Integrative Medicine, Complementary Alternative Medicine and Health Round-up #60: October 2012

Granted $774,000 to create NccIM

American College for Preventive Medicine wins $774,000

Michael Barry, ACPM Exec

Comment: The NccIM award caused a special happiness for this writer. The Academic Consortium for Copmplementary and Alternative Health Care (ACCAHC) with which I work was asked to be a partner organization on this grant. ACCAHC wrote a support letter. I was also asked to serve on an advisory panel. The panel is expected to be chaired by Yale integrative medicine leader David Katz, MD, MPH, and also includes his colleague there, Ather Ali, ND, MPH. Other partners include, on the integrative health side, the American Association of Naturopathic Physicians and the Integrative Healthcare Policy Consortium (IHPC). Also on the team with deep background in integrative medicine and health are Len Wisneski, MD, IHPC chair, and Pamela Snider, ND, an AANP leader with strong links to both IHPC and ACCAHC. What was most pleasing in ACPM's approach was the interprofessional and approach lodged in a deep commitment to primary prevention. Here's hoping this Community of Learning has tremendous, positive influence in the evolution of education in integrative medicine.

Barbara Brandt, PhD: point on huge IPE center

U Minnesota receives $4-million from HRSA as the first National Coordinating Center for Interprofessional Education and Collaboration

Mary Jo Kreitzer, RN, PhD: integrative leader at U Minn

Comment: The University is a terrific site for this award, from the perspective of the integrative health community. First, Mary Jo Kreitzer, RN, PhD, FAAN, integrative health leader at the academic health center, is a long-time colleague of Brandt. Second, Kreitzer's center for Spirituality and Healing has a history of collaborating with academics in the licensed CAM fields, particularly through Northwestern Health Sciences University but also Bastyr University. Third, Brandt is personally familiar with the integrative health movement. She will key-note the upcoming International Congress for Educators in Complementary and Integrative Medicine. Fourth, the Center will focus on connecting professionals more deeply with the real world needs of the healthcare delivery system. The Twin Cities has perhaps the highest level on integration of integrative health practitioners into mainstream service delivery of any metropolitan area of the country.

Lead author Patricia Herman, MS, ND, PhD

Key data for policy leaders published in Herman-Eisenberg systematic review of cost-effectiveness in CIM

A critically-needed review of all cost-effectiveness studies on complementary and integrative medicine (CIM) found 28 "high-quality studies," according to lead author Patricia Herman, MS, ND, PhD. The review was global and covered the years 2000-2010. Herman, an economist and licensed naturopathic doctor, first engaged the project with David Eisenberg, MD with the Harvard School of Public Health, in 2008. The report is entitled

Comment: First, credit Herman, in particular, for the labor that this survey entailed. She personally read over 13,000 abstracts generated through key words searches. Second, why just 28 studies, globally, in 10 years? heck, this is an era in which many are obsessed with the awful cost situation. In fact, if one looks closely, one finds only 2 that are actually looking at the way whole person practitioners treat patients in the real world. This is a time to truly bemoan the fact that the NIH National Center for Complementary and Alternative Medicine has failed to comply with the real world, outcomes-plus-health services charge Congress gave the agency in 1998. Will the next decade bring more than this sparse yield. Regardless, as Herman says, those who say there are no cost benefits from CIM services should be muzzled. The comment field here shows, however, that the Polarizing Science Blogger naysayers cannot be convinced by evidence.

Scirmish over EHB

Washington Post touches on state decisions relative to chiropractic and acupuncture in essential benefits

The WonkBlog for the Washington Post included a September 22, 2012 piece called: "Is acupuncture an essential benefit? Weight loss surgery? Under Obamacare, states choose." In California acupuncture is in. In Michigan chiropractic is in. Yet in Oregon "officials would leave both of those benefits on the cutting-room floor." The article details other negotiations and decisions in other states: "That nationwide patchwork highlights the difficulty of agreeing on what constitutes good basic health care, as well as the tricky balances that states face in weighing coverage vs. cost." An Oregon administrator opined:

Comment: What is particularly notable in the Oregon decision is that the state also has a top acupuncture and Oriental medicine school and a top school of naturopathic medicine. Basic patient evaluation and management from members of the latter profession will likely be included under "ambulatory patient services" - after a lawsuit or two - if Section 2706 of the Affordable Care Act stays on the books. The section which requires non-discrimination among different disciplines, stays on the books. A brief below looks at efforts of massage therapists in Washington state to gain inclusion in that state's plan. (Thanks to Kory Ward-Cook, PhD for the link to the CMA article.)

Len Wisneski, MD: an integrative case for CFOs

IHPC's Wisneski speaks on integrative medicine to over 400 employers on CFO Magazine webinar

Comment: Good for Miller to pull this together and get this audience thinking more deeply about how to create sustainable solutions through integrative approaches.

Sean Sullivan, JD: taking over WEF initiative

E

Much integrative medicine activity

October 2012 Integrator

Comment: As a side-note, two areas of significant media attention during the month were stimulated by scientific publications with positive outcomes for integrative approaches. One is the Scripps-based study on mind-body for PTSD in Marines.  The other was the systematic review of patient outcomes in the acupuncture literature noted elsewhere in this Round-up. 

ACA's delegates look at integrative practice

ACA House of Delegates passes resolutions on a chiropractor's role in integrative centers

The House of Delegates of the American Chiropractic Association passed a resolution relative to appropriate relationships in integrative centers at their late September 2012 meeting. The policy "offer(s) guidelines on participating in multi-disciplinary practices to help chiropractic physicians evaluate whether such opportunities emphasize financial gain over clinical appropriateness." It goes on: "The policy touches on the importance of an independent legal consultation before entering into an agreement and also provides specific guidance on hiring personnel, patient supervision, referrals, and coding and billing issues."

Comment: The disquieting chiropractic focus on a potentially non-patient-centered motivation leads to a flippant recollection that a great deal of "integration" into hospitals health systems over the past 15 years was stimulated more by financial gain (luring and pleasing customers) rather than medical leadership arguing for "CAM" inclusion as "clinically appropriate." That said, the chiropractors' focus on motivation leaps out. This is particularly so since the House also passed a resolution "promoting strict standards of conduct by encouraging members to adhere to not only ACA's Code of Ethics but all relevant federal and state statutes providing anti-fraud standards." That the ACA believes that focusing on ethics and motivation is this important evidences an apparent need. Credit the ACA's willingness to step into what must be a challenging internal issue. No one likes airing dirty laundry in public. Again, credit the ACA's self-regulatory instinct.

However, perhaps the most interesting statement in the report of the House of Delegates meeting is the quote from ACA president Keith Overland, DC describing the lure of chiropractic to patients. Overland attributes it to the profession's “collaborative, integrated, distinctive approach to health care that uses conservative, natural approaches first.” The "collaborative, integrated" language is welcome positioning for a profession that has historically been quite isolated. Good also to see the profession making a point of its respect for the therapeutic order that in embodied by putting the least invasive, conservative practices first. 

Businesses

Unsual network operator

Data collected by Jill's List available free for academic research; firm moves into employer market

Comment: Since the "integration" era began some 15-20 years ago, many businesses started to link consumers and other stakeholders to vetted lists of providers have come along. Many have long since departed, with their business models. Jill's List intrigues for reasons like this referral list, and the openness to partnership with academic researchers, and a project in which Shah has had a lead role in convening integrative medical doctors in the Boston area. Jill's List is presently in a league of its own for its commitment to actual integration, both in its modeling and its products. This business is worth looking into.

Sold again

Massage Envy, with now 800 locations, (re)sold to Roark Capital Partners

Comment: A massage leader who sent this on commented wryly: "What a quaint, personal craft/cottage industry!" In May 2008, Veria, a wellness conglomerate, acquired Massage Envy. Veria, which described itself in their release as "a growing natural health and wellness company," is part of the Essel Group of companies, a multi-billion dollar consortium encompassing television networks, cable systems, satellite communications, entertainment enterprises, and one of the world's largest packaging companies. At that time, Massage Envy, founded in 2002, had 420 clinics nationwide. This was up from 265 when the Integrator covered its exploding business in September 2007. The Integrator article was called $90-Million Massage Envy Turns to Employee Benefits Market.

Patients at Crossroads

Samueli Institute's "Patients at the Crossroads" to explore intersection of integrative, evidence-based and patient-centered health

The subtitle of the conference intrigues: "

Comment: Morrison may prove a terrific choice for this role, particularly in drawing the health system audience Samueli is targeting. Given the question Samueli Institute is posing, Merlin may have been a better moderator. The research community has not thus far been much interested in asking the kinds of health services and outcomes questions that will help us provide the qualitative and quantitative evidence to guide a less magical resolution to the issues that will be on the table at this conference. I picture the patient advocate for integrative practices and practitioners facing off with an evidence curmudgeon. These typically fail to see the evidence holes in conventional practice. One hand over the other, each ascends the length of a bat, to determine who gets to be first. Patient-centered is not synonymous with evidence-centered. There is a winner here.

Pathways: $ for new digs

Pathways to Wellness begins drive to support move to new location for serving the under-served in Boston

One of the nation's most significant providers of free and low-cost acupuncture and other so-called "CAM" services to the underserved, Boston's Pathways to Wellness, has begun a $380,000 fund drive to support a forced move. According to a message to Pathways supporters from director Demi Stathoplos, MSW, MBA, the Southend Community Health Center, Pathways' landlord for 6 years, needs the space while also wishing to maintain the collaborative relationship. Pathways, which delivers over 10,000 free and low cost acupuncture, massage and Traditional Chinese Medicine treatments annually, has found space nearby. Details of the plan for the move are here.

IN-CAM: parallel themes

Detailed plans for November 2-4 IN-CAM Symposium in Toronto include massage summit, exploration of optimal benefits

The Canadian research organization IN-CAM has published a detailed schedule for its annual research symposium, to be held in Toronto November 2-4, 2012. Various pre-conference events are scheduled for November 2. These include an invitational National Massage Research Priority-Setting Summit which was organized by Trish Dryden, MEd, RMT and Bryn Sumpton, BSN and will be facilitated by Barbara Reece, RN, BS. Reece,a former vice president for Optimal Healing Environments with the Samueli Institute is also offering a keynote entitled: "Cultivating Leaders: The Next Priority for Integrative Health Care?" Keynoter Herbert Emery, PhD will ask: "Should complementary and integrative health services be included in Canada's "Medicare Basket" of publicly funded services?" IN-CAM co-founders Marja Verhoef, PhD and Heather Boon, BscPhm, PhD also offer keynotes, as does Claudia Witt, MD, MBA.

Comment: The border with Canada appears all the more porous as I read this agenda and the keynotes. Substitute "essential benefits" for "Medicare package." Leadership is indeed a major issue for integrative health organizations south of the border. Rumors are afloat of a leadership program in development associated with the Consortium of Academic Health Centers for Integrative Medicine. Reece herself has a key role in developing and facilitating an "ambassadors" program for integrative health for the Academic Consortium for Complementary and Alternative Health Care. In addition, Dr. Roger's Prize winner Verhoef is asking a question that crossed over into the Patients at the Crossroads theme of the Samueli Institute conference. Her title: "Evidence-based CAM: Can We Get it and Do We Need It?" Hate to miss this conference.

Academics

Networking residents in IM

Consortium of Academic Health Centers for Integrative Medicine begins forum for residents interested in integrative medicine

The co-chair of the Education Working Group of the 51 medical school member Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) announced in the organization's newsletter a new initiative to network residents from CAHCIM schools with an interest in integrative medicine. According to an open letter to such residents, the group will share best practices, engage a quarterly conference call, and support other such networking opportunities,. One feature is a Facebook site entitled Resident Doctors for Integrative Medicine. The leaders on the effort are residents Ashley Salomon, MD (PGY-2 University of Arizona Family Medicine) and Stephanie Cheng, MD (PGY-1 Contra Costa Family Medicine).

Comment: The initiative might eventually be smartly linked with the National Coordinating Center for Integrative Medicine, reported above, given its close relationship to the dozen preventive medicine residencies in integrative medicine.

Ron Zaidman, MTCM, MBA: huge growth at Five Branches

Portrait of growth in an AOM school: Five Branches University

The Santa Cruz Sentinel ran a focus on a local business on September 1, 2012: "Profile - Five Branches University grows to faculty of 100." The for-profit acupuncture and Oriental medicine institution was founded in 1984 with five faculty members and 18 students, according to founder and  current president Ron Zaidman, MAOM, MBA. The school now has 200 students in Santa Cruz and 240 students in a second campus in San Jose, California.

Comment: The story exemplifies the type of vision and leadership many of those responsible for the development of integrative care options in the 1980s. In an era of virtually no "cultural authority," and even less access to any public, private or foundation financial investment, individuals like Zaidman pulled together a handful of colleagues and started schools. These provided infrastructure that led to expanded availability of practitioners and services. The Five Branches story is multiplied across disciplines like massage, naturopathic medicine, yoga therapy and direct-entry (home-birth) midwifery, its growth and success a marker of the changes in the US culture, and a reminder of the gutsy, passion-driven work of those who pioneered.  

Congress for educators draws from 10 nations

Historic International Congress for Educators in Complementary and Integrative Medicine close to selling out

A near capacity crowd of close to 300 educators, researchers and leaders are signed up for the first ever

Comment: This is the most significant event ever developed from the ground up via a direct, horizontal collaboration between academics in integrative medicine and academics from the licensed complementary and alternative healthcare disciplines. The collaboration is apparent in planning teams, program teams, content and sponsorship.

Professions

Focal point of battle over chiropractic/chiropractic medicine

Battle in New Mexico

Comment: In a moment in which the documentary Doctored celebrates the contributions of chiropractic, the long simmering fight between what used to be called the "straights" (ICA) and "mixers" (ACA) comes curdling to the surface. A commentary in the Integrator by Stephen Bolles, DC, explores the issues. (See Stephen Bolles: Regarding a Trojan Horse with Chiropractic/Chiropractic Medicine at a Cross Roads.) Bolles, presently a consultant to LIFE, opposes New Mexico move toward advanced practice. He finds the association of chiropractic with "medicine" damaging to the field. In my commentary, I consider perspectives and come down in favor of the ACA's stance in favor of the right to self-determination.

Diana Thompson, LMP: retained to create cost document

Washington state massage organization pushes inclusion in essential benefits package

Comment: Since the 1995 every category of provider law, Washington has been an insurance leader for AMTA and the massage field. Are other states were so-engaged. Brooks responded: "I do not know of any other states in this same fight. My assumption is that we are leaders or rather in front, in that we have the every category provider rule backing and grounding our position. I am not totally in the know though. I do know that AMTA-WA is assuming that national will be using the document."

Suggests IM is a solucion

Escape Fire opens across country, highlights Weil, Berwick, integrative medicine

Andrew Weil, MD: highlighted in documentary

Comment: Interesting that this came out within 3 weeks of Doctored,which also examines the mess of US healthcare. Here integrative medicine is presented as a voice for solution. "Doctored," on the other hand, focuses on the complicity of the American Medical Association. Positive contributions, not of integrative medical doctors, but of the chiropractic profession, are highlighted.

Perhaps one day all of the integrative health vectors, from holism in medicine and nursing through chiropractic to patient-centered care to massage and yoga, may be brought forward in the same medium to name the value of this movement to shift the healthcare system. An LA Times review of Doctored is here. The movie will be featured at the upcoming Heal Thy Practice conference organized by Holistic Primary Care. HPC editor Erik Goldman calls it "a pretty right-on documentary that manages to get across some really important points w/o succumbing to partisan polemics. Please help us spread the word if you can." 

Larry Fitzgerald: using D'Adamo's genotype diet

Taylor Walsh seminars for Integrative Practitioner on social media in integrative practice

The Integrative Practitioner online community for integrative healthcare professionals is offering a series of seminars by Taylor Walsh on using social media in integrative practice. Walsh is the founder of Integrative Health and Wellness Strategies. His background includes a successful high tech start-up from the 1990s. He has recently consulted with the Samueli Institute and The Institute for Integrative Health. He is a columnist and adviser to the Integrator. The three down-loadable sessions are available for $59.

Taylor Walsh: social networking in integrative health

Report says NFL great Larry Fitzgerald uses Peter D'Adamo, ND's genotype diet to extend career

Comment: D'Adamo has established a Center for Excellence in Generative Medicine, in collaboration with the University of Bridgeport Department of Naturopathic Medicine, where his ideas are being explored.

Ryan Bradley, ND, MPH: research advances his profession

Research on naturopathic approach to diabetes gives that field significant positive attention in key diabetes publication

Comment: This study is a classic example of a profession advancing via quality research. Bradley and his team had the guts to proceed via the real world ambiguity of examining the whole practice of naturopathic medicine. Because reductionist researchers can't pinpoint the cause of the success, this leaves single agent researchers with, as a colleague of mine likes to put it, "their panties in a bunch." Instead, Bradley and Cherkin researched the way naturopathic doctors actually practice, using individualized multiple inputs that reflect their whole person approach. The result is the best press the naturopathic profession, as a profession, has ever received based on a researched contribution to human health.

Esther Sternberg, PhD: NIH researcher moves to Arizona Center

Esther Sternberg, PhD to lead research at University of Arizona Center for Integrative Medicine

Comment: Sternberg is indeed quite a catch for the Center. Anyone who comes and brings barrels of money is! Weil's comments on the "practical applications," "outcomes" and "cost-effectiveness research" are intriguing, however. While this is what the field desperately needs, these are not areas of special strength in Sternberg's past. He background is  compelling: chief of the Section on Neuroendocrine Immunology and Behavior at the National Institute of Mental Health, Director of the Integrative Neural Immune Program, NIMH/NIH, and Co-Chair of the NIH Intramural Program on Research in Women's Health. But there is not a lot of health services type experience here or in her CV. Perhaps the Center should re-enforce their connection with economist-researcher Patricia Herman, MS, ND, PhD who led the major cost-effectiveness review reported in this issue of the Round-up for some tutoring. Herman, who has a role in the Center's most significant cost study, recently left University of Arizona for the RAND Corporation.

Goldblatt: ACCAHC chair featured by IOM

Acupuncture and ACCAHC leader Elizabeth Goldblatt, PhD featured in Institute of Medicine Spotlight

In what may be a first for an individual principally associated with the so-called "CAM" disciplines, the Institute of Medicine of the National Academy of Sciences has featured Elizabeth (Liza) Goldblatt, PhD, MPA/HA in special Spotlight portrait. Goldblatt is among the most influential leaders in the development of educational standards in acupuncture and Oriental medicine via various roles in the leadership of the Council of Colleges for Acupuncture and Oriental MedicinE (CCAOM). Goldblatt was featured for her work as CCAOM's representative to the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), which she chairs. ACCAHC is a sponsor of the IOM's Global Forum on Innovation in Health Professional Education. Goldblatt's comments in the Spotlight include this: "ACCAHC has identified the need to better educate students, faculty and practitioners to not merely be reactive and treat symptoms, but also to focus on helping people get healthy.”