Pain Insights, Inc. announces a comprehensive market research study conducted among 1,044 patients with moderate-to-severe chronic pain and measured patient views/satisfaction/outcomes on the use of opioids, non-opioids, OTCs, and non-pharmacologic therapies for treatment of chronic pain. The report, published in July 2019, updates “Harmonizing Clinical Practice and Clinical Guidelines in the Management of Chronic Pain: — From the Patient Perspective” published in June 2017. The updated report also looked at the impact of recent guideline recommendations on patient/practitioner views regarding opioids, the uptake of medical marijuana/cannabis, utilization of non-opioids and opioids for post-surgical pain (inpatient/outpatient). Among the study’s key findings: Patients currently taking an opioid for chronic pain declined from 59% to 48% in the updated study; approximately one in five patients with chronic pain indicated they have tried medical marijuana/cannabis as part of their pain therapy; and moving forward patients are recommending a broader approach that can be tailored to individual needs and include pharmacologic, non-pharmacologic, cognitive and spiritual support. Read more here http://www.paininsights.com/tracking-pain-in-america
Group medical visits are exceptional methods delivering critical components of integrative health care for treating and reducing the risk of a wide variety of chronic diseases, particularly in underserved populations. A Special Focus Issue on Innovation in Group-Delivered Services is published in The Journal of Alternative and Complementary Medicine (JACM), a peer-reviewed publication dedicated to paradigm, practice, and policy advancing integrative health. The Special Issue was developed in partnership with Integrative Medicine for the Underserved (IM4US) and Centering Healthcare Institute. The issue was led by Guest Editors Paula Gardiner, MD, MPH, University of Massachusetts Medical School (Worcester, Mass.), Maria Chao, DrPH, MPA, University of California, San Francisco, and Marena Burnett, Centering Healthcare Institute (Boston). The issue includes two editorials, four commentaries, a systematic review and eight original research articles. The broad diversity of contexts that are conducive to review are featured, from applications in federally qualified health centers to integrative oncology, and with themes ranging from the growing movement for community acupuncture to a commentary exploring the special ingredient that group brings. Read more here https://medicalxpress.com/news/2019-07-group-medical-access-advance-heath.html
A proposed study from the Centers for Medicare and Medicaid Services (CMS) on acupuncture for chronic low back pain represents what the IHPC Partner for Health, American Society of Acupuncturists (ASA), called a massive step toward incorporation of acupuncture into national health care. The goal of the CMS work is to conduct studies in the age group covered by Medicare, in order to determine if the evidence for acupuncture’s effectiveness in this specific group is sufficient to include it under general Medicare coverage. Once the studies are completed, the data will be analyzed to determine whether to cover acupuncture for low back pain in this population. While it is a step in the right direction and good news that acupuncture is being studied at this level, the ASA does have some concerns, according to David W. Miller, MD, L.Ac., chair of the group’s Board of Directors and a private practitioner at East-West Integrated Medicine in the Chicago area. “Our main concern is that licensed acupuncturists be explicitly included in the process, and that the service they provide be clearly recognized.” The association asked its members to provide comments to CMS by Aug. 15, asking that the section regarding “auxiliary providers” be changed to more clearly name “Licensed Acupuncturists or state equivalent.” The group also asked members to request that the supervision required during the study period be done only by medical doctors. The current language states that other practitioners such as Physician’s Assistants, Nurse Practitioners, and Nurse Specialists can also provide supervision. The ASA does not see this as appropriate, given that these practitioners do not typically have the training required to supervise acupuncture practice, unless they themselves are also legally trained as licensed acupuncturists, Miller noted. Supervision by other licensure types does not have any legal precedent and does not add in any way to the safety or quality of the trials, the group said in a statement to members. ASA cautioned members to remember in their comments that this is a groundbreaking moment for this type of study, and some error in concept is inevitable. In general, the acupuncture community is thrilled that CMS is moving in this direction. This type of access will allow millions of American seniors access to this effective, non-pharmacological option for pain control. This care may be a significant component in boosting quality of life for Medicare recipients, and decreasing our national opioid dependence.
Linking toxins to the diabetes epidemic Collaboration is an important way that IHPC moves forward in its mission to eliminate barriers to health. To advance that mission, we work in partnership with many experts and health care professionals around the United States. IHPC is pleased to note that one of these partners, Joseph Pizzorno, ND, is taking on an expanded role as co-chair of the Environmental and Health Committee. Dr. Pizzorno is a naturopathic physician, educator, researcher and expert spokesperson, as well as the founding president of Bastyr University. He is also an author or co-author of 12 books including the Textbook of Natural Medicine and the Encyclopedia of Natural Medicine and is one of the world’s leading authorities on science-based natural medicine. Under his leadership, Bastyr became the first accredited multidisciplinary university of natural medicine and the first NIH-funded center for alternative medicine research. He retired from Bastyr in 2000 and has since served on President Clinton’s White House Commission on Complementary and Alternative Medicine Policy and the George W. Bush administration’s Medicare Coverage Advisory Committee. IHPC recently had a conversation with Dr. Pizzorno about natural medicine, the group’s overall mission as well as the agenda for the Environmental and Health Committee: IHPC: You have been at the forefront of integrative medicine for more than four decades. Are you satisfied with the progress you have seen? Pizzorno: We have made dramatic progress in awareness of natural medicine. When I graduated in 1975, natural medicine was only licensed in six states and practicing was a felony in some states. Now, 22 states allow the practice of natural medicine and that is a dramatic increase. Clearly conventional medicine has had lots of successes over the years, obviously in areas like infection and acute care. But for everyday health and chronic disease the natural model works best. We now know that optimal medicine is integrating the best of both conventional and natural medicine. That is why IHPC is so important–because it brings together health professionals from all fields to develop better medicine. I think it is an incredible time to be in natural medicine. What we have accomplished is being recognized, and we have changed the dialogue of what medicine should look like. We are at the forefront of this change, so it’s a pretty exciting. IHPC: You are now working with the Environmental and Health Committee. Are people connecting the dots between chronic health issues and environmental toxins? Pizzorno: I have been involved with the committee since it was created to respond to the water contamination issues in Flint, Michigan. We formed the committed and offered guidance to the city of Flint about lead toxicity and ways to use natural medicines to facilitate excretion. It proved to be a fairly frustrating situation. Even though we had a good committee and local influence, we couldn’t get the powers that be interested. IHPC: It sounds like a difficult task. Explain the new work you are doing with the committee. Pizzorno: We are now working on the growing diabetes epidemic in most of the world. Fifty years ago diabetes affected less than one percent. Now it is projected that 30 percent of the U.S. population will get it in their lifetime. That is a dramatic increase. Why? Most people would say it is because we are eating more sugar. And that is true we eat too much sugar. But the diabetes epidemic doesn’t correlate with sugar consumption, which has been fairly stable. Then people say it is because of obesity. And it’s clear obese people do have far more diabetes, especially morbidly obese women who have a 50 percent higher risk than men. But if you look at obesity, those at the bottom 10 percent of environmental toxin load don’t have increased risk for diabetes. Even if someone is morbidly obese, if they don’t have high levels of toxins, they don’t have significantly increased risk for diabetes. IHPC: What is the committee doing with this? Pizzorno: About a year ago, I brought a hypothesis to the committee that the diabetes epidemic is due to environmental toxins. I developed a three phase research protocol to see if it is a correct hypothesis. So that is what we are working on. In the first phase, we will take 10 early stage diabetes patients and measure not only insulin and blood sugar levels, but also several measures of toxin load. We will teach those with a high-toxin load how to avoid these toxins, and then re-measure after three months. We will then determine if there is a correlation between decreasing toxin load and improving blood sugar regulation. Assuming Phase I is successful, Phase II will take on diabetes with an aggressive program of toxin avoidance and sophisticated detoxification protocols to help the patients get rid of toxins over a six-month period. If this shows promising results, we will go to Phase III, which is to propose a large, controlled National Institutes of Health study that will take about one year. IHPC: In general, what do you see as some of the biggest challenges still facing natural medicine today? Pizzorno: Getting the resources we need to research foundational concepts. The problem is, the money comes from the federal government, which is dominated by pharmaceutical companies and their priorities. The money is there to promote the drug and medicine model, but for most health problems is not a curative system. And there is really no group that makes large amounts of money from our medicine. You might say, well, there are successful supplement companies, but the challenge is even the largest is far smaller than the typical pharmaceutical company, and they don’t have the resources to subsidize the research that is needed. IHPC: Are there still issues in formatting of research to provide solid answers and deliverables? Pizzorno: I think at this point we know that the research can be done. We know what to do and how to do it–it’s just a matter of getting the resources to […]
There is an African proverb that says, “if you want to go fast, go alone. If you want to go far, go together.” IHPC couldn’t agree more. We know there is a long road ahead and much work to do in our mission to eliminate barriers to health. That is why we have our Partners for Health Program, in which we work together with like-minded, non-profit organizations toward our common goals. These organizations work tirelessly in their respective areas to advance the cause of integrative therapies for pain management and to support protocols for overall health and wellness. Here is an update from a few of these partners on their recent activities in Washington, DC: American Society of Acupuncturists hosts inaugural convention in Washington, DC IHPC Partner for Health, American Society of Acupuncturists (ASA), which strives to promote the highest standards of professional practice for acupuncture and East Asian Medicine in the United States, held its inaugural convention on May 31-June 3, 2019. The event, entitled “The State of Our Union: Licensed Acupuncturists in U.S. Healthcare,” featured speakers from both integrative healthcare and regulatory agencies discussing both the status of working relationships with licensed acupuncturists and development of opportunities for integration within our healthcare system. IHPC Chairman Leonard Wisneski, MD, fired up the crowd with opening remarks, and IHPC Board Member Robert Twillman, Ph.D., provided an overview of the work that is being done in the realm of comprehensive integrative pain management. Other presenters were brought in from the Department of Veterans Affairs, the Department of Defense, and Indian Health Services, along with important speakers in the field of insurance from both the Hartford Group and American Specialty Health. The keynote speaker for the first day was Ellen Hamilton, representing the Office of Representative Judy Chu (D-CA). With more than 40 exhibitors and break-out sessions that included topics on social media, billing and research, there were over 300 attendees over the two-day event. Nearly 200 of the attendees spent the latter part of Sunday being trained in advocacy by IHPC director of government affairs, Kallie Guimond. The group had 3 asks that included asking House Members of Congress to join the Congressional Integrative Health & Wellness Caucus, and to co-sponsor Congresswoman Judy Chu’s bill HR 1182: Acupuncture for Our Heroes Act. IHPC has tirelessly advocated to help build the new Caucus and recently endorsed this bill as well. For their last ask, they accomplished adding nine co-sponsors to HR 1959: Preserving Patient Access to Compounded Medications Act. All in all, 183 people across 200 Congressional and Senate offices resulted in 565 meetings on the hill Monday June 3rd. They also held a Health Fair and provided acupuncture demonstrations to 180 additional offices in the Rayburn Foyer. AANP Canvasses the Hill with advocacy efforts IHPC Partner for Health American Association of Naturopathic Physicians (AANP), which strives to enhance human health and wellness by advancing the profession of naturopathic medicine, held its annual Washington, DC Federal Legislative Initiative for practitioners and students of naturopathic medicine on June 10. This is the second year that AANP has included as one of their “asks” that their Members of Congress join the Congressional Integrative Health & Wellness Caucus. AANP’s advocacy effort generated 954 meetings scheduled over 239 Congressional and Senate offices with many people visiting between 9 and 12 offices over the course of the day. Their outreach yielded an immediate uptick in co-sponsors for New York Representative Paul Tonko’s bill HR 2482: The Mainstreaming Addiction Treatment Act of 2019 and additional sponsors for Virginia Congressman Morgan Griffith’s HR 1959: Preserving Patient Access to Compounded Medications Act of 2019. The day concluded with a Whole Health Reception in the evening where guests were treated to organic foods including salmon, dark chocolate, and organic wines as they reviewed display tables that introduced naturopathic methods of treatment for chronic conditions. Integrative Medicine Foundation to host Veterans benefit IHPC Partner, the National Foundation for Integrative Medicine, a group committed to finding 21st century health solutions, is holding a Veterans benefit event on July 13, 2019 to support Veterans Quick Response Initiatives for Veterans suffering from pain and addiction and to support the cause of ending Veterans suicide once and for all. The charitable event, to take place at Running Hare Vineyard in Prince Frederick, Md., will include a concert from High Voltage and a silent auction with rare military items along with food and beverages, ice cream for the kids, and a social corn hole tournament during the day. All proceeds are considered a charitable tax deduction. To contribute to the event or take part as an exhibitor for Veteran’s initiatives, please contact Kallie Guimond at 240-432-7522. For more information or to purchase tickets visit Vets and Voltage 2019.
Programs that support the concepts of integrative health and wellbeing are gaining traction at the Veterans Health Administration. According to Ben Kligler, M.D., director of the Integrative Health Coordinating Center at the VA’s Office of Patient Centered Care and Cultural Transformation, this huge organization, with 140 centers treating six million patients annually, is seeing these programs make a difference for veterans. At the recent Congressional Integrative Health and Wellness Caucus in Washington, D.C., Kligler discussed the department’s efforts to move forward with programs that focus beyond drugs and surgery, inquiring what patients are living for and their health goals. It is a big shift for both patients and physicians, Kligler told attendees. He stressed that the effort goes far beyond pain management. “We talk about pain, but the big opportunity in the opioid crisis is the opportunity to learn from it—that the whole concept of taking a pill for a disease is really flawed, and if we change how we handle pain, that will be great, but it won’t be enough,“ he said. “The same opportunity applies to how we’re handling diabetes, heart disease and mental health. It’s about flipping the concept of where healing takes place.” We have an opportunity to push the envelope, he added, and “the fact that this caucus exists shows that it’s time for this to happen.” Jill Sheppard Davenport, a certified nutrition specialist who works at VA hospitals in the Integrative Health and Wellness Program has first-hand knowledge of how programs like nutrition, meditation and health coaching are helping patients. “Nutrition is core to health,” she told Caucus attendees, “but not yet core to health care.” She explained how anti-inflammatory foods like ginger, sweet potato, cashew, and kale work as medicines to prevent the compounds that can cause pain and stoke the fires of inflammation. Davenport shared three policy priorities: to expand Medicare and Medicaid reimbursement to cover nutrition for pain; to educate patients about programs like SNAP-Ed funding and the USDA nutrition guidelines to help them understand the power of food as medicine; and to use existing programs like SNAP and WIC and expand funding so providers can prescribe food as medicine. There is tremendous progress. The VA is in the midst of a three-year project to coordinate the efforts among care teams and look at the outcomes for these programs. Kligler noted that in 2017, the VA passed a policy mandating that evidence-based complementary/integrative health and wellness approaches are now part of VA standard medical benefits, which, at least in the VA, address the current barriers of payment for these treatments. Chiropractic has long been included in the standard of care, but this policy means that other therapies that have published evidence meeting the evidentiary bar will be covered by the VA, he noted. “That doesn’t mean we are there yet,” Kligler added. “There is a huge amount of cost and work yet to be done and the list is not yet hard and fast, but it does mean the VA is committed to cover therapies that demonstrate this evidence.”
Collaboration and a team approach is an important part of the solution for addressing non-opioid, integrative therapies for pain management, health and wellness, according to two of the presenters at the recent 2nd meeting of the Congressional Integrative Health and Wellness Caucus in Washington, DC on March 6th. The presentations were part of a larger program devoted to addressing barriers to access and other models of care with nonpharmacological treatment options titled “Pain Management in the U.S.: An Underlying Contributor to the Opioid Crisis.” Both presenters, Susan Luria, director of University Hospital’s Connor Integrative Health Network in Cleveland, Ohio, and Casey Seenauth, ND, staff physician at the Neil Riordan Center for Regenerative Medicine in Tempe, Arizona, underscored the substantial evidence that current systems are not working to address prevalent chronic health conditions that are caused or exacerbated by lifestyle factors and lead to opioid use. Luria described how a collaborative integrative approach is working in the University Hospital system. “Our health system has a program, the Connor Integrative Health Network, with the belief that optimal health could best be achieved by a combination of traditional medicines and complementary therapies and support of patients to achieve lifestyle choices and behavior that supports their health.” She detailed the program, which provides hour-long integrative consults with patients to identify the underlying causes of their health issues and pain and then prescribe the appropriate therapies, such as chiropractic, acupuncture, massage, yoga and even music and art therapy. “We are taking these therapies and embedding them where they should be with the physician,” she said. “So the acupuncturist is in a primary care office, music and art therapy are in the inpatient setting and we are bringing these tools to the patient in their homes. It helps patients take care of themselves and provides physicians with tools to take care of their patients. In his presentation, Seenauth noted the ample evidence and recommendations supporting integrative therapies from both medical experts and governmental agencies specifically for patients who have lower back pain—95 percent of whom are using opioids to address their pain. The recommendations overwhelmingly endorse non-pharmacological treatments, such as exercise, multidisciplinary rehabilitation, acupuncture, mindfulness, stress reduction, tai chi, yoga and spinal manipulation. He described how the Riordan Center with Southwest College of Naturopathic Medicine and other integrative health organizations have put together a program using the naturopathic therapeutic order to develop curricula that can be used in academic programs in Arizona for physicians, NDs, dentists, and even veterinarians. “Physicians who don’t typically have training in these therapies will get more training emphasizing this team-based approach so they know from the beginning how to collaborate to help patients. ND’s are uniquely positioned to be a part of these integrative care teams because they understand when to apply these various modalities,” he said. Both presenters also discussed barriers to access. Even though there is evidence that these modalities are effective, they are largely unavailable, Seenauth said, because there seems to be an issue of insurance companies not covering these treatments so patients have pay out of pocket and others aren’t able to afford the treatments. “The good news,” said Luria, “is that some things are covered in our program. The integrative Consult and chiropractic are covered, but the therapies they might recommend are not—acupuncture, massage and yoga are all cash pay. So the real barrier we have to break is the physicians inside our system who really don’t want to have to make that choice about changing care based on a patient’s ability to pay. Our physicians want to know that they are providing the same fantastic care to all their patients.”
IHPC Board Member John Weeks recently interviewed Andrew Weil MD on his monetary gift $15 million to the University of Arizona Andrew Weil Center for Integrative Medicine. This contribution will allow the center to leadership roles and staff and support a much larger strategic plan for the future. Read More Here
Harvard T. Chan School of Public Health, Boston, released a much-anticipated manifesto in JAMA on April 2, 2019 that dramatically shifts the philosophy of patient care from an “absence of disease or infirmity” to a concept that embraces whole-person care and patient well-being. This important paradigm change that “reimagines health” is a concept that is not new to integrative health. It respects patients’ desires to grow and feel satisfied with their health and subsequent quality-of-life. Author Howard, K. Koh, MD, MPH defines this as a flourish index, which includes six domains of patient wellness: 1: happiness and life satisfaction, 2. physical and mental health, 3. meaning and purpose, 4. character and virtue, 5. close social relationships, and 6. financial and material security. Dr. Koh writes: “Measurement of flourishing makes possible weighing the effects of different treatment decisions not only on physical and mental health, but in the full context of what matters in a person’s life. While this makes treatment decisions more complex, it lies at the heart of patient-centered care.” Click to read the full report
Exclusive Interview with Dr. Paul Anderson: The FDA and the Fate of Compounded Medicines The following is an excerpt of interview with Paul Anderson, ND on the FDA’s recent stance on compounded medicine as published in the Journal of Restorative Medicine, Volume 8, Number 1, 4 January 2019, pp. 1-5(5). Excerpt provide by Today’s Practitioner. The Journal of Restorative Medicine (JRM) recently interviewed Paul Anderson, ND, who is testifying atU.S. Food and Drug Administration (FDA) hearings in support of maintaining the availability of several hundred compounded medicines. The FDA is considering enacting legislation that would make it illegal to compound or possess these commonly prescribed natural substances. If enacted, this legislation would affect clinicians as well as compounding pharmacies. JRM believes it is crucial for integrative medicine practitioners to have information about this process. JRM: You’ve been attending hearings at the FDA, where the fate of a large number of natural medicines is under review. Please give us an overview of what’s going on and how you came to be present at these hearings. Dr. Anderson: A number of years ago, the FDA asked compounding pharmacies, natural medicine practitioners, and integrative medicine practitioners to nominate substances for a hearing process. I believe the people who nominated substances took the FDA at its word, namely that all substances would get a fair hearing. However, the FDA’s motivation was that if any of these substances did not have what is known as a USP-NF federal monograph (a combination of two compendia: the United States Pharmacopeia and the National Formulary), regardless of whether the substance was a regular drug, an off-label drug, or a natural substance, it would become illegal to compound. These hearings are referred to as the “bulk drug substances for pharmacy compounding” under Section 503A of the Federal Food, Drug, and Cosmetic Act. Around 310 substances were nominated for review. The FDA said it would look at each of these substances individually. I’ve attended the hearings as a subject matter expert. Subject matter experts write testimony that gets included when a substance is nominated for review, as well as attending in person to testify on behalf of that substance. JRM: So, what is happening to the fate of these 310 substances? Dr. Anderson: Contrary to what we expected, the FDA went through the list of 310 substances and said that only a certain number of them even warranted a hearing. As a result, the list was cut down from 310 to about 68 substances that were deemed worthy of a hearing. The remaining approximately 242 substances, most of which happen to be natural medicines, got assigned to category 3, comprising bulk drug substances nominated without adequate support. This means that if the FDA process is enacted as a federal rule, these substances will automatically become illegal to compound, without even having had a hearing. JRM: What are examples of some of the substances listed under category 3 that would become illegal to compound? Dr. Anderson: Lactobacillus acidophilus, alfalfa, anise seed, certain types of copper, certain types of magnesium, a lot of minerals, a number of herbal substances that might be used in a compounded sense, and a whole host of things nominated by pharmacists that aren’t used as medicine but are used as binders or excipients (such as powdered milk) and would become illegal according to this list for a pharmacy to use. In reality, what it comes down to is everything will automatically be illegal to compound, except whatever tiny fraction of substances of the already small group deemed worthy of hearings that make it to the FDA “yes” list! JRM: What has happened to the remaining 68 or so substances that were deemed worthy of a hearing? Dr. Anderson: Those substances were put on the category 1 list. As of this time, hearings have taken place for 53 of them. Thirty have been deemed unsafe for compounding; 16 have been approved as safe; and about 18 are still awaiting hearings. Examples of things on the category 1 list that did get FDA hearings and which the FDA says should be illegal to compound include many substances that are inside our bodies, such as acetyl carnitine, certain forms of glutamine, chondroitin, D-ribose, and a number of other things that we actually can’t live without. The list also includes commonly used natural substances such as artemisinin, Boswellia, MSM (methylsulfonylmethane), glycyrrhizin, and certain B vitamins such as nicotinamide. The way the FDA hearings are set up, if these substances do not have some very clear medical indication for which they are the only treatments, the FDA essentially tells the committee that they should not approve it. Click on the link below to read the full interview and more on how the FDA’s stance places integrative providers in a difficult situation and what you can do to support Dr. Anderson and others. Click Here for the Full Interview Paul Anderson, ND, is a graduate of the National University of Natural Medicine and a full professor at Bastyr University. He is cofounder of Advanced Applications in Medical Practice and is a well-known continuing education presenter specializing in complex clinical medicine, intravenous and injection medicine, oncology, and genomics. Dr. Anderson has participated in National Institutes of Health – funded research in integrative oncology and is coauthor of Outside the Box Cancer Therapies: Alternative Therapies That Treat and Prevent Cancer. He has also authored or coauthored numerous peer-reviewed and educational publications in science and health.