John Weeks January 2013 Integrator Round-up covering the topics of Integratve Healthcare Policy; Integrative Clinical Care; Academics & Education; International; Philanthropy; People

Powerhouses behind integrative health policy, Mikulski and Harkin, take key U.S. Senate Appropriations roles

A recent policy update from the Consortium of Academic Health Centers for Integrative Medicine notes that U.S. Senator Barbara A. Mikulski (D-MD) will be new the chairwoman of the U.S. Senate Appropriations Committee.  The spot became available to the long-time champion for complementary and integrative medicine and health when the chair role was passed up by two senior members who chose to retain their subcommittee positions. One of these is Tom Harkin (D-Iowa), who will continue to oversee the powerful Labor-HHS-Education Appropriations Subcommittee “based on where my passions lie.” Mikulski, who is in her fifth term, will become the first woman to lead the panel.

Comment: Movements, such as for integrative health, are about grassroots, bottom-up. They are also about individual leadership, top-down. The latter includes those who can move mountains with a stroke of the pen. The public service of Harkin over the last 20 years, principally, with Mikulski working as a close colleague on his Appropriations subcommittee, have profoundly shaped the ability of the popular interest in new approaches to health and medicine to express itself in U.S. policy. To ask what-if they hadn’t been in their positions is to imagine an astonishingly different course for “CAM” and integrative health in the U.S. Mikulski’s elevation can only bode well for the advance of the integrative health field.

PCORI’s Selby credits presentation for inclusion of CAM in funding announcement; two projects funded

In a recorded dialogue with members of the Research Working Group of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), Joe Selby, MD, MPH, CEO of the Patient Centered Outcomes Research Institute, credited a special September 2011 presentation for the explicit inclusion of complementary and alternative medicine in funding priorities. He stated: “That that was a memorable presentation, and it has stuck with us. It probably did have something to do with the fact that we called out complementary and alternative medicine.” He noted that this explicit inclusion was an usual in an “exceptionally broad” funding announcement which typically did not focus on therapies or conditions. To a later question in the dialogue, Selby left open the door to PCORI potentially having a specific funding announcement in the CAM or integrative health area, though this sounded to be a ways off. Two ACCAHC leaders were participants in the September 2011 meeting which was organized through Bob Mootz, DC and the state of Washington for a PCORI Board of Governors meeting in Washington State. Notably, the list of 25 initial PCORI awards includes two that are CAM or integrative health focused. One is Evaluation of a Patient-­Centered Risk Stratification Method for Improving Primary Care for Back Pain. Lead investigator is Dan Cherkin, PhD, from Group Health Research Institute/Bastyr University. The second is led by University of Pittsburgh researcher Michael Schneider, DC, PhD: A Comparison of Non-Surgical Treatment Methods for Patients with Lumbar Spinal Stenosis. The ACCAHC dialogue was facilitated by Greg Cramer, DC, PhD, the chair of the ACCAHC panel. 

Comment: Selby proved to be an open and engaging partner in the 50 minute dialogue, accessible here, which included his CAM-focused opening remarks, and back-and-forth exchanges with Cramer and his colleagues on the working group Carlo Calabrese, ND, MPH, Bill Meeker, DC, PhD, Richard Hammerschlag, PhD and Martha Menard, PhD, CMT. A written transcript is available from me on request. Congratulations to Cherkin and Schneider. Two of 25 is not a bad showing for “CAM.” 


Sebelius letter is first HHS push for the non-discrimination Section 2706 of the Affordable Care Act

In his useful Health Insights Today, policy-oriented educator and journalist Dan Redwood, DC recently published a useful review entitled Provider Nondiscrimination Update. The most significant segment is this: “In December 2012, we saw the first HHS regulatory language specifically referencing the nondiscrimination policy of Section 2706. Included in its extensive rule-making on requirements for coverage in ‘multi-state’ health insurance policies that will be available on the new healthcare exchanges starting in 2014, HHS unambiguously noted that all such insurance policies must be in compliance with Section 2706.  

Redwood adds: “While this marks a key milestone regarding regulation of multi-state plans (which are just one of many types of insurance plans that will be sold through the exchanges), it more importantly demonstrates that 2706 is on the HHS radar screen and that Secretary Kathleen Sebelius and her department intend to follow the law and require states to do so as well.” The newsletter is published through Cleveland Chiropractic College. The Non-discrimination language of the Affordable Care Act is here. 

Comment: Redwood’s report is good news. However, the reading of the HHS memo by some others is a message that this issue will remain in low profile, perhaps because the section continues to be a subject of discussion at the American Medical Association’s House of Delegates. See the following piece. 

AMA House of Delegates reiterates interest in continuing to foster discrimination and prejudice against certain healthcare providers

At its interim meeting in Honolulu, Hawaii on November 9-11, 2012, the AMA House of Delegates re-affirmed its opposition to the non-discrimination clause, Section 2706, of the Patient Protection and Affordable Care Act. No current lobbying effort is apparently underway: “At this time, no specific lobbying effort to repeal Section 2706 has been initiated. This is due to the lack of willingness by Congress to enact necessary improvements in the ACA at this time. The AMA will continue to closely monitor this issue and work to identify opportunities to repeal Section 2706.” The AMA;s House enacted amendments to their policy H-35.968 that opposes the section. These include recommendations to “create and actively pursue legislative and regulatory opportunities to repeal the so called ‘Non-discrimination in Health Care’ clause” and “lead a specific lobbying effort and grassroots campaign in cooperation with members of the federation of medicine and other interested components of organized medicine to repeal the provider portion of PPACA‟s “Non-Discrimination in Health Care‟ language. They asked the AMA Board of Trustees report back at our 2013 AMA Annual Meeting.

Comment: And the war, as the singer Donovan sang it in the mid 1960s, drags on … I wonder which grassroots they are referring to. Will it be a patient-centered campaign for a march on Washington to demand that fellow citizens be denied the right to services? No, likely they are talking about an effort in which the grassroots willnot be patient-centered but MD-centered, focusing on the 17% of medical doctors that are still AMA members. I picture the tendrils of those “grassroots” reaching down into a hydroponic mix that has been starved of connection with patients for two decades.  

FDA approves first botanical drug for oral administration

The American Botanical Council announced January 2, 2013 that the U.S. Food and Drug Administration has approved for the first time a botanical drug for oral administration. The botanical, crofelemer, is an Amazone tree derioved extract for usafge in HIV patient with diarrhea. it marks the agency’s second approval of a botanical, with the first being a topical product that is a green team extract. The firm Salix owns the license for crofelemer’s development and submitted the product’s New Drug Application (NDA) for review, The FDA announcement is here.

Comment: I guess extracts of hops, John Barleycorn, cana, and various mashes don’t count as approved botanical drugs.

January 2013 John Weeks Integrator Round-up