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background resources in PDF |
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some CAM/IM publication links |
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Top 10 for Policy and Action in Integrative Medicine and Health in 2012 |
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Written by John Weeks
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Coming of the Light! Top 10 for Policy and Action in Integrative Medicine and Health in 2012
 Coming of the Light! Happy Solstice
The links listed here and here
evidence the seeding of integrative health and medicine, from
Shreveport to South Amboy, Asheville to eastern Oregon, Manchester to
San Diego. Medicine is changing to reflect popular interest, evidence,
and an emergent movement in health systems toward personal empowerment
and health creation.
What we call "integrative medicine" was made possible, in part, by
work in the 1980s of complementary and alternative health care
practitioners like chiropractors, acupuncturists, massage therapists and
naturopathic doctors. They laid a groundwork of licensing and
certification that enhanced popular interest in, and access to, natural
health services. Just so, present action and policy are laying
infrastructure that will inform and embolden participants into the
future. Here are the Top 10 for policy and action in integrative
medicine and health for 2012.
 Herman: lead author of key cost-effectiveness publication
Evidence of effectiveness is a classically "necessary but not
sufficient" tool in fostering integration. "Show me the money" is the
rejoinder. The year 2012 put two jewels in this crown. Insurers and
employers will be most taken with an analysis in Medical Care grounded
in the Medical Expenditure Panels Survey (MEP) 2002-2008 that showed
CAM users with spine-related care had $526 lower costs per year for
spine-specific costs and $796 lower per year for total health costs. A long-awaited review
led by Rand economist and naturopathic doctor Patricia Herman, N.D.,
Ph.D. and Harvard's David Eisenberg, M.D. reported cost-effectiveness in
28 high-quality studies. The emergence of a positive Swiss government's report on homeopathy added fuel. Time for payers to be more proactive.
 Parker Hannifin's Washkewitz
Among payers taking the lead, none is more bodacious in his inclusion
of CAM in his benefits plan or confidence in cost savings than global
manufacturer Parker Hannifin's CEO Don Washkewicz. In "A Solution to Our Country's Big Health Care Problem?"
Washkewicz admits that cause and effect aren't clear. But after
introducing his robust CAM benefit, annual per-employee medical costs
sunk from $6,500 to $3,200 between 2007 and 2012. His plan is to measure
and report the savings then "publicize the hell out of it." As reported
in my previous HuffPost blog,
Washkewicz' confidence and some related reporting convinced CFO's
deputy editor to urge his audience of chief financial officers (CFOs) to
"think bigger, much bigger" via exploring new integrative medicine
coverage options to control costs and achieve better outcomes.
 CAM benefits: will they or won't they?
All we know about what the Affordable Care Act (ACA) will do to
access to complementary and alternative health care practitioners and
services is that we don't know. Will hard-won "mandates" for coverage
over recent decades be lost if services and providers are not in
Essential Health Benefits (E.H.B.)? Or might they be expanded to
self-insurers via that act's Section 2706's non-discrimination clause, as some believe? A New York Times article
featured Jeannie Kang, LAC, past president of the American Association
of Acupuncture and Oriental Medicine, on her work to get acupuncture
into E.H.B.s in California and five other states. The American
Chiropractic Association is activating its state leaders to get to the
table. In Oregon, naturopathic doctor Bill Walter, N.D. is finding success
in getting his profession into that state's Coordinated Care
Organizations. In response to perceived needs at the state level, the
multidisciplinary organizing and lobbying collaboration called the Integrative Healthcare Policy Consortium
has decided to focus 2013 efforts on supporting state organizations in
engaging the changes such as 2706 that are flowing downstream from the
ACA's passage.
 Hyman: powerful influencer in multiple arenas
Integrative and functional medicine clinician and author Mark Hyman,
M.D., seems to have been everywhere in 2012. The new book by the
chairman of the Institute for Functional Medicine, The Blood Sugar Solution,
is graced by a cover quote testimonial from none other than former
President Bill Clinton hoping the book "will inspire you as he has
inspired me." The New York Times No. 1 best-seller received heady endorsements from
about every other bright light for a new medicine. Meantime, Hyman, a
HuffPost blogger, published a welcome manifesto in two parts for what we
need in true health reform: Money, Politics and Health Care: A Disease-Creation Economy. Talk not being enough, Hyman partnered with Pastor Rick Warren, Mehmet Oz, M.D., and others to promote The Daniel Plan
for weight loss via a church network. Credit Hyman for translating
theory into function in both clinical and public health environments.
 Adi Haramati, PhD: the lead convenor
Integrative medicine and health care are, at their best, team sports.
One provider can't do it all. Licensed acupuncture and Oriental
medicine practitioners, holistic nurse, massage therapists, mind-body
specialists, coaches and others need to be linked with the
physician-level services of chiropractors, naturopathic doctors and
medical doctors and surgical specialists in optimal teams. That means
bringing the disciplines together as they are educated. Pent-up demand
was evident when the announcement of the International Congress for Educators in Complementary and Integrative Medicine
drew over 250 proposals. The nearly 350 academics who met at Georgetown
University, via the leadership of Aviad (Adi) Haramati, PhD, on Oct. 26-28, 2012 experienced a historic phenomenon: a
true, lateral collaboration between a 54-member consortium of medical schools and a consortium
of 17 national organizations from the licensed complementary and
alternative healthcare disciplines. Numerous fruitful,
interprofessional collaborations are anticipated to follow.
 Cherkin: straddling the two institutions
So what happens when a population of individuals are treated
by integrative medicine physicians? A Seattle area research partnership
between an HMO-based research center and naturopathic medicine-based
institution of natural health sciences is taking a lead in researching
the key questions. The collaborators from Group Health Research Institute (GHRI) and Bastyr University
published an influential pilot led by Ryan Bradley, N.D., MPH showing
the success in lowering blood sugar and fostering habit change via
naturopathic care's personalized, multi-modality approach. A similar
team led by Erica Oberg, N.D., MPH followed up with an exploration of what a GHRI newsletter called the "secret sauce"
that helped these patients toward greater self-efficacy. That something
is right in the care was evident when Bastyr's teaching clinic ranked
first among all Northwest primary care clinics in a Puget Sound Health Alliance survey
of patient experience. The link between the two institutions was
recently fused further when GHRI's Dan Cherkin, Ph.D., a colleague on
both the studies, chose to take an additional position as chair of
Bastyr's Reseach Institute. Notably, Cherkin was also part of the cost study using MEPS data noted above.
 Westreich: modeling a more integrative philanthropy
While practitioners and academic health care institutions work toward
inter-institutional and interdisciplinary collaboration, the critically
important philanthropic sector has typically put its apples in the
baskets of M.D.-led initiatives. For most, empowering the institutions
connected to the 400,000-plus licensed "CAM" practitioners has been a
non-starter. There are signs of awareness that moving integrative health
can benefit from investment in these other sectors is growing.
Philanthropist and integrative medicine activist Ruth Westreich and the
Westreich Foundation epitomizes the new thinking. With roots in Scripps
Integrative Medicine, San Diego Hospice and the Bravewell Collaborative,
she attended a meeting of roughly 100 members of the Academic
Consortium for Complementary and Alternative Health Care (with which I
am involved), chose to join their Council of Advisers and then made a $100,000 gift. Westreich subsequently joined the Board of Trustees of
the multidisciplinary Bastyr University to assist its opening of a
naturopathic college in California. Westreich subsequently joined the
board of the Samueli Institute with
its historically multidisciplinary agenda. This new philanthropy
realizes that moving multiple, inter-related pieces on the chess board
can best advance the transformation of U.S. health care.
 Base for the new integrative medicine specialty
An awakening juggernaut in the medical doctor sector of the
development of integrative health and medicine is the American Board of
Integrative Medicine (ABOIM) as an approved specialty of the American
Board of Physician Specialties. ABOIM's still-quiet influence will pick
up speed with the first certifications in 2013. After announcement, the gestation period appears to be provoking healing and converging of disparate forces in holistic and integrative medicine. Grandparenting
guidelines have reassured those who have been in the field for decades
and held prior certification. The quality of accredited education in
chiropractic, naturopathic medicine and acupuncture and Oriental
medicine was honored through recognizing those with dual training (M.D.,
D.C. or M.D., N.D. or M.D., LAc). First tests are expect by mid-year.
Meantime, the ABPS' list of 21 approved fellowships
is testament to the current penetration of integrative medicine as an
innovation in the health professional education of medical doctors.
 Health Resources Services Administration: NccIM funder
That a federal agency, the Health Resource Services Administration
(HRSA), saw fit to announce a competitive grant for $770,000 to support
development and management of a National Coordinating Center for Integrative Medicine is news enough. While the wing-spread of that title overreaches the goals of the awardee, the American College of Preventive Medicine (ACPM),
there is much in the grantee's plans that can help fulfill on that
charge. ACPM will support placement of integrative medicine content in
12 preventive medicine residencies established under a parallel grant.
Placing this initiative in a specialty focused on prevention and health
promotion reconnects the integrative care movement to its roots in
health. The ACPM's decisions to drive the initiative via a
multidisciplinary steering committee, a diverse set of partner
organizations and a broad community of learning each opens new windows.
ACPM and its grantees will learn a great deal from their integrative
medicine colleagues. Hopefully some of these project characteristics
will enhance the broader academic movement.
 Mack: powerful president of the sunsetting collaborative
Last listed here, in the spirit of the rain-maker who is often named
last on research publications, is the powerful generator of much
development of academic integrative medicine in the past decade, the Bravewell Collaborative of philanthropists in integrative medicine. The organization, under the watch of its second president, Duke integrative medicine angel Christy Mack,
has announced that it has done much of what it set out to do when
founded in 2001. The organization plans to sunset itself in late 2013.
Meantime, Bravewell published a significant report entitled "Integrative Medicine in America"
that provides exceptional details on the services offered in academic
integrative medicine programs, and those believed to be most fruitful
for patients. While my blog here on HuffPost
notes that the title is an overreach, the gorgeously-delivered report,
co-authored by Bonnie Horrigan, Sheldon Lewis, Donald Abrams, M.D. and
Constance Pechura, Ph.D., is yet another strategically-delivered gift
from that strategically-created organization for integrative medicine.
Quite a year. Under-girding much of the activity is the decision by
U.S. President Barack Obama, the U.S. House of Representatives, led by
Nancy Pelosi, and U.S. Senate, with influence from Tom Harkin, to pass
health care payment reform. Included in that law, upheld in June, are direct footholds
for complementary and integrative practices. More importantly, many
characteristics and incentives in that act mark a general course
correction toward payment and delivery that turns attention to health
creation. This is an inviting host for the integrative health community.
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