• Patient-Centered Outcomes Research Institute draft plan comment period ends March 15: No CAM-IM presently included
  

• Dana Ullman, MPH: Swiss government finds homeopathy cost-effective, covers in national health plan
• Update: Marilyn Allen and the advancing effort to place TCM in World Health Organization's ICD11 codes

• Bravewell publishes landmark Integrative Medicine in America (but does the subject matter reflect the title?)
• University of Minnesota's Center for Spirituality and Health sets sights on "whole systems healing"

• Six profession organization enters the team care/interprofessional education space: from dictatorship to oligarchy?
• Consortium of academics in licensed fields of chiropractic, AOM, naturopathic medicine, massage and midwifery receive a breakthrough $100,000 grant from the Westreich Foundation

• Aetna's mind-body programs developed in partnership with Duke, Viniyoga and e-Mindful
• Swiss analysis finds those with CAM services cost the same or less than conventional care, with higher patient satisfaction
• Insurance coverage of alternative therapies on the rise ... for pets!

• NCQA to "score" Vermont's naturopathic doctors in medical homes, according to report from Vermont's Lorilee Schoenbeck, ND
• American Chiropractic Association House of Delegates chastise some chiropractors in effort to position the profession for primary care role
• Notes from the 2010 annual report from the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM)
• Effort underway to revitalize National Association of Nurse Massage Therapists
• Foot Levelers, major donor to chiropractic PR effort, pledges additional million dollars

• Global Advances in Health and Medicine, launched by veteran team, to focus on case reports
• The Joint ... a chiropractic place: Massage Envy franchise model developed to offer low-cost adjustments
• An early peer-reviewed publication in this space, Alternative Medicine Review, faces challenges

• Kara Kelly, MD elected to presidency of Society for Integrative Oncology
• Christine Goertz, DC, PhD honored as Chiropractor of the Year
• Botanical resource from Roy Upton and the American Herbalist Pharmacopoeia honored by the American Botanical Council
• Daniel Redwood, DC begins new health policy blog

Calls for public comments

Patient-Centered Outcomes Research Institute draft plan comment period ends March 15:

Comment: Through my work with the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), I have been involved with a team in tracking PCORI activity. Inside ACCAHC, we take the position that, at this point in the evolution of U.S. health care, if "complementary and alternative medicine" and "integrative medicine" or "integrative health" are not explicitly included in a guidance document, these practices and disciplines are not likely to be in the minds of readers as part of any recommendations or future actions. We have urged explicit inclusion in two prior responses and September 2011 when two of us had a chance to present to the Board of Governors.

There is significant precedent for explicit inclusion. A June 2009 Federal Coordinating Council report on CER listed "complementary and alternative medicine" as a topic for CER. More importantly, the March 2010 Congressional mandate in Section 6301 of the Affordable Care Act that established PCORI explicitly states that a "state-licensed integrative health practitioner" should be among the members of the Board of Governors and that an "expert advisory panel" should include "experts in integrative health." This draft plan lacks any direct references. Time to get the language in there. Go here to comment.

International

Dana Ullman, MPH

Dana Ullman, MPH: Swiss government finds homeopathy cost-effective, covers in national health plan

In the Huffington Post article The Swiss Government's Remarkable Report on Homeopathic Medicine, author-advocate Dana Ullman, MPH has again shown how homeopathy's minimal dose can somehow generate enough energy to heat up the internet. Ullman's review of the Swiss government's review had generated some 800 comments and

Comment: Nothing stimulates the paradigm wars quite like homeopathy and Ullman's Huffington Post writing on the topic is continuously a battle ground. He pointedly opened his piece with reference to Switzerland's vaunted neutrality. Another of that country's signature attributes is now also in play for homeopathy: the report may be viewed as a Swiss bank account from which homeopathic advocates can spend to advance initiatives all over the world. Ullman's article was a first big draw from the Swiss account.

AOM activist Marilyn Allen

Update: Marilyn Allen and the advancing effort to place TCM in World Health Organization's ICD11 codes

"Key Definitions in ICTM [International Classification Traditional Medicine]:

"A disorder in traditional medicine, disorder (TM)*, refers to a set of dysfunctions in any of the body systems which presents with associated manifestations, i.e. a single or a group of specified signs, symptoms, or findings. Each disorder (TM) may be defined by its symptomology, etiology, course and outcome, or treatment response.

"1 Symptomology: signs, symptoms or unique findings by traditional medicine diagnostic methods, including the taking of the pulse, examining the tongue or any tongue coating, abdominal examination, and other methods.

"2 TM Etiology: the underlying traditional medicine explanatory style, such as weather factors (historically known in TM translations as the external contractions), emotional factors (historically known in TM translations as the seven emotions), or other pathological factors, processes, and products."

Integrative Centers

Mapping health system integrative centers

Bravewell publishes landmark Integrative Medicine in America (but does the subject matter reflect the title?)

Comment: This study is tremendously interesting to anyone who cares about integrative medicine. It's truly a treasure trove of riches into which one can dig and then mull. Click in and check it out! I had one significant concern which I addressed with a posting query: Integrator Forum: Does the Landmark "Integrative Medicine in America" Actually Portray Integrative Medicine in America? The reason: The vast majority of consumer experience of "integrative medicine in America" is through community-based practices. Does this portrait capture what a consumer is likely to experience - or what an integrative medicine practitioner offers? Is the field appropriately represented in this report? What would be different if such a report were based on surveys of community-based practices? If you have an opinion, send it to [email protected] and it will be included in an upcoming Integrator forum.

Mary Jo Kreitzer, RN, PhD, FAAN

University of Minnesota's Center for Spirituality and Health sets sights on "whole systems healing"

An exceptional February 11, 2012 keynote by Mary Jo Kreitzer, RN, PhD, FAAN at the Integrative Healthcare Symposium (IHS) introduced participants to the Whole Systems Healing (WSH) initiative of the University of Minnesota's Center for Spirituality and Health, which Kreitzer founded and directs. The initiative, engaged in partnership with the Life Science Foundation, describes WSH as "a way of cultivating the health and well-being of individuals, communities, organizations, societies, and the environment by living and acting with awareness of the wholeness and the interconnectedness of all living systems." Among the WSH "Strategies and Practices" explored on the site are: Gentle Action, Social Entrepreneurship, Reflective/Contemplative/Spiritual Practices, Interpersonal Relational Practices, and Restorative Dialogue. A significant section is devoted to Whole Systems Leadership. Those interested can take a 50 minute module.

Comment: Making headway in creating a health and wellness orientation in our culture and our medical practices requires a tough acknowledgment for any practitioner; that is, what goes on in the clinic reflects a mere fraction of what contributes to one's health or illness. One needs a systems approach. Our world needs more individuals who walk comfortably in the complexity of such a whole systems view. The integrative practitioner would seem a natural for such leadership, given the philosophy. But, as my colleague Pamela Snider, ND, likes to say, we need to "operationalize" our philosophy. Credit Kreitzer and her team, and their partners at the Life Science Foundation, for helping operationalize this connection for our community. Now, time to go take that whole systems healing leadership module!

Academic Health

First product of the IPEC group, pre-incorporation

Six profession organization enters the team care/interprofessional education space: from dictatorship to oligarchy?

The movement toward interprofessional education (IPE) and team care took a curious organizational step in February 2012. Academic organizations representing the six most significant health professions (medicine, pharmacy, nursing, public health, dentistry and osteopathy) announced that they have formed a new organization, the Interprofessional Education Collaborative (IPEC).

Comment: Normally I would greet news of collaboration between medical disciplines with unrestricted positivity. It furthers us to cross the great water out of our guilds. But the timing of this announcement looks like a power-play by a subset of professions to control what was shaping up as a broadly inclusive movement. The image is of a transition from the historic dictatorship of care by MDs to a six family, biomedical oligarchy that may make second class citizens of other professions in the whole body-mind-spirit of quality care.

Here is context. Just last year, a project that has carried the IPE torch in the U.S., American Interprofessional Healthcare Collaborative, formally incorporated as a stand-alone entity. This group, closely connected with the pioneering (and Canadian government funded) Canadian Interprofessional Health Collaborative, has pushed IPE/C for years as an important shift in U.S. health care. The group, headed by Barbara Brandt, PhD, is inclusive. Among the board members, for instance, is CIHC leader, John Gilbert, PhD, a phonetician who founded the School of Audiology and Speech Sciences at University of British Columbia. The work in Canada, which Gilbert leads, has included chiropractors and midwives. The AIHC and CIHC organizations jointly promote the biennial Collaboration Across Borders conference. The conference surged in attendance in 2011 to roughly 700 from half that size two years earlier. The felt sense among the long-time laborers in this fields was that the movement had finally arrived.

As a participant in that meeting on behalf of educators in integrative health care, I experienced the openness and receptivity to the integrative health disciplines participating in this nominally patient-centered movement. As one who has known what it is to labor in obscurity and without two dimes to rub together, I had hoped that the foundation community would finally bless and empower the AIHC work in a significant way. The work is important.

Yet it appears that the "Big Six" professions comprising IPEC are taking that wind and inserting their professions in the movement's driver's seat. With announcement of the founding of IPEC organization came word of a May 2012 meeting. I clicked in: the May 2012 IPEC Institute was already announced as Sold Out!

The problem with this limited set of disciplines is that the whole person is poorly represented. Will this group insure there is space at the table for psychologists? Social workers? Physical therapists? Chiropractors? Mental health counselors? Naturopathic doctors? Functional medicine educators? Will members of other disciplines have any say over programs and organizational directions? Or have they decided that, for now, IPE is a 6 discipline game.

A colleague who is a seasoned academic veteran urged time and patience. She shared her willingness to accept this as a step in the right direction for these typically silo-ed guilds. Yes, this is good. But why begin without the mind, spirit, treatment of the body and access to community services fully included-- via psychology/mental health, PT/chiropractic/massage and social work -- not to mention the other licensed integrative practice fields. I will learn more about this soon and report back whether my concern is valid that this was less a "patient-centered" move than a "profession-centered" power play to limit and control the emergence of democracy among professions. In place of dictatorship, oligarchy. I hope I am wrong.

Consortium of academics in licensed fields of chiropractic, AOM,

"I believe that [ACCAHC] is playing a significant role in breaking down the dreaded silos of individual groups and are able to envision the greater, larger picture of a preferred patient-centered care model. I am hoping that this grant will allow you even more time to create collaborations between CAM [complementary and alternative medicine], integrative medicine and palliative medicine."

Consortium in breakthrough grant

Comment: As a part of the ACCAHC team, I found the Westreich Foundation's grant to be particularly good news. I will personally be allowed more time to work through ACCAHC on networking and program development to help knit new relationships between the disciplines. It remains a curious thing that long-time builders of the movement for whole person, human-intensive, natural health approaches have substantially been passed over since significant philanthropy entered the integrative medicine picture 15 years ago. Money has instead gone to the last players to arrive in the game; namely, the academically-based integrative MDs. There is much good that has come of that priority. Witness the Bravewell study reported in this Round-up as an example.

But what are the optimal strategies to effect the transformation toward a wellness model of care? Change can certainly come from the top down and often does. Yet strategies for leveraging transformation may also come bottom-up, through empowering the already committed grassroots. In the integrative practice movement, the most organizable grassroots are the 350,000 plus licensed CAM practitioners who are delivering high-touch, integrative care daily. What might be accomplished through better empowering these professionals? Doesn't a kind of pincer movement for integrative health make sense, enabling both top-down and bottom-up strategies? The Westreich Foundation grant represents a visionary breakthrough as a philanthropic contribution toward potentiating pent-up collaborative interest in these disciplines.

Swiss analysis finds those with CAM services cost the same or less than conventional care, with higher patient satisfaction

A recently-published study,

"Results: Statistical procedures show similar total practice costs for CAM and COM, with the exception of homeopathy with 15.4% lower costs than COM. Furthermore, there were significant differences between CAM and COM in cost structure especially for the ratio between costs for consultations and costs for medication at the expense of basic health insurance. Patients reported better quality of the patient-physician relationship and fewer adverse side effects in CAM; higher cost-effectiveness for CAM can be deduced from this perspective.

"Conclusion: This study uses a health system perspective and demonstrates at least equal or better cost-effectiveness of CAM in the setting of Swiss ambulatory care. CAM can therefore be seen as a valid complement to COM within Swiss health care.

Comment: I anticipate a rash of hiring of veterinarians by integrative clinic to take advantage of this new opportunity for income from covered services.

Professions

Lorilee Schoenbeck, ND: leads her profession's dialogue with NCQA

NCQA to "score" Vermont's naturopathic doctors in medical homes, according to report from Vermont's Lorilee Schoenbeck, ND

The February 2012 issue of the newsletter of the American Association of Naturopathic Physicians includes a synopsis of medical home developments from a naturopathic perspective by Lorilee Schoenbeck, ND, a leader of that profession in Vermont. Of particular note is the effort of Vermont naturopathic doctors to gain recognition through the National Committee for Quality Assurance (NCQA), which accredits medical homes. Schoenbeck writes:

"NCQA: The Medical Home Model is currently being promoted and accredited by a national, private organization called the National Committee for Quality Assurance (NCQA). Prior to the efforts of Vermont, the NCQA did not acknowledge or 'assess and score' NDs as Medical Home applicants. However, now through our state's health reform agency, we have been successful in having NCQA assess our clinics to provide scores. To date the NCQA has not formally certified NDs. The assessment is a major breakthrough and one we continue to use with our state legislature to gain recognition."

Delegates pass pointed resolution

American Chiropractic Association

"Public Health Concerns Due to Failure to Differentially Diagnose. ACA condemns as a threat to public health the failure by doctors of chiropractic/chiropractic physicians to adequately differentially diagnose and/or to sell treatment packages in the absence of a differential diagnosis. Such practices are contrary to the doctorate level of education inferred by our degree. Furthermore, they are contrary to the universally accepted standards of care and do not represent the customary practices of a member doctor of this organization."

Comment: The position of chiropractic doctors relative to primary care is a challenge on many fronts. On one hand, some chiropractic colleges train these professionals for the broad scope practice of what they prefer to call "chiropractic medicine." On the other are those who find any connection of "chiropractic" to "medicine" an utter violation of the profession's core values. This ACA resolution appears to be a slap to the subset of the latter group who may be adjusting without thorough diagnosis. Then again, the business model of The Joint ... the chiropractic place, reported elsewhere in this Round-up, is also likely to be a target. The low costs services will also be likely to stimulate a limited commitment to differential diagnosis.

AOM's certification organization

Notes from the 2010 annual report from the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM)

Comment: As a sometimes patient, my bias is that more nursing professionals would be good at massage. It is pleasing to see that the massage education standard is not less than the already low standard (500 hours) for massage education. This is in contradistinction to the typically 150-300 hour of training typically required for a medical doctor, chiropractor or naturopathic doctor to be allowed to practice acupuncture under their MD, DC, or ND licenses - as compared to 10 times as many hours for a licensed acupuncture and Oriental medicine professional.

Supplier provides second million

Foot Levelers, m

• American Chiropractic Association (ACA) increased its annual contribution of $4,000 to $8,000 (prior donations total $31,800)

• Michigan Association of Chiropractors made its annual pledge of $18,000 (prior donations total $57,000)
• Northwestern Health Sciences University contributed $14,000 (total contributions equal $102,500)
• Performance Health contributed $10,000, in addition to its normal $25,000 pledge, in honor of General Halstead's service to chiropractic (total contributions equal $115,000)
• ChiroHealth USA contributed $2,500 in addition to its normal monthly pledge for 2012 (total contributions equal $26,205)
• Hill Laboratories became a contributor with a donation of $6,000 annually

Business

David Riley, MD

Global Advances in Health and Medicine, launched by veteran team, to focus on case reports

"Improving Healthcare Outcomes One Case at a Time." So runs the title of the founding column from David Riley, MD, editor-in-chief of the new publishing venture entitled Global Advances in Health and Medicine. The February 10, 2012 introduction of the international journal adds that the editors "believe that high quality, professional case reports will inform the design of clinical trials, improve the quality of scientific information, and enhance healthcare delivery." (See announcement here.)

Riley, a long-time leader in integrative medicine, is the former editor of Explore and of Alternative Therapies in Health and Medicine. Two members of his former editorial teams, Jason Hao, DOM, and Michele Mittelman, RN, MPH, are part of the new international group, as is Greg Plotnikoff, MD, MTS, FACP. At the top of the list in the Information for Authors

Comment: Riley, credited by many for coining the phrase "integrative medicine," is a veteran's veteran in this field. His work has included consulting on the minutiae of the Alternative Link coding system to helping establish an integrative center in Dubai. I've had a chance to speak informally with Riley and Mittelman about this project and am intrigued with the ways they see technology adding power to case reports. It is about time someone started a journal that has as its central focus what actually takes place in integrative clinical practice. More on this venture as it evolves.

Low cost chiropractic

The Joint ... a chiropractic place: Massage Envy franchise model developed to offer low-cost adjustments

After selling the hugely successful Massage Envy firm in 2010, founder John Leonisio hit on the idea of rolling out a similar business model for chiropractic. He has done so as The Joint ... the chiropractic place. The Joint members pay $49/month for which they can receive 4 chiropractic treatments. If members want additional visits, they pay $19 apiece. Non-members who walk-in off the street in this no-appointments environment pay $29 for an adjustment. An article in Arizona Business and Money form Leonesio's home state reports that 146 franchises have already been awarded. These are open or under development in 17 states. Two St. Louis-based owners of Massage Envy franchises recently purchased rights as regional directors for The Joint for $145,000, according to this article.

Comment: There appears to be a good deal of excess capacity in all of the licensed "CAM" professions. The appearance of program that take advantage of the willingness of practitioners to work for less is not surprising. What dreams are some aspiring CAMpreneurs now having about how to use acupuncturists or naturopathic doctors in a similar model?

Comment: Al Czap has always ranked among the more impetuous and influential characters in professional line supplement manufacturing for the evolving fields of alternative, naturopathic and integrative medicine. Al Czap chose the company name in the early 1980s as he wished to be a thorne in the side of conventional treatment. If the business was to be a thorne, then this journal, which grew up with Thorne, was perhaps the point of the spear. It gained PubMed searchable status early with a mix led by NDs but including MDs, chiropractors and others filling out the editorial team and advisory panel. Sun-setting is an honorable end-point. Perhaps the journal's time has come.

People

Kara Kelly, MD

Kara Kelly, MD elected to presidency of Society for Integrative Oncology

Kara Kelly, MD is the new president of the Society for Integrative Oncology. Kelly is medical director of the Integrative Therapies Program for Children with Cancer at the Herbert Irving Child & Adolescent Oncology Center. Kelly also chairs both the integrative oncology committee and the Hodgkin lymphoma committees for the Children's Oncology Group (COG). She is an associate professor of clinical pediatrics at Columbia University Medical Center and an attending physician at New York-Presbyterian/Morgan Stanley Children's Hospital and

Christine Goertz, DC, PhD

Christine Goertz, DC, PhD honored as Chiropractor of the Year

Christine Goertz, DC, PhD, was honored by the American Chiropractic Association as their chiropractor of the year. Integrator adviser Goertz presently serves as the sole licensed integrative practitioner on the Board of Governors of the Patient-Centered Outcomes Research Institute. A decade ago, Goertz held a similarly pioneering position as the first licensed "CAM" professional to be hired by the National Institutes of Health as a program officer. Goertz day job is as vice-chancellor for research and policy at Palmer College.

Roy Upton, RH (AHG)

Botanical resource from Roy Upton and the American Herbalist Pharmacopoeia honored by the American Botanical Council

In a February 28, 2012 release, the American Botanical Council (ABC) announced that the

Daniel Redwood, DC

Daniel Redwood, DC begins new health policy blog

Daniel Redwood, DC, considered "a gifted translator of complex ideas," has initiated a health policy blog as Redwood HealthSpeak: Health Policy Perspectives. Redwood has held a series of roles as a go-between between his profession and other health policy players. His site boast testimonials, for instance, from James Gordon., MD and Marc Micozzi, MD, PhD. Redwood remains as editor-in-chief of Health Insights Today, a publication of Cleveland Chiropractic College where Redwood is a member of the faculty. Redwood was a co-editor of the recent