June 2014 John Weeks Integrator Round-Up: Useful Data Points

John Weeks, Publisher/Editor of The Integrator Blog News & Reports provides his monthly Integrator Round-Up of the latest news in integrative health including updates in integrative health policy, integrative health research, integrative health resources, useful data points, international integrative health, integrative health professions, integrative health people, and more

Use of "CAM" providers among monthly health and medicine choices for US citizens

In a presentation at the recent American Association of Medical Colleges (AAMC) 10th Health Workforce Research Conference, Duke's family medicine residency head Lloyd Michener, MD included a useful slide from a 2001 study that placed human "visits to complementary or alternative medicine provider" in the context of typical monthly health and medical use patterns. Michener’s slide, from a NEJM-published study, first noted that of 1000 people, 800 will report some symptoms related to health problems each month. Of these, 327 will "consider seeking medical care" and 217 will visit an MD's office (113 of which will be primary care doctors). Of the total, 21 will visit a "hospital outpatient clinic," 14 will receive home health care, 13 will visit an ER, 8 be hospitalized, and "less than 1" Michener reported to his AAMC audience, will be hospitalized in an academic health center. Where do CAM providers fit in? The study reports that "65 will visit a complementary or alternative healthcare provider." Michener, who was not speaking at AAMC on a complementary or alternative medicine topic, serves on the NIH National Advisory Council on Complementary and Alternative Medicine. (Green LA, et al. Ecology of Medical Care Revisited. NEJM 344:2021‐205. June 28, 2001.)

Comment: I spoke to the 200 plus workforce data heads at the AAMC conference on "Integrative Health and Medicine" just before Michener’s community medicine focused talk. We were part of a May 2, 2014 plenary panel entitled "Come Together: Using Teams to Meet Post-ACA Healthcare Needs." My key point was that licensed complementary, alternative and integrative health and medicine practitioners are part of the "workforce" selected by many human beings in the U.S., daily. Then I posed the perhaps plaintive question: Might these one day be an acknowledged part of your workforce calculations and planning? Michener's slide, which he used in part to put academic health centers (<1 visit/month) in their context, supported my point. Notably, the study authors did not ask how many use "CAM" or any other form of self-care.

UPMC leader: "Only about a quarter of what we do has strong evidence and we only do that about half the time."

On June 7, 2014, one of the plenary speakers at the largest, international, interprofessional health meeting, All Together Better Health 7 made a stunning comment on evidence. The speaker was Steven D. Shapiro, MD, chief medical and scientific officer for the University of Pittsburgh Medical Center/UPMC Physician Services. In dialogue with his international audience and his fellow panelists, health system leaders from Mayo and University of Minnesota, Shapiro stated bluntly: "Only about a quarter of what we do has strong evidence and we only do that about half the time." The comment was tossed off in a matter of fact way. He made no citation. Sharpiro was not judging or startling, but merely sharing evidence that made a point. UPMC is that city's largest employer.

Comment: The honest human question is: How are leaders from hospital medicine, in full integrity, to approach the evidence question relative to complementary and alternative medicine practices? Should their question be: Can you guarantee me that 25% of what you integrative doctors do is evidence based and that you do that at least half the time? Otherwise, you are out! Of course, we often see a full on double standard, which presumes that what is done and paid for in regular medicine is evidence-based and that practiced by infidels does not make the grade.

At dinner with a local colleague who took me to a restaurant on a hill with a view of downtown, a tower with the UPMC logo emblazoned on its crown loomed above the Highmark Blue Cross Blue Shield building and over all of the other downtown towers. The image of that tower on this precarious base in evidence reminded me of a line from a poet friend in university, Valerie Clappison (now a retired Portland psychiatrist): Idol children have clay feet/ and angels fall in spirals. I often think the most significant issue for complementary and integrative medicine practitioners around "research literacy" is not so much the ability to evaluate studies but rather the necessary bilingualism to managing the interprofessional politics in these zones of conflict, power, uncertainty, and ambiguity.