Summary: The idea of "comparative effectiveness research" (CER), the new $1.1 billion economic stimulus program, strikes a happy chord for many in the integrative practice community. Isn''''t this the appropriate research terrain for showing value of integrative care? In this first of two part Integrator series, reporter and regular Integrator contributor Daphne White, CHTP, shares how she attended the "listening session" of the government''''s CER advisory board to understand what was going on and see if the integrative practice community was showing up. White ended up taking off her journalist hat and testifying. She shares her perspectives on why and how the integrative practice community should be involved. White''''s second is a very well-reported analysis of the "kabuki dance" she witnessed as vested medical interests developed their strategies to make sure that the CER initiative does not gore their own oxes.
Integrative Medicine and Integrated Health Care Round-up: May 29-June 18, 2009
Summary: Poll on health reform finds public favors investment in prevention over treatment by 4 to one margin ... Obama on acupuncture and prevention ... U.S. Senator Murray goes to bat for expanding chiropractic to all VA facilities ... Bravewell Collaborative announces "important evening" in Washington, D.C. November 4, 2009 ... AAAOM renews push for acupuncturists in medicare, federal employee benefits ... Chiropractors challenge Office of Inspector General Report on over-payments ... Massage accrediting agency names Henrioulle as executive director, Schwartz as top volunteer ... Association of Chiropractic Colleges in expanded role internationally, meet with Sebelius at WHO meeting ... International organization of health services researchers in complementary and integrative medicine meets in Brisbane, educator meeting in England ... Society for Integrative Oncology focuses on whole systems, interdisciplinary practices, at November 2009 meeting ... MSNBC series negative on CAM, 76% of in reader poll "skeptical" about alternative medicine; NCCAM''''s director Briggs responds ... Oregon Public Broadcasting stimulates online debate over prescriptive rights and primary care in naturopathic practices ... Gawande''''s New Yorker article on money-making corrupting medicine makes Obama''''s must-read list ... 2.5-year-old community acupuncture clinic, Communi-chi, provides 5000th patient visit ... Educators offered free access to online version of American College of Physicians CAM book.
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Policy
 Co-sponsored the poll with Robert Wood Johnson Foundation
A June 8, 2009 release on
a survey from the Trust for
America''''s Health (TFAH) and the Robert Wood Johnson Foundation reports that US
citiens rate "disease prevention as the most important health reform
priority." Those surveyed "overwhelmingly support
increasing funding for prevention programs to reduce disease and keep people
healthy." In the poll, 70 percent ranked investing in prevention between an
eight and 10 on a scale of zero to ten, where zero means not at all an
important health care priority and 10 means very important and 46%
rated prevention as a 10 out of 10. Only 15% felt more emphasis should
be placed on treatment. Prevention was rated
higher than all other proposals, including providing tax credits to
small
businesses and prohibiting health insurers from denying coverage based
on
health status.
 The release includes a comment from U.S. Senator Tom
Harkin (D-Iowa): "This survey underscores what I have been
saying from the outset: If we pass comprehensive health reform that
extends coverage but does nothing to reform our broken system by emphasizing
prevention and public health, then we will have failed. And we do not
intend to fail. We know that
prevention and wellness efforts are a key to reducing costs within a reformed
health care system. And they will be a centerpiece of the reform effort
underway on Capitol Hill." US Senators Baucus and Wyden were also quoted in support of this direction, as was Congresswoman Kay Granger (R-TX), co-chair of the Congressional Prevention Caucus: "An investment of just $10 per person
per year in proven community-based programs could save this country more than
$16 billion annually within five years."
Comment: The release on this poll is an excellent compendium of comments on the importance of prevention from the lips
of leading policy leaders. (The membership in the Prevention Caucus, co-chaired by Harkin, on the Senator side, is an interesting list.) As noted in this Integrator article from Wayne Jonas, MD, it is not altogether clear how creatively and aggressively this new direction is
being imagined and forged. We still see virtually no mention, for instance, of either integrative
practices or shifts in primary clinical services toward a preventive
orientation. (Note that Obama has spoken knowledgeably about the complementary health care/prevention connection. See below.) Instead, employer-based and community-based nitiatives regarding prevention are given
the focus.
 Obama: commenting on acupuncture
What does Barack Obama think about complementary or integrative practices? Thanks to a questioner at an open forum in St. Louis in May 2009, we have some idea of his views about acupuncture and massage, and a sense of how he thinks about complementary therapies. The questioner began: "I’m a licensed acupuncturist and licensed massage therapist in Florissant. And so ... " Obama interrupted: "I could use one right now." This stimulated laughter. He added: "My back is stiff. I’ve been working hard." The questioner follows up, asking "how will alternative medicine
fit in your new health care program?" Obama replied: "Well, look, my attitude is that we should — we
should do what works. So I think it is pretty well documented through
scientific studies that acupuncture, for example, can be very helpful
in relieving certain things like migraines and other ailments — or at
least as effective as more intrusive interventions?" Obama then goes in, conecting his thinking to the importance of good science, and more than that. his stra5tegy around prevention. The whole dialogue is printed in the following Integrator article: Obama''''s Comments on Acupuncture and Complementary and Alternative Medicine: A Link to Prevention, June 17, 2009.)
 US Senator Patty Murray: taking the lead for chiropractors in the VA
Chiropractic benefits, now available in 32 facilities across the nation would be in all 120 hospitals by 2012 under S. 1204, introduced by US Senator Patty Murray (D-WA). Murray
is the daughter of a disabled World War II veteran and is the first woman to
serve on the Senate Veterans Affairs Committee. Frank Nicchi, DC, MS, president of the Association of Chiropractic Colleges commended Murray: “We are very pleased that Sen.
Murray recognizes the value and necessity of full access to chiropractic care
by our nation’s veterans.” A release from the American Chiropractic Association notes that a reason for the legislation is that "the VA continues to drag it''''s feet." The chiropractors also note that a January 2009 report from the VA found that over 49 percent of veterans returning from the
Middle East and Southwest Asia who have sought VA health care were treated
for symptoms associated with musculoskeletal ailments, the top complaint of
those tracked for the report. The bill has been introduced in the house as HR
1017, was introduced in February by Rep. Bob Filner (D-Calif).
Philanthropy
 Bravewell announces "important evening" November 4, 2009 in Washington, D.C.
The Bravewell Collaborative of philanthropists for integrative medicine has announced "a special evening in Washington, D.C." on November 4, 2009 that will celebrate the organization''''s collaborations with the Institute of Medicine on the Feburary 25-27, 2009 National Summit on Integrative Medicine and the Prince''''s Foundation for Integrated Health. The pricey black-tie dinner is the fourth in a series of gatherings which Bravewell has organized every two years since Novembger 2003. The other three were all held in New York City. Mehmet oz, MD will be the master of ceremonies at the Mandarin Oriental Hotel function. Single tickets start at $750 with tanle prices running $10,000 to $50,000. Contact David Rosenstock at 212-838-2660, ext. 13 for more information.
Professions
 Leading the drive on HR 646
Licensed acupuncturists, led by the American Association for Acupuncture and Oriental Medicine (AAAOM), are in the midst of a significant push for the piece of federal legislation that has been on their table for the last decade: HR 646, the Federal Acupuncture Coverage Act of 2009.
HR 646 Title: To amend title XVIII of the Social Security Act to provide for coverage of qualified acupuncturist services under part B of the Medicare Program, and to amend title 5, United States Code, to provide for coverage of such services under the Federal Employees Health Benefits Program. The term `qualified acupuncturist'''' means an individual who has been certified, licensed, or registered as an acupuncturist by a State (or the State regulatory mechanism provided by State law). Sponsor: Rep Hinchey, Maurice D. [NY-22] (introduced 1/22/2009) Cosponsors (13). For the full text of the bill check here.
To support the campaign, the AAAOM has develop[ed a Medicare Factbook on HR 646 and Lobbying Activities to inform members about a payer zone about which few are knowledgeable. The association is hopeful that with its new lobbying team, a political action fund, recent positive comments from President Obama, and national unity, that this year long-time sponsor, Congressman Maurice Hinchey (D-NY), will have more luck in securing support. AAAOM is working to rally their troops, with a stream of emails to their list. A recent posting reads: "In this era of
healthcare reform, the time couldn’t be brighter for us to gain recognition in
order to help so many more people than we ever dreamed possible." A Senate bill has not been introduced.
 Report challenged by chiropractors
A May 2009
report from the Office of the Inspector General (OIG), based on a sampling of claims data from 2006, concluded that Medicare
inappropriately paid $178 million in chiropractic claims for services
considered maintenance therapy, miscoded, or undocumented. This was out of a total of $466-million in paid claims in 2006. A major focus has been on ending payments for "maintenance therapy." In a June 15, 2009 release, the American Chiropractic Association challenged the findings "noting the methods
used by the OIG may have resulted in an overestimate of inappropriate claims." The tone of the challenge is not strong: "It is the opinion of the ACA
that the numbers in this report may be inflated,” said ACA President Glenn
Manceaux, DC. In fact, the ACA''''s statement underscore the efforts that a coalition of chiropractic organizations have engaged, since 2005, to tightened up documentation standards in the profession. These have included efforts led inside colleges, and through state licensing boards. The ACA noted that the reexamination in 2006 would not have allowed those initiative to have yet had a measurable outcome. ACA has submitted a Freedom of Information
Act request for copies of the protocols, training tools, and credentialing standards
used by medical reviewers. The full response from the ACA, led by a 3-person team including Integrator adviser Christine Goertz, DC, PhD, is available here.
 COMTA''''s incoming executive Kate Henrioulle
Kate Ivane Henrioulle has been named executive director of the Commission on Massage Therapy Accreditation (COMTA), the U.S. Department of Education-recognized accrediting agency for massage therapy programs. According to the announcement from COMTA, Henrioulle most recently served as dean of education for the International
Professional School of Bodywork (IPSB) in San Diego, California where she
supervised 80 faculty members and 3 administrative staff members,
working with more than 200 students. Henrioulle earlier served as an IPSB massage instructor and clinic supervisor. Before joining IPSB, Henrioulle was a massage
therapist for the SK Sanctuary in La Jolla, California. COMTA has accredited roughly 100 massage therapy training programs to a standard that is typically higher than most massage schools. Henrioulle takes the place of interim executive director John Goss, PhD, who will return to his role as a commissioner.
 COMTA leader Jan Schwartz
Comment: Sorting through the hundreds of massage programs in search of quality can be a challenge. Some are "accredited" by other agencies which do not focus specifically on massage. The commitment to COMTA accreditation is a strong sign of respect for standards.
International
 L-R: O''''Bryon, WFC''''s Michael Flynn, DC, Secretary Sebelius and WFC’s Rand Baird, DC.
According
to a note from Frank Nicchi, DC, MS, president of the Association of
Chiropractic Colleges (ACC), key representatives from the World
Chiropractic Federation (WFC) and ACC executive director David O''''Bryon
had the opportunity
to talk with the U.S. Secretary of Health and Human Services Kathleen Sebelius and some of her top aides about the profession and health
care reform at a May 2009 meeting that took place in Geneva at the World Health Organization''''s (WHO). The
WFC is a recognized NGO with status with WHO. O''''Bryon shares that
"there are more chiropractic colleges outside the US than in the US
these days as the profession continues to grow dramatically around the
world."
The ACC, under O''''Bryon''''s direction and that of Nicchi and his predecessor Carl Cleveland, III, DC, has taken an active role over the last half dozen years
with both the WFC and the WHO. O''''Bryon notes that WHO published a book in 2005 on guidelines for countries and their health
professionals wishing to expand the use of chiropractic within their
borders. The booklet is entitled, "WHO guidelines on basic training
and safety in chiropractic." About with meeting with Sibelius, O''''Bryon wrote: "At the annual WHO spring meeting the top health leaders from around the
world gather and discuss the major issues of the day. We had the
opportunity to catch up with the American delegation lead by HHS secretary
Kathleen Sebelius. She will be a major player for the Obama administration
on the current health reform legislation moving through Congress."
Side-note and comment: As
U.S. chiropractic educators have advanced their role internationally, a
parallel notable development among leaders of the ACC has been a move
out of the combative isolation which has marked most of that
profession''''s political history. O''''Bryon, for instance, is a co-founder,
prime-mover and current vice-chair of the multidisciplinary Academic Consortium for Complementary and Alternative Health Care
(ACCAHC) and Nicchi serves on the ACCAHC board of directors. Both
participated in a May 11, 2009 meeting between ACCAHC''''s leaders and
members of the executive committee of the Consortium of Academic Health Centers for Integrative Medicine and both advocate stronger educational connections with conventional medical centers.
Australia: International network of health services researchers in CAIM to hold meeting
A notice, via University of Washington complementary and integrative
medicine researcher-educator Jane Cornman, RN, PhD informs me of the
existence of the Network of Researchers in Public Health and Complementary and
Alternative Medicine "a collaborative network set up to increase the role of public health and
health services research in complementary and alternative medicine."
The founders are from Australia, but with associates around the globe.
(Among those in the United States is Claire Johnson, DC, PhD, editor of
a group of journals out of National University of Health Sciences whose
Integrator comments on the February IOM Summit are available here.) The organization is holding its 2009 conference at the University of Brisbane on October 17-18.
England: Complementary medicine in education conference
Educators interested in an excuse to go to England may be interested in the Complementary Medicine in Education Conference that will be held at Blackburn College. The day-long meeting will take place on October 22, 2009.
Media
Dietary Supplements, CAM, NCCAM take hits from MSNBC and Associated Press
The MSNBC featured on June 10, 2009 was $2.5 billion spent, no cures found.
The article, interestingly, includes comments on positive research outcomes, seeming to question the title. The overall thrust, however, is negative, with the target the National Center for Complementary and A;lternative Medicine, the budget for which has been at roughly $2.5-billion over the last decade since it was founded. The lead ran with 3 related stories, the titles for which capture the tone: Many herbal products made by Big Pharma; Contaminents lurk in many ''''natural'''' products; and Doctors eager to try ‘mystical mumbo jumbo.’ The latter focused on Reiki services at University of Maryland Medical Center. The MSNBC article references "an Associated Press review of dozens of studies and interviews with
more than 100 sources found an underground medical system operating in
plain sight, with a different standard than the rest of medical care,
and millions of people using it on blind faith." The article ran on June 7, 2009 as Altenative Medicine Goes Mainstream. If you click in, note the URL, which ends with "unproven_remedies."
A reader poll on the MSNBC site, with over 13,000
votes when accessed June 17, 2009, asked "How do you feel about
alternative medicine?" Of readers, 76% said they are "very skeptical"
and just 16% thought it "great used in conjunction with traditional
Western medicine." Voters were guided to this conclusion by the article, the sub-heads for which outdid the biases of the titles themselves. Examples: "Potential health threats," and "Be skeptical of natural." [Breaking News: Shortly after this Integrator Round-up was published, an NCCAM e-newsletter came out with a June 12, 2009 response to teh negative medicine from NCCAM Director Josephine Briggs, MD, available here.]
Comment: In a gathering of researcher in integrative practice recently, the subject came up about how even peer-reviewed research will wrongfully conclude, based on one study, that a therapy or an entire practice doesn''''t work. This is parallel to a failed study of a drug leading to a dismissal of all pharmaceuticals. Prejudice still rears its ugly head. That said, the quality problems with dietary supplement do taint the entire "alternative medicine" and for that matter "integrative medicine" realms; and the early focus of NCCAM on funding large drug-like trails of botanicals promotes this focus on supplements in the media. One wonders what body of work the $2.5-billion would have produced had we begun, where we are edging toward now, with more appropriate looks at whole systems and whole practices, such as are the subject of the Society of Integrative Oncology conference noted in this Round-up.
Oregon Public Broadcasting heats up dialogue on prescriptive rights and primary care roles for naturopathic doctors
A June 16, 2009 show entitled "Natural Medicine" on Oregon Public Broadcasting
stimulated a significant blogosphere dialogue over a new law which will
allow naturopathic physicians to gain prescriptive authority beyond
"naturally-derived" agents. A spokesman for the Osteopathic Surgeons and Physicians of Oregon
argued that NDs are more likely to make prescribing errors. Some
aligned respondent blasted the expansion of scope for practices they
already deemed by them to be unscientific. Meantime, among those
weighing in positively was Jennifer Pratt, director of policy for the Oregon Primary Care Association.
Pratt focused on the potential value of naturopathic doctors meeting
primary care needs, an ability which will be enhanced with the broader
prescriptive rights: "I wanted to just say how important this piece of
legislation is to the 28 community health clinics (with 146 sites
across Oregon) that I represent as the Director of Policy at the Oregon
Primary Care Association. Several of our clinics already employ naturopaths VERY successfully.
They work along side, and must meet all the same requirements as, their
"Western-trained" counterparts, and many are willing to serve in areas
that have less of a draw to their Western counterparts - rural and
inner-city clinics."
 Gawande article hits nerve
The article by Atul Gawande, MD in the June 1, 2009 New Yorker that explored the invasion of physician-interested economics into patient care, a which was the subject of this Integrator perspective, has had a huge and still growing impact. Among the signs: A New York Times piece noted that Obama''''s has made it required reading for his staff. National Public Radio featured an interview with Gawande, with a guest interviewer, in the Fresh Air niche.
Comment: Gawande''''s finding, that in many practices and regions in hte United States medicine is increasingly a business, rather than a service, appears to have connected deeply with both policy-makers and the public. In a nation of policy-makers afraid to talk about single-payer because of some left over red scare of "socialized medicine," we may just be hungry for some honest accounting of what we know in our bones to be serious downsides of uncontrolled capitalism as it relates to our health.
Conference
 Integrative oncology conference to focus on interdisciplinary and whole systems approaches
The 6th conference of the Society for Integrative Oncology
promises to focus on "Revitalizing Cancer Care: Comprehensive
Interdisciplinary Programs and Whole Systems Research." The meeting
will be held in New York City November 12-13, 2009. Chair Kara Kelly,
MD states that "once again we have assembled an outstanding array of
exciting speakers to discuss the controversies and challenges of
integrative oncology, especially focusing on the area of whole
systems." Stated objectives are to: define whole systems and their role
in integrative oncology: traditional Chinese medicine, Ayurveda,
homeopathy and naturopathy; identify gaps in research in each whole
system with respect to cancer care; evaluate the role of lifestyle and
placebo effects on cancer care; and begin to develop a plan to
integrate whole systems care into your oncology setting.
Comment: This looks to be an inclusive meeting, with quality inputs from representatives from a variety of disciplines. Speaking as a patient who used diverse practices and practitioners in a non-intergated, refracted "system," it is especially good to see this level of practitioner integration and the emerging focus on the whole system.
Briefly Noted
 Jacobs offers educators free online access to ACP CAM text
Integrator adviser Bradly Jacobs, MD, MPH, co-editor of the
The ACP
Evidence-Based Guide to Complementary and Alternative Medicine
has extended an offer to all educators to have complimentary access to
the volume in its e-book form. If you aer an educator, you can view the
copy, at
www.acppress-ebooks.com and click the sign-in link
at the top of the page. Login name: ACP
Press CAM. The password is acppress. The Integrator review of the volume is available here.
 Community acupuncture clinic provides 5000 visits in first 2.5 years
The Seattle-based Communi-Chi community acupuncture clinic which delivers acupuncture services in a community room model, to this reporter among others, reports in a recent e-news notice from co-founder Jordan Van Voast, LAc that it has delivered "close-to 5000 treatments" in its 2.5 years of existence, or roughly 40 per week in a 50 week/year estimate. The clinic is part of the not-for-profit Community Acupuncture Network .
Comment: Not bad at all for a for a start-up, especially considering that some surveys have suggested that many practitioners in the conventional, one-on-one model, often average just 8-15 visits per week. Some of the Communi-chi visits do not directly help with the clinic''''s bottom line, however, as Van Voast and his colleagues are committed to free care for returning veterans.
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