Policy

Government agency stimulates integrated cancer care

British Columbia government backs 5 clinics for integrated cancer care

InspireHealth, began operating its anchor Vancouver center in 1997.

Gunn: InspireHealth CEO

In the release, the BC agency portrays integrated cancer care as "combin(ing) nutrition, exercise, and stress management programs with standard cancer treatments to promote an overall healthier lifestyle, which is proven to lead to better patient outcomes and cancer survival rates." According to the release:

"Core health classes, dedicated to supporting health and healthful lifestyle changes such as healthy nutrition and cooking classes, exercise, medication, yoga, shared learning groups and stress reduction classes will be offered at all integrated cancer care centres ... Access to InspireHealth's physicians and nurse practitioners is free. InspireHealth has a number of other programs including core health classes, as well as a two-day LIFE Program that costs $445 for the first year of membership and $95 for annual renewals. The fee is waived for patients on Medical Service Plan Premium Assistance. In-house therapy practitioners -such as massage therapists, acupuncturists and naturopathic doctors - have patient-pay-fees."

Comment: This is a truly remarkable governmental investment. Can US policy-makers allow themselves to be led by their Northern neighbor? That InspireHealth co-founder Rogers had left a tremendous legacy is evident via the Dr. Rogers Prize, named in his honor. Funded through the John & Lotte Hecht Memorial Foundation, the prize awards $200,000 every second year to an integrative medicine leader. (See notice of September 2011 event under Awards, below.) This expansion of InspireHealth as official provincial policy is phenomenal testament to the enduring value of Rogers' work and that of InspireHealth co-founder Gunn.

Van Horn: Key player in shaping integrative health

Complementary and integrative language in recommendations of Advisory Group to National Prevention and health promotion Council

On May 24, 2011, the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health met for its second time. Two integrative practitioners

• Gather background information and evidence that can be used to effectively describe a continuum of services that includes clinical, community, and integrative approaches to prevention.
  

Kerr: Key player in shaping integrative health

The working group will develop the basis for a full Advisory Group discussion "of how the new health care delivery and financing system envisioned in the Affordable Care Act can best support this continuum." The group will also "collect additional background and engage experts from agencies involved in the design of the reformed system (HHS/CMS), as well as other agencies that provide for health care (e.g., DOD and VA)."

Comment: New here is the inclusion of the word "complementary." In this era of integration, if "CAM" (or complementary) is not explicitly mentioned, one can still bet that these therapies and providers will be excluded. So this language is important. More exciting is the focus on clinical preventive services. Clinical prevention in "integrative health" goes beyond immunizations and screening to true primary prevention. The naturopathic doctors sublimely call this treating disease by restoring health. Now that would transform health care. Here's hoping Van Horn and Kerr and those working with them make some noise about a health-creating way of practicing primary care. Might they suggest that the government of British Columbia (see story immediately above) is providing a model of secondary clinical prevention and health promotion which we might embrace here?

Wakefield: Running point for team-care push

HRSA, foundations and academic organizations make historic push for team care; possible value for CAM/IM

On May 10, 2011, a powerful consortium of healthcare leaders joined to promote team care at an event at the National Press Club. This column in the Integrator suggests the initiative may be an exceptional opportunity for "CAM" practitioners and integrative medicine. Joined on the stage were Mary Wakefield, RN, PhD, administrator of the Health Resource Services Administration, and leaders of the powerful Robert Wood Johnson Foundation and

Thibault: Urges academics to break down silos

Comment: One intriguing political outcome of these initiatives is the language with which the American Medical Association greeted the members of the Coalition for Patient Rights (CPR) in a recent meeting. CPR's leaders were protesting the AMA's organized efforts to squash their scope expansions. The AMA greeted the nurses, psychologists and naturopathic doctors and others with strong expressions of the importance of team care and multidisciplinary collaboration. (See "AMA meets with representatives of the Coalition for Patients Rights," below.) Wouldn't it be nice if the AMA actually let go of its need to dominate? Actual competence in the "interprofessional collaborative practices" will require they AMA to do so. And the patient-centered focus of these competencies will require them, if they act in integrity, to include "CAM" practitioners. Note however that it was the American Association of Medical Colleges, not the AMA, from which the MD leaders who endorsed the competencies were selected. Still, these interprofessional efforts are tremendous steps, if remedial, for healthcare.

Integrative Delivery

Piloting CAM/IM networks with hospitals

Jill's List invites LAc, DCs and massage therapists to pilot referral program with 3 Boston medical centers

Applications are open to

Shah: Planning national roll-out

Comment: I have on occasion spoken with Shah, an experienced internet entrepreneur. Each time I have been impressed by her quick grasp and constructive reframing of both the challenges and opportunities in the integrative space she is seeking to create for Jill's List.  She and the organization get 5 stars for understanding the critical importance of relationship-building behind this pilot. Relationships seems to be key to the network's emerging business model.

Educators from licensed CAM disciplines publish Competencies for Optimal Practice in Integrated Environments

An organization of educator leaders in chiropractic medicine, acupuncture and Oriental medicine, naturopathic medicine, massage therapy, direct-entry midwifery and related fields announced in May 2011 a set of collaboratively-developed

"The era of integration is here. Yet the educational standards and clinical models of the licensed integrative healthcare disciplines are generally not emphasizing integrative models of care. These competencies focus us all on the current and future needs of providers."

Wiles: Integration era requires educational changes

The work was engaged in late 2009 through the Academic Consortium for Complementary and Alternative Health Care (ACCAHC). One of Wiles' collaborators, Jan Schwartz, MA, a massage professional and online educator with Education Training Solutions, notes in an ACCAHC release that the organization's

Prenguber: Health system role underscores competency needs

Comment: When conventional medicine dropped a box over scores of disciplines and therapies and declared them "CAM," they created false community. Author Kurt Vonnegut calls this a "granfalloon." These collaboratively-developed competencies, on the other hand, are a significant declaration of an actual community of interest. ACCAHC plans to ensure that the competencies don't merely gather dust on a shelf by creating the Center for Optimal Integration. This portal will work to continuously re-invest the involved fields in this work in collaborating to enhance optimal integration. Note the parallel with the work of the 6 conventional academic fields noted in the article on collaboratively-developed team care competencies in this Round-up. The medium is the message. Marshall McLuhan would like this. 

Briggs: Promoting NCCAM's new provider resource

"CAM practices are used by many Americans to promote health and it's also a valuable entry for the healthcare provider to talk about health behaviors. The advice that we need to be more active and eat a healthy diet is one that patients need to take charge of themselves and talking about their health practices, the whole range of health practices, is a very good way as a physician, and I know this from my own care patients, to begin that dialogue."

Comment: Credit Briggs for linking evidence that people use CAM therapies and providers for health-promoting reasons to the ongoing campaign for conventional doctors to discuss CAM use with their patients. The other 2 reasons (interactions, missed care) cast CAM the black hat role that is most comfortable for her conservative colleagues. Briggs' 3rd reason, however, is affirmative. The question of CAM use is urged to kick-start a conventional practitioner's shift out of reactivity toward more focus on health promotion. CAM stimulates stimulates changing the medical interaction toward a focus on health. This is high honor. Meantime, NCCAM provides a great resource by pulling all these guidelines into one place. Good work.

Greenlee: ND presents poster, gives talk at ASCO

American Society for Clinical Oncology featured integrative track

According to a blog post from Glenn Sabin, a board member for the Society for Integrative Oncology, complementary and integrative medicine had a heightened profile at the 2011 meeting of the American Society for Clinical Oncology (ASCO). Sabin notes that his own efforts and those of others led to inclusion of a 5-speaker, 2-hour afternoon session entitled "Extended Education Session: Role of Nutrition, Supplements, and Integrative Medicine in Cancer Prevention, Treatment, and Survivorship." The integrated group of presenters included an ND, MD, 2 PhD, RDs and PhD researchers. In addition, the naturopathic doctor, Heather Greenlee, ND, PhD, and Gary Deng, MD delivered oral poster presentations. Sabin links the integrative interest to the "buzz this year around personalized oncology."

Comment: This is nice sign for ASCO, if rather remedial, given the comparison of governmental funding of integrated care cancer clinics in British Columbia. (See Policy, above.)

Penny George: Institute provides practical teaching on integration

Penny George Institute offers

• Integrative Health Practitioner Training for Massage Therapists, June 27 to July 1, Sheraton Hotel, Minneapolis, Minnesota
• Integrative Health Practitioner Training for Oriental Medicine Professionals, August 15 to 19, Sheraton Hotel, Minneapolis, Minnesota
• Hospital-Based Integrative Health Care Conference: Transforming Health Care Practice, August 3 to 6, Westin Hotel, Edina, Minnesota. This part of the Integrative Health in the Hospital Setting series is for all medical professionals.

Academic Integrative Medicine

Myra Brind Center in former Federal Reserve Bank

Myrna Brind Center of Integrative Medicine a marketing pearl for Jefferson Health System

An Integrator interview with medical director Daniel Monti, MD and philanthropic backer Ira Brind offers insight into recent developments at the Myrna Brind Center of Integrative Medicine. The 13-year-old operation now provides over 12,000 patient visits annually in its posh home in a former Federal Reserve Bank building in downtown Philadelphia. Monti expects visits to grow more than 10% in 2011.

Ira Brind: Philanthropic backer and well-connected Jefferson leader

Comment: The visit to the former Federal Reserve Building provoked an almost dissociative response. How can one not be dumbfounded by the cultural dissonance between these philanthropically-backed manifestations of integrative medicine and the grassroots, hang-up-a-shingle, natural/alternative medicine movement which seeded it? Brind's generously-based model seems to be working to attract his target clientele of health system and civic leaders.

Brian and Sue Berman: 2 major initiatives in Maryland

Bermans' U Maryland Center celebrates 20th anniversary with kick-off of $20-million campaign

On May 17, 2011, the nation's charter academically-based center for complementary (and now integrative) medicine celebrated its 20th year. The University of Maryland Center for Integrative Medicine, founded by Brian Berman, MD and Sue Berman, used the occasion to cut a ribbon on new office space. They also kicked off a $20-million fundraising effort. An anonymous donor has given them a $7.5 million match grant. Speakers at the celebration evidenced the Center's importance to the local and national community. In

Mikulski: Praising the work of her constituents

Comment: Brian Berman brought to Maryland what was already a rich, clinical experience and curiosity. In the 1980s he had studied and practiced acupuncture and homeopathy in England, and explored other integrative practices prior to the founding of the Center. All the while, his interest and skills in Western medical research led him to become the most funded of researchers by NCCAM. His group has had over $30-million in grants. Yet the work at U Maryland has always seemed, as Mikulski pointed out, the success of not one but two Bermans. Comments on the site from Mikulski, Reece and Perman speak to the abilities of the Bermans' as educators and diplomats in the Maryland system and in US policy. The $20-million campaign is an interesting addition to their ambitions for The Institute for Integrative Health, which they founded in 2009. The health of Baltimore and the nation will each be bettered by their work in the next two decades. Congratulations!

Alliance: Pushing field toward new alignment on certification

Comment: The Alliance is to the massage field as the Community Acupuncture Network is to the acupuncture field. Each is a "disruptive innovator." NCBTMB's role as a support for licensing agencies has certainly diminished. The altered role, however, will also mean a significantly decreased budget for the NCBTMB.

Winterstein: Backed NUHS-Georgetown relationship

National University of Health Sciences and Georgetown University program launch agreement for mutual cooperation

Marks 30th year of onsite training

Tai Sophia graduates 233 from 7 programs in celebration of 30th year

Comment: Under founders Bob Duggan and Dianne Connelly, the Institute was outspoken about its efforts to model a radical break from the disease focus of health care and health professions education. Duggan calls school as an "academic wellness institution." The school's god-parent, and a teacher to Duggan, was Ivan Illich, author of Medical Nemesis. I've always been partial to the Duggan/Connolly outspoken commitment to wellness, especially having observed the tendency of many to be corralled into increasing disease orientation. It is good to see the Vitale-Broida team continue this focus.

Professions

Nurse-led group meets with AMA on contentious issues

AMA meets with representatives of the Coalition for Patients Rights, focuses on team care

On May 10, 2011, the American Medical Association (AMA) met with fourteen representatives of the Coalition for Patients' Rights (CPR). The CPR was formed to oppose the AMA's efforts to restrict other disciplines' via the AMA's Scope of Practice Partnership. Its 3-dozen member organizations represent those for nurses, psychologists, audiologists, physical therapists, chiropractors, acupuncture and Oriental Medicine professionals and others. Among those in the CPR delegation were American Association of Naturopathic Physicians (AANP) executive director Karen Howard and president Carl Hangee-Bauer, ND, LAc. Howard filed this report to AANP members:

Calls for a future with more team care

"This meeting was the result of a series of letters and phone calls from CPR to the AMA initiated in 2010 by a letter raising our concerns about the AMA's Scope of Practice Data Series. More than a year later, after numerous letters and conversations, the meeting was held. The meeting was cordial and frank, offering new potential to revise the existing documents originally created by a mandate of the AMA House of Delegates. Through our introductions and commentary, this face-to-face meeting with Dr. Ardis Hoven, Chair of the Board of Trustees, and Dr. Michael Maves, MBA, Executive VP and CEO, was respectful and collegial, focused on a need to move forward in recognition of how patient care is evolving in the field and, as Dr. Hoven described it, "team care." During the two-hour session a general commitment was expressed to continue to dialogue with a focus on seeking a shared understanding of how we could build interdisciplinary, patient-centered teams - what they would look like and how they are developed and maintained within different locales and settings. While no specifics were delineated, we did agree that staff from AMA and CPR will look for future meeting dates to come together and move forward productively."

Research

Advisory Council focuses on outcomes, effectiveness

NCCAM advisory council focuses on outcomes, effectiveness, cost at June 3, 2011 meeting

The real world portion of the 2011-2015 strategic plan of National Center for Complementary and Alternative Medicine (NCCAM) was a principal focus of the June 3, 2011 meeting of the National Advisory Council for Complementary and Alternative Medicine. Presentations and speakers were:

• Outcomes and Effectiveness Research at NCCAM (Josephine Briggs, MD)
• Science to improve the Nation's Health: The Case for Comparative Effectiveness Research (Michael Lauer, MD) 
• Cost Minimization Analyses and Washington State's Approach to Funding CAM (William Lafferty, MD)
• Complementary and Alternative Medicine at the Department of Veterans Affairs (Stephen Ezeji-Okoye, MD)

The NACCAM meeting was the first since the February 2011 release of NCCAM's 2011-2015 Strategic Plan.

Comment: This is an excellent signal of the importance of the "real world" to NIH and to NCCAM in the Briggs era. Outcomes and effectiveness, while mandated as top focus in the NCCAM enabling law from Congress, only accounted for 0.5%-2% of funding under first NCCAM director Stephen Straus, MD. This direction was elevated to Strategic Priority #3 in the 2011-2015 plan, with elements potentially in #1 and #2 also. Kudos to Briggs and her staff for this prioritization. If NCCAM wants to influence access and discover whether these integrative disciplines and approaches can make a difference in changing our typically dismal churning of reactive treatment, this is the way to go.

Keckley: Former Vanderbilt IM leader co-authors Deloitte paper

Deloitte study highlights CAM as major portion of "hidden costs of healthcare for consumers" 

Comment: These data are most useful as a general awareness that US consumers spend even more on health-related care than the the already horrendously high costs. They are casting a wide note. For instance, inclusion of all nutritional drinks (Ensure, etc.) jacks the "Nutritional Products" category up significantly.  

Surowiecki: Talk providers if you are focusing on cost

New Yorker economics writer aims cost-cutting guns at providers

Comment: I reference Surowiecki's comment because it is my perception, also, that insurers are often made the scapegoats on health costs when more attention deserves to be focused on practitioners. No one much likes to think that one's provider's economic interests is a major player in clinical decisions and thus health care costs. The findings of Wennberg and others tell us we should. We certainly don't like to think it is our doctors. I saw an ophthalmologist recently for a second opinion regarding an eye issues related to an old basketball injury. She recommended a surgery. I said I knew that the Institute of Medicines has said some 50% of what we do is waste and much of that harmful. In which category is your recommendation, I asked her. How to win friends.

Hamm: Chiropractor in historic role with AMA group

Chiropractor Hamm elected co-chair of powerful AMA payment committee

Anthony Hamm, DC, president of American Chiropractic Association's Council of Delegates, was recently elected co-chair of the American Medical Association's (AMA) Health Care Professionals Advisory Committee Review Board (HCPAC). According to a release from the American Chiropractic Association, Hamm is the

Comment: Since my exploration of the value of the CPT to the AMA last year, which also touched on the powerful RUC, I had been surprised that no one has mounted an anti-trust case against the AMA's guild control of payment. (See The AMA's $70-Million Taxation without Representation: Is it Time for a "CPT Party" Revolt?). Hamm's elevation may be viewed as an interesting chess move.

Natural Products

Self-regulation, plus reporting to federal regulators

Natural Products Foundation asks FDA and FTC to take action against 13 nutritional products advertisers

Comment: Talk of the need for self-regulatory efforts in the natural products industry has been as enduring as the talk of need for peace in the Middle East. Kudos to the NPF for developing the program and giving it teeth by turning state's evidence on non-compliant firms..

Reports growth in herb market in 2010

American Botanical Council reports herb sales up 3.3% in US in 2010

On May 19, 2011, the American Botanical Council (ABC) announced its finding

Awards

September 23, 2011 event

Jonas, InspireHealth and depth exploration on integrative clinics to be featured at September 2011 Dr. Rogers Prize event

Comment: If anyone in the U.S. was wondering why spend precious time and resources to journey to Vancouver to explore Canadian models of integrative care, the recent decision of the government of British Columbia to fund expansion of the InspireHealth model (see related article under Policy, above) should be reason enough. Best practices appear to be north of the border.

Bland: Lifetime achievement

Jeff Bland, PhD honored with Linus Pauling Functional Medicine Lifetime Achievement Award

"With a PhD in biochemistry, Bland became a prominent educator for the natural foods Industry, served as President of the Northwest Academy of Preventive Medicine, and helped establish Bastyr University of Natural Health Sciences in the Northwest. In 1981 he was invited by two-time Nobel Laureate Linus Pauling to become the Director of Nutritional Supplement Analysis at the Linus Pauling Institute in Palo Alto, California. In 1984 he introduced the concept of using foods to create biochemical change, and started HealthComm, Inc..

Lebensohn: Directs award-winning program

U Arizona Integrative Medicine in Residency receives national Innovative Program Award

Society of Teachers of Family Medicine (STFM) bestowed its