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Integrative Medicine, Complementary and Alternative Health and Medicine Round-up #94: August 2015 |
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Written by John Weeks
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Integrative Medicine, Complementary and Alternative Health and Medicine Round-up #94: August 2015
Policy
-Research
Priorities: Integrative Consortium (ACCAHC) Finds Decline to 2.27% in NIH
NCCIH Grants to Licensed "CAM" Institutions
-Two Opportunities to Influence: NIH Plan and a National Academy of
Medicine Guidance to the New Administration
-The Intersection of Integrative and
Community Health: Accountable Communities 2015, September 9-10, 2015
-AANP Pushes Federal Legislation (S. 1406) to "Save Access to Compounded
Medications"
-Respond by August
17, 2015: US Veteran's Affairs Seeks Clinical Lead for Integrative Health
 Terrific conference Sept.9-10
Employers and
Economics
-American Sustainable Business Council Promotes Action on
Section 2706, the ACA's Non-Discrimination in Healthcare Provision
-Harvard Pilgrim Begins Covering Acupuncture Treatments
in a Step toward "Eastern Harmony"
-Global Wellness Institute Reports 10 Recommendations
from Corporate Summit to "Redefine Workplace Wellness"
-Insurance Giant Aetna Is Hiring a "Chief Mindfulness
Officer"
-Saying Good-Bye to
Traditional Medicare: Useful 3-Page Primer Explains U.S. Medicine's
Shifting Economics
Research
-Two Journal Clubs: AIHM's David Riley, MD-led Initiative
and Researcher Joshua Goldenberg, ND's DrJournalClub.com
-Oberg and Rioux: Dialogue on the Systematic Review of Whole-system Naturopathic Medicine in select
Chronic Disease Conditions
Clinical Care
-Two Steps Backward for
Integrative Pain Care: Kaiser Patients Not Sharing Who They See, AMA Still Not
Elevating Teams
-Chiropractors Push
Conservative Treatment in Campaign to End Prescription Painkiller Abuse
-Portland Tribune Profiles Naturopathic Physician-Owned
Patient-Centered Medical Home
- Special
to the Integrator: Lori Knutson, Duke Leadership Faculty
Member and Integrative Pioneer, on Working with Health System Values and
Culture
 Taylor Walsh: point for 2706 newsletter
Organizations
-Oregon Collaborative for Integrative Medicine (OCIM)
Forms Partnership on Academy of Integrative Health and Medicine Fellowship
-Two New Medical System Members at ACIMH: Beaumont and U
Hospital/Connor
-NABNE and CHI in Partnership with ACCAHC to Explore Integrative
PCMHs
-IHPC Debuts Bi-Weekly CoverMyCare Newsletter on
2706/Non-0Discrimination in Health Care
-AIHM Co-Executive Director Nan Sudak, MD Interviewed in Acupuncture Today
-AANP Partners with Foundation for Care Management to
Provide Naturopathic CME to Multiple Other Professions
Integrative
Academics
-First Chiropractic Residents in the Veteran's Health
Administration Share Their Experiences
International
- John
Weeks' GAHMJ
Global
Integrator Round-Up for July 2015
Miscellaneous
-Is Your City One of the Most Zen in the United States?
-"Crone & Sage School" Seeks to Create
Sacred, Interprofessional Space for Integrative Practitioners
People
-Integrative & Hospice Strategist and Philanthropist
Ruth Westreich Honored
-Liza Goldblatt-Martha Menard Team Named to Co-Direct
ACCAHC
-AANP's Annual Naturopathic Physician Awards to Snider,
Parker, Schleich and Labriola
_________________________
Policy
 Consortium led research priorities paper
Research Priorities: Integrative
Consortium (ACCAHC) Finds Decline to 2.27% in NIH NCCIH Grants to Licensed
"CAM" Institutions
The open
access article in the Journal of
Complementary and Alternative Medicine shares data that grants from the
National Center for Integrative Health to institutions associated with the
licensed complementary and integrative health professions (DC, LAc, ND, massage
therapy) represented just 2.27% of total awards in 2014. This is down from an
already low 5.87% in 2010. The article
is entitled "Health Policy Consensus Recommendations to NCCIH from Research Faculty
in a Transdisciplinary Academic Consortium for Complementary and Integrative
Health and Medicine." The value of the document is that the suggestions come
from a consortium of leading research leaders of five "major
systems with which the Center is concerned." (See Section a.)
The team
proposes these top three areas of investment: 1) "Research CIH the way it is
practiced;" 2) "Balance funding between basic science (bench science and efficacy trials to move science
forward) and health services
research (effectiveness and economics to
provide information for health policy)"; and 3) "Focus on the role of CIH therapies and disciplines in prevention and health promotion."
The work was led by Martha
Menard, PhD, LMT, and her fellow members of the Research Working
Group of the Academic Consortium for Complementary and Alternative
Health Care (ACCAHC). The team turns its attention to the new NCCIH strategic
plan, now in development. They offer multiple recommendations, coupled with
this comment: "We believe that affirmative, directive programs from NCCIH in
2016-2020 can significantly advance the quality and quantity of CIH research contributions,
particularly to bettering public health."
.jpg) Does agency reflect constitutent interests?
Comment:
I was a co-author with Menard on this piece, together with a sterling
interprofessional group that included Belinda Anderson, PhD, LAc, William
Meeker, DC, MPH, Carlo Calabrese, ND, MPH, David O'Bryon, JD, CAE, and Greg D.
Cramer, DC, PhD. One of the values in the piece is a table, constructed by
Menard and with significant input from Calabrese, proposing distinct
definitions for: Real World Research, Comparative Effectiveness Research, Whole
Systems Research and Disciplines Research. The latter is particularly important
as, through the communication
from ACCAHC to with NCCIH, the concept of researching the value of a "discipline"
is strewn throughout the NCCIH 2011-2015 Strategic Plan. Isn't a core question
facing insurers, hospitals and employers what
will it mean if we cover providers from these new disciplines of acupuncture,
chiropractic, massage therapy and more? Great leadership from Menard, now a
co-executive director of ACCAHC. (See People, below.) Here's hoping the
2016-2020 plan will reflect this guidance.
 Looking for input
Two Opportunities to Influence:
NIH Plan and a National Academy of Medicine Guidance to the New Administration
August 16, 2015: NIH Framework for a Strategic Plan: The NIH has published a Request for Information (RFI): Inviting Comments and Suggestions
on a Framework for the NIH-wide Strategic Plan. Deadline is August 16, 2015.
August 14, 2015 - National Academy of Medicine
(NAM): Influencing the New Administration: The NAM, formerly the Institute
of Medicine (IOM) is undertaking a new initiative, Vital Directions for Health and Health Care.
The reason: "With a new administration on the horizon ... to inform the
next administration - and the nation - about the most pressing issues in the
next phase of health reform."
Comment: Terrific to know that, under the leadership
of Bill Reddy, LAc, Dipl-Ac, the Integrative Health Policy Consortium-Academy
of Integrative Health and Medicine partnership is actively developing input to
the NAM. The rule is simple for all in a democracy: send no input, lose grounds
for complaint about their choices. Here's hope some of you will chose one and
take the time to be heard.
.jpg) Jamie Harvie: conference organizer
The Intersection of Integrative and
Community Health: Accountable Communities 2015, September 9-10, 2015
The conference title is "Accountable
Communities 2015: Advancing Integrative Approaches to Community, Health and
Well-Being." The focus of the September 9-10 meeting in Duluth, Minnesota,
is on what award-winning organizer Jamie Harvey and his Commons
Health project calls "health creation." More specifically, the meeting
engages the intersection between the integrative health and medicine movement
and the broader movement to engage determinants of health. The conference is "designed to catalyze place-based
health creation." Specifically: "By melding integrative and community expertise
and engaging in conversations that matter, this event helps healthcare, human
service, business, clinical, wellness and community leadership link and align
whole person approaches to health and well-being in the context of community."
Among cross-fertilizing topics: "Your Zip Code and your
Epigenetic code; Land Trusts as Health Policy; Pathways out of Poverty; A
Community Supported Agriculture (CSA); Health Plan National Model; Community
Listening Sessions and a Community Equity Agenda; A Sugar Free, Diet Soda Free
Hospital; Mental Health and Food; and Workplace Wellness and Community Health."
The sponsors and speakers for Accountable Communities
2015 reflect the dual movements. Among the dozen sponsors are not only Blue
Cross-Blue Shield of Minnesota, but also the Academy of Integrative Health and
Medicine (AIHM) and the Center for Spirituality and Healing at the University
of Minnesota (led by GAHMJ's
co-editor Mary Jo Kreitzer, PhD, RN, FAAN). The speakers range from Kellogg
Foundation vice-president Gail
Christopher, DN, a licensed naprapath who serves as board chair at the
Trust for America's Health (pictured) to AIHM co-founder, integrative
psychiatrist and author Scott
Shannon, MD Allina Health's Courtney Baechler, MD, MSCE
who heads up the most significant inpatient-outpatient integrative care program
in the United States.
.jpg) Kellogg's Christopher: keynote
Comment: In my
recent column in Global Advances in
Health and Medicine Journal (The End of Tinkering:
International Academic Group Explores Transformational Needs in Health
Professional Education) I referenced that just 10%-15% of health
influencers are clinical care related. I added that "an integrative health
and medicine practitioner might take solace that prioritizing clinical
engagement with patients on bettering lifestyle choices affirmatively shifts
the balance." The intersection that this meeting puts front and center is long
overdue.
In fact, one increasingly hears content at integrative
care conferences related to determinants, and particularly environmental
health. The late October conference of AIHM, for instance - with which I am
involved as a member of the board, and, in this conference, as a speaker - People, Planet, Purpose: Global
Practitioners United in Health and Healing is an exemplar. Content there bridges
lifestyle, mind-body, lifestyle and environment and deep clinical enrichment.
The Commons Health-AIHM connection is strong. The Commons Health site describes
AIHM's "Wellness Route Map." Harvey
writes: "Commons Health is working to actualize this vision." Accountable
Communities 2015 offers a delicious guide to the steps to health creation.
Credit to all parties. Now, how can I get there? (Note: this piece was originally developed for the Global Integrator Blog of Global Advances in Health and Medicine Journal.)
 Prioritizing compounding issue
AANP Pushes Federal Legislation
(S. 1406) to "Save Access to Compounded Medications"
The American Association of Naturopathic Physicians (AANP) continues to
prioritize protecting compounding pharmacies. In a late July 2015 e-communication
from Michael Jawer, the AANP's director of government and public affairs, the
organization urged members to Save
Access to Compounded Medications - Support S. 1406. The AANP's background:
the FDA is "seeking to limit the availability of safely compounded drugs through
an onerous limitation on their interstate distribution as well as a ban on
office use when the medications are supplied by traditional compounders." The
bill, introduced in the US Senate by Senator
David Vitter (R-LA) "would remedy this situation." Writes Jawer:
"Whether you're a naturopathic doctor or a patient of a naturopathic doctor, a
friend or family member, please act right away! We need to preserve
access to safely compounded medications that meet unique patient needs."
 Gaudet: seeking key colleague
Respond by August 17, 2015: US Veteran's
Affairs Seeks Clinical Lead for Integrative Health
US Veteran's Administration is seeking a "physician, nurse
or psychologist" to serve as the "clinical lead for integrative health." The person will oversee the organization's
"integrative health coordinating center" and will be supported in a move to
Washington, D.C. In a note to colleagues
to get out the word, Tracy Gaudet,
MD, director of the VA's Office of Patient Centered Care and Cultural
Transformation says that "this is a critical position in taking the lead on
Integrative Health in the VA, and we obviously want the best people in the
nation to be aware of it. In addition: "Despite the VA's challenges right
now, the commitment to transforming healthcare stays strong, and the
opportunity is great." Here is more info. Act
now: the listing closes August 17.
Comment: This
is a terrific opportunity. Do you know someone who would be perfect to serve? Let
them know!
Employers and Economics
.jpg) Promoting 2706 to employers
American
Sustainable Business Council Promotes Action on Section 2706, the ACA's Non-Discrimination
in Healthcare Provision
The American
Sustainable Business Council (ASBC) is supporting members'
efforts to inform their employees, and their state insurance commissioners,
that under the Affordable Care Act's Section 2706, Non-Discrimination in Health
Care, employees should have greater access to covered care from a broader range
of licensed practitioners. The ASBC describes
the effort here. The intro: "One of the most important developments in
American healthcare is the growing use of integrative health options like
acupuncture, massage therapy, and naturopathic medicine. These therapies
have been increasingly shown to deliver better outcomes, at lower costs, than
standard care."
The ASBC action stems from a long-time partnership with
the Integrative Health Policy Consortium. The
site features a blog from Taylor Walsh who heads IHPC's CoverMyCare program
entitled "Cost
Benefits of Integrative Health Practices." A section of the website on "What is
Section 2706?" points members to an IHPC clip from Deborah Senn, JD, former
insurance commissioner from Washington State who has battled for consumer
rights to licensed integrative health and medicine practitioners. Walsh shared with the Integrator that "the
plan is being synchronized with the CoverMyCare state project, so is organized around the four states we're
emphasizing there: Minn, Cal, Hawaii, and New Mexico." He adds that ASBC "sees
its national potential clearly."
Comment: Great to see this long-nurtured IHPC-ASBC
relationship bearing this fruit. Does it make sense for integrative health and
medicine to increasingly promote itself as "sustainable health care"? Nice work
from each party.
.jpg) Insurance program adds acupuncture visits
Harvard Pilgrim
Begins Covering Acupuncture Treatments in a Step toward "Eastern Harmony"
A July 24, 2015 article in
the New Hampshire Business Journal
states that the insurer-provider Harvard
Pilgrim Health Care began to see
growth in membership from people originally from both China and India. In an
effort to be culturally appropriate and to draw these individual in as member,
the plan chose to initiate an "Eastern initiative." A key component: members
can have up to 20 covered acupuncture treatments. The head of the Harvard
Pilgrim's Center for Inclusion Initiatives, Karen Brown, explained that "we went directly to the community to share with us what would be of
most value." The finding, as explained by Brenda Cole, vice president of
marketplace inclusion development: "We realized that they were looking for a
more comprehensive approach to health and wellness." As part of the effort,
Harvard Pilgrim took time to educate its conventional practitioners to the
potential in the new services.
Comment: All and all this appears to be an exceedingly
thoughtful bit of new product development: listen to a new consumer category,
seek culturally appropriate solutions, and educate those who needed to know.
Note in the workplace wellness article below that the issue of culturally
appropriate products and services was also alive in this initiative, with
Ayurvedic medicine an example of what firms operating in Southeast Asia must
add to their mixes.
.jpg) Fine work refining workplace wellness
Global Wellness
Institute Reports 10 Recommendations from Corporate Summit to "Redefine
Workplace Wellness"
"Stop the Mud-Slinging on ROI and Focus on Total Return
on Value." This is the top
recommendation among ten after the Global Wellness Institute convened
experts "from high-profile organizations" to explore the state of the workplace
wellness movement. Among the
corporations represented were the Cleveland Clinic, Clinton Global Initiative,
Johnson & Johnson, Citi and Goldman Sachs. Michael Roizen, MD from the
Cleveland Clinic and longtime integrative health and medicine leader and
integrative corporate wellness expert Kenneth Pelletier, PhD, MD (hc) were among
participants. The top recommendation notes that 93% of the gains in the first
year from workplace wellness initiatives are in "productivity gains not reduced
costs." Recommendation #5 is to better adapt programs to local culture.
Mentioned is "the reality that if you exclude Ayurveda in many Southeast Asian
countries you're alienating the vast majority of the population." The full
17-page report from the July
15, 2015 meeting is here.
Comment: Great
to see the cultural sensitivity and push for appropriate integration of
traditional practices. It is notable that a study of the cost-effectiveness of
an integrative naturopathic intervention for Canada Post employees, led by the
Rand Corporation's economist and researcher Patricia
Herman, ND, PhD, was in "presenteeism" - a productivity measure. This
finding supports the top recommendation. Good to see this more holistic,
long-term view emerging. Credit the ambitious Global Wellness Institute
for the convening.
 Bertolini: Aetna's change agent CEO
Insurance Giant Aetna
Is Hiring a "Chief Mindfulness Officer"
The insurance giant Aetna placed a notice on
the National Register of Health Service Psychologists that it is seeking
applicants for a "Chief
Mindfulness Officer." The August 3, 2015 notice (no longer available at the
link) states that the new employee will report directly to Hal Paz, MD, CMO.
The person will "(serve) as a business leader in mindfulness, helping to
positively impact peoples' lives and integrate the insights of mindfulness to
foster compassionate communities, this leader will also work closely with the
leadership team to assess and direct the impact of the changing industry
landscape on Aetna's mindfulness strategy and approach. Additionally, the
Chief Mindfulness Officer will support the business by recommending appropriate
actions, strategies and/or alternatives to meet business needs."
Comment: The note to the Integrator on this new position from colleague Len Wisneski, MD, a
former corporate medical director at Marriott, began with "never thought I'd
see the day." I think it is fair to say that, as long as Mark Bertolini is
leading the firm, more surprises will be ahead. Was a pretty cool job
description when it was up!
.jpg) Johnson: making the complex simple
Saying Good-Bye to Traditional Medicare:
Useful 3-Page Primer Explains U.S. Medicine's Shifting Economics
A medical columnist who does not shy away talking about
the perverse incentives in the conventional payment and delivery system that
harm appropriate integrative health and medicine integration is David
Johnson, MPP, the CEO of 4sight Health. John is a health policy educator at
the University of Chicago. His recent column, "Medicare
at 50: More Yesterdays than Tomorrows," exemplifies this straight talk and,
at the same time, knack for making the complicated simple. One of his suggestions to medical system
leaders: "Don't expect continuation of higher payments for routine procedures
performed in high-cost settings. Respond to payor and consumer demands
for more cost-effective and convenient routine care in lower-cost, distributed
ambulatory facilities." Another of Johnson's columns that moves into similar
ground on the shifting economics is "Reimbursement
Roulette: Health Companies ‘Doube-Down' on Revenue."
Comment: Optimal integration requires solid awareness
of the economic platforms and incentives with which one is connecting. This
short article is as good of a summary of the effort to shift to "values-based"
from "production-based" that I have seen. It's a good introduction for anyone
who would like as basic primer. All of us participating in the medical economy
have skin in this game! (Thanks to Tom Weeks for putting me in touch with
Johnson.)
Research
 Riley: runs AIHM journal club
Two Journal Clubs:
AIHM's David Riley, MD-led Initiative and Researcher Joshua Goldenberg, ND's
DrJournalClub.com
Two possible on-line engagements for individuals who wish
to keep their research chops while engaging literature curated by integrative
health and medicine leaders have recently become known to the Integrator. The open access AIHM Journal Club
from the Academy of Integrative Health and Medicine is edited by long-time
integrative medical doctor David Riley, MD the principal mover-and-shaker in
the 2011 development of the CARE guidelines, the consensus reporting structure for case
reports. Riley's AIHM site hosts roughly 10 articles per month. The index is here. Naturopathic
physician researcher Joshua Goldenberg,
ND, a member of the research faculty at Bastyr University, has founded the
subscription-only DrJournalClub. The
site uses video-based article summaries. The site also hosts good resources on evidence-based
medicine skills. Some open access sample videos are here.
Comment: I
love the concept and potential of journal clubs and hope initiatives such as
these will quickly aggregate robust exchanges. So, far, movement is slow. Is
this due to some characteristic in the integrative health and medicine
community? A brief search found no information on the actual percentage of
regular medical doctors and conventionally practicing nurses who participate in
such initiatives.
Oberg and Rioux:
Dialogue on the Systematic Review of
Whole-system Naturopathic Medicine in select Chronic Disease Conditions
A systematic review of whole system research in health
care is unfortunately rare. So when Erica Oberg, ND, MPH and a
team of mainly naturopathic physicians published
this open access article, I immediately wrote it up. (See the July
Integrator Round-up.) I also
wondered what a whole-systems-focused researcher who was not a naturopathic
physician thought of it. I turned to Ayurvedic practitioner and research Jennifer
Rioux, PhD. Rioux, a member of the Research Working Group of the Academic
Consortium for Complementary and Alternative Health Care, has been associated
with medical schools in New Mexico and Arizona. I then sent Rioux's comments
back to Oberg - with knowledge of the author, Rioux, blinded - for Oberg's response.
Here is Rioux's commentary, and Oberg's return view.
.jpg) Rioux: comments on ND whole systems paper
Comments from Jennifer
Rioux, PHD: "This publication is the result of an ambitious undertaking by
the authors, who endeavored to provide an analysis of the overall trends in
patient outcomes for whole-practice Naturopathic medicine pragmatic trials to
date (2003-2014). The heterogeneity across the 13 clinical trials (plus two
cost effectiveness analyses) made the authors' task very challenging. None of
the trials were blinded, which is impractical for a multi-modal, synergistic
system of care, such as naturopathic medicine. Four of the thirteen trials did
not include a control group, including one that was a case series, but most
used a usual care comparator. The common factor across studies was that all
patients were being treated for chronic conditions, however it was difficult
for the authors to draw conclusions about any particular conditions, as the
greatest number of studies concerning any one specified condition was three.
The authors found data to support their primary claim that ‘the care delivered
by naturopathic doctors improves the health outcomes of patients affected by
chronic disease, as measured by both clinical and patient-reported outcomes.' They also showed that naturopathic care
resulted in small to moderate improvements in quality of life measures. Findings associated with traits of the
naturopathic care model included: 100% of patients received therapeutic
lifestyle change recommendations; 94% were prescribed exercise and 69% were
given counseling on stress reduction techniques.
"Meta-analyses of observational studies of whole-practice
care are a necessary step in evolving the evidence base for this discipline, as
they are characterized by greater external validity. This task will become easier as the number of
studies increases. Though the authors' described the data from individual
studies well, their primary conclusions were limited to: 1) suggestion of
clinical benefit; 2) no adverse reactions; 3) generally good quality of
research, despite considerations of bias due to impracticality of RCT
conventions (blinding; incomplete data; selective reporting); and 4)
potentially positive public health implications for naturopathic care given the
positive outcomes from individual studies on chronic disease precursors such as
hypertension; lipids, glycemic control, anxiety and pain. The most important
recommendation emanating from the systematic review is mentioned at the end, where
the authors encourage future researchers of whole practice NM to include
clinically relevant and patient-centered objective measures. I would take this
one step further and encourage the naturopathic research community to engage in
the standardization of assessment and data collection instruments and
procedures via a Delphi process or similar effort. This would be a major accomplishment for the
discipline which would facilitate all future research efforts."
 Oberg; lead on ND whole systems review
Erica Oberg, ND,
MPH, responds: "One of the most useful applications of this research is
that it helps patients, and referring MDs, understand what patients can expect
when they work with a naturopathic doctor on a chronic health condition. They
can expect a multi-modal intervention that addressed both biometric and
patient-centered domains. They can expect improvement, albeit effects may be
small at first (most of these studies were about 12 weeks in duration, a few
extended out to 1 year). NONE of these studies showed a worse outcome when
compared to usual care or when compared to baseline. Patients can expect
additive and incremental improvement beyond other healthcare treatments and
strategies they may be already trying.
"With attention to the research agenda, it is worth noting
that researchers of naturopathic medicine recognized the importance of outcomes
that measure both objective biometric data as well as patient-centered quality
of life outcomes long before such metrics were favored or recommended by PCORI.
Most of the studies included in this systematic review included both. Of course, this is not surprising given the
naturopathic orientation to treat the whole person - body, mind, and spirit,
but it may warrant a footnote in history as an acknowledgement of the
discipline's contributions to changing the perspective, and the conversation,
on health and healthcare to equally prioritize ‘improvement' in both the eyes
of the patient and the eyes of the doctor/healthcare system."
Comment: The theme is powerful, personally, given a
history of involvement in promoting these research directions (see article on
recommendations to NCCIH under Policy, above) and a recent decision to join a
team that has a mission of "catalyzing whole person and whole systems care and
healing" at the peer-reviewed and indexed Global Advances in Health and Medicine
Journal. Rioux's recommendation for a Delphi process in the
naturopathic research community to set more routine guidelines is interesting. It
applies more widely to the rest of the integrative health and medicine research
community. If, to paraphrase the closing
comments of Jon Stewart in his last show it "smells like bullshit" to have
inherently whole systems practices measured based on single agent and reductive
models, then "speak up about it!"
Clinical Care
Two Steps Backward for Integrative Pain Care: Kaiser Patients
Not Sharing Who They See, AMA Still Not Elevating Teams
Two recent news stories
show what a long way we are yet from optimally integrative pain care. A widely-covered study from the HMO Kaiser Permanente found that most patients, even when
their services are covered by the same insurance plan, are not talking to their
conventional practitioners about their decision to see chiropractic doctors or
acupuncturists. Many see these for pain conditions. Meantime, a new initiative
from the American Medical Association to combat opioid abuse keeps integrative
professional organizations out of the picture. The title of the release: Physicians Groups Band Together to Address America's
Opioid Crisis.
Comment:
Both articles are startling, in their separate ways. One might have hoped in a
city such as Portland, Oregon that views itself as one of the most integrative
in the country - and with an HMO that has been partnering with so-called "CAM"
organizations for years - would have seen more open communication by now. At
the same time, one might also hope that following the November 2014 Joint Commission pain guideline, the AMA might extend itself to those who are
primarily responsible for the non-pharmacologic services that the Joint
Commission is elevating. These two outcomes taken together reinforce a vicious
circle, co-conspiring to keep prejudices intact and best practices beyond the
horizon of knowing. The AMA initiative reminds me of the Jim Hensen children's
story: "I
Can Do It. I Can Do It Myself." Time for these folks to reach beyond the
toddler mind to appreciate the importance of teams. Try this: "We can do it. We
can do it together!" (Thanks to Lou Sportelli, DC for the piece on the AMA
initiative. His apt title to his email: "What a crock.")
 Chiropractors push conservative pain care
Chiropractors Push Conservative Treatment in Campaign
to End Prescription Painkiller Abuse
The media release
from the American Chiropractic Association announced a profession-wide
campaign: Chiropractic
Physicians Call for Conservative Treatments for Pain Management Amid
Prescription Painkiller Epidemic.
The organization plans to "offer chiropractic physicians resources to help them
share information about their conservative approach and why it is especially
significant to today's health care consumers amidst the opioid epidemic." They
reference the new November
2014 Joint Commission Clarification of Pain Management Standards as having
"revised its pain management standard to include chiropractic services and
acupuncture."
Comment: Great
campaign. This would be a unifying banner for each of the integrative health
and medicine fields, perhaps in collaboration, to march under. Wouldn't it be
nice if the AMA's campaign, noted above, was entitled "Health Professions
Groups Band Together to Address America's Opioid Crisis." That's what we need.
Side-note to the ACA: Interesting that the edit made by the writers of the ACA
release. The Joint Commission's "clarification"
also includes osteopathic manipulative therapy, massage therapy, relaxation
therapy and cognitive behavioral therapy. A bit of guildishness appears to have
creeped in here, even as it shows up in spades in the AMA initiative.
 Milner: his ND-led PCMH portrayed
Portland Tribune Profiles Naturopathic
Physician-Owned Patient-Centered Medical Home
The title of the July 21, 2015 feature reflects a still
awkward relationship with the local medicine: "Naturopathics
mix traditional, modern medicine." Naturopathics?
The article's focus is the Center for Natural
Medicine, a 5,000 square foot clinic founded by Martin Milner, ND. The clinic is "a patient-centered primary
care home in Oregon, credentialed by the Oregon Health Authority, to deliver
primary care in a coordinated fashion." Then: "The focus at his Portland clinic
is to rebuild a patient's health." The
article notes that Oregon naturopathic doctors have prescription drugs in their
scope of practice. Adds Milner: "The naturopathic doctor spends a lot more time
with their patient (than conventional treatment). We want to focus on diet,
exercise, stress management, counsel our patients and get to know them
personally."
Comment: The
focus Milner describes is strongly aligned with the Triple
Aim and values-based health care movement. The article did not share any
outcomes from Milner's clinic. This article is an interesting companion piece
to the brief on the Casey Health Institute in the July
2015 Integrator Round-up.
 Knutson: great leadership directions
Special to the Integrator: Lori Knutson, Duke Leadership Faculty
Member and Integrative Pioneer, on Working with Health System Values and
Culture
If one measures a
professional's integrative health wisdom based on the total number of
integrative visits engaged under one's watch, Lori Knutson, RN, BSN, HNB-BC
stands head and shoulders above the rest of the field. The former director of
the Penny George Institute guided
the development of the nation's most significant inpatient and outpatient
initiative in integrative care. The initiative's processes and outcomes have
served as the foundation for start-up pitches and plans for scores of programs
in other systems around the country. Knutson's present work is as the
founder/president of Integrative Healthcare Solutions LLC. She is also a core
faculty member of the Duke Leadership Program in Integrative Healthcare.
This column from Knutson features some of the measured wisdom from her
experience, a sample of what participants in the Duke program will learn. An
honor to present it here.
Organizations
 Terrific AIHM partner for fellowship
Oregon
Collaborative for Integrative Medicine (OCIM) Forms Partnership on Academy of
Integrative Health and Medicine Fellowship
An August 7, 2015 media release announces the Oregon Collaborative for
Integrative Medicine (OCIM) is developing a partnership with the Academy of
Integrative Health and Medicine (AIHM). The focus is AIHM's "first truly
interprofessional advanced training Fellowship
in Integrative Health & Medicine" that AIHM is creating under the
direction of Tieraona Low Dog, MD. The Portland, Oregon-based OCIM includes an interprofessional mix of institutional members: National
College of Natural Medicine (ND, LAc, nutrition, plus), Oregon College of
Oriental Medicine (LAc), Oregon Health & Science University (MD, multiple
other conventional), Pacific University (multiple allied health) and University
of Western States (DC, nutrition, massage). The chair of OCIM,
University of Western States president Joseph Brimhall, DC, states: "Our
collaborative is thrilled to partner with the AIHM in training
interprofessional healthcare providers to better understand and appreciate each
other's disciplines. Patients ultimately benefit when practitioners collaborate
to provide inclusive integrated health care." Here is the view from OCIM's site.
Comment: OCIM (pronounced "awesome") is a terrific, one-of-a-kind partnership
for AIHM (with which I am involved as a member of the board). AIHM is seeking
to find ways through multiple historic, cultural and economic barrier to
establish this as a truly interprofessional fellowship. This is Sisyphysian,
shoulder-to-the-boulder work. So it is particularly good to have the link to
this set of institutions that began formally
collaborating two decades ago.
Credit the potential in this moment to the vision of Anne Nedrow, MD, MBA, who took the lead in creating OCIM when
she was headed the integrative medicine program at Oregon Health Sciences
University.
.jpg) New medical delivery members
Two New Medical
System Members at ACIMH: Beaumont and U Hospital/Connor
In an August 7, 2015 memo to their list, the Academic Consortium for Integrative Medicine and Health announced organizational members #62 and #63:
Beaumont Health and University Hospitals/Connor Integrative Medicine Network.
Beaumont is an 8-hospital system in Southeast Michigan that, in 2014, for
integrative services offered "over 22,000 outpatient appointments and
over 5,000 inpatient encounters" through a 57 employee department. University Hospitals/Connor Integrative Health Network in Ohio is a major
not-for-profit medical complex in Cleveland, Ohio. University Hospitals'
Case Medical Center is the primary affiliate hospital of Case Western Reserve
University.
Comment:
Remarkable stats from Beaumont, clearly in the top bracket of medical delivery
organizations for integrative care services nationally. Good for ACIMH, also:
these medical delivery organization memberships count $5000 dues each. That is
real money in integrative health and medicine dollars.
.jpg) Exploring ND PCMHs
NABNE and CHI in
Partnership with ACCAHC to Explore Integrative PCMHs
The North American Board of
Naturopathic Examiners (NABNE) and the Casey
Health Institute (CHI) have developed separate, limited partnerships with
the Academic Consortium for Complementary and
Alternative Health Care (ACCAHC) to explore and publish information on
integrative primary care medical homes (PCMH).
The work, led by Jennifer Olejownik, PhD and involving this writer, will
be engaged through ACCAHC's Project for
Integrative Health and the Triple Aim. The two projects will methods,
issues, practices and outcomes in multiple integrative PCMH environments. The
NABNE partnership will focus on formally recognized naturopathic physician-led
PCMHs in Oregon and Vermont. (See the related piece on Portland's Center for
Natural Medicine, under clinical services, above.) The partnership with Casey
Health Institute will examine work of that MD-led non-for-profit center in
Maryland. (See "Integrative Services" in the June
2015 Integrator Round-up.)
.jpg) Modeling integrative MD-led PCMH
Comment: The
product of these partnerships will be a good luck at some of the most
significant integration in the primary care arena. The goal is two-fold: help
people in the integrative practice community see how medical homes can be
engaged; and, at the same time, inform those in the non-integrative PCMH world
how these more inclusive, person centered approaches can work. As CHI's
co-founder David Fogel, MD postulated in the June 2015 Round-up: "The power in integrative medicine is team-based
collaboration. I think we will blow values-based metrics out of the water with
our outcomes using a team-based staff model of care." Let's see!
.jpg) 2706/Non-Discrimination newsletter
IHPC Debuts
Bi-Weekly CoverMyCare Newsletter on 2706/Non-0Discrimination in Health
Care
The executive director of the Integrative Health Policy
Consortium (IHPC) Alyssa
Wostrel, MBA, DIHom sent a July 28, 2015 notice to colleagues that the
organization is publishing a bi-weekly CoverMyCare newsletter on 2706/Non-Discrimination
in Health Care. Wrote Wostrel: "The newsletter will provide us with a regular
vehicle to stay abreast of CoverMyCare and Sec 2706 happenings."
This first
edition included news on the following: the CMC's States Initiative; IHPC's
cooperative partnerships and collaborations pertaining to CMC with the Academy
for Integrative Health and Medicine, the American Sustainable Business Council
(see article below under Employers and Economics); the State Pain Policy
Advocacy Network; media partnerships and other relevant/current news about Sec
2706. The newsletter notes, for instance, that Oregon and Rhode Island have
become the first two states to pass state legislation that mimics the federal non-discrimination
in health care language. Integrator
columnist Taylor
Walsh, the director of the CoverMyCare campaign, has the lead on the
newsletter.
 Co-CEO Sudak lays out AIHM plans
AIHM Co-Executive
Director Nan Sudak, MD Interviewed in Acupuncture
Today
The title of the article by Bill Reddy, LAc, DiplAc is "The Integrative
Medicine Puzzle: Putting the Pieces Together." The title is fitting for an interview with
Nan Sudak, MD, the co-executive director of the Academy
of Integrative Health and Medicine.
The organization is attempting to "put the pieces together" under one
big tent. Among her comments: "The Academy hopes to support the implementation
of integrative medicine in the U.S. and globally by providing community and
empowering unification of multiple disciplines within a single organization.
The AIHM will provide a home to a broad international community of healthcare
practitioners and health seekers connected by a shared holistic philosophy of
person-centered care, and recognizing the link between our health and the
health of the planet."(Alignment of interest note: I serve on the interprofessional AIHM Board.)
Comment: Interviews can be good divining rods into
organizations. For those vaguely aware of AIHM's presence, this is a good
review of plans, and works in progress.
AANP Partners with
Foundation for Care Management to Provide Naturopathic CME to Multiple Other Professions
In a media release
entitled "American
Association of Naturopathic Physicians to Provide Naturopathic Education for
Physicians, Nurses, Pharmacists, Physician Assistants, Dietitians, and Other
HCPs," the AANP announced a CME partnership with the Foundation for Care
Management. In the release, the AANP positions the profession as care
collaborators: "AANP intends to enhance these collaboration
opportunities via education programs on integrative approaches to common
patient conditions. The association will seek to develop education programs
that focus on cancer, diabetes, obesity, digestive disorders, fertility
problems, and other conditions." The Foundation
for Care Management (FCM) is a recognized leader in local, national, and
international continuing medical education for physicians, nurses, pharmacists,
and other healthcare professionals.
Comment: This
is a good, interprofessional gesture from a position of power for a profession
that too often is licking its wounds out of concern that other fields might
lift what they view as their family jewels. Truth is, it will be something
short of an eon before any other field approximates the depth of integrative
education in naturopathic medicine's four-year, residential program. Good to
see this education commencing.
Integrative Academics
 First VHA chiropractic residents speak
First Chiropractic
Residents in the Veteran's Health Administration Share Their Experiences
History was made two years ago when the Veteran's Health
Administration began
a program to accept chiropractic doctors as residents in VA facilities. A recent
article in Dynamic Chiropractic is a
joint interview with the inaugural class of 5 residents with 4 separate
academic institutional affiliations: Logan University, Southern California
University (SCU), University of Bridgeport, each with one resident, and New
York College of Chiropractic, with two. The three male and two female
chiropractic physician residents respond to questions on research, payment, reception
in the VA, types of VA departments involved, and more. One, answering a
question regarding the level of collaboration with other practitioners,
concluded: "This system allows all providers the ability to view the patient
through a whole-body approach, provide integrative treatment plans, and improve
quality of care."
Comment: One
of the early champions of the chiropractic-VA relationships was Reed
Phillips, DC, PhD, presently the president
emeritus of SCU. Phillips chaired many of the early chiropractic-VA collaborative
committees. I recall him reflecting on those first meetings. To paraphrase:
they started with people imagining each other with horns but in time, as humans
met humans, horns retracted and the new partners began to think about how to
best collaborate to better care. This process of prejudice being eroded by
human contact seems to happen roughly 100% of the time. The happy conclusion
from this non-scientific assertion might be that, for all the vitriol and
bluster about the "quacks" on one side and the "medics" on the other, for most people
the prejudice is shallow and quickly recedes.
International
 (200x37).jpg) Source for global IHM activity
John Weeks' GAHMJ Global Integrator Round-Up for July 2015
The Global Integrator Blog
posts for June 2015 include:
Comment: Interesting to see the work of Integrator
advisor Paolo Roberti di Sarsina, MD and his colleagues to ensure that
"person-centered medicine" includes global healing traditions. The pieces above
on Harvard Pilgrim Health Care and the worksite wellness initiative each
underscore the growing awareness in corporations of the point that these
authors make repeatedly.
Miscellaneous
Is Your City One
of the Most Zen in the United States?
The markers chosen were the number of yoga studios and
alternative medicine businesses per 10 thousand souls in each city. Using data
from Dunn & Bradstreet, FindTheHome
and FindTheCompany created
a "Zen-dex"
through which they determined that the top 5, in order, were Boulder, Santa
Monica, Santa Cruz, Encinitas and Santa Fe. Of the top 25, 8 more were from
California (thus 11/44%). The Easter
Seaboard makes it first as number 11 (Bethesda), and includes a trio of Florida
cities as well as Cambridge, MA and Ashville, NC. The West is the best, with 3
Washington state communities (Seattle, plus two of its suburbs, Kirkland,
Bellevue) and two Oregon (Portland, Bend) on the top 25.
Comment: A
more thorough accounting would probably add in some minuses. For instance, if
the number of elective plastic surgeries were factored in as un-zen sorts of activities,
Santa Monica would likely tumble. And if the length of the average workday, capitals
overworked software engineers such as Palo Alto and San Francisco (Silicon
Valley, etc.) and Seattle, Bellevue and Kirkland (Microsoft, Amazon, etc.)
would likely fall from their perches.
"Zen and the Art of the 14 Hour Work Day" remains an unwritten book. That
said, the list is a fun little exercise.
.jpg) Misbrener: access to elders
"Crone &
Sage School" Seeks to Create Sacred, Interprofessional Space for
Integrative Practitioners
The Academy of Integrative
Health and Medicine (AIHM) has an emerging structure through which to impart
some of the wisdom of the field's elders. In this
special article for the Integrator, AIHM writer and staffer Kelsey
Misbrener writes on her experience with AIHM's "Crone and Sage
School." AIHM is "an interprofessional membership and education
organization committed to the transformation of health care on a global
level." The Crone and Sage School are ceremonies that are part of the
Academy's annual conference. "During these events," writes Misbrener,
the wisdom of the elders is honored as they lead a group of healers to share in
reflection and come together to celebrate our shared humanity and holistic
heritage." The conference will be held this year on October 25-29 in San
Diego, California. The theme is People,
Planet, Purpose. The leading "crone" is the godmother of holistic
medicine, Gladys McGarey, MD.
People
 Westreich: well-deserved honor
Integrative &
Hospice Strategist and Philanthropist Ruth Westreich Honored
"It's her passion for integrative
therapies, for palliative care and really for hospice. She is an undying advocate
for those kinds of programs." These were among the words used by Jill Mendlen,
chair of the LightBridge Hospice
Community Foundation, regarding Ruth Westreich who was honored
at this San Diego function. Mendlin adds: "Ruth can be feisty and she
doesn't mind being out there ‘fighting the fight' for people and that is part
of what I love about her. She is real and genuine." Westreich, who
runs the Westreich Foundation,
is a long-time advocate and strategist for whole person hospice care, and
integrative health and medicine.
Comment:
Westreich has been at the leading edge of multiple developments in the field of
integrative health and medicine. She's has past membership on the board of the
Samueli Institute and with the Bravewell Collaborative, influence on Bastyr
University's Southern California campus, and empowerment of such organizations
as the Academy of Integrative Health and Medicine and the Academic Consortium
for Complementary and Alternative Health Care. A professional artist herself,
she's helped bridge the creative arts therapies and integrative communities. She
recognizes that transformational influence will be most likely through expanded
collaboration. Mendlin's quote is apt. Westreich will comfortably take what for
others may be uncomfortable stances. Terrific to see her honored.
 Goldblatt:ACCAHC co-CEO
Liza Goldblatt-Martha
Menard Team Named to Co-Direct ACCAHC
Two long-time professionals in the integrative health and
medicine space have been selected to co-direct the Academic
Consortium for Complementary and Alternative Health Care (ACCAHC): Elizabeth A. (Liza) Goldblatt,
PhD, MPA/HA and Martha
Menard, PhD, LMT. Goldblatt is a leading educator in the acupuncture and
Oriental medicine profession. She has been involved in interprofessional
education and collaborative practice educational projects and activities since
1990 when she became president of Oregon College of Oriental Medicine. Author
and researcher Menard, is also the director of the Crocker Institute, where she
uses program evaluation as a means for helping nonprofit organizations,
businesses, and institutions assess their outcomes and impact.
 Menard: ACCAHC co-CEO
According to this ACCAHC
media release, together they have over two decade of experience as
volunteer leaders of ACCAHC. Goldblatt is an ACCAHC co-founder and served as
board chair from 2008 until she was selected for her new position. Menard has
held key roles as co-chair of the organization's Research Working Group and as chair
of the organization's task force on integrative pain treatment through which
she had the lead role in the Never Only
Opioids policy brief. Goldblatt has twice served on Institute
of Medicine committees on behalf of the organization. They replace the
present writer, John Weeks, who held the position starting from January 2007-June
2015.
Comment:
ACCAHC's 17 North American organizational members across 8 professions, and 40
college/university members. These descriptors make it a one-of-a-kind
organization to manage and grow. Add to it that some 80% of its revenues are
soft money and that challenge can feel Herculean. My shoulders have lightened
substantially since the June 30, 2015 transition. I was very happy when I
learned that these two had come forward to apply for the position and were
willing to shoulder the heavy lifting. I wish the best to them, the ACCAHC staff, and the rest of the
ACCAHC teams and its network of over top-flight 100 volunteers. I am pleased to
continue involved in a minor way as a retained consultant on a couple of projects including partnering with Goldblatt at the
IOM Global Forum on Innovation in Health Professional Education.
 Snider: Vis Award
AANP's Annual Naturopathic
Physician Awards to Snider, Murray, Parker, Schleich, and Labriola
At the banquet at the 30th anniversary
conference of the American Association of Naturopathic Physicians (AANP),
the organization presented its bevy of awards. The Physician of the Year went to
Tabatha Parker,
ND. Parker co-founded and directed Natural
Doctors International and is co-leading the campaign for the field's
representation with the WHO. She presently serves as director of education for
the Academy of Integrative Health and Medicine (AIHM). The profession's
esteemed "Vis Award" - for the vis medicatrix naturae (healing
power of nature) - went to Pamela
Snider, ND, the executive editor and founder of the Foundations of Naturopathic Medicine
Project. Snider's immensely productive career also includes significant
interprofessional and policy leadership as a co-founder and executive member of
the Integrative Health Policy Consortium, the Academic Consortium for
Complementary and Alternative Health Care and, more recently, as board member
of AIHM. Best-selling author, speaker and natural products expert Michael Murray, ND was given a lifetime achievement award. Through his over a dozen books and countless presentations, Murray, whose contributions including popularizing standardized extracts in the United States, also helped brand the modern naturopathic profession from the mid-1980s forward.
 Murray: Lifetime Achievement
The AANP's "Champion" award, given to a non-ND who has meaningfully
assisted the profession, went to David Schleich, PhD,
the visionary president of National College of Natural Medicine. Schleich previously
played a major role in lifting the Canadian College of Natural Medicine toward
its present health while serving as president there. The "President's Award"
that is selected each year by the AANP president - in this case former
Washington States Association of Naturopathic Physicians' president Kasra Pournadeali,
ND, went to one of Pournadeali's predecessors at WANP, Daniel Labriola, ND.
Labriola had the central role in creating the first modern naturopathic
licensing statute in the mid-1980s and subsequently became known nationally for
work in integrative oncology. He is director of integrative ser4vices for
Swedish Medical Center and Seattle Children's Hospital.
.jpg) Parker: Physician of the Year
Comment: Great crop this year. Time will show Snider
to be as the Queen of the Vis once the long-awaited life-work of the
Foundation's textbook comes out. The
sky's the limit for Parker who has already been recognized by Utne Reader as a visionary. Schleich has done nothing less than take the
risks to guide both CCNM and NCNM through periods of tremendous expansion. His
commitment to the field is profound. Labriola provided critical foundational
mark and has since, through a conservative approach to his field, built bridges
with many institutions that likely could not have otherwise been built.
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