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Your Comments: Riley on origins of "integrative medicine," plus Spelman, Crites, Bark, DellaGrotte PDF Print E-mail
Written by John Weeks   

Your Comments Forum: Riley on how "integrative medicine" was coined, Spelman, Crites, Bark, DellaGrotte

Summary:  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 ... 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" ...
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David Riley, MD
1.  David Riley, MD: On the first mention of "integrative medicine"

David Riley, MD, wrote to correct a statement in an article in which I attributed the use of the phrase "integrative medicine" to Andrew Weil, MD (
Next Generation Integrative MD Leader David Rakel, MD on ABIHM, CAHCIM and Family Medicine, May 31, 2008). Riley, the past editor of the Explore journal, has a long history in complementary and alternative and integrative medicine (pre-dating the use of the term). He provides a nice bit of history.
"The term integrative medicine was first mentioned at one of the Harvard CAM conferences by a speaker who said it was more correct from a linguistic perspective than integrated medicine. In 1994 I  created the Integrative Medicine Institute and secured the domain name

"I actually applied for a trademark in the same year and there is a one year waiting period.  I was told that during that year the name had become used so much that it could no longer be trademarked.  Andy's program began in 1997."

David Riley, MD
Clinical Associate Professor, University of New Mexico Medical School
Member, Board of Trustees, American Holistic Medical Association
Founder, Integrative Medicine Institute

2.  Laura Crites: A health reform focus for the Bravewell-Institute of Medicine Summit

Laura Crites serves as the executive director of the Hawaii State Consortium for Integrative Healthcare. She wrote in response to my commentary on the best use of the Institute of Medicine's National Summit on Integrative Medicine (How the IOM-Bravewell Integrative Medicine Summit Could Make a Difference: A Proposed Action Plan, June 19, 2008).

"I just read about the IOM-Bravewell Summit on your Integrator Blog and very much appreciated your comments and suggestions. 

"Although your suggestions all address the topic, I think a direct and specific articulation of the goal of 'exploring the role of integrative health care in healthcare reform' would establish clarity about what the summit is about.  Thus, I urge the planners to establish this as a priority. 

"Healthcare reform is one of the biggest topics addressing presidential candidates as well as local governments.  This is THE moment for us to open the dialogue.  In today’s local paper, the headline is that the leading insurance company, HMSA, will be increasing their premiums by 10%.  This occurs as a shortage of doctors and nurses is acute and rural areas are going unreached by health professionals. 

"It is clearly time for new thinking.  Making a broken system more available to more people is not the answer.

Laura Crites, Executive Director
Hawaii State Consortium for Integrative Healthcare

Body-worker Josef DellaGrotte
3.   Josef DellaGrotte: Another approach for an emplpoyer's hands-on program

Josef DellaGrotte is a long-time body worker who wrote in response to the Integrator article which explored a pilot project that Intel has engaged with the Dorn Companies for an onsite musculoskeletal solution (
IHPM/Employer Focus: Intel Explores Manual Therapies as an Onsite Musculoskeletal Pain Solution, June 22, 2008).
"A different approach such as the Rolf-based massage techniques [goes] a step beyond conventional medicine (which has virtually no sustained results despite the enormous costs of MRIs and cortisones, etc.)

"However, even treatment by alternative means will not lead to sustained improvement for life. Back pain is the result of too much sitting, poor walking, poor posture, the loss of core stabilization, plus compression of the spine. The research is very clear.

"The next phase of effective  treatment will include myofascial release and neuromuscular re-education. That is how we are getting sustained improvement, and, we have clinical research to back this up.

"Visit our website for the clinical research study, and the description, on video, of the method of Core Integration together with the Feldenkrais principles of functional movement integration."

Josef DellaGrotte
Muscular therapist, trained with Ida Rolf and Moshe Feldenkrais
Author of: Core Integration: Instructions From Within. 2007
Director:  Core Integration Training Institute, Inc.

Linda bark, RN
4.     Linda Bark, RN: From the Health Forum Integrative Medicine Conference - "
The Times They Are a Changing

Linda Bark, RN, is a nurse and coach who founded AsOne Coaching Institute. She was last seen here wondering why coaching was not better represented in an Institute for Health and Porductivity Management employer conference
"I attended the conference Leadership and Business Strategies for Integrative Health Care, May 14-17 in Phoenix sponsored by the Health Forum and the American Hospital Association.  In the 90’s, when I was consulting in healing centers start-ups, there was a saying that out of 100 groups that wanted to start a center, one actually was established.  Out of the 100 that were created, only one made it for more than a couple of years.  

"HOWEVER, things are different now.  Business models are more realistic.  More people know about the integrative services.  Hospitals are developing healing environments and patient centered care.  Healthy organizational cultures are a hot topic these days and progress is being made in how to develop and maintain them.

"At the conference, center directors, consultants and researchers described hospital integral centers that were working…and preliminary research from one integrative hospital showed that it was saving some money because of the integral services and innovative approaches provided at no cost to the in-patient population.  Once we have solid ROI numbers that prove what people have predicted, many hospitals will jump on the integrative care and patient centered band wagon.

"If you are interested in finding out more about this trend, read Reinventing the Patient Experience: Strategies for Hospital Leaders by Jon Christianson, Michael Finch, Barbara Findlay, Wayne Jonas and Christine Goertz Choate, (Health Administration Press). The book describes 8 hospitals considered innovators in patient centered care. 

  • Windber Medical Center (PA)
  • St. Rose Dominican Hospitals—Siena Campus (NV)
  • Abbott Northwestern Hospital (MN)
  • Florida Hospital—Celebration Health (FL)
  • Highline Medical Center (WA)
  • St. Charles Medical Center—Bend (OR)
  • North Hawaii Community Hospital (HI)
  • Valley Hospital (NJ)

"More than half have medium to high emphasis in holistic nursing, healing environments, CAM therapies and spiritual support.  They discuss their keys to success as well as the barriers they encountered and how they overcame them." 

Linda Bark, RN
AsOne Coaching Institute
Comment: The book is from the leaders of the Optimal Healing Enironments initiative of the Samueli Institute.

Herb researcher Kevin Spelman
5.     Kevin Spelman: Following up the review of Stargrove's book on interactions

Research scientist and botanical lecturer Kevin Spelman wrote in response to the article on the breakthrough text Mitch Stargrove, ND, LAc and others wrote on interactions (Herb, Nutrient and Drug Interactions: Multi-Disciplinary Team Plots Course Out of Paranoia, May 25, 2008).
"We met many years ago at a DC meeting. After reading the well done review article on Herb, Nutrient, and Drug Interactions: Clinical Implications and Therapeutic Strategies (Stargrove, McKee, Treasure) I wanted to alert you to the upcoming issue of Molecular Nutrition and Food Research (July 08) that was edited by Jerry Cott (one of the first true researchers in the US to open-mindedly investigate Hypericum).

"In this issue, herbalists such as myself and Kerry Bone write on drug-herb interactions (which is a more appropriate name than herb-drug interactions; when the medical system suggests that agricultural products are screwing up their therapies based on new-to-nature molecules coming from corporate interests, it is truly time for a reevaluation of medical therapies). Originally, the whole issue was supposed to be on HDI, but I don't know how many authors successfully completed their proposed papers. I have attached a draft of  our paper (Freeman & Spelman, abstract below).

"This paper is also significant because it represents our first graduate from Tai Sophia's MS in Herbal Medicine to make it into the peer review literature. If I may be so bold, we challenge the dogma!

A critical evaluation of drug interactions with Echinacea spp.

- Camille Freeman 1, 3 and Kevin Spelman2, 3

1 Department of Physiology and Biophysics (MS candidate), Georgetown University, Washington, DC, USA
2 Department of Chemistry and Biochemistry, University of North Carolina, Greensboro, NC, USA
3 Department of Herbal Medicine, Tai Sophia Institute, Laurel, MD, USA
Accurate information concerning drug–herb interactions is vital for both healthcare providers and patients. Unfortunately, many of the reviews on drug–herb interactions contain overstated or inaccurate information. To provide accurate information on drug–herb interactions healthcare providers must account for product verification, dosage, medicinal plant species, and plant part used. This critical review assessed the occurrence of drug interactions with one of the top selling botanical remedies, echinacea including Echinacea angustifolia, E. pallida, and E. purpurea. Only eight papers containing primary data relating to drug interactions were identified. Herbal remedies made from E. purpurea appear to have a low potential to generate cytochrome P450 (CYP 450) drug–herb interactions including CYP 450 1A2 (CYP1A2) and CYP 450 3A4 (CYP3A4). Currently there are no verifiable reports of drug–herb interactions with any echinacea product. However, further pharmacokinetic testing is necessary before conclusive statements can be made about echinacea drug–herb interactions. Given our findings, the estimated risk of taking echinacea products (1 in 100 000), the number of echinacea doses consumed yearly (A10 million), the number of adverse events (a100) and that the majority of use is short term, E. purpurea products (roots and/or aerial parts) do not appear to be a risk to consumers.

Kevin Spelman
Research Scientist
Department of Chemistry & Biochemistry
University of North Carolina
435 Science Building
Greensboro, NC 27412

Core Faculty
Department of Herbal Medicine
Tai Sophia Institute
7750 Montpelier Rd
Laurel, MD 20723
Comment: Congratulations to Tai Sophia for this outcome of their Herbal Medicine program!

6.    A side challenge to NDs on the Peter Glidden's challenge to "integrative medicine"

An interesting perspective on naturopathic physician Peter Glidden's assertion that "integrative medicine" is a pale reflection of his own field came from an integrative center activist who wished to remain anonymous ("
Guest Column: Peter Glidden, ND, Lashes Out Against His Idea of MD-led "Integrative Medicine," July 2, 2008). .
"[Glidden's] absolutely correct. However, one of the effects of this allopathic hegemony is that far too many naturopaths also cower before the almighty allopathic approach and are too timid, leading to prescribing antibiotics (too soon) or afraid of detoxification strategies."
Comment: The writer, neither an ND nor an MD, touches on an internal dialogue in the naturopathic field about the ultimate outcomes of increasing prescription rights.

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