| ||Glenn Sabin on the Evolving Role of Philanthropy in Integrative Medicine||
Note: This article was written by Integrator adviser Glenn Sabin and originally posted here at Sabin's FON Therapeutics site. Sabin is a member of the board of the Society for Integrative Oncology. He has a passion for whole systems outcomes research. He consults with integrative practice clinics and centers on their business planning. Sabin showed me an earlier version of this column. I suggested a few changes and additions, some of which were incorporated. I follow Sabin's column with a couple of additional perspectives.
Over time philanthropy has contributed greatly to the maturation of
integrative medicine/oncology clinical programs. This is especially
true within the academic medical center setting, and has had a profound
effect on the growing consumer base of integrative medical services and
natural products-an industry now estimated at over $50 billion annually.
Philanthropic leaders with a passion for integrative care have helped
give these services a formal presence in some 50 of the nation's
academic health centers.
Glenn Sabin: Assisting integrative centers
Philanthropy Makes it Possible
- contributed to capital fundraising campaigns that have made
possible the formation of several major academic-based integrative
- supported the construction of several institutions' physical infrastructure, and even entire buildings
- enabled the creation of numerous educational and community outreach programs centered around integrative care
- substantially supported the educational program producing the growing cadre of academic integrative medicine leaders
- supported select integrative medicine research projects
- been utilized to subsidize clinical services
The Sad, Current Reality
If not for the largesse of philanthropic organizations that have
consistently supported academic-based integrative medicine and oncology
programs, many of these centers would be operating in the red, greatly
reduced in stature, or closed altogether. Often, it's the combination of
philanthropy, private foundations, angels, parental institutional
support and individual giving that keeps these centers afloat. The
generosity of philanthropists has been the consistent thread keeping
many a center together.
No Different Outside of Academia
While this post focuses on integrative medicine/oncology centers
under the rubric of academia, it should be noted that many
community-based hospitals and centers also rely heavily on philanthropy
and additional similar sources-i.e., private foundations, angels,
corporate coffers, individual giving and volunteers-to sustain their own
What about the Little Guys?
The independent centers, whether structured as 501(c)3 non-profit
entities or for-profit clinics, also struggle depending on their unique
clinic and business models. But for them, philanthropy is much harder
to come by. They typically don't have the necessary human resources or
wherewithal to seek this support thru consistent networking and
grant-writing. Staunch patient supporters do give, and local charity
organizations sometimes subsidize select services for those less
fortunate, but many independent clinics are able to survive by running
leaner operations than their academic brethren-and by implementing
various clinic and business models that cannot always be replicated
within an academic-based or community hospital setting. This post is
focused on philanthropy; a future post will home in on integrative
clinic and business models, some of which tie directly back to the
funding types discussed in this writing.
The fact is that operations in academic medicine have significant
additional levels of overhead and oversight. This makes them more
costly. And it is worth noting that conventional primary care operations
owned by health systems are often subsidized, sometimes handsomely. The
health system sees them as "loss leaders" for generating referrals to
their money-making inpatient operations. In this, outpatient integrative
centers are not so unusual.
Philanthropy for Research, Community Outreach and Education is Smart
Philanthropy is desperately needed to support the next generation of innovative integrative medicine research, especially whole systems designs
that look at outcomes based on sets of synergistic interventions-much
the same way comprehensive, high quality integrative medicine is
practiced in clinic. As long as there is no compelling commercial
upside for industry-who cannot easily create intellectual property
around natural products-philanthropy will be needed to support this
FON has reported on integrative medicine
community outreach educational programs being offered to consumers (and
medical professionals alike), and has offered tips for how to set up a program.
Without philanthropic support, these programs would be very difficult
to maintain. Done right, these experiential programs should and can
result in the increase of integrative services-increasing patient
volume-but often this is tough to track. Philanthropy remains important
for academic centers to get out and educate the community about
prevention and integrative medical care.
Philanthropy for the Support of Clinical Services is Not Good for the Business of Integrative Medicine.
I realize I will take some heat for this, but I'm going to just come
right out and say it: using philanthropic support to subsidize
integrative clinical services for all but the indigent or those that
cannot afford to pay is unsustainable as a clinic/business model; it can
be a costly long-term decision that has over time resulted in the
closing of many integrative medicine programs. These are typically
"step-child" programs that are championed by their leaders, but rarely
wholly supported by practitioner colleagues and those administrators
charged to run a fiscally viable medical center.
Economic Realities of Providing Integrative Care Under Recessionary Times
Let's face it: it's a tough economy out there and folks-including
middle class America-are often hesitant to pay out-of-pocket for
integrative medical services not covered by their insurance policies.
They have to be convinced of the benefit and overall economic value of
the intervention. But folks can afford and do spend money around their
health-on things like gym memberships, food choices and their
recreational activities. True, many integrative services are not
covered by payers-and help could be on the horizon-but
health consumers, especially those that have not had success with a
purely conventional medical route, can decide for themselves if there is
value to paying for a nutritionist, an exercise physiologist or an
I speak with center administrators of different types and sizes
daily, and quite a few are offering clinical services at no fee, fully
subsidized by philanthropy and/or additional sources like those noted
above. Most have more demand for integrative services than they have
providers to supply. In order to provide more services they need to
secure more resources. The services are provided at no charge
regardless of one's income level or overall ability to pay.
Centers that provide these services and others at no fee are not
creating the foundation for a sustainable, long-term integrative
medicine service line. These clinical services have been devalued, and
the folks in the executive suites see them at best as loss leaders,
sometimes being able to connect these low tech, high touch, low margin
services to their high tech, low touch, high margin services.
Philanthropy used for development, education and research around
integrative medicine is critical, but better clinic and business models
need to be devised to allow clinical services to operate efficiently and
profitably in a self-sustainable manner. This is how we grow the
business of integrative medicine with the future in mind.
Comment: First, definitions: If "integrative medicine" includes the subset of chiropractic doctors, naturopathic doctors and acupuncture, Oriental medicine practitioners and first generation holistic medical doctors and environmental medical doctors who see themselves as "integrative," philanthropy was and remains basically a non-factor.
Blood, sweat, tears, time and tuition were virtually the only capital backers for these movements. As such, philanthropy had virtually no role in bringing the lions' share of what I sometimes call "integrative practice" (practice that respects and seeks to treat the whole body-mind-spirit) to the U.S. consumer. These necessarily followed the Jim Henson's toddler's motto: I can do it. I can do it myself!
The glass ceiling between philanthropy and most integrative fields
In truth, when it comes to initiatives of the licensed "CAM" disciplines, we see a classic "glass ceiling." Very few individual philanthropists, mainstream foundations, corporate or governmental granting agencies give to projects led by members of these fields. The choices do not seem to be related to merits, or contributions to human health. The grateful patient or practitioner who leaves a chunk when he or she dies is the source of most of the very few contributions of $50,000 or more.
There is irony here: the leading philanthropists in "integrative medicine" are women 55-70 whose generation has battered against and broken through their own glass ceiling in US business and culture.
But if by "integrative medicine" we mean the MD-led field that is now promoting a specialty as the American Board of Integrative Medicine, the philanthropic relationship is so close as to be a kind of symbiosis. The mark of imported money is even greater if one includes governmental research dollars. I say symbiosis because it is almost impossible to imagine integrative medicine without these infusions.
Hydroponics and the IM-philanthropy symbiosis
None of this is meant to downplay the huge contribution of blood, sweat, tears and time from integrative medical doctors in growing their initiatives and field. The tasks are and have been heroic, if typically sustained by higher salaries than the incomes underwriting "CAM" practitioner sweat-equity in growing their fields. Their projects have simply been boosted by a sort of hydroponic infusion of cash from philanthropic and governmental sources. As Sabin notes, these dollars have grown clinical services, educational programs and research - all 3 legs of academic medicine.
To risk sounding oxymoronic: The organic growth of integrative medicine in the US culture has been philanthropically dependent. Philanthropists can get donor fatigue. What happens if the injections of capital are cut off? History may one day tell us that philanthropy was midwife, mother and carrier of the field until it reached the maturity of board certification when more typical guild considerations increasingly shaped activity. Many philanthropists would look upon the and say: Job well done!
Sabin is right to distinguish between better and worse uses of philanthropy in integrative initiatives if sustainability is the goal. Yet the standard joke at this time for integrative medicine of all sorts remains that the only bad philanthropy is the kind that doesn't land on one's own shop.
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