Summary: On or about the winter solstice, the Integrator announces a Top 10 from the previous year which will support the coming of the light for integrative practice in the New Year. Here is the 2009 Integrator Top 10 for integrative policy, practice, research and professional activity. Just 9 are listed. What are your suggestions for #10? Thanks to the individuals behind the good work. Happy reading, and reflecting, on the year that was as we look ahead.
What action do you think should be included here?
for inclusion in a future Integrator.
Each dark time of year since the electronic Integrator
was first published, I have offered a reflection on events integrative
from the previous calendar year in the form of a Top 10. The object of
the exercise is to locate the light from the past year that will help
illuminate the road ahead. Not surprisingly, this
year the Top 10 focuses on policy. As in prior years, I ask you to
help out with #10. What deserves recognition that is not here? What are the beacons?
1. Light amidst the quagmire of Congressional health reform
The consuming effort to reform U.S. healthcare recalls the legislative adage that you know that you have legislation that is ready for passage once everyone hates it. Yet the effort has been meaningful for the integrative practice world in many ways. Early
months brought a venting and discussion of exciting new directions for
health care delivery, including the image of a wellness society, that
reflect the values in integrative care. While current proposals have
regressed to a coverage-focused mean, a few handholds and footholds for new inclusion of integrative care and wellness
appear on their way to creation. Meantime, the quagmire of U.S. medical
and healthcare policy reminds us that we needn’t take personally the
shortcomings of our own efforts to move medicine toward a health
creation paradigm. Congress’ action and inaction provide an exceedingly
gray and foggy backdrop against which to measure our progress.
2. Advancing Integrative Health Care via the Institute of Medicine Summit
The integrative healthcare reform drama within the broader reform
drama was a February 25-27, 2009 production called the National Summit
on Integrative Medicine and the Health of the Public. This event was
followed 8 months later with IOM’s publication of a Summary book on the gathering.
The Summit was celebrated in the IOM book and as the largest and most
diverse and inclusive of any meeting in the IOM’s history. The 600
souls onsite made a piece of that history as it became clear that “integrative health care” was believed to be a more fitting title for the movement than “integrative
medicine.” While the IOM published no specific recommendations, the
summary text effectively advocates for much in this vision of a
reformed health system as an aspirational future for US medicine.
3. Stakeholder input, including Congress’, on NCCAM’s next strategic plan
In mid-year, the NIH National Center for Complementary and Alternative Medicine engaged development of its 2011-2015 strategic plan.
Like the IOM process, this is a drama inside the larger health reform
drama. Themes of effectiveness, comparative effectiveness, medical costs and
the role of research in reform are on the table. NCCAM leaders opened their process for
stakeholder comment in October. Since then, a flurry of leading integrative healthcare professional and academic associations weighed in for more attention to pragmatic, real-world, effectiveness approaches. An Integrator analysis of
mandate from Congress suggests that an NCCAM more closely aligned with
these recommendations would better comply with Congressional intent
than past NCCAM priorities. Happily, NCCAM shows
signs of responsiveness to the national trends and to its stakeholders,
including the direction Congress originally set. NCCAM promises
additional loops of stakeholder input in the year ahead. Stay
tuned. And stay involved. At stake, for stakeholders, is the fate of
some $600-million in government investment.
4. The MAMA Campaign for access to homebirth midwifery
One shocking surprise in the integrative care dialogue is how little birth practices are considered or examined. This year the MAMA Campaign hit
the scene for the first time nationally to inject natural child birth,
at home, into the reform debate. This coalition of organizations
supporting Certified Professional Midwives
(CPM) went to Washington, DC to gain inclusion of CPMs as providers and
homebirths as services. The MAMA Campaign hired a lobbyist, sponsored a
lobby day, worked with staff of Congressman Henry Waxman (D-CA) to deliver a cost-analysis to the Congressional Budget Office based
on Washington State Medicaid data,
held a high-level meeting with top Medicaid and Medicare officials and
raised over $140,000 for lobbying to make it happen. MAMA achieved a partial victory when Senator Maria Cantwell (D-WA)
inserted a provision in the
Senate bill that will, if passed, require Medicaid to pay provider fees
to CPMs attending births in birth centers. Not all that MAMA wants,
but an exceptional start for
a profession with only 1500 certified practitioners and regulation in
just 26 states making its first appearance on the national scene.
5. Society for Integrative Oncology examines inter-disciplinary and whole system treatment
The 6th conference of the Society for Integrative Oncology
(SIO) held in New York in November was entitled “Revitalizing Cancer
Interdisciplinary Programs and Whole Systems Research.” This was the
first major meeting in the integrative practice field to focus on these
central themes. (The treatment of what chronic condition could not
benefit from a similar exploration?) Over 300 attendees examined acupuncture and Oriental medicine, Ayurveda,
homeopathy, naturopathy and
systems, evaluating particularly the potential contributions of each
for treating cancer patients. SIO’s speakers sought to
identify gaps in research in each system relative to cancer care.
Content also focused on practical strategies for
integrating whole systems care into oncology settings. From its
founding, the SIO has demonstrated a commitment to interdisciplinary
practices, with a board that includes MD, ND, PhD, LAc, RN and other
titles. It is no wonder that SIO would take this lead in examining how
best to use each other in a whole system of treatment for patients. SIO
would seem to be perched for additional advances during the term of its
incoming president, author and
integrative medicine leader Donald Abrams, MD.
6. Obama’s stimulus to comparative effectiveness research (CER)
One valuable teaching from the endless healthcare punditry of 2009 is
that virtually everyone knows that, compared to other nations, the
cost of the US medical system is awful and the outcomes horrendous,
given the costs. Yet as the evidence of this mess has grown over the
years, the U.S. research establishment has basically shrugged and said:
Not my problem. We’re focused on other, more important things. Happily, the Obama stimulus plan elevated a movement toward comparative effectiveness research (CER) which will help reset our research course via an exceedingly stimulating $1-billion of grant awards. The ascending
CER movement would appear to be
particularly favorable toward integrative practice fields. After all, the
main claims to value from these practitioners have been that, compared to
conventional treatment, inclusion of their services will make care more effective
and cost effective. Notably, the director of NIH NCCAM co-chairs a trans-NIH committee on CER and a new institute in integrative health led by NCCAM’s most-funded researcher (see #8) devoted its first significant symposium to the topic.
7. The Institute for Functional Medicine and its white paper 21st Century Medicine
Many advocates perched in one or another of the branches of the
integrative healthcare tree readily make claims for how much better the
world will be if consumers had more of what they’ve got. Yet rarely has
a case been so thoughtfully built by an interest group as that for
functional medicine in 21st Century Medicine: A New Model for Education and Practice. This
white paper from the Institute for Functional Medicine (IFM), developed
by David Jones, MD, Laurie Hoffman, MPH, and Sheila Quinn, provides
excellent short synopses of other, progressive models for re-shaping clinical medicine. The authors then explore the overlap
and alignment of functional medicine with these clinical reform
efforts. They artfully argue that functional medicine is not only of
similar stuff as these more conventionally-accepted emerging models,
but the functional medicine approach also includes some beneficial
extras. The IOM book (#2 above) and this white paper are exceptional
primers for grounding students and newcomers in the broader context of
emerging models of integrative care.
8. The founding of the Institute for Integrative Health
The Institute for Integrative Health stepped into the integrative practice landscape this year with quite an agenda. According to its website the Institute would, among other things, “challenge conventional thinking on health and
healthcare, reframing the conversation, nurturing creative solutions,
and exploring cutting-edge ideas.” Daunting ambition. Yet the prior accomplishments of the Institute’s founding team of Brian Berman, MD, Aviad (Adi) Haramati, PhD, Margaret Chesney, PhD
Susan Hartnoll Berman make one sit up and pay attention. The
Institute’s first significant event did not disappoint. IIH convened
top federal policy and integrative health leaders to explore comparative effectiveness research
and its relationship to integrative practice. The organization’s
website and related SpeakHealth.org blogging and tweeting further open
opportunities for influence. Here’s hoping IIH continues to find
funding amidst what the founders call “a unique opportunity at this point in time to improve our
healthcare system through an integrative approach that values mind,
body, and spirit and blends complementary and conventional medicine.”
9. NARCCIM draws 810 to Minneapolis
In May, 810 professionals from 24 countries gathered in Minneapolis for the second North American Research Conference on Complementary and Integrative Medicine
(NARCCIM). The first was Edmonton in 2006; that conference made the
2006 Top 10. The 2009 NARCCIM was as multidisciplinary as it was
multinational. Under the steady hand of Adi Haramati, PhD, the overall organizer and founding vice-chair of the sponsoring organization, the Consortium of Academic Health Centers for Integrative Medicine,
NARCCIM was an even more outrageous demonstration of the plenitude of
research flowing from these allied fields. The only complaint was how
little of the bounty one attendee could directly experience. These
conferences are on a 3-year cycle. The next is scheduled for May 15-18,
2012 at the Portland Marriott Downtown Waterfront. Be there!
10. And What Is It That You Would Add?
My Top 10 turns around the inter-related fields of policy and research.
I have certainly left much out. Send me a note with your thoughts! A
future Integrator will include your ideas about top action from 2009 as we move forward.
Coda: Integrator Sponsors
I have additional action for which I am
particularly thankful. The Integrator relies on the generosity and
commitment of a few dedicated executive teams and businesses with
which they are associated. These were the Integrator sponsors in 2009.
Sportelli, DC and Patrick McNerney and their team at NCMIC (January 2006-present)
Zechman and Richard Sarnat, MD, co-founders of Alternative Medicine Integration Group (August 2006-present)
Amato, founder of Inner Harmony Wellness Centers. (March 2007-present)
Abernathy and Liz Plizga with Integrative Practitioner and the Integrative
Healthcare Symposium (September 2008-present)
- Sean Sullivan and Deborah Love with the Institute for Health and Productivity Management.
Thank you Sponsors and thank you all! Enjoy your holidays.
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