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Medicial Mistakes?
How many people each year suffer some type of preventable harm that contributes to their death after a hospital visit?
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| | Integrative Medicine, Complementary Alternative Medicine and Health Round-up #54: April 2012 | |
Summary: Reporting on the latest in the world of Integrative Medicine around Policy, Insurance, Academics, Natural Products, Integrative Care and the Media.
Policy
- Washington State pushes to double Medicaid home births: disruptive innovation of the first order
- New SAMHSA addictions guidelines includes CAM
- Holistic Primary Care convenes e-forum of holistic practitioners on the ACA's individual mandate
- Alyssa Wostrel named executive director of the Integrated Healthcare Policy Consortium
Insurance
- Duke integrative medicine moves to insurance model
-
Portland, Oregon's managed CAM business announces high patient satisfaction, suggestions of cost savings
Academics
- Anne Nedrow, MD to leave Oregon Health Sciences to launch primary care program at Duke Integrative Medicine
- Team care, interprofessional education and the move to give medical schools ownership of collaboration
- National College of Natural Medicine reports the institution's $56-million contribution to Portland, Oregon economy
- Frank Vitale's frank explanation of Tai Sophia's transition from the "academic wellness institute" toward university
- Horse needling: LSU veterinarian school goes integrative
- New York Chiropractic Colleges announces the Veteran's Administration's first chiropractic clinical residency
Natural Products
- Proctor & Gamble buys herb company New Chapter
Integrative Care
- Article suggests "integrative oncology" is often non-integrated, parallel practice
- The (intense) home birth midwifery model of integration with other CAM fields
- Mayo Clinic takes alternative medicine to Mall of America
- Canadian College of Naturopathic Medicine opens oncology research center
- Bravewell Collaborative makes November 2011 symposium talks available
- University of Toronto awards spine professorship to chiropractor
- Acupuncture association reaches out to secure more submissions to their professional journal
- Short Notes on integrative care in the nation's hospital and health systems
Media
- Can community hospitals learn integration from the military?
- Wallstreet Journal boosts massage as medicine and as stress reduction
________________________
Policy
 Home birth midwives: Triple Aim threat
"Midwives have a central focus in our strategic plan. We are hoping
Washington State can double out-of-facility births in the next two or
three years." The speaker was Jeff Thompson, M.D., MPH, chief medical officer of
the state of Washington's Medicaid program. He spoke in a taped
interview for Symposium 2012 -- Certified Professional Midwives and Midwifery Educators: Contributing to a New Era in Maternity Care. Thompson proceeded to layout how his state has determined that home birth essentially meets the Triple Aim
evidence Trifecta of satisfaction, effectiveness and cost savings. In his state, Medicaid
payments to licensed midwives for uncomplicated vaginal birth runs
$2,500. Payment for birth center births is $5,000 and doubles again to
$10,000 for those performed inside of hospitals. The cost doesn't touch
additional savings from reducing the rate of often over-used medical
interventions such as epidurals and inductions of labor. And there's the rub. An obstetrician presenter noted that the #1 surgery performed in hospitals is C-section, the #1
one diagnostic-related group (DRG) in hospitals nationally is birth and that the #2 two surgery in hospitals is hysterectomy, often associated with
birth. He summed up: "Birth keeps the lights on in
hospitals."
Comment: See this this Huffington Post article for more. I contributed after attending the Symposium. The posting had generated over 630 Facebook shares, 2,200 "likes" and some 90 comments as of April 3. (See the comment stream.) Can we have true healthcare reform without moving birth out of the hospital and back into our communities - either in birth centers or homes, where normal birth belongs? What could be more radical, or positively disruptive of the present harmful economic preference of US healthcare for hospital services?
 Agency guideline includes CAM
A March 12, 2012 press release from Portland, Oregon-based CHP Group reports
that complementary and alternative medicine (CAM) is included in a new
evidence-based clinical guideline that was recently released by the
Substance Abuse and Mental Health Services Administration (SAMHSA).
SAMHSA is part of the US Department of Health and Human Services. The
guidelines is entitled "Managing Chronic Pain in Adults With or in
Recovery from
Substance Use Disorders." It is published as Treatment Improvement Protocol (TIP) Series
54. HHS Publication No. (SMA) 12-4671. The guideline focused on people with chronic
pain and a history of substance abuse.
The CHP Group, which provides managed CAM services to employers, insurers and managed care organizations (see Insurance,
this Round-up), was connected to the study via CHP co-founder and
medical director Chuck Simpson, DC, a TIP panel member. The CHP release
notes that many patients look for non-drug, non-surgical treatments offered by
licensed CAM providers: "The evidence shows how often these treatments
are sought out and used. One study revealed that over 40% of pain
patients treated with opioids also used some form of CAM. (Fleming S,
Rabago DP, Mundt MP, et al. CAM therapies among primary care patients
using opioid therapy. BMC Complement Altern Med 2007;7:15.)"
 Chuck Simpson, DC: on the SAMHSA panel
"That CAM was considered at all is a step
forward [in my humble opinion]. The consensus panel was not particularly
CAM-savvy, or CAM advocates. So the
discussions centered around the reality of CAM use in chronic pain
populations
(it's very prevalent) and the evidence for CAM in chronic pain (it's
thin) but
conventional medicine approaches to chronic pain and this population in
particular are similarly shy on evidence of effectiveness. And the
evidence of
the down-sides to Rx pain treatment in this population is robust
(e.g drug diversion, non-compliance, addiction, lack of efficacy).
"I think that point was made. I was drafted for the
consensus panel because of my publication in an issue of PMR Clinics of North America a
couple of years ago. It was a great experience. While not
related it's interesting to see that NCCAM has increasingly focused on
pain and CAM. Will this TIP revolutionize treatment of chronic pain in
people with substance abuse issues? Not sure. But it is a small
step. At this point in my path along CAM integration, I'll appreciate any
step in the right direction".
 Goldman: HPC forum on the ACA
During the week of the Supreme Court hearings on the constitutionality of the Affordable Care Act (ACA), Erik Goldman, editor of Holistic Primary Care, queried a few hundred of his mainly MD/DO subscribers for their perspectives as holistic practitioners on the individual mandate in the ACA. Some are compiled here at Practitioners Sound off on Healthcare Reform Hearings. Goldman summarizes that, while most see a need for fundamental healthcare reform: "It seems the holistic community has little love for the ACA or the
individual mandate. Many respondents say the plan fails to address the
main drivers of the country's health crisis, and does little to foster a
meaningful shift toward holistic care. Further, since many practice
outside of insurance, they are leery of any reform plan that keeps
insurance companies in the Catbird seat." Goldman reports that 90% of respondents (total respondents not noted) believe the act would be declared unconstitutional. In a March 30, 2012 call for additional perspectives, he summarized themes in early returns as:
- A mandate forcing people to purchase insurance is morally wrong and economically questionable.
- Being against the ACA is not synonymous with being against health care reform.
- Elimination of 3rd party payors and restoration of direct relationships
between patients and practitioners is the true corrective for the
system.
- Holistic & integrative modalities have tremendous
potential for cost savings and for improving health outcomes---if only
they were given a fair chance.
- Partisan politics & the
influence of corporate special interests have corrupted the process,
making meaningful large-scale reform difficult if not impossible.
To participate, email Holistic Primary Care at:
[email protected] and share what you think about the individual mandate.
Comment: The holistic medicine movement is all over the map politically. Back in the 1960s-1980s, the alignment of the FDA and FTC with the "health fraud" movement, and the general support of big government for big medicine created a powerful anti-government sentiment among many "alternative medicine" providers. Liberal Democrats like Henry Waxman focused on regulating the natural products industry, alienating others. Meantime, politicians on the right, like Dan Burton and Orrin Hatch, often supported "alternative medicine" and "health freedom" as consumer choice and opposed government regulation of the industry. Other politicians on the left, like Tom Harkin, began pushing integrative medicine as a part of systemic reform toward a wellness focus. Harkin and his colleagues inlaid integrative practice and complementary and alternative medicine in the ACA. Presently, Republicans are presently refusing to co-sponsor a bill to cover Medicaid payments for home birth (a choice issue, one way you look at it) because to do so would imply support for Big Government and Medicaid itself. Political leanings of the field are anything but monolithic.
I personally support the ACA. This is on one hand quite personal. I have had a health condition that would have had very crappy economic consequences for our family had we not had good health insurance. I wouldn't wish lack of coverage on anyone. So I can hold my nose to a lot of other aspects of the law that i don't much like to extend insurance protection to other human beings and their families.
I also support the present reform as the best option in a nation that didn't have the good sense to go for single payer. (Do comparative outcomes with other nations mean nothing? Of course, the politics of evidence, in the U.S. is basically nothing more than the evidence of politics.) Finally, I support the law out of professional self-interest and related personal pleasure. Language inlaid in the Affordable Care Act, noted above, put licensed complementary and alternative professions or some variant of integrative practice, integrative practitioners and licensed members of integrative practice professions into federal policy for the first time. It is a pleasure after 28 years of working from a position of significant disenfranchisement to now be working on reform with a footholds on the inside. Complex stuff, for our fields as for the nation itself. It will be interesting to see what Goldman's survey will find.
 Wostrel: new IHPC exec
The leading multidisciplinary organization lobbying for advancement of
integrative healthcare at the federal level, the multidisciplinary Integrated Healthcare Policy Consortium (IHPC), has announced that Alyssa Wostrel, MBA, DIHOM will be its new executive director. The release notes that Wostrel brings to the job more than a decade of experience in marketing
and organizational leadership positions within the natural products industry. The release notes that Wostrel "is
skilled in development and fundraising, including as Chair of the fundraising
committee for the American Medical College of Homeopathy, where she focused on
cause-related marketing at both the community and national level." She remains actively involved as a Board
member. States Wostel: "My
for-profit career offered rewarding work, but I also wanted a deeper purpose. So,
I'm excited to bring more visibility and awareness to IHPC's groundbreaking
accomplishments in the legislative arena of integrative healthcare." Wostrel succeeds former IHPC Executive Director,
Janet
R Kahn, PhD who remains involved as IHPC's Senior Associate. IHPC states that the organization and it Partners for Health represent more than 250,000 licensed
integrative health care providers including medical doctors, naturopathic physicians,
acupuncturists, chiropractors, massage therapists, professional midwives, and homeopathic
practitioners.
Comment: Here's hoping that Wostrel will have the tenacity, creativity and fundraising chops to allow IHPC to fulfill on its promise for integrative health care.
Insurance
 Perlman: changes at Duke
In a change from past practice, on March 15, 2012, Duke Integrative Medicine began accepting insurance "for all
physician consultations and many health psychology services."
Duke's director Adam
Perlman, MD, MPH states: "We are
tremendously excited to be able to make our services available to more
people than ever, now that we are enrolled in the insurance plans of
most of the people who live in the Triangle and beyond." The program's
statement about the change describes the patient process:
"A
physician consultation at the [integrative medicine] center is a comprehensive evaluation by
an expert Duke physician who is trained in conventional and
complementary medicine. It
offers a complete assessment of a patient's physical, emotional, and
spiritual health during which the physician takes the time to listen to
and understand a patient's health concerns and goals. The
physician works in partnership with the patient and his/her other
physicians to create a plan including the very best treatments available that aims to
optimize health and well-being. [Italics added.] At the time of any appointment, the
patient has full use of all of the Duke Integrative Medicine facility
including spa, whirlpool, sauna, steam room, library, meditation spaces,
walking labyrinth, and more."
Comment: It is no surprise that
this change came after the arrival of Perlman. He recently transited to
Duke from the integrative medicine program at the University of Medicine and Dentistry of New Jersey,
a public university serving an under-served population. Another change
that may yet come as Perlman's stamp goes on the program is away from
the physician dominance displayed in the language in this announcement.
The program has 7 MDs and some 30 other providers. These include massage
therapists, acupuncturists, mental health counselors, health coaches,
yoga teachers, exercise therapists, mindfulness educators). One would
never know this diversity exists, or that these representatives of
distinct disciplines were even present, from this language: "The physician works in
partnership with his/her other physicians ..." Are the MD physicians not in partnership with the others? Is that not worth noting? Perlman, a past chair of
the Consortium of Academic Health Centers for Integrative Medicine, is known to be an exceptional collaborator and advocate for respectful relationships between integrative medicine and licensed CAM providers. He may need to give an in-service to his colleagues on respectful language.
 High client satisfaction, perception of savings
The
CHP Group (CHP) of Portland, Oregon announced March 12, 2012 that it is "thrilled" to release outcomes of its 2011 patient satisfaction survey. CHP looks at patient experience of chiropractors and acupuncturists and naturopathic doctors and others through questions
from the Consumer Assessment of Healthcare Providers and Systems (CAHPS)
developed by the US Agency for Healthcare
Research and Quality. The CHP Group also adds additional questions developed
internally by the firm to explore cost and quality issues in the integration dialogue. On the basic CAHPS, the firm's overall score for
2011 was 96%, consistent with its outcomes since 2000, according to the
release. In addition, the CHP-developed questions found that:
- 98% of respondents replied "always" or
"usually" to the question "Has the treatment or recommendation you
received from this provider helped you?"
- 82% answered "usually" or "always" to: "Has the treatment
or recommendation you have received reduced your use of prescription
drugs?"
- 92% of respondents answered "usually" or
"always" to: "Has the
treatment or recommendation you received reduced your use of other
medical care for this problem?"
States Michell Hay, CEO of The CHP Group: "We are
well aware of the high-quality of care our network providers render to
their patients, but it is gratifying to see patients acknowledge the
beneficial outcomes of the quality care they received."
Comment: I find it astonishing that the prejudice or corrupt incentives of the present system limit affirmative exploration of the patient experience behind these data. Are patient perceptions so belittled that a finding that 82% perceived experience of decrease in drug use is discounted and unexplored? Do they judge worthless that 92% of these human beings said they reduced medical costs elsewhere through services of CHP's CAM networks? All integrative practitioners
who do any kind of outcomes work should gather these data from these 3 questions. Why don't the employer, payer or research
communities find these findings worth exploration? My default answer is that it does not serve the dominant school of medicine
to affirm the value of another discipline. Am I missing something?
Academics
 Nedrow: from OHSU to Duke
Oregon Health Sciences' integrative medicine leader Anne Nedrow, MD, MBA is leaving the institution to become associate medical director at Duke Integrative Medicine. The position begins June 1, 2012. According to Isabell Geffner, communication's director for the Duke program, Nedrow "will be responsible for administrative
oversight of all of our clinical initiatives. She adds that "her first priority [will] be the launch of our primary care practice in July, 2012." The new program will be called PRIMARY CARE @ Duke Integrative Medicine: New Dimensions
in Health and Healing. Geffner notes that the practice will be
a "retainer [concierge] model in which patients will pay a nominal annual fee ($1500)." For this they'll receive:
- Full
primary care services
- Evidence-based
complementary and alternative medicine treatments as appropriate
- 24-hour/7-day-a-week access to your physician
- Same
day or next day appointment
- Personalized Health Plan
- Group-Based Integrative
Health Coaching
Geffner notes that the change is linked to the program's movement to accept insurance for all physician consultations and
select health psychology and nutrition services, noted above. Nedrow joins Adam Perlman, MD, MPH, the Duke IM leader. She'll also have research and development responsibilities.
Comment: Nedrow's move joins her with Perlman, another long-time leader of the Consortium of Academic Health Centers for Integrative Medicine. Nedrow's cross country move also joins two of the medical doctors in that field who have most embraced the interprofessional and multidisciplinary forms of that field's self-expression. Nedrow was the prime mover behind the Oregon Collaborative for Integrative Medicine (OCIM), which links OHSU with chiropractic, naturopathic and acupuncture schools in Portland. Nedrow also provided the cover of her license for the integrative services practice at OHSU. Nedrow's exit will be felt. Meantime, it is fascinating that two individuals known as interdisciplinary collaborators are located at an integrative medicine program principally funded by an angel, Christy Mack, who is famous for not only MD-centrism but for routinely publicly denying - or so it seems to me - the CAM roots of "integrative medicine." I view Nedrow's appointment as a kind of healing.
 IPEC's Core Competencies document
Comment: The long-overdue movement toward team care in the academic medicine environment is
called interprofessional education (IPE). As
a nominally patient-centered movement, IPE would seem an exceptional
arena for better collaboration between medical doctors and other allied
health professionals including those not yet formally considered "allied health" such as chiropractors, naturopathic doctors and licensed acupuncturists. The March Integrator Round-up reported the unsettling movement "from dictatorship to oligarchy" in the formation of the Interprofessional Education Collaborative (IPEC)
by the Big disciplines of medicine, nursing, public health,
osteopathy, pharmacy, dentistry. The formation of IPEC was effectively a decision to not empower a separate US IPE organization had no discipline boundaries.
In March, the weekly bulletin
from the American Association of Medical Colleges (AAMC) has announced
that the Josiah Macy Foundation is funding an IPE web-portal. The decision follows the same pattern. Rather than launching it through the interdisciplinary American Interprofessional Health Collaborative that has no discipline boundaries, they placed it squarely in the lap of the profession that has most resisted collaboration in the American Association of Medical College (AAMC). The launch is presented as a collaboration with the other 5 of the Big 6. The launch also takes a positive step in noting that the American
Psychological Association, Physician Assistant Education
Association, and American Physical Therapy Association are to
collaborate
on the portal. The AAMC note states that "published resources
will serve as the initial content for the interprofessional portal and
resource collection, scheduled for release in March 2013 on the AAMC's MedEdPORTAL."
The direction of all this work is good. Perhaps I
simply live with too great a legacy of mistrust of medicine's former dictatorship to be comfortable with
the dominant school as the first among equals; as, effectively, the primary steward of interprofessional collaboration. Why not let the medium be the message and place to with the AIHC or even the Canadian Interprofessional Health Collaboration which has already developed a Wiki on the subject? Then again, Macy might have been betting that the way to get the MDs to buy in was to put them in the driver's seat. Good money suggests that IPEC will take the wind, as in cash, out of AIHC's sails.
 Manahan: questioning the control of IPE
"Here is the paragraph you wrote: 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.
Then Manahan added his comment:
"In my opinion, your concern is valid. I do not believe that those
six professions do not exclude other groups such as PT, DC, ND, MSW,
psychology, etc on purpose. It is that they do not know enough
about them to even understand that they are excluding them. Ignorance is bliss - but sometimes not all that healthy. The silo
those professions exist in is so tight and exclusionary that it does not
even enter their world view to include those other disciplines in their new
group. In their thinking, it would be similar to the college sports team
including the high school sports team on their roster. Anyway, my experience has been that the majority of our
MD/DO/RN/Etc. colleagues are good people who don't have a clue!"
Comment on Manahan's comment: The good news in the roll-out of the website is that there is a good sign of a "clue" having been found. The psychologists, physical therapists and physicians assistants have at least been invited to dinner, if at the kiddies table.
 Significant economic contributor
A study of the impact of National College of Natural Medicine (NCNM) on
the Portland, Oregon economy by ECONorthwest found a $56-million contribution. The
institution, with 550 students studying naturopathic medicine and
Classical Chinese Medicine, contributed in these ways: $25,815,000 in
direct spending on payroll and other operating costs,
capital spending, and student spending on food, rent, entertainment and
other expenses within the city; $10,883,700 in indirect or supply-chain
spending related to the college's purchases of goods and services from
local businesses; and $19,160,700 in other spending resulting from the
enhanced purchasing power of households directly or indirectly affected
by NCNM's economic activity." Altogether these impacts were estimated to have generated 613 jobs
and contributed $55,859,400 to the local economy.
Comment: Bastyr University carried out a
similar study last year. My guess is that these millions will make some
of Portland's leaders who were formerly skeptical about
non-conventional care begin to think that there just might be something
to it. This is bound to have a nice placebo effect on the Portland Chamber
of Commerce. Notably, the college was subsequently featured in the local business media laying out an ambitious master plan.
 Tai Sophia's Frank Vitali
Maryland's Tai Sophia Institute is poised to become a university. Institute president Frank Vitale made an unusual decision to publicize and post a transcription
of his meeting with his leadership team on the transition of what
founding president Bob Duggan used to call an "academic wellness
institution." Vitale positioned the action this way: "The field of
integrative medicine is growing and Tai Sophia needs to remain in the
forefront in its evolution." Tai Sophia's move toward university status began in 1998
and is expected to be completed in 2-3 years. The university status is
expected to confer prestige on diplomas. Vitale also shares that the
school is still carrying too much debt for an
institute of its size. Vitale and his team have been exploring an array of strategic
partnerships.
Comment: The positioning of this institution as "integrative medicine" may come as a surprise to the authors of the recent Bravewell mapping report. That noted, overall, the
piece feels a bit like voyeurism even as I respect Vitale's forthright
presentation of the issues. How well the radicalism
of the Institute's original message be maintained as it gains the trappings of a university? The tendency in
the universification of the school will be a regression to a very conservative mean. An "academic wellness institution" seems easier to maintain on mission than an
"academic wellness university." Here is hoping that Tai Sophia holds on
to the advocacy of a wellness model as it builds into this conventional
framework. A wellness university is exactly the kind of innovation in health professional education that we need.
School seeks Director, Nutrition & Integrative Health Program: Tai Sophia's provost and executive vice president Judith Broida, PhD separately sent a note that the institute is looking to fill this leadership position. Information is here.
Horse needling: LSU veterinarian school goes integrative
The March 2012 Integrator Round-up included a brief note entitled Insurance coverage of alternative therapies on the rise ... for pets!. Now comes news that the LSU Veterinary Teaching Hospital has
"broadened its services to include acupuncture, massage therapy and
herbal treatments for animals — the large ones for now and dogs and cats
soon." Associate professor of veterinary medicine Rebecca McConnico
notes that horses seems to be particularly amenable to acupuncture. She
notes that she has "worked with about two dozen animals since her
recent certification, including horses, goats and cattle." The reception of the new program has been good: "It
seems to be well-received. Some clients just ask for it and sometimes
it's offered to them. Most are willing to try it." The initial consult
to see if the animal is right for the care costs $40. An acupuncture
treatment is $100.
 New York Chiropractic College: pioneering VHA residency
The Seneca Falls-based New York Chiropractic College announced in late March the establishment of
"an integrated care chiropractic residency program." According to the release, this is "the first such program to
be located at a Veteran's Health Administration (VHA) facility." NYCC has been running several academic and research
programs at the Canandaigua, NY, VHA site. The residency is anticipated to prepare the College's chiropractic clinical residents for optimal
management of patients with a diversity of musculoskeletal disorders. Executive vice president and provost Michael Mestan, DC stated:"The new groundbreaking VA residency
program significantly complements the College's existing offerings there." Residents' duties will
include working alongside the VA system's established providers while providing rotations with specialists in neurology, orthopedics,
physiatry, pain management, primary care and physical therapy.
Natural Products
Proctor & Gamble buys herb company New Chapter
“Our
shared mantra is acquisition, not assimilation,” wrote the former owners
of the Brattleboro, Vermont-based New Chapter in
a letter to their employees that provided details about their purchase
by the world's largest consumer products firm Proctor & Gamble
according to a story on the acquisition
posted by the American Botanical Council (ABC). New Chapter's founders, Barbi and
Paul Schulick state: “Our culture,
guiding principles, and credo will not change and will only be buoyed by
the superlative values gleaned from Procter & Gamble’s resources
and experience." The firm, founded in 1982, had a history of partnering
with significant institutions for research on its products. States ABC
founder Mark Blumenthal: "There's
probably no better evidence of mainstream consumer acceptance of the
benefits of herbal dietary supplements than P&G's acquisition of New
Chapter. Obviously, Procter & Gamble has done a significant amount of due
diligence in researching not only New Chapter's history and product
quality but also in determining the future growth potential for New
Chapter's herbal and other dietary supplement products. A company like
P&G doesn't make such a strategic move into a new area like dietary
supplements without a considerable level of research." No price was disclosed.
Comment: The first phase of complementary and alternative medicine integration, in the late 1990s, saw a rash of ventures by
big pharma into the botanical trade. This is the first significant
re-entry in some time. New Chapter is distinctive in its combination of
Vermont back-to-land herbalism and research savvy.
Integrative Care
Article suggests "integrative oncology" is often non-integrated, parallel practice
Integrator adviser and integrative oncology consultant Glenn Sabin of FON Therapeutics sends note of a March 15, 2012 article in the ASCO Post (American Society of Clinical Oncology) entitled Some Patients Using Complementary and Alternative Therapies May Be Receiving ‘Parallel' Rather Than Integrative Care. The article by Charlotte Bath focuses on a study by University of British Columbia researcher
Lynda Balneaves, RN, PhD. She concludes: "For most
individuals, true integration is not occurring.
Complementary, alternative medicine and conventional care are being
provided in parallel systems by health professionals who are not
consulting each other." Balneaves presentation was at the 2011 meeting of the Society
for Integrative Oncology (SIO). Balneaves also found that integration is desired by patients. She is quoted as saying that patients wished “to have
complementary and conventional care combined." She added that one woman
described integrative care as “like an orchestra - everyone is working
together and there is synergy."
Comment: The finding is not surprising. And, 15 years ago, the finding of any integration would have been shocking. Here's to recruiting to the orchestra.
 Midwives - regular referers to CAM practitioners
At Symposium 2012 of the Certified Professional
Midwives (CPM) and Association of Midwifery Educators (AME), I asked the
roughly 150 midwifery leaders assembled for a shows of hands of those who had "used or referred for" the services of acupuncturists? What
do you think the percent would be? For chiropractors? For AOM?
For massage? For naturopathic doctors? The answer: virtually all arms
shot up with each question, at close to
100%. The only fall-off was for NDs,
who are only licensed in 16 states, but still at perhaps 80%.
Comment: I was quite surprised to see how profoundly integrated these practices are with the other natural health disciplines. I queried a couple of colleagues who were similarly surprised. I'd have guessed 30%-50% for each, except for massage. The suggestion here is that this field incorporates perhaps the most thorough approach to team care of any health care field. It's too bad that more obstetrician's don't allow the home birth midwives to comfortably round out their care teams.
 Bauer: Mayo's IM leader
One of the biggest names in medicine has linked with the biggest mall in America to feature integrative medicine (Mayo Clinic's focus on integration on display at Mall of America).
Mayo already had one clinic in the Mall. The second will offer a
variety of integrative services "that we already offer on campus,"
Mayo's integrative medicine leader Brent Bauer, MD is quoted as saying.
Adds Bauer of the Mall gambit:
"There seems to be quite a bit of demand (at the Mall). It's a nice
place to kind of test, and push a little
bit, the idea of how do we promote wellness." According to the article the clinical site now includes acupuncture, massage therapy and counseling about supplements.
 Seely: heading major naturopathic oncology initiative
The Canadian Colleges of Naturopathic Medicine (CCNM) has opened
the first integrative cancer center in Eastern Canada, according to a March 26, 2012 release. The Ottawa Integrative Cancer Centre
(OICC) will provide "multi-disciplinary complementary
medicine and whole-person care for people with cancer, and to those
wanting to prevent cancer or its recurrence." The center, which will feature both clinical services and research, is led by
Dugald Seely, ND, MSc, FABNO.
Seely is also the director of research and clinical epidemiology at
CCNM. The release notes that Seely "has helped to
establish CCNM as one of North America's leading research center in
complementary medicine." The program "has two pillars: clinical trials
of complementary
therapies and evaluating integrative whole-systems of care." The work is
expected to be integrated with conventional treatment and is anticipated to benefit from Seely's extensive relationships developed as an affiliate investigator at the Ottawa
Hospital Research Institute (OHRI) where he has "a number of collaborations
with OHRI scientists."
Comment: Seely is developing a fine
body of work, particularly in the whole practice, whole systems
examination of naturopathic care. See Model Whole Practice Study Finds Naturopathic Care Effective, Cost Saving for Canadian Employer.
Notably, the release includes a supportive quote from the Ottawa
Regional Cancer Foundation, which anticipates collaborating with the
OICC. Kudos to Seely, CCNM and all parties involved. We can expect a good deal
from this operation.
Bravewell Collaborative makes November 2011 symposium talks available
The Bravewell Collaborative has made public a series of significant presentations at their November 2011 Integrative Medicine in Action
seminar. Those video-taped include integrative cardiologist Mimi
Guarneri,MD; Col. Kevin Galloway of the US Army Pain Management Task
Force; Tracy Gaudet, MD from the VA; F16 pilot and health coach Lt.
Wendy Hendrick; Allina CEO Ken Paulus; and Allina chief medical officer
Penny Wheeler, MD.
Comment: The Bravewell program was a
well-assembled and powerful testament to integrative medicine in both civilian and military environs. Particularly
compelling were the comments of Paulus, speaking about how integrative medicine has become his ally since, for the
first time in 100 years, Allina can "get paid to keep the village healthy."
University of Toronto awards spine professorship to chiropractor
The University of Toronto has awarded the Canadian Chiropractic Research Foundation (CCRF) Professorship in
Spine to Carlo Ammendolia DC, PhD. The professorship is funded with an initial investment
of $500,000 from CCRF in a partnership agreement between the CCRF and the University of
Toronto. The new
"Research Professorship in Spine" will have its home in the Faculty of
Medicine. Ammendolia is a clinical epidemiologist and assistant professor in the Institute of Health Policy, Management and Evaluation at the
University of Toronto. This is the 12th research chair or professorship to be funded through CCRF.
Comment: I have a couple queries out as to gain clarity on how CCRF funds these. What I recall from informal conversations is that in the Canadian system, the structure of professional organizations is quasi-governmental, and, as such, as I recall, associations can have coercive powers to require contributions. Huey Long, the master of the "deduct," would like this. I, by the way, do too.
Acupuncture association reaches out to secure more submissions to their professional journal
The American Association for Acupuncture and Oriental Medicine is actively reaching out to beef up submissions to The American Acupuncturist, its journal. According to a statement available here,
the professional association is "aggressively pursuing a goal of being
indexed by Medline." Details for submission to the quarterly are here.
Short Notes on integrative care in the nation's hospital and health systems
These briefs arfe from Google Alerts: Beth Israel director of integrative medicine talked up the value of probiotics on KXLY radio ... The Parkview Physicians Group in Fort Wayne, Indiana announced a new integrative medicine program. It will be led by Angella LaSalle, MD, a University of Arizona Fellow in Integrative Medicine ... Patrick Massey, MD, PhD, the medical director for complementary and
alternative medicine for the Alexian Brothers Hospital Network promoted "bioenergy healing" in the Illinois Daily Herald" ... Kaiser Northern California integrative medicine leader Catherine Gutfreund, MD was named Sonoma County Family Physician of the Year ... Acupuncture,yoga and Tai chi are featured public education programs over the next 3 months at the Osher Center for Integrative Medicine at Harvard University .. . Integrative Medicine for the Underserved (IM4US)
has made available a powerpoint on introducing integrative medicine to faculty ... Mercy Health posted back integrative content from the Springfield, Missouri system's integrative medicine leader Lance Luria, MD of Mercy ... Integrative medicine is one of the subjects at Stamford Hospital's mini-medical school ... Sierra Tucson has linked with Univresity of Arizona to help educate students their integrative programs for treating addictions ... OhioHealth promotes its integrative medicine program- but without any evidence of who the providers may be ...
Media
 Sita Ananth: translating military IM to civilian use
The column in the American Hospital Association's Hospitals and Health
Networks magazine by Samueli Institute's knowledge leader Sita Ananth,
MPA and Leila Kozak is entitled "Complementary and alternative medicine within the VA system." The subtitle states: "Community hospitals can learn from the success of efforts to integrate CAM into veteran services."
The article notes that a 2011 survey found that 89% of VA facilities
offer some kind of complementary and alternative medicine. This is more
than double the 42% in community hospitals found in a 2010 survey.
Chiropractic has already been "re-classified as mainstream
practice." According to the authors, the other area of significant use
of complementary care in the military is
mind-body treatment, for an array of disorders. Samueli Institute is the
nation's leader in partnering with the military on integrative
strategies.
Comment: Growing up in what used to be
called "Boeing country" (Seattle), we always heard plenty about the
transfer of high technology from military and space programs to civilian
use. So forgive me if technology transfer from the military to civilian
hospitals of mind-body therapies and chiropractic feels an oxymoron.
Who would have thunk it? Nice piece.
Wallstreet Journal boosts massage as medicine and as stress reduction
The title of the March 13, 2012 story was "Don't Call it Pampering: Massage Wants to Be Medicine." While condescending in title, the article's review of the field and recent findings reads almost like a media brief on behalf of the profession - and not just as focused "medicine" but also in reducing stress. Included was reference to the osteoarthritis research led by Adam Perlman, MD, now director of Duke Integrative Medicine. NIH NCCAM's deputy director Jack Killen, MD was quoted this way: "There is emerging evidence that [massage] can make contributions in
treating things like pain, where conventional medicine doesn't have all
the answers."
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