Integrative Medicine and Integrated Healthcare Round-up: June 2010

Summary: AMA specialists seek continued discrimination against integrative practitioners in effort to repeal Section 2706 of healthcare overhaul … Ornish program receives penultimate boost toward full coverage from CMS/Medicare … AANP proposes a definition of “integrative practitioner” to shape federal policy post reform .. Integrator publishes resource on the mentions of CAM/IM in the healthcare overhaul law … Notes on the overhaul’s impact on health psychologists and LAcs from Bastyr University … Brief comment/update on the Integrative Medicine Clinic of Santa Rosa … Medical schools begin offering tenure to integrative medicine leaders … College links with integrative medicine clinic to offer certificate course for “patient navigators” … Duke’s Integrative Health Coach program booked solid, certification program begins soon … NCCAM begins publishing priorities for the 2011-2015 strategic plan, holds session on CAM and behavioral change … Botanical sales up in 2009 to over $5-billion .. Survey finds MD knowledge of herbs remains low … Standard Process honored for commitment to advancing integrative medicine … Bravewell publishes 50 page booklet on integrative medicine … Helfgott’s Tippens reports socio-demographic data on clients of community acupuncture model .. Fall 2010 American Public Health Association conference will include 16 segments on alternative healthcare practices and chiropractic … Integrative medicine featured in Minnesota Monthly and group visits in the Denver Post … Micozzi’s pioneering Fundamentals of Complementary & Integrative Medicine textbook in 4th edition with forward from former JAMA editor George Lundberg … Mark Hyman, MD takes role as chair of the Institute for Functional Medicine … Integrative behavioral health leader Joseph DeNucci announces new retreat center …



Proposed resolution urges stepped-up campaign to maintain discrimination against other professions

AMA Specialists Promote Repeal of Non-Discrimination
Toward Licensed
Integrative Practitioners, Others, in Section 2706 of Healthcare Reform

The ink was hardly dry on the landmark Non-Discrimination
in Health Care provision (Section 2706)
of the Obama-Pelosi
healthcare overhaul, the Patient
Protection and
Healthcare Affordability Act
, and MD specialists are pushing its
Anesthesiologists and
ophthalmologists have asked the AMA to initiate a lobbying
campaign at the executive, Congressional and grassroots levels so the
Section 2706 of the 2010 law, scheduled to come into effect in 2014,
never does. The
request is framed as part of the AMA’s ongoing Scope
of Practice Partnership
against other professions. Section 2706 is
healthcare reform’s most significant
inclusiveness measure for DCs, NDs, LAcs, massage therapists and
licensed midwives. Section 2706, if not repealed, could open consumer
choice to these practitioners to tens of millions of US residents. In
the name of patient protection, the two
AMA specialty societies are acting against their direct competitors,
anesthetists and optometrists, but taking out integrative practitioners
with them. A look at the language in the proposed resolution as it
will go to the AMA House of Delegates in June 2010 is available


Is it all about the money?

Comment: I
had the opportunity at the research conference of the Massage Therapy Foundation to be on a policy panel on May 13, 2010 with Deborah
, the former Washington State insurance commissioner. Senn is
widely credited with saving a 1995 state statute
effectively, a “non-discrimination” law in Washington State
legislature. Senn
repeatedly battled back the
courtroom and lobbying efforts of insurers for
repeal. She and I spoke of the likely battle ahead over Section 2706,
just 10
days before the campaign of the two AMA specialty societies,
noted above, came to light. Get involved, friends, if you want to see
this language stay in the law. Two coalitions that are likely to be
involved are the Integrated
Healthcare Policy Consortium
and the Coalition for
Patients Rights
To gain a sense of the
potential battle ahead, the
AMA’s “grassroots” anesthesiologists average $311,600
to $446,994
of income per year and their “grassroots”
ophthalmologists average

$349,766. Redwood grasses, I guess.


Close to coverage of Ornish program

CMS/Medicare takes huge step toward
routinely covering Ornish’s integrative cardiac program  

Following 16 years of lobbying and a major federal pilot project, the Centers for
Medicare and Medicaid Services
(CMS) is on the brink of routinely
covering the revolutionary integrative medicine program developed by
Dean Ornish, MD and the Preventive Medicine Research Institute

to reverse coronary artery disease. One May 14, 2010, the agency
published a Proposed
Decision Memo
which states that:

“The Ornish Program for Reversing Heart Disease meets the intensive
cardiac rehabilitation (ICR) program requirements set forth by Congress
in §1861(eee)(4)(A) of the Social Security Act and in our regulations
42 C.F.R. §410.49(c) and, as such, should be added to the list of
approved ICR programs.”


Ornish: 16 year campaign may find success

The decision memo requested final public
comment on the action, a 30 day period. Ornish mentions the action in
his Huffington
Post blog on May 15, 2010
. Ornish writes: “This
is the first time that Medicare will be providing coverage for an
integrative medicine program, so we are grateful to everyone involved in
this decision.”

Comment: Ornish has shown tremendous
perseverance on this work. Integrative
medicine leader Lee Lipsenthal, MD
, who was involved for years with
the Ornish team, sent news of the action to the Integrator
with this comment: “This is the first time that a healthy lifestyle
program including
yoga and veggie diet will be covered as a treatment option from the
government.” Here’s hoping there are no glitches in the final comment


ND organization offers definition in its own image

AANP makes stab at defining
“integrative practitioner” for federal policy makers

A key focus of the May 2010 annual lobby-day of the American
Association of Naturopathic Physicians
was on defining
the term
“integrative health care practitioner” according to a May 7, 2010 note
to me3mbers from AANP executive director Karen Howard.
The term, “integrative health care
practitioner” is used throughout the health
care reform law
and is not
defined in the statute. Howard writes that the AANP is proposing
language from two wellness resolutions (H.Con.Res 406 which became H.Con.Res. 58)
introduced by Congressman James Langevin (D-RI). The
language reads
as follows:

“An Integrative Health Care Practitioner,
acting within the scope of that provider’s license or certification
applicable State law, addresses the underlying causal factors
chronic disease; improves individual health and increases individual
to engage in activities of daily living through lifestyle change,
strategies relating to diet, exercise, smoking cessation, and stress
and provides patient-centered care that:

A. addresses personal
health needs;

  1. uses a
    multidimensional approach to encourage patients to improve their
    wellness through lifestyle changes and the use of scientifically
    therapies and outcomes based treatments that facilitate the
    ability of the human body to maintain and restore optimal health;
  2. utilizes clearly
    defined standards to determine when the implementation of wellness
    health promotion activities will be useful for each patient based
    on the
    diet, exercise habits, individual health history, and family health
    history of the patient.”

The AANP’s171 participants, 100 of them students, made
170 visits to offices representing 38 states. Other foci were on how
Congress can address the critical shortage of primary care
physicians by accessing naturopathic medicine and specifically,
inclusion in all federal loan repayment programs.

Comment: While I like this definition
of a practitioner, it is too ND-centric for the law. I would urge an
understanding of the bill language that is broad and that clearly
includes, for instance, licensed massage therapists, chiropractors,
acupuncture and Oriental medicine practitioners and midwives. (I don’t
mention integrative medical doctors and holistic nurses as MDs and
nurses are already included in the relevant sections of the law.) Each
of these other professions would need to stretch in various ways to meet
this naturopathic-centric definition of integrative practitioner. Mean
time, the AANP’s focus on elevating the wellness-orientation of
integrative practitioners is worth noting. We often say that all of
these fields share that focus.


Special report meant as a reference resource for federal political action

Integrator report details 7
sections in the federal healthcare overhaul law that expand inclusion of
integrative practices

In the Integrator Blog News & Reports,

I recently published
a report
that includes locations and
language of all of the chief sections of
the Patient
Protection and Affordable Healthcare Act
(HR 3590), the healthcare
overhaul law. These sections, including 2706, non-discrimination,
will likely shape policy action relative to integrative practices in
Complementary and
alternative medicine
practitioners and integrative practices
included in sections 2706, 3502, 4001, 4206, 5101,
6301 and 2301. These relate, respectively, to: non-discrimination;
workforce planning;
community medical homes; wellness, prevention and health promotion;
individualized wellness plans; comparative effectiveness research; and birthing services. The
report includes the sections with the language related to integrative
practices in bold. Also included is a link
to a You Tube file
which includes a useful analysis from a longtime
lobbyist for the chiropractic profession who called this combined
inclusion “major steps
toward recognition.”

Comment: Fascinating that the concept
of “integrative practices” and “licensed integrative practitioners”

did not exist in federal law until this law in 2010. It
is worth a moment of reflection on how far this movement has come, even
if slower than any of us might want. And, for those of you who
participate in US politics through contributing to elected officials, I include
of those elected officials who appear to have had the most
impact: Harkin, Mikulski, Sanders, Conrad and  Cantwell for specific
sections; and Obama and ultimately Pelosi for shouldering the
legislation into law.


Courtney: Regulations will shape meaning of non-discrimination

Analysis of healthcare overhaul for
health psychologists and acupuncturists

The e-newsletter
from Bastyr University
for May 27, 2010 includes a useful look at
the impact of the Patient Protection and Affordable Healthcare Act on
health psychologists and licensed acupuncturists. The health psychology
component leans heavily on perspectives from the American
Psychological Association
. The article celebrates the potential for
more mind-body integration in various components of the law. Chief
concerns regard the breadth of the panels of psychologists with whom
insurers will choose to work and whether licensed mental health
counselors will be included. The section on acupuncturists focuses on
insurance coverage under Section
2706, Non-Discrimination in in Health Care
The dean of Bastyr’s program in acupuncture and
oriental medicine,
Courtney, LAc, MPH
, points out that
“while all
insurance plans will soon include acupuncturist
benefits, what the actual scope of coverage and rates of reimbursement
will look like remain to be seen.”

Comment: Clearly, with the likelihood
of an AMA campaign to gut Section 2706 (see Battle
: MD Specialists Promote Repeal of Non-Discrimination Vs
Integrative Practitioners, Others
), a
variety of hands besides insurers may be on deck trying to stir this

Academic Integrative Care


Kemper: One of 6 tenured integrative medicine leaders featured

Explore features 5 integrative medicine
academics  granted tenure

An article in the May 2010 issue of Explore marks a form of arrival of
integrative medicine in U.S. academic health centers. Entitled University
Professors Awarded Tenure for Integrative Medicine Accomplishments
the piece includes short synopses of the now tenured academic careers
of Victor Sierpina, MD (U Texas), David Rakel, MD (U Wisconsin), Brian
Berman, MD (U Maryland), Kathi Kemper, MD, MPH (Wake Forest) and Brent
Bauer, MD (Mayo). Each offers some analysis of major contributing
factors to their success in achieving this recognition. Comments from
Kemper capture the gist of the communication from the others:

“It was the extramural funding and the publication
record rather than my particular topics [of research] that led Wake
Forest to offer me a position as professor and within a few years,
extend tenure as well … Department chairs and administrators look for
faculty who can generate revenue to support the academic enterprise.
also need to be assured that faculty
contribute to the morale and teamwork of the overall institution.”

Comment: Now, recalling my experience
of long-tenured, accomplished faculty at the esteemed academic
institution I attended, I suppose the mark of ultimate arrival of
integrative medicine in academia will be when new students find
themselves wondering about the early accomplishments of the old codger
in front of them who hasn’t had a new thought for 3 decades. Perhaps the
focus on mindfulness in this integrative MD group will save their
future students from such a sentence! (Thanks to Integrator
reader Paolo
Roberti di Sarsina, MD
for pointing me to this article.) 

Integrative Medicine Clinics


12 practitioner center

Update: Integrative Medicine
Clinic of
Santa Rosa

Pam Koppel, LCSW, a clinical associate of
the Integrative
Medical Clinic of Santa Rosa
, was in touch regarding the Patient
Certificate Program described in this Round-up. I asked Koppel
for an update on the clinic, founded 10 years ago by Robert Dozer, MD
and Ellen Barnett, MD, MPH
. The clinic has roughly a dozen
practitioners and includes a concierge component.
Koppel reports:

clinic is still going ( and
has been running smoothly for a long time now. About 4 years ago we
changed it
from an employee model (not working) to a model where the
practitioners rent
space and buy services. That is working well. I can’t say that Bob
& Ellen
are making big money from it but it is working well enough. There has
been a
steady group of about 12 practitioners there for about 6 years, some
and some a bit shorter. I don’t work for the clinic much anymore, but I
run the practitioner team activities – weekly patient care
bi-monthly team meetings, and I do new patient intakes via phone as
well. And
yes, it is still integrative and the group continues to explore and
with what integration really is. Even after 10 years, it clearly is
not an easy
thing to do, and part of the reason it has been determined a navigator
can play
an important role in making integration happen, as practitioners tend
to be
mostly focused on their own modality.”

Comment: I find Koppel’s comment on the
value of the navigator to be telling. This clinic has invested
significantly in provider education and cross-fertilization. Yet in
Koppel’s estimation, the model still serves patients best with a 3rd
party arbiter, the navigator, to “make integration happen” and keep
practitioners from over-dependence on “their own modality.”

Patient Navigation and Health Coaching



Koppel: Developer of navigator program

Sonoma State University teams with
integrative medicine clinic to offer Patient Navigator Certificate

Sonoma State University has teamed with the Integrative
Medical Clinic Foundation
to offer what it considers a
“first-of-it’s kind” Patient
Navigator Certificate Program
. The Foundation is the non-profit arm
of the Integrative Medical Clinic of Santa Rosa (see related story
above), a clinic operating since 2001. This “integrative health
specialty,” to be offered beginning in the fall of 2010, includes 150
classroom hours and 50 hours of fieldwork. Students must also receive at
least 15 different forms of complementary care treatments as part of
the training.

The announcement of the program notes that “the role of a Patient
Navigator is becoming more prevalent in the health care system,
especially in the area of oncology …  to help patients wend their way
through the complexities of the health care maze, understand their
treatment options, access resources and advocate for themselves.” The
program director, Pam Koppel,
, has been developing this program and implementing it for over 5
years with her colleagues at the Integrative Medicine Clinic. Koppel
anticipates such navigators will one day be placed in every physician’s
office. She sees this program as a first step towards making that vision
a reality. Koppel, Ellen Barnett, MD and Amy Schiff, LAc, from the
clinic are among the instructors. For more information or to apply for
the program, visit the website
or call Koppel at 707-284-9235. A release on the program is available

ImageDuke’s integrative health coach
professional training sessions selling out; certification to start in
July 2010

A visitor to the Integrative
Health Coach Professional Training Program
web page at Duke Integrative
will discover that the program, begun in late 2008, is
finding significant interest. This program is part of a growing Duke
initiative that also includes a certification
that starts July 2010. The $4500 basic program, featuring
four, 4-day modules and 11.3 CEUs, is sold-out at 40 participants for all three 2010 sessions.


McCabe: Lead role in Duke’s health coach program

According to senior program coordinator
Kathy McCabe, roughly 50% of the class comes from
some medical or allied
health background. These
include RNs, OT/PT, exercise physiologists, RDs,
psychotherapists, and some MDs, PAs and nurse practitioners.

Interestingly, the other half of registrants “come from
various backgrounds including, but not
limited to health education, social work, human resources, ministry,
consultants or business owners, military personnel and life coaches.”
McCabe clarifies: “
Our Integrative Health Coaches
are not providing health advice, nor health education, therefore we can
people from many different backgrounds. Some are seeking a career
or re-tooling if they are unemployed.

program focuses on health behavior change.”

An overview of the curriculum is here.
The topic list is intriguing if not always
self-explanatory. Besides subjects such as mindfulness and basic
complementary healthcare approaches, the curriculum also includes themes
called “bottom-lining,” “requesting,” “challenging” and “using
Participants are trained to work
one-on-one with clients and to work with groups.

Duke will initiate a second component of the coaching initiative, its

certification program, in July 2010. Certification is only open to
those who have completed the basic program. (Thanks to Kathy Taromina,
LAc, for recalling this program to my attention.)



Rolling out strategic plan

NCCAM moving toward clarity on 2011-1015 strategic plan:
chronic pain and natural products highlighted

Testimony to Congress and two white papers recently published by the NIH
National Center for Complementary and Alternative Medicine
setting the first formal clarity for the first strategic plan under
director Josephine Briggs, MD. In Briggs’
testimony to Congress
to support a $132-million request for NCCAM
for fiscal year 2011 (3% increase), she turns Congress attention in two
directions: first chronic pain and then natural products. In addition,
NCCAM has just closed a comment period on two white papers on the
strategic plan. The first is Principles
Guiding CAM Natural Product Research and Development
. The second
focuses on one region and type of chronic pain: Better
Strategies for Management of Back Pain
.  In support of the second
agenda, the NIH hosted a May 10-11, 2010 workshop on Deconstructing
Low Back Pain
. At the end of March, NCCAM held a March 26, 2010 Think Tank on
Natural Products
. Natural products were also the subject, with
mind-body medicine, of the December 8, 2009 10th
Anniversary Research Symposium

Comment: On May 7, shortly after the
May 2010 Round-up was published, NCCAM sent a note about the
two white papers, stating that a comment period would last from May
10-24. Unfortunately, the Integrator publication schedule did
not allow me to include timely notification of the comment period.
Perhaps I should have gone ahead with a special mailing. Apologies to
those of you who might have responded.

Additional Note: I was pleased to see that NCCAM is
engaging a special focus on behavior change June 3, 2010 just prior to
the 39th meeting of the National Advisory Council on Complementary and
Alternative Medicine. Entitled “Gaps
and Opportunities in Health Behavior Research,”
the day-long
strategic planning session begins with a series of short presentations
and concludes with an exploration entitled “Improving Healthy Behavior:
What is the Role of CAM?” Hopefully the segment will engage the more
focused, practical question of improving healthy behavior -the role
of the CAM/integrative practitioner
. That’s the topic that will
most assist agencies in how to implement programs related to integrative
practices in healthcare reform.

Mailing list purveyor offers erratic estimates on
the size of the integrative practitioner market

I recently received a query from an individual who was looking for data
on the size of the integrative practitioner market.  shared up-to-date data on the number from the licensed
CAM disciplines, based on their councils of colleges, and published on
page 9 of
the 2009 Clinicians
and Educators Desk Reference on the Licensed Complementary and
Alternative Healthcare Professions
I asked
him to share what he discovered.
The individual
noted that “one

site that’s been helpful in ascertaining the number of health
professionals in
a given discipline has been
database [from Nextmark] of available mailing lists
.” The mailing
lists from Nextmark include the numbers in the table below.



Practitioners by Category from
Mailing List Purveyor Nextmark: How Good Are They?




treatment professionals





















and family therapists






and homeopaths


















(Total) Nurses


(Total) Physicians




Comment: Many of the Nextmark numbers
are odd. First, the US Department of Labor
put the total number of employed MDs/DOs at 661,400 in 2008, rising to
805,000 in 2018. Nextmark has this number at 1,376,602. Perhaps home and
office addresses for the MDs are included. Interestingly, naturopathic
physicians are listed at 790, 20% of their total of nearly 5000. Massage
therapists actually count up to 250,000, 250% more than the Nextmark
list at 102,800. The total of 42,322 for “integrative physicians” is
well beyond my own estimates that might go as high as 15,000-20,000.
While the American
Holistic Nurses Association
has been growing steadily in recent
years, their 3,000-5,000 is a minor fraction of the 118,097 Nextmark
seems to have corralled as “holistic nurses.” Best numbers are
chiropractors (59,995 is quite close to the 60,000 level in
the U.S. the professional associations will give you – 75,000
internationally) and the  number for acupuncturists is also not bad, at
16,100, though the Council of Colleges of Acupuncture and
Oriental Medicine
puts the number at 20,000-25,000.

Natural Products

ImageAmerican Botanical Council report 5% growth in herbal
supplement sales in 2009 to over $5-billion

Sales of herbs in the U.S. grew by nearly 5% in 2009 to just over
$5-billion according to a May
7, 2010 report
from the not-for-profit American
Botanical Council
. Most growth was seen in sales via mainstream
retail outlets, such as drugstores. In these categories, sales soared
14th from 2008. ABC’s
comments: “In
the most economically difficult market in over 70 years, when almost
consumer goods experienced a drop in sales, consumers voted strongly
scarcer dollars for herbal dietary supplements.” The report found that:

  • 5 top-selling via health and natural food
    : aloe,
    flaxseed oil, wheat grass and barley
    grass, açaí, and turmeric.

  • 5 top-selling
    via food, drug, and mass market channel
    : cranberry, soy,
    palmetto, garlic,
    and echinacea. (The rankings do not include herb combination

The HerbalGram report is based on herb supplement sales
statistics from market research firms Information Resources Inc. (IRI),
(NBJ), and SPINS.


Products firm honored for donations and for workplace as employer

Standard Process honored
with Corporate Vision Award from ACAM; recognized as a top work place in
home state

The American
College for Advancement in Medicine
(ACAM) has awarded
with its highest honor, the ACAM Corporate Vision Award. The
award to the Palmyra, Wisconsin firm was made at ACAM’s Spring 2010
Education Summit
held in San Diego, April 21-25, 2010. Charles
, president of Standard Process commented in a press release:
ACAM, we are dedicated to optimizing health and wellness. Together we
committed to a single vision: a time when all health care professionals
working in the best interest of the patient by combining conventional
care with
alternative solutions to obtain optimal results and health.” In 2009, Standard Process donated or committed more
$3 million “for the growth and development of complementary practices.”

represents more than 1,000 physicians in 30 countries and presents
itself as “the
largest and
oldest organization of its kind in the world dedicated exclusively to
the needs of the integrative medicine industry.”

Comment: My own work has benefited
doubly from Standard Process’ generosity. The firm helped launch the Integrator,
coming on as the second sponsor and maintaining support for a 2-year
period, thank you! In addition, beginning in 2007, the firm has
supported staff costs relative to the Research Working Group of the
Academic Consortium for Complementary and Alternative Health Care
with which I am involved. I was pleased to see this recognition of
Standard’s investments. Notably, the firm was also honored May 24, 2010
as a ‘Top 100
by the Milwaulkie Journal Sentinel with
particular kudos for its wages and benefits.

Survey finds medical doctors know little about
herbal medicines

The May 2010 issue of Herbalgram, the electronic publication
of the American
Botanical Council
(ABC), includes a brief entitled Survey
Reveals Doctors Know Little about Herbal Medicine
. The survey of randomly-selected subscribers to Drug and
Therapeutic Bulletin
, a British Medical Journal
publication, mainly reached medical doctors in England. The conclusions,
as summarized by ABC, include:

“Despite the small number of responders, the results of
the survey have
notable majorities: 71.8% responded that they believe the public has a
misplaced faith in herbal medicines, 84.1% do not believe herbal
medicine is well regulated, and 62.8% said they did not provide
herbal medicine information to their patients. Furthermore, 75.5% of
respondents believe that doctors are poorly informed about herbal
medicines while 46.6% admitted to being poorly informed themselves. Of
the 21.3% who responded that they wouldn’t seek more information about
an herbal medicine their patient was taking, 60% said they were unsure
where to seek such information. Overall, 50% said they’d use Google or
similar Internet tools if they were to seek such information.”

Mark Blumenthal, ABC’s founder and executive director
notes that
education of medical professionals on
botanicals is “still woefully inadequate.” Blumenthal also pointed out
that “the potential for potentially serious
[herb-drug] interactions still exists and all healthcare professionals,
not just physicians, should be adequately trained on these potential
interactions, as emerging scientific and clinical data reveal them.”


ImageBravewell publishes 50-page booklet on integrative

The Bravewell

collaborative of philanthropists for integrative medicine has published
a handsome, 50-page booklet entitled Integrative
Medicine: Improving Health Care for Patients and Health Care Delivery
for Providers and Payors
. The short description from Bravewell
states that the booklet:

” … explains what integrative medicine
is and how it can help transform our health care system. It summarizes
the evidence presented at the Institute
of Medicine’s 2009 Summit on
Integrative Medicine and the Health of the Public
and answers the
question: What is health?
The report also
discusses the need for health care that addresses
the whole person, the connection between lifestyles and health, the
importance of the doctor patient-relationship and the need to embrace
complexity and connection in both care and research.In addition, it
contains patients stories from Duke Integrative Medicine, Scripps
for Integrative Medicine, UCSF Osher Center for Integrative Medicine,
and The Alliance Institute for Integrative Medicine.

Of note are the concluding references to two initiatives
under development. One is the Healthy
Nation Partnership
, engaged with the Institute of Medicine and the
AARP. The second is “the possibility of one or more nationally-based
pilot projects that would demonstrate how the integrative model of care
can improve patient care and lower costs.” Both are portrayed as under
exploration. The “briefing” paper is available by calling

Public Health & the Underserved


Tippens: Exploring group acupuncture clientele

Helgott’s Tippens reports first data on
socio-demographics of community acupuncture network clientele

Those observing the growth of the Community
Acupuncture Network
and movement for low-cost, community room
services will be interested in data that are emerging from an ongoing
analysis led by
Kim Tippens, ND, MPH
, a post-doctoral fellow at the Helfgott
Institute associated with the National College of Natural Medicine. At
the April 2010 meeting of the Symposium
for Portland Area Researchers in CAM
(SPARC), Tippens presented a
poster with some of the demographics of the users of the acupuncture
services at the mothership of the CAN movement, Portland, Oregon-based Working Class
, co-founded by Lisa
Rohleder, LAc
. Clients choose to pay between $15-$40 per visit. In a
sample of 478 clients, Tippens found that the
clientele are:

” … primarily white (87%) and female (72%); 25% of
respondents are uninsured, 29% are unemployed, and 77% have an annual
household income of less than $55,000; 69% completed a college degree or
higher level of education. The majority (87%) of WCA clients used
acupuncture for a specific health problem. More than half (55%) of
respondents reported that acupuncture had helped their condition and 90%
reported being ‘very satisfied’ with the treatment they had received at
[Working Class Acupuncture].”

Interestingly, 66% had some kind of private insurance.
The most significant “extremely important” reason for choosing the
community acupuncture was found to be “affordability” with “quality of
treatment” next as “extremely important” for approximately 67%.

asked Rohleder for her comments, and specifically if there were any
surprises relative to the incomes of the users, and for latest data on
the payment levels clients choose. She notes that she can’t respond
expansively because, while she has seen the rest
of Tippens’ data, “the rest haasn’t been published.” She offered the

“The 77% below 55K/23% above is about what
I would have guessed. We draw folks from all income categories. We
haven’t tracked payment categories for quite a while,
but the last time we did, I think about 50% paid $15, and about 10% each
paid $20,
$25, $30, and $35. I would estimate another 5-10% are people with whom
we have ‘special arrangements’: temporarily paying nothing because they
their jobs, paying $5 because they have very low fixed incomes, paying
$15 because they are coming every day for
treatment for
something acute, etc.”

Rohleder notes that, for context,
WCA, had a gross income of
$509,000 via its two clinics in 2009. Working Class Acupuncture offers roughly 1600 visits per month and averages about $18 per treatment.

Comment: The portrait that emerges
from Tippens’ socio-demographic data is of a user population that, while
well-educated, is solidly in the so-called working poor/middle class
range. Members of any household with family income of less than $55,000
are likely to have trouble paying for a series of acupuncture treatments
at $65-$125 per needling. Ten visits at $15 is $150 and doable for
most; at $75 each, the cost is simply prohibitive for many.


American Public Health Association

APHA conference to feature 11 segments
from alternative heath special interest group, 5 from chiropractic

The early announcement from the American Public Health Association on
their 138th annual conference, November 1-6, 2010 notes 11 segments for
their Alternative
and Complementary Health Practice Special Interest Group
. The
co-chairs of the group are Richard Harvey, PhD,
from San Francisco State University and Beth
Sommers, LAc, MPH
. Program leads for the 2010 conferece content are
Harvard-based Anne Doherty-Gilman, MPH and massage therapist and
researcher Karen Boulanger. The conference will also include 5 sections
from the more established Chiropractic
Section of the APHA
led by Paul Doherty, DC. Information on the
conference is available here.


Integrative medicine featured in Minnesota Monthly

a May 2010 feature in Minnesota Monthly, offers 6
thumbnail portraits of integrative medicine practitioners in Minnesota.
Integrator adviser Bill
Manahan, MD
, portrayed as “the father of holistic medicine in
Minnesota,” is quoted as having been “‘blown away’ by the innovation and
success rates he
encountered” during a recent tour of 20 integrative practices in his

Group visits to doctors get plug in Denver Post

Those who see group visits as one of the smart
directions for quality, cost effective healthcare and support of
behavior change in  patients will be interested in the May 6, 2010 Denver
article entitled Shared
health visits get patients more time with doctors
. The article
describes a pilot project involving 5 insurers and 17 physician clinics
in which medical doctors will be paid for their group visits. Lack of
payment has been an obstacle to development of such programs.
Payment, which includes an incentive for performance in
bettering patient health, is available through a monthly fee to medical
doctors in the pilot for care coordination. The article describes one
session with 5 patients with cholesterol issues: “For more than an
hour, the group at Clinix
in Centennial chatted with Dr. Raphael d’Angelo, who told them to
exercise, cut back on sugar — including beer and soda — and pick up red
yeast rice supplements and vitamin D at a health food store. They also
got their blood pressure checked and went over medications.”

Comment: Staff model organizations such as Kaiser Permanente and
Group Health Cooperative have been leaders in using the group model
over the last decade. (See related Integrator
article with a former Group Health MD entitled Holistic
Leader Kjersten Gmeiner, MD on the Fit of “Group Visits” with
Holistic Medicine
.) Nice that typical
insurers and physician groups are figuring out ways to create the same
incentive structure to support payment for these services.
Groups are an area in which integrative practice, by its
philosophy of patient-empowerment, could be providing leadership.


200,000 subscribers to newsletter

Jackson & Coker report to
physicians focuses on spirituality and medicine

The May issue of the
Jackson & Coker Industry Report
from the medical staffing
consulting firm focuses on spirituality and medicine via an editorial, a
and a reprint of a feature
on the subject
from Christina
Pushaklski, MD, MS
, the head of the spirituality and health program
at George Washington University. The editors share that their intent is to “examine the study of spirituality in
medical education, the
correlation of health outcomes, positive and negative coping
and striking a balance between patients’ spiritual needs and
physicians’ adherence to scientific methodology in diagnosing and
treating illness.”
The electronic Jackson &
Coker report currently reaches 200,000 on their list.



Micozzi’s Fundamentals: Into 4th edition

Micozzi’s update on Fundamentals, the original
integrative medicine textbook now in a 4th edition with Lundberg’s

Micozzi, PhD, MD
shares that his edited volume Fundamentals
of Complementary and Integrative Medicine
is going into its
fourth edition with a new forward from former JAMA
editor George Lundberg, MD
. In a note to the Integrator,
Micozzi shares that “through the prior three editions, each with three
printings, we
sold over 50,000 copies over 15 years.”  Roughly one-fifth were sold
internationally. The textbook’s impact has been broader:
Japanese, Korean, Spanish and German
translations have been created through firms that simply purchased
rights to the material.
Micozzi reflects on the
limits of the book’s impact: “On the one hand, 50,000 is only about the
number of students
in medical school at any given time, and less than one-tenth of the
number of practicing physicians out
there.” Lundberg offers significant endorsement in his forward:
“There is a vast historical,
cultural, experiential, and, increasingly clinical and evidentiary
about that body of practice termed ‘CAM’. I know of no other one place
where the interested reader can find a better collection of accurate
and objective information about such CAM as the Micozzi text
.” The forward is called “Your ‘Good Medicine’ Guide to CAM,”



Hyman: Stepoping into lead role at IFM

Mark Hyman, MD take on role as chair for the
Institute for Functional Medicine

Integrative medicine clinician, author and policy influencer Mark Hyman,
has become chair of the Institute for Functional
. Hyman shared the news with his Ultrawellness list on May
19, 2010 with this commentary:

“Through education, research and strategic
partnerships and policy change we can facilitate the transformation of
based on new science that allows us to treat the underlying causes of
disease …
Our first goal is to scale our
educational model to train health care providers
in the medicine of the future. We are at a moment in medical history
requires a new way of thinking to successfully address our global
epidemic of
chronic disease. Practitioners need a new set of lenses to interpret
and act on
clinical information.  Functional Medicine provides those lenses, a
way of seeing the epidemic of chronic disease based on underlying
causes, and
treatments based on restoring balance within dysfunctional biological
and networks.  It focuses on treating the whole system, not just the
symptoms.  Applied in practice, Functional medicine can more
prevent, treat and often cure chronic conditions, at lower cost,
failed by our
current paradigm.”

In his message, Hyman also noted that IFM’s May 2010
conference, the organization’s 17th annual meeting, was the first to be
sold out. The theme was Confronting
Cancer as a Chronic Disease: Primary Care Takes a 360 Degree View


DeNucci: Opening retreat center in Colorado

Joseph DeNucci opens retreat
center for “
young adult men in
need of intensive mentoring, coaching
and life skills

, host to some of the most significant
organizing gatherings for integrative medicine and a leader in
establishing the Duke Center for
Integrative Medicine
, has opened a retreat center for young men on
100 acres outside of Boulder, Colorado.
to a letter DeNucci sent to colleagues, Insight Intensive at Gold
will provide mentoring for “young men who are coming out of
treatment and other therapeutic programs, as well as those who have had
previous program experience but are living aimlessly in their home
environments, who simply do not have the skills, the competence or the
confidence to enter into early adulthood effectively.”

As general manager for the luxury Miraval Resort, DeNucci’s
facility hosted founding meetings in 1999-2000 of philanthropists and
integrative medicine leaders in academic medicine. The philanthropists
subsequently organized themselves as the Philanthropic Collaborative for
Integrative Medicine which became the Bravewell Collaborative. DeNucci’s
support for the emerging integrative practice field also led him to host
gatherings led by Andrew Weil, MD and the 2000
Integrative Medicine Industry Leadership Summit
, with which I was
involved. DeNucci developed an early reputation for quality integrative
business strategies through his launch of a holistic behavioral health
program. He notes that the target population for Insight Intensive is
young men for whom “
it has been simply a ‘failure
to launch’ and for others it is about
the ‘reset button.'”

Comment: DeNucci is a relatively
unsung influencer in the emergence of the integrative medicine field. He
was among the very first who united personal practice and commitment
with significant business skills. A long-time yoga instructor and
meditator, DeNucci was also a turn-around artist for inpatient
behavioral health facilities and then a holistic behavioral health
program developer.

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