December 2012 John Weeks Integrator Round-up covering the topics of:  Policy; Employers & Costs, Integrative Clinics & Services; Education;
Professions and Organizations and People
 

by John Weeks, Publisher/Editor of the Integrator Blog News & Reports 

Policy

Essential benefits: New York Times reports chiropractors included in most states, acupuncturists in six

A feature in the New York Times entitled Interest Groups Push to Fill Margins of Health Coverage reports that chiropractors appear to be included in “most” of the two dozen states that have announced their essential health benefits (EHB) packages while licensed acupunctirists are in six. The article begins with reference to the organizing efforts of the American Chiropractic Association (ACA) and the American Association of Acupuncture and Oriental Medicine (AAAOM). The six states where acupuncture made the grade are California, Washington, Maryland and New Mexico, with Nevada and Alaska expected to follow. Jeannie Kang, LAc, a past AAAOM president characterized the wins in the six states as “huge” since their profession couldn’t afford “a million dollar lobbying effort.” John Faldareau, vice president for governmental affairs for the ACA is quoted as saying: “We’ve been in constant contact with our state chapters, just telling them, ‘Look, you’ve got to get in the room.” Coverage is typically for much less than these practitioners’ scope of practices. For instance, Washington state reportedly covers just 12 visits for acupuncture and 10 visits for chiropractors.

Comment: First, congrats to these associations for showing up. The article’s framing is interesting. It might have been called “Chiropractors and Acupuncturists Fight for Scraps After Large Interest Groups Divey up Coverage Pie.” The article in this Round-up on the cost savings from CAM users using the MEPs data, below, suggests that if these practitioners were less marginalized and more at the core of essential health benefit planning that there may be a larger pie to divey up.   

 

Integrative medicine in accountable care: report from Oregon naturopathic physician Bill Walter, ND

Bill Walter, ND of  Golden Apple Healthcare has been on a quiet campaign for months to create a place for naturopathic doctors and other complementary and alternative healthcare services in the emerging payment and delivery model called coordinated care organizations (CCO) in his home base of Lane County, Oregon. The county includes the liberal university town of Eugene and its working class sister city of Springfield. Walter’s participation in care delivery as a naturopathic physician has been supported by a handful of medical leaders in the local community health clinic system.

In a report here in the Integrator on his efforts, Walter shared that he has also been integrated into two of the CCO’s committees. These were established to explore “transformation” in care delivery. One relates to behavioral health and primary care integration and the other to chronic pain/opiate reform. The latter committee also includes another naturopathic doctor, Miriam Mazure-Mitchell ND, MS who also sits on the board of the Pain Society of Oregon. In the report Walter notes that naturopathic physicians are not presently credentialed, but the CCO’s clinical advisory panel (CAP) will soon make determinations about which services and providers to cover. A naturopathic doctor who is also a midwife been credentialed to provide births in an Eastern Oregon CCO. Walter credits the Oregon Association of Naturopathic Physicians for its support.

Comment: Over the last few months, Walter documented his stepwise engagement with the web of connection he and colleagues have spun through this commendable work. From the list of committees and meetings he attends, the fellow clearly needs to be cloned. The cloning is not just for his profession but for others, around the country, where accountable care organizations in various forms are taking shape. Walter concluded a recent missive from the field on this optimistic note about his own profession in his home county: “We’re getting rumblings that some major specialty groups from the hospital are interested in creating wellness centers and ND partnerships. Gastro and cardiology are now starting to refer to NDs. If we pull this off right, we’ll have NDs peppered throughout the [conventional] healthcare landscape in Lane County in the next 5-10 years. May be overly optimistic but there’s a lot of buzz for what we’re doing.” I am reminded of two phrases from my dabbling in the I Ching in my early 20s. First, “it furthers one to cross the great water.” This is perhaps the Integrator slogan. The second blunt charge, worthy of Polonius’ maxims: “Perseverance furthers.” As the ACA’s Falardeau says in the article above: “Look, you’ve got to get in the room.”

 

Holistic medical doctors collaborate as NDs cross 25,000 signature threshold in petition to the White House

Getting the attention of the federal government when a profession is only licensed in 16 states can be challenging. That is the situation of the naturopathic medical profession as it seeks inclusion in federal work force planning on primary care, and access to programs that support service for rural, Indian health and underserved communities. A lone naturopathic doctor in Portland, Oregon, Shawn Soska, ND, LAc decided to petition the new Obama administration via WhiteHouse.gov for inclusion of the naturopathic profession in such federal programs. The target was 25,000 signatures by December 7, 2012, enough to guarantee that someone from the White House would pay attention. This goal from the profession of 4,500 practitioners is roughly equivalent to a campaign among the some 800,000 medical doctors to gather 4,000,000 signatures. Though the campaign did not begin through the profession’s organizations, individuals, institutions and the professional organizations eventually picked up the campaign. I sent a push via the Integrator list when the number was at 19,100.

Notably, early on December 5, 2012, the American Holistic Medical Association (AHMA) followed up with a resend of the Integrator blast. They led with a cover note from AHMA president Molly Roberts, MD. She urged AHMA’s predominantly medical doctor membership to consider helping “our allies who are naturopathic doctors.” Late on December 5th, the campaign went over the top. Nearly 400 of the holistic medical doctors appear to have responded. Some may have sent on to their own lists. Apprised of the AHMA initiative, AANP executive director Jud Richland, MPH, MPA sent an e-note of thanks to the AHMA leadership. Richland’s included this: “It was like watching election returns last night as things sped toward 25K. We’re going to take maximum advantage of this. It’s a great boost to naturopathic medicine. Thanks again!”  

Comment: Who knows what this may mean? As Rand Corporation and Samueli Institute researcher Ian Coulter, PhD has said of the many contributions of the naturopathic profession to the integrative health movement: “They are fighting above their weight class.” Empowering the NDs with success in this drive gives them  an additional boost. Kudos to the collaborative support from the holistic medical doctors. Now Richland and the AANP: Go make something of it!  

Employers and Costs

MEPS study from Group Health/Kaiser/Dartmouth/OHSU/Missouri/Palmer group finds significant cost savings among CAM users for low back pain

 
An e-notice of emerging research with which Group Health Research Institute (GHRI) is affiliated begins: “One reason for resistance to complementary and alternative medicine (CAM) is the fear that it will raise health care spending.” A consortium of researchers from GHRI, Dartmouth, University of Missouri, Kaiser Permanente, and Oregon Health and Science University recently dispelled some concern when they reported their study that CAM for back care was cost effective. The team examined a national sample of some 12,000 patients with spine problems. The conclusion: “Those who used some CAM had lower yearly medical costs for spine-related and total health care costs than did those who did not use any CAM.” The team included GHRI’s Karen Sherman, PhD, and Dan Cherkin, PhD as well as Christine Goertz, DC, PhD. Cost differences were found to be mainly due to lower inpatient expenditures among CAM users. A key value of the study was its use of the most respected data pool on costs, the Medical Expenditure Survey of the Agency for Healthcare Research and Quality. The researchers examined data for the years 2002-2008.

Comment: The most important research questions regarding the so-called “CAM” disciplines are to understand the value of what they do. This, typically, this is to work with people and their conditions in the outpatient environment. Diminution of overall costs, as found here, has always been a “hot-tub claim” from these practitioners.  Hopefully findings such as these from the MEPS data will convince the research and delivery community to explore these and other observational claims from these fields, rather than continue on their merry way in research which, as my sometimes salty father used to say, focuses on “separating fly shit from pepper.” Researching Hot-Tub Claims of Whole Person Practitioners May Interest Healthcare Purchasers offers ten areas of potential value where these practitioners speak of the outcomes reported by their patients. The piece below on patient experience of a CAM discipline’s members in successful care of diabetes is further confirmation of the value of listening to the claims of such practitioners as a direction for research.

 

Engaging a new audience: can the CAM/IM community cross the chasm to employers?

The rash of news in the November 2012 Integrator Round-up related to the potential richness in the employer-integrative health connection led to the publication of this well-received Huffington Post article: CFO Magazine Urges Fortune 500 Firms to Explore Cost Savings Via Alternative and Integrative Medicine. Integrative medical consultant and Integrator adviser Glenn Sabin of FON Therapeutics followed up his piece on the Perfect Marriage between these two stakeholders with this tickler: How to Sell Integrative Medicine to Corporate America. Sabin urges a focus on promoting integrative strategies that will help lower the high cost of chronic conditions.

Comment: A challenge for clinicians of any sort is that they often choose to be clinicians because they see themselves as a service profession. They aren’t interested in business. Maybe, then, the trick is to reframe this employer relationship as a mission to reach employees who are underserved populations. On this context, learning the employer culture and the specialized language of “presenteeism” and “productivity” is a necessary bilingualism to reach and serve this needy population. The opportunity certainly exists in this time as employers increasingly express their rancor with a conventional, disease-based system that can seem like little more than, in IBM’s Paul Grundy, MD, MPH’s words, “a milking machine.”

Integrative Clinics and Services

From Google Alerts: links to integrative medicine in hospitals, health systems and community centers in December 2012

This monthly report from the Integrator includes 35 short segments, with links, on developments in integrative medicine in hospitals, academic health centers and health systems from mid-November through December 9, 2012. This month’s report also includes some links to non-health system community of integrative practices to provide more balance on the range of developments associated with “integrative medicine.” Included are centers in New Jersey, Connecticut, North Carolina, California, Texas, Florida, Colorado and much more.

 

Principles for limiting opioids use fail to mention complementary and integrative therapies

Group Health Research Institute has published Principles for More Selective and Cautious Opiod Prescribing following a National Summit on Opioid Safety. The principles emphasize the importance of self care for the patient and empathy and listening for the practitioner. Intermittent use of opioids is one recommendation for limiting addiction. The principles cover such ares as considerations for long-term use, and the practice of long-term administration. Complementary or alternative therapies are not mentioned.

Comment: The Group Health posting has a comment field. The one statement these is from this writer: “I am honestly astonished that an organization as progressive as Group Health, in the Pacific Northwest, and with as long of experience in researching and covering various forms on complementary, alternative, mind-body and integrative therapies, can put out such a statement without any reference to these tools for both self-care and professional management of pain conditions. Doesn’t even merit a mention?” I would add now that this is particularly so given a blueprint for pain treatment from the Institute of Medicine that recommends a multidisciplinary, integrative approach. Recommendations for intermittent use of opioids, for instance, would seem a smart place to use integrative therapies. Backing people off harsh drugs is a top propellant of CAM use.   

 

James Gordon, MD’s work with trauma and cancer in Gaza and Israel featured

The work of the Center for Mind-Body Medicine’s (CMBM) founder James Gordon, MD with trauma and cancer in Gaza and Israel was recently featured in Israel’s leading liberal daily, Haaretz. Psychiatrist Gordon told his CMBM list that the “need for our work … has never been greater.” He adds: “The escalation of the conflict has taken a psychological as well as a physical toll that seems to grow deeper every day in spite of the present cease-fire.” The Haaretz writer observed that “it’s not often that a Jewish psychiatrist is spotted in the Gaza strip.” Gordon, the former chair of the White House Commission on Complementary and Alternative Medicine Policy, has been working with integrative approaches on relief in disaster zones since 1995. He notes in the Haaretz piece that “mental health is neglected, even in very good relief efforts.”

Comment: Gordon and his Georgetown colleague, integrative medicine leader Aviad (Adi) Haramati, PhD, are each involved in some ways in healing in the Middle East. Some of Haramati’s work is here

 

Case report on successful integrative medicine primary care clinic in Sydney, Australia

The recent issue of the Journal of Complementary and Alternative Medicine reports an examination of supportive factors and challenges in an ultimately financially successful, multidisciplinary, community-based, integrative medicine (IM) clinic. The clinic was established in Sydney, Australia in 2006, with both primary care and consultative services in the model. The results follow:  

“Consistent with success factors identified in the literature, the clinic had an open-minded culture, credible supporters, suitable facilities, and clinically competent practitioners. Throughout the 4 years of its existence, the clinic strove to create an economically sustainable environment and to develop the service. As time progressed, it became evident that at least half of the practitioners needed to be biomedical doctors for the practice to remain viable. The challenges encountered were creating an economically sustainable clinic, managing high staff and practitioner turnover, finding the right balance between practitioners and services offered, developing an integrative medicine team, and building research capacity to evaluate the clinic and patient outcomes.

 The authors share that “this multidisciplinary primary care clinic succeeded in establishing a viable health care service offering both integrative medicine and conventional, traditional, complementary, and alternative medicine.” They added: “Finding the right mix of staff members and following up with evaluations to track progress are important.”

 

Boston’s Visions Healthcare, led Edward Levitan, MD, to move to 21,000 square foot integrative clinic facility 

Begun three years ago in Wellesley, MA with just three employees, the integrative medicine operation Visions HealthCare now employs 60, including 12 medical doctors. The clinic is about to move into a 21,000 square foot space in Dedham, MA. The founder of the operation, Edward Levitan, MD was profiled in the Boston Business Journal as an Emerging Leader. Visions HealthCare’s website features service-related drop-downs in two categories: medical and wellness. The former features 6 MD specialties, including palliative care, while the latter is topped by acupuncture, bodywork and energy approaches. Levitan says he is also looking for 200 acres near Boston to host an organic farm and school. The 37-year-old Levitan counts Institute for Functional Medicine founder Jeffrey Bland, PhD as a mentor and chief influencer.

 

“When naturopaths help people with diabetes to change their ways, what’s the ‘secret sauce’?”

This question head-lined a second short newsletter item from Group Health Research Institute (GHRI) reporting research by GHRI members and other collaborators. The study itself had a more mundane title: Patient-reported experience with first time naturopathic care for Type II diabetes. The GHRI article noted that GHRI and Bastyr University researchers had already published research that “adding naturopathic care to standard care improved health behavior and self-care for Group Health patients with diabetes.” This time collaborators from GHRI, Bastyr, Oregon Health Sciences University and the Naturopathic Physicians Research Institute examined how the approach of the naturopathic doctors’ had these positive impacts. The overall conclusion: “Results indicate that the routine clinical approach used by NDs is consistent with behavior change theory and clinical strategies found most effective in promoting self-efficacy and improving clinical outcomes.”

The researchers used a “content analysis approach” in interviews with 22 of the participants in the original study. They found the following nine elements of continuity. The first three were said to “characterize the nature of the ND-patient interaction.” These were that it was patient-centered, holistic health rather than diabetes focused, and collaborative. They then noted five themes “related to the content of the clinical encounter.” These were: individualized and detailed health promotion; counseling that promoted self-efficacy; pragmatic and practical self-care recommendations; novel treatment options that fostered hopefulness; and patient education that addressed both diabetes self-care and general health. Finally, the researchers added a ninth theme that they called “cross-cutting.” This was the contrast, for the patients, between naturopathic care and conventional medical care. The team was led by NPRI’s acting chair Erica Oberg, ND, MPH, and included Ryan Bradley, ND, MPH (the lead on the original diabetes project), Clarissa Hsu, PhD, Karen Sherman, PhD, MPH, Sheryl Catz, PhD and Dan Cherkin, PhD.

Comment: In a world in which soaring costs are linked to poor personal habits, these outcomes should prompt significant research and payer interest. In a research context in which millions are being spent to understand “patient-reported outcomes” and “patient-centered outcomes,” the nine themes particularly merit examination. At a time when the Institute of Medicine Global Forum on Innovation in Health Professional Education is looking for education models that will better practice, the naturopathic medical education strategies, and those integrative medicine programs in conventional medical schools, merit exploration.  

Education

ACPM’s National Coordinating Center for Integrative Medicine seeks director

The American College of Prevention Medicine (ACPM) is seeking a director for the National Coordinating Center for Integrative Medicine (NccIM). NccIM, funded through a competitive $770,000 award from the Health Resources Services Administration, will assist with development of integrative medicine curricula in 12 residency programs associated with the preventive medicine specialty. ACPM has called its program IMPriME, for Integrative Medicine in Preventive Medicine Education. The job description from the ACPM states: “The purpose of the Center, which is funded under a cooperative agreement, is to create a sustainable, Preventive Medicine-specific infrastructure to provide technical support for Preventive Medicine Residency and other health professions training programs interested in incorporating evidence-based integrative medicine content into their programs.” Information is here. Send applications to Paul Bonta at pbonta@acpm.org.

 

Bastyr University and National Ayurvedic Medical Association collaborate to offer Masters in Ayurvedic Medicine

The first regionally-accredited, masters-level program in Ayurvedic medicine will be offered by Bastyr University beginning in late 2013. In a December 7, 2012 release from the university, Timothy Callahan, PhD, Bastyr’s vice president charged with developing the program, states that “we believe this form of natural medicine is growing in popularity as people seek preventive solutions to their medical issues, and the need for providers with accredited training will increase in the coming years.” Bastyr, regionally accredited since 1989 through the Northwest Accreditation Commission and its predecessors, partnered with the National Ayurvedic Medical Association (NAMA) in developing the degree program. Students will have access to guaranteed student loans. The two-year program includes an option for students to ‘pursue an externship in India where they will observe and assist Ayurvedic practitioners in local clinics and hospitals.”

Comment: This level of recognition of an educational program in Ayurveda begs questions about practice rights, licensing and scope. Will the program draw mainly from other licensed providers who can then put the learning to use inside their separate practice rights? NAMA’s recognized educational programs are typically to a 500 hour standard. The standards and grandfathering issues for this field, as reported in this Round-up for Yoga therapy and integrative medicine, are now more clearly on a horizon. Student loan debt and tuition cost in itself has a way of stimulating guild formation. Witness the reasons for pushing the integrative medicine board noted here

 

Twenty-one integrative medicine fellowships recognized by the American Board of Physician Specialties

As part of the move to create a specialty certification through the American Board of Integrative Medicine (ABOIM), the agency has publicized its first list of approved fellowships that are recognized as preparing one for the ABOIM recognition. Twenty one programs are listed. These include well-known fellowships via the University of Arizona and Harvard and lesser known offerings at places like Santa Rosa Family Medicine and Swedish-Cherry Hill in Seattle. Foci range from integrative medicine in family medicine to fellowships focused on integrative medicine research, academics, cardiology and geriatrics. The site does not list the standards that the fellowships must share. Most are academically based. Some are sponsored through delivery organizations.

Comment: This is quite a list of fellowships, perhaps double what I would have guessed. The number speaks volumes for the work of the academic integrative medicine leaders and their penetration of this field into US medical education. 

 

CAHCIM to sponsor International Clinical Congress for Complementary and Integrative Medicine

Following the success of international meetings related to research and education in complementary and integrative medicine and health, the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) has announced that it will sponsored its inaugural International Conference for Clinicians in Complementary and Integrative Medicine (ICC-CIM) October 29-31. The conference, co-chaired by Melinda Ring, MD and Henri Roca, MD, ACU, will be held in Chicago in association with the CAHCIM annual meeting. The host is Northwestern Integrative Medicine, Ring’s base. The team has developed an integrated program committee with local representatives from National University of Health Sciences and Pacific College of Oriental Medicine plus a nominee from the Academic Consortium for Complementary and Alternative Health Care.

A note from the CAHCIM organizers to new program committee members states that ICC-CIM is “designed to explore the clinical frontiers of a wellness-based healthcare system supported by individuals and teams practicing holistic, integrative medicine incorporating both complementary and conventional medical strategies.” Its objectives are listed as: “create an environment where science-informed best practices of holistic and integrative medicine utilizing both CAM and conventional modalities can be shared and discussed; explore sustainable clinical and financial models for an integrative patient centered wellness/medical home utilizing the above approach; and, provide opportunities for clinicians of all types to experience and learn new approaches to the optimization of patients’ health and the reversal and treatment of chronic disease.”

 

AAMC opens portal with links to interprofessional education and practice tools, resource and solutions

Among the most significant opportunities for integrative health in the changing US medical landscape is the parallel movement for interprofessional education and practice. The Association of American Medical Colleges has announced that it has opened its new Interprofessional Education (IPE) resource site via its robust MedEdPortal. Included are foundational resources and a less restrictive but more dynamic iCollaborative where professionals can exchange non-peer-reviewed information. The collaborative is open to professionals of all types, globally. Carol Aschenbrener, MD, the AAMC’s vice president, is the principal investigator for the grant-funded project.

Comment: The IPE portal’s advisory panel is multidisciplinary, with representatives from public health, dietetics, psychology. No sign of anyone directly related to the complementary, alternative and integrative health and medicine fields. The door appears to be open to involvement ofd any who show up to work respectfully and collaboratively. It is noteworthy that the president of the Josiah Macy, Jr. Foundation, a leading funder of the portal, has called for “widening the circle” in patient team inclusion.

 

Series to feature hospital-based massage programs in five leading health systems

Beth Rosenthal, PhD, MBA, MPH writes that massage educator, author and researcher Tracy Walton, LMT, MS is offering a webinar series on hospital-based massage therapy (HBMT) programs. In each, Walton will offer a depth interview of a representative from a different hospital program. Included are MD Anderson Cancer Center, California-Pacific Medical Center, Beaumont Health System, Dartmouth-Hitchcock Medical Center, and Boston Medical Center. The development of the five HBMT programs will be explored. The interactive series will be offered between January 15-February 19, 2013. After the series, recorded sessions will be available on demand, indefinitely, as an ongoing resource. The webinars are produced by the Benjamin Institute.

Professions & Organizations

Yoga therapists publish guidelines for grand-parenting of providers as educational standards advance

The International Association for Yoga Therapists (IAYT) has published Emerging Guidelines for Grandparenting Yoga Therapists. Work on this document has been the primary focus of IAYT’s accreditation committee since IAYT’s adoption of the Educational Standards for the Training of Yoga Therapists earlier this year. The grand-parenting issues were engaged as part of “developing the process for accrediting yoga therapy training programs that meet these standards” according to the document. A cover note states that these presently focus on current students or on recent graduates of courses of 300 or more hours. A separate focus will be on grand-parenting “seasoned yoga therapists.”

Comment: As twin signs of emergence, in the present moment of time, both Yoga therapists and integrative medical doctors, via the American Board of Physician Specialists’ “time-limited eligibility option,” are each engaged in grand-parenting standards.

 

AHMA executive director Cadwell and the convergence of various integrative and holistic organizations

A November 13, 2012 report from Steve Cadwell, executive director of the American Holistic Medical Association notes that the organization picked up 79 new members during and around the annual course review and exam for the American Board of Integrative and Holistic Medicine (ABIHM). In the past two years, the numbers of new members AHMA gained via the meeting more than doubled that of the last two years. AHMA did not feature an educational conference of its own in 2012 so had its annual meeting at the San Diego gathering. Sixty AHMA members attended. Cadwell notets that past AHMA president Hal Blatman, MD is chair of the Integrative Medical Consortium  of which AHMA is one of six member organizations. Present AHMA president Molly Roberts, MD is slated to be his successor. Writes Cadwell: “The AHMA Board wants to help support ABIHM diplomates and AHMA members keep ‘holistic’ and the established Principles of Holistic Medical Practice in integrative medicine, especially as a new program is developed and transitioned into existence, the American Board of Integrative Medicine (ABOIM).” 

Comment: Cadwell’s report offers a collision of the acronyms in integrative medicine: AHMA, ABIHM, IMC and ABOIM. Oh, he didn’t mention CAHCIM, but its with that organizations members that ABIHM is converging to create ABOIM. New alignments are being created as the new American Board of Integrative Medicine takes shape. Meantime, ABIHM is likely to feel a spike in interest in its waning years as the most direct way for medical doctors and osteopaths to meet the “time-limited eligibility optionotherwise known as grand-parenting. ABIHM makes this case on their website. AHMA remains the one membership, professional organization of the group. How will it frame or reframe its role as the field reaches the new level of recognition. Cadwell indicates that a focus will be on maintaining a philosophic grounding in holism.

 

Academic integrative medicine doctors reach out to support community medical doctors on legal issues

The chair of the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM), Ben Kligler, MD, MPH, has urged his fellow members to consider submitting their names to be on an “Integrative Medicine Expert Witness List.” Via the CAHCIM newsletter list, Kligler directed CAHCIM members to a letter from the multi-organization Integrative Medicine Consortium (IMC). The IMC letter asks interested integrative medicine parties to submit CVs and related materials to become part of a pool of potential consulting witnesses. These will “provide information allowing physicians under investigation and in need of expert review, and their attorneys, to locate these important resources.” The initiative is supported in this editorial from Molly Roberts, MD, president of the American Holistic Medical Association.

Comment: Legal issues have historically been a hot topic for the town-side of the town-and-gown mix that makes up the whole, sometimes acrimonious, integrative MD community. Organizations like the former American Preventive Medical Association, now the Alliance for Natural Health, have promoted legal defense of integrative physicians as a key purpose. In recent years, the townies tend to push the integrative clinical envelope beyond what the gown-side condones as an evidence-based boundary for clinical practice. If an expansive integrative MD in Wilkes-Barre or Sedona finds some local law enforcement after him or her, he or she just might like some ivory tower ju-ju weighing in on their behalf. So then you are a leader of a consortium of 51 medical schools that have programs in the kind of medicine practiced by my client? Here is a piece of timing that is interesting though I would guess utterly coincidental. The request from CAHCIM came shortly after one of the most disputed and lucrative townie therapies, chelation, saw its huge NIH trial come out positive. 

 

Obstetricians’ challenged on bad science in their effort to deny value of planned home births

The American Association of Obstetricians and Gynecologists has published a recent paper that warns mothers to stay away from home birth. The paper is entitled Planned Homebirth: The Professional Responsibility Response. The authors build a case against recent claims of safety, effectiveness, diminished adverse effects, and cost-effectiveness of planned home birth. They conclude: “We call on obstetricians, other concerned physicians, midwives and other obstetric providers, and their professional associations not to support planned home birth when there are safe and compassionate hospital-based alternatives and to advocate for a safe home-birth-like experience in the hospital.”

The work is countered by Bastyr University adjunct faculty member in the Department of Midwifery, Wendy Gordon, CPM, LM, MPH, in this blog posting at Science and Sensibility: A Research Blog on Healthy Pregnancy, Birth and Beyond.  Gordon argues that the AJOG article rests on an analysis that confounds planned home birth with unplanned out-of-hospital birth. She argues that the OBGYn team also use “several more poor-quality studies, as well as 52 citations of commentaries, opinions and anecdotes (some even pulled from the popular media) to build their ‘evidence’ basis.” Gordon ticks off 8 studies she views as high quality that the authors did not cite. Gordon refers back to the title the AJOG team gave to their piece in her conclusion: “’Professional responsibility’ demands that we examine and disclose our own personal, religious or anecdotal beliefs that may bias our interpretation and presentation of the research.” 

Comment: The obstetricians are behaving with the paranoia of Richard Nixon when he caused the Watergate break-in. Up more than 60% in the polls, Nixon urged his team to engage illegal activity to secure his re-election. The abuse of evidence by the obstetricians, and the sanction from their journal, in the pious name of professionalism, against this band of less than 2000 Certified Professional Midwives, should merit time in science’s slammer. Or at least time, to recall Nixon in the White House corridors at that time, on their knees pleading to the fore-parents of evidence-informed medicine to forgive them for their abuse of their office. Never mind that the OBs, through nurse midwives, had the same position before they were providing “safe and compassionate hospital-based alternatives.” Another look at the evidence, and the politics, is here: Homebirth Midwives and the Hospital Goliath: Evidence Builds for Disruptive Innovation. Nice work Ms. Gordon.

 

Society for Integrative Oncology seeks new executive director

The first executive director of the Society for Integrative Oncology (SIO), Sarah Rausch, PhD, is stepping down after two years. The not-for-profit SIO’s mission is “to advance evidence-based, comprehensive, integrative healthcare to improve the lives of people affected by cancer. The organization was established in 2003 and currently has approximately 300 members from 40 states and 21 countries. Information about the position is available through clicking this link.

 

American Chiropractic Association “retracts” challenge to International Chiropractic Association on pediatrics program

The November 2012 Integrator Round-up reported a skirmish between the two feuding national chiropractic associations over a pediatrics specialty program. On November 27, 2012, the ACA published this statement: ACA Retracts Earlier Statement About the Safety of ICA Council on Pediatrics Certification Program. Said ACA president Keith Overland, DC: “We apologize that our Nov. 1 statement has been misunderstood by some, particularly on the important issue of public safety. It was not intended as a commentary on the quality of that program’s training or the level of competence of its diplomates who provide wonderful care to children. We also regret any inconvenience our earlier statement might have caused ICA leaders or diplomates in the ICACCP’s diplomate program.” Meetings between ACA and ICA leaders clarified two key points: membership in the ICA Pediatrics Council is not required to sit for the examination or to become re-certified, and ICA Pediatrics Council membership will continue to be required to participate in educational programs of the ICA Pediatrics Council. Bill O’Connell, ACA executive vice president commented: “We appreciate the ICA’s patience with ACA as we discuss this matter.”

Comment: Good to see this misunderstanding resolved and the cooperation between the two organizations continue in this area. In similar good news for those who would rather see this rift mended, ACA’s Overland made history in mid-November as the first ACA president to speak at Life University. Life is at the engine of the ICA branch of the profession. Overland reportedly pulled for unity, saying that the two organizations are aligned on 90% of issues. In a separate e-mail communication, the ICA’s Steve Welsh, DC notes: “Please be aware that the ICA has been working closely with the ACA through the Chiropractic Summit, along with about 35 other chiropractic organizations, in order to present a common message to federal policymakers.”

 

American Holistic Nurses Credentialing Corporation to provides two new certifications in 2013

Mary Brekke, PhD, RN, AHNC shares that the American Holistic Nurses Credentialing Corporation (AHNCC) will be offering two new certifications related to holistic nursing in 2013. One is a certification exam in nurse coaching. Those who are successful are awarded Nurse Coach, Board Certified (NC-BC) status if they are nurses with a minimum of a bachelors in nursing. Others currently certified by AHNCC who successfully pass the exam may be awarded the Health and Wellness Nurse Coach, Board Certified (HWNC-BC). Brekke notes that the “eligibility criteria during the phase-in period, which lasts until March 31, 2013, differ from those required effective April 1, 2013.” In addition, following requests, AHNCC will begin offering a new Advanced Practice Holistic Nurse Certification Exam for nurses who are licensed as APRN and wish to be certified as an APHN-BC, APRN.  The latter is “designed to test knowledge and skills in Advanced Holistic Nursing including the APRN Prescriptive Authority competencies surveyed in the 2012 Role-Delineation study.  

Comment: The nurses may get the award for the most contributions to the hieroglyphics of acronyms that mark the pathway of integrative health maturation.

Miscellaneous

Sarsini on the link between CAM and personalized, predictive, and preventive medicine

Mind-body medicine began to make some of its first inroads in the 1980s after it was re-named psychoneuroimmunology. Just so the complementary and integrative medicine principles that the best care is of necessity individualized and therefore confounding to conventional research design gained ground when industrial medicine’s exploration of the genome begat a medicine characterized by “personalization, prediction and prevention.” Duke’s Chancellor Emeritus Ralph Snyderman, MD was among the first to draw these connections between two fields of disparate origin.

A team led by Italian integrative medicine leader Paolo Roberti di Sarsina, MD has recently published an open-access paper exploring this overlap in language from the non-industrial perspective. The paper is entitled Traditional, complementary and alternative medical systems and their contribution to personalisation, prediction and prevention in medicine – person-centred medicine. The treatise recommends a research agenda “broadened with methodological tools to investigate person-centred medical interventions” and a focus on “salutogenesis, a fundamental principle of [patient-centered medicine], promoting health and preventing illness by strengthening the individual’s self-healing abilities.”

Comment: We need more efforts that directly explain language and concepts that are core to the integrative health field which also have overlapping but differing uses in conventional medicine. Words like “nutrition” and “prevention” and now “personalization” and “predictive.” This work, led by Sarsini, an Integrator adviser, is a step toward bridging the divide.

 

Selected Conference Links

This list of conferences particularly focuses on those that have an integrative health focus or component.

 

People

Health Tick, MD appointed to endowed chair in integrative pain management

Integrative medical doctor and integrative pain pioneer Heather Tick, MD has been appointed to the Gunn-Loke Endowed Professorship for Integrative Pain Medicine at the University of Washington. The position was approved by the institution’s Board of Regence on November 11, 2012.  The position is named for C. Chan Gunn, MD, whose family endowed the position. Gunn is the longest-serving clinical faculty member in the UW Department of Anesthesiology and Pain Medicine. Tick has worked in integrative pain management for over two decades. She pioneered an inter-disciplinary pain clinic in Toronto in the early 1990s and is a leader in promoting  the importance on interprofessional education and practice in pain treatment.

 

Mark McKenzie, LAc, MAOM becomes executive director of the Accreditation Commission for Acupuncture and Oriental Medicine

A leading educator in acupuncture and Oriental medicine, Mark McKenzie, LAc, MAOM, has stepped in to a critical role in the acupuncture and Oriental medicine (AOM) field. Until recently the director of the AOM program at Northwestern Health Sciences University in Bloomington, Minnesota, McKenzie is now the executive director of the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM).  McKenzie, until recently the chair of the ACAOM, will guide it through the next stages of the profession’s rocky road toward a first professional doctorate.

 

Barbara Bakus, DO to be new president of the American Holistic Medical Association

A report from the American Holistic Medical Association shared that Barbara Bakus, DO, ABIHM will take over as president of AHMA in 2013. Beechwood, Ohio-based Bakus became board-certified in family practice and osteopathic manipulative treatment through the American Osteopathic Board of Family Physicians. She was also trained in acupuncture at the UCLA extension course. Bakus completed the integrative medicine fellowship through the University of Arizona School of Medicine. She became Board-certified in integrative medicine in 2011 through ABIHM. Bakus is here on You Tube speaking about the No Diet Weight Solution.

 

Jo Anne Yanez, ND selected as first, full-time executive director for naturopathic colleges group

The Association of Accredited Naturopathic Medical Colleges (AANMC) took a step toward its maturation when it recently named JoAnn Yanez, ND, MPH as its first full-time executive director. Yanez has served the field in a variety of capacities including roles with the New York Association of Naturopathic Physicians and the Council on Naturopathic Medical Education. Yanez has been honored in multiple ways for her volunteerism. The AANMC, which represents the seven North American naturopathic medical colleges that are recognized by the United States department of education, was in the past directed by Karen Howard, who was concurrently the CEO of the American Association of Naturopathic Physicians. Yanez is not only AANMC’s first full-time director. She is the first without competing professional involvement. This change was effected under the term of AANMC president Guru Sandesh Khalsa, ND, president Boucher Institute of Naturopathic Medicine