Summary: Integrative community dialogue on board certified integrative MDs and the direction of "integrative medicine" ... Congressional Wellness Caucus established with bipartisan backing ... Obama names Kahn and Ornish to Advisory Group for National Prevention Council ... IHPC's Partners for Health group expands ... Integrative medicine not featured at TEDMED 2011, moves to the Beltway in 2012 ... Knutson urges response to US Preventive Medicine Task Force ... Dartmouth researcher Davis breaks down $$$ in CAM market ... Bastyr reports $136-million of economic impact ... CHP Group offers case statement for CAM integration ... Steiner Leisure purchases Cortiva Group ... Sabin on role of philanthropy in integrative medicine ... Chesney in line to chair conventional academic consortium ... Acupuncturist Beau Anderson gains faculty appointment at Albert Einstein ... Taylor Walsh adds perspective on debate over whether alternative medicine killed Steve Jobs ... IAYT's John Kepner addresses the Group Health findings relative to "sham yoga" ... Report on naturopathic profession's Science & Policy Summit ... Chiropractors push inclusion in loan repayment ... New Hampshire Republicans cross party line to support mandate to cover naturopathic doctors ... Acupuncture Without Borders in tough financial position ... American Medical Student Association leader is a naturopathic medical student, SCNM's Rebecca Snowden ... Zunin's Manakai O Malama, Hawai'i's most significant integrative center, seeks additional integrative MD/DO ... Christina Jackson named the 2011 Holistic Nurse of the Year ... Rita Bettenburg takes position at CHP Group

Policy

Taking lead on board certification

Expansive integrative community dialogue on effort to create an MD specialty through an American Board of Integrative Medicine

The September 2011 "strategic change in direction" by leaders of the Arizona Center for Integrative Medicine to promote recognition of a board-certified integrative medicine specialty prompted significant, sometimes fractious dialogue in the integrative practice community. Some perspectives on the proposed American Board of Integrative Medicine (ABIM) were captured in

Daniel Redwood, DC: Balanced remarks

Comment: This is not capital "P" policy but is certainly core policy inside the integrative practice community. The topic is like a natural therapeutic regime that successfully surfaces both entrenched morbidity and abiding hope. My sincere intent is that the perspectives registered in these Integrator postings will lead those establishing ABIM to more deeply embrace the emerging discipline's most transformational potential. This means an enhanced focus on the interprofessional education that a patient-centered approach requires. This will address the critical interprofessional concerns directly and indirectly note by many. Many who can't sit for the BCIM are not yet sure that historic and continuing political-economic suppression of other disciplines by medical doctors will not be furthered, again, by the emerging guild of MD-BCIMs. Or, as the framing keeps coming to me, should these professionals listen when they are told we are not like all the others? 

US Senator Amy Klobuchar

Congressional Wellness Caucus established, linked to National Prevention Strategy

US Senator Amy Klobuchar(D-MN) and US Representative Erik Paulson (R-MN) have announced the creation of the Congressional Wellness Caucus. The focus is "to put workplace wellness on the national agenda," according to an article on the June kick-off. Despite well-researched savings associated with wellness programs, "only about 27 percent of employers with 500 or more employees offer wellness programs and about 43 percent with 10,000 or more do" according to

Congressman Erik Paulsen

The caucus, expected to be fully functional by this fall, was referenced in a November 1, 2011 Congressional briefing that was led by Trust for America's Health (TfAH). Notably, the executive director of TfAH, Jeffrey Levi, PhD, serves as chair of the

(Thanks to  the Integrated Healthcare Policy Consortium for bringing the November event to my attention.) 

Janet Kahn, PhD

Obama appoints Janet Kahn and Dean Ornish to the Advisory Group to the National Prevention Council

Comment: This brings to 4 the number of individuals closely connected to the integrative practice fields to gain appointment to the Advisory Group. The first were Charlotte Kerr, RSM, BSN, MPH, MAc, an emeritus faculty member at Tai Sophia Institute and UCLA-based integrative medical doctor Sharon Van Horn, MD. The Advisory Group, charged with assisting the Council in developing the nation's prevention and health promotion strategy, was mandated to include integrative practitioners.

Partners for Health expands

Integrated Healthcare Policy Consortium update: Partners for Health expands

The Integrated Healthcare Policy Consortium (IHPC- www.ihpc.info) is celebrating the appointment of senior associate and past executive director Janet Kahn, PhD, to the Advisory Group of the National Prevention, Health Promotion and Public Health Council. According to an IHPC release from chair Len Wisneski, MD, Kahn, a researcher and practicing massage therapist, is expected to have a significant role in shaping the nation's relationship to integrative care from her position on the Advisory Group.  Meantime, IHPC has announced new members of its diverse Partners for Health program. The current list includes the following, with those relatively new in italic:

• American Academy of Pain Management
• American Association for Acupuncture and Oriental Medicine
• American Association of Naturopathic Physicians
• American Massage Therapy Association
• Bastyr University
• International Chiropractic Pediatric Association
• National Association of Certified Professional Midwives
• National Center for Homeopathy
• Naturopathic Medical Student Association
  
• Oregon College of Oriental Medicine
• Palmer College Center for Chiropractic Research
• Sojourners Community Health Clinic 
• Tai Sophia Institute

New IHPC Partner

Comment: It is pleasing that Kahn will continue to work with IHPC in her Senior Adviser capacity. She helped IHPC accomplish a good deal as executive director in an environment of great scarcity. Kahn extended herself personally in many ways. She had a key role in placing licensed complementary and alternative healthcare practitioners in the nation's workforce planning, via her home state connection with US Senator Bernie Sanders. Meantime, this is a nice group of Partners for Health! Here's a wish that some philanthropist or corporation with skin in this game will realize how much fun and value could come from jumping in and empowering this group with some real cash!



Integrative medicine at TEDMED 2011 (not), plus a changed venue to influence policy in 2012

I place the TEDMED conference under Policy because of a decision by the new owner of the brand, Jay Walker. The

Walker: TEDMED curator

Comment: The barrier to entry for TEDMED is high, at $4000 per person. I was gifted an opportunity to attend the October 25-28, 2011 meeting. I will report the excitement and sometimes disturbing trend-lines more fully soon. Walker, whose passion for the history of innovation is infectious, noted during closing comments that some attendees had told him that the 2011 iteration "left out the patient perspective." Walker said he'd bring it back. Here's hoping that his concept of innovation is broad enough to include the substantial cultural innovation engaged by the patient population when human beings as healthcare consumers co-conspired with diverse practitioners to invent the holistic and complementary and alternative healthcare disciplines. I understand that Walker is personally supportive of integrative medicine. Hopefully TEDMED's obvious high-tech strengths will have more high-touch balance in 2012.

Lori Knutson, RN, BC-HN

Knutson calls for community response on academic curriculum for US Preventive Service Task Force

"This is a cultural imperative. If we are serious about influencing the health of our nation and integrating 'CAM' in the tapestry of care then we must not only focus on delivering services and researching outcomes and best practice. We must proactively embed this work in academic institutions so that integrative care/medicine/health is the norm and not the exception for healthcare provider education. The U.S. Preventive Services Task force is asking for feedback on how to improve the academic training of healthcare providers to ensure health promotion and prevention as having equal relevance to the academic focus on treatment of disease and illness.  I propose we have an obligation to be active partners in ensuring this.

Cost & Business

Mathew David, MPH, DC

NCCAM-funded Dartmouth researcher Mathew Davis reports $$$ in CAM market 

In a paper delivered at the Annual Research Meeting of AcademyHealth, Mathew Davis, MPH, DC reported useful data on the size of the CAM market and consumer spending. According to this article in Family Practice News, Davis found that:

• visits to chiropractors fell from about 110 million in 2005 to just under 100 million in 2008
• spending on CAM services increased from about $8 billion in 2002 to $8.6 billion in 2008
• spending on CAM is concentrated in a minority of users, with about 25% accounting for 72% of spending
• heavier spenders (those who spent $520-$10,000 in 2007) aren't any sicker than light spenders (those who spent less than $87)
• in 2007, the top 10% of users, accounting for almost half of expenditures, spent a mean of $2,392.

Dan Church, PhD

Bastyr University reports $136-million of economic impact in

Comment: Brilliant move to commission this report. This is no homeopathic dose.

CHP Group offers concise resource on evidence, cost-effectiveness of CAM

A 20-page resource entitled "Integrating Evidence-Based Complementary and Alternative Medicine into the Healthcare System" is available as a PDF file from Portland, Oregon-based CHP Group. CHP Group uses the document in its outreach to prospective employer and insurer clients. CHPs manages networks of chiropractors, naturopathic doctors, acupuncturists and massage therapists. A key client is Kaiser Northwest Permanente. The referenced document, with 32 useful end-notes, seeks to make a case that "research has demonstrated the clinical effectiveness of many CAM interventions and recent studies have shown that CAM is cost-effective." The firm, co-founded by medical director Chuck Simpson, DC and led by Michelle Hay, CEO, was named Carrier of the Year at the August 2011 meeting of the Oregon Association of Health Underwriters (OAHU) for "exceptional leadership in the health insurance industry."

Comment: While published in 2010, this CHP document may be useful to more than one Integrator reader.

Massage education and services firm Steiner Leisure purchases Cortiva Group

On October 12, 2011, Steiner Leisure Limited announced an agreement for the acquisition of the assets of Cortiva Group. Cortiva was a venture-backed roll-up of seven of the nation's most influential for-profit massage schools with 12 campuses in Arizona, Florida, Illinois, Massachusetts, New Jersey, Pennsylvania and Washington. Revenues in 2010 were approximately $24.6 million. Post-closing, Steiner will own and operate a total of 30 campuses in 14 states with an anticipated total population of approximately 5,200 students. Steiner president and CEO Leonard Fluxman said: "The acquisition of Cortiva Institute, a well-known participant in the massage therapy education field and one of our longtime competitors, would considerably expand and fortify the presence of our Schools division in the post-secondary massage therapy school market." The sale price was $33-million.

Comment: Interestingly, this move brings into one large corporation the 2 branches of the massage field. Cortiva's mix has leaned involvement in medical massage, integrated care and research involvement while Steiner's core have a focus on the spa services and cruise ships that are the public corporation's Steiner's forte. Fluxman captures the duality this way: "We look forward to introducing even more graduates, with increasingly diverse skill sets, into the growing massage therapy and spa industries." Here's hope there is a vital exchange between the spa and medical interests. (Thanks to Jan Schwartz, MA for the link to this story.)

Integrative Centers

Article surveys role of philanthropists in integrative medicine

Integrative center consultant Glenn Sabin of FON Therapeutics has offered up his reflections on the Evolution of Philanthropy in Integrative Medicine. He supports applying philanthropic dollars to performing research, community outreach and for educational purposes. However, while he believes he "will take some heat for this," Sabin argues that philanthropically subsidizing integrative clinical services "for all but the indigent or those that cannot afford to pay is unsustainable as a clinic/business model." He points out that this can be "a costly long-term decision that has over time resulted in the closing of many integrative medicine programs."

Comment: It is almost impossible to imagine the integrative medicine movement without thinking of philanthropy and philanthropists. What other medical fields are as cobbled to, energized through, and hobbled by, this need? Meantime, as I note in comments on Sabin's piece, the creation of the holistic medicical, naturopathic, chiropractic and other clinics that predated the invention of integrative centers were and remain of an opposite ilk. These necessarily followed the Jim Henson's toddler's motto: I can do it. I can do it myself! Fascinating to consider where we would be now had, say, 50% of the philanthropic millions used as battering rams to break down the antagonism in hospitals and academic health systems been re-directed. What if these dollars were strategically used to empower for those whose sweat equity created the response to patient demand known as "CAM" and holism? Some of us are working on this going forward and will be happy to increasingly find partners! There has clearly been value in top-down philanthropy. Be smart to have some more bottom-up, empowering these other disciplines and and providers toward integrative leadership. 

Academic Medicine

Margaret Chesney, PhD

UCSF's Margaret Chesney, PhD in line to chair the Consortium of Academic Health Centers for Integrative Medicine

Integrative medicine leader at the UCSF Osher Center director Margaret Chesney, PhD

Beau Anderson, PhD, LAc

Licensed acupuncturist Beau Anderson, PhD, LAc in academic appointment at Albert Einstein medical school

I recently became aware of the appointment of Belinda (Beau) Anderson, PhD, MAOM, LAc as assistant clinical professor at Albert Einstein College of Medicine, Yeshiva University. Anderson, academic dean and research director at Pacific College of Oriental Medicine (PCOM), New York, is among the first licensed acupuncturists to receive such an appointment. She shared the following educational responsibilities that come with the title:

• As part of an educational exchange program, 1st year Einstein students in the Introduction to Clinical Medicine course attend Anderson's introductory lecture about Chinese medicine. They also attend a clinic shift at the PCOM student clinic. (In addition, a group of PCOM interns attends an introductory lecture followed by a three-hour cadaver dissection lab at Einstein.)
• Anderson teaches a workshop on stress reduction called "The Use of Integrative Medicine" in the clinical examination section of Einstein's Introduction to Clinical Medicine course.
• Family practice residents at New York Beth Israel, an Einstein-affiliated residency program, attend a lecture of Anderson's and then shadow licensed acupuncturists in the PCOM clinic during their 2nd year of training.

Comment: Among the pleasures of this work is noting these historic moments, quiet breakthroughs, stones dropped in ponds, as the choices of patients and the actions of professionals begin to be reflected in the practice of institutions. Kudos to Marantz and Kligler for facilitating this door opening and to Anderson for having the skill sets to step through .

Media

Steve Jobs

Steve Jobs decision to delay conventional treatment to explore alternative medicine spins through media

"Did alternative medicine kill Steve Jobs?" This question was asked in a flurry of articles that came out subsequent to the death of Apple founder Steve Jobs. In fact, search that title and page after page will show up. One headlines asks more specifically if Vegan quackery" was the culprit. Jobs chose to explore alternatives before his surgery, allowing the tumor to grow. The media brouhaha led NIH NCCAM director Josephine Briggs, MD to publish a comment on it on her Director's Page. Briggs takes a view that the evidence is not there for using CAM in lieu of conventional treatment. She adds that complementary approaches can be useful in the areas of quality of life, giving patients active participation and empowerment, and alleviating the symptoms and side effects.

Integrator columnist Taylor Walsh notes that a CNN feature in which

• Jobs, a vegan, had "... obsessive diets and weird routines of purging and fasting that he had practiced since he was a teenager."

• Jobs' reluctance to go with surgery when first diagnosed with the pancreatic cancer drove his friends and advisors crazy.  This included former Intel chairman Andy Grove, who had surgery for prostate cancer and overcame it.

• "Even diet doctor Dean Ornish, a pioneer in alternative and nutritional methods of treating diseases, took a long walk with Jobs and insisted that sometimes traditional methods were the right option. 'You really need the surgery,' Ornish told him."

• Once diagnosed, in addition to his diet, "he added acupuncture, a variety of herbal remedies and occasionally a few other treatments he found on the Internet...for a while he was under the sway of a doctor who operated a natural healing clinic in southern California that stressed the use of organic herbs, juice fasts, frequent bowel cleansings, hydrotherapy, and the expression of all negative feelings."

Taylor Walsh: Comments on issue

• When the surgery was done 9 months after diagnosis, it involved removal of part of the pancreas, which, according to Isaacson's text, meant his pancreas would would produce less protein: "Patients are advised to make sure that they eat frequent meals and maintain a nutritious diet, with a wide variety of meat and fish proteins as well as full-fat milk products.  Jobs had never done this, and he never would."

• When Isaacson discussed the book with Charlie Rose last week, Rose asked several times basically if anyone was responsible for giving Jobs bad health advice.  Isaacson would not bite and repeated that Jobs' health choices reflected his lifelong attitudes and lifestyles.

• In the book he quoted Apple board member Art Levinson, also chairman of Genentech: "I think Steve has such a strong desire for the world to be a certain way that he wills it to be that way.  Sometimes it doesn't work.  Reality is unforgiving."

Research

Karen Sherman, PhD

Sherman/Cherkin Group Health group finds both yoga and stretching better than usual care

"Re sham/stretching and yoga

"1. Karen (Sherman) had a good explanation - that the stretching classes were more "Yoga like" than the typical exercise program. "We expected back pain to ease more with yoga than with stretching, so our findings surprised us," Dr. Sherman said. "The most straightforward interpretation of our findings would be that yoga's benefits on back function and symptoms were largely physical, due to the stretching and strengthening of muscles." But the stretching classes included a lot more stretching than in most such classes, with each stretch held for a relatively long time. "People may have actually begun to relax more in the stretching classes than they would in a typical exercise class," she added. "In retrospect, we realized that these stretching classes were a bit more like yoga than a more typical exercise program would be." So the trial might have compared rather similar programs with each other.

"2. But note, this study was focused on a very narrow definition of benefits, (reducing chronic low back pain). Yet the classical goal of Yoga is mental health, i.e., quieting the mind. The tangible and demonstrable integration of body breath and mind in a classic Yoga practice is focused on that. That was not measured here. 

"3. When I ask my personal students the primary reason they come to Yoga class, the 'benefits' if you will, they will not say reducing pain.  They say 'defragging' their brain, which I interpret as simply expressing the classic 'quieting the fluctuation of the mind'  in modern terminology.    

"4. The benefits of Yoga in reducing physical pain could be interpreted simply as positive 'side effects' of the practice -although they are not very inconsequential to a person in actual pain." 

IAYT's John Kepner: Comments on issue

The Group Health release is here.

Comment: This findings continue an interesting pattern from the Cherkin-Sherman team. Their examination of acupuncture found it more effective than usual care, but no more effective than "sham acupuncture." An examination of massage therapy found a focused medical massage effective and reflection on many of our parts. It is intriguing to see Sherman's view that the form or stretching may have tilted toward the more reflective and mind-slowing experience many find in yoga. Stretching can be a mind-body engagement. Meantime, Kepner's perspective is a fun reversal, placing the back pain benefits as positive side effects of mind-spirit value of the Yoga therapy. A Cherkin-Sherman paper on positive side-effects is noted here.

Report published on Naturopathic Science & Policy Summit 2011

The Natural Medicine Journal has published a report on the August 2011 Naturopathic Science & Policy Summit led by the Naturopathic Physicians Research Institute (NPRI). Key conclusions:

"1. There was consensus that research toward policy objectives in the field is essential to the profession's identity and advancement. Simultaneously, better focus on critical goals is needed. This means that research on naturopathic practice, naturopathic physicians and their patients, and naturopathic medical theory is required, and not simply studies on single agents and modalities. Broad outcome measures are necessary to measure the impact of naturopathic medicine on whole health and prevention, not just biomarkers of disease progression.

"2. The most compelling work has been and will be outcomes studies in naturopathic practice in comparison to conventional medical models, particularly on clinical effectiveness, safety, and cost, published in peer-reviewed journals."

The participants in the Summit also concluded that "financial and other resources from the profession must be accessed" to develop the necessary information. The NMJ is the official publication of the American Association of Naturopathic Physicians, a Summit co-sponsor. (Alignment of interest note: I helped develop this meeting as a member of the NPRI board.)


Professions & Organizations

US Rep. Bruce Braley

Chiropractors in bill to allow loan repayment for service in under-served areas

A late October newsletter from the American Chiropractic Association (ACA) reminded members that their help is needed to increase sponsorship for the Access to Frontline Healthcare Act (HR 531). The legislation was originally introduced February 2011 in the US House of Representatives by Rep. Bruce Braley (D-Iowa). It would designate certain types of health care providers as "frontline" providers. According to the ACA, the association and the Association of Chiropractic Colleges worked closely with the Braley "to ensure that chiropractic physicians are specified in the bill as qualifying for this status." A draft letter is available at the ACA's Legislative Action Center.

A mandate already exists in nearby Vermont where naturopathic doctors are also included as Medicaid providers. (Thanks to Pamela Snider, ND for bringing this article to my attention.)

Acupuncturists without Borders in tight spot financially

In an October 18, 2011 e-blast boldly labeled SUPPORT NEEDED! Acupuncturists without Borders (AWB)  announced that it "had to cut back on our staffing temporarily until we receive more funds, donations and membership dues." The organization's mission is to "provide immediate relief and recovery acupuncture services to global communities that are in crisis from disaster or human conflict." AWB says it has helped more than 20,000 people recover following Hurricane Katrina, Iowa floods, California wildfires, Boulder wildfires, shootings in Tucson, earthquake in New Zealand and in recent work with traumatized populations in Nepal, Ecuador, Mongolia, and Haiti as well as Missouri, Minneapolis, and Springfield, Mass. after the tornadoes of 2011.

Rebecca Snowden

Naturopathic student Rebecca Snowden in leadership role with the American Medical Student Association (yes, you read that right)

The committee chair for the Medical Professionalism Action Committee of the American Medical Student Association is a naturopathic medical student, Rebecca Snowden. The committee's charge is, according to the web site, "to change how future physicians interact by promoting:

Snowden,

Miscellaneous

Ira Zunin, MD, MPH

Hawai'i's most significant integrative center seeks additional primary care MD

Integrator editorial adviser Ira Zunin, MD, MBA, MPH writes: "Manakai O Malama Integrative Health Care Group and Rehabilitation Center is seeking a board certified/board eligible family physician or other primary care provider to join our group. Enjoy the practice of medicine in a large, well-established, dynamic integrative facility. Our philosophy is to bring together the best of modern medicine and traditional healing arts with cultural sensitivity to optimize whole-patient outcomes. The multidisciplinary team includes: family medicine, women's health, psychology, physiatry, physical therapy and acupuncture. This facility is well-suited for the Patient-Centered Medical Home (PCMH) and recently completed EMR transition to EPIC. The office is open 8-5pm M-F and 8-3pm Saturday. The position is for a PT/FT physician." Contact Ira Zunin MD Medical Director: [email protected]

Comment: I recently interviewed Zunin for a piece on integrative medicine and the PCMH which I expect to publish shortly. Manakai O Malama  appears to be a national leader in manifesting integrative care in the PCMH environment. An exceptional opportunity. Zunin's work was last seen here in the Integrator: Ira Zunin, MD and Manakai O Malama: Checking in on a Thriving Integrative Center.  

People

Christina Jackson, RN, BC-HN

Christina Jackson, PhD, RN, AHN-BC is

Rita Bettenburg, ND

CHP Group hires Rita Bettenburg, ND as assistant medical director

Portland Oregon-based