May 2015 John Weeks Integrator Round-Up
by John Weeks, Publisher/Editor of The Integrator Blog News and Reports
PERSPECTIVES NEEDED: Comment Periods End for NCCIH Research Strategy and HHS Pain Strategy
Strategies are on the table for the two of the areas that most influence the future of integrative health and medicine. The first is the 2016 Strategy for the National Center for Complementary and Integrative Health with comments due May 18. The second is the Health and Human Services' National Pain Strategy with comments due May 20.
by John Weeks, Publisher/Editor of The Integrator Blog News and Reports
YOUR PERSPECTIVES NEEDED: Comment Periods End for NCCIH Research Strategy (May 18) and HHS Pain Strategy (May 20)
Strategies are on the table for the two of the areas that most influence the future of integrative health and medicine. The first is the 2016 Strategy for the National Center for Complementary and Integrative Health with comments due May 18. (Send comments to [email protected].) The second is the Health and Human Services' National Pain Strategy with comments due May 20. These follow the posting of a 72-page draft strategy that isonline here. (Send comments to [email protected].)
For anyone wishing to view some pain-related ideas, a multidisciplinary pain team including Martha Menard, PhD, LMT (massage), Heather Tick, MD, Arya Nielsen, PhD, LAc, Bill Meeker, ND, MPH, Kevin Wilson, ND and John Weeks developed these two-page Recommendations for Policymakers after developing this 8-page Policy Brief entitled Never Only Opioids: The Imperative for Early Integration of Non-Pharmacological Approaches and Practitioners in the Treatment of Patients with Pain. Crib away!
For policy ideas for the NCCIH you might consider perspectives from the most recent strategic planning process of the organizations reported here in the Integrator Stakeholder Organizations on NCCAM's Strategic Plan: IHPC, ACCAHC, AHMA, AANP, IAYT, NCH, AANMC and MTF and here in the Integrator NCCAM Strategic Plan: Positions of CAHCIM (MD/IM academics), CRN (supplements) and AMTA. (massage), plus. On the positive side, the NCCIH is presently moderately better focused on the “real world” and on pain conditions, and, for instance, has engaged with the military. In addition director Josephine Briggs, MD has announced interest in an excellent initiative to take on the paranoia surrounding herb drug interactions. At the same time, NCCIH is increasingly less interprofessional and less likely to provide any grants to any institution that
Comment: These are opportunities to participate in two processes under the U.S. democracy. I come from the school that says voting – in this case making one’s voice heard through public comments – gives one the right to complain. Celebrate what you like in these agency’s work and ask for more of it. Then participate, if for no other reason than to have no hitch in your Chakra’s when you lay down a diatribe against some policy with which you disagree in the future. Who knows, maybe there will be ears to hear. The only thing known for sure is that if you don’t participate, you might as well be living under another kind of governmental structure.
HHS Shuns Congressional Intent on “Non-Discrimination in Health Care” and Refuses to Clarify Position
In an April 24, 2015 e-mail made available to the Integrator by Mike Jawer of the American Association of Naturopathic Physicians (AANP), the US. Department of Health and Human Services effectively told those following “non-discrimination in health care” (Section 2706) that HHS will not, anytime soon, abide by the law. The background, captured in this article, relates to Section 2706 Non-Discrimination in Health Care of the Affordable Care Act. More precisely, HHS’s silence is connected to a subsequently published statement by the agency that dismissed Congress’ intent in their 2013 publication of Affordable Care Act Implementation FAQs -- Set 15. More specifically, at stake is a US Senate retort to HHS in a July 11, 2013 committee report that told the agency “to correct the FAQ to reflect the law and congressional intent." The Senate requested the response from HHS by no later than October 2014.
On behalf of the AANP, Jawer had asked a representative of CMS to clarify current activity on the issue. A team from the AANP had met with HHS in October of 2014 on the issue. He also asked if a CMS representative might meet with naturopathic doctors and students at an early May 2015 DC-FLI “lobby day” for the profession in D.C. The response came from Jim Mayhew. Mayhew is director, Division of Regulations and Policy, Office of Oversight, Center for Consumer Information and Insurance Oversight of the Centers for Medicare & Medicaid Service. He wrote to Jawer: “Many thanks for reaching out to us. Unfortunately, no one is available on May 4th for a meeting. Furthermore, we have nothing new to report since October in terms of publically available information. We’re continuing to work on issues related to section 2706 with our colleagues at Labor and Treasury and also with State regulators. Best regards, Jim Mayhew.”
Comment: Dear Dr. King. We have nothing new to publicly report on your desire to sit in the front of the bus where I do or to be able to get a cup of coffee where I enjoy my coffee and newspaper. We’re continuing to work with the owners of the bus lines and coffee shops. Best regards.
Integrative health and medicine’s main advocate, former US Senator Tom Harkin, who has pushed HHS to respect Congressional intent, is retired to Iowa. One wonders if anything will move the agency short of a Big Honking Lawsuit. This continuing discrimination is harmful, to individuals, and to the public health. Good for the AANP to be remaining on this. What is the next step?
PETITION: Congressman Ryan, Hyman, Promoting Measure to Force Nutrition Education in Medical Schools
A note reached the Integrator via integrative cardiologist Mimi Guarneri, MD from author and functional medicine advocate Mark Hyman, MD. “I need your help on something,” wrote Hyman. “I have helped Congressman Tim Ryan introduce the ENRICH ACT into Congress to fund nutrition education in medical school! We need to get as many signatures on the petition now to get this passed!” The petition is here. A supportive article from the Bi-partisan Policy Center is "The ENRICH Act will provide better tools to fight obesity" and it provides a good overview of key points – which also include adding physical activity content.
Comment: I believe it was 2007 when the first report came out in the United States suggesting increased nutrition in medical schools. This is the most recent attempt to get medical education to be evidence based in this fundamental area. I signed and posted via Facebook. Doesn’t take much. Good luck Congressman Ryan – who by the way is, yes, the same fellow who has been a strong advocate of meditation and the mind-body connection. Nice work from Dr. Hyman, himself a warrior against poor nutrition, obesity and diabetes .
Change from the Inside Out: Berwick Group’s Pushes New Delivery Principles “Beyond the Triple Aim”
The most progressive forces in U.S. medicine have signed on and are promoting a new strategy for medicine and health in the United States. In a recent issue of the Journal of the American Medical Association, Institute for Health Improvement co-founder and former Center for Medicare and Medicaid Services administrator Don Berwick, MD published Change from the Inside Out: Healthcare Leaders Taking the Helm. They declare a set of eight principles including: "Cooperate and collaborate, above all. Eliminate silos and tear down self-protective institutional and professional boundaries that impede flow and responsiveness.” Another: “Move knowledge, not people. Exploit all helpful capacities of the modern digital age, and continually substitute better alternatives for visits and institutional stays. Meet people where they are, literally."
The printed word gathers gravitas with the simultaneous publication of a list of a score of voluntarily participating major delivery organizations. A Wisconsin member posts a blog on the subject of their membership that includes: "Our efforts to improve population health and lower cost are not aligned with how government pays us for services - but we cannot wait for government to fix the health care system or wait for what happens with the Affordable Care Act." Berwick is saying that this goes well-beyond the Triple Aim - and in multiple ways focuses on de-institutionalization.
Comment: The process of “integration” assumes there is a “here” and a “there.” The principles to shape regular medicine described in this article are the most attractive yet to emerge when viewed through the lens of the values set of integrative health and medicine. My reading is that this is the action step that Berwick developed for the 30-year march he articulated in hisDecember 2013 speech to health system leaders. There he dwelled deeply on the “more radical than we have imagined” concepts of “health creation” and “salutogenesis.” Berwick explained that he had become enamored through mentorship from the likes of integrative health leaders Herbert Benson, MD, John Kabat-Zinn, PhD and above all and Wayne Jonas, MD. The JAMAprinciples are an opportunity to white board the values alignment and points of optimal intersection, support and alignment between “here” and “there” to create a health care system out of our medical industry. To paraphrase that visionary Buzz Lightyear: To the Triple Aim and Beyond.
Health Creation Economics: IHPC Publishes Cost-Effectiveness Booklet
The title of the long-awaited 16-page is "Integrative Health and Medicine: Today's Answer to Affordable Healthcare." The subhead is: “Health Creation Economics.” The top-flight author trio is Erica Oberg, ND, MPH, RAND Corporation economist Patricia Herman, ND, PhD, and former integrative cardiologist and present president of the Academy of Integrative Health and Medicine Mimi Guarneri, MD. The sponsor is the Integrative Health Policy Consortium (IHPC). The author team also includes sometimes Integrator columnist and IHPC’s CoverMyCare manager Taylor Walsh and IHPC’s executive director Alyssa Wostrel, MBA. The booklet is handsome, easily scan-able, and meant for use in policy environments. The cover lists the following organizations for their backing of the project: Miraglo Foundation and the Taylor Advised Endowment Fund for Integrative and Holistic Medical Education and Research, and Emerson Ecologics.
Comment: This is a great tool that, after all of the work and investment, threatens to gather dust in the woods with no one there to use it and read it if work is not done to raise its visibility and get it into the right hands. There does not appear to have been a media release yet by IHPC, for instance. I know from posting it on a couple of organization sites with which I am involved that its gets good play when it is made visible. Here’s hoping that an outreach campaign will be executed. Circulate it!
Integrator Columnist Michael Levin: How $2.00 of Vitamin C Can Save Thousands of Dollars for Patients Following Cardiac Surgery
Integrator columnist Michael Levin has a passion for righting the failure of regular medicine to optimally use vitamins and other natural agents as cost savings tools. On April 23, 2015 he sent theIntegrator a link to a review article entitled “Vitamin C Aids Recovery from Cardia Surgery.” Levin referenced the original research and synopsized: “The group that got the vitamin C (as ascorbic acid) had significantly less atrial fibrillation (a-fib), less intubation time, and less of what the authors dubbed ‘significant complications’ which included ‘death, any infection and any impairment in the renal function.’ Those who received vitamin C stayed approximately two days less in the hospital, likely due to the lower complication rates.”
Then he opined: “So, is vitamin C routinely used in cardiac surgeries? Far from it. Of course, one study does not a standard of care make. However, delving into the literature I found there are many other studies that show this simple intervention consistently lowers atrial fibrillation after cardiac surgeries and shortens hospital stays. [Note: there review also references multiple.] One meta-analysis that included 23 studies on various antioxidants around the time of cardiac surgery found the average reduction in a-fib was 50% for those taking vitamin C. If a drug were invented with such a measurable benefit, would the FDA approve its use? Seems likely, but of course, vitamin C is not patentable so this is conjecture.” He adds: “Nothing is risk free, but vitamin C in these moderate doses comes darn close to it. That said, why isn't it standard of care? If the simplest answer is usually the right answer, then it may just be that no one is really looking at the data.”
Comment: This looks a good place for a front-runner like the Cleveland Clinic, with its functional medicine program, to work on getting engagement with their cardiologists. This may be enough of a no-brainer to bring into any cardiology setting. Who loses on this?
Bravewell Publishes Promising Results of PRIMIER Practice Based Research Network in IM
On April 30, 2015 the Bravewell Collaborative of philanthropists in integrative medicine published a report on outcomes of one of its legacy projects. The report is entitled PRIMIER: A National Integrative Medicine Database. The data in the Patients Receiving Integrative Medicine Interventions Effectiveness Registry (PRIMIER) show that the “use of integrative medicine interventions leads to significant improvements in patient activation and patient-reported outcomes in the treatment of chronic pain, depression, and stress” according to a release on the project. One outcome: over six months, the percentage of patients with low levels of patient activation decreased from 29 percent to 17 percent, while those with higher levels of activation increased from 71 percent to 83 percent. The outcomes were created through the BraveNet practice-based research network that is coordinated through the Albert Einstein College of Medicine of Yeshiva University. The lead author of the report is UCSF Osher’s Donald Abrams, MD.
Comment: Whatever the hopeful expectations for the PRIMIER program were there at its outset, this report is a good beginning on outcomes. The findings nestle in nicely with the Patient Experience database of reports gathered through the Project for Integrative Health and the Triple Aim (PIHTA) at the Center for Optimal Integration: Creating Health directed by Jennifer Olejownik, PhD.
Where the Rubber Meets the Road: AANMC, AANP and ACCAHC Urge Interprofessional Make-up of NCCIH Advisory Council
Separate letters to Josephine Briggs, MD, from three organizations have urged the director of the National Center for Complementary and Integrative Health to take an interprofessional approach in her recommendations for membership on the agency’s advisory council. In a March25, 2015 letter from the American Association of Naturopathic Physicians (AANP) and shared with theIntegrator, Kasra Pournadeali, ND, noted that soon just one of the Council’s 18 members “will be affiliated with an organization representing licensed professionals within the field of complementary and integrative health.” Pournadeali adds that practitioners from “complementary and integrative medicine bring a strong base of clinical training as well as the understanding of patients’ interests, questions, and concerns.” They are, he added “where the proverbial rubber meets the road.”
An April 3, 2015 letter from JoAnn Yanez, ND, MPH, executive director of the Association of Accredited Naturopathic Medical Colleges (AANMC) and also made available to the Integratorsimilarly urges Briggs to widen the pool of those she recommends. “Not only do the licensed represent the majority of practitioners prescribing the modalities and therapeutics NCCIH is tasked to review,” Yanez writes, adding: “How better to fulfill the Congressional mandate of half of the Council being composed of practitioners licensed of one or more of the major systems with which NCCIH is concerned.” (See Integrator Guide: NIH NCCAM's Mandate: 1998 Congressional Enabling Act.) The Academic Consortium for Complementary and Alternative Health Care (ACCAHC) has also submitted a letter that included CVs of 15 candidates. ACCAHC has an observer on a task force on the subject convened by the Integrative Health Policy Consortium (IHPC), and headed by Erica Oberg, ND, MPH, with which this writer is also participating.
Comment: While I’d bet my house that the NCCIH is wrong in asserting that a medical doctor who uses herbs is “licensed in one or more of the major systems with which NCCIH (was) concerned” when the mandate was passed in 1998, I increasingly view this excision of whole disciplines from NCCIH process as a major interprofessional blunder by Briggs and the agency. The documentable retraction of the membership back to the NIH’s default of MDs and PhDs from conventional academic health centers runs contrary to the movement coursing through U.S. healthcare toward teams, and to multidisciplinary and interprofessional activity. We are all more richly served with more rather than less diversity in the intelligence at the table. Sources say that Briggs may have plans to nominate at least two others from these licensed fields this fall. These are good steps in the right direction. To have 3/18 (17%) is better than 1/18 (6%). Why not head toward the mandated 9/18 (50%) to create a robust dialogue of ideas, perspectives and, most importantly, clinical experience, on the NCCIH Council? As the I Ching puts it: It furthers one to cross the great water.
Oregon’s Interprofessional and Interdisciplinary OCIM Hosts June 2015 SPARC Conference; Sternberg Featured
One of the great interprofessional engagements in integrative health and medicine, the Oregon Collaborative for Integrative Medicine (OCIM – pronounced “Awesome”) has announced the2015 SPARC Conference. A note to the Integrator from OCIM director Samantha Simmons, MPH, shares that the keynote speaker is Esther Sternberg, MD. Her topic: “Brain Immune Interactions: The Science of the Mind-Body Connection & Implications for Health.” OCIM consists of the University of Western States (chiropractic), Oregon College of Oriental Medicine, National College of Natural Medicine (naturopathic base), Oregon Health Sciences University (MD medicine, plus) and University of Pacific (optometry and other allied health). The program includes posters and multiple other presentation.
Comment: Check the member page at OCIM. The initiative is an enduring model of interprofessionalism. The OCIM mission: “Providing leadership in advancing integrative health through collaborative education, research, patient care and advocacy for the benefit of patients.”
$4.5 Million in Templeton Grants to Fund Research Literacy for Hospital Chaplaincy
The John Templeton Foundation will provide two grants to Rush University and Brandeis University totaling $4.5M over four years “to better equip hospital chaplains to use research to guide, evaluate and advocate for the spiritual care they provide” according to this release. The project, entitled "Training Research-Literate Chaplains as Ambassadors for Spirituality and Health" was developed to “close the gap between hospital chaplains' current limited research literacy and the importance of evidence-based care for all members of the health care team.” The grants will focus in two areas: advanced education for a cadre of leaders, and introducing evidence concepts more deeply into recognized chaplaincy training programs.
Comment: Years ago when I did some hospital consulting in integrative health I often found myself thinking that there was interesting theater potential between the Sisters who frequently retained me and the (male) medical directors who weren’t always happy they did. Given the growing scientific support for the mind-body connection – thanks in part to the National Center for Complementary and Integrative Medicine -- this rendering unto Caesar by these chaplains, by bowing to medicine’s evidentiary priorities, will likely empower these spirit guides in hospitals and health systems. Good timing for the grants!
Four Major Delivery Systems Contract with Healthways for the Ornish Heart Program
This April 20, 2015 media release announces that Beacon Health System, South Bend, Indiana, ‘Ekahi Health System in Honolulu, New Jersey’s Hunterdon Medical Center and Jacksonville’s St. Vincent’s HealthCare are the latest to partner with Healthways to deliver Dean Ornish, MD’s Program for Reversing Heart Disease.. Healthways and Ornish joined forces in 2013. Since then, 17 hospitals and health systems have added the program to their “roster of treatment options for heart disease patients.”
Comment: At a time nearly 15 years ago time when Ornish believed he was about to gain Medicare coverage of his program, he partnered with the Highmark Blues plans in a venture called Lifestyle Advantage to roll the program out nationwide. His lead there was a remarkable health promotion leader named Anita Silberman. Silberman had gathered data at Highmark that helped make the Ornish program’s case. We were all excited: quality evidence, a major insurer partnership, and cash to support the roll-out. Then Medicare’s approval was delayed - until 2011. Even more significantly, it turned out almost no cardiologists around the country were willing to go to bat inside their health systems to introduce the program. In those fee-for-service economics, success with Ornish’s approach would limit the need and payment for stents and coronary artery bypass grafts. Lifestyle Advantage died. Now, under the Affordable Care Act, and in this era of bundled payments, accountable care and creeping capitation, it would be useful to know just how much the recent uptake is linked to new payment incentive schemes.
Quick Links to Integrative Medicine News in Medical Systems and Communities: April 2015
This typically monthly Integrator feature for April 2015, a quick capture of highlights from the stories that flow in daily from various sources relative to "integrative medicine." A couple of themes and events that showed up significantly in April were the controversy surrounding the efforts of Columbia medical school faculty to oust TV celebrity Mehmet Oz, MD – and his work against them -- and the April 20-21, 2015 FDA hearings on homeopathy. Here are fifteen quick links from IM in health systems and seven from the community.
Duke Leadership in Integrative Medicine Program Strikes up Deal with Today’s Practitioner
The Duke Leadership Program in Integrative Medicine has announced that it has a media partnership with Today’s Practitioner through which it will post information on business models and strategies on a leadership site of the online publication. The web portal presently includes content mostly from Duke’s leadership program director Adam Perlman, MD, MPH. Today’s Practitionerdescribes the “content partnership” this way: “The Leadership Program in Integrative Healthcare will share key aspects of Integrative Leadership, integrative business strategies and the art of cultural transformation.”
Comment: Nice to see this town-gown collaboration between the academic center and a media channel for a broad array of integrative content that is culturally based in the practicing, non-academic community.
Two Presentations from Integrative Health and Medicine Academic Programs and Bridgeport and Arizona Featured at an IOM Forum
The subject of the two-day workshop at the National Academy of Medicine (formerly Institute of Medicine) was “Envisioning the Future of Health Professional Education.” Among subjects featured were six 8-minute examples of forward thinking academic initiatives. Two of the six came from the integrative health and medicine community. Jennifer Brett, ND, LAc who directs integrative clinics at the University of Bridgeport provided a concise look at an interprofessional engagement at the UB. The elective involves students in chiropractic, naturopathic medicine, acupuncture and dental hygiene including some outcomes. The segment is archived here. In addition, Elizabeth A. Goldblatt, PhD, MPA/HA, a member of the leadership advisory team for the Health Resources Services Administration (HRSA)-funded National Center for Integrative Primary Healthcare (NCIPH) at the University of Arizona Center for Integrative Medicine described core traits of this $1.7-million interprofessional collaboration. Goldblatt’s presentation is archived here. The workshop is part of the NAM Global Forum on Innovation in Health Professional Education that involves councils of colleges for virtually all health professional disciplines. The Goldblatt and Brett presentations were recruited by forum member Academic Consortium for Complementary and Alternative Health Care.
Comment: At some point it will no longer seem a win for integrative health and medicine to simply be present in such a forum. Not yet though! Each presentation is a terrific example of representingforward thinking in interprofessional practice. One is based in an extended MD environment (U Arizona) and the other rooted in the non-MD intersection (U Bridgeport) of other distinctly licensed integrative disciplines. Those who open either link will discover a familiar face introducing the speakers. The rest of the Forum video content is here.
Can a Naturopathic Degree Be a “Bridge” for an International Medical Graduate?
In May 2015 Canadian College of Naturopathic Medicine will graduate the first students of a unique program for international medical graduates. The 24 month course allows immigrants who arrive in North American with degrees in medicine from abroad, and who meet critical standards, to convert their careers from regular medicine in their home country to naturopathic medicine in North America. This article on the program describes the standards and includes musings from this author on what the imported MD might think of the new naturopathic medical universe.
Comment: Most of us have the experience of encountering an immigrant in a job as cab driver or parking attendant who, one discovers, was a professional back home. Yet due to some regulatory hurdle he or she cannot practice here. It will be intriguing to see how many of these international medical graduates who become CCNM students agree with the CCNM assertion that practicing as a naturopathic physician may in fact be a good deal more like their practices in their native countries than to participate as an MD in the medical industry here.
New England School of Acupuncture to Combine with MCPHS University
The nation’s oldest acupuncture school, the New England School of Acupuncture (NESA) has“agreed to combine” with MCPHS University, formerly known as Massachusetts College of Pharmacy and Health Sciences. The decision, described here, is presented by NESA president Susan Gorman as having “great opportunities for the NESA community as we would become part of a vibrant university, widely known for its programs in health sciences education.” The school has been seeking a strategic partner for many months “to help us reach our strategic goals of strengthening our academics, building enrollment, promoting research, and advocating for our profession.” MCPHS University, founded in 1823, has 7,000 students on 4 campuses Boston-area campuses and online with 65 programs including nursing, pharmacy, optometry, physical therapy, physician assistant, medical imaging and therapeutics, and premedical health studies.
American College of Traditional Chinese Medicine to Merge with CIIS
San Francisco-based American College of Traditional Chinese Medicine (ACTCM) has merged with the California Institute of Integral Studies (CIIS). An intent was published June 2014. Implementation of the merger will begin as soon as necessary approvals are granted. In a note to the Integrator, Meg Jordan, PhD, RN, dean of integrative studies for CIIS, shared that CIIS will then have four schools: School of Consciousness and Transformation (women's studies, gender studies, philosophy, anthropology, etc.); School of Professional Psychology and Health (five masters of counseling psych degrees and a PsyD in Clinical Psych and M.A. in Integrative Health); and now a School of Traditional Chinese Medicine. The merging allows the School of Chinese Medicine to launch a first professional doctorate in AOM. CIIS has held regional accreditation since 1981. The combined financials are expected to be in place at the start of CIIS’s fiscal year beginning July 1, 2015.
Comment: The news pairs with the NESA merger above. In each case the single purpose school is partnering with a program that has regional accreditation. The status and the multidisciplinary environment the merging creates offer a great deal more opportunity for research and foundation support, as well as base for interprofessional learning and community presence. Good moves! Notably, neither partner has a school of medicine. In an e-mail exchange, Jordan offered two examples of value in the ACTCM-CIIS move: “I just taught health coaching to acupuncture students for the first time, and our non-clinical integrative health studies M.A. students are assisting the Director of Integrative Medicine at SF General Hospital Rick McKinney, MD, in establishing a first-time outpatient acupuncture clinic for pain relief. “
Commission on Massage Therapy Accreditation (COMTA) Initiates “COMTA-endorsed Curriculum Status” Program
The accrediting agency for massage schools, the Commission on Massage Therapy Accreditation, has come up with a unique program to extend its positive influence in the realm of massage education. The COMTA-endorsed Curriculum Status respects the financial burden of accreditation for the typical massage school. The new status examines only the adequacy of the curriculum and the faculty rather than the full range of standards needed for full programmatic accreditation.
Comment: COMTA’s is an agile response in a tough environment in which over 1400 programs exist yet COMTA presently accredits less than 100. (Some others may have status with a separate agency that has no focused expertise in massage.) Smart move for the agency, and to give credit to those schools who can guarantee prospective students and the public that they meet some agreed upon educational standards.
60 Minutes Features James Gordon’s Center for MindBody Medicine’s Gaza Work in “Lessons of War”
On May 3, 2015 CBS 60 MINUTES featured the work in Gaza of James Gordon, MD and Center for Mind-Body Medicine in on a 13 minute segment entitled “Lesson of War.” Gordon, a Georgetown University-affiliated psychiatrist, is the former chair of the White House Commission on CAM Policy. He appears at minute 5:13 working separately with both Palestinian and Israeli children whose psyches have been war-torn. An estimated 20% of Palestinian children have experienced the death of a relative and 40% some form of PTSD. Gordon and his team work with drawing and other tools to help children visualize other futures than, for instance, the stick figure drawn by one with a suicide bomber belt around his waist.
Comment: This is a powerful, affecting segment with some glimmers of individual hope. Gordon’s trajectory as a professional has been fascinating, from being a very holistic MD with an academic appointment at a prestigious school, then influential author, and now a healing activist in Bosnia and Gaza and other places. Wonderful how he has created ways to use his tools to help influence the health of populations in the toughest of situations. Thanks, Jim.
New Website of Consortium of Academic Centers Announces Organization as “Collective Voice”
Open the new website of the 64-medical school Academic Consortium for Integrative Medicine and Health (ACIMH), the former CAHCIM, a.k.a. “The Consortium”) and one is greeted with a bold welcoming statement: “The Consortium is a collective voice for influencing and effecting change within integrative health.” Below that is the aspirational self-appellation: “Pioneering. Visionary. Integrative.” A somewhat truncated “History” focuses largely on its origins 15 years ago – a good story for those unaware. A Fact Sheet provides a little more information. A closer read shows that the main “collective” of interest is its member organizations, academic health centers.
Comment: This consortium has a powerful opportunity to lead as its members did in helping change the Joint Commission pain standard. (See Joint Commission Issues New Pain Standards in Response to Integrative Medicine Team.) And this sort of initiative is clearly not only for “effecting change within integrative health.” These Consortium members are doing so within U.S. health care, period. At the same time, the organization walks an interesting line. By membership requirements, only regular academic health centers and medical delivery organizations can join. So the “collective” it represents is just a narrow band among all of those professions, stakeholders and interests in “integrative health.” The best way in its present structure to represent the broader collective? Here’s to more of the ACIMH’s exciting recdent commitment to collaboration and partnership. The best example is showing through its partner base in the International Congress for Integrative Medicine and Health. Finally, an editorial suggestion. Why not change the greeting commitment to: “The Consortium is a collective voice for influencing and effecting changethrough [vs. “within”] integrative health.”
Sutter Health Systems Joins Academic Consortium for Integrative Medicine and Health
A major player in care delivery in Northern California, Sutter Health Systems has become the newest member of the Academic Consortium for Integrative Medicine and Health (ACIMH). In an announcement April 27, 2015, ACMIH notes that Sutter “is a major healthcare system that serves over 100 communities in Northern California.” A key Sutter component is the Institute for Health and Healing (IHH), a pioneering integrative health and medicine site at the California Pacific Medical Center.
Comment: The move by ACMIH a few years back to include health systems as well as academic health centers as members clearly has been valuable for revenue generation as Bravewell’s founding financial backing was pulled back. However, the two types of membership allow ACIMH to move to the front of the class in an area of major interest in all of health professional education; that is, better connecting the academy and the real world of healthcare delivery in the community. For instance, how does integrative care dovetail with accountable care? How does it fit best with patient centered medical homes? The Clinical Working Group page notes a focus on creating “information and strategies regarding clinic administrative structures, credentialing, privileging, operational issues, billing, and insurance” – a step in the right direction. It is not clear from the ACIMH website whether any targeted programs meant to cross the academic-delivery divide are in the works.
AIHM Portrayal in IMCJ Interview with Executive Director Nan Sudak, MD
Integrative Medicine: A Clinician’s Journal chose to devote significant space to a portrait of the new kid on the block, the Academy of Integrative Health and Medicine (AIHM). The vehicle is an interview with AIHM executive director Nan Sudak, MD entitled “On Unifying the Voices of Integrative Practices.” The piece documents AIHM’s origins as a re-unification of two holistic and integrative mainly MD groups, and also speaks to AIHM’s direct efforts to expand its circle. Partnerships with the Integrative Health Policy Consortium and the Academic Consortium for Complementary and Alternative Health Care are described. Sudak notes that AIHM’s reach and influence is intended to be international. The membership ranges from individuals to organizations to consumers.
Comment: AIHM’s is an incredibly ambitious agenda. As noted above, I serve on the AIHM Board. I can only say that any ride that promises to go as wide as global and as deep as forming full, trusting partnerships between professions that have mistrusted and misunderstood each other for decades if not centuries, well, there are no dull moments!
GAHMJ Special Report: Foundational Work of the National Consortium for Credentialing Health and Wellness Coaches
The Special Report in Global Advances in Health and Medicine Journal is entitled National Training and Education Standards for Health and Wellness Coaching: The Path to National Certification. The work documents the foundational efforts of an ad hoc group that formed within months after the passage of the Affordable Care Act suggested an important place for health coaching in the new system. The report, written by coaching pioneers at California Institute of Integral Studies, Duke, Harvard and U Minnesota, documents the emergence of the National Consortium for Credentialing Health and Wellness Coaches (NCCHWC) and two principal activities: “(1) to announce the findings of the job task analysis [for health coaches] as well as national training and education standards for health and wellness coaching (HWC) that have been developed by the large-scale, collaborative efforts of the National Consortium for Credentialing Health and Wellness Coaches (NCCHWC) and (2) to invite commentary from the public.” A grant from Aetna supported the report development.
Comment: In so much of the transformative work in U.S. medicine I am reminded of a Biblical phrase taught me via the social gospel Protestantism (United Church of Christ version) in which I was raised: the first shall be last and the last first. A medical industry targeting acute conditions, disease reactivity and ectomies pedestals the specialist and leaves health coaches utterly off their totem pole. Why didn’t we have these team members or these competencies ingrained in multiple other professional groups all these years? Build a system of health creation, however, and these coaches and community health workers are the foundation. Good to see this labor mainly of love, reach this stage.
The Global Integrator Blog Round-up for April 2015 from Global Advances in Health and Medicine
In January 2015, Integrator publisher-editor John Weeks (this writer) began producing "The Global Integrator Blog" for the web portal of Global Advances in Health and Medicine Journal. Each month, I produce 6-10 posts that are gathered into a monthly Round-up. For the April 2015 Round-up, the 6 posts are: Acupuncturists without Borders Responds to Nepal Earthquake; Traditional Medicine in Universal Health Care: The Powerful Perspective in the WHO Strategic Plan; India Report: Announcement of Department of AYUSH Promotes Flurry of Activity; British Official Acts against Public, WHO, Prior Recommendations, and Will Not Regulate Herbalists; Quick Links to Global News in Traditional, Alternative, and Integrative Health and Medicine for March 2015; and The Remarkable International Reach of Pizzorno-Murray’s Textbook and Their Encyclopedia of Natural Medicine. Click in here for the March 2015 Global Integrator Round-up.
Comment: If any of you have not poked into the WHO Traditional Medicine Strategy 2014-2023 take a look at this short summary piece. Fascinating document. Comments and suggestions are welcome.
Harmonic Emergence? The Late 1970s Birth of the Organized Movement for Integrative Health and Medicine
Comment: I recently had a call from a colleague who was recently asked to deliver a course on the history of integrative health and medicine. I shared one of my favorite discoveries as a chronicler of numerous streams of activity in the movement documented in the Integrator. That is: the late 1970s witnessed a remarkable surfacing of the new values in U.S. medicine. The National Wellness Institute was founded in 1977. The year 1978 birthed the Planetree movement that awakened the idea of “patient-centered care” in the United States. That same year the American Holistic Medical Association was founded as were the first new modern era naturopathic medical schools, Canadian College of Naturopathic Medicine and the then John Bastyr College of Naturopathic Medicine. Then in 1979, nurses founded the American Holistic Nurses Association.
Meantime, within a couple of years, national organizations to funnel the advance of acupuncture and Oriental medicine, the maturation of the herb industry, and the elevation of the therapeutic value of massage therapy were created or re-purposed. Clearly, something was in the air. The advent of the wild ideas from the 1960s of holism, globalism, back-to-the-land, East-meets-West, respect for nature, and environmentalism needed a decade to congeal into vehicles for change. I see it as huge, cultural amniotic soup out of which we all emerged. It has not always been harmonic among these groups. And it is wonderful that in the last decade through multiple means and re-directed intention we are seeing these family lines re-connecting. I am pleased to have a chance to speak to this at a plenary session at the October 2015 conference of the Academy of Integrative Health and Medicine, People, Planet, Purpose: Global Practitioners United in Health & Healing.
Meg Jordan, RN, PhD in Co-Presidency of the National Wellness Institute
The co-president of the National Wellness Institute is Meg Jordan, PhD, RN. Jordan, an anthropologist, is dean of integrative studies at the California Institute for Integral Studies. NWI, founded in 1977, “was formed to realize the mission of providing health promotion and wellness professionals unparalleled resources and services that fuel professional and personal growth.” Jordan is also a leader in the health coaching movement for which she developed one of the initial academic programs. She was the chief author on the recent publication of results of a job Task Analysis and recommended coaching standards.
Comment: Jordan continues to pop up as a leader in multiple places that are critical to the advance of integrative health and medicine. Discovering that she has made herself a significant force as connective tissue between integrative health and medicine and the sometimes surprisingly separate “wellness” movement was a pleasant surprise.
Honoring Dan Cherkin, PhD in His (Partial) Retirement and New Consulting
On April 7, 2015 a set of advisers to his “BACK Choices” PCORI grant to Group Health Research Institute’s Dan Cherkin, PhD received an email from Cherkin in which he announced that, for a variety of reasons, he will not be re-submitting a follow-up PCORI proposal that already received excellent reviews. In fact, he shared that he will no longer be submitting more grant proposals and will “at least partially retire” early next year after his 30 years at Group Health. Cherkin noted that he might be “seeking other ways to use my continued passion for improving care for back pain, possibly as a consultant to health care systems and others committed to this goal.” But meantime: “I am looking forward to spending more time with my growing family (including 4 grandchildren in Seattle), reading, traveling, hiking, puttering, and re-discovering many of the joys of life that have gotten lost in the shuffle of life.”
Comment: Cherkin’s decades of research in the integrative health and medicine field and at one of the most prestigious real world research centers has spanned across chiropractic, massage therapy, acupuncture, and mind-body (yoga). He built a team that included his frequent partner Karen Sherman, PhD and mentored leading researchers in the naturopathic field, Ryan Bradley, ND, MPH and Erica Oberg, ND, MPH. For a brief period Cherkin remarkably held a joint position as director of Bastyr’s research effort, with which Bradley and Oberg were then affiliated. Cherkin chaired the program committee for the 2012 International Congress for Research in Integrative Medicine for the Academic Consortium for Integrative Medicine and Health (then CAHCIM) and served for a period on the Research Working Group of the parallel consortium representing all the councils of colleges in the distinctly licensed integrative health fields. His results did not always please. In fact, he had a run of studies that raised the paradoxical issues of the intervention showing better than regular care but not better than the placebo he selected. He’s been a major influencer.
My personal favorite piece of Cherkin’s work is a secondary, qualitative study of the patients in his “CAM” trials. He and his team wanted to understand better what the experience with these “CAM” practitioners was like. The result was a paper entitled Unanticipated Benefits of CAM therapies for back pain. In this remarkable exploration of patient experiences, he and his team concluded: "Positive outcome themes included increased options and hope, increased ability to relax, positive changes in emotional states, increased body awareness, changes in thinking that increased the ability to cope with back pain, increased sense of well-being, improvement in physical conditions unrelated to back pain, increased energy, increased patient activation, and dramatic improvements in health or well-being. The first five of these themes were mentioned for all of the CAM treatments, while others tended to be more treatment specific. A small fraction of these effects were considered life transforming." Thanks for the work, Dan. Enjoy the re-discovery of self (including of consulting) and the grandkids.
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