know for sure what Berwick will do. There is non-magical evidence that big government can be good for integrative practices. I site the experience in Washington State. Since the implementation of the "every category of provider" law in 1996, the State has had the nation's most significant inclusion of licensed complementary and alternative practitioners in the mainstream payment and delivery system. Consurmers have had more access that in states without government intervention.

Notably, the inclusion came amidst passage of a state-wide "managed competition" act by the very liberal-left governor Mike Lowry, and was promoted by the populist-left insurance commissioner Deborah Senn. Lowry's this left-learning managed competition plan and Senn's shepherding proved quite good for integrative practices.

3.   Anti-CAM blogger blasts Berwick

Among those opposing Don Berwick's appointment to CMS is the entrenched, polarizing, anti-CAM, anti-integrative medicine, anti-NCCAM blogger David Gorski, MD. His column,
Dr. Donald Berwick and “patient-centered” medicine: Letting the woo into the new health care law? lambastes the appointment as elevating an individual who appears to be too open to integrative thinking and practices. The lengthy posting concludes with: "No matter John Weeks at The Integrator Blog is so happy."
Comment: The theme of strange bedfellows, noted above, and noted again in my penultimate comment below, comes to mind here again. Only here those sharing the bed of opposition are some outspoken anti-CAM voices and some outspoken pro-CAM voices. I am not sure anyone in even the next room would get much sleep.

Cindy Krueger, MPH
4.  Cindy Krueger, MPH: "Your position is uninformed ..."

Cindy Krueger, MPH is the founder of Preservion, Inc., a health research, consultation and education company. Asked about her background, Krueger wrote that she "design(s) therapeutic health and healing protocols for individual clients and corporations" and that the "fundamentals of the program include a non-drug approached supported by wholesome eating, exercise, stress reduction, sleep, supplements and education." Krueger is vehemently opposed to Berwick's appointment.

"Your position on Dr. Berwick's appointment is uninformed.  In the 1930's the German electorate thought they were voting for a man who also displayed wisdom, experience, leadership and vision to help them with high unemployment, a broken financial system and lack of education. Shortly after the man's ascendancy to power, they realized their mistake. Today's scenario is all too familiar.

"One need not dig deep to find that Dr. Berwick is a student and promoter of socialized medicine. Obamacare promotes dependency, entitlement and rationing in hopes of achieving a greater good. What is good about any of those?  Abortion advocates have similar goals.  They believe it is better to murder an unborn child rather than 'saddle' the mother with the responsibility for her actions, the innocent child. Mr. Obama in so many words has said the same thing and Dr. Berwick agrees.

"What has happened to the IOM? Have they lost their moral way?  Today, dollars rather than standards drive too many organizations. I hope I'm wrong in this inference. 

"The IOM organization was making progress, creating change benefitting patients by promoting disease prevention and natural health and healing protocols. Supporting Obamacare is a disservice to those you we're helping. The American Hospital Association and the American Medical Association, historically the nemesis of alternative medical organizations are now IOM allies in supporting Dr. Berwick's position. What has changed?

"Are you proud that your President and Congress slammed this bill and Dr. Berwick through recess appointment down our throats?  Do you understand that Obamacare will ration care in the name of providing more equity to all and for less money?  Promoting entitlements rather than personal responsibility is contrary to what IMO stand for, no?  

"The influence and control by pharmaceutical, insurance and medical groups benefiting from our system of healthcare should be stopped, but now the power has transferred to the government.  What has it managed correctly; the postal service, Sallie Mae/Freddie Mac, Katrina, the gulf oil spill, the war, the borders, airline security? 

"Dr. Berwick wants to base the new system on evidence based medicine.  It does not exist.  Although evidence based medicine sounds attractive, only 11% of its guidelines are based on firm clinical evidence; most are based upon expert opinions.   Clinical practice guidelines are heavily influenced by big pharma rather than the patients' best interest. Have you reviewed the role big pharma will play in this new healthcare?

"A single payer system?  A large portion of the bill forced upon the American people is lies.  Dr. Berwick and Mr. Obama are acting like elitists thinking they know what is best and their constituency is following. 

"Dr. Berwick makes it very clear he wants to redistribute wealth in this country. This undermines the core on which America was founded!   Americans are some of the most generous people on this earth and to take over and regulate wealth is the antithesis of American exceptionalism. 

"Why is it that this Congress will not be subjected to this pitiful Obamacare?  If it is so good for the masses, it should be good enough for those who masterminded it. And if Dr. Berwick is the man for the job then why didn't Mr. Obama give him the chance to explain his views to the Senate so we could better understand what he is really going to do. Through the back door in the middle of the night is not the way to put someone in charge of the biggest job in America unless you have something to hide or you don't want the people to know his philosophy.  Where is the transparency that Mr. Obama promised? The promised change is based on lies.

"All that the preventive, alternative and integrative specialists have worked for over the years will become moot.  You have lost control. What the government gives, it can take away and if you have read any of the bill, you will see there are more take aways than givings.

"Can you name one government program that has provided better outcomes than the free market? Name one that has not gone over budget or has ceased to exist due to its success?  How can three hundred million people be better served under a government that shows disdain for competition and choice?   Socialized medicine does not serve people better in any nation, yet you think power driven bureaucrats in charge, with no accountability, spending the American people's money, can do it better than the other failures. 

"You have lost your argument already by supporting a group of people who could not sell the bill or Dr. Berwick on merit, good sense and public opinion.  Deceit, manipulation, pork spending (bribes) and the like was necessary to pass Obamacare."

"My disappointment in your support of Dr. Berwick will not dim my hope for the possibility of an ever-growing informed electorate who will challenge this anti-American style of politics and medicine.  Although Dr. Berwick's appointment is lauded as revolutionary by his supporters, the American people believe otherwise. Those of us who support a nation of responsible doers will continue to work at abolishing the dreadful changes connived by this administration."
Comment: My first thought: The Tea party hits the Integrator. My response to Krueger's content was finalized in her first paragraph. She draws a ludicrous parallel between Berwick and Hitler. In place of the boy who cries wolf we have the commentator who cries Adolph. I stopped listening. What, was Berwick's recess appointment - a standard ploy used by presidents of both parties - a successful Beer Hall Putsch? Integration is about strange bedfellows finding shared cause. It's not very compatible with polarization.

Regarding Big Government and integrative practices:
How about the Big Government mandate from the Big Spender Harkin that established NCCAM? How about the importance of Big (state) Government mandates that have produced most coverage of CAM practices and vastly expanded the ability of consumers to access services? Are we better off with those unfettered icons of the private sector called insurers?

Send your comments to
for inclusion in a future Integrator.

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