Word began to break mid-summer of two developments at the Veteran’s Administration related to the giant agency’s integrative whole health effort. One was that Tracy Gaudet, MD, the charismatic founding director of the VA’s Office of Patient-Centered Care and Cultural Transformation that birthed the initiative was moving on. The immediate response of many is concern. Yet the news came concurrently with word that the VA’s initiative is expanding from the initial 18 to 37 new sites. Even with leadership change at the top of the VA, the initiative is secure and strongly supported. I connected with Ben Kligler, MD, MPH, Gaudet’s colleague who is presently acting director for an update.
Most involved in integrative and functional medicine have by now heard of how traffic on scores of integrative health and natural products websites dropped 50%-95% via the cutting stroke of changes quietly made by Google leaders. I summarized and commented on the reporting of others in Self-Interested Whims of the Oligarchs: Google and Facebook Kill Access to Alternative and Integrative Medicine. The bias in the title was my judgement based. More questions than answers remain. I chose to explore further via a colleague of 30 years, medical writer, Erik Goldman. The traffic at his relatively conservative website, Holistic Primary Care (HPC), the hard-copy broadsheet for which he serves as founding editor, was one of those whacked. Goldman, who will host a panel on the Google issues at HPC‘s “Practitioner Channel Forum” (April 23-24 at the TWA Hotel at JFK Airport) offers a look under the covers at Google’s actions that seem to have motivations somewhere between unintended consequences and an external pernicious influences of the first order.
The decision of the Cleveland Clinic to start a Center for Functional Medicine was big news. That the $9-billion system gave the initiative significant visibility suggested arrival for functional medicine. A few hurdles still existed. Cleveland Clinic’s new partners needed to clarify and create a clinical model that could be measured. That was the caveat. This Center was a bet – a pilot based on a largely untested belief that functional medicine could outperform regular medicine, and at lower cost. Most in the field assumed this would prove a slam dunk. Care from a team of functional medicine physician/nutritionist/health coach and then behavioral specialist became the unit for which outcomes would be measured. Now in a publication in JAMA Network, the first results are in. The headlines were positive – but what do the data really say?
Long-timers in the integrative trenches will know the paradoxical feelings of dismay at how messed up health care still is and at the same time satisfaction at just how far “integration” has advanced. Evidence for the latter comes from not one but two recent moves in the career of chiropractor and health services researcher Christine Goertz, DC, PhD. Place yourself in 1988. The chiropractors were just concluding their decade-long, successful Wilk vs. the AMA anti-trust suit. Most of medicine and much of the media – in part because of the AMA’s economically-driven attacks – equated “chiropractor” with “quack”. Now consider where Goertz has arrived via her health services research and policy career that focused on safety, effectiveness and quality issues. She was recently named by the General Accounting Office as Chairperson, Board of Governors, for the Congressionally-funded, quasi-public Patient Centered Outcomes Research Institute (PCORI). And Goertz just began a new role as Professor and the Director of System Development and Coordination for Spine Health at Duke Health in the Department of Orthopaedic Surgery. I reached Goertz to talk with her about her dual ascension.