But CAM Practitioners Must Seize the Initiative

 By Izabella Tabarovsky

Note: This post is part of the discussion on the Summit on Integrative Medicine

The 3-day Institute of Medicine Summit on Integrative Health was truly mind-broadening for me.  I came away excited about the possibilities and bursting with ideas.

The key was that we are living at a time of huge opportunities.  But no one is going to hand anything to us on a silver platter.  We must fight for what we believe in - and we must get creative about it. 

We can continue complaining how mainstream establishment doesn't recognize or accept us, that insurance companies don't reimburse us, and how the public doesn't understand what we do.  Or we can get beyond the current paradigm and think creatively about our competitive advantages vis-a-vis mainstream medicine and go there. 

Two key ideas were voiced at the Summit in this regard:  Community-based care networks and work-site CAM interventions.  Both require initiative on our part. And to become viable, both require that we overcome our tendency to get silo'ed and act alone.  Right now we will benefit from acting together, from helping each other out, from, together, creating the new paradigm in which the benefits of CAM modalities will be apparent to everyone. 

With that, here, briefly, are some of my take-aways from the Summit:

• The new paradigm is being birthed.  It seemed that everyone, from MDs to insurance reps, agreed that the old paradigm of health care is broken. We are present at the birth of the new paradigm.  No one knows yet what it will be.  The moment to contribute to the shaping of this new paradigm is now.  Each of us participating in the CAM field must now step up to the plate and do our part in making sure that integrative health care truly becomes a reality. 

• From evidence-based practice to practice-based evidence.  Pedigreed scientists such as Ken Brigham and Lawrence Green suggested that "to reject a treatment because we don't understand the mechanism is a mistake." The idea that randomized control trials don't work with CAM modalities and that practice-based evidence is "the only way to integrate practices that have hundreds of years behind them" was voiced repeatedly.  This means that if your practice shows results, that should be considered good enough evidence.  Music to the ears of a CAM practitioner.

• Shortage of primary care physicians creates opportunities for CAM practitioners.  The PCP shortage is already affecting the health care industry.  By 2025 we could be short as many as 200,000 PCPs, and, according to Richard "Buzz" Cooper, the health care reform could increase the shortfall by another 400,000.  Doctors' functions are becoming increasingly narrow and high-tech.  The offloading of tasks by physicians will accelerate, leaving physicians with increasingly narrower responsibilities, more high-tech and less relevant to the real issues affecting the health of their patients.  Other disciplines will, by necessity, be called upon to fill the gap, and this is where CAM practitioners will have their entry.

• There is room for everyone at the table to provide an amalgam of services.  This means that there will be room for everyone, from chiropractors to acupuncturists to health coaches to energy healers in creating an amalgam of care.  Because of the above, we are moving into a place where physicians will share the platform of care with a broad range of non-physician clinicians. 

• We must educate MDs and the public about our modalities. For the above point to be true, PCPs have to become educated about what we as CAM practitioners do.  83 percent of PCP practices in this country are groups of 1 or 2.  They account for nearly 50 percent of primary care.  This means that there are great opportunities to develop community care groups that could include nutritionists, dietitians, social workers, all connected to small PCP practices. The problem is that many times MDs, along with general public, have no idea what it is that we do.  So it is up to each and every one of us to take the initiative and reach out to the PCPs and educate them.  Go introduce yourself to PCPs in your neighborhood, tell them about what you do, show your credentials, build a relationship.  Begin where you are. 

• Empathy is CAM practitioners' competitive advantage.  I was floored by a slide presented by one of the speakers that illustrated the dramatic decline of empathy in medical students as they progress through medical school. This shift particularly affects men, whose levels of empathy drop nearly to zero.  (I don't have that particular slide, but here's a link to another onethat demonstrates the same point.)  What this suggests to me that we as CAM practitioners are, first and foremost, in the business of empathy.  In fact, empathy is our competitive advantage vis-a-vis the MDs - all the more so because studies show that empathy is the top quality that patients long to see in their caregivers.  Emphasize this with your prospects, let this be your selling point.

The one thing I found myself wishing for was that the Summit had lived up to the word "integrative" in its name and included the discussion of mind and spirit, not just the body. Dealing with questions of meaning and purpose is integral to whole person health.  But hey, you can't get everything right right away.  Perhaps next time.   

Practitioners Must Lobby Congress to Make it Happen

By Daphne White, CHTP

Note: This is a guest post that is part of the discussion on the Summit on Integrative Medicine

It was not your usual Senate hearing.  Testifying on behalf of integrative medicine before Senators Harkin, Mikulski and Enzi at the Senate HELP Committee were four leading physicians:  Mehmet Oz, Dean Ornish, Andrew Weil and Mark Hyman.  Testifying on behalf of the status quo was … no one!  That’s an unusual set-up on Capitol Hill, where panels are usually set up to represent “both points of view.”  Lobbyists for the medical establishment were present to watch the proceedings and plot their next steps, but they didn’t have a seat at the table.  Not this time, anyway.

By any measure, it was a watershed week:   the Feb. 26 HELP Committee hearing was the second in four days to focus on integrative medicine.  And the very next day, Sen. Harkin traveled across town to the Institute of Medicine, to address the 500-strong Summit on Integrative Medicine.

“Clearly, the time has come to ‘think anew’ and to ‘disenthrall ourselves’ from the dogmas and biases that have made our current health care system – based overwhelmingly on conventional medicine – in so many ways wasteful and dysfunctional,” Harkin told both groups, borrowing some quotes from President Lincoln’s 1862 address to Congress.

“It is time to end the discrimination against alternative health care practices.  It’s time for America’s health care system to emphasize coordination and continuity of care, patient-centeredness, and prevention.  And it’s time to adopt an integrative approach that takes advantage of the very best scientifically based medicines and therapies, whether conventional or alternative.”

Speaking to the IOM Summit on Monday, Harkin said, “I have just four words for you:  Our time has come!”  He added that IOM visitors to Washington might think “it looks like the same old Washington, but it’s not.” 

Yet Harkin warned the IOM participants that the real work of serious health reform is still ahead of us.  “Just because what we’re talking about here is the most common sense, most cost-effective kind of medicine doesn’t mean it’s a done deal,” he said.  “Nothing in Washington is a done deal.” 

Even though the “status quo is broken and wasteful” to the tune of $2.1 billion, Harkin said, “the ‘stagnant quo’ is still” very powerful and very much alive.  “There are forces that will defend allopathic medicine with all their power,” Harkin said.  “It’s human nature.” 

“We pay trillions for surgery but peanuts for prevention,” he added, noting that only 5 cents of every health care dollar is spent on prevention.  “We are happy to pay for amputation” for diabetes patients, but there is almost no re-imbursement for nutrition and prevention.  “The time has come to think of outcomes and quality, and to reimburse for that,” Harkin said.

But Harkin said he can’t bring about this revolution in health care reform and reimbursement on his own.  “I will do everything I can to include integrative medicine in the health care reform bill,” he said.  “But I can’t do it alone.  I need each and every one of you here to go home and be real health evangelists for health reform.” 

Integrative practitioners must take the message of integrative and preventive health to their places of worship, to civic leaders, to their friends and everyone else they know, Harkin said.

“I need you to make appointments with your Congressmen and your Senators, either here in Washington or in your home districts,” he said.  “This reform won’t just happen.  We have to get people around the country to demand this change.  Seize the day” and make it happen he said. 

(Follow the links for contact information for all the Senators and Congressmen.)

Harkin is clearly looking for active partners in this health care reform effort.  In the middle of the Senate hearing, he had asked Ornish, Weil, Oz and Hyman:  “I’m just wondering, how do we harness you all in advising us and advising the President?  How can I put you in great positions of power so you can” help make decisions about the needed reforms? 

“How can you get us involved?” Ornish responded.  “Ask us!  We’ve been waiting for this opportunity for a long time!”  Ornish added that he had once naively assumed that good research was the key to reforming medicine.   But research alone doesn’t cut it, he said.  “We need to change the re-imbursement system.  We are all here to help you.  Just ask!”  Responded Harkin, “we just have to figure out how to integrate you into the health care reform debate.”

The next day at the IOM Summit, Harkin took the time to answer questions from the floor, and I asked whether part of the $1.1 billion he appropriated for comparative effectiveness research in the stimulus bill could be used to study the effectiveness of Complementary and Alternative Medicien (CAM) treatments.  Harkin had indicated at the Senate hearing that he was “afraid” this money would be used simply to compare one kind of allopathic treatment against another.  Apparently, there is nothing in the stimulus package language requiring that CAM treatments be included, but Harkin was receptive to the suggestion.

Harkin didn’t mince words at the Senate hearing in an impromptu assessment of the National Center for Complementary and Alternative Medicine (NCCAM) at the NIH, an office that he spearheaded and funded through the Senate Appropriations Committee.  “One of the purposes of this center was to investigate and validate alternative approaches,” he said.  “Quite frankly, I must say publicly that it’s fallen short.  The focus, quite frankly, has mostly been on disproving rather than seeking out and improving” alternative therapies.

The next day, Harkin told the Summit that he thought the time has come to rename NCCAM:  instead of the National Center for Complementary and Alternative Medicine it should be called the “National Center for Integrative Medicine,” he said. 

Previous to his arrival, there had been much discussion at the Summit about the need to move away from the concept of “integrative medicine” and toward “integrative health care,” a term more inclusive of non-physicians.  “Why not call it the National Center for Integrative Health Care?” someone asked Harkin.  He seemed to agree, and wrote down the suggestion on his notes at the podium. 

“Let’s disentangle from the status quo and get health care reform done right this time,” he said.

The question is whether those who attended the Summit will take the enthusiasm home with them, and take time off from their practices to actually begin lobbying and agitating for change.  Those who are profiting from the current broken system -- the AMA, health insurance companies, big Pharma – will be spending hundreds of thousands  (and possibly millions) of dollars to make sure their “voice” is heard.  Their “First Amendment right,” as the spokesman for the Chamber of Commerce so poetically put it, will be amply represented. 

Who will speak for us?  Don’t look to the right or the left:  there is nobody there!  If you want to make sure that integrative health care is really included in this health care reform effort, you’re going to have to put the sweat equity in yourself.  If we don’t get ourselves, our clients, our friends and colleagues organized now, we’ll have no one to blame but ourselves.

Call your Senator. 

Call your Congressman 

Write the Integrator Blog and tell John Weeks who you’ve called, and what the response was! 

As Hillel once said:  “If I am not for myself, who will be for me? If I am not for others, what am I? And if not now, when?”

Daphne White is a Certified Healing Touch Practitioner with additional training in trauma release work. Daphne also practices a powerful form of trauma release work called Somatic Experiencing.Using one or both of these techniques, Daphne helps clients alleviate chronic pain conditions; reduce anxiety and increase the body's relaxation response; recover from painful childhood accidents; strengthen the body's immune system; prepare or recover from surgery; heal trauma from car accidents, whiplash and falls; and more.