| | Integrative Medicine and Integrated Health Care Round-up: July 18-August 5, 2009 | |
Summary: Controversial NCCAM report suggests use of CAM practitioners may be down 50% between 1997 and 2007 ... IHPC offers opportunity for integrative practice community to participate in federal policy work, starting with thanking US Senator Sanders ... Homebirth midwives make huge commitment to lobbying Congress for inclusion under healthcare reform ... Boston Globe says Harkin, others are pushing for coverage of licensed CAM practitioners in reform package ... Invite to September 25, 2009 Dr. Rogers' Prize gala where $250,000 will be awarded to a top integrative practice leader ... Health Journey's Belleruth Naparstek shares significant advances of mind-body approaches in the military ... James Gordon, MD to chair new College of Mind-Body Medicine at Saybrook University ... Obama team convenes group of employers to explore progressive health and productivity program for federal employees ... Pelletier examines 2004-2008 employer studies of cost-benefits of health promotion programs ... Holistic nurses name Hines to national presidency ... Renaud steps down after 16 years managing acu-detox association, new manager sought ... Abrams/Weil Integrative Cancer book becomes standard textbook for the field ... Example of integrative center inside a private medical group sought ...
Policy
 Sets up new grassroots communication tools
Here is a chance to connect to federal policy work which represents the entire integrative practice field. As reported last month in this Integrator article, the multidisciplinary
Integrated Healthcare Policy Consortium (IHPC) was instrumental
in getting "licensed complementary and alternative medicine
practitioners" and "integrative practitioners" into the leading US Senate health reform bill. IHPC, which has worked quietly on these issues for years, has begun sending out alerts to those interested in learning more and participating in helping IHPC advance their agenda, including thanking those who assist integrative practice. Their opener in the August 3, 2009 initial mailing:
"Welcome
to the Integrated Healthcare Policy Consortium’s (IHPC) new online
action tool! Perhaps you know IHPC, perhaps you don't know us yet. Either way,
we have been working steadily on your behalf for the past 6 years to direct the national healthcare
agenda toward a health-oriented, integrated system that ensures all people –
not just those who can afford to pay out of pocket -- have access to the full
range of safe and regulated conventional, complementary, and alternative
healthcare options."
 IHPC executive director Janet Kahn, PhD
Comment: I urge you all to sign-up for the IHPC alerts. I am quite familiar with the organization, having been involved directly until last year when I let go of a few things. IHPC's work is for the integrative practice community, and the betterment of healthcare. It is largely a labor of love. Integrator readers are core constituency. What we get, as the poet Phillip Levine once said, is what we bring. I hope you'll show up in this way. I've chosen also to be one of IHPC's contributors. This is a political contribution, not a donation, as IHPC is a 501c4 lobbying organization which was established precisely to be a big tent to help us move Congressional action to advance health. Meantime, I just used the CapWiz link to send a small note to my US Senators here in Washington (Cantwell and Murray), my first real communication on integrated practice with them. Felt nice. Not huge, just nice, and right. Do it!
 The MAMA Campaign for inclusion of Certified Professional Midwives
The nation's smallest regulated complementary/alternative healthcare discipline with broad licensing, the Certified Professional Midwives (CPM), has stepped up in a big way to work to get inclusion of their relatively inexpensive and safe birthing services into US health reform. Licensed in 26 states, but with only 11 schools recognized by the US Department of Education and just 1500 practitioners, the CPMs none-the-less told their supporters on August 4, 2009 that they have "$70,000 in
hand or pledged" as they work to "stay on our pace of raising $10,000 a week for
the rest of the Congressional session in order to complete our goal." Their campaign is called The MAMA Campaign: "Midwives and Mothers in Action: Advocating for CPMs as a High-value option for quality cost effective maternity care." The campaign has a solid website, regular blogs, alerts, a facebook page, twitter account and more. The campaign is coordinated by a steering committee representing all the national organizations directly involved with the field. Numerous women's organizations have stepped up to support the MAMA Campaign, including the National Women's Law Center, Our Bodies Ourselves, National Women's Health Network, Raising Women's Voices, Childbirth Connection and Coalition for Improving Maternity Services.
Comment: As I have shared here in the past, I have an abiding bias toward opening the homebirth option more broadly. The inclination stems from my own experiences with my spouse and the births of both of our children at home. (See Father's Day: Reflections on My Firstborn's Homebirth as Alignment with Healthcare Reform, June 18, 2007.) I also have great respect for the can-do feistiness of this community of practitioners and their allies. Thus, while not surprised, I was none-the-less chagrined to learn that nurse midwives, who typically provide hospital-based midwifery services, have not supported the CPMs. I am reminded how detectives, in a murder investigation, tend to look first at the alibis of the closest kin.
Media
 US Senator Mikulski, teamed with Harkin, others in pushing non-discrimination
The blogosphere was pretty well ignited, both mainstream and integrative practice-leaning, after a July 24, 2009 article in the Boston Globe ran with this headline: "Senators seek coverage for alternative therapies." The article started with this comment:
"Naturopathic doctors, herbal healers,
mind-body specialists and acupuncturists often have been scorned by the
medical establishment, but growing numbers of Americans are seeking
such care, and now an influential group of U.S. senators believes the
time has come to embrace an array of alternative therapies."
US Senator Tom Harkin (D-IA) was reportedly
behind this initiative. Harkin reportedly stated, at a hearing: “It’s time to end the
discrimination against alternative healthcare practices.’’ The
amendment focused on inclusion of license practitioners. Other backers are Barbara
Mikulski (D-MD) and Mike Enzy (R-WY). The amendment would need to be
debated in both the House and Senate. The American Medical Association
went on the record opposing the idea. ( Interestingly, on August 5, 2009, the day of
this posting, the Globe's article was not any longer available online,
and the links from other online sites similarly showed "Page Load
Error." A google group still has the whole article, here.)
Research
 Examination of CAM expenditures and visits stirs controversy
On July 30, 2009, the NIH National Center for Complementary and Alternative Medicine (NCCAM) released a report based on 2007 data which suggest that, since 1997, expenditures on complementary and alternative medicine have been nearly flat and visits to practitioners may have dropped as much as 50%. Major media coverage in such papers as the LA Times, Washington Post and Boston Globe universally focused on the gross finding of $33.9-billion in expenditures and 354-million visits rather than the somewhat shocking suggestion that consumers are turning away from CAM practitioners. (Notably, most, like this initial LA Times article, were based on an Associated Press account.) However, a blog at the LA Times the same day of the NCCAM release was entitled Use of Alternative health practitioners falls.
The NCCAM research team acknowledges that comparison with data from the 1997 telephone survey by David Eisenberg, MD and colleagues at Harvard University, published in JAMA, may be inappropriate, given significant differences in methodology. Richard Nahin, PhD, MPH, the study's leader, is quoted as explaining some of the differences in outcomes this way in the LA Times blog: "'In (the Eisenberg) survey, costs were driven primarily by the practitioner costs.
In our data the expenditures are driven by the self-care costs.' But, Nahin added, the
two surveys were conducted using different methodologies." The findings run contrary to data on growth of CAM and integrative professions from virtually all CAM professional organizations during the 1997-2007 decade.
Comment: The findings were startling. They did not agree with general perception. I participated in the press conference and then undertook a significant analysis of the differences between Eisenberg's methods and those of Nahin's group. (See Special Integrator Report: Is CAM Practitioner Use Down 50% Since 1997? NCCAM's Report on Costs of CAM and Visits: An Analysis, August 5, 2009.) My conclusions were that Eisenberg's methods probably selected high, and Nahin's low.
Oddly enough, my
exploration led me to conclude that, with some simple changes in the
2007 instrument, the media accounts could have reported substantial
growth in expenditures. However, there is no sign that there was any negative intent, given the tone and feel of the report's roll-out by NCCAM. The gaps in the findings of these two studies is worth better understanding, particularly since the entire integrative practice field may for the next decade be, to paraphrase and perhaps abuse Irish poet William Butler Yeats, "lulled to nightmare by a faulty comparison." Take a look at the analysis if you haven't.
Mind-Body
 Belleruth Naparstek, LISW - working on the mind-body of returning vets
The indefatigable Belleruth Naparstek, LISW, founder of mind-body media producer and distributor Health Journeys, shares
new information on her firm's service in military markets. She writes:
"Unlike other times, I'm sharing content info about the download
interventions with the
other investigators (with their permission, of course) because everyone
feels
there's no time to waste and we need to be learning what works best
ASAP.
It's extraordinary to see these academic researchers being so generous,
flexible and non-paranoid re their findings. It's wonderful, really."
Some of these insights are included in a fascinating blog Naparstek posted last spring entitled "What Returing Troops Are Teaching Us." It is based
on a conversation with Adrianna Tarazon, PhD, a psychologist with the
Arizona Veterans' Administration. Tarazon shares that most
returning soldiers are adverse to cognitive behavioral counseling for their stress, "the treatment du jour."
But 70% "respond well to guided imagery" via CDs. Notably a walking
meditation is described as particularly useful for some who are "too
antsy to sit and listen." Tarazon has learned that the CDs sometimes
complement the counseling approaches: "Dr. Tarazon found
herself preparing her vets with
guided imagery, building up their relaxation response and
self-regulation skills, so they could tolerate the therapy long enough
to get better."
Naparstek prefaces these remarks by saying: "We’ve already learned a ton
from principal investigator Jennifer Strauss’ amazing work at Duke
Medical Center/Durham V.A." The Duke studies are available at this link. Naparstek notes in addition that "another study out of Dr. Mimi Guarneri's shop at Scripps with returning
Marines is getting similar results, but with different audios." Naparstek celebrates her staff''s work in this comment for the Integrator: "Meantime,
thanks to our staff's demented persistence, guided
imagery is getting into the ears of our troops at over a hundred
V.A.'s, Army bases and Marine camps, and is being used heavily at
Walter Reed, Bethesda
Naval Hosp and Landstuhl hospital in Germany. So, slowly but surely - our
company is definitely more tortoise than hare!"
Comment: I found
particularly compelling the role of the lowly CD in reaching veterans
who shy away from counselors, and then the potentially complementary
value of the two approaches together. It is a gawd-awfully long
road home for many of these vets.
 James Gordon, MD - additional post with Saybrook
James Gordon, MD the founder/director of the Washington, D.C.-based Center for Mind Body Medicine has announced that he will serve as dean of a new College of Mind-Body Medicine planned for San Francisco's Saybrook University. Gordon notes that his Center's two decades of experience, educating over 7,000 professionals, will be united with an institution which has "pioneered a holistic approach to the study of human
experience and well-being for almost 40 years." An announcement of the bi-coastal affiliation is available here. The college will also offer a certificate program in mind-body medicine. Don Moss, PhD is faculty chair for the department.
Employers
 Cathy Baase, MD - advising Obama's team on employer health strategies
President Obama met in early June with a handful
of CEOs about health reform. One aspect of their discussion was related
to the importance of prevention and worksite health programs. Suggestions were made that President Obama could drive
progress by establishing model worksite health programs for federal
employees. Following the meeting, Obama charged a team of leaders with the Office of Personnel Management (OPM), the Office of Management and
Budget (OMB) and the National Economic Council (NEC) to develop a plan to advance
worksite health programs for federal employees. As part of
their development work and planning, these leaders invited several employee health experts to summarize their insights about the programs by completing a template and then
presenting highlights of their documents at an in-person meeting along
with the team from OPM, OMB and NEC. Among those participating were Integrator adviser Kenneth R. Pelletier, PhD, MD (hc), and Cathy Baase, MD, global director of health for Dow Chemical. (Baase's work in the complementary healthcare domain has been noted here in the Integrator.) The dialogue with the advisers has continued since. Baase, contacted by the Integrator, states: "It is very encouraging that this effort is underway for the federal
employees. There are many good efforts throughout various
departments of federal employees but this intent is to establish a systematic
approach and model program."
Comment: As the Samueli Institute's Wellness Initiative for the Nation has advocated, and successfully helped introduce into a US Senate health reform bill, creation of a healthy population is a whole system endeavor involving diverse stakeholder. I agree with Baase that it is very good to see Obama's staff looking at setting an example for a health-focused initiative for all federal employees.
 Kenneth R. Pelletier, PhD, MD (hc)
Those interested in the mind of the employer relative to health promotion and disease management programs will have followed the now 7 consecutive reports on the subject from Kenneth R. Pelletier, PhD, MD (hc) dating back to the 1980s. The most recent, published in the Journal of Occupational Environmental Medicine (2209;51) covers the 2004-2008 period. Pelletier's search found only one significant randomized trial in the literature in that period. He found instead that employer activity was more focused on "pilot studies, quasi-experimental methodologies and econometric modeling as indicative of future trends." In the period, 7 of the 16 new studies showed positive return on investment. He notes that a recent analysis of 10 years of economic outcomes in 12 studies concluded that the evidence is "very strong for average reductions in sick leave, health plan costs, worker's compensation, and disability costs to be slightly more than 25%." Pelletier also notes that more studies have begun looking at new outcome measures, "such as the 'Presenteeism' or 'SPS6' scale. The article is entitled "A Review and Analysis of Clinical and Cost-Effectiveness Studies of Comprehensive Health Promotion and Disease Management Programs at the Worksite: Update VII 2004-2008."
Comment: I continue to believe, as do Baase (see article above), Pelletier and others working on employee health programs that there is a potentially rich but under-explored link between employer interests in health and the health-oriented focus of integrative practices. This study, with its extensive charts on individual programs, provides many useful windows into the kinds of pilots and projects that employers have engaged that may have an overlap with integrative thinking and practice.
Honors
 Open invite to gala evening September 25, 2009
Friday September 25, 2009, and the subsequent weekend, make Vancouver,
British Columbia an attractive destination. The centerpiece is the Dr. Rogers Prize Award Gala,
a biennial gathering to highlight the granting of $250,000 to one or
more individuals who have had significant impact on complementary and
alternative medicine practice. (A 2007 award winner was Abram Hoffer, MD, founder of orthomolecular medicine, who died this past summer at 92 years of age. See Integrator article here.)
This is the most significant North American award in the integrative
practice space. The gala dinner will include a panel discussion on "The
Future of CAM" involving James Gordon, MD, Joseph Pizzorno, ND, Stephen
Aung, MD, and Marja Verhoef, PhD. Gordon and Pizzorno are among the
international jury of 5 who will choose the award-winner. For the $125 tickets, click here.
The dinner will part of a big CAM weekend in Vancouver. The dinner will be preceded by a free afternoon Colloquium
with the 4 dinner panelists, starting at 1:00 PM on the 25th. Nancy
Baxter, the Dr. Rogers Prize coordinator, also shares that the
Vancouver weekend includes the annual conference of the Canadian
Institute of Chinese Medicine Research, Sept 25th
– 27th; a one-day conference on CAM policy in Canada, sponsored by the Fraser Institute on September 26th; and the Dalai Lama
Peace Summit that will take place September 26th – 29th. Kudos, again, to the Lotte and John Hecht Memorial Foundation for sponsoring this prize and other important integrative practice activities in Canada.
Comment: Great place to be. Besides
the dinner, I am attracted to the Fraser Institute gathering. It is
always refreshing to look in on Canadian policy developments in CAM
where cross-disciplinary dialogue is more comfortably engaged.
People/Changes
 Mary Enzman Hines, RN, PhD, AHN-BC
The American Holistic Nurses Association has announced that Mary Enzman Hines,
RN, PhD, CNS, CPNP, AHN-BC has become the association's new president. Hines is professor and chair of the
Graduate Nursing Department and Program Coordinator of the Doctor of Nursing Program at Beth
El College of Nursing and Health Sciences at the University of Colorado,
Colorado Springs. According to the release, Hines has more than 30 years experience as a pediatric and holistic nurse and has
an active pediatric nurse practitioner practice integrating a holistic
philosophy at Colorado Springs Health Partners. Hines, who "believes that holistic nursing is the most complete way to view
and create models of healthcare," is particularly interested in "find(ing) innovative ways to integrate holism into the health care of each
individual." Glenda Christiaens
PhD, RN, AHN-BC was selected as president-elect. Christiaens is currently an associate teaching professor of nursing at
Brigham Young University. AHNA has more than 4,200 members nationwide.
 Jay and Mary Renaud, left, with NADA colleagues in Cambodia
Long-time colleague Jay Renaud, who has
managed the National Acupuncture Detoxification Association (NADA) and published its newsletter for 16 years sent this note
regarding a position which has opened because he and his spouse are stepping down "due to old age after 16 years of publishing and association
managing in this field."
He writes that "the contract is very flexible and the new office
provider could be located in any appropriate and viable geographical
locale, or
even more than one locale depending on how the work is allocated."
Contact Jay at
[email protected]. Congratulations on good, sustaining
work with NADA, Jay and Mary.
Miscellaneous
 Donald Abrams, MD
Donald Abrams, MD and
Andrew Weil, MD have produced what has become the standard textbook on
integrative oncology in the academic integrative medicine field. The
book, appropriately, is called Integrative Oncology. Abrams, a graduate of the Fellowship in Integrative Medicine at the University of Arizona which Weil founded, is director of clinical programs at the Osher Center for Integrative Medicine at UCSF Medical Center. The
book Abrams took the lead in assembling has over 30 chapter authors
from the integrative medicine field. I asked Abrams if he was familiar
with a similar text authored by naturopathic physician Lise Alschuler,
ND. Abrams replied with great affection and respect for Alschuler, adding that a
difference between the two books is that "with 30 different chapter authors, ours may be a
bit more inclusive and academic."
Sample of successful integrative practice/center in private medical group sought
An integrative medicine educator is seeking an example of "an integrative center that is perhaps located or was born out of a private medical
group." The reason: "A large private medical group has a Spa/CAM Center
that they are looking to convert to something more medical and hopefully more
profitable. The new Director would like
to visit the right center. Most of the ones I could think of are either
free standing CAM based or are at Academic Centers." Any ideas? Contact me and I will put you in touch with the inquiring physician.
Send your comments to
[email protected]
for inclusion in a future Your Comments Forum.
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