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The Myrna Brind Center of Integrative Medicine: An Interview with Daniel Monti, MD and Ira Brind PDF Print E-mail
Written by John Weeks   

The Myrna Brind Center of Integrative Medicine at Jefferson: An Interview with Daniel Monti, MD and Ira Brind

Summary: Since shortly after its founding in 1998, the integrative medicine program at Jefferson University distinguished itself for the success of its clinical services. Now named the Myrna Brind Center of Integrative Medicine after an early backer, the program delivers over 12,000 patient visits a year from its location in a century-old landmark building formerly housing the Federal Reserve. With three separate sites on the campus, the program is a centerpiece of 2011 marketing for the entire Jefferson Health System. I met with medical director Daniel Monti, MD and the clinic's substantial backer, Ira Brind, on the elements of the center's success. Here is the interview.
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Interior of the Brind Center, a former Federal Reserve bank
Aficionados of the integrative medicine movement will find it humorous that an academic health center-owned integrative medicine center is based inside a building that formerly housed a
Federal Reserve bank.

The durability of the edifice may be pure irony for a field challenged with sustainability. Might an architectural doctrine of signatures lend a kind of credit that has frequently gone wanting?
What would Jon Stewart or Stephen Colbert do with this information, were they IM insiders? Guaranteed business success in a building where those who print money couldn't make a go of it.

The Myrna Brind Center of Integrative Medicine at Thomas Jefferson University has taken over the ground floor of just such an imposing structure, in the heart of downtown Philadelphia. I recently had the opportunity to visit with Daniel Monte, MD, the center's executive and medical director, and Ira Brind, the center's lead philanthropic backer. From the accounts of these partners, the venture has become a centerpiece of the Jefferson Health System's strategic plan.

In fact, the two report that the force and grandeur of the location does indeed seem to be lending the center more power, credit and visibility in the Jefferson system as well as to health care in Philadelphia.

In her name: Integrative medicine enthusiast Myrna Brind
Founded in 1998,
the center at Jefferson was among the pioneering ventures in academically-based integrative medicine. Original medical director Steven Rosenzweig, MD created an early reputation as a relatively robust clinical operation. In 2003, the clinic was renamed the Myrna Brind Center after a major gift from Ira Brind in honor of his then recently deceased wife. Myrna Brind was an integrative medicine enthusiast. The center is presently part of a $1.5 billion Jefferson system with 650 salaried doctors.

Brind is a former
CEO and president of McDonnell Douglas Truck Services. He has substantial experience in private equity and venture capital initiatives. In the integrative health space, Brind's involvements have included helping found and advise North Castle Partners, a major natural products player, and service on the board of the Bravewell Collaborative. He also serves as chair of the board of the Jefferson Health System. Brind, whose undergraduate major was biology, takes a keen interest in all aspects of the center's functioning.

Monti is a research psychiatrist with significant interest in both natural products and mind-body interventions.
This interview is composed based on our first encounter and subsequent exchanges.

Daniel Monti, MD, executive and medical director
Integrator: Some numbers. How big is the practice? How many people are you serving?

Monti: We have 3 sites on the Jefferson Campus, our academic offices, the main clinical Center, and the lifestyle facility for fitness training and group programs. The clinical center is unique in that we have a micronutrient program (e.g., IV Vitamin C and others). We also have an executive health program called the Great Life Program, based on our popular press book, The Great Life Makeover. We provide about 12,000 visits a year at this facility. This does not include all of the Mindfulness-based Stress Reduction and lifestyle programs we offer. The numbers have been going up about 10% a year. They'll go up higher this year.

: What are your chief clinical programs?

: We have many. Integrative Cancer Care is one of our lead programs and it includes some cutting edge therapies we are researching, women's health with a focus on menopause and bone health, integrative pain management, bio-identical hormone replacement therapy (HRT) for women and TRT (testosterone replacement therapy) for men. Also the programs I've mentioned, mindfulness and executive health. We also feature an acupuncture and Oriental medicine program. These are top. We have others.

: Many of the integrative centers such as New York Beth Israel seem to have moved toward a primary care model. How would you typify yours?

Ira Brind, hands-on philanthropic partner
Monti: Ours is a consultation model that provides assessments, treatment plans that complement current primary and specialty care, and follow-up care that may have primary care components. We encourage our patients to maintain their primary care providers and we work collaboratively with the other physicians providing care to our patients.

: Top diagnoses?

: Cancer. Pain. Wellness. Auto-immune. Gastro-intestinal issues.

: How is care managed? What is the experience when a patient comes into the clinic?

: The gatekeepers for clinical care are our integrative medicine MD's, all of whom are board-certified in their respective fields with full Jefferson credentials. All have extensive training in integrative medical care and most practice functional medicine. The physician sets the treatment plan.  For example, the head of the Pain Program is a physical medicine specialist.  She does the initial assessment and determines the appropriate treatment plan, which could include acupuncture, nutrition, manual therapies, tailored exercises, the stress reduction program, or even additional diagnostic tests and referral to other medical specialists.

: You would seem to have come a long ways from 1998 to inhabiting this facility.

: We started out in 1998. Early on, the main response from physicians was disdain. At this point we are an important part of the strategic plan for the system. We are pretty well embraced. Last fall the Jefferson Alumni Bulletin ran a big cover story on us. At this point there is still some disdain and ignorance, but now they would be silent when before they would speak. Those who oppose what we are doing wouldn't speak out as quickly now.

: How do you measure the advancement? What are the signs?

: We've built respect over several years of clinical trials, with several million from the NIH, plus a large foundation grant to support research. We just did a big mechanism study in nutraceuticals.

: Our success with research has helped us to establish service line integration with other Jefferson departments. For example, we have several collaborative studies with the Cancer Center, including 2 vitamin C trials and a lifestyle intervention trial.

Andy Newburg, MD, research director
: We also did a major meditation study, showing changes in the way the brain responds to stress. The research has been important. We recently recruited Andrew Newberg, MD, from Penn as our new director of research. He is an international leader in neuro-imaging and mechanisms of integrative modalities. The cancer doctors are now sending people to us. We're integrated into the GI malignancy team. The chief of surgery at Jefferson, a well known pancreatic doctor, is supportive.

: Your infusion room is unusual in integrative clinics. To my knowledge, very few offer these treatments and may not know how to say "Myers cocktail." I noticed in the major write up on your work last fall a picture of an infusion patient getting her treatment in your outdoor courtyard. How did you get that started? What all do you treat via infusion? How important is it to your model?

: It is very unique and it took a lot of work and collaboration with other Jefferson leaders to make this happen.  It was helpful that our academic department is Emergency Medicine, and the Chairman, Ted Christopher, MD, has been highly supportive.  We have approved study protocols for high dose, intravenous Vitamin C in cancer patients, and we also offer the Myers cocktail as you mention, which has a variety of vitamins and other nutrients that can be helpful to a range of patients that would benefit from supplementation that bypasses the gut.  I am the principal investigator on our infusion trials and it has been a labor of love to establish this unique service. We sometimes see astounding results, which is very gratifying.

: So your engagement in research and receipt of NIH grants has been instrumental to your acceptance?

: We're very involved in education too, and the current Dean of the Medical School has been highly supportive. We have a college credit course in mindfulness meditation plus an American Psychological Association-approved course on mindfulness for health professionals. We teach professional how to teach. We offer these programs in several sites all over town. We also do monthly grand rounds. Yesterday was  Vitamin C for cancer treatments. Dan did it.

: Let's talk bottom line. Is the clinic self-sustaining?

: 90% of the revenues are from operations. We are an operations-driven organization.

: On what level of gross revenues per year?

: A couple million dollars, and like everyone, we struggle to have a balanced budget. Our combined revenue streams, research, development efforts thanks to our wonderful advisory board, and tremendous institutional support from the hospital have been a winning combination for us.

: What aspects of the operation are chief contributors to the bottom line?

Anthony Bazzan, MD, leading functional medicine physician
: The cancer research and the infusion program are important as is the executive health program. We have very well-trained physicians. Just about everyone in the Center has completed the (Institute for Functional Medicine) training. Anthony Bazzan, MD is our big functional medicine guy. We've had 5 do the Weil fellowship training at University of Arizona. We always have 2 or 3 fellows in the  program, and they are generously funded by the Bravewell Philanthropic Collaborative.

: I am told by Bravewell that we have the highest retention rate of Bravewell Fellows who complete the fellowship and are able to stay and earn a living.

: How about inpatient care. Do you have any involvement there?

: We would like to do it but we need to completely absorb the cost. Once patients are in the hospital, we can't charge extra. There would have to be subsidies. Right now the average payment for Medicare patient is $3000 less than it was. This is a tough environment. We'll see. I expect that the (Accountable Care Organizations) will drive a change. But this is just speculation now.

: Covering inpatient services is now a wish-list for potential foundation support. We're beginning to work more with our nurses. We were featured for Nurses Appreciation Week in April. I keynoted at their request, and the topic was how to improve health and wellness with an integrative approach.  We also offered them a free four-hour introduction to Mindfulness, and over 70 nurses attended!

: This interview is evidence that the two of you have quite a close working relationship on this Center.


"The Center, in this facility, has high
strategic impact. The value is not just
it's bottom line. We have a very high
profile list of clients here. Our
reputation continues to grow. When
doctors come they are impressed."

- Ira Brind

Brind: Dan and I talk weekly. I try to help negotiate the politics.

: Ira's been a tremendous mentor to me. He provides a vantage point of having navigated twisted roads and he knows how to pass through.

: I bring business expertise. The place has to make sense. Business sense. This year we will be a major focus of the health system's marketing. As large as neurosurgery. As large as orthopedics.

: But couldn't this basically be from what one might call the Brind effect? I mean, you are chair emeritus of the hospital. You are on the board of the university. You are chairman of the board of the Jefferson Health System. Not to mention a huge funder.

: No, the attention the Center is getting now is a combination of Dan's work, his team here, and the real estate. The system's leadership sees featuring the Center as something that distinguishes them in the community. It is a way of extending to impact-full people. I had nothing to do with this. The Center, in this facility, has high strategic impact. The Center's value is not just it's bottom line. We have a very high profile list of clients here. Our reputation continues to grow. When doctors come they are impressed. That helps with referrals. We'll get more doctors to come here. The patients are impressed too. This facility has been very important for some very impact-full people.

: I'm excited about the marketing plan. The focus is print media. A big focus will be in Philadelphia Magazine.
I'm excited to see what will come of it. We recently were featured twice in the Health section of the Philadelphia Inquirer, which has had a tremendous impact on visibility and call volume.

: Dan's got a blog there.

: Perhaps I will have a chance to check in after Jefferson's campaign is under way to see what it has meant to the system and to the Center, to see this marriage of interests realized. Thanks for your time today in sharing your work.


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