Summary: Obama transition watchers have noted a number of nominations which may bode well, or ill, for the integrative practice community and natural products industry. Most give a thumbs up to appointments for former U.S. Senators Tom Daschle and U.S. Senator Tom Harkin. Congressman Henry Waxman, who has taken over a key role in the House, is a cause of concern for some. Meantime, leading “health freedom” advocates believe that the sky may be falling with the Democratic majorities: writer Peter Chowka forecasts that we may be witnessed “the end of alternative medicine” and health freedoms. Here is a run-down with comments from members of the community. The stage is first set with a Cliff’s Notes review of action under Clinton and Bush.
Obama transition watchers focused their attention this past week on whether or not US Senator Hillary Clinton would be asked to serve as Secretary of State, and whether she would accept. (She was, and has.) Meantime, those in the integrative practice community have focused their attention on health-related leadership, in the Obama cabinet and in Congress. The look at what may be coming begins with a look back at action in the Clinton and Bush years.
Looking Back #1: Heights of action and consideration in the late Clinton years
The Presidential transition in 2000 came at a moment in which federal policy consideration relative to complementary, alternative and integrative medicine was at its height. The White House Commission on Complementary and Alternative Medicine Policy was busy at work, funded through U.S. Senator Tom Harkin (D-IA), as a $1-million rider on the 1998 enabling legislation which established the National Center for Complementary and Alternative Medicine (NCCAM) at the NIH. Harkin was the champion, but the Clintons, and particularly Hillary Clinton, were known to be interested in the emerging fields. During her aborted work at the helm of reform efforts, the First Lady convened a gathering at the White House of two dozen alternative medicine leaders to brief them on how they might participate in the reform movement. In the later Clinton era, NCCAM, the Commission and significant residual energy from the 1994 passage of the Dietary Supplement Health and Education Act (DSHEA) led to the creation of a bi-partisan Congressional Complementary and Alternative Medicine and Dietary Supplement Caucuses in both the US House and US Senate. Everything was formative and seemed possible.
Looking Back #2: The Bush years
Fifteen months after the beginning of the George W. Bush Presidency, Clinton’s Commission issued its report. While filled with policy recommendations, as an artifact of a Democratic regime, the report was early viewed as destined for the dustbin. (See this October 2008 interview with Commission chair James Gordon, MD for perspective on the value the Report created.) George Bush never showed personal, proactive interest, nor did any of his top staff. NCCAM did benefit from the all-boats-floated effect of the administration’s promotion of a significant expansion of the NIH budget. The 8 years of research generated few studies which advanced the field’s stature, however. Appointment of Surgeon General Rafael Carmona in 2002, well-known to the Andrew Weil camp via his Tucson base and shared publicist, Matt Russell, suggested possibilities of some access. None were realized, to my knowledge.
Rep. Dan Burton: active from the far right
Meantime, a very conservative Congressman Dan Burton (R-IN) used his position as chair of the House Government Oversight Committee to hold a series of hearings between 2000-2002 on alternative medicine topics. Policy advocate and lobbyist Beth Clay, currently of the Wisneski Institute, staffed that work. During the period a few of Congressional earmarks (known to their opponents as “pork”) passed however. One benefited what is now the University of Arizona Center for Integrative Medicine and others supported research at the Samueli Institute. The most Congressional action was the continuous, tenacious, successful work of the chiropractic profession to gain access to the Veteran’s Administration and other Department of Defense programs. In addition, the Good Manufacturing Practices rules from dietary supplements, required under DSHEA, were finally issued. By and large, as I have written elsewhere, complementary and integrative medicine mainly did not show up on the national stage. (See Why Integrative Practice is Missing from the Health Reform Debate.)
Daschle selected as Obama’s Secretary for Health and Human Services
HHS nominee Daschle: reason for hope
This brief overview (what have I missed?) leads us to the present transition. To most, former U.S. Senate Majority Leader Tom Daschle (D-SD) appears to be a welcome appointment as the new Secretary of Health and Human Services. Daschle is a long-time friend of chiropractic. When the chiropractors celebrated inclusion in the VA, they specifically singled out Daschle’s support. (Chiropractic has a historically important role in health care provision in Daschle’s home state, and chiropractic political action committees donated significantly to Dashle in his elected positions.)
Daschle has some history with the broader
integrative care discussion. In the mid-1990s, as US Senate
Majority leader, Dashcle and Harkin invited a group of integrative care advocates who later
organized as the Integrated Healthcare Policy Consortium
(IHPC) to submit a paper showing where integrative practices could lead
to cost savings. That paper helped stimulate the dialogue which led to
the NCCAM legislation. Among the leaders of the IHPC group was Sheila Quinn, IHPC’s current chair, who was then executive director of the American Association of Naturopathic Physicians (AANP). In a recent e-message to members, the AANP called Daschle a “voice of experience” on the Obama team. The AANP directed members to Daschle’s recent stepping back from single-payer and to his focus on cost effectiveness. The association urged its members to write letters to their members of Congress, promoting inclusion of naturopathic doctors in the public health system. The letter states: “
Particularly in the case of
chronic diseases, naturopathic medicine provides an alternative to high-cost
drugs and surgeries. underscoring the potentially cost-saving approaches of naturopathic medical care.”
Harkin chosen to “spearhead prevention efforts” in Kennedy’s Senate reform bill
Harkin: integrative practice’s best friend in key role
A potential boost came with the selection of US Senator Tom Harkin, integrative care’s best friend in Congress, to “head up prevention elements” in planning for the new healthcare reform effort. Harkin was selected by Senator Edward Kennedy (D-MA) chairman of the Senate Committee on Health, Education, Labor and Pensions (HELP).
“I have long believed that prevention
and wellness are the keys to
our health care crisis.
We must recreate America as a
society’ focused on fitness,
good nutrition, and disease prevention –
ultimately keeping people out
of the hospital in the first place.”
U.S. Senator Tom Harkin
Kennedy has dropped in a major health reform bill. Harkin, according to his site,
has been “tasked to head a work group which will look at prevention and
public health efforts.” While what Harkin means by “prevention” (will
policy action remain stuck in vaccinations and early diagnosis?) has
not been defined legislatively, he began on an expansive note: “I have long believed that prevention and wellness are the keys to
solving our health care crisis. We must recreate America as a ‘wellness
society’ focused on fitness, good nutrition, and disease prevention –
ultimately keeping people out of the hospital in the first place.” Notably, the other two workgroup heads, Senator Barbara Mikulski (D-MD) and Senator Hillary Clinton (D-NY) also are known to be familiar with and supporters of complementary care. Mikulski, with whom personnel at Tai Sophia Institute have connections, is in charge of medical quality initiatives. Clinton’s charge, had she not taken State, would have been insurance coverage.
Waxman takes Dingell’s position – problem for natural products?
The Congressman from Hollywood, Henry Waxman (D-CA), last week won a hard-fought battle in the House which stripped the Congressman from the Auto Industry, John Dingell (D-Mich), of his position as chair of the House Energy and Commerce Committee. The battle had nothing to do with integrative practice, except in the most global perspective: smart energy moves against global warming are critical to long-term human health. Dingell is a well-known protector of the worst practices in the auto industry. (See Associated Press “House goes greener” article on the selection of Waxman.)
Waxman: what’s good for the globe may be a challenge to DSHEA
Yet Waxman is viewed by some as having asignificant down side. Prior to his win, the AANP commented on the battle this way: “Congressman Waxman has very
strong sentiments regarding the Dietary Supplement Health and Education
Act, none of which will work to the benefit of consumer access to
supplements.” Waxman, like many Democrats, has focused on consumer protection via industry regulation rather than consumer rights through a let-the-buyer-beware health freedom approach of Burton and other Republicans. He is a favorite target of health
freedom bloggers and advocates, as is Kennedy. For instance, the Vitamin Lawyer blogger lumps them as part of a “Gang of Four” opposing health claims under DSHEA. The site blasts the “Kennedy-Waxman Axis of Control.” Underscoring the importance of Waxman’s role is the posting of health care as the lead topic on the House Energy and Commerce Committee website (as of November 23, 2008).
Global view: Is control by the Democratic Party a threat to choice?
The answer to this question is a resounding “Yes!” according to the National Health Federation (NHF). The NHF’s heyday was in supporting chiropractic in the 1960s and the laetrile wars of the 1970s. In a November 8, 2008 press release, NHF’s lobbyist Lee Bechtel writes: “Lost
in the glow (of the election of Obama) is the very real fact that the Congressional and Executive Branch
public-policy impact of the elections will not be favorable for health freedom … The
increased control of Congress by
“What we have noticed over the many
decades of our existence is the fact
that the Democratic Party is the most
anti-health freedom party in America.
Bar none, they hate
us and what we
– Lee Bechtel, Lobbyist,
National Health Federation
Congressional Democrats is the bigger threat
to health freedoms, all across the public-policy board.” After noting a nominal non-partisanship of NHF’s membership, Bechtel writes: “What the NHF does take a position on is health
freedom and health-freedom policy; and what we have noticed over the many
decades of our existence is the fact that the Democratic Party – all media hype
aside – is the most anti-health freedom party in America. Bar none, they hate
us and what we stand for.” The singular focus of Bechtel’s letter is that noted by the AANP: concerns over natural product regulation and the future of DSHEA.
Long-time healthcare journalist and health freedom advocate Peter Barry Chowka offers a similar view through his Natural Health Line column. In a November 15, 2008 posting, Chowka stands by a case he made three days prior to teh election: “In light of the results of the voting … I would posit
that the end of alternative medicine in the United States is not only
possible – it is now highly probable.“Chowka’s perspective is that “true alternative medicine” went into decline 17 years ago with the “migration of alt med to an insidious hybrid called CAM –
complementary alternative medicine.” He goes on: “Today, while CAM or ‘integrative/integrated medicine’ may be flourishing, true alt med is
increasingly hard to find and is approaching unavailability.” He views the Democratic victory as a final stake in the coffin.
Comment: Two take-homes. First, I am not sure why I am choosing to include the perspectives of the National Health Federation and Chowka’s. The Integrator
is clearly committed to strategies and tactics which will lead to
inclusion, and this involves regulation and self-regulation and change
from the (im)purity of being an “alternative.” It is interesting that
the most significant inclusion of distinctly licensed complementary
healthcare practitioners into payments systems, in my home state of
Washington, was actually an outgrowth of a liberal Democrat led,
managed competition-style health reform program passed in this state.
The N-of-1 evidence here is that government involvement has led to more
choice, among those who have insurance coverage, not less, as the
Republican, Libertarian, or Anarchist leaning health freedom advocates
would tend to argue.
Second, some of the best friends of alternative and integrative
medicine in Congress will be empowered as leaders of the health reform
effort. Second, a language of wellness has begun to seep into the
dialogue. If there was ever a time for integrative activists to get
into the game, this appears to be it. Will we step up? Will members
join associations so associations can have the strength to participate?
(A sickening reality is that membership in our various national associations, as a percent of potential members, is typically quite low, in the 5%-20% range.) Will associations join with each other so that we form coalitions which
have some clout? We have recent evidence that we can. See Historic Alliance: Integrative Practice Groups Unite Behind Congressional Resolution Promoting Wellness. Coalition is the form of power. Wellness may be the perfect opening.