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Medicial Mistakes?
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| | Eight Views on Andrew Weil's Seven Recommendations for True Healthcare Reform: Major ND Response | |
Summary: The call for responses to Andrew Weil's recommendations for true healthcare reform brought the most response from the naturopathic medical community, plus a mix of others. Author and AANP president Lise Alschuler, ND, FABNO commends Weil for his "revolutionary" recommendations, and underscores the importance of gathering outcomes data. Integrative health leader Pamela Snider, ND urges Weil to go further and points some useful directions, including interesting references suggesting cost savings. Holistic medicine leader Bill Manahan, MD suggests changes in consciousness as central to the 8 "transitions" he recommends. Thaddeus Jacobs, ND, LAc and Pamela Frank, BSc, ND urge more inclusion. Health coach educator Linda Bark, PhD, RN likes the ideas, but wonders how they will take off if we don't work together. True North executive director Tom Dahlborg explores what might happen if we viewed healthcare not as a right but as an obligation, Finally, reader Mary Klifman wonders if we will get anywhere with any of Weil's recommendations without "corruption reform."
The publication in the Integrator of the 'Health Care Call for Action" from author-educator Andrew Weil, MD, generated a strong set of responses from clinicians and leaders associated with the naturopathic medical profession, and a sprinkling of other views. Most, as you will see, find Weil's recommendations solid, even "revolutionary," but still not going far enough. A key issue regards inclusion.
 Lise Alschuler, ND, FABNO
Lise Alschuler, ND, FABNO, the president of the American Association of Naturopathic Physicians (AANP) and author of a significant book on integrative approaches to cancer treatment, views Weil's comments as "revolutionary." She also urges an 8th recommendation to go with Weil's seven.
"While I have not yet read the
entire book (on my weekend reading list), from the Integrator summary, Dr.
Weil’s Health Care Call to Action is compelling, on target and, if fully
adopted, revolutionary. The underlying theme of his call of individual
responsibility for prevention and health promotion is fundamental. Any
lasting health care reform must be based upon investment in personal
responsibility.
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"Dr.
Weil’s Health Care
Call to Action is compelling,
on target and, if fully
adopted, revolutionary."
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"This being said, it is my contention that for health care
reform to be long-lasting, every effort must be made to capture outcomes data
on preventive and health promotion programs and behaviors. The Offices that Dr.
Weil proposes would be well served to include a comprehensive outcomes data
collection program that is inclusive of the cost and clinical effectiveness
from diverse applications of integrative and preventive healthcare.
"I
would perhaps add an 8th point to Dr. Weil’s seven: 8. Use Federal
programs to make wellness financially sound. Incentivize corporations by
revision of the federal tax code to include tax incentives for those
corporations meeting established benchmarks of health prevention and promotion
behaviors. Furthermore, significantly increase Federal tax on cigarettes,
alcohol, refined and processed ‘junk’ food. The dollar speaks most strongly and
to transform the health of this country, financial incentives must be applied.
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"For health care
reform to be
long-lasting, every effort must
be made to capture outcomes
data
on preventive and health
promotion programs
and behaviors."
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"During the May 2009 federal
lobby day, naturopathic physicians lobbying for health promotion and
prevention-based healthcare reform encountered almost universal acceptance of
the philosophical basis to a holistic and integrative approach to health care.
Any resistance encountered came from either allegiance to the current vested
powers (i.e. big pharmacy) or from concerns about how to fund such broad
sweeping change. In either case, a part of the healthcare solution must be
based upon a firm commitment on the part of our government to investing in wellness
and to insinuating health promotion into every aspect of healthcare.
Until this becomes the resolve of Congress, true healthcare reform
will be inadequate at best and inconsequential at worst."
Lise Alschuler, ND, FABNO
President, American Association of Naturopathic Physicians
Naturopathic Specialists
Scottsdale, Arizona
Comment: Alschuler focuses on the importance of gathering outcomes, as does the subsequent writer, Pamela Snider, ND, also a leader in Alschuler's profession. Her focus on the promotion of wellness was taken up by the AANP in a multidisciplinary campaign in 2008 to elevate these issues in Congress, highlighted last year in the Integrator Top 10. Notably, Alschuler is the only one of the commentators from the naturopathic profession who does not urge Weil to better value, in a health creation agenda, the use of naturopathic physicians or other licensed CAM practitioners.
 Pamela Snider, ND
Pamela Snider, ND
has been one of the top thinkers, strategists and organizers in the
naturopathic medical and broader integrative practice arenas. An Integrator adviser, Snider currently works primarily as the executive editor of the Foundations of Naturopathic Medicine Project.
"I like Weil's recommendations for setting up the National Institute of Health and Healing and the Office
of Health Promotion. I support his push for teaching integrative medicine at medical schools. In
fact, all are excellent and useful recommendations. I appreciate Weil’s vision
of health creation.
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"I support Weil's push for teaching
integrative medicine at medical
schools. In
fact, all are excellent
and useful recommendations.
I appreciate Weil’s vision
of health creation."
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"But just like the turf issues recognized in Weil’s big
pharma recommendation, Weil’s recommendations tend to be biomedicine centric.
They stop short of real reform. How can biomedicine do this alone and with any
real alacrity? This is a continuing problem. I wonder why he is silent on the
issue of the CAM licensed workforce. This national treasure of well trained
providers, eager workers, and new practices in prevention, healing and health
promotion is at the nation’s fingertips. Can IM and the CAM disciplines finally
get past this obvious turf stuff and get down to the real issues of bringing every
solution available to the table to tackle the nation’s ills?
"The evidence on cost implications is intriguing. In one of William Lafferty’s studies of CAM coverage in WA State, the CAM workforce did not appear to have cost the system
extra and may have saved significantly. Lafferty concluded:
“ A substantial number of insured cancer patients will use alternative
providers if they are given the choice. The cost of this treatment is modest
compared with conventional care charges. For individuals with cancer, CAM
providers do not appear to be replacing conventional providers but instead
are integrated into overall care. Cancer 2004;100:1522-30. © 2004 American
Cancer Society.”
This was affirmed in a report by Blue
Shield of Washington, now Regence, where cost savings were also suggested.
“There is significant potential to control costs with
alternative health care. There is mounting evidence that practitioners of
alternative therapies can be highly cost effective relative to conventional
providers at treating several increasingly pervasive chronic and stress related
conditions (savings of 30% and more have been found in recent European outcomes
studies), such as heart disease, chronic pain, respiratory illness, diabetes,
arthritis, GI problems and substance abuse, etc which are major cost drivers in
the health care system and for which conventional medicine has few cost
effective treatments.” Phase One
Final Report. Alternative Health Care Project Steering Committee. Geoffrey C.
Henny. Executive Summary-Opportunities. August 5, 1995. Page ii. King County Medical Blue Shield, now Regence.
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"I wonder why Weil is silent
on the
issue of the CAM licensed
workforce. Real reform must get
beyond turf issues and bring all
qualified
providers to the table."
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"Real reform must get beyond turf issues and bring all qualified
providers to the table. Here's my list of reform directions, which overlaps significantly with Weil's:
- Bring integrative medicine training to all medical
schools.
- Build bridge programs between the biomedical, public health and
nursing colleges and CAM accredited colleges.
- Create federal programs to train
many more CAM and conventional providers in public and community health.
- Mandate use of/inclusion of the licensed CAM disciplines in mainstream health
care delivery and all federal health care programs.
- Do outcomes studies on
whole practices of these fields and find out where comparative effectiveness
emerges. This strategy is faster than clinical trials on therapies for symptoms
and diseases.
- To foster innovative change in the health care workforce,
establish an office of emerging health professions. This office could assess
readiness, monitor development accredit and assist accountable integration of
new disciplines, practices and well trained providers rapidly into
mainstream health care delivery systems, such as homeopathic medicine, yoga
therapy, Ayurveda, Tibetan medicine (all a wealth of accountable practices in
health promotion). Imagine the $$ that would be saved on state licensing
battles, and campaigns for federal recognition!
"Finally, overarching all this, and I think this is also aligned with Dr. Weil's recommendations, change the financial therapeutic order of the nation.
- Prioritize federal, state and payer financing for health promotion, wellness
and prevention in specific ways to leverage and incentivize the workforce to do
that work.
- Pay qualified providers (integrative medicine, biomedical, CAM, nursing, public
health, allied health, others) adequately for the work of supporting individuals in behavior change.
- In
the case of public and community health, increase the budget and expected
outcomes for that budget to focus on impacting socioeconomic and
environmental health factors, system wide.
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"Finally, overarching all this,
and I think this is also aligned
with Dr. Weil's recommendations,
change the financial therapeutic
order of the nation."
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"Until providers
have an incentive (reimbursement by payers, federal and state programs that
prioritize this financing) to do health promotion, adverse selection of
providers to high paying specialty and surgical professions will draw the
workforce away from the day to day work of primary care,
health promotion, prevention and wellness on the front lines of health care.
Yes, we must prioritize federal and state program financing of health
promotion, as Weil suggests. But how about if, in the CPT Manual, change the statement that reads “providers may be
paid for behavioral change” to “providers shall be paid for behavioral
change” (italics added). This stroke of the pen creates a system wide mandate for payers to pay for the
work that needs to be done to make an impact on our nation's health.
"I support Dr. Weil’s recommendations. Let’s take them
further and get this done."
Comment: Weil has a fascinating resume relative to the licensed CAM practitioners. He can infuriate these providers by leaving them out, as he does in his recommendations. Snider notes this, as do two writers below. But Weil has also gone to bat for them repeatedly, in legislative efforts (see the video here) and recently by a significant personal contribution to support a meeting of CAM educators. Interestingly, Snider profession of naturopathic medicine - also the profession of the two commentators below - is one for which he has particularly strongly advocated. Politically, I could see how Weil might not want to allow those who can't stomach "CAM" to dismiss the rest of his argument by an association with these fields, has he directly included them. My guess is that, when it comes to substance, Weil would be significantly aligned with a good deal of what Snider recommends.
 Bill Manahan, MD
Bill Manahan, MD's professional work includes decades as a clinical professor of family medicine at the Medical School at the University of Minnesota and concurrent decades in the leadership of the movement toward holistic medicine in the United States. He reminds us of the need for a shift in consciousness to both create and inform the structural and policy changes.
"Thank you for bringing to our attention Andy Weil's seven recommendations. I had not yet heard about them.
"I believe that all seven of Andy's suggestions are good ones that
would somewhat improve our present system. They are fairly practical and
quite possible to begin to accomplish.
"At the same time, I personally believe that the changes needed in the
American healthcare system go much deeper than those seven ideas of Dr.
Weil. I suspect that we need a cultural shift; a change in consciousness;
a different way to view the world and our place in it.
"I have proposed eight shifts or transitions I beleive are necessary
for us to truly have significant changes in our health and healthcare
system. I have attached them. In fact, I believe you published them
in the Integrator Blog earlier this year. So, even though my
ideas are 6 or 8 months old, I think they are still quite relevant."
Bill Manahan, MD
Minneapolis, Minnesota
Comment: The Integrator did publish Manahan's 8 "transitions" for revisioning healthcare in 2009 which you can access by clicking here. Manahan's holistic, focused, energetic approach dovetails nicely with Snider's call, including as he does a transition "from focusing on individual health to also focusing on community health" and #8, "from single
causality to an understanding and acceptance of the multiple causality of
disease." Snider suggests we embrace this in our research models and Weil's move to have an Office of Health at the NIH will necessarily raise these issues. I also like Manahan's #5, this practical bit of energy medicine: "The transition from unrealistic expectations of the medical system to more realistic expectations of the medical system." I do think that means "realistic expectations" and not "pessimistic projections."
 Thaddeus Jacobs, ND, LAc
Thaddeus Jacobs, ND, LAc is a
licensed naturopathic physician and acupuncturist practicing in Santa Barbara,
California and Park City, Utah. He is
co-author of Interactions Between Drugs and Natural Medicines:
What Every Doctor Must Know and is a chapter contributor on naturopathic oncology for the Foundations of Naturopathic
Medicine (Elsevier, 2010) text for which Snider, above, is executive editor.
"Before I go off on my comment about Dr. Weil's 7 challenges
to our healthcare system, I'd like to thank Dr. Weeks for creating such a vital
and informative medium. I believe the efforts Dr. Weeks extends to our
vast web-savvy community truly contribute greatly to the much needed
health care reform efforts.
"Our current health care system, which we often refer to as 'conventional medicine,' has been for a long time defined by high
cost medications and gadgets. While it is essential that we continue our
search for answers to the many existing health issues physicians and surgeons
deal with every day, we are often too hasty in using new, expensive drug
therapies and technologies.
"This brings us to the issue of Big Pharma's influence on
medical education both in the classroom and continuing education venues. Bringing health-promoting diet and lifestyle education into the intense
academic and continuing education requirements doctors medical students face
will require a monumental paradigm shift. I agree with Dr. Weil that this
must take place for the sake of our nation's health; either that or a ban or
heavy tax on unhealthy products in our food supply.
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"I struggle with the logic
behind creating the
NIH Office
of Healing within the NIH and,
for the same reasons, an
Office of Health
Promotion
within the US Department of
Health and Human Services.
Shouldn't health care be about
healing in the first place?"
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"I also agree with a ban on direct-to-consumer marketing and
advertising by Big Pharma, but I struggle with the logic behind creating the
NIH Office of Healing within the NIH and, for the same reasons, an Office of Health
Promotion within the US Department of Health and Human Services.
Shouldn't health care be about healing in the first place? We should
rather re-focus on what it is to heal, starting first with understanding
the etymology of the word, "heal." It means 'whole' or 'being
whole' or 'uninjured'. Drugs and surgery don't make us whole. They
may be necessary at times, but there are fundamental health-promoting diet and
lifestyle factors that should be adhered-to, regardless of whether or not we
employ the advanced medical treatments available to us. There also are
therapies that facilitate normal healthy bodily functions, even though these
therapies may not be a specific treatment for a particular disease or ailment.
"I've always been a proponent of revamping health education
in our schools. Like Big Pharma, the food industry needs to stay out of
our school cafeterias. Nutrition education materials used in
classrooms should also be science-based, not industry hear-say. It is
important for us to make good choices and learn how to care for ourselves,
which is Dr. Weil's seventh recommendation. It is hard to make good choices
when industry propaganda relentlessly tells us to 'eat this food' or 'take that
drug.' Bottom line: educated doctors and an educated public are key.
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"Provider inclusion is
essential. How about including
in the health care reform
mandates the types of
providers who already offer
the type of health care
Dr.
Weil professes?"
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"Also, how about including in the health care reform
mandates the types of providers who already offer the type of health care Dr.
Weil professes? Dr. Weil gives a prime example of such providers,
naturopathic physicians, on his website.
As a naturopathic physician, myself, I enjoy the collaborating with my MD
counterparts to offer my patients the best of what both 'conventional medicine'
and naturopathic medicine have to offer. Naturopathic medicine is
essentially integrative medicine plus wellness-oriented care.
"Provider inclusion is essential, for we can't wait around
for the established system of education and health care delivery to
change. There are too many lines of resistance against the movement Dr.
Weil, myself and many others call for."
Thad Jacobs, ND, LAc
Santa Barbara Center for Natural Medicine
Comment: No one has ever attempted to precisely create the Venn Diagram of how and where "integrative medicine" and "naturopathic medicine" and "functional medicine" overlap. (See my call for clarity in this area in a review of the Institute for Functional Medicine's recent 21st Century Medicine.) I can say, on behalf of many of my MD colleagues in integrative medicine that their view of IM practice also includes "wellness-oriented care." I like, in principal, Jacobs' wish that we could start with the meaning of "to heal," and build the system back up from scratch. Perhaps it's what we need. For the time being, securing the two governmental centers Weil proposes would be an exceptional start.
(Meantime, I let Jacobs' use of "Dr. Weeks" stand in the first paragraph as I was, in 1991, granted an honorary doctorate by Bastyr University and this past June, while playing a role in Bastyr's graduation ceremonies, I was gowned as a graduate of their doctoral program in naturopathic medicine. Rather enjoyed that. Don't worry: I haven't opened a clinical practice.)
 Pamela Frank, BSc, ND
Toronto-based Pamela Frank, BSc, ND
describes herself as a natural healthcare specialist with a focus on natural treatment of women's health issues.
"I think Dr. Weil is generally very well spoken and has
covered most of the bases. However, I think it's unrealistic to create a breed
of MD's who are 'as knowledgeable about promoting health practices
that their patients can adopt to prevent serious, chronic diseases as they are
about disease management and crisis intervention.'
"There is only so much knowledge one person can be
sufficiently well versed in to be a good doctor. This is what naturopathic doctors are
for. There are already doctors who are promoting
health practices, they're called ND's and they are experts in prevention of
serious, chronic diseases and use of gentle, natural therapies to reverse
existing conditions, often permanently.
What needs to happen is greater licensing and recognition of ND's and
more integration of them into the current health care system, both in the US
and here in Canada. Don't try to water
down naturopathic medicine and teach it to MD's, it will only lose something in
the process."
Pamela Frank, BSc, ND
Forces of Nature Naturopathic Clinic
Toronto ON
Comment: While I respect Frank's point about the distinct clinical value that comes from a naturopathic physician's commitment to 4 years of post-graduate training in integrative practices, I find the argument faulty in its view of the potential, near-term, contribution from increased inclusion of naturopathic physicians. Last count put the total number of licensed NDs in North America at 4,500. There are over 700,000 medical doctors and some 16,000 new ones each year. Naturopathic doctors, driven by a health-creating mission, rather than their own guild interests, must resoundingly embrace Weil's recommendation #4 which is to "teach health
promotion and integrative medicine at medical schools and residency programs." In fact, I think it a good possibility, from the guild perspective, that respect for the potential contribution of the profession of Frank, Jacobs, Snider and Alschuler will most quickly advance the more MDs have, as Weil urges and Alschuler and Snider directly support, integrative components in their medical education.
 Linda Bark, PhD, RN, MCC
Linda Bark, PhD, RN, MCC is the owner-operator of AsOne Coaching Institute. She last commented on cost savings from coaching in this October 2008 Integrator article.
"My overall impression is that these are all good ideas but what is
distressingly to me in the big picture is coordination among the healing
professions. That means everyone: the NDs, Chiropractors, Nutritionists,
Coaches, Nurses, Chinese Traditional Medicine practitioners, the Ayurveda
practitioners, MDs to name a few. Honestly, there is enough for
everyone. We have an entire country and planet to heal! We all have a part. The
field as a whole is going no where unless we join together.
"I want to applaud
the ND association [AANP] who held their annual legislative training in DC last spring
and invited other organizations to attend. It was a rich, practical training
and all benefited. How can we do more of that? Where is the integrative voice
and action for the integrative industry? I don’t know about it except for
you, John, and your sponsors who are doing your part. Please let me know about
others who are coming together and working collaboratively. We just need more
and we need it now."
Linda Bark PhD, RN, MCC
Comment: Ummm ... change is slow! I had good laughs on the phone today, under my ACCAHC executive director hat, about how easy it is for me, in my home office, staring out across Puget Sound and the southern tip of the Olympic Mountains, to call for change, and how hard it was for my colleague, inside a multidisciplinary educational institution to push that stone of change up the hill against the repeated waves of reaction from colleagues, from administrators, from accreditors, from state regulators, from federal officials and from the exhaustion of being continuously over-burdened and not that well compensated. That said, here are a couple good signs around. Inside just one discipline, acupuncture and Oriental medicine, all of the leading national associations have finally begun meeting regularly, a couple times a year. This is a good step. The Natural Medicine Journal is beginning to emerge as a potential meeting ground of ideas. (This effort was also organized in partnership with the AANP, and now includes many others. Third, the February 25-27, 2010 Integrative Practitioner Symposium will once again feature two policy panels, one of which will include executives or board members from 8 leading national organizations. I mention also the inclusive efforts of the Consortium of Academic Health Centers for Integrative Medicine, for which Weil was a founder, in the content of the North American Research Conference last May. Finally, there are rumors emerging of some major, multidisciplinary national gatherings in 2011. We'll see. Meantime - and I know you know this, Linda- we must make sure we each have your own happy views to get us through how frustratingly slow all this is!
 Tom Dahlborg, True North executive director
Tom Dahlborg is the executive director for one of the nation's top integrative centers, the True North, in Falmouth, Maine. The clinic's "democratic model of integration" was featured in this Integrator article. Here Dahlborg sends, for re-publication, an article he wrote for the clinic's newsletter.
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