The Integrator Blog News & Reports annually marks the winter solstice with a Top 10 list for integrative health and medicine. The focus is on the coming of the light -- the (mostly) positive signs -- in policy and action from individuals and organizations in the field. Those for 2006-2014 are here and 2015 here. Below are the Top 10 for 2016.
1. The Opioid Crisis and Policy-Makers' Uneven Inclusion of Integrative Therapies and Practitioners
The Obama $1.1-billion plan. The CDC Guideline for prescribing. Congressional passage of initial legislation. The Surgeon General's entrance into the game. Throughout, we witnessed a surprisingly uneven entrance of the important role for integrative therapies and practices. Common sense here: why leave tools and approaches out? Chiropractic, naturopathic and acupuncture organizations worked to insert themselves in the dialogue. Credit the NCCIH for their timely Mayo publication on the scientific support for integrative pain care. Good news: thanks to the work of Matthew Bauer, LAc and colleagues, we know the AMA and other leading organizations are urging the "public and private payer policies must be fundamentally altered" to include more non-pharmacologic approaches.
2. Oregon Collaborative for Integrative Medicine Steps Up to Help Shift the Nation's Therapeutic Order in Pain Care
Individual states are taking the lead on integrative opioid strategies. Vermont has new acupuncture Medicaid pilot. News will be coming soon from a Rhode Island integrative pilot. The key initiative, however, is in Oregon where their Coordinated Care Organizations are charged to reverse the therapeutic order in pain care and actually put integrative, non-pharma first. Coverage is extended to acupuncturists, chiropractors and more. Knowing the depth of this transition, for all parties, Samantha Simmons, MPH and the Oregon Collaborative for Integrative Medicine (OCIM- pronounced "awesome") have joined with the Oregon Pain Management Commission to step into the breach. We will all have a lot to learn. This pilot warrants major philanthropic and governmental investment.
3. Claiming a History for Integrative Health and Medicine: Rise, Bravewell Story, EvoMed, Plus
Two decades after "integrative" was named as a direction for medicine, versions of the field's shared history are coming forward. The Bravewell Story from Bonnie Horrigan captured the massive, 15 year influence of that collaborative of philanthropists. Early chapters in James Maskell's functional medicine-leaning Evolution of Medicine describe the shifts in medical understanding. My own chronicling found wide audience for exploring the shared history as captured in this slide desk from a plenary for the Academy of Integrative Health and Medicine, since refined at Duke, Georgetown, AMSA IM Scholars, and elsewhere. I propose five "eras" since the 1960s. Above all The Rise of Integrative Health and Medicine from FON therapeutics and Xymogen, with 125 milestones since 1963. If it is true, as Walter Benjamin wrote, that "history is written by the victors," then what are the chances for those with no history? Steps are being made to document, and weigh, the movement's history.
4. Glenn Sabin: Integrative Consultant and Marketeer Creates Rise, Writes N of 1, Produces Influential Blog
Over the past half-decade integrative center consultant Glenn Sabin has emerged as a powerful influencer in the field via his consulting, speaking and widely-read and utilized blog at his site, FON Consulting. This year Sabin branched out in big ways with two books. With his strong sense of the pulse on the field, Sabin conceived and organized the creation of Rise, #3 above, recognizing the value of history to the field. For me - who had the honor of writing the forward to Rise - Sabin's even more important contribution to the field is his remarkable journey that brought him personally, then professionally, to integrative health: N of 1: One Man's Harvard-Documented Remission of Incurable Cancer with Only Natural Methods. The tone, flow, layout and content all combine to hold the reader close. The gift of Glenn's engaging tale of working with top-tier conventional oncologists, leading integrative oncologists, pharmacists and others - including his spouse Linda as culinary medicinal agent! - is that one immediately begins thinking of "N of 1" as a verb. As in: How can I better "N of 1" this health issue of my own? What's my path? His path shines multiple lights on one's own. For the integrative health and medicine field, as for his cancer treatment, Sabin is an N of 1.
5. The Medical Industry's "Rounding Error" - Shuttering of Major Integrative Centers
To the budgets of the multi-billion juggernauts of the US medical industry inappropriately styled as "healthcare systems," integrative medicine is - as a colleague suggested recently - a "rounding error." And as has become clear over the past two decades of multiple shuttering of significant integrative centers, a profound economic misalignment exists between the "volume-based" and technology-driven industry and the mission-and-value orientation of relatively low cost, human-intensive, integrative care. Still it was a shock when word came out - apologies, I am part way into writing this story - that the powerfully influential Continuum Center for Health and Healing no longer fit into the plans of its parent, the $3.5-billion, plus, Mount Sinai Health System. Meantime, when the $7-billion Banner Health took over University of Arizona Medicine they showed no interest in the Phoenix-based Arizona Integrative Health Center where the Andrew Weil-founded Arizona Center for Integrative Medicine anticipated proving integrative health's business model as a low cost option for chronic disease. Be aware: another shoe is about to drop. Each, notably, was showing patterns of positive outcomes. Are these centers simply a misfit with the industrial focus of the volume based system?
6. Crucible for Transformation: Duke Leadership Program in Integrative Healthcare
If the present misfit of business models in #5 is a problem, then the critical response is to prepare leaders to understand this environment and figure out how to forge quality, and useful relationships and models. That, in a nutshell, is the mission of the Duke Leadership Program in Integrative Healthcare led by Adam Perlman, MD, MPH. This article on the program notes that the core faculty unites a deeply experienced team: Ben Kligler, MD, MPH, from Continuum (above), now with the Veterans Administration; Lori Knutson, RN, BCHN, formerly Penny George Institute, now Meridian Health; Horrigan, who brings in 20 years in the field as a publisher, editor, executive director and writer (see The Bravewell Story, above); and Perlman whose system work includes both St. Barnabas in New Jersey, and Duke. Faculty includes Melinda Ring, MD, whose clinical program is financially thriving at the Osher Center for Integrative Medicine at Northwestern. Perlman's Duke program, while still climbing toward the black financially, is hitting on key quadruple aim targets that make the values case. Clearly this leadership program at Duke program must, with each class, become an even more potent crucible for finding answers.
7. The Whole Person, "Kitchen Sink," Individualized MEND Protocol: The Ornish Progam for Alzheimers?
The data from the whole person, eclectic, exploratory and broadly integrative work with patients with Alzheimers of UCLA's Dale Bredesen, MD began coming out in 2014 as the MEND protocol: Metabolic Enhancement for NeuroDegeneration. Bredesen shared details of a ten patient case series that had nine successes, many remarkable. The chart of therapies is a classic "kitchen sink" integrative protocol for a complex patient: any agent or practice - 35 in this case - that might in some way support the healing. Then build from among them an individualized plan - with a high prioritization on a diet and sleep lifestyle combination. In 2016, a second publication, in Aging, stimulated a burst of media. Muses Labs, a business, with which Bredesen is no longer involved, is working on rolling out the clinical and research program nationally. George Washington University's integrative medicine program, led by Mikail Kogan, MD, became the first academic health center to offer MEND. The question arose: might MEND be the vehicle for elevating the value of an integrative approach to Alzheimer's the way that Dean Ornish's program brought them forward for reversing heart disease?
8. Toward a Global Movement: AIHM and European Anthroposophic Group Announce the "Stuttgart Declaration on Integrative Health and Medicine"
At the conclusion of a June 2016 international conference in Germany, the sponsoring organizations and over 600 participants issued the Stuttgart Integrative Health & Medicine Declaration. The document is a "call for action on governments, WHO and professional organizations" to sponsor and promote the integrative model as a solution to the global healthcare crisis. The sponsors are the USA-based Academy of Integrative Health and Medicine (AIHM) and the Dachverband Anthroposophische Medizin in Deutschland e.V. (DAMiD). The Stuttgart Declaration takes the important step of linking the "integrative" movement with the WHO-led efforts to bring primary care to all through more appropriate inclusion of traditional medicine products, practices and practitioners. The declaration does not have an action plan attached. It was posted here at Change.org and has attracted 6405 signatures. Not much yet, but a fine document and a start toward globalizing the movement.
9. Integrative Birth: New Hope in Bridging the Obstetrician-Midwifery Divide
The most awful evidence of medicine gone wrong is the way male doctors took birth away from midwives and natural process, put women on their backs, consigned them to hospitals, and took their newborns away from them. For starters. With c-sections still very high, the damage persists. Yet 2016 saw some steps in the right direction. The American Congress of Obstetricians and Gynecologists is finally softening its views on midwifery and homebirth. While their Committee Opinion on Planned Home Birth reiterates the perspective that out of hospital births are safest in birth centers, they acknowledge that "each woman has the right to make a medically informed decision about delivery." ACOG also endorsed global standards promoted by the National Association of Certified Professional Midwives NACPM), the professional organization representing the homebirth-focused, non-nurse midwives. Meantime, in another good sign, NACPM celebrates the first CPM to head the American Association of Birth Centers, Amy Johnson-Grass, ND, LM, LN, CPM, the organization's new president-elect.
10: The Backdrop of the Ongoing and Often Ugly Challenges of the Medical Industry
The year ends amidst debate over the future of "Obamacare." That 2010 law has positives, including expanded access, and for this field, inclusion - in language if not yet in practice - for the first time of integrative health ideas and practitioners. The downsides are the failure to control costs and the weakness in the transformational vision toward the medical industry. If anyone needed more evidence of the latter, 2016 produced. A Hopkins researcher published a review that concluded that medicine itself is the nation's 3rd top killer, at 251,000/year. Still tangled in efforts to be "evidence-based" and "patient-centered" and "value-based," the predominantly volume-focused industry was urged by Don Berwick to finally enter a "moral age." Awful levels of student, resident and physical depression and discontent are finally provoking action on health and wellbeing from the Accreditation Council for Graduate Medical Education (ACGME) among others. Then as though to make the point that the point has not yet been made, in December the ACGME took comments on its plan to expand the presently acceptable 16 hr work day to 24-28 hr work day for young physicians. The combination of the industrial focus on volume and production, reductive mindset of biomedicine, and the still shocking low level of quality evidence in most medical practices may be a "perfect storm" for guaranteeing this thinking, and outcomes. Integrative principles of person-centered, whole person care, drawing on all useful traditions, and using the least invasive first are exceptional guides for actual reform. These don't appear to be high on the list of the new administration. Hold on!
Credit Where Credit is Due: Westreich Foundation Makes This Reporting Work Possible
A final note of gratitude to Ruth Westreich who has had her own big year with the publication of for her Creativity Unzipped, the development of an insightful short video on the glyphosate-GMO relationship, and a first summit of the Consciousness and Health Initiative that she helped found. Ruth's foundation's support of the Integrator Blog News and Reports makes possible the week-in and week-out chronicling from which these highlights are plucked. Happy Solstice!