May 2012 John Weeks Round-up on Policy.

PCORI Changes Language to Include Integrative, Complementary and Alternative Medicine Providers

The Board of Governors of the Patient-Centered Outcomes Research institute (PCORI) has listened to public input and made a series of responsive changes to their draft “National Priorities for Research and Research Agenda.” Page 6 of their publication entitled “Major Themes from Public Comments on the Draft National Priorities for Research and Research Agenda and PCORI Response” notes that the public “recommends that PCORI study new and expanded roles for allied health professionals.” PCORI then shares language in their section on “Improving Health Systems” which now includes “integrative healthcare providers, complementary and alternative medicine providers” in the list of allied health practitioners adding: “Research that compares the effectiveness on patient outcomes of alternative strategies to composition of health care teams through alternative workforce deployment models including care collaboration and team based care approaches.” A more through Integrator look at these and other changes that are positiuve for whole person approaches is here.

Comment: First, it’s great to see PCORI acting with such conscious responsiveness. Inside the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), my day job, we have the view that, at this point in time in U.S. health care, if integrative healthcare providers, complementary and alternative medicine providers are not explicitly included, as PCORI now does, they are likely yet to be excluded. This need is not ideal health care. It is realpolitik. Thanks to all who, responding to an Integrator push (Patient-Centered Outcomes Research Institute draft plan comment period ends March 15: No CAM-IM presently noted) or for other reasons, made such comments in any of PCORI’s comment periods. Healthcare writer Elaine Zablocki was among these. You were heard.

Recent news on the diabetes front underscores the wisdom of PCORI’s change. When Group Health Cooperative allowed patients with non-insulin dependent diabetes to have access to “adjunctive naturopathic care” from a network of naturopathic physicians, the outcomes proved beneficial on an array of fronts. Following up on pilots such as this work, led by Ryan Bradley, ND, MPH, Dan Cherkin, PhD and others, would appear to be rich ground for PCORI funding.


Kahn: Prevention Fund under 6th attack by Republicans

Janet Kahn, PhD, a member of the Advisory Group on Prevention, Health Promotion and Integrative and Public Health to the National Prevention, Health Promotion, and Public Health Council provided a list of the series of attacks the Prevention Fund has take from Republican antagonists. The Fund, established as part of the Affordable Care Act, is now threatened through the most recent of these gutting measures.


4/25/12 – Rep. Judy Biggert, on behalf of House Republicans, introduced the Interest Rate Reduction Act (HR 4628), which would delay the increase in federal Stafford Direct Stafford Loan rates, offset by repealing the Prevention and Public Health Fund.

4/25/12 – The House Energy & Commerce Committee advanced a budget reconciliation measure (Proposed Matters for Inclusion in Reconciliation Recommendations), which includes elimination of the Prevention and Public Health Fund. The title was approved by a committee vote of 30-22 (party line). Several Democratic members, including Capps and Matsui, offered amendments to cut the provision.

2/22/12 – The Middle Class Tax Relief and Job Creation Act (HR 3630) became law, extending the payroll tax cut, unemployment benefits, and physician payment updates (“doc fix”), offset by a $6.25 billion cut to the Prevention and Public Health Fund.

9/29/11 – The Labor-HHS FY2012 Appropriations bill offered by House LHHS Chairman Rehberg rescinded funding for the Prevention Fund for FY12.

4/13/11 – Legislation to repeal the Prevention and Public Health Fund (H.R. 1217, introduced by Rep. Joseph Pitts) passed the House on a vote of 236 – 183. The bill did not pass Senate.

1/19/11- H.R.2 – Legislation entitled “Repealing the Job-Killing Health Care Law Act” (H.R. 2, introduced by Rep. Eric Cantor) passed the House on a vote of 245 – 189. It did not pass the Senate. This bill repealed the entire Patient Protection and Affordable Care Act (including the Prevention and Public Health Fund) and the Health Care and Education Affordability Reconciliation Act, which together comprise the landmark health care reform that was signed into law by President Obama in March 2010.

9/14/10 – The Senate defeated an amendment offered by Sen. Johanns that would offset the costs of repealing a 1099 tax reporting requirement by eliminating the Prevention Fund.

The American Public Health Association’s letter-writing campaign to preserve the fund is available via this link.

Comment: As a parent of a student with loans, and another on the way, this pitting of a national prevention strategy against prevention of ignorance and limited job potential for hundreds of thousands of young adults is Machiavellian ugly. Not investing in prevention and health promotion is akin to denying global warming. Republican readers of this blog: can you defend these actions?


Integrative oncologist Donald Abrams, MD takes public position for legalization of marijuana

Integrative medical oncologist Donald Abrams, MD, with the UCSF Osher Center, is an outspoken advocate for legalizing marijuana. In an April 10 Boston Herald article, Doc urges Bay State to decriminalize marijuana, Abrams is quoted as bluntly telling the reporter: “It’s a flower. Get a grip. It’s part of nature. It should be available at sports events instead of alcohol. There’d be less violence.” Abrams, chief of hematology/oncology at San Francisco General Hospital, was headed to Boston to lecture at the Dana-Farber Cancer Institute when he took a moment to lecture the reporter on Massachusetts’ marijuana policy: “Cannabis has been a natural medicine for thousands of years. It’s an analgesic, it’s anti-inflammatory.” Abrams is a past-president of the Society for Integrative Oncology and a leader of the Bravewell Clinical Network.

Comment: There is a worried line of political reasoning that says if you are already in one field that is not fully accepted, such as integrative medicine, you’re a damn fool to attach yourself to another that is also marginalized by many, such as marijuana legalization. I love the disregard Abrams shows in standing up for what he believes, instead of kowtowing to some notion of political savvy. Go Don! Personally, I never inhaled.