April 2014 John Weeks Integrator Round-Up: Policy

VA's integrative pain initiative shows early positives in limiting opioid dependency The US Veteran's Administration recently sent a media release announcing that VA Initiative Shows Early Promise in Reducing Use of Opioids for Chronic Pain. The article notes that the

VA's integrative pain initiative shows early positives in limiting opioid dependency

The US Veteran's Administration recently sent a media release announcing that VA Initiative Shows Early Promise in Reducing Use of Opioids for Chronic Pain. The article notes that the comprehensive initiative includes "an emphasis on patient education, close patient monitoring with frequent feedback and Complementary and Alternative Medicine practices like acupuncture." Robert Petzel, VA’s Under Secretary for Health is quoted: “The Opioid Safety Initiative is an example of VHA’s personalized, proactive and patient-centered approach to health care. We are also using a full-range of support treatments for Veterans, including Complementary and Alternative Medicine. We are delivering health care with the patient’s long-term personal health goals at the forefront.” The program includes a pain monitoring app.

Comment: This is evidence that, as integrative health policy leader Janet Kahn, PhD has suggested, the military may be the change agent for patient-centered policy on integrative health and medicine even as the AIDS activists changed FDA approval timelines to better reflect the interests of the individuals the agency is to serve. (Thanks to Jud Richland, MPH for the heads-up on this story.)

Is a major threat to integrative medicine practice rolling south and west from Nova Scotia's medical board?

Chris Foley, MD, a long-time leader of both health system-based and community-based integrative centers sent an alert about a new Policy and Guidelines on Complementary and Alternative Therapies. The paper was issued by the Council of College of Physicians and Surgeons of Nova Scotia. The 3-page guideline requires "ethical physicians" to:

• Carry out appropriate and conventional examinations and investigations in order to establish a diagnosis and basis for treatment;
• Prescribe or recommend an effective and proven therapy not delayed or supplanted by the choice of a complementary or alternative treatment;
• Not expose patients to any undue risk from a complementary or alternative therapy; Not misrepresent the safety or efficacy of any therapy or procedure, whether conventional or unconventional;
• Not exploit the emotions, vulnerability, or finances of patients for personal gain or gratification;
• Respect the autonomy of patients in choosing from available treatment options.

The guidelines go on to allow a physician to "discharge" a patient who does not consent to these guidelines. The Nova Scotia group worked off a document prepared by their colleagues in British Columbia.

Comment: Such guideline writers need to ask what to do if one has first rate evidence on how to suppress the symptoms of a disease but only impressionistic evidence on how to get at root causes and create health. In this context, how then does one respond as an "ethical physician" to the second bullet on delay of suppression? And how ethical is it to decisively suppress symptoms if we have some evidence that the problematic causes may altered if one only takes another approach? Foley wonders what will become of integrative medicine if the guidelines embraced in Nova Scotia are widely embraced across Canada and sweep through the U.S.

IHPC Brings 2706, CAHCIM and Allina to Congressional Briefing on "Easing the US Healthcare Crisis: The Role of Integrative Health Care"

On April 10, 2014, key staffers for numerous members of the US House of Representatives and US Senate were treated to unusual fare at a briefing entitled "Easing the US Healthcare Crisis: The Role of Integrative Health Care." Staff for over 17 US Senators, and 7 members of the House, together with representatives from10 outside organizations were among the roughly 70% of attendees who signed-in. Among those in attendance were staff members for the powerful US Senate Health Education Labor and Pensions Committee, as well as counterparts from Appropriations and the Special Committee on Aging. Janet Kahn, PhD, who organized the session on behalf of the Integrative Healthcare Policy Consortium (IHPC), shared with the Integrator that the audience "was attentive throughout the 70+ minutes of presentation - questions were thoughtful" and that "the Senate Q&A in particular went into some depth on 2706" - Non-Discrimination in Health Care. Kahn's report continues:

Kahn/IHPC report-Chesney: I think the presentations built well.  I was the set-up person, using material from the IOM Report "Shorter Lives, Poorer Health" to identify what the crisis is; distinguish between the contributions of prevention and those of health promotion/health creation; also the needed synergy between integrative health care and integrative health policy. Margaret Chesney, PhD, chair of the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) and integrative medicine leader at UCSF Osher Center, explained IM/IHC and used heart disease exquisitely to illustrate the problem, and the difference between usual care and integrative care. She illustrated the growth of IM/IHC through the increase from 8 to 57 centers in CAHCIM between 1999 and today; and the comparable growth in number of hospitals offering integrative healthcare services.  She offered good cost data, including Ornish's work on both heart disease and prostate cancer - the latter showing telomere growth which is hugely important.

The Kahn/IHPC report continues-Baechler: "Courtney Baechler, MD, MS, a cardiologist, and Chief Wellness Officer & Vice President, Penny George Institute for Health and Healing, Allina Health, presented on Allina's growth from 2003-present.  She gave the audience a good picture of the size and complexity of the Allina system; the decision to move from a single site - the Penny George Institute of Health and Healing - to ultimately seeking to integrate all 13 hospitals.  The range of things Allina is doing - in-patient and outpatient, community-based programs, etc. is impressive - as is their data.  Across these presentations people saw examples of IM/IHC in relation to chronic pain, heart disease, cancer, spinal fusion, and more.  And the problem identified in the first presentation - that the US has been getting a horrible return on investment when it comes to health care $$ spent, was well-answered with a look at Allina's and Ornish's cost data.

Kahn/IHPC report concludes - Wisneski: Finally Len Wisneski, MD, IHPC's chair and faculty member at Georgetown University, George Washington University and University of Colorado, capped the presentations by focusing on the common  sense of IHC, the importance of 2706 and use of the full healthcare workforce, importance of supporting the two active bills bringing IHC into the VA and DOD, and on IMPriME and the importance of training physicians for these times and this kind of team work, especially knowing when to refer to other kinds of providers."

Comment: Kudos to the Integrative Healthcare Policy Consortium for the time, energy and expense of organizing this meeting, and to the contributions of Chesney and Baechler and their respective organizations. For all the talk of health reform and "transforming" the medical industry toward health, very few in this community ever set foot in the nation's Capitol where the lever's get pulled that make new directions possible. Who knows which staffer in IHPC’s briefing room might add just the right language in a bill?  Notably, Kahn reports that she and Wisneski also pointed out to the staffers that as federal employees, they may be among the first Americans to benefit from Section 2706, as Blue Cross Blue Shield included in their pamphlet to federal employee plan participants that "we now cover any licensed medical practitioner for covered services performed within the scope of that license, as required by Section 2706(a) of the Public Health Service Act (PHSA)."

Doctors of chiropractic and naturopathic medicine on National Quality Forum

The quasi-governmental National Quality Forum has a good deal of clout in the emergence of the new system for medicine. The organization sets standards by which quality will be measured, and compared, between plans and systems. The American Association of Naturopathic Physicians recently chose to join the NQF and, according to CEO Jud Richland, MPH, “successfully nominated Christian Dodge, ND, to serve on the Musculoskeletal Measures Standing Committee.”  (To a query, Richland noted that there is also a chiropractor on the committee, John Ventura, DC, via NQF member the American Chiropractic Association.) Richland notes that the AANP has another nomination in for a second committee. “Our goal in joining NQF is obviously to influence the health system to place greater emphasis on whole person care and integrative medicine,” explains Richland, adding: “We know that what gets measured gets done, and NQF is the most influential organization in determining what gets measured.”  Richland states that the AANP “certainly anticipates placing AANP members on a number of the measure development committees in the future.”

Comment: Inside the Academic Consortium for Complementary and Alternative Health Care, with which I work, we talk about the value in placing key representatives “of the values, practices and disciplines associated with integrative health and medicine” in every important healthcare dialogue. Kudos go to the AANP, and to the ACA, for having the foresight to be involved in this significant process.