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International Trends in Integrative Medicine: A 10-Minute Guided Tour for the 2011 Dr. Rogers Prize PDF Print E-mail
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.   

_______________________________

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.

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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.


There's a kind of healing in that.


Some country-by-country examples:




  • 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.


  • 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.


Let's start with data from 3 recent surveys:


  • 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.


In the United Stated, we are now increasingly seeing CAM directly included in significant federal reports and documents. The June Institute of Medicine report: Relieving Pain in American: A Blueprint includes multiple, affirmative references to CAM.

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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