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More Than Two Dozen Studies Demonstrate CAM Cost-effectiveness … plus more
This column is offered in collaboration with The Integrator Blog News & Reports (http://theintegratorblog.com), a leadership-oriented news, networking, and organizing journal for the integrative medicine community. For more information on these and other stories, enter keywords from the articles in the site’s search function.
Systematic Review Finds Cost-effectiveness in Complementary and Integrative Medicine in Over Two Dozen Studies A critically needed review of all cost-effectiveness studies on complementary and integrative medicine (CIM) found 28 “high-quality studies,” according to lead author Patricia Herman, MS, ND, PhD. The review was global and covered the years 2000 to 2010. Herman, an economist and licensed naturopathic doctor, first engaged the project in 2008 with David Eisenberg, MD, of the Harvard School of Public Health.. The report is entitled “Are Complementary Therapies and Integrative Care Cost-effective? A Systematic Review of Economic Evaluations.” 1 In an interview in the Huffington Post, Herman states: “I’m tired of this talk that there is no evidence for cost-effectiveness of complementary and integrative medicine. There is evidence. We need to move on to phase two and look at how transferable these findings are. We can take this evidence and run.”2 Studies that found frank “cost savings” ranged from acupuncture for breech delivery and for low back pain, to manual manipulation for neck pain, natural products for various conditions, and a study of the whole practice of naturopathic medicine for chronic low back pain. Those found to be cost-effective based on analysis of changes in quality adjusted life years included treatment in clinics of Oregon chiropractors, plus others related to massage, tai chi, Alexander technique, and numerous studies of adjunctive acupuncture treatment. Comment: First, credit Herman, in particular, for the labor that this survey entailed. She personally read over 13 000 abstracts generated through key words searches. Second, why just 28 studies, globally, in 10 years? This is an era in which many are obsessed with the awful cost situation. In truth, if one looks closely at the 28, one finds only two that actually report the way whole-person practitioners treat patients in the real world. This is a time to
12 Integrative Medicine • Vol. 11, No. 6 • December 2012
bemoan how the NIH National Center for Complementary and Alternative Medicine has failed to comply with the real-world, outcomes-plus-health services charge Congress gave the agency in 1998.3 Will the next decade bring more than this sparse yield? Regardless, as Herman says, those who say there are no cost benefits from CIM services should be muzzled. The comment field here shows, however, that CIM’s naysayers, on their platform of high science, cannot be convinced by evidence. National Coordinating Center for Integrative Medicine Established at the American College of Preventive Medicine via HRSA Award The Health Resources Services Administration (HRSA) selected the American College of Preventive Medicine (ACPM) as the sponsors of a new National Coordinating Center for Integrative Medicine (NccIM). ACPM is the national organization for the medical specialty in that field. The $774 000 award will focus on the preventive medicine specialty and particularly 12 preventive medicine residencies that received smaller awards. Under the cooperative agreement, ACPM will “provide technical support for other preventive medicine residencies and other health professions training programs in integrative medicine.”4 The ACPM release on the topic states that their model is to “create, convene, administer and sustain a Community of Learning for integrative medicine (IM) and preventive medicine that includes partners in Preventive Medicine training, primary care, other health professions such as nursing, dentistry, and pharmacy, and complementary and alternative medicine (CAM) practitioners from a wide variety of practice modalities.” The ACPM developed a set of proposed partner organizations for the program. These include, on the integrative health side, the American Association of Naturopathic Physicians, the Integrative Healthcare Policy Consortium, and the Academic Consortium for Complementary and Alternative Health Care (ACCAHC). An advisory group, expected to be led by Yale preventive and integrative medicine leader David Katz, MD, MPH, is expected to include (also from the integrative medicine side) his colleague Ather Ali, ND, MPH, Len Wisneski, MD, Pamela Snider, ND and the present writer, John Weeks, under his ACCAHC hat. ACPM executive director, Michael Barry, comments: “With our focus on evidence-based intervenWeeks—Industry Insights
please visit copyright. and policy leader Len Wisneski. linked to new education and competencies.”9 uLong-time integrative medicine educator. Self-Management. the Academic Consortium for Complementary and Alternative Health Care.com. To share or copy this article. that allows prescribing rights.7 American Academy of Family Physicians (AAFP) approved a program developed by Satkirin Khalsa. a Boston-based not-for-profit that annually offers over 10 000 free or low-cost acupuncture and Oriental medicine and massage visits to the underserved.8 u The uThe uElizabeth u Two uResearch showing positive outcomes of the adjunctive care of naturopathic physicians for patients with diabetes. MPH. PhD. the latter boosts chiropractic. has begun a $370 000 fund drive to support a forced relocation. the franchise operation founded in 2002 with 800 current locations. the second in San Jose.This article is protected by copyright. An internal study put average location revenue at $1. is the founder and current president. Ron Zaidman. MD. ND. was the featured presenter on a widely attended CFO Magazinesponsored webinar. MBA. which includes yoga. uPathways to Wellness.12 Weeks—Industry Insights Integrative Medicine • Vol. 11. The chair of the Integrative Healthcare Policy Consortium presented integrative medicine as a cost-saving direction. clinician. but on how to do poses.6 split in the chiropractic profession between the “straights” and the “mixers” has boiled into direct legal combat in New Mexico over a successful move by the chiropractic organization in that state to have the legislature approve a voluntary advanced practice chiropractic program. including a September feature in Diabetes Practice Options entitled “Naturopathic Care Can Enhance Diabetes Patients’ Outcomes. 6 • December 2012 13 . MTCM. To subscribe. was sold to Roark Capital Partners for an undisclosed amount. has been named director of research at the University of Arizona Center for Integrative Medicine.11 uA report on Five Branches University marked the growth of that Santa Cruz. PhD. uA leading National Institutes of Health (NIH) researcher. No. visit imjournal. MPA/HA. Use ISSN#1543953X. has generated significant positive coverage of the field in the diabetes community. California-based acupuncture and Oriental medicine school from five faculty and 18 students when founded in 1984 to its present status of 100 faculty serving 440 students and offering 100 patient visits daily on two campuses. making it a roughly $1 billion operation.10 uMassage Envy. The rationale was that physicians need to know these to deliver the Medicare-approved Ornish program. Her NIH portfolio included director of the Integrative Neural Immune Program. MD. as continuing medical education in which medical doctors were instructed not on the research background for yoga.” The educator in acupuncture and Oriental medicine was selected for her role in the IOM’s Global Forum on Innovation in Health Professional Education where she serves on behalf of one of the 31 organization sponsors.5 (Liza) Goldblatt. Esther Sternberg. was featured in a September 2012 Institute of Medicine (IOM) “Spotlight.” The former elevates integrative medicine as a positive force.com ShortTakes significant documentaries with critical views of US medicine opened: “Escape Fire!” and “Doctored. The International Chiropractors Association has joined the New Mexico Board of Pharmacy and the New Mexico Medical Board in opposing the law while the American Chiropractic Association has filed a friend of the court brief on behalf of the state association arguing that individual states should have the right to establish their own scopes. and cochair of the NIH Intramural Program on Research in Women’s Health.2 million. led by Ryan Bradley.
2012. who at the time sent me regular blurbs about developments in integrative medicine.” In addition. Note the following list of health systems and geographic locations.com tions to prevent disease and promote health. The most recent report. The center has long-time connections to the nearby Northwestern Health Sciences University with its programs in chiropractic. This is not always the case. Florida). Scripps. University of Alabama. According to the released. The University of Minnesota Receives $12. PhD. thus lodging the interprofessional pursuit in the terrain out of which integrative health grew. “the medicine of the future. RN. in fact. I believe ACPM is uniquely qualified to lead this effort. First is the interprofessional vision for integrative medicine. The endpoint is on what are the outcomes of health. in overwhelming quantities. give it up. MD Anderson. is to stop the growth of integrative medicine.6 million from a consortium of private foundations to create a National Coordinating Center for Interprofessional Collaborative Practice. East Connecticut Cancer Institute.” The award is to cover 2 years of operations. No. ACPM brings a deep commitment to primary prevention and health promotion. Arizona Center for Integrative Medicine. The practice is a redundant. To share or copy this article. and systems-based approaches to health care. To subscribe. and our longstanding relationship with and commitment to Preventive Medicine Residency training programs. the initiative is charged to foster education that will be practical and aligned with real-world need. Center for Spirituality and Healing. Glenn Sabin. The links flooded in.” “complementary and alternative medicine. and Oriental medicine and massage. publicly associated with some integrative medicine activity that popped up via Google in this 30-day period: Duke. and more.com. The integrative health community should be knocking on this door. 13 The announcement from the University of Minnesota’s associate vice president and center director Barbara Brandt. becoming the medicine of today. health systems. Sutter Sacramento. visit imjournal. physicians. LSU Shreveport.” Comment: The NccIM award brought a special excitement to this writer as a prospective advisor to the project. Other types of providers are reduced to “modalities” rather than respected as comanagers in a “community of learning. 6 • December 2012 Weeks—Industry Insights . through such vehicles as ScienceBasedMedicine. pharmacists.com.15 The extraction process also yielded a 2-hour meditation on how integrative medicine. healthy lifestyles. from the perspective of the integrative health community. jolted me out of my curmudgeonly amazement that he had his hand on the pulse of so much. NCH Healthcare (Naples. step by step. Michigan’s Holland Hospital. please visit copyright. UC Irvine Primary Care. ACPM has “committed to the sustainability of the NccIM initiative beyond the life of the HRSA funding cycle. social workers and other health professionals to improve communication with each other and to work as a team. NY Beth Israel. particularly given a growing realization that there should be a “widening of the circle” in thinking about who should be part of the new teams. My intent was to pull the stories that speak to the action in US hospitals.6 Million to Become the First National Coordinating Center for Interprofessional Education and Collaboration The University of Minnesota bested 13 other applicants in gaining a $4 million award from the Health Resources Services Administration that will be significantly enhanced via $8. yielded 35 short pieces. The Twin Cities community has the nation’s most significant integration of diverse integrative practitioners with mainstream health care delivery.” and “integrative oncology”). In addition. New Hampshire’s Hospital for Children. three New Jersey systems. So how do we improve the health of people and communities?” Comment: The move toward interprofessional education and team care is a welcome trend in health care as well a significant alignment with the interprofessional dimensions of integrative health practices. Greenwich Hospital (CT). beginning a monthly practice of review and extraction. Northwest Memorial Physicians Group.” is. Use ISSN#1543953X. Simms-Mann at UCLA. He introduced me to Google Alerts. PhD.14 What Google Alerts Teaches About the Growth of Integrative Medicine Comment: Some months ago a colleague. an eastern Oregon Veterans Affairs center. Other institutions promoting integrative medicine essentially view the field as one in which diverse therapies are integrated by a medical doctor.” Adds Brandt: “The endpoint is not how professionals are collaborating. Spaulding Rehabilitation Hospital. notes that the new center will “teach nurses. from early September 2012 to October 6. and academic health centers relative to integrative medicine. I put in my favored key words (“integrative medicine. Banner Health in Arizona. the university is a terrific site for this award. I would aggregate these into a monthly report with single sentence bullet-points and a link for any readers who might want more.This article is protected by copyright. Dudes. You’ve lost that battle. While this center clearly focuses on relationships between the typical practitioner groups in an academic health center. mining type of labor but with regular rewards. It is the site of the Mary Jo Kreitzer. Pity the polarizing science bloggers whose passion in life. 11. I glanced at them and filed them. Two aspects of ACPM’s approach are most pleasing. Mission Hospital (NC). acupuncture. 14 Integrative Medicine • Vol.
cfm?CID=4972. 2012. Published September 26.com/ content/2/5/e001046. Pathways to Wellness.acatoday. 2012.com ALCAT Europe GmbH August-Bebel Str. Ann Arbor. Widening the circle: ACCAHC report from the 1st IOM Global Forum on interprofessional education and care. To share or copy this article. Published September 26. Atlanta Center for ENT. GA “I strongly believe that everyone.bmj. Wellness Director. 2012. University of Minnesota Daily.B.org/story/dr-esther-sternberg-head-researchua-center-integrative-medicine.. Updated October 1. 2009. 2012. Letter from the executive director. New York.php?option=com_ frontpage&Itemid=1. Accessed October 10. Gumz J. The ALCAT Test has provided physicians and their patients successful tools for testing food and chemical sensitivities. 2012. ACPM to establish National Coordinating Center for Integrative Medicine. N.A. The Integrator Blog. 2012. 2012. additives and environmental chemicals are available for testing. Shawnee Mission. M. BMJ Open.” . Accessed October 10.. Accessed October 10. org/newsletter/2012_Sept/12Sept_edletter. Diabetes Options. M. 2012. 2012. Accessed October 10.Donald Dennis. Published October 7. MI Cell Science Systems. Practicing Physician.acpm.mndaily. M.ALCAT. 2012.” .ALCAT-Europe. I am consistently shocked by the results achieved for my most complicated patients. http:// uanews. Eisenberg D.html. The Centers for Balanced Living. Review finds cost effectiveness of complementary and integrative medicine in more than two dozen high-quality studies. Accessed October 10.cgi?article_id=2324. and I mean EVERYONE. Spinelli J.” . Published October 4.Michael Brown. ACA files amicus curiae brief with New Mexico Court. 2012. digestive. Practicing Physician. http://www. com/2012/09/25/academic-health-center-start-newcenter. 11. 3. Published September 1. American College of Preventive Medicine. self-management.aspx. ABAARM. http://www. Medical Director.. 2012.com. Physician heal thyself: MDs earn continuing education credit to learn yoga poses.php?option=com_content&task=v iew&id=839&Itemid=189. Accessed October 10. The Integrator Blog.. Accessed October 10.full. 68.cfo. 13. +49 (0)331 74 00 88-0 f. http://www. Weeks J. FL “Most of my patients who take The ALCAT Test have marked improvements of their symptoms. 2012. The Integrator Blog. 2. 2012. http://www. M. I am able to obtain better and more dramatic results. F. Medical Director.A. Weeks J. Atlanta. Integrative medicine in academic centers. 8. http://www. visit imjournal. KS "In my opinion. Neveleff DJ. 2012.diabetesoptions. M. Santa Cruz Sentinel.. 14482 Potsdam t. 4.. Stathoplos D. Published November 6. http://theintegratorblog. +49 (0)331 74 00 88-29 www. Corp. 10. Accessed October 10. should have an ALCAT Test. NY “I have found that with the elimination of food sensitivities through The ALCAT Test.D. Accessed October 10.M. 2012. Dr Esther Sternberg to head research at UA Center for Integrative Medicine. 14. http://www. i o m .net/cgi-bin/ article. Weeks J. CFO. 2012.S. Weeks J. Dauphinais D.D. Accessed October 10.html. The CFO playbook on health care cost management.” . Published September 27. http:// www. e d u / A c t i v i t i e s / G l o b a l / InnovationHealthProfEducation/Member-Spotlights/ Goldblatt. Institute of Medicine of the National Academies. No authors listed. 6.com/webcasts/index.com Weeks—Industry Insights . CNS. 2012. No authors listed. UA News.D. http://bmjopen. hospitals and health systems via Google Alerts: October 2012. Huffington Post.D." .org/content_css. http://theintegratorblog. Elizabeth Goldblatt. 12. 7. 9. The benefits include improvement in metabolic. A new. Poindexter B. 2012.html. To subscribe. Accessed October 10. Largent B.This article is protected by copyright. Wellness Institute of the Americas. Miami. Published September 3. respiratory.com/localnews/ci_21451253/profilef ive-branches-university-grows-faculty-100. American Chiropractic Association. http://www.com/john-weeks/cme-yoga_b_1883470.com/index. FACOOG.C. 2012.H. Your Wellness Connection.com References 1. Accessed October 10.Jamie Wright DO. registered Awarded 3 US patents CLIA licensed and inspected Available in over 20 countries worldwide Supported by the EU 98% success with improvement of scale weight and/or body composition The ALCAT Test is 83. 2012. http:// theintegratorblog.huffingtonpost. http://www. skin and other conditions. Published September 2012. No authors listed.org/news/104690/ACPM-to-EstablishNational-Coordinating-Center-for-IntegrativeMedicine. Accessed October 10.php?option=com_content&task=view &id=606&Itemid=189. Profile: Five Branches University grows to faculty of 100. Published October 3. Witt C. FAARM. 2012. com/site/index. How NCCAM’s “real world” congressional mandate is optimal for NCCAM’s 2010-2015 strategic plan.huffingtonpost. Accessed October 10. more powerful tool to improve patient outcomes and grow your practice Over 400 foods. Huffington Post. New test agents available No cost to get started Enjoy the additional benefits of belonging to our Physician Referral Network at no cost to you Results are available online within 5 business days of testing Mobile and lab based blood draw service available upon request FDA inspected. 2012.pathwaysboston. Are complementary therapies and integrative care costeffective? A systematic review of economic evaluations.Fred Pescatore. please visit copyright.4% accurate with foods and 96% accurate with food additives “For ten years I have used The ALCAT Test in my practice .com/john-weeks/complementary-integrative-medicine_b_1916514. the ALCAT is the most clinically relevant test in all of functional medicine. Fed gov picks U for new health center. FL 33442 1(800)US-ALCAT (872-5228) 1-954-426-2304 www. Herman P. Deerfield Beach. Published September 9. 852 South Military Trl. 2012.no other test is as useful. Weeks J. Partners in Integrative Medicine. Use ISSN#1543953X.santacruzsentinel. 2012. 5. 15.com/index.cfm/l_eventarchive?webcast=14653926. For over 24 years.. http:// www. 2012..P.htm.Juan Remos. Published September 17. Naturopathic care can enhance diabetes patients’ outcomes. Accessed October 10.
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