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Manahan: Priorities for Integrative Medicine/Health - NDs, Health Caches, and Evidence-based Payment PDF Print E-mail
Written by John Weeks   

Bill Manahan, MD: Priorities for Integrative Medicine/Health Should be More NDs and Health Coaches, and Evidence-based Payment

Bill Manahan, MD
At the Integrative Healthcare Symposium in March 2013, I interviewed 8 clinicians and asked them to step out of their clinical mindsets and talk policy. Picture the roughly 1000 clinicians from diverse disciplines gathered at the conference. What do you see as the most significant policy action the group can engage to advance integrative health and medicine in the U.S. Their responses were published as
Integrative Medicine Clinicians on Policy Priorities: Bland, Gahles, Hui, Kligler, Luck, Hudson, Gorman, and Jones.
Bill Manahan, MD, the Minnesota-based family physician, educator and long-time leader in holistic medicine responded to a call for additional perspectives. An Integrator adviser, Manahan organizes and runs an active Minnesota branch of the American Holistic Medical Association. Here are his additions to the dialogue.


Policy Recommendations: More Naturopathic Schools and  Health Coaches, plus Evidence-based Payment in Regular Medicine

-  Bill Manahan, MD

March 24, 2013

"The top policies regarding health care in the U.S. are probably a combination of the elements mentioned by the amazing and articulate people you interviewed in NYC recently.  Here are my ideas - most of which have already been discussed by the interviewees.  Knowing me, John, you know that it is impossible for me to just say one policy!

Conventional medicine follows good science
in just 38% of what they do ...
Just imagine
how practices would change if hospitals and
physicians were reimbursed for only that 38%!

"First, I think we have to recognize that allopathic medicine is following good science (according to Cochrane) in only 38% of what they do. That means that a majority of what is presently insurance and Medicare reimbursable may be doing more harm than good. Just imagine how practices would change if hospitals and physicians were reimbursed for only that 38%!  Added to this first policy change would be tort reform regarding malpractice. We order lots of unnecessary tests because we protect ourselves from lawsuits by doing that (or at least we think we do).

"Second, I would greatly expand the number of naturopathic schools so the students trained there become the primary care, outpatient doctors of the future. They would also have special expertise in functional medicine and in working collaboratively in teams with other types of providers. They would have at least a one-year residency after the four years of naturopathic school.  These schools would become models of medical education that truly balanced science and linear thinking with compassion,
Greatly expand the number of naturopathic
medical schools ... and go into communities
and provide each family with a health coach.

love, spirit, heart, and self-care. Medical training would actually be fun!  Medical and osteopathic schools of the future would train only subspecialists and hospitalists; not primary care doctors.  It is time to recognize that the treatment of acute illness and injury is often quite different from the treatment of chronic and multifactorial disease.  Therefore, we need to train the providers in a different manner. 

"Third, we need to go into the communities and provide each family with a health coach.  We have coaches for sports, for fitness, for financial advice, for tax advice, and for most of our education (called teachers), but we do not really have anyone to educate and assist us with our health and medical problems.  Bringing the community together for health-related problems (as we did for tobacco-related problems) could be the most important change in health policy to occur.  The nursing profession could be the leaders in this hands-on, community-based health care and health coaching.

"Well, John, there are other important policy changes needed, but I have already surpassed my 200 words.  In closing, I will say that I really agree with Jeff Bland's idea to have one state step forward and become a model of these new policies.  Maybe we will get working on that here in Minnesota!"

: I don't imagine that many of Manahan's integrative medicine colleagues will support his second recommendation. Yes, a vast expansion of naturopathic medical institutions would likely lead to advances in the public health - particularly if that field adheres closely to its principle of what it originally called "treating disease by restoring health." Yet we need to re-purpose general practitioners in all fields toward integrative health. Its a numbers game. We have 700,000 medical doctors and 5,000 naturopathic doctors. So, push on this at both ends.

Notably, if an expanded set of NDs and re-purposed general practitioners of all types see themselves as working collaboratively as teams in protecting and restoring health,
they will of necessity both be health coaches and be utilizing this emerging practitioner group pro-actively and routinely. 

Manahan's recommendation regarding evidence
creates an LOL sort of moment. Imagine if what was good for the goose was indeed good for the gander, relative to evidence. The edifice of waste, over-treatment and harm that is an evidence-based portrait of some 30% of the hospital-centric U.S. system would begin to look like a tourist site in Greece.

Finally, Minnesota is certainly among the top contenders to take up Jeff Bland's charge to model reversing the perverse incentives in our payment system to stimulate health-creating practices. I'd put Oregon and Vermont there too, with the latter the most likely. Wouldn't it be wonderful if state health policy makers around the country were scurrying around to best practices conferences on this charge? Instead, the best of them are proactively engaged in the contorted, contradictory movement for affordable care organizations in which they must both protect the present capitalist ca-ching while trying to recourse medicine's rivers of cash.

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