Policy IOM Pain Committee includes integrative MD Lonnie Zeltzer and Rick Marinelli, ND, LAcThe Institute of Medicine (IOM) Committee on Advancing Pain Research, Care and Education, named in November 2010, includes two practitioners of integrative medicine. Portland, Oregon based clinician

IOM Pain Committee includes integrative MD Lonnie Zeltzer and Rick Marinelli, ND, LAc

The Institute of Medicine (IOM) Committee on Advancing Pain Research, Care and Education, named in November 2010, includes two practitioners of integrative medicine. Portland, Oregon-based clinician Rick Marinelli, ND, LAc, is the immediate past-president of the American Academy of Pain Management and a gubernatorial appointee to the Oregon Pain Commission. Lonnie Zeltzer, MD, is an integrative pediatrician and researcher associated with the UCLA Collaborative on Integrative Medicine, a member of the Consortium of Academic Health Centers for Integrative Medicine. According to a release published here, Marinelli is the first naturopathic physician to be appointed to an IOM committee and the first licensed acupuncturist to gain an appointment to committee that is not specifically focused on “CAM” or integrative care. Marinelli was nominated through the Academic Consortium for Complementary and Alternative Health Care for which he serves as an external affairs representative. The IOM panel is charged with developing a national pain strategy and delivering recommendations to Congress by the summer of 2011. The IOM project was engaged as a follow-up to the National Pain Care Policy Act of 2010 (SB 660), passed as part of the Affordable Care Act.

Comment: Fascinating convergence of interest here. First, millions of citizens are using chiropractic doctors, massage therapists, acupuncturists, mind-body practices, holistic nurses, integrative medical doctors and naturopathic doctors for pain conditions. Second, the proposed 2011-2015 NIH NCCAM Strategic Plan states that a key “area of promise and need” is in treating chronic pain. Third, unintended consequences of the JCAHO Pain Management Standards adopted in 1999 have stimulated a growing crisis in cost and care. (Interestingly, the JCAHO standards that fostered vast expansion of parma-based pain relief were also an early inclusion of CAM in a significant mainstream document. The JCAHO pain standards included reference to complementary healthcare practices under “non-pharmacological” treatment options.)

Good for the IOM to recognize, in the appointments of Marinelli and Zeltzer, the potential for contributions from the complementary, alternative and integrative practice communities in developing optimal treatment strategies. What if the national strategy actually elevated integrative approaches toward the front-line rather than burying them as after thoughts? Will this IOM national strategy be remembered as the time when the optimizing use of “non-pharmacological” approaches will help us break our pattern of growing pain pill addiction?


Federal comment periods open, close on health reform initiatives: Are integrative practice interests showing up?

Opportunities to have a say in 3 important new federal health initiatives following passage of the Obama-Pelosi Affordable Care Act opened and closed in November/early December. The US Surgeon General Regina Benjamin, MD, MBA called for comments on an emerging “framework” to guide the work of the National Prevention and Health Promotion Council. (The first 4 duties of this council directly reference “integrative health care,” making this a quality opportunity to participate.) An Institute of Medicine study on Essential Health Benefits had a short comment period in early December. The IOM study will create guidelines for what’s in and out of coverage with the 2014 implementation date for the new healthcare law. Finally, the Center for Medicare and Medicaid services offered a comment period that expired on December 3, 2010 on Accountable Care Organizations. This was a chance to comment on how integrative approaches and practices may be part of a leading payment and delivery model promoted by the new healthcare law.

Comment: I corresponded recently with an Integrator reader who works inside a large federal healthcare agency. The reader noted that most people probably don’t realize how much agencies do, in fact, pay attention to comments. That said, it does not appear that the integrative practice fields, as individuals or organizations, have stepped up significantly to be heard. Sadly, this is despite the fact that hard work from integrative practice-related interests actually placed language about integrative health care in at least one of the laws (Prevention Council) on which the comment period was recently open.

Credit the Samueli Institute’s Wayne Jonas, MD and Brian Thiel for a response which I will publish later this month in the Integrator. Samueli was instrumental in getting the “integrative healthcare” language in the prevention and health promotion section of the law. Credit also former policy wonk Bob Benson, founder of the Association of Bodywork and Massage Professionals, for contracting with Diana Thompson, LMP, immediate past-president of the Massage Therapy Foundation, for an excellent submission ABMP posted here. I have also heard from a couple of other individuals who participated.

Perhaps more organizations and individuals have commented but simply not shared their input. Bottom line, if the dozens of institutions and organizations associated with the integrative practice fields don’t show up, we lose a chance to make a difference. The community also loses rights to complain about being left out. It’s a shame to have opened doors, in the prevention arena, and then, it appears, only barely walked through. Too bad, especially, given the claims of virtually all integrative practitioners and organizations that their fields have a special relationship to prevention, health promotion and wellness. We may simply not be ready for prime time. (Thanks to Claire Johnson, DC, Taylor Walsh, and Molly Punzo, MD for alerting me to these opportunities to participate, which I passed on to Integrator readers and, in the case of the prevention-related opportunity, to Integrative Practitioner readers.)

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