Integrative Medicine and Integrated Health Care Round-up #45: July 2011

Summary: Integrator Special Report shares 15 key areas where complementary and alternative medicine (CAM) and related terms are explicitly included in IOM’s major report on pain care, education and research … Segments identified where 125 page National Prevention Strategy references “complementary and alternative medicine” … Dietary supplement industry worried by S 1310, Durban’s plan for additional regulation … ACCAHC report finds CAM schools received just 4.6% of NCCAM’s $1.29-billion (1999-2010) … 4 new members added to National Advisory Council for Complementary and Alternative Medicine … Canadian government in major, multidisciplinary look at safety of spinal manipulation … Bravewell meets the military around comprehensive pain program … The Institute for Functional Medicine’s formal certification of functional medicine practitioners … Cancer Treatment Centers of America and Parker University team for chiropractic internship … What parts tuition, grants and donations? Inside the budget of a leading university of natural medicine … Alliance for Massage Therapy Education continues to stake claim toward education leadership for massage’s 1440 programs … Roberti di Sarsina announces unique Italian master course in CAM in business, policy and and practice … Physical therapists in push for embrace of psych factors realted to physical maladies … Freedman’s Atlantic feature, Triumph of New Age Medicine, raises storm of debate, possible re-frame of science-CAM issues … Jackson-Coker physician employment group sends 2 CAM/IM reports to 200,000 MDs … Reports document dietary supplement use by various specialists and by diabetics … Notes on the meetings of the International Association for Yoga Therapists (September 2011), Society for Integrative Oncology (November 2011) and Integrative Healthcare Symposium (February 2012).

Policy

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IOM pain blueprint

Institute of Medicine publishes blueprint for pain; Integrator report documents presence of CAM

On June 29, 2011, the Institute of Medicine released a consensus report entitled Relieving Pain in America: A Blueprint for Transforming, Prevention, Care, Education and Research. The consensus committee calls
for a “cultural transformation” relative to pain treatment. The
Blueprint accepts that pain is a mind-body phenomenon. The IOM strategy
stresses the multimodal and multidisciplinary approaches in pain
treatment.
The IOM Committee included
UCLA integrative pediatrician Lonnie Zelzer, MD and
nationally-recognized integrative pain expert Rick Marinelli, ND, LAc.
(See IOM Pain Committee includes integrative MD Lonnie Zeltzer and Rick Marinelli, ND, LAc
.) An Integrator Special Report
compiled the segments of the blueprint in which complementary and
alternative medicine modalities and providers are included. The Integrator review includes 15 sections, with implications for pain care, education and research.  

Comment: The report’s frontispiece is an aphorism and charge from Goethe: “Knowing is not enough;
we must apply/Willing is not enough; we must do.” The saying is meant
to reflect the need to engage a broad “cultural transformation” relative
to pain and its treatment. Goethe’s words are certainly applicable to what
we know about consumer use of CAM. Since consumer perception of value
is as high, it is definitely time to proactively “apply”
this knowledge to the care others. Or are we forgetting that if this is “patient-centered” then, well, patient choice is at the center, no?



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Health promotion Council’s work

The inclusion of CAM in the National Prevention Strategy published through the multi-agency National Prevention and Public Health Council

A quickly assembled National Prevention Strategy has been published,
prior to the June 30, 2011 deadline, by the National Council on
Prevention, Health Promotion and Public Health Council
. The Council was
established under the 2010 Affordable Care Act. The subtitle for the 125
page report is “America’s Plan for Better Health and Wellness.” A quick
search of the document found the following number of CAM/IM-related references:
complementary and alternative medicine (4), massage (1), spinal
manipulation (1), acupuncture (1), integrative health (1). Zero
references were found for: integrative medicine, naturopathic, herbs,
botanicals, vitamins, chiropractic, integrative practitioner or
mind-body.

The first mention of complementary and alternative medicine is under the Recommendations related to the plan’s Strategic Priorities:

“Future research and evaluation, including well designed
trials for many complementary and alternative medicine therapies, will
be critical to addressing unmet prevention and wellness needs, and new
evidence-based strategies will be incorporated as they emerge.”
(page 14)


ImageThe most significant inclusion is under “Recommendations: What Can be
Done?” on page 22 under Clinical and Community Preventive Services. Recommendation #6
reads:
Enhance coordination and integration of clinical, behavioral, and complementary health strategies.

“Integrated health care describes a coordinated system
in which health care professionals are educated about each other’s work
and collaborate with one another and with their patients to achieve
optimal patient wellbeing.
Implementing effective
care coordination models (e.g., medical homes, community health teams,
integrated workplace health protection and health promotion programs)
can result in delivery of better quality care and lower costs. Gaps and
duplication in patient care, especially among those with multiple
chronic conditions, can be reduced or eliminated through technologies
(e.g., electronic health records, e-prescribing, telemedicine).
Evidence-based complementary and alternative medicine focuses on
individualizing treatments, treating the whole person, promoting
self-care and self-healing, and recognizing the spiritual nature of each
individual, according to individual preferences. Complementary and
alternative therapies for back and neck pain (e.g., acupuncture,
massage, and spinal manipulation) can reduce pain and disability.”

(page 22)

The document also includes as related Action Steps for the Federal Government:

“Research complementary and alternative medicine
strategies to determine effectiveness and how they can be better
integrated into clinical preventive care.”
(page 22)

And for Health Care Systems, Insurers and Clinicians:

“Facilitate coordination among diverse care providers
(e.g., clinical care, behavioral health, community health workers,
complementary and alternative medicine).” (page 23)

Comment: I have not yet read the
document thoroughly. Clearly it is a step in the right direction for the integrative practice fields to have
“CAM” described in connection with the paradigm most integrative
providers posit:
” … individualizing treatments, treating the whole
person, promoting self-care and self-healing, and recognizing the
spiritual nature of each individual, according to individual
preferences.” Two members of the Council’s Advisory Group (page 64) likely assisted in ensuring these inclusions:
Charlotte Kerr, RSM, BSN, MPH, MAc, and integrative physician Sharon Van Horn, MD, MPHFascinating that the explicit concept of “integrative health,” so visible in the Council’s charge (see Section 4001 here) was largely lost on the way to the strategic plan.

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US Senator Dick Durban (D-IL)

Senators Durban and Blumenthal introduction of Dietary Supplement Labeling Act (S. 1310) raises industry concerns

Two Democrat US Senators, Dick Durban, (D-IL) and Richard Blumenthal
(D-CT) introduced The Dietary Supplement Labeling Act (S. 1310) on July
1, 2011. The bill is viewed as “primarily targeting products that blur
the line between dietary supplement and food and beverages,” according
to this useful write-up via Natural Products Insider. In a notice to members, Michael McGuffin, executive director of the American Herbal Products Association supports the view that the bill “would largely propose legislative solutions where what is needed is regulatory
enforcement.”
The Natural Foods Merchandiser, an industry publication, escalates concern by referring to S. 1310 as a “cruise missile shot at the industry.” AHPA notes that “the most controversial part of the Dietary Supplement Labeling
Act may well be its requirement for product registration, a change that Durbin
has sought in the past.”
Adds McGuffin: “AHPA is in communication with Sen.
Durbin’s office, and I will be reviewing the actual legislation as soon as it
is available.” AHPA has concerns about the reach of the legislation: “As always, AHPA’s primary focus will
be on identifying and opposing any legislation that in any way reduces consumer
access to safe dietary supplements.”




Research

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Team surveyed CAM schools

ACCAHC reports that CAM schools received just 4.6% of NCCAM’s $1.29-billion between 1999-2010

At the June 2011 Biennial Meeting of the Academic Consortium for Complementary and Alternative Health Care, researcher participants reported that, of the roughly $1.29-billion in appropriations to the NIH National Center for Complementary and Alternative Medicine

from 1999-2010, 4.6% ($60-million) went to institutions that educate
distinctly licensed CAM practitioners. Of the total, two institutions, Palmer College of Chiropractic and Bastyr University each accounted for roughly a third of the total. The data, below, were developed through an informal survey of ACCAHC’s research leaders. The total for NCCAM expenditures was created by adding up each year’s appropriations.

__________________________________


NCCAM Investment in CAM Schools: 1999-2010


 Institution   Millions $

 Bastyr University
      $19.8
 National College of Natural Medicine
   $2.8
 National University of Health Sciences
   $4.0
 New England School of Acupuncture

   $4.0
 Northwestern Health Sciences University
   $2.5
 Oregon College of Oriental Medicine
   $2.2
 Palmer College
   $20.4
 University of Western States
   $4.0
 Total    $59.7

Source: ACCAHC presentation to NIH NCCAM, February 28, 2011, as
presented at the ACCAHC Biennial Meeting, June 28, 2011.  

__________________________________


Comment: A colleague at a conventional academic
institution responded to these data with a view that the percent is
about where it should be, and perhaps even high. He reaches this
conclusion based on the number of CAM schools, and their present research capacity, compared to that in the 125+ conventional medical programs.
My own view is that this is akin to declaring that researchers in any
medical specialty have equal rights to the dollars dedicated to research
in any other specialty. Imagine
if family medicine researchers told oncology researchers that they have
a right to a percent of oncology research dollars.
That would cause a huge uproar. Truth is, the
accredited CAM schools represent over 95% of the integrative
practitioners who are educated to a US Department of
Education-recognized standard for integrative care. To believe anyone
can do the research is to disrespect the distinctive care the consumer is receiving from members of these disciplines.

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There are good and bad historic justifications for these investment patterns.
First, the founding NCCAM director Stephen Straus, MD, utterly unpracticed as he was in any form of integrative care, drove investment away from the practical, integration focus urged in the NCCAM mandate.
He knew nothing about actually integrative care, by experience or interest, and much less by passion. Strauss’ NCCAM had little interest in understanding why patients were drawn to the whole
person practice outcomes of these practitioners. Thus “CAM” practitioner
expertise was sidelined by the reductive, single agent and mechanism
focus of his favored agenda.

Second, and more sympathetically, the distinctly
licensed CAM fields were yet new to the culture of NIH and, with some
exceptions, to significant research.
Finding the CAM school-based PIs to lead projects was challenging. The good news is that
the 1999-2010 period incubated a much larger community of skilled
CAM investigators (even if, following Strauss’ priorities, their specialties tend to be in reductive approaches). Present NCCAM director Josephine Briggs, MD has
written “real world research” into the 2011-2015 Strategic Plan. (See
Jaded by Past NIH NCCAM Past Priorities? The 2011-2015 Strategic Plan Says Think Again.)
In fact, Briggs’ plan specifically states that “CAM practitioners are the
key holders of knowledge related to the potential application of CAM
interventions and disciplines.” This is what Congress mandated NCCAM to
explore. Here’s hoping that an analysis in 2015 will see closer to 20%
of NCCAM’s budget going directly to these CAM institutions where these “key holders of knowledge” are housed.

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Dan Cherkin, PhD

NCCAM adds Berman, Cherkin, Kingston and Michener to National
Advisory Council on CAM

The National Center for Complementary and Alternative Medicine
(NCCAM) announced 4 new members to the NIH National Advisory Council for
Complementary and Alternative Medicine
at their June 2011 meeting.
The incoming group includes: Brian Berman, MD, integrative medicine leader at the
University of Maryland; Daniel Cherkin, PhD, health services researcher
at the Group Health Research institute; biodiversity expert David Kingston, PhD, a former
head of the American Society of Pharmacognosy;
and James Michener, MD, chair of the department of community and family
medicine at Duke University.
The NCCAM release on the appointees is here.

Comment: This is an interesting crop.
Berman and Cherkin may be considered deans of research for the entire
field. Each is an excellent choice. Unlike the vast majority (I would
guess over 95%) of NCCAM-funded researchers from conventional academic
health centers, Berman is a skilled and inquisitive, whole-person
focused clinician. Cherkin is closely connected to all of the licensed
CAM disciplines and has done exceptional health services work with his colleague Karen
Sherman, PhD, also at Group Health. His expertise will be especially
important with NCCAM’s emerging “real world” interests.

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Brian Berman, MD

I am less excited about the other two. Kingston’s work supports natural products research. This remains NCCAM’s comfort zone, if not its highest
value to the public health. A leader
in the botanical field shares that Kingston is a “highly respected
natural products chemist.” Kingston’s biodiversity connection adds an
intriguing whole-system alignment with CAM philosophy. Michener is something of a
wild-card, from the resume. Duke has a significant integrative medicine
program, yet Michener doesn’t appear to be involved with it. Perhaps his
work relative to obesity and prevention programs is seen to fit with
NCCAM’s new interest in preventive approaches.

It is interesting that nothing was done in this group to address the chronic failure
of NACCAM to comply with the NCCAM mandate that at least half be
“licensed in one of the major systems” that NCCAM is charged to explore, and that others would be selected to reflect consumer interest. More on that soon.

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Sunita Vohra, PhD

Canadian government grants $2-million for inter-disciplinary research on safety of spinal manipulative therapy

In a June 10, 2011 note to his Consortium of Academic Health Centers for Integrative Medicine colleagues, Sunita Vohra, PhD, reported a $2-million “team grant” from the Canadian Institutes for
Health Research to research patient
safety of spinal-manipulative therapy.
The
$2-million grant is innovative in that it will “involve input from four
regulatory colleges in Alberta.” One investigator is chiropractor Greg Kawchuck, DC, PhD. Involved also is the nation’s single chiropractic program, Canadian Memorial Chiropractic College.
Vohra is professor at the University of Alberta Faculty of Medicine & Dentistry and Alberta
Heritage Foundation for Medical Research scholar.
“To the best of our knowledge, this is the first time that the
four colleges have collaborated with each other in a research initiative. We’re
thrilled to work with the colleges of medicine, osteopathy, physical therapy
and chiropractic.” Vohra speaks to the known importance of teams in safety issues:
“From everything we understand about patient safety, the best way
to achieve it is through a multidisciplinary approach-this involves four
different professions all of whom have one area that overlaps.”

Comment: Nice balance here, for a hot topic. Vohra seems a good person to be quarterbacking it. The inclusion of Toronto-based researcher Heather Boon, PhD is also hopeful. 


Organizations


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Schoomaker: Leading military team

Bravewell Collaborative joins military leadership in symposium on Army Comprehensive Pain Management Campaign Plan


On June 23, 2011, leaders of the Bravewell Collaborative and senior military leaders met, according to Bravewell release, “
to
discuss improving pain management for warriors and veterans through the use of
integrative medicine.” This meeting, the
Comprehensive
Pain Management Campaign Plan Symposium
, was part of the work
of the Army Pain Management Task Force (PMTF), begun in 2009. The PMTF called for building best practices for
the continuum of acute and chronic care based on a “holistic,
multidisciplinary, integrative approach to care.”
The symposium was presented by Bravewell as “an important step in implementing
the PMTF recommendations.”
Bravewell’s release states that this is part of the Army’s effort to provide ‘a
standardized DoD and VHA vision and approach to pain management to optimize the
care for warriors and their families.'”

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Philanthropy group develops military plan

Army Surgeon General Lt. Gen. Eric B. Schoomaker, MD,
PhD
said that the meeting “marks the beginning of a cultural shift in how health care is
practiced in the military.” Among the scientific reports considered were outcomes of the 9 clinics involved in the Bravewell Clinical Network. Christy
Mack, president of Bravewell, states in the release that “the centers in the Bravewell Clinical Network have been developing
successful models of integrative care for the past nine years and we are
pleased to be able to share these with the military and the VHA.”

Comment: The military is proving to be quite a workshop for integrative approaches. Interesting
that Bravewell is showing up in this military zone after its apparently
abortive (though intriguing)
Healthy Nation Partnership in late 2009-2010. The organization of philanthropists in integrative medicine has done some exceptional mapping work.

It would be useful if Bravewell chose to map all of the military
programs involving complementary and integrative-related approaches and
studies underway. These range from naturopathic physician Terry Davis,
ND offering a mindfulness program in Tucson, to yoga therapist Richard
Miller, PhD’s work with mindfulness, to the chiropractic and acupuncture
programs in VA hospitals, to the many significant projects led by the
Samueli Institute. There may be real value in both the map and in
creating an unofficial network of integrative researchers and
care-givers who are working with military populations.


Education

ImageIFM’s program to become a Certified Functional Medicine Practitioner

For 14 years, the Institute for Functional Medicine has offered a
5-day training program entitled Applying Functional Medicine in Clinical
Practice (AFMCP) as the cornerstone of its educational offerings. The
program is also a core requirement for the organization’s requirements
to become a Certified Functional Medicine Practitioner. The list of requirements includes the following elements:


  • Six 2 ½ day onsite Advanced Practice Modules

  • Functional Medicine Fundamentals 

  • Webinar case studies following each module

  • Course review webinar 

  • Certification exams & case presentations   

The next iteration of the basic training will
be held in Baltimore September 12-16, 2011. The brochure includes a
powerful endorsement quote from integrative medicine leader Brian Berman, MD.
Price is $2875. The 20 listed faculty members include 18 medical
doctors and 2 naturopathic physicians. IFM’s promise is in the cut-line
on its brochure: “If you want to transform your practice, you need a
plan.” IFM’s certification does not at this time have any 3rd party
accreditation of its certification process.

Comment: Perhaps I am the last to be
aware of IFM’s certification program. Setting a standard is good. One
of the most significant issues to a consumer relative to both
“integrative medicine” and “functional medicine” is that anyone can
apply the terms to their practice, with or without any specialized
training. How can a consumer know what the term means if there are no
standards? This certification is a step in the right direction.



One small gripe: Does IFM model appropriately utilize the discrete skills
of other natural health practitioners? A decade ago a leading
information firm called Integrative Medicine Communications, to which I sold my hard-copy Integrator, marketed its
products to medical doctors will the cut-line: “Know It All.” Via
hubris, maybe, the firm went under. No single practitioner of any type
can, of course, know it all. And even the most integrative of providers
is not likely to fully understanding how best to use other
practitioners, including other integrative practitioners. Integrating
“science, research and clinical insights to treat and prevent disease
and maintain health,” as the IFM brochure claims, is not enough. One must
also know how to best integrate other practitioners. This appears to be an area
that could stand some work.

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Partnering with CTCA for chiropractic internship

CTCA begins chiropractic internship with Parker University

Cancer Treatment Centers of America (CTCA) has
initiated a chiropractic internship program with Parker University. CTCA
has been known for its inclusion of naturopathic doctors in its
integrative treatment processes but chiropractors have not been
significant players. An article in the July 15, 2011 issue of Dynamic Chiropractic

described the program, which will be directed by John Silbey, DC at
CTCA’s Tulsa, Oklahoma site. “This internship is designed to best prepare Parker
students for
clinical practice within integrated health care settings,” added Dr.
Patrick Bodnar, assistant dean of clinics at Parker University. “It will
expand the clinical portion of the student’s education and will benefit
them tremendously.” An intern notes that the experience is also
broadening her understanding of other natural health fields: “So far, I
have been with the intake department, two medical oncologists,
acupuncture, mind/body medicine, and naturopathic medicine.”

Comment: Kudos to
CTCA and Parker for establishing a remarkable opportunity for both
chiropractic integration and also for interprofessional education/care
(IPE/C). Experts in IPE/C say that the optimal site for education that creates
respect across disciplines is in the clinical setting. This program is a
still rare opportunity. (Thanks to Glenn Sabin for alerting me to the
story.)

ImageInside the 2009-2010 budget of a leading institution of natural health sciences: Bastyr University

The Bastyr University 2009-2010 Annual Report provides
on interesting look at the economics in a leading institution of
natural health sciences. The university had 927 students in this period:
176 undergraduate, 499 first professional degree and 237 graduate students.
Total operating revenues reached $28.8 million. Of this, 88%
($25.5-million) is represented as Education and General Revenues.
Tuition alone represents 71% of revenues, or just over $20-million. (The largest
portion of the remainder of the General Revenues is likely clinic fees.)
Governmental grants totaled $2.3-million and
philanthropic gifts $888,475. The portion of the Bastyr
revenues from grants and donations was lower than any year
since 2006. It has remained between $3.1-$5.1-million throughout. The
33-year-old institution shows roughly $2.7-million in endowment
investments and net assets of $14.2 million. Bastyr showed a net from operations of $1.8-million in the period of the report.

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Dan Church, PhD, Bastyr president

Comment:
Many trained in conventional academic health centers
have little idea how dependent on tuition are the schools educating students for the
distinctly licensed CAM fields. A colleague recently sent a
note estimating that tuition probably accounts for upward of 85% of
revenues in most CAM fields.
By that standard, Bastyr’s dependency is relatively low. The university is a huge recipient, compared to most other CAM schools, of
federal research funding. (See related article this Round-up.)
I suspect that the level of philanthropy, at
roughly 3%, is also high compared to most others. Bastyr has invested in development since it was founded.
Still,
the pressure on tuition is extreme. Here’s hoping that Bastyr president
Dan Church, PhD, who first had to clean up a budget mess he inherited, will find a way
to that promised land. It’s tough to be the Harvard of natural medicine
an aspirational phrase one sometimes hears around Bastyr- without the
room to dream and act that an endowment affords. The nation will be
better off with not one but a half-dozen or more thriving,
multidisciplinary universities of natural health sciences. 


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Growing influence in massage education

Alliance for Massage Therapy Education continues step-wise effort to fill gap in massage self-regulation

Comment: The program for the second annual conference of the Alliance for Massage Therapy Education,
August 18-20, 2011, gives ample evidence of the critical role this
organization is already modeling for that field. The program includes a
keynote from a nurse educator on teaching excellence, plus presentations
on developing competency-based assessment on student performance and
something called “instructional design for inspired learning.” These are
coupled with two presentations related to the organization’s own Teacher Education Standard Project.
Other presentations focus on policy and regulatory issues of interest
to massage educators, plus nuts-and-bolts content on marketing and
ethics. The massage field reportedly has over 1440 schools. It needs just the kind of strong leadership that Rick Rosen, MA, LMT and his team are assembling. I honored Rosen in the Integrator Top 10 People from 2010. The organization’s necessary work continues.



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Roberti di Sarsina: New Masters course

Roberti di Sarsina’s Italian “master course” links policy, management and CAM

Integrator editorial adviser Paolo Roberti di Sarsina, MD has announced a new “Master-course” he will
be
offering entitled “Health Systems, Traditional and non-Traditional
Medicine.” The course will “address the subjects of health,
person-centred medicine, Traditional and Non
Conventional Medicines, anthropological health systems. To this end it
will
survey various health models and their impact on welfare, and go into
the
latest topics of Health Sociology.” In a note to the Integrator, he adds:

“The Master-course is
designed for those in search of new skills and professionalism to employ in
improving management of health trusts, veterinary branches of the health
system, hospitals and clinics, wellness centres, centres studying and
researching into health and disease. It will focus on changes in people’s
demand for treatment, and cater to researchers on issues of Health and
Wellness …
The intention is to
train managers, decision-makers, researchers and health workers to plan a
person-centred, sustainable, transparent and honest health model of relevance
to the individual citizen, health units and epidemiological research teams.

Again: “The Master-course aims,
in short, to train a manager to plan a health model from the citizen’s angle.
” The first
postgraduate course of this kind in Italy
will be taught in Italian and requires attendance onsite. An announcement in English is here.

Comment: What I found of particular
interest in Roberti di Sarsina’s course is the way that traditional
medicines and “CAM” are implanted in a broader discussion of the status
of the health system, both management and economics. I don’t think I’ve
ever seen such a course description here. One has to love the ambition, if be overwhelmed with the potential subject matter.


Professions

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APTA: Urging more focus on psych issues

Journal of the American Physical Therapy Association pushes role of psychological factors

Colleague Matthew Taylor PhD, PT sends notice of a special issue of the Journal of the American Physical Therapy Association. The May 2011 issue leads with a piece entitled A Convincing Case for the Psychologically-Informed Physical Therapist.
The writer notes numerous places in the profession’s organizational and
accreditation documents where psych components are deemed important.
Yet the therapy is not fully reflected in practice. The underscores the
importance of the special issue:

“So, we have long paid lip service to the influence of psychosocial
factors on clinical outcomes, but the time has come to
YELL about the importance of these factors. This
special issue is deliberate in laying out evidence to support adopting a
broader approach for practice that includes a
cognitive-behavioral framework, using low back pain as the example  … W
e hope that we will stimulate and encourage the development
of a broader approach to physical therapist practice,
with a focus on the identification and management of psychological and
psychosocial obstacles to recovery of optimal
function. This is a call to action for educators, research scientists, and clinicians to move forward with this agenda.”

One web-available article is entitled Psychologically-Informed Practice for Low Back Pain: Future Directions in Practice and Research.

Comment: This focus is a smart fit with
the multimodal and multidisciplinary approach toward pain advocated in
the new Institute of Medicine blueprint, reported above. I find myself
curious about the ways the standards for chiropractic education and
accreditation line up with those for physical therapists. If so, or even
if not, is that field adequately embracing the psych components? Thanks
for the head-up, Matt.


Media

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Image accompanying Atlantic article

Atlantic’s “Triumph of New Age Medicine” raises storm of debate over science and practice of medical alternatives

David Freedman’s feature, The Triumph of New Age Medicine (Atlantic,
July-August 2011) has stirred the most significant debate in years over
the science and use of what Freedman prefers to call “alternative
medicine.” Freedman stirs the dialogue by wading into the chasm between
the failure of large clinical trials of single agents and yet the
growing respect, even among clinicians at the Mayo Clinic, for the value
patients find in the whole person approaches of alternative medicine
practitioners. Atlantic’s e-version quickly generated a storm of
responses. The magazine then hosted a series of response columns. Authors ranged from anti-CAM bloggers to integrative care leaders Mimi Guarneri, MD, Andrew Weil, MD and Dean Ornish, MD to NIH
NCCAM’s Josephine Briggs, MD and Jack Killen, MD. The
Briggs/Killen piece is entitled Don’t Dismiss These Treatments as Placebos. Meantime, Freedman fairly takes apart the antagonists in Evidence, not Anecdotes. Two columns in the Integrator review Freedman’s work from a largely positive perspective. Taylor Walsh pulls an extraordinary set of quotes that reframe how “alternative medicine” is being viewed.

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David Freedman

Comment: After Walsh alerted me to the original story, I weighed in with David
Freedman’s Atlantic Monthly Feature on Alternative
Medicine and the Holy
Trinity of Patient-Centered Outcomes
.
In showing the failures of reductive science to capture alternative
medicine’s value as felt by consumers and from a cost perspective,
Freedman walks right up to a huge question. He doesn’t quite ask it. And
that is: Is US healthcare damaged by allowing decisions on
valuation of research methods, on research
funding, and on publication decisions, to be controlled by
professionals who do not respect the synergies from multi-modal,
patient-centered, healing-oriented approaches?
Freedman may just be the journalist to do take this on. Personally, I consider this suppression of research on whole-person, healing approaches a kind of paradigm water-boarding.

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Ongoing reporting on growth of CAM

Jackson Coker offers 2nd CAM feature plus Taylor Walsh resource on IM education

Two significant CAM features headline the July issue of the Jackson & Coker Industry Report. The report from the physician employment consulting firm, entitled The Mainstreaming of Complementary Medicine, begins with reference to a Jackson & Coker 2008 feature entitled : “In
the last three years, the influence of CAM has grown significantly.  In
this issue we take another look at the mainstreaming of non-traditional
approaches to improving patients’ health and well-being. This time, we
focus on how widespread CAM is being incorporated into medical service
offerings at major hospitals and in medical education programs.” The
feature also includes a useful, well-referenced survey of academic
programs for training medical doctors in integrative medicine. Written by Integrator columnist Taylor Walsh, the report is entitled The Evolving Role of CAM Integrative Medicine in American Medical Education.
These two reports were electronically mailed to over 200,000 conventional doctors.


Natural Products


ImageDietary supplement use by cardiologists, dermatologists and orthopedists

A study entitled Use of dietary supplements by cardiologists,
dermatologists and orthopedists: report of a survey
found that 57%
percent of cardiologists said they use dietary supplements at least
occasionally, as did 75% of dermatologists and 73% of orthopedists. Regular dietary supplement use was reported by 37% of
cardiologists, 59% of dermatologists, and 50% of orthopedists. In addition, 72% of cardiologists, 66% of dermatologists, and 91% of orthopedists
reported recommending dietary supplements to their patients. According to the summary, the “primary reason
given for recommending dietary supplements to patients was for heart health or
lowering cholesterol for the cardiologists; benefits for skin, hair and nails
for the dermatologists; and bone and joint health for the orthopedists”.

The product
most commonly reported to be used was a multivitamin, but over 25% in each
specialty said they used omega-3 fatty acids and over 20% said they used some
botanical supplements. Integrator reader Mitchell Stargrove, ND, LAc, author of Herb, Nutrient and Drug Interactions, comments on the report: “It’s
great to see specialist MDs using nutrrients. They are working to expand their
repertoire and respect patient’s choices; that should be the approach we all
embrace with respect and collaboration. An
intriguing question is whether they actually pay attention to interactions
(beneficial and adverse) and quality issues? And, fundamentally, do they
actually have a transdisciplinary strategy?’

Survey shows dietary supplement use in diabetics

A survey on Use of complementary and alternative
medicine supplements in patients with diabetes mellitus
found that regular
use of one or more CAM supplements was reported by 34% of type 1 diabetics and
31% of type 2 diabetics.”
The
patients reported that prevention and improved well-being and quality of
life
were significant motivations to use CAM preparations. A focus of the
researcher was on the use of cinamon as a biological agent.
Eighty-three
percent
of type 1 diabetics and 70% of type 2 diabetics said they had already
heard of
the postulated positive effect of cinnamon on blood glucose and
diabetes. Women knew more about this than men. Some 85% of all the
patients said they would be “willing, or probably willing, to test
the effect of cinnamon on blood glucose and diabetes management.” This
report came via HerbClip, a service of the American Botanical Council.

Conferences

ImageIntegrative Healthcare Symposium, February 9-11, 2012

The 2012 iteration of the most integrated of major conferences, the
Integrative Healthcare Symposium (IHS), will be held at the New York Hilton on
February 9-11, 2012. The conference will once again be chaired by Woodson Merrell, MD, a long-time integrative medicine clinician who co-founded the Continuum Center for Health and Healing.
The 2011 conference drew roughly 1200 practitioners and 120 exhibitors.
Typically the most significant subset of attendees is medical doctors,
followed by nurses, chiropractors, naturopathic doctors, nutritionists,
acupuncturists and more. Materials from the organizers state that the
clinically-oriented presentations will focus in similar areas as recent
conferences, including: Nutrition, Cardiovascular Health, Hormone, Pain Management, Allergy, Practice Management, Spirituality and Mind Body Medicine.

Comment:Alignment of interest note: IHS and its sibling website, IntegrativePractitioner.com, are Integrator
sponsors. I have enjoyed a long relationship with the IHS team and am once
again working with them on 2-4 programs. One is expected to be a
presentation with integrative pediatrician Larry Rosen, MD on
integrative health on primary care and medical homes. Another may be an opportunity to once again present my year in review on the business and policy
of integrative healthcare. Be there or be square.

ImageIAYT presents not one but two yoga research meetings in September 2011

Under the leadership of John Kepner, MBA, executive director of the International Association of Yoga Therapists
(IAYT), the organization has significantly highlighted
the research that supports the practice of Yoga for therapeutic
purposes. On September 1-4, 2011 IAYT’s 5th annual Symposium on Yoga Therapy and Research
(SYTAR) will be held in Pacific Grove, California. The meeting is
IAYT’s annual membership meeting. Just three weeks later the organization will mount its 2nd annual Symposium on Yoga Research. The latter gathering is
described as the second “comprehensive and widely publicized academic
meeting in the West devoted to Yoga therapy research.” The meeting is co-sponsored by, and will
be held at, the Kripalu Center
in the Berkshires of Western Massachusetts. Presenters will include IOM
Pain Committee member Lonnie Zelzer, MD (see related article this

Round-up). The Samueli Institute is Platinum Sponsor for both
conferences. 

ImageSociety for Integrative Oncology mails to all AMA-member oncologists for November 2011 conference

The annual meeting of the Society for Integrative Oncology has grown in stature with each of its 8 years. The November 10-12, 2011 conference will include a keynote from Francis Collins, MD, director of the National Institutes of Health. SIO board member Glenn Sabin shares that the conference flier will “go out to
45,000 practitioners across multiple disciplines, including every AMA member
oncologist in the U.S.
This year the conference will be
held in Cleveland, Ohio. Among the sponsors are the Bank of America,
Merrill Lynch, The Cleveland Foundation, Mt. Sinai Health Care
Foundation, Parker Hannifin, Philips HealthCare, Positively Cleveland
Convention and Visitors Bureau, Saint Luke’s Foundation, Susan G. Komen
for the Cure and University Hospitals Seidman Cancer Center.



John Weeks Written by John Weeks

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