Summary: Integrator Special Report shares 15 key areas where complementary and alternative medicine (CAM) and related terms are explicitly included in IOM's major report on pain care, education and research ... Segments identified where 125 page National Prevention Strategy references "complementary and alternative medicine" ... Dietary supplement industry worried by S 1310, Durban's plan for additional regulation ... ACCAHC report finds CAM schools received just 4.6% of NCCAM's $1.29-billion (1999-2010) ... 4 new members added to National Advisory Council for Complementary and Alternative Medicine ... Canadian government in major, multidisciplinary look at safety of spinal manipulation ... Bravewell meets the military around comprehensive pain program ... The Institute for Functional Medicine's formal certification of functional medicine practitioners ... Cancer Treatment Centers of America and Parker University team for chiropractic internship ... What parts tuition, grants and donations? Inside the budget of a leading university of natural medicine ... Alliance for Massage Therapy Education continues to stake claim toward education leadership for massage's 1440 programs ... Roberti di Sarsina announces unique Italian master course in CAM in business, policy and and practice ... Physical therapists in push for embrace of psych factors realted to physical maladies ... Freedman's Atlantic feature, Triumph of New Age Medicine, raises storm of debate, possible re-frame of science-CAM issues ... Jackson-Coker physician employment group sends 2 CAM/IM reports to 200,000 MDs ... Reports document dietary supplement use by various specialists and by diabetics ... Notes on the meetings of the International Association for Yoga Therapists (September 2011), Society for Integrative Oncology (November 2011) and Integrative Healthcare Symposium (February 2012).

Policy

IOM pain blueprint

Institute of Medicine publishes blueprint for pain; Integrator report documents presence of CAM

On June 29, 2011, the Institute of Medicine released a consensus report entitled Relieving Pain in America: A Blueprint for Transforming, Prevention, Care, Education and Research. The consensus committee

Comment: The report's frontispiece is an aphorism and charge from Goethe: "Knowing is not enough; we must apply/Willing is not enough; we must do." The saying is meant to reflect the need to engage a broad "cultural transformation" relative to pain and its treatment. Goethe's words are certainly applicable to what we know about consumer use of CAM. Since consumer perception of value is as high, it is definitely time to proactively "apply" this knowledge to the care others. Or are we forgetting that if this is "patient-centered" then, well, patient choice is at the center, no?

Health promotion Council's work

The inclusion of CAM in the National Prevention Strategy published through the multi-agency National Prevention and Public Health Council

"Future research and evaluation, including well designed trials for many complementary and alternative medicine therapies, will be critical to addressing unmet prevention and wellness needs, and new evidence-based strategies will be incorporated as they emerge." (page 14)

The most significant inclusion is under "Recommendations: What Can be Done?" on page 22 under Clinical and Community Preventive Services. Recommendation #6 reads:

"Integrated health care describes a coordinated system in which health care professionals are educated about each other's work and collaborate with one another and with their patients to achieve optimal patient wellbeing. Implementing effective care coordination models (e.g., medical homes, community health teams, integrated workplace health protection and health promotion programs) can result in delivery of better quality care and lower costs. Gaps and duplication in patient care, especially among those with multiple chronic conditions, can be reduced or eliminated through technologies (e.g., electronic health records, e-prescribing, telemedicine). Evidence-based complementary and alternative medicine focuses on individualizing treatments, treating the whole person, promoting self-care and self-healing, and recognizing the spiritual nature of each individual, according to individual preferences. Complementary and alternative therapies for back and neck pain (e.g., acupuncture, massage, and spinal manipulation) can reduce pain and disability." (page 22)

"Research complementary and alternative medicine strategies to determine effectiveness and how they can be better integrated into clinical preventive care." (page 22)

"Facilitate coordination among diverse care providers (e.g., clinical care, behavioral health, community health workers, complementary and alternative medicine)." (page 23)

US Senator Dick Durban (D-IL)

Senators Durban and Blumenthal introduction of Dietary Supplement Labeling Act (S. 1310) raises industry concerns

Two Democrat US Senators, Dick Durban, (D-IL) and Richard Blumenthal (D-CT) introduced The Dietary Supplement Labeling Act (S. 1310) on July 1, 2011. The bill is viewed as "primarily targeting products that blur the line between dietary supplement and food and beverages," according to this useful

Research

Team surveyed CAM schools

ACCAHC reports that CAM schools received just 4.6% of NCCAM's $1.29-billion between 1999-2010

At the June 2011 Biennial Meeting

Truth is, the accredited CAM schools represent over 95% of the integrative practitioners who are educated to a US Department of Education-recognized standard for integrative care. To believe anyone can do the research is to disrespect the distinctive care the consumer is receiving from members of these disciplines.

There are good and bad historic justifications for these investment patterns.

In fact, Briggs' plan specifically states that "CAM practitioners are the key holders of knowledge related to the potential application of CAM interventions and disciplines." This is what Congress mandated NCCAM to explore. Here's hoping that an analysis in 2015 will see closer to 20% of NCCAM's budget going directly to these CAM institutions where these "key holders of knowledge" are housed.

Dan Cherkin, PhD

NCCAM adds Berman, Cherkin, Kingston and Michener to National Advisory Council on CAM

The National Center for Complementary and Alternative Medicine (NCCAM) announced 4 new members to the NIH National Advisory Council for Complementary and Alternative Medicine at their June 2011 meeting. The incoming group includes: Brian Berman, MD, integrative medicine leader at the University of Maryland; Daniel Cherkin, PhD, health services researcher at the Group Health Research institute;

Comment: This is an interesting crop. Berman and Cherkin may be considered deans of research for the entire field. Each is an excellent choice. Unlike the vast majority (I would guess over 95%) of NCCAM-funded researchers from conventional academic health centers, Berman is a skilled and inquisitive, whole-person focused clinician. Cherkin is closely connected to all of the licensed CAM disciplines and has done exceptional health services work with his colleague Karen Sherman, PhD, also at Group Health. His expertise will be especially important with NCCAM's emerging "real world" interests.

Brian Berman, MD

I am less excited about the other two. Kingston's work supports natural products research. This remains NCCAM's comfort zone, if not its highest value to the public health. A leader in the botanical field shares that Kingston is a "highly respected natural products chemist." Kingston's biodiversity connection adds an intriguing whole-system alignment with CAM philosophy. Michener is something of a wild-card, from the resume. Duke has a significant integrative medicine program, yet Michener doesn't appear to be involved with it. Perhaps his work relative to obesity and prevention programs is seen to fit with NCCAM's new interest in preventive approaches.

It is interesting that nothing was done in this group to address the chronic failure of NACCAM to comply with the NCCAM mandate that at least half be "licensed in one of the major systems" that NCCAM is charged to explore, and that others would be selected to reflect consumer interest. More on that soon.

Sunita Vohra, PhD

Canadian government grants $2-million for inter-disciplinary research on safety of spinal manipulative therapy

Comment: Nice balance here, for a hot topic. Vohra seems a good person to be quarterbacking it. The inclusion of Toronto-based researcher Heather Boon, PhD is also hopeful. 

Schoomaker: Leading military team

Bravewell Collaborative joins military leadership in symposium on Army Comprehensive Pain Management Campaign Plan

Philanthropy group develops military plan

Army Surgeon General Lt. Gen. Eric B. Schoomaker, MD, PhD said that the meeting "marks the beginning of a cultural shift in how health care is practiced in the military." Among the scientific reports considered were

Comment: The military is proving to be quite a workshop for integrative approaches. Interesting that Bravewell is showing up in this military zone after its apparently abortive (though intriguing) Healthy Nation Partnership in late 2009-2010. The organization of philanthropists in integrative medicine has done some exceptional mapping work. It would be useful if Bravewell chose to map all of the military programs involving complementary and integrative-related approaches and studies underway. These range from naturopathic physician Terry Davis, ND offering a mindfulness program in Tucson, to yoga therapist Richard Miller, PhD's work with mindfulness, to the chiropractic and acupuncture programs in VA hospitals, to the many significant projects led by the Samueli Institute. There may be real value in both the map and in creating an unofficial network of integrative researchers and care-givers who are working with military populations.

IFM's program to become a Certified Functional Medicine Practitioner

For 14 years, the Institute for Functional Medicine has offered a 5-day training program entitled Applying Functional Medicine in Clinical Practice (AFMCP) as the cornerstone of its educational offerings. The program is also a core requirement for the organization's requirements to become a Certified Functional Medicine Practitioner. The list of requirements includes the following elements:

• Week-long onsite AFMCP

• Six 2 ½ day onsite Advanced Practice Modules
• Functional Medicine Fundamentals 
• Webinar case studies following each module
• Course review webinar 
• Certification exams & case presentations   

Comment: Perhaps I am the last to be aware of IFM's certification program. Setting a standard is good. One of the most significant issues to a consumer relative to both "integrative medicine" and "functional medicine" is that anyone can apply the terms to their practice, with or without any specialized training. How can a consumer know what the term means if there are no standards? This certification is a step in the right direction.

One small gripe: Does IFM model appropriately utilize the discrete skills of other natural health practitioners? A decade ago a leading information firm called Integrative Medicine Communications, to which I sold my hard-copy Integrator, marketed its products to medical doctors will the cut-line: "Know It All." Via hubris, maybe, the firm went under. No single practitioner of any type can, of course, know it all. And even the most integrative of providers is not likely to fully understanding how best to use other practitioners, including other integrative practitioners. Integrating "science, research and clinical insights to treat and prevent disease and maintain health," as the IFM brochure claims, is not enough. One must also know how to best integrate other practitioners. This appears to be an area that could stand some work.

Partnering with CTCA for chiropractic internship

CTCA begins chiropractic internship with Parker University

Cancer Treatment Centers of America (CTCA) has initiated a chiropractic internship program with Parker University. CTCA has been known for its inclusion of naturopathic doctors in its integrative treatment processes but chiropractors have not been significant players. An article in the July 15, 2011 issue of Dynamic Chiropractic described the program, which will be directed by John Silbey, DC at CTCA's Tulsa, Oklahoma site. "This internship is designed to best prepare Parker students for clinical practice within integrated health care settings," added Dr. Patrick Bodnar, assistant dean of clinics at Parker University. "It will expand the clinical portion of the student's education and will benefit them tremendously." An intern notes that the experience is also broadening her understanding of other natural health fields: "So far, I have been with the intake department, two medical oncologists, acupuncture, mind/body medicine, and naturopathic medicine."

Comment: Kudos to CTCA and Parker for establishing a remarkable opportunity for both chiropractic integration and also for interprofessional education/care (IPE/C). Experts in IPE/C say that the optimal site for education that creates respect across disciplines is in the clinical setting. This program is a still rare opportunity. (Thanks to Glenn Sabin for alerting me to the story.)

Inside the 2009-2010 budget of a leading institution of natural health sciences: Bastyr University

The Bastyr University 2009-2010 Annual Report provides on interesting look at the economics in a leading institution of natural health sciences. The university had 927 students in this period: 176 undergraduate, 499 first professional degree and 237 graduate students. Total operating revenues reached $28.8 million. Of this, 88% ($25.5-million) is represented as Education and General Revenues. Tuition alone represents 71% of revenues, or just over $20-million. (The largest portion of the remainder of the General Revenues is likely clinic fees.) Governmental grants totaled $2.3-million and philanthropic gifts $888,475. The portion of the Bastyr revenues from grants and donations was lower than any year since 2006. It has remained between $3.1-$5.1-million throughout. The 33-year-old institution shows roughly $2.7-million in endowment investments and net assets of $14.2 million. Bastyr showed a net from operations of $1.8-million in the period of the report.

Dan Church, PhD, Bastyr president

Comment: Many trained in conventional academic health centers have little idea how dependent on tuition are the schools educating students for the distinctly licensed CAM fields. A colleague recently sent a note estimating that tuition probably accounts for upward of 85% of revenues in most CAM fields. By that standard, Bastyr's dependency is relatively low. The university is a huge recipient, compared to most other CAM schools, of federal research funding. (See related article this Round-up.) I suspect that the level of philanthropy, at roughly 3%, is also high compared to most others. Bastyr has invested in development since it was founded. Still, the pressure on tuition is extreme. Here's hoping that Bastyr president Dan Church, PhD, who first had to clean up a budget mess he inherited, will find a way to that promised land. It's tough to be the Harvard of natural medicine - an aspirational phrase one sometimes hears around Bastyr- without the room to dream and act that an endowment affords. The nation will be better off with not one but a half-dozen or more thriving, multidisciplinary universities of natural health sciences. 

Growing influence in massage education

Alliance for Massage Therapy Education continues step-wise effort to fill gap in massage self-regulation

Comment: The program for the second annual conference of the Alliance for Massage Therapy Education, August 18-20, 2011, gives ample evidence of the critical role this organization is already modeling for that field. The program includes a keynote from a nurse educator on teaching excellence, plus presentations on developing competency-based assessment on student performance and something called "instructional design for inspired learning." These are coupled with two presentations related to the organization's own Teacher Education Standard Project. Other presentations focus on policy and regulatory issues of interest to massage educators, plus nuts-and-bolts content on marketing and ethics. The massage field reportedly has over 1440 schools. It needs just the kind of strong leadership that Rick Rosen, MA, LMT and his team are assembling. I honored Rosen in the Integrator Top 10 People from 2010. The organization's necessary work continues.

Roberti di Sarsina: New Masters course

Roberti di Sarsina's Italian "master course" links policy, management and CAM

"The Master-course is designed for those in search of new skills and professionalism to employ in improving management of health trusts, veterinary branches of the health system, hospitals and clinics, wellness centres, centres studying and researching into health and disease. It will focus on changes in people's demand for treatment, and cater to researchers on issues of Health and Wellness ... The intention is to train managers, decision-makers, researchers and health workers to plan a person-centred, sustainable, transparent and honest health model of relevance to the individual citizen, health units and epidemiological research teams.

Comment: What I found of particular interest in Roberti di Sarsina's course is the way that traditional medicines and "CAM" are implanted in a broader discussion of the status of the health system, both management and economics. I don't think I've ever seen such a course description here. One has to love the ambition, if be overwhelmed with the potential subject matter.

Professions

APTA: Urging more focus on psych issues

Journal of the American Physical Therapy Association pushes role of psychological factors

Colleague Matthew Taylor PhD, PT sends notice of a special issue of the Journal of the American Physical Therapy Association. The May 2011 issue leads with a piece entitled A Convincing Case for the Psychologically-Informed Physical Therapist. The writer notes numerous places in the profession's organizational and accreditation documents where psych components are deemed important. Yet the therapy is not fully reflected in practice. The underscores the importance of the special issue:

"So, we have long paid lip service to the influence of psychosocial factors on clinical outcomes, but the time has come to YELL about the importance of these factors. This special issue is deliberate in laying out evidence to support adopting a broader approach for practice that includes a cognitive-behavioral framework, using low back pain as the example  ... We hope that we will stimulate and encourage the development of a broader approach to physical therapist practice, with a focus on the identification and management of psychological and psychosocial obstacles to recovery of optimal function. This is a call to action for educators, research scientists, and clinicians to move forward with this agenda."

Comment: This focus is a smart fit with the multimodal and multidisciplinary approach toward pain advocated in the new Institute of Medicine blueprint, reported above. I find myself curious about the ways the standards for chiropractic education and accreditation line up with those for physical therapists. If so, or even if not, is that field adequately embracing the psych components? Thanks for the head-up, Matt.

Media

Image accompanying Atlantic article

Atlantic's "Triumph of New Age Medicine" raises storm of debate over science and practice of medical alternatives

David Freedman's feature, The Triumph of New Age Medicine (Atlantic, July-August 2011) has stirred the most significant debate in years over the science and use of what Freedman prefers to call "alternative medicine." Freedman stirs the dialogue by wading into the chasm between the failure of large clinical trials of single agents and yet the growing respect, even among clinicians at the Mayo Clinic, for the value patients find in the whole person approaches of alternative medicine practitioners. Atlantic's e-version quickly generated a storm of responses. The magazine then hosted a series of response columns. Authors ranged from anti-CAM bloggers to integrative care leaders Mimi Guarneri, MD, Andrew Weil, MD and Dean Ornish, MD to NIH NCCAM's Josephine Briggs, MD and Jack Killen, MD. The Briggs/Killen piece is entitled Don't Dismiss These Treatments as Placebos. Meantime, Freedman fairly takes apart the antagonists in Evidence, not Anecdotes. Two columns in the Integrator review Freedman's work from a largely positive perspective. Taylor Walsh pulls an extraordinary set of quotes that reframe how "alternative medicine" is being viewed.

David Freedman

Comment: After Walsh alerted me to the original story, I weighed in with David Freedman's Atlantic Monthly Feature on Alternative Medicine and the Holy Trinity of Patient-Centered Outcomes. In showing the failures of reductive science to capture alternative medicine's value as felt by consumers and from a cost perspective, Freedman walks right up to a huge question. He doesn't quite ask it. And that is: Is US healthcare damaged by allowing decisions on valuation of research methods, on research funding, and on publication decisions, to be controlled by professionals who do not respect the synergies from multi-modal, patient-centered, healing-oriented approaches? Freedman may just be the journalist to do take this on. Personally, I consider this suppression of research on whole-person, healing approaches a kind of paradigm water-boarding.

Ongoing reporting on growth of CAM

Jackson Coker offers 2nd CAM feature plus Taylor Walsh resource on IM education

Two significant CAM features headline the July issue of the Jackson & Coker Industry Report. The report from the physician employment consulting firm, entitled

Dietary supplement use by cardiologists, dermatologists and orthopedists

A study entitled Use of dietary supplements by cardiologists, dermatologists and orthopedists: report of a survey found that 57% percent of cardiologists said they use dietary supplements at least occasionally, as did 75% of dermatologists and 73% of orthopedists. Regular dietary supplement use was reported by 37% of cardiologists, 59% of dermatologists, and 50% of orthopedists. In addition, 72% of cardiologists, 66% of dermatologists, and 91% of orthopedists reported recommending dietary supplements to their patients. According to the summary, the "primary reason given for recommending dietary supplements to patients was for heart health or lowering cholesterol for the cardiologists; benefits for skin, hair and nails for the dermatologists; and bone and joint health for the orthopedists".

The product most commonly reported to be used was a multivitamin, but over 25% in each specialty said they used omega-3 fatty acids and over 20% said they used some botanical supplements. Integrator reader Mitchell Stargrove, ND, LAc, author of Herb, Nutrient and Drug Interactions, comments on the report: "It's great to see specialist MDs using nutrrients. They are working to expand their repertoire and respect patient's choices; that should be the approach we all embrace with respect and collaboration. An intriguing question is whether they actually pay attention to interactions (beneficial and adverse) and quality issues? And, fundamentally, do they actually have a transdisciplinary strategy?'

Survey shows dietary supplement use in diabetics

A survey on

Conferences

Integrative Healthcare Symposium, February 9-11, 2012

The 2012 iteration of the most integrated of major conferences, the Integrative Healthcare Symposium (IHS), will be held at the New York Hilton on February 9-11, 2012. The conference will once again be chaired by Woodson Merrell, MD, a long-time integrative medicine clinician who co-founded the Continuum Center for Health and Healing. The 2011 conference drew roughly 1200 practitioners and 120 exhibitors. Typically the most significant subset of attendees is medical doctors, followed by nurses, chiropractors, naturopathic doctors, nutritionists, acupuncturists and more. Materials from the organizers state that the clinically-oriented presentations will focus in similar areas as recent conferences, including:

Comment:Alignment of interest note: IHS and its sibling website, IntegrativePractitioner.com, are Integrator sponsors. I have enjoyed a long relationship with the IHS team and am once again working with them on 2-4 programs. One is expected to be a presentation with integrative pediatrician Larry Rosen, MD on integrative health on primary care and medical homes. Another may be an opportunity to once again present my year in review on the business and policy of integrative healthcare. Be there or be square.

IAYT presents not one but two yoga research meetings in September 2011

Under the leadership of John Kepner, MBA, executive director of the International Association of Yoga Therapists (IAYT), the organization has significantly highlighted the research that supports the practice of Yoga for therapeutic purposes. On September 1-4, 2011 IAYT's 5th annual Symposium on Yoga Therapy and Research (SYTAR) will be held in Pacific Grove, California. The meeting is IAYT's annual membership meeting. Just three weeks later the organization will mount its 2nd annual Symposium on Yoga Research. The latter gathering is described as the second "comprehensive and widely publicized academic meeting in the West devoted to Yoga therapy research." The meeting is co-sponsored by, and will be held at, the Kripalu Center in the Berkshires of Western Massachusetts. Presenters will include IOM Pain Committee member Lonnie Zelzer, MD (see related article this Round-up). The Samueli Institute is Platinum Sponsor for both conferences. 

Society for Integrative Oncology mails to all AMA-member oncologists for November 2011 conference

The annual meeting of the Society for Integrative Oncology has grown in stature with each of its 8 years. The November 10-12, 2011 conference will include a keynote from Francis Collins, MD, director of the National Institutes of Health. SIO board member Glenn Sabin shares that the conference flier