Institute of Medicine publishes blueprint for pain; Integrator report documents presence of CAM 

On June 29, 2011, the Institute of Medicine released a consensus report entitled Relieving Pain in America: A Blueprint for Transforming, Prevention, Care, Education and Research. The consensus committee calls for a “cultural transformation” relative to pain treatment. The Blueprint accepts that pain is a mind-body phenomenon. The IOM strategy stresses the multimodal and multidisciplinary approaches in pain treatment. The IOM Committee included UCLA integrative pediatrician Lonnie Zelzer, MD and nationally-recognized integrative pain expert Rick Marinelli, ND, LAc. (See IOM Pain Committee includes integrative MD Lonnie Zeltzer and Rick Marinelli, ND, LAc.) An Integrator Special Report compiled the segments of the blueprint in which complementary and alternative medicine modalities and providers are included. The Integrator review includes 15 sections, with implications for pain care, education and research.  

Comment: The report’s frontispiece is an aphorism and charge from Goethe: “Knowing is not enough; we must apply/Willing is not enough; we must do.” The saying is meant to reflect the need to engage a broad “cultural transformation” relative to pain and its treatment. Goethe’s words are certainly applicable to what we know about consumer use of CAM. Since consumer perception of value is as high, it is definitely time to proactively “apply” this knowledge to the care others. Or are we forgetting that if this is “patient-centered” then, well, patient choice is at the center, no?

 

The inclusion of CAM in the National Prevention Strategy published through the multi-agency National Prevention and Public Health Council 

A quickly assembled National Prevention Strategy has been published, prior to the June 30, 2011 deadline, by the National Council on Prevention, Health Promotion and Public Health Council. The Council was established under the 2010 Affordable Care Act. The subtitle for the 125 page report is “America’s Plan for Better Health and Wellness.” A quick search of the document found the following number of CAM/IM-related references: complementary and alternative medicine (4), massage (1), spinal manipulation (1), acupuncture (1) and integrative health (1). Zero references were found for: integrative medicine, naturopathic, herbs, botanicals, vitamins, chiropractic, integrative practitioner or mind-body.
The first mention of complementary and alternative medicine is under the Recommendations related to the plan’s Strategic Priorities:
“Future research and evaluation, including well designed trials for many complementary and alternative medicine therapies, will be critical to addressing unmet prevention and wellness needs, and new evidence-based strategies will be incorporated as they emerge.” (page 14)

The most significant inclusion is under “Recommendations: What Can be Done?” on page 22 under Clinical and Community Preventive Services. Recommendation #6 reads: Enhance coordination and integration of clinical, behavioral, and complementary health strategies.  

“Integrated health care describes a coordinated system in which health care professionals are educated about each other’s work and collaborate with one another and with their patients to achieve optimal patient wellbeing. Implementing effective care coordination models (e.g., medical homes, community health teams, integrated workplace health protection and health promotion programs) can result in delivery of better quality care and lower costs. Gaps and duplication in patient care, especially among those with multiple chronic conditions, can be reduced or eliminated through technologies (e.g., electronic health records, e-prescribing, telemedicine). Evidence-based complementary and alternative medicine focuses on individualizing treatments, treating the whole person, promoting self-care and self-healing, and recognizing the spiritual nature of each individual, according to individual preferences. Complementary and alternative therapies for back and neck pain (e.g., acupuncture, massage, and spinal manipulation) can reduce pain and disability.” (page 22) 

The document also includes as related Action Steps for the Federal Government: 

“Research complementary and alternative medicine strategies to determine effectiveness and how they can be better integrated into clinical preventive care.” (page 22) 

And for Health Care Systems, Insurers and Clinicians:

 

“Facilitate coordination among diverse care providers (e.g., clinical care, behavioral health, community health workers, complementary and alternative medicine).” (page 23)

 

Comment: I have not yet read the document thoroughly. Clearly it is a step in the right direction for the integrative practice fields to have “CAM” described in connection with the paradigm most integrative providers posit: ” … individualizing treatments, treating the whole person, promoting self-care and self-healing, and recognizing the spiritual nature of each individual, according to individual preferences.” Two members of the Council’s Advisory Group (page 64) likely assisted in ensuring these inclusions: Charlotte Kerr, RSM, BSN, MPH, MAc, and integrative physician Sharon Van Horn, MD, MPH.  Fascinating that the explicit concept of “integrative health,” so visible in the Council’s charge (see Section 4001 here) was largely lost on the way to the strategic plan.

Senators Durban and Blumenthal introduction of Dietary Supplement Labeling Act (S. 1310) raises industry concerns 
Two Democrat US Senators, Dick Durban, (D-IL) and Richard Blumenthal (D-CT) introduced The Dietary Supplement Labeling Act (S. 1310) on July 1, 2011. The bill is viewed as “primarily targeting products that blur the line between dietary supplement and food and beverages,” according to this useful write-up via Natural Products Insider. In a notice to members, Michael McGuffin, executive director of the American Herbal Products Association supports the view that the bill “would largely propose legislative solutions where what is needed is regulatory enforcement.” The Natural Foods Merchandiser, an industry publication, escalates concern by referring to S. 1310 as a “cruise missile shot at the industry.” AHPA notes that “the most controversial part of the Dietary Supplement Labeling Act may well be its requirement for product registration, a change that Durbin has sought in the past.” Adds McGuffin: “AHPA is in communication with Sen. Durbin’s office, and I will be reviewing the actual legislation as soon as it is available.” AHPA has concerns about the reach of the legislation: “As always, AHPA’s primary focus will be on identifying and opposing any legislation that in any way reduces consumer access to safe dietary supplements.”