Caught up in a movement, one likes to assign causality to explain advances. A pressure applied in one place brings movement in the other. The set of collaborating entities manage to get to a policy table and push something positive through. A story begins to accumulate. Yet a close reading finds also influences of what that ancients might have called fate. The New Age may associate these with intention. I enjoy thinking of these as serendipity. I have accumulated a few favorites for the integrative health and medicine field. They begin with the circumstance of my own connection. None is more striking than that which I encountered in a new publication on the influential Wilk vs. the AMA trial that muzzled the AMA’s worst bigotry toward non-pharma approaches. It turns out that L Ron Hubbard, the founder of Scientology, may be credited with opening the integrative era.
The chain of events through which I got involved
Google dictionary defines serendipity as “the occurrence and development of events by chance in a happy or beneficial way.” Given my good fortune in finding my way into this work the past 37 years, the steps that got me here are a personal example. When I was working in and out of staffing in the Washington state legislature and as a freelance reporter in the late 1970s and early 1980s, I was instrumental in pushing a Seattle Sun endorsement toward the charismatic and slick Art Skolnick and away from a longtime human services activist named Dave Wood. My position on the endorsement was a little challenging as I vaguely knew the more moderate Wood who was a business acquaintance of my father.
Within a few months, I realized I’d been played in my interview by Skolnick. Rookie error. I called up Wood and invited him to lunch. I apologized for my position. We began a friendship. Two years later, in the fall of 1983, I was between things, trying to write a song cycle, driving taxi, not comfortable merely being a critic in my political work and writing. I began to mention to a few people that if they knew of anything that was aligned with my values that I might help build, that maybe I was ready to exit the cab. Dave told me about a very limited part-time position at a place I’d barely heard of, in a field about which I knew virtually nothing, and about which I had no particular passion: John Bastyr College of Naturopathic Medicine. I discovered values that were consonant with my own, and terrific people working to advance them. The rest is history. If I hadn’t called up Dave, what would the past 37 years have held for me? Serendipity.
The state of Washington’s influential “Every Category of Provider” law
Such fates played their invisible hands in two big ways in the rich integrative activity that burst forward in my home state of Washington, making it an early learning ground in integration for the nation. A Democratic legislature under a super-liberal Governor Mike Lowry passed a full-blown, Clinton era “managed competition” healthcare plan. Legislators determined that, since it would cover the whole state, that all insurers would have to include “every category of [licensed] provider.”
The pressure to pass managed competition did not come from the integrative field. Nor did the decision to include all types of licensed practitioners. The language was put there by professions with more clout than ours who wanted to make sure that not just medical doctors, but also nurses, mental health counselors, physical therapists, occupational therapists, psychologists, and etc. be included. Yet the language selected to secure places for these professionals also opened the door for others. Five other licensed fields got a free ride into into the room: chiropractors, naturopathic doctors, acupuncture and East Asian medicine professionals, massage therapists, and direct-entry, Certified Professional Midwives. The inclusion did not follow legislative debate over the merits of coverage. This big jump in recognition, that became a frequently studied model for the nation, was about being in the right place at the right time. Serendipity.
Just the right Insurance Commissioner at the right time
Washington State’s licensed “CAM” professions had no role in getting Deborah Senn elected as Insurance Commissioner. Yet when the state’s politicians, major medical delivery organizations and, above all, insurers, began trying to figure out ways to make sure “every category of provider” didn’t really mean those 5 non-pharma fields, there happened to be in office a politician who may well have been the most powerfully consumer-focused insurance commissioner anywhere in the United States in the 20th Century. Characterized by a tenacity she credited to her Chicago upbringing, and with a mother who was in the care of naturopathic physician Bruce Milliman, ND, Senn became the insurers’ worst nightmare. The attorney by training and a justice campaigner by nature, beat them in court, beat them in the legislature, and beat them on the streets of public opinion. Senn forced their chief medical officers into an intensive, two year process of interprofessional learning called the Clinician’s Workgroup on the Integration of CAM. Through work principally of what is now the Kaiser Permanente Washington Health Research Institute with renown integrative health researchers such as Dan Cherkin, PhD and Karen Sherman, PhD, the state’s experience, from credentialing through cost-effectiveness, became a learning zone for the nation. All close observers agree that, had Senn not been Insurance Commissioner, the statute would have been as ineffectual as the basically forgotten “Non-Discrimination in Health Care” Section 2706 of the Affordable Care Act. We didn’t elect her. Senn was a gift. Serendipity.
How about if integrative health’s best friend in Congress happens to control healthcare appropriations?
Former Iowa Senator Tom Harkin (D) is the member of Congress who was, from 1991-2014, the leading political champion for the complementary and integrative health and medicine fields. His mentor, former Congressman Berkley Bedell (D) had a personal interest in medical alternatives. The story is that Bedell got Harkin interested and Harkin found bee pollen useful for his allergies. Harkin happened to be in the power seat for healthcare in Congress as chair of the Senate Sub-Committee on Health, Education, Labor, and Pensions of the US Senate Appropriations Committee. In 1991, Harkin attached a $2-million rider onto a major appropriations bill that led to the founding of the Office of Alternative Medicine and the National Institutes of Health. Committee chairs could easily do that. (When our enemies do this, we call it “pork-barrel politics”.) He subsequently supported increases in the office’s funding . He became the principal backer, in 1998, of the legislation that created what is now the NIH National Center for Complementary and Integrative Health, with its present $150-million of annual funding. Like Senn, Harkin was a battler for just causes, even if such causes were disparaged by his colleagues. The integrative health field did not put him in his powerful seat. Yet at the moment of the arrival of the integrative era, there Harkin was, the most powerful person in Congress on health care, ready to champion the field. Serendipity.
L. Ron Hubbard, Scientology, and ending the AMA’s conspiracy against chiropractic and non-pharmacologic approaches
Wilk versus the AMA was an underappreciated, powerful influence on the path to interprofessional civility required for anything remotely like “integrative health” to flourish in the US. It forced the AMA to “heel”. The story on the street was that a disgruntled medical doctor inside the AMA who would be dubbed “Sore Throat” began priming members of the media with evidence of an AMA conspiracy against chiropractic. The 13 years of courtroom activity, led to a series of decisions that the American Medical Association illegally conspired to “contain and eliminate” chiropractic. The courts described a concerted campaign that involved rules from the AMA’s House of Delegates, the Joint Commission, the American Hospital Association, and multiple state and national medical professional organizations that made it illegal to associate in any way with a chiropractor. They found that it was the AMA’s economic protection rather than protection of the public that was the prime motivator. For the broader integrative health field, it is important to realize that the AMA’s basic stance, while targeting chiropractic above all, was not chiropractic specific. Other non-pharma approaches that didn’t fit bio-medicine’s model were also contained in the AMA’s “quackery” and “fraud” nooses. The loss, eventually in the United States Court of Appeals for the 7th Circuit, ended the hot-war of the AMA’s medical apartheid. It popped open the integrative opportunity.
A new history of the case reveals what can only be viewed as a hilarious twist to this story. It turns out that”Sore Throat” was not a disgruntled medical doctor. Rather, the source of the documents that revealed the details of the AMA’s conspiracy was the founder of Scientology, L Ron Hubbard. Hubbard was upset that the AMA did not accept Dianetics and Scientology as a legitimate field. Hubbard became convinced that the AMA was conspiring to destroy Scientology. He placed members of his church in employed positions in AMA offices in Chicago and Washington, D.C. These began rifling through AMA files in off-hours to find evidence of the presumed anti-Scientology conspiracy. The AMA’s “Committee on Quackery” was an obvious place to look. Hubbard’s people didn’t find the conspiracy that they sought. They did however discover a conspiracy: the AMA’s detailed strategy to “contain and eliminate” chiropractic. The stream of pilfered materials led to changes in AMA policies, withdrawal of rules again association. The AMA would no longer openly blast chiropractic or any other field of medical alternatives as “quackery” and “fraud.” The evidence that forced the AMA’s hand did not come from inside the integrative practice fields. Nor was it even a disgruntled medical doctor. It was the effect by which one accidentally stumbles upon something truly wonderful while looking for something entirely unrelated. Serendipity.
The process of advancing appropriate integration has faced its share of obstacles, the worst of which is a production-oriented medical industry in which the last thought too often is toward health and well-being. Burdened as the field is with that oppressive antagonism, it is useful to note be grateful for the places where, depending on one’s world view, Gods and Goddesses smiled mightily, fates intervened, or good karma was attracted good fortune. Serendipity. Thanks for your paranoia, Ron.