Perhaps
the best way to gauge the impact of a healthcare researcher's work is
whether medical practice changed. By such a measure, the Samueli Institute's robust
military research initiative relative to integrative practices, led by
Joan Walter, JD, PA is showing significant success. Pilot projects in
auricular acupuncture, for instance, have led to education of Air Force
doctors in a novel, 5-point auricular acupuncture protocol. A Yoga
Nidra trial is incorporated in a program for soldiers with
post-traumatic stress disorder. Here is a look at some Samueli
Institute initiatives that are transitioning from research to practice.
Will these breakthroughs one day shift civilian care?More ...
Ever
wonder the origins of "integrative medicine" as a descriptive term?
David Riley, MD, recounts the story ... Laura Crites, executive
director of the Hawaii Consortium comments on a proposed strategy for
the IOM Summit ... Bodyworker Josef DellaGrotte has additional
suggestions for Intel and otehr employers on the value of body work ...
Linda Bark, RN, found good news at the recent Health Forum conference
and suggests a Samueli Institute text as a resource ... Tai Sophia's Kevin Spelman
comments on Stargrove's work on drug-nutrient interactions ... plus an
anonymous follow-up to Glidden's naturo-centric view of "integrative
medicine" ... More ...
August 6, 2008
In
2005, Hawaii's major Blue Cross Blue Shield carrier, HMSA, contracted
with Manakai O Malama, the integrative clinic founded by Ira Zunin, MD,
MPH, MBA on an unusual integrative, outpatient pilot for some of their
most costly, pain-ridden, disabled members. The elaborate approach
included diverse mind-body approaches, Feldenkrais and Yoga, and group
acupuncture. Zunin, who was interested in a thorough biopsychosocial
model, observes of the positive outcomes - reduced anxiety and
depression, lower disability, reduced opiate use - that the ethical
value in group process has both "carrot and stick" sides. Here is the
pilot, with its outcomes. More ...
July 31, 2008
Report shows
hundreds of million in savings to states from wellness model ... Center
for Disease Control director Gerberding calls for "changing the conversation" in order to make the U.S. the "healthiest nation" via new CDC
campaign ... Licensed complementary healthcare practitioners still not included in healthcare
workforce dialogue ... Debate at the University of Bridgeport to focus on whether
chiropractors should follow the New Mexico model of primary care chiropractic with limited prescribing rights ... NCCAOM pushes to get acupuncture and Oriental medicine recognized as a profession by the
U.S. Bureau of Labor Statistics ... AMA and OB/Gyn opposition to homebirth
sparks debate on ABC news site ... Chiropractic lobbying may open a door for all "CAM"
colleges ... Wake Forest integrative medicine's Kathy Kemper, MD, MPH
shares new integrative clinical services ... True North's Bethany Hays,
MD honored by the Institute for Functional Medicine with the 2008 Linus Pauling Award ...More ...
July 29, 2008
The last Integrator issue included views on whether "integrative
medicine" is inclusive or denies other disciplines. In this set of comments: Tom Ballard, ND,
a part of the naturopathic medical field for 30 years describes how his
excitement about "integration" has panned out as an unhealthy
"assimilation." Sheila Quinn, a long-time leader in integrated health
care, offers a few perspectives, including that of a patient. Holistic
medicine pioneer and contributor to Rakel's Integrative Medicine,
Bill Manahan, MD, finds himself aligned with a "heretical model" of
leveling the playing field. Holistic nurse Sonja Simpson, RN, wonders
if any of this will amount to better patient care. Thoughtful
submissions on what Manahan rightfully called "an elephant in the room."More ...
[From my column at Integrative Practitioner Online] Three recent encounters with initiatives in “integrative medicine,”
plus the letters received at the Integrator, strongly suggest that this field will increasingly be viewed as an MD
subsidiary unless remedial action is taken to affirm a more inclusive
role for non-MD integrative medicine professionals. I am not sure what to think about this. Here are my reflections for my column of this title for Integrative Practitioner Online. More ...
Commonwealth
Fund reports double cost, horrible outcomes of US medicine ...
Expansion of low-cost community acupuncture models featured by AAAOM
and in Philadelphia weekly ... Alaska's Native-owned,
community-focused, team-oriented healthcare approach approach shows
huge cost savings, increased practitioner satisfaction through a
relationship-centered approach ... Ian Coulter, PhD offers insight into
strengths and shortcomings of health services research as the "holy
grail" for integrative practices ... Holistic board requires self-care
knowledge in re-certification ... AHMA celebrates 30th birthday ...
Chiropractic organization and NCMIC clarify manipulation/stroke
evidence for 16,600 neurologists ... Cohen and Dumoff combine for
webcast seminars on legal issues for integrative clinics and spas. More ...
July 16, 2008
My
back-and-forth with David Rakel, MD, on the meaning of "integrative
medicine" as it is presented in his influential textbook of the same
name led to two quick responses from excellent observer/participants in
the integrative practice arena. Bradly Jacobs, MD, MPH, directed the
integrative clinic affiliated with the UCSF Osher Center before taking
his present position with Revolution Health. Christy Lee-Engel, ND, LAc
has been a principal or affiliate with the two most significant
integrative clinic initiatives in Seattle and has also held leadership
positions at Bastyr University. Here are their perceptive enrichments
of this discussion. More ...
The big medical
news just after Independence Day was that, following new American
Academy of Pediatrics recommendations, thousands of children will soon
be dependent on statins for cholesterol management. Integrator
columnist Michael Levin muses on this news together with a virtually
unnoticed whole system, integrative Mayo Clinic study which found that
lifestyle, supplements, diet and yoga or Tai chi not only lowered
cholesterol but also weight and who knows what other positive outcomes.
Are statins parenting replacement therapies? More ...
July 7, 2008
Integrative Medicine, developed and edited by David Rakel, MD, makes quite an impression. The 1238 page volume, with over 100 authors, 97% either MD/DO or medical-school affiliated, marks
an arrival and launching pad for that field. The text asserts a body of
knowledge and is immediately a political tool for the advance of that
field. I was reminded, on reviewing the book's look and feel, of a
moment two decades ago when A Textbook of Natural Medicine, was published. That book allowed the re-emerging field of naturopathic medicine to claim it was modeling a new form
of science-based, integrated care. What does Rakel's remarkable
contribution assert about "integrative medicine" and in particular
about the value of other disciplines? Here are my reflections plus
Rakel's comments on the book's intent, and some next steps.More ...
Kaiser
Permanente models natural pharmacy in managed care ... American
Acupuncture Council offers acu-coding book ... Successful Massage Envy
franchise operation purchased by huge Indian conglomerate with strong
wellness interest ... URAC developing accreditation standards for
wellness programs - comment period now ... Details on the AMA's Scope
of Practice Partnership campaign against expanding scopes of other
disciplines: NDs and midwives taking heat ... Healthcare advisers for
presidential campaigns have loose links to integrative practice
movement .. IOM puts annual waste in US healthcare at over
$1,000,000,000,000 (that's one trillion wasted, or a lot of what might
have been fully-reimbursed integrative care) ... A few words about
Penny Simkin, a quiet hero of empowering healthcare, plus more. More ...
Naturopathic physician Peter Glidden, ND, sent me this column on a dare. He didn't think I'd publish it. Glidden blasts much of the so-called "integration" effort, lambasting MD-directed "integrative medicine" in particular."
In truth, I held this for a few months. But I think that Glidden does
capture sentiment frequently expressed by members of the distinctly
licensed complementary healthcare professions as they observe the
ascendancy of the "integrative MD." It's just that it's usually not
shared in mixed audiences - such as the Integrator readership. What do you think? More ...
Where should we prioritize research investment to help maximize the value to the public health of integrative practices? Does all the talk of healthcare reform and "transformation" need a parallel push to re-focus our research agenda? Qi-Unity, the monthly e-newsletter of the American Association of Acupuncture and Oriental Medicine, recently published an interview with me on my perspectives on these and other research agenda questions. Here is the link to the AAAOM interview. Send your comments back here to
. What do you think we should be advocating for a research agenda? How can we get there? To go to the AAAOM site, click here ...
In June
meetings, the House of Delegates of the American Medical Association
(AMA) kicked off an escalating round of attacks on the advancement of
other healthcare professions. Targeted this year were all disciplines
with doctoral-level training, as well as licensed midwives.
Chiropractors, naturopathic physicians and nurses - who cited Wilk v
AMA - are among those quick to challenge the AMA. The AMA actions
are part of that guild's divisive AMA Scope of Practice Partnership
(SOPP), announced in January 2006. Meantime, one action at the House of
Delegates meeting suggests that the snake on the AMA's caduceus may be
biting its own tail. Resolution 235 is an effort to keep the AMA's own
specialty societies from legislative actions that seek to restrict each
other's scope of practice. More ...
June 22, 2008
Why would an employer want
to explore a complementary therapy? How might a pilot project be
established? This article describes a relationship betweenmicroprocessor giant Intel,
researchers looking for onsite solutions to low-back pain at the
Institute for
Health and Productivity Management (IHPM), and the Dorn Companies, which hires licensed massage therapist to
supply a Rolfing-based manual therapy to employees. Outcomes of this pilot project will be
reported at the IHPM's fall conference in Scottsdale, October 15-17,
2008. More ...
Marc Micozzi,
MD,PhD, convened an early federal exploration of complementary and
integrative medicine, wrote the first academic textbook on
complementary and integrative medicine, worked with Dr. Koop on his
dot.com website (may it rest), and ran an academic integrative medicine
program. Lately he has been thinking outside of mainstream delivery,
specifically in the spa/wellness zone. He notified the Integrator
of a relationship he has teaching in an online certification program
through UC Irvine's School of Business. I invited his direct comment on
the spa field. Here is Micozzi's commentary, and some information about
the program. More ...
Integrator columnist
Michael Levin recently had occasion to read a series of reports,
prepared by the internationally-known health care consulting firm, The
Lewin Group. The subject: possible cost impact of pro-actively using a
few dietary supplement interventions for a handful of conditions. The
outcomes were compelling. Levin argues that this kind of work, funded
by the dietary supplement industry, exemplifies forward thinking
collaborative effort needed to advance the integrative and natural
health fields. The story of this strategic funding will be familiar to
chiropractic. More ...
June 20, 2008
Among those
noted University of Arizona Program in Integrative Medicine designated
a Center of Excellence by Arizona Regents ... Council on Naturopathic
Medical Education gains 5 years from the USDE ... US/China accord on
traditional Chinese and integrative medicine ... Integrative MD/ND/LAc
Goshen Cancer Center awarded ... Trustee
features integrative medicine for Boomers ... Integrated community care
leader Community Health Centers of King County becomes HealthPoint ...
The debate over the JAMA St. John's wort for ADHD article ...
National advertising campaign for chiropractic and the IOM use the
Alternative Medicine Inc. study on cost savings ... AMI's state
partnerships grow ... Chiropractic associations in agreement on pediatrics specialty ... More ...
Do you
think the National Summit on Integrative Medicine can make a difference?
Planning for this February 25-27, 2009 gathering, sponsored by a
partnership of the Institute of Medicine of the National Academies and
the Bravewell Collaborative, is under way. I organize my recommendations around areas where exploration of integrative practice could have
a significant impact on the nation's health care crisis. The high notes are
a health-oriented approach, outpatient services, the patient-centered medical
home, respect for multiple disciplines, researching whole practices as
basis for managing chronic disease, and whole cost accounting. How do
you think this Summit might create possibilities which the IOM's 2005
report didn't already open? More ...
The
Institute of Medicine (IOM) of the National Academy of Sciences has
announced a 12-person planning committee which will oversee development
of the February 25-27, 2009 National Summit on Integrative Medicine and Health of the Public. The
IOM is sponsoring the Summit in partnership with the Bravewell
Collaborative of philanthropists. Here is a look at the 12 member team,
chaired by Ralph Snyderman, MD, plus some musing on the not very
integrated mix. Nine are MDs, suggesting that to the IOM, "integrative
medicine" is an MD franchise. The Bravewell philanthropists have made a
substantial commitment to make this happen. More ...
Integrator columnist Michael Levin
shares intriguing outcomes of a healthcare survey from the Deloitte
Center for Health Solutions. The authors examine opinions and practices
of over 3000 consumers, identifying use of alternative healthcare
services as a key identifier of behavior across a series of consumer
types. The six types range from "content and compliant" to "out and
about" (the most significant alt-med users) to "shop and save." Current
complementary medicine use represents a fraction of the openness
expressed by these consumers. Paul Keckley, PhD, co-author
and director of the Center was formerly the head of integrative
medicine planning for Vanderbilt University. Levin is correct: there is
much here to ponder about integrative care and the changing nature of
the healthcare consumer.More ...
From March 31-April
2, 2008, an unusual cross-disciplinary group of complementary, alternative and integrative
medicine (CAIM) practitioners and researchers gathered with
a much larger group of employer organizations at the Institute for Health and Productivity
Management's Fourth Annual Health Management Conference. The conference was entitled The
Employer-Sponsored Value-Based Health System: New Key to Global Competitiveness. The questions on the table were
whether and how CAIM practices might be useful to an employer’s cost-conscious
health and productivity agenda, and, if so, were the two parties ready to take
advantage of the opportunity presented. This reports some of that meeting. Next conference: Oct. 15-17, Scottsdale. More ...
May 31, 2008
The most
significant penetration of complementary and alternative health care
into mainstream US medicine is not integrative medical doctors, or
holistic nurses, or massage therapists or any other complementary,
integrative or holistic practitioner type. Rather, that position is
held by digitized CDs and now web-available downloads of guided imagery
tapes. The leader in the field is been HealthJourneys, founded by
Belleruth Naparstek, LISW, BCD. Here is a portrait of the growth of
that business since 1989, when a little audio cassette was introduced
into a Kaiser Permanente hospital. More ...
The
pace of action in integrative medicine and integrated healthcare picks
up monthly. This article begins a new, regular feature of the Integrator.
I scan the incoming and offer quick links on the business, academic,
research, professional, integrative, media and employer actions
relative to these fields. You click into the longer stories of interest
to you. 20 short notes here. I hope this new services is useful. More ...
May 31, 2008
Integrative medicine is producing its second wave of leaders. Among these is David Rakel, MD. Rakel is a board member of the
American Board of Integrative Holistic Medicine, an executive committee member of
the Consortium of Academic Health Centers for Integrative Medicine and editor
of the 1300 page tome Integrative Medicine. The Integrator spoke with
Rakel recently about the movement, and his day job, at the University of
Wisconsin School of Medicine, where his focus is on a new model of family medicine. More ...
May 25, 2008
Dialogue over
the integration of herbs and nutrients into clinical practice has
focused on potentially negative impacts on the value of prescribed
pharmaceuticals. Missing has been a view which respects these concerns,
but which puts the patient, rather than the pharmaceutical regime, in
the center of clinical concern. The recently published 930 page Herb,
Nutrient, and Drug Interactions: Clinical Implications and Therapeutic
Strategies
(Stargrove, McKee, Treasure) offers a measured walk for clinicians
which Tieraona Lowdog, MD, chair of the US Pharmacopoeia Dietary
Supplements Information Committee calls, in a forward, "appropriate
balance between recommendation and risk based on the overall strength of the
scientific evidence and their own clinical experience." More ...
[From my Integrative Practitioner Online (IPO) column] Do you recall the debates in communities across the United States in
those rare periods when the US Congress has considered limiting our
military expenses and moving toward a peacetime economy. Typically, Congress creates a commission to recommend closure of
certain military bases. Then, when a community hears that a nearby
base is slated for closure, reports of that base’s contributions to the
local economy hit the editorial pages. Local members of Congress begin
battling to keep “their” bases open, and the money flowing. I was reminded of this pattern of behavior when I saw an April 2008
report from the American Hospital Association (AHA). The report did
not highlight cures or positive movement on one or more health indicators.
Rather the AHA’s monthly TrendWatch ran under this title: “Analysis Celebrates the Economic Contribution of Hospitals to Communities.” Click here to go to IPO for the full column.
Bob Sager,
MD wanted integrative MD questions in the CodeBlueNow! voter surveys
... Wellpoint fraud expert Howard Levinson, DC comments on the state of
managed care ... Former holisitic nurses association leader Sonja
Simpson, RN, AHN-BC believes commentator Beth Wooton, ND was spot on
regarding practitioner education ...
Researcher Lyn Freeman, PhD has some suggestions about new routes to
project funding that are not NCCAM dependent ... Lisa Yater, LCSW, on
how the structure of conventional care delivery limits the opportunity
for inclusion. More ...
Two individuals
who have played significant roles in different areas of the integrative
care universe died recently. Robert (Bob) Timberlake was a leader in
jump-starting the re-emergence of naturopathic medicine, and
particularly its expansion of new licensing of naturopathic physicians
in the 1990s, serving later in a leadership capacity with Vital
Nutrients, a quality leader in natural products. He was a valued
colleague and friend ... Steve Gorman, founder of Alternative Health
Insurance Services, began talking about, and dreaming up ways to
expand, coverage of alternative medicine services over two decades ago.
Adviser Michael Levin offers appreciation for Gorman's life. More ...
April 21, 2008
Breakthrough:
American Medical Student Association formally recognizes the
Naturopathic Medical Student Association as an affiliate ... Fønnebø to propose a "peace treaty" in "research battleground" at May 18 SPARC meeting ... Harvard
integrative clinic featured ... UCLA program offers seven approaches to
back pain in consumer-focused event ... Formerly chiropractic-only
schools gain recognition for AOM and ND programs ... Yale's kick-off
event draws overflow crowd ... NIH to have May Yoga week ... U Mass
natural products Master's degree now largely internet-based ... BU and
Northwestern Feinberg medical schools bring to 41 the members of the Consortium of
Academic Health Centers for Integrative Medicine ... Master's in
Integrative Health in development for 2008 at National University, San
Diego. More ...
Guest
writer Beth Clay's mention of homeopathy and her challenging of the
credentials of a top NIH NCCAM deputy, Jack Killen, MD, provoked strong
responses. I corresponded multiple times with an anonymous scientist
who was livid with the Integrator and Clay yet did not want his comments
published, even anonymously. I capture some of the exchange, as I
believe there may be many others who agree. Entrepreneur Taylor Walsh
wonders if the challenges to Killen are merited. Consultant David
Matteson, MPH credits the Integrator (and Clay) for the
discussion. Finally, author and homeopath Dana Ullman, MPH, details a
rebuttal to Killen's view, as quoted in Newsweek, that there is "no condition for which homeopathy has been proven to be an effective
treatment." More ...
Integrator columnist
Michael Levin, founder of Health Business Strategies, is a long-time
promoter of integrative medicine strategies that challenge the often
costly, unsafe and quality of life-damaging interventions promoted by
Big Pharma. So when Levin, who has been an executive with both pharmaceutical
and dietary supplement firms, saw the new AARP report on drug price
trends pre and post the implementation of the Medicare Drug Benefit, he
analyzed it both for what Pharma had already extracted, and for what
integrative medicine might. Here is Levin's brief report and view of
opportunities. More ...
April 15, 2008
When Yale University School of Medicine
recently chose to bring a chiropractor into their first Integrative Medicine
Symposium, Anthony Lisi, DC was the chosen presenter. As director of the
Veterans Health Administration's Chiropractic Service, Lisi sits in the
hot-seat for the most significant complementary and alternative healthcare
integration effort nationwide. To Lisi's account, practitioner-to-practitioner
relationships and patient reports are overcoming the deep reluctance which
greeted this Congressionally-mandated program. The Integrator caught up
with Lisi to learn more about this pioneering initiative. More ...
