September 2015 John Weeks Integrator Round-Up
Report Published on Integrative Health Policy Day – with Commitments of Participants - to Honor US Senator HarkinThe broad collaboration that honored US Senator Tom Harkin, on his retirement with a late September 2014 policy day has published proceedings under the same title: “A Call to Action on Integrative Health and Medicine Policy – Advancing the Legacy of U.S. Senator Tom Harkin”. Harkin was, sequentially, a champion for chiropractic, alternative medicine, complementary and alternative medicine and finally integrative medicine and health, over a 30 plus year career. The day was convened by a collaboration the primary sponsors of which were ACCAHC, ACIMH, AIHM, IHPC, IIH, Samueli Institute, Life University, and Georgetown University, where the event was held.The booklet, edited by D.C.-based integrative health consultant and sometimes Integrator contributor Taylor Walsh with support from IHPC’s Alyssa Wostrel and John Weeks (then with ACCAHC), includes excerpts of talks in two themes categories. The morning sessions focused on a review of progress and changes since a 2010 post-ACA symposium similarly co-led by the Integrative Health Policy Consortium (IHPC – see Affordable Care Act and Beyond: Report from the Stakeholder Conference on Integrative Health Care) In place of a plaque, the participants chose to honor Harkin with what Wostrel called “inspirational commitments made by symposium participants.” These on pages 37-40 of the report. Excerpts from the tributes given to Senator Harkin, by former Congressman Berkley Bedell, US Senator Barbara Mikulski and others are on pages 41-43. Senator Harkin’s remarks follow.Comment: One of Harkin’s contributions – among the multitude noted in the proceedings – is a message he gave to activists in the mid-1990s. If they wanted to have an impact in Congress, they would be served to learn to collaborate and speak as a single and thus more powerful voice. It is especially fitting that the planning team for this invent was, in fact, the broadest collaboration to ever get behind, sponsor and plan a single integrative health and medicine policy event. It is fitting as well that the report is hosted on the site of IHPC, the founders of which took Harkin’s message to heart. IHPC’s 16 Partners for Health organizations and the collaborative accomplishments – which now include closing the loop with this remarkable event – speak to the value of the Senator’s tutelage.
Dismal Outcomes, New Directions: American Botanical Council Feature on NCCIH’s Botanical Strategy - Past, Present and FutureThe American Botanical Council has published an 8-page look at botanical research at the National Center for Complementary and Integrative Health (NCCIH). The author is NCCIH’s chief program officer for botanicals, Craig Hopp, PhD. ABC’s founder and executive director Mark Blumenthal prepares readers for what it to come in his overview note for the issue. He notes that of NCCIH-funded botanical trials, “most have resulted in less than encouraging outcomes.” The article, entitled “Past and Future Research at NCCIH with Respect to Botanicals,” includes a remarkable table showing outcomes of 17 NCCIH-funded trials. A not-so-sweet 16 include a variant of “no detectable benefit” as the chief outcome. The single positive trial, on cranberry extract for prevention of urinary tract infections, resulted in a less than enthusiastic “may be beneficial in some populations of women.” Hopp speaks to the subsequent decision of NCCIH to no longer fund trials on herbs that focus on specific diseases. Instead, NCCIH is taking on basic research in such areas as the emerging “omics” and “network pharmacology.” The latter reflects the emerging awareness that an herb may have a multitude of impacts on an organism.Comment: The publication of this article by ABC in its flagship journal Herbalgram is gutsy. What is the herb-prescribing and herb-using community to make of these findings? Hopps is a good guide though NCCIH’s thinking, while letting the data speak for themselves on the findings of minimal effectiveness. The basic question, however, stays on the table, begging for a metaphor of, say, is there an elephant in the room? Meantime – see the piece below under Cost – dietary herbal supplement sales were up 6.8% in 2014.
Glenn Sabin: Names, Nomenclature, Trends – Where We Are Headed?Integrative center consultant and Integrator adviser Glenn Sabin has stimulated a good deal of chatter with his recent blog: Names, Nomenclature, Trends – Where We are Headed. Sabin’s post is based on trends in Google search terms from 2005 to the present in the continuously evolving what-do-we-call-ourselves world of (now) integrative health and medicine. While “alternative medicine” continues to lead, searches for that term are in a marked decline. “Complementary medicine” is also sliding. Bumping up at high rates relative to past usage are “functional medicine” and “integrative health.” The term “integrative medicine” held pretty steady. Sabin concludes: “While it’s interesting to view search trends of the subcategories of integrative health and medicine, and the steady rise of functional medicine, the biggest takeaway I see is that the industry continues to have a significant branding challenge.”Comment: Missing from Sabin’s analysis are the terms “holistic health” and “holistic medicine.” On the instigation of Molly Roberts, MD, a past president of the American Holistic Medical Association, Sabin ran a similar query that included those titles. Roberts shared them with the Integrator. Remarkably, “holistic health” and “holistic medicine,” while in a decline that stabilized in 2009, rank higher than “alternative medicine” and significantly higher than the “integrative” names.The name game in this field always brings to mind the 1996 decision of the then marketing genius Oxford Health Plans when it chose to name its pioneering coverage program “alternative medicine.” The HMO tested various names and found that their prospective members called the services of acupuncturists, naturopathic doctors, chiropractors and others “alternative medicine.” I suspect that the evocative “holistic” terms fall into a similar patient-friendly category. That “functional medicine” is on the rise may in part be due to the fact that, like “alternative” and “holistic,” “functional” strikes an immediate chord for the average person. Part of the branding problem that Sabin references may be due to a misalignment between what medical professionals deemed was the best term and those that ring true for their patients. Interesting thought piece, Glenn!
French and German Mixed Results on Homeopathy Costs; Possible Public Health Role?Two recent studies reported here in the Global Integrator Blog analyzed the impact of access to homeopathic services on national health costs. “Economic impact of homeopathic practice in France” reported a 20% reduction in costs for patients of medical doctors using homeopathic care. Though visit costs were higher, pharmacy costs were lower. Fewer drugs of significant public health interest such as antibiotics and pain-killers were prescribed. Overall the conclusion was that “management of patients by homeopathic (general practitioners) may be less expensive from a global perspective and may represent an important interest to public health.”Meantime, an analysis in Germany that asked if “homeopathic treatment can save costs” found quite the opposite. A research team that included Claudia Witt, MD, concluded that “compared with usual care, additional homeopathic treatment was associated with significantly higher costs.” The researchers added: “These analyses did not confirm previously observed cost savings resulting from the use of homeopathy in the health care system.”Comment: If one only had the French study, one might pose this Triple Aim question: What if homeopathics are nothing better than placebo, clinically, yet 1) lower costs, 2) please the patients and enhance their experience of care, and 3) have a positive impact on population health by limiting prescriptions of problematic pharma? Bingo on the Triple Aim. Interesting conundrum, especially for those who can’t get over that issue about potency and Avogadro’s number. The Queen’s Physician in the United Kingdom, homeopathic doctor Peter Fisher, MD promotes the public health value in his recent opinion piece on homeopathy in the British Medical Journal. Of course, if the conclusions of the German study prove to better characterize the cost realities, the Triple Aim claims for homeopathy are then perched on a teetering two-legged stool.
Botanical Sales up for 11th Straight Year: 6.8% to $6.4 Billion in 2014The American Botanical Council, working with the Nutrition Business Journal and others has published is annual market report for herbs. In 2014, for the 11th straight year, sales of “herbal dietary supplements” were up. They jumped 6.8%. This was down from the 7.9% in 2013 yet the second biggest jump of the millennium. Some lead performers in terms of year over year sales were Echinacea (up 79%), cranberry (up 16%), elderberry (up 64%), turmeric (up 60%) and ivy leaf (up 379%). Ivy leaf was new to the top 40 list. Saw palmetto, flaxseed and rhodiola were among those for which sales dropped. The authors note that some in the industry are concerned that the steady growth may end in 2015 following the negative publicity in particular from the New York attorney general’s non-scientific attack on the field.Comment: From time to time, the best commentary on a situation is Van Morrison’s line from Wild Night: “All the girls walk by dressed up for each other/and the boys do the boogie-woogie on the corner of the street.” Here the NIH researchers (see article under Policy, above), dressing up for each other, while the citizen as consumer pay no mind while keeping up the boogie-woogie of botanical purchases. The Herbalgram editors ran the two stories back to back.
Triple Aim to Trickle Up: Conventional Medical Students (Finally) Being Taught about Cost, Value, and EffectivenessA recent Kaiser Health News article marked an important threshold for bringing sanity to medicine in the USA. Here is the lead in: “It might seem natural for new doctors to learn about the cost of the care they’re providing, but, in fact, doctors have been taught to provide the best care possible, leaving the cost considerations aside.” Then: “Now, in a stark departure from the past, the vast majority of the country’s medical schools now integrate discussions of cost, value and effectiveness into their curricula.”The chief medical officer with the Association of American Medical Colleges (AAMC), Janis Orlowski, MD, calls the move “a dramatic change.” An AAMC survey reportedly found that “129 of 140 responding medical schools offered a required course on the cost of health care” for the 2013-2014 school year and nearly 40 percent of the schools said they also present the issue in elective courses. In one initiative, at UCLA, “In the everyday teaching that students get about clinical medicine, what medications to prescribe, what’s the name of this diagnosis, we’re going to add a layer to every discussion about the value part of that (economics, value) as well.”Comment: The move from insanity to sanity is generally in the right direction. The idea that a practitioner should make therapeutic choices based solely on his or her sense of what is best for the patient, without reference to cost – or a hard look at any other value issue - fell hard when the U.S. woke from its sullied idealism. Even as the so-called Alliance for Progress abroad proved a methods for stimulating business of US corporations, so medicine’s white hat was sullied by something called “perverse incentives” that has infected the judgement of doctors and other decision makers on what patients need and how medicine is to be organized. The advent of the classes documented by the AAMC are an excellent remedial measure.For the integrative health and medicine fields, teaching to cost and value may have a different sort of value. I explore this in “Perverse Incentives” and the Triple Aim: Overcoming the Troubled Path to Economic Integration for Integrative Medicine and Health for Global Advances in Health and Medicine Journal. An initiative with which I have been involved for the Academic Consortium for Complementary and Alternative Health Care, The Project for Integrative Health and the Triple Aim, was created in part to eventually shape curricular content and elements through which cost, value and effectiveness can be introduced into IHM educational programs.
Between Qi and the RCT: Lessons on the Road to Certification of Licensed Acupuncturists at San Francisco General HospitalThis article and the generously gifted internal documents describe the remarkable four-year road to certification for licensed acupuncturists led by Richard McKinney, MD at San Francisco General Hospital (SFGH). As the process unfolded, the surrounding public health system also necessarily became involved. The credentialing then opened to a broad set of facilities. McKinney and his colleague Hali Hammer, MD generously provided information that could be useful to licensed integrative practitioners of all kinds, and to medical delivery organizations seeking how-to information. These include the SFGH “Memorandum of Understanding” with licensed acupuncturists and the SFGH “Standardized Procedure for Licensed Acupuncturists.” Each is linked from the overview piece. This article is part of Integrator media support for a partnership between the Center for Optimal Integration: Creating Health of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC) and the National Certification Commission for Acupuncture and Oriental Medicine.Comment: The business of credentialing a licensed acupuncturist for practice in a hospital or health system can seem like a slam dunk. The basics of accredited education, licensing and malpractice insurance are in place. Yet somewhere in the chasm between Qi/Chi and the RCT, the route can take heroic dimensions. This is quite a story. More importantly, the patience and perseverance of McKinney, the co-founder of the Integrative Medicine for the Underserved, and Hammer, not only resulted in a more expansive result. The openness and sharing will assist scores of others, especially through the exceptional SFGH policy documents. Delivery organization administrators exploring credentialing will also find much to crib from here.
Teaching Clinic and National College of Natural Medicine Gains Recognition as a Level 3 PCMH/PCPCHIn a unique development in integrative health and medicine academics, the teaching clinic at the Portland, Oregon-based National College of Natural Medicine (NCNM) has been awarded Level 3 recognition as what that state calls a “Patient Centered Primary Care Home (PCPCH).” A release from NCNM notes that this is the highest award level that the Oregon Healthcare Authority (OHA) grants. The NCNM effort was led by Regina Dehen, ND, LAc, NCNM’s dean of clinical operations and chief medical officer. Said Dehen: “From a PCPCH care perspective, NDs meet the OHA requirement of patient-centered care, which addresses a patient’s overall care. What’s new at the NCNM Clinic is that we’ve created ‘healthcare teams,’ based on the PCPCH model that assures each patient’s continuity of care.”Comment: This is a remarkable accomplishment and one that can have significant downstream impact. All of NCNM’s clinicians – naturopathic doctors, acupuncture and Oriental medicine professionals, nutritionists and others - will henceforward be experiencing what it is to work inside the outcomes and assessment focused environment of a PCPCH. Congratulations to Dehen and her NCNM team. For those interested in more on the NCNM initiative, Dehen spoke on the work in this June 2015 webinar: If I Ran the Zoo: Quality Measures and their Alignment with Integrative Health and Medicine.
Georgetown and Maryland University of Integrative Health Sign Affiliation AgreementGeorgetown University and the Maryland University of Integrative Health (MUIH) have signed an affiliation agreement. Elements reportedly include commitments to “shared faculty, mutual support for common and independent initiatives, and preferred admissions and advanced standing for graduates of each university into academic programs of the other.” Georgetown’s integrative health leader Adi Haramati, PhD provided the commencement talk at MUIH’s June graduation. Frank Vitale, MUIH’s president and CEO positions the move as “one more example of the work that MUIH is doing to build meaningful partnerships with other universities, to build bridges between conventional and integrative care, and to provide opportunities for our students and faculty.”
New American Society of Acupuncturists Looks to Take on National Mantle for the ProfessionA September article in Acupuncture Today has announced that a new 501c6 national organization for the acupuncture and Oriental medicine (AOM) field, the American Society of Acupuncturists, is now part of the landscape. The organization has some immediate credibility as it houses that field’s Council of State Associations: “The ASA is a maturation of the CSA, which has been an informal collaboration in evolution for 5 to 10 years. The structure of the ASA has essentially been ‘beta tested’ via the work of the CSA, and so we are founding this organization on a solid bedrock of experience.”Twenty-four state organizations are founding voting members of the ASA. The article describes the relationship with the American Association of Acupuncture and Oriental Medicine (AAAOM). The CSA, which was born out of the AAAOM, decided not to merge back into it. Will they be competitors? This is the answer in the article: “The ASA and the AAAOM have agreed in professional discussion to ‘play in parallel’ for a few years. Each organization may have gifts for the profession, and there is certainly enough work to be done.” The initial ASA business model leaves a great deal of power with the state associations as membership in the state association gives one status with the ASA. The ASA does not appear at this point to have a website. ASA’s Facebook page is here. The founders are working on finding necessary resources and industry partners.Comment: It will be interesting to see how this parallel play will work out. AAAOM has been limping along with a paying membership that reflects no more that 2%-3% of the 30,000 licensed acupuncturists. Many view the AAAOM as being mired in challenging personality issues, as featured in this two-part Acupuncture Today feature: AAAOM - Making Promises it Can't Keep. Let’s see what this new phase will mean for that profession’s troubled effort to create a quality national organization.
Note: Selection bias. Many of these conferences and meetings are ones at which I will be presenting or am otherwise involved in some capacity. There are certainly others among the multitude of conferences that deserve mention. This is an irregular mention of a few notable meetings.
Dr. Rogers’ Prize Announces Speakers for Award Event & Free Public Colloquium: September 25-26, 2015, Vancouver, BC”One Friday evening, September 25, 2015 a Canadian leader in complementary and integrative medicine will discover that they have been awarded the $250,000 Dr. Rogers prize. The prize is awarded every two years. The next say, a free Public Colloquium will feature an interesting trio: Joseph Sung, MD, the vice chancellor at the Chinese University of Hong Kong, functional medicine leader Jeffrey Bland, PhD, and environmental medicine thought leader Robert Rountree, MD. Tickets are still available for the gala awards banquet.
Golfer Jordan Spieth Credits Chiropractor, Joins Chiropractic Marketing EffortThe September 2015 Bulletin from the Foundation for Chiropractic Progress (F4CP) reports this: “In May, Masters Tournament winner, 21-year-old Jordan Spieth, recognized those who significantly contributed to his impressive victory, including his doctor of chiropractic (DC), Troy Van Biezen, DC.” Spieth went on to with the U.S. Open and is presently the top golfer in the world. F4CP has brought Spieth onto the organization’s team of “chiropractic champions.” He will be one of the marketing faces for F4CP’s impressive marketing campaign. Spieth’s chiropractor, Van Biezen, “currently travels full-time with Spieth and several other professional golfers, providing chiropractic care as regularly as once or twice per day,” according to this article.Comment: From an organizer’s perspective, the remarkable thing about this story was not so much that Spieth used a chiropractor. Rather, it was that the F4CP was in place to swoop in and make the most of it. All the other integrative health professions would be served to mimic the F4CP fund-raising strategy.