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

Johns Weeks, Publisher-Editor of the Integrator Blog News & Reports 

Policy

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.  
 

 

Integrative Clinical Care

Resources to support the emerging field of hospital based massage therapy

A recent issue of Massage Today includes a useful feature, Help for Hospital-Based Massage Therapy, which offers a list of emerging resources for massage therapists and their perspective employers as hospitals and health systems increasingly add massage services for their clientele. The hospital-based massage therapy (HBMT) resources include: a new task force on the topic of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), led by MK Brennan, MS, RN, LBMT; a resource from the American Massage Therapy Association; and series of webinars with hospitals that have such programs, led by the article’s author, Tracy Walton, LMT, MS, and noted in the December Round-up. Walton reports that the intention of the task force is to serve as a “clearinghouse for HBMT information.” The ACCAHC group is seeking information on any HBMT programs. Contact Brennan at brennanmk@aol.com.
 

 

A recent issue of includes a useful feature, , which offers a list of emerging resources for massage therapists and their perspective employers as hospitals and health systems increasingly add massage services for their clientele. The hospital-based massage therapy (HBMT) resources include: a new task force on the topic of the , led by MK Brennan, MS, RN, LBMT; a from the American Massage Therapy Association; and series of webinars with hospitals that have such programs, led by the article’s author, Tracy Walton, LMT, MS, and noted in the . Walton reports that the intention of the task force is to serve as a “clearinghouse for HBMT information.” The ACCAHC group is seeking information on any HBMT programs. Contact Brennan at .

 

From Google Alerts: links to integrative medicine developments in hospitals, health systems and community – January 2013

This monthly report includes 28 short segments on integrative medicine developments in health systems and the community for December 12, 2012-January 5, 2013. One might have expected fewer in a month in which one’s audience has little capacity to receive anything new.  The new initiatives at USC, Banner MD Anderson and Uniformed Services University may top the list, while the reach of Mayo’s program, funded originally via a grant from Lucy Gonda, is notable in four areas.

 

Academics & Education

Exiting the Ivory Tower #1: Focus on “practice” in the interprofessional education (IPE) movement

Comment: The interprofessional education (IPE) movement in conventional health professional education has been recognized by many integrative health leaders as an open door for integrative health values and for the so-called CAM disciplines. Integrative medicine at is best, like IPE, see health as a team sport. And what “patient-centered” initiative would leave out the licensed “CAM” practitioners? So it is notable that the announcement of the new, $13.5-million National Center for Interprofessional Practice & Education (NCIPE) was called what it was; meaning, “practice” is prioritized over “education.”

This is a welcome shift. It marks a focus on the real world that was called for in the powerful 2010 report in The Lancet, Health Professionals for a New Century. Written on the centennial of the 1910 Flexner Report, the Lancet document was a necessary corrective to the silos, top-down patriarchy, and focus on expertise in-patient practices that were both intended and unintended consequences of Flexner. The prioritization of “practice” by NCIPE director Barbara Brandt, PhD, and the team with which she is working is a next step in translating the real world focus of the Lancet into practice. It’s a step away from the harmful insulation of the ivory tower. This is good for health care and for the community-based, outcomes focus of much of the integrative practice community.

Exiting the Ivory Tower #2: Student-faculty-practitioner combination at Oregon College of Oriental Medicine opens state Medicaid program to acupuncture treatment

A story in Acupuncture Today, History in the Making from Oregon Practitioners and Students, tells how a remarkable collaboration of students, researchers and a professional association opened Oregon Medicaid to acupuncture treatment. On April 1, 2012, “acupuncture for the treatment of pregnancy, depression and mood disorders, tension headache and migraine has been added to the Oregon Health Plan (OHP).” Students at Oregon College of Oriental Medicine were organized through an associate of the college’s research department, as part of OCOM’s Masters’ of Acupuncture program, to put a required research project to use in the real world. The subsequent student searches for supportive data fed efforts led by Laura Ocker, LAc, head of the Oregon Association of Acupuncture and Oriental Medicine, that the association submitted to the state’s Health Evidence Review Committee (HERC). The April inclusion decisions followed. In the current phase of the project, students will focus on arming OCCAOM for submissions “of high quality research on neck pain and osteoarthritis” for HERC’s next prioritized list in 2014.

Comment: My organizer’s mind immediately imagines such efforts mutiplied many times over in the educational programs in represented by the councils of colleges and schools of the licensed CAM disciplines, and in the integrative medicine programs. Resources are tight. This is a great appropriation of free labor for good, public health purposes.

Heal the healers: Samueli and Uniformed Services University of Health Sciences team to teach medical students good lifestyle habits

A program that focused on yoga and meditation was offered to 4th year medical students December 6-7, 2012 via a partnership between the Samueli Institute and Uniformed Services University of Health Sciences. In a letter to Samueli Institute subscribers, CEO Wayne Jonas, MD credited the former Army Surgeon General LTG (RET) Eric Schoomaker, MD, MPH, for organizing the event. Jonas views the military as ahead of the pack of regular medical schools in helping new practitioners practice good health habits. The importance, says Jonas, lies in evidence that “physicians and other health care practitioners who engage in more healthful activities such as non-smoking, better diet and more exercise are the ones who also discuss and work with their patients more on these topics.” More than 170 medical students attended the training, which was mandatory, as is noted in this account at DCMilitary.com.  

Selected Conference Links

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

 

 

International

Special issue of journal captures findings of the work of the European CAMbrella

The special issue of Forschende Komplementarmedizin (Research in Complementary Medicine) is entitled Insights into the Current Situation of CAM in Europe: Major Findings of the EU Project CAMbrella. The issue, which is the final work product and legacy of the multi-year CAMbrella project of 16 partner institutions from 12 Europeean countries of the European Union, includes reviews of literature on CAM prevalence, on legal status and regulation, lessons Europea might take from international developments, strategies for building a sustainable research network in CAM, and a questioning look at the potential to develop a pan-European definition of CAM. Editors of the special report are Harald Walach and W. Weidenheimer. 



Europe-wide CAM group issues call for action following meeting in European Parliament

Integrator adviser Paolo Roberti di Sarsina, MD shares a report and call for action issued October 9, 2012 that followed the European CAM Conference. The recommended action steps range from creating more access and expanding regulation of providers to developing methods for better incorporation in the healthcare to “encourag(ing) Member States to explore the ways in which CAM can contribute to sustainable healthcare  systems in Europe.” The call to action was issuesd after a day of presentation and discussions in hte European Parliament. according to a post-meeting press release. The release notes that across Europe there are “in the order of 300,000 CAM practitioners and 150,000 medical doctors practising a range of modalities such as acupuncture, aromatherapy, herbal medicine, homeopathy, kinesiology, naturopathy, massage, reflexology, shiatsu TCM etc.”

Participant Harald Walach, professor of research methodology and complementary medicine at European University Viadrina, Frankfurt/Oder, Germany, offers the final comment in the release: “The growth potential of the sector, both in terms of GDP, savings on healthcare, healthier citizens, CAM workforce and innovative competitiveness is enormous. For this to happen, we need the EU to give it its due consideration and adequate resources, as well as a framework for professionals to operate in.”

Canada’s IN-CAM posts 2012 keynotes for member access

The Canadian Interdisciplinary Network for Complementary and Alternative Medicine Research (IN-CAM) has made available to members the presentations from its November 2012 annual conference. Membership ($100) is required to access these resources. The presentations include:  

  • Claudia Witt, MD, MBA: Comparative Effectiveness Research and the Efficacy-Effectiveness Continuum in Clinical Research – Learning from Acupuncture Research
  • Barbara Findlay-Reese, RN, BS: Cultivating Leaders: The Next Priority for Integrative Health Care
  • Herbert Emery, PhD: Should Complementary and Integrative Health Care Services Be Included in Canada’s ‘Medicare Basket’ of Publicly Funded Services
  • Heather Boon, BScPhm, PhD: Safety and CAM – Assumptions, Rhetoric & Reality
  • Marja Verhoef, PhD: Dr. Roger’s Prize Lecture on Evidence Based CAM: Challenges and Opportunities

 

Public health-CAM connection: update on Australia’s NORPHAM

The Sydney, Australia-based Network of Researchers in the Public Health of Complementary and Alternative medicine (NORPHCAM) continues to gather steam as lead actor at the nexus of the integrative health-public health convergence. The indefatigable Jon Adams, PhD references in the organization’s December 2012 newsletter the 69 authored or co-authored publications in the prior year by members of the organization’s executive team, plus a top rating for productivity as a research center. While Australia and Southeast Asia are the base of the vast majority of NORPHCAM’s 240 members, the associates include a smattering of well-recognized US and Canadian participants, including Beth Sommers, LAc, PhD, chair of the complementary and alternative practices section of the US Public Health Association and the Rand Corporation/Samueli Institute’s Ian Coulter, PhD. Notably, the organization’s first-listed objective is the practical one to “promote excellence in public health and health services research focusing upon CAM use, CAM practice and workforce, CAM-conventional health care integration, economics of CAM, CAM policy and regulation.”

Comment: This nexus may be elevated as the American College of Preventive Medicine engages its work as the National Coordinating Center for Integrative Medicine. What does “integrative medicine” mean in a prevention and public health context, versus a view of integration one shaped its location in cardiology or oncology?

Philanthropy

Murdock Trust in $220,000 award for NCNM’s Helfgott Research Institute

The National College of Natural Medicine announced on December 10, 2012 that it received a $220,000 grant from the M.J. Murdock Charitable Trust for the renovation of NCNM’s Helfgott Research Institute and Community Education Center. The release notes that this grant is the largest NCNM, founded in 1957, “has ever received from a private charitable foundation.” The Institute, directed by Heather Zwickey, PhD, was established in June 2003 with a donation of $1.2 million from Don Helfgott, the co-founder of Inspiration Software, based in Beaverton, Oregon. The release notes that in addition to this grant, NCNM has received “a number of other sizeable donations” for the research building project. These include $198,000 from the Meyer Memorial Trust, $700,000 from Bob and Charlee Moore, co-founders of Bob’s Red Mill Natural Foods, $100,000 from the estate of Violet Beebe of Coeur d’Alene and $100,000 from the estate of Marjorie A. Gage of Portland. The last two were grateful patients of NCNM natural medicine practitioners. The Murdock grant is an outright cash award of $65,000 as well as a conditional matching grant of $155,000.

Comment: Congratulations to NCNM, to Zwickey, and to NCNM’s president and fund-raising lead David Schleich, PhD, for this success. As a sometimes seeker of philanthropic support for integrative health projects which, like NCNM, are not led by non-MDs, I am aware of the glass ceiling that still exists between most mainstream giving and these institutions. Schleich is right to note the historic important of the Murdock gift, breaking through this glass ceiling. It is notable that both the Murdock and Meyer trusts focus on the Northwest, as is Inspiration Software, where the value of naturopathic physicians, NCNM’s main work product, is well-known, People often give to people, particularly in a context of historic prejudice and second-class citizen ship. I have found that colleagues in conventional academic medicine whose institutions are strewn with large dollar donations sometimes just don’t get this.  

Integrative medicine philanthropist Penny George delivers keynote on her integrative health and medicine work and vision

Author, Harvard professor and industrialist Bill George used the bully-pulpit of his website to feature the full text of a December 6, 2012 keynote on Integrative Medicine and the Transformation of Health Care. The venue was the Emory University’s Predictive Health Institute Annual Conference. The speaker was psychologist Penny George, the founding president of the Bravewell Collaborative and Bill George’s spouse.  Penny George weaves something of her own story as she drills into her main theme: “My message is that healthcare reform must be about health reform.” She repeats herself: “Let me repeat that… healthcare reform must be about health reform.”  Notably, George notes that integrative medicine “is now morphing into integrative health and healing” from its more distant roots in complementary and alternative medicine. The article describes her own perspectives, her work with Bravewell and its strategic investment, and the George Family Foundation’s work in Minneapolis.

Comment: This speech is a tremendous opportunity to look at the thinking and perspectives of one of the most significant influencers of integrative healthcare in the U.S. in the last decade. I like the way she describes the changes asked of us for this new health and healing: “That we must each become the principal agent of our own health. That integrative care for illness is more effective than devices, pharmaceuticals and other conventional interventions alone. To get to this reality we will all – physicians especially – need to learn to collaborate in ways that are more inclusive and empowering. And that involves a consciousness shift for all of us.” Amen.

People 

Former US Army Surgeon General Schoomaker “coordinates his work” with Samueli Institute

A close collaborator with the Samueli Institute in its integrative health initiatives in the military in recent years, Eric Schoomaker, MD, PhD currently “coordinates his work with Samueli Institute” according to a recent notice from the Institute. Schoomaker, the former U.S. Army Surgeon General, also serves as a scholar-in-residence at Uniformed Services University. Schoomaker is credited with turning the military’s attention to exploring non-pharmacological, less-invasive health care approaches in various arenas, from battlefield readiness to pain management and the care of wounded and returning soldiers.

Bryan McAuley, DC, PhD appointed president of Parker University

Parker University and Parker Seminars has appointed Brian McAulay, PhD, DC, as its next president. According to a release from the chiropractic institution based in Dallas, Texas, McAulay’s education and experience includes a PhD from Temple University and a doctor of chiropractic degree from Pennsylvania College of Chiropractic. Most recently an executive vice president and provost for Life University, he also served in a similar capacity for Sherman College and was vice-president for academic affairs at Palmer College. McAuley will replace Fabrizio Mancini, DC, who retired after serving as president for just under 14 years.