Sometimes synergies call for a solid moment of appreciation. In early 2019, Delia Chiaramonte, MD, an educator and integrative doctor who works in palliative medicine pinged me under my journal editor hat. How about a special issue of JACM-Paradigm Practice and Policy Advancing Integrative Health to highlight “integrative palliative care”? I liked the idea. I also knew that Chiaramonte, principally a clinician-educator, would be served to have a partner with more research experience. Two days later, Shelley Adler, PhD emailed me. The UCSF educator with fine research chops informed me she would be co-author on the next in a series of quarterly JACM commentaries from the Osher Collaborative for Integrative Medicine. The subject: the integrative-palliative intersection. Last week the JACM special issue was published with the Chiaramonte-Adler dyad offering the introductory editorial as curators and guest editors. The entire issue is in open access for a month.
In academic medical centers promoting transformation toward integrative medicine and health, nurse leadership is rare. So is branding them with “spiritual” and “healing”. The usual chess game of change-making focuses on moving RCTs and systematic reviews like pawns to gain an advantage. Honoring the full professional value of licensed acupuncturists, chiropractors, naturopathic doctors and others is also rare. Most find it easier to gain the support of a dean by reducing such professionals to tools to deploy instead of as interprofessional partners. This year marks the 25th anniversary of an institution that modeled a road less traveled that included these and other distinctive, inclusive traits. The founder-director is nurse and health services researcher Mary Jo Kreitzer, RN, PhD, FAAN. I reached her for a long-overdue profile of a center that a close observer of the field has called “one of the most important centers globally for advancing integrative health.”
Tracking the inclusion of integrative strategies inside the Veteran’s Administration (VA) is an exception to the saying that a watched pot never boils. Integrative health research inside the VA funded in 2016 was the basis by which VA leaders chose 3 years later to more than triple the implementation of the “whole health” model to 55 medical centers. It was cause to exult. Now a special issue of the American Public Health Association journal Medical Care documents a further percolating of the inclusion process. With The Implementation of Complementary and Integrative Health Therapies in the Veterans Health Administration, one witnesses the powerful potential for change when a will is linked to a plan and a budget. The success at the VA casts cold light on the relative failure of reduction-oriented and production-minded public and private agencies to guide optimal implementation of integrative practices and practitioners into the delivery institutions on which the vast majority of U.S. citizens rely for their care.
Many years ago, an integrative colleague and adviser – my spouse! – explained something to me about an important part of her lengthy integrative intake process. The time is needed to build trust to have the patient divulge what is going on at the time a chronic condition set its hooks so that the freeing might commence. The past half-century was witnessed a slow, cultural recognition of the power of trauma in micro and macro ways. The “shell-shocked” of WWI became, post Vietnam, a potentially actionable PTSD. The women’s movement opened the lid on pervasive sexual abuse, emotional abuse, and rape. Adverse Childhood Experiences (ACES) emerged as powerful determinants of life chances and choices. George Floyd’s murder ripped open reckoning on police battery, slavery, Jim Crow, red-lining, and mass incarceration.