In the United States, the complementary and integrative medicine dialogue about “traditional medicine” typically looks to Asia. The West-meets-East orientation respects the power and influence of Chinese and Indian traditions. Yet in doing so, both local indigenous practices and the roles of traditional, complementary and integrative medicine (TCIM) in Mexico, Central America, South America and the Caribbean are mostly overlooked. The Pan American Health Organization (PAHO) recently created a partial remedy for this hemispheric forgetfulness. A two-year collaborative process with representatives of over 20 nations has created a powerful network and opened access to a nation-by-nation bounty of practices, papers, research, and regulations.
When Oregon announced in 2016 that it would shift its back and neck care for Medicaid clients from opioids toward acupuncture, spinal manipulation, massage, yoga therapy and mind-body methods, it was heralded as a breakthrough for pain treatment nationally. Inside that policy was a mandate many now consider even bigger news. Doctors were required to totally taper patients off opioids. A backlash propelled by a letter signed by over 100 conventional pain academics nationwide – plus with one notable signer from the integrative pain community – stopped Oregon’s planned expansion of the model in its tracks. While there are good reasons for caution on mandatory tapering, the one-sided reactivity missed a chance for practitioners and patients alike to gain more experience with non pharmacologic tools to rein in the known abuses associated with opioids.
Seven years ago, David Fogel, MD set the goal of proving what he hoped could be a primary care cornerstone of a transformed system of health care. With a generous philanthropic grant, he and his spouse Ilana Bar-Levav, MD created a team-based integrative health patient-centered medical home (PCMH). To give it power as a national model, the integrative PCMH was fully webbed into the emergent accountable care and value-based system. Early cost and health outcomes at their CHI Health Care significantly outperformed conventional practice metrics. They drew a visit from a US Surgeon General who was in search of innovative, value-based models. Yet now comes news that on July 23, 2019, the Center will shut its doors. An apparent guiding light for health system transformation will be snuffed. What gives?
I recently gave a commencement talk at Northwestern Health Sciences University, the day before Episode One of the last season of Game of Thrones. I chose to inject the sacredness of that day by referencing that other world by presenting the landscape of health and medicine that the graduates were entering as a jockeying between three Houses. In power on the Iron Throne: the House of Volume/Industry. The other two Houses are each insurgencies: the House of Integrative Health and the House of Value-Based Medicine. Can this life-and-death game play out favorably with an alliance between the two insurgencies in a field of health creation?