When a global scientific community for traditional, complementary and integrative medicine emerged 20-years ago, it declared for the importance of what it called “whole systems research” (WSR). Such exploration was declared as core mission of an organization, ISCMR, formed to network the community. It was formed in contra-distinction to reductive, single agent trials that were then a relatively unchallenged “gold standard” for research. Researchers associated with chiropractic, naturopathy, acupuncture and other licensed integrative practice fields prioritized such research in a 2009-2011 campaign to influence the priorities at what is now the NIH National Center for Complementary and Integrative Health. Academic integrative medical doctor researchers called for it. Yet now a special issue of an integrative health journal – available entirely in open access to the public – is questioning whether steam is left in that thrust – and whether, ironically, such interest is dissipating at a moment of potentially broader embrace.
The news broke last week that the physician most associated with the term “integrative medicine”, Andrew Weil, MD, had donated $15-million to fuel the work of what is now known as the University of Arizona Andrew Weil Center for Integrative Medicine. The donation comes on top of $5-million Weil has already gifted the program he founded over two decades ago. In October 1996, I met him during a small symposium on the coverage issues in integration co-sponsored by the National Institutes of Health and Weil’s nascent program. (For perspective on one of the program’s influences, it was held in the first week of work of the individual Weil chose as his program’s first executive director, Tracy Gaudet, MD, now head of the VA’s Office of Patient Centered Care and Cultural Transformation.) A time of beginnings. The huge gift seemed a good excuse to connect with Weil on his generous bequest, and to ask him to muse on developments in an “integrative” field that in 1996 had just been birthed as such. This article reconstructs some of that conversation.
Spoiler alert. The title of a recent column marking the 10th anniversary of Triple Aim efforts to move medical payment and delivery from volume toward value makes no bones about the effort’s shortcomings. This report card from the Triple Aim’s top cheer-leader is meaningful to the high touch, human-intensive movement for integrative health and medicine for one important reason: the field’s potential uptake is pegged to advance of the values orientation. Success is more broadly meaningful because the values-based war against the forces in the industry that causally associate it with 250,000 medical deaths each year – effectively medicine’s white walkers in Game of Thrones terms – is the bullseye point of reference on what is at stake.
The budding 2020 presidential primary season for Democrats is already focusing on health care. Some advocate for single payer. Others don’t. The prospective force of the issue was underscored on February 27, 2019 when Congresswoman Pramila Jayapal (D-WA) and 106 Democratic co-sponsors introduced Medicare for All legislation. For those involved in the movement to shift US health and medicine toward an integrative model, a question arises: What might be expected, given existing US experience, for coverage and inclusion of integrative health and medicine services if single payer legislation becomes the law of the land?