November 2015 John Weeks Integrator Round-Up
Harvard Team Promotes Spread of Mind-Body Practice as Broad as Vaccinations after Finding 43% Reduction in Use of Healthcare ServicesThe title of the open access article at PLOS from a Harvard Benson-Henry Institute mind-body team is “Relaxation Response and Resiliency Training and Its Effect on Healthcare Resource Utilization.” The team took a retrospective look at healthcare utilization of more than 4000 patients in the Relaxation Response Resiliency Program (3RP) and compared them to a usual care cohort. The finding: “At one year, total utilization for the intervention group decreased by 43%, clinical encounters decreased by 41.9%, imaging by 50.3%, lab encounters by 43.5%, and procedures by 21.4%. Measured by dollar, reduction was estimated as “on the order of $2360/patient/year.” The authors note that “this reduction is on the order of that found by 3 other groups in “other similar time-limited interventions.”Their Policy Recommendation: “The data suggests that the intervention should be applied to all at risk populations, since the intervention has minimal risk, minimal cost and yields substantial benefits for patients with a wide variety of illnesses. The long-term effect of these interventions on healthy populations is unclear, but the data suggests that mind body interventions should perhaps be instituted as a form of preventative care similar to vaccinations or driver education. Such interventions are likely to be useful in population management and supported self-care, have negligible risk and cost and may help reduce the demand curve in healthcare. While the risk benefit ratio of this intervention is very favorable to further elucidate the effect size a prospective evaluation is called for.” The 3RP work began with research by Herbert Benson, MD 4 decades ago and evolved into a group-delivered intervention developed by Benson and Eileen Stuart, RN, PhD and others starting in the 1980s.Comment: This is a very important paper showing a huge reduction with tremendous potential personal and socio-economic benefits. Imagine the headlines if a pharmaceutical was found to have this impact. Given the cost crisis in US medicine, a network of trials should immediately begin with multiple populations in diverse social and cultural settings to see how well these findings can be replicated. To not do so is unconscionable for anyone who thinks we have a crisis in our medical delivery industry and who sees how medicine’s voracious appetite is devouring the ability of the USA to deliver other basic human services. Then again, if one is whirling in the cash of the 3-trillion industry like Slim Pickens riding the bomb in the 1964 classic, Dr. Strangelove, this Harvard study is one to brush aside, like a gnat.American Public Health Association Resolution Includes Language from Chiropractors, Others, Elevating Integrative Approaches against Opioid OveruseThe past chair of the Chiropractic Health Care Section of the American Public Health Association (APHA), Michele Maiers, DC, MPH, PhD took the lead on a campaign two years ago to get the powerful organization to pass a resolution based on Recommendations for Policy Makers in the Never Only Opioids policy paper. Never Only Opioids was developed through the Academic Consortium for Complementary and Alternative Health Care. Maiers shared with the Integrator that when the chiropractors effort got tangled in some challenging interprofessional politics, she and colleagues changed course and offered amendments to a separate policy statement championed by public health nurses. They proposed and had incorporated changes noted in bold, below:
“[APHA] Urges public health and public policy education programs to prioritize and implement evidence based community and provider training programs on mental health, non-pharmacological pain treatment alternatives, substance abuse and overdose prevention...
“[APHA] Urges pain prescription providers to be educated on identifying, and treating pain with alternative modalities and to coordinate pain management with complementary and integrative care providers.”
The policy statement, entitled “A5: Prevention and Intervention Strategies to Decrease Misuse of Prescription Pain Medications,” was passed by APHA on November 3, 2015. It was championed by Cynthia Stone, DrPh, RN from the APHA’s Public Health Nursing Section.Comment: Sometimes fun to recall how the sausage of policy is made. Here’s a re-cap of some of the inputs, for those counting. An interprofessional ACCAHC team lead by Martha Menard, PhD, LMT creates the Never Only Opioids paper. (I had the opportunity to be on the team.) NCMIC Foundation provides a grant to support publication. It is published through the 40-organization Pain Action Alliance to Implement a National Strategy (PAINS) to give it more stature. A group of chiropractors begin championing the theme and Maiers takes the lead in moving it toward an APHA resolution through the Chiropractic Section. The APHA Section on Integrative, Complementary and Alternative Healthcare Practices provided some support. When the chiropractic-led initiative hit prejudice-based road-blocks, Maiers and her team turned to the Public Health Nurses, who incorporate supporting language. It is passed by APHA. Nice. Now, here’s hoping that the chiropractors will persevere in promoting a more powerful version. Good work!Take Action! IHPC Joins Campaign to Guarantee Quality GMO LabelingThe Integrative Health Policy Consortium (IHPC) has issued a call to action to derail the misleadingly titled "Safe and Effective Food Labeling Act of 2015" (H.R. 1599). The industry backed bill does not require mandatory labelling of GMOs and includes a clause “that legally restricts states from passing their own labeling laws to protect their citizens!” The bill, according to IHPC, “snuck through Congress and is on its way to the Senate.” They urge registering opposition to HR1599 and also support of a separate bill, S. 511, sponsored by California Senator Barbara Boxer that “supports mandatory GMO food labeling, and can be found here.”I’ll Be Baack: APHA Panel Explores Sustainability and the USA Dietary Guidelines Issue, Points to 2020 ReturnThe October 2015 Integrator Round-up highlighted the battle over adoption of a whole systems view that would put sustainability considerations into USA Dietary Guidelines. Such inclusion, denied by industry-influenced federal agencies (Agriculture, Health and Human Services), could, if included, impact policies related to transportation, energy, farming, economics and environment, to name a few. On November 2, 2015 at the American Public Health Association’s annual meeting in Chicago the following trio were part of a panel focused on the issue: Roni Neff, PhD, MS from Johns Hopkins, Kim Robien, PhD, RD, from George Washington University and David Wallinga, MD, MPA with the NRDC took up the subject. Robien noted that the 2010 guideline acknowledged sustainability as an issue but did not directly address the issue. Wallinga discussed a billionaire-funded foundation strategy that is seeking to move the Guidelines work to the Institute of Medicine. In comments after the session, Wallinga shared that plans are already beginning= toward a campaign to successfully include sustainability provisions in 2020.Comments: The quality of the coalition on this is extraordinary – including not only NRDC and Hopkins but the Sierra Club, Citizens for Science in the Public Interest, and many more. The Integrator is planning a Reader Forum on the topic. Stay tuned. Meantime, consider this excellent blog on Embracing Complexity in the Guidelines by Integrator reader Jamie Harvey of Commons Health. Harvie’s post was written last spring and includes excellent links, including this from Marion Nestle’s Food Politics blog. Harvie states that “the arguments that individual health is somehow isolated from the health (or sustainability) of our food system are the frantic, specious, cries of a failing industrial food industry.”
Business Group Webinar Argues That “The Future of Health Care is Complementary, Integrative and Holistic”The title of the November 17, 2015 (11:30 AM ET) webinar captures the dreams and beliefs of many in the integrative health and medicine movement: The Future of Health Care is Complementary, Integrative and Holistic. The difference is that the sponsors include two employer organizations: the American Sustainable Business Council and the Holistic Chamber of Commerce. They combined with the Integrative Health Policy Consortium (IHPC). Speakers include John Hamlin, Director of Human Resources at New Belgium Brewing, Kent Bradley the former Chief Medical Officer of Safeway, and Wayne Jonas, MD, CEO of the Samueli Institute. One focus is Section 2706, Non-Discrimination in Health Care. To sign up, click here.Comment: How pleasing when someone else runs your own copy: “One of the most important developments in American healthcare is the growing use of complementary and integrative options like acupuncture, massage therapy, midwifery, chiropractic and naturopathic medicine. These therapies have been increasingly shown to deliver excellent outcomes with high levels of personal satisfaction and often at lower costs than standard care alone. This is why corporate wellness programs are beginning to use these complementary and integrative health options.” Looking forward to the regular Chamber catching up with these leading edge, whole system, business types.International Chiropractic Association Endorses IHPC’s Cover My Care Initiative (2706)A note to the Integrator from Alyssa Wostrel, executive director of the Integrative Health Policy Consortium (IHPC) shares that the International Chiropractic Association has fully endorsed via this release IHPC’s CoverMyCare campaign. ICA “encourages all organizations in the chiropractic profession to become familiar with and engaged in its promotion and its utilization.” Wostrel thanks to ICA vice president Steven Welsh, DC “for his lead with ICA on behalf of CoverMyCare and especially for the outreach program to the state chiropractic associations through the Congress of Chiropractic State Associations.” She adds that “this is the perfect model of engagement for IHPC and CoverMyCare as it provides a link to the state associations so we can stay engaged and current with those leaders about state level activities regarding Sec 2706.”
Hello Gabby! Boston Group Uses “Embodied Conversational Agent” to Enhance Integrative Medicine Group VisitsThe low-tech, high visibility work of the Paula Gardiner, MD, MPH-led group at Boston Medical Center in integrative medicine group services is now being explored with a high-tech addition. The new component, according to team member Kelly McCue, MPH in a presentation at the American Public Health Association, is “embodied conversational agent” known to the team as “Gabby.” In a trial, Gabby – presented via an 8” Dell tablet - received high marks from trial participants in the safety-net setting in “reducing stress” and “talking about healthy eating.” Gabby proved useful in helping participants maintain positive habits and extend the duration of the value of the group visit intervention.Comment: Fascinating tool. This is a surprising and interesting advance on the pioneering work of the Boston University team that recently netted a quality piece in Health Affairs. (See “Health Affairs Features Katherine Gergen Barnett, MD on BMC's Integrative Group Visits Program” at this July 2015 Integrator Round-up link.) Great low-tech and high-tech mix.Upper Chesapeake Health Links with Maryland University of Integrative Health for Integrative CareOn November 2, 2015 Maryland University of Integrative Health (MUIH) announced that the multidisciplinary MUIH and the University of Maryland Upper Chesapeake Health (UCH) have signed a partnership agreement. Under the agreement, MUIH graduate student interns will collaborate with physicians, nurses and other health providers at UM UCH to develop and offer an integrative medical model. Among MUIH degree programs are herbalism, acupuncture and Oriental medicine, Yoga therapy, health couching and more.MUIH president Frank Vitale framed the partnership with reference to a view that “the future of healthcare in this country depends on a model that embraces collaboration and cooperation among providers and patients." He adds: “This agreement between a university dedicated to natural medicine and a health system dedicated to the optimum patient experience is a small step with the potential for enormous impact." In the release, Lyle E. Sheldon, FACHE, president and CEO of UM UCH offers this perspective: "Treating the whole person, not just the disease or symptoms, is an integral focus in the UM UCH Kaufman Cancer Center," said. "Our affiliation with MUIH enhances our integrative health therapy services to promote balance of mind, body and spirit-a cornerstone of the mission of UM UCH." UCH, the leading medical delivery organization and largest private employer in Harford County, consists of the Upper Chesapeake Medical Center, the Patricia D. and M. Scot Kaufman Cancer Center in Bel Air and the Harford Memorial Hospital in Havre de Grace.Comment: It will be interesting to see how deeply imbedded MUIH’s students can become in assisting UCH’s requirements to cap and lower costs, under the unique system of hospital cost controls in Maryland. Hopefully this will be a workshop from which other can learn. (Alignment of interest note: I consult with MUIH.)Pharmacy Times Offers Business Care Portrait of Dallas-Based Integrative Flower Mound Pharmacy and Herbal AlternativesAn integrative pharmacy in Dallas, Texas, Flower Mound Pharmacy and Herbal Alternatives is reported in Pharmacy Times to be an exemplary integrative pharmacy. The business flavors itself as “a family-owned, innovative practice with an integrative approach to health through medicine, supplements and nutrition.” The October 22, 2015 article notes that the pharmacy is gathering outcomes data and has achieved “measurement of reductions in cholesterol, A1C, and blood pressure seen with drug therapy and integration of supplements and lifestyle changes.”The integrative component is good for the bottom line, according to the article. The writer notes that community pharmacy revenues from prescription fees “have been progressively shrinking.” Yet at Flower Mound, the owners take “a 3-pronged approach—comprising prescription fees, OTC and dietary supplement sales, and clinical services and consulting fees—to ensuring its long-term financial sustainability.” While revenue from prescriptions accounts for more than 70% of total gross revenue, these provide less than 10% of gross profit. The larger portion of profits is in vitamin and supplement sales and related consultations: “Scheduled private consultations paid for by the patients provide an additional $12,000/year in revenue. In addition, these consultations drive dietary supplement sales, which amount to more than $250,000/year.”Comment: Nice when “doing good” means doing well. Fifteen years ago some of us placed a line in some Design Principles of Healthcare Renewal that “the renewed healthcare system is a partnership between an expanded commitment to the public health and a thriving industry of health creation.” Flower Mound looks to be a piece of such an industry’s contribution.Quick Links to Integrative Medicine News in Medical Systems and Communities: October 2015This Integrator feature captures highlights from stories on the web relative to integrative medicine in the prior month. Here are 31 involving medical delivery systems and 13 more in communities. Included is the remarkable move in Oregon Medicaid to cover massage, acupuncture, chiropractic and naturopathic services in pain treatment with the intent to limit opioid addiction. Check the effective, short interview with Penny George, the first Bravewell chair. Great post from Yale IM leader David Katz, MD, MPH taking on the polarization-based medicine leaders. Out in the community, naturopathic and homeopathic clinician and educator Amy Rothenberg, ND offers a short series of videos on her own cancer process.Is Regular Medical Delivery Creating Openness through New “Rules for Radical Redesign”?Some of the most progressive forces in regular medical delivery, acting through the Institute for Healthcare Improvement, have published New Rules for Radical Redesign in Health Care. Do you see in these a noticeable move toward integrative health and medicine values and practices?
1. Change the balance of power by co-producing health and well-being in partnership with patients, families and communities.2. Standardize what makes sense to reduce unnecessary variation and increase the time available for individualized care.3. Customize to the individual's needs, values and preferences, guided by the understanding of what matters to the person, in addition to the typical "What's the matter?"4. Promote well-being and focus on outcomes that matter the most to people, appreciating that their health and happiness may not require health care.5. Create joy in work by cultivating and mobilizing the pride and happiness of the health care workforce.6. Make it easy, continually reducing waste and all non-value-added requirements and activities for patients, families and clinicians.7. Move knowledge, not people, exploiting all helpful capacities of modern digital care and continually substituting better alternatives for visits and institutional stays.8. Collaborate and cooperate, recognizing that the health care system is embedded in a network that extends beyond traditional walls.9. Assume abundance by using all the assets that can help to optimize the social, economic and physical environment, especially those brought by patients, families and communities.10. Return the money from health care savings to other public and private purposes.Comment: So much of this reads like an invitation. Numbers 1, 3, 4, 5, and 8 each have deep roots in the integrative health and medicine field. Yet there is no mention anywhere that anything like integrative health and medicine exists. If there is awareness of that field among these leaders – as has been noted by IHI leader Don Berwick, for instance - is this a failure to acknowledge and credit one’s sources? Is this a kind of plagiarism of ideas? Why not credit the outsiders who have been promoting these values for decades? Or is this simply movement toward similar values from different starting places in separate silos? Bottom line for “movement” people is that one of the rules for radicals is not to care who gets the credit. Nice to see these values articulated. And they are radical. Can you help with the redesign? Here is the link at the IHI site.
Bastyr University Begins First MPH Program in an Integrative Health InstitutionBastyr University in Kenmore, Washington is now offering a Masters of Public Health (MPH) degree program among its roughly two dozen degree programs. The program has a specialization in community health education. Graduates of the two year program are expected to find a positive job market as “public health workers who specialize in community health education are projected to grow at a rate that is significantly higher than average over the next eight years.”Comment: I believe this is the first MPH program based in an institution that specializes in integrative health and medicine. Curious whether the program is a more or less a cookie cutter of what one might be seen in any other MPH program, or whether the program is infused with integrative health values. This is not immediately clear from Bastyr’s site. The program will focus on giving graduates the ability to “apply human rights and social justice principles to public health problem.”
First AIHM Congress Draws 900, Fuels Interprofessional Fellowship, Boosts Membership, Dream-Builders, and Association Leadership Council
Former Ornish Team Members Scherwitz and Kesten Lead Lifestyle Conference in Ecuador
The town of Cuenca, Ecuador, will host a 3-day Congreso Internacional Estilo de Vida Saludable through its Casa de la Diabetes November 11-13, 2015. The leadership of the gathering, reportedly the first of its kind in Ecuador, is through recent ex-pats in Ecuador Larry Scherwitz, PhD and Deborah Kesten, MPH. Authors and educators, Scherwitz and Kesten were the lead scientist and nutrition expert, respectively, on the first research on Dean Ornish, MD’s program to reverse atherosclerosis through an integrative lifestyle program. Another lead presenter at the event is Oregon-and-California-based Ryan Bradley, ND, MPH.
Comment: In an e-dialogue with the Integrator regarding the conference, Scherwitz shared this blog post that tells the story of the origins of the groundbreaking Ornish program. (Anyone else out thre think that Ornish deserves a Nobel in Medicine for shocking the medical establishment with the power of natural health care in reversing atherosclerosis and later, extending telomeres?) It appears that Scherwitz and Kesten are hardly dropping out of their life’s work in their new Andean community.
Global Integrator Round-Up from Global Advances in Health and Medicine for October 2015
The October Global Integrator Round-up from Global Advances in Health and Medicine Journal includes 8 short pieces including: a review of activities in multiple nations on Africa Traditional Medicine Day; a notice on the need to fund research by, and about, the clinicians who provide the most Western care in Africa, namely nurses; an unusual Canadian naturopathic college collaboration with Rwanda researchers shows promise for supplemental selenium; the Dr. Roger’s Prize of $250,000 that went to the immensely deserving Heather Boon, PhD, at the University of Toronto; an ambitious initiative to galvanize integrative initiatives in Scandinavia via the new Nordic Integrative Medicine; and theQuick Links to Global News in Traditional, Alternative, and Integrative Health and Medicine for August 2015 with 75 one-liners on myriad global activities in traditional medicine.
Boston Patriots QB Tom Brady Advocates an Integrative Model
A recent media alert from Bastyr University began with a statement that the institution “and 4-time Super Bowl champion Tom Brady have something in common: we know about the benefits of natural medicine.” The message links to this radio interview in which, among other topics, Brady opines on how his view of medicine differs from the mainstream: "That's kind of [the conventional] approach to medicine -- let's wait until you get sick, let's wait until you get hurt, oh, and then we'll treat you. Well, how about finding ways to try to prevent yourself from that even happening? I think that's a much better approach to medicine. When you say, 'This sounds like quackery', well, there's a lot of things I see on a daily basis in Western medicine that I think, 'Wow, why would they ever do that? That's crazy. It doesn't work.' But that's just the way life is; I think a lot of things that are the norm, that are very systematic, don't work."
Comment: As a Seattle Seahawks guy, hard to give it up to Mr. Deflategate on anything. But hey, politics makes for strange bedfellows.
Is There a Role for You in Right Language to Release the River of Health from the Medical Industry?
Confucius said: “The beginning of wisdom is to call things by their proper name.” Mark Twain said: "The difference between the right word and almost the right word is the difference between lightning and a lightning bug." These quotes were shared with me by colleagues Suzanne Snyder and Greg Bush, MPH, respectively, when I shared with them the gist of a column I recently had published in Global Advances in Health and Medicine Journal. The title: Right Language to Release the River of Health from the Medical Industry.
In the column, I take off with the unveiling and empowering that came with President Obama’s renaming of Mt. McKinley as Denali to cast light on how the concept of “health” has been bruised and buried by misappropriation. Should we use “health” when we are referring to the practices of a medical industry that is focused more on production of procedures or, at best, sick care, than on health care, or on, as Don Berwick, MD has called it, “health creation.”
The column concludes with this recommendation: “To foster the liberation of the health creation enterprise, consider committing to these everyday language changes. In the place of routine use of healthcare system’ speak of the ‘medical delivery organization.’ Use ‘disease treatment’ or ‘symptom suppression’ when these describe the boundaries of the intervention. If motives in a given context are substantially focused on production of procedures, call that ‘medical industry.’ If a clinical or community strategy takes on the holistic view of engaging the causes, then consider ‘healthcare.’ The exercise is not punitive. Each type of intervention can be useful. Clarity of purpose is the goal. Call salt, salt and pepper, pepper. Call sick care what it is. And call the unsolved puzzle of health creation honey. Each right use will help release the river of health.”
Comment: The quotes sent by my colleagues convince me further that this conscious use of language is critically important. Listen to yourself and others. See if you don’t get a wee bit offended when “health” is abused. Let’s liberate it from false patterns of expression. (If you cannot access the column and would like to read it, send me a request to [email protected].)
David O’Bryon the new Chair of the Academic Consortium for Complementary and Alternative Health Care
In an October 12, 2015 newsletter, the Academic Consortium for Complementary and Alternative Health Care (ACCAHC) announced that David O'Bryon, JD, CAE was elected ACCAHC chair. O’Bryon is the long-time president of ACCAHC core member organization, the Association of Chiropractic Colleges. He also currently serves as the co-chair of the Advisory Council of the National Association of Advisors to the Health Professions. O’Bryon states: "ACCAHC continues to be a guiding force in integrated health care and I hope it continues to provide its member organizations leadership opportunities to enhance the health care system." One of the founders of ACCAHC, he previously served as the board's vice chair. He replaces Elizabeth Goldblatt, PhD, MPA/HA who was selected by the board as a new co-executive director of ACCAHC with Martha Menard, PhD, LMT.
Comment: O’Bryon was an early visionary in the chiropractic community who saw the value in the interprofessional engagement ACCAHC represents. His leadership extends to key roles with the Integrative Health Policy Consortium particularly in the area of policy where his background in successful lobbying for chiropractors has been particularly valuable.
Anne Doherty, LAc, MPH Chairs APHA Section on Integrative and Traditional Practices
The former director and organizer of the pioneering integrative cancer program at Dana Farber Anne Doherty-Gilman, MPH has stepped up to chair the Integrative, Complementary and Traditional Health Practices Section of the American Public Health Association. She takes over from her close Boston colleague Beth Sommers, LAc, MPH, PhD whose term has seen what was a CAM special interest group successfully gain elevation as a full Section as its membership doubled to nearly 500 members.
Comment: The Sommers-Doherty duo has brought powerful advances to this work inside the huge APHA machine. Here’s looking forward to the new advances under Doherty’s leadership.
Gladys Mc Garey, Jean Watson and Deborah Szekely Honored by AIHM
In its first award ceremony, the Academy of Integrative Health and Medicine chose to honor three powerful pioneers. Two are novogenarians. Gladys Mc Garey, MD of the Foundation for Living Medicine was honored with the Lifetime Achievement Award. San Diego local, Deborah Szekely, known as the Godmother of the Wellness Movement, received the Change Maker Award for work as activist, philanthropist and writer. Jean Watson, PhD, RN of the Watson Caring Science Institute, was awarded the Visionary Award for caring science leadership. The award descriptions are here.
Comment: Of the three, Mc Garey is the one with whom I have had the opportunity to connect with over the years, going back to the early 1980s. Most recently her close aide and CEO of her Foundation for Living Medicine Rose Winters contacted me for a brainstorm when Mc Garey decided to take on Congress a few years back at the youthful age of 90. Wow! All I felt was: Bow down! Three lives well-lived.