About the first thing one is taught in medical research is that there are hierarchies of evidence and that the “RCT” (randomized controlled trial) sits on the Iron Throne. What the integrative user of multimodal, individually-tailored approaches immediately feels is estrangement and resentment at rules that seem form-fit for pharma. Can integrative even get an audience in such a court? Now the American College of Lifestyle Medicine (ACLM) and the True Health Initiative led by Yale public health, integrative, and lifestyle medicine leader David Katz, MD, MPH have published a model that seeks to take the RCT’s down a notch. It’s a diversity play. They recommend a “systematically weighted approach” involving multiple research models that “(increase) the weight and thereby validity of evidence specially applied to lifestyle interventions.” I reached Katz for an interview in which he spoke to the model’s relationships to integrative whole system research models and of the “tyranny of the RCT”. He shares intriguing political, strategic and tactical dimensions to lifestyle medicine’s Hierarchies of Evidence Applied to Lifestyle Medicine (HEALM).
The number of acupuncturists employed in federally qualified health centers (FQHC) is no longer negligible yet still far from routine. The number who have that experience and have also served their state as members of technology review panels charged to evaluate the science behind non-pharma approaches to pain may be just one. The person doing both in what is essentially a national pilot program in the state of Oregon is Laura Ocker, LAc. I got in touch with Ocker, the past president of the Oregon Association of Acupuncture and Oriental Medicine (OAAOM, for an acupuncture practitioner’s perspective on practicing in the context of the controversial program that led national pain leader Sean Mackey, MD, PhD` to spark a national campaign to limit its expansion. While not fond of the spotlight, Ocker agreed to share some of her experience as part of this ongoing Integrator series.
An organization that sees its mission as larger than its present reach hits natural barriers if it uses an association management firm. The management organization is not an “association growing” firm. Nor is the firm devoted solely to the association. In fact, the management firm’s financial incentive structure is akin to that of a fitness center: the best member is one who pays dues and never requires anything. It’s job is to manage and control something that, optimally is passionate, dynamic, and slightly out of control because it is actively flourishing in multiple directions. These disparate tendencies came to mind as good news arrived December 21, 2018 – Solstice Day – that arguably the most powerful engine in the integrative space, the Academic Consortium for Integrative Medicine and Health (“the Consortium”), completed a transition away from an association management firm to its first, 100% time, fully devoted executive director.
At one point over the past three years of robust expansion of dialogue related to chronic pain care I received a somewhat panicky email from an integrative care advocate. He was concerned that by me speaking of the “opportunity” for integrative health produced by the US’ enthrallment with opioids that his field would be tainted as “opportunists.” Fact is, the dialogue over right use of “non-pharmacologic” practices and practitioners in chronic pain treatment has provoked a quantum opening in many quarters. This article shares an invitation to a December 4-5 workshop at from the National Academy Medicine (NAM) – the most robust inclusion of integrative health there since the 2009 Summit. Also included: another positive development at NAM, and first notes of advances at AIPM’s recent Integrative Pain Care Policy Congress. The bad news of the opioid crisis is proving very good for opening needed dialogue.