The Integrator article two issues ago on Google’s activities that precipitously gouged traffic at key websites (Self-Interested Whims of the Oligarchs: Google and Facebook Kill Access to Alternative and Integrative Medicine) immediately drew a range of responses. Longtime medical journalist Erik Goldman shared the remarkable diminution of traffic at his Holistic Primary Care site. Some spoke of organizing efforts. At the same time, other good analyses have been published. New information regarding Google’s growing partnerships with members of the medical industry and particularly pharmaceutical giants has come out. And there is an interesting coincidence of Google’s choice of dance partners as it matures and measures it global strategy and the corporate decision to excise its cheeky formative promise to “Don’t Be Evil”. Is it time to wonder whether there is a next level war for access emerging?
About the first thing one is taught in medical research is that there are hierarchies of evidence and that the “RCT” (randomized controlled trial) sits on the Iron Throne. What the integrative user of multimodal, individually-tailored approaches immediately feels is estrangement and resentment at rules that seem form-fit for pharma. Can integrative even get an audience in such a court? Now the American College of Lifestyle Medicine (ACLM) and the True Health Initiative led by Yale public health, integrative, and lifestyle medicine leader David Katz, MD, MPH have published a model that seeks to take the RCT’s down a notch. It’s a diversity play. They recommend a “systematically weighted approach” involving multiple research models that “(increase) the weight and thereby validity of evidence specially applied to lifestyle interventions.” I reached Katz for an interview in which he spoke to the model’s relationships to integrative whole system research models and of the “tyranny of the RCT”. He shares intriguing political, strategic and tactical dimensions to lifestyle medicine’s Hierarchies of Evidence Applied to Lifestyle Medicine (HEALM).
The idea that “the first is the last and the last the first” was a value in my liberal Protestant upbringing. It likely had some noblesse oblige in it too. The concept can be challenged as an entrapping promise that good will come of waiting. Regardless, in some the call to work with the least-cared-for becomes a guiding mission. Self-preservation of the integrative field may be another motivator of such a mission. A past head of the NIH agency that researches integrative practices has challenged the main body of clinical research as un-generalizable due to the research being on upper income, well-educated, white, female patients. For a multitude of reasons, Integrative Medicine for the Underserved (IM4US) has emerged as the leading edge of the movement for integrative health.
I sometimes refer to my 1983-1993 years with the re-emergence of the naturopathic profession – amidst the broader social-medical movement that birthed integrative health – as my boot-camp. Given the decade duration of the commitment, it was more of an extended Marine Corp stint. The work was hard, ground won celebrated, compensation scarce, friendships fierce, and mission central. The pole star was the naturopathic profession’s commitment to “treat disease by restoring health.” The constellations that guided the voyage were a set of principles and something educators Jared Zeff, ND and Pamela Snider, ND would articulate as the “naturopathic therapeutic order.” So when the Association of Accredited Naturopathic Medical Colleges (AANMC) recently posted an updated version of the profession’s therapeutic order, I thought it a good time to re-visit the engine room of that field’s transformational work.