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Coming of the Light: Integrator Top 10 for Integrative Medicine and Integrated Care from 2008 PDF Print E-mail
Written by John Weeks   
Sunday, 28 December 2008

Coming of the Light: Integrator Top 10 for Integrative Medicine and Integrated Practice from 2008

Summary:  On winter solstice 2006, the Integrator began a tradition of announcing a Top 10 from the previous year which will most support the coming of the light for integrative practice in the New Year. Here is the 2008 Integrator Top 10 for integrative policy, practice, research and professional activity. Like last year, 9 are listed here. What are your suggestions for #10? Thanks to all these individuals behind the good work noted here. Happy reading, and reflecting, on the year that was, and the year to come.
Send your ideas of highlights from 2008 for publication
in a future Integrator Forum.


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Winter Solistice & the Coming of the Light
In Seattle, it gets dark, dark this time of year. One can long for the
winter solstice and the end of the shortening of daylight. In late November, to alleviate the darkness, my daughter and I typically create a meandering doodling of multicolored winter-lights on our family home, bushes, trees and fence. We may keep them shining until the end of January this year. Winter lights, we call them. They are a palliative medicine.

As 2008 turns to 2009, the yearning for the
coming of the light is more than metaphor after the long dark through which our country has passed. A moment full of potential lies ahead. For those particularly dismayed by the shockingly poor performance of our misdirected medical system, reform is in the air. We hear talk from on high of a "society of wellness." The 2008 Integrator Top 10 speaks to the new relationships and collaborations around health which will be necessary if we are to move hope into action.

First, a Word about Our Sponsors


Please take a moment to thank the sources of whatever light the Integrator may have cast into your work and life this year: the Integrator sponsors. While I have the good luck to serve in this way, my work is not entirely a labor of love.
The generosity of the organizations and individuals behind them who collaborate to sponsor the Integrator are what allow me to spend my time scanning the waterfront, reading, interviewing, reporting and creating forums of your comments. Their sponsorship is principally out of a belief that the Integrator is a connective tissue that performs services and potentiates positive change. Please thank them with me:

Thank you all! 
_______________________________

The Integrator Top 10 from 2008 as We Enter 2009

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Henry & Susan Samueli - sponsoring significant work on many fronts
1.  The Samueli Institute, Henry and Susan Samueli, Wayne Jonas, MD and the Wellness Initiative for the Nation (WIN
)

Two months ago a USA Today article featured the use of acupuncture in the military. A Christmas Day 2008 article in the Air Force Times focused on a similar topic. Both were based significantly on research carried out through a not-for-profit institute. Eighteen months ago, the Health Forum of the American Hospital Association formed a partnership with a not-for-profit which dramatically increased attendance as well as the quality of content at its annual conference on Integrative Medicine for Healthcare Organizations. The focus: Optimal Healing Environments. In February 2008, the influential Rand Corporation announced a partnership with a not-for-profit institute to explore practical values of integrative medicine. Just last week, the Integrator invited readers to a forum led by the leader of a not-for-profit which is connected to Obama transition leaders on a much needed, transformative Wellness Initiative for the Nation (WIN). In each case, the not-for-profit was the Samueli Institute. The impact of the Samueli Institute, funded through the vision and generosity of Susan and Henry Samueli and led by Wayne Jonas, MD and his fine team (see related Integrator article) has been substantial. We can all be thankful that the Samuelis and Wayne Jonas had a meeting of the minds some years ago to create this force for bettering health.

Note: Samueli was acknowledged last year for its Health Forum work on the business of health system integration. The WIN initiative, in particular, led to the re-recognition this year.

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American Association of Naturopathic Physicians
2.  American Association of Naturopathic Physicians and the Formation of Cross-Disciplinary Coalitions


Collaboration with ever
larger circles is critically important for any of healthcare’s minor entities. And, my friends (to quote John McCain), every single component of the integrative practice community is but a gnat on the back of the $2.4 trillion per year medical business. If we are to foster a health-and-wellness oriented movement and industry, we must commit time and resources to learn to act in unity on our shared mission. For extraordinary leadership in this area, the American Association of Naturopathic Physicians (AANP) deserves special recognition. In 2008, the AANP took the lead in developing and promoting H. Con. Res. 406, a Congressional Resolution which, if passed, would elevate the importance of quality wellness programs in any U.S. healthcare reform. The association convened public and private forums of leaders of a half-dozen associations representing medical doctors, holistic nurses, educational consortia and natural products interests; these subsequently chose to support this initiative as a first step together. The AANP, under the direction of former Congressional staffer Karen Howard, has since provided the heavy lifting for this wellness initiative, the most significant of coalitions for integrative practice in a decade. In addition, the AANP invited the participation of the American Holistic Medical Association (AHMA) at their annual conference for a refreshing merging of MD-ND energies. Meantime, leaders of the Naturopathic Medical Student Association (NMSA) successfully forged a tie with the American Medical Student Association (AMSA) to create an AMSA Special Interest Group. Special credit to the AANP's past and current presidents, Jane Guiltinan, ND and Lise Alschuler, ND, NABNO, respectively, board member Bill Benda, MD, consultant David Matteson, student leader Cheri King and particularly to Howard, the AANP's executive director. We need all of our associations to commit to collaborative action.

3. Resurgence and Expansions of Integrative Clinics and Centers

The year 2008 has been sprinkled with a steady stream of news reports of expansions or creations of new integrative practice centers. Among these are: the achievement of Center of Excellence status for the Arizona Center for Integrative medicine led by Victoria Maizes, MD and Andrew Weil, MD; an expansion and a new clinic for Integrator sponsor Inner Harmony Wellness Centers led by Peter Amato; growth to new facilities by the Community Health Centers of King County (now Healthpoint), a leader in integration of complementary healthcare practitioners in community medicine guided by Tom Trompeter, MHA; an award to the integrative program at Goshen Health System, led by Marcia Prenguber, ND; a vast new building location for Heart Spring Wellness Center at Corvallis, Oregon-based Good Samaritan Regional Medical Center, part of a multi-clinic integrative program led by Mary Ann Wallace, MD (reported here); the unveiling of the Osher Clinical Center as part of the integrative program at Harvard Medical School, led by David Eisenberg, MD; first integrative clinical programs at Johns Hopkins and the University of Hawaii; continuing expansion of clinical services at the Wake Forest program led by Kathy Kemper, MD, MPH; the pilot with the Hawaiian Blue Cross Blue Shield firm, HMSA, at the Manakai O Malama clinic founded by Ira Zunin, MD, MPH, MBA; the formal naming of the Penny George Institute for Health and Healing by the Allina Health System, honoring the founding energy of the nation's most robust health system-based program; and expansion into new facilities for the academic program at the University of New Mexico led by Arti Prasad, MD and at the University of Kansas, led by Jeanne Drisko, MD. There are more, no doubt. (Who have I missed?) It seems clear that lessons from a first wave of expensive failures in integrative medicine are creating more durable models for integrative practices. Congratulations, all!

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NCCAM Director Josephine Briggs, MD
4.  The Outlaw Josie Briggs: NCCAM and a Real World and Effectiveness Approach at the National Institutes of Health


For the past 8 years, since the publication of the IOM's To Err is Human, the real world in-effectiveness and harm from US medicine has finally received attention. (The alternative medicine community has been writing on these topics since at least 1983, when I first got involved.) A growing percentage of our citizens now know that the "best medicine in the world" actually costs twice as much as that in other countries while achieving half as good of health outcomes in the populations served. Common sense says our nation’s research dollars should be re-focused on finding
strategies that are effective in helping people become healthier at a lower cost. Common sense suggests that the National Institutes of Health should focus on these very practical outcomes. Yet such a view is counter-cultural inside the NIH. Meantime, serving the functional and health-oriented desires of patients is the alpha-and-omega of the consumer-led integrative practice movement. So it was extremely refreshing to learn that Josephine "Josie" Briggs, MD, who took over as director of the NIH National Center for Complementary and Alternative Medicine in January 2008, has determined that NCCAM under her guidance will have a greater focus on "real world, effectiveness research." (See New "Effectiveness" Direction for NCCAM: An Interview with Director Josephine Briggs, MD, November 26, 2008.) We do not know how aggressively Briggs will push this agenda. James Gordon, MD, has suggested that at least 25% of the NCCAM budget should focus on whole practices and economic outcomes. Briggs notes that the NIH as a whole is focusing somewhat more on effectiveness. Surely Briggs' ability to promote this still non-traditional focus for the NIH will be bolstered if she hears from leaders of all integrative care organizations and professions that they look to her to lead a jailbreak from the restrictive confines of reductive trials. By doing so, Briggs can make NCCAM a discovery zone for a health-oriented research agenda for the nation. Not a bad legacy - for integrative practice and for Briggs!

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Bravewell Collaborative: funds IOM Summit
5.  Bravewell Collaborative, the Institute of Medicine and the National Summit on Integrative Medicine


One of the most significant actions of 2008 for integrative medicine has been taking place mostly under the radar. It began as a partnership and is emerging as a coalition. For the past 10 months, a 14-person Planning Committee of the Institute of Medicine plus some contracted writing teams have labored to develop the National Summit on Integrative Medicine and the Health of the Public which will be held in Washington, DC, February 25-27, 2009. The Summit's origins reflect the way much gets done in Washington, DC: the Bravewell Collaborative of philanthropists, led in this initiative by Bravewell's president Christy Mack, partnered with the IOM by granting the quasi-governmental organization $445,000 to fund the Summit.
Bravewell is making the most of the meeting through a coalition that includes the US Chamber of Commerce and the AARP, to move whatever energy is created at the Summit. The February meeting is a welcome push for patient-centered, mind-body care. The Summit also promises to be a fascinating benchmark in the evolution of the idea of "integrative medicine," not only because of the power of the players involved, but also for a kind of historicide the Bravewell typically practices in its view of "integrative medicine." Mack declared in a kick-off on the Charlie Rose Show on March 28, 2008 that this Summit is “not about CAM.” The statement suggests the Bravewell is distancing "integrative medicine" from its roots. It surgically excises a history which clearly documents that “integrative medicine” was born out of consumer use of a vast array of alternative or complementary therapies and practitioners, dubbed "CAM" by conventional medicine. Was it the white man Elvis who first sang and moved like that? I earnestly hope that the patient choice of "CAM" practices, most of which inherently embrace and advance holism and health and wellness, will be honored rather than co-opted in Bravewell's own vision of a patient-centered, mind-body "integrative medicine" for medical doctors. Here is hoping that the February 25-27 Summit will be a transformative meeting which also models inclusiveness and collaboration rather than the disrespect for other disciplines which pocks our current medicine. We need all our forces to be respectfully engaged here.

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Now boasting over 5600 members
6.  Integrative Practitioner Online: A New Platform for Our Community


The business idea of a robust online gathering place for the integrative practice community has been in play for a dozen years. A year ago, other than the low band-width Integrator, we lacked such a home. In February, Maine-based Diversified Business Communications, the sponsor of the influential Integrative Healthcare Symposium, kicked off the Integrative Practitioner site. The value began to be realized. I selected this website prior to its formal kick-off last year for the Top 10 from 2007 as a good luck wish. Now the Integrative Practitioner Online community has grown to presently include 5600 members from a dozen disciplines and over two dozen practice areas.
The clinical, policy and business articles, discussions and webinars are top-quality and well-themed. The site is promoting collaborative policy action. Check the policy page. Marydale Abernathy (website) and Marnie Morrione (conference) lead the initiative through a National Advisory Board on which I have the opportunity to serve. (I like to think that the team's savvy is also evident in a decision last September to become a sponsor of the Integrator.) The February 19-21, 2009 iteration of the annual Integrative Healthcare Symposium promises to convene over 1000 participants. Take a look at the site if you are not familiar with it. Here is hoping that Diversified Business Communications and other integrative practice interests will continue to support this platform for health care advancement.

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Anthony Lisi, DC; Heading up the VA program
7.  The Chiropractic Profession and the Veteran's Administration: Opening Doors for More than DCs


Sometimes, in the course of human events, people chose the right thing. Sometimes they have to be forced to. In the case of the access of veterans to services of chiropractors, the latter was the case. Under the force of the mandate of federal legislation backed by the chiropractic profession,
and under the direction of Anthony Lisi, DC, the nation's Veteran's Affairs facilities are slowly uptaking chiropractic services. (See Chiropractors in the Largest Health System: Anthony Lisi, DC on Integration in Veterans' Facilities, April 15, 2008.) The pattern of relationships goes like this: Once the reluctant medical doctor and the staff chiropractor have a chance to meet each other and work together, respect grows. Care is better coordinated. Patient choice, and patient-centered care is honored. In addition, we have learned through dialogues in the Clinical Care Working Group of ACCAHC, on which Lisi serves, that the VA's doors, once wedged opened, are also creating opportunities for licensed acupuncturists. For instance, the multidisciplinary New York Chiropractic College and Southern California University of Health Sciences, both of which have VA partnerships for chiropractic services, are also providing acupuncture services through their acupuncture degree programs. "Integration" advocates don't typically like to see their process as moved by mandates, but this forgets how much major cultural changes in the US have required sit-ins, strikes, demonstrations, marches and ultimately the force of law. Credit the chiropractic profession for creating these opportunities for better integrating patient care.

Image8.  Game-Changer: Lucy Gonda and the Academic Consortium for Complementary and Alternative Health Care (ACCAHC)

Five years ago, an individual named Lucy Gonda made the first of a series of financial commitments to support a dialogue between educators from 12 integrative practice disciplines. (See the National Education Dialogue to Advance Integrated Health Care.) Gonda's vision and continued support quietly led to the incorporation in January 2008 of an entity called
the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), a collegial counterpart to the Consortium of Academic Health Centers for Integrative Medicine. Following early direction from Pamela Snider, ND, ACCAHC has grown to become one of healthcare's most significant multidisciplinary educational collaborations. ACCAHC's 14 dues-paying organizational members represent the leading educational, accreditation, and certification and testing organizations for the 6 disciplines of chiropractic, acupuncture and Oriental medicine, massage therapy, naturopathic medicine, direct entry midwifery and yoga. The alphabet soup includes the CCAOM, AANMC, AMTA-COS, ACC, COMTA, CNME, CCE, MEAC, NABNE, NCBTMB, NBCE, NCCAOM, IAYT and YA. (Links to all the organizations are on ACCAHC's home page.) Some three score of busy leaders from these organizations are slowly changing the landscape through their commitment to shaping a system based on mutual respect rather than competition. ACCAHC is emerging as a potential “game changer.” Emerging projects are many. Two highlights: ACCAHC was instrumental in placing the only person principally associated with a licensed complementary healthcare discipline on the Planning Committee of the Institute of Medicine's February 2009 Summit; ACCAHC is also planning a half-day retreat with academic leaders from the conventional Consortium.  I count myself lucky to have taken on the role of executive director of ACCAHC when Snider stepped down. Kudos to the individuals who cajoled their fellow board members of that alphabet soup of organizations to take a leap into multidisciplinary association and particularly to ACCAHC's president Elizabeth (Liza) Goldblatt, PhD, MHA/PA. Here’s to leaving the isolation in which all of our fields were reared and fully engaging this great potential.

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Tom Daschle - Obama's point person on health reform
9.  Obama, Daschle, Harkin, Kennedy and the Emerging Society of Wellness 


These words, or something like this, are behind what brought many of us into this work:
“I have long believed that prevention and wellness are the keys to solving our health care crisis. We must recreate America as a 'wellness society' focused on fitness, good nutrition, and disease prevention – ultimately keeping people out of the hospital in the first place."
What a happy thing that these words are not merely a wishful keynote at a professional meeting, or a tag-line of a pitch to some reluctant person of power through which we must move our agenda. Instead, these are the words of US Senator Tom Harkin, a key player in the emerging health reform team which is shaping up under the Obama administration and which will be led by Tom Daschle, Obama's point person for health reform. Wellness encompasses collaboration, mind-body, deep personal process, community, the environment - all integrative practice values. Now is the time to show up!

10.   And What Is It That You Would Add?

I have certainly left much out which is particularly hopeful that is on our horizon. Send me a note with your thoughts! A future Integrator will include your sightings of the coming of the light.


For the Top 10 list from 2006 click here and for 2007 click here.

________________

Comment on the Selections


I was struck as I began writing with the common-denominators across many of the choices: the focus on coalitions and collaborations; promotion of wellness and real world approaches, rather than "CAM therapies" to attack diseases; and the policy opportunities which have never looked so good for the approaches many of us have been advocating or practicing for decades. It's an exciting time. 

Here is the annual caveat. This list is particularly filled with action with which I am somewhat connected. Assume interest, or conflict-of-interest. While I prefer to view my involvement as evidence of my pleasure in mixing it up with that which shows the most potential, there may be awful signs of short-sightedness and self-aggrandizement in this list. What have I overlooked? Overstated? I welcome your comments on action areas from your own Top 10 - or at least for #10.

Wishing medicine a memorable turn toward health care in the year of change ahead!

Send your ideas for #10 or your own Top 10
to for future publication.



Last Updated ( Monday, 29 December 2008 )
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