International Trends in Integrative Medicine: A 10-Minute Guided Tour for the 2011 Dr. Rogers Prize
Written by John Weeks
International Trends in Integrative Medicine: A 10-Minute Guided Tour for the 2011 Dr. Rogers Prize Colloquium
Summary: The Vancouver, B.C.-based organizers of the 2011 Dr. Rogers' Prize asked me to help kick off the afternoon Colloquium that preceded the black-tie event. Their theme was integrative clinic models. They wanted a look at trends in integrative medicine internationally, though focusing principally on the United States. I'd have 10 minutes and would be followed by Steven Carter speaking at similar length on Canadian trends. After Carter gave me an okay to publish his comments, I thought why not publish mine. I am curious about any major blind spots. What did I miss or should have included to give that audience a better picture of the world integrative that is emerging. (Congratulations to Marja Verhoef, PhD on winning the $250,000 prize!).
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Sponsors of the Colloquium
One of the most significant North American gatherings in the world integrative is the Dr. Rogers Prize event. The black-tie dinner, held in Canada every second year, features the awarding of a $250,000 prize to a Canadian leader in integrative medicine. (This year the internationally-renown whole-systems, outcomes-focused health services researcher Marja Verhoef, PhD was the deserved prize winner.) The September 23, 2011 event was preceded by a Dr. Rogers Prize Coloquium on integrative clinic models. Four centers were featured, two directed by medical doctors and two by naturopathic doctors.Journal of Orthomolecular Medicine editor Steven Carter and I were asked to help set the stage. The organizers charged me with capturing international trends. Carter followed with a talk on Canadian trends published here. Here is this 10 minute travel guide, briefly touching down in Australia, South Africa, Switzerland, the European Community, Uniterd Kingdom before exploring developments south of Canada's border in more detail.
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It is wonderful
to have this opportunity to be with you today. As many of you will know,
down in the States, half of our national leaders count such jaunts across the
border as evidence of international expertise and their preparation for global
leadership. I guess I am ready for office.
I have always enjoyed my
involvements in integration up here – the first in 1999 or so. You Canadians are
more civilized, more open, more friendly to the whole mix of disciplines. It turns out, when it comes to
integration, that this view of Canadians is not only a stereotype.
Dr. Rogers Prize colloquium
program today is evidence. We see a focus that visibly highlights both MDs and non-MDs.
Rare, State-side. If it’s not run by a medical doctor, it’s not worthy of
consideration. Too often that seems to be the view. I continue to be startled
by the glass ceiling that exists below the border that marginalizes the non-MD
integrative disciplines. Congratulations
to the organizers of the Dr. Rogers Prize for their equanimity and leadership
in integration of the disciplines as evident in the program.
Happily, we are seeing
some changes in the United States, as I will share. Perhaps with your dollar stronger than ours, we
might start thinking we have something to learn from you.
Google Alert and the deluge of activity
Around the world
integrative in 10 minutes was the charge.
I’ve already spent 90 seconds.
I invite any of you to go
to Google Alerts and plug in “integrative medicine” or and “complementary and
alternative medicine” and ask for a daily report. Only the most obsessive CAM-wonk
among you won’t want to unplug from the deluge within days.
Never mind for a moment
the flood of articles in peer reviewed journals. One witnesses a great deal
going on in hospitals and health systems, in government policies, in
universities, in integrative clinics and centers. Then there is the continuous,
often not altogether friendly, battling back from the anti-integrative crowd for
the high moral ground about what is legitimate to offer as medicine or health
care, and what should be left out.
Author Weeks at Dr. Rogers event with spouse Jeana Kimball, ND, MPH
Meantime, there is still
much less going on in coverage and payment of integrative practices and complementary and alternative medicine services
than many consumers and practitioners would like. Many of you will know what I
am talking about.
If one is to begin with
trends, internationally, there are three important lines that are constants,
two of them for millennia.
One is that roughly 80% of
the world’s population uses traditional, natural, indigenous medicine for the
vast majority of primary care.
The second is that the
single largest system of medicine in use globally is acupuncture and Oriental
medicine, in its various forms.
These are more facts of
life than trends. They are use patterns. They are significant if we think about what we are doing in integrating natural health and high tech medicine. We are, as a naturopathic
doctor colleague once put it, engaging a "return to the memory." We are probing
and plodding with various more or less clumsy forms of science to guide this
re-inclusion of mind-body and whole system philosophy and story and humanity
and diet and exercise and natural products in our care of ourselves.
Six countries in 90 seconds
It is worth a mention that
in August of 2011, the oldest University in the West, the University of
Bologna, founded 1088 AD, appointed Paolo Roberti di Sarsina, MD to its faculty to
teach a course on traditional and non-conventional medicine. This was a first
ever such course and faculty appointment for that esteemed institution.
Given the age of the University
of Bologna and the timeless durability of the non-traditional therapies under
consideration, we might perhaps look upon this as two of our elders beginning
to make eyes at each other in a senior home.
In Australia, via strong
connection with China, we've seen a chair of Chinese medicine sponsored at the
University of Sydney. There is a move for a quality, standardized regulatory
framework for traditional Chinese medicine throughout the country by 2012.
In Switzerland, a
multi-year, controversial, governmental process is under way examining whether
the government should continue to cover CAM treatments. Consumers and public
officials and a subset of doctors are pitted against many in the regular
medical community in a debate that has spilled across the borders.
Meantime, in the European
Community, a new pan-European research network organization called, quaintly,
CAMbrella, held its second meeting last spring and its third earlier this month.
They are working on efficiently utilizing a first ever $1.5 million Euro grant
from the 7th Framework Programme for Research and Technological
Development.
Then in the United
Kingdom, amidst a battle over homeopathy, we have the ongoing tele-novella
called "Dr. Ernest and the Prince." Stay tuned for the next installment.
Here's a spot of data on
growing interest. A major international research meeting in this field, renamed
this year the International Research Congress on Integrative Medicine and
Health, anticipates drawing over 1000 to its May 15-18 meeting in Portland,
Oregon. The founding meeting, in Edmonton in 2006, was viewed as wildly
successful. There were 560 attendees. The field is growing.
Trends in the United States
Now I take you stateside. My
focus here will be evidence that my own perimeter is roughly as narrow as my fellow
country people who think a trip to Vancouver prepares them as experts in
international affairs.
An August 2011
study found that 76% of healthcare workers use some complementary and
alternative medicine. This is above the use level in the general population.
Since most integration is led by the passion of users, this bodes well.
In those
hospitals, some 42% of respondents to a survey repeated in some form since 1999
say they offer CAM. The sponsors of this September 2011 report were the
American Hospital Association and the Samueli Institute, Wayne Jonas' operation.
This is up from 7.7% just 12 years ago.
A major Consumer
Reports survey was published in July. It not only showed high use. It also
showed that for some conditions, consumers valued various CAM modalities as
more effective than pharmaceuticals or OTCs. Chiropractic, deep tissue massage
and yoga faired particularly well. Use these first if you want effective
treatment, the consumers said.
Notably, the consumer
perspective is supported by research evidence and incorporated in significant
guidelines. The American College of Physicians and the Academy of Pain
Management recommended 8 treatments for persistent back pain in their
guidelines. 4 of these are CAM treatments.
The United States' National Prevention Strategy also published last June specifically included
CAM. The new quasi-public Patient Centered Outcomes Research Institute - PCORI
we call it -- which will soon begin dispensing over $600-million a year for
research on patient-focused outcomes, has a chiropractor on its Board of Governors.
The Governors heard from a CAM panel in a listening session last Monday,
September 19. The presentations we
apparently well received. New connections were made about how utterly patient-centered the movements that have grown the CAM disciplines are.
Inclusion grows
The most significant
example of that inclusion was the Obama Affordable Care Act passed in 2010. That new, highly debated law was in fact the
stimulant for each of the 3 forms of integration into federal policy I just mentioned: the IOM's pain blueprint, the natural prevention strategy, each published in June
2011, and the work of PCORI.
From the perspective of a
single issue voter who cares about integrative medicine and complementary and
alternative medicine integration with conventional treatment, that law was a
huge advance. The Obama-Pelosi Patient Protection and Affordable Care Act
mandated inclusion of licensed CAM disciplines in: workforce planning; the
national prevention strategy; patient-centered outcomes research; and in the
delivery model in the states that is all the buzz that we are calling
patient-centered medical homes (PCMHs).
Last but not least, and
certain to be a source of a significant battle, there is a non-discrimination
clause that, if passed, would force a new level of insurance coverage and
inclusion of licensed CAM practitioners. Not surprisingly, the American Medical
Association's House of Delegates passed a resolution within 3 months opposing
the clause.
A factor in these shifts
is that the CAM and integrative medicine fields have achieved new levels of internal
organization in the past decade. The Consortium of Academic Health Centers for
Integrative Medicine, which includes Canadian institutions, now has 50 members.
Some of us have formed the
Academic Consortium for Complementary and Alternative Health Care to bring all
of the licensed CAM disciplines of chiropractic, naturopathic medicine,
acupuncture and Oriental medicine, massage therapy, midwifery together.
These are jointly seeking to advance whole person practice and to better
patient care through enhancing mutual respect and understanding across the
disciplines.
These two Consortia, you
heard it here first, plan to jointly sponsor a first-ever International
Congress on Education in Complementary and Integrative Medicine in October
2012. Stay tuned.
Another important advance
- though slow: an Integrated Healthcare
Policy Consortium is, while grossly under-funded, on the ground in Washington
DC as a lobbying organization promoting integration in federal policy. They
were partly responsible for some of the language noted above in Obama's 2010
plan. It pays to show up. The Samueli Institute, led by the keynoter this
evening, Wayne Jonas, is the only other significant player, besides the
American Chiropractic Association, working routinely in the Nation's capitol on
behalf of integrative practice, approaches and interests.
Finally, a forth
organization worth noting has announced a significant new development two weeks
ago. The University of Arizona Center for Integrative Medicine, founded by
Andrew Weil, a past Dr. Rogers Prize keynoter, is the most significant North
American player in educating integrative medical doctors. Philosophically they
have stood for integrating all medical specialties. They have resisted pushing
the creation of a separate integrative MD specialty, or guild. That way of
thinking is now in the past. The Center is now, in a "both/and" strategy: a
formal dialogue has begun to establish the American Board of Integrative
Medicine. A new specialty, a new guild, is arising!
Closing
I close with a couple of
general trends in health care that support integration.
One is the focus on what
is patient-centered, in research, in policy, in practice. How can one be patient
centered and not include CAM? All patients don't use complementary and alternative therapies and practitioenrs, but enough do that
anyone who attempts to align with "patient-centered" needs to include CAM.
Period, the end. To not include CAM may
be positioned as evidence-centered or honestly as provider-centered or
guild-centered. It's not patient-centered.
The second general trend is
the focus on the real world and outcomes in research. This is a priority in the
NIH National Center for Complementary and Alternative Medicine 2011-2015
strategic plan. The Canadian In-CAM network has led this work for our fields
internationally. The OutcomesDatabase.org is a fine piece of work from IN-CAM.
This is also the heart of PCORI's work. Research questions are moving closer to
patient experience. The whole practice of integrative care will be a
beneficiary.
A third is the emergence
of inter-professional education and care in academic medicine, another
nominally patient-centered endeavor. This is engaged in part to reduce errors and also to
enhance care. This effort also has a hard time, from a perspective of
mission and stated values, in excluding licensed CAM educators and integrative practitioners.
The trend-line of globalization
The fourth general trend is
the inter-relationship between the medical cost crisis and the gawd-awfully
slow emergence of prevention and health-creation on the agenda of researchers,
delivery organizations, payers and policy makers. Health outcomes are actually,
for the first time, in the NIH NCCAM strategic plan. This direction, the wake
up to the very concept of whole person, health-focused practices that routinely
have positive side effects, is finally coming around.
The most significant trend
line we are riding is the human trend of globalization. Integrative medicine is
part of a broader human process. Our movement toward internal wholeness is a
movement in which our humanity extends across borders as we embrace practices
and welcome insights of other traditions. The healing with which we work is a
marker of global healing. The postulate would be that if technology continues
to lord over medicine as overseers and the only fount of wisdom, I fear this
bodes poorly for peace on earth.
Finally, more of a truism
than a trend, is that if one doesn't show up, one can't really complain about
not being in the picture. The rule in the United States still seems still to
be: If complementary and alternative healthcare experts, researchers or clinicians, or Board Certified
Integrative Medicine doctors, are not at the table, they are still likely to be
overlooked and not integrated, whatever the level of policy initiative, education
endeavor or clinical effort.
From the perspective of
the patient, and the globe, it serves us to figure out how to be at as many
tables as possible.
Thank you.
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