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 Integrative Medicine and Integrated Health Care Round-up: September 16-30, 2008 
The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series

The Asian Institute of Medical Studies and The Mien Shiang Institute are hosting monthly networking opportunities for the complementary and alternative healthcare professionals in Tucson. The first of the 2-hour events focused on "The Vision of Integrative Medicine in Tucson" and featured Victoria Maizes, MD, MPH from the University of Arizona Center for Integrative Medicine as well as the president's of the two institutes, Alex Holland, MAc, LAc, and Patrician McCarthy, respectively.

Campus expansino under way
National College of Natural Medicine (NCNM) expands campus

Another part of the OCCIM network of academic institutions noted in the OCOM piece, above, is the former National College of Naturopathic Medicine, which changed its name to National College of Natural Medicine (NCNM) when it began offering a second professional program, in Classical Chinese Medicine. NCNM has announced a plan to purchase additional land and buildings adjacent to NCNM's present location, not far from Oregon Health & Science University facilities in downtown Portland, Oregon. With the purchase, NCNM will consolidate the school's teaching clinics. NCNM's president David Schleich, PhD, views the acquisition as a part of a "multi-phased growth plan" to meet anticipated demand. NCNM's clinical services, many through neighborhood clinics, have a significant role in meeting needs for the underserved in the Portland area. NCNM provides over 40,000 free or low-cost medical visits to the underserved each year through a network of relationships with community clinics. The school's research arm is the Helfgott Research Institute.

Federal AHEC program extends $20,000 scholarship to Arizona integrative medicine fellowship

The Arizona Area Health Education Centers (AzAHEC) has made $20,000 available for a scholarship to the Fellowship inm Integrative Medicine at the Arizona Center for Integrative Medicine. The scholarship is available to MDs, DOs, physicians assistants or nurse practitioners who practice in one of the five "qualifying AHEC areas." The mission of the AzAHEC program is "to improve the recruitment, diversity, distribution, and retention of culturally competent personnel providing health services in rural and medically underserved communities."

Comment: Many states have AHEC programs which share this vision. The move in Arizona may open a door to access to integrative services among the underserved if others become interested. Notably, the state of Washington has followed a different route for expanded access to integrative services through increasingly opening its loan-repayment program for naturopathic physicians. The Washington state program, nourished along through an advisory role of Pamela Snider, ND, has focused on expanding primary care services.

Professions and Organizations

Clarity on use in stress, pain conditions
Thriving acupuncture detox group expands beyond addiction to pain and stress services

The September 2008 newsletter of the board of the National Acupuncture Detoxification Association (NADA) has "explicitly affirmed the expansion of NADA protocol therapy into others areas of behavioral health care in addition to our historical and abiding focus on addiction, recovery and relapse prevention." While scope is not specifically addressed, the newsletter notes, as examples, its support of the work of Laura Cooley, LAc. Cooley has worked "with victims, patients, communities, first responders, healthcare entities, military personnel, elective officials and legislators in post-Katrina Louisiana." The organization boasts 1400 members, 40% licensed acupuncturists. Over 1000 programs in the United States presently use the NADA protocol. Notably, this growth has come during a period when the Bush administration has delayed in issuing guidelines on the use of the NADA protocol, according to an editorial in the same issue.
Comment: This looks like a natural move toward pain and stress conditions, and also a confirmation that those in the licensed acupuncture world who opposed NADA's certification movement were right that the NADA practitioners would eventually move beyond addiction treatment. My own bias is toward the expansion of this low cost treatment model. Notably, this comes at a time in which the military is approving a NADA-like protocol (see article on Samueli Institute program) and the community room acupuncture model is taking off (see recent article on Working Class Acupuncture).
Walking into the guidelines challenge
Steps toward Massage therapy guidelines reported

The founding issue of the International Journal of Therapeutic Massage and Bodywork includes an 18 page article entitled
"Steps Toward Massage Therapy Guidelines: A First Report to the Profession" (Grant K et al) which is available in PDF by clicking here. The work reported in the article was carried out by the Best Practices Committee of the Massage Therapy Foundation, which funded the work. The authors note that the working definition of guidelines used by the Committee is that of the Institute of Medicine of the National Academies. The goal of the work was to create a product which would be submitted to the National Guidelines Clearinghouse. The team suggests a process for guideline creation, under-scoring the importance of transparency and inclusion.

Reporting policy action
American Chiropractic Association (ACA) reports policy action from Delegates meeting

The ACA has reported the following policy-related actions from its September 17-2008, 2008 House of Delegates meeting. The following bullets are directly as published by the ACA:

  • Noting that informed consent is a process, and more than simply obtaining a signed form from the patient that is then kept in their patient health record. Moreover, informed consent is an ongoing process and the discussion should continue throughout the course of patient care.
  • Extending the benefit of complimentary Chiropractic Assistant membership to all actively practicing doctor members.
  • Stating it is appropriate to manipulate/adjust a segment(s) that may not be symptomatic and/or located in the same spinal region as the patient’s area of chief complaint. The policy notes that segments should be identified through objective measures and should have a direct therapeutic effect.
  • Reminding providers that third-party billing for assessment and treatment of persons of a close personal nature that would by common practice be furnished gratuitously may be unethical.
  • Encouraging the affiliation and collaboration of state chiropractic organizations with the ACA.

In addition, the ACA told is members that it is creating a Practice Profitability Task Force "to provide ACA members with opportunities to increase their bottom line." One step will be a monthly webinar through which members can receive expert advice on how to profit in practice."
Comment: I approached this report with the hope that the ACA would be looking at broader health reform issues. Of the 5 bullets, 3 are relatively obscure and clinical (if important clarifications), and two internal organizational. None reflect on the broader culture of healthcare or suggest any sort of connectivity. In some parts of the chiropractic profession, the focus of discussion is over the profession's "cultural authority" - or, more typically, lack thereof. (See Chiro Group Consensus-Priorities on Public Trust and Equity, March 16, 2006.) This navel gazing, and continued focus on profit and bottom line are cases in point for why cultural authority may be escaping them.

Business Developments

Gary Sandman, Signature Supplements' CEO
Signature Supplements receives state of Maryland development loan

Urbana, Maryland-based Signature Supplements announced in September that its has been selected by the state of
Maryland’s TEDCO business technology development agency to receive a $50,000 business development loan. The firm's founder and CEO is Gary Sandman. The release notes that the firm is "part of the Maryland BioTech incubator program." The firm's proprietary technology is a health test based on "25 years of research on 100 aspects of 25,000 clients’ blood, tissue and urine biochemistry." The test, available on their site, helps the firm then individualize a supplement regime. Marc Micozzi, MD, PhD, a consultant to the firm, explains the process: “Signature Supplements provides the nutrition test for free, so that everyone can determine if they need to adjust their supplements and their eating habits.” The loan will be used for the expansion of the firm. The release notes that the firm "is working with the Maryland Governors office and the United States Department of Agriculture to determine the learning benefits of the Signature Supplements program with students with ADD, ADH and aggressive behavior."

L to R: Zdychnec, Donahue and Heim
Update on Minnesota-based "Collaboration Health Care" formed by managed DC leaders

Michael Zdychnec, DC, a former leader of the United Healthcare affiliate American Chiropractic Networks sent the Integrator a brief report of activities of Collaboration Health Care, Inc. for which he is CEO. The consulting firm, which also includes RT Donahue, DC and Sara Heim, "is dedicated to helping create a collaborative health care system in the by facilitating change and introducing new ideas to the health care market." An early client was a chiropractic independent practitioner association (IPA) and a second Health Fitness Corporation. They believe that chiropractic has is at a "strategic infection point" in its development, to use a phrase of former Intel chair Andy Grove. Their role: "Focus on new concepts and new ideas and not focus on the way things 'always have been' and giving it a go." Zdychnec notes that they are in discussion with from ACN CEO Tom Allenburg, DC and Stephen Bolles, DC "to explore opportunities in the integrative medicine marketplace." (See Bolles' Integrator interview on the third party payment world here.) Zdychnec adds: "After working 30 years in an industry with silos and relatively poor relationships, we think it’s time to break the silos down and develop the relationships that are going to be required to change the way things are (hence, our name).


Charting the Mainstream & Miscellaneous

Consumers cutting healthcare spending

A recent Wall Street Journal article, Consumers Cut Health Spending as Economic Downturn Takes Toll (September 22, 2008) notes that pharmaceutical purchases are off for the first time in 10 years and that
"despite an aging and growing U.S. population, the number of physician office visits also has been declining since the end of 2006." Visits fell 1.2% between July 2007 and July 2008. One survey found that 22% were cutting back on visits and 11% on prescription drugs. Another found that even those with good insurance plans were cutting back.
Comment: One wonders if self care, and integrative care expenditures will also decrease, or will they be counter-cyclical? Best bet is that, with less cash, there will be fewer shoppers.

Integrator adviser Jan Schwartz, CMT sends a note about an article in Massage Magazine in which the writer, a chiropractor and massage therapist, Drew Riffe, DC, MT writes about the growing trend for chiropractors and massage therapists to work together. While the article is a promotional piece for Parker College of Chiropractic where Riffe runs the massage program, the content is a good sign of collaboration. Many DC schools have massage programs ...

Naturopathic services growth
NCMIC Group, an Integrator sponsor, has a new site, NCMIC Naturopathic Solutions that focuses on their naturopathic medical services. Featured on the site is Michael Traub, ND, a past president of the American Association of Naturopathic Physicians, who played a major role in forging the relationship between his profession and the firm ...

An Integrator reader, a chiropractic practitioner, sent a note that those interested in "some straight talk for a doctor who practices at the heart of alternative medicine" might be interested in his blog." On first look, I saw reference to the "absolute lack of nutrition training of MDs." I wrote back that I don't think that is "straight talk" but ranks with saying chiropractors "have an absolute lack of interest in evidence-based medicine" (which is the sport of thing the anti-chiropractic MDs might say). Monolithic portrayals and polarization are not very useful to us in this time, in health care or in world politics.

Taylor Walsh notes a Forbes magazine article about "patient-driven organizations that raise enough money to hire drug companies to create drugs for their specific disease" with examples being Leukemia and Lymphoma. He wonders if these groups might invest in non-pharma solutions - maybe they have" ...

IN-CAM, the Canadian Interdisciplinary Network for Complementary and Alternative Medicine Research organization has announced an affiliation with
Homeonet, a newly formed research network to advance research in homeopathy.

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Resumes are useful in employment decisions. I provide this background so that you may understand what informs the work which you may employ in your own. I have been involved as an organizer-writer in the emerging fields......moreJohn Weeks
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