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Brian Berman’s new Institute for Integrative Health seeks to “reframe the conversation”
I have been remiss in not reporting the public existence of the Institute for Integrative Health as a new part of the integrative practice landscape. Formally announced in May 2009, the Institute, founded by Brian Berman, MD, Susan Hartnoll Berman, and a team which includes Georgetown integrative medicine leader Aviad (Adi) Haramati, PhD and former deputy director of NCCAM Margaret Chesney, MD (see bios of all here), states on its homepage that it is a 501c3 organization that “provides an environment for innovative thinking on health and healthcare, fosters collaborations, and facilitates the testing and implementation of novel solutions.” The Institute plans to “challenge conventional thinking on health and healthcare, reframing the conversation, nurturing creative solutions, and exploring cutting-edge ideas.” The Institute’s current projects focus on re-framing the healthcare dialogue toward health. One is a collaboration with the University of Maryland’s Imaging Research Center, in which they are pushing “the discovery of new forms of media that can be more effective at weaving knowledge into culture and inspiring activity beyond the more traditional means of interaction.” Berman used the $100,000 award that he received from the Bravewell Collaborative to seed this organization.
Integrator reader Taylor Walsh, of MetroHealth Media, took a close look, at my request, at HR 3200, American’s Affordable Health Choices Act of 2009, the major health reform bill in the US House of Representatives, to see if “licensed CAM professionals” or “integrative practitioners” or “integrative medicine” had directly made it into the bill. The chief bill on the Senate side has brought many in the integrative practice community into the fold for the first time in federal policy of this nature. (See Update: IHPC, Others, Place CAM, Integrative Practices/Care in US Health Reform Legislation.) Walsh responds: “On limited further review, the language is noticeable for the absence of such references.” Despite coming up empty, Walsh notes potential points of access. The first that he mentions is that the Integrated Healthcare Policy Consortium (IHPC) and others might help make sure that the Senate’s inclusive language makes it into the reconciliation bill negotiations between House and Senate. Other potential points of access include: a Health Benefits Advisory Committee (Section 123) which is to come up with basic benefits designs within 18 months of the bill’s passage; and a public health workforce assessment (Section 2252) which decides the disciplines and institutions eligible for inclusion as part of the public health workforce, in such areas as the National Health Services Corps. The current workforce definition, unlike that in the language on the US Senate side, does not specifically mention “licensed complementary and alternative medicine practitioners” or “integrative practitioners.”
Economist researcher Herman finds 9 approaches/21 conditions for cost-savings from CAM
Preliminary results of a systematic review of approximately 6600 articles so far yielded 9 complementary and alternative medicine (CAM) approaches and 21 conditions where CAM has generated evidence of not merely cost-effectiveness but of cost-savings. These findings came from the 256 studies with CAM economic evaluations, 48 of which were deemed “high quality” and that had adequate comparison data available. The findings, reported at the August 2009 convention of the American Association of Naturopathic Physicians, were the work of the professional who is emerging as the leading North American voice on CAM costs: economist-practitioner-researcher Patricia Herman, ND, MS, PhD. Herman co-authored the paper on the economics of integrative medicine for the recent Institute of Medicine Summit on Integrative Medicine and the Health of the Public. She reported findings from her 80% complete systematic review of over 8,000 references. Herman’s top 9 therapies and 21 conditions are listed in this Integrator article.
Influential acupuncture and Oriental medicine researcher Richard Hammerschlag, PhD retires this month from his role in directing research at the Oregon College of Oriental Medicine. He completes a decade of remarkably productive leadership as researcher, author, educator and infrastructure-builder. Hammerschlag was not only the lead researcher from a CAM institution in the AOM field. He also played important roles in the creation and direction of the Society for Acupuncture Research, Oregon Collaborative for Integrative Medicine, and the Research Working Group of the Academic Consortium for Complementary Health Care (ACCAHC). Hammerschlag was one of just two researchers from CAM institutions to serve on the planning committee of the North American Research Conference on Complementary and Integrative Medicine. In retirement, Hammerschlag’s will serve as a scholar at the Institute for Integrative Health, founded by Brian Berman, MD where he will be focusing on “energy physiology.” (See article this Round-up on Berman’s Institute). Click here for comments honoring Hammerschlag’s roles from Berman, Elizabeth Goldblatt, PhD, MPA/HA, Anne Nedrow, MD, Rosa Schnyer, LAc, DAOM, Christine Goertz, DC, PhD, and Dan Cherkin, PhD, together with Hammerschlag’s on his directon in retirement.
One of the modern naturopathic profession’s most accomplished leaders, Jane Guiltinan, ND, has been selected to head up naturopathic medicine at Bastyr University, the Bothell, Washington-based institution which began as a naturopathic medical school. Guiltinan’s resume includes serving in the late 1980s as the medical director for Bastyr’s Healing AIDS Research Project, a clinical research trial studying naturopathic therapies for HIV/AIDS which led to Bastyr’s first NIH grant a half decade later and for which she shared the Blackmore International Award for Outstanding Research in Natural Medicine in 1990. In the mid-1990s, Guiltinan served as the co-medical director for the King County Natural Medicine Clinic, the first publicly-funded integrated medicine clinic in the United States, which continues to this day as Health Point. She was a co-investigator in several research studies at Bastyr and the Group Health Center for Health Studies. Guiltinan was named the 1995 Physician of the Year award by the American Association of Naturopathic Physicians (AANP) in recognition of impact on students as a clinical educator. In 1998, she was appointed to the Board of Trustees of Harborview Medical Center, the region’s largest public health hospital, and is currently serving a third term on that board. In 2005-2007, she served a term as president of the AANP. Her focus as a clinician has been on women’s health, disease prevention and wellness promotion.
Liz Kaltman, MPH announced on August 13, 2009 the opening of the website of the not-for-profit Center for the Center for Integrative Medicine in Public Health (CIMPM) which was incorporated last spring. CIMPH’s mission is to improve health outcomes in underserved communities through integrative medicine. The homepage notes that CIMPH established a partner relationship this past summer with the Coalition of Community Health Clinics, an organization of 13 not-for-profit community health clinics in Oregon through which it is assisting in creating residency opportunities for naturopathic physicians, and therefore incorporation of naturopathically-delivered integrative medicine to the underserved. The project is called the Preventive Medicine/Public Health Residency Program and is a two year residency that commences in the fall of 2010.
The Chiropractic Health Section (CHS) of the American Public Health Association (APHA) recently established a relationship between two multidisciplinary entities in order to advance the nation’s ability to grapple with the $850 billion per year linked to musculoskeletal disorders. The CHS, founded in 1995, brought together Georges Benjamin, MD, FACP, FACEP (E) executive Director of the American Public Health Association (APHA) and Toby King, executive director of the US Bone and Joint Decade, to explore how the chiropractic profession could serve as a bridge between the two groups. After the meeting, APHA director Benjamin, MD, stated: “I am pleased by the positive steps being made in regards to an interdisciplinary approach” and that he “looks forward to working with” the CHC and U.S. Bone and Joint Decade “to explore new ways to improve prevention and treatment of musculoskeletal injuries and disorders.” Paul Doherty, DC, incoming chair of the CHC views this as a step in the CHC becoming a leader in chiropractic taking a larger role in meeting the public health challenge of musculoskeletal problems. The communication came from Integrator reader Claire Johnson, DC, MSEd, communications chair of the CHS. Johnson’s comments in the Integrator on the IOM Summit on Integrative Medicine werepublished here. More information about the APHA-CHC is available by clicking here.
Inner Harmony Group brings in U Arizona Fellow Shay as medical director
Peter Amato, founder of the Inner Harmony Group (IHG), an Integrator sponsor, shares his excitement that Phaythoune Chothmounethinh, MD has been hired to serve as medical director for the Inner Harmony Wellness Center in Scranton, Pennsylvania. Chothmounethinh (a.k.a. Dr. Phay) is a 2009 fellow of the University of Arizona Center for Integrative Medicine where he also complete his family medicine residency. Dr. Phay as he is called (according to an IHG twitter on August 5) has also completed medical acupuncture training. While at the University of Arizona, he helped establish the first medical acupuncture clinic to be incorporated into a family medicine residency program for medical doctors. Amato’s clinic is one of the pioneering centers for integrative medicine and Amato’s lessons learned have benefited many other centers, both through presentations and consulting. Amato anticipates that Dr. Phay will also participate in the national consulting work of IHG. More on Chothmounethinh is available here.
AMA’s Scope of Practice Partnership targets 30 legislative issues of DCs, NDs, LAcs and certified professional midwives in 2009
The American Medical Association’s Scope of Practice Partnership (AMA-SOPP) campaign, through which the medical association is monitoring and typically fighting against scope expansions by non MDs, has its hands full. A chart from the AMA lists 154 separate legislative campaigns for practice expansion in 2009 from professions ranging from psychologists, advance practice nurses and optometrists to naturopathic doctors and chiropractors and other “CAM” disciplines. Of this legislation of concern to the AMA, 30 (19%) relate directly to the distinctly licensed, or would-be-licensed, complementary and alternative healthcare fields: 14 are initiatives of naturopathic doctors, 8 of chiropractors, 6 those of certified professional midwives (homebirth-oriented direct entry midwives) and 2 involve practitioners of acupuncture and Oriental medicine. (For the complete list of 30, see this September 3, 2009 Integrator article.) The AMA-SOPP campaign, initiated in 2006, stimulated the formation of the Coalition for Patients Rights, led by advanced practice nurses including organizations representing DCs, NDs and LAcs. (See Coalition Battles AMA Campaign to “Thwart” Other Disciplines’ Scope Expansion, June 21, 2009.) The most recent Coalition action noted on their website was a May 29, 2009 letter to President Barack Obama which argued that “the more than three million healthcare professionals in the U.S. who are not doctors of medicine or osteopath are critical stakeholders in the movement to improve our nation’s healthcare.” See the letter here. Again, the entire list of 30 “CAM” initiatives is here.
Comment: The AMA has never shown any real threat to the public from the practitioners they are seeking to restrict. The combination of the significant financial benefits from being in the MD guild (see table under “Factoids to ponder: Salaries of conventional physicians in 2007, from JAMA,” in this Round-up) and these campaigns casts the MD guild in an ugly light in which the concept of a service industry is thoroughly transformed into one meant for self-service. (For the list of 6 prior Integrator articles on the AMA-SOPP, click here and scan down.)
Naturopathic physicians have made advances in numerous states toward expanding and clarifying scope of practice, according to reports at the August 18, 2009 House of Delegates meeting and August 22 General Membership meeting of the American Association of Naturopathic Physicians.
Oregon Under the leadership of the Oregon Naturopathic Physicians Association, the NDs broadened their formulary and “can now prescribe almost anything,” according to Kevin Wilson, ND. He adds: “We don’t want to be MDs but we now can be more full-fledged primary care physicians.”
Hawaii Significant upgrade of a 1925 law which expands the scope of practice for naturopathic physicians regarding parenteral therapy, (prescription drug) formulary, and minor surgery. The new licensing statute, according to Michael Traub, ND, “is based on modern laws in Washington, Oregon and Montana.” Passage required an override of a gubernatorial veto in July.
Vermont Lorilee Schoenbeck, ND reports that following changes in 2005, 2006 and an insurance mandate in 2007, naturopathic doctors are now covered as primary care providers and at the same rate as medical doctors by insurers. This is the first state where naturopathic doctors are fully recognized as providers under a Medicaid plan.
California The state’s budget pressures led to consolidation of various agencies, including moving the bureau which was charged with regulating NDs under the osteopathic licensing board. The naturopathic doctors will now have 2 representatives on that board. Work is continuing on clarifying the profession’s prescriptive authority.
New Hampshire NDs had been left out of a general law regarding all provider types with prescriptive authority; that the state’s licensed naturopathic doctors have been re-inserted.
Connecticut Passed a minor statute to amend an outdated 1922 act (like that which had been in place in Hawaii) relative to adding continuing education hours. This is a step toward an effort for thorough modernization such as was completed by NDs in Hawaii this year.
Comment: These advances, many of them in gaining or expanding prescriptive authority, came despite opposition to naturopathic physician scope expansion from the American Medical Associations Scope of Practice Partnership (AMA SOPP). However, according to the AMA SOPP list, some of these efforts appear to have been under the AMA radar. In addition, notably, the members of the AANP House of Delegates did not hear about any expansion of licensure into any new states, a priority of the AANP against which the AMA is fighting in at least 10 states. It appears from the success in expansion of scope by naturopathic doctors once licensed, that once these physicians are a known and legal part of the landscape, their respect and political clout builds. Legislators are comfortable in giving them more practice rights. As Simon Barker, ND, the vice president of the California Naturopathic Doctors Association joked in his comments to the AANP’s general membership: “We’re like puppy dogs. It’s really hard not to like naturopathic doctors.” The AMA’s effort to slam the door of entry to NDs may be its best strategy for keeping out this competition.
Factoids to ponder: Salaries of conventional medical doctors in 2007, from JAMA
Medicine is a service profession. From the perspective of most human beings, being an MD specialist, in particular, is also a most lucrative way to be in service to your fellow humans. Integrator adviser Michael Levin recently sent me this list from JAMA, with the simple heading, “a factoid to ponder.”
Comment: There is always a good deal of argument about these kinds of listings, typically from medical doctors who claim the averages are too high. Never-the-less, they and the reality they attempt to describe are cause for pondering. For instance, these data stimulate a good deal of income-envy in many non-MD practitioners. For instance #2, one may recall that corporate law is also a service profession. A real question is why these salaries are basically off the table in the current healthcare reform debate. Once one moves north of general medicine, it’s a hell of a lot of money and reflects the income inequities that are part of what is imbalanced in our culture.
Foundation for Chiropractic Progress purchases $1M million media blitz for chiropractic in healthcare reform
The Foundation for Chiropractic Progress announced a $1-million media blitz on August 20, 2009 which is meant to support the role of chiropractors in healthcare reform. The 4-week campaign, based on contributions from the organization’s 1000+ monthly donors will reach such publications as the Wall Street Journal, Politico, Roll Call, USA Today, and the Washington Post. The release notes that the campaign is expected to generate over 10 million media impressions and will reinforce the role of chiropractic care as it impacts the delivery of quality, cost-effective health care nationwide. The ads feature individuals such as Brig. Gen. Becky Halstead (retired), likely football Hall-of-Famer Jerry Rice, as well as, according to the release “the AMI Study by Richard Sarnat MD revealing that regular utilization of chiropractic care could reduce overall global health care cost by almost 50 percent.”
Comment: Okay, the only nominally “CAM” profession that routinely touches the salary levels reported in the JAMA article noted in this Round-up is chiropractic, thus generating the financial base for a campaign like this. Give the chiropractic profession and their state associations credit for pulling this off through their monthly commitments. A side note: I have to chuckle with the use of the “AMI study” given the reluctance of much of the chiropractic profession to embrace the broad-scope chiropractic medicine model of chiropractic taught at National University of Health Sciences which partnered with AMI (a.k.a. Integrator sponsor Alternative Medicine Integration Group) to create the pilot. It was that minority view, promoted by NUHS president, AMI board member and sometimes Integrator commentator James Winterstein, DC, which allowed these chiropractic graduates to serve as AMI’s primary care physicians. (For Winterstein’s view, see Can Chiropractic Be “Integrative Medicine?” A Patient Survey and a University President Weigh In, August 26, 2008.)
Huffington Post selects Dean Ornish, MD as its medical editor
On August 10, 2009, the Huffington Post announced that it had selected Dean Ornish, MD as the online publication’s medical editor. Huffington Post is one of the most significant online publications, most read by the left/progressive side of the political spectrum. Ornish is the founder and president of the Preventive Medicine Research Institute in Sausalito, California. He has received a raft of honors for his breakthrough work in using a whole system, natural healthcare approach to reversing coronary artery disease. Ornish served on the White House Commission on CAM Policy and the planning committee of the recent IOM Summit on Integrative Medicine. The Huffington Post kicked off Ornish’s term with Ornish’s post, “Resuscitating Health Care Reform,” and an additional post from Andrew Weil, MD, also on health reform, entitled “The Wrong Diagnosis.” Both, according to a statement from the Huffington Post on Ornish’s appointment “highlight the pivotal importance of intensive lifestyle change and prevention in the health care reform discussion.” Ornish’s role will include reporting on wellness and health care policy issues and helping recruit experts in these fields to blog on Huffington Post.
Ullman: “It is strange that you choose to give a voice to a small group of ‘fundamentalist’ physicians who are antagonistic to anything other than conventional drug treatment. Steven Novella’s website and blog spews venom against virtually every alternative treatment, while rarely raising a word to the questionably effective mainstream drugs. This website typically ignores reference to any of the many good clinical or basic science studies show that benefit from the various alternative treatments, while they parade any negative study as it was the end-all for ‘alternative medicine.’
“And it is even more strange that you choose to have a naturopathic physician be your sole source of defense of the National Center for Alternative and Complementary Medicine. Although this naturopath is certainly a respected one, you could have quoted from any of the 100 or so professors of medicine at recently attended the Institute of Medicine’s Summit on Integrative Medicine, but no, you purposefully chose not to do so.
“Actually, this is not strange at all IF you have an axe to grind and IF you want to show your own journalistic biases.
“A recent report from the Institute of Medicine reported that one-third of Americans today take FIVE or more conventional drugs. Please show me ONE study that shows the efficacy of treatment of using five drugs concurrently. If you were sincerely interested in ‘science-based medicine,’ you would be writing very different stories than your recent one.
“Today’s medicine is tomorrow’s quackery…and today’s quackery is tomorrow’s medicine. This is not a prediction; this is the evolution of medicine.
“Attached is a ‘Report on the Historic Summit on Integrative Medicine’ that was sponsored by the Institute of Medicine. You would think that you would give a voice to the Institute of Medicine rather than a fringe group of disgruntled doctors.”
Dana Ullman, MPH
Homeopathic Educational Services
2124 Kittredge St.
Berkeley, CA. 94704
To which Brown replied:
Brown: “Thanks for your message and sorry you didn’t like the story. As you can imagine, there was a limited amount of space in which to describe the debate and try to be fair to both sides. I quoted [US Senator]Harkin and [researcher Carlo] Calabrese on the pro-NCCAM side and Salzberg and [Steven] Novella on the con side, and [NCCAM director] Josephine Briggs in the middle. I’ve gotten critical e-mail from the NCCAM opponents, so I couldn’t have been too far off.”
The Washington Post
Comment: In Brown’s accounting, nominally “objective” journalism, like politics, is a necessary compromise where you know you are successful when no one is fully pleased. Of course, the other phrase about the making of legislation is that it is like making sausage. Not at all pretty. By the way, Ullman’s report on the IOM is among the best. Take a look here.
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