Berwick Bad for Integrative Care: Comments of Chris Foley, MD, Ron Hoffman, MD & Cindy Krueger, MPH
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?
My support for Berwickis 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 ..."
"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.
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?
