Integrative Medicine, Complementary and Alternative Medicine and Health Round-up #82: August 2014

Policy
-Whole System Health: Consider donating to the Massachusetts gubernatorial campaign of former CMS administrator Don Berwick, MD!
-American Herbal Products Association urges lawmakers to include "CAM" in new veteran's legislation
Research
-NCCAM-ipedia: agency responds (sort-of) to corrective appeal on acupuncture and chronic pain
-Regarding Christine Goertz, PhD, the "licensed integrative health practitioner" on the PCORI board of governors
-NCCAM advisor Jane Guiltinan, ND and Bastyr University on the NCCAM's proposed name change
Integrative Practice
-Naturopathic research group publishes data on naturopathic primary care based on 300,000 patient visits at teaching clinics
-Michael Cohen offers thorough exploration of "fee-splitting" in integrative practice for FON Therapeutics
-From Google Alerts: Links to Integrative Medicine in Health Systems and Communities from July 2014
Academic medicine
-Health reform stimulates U Minnesota to offer Masters in Integrative Health and Wellbeing Coaching
-Without Medicare, naturopathic doctors offer residencies to 17% of graduates
Organizations
-The 213 professionals certificated by the Institute of Functional Medicine
-APHA gives elevates complementary/integrative/traditional medicine group to section status
-Hospital group begins campaign promoting its role disease as an economic engine
-American Acupuncture Council offers seminars to bring acupuncturists up to speed on insurance changes under the Affordable Care Act
Professions
-American Herbalists Guild celebrating its 25^th year
-Nutritionists win first battle, in Michigan, following federal opening to non-RD nutritionists
-Naturopathic organizations to form World Naturopathic Federation with sights on W.H.O.
People
-John Tew, MD selected to head University of Cincinnati integrative medicine
-Chris Cassirer, PhD named president at Northwestern Health Sciences University
-Lynda Balneaves selected as founding director of the U Toronto Centre for Integrative Medicine
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Policy

Berwick: the candidate

Whole System Health: Consider donating to the Massachusetts gubernatorial campaign of former CMS administrator Don Berwick, MD!

Additional comment: For some of you, Berwick is a lightening rod because he has noted that outcomes are better - from human health and cost perspectives - under single payer systems, and thus he has advocated a single payer model. I appreciate his respect for the evidence.

McGuffin: AHPA director

American Herbal Products Association urges lawmakers to include "CAM" in new veteran's legislation

On July6 17, 2014, the American Herbal Products Association (AHPA) sent a letter to members of Congress in support of legislation that would expand complementary and alternative medicine (CAM) options for the nation's veterans. AHPA was supporting the Expanding Care for Veterans Act (H.R. 4887). This bill would "require the U.S. Department of Veterans Affairs (VA) to conduct research and develop a plan for inclusion of CAM, carry out a program for three years to ‘assess the feasibility and advisability of integrating [CAM services] with other health care services' provided by VA medical centers, and study any barriers that exist to receiving and administering CAM services in VA facilities." Says AHPA president Michael McGuffin: "H.R. 4887 is a good step toward expanding access to CAM for our nation's veterans." H.R. 4887 was introduced on June 18 by Rep. Julia Brownley (D-CA) and the bill language is also included in a broader Senate bill, the Restoring Veterans Trust Act (S. 2413).

Comment: Good to see this industry association acting beyond its strict industry agenda to support the direction for health care with which it is associated. McGuffin contacted the Integrator with this additional comment: "Even as we endorsed this we knew that the likelihood of getting this into the final VA bill is small. But the AHPA board feels strongly that our veterans should have meaningful health care choices that include modalities such as acupuncture, chiropractic, physical therapy, and naturopathy."

Research

Nielsen: informing NCCAM

NCCAM-ipedia: agency responds (sort-of) to corrective appeal on acupuncture and chronic pain

When New York Beth Israel acupuncturist Arya Nielsen, PhD, Ac, reviewed the NCCAM website on chronic pain last March she concluded that the site did not fully reflect present evidence, to the detriment of her field: "It seemed dated and oddly biased." Rather than simply complain, Nielsen, who in 2013 instigated the campaign to get the Joint Commission on Accreditation of Healthcare Organizations to re-open its guidelines on non-pharmacological approaches, put together what she called a "lit review" case for a change. On August 7, 2014, Nielsen shared with the Integrator that "we heard this morning they have updated their page informed by what we sent." The site now includes reference to two meta-analyses "that conclude acupuncture is effective for chronic pain beyond the placebo effect." She adds, however, "that the site doesn't exactly reflect it." She and her colleague are responding again.  Nielsen also serves as director of the Acupuncture Fellowship for NY Beth Israel.

Comment: Someone should give Nielsen an action award for, in this 12 month period, getting both the Joint Commission and NCCAM to engage changes in their documents. Thank you, Arya. And credit NCCAM for its responsiveness to good, if formerly overlooked, data.

Goertz: new PCORI role

Regarding Christine Goertz, PhD, the "licensed integrative health practitioner" on the PCORI board of governors

When the Patient Centered Outcomes Research Institute (PCORI) was formed, via the Affordable Care Act, Congress required the agency to have at least one "state licensed integrative health practitioner" on the agency's Board of Governors. Christine Goertz, DC, PhD has been that person.  Goertz' has since held a sequence of important roles at PCORI. She was first chair of the PCORI Program Development Committee. More recently, she began serving in the same capacity as chair of the PCORI Science Oversight Committee. According to its charter, this committee "provide(s) recommendations to the Board on the strategic goals to produce quality, timely, usable, and trustworthy comparative research information." This is in such areas as "research and scientific program priorities and topics, merit review process for applications, designation of specific research projects for funding and active portfolio management by staff."

Comment:  A challenge to the "state licensed integrative health" disciplines is to put forward candidates for this type of responsibility, relative in this case to a $650-million annual PCORI budget, who have the bandwidth and background to hold their own in a group of experts from professions whose institutions - and careers - have been powered by three generation of billions in NIH funding. Goertz is one such. Is there a PCORI "program priority" available to explore cloning her?

Taking a position on NCCAM's name change

NCCAM advisor Jane Guiltinan, ND and Bastyr University on the NCCAM's proposed name change

The recent Integrator article by Taylor Walsh on the proposed name change for the NIH National Center for Complementary and Alternative Medicine (NCCAM) included this statement in the comment field: "Notably, [Scott] Haldeman, an MD-DC, spoke to the exclusion he feels is implicit in not including ‘complementary' in the title. Walsh did not report whether Jane Guiltinan, ND, the only other member who meets the criterion [as a licensed ‘CAM' professional] spoke up." Guiltinan sent the Integrator the following clarification:

"I did indeed speak to this issue ... In my comments I agreed with Scott Haldeman, and expressed my concerns that eliminating any reference to ‘CAM' in the name would move us further down the road to less visibility and more exclusion for CAM disciplines and practitioners in the public's eye.  I stated my support for using the word health or health care instead of medicine, my support for omitting the word research, and finally, expressed my support for the name ‘National Center for Complementary and Integrative Health.' Further, I advised Bastyr's Chief of Staff on these matters and helped her craft the public comment made by Bastyr University."

Guiltinan: clarifies role

Guiltinan subsequently shared the formal comments submitted by Bastyr University, for which she serves as dean of naturopathic medicine. Bastyr's perspective is particularly of interest as a 2010 analysis found that it was, at that time, a recipient of roughly 33% of all NCCAM grants to "CAM" institutions. The Bastyr letter, signed by Coquina Deger, MBA, chief of staff at Bastyr, said:

"On behalf of myself and the academic leadership of Bastyr University, we thank you for opening the door to feedback in response to NCCAM's proposed name change. We are in support of the direction that NCCAM has taken with its newly proposed name, ‘The National Center for Research on Complementary and Integrative Health (NCRCIH).' After some contemplation and discussion, we have one suggestion to offer up for your consideration, and this is to consider dropping the words ‘Research on.' This would result in a shorter and more approachable title: ‘The National Center for Complementary and Integrative Health (NCCIH).'

"While we undoubtedly agree that the research objective is crucial to the activities carried out through NCCAM, our reasoning for this suggestion is largely for consistency among other NIH agency names. For example, NIDDK and NHLBI do not mention research in their title, even though research is at the core of what they do. Please note that we appreciate your recognition that ‘alternative' no longer serves to accurately describe what this Center does. We also appreciate your replacing the term ‘medicine' with ‘health.'"

Integrative Practice

Key data on the ND profession

Naturopathic research group publishes data on naturopathic primary care based on 300,000 patient visits at teaching clinics

A study led by members of the Naturopathic Physicians Research Institute (NPRI) examined 300,483 patient visits to naturopathic doctors at the field's academic teaching clinics. Some demographic findings were: patients were 69% female with a mean age of was 39; seniors totaled 9% of the population and children 8%. The group compared the profile of these settings to national conventional primary care and found a 44% overlap in the most frequent 25 diagnoses for primary care at these settings and conventional settings. Notably, 50% of patients paid out of pocket at naturopathic clinics, versus 4% in conventional centers, and naturopathic clinics more frequently offered discounted care - 26% of visits vs. 0.3%.  These data did not include visits at clinics operated by the schools in community settings. (Disclosure: I serve on the NPRI board.)

Comment: These findings support a key assertion of leaders of naturopathic medicine that these practitioners serve a broad primary care population and can be useful in meeting the nation's primary care needs. The similarities with typical primary care in this study would likely be stronger if the patients seen at the off-campus settings were included. These clinical education opportunities are meant to broader experience. Students work rotations through community clinics, health centers, schools and other external organizations. These patients, many on Medicaid or Medicare, and thus not cash paying, would show even a greater diversity.

Cohen: clarifying a complex issue

Michael Cohen offers thorough exploration of "fee-splitting" in integrative practice for FON Therapeutics

Lawyer, consultant and yoga teacher Michael Cohen, whose leadership and legal insight into integrative practices goes back to a seminal paper in 1995 has published at FON Therapeutics a thorough review of a key issue in integrative practice models - "fee-splitting." The perspective is entitled "Fee-Splitting 101 for MDs and Other Integrative Health Practitioners." The perspective will be particularly valuable for Californians, where Cohen, a former faculty member at Harvard Medical School, currently resides.

From Google Alerts: Links to Integrative Medicine in Health Systems and Communities from July 2014

This monthly Integrator feature is a quick capture of highlights from the multitude of links that flow in daily via Google Alerts for "integrative medicine," "complementary and alternative medicine" and "alternative medicine." It is interesting to see in one month the strong pieces supporting lifestyle for cardio risk, "CAM" during treatment for brain surgery, and "CAM" for MS.  The month was also notable for a number of announcements of new integrative medicine centers or clinics in health systems. Here are 17 selections related to hospitals and medical organizations in integrative medicine, 11 from alternative and integrative medicine in community non-system practices, and 8 developments from around the world for June 26-July 31. 2014.

Academic medicine

Lawson: health coach leader at U Minn

Health reform stimulates U Minnesota to offer Masters in Integrative Health and Wellbeing Coaching

The June 17, 2014 announcement of from the University of Minnesota distinguished itself by starting with a reference to federal politics: "The passage of the Affordable Care Act (ACA) as part of healthcare reform has stimulated numerous changes in the delivery of care, including more emphasis on health promotion, lifestyle management, and team-based care." The release noted that in "responding to these important and timely needs" they will begin a new Master of Arts in Integrative Health and Wellbeing Coaching. A local health system leader Nico Pronk, MD, heralded health coaching as having "promise as a player in changing the nature of our existing healthcare system." The 38-credit degree program will offer coursework in a blended format of online and in-person intensives.

Comment:  The Center has been a leader in the health coaching field for many years, via the visionary leadership of Center director Mary Jo Kreitzer, PhD, RN and of health coaching lead Karen Lawson, MD. This is an intriguing next step.  Here's hoping that the graduates will be readily hired, as the release hopefully suggested, into "a multitude of practice settings, including hospitals, clinics, health educational facilities, community centers, senior living centers, fitness venues, corporations, schools, and private practice." The question is certainly not one of need. Good for the U Minnesota team to respond to this call for transformation.

Beeson: NERC co-founder

Without Medicare, naturopathic doctors offer residencies to 17% of graduates

A little known fact for many outside of conventional medicine is that the residencies for medical doctors and osteopathic doctors are mainly funded through a Medicare subsidy to medical education. This amounts to some $10-billion per year or $113,000 per resident per year. Naturopathic educators have prioritized a rapid increase in post-graduate educational opportunities such as residencies as a critical next step in the professional's advance. But how can the field do this without federal subsidy? In the ND's experience, the cost of such a residency is roughly $45,000 a year. 

Hudson: NERC co-founder

In 2005, two leading naturopathic clinicians, Portland, Oregon-based Tori Hudson, ND and Billings, Montana-based Margaret Beeson, ND chose to take this challenge on by founding the Naturopathic Education and Research Consortium (NERC). The not-for profit's purpose would be to develop resources in a grassroots way to drive the growth in residencies. At a fourth annual "Resveritrol and Residencies" event on August 8, NERC celebrated the successes of their grassroots model. From 2 residencies in 2006, they currently have stimulated the development of 16. This is 28% of the 56 available to the 350 naturopathic graduates last year. The vast majority of the 40 others are positions in the teaching clinics of the 7 accredited North American schools. The NERC residencies are funded by a combination of corporations, grateful patients, and outlays from doctors at the clinical sites where the residents practices. The total of 56 residencies is amounts to 17% of the 350 naturopathic graduates in 2013.

Comment: Imagine that your taxes were paying for residencies of another profession yet your own field can only provide a similar opportunity by going booth to booth to exhibitors, or making asks from grateful patient to grateful patient, to create the capital to stitch together a meaningful experience for graduates. The Hudson-Beeson team is doing pure heavy lifting here. Just $15,750,000 million annually would give all the ND graduates a chance.

Organizations

The 213 professionals certificated by the Institute of Functional Medicine

The Institute of Functional Medicine recently shared with the Integrator data on the growth of their new certificate program. Presently 213 have been certificated, in 2013-2014.  The organization's leaders expect another 200 or so in 2015 "if our tracking is correct." Of the current group, 63% are female and 10% international. Nearly two-thirds of those certificated are MD/DO (65%), with chiropractors next (12%) then nutrition professionals (10%), naturopathic doctors (7%), and nurse practitioners (6%). In a separate note, IFM shares that 25 medical schools or residency programs "currently incorporate functional medicine in their curriculum."

Comment: I learned this while assembling some data on the number of medical doctors who have been educated to a set standard in the field of integrative/functional medicine. We know that the American Board of Integrative Holistic Medicine has certified roughly 2500 and that the U Arizona Fellowship in Integrative Medicine has roughly 1200 graduates. Together with IFM, the total pushes 2850, with some overlap. What other programs belong in this set?

APHA elevates traditional/integrative

APHA gives elevates complementary/integrative/traditional medicine group to section status

The co-chair of the recently renamed interest group of the American Public Health Association,  Integrative, Complementary and Traditional Health Practices, Elizabeth Sommers, PhD, MPH, LAc, sends news that, after 20 years, the group has been elevated to "section" status by APHA.  The group has over 400 members with "growing 'sister' groups in South Africa and Australia," says Sommers. These are part of a "wide net" that includes practitioners, academics, researchers, students, consumers, policy-makers.  Sommers said a common bond is "recognition of the importance of self-care and health promotion." Members of the new APHA Section are "involved in many practices and look toward trans-disciplinary approaches to yoga, massage, Tai Chi, nutrition, Ayurveda, naturopathic healthcare, Traditional Asian Medicine, herbal care, spirituality, Indigenous healing practices, relaxation and mindfulness."

Comment: Sommers, who produces a public health haiku daily, also sent this with the news: "Embracing fullness/Vision of global health and/Renewal for earth." Great to see this earned recognition. The next APHA Annual Mtg. in New Orleans, Nov. 16-19. Sommers urges "folks involved in CAM to consider joining APHA and getting involved.

Hospital group begins campaign promoting its role with disease as an economic engine

The group is called the Coalition to Protect America's Health Care. On its website the group lays out evidence of the economic impact it is seeking to protect. Hospitals are major economic engines in their communities. They have created 5.5 million jobs - one in every nine in the United States. This "contribution" totals $900-billion of economic activity. A recent appeal to members stimulates concern over $121.8-billion in federal budget cuts in recent years. The group is focused on keeping access to cutting edge technologies. Patient stories of gratitude are solicited top put human faces on their desire to protect the status quo.

Comment:  We know that something is terribly awry when those nominally in charge of our medicine show such a profound remove from responsibility for assisting us to health. This should be called the Coalition to Protect the Medical Industry. Remember the phrase in the kiddy book: "'More' said the baby, ‘more, more, more.'" Like a military base threatened with a shut down or a Port District questioned for its taxing authority, the hospital organization seeks to maintain its position by sowing the fear. Imagine a day when we are invited by hospitals to a campaign promising to give each person access to health coaches and successful, self-care technologies that will, in a staged way, allow them to cut their HOSPITAL employment and transition to a community-based, economy of health creation.  Meantime, while reflecting on this, a colleague sent this note:  "I'm at the docs for a stress test. His $120K Mercedes is parked outside with a vanity plate that reads STENTS ! American Healthcare at its best." 

Payment seminars

American Acupuncture Council offers seminars to bring acupuncturists up to speed on insurance changes under the Affordable Care Act

The American Acupuncture Council (AAC) is offering a series of live conferences around the country on insurance issues and the Affordable Care Act. While generally set for any acupuncture practitioner who works with 3^rd party payment, the themes include Section 2706, "Non-Discrimination in Health Care." Content includes specific looks at some states where acupuncture is directly included in benefits. ACC is the leading provider of malpractice coverage to acupuncture practitioners.

Professions

25 years

American Herbalists Guild celebrating its 25^th year

In early November 2014 members of the American Herbalist Guild (AHG) will celebrate the organization's 25^th year.  Founded in the home of Christopher Hobbs and Beth Baugh, AHG was dedicated to "growing herbalism in the United States, thereby, establishing herbal practices as a viable source of health care in every community." Today the AHG has, according to a release on the celebration, "over 1,750 members all over the world, more than 225 professional members, and over 12 active state chapters." On November 6-10, 20144, in Pine Mountain, Georgia, the AHG will gather in its annual conference to educate and celebrate.

Comment: The AHG fills an important place in the evolving integrative health and medicine world, especially as the pressures and biases in research push the herbs as phytomedicines and thus as standardized extracts, and each removes us from the ground from which they sprout. The best of integrative health thinking is deeply connected to our communities and to the earth. A part of the AHG's work is to take the big and sometimes abstracted picture of a healthy and whole earth and put it under our fingernails.

Nutritionists win first battle, in Michigan, following federal opening to non-RD nutritionists

In a July 17, 2014 release, the American Board for Certification of Nutrition Specialists announced that Michigan governor Rick Snyder "signed legislation (HB 4688) repealing Michigan's nutrition and dietetics licensing law, which had prohibited a broad range of nutrition practitioners from providing nutrition counseling." The release added that "with his action, Michigan becomes the first state in the nation to roll back a law that made it illegal for essentially all nutrition professionals other than Registered Dietitians®-no matter how highly qualified-to practice individualized nutrition counseling.

Parker: US lead in WNF

Naturopathic organizations to form World Naturopathic Federation with sights on W.H.O.

At the 2nd International Congress on Naturopathic Medicine (ICNM) in early July 2014 in Paris, over 30 participants representing national associations from around the world voted unanimous to form the World Naturopathic Federation (WNF). The mission of the WNF is to:

" ... support the growth and diversity of naturopathic medicine worldwide; support the regulation of naturopathy and naturopathic medicine; promote accreditation and the highest educational standards for our global profession; encourage naturopathic research; establish and maintain a database of Naturopathic organizations, regulation, accreditation, conferences and research activities and work with world agencies (World Health Organization, United Nations, UNESCO) and governments to promote naturopathic medicine."

Comment:  Two possible names for the organization were not selected: "World Federation of Naturopathic Medicine" and "World Federation of Naturopathy." The reason: in many countries naturopathy is not recognized as a field of "medicine" (nor the practitioners as "physicians" or "doctors" as they are in most U.S. jurisdictions in which they are licensed). The strength and viability of this global organization will rest on the ability to merge the less educated and the physician-level versions of the field. 

People

Tew: U Cincinnati IM leader

John Tew, MD selected to head University of Cincinnati integrative medicine

Neurosurgeon John Tew, MD, selected as a Great Living Cincinnatian in 2011, has been selected to head up the University of Cincinnati's Center for Integrative Health and Wellness. In the release announcing his acceptance of the position, Tew, who has had a neurosurgery chair named after him, noted plans to engage employers and the community: "I appreciate the university's commitment to changing the way we approach patients and care for them. This truly represents a significant change in the care delivery model, one that puts patients in the center and empowers them to take control of their health and wellness." Under his neurosurgeon hat, Tew has completed over 700 visiting professorships. A part of his work with WILL be to access philanthropic dollars.

Comment: Tew appears to be a very interesting and powerful choice - a neurosurgeon who only recently left 45 years of practice - iF in fact he can integrate well with the rest of the integrative staff. His focus on the community and employers is exceptional. His tenure will be interesting to watch.

Cassirrer: talkes helm at Northwestern

Chris Cassirer, MPH, ScD, named president at Northwestern Health Sciences University

On June 23, 2014,  Northwestern Health Sciences University named Chris Cassirer, ScD, former president and executive at Capella University, as president of the university. Cassirer was most recently dean of the College of Arts and Sciences and the College of Management and Business at National Louis University.  He has also served as a professor at The George Washington University and the University of Minnesota.  Northwestern has degrees or focused programs in chiropractic, acupuncture, Oriental medicine, therapeutic massage, and in human biology serving roughly 900 graduate and undergraduate students on their 25-acre Bloomington, Minnesota campus.

Balneaves: first Toronto IM leader

Lynda Balneaves selected as founding director of the U Toronto Centre for Integrative Medicine
 
Lynda Balneaves, MD, has been chosen as inaugural Director of the Centre for Integrative Medicine at the University of Toronto. According to a report from IN-CAM, the Canadian integrative research organization, the Centre is a collaboration between the University of Toronto's Faculty of Medicine, the Leslie Dan Faculty of Pharmacy, and the Scarborough Hospital. Balneaves will concurrently serve as associate professor in psychiatry at the University of Toronto and will be a Scientist in the Department of Psychosocial Oncology and Palliative Care at Princess Margaret Cancer Centre. Balneaves is a board member of the Society for Integrative Oncology.
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