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Integrative Medicine and Integrated Health Care Round-up: October 7-November 3, 2009 PDF Print E-mail
Written by John Weeks   

Integrative Medicine and Integrated Health Care Round-up:  October 7-November 3, 2009

Summary: Respond now! NCCAM seeks stakeholder comments on 5 year plan ... IOM publishes report on February 2009 Summit ... FTC/FDA cracks down on dietary supplement sites, including, for "fraudulent" H1N1 claims such as are made in many kitchens every morning ... Update on action relative to LAc, certified professional midwives, "non-discrimination" and ABC Codes in federal health reform ... 2009 consumer use data on massage (more each year for medical purposes) ... Council for Responsible Nutrition survey info on use of dietary supplements ... MSNBC stirs antagonism to integrative medicine programs in medical and nursing schools ... School yoga champion creates new not-for-profit organization to support advance of programs ...  AMTA responds to Integrator comments the termination of its Council of Schools ... International CAM: Brief reports on recent developments in Switzerland, Italy, England and South Africa ... Harvard professor, key employer leader find chiropractic cost effective for low back and neck pain in new review study ... Congressional amendment stimulates debate over financial incentives for healthy behaviors ...  November is a time for giving of thanks to the Integrator sponsors ... Kokolulu Farm and Cancer Retreat shifts to donations-based business model ... Integrative Medicine Alliance announces new website ... plus more
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Will 5-year plan include real world research?
Be heard now:  NCCAM seeks stakeholder comments on strategic plan until November 19

Go to this website and let your views of what you believe NCCAM should focus on over the next 5 years be heard. The NIH National Center for Complementary and Alternative Medicine (NCCAM) is seeking comments on its 5 year strategic planning process via the NCCAM website. In an October 21, 2009 NCCAM Update, the Center noted that it has posted papers "on 3 'big picture' topics" on which it is seeking feedback. The topics of the papers are: mission; priority setting and information and communication.
The 3 NCCAM papers are each roughly 3 pages long. Here are the papers and the 3 questions each for which NCCAM seeks stakeholder responses.
Paper 1: NCCAM’s Mandate [from Congress] & Mission
  • Major features of the current CAM research landscape that are important in considering future strategic directions for NCCAM and the field of CAM research in general
  • Particular needs and opportunities of importance to NCCAM's efforts in research capacity building
  • Opportunities, obstacles, and NCCAM's future role in supporting research on approaches to improved states of general health and well-being

Paper 2: NCCAM Priority Setting — Framework and Other Considerations

  • The need for greater shaping of the Center's research portfolio
  • The four factors (scientific promise, extent and nature of practice and use, amenability to rigorous scientific investigation, and potential to change health or health care practices) identified as key components of a framework for research priorities
  • The types and sources of information that must be included in an optimal priority-setting process.

Paper 3: Information and Communication about CAM Research and Decision-making about CAM Use

  • The major unmet needs of consumers and the general public in accessing, interpreting, and making use of research evidence about CAM
  • The major unmet needs of health care providers in accessing, interpreting, and making use of research evidence about CAM
  • Research needed to better understand how both health care providers and the general public make decisions about CAM practice and use.
A major shift in NCCAM funding under consideration is the priority setting. NCCAM's direction under director Josephine Briggs, MD will likely focus on a very few key areas and to invest deeply in them and therefore essentially end support of other areas. The top areas of interest presently appear to be drug research on herbs and examination of mind-body medicine.
Comment: Prior to NCCAM's publication of these papers, I wrote a column entitled Why We Should Seek to Influence NCCAM's Next 5-Year Strategic Plan. My reading of these 3 papers underscores my concerns, expressed there, that NCCAM's is at risk of making fear-based decisions "pushing NCCAM to act like all of the other agencies in that reductive, drug-and-device focused NIH culture."
Those of you who desire answers
to questions regarding the effectiveness
and cost-effectiveness and health value
of whole practices of integrative

care such as is consumed by
the public from over 100,000
practitioners of integrative medicine,
naturopathic medicine, chiropractic
medicine and acupuncture and
Oriental medicine and others need
to weigh in or risk being
shut out entirely until 2015.

Those of you who have research questions relative to real world outcomes, costs, cost-offsets, and how integrative practices can become part of the payment and delivery systems and play a role in meeting the US medical crisis needs to speak out. Those of you who desire answers to questions regarding the value of whole practices of integrative care such as is consumed by the public from over 100,000 practitioners of integrative medicine, naturopathic medicine, chiropractic medicine and acupuncture and Oriental medicine need to weigh in or be shut out entirely. We stand the risk of watching a door to the only significant research funding available to look at the real world value of integrative practices slam for 5 more years.

Ironically, in suggesting this real world focus, you would only be asking NCCAM to substantially align itself with the 1998 Congressional mandate in establishing NCCAM, which was the very practical charge to:
" ... study the integration of alternative treatment, diagnostic and prevention systems, modalities, and disciplines with the practice of conventional medicine as a complement to such medicine and into health care delivery systems in the United States." [Note: The NCCAM mandate will be published in its entirety on the Integrator website by November 12, 2009.]
Go, respond here to the survey!

NCCAM Director Briggs: Looking at NCCAM from both sides now
Side-note: It was intriguing to see that the agenda for NCCAM advocated in the Integrator, based on the real world integration challenges the Integrator seeks to help resolve, was pretty well summarized near the end of Paper #1 as "one end of the spectrum" of pressures NCCAM faces. The NCCAM paper reads, interestingly, quite like an agenda one might follow if one sought to fulfill on the Congressional intent in establishing NCCAM (soon to be published in full on the Integrator site). First, NCCAM's Paper #1 writers describe the the position of NCCAM skeptics. Then:
"At the other end of the spectrum are claims that NCCAM research fails to evaluate CAM as it is actually used in 'real-world' CAM practice settings, that there is insufficient support of CAM practitioner involvement in the research process, that the field is dominated by reductionist scientific approaches or inappropriate methodology, that the peer-review process is biased against CAM, that most NCCAM research is designed or conducted with a goal of 'debunking' or disproving value, and that there has been insufficient focus on health and wellness."
An academic medicine researcher colleague, aware of the Integrator advocacy in this area, suggested, tongue well in his cheek, that I toss my hat in the ring for the newly advertised NCCAM position of Director, Office of Planning, Policy and Evaluation. Knowing that all I lack are the requisite professional skills, I asked my colleague if a college drop-out such as myself qualified and he said: "In a world in which GWB can be president, anything is possible."
Report on Integrative Medicine Summit published
IOM publishes report on the February 2009 National Summit on Integrative Medicine

On November 4, 2009, the Institute of Medicine of the National Academy of Sciences published Integrative Medicine and the Health of the Public: A Summary of the February 2009 Summit. The site includes links to download the entire document, or a 45 page Executive Summary, for free, plus a link purchase a hard copy. Price is $52. The 245 page report is featured on the front page of the IOM's redesigned website. The Bravewell Collaborative of philanthropists who backed the meeting with a $445,000 grant sent a release which included a comment from the Summit chair Ralph Snyderman, MD: “Utilizing some of the models and learning’s from the summit, the next step is to conduct pilot programs of care delivered in a holistic way. It’s the missing piece of health reform.” Bravewell's president Christy Mack is quoted in this way: “We have to start valuing and paying for health ... The findings in this summary which highlight the integrated approach to health care and a focus on the individual becoming a proactive partner in wellbeing should be a critical part of our nation’s health reform discussion moving forward.” The IOM report, which became available on deadline for this Round-up, will be reviewed in the coming month at the Integrator. Your comments on the report are welcome as part of a discussion via . (Thanks to Taylor Walsh for his link to the Bravewell release.) 
Joins with FTC in action again websites
FTC and FDA crack down on 75 websites for "fraudulent" claims related to H1N1 flu treatments

In a combined action on October 15, 2009, the Federal Trade Commission (FTC) and the Food and Drug Administration (FDA) sent a "joint warning letter" to numerous websites that they were making what the FTC/FDA considered "fraudulent H1N1 flu supplements." In the FTC/FDA release, the FTC/FDA declared in a sub-heading that the two agencies are continuing their "efforts to protect public health from illegal web activity." The notified sites were given 48 hours to tell the agencies of their "plan to discontinue their fraudulent marketing." The FTC/FDA joint action, a first for the two agencies, noted that since
May 2009, the FDA has warned more than 75 Web sites to stop the sale of more than 135 products with H1N1 influenza virus claims. These products "come in many varieties, including dietary supplements, as well as products purporting to be drugs, medical devices or vaccines." Michael Chappell, FDA's acting associate commissioner for regulatory affairs, states: “The FDA continues to consider the sale and promotion of fraudulent H1N1 influenza products to be a possible threat to the public health and in violation of the Federal Food Drug and Cosmetic Act." The FDA's warning letters can be viewed here. The most visible of the websites sent letters, and notably one which received a warning the day of the FTC/FDA release, is An example of the content on the site that the FDA/FTC lambasted as fraudulent is:
"The Immune Support Formula contains astragalus ... Astragalus ... is used traditionally to ward off colds and flu and has been well studied for its antiviral and immunity-enhancing properties ... Th[e] synergistic combination of immune modulators [found in the Immune Support Formula] is especially useful for those who tend to get every bug that goes around during the winter."
Weil: His high visibility website among the 75 targeted
NIH NCCAM director Josephine Briggs, MD
issued a statement on the topic on October 21, 2009, in which she warned that "unproven claims abound regarding the flu." Briggs urges those "thinking about using a CAM product to prevent the flu or 'boost your immune system,' [to] first get information on it from reliable sources." She suggests The NCCAM Web site and the NIH Office of Dietary Supplements and MedlinePlus. Weil, contacted by the Integrator, stated that his website will be split into an educational site and a products site, a move which he favors. 
Comment: The morning after I received word of this action against I found myself somewhat complicitous. The FDA/FTC was suddenly present in my kitchen. I was laying out the supplements for my children to take with their meal. These included Vitamin C and a multivitamin and Quercetin. All could be framed, in some fashion, as "immune boosting" and as potential support for the body against "bugs that go around."  I noticed a new supplement was in the mix on the list, a Reishi mushroom extract. I turned to my ND, MPH spouse who'd prepared the list: "So why the Reishi mushrooms?"  She responded: "Immune support. It's the flu season." I said: "Watch your mouth, you could have your parenting shut down by the FDA/FTC." We had a laugh. That said, we who willingly purchase these agents based on traditional uses and on what is presently known of them were all served a letter on October 15.  
Scambling for integrative practices under the dome
Update on integrative practices and on how ABC Codes and pushed in U.S. health reform

As Congressional action continues toward a massive healthcare bill, roughly one zillion side conversations on specific phrases and definitions are being negotiated. Some of these involve natural healthcare and integrative practice. Here is a quick update on related action.

  • Homebirth midwifery/Certified Professional Midwives  The Midwives and Mothers Action (MAMA) campaign report that they have now raised over $130,000 to support their effort to get coverage of services of Certified Professional Midwives under Medicaid. Their focus has been on the House bills, and they anticipate work will eventually focus on the House Education and Commerce committee. An insider says of the MAMA effort that it is "common for a new provider group on the Hill to take 3-4 years to accomplish what [the midwives] have done in just six months!”

  • Image
    Inouye: Possible sponsor for AOM bill on Senate side
    Licensed acupuncturists 
    A report from the American Association for Acupuncture and Oriental Medicine states that HR646 now has 34 co-sponsors with 4 additional sponsors pending, and that lobbyists have delivered
    38,000 letters. The measure would place services of licensed acupuncturists in Medicare and the Federal Employee Benefits Plan. The AAAOM focus in November is on raising the number of their House co-sponsors to 75-100, the threshold at which they believe they can get a hearing. They are also seeking Senate sponsors. Hawai'i Senator Daniel Inouye is noted as a likely co-sponsor. In their update to members, the AAAOM also shared that they spent $35,000 to sponsor "a major plenary session on Saturday, September 5th" at the conference of the National Foundation for Women Legislators (NFWL). This is "the largest single political investment [the AAAOM has] ever made, with significant risk, but we received the political dividends we hoped to achieve." Details of the AAAOM's NFWL initiative are available in this Integrator Round-up.
  • "Non-discrimination" - naturopathic physicians and chiropractors The American Chiropractic Association and the American Association of Naturopathic Physicians have each focused efforts this past month on maintaining what known as the 'Ross Amendment" in health reform. The bill is an essentially defensive measure, and as provider neutral: It states that any reform plan will not undo any state level initiatives which require the inclusion of a given set of licensed practitioners. The most recent Round-up noted that 47 members of Congress had co-signed a letter to House Speaker Nancy Pelosi in support of this direction. This measure would protect chiropractors in dozens of states where they have secured legislate mandates, and would appear to directly benefit the naturopathic doctors in a very few states. Side-note: The powerful chiropractic lobby has just expanded to include former House majority leader Richard Gebhardt.

  • Image
    AAHFl: Pushes ABC Codes as way of gaining access
    Inclusion through recognition of the ABC Coding System
      The American Association for Health Freedom (AAHF) is taking an unusual tack toward gaining inclusion of diverse complementary healthcare practitioners. The strategy is to promote recognition of the coding system called ABC Codes developed by Melinna Giannini and others at Alternative Link . The codes were developed, beginning in the mid-1990s, as an attempt to better capture non-conventional services in coding and to break the stranglehold of the AMA's CPT coding on practices. In a letter to members, AAHF urged them to write letters to Health and Human Services Secretary Kathleen Sebelius to "accept and implement the ABC coding as a way to ensure that services currently not coded under the existing systems will be made available to any willing healthcare-providing entity in order to process insurance claims more efficiently." The suggested letter to Sebelius asserts that
    "ABC has been employed successfully in over 2 million claim transactions at a cost benefit of 50 percent."
Comment:  As noted, the non-discrimination measure appears only to be protective of gains in individual states and does not require an end to discrimination against any licensed category throughout the federal legislation. Thus if a major reform bill were to pass today, we would not see any major changes in the status of integrative practices in federal health policy. Notably, as was said of the midwives, these relatively new, professional lobbying campaigns are beginning a process that typically takes years.

Consumer Use

Massage use increases
Massage use at 32% of population, more than ever for medical and health reasons

The report of the13th annual survey on consumer use of massage from the American Massage Therapy Association (AMTA) found that 32% used massage in the past five years for medical or health related reasons. A roughly equivalent percentage used massage for relaxation or stress reduction. This was the first year that the medical/health issues had ranked as "feel good massage." Notably, of those for whom finances were less of a problem ($75,000-$100,000 annual income), 49% had used massage for medical or health reasons. A substantially higher percentage (25%) of consumers spoke to their medical doctor about getting massages and, of these, over half report that their medical doctors strongly recommended the care. In the general population, 80%-85% believe massage can be valuable in easing pain and for health conditions. The survey captured a marked increase in highly stressed respondents, with 57% saying their stress had increased over last year.
The survey was conducted by CARAVAN® Opinion Research Corporation International during July 2009, among a sample of 1001 adults, 501 men and 500 women, ages 18 and older and contracted by the AMTA.

Supplement use grows marginally amidst "complicated economic times"

An October 23, 2009 release from the Council for Responsible Nutrition (CRN)
on CRN's annual Consumer Survey on Dietary Supplements reports that 65% of adults are using dietary supplements, up from 64% in 2008. Near three-fourths (74%) of those taking supplements said they have not declined the amount of their use despite the economic recession. Of the roughly 27% of supplement consumers who altered their purchasing habits, most did so to save money (59%), some switched to less expensive brands (31%) or relied on promotions (23%) or sales (22%). Just 5% said they are purchasing more supplements to better maintain their health (and avoid other costly care). The survey was conducted by Ipsos Public Affairs and included 2,043 adults. Some data reports of the survey are here. The CRN is the organization representing large industry players in the supplement business.
Comment: A side-note: The public affairs firm contracted for the survey notes that they "specialize in reputation and risk management." One wonders if the choice of a firm with this specialty is through the substantial influence of the pharmaceutical industry in the CRN, or if it through concerns native to dietary supplement firms, or both.    

Academic Medicine and Education

Takes gratuitious swipe at integrative medicine
MSNBC article on medical and nursing CAM/IM programs begins with gratuitous dissing

The title of the MSNBC article, widely picked up by other media, is "More medical schools teaching  alt. remedies." On AOL, the heading focused on both nursing and medical schools. Both had in common an unusual, italicized "Editor's Note" leading into the article proper:
EDITOR'S NOTE: Ten years and $2.5 billion in research have found no cures from alternative medicine. Yet these mostly unproven treatments are now mainstream and used by more than a third of all Americans. This is one in an occasional Associated Press series on their use and potential risks.
The article places at $22-million the direct investment of "the government" (NCCAM, through its R-25 education grant program) to help medical and nursing schools start teaching about alternative medicine, "lesson plans that some critics say are biased toward unproven remedies." The article includes balancing quotes from two recipients of the education grants: Victor Sierpina, MD, chair of the Consortium of Academic Health Centers for Integrative Medicine and from Mary Jo Kreitzer, RN, PhD, a past chair of the organization. One section is as follows: "Consumers are demanding it" and more research is needed to see what works, said Mary Jo Kreitzer, who directs the Minnesota school's alternative medicine curriculum. "Ultimately we need to align policy" so that insurers pay for these therapies, she said. "You could say that in that respect, we are advocates."  Familiar anti-CAM personages such as self-described quack busters Stephen Barrett, PhD and Wallace Sampson, MD (who has called for defunding NCCAM) are quoted in opposition to these educational initiatives. Their remarks led to the subheading: "Some critics are concerned abut the 'teaching of illogical thinking."
Comment: Imagine this "Editor's Note" to an "occasional series" on pharmaceutical developments: Despite 50 years of claiming to be the magic bullet for scores of health conditions, experience finds that many of these agents end up causing more harm than good. Oh well. Meantime, in a not entirely unrelated note, Integrator reader Elaine Zablocki sent a news-link on another front in the quack wars. Barrett's Quackwatch website sent out a newsletter November 4, 2009 requesting donations to support Barrett's legal costs in fighting two lawsuits. According to Barrett's group, one organization has made "false claims that (Barrett) lost his medical license" and in a separate action, another organization claims Barrett is a "habitual criminal." Barrett is running up costs fighting both. One can at least be thankful that one inhabits a different corner of the medical wars, trying to keep these naysayers from shaping NCCAM's future wondering, for instance, what form of "logical thinking" makes the so-called quack-busters think that the best cure for the multiple factors that typically lead to a person's poor health is a pill.  
Beneficiaries of school yoga at Bonnie Eagle Middle School
New school Yoga organization grows out of K-12 Yoga, seeks support

Many in integrative practice recognize that health is multi-dimensional, is best fostered through community-based initiatives, through bettering early childhood experiences and habits, and requires public health inputs such as can be delivered through schools. Yoga teacher and organizer Karma Carpenter, LCSW, recognized an emerging area for potential influence and of need a few years ago. She began supporting educators and yoga teachers nationwide with a labor-of-love website she developed as K-12 Yoga. This not-for-profit work is now morphing into the International Association for School Yoga (IASY). Carpenter calls it "a web-based public service providing research, resources and referral with the goal of developing sustainable, accredited school yoga programs." The targets are both public and private schools. Carpenter has assembled a group of
senior yoga trainers, health clinicians, and college faculty for the IASY Board. While the focus is on schools, Carpenter notes that the network also links into yoga programs in clinics and correctional facilities. Carpenter's ambitious agenda for IASY includes promoting collaboration amongst stakeholders on healthy schools legislation, providing research for public awareness and supporting lobbying efforts. Carpenter is seeking funding to get the organization up and running, including support for her own work as a networker.
Comment: Since reporting on the school yoga program Integrator adviser Peter Amato developed in Scranton, Pennsylvania (Outcomes of a Mindfulness Program in an Elementary School) and particularly, seeing a clip they developed on some of the ways these kids responded, I have been a huge advocate of school yoga. The work Carpenter and her team are seeking to accomplish via IASY will be a wonderful public health contribution. Carpenter's not looking to get rich, merely some funds to sustain the site and effort. Know anyone?
AMTA responds to article on its Council of Schools in the October Round-up 

The October Round-up included an article on the decision by the American Massage Therapy Association (AMTA) to terminate the AMTA Council of Schools and instead have a member classification of Massage Therapy Schools and Educators. Ron Precht, AMTA's communication manager, called with concern that the article left a sense that the AMTA was in some way abandoning its commitment to this membership group. Precht sent information which he had sent to Massage Today clarify the AMTA's intent in taking this step. (The follow-up Massage Today article is here.) Precht's memo describes internal AMTA processes leading to the decision, adding that, for AMTA, "t
he recent decisions confirm the association’s ongoing commitment to deliver high quality services and programs to its school members." Precht states that AMTA is taking "input in making decisions about forming committees to further serve these members." The memo also notes that the decision of the AMTA board to not support the new Alliance for Massage Therapy Education (AfMTE) was a function of the Alliance "not meet(ing) the association’s granting criteria." AMTA, says Precht, looks forward to "learning more about the Alliance and any possible opportunities for collaboration."
Comment: The status quo in the United States is that mature professions have 501c6 not-for-profit (trade) organizations of their schools, colleges or universities that are separate from the professional organization, such as AMTA. In the best of all possible worlds, AMTA will continue to nourish teachers and schools even as, at the same time, it recognizes that massage, as a trade that aspires to be a profession, needs something like AfMTE to set solid standards and better develop a spirit of professionalism and service for massage therapy schools. Time will yet tell if AfMTE will step up to this task. 


Black: Report from England recommends new models for CAM research
Reports on key CAM action in Switzerland, Italy, England and South Afric

The international nature of the cultural-medical-political challenges of better integrating use of non-conventional natural therapies with conventional healthcare has been highlighted by a series of developments in recent months. In May, 67% of the Swiss people, via national referendum, voted in favor of "a constitutional article for complementary medicine" that, according to a release, "set out in the constitution authority for the state and constituent states (cantons) to take complementary medicine into consideration in the public health service." The popular action followed an anti-CAM decision by a Swiss governmental panel in 2005 which Harald Walach, PhD has lambasted in an editorial in the Journal of Alternative and Complementary Medicine. Meantime,  in Italy, CAM and integrative medicine leader Paolo Roberti di Sarsina, MD co-authored an 8-page paper, Non-Conventional Medicine in Italy: The Present Situation, which details various levels oif integration of CAM (mostly acupuncture, homeopathy and anthroposophical medicine) into Italy's regional systems. Some of the integration into community medicine is significant. Roberti calls for
"a full-scale national law on non-conventional medicine to protect citizens’ safety and freedom of choice."

Meantime a group convened via the King's Fund in England and chaired by Dame Carol Black has had published a white paper entitled
Assessing Complementary Practice: Building Consensus on Appropriate Research Methods. The paper is especially instructive in the clarity about the unique challenges in assessing these fields. The groupo urges exploration of new methods for examining  effectiveness (a direction that NCCAM has been reluctant to take). Black also served on the Institute of Medicine planning committee for the Summit on Integrative Medicine, noted above. Finally, South African actuary and professor Heather McLeod notes that a CAM group has formed inside the African Health Economics and Policy Association. McLeod is a leader of CAM issues in the International Actuarial Association. For a longer review of all 4 developments, click here.
Comment: Two comments. First, the paper from the King's Fund is especially timely, given the present efforts of the NIH NCCAM to chart the future of NIH-funded research in the United States. NCCAM could do well to be guided by some of those recommendations. Second, the success of the Swiss people, via referendum, marks a rare time in integrative practice where prejudice-based behavior of a government agency has led to a successful response to do what evidence suggests, according to Walach, the agency should have done in the first place. Kudos to the organizers of that effort.

Employers and Cost Issues

Leader of employer group finds cost-effectiveness in chiropractic services
Harvard professor, director of Pacific Business Group on Health find chiropractic cost effective for back and neck pain

So, is chiropractic effective and, more specifically, cost effective, compared to other care of those with neck and low back pain? Two top researchers, Niteesh Choudhry, MD, PhD and Arnold Milstein, MD filed a 15-page report on October 12, 2009 which attempts to resolve this medico-political question which has rattled around US healthcare for the last 20 years since the American Medical Association was forced, by dint of the Wilk vs the AMA anti-trust lawsuit, to allow chiropractic into the public debate as something other than quackery. Choudrey is a professor in pharmacoeconomics from Harvard Medical School and Milstein a consultant with with Mercer Health and Benefits and medical director for the influential Pacific Business Group on Health. The report is titled: Do Chiropractic Services for the Treatment of Low Back Pain and Neck Pain Improve the Value of Health Benefit Plans? An Evidence-Based Assessment of Incremental Impact on Population Health and Total Healthcare Spending. The chief conclusions are:
  • Effectiveness Chiropractic is more effective than other modalities for treating low back and neck pain.

  • Total cost of care per year  For low back pain, chiropractic care increases total annual per patient spending by $75 per year over "medical physician care."  For neck pain, chiropractic care reduces annual spending $302 per year compared to medical physician care. The cost of care for neck pain is lowered when chiropractic is combined with exercise (and better than exercise alone).

  • Cost-effectiveness  If both cost and effectiveness are considered together, chiropractic is "highly cost-effective" and "represents a good value" relative to medical physician care and "widely-accepted cost-effectiveness thresholds." The authors then note that they were not able to incorporate data on pharmacy costs but project that, had they been able to do so, "our estimate of chiropractic's comparative cost effectiveness is likely to be understated."

The report was sponsored by Foundation for Chiropractic Progress, a promotional organization for the chiropractic profession that is attempting to insure that chiropractic medicine is well represented in any emerging US health reform plan.

Ensign: Amendment provokes debate
Congressional amendment stimulates debate on financial incentives for wellness

A bipartisan amendment to leading health reform legislation from US Senators John Ensign (R-NV) and Tom Carper (D-DE) will, if enacted, allow health plan costs to be cut by as much as 50% for those who engage healthy behaviors. The amendment has stimulated significant controversy with some unions and major disease-based organizations opposed and employer groups and some integrative medicine advocates including Kenneth R. Pelletier, PhD, MD(hc) and Michael Levin of Health Business Strategies supportive. Ensign describes the amendment in this release. A tremendous discussion has been kindled on the Washington Post site. Pelletier, founder of the Corporate Health Improvement Program, argues here that "from all of the research literature, it is clear that positive (carrots are better than sticks) financial incentives [such as the amendment makes possible] elicit and sustain positive, long term behavioral changes." Levin describes what he believes are significant opportunities for the integrative medicine community in carving out niches to assist people toward healthy options. An Integrator discussion in which Pelletier and Levin contribute is here.
Comment: How would the integrative practice community come down on this issue were it polled? Would the typical integrative practitioner support incentives that must look to some like, as the Washington Post story begins, "get in shape or pay the price"?
November and Thanksgiving

Thanks to the financial sponsors who make the Integrator possible
Thanks to Integrator sponsors NCMIC Group, Alternative Medicine Integration Group, Inner Harmony Wellness Centers, plus

This is a rare note to directly appreciate and give thanks to the businesses and business leaders who chose to make the Integrator possible. The newsletter, and the Integrator Round-up, are possible only through the commitments of the Integrator sponsors. While this work is mission for me, I do get paid. The Integrator is blessed with a big three of sponsors from whom support is virtually a straight donation to the cause of fostering the cross-stakeholder, inter-disciplinary and integrated care which the Integrator promotes through reports, commentary and dialogue. These are: NCMIC Group and its president Lou Sportelli, DC (who sends the Integrator potential news or comments from time to time); Alternative Medicine Integration Group, and its co-founders James Zechman and Richard Sarnat, MD (whose report based on his participation as an invited participant at the IOM Summit is here); and Inner Harmony Group, founded by integrative clinic pioneer Peter Amato whose school of hard-knocks learnings have benefited integrative centers across the country. These individuals and their businesses essentially make charitable gifts to support the Integrator. All of them have also supported other initiatives which advance the mission of better integrated care.

Publication of the Integrator is also supported by sponsorship from two other entities, with the caveat that in these two cases the sponsorship (while thankfully received) is linked to specific consulting responsibilities. These are: the Institute for Health and Productivity Management, an employer not-for-profit that is open to integrative medicine contributions to employee health and wellness; and Integrative Healthcare Symposium (sibling enterprise to which, among other things, re-packages the Round-up for its 7200 members, the nation's most robust integrative practice community). So, if the Integrator is of any value to you, amidst whatever else you may be giving thanks for this year, please take a moment to consider the whole of what makes this newsletter possible: the Integrator's sponsors. 

Corrections and Additions

NCCAM funds from ARRA  The article in the October Round-up on the American Reconstruction and Recovery Act grants incorrectly stated that there were 52 NCCAM grants. In fact, there were 45 NCCAM grants and 7 others which were grants funded through the NIH office of the Director which are administered through NCCAM. The total of NCCAM grants was $16,782,761 not the $17.8-million as reported.

Challenges to academic medicine integrative programs  An academic medicine colleague notes that Academic Medicine is planning to run a series of responses to the article challenging the veracity of the evidence base in evidence-based medicine programs. (See lead article under Academic Medicine and Education, above.) The original article in Academic Medicine, which has also been supportive of these programs, was written by a long-time CAM antagonist. The response articles are scheduled to run in a February 2010 issue.

The size of the naturopathic medical profession  A reader who directs a state naturopathic association writes that the 4500 figure used to describe the size of that profession in hte United States is actually closer to 3180 licensed NDs. The 4500 figure was taken from a paper which estimated the size of the profession in North America.


Center shifts to donation-based business model
Kokolulu Farm & Cancer Retreats on the Big Island offer services free of charge

Kokulu Farms and Cancer Retreats on the Big Island of Hawai'i announced November 2, 2009 that it is changing its business model and will now offer its regular cancer retreats for free. Attendees are responsible for getting themselves there. Donations will cover the rest of the costs of the
programs in which participants "learn new tools to empower themselves and take charge of their own healing despite their physical condition and diagnoses." The programs have been in operation by Lew Whitney, MEd, SH and Karen Whitney Cooke, RN for the last 4 years. The lead consulting adviser to the Kokolulu Farms is researcher and mind-body expert Jeanne Achterberg, PhD. They anticipate running 6 retreats in 2010. Among the advisers to the organization are long-time integrative health leader and Patricia Culliton, MA, LAc and Peggy Brevort, past-president of the American Botanical Council and a member of the Bastyr University Board of Trustees.
Comment: I am familiar with and have utilized services of a Seattle-area center, Harmony Hill, which also relies entirely on donations to offer its programs for free. (Those who can immediately donate upon receive services!) I wish the Whitneys and their team the best in making this model work. 
Practitioenr network initiates new public face
Integrative Medicine Alliance, the Boston-area practitioner group, announces new website

The decade old, practitioner-driven, Boston-area regional network Integrative Medicine Alliance has announced that it has a new website. Harvey Zarren, MD serves as president of the not-for-profit which describes itself as
"an open, diverse network of concerned citizens, including practitioners such as: physicians, nurses, acupuncturists, chiropractors, pharmacists, homeopaths, herbalists, energy healers, massage and shiatsu therapists, movement educators and traditional healers, as well as people such as: teachers, public health advocates, researchers, business professionals, parents, students and others seeking caring, competent healthcare." The organization's values are here. Note: I am loosely affiliated as an original member of the Alliance's advisory board. 

Top Journal in deal with Natural Standard
JACM forms content partnership with Natural Standard for regular submissions

The Journal of Alternative and Complementary Medicine, the leading peer-reviewed journal in the integrative practice field, has announced a program through which the JACM's readers will regularly receive a monograph from Natural Standard. The monographs are edited
by Catherine Ulbricht, PharmD, the co-founder of Natural Standard Research Collaboration, and senior attending pharmacist at Massachusetts General Hospital. The first is a monograph on Alzheimer's disease.

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