Integrative Practitioners in Senate’s Comparative Effectiveness Research (CER) Section of Reform Bill

Summary: An additional significant place where integrative practitioners gained an explicit foothold in Congressional action relative to health reform is in the comparative effectiveness research (CER) language in SB 3590. Gretchen DuBeau, executive director of the Alliance for Natural Health-USA shared with the Integrator that her association worked closely with US Senators Kent Conrad and Barbara Mikuski to secure the inclusion. Interestingly, ANH-USA, despite its work, is deeply concerned about the outcomes of the CER movement, and in fact opposes the reform legislation. The relevant sections are printed here.

Integrator articles on CER are available here and here.


ANH-USA: Pushed inclusion of integrative practitioners in key CER teams

The Patient Protection and Affordable Healthcare Act HR 3590 that passed the US Senate on December 24, 2009, explicitly includes at least one “State licensed integrative health practitioner” on the Board of Governors. In addition, an expert advisory panel is to have “experts in integrative health and primary prevention.”

Gretchen DuBeau, executive director of the Alliance for Natural Health-USA (formerly the American Association for Health Freedom) told the Integrator that this  language was placed in the bills through contacts her organization initiated with US Senator Barbara Mikulski (D-MD) and Kent Conrad (D-ND). Interestingly, DuBeau’s says that her organization “doesn’t think that CER is a good thing.” She notes that her board concluded that “CER is happening” as a movement in U.S. research and “will be moving regardless of whether reform passes.” She adds: “The last thing we wanted is to see a board of nobody but conventional people. This is a gamble. But we decided to work to get people on the Board.”  


Page 1628 [CER Board of Governors]


Mikulski: With Conrad, credited with leadership in inserting the inclusionary language

IN GENERAL.—The Institute shall have a Board of Governors, which shall consist of the following members:

A) The Director of Agency for Healthcare Research and Quality (or the Director’s designee)
(B) The Director of the National Institutes of Health (or the Director’s designee)
(C) Seventeen members appointed, not later than 6 months after the date of enactment of this section, by the Comptroller General of the United States as follows:
(i) 3 members representing patients and health care consumers.
(ii) 5 members representing physicians
and providers, including at least one surgeon, nurse, State-licensed integrative health care practitioner, and representative of a hospital

(iii) 3 members representing private payers, of whom at least 1 member shall represent health insurance issuers and at least 1 member shall represent employers who self-insure employee benefits.
(iv) 3 members representing pharmaceutical,
device, and diagnostic manufacturers
or developers.

(v) 1 member representing quality improvement or independent health service researchers.
(vi) 2 members representing the Federal
Government or the States, including at least 1 member representing a Federal health program or agency.


1629 [CER Expert Advisory Panel]

COMPOSITION.—An expert advisory panel appointed under subparagraph (A) shall include representatives of practicing and research
clinicians, patients, and experts in scientific
and health services research, health services
delivery, and evidence-based medicine who have experience in the relevant topic, and as
appropriate, experts in integrative health and primary
prevention strategies
. The Institute may include a technical expert of each manufacturer or each medical technology that is included under the relevant topic, project, or category for which the panel is established.


DuBeau says that the ANH-USA’s concerns about the CER movement are that it might push medicine toward “one size fits all.” This would particularly be problematic since the organization is concerned that “any such government body will very likely be captured by special interests such as drug companies, medical equipment manufacturers, or the AMA.” DuBeau believes CER is a “scary proposition” yet her organization felt that, given the limited resources available to examine “non-patentable therapies,” CER is an opportunity on which they decided to bet.


DuBeau: 16 months with ANH-USA

Despite this success, ANH-USA has taken an overall position in opposition to the health reform bill. The reasons include concerns over privacy issues relative to electronic medical records, requirements to participate in mandates, caps on flexible spending accounts and more. The position statement is available here. AHN also lobbies on other fronts via the firm of Parry, Romani, DeConcini and Symms.

ANH-USA changed its name from the American Association for Health Freedom when it merged with a similarly named British association on December 1, 2009. DuBeau, who has been directing the organization for 16 months, is an environmental attorney “who has always been drawn to natural health, healing and mind-body medicine.” In the late 1990s, DuBeau studied in Belize with noted herbalist and naprapath Rosita Arvigo. Explains DuBeau: “I don’t think you can divorce natural health from the environment.”

Comment: Thanks go to Mikulski and Conrad and kudos to the ANH-USA for this successful inclusionary work. Of course, this may not mean much if no health reform bill passes, or if these words are edited out. Notably, however, this inclusion follows a trail of other placed where CAM and integrative practice are visible in this emergign movement. For instance, CAM is specifically referenced in reports on CER from Obama’s own team and from the IOM. In addition, NCCAM director Josephine Briggs, MD has a role on the CER initiative inside the NIH. CER is proving to be the most significant area of CAM-integrative practice inclusion in US policy.

I admit to losing track of ANH-USA’s predecessor, the AAHF, in 2008 after Brenna Hill resigned as executive director. The organization appears to live off significant fluctuations of donations, on each of which a new executive crests. DuBeau anticipates the organization will be financially secure for some time.

That said, ANH-USA is presently in an interesting position relative to health reform, lobbying for inclusion in a bill they’d like to kill. As one who would hold his nose to vote yes on the current bills over what we now have, the news of this new language is a bit of pleasant aromatherapy.

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Written by John Weeks

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