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.
Integrative Healthcare Goes to Washington with the Congressional Integrative Health and Wellness Caucus
Legislators and Staffers Get a Hands-On Introduction to Integrative Medicine By Kimberly Lord Stewart WASHINGTON DC – On March 6, 2019, the second annual Congressional Integrative Health and Wellness Caucus, co-led by Rep. Judy Chu (D-CA), and Rep. Jackie Walorski (R-IN), was held for an audience of 50 Democratic and Republican House offices, representing 24 states, and eight Senate offices, including the Democratic Leader, Democratic Whip, Assistant Democratic Leader, Senate HELP Committee, and Senate Committee on Homeland Security and Government Affairs. “The Congressional Briefing and interdisciplinary therapy demonstration were extremely successful with representation form 58 legislative offices from both sides of the aisle. The briefing provided important information regarding effective, non-opioid, integrative approaches to the treatment of pain which will hopefully impact future policy,” said Len Wisneski, IHPC Board of Director’s Chair. “The response was amazing,” said Kallie Guimond, IHPC’s Director of Government Affairs. “These people are the very same who are going to write legislation for non-pharma options to pain management. Eight Senatorial offices crossed the street to find out more.” Above all, this year’s caucus itinerary gave participants a true reflection of the heart and soul of integrative medicine. That humanistic touch started with the opening chairs remarks. “The two Co-chairs of the Congressional Caucus broke away from their critical Ways and Means Committee meetings to open the briefing, sharing touching personal stories about why they are committed to advancing non-pharmacological approaches to pain and doing so now,” said Margaret Chesney, PhD, IHPC’s Special Advisor, Professor of Medicine School of Medicine, University of California, San Francisco. In her remarks, Rep. Walorski shared the following, “I have heard from physicians and providers in my district who are eager to see the nonopioid methods of treating become more integral in patient’s conversations.” She closed by reiterating the horrific story of a death in South Bend, Indiana of a dear friend, Dr. Todd Graham, a local physician who believed in finding creative and alternative ways to address pain. A little more than a year ago, he was shot in his practice driveway from an opioid addict after trying to falsify records to get opioids. Graham’s refusal led to his death. Rep. Walorki said this tragedy is the motivation behind her work to expand the scope of integrative care for chronic pain. In her opening statement, Rep. Chu held nothing back as she praised the skills of experts in the room and how their respective professions can make a significant difference in the opioid crisis. “The opioid epidemic is taking over lives in every state every day. Right now, deaths from overdoses exceeds those of all other deaths for people under 50,” said Rep. Judy Chu in her opening statement. “The good news is that studies conducted by NIH have concluded that alternative treatments can be effective in treating conditions like chronic pain.” Rep. Chu shared how she has been a long-time advocate of acupuncture. In 2001, when she was elected to the state legislature, Chu worked to get approval for acupuncture to be included in the workman’s compensation system. “I understand well, how important these alternative therapies are. But here in Congress, our biggest challenge is convincing our fellow members that not only do these integrative therapies work, but they should be available to all patients no matter how they get their health coverage,” she said. Click here for video of opening remarks. The caucus made great headway this year to get that message across. There were multiple opportunities for legislators and staff to learn about integrative medicine. Integrative health experts from academic, government, and association settings held an educational briefing, a lunch featuring anti-inflammatory foods, as well as demonstrations on complementary therapies whereby attendees experienced the benefits of integrative medicine for pain and stress management. Speakers included members of the military who shared moving and captivating testimonials of how integrative care made a dramatic impact on their health, said Guimond. Other speakers included: Margaret Chesney, PhD, on an integration to integrative health; Bob Twillman, PhD, on comprehensive integrative pain management; Casey Seenauth, ND, on non-pharmacological multi-modality approach to pain; Susan Luria, MD, MPH, on models of care in the Veterans Administration; Jill Sheppard Davenport, MS, MPP, CNS, NBC-HWC, LDN, LN, on nutrition’s role in pain management. The integrative therapy room was remarkably successful thanks to teams of therapists and practitioners in acupuncture, chiropractic, massage therapy, and naturopathy, as well as certified reflexologists and craniosacral practitioners. “In a matter of minutes, a meeting room in the Rayburn Building was transformed into a healing environment, said Chesney. “This is a first. We’ve never had so many therapies and disciplines in one room on Capitol Hill. Ninety offices took time out of their day to stop in for 20 minutes for a therapy session. Many came back twice,” said Guimond. Capitol Hill is known for being a pressure tank. This was not lost on the therapists who immediately saw a difference after a 20-minute treatment. “The feedback that I got from staffers and legislators was how fried they were and how much better they felt with the treatment,” said Amy Mager, vice chair of the American Society of Acupuncturists. “A staffer came in and said she was so grateful we were there because she didn’t have time to get to her acupuncturist. It was a privilege to be of service and watch staffers and legislators slow down. I watched them hold their bodies with more ease during and after the treatment. Providing value and the opportunity for people to reframe what’s going on in their body and come to a place of ease is a privilege.” A common observation among the therapists was the level of genuine interest by those who came in for a therapy session. “What I found surprising, was that each person I worked with had quite a few questions about reflexology,” said Tish Gilmore, owner of Reflexology by Tish. “I thought people were just being polite, but I was given thoughtful, in depth and inquisitive questions. It was […]
Bipartisan Effort Cites Prevention and Healthcare Delivery Change The bipartisan Congressional Integrative Health and Wellness Caucus has been registered with two new co-chairs at the helm for the 116 th Congress. Representative Judy Chu (CA-21 st ) will serve as the Democratic leader with Representative Jackie Walorski (IN-2 nd ) as the Republican leader, replacing former Caucus co-chairs Colorado Congressmen Polis and Coffman, respectively. The Caucus will hold its first meeting of the new Congress on Wednesday, March 6, 2019 on Capitol Hill with an education program and active demonstrations of integrative treatments provided to House Members and staff. Given the recent passage of the HR6 SUPPORT Act addressing the country’s opioid crisis, the focus of the event will be integrative models of care for pain management. Both Representatives sit on the powerful Committee for Ways and Means, which ultimately governs Medicare, along with payments to health care providers delivering care to Medicare beneficiaries, such as those working in hospitals, surgery centers and outpatient departments. Both new Caucus co-chairs were instrumental in crafting language for the HR6 SUPPORT Act and are involved in seeking legislative solutions regarding patient access to nonpharmacologic treatments and services for pain and addiction. Congresswoman Chu stated, “The opioid epidemic in our country has made it more important than ever to explore non-opioid alternatives to pain management. That is why I am so pleased to be a cofounder of the Integrative Health and Wellness Caucus. Through this caucus, we hope to educate our colleagues about safe alternatives like acupuncture, which for millennia has been successful at treating a number of health conditions in addition to pain. I am hoping we can help make more healthcare options available and accessible to all Americans.” “Integrative health care approaches are critical to treating pain, one of the biggest health challenges Americans face,” said Congresswoman Walorski. “As co-chair of the bipartisan Integrative Health and Wellness Caucus, I look forward to working with my colleagues to combat the opioid crisis and help patients by improving access to innovative and multidisciplinary approaches to pain management. I am committed to working across the aisle to ensure patients and providers have access to non-opioid alternatives and the comprehensive care they need.” The event sponsored by the bipartisan Representatives is open to all members of Congress and their staff. Hosted by the Integrative Health Policy Consortium, speakers will educate lawmakers on what integrative health models of care look like, what current barriers to access for these care models are, as well as hold demonstrations of services designed to treat chronic neck and back pain with nonpharmacologic methods. IHPC Director of Government Affairs, Kallie Guimond, stated “IHPC applauds the efforts of the Integrative Health and Wellness Caucus co-chairs in addressing the current opioid crisis and looking for innovative ways to deliver healthcare services and treatment options that include nonpharmacologic options for the millions of Americans that struggle with pain and addiction. We look forward to working with the co-chairs to build Caucus membership and to be a resource for its members for many years to come.” Members of Congress who would like to join the Caucus should contact Representative Chu’s office directly at 202-225-5464. For more information on the IHW Caucus, contact IHPC’s Director of Government Affairs, Kallie Guimond, at email@example.com or visit IHPC Info For Congress. See Full Report Here
As we enter the latest week of the Federal Government shutdown, there is still a flurry of activity in the states that impact Integrative Health organizations, practitioners and patients. IHPC is currently tracking 84 bills nationwide with most of the state legislatures looking to resolve the opioid crisis by expanding access to complementary treatment services and fill gaps in healthcare delivery regarding pain management. Read Our Full Report Here
Want your voice heard about integrative pain management? The Pain Management Best Practices Interagency Task Force issued its draft report in late Dec. 2018. The comment period is open for the next 90 days. Read more here.
While Congress spent much of 2018 locked in a stalemate, a key integrative health and wellness legislative effort gained traction and was moved to enactment, which created a significant opportunity for 2019. HR6, the SUPPORT Patients and Communities Act (PL 115-271), touted by mainstream media as “the opioid package,” was signed into law on October 28, 2018 and set up the integrative health community as stakeholders in a series of government studies. The anticipated outcomes will shape new integrative models of care for people who suffer from pain and addiction to include a variety of treatment options and therefore, reduce both the amounts of opioids being prescribed and the number of people suffering from substance-use disorders. HR6 was an unusually bipartisan effort on the part of the 115th Congress, answering the call of an immediate crisis that has brought what seems to be a rare example of cooperation between Republican and Democratic constituencies. Upcoming studies will identify barriers of access to nonpharmacologic treatment options and define appropriations for demonstration programs to state acute care and emergency room settings. These actions will determine effective models of care for pain management that are medically-assisted, nonpharmacologic and incorporate multiple modalities. Many members of the Congressional Integrative Health and Wellness Caucus (IWHC) contributed directly to language that was enacted in HR6. IHPC will continue to help build out this Caucus as the 116th Congress begins their duties following the Democrats taking the House gavel on January 3, 2019. Priorities for the upcoming members of Congress will continue in this arena, with an effort to provide appropriations for coverage and reimbursement for integrative treatment options not currently covered. The legislative environment in the states also mimicked this trend of efforts to combat the opioid crisis with numerous states passing legislation that would either provide coverage for integrative treatment options or fund pilot programs to study the issues. As the 2019 legislative season unfolds, the states will begin to apply for available funding to participate in the initial fifteen state demonstration programs to share data regarding models of care. IHPC and their Partners for Health played instrumental roles in building out the new IHW Caucus, helping shape language surrounding pain management, expansion of providers who can prescribe medically assisted treatments and the study and implementation of nonpharmacologic treatment options. These efforts will continue and grow through state and federal initiatives as we move forward in 2019. The Integrative Health Policy Consortium (IHPC) is a unique interprofessional federation of organizations focused on health creation—the proactive promotion of and focus on prevention, wellness, and well- being. As the policy and advocacy voice of integrative health and wellness professionals, IHPC has achieved groundbreaking success toward the transformation of health and healthcare delivery, even as the prevailing paradigm of healthcare remains entrenched in a disease-based philosophy. IHPC–a 501(c)(4) non-profit organization—advocates 1) for better access by individuals to their choice of licensed or certified providers within a pluralistic healthcare system, 2) for non-discrimination in payer coverage of all licensed providers within their scope of practice, and 3) for collaborative efforts among healthcare providers and other stakeholders to take a whole-person healthcare-delivery approach to the individual, which includes consideration of the social, cultural, economic, and environmental determinants of health.