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

Summary: NCCAM issues DRAFT 2011-2015 strategic plan, includes “real world” and health-promoting outcomes; Briggs on researching complex approaches; Canada Post outcomes show effectiveness and cost-savings from whole practice of integrative naturopathic medicine; Medicare to reimburse Pritikin for onsite services; Medicare to investigate chiropractic billing; doulas lay infrastructure for reimbursement; NYU integrative urology program led by naturopathic doctor Geovanni Epinosa; Mayo Clinic embraces Alexander Technique; 4 integrative medicine organizations link for April 2011 iMosaic conference; holistic nurses endorse new coaching program; American Chiropractic Association and National Wellness Institute partner for wellness certification for chiropractors; Helbig’s Institute for Therapeutic Massage pioneers oncology massage certification and services for the under-served in collaboration with Perlman’s UMDNJ; U Minnesota offers first nursing doctoral program specialty in integrative practice; National University of Health Sciences’ innovative integrated DC/ND/AOM programs featured; George Family Foundation grants $556,000 for nurse leadership in integrative practice; former HHS secretary Thompson visits, lauds Standard Process; Alternative Therapies offers all nursing issue; and a note on Rustom Roy, 1924-2010.

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

Summary: NCCAM issues DRAFT 2011-2015 strategic plan, includes “real world” and health-promoting outcomes; Briggs on researching complex approaches; Canada Post outcomes show effectiveness and cost-savings from whole practice of integrative naturopathic medicine; Medicare to reimburse Pritikin for onsite services; Medicare to investigate chiropractic billing; doulas lay infrastructure for reimbursement; NYU integrative urology program led by naturopathic doctor Geovanni Epinosa; Mayo Clinic embraces Alexander Technique; 4 integrative medicine organizations link for April 2011 iMosaic conference; holistic nurses endorse new coaching program; American Chiropractic Association and National Wellness Institute partner for wellness certification for chiropractors; Helbig’s Institute for Therapeutic Massage pioneers oncology massage certification and services for the under-served in collaboration with Perlman’s UMDNJ; U Minnesota offers first nursing doctoral program specialty in integrative practice; National University of Health Sciences’ innovative integrated DC/ND/AOM programs featured; George Family Foundation grants $556,000 for nurse leadership in integrative practice; former HHS secretary Thompson visits, lauds Standard Process; Alternative Therapies offers all nursing issue; and a note on Rustom Roy, 1924-2010. 

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johnweeks@theintegratorblog.com


for inclusion in a future Integrator.


Research Policy

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NCCAM: Draft shows better understanding of the field

NCCAM DRAFT strategic plan includes health and real world focus; comments until September 30

One August 30, 2010, NIH National Center for Complementary released its draft 2011-2015 Strategic Plan. This, the 3rd NCCAM strategic plan, is the first from the era of
Josephine Briggs, MD as director. 
The intriguing structure for the plan is built around 4 conclusions from the
team’s landscape assessment, 3 overarching goals, 5 “guideposts for
keeping on track,” 4 frames for priority-setting and and 5 strategic
objectives, all outlined in this article. The strategic objectives, as numbered in the plan, are:

  1. Advance research on CAM pharmacological interventions.
  2. Advance research on mind/body and manipulative/manual CAM interventions and practices.
  3. Increase understanding of
    “real-world” patterns and outcomes of CAM use and its integration into
    health care and health promotion.
  4. Improve the capacity of the field to carry out rigorous research.
  5. Develop and disseminate objective, evidence-based information on CAM interventions.

The comment period closes September 30, 2010 and the final plan is expected to be released December 2010.
The publication of this draft is a penultimate step in a process that
effectively began when Briggs took over NCCAM in January 2007 but
formally in September 2009. Related Integrator articles on this process include:


Comments
:
As observers of NCCAM’s past
plans
will know, the proof of the pudding will be in how, exactly, the plan
is
carried out. Like a good poem, or an Obama campaign speech, the
strategic plan can be vested with varying aspirations for the agency’s
future. What is most intriguing is a pervasive focus, for the first
time at NCCAM, on the potential health creating value of natural agents,
therapies and practices of integrative providers. This is noted in the
3rd strategic objective, where health-as-outcome is linked to a broader
priority to examine real world endpoints for integrative approaches.
Unfortunately, a good deal of the focus continues to be on drug
mechanism and trials relative to “CAM pharmacologicals.” The plan’s
priorities don’t yet match what US Senator Tom Harkin and his colleagues directed in the NCCAM mandate. It is clear however that Briggs’ NCCAM team not only is beginning to embrace but also stands up for the
particular research challenges in a whole person approach. Kudos to
Briggs and her team for new directions that may begin to more directly
advance our understanding of the usefulness of integrative practices in
both human health and cost-saving.
More thorough Integrator commentary on the plan, including 5 reasons for excitement and 3 reasons for concern, is posted here.


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Briggs: Naming the issues in whole practice research

NCCAM’s Briggs offers statement on research on complex approaches

NIH NCCAM director Josephine Briggs, MD used the occasion of the recent New England Journal of Medicine publication of positive outcomes of Tai chi for individuals with fibromyalgia to discuss her views on researching complex interventions.  Writes Briggs: “As an accompanying editorial in NEJM notes, [Tai chi] is a complex intervention
involving multiple components: exercise, breathing, meditation,
relaxation, and a practitioner. How do you control for all of these
variables when designing a study?” Then she sets up the struggle over good science:

“Some CAM proponents will say that it is the combination that makes the
intervention work; many conventional researchers will say you must
isolate the components to identify the active ‘ingredient.’ Critics
will say it all just the placebo effect—you expect the intervention to
work, and so it does.

Briggs strikes a balance, noting that studying complex interventions is a focus of the draft 2011-2015 Strategic Plan and that NCCAM recently held a methods conference to address challenges of finding appropriate controls for CAM’s multi-modal interventions. She concludes with a few sentences on her interest in the complexities of the placebo effect.

Comment: Three weeks ago, a naturopathic physician challenged Briggs in an open forum for giving a presentation on NCCAM that, by focusing on single agents, “had nothing to do with the way (we) practice.” (See #3 here.) Briggs would have won her audience had she wrapped her speech around the issues in the 3 perspectives noted in this column. Given the fact that the perspective of the ND was that of most integrative practitioners, Briggs provides useful leadership by highlighting and exploring the pros and cons of the differing perspectives mentioned in the column. She’s walked directly into the vortex here. Meantime, Briggs column and focus on real world research plan have created an “expectation effect” that has me feeling measurably positive toward Briggs’ therapeutic protocol (a.k.a. “strategic plan”) for the agency.

Side note: I love how the group of “conventional researchers,” as Briggs calls them, dismisses
the “real world” of the multi-modal way people practice in favor
isolating components. This insures that life follows art; or rather, in this case, follows the reductive research preferences of their preferred science. Wouldn’t it
be more appropriate if the reductionists were on the defensive for
failure to have a fitting relationship with what is practiced? 


Costs and Coverage

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Seely: Outcomes help decision-makers

Model whole practice research shows
integrative naturopathic medicine effective and cost-saving for Canada Post employees

The preliminary results from a randomized controlled pragmatic trial of the whole practice
of naturopathic medicine for
Canada Post employees
with elevated cardiovascular risk
found that treatment by integrative naturopathic doctors was both
effective and cost-saving. Naturopathic treatment produced an overall
$1025 cost benefit per participant.
The Canada Post employees who were patients of naturopathic doctors showed significant reductions in levels of
cardiovascular risk and in the incidence of metabolic syndrome.
The results were reported by Dugald
Seely, Bsc, ND, MSc
and economist Patricia Herman, MS, ND, PhD, on
August 12, 2010 at the conference of the American Association of
Naturopathic Physicians
.
The researchers, who
are preparing to publish the results in a peer-reviewed journal, also
found benefits across numerous biometric and
self-reported health-related markers.

Comment: The methods for researching this whole
practice, individualized treatment are a model for all  integrative
practitioners, whether integrative MDs/DOs, wellness-oriented DCs, AOM
practitioners or other multi-modal care-givers for whom reductive trials
fail to capture their practices.
Happily, Strategic Objective #3 in the 2011-2015 NCCAM Strategic Plan (see above) suggests NCCAM will be moving more funding in this direction. The potential values of this approach are evident in a set of 8 commentaries
from various stakeholders on the Seely-Herman study. These indicate usefulness of these data to employer
purchasers, policy-makers, hospital administrators and clinicians
interested in practice betterment. In short, the Seely-Herman approach
is worth studying, emulating and amending as necessary. The study supplies critical
information for healthcare decision makers.
For many in the naturopathic profession, the
outcomes are celebrated as a potential game-changer in their efforts to
expand inclusion of their services in the mainstream payment and delivery system.

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35 year campaign leads Medicare to reimburse

Pritikin Program covered by Medicare-Medicaid

On August 16, 2010 the Centers for Medicare and Medicaid (CMS) announced a
plan to cover the Pritikin Program for intensive cardiac
rehabilitation. A release from Pritikin notes that “the decision makes the Pritikin
Longevity Center & Spa
, located in Miami, FLA, the first and only
residential healthy-lifestyle education program in the country to offer
Medicare-covered intensive cardiac rehabilitation.” Pritkin’s long road to coverage is described in this release:

“The criteria for coverage of an intensive cardiac rehabilitation
program by Medicare are stringent, including such requirements as
peer-reviewed, published research demonstrating that the program reduces
the need for bypass surgery as well as significantly lowers cholesterol
levels, triglycerides, body mass index, and blood pressure, and the
need for medications for cholesterol, blood pressure, and diabetes. Over
the past 35 years, more than 115 studies have been published in leading
peer-reviewed journals, including the Archives of Internal Medicine and the New England Journal of Medicine,
proving that participants in the Pritikin Program achieve these and
other significant health benefits, including substantial and sustained
weight loss.

Under the plan, Medicare will reimburse roughly $40 for
each 1 hour session of education
and for each 1 hour session of exercise at the Center. Coverage can be for up to six sessions per
day with a maximum of 72 reimbursable hours (roughly $2880 total) in the treatment plan. This fact sheet on the Pritikin site describes details of the coverage.

Comment: CMS’ action on Pritikin
follows the recent announcement of coverage of the non-typical diet and lifestyle program for seniors with cardiac risk led by Dean Ornish, MD. Whole person interventions to create health are finally gaining traction. (Thanks to Lucy Gonda for sending the link.)

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Chiropractic billing under examination

Medicare to begin special chiropractic audit regarding maintenance care

A notice from the Chiropractic Essential Benefit Campaign

(CEBC) notes that Medicare “through its Comprehensive Error Rate
Testing (CERT) program, is scheduled
to begin a specialized audit of the chiropractic profession
nationally.” The audit is to focus on the inappropriate use of the AT
(Active Treatment)
modifier on claims. Prior examination of the profession’s billing
practices has found that a “significant percentage of chiropractic
claims inappropriately used this
modifier in an attempt to disguise maintenance or wellness care.” The
CEBC, established to insure that chiropractic is in any national health
plan, argues that “this audit will be unfavorable to the chiropractic
profession and the results
will be used by insurers and major corporations like Wal-Mart as the
justification to keep neuromusculoskeletal conditions off the essential
benefits list.” CEBC suggests that some
chiropractors justify this billing practice because chiropractic doctors
are the only healthcare professionals who are “required to perform
a service (exam) for which there is no reimbursement.”

Comment: Pair this article with the recent American Chiropractic Association-sponsored wellness certification course developed in partnership with the National Wellness Institute (NWI). See article in this Round-up. My guess is that practice by chiropractors of “maintenance” chiropractic as “wellness care” will be altered if delivered in the context of NWI’s concept of wellness.



ImageDoulas developing infrastructure for reimbursement

A recent article in the Arizona Republic, Doulas provide support, encouragement during childbirth
notes that this growing movement in natural childbirth is laying down
the infrastructure to push for eventual 3rd party reimbursement. In October of
2009, the National Uniform Claim Committee assigned doulas an
insurance-provider code,
an early step to getting reimbursement. According to the article, certified doulas in Arizona presently charge an average of $500 to $750 for services in a birth process.
The field is growing rapidly. The Arizona Doula Organization and Birth
Education Association
estimates that 350 to 500 doulas practice in
the Phoenix area, up from “almost none” when the organization was formed
in the mid-1990s. The doulas believe their services can be a
cost-effective addition to healthcare, limiting the need for more
expensive hospital services and surgical births. The article states: “
In a year of sweeping health-care reforms and state budget cuts,
Valley doulas say that their services could help relieve an overburdened
system.” (Thanks to Lou Sportelli, DC for sending me the link.)

Comment:I view as a no-brainer the idea that giving a mother the experience of natural childbirth is one of the best, if untested, avenues toward lowering medical costs. First, there is the cost of the birth itself, with or without doula care. Never mind, for a moment, the significant satisfaction and empowerment that such births can create. I am intrigued by potential impact on future motherly healthcare choices of the message that high technology is not necessarily the solution; and the reverse impact that comes if one believes, via birth choices, that high tech is the solution. Go doulas!


Integrative Medicine

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Espinosa: Heads up NYU integrative program

Integrative urology program at NYU Langone Center headed by Geovanni Espinosa, ND, LAc

Geovanni Espinosa, ND, LAc is the director of the Integrative Urology Center (IUC) at Langone Hospital. The hospital is associated with New York University’s medical school. The IUC’s website notes a wide array of conditions treated: prostate cancer, benign prostatic hyperplasia, male infertility, erectile dysfunction, urologic cancers and female urology. Espinosa was a clinician and researcher at the Center for Holistic Urology at Columbia University Medical Center before taking the position with NYU. A short video of Espinosa describing his integrative urology practice is here

Comment: What does Espinosa have in common with these two naturopathic doctors, besides the current jobs all 3 have with hospitals: Marcia Prenguber, ND, director of integrative care for Indiana’s Goshen Health System and current NCCAM advisory council member Tim Birdsall, ND, vice president for integrative medicine with Illinois-based Cancer Treatment Centers of America? The answer: All 3 not only have significant hospital positions in integrative medicine but each practices in a state where there is no licensing for naturopathic physicians. Fascinating. Where there is a will, there is a way.

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William Mayo: Now offering Alexander Technique

Mayo Clinic embraces Alexander Technique

Colleague and Integrator supporter Lucy Gonda sends a note that the Mayo Clinic has sponsored a You Tube in which they note that Alexander Technique

has now been added to “yoga, Pilates, tai chi and meditation as a means
to enhance the mind-body balance.” Mayo’s fitness expert Laurel
Padulke
is interviewed, together with a senior citizen patient who used the
technique to learn to live with essential tremor. In a note to
the Integrator, Brent Bauer, MD, director of integrative medicine for Mayo calls the inclusion of the Alexander Technique at Mayo

“part of the continued integration of the
best of both worlds!”

Comment:  I have been familiar with the Alexander Technique over the years through Gonda’s colleague Jean-Louis Rodrigue. Rodrigue, a leader in the development of the field in California, has worked closely with many well-known actors and musicians in the LA area and internationally using the technique. Interesting to note its uptake and promotion at Mayo, where, coincidentally, Gonda was instrumental in launching Bauer’s integrative program.

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4 national IM organizations in joint conference

Integrative Medical Consortium of 4 organizations to sponsor April 2011 national conference

The Integrative Medical Consortium (IMC), an association of
4 national medical organizations with “a common mission of
advancing the field of integrative medicine” have announced their first collaborative CME
conference to be held in Minneapolis, MN on
April 6-10, 2011. The consortium, while not a formal business entity, reflects a multi-year collaboration between
the American Academy of
Environmental Medicine
(AAEM), American College for Advancement in Medicine (ACAM), American Holistic Medical
Association
(AHMA) and the International College of
Integrative Medicine
(ICIM).
In an August 2010 press release, Kenneth Bock, MD, co-chair of the IMC  notes that “the integrative
medicine consortium has had the dream of a large collaborative integrative
medicine conference for years.”  Gerald Natzke, DO, IMC’s other co-chair offers this argument for the joint meeting:
Healthcare freedom for the integrative medical
practitioner requires unprecedented cooperation and collaboration among the
various organizations.”
The conference title will be


iMosaic, an acronym that
stands for Integrative Medicine Offering Science-based Alternatives in
Collaboration. The organizations expect over 1000 participants. The website is here.

Comment: Note that this group is not, nor does in include, the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM)While there is some overlap between the alternative/integrative and holistic MD/DO practitioner organizations and academic integrative medicine led by CAHCIM, a significant town and gown split continues to exist. The practitioner-members of the IMC’s organizations are typically comfortable using an array of treatments, such as chelation, that are not accepted in most academic integrative sites. In parallel, the IMC practitioners are more likely to be talking about the importance of “healthcare freedom,” as noted by Natzke. For CAHCIM, this is a virtually non-existent agenda item except as one may believe in gaining freedom through science.


Wellness and Coaching

ImageAHNA/holistic nurses endorse programs for whole health education with health coaching competencies

The American Holistic Nurses
Association
(AHMA) announced on September 1, 2010 a plan to “endorse certificate programs that offer holistic
education to nurses.”
The certificate programs will be provided through a collaboration between 

Bark Coaching Institute,
formerly AsOne Coaching
, and the National Institute of Whole
Health
(NIWH).
The NIWH component “provides … clear, integrated and scientific understanding of how and why
disease manifests in the body due to chronic lifestyle choices (and how) nurses can
provide their patients with the information they need to take greater control
of their health.” The AsOne program, developed by Linda Bark, RN, PhD, MCC
, “gives nurses new tools and modalities with which to facilitate their
patient’s organic choices of how they would like to get well, stay well and
take control of their health and the quality of their life.” The AHNA notes
that:

” … the combination of these two evidence-based, hospital tested disciplines are
not only important skills for today’s nurse, but this patient education model
of disease prevention with health coaching, is a billable and reimbursable
health insurance service when provided in a medical practice or by a nurse
practitioner.”

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Bark: A national leader in health coaching for holistic nurses

In addition, AHNA noted that the joint program meets “the published guidelines that Medicare, Medicaid,
the Institutes of Medicine and the Joint Commission for Accreditation of Health
Organizations
(JCAHO) published in 2005 for the practice of health care in all
settings.” Bark, a sometimes Integrator contributor,
co-chaired the AHNA task force on the coaching and
also works on the a 12-person National Coach Credential Team.

Comment: This news hits at a moment
when not-yet-public plans are afoot for an invitational summit of
parties interested in setting standards for clinical health coaching.
The timeliness of the AHNA move, and the upcoming summit, is linked to the Patient Protection and Affordable
Healthcare Act, in which health coaching is valued as a critical practitioner skill in addressing chronic issue.   



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Partnership with chiropractic organization

Chiropractic association partners with National Wellness institute for wellness certification for chiropractors

The American Chiropractic Association (ACA) has partnered with the
National Wellness Institute (NWI) to offer a wellness certification program
for doctors of chiropractic starting in 2011. According to an ACA release, completion of the 40-hour program will allow participants to become Certified Chiropractic Wellness Specialists through
NWI, “a well-respected organization.” The program consists of four,
10-hour modules through which chiropractors and chiropractic students will “integrate principles of wellness
coaching, health promotion and disease prevention into their current
practices.” ACA president Rick McMichael, DC describes his sense of the fit with historic chiropractic practice: “The chiropractic profession has a long history of counseling
patients on risk avoidance, exercise, proper nutrition and good health
habits. This is a great opportunity to further our knowledge in this important
area of practice and to position ourselves as experts in this emerging
field.” The leading chiropractic educators involved in developing the program are
Cheryl Hawk, DC, PhD, CHES, and Will Evans,
DC, PhD, CHES
. They worked with
Michael Perko, PhD, from the University
of North Carolina at Greensboro.
The NWI, founded in 1977, is a recognized national leader in wellness promotion. Certification will last five years.


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Hawk: Key chiropractic leader in wellness certification

Comment: Most of the integrative practice fields, including chiropractic medicine, view themselves as involved in a healthcare approach that fosters wellness. The NIH NCCAM research agenda appears to be beginning to appreciate such a health-promoting practice focus in their Strategic Objective #3. Yet significant funders who repeatedly espouse interest in transforming US medicine toward a health and wellness apparently view such claims as balderdash, at least when it comes to setting their funding priorities. To be recognized for their wellness orientation and as part of the wellness workforce, as well as to put a conventional overlay around these skills, naturopathic doctors, acupuncturists and massage therapists who wish to legitimate what they are already doing may be well-served to take the lead from the chiropractors and offer a specialty certification. Credit the ACA for forming the partnership and developing the program. 

Academic Medicine & Education

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Distinctive oncology massage certification program

Institute for Therapeutic Massage and UMDNJ collaboration leads to treatment of the underserved and Oncology Massage Certification Program

Lisa Helbig, massage therapist and executive director of the New Jersey-based Institute for Therapeutic Massage
(ITM) has developed a unique array of collaborations with local institutions through which she educates massage therapists.
ITM’s business model involves delivering education onsite with
partner institutions. These include Morristown Memorial Hospital and Holyname
Hospital. Perhaps the most significant is a partnership Helbig developed
with Adam Perlman, MD, MPH, director of the Institute for Complementary and Alternative Medicine
(ICAM) at the University of Medicine and Dentistry of New Jersey
(UMDNJ). Through the UMDNJ collaboration, Helbig developed the first Oncology Massage Certification Program (OMCP), a 759 hour curriculum that is recognized by the Commission on Massage Therapy Accreditation (COMTA). Helbig’s basic program is 620 hours and the basic COMTA requirement is 500 hours. Meantime via this partnership, Perlman is able to
offer massage treatment at the UMDNJ to low income cancer patients who
could not otherwise afford the services. Helbig offered these comments
via email on the relationship she and
Perlman created:

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Helbig: ITM’s executive director

“In
my role as Executive Director of The Institute For Therapeutic Massage (ITM) I
have had the distinct pleasure of working with Dr. Adam Perlman, director of the
Institute for Complementary and Alternative Medicine (ICAM) at UMDNJ. Our
charge is to help create a higher level of awareness regarding the benefits of
massage therapy, most notably as it pertains to the oncology patient, their
family, and the healthcare team.

“The
majority of patients seen come from an underserved population, who
traditionally have not been exposed to alternative forms of health &
wellness care, with this being their first massage. At the same time, our
students benefit from an educational experience that includes numerous
pathologies, treatment modalities, and patients who are in various states of
infirmity. Together, this partnership has created a win-win situation in which
the patients benefit from a new form of care, and our students now have an
added (well-rounded) dimension to their evaluative and hands-on skill set.”

Helbig notes the OCMP is a basic massage therapy program
with a heavy concentration in oncology, including training in useful
hospital-based modalities such as Reiki, aromatherapy, reflexology and
lymphatic drainage and hospital experience. 

Comment: Perlman had an “Aha!” moment at the National Dialogue to Advance Integrated Health Care in 2005 when he realized that a CAM school’s interest in providing clinical experience to its students could be a way to access low cost/no cost integrative care for an under-served population. He found Helbig’s ITM and she has clearly stepped up. Her oncology massage certification program appears to be a model of education born within a model of collaboration. Good work all around!


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Kreitzer: Integrative nursing leader

University of Minnesota offers integrative practice specialty in nDoctor of Nursing Practice program
 
The University of Minnesota’s School of
Nursing
now
offers a doctoral-level degree program that specializes in integrative health and
healing. The program is offered through the Doctorate of Nursing Practice (DNP) in which one of 14 specialties is called Integrative Health and Healing
(IHH). According to a related release, the specialty, the first of its kind in the country, “prepares nurse leaders to work with individuals, families, communities and
health systems on ways to improve health by focusing on health promotion,
disease prevention and chronic disease management, with a special emphasis on
managing lifestyle changes and incorporating use of complementary therapies.” In the program, offered in collaboration with the Center for Spirituality & Healing, nurses will be prepared “to apply a new set of perspectives and skills in many
different settings including hospitals, outpatient facilities, health plans,
corporate and community organizations, as well as in private practice.”

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Winterstein: Visionary behind the integrated university model

Out of their silos: National University’s leadership in integrated DC/ND/AOM education featured

A recent e-news note from the Association of Accredited Naturopathic Medical Colleges  featured the commitment of National University of Health Sciences to provide an inter-professional and integrated care experience for students. NUHS, led by president James Winterstein, DC, offers programs in chiropractic medicine, naturopathic medicine and acupuncture and Oriental medicine. The AANMC publication notes that NUHS students “participate
in integrated learning opportunities that may very well change the face of
alternative medicine.”
The university creates environments in which students “work alongside each other sharing vital classroom and clinical experiences.” Students are also able to take elective courses in other programs. Dual degree programs are facilitated. The benefits are described this way:

“When students from varying fields of
medicine share the same learning environment, they are able to see how
other areas of medicine relate to and benefit their own. While carrying out
their own distinct objectives … students at
NUHS learn from their peers in other disciplines, a process that results in
better doctors.”

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Smith: Naturopathic perspective

An integrated patient chart helps integrate care, according to assistant naturopathic dean Fraser Smith, ND: “In
our clinic, patients have one chart. That chart has sections related to each
discipline that the patient receives care from. Patients can be referred
amongst the various clinicians, and experts from differing specialties can
work together to find care strategies that work best for each individual.
Our aim is to put the patient’s needs and choices foremost, while improving
patient care outcomes.” Fraser points to the value of this inter-professional education (IPE):


“The effect of
students studying together, learning together and collaborating in the clinic,
as well as learning from faculty who teach across disciplines, is a powerful
one. Misunderstandings and rivalries quickly disappear when people come
together and work for a common purpose.
More appreciation and respect for
other approaches is one tangible benefit. We also see more students
choosing to dual enroll and complete another degree that complements their
initial work. Ultimately, the person who benefits the most is the patient, who
enjoys a collaborative, not competitive, approach.”

Comment: Winterstein’s vision was the focus of an Integrator feature in September 2006 entitled. Winterstein/NUHS Explore New Ground for Multidisciplinary/Integrated Education. NUHS’s commitment to IPE has since been evident in multiple ways via the Academic Consortium for Complementary and Alternative Health Care, for which I serve in a part-time capacity as executive director. Winterstein serves on ACCAHC’s Education Working Group and members of his staff are active on two other key teams. In addition, seeing the value of ACCAHC’s Clinicians’ and Educators’ Desk Reference on the Licensed Complementary and Alternative Healthcare Professions, NUHS contributed $10,000 to assist with the book’s final publication costs and early marketing. Winterstein’s university is also a Gold Sponsor of SIMPLE (Symposium of Integrative Professionals in the Land of Enchantment) organized via the University of New Mexico integrative medicine program. It was pleasing to see NUHS’s leadership described so well in the AANMC bulletin.

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George: Major investment in integrative nursing

George
Family Foundation invests $556,000 in integrative nursing leadership

The George Family Foundation announced in August a $556,000
gift to the University of Minnesota to “support nursing fellows to obtain integrative
health and healing education.” The grant, announced as an investment in nursing leadership, was made to the Center for Spirituality & Healing at the University of Minnesota (CSH) and will “create
a fellowship and co-curricular program that will prepare nurse leaders in
integrative health and healing.”
The 6-year program is expected to provide “unprecedented clinical and professional
development opportunities to more than 40 nurse
fellows.”
Penny George, president of the George Family
Foundation describes the program’s intent in “preparing doctoral level nurses for leadership positions” this way:

“For healthcare to shift its focus from disease to health, healing
and optimal wellness, nurses need to be empowered with greater skills in
leadership and collaboration.
We hope the nurses who emerge from this esteemed
program will be prepared to lead healthy lives themselves and will collaborate
with medical leaders, administrators and allied health professionals to bring
about the transformation of our healthcare system that is so desperately
needed.”

The grant also involves
Allina Hospitals & Clinics, home of the Penny George Institute for Health and Healing.
Allina’s nurse leaders including Lori Knutson, RN, BSN, HN-BC, executive director
of the George Institute, and the George Institute’s nurse clinicians will help
design the initiative’s co-curricular component.
Says Knutson: “This financial support also
speaks to the commitment to bridge the gap between academia and the clinical
practice environment.”
Adds CSH director, Mary Jo
Kreitzer, PhD, RN, FAAN
: “We are so grateful to Penny and Bill George for their
thoughtful, creative leadership in this field, and for being agents of bold
changes in healthcare.”
Interested nurses will be encouraged to enroll in the
Doctorate of Nursing Practice (DNP – see related article this Round-up) program in order to take advantage of
several fellowship opportunities designated for Allina staff. 

Comment: The release included the additional information that the George Family Foundation has now invested over $3.5-million in the George Institute at Allina. The work of the Georges in supporting medical doctors and nurses in engaging integrative practices continues to be extraordinary.

Natural Products

Safe Cosmetics Act of 2010 may be dangerous to the organic cosmetics industry

Mary Morton, a long-time integrative health activist and writer and current communications director for Nourish America sent me news of what she views as problems in the Safe Cosmetics Act of 2010, co-sponsored by Reps. Jan Schakowsky, (D-Il), Ed Markey (D-MA), and Tammy Baldwin, (D-WI). Her colleague Robert Tisserand , condered by some to be among the fathers of aromatherapy, calls the act an “inappropriate and seriously flawed attempt to make cosmetics safer” in his blog on the subject. Morton wrote, based on Tisserand’s views:

“This bill includes both regulations
that are radically extreme and standards that are so vague that if passed, it
promises to be a nightmare for the FDA. More to the point, it will likely
cripple the natural cosmetics industry. Just as an example, this bill would needlessly
ban fruit extracts from cosmetics.”


Morton adds: “[Tisserand] is very
supportive of legislation protecting the consumer from toxic cosmetics and
believes cosmetics need to be responsibly regulated. But he also believes
that a new bill should be written that also protects the survival of
responsible natural cosmetic manufacturers (particularly small business owners)
as well as consumers’ rights to a wide variety of natural cosmetic choices.”

Comment:  I have not gone to school on the issue, nor can I vouch for Tisserand, but I am happy to do so for Morton, the co-author with her spouse Michael Morton, PhD of Five Steps to Selecting the Best of Alternative Medicine. As with the broader natural products industry, increased standards mean higher barriers to entry, which in turn can stifle innovation, especially for an important emergence as significant as focusing on organic products.

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(L-R) Standard Process President Charles C. DuBois; Sue Ann Thompson; Standard Process Vice President Sylvia DuBois; and Tommy Thompson.

Former HHS Secretary Tommy Thompson Lauds Standard Process 

On Monday, August 30, Tommy Thompson, the former secretary of the United States Department of Health and Human Services and
former Governor of the State of Wisconsin visited Palmyra, Wisconsin-based Standard Process,
a $100-million/year natural products firm. In a release from the firm,
Thompson is quoted as telling the firm’s employees that “Standard
Process is on the cutting edge of health and
wellness.” Thompson and his spouse toured the firm, which has received
awards for its wellness programs, and also its surrounding organic
farm.

Comment: I note this story as an
example of the supplement industry coming of age. Inducing such visits
from political luminaries typically requires some combination of
economic importance, history of community involvement, network of
relationships, financial wherewithal and chutzpah. Standard Process is one of the few natural products firms that clearly has arrived. I also note the visit
because the firm supplied critical early sponsorship for the Integrator for which I remain thankful.


Publications

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Mittelman: Key role in special issue

Alternative Therapies devotes issue to holistic/integrative nursing

In honor of the 2010 international year of the nurse, the September-October 2010 issue of Alternative Therapies in Health and Medicine (ATHM) is devoted to articles on education, research and practice related to holistic and integrative nursing. The project was jointly engaged by ATHM and Holistic Nursing Practice. ATHM’s nursing editor, Michele Mittelman, RN, MPH, described as an “advocate for the nursing profession, with a focus on integrative care,” begins the issue with an editorial. Among the dozen articles are: American Holistic Nurses Association executive director Jeanne Crawford, MA, MPH, MBA offering a perspective on why holistic nursing “has taken off in the past 5 years;” Susan Susan Luck, RN,  BS, MS, HNC, CCN writing on nursing and health coaching as a contributor to healthcare reform; research from Mary Jo Kreitzer, RN, PhD and others on mindfulness in organ transplant patients and a paper from a group led by Barbara Findlay, RN, BSN on methodological complexities in examining healing relationships. Mittelman also leads a roundtable that includes Kreitzer, Mary Koithan, PhD, RN-C on “Nursing and Integrative Practice.”

Comment: This Integrator Round-up has begun to look like a smaller version of an issue devoted to nursing, given the articles on the George Family Foundation’s gift, the related development of a Doctor of Nursing Practice with a focus on integrative care, and the new holistic nursing coaching certification. History may show that the entire integrative care movement, as a movement for health, finally took off when the practitioner focus shifted toward the nation’s 3-million nurses, many of whom proudly assert their distinction from medicine.

People

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Roy: Influenced the influencers

In Memoriam: Rustom Roy, PhD – 1924-2010

Penn State geochemist Rustom “Rusty” Roy, PhD,
a significant contributor to the philosophic and scientific dialogue
relative to holistic care, died on August 26, 2010. Roy was a
founder, with Andrew Weil, MD, Larry Dossey, MD and Deepak Chopra, MD of
Friends of Health, an organization with which they worked through such vehicles as the Wall Street Journal to move US healthcare toward a focus on health. Roy was a visiting faculty member at the University of Arizona Center for Integrative Medicine, the director of which, Victoria Maizes, MD, MPH, notes that Roy “challenged us
all with his ideas about the boundaries of science.
Newsweek once called Roy the “leading contrarian

among U.S. scientists.” He was an early proponent of interdisciplinary
studies. A Penn State obituary notes that though he published over 1,000 papers
in his field, “it was his counter-establishment embrace of
interdisciplinary studies and integrative learning that brought him wide renown
inside and outside of academia.
” He was 86 when he died. Roy’s fascinating Penn State obituary is here. Integrator adviser Ken Pelletier, PhD, MD(HC) forwarded the news of Roy’s death. I asked Pelletier for a comment. He wrote:

“It was over 40 years ago that I first met Rustum Roy
at a conference and our last meeting was when I presented my invited paper to
the [Institute of Medicine] in February 2009. At that meeting and in his remarks, he was the same
insightful, vigorous, challenging, brilliant, and generous of spirit pioneer
that was the hallmark of his professional and personal achievements. Another
light has gone out and he will be missed by many of us who owe him a debt of
gratitude for his courage and brilliance.”



Comment: I knew of Roy’s work and
influence for years, but only had the most passing of relationships with
him, via a conference call organized by Jery Whitworth in 2001. Reading his obituary and
hearing Maizes’ and Pelletier’s comments sadden me that the opportunity
never arose for a more significant connection. Interestingly, what most
attracts me are the combination of his health-related work with two of
his other passionate involvements, on the board of the National Council
of Churches
and as a visiting fellow with the Institute
for Policy Studies
in Washington, DC. Quite a life. Nice for us that parts of it were spent with the integrative practice community.

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johnweeks@theintegratorblog.com

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johnweeks@theintegratorblog.com

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John Weeks Written by John Weeks

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