The idea that “the first is the last and the last the first” was a value in my liberal Protestant upbringing. It likely had some noblesse oblige in it too. The concept can be challenged as an entrapping promise that good will come of waiting. Regardless, in some the call to work with the least-cared-for becomes a guiding mission. Self-preservation of the integrative field may be another motivator of such a mission. A past head of the NIH agency that researches integrative practices has challenged the main body of clinical research as un-generalizable due to the research being on upper income, well-educated, white, female patients. For a multitude of reasons, Integrative Medicine for the Underserved (IM4US) has emerged as the leading edge of the movement for integrative health.
Cast a net for papers on “innovations in group-delivered services” and what do you get? Guest editor Maria Chao, DrPh, MPA summed up the nearly 40 submissions this way: “Our editorial team was struck by the heterogeneity of integrative group visits for a range of health conditions, serving diverse patients across the life course and implemented in varied healthcare settings. A unifying theme is the potential for integrative group visits to address unmet needs of underserved and vulnerable patients. In many ways, group visits serve as a critical model towards integrative health equity.” The commentaries and research articles in the JACM Special Focus Issue on Innovation in Group Delivered Services make a potent case for an expanded role for groups not just for those who can pay cash but for all populations in a transformed healthcare system. All the articles are in open access until August 25, 2019.
I recently gave a commencement talk at Northwestern Health Sciences University, the day before Episode One of the last season of Game of Thrones. I chose to inject the sacredness of that day by referencing that other world by presenting the landscape of health and medicine that the graduates were entering as a jockeying between three Houses. In power on the Iron Throne: the House of Volume/Industry. The other two Houses are each insurgencies: the House of Integrative Health and the House of Value-Based Medicine. Can this life-and-death game play out favorably with an alliance between the two insurgencies in a field of health creation?
A significant trend is appearing in major research organizations on integrative health and medicine. The timing is right: in the United States, major reports, meetings and guidelines now include non-pharmacologic, a.k.a. integrative approaches. But how do we move these into practice? Top acupuncture, integrative oncology and general integrative health conferences are featuring what is called “implementation science.” This study of methods to promote the integration of research findings seeks to propel changes in healthcare policy and practice. The integrative trend arises amidst a renewed push for health services research of all kinds. Action on these lines can straighten out some twisted karma relative to the 1998 US Congressional legislative mandate that established the globe’s most significant scientific investment in alternative, complementary and integrative medicine.