The Integrator Blog News & Reports annually marks the winter solstice with a Top 10 for Policy and Action in Integrative Health and Medicine. In the selection of the Top 10, the accent is on the affirmative – as the jazz-man sings. Thus, the Coming of the Light focuses on individuals and organizations in the field making positive contributions to shift the medical industry toward a system that focuses on creating health. Less positive things sometimes make the list. Who would have guessed that 2020 might have some of these! Integrator articles are now published at johnweeks-integrator.com/posts with content going back to 2006 at the original Integrator site. Prior Top 10 lists, a sort of Cliff Notes of the movement’s history, are linked at the bottom of this column. Below are the Top 10 for 2020. Happy Solstice!
Note the “whole” in the first 3 of these. A betting-person might guess that we are moving toward a whole health framing for the movement going forward. Integrative health and medicine are tools. Whole health is mission.
Given a choice, one would rather have the world’s wealthiest woman be aligned with your cause. January brought news that Walmart heiress Alice Walton (Integrator #237) was forming a Whole Health Institute (WHI) in, of all places, her base and Walmart’s in Bentonville, Arkansas. The leader? None other than longtime integrative center leader, Tracy Gaudet, MD. Gaudet more recently founded the Veterans’ Administration’s stunning “Whole Health” program. (See #3, below.) In an Integrator interview, Gaudet revealed that the WHI plan includes taking the model into transforming civilian healthcare toward a whole health model. The depth of the commitment became evident when Gaudet attracted the nation’s most experienced builder of inpatient-outpatient integrative programs, Lori Knutson, RN, BCHN, to lead the charge into medical delivery organizations. Meantime, why not start a medical school shaped by the model? And what roles can public education have? They started an early partnership with Whole Health Ed, the consortium of health-oriented K-12 educators seeking to bring yoga-nature-mindfulness-nutrition and etc. into the institutional rearing of our children. Gaudet says the overall WHI strategy is to work through partnership and collaboration. Imagine if Walton decides to make an impact on health via WHI like Bill Gates made to biomedicine. We could see a fighting (read “funded”) chance to truly help regrade the ruts of the medical industry.
The 2019 Top 10 noted the first presentation of then first year NCCIH director Helene Langevin, MD on her interest in whole system research. Welcome that! It only took 20 years for the agency to begin to highlight the multi-modal models the agency was charged to examine. This year Langevin doubled down. The kick off for the public process for the agency’s 5th 5-year plan was a Langevin talk she called “Whole Person Health.” Three months later, she presented a more polished and thorough version as public webinar for the Consortium that originally was to be a plenary at a COVID-cancelled conference. Will it amount to much? Langevin notes that most agency funds are already committed. Reductive research relative to dietary supplements suck up a vast percentage of NCCIH dollars. And the agency’s ideas about “whole person health” research can seem as far removed from the original idea of whole practice and whole systems research of multi-modal TCM, naturopathic, functional and integrative practices as the definition of “nutrition” to the integrative community as a grade school dietician. Yet it’s a great direction for NCCIH and NIH in general. This is where the field, and Langevin can lead, not just the field but the nation The time is right, as the items #1 and #3 on this list make clear.
The thing about evidence that informs decisions is that first, it depends who is asking. And then on whether they have any interest in the answers. The US Veterans Administration is a “learning organization.” When the agency began the transformative “whole health” programs, they devoted a team of researchers to examining the delivery, up one side and down the other: effectiveness, cost, perception, implementation, change creation, and more. Early data convinced them in September of 2019 to triple the uptake into now 55 VA medical centers , earning them a #1 spot on the list last year. In 2020, the research team made public a huge body of research that propelled the decision. I wrote: Yes, Friends, the Medical Industry Can Be Transformed: The VA’s Whole Health System of Care at 2 Years. Seven months later, two top members of their teams, Rani Elwy, PhD and Stephanie Taylor, PhD, MPH guided to publication a special issue of Medical Care on finished implementation research. The learning organization’s outcomes provoked this: The VA’s Fast Track for Integrative Health from Evidence to Implementation: Reflections on a Special Issue of Medical Care. The work, led now by long-time integrative medicine change maker Ben Kligler, MD, MPH, stands as bold evidence that where there is a will, the evidence will inform the way toward a more integrated, whole health future. Most of us are shit out of luck, as the street would put it – and that’s where the medical industry, with its failure to fundamentally engage a learning organization frame, has put us. Whole is not being piloted. The questions are not being asked. The dominant medical industry’s continued entrancement with volume over value guarantees that the medical industry won’t be asking the right questions. It’s not an issue of evidence. There is no economic incentive. There is no will. It’s good the Veteran’s have it, inside their United Kingdom-style single payer, employed practitioner payment and delivery system.
A core challenge in the integrative field is the tilting, by non-coverage of services, toward attracting the cash-paying well-to-do. The field is thus riddled, from the get-go, with powerful, systemic inequities. In the last decade, the founding and investment in Integrative Medicine for the Underserved (IM4US) kick-started redressing these. With the potential of a new national accounting after George Floyd was murdered, over a score of integrative health organizations quickly announced solidarity with Black Lives Matter. Many made new commitments – covered here and here in the Integrator in June. Talk is cheap. But would this spike of passion be sustained? In December, I contacted leaders of those organizations for 300 word summaries of their action. These were published as Update on Actions from 18 Integrative Health Organizations and Institutions. Many made me proud. What do you think? It’s a long game. This is an important story to keep front and center. Celebrate advances of the deeply engaged. Prod the forgetful. Address the determinants. Reconcile. Heal.
The arrival of COVID brought a flurry of hope-filled action in the integrative health community. Might the absence of medicines and the long delay in awaiting vaccines be the commonsense context to finally provoke earnest official interest in natural health products and practices given all the significant evidence in like conditions? Lise Alschuler, ND and Andrew Weil, MD led a team that published the artfully headlined (no claims!) “Integrative Considerations During the COVID-19 Pandemic.” The NIH NCCIH, on the other hand, immediately warned people away from exploring. In an early Integrator interview, NCCIH director Helene Langevin, MD shared what can only be considered a paltry response, given the level of interest of citizens and in the practitioner community. (They’ve done more since, but not much.) Then the Federal Trade Commission (FTC) and the FDA began campaigns against practitioners and companies. The issues were claims and over-claims, and they had plenty of foreheads with bullseyes on them. Yet are these agencies pushing into suppressing speech between practitioners and patients? Credit the American Association of Naturopathic Physicians for their work separating wheat from chaff. The Integrator explored this work in FTC’s Crackdown on COVID Claims: Insights on Novel Regulation from the Integrative Canaries in the Coal Mine. Meantime, Eastern Virginia University clinician Paul Marik, MD led a charge nationally for an integrative protocol. He includes multiple natural agents that are gaining credibility such as D, C, zinc, and melatonin, explored in this Integrator interview. (It has been a peculiar co-existence that the wacky “self-physician” in the White House seems to have used the method – see Integrator #257.) Meantime, many wondered why the field hasn’t seized this moment to transform the medical industry’s structural-economic bias against supportive natural health methods. Most likely have never tried to make change. This is an honorable and awfully challenging mark!
The first big news about a possibly significant role for traditional medicine methods with COVID came out of China. The Chinese agencies and media reported that some 90% of their citizens used traditional methods for part of their care. And this was in the context of China reporting outcomes better outcomes in the general than the USA. China’s historic use of its traditional medicine as a tool of global power led some to question. (Never mind the parallel to the USA’s reductive focus on promoting its strength – biomedical solutions.) India set up infrastructure to promote and research its AYUSH methods (Ayurveda, Yoga, Unani, Siddha, Homeopathy – and naturopathy). Some are featured in this paper co-authored by a co-chair of India’s national AYUSH-COVID strategy (Integrator #251). Where the NCCIH gingerly entered the terrain, these nations funded scores of studies. Korea-based Integrative Medicine Research published an extensive special issue (Integrator #255). JACM published a series of articles, including one from a team from the Chopra Library on possible value of yoga and mindfulness (Integrator #253). The Integrator’s “Quick Links” popped with activity of governments throughout Africa. The WHO stepped in with a public statement supporting the potential value of Africa’s traditional methods, helping shape research agendas. These levels of interest and respect found their way to North America and Europe via social media. They began to seep into mainstream channels. Researchers from Portland, Oregon and Toronto, Ontario continue to co-lead a Traditional, Complementary, and Integrative Medicine COVID 19 Support Registry to capture basic outlines of how such practices are being used (Integrator #243). An awareness of potential additional options grew beyond what the dominant school in the USA would have in the conversation. A researcher out of the University of Shiraz, Iran, where researchers are looking at potential contributions from traditional Persian medicine, was among those who have convened a global webinar (Integrator #256). The emergent experience was of COVID helping create a growing global connection for the “TCIM” (Traditional, Complementary and Integrative Medicine) field.
A key to shifting medicine is getting more medical doctors educated to referring for and using integrative modalities and practitioners. Recent years mark chilling awareness that one after another long-time integrative CME provider was attacked by the Accreditation Council for Continuing Medical Education (ACCME). This led to a flurry of organizing when ACCME announced plans to make changes in their accreditation standards. Changes focused on what could be taught, who could teach, and conflict of interest changes felt as draconian. The ACCME threat produced useful internal reviews. Others appeared to be nothing less than bigotry – the dominant school blocking a rival necessary to nourish the integrative fields. The Integrator produced a 5-part series. The chair of the Consortium, Rick Hecht, MD, cautioned in an interview to not be paranoid, pleased that ACCMEs powerful executive director Graham McMahon, MD would be a guest at a coming Consortium meeting. A follow up Integrator interview with McMahon found him surprisingly friendly toward integrative medicine. He asserted that the field was not being targeted. Yet these fell flat amidst McMahon’s inability to point a finger at any other significant players in ACCME’s sights. I reviewed all evidence and concluded, that the ACCME actions had the blunt character of restraining trade ( ). At press time, ACCME released its new accreditation standards. One close observer felt that the field’s response may have positively shifted their “content validity” criterion. (More in Integrator #259, December 27.) One take home note is that the field’s top financial practice model is making life difficult. In-office pharmacies are not only creating problems with the FTC related to COVID, but with the ACCME relative to CME. This is not going away.
I decided to portray the work of Mary Jo Kreitzer, PhD, RN, FAAN and her team at the University of Minnesota Bakken Center for Spirituality and Healing on the occasion of their 25th birthday celebration. The process opened my eyes to the multitude of impacts the Center has in its environment: Mary Jo Kreitzer, PhD, RN and U Minnesota’s Bakken Center for Spirituality and Healing at 25 Years: An Homage. I decided to run a series through the end of the year. The second was a newer center, led by Francine Adan, MD, on the Connor Integrative Health Network associated with Case Western. Notable was Adan’s attraction of renown real world researcher Jeff Dusek, PhD and lauded organizer of the cats called acupuncturists, David Miller, MD, LAc. Check where they may be headed at Where the Rock n Roll Hall of Fame Meets Integrative Medicine: University Hospitals’ Connor Integrative Health Network. Third was a center known among the Consortium of such centers as a successful primary care integrative clinical model. It is directed by internist Melinda Ring, MD, who is also a key informant on the ACCME issue, above: “Show Me an Example of Where They are Really Doing Anything” – A Look Under the Hood at Integrative Medicine at Northwestern.” Next was an examination of the 20-year old research-first “Mayo method” guided by Brent Bauer, MD and kicked off through a grant from Lucy Gonda: Two Decades of the Mayo Model of Integrative Medicine: The “Societal Thing” and “Philosophic Challenges” The most recent has little to show clinically but is without parallel as the most powerful global influence in academic medicine. It was founded by Andrew Weil, MD in 1994 and guided since 2000 in partnership with Victoria Maizes, MD: The Andrew Weil Center: Primary Engine for the (Global) Growth of Academic Integrative Medicine. Next up: the academic medical center that published in 1993 the survey that transformed mainstream stakeholder perspectives on the nascent field. Dangling $13.7-billion helped. (Check the upcoming Integrator #259.) The movement is having its significant impacts.
A little appreciated fact of the integrative health field: to the best of my knowledge, if we take the chiropractors and dietary supplement industry out of the picture, and for a couple of years the direct entry midwives, and also the Samueli Institute when it was operating, the entire field has never had more than a fraction of a single FTE lobbyist on the ground at any time in the last 25 years. By that I mean a professional dedicated to walking the halls, creating relationships in Congress, and in the agencies and among other lobbyists, laying ground work, finding the right friends, and pushing things through. I am speaking of a full-on lobbyist, like most self-respecting health and medical interests have: a person devoted entirely to advance an agreed upon short and long-term goals to foster inclusion of integrated health in dialogue, policy, grant receiving, and practice. Bottom line: if integrative ideas and practices are left out, it’s because we’ve almost never showed up. Yet when we have, it is remarkable how quickly integrative health ideas can attract advocates, and on both sides of the aisle. Presence begets participation. When the multi-talented Janet Kahn, PhD, LMT directed the Integrative Health Policy Consortium (IHPC) for a time, IHPC got some things done, especially in partnership with Samueli, and in the build-up to the Affordable Care Act. For most of the next decade, the field’s single 501c4 lobbying organization couldn’t marshal the resources. Now they’ve an energetic force in the person of David Fogel, MD, who is paid by a separate entity, and an executive director in Tracy Bowen, with lobbying experience. Under the leadership of Len Wisneski, MD, the main DC accomplishment was getting the Integrative Health and Wellness Congressional Caucus moving. This is critical lobbying infrastructure, but it’s not yet much of the thing itself. The Biden-Harris administration is coming in. New opportunities will fire up after the chaos and negativity on heath care in the prior 4 years. This is a wish. The field needs to power up that team and continuously add to it. IHPC is still nowhere near able to fund a devoted lobbyist. Pointing IHPC’s experienced executive director lobbyist at the emerging game is the best way to get moving. And things are already in a whirl and the integrative fields are basically nowhere in the mix. So this #9 for 2020 is in fact a #1 wish for 2021. If you don’t show up, you can’t complain. Be there or be square.
Okay, after 15 years, this is me up on the Juke box of this Top 10. Only it’s not so much for what I have done, but for what I am stopping doing: writing and producing the Integrator. I announced the decision in September. Many expressed loss. Some spoke of wanting to help a resource such as the Integrator on the policy and organizational and institutional action in integrative health and medicine continue. To help those considering, I published some basic tricks of the Integrator trade. The potential carve out roles are many: information curators on org action, from Google Alerts, from global sources, for Quick Links; web skills; article writing; philanthropic partners. What else? An ad hoc team of leaders with key organizations plus others of similarly high quality have come together. An Integrator 2.0? There’s a nice next gen feel in many. They’ve met twice by zoom. I am not involved except to advise as they wish. If you are interested, contact me and I will put you in touch with them. I have told them I hope they are successful. I’d love to have access to those Quick Links and action summaries myself! If interested or have ideas of personnel or sources of revenue or directly wish to be part of the effort, let me know. Vamos a ver. We shall see. Hope something materializes!
And in the Spirit of Coco: Exited Leaders Whose Spirits We Serve Ourselves to Keep Alive
The movie Coco three years ago was a wonderful meditation on death and dying that took place during a Mexican Day of the Dead. The message is one of continuing connection with those who leave before us. In 2020, multiple significant leaders exited. The mentor to Tom Harkin, Berkley Bedell (D-IA) who pushed him to set up the Office of Alternative Medicine and remained active in integrative pursuits via his foundation until his end, in the last days of 2019, at 98. Robert Anderson, MD, the founder of the American Holistic Medical Association and also of what became the American Board of Integrative Holistic Medicine died in April at 88. One of the great acupuncture researchers globally, and longtime Society for Acupuncture Research board member, UK’s Hugh Macpherson died at 72 of recurrent pancreatic cancer. Hugh was the only Professor of Acupuncture Research in a UK institution. Allen McDaniels, MD, an avid fisherman, a founder of the American Academy of Medical Acupuncture and also of its society journal, Medical Acupuncture, died in August at 77. Rest in Peace.
For any of you who might enjoy a little journey through the field’s history, these prior Top 10 lists – some published in the Integrator, some in the Huffington Post, others in Today’s Practitioner – provide snapshots of the field’s evolution the prior 14 years. Happy Solstice!