The Coming of the Light: 2014 Top 10 for Policy and Action in Integrative Medicine and Health
Written by John Weeks
The Coming of the Light: 2014 Top 10 for Policy and Action in Integrative Medicine and Health
The Coming of the Light
In 2006, I began publishing, on or near the winter solstice, an annual Integrator Top
10 list for the emerging field of integrative health and medicine.
Together these chronicle nine years of policy and action in this popular
movement. Links to past Top 10 lists are at the bottom of this posting.
Here is the Coming of the Light Integrator Top 10 for Policy and Action in Integrative Health and Medicine for 2014.
Nielsen: led in prodding the Joint Commission
1. Joint Commission Promotes Integrative Pain Care via Elevating Non-Pharmacologic Approaches and Practitioners
The Joint Commission accredits most hospitals, and thousands of outpatient settings. With a new pain guideline
that goes into effect January 1, 2015, "non-pharmacologic" approaches
such as acupuncture, chiropractic, massage and relaxation are now
presented roughly on par with opioids and other pharmaceuticals- which
are themselves presented with a new warning sign. The change came via a
remarkable campaign from the integrative health and medicine community
led by Arya Nielsen, PhD, LAc, reported here. The step follows publication by a coalition of over 40 mainstream pain-related organizations of Never Only Opioids , written via a multidisciplinary task force in which Nielsen participated, that urged the "imperative" for early use of integrative approaches and practitioners.
Berwick: speaking up for health creation
2. Growing Focus on "Health" and "Health Creation"
Just
as putting the accent on integrative "medicine" aligns with a top-down,
physician-centric paradigm, so integrative "health" is true to the
values of the multidisciplinary era. Health is slowly being reeled
toward the center of reform of what we have to date inappropriately
called "health care." The NIH National Center for Complementary and
Alternative Medicine changed its name to the National Center for Complementary and Integrative Health. The theme of health creation - salutogenesis - was the focus of a plenary at the Institute for Health Improvement by Don Berwick, MD and at Grantmakers in Health by Wayne Jonas, MD. Even the American Hospital Association president is talking about "the tough transition from sick care to health care."
Finally we begin to distinguish what is merely a medical industry from
what is sick care and then to reserve the idea of a "healthcare system"
for what is actually a system of health creation.
Cochran: new face for Appropriations
3. The Republican Win and Awful Losses of Political Power: Harkin, Mikulski and Sanders
It was one thing to learn that integrative medicine's powerful and stalwart federal policy champion Tom Harkin (D-Iowa) was resigning. Then came the Republican control of the U.S. Senate
which removed from power Harkin's closest colleague on all things
integrative, Barbara Mikulski (D-MD), the chair of the US Senate
Appropriations Committee, and Bernie Sanders (I-Vermont), the chair of
the integrative-active Veterans Affairs. Federal policy in integrative
health and medicine is going to be a different game with Senator Thad Cochran (R-Miss) from a state with no integrative academic centers, and no licensing of naturopathic doctors, at the US Senate
Appropriations Committee's spigot.
Breakthroughs on multiple fronts
4. The Remarkable Integrative Path of the Cleveland Clinic
First there was the word last April from Time, the Wall Street Journal, Katie Couric and others that through a partnership with Crane Herbs
the Cleveland Clinic was setting up a traditional Chinese medicine
program - a first of its kind in a major health care system. In
September, Cleveland Clinic was again in the integrative health news
with a partnership with the Institute for Functional Medicine and the
indefatigable Mark Hyman, MD to set up a functional medicine program.
Some view this as a tipping point.
Cleveland Clinic CEO Toby Cosgrove, M.D. was more blase. He positioning
the move as post-transitional: " ... not a departure for Cleveland
Clinic, but a continuation of the innovative, holistic approach that we
have embraced."
Leading in interprofessional collaboration
5. The Emergence of the Academy of Integrative Health and Medicine
The new Academy of Integrative Health and Medicine
(AIHM, a.k.a."The Academy") is making headway in its first year in
aggregating a game-changing organization. In its first year, this
interprofessional entity with global aspirations has not only brought
into one fold two pioneering organizations from 1978 and 1997 created by integrative, holistic medical doctors. AIHM Is forming a policy partnership with the influential Integrative Healthcare Policy Consortium (IHPC) and has engaged an educational and potentially certification initiative with the Academic Consortium for Complementary and Alternative Health Care (ACCAHC).
In October, AIHM convened representatives of over 50 organizations to
explore where they might wish to co-create their future. The meeting led
up to a first annual AIHM conference that drew over 800. Meantime,
anchoring this embracing culture is the election to AIHM's still
MD-dominant board of a naturopathic doctor, a chiropractic doctor, a
licensed acupuncturist, two holistic nurses and leaders of both IHPC and
ACCAHC. (Alignment of interest note: I am one of the latter.) This big,
inclusive round table has been a long time coming.
VA: declaring integrative strategy
6. Integrative Care Expands in the Veterans Health Administration
In
November, the U.S. Veteran's Health Administration Office of Patient
Centered Care and Cultural Transformation convened over 40 integrative
health leaders from the V.H.A. to set an assertive course for
integrative care for the nation's veterans. (See "Veteran's Health
Administration Initiates Integrative Health Coordinating Council to Set
System-wide Plan via Gaudet's Office" at this link.) The strategy session followed an NIH NCCAM announcement of a $22-million research initiative on 13 non-pharmacological approaches. Meantime, US Senator Bernie Sanders promoted expanded integrative services in basic Veteran's benefits. The initiatives stood on good ground. Data from the front-lines gave high visibility to early indications that integrative approaches high decrease high-opioid use in veterans by up to 70%.
Massage groups gain alignment
7. Moves toward Unity and Maturation in the Massage Field
There
are roughly 380,000 licensed so-called "CAM" (complementary and
alternative medicine) practitioners. Of these, all but 110,000 are
massage therapists. The field - a schizoid trade/profession mix
influenced by huge corporate players like the $1-billion Massage Envy -
has struggled with disunity. Earlier this year a half dozen
organizations corralled by the Alliance for Massage Therapy Education
and Commission on Massage Therapy Accreditation choose to jointly
sponsor a July 2015 conference
- a remarkable collaboration between sometimes warring parties. In
October, the National Certification Board for Therapeutic Massage and
Bodywork, led by Leena Guptha, DO, MBA, announced that it is going to stick with certification
and leave licensing to its former competitor, the Federation of State
Massage Therapy Boards. Here's hoping that one outcome will be advanced
certification for those massage therapists who wish to work in
integrated environments.
Greenlee: SIO advances on her watch
8. Society for Integrative Oncology: Integrative Breast Cancer Report Card and JNCI Publications
Oncology,
with its big dollars and brutal treatments, was for good reasons an
early ground for exploration of the potential value of complementary and
integrative approaches and practitioners. The Society for Integrative Oncology (SIO) has
for years legitimized and stimulated awakening of scores of integrative
programs across the nation, as former SIO board member Glenn Sabin documents in the list here. In 2014, under the leadership of president Heather Greenlee, ND, PhD, the SIO reached new influence. It's smartly "graded" practice guidelines
for integrative care for patients with breast cancer were widely
covered in the popular media. The guidelines were published as part of a
15 article monograph in the Journal of the National Cancer Institute
developed via SIO's partnership with the Consortium of Academic Health
Centers for Integrative Medicine. Another fine collaboration.
Organized effort to align economics
9. Show Me the Money: Project for Integrative Health and the Triple Aim
The
most important among equals in progressive medicine's Triple Aim
(better patient experience, enhance population health, lower per capita
costs) is the latter: money. The new Project for Integrative Health and the Triple Aim (PIHTA) at the Center for Optimal Integration: Creating Health has aggregated the cost studies
to provide leverage and guidance for decision makers. PIHTA caught the
attention this year of the workforce arm of the Association of American
Medical Colleges (poster, plenary), the interprofessional All Together
Better Health (presentation, poster), and the patient-experience leader
Beryl Institute (invitation to diverse collaborations) among others.
Since I am involved in this initiative, I'll let another speak. Here is a
member of the Integrative Medicine Advisory Group of the Oregon Health Authority:
"It's kind of astounding the caliber of the resources available on the
Center for Optimal Integration website, not just for practitioners but
also for our Patient Centered Primary Health Homes and for the state."
PIHTA's goal is to enable those seeking appropriate use of the values,
practices and disciplines associated with integrative health and
medicine in the Triple Aim era.
Biofield: key forces gather
10. Coalition Forming to Promote Research and Practice on the Biofield
In
April, big names in energy medicine met to explore creating a unified
voice and platform for research and practice related to the most suspect
of integrative forces to the Western scientific mind: the biofield.
Deepak Chopra, Mimi Guarneri, Rauni King, Cassandra Vieten, and Wayne
Jonas and a few others convened at the home of philanthropist Ruth
Westreich. They represented, respectively, the Chopra Foundation,
Miraglo Foundation (Guarneri/King), Institute of Noetic Sciences and
Samueli Institute. The organizations then co-sponsored a September
convening of 45 leading scientists. Paper contracted for the La Jolla
event and a strategic plan will be published in 2015 in Global Advances in Health and Medicine. Shamini Jain, PhD, an organizer, is forwarding this collaboration - with most of the original parties intact - as the Consciousness and Healing Initiative.
Will big names in one room attract big dollars to this under-funded
arena? Right respect for subtle energies will be advanced by outspoken
collaborations and coalitions.
A surprising tribute, thank you
Was something left out that should
have been included? Let me know via
Finally, I cannot close these reflections on 2014 without personal
thanks to the over 150 friends and colleagues who offered written
contributions for the Lifetime Achievement Living Tribute Award presented
to me at the May 2014 banquet of the International Research Congress
for Integrative Medicine and Health. A surprising, odd, and wonderful experience. Thanks to all of you with a hand in making it so.
Best to all for advancing health in medicine, and in those we serve, in 2015!
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