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Integrative Medicine and Integrated Health Care Round-up

The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series

Summary: A Medscape piece on pharma and medical professional organizations has its natural products parallels ... Integrative medicine programs at U Kansas and New Mexico expand to new clinical facilities ... Quinn assists U Kansas in establishing a unique fellowship program for an MD, DO or ND ... Pelletier's CHIP program adds Pfizer, Pepsi and GlaxoSmithKline as participating firms in exploring integrative medicine in employee health ... Boston's Integrative Medical Alliance teams with Tufts to give experience in complementary therapies to conventional health professions students, clinicians ... Rafal's "mind heals" program in Rhode Island ... Alexander technique expert Jean Louis Rodriguez shares a widely reported BMJ trial which could launch expanded interest in the little utilized but powerful patient-centered approach ... Big kudos: population-based, group-oriented mind-body program for adolescents led by James Gordon, MD shows positive outcomes in Kosovo ... Team co-led by Moshe Frenkel, MD publishes a dozen integrative oncology papers in Hematology/Oncology Clinics of North America ... Bethany Hayes, MD looking for practitioners for True North Center ... and more

A recent Medicare announcement relative to the organizations to end reimbursement for medical errors has added not paying for "extra complications from poor control of blood sugar levels" according to a San Francisco Chronicle story ... A National Association of Insurance Commissioners study reports that 22% of Americans have reduced patient visits due to the economic downturn. Are complementary and integrative practices seeing this trend? Or is self-care, and interest in practitioners who claim to enhance self-care, counter-cyclical? ...

Medscape and medical professional organizations and Big Pharma and "Little Pharma"

A Medscape commentary by Lawrence Grouse, MD, PhD describes some of the multifacted ways that "medical professional organizations" (MPOs) aide and abet the intrusion of pharma-thinking on medical practices. The column provides some excellent detail, which I consider from the vantage point of just having attended an MPO-organized naturopathic medical conference in which the vendor halls overflowed and reportedly over 40 vendors were not able to exhibit. The program also included sponsored presentations. A naturopathic residency model floats on contributions from two dozen supplier funders. Natural pharma chipped in a couple thousand dollars to fund two research awards. What have I missed?

I also consider Grouse's comments from my own professional positions. I am part-time executive director of an organization which has a vendor (though not a natural product supplier) as a core supporter. I am editor-publisher of a newsletter which is dependent on vendors for its revenue. Alas, as the 19th century French poet Charles Baudelaire sardonically put it, "you, hypocrite reader" are also implicated: this content is "free" to you because of the support of these firms. Meantime, full disclosure, I am off to a Seattle Storm game with my daughter tonight using tickets made available through one of those natural products suppliers. Thanks George. Yikes. The differences between Big Pharma and Little (natural) Pharma seem to be largely in the quantity of the supplier largesse. (Thanks to naturopathic medical student Bill Walter for the link to the Medscape piece.)

Integrative Clinics & Practices

Arti Prasad, MD
Medical school at the University of New Mexico opens new integrative Center for Life

Salon.com ran a short feature on the new integrative clinic that the University of New Mexico program in integrative medicine is establishing (See "UNM opening new integrative medicine center," August 16, 2008). Called the Center for Life, longtime program director Arti Prasad, MD is quoted as saying that the center distinguishes itself not just for integrating the traditions of Western medicine and the East, but also those of New Mexico. Integrative services have been offered through University facilities since 2001. The article acknowledges a move to an off-campus, healing oriented facility. Prasad's vision is described here.

Drisko's U Kansas integrative program moves into 4600 sq.ft facility, adds fellowship

Drisko, left, with U Kansas Chancellor Barbara Atkinson, MD
This summer, the Program in Integrative Medicine at the University of Kansas Medical Center moved into its new 4,600 sq ft center that is, according to program director Jeanne Drisko, MD, "aesthetically pleasing and functional for all the therapies we provide our patients." The facility accommodates 10 infusion patients, has three exam rooms, two consult rooms, a meditation/conference room, patient check-in, a massage therapy room and eight administrative offices. These house, according to Drisko, the programs MD and ND physicians, nurses, a nutrition educator, acupuncturist, other support staff "and a new Fellow this summer."

Drisko notes that the addition of the Fellow followed a lengthy effort "to develop a curriculum of clinical, educational, and research activities related to integrative medicine for MDs, NDs, or DOs who have satisfactorily completed their residency program." She credits consultant Sheila Quinn, Bastyr University co-founder, co-editor of the Textbook of Functional Medicine, and Integrator adviser, for assembled the pieces and pulling the Fellowship together. Components of the include:

Two days a week in clinical care at integrative clinics. Clinical sites include the University of Kansas Medical Center and the Center for the Improvement of Human Functioning in Wichita, Kansas.
Two days in educational pursuits related to integrative medicine.
One day on research in integrative medicine. Fellows will help "build a library of case studies and teaching materials as well as providing feedback on the program at the end of the fellowship year.

Drisko figures that with these developments, the UK program, where she is the Riordan Endowed Professor of Orthomolecular Medicine, has earned some "bragging rights." I think so.

Integrative Medical Alliance and Tufts team for experiential education of conventional practitioners

The Integrative Medicine Alliance of New England is partnering with Tufts University's Medical School for a September 27, 2009 event in which the IMA will send its "mobile clinic" to Tufts to offer a smorgasboard of integrative services to conventional practitioners at the medical school. In early August, the IMA, one of the nation's most robust regional networks of integrative interests, sent a "Calling All CAM Practitioners" bulletin out to its list urging recipients to volunteer to participate in delivering the free care. "As you know," the notice stated, "the value of CAM practices is best learned experientially."

Keith Rafal, MD
Rhode Island integrative clinic focuses on "mind heals" approach

Keith Rafal, MD, has been in rehabilitative medicine for two decades. He began germinating his The Mind Heals Approach (sm) integrative practice strategy in recent years. In 2007, he hired a facilitator and convened a retreat of a diverse set of a dozen local providers to move his Healing Choices model into being. Rafal, the medical director of the Rehabilitation Hospital of Rhode Island, says that, while the full program is in place in his private practice, an integrative program for the treatment of fibromyalgia is in the hospital and "being integrated into a large regional program." Rafal's practitioner team includes doctors of acupuncture, massage therapists, psychotherapists, a Tai chi practitioner and a medical intuitive. He envisions rolling out the his service-marked approach into other facilities.

Employers

Pepsi, Pfizer and GSK join Pelletier's integrative initiative for employers

Kenneth Pelletier, PhD, MD (hc)
The employer-funded Corporate Health Improvement Program (CHIP) led by Kenneth R. Pelletier, PhD, MD (hc) has picked up 3 new member companies in recent month: Pepsi, Pfizer and GSK. (See Pelletier-Weil Program Has Major Employers Exploring Integrative Medicine Approaches, September 24, 2006.) In this phase of CHIP, employers are focusing on integrative medicine strategies. Here are brief summaries of the interests of these firms as part of CHIP.

Pepsi - Integrative Weight Management Pelletier notes that weight management is a major part of a new corporate-wide initiative on health promotion and disease management. The firm is working with Pelletier and University of Arizona professor Tim Lohman in developing an "internet plus exercise and diet intervention for weight management and improved fitness." Phoenix, the home of a 5000 employee Pepsi Bottling Group facility, will be the site of this pilot. Pelletier notes that Lohman is a nationally-recognized expert in developing health promotion interventions. Pelletier says the approach "will use an integrative medicine model with the inclusion of non western dietary and physical activity options."

Pfizer -"Behavioral Wraparound" Pelletier explains that increasingly, many major pharmaceutical companies are creating "behavioral wraparounds" for their pharmaceutical products. The goal, Pelletier adds, "is to increase appropriate use, compliance, and improved outcomes" through the integration of these approaches with pharmaceutical treatment. Pfizer is interested in working with major corporations to implement such interventions with clinical and cost outcomes. CHIP and Pfizer are working together to develop such behavioral programs with several Pfizer pharmaceuticals. The wraparound will use, says Pelletier, "an integrative medicine approach."

GSK (GlaxoSmithKline) - Education Chief Medical Officers (CMOs) This initiative has a broad but pointed focus. Chief Financial Officers (CFOs) will work with CMOs "to help the health and medical providers to understand the metrics, vocabulary, evidence based information, as well as the formatting of that information" which will make a convincing case. Pelletier notes that CMOs need this awareness "in making their health and medical recommendations to the senior management of their companies." Pelletier shares that an initial CHIP project funded by GSK and by Prudential, a long standing CHIP member, will be to hold a "CMO-CFO Summit" in early March 2009 at the Canyon Ranch Resort, Lenox, Massachusetts. A limited group of 7-8 invited companies will be involved. Pelletier anticipates that this "Summit" will be the first of a series with other companies added in future meetings.

A place to learn employer practices
Comment: The message, clearly, is learn to frame your value proposition in financial terms if you want to pass "Go." The message may be as necessary for integrative practice researchers and advocates everywhere. If getting the ear of those large corporations and government agencies that make buy decisions is of any interest to you, then maybe learning the language and strategies is critical. For those who want a look at the kind of information corporations may find most interesting about healthcare interventions, the October 15-17, 2008 conference of the Institute for Health and Productivity Management is a good bet. IHPM, an Integrator sponsor, will include presentations on the Work Limitations Questionnaire, as well as presentations from James Prochaska, PhD, a leader in exploring "readiness for change" instruments. Both are research tools many large employers find valuable, yet are rarely part of integrative health research.

This information chasm continues to separate integrative practice from major purchasers despite claims of integrative practitioners that some of their best value is both in functional outcomes and the kind of patient empowerment that these instruments capture. When will we awaken to the obvious? Credit Josephine Briggs, MD and the NIH National Center for Complementary and Alternative Medicine for sending senior researcher Richard Nahin, PhD, MPH to the meeting to speak and learn. (See Top 10 Reasons to Attend IHPM's Employer-Focused Conference, October 15-17, 2008, August 28, 2008, for more information.)

Professions

School as lender program protected

One of the small ways the federal government supports non-conventional healthcare education is through the school as lender program through which schools, acting as lenders to their students, make a margin off the service. For them, the margin is significant. This practice was at risk in Congress this year. The American Association of Naturopathic Physicians (AANP) was among as coalition of organizations that successfully sought to hold on to the practice. The AANP sent a notice to members on August 1, 2008, that the College Opportunity and Affordability Act of 2007, which just passed Congress, retained the school as lender program.

Research

Alexander Technique: Low-tech, patient empowernment technique gains research support in BMJ

Jean Louis Rodrigue, Alexander technique expert
Jean-Louis Rodrigue, a long time practitioner of Alexander Technique who has served score os of well-known actors and musicians in Hollywood and in Europe brought to my attention that the technique recently gained exceptional scientific support in alleviating back pain in a recent study in the British Medical Journal. The self-care, postural technique, when provided by registered Alexander Technique teachers, was found to be significantly more effective than regular care, more long-lasting than massage and best when couple with an exercise plan. Created by a Shakespearean actor at the end of the 19th century, the approach "teaches correct posture and is designed to align muscles in the head, neck and back" according to a Reuters report. The report received significant media coverage. Chalk one up for patient empowerment and the use of the least invasive force: teaching. Rodrigue has led efforts to create more stature and presence for the Alexander Technique field. Perhaps the research will give the adherents a boost.

Gordon's mind-body work with children in war-torn Kosovo shows positive outcomes

Integrative psychiatrist and former chair of the White House Commission on CAM Policy Jame Gordon, MD, is known to many for his passion in recent years for bringing integrative therapies to the Middle East and to war-torn Kosovo. I admit to having had some wonderment: We struggle for business models for integrative practice here and now you are off trotting around the world. On August 12, 2008, Gordon's Center for Mind-Body Medicine at Georgetown University sent out a release which provided research evidence of what he has been up to. Gordon's study, “Treatment of Posttraumatic Stress Disorder in Post-War Kosovar Adolescents Using Mind-Body Skills Groups: A Randomized Controlled Trial,” published today online in the Journal of Clinical Psychiatry, offered outcomes of "the first randomized controlled trial (RCT) ever of any intervention with war traumatized children."

James Gordon, MD - taking integrative care into war zones
The mind-body intervention, via groups, reportedly lowered levels of post-traumatic stress syndrome (PTSD) from 100% to 18% in children from areas of Kosovo where over 90% of all homes were flattened during the burning and bombing of 1999-2000. Says Gordon: “This model is educational, non-stigmatizing, and powerfully effective. It can be easily taught and can be used by people of all ages on their own,” Dr. Gordon explains. “It’s highly acceptable to populations which do not want to be given medication, those with no access to a doctor or therapist, and those who are in psychotherapy.” The report is an interesting companion to the work of the Samueli Institute on integrating mind-body and other integrative approaches into the military. (See From Research to Practice: Samueli Institute's Work on Integrative Medicine in the Military, August 7, 2008.) Notably, the CMBM release states that "the CMBM model is also of increasing interest to the US Department of Defense and the Veterans Administration."

Hematology/Oncology publication features a dozen integrative oncology articles

Moshe Frenkel, MD - co-editing a high-visibility integrative oncology publication
Researcher Moshe Frenkel, MD writes to "share the exciting news" that the August issue of Hematology/ Oncology Clinics of North America (Aug 2008) "is mostly dedicated to integrative medicine in oncology." Frenkel and Lorenzo Cohen, PhD, the co-editors of the issue, are both principals with the integrative medicine program of the MD Anderson Cancer The issue includes a dozen articles, including reviews of the potential roles of massage, acupuncture, mind-body therapies and dietary supplements. Among well-known authors are James Gordon, MD and Rachel Naomi Remen, MD. Says Frenkel: "We tried to include topics that we feel are important to this emerging field and not quite emphasized elsewhere." He says the issue exposes one to the "evidence, theories, research challenges, and philosophy of integrative oncology." The approach to integrative oncology is from a "bio-psychosocial-spiritual manner." The publication looks at "issues that relate to the ''physical body' and evidence based research and practice. This is followed by examination of the psyche and the social context in relationship to health and healing and ends with the spirit. Notes Frenkel: "We see this issue as a stimulus and a base for further discussion and research, and hope that it surprises (the reader) at times touches your heart."

Miscellaneous

Mandated vacation as a public health intervention
A note from dietary supplement industry maven Loren Israelson to his e-list reminds us of part of the reason we are so sick, as a people, in the United States. The legally required paid vacation in France is 30 days/year, in Sweden 25, in the UK 20 and in the United States it is zero. Nada. Zilch. It's time for a whole system study which takes the whole populations, mandates 4 weeks of paid vacation that looks at the effects on health status in the United States. Israelson's data are from the Center for Economic Policy Research, May 2007 ... The Journal of Acupuncture and Meridian Studies is calling for submissions for their next journal ... Bethany Hayes, MD, director of the not-for-profit True North integrative center in Maine, notes that the clinic "is always looking for like minded practitioners with similar philosophies to join the group." A good time to check it out might be the True North conference October 15-18, 2008, "Relationship: Integrating the Science and Spirit of Healing." Autumn's brilliance may still be hanging on the trees in Maine ...

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