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Integrative Medicine and Integrated Health Care Round-up: May 2010

John Weeks6 min read

Policy

Sebelius: Confronted with a question about alternative health care

HHS Secretary Sebelius speaks positively on acupuncture,
homeopathy, alternative health care

In a question from a reporter following a talk at the National
Press
Club on April 6, 2010, US Health and Human Services Secretary Kathleen
Sebelius was asked about her “own view of using acupuncture,
meditation, and other alternative healing methods in health
care?” Sebelius response, printed
in
full
here, is generally positive, if apparently misinformed about the limitations of the homeopathy category. In her comments, however, Sebelius links these practices with patient choice, prevention,
potential cost-effectiveness and her comparative effectiveness research initiative.
The following day, former chair of the Democratic National Committee
Howard Dean, MD, was stimulated to make a few remarks on
chiropractic and alternative practices, also reported
here. Dean relays an anecdote from his term as governor that is
unfavorable toward chiropractors, but then uses generally positive
language. Sebelius’ remarks are
reminiscent of Obama’s
own
comments
on acupuncture and other alternative approaches while
campaigning in 2008.

Comment: It must have been
interesting for Secretary Sebelius to catch these questions at the
National Press Club back-to-back with those she was asked by
Congressman
Tim Ryan (D-OH) during a Congressional hearing (below). The Secretary may be served to request a short briefing paper so she can get her facts
right the next time a question is popped. Her general support, like
that
of Obama’s, is good.

Ryan: Congressional champion for mindbody stress reduction programs

Congressman Tim Ryan “boosts meditation
from his position in
Congress;” Sebelius responds

The Cleveland.com
site
has tongue-in-cheek in it’s
opening line: “Congressman Tim Ryan of Niles may not be a
free trade fan, but there’s at
least one Asian import he swears by. It’s called ‘mindfulness
meditation.'” In a video, which Ryan placed on his
YouTube site, he is addressing HHS Secretary Kathleen Sebelius in
a Congressional hearing. He references National
Institutes of Health (NIH) brain research on mindfulness before speaking to its the potential value of
meditation in numerous settings. He includes the stress facing the unemployed, helping attention spans in children and
supporting adults with
chronic pain and tension. Sebelius responds that she is “certainly a bit
familiar
with it” then calls it “a prevention
strategy that has the potential of paying huge dividends.” She refers to
mindfulness being used in schools in violence control. Sebelius then
turns to applications in health care, suggesting that the therapy is of interest in health reform, will be valued by HHS’s new leader for
mental health and also in “work we are doing in early childhood” development.
Ryan notes that Congressman Jesse Jackson, Jr.
(D-IL) also raised the importance of research meditation when a
representative from the NIH testified before the committee. Ryan’s
personal meditation practice provides the opening paragraph in this USA
Today feature, “‘Mindfulness’
Meditation
being
used in hospitals and schools” last July.

Comment: Good for
Ryan to elevate the visibility of this research and kudos to both Ryan
and Sebelius for seeing the broad, public health value of imbuing our
population with these skills. I am reminded of some fine,
federally-funded research Integrator adviser Peter Amato and
his Inner Harmony Group completed
in 2005 (see Outcomes of a Mindfulness Program in an Elementary School).
The positive ramifications spread beyond the class room. A 10-year old
baseball pitcher talked of using mindfulness on the mound. A young girl
reports using the school-learned skills in breath work to calm her when she feels like fighting with her
sister. Given the breadth of value indicated here, why not a nation-wide MBSR initiative like President Kennedy’s physical fitness initiative?

Funding exploration of primary care

Macy report boosts primary care role
for nurse
practitioners; quiet on DCs, NDs, AOM practitioners, midwives

In January 2010, an invited set of professionals gathered under the
auspices of the Josiah Macy, Jr. Foundation
to consider the future of primary
care in the United States. The preliminary report of the meeting from co-chairs Victor J. Dzau, MD, Duke University Health System and Linda
Cronenwett,
PhD,
RN, FAAN, North Carolina School of Nursing, was
published a month later as
“Who Will Provide Primary Care and How Will They Be Trained.” Of
particular interest is the promotion of nurse practitioners and
physicians assistants for primary care roles. The conference attendees
recommended significant changes in the regulatory and payment
environment which would make the system more hospitable to expanded roles for
these practitioners. The
report focused on the importance of team strategies,
while also clarifying that barriers to nurse practitioner practices
should be removed:

“Coupled with
efforts to increase the number of physicians, nurse practitioners, and
physician assistants in primary care, state and national legal,
regulatory, and reimbursement policies should be changed to remove
barriers that make it difficult for nurse practitioners and physician
assistants to serve as primary care providers and leaders of
patient-centered medical homes or other models of primary care
delivery.”

Thibault: Macy’s executive behind the study

In a telephone press
conference on the release, I asked whether the group
had considered the potential roles naturopathic physicians,
chiropractors and
acupuncture and Oriental medicine practitioners in meeting primary care
needs. Macy president George
Thiebault,
MD noted that that Macy “did not have that group of providers
at the meeting.” He added however that he believed “there is an appropriate
place on the team for complementary medicine (practitioners),” assuming
that they are “held to similar standards.” Both Dzau and a nursing
participant in the press conference, Joanne
Pohl, PhD, ANP-BC, FAAN with the University of Michigan School of
Nursing, agreed that there was a place for these practitioners. To my question, Dzau
volunteered this about Duke: “We believe in integrative medicine.” Dzau’s
predecessor as chancellor was Ralph Snyderman, MD, the first winner of
the $100,000 Bravewell
Award and chair of the 2009 IOM Summit on Integrative Medicine. Pohl
chimed in:
“We have a center (at U Michigan)

where we expose (students) to
strategies” with complementary medicine. Each of these academic health
centers are long-time CAHCIM members. 

Comment: Despite the views expressed by
workforce expert Richard Cooper, MD and others at the 2009 IOM Summit
that the distinctly licensed CAM professionals might help meet the
need for primary care, they didn’t make it into this study. None-the-less, the Josiah Macy Foundation, Thiebault and the team he assembled
are to be commended for convening this gathering to promote more investment, and sanity, to resolve the nation’s primary care challenges. Meantime, the comments of Dzau and Pohl are evidence of the game-changing influence of the Consortium of Academic Health
Centers for Integrative Medicine (CAHCIM) in academic medicine. 

Boutin: Excited about value of healthcare overhaul for nutritionists

Healthcare overhaul viewed as
positive for
nutritionists in Bastyr publication

The chair of
nutrition and exercise science at Bastyr Universtiy, Debra
Boutin, RD,
MS calls the new healthcare overhaul legislation an “unambiguously
positive” development for the school’s whole
foods-oriented nutrition students and graduates. “Nutritionists
have been eager to actively engage in prevention rather than
treatment,” Boutin says. She adds: “This legislation is a step in that
direction.
Preventive approaches are beneficial in the long run not only for the
general population, but for our profession and the economies of health
care.” In a recent
article in Bastyr’s e-news, the
following traits of the healthcare overhaul legislation are listed as
positive benefits for nutritionists.

• A pilot program to provide at-risk
  populations (who
  use
  community health centers) with individualized wellness plans that
  include nutritional counseling.
• Grant
  opportunities for
  nutritionists working for public health departments and Indian tribes.
  The grants are for intervention programs designed to either prevent or
  treat chronic disease in adults ages of 55 to 64.
• Grant
  opportunities to develop school-based health clinics with potential for
  nutrition services.
• A requirement for
  national chain restaurants
  to label the nutritional content of foods they sell.
• Funding
  for a demonstration project aimed at reducing childhood obesity in
  community-based settings and schools.

In addition, according to the article, the
legislation
“may”
also support nutritionists by:

• Providing local governments
  with incentives to improve community wellness.
• Offering grants
  to small businesses that provide comprehensive workplace wellness
  programs (likely to include nutrition and exercise science counseling).
  
• Encouraging
  the distribution of science-based nutrition information to families.

Costs

More upfront but fewer inpatient costs

Analysis of Washington insurer data finds CAM-using
insureds have lower expenditures than non-users

An analysis of insurance data in Washington state
found that “among insured patients with back pain,
fibromyalgia, and
menopause symptoms, after minimizing selection bias by matching patients
who use
CAM providers to those who do not, those who use CAM will have lower
insurance expenditures than those who
do not use CAM.” Findings also indicated that:

“CAM users had higher outpatient expenditures that which
were offset by lower inpatient and imaging
expenditures. The largest difference was seen in the patients
with the heaviest disease burdens among whom CAM users averaged $1,420
less than nonusers, p<0.0001, which more than offset slightly higher average expenditures of $158 among CAM users with lower disease burdens.“

Lafferty: Learning continues through his NCCAM-sponsored health services work

The results were part of a broad NIH NCCAM-funded
initiative led by William Lafferty, MD, and published in the Journal
of Alternative and Complementary Medicine as Comparison
of health care expenditures among insured users and
nonusers of complementary and alternative medicine in Washington State: a
cost minimization analysis. Bonnie Lind, PhD
was the lead author. This study follows a more limited study of
fibromyalgia patients alone that reached a similar
conclusion: “CAM use is not associated with higher overall expenditures.
Until a cure
for (fibromyalgia) is found, CAM providers may offer an economical
alternative for
FMS patients seeking symptomatic relief.”

Comment:  Is there a hint here regarding health reform priorities? The movement toward care from these covered providers in both
studies is from inpatient to outpatient, from more costly procedures, to
less invasive services, from machinery and edifice to time-intensive treatment from licensed human beings. There is a parallel movement of
dollars, but with less overall cost. Credit
NCCAM for funding the work. (Thanks to Paolo Roberti Di Sarsina for
alerting me to thsi study.)

Research Policy

NCCAM appears to retreat to
reduction
in conceptual
framework for 2011-2015 strategic plan; Briggs offers clarification

In an April 2010 Message
from
the
Director, Josephine Briggs, MD, director of the NIH
National Center for complementary and Alternative Medicine (NCCAM)
offers “a
priority-setting
framework to help determine which research directions
to pursue.” The language focuses exclusively on the study of “products.” The methods noted are limited to basic research and efficacy trials. The framing did not reflect the new
“effectiveness”
direction and emerging interest in “real
world
outcomes” about which Briggs speaks from time-to-time. Nor would the focus on “products” reflect Congress’ mandate to examine “complementary
and
alternative
treatment,
diagnostic and prevention modalities,
disciplines and systems.” This article in the Integrator
Blog
News & Reports includes an e-letter from Briggs in
response to a query about the intent in her message. Briggs responds, in part:

“It is not our
intention to
only study products, but more broadly to encourage research on CAM
practices,
disciplines, and whole systems- as well as products. The language
suggesting a
focus on natural products was quite inadvertent; in fact, there are
many
important CAM interventions that would not be labeled as products.” 

Briggs’ message, entitled “Listening to Differing
Voices,”
begins with references to “two meetings
with
groups that represent disparate views of CAM research” that she hosted.

Comment: I was at first tickled to see
Briggs message,
since shortly before she published her Message I had posted an
article which described her recent meetings with two quite groups. (See
Anti-CAM
Bloggers and Homeopathic
Researchers: Reports on Two Stakeholder Meetings with NCCAM’s Briggs.) However, the words in the framework quickly stifled that self-important pleasure. This
framework as stated is an awful retreat by NCCAM into the comfort and language
of the NIH’s drug-focused, reductive home turf aty the very moment when it needs to engage a gutsy venture
out into the visionary, real world exploration asked
by Congress, and urged
by practitioners and even supported at times by
Briggs herself. I thank Briggs for her corrective response, yet remain concerned that this far into her tenure this level
of conceptual mistake can be made. It wasn’t a slip of the tongue. This
was a slip of the paradigm. I worry that under the 2011-2015 strategic
plan, due for publication in draft form in less than a month, NCCAM will
once again fail to embrace its distinctive destiny. 

Weeks in ’97, not quite 1993, or 1968

1993: A personal view, impatience and
NCCAM’s
“crucifixion (of CAM) on a cross of gold”

Comment and Clarity: Why do I push with such impatience for
NCCAM to shift the center of its focus to examination of outcomes of
actual practices? (Six related stories are listed
here.) My announced reasons are that multiple stakeholders have
taught me that these kinds of data are their priorities: employers,
hospital administrators, health systems, insurers, integrative practice
organizations and Congress itself. My interest is also personal. In 26+
years in the field, I have been promoting more integrative and natural health oriented practices. My evidentiary basis for such promotion is a combination of principles, philosophy, personal experience and countless stories from
practitioner colleagues. Yet throughout I have had what has festered into a
yearning for outcomes data,
the depth of which late-comers will not likely understand. Are we going to focus significant resources on these real world questions before die? So when I recently stumbled upon this
letter to the editor published in the Seattle Post-Intelligencer
on January 12, 1993, I decided to print it here. This letter was written at
the height of the Clinton health reform era during the beginning of the
earliest NIH efforts to examine “unconventional medicines.” I was at the
time the executive director of the American Association of Naturopathic
Physicians.

Letters to the editor
____________________________

Naturopaths recognize impact of diet,
environment

     I am writing to clarify a quote in Tom
Paulson’s article
about the investigation the National Institutes of Health is
undertaking into medical practices that are not yet accepted by the
dominant school of medicine. Paulson quoted me as saying: “We have an
approach to health care grounded in 19th century sciences. It’s time we
moved away from that.” From the context, it was not clear that the “we”
to which I was referring was the dominant medical culture.
     Medical practice in our culture claims to adhere to a scientific
“gold standard” of the double agent, placebo controlled trial. That
standard is particularly useful in measuring the utility of
pharmaceutical drugs in disease management. That therapeutic approach
is
readily standardized and drug agents are readily placebo-controlled.
Some natural therapeutic agents can be effectively measured and
utilized
in that fashion
   

“Unless medical science addresses the best means of measuring the impact of nutrition, lifestyle and the environment, our attempts to reform our health system risk, to appropriate William Jennings Bryan’s phrase from 100 years ago, ‘crucifixion on a cross of gold.'”

However, once the practitioner’s focus shifts from
disease management to health care and from infectious diseases to the
chronic diseases that most afflict our population, the double-blind,
placebo-controlled scientific standard has limited utility. The
recognition, management and reversal of early stage chronic disease –
the specialty of naturopathic physicians – is by its nature
individualized, not standardized.
     The naturopathic physician works with the patient toward health,
on a schedule and with protocols best suited to the patient. The key
therapeutic tools, such as nutrition education, dietary adjustment,
stress management and lifestyle counseling are not placebo
controllable.
In addition, the optimal care for chronic disease generally involves a
multi-agent protocol. For a patient with hypertension, for instance, a
naturopathic physician’s protocol might include dietary adjustments, an
exercise regime, hypotensive botanicals and foods and additional
dietary
supplementation.
     The naturopathic profession is pleased that one aspect of the
National Institutes of Health investigation is to embrace that research
challenge.
     Unless medical science addresses the best means of measuring the
impact of nutrition, lifestyle and the environment, our attempts to
reform our health system risk, to appropriate William Jennings
Bryan’s phrase from 100 years ago, “crucifixion on a cross of
gold.”

John Weeks
Executive Director
American Assoc. of Naturopathic Physicians
January 12, 1993                                                                                         

__________________________________

Here we are in 2010, 17 years later, knowing almost
nothing, from a research perspective, about the outcomes of the kinds of
whole-person, integrative practices that not just NDs but also TCM
practitioners, integrative medical doctors, holistic nurses, broad-scope
chiropractors and others model. In a
related acticle in this Round-up I speak to the apparent, reductive
“product” focus in the NIH NCCAM priority-setting
framework for 2011-2015. If that view continues to dominate, we appear to be sending
our horses down the same blindered path as
they have been hurtling, million-dollar investment following million. Impatience? Were I a student in 1968 instead of a
home-owning part of the dialogue in 2010, I am sure I would end this
column with down with the dictatorship of the reductionists!

Academic Medicine

Manzini: Chaired the successful ACC-RAC

2010 chiropractic ACC-RAC conference the most highly attended event with the most scientific
presentations

On March 17-20, 2010 the major national meeting of chiropractic
educators and researcher, the ACC-RAC (Association of
Chiropractic Colleges (ACC) Educational
Conference and Research Agenda Conference (RAC)) was held at
Caesar’s Palace in
Las Vegas. The meeting reached a new peak in attendees, at 439. The
conference included 200 scientific papers
submitted for peer
review from which 66 were selected for poster presentation and 92 for
platform
presentation. The theme, Chiropractic
and Public Health in the 21st
Century, featured Georges C.
Benjamin, MD, executive director of the
American Public Health Association. The meeting concluded
with
what was reported as “a lively panel discussion”
entitled Subluxation
Theory as a Component of Public
Health.

In an April 23, 2010 release, ACC president Frank J. Nicchi, MS, DC
summarized his pleasure with the outcome “I feel like we accomplished a
great deal this year, attendance was robust and important issues in
chiropractic education were addressed.” The annual gathering includes
breakouts for various institutional leaders including one for the ACC
president’s group. According to the release, the presidents focused on these
strategic issues:
 

• achieve consensus on how the chiropractic
  academic community may contribute to
  integration within the existing and emerging health care systems;
  
• promote
  collaboration in research efforts among member institutions;

• increase the
  quantity, quality and diversity of applicants pursuing chiropractic
  education;
• review the ACC
  Paradigm from an educational perspective;
  
• develop relationships
  with other chiropractic and allied health institutions globally that
  complement
  ACC’s mission, vision and values and to look at the possibility of
  developing
  clinical residencies as part of the doctor of chiropractic program
  training.
  

The planning committee was chaired by ACC vice-president Fabrizio
Mancini,
DC. Peer review committee
chair Claire
Johnson, DC, MSEd, called the
the 2010 program “the largest turn out of chiropractic
research in the history of the conference.” The 2011 conference will be
themed “integration.”

Comment: The ACC-RAC is quite a
gathering. I had an opportunity to attend in 2008 and recall it as a
significant, eye-opening experience of the richness and maturity in
chiropractic research and education. I recommend the conference for
anyone who wants to pull back the covers and gain a clear measure of what is best in
healthcare’s limbo profession.

Brodsky: Stamford’s integrative medicine director

Stamford Hospital begins integrative
medicine fellowship

Stamford
Hospital, an affiliate of Columbia University College of
Physicians and Surgeons, has announced a 2-year Integrative
Medicine
Fellowship at the Center
for Integrative Medicine and Wellness. The program will offer
clinical experience in complementary therapies relative to pain
management, nutrition/supplement
consultation, stress management with guided imagery and mindfulness
meditation, and preventive cardiology. According to this
web
description, the program’s consultation practice, in 4000
square feet, has had roughly 4100 patient visits since opening October
2008. As part of the program, fellows will be paid and funded to
complete the 1000-hour University
of
Arizona distance learning and
residential curriculum as well as a 300 hour acupuncture program for
physicians. Interested
candidates must be primary care physicians and are expected to already be board certified in a primary care specialty or to achieve board
certification during their first year of fellowship. Marc
Brodsky,
MD, MBA, MPH is the director of integrative medicine at
Stamford.

Comment: It is
interesting to compare, from the prospective fellow’s perspective, this
program with the fellowship for licensed acupuncturists in inpatient programs at
New York’s Beth
Israel Department of Integrative Medicine. Rather than being paid, the acupuncturists pay
for their fellowship. It is a mark of the confusion in this world, or in me, that regardless of these inequity, I continue to honor Beth Israel for its
pioneering program for LAcs.

Amri: Co-founder and co-director of Georgetown CAM-MS program

Georgetown educates 7th class in
CAM-Master of Science program

The Program in Complementary
and Alternative Medicine associated with the Master of Science
degree in Physiology advanced its 7th class in 2010. The program is
co-directed by Aviad
Haramati,
PhD and by Hakima
Amri,

PhD
and was developed by Amri and Adam Myers, PhD under an NCCAM R-25 educational
grant on which Haramati was principal investigator. The program,
according to a brochure, is “designed to
provide advanced study in the science and philosophy of predominant CAM
therapies and disciplines.” The course focuses on “training students to
objectively assess the safety and efficacy of various CAM modalities and
to introduce scientific rigor to much needed research into
understanding the mechanistic basis for CAM therapies such as
acupuncture, massage, herbs and supplements and mind-body interactions.”
This “CAM-MS” program takes 11 month and
includes 14 courses, an elective, and a 6-8 week summer practicum that
“emphasizes the cross-disciplinary application of academic knowledge.”
The program was designed to draw students in diverse fields, from medicine and
biomedical research, to law and healthcare administration. The common denominator is that each would anticipate
a professional practice related to complementary and alternative
medicine. Thus far, according to Amri, 133 students have graduates with a
“Master of Science Degree in Physiology and Biophysics with an 
Emphasis on CAM.” An additional 32 will graduate in September 2010.

Comment: Close readers of the CAM-MS
program will see an unusual focus: the materials note the study of not
just therapies but “disciplines.” It’s a nice sign of the importance of
inter-professional education to quality understanding of “CAM.”
Notably,
according to Haramati, graduates of the 2010 were each presented a copy
of the Clinicians’
and Educators’ Desk Reference on the Licensed Complementary and
Alternative Healthcare Professions.

The Ozes: Honorary degrees from Bastyr

Mehmet and Lisa Oz to be awarded
honorary doctorates by Bastyr University

In a special ceremony on June 2, 2010, Bastyr University
will confer honorary doctoral degrees on Mehmet
Oz, MD and on Lisa Oz.  Mehmet Oz is vice chair and professor of surgery at Columbia University,
where he developed one of the nation’s first complementary medicine
department with Jery Whitworth, RN, and
others. Oz, who is host of The Dr. Oz Show, also finds time
to perform 250 heart surgeries annually. Lisa Oz is an actress, writer
and strong proponent of complementary and integrative healthcare
practices who also serves as co-host of the show. The honorary degrees
will be conferred by Bastyr president Dan Church, PhD.

A statement in a recent Round-up of success of the Acupuncture
and Oriental Medicine of Austin led to a clarifying electronic
exchange between two of that field’s separately interested historians. A note from long-time
acupuncture and Oriental medicine (AOM) board volunteer and Georgetown
Law professor Sherman
Cohn, JD corrected my statement that AOMA was the first
“free-standing” AOM school to gain regional accreditation. In fact, Tai
Sophia Institute, on the board of which Cohn
serves, was the first free-standing school to achieve this standing. Tai Sophia grants an array of degrees. However, the claim that AOMA president Will
Morris, LAc, PhD had made was that AOMA was the “only stand-alone, single-degree granting school” to gain this recognition. Morris used appropriate language; the Integrator didn’t. Apologies. The clarification was a
good-natured exchange between the two.

Professions

Seitz: Mapping the regulatory roads

Three associations in Yoga and Ayurveda join forces to publish paper on emerging regulatory issues in their fields

The report by consultant Dan Seitz, JD, EdD is called, simply, Regulatory Issues for Yoga, Yoga Therapy, and Ayurveda. Behind the report is percolating interest in both the Yoga and Ayurvedic fields regarding self-regulatory issues relative to education and certification. The International Association of Yoga Therapists (IAYT), the Yoga Alliance and the National Ayurvedic Medical Association jointly funded the report. In the paper’s abstract, Seitz, known for his work in accreditation relative to the acupuncture and Oriental medicine and naturopathic medicine, begins: “In order to gain greater credibility, emerging healthcare and health-related fields usually establish a variety of self regulatory structures and organizations.” After ticking off possible values to such internal work, he adds: “Developing self-regulatory structures, however, can pose significant challenges and invariably involves trade-offs.” The 7-page report was published in the International Journal of Yoga Therapy and is available as a download here.

Comment: Interestingly, the March 2010 issue of IAYT’s publication Yoga Therapy Today includes a 2-page opinion piece entitled “Embracing Balanced Regulation.” Seitz’ allusion to challenges remind me of a classic comment from Carlo Calabrese, ND, MPH in the late 1980s when he was shepherding the single purpose accrediting agency of his profession through US Department of Education approval. Said Calabrese: “Any time you create standards, you create pain.” Seitz is right to urge his clients to “engage in inclusive, representational, and transparent decision-making processes to build support for any self-regulatory measures being considered.” At this point, these fields are doing a remarkable job of doing so.

Zahourek: Led the holistic nurse’s white paper team

Research agenda for holistic nurses
articulates
holistic, healing, complexity requirements

In April 2009, the American
Holistic Nurses Association approved a white
paper
on research in holistic nursing. The four page document include an “important caveat.” That is: “To be ‘holistic’ nursing research,
the theoretical basis and interpretation of results must be within the
context of holism.” Also: “Understanding the
effect of an intervention on the whole person often requires describing
and evaluating feelings, sensations, and responses.” And: “As a result,
research is often challenging and the questions posed may not always
lend themselves to traditional designs such as the double-blind
randomized controlled trials. In general, the strongest and most
appropriate design and methods for research question posed should be employed. Results may need to be
interpreted in functional and practical ways that apply to all areas of (holistic nursing)  practice.” The white paper development was led by Rorry
Zahourek, PhD,
APRN, BC, AHN-BC.

Comment: I
found this short document’s direct engagement of complexity refreshing.
It is an interesting counterpoint to NIH NCCAM’s recent, unfortunate
use of the term “product” to describe the complementary and alternative medicine arena.

Naturopathic organization goes after loan payback programs

Naturopaths “demanding” that members of Congress
include NDs in loan-payback programs



The American Association of Naturopathic
Physicians is focusing political efforts of their profession on
inclusion in loan payback programs according to an e-letter which
coincides with their annual lobbying day. The language to members is strident, urging members to make demands of Congress. The message in a sample capwiz letter
to members of Congress highlights the following:

“INTEGRATIVE HEALTH PRACTITIONER  Defining this
innovative term of art, included throughout the Patient Protection and
Affordable Care Act, to include qualified, licensed non-MD/DO providers
will prevent regulators from restricting the definition by using
outdated definitions in current law.
 
“INDIAN HEALTH CARE IMPROVEMENT ACT  Inclusion of
naturopathic medicine in the definition of Health Profession in the
Indian Health Care Improvement Act for the Indian Health Service Loan
Repayment Program.

“NATIONAL HEALTH SERVICES CORPS Inclusion of
naturopathic medicine in the definition of approved education for the
National Health Service Corps loan repayment program.

“PUBLIC HEALTH WORKFORCE LOAN REPAYMENT PROGRAM 
Inclusion of a clear, inclusive definition of health professions degree
for the Public Health Workforce Loan Repayment Program in PL 111-148. 
Left  undefined, this program could be restricted to students and
graduates of conventional medical programs as defined in section
799(1)(A) of the Public Health Service Act (see below).”

At this time, the AANP has not reported that sponsors have been found for specific
bills to be introduced to
advance this agenda. AANP efforts from 2008-2010 to gain inclusion in the Indian Health
loan program fell short when the AANP
couldn’t
secure a  sponsor on the Senate side to place the language in the
version of the healthcare overhaul bill that was passed into law.

Comment:  A recent newsletter
from Bastyr University offers
additional perspective on the impact of the healthcare overhaul
legislation on naturopathic practice.

International

Roberti: Useful links to key WHO documents

Links to all World Health
Organization publications on traditional, complementary and alternative
medicine

Integrator reader Paolo
Roberti di Sarsina, MD, an leader in complementary and
alternative medicine in Italy recently scoured the World Health Organization
(WHO) data bases and developed this set of links to documents on the WHO
site. He shared them with his list. I pass them on. The categories were created by Roberti di Sarsina.

WHO Publications on Traditional, Complementary
and Alternative Medicine

acupuncture (8 documents)  
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.1.7/clmd,50.html#hlCL6_1_1_1_7

alternative medicine (2
documents)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.1.11/clmd,50.html#hlCL6_1_1_1_11

anti-HIV activity (1 document)

http://apps.who.int/medicinedocs/en/cl/CL6.1.1.1.13/clmd,50.html#hlCL6_1_1_1_13

chiropractic (3
documents)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.3.2/clmd,50.html#hlCL6_1_1_3_2

clinical trials on treatment (1
document)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.3.5/clmd,50.html#hlCL6_1_1_3_5

clinical evaluation (1 document)

http://apps.who.int/medicinedocs/en/cl/CL6.1.1.3.4/clmd,50.html#hlCL6_1_1_3_4

herbal medicines (11 documents)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.8.12/clmd,50.html#hlCL6_1_1_8_12

homeopathic medicines (1
document)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.8.17/clmd,50.html#hlCL6_1_1_8_17

homeopathy (1 document)

http://apps.who.int/medicinedocs/en/cl/CL6.1.1.8.18/clmd,50.html#hlCL6_1_1_8_18

medicinal plants (21 documents)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.13.14/clmd,50.html#hlCL6_1_1_13_14

traditional medicine (31
documents)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.20.6/clmd,50.html#hlCL6_1_1_20_6

Traditional Practitioners as Primary Health Care Workers

http://apps.who.int/medicinedocs/en/d/Jh2941e/

Traditional Medicine and Health Care Coverage
http://apps.who.int/medicinedocs/en/d/Js7146e/

Report of a WHO Consultation on Traditional Medicine and AIDS:
Clinical
Evaluation of Traditional Medicines and Natural Products
(Geneva, 26-28
September 1990)
http://apps.who.int/medicinedocs/en/d/Jh2954e/

Report of the Consultation on AIDS and Traditional Medicine:
Prospects for
Involving Traditional Health Practitioners (Francistown,
Botswana, 23-27 July
1990)

http://apps.who.int/medicinedocs/en/d/Jh2955e/

traditional practitioners (4
documents)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.20.7/clmd,50.html#hlCL6_1_1_20_7

traditional remedies (2
documents)
http://apps.who.int/medicinedocs/en/cl/CL6.1.1.20.8/clmd,50.html#hlCL6_1_1_20_8


WHO Monograph on Good Agricultural and Collection Practice (GACP) for
Artemisia Annua L.

http://apps.who.int/medicinedocs/en/m/abstract/Js14074e/

Media

May issue features integrative medicine

Real Simple features integrative medicine, distinguishes IM from DO and ND

The title for the Real Simple feature is “How
Integrative
Medicine Can Help You Be Healthier: Best of both worlds
approach to medicine blends conventional science and complementary
practices.” Featured are leaders of many of the programs associated with
the Consortium of Academic Health
Care Centers for Integrative Medicine. One leader is quoted as stating that the hope is
that this medicine will simply become the medicine of the future.
Interestingly, the writer thought it important to help her audience
distinguish integrative MDs from osteopathic doctors (DO) and naturopathic
doctors (ND):

“A few important distinctions: An IM doctor is not the
same as an
osteopathic or naturopathic doctor, although all three share
similarities. A doctor of osteopathic
medicine (or DO) gets conventional medical training but with additional
instruction
on the structure of the body in relation to
how it functions; treatment protocol may involve physical manipulation
of your
body with his hands to diagnose injury or
illness and help the body function efficiently. A naturopathic doctor
(or ND) gets
Western-style medical training but also
learns about botanicals, nutrition, and Eastern therapies. ‘It’s a bit
of ‘buyer,
beware’ for this specialty,’ says Tracy
Gaudet, executive director of Duke Integrative
Medicine, in Durham,
North Carolina. ‘There are quality, accredited programs for
naturopathic medicine, but people can also get an online degree and
call
themselves
an ND with very little education.'”

Mussalli: Midwife-friendly OB

Closing of St. Vincent’s ends quality
midwifery, childbirth and CAM options

The New York Times ran an April
9, 2010 feature that marked a sad turn for
natural childbirth: St. Vincent’s Medical Centers was shut down. The
hospital’s obstetrics program was run by an “an exceptionally-midwife
friendly” medical doctor, George
Mussalli, MD, who describes his work as “minimally invasive
obstetrics.” While the city’s c-section rate “soared to 36%” from
2000-2007, under Mussalli’s leadership, the c-section rate at St. Vincent’s
“inched down” to 24%. (The World Health Organization says anything above
15% is likely to be “causing preventable deaths and complications.”)
While not covered in the article, St. Vincent also had an early
complementary and alternative medicine program and an inpatient
fellowship for licensed acupuncturists. I asked healthcare consultant
and poet Linda Rapauano if this hospital was indeed the one in which she
had worked on complementary health care. She wrote:

Rapuano: Plans for St. Vincents’ integrative care will not be realized

“That’s the one; ten years of my
life trying to build a model of integrative care there. Just last year I
did a very large ‘consumer-focused facility design’ project around the
new
hospital they were planning to build. All the components supporting
integrative
care would have begun with that facility design including re-engineered
administrative processes and technology interface. I am glad the
laughing
Buddha is entertained. The hospital itself will close in 30-40 days
time. There are some services like the HIV and Behavioral Health which I
believe may still be under discussion with un-namable entities.”

Comment:  The program lives on. According to Rapuano, the
inpatient fellowship for licensed acupuncturists at Beth Israel was
modeled on one who and colleagues developed at St. Vincents.

People

Mathews: Taking the YA helm

Mathews selected as president of the Yoga Alliance

Yoga practitioner John Mathews has been selected to serve as president of the Yoga Alliance. Mathews has been a consultant to hte organization for 6 years. He most recently service as vice president of the Federaton of State Humanities
Councils. The Alliance serves as a registry for yoga schools and practitioners with over 30,000 practitioners presently registered.

Hangee-Bauer: AANP’s new president

Hangee-Bauer new president of AANP

Carl Hangee-Bauer, ND, LAc stepped into the presidency of the American Association of Naturopathic Physicians in January 2010 for a 2-year term. A long-time leader of his profession in California, San Francisco-based Hangee-Bauer played important roles in gaining licensing for naturopathic doctors in that state. He comments here on his profession’s efforts to build relationships.