Integrative Medicine, Complementary Alternative Medicine and Health Round-up February 2012 featuring the topics of: Policy, Research, Integerative Centers, Integrative healthcare professions, academic medicine and health, healthcare media updates, CAM research, practice and people.
Comment: Is the integrative community a Puer Aeternis? This is the Jungian, dreamy “eternal boy” who refuses to grow up. The image came to mind last month while I wrote about the policy opportunities for integrative health care as described in the remarkable report The Affordable Care Act and Beyond: A Stakeholder Conference on Integrated Healthcare Reform. I juxtaposed the practical potential in this document from the Integrated Healthcare Policy Consortium (IHPC) and our lofty vision of transforming our healthcare system, on the one hand, with the fact that the only multi-stakeholder lobbying entity for the integrative health community can only support a not very well paid half-time executive director. This community would seem to want transformation without stepping into the messy, not very boyish, and not at all dreamy work of lobbying to get what we want. Thus Robert Bly’s story of the puer aeternis came to mind. Can the community wake up, and step up?
I note with pleasure the efforts noted below as we enter the Chinese Year of the Dragon that commenced January 23, 2012. One website speaks of the dragon in remarkably integrative terms: ” … powerful almighty king because (the dragon) was made up of different parts of animals such as a tiger, fish, snake and an eagle. The Chinese dragon was not seen as a threatening evil being as we do in the west – rather a symbol of power, superiority and rule.” One of my colleagues used street terms to describe the meaning of the Year of the Dragon: “It’s the year to get shit done.” Perhaps this is the time to cast off the puer aeternis and reveal the dragon!
A bit of integrative medicine history was made in January 2012 when the U.S. Indian Health Service (IHS) quietly announced that licensed naturopathic doctors, acupuncturists and chiropractors would be included in 2012 in the IHS’ student loan repayment programs. The announcement magnetized students and recent graduates. Is this finally a the beginning of the end to what they view as a long-overdue chance end discriminatory exclusion from a program to relieve their debt burden? The inclusion was immediately celebrated by the American Association of Naturopathic Physicians (AANP). The AANP has targeted such inclusion as its top federal priority for the last decade. The American Chiropractic Association followed suit with a release to their members. An article on the inclusion is here in the Huffington Post. Actual inclusion will be a function of relationships: one tribe selecting one practitioner. A view from inside the naturopathic profession is here.
Comment: These practitioners may be an exceptional fit for tribal health. Licensed naturopathic doctors link their primary care scope to expertise in natural healing methods such as herbal medicine and sweats (cleansing), lifestyle change and a belief in the importance of spirit in health. Emerging research on naturopathic diabetes care is also hopeful in a population in which this condition is epidemic. Naturopathic doctors would seem uniquely useful. While the connections are not as direct, practitioners of acupuncture and Oriental medicine (AOM) and chiropractors are similarly disposed, philosophically, toward indigenous and natural healing methods. The comments here include some discussion of the fit of AOM and particularly group acupuncture in the I.H.S. environment.
So far 5,524 emails and letters sent! So headlined the campaign page for the late January 2012 push of the Association for Acupuncture and Oriental Medicine to place acupuncture in the Essential Health Benefits (EHBs) package. Under the 2010 Affordable Care Act, starting in 2014 most health plans will be required to offer EHBs as part of a strategy to ensure access to quality and affordable health insurance for all U.S. citizens. The AAAOM is supporting their campaign with a 5-page position statement. The core of the documents is entitled “The Medical and Comparative Effectiveness of Acupuncture.” The authors argue that evidence supports the conclusion that: “The inclusion of acupuncture in the Essential Health Benefits package will increase patient access to safe, cost-effective and comparatively-effective health care, improve outcomes, and reduce adverse events of conventional therapies, and provide an overall increase in cost-savings for American health care.” A note on January said that, at the closure of the period, 23,000 letters e-notes had been sent.
Comment: Credit the AAAOM for bellying-up to this bar, submitting a short white paper and mounting this campaign. Note the American Chiropractic Association, which is continuously on the ball in D.C. representing chiropractic interests, is dogging this issue. An example is this testimony to the Institute of Medicine (IOM) during the IOM’s development of its recommendations.
The February 2, 2012 event was titled: “Improving American Health Care by Leveling an Uneven Playing Field: Ending Discrimination against Integrated Health Care.” The audience(s): members of the US Senate (or, more likely, staff) in the Dirksen Senate Office Building during the morning then, that afternoon, to members of the House of Representatives in the Cannon House Office Building. For each audience, the three speakers addressed “forms of discrimination against licensed Complementary and Alternative Medicine (CAM) professions: acupuncture, chiropractic, massage, naturopathic medicine, and professional midwifery” including “discrimination against federally recognized CAM educational institutions.” Among the speakers was former Washington State Insurance Commissioner Deborah Senn, JD. Senn is credited with holding insurers’ feet to the fire when they sought to evade the 1995 Every Category of Provider Law law in that state which required all plans to cover all categories of licensed providers. Senn spoke to the results of its implementation and national implications. The other speakers were former IHPC executive director Janet Kahn, PhD and Bastyr University dean of naturopathic medicine Jane Guiltinan, ND. The event was sponsored by the Integrated Healthcare Policy Consortium (IHPC).
Comment: The is the second in 3 such briefings that IHPC is arranging through its former executive director Janet Kahn, PhD. Discrimination against the CAM disciplines is far more pervasive than in payment, the usual target of such concern. Discrimination extends to numerous federal grant programs and policy-making initiatives. Non-discrimination in that area will begin to be righted if the Section 2706 of the Affordable Care Act is not over-turned by the American Medical Association and its allies. Good for IHPC to highlight these additional areas where inequities prevail.
The January 10, 2012 Alert from the Alliance for Natural Health for its members was entitled “New Regulations Threaten Insurance for CAM Patients.” The complicated message is that Health Savings Accounts (HSAs) through which many individuals are accessing coverage for otherwise non-covered complementary health services are on the line. They share that recently issued final standards from the US Department of Health and Human Services will harm health plans like HSAs with higher deductibles: “Particularly hard hit will be the [HSAs] that help so many of us pay for complementary and alternative medical (CAM) treatments not covered by regular insurance.” At issue is the treatment of plans who do not meet requirements to limit their overhead and profit less than 20% of premiums, or 15% for large employers. The Alliance is calling on members to contact their members of Congress to save these HSAs. They argue:
“If high-deductible plans are eliminated, then our only option is to combine an HSA with a much more expensive conventional policy. That will make integrative care completely unaffordable for many. It will also lead to less demand for HSAs. Before long, they would probably disappear. If HSAs disappear, direct consumer control over healthcare would suffer yet another blow. As many analysts have suggested, the fact that consumers do not directly buy medical services explains much of what is wrong with medicine today.”
The notice concludes with a statement that “the good news is that since HSAs are specifically mentioned in the [Affordable Care Act], they can’t legally be killed by agency regulations, over and above the injury already received from the statute.”
Comment: Simulating a popular movement, as the Alliance is seeking to do, that will allow insurers to keep more of the insured’s subscription for overhead and profit would seem oxymoronic, if not utterly wrong-headed. Yet I credit the Alliance for taking on this issue and raising awareness of it. Meantime, I would hope the Alliance would also stimulate action amongst its members to keep the non-discrimination clause in the Affordable Care Act – another and more broad-sweeping way to allow more coverage of many integrative practices.
The name of the new Institute of Medicine (IOM) report is Living Well with Chronic Illness: A Call for Public Health Action. The purpose of the 307 page document, stimulated by interest from the fibromyalgia community, is stated this way: “The overall goal of this report is to highlight the toll of all chronic illnesses on living well from a population health perspective, discuss the deficits in chronic disease control, and make recommendations to improve public health efforts to help individuals live better with chronic illness.” A section on Community Based Intervention includes a 2-page segment (157-158) entitled “Complementary and Alternative Medicine.” The conclusion of that section: “The use of CAM approaches in the management of chronic illness raises some concerns among health care providers because of the lack of scientific evidence supporting the use of these products and the potential for ignoring traditional and effective therapies but also in terms of safety and efficacy (Ventola, 2010b). The Dietary Supplement Health and Education Act of 1994 did not mandate that manufacturers prove that their products are safe but put the burden on the U.S. Food and Drug Administration (FDA) to prove them unsafe (Ventola, 2010b).
Comment: The report appears to have been developed via a committee without members active in the integrative medicine community. Clearly, none were members of the licensed complementary and alternative medicine professions. Nor were these communities represented in the review panel. Given the high exploration of “CAM” by people with chronic conditions, typically in the 50%-70% range, this was a huge oversight, and effectively a non-representative disservice by this quasi-public agency. How can we continue, in this so-called “patient-centered” era, to so easily dismiss what so many patients are doing? While there is much in this report that can be instructive to the integrative health community, it is a sign of the poor state of “integration” that the Committee was not only non-inclusive but also comfortably dismissive. This was a missed opportunity for healing, at many levels. (Thanks to Demie Stathoplos of Pathways to Wellness for this link.)
An integrative medicine home-care proposal developed with support of the Charles and Agnes Kazarian Foundation has gained approval as part of the Healthcare Innovation Challenge Proposal of the Center for Medicare and Medicaid Services. The Foundation will provide $6-million of the funding to establish a volunteer and internship-based Health Corps of America to deliver in-home integrative medicine services with CMS providing an additional $30-million. According to the February 8, 2012 release, the Foundation’s is supporting creation of a nationwide Health Corps of America. These healthcare professionals will deliver care at home to high-cost, high-risk elderly populations. The release notes that “the Health Corps of America is significantly based on the Foundation’s propriety research, especially on the global benchmarks and high value-add best practices of internships and volunteerism.” The Health Care Innovation Challenge, sponsored by the United States Centers for Medicare & Medicaid Services and funded by the Affordable Care Act, will award up to $1 billion in grants to applicants who will implement the most compelling new ideas to deliver better health, improved care and lower costs to high-cost, high-risk individuals.
Comment: This unusual and intriguing announcement reached me just prior to press time. Frankly, I haven’t looked at it closely but thought I would pass the link along.
Each year, the American Chiropractic Association (ACA) has its own March on Washington. The 2012 rendition of the National Chiropractic Legislative Conference (NCLC) features an impressive array of Congressional and executive level personnel who will address their assembled members. In their January 25, 2012 release, the ACA announced that Sen. Orrin Hatch (R-Utah) will deliver the keynote address. Hatch is the ranking Republican on the powerful Senate Finance Committee and a member of the Senate Health, Education, Labor and Pensions Committee. Other featured speakers include:
- Rep. Bruce Braley (D-Iowa), member of the Committee on Veterans’ Affairs and the Veterans’ Subcommittee on Economic Opportunity and co-sponsor of the Chiropractic Care Available to All Veterans Act
- Rima Cohen, counselor to the Secretary for Health Policy, Department of Health and Human Services
- Rep. Bob Filner (D-Calif.), recipient of the NCLC Lifetime Outstanding Leadership Award for 20 years of steadfast support for doctors of chiropractic and their patients, and especially for his work in expanding chiropractic in the U.S. Department of Veterans Affairs, and
- Dick Gephardt, former House Majority Leader and president and CEO of Gephardt Government Affairs.
Comment: Imagine a day when a multidisciplinary, multi-stakeholder movement toward a health-focused system had such a conference and lobby day in the Beltway that attracted such federal leadership. Behind it, of course, are years of political action leavened by political contributions. Visualize also making those donations, strategically. The make one, and let your member of Congress or a known leader of these fields know why. That will wake up a Puer Aeternis (see note above), fast.
Gerald Clum, DC sends notice that Life University will mount a policy-related conference through The Octagon, an affiliated institute, which Clum directs. The conference will be held in Marietta, Georgia, April 12-14, 2012. The conference is entitled Reimagining Health Care; Making Health the Goal. The speaker line-up is expected to include at least 2 US Senators and numerous other policy and corporate leaders whose decisions will impact the future of integrative care. IHPC’s legislative interim chair Nancy Gahles, DC, CCH, RSHom(NA), and Academic Consortium for Complementary and Alternative Health Care executive director John Weeks have been asked to present. The conference overview is:
“Health care reform is presenting significant opportunities for redefining all aspects of health care: which services for which conditions under which circumstances; how those services and providers are organized; how care is delivered; and the economic organization of the transactions that fund the system … Great attention is being paid to the concepts of a Patient Centered Medical Home (PCMH) and of an Accountable Care Organization (ACO). These models may prove to be vehicles that are broadly adopted as health care reform continues to unfold … If they are, what are the opportunities, perils, threats, and rewards for various professions already engaged in health care-but rarely in a coordinated fashion? Is care integration required? By whom, and under which circumstances? Many more questions exist than answers … The Octagon will bring together significant voices and stakeholders to address these and other questions in an effort to develop templates for health homes and ACOs that incorporate a broad spectrum of health care options-especially as the need for wellness promotion in vitalistic terms becomes more clearly understood-and economically important.”