Work to create pilots comes to fruition

Institute for Functional Medicine begins $1.2-million Florida state-backed clinical pilot with Tallahassee family medicine program

On January 21, 2011, the Gig Harbor, Washington-based Institute for Functional Medicine

funded by a $1.2 million grant from the Florida Agency for Health Care Administration, will be a pilot project to "establish a Medical Symptom Reduction Clinic utilizing the functional medicine model and a chronic-care team approach for patient care." The project, according to the release, will "integrate functional medicine/nutrition into [the residency's] curriculum and clinical activities."

Florida agency supports project

One area of investigation includes

Comment:  This breakthrough project is more thoroughly described here in the release. This appears to be a model to potentially emulate. Take a look. Congratulations to IFM, the leaders of which have been promising a development like this since publication of their exceptional white paper 21st Century Medicine.Fun to see Panico involved. His integrative medicine leadership at Athens (Georgia) Regional Medical Center was featured in this Integrator article. 

Upbeat on survey results

Holistic Primary Care finds "convergence of conventional and holistic medicine" in physician survey

An article in the Winter 2010 issue of Holistic Primary Care contains results of a 52 item survey of 2000 primary care doctors (9% response rate) across the United States. Core finding: "The numbers tell us that nearly 80% of all primary care practitioners are incorporating some modalities from holistic or 'alternative' medicine into their practices, with nutrition counseling and stress management being most common. Many are getting into functional medicine, botanical medicine, and acupuncture. One-fifth ... are using some form of hands-on manual technique with your patients."

The survey was sent to practitioners who routinely receive HPC. Of the respondents: 78% were MDs, 12% DOs, and the remainder NDs, DCs, nurses and others; 62% were men; and the average age was 50. Over half of the respondents surveyed said they use information from HPC in their practices and one-third have it available in their waiting rooms. The 

Comment: The sample selected for this survey and the low response rate each urge caution on extrapolations to the broader primary care population. Still, these data, and the spin on them, are interesting.

Graduates of IM Fellowship surveyed

Survey of recent graduates of the University of Arizona IM Fellowship finds many struggling to create practices

Schneider: Checking in with the success of his other Fellows

Schneider's report includes information on the barriers and ideas where the Fellows need to focus attention to foster the development of their integrative medicine practices. Schneider is medical director at

Comment: Schneider's findings recalled to mind survey data on practices of licensed acupuncturists in which significant under-employment was found. My sense is that many naturopathic medical graduates are similarly under-utilized. Detractors may conclude that the problem is that these services don't work, otherwise they'd draw patients, wouldn't they? Advocates will say that time and money (reimbursement and constraints) are significant obstacles; challenges with business models has little to do with the potential health care value of these practices. Meantime, I wonder how long spirits across these fields will remain willing if something doesn't give. The best hope on the horizon are practical pilots such as that which appears to be modeled by IFM in Tallahassee (see article this Round-up).

Policy

Surgeon General Benjamin: Urged to take more integrative health input

Integrative practice organizations find holes in draft National Prevention Strategy, urge more community input

• Appoint the Advisory Group of community experts, including those expert in "integrative health care" specifically noted in the law.
  

• Change the title: National Prevention Strategy says more of the same. 
  
• The present definitions and approaches are too limited if you want the transformational outcome asserted.
• Explore the value in primary prevention and health promotion of integrative practices and practitioners.
• Use emerging community and self-care resources.
  
• Engage in integrative practice research that has health and wellness outcomes.
• Bear in mind that the ultimate national strategy that will be transformational will rely on research we need to first engage.

Jonas: Draft still not health focused

Comment: By sharing their perspectives publicly, these integrative practice organizations allow us to begin to see where common themes emerge and lines of continuity exist. Thanks to each of these organizations and individuals for sharing. My own conclusion, more harsh than these, is that the Council must dramatically slow its time-table. Otherwise it will not successfully engage what the draft declares in the first sentence as "the unprecedented opportunity to shift the nation from a focus on sickness and disease to one based on wellness and prevention."

• New Prevention Council Thumbs Nose at Congress & Public by Closing Comments on National Strategy Prior to Naming Advisory Group
• Draft National Prevention Strategy: Samueli, IHPC, AANP, ACA, SIO, Pino, Maclean, Weeks Respond
• Positive Side-Effects: Evidence of Prevention & Health Promotion via Integrative Clinical Practices from Ornish, Cherkin-Sherman, Seely-Herman & Gaby

• Alert Plus: Responses to US HHS on the New Prevention & Integrative Practice Strategy: Samueli, ABMP

• Alert: Comments Due on "Integrative Health Care" in Nation's New Prevention and Health Promotion Strategy

Kerr: Sole integrative health practitioner on key panel

Charlotte Kerr, RN, MPH, LAc appointed to Advisory Group on Prevention, Health Promotion and Integrative and Public Health

Comment: Never mind, for a moment, that this Advisory Group was appointed after the National Prevention Strategy was drafted and the public comment period closed. Comments on the draft National Prevention Strategy by organizations associated with integrative practice, as noted above, called for more input from the integrative practice community and specifically for appointment of the Advisory Group before the Strategy is finalized.

Kerr is a familiar face representing CAM/IM in the Beltway. I can't think of anyone else with such a scope of appointments. Yet, to my knowledge, Kerr hasn't thus far viewed those positions as a responsibility to network deeply with the expertise that surrounds her in the integrative health world to best inform her work as a public servant. I may have missed something. Here's hoping that Kerr will do all she can to connect with and gather ideas from these community experts for whom she may be the one-and-only obvious point of access. Congratulations, Charlotte, and good luck with this "the unprecedented opportunity to shift the nation from a focus on sickness and disease to one based on wellness and prevention."

Was Congressional intent side-stepped?

Integrative health community researchers shut out from appointments to the PCORI Methodology Committee

The January 21, 2011 announcement of appointees to the critically important Methodology Committee of the Patient Centered Outcomes Research Institute (PCORI) did not include any individuals whose published biographies referenced significant experience in integrative health. The language of the enabling statute requires that PCORI's "Expert Advisory Council(s) shall ... include experts in integrative health and primary prevention strategies." Among organizations that submitted nominations were the Integrated Healthcare Policy Consortium and the Academic Consortium for Complementary and Alternative Health Care, with which I am involved.

Comment: Following a note I sent to colleagues regarding the missing appointment of anyone deeply experience in integrative health research methods, one colleague wrote back that Brian Mittman, PhD, Director, VA Center for Implementation Practice and Research Support, Department of Veterans Affairs in Los Angeles "is a good guy" has some prior involvement in chiropractic research. At present, however, it would appear that the distinct experience that whole person, health-focused integrative practices might have brought into the Committee, as apparently required by Congress, were left on the appointment room floor. My auditor brother-in-law, formerly with the US General Accounting Office, once taught me about the meaning of "compliance audit." An auditor would find non compliance here.
 

Seeks to assist workforce planning

Integrated Healthcare Policy Consortium (IHPC) offers statement on meaning of "integrative practitioners" for federal policy-makers, sort of ...

Comment: The significant short-coming in the IHPC statement is that it does not note any specific traits that distinguish an "integrative practitioner" from one who is not an integrative practitioner. This is a significant problem. How can IHPC or anyone else argue for the need for inclusion of "integrative practitioners" if Congress does not have a handle on what the term means. The American Association of Naturopathic Physicians, a recent member of the IHPC's Partners in Health program, offers such a definition in their response to the National Prevention Strategy. IHPC is the ideal body to do this. I hope they still plan to tackle it.  

Gaudet: Key position at the VA

Veterans Administration names Tracy Gaudet, MD to head new

Vet's Administration: Openness to integrative practices

Comment: This is a huge sign of the uptake of integrative approaches in the nation's largest healthcare system. I couldn't help but notice that the release stated that Gaudet worked at "Duke Integrated Medicine" rather than its correct title of "Duke Integrative Medicine."  May have been a slip up. Then again, the VA media managers may have chosen a term more comfortable to the mainstream and less revealing that would allow Gaudet to begin her work without being beset by integrative medicine's antagonists. My guess: The integrative practice community will soon have a FOT group paralleling the informal FOB that surrounded another influential Beltway person a decade ago.

Stargrove: Leadership role as interactions expert

 " ... a breakthrough effort to improve the quality of health care across America by integrating evidence-based clinical pharmacy services into the care and management of high-risk, high-cost, complex patients ... PSPC uses a fast-paced, iterative improvement method designed to support teams in testing and spreading leading practices found to significantly improve health outcomes and patient safety through the integration of clinical pharmacy services. Key to the method's effectiveness is that the leading practices are drawn from real practice in organizations that have achieved outstanding results.

Declares top priorities

1. Promote AOM as a viable profession and healthcare option
2. Enhance graduate financial and professional success
3. Provide leadership on issues that impact member institutions
4. Promote the effective use of technology
5. Enhance faculty development and student learning

NYCC President Frank Nicchi, DC, MS: Integration agenda

NYCC promotes "integration" to attract students

New York Chiropractic College is using integration as a calling card for new students. In a website listing of reasons for why to choose NYCC, just after the standard "Academic Excellence," web-surfing prospective enrollees will see "Integration." Clicking on the word brings them to a special page that states that students at NYCC, which also has boasts a School of Applied Clinical Nutrition and the Finger Lakes School of Acupuncture and Oriental Medicine, will:

• "Gain the opportunity to work in collaborative settings with providers of mainstream medical therapies and scientifically supported alternative therapies
• "Benefit from a holistic educational approach with shared emphases on the science, art and philosophy of chiropractic and Oriental medicine
• "Experience integrated internship opportunities including NYCC's own health centers, nationally renowned hospitals, Department of Defense sites and free-standing ambulatory care centers
• "Discover our teamwork approach to integration - to create integral care, cooperation is needed between physicians, chiropractors, acupuncturists, massage therapists, and other practitioners
• "Learn the knowledge and specialized skills to be part of a holistic circle of care, and modalities dedicated to the total wellness of patients."

Seeks candidates for presidency

Boucher Institute for Naturopathic Medicine seeks new prdsident

The Boucher Institute of Naturopathic Medicine (BINM), Western Canada's one accredited naturopathic medical school, is seeking a new president. BINM accepts a maximum of 36 students per new enrollment and currently employs 42 faculty members and 34 support staff. The job description notes responsibility for "overall leadership, management and direction of BINM" together with the ability to "create a conscious, caring, learning community consistent with the principles of naturopathic medicine." while also "lead(ing) by example to encourage personal growth, individual responsibility, collaboration, holistic living and contemplative education." The posting points toward an individual training as a naturopathic physician but does not require it. More information is available through

Philanthropy

Forming CAM group

Grantmakers in Health to establish "

"The purpose of this network is to: increase information exchange, support knowledge, allow grantmakers to build constructive relationships with other funders, and facilitate peer learning by allowing participants to hear what other funders have to say about opportunities, challenges, and potential partners in the field of complementary and alternative medicine ...

"This face-to-face meeting will allow us to think strategically about what philanthropy's role can and should be in shaping a future healthcare delivery system that integrates complementary and alternative medicine into conventional care settings."

Comment:  This is a smart development and a great constituency in which to create visibility for "CAM" and integrative medicine, which still typically need a kick-start from philanthropy to get moving inside the mainstream delivery system. (See article on U Arizona Fellows in this Round-up.) This initiative is distinct, in my view, from the Bravewell Collaborative of philanthropists. The Bravewell has, from shortly after its founding a decade ago as the Philanthropic Collaborative for Integrative Medicine, aggregated donors to back a few specific, strategic initiatives. Credit the 3 foundations that have taken the lead in organizing the meeting.

Largest grant ever to ND school

National College of Natural Medicine receives $1.35-million gift from owners of Bob's Red Mill Natural Foods

NCNM student clinicians presently delivery care in a wide network of community health clinical programs.

Donors Bob and Charlee Moore

NCNM President, David J. Schleich, PhD noted that nutrition "is the cornerstone to good health, and the foundation of the medical education that we provide."

NCNM President David Schleich, PhD

Comment: One of the challenges for the licensed "CAM" fields is that few foundations, family funds, individual philanthropists or major corporations choose to bestow major gifts on their educational, clinical and research or community programs like the ECO Project funded here. Few government grants for education are open and in fact, very few NIH NCCAM dollars, relatively speaking, go to these "CAM" schools. All donors and granters favor conventional institutions and academic health centers. I can only think of 2 prior donations of over $1-million to naturopathic medical institutions.  The maturation of the fields, scores of good ideas, and access to integrative services are each held back. The generosity of Bob and Charlee Moore must be appreciated in this context. As one who sometimes looks for such dollars to bridge this healthcare education disparity, here's hope that this is the beginning of a trend! Congratulations NCNM, and to the many individuals and families who stand to benefit from the ECO project.

Professions & Organizations

Hawk: Health and wellness-focused PBRN

Health & wellness-focused chiropractic practice-based research network (PBRN) founded

Comment:  This is a timely development, particularly given the elevated interest of NIH NCCAM in the real world, and a nascent but apparently significant interest in health and wellness outcomes. My only concern is for Hawk, who seems to have started up a dozen useful projects and relationships in the last year, for which she was honored in the Integrator Top 10 People for 2010. Hawk appears to be making the argument for human cloning.

Upton: Lists organization's impacts

Impacts of the American Herbal Pharmaciopoeia recounted by exec Roy Upton

Roy Upton, RH, DAy, executive director and founder of the American Herbal Pharmacopoeia (AHP), recently reported to his board a list of impacts AHP "has had on the botanical world worldwide." AHP was formed in 1995 "

• "Canada: When the Natural Health Product Directorate was formed in Canada, some of the consultants to Health Canada brought our St. John's wort monograph to the regulators as an example of what was needed in Canada. This led to the adoption of the monograph system that they now have in place. They likely would have come to that conclusion without AHP but it greased the wheels and was a no-brainer. Canada formally acknowledges the authoritativeness of AHP monographs and recently entered into a collaboration to develop a bacopa monograph.

• "Hong Kong: After the publication of [AHP's] Schisandra and Reishi monographs, two researchers from Hong Kong's Baptist University came up to me at a conference there and excitedly told me they had proposed and it was adopted to develop a similar set of monographs for Chinese herbs in Hong Kong. This gave birth to the Hong Kong standards, now a corner stone of TCM quality assurance.

• "Africa and South America: AHP was partly responsible for inspiring the development of the South American and African Herbal Pharmacopoeias, the latter of which was just published. At USP, their researchers told me that whenever they are going to do a botanical monograph they first look to see if AHP has done one and then takes their lead from that.

• "US Pharmascopoeia: AHP's monograph format was also almost completely emulated by USP in their recently published Dietary Supplement Compendium. [Upton was a member of the committee that did this.]

• "HPLTC and Microscopy: Eike Reich of Camag, the world's leader in HPTLC [High Performance Thin Layer Chromatography] equipment, used AHP's focus on HPTLC and inclusion of HPTLC images as a spring-board to show USP, the European Pharmacopoeia, Indian Pharmacopoeia, and Chinese Pharmacopeia how valuable it is to have the images. As of that time, none of them provided images. Now they are all developing compendia to present the images. And, HPTLC, which prior to AHP's work was relegated to the doldrums of analytical technologies in the botanical world, has become a fully integrated component of the QC programs of many companies. We have pushed the community on microscopy as well with USP seeing our work and developing their own micro images in the Compendium."

Gawande: Health coaches in key cost-cutting role

Health coaches get boost from Atul Gawande's recent New Yorker piece

Comment: The writings of Atul Gawande, MD on the state of the US healthcare system have had a particularly significant influence on policy makers since Barack Obama singled out his June 2009 New Yorker article on the shocking variations in Medicare payments in McAllen, Texas compared to other parts of the country. Gawande's January 17, 2011 New Yorker article, The Hot Spotters: Can we lower costs by giving the neediest patients better care, is stimulating a similarly high level of interest. One beneficiary will certainly be health coaches and health coaching. In examining how one medical group works with its most expensive an demanding clientele, Gawande reports that a central strategy is the employment of a small battalion of health coaches. This visibility for health coaches gives added urgency to the initiative led by Harvard's Margaret Moore, RN and University of Minnesota's Karen Lawson, MD to set standards of education and credentialing for this emerging field. That initiative, reported here, is presently developing a white paper that is expected to be completed by April 1, 2011. 

Re-examining CAM coverage

Swiss government reverses itself gives CAM "chance to prove its worth as insurable"

The

• In 2005, the Swiss interior ministry banned the therapies.
  
• In 2009, 2/3 of the Swiss population voted to have them on the list of paid services.
  
• In December 2010, a Swiss federal commission recommended thatthey be banned permanently.

Wheedon: Huge Medicare-chiro pilot examined

Health services researcher James Wheedon, DC explores whether Illinois outcomes biased chiropractic-Medicare study

Dartmouth health services research James Wheedon has published a follow-up analysis of the controversial Medicare-expanded chiropractic pilot in Topics in Integrative Health Care as Did Inclusion of Illinois Bias the Medicare Chiropractic Services Demonstration?

D'Adamo: Spring Generative Medicine symposium

Institute for Human Individuality (IfHI) Biannual Symposium: Generative Medicine, May 20-22, 2011  

(Note: Stargrove's appointment to the leadership of a Health Resources Services Administration project is noted under policy in this Round-up.) Dolce Conference Center, Norwalk, Connecticut.

Homeopath Ullman: Focus on Nobel winner stirs debate

Homeopathy spokesperson Dana Ullman, MPH stirs up Huffington Post audience with piece on Nobel-winning virologist

Author, homeopath and frequent Huffington Post blogger Dana Ullman, MPH, struck a rich chord with his January 30, 2011 post entitled, "Luc Montagnier, Nobel prize winner, takes homeopathy seriously." Ullman begins noting Montagnier's 2008 Nobel Prize in 2008 for discovering the AIDS virus then turns to a December 24, 2010 interview with Montagnier in Science magazine. There, Montagnier not only supports the field but also backs the ideas in homeopathy that are most ridiculed: "I can't say that homeopathy is right in everything. What I can say now is that the high dilutions (used in homeopathy) are right. High dilutions of something are not nothing. They are water structures which mimic the original molecules."

Manahan: View of health reform re-published

Bill Manahan, MD featured in Minnesota Medicine 

Comment: A few months after Manahan graciously contacted me for approval for re-publication (the Integrator has a liveral re-publication policy, in line with its mission), he sent along the link, with this note: "This is the article that came about because an editor at Minnesota Medicine was reading your Blog and she came across my article." Ahh ... the power and influence!

La Lanne: Fitness pioneer dies

Jack LaLanne: 1914-2011

The appropriate metaphor for showman and bodybuilder Jack LaLanne's role in the fitness, wellness and integrative health movement is more pillar than roots. The "godfather of fitness" as he was known by many (and as is advertised on his site) died January 23rd at 96. In a "Meet Jack" video on his site from what looks like 50 years ago, La Lanne coaches his early television audience with:

 " ... you know, there has been so much talk of late of the importance of exercise, the importance of fitness, the importance of positive thinking .. I don't like to call it exercise, I like to call it trim-nastics."