June 2014 John Weeks Integrator Round-Up: Policy

John Weeks, Publisher/Editor of The Integrator Blog News & Reports provides his monthly Integrator Round-Up of the latest news in integrative health including updates in integrative health policy, integrative health research, integrative health resources, useful data points, international integrative health, integrative health professions, integrative health people, and more

IHPC with 15 Partner Organizations Weighs in on NCCAM Name Change, and an Integrator Response

When the NIH National Center for Complementary and Alternative Medicine director Josephine Briggs, MD requested public comment on her proposal that the agency's name be changed to the National Center for Research in Complementary and Integrative Health, the Integrative Healthcare Policy Consortium (IHPC) engaged an e-dialogue between leaders of its 15 Partners for Health. These include many of the best informed policy leaders in alternative, complementary and integrative health and medicine. The Partners range from massage to integrative medical practice organizations. The entire letter is available as NCCAM Name Change: IHPC/Partners Weigh in, plus Integrator on the Name is Not the Mandate. While generally supportive, IHPC notes a strong concern that the name marks a move away from the "CAM" discipline and professions on which the agency was to focus. They wrote: "At this time in the evolution of the 'integrative' dialogue, the so-called complementary and alternative health disciplines and practices must continue to be explicitly included or they will, likely, be excluded." The letter was signed by all the Partners.

: IHPC's letter underscores that the politics of naming is huge. In a high school political campaign in 1968 for the college resume-enhancing but otherwise meaningless post of school VP (which I lost), I was successfully labelled "wishy-washy Weeks" for my back-and-forth swing on a position regarding open campus privileges. I remember that flip flop as I watch myself go all over the map on this name-game:

  • hating the limits and disrespect implicit in the "CAM" box;
  • knowing that "CAM" is the only way many of the integrative health disciplines exist in the affordable care act, and still do in NCCAM;
  • knowing that "alternative" is anathema to the MDs which whom we must one day integrate;
  • believing that we want "alternatives" to what the mainstream offers;
  • knowing, as noted in the IHPC letter, that for many so-called "integrative" MDs and the systems in which they work, "integrative" means MDs plus behavioral health, PT, nursing and dieticians;
  • knowing that "integrative" often leaves the "CAM" modalities, systems and disciplines on which NCCAM is supposed to be focused on the cutting room floor; and
  • knowing that NCCAM itself has successively shunted the "CAM" fields to the side in favor of members of its own more comfortable tribe of MDs and PhDs from conventional academic health centers.

In an extensive comment field also noted in the article referenced above, I share my perspective that more important than the name is what NCCAM is, or is not, doing with the unchanged mandate. Evidence is that the change of the name is only acknowledging what the agency has already done in leaving its mandated relationship to the licensed CAM disciplines behind. One sign: instead of at least 50% of its members from the licensed "CAM" fields ("integrative medicine" is not mentioned in the mandate nor did the field much exist in 1998), the 18 member National Advisory Commission on Complementary and Alternative Medicine now has just two licensed CAM members. It's long past time for some organizing to right that course or the "CAM" disciplines and institutions that NCCAM remains mandated to research will remain, forever, in a dusty backwater of science with little or no skin in the evidence game.

A perspective on the reason to keep "alternatives" from Nancy Gahles, DC, CCH

After I sent an Integrator push to urge readers to respond to the NCCAM call regarding the proposed name change, I received permission to post the following impassioned view from reader and sometimes contributor Nancy Gahles, DC, CHT. Gahles shared this with the Integrative Health Policy Consortium (IHPC) members as part of their dialogue, reported above. Gahles notes that "all capitals are my own emphasis and passion."

"This is a link to an article in the Orlando Sentinel that I believe tells the story of the fast moving trend of 'conventional' medicine to 'integrate' alternative medicine into their practices. That would be known as the practice of medicine. Notwithstanding the fact that the round peg in a square hole theory would prevail as the philosophies of conventional and alternative medicine are distinctly different.

"Note paragraph #5: "...more mainstream medical practitioners incorporate therapies ONCE CONSIDERED alternative into their conventional practices." And paragraph #6: "...students are learning how to make UNCONVENTIONAL therapies part of conventional treatment plans."

"Couple this article with the recent survey from infectious disease docs who said that they would be comfortable with alternatives IF they were able to incorporate them into their practices and you have the run-away integrative MEDICINE train. Then add in the American Board of Holistic and Integrative MEDICINE and take a look at the required courses and you will see a 1 credit course in homeopathy taught by an MD.  And will the "A" in ACCAHC come out? What about "Alternative Therapies" magazine? What about "alternatives" to opioids for pain management that are so desperately needed.

"Alternative is honorable. Alternative allows for exploration of possibilities OUTSIDE of the conventional. Alternative requires the courage to dare to be different.

"At the risk of being banal, the dictionary does describe 'alternative' as 'a choice limited to one of two or more possibilities, as of things, propositions, or courses of action, the selection of which precludes any other possibility: You have the alternative of riding or walking.' For all intents and purposes, in this context, we have the opportunity to name an agency that is required to research the possibilities, the alternatives to the conventional system of drugs and surgery that clearly do not have the solutions.

"In considering the NCCAM name change I stand firmly in support of keeping the word 'alternative' squarely in the research opportunity field.

"It is only in exploring and discovering the mechanisms of action and the implications of whole systems of alternative medicine that one can truly understand how to utilize them appropriately to first, do no harm and second, achieve the highest ideal of cure. When that has been accomplished there can be discovered areas of complementary action and conditions and situations that lend themselves well to that such as Arnica and surgery.

"The field of integrative health is being defined right now, as we are all abundantly aware.  Alternative medicine, whole systems of medicine, must stand alone in the right to share in the research funding available in order to further its integration into the health care delivery system of the US.

"The price of freedom is eternal vigilance", as Thomas Jefferson said.

: My own stubborn, and, okay, vigilant connection to "alternative" comes from a strong belief that if Donald Berwick, MD is talking to regular medicine about how "radical" a change is his vision of "health creation" compared to the focus of the medical industry that dominates today, our letting go of the radical "alternative" our movement represents is too early of a concession. We should not be supporting the idea that merely "integrating" a few therapies and modalities, or even adding an acupuncturist or massage therapist to a team, is the endpoint. This disregards the values origins in this work.

Take the Pledge
: Don't say "healthcare system" when describing "disease treatment" or the medical industry"

Language it's a virus, as performance artist Laurie Anderson sings. Do we harm our discourse about the future of health and medicine by a laziness of language that has us speaking of "health care" or a "healthcare system" when what we are describing is neither? This column reprinted here in the Integrator makes the case that all players in health and medicine should exercise greater consciousness of their word choices when talking about medicine, health and the business of producing medical procedures. Might the effort to liberate "health care" from the "medical industry" and the "disease management system" benefit from higher consciousness about our language? Might such attention to language help us identify what we are doing when we are in fact moving toward "health creation"? The column sets the stage with a parallel language issue that mystifies reality amidst the horribly challenged economics in the colony (not country) of Puerto Rico.

: A mentor warns that this campaign over language will alienate those whose choices are, once the sorting by category begins in earnest, squarely motivated by the profit interests in the medical industry. Clearly, some therapeutic choices made by all types of practitioners, including "CAM" and integrative providers, are stimulated by concern over business returns and personal income. I think of programs for patients with more visits than may be necessary and of sales of some products or tests.

Here is a case in point regarding re-languaging that is included in the column. Former Center for Medicare and Medicaid Services administrator Donald Berwick, MD, recently elevated the concept of "health creation" as the optimal focus of the U.S. policy and practice in medicine and health. Berwick shared how it is "fortunately commonplace now to say that we would be better off to re-direct some of our healthcare enterprise from fighting illness to pursuing health, going from health care to health creation." Look at Berwick’s language. In fact, we are not "going from health care to health creation. His communication would have been clearer had he said that we need to re-direct some of our disease management enterprise from fighting illness to pursuing health, going from disease treatment to health creation."  Perhaps better would be "from our medical industry's focus on production of services to health creation."

Such a correction of language would better project the distance across a great chasm that we must travel than does "from health care to health creation." The movement for women's liberation required us to re-think our common use of male pronouns to refer to all of humanity. Perhaps the effort to liberate health creation from the medical industry will require a similar shift of consciousness in our language. Will you take the pledge?   [Italics added.]