Summary: On or about the winter solstice, the Integrator publishes a Top 10 of actions, events and trends from the previous year which will support the coming of the light for integrative practice in the New Year. This column is paired with a separate Top 10 People. Just 9 are listed in each. What are your suggestions for #10? Thanks to the individuals behind the good work. Happy reading, and reflecting on the year that was as we look ahead.
Coming of the Light: Integrator Top 10 from 2010 for Integrative Medicine/Integrated Health Care
Summary: On or about the winter solstice, the Integrator publishes a Top 10 of actions, events and trends from the previous year which will support the coming of the
light for integrative practice in the New Year. This column is paired with a separate Top 10 People. Just 9 are listed in each. What are your suggestions
for #10? Thanks to the individuals behind the good work. Happy reading, and reflecting on the year that was as we look ahead.
What action do you think should be included here?
for inclusion in a future Integrator.
Each dark time of year since the electronic Integrator began publication in 2006, I have offered a reflection on events integrative
from the previous calendar year in the form of a Top 10. The object of
the exercise is to locate the light from the past year that will help
illuminate the road ahead. In 2009, I began to offer a separate Top 10 People, which I will do again this year. This year I began by sending a query to the Integrator Editorial Advisers, many of whom gave input that is wrapped into one or the other of the lists. For each, I ask you to
help out with #10. What (and who) deserves recognition that is not here? What are the other beacons as we go forward?
1. “Integrative Health Care” Becomes Law in US Healthcare Reform: Will the Community Respond?
Passage into law of the Patient Protection and Affordable Healthcare Act marked a break-through hardly noticed outside the integrative practice community. In a half dozen key sections of the law,
“integrative health care,” “integrative practitioners,” “integrative
practices,” and “licensed complementary and alternative medicine
practitioners” are explicitly included. No, integrative philosophy was hardly the polestar that guided the reform effort. Yet such language is embedded in
content areas relative to care, cost, research, payment and health promotion. The “them” of once exclusionary policy is now “us” via these footholds. Integrative community leaders met at a Stakeholder Conference on Collaboration for the Ongoing Purpose of Healthcare Reform convened by the Integrated Healthcare Policy Consortium, The Institute for
Integrative Health, and Palmer College. The goal: develop a comprehensive
plan to seize the opportunities. At least one key appointment has been
secured for Christine Goertz, DC, PhD, one of just 19 GovernorS of the new Patient Centered Outcomes Research Institute.
Yet other recent opportunities to show up appear to have been poorly seized. Time
only will tell whether the community is ready to take advantage of the
opportunities quietly inserted by Congressional leaders Harkin, Mikulski, Sanders and others.
2. Dugald Seely and Research as Change Agent: Canada Post Finds Significant Cost Savings from Whole Person Integrative Practice
Integrator columnist and adviser Michael Levin writes: “My
vote for Number One (let alone Top 10) is, without hesitation, the
Seely/Herman Canada Post study
on cardiovascular disease risk reduction and economic outcome
comparisons between naturopathic and (conventional) interventions. This
whole systems, real-world comparison with its well defined economic
has the potential to advance the business of integrative medicine, and,
doing, save money and help people live healthier lives longer.” The study led by Dugald Seely, ND and his economist researcher colleague Patricia Herman, MS, ND, PhD,
found multiple clinical benefits plus cost savings estimated at $1025 per
The study was heralded by multiple stakeholders as a textbook example of
research-as-change agent. While the study focused on care by naturopathic physicians, the Seely/Herman model can be applied in many fields. These
elements deserve emulation: employer partnership; focus on a
costly-chronic condition; analysis of functional outcomes; and a cost
analysis that includes a presenteeism measure. The oeuvre Seely and his Canadian College of Naturopathic Medicine team are developing through the partnership with Canada Post is one-of-a-kind. I agree with Levin that proof of cost-savings will ultimately drive access to integrative care. For that reason, this project ranks near the top.
3. RWJF-IOM’s Future of Nursing: The End of the AMA Headlock on Independent Practice by Non-MDs
October 5, 2010 will go down as the moment when the American Medical Association (AMA), officially lost clinical control of the future of US medicine. On that date, the US Institute of Medicine of the National Academies, Adviser to the Nation on Science, Engineering & Medicine, released the long-anticipated The Future of Nursing: Leading Change, Advancing Health. Much to the chagrin of the AMA, the report not only positioned nurses as leaders, but did so through recommending vast expansion of independent practice by nurses. The Robert Wood Johnson Foundation
(RWJF) committed $10-million to both fund the IOM’s report and the
post-release marketing to increase cultural receptivity to nursing
leadership. Have you heard RWJF’s NPR
spots? The report doesn’t touch on fields such as chiropractic medicine,
naturopathic medicine, and acupuncture and Oriental medicine and
direct-entry midwifery that are also chaffing against the AMA’s view
that MDs should control all care delivery.
Yet this boost to the independence
of nursing practice may be expected to prove as important for the primary care
developments in these “CAM” fields as the chiropractors’ success in
striking down the AMA monopoly in anti-trust Wilk case was important for the opening dialogue on inclusion of non-conventional treatment. Notably, the report was released in the International Year of the Nurse in which the George Family Foundation funded the first integrative nursing fellowship, at the University of Minnesota. Integrator adviser and holistic nursing educator Carla Mariano, RN, EdD, calls the report “a very important message to
the health care community and the government re: the necessary contributions of
nursing to the health and well-being of society.”
4. And the Oscar Goes to: Weil, Maizes and the Arizona Center for Integrative Medicine
The Academy of Motion Picture Arts & Sciences sometimes honors lifetime achievements of individuals who made huge contributions but never received an Oscar. The Arizona Center for Integrative Medicine, founded by Andrew Weill, MD and directed by Victoria Maizes, MD, MPH, tops the Integrator’s list of deserved but previously unsung. The work of the Center’s team (including also Tieraona Low Dog, MD, Kenneth R. Pelletier, PhD, MD (hc), Iris Bell, MD, Randy Horwitz, MD, PhD, and Patricia Lebensohn, MD) could have been acknowledged any year. This year, the Center’s Fellowship in Integrative Medicine topped 500 total graduates since the program began. (See University of Arizona’s Integrative Medicine Fellows: Portrait of an Emerging Cadre of Leaders.)
The 1000 hour, 2-year course of study is the standard-setter for the field and spawning ground for academic and clinical leaders now in scores of key posts in health systems and medical schools across the nation. In addition, the Center-led Integrative Medicine Fellowship in Residency is directly embedding integrative content in a half-dozen partnered family medicine programs. In 2010, the Center’s Integrative Mental Health conference struck a chord in the community, topping 500 attendees in its first iteration. The multiple educational programs are backed by diverse research projects. These include exploration of methods, examination of the value of integrative medicine in corporate health, and analysis of the Center’s own unique educational programs. The Center’s contributions to the advance of integrative health, year-in-and-year-out, cannot be overstated.
5. Integrative Opportunities in the Nation’s Focus on Pain
Pain has stimulated a significant portion of consumer exploration of complementary and alternative health care practitioners and services. Not surprisingly, the focus on pain as a policy issue in 2010, through the passage of the National Pain Care Policy Act of 2010, is creating opportunities. A new Institute of Medicine Committee on Advancing Pain Research, Care and Education was named in November 2010. The Committee includes well-known integrative pediatrician Lonnie Zeltzer, MD, naturopathic doctor-acupuncturist Rick Marinelli, ND, LAc, and nurse-executive with a background in “CAM” research, Margaret Heitkemper, RN, PhD, FAAN. In a separate but similarly focused initiative, various integrative practitioners are taking part in regional meetings of the Pain Action Initiative: PAINS, convened by the Center for Practical Bioethics (CPB).
The Center’s director, Myra Christopher, who sought participation by integrative practitioners in the pharma-funded CPB initiative, was also appointed to the IOM Committee. Meantime, the NIH National Center for Complementary and Alternative Medicine has identified chronic pain-conditions as a top focus in the agency’s 2011-2015 strategic planning process. Perhaps the depth of the cost and care challenges related to pain will open policy-makers to setting new directions in the same way as frank pain in individuals fosters exploration of services of acupuncturists, chiropractors, massage therapists, Yoga therapists, mind-body practitioners and others.
6. The Question of Practice Viability for Licensed Acupuncturists, and Others …
The idea of a healing crisis is useful in understanding why this theme marks the coming of light. Release by the National Certification Commission on Acupuncture and Oriental Medicine of survey data on the incomes of licensed acupuncturists stimulated an ongoing, sometimes acrimonious reckoning in that field. (See Financial Challenges & Warning Labels: How Much Does a Licensed Acupuncturist Earn?) At least 60% of respondents reported a gross income
of less than $60,000. Many took home substantially much less. Nor did the data capture how many had already dropped out of their chosen profession, even with an average
of $55,000 in educational debt. That even these numbers may be rosy is
suggested by a founder of the Community Acupuncture Network. (See The Terrible, Horrible, No-Good, Very Bad Numbers.)
The reality seems finally to be creeping in that expanding viable
business models for integrative practice is not just an issue with
health-system-based integrative clinics. The vast expansion over the
past decade of licensed practitioners of
AOM, naturopathic medicine and massage therapy appears to be proving my
own ugly saying that these fields have gained enough recognition to go into debt, just not enough yet to get out of it. High percentages of graduates with clinical skills but little marketing know-how or entrepreneurial chutzpah are deeply challenged in all 3 of these fields. The good news is that
the professions and educators appear to be beginning to see that focused
attention is needed.
7. The Importance of Inter-Professional Education for Integrated, Team Care
The common sense notion first given to me by now Integrator adviser Clyde Jenson, PhD, that practitioners who are educated together
practice together seems finally to be gaining traction. The Obama
administration’s Health Research Services Adminisration (HRSA) head Mary
Wakefield, PhD, RN is a vocal proponent of interprofessional education (IPE). A January 2010, guide to IPE in HRSA underscores the importance of IPE to team care in the emerging medical homes model of care delivery. Notably, Section 3502 of the health reform law, “Establishing Community Health Teams to Support the Patient-Centered Medical Home,”
explicitly includes doctors of chiropractic
and licensed complementary and alternative medicine practitioners as
potential team members.
Up north, the Canadian Interprofessional Health Collaborative, backed by Health Canada and led by John Gilbert, PhD, published a National Inter-Professional Competency Framework for IPE in February 2010. Here in the United States, the Josiah Macy Foundation co-sponsored a June 2010 meeting to “advance interprofessional education reform” that focused on MD-nurse relations. Closer to home, the publication and marketing of the Clinicians’ and Educators’ Desk Reference on the Licensed Complementary and Alternative Healthcare Professions (CEDR) by the Academic Consortium for Complementary and Alternative Health Care (ACCAHC) introduced scores of academic leaders in programs and colleges associated with the integrative practice fields to the emerging IPE field.
The Pacific College of Oriental Medicine began an annual award to the
acupuncture and Oriental medicine professional who advances IPE. Gilbert, who has dialogued with ACCAHC leaders, is also on the
founding board of the American Interprofessional Health Collaborative (AIHC) which is in the process of incorporation.
AIHC will host a major IPE meeting in Tucson November 19-21, 2011.
Integrator adviser Lou Sportelli, DC, suggested that the team of
writers and editors from 5 licensed disciplines and 6 other integrative
practice fields who wrote the Clinicians’ and Educators’ Desk Reference on the Licensed Complementary and Alternative Healthcare Professions, headed by Elizabeth Goldblatt, PhD, MPA/HA, be acknowledged in the Top 10 this year. (I am
involved with ACCAHC and the book.)
8. Huffington Post Promotes Integrative Medicine in Its Editorial Line
One sign of arrival is if others see value in tooting your horn. The first major media outlet to choose to routinely boost
integrative medicine is
the Huffington Post. The liberal blog HuffPo reaches 40-million distinct viewers each month. Medical editor is Dean Ornish, MD. Wellness editor is acupuncturist-homeopath-nutritionist, Patricia Fitzgerald, DHM, LAc, CCN. Other
regular contributors include Andrew Weil, MD, Mark Hyman, MD and Dana
Ullman, MPH, whose posts on homeopathic medicine themes regularly stimulate significant debate, plus a trio of naturopathic physicians including cleansing ace Walter
Crinnion, ND. On the day of this writing, the top post online at the HuffPo health section is written by a senior
researcher at the Samueli Institute (#1 in the 2008 Top 10) writing on the “illness profit system”
as a national security issue. Notably, HuffPo is
also honored in the top events of 2010 by Coquina Deger, managing editor
for the Association of Accredited Naturopathic Medical Colleges. Thanks to Integrator columnist Taylor Walsh for this nomination. Nice going, Ms. Huffington!
9. A Shift Toward Health, Health Coaching & Wellness
The often articulated, ardently desired paradigm shift away from reactivity toward a focus on health creation saw important gains. At the top of the policy food chain, a National Prevention, Health Promotion and Public Health Council was created as Section 4001 of the new health law – which included multiple references to “integrative care” and “integrative practitioners.” The debate included focused discussion on emerging roles for health coaches in this new medical order. Coaching and integrative practice leaders at Harvard and U Minnesota subsequently convened the Summit on Standards & Credentialing of
Professional Coaches in Healthcare & Wellness to advance the field. In parallel fashion, holistic nursing leaders endorsed programs for nurse-coach training.
Integrator adviser Brad Jacobs, MD, MPH highlights the Obama administration’s decision to create a committee, including Integrator adviser Kenneth R. Pelletier, PhD, MD (hc) to develop and study outcomes of wellness
programs for 2 million federal employees. In this context, the American Chiropractic Association announced a partnership with the National Wellness Institute for a new wellness certificate program for chiropractors. Happily, the NIH NCCAM, responding to both consumer use patterns and to practitioner claims, appears to finally be elevating investigation of health and health-promoting outcomes of integrative practice as a key strategic objective in the emerging 2011-2015 strategic plan. In the end was the beginning.
10. What Would You Add?
I have certainly left much out. Send me a note with your idea or ideas. I will publish all I receive in a
Coda: Integrator Sponsors
I have additional 2010 action for which I am
particularly thankful. The Integrator is possible only through the generosity and
commitment of a few dedicated executive teams and businesses with
which these individuals are associated. I am truly honored that they have hung in this long. These were the Integrator sponsors in 2010 and the total years of support for each.
Sportelli, DC, Patrick McNerney and their team at NCMIC (January 2006-present)
Zechman and Richard Sarnat, MD, co-founders of Alternative Medicine Integration Group (August 2006-present)
Amato, founder of Inner Harmony Wellness Centers (March 2007-present)
- Liz Plizga and her team, with Integrative Practitioner and the Integrative
Healthcare Symposium, business lines at Diversified Communications (September 2008-present)
Thank you Sponsors and thank you all! Enjoy your holidays.
for inclusion in a future Your Comments Forum.