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.
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?
The way Joe Selby, MD, MPH tells it, the naming of the $3.2-billion Patient Centered Outcomes Research Institute (PCORI) – which from the outset had a charge to explore the comparative effectiveness of complementary and alternative medicine methods – was both serendipitous and brilliant. At the time the quasi-public agency was established as part of the Affordable Care Act, the idea of “comparative effectiveness research (CER)” a hot-potato for the medical industry. Medicine’s waste, morbidity, mortality and cost prompted interest in real-world, decision-oriented research. But powerful medical stakeholders were worried enough about the comparative effectiveness of their part of the status quo that elevating a “CER Institute” was not attractive. The patient centered name was a political compromise. It captured something of the real world. And what politician or stakeholder could oppose a name like that? In this interview at the end of his 9 year stint as PCORI’s founding executive director, Selby shares some of the “undeniable influence” – including at the NIH and the FDA and in discovering influences on cost savings that is growing out of PCORI’s active placement of patients at the table in decision-making.