Richard Sarnat, MD - on the IOM's economic-related assessment group

One action area at the IOM's Summit on Integrative Medicine and the Health of the Public was a set of invitational working "groups" or "assessment groups" that met privately during the Summit. By theme, the half-dozen groups roughly paralleled the themes of the IOM's keynotes and panels (vision, models, economic, etc.).

and his partner James Zechman, at Alternative Medicine Integration Group, have managed to produce two of the perhaps half-dozen most interesting sets of data on outcomes of integrative practices. The chronic pain initiative of AMI, an Integrator sponsor, is generating data in Florida via a Medicaid waiver. I covered the structure and outcomes of this initiative in a 4-part Integrator series. The 7-year data of their primary care integrative independent practitioner association (IPA) model in Illinois was noted as one of the Integrator Top 10, for 2006. The outcomes of that model, published in the peer-reviewed media, are available via that link.

When I think of how it is that one firm can be operating 2 of the most important projects of the sort that we all need to being examining, I think back to a practice of Sarnat. Together with his business savvy and medical knowledge, Sarnat has for 30 years had a serious meditation practice. Did the combination allowed him to access some possibilities not available to most? Enjoy his report and musings.

A SUMMIT REPORT AND INDIVIDUAL MUSINGS ON THE FUTURE OF HEALTH CARE:  (FOLLOWING MY ATTENDANCE AT) THE SUMMIT ON INTEGRATIVE MEDICINE AND THE HEALTH OF THE PUBLIC - HELD AT THE INSTITUTE OF MEDICINE, A BRANCH OF THE NATIONAL ACADEMY OF SCIENCES Feb. 25 – 27, 2009 

By Richard L. Sarnat M.D.
Co-founder and Chief Medical Officer,
Alternative Medicine Integration Group (AMI)

BACKGROUND

My invitation to the summit from the Institute of Medicine requested that I participate in the working group called “designing and building the economic incentives.”  All working group members were asked to answer the following questions: 

1) What are the three most important priorities in addressing the focus issue?
2) Who are the key actors for implementation and their roles?
3) What might be the achievable 3-year and 10-year goals?
4) What are the next steps? 

This editorial is an attempt to answer these questions more fully, while synthesizing the “highlights” presented at the summit

THE CASE FOR CHANGE

Real change and momentum exists within Washington, D.C. to promote actual health reform, as opposed to allocating more money for our current dysfunctional disease care system.  An historical window of opportunity exists, which must be seized now.  It is imperative for each of us to contact our Federal Congressional Representatives and Senators and make our passions on this issue known.  Grass roots activism is essential if we are to triumph against the prevailing forces of the “stagnant quo” who will rise to protect their economic interests.  All licensed health care providers have a place in this future model, where primary prevention and wellness strategies intersect with disease care.  But clearly, a new balance in the allocation of resources between these two disparate systems must be achieved.

A.  There is recognition that each person’s current and future state of health needs to be “spotlighted” as a national priority. Funds will be allocated to changing our current culture in order to make health a cradle to grave strategic priority for every person.

	At the conclusion of this paper is a website that lists all federal congressmen and their emails. We all have homework to do, once you finish reading!

B.  Economically, our nation can no longer afford to pay the costs of treating the manifestation of disease in its late stages (current system).  We must intercept the disease process at the earliest possible stage.  Screening tests for the early detection of disease manifestations are not early enough (mammograms, rectal hemacult, etc).  We must launch a national awareness campaign to all stakeholders.  Our new national motto must recognize that lifestyle changes are more powerful than pharmaceuticals.  Hippocrates was correct: your foods must be your medicines and your medicines must be your foods.

C.  We now understand the social and behavioral determinants of disease, which create a disproportionate amount of disease and expense in the under-privileged, the lonely, isolated, depressed and abused.  Evidence reveals a 5-fold disparity in total medical cost over one’s lifetime between the lowest and highest socioeconomic strata (NHIS 2001 -2005

Our new national motto must recognize that lifestyle changes are more powerful than pharmaceuticals.

Overcoming Obstacles to Health). Additionally, people exhibiting loneliness, isolation and depression have a 3 -7 times increased mortality.  We must intervene and build a sense of community, well-being and support within all our social agencies: early education (K-12), community service centers, corporate environments and all governmental agencies.  We must change the national consciousness to make health a cradle to grave strategic priority for every citizen. 

D.  We must re-evaluate our food and water sources, exercise habits, options for stress management and overall community support services.  Obesity, tobacco usage, diabetes (metabolic syndrome), cardiovascular disease, depression, anxiety and other debilitating manifestations of stress can all be avoided with early intervention, if the support system and new culture for personal responsibility and proactive health initiatives are pervasive.

E.  Primary school initiatives, such as placing free fruits and vegetables within the classroom and halls have been documented to produce positive behavioral changes.  Further effort must be placed on the removal of harmful foodstuffs from our school’s cafeterias.  It is unrealistic to remove all vending machines from schools, as this is a source of revenue for extracurricular school activities.  But the quality of the food offerings within the vending machines must be closely monitored for their positive/negative effect on the health of our children.

F.  No discussion of prevention and wellness can be complete without considering it a national priority to refocus our attention on creating a healthy and sustainable environment in which to thrive.  Numerous toxins, known as endocrine disruptors, such as pesticides and industrial chemical byproducts now poison our environment and negatively affect the

	"It is important to remember that while all models are wrong; some are useful.”

population.  These same chemicals, known to create infertility in mice, are presumably responsible for the 11% of our population who now have fertility problems.  Similarly, the same gene for ovarian and breast cancer now carries a 3X times risk of expression in people born after 1940, when compared to the relatively “toxic-free” environment of the pre1940s.  It is instructive to look to Darwin and understand what allows for species longevity:  “It is not the strongest of the species that survives but the ones most adaptable to change.”  If awareness is truly the first step to healing, then let this be a call to action for our government - that an increased focus on wellness and prevention cannot take place without a comprehensive strategy that encompasses our family, our schools, our communities, our nation and our entire planet.