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 Integrative Medicine and Integrated Health Care Round-up_#41: March 2011  
 
The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series
Summary: Nutrition Business Journal estimates size of integrative practitioner market by discipline ... Patients of general practitioners who use CAM cost less and live longer than those of conventional doctors in Netherlands study ... Clinicians note: NCCAM's 3rd strategic plan begins to honor "real world" mandate ... CAHCIM changes name of 2012 research conference ... Palmer-Rand-Samueli group receives $7.4 million for study of chiropractic in the military readiness ... Sebelius in strong endorsement of chiropractors ... New York Times articles describes how Colorado medical society and mail-order NDs combine to oppose naturopathic licensing ... Hospitals and Health Networks column proposes value of integrative health care in Accountable Care Organizations (ACOs) ... ESPN viewers give thumbs up to yoga for professional sports teams ... Consortium of Academic Health Centers for Integrative Medicine sets up integrative mental health group ... Medical dean and past dean at U Minnesota offer articulate defense of integrative medicine program at the Center for Spirituality and Healing ... Samueli Institute launches nurse training at VA medical centers ... Urban Zen continues promoting new "integrative practitioner" training ... Seattle's Swedish Hospital educates to foster MD-ND relationships in chronic disease management ... Data on total number of Board Certified Holistic Nurses ... Bravewell to host 5th leadership award dinner in November 2011 ... AAAOM takes steps to right its course ... MD and DO groups push back against IOM-Robert Wood Johnson Foundation report promoting independent practice by nurses ... Homeopathic accreditation agency changes name to Accreditation Commission for Homeopathic Education in North America ... Herbal organization appoints integrative media leader Frank Lampe to communications post ... Data on growth of the National Acupuncture Detoxification Association ...


Economics

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Annual issue explore IM business
Nutrition Business Journal estimates
1999-2010 doubling of integrative practitioner service revenues plus supplement sales to $50-billion

Most years the Nutrition Business Journal (NBJ), the supplement industry's pricey monthly ($1,195/year), focuses an issue on the business of integrative medicine and the practitioner marketplace. The most recent iteration, the November-December 2010 issue of the 48 page resource, opens with a chart that estimates that integrative medicine services and revenues are 2% of the $2.5 trillion in national healthcare expenditures. NBJ estimates there has been a doubling in integrative practitioner service and supplement revenues from roughly $25 billion to nearly $50-billion from 1999-2010. A chart on page 3 estimates these revenues by practitioner type. Then the following pages offer brief synopses on 11 different categories. A sampling of these data is below.
_______________________________

NBJ's Estimated Integrative Practitioner Service Revenues
and Supplement Sales in 2009


 Practitioner Types
   IM Service  
Revenues
    Supp.   
Sales

    Supp. Mkt 
Share*
Chiropractic
 $18, 010
$430
 20%
Traditional Chinese Medicine
 $5,300 $430
 20%
Acupuncture  $4,550  $150  7%
Massage Therapy
 $14,790  $100  5%
Naturopathy  $2,690  $440  21%
(Integrative) MDs
 $160  $240  11%
Osteopathy
$370
$50
2%
Nurses
$110
$$60
3%
 
* Chart is only part of that published and does not include all categories
so figures do not add up to 100%.

Source: Nutrition Business Journal, Volume 15, No. 11/12; Nov-Dec 2010; page 3.
 ______________________________

Comment: I have had the pleasure a few times over the past decade to be interviewed for this issue of NBP. I subsequently look forward to the complementary copy that comes in the mail. The examination of integrative practices as a market for the supplement industry always yields interesting information. I also have come to know that something I read will typically make me wonder how did they come up with that?  For instance, how does one split "TCM" from "acupuncture" and then count each as 35,000 or so practitioners? (The national organizations representing licensed acupuncturists will tell your there are roughly 25,000 licensed practitioners with another 8,000 in the pipeline; these represent the lion's share of "TCM" practitioners.) The 31,000 figure for the naturopathic doctors, a field with less than 5,000 licensed practitioners, must result from including those who purchased mail order "Doctor of Naturopathy" degrees and only offer services in states without licenses. They could, of course, still be selling a good deal of product. Still, the desire to see the "practitioner market" quantified in simple columns makes this issue always an interesting read, and illuminating, even if let the buyer beware is the operative note. Single issues are available. 303-998-9263. Among the others interviewed are Penny George, co-founder of the Bravewell Collaborative, NIH NCCAM director Josephine Briggs, MD, Mimi Guarneri, MD with the Scripps Center for Integrative Medicine.

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GPs with CAM saving system money
Netherlands study concludes that patients of integrative MDs have lower costs


A study from the Netherlands entitled Patients Whose GP Knows Complementary Medicine Have Lower Costs and Live Longer was
reported in mid-2010 by researchers Peter Kooreman and Erik Baars. The abstract follows:
"A small fraction of general practitioners (GPs) in the Netherlands has completed additional training in complementary medicine after obtaining their conventional medical degree. Using a data set from a health insurer, this paper documents that patients whose GP has additional training in anthroposophic medicine, homeopathy, or acupuncture have substantially lower health care costs and lower mortality rates. The lower costs result from fewer hospital stays and fewer prescription drugs. Since the differences remain once we control for neighborhood specific fixed effects at a highly detailed level, the lower costs and longer lives are unlikely to be related to differences in socio-economic status. Possible explanations are selection (e.g. people with a low taste for medical interventions might be more likely to choose CAM) and better practices (e.g. less overtreatment, more focus on preventive and curative health promotion) by GPs with knowledge of complementary medicine."
The data reported projects various ranges of savings by population and practitioner type. For instance, patients 75 and older seeing a doctor with anthroposophical training spend over 1000 Euros less per year on health care. Over all, costs are roughly 7% less for patients of general practitioners with CAM practices, compared with those practicing conventionally, or 170 Euros per person per year. The overall conclusion: "The results provide strong evidence of substantially lower costs for general practitioners who have additional training in complementary medicine."
Comment: This is an interesting example of a "disciplines research," a sort of research focus noted below in the discussion of the 2011-2015 NCCAM Strategic Plan. We need to see more of this type of examination in the States. 

Research

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NIH center begins to reconnect with mandate
NCCAM's 3rd Strategic Plan shows signs of embracing clinical and "real world" focus of original mandate

Comment: On February 4, 2011, the NIH National Center for Complementary and Alternative Medicine released its 3rd Strategic Plan. This 2011-2015 plan is the first under the leadership of NCCAM director Josephine Briggs, MD and her deputy director Jack Killen, MD. Killen had the lead in marshaling the plan, developed through inputs from a multitude of sometimes oppositional stakeholder perspectives, into being. Among these competing influences are the natural products industry, the conventional academic health centers that received most of the agency's funding from 1999-2010, and the licensed "CAM" and integrative practice disciplines that would seem, given the language of Congress's 1998 mandate, to have been a core interest. Which brings up another significant set of competing forces with which NCCAM must contend: on the one hand Congress, which gave NCCAM a real world, outcomes and integration-focused mandate; and on the other, the NIH itself, which tends to demean such messy real world questions in favor of the of basic research and clinical trial approaches into which they've been trained. Congress be-dammed.

The good news in this plan is that Briggs, herself clinically inexperienced in integrative care, appears to have listened a good deal to stakeholders outside of NIH. The new strategic plan can be read as the beginning of a course correction. Strategic Objective #3 reads:
"Increase understanding of 'real world' patterns and outcomes of CAM use and its integration into health care and health promotion." Here we see not only a prioritization of "outcomes" and "integration" (Congress' chief interest). We also see, for the first time, acknowledgment that many patients use CAM modalities and practitioners to promote their health rather than only to combat disease or symptoms. Similarly, CAM/integrative disciplines claim health promoting outcomes. The interest in health outcomes was also urged by Congress in NCCAM's enabling act. Here is Congress' first directive:
"The Director of the Center shall, as appropriate, study the integration of alternative treatment, diagnostic and prevention systems, modalities, and disciplines with the practice of conventional medicine as a complement to such medicine and into health care delivery systems in the United States." (Italics added.)

How does one most effectively research the impact of a "discipline"?

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Briggs: How will she lead work on the real world?
One remarkable change between the draft plan's release in August 2010 and the final document is that for the first time in NCCAM's history we see a routine inclusion of
"disciplines" as a unit of inquiry. This reflects Congressional language. The idea of examining the value of disciplines appeared only once in the draft. Yet this idea appears 37 times in the final. For this reason, integrative clinicians and their professions would be served to once again consider this agency as potentially interested in the whole person approaches they represent, and which they urged.

Briggs and team are to be commended for the direction set here. No doubt the NIH remains a fairly inhospitable ground for these outcomes, health, disciplines and integration directions to take seed and flourish. According to the plan, however,
"CAM practitioners are the key holders of knowledge related to the potential application of CAM interventions and disciplines." The message to clinicians and their institutions and organizations: There is an opening here. Show up. Don't leave research to the researchers
 
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Conference embraces international flavor
CAHCIM's 2012 research conference now the International Research Congress on Integrative Medicine & Health
 

In  2006 and 2009, the now 46-member Consortium of Academic Health Centers for Integrative Medicine has sponsored the most significant international research meeting in this field. The first two versions were called the North American Research Conference on Complementary and Integrative Medicine (a.k.a. NARCCIM). In part because that conference has had a strong international flavor, the Consortium has renamed the
May 15-18, 2012 event the International Research Congress on Integrative Medicine and Health (IRCIMH).

Adi Haramati, PhD, integrative medicine leader at Georgetown and
IRCIMH conference chair, explained that the name change was part of "an effort to reach out globally to individuals and organizations working in the complementary and integrative medicine and health care field." The conference' tagline is: Strengthening Research in Integrative Healthcare Around the World. Haramati adds that the name change will also align with the conferences sponsored by the International Society of Complementary Medicine Research that rotate between Europe and Asia when not in North America. (The next is in Chengdu, China, May 6-9, 2011).  The program committee, chaired by Rick Hecht, MD from the Osher Center at UCSF, will issue the call for proposals for sessions and research abstracts in May.
Comment: The name-game has always been a side-sport in the integrative practice field as "alternative medicine" has migrated in various forms into conventional practice. The big changes here, besides moving from North American to international, are the deletions "complementary" and the addition of "health." The latter is aligned with Strategic Objective #3 of the new NCCAM Strategic Plan, which begins a focus on the health-promoting uses of "CAM" and CAM disciplines for the first time. The dropping of "complementary" appears to be aligned with a long-held perspective of the Consortium's founding backer, the Bravewell Collaborative, as expressed by current Bravewell president Christy Mack on the Charlie Rose Show that "integrative medicine is not CAM." 
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Goertz: Her team oversees bulk of grant
Palmer-Samueli-RAND receive $7.4-million on chiropractic treatment for military readiness

A powerful consortium of the Palmer Center for Chiropractic Research (PCCR), the RAND Corporation and the Samueli Institute were recently awarded a $7.4 million grant
for a 4-year research project "to assess chiropractic treatment for military readiness in active duty personnel." The funds came through the the Congressionally Directed Medical Research Program. The grant is the largest single award for a chiropractic research project in the history of chiropractic. Ian Coulter, PhD, the Samueli Institute Chair in Policy for Integrative Medicine at RAND Corporation, is the research project's principal investigator. Christine Goertz, DC, PhD, Palmer College of Chiropractic's vice chancellor for research and health policy, is a co-PI. Goertz will oversee the design and implementation of the three clinical trials funded by this award, for which the Palmer Center for Chiropractic Research will receive approximately $5.1 million. Samueli Institute medical research head Joan Walter, JD, is a co-principal investigator.

Via 3 clinical trials, the study will assess chiropractic's effectiveness in: relieving low back pain and improving function in active duty service members; evaluating the effects of chiropractic treatment on reflexes and reaction times for Special Operations forces; determining the effect of chiropractic treatment on strength, balance and injury prevention for members of the Armed Forces with combat specialties; and, assessing the impact of a chiropractic intervention on smoking cessation in military service members.

Comment: Coulter-Goertz-Walter are truly a sterling, deeply interconnected, A-list team of researchers for a project of this magnitude. Recent reports on the awful 70-80 pound loads US troops are routinely carrying only begin to suggest the value in investing in this project.

Policy

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Sebelius: Emracing words for chiropractors
Sebelius: "Chiropractors proven to be effective and cost-effective ... a vital part of our healthcare system"


Comment: The audience was not the AMA but the ACA, as in American Chiropractic Association. So US Department of Health and Human Services Secretary Kathleen Sebelius knew her audience in pre-recorded comments available in this YouTube video: 500+ chiropractic physicians and chiropractic students who gathered in the nation's capitol February 14-15, 2011. Sebelius underscored a point made by the keynoter, US Senator Tom Harkin (D-Iowa) that chiropractors are a critical part of moving the nation away from the present "sick-care system." Said Harkin:
"Patients want options, alternatives and noninvasive care." He added: "We need to keep moving forward, away from the current sick care system to a health care system. Chiropractic physicians must be a part of the health care team."

This level of affirmation must be confounding to members of the profession who, in the next breath, may see their profession lumped with the not-yet-acceptable and to some untouchable "CAM." Perhaps chiropractic medicine will never cross over into the promised land until, and when, the promise land is actually no longer merely a sick-care system.


Media

ImageNew York Times reports strange allies working to keep
naturopathic doctors from licensing in Colorado

A February 21, 2011 article entitled Colorado Faces a Fight over Naturopathy reports the rock and hard-place that hem in expansion of licensing of naturopathic doctors. On the one hand, the Colorado Medical Association opposes licensing based on their view that diagnosis and treatment is beyond the ken of this profession.  On the other hand, a Colorado Coalition for Natural Health, led by individuals who have picked up their "Doctor of Naturopathy" diplomas through what were once called "mail-order schools," oppose the NDs. Why? The passage of a law would stop such poorly-trained people from hanging up their shingles and practicing as doctors in a field of medicine.
The Colorado Association of Naturopathic Doctors is leading the licensing effort. One must appreciate the irony of the Colorado Medical Association defending the practice rights of mail order practitioners. 

Hospitals & Health Networks
explores integrative health care in accountable care organizations


Sita Ananth, MHA is co-author of ACOs and Integrative Healthcare, published online in early February in Hospitals and Health Networks, the American Hospital Association magazine. The cut-line of the column: "Integrative health care can help accountable care organizations (ACOs) reduce costs and improve health." The authors include reference to a U.S. study of integrative health care that found that "clinical and cost utilization over a seven-year period showed a 60.2 percent reduction in hospital admissions, 59 percent reduction in hospital days, 62 percent decrease in outpatient surgeries and procedures, and 85 percent reduction in pharmaceutical costs when compared with conventional medicine alone." [Though not directly cited, these data are from this report from Alternative Medicine Integration Group, an Integrator sponsor."]
Comment: The article may be as useful for those unfamiliar with ACOs as it is for those unfamiliar with integrative health care. I shared the article with Rick Branson, DC, a leader among chiropractic doctors in exploring the role of that profession in medical homes and ACOs. He states: "This is a good article to share with busy hospital admin folks as it is short and gets to the point." (Thanks to Dan Redwood, DC, for sending the link.)
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Couch potatoes endorse yoga
ESPN's absolutely scientific poll comes down in favor of pro sports teams "embracing yoga"


Those who receive multiple, daily pushes from Huffington Post will have had the opportunity on February 25, 2011 to waste some time by clicking into a piece called "5 Ridiculous ESPN Poll Maps." These show ESPN viewer responses from different states on a variety of questions. One was: "Should more sports teams embrace yoga?" The overall response from this group of sports fiends and coach-potatoes was "yes" by a 60-40 vote.  ESPN watchers from Alaska, Delaware and Iowa were outliers in voting thumbs down on yoga.
Comment: First, the findings suggest that integrative health backer US Senator Tom Harkin (D-Iowa) still has some work cut out for him in his home state. Second, this ranks as a 3rd significant endorsement of a distinct integrative practice in this Round-up. First, there is policy leader and HHS Secretary Sebelius, above, backing chiropractic's vital role in the health system. Next, below, Seattle delivery system Swedish Medical Center supports integrating the care of naturopathic doctors to enhance chronic disease treatment. Now, this patient-centered perspective (if this concept extends to the wished for treatment of  one's televised sports companions). The ESPN poll may mean we've hit a tipping point for integrative practice ...

Academic Medicine

Focus on integrative mental health for conventional academic consortium


The Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) is highlighting developments in integrative mental health. According to a recent notice to members,
the CAHCIM executive committee approved establishment of a sub-group of the CAHCIM Clinical Working Group that focuses on integrative mental health care. The action was taken "in response to the unsatisfactory state of mental health care in the U.S. and other countries, and increasing public and research interest in integrative mental health care." The group operates with 4 goals:

  • systematically evaluating research evidence pertaining to non-conventional and integrative assessment and treatment approaches in mental health care
  • recommending research priorities to the Consortium leadership
  • developing resources for educating and training mental health professionals in integrative mental health care, and
  • establishing best practice clinical guidelines in integrative mental health care for common psychiatric disorders.

Important aspects of the group's work in 2011 are expected to be developing an agenda on research priorities in integrative mental health and facilitating collaborative research efforts between different Consortium member institutions. Leaders include Ron Glick, MD and Kelsey Hippen.


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Historic involvement in policy renewed
Bastyr University Launches Center for Health Policy and Leadership 

On February 17, 2011, Bastyr University kicked off a new Center for Health Policy and Research. The center will be led by Gregory Goode, chief of staff to Bastyr president Daniel Church, PhD. The vision for the new center has 3 elements.

  • Encourage active participation in public affairs through thoughtful citizenship and public service.
  • Provide a forum for nonpartisan, critical discussion of all topics relating to health.
  • Serve to build community and integrate the disciplines of natural medicine through education, discussion and connection.

The ceremony coincided with an onsite meeting of the board of directors of the Integrated Healthcare Policy Consortium (IHPC) for which the multi-disciplinary Bastyr, alone among the institutions with a naturopathic medical program, is a Partner in Health. William Reddy, LAc, helped kick off the Bastyr Center with a talk on the role of health reform on the acupuncture and Oriental medicine field.
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Church: Importance of institutional leadership
Comment
: This is a welcome step for an institution that has played significant roles in integrative care policy in the past. These have included significant involvement in the White House Commission on CAM Policy on which founding president Joseph Pizzorno, ND, served with exceptional staff support from Bastyr's then policy leader Pamela Snider, ND. Snider had earlier had a significant influence on the language in the NCCAM mandate and played a key role, with Bastyr sponsorship, in the development of the National Policy Dialogue to Advance Integrated Health Care that helped birth the IHPC. More recently, Bastyr has supported the "integrate the disciplines" portion of its vision point #3 as a Sustaining Donor of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), one of just two "CAM" institutions to be supporting ACCAHC at that level or higher. Great to see Church, Goode and Bastyr stepping up here. More of our schools need to know that, while they are C3 organizations, that they can be key instruments of local, state and national policy. (Alignment of interest note: I am in ACCAHC's leadership.)


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Deans assert value of CAM/IM program
Academic Dean(s) at Minnesota Declare Reasons for Supporting Center for Spirituality and Healing 


A blogger's antagonism toward complementary and alternative medicine and in particular, homeopathy, led him to lambaste the University of Minnesota Center for Spirituality and Healing, directed by Mary Jo Kreitzer, RN, PhD FAAN. Kreitzer shared this response from Frank Cerra, MD former vice president and medical school dean, University of Minnesota Academic Health Center and the current holder of those positions, Aaron Friedman, MD.
"In a February 4, 2011 blog post-turned-editorial, University of Minnesota associate professor Bill Gleason openly questions why a University with an evidence-based medical school would dedicate resources to a Center for Spirituality & Healing (CSH).

"We thought that was an excellent question, so are pleased to have an opportunity to respond.

"The Center for Spirituality & Healing was established in 1995 during a period of time when medicine and the health professions in general were coming to terms with the idea that what we don't know about improving human health is far greater than what we do know within the confines of our traditional, Western-based practice. The original concept was to develop a program that provided faculty, students, and the community with an entry point to what's now called integrative medicine, or integrative health care.

   
"Since its inception in 1995, the Center
for Spirituality & Healing has helped
push health care forward. "
 
    
"Since its inception in 1995, the Center for Spirituality & Healing has helped push health care forward.  Students have been and continue to be one of the major drivers for the growth of CSH by crossing disciplines to expand their field of study and adding integrative medicine insight to their scope of study. The Center's growing number of faculty educates health professionals on new models of care and positions consumers at the center of their health care. Most importantly, the Center helps patients more effectively navigate the health care system, a benefit to any health provider.

"The field of health care is undergoing profound change.  Today, patients more frequently combine a complementary treatment approach to traditional therapies. They're also taking a more active role in the health care decisions that impact them and to do so, are seeking care from providers who are able to safely and effectively integrate these two types of therapies. Such a shift is an asset - not a threat - as we look to treat the entire patient.

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Kreitzer: Her work lays solid foundation
"The operating principle of the CSH is to have an evidence-based approach to complementary approaches to health, and also to promote comparative, evidence-based research between complementary and traditional therapies-knowledge that providers need to best serve the patients coming to them for integrative care. So in charging the University with wasting its resources in supporting the CSH, Gleason couldn't be further from the truth.


"In actuality, only a small percentage of the Center's funding comes from University resources. The rest, it earns through tuition revenue, philanthropic gifts, and extensive research funding.  Integrative medicine is an internationally recognized area of study, including by the National Institutes of Health, and our CSH has been very successful in competing for NIH funding.

"For all of these reasons, the CSH is a great investment with incredible returns. In fact, for every University dollar invested in the CSH, it leverages such funding to generate ten more dollars. If all University Centers, Institutes, and faculty functioned as efficiently or as productively as the CSH, our University would be on very solid footing indeed.

   
   "  .. it would be the height of arrogance
to think that one line of thinking could
possibly supply every brush stroke
needed to complete the overall scene."


"The University of Minnesota's Center for Spirituality & Healing was founded on the assumption that Western medicine may not have all the answers.  In 2011, what we don't know about improving human health still exceeds that which we do know.  Perhaps this will always be the case.

"But either way, it would be the height of arrogance to think that one line of thinking could possibly supply every brush stroke needed to complete the overall scene.

"In its short 15 year tenure, the CSH has established a model curriculum, hired faculty, and developed a graduate minor as well as a post-baccalaureate certificate program. And for 15 years, the Center for Spirituality & Healing has enriched health and well-being by providing high-quality interdisciplinary education, conducting rigorous research, and delivering innovative programs that advance integrative health and healing.
 
"We look forward to discovering what the next 15 years holds for not just our Center, but the field of integrative medicine as a whole.

"It's critical to remember that our University is a state-wide resource and its mission is to serve the whole patient, the whole state, and the nation."
Meantime, the U Minn program's celebration of its 15th year was featured here on the the University's website.
Comment: This was an extraordinary, direct statement on how an academic health center views its integrative medicine shop. It says a lot about Kreitzer's work over the last decade and a half.

Education for Integration


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Institute begins nurse training to deliver CAM
Nurse Trainings at VA Medical Centers Launched


The Samueli Institute  reported in its February 2011 newsletter that is has "launched the first in its series of four training programs in holistic nursing philosophy, theory and practice along with instruction in select complementary and alternative medicine (CAM) practices for almost 100 nurses from Veterans Administration Medical Centers in Long Beach and Los Angeles." According to the newsletter, the trainings are one component of a larger study that it is testing in both military and civilian hospital settings. The project began last fall with
an introduction to the concept of Optimal Healing Environments to each hospital's administrative team meant to "demonstrat(e) its potential impact on patient safety, patient satisfaction and improved outcomes." In the fall of 2011, the Institute will meet again with "both administrators and nurses ...  to ascertain increased knowledge of the business case for creating healing environments, and increased comfort with knowledge and use of complementary medicine and other factors."

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Seeks enrollees for branded training
Karan's Urban Zen Integrative Therapists training accepting applicants

 
Urban Zen Integrative Therapists (UZITs), a project led by philanthropist Donna Karan, is
currently accepting new applicants for the 2011 program. Urban Zen describes the year long UZIT curriculum, which was developed in the context of an inpatient partnership with Beth Israel's Department of Integrative Medicine, this way: 
"Students from the healthcare and yoga communities are trained in five modalities of treatment; yoga therapy (breath awareness, in-bed movement, guided meditation), Reiki, essential oil therapy, nutrition and contemplative care.  Each modality is introduced separately and then students are taught how to integrate the modalities to address whatever symptoms the patient or client is experiencing (pain, anxiety, nausea, insomnia, constipation (PANIC)). Once integration has been instructed, students begin their practical experience during their clinical rotation hours working with patients, loved ones and caregivers.  One hundred hours of such practice is required for certification."
A six minute video from Urban Zen, including comments from patients, therapists and Beth Israel's integrative medicine leaders Woodson Merrell, MD and Ben Kligler, MD, MPH, is here. Applications to the programs are available here.  Urban Zen hopes eventually to spread similar care delivery programs into facilities throughout the country.
Comment: One appreciates the commitment of Urban Zen to preparing professionals for inpatient integrative service while wondering at the strategy about the efficiencies of promoting a new profession instead of fashioning partnerships with existing groups. If the desire is truly to roll out new delivery across the country, partnership would be a more efficient strategy than branding the Donna Karan collection of integrative therapists.
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Labriola: Co-director of program
Seattle Swedish Hospital promotes MD-ND ties

Along with the University of Washington, Swedish Medical Center is the dominant player in the Seattle market. On April 8, 2011, Swedish will host a one-day educational event entitled The Art and Science of Combining Naturopathic and Allopathic Medicine in the Clinical Setting. According to materials from the hospital, the sessions are "designed to open the lines of communication between allopathic and naturopathic health-care providers engaged in the prevention and management of chronic diseases." The brochure further states that "improved communication between the two disciplines will enhance competency for health-care providers using traditional and/or alternative treatment methods in the prevention and treatment of heart disease, stroke, cancer, gastrointestinal disorders, and metabolic syndrome." The course co-directors are Daniel Labriola, ND and Sarah Speck, MD. Labriola, a long-time director of naturopathic medicine for Swedish, sits on the board of the Society for Integrative Oncology.
Comment: The direct embrace of NDs as partners in this brochure from Swedish makes me think that there may actually be a post-prejudice era of affirmative integration on the horizon.

Organizations

ImageBoard Certified Holistic Nurses: How many are there?

I recently contacted the American Holistic Nurses Certification Corporation for information on the number of holistic nurses. Here is the response: "
Since 1996 over 1500 people have applied for certification in holistic nursing. Since then many have retired, some have died, and some of them have not successfully passed the examination. At this time we have 899 nurses who are actively certified in holistic nursing. 303 are certified at the basic level as HN-BC; 314 have a baccalaureate degree or non nursing graduate degree and are certified as HNB-BC; and 282 have a MSN or PhD and are certified at the advanced level as AHN-BC. In addition there are currently 180 applicants in process: 40 at the HN-BC level; 82 at the HNB-BC level ; and 58 at the AHN-BC exam level." Thanks to Barbara Dossey, RN, PhD, AHN-BC and Margaret Erickson PhD, MSN, CNS, APRN, AHN-BC for the information.
Summary: I was surprised that the numbers are this low, especially given the extent to which nurses are employed in key roles in integrative centers and hospital-based integrative care. Despite recognition by the American Nurses Association, the certification doesn't seem to have yet drawn significant interest.
ImageBravewell to host 5th leadership award event November 10, 2011

The Bravewell Collaborative of philanthropists in integrative medicine will hold its 5th Biennial awards event on November 10, 2011 in New York City. The black-tie gathering will be hosted by Mehmet Oz, MD. The award was established to honor "champions who are willing to undertake the risks and sacrifices necessary to catalyze the change" Bravewell is seeking to spread an integrative medicine model. The recipient will be a physician or an individual with a PhD-level degree. In past years, the award has been $100,000.  Jonathan La Pook, MD, will headline an afternoon educational the same day.
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Family practice group opposes nurse independence
Push-back: AAFP, other MD specialties tell IOM they got it wrong on freeing nurses


Chiropractic and naturopathic physicians are among the fields that have believed they can help meet the nation's primary care shortage. So the discussion following the release of the Robert Wood Johnson Foundation-backed and Institution of Medicine produced report on the Future of Nursing may be of particular interest to these disciplines. The IOM recommended a vast expansion of independent practice by nurses - linked to new educational standards. Of note recently: the American Academy of Family Physicians joined other groups to weigh in against the IOM's recommendation. Under a headline "AAFP tells IOM: 'Nurses and physicians are not interchangeable," the AAFP:
" ... called on the Institute of Medicine, or IOM, and the Robert Wood Johnson Foundation, or RWJF, to clarify recommendations promulgated in an IOM report on nursing that call for removing scope-of-practice barriers for advanced practice registered nurses, or APRNs, in all states."
The basic message: MDs/DOs need to be the heads of practitioner teams. Joining the AAFP in the letter were the American College of Physicians, the American Academy of Pediatrics, the American Osteopathic Association, and the American College of Obstetricians and Gynecologists.
Comment: An online post from "Clarissa" in response to the AAFP notice is to the point: "The emphasis on differences in training is not very compelling because it says little about whether NP's can provide comprehensive, quality care for less cost."
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Seeking a solid foundation
AAAOM continues to take steps to right it's course

A column in Acupuncture Today by Doug Newton, operations manager of the American Association for Acupuncture and Oriental Medicine details steps that the organization is highlighting in its long walk back to greater functionality. One focus is the May 13-14, 2011 conference, in collaboration with the IM program at the University of Maryland, entitled Whole Medicine: Teaming Up for Our Patients. The meeting will be kicked off with a session entitled The Next Frontier: Acupuncture and the Principles of Oriental Medicine in an Integrated Hospital Setting. Meantime, according to Newton, most of the organization's activity is focused on present frontiers such as: responding to negative media (here is a response to Edzard Ernst, whose anti-acupuncture article earned him the Integrator's Bottom-feeder of the Year Award for 2010); promoting the use of licensed acupuncturists; and building the organization's membership. One key program described in the letter involves a membership campaign in which donations from vendors amount to more than the price of membership.
Comment:  Perhaps one day we'll have a robust voice for this field in US policy. It must be exceedingly tough to still be boot-strapping at this date.
Homeopathic accreditation organization renamed Accreditation Commission for Homeopathic Education in North America (ACHENA) 

Accreditation Commission for Homeopathic Education in North America (ACHENA) is the new name for the former Council on Homeopathic Education (CHE). Heidi Schor, CHT, serves as the point person and director of ACHENA.  The organization plans to seek recognition from the US Department of Education as the recognized accrediting agency for homeopathic education programs. Success would create a necessary platform for the acceptance and inclusion of homeopathy in US health care.

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Lampe: Takes communications role for herb group
American Herbal Products Association names Frank Lampe to communications position

Frank Lampe, a long-time leader in integrative health communications, is the new director of communications for the American Herbal Products Association (AHPA). A release from AHPA notes that Lampe,
co-founder of Natural Business Communications, is one of the pioneers in the LOHAS (Lifestyles of Health and Sustainability) marketplace. Lampe will oversee AHPA's communications, media, and marketing initiatives as well as contribute to member support and development. In a note to the Integrator, Lampe, most recently with Innovision Communication, muses that "this will be a good fit on many levels, and strategically, AHPA really needs to come play in the IM space sooner than later."

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Acu detox group in significant growth
National Acupuncture Detoxification Association: Growth in Transition

The January 2011 issue of Guidepoints, the newsletter fo the National Acupuncture detoxification Association, reports that the field and the organization are each growing. Nada boasts 1858 members, up 400 from the previous year. The growth is attributed to increased training of specialists;\. The issue reports that 458 people completed the training in 2010 as compared to 210 in 2009. NADA trainers,
viewed as the "bricks and mortar" of the movement, total 115 "in the U.S., on Native American reservations, and in Canada."  The organization, now under the direction of office manager and acu detox specialist Sara Bursac, LCSW celebrated its 25th anniversary in 2010.


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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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