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 Integrative Medicine and Integrated Health Care Round-up: April 8-April 25, 2009 
 
The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series
Summary: Holistic nurses take on Catholic Bishops over Bishops'' position against Reiki ... Oregon Collaborative for Integrative Medicine, nation''s top inter-institutional effort in integrated care, expands action ... Minnesota Center for Spirituality and Healing strikes strategic alliance with Alternative Medicine Clinic of Hennepin Faculty Associates ... Community Acupuncture Network seeks NADA alliance in opposing first professional doctorate for acupuncture and Oriental medicine field ... Survey shows low uptake of key NCCAM research by internists, acupuncturists, naturopathic doctors and rheumatologists ... Significant CAM/IM chapter by Academic Consortium for Complementary and Alternative Health Care in new textbook, Collaboration Across the Disciplines in Health Care ... AAAOM hires DC lobbying team, including former NIH and Congressional staffer Beth Clay ... Chiropractors set up ChiroVoice.org to foster patient communication with members of Congress during reform era ... IHPM/Intel pilot of onsite manual therapies program show positive outcomes ... Policy, as in Religious Doctrine

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Catholic Bishops thumbs down on Reiki
Holistic nurses challenge Catholic Bishops'' position opposing Reiki


On March 25, 2009 the US Conference of Catholic Bishops surprised many in the complementary and alternative healthcare community with their promulgation of Guildeines for Evaluating Reiki and an Alternative Therapy. The 6 page document from the organization''s Committee on Doctrine references both scientific and theological issues. The anti-Reiki doctrine concludes:
Since Reiki therapy is not compatible with either Christian teaching or scientific evidence, it would be inappropriate for Catholic institutions, such as Catholic health care facilities and retreat centers, or persons representing the Church, such as Catholic chaplains, to promote or to provide support for Reiki therapy.
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Holistic nurses take on Bishops
The American Holistic Nurses Association(AHNA), many of the members of which practice Reiki in healthcare facilities associated with a Catholic orders, quickly developed and sent a reply which directly challenged the Bishops. The AHNA''s Response to Catholic Bishops Guidelines on Reiki first notes that the use of Reiki by holistic nurses is not willy-nilly but follows the profession''s formal Scope and Standards of Practice. The AHNA then argues that "prohibiting a nurse from administering Reiki violates the ethical principles of patient and nurse autonomy." Finally, the AHNA document references "empirical research" showing that Reiki is useful. They conclude with:
While studies involving Reiki are not conclusive and the exact mechanism in which Reiki healing occurs is unknown, Quantum Physics provides an explanatory model. Not all natural phenomenon are understood by science – new discoveries are first ridiculed, then argued against, then accepted as obvious.
Comment: Why do I feel like I am back in the Middle Ages here, the men of the Bishopric versus the Women of Holistic Nursing. Wouldn''t the Bishops have a greater impact on current healthcare if they addresses the fact that it''s likely that a good 1/3 to 1/2 of the medicine provided in those hospitals, led my mainly male medical directors, is wasteful and perhaps harmful, creating a system where getting care to all is inexpensive. I earnestly hope that I won''t have to share with you in an upcoming issue that anyone has been burned at the stake. It will be interesting to see how this one unfolds.

Academic Medicine

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Anne Nedrow, MD - key OHSU force behind OCIM
Oregon Collaborative for Integrative Medicine hires executive director, enters new frontiers

Good news department: Perhaps the leading multidisciplinary
(MD, ND, DC, AOM) and inter-institutional effort in the nation, the Oregon Collaborative for for Integrative Medicine (OCIM), has hired an executive director and is taking on some fascinating projects. OCIM began in 1999 as an outgrowth of relationships developed between Oregon Health & Science University, Western States Chiropractic College, National College of Natural Medicine and Oregon College of Oriental Medicine in work on a series of NIH grants. The most important of these was an R-25 educational grant led by Ann Nedrow, MD, which formally birthed the OCIM idea. The current board includes Nedrow, an associate dean at OHSU, and presidents of the 3 other member schools. OCIM''s mission is to expand integrative care through education, research and patient care. One fascinating direction, though still under development, is the potential of new accelerated dual degree programs. Here, from the site:
The Oregon Collaborative for Integrative Medicine believes the new frontier is to allow motivated students to cross between the academic institutions without barriers and without duplication, completing combined degrees in accelerated timelines.  Standing beside the traditional MD/Phd or MD/MPH will be the ND/MD, the MD/DAOM, the ND/DC, the ND/PhD, the DAOM/MPH, the DPN/DC and countless other combinations to build a new cadre of cross trained clinicians focused on collaboration, not competition.  OCIM''s vision is to maximize our stewardship of the gifts of Portland to model the ''stem-cell'' clinician, differentiated not by a paradigm, but by choice.
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Samantha Simmons, MPH, OCIM executive director
OCIM announces here a significant and intriguing direction. The new executive director, charged with moving some of this energy in her half-time capacity is Samantha Simmons, MPH, a veteran of the R-25 that got things moving. (The rest of Simmons professional portfolio is in research in pediatrics at OHSU.) Simmons notes in an email to the Integrator that
OHSU is on a panel with educators at Georgetown and U of Minnesota at the North American Research Conference on Complementary and Integrative Medicine about joint degree endeavors. The panel will be Thursday, May 14 at 3:00 pm.
Comment: Having had a chance to work with some of OCIM''s leaders in its earlier years, and with some of the parties back in the 1990s when relationships first began, it is wonderful to see this maturation, web presence and hiring of staff. The distinguishing feature is the level of buy-in. The board meets quarterly - a significant commitment of presidential time and energy. It is exciting to think what may be accomplished given time and resources. This is the zone where the phrase "lateral integration" was coined by Nedrow, to counter the typical verticality in MD-dominated models.
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Patricia Culliton, LAc, MAc, founder of Hennepin''s Alternative Medicine Clinic
Minnesota Center in strategic affiliation with Alternative Medicine Clinic at Hennepin Faculty Associates


Two of the most enduring integrative healthcare entities, one principally in academic medicine the other in clinical services, have established a formal affiliation, according to a March 13, 2009 release. One partner is the Alternative Medicine Clinic at Hennepin Faculty Associates,
led by acupuncturist Patricia Culliton, LAc, MAc. Culliton clinic is one of the nation''s longest-standing and most successful integrated care efforts, currently providing over 1200 visits each month. According to the release, services include functional medicine, acupuncture, chiropractic care, physical therapy, herbal therapy, and massage therapy. The other partner is the Center for Spirituality and Healing at the University of Minnesota, headed by Mary Jo Kreitzer, PhD, RN, FAAN. The clinic will become a teaching point for students in the diverse integrative practice programs at the University of Minnesota. The two entities anticipate various research initiatives. Notable is a current project in which the Center and the Alternative Medicine Clinic are "collaborating on a community-based assessment of the health needs of immigrant and refugee populations." The assessment, funded by the Marbrook Foundation, "aims to provide underserved populations with greater access to integrated therapies and shed new light on pressing health questions."

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Acupuncture group opposes first professional doctorate
Community Acupuncture Network opposes AOM move toward first professional doctorate


The March 2009 issue of Guidepoints, the hard-copy newsletter of the National Acupuncture Detoxification Association (NADA) reports that the Community Acupuncture Network (CAN) has appealed to the NADA board to join CAN in opposition to the move within the acupuncture and Oriental medicine (AOM) field toward an educational standard that sets a doctorate as the entry level into the profession. CAN believes that upping the bar for education will be more expensive and thus require new AOM practitioners to raise fees thus distancing themselves further from a consumer base which already is challenged in paying fees for services.  CAN also argues that many AOM practitioners are having a hard-time making a living because fees have already been increased too much. The CAN model, like the NADA model, is delivered in a group-based, community room model.
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Detox group asked to weigh in
A significant difference is that CAN practices use the full body in the treatment, though focusing on head and extremities, rather than the ear acupuncture NADA protocol which is mostly used for addiction recovery. The fee scale to patients in the group model is $15-$35 per treatment, typically, rather than $65-$150 per treatment. NADA, which describes CAN "as an organization of acupuncturists advocating to make Oriental medicine more accessible to consumers," had not taken a position as of the publication of the article. Most education of acupuncturists is presently at a masters level. Those favoring the doctorate crossed a major hurdle in May of 2008 when the Council of Colleges of Acupuncture and Oriental Medicine passed a resolution in favor of moving toward the "first professional doctorate."

Correction: An earlier version of this article stated that CAN co-founder Lisa Rohleder, LAc was lead on this initiative. She clarified in an April 29, 2009 note that CAN board member Larry Gatti had the lead on it and that she is no longer on the board.




Research

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Highlights Arhives article
Survey offers comparative CAM takes on research evidence for NDs, LAcs, internists and rheumatologists

A study recently published in the Archives of Internal Medicine (
Translating CAM Research Results Into Clinical Practice: Results From a National Survey of Physicians and CAM Providers, 2009;169(7): 670–677) provides fascinating insights into not only awareness of research but self-perception of clinicians regarding research across 4 disciplines, two "CAM" and two conventional. As highlighted in the April 15, 2009 letter from NCCAM Director Josephine Briggs, MD, and the April 24, 2009 NCCAM Update, one finding was that more acupuncturists (20%) and naturopaths (25%) than internists (17%) are "very confident" in their ability to interpret research literature. (33% of rheumatologists put themselves in this category.) The survey focused on awareness of two NCCAM-backed trials, one using acupuncture and another on glucosamine-chondroitin. Just 23% of all those surveyed were aware of both trials, with acupuncturists and rheumatologists most aware of the acupuncture trial and rheumatologists and internists most aware of the supplement trial. Not surprisingly, as the NCCAM report notes, "awareness of CAM clinical trials was greatest among respondents with research experience, confidence in their ability to interpret results, and favorable opinions about the role of research in their practice." Briggs, in her letter, focuses on the steps NCCAM is taking to help clinicians stay informed of scientific developments. In its first 10 years, NCCAM funded more than 2,200 projects leading to over 3,300 articles in the peer-reviewed literature.
Comment: The NCCAM review of the article points out an odd paradox. Clusters of CAM practitioners were both more likely to view research as "most important" and as "least important" in their clinical decision-making, relative to their conventional counterparts. The two physician groups were much more likely than their CAM counterparts to rank "patient preference" as least important.

Resources


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Produces key chapter
Collaboration Across the Disciplines in Health Care
features ACCAHC chapter on CAM/IM collaboration


Jones & Bartlett has published a new textbook which deals with one of the most significant challenges in our medical system: undoing the silos of education and care which hinder optimal practice between professionals. In
Collaboration Across the Disciplines in Health Care, the wide-ranging content in the 15 chapters from invited authors includes systems views, leadership training, inter-professional issues and a provocative "Doctors are from Mars, Patients from Venus." (The list of chapters is here.) Included is a 30 page section entitled "Complementary, Alternative and Integrative Health Care Perspective," written by a team of authors from the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), including yours truly. The chapter reviews recent efforts toward collaboration, especially in the educational arena, such as the National Education Dialogue to Advance Integrated Health Care, inter-disciplinary engagements of members of the Consortium of Academic Health Centers for Integrative Medicine and of ACCAHC. The author/editors of the book are Brenda Freshman, Louis Rubino and Yolanda Reids Chassiakos. The text can be ordered here.


Professions

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Setting up DC presence
AAAOM hires D.C. lobbying arm, headed by Sam Brunelli and Beth Clay


The American Association of Acupuncture and Oriental Medicine (AAAOM) has hired Sam Brunelli of Team Builders International to head upcthe presence of the licensed acupuncture profession in Washington, DC. According to an April 9, 2009 AAAOM release, part of the Brunelli package which the AAAOM chose in a search which began in September 2008 is lobbyist Beth Clay. Clay,
formerly an aide in NIH Office of Alternative Medicine and a Congressional staffer to Dan Burton (R-IN), as well as an Integrator contributor, has had a long association with alternative and integrative care developments in the Beltway. (For the Integrator piece, see Past NIH Staffer Clay: Who Is NCCAM Deputy Killen and Why Is He Demeaning Homeopathy in Newsweek? March 18, 2008.) Brunelli, a former NFL football player, has held a number of positions in Washington, DC, including, according to the release, taking up "an invitation from Ronald Reagan to accept a presidential appointment as director of Intergovernmental Affairs in the Department of Education (William Bennett, secretary) where he provided liaison between the federal department, state legislatures, governors, Congress and the White House." Brunelli''s integrative practice-related clients have included the health freedom activist and alternative medical doctor Julian Whitakker, MD, and ABC Coding Solutions/Alternative Link

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Lobbyist Beth Clay - part of AAAOM team
The hiring of lobbyists is part of a significant push by the AAAOM in federal policy that also includes, according to the release, "developing a national advocacy network and handbook that will be distributed throughout the US to our practitioner community in May for the purpose of building advocacy support within all states, and from each state to Washington DC to formulate a united voice for AOM in US Healthcare Reform.
" Another tool the AAAOM has developed, jointly with the Society for Acupuncture Research, is a short white-paper entitled "Acupuncture and Oriental Medicine (AOM) in the United States."
Comment: I salute the AAAOM for getting this act together at the national level. The profession has essentially been without representation in Washington, D.C. I am a little surprised at their decision, in this moment in which the Democratic Party has a good deal of power, to select key individuals whose primary affiliations have been with Republican party. Relationships may not be everything in politics, but they count for a lot, especially if quick relationships can''t be bought, which is the case with underfunded entities like the AOM profession. There is no evidence yet of an AAAOM political action committee, the type of entity which is typically established to do the purchasing.
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Force behind patient site
Chiropractors promote ChiroVoice.org as patient platform in lobbying


The American Chiropractic Association has established a lobbying arm for chiropractic patients at ChiroVoice.org to ensure that chiropractic suffers no losses in any health reform plan. The priorities for participating consumers of chiropractic services, as noted in a PDF file attached to the site, are that:

  • Congress does not restrict your ability to access ESSENTIAL services provided by a Doctor of Chiropractic.
  • Congress does not force patients to join or support a health plan they do not want.
  • Congress does ensure that Medicare beneficiaries may choose a Doctor of Chiropractic to provide all Medicare covered services for which the Doctor of Chiropractic is licensed to provide.
  • Congress does enact new federal protections to help ensure that insurance and managed care companies treat patients fairly and do not deny them their rights or access to the care they need.
Comment: The chiropractors, alone among the integrative practice fields, have developed a strong, multi-faceted presence in the D.C. arena. ChiroVoice appears to be part of their tool kit.



Employers

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Pleased with pilot
Dorn Companies'' onsite myofascial release technique works well in Intel pilot


Outcomes have shown positive from an employer initiative using a myofascial release method to limit musculopskeletal disease which was reported in the Integrator. (See
IHPM/Employer Focus: Intel Explores Manual Therapies as an Onsite Musculoskeletal Pain Solution, June 22, 2008.) In the study of 208 participating employees, all but one found symptom improvement with over 55% finding "great improvement." Of the individuals who had a level of pain above 5 on a Likert scale prior to the 4 session intervention, 79% had the pain fall to below 5. Some presenteeism gains were also found. The findings were published in the Spring 2009 issue of Health and Productivity Management, a publication of Integrator sponsor Institute for Health and Productivity Management (IHPM).
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Behind the Intel pilot
The pain-reducing services were provided for the Oregon employees by licensed massage therapists who were specifically trained in a Trauma Release Technique developed by Dorn Companies. The authors of the article, John Schaab from Intel and Rick Nevins, MD from IHPM, noted that one area of savings to employers may be in keeping employees from needing more advanced and costly treatment, with potential savings in workman''s compensation claims although more study was deemed necessary. The program was developed under IHPM''s WorkPlace Centers program. In a side-bar, IHPM notes that their own research with large employers has found that musculoskeletal pain is the leading reported reason for absence from work and the second most significant reason for diminished productivity while at work.



Send your comments to johnweeks@theintegratorblog.com
for inclusion in a future Your Comments Forum.
      
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 About The Author
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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