Virtually every corner of the medical industry houses an entangling drama between mission and money. There is the service, the need to make a living, and then the way making a living can transform into a production orientation dominated by the impulse to make more money. For integrative health and medicine, the drama is intense, whether in integrative centers owned by large institutions or solo practices in the community. The mission-money challenges get “curiouser and curiouser” for the licensed integrative practice fields that are not fully swept up into the thundering $3.3 trillion river of cash that annually rips through the dominant medical industry. An edginess sets in when, as the sick joke has it, you have just enough recognition to get into debt, but not enough to get out of it yet. So it is always interesting to explore new data on income and practice methods such as were recently published by the Association of Accredited Naturopathic Medical Colleges in it’s 2020 Graduate Success and Compensation Study.
In recent weeks, two influential integrative health organizations each chose to feature presentations on the expansive, multidisciplinary, and remarkably patient-choice integrative pain pilot associated with the University of Vermont Medical Center (UVMC). The presentations for the Academic Consortium for Integrative Medicine and Health and the Alliance to Advance Comprehensive Integrative Pain Management (AACIPM) featured the project’s remarkable, multi-stakeholder partners: the state’s dominant payer, Blue Cross Blue Shield, the Vermont Department of Health, and the academic medical center. Included in the latter was the project’s research leader, longtime integrative health policy activist and prior NIH National Center for Complementary and Integrative Health adviser Janet Kahn, PhD, LMT. The parties shared early outcomes from the unique bundled payment model. Many consider the strategy a potential pilot for the nation. What is being discovered? Can it be implemented elsewhere?
Health creation. Transformation. From reactivity to well-being. Empowerment. From system-centered to person-centered. Using the least force. Changing the therapeutic order of the nation. These aspirations warm and power the integrative health movement, dreams on the long march for radical re-direction of a $3.5-trillion industry. Yet how often do change prescriptions meet the radical requirements of the dreams? Acupuncture in Medicare doesn’t do it. Nor non-pharma into chronic pain guidelines. In The Community Cure: Transforming Health Outcomes Together, Evolution of Medicine impresario James Maskell offers a re-framework that seeks to rise to the task. Maskell grounds his “cure” in group services models through which the medium is the message for a population crippled by loneliness.
In July 2019 I published a piece entitled Harvard Medical School Grand Rounds Powerfully Interlocks Integrative Medicine and Climate Agendas. It was based on an event led by Peter Wayne, PhD. Now Wayne and two colleagues with the Osher Collaborative for Integrative Medicine have published a related commentary that makes a direct claim in its title: Integrative Medicine Is a Good Prescription for Patients and Planet (in open access throughout January). The authors initiate an intriguing and expansive case for myriad ways that this assertion may be so. For instance: how might an increase in mindfulness diminish shopping addiction, and thus resource consumption? This column is a call for your perspectives of up to 250 words on angles and arguments that support – or oppose – that bold claim. I will select from and publish responses along with photos and brief bio data of contributors in a future Integrator piece. The findings are meant to deepen an evidence-informed dialogue on this topic. Might the integrative health-climate change connection re-frame much more broadly the transformative meaning of this movement?