The Integrator Blog
Home
Share |
about
Contact Me, Experience, Mission, Sabbatical in Central America, plus
Editorial Advisory Board
Columnists
Bill Benda, MD
Michael Levin
Taylor Walsh
Daphne White, CHTP
background resources in PDF
Insurance, Integrative Clinics, Industry Summit Reports, News Files '99-'04
some organization links
Professions, Academia, Research, Policy
some CAM/IM publication links
Electronic, Peer-Reviewed, Blogs, More
Bradly Jacobs, MD, MPH, Revolution Health Blog
supported conference
Institute for Health & Productivity Management - Integrative/Complementary Healthcare
Your Comments on NCCAM Report Suggesting Visits to CAM Practitioners Have Gone Down 50% Since 1997 PDF Print E-mail
Written by John Weeks   
Monday, 10 August 2009

Your Comments on the NCCAM/CDC Report Suggesting Visits to CAM Practitioners Have Gone Down 50% Since 1997

Summary:  The Integrator Special Report, "Is CAM Practitioner Use Down 50% Since 1997? An Analysis of NCCAM's Report on Costs of CAM and Visits in 2007," prompted a handful of responses. Here are brief notes from Georgetown University professor of law Sherman Cohn, JD, Stephen Bolles, DC and National Center for Homeopathy President Nancy Gahles, DC, CCH, RS Hom, followed by longer notes from integrative clinic leader Bethany Hayes, MD, Massage Research Foundation president Diana Thompson, LMT, holistic medicine leader Bill Manahan, MD, NCMIC president Lou Sportelli, DC, natural products manufacturers and marketer Gary Sandman, and Integrator reader Michaela Donohue. Not surprisingly, all agree that something is amiss in one end or the other of these comparative data.
Send your comments to
for inclusion in a future Integrator article.

These comments all followed publication of the Integrator
Special Report, Is CAM Practitioner Use Down 50% Since 1997? An Analysis of NCCAM's Report on Costs of CAM and Visits in 2007, August 4, 2009. Have you more to say on the topic?

Image
Sherman Cohn, JD
1.  Cohn: "Treacherous slopes ..."


Sherman Cohn, JD is a professor of law at Georgetown University who has served in numerous leadreship positions in the evolution of the acupuncture and Oriental medicine field and, more recently, in integrated health care. \
"Good report, John.   It shows again the treacherous slopes of dealing with surveys and statistics." 

Sherman L. Cohn, Professor of Law
Georgetown University Law Center

Image
Nancy Gahles, DC, CCH, RSHom(NA)
2.  Nancy Gahles, DC, CCH, RSHom: "Yes, let's question investigators ..."


Nancy Gahles, DC, CCH, RSHom, president of the National Center for Homeopathy, was last seen in the Integrator commenting here on the 2009 Integrative Healthcare Symposium in New York City.
"The blog was an incredibly diligent comparison and raised the thought provoking questions that need to be asked. Importantly, you broke the proverbial wall of silence that surrounds an NIH investigator where they are deemed to be the last word. Yes, we can and should question motive and validity, tools,etc. Excellent!"

Nancy Gahles, DC, CCH, RSHom (NA)
President, National Center for Homeopathy

Image
Stephen Bolles, DC
3.  Stephen Bolles, DC:  Thumbs up, more to follow ...  

"John, extremely well-written and thoughtful. Kudos."

Stephen Bolles, DC
Minneapolis, Minnesota
Bolles sent this note and I immediately responded asking if he didn't have more to say.  Bolles perspective is uniquely informed by leadership roles in the consumer division of United Health Care, plus multidisciplinary complementary healthcare education, health system-based integrative clinics and his chosen profession of chiropractic. Bolles excellent piece will be posted shortly.

  
Image
Bethany Hays, MD
4.  Bethany Hays, MD, FACOG: Did this capture visits for CAM services from conventional providers?


The last Integrator offering from Bethany Hays, NMD, FACOG was actually from the team she has assembled at her integrative clinic,
True North Team Offers Perspective on a Democratic Model of Clinical Integration, October 19, 2009. This response reflect the deep integration they practice.  
"I read your blog on the NCCAM report with interest. I have a question and comment. In the table 'Comparative Findings on Consumer Use of CAM in 1997 and 2007 Studies,' the % CAM vs all out of pocket costs in Eisenbergs study (!00%) suggests that there were no out of pocket costs for conventional physicians or that the only expenditures that weren't covered were CAM. That can't be right. Was that a typo or did I mis-interpret?
Clarification:  What I meant to convey was that the numbers were the same, that in the 1997 Eisenberg report, the total CAM visits were roughly equal to total visits to conventional physicians. This was much reported. In the 2007 Nahin/NCCAM version (which used the significantly) different methodology, the CAM visits were just 25% of the level of conventional physician visits.  
"Secondly, is the 50% drop due to the fact that many of the CAM visits are now being performed by conventional doctors nurse practitioners, PA, and the like with dual training as occurs in our community? For instance we have or have had: 5 MD's and one APRN who practice functional medicine and prescribe the bulk of vitamins sold in our store, a DO who practiced acupuncture, manual medicine and family medicine, two DO's who do manual medicine within their medical practices (one family practice one pediatrics), and an APRN and DO who use hypnotherapy in their pediatric practices.

   
 "Is the 50% drop due to the
fact that many of the CAM visits
are now being performed by
conventional doctors, nurse
practitioners, PAs, and the like
with dual training as occurs
in our community?

 
"We have had the best 6 months in our 7 year history despite the recession.

"You might wonder if we have captured the local market (if you believe there has been a 50% drop in consumer interest, but in fact there are an increasing number of naturopathic, Integrative, massage and Functional medicine practices since we opened our doors. (Two, a multipractitioner chiropractic practice and a multipractitioner homeopathic practice have moved into our building!) It's a small community and I think I have my ear to the ground on who is practicing around us.

"Perhaps they need to pick some reliable markers for CAM practice and just study them instead of trying to capture everything. Perhaps the national organization for each type of practice should be required to keep track of their growth or failure to grow (I know, they wouldn't want to admit it if they didn't but it would help.)
"

Bethany Hays, MD
Medical Director, True North
Falmouth, ME
Comment/Response: The reader of the NCCAM document would not be made aware of how many conventional practitioners are beginning to provide "CAM" services via their integrative practices. I don't know if this is because there is an operating conceptual view that these are no longer "CAM" if practiced by conventional providers, or what. Nahin did say that with some of the therapies, they then asked people if they saw practitioners in hte process of using them. The report does not capture any breakdown of those services provided by conventionally-trained practitioners. But I thoroughly agree that to not capture these is to mis-portray the breadth of "CAM" visits.

Image
Diana Thompson, LMT
5.  Diana Thompson, LMT: Why isn't massage more visible?


Diana Thompson, LMT, is a private practitioner and author who currently serves in a volunteer capacity as president of the Massage Therapy Foundation.  Her work was noted in this Integrator Round-up.
"I want to comment on the absence of the word 'massage' in the headlines. I couldn't help but notice that massage ranked #2 in out-of-pocket costs, #1 when comparing CAM requiring individual practitioner visits, yet the headline you quoted (and others) chose to mention acupuncture (#9 I believe), chiropractic (#4), and lumped massage into 'other alternative therapies'.

"The word 'massage' was also glaringly absent at the [IOM] Public Health Summit; and, unfortunately, the only speaker at the Summit who is a practicing massage therapist didn't mention the word. One speaker (an MD) had the word on a slide but didn't say it out loud, so it was never, ever spoken from the podium.
"Thankfully, 'massage' was mentioned fairly often at NARCCIM. But if we look at the rank order of massage in this survey, I am prompted to wonder out loud why massage research represents only 1% of the peer-reviewed, indexed articles on CAM therapies, and why it continues to be left out of the headlines.

"My patients wonder the same thing."

Diana Thompson, LMT
Seattle, Washington
Comment: Good question! My guess is that the headline writer, in this case. thought that the other disicplines named better carried the effect he or she intended. No haviung been able to attend the IOM, I am not sure. I do know that Bravewell, as sponsor, was principally interested in promotive integrative medicine. This may have taken the focus away from any CAM practices or providers.

Image6. Lou Sportelli, DC

Lou Sportelli, DC has been an activist, observer, commentarist and executive in the chiropractic and integrative care arenas for over 40 years. He currently serves as president of Integrator sponsor NCMIC Group, for which he serves as president.
"I am sorry John, but I simply cannot get excited about the NCCAM study.  I do not believe that the government analysis of anything is accurate. In recent months we have studies and surveys from the White House and Congress only to be refuted by the Office of Management and Budget and the variation is huge. We next have housing sales which are down and people unable to get mortgages because of a simple yet very effective way to distort numbers. The appraisers are using foreclosure and bankruptcy numbers to determine real estate comparable values. Is that an accurate way to determine a number, possibly?  Is it a fair representation of what real estate is worth? No! Yet we go through these machinations with everything from voter confidence to who uses CAM.

   
 In law there is a phrase
res ipsa loquitur (the thing
speaks for itself) that could
easily apply here.

 
"In law there is a phrase res ipsa loquitur (the thing speaks for itself) that could easily apply here. There has been a huge movement by consumers to utilize many and often any, alternative services to what might be called traditional medical services. WHY they are doing this is for another column but it is obvious that what is 'lumped' into CAM is probably more of the issue than what is not. Spiritual healing and prayer, energy techniques and meditation have been and are lumped with more definable services such as chiropractic medicine, naturopathic medicine, Ayurvedic Medicine, acupuncture, and massage. Since many of these are covered services the dollar amount and the utilization can easily be distorted. So depending on how the researchers want to obfuscate, the data (intentionally or unintentionally) can result in the confusion you have illustrated in your analysis.

"There is an obvious intent by many to diminish the entire world of complementary and alternative because the 'health care pie' is only so big and between the political clout of Big Pharma and the confusion which is evident by Big Medicine, you can rest assured that when the dust settles unless the study is unbiased it will not look good for CAM.

   
  "There is an obvious intent
by many to diminish the entire
world of complementary and
alternative because the
'health care pie' is only so big ..."
 
"I hate to be a cynic, but in order to find the underlying reason one must 'follow the money' and the money trail will lead to reason why this study was distorted.

"The entire CAM community began to respond many years ago to the allegations of not having enough research. Well for chiropractic that is not the case, for naturopathy [this area] is promising, for acupuncture the data seems compelling for some issues. Now there will be another challenge that this is not right or that is not right, yet the consuming public is not dissuaded one iota by any data, and it is obvious that for the past 100 years the struggle of any health care profession, other than medicine, has been an uphill battle. People sought those services because they afforded help, comfort, relief and often cure when all else failed.  

"The survival of the CAM community for over 100 years is now testimony to the fact that the public has decided what they will do and not do... 'lets not forget that.'"

Lou Sportelli, DC]
President, NCMIC Group


Image
Bill Manahan, MD
7.  Bill Manahan, MD: "No one knows what CAM is or is not ..."


Integrator adviser Bill Manahan, MD, has been a leader in the field of holistic medicine for 30 years, while also maintaining a foot in conventional medical education as a associated clinical professor for the medical school at the University of Minnesota. 

"You have done it again - a thorough and balanced analysis about the NCCAM report regarding the use of CAM services.  Thank you for a fabulous job.  You have an incredible knack for getting to the core issues of stuff.
 
"[The article reminds] me of when I saw the documentary, 'Who Killed the Electric Car?'  I left that movie saying, Wow, that was really a fair and balanced evaluation of this topic.  I do not usually feel that way when I leave a Michael Moore movie - even though I pretty much agree with most of what Moore has shown or said in the movie.
 
   
 
 I would be very surprised
(shocked, I could say) if the
NCCAM report is correct in
that the number of visits
to CAM practitioners is down.

"Here in the Twin Cities of Mpls and St. Paul, the number of CAM practitioners is up dramatically in the past decade, so I have to believe that most of them are seeing clients and patients. I would be very surprised (shocked, I could say) if the NCCAM report is correct in that the number of visits to CAM practitioners is down.  My guess is that your analysis is correct; Eisenberg probably overestimated and NCCAM used criteria that were too confining and strict.
 
"But as you also said, John, no one really knows what CAM is or is not. So, to put it mildly, it makes it difficult to do a valid study on a topic that we really cannot obtain consensus regarding what it is.
 
"Thank you for your good work."
 
Bill Manahan, MD
Past President, American Holistic Medical Association
Minneapolis, Minnesota

 

Image
Gary Sandman
8.  Gary Sandman: "Is this a reckoning for CAM?"


Gary Sandman's involvement in integrative practice spans three decades and includes founding and managing a network of complementary and integrative practitioners in the Washington, DC, area, and his current work as founder and president of Signature Supplements, which creates individualized supplements for consumers.
"According to Marty Feldman: 'Interesting. Very interesting ...'  Where did all the people go?

"I remember reading Eisenberg’s study that more money was paid out of pocket to alternative medicine practitioners than to MD’s and the appointments with CAM practitioners were greater than those with a primary care physician. So where lies the truth?


   

"Is this the reckoning for CAM?
Is this our AIG of 'funny'
accounting of visits?

 
"Is this the reckoning for CAM ? Is this our AIG of 'funny' accounting of visits and sales of CAM programs in a favorable way in the 90’s collapsing due to the news from a new survey – different in many details, that wipes out 50% of CAM visits? All of a sudden, as John points out, yoga that alone accounted for millions of visits with a teacher instructor before but not now – God is in the details. However, people are still attending yoga class and what if it is for their overall health and wellness and not just injury directed?

"From my own personal accident experience after being rear ended, I paid for chiropractic, massage, a DO, acupuncturist, and physical therapist. Since this was my third rear-ender over 20 years (I was the one rear ended each time), I noticed the treatments were pretty much the same. ( I was an early adapter for CAM.) The costs were a little more each time and as I aged, the healing time was longer. I don’t have the range of motion I used to have but I am glad they were there for me as I am no longer in pain! My only choice with a regular doctor was cortisone shots – which ended after the second round.

   
  I can add from my experience
that my Individualized Nutritional
business has grown 5 out of the
last 6 months! Someone is buying."
 

"Running a credentialed CAM referral service for most of this time, I did notice 1/3 of our referrals stated they wouldn’t go to a CAM referral unless it was covered by insurance even though 90% were unhappy with their medical outcome and wanted to try an alternative. So where are those new walking wounded that elected to use an insurance covered CAM practitioner? Did they not include weekend CAM Doctors who are picking up bits and pieces of CAM practices and providing them to their patients. And not reporting them?

"As John says this is beyond my scope, but I can add from my experience that my Individualized Nutritional business has grown 5 out of the last 6 months! Someone is buying."

Sincerely,

Gary Sandman
Founder President
Signature Supplements – Made for You!

9.  Michaela Donohue: "Great job!"

Just before posting this group of comments, I received this notice from a reader about whom i know nothing.

"What a great job you have done on this report!! Why don't you get it published in one of the CAM journals? It certainly deserves much discussion.  Good work!

Michaela Donohue

Comment: Thanks! I do intent to run something on this in my regular column in Integrative Medicine: A Clinician's Journal and may write something for Integrative Practitioner Online. No other plans.
Send your comments to
for inclusion in a future Integrator article.


Last Updated ( Monday, 10 August 2009 )
< Prev   Next >
Subscribe to the Newsletter
Search
Advertisement
Advertisement
 
 
Advertisement
Sponsors
NCMIC Group
AMI Group
Integrative Practitioner
voluntary contributions
Support the work!
Archive
All Integrator Round-ups
Integrator Top 10 Lists 2006-2013
Issues #116-#118 - Oct-Dec 2013
Issues #113-#115 July-Sept 2013
Issues #110-#112 April-June 2013
Issues #108-#109 Jan-March 2013
Issue #105-#107 Oct-Dec 2012
Issues #102-#104 - July-Sept 2012
Issues #99-#101 - April-June 2012
Issues #96-#98-Jan-March 2012
Issues #94-#95 Nov-Dec 2011
Issues #92-#93 Sept-Oct 2011
Issues #90 and #91 - July-Aug 2011
Issues #88 and #89 - May-June 2011
Issues #86 and #87 - March-April 2011
Issues #84 and #85 - Jan-Feb 2011
Issues #82 and #83 - Nov-Dec 2010
Issues #80 & #81 - Sept Oct 2010
Issues #78 & #79 - July August 2010
Issues #76 & #77 - May June 2010
Issues #74 & #75 - March-April 2010
Issues #73 & #73 - Jan-Feb 2010
Issues #69, #70 & #71 - Nov-Dec 2009
Issues #67 and #68 - Sept-Oct 2009
Issues #65 and #66 - July-August 2009
Issues #63-#64 - May-June 2009
Issues #60-#62 - March-April 2009
Issues #57-#59 - Jan-Feb 2009
Issues #55-#56 - Nov-Dec 2008
Issues #51-#54 - Sept-Oct 2008
Issues #47-#50 - July-August 2008
Issues #46 & -#47 - May-June 2008
Issues #43-#45 Mar-April 2008
Issues #41 & #42 - Feb 2008
Issues #39 & #40 - Dec-Jan '08
Issues #37 & #38 - Nov 2007
Issues #35 & #36 - Oct 2007
Issues #33 & #34 - Sept 2007
Issues #30-#32 - July-Aug 2007
Issues #28 & #29 - June 2007
Issues #26 and #27 - May 2007
Issue #25 - April 2007
Issues # 23 & #24 - March 2007
Issues #21 and #22 - Feb 2007
Issues #19 and & 20 - Jan 2007
Issues #17 and #18 - Dec 2006
Issues #15 and #16 - Nov 2006
Issues #13 and #14 - Oct 2006
Issues #11 and #12- Sept 2006
Issues #9 and #10 - Aug 2006
Issues #7 and #8 - July 2006
Issues #5 and #6 - June 2006
Issues #3 and #4 - May 2006
Issues #1 and #2 - April 2006
All Articles by Subject: 2006
All Articles by Subject: Jan-June 2007
IAYT-Sponsored Series on the Future of Yoga Therapy