Moreover, all practitioners of all types must become conversant in the full range of health care approaches (both conventional and CAM) available in the U.S. health care system. This does not mean that medical internists must themselves deliver spinal manipulation, acupuncture, or massage treatments; it means they need to know what these therapies involve and where evidence supports their appropriate use. When those circumstances arise, referrals should be made. This is a two-way street; CAM practitioners must also be well-informed about the biomedical options available to patients in order to make appropriate referrals, and must not hesitate to do so. It must never be considered acceptable for either conventional or CAM practitioners to be ignorant of what other health care approaches have to offer. Wide-ranging knowledge and mutual respect must be our watchwords.

Failure to inform patients of the available options is a form of negligence.5 This is particularly egregious when a negative outcome results from an invasive therapy and the patient was not informed of less invasive evidence-based alternatives. The overarching goal for all practitioners must be collaboration and cooperation for the benefit of our patients.

Status Quo with Continuing Decline or a Historic Step Forward?
The current health reform initiative is a high-impact event for all concerned. Failure by Congress and the Obama Administration to enact universal coverage now would likely doom such efforts for a generation. Failure to properly fund and prioritize lifestyle-based prevention methods would more deeply entrench a status quo that has already proven woefully inadequate at serving society's health needs. Failure to institute a level playing field among the professions would be tantamount to an endorsement of ongoing injustice. Excluding established professions that provide essential services from a national core benefit plan would mark a major step backward. Make no mistake - a very real possibility of disaster on many levels lurks in the shadows.

But President Obama's health reform effort also offers the best chance we've seen in our lifetimes to take a truly large and historic step forward, with coverage for all, nondiscrimination among providers, a commitment to research the integrative approaches that may hold the best hope for dealing with our era's epidemic levels of chronic disease, and an all-hands-on-deck national program for lifestyle-based prevention and health promotion. The possibilities are breathtaking. This is a time to dream big dreams.

Everything is on the table. The potential risks and rewards could not be greater. Make your views known. Be part of the solution. What happens next is up to all of us.

Daniel Redwood, DC
Cleveland Chiropractic College - Kansas City
10850 Lowell Avenue
Overland Park, KS 66213
dan.redwood@cleveland.edu



References

1. Yarnall KS, Pollak KI, Ostbye T, Krause KM, Michener JL. Primary care: is there enough time for prevention? Am J Public Health. Apr 2003;93(4):635-641.
2. Redwood D, Globe G. Prevention and Health Promotion by Chiropractors. Am J Lifestyle Med. Nov-Dec 2008;2:537-545.
3. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet. Jul 21 1990;336(8708):129-133.
4. Ornish D, Scherwitz LW, Billings JH, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. Dec 16 1998;280(23):2001-2007.
5. Cohen MH, Ruggie M, Micozzi MS. The Practice of Integrative Medicine: A Legal and Operational Guide. New York: Springer; 2006.