Summary: Top NCCAM-funded researcher Berman founds Institute for Integrative Health ... Walsh''s examination of inclusion (or not) of CAM/integrative practitioners in US House healthcare reform bill ... Economist/researcher Herman reports 9 therapies/21 conditions where use of CAM is shown to be cost saving ... Response to Integrator from NCCAM director Briggs shares reasons for 10th anniversary symposium theme, coming priorities ... Janet Polli selected as first executive director of the Consortium of Academic Health Centers for Integrative Medicine ... Key AOM researcher Hammerschlag retires ... Guiltinan selected to chair naturopathic medicine at Bastyr University ... Center for Integrative Medicine in the Public Health forges relationships with network of 13 clinics to provide integrative services to the underserved ... Chiropractic professional forge links between the American Public Health Association and US Bone and Joint Decade ... Inner Harmony Wellness Center selected University of Arizona Center for Integrative Medicine fellow Phaythoune Chothmounethinh, MD as medical director ... AMA''s Scope of Practice Partnership targets 30 ND, DC, LAc and certified professional midwife scope expansion legislative initiatives in 2009 ... Naturopathic physicians report legislative gains in HI, OR, WA, CT, NH, VT and elsewhere ... MD starting salaries: Are they part of the problem in the health of the nation? ... Chiropractic organization raises $1-million for autumn ad campaign to promote the role of DCs in health reform ... Huffington Post selects Dean Ornish, MD as its medical editoror ... Author and integrative medicine policy enthusiast Dana Ullman, MPH shares letter exchange with Washington Post writer regarding coverage of anti-NCCAM story ...

Policy

Brian Berman, MD: Institute for Integrative Health founder

Brian Berman''s new Institute for Integrative Health seeks to "reframe the conversation"

I have been remiss in not reporting the public existence of the Institute for Integrative Health as a new part of the integrative practice landscape. Formally announced in May 2009, the Institute, founded by Brian Berman, MD, Susan Hartnoll Berman, and a team which includes Georgetown integrative medicine leader Aviad (Adi) Haramati, PhD and former deputy director of NCCAM Margaret Chesney, MD (see bios of all here), states on its homepage that it is a 501c3 organization that "provides an environment for innovative thinking on health and healthcare, fosters collaborations, and facilitates the testing and implementation of novel solutions." The Institute plans to "challenge conventional thinking on health and healthcare, reframing the conversation, nurturing creative solutions, and exploring cutting-edge ideas."

Comment:  The Institute team is one of the most potent one could aggregate in the integrative education, research and practice arena. Berman is likely the most funded of NCCAM researchers, with over $30-million in awards; Haramati has been, among other things, a key force in knitting conventional educators and researchers into dialogue with diverse colleagues from other licensed disciplines; Chesney earned tremendous respect during her stint as, effectively, NCCAM director when her nominal boss, Stephen Strauss, MD, was dying of brain cancer; and Susan H. Berman is known to those who know her as a force in her own right. It speaks well of them that they have affiliated influential acupuncture researcher Richard Hammerschlag, PhD (see Academic Organizations/Personnel, this Round-up issue) as one of their network scholars. Notice the choice in language for a director of the Center for Integrative Medicine and the University of Maryland: integrative health. They explain: "There is a unique opportunity at this point in time to improve our healthcare system through an integrative approach that values mind, body, and spirit and blends complementary and conventional medicine." I am excited to see what this group will accomplish in our transit toward health creation.

Work yet to be done on the House side

Has the US House included licensed CAM or integrative practitioners in health reform? An examination comes up empty

Comment:  US Senator Bernie Sanders (Independent-Vermont) credited IHPC''s work in educating committee members for gaining inclusion on the Senate side. Looks like the IHPC and others have a good deal of work ahead on the House side. Thanks for this clarity, if disquieting, Taylor. We promise not to shoot the messenger.

Research

Patricia Herman, ND, MS, PhD - economist, researcher, practitioner

Economist researcher Herman finds 9 approaches/21 conditions for cost-savings from CAM

Comment:  It is a shame that just 0.007 of the 6600 studies have high quality economic data. Friends, we are guaranteeing that integration will happen glacially. This allows most insurers to deny that appropriate integration of "CAM" will lead to cost savings, citing lack of evidence. Herman''s exhaustive review, akin to finding needles in a haystack, is filling a huge gap for the field. Hers is perhaps the most critically needed and valuable CAM research today - other than that of those researchers who have the street smarts to ask economic questions - if we really want to change the services to which consumers have access. Herman''s database will be a resource for all of us going forward.

Josephine Briggs, MD offers clarity on NCCAM directions

NCCAM Director Josephine Briggs, MD shares priorities for 10th anniversary celebration, perspectives on "real world outcomes" and researching pain conditions 

Comment: Briggs tenure as NCCAM director has been marked by a strong commitment to connecting with the communities of interest to NCCAM. Her letter of response, despite an oppositional stance in my queries and an editorial line in the Integrator that doesn''t always agree with NCCAM''s priorities, continues this welcome pattern of engagement. The more important reality at this time is that NCCAM is beginning the process of setting its next 5 year strategic plan. This is where commitment to real world outcomes - such examinations which will give Herman more fodder in her cost comparison research (see related article this Round up) - needs to be prioritized.

Janet Polli - first Consortium executive director

Comment:  I doubly welcome Polli into this integrative education and practice landscape, both as Integrator publisher-editor and as her counter-part in my other chief professional role as executive director of the Academic Consortium for Complementary and Alternative Health Care. Here''s to future collaboration, Janet! And good work, Vic (an Integrator adviser) in helping move CAHCIM to this key point.

Richard Hammerschlag, PhD

Influential AOM researcher Hammerschlag retires from Oregon College of Oriental Medicine

Influential a

Comment: Hammerschlag is a rare combination of practical scientific thinking in a rarefied context, and grounded, realistic political strategist. I had a chance to work with him some in his ACCAHC position and we''re hoping to hold onto a sliver of him as he makes this transition.

Jane Guiltinan, ND - key role at Bastyr

Bastyr University chooses Jane Guiltinan, ND as new dean naturopathic medicine

One of the modern naturopathic profession''s most accomplished leaders, Jane Guiltinan, ND, has been selected to head up naturopathic medicine at Bastyr University, the Bothell, Washington-based institution which began as a naturopathic medical school. Guiltinan''s resume includes serving in the late 1980s as

Comment: I view Guiltinan''s appointment as a healing move by the institution, which has struggled, like the handful of other universities of natural health sciences, with breaking it solo commitment to a single profession, in Bastyr''s case, naturopathic medicine, as it embraced education in other disciplines and the responsibilities and possibilities from being a multi-purpose institution. Many of Bastyr''s earlier naturopathic graduates wanted to see a connection with its history and founders and Guiltinan, on top of her extensive qualification, brings that richness to her position.

Public Health

New public health/integrative medicine initiative

Center for Integrative Medicine in the Public Health forges relationship with 13 community health clinics for integrative medicine residency program

Liz Kaltman, MPH announced on August 13, 2009 the opening of the website of the not-for-profit Center for

Linked to another multidisciplinary effort by chiropractic group

Chiropractic Health Section brokers relationship between American Public Health Association and "US Bone and Joint Decade"

Integrative Clinics

Phaythoune Chothmounethinh, MD

Inner Harmony Group brings in U Arizona Fellow Shay as medical director

Professions/Guild Politics

Campaign seeks to shut doors to other professions

AMA''s Scope of Practice Partnership targets 30 legislative issues of DCs, NDs, LAcs and certified professional midwives in 2009

The American Medical Association''s Scope of Practice Partnership (AMA-SOPP) campaign, through which the medical association is monitoring and typically fighting against scope expansions by non MDs, has its hands full. A chart from the AMA lists 154 separate legislative campaigns for practice expansion in 2009 from professions ranging from psychologists, advance practice nurses and optometrists to naturopathic doctors and chiropractors and other "CAM" disciplines.

Comment: The AMA has never shown any real threat to the public from the practitioners they are seeking to restrict. The combination of the significant financial benefits from being in the MD guild (see table under "Factoids to ponder: Salaries of conventional physicians in 2007, from JAMA," in this Round-up) and these campaigns casts the MD guild in an ugly light in which the concept of a service industry is thoroughly transformed into one meant for self-service. (For the list of 6 prior Integrator articles on the AMA-SOPP, click here and scan down.) 

Michael Traub, ND - leading the ND''s scope expansion effort in Hawaii

Naturopathic physicians share legislative advances in Hawaii, Oregon, Washington, Vermont and elsewhere

• Oregon Under the leadership of the Oregon Naturopathic Physicians Association, the NDs broadened their formulary and "can now prescribe almost anything," according to Kevin Wilson, ND. He adds: "We don''t want to be MDs but we now can be more full-fledged primary care physicians."
  
• Hawaii Significant upgrade of a 1925 law which expands the scope of practice for naturopathic physicians regarding parenteral therapy, (prescription drug) formulary, and minor surgery. The new licensing statute, according to Michael Traub, ND, "is based on modern  laws in Washington, Oregon and Montana." Passage required an override of a gubernatorial veto in July.
• Vermont  Lorilee Schoenbeck, ND reports that following changes in 2005, 2006 and an insurance mandate in 2007, naturopathic doctors are now covered as primary care providers and at the same rate as medical doctors by insurers. This is the first state where naturopathic doctors are fully recognized as providers under a Medicaid plan.
• California   The state''s budget pressures led to consolidation of various agencies, including moving the bureau which was charged with regulating NDs under the osteopathic licensing board. The naturopathic doctors will now have 2 representatives on that board. Work is continuing on clarifying the profession''s prescriptive authority.
• New Hampshire   NDs had been left out of a general law regarding all provider types with prescriptive authority; that the state''s licensed naturopathic doctors have been re-inserted.
  
• Connecticut  Passed a minor statute to amend an outdated 1922 act (like that which had been in place in Hawaii) relative to adding continuing education hours. This is a step toward an effort for thorough modernization such as was completed by NDs in Hawaii this year.
  

Comment:  These advances, many of them in gaining or expanding prescriptive authority, came despite opposition to naturopathic physician scope expansion from the American Medical Associations Scope of Practice Partnership (AMA SOPP). However, according to the AMA SOPP list, some of these efforts appear to have been under the AMA radar. In addition, notably, the members of the AANP House of Delegates did not hear about any expansion of licensure into any new states, a priority of the AANP against which the AMA is fighting in at least 10 states. It appears from the success in expansion of scope by naturopathic doctors once licensed, that once these physicians are a known and legal part of the landscape, their respect and political clout builds. Legislators are comfortable in giving them more practice rights. As Simon Barker, ND, the vice president of the California Naturopathic Doctors Association joked in his comments to the AANP''s general membership: "We''re like puppy dogs. It''s really hard not to like naturopathic doctors." The AMA''s effort to slam the door of entry to NDs may be its best strategy for keeping out this competition.

Is income envy a factor in integration?

Factoids to ponder: Salaries of conventional medical doctors in 2007, from JAMA

Medicine is a service profession. From the perspective of most human beings, being an MD specialist, in particular, is also a most lucrative way to be in service to your fellow humans. Integrator adviser Michael Levin recently sent me this list from JAMA, with the simple heading, "a factoid to ponder."

Comment: There is always a good deal of argument about these kinds of listings, typically from medical doctors who claim the averages are too high. Never-the-less, they and the reality they attempt to describe are cause for pondering. For instance, these data stimulate a good deal of income-envy in many non-MD practitioners. For instance #2, one may recall that corporate law is also a service profession. A real question is why these salaries are basically off the table in the current healthcare reform debate. Once one moves north of general medicine, it''s a hell of a lot of money and reflects the income inequities that are part of what is imbalanced in our culture.

Comment: Okay, the only nominally "CAM" profession that routinely touches the salary levels reported in the JAMA article noted in this Round-up is chiropractic, thus generating the financial base for a campaign like this. Give the chiropractic profession and their state associations credit for pulling this off through their monthly commitments. A side note: I have to chuckle with the use of the "AMI study" given the reluctance of much of the chiropractic profession to embrace the broad-scope chiropractic medicine model of chiropractic taught at National University of Health Sciences which partnered with AMI (a.k.a. Integrator sponsor Alternative Medicine Integration Group) to create the pilot. It was that minority view, promoted by NUHS president, AMI board member and sometimes Integrator commentator James Winterstein, DC, which allowed these chiropractic graduates to serve as AMI''s primary care physicians. (For Winterstein''s view, see Can Chiropractic Be "Integrative Medicine?" A Patient Survey and a University President Weigh In, August 26, 2008.)

Dean Ornish, MD - medical editor for Huffington Post

Huffington Post selects Dean Ornish, MD as its medical editor

On August 10, 2009, the Huffington Post announced that it had selected Dean Ornish, MD as the online publication''s medical editor. Huffington Post is one of the most significant online publications, most read by the left/progressive side of the political spectrum.

Comment: This may be the first for a very influential medium to have an integrative medicine doctor as their lead health writer. Do we see anything parallel on the conservative side of the blogging/news world?

Dana Ullman, MPH

Stuck in the middle with you: Dana Ullman''s dialogue with the Washington Post a useful lesson

Homeopathic historian, writer and practitioner Dana Ullman, MPH shared with the Integrator an interesting letter exchange with Washington Post writer David Brown which casts light on the media''s role in the sometimes heated battle over the future of NCCAM, given the polarized perspectives in the broader culture. At issue was Brown''s coverage of a campaign by anti-CAM skeptics to get the Obama administration to defund the NIH National Center for Complementary and Alternative Medicine. Brown''s article was titled "Critics Object to ''Pseudoscience Center.''" Ullman started out with an email to Brown, the subject line of which was: "

Ullman:  "It is strange that you choose to give a voice to a small group of ''fundamentalist'' physicians who are antagonistic to anything other than conventional drug treatment.  Steven Novella''s website and blog spews venom against virtually every alternative treatment, while rarely raising a word to the questionably effective mainstream drugs.  This website typically ignores reference to any of the many good clinical or basic science studies show that benefit from the various alternative treatments, while they parade any negative study as it was the end-all for ''alternative medicine.''

"And it is even more strange that you choose to have a naturopathic physician be your sole source of defense of the National Center for Alternative and Complementary Medicine. Although this naturopath is certainly a respected one, you could have quoted from any of the 100 or so professors of medicine at recently attended the Institute of Medicine''s Summit on Integrative Medicine, but no, you purposefully chose not to do so. 

"Actually, this is not strange at all IF you have an axe to grind and IF you want to show your own journalistic biases.

"A recent report from the Institute of Medicine reported that one-third of Americans today take FIVE or more conventional drugs. Please show me ONE study that shows the efficacy of treatment of using five drugs concurrently.  If you were sincerely interested in ''science-based medicine,'' you would be writing very different stories than your recent one.

"Today''s medicine is tomorrow''s quackery...and today''s quackery is tomorrow''s medicine. This is not a prediction; this is the evolution of medicine.

"Attached is a ''Report on the Historic Summit on Integrative Medicine'' that was sponsored by the Institute of Medicine.  You would think that you would give a voice to the Institute of Medicine rather than a fringe group of disgruntled doctors."

Dana Ullman, MPH
Homeopathic Educational Services
2124 Kittredge St.
Berkeley, CA.  94704
http://www.homeopathic.com

Brown: "Thanks for your message and sorry you didn''t like the story.  As you can imagine, there was a limited amount of space in which to describe the debate and try to be fair to both sides. I quoted [US Senator]Harkin and [researcher Carlo] Calabrese on the pro-NCCAM side and Salzberg and [Steven] Novella on the con side, and [NCCAM director] Josephine Briggs in the middle.  I''ve gotten critical e-mail from the NCCAM opponents, so I couldn''t have been too far off."

Best,
 
David Brown        
National Staff            
The Washington Post

Comment: In Brown''s accounting, nominally "objective" journalism, like politics, is a necessary compromise where you know you are successful when no one is fully pleased. Of course, the other phrase about the making of legislation is that it is like making sausage. Not at all pretty. By the way, Ullman''s report on the IOM is among the best. It was recently published by Oxford University Press here in the E-CAM Journal.

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