Integrative Medicine and Integrated Health Care Round-up #42: April 2011

Summary: Obama appoints U Arizona IM fellow Sharon Van Horn to key prevention panel ... Brian Berman, MD and Jane Guiltinan, ND to join NCCAM Advisory Council ... Weeks' powerpoint on 2010 policy and cost developments available via Integrative Healthcare Symposium ... Aetna-Duke-Kraftsow in major yoga trial on effectiveness and cost ... Asheville, North Carolina suggesting integrative medicine for economic development ... Daniel Redwood, DC offers additional resources on cost benefits of integrative practices ... Sierra Tucson, Ted and Dr. Roberta Mann Foundation back new International Network on Integrative Mental Health ... $250,000 Dr. Rogers' Prize announces applications, September 23, 2011 set for awards dinner ... Data on the remarkable 2010 contributions of the Wake Forest integrative medicine program ... "Integration theme" presented as reason for record turnout at conference of chiropractor educators and researchers ... Bonnie Horrigan offers exceptional resource on IM fellowships in Explore ... Tai Sophia offers new nutrition MS program ... Congresswoman Carolyn Pingee (D-ME) sponsors bill to for Medicaid coverage of Certified Professional Midwives ... American Chiropractic Association priorities on health reform ... Public visibility work of the American Association of Naturopathic Physicians ... Suzanne Somers' Dateline appearance shows rift between alternative cancer treatment doctors Gonzalez/Bryzynski and interviewed integrative medicine leaders ... Reiki effectiveness in health condition published ... American Botanical Council and American Herbal Products Association announce 2011 awards ... Seattle Business honors Bastyr community medicine program led by Melissa McCarty, ND ... Richard Brassard, DC selected to head Association of Chiropractic Colleges ... Integrative medical doctor Shay Pintov, MD leads Israeli delegation to help in Japan ... In Memoriam: Michele Eustache

Van Horn: Arizona fellow in key appointment

U Arizona Fellow Sharon Van Horn, MD, MPH appointed to federal prevention Advisory Group

Oversight: The

Comment: Good to see this additional present among the 13 named thus far. It is frustrating, as Integrator columnist Taylor Walsh reports here, that the national prevention effort that this Advisory Group is to advise continues to roll forward without the full panel of advisers in place.

Brian Berman, MD

New NCCAM Advisory Council Members: Jane Guiltinan, ND and Brian Berman, MD

Sources in the field share that two new members coming on to the National Advisory Council for Complementary and Alternative Medicine this year will be Brian Berman, MD and Jane Guiltinan, ND. Berman, founder of the Center for Integrative Medicine at the University of Maryland has received more funding from NIH NCCAM than any other researcher. The co-founder of The Institute for Integrative Health, Berman is among the integrative MD leaders with the most significant clinical experience in integrative practice. His clinical strengths include acupuncture, mind-body medicine and homeopathy. The founding chair of the Consortium of Academic Health Centers for Integrative Medicine was honored with the $100,000 Bravewell Leadership Award in 2005.

Jan Guiltinan, ND

A February 2011 note from the American Association of Naturopathic Physicians (AANP) shared that Guiltinan is expected to take her NACCAM position later this year. She will effectively replace Tim Birdsall, ND, the one ND presently on NACCAM. Guiltinan, dean of naturopathic medicine at Bastyr University, is principally known as a clinician and educator. A trustee since 1998 at Harborview Medical Center, Guiltinan heads up

Bastyr grant related to evidence based education. She has held many significant roles for her profession, including president of the AANP.

Symposium offer policy resource

Weeks' powerpoint highlighting 2010

Asheville: Looking to IM for economic development

Economic development officials in Asheville, North Carolina explore integrative medicine as a growth opportunity

The March 19, 2011 feature is headlined: "Asheville thrives as regional hub for integrative medicine." The surrounding county is reportedly home to 32% of the state's licensed acupuncturists and nearly a half of its licensed massage therapists. The area also includes 30% of the state's naturopathic physicians and 60% of the American Herbalist Guild members in the state. The article notes that the Institute for Emerging Issues at N.C. State University recently urged that Western North Carolina consider investing in integrative medicine "to generate high-quality jobs." The topic of integrative medicine was recently one of 11 breakout sessions at the Institute's 26th annual forum. David Brown, executive director of the Asheville Hub Alliance, an economic development group, notes that "the area has a high concentration of Western and alternative medical providers and the health industry is one of the few areas that has grown during the recession." He adds: "If you put all these things together, you conclude that Asheville could have a competitive advantage in advancing integrative health."

Comment: The nation's most well-developed model for this approach to economic development, and medical tourism, is the Hawai'i Consortium for Integrative Healthcare. The Consortium was the brainchild of Integrator adviser Ira Zunin, MD, MPH, MBA. Take a look at the stakeholder mix on the Consortium's board.

Duke IM: Research leadership in Aetna study

Expanded Aetna yoga trial with Duke Integrative Medicine, Kraftsow to examine cost-savings related to stress

"The positive results seen in these studies offer evidence that mind-body approaches to health improvement are an effective and targeted solution for employers who want to lower the costs associated with stress and help their employees achieve better overall health." The speaker is Kyra Bobinet, MD, MPH, medical director of Health and Wellness Innovation at Aetna, and clinical director of an expanded Aetna study based on two pilots. The studies were developed in collaboration with Duke Integrative Medicine and American Viniyoga Institute (AVI).

Kraftsow: Yoga leader in Aetna study

A Businesswire release from Aetna shared that early results from randomized controlled pilot studies found significant reductions in stress as compared to the control group. In addition, Aetna's review of medical claims' data showed a positive correlation between costs and stress levels. Among the Aetna study volunteers, those reporting the highest level of stress had nearly $2,000 more medical costs annually than those reporting the lowest level of stress. The findings, according to the release, "suggest potential health care costs savings could be realized by reducing stress." Ruth Wolever, PhD, director of research at the Duke IM program is principal investigator on the study. AVI founder

Comment: The Aetna move recalls Mind Matters, Money Matters, the breakthrough article written by Kaiser physician David S. Sobel, MD, MPH over a decade ago. Sobel concluded: "Mind/body medicine is not something separate or peripheral to the main tasks of medical care but should be an integral part of evidence-based, cost-effective, quality health care." The still slow uptake is likely linked to system discomforts with new players, approachs and patterns of behavior. Credit Aetna for its published commitment.

Dan Redwood, DC: Two additional recent resources show cost savings from "CAM"

• $2000 for chiropractic versus $20,000 for microdiskectomy
  

A comparison between chiropractic and microdiskectomy (low back surgery) found that 60% of those randomized to chiropractic care were able to both avoid surgery and achieve long-term outcomes equal to those who underwent the surgery. Chiropractic care cost roughly $2,000 versus approximately $20,000 for the surgery. The lead author is a chiropractor. The other authors include 3 neurosurgeons. Redwood's review of the research article is the second piece here. The research citation is McMorland G, Suter E, Casha S, du Plessis SJ, Hurlbert RJ. Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. J Manipulative Physiol Ther. Oct 2010;33(8):576-584.

• 

  Redwood: Two additional cost resources
  
  $2.75-billion to $3-billion in annual savings in the U.S.?
  

A follow-up article in Employee Benefits News by Gerald Clum, DC extrapolates from these findings: "In the U.S., at least 200,000 microdiskectomies are performed annually at a direct cost of $5 billion, or $25,000 per procedure. Avoiding 60 percent of these surgeries would mean a reduction savings of $3 billion annually. In the Canadian study, patients receiving chiropractic care averaged 21 visits during their course of care. If a cost of $100 per patient visit is assumed for the care provided by the chiropractor, then the total cost per patient would be $2,100, yielding per patient savings of $22,900, or $2.75 billion dollars annually.The conclusion: $2.75 billion of savings each year if patients used chiropractic treatment first.

Organizations

Dodds: Part of organizing team for integrative mental health group

International Network on Integrative Mental Health in formation; Sierra Tucson sponsors 4-day planning retreat

Integrative mental health now has a new, international organization to network interested parties: the 501C3 International Network on Integrative Mental Health (INIMH). The group's formation followed the

• 

  Labyrinth at Sierra Tucson, sponsor of working meeting
  
  Network and collaborate among thought leaders and change agents in IMH.
• Learn about the IMH model at ST and obtain feedback from INIMH members on optimizing the model.
• Discuss differences between a conceptual model of Integrative Psychiatry and Integrative Mental Health (IMH) and the strengths and limits of each.
• Develop a plan and a working group to develop a white paper on IMH as a separate discipline.
• Develop a plan and a working group to develop curricula/training projects in IMH, including an interdisciplinary fellowship in Integrative Mental Health at Sierra Tucson.
• Develop a plan and a working group to develop an agenda on IMH research priorities.
• Develop a plan and a working group to establish model best practice IMH clinical guidelines (for 3 major disorders).
• Introduce and demonstrate INIMH website.
• Develop a strategy for broadening international representation within INIMH

Comment: This is excellent, important and obviously needed work. How many clients of a mental health providers have never been urged to go for a walk? Or swing their arms a bit? Eat well? Take appropriate micronutrients? I look forward to continuing to follow the organization's work. (Thanks to Patricia Herman, ND, PhD, for linking me to this development.)

Major Canadian IM award

Dr. Rogers' $250,000 Prize calls for nominations, sets September 23rd for awards dinner

Academic Medicine

Kemper: Wake Forest IM leader

Highlights: 2010 Report from the Wake Forest Center for Integrative Medicine

The March 2, 2011 newsletter for the Wake Forest-Baptist Health Center for Integrative Medicine offers a quantitative look at the production of the Center based on grants and projects under way in 2010. The CIM is led by Kathy Kemper, MD, MPH holder of the Caryl J Guth Chair for Integrative Medicine. Ed Shaw, MD is program director for research. A full PDF, available through the newsletter link above, describes these in detail.

Comment: Quite simply, remarkable.

Integration theme key to conference's record turnout

Integration theme propels record turnout for conference of chiropractic educators and researchers

O'Bryon: ACC executive

Comment: I had an opportunity to participate in this meeting by helping lead a workshop on practical integration. I shared soem perspectives on the emerging environment that I later converted into 8 Major Trends Promoting Integration of Integrative Practices and Complementary and Alternative Healthcare Disciplines. In the midst of the ACC-RAC, I began a conversation with a chiropractic clinician with 4 decades of scars from poor relationships with medical doctors. He sees no future in investing in integration, except perhaps among the natural healthcare disciplines. Given the poor inclusion of chiropractic doctors even in most integrative medical settings, it's no surprise that the purple-ing of the DC-MD bruises is still visible. The slow mainstream response to the evidence on cost and care noted above is yet more fanning of the ire. Good for the ACC to both chose this topic, and then turn out for it in such numbers.  

Horrigan: Excellent resource on IM residencies and fellowships

Explore publisher Horrigan provides resource on integrative MD residencies

The March 2011 issue of Explore includes an article by publisher Bonnie Horrigan entitled

Comment: This is an excellent resource for not only prospective fellows but also for interested observers of this field. While Horrigan's title claim that the residencies are "transforming the healthcare landscape" may yet be an aspirational reach, certainly this report signifies integrative medicine's growing entrenchment in medical education. Horrigan's article is a fine, useful piece of work. (Thanks to Taylor Walsh for pointing me to this information.)

Branching into new nutrition MS program

Tai Sophia offers Nutrition and Integrative Health Masters; link with James Gordon's "Food as Medicine"

Fall 2011 will be the first class of a new Master of Science in Nutrition and Integrative Health program at the Tai Sophia Institute

• Taught from a holistic and integrative perspective
• Prepares graduates for a variety of nutrition and wellness careers
• Prepares graduates to sit for the Certified Nutrition Specialist (CNS) exam
• Features custom-designed science courses and core competencies in nutrition assessment and treatment strategies
• Includes whole foods cooking as part of academic curriculum
• Addresses sustainability and the relationships between our food choices, our agricultural and food processing practices, and the environment
• Integrates students into the broader health and wellness learning community at Tai Sophia Institute.
  

Pingee: Lead sponsor for homebirth option

Certified Professional Midwives introduce

Comment: The MAMA Campaign had a success it's first jump into the Beltway in 2009-2010 when CPMs were included in Section 2301 of the healthcare overhaul bill as covered providers in free-standing birth centers. The group has good evidence of cost-effectiveness. Alignment of interest note: I'm a donor to the campaign due to powerful, transformative homebirth experiences in the birth of each of my children.

American Chiropractic Association priorities under PPACA

The AANP's pitch: Getting out the word on naturopathic medicine

Media

Somers: Promoting alternative cancer on Dateline

Cancer wars on Dateline: Follow-up from Clay, Gonzalez, Bryzynski

Gonzalez: Offers thorough, measured response

Comment: Commenting on the therapeutic substance of this battle is well beyond my skill set. However, I do have some background in journalism. This includes working knowledge of how one focuses a story, chooses to include and decides to leave out. This has left me as something of a radical in questioning the journalistic "objectivity" of any participant in this sport. The multiple biases produced through genes, home, culture and environment layer so densely over the imagined balance point to the point of utter obscurity. The Dateline story and these posts are especially interesting because they focus not only on the macro-cancer wars between mainstream and alternative treatments. We also see here a rather ugly micro-battle between individuals associated with "alternative" and others with "integrative" approaches. My (biased) read: Gonzalez and Bryzynski aren't getting a fair shake.

Comment on the comment: A working postulate: Battles and bias are most feverish when a) parties are defensive; and b) there is a good deal of cash at stake. Cancer fits both categories. Big money. Big challenges. Everyone talks about how much the other makes, and focuses on the worst of the other's results. Thus the vehemence.

Miscellaneous

Conference Reports: ACHM, I-Mosaic, Integrative Practice Symposium

The Arizona Center for Integrative Medicine reports that its May 9-11, 2011 Nutrition & Health conference in San Francisco is sold out at 740 paid attendees and over 900 total. The next iteration will be April 15-18, 2012 in Boston ... The I-MOSAIC conference led by 4 integrative MD/DO organization is reportedly drawing some 800 to their first conference, in Minnesota ... The Integrative Healthcare Symposium held in New York City March 4-6, 2011 drew 1180 paid attendees plus half-again as many additional souls present as speakers or exhibitors. (I am pleased to be affiliated with this meeting and organization, an Integrator sponsor.)

Miles: Pushing awareness of Reiki research

Milestone: Reiki's first appearance in mainstream journal

Comment: Two significant questions. First, with something as subtle as Reiki, is it appropriate to measure an achievement as a "milestone"?  Second, what will be most excruciating for the anti-IM/CAM bloggers: the report above on the expansion of integrative MD fellowships, or this published account that a Reiki practitioner holding his/her hands a few inches above a person's body can elicit a clinically meaningful response?

Rom: Award from American Botanical Council

American Botanical Council and American Herbal Products Association announce awardees

The American Botanical Council and the American Herbal Products Association each announced their annual awards at the major industry gathering at EXPO West in Anaheim in March. This release from ABC offers more details on the following 3 awards:

• ABC James A. Duke Excellence in Botanical Literature Award was presented to Aviva Romm, MD, for her new book Botanical Medicine for Women's Health.
  
• The ABC Norman R. Farnsworth Excellence in Botanical Research Award was presented to Professor A. Douglas Kinghorn, PhD, of Ohio State University. 
  
• The ABC Varro E. Tyler Commercial Investment in Phytomedicinal Research Award was presented to New Chapter Inc., a producer of a unique line of dietary supplements.

In this AHPA release, the honoring of the following individuals was announced:

• The AHPA Herbal Hero Award, which recognizes individuals who make outstanding contributions to AHPA committees or initiatives, was awarded to Edward J. Fletcher, chief operating officer of Strategic Sourcing, Inc.
• The AHPA Herbal Industry Leader Award, which recognizes companies that set an example of outstanding business practices or organizations that work to move the industry forward above and beyond normal business practices, was awarded to NOW Foods, based in Bloomingdale, Ill. 
• The AHPA Herbal Insight Award, which recognizes individuals or non-commercial organizations that have a significant impact on furthering knowledge and understanding of botanicals and their uses, was presented to the members of the Expert Advisory Council for the revision to AHPA's Botanical Safety Handbook.
• Special Award: The 2011 AHPA Visionary Award, which recognized unwavering, persistent dedication in the advancement of all-natural stevia, goes to James A. May, CEO of Wisdom Natural Brands of Gilbert, Ariz.

McCarty: Community ND care program awarded

Bastyr's University community services to the underserved honored by business magazine

"The largest university for natural health arts and sciences in the country, Bastyr University offers free or low-cost naturopathic care to underserved populations in King County through its 15-year-old external site program. Students in advanced naturopathic medicine and acupuncture and Oriental medicine treat patients at 12 locations, including a downtown homeless shelter, a rural community center in Carnation and the Country Doctor Clinic for low-income patients on Seattle's Capitol Hill. The program reached 3,567 patients in 2009.

Comment: A useful data point would be the total number of underserved people who are annually served via schools and programs to clinically educate licensed "CAM" practitioners. A survey with which I was involved via the National Education Dialogue (2005-never published) found a very high percentage of schools had such programs. Bastyr's was in good company as a runner-up: the other operation similarly noted is the internationally-recognized Airlift Northwest.

Brassard: Taking helm at ACC

Brassard chosen as incoming president for the Association of Chiropractic Colleges

Richard G. Brassard, DC, president of Texas Chiropractic College, was elected as incoming president of the Association of Chiropractic Colleges. Brassard, the son of a chiropractor, is a past president of the American Chiropractic Association and has held many leadership positions in his field over the past 40 years. Brassard succeeds Frank Nicchi, DC, MS, president of New York Chiropractic College. Nicchi's term was marked by a focus on, and advances in, integration. (See article on ACC-RAC conference under Academics, above.) Mark Zeigler, DC, president of the multidisciplinary Northwestern Health Sciences University, will serve as ACC's vice president.

Eustache: Huge loss

In Memoriam: Michelle Eustache

There was a huge loss to the naturopathic medical profession and, from all accounts, to healing, when 3rd year Bastyr University ND student Michelle Eustache

Comment: The loss is all the worse in that the integrative practice fields tend to have relative few non-Asian people of color involved. Eustache had all the marks of a person who would have opened a network of relationships into new communities. The sadness is that much deeper.