John WeeksSummary: McCain-Dorgan bill stirs battle over supplement regulation McCain backs off … Action urged to support “licensed integrative practitioners” in federal legislation … Senator Mikulski salutes Integrative Healthcare Symposium attendees … Bill George pushes reform at personal and state levels .. Brent Bauer, MD reports on Mayo’s growing integrative medicine initiative … True North patient survey featured in American College of Physicians’ publication … Naparstek’s Health Journeys CD sent by DoD to help soldiers in war zone … Acupuncture accreditation agency moves ahead with “first professional doctorate” … A first: Chiropractic faculty members credentialed to teach in VA facilities via NYCC relationships … Washington state legislature announces annual Bastyr Day … Oregon naturopathic doctors included in loan-forgiveness program for service to the underserved and in rural areas … Chiropractors explore role in public health … NJ chiropractors add homeopathy, nutrition to practice; Gahles comments … Hawai’i medical association seek to strip scope additions of state’s naturopathic doctors … AMI seeks expansion of integrative Medicaid pilot into Arizona … ABC blasts peer-reviewed piece on drug-herb interactions … Newsweek rips anti-depressants as “Tic tacs” … Stargrove and MedicineWorks release electronic interactions guide … Olympic athletes sponsored by supplement lines … Profootball chiropractic association in 4th conference … Integrative Healthcare Symposium up 31%, gains status as community gathering … Arizona Center’s integrative mental health conference sells out … Ann Fonda reports on the Annie Appleseed Project … Pelletier takes vice president role at American Specialty Health … Miller-Read takes over as AMTA president …
Policy
McCain-Dorgan bill aims to change dietary supplement
regulation, industry raises strong opposition; McCain backs away
US Senator John McCain (R-AZ)and US Senator Bryan Dorgan (D-ND)
introduced the Dietary
Supplement Safety Action of 2010 that
would significantly impact the regulation of dietary supplements. The
bill was greeted with significant opposition by industry, practitioner
and consumer organizations. These argue that the bill will drive up
costs and limit access to consumers for products that are already safer
than most drugs. The Council for
Responsible Nutrition position is linked
here and that from the American Herbal Products Association is here.
The American Association of Naturopathic Physicians generated 2000
practitioner letters. The Alliance for
Natural Health-USA has stirred up vigorous opposition, eliciting
over 80,000 pieces of electronic mail, according to Gretchen DuBeau, the
organization’s executive director. Asserts
DuBeau:
“If passed as written, this bill
would likely result in the
disappearance from store shelves of many supplements currently on the
market,
and unbridled authority would be handed to the FDA, an agency that needs
a top
to bottom overhaul, not ever more power over our lives.”
McCain is aware of the antagonism and has
responded with a statement
on the Senate floor. He states that the bill was introduced based
on requests from numerous professional and amateur sports organizations.
The debate breaks over whether the bill fundamentally shifts regulation
of supplements and will limit consumer access; McCain says yes, the
industry and related groups say no. A thoughtful column on the bill by Integrator
columnist Michael Levin in which he poses a potentially useful
regulatory strategy is posted
here. [Note: At publication, ANH sent a note to
their list indicating that following a meeting with US Senator Orrin
Hatch, McCain has backed away from his advocacy. Dorgan’s next steps
are not known.]
Comment: Asked if McCain’s bill would
significantly impact consumer access to dietary supplements, policy
panel members at the February 25, 2010 session of the Integrative
Healthcare Symposium unanimously agreed that it would, with
additional commentary that there are reasons to better regulate the
industry. The mantra from opponents, including Levin, is that rather
than a new law, better to enforce the Dietary
Supplement Health and Education Act (DSHEA). The Alliance for
Natural health campaign is here.McCain’s quick reversal following his
passionate advocacy and warning of deaths from supplements makes one
recall what a flip-flopper he was in his presidential candidacy.
Action letter calls for support of “licensed integrative
practitioners”
in federal legislation
The Oregon Collaborative for
Integrative Medicine. Health Action and Healer Within founder Roger
Jahnke,
OMD. The national massage business Associated
Bodywork
and Massage Professionals (ABMP). These are among the
respondents to a recent action
letter
in the Integrator and posted at Integrative
Practitioners
Online asking members of the integrative practice
community to contact members of Congress to include integrative
practices and integrative practitioners in healthcare legislation. The
campaign was stimulated by integrative health entrepreneur Richard
Sarnat, MD, who believes that, despite the challenges of any reform
efforts, that relationships with Congress are key. Since “licensed
integrative practitioners” have been included in multiple places in
drafts of reform legislation, he argues that we must advocate for this
inclusion. Among the sections in which licensed integrative
practitioners are included are workforce planning, comparative
effectiveness
research and medical homes. (See details in
the call
to
action.) The call to action also
notes relevant
sections relative to health promotion, wellness and non-discrimination.
ABMP posted their
own
call to action here.
Comment: Sarnat stimulated me to get
over my own cynicism about reform this year and realize that this kind
of inclusion is key regardless of whether a huge reform bill is passed
or sections are taken up independently. To the extent that change can
come via such inclusion, action will rest on relationships. Sarnat is
right when he says we need to be in the habit of contacting our members
of Congress. So, start now! Send a letter. I timed myself. Using the
model letter, which I slightly adjusted and personalized, I spent under
15 minutes to send to both US Senators from my state of Washington
(Murray, Cantwell) and my member of
the House (McDermott). Feels good to have done it.
Senator Mikulski letter greets participants at Integrative
Healthcare
Symposium
The IntegrativePractitioner.com
website includes an unusual
posting as of February 25, 2010, the first day of the Integrative
Healthcare Symposium (IHS). US Senator Barbara Mikulski (D-MD) sent an
official
letter to participants in the symposium “applauding them
for their participation.” In the letter, Mikulski notes that “I am a
longtime advocate of
integrative health and commend all of the work that you do.” She
states the “integrative health is a vital part of our delivery system,”
then ticks off sections of proposed legislation where she was actively
involved, including workforce planning and comparative effectiveness
research. The letter was provoked by a late decision by one of
Mikulski’s staff to stay in D.C. on the day of the February 25, 2010 Obama
healthcare
summit rather than participate in an IHS panel on integrative
healthcare and US health policy.
Comment: Nice to see this kind of
support from an extremely influential member of
Congress. Credit Mikulski’s Maryland constituents like Robert Duggan,
LAc and the Tai
Sophia Institute and Brian Berman, MD and the University of Maryland program in
integrative medicine, for building a relationship with Mikulski
through the years.
Bill George urges shift
to state focus for health reform via column in Minnesota Tribune
In a column
in the March 6, 2010 Minnesota StarTribune, integrative
medicine philanthropist and
former Medtronic chair Bill George urges that his state take the lead
in health reform rather than focusing at the federal level. “Rather than waiting for Washington
to devise the ideal national system, what should Minnesota’s leaders do
to transform the
state’s health care?” George urges as a general principle that “each of us
should take responsibility for our own health,
supported by our health
care team, composed of physicians, nurses, health care and wellness
professionals.” The teams would include complementary healthcare
practitioners. He notes that the federal efforts focus on insurance
coverage and access: “Virtually
overlooked at the federal level are three
equally important aspects
of health care: cost, quality and personal responsibility. Addressing
these essential areas, the health care crisis cannot be resolved.”
George underscores that we “have not health care system in this
country.” He points to perverse incentives in our payment system as an
obstacle, and personal responsibility, community medicine, team care,
primary care and wellness expansion as directions to resolve the
situation in his home state. Minnesota is a recognized national leader
in health care. (Thanks to Mary Jo Kreitzer, PhD, RN for alerting me to
this column.)
Integrative Practices
Brent Bauer, MD’s short report on advances in Mayo
integrative medicine program
Brent Bauer, MD provided this quick glance into developments in integrative
medicine
at
Mayo Clinic: “The biggest
recent news was the release of the iPhone
meditation
app last month (Mayo Clinic Meditation) that has
received national attention as well as internal notice. A new edition of the Time
book Mayo
Clinic
Book
of Alternative Medicine will be out at the end of march
or early April. We are just reviewing
the
data but our stress
management
and
resiliency training program is showing
statistically significant benefits in physicians at risk for burn-out
and in breast cancer survivor advocates. This strategy is the focus
of our Mind Body Medicine initiative being led here by Amit Sood, MD,
Sc.”
Bauer continues: “We also had a series of
massage papers accepted in 2009 all showing beneficial outcomes and
all
leading
to
practice
change. For example, massage therapy is now included as
part of
routine aftercare for patients undergoing open heart surgery. Animal assisted therapy
is on the rise here – trying to raise funding to move it beyond the
current
volunteer status. Lot’s of interest as one of our key dogs (‘Jack’)
was featured on Animal Planet and is having a children’s book written
about him. The book should be out in 1-3 months. All the usual stuff
(acupuncture, massage, meditation training) continue to grow, driven by
practice demand, so well integrated and doing well even in these
uncertain
economic times.” Bauer adds: “Hate to
sound too
Pollyanna-ish but definitely in the right place, doing purposeful work
with
people I love. Doesn’t get much better than this!” (For a 2006 feature
on Mayo’s program click
here.)
Comment: I had the pleasure of an early
association with this program when the work of Bauer and his colleagues
was boosted by a significant grant from my colleague Lucy Gonda in
2001. It is
remarkable to see these stepwise changes via the persistence in
following Bauer’s strategic vision of the Mayo way for advancing
patient
care. Mayo’s reputation as a national leader means these integrative
steps resonate widely. Note the sudden elevation of Jack, from quiet
therapist to national celebrity.
True North integrative clinic featured in ACP Internist
for
patient survey work
The True North integrative
clinic was featured in the February 2010 issue of the ACP
Internist for use of the American College of Physician’s (ACP’s)
patient
assessment survey for
care outcomes. The True North team team includes 28 practitioners, from
medical doctors to, in the article’s language, “advanced practice nurses, mental health practitioners,
pharmacists,
chiropractors, life coaches, fitness trainers, naturopaths and other
credentialed integrative practitioners.” (See Integrator feature
on True North’s distinctive
“Decision
Circle”
clinical
model here.) ACP member Joseph Semmes,
MD, the not-for-profit clinic’s director of research, had access to the
survey and received permission to modify the 29 question tool to include
16 additional questions. The additional 16 are,
according to a February 9, 2010 True
North
release, “not only uniquely relevant to True North’s
integrative approach but also key to true prevention, healing and
wellness.” The ACP Internist article includes this
general finding: “The group found that
patients had improved their level of fitness but
not as much as they had improved in other key areas such as nutrition
and sleep patterns.”
Comment: I will contact True North for
more information on their outcomes, as well as their choices on the
additional 16 questions.
Department of Defense expands use
of Health Journeys’ integrative wellness tools
The Dept of Defense continues to
demonstrate steady interest in distributing integrative wellness tools
for its
active troops. Beginning in March, 1500 guided imagery audio recordings
designed to help with sleep and stress will be shipped to Iraq
and Afghanistan, according tob a note to
the Integrator from Belleruth
Naparstek, LISW, from Health Journeys. The DoD interest is in helping “U.S.
fighting forces access mind-body skills for increasing relaxation and
emotional resilience.” The guided imagery
tools were created by Naparstek with music by Steven Mark Kohn, is
produced by Health
Journeys
Inc of Cleveland, Ohio. Naparastek not4es that the content is loaded
onto PlayAways, a
newly patented 2-oz players that comes complete with ear buds and
batteries,
and
requires no downloading or USB charging. The recordings are ordered
through the Army’s Department of Morale, Welfare
and Recreation. Naparstek’s imagery
has been tested in
outcome studies at Duke, Scripps and the Phoenix V.A. with subjects
suffering
from posttraumatic stress and traumatic brain injury. Naparstek notes
that she hopes
that
these tools “might alleviate warrior stress and sleep deprivation to the
extent
that some of the more severe symptoms of combat can be averted.” Additional information is available through Health
Journeys and through the DoD’s PlayAlways site.
Comment: I was once involved with a
day-long retreat in which one of the questions quietly broached was the
ethics of providing healing healthcare that will enhance the ability to
pursue wartime activities. Ought one
remain calm, relaxed and balanced in the midst
of killing? Were I 25 again I would have
an absolute and authoritative clarity about what one should and should
not do relative to war. Ethics aside, it remains intriguing that the
military, like performers and professional athletes, are leading
adopters of integrative practices. Naparstek’s dogged work is expanding
access in multiple environments.
Education
AOM accrediting body chooses to go ahead with “First
Professional
Doctorate, opponents organize
The Accreditation
Commission
for
Acupuncture and Oriental Medicine (ACAOM) has chosen
to go ahead with planning toward its controversial “First Professional
Doctorate” (FPD)according to a
statement from the accrediting body following its February 2010
meeting. The agency, which reviewed over 3000 letters and comments,
concluded:
“Based on this review the Commission, in its
exercise of professional judgment, is satisfied that there is sufficient support to justify the further
development of first-professional doctoral standards. Accordingly, the Commission voted to authorize the ACAOM Doctoral
Task Force to complete its work in developing standards for accrediting first-professional doctoral programs
in AOM for the Commission’s review and
consideration. In taking this action, the Commission does not take any
position on whether or not the first professional doctorate should be the required educational requirements for
professional practice in AOM,which is the prerogative of state
legislative and AOM regulatory authorities.”
The ACAOM plans to reconvene its task force to refine the first
draft
of
its proposed standards. These will then be sent out to the
AOM community for review. The decision has already created a stir. The
depth of opposition and challenges ahead for the profession are evident
in this
post
from
Lisa
Rohleder, LAc, a co-founder of the Community Acupuncture
Network (CAN). Rohleder’s post stimulated scores of responses, all
opposed. The tenor is not friendly.
Comment: I continue to be
torn by this
issue, with strong internal, personal and professional pulls both pro-
and con, as expressed at the bottom of this compilation
of various perspectives on the FPD. Frank
Ervolino, ND, LAc, a member of the first national commission on the FPD
who presently opposes the move “at this time,” helps clarify
some of the opposing interests inside the AOM community inthis Integrator posting. The post is clarifying, if shaped
by
Ervolino’s present opposition. The best news for those worried about
aggravations to the historic divisions in the field is that ACAOM is
merely entering a new phase in a long process. Any Battle Royale that
may be pending will be put off for a period.
New York Chiropractic College faculty member
credentialed to teach in VA system
A bit of history was made in
November 2009 when two chiropractic radiologists who are assistant
professors at New
York Chiropractic College earned
clinical teaching privileges in the nation’s veteran’s hospital
system. Jean-Nicolas Poirier, DC, DACBR,
CCPS and Chad
Warshel, DC, DACBR are the first chiropractic radiologists to have
received
credentialing by the United States Veteran Affairs
system to teach radiology to chiropractic students and residents
enrolled in a Masters of Science Degree in Diagnostic Imaging residency.
The appointments are for 2 years. The teaching will take place at the Canandaigua Veteran Affairs
Medical
Center where the two faculty members will work with chiropractic
doctors and review
radiological images of their patients with NYCC interns and NYCC
diagnostic
imaging residents. NYCC’s
January 2010 release on the subject notes that “this new arrangement
will enhance the radiological experience of NYCC interns
and residents by increasing the variety of conditions seen by the
students
using multiple advanced imaging modalities.” The Canandaigua VA Medical Center, part of VA Healthcare
Network Upstate New York, is located 30 miles southeast of Rochester in
Canandaigua, New York. New York
Chiropractic College has developed a series of VA affiliations with VA
programs.
Comment: Accepting “licensed CAM”
professionals as members of clinical teams in conventional medicine is
becoming familiar, if not yet standard. Formally granting these
distinctly licensed practitioners authority as teachers in these
institutions is more rare. Credentialing them to teach medical doctors,
which apparently is not part of this agreement, is even more rare.
Still, to allow faculty members from the accredited institutions, like
NYCC, to formally teach in hospitals and health systems, is an important
step toward resolving health care’s guild divisions.
Washington legislature
initiates
annual Bastyr University
Day
February 24, 2010 was the official Bastyr
University
Day for the
Washington State Legislature according to
resolution SR 8693. According to the resolution, the recognition of
Bastyr
contributions is to happen annually. A prime mover behind the
resolution, State Senator Paull Shin
(D), is a Bastyr
University
trustee. Bastyr has over a dozen undergraduate and
graduate academic programs (ND, LAc, DAOM, midwifery, whole foods
dietetics, etc.). The resolution honored Bastyr for it’s “
commitment to a sustainable health
care
model, the University’s role in
minimizing its environmental impact through green building practices,
and its instrumental role in increasing research activity in the natural
health sciences.“ The comments can be
accessed by clicking
here
and
advancing the video to 11:00.
Comment: While this is a good sign for
the institution, I imagine Bastyr’s leadership would be happy to see
the special day go away if Bastyr were instead thoroughly integrated
into the state’s higher education and healthcare funding practices.
Professions
Oregon naturopathic physicians approved for rural
health and underserved area loan
forgiveness program
A key
2009-2010
objective of the Oregon Association of Naturopathic Physicians
was reached in late February when the Oregon State legislature passed a
bill to include naturopathic doctors in the state’s Rural
Health
Services
Loan Repayment Program. Laura Culberson
Farr, OANP executive director shared with the Integrator that the program “was
also expanded to include medically underserved communities” together
with
rural communities. A model for the program is an existing program in
which naturopathic physicians have served for over a decade in
Washington State. The program would cover
up to $25,000 in loans with a 3 year commitment of service. Farr notes
however that the vote was merely “a policy victory” because, given the Oregon’s challenged fiscal status, the
program in its
entirety, including loans for MDs serving similarly, is presently
unfunded. States Farr: “(Getting the funding back) will
be the next step of the battle.” An
OANP representative shared that “an
important
point is that the Oregon Medical
Association did not oppose our inclusion.” The OANP has “been
working hard to
build
relationships with that organization and forge common ground. As a
result, we
have a strong coalition moving forward to fund the program in 2011.”
Comment: This level of collaboration
between medical doctors and naturopathic doctors to help serve the
underserved is remarkable, especially given the AMA’s
Scope of Practice Partnership through which the national
organization is seeking to stop greater inclusion of naturopathic
services. The process of the bill’s passage wasn’t
without typical turf skirmishes, however. At one point such jockeying
provoked
committee chair Mitch Greenlick (D-NW Portland)
to make a statement which
should be tattooed on the foreheads
of all guild warriors who forget that patients must come first:
“We have created these silos, and
created such heavy bricks around them, that it seems very hard for
professions
to see beyond the threat of somebody else coming into their territory.
And it
just seems to me that as long as we are blinded by this kind of
inter-professional rivalry and silos, we are going to have a very
difficult time
creating the workforce of the future.”
Chiropractors engage member survey
on DC roles in public
health
The American Chiropractic Association
has recently asked its members for feedback on “Chiropractors Attitudes
and Involvement” in the public health. The
explanatory note reads: “In a health
care system that has been overly focused on curing acute diseases,
providers are increasingly expected to practice health promotion and
disease
prevention. Promoting wellness has always been a part of chiropractic
philosophy. Until
recently, however, public health has been taught in chiropractic
colleges only
to a limited degree. Tell us about your view on how chiropractors should
be involved in public health, and let us know how you currently
participate in
disease prevention and health promotion.” A subset of chiropractors have
been significantly involved in the public health through the American
Public Health Association which has a chiropractic
healthcare
section.
Comment: Most integrative practitioners
and licensed complementary and alternative healthcare professionals
feel
a philosophical kinship with the health-promoting and wellness
functions the public health. Yet these practices are poorly articulated
with
formal public health programs. It will be interesting to see what the
ACA
finds through this survey.
Regulation
New Jersey chiropractors add homeopathy, nutrition to
scope; DC-homeopath Nancy Gahles comments
I received a note recently from Nancy Gahles, DC, CCH, RS (Hom)
notifying me of a practice change in New Jersey in which homeopathy and
nutrition were added to the scope of practice for chiropractors in New
Jersey. She noted her concern, as both NJ-licensed chiropractor and a
homeopath who is presently president of the National Center for
Homeopathy, that homeopathy may not be appreciated for its full value. I
asked her for comments. She wrote:
“As a Chiropractic Physician
licensed in the state of New Jersey, expanding scope of practice to
include
nutritional counseling and homeopathy serves to add to the pool of
primary care
providers that we so desperately need in the fields of CAM where
prevention and
wellness paradigms already exist in both philosophy and practice.“As first portal of entry physicians,
chiropractors see their
patients on a more frequent basis than do medical doctors and the
opportunity arises for more detailed analysis of etiology and
co-morbidities associated with the neuromusculoskeletal issues such as
low back
pain that the majority of patients present with.“Having access to more tools in the toolbox is
always an
advantage in a wholistic practice and , when dealing with whole people
we do
know that one size treatment does not suit all. Research shows that
lifestyle choices in diet, nutrition and exercise positively effect
changes in
chronic disease relieving the costly burden on the healthcare system
and
increasing quality of life.
“Homeopathy
does not lend itselfto a weekend
course that allows
you to
practice quality homeopathy
on Monday morning. As President
of the
National
Center for Homeopathy,
it is incumbent upon me to preserve theintegrity
of the homeopathic profession.”
“The inclusion of homeopathy into scope of
practice
presents
a challenge along with a victory. Homeopathy is a stand alone system of
medicine with its own Pharmacopoeia of homeopathic medicines regulated
by
the FDA. Homeopathy does not lend itself to a weekend course that
allows
you to
practice quality homeopathy on Monday morning. As President of the
National
Center for Homeopathy it is incumbent upon me to preserve the integrity
of our
profession. That being said, while we are awaiting promulgation of the
regulations, I am in direct contact with the appropriate DOE college to
ensure
curriculums leading to nationally recognized certification standards
such as
the CCH are made available to DC’s in NJ.“The victory is that homeopathy is a system of
medicine
that
is directly in alignment (pardon the pun) with chiropractic philosophy.
As both
a chiropractor and a homeopath, I feel that the intimate,
complex relationship of body, mind and spirit is addressed most
eloquently when a combination of both of these dynamic therapies are
employed.“It is also true that many professionals, while
understanding
the need for nutritional counseling and homeopathic care, do not want
to
undertake the studies required for them to become practitioners
themselves.
This opens the door for integrative practice among chiropractic
colleagues as
well as CAM professionals outside of chiropractic.
“As
both
a chiropractor and a
homeopath, I feel that the intimate,
complex relationship of body,
mind and spirit is addressed
most
eloquently when a combinationof both of these dynamic therapies
are
employed.”
“The fact that homeopathy is not covered by
insurance brings
the patient responsibility factor into play, one that was spoken about
at the
IOM summit as a necessary factor in the emerging patient-centric
healthcare
model. Self-pay brings Health Savings Accounts squarely to the fore and
the
changes in language necessary that will allow people to use their tax
free
dollars for the CAM services they want. Freedom and choice do not come
without
some work. When legislation is enacted, invariably there are other
components
that flow from that. Both practitioner and patient need to tell their
legislators what they need and what they want. With the insurance
industry
crippling small businesses with their outrageous increases ( Blue Cross
some
37% and Healthnet 48%), doctors need a revenue stream outside of those
paid for
by insurance. Consumers of healthcare may be better off paying fee for
service from their own HSA’s. Safe, effective and cost saving therapies
like
homeopathy may be just what the doctor ordered.“With the proper education and inspiration,
expanding scope
of practice for chiropractors is a win-win situation.“
Comment: Licensed “CAM” practitioners frequently question the
clinical skills in complementary modalities of
integrative medical doctors who typically have significantly
less training in a specific modality or system than the distinctly
licensed integrative practitioners have through
their recognized educational programs. The same issues break between and
among these licensed disciplines. In my work with the multidisciplinary Academic
Consortium for Complementary and Alternative Healthcare (ACCAHC), we
call
these “hotspots.” The challenge across the board is to know when to use
the therapies but know also when patient care will be better via
referral to professionals who are more deeply schooled in a given system
of care. This distinction
was behind the development of ACCAHC’s Clinicians’
and
Educators’ Desk Reference on the Licensed Complementary and
Alternative Healthcare Professionals. Our view is that practitioners
may need a
handy way to know about their prospective colleagues and team care
members, just as they need one to know about drugs, herbs, nutrients and
needles.
Hawaii Medical Association seeks to squash new pharmacy
rights for naturopathic doctors
Michael Traub, ND, DHANP, a long-time leader of the naturopathic
profession in Hawai’i shares with the Integrator that organized
allopathic medicine
in his home state is seeking to repeal significant portions of a
modernization of naturopathic practice in 2009.
States Traub: “Our bill passed nearly unanimously, but no sooner had it
passed than
Dr. Judith Orloff MD
Barry Bittman MD
Tom Ferguson MD