| | The Integrator Top 10 as Integrative Medicine and Natural Health Care Enter 2008 | |
Summary: On the winter solstice of 2006, an Integrator tradition began: the announcement of a Top 10 from the previous year which will most support the coming of the light in the new year. Here, a month late, is the Integrator Top 10 from 2007 which will shape integrative medicine and natural health care as we enter 2008. What were the key actions in hospitals, with employers, in the community, in research, in the Nation's Capitol - and on Oprah - which will make a positive difference for 2008? Actually, just 9 are listed here. What are your suggestions for #10? Happy reading, and reflecting, on a hopeful year that was, and year to come.
A caveat. This list is particularly filled with action with which I am at least partially connected. Assume interest, or conflict-of-interest, as you read. While I prefer to view my involvement as evidence of my pleasure in mixing it up with that which shows the most potential, there may be awful signs of short-sightedness and self-aggrandizement in the list presented here. What have I overlooked? Overstated? I welcome your comments on exciting action areas from your own Top 10.
Send your Top 10 thoughts to
[email protected]
for inclusion in a future Your Comments Forum.
The Integrator Top 10 from 2007 as We Enter 2008
 For looking at effectiveness and cost-effectiveness
A new NIH NCCAM research initiative, approved in September 2007,
announced a simple goal. They would fund explorations of the
effectiveness and cost effectiveness of complementary and integrative
approaches in community settings. (See "Making Amends: Studies of Effectiveness and Cost-Effectiveness Represent Less Than 1% of NCCAM Budget," September 27, 2007.) Now that sounds interesting. When did common sense take over at NCCAM? In 2006, just 1% of the total NCCAM budget was involved with such questions. Such
a practical initiative might even get the average complementary
practitioner, long alienated by an NCCAM agenda that seemed more
about researcher anal-retentiveness than a practitioner's openness to
the whole person, to renew interest in research outcomes. Even employers might take notice:
a work-site is a community setting, is it not? While just one among
scores of NCCAM programs, I like to think of US Senator Tom Harkin (D-IA) and his colleague who have backed NCCAM expanding the program with a couple strokes of the pen: You
know, this might be the way to really see if these therapies and
providers we've been backing can be meaningful contributors to health
reform.
 Oprah and two words about God ...
Growing up as I did in an ecumenical, social action-oriented Protestant church back in the 1960s - the United Church of Christ
into which Obama was reared - the denomination's ministers were fond of
both shocking and bringing laughter to their congregations by an
expression of faith that went like this: "Yes, I believe in God. She's
black." At some point last year, I realized that all that those
ministers were prescient: they'd foreseen the coming of Oprah. Her power in the culture, and her coupling with cardiothorassic surgeon and Bravewell event host Mehmet Oz, MD,
is bringing natural healthcare to a huge audience in its best form: practices to aide and abet one's personal
empowerment. This year, Oprah had viewers watch acupuncture be
administered on a patient who gave it a rave review. On a later show,
Oprah received a treatment herself. Oprah and Oz demystifyied the needles for
millions. More recently, Reiki made the show. In a world so shaped by Big Media, having the Oprah/Oz couple
promoting one's work is to have god on one's side.
 Exploring the employer-CAIM connection
In October, the Institute for Health & Productivity Management (IHPM), an organization of large employers, held its first complementary, alternative and integrative medicine (CAIM) track at one of its regular conferences. (See "Alliance with 'Health Enabling' Corporations? Notes on
Complementary/Integrative Medicine and the Institute for Health & Productivity
Management Conference," October 25, 2007.) IHPM and its members - employers like Boeing, John Deere and Ford - has a capitalist's, real-politik view that investing in health may be the most robust frontier in which they can enhance profitability. Founder Sean Sullivan is among those who believe that CAIM approaches may be the wave of the future for serious employers who want to limit the global costs associated with health and enhance employee productivity. IHPM has committed to stimulating a dialogue between CAIM and employer interests. Happily, they have asked me to take the lead in this organizing. IHPM will also soon learn from the pilot project at Chrysler and from leaders like Cathy Baase, MD, corporate medical director for Dow Chemical. More soon!
 The business model for hospital integration
Since its inception a dozen years ago, hospital-based "integrative
medicine" efforts have been hampered, when not altogether strangled, by
the perverse incentives in the tertiary care system. From a strictly
business perspective, hospitals and their most powerful specialists
thrive off of disease. From inside the corporate hospital complexes it
can be tough to fully embrace a movement which, with ultimate success,
would shut down wards, expand community medicine, and foster
self-reliance. Into this mess of contradictory impulses strode the Samueli Institute, under the leadership of Wayne Jonas, MD, promoting what they call "optimal healing environments" (OHE). But it was with the Institute's prominent role in the 5th Integrative Medicine for Health Care Organizations conference last April, and the publication of Reinventing the Patient Experience: Strategies for Hospital Leaders, that Samueli's OHE initiative, led then by Barbara Findlay, RN, clearly determined that the future of OHE rested with building the business case for integration of healing strategies. (See "The Business Case for Hospital Integration: Some Perspectives from the 5th Annual AHA/Health Forum Conference," May 3, 2007.) The
next step is to train OHE leaders to partner with large employers when
they ask hospital leaders for healing changes. Then OHE will have found
the ultimate business case.
 Florida's Agency for Health Care Administration
Last year I honored Integrator sponsor Alternative Medicine Integration Group for publishing outcomes of their integrative primary care pilot with Blue Cross of Illinois. Recent issues of the Integrator have featured another unique AMI pilot project, this one with the State of Florida. (See "Integrator Special Report: Medicaid Integrative Therapies Pilot Project in Florida - Part 1, Overview," October 22, 2007. and additional 3 parts.) The pilot from the Florida legislature and the Florida Agency for Health Care Administration, now moving into a second phase, has found high patient satisfaction and significant cost savings on a per participant per month basis through a hands-on, holistically-oriented nurse-managed strategy which utilizes licensed massage therapists and acupuncture physicians for patients with significant chronic and often disabling pain. Beth Sommers, MPH, LAc and others who are seeking to re-invigorate the complementary healthcare practices section of the American Public Health Association might find this outcomes-oriented, integrative strategy a great approach to explore.
 Birthing an online community
Maine-based Diversified Business Communications got into the integrative medicine zone with its CAM EXPO events when I was in another zone, Central America, on sabbatical. This year, the Diversified team, a values-clarified business, led by CEO Nancy Hasselback and Marnie Morrione,
made 3 smart moves. They ended their West Coast gathering, which never took
off like their New York conference. They changed the conference name to
Integrative Healthcare Symposium, which better reflects the educational vibe they are seeking to create. And Diversified added an important element, Integrative Practitioner Online
(IPO), a web 2.0 site only now being
launched. IPO has the potential to be a significant meeting place and
cross-fertilization for diverse practitioner groups and
integrative care stakeholders. IPO shares a good deal of the Integrator mission, and also brings the depth, girth and backing to fill an important, ongoing, community-building and convening role for our still very fragmented movement.
 7. CAM/IM: Struggling Toward Washington, DC to Be Born Into the Reform Debate
The Iowa voter survey - and soon to be revealed Washington survey - from CodeBlueNow! suggested that a savvy presidential candidate will appeal to the self-interest of the complementary healthcare user. (See "Iowa Health Reform Poll: 68% of Voters Want Licensed CAM Professionals Covered in Basic Benefits," October 8, 2007.)
Yet complementary and integrative medicine are not even in the health reform debate. Why? Other than chiropractic, and the natural products industry when on the defensive, integrative care interests are hardly visible in the Nation's Capitol. But there are hopeful signs of change. The American Association of Naturopathic Physicians, Integrated Healthcare Policy Consortium, Tai Sophia Institute and the American Association for Health Freedom are among the entities that are stepping up D.C. related activity. Hopefully the re-constituted American Association for Acupuncture and Oriental Medicine and re-invigorated American Holistic Medical Association will soon follow suit. Got to show up to play, Dudes and Dudettes. Shoot, maybe we'll even figure out how to collaborate!
 Collecting whole systems research instruments
To paraphrase: It's easier for a camel to get through the eye of a needle than for a whole practice of integrated care to be evaluated through a reductive trial. The game is up, friends, if reduction is the yardstick for success of the whole systems of care we represent. Why have we allowed this to go on? (Answer: What color is the money?) Now our Canadian brothers and sisters, at IN-CAM, thanks to the John and Lotte Hecht Foundation, have taken the lead in developing a data base of instruments that can be useful in measuring a whole system of care. (See "Research Initiatives Update: IN-CAM Outcomes Tools, etc...," April 10, 2007.) These issues emerged as top priority when the Research Working Group of the Academic Consortium of Complementary and Alternative Health Care began its work to create a white paper on shared research issues across the licensed CAM disciplines. Even the NIH NCCAM dipped a toe in the water in early October when they sponsored a meeting, led by Adi Haramati, PhD, of Georgetown University School of Medicine which explored complexity science as it relates to integrative care. Are we finally beginning to realize that we need to be a part of a broad coalition that argues that a dominant reductive research gene is hazardous to to all our health when it comes to addressing the multi-factorial chronic conditions and the cost crisis in health care?
 9. "Heal Your Self Health Care" and Heal Your Bottom Line as Well
When PricewaterhouseCoopers Health Research Institute announced last June that it had completed an analysis that suggested that healthcare costs to employers will increase at a lower rate in 2008, their study noted four areas responsible for the good news. Among these contributors: "Total-health management approach to benefits, such as wellness." One of the other four was a drop in prescription drugs, which might also be associated with wellness practices. No wonder trends aficionado Gerald Celente of the Trends Research Institute started the year with a prediction that "heal yourself health care" was on the rise. (See "2008 Good News: Trends Maven Celeste Highlights "Heal Yourself Health Care," January 12, 2008.) It is indeed interesting, given the long-time association of affluence with complementary and integrative medicine use, that - as Celeste points out - economic challenges may be leading us to better health, to healthier practices, and to an uptake in natural healthcare usage.
10. And What Is It That You Would Add?
I have certainly left much out which is particularly hopeful that is on our horizon. Send me a note with your thoughts! A future Integrator will include your sightings of the coming of the light.
Coda: Speaking of Economics - the Sponsorship that Floats This Boat
Finally, I have some additional action for which I am particularly thankful - the shimmery green light which pays me to engage this work. First, some of you have sent personal checks. You know who you are. Thanks! They are precisely useful! But the Integrator business model, for better and for worse, relies on the generosity and commitment of a few dedicated executive teams and the businesses with which they are associated. As pure marketing, the Integrator is a lousy buy. Integrator sponsorship is a commitment to the Integrator mission. Here are the committed Integrator sponsors as we move into 2008.
- NCMIC and the firm's president Lou Sportelli, DC, got me going in January 2006 and recently paid in full for their third, full year.
- Alternative Medicine Integration Group, led by Jim Zechman and Richard Sarnat, MD, is in its 17th month of continuous support.
- Inner Harmony Wellness Center, founded by Peter Amato, came on last spring in is in it for awhile.
- I am pleased to report that the Institute for Health & Productivity Management, led by Sean Sullivan and Deborah Love, began sponsoring this month. Stay tuned!
Finally, I deeply thank two sponsors who have either ended this relationship or indicated that they will not renew. Triad Healthcare, led by Tino Villani, DC, made a critically important second commitment back in 2006. Triad supported the work for 18 months, and Villani stimulated some excellent dialogue around payment issues. In addition, Standard Process decided after 18 months of sponsorship to shift its investment elsewhere. It's sponsorship is scheduled to end this year. (Happily, some of Standard's funding is supporting the Research Working Group of the Academic Consortium for Complementary and Alternative Health Care, noted in #8, above.) Standard's David Barnes, PhD, has made important contributions regarding a whole system context for examining the value of natural products. Thanks to both! Each will remain as a member of the Integrator Editorial Advisory Board.
Send your Top 10 thoughts to
[email protected]
for inclusion in a future Your Comments Forum.
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