By John Weeks
In which the integrative medicine/health community, as Puer Aeternis, enters the Year of the Dragon
Comment: Is the integrative community a Puer Aeternis? This is the Jungian, dreamy "eternal boy" who refuses to grow up. The image came to mind last month while I wrote about the policy opportunities for integrative health care as described in the remarkable report The Affordable Care Act and Beyond: A Stakeholder Conference on Integrated Healthcare Reform. I juxtaposed the practical potential in this document from the Integrated Healthcare Policy Consortium (IHPC) and our lofty vision of transforming our healthcare system, on the one hand, with the fact that the only multi-stakeholder lobbying entity for the integrative health community can only support a not very well paid half-time executive director. This community would seem to want transformation without stepping into the messy, not very boyish, and not at all dreamy work of lobbying to get what we want. Thus Robert Bly's story of the puer aeternis came to mind. Can the community wake up, and step up?
I note with pleasure the efforts noted below as we enter the Chinese Year of the Dragon that commenced January 23, 2012. One website speaks of the dragon in remarkably integrative terms: " ... powerful almighty king because (the dragon) was made up of different parts of animals such as a tiger, fish, snake and an eagle. The Chinese dragon was not seen as a threatening evil being as we do in the west - rather a symbol of power, superiority and rule." One of my colleagues used street terms to describe the meaning of the Year of the Dragon: "It's the year to get shit done." Perhaps this is the time to cast off the puer aeternis and reveal the dragon!
Indian Health Service includes naturopaths, acupuncturists and chiropractors in loan repayment programs
A bit of integrative medicine history was made in January 2012 when the U.S. Indian Health Service (IHS) quietly announced that licensed naturopathic doctors, acupuncturists and chiropractors would be included in 2012 in the IHS' student loan repayment programs. The announcement magnetized students and recent graduates. Is this finally a the beginning of the end to what they view as a long-overdue chance end discriminatory exclusion from a program to relieve their debt burden? The inclusion was immediately celebrated by the American Association of Naturopathic Physicians (AANP). The AANP has targeted such inclusion as its top federal priority for the last decade. The American Chiropractic Association followed suit with a release to their members. An article on the inclusion is here in the Huffington Post. Actual inclusion will be a function of relationships: one tribe selecting one practitioner. A view from inside the naturopathic profession is here.
Comment: These practitioners may be an exceptional fit for tribal health. Licensed naturopathic doctors link their primary care scope to expertise in natural healing methods such as herbal medicine and sweats (cleansing), lifestyle change and a belief in the importance of spirit in health. Emerging research on naturopathic diabetes care is also hopeful in a population in which this condition is epidemic. Naturopathic doctors would seem uniquely useful. While the connections are not as direct, practitioners of acupuncture and Oriental medicine (AOM) and chiropractors are similarly disposed, philosophically, toward indigenous and natural healing methods. The comments here include some discussion of the fit of AOM and particularly group acupuncture in the I.H.S. environment.
AAAOM leads campaign to get acupuncture listed as Essential Health Benefit
So far 5,524 emails and letters sent! So headlined the campaign page for the late January 2012 push of the Association for Acupuncture and Oriental Medicine to place acupuncture in the Essential Health Benefits (EHBs) package. Under the 2010 Affordable Care Act, starting in 2014 most health plans will be required to offer EHBs as part of a strategy to ensure access to quality and affordable health insurance for all U.S. citizens. The AAAOM is supporting their campaign with a 5-page position statement. The core of the documents is entitled "The Medical and Comparative Effectiveness of Acupuncture." The authors argue that evidence supports the conclusion that: "The inclusion of acupuncture in the Essential Health Benefits package will increase patient access to safe, cost-effective and comparatively-effective health care, improve outcomes, and reduce adverse events of conventional therapies, and provide an overall increase in cost-savings for American health care." A note on January said that, at the closure of the period, 23,000 letters e-notes had been sent.
Comment: Credit the AAAOM for bellying-up to this bar, submitting a short white paper and mounting this campaign. Note the American Chiropractic Association, which is continuously on the ball in D.C. representing chiropractic interests, is dogging this issue. An example is this testimony to the Institute of Medicine (IOM) during the IOM's development of its recommendations.
IHPC mounts Congressional briefing on policy discrimination against CAM institutions
The February 2, 2012 event was titled: "Improving American Health Care by Leveling an Uneven Playing Field: Ending Discrimination against Integrated Health Care." The audience(s): members of the US Senate (or, more likely, staff) in the Dirksen Senate Office Building during the morning then, that afternoon, to members of the House of Representatives in the Cannon House Office Building. For each audience, the three speakers addressed "forms of discrimination against licensed Complementary and Alternative Medicine (CAM) professions: acupuncture, chiropractic, massage, naturopathic medicine, and professional midwifery" including "discrimination against federally recognized CAM educational institutions." Among the speakers was former Washington State Insurance Commissioner Deborah Senn, JD. Senn is credited with holding insurers' feet to the fire when they sought to evade the 1995 Every Category of Provider Law law in that state which required all plans to cover all categories of licensed providers. Senn spoke to the results of its implementation and national implications. The other speakers were former IHPC executive director Janet Kahn, PhD and Bastyr University dean of naturopathic medicine Jane Guiltinan, ND. The event was sponsored by the Integrated Healthcare Policy Consortium (IHPC).
Comment: The is the second in 3 such briefings that IHPC is arranging through its former executive director Janet Kahn, PhD. Discrimination against the CAM disciplines is far more pervasive than in payment, the usual target of such concern. Discrimination extends to numerous federal grant programs and policy-making initiatives. Non-discrimination in that area will begin to be righted if the Section 2706 of the Affordable Care Act is not over-turned by the American Medical Association and its allies. Good for IHPC to highlight these additional areas where inequities prevail.
Alliance for Natural Health leads campaign to protect CAM-friendly Health Savings Accounts
The January 10, 2012 Alert from the Alliance for Natural Health for its members was entitled “New Regulations Threaten Insurance for CAM Patients.” The complicated message is that Health Savings Accounts (HSAs) through which many individuals are accessing coverage for otherwise non-covered complementary health services are on the line. They share that recently issued final standards from the US Department of Health and Human Services will harm health plans like HSAs with higher deductibles: “Particularly hard hit will be the [HSAs] that help so many of us pay for complementary and alternative medical (CAM) treatments not covered by regular insurance.” At issue is the treatment of plans who do not meet requirements to limit their overhead and profit less than 20% of premiums, or 15% for large employers. The Alliance is calling on members to contact their members of Congress to save these HSAs. They argue:
“If high-deductible plans are eliminated, then our only option is to combine an HSA with a much more expensive conventional policy. That will make integrative care completely unaffordable for many. It will also lead to less demand for HSAs. Before long, they would probably disappear. If HSAs disappear, direct consumer control over healthcare would suffer yet another blow. As many analysts have suggested, the fact that consumers do not directly buy medical services explains much of what is wrong with medicine today.”
The notice concludes with a statement that “the good news is that since HSAs are specifically mentioned in the [Affordable Care Act], they can’t legally be killed by agency regulations, over and above the injury already received from the statute.”
Comment: Simulating a popular movement, as the Alliance is seeking to do, that will allow insurers to keep more of the insured’s subscription for overhead and profit would seem oxymoronic, if not utterly wrong-headed. Yet I credit the Alliance for taking on this issue and raising awareness of it. Meantime, I would hope the Alliance would also stimulate action amongst its members to keep the non-discrimination clause in the Affordable Care Act – another and more broad-sweeping way to allow more coverage of many integrative practices.
Institute of Medicine's "Living with Chronic Pain" report minimizes values of complementary and integrative approaches
The name of the new Institute of Medicine (IOM) report is Living Well with Chronic Illness: A Call for Public Health Action. The purpose of the 307 page document, stimulated by interest from the fibromyalgia community, is stated this way: "The overall goal of this report is to highlight the toll of all chronic illnesses on living well from a population health perspective, discuss the deficits in chronic disease control, and make recommendations to improve public health efforts to help individuals live better with chronic illness." A section on Community Based Intervention includes a 2-page segment (157-158) entitled "Complementary and Alternative Medicine." The conclusion of that section: "The use of CAM approaches in the management of chronic illness raises some concerns among health care providers because of the lack of scientific evidence supporting the use of these products and the potential for ignoring traditional and effective therapies but also in terms of safety and efficacy (Ventola, 2010b). The Dietary Supplement Health and Education Act of 1994 did not mandate that manufacturers prove that their products are safe but put the burden on the U.S. Food and Drug Administration (FDA) to prove them unsafe (Ventola, 2010b).
Comment: The report appears to have been developed via a committee without members active in the integrative medicine community. Clearly, none were members of the licensed complementary and alternative medicine professions. Nor were these communities represented in the review panel. Given the high exploration of "CAM" by people with chronic conditions, typically in the 50%-70% range, this was a huge oversight, and effectively a non-representative disservice by this quasi-public agency. How can we continue, in this so-called "patient-centered" era, to so easily dismiss what so many patients are doing? While there is much in this report that can be instructive to the integrative health community, it is a sign of the poor state of "integration" that the Committee was not only non-inclusive but also comfortably dismissive. This was a missed opportunity for healing, at many levels. (Thanks to Demie Stathoplos of Pathways to Wellness for this link.)
Kazarian Foundation’s $36-million Health Corps proposal for integrative medicine homecare approved via CMS Innovations program
An integrative medicine home-care proposal developed with support of the Charles and Agnes Kazarian Foundation has gained approval as part of the Healthcare Innovation Challenge Proposal of the Center for Medicare and Medicaid Services. The Foundation will provide $6-million of the funding to establish a volunteer and internship-based Health Corps of America to deliver in-home integrative medicine services with CMS providing an additional $30-million. According to the February 8, 2012 release, the Foundation's is supporting creation of a nationwide Health Corps of America. These healthcare professionals will deliver care at home to high-cost, high-risk elderly populations. The release notes that “the Health Corps of America is significantly based on the Foundation's propriety research, especially on the global benchmarks and high value-add best practices of internships and volunteerism.” The Health Care Innovation Challenge, sponsored by the United States Centers for Medicare & Medicaid Services and funded by the Affordable Care Act, will award up to $1 billion in grants to applicants who will implement the most compelling new ideas to deliver better health, improved care and lower costs to high-cost, high-risk individuals.
Comment: This unusual and intriguing announcement reached me just prior to press time. Frankly, I haven’t looked at it closely but thought I would pass the link along.
Lessons on making a Beltway impact: American Chiropractic Association's Congressional line-up on their grassroots legislative day
Each year, the American Chiropractic Association (ACA) has its own March on Washington. The 2012 rendition of the National Chiropractic Legislative Conference (NCLC) features an impressive array of Congressional and executive level personnel who will address their assembled members. In their January 25, 2012 release, the ACA announced that Sen. Orrin Hatch (R-Utah) will deliver the keynote address. Hatch is the ranking Republican on the powerful Senate Finance Committee and a member of the Senate Health, Education, Labor and Pensions Committee. Other featured speakers include:
- Rep. Bruce Braley (D-Iowa), member of the Committee on Veterans' Affairs and the Veterans' Subcommittee on Economic Opportunity and co-sponsor of the Chiropractic Care Available to All Veterans Act
- Rima Cohen, counselor to the Secretary for Health Policy, Department of Health and Human Services
- Rep. Bob Filner (D-Calif.), recipient of the NCLC Lifetime Outstanding Leadership Award for 20 years of steadfast support for doctors of chiropractic and their patients, and especially for his work in expanding chiropractic in the U.S. Department of Veterans Affairs, and
- Dick Gephardt, former House Majority Leader and president and CEO of Gephardt Government Affairs.
Comment: Imagine a day when a multidisciplinary, multi-stakeholder movement toward a health-focused system had such a conference and lobby day in the Beltway that attracted such federal leadership. Behind it, of course, are years of political action leavened by political contributions. Visualize also making those donations, strategically. The make one, and let your member of Congress or a known leader of these fields know why. That will wake up a Puer Aeternis (see note above), fast.
Life University's Octagon Institute to Sponsor Follow-up Policy Conference on the Affordable Care Act, April 12-14, 2012
Gerald Clum, DC sends notice that Life University will mount a policy-related conference through The Octagon, an affiliated institute, which Clum directs. The conference will be held in Marietta, Georgia, April 12-14, 2012. The conference is entitled Reimagining Health Care; Making Health the Goal. The speaker line-up is expected to include at least 2 US Senators and numerous other policy and corporate leaders whose decisions will impact the future of integrative care. IHPC's legislative interim chair Nancy Gahles, DC, CCH, RSHom(NA), and Academic Consortium for Complementary and Alternative Health Care executive director John Weeks have been asked to present. The conference overview is:
"Health care reform is presenting significant opportunities for redefining all aspects of health care: which services for which conditions under which circumstances; how those services and providers are organized; how care is delivered; and the economic organization of the transactions that fund the system ... Great attention is being paid to the concepts of a Patient Centered Medical Home (PCMH) and of an Accountable Care Organization (ACO). These models may prove to be vehicles that are broadly adopted as health care reform continues to unfold ... If they are, what are the opportunities, perils, threats, and rewards for various professions already engaged in health care-but rarely in a coordinated fashion? Is care integration required? By whom, and under which circumstances? Many more questions exist than answers ... The Octagon will bring together significant voices and stakeholders to address these and other questions in an effort to develop templates for health homes and ACOs that incorporate a broad spectrum of health care options-especially as the need for wellness promotion in vitalistic terms becomes more clearly understood-and economically important."
Report finds NIH invests over $120-million in CAM-related cancer research
The article by Libin Jia, the manager of many international programs of the Office of Cancer and Complementary Medicine (OCCAM), is entitled Cancer Complementary and Alternative Medicine Research at the US National Cancer Institute. Jia reports that "in recent years, NCI has spent around $120 million each year on various CAM-related research projects on cancer prevention, treatment, symptom/side effect management and epidemiology." Roughly 85% targets vitamins, minerals and "pharmacological and biological treatments." Mind-body medicine is the most significant therapy explored. The article includes useful breakdowns by organ system as well as type of therapy. The author's interest in Chinese medicine shapes the back end of the article. (Note:Thanks to adviser Paolo Roberti di Sarsina, MD for sending the link.)
Comment from Integrator editorial adviser Glenn Sabin, of FON Therapeutics, and board member, Society for Integrative Oncology:
"A useful report evidently supported and vetted by OCCAM and its director, Jeffrey White, MD, who was thanked at the end for reviewing the work. Interesting to note that OCCAM's annual research budget to investigate cancer specifically is close to NCCAM's $128M. White states elsewhere that approximately $500M of NIH/NCI's total $5B is annually put toward investigating cancer "CAM".
"Also interesting that almost 60% of this research goes toward 'prevention'. Only a mere 0.7% of this funding is used to look at 'alternative medical systems', which, in addition to naturopathy, Ayurveda, TCM and homeopathy, presumably includes integrative medicine and integrative oncology whole systems. This is troubling to this staunch proponent of the rigorous scientific inquiry into comprehensive whole systems-aligned with how true integrated care is provided in clinic. The bioactive synergistic effects of whole systems delivery cannot be properly examined in a reductive manner. Perhaps under the rubric of ACA-CER, PCORI, ACOs and PCMHs-early compelling outcomes and proven cost-effectiveness will lead to a substantive investment that allows for proper inquiry into integrative whole systems v. standard of care.
"Meanwhile, more useful than this helpful report would be to know how these findings around nutrition, herbs, exercise and more have been or will be translated RIGHT NOW to clinical application. What happens with this data after the results are tallied and published? Who is charged with making appropriate recommendations to practitioners? Or are clinicians always left to their own devices while waiting for larger studies that are so hard to get funded? Ensuring translation to clinical application-and to those practicing disease prevention and wellness in myriad settings-is the important ROI metric for our precious research tax dollars."
NIH NCCAM announces 6 new members of its National Advisory Council
Just prior to its regular February meeting, the NIH National Center for Complementary and Alternative Medicine (NCCAM) announced 6 new members. The council serves as the principal advisory body to NCCAM, the lead federal agency for research on complementary medicine, and a component of the National Institutes of Health. The members are:
- Catherine Bushnell, PhD a pain expert and professor of anesthesia and professor in dentistry and neurology at McGill University whose research focuses on brain imaging techniques to study how pain is processed by the nervous system in humans.
- Jane Guiltinan, ND is the dean of the school of naturopathic medicine at Bastyr University, Seattle whose clinical practice is focused on women's health, disease prevention, and wellness promotion.
- Scott Haldeman, DC, MD, PhD, is adjunct professor in the department of Epidemiology at UCLA, clinical professor in the Department of Neurology at the University of California, Irvine and chairman of the research council of the World Federation of Chiropractic.
- Frances C. Henderson, RN, EdD, is a clinical professor in the department of medicine at the University of Mississippi Medical Center, Jackson with a focus on for her work in promoting health in adolescents, minority elderly, and rural individuals.
- John Licciardone, DO, is associate dean for clinical research and executive director of the Osteopathic Research Center at the University of North Texas Health Science Center, Fort Worth who has served in various research and review capacities for NCCAM projects relative to osteopathy.
- Lynda H. Powell, PhD, is a licensed clinical psychologist and professor and chairman of the department of preventative medicine at Rush University Medical Center, Chicago who has focused on women's psychosocial and cardiovascular health as well as lifestyle interventions aimed at reducing the risk for developing type-2 diabetes and cardiovascular disease.
Comment: Interesting crop: two with health promotion expertise, two from the licensed complementary and alternative medicine disciplines NCCAM was originally charged to explore; one from a discipline (osteopathy) that NCCAM subsequently decided to add to the list; and a Canadian basic scientists. The mix reflects the 2011-2015 strategic plan’s new focus on health promotion.
Institute for Integrative Health offers workshop on research methods, March 29-April 4, Baltimore, Maryland
Brian Berman, MD, co-founder of The Institute for Integrative Health shares that the Institute is sponsoring a 5 day research training that includes the complementary and integrative medicine field coordinators for the Cochrane Collaboration, Eric Manheimer and Susan Wieland, on Systematic Reviews and Meta-Analysis. In a separate module, whole systems and real world research experts Claudia Witt and Klaus Linde will teach on study design and pragmatic trials. Participants can purchase individual components of the workshop. Writes Berman: “The course will provide participants with the skills necessary to both critically appraise clinical research, identify gaps, and to plan and perform their own study projects. Another important aim of the course is to foster international networking among participants.” For information click here.
Huge outpouring of proposals for the International Research Congress on Complementary and Integrative Medicine, May 15-18, 2012, Portland, Oregon
The already robust international research gathering sponsored by the Consortium of Academic Health Centers for Integrative Medicine has witnessed a huge influx of interest from researchers. According to organizers, just one-in-three presentation proposals was accepted. The Congress, first held in Edmonton in 2006 as the National Research Conference in Complementary and Alternative Medicine (NARCCIM), has continually grown with roughly 600 attendees at the first meeting, over 800 at the second, in Minneapolis in 2009. Organizers are targeting over 1000 attendees for the May 15-18, 2012.
Comment: For anyone with an interest in research in these fields, this Congress is an absolute smorgasbord of continuous abundance – in presentations, ideas and colleagues. If you have considered going, go.
Jefferson-Myrna Brind begins integrative pediatrics program
The Jefferson University’s Myrna Brind Center of Integrative Medicine has announced creation of a new integrative pediatrics program. The program will be led by Christina DiNicola,MD, FAAP. In a release from the Center, DiNicola states: “Integrative medicine’s natural and comprehensive approach can help young people feel better, perform better and thrive at their fullest potential. An integrative approach acts to enhance conventional pediatric care.” The “whole child approach” of the program is presented as treating multiple medical conditions including “ADD/ADHD, allergies, asthma, behavioral and developmental concerns, digestive disturbances, cancer care support, emotional health, eating problems, chronic headache, sleep problems, weight management and more.”
DiNicola, a Bravewell Scholar at the University of Arizona College of Medicine in the Arizona Center of Integrative Medicine graduates of the states that the move is a response to consumers: “Families were growing more curious about alternative therapies and their use as a complement to traditional medical care.”
Pathways to Wellness reports remarkable pattern of community and public health participation
Recently Demie Stathoplos, MBA, MSW, the director of Boston's Pathways to Wellness participated in a recent dialogue organized by the Academic Consortium for Complementary and Alternative Health Care, with which I am involved. The exchange explored the present and potential future intersection between the licensed so-called "CAM" disciplines and the public health. More precisely: Where is there a fit with the National Prevention, Health Promotion and and Public Health Council? Afterwards, Stathoplos tapped out an overview of Pathways' involvement in community medicine and public health initiatives. Pathways' clinical services features acupuncture and Oriental medicine, bodywork and Yoga in partnership with numerous centers and agencies. The remarkable contributions are a national model. Stathoplos granted permission to re-publish this overview for Integrator readers.
- "Participation in research and national conversation on Public Health: Our Research Director, Beth Sommers, PhD, LAc, serves as the co-chair on the Alternative and Complementary Health Practices Group of the APHA. She is editor of a forthcoming European Journal of Integrative Medicine that is focusing on "Public Health in Integrative Medicine". She writes regularly on public health issues in Acupuncture Today. Her research has focused on the public health impact of acupuncture on medication adherence in people living with HIV/AIDS, and on the reduction of cravings for addictive substances in military veterans.
- Safety & Efficacy: Pathways has been in the forefront of ensuring safety and efficacy of the practice of acupuncture in Massachusetts. We were asked by the Massachusetts Dept. of Public Health to develop standards of care for the provision of acupuncture. We assist in training of acupuncturists by working with the New England School of Acupuncture to provide supervised intern clinics, that also allow us to offer free or low cost care to people in the community. Because of our work with clients with HIV/AIDS, our training is excellent in the areas of confidentiality, clean needle/needle count methods, needle stick procedures and other clinical practices. We collect baseline data and treatment data on clients served in our main clinic, and maintain a client database that allows us to analyze the data to determine trends in efficacy. In one example, we were able to determine that for a specific group of clients with pain, that gains were only seen up to 40 treatments, after which no further improvements were found.
- Consumer Education: Pathways clinicians provide free education on the efficacy of acupuncture through outreach activities (talks and demonstrations) to underserved communities, including elders, LGBTQ clients, Spanish speaking groups (i.e, hotel workers), and AIDS Service Organizations. We provide free workshops on topics related to Chinese medicine - i.e., Acupuncture for Allergies, Chinese Herbal Medicine, Acupuncture for Headache, etc. Our clinicians also speak at professional conferences locally, nationally and internationally. We reach about 1500 lay and medical professionals each year.
- 10 years+ of in-home acupuncture and massage to elders and people living with complex health issues and/or disabilities, referred by RN Case managers to address pain, mood/anxiety, digestive issues, quality of life issues - assisting people to remain in their homes, and reduce use of emergency and other medical services. Reimbursed through elder service plans or care management groups with disability case load. We served 90+ clients last year with about 2300 treatments, and growth this year has been about 35% over last year.
- Referrals from primary care physicians at the South End Community Health Center for acupuncture and/or massage. We are in 5th year of a pilot program with a local insurer which reimburses for acupuncture with South End Community Health Center PCP referral for one of 5 diagnoses: pain, headache, menopausal sx, menstrual sx, carpal tunnel sx. Our clinical results show statistically significant improvement in pain symptom duration, frequency and intensity for clients treated for pain and headache. Our results also show statistically significant improvements in quality of life indicators. Insurer's analysis indicated that they see minimal cost impact on reimbursing for acupuncture vs. matched demographic set of clients with pain and headache who do not receive acupuncture.
- Infectious Disease units of Mass. General Hospital, Tufts Medical Center and Cambridge Zinberg Clinic Pathways has been providing free acupuncture in our main clinic and in hospital and community health settings for people with HIV/AIDS for 22 years. Our satellite programs are funded through grants from the host agencies. We collect data on adherence to anti-retroviral medication, as well as measures of t-cells and viral load, visits to emergency rooms, use of addictive/illegal substances, pain and other symptom levels.
- Pilot program with Spaulding Rehab hospital We recently completed a pilot where we provided massage and/or acupuncture to inpatients recovering from surgery or injury. We went through the pilot funding, which was meant to cover 2 years, in about 9 months, due to demand from referring physicians. We provided 300 treatments to more than 50 inpatients. Spaulding is now trying to figure out how to bring these services in-house rather than have an outside vendor provide (presumably to save money, as the services were funded by a donor to the hospital).
- Reducing disparities in care/ Access to care We provide Community style acupuncture ($25-$45/hour) to increase economic accessibility. We have Spanish and Portuguese speaking practitioners to improve cultural competence of care. Our location inside the South End Community Health center, which serves a largely Latino population, allows us to develop "word of mouth" recommendations within the local Latino community. We participated in the Jill's List Beta test, providing free care to 13 low income clients referred from Boston Medical Center.
Comment: This is truly a remarkable set of community contributions from a free-standing center focusing on AOM services.
True North celebrates 10th year with "Empower Me" initiative
Maine's True North health center announced January 31, 2012 that it is marking its 10th year with a patient-focused initiative called "Empower Me." The ingredients in the not-for-profit Center's plans include: a means for patients to directly access 3 laboratory tests; a Drug and Supplement Interaction Assessment; and access to the clinic's supplement store. The release argues to readers that these supplements are of high quality since they are pre-selected by the Center's staff.
Comment: While the release is basically a marketing promotion for the Center, I found the inclusion of the testing strategy and interactions reports of particular interest.
Update from holistic nursing leaders Susan Luck and Barbara Dossey on the nurse coach certification process
Holistic nursing leader Susan Luck, RN, MS, HNC, CCN recently sent an update from her colleague Barbara Dossey, PhD, RN, BC-HN, FAAN on the efforts to establish, via the American Holistic Nurses Certification Corporation (AHNCC), a nurse coaching certification. Says Luck: "It captures the work that has gone into this and the potential to greatly impact our nation's health with over 3 million nurses in the U.S. working in all settings within all communities." Luck notes that the nurses leading this effort have also created the International Nurse Coach Association "to bring nurse coaches together local to global, to network, support one another and share our work and stories." She adds that "in the Nightingale spirit, we are also committed to change through advocacy and in supporting health policy initiatives that focus on health and the environment." Here is Dossey's report:
"The following provides the reader with a brief overview of the Nurse Coach Certification Process offered by the American Holistic Nurses Certification Corporation (AHNCC).
"Over the last two years the American Holistic Nurses Certification Corporation (AHNCC) has followed the development of the health and wellness coaching movement and the increased interest in the nurse coach role as reported in the literature and in various healthcare areas. This also included a series of conversations with a cohort of holistic nurse leaders, including Linda Bark, Barbara Dossey, Darlene Hess, Susan Luck, Bonney Schaub, and Mary Elaine Southard.
"After lengthy discussions, extensive reading, and consideration of the implications for nursing, the topic was added to the AHNCC Board Meeting Agenda in February 2010. The AHNCC Board decided that the role of Nurse Coaching was important to the Profession of Nursing, and should be proactively addressed. That is, Nursing should hold its space with this role so to ensure that Nursing is included in the consortium of healthcare providers that are supported in the delivery of care based on a health coach model.
"AHNCC also determined to move forward with a needs assessment to determine if there was interest in a national certification program for nurses who wished to carryout the Nurse Coach Role. See details at www.ahncc.org.
"AHNCC contacted the cohort of nurse leaders described above, identified as the Professional Nurse Coach Workgroup (PNCW). AHNCC and the PNCW discussed options for moving forward with a Needs Assessment and a National Certification Program if indicated by the Needs Assessment. Together, an alliance was formed with the intent of holding and promoting the Role of Professional Nurse Coaching.
"AHNCC needs assessment was launched in March 2011. For more details see www.ahcc.org. The findings indicated that there is an interest in a National Certification Program in the Role of Professional Nurse Coach.
"The PNCW is in the final international review process on the draft Professional Nurse Coach Role: Defining the Scope of Practice and Competencies (2012).This document has identified competencies relevant to the role of Nurse Coach. The AHNCC is now having these competencies reviewed by expert panels that will be revised accordingly to the experts' review. Following completion of the competencies, a Role-Delineation Study (RDS) will be undertaken, under the guidance of the Professional Testing Corporation.
"Specifics regarding required AHNCC criteria, the certification process, related literature, and other factors will be provided in early 2012. Helen Erickson, AHNCC Board Chair welcomes questions and comments contact AHNCC at firstname.lastname@example.org."
Comment: Coaching, as mentors have taught me, is not precisely "educating." Nor is it "counseling." It is an art-form of its own. In an era wracked by diseases that baffle many who have been educated and counseled to better habits, I wonder that these new soft technologies are not front-and-center for all integrative clinicians and healers who like to see themselves as change agents for people's lifestyle choices. That said, a part of me wishes this nursing group would have chosen to work within the fold of the broader, multidisciplinary initiative to establish coaching standards kicked off in late September 2010 and reported here. The idea of standards that bridge disciplines has an appeal in a time when we have increased awareness of the way guild boundaries harm patient care. Yet creating a formal method for certification inside an army of 3-million nurses is undeniably a great step toward health.
Report finds homebirth is making a comeback
A January 26, 2012 report from the National Center for Health Statistics led the Certified Professional Midwives to declare in an e-message that “Homebirth is on the Rise!” Homebirth, on a 14 year decline, increased 29% to 1-in-90 births. Roughly 90% of the increase was among non-Hispanic white women. Differences based on race adnd ethnicity have increased over time. Montana has the highest frequency, at 2.6% with Louisiana and Washington, D.C. the lowest, at 0.2%. The National Association for Certified Professional Midwives also shared a video of testimony from US Congresswoman Lucille Roybal-Allard (D-CA) in which she heralds the outcomes of a November 2011 midwifery summit. NACPM holds its first annual meeting March 11-13, 2012 in Virginia.
Acupuncture accrediting body calls for public comment on standards for new “First Professional Doctorate"
The Accreditation Commission for Acupuncture and Oriental Medicine is has opened a comment period on its standards for creating a “first professional doctorate” (FPD) for the acupuncture and Oriental medicine field. Since the creation of the ACAOM in the 1980s, the focus of the agency has been on accreditation standards for Masters’ level education. Over the past decade, a small but growing subset of schools have commenced clinical programs that offer a Doctorate in Acupuncture and Oriental Medicine (DAOM). Meantime, the profession has debated the increase in standard to bring the core education to the doctoral level. This is the second round of public comments issue by ACAOM following a controversial first round. Comments are urged by all members of the public. Click here for information.
Super Bowl: Chiropractors Help Patriots, Giants (and 30 other teams) "Prepare for Battle"
The Foundation for Chiropractic Progress (F4CP), a marketing arm of the chiropractic profession, used the occasion of Super Bowl XLVI to tout the role of chiropractors in keeping professional football players on the field and playing. The February 1, 2012 release features comments from Michael Miller, DC of the Patriots and Robert DeStefano, DC of the Giants. States Miller: "Most of our players will get adjusted prior to games to adequately prepare their bodies for battle. Several times during the playoffs, incidents occurred that required chiropractic care and, subsequent to sideline treatment, players were able to return to action the following play. We expect to have the same efficiency going into and during the Super Bowl." The article stresses the multidisciplinary manner in which the chiropractors work. The Professional Football Chiropractic Society links these clinicians from the 32 teams.
Comment: My fantasy is this: one of the academic bloggers who spends his free moments railing against chiropractic, CAM and integrative medicine bellies up to one of these inside linebackers freshly off the adjusting table and girded for battle. The anti-CAM blogger shows the courage of his or her (usually his) convictions and says: What you just did is a waste. It's all in your head. It's of no real use. Why waste your time on it? I think I just heard the sound of a body slammed against a locker.
Academic Medicine and Health
Author-clinician Peter D'Adamo, ND and University of Bridgeport establish Center for Generative Medicine
On January 26, 2012, the University of Bridgeport and Peter J. D'Adamo, ND announced the "collaborative launch of the Center for Excellent in Generative Medicine. According to the release, the COE "will continue to train naturopathic doctors while broadening the College of Naturopathic Medicine's curriculum." David Brady, ND, Bridgeport's vice provost for health sciences called D'Adamo "a giant in the field of naturopathic and integrative medicine (who) has made transformational changes in the way thousands of doctors treat their patients." D'Adamo, the author of the 1996 international best-seller Eat Right 4 Your Type, which promoted the ideas of blood type, diet and personalized nutrition, has published over 20 books. The most recent is the Textbook of Generative Medicine. States D'Adamo: "I believe that today we embark on a project that holds great promise for humankind and I am especially proud that this initiative has found a partner in the University of Bridgeport, a recognized educational world leader in the field of integrative medical education." According to the release, the Center also will sponsor research in the fields of nutrigenomics and epigenetics. D'Adamo's speech at the January 24, 2012 ceremony is here.
Comment: I have been intrigued to see D'Adamo move toward this affiliation in recent years. Since an important stint for his profession's national organization as the founding editor of ahead-of-its-time Journal of Naturopathic Medicine in the late 1980s and early 1990s, he has mostly practiced and written as a solo-operator. As the release notes, the Center was 2 years in discussion and planning. The concept of a generative medicine is an attractive one. It nestles nicely with a favored phrase for the work of the integrative practice community: health creation.
Brian Berman, MD joins Tai Sophia Institute Board of Trustees
Maryland-based Tai Sophia Institute has appointed Brian Berman, MD to its board of trustees. Berman is co-founder of the The Institute for Integrative Health (TIIH), director of Center for Integrative Medicine at the University of Maryland and a former Bravewell prize winner. He was also the founding chair of the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM).
Comment: Pleasing always to see these interlocking directorates established between the complementary and alternative education and practice community and the integrative medicine community. Another excellent example is the role of Ben Kligler, MD, MPH, the current CAHCIM chair, on the board of the Pacific College of Oriental Medicine.
Data points on a decade of growth in naturopathic medical education
Coquina Deger, MBA, the editor of the newsletter of the Association of Accredited Naturopathic Medical Colleges (AANMC), offered interesting data on the evolution of naturopathic medical education in a recent reflection on her 10 years in the job. Since 2002, the pool of students applying to the 7 accredited programs has grown from 617 to 1,119. New enrollments increased from 265-606 in 2011. The number of accredited schools in North America was at 5 in 2002 and is anticipated to be at 8 total campuses when Bastyr University adds it San Diego campus in late 2012. (The other new programs are the British Columbia-based Boucher Institute and the ND program at National University of Health Sciences in Chicago.) Deger's note lists additional markers of growth.
Comment: Some of you will know that I began my work in the integrative health field in the 1983 working for a little educational entity called the John Bastyr College of Naturopathic Medicine. JBCNM was the second of two schools, then housed in a former Seattle elementary school. At the time, that profession that was fighting with itself about whether it could sustain two schools or if all resources should go to the mother ship, then called the National College of Naturopathic Medicine. At the time, the total number of licensed NDs in the United States was fewer by half than the number of students today
International effort? Organized attacks on CAM programs in UK universities surface in Australia
Heather McLeod, a New Zealand educator and leader in integrative medicine writes that "the concerted effort against CAM at UK universities that you reported on in January 2012 is now making its way to Australia." McLeod sends as example this link. McLeod's upcoming report in her next New Zealand Center for Evidence-Based Research in CAM (ENZCAM) newsletter notes that "more than 400 doctors, medical researchers and scientists have formed a powerful lobby group to pressure universities to close down alternative medicine degrees. According to McLeod, the new group, entitled Friends of Science in Medicine, "wrote to vice-chancellors this week, warning that by giving 'undeserved credibility to what in many cases would be better described as quackery' and by 'failing to champion evidence-based science and medicine', the universities are trashing their reputation as bastions of scientific rigour." The group is also campaigning against insurance coverage. Chiropractic is a favorite target.
The story has jumped the ocean and was reported here in the New York Times. McLeod reports that presently in three Australian universities offer courses in some form of alternative therapy or complementary medicine, including traditional Chinese herbal medicine, chiropractics, homeopathy, naturopathy, reflexology and aromatherapy. An international connection is noted. David Colquhoun, a professor of pharmacology at University College London who has called for ending of alternative-medicine programs in Britain, is also a member of the Australian group.
Comment: The passion of these antagonists deserves a DSM code. Perhaps the starting place of an international counter-insurgency is to begin defining the nature of CAM-phobia. Is it linked to Nature Deficit Disorder? Unfortunately, phobias continue to shape themselves into public policy in many arenas and nations. Phobias presenting themselves as rational are particularly dangerous.
Article by Sita Ananth in Hospitals and Health Networks synopsizes latest hospital-CAM study
A January 26, 2012 article by Sita Ananth, MHA in the electronic Hospitals and Health Networks provides a good synopsis of a large survey based report led by Ananth for the Samueli Institute. The reportwas published in August 2011. The article is entitled More Hospitals Offering CAM. Ananth splices in a few comments from David Eisenberg, MD. Mayo's Brent Bauer, MD and hospital trend expert and futurist Ian Morrison. Ananth finishes with a statement that many hospitals "include 'whole person health' in their mission statements, making CAM a natural fit." She tags on a quote from Nancy Foster, vice president for quality and patient safety at the American Hospital Association: "The rise of complementary and alternative medicine reflects the continued effort on the part of hospitals and caregivers to broaden the vital services they provide to patients and communities ... Hospitals have long known that what they do to treat and heal involves more than just medications and procedures. It is about using all of the art and science of medicine to restore the patient as fully as possible."
Niemtzow leads special issue of Medical Acupuncture on acupuncture in the military
The December 2011 issue of Medical Acupuncture (Vol. 4, #4) begins with a column from the dean of military acupuncture, Richard Niemtzow, MD, PhD, MPH, Col (Ret), USAF, MC, FS entitled Integrating Acupuncture into Military Medicine: Strategies and Challenges. The dozen separate contributions include a roundtable, led by Wayne Jonas, MD and including Niemtzow and Joseph Helms, MD, plus a series of military-related research projects.
Comment: Growing up in Seattle with Boeing as a near neighbor and many Boeing engineers and machinists as literal neighbors provided my original context for understanding the meaning of "defense contractors." Little did I know that in getting involved in natural healing modalities in 1983 I would once again be surrounded by them in 2012. This issue of the journal is certainly an excellent resource for anyone working in or around the military's exploration of integrative therapies in the care, treatment and resilience of its troops. (Thanks to Stacy Gomes, EdD at the Pacific College of Oriental Medicine for alerting me to the issue.)
Kreisberg-edited special issue of the Journal of Integral Therapy and Practice on integral medicine
The December 2011 issue of the Journal of Integral Therapy and Practice (Volume 6, #4) is the first full issue feature on Integral Medicine. The editor is Joel Kreisberg, DC, MA whose, known for his work in environmental medicine, green medicine andf sustainable medicine. Articles include special foci on integral psychiatry and integral nursing. The team of authors for the latter includes Barbara Dossey, PhD, RN, BC-HN, FAAN. Kreisberg offers a review of author Elliott Dacher's two books on integral health, most recently Aware, Awake Alive: A Contemporary Guide to the Ancient Science of Integral Health and Human Flourishing.
Comment: The journal's attractive subheading is: A postdisciplinary discourse for global action. Both ends of that phrase are nice. None of the author's names on the title page have degrees or disciplines attached. I was first introduced to Ken Wilbur's integral thinking via Dossey and her colleague in holistic nursing standard-setting, Carla Mariano, RN, PhD, BC-HN, FAAN, an Integrator adviser. The most significant take-home in that 2006-2007 inter-professional exploration was how much we abuse "integration" when we approach it only from right quadrants. And we have. How is it that Dr. Spock became the arbiter of optimal health?
Jill's List marks deal with Massachusetts Chiropractic Society
A January 24, 2012 release has announced that Jill's List has inked a deal with the Massachusetts Chiropractic Society through which the Society will urge its 700 members to become participating providers on Jill's List. Scott Darragh, DC, a vice president with the Massachusetts Chiropractic Society calls it "a wonderful partnership." He adds: "We are aiming to have all our 700 plus members of the MCS on Jill's List and it's a great way for us to collaborate with other practitioners, help patients get the right information about their overall health and even work with other doctors to complement our patients overall well being." Jill's List calls "all about sharing the health — the resources, information, practitioners — so consumers can have one place to go to evaluate and construct their overall comprehensive health and wellness plan." Jill Shah, CEO and founder, calls the relationship "our first of many partnerships to come with organizations who represent professionals in the Integrative Healthcare community."
Comment: I recently had the opportunity to participate in an evening event that Jill’s List founder and CEO Jill Shah facilitated in which the integrative medical leadership of all of Boston's health systems gathered together for the first time. Shah was a lead organizer of the meeting and the group met at her offices as does Boston's integrative health community, monthly. The firm thus far appears to have nested in its business model a far deeper integration of health consumers and practitioners than other similar inter-net based operations that have popped up. This firm bears watching.
AHPA’s McGuffin receives Nutrition Business Journal’s industry award
Long-time executive director of the American Herbal Products Association executive director Michael McGuffin has been selected as the winner of the Efforts on Behalf of the Industry Award by the Nutrition Business Journal (NBJ). McGuffin was chosen from more than 215 nominations submitted by the general public, as well as nominations from NBJ's editorial advisory board and the content team at New Hope Natural Media, which publishes NBJ. The vetting process included review by NBJ staff, New Hope's advisory board, and the New Hope standards team. Nutrition Business Journal is the publication of record for the nutrition, natural, organic, dietary supplement, and integrative medicine industries.
Comment: McGuffin was an executive with McZand Herbals in the late 1980s when AHPA and the industry just began to mature. Under his passionate and insightful leadership, the organization has become an able and active trade association. This is a well-deserved accolade.
Haramati and Harazduk: Is mindfulness positioned as bridge-builder in Middle East?
In a special Common Group News Service on December 13, 2011, Georgetown integrative medicine leaders Aviad Haramati, PhD and Nancy Harazduk, MSW ask if mindfulness can help bridge divisions in the Middle East? The two spoke at the Middle East Cancer Consortium (MECC), an initiative begun during the Clinton administration. The MECC was formed with the support of the Health Ministries of Israel and the Palestinian Authority and joined by Egypt, Jordan, Cyprus and Turkey. It brings together 40-50 cancer care-givers (physicians, nurses and social workers) for three days to share aspects of their oncology practice and to learn about best practices. One feature of the gathering: participants spend two hours each day together “experiencing meditation, guided imagery and even expressive movement to reduce stress and foster self-awareness.” The outcomes: “Individuals who would likely never interact with each other, much less share personal stories or feelings – come to genuinely care about each other and explicitly express such sentiments.”
Comment: Haramati has been a principal go-between for the sometimes thick cultural wars between conservative academic health center leaders and more exploratory integrative medical doctors, and between conservative academic MDs and the licensed integrative practitioners from non-MD disciplines. I have joked with him that he ought to have a hand in Mideast negotiations. This is fun to see his work and that of Harazduk directly involved in bringing those parties together in this community. My guess is that something like such mindfulness personal work with be a necessary, if not sufficient, part of the peace process if we are to ever find our way there.