by John Weeks, Publisher Editor of The Integrator Blog News & Reports President’s Planning Budget for VHA focus on “Whole Health” for 2016 2021The way integrative medicine leader Tracy Gaudet, MD recounted it, “whole health” emerged as top dog in a competition for

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

President’s Planning Budget for VHA focus on “Whole Health” for 2016-2021

The way integrative medicine leader Tracy Gaudet, MD recounted it, “whole health” emerged as top dog in a competition for the Veteran Health Administration’s focus through 2021. The former integrative medicine leader at the University of Arizona and then Duke is presently the director of the Office of Patient-Centered Care and Cultural Transformation for the VHA. She shared the following description of whole health in a keynote for the International Clinical Congress for complementary and Integrative Medicine: “A well developed national infrastructure for provision of a proactive integrative health approach for Veterans, which is inclusive of a relationship-based approach, self-care strategies, complementary and alternative approaches, and integrative health coaching.” 

The VHA’s initiative will be backed by a system-wide practitioner education program developed by a University of Wisconsin integrative medicine team. She continued: “When implemented, veterans will have the guidance to address the broad aspects of their life that affect their health, will have education and training to build new self-care skills, will have the opportunity to incorporate more holistic and integrative approaches into their health care, and will have ongoing support to help them make the changes they identify as priorities.”

Comment: Discussion of the VHA at ICCCIM touched repeatedly on the fact that the VHA is a single payer system and that the military’s top-down culture facilitates system-wide exploration. When will a private US health system mandate training in integrative therapies for its doctors? Perhaps the answer will be: once this “Whole Health” education is proven and outcomes in hand.  The VHA’s leadership in developing low-tech options for pain and other forms of care appears to be secure for years ahead.


Side-note
: Veteran’s clinician in Washington state seeks to connect with others working to advance integrative programs in the VHA

The high level advances for integrative health and medicine described by Tracy Gaudet, MD, above, don’t capture the frustrating experience on the ground in a Washington state Veteran’s facility, according to a November 5, 2013  request to the Integrator from psychologist and yoga teacher Dawn Irene Aragon, PhD.  Wrote Aragon: “I am inspired to be a conduit of change at a systems level at the VA. Not sure I can stay in it’s current form, knowing there are healing modalities better than what Allopathic/Pharma offers. I’m beginning to feel out of integrity by NOT sharing and USING training I have outside my PhD as a psychologist. Though I can see a trend toward ‘mindfulness’ and ‘Acceptance Commitment Therapy’, it’s just not enough.” She requested any support in linking with others.

Comment: Know anyone who might wish to commiserate, swap stories and collaborate on how to move these integrative therapies forward? Contact Aragon at dawn.irene.aragon@gmail.com.

Coalition for Patients Rights joins chorus of practitioner organizations against maintaining discrimination in health care

The huge, nurse-led Coalition for Patients Rights has also sent a letter to Congressmen Fred Upton (R-MI) and Henry Waxman (D-CA) to register the organization’s strong opposition to HB 2817, the disingenuously entitled “Protect Patient Access to Quality Health Professionals Act of 2013.” In truth, HB would overturn the Non-Discrimination in Health Care provision of the Affordable Care Act. They argue that “if you and your colleagues do not succeed in protecting the non-discrimination clause, you risk driving up costs for consumers, providing significantly less value to patients, and discouraging qualified, trained and licensed healthcare professionals from delivering much-needed care.” The CPR members range from organizations representing nurses, physical therapists and psychologists to those for acupuncture, chiropractic and naturopathic medicine.

Comment: The CPR letter compliments the letter from the Patient’s Access to Responsible Care Alliance (PARCA) which was reported in the September 13, 2013 Integrator Round-up. Viortually the entire non-MD world has joined to beat back this attack from the group of MD specialties promoting H.B. 2716.  

Following Washington GMO vote, Herbal Products Association calls for federal standard on voluntary disclosure 

On the heels of the defeat of I-522 in Washington State, which would have required labeling of GMO (genetically modified organisms) on feeds, the American Herbal Products Association is advocating a new strategy. In a November 8, 2013 release, the herb industry organization both called for “a federal standard for voluntary disclosure of GMOs” and “federal legislation that instructs either the FDA or USDA to establish a standard for non-GMO labeling that would ensure the absence of GMO ingredients.” The industry organization first came out in favor of GMO labeling in 2007. The Washington measure closely followed the pattern in a similar California initiative in 2012: early voter support for labeling was twisted by multi-millions in food industry money, leading to defeat by a similar margin. Consumer groups are wary of any voluntary disclosure schemes, according to this article. The margin of defeat for I-522 is down from 55%-45% to 53%-47% at the time of this writing, but the outcome is not expected to change. 

Comment: The American Medical Association is among organizations that do not think GMO labeling is necessary. Notably, a brief web-search did not elicit much evidence that parallel organizations in the integrative health and medicine fields had come out in favor of labeling. An exception is the American Academy of Environmental Medicine has come out for a moratorium on GMOs. A formal 2009 discussion paper from the naturopathic doctors is here, but it doesn’t appear to have been passed. The Natural Health Alliance is active on the matter. Where do integrative health professional organizations stand on the topic? Silent seems to largely be the present answer. 

Herbalgram looks at Obamacare’s impact on those with Health Savings Accounts  

A feature in Herbalgram, Will Obamacare Affect Natural Healthcare in the United States? provides good summary information on what many in the natural health and integrative medicine communities oppose in the Affordable Care Act. Writer Lindsay Stafford Mader notes that “various conservative and libertarian-leaning commentators and groups have criticized the individual mandate for infringing on ‘basic’ notions of freedom and liberty.” She adds that “some CAM customers and organizations, including Citizens for Health (CFH) and the policy-focused nonprofit Alliance for Natural Health-USA (ANH), also disagree with this tenet of the ACA.” Mader notes that these have often promoted Health Savings Accounts – which can be used to pay for many alternatives – backed by catastrophic coverage. Yet now such individuals would be required, according to the article, to purchase full plans. Attorney Michael Cohen and his colleague Ryan Abbott make the case that, while catastrophic coverage is available, “for someone really not wanting conventional coverage, they’re stuck with a premium based on coverage they don’t want.” Herbalgram is the lead publication of the American Botanical Council.

Comment: I was interviewed and quoted for this piece. I offered my usual underscoring of new levels of inclusion of complementary and integrative health views and practitioners in positive aspects of the plan. My own commitment to community and public health leads me away from Libertarian views. Yet if i were to vote my pocketbook interests, these adversaries are spot on – particularly given the long battle Section 2706 is likely to have in most places.

Rockefeller Center at Dartmouth issues report on naturopathic doctors as primary care providers

The Nelson A. Rockefeller Center for Public Policy at Dartmouth University has published a report entitled Naturopathy in Vermont: Evaluating Education Differences and the Role of Naturopathic Doctors (NDs) as Primary Care Providers.  The report was prepared for and presented to the Vermont Senate Governmental Operations Committee. The six key areas of concern in the 25-page report are “the undergraduate prerequisites to entering ND programs, the teaching of homeopathy, medical coursework, the lack of ND residencies, the licensing examination, and the continuing education policies.” 

The authors conclude that options for Vermont include “stricter regulations on the practice of homeopathy, providing quality ND internships and residencies, formulating an additional examination for new ND practitioners, requiring more continuing education hours, and improving the integration of NDs into existing hospital systems.” Such steps “may yield improved quality of care provided by NDs, broader patient access to naturopathic practices, increased alignment of ND and MD care through Blueprint for Health teams, and the drawing in of more primary care practitioners to Vermont.” They state that “properly trained naturopaths as primary care providers can contribute to reduced healthcare costs in Vermont and personalized care for patients.” And finally: “MDs can learn from NDs about holistic evaluations of disease while NDs can learn about modern technologies for improving the efficacy of care.”

Comment: All-in-all, this is quite a positive report from the perspective of those naturopathic doctors who are seeking to up their status as primary care providers. This is not a moment too soon for that profession which, like all the other licensed integrative health field, was overlooked in this recent Health Affairs devoted to “reinventing” primary care. I personally was pleased to see the concluding observation: “MDs can learn from NDs about holistic evaluations of disease while NDs can learn about modern technologies for improving the efficacy of care.” What a simple world it could be if we just cut through the prejudice and focused on value. 

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