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 Integrative Medicine and Integrated Health Care Round-up #44: June 2011 
 
The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series
Summary: British Columbia government partners with InspireHealth to expand integrated cancer care to 5 new clinics ... U.S. panel seeks to implant complementary and integrative services in US prevention and health promotion strategy ... HRSA-backed push for team care announces collaboratively-developed competencies; opportunity for integration ... Jill's List invites massage therapists, acupuncturists, chiropractors into integrative pilot with Boston Medical Center, others ... "CAM" academics publish Competencies for Optimal Practice in Integrated Environments ... New NCCAM site for conventional providers includes 25 practice-guidelines with CAM; Briggs notes value of CAM use in promoting health-focused dialogue between MDs, patients ... Major oncology group includes integrative care track ... Penny George Institute offers focused integrative practitioner programs for AOM, massage professionals and administrators ... Myrna Brind Center for Integrative Medicine a marketing jewel for Jefferson Health System ... Bermans' U Maryland program celebrates 20th year with $20-million campaign, $7.5-million committed ... Alliance for Massage Therapy Education promotes significant changes in mechanisms for massage certification ... Haramati's Georgetown program and Winterstein's National University of Health Sciences in collaborative agreement ... Tai Sophia celebrates growth and commitment to a wellness paradigm at 30 year mark ... Naturopathic leader reports on AMA meeting with Coalition for Patient Rights ... NCCAM focuses on real world research at Advisory Council meeting ... Deloitte study finds CAM expenses a key portion of "hidden costs" of health care ... New Yorker writer names provider income as major cause of cost growth ... Anthony Hamm, DC named to leadership of key AMA cost panel ... Natural Products Foundation turns in 13 companies to FTC/FDA for false advertising ... American Botanical Council reports 3.3% growth in botanical sales in 2010 ... Wayne Jonas, MD and InspireHealth to be featured at September 2011 Dr. Rogers' Prize event ... Jeff Bland, PhD honored by Institute for Functional Medicine's with Linus Pauling award ... University of Arizona Center's integrative medicine residency honored by Society of Teachers of Family Medicine.



Policy

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Government agency stimulates integrated cancer care
British Columbia government backs 5 clinics for integrated cancer care


"Integrated cancer care is part of our commitment to support British Columbians make the healthier choice, the easier choice. Integrated cancer care provides cancer patients with access to improved physical, emotional and nutritional health as well as new opportunities for patients to engage with practitioners about natural therapy interventions and healthy lifestyles." So states British Columbia Minister of Health Michael de Jong in a June 3, 2011 release that announced a partnership with not-for-profit InspireHealth to establish 5 integrated cancer centers throughout the province. The centers will open in Victoria, Kelowna, Abbotsford and Prince George and additionally include "a virtual one in Vancouver to serve rural and remote parts of British Columbia." The new InspireHealth centers are scheduled to open in a phased approach beginning in September 2011. Full implementation is expected by September 2012. The centers will open as part of Healthy Families BC. InspireHealth, began operating its anchor Vancouver center in 1997.

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Gunn: InspireHealth CEO
In the release, the BC agency portrays integrated cancer care as "combin(ing) nutrition, exercise, and stress management programs with standard cancer treatments to promote an overall healthier lifestyle, which is proven to lead to better patient outcomes and cancer survival rates." According to the release:
"Core health classes, dedicated to supporting health and healthful lifestyle changes such as healthy nutrition and cooking classes, exercise, medication, yoga, shared learning groups and stress reduction classes will be offered at all integrated cancer care centres ... Access to InspireHealth's physicians and nurse practitioners is free. InspireHealth has a number of other programs including core health classes, as well as a two-day LIFE Program that costs $445 for the first year of membership and $95 for annual renewals. The fee is waived for patients on Medical Service Plan Premium Assistance. In-house therapy practitioners -such as massage therapists, acupuncturists and naturopathic doctors - have patient-pay-fees."
InspireHealth, co-founded by Roger Rogers, MD and current CEO Hal Gunn, MD, is funded through a mix of physician salary support, patient fees and private donations. According to the release, the Ministry of Health is providing one-time, start-up funding of $2.5 million for the five centers. Additional annual funding of $2.5 million from the Provincial Health Services Authority will provide up to 12 additional medical doctors. The investment is portrayed as "directly complementary to the work of the BC Cancer Agency."
Comment: This is a truly remarkable governmental investment. Can US policy-makers allow themselves to be led by their Northern neighbor? That InspireHealth co-founder Rogers had left a tremendous legacy is evident via the Dr. Rogers Prize, named in his honor. Funded through the John & Lotte Hecht Memorial Foundation, the prize awards $200,000 every second year to an integrative medicine leader. (See notice of September 2011 event under Awards, below.) This expansion of InspireHealth as official provincial policy is phenomenal testament to the enduring value of Rogers' work and that of InspireHealth co-founder Gunn.
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Van Horn: Key player in shaping integrative health
Complementary and integrative language in recommendations of Advisory Group to National Prevention and health promotion Council


On May 24, 2011, the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health met for its second time. Two integrative practitioners
were appointed to the Advisory Group to reflect the nominal importance of "integrative health" in the new federal initiative: licensed acupuncturist Charlotte Kerr, RSM, BSN, MPH, LAc and integrative medical doctor Sharon Van Horn, MD, MPH. A slide presentation that kicked off the meeting announced the Advisory Group's recommendations. The first was entitled "Clinical and Community Preventive Services." It reads: "Enhance coordination and integration of clinical, behavioral, and complementary health strategies." Also described were 2 Advisory Group working groups established to move key areas of identified interest. The first is on co-benefit design. The second is entitled "Working Group on Prevention (Clinical and charge:

  • Gather background information and evidence that can be used to effectively describe a continuum of services that includes clinical, community, and integrative approaches to prevention.

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Kerr: Key player in shaping integrative health
The working group will develop the basis for a full Advisory Group discussion "of how the new health care delivery and financing system envisioned in the Affordable Care Act can best support this continuum." The group will also "collect additional background and engage experts from agencies involved in the design of the reformed system (HHS/CMS), as well as other agencies that provide for health care (e.g., DOD and VA)."
Section 4101 of the healthcare overhaul law which created the Council, described here, includes 3 references to "integrative health" in the Council's top 4 "purposes and duties." (Bolding added.)
Comment: New here is the inclusion of the word "complementary." In this era of integration, if "CAM" (or complementary) is not explicitly mentioned, one can still bet that these therapies and providers will be excluded. So this language is important. More exciting is the focus on clinical preventive services. Clinical prevention in "integrative health" goes beyond immunizations and screening to true primary prevention. The naturopathic doctors sublimely call this treating disease by restoring health. Now that would transform health care. Here's hoping Van Horn and Kerr and those working with them make some noise about a health-creating way of practicing primary care. Might they suggest that the government of British Columbia (see story immediately above) is providing a model of secondary clinical prevention and health promotion which we might embrace here?
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Wakefield: Running point for team-care push
HRSA, foundations and academic organizations make historic push for team care; possible value for CAM/IM


On May 10, 2011, a powerful consortium of healthcare leaders joined to promote team care at an event at the National Press Club. This column in the Integrator suggests the initiative may be an exceptional opportunity for "CAM" practitioners and integrative medicine. Joined on the stage were Mary Wakefield, RN, PhD, administrator of the Health Resource Services Administration, and leaders of the powerful Robert Wood Johnson Foundation and
Josiah Macy Jr. Foundation. With them were representatives of national academic organizations representing conventional medicine, nursing, public health, pharmacy, osteopathy and dentistry. The group officially released two collaboratively-developed documents: Core Competencies for Interprofessional Collaborative Practice and Team-based Competencies: Building a Shared Foundation for Education and Clinical Practice. George Thibault, MD, president of the Macy Foundation made the case: "We have good evidence that health care delivered in teams is more efficient and more effective, yet we continue to educate our health professionals in silos. We will not have health reform unless we change the way we imprint our students. We cannot change healthcare unless we change education."
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Thibault: Urges academics to break down silos
Comment
:
One intriguing political outcome of these initiatives is the language with which the American Medical Association greeted the members of the Coalition for Patient Rights (CPR) in a recent meeting. CPR's leaders were protesting the AMA's organized efforts to squash their scope expansions. The AMA greeted the nurses, psychologists and naturopathic doctors and others with strong expressions of the importance of team care and multidisciplinary collaboration. (See "AMA meets with representatives of the Coalition for Patients Rights," below.) Wouldn't it be nice if the AMA actually let go of its need to dominate? Actual competence in the "interprofessional collaborative practices" will require they AMA to do so. And the patient-centered focus of these competencies will require them, if they act in integrity, to include "CAM" practitioners. Note however that it was the American Association of Medical Colleges, not the AMA, from which the MD leaders who endorsed the competencies were selected. Still, these interprofessional efforts are tremendous steps, if remedial, for healthcare.

Integrative Delivery

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Piloting CAM/IM networks with hospitals
Jill's List invites LAc, DCs and massage therapists to pilot referral program with 3 Boston medical centers


Applications are open to
Boston-area massage therapists, acupuncturists and chiropractors to become credentialed participants in a new program with Boston Medical Center, Spaulding Rehab Hospital and Beth Israel Deaconess Medical Center. The initiative, developed and managed by Jill's List, is called Comprehensive Medicine for All. The internet-based business is seeking 30 practitioners for a 3-month initiative. The site tells prospective participants that if they "would like to participate in this program you must be willing to donate 2-4 hours of pro bono time per week to the Pilot Program." With this labor comes potential reward: "Hospitals will refer both MASS HEALTH patients and patients who are willing to pay out of pocket for treatments not covered by insurance." Jill Shah, founder of the well-connected internet start-up, hopes to see the program flourish in Boston then expand to other major metropolitan areas. Among those on the Jill's List advisory board are Mark Hyman, MD, David Reilly, MD, former editor of Alternative Therapies in Health and Medicine (ATHM), Michele Mittelman, RN, ATHM's former nursing editor and a Bravewell member, plus former Bravewell member and thought leader Linda Stone.  
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Shah: Planning national roll-out
Comment
: I have on occasion spoken with Shah, an experienced internet entrepreneur. Each time I have been impressed by her quick grasp and constructive reframing of both the challenges and opportunities in the integrative space she is seeking to create for Jill's List.  She and the organization get 5 stars for understanding the critical importance of relationship-building behind this pilot. Relationships seems to be key to the network's emerging business model.

ImageEducators from licensed CAM disciplines publish Competencies for Optimal Practice in Integrated Environments

An organization of educator leaders in chiropractic medicine, acupuncture and Oriental medicine, naturopathic medicine, massage therapy, direct-entry midwifery and related fields announced in May 2011 a set of collaboratively-developed
Competencies for Optimal Practice in Integrated Environments. Mike Wiles, DC, MEd,vice president and provost at Northwestern University of Health Sciences explains the importance of the initiative:
"The era of integration is here. Yet the educational standards and clinical models of the licensed integrative healthcare disciplines are generally not emphasizing integrative models of care. These competencies focus us all on the current and future needs of providers."
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Wiles: Integration era requires educational changes
The work was engaged in late 2009 through the Academic Consortium for Complementary and Alternative Health Care (ACCAHC). One of Wiles' collaborators, Jan Schwartz, MA, a massage professional and online educator with Education Training Solutions, notes in an ACCAHC release that the organization's
"central focus going forward is the development and hosting of an extensive body of resources that will assist educators, students, clinicians and administrators toward bettering patient care through the identified competencies." ACCAHC, notes Schwartz, is seeking philanthropic partners to create what it calls the Center for Optimal Integration as a clearinghouse and organizing site for this work. Other leaders of the Competencies initiative are Marcia Prenguber, ND and Jason Wright, MS, LAc. (Alignment of interest note: I was involved in ACCAHC's work to develop the competencies.)
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Prenguber: Health system role underscores competency needs
Comment
: When conventional medicine dropped a box over scores of disciplines and therapies and declared them "CAM," they created false community. Author Kurt Vonnegut calls this a "granfalloon." These collaboratively-developed competencies, on the other hand, are a significant declaration of an actual community of interest. ACCAHC plans to ensure that the competencies don't merely gather dust on a shelf by creating the
Center for Optimal Integration. This portal will work to continuously re-invest the involved fields in this work in collaborating to enhance optimal integration. Note the parallel with the work of the 6 conventional academic fields noted in the article on collaboratively-developed team care competencies in this Round-up. The medium is the message. Marshall McLuhan would like this. 
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Briggs: Promoting NCCAM's new provider resource
Briggs' cites promotion of healthy behaviors as reason for MDs to talk CAM with patients; 25 CAM-related practice guidelines posted

The new Resources for Health Care Providers portal on the NIH National Center for Complementary and Alternative Medicine website includes links to 25 practice guidelines with CAM/IM components from conventional sources. These range from Alternative Therapies for Parkinson's Disease (Neurology) to Integrative Oncology in Lung Cancer (ACCP) and Management of Traumatic Stress Disorder and Acute Stress Reaction (Veteran's/Department of Defense). Each is presented as a down-loadable PDF. That NCCAM is proud of the new site is clear in this audio-file transcript of an interview with NCCAM director Josephine Briggs, MD. In her comments on the site, Briggs is asked why conventional practitioners should routinely be talking about CAM with their patients. She notes three reasons. One is potentially negative drug-herb-nutrient interactions. Another is the possibility that a patient is inappropriately using the alternative in lieu of a proven conventional treatment. The third, states Briggs, is:
"CAM practices are used by many Americans to promote health and it's also a valuable entry for the healthcare provider to talk about health behaviors. The advice that we need to be more active and eat a healthy diet is one that patients need to take charge of themselves and talking about their health practices, the whole range of health practices, is a very good way as a physician, and I know this from my own care patients, to begin that dialogue."
Comment: Credit Briggs for linking evidence that people use CAM therapies and providers for health-promoting reasons to the ongoing campaign for conventional doctors to discuss CAM use with their patients. The other 2 reasons (interactions, missed care) cast CAM the black hat role that is most comfortable for her conservative colleagues. Briggs' 3rd reason, however, is affirmative. The question of CAM use is urged to kick-start a conventional practitioner's shift out of reactivity toward more focus on health promotion. CAM stimulates stimulates changing the medical interaction toward a focus on health. This is high honor. Meantime, NCCAM provides a great resource by pulling all these guidelines into one place. Good work.

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Greenlee: ND presents poster, gives talk at ASCO
American Society for Clinical Oncology featured integrative track


According to a blog post from Glenn Sabin, a board member for the Society for Integrative Oncology, complementary and integrative medicine had a heightened profile at the 2011 meeting of the American Society for Clinical Oncology (ASCO). Sabin notes that his own efforts and those of others led to inclusion of a 5-speaker, 2-hour afternoon session entitled "Extended Education Session: Role of Nutrition, Supplements, and Integrative Medicine in Cancer Prevention, Treatment, and Survivorship." The integrated group of presenters included an ND, MD, 2 PhD, RDs and PhD researchers. In addition, the naturopathic doctor, Heather Greenlee, ND, PhD, and Gary Deng, MD delivered oral poster presentations. Sabin links the integrative interest to the "buzz this year around personalized oncology."
Comment: This is nice sign for ASCO, if rather remedial, given the comparison of governmental funding of integrated care cancer clinics in British Columbia. (See Policy, above.)
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Penny George: Institute provides practical teaching on integration
Penny George Institute offers
programs to educate massage therapists and acupuncturists on becoming integrative practitioners

The Penny George Institute, which operates the nation's leading inpatient-outpatient integration operation, offers three programs this summer as part of its Integrative Health in the Hospital Setting program.



Academic Integrative Medicine

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Myra Brind Center in former Federal Reserve Bank
Myrna Brind Center of Integrative Medicine a marketing pearl for Jefferson Health System

An Integrator interview with medical director Daniel Monti, MD and philanthropic backer Ira Brind offers insight into recent developments at the Myrna Brind Center of Integrative Medicine. The 13-year-old operation now provides over 12,000 patient visits annually in its posh home in a former Federal Reserve Bank building in downtown Philadelphia. Monti expects visits to grow more than 10% in 2011.
Clinical services are organized based on an MD-centric, collaborative model. Top diagnoses are cancer, pain, wellness, auto-immune and gastro-intestinal issues, according to Monti. Says Brind: "The Center, in this facility, has high strategic impact. The Center's value is not just it's bottom line. We have a very high profile list of clients here. Our reputation continues to grow. When doctors come they are impressed. That helps with referrals. We'll get more doctors to come here. The patients are impressed too." The Center has formed good partnerships with local media. Inpatient services are not presently a part of the mix, because there is no mechanism for payment. Brind thinks some aspects of the Accountable Care Organization model may offer future opportunities for inpatient payment.
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Ira Brind: Philanthropic backer and well-connected Jefferson leader
Comment
: The visit to the former Federal Reserve Building provoked an almost dissociative response. How can one not be dumbfounded by the cultural dissonance between these philanthropically-backed manifestations of integrative medicine and the grassroots, hang-up-a-shingle, natural/alternative medicine movement which seeded it? Brind's generously-based model seems to be working to attract his target clientele of health system and civic leaders.

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Brian and Sue Berman: 2 major initiatives in Maryland
Bermans' U Maryland Center celebrates 20th anniversary with kick-off of $20-million campaign


On May 17, 2011, the nation's charter academically-based center for complementary (and now integrative) medicine celebrated its 20th year. The University of Maryland Center for Integrative Medicine, founded by Brian Berman, MD and Sue Berman, used the occasion to cut a ribbon on new office space. They also kicked off a $20-million fundraising effort. An anonymous donor has given them a $7.5 million match grant. Speakers at the celebration evidenced the Center's importance to the local and national community. In
comments available here on the University of Maryland site, US Senator Barbara Mikulski joked that Berman was "a 20-year overnight success." She noted her admiration for both Berman and the University of Maryland leadership for embracing the integrative approach. She specifically called out Berman's policy role. She also underscored the key role his spouse, Sue Berman, has played in the Center's growth and success. Another speaker, Albert Reece, MD, PhD, MBA, U Maryland's vice president for medical affairs, honored the Center for "an impressive list of over 400 peer-reviewed publications, which has significantly expanded the body of knowledge about integrative medicine and how it can be used to treat diseases and conditions such as arthritis, chronic back pain, inflammatory bowel disease, and cancer pain." Other speakers included U Maryland president Jay Perman. He credited the Bermans' team for modeling academic collaboration and interprofessionalism. 
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Mikulski: Praising the work of her constituents
Comment
:
Brian Berman brought to Maryland what was already a rich, clinical experience and curiosity. In the 1980s he had studied and practiced acupuncture and homeopathy in England, and explored other integrative practices prior to the founding of the Center. All the while, his interest and skills in Western medical research led him to become the most funded of researchers by NCCAM. His group has had over $30-million in grants. Yet the work at U Maryland has always seemed, as Mikulski pointed out, the success of not one but two Bermans. Comments on the site from Mikulski, Reece and Perman speak to the abilities of the Bermans' as educators and diplomats in the Maryland system and in US policy. The $20-million campaign is an interesting addition to their ambitions for The Institute for Integrative Health, which they founded in 2009. The health of Baltimore and the nation will each be bettered by their work in the next two decades. Congratulations!
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Alliance: Pushing field toward new alignment on certification
Alliance for Massage Therapy Education urges changes in national certification for massage

A press release from the young but ambitious Alliance for Massage Therapy Education calls for significant changes at the National Certification Board for Therapeutic Massage and Bodywork (NCBTMB). Alliance executive director Rick Rosen, MA, LMT, took the lead on an 8-page position paper entitled The Optimal Role of National Certification in the Massage Therapy Field. Rosen argues that shifts in the field in recent years have altered NCBTMB's relevance. The first shift is vast expansion in massage licensing and the creation of the Federation of State Massage Therapy Boards which now offers a unified licensing exam. According to the report, over 80% of recent massage graduates take the new exam. NCBTMB's certification formerly served this role. Rosen argues that NCBTMB should focus on specialty certification for those among the nation's 250,000 licensed massage therapists who are choosing to work in focused environments, such as inpatient care. In addition, Rosen urges NCBTMB to sunset its own continuing education approval program and adopt the program the Federation and Alliance collaborated to develop.
Comment: The Alliance is to the massage field as the Community Acupuncture Network is to the acupuncture field. Each is a "disruptive innovator." NCBTMB's role as a support for licensing agencies has certainly diminished. The altered role, however, will also mean a significantly decreased budget for the NCBTMB.

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Winterstein: Backed NUHS-Georgetown relationship
National University of Health Sciences and Georgetown University program launch agreement for mutual cooperation


Lombard, Illinois-based National University of Health Sciences (NUHS) announced on June 1, 2011 a new cooperative arrangement with the graduate program in complementary and alternative medicine (CAM) at Georgetown University at Georgetown University Medical Center in Washington DC. Under the agreement, "faculty at the two schools will work together to help students seeking advanced degrees in health care." They will do so "by advising students of the benefits of each other's programs and providing preferential seating and advanced standing in each other's programs when appropriate." NUHS offers degrees of doctor of chiropractic, doctor of naturopathic medicine, master of science in acupuncture, and master of science in Oriental medicine. The co-director of the Georgetown program, Aviad "Adi" Haramati, PhD, says that the academic affiliation is intended to "break down the silos that hold the disciplines apart" and create relationships "between the disciplines and the educational institutions that prepare the nation's future healthcare providers." NUHS president James Winterstein, DC notes one particular value of the Georgetown program for NUHS students and applicants who have interests primarily in CAM research and public policy, but who may not wish provide care. The agreement with NUHS follows a similar agreement, reported here, that Georgetown developed with Bastyr University.

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Marks 30th year of onsite training
Tai Sophia graduates 233 from 7 programs in celebration of 30th year

Thirty years ago, June 6, 1981 was the start of the first acupuncture class taught at Tai Sophia in Maryland. From that single class of 23 acupuncture students, the multipurpose institute now has 10 graduate programs and nearly 500 students. Among the 233 total graduates, 65 in the founding Master of Acupuncture program were surpassed by 69 who completed a Graduate Certificate in Transformative Leadership. Tai Sophia provost and executive vice president for academic affairs Judith Broida, PhD attributed the growth to "a greater number of people and organizations seek(ing) an integrative approach to health and wellness and as individuals increasingly seek to work and live to their fullest potential." At graduation ceremonies, speaker Charles Eisenstein, a faculty member at Goddard College, presents Tai Sophia's value in terms of global change: "Our old ways of making sense of the world no longer make sense, and the tools based on these ways - tools of reason, of technology, of separation and control - are becoming less and less effective. Tai Sophia is grounded in a new and very ancient way of being human, and its graduates are helping to create a world aligned with it." Frank Vitale, MBA is the Institute's president and CEO.
Comment: Under founders Bob Duggan and Dianne Connelly, the Institute was outspoken about its efforts to model a radical break from the disease focus of health care and health professions education. Duggan calls school as an "academic wellness institution." The school's god-parent, and a teacher to Duggan, was Ivan Illich, author of Medical Nemesis. I've always been partial to the Duggan/Connolly outspoken commitment to wellness, especially having observed the tendency of many to be corralled into increasing disease orientation. It is good to see the Vitale-Broida team continue this focus.

Professions

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Nurse-led group meets with AMA on contentious issues
AMA meets with representatives of the Coalition for Patients Rights, focuses on team care

On May 10, 2011, the American Medical Association (AMA) met with fourteen representatives of the Coalition for Patients' Rights (CPR). The CPR was formed to oppose the AMA's efforts to restrict other disciplines' via the AMA's Scope of Practice Partnership. Its 3-dozen member organizations represent those for nurses, psychologists, audiologists, physical therapists, chiropractors, acupuncture and Oriental Medicine professionals and others. Among those in the CPR delegation were American Association of Naturopathic Physicians (AANP) executive director Karen Howard and president Carl Hangee-Bauer, ND, LAc. Howard filed this report to AANP members:
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Calls for a future with more team care
"This meeting was the result of a series of letters and phone calls from CPR to the AMA initiated in 2010 by a letter raising our concerns about the AMA's Scope of Practice Data Series. More than a year later, after numerous letters and conversations, the meeting was held. The meeting was cordial and frank, offering new potential to revise the existing documents originally created by a mandate of the AMA House of Delegates. Through our introductions and commentary, this face-to-face meeting with Dr. Ardis Hoven, Chair of the Board of Trustees, and Dr. Michael Maves, MBA, Executive VP and CEO, was respectful and collegial, focused on a need to move forward in recognition of how patient care is evolving in the field and, as Dr. Hoven described it, "team care." During the two-hour session a general commitment was expressed to continue to dialogue with a focus on seeking a shared understanding of how we could build interdisciplinary, patient-centered teams - what they would look like and how they are developed and maintained within different locales and settings. While no specifics were delineated, we did agree that staff from AMA and CPR will look for future meeting dates to come together and move forward productively."

Comment: Intriguing that the AMA responded with reference to interprofessional education and team care. One wonder what long-term value will be created between the AMA and these other guilds if the interprofessional education and team-care initiative that produced Core Competencies for Interprofessional Collaborative Practice spreads its root throughout health professions education and practice. (See related article, above.)


Research

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Advisory Council focuses on outcomes, effectiveness
NCCAM advisory council focuses on outcomes, effectiveness, cost at June 3, 2011 meeting

The real world portion of the 2011-2015 strategic plan of National Center for Complementary and Alternative Medicine (NCCAM) was a principal focus of the June 3, 2011 meeting of the National Advisory Council for Complementary and Alternative Medicine. Presentations and speakers were:

  • Outcomes and Effectiveness Research at NCCAM (Josephine Briggs, MD)
  • Science to improve the Nation's Health: The Case for Comparative Effectiveness Research (Michael Lauer, MD) 
  • Cost Minimization Analyses and Washington State's Approach to Funding CAM (William Lafferty, MD)
  • Complementary and Alternative Medicine at the Department of Veterans Affairs (Stephen Ezeji-Okoye, MD)
The NACCAM meeting was the first since the February 2011 release of NCCAM's 2011-2015 Strategic Plan.
Comment: This is an excellent signal of the importance of the "real world" to NIH and to NCCAM in the Briggs era. Outcomes and effectiveness, while mandated as top focus in the NCCAM enabling law from Congress, only accounted for 0.5%-2% of funding under first NCCAM director Stephen Straus, MD. This direction was elevated to Strategic Priority #3 in the 2011-2015 plan, with elements potentially in #1 and #2 also. Kudos to Briggs and her staff for this prioritization. If NCCAM wants to influence access and discover whether these integrative disciplines and approaches can make a difference in changing our typically dismal churning of reactive treatment, this is the way to go.

Cost

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Keckley: Former Vanderbilt IM leader co-authors Deloitte paper
Deloitte study highlights CAM as major portion of "hidden costs of healthcare for consumers" 


The consulting firm Deloitte announced in late May 2011 publication of a study that "aims to capture all health-related spending." The firm notes that
official National Health Expenditure Accounts (NHEA) do not capture many health expenditures. The study, entitled The Hidden Costs of Health Care for Consumers: A Comprehensive Analysis, found that actual costs in 2009 were at $2.83-trillion. This is roughly $357-$363-billion or 14% higher than official estimates. The Deloitte team "adopted a broad view of health care expenditures which includes both direct and indirect costs, as well as items such as functional foods and nutritional supplements, complementary and alternative medicine (CAM) goods and services." An estimated $55-billion were supplement costs, $28-billion CAM practitioner costs and $2-billion other CAM costs. Together these amounted to 24% of the "hidden costs." The CAM practitioner portion was estimated at $92 per capita.
________________________

Estimated Direct Annual Costs for Certain CAM-Related Services

Age Group
 
Nutritional
Products*
   CAM Practitioner
Costs
  CAM Products
Costs

0-18    $105.73    $30.57    $4.20
19-24    $69.18    $41.78    $2.79
25-44
   $122.27    $87.73    $4.93
45-64    $95.36    $153.94    $3.78
65 plus

$680.56

$137.98

$27.79
 
* Category includes functional foods and special health-related drinks.


Source: The Hidden Costs of Health Care for Consumers: A Comprehensive Analysis
Deloitte Development, LLC, 2011, page 18.
________________________

An additional category, "the imputed value of unpaid supervisory care provided to sick people by family and friends
" was estimated to be the single largest cost not included in NHEA reporting, at $199-billion. One of the two lead authors is Paul Keckley, PhD, former CAM/integrative medicine lead at Vanderbilt University. (Thanks to Taylor Walsh for the heads-up on this study.)
Comment: These data are most useful as a general awareness that US consumers spend even more on health-related care than the the already horrendously high costs. They are casting a wide note. For instance, inclusion of all nutritional drinks (Ensure, etc.) jacks the "Nutritional Products" category up significantly.  
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Surowiecki: Talk providers if you are focusing on cost
New Yorker economics writer aims cost-cutting guns at providers


"Discussions of health care in the United States usually focus on insurance companies, but, whatever their problems, they're not the main driver of health care inflation: providers are." The deadpan conclusion is the centerpiece of a column by the New Yorker's budget and debt journalist James Surowiecki. The column in the May 2, 2011 edition is entitled Bitter Pills. "One's person's 'waste,'" Surowiecki adds, "is another person's 'income' - the income of doctors, nurses, hospitals, drug companies, medical technology makers." And: "If we want to restrain the growth of health-care spending, less money will have to go to them." He concludes by stating that an ideal system "would guarantee all senors affordable health care, stop the debt from getting out of control and keep paying health providers as before." But: "The problem is, you can only do two of those things at once."
Comment: I reference Surowiecki's comment because it is my perception, also, that insurers are often made the scapegoats on health costs when more attention deserves to be focused on practitioners. No one much likes to think that one's provider's economic interests is a major player in clinical decisions and thus health care costs. The findings of Wennberg and others tell us we should. We certainly don't like to think it is our doctors. I saw an ophthalmologist recently for a second opinion regarding an eye issues related to an old basketball injury. She recommended a surgery. I said I knew that the Institute of Medicines has said some 50% of what we do is waste and much of that harmful. In which category is your recommendation, I asked her. How to win friends.
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Hamm: Chiropractor in historic role with AMA group
Chiropractor Hamm elected co-chair of powerful AMA payment committee

Anthony Hamm, DC, president of American Chiropractic Association's Council of Delegates, was recently elected co-chair of the American Medical Association's (AMA) Health Care Professionals Advisory Committee Review Board (HCPAC). According to a release from the American Chiropractic Association, Hamm is the
first doctor of chiropractic to be elected to the position. As HCPAC co-chair, Hamm will also serve on the AMA/Specialty Society Relative Value Scale Update Committee (RUC). The HCPAC develops recommendations on relative values for new and revised CPT codes for non-MD/DO services. The RUC makes annual recommendations on relative values regarding to the Centers for Medicare and Medicaid Services (CMS), 90% of which are adopted. The RUC also performs broad reviews every five years of the Resource-Based Relative Value Scale (RBRVS), which determines Medicare provider reimbursement. Hamm's two-year term begins in September. Hamm brings a long policy and teaching background relative to coding to his new position. According to the release, the ACA "strongly supported Dr. Hamm's nomination to this position given his clinical and socioeconomic experience and expertise in making appropriate recommendations for CPT codes across specialties."  ACA President Rick McMichael, DC added: "This historic event is consistent with the ACA's commitment to the delivery of high quality the heads-up on this news.)
Comment: Since my exploration of the value of the CPT to the AMA last year, which also touched on the powerful RUC, I had been surprised that no one has mounted an anti-trust case against the AMA's guild control of payment. (See The AMA's $70-Million Taxation without Representation: Is it Time for a "CPT Party" Revolt?). Hamm's elevation may be viewed as an interesting chess move.

Natural Products

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Self-regulation, plus reporting to federal regulators
Natural Products Foundation asks FDA and FTC to take action against 13 nutritional products advertisers


In a May 25, 2011 release, the Natural Products Foundation (NPF) reported that the organization's representatives met with representatives of the Federal Trade Commission (FTC) and the US Food and Drug Administration (FDA).
The NPF shared documentation "regarding 13 non-compliant advertisers who have failed to amend their marketing materials after being contacted by NPF's Truth in Advertising program." NPF asked the regulatory agencies to take action against those companies. Over the past 12 months, the Truth in Advertising initiative mailed 77 warning letters to companies marketing dietary supplements and making drug and disease claims. Most, according to NPF, followed by bringing their advertisements into compliance. NPF executive director Deb Knowles says the program's goal "is a level playing field for the responsible core of the industry, as well as making sure fringe companies aren't misleading consumers." In 2010 NPF notified the FTC of 12 companies who were out of compliance and unwilling to amend their practices. Marc Ullman of Ullman, Shapiro & Ullman, led the NPF team.
Comment: Talk of the need for self-regulatory efforts in the natural products industry has been as enduring as the talk of need for peace in the Middle East. Kudos to the NPF for developing the program and giving it teeth by turning state's evidence on non-compliant firms..
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Reports growth in herb market in 2010
American Botanical Council reports herb sales up 3.3% in US in 2010


On May 19, 2011, the American Botanical Council (ABC) announced its finding
that sales of herbal dietary supplements in the United States increased by 3.3 percent in 2010. This brought the total to an estimated 5.2 billion dollars. The finding was contained in the latest issue of HerbalGram, the nonprofit ABC's quarterly journal. The growth was below the 2009 rate of 4.8%. Among significant gainers were black cohosh (14%), ginger (17%), evening primrose (13%) and cranberry (15%). Sales fell for echinacea (20%), soy (13%), ginseng (10%), green tea (15%), grapeseed (20%) and elderberry (49%). The HerbalGram report is based on herb supplement sales statistics from market research organizations Nutrition Business Journal (NBJ), SPINS, and SymphonyIRI.


Awards

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September 23, 2011 event
Jonas, InspireHealth and depth exploration on integrative clinics to be featured at September 2011 Dr. Rogers Prize event

 

New information is available on events surrounding the September 23, 2011 Dr. Rogers Prize for Excellence in Complementary and Alternative Medicine. The keynote speaker will be Wayne Jonas, MD, CEO of the Samueli Institute and past director of the Office of Alternative Medicine at the National Institutes of Health. At a dinner event, Jonas will share his journey as a pioneer. In addition, the event's afternoon Colloquium to explore integrative medicine in 4 Canadian clinics will be facilitated by Harvard University's Allen Grossman. The featured clinics will include Inspirehealth (see related story under Policy, above) and Integrative Healing Arts. The discussion will explore barriers faced by the clinics. Breakout groups will examine questions on success factors and on the extent to which present models are fulfilling the needs of the patients. Registration is required for this free event. Early bird pricing for the dinner, featuring Jonas, is $125. Tickets are available for purchase.
Comment: If anyone in the U.S. was wondering why spend precious time and resources to journey to Vancouver to explore Canadian models of integrative care, the recent decision of the government of British Columbia to fund expansion of the InspireHealth model (see related article under Policy, above) should be reason enough. Best practices appear to be north of the border.
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Bland: Lifetime achievement
Jeff Bland, PhD honored with Linus Pauling Functional Medicine Lifetime Achievement Award


Nutritional medicine pioneer Jeff Bland, PhD was honored in May with the Linus Pauling Functional Medicine Lifetime Achievement Award by the Institute of Functional Medicine (IFM). Bland and his wife, Susan Bland, founded the Institute 20 years ago. In recent years IFM has attracted to its leadership such integrative and nutritional medicine luminaries as Mark Hyman, MD and Joseph Pizzorno, ND. IFM has just passed the threshold of 20 years of service. A release from IFM notes some of Bland's long history:
"With a PhD in biochemistry, Bland became a prominent educator for the natural foods Industry, served as President of the Northwest Academy of Preventive Medicine, and helped establish Bastyr University of Natural Health Sciences in the Northwest. In 1981 he was invited by two-time Nobel Laureate Linus Pauling to become the Director of Nutritional Supplement Analysis at the Linus Pauling Institute in Palo Alto, California. In 1984 he introduced the concept of using foods to create biochemical change, and started HealthComm, Inc..
Bland has been a thought leader and consultant to the natural products industry. More recently, he has focused on nutrition and nutrigenomics, the study of the effects of foods and food constituents on gene expression.

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Lebensohn: Directs award-winning program
U Arizona Integrative Medicine in Residency receives national Innovative Program Award


Society of Teachers of Family Medicine
(STFM) bestowed its
Innovative Program Award on Integrative Medicine in Residency (IMR), a program of the Arizona Center for Integrative Medicine. STFM's award honors excellence in the development of an original educational program or activity for family practice residents, students, or faculty. A release forwarded to the Integrator by ACIM director Victoria Maizes, MD describes IMR as "the first competency-based, online integrative medicine curriculum for residencies." IMR has been pilot tested in 8 academic institutions over the past 3 years. The positive results led ACIM to begin "early adopter programs." The curriculum and is now being utilized as part of a three-year residency at 14 residency programs nationwide. Director of IMR Patricia Lebensohn, MD, states: "We appreciate that STFM, the organization that represents the core users of our curriculum, is recognizing IMR's innovation, scope and, ultimately, potential impact on the education of future family physicians." Adds Maizes: "We believe this project has the potential to serve as a national model for training all primary care physicians in integrative medicine."

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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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