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 Integrative Medicine and Integrated Health Care Round-up: May 2010 
 
The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series
Summary: HHS Secretary Sebelius and former DNC chair Howard Dean, MD comment on acupuncture, homeopathy other natural healing methods ... US Congressman Tim Ryan champions mindfulness-based stress reduction programs in hearing; Sebelius responds ... Josiah Macy Foundation urges lifting of obstacles for nurse practitioners in primary care; roles of DCs, NDs, LAcs commented upon ... Washington state data show insurance costs for individuals using CAM for back pain, fibromyalgia, menopause symptoms are less than those who don't use CAM ... NCCAM references only "products" research in key message on 2011-2015 strategic plan; Briggs responds ... 1993 Seattle Post Intelligencer letter from by Integrator publisher-editor submitted as defense for impatience with reductive research on integrative practices ... White paper on research for holistic nurses articulates critical importance of complex modeling ... Bastyr's Boutin on 8 reasons why healthcare overhaul is good for nutritionists ... Chiropractic educator/researcher conference draws record turnout; college presidents group shares top 6 strategic initiatives ... Update on Georgetown Masters Degree that links basic sciences and CAM ... Stamford Hospital begins 2-year integrative medicine fellowship ... Bastyr to award honorary doctorates to Mehmet Oz, MD and to Lisa OZ ... Correction on the first regionally accredited "stand-alone" AOM school ... White paper on regulatory issues for Yoga, Ayurvedic fields ... Naturopathic doctors push Congress for inclusion in loan repayment programs ... Real Simple features integrative medicine; distinguishes this category from DOs and NDs ... Mathews to head Yoga Alliance ... Hangee-Bauer the new AANP president ...



Policy

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Sebelius: Confronted with a question about alternative health care
HHS Secretary Sebelius speaks positively on acupuncture, homeopathy, alternative health care

In a question from a reporter following a talk at the National Press Club on April 6, 2010, US Health and Human Services Secretary Kathleen Sebelius was asked about her "
own view of using acupuncture, meditation, and other alternative healing methods in health care?" Sebelius response, printed in full here, is generally positive, if apparently misinformed about the limitations of the homeopathy category. In her comments, however, Sebelius links these practices with patient choice, prevention, potential cost-effectiveness and her comparative effectiveness research initiative. The following day, former chair of the Democratic National Committee Howard Dean, MD, was stimulated to make a few remarks on chiropractic and alternative practices, also reported here. Dean relays an anecdote from his term as governor that is unfavorable toward chiropractors, but then uses generally positive language. Sebelius' remarks are reminiscent of Obama's own comments on acupuncture and other alternative approaches while campaigning in 2008.
Comment: It must have been interesting for Secretary Sebelius to catch these questions at the National Press Club back-to-back with those she was asked by Congressman Tim Ryan (D-OH) during a Congressional hearing (below). The Secretary may be served to request a short briefing paper so she can get her facts right the next time a question is popped. Her general support, like that of Obama's, is good.
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Ryan: Congressional champion for mindbody stress reduction programs
Congressman Tim Ryan "boosts meditation from his position in Congress;" Sebelius responds


The Cleveland.com site has tongue-in-cheek in it's opening line: "Congressman Tim Ryan of Niles may not be a free trade fan, but there's at least one Asian import he swears by. It's called 'mindfulness meditation.'"
In a video, which Ryan placed on his YouTube site, he is addressing HHS Secretary Kathleen Sebelius in a Congressional hearing. He references National Institutes of Health (NIH) brain research on mindfulness before speaking to its the potential value of meditation in numerous settings. He includes the stress facing the unemployed, helping attention spans in children and supporting adults with chronic pain and tension. Sebelius responds that she is "certainly a bit familiar with it" then calls it "a prevention strategy that has the potential of paying huge dividends." She refers to mindfulness being used in schools in violence control. Sebelius then turns to applications in health care, suggesting that the therapy is of interest in health reform, will be valued by HHS's new leader for mental health and also in "work we are doing in early childhood" development. Ryan notes that Congressman Jesse Jackson, Jr. (D-IL) also raised the importance of research meditation when a representative from the NIH testified before the committee. Ryan's personal meditation practice provides the opening paragraph in this USA Today feature, "'Mindfulness' Meditation being used in hospitals and schools" last July.
Comment: Good for Ryan to elevate the visibility of this research and kudos to both Ryan and Sebelius for seeing the broad, public health value of imbuing our population with these skills. I am reminded of some fine, federally-funded research Integrator adviser Peter Amato and his Inner Harmony Group completed in 2005 (see Outcomes of a Mindfulness Program in an Elementary School). The positive ramifications spread beyond the class room. A 10-year old baseball pitcher talked of using mindfulness on the mound. A young girl reports using the school-learned skills in breath work to calm her when she feels like fighting with her sister. Given the breadth of value indicated here, why not a nation-wide MBSR initiative like President Kennedy's physical fitness initiative?
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Funding exploration of primary care
Macy report boosts primary care role for nurse practitioners; quiet on DCs, NDs, AOM practitioners, midwives


In January 2010, an invited set of professionals gathered under the auspices of the Josiah Macy, Jr. Foundation to consider the future of primary care in the United States. The preliminary report of the meeting from co-chairs Victor J. Dzau, MD, Duke University Health System and Linda Cronenwett, PhD, RN, FAAN, North Carolina School of Nursing, was published a month later as "Who Will Provide Primary Care and How Will They Be Trained." Of particular interest is the promotion of nurse practitioners and physicians assistants for primary care roles. The conference attendees recommended significant changes in the regulatory and payment environment which would make the system more hospitable to expanded roles for these practitioners.
The report focused on the importance of team strategies, while also clarifying that barriers to nurse practitioner practices should be removed:
"Coupled with efforts to increase the number of physicians, nurse practitioners, and physician assistants in primary care, state and national legal, regulatory, and reimbursement policies should be changed to remove barriers that make it difficult for nurse practitioners and physician assistants to serve as primary care providers and leaders of patient-centered medical homes or other models of primary care delivery."
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Thibault: Macy's executive behind the study
In a telephone press conference on the release, I asked whether the group had considered the potential roles naturopathic physicians, chiropractors and acupuncture and Oriental medicine practitioners in meeting primary care needs. Macy president George Thiebault, MD noted that that Macy "did not have that group of providers at the meeting." He added however that he believed "there is an appropriate place on the team for complementary medicine (practitioners)," assuming that they are "held to similar standards." Both Dzau and a nursing participant in the press conference, Joanne Pohl, PhD, ANP-BC, FAAN with the University of Michigan School of Nursing, agreed that there was a place for these practitioners. To my question, Dzau volunteered this about Duke: "We believe in integrative medicine." Dzau's predecessor as chancellor was Ralph Snyderman, MD, the first winner of the $100,000 Bravewell Award and chair of the 2009 IOM Summit on Integrative Medicine. Pohl chimed in: "We have a center (at U Michigan) where we expose (students) to strategies" with complementary medicine. Each of these academic health centers are long-time CAHCIM members
Comment: Despite the views expressed by workforce expert Richard Cooper, MD and others at the 2009 IOM Summit that the distinctly licensed CAM professionals might help meet the need for primary care, they didn't make it into this study. None-the-less, the Josiah Macy Foundation, Thiebault and the team he assembled are to be commended for convening this gathering to promote more investment, and sanity, to resolve the nation's primary care challenges. Meantime, the comments of Dzau and Pohl are evidence of the game-changing influence of the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) in academic medicine. 

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Boutin: Excited about value of healthcare overhaul for nutritionists
Healthcare overhaul viewed as positive for nutritionists in Bastyr publication


The chair of nutrition and exercise science at Bastyr Universtiy, Debra Boutin, RD, MS calls the new healthcare overhaul legislation an "unambiguously positive" development for the school's whole foods-oriented nutrition students and graduates. "Nutritionists have been eager to actively engage in prevention rather than treatment," Boutin says. She adds: "This legislation is a step in that direction. Preventive approaches are beneficial in the long run not only for the general population, but for our profession and the economies of health care."
In a recent article in Bastyr's e-news, the following traits of the healthcare overhaul legislation are listed as positive benefits for nutritionists.

  • A pilot program to provide at-risk populations (who use community health centers) with individualized wellness plans that include nutritional counseling.
  • Grant opportunities for nutritionists working for public health departments and Indian tribes. The grants are for intervention programs designed to either prevent or treat chronic disease in adults ages of 55 to 64.
  • Grant opportunities to develop school-based health clinics with potential for nutrition services.
  • A requirement for national chain restaurants to label the nutritional content of foods they sell.
  • Funding for a demonstration project aimed at reducing childhood obesity in community-based settings and schools.

In addition, according to the article, the legislation "may" also support nutritionists by:

  • Providing local governments with incentives to improve community wellness.
  • Offering grants to small businesses that provide comprehensive workplace wellness programs (likely to include nutrition and exercise science counseling).
  • Encouraging the distribution of science-based nutrition information to families.


Costs

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More upfront but fewer inpatient costs
Analysis of Washington insurer data finds CAM-using insureds have lower expenditures than non-users


An analysis of insurance data in Washington state found that "among insured patients with back pain, fibromyalgia, and menopause symptoms, after minimizing selection bias by matching patients who use CAM providers to those who do not, those who use CAM will have lower insurance expenditures than those who do not use CAM." Findings also indicated that:
"CAM users had higher outpatient expenditures that which were offset by lower inpatient and imaging expenditures. The largest difference was seen in the patients with the heaviest disease burdens among whom CAM users averaged $1,420 less than nonusers, p<0.0001, which more than offset slightly higher average expenditures of $158 among CAM users with lower disease burdens."
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Lafferty: Learning continues through his NCCAM-sponsored health services work
The results were part of a broad NIH NCCAM-funded initiative led by William Lafferty, MD, and published in the Journal of Alternative and Complementary Medicine as Comparison of health care expenditures among insured users and nonusers of complementary and alternative medicine in Washington State: a cost minimization analysis.
Bonnie Lind, PhD was the lead author. This study follows a more limited study of fibromyalgia patients alone that reached a similar conclusion: "CAM use is not associated with higher overall expenditures. Until a cure for (fibromyalgia) is found, CAM providers may offer an economical alternative for FMS patients seeking symptomatic relief."
Comment:  Is there a hint here regarding health reform priorities? The movement toward care from these covered providers in both studies is from inpatient to outpatient, from more costly procedures, to less invasive services, from machinery and edifice to time-intensive treatment from licensed human beings. There is a parallel movement of dollars, but with less overall cost. Credit NCCAM for funding the work. (Thanks to Paolo Roberti Di Sarsina for alerting me to thsi study.)

Research Policy

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NCCAM appears to retreat to reduction in conceptual framework for 2011-2015 strategic plan; Briggs offers clarification


In an April 2010 Message from the Director, Josephine Briggs, MD, director of the NIH National Center for complementary and Alternative Medicine (NCCAM) offers "a priority-setting framework to help determine which research directions to pursue." The language focuses exclusively on the study of "products." The methods noted are limited to basic research and efficacy trials. The framing did not reflect the new "effectiveness" direction and emerging interest in "real world outcomes" about which Briggs speaks from time-to-time. Nor would the focus on "products" reflect Congress' mandate to examine "complementary and alternative treatment, diagnostic and prevention modalities, disciplines and systems." This article in the Integrator Blog News & Reports includes an e-letter from Briggs in response to a query about the intent in her message. Briggs responds, in part:
"It is not our intention to only study products, but more broadly to encourage research on CAM practices, disciplines, and whole systems- as well as products. The language suggesting a focus on natural products was quite inadvertent; in fact, there are many important CAM interventions that would not be labeled as products.
Briggs' message, entitled "Listening to Differing Voices," begins with references to "two meetings with groups that represent disparate views of CAM research" that she hosted.
Comment: I was at first tickled to see Briggs message, since shortly before she published her Message I had posted an article which described her recent meetings with two quite groups. (See Anti-CAM Bloggers and Homeopathic Researchers: Reports on Two Stakeholder Meetings with NCCAM's Briggs.) However, the words in the framework quickly stifled that self-important pleasure. This framework as stated is an awful retreat by NCCAM into the comfort and language of the NIH's drug-focused, reductive home turf aty the very moment when it needs to engage a gutsy venture out into the visionary, real world exploration asked by Congress, and urged by practitioners and even supported at times by Briggs herself. I thank Briggs for her corrective response, yet remain concerned that this far into her tenure this level of conceptual mistake can be made. It wasn't a slip of the tongue. This was a slip of the paradigm. I worry that under the 2011-2015 strategic plan, due for publication in draft form in less than a month, NCCAM will once again fail to embrace its distinctive destiny. 
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Weeks in '97, not quite 1993, or 1968
1993: A personal view, impatience and NCCAM's "crucifixion (of CAM) on a cross of gold"

Comment and Clarity
: Why do I push with such impatience for NCCAM to shift the center of its focus to examination of outcomes of actual practices? (Six related stories are listed here.) My announced reasons are that multiple stakeholders have taught me that these kinds of data are their priorities: employers, hospital administrators, health systems, insurers, integrative practice organizations and Congress itself. My interest is also personal. In 26+ years in the field, I have
been promoting more integrative and natural health oriented practices. My evidentiary basis for such promotion is a combination of principles, philosophy, personal experience and countless stories from practitioner colleagues. Yet throughout I have had what has festered into a yearning for outcomes data, the depth of which late-comers will not likely understand. Are we going to focus significant resources on these real world questions before die? So when I recently stumbled upon this letter to the editor published in the Seattle Post-Intelligencer on January 12, 1993, I decided to print it here. This letter was written at the height of the Clinton health reform era during the beginning of the earliest NIH efforts to examine "unconventional medicines." I was at the time the executive director of the American Association of Naturopathic Physicians.

Letters to the editor
____________________________

Naturopaths recognize impact of diet, environment

     ImageI am writing to clarify a quote in Tom Paulson's article about the investigation the National Institutes of Health is undertaking into medical practices that are not yet accepted by the dominant school of medicine. Paulson quoted me as saying: "We have an approach to health care grounded in 19th century sciences. It's time we moved away from that." From the context, it was not clear that the "we" to which I was referring was the dominant medical culture.
     Medical practice in our culture claims to adhere to a scientific "gold standard" of the double agent, placebo controlled trial. That standard is particularly useful in measuring the utility of pharmaceutical drugs in disease management. That therapeutic approach is readily standardized and drug agents are readily placebo-controlled. Some natural therapeutic agents can be effectively measured and utilized in that fashion
   
   
"Unless medical science addresses
the best means of measuring the
impact of nutrition, lifestyle and the
environment, our attempts to reform
our health system risk, to appropriate
William Jennings Bryan's phrase from
100 years ago, 'crucifixion on a
cross of gold.'"

 
However, once the practitioner's focus shifts from disease management to health care and from infectious diseases to the chronic diseases that most afflict our population, the double-blind, placebo-controlled scientific standard has limited utility. The recognition, management and reversal of early stage chronic disease - the specialty of naturopathic physicians - is by its nature individualized, not standardized.
     The naturopathic physician works with the patient toward health, on a schedule and with protocols best suited to the patient. The key therapeutic tools, such as nutrition education, dietary adjustment, stress management and lifestyle counseling are not placebo controllable. In addition, the optimal care for chronic disease generally involves a multi-agent protocol. For a patient with hypertension, for instance, a naturopathic physician's protocol might include dietary adjustments, an exercise regime, hypotensive botanicals and foods and additional dietary supplementation.
     The naturopathic profession is pleased that one aspect of the National Institutes of Health investigation is to embrace that research challenge.
     Unless medical science addresses the best means of measuring the impact of nutrition, lifestyle and the environment, our attempts to reform our health system risk, to appropriate William Jennings Bryan's phrase from 100 years ago, "crucifixion on a cross of gold."

John Weeks
Executive Director
American Assoc. of Naturopathic Physicians
January 12, 1993                                                                                         
__________________________________
Here we are in 2010, 17 years later, knowing almost nothing, from a research perspective, about the outcomes of the kinds of whole-person, integrative practices that not just NDs but also TCM practitioners, integrative medical doctors, holistic nurses, broad-scope chiropractors and others model. In a related acticle in this Round-up I speak to the apparent, reductive "product" focus in the NIH NCCAM priority-setting framework for 2011-2015. If that view continues to dominate, we appear to be sending our horses down the same blindered path as they have been hurtling, million-dollar investment following million. Impatience? Were I a student in 1968 instead of a home-owning part of the dialogue in 2010, I am sure I would end this column with down with the dictatorship of the reductionists!


Academic Medicine

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Manzini: Chaired the successful ACC-RAC
2010 chiropractic ACC-RAC conference the most highly attended event with the most scientific presentations


On March 17-20, 2010 the major national meeting of chiropractic educators and researcher, the ACC-RAC (Association of Chiropractic Colleges (ACC) Educational Conference and Research Agenda Conference (RAC)) was held at Caesar's Palace in Las Vegas. The meeting reached a new peak in attendees, at 439. The conference included
200 scientific papers submitted for peer review from which 66 were selected for poster presentation and 92 for platform presentation. The theme, Chiropractic and Public Health in the 21st Century, featured Georges C. Benjamin, MD, executive director of the American Public Health Association. The meeting concluded with what was reported as "a lively panel discussion" entitled Subluxation Theory as a Component of Public Health.

In an April 23, 2010 release, ACC president Frank J. Nicchi, MS, DC summarized his pleasure with the outcome "I feel like we accomplished a great deal this year, attendance was robust and important issues in chiropractic education were addressed." The annual gathering includes breakouts for various institutional leaders including one for the ACC president's group. According to the release, the presidents focused on these strategic issues:
 
  • achieve consensus on how the chiropractic academic community may contribute to integration within the existing and emerging health care systems;
  • promote collaboration in research efforts among member institutions;
  • increase the quantity, quality and diversity of applicants pursuing chiropractic education;
  • review the ACC Paradigm from an educational perspective;
  • develop relationships with other chiropractic and allied health institutions globally that complement ACC's mission, vision and values and to look at the possibility of developing clinical residencies as part of the doctor of chiropractic program training.

The planning committee was chaired by ACC vice-president Fabrizio Mancini, DC.
Peer review committee chair Claire Johnson, DC, MSEd, called the the 2010 program "the largest turn out of chiropractic research in the history of the conference." The 2011 conference will be themed "integration."
Comment: The ACC-RAC is quite a gathering. I had an opportunity to attend in 2008 and recall it as a significant, eye-opening experience of the richness and maturity in chiropractic research and education. I recommend the conference for anyone who wants to pull back the covers and gain a clear measure of what is best in healthcare's limbo profession.
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Brodsky: Stamford's integrative medicine director
Stamford Hospital begins integrative medicine fellowship

Stamford Hospital, an affiliate of Columbia University College of Physicians and Surgeons, has announced a 2-year Integrative Medicine Fellowship at the Center for Integrative Medicine and Wellness. The program will offer clinical experience in complementary therapies relative to pain management, nutrition/supplement consultation, stress management with guided imagery and mindfulness meditation, and preventive cardiology. According to this web description, the program's consultation practice, in 4000 square feet, has had roughly 4100 patient visits since opening October 2008. As part of the program, fellows will be paid and funded to complete the 1000-hour University of Arizona distance learning and residential curriculum as well as a 300 hour acupuncture program for physicians. Interested candidates must be primary care physicians and are expected to already be board certified in a primary care specialty or to achieve board certification during their first year of fellowship. Marc Brodsky, MD, MBA, MPH is the director of integrative medicine at Stamford.
Comment: It is interesting to compare, from the prospective fellow's perspective, this program with the fellowship for licensed acupuncturists in inpatient programs at New York's Beth Israel Department of Integrative Medicine. Rather than being paid, the acupuncturists pay for their fellowship. It is a mark of the confusion in this world, or in me, that regardless of these inequity, I continue to honor Beth Israel for its pioneering program for LAcs.
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Amri: Co-founder and co-director of Georgetown CAM-MS program
Georgetown educates 7th class in CAM-Master of Science program


The Program in Complementary and Alternative Medicine associated with the Master of Science degree in Physiology advanced its 7th class in 2010. The program is co-directed by Aviad Haramati, PhD
and by Hakima Amri, PhD and was developed by Amri and Adam Myers, PhD under an NCCAM R-25 educational grant on which Haramati was principal investigator. The program, according to a brochure, is "designed to provide advanced study in the science and philosophy of predominant CAM therapies and disciplines." The course focuses on "training students to objectively assess the safety and efficacy of various CAM modalities and to introduce scientific rigor to much needed research into understanding the mechanistic basis for CAM therapies such as acupuncture, massage, herbs and supplements and mind-body interactions." This "CAM-MS" program takes 11 month and includes 14 courses, an elective, and a 6-8 week summer practicum that "emphasizes the cross-disciplinary application of academic knowledge." The program was designed to draw students in diverse fields, from medicine and biomedical research, to law and healthcare administration. The common denominator is that each would anticipate a professional practice related to complementary and alternative medicine. Thus far, according to Amri, 133 students have graduates with a "Master of Science Degree in Physiology and Biophysics with an  Emphasis on CAM." An additional 32 will graduate in September 2010.
Comment: Close readers of the CAM-MS program will see an unusual focus: the materials note the study of not just therapies but "disciplines." It's a nice sign of the importance of inter-professional education to quality understanding of "CAM." Notably, according to Haramati, graduates of the 2010 were each presented a copy of the Clinicians' and Educators' Desk Reference on the Licensed Complementary and Alternative Healthcare Professions.
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The Ozes: Honorary degrees from Bastyr
Mehmet and Lisa Oz to be awarded honorary doctorates by Bastyr University

In a special ceremony on June 2, 2010, Bastyr University will confer honorary doctoral degrees on Mehmet Oz, MD and on Lisa Oz.  Mehmet Oz is vice chair and professor of surgery at Columbia University, where he developed one of the nation's first complementary medicine department with Jery Whitworth, RN, and others. Oz, who is host of The Dr. Oz Show, also finds time to perform 250 heart surgeries annually. Lisa Oz is an actress, writer and strong proponent of complementary and integrative healthcare practices who also serves as co-host of the show. The honorary degrees will be conferred by Bastyr president Dan Church, PhD.

Correction
: Regarding regional accreditation firsts for acupuncture education

A statement in a recent Round-up of success of the Acupuncture and Oriental Medicine of Austin led to a clarifying electronic exchange between two of that field's separately interested historians. A note from long-time acupuncture and Oriental medicine (AOM) board volunteer and Georgetown Law professor Sherman Cohn, JD corrected my statement that AOMA was the first "free-standing" AOM school to gain regional accreditation.
In fact, Tai Sophia Institute, on the board of which Cohn serves, was the first free-standing school to achieve this standing. Tai Sophia grants an array of degrees. However, the claim that AOMA president Will Morris, LAc, PhD had made was that AOMA was the "only stand-alone, single-degree granting school" to gain this recognition. Morris used appropriate language; the Integrator didn't. Apologies. The clarification was a good-natured exchange between the two.


Professions


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Seitz: Mapping the regulatory roads
Three associations in Yoga and Ayurveda join forces to publish paper on emerging regulatory issues in their fields


The report by consultant Dan Seitz, JD, EdD is called, simply, Regulatory Issues for Yoga, Yoga Therapy, and Ayurveda. Behind the report is percolating interest in both the Yoga and Ayurvedic fields regarding self-regulatory issues relative to education and certification. The International Association of Yoga Therapists (IAYT), the Yoga Alliance and the National Ayurvedic Medical Association jointly funded the report. In the paper's abstract, Seitz, known for his work in accreditation relative to the acupuncture and Oriental medicine and naturopathic medicine, begins:
"In order to gain greater credibility, emerging healthcare and health-related fields usually establish a variety of self regulatory structures and organizations." After ticking off possible values to such internal work, he adds: "Developing self-regulatory structures, however, can pose significant challenges and invariably involves trade-offs." The 7-page report was published in the International Journal of Yoga Therapy and is available as a download here.
Comment: Interestingly, the March 2010 issue of IAYT's publication Yoga Therapy Today includes a 2-page opinion piece entitled "Embracing Balanced Regulation." Seitz' allusion to challenges remind me of a classic comment from Carlo Calabrese, ND, MPH in the late 1980s when he was shepherding the single purpose accrediting agency of his profession through US Department of Education approval. Said Calabrese: "Any time you create standards, you create pain." Seitz is right to urge his clients to "engage in inclusive, representational, and transparent decision-making processes to build support for any self-regulatory measures being considered." At this point, these fields are doing a remarkable job of doing so.
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Zahourek: Led the holistic nurse's white paper team
Research agenda for holistic nurses articulates holistic, healing, complexity requirements


In April 2009, the American Holistic Nurses Association approved a white paper on research in holistic nursing. The four page document include an "important caveat." That is: "To be ‘holistic’ nursing research, the theoretical basis and interpretation of results must be within the context of holism." Also:
"Understanding the effect of an intervention on the whole person often requires describing and evaluating feelings, sensations, and responses." And: "As a result, research is often challenging and the questions posed may not always lend themselves to traditional designs such as the double-blind randomized controlled trials. In general, the strongest and most appropriate design and methods for research question posed should be employed. Results may need to be interpreted in functional and practical ways that apply to all areas of (holistic nursing)  practice." The white paper development was led by Rorry Zahourek, PhD, APRN, BC, AHN-BC.
Comment: I found this short document's direct engagement of complexity refreshing. It is an interesting counterpoint to NIH NCCAM's recent, unfortunate use of the term "product" to describe the complementary and alternative medicine arena.
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Naturopathic organization goes after loan payback programs
Naturopaths "demanding" that members of Congress include NDs in loan-payback programs


The American Association of Naturopathic Physicians is focusing political efforts of their profession on inclusion in loan payback programs according to an e-letter which coincides with their annual lobbying day. The language to members is strident, urging members to make demands of Congress. The message in a sample capwiz letter to members of Congress highlights the following:
"INTEGRATIVE HEALTH PRACTITIONER  Defining this innovative term of art, included throughout the Patient Protection and Affordable Care Act, to include qualified, licensed non-MD/DO providers will prevent regulators from restricting the definition by using outdated definitions in current law.
 
"INDIAN HEALTH CARE IMPROVEMENT ACT  Inclusion of naturopathic medicine in the definition of Health Profession in the Indian Health Care Improvement Act for the Indian Health Service Loan Repayment Program.

"NATIONAL HEALTH SERVICES CORPS Inclusion of naturopathic medicine in the definition of approved education for the National Health Service Corps loan repayment program.

"PUBLIC HEALTH WORKFORCE LOAN REPAYMENT PROGRAM  Inclusion of a clear, inclusive definition of health professions degree for the Public Health Workforce Loan Repayment Program in PL 111-148.  Left  undefined, this program could be restricted to students and graduates of conventional medical programs as defined in section 799(1)(A) of the Public Health Service Act (see below)."
At this time, the AANP has not reported that sponsors have been found for specific bills to be introduced to advance this agenda. AANP efforts from 2008-2010 to gain inclusion in the Indian Health loan program fell short when the AANP couldn't secure a  sponsor on the Senate side to place the language in the version of the healthcare overhaul bill that was passed into law.
Comment:  A recent newsletter from Bastyr University offers additional perspective on the impact of the healthcare overhaul legislation on naturopathic practice.

International

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Roberti: Useful links to key WHO documents
Links to all World Health Organization publications on traditional, complementary and alternative medicine


Integrator reader Paolo Roberti di Sarsina, MD, an leader in complementary and alternative medicine in Italy recently scoured the World Health Organization (WHO) data bases and developed this set of links to documents on the WHO site. He shared them with his list. I pass them on. The categories were created by Roberti di Sarsina.
WHO Publications on Traditional, Complementary and Alternative Medicine

acupuncture (8 documents)  
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.1.7/clmd,50.html#hlCL6_1_1_1_7

alternative medicine (2 documents)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.1.11/clmd,50.html#hlCL6_1_1_1_11

anti-HIV activity (1 document)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.1.13/clmd,50.html#hlCL6_1_1_1_13

chiropractic (3 documents)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.3.2/clmd,50.html#hlCL6_1_1_3_2

clinical trials on treatment (1 document)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.3.5/clmd,50.html#hlCL6_1_1_3_5

clinical evaluation (1 document)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.3.4/clmd,50.html#hlCL6_1_1_3_4

herbal medicines (11 documents)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.8.12/clmd,50.html#hlCL6_1_1_8_12

homeopathic medicines (1 document)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.8.17/clmd,50.html#hlCL6_1_1_8_17

homeopathy (1 document)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.8.18/clmd,50.html#hlCL6_1_1_8_18

medicinal plants (21 documents)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.13.14/clmd,50.html#hlCL6_1_1_13_14

traditional medicine (31 documents)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.20.6/clmd,50.html#hlCL6_1_1_20_6

Traditional Practitioners as Primary Health Care Workers
http://apps.who.int/medicinedocs/en/d/Jh2941e/

Traditional Medicine and Health Care Coverage
http://apps.who.int/medicinedocs/en/d/Js7146e/

Report of a WHO Consultation on Traditional Medicine and AIDS: Clinical Evaluation of Traditional Medicines and Natural Products (Geneva, 26-28 September 1990)
http://apps.who.int/medicinedocs/en/d/Jh2954e/

Report of the Consultation on AIDS and Traditional Medicine: Prospects for Involving Traditional Health Practitioners (Francistown, Botswana, 23-27 July 1990)
http://apps.who.int/medicinedocs/en/d/Jh2955e/

traditional practitioners (4 documents)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.20.7/clmd,50.html#hlCL6_1_1_20_7

traditional remedies (2 documents)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.20.8/clmd,50.html#hlCL6_1_1_20_8

WHO Monograph on Good Agricultural and Collection Practice (GACP) for Artemisia Annua L.

http://apps.who.int/medicinedocs/en/m/abstract/Js14074e/

Media

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May issue features integrative medicine
Real Simple features integrative medicine, distinguishes IM from DO and ND


The title for the Real Simple feature is "How Integrative Medicine Can Help You Be Healthier: Best of both worlds approach to medicine blends conventional science and complementary practices." Featured are leaders of many of the programs associated with the Consortium of Academic Health Care Centers for Integrative Medicine. One leader is quoted as stating that the hope is that this medicine will simply become the medicine of the future. Interestingly, the writer thought it important to help her audience distinguish integrative MDs from osteopathic doctors (DO) and naturopathic doctors (ND):
"A few important distinctions: An IM doctor is not the same as an osteopathic or naturopathic doctor, although all three share similarities. A doctor of osteopathic medicine (or DO) gets conventional medical training but with additional instruction on the structure of the body in relation to how it functions; treatment protocol may involve physical manipulation of your body with his hands to diagnose injury or illness and help the body function efficiently. A naturopathic doctor (or ND) gets Western-style medical training but also learns about botanicals, nutrition, and Eastern therapies. 'It’s a bit of ‘buyer, beware’ for this specialty,' says Tracy Gaudet, executive director of Duke Integrative Medicine, in Durham, North Carolina. 'There are quality, accredited programs for naturopathic medicine, but people can also get an online degree and call themselves an ND with very little education.'"
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Mussalli: Midwife-friendly OB
Closing of St. Vincent's ends quality midwifery, childbirth and CAM options


The New York Times ran an April 9, 2010 feature that marked a sad turn for natural childbirth: St. Vincent's Medical Centers was shut down. The hospital's obstetrics program was run by an "an exceptionally-midwife friendly" medical doctor, George Mussalli, MD, who describes his work as "minimally invasive obstetrics." While the city's c-section rate "soared to 36%" from 2000-2007, under Mussalli's leadership, the c-section rate at St. Vincent's "inched down" to 24%. (The World Health Organization says anything above 15% is likely to be "causing preventable deaths and complications.") While not covered in the article, St. Vincent also had an early complementary and alternative medicine program and an inpatient fellowship for licensed acupuncturists. I asked healthcare consultant and poet Linda Rapauano if this hospital was indeed the one in which she had worked on complementary health care. She wrote:
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Rapuano: Plans for St. Vincents' integrative care will not be realized
"That's the one; ten years of my life trying to build a model of integrative care there. Just last year I did a very large 'consumer-focused facility design' project around the new hospital they were planning to build. All the components supporting integrative care would have begun with that facility design including re-engineered administrative processes and technology interface. I am glad the laughing Buddha is entertained. The hospital itself will close in 30-40 days time. There are some services like the HIV and Behavioral Health which I believe may still be under discussion with un-namable entities."

Comment:  The program lives on. According to Rapuano, the inpatient fellowship for licensed acupuncturists at Beth Israel was modeled on one who and colleagues developed at St. Vincents.


People

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Mathews: Taking the YA helm
Mathews selected as president of the Yoga Alliance


Yoga practitioner John Mathews has been selected to serve as president of the Yoga Alliance. Mathews has been a consultant to hte organization for 6 years. He most recently service as
vice president of the Federaton of State Humanities Councils. The Alliance serves as a registry for yoga schools and practitioners with over 30,000 practitioners presently registered.


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Hangee-Bauer: AANP's new president
Hangee-Bauer new president of AANP

Carl Hangee-Bauer, ND, LAc stepped into the presidency of the American Association of Naturopathic Physicians in January 2010 for a 2-year term. A long-time leader of his profession in California, San Francisco-based Hangee-Bauer played important roles in gaining licensing for naturopathic doctors in that state. He comments here on his profession's efforts to build relationships.
 


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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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