February 2014 John Weeks Integrator Round-Up: Research
by John Weeks, Publisher Editor of The Integrator Blog News & Reports Employer focused Journal of Occupational and Environmental Medicine publishes report showing cost savings from naturopathic careA research team led by naturopathic physician and economist Patricia Herman, ND, PhD, has published Aby John Weeks, Publisher/Editor of The Integrator Blog News & ReportsEmployer-focused Journal of Occupational and Environmental Medicine publishes report showing cost savings from naturopathic careA research team led by naturopathic physician and economist Patricia Herman, ND, PhD, has published A naturopathic approach to the prevention of cardiovascular disease: cost-effectiveness analysis of a pragmatic multi-worksite randomized clinical trial in the Journal of Occupational and Environmental Medicine. The positive treatment outcomes of this trial were previously published in the Canadian Medical Association Journal in this study led by Dugald Seely, ND. The cost exploration by Herman, now with the RAND Corporation, was a one-year study of the care of naturopathic doctors on a population of employees of Canada Post, the Canadian government's postal service. Herman and her team estimated that "the risk reductions came with average net study- year savings of $1138 in societal costs and $1187 in employer costs." Comment: The old saw about how "it isn't what you know but how you say it" is re-framed in journal-speak to "it's not what you find but where you publish it." I recall learning a dozen years ago that corporate medical directors don't have the same hierarchy of journals as the NIH or the academic medicine community. JAMA is not necessarily the cat's meow. In fact, that journal might be rarely read. Rather, right up in the top tier of the most read list for the powerful employer stakeholder is the Journal of Occupational and Environmental Medicine. Credit the Herman team for this article's brilliant placement.The twin CMAJ and JOEM publications from this study certainly make this the most powerful single study relative to naturopathic integrative medicine. It may well be the most significant positive outcomes for any integrative medicine intervention. The value is that it is a real world context that explores all aspects of the Triple Aim: patient experience, population health outcomes and cost. We need more such trials. Many more.NCCAM's Briggs speaks of her agency's involvement in the "paradigm shift" toward pragmatic trials In a blog posting, "When to Get Pragmatic," Josephine Briggs, MD, the director of the NIH National Center for Complementary and Alternative Medicine, Briggs speaks to the need of her agency to engage in real world studies: "Many complementary approaches are readily available in the marketplace. As a consequence, NCCAM sits at the crossroads between research and real-world consumer use." For this reason, she and her agency made the decision "about 2 years ago to take on a major administrative and leadership role in an NIH Common Fund initiative called the Health Care Systems Research Collaboratory." Through this engagement with large health systems, NCCAM will participate in significant "pragmatic trials." She defines these as those that "test an intervention, or compare several interventions, delivered under conditions as close to the 'real world' as possible." Two integrated pain management studies are underway via the Collaboratory. Briggs calls this type of research "a paradigm shift in clinical research."Comment: First, credit Briggs for the direction. Examining the value of integrating complementary and alternative "modalities, systems and disciplines" with mainstream delivery was at the top of Congress' list when they passed the NCCAM mandate. It was also smart to get NCCAM into leadership of these NIH Common Fund projects. At the same time, particularly in light of the Herman-Seely publications noted above, one can't help but remark that NCCAM could do a great deal more, now, by fostering such real world examination of the impact of integrative health and medicine disciplines on populations. These outcomes suggest there may be easier, and less expensive, and more inclusive methods for NCCAM to help us understand real world impact than through this Collaboratory.