Byline: Laura Culberson Farr, Executive Director, American Association of Naturopathic Physicians
Since the novel coronavirus (COVID-19) pandemic began in March, the U.S. Food and Drug Administration along with the Federal Trade Commission have sent over 300 warning letters to physicians, clinics, individuals, pharmacists, and manufacturing and retail companies reprimanding them for making false and misleading claims about the ability of products or services to prevent, mitigate, treat, or cure COVID-19. Dozens of these warning letters have gone to practitioners in the integrative healthcare space, including functional medicine physicians, naturopathic physicians, chiropractic doctors, and acupuncturists, many of whom often recommend natural approaches to care through diet and lifestyle changes, and the use of herbs and/or supplements.
The American Association of Naturopathic Physicians conducted an analysis of the warning letters and providers who received them, and found that many of the offending communications were discussions about ways to “boost the immune system,” methods for how to stay healthy, and natural protocols that may be helpful in mitigating COVID-19 symptoms or that have been successfully deployed to treat other acute respiratory distress syndromes. Most of the warning letter recipients sell products through their clinic or online dispensary or advertise services like intravenous (IV) Vitamin C therapy.
The warning letters usually begin by citing language from a clinic’s website or newsletter that regulators determine makes a misleading claim, requesting that the offending language be removed and that the FTC be notified within 48 hours that the recipient has come into compliance.
However, there can be a cascade of downstream consequences from receiving one of these warning letters. Some integrative medicine providers have reported one or several of the following:
- Negative media about the practitioner or their clinic
- Merchant service accounts frozen upon a bank learning of the warning letter, and can only be reactivated after establishing proof of compliance
- Fraud investigations by the Oregon Department of Justice for violations of the Oregon Unlawful Trade Practices Act
- Reports from recipients that their state licensing board was notified
While there are no known cases of disciplinary action by licensing boards on any practitioner, the risk is possible and the anxiety and legal defense fees are even more real for providers who genuinely thought they were sharing important information about potentially beneficial, low-cost, low-risk ways to stay healthy or mitigate COVID-19 symptoms.
Providers at the Crossroads of Commercial and Free Speech
Warning letters are triggered when the FTC perceives that there is advertising or marketing language that violates the FTC Act. For integrative medicine providers, the AANP’s research found that this is almost always the nexus of discussing treatment protocols, services, or research related to COVID-19 with either a direct or implied marketing reference to selling products through a clinic store, online dispensary, or services such as IV therapy. This is considered “commercial speech,” and is highly regulated.
In the middle of this crossroads stands the Dietary Supplement Health and Education Act (DSHEA), which strictly prohibits supplement producers and marketers from making disease-related claims. A disease-related claim, such as stating a product can be used to treat COVID-19, can only be legally made for FDA-approved drugs and medical devices.
Supplement manufacturers and marketers are limited to making what are called structure and function claims and must include a disclaimer that the statements have not been evaluated by the FDA.
Here is a simple example of the difference between a structure/function claim and a disease claim. “Calcium can help build strong bones” is a structure/function claim. “Calcium can help treat osteoporosis” is a disease claim.
Under DSHEA, marketing a product associated with a disease like COVID-19, whether directly, as in “buy my vitamin C to boost your immune system to protect you from COVID-19,” or indirectly, as in “vitamin D deficiency may increase the risk of contracting COVID-19,” is considered making a false and misleading disease claim that a supplement can prevent, cure, mitigate, or treat COVID-19.
Providers who sell products and advertise the availability of products in newsletters, websites or social media are generally viewed by regulators as marketers, but have not usually been the target of FDA and FTC regulatory actions. The combination of heightened consumer fear with the explosion of consumer scams, has led to a regulatory environment that supplement industry consultant Michael Levin has called “a radioactive recipe waiting to explode.”
Synonyms, Euphemisms and Syllogisms of COVID-19
What has been particularly confounding for many integrative medicine providers trying to communicate legitimate educational content, research, protocols, tips, and recommendations to patients and the public is the ever-growing list of synonyms and euphemisms that regulators are associating with COVID-19, and asserting that they are syllogisms to making a disease claim to prevent, treat, or cure COVID-19. For example, the term “virus” is often associated with a disease, therefore a statement that a dietary ingredient has shown promise to treat or prevent “viruses” would likely be considered a false and misleading disease claim, and may trigger a warning letter specific to COVID-19.
The legal team of a popular supplement company used by many integrative medicine practitioners has cautioned their marketing team to also avoid using phrases like “during this pandemic,” or “in this new normal,” which may be considered euphemisms for COVID-19 when viewed through a marketing lens. A statement along the lines of, “during this pandemic, we need to make sure our immune systems are strong,” that then recommends a sample protocol to boost immune resilience would be viewed by the FTC as an inference to COVID-19 and a prohibited disease claim.
In a recent call with the FTC task force charged with protecting the public against COVID-19 scams, the Assistant Director of the FTC’s Bureau of Consumer Protection remarked “there is a syllogism between immunity and COVID-19 that is not definitively supported by scientific evidence.” He explained that if there is a communication about the pandemic, immunity, and dietary ingredients that links to a store selling related products, the FTC will view this as marketing and a false and misleading disease claim about the products.
The proliferation of fraudulent COVID-19 cures is a real and significant problem, as is the potential for restricting open communication about potentially beneficial, natural approaches to improve health. Some natural health advocacy organizations have argued that the regulators have gone too far and are stifling the ability of providers to communicate appropriate information about natural approaches to preventing or treating COVID-19.
“Your right to learn from your doctor about natural methods of staying healthy during the pandemic are under threat,” said the Alliance for Natural Health in a May statement. “The FDA, FTC, Department of Justice, and some state attorneys general have launched a coordinated censorship campaign that prevents medical doctors and other healthcare providers from communicating their extensive knowledge about how to stay healthy…using natural medicine.”
This front is also evolving rapidly, research is changing constantly, and some providers and clinics who have received warning letters are pushing back to defend the ability to educate consumers and market dietary supplements. Ongoing dialogue needs to happen with regulatory bodies to fine-tune the line between what constitutes free speech, which is not regulated, and commercial speech, which is heavily regulated.
Providers must quickly become educated about marketing laws, DSHEA, what constitutes commercial speech, and the domains that have long been the purview of the supplement industry but are now broadly being applied to providers who have become de facto marketers.
Additionally, providers also need to understand the line between free speech and commercial speech. Author Erik Goldman provides an example in his article Words of Warning: “Saying ‘Vitamin D boosts immunity’ on your website is free speech. Saying “Vitamin D boosts immunity and you can buy it at my store” is marketing. Regulators are unlikely to object to the first statement. They very well could target the second.”
To ensure compliance with marketing regulations, practitioners are urged to analyze their marketing communications with the following considerations:
- Educate the public about COVID-19 treatment approaches without any marketing for product sales on websites, newsletters, social media posts, etc; OR
- Market dietary supplements/products without making prevention or treatment claims, including but not limited to COVID-19, antiviral, or other disease properties;
- Do not make claims about COVID-19 treatment approaches with product sales or a link to an online dispensary in either a direct or implied manner;
- Get to know laws around marketing, the FTC Act and DSHEA, and the important distinction between commercial and free speech. The AANP co-hosted a FREE webinar with Holistic Primary Care, with guests from the FTC department issuing warning letters, and several legal and practitioner experts. Please click here to watch and share Your COVID Communications Could Be Illegal: How to Avoid FTC/FDA Trouble When Marketing Your Practice.
Integrative medicine practitioners play an important role in helping consumers understand what are credible, evidence-informed natural approaches to health. Developing a deeper understanding of marketing laws and commercial speech regulations will help providers accomplish this effectively and legally.
About the Author
Laura Culberson Farr
Laura Culberson Farr is the Executive Director of the American Association of Naturopathic Physicians, the national association representing licensed naturopathic doctors, and Board of Director of the Integrative Health Policy Consortium. A health advocate for over 25 years, she has a deep knowledge of the complexities of healthcare reform, and is an expert on how naturopathic and integrative medicine doctors, conventional clinics, and insurers can work together to improve patient care and reduce healthcare costs.
Nursing may be one of the most trusted professions around, but Margaret Erickson believes it needs to be elevated and respected at a new level. Nurses and the care they provide are foundational to the healthcare system and play a prominent role in today’s pandemic crisis. Yet nursing care is usually included in hospital budgets, shockingly, as “lodging expenses.” Erickson is uniquely qualified to discuss current and future nursing care, having practiced holistic nursing for more than 40 years and holding her PhD, RN, CNS and APHN-BC®. Since 2000, she has been working to educate and advance the role of nurses as CEO of the American Holistic Nurses Credentialing Corporation (AHNCC).
In this interview, Erickson offers her thoughts on how holistic nursing goes beyond today’s typical nursing tasks and the role it plays in today’s shifting healthcare paradigm, on the importance of self-care for patients and practitioners, and on the mission of AHNCC. Erickson, as the newly-elected Co-Chair of the IHPC Board of Directors, discusses her expanding role with IHPC.
IHPC: Tell me about the philosophy behind holistic nursing and how it is different from traditional nursing?
Margaret Erickson: Holistic nursing is grounded in the roots of nursing and a philosophy of holism. Holistic nurses believe that people are spirit-mind-body-emotion integrated beings, that all people are greater than the sum of the parts, and that our subsystems are constantly interacting and affecting one another. People cannot be separated from their environments. Nursing is not something we do as tasks or based on the policy and procedure manual but rather, it is how you show up, interact, connect with the person; and help them access resources so they can be healthy and have a higher state of wellbeing, even if they are taking their last breath. Holistic nurses are always competent in the tasks and care for the physical needs of the person but that does not define their practice.
If we go back to Florence Nightingale in the 1800s, nursing was about caring for the whole person. Florence recognized the importance of meeting patients’ basic, trust, and safety needs as well as higher needs such as growth, spiritual, and needs for beauty and nature. Care was holistically focused. She recognized that people have an innate ability within to heal and that as nurses our goal was to facilitate them in that healing process. However, in the 1970s, nurses aligned with the bio-medical paradigm to validate themselves rather than seeing they had their own discipline, a unique perspective and something special to offer. The focus of nursing care within this paradigm is treating and curing–when possible–illness and disease and is task oriented. Again, Holistic Nursing isn’t about doing tasks. However, we do have to be competent in any work or tasks we do. You can’t try to start an IV on someone several times or the patient will be very stressed, their blood pressure and respiratory rate will be elevated, which in turn affects their immune system and ability to heal. How we approach and complete our work–whether it is as an advocate, educator, or with hands on care at the bedside–affects the entire person and their ability to heal and achieve a greater state of well-being. So, you have to be competent in tasks but again that is not what defines nursing. We believe the most important instrument of healing is ourselves. It is not about us telling patients—I call them clients– what they need to do. It is about understanding who they are and facilitating and supporting them in accessing their resources to help them have the highest quality of life they can achieve.
IHPC: How do you use these philosophies in dealing with patients?
ME: The newest research shows that we make an impression in the first 7-10 seconds when we interact with others. When I walk in a room, am present, recognizing that I am in sacred space with another, I might say ‘Mr. Jones I am here to take care of you’– I speak slowly, and quietly respecting his space. My focus is on the person not the equipment, medicine, documentation, etc. In this first interaction with the client I tell him, he is important to me.
On the other hand, if I hurry into the room and do tasks like checking the IV, foley, or charts it shows that that is what is most important. The patient is then less likely to feel safe and trust you. Consequently, they often don’t share the important information you need to help them get well. When they don’t trust you, they won’t tell you the real story, what their needs are, and what brought them into the hospital or healthcare system. When we focus on tasks and decide what peoples’ needs are, we have a problem. No one knows someone better than they know themselves. Yet, we decide what their problem is, develop a plan of care in which they are not engaged and then we call them non-compliant. This contributes to treating the symptom rather than the root of the problem and then we have clients having multiple admissions for the same problems.
IHPC: Can you give me some examples of how this might have an impact on patient care and treatment?
ME: In most programs, we currently teach nurses to focus on the presenting symptoms, but that is only part of their care. For example, as a Case Manager in South Dakota, I had a patient admitted with severe respiratory distress. He was medicated and put on oxygen. The physician wanted to intubate him. He demanded that they call me. He told me between gasps that a blizzard was coming and his dog, who was the only person in the world who loved him, kept his home safe from others, would die if left out in cold. He refused to be intubated until I got back from taking care of the dog. I told him I would check on the dog and make sure he was safe. I asked him if while I was taking care of his dog if he could try to slow down his breathing and let the medications he had received begin to work. I spent a couple of minutes with him, talking quietly, and working with him so he could breathe easier and deeper. I told him I would be back shortly after taking care of his major support system (his dog). I contacted a neighbor and asked him if he would go over and care for the dog. When I got back, and told him his dog was inside, he was better and we didn’t need for him to be intubated. He was so anxious about the dog that it was making his symptoms worse. Some people would have said don’t worry about the dog, you must get intubated first. As holistic nurses we try to listen, understand, and then address a person’s needs as we know that their emotional, spiritual, social, cognitive subsystems all affect their physical wellbeing. People cannot be separated into parts. So, in a biomedical paradigm, nursing and medicine focus on physical health, the body; treating illness and disease. The difference in holistic nursing is we recognize that people are unified beings; we can’t separate them into pieces or systems.
Listening to people is very important. It is essential if we want to understand what is really going on and be able to treat the root of problems versus the presenting symptoms.
I had a gentleman who was a revolving-door patient coming in and out of the hospital, nothing was working for him. His angina was getting worse, and he was identified as a financial problem for the hospital as well as an “impending cardiac event.” I was asked to see him as “he is spending too much time in our hospital and he is getting worse, not better.” I entered his room quietly and respectfully, focusing on his face and eyes. I didn’t say anything about his admitting symptoms, but rather introduced myself, and asked why he came in? He told me to check with doctor, and I responded, ‘I don’t care what the doctor or anyone else says or what the records say, I want to know why you think you are here? No one knows you as well as you know yourself.’ His. eyes filled up with tears and he told me his wife of 60 years had died six months ago and that he was broken hearted. He shared that he was a rancher, who lived a long way from town, that he had COPD after decades of dust and exposure to his environment from working outside. Although he had COPD he had managed as his wife had taken care of him, and they had had each other. He was dealing with unresolved loss, and it was affecting his physical, emotional, and social well-being. I asked him how I could help and what he needed. Then I listened. He said he missed his wife terribly and was very lonely. He needed to be with other people, to talk to someone about his wife, and to have help with his activities of daily living. I worked with him, made some referrals, and he moved into town to assisted living. His chest pains went away, and he no longer needed his medication.
Understanding peoples’ life experiences is another important factor. As a case manager I was asked to follow up with an elderly gentleman who lived on the Pine Ridge Sioux Reservation. I was told I needed to talk to him after the nurse educator (NE) provided his ‘diabetic teaching’ and before he was discharged. I was asked to see him because he was diabetic and non-compliant with his medication and diet. He and his niece came to get instructions before going home. Due to his poor vision and hearing, the niece, as his caregiver, was watching and listening close to the nurse educator. He was very respectful and trying to listen but watching him I was reminded of Snoopy in the Peanuts cartoon, where all he would hear was “blah, blah, blah.” It looked like the ‘education’ was going right over his head.
After the session I asked him if he had any questions. He quietly responded, ‘no,’ at which point I gently said, ‘I noticed when she talked about eating fresh fruit and vegetables that you might have a question.’ He said ‘well yes, I guess I do. I was thinking that fresh fruit and vegetables only come to the reservation once a month. If I am not there, I don’t get any, so what am I supposed to eat?’ Then he asked ‘Did you say insulin must be kept cold? I don’t have electricity for a refrigerator.’ His healthcare providers had never heard about his real-life experience. For the last 20 years the system had treated him based on their perceptions and assumptions, never understanding his needs or his lived reality. I was really upset. He’d been identified as non-compliant for the last 20 years when in reality the system was neglectful and let him down. Now he was nearly blind and had chronic renal failure. It was outrageous!’
IHPC: Sounds like this comes down to education and training of nurses?
ME: That’s right. The focus and philosophy that guides nursing education and the curriculum taught determines what the nurse focuses on in their practice. Is the focus tasks or is it holistic, relationship-based care of all aspects of the person’s care? Wholism with a ‘w’ is what is currently taught in most nursing program. In these programs, nurses are taught that people have different subsystems which need to be care for. That people are the sum of these different parts. This is different that the belief that all of our subsystems, are in constant interaction, affecting one another. With “wholistic” care we look at the different parts of the person and treat them accordingly. The focus is usually dealing with the physical domain. For example, when a nurse takes a history and assessment, they focus on the physical or clinical health–they assess the body; whereas in holistic nursing, we do a holistic assessment and include an emotional, cognitive, psychosocial and spiritual as well as the physical assessment. We look at how the spiritual aspects of the person affect the emotional or the emotional aspects/subsystem affect the person’s physical health. Most nursing education programs teach that you must consider the different subsystems, but they don’t teach a holistic approach, where the nurse learns to assess the person holistically. Nurses need to look at the whole person, not just the heart attack in room 225, the post-surgical hip replacement in room 5, etc. Nursing education must change if we expect to have nurses provide holistic care vs. focusing on the person’s bio-medical needs and issues.
IHPC: How does AHNCC work to address these issues?
ME: –AHNCC is the national credentialing body for Holistic Nursing and Nurse Coaching. We work closely with the American Holistic Nursing Association (AHNA), which is our membership organization. AHNCC’s mission is to provide rigorous, valid examinations that test holistic nurse and nurse coaches’ knowledge, skills, expertise, attitudes, and values. Although our nurses may use healing therapies/interventions such as massage, aromatherapy, or healing energy, it’s not what defines them. They are just additional tools that they carry in their tool box.
To apply for holistic nursing certification, AHNCC applicants must complete educational programs and courses that focus on holistic nursing theory, research, practice, spirituality, health, wellness, wellbeing, etc. Many of these educational programs are offered by AHNA or by other accredited institutions or organizations. Recent, active nursing practice is also required. AHNCC also offers nurse coaching certification which is geared toward the skills, knowledge, expertise, values, and attitudes utilized when practicing in the role of nurse coaching. Our nurses work in all settings and with people throughout the lifespan. At this time, we credential only RNs; we don’t have programs for other disciplines.
IHPC: You have been involved with the organization two decades. How have you seen it evolve?
ME: AHNCC started with one exam in 2000: we now have 5 and two certification programs (holistic nursing and nurse coaching). We are very proud of that. In addition to the two certification programs, AHNCC has acquired national accreditation from the ABSNC, and our examinations are ANCC Magnet approved. Both of these recognitions validate the rigor and value of our certifications. AHNCC also works with universities around the country to create holistic-based nursing curriculum because how we educate nurses is so important. If we educate only about symptoms, illness, and disease then you have nurses prepared to work within and support a sick-care system.
We believe that self-awareness, self-reflection, self-care, and ongoing growth and development is essential to holistic nursing practice. What I learned 20 years ago is not sufficient for what I need to know now. As a holistic nurse, one is expected to continually commit to learning experiences and educational opportunities to support the lifelong learning process. With that in mind, we have built a repository for current educational programs that will support our certificants’ lifelong learning needs. We have seen a lot of growth and many changes in the last 20 years, but it is not happening fast enough.
IHPC: Nurses are under a lot of pressure in the current COVID-19 crisis. How do you see their role changing as a result?
ME: Self-care is something we have been talking about for 40 years, but COVID is bringing it forward full force. Self-care is not just for patients. It means caring for yourself as a nurse so you can care for others. You have to have balance and a sense of harmony to do that. I also facilitate self-care for my patients so they have resources to do what they need to do to get well. It’s a big problem now, as we see nurses and other healthcare providers who are stressed out; nurses leaving the profession or retiring earlier than ever before. But we are making progress. The importance of caring for self and how it impacts a nurse’s or other care providers’ resiliency and decreases compassion fatigue and the need for care providers to have the support and resources so they can care for others is being recognized and valued.
The role of holistic nursing is also becoming more prominent in the COVID era. The ability to be present, hold a hand, support families and people who are dying has often been absent during this pandemic, and these services have been missed. Nurses and those they care for expect and need to have their physical needs met, but what has been missing and is often shared by distraught nurses is their ability to address the client’s spiritual, emotional, and social needs. We need to pay attention because viruses don’t go away. We need to learn to live with them. One of the things we can do is to help people build stronger immune systems and seek higher levels of wellbeing. How we feel and think, what we eat, the stress we experience, toxic relationships, etc. all impact on our ability to stay well and fight off viruses or other health challenges. We also know that the healthcare system we have is broken, and we need to make changes. A paradigm shift is required which moves our focus from illness and disease to health, wellness, and wellbeing. COVID has challenged and highlighted what isn’t working and given us the opportunity to keep what is working, and make the necessary changes that will better serve all of us.
IHPC: You have an expanding role with IHPC. What do you hope to accomplish?
ME: One thing I am encouraging IHPC to do is to continue think about who we are as organization. Are we a collection of integrative practitioners who practice separately or a holistic integrative organization working together, grounded in our values and philosophy. Who do we serve? We need to dialogue more about the intent of our work and our mission, collectively, as an organization.
The challenge in healthcare is to get out of our silos while respecting and validating what each profession offers and to recognize the expertise, skills, and knowledge each profession can share with the collective group. Traditionally in healthcare we have had a linear, patriarchal system. Our system is top to bottom with clients at the bottom and that needs to change. I believe that all of healthcare providers are my colleagues. We work and collaborate together to empower and facilitate the client in healing. That if anyone is in the driver’s seat, it is the client. I know I have a different perspective than some of my colleagues. We often talk about patients being noncompliant. I believe that is because we are approaching it the wrong way. We need to be empowering the client–who by the way has the most invested and the most to lose–to co-create a plan of care with them that they buy into. When people are supported–given control and choices–they engage and healthcare outcomes become very different.
IHPC: You are also working with IHPC to address issues of equity, diversity and inclusion in health care. How can this lead to a change in the system?
We have systemic problems in healthcare, the government, and education. As an organization, IHPC’s intent is to address making healthcare accessible for all. I think we need to become more educated and informed if we are to work towards our goal of equal access and health care services for all people, especially the vulnerable and disenfranchised populations. Our communities, society, and even globally is only as strong as our most vulnerable populations. Learning about equity, diversity, inclusion, and social justice (EDISJ) issues and how we change systemic racism will impact on not just who sits on the Board, but on how IHPC presents ourselves, our policies, and procedures, our committee work, etc. We all have blind spots, so we have to commit to learning opportunities that present themselves and recognize that this is an ongoing process. Working with Tracy Bowen, Executive Director at IHPC, is helping me to realize some of my own blind spots. The more blind spots we uncover, the more of a holistic understanding and perspective we will have to address these critical issues.
As a starting point, I believe that IHPC needs to begin our EDISJ education, so we will be better able to do our work. Currently, we have a fairly homogenous organization, our diversity is not great. More diversity will broaden and strengthen our world view. Diversity makes us stronger and allows us to have more resources to do our work. As our organizational worldview expands and we have fewer blind spots, we will be better able to serve our stakeholders.
Going back to my American Indian patient, if we had had someone there who could have bridged that gap, we would have been more attuned to his needs. So that is one of the areas I am working on: to see that our world view is expanded. The broader it is, the more effective we will be in supporting health, wellness, and wellbeing for our clients and society at large.
IHPC is a great model for interdisciplinary work, and I believe a team approach is the future in health care systems. IHPC is one of the few organizations I have worked with that sets the intent to honor and respect each other. It has great potential for helping change the paradigm. We just have to get past the growing pains, like all organizations. It is a wonderful inclusive model, and I would like to see this idea accepted, valued, and implemented in all health care systems. By elevating, recognizing, and validating the significance and worth of integrative practitioners like acupuncturists, naturopaths, or chiropractors, we are better able to serve our clients and communities.
Perhaps now, COVID, the continued highlighting of systemic racism, our sense of being disconnected from our loved ones and support systems, extreme economic upheaval, and other issues that have changed how we live our lives as we knew it, etc. are creating a perfect storm which will mandate systemic changes. We need to embrace this opportunity. Change is hard, but we can do it.
“Pain-demic” – Fallout from COVID-19 Congressional Briefing
The Opioid Epidemic and Recommendations for Non-Drug Approaches to Pain Management
WASHINGTON, DC – July 30, 2020 – The “Pain-demic” bi-partisan virtual briefing hosted by the Integrative Health Policy Consortium (IHPC) and the Congressional Caucus for Integrative Health and Wellness highlighted how COVID-19 has exacerbated the nation’s raging opioid crisis and amplified the need to remove barriers to essential cost effective, non-opioid, non-drug pain treatments. “Unfortunately, the measures we have taken to control the spread of the Corona Virus have only exacerbated our fight against another crisis, the Opioid epidemic,” stated Congresswoman Judy Chu (D-CA) Co-Chair of the Congressional Integrative Health and Wellness Caucus.
This briefing identified current highly effective Federally sponsored programs that are proving the effectiveness of non-opioid, non-drug pain management. U.S. Department of Health and Human Services (HHS) Task Force Chairperson and pain management expert, Vanila Singh, M.D. presented the groundbreaking findings and recommendations of her 29-member, inter-agency Task Force, in their exceptional Best Practices in Pain Management report. “The Congressionally mandated Pain Management Report establishes a 360-degree strategy to effectively address the various chronic painful conditions in a patient-centered, individualized manner that presents all the various treatment modalities utilizing non-pharmacologic and pharmacologic integrative health solutions. The recommended best practices present effective and compassionate approaches to acute and chronic pain with the aim to improve clinical best outcomes with an improved quality of life for the millions of Americans suffering from chronic pain,” stated Dr. Singh.
Federally Qualified Health Centers (FQHC) are leading the way in implementing the HHS Task Force best practices to address the opioid crisis. FQHC’s are the nation’s largest public healthcare safety net caring for 30 million children and adults who are part of our rapidly growing Community Health Center population. Sharad Kohli, M.D., a FQHC family physician, detailed his experience “in the trenches” bringing non-drug, innovative pain management programs to some of the hardest hit communities in Austin Texas. Dr. Kohli shared that a major challenge is that these effective non-drug approaches are not reimbursed through insurance programs. “If we can figure out how to make the non-drug treatments reimbursable, then we could widely expand our services and would not be dependent on limited grant funds.” Dr. Kohli also stated that he is uncertain how many FCQHC’s are currently using these effective non-drug pain approaches as there has not been a survey to assess how many Clinics are adopting the recommendations as yet.
“We are working to expand access to non-opioid alternatives to pain management, and committed to educating patients and providers about these innovative options,” stated Congresswoman Jackie Walorski (R-IN), Caucus Co-Chair and supporter of recent key language in the 2021 Appropriations Bill to that effect. Indeed, the U.S. House of Representatives included language in a report accompanying its version of the Fiscal Year 2021 Labor, Health and Human Services and Education Appropriations bill requesting that the Department of Health and Human Services develop a plan for disseminating and implementing the Task Force Report’s recommendations. “It is essential that as we look towards recovery, we ensure that Integrative Health policies are included. We need to ensure that patients have access to non-opioid, non-surgical options like Acupuncture, to treat their chronic pain. These therapies are non-addictive and do not carry similar risks of overdose,” stated Congressmember Chu.
To view the recorded briefing/slides: http://www.ihpc.org/the-congressional-integrative-health-and-wellness-caucus/
To access HHS Task Force Report & toolkit: https://www.hhs.gov/ash/advisory-committees/pain/reports/index.html
About the Integrative Health Policy Consortium:
The Integrative Health Policy Consortium (IHPC), a trusted voice on Capitol Hill, is comprised of 26 professional organizations and institutions representing more than 650,000 state-licensed and nationally certified healthcare professionals. IHPC champions the Congressional Integrative Health & Wellness Caucus and functions as a critical watchdog of the federal agencies overseeing America’s health and health
FOR MORE INFORMATION CONTACT:
Tracy Bowen, Executive Director
Integrative Health Policy Consortium, IHPC
(202) 746-1663 / Tbowen@ihpc.org
Reevaluation, vision and opportunity
In times of trouble or when crisis strikes, what is most important to us usually becomes crystal clear. The global pandemic and the surging movement to finally end systemic racism have sharpened that clarity for IHPC through its mission to eliminate barriers to health for All. Over the last four months that has translated into increasing our advocacy with lawmakers to meet the immediate needs of the integrative health community, to elevate the efficacy and fiscal importance of a wellness approach to health, and to seize new opportunities to impact the healthcare debate during this time of extraordinary change.
This week, as a result of these efforts and the leadership of the Congressional Health and Wellness Caucus co-chairs, Congresswoman Judy Chu (D-CA) and Congresswoman Jackie Walorski (R-IN), as well as Congressman Tim Ryan (D-OH), the House Appropriations committee added language directing the U.S. Department of Health and Human Services (HHS) and the Veterans Affairs Administration (VAA) to implement measures that will expand the availability of integrated health services and open new opportunities for integrative health providers. Specifically, HHS is to implement recommendations of the HHS Pain Management Best Practices Inter-Agency Report and VA is to expand its ground-breaking Whole Health System of Care program. You can review specific language of Labor, Health and Human Services and Education Appropriations Bill here and the Miliary Construction, Veterans Affairs and Related Agencies Appropriations Bill here.
IHPC Executive Director, Tracy Bowen, stated, “The inclusion of this language is a major step forward toward meeting our larger objective of having integrative health recognized as a cornerstone of our nation’s healthcare system.” The early days of the pandemic saw Bowen and the group’s Capitol Outreach Team shifting their focus to aggressively address integrative health issues relevant to the pandemic such as telehealth, insurance reimbursement and inclusion in legislation for healthcare pandemic relief. “When the COVID crisis came into full swing, our first concern was to get support for integrative health professionals during this difficult time,” said Bowen. “We also recognized that this crisis presents a unique opportunity to raise awareness about the critical importance of integrative health professions and a wellness approach to healthcare.”
“The pandemic has highlighted many of the deficiencies of our current healthcare system, which has prioritized acute and reactive care instead of prevention, lifestyle modifications and wellness for chronic disease,” noted David Fogel, MD, CEO and co-founder of CHI Health Care, and an IHPC at-large board member and co-chair of IHPC’s Policy Committee. Because IHPC has now established a place at the table for emergency relief, Fogel said, it will help the group remain relevant for further dialogue and opportunity in the future. “We are advocating for language and strategies that will affect the larger footprint of health and wellness for years to come, and our current engagement with congressional leaders is establishing momentum for our long-term core policy agenda,” Fogel added.
As the group developed new strategies and priorities, Bowen and the IHPC board kept coming back to one essential truth. “We realized that our COVID efforts must reflect our mission of eliminating barriers to health — to provide access to wellness approaches to health.” The brutal murder of George Floyd and the subsequent national upwelling to end systemic racism elevated IHPC’s dialogue about health disparities and structural inequities, sharpening the focus on eliminating barriers to health for All. “We are deeply committed to our own internal work of equity, diversity and inclusion and to elevating our policy focus on access to wellness care in underserved populations.” Bowen noted.
An Enduring Mission in a New Normal
IHPC continues to watch and advocate for inclusion of the integrative health community in future Congressional COVID-19 economic relief packages, but the group is also redoubling their efforts on their core policy agenda. IHPC believes that its mission to eliminate barriers to health by championing systemic change to U.S. healthcare and prioritizing health creation over reactive disease management is now more meaningful than ever. IHPC’s 2020 four key focus areas continue to be relevant:
- Expand awareness of the nation’s pain and opioid crisis, which has been severely impacted by the COVID-19 crisis, and advocate for accessible, non-pharmacological approaches to pain management.
- Elevate a whole person model of care that champions a patient-centric and interdisciplinary care team.
- Advocate for veteran’s health by promoting the Veteran’s Whole Health program, a federally funded systems-approach to healthcare.
- Support the nation’s Federally Qualified Health Centers (FQHCs), a system of Community Health Centers which provides health services to more than 29 million uninsured or underinsured people nationwide, and advocating for their use of integrative health professions.
As the world shifts to a new standard of social engagement through virtual events, IHPC is finding that it can actually access a much larger audience than ever. “Because we are no longer limited to physical space and time to go from one office to another, we can reach a lot more people at the same time, and it makes it easier for staff to tune in or watch a recording later,” Fogel said. As a result, IHPC, in collaboration with the Congressional Integrative Health and Wellness Caucus, will host a virtual congressional briefing on July 24th (see the invitation here). “What always gets the attention of staffers on the Hill is an event that will impact a member’s constituents,” said Fogel. These virtual events, he explained, are “gaining momentum because they offer the possibility of a much broader audience interested in these issues, who will be writing, calling and emailing their members of Congress.”
As IHPC continues to adapt to the immense challenges brought about by COVID-19 and to respond to its enhanced mandate to eliminate barriers to health for All, the group has discovered new energy and meaning in the tasks at hand. Even though things are changing at lightning speed, the challenges are fueling the IHPC membership’s passion and energy to support the mission of IHPC.
House Appropriations Committee Supports IHPC Priorities
July 14, 2020
The Integrative Health Policy Consortium (IHPC) praises the U.S. House of Representatives Appropriations Committee for including language in two recent reports accompanying the Fiscal Year 2021 Labor, Health and Human Services and Education Appropriations and the Fiscal Year 2021 Military Constructions, Veterans Affairs Appropriations bills addressing priorities of the integrative health care community.
Specifically, reports accompanying these essential annual funding bills include language urging:
- The U.S. Department of Health and Human Services (HHS) to widely disseminate and to create a strategic plan to implement recommendations in the HHS Pain Management Best Practices Inter-Agency Task Force Report; and,
- The Veterans Affairs Administration to support and expand the Whole Health System of Care (WHS) program.
The language, as it appeared in both reports, is listed below.
IHPC is very grateful to the co-chairs of the Congressional Health and Wellness Caucus, Congresswoman Judy Chu (D-CA) and Congresswoman Jackie Walorski (R-IN), and to Congressman Tim Ryan (D-OH) for their leadership and for championing the inclusion of these provisions in both appropriations reports.
IHPC looks forward to working with Congress and the Administration to achieve the ambitious goals articulated in both reports.
Chronic Pain.—The Committee remains concerned about the public health epidemic of acute and chronic pain, including its interrelationship with the opioid crisis. The Committee is pleased with the release of the HHS Pain Management Best Practices Inter-Agency Task Force Report in May 2019, but remains concerned over delayed dissemination and implementation of the Report’s recommendations. A strategic plan to disseminate the report and implement recommendations is needed, and the Committee strongly encourages the Department to widely disseminate the Report to health care providers and other public health stakeholders, and to update relevant pain management policies and educational tools to reflect Task Force recommended best practices across all relevant HHS agencies, including the CDC, CMS, SAMHSA and other relevant agencies. The Committee also urges the Department to coordinate with the Department of Defense and Veterans Affairs to launch a public awareness campaign to educate Americans about acute and chronic pain and the evidence based non-opioid treatment options that are available, including non-opioid medications; interventional procedures such as nerve blocks, injections and surgical devices; behavioral health approaches such as cognitive behavioral therapy; and complementary and integrative health therapies such as massage therapy and acupuncture. (page 204)
Continued Support and Expansion for Whole Heath.—As of October 2017, 18 VA medical centers have received funding to implement the Whole Health System of Care (WHS). WHS, a three-year pilot program, meets the intent of the Comprehensive Addiction and Recovery Act by delivering patient-centered care and complementary and integrative health approaches to our nation’s Veterans especially those who are struggling with opioid use disorder and chronic pain. In January 2020, VA released an evaluation of the WHS, which concluded: (1) the program had a positive impact on reducing opioid use among Veterans; (2) Veterans who used WHS, compared to those who did not, experienced greater improvements in perceived stress indicating improvements in overall wellbeing; and (3) comprehensive WHS service revealed potential savings in pharmacy costs. The Committee is pleased by the results of this evaluation and urges VA to continue supporting the WHS and to expand it beyond the 18 flagship sites in fiscal year 2021. (page 65)
Co-Chairs Congresswoman Judy Chu (D-CA) and Congresswoman Jackie Walorski (R-IN)
Friday, July 24, 2020 at 1:00 pm – 2:00 pm ET
0:00 minutes – Pre-briefing rotating credits
1.30 minute – Opening remarks – David Fogel, M.D.
4.40 minutes – Congressmember Judy Chu remarks
9.10 minutes – Congressmember Jackie Walorski remarks
12.21 minutes Vanila Singh M.D. presentation
37.30 minutes Sharad Kohli, M.D. presentation
56.34 minutes- Q and A
1.00.16 minutes Closing Remarks
The Pain-demic: Fallout from COVID-19
Solutions for Our Worsening Opioid Crisis and the Rising Impact of HealthCare Disparities
COVID-19 has exacerbated the raging opioid crisis, is magnifying existing healthcare disparities and heightening barriers to essential, cost effective, non-opioid, non-drug pain treatments.
Learn from Department of Health and Human Services (HHS) Task Force Chairperson and pain management expert, Vanila Singh, M.D. about the groundbreaking findings and recommendations of her 29-member, inter-agency Best Practices in Pain Management Task Force report.
Learn how the nation’s largest healthcare safety net, our system of Federally Qualified Health Centers (FQHC’s), are leading the way in implementing the HHS Task Force recommendations to cope with the opioid crisis and care for the 29 million children and adults who are part of our rapidly growing Community Health Center population. FQHC family physician Sharad Kohli, M.D. details his “in the trenches” experience with non-drug, innovative pain management programs being piloted in these hardest hit communities.
Vanila Singh M.D. – Former Chief Medical Officer, U.S. Department of Health and Human Services; Chair, HHS Pain Management Best Practices Interagency Task Force; Clinical Associate Professor Stanford School of Medicine
Opioid Crisis: HHS Strategy and Advancing Pain Management
HHS Task Force Pain Management Final Report
Sharad Kohli, M.D. - Family Physician, People’s Community Clinic – Federally Qualified Health Center; Board of Directors, Integrative Health Policy Consortium
David Fogel, MD – CEO & Co-founder CHI Health Care; Board of Directors & Co-Chair, Policy Committee, Integrative Health Policy Consortium
This is the first in a series of Congressional Integrative Health and Wellness briefings exploring pressing national health policy issues and innovative solutions hosted by the Integrative Health Policy Consortium – www.ihpc.org
IHPC Requests Capitol Hill Leaders Support Integrative Health Sector in Expanded COVID-19 Stimulus #3
The Honorable Mitch McConnell The Honorable Charles E. Schumer
Majority Leader Minority Leader
United States Senate United States Senate
Washington, DC 20510 Washington, DC 20510
The Honorable Nancy Pelosi The Honorable Kevin McCarthy
Speaker of the House House Minority Leader
Washington, DC 20515 Washington, DC 20515
Dear Majority Leader McConnell, Minority Leader Schumer, Speaker Pelosi, and Minority Leader McCarthy,
On behalf of the Integrative Health Policy Consortium (IHPC), we are writing to communicate our interests in the ongoing negotiations regarding an interim coronavirus relief bill that would provide money to businesses, hospitals and state governments.
IHPC represents 26 organizations and more than 650,000 state licensed and/or nationally certified healthcare professionals and academic, research, clinical and public education organizations who help generate annually nearly $27 Billion in the U.S. economy. We share the integrated health professional team approach that the Nation is employing to combat COVID-19. This approach applies the full spectrum of care, continuously informed by the best scientific evidence to optimally treat every patient and inform the public during this critical time. This team approach integrates the best of (1) medicine from testing through treatment and recovery, (2) optimal delivery of effective preventive and health-enhancing practices, and utilizes (3) evidence-based therapies to treat physical and mental health challenges in patients and the public.
Our members have been adversely affected by the extreme economic fallout instigated by the COVID-19 pandemic. The Paycheck Protection Program (PPP) created by the CARES legislation is benefitting our members. However, they are experiencing delays and are concerned about its future liquidity. We endorse your efforts to boost funding for this program as well as to expand funding for hospitals and, hopefully, other health care providers, immediately. In previous communications (IHPC Stimulus #4 letter) and in coordination with members of the House Integrative Health and Wellness Caucus, we have expressed our community’s needs. Respectfully, we urge you to consider our requests as you work on the current and future COVID relief packages. We simply ask that every health care profession be treated equally in all of the COVID-19 response and recovery programs, from PPP to student loan forgiveness, to telehealth and Medicare, to small business loans.
Thank you for your leadership and dedication to negotiating an interim COVID relief package and for considering the needs of Integrative Health providers. Support for Integrative Health providers and their professional organizations will ensure ongoing healthcare service for the millions of Americans who use integrative health, and will be relying on these critical services and workers, including extensive primary care services, throughout the United States to help cope with the ongoing pandemic and its aftermath.
Thank you for your consideration.
Tracy Bowen Gerard Clum, D.C. Sharad Kohli, M.D.
IHPC Executive Director IHPC Co-Chair IHPC Co-Chair
(202) 746-1663 Board of Directors Board of Directors
tbowen@IHPC.org email@example.com firstname.lastname@example.org
cc: Members of the Congressional Integrative Health and Wellness Caucus
The Honorable Judy Chu, Co-Chair, Integrative Health & Wellness Caucus
The Honorable Jackie Walorski, Co-Chair, Integrative Health & Wellness Caucus
The Honorable Tim Ryan, Member, Integrative Health & Wellness Caucus
The Honorable Fred Upton, Member, Integrative Health & Wellness Caucus
The Honorable Kathy Castor, Member, Integrative Health & Wellness Caucus
The Honorable Peter DeFazio, Member, Integrative Health & Wellness Caucus
The Honorable Ted Lieu, Member, Integrative Health & Wellness Caucus
The Honorable Raul Grijalva, Member, Integrative Health & Wellness Caucus
The Honorable Brett Gutherie, Member, Integrative Health & Wellness Caucus
The Honorable Jamie Raskin, Member, Integrative Health & Wellness Caucus
IHPC Stimulus #4 letter – April 2, 2020
April 2, 2020
The Honorable Nancy Pelosi
Speaker of the House
Washington, DC 20515
Minority Leader Kevin McCarthy
Minority Leader of the House
Washington, DC 20515
Dear Speaker Pelosi and Minority Leader McCarthy,
On behalf of the Integrative Health Policy Consortium (IHPC) (www.ihpc.org) we congratulate you on leading efforts to enact the Coronavirus Aid, Relief and Economic Security (CARES) Act (P.L. 116-136). The law will help millions of Americans and businesses affected by the ongoing COVID-19 pandemic.
We are pleased you intend to introduce a fourth COVID-19 economic relief package that will focus on meeting the needs of health care professionals. Despite the ambitious reach of the CARES Act, its provisions could be strengthened by including thousands of integrative health professionals and their patients, who are being adversely affected by the COVID-19 pandemic. Many integrative professionals are treating patients during this public health crisis; however, their practices have been devastated by the crisis, rendering them unable to deliver necessary care and services and support their livelihoods.
IHPC represents 26 organizations and more than 650,000 state licensed and nationally certified healthcare professionals who generate annually nearly $27 Billion in the U.S. economy. We share the integrated health professional team approach that the Nation is employing to combat COVID-19. This approach applies the full spectrum of care, continuously informed by the best scientific evidence to optimally treat every patient and inform the public during this critical time. This team approach integrates the best of (1) medicine from testing through treatment and recovery, (2) optimal delivery of effective preventive and health-enhancing practices, and with (3) all evidence-based therapies to treat physical and mental health challenges in patients and the public.
As you and your colleagues craft a fourth COVID-19 relief package, we respectfully ask that you consider including the following provisions to address the immediate needs of integrative health care professionals.
Summary of IHPC’s Requests: Please refer to attached Addendum for more details.
- Provide direct economic relief to all state-licensed and/or nationally certified Integrative Health Care providers, their small businesses, students and Institutions.
- Insert “state-licensed and/or nationally certified” when referring to “Health Care Professionals” in all sections of Stimulus or Recovery Acts. Without this phrase many integrative health providers are not included.
- Allocate $500 million in micro-grant support for the integrative health professionals who are state-licensed and/or nationally certified providers of integrative and whole person health care services to ensure these providers remain part of the workforce during this national emergency.
- Include any integrative health professional associations, nonprofits and other tax-exempt organizations, and their workers for support within any federal aid packages or supplemental appropriations measures, as many have been and will be harmed by event cancellations due to quarantining, social distancing and other public health measures.
- Expand HRSA’s National Public Health Service Corps to include integrative health professionals who are state licensed and/or nationally certified providers. These professionals are important members of the integrated health professional team supporting the U.S. population to cope and recover from COVID-19. We recommend you explore and implement student loan debt forgiveness immediately and over time for integrative health graduates.
- Expand Medicare coverage through CMS for all integrative health providers who are state-licensed and/or nationally certified. Currently most of our providers are not included.
- Expand telehealth coverage for services by all integrative health providers who are state-licensed and/or nationally certified.
- Allocate immune/respiratory research support of $20 million be directed at the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health (and other institutes and centers, including NIA, NHLBI, and NCI) and of $20 million be directed to the Department of Defense, Defense Threat Reduction Agency (DTRA).
Thank you for considering our request and for your stalwart leadership during these uncertain and difficult times. IHPC looks forward to working with you and your colleagues.
Tracy Bowen Gerald Clum, D.C. Sharad Kohli, M.D.
Executive Director Co-Chair Co-Chair
Integrative Health Policy Consortium, IHPC IHPC, Board of Directors IHPC, Board of Directors
(202) 746-1663 / tbowen@IHPC.org email@example.com firstname.lastname@example.org
The Honorable Judy Chu, Co-Chair, Integrative Health & Wellness Caucus
The Honorable Jackie Walorski, Co-Chair, Integrative Health & Wellness Caucus
The Honorable Tim Ryan, Member, Integrative Health & Wellness Caucus
The Honorable Fred Upton, Member, Integrative Health & Wellness Caucus
The Honorable Kathy Castor, Member, Integrative Health & Wellness Caucus
The Honorable Peter DeFazio, Member, Integrative Health & Wellness Caucus
The Honorable Ted Lieu, Member, Integrative Health & Wellness Caucus
The Honorable Raul Grijalva, Member, Integrative Health & Wellness Caucus
The Honorable Brett Gutherie, Member, Integrative Health & Wellness Caucus
The Honorable Jamie Raskin, Member, Integrative Health & Wellness Caucus
The Honorable Nita Lowey, Chair, U.S. House of Representatives Appropriations Committee
House Majority Whip James Clyburn, U.S. House of Representatives
Minority Leader Kevin McCarthy, U.S. House of Representatives
ADDENDUM: BACKGROUND OF REQUESTS:
Integrative health providers, their educational & training institutions, their students and support associations have been profoundly and negatively impacted by COVID-19. Your support for this request ensures that the integrative health professionals and industry can safely provide continued support to their patients, and ensures the integrative health sector as a whole will not lose infrastructure and capacity to support Americans in need in the coming months as we cope and recover from this international pandemic.
- Provide direct economic relief to all state-licensed and/or nationally certified Integrative Health providers, their small businesses, students and institutions
- Insert the phrase “state-licensed and/or nationally certified” when referring to “Health Care Professionals” in all sections of Stimulus or Recovery Acts. This is essential. Without this phrase being inserted, integrative medicine and whole person health professionals are not included.
- Allocate $500 million in micro-grant support for the integrative health professionals who are state-licensed and/or nationally certified providers of integrative and whole person health care services to ensure these providers can remain part of the workforce during this national emergency. More than 554,000 of these health professionals operate their own small businesses with over 1 million employees who generate nearly $27 Billion annually to the U.S. economy. Most are unable to provide services and are not receiving any income during this COVID-19 pandemic. It is critical to financially support this sector of health care providers during this crisis so they can continue to provide services as America is coping and recovering from COVID-19.
- Include any Integrative Health professional associations, nonprofits, educational and training institutions, and other tax-exempt organizations and their employees for support within any federal aid packages or supplemental appropriations measures as many have been and will be harmed by event cancellations due to quarantining, social distancing and other public health measures. Financial impacts from COVID-19 stem from class cancellations, project stoppage, unexpected costs, and reduced meeting attendance and education programming and trainings. The fast-spreading COVID-19 pandemic has prompted the cancellation of dozens of major conferences, educational meetings and events in the U.S. and forced other event sponsors to consider cancelling or postponing innumerable other events dependent on in-person attendance at convention centers, hotels and other event facilities. The Integrative Health industry, its professionals, health care providers, workers, educators, students and organizations have been deeply impacted.
- Expand HRSA’s National Public Health Service Corps to include integrative health professionals who are state licensed and/or nationally certified providers. This will address current and future health care professional shortages, as being demonstrated during the COVID-19.
- Include employment at integrative educational and training institutions in HRSA’s Faculty Loan programs.
- Explore and implement student loan debt forgiveness immediately and over time for integrative health graduates recognizing the significant long-term systemic impact of COVID-19 on our economy and the significant strain student debt poses on our system and impacts addressing our health service worker shortage.
- Expand Medicare coverage through CMS for all state-licensed and/or nationally certified integrative health providers. Currently most of our providers are not included.
- Expand telehealth coverage for integrative health care services. We acknowledge and deeply appreciate the recent reforms that Medicare has already made for telehealth services (Coronavirus Preparedness and Response Supplemental Appropriations Act), however, many of our practitioners are still unable to provide critical patient care services utilizing telehealth. We urge you to:
- Provide the Secretary of Health and Human Services (HHS) with the ability to include expanded Medicare telehealth coverage not only for physicians, but for all state-licensed and/or nationally certified providers of integrative and whole person health care services so that they can help effectively meet the urgent health needs of their communities.
- Provide the Secretary of HHS with the ability to include expanded telehealth coverage ability to extend to non-Federal programs not only for physicians, but for all state-licensed and/or nationally certified providers of integrative and whole person health care services.
- Legislate consistency of access to telehealth, as well as meaningful reimbursement mechanisms and values, across the insurance industry.
- Currently telehealth availability and reimbursement are inconsistent and unusable by many consumers and providers. Health plans shall reimburse providers at the same rates, whether the service is provided in-person or through telemedicine.
- All state licensed and/or nationally certified healthcare professionals shall be granted rights to the practice of telehealth, regardless of contracting rules prior to the COVID-19 crisis.
- Payers, whether Medicare, Medicaid or non-Federal programs, shall not limit the types of licensed clinicians able to treat via telehealth as long as the services provided are clinically appropriate.
- Further, telehealth shall be allowed and reimbursed the same regardless of whether the patient connection is made by voice only (e.g. via telephone), or via a visual interface platform.
- Patient cost-sharing in visits shall be made equal to that expected during in-person care.
- Remove restrictions on the practice of telehealth across state lines for non-Federal healthcare programs, and allow telehealth services to be tied to the provider location and licensure rather than to the location of the patient.
- Allocate at least $20 million be directed to the National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health (and other institutes and centers, including NIA, NHLBI, and NCI) and of at least $20 million be directed to the Department of Defense, Defense Threat Reduction Agency (DTRA) to conduct well-designed, basic science and clinical research for these complementary, integrative and Whole Person Health approaches. The COVID-19 Global Pandemic has highlighted the gaps that remain in the scientific literature regarding the potential benefits to immune and respiratory function of established integrative health and whole person health approaches to preventing and treating infections and preventing epidemics. Many of these approaches are currently used by millions of Americans.
While there is peer reviewed scientific literature on immune function, including randomized trials that show beneficial findings, in order to close this gap and provide policy makers, public health officials, and the public evidence-based information in the COVID-19 pandemic, there is an urgent need to expand research on these well-established and widely practiced health approaches in the COVID-19, immune and respiratory function research portfolios. It is vital that the experts, organizations, and research/academic institutions from these professions and fields be included in the planning and implementation of the research. We recommend that the directors of the NCCIH and DTRA within 30 days of enactment to host a digital planning conference with other institutes and centers at NIH to create a draft strategic plan for these funds; and within 60 days, host the first in a series of digital town halls inviting input from the public, professional organizations, the scientific community, and other stakeholders.
The IHPC board elevated the importance of Equity, Diversity and Inclusion (EDI) at its January board retreat by creating a Standing EDI Committee. The committee will ensure that IHPC is consistently working to build a diverse and inclusive organizational culture and membership and that it is advocating on behalf of all people, eliminating barriers to health and health justice. The committee will be chaired by Sharad Kohli, MD, who will be working with the Partners for Health to recruit additional committee members.
The board focused much of its time in the retreat on restructuring of the organization to improve its effectiveness and expand its representation of integrative health professionals. IHPC Executive Director, Tracy Bowen, notes that the current structure limits the number of member organizations. The proposed new IHPC Assembly will allow for an unlimited number of members that meet IHPC’s criteria for professional associations. Under the proposal, a smaller and nimbler IHPC Board would be voted in by the Assembly. “There was broad consensus and support for this, and I am excited for this evolution of IHPC,” said Bowen. The proposed changes will now be honed and finalized by the Restructure Workgroup and presented to the IHPC leadership and board for approval. The Workgroup is hoping to present the final details on the restructure as early as April of this year.
Bowen and David Fogel, MD, provided an update on the just formed IHPC Capitol Hill Outreach Team that includes Bowen, Fogel and Mary Jo Hoeksema, IHPC’s new Government Relations support. Bowen and Fogel reported that near-term focus will be strengthening, expanding and educating the Congressional Integrative Health and Wellness Caucus. “We’ve generated renewed enthusiasm with the Caucus co-chairs Congresswomen Chu and Walorski and their staffs, and we are developing plans with them for the Spring and onward,” said Bowen. Fogel and Bowen are working to increase the size of the Caucus and reported that they have started meeting with several Congressional offices and have already added Congressman Jamie Raskin as a new Caucus member. The group discussed ways to support Capitol Hill Outreach efforts, including reaching out to Representatives to invite them to join the Caucus, and explored legislative priorities for 2020 and beyond.
The IHPC board also elected new Co-Chairs Sharad Kohli, MD and Gerard Clum, DC. The pair replaces long-time chair Len Wisneski, MD, FACP, who will remain on the IHPC board. Dr. Kohli currently works as a primary care physician at People’s Community Clinic, a Federally Qualified Health Center in Austin, Texas, where he is developing an integrative pain management program, and was previously a leader of the Partner for Health organization Integrative Medicine for the Underserved (IM4US). Since retiring from the presidency of Life Chiropractic College West, Dr. Clum has worked as Presidential Liaison for External Affairs at Life University. He has also been appointed the director of The Octagon, a think-tank sponsored by Life University. In addition, he serves as a consultant and expert witness in matters related to chiropractic practice and care.
Other newly elected members of the executive committee include:
- Margaret Erickson, Ph.D., RN, CNS, APHN-BC, who will serve as Vice Chair. Erickson has been CEO of the American Holistic Nurses Credentialing Corporation (AHNCC) since May 2000 and has practiced holistic nursing for almost 40 years.
- Stephen Welsh, DC, FICA, who will serve as treasurer. Welsh is an active member of the International Chiropractors Association (ICA) and the Georgia Council of Chiropractic (GCC). He has more than twenty years’ experience in financial, technical and administrative services supporting a successful chiropractic practice with his wife, Dr. Claire and daughter Dr. Kristen.
The board also elected three new At-Large Directors including:
- C Leslie Smith, MS, MA, LAc, MD, Integrative Medicine Director, Culinary Medicine Assistant Professor SIU School of Medicine, who will serve on the Communication Committee.
- David Fogel, MD, who will work on advocacy on Capitol Hill.
- Laura Farr, Executive Director of the American Association of Naturopathic Physicians since 2017- and 15-years’ experience with the naturopathic profession, who will work on public policy.
IHPC wishes to extend its deep gratitude to the outgoing At-Large Directors for their years of excellent service: Coquina Deger, of a Partner for Health representing Bastyr University, Ron Duskin of AIH, and Susan Luria, former director of University Hospitals Connor Integrative Health Network in Cleveland.
Moving IHPC policy goals forward takes ongoing and consistent effort with all hands on deck and boots on the ground. That is why IHPC has announced its 2020 Capitol Hill Outreach efforts will include a new collaborative partnership with David Fogel, MD, founder of the groundbreaking integrative clinic Chi Health Care. He will be teaming up with Tracy Bowen, IHPC’s Executive Director to bring his unique background in integrative healthcare and help IHPC to build and support the bi-partisan Congressional Integrative Health and Wellness Caucus. He will also help advance targeted federal legislative priorities, such as expanded coverage for Integrative Health and Wellness in CMS Medicaid, Medicare, Veterans, Pain Management; the Social Determinants Act; and research funding for integrative health and wellness.
As a pioneer in the concept of integrative medicine, Dr. Fogel is uniquely qualified for this new advocacy role. A native of Washington, DC, his background in alternative and integrative practice stems from a boyhood experience in martial arts, which set the stage for a lifetime of interest in eastern philosophy and an openness to the idea that western conventional culture is not the only way to see things. Fogel did go to medical school but quietly experimented with alternative approaches like acupuncture as far back as the 1970s. He started his first integrative center in the late 90s, and he says this gave him the first taste of the power of a team-based interdisciplinary approach.
Unfortunately, this early effort struggled financially because of the poor reimbursement standard, so Fogel went back to private practice in internal medicine with a specialty in mind/body psychotherapy. But his interest in the integrative model remained and he continued to refer his patients to alternative practitioners as his own form of collaborative care.
Fast forward to 2011. A local philanthropist in Gaithersburg, Md., approached Fogel about opening a new integrative center. His first thought was to decline because of his experience with the discouraging financial prospects, but then reconsidered. Fogel asked the group to fund a study, in which he and a team of healthcare professionals would look at existing integrative centers and discover what made them successful.
“Based on that study, we put together a model using different parts of what we’d seen,” he said. “An important part of that was the new value-based model that was just coming on the scene. Fee-for-service is a horrible incentive. It makes much more sense to incentivize keeping people well.”
The research also taught them that most centers were surviving with grant money or by bypassing insurance reimbursement altogether, which made integrative care largely accessible only to the elite and affluent.
Because the new clinic, name Chi Health Care, had a generous grant, Fogel, serving as the CEO, made it open to all insurance including Medicare and Medicaid and developed a sliding scale for people who were under ensured. “The exciting part of the practice was that it exposed us to a whole new segment of people who knew nothing about integrative medicine,” he recalled.
The clinic also explored the culture of an integrative primary care practice looking not only at what it did for patients but staff as well. “Our model was not just about teaching practitioners to meditate or eat better, but looked at how they interacted with each other,” Fogel explained.
So many clinics had different practitioners under one roof but they were all doing their own thing, he added. “Our model paid and required practitioners to collaborate. So we actually got better health outcomes at a lower cost, with fewer hospitalizations, lower pharma use and fewer ER visits when compared to conventional practices.” Sadly, after six years in practice, value based payment reforms which were central to the business model, hadn’t matured to a level to make the clinic financially sustainable and David made the difficult decision to close the clinic in 2019.
When asked why he thinks the concept of integrative medicine is still such a tough model, Fogel cited the need for ongoing and extensive education. “In some ways, even though there is a lot of information and evidence that people are using an alternative-based lifestyle approach to health, I don’t think, in general, people understand much about the integrative approach. Small segments of the population and physicians do get it, a growing number of people are trying acupuncture, but they don’t understand how powerful and cost-effective a collaborative approach is.”
The rest, he added, comes down to the counterintuitive resistance from pharmaceutical companies and just plain old ignorance. “Many medical societies including the one here in Maryland are still opposed to naturopathic doctors getting prescribing rights. People also don’t know that NDs get the same curriculum as allopathic doctors. So lots of education still needs to happen,” he said.
With the closing of his clinic some of Fogel’s time and resources remained available through his nonprofit Chi Health Care, which led him to connect with IHPC. Fogel sees IHPC strategic goals of building the Congressional Caucus and supporting the broader applications of integrative care for the opioid crisis as critical. “That is one message to bring to folks on the hill,” he noted, “that integrative medicine is not just for pain but also an approach for addiction treatment.”
While Fogel is a newcomer to policy work, he believes that he and IHPC’s executive director Tracy Bowen make a good team. “Tracy has the background in policy work and I bring my passion and clinical experience to it.” The bottom line, he added, is that “I feel like this is something I am supposed to be doing. While it was painful to close the clinic, I can use the tools and messages I have gained to get out there and help make integrative care a key part of health care.”
The Integrative Health Policy Consortium (IHPC) will hold its annual board retreat next month. On January 23-26, 2020, the board will gather at Life University in Marietta, Ga., to discuss a restructuring of the consortium’s governance, as well as legislative priorities of their Partners for Health organizations.
As a fast-growing not-for-profit corporation that has built a vital network of professional organizations who are bringing integrative health care to the forefront in the U.S., IHPC depends on its members to help determine this ongoing work and strategy. If you have any pressing issues that you would like to see addressed, please connect to the leadership site on the IHPC website or contact IHPC directly via email at email@example.com.
IHPC is comprised of 28 organizations and institutions and 12 at-large national experts representing more than 600,000 state-licensed and nationally certified healthcare professionals. They are the regulated (licensed or nationally certified) providers of integrative medicine, holistic nursing, chiropractic, acupuncture, naturopathic medicine, public health, certified professional midwifery, massage therapy, nutrition and homeopathy.
IHPC is a trusted voice on Capitol Hill. It was founded in 2001 at the request of legislators who recognized the need on the Hill for a national organization representing the consensus voice of the integrative healthcare community, aligned around wellness, health creation and choice. IHPC is championing the Congressional Integrative Health & Wellness Caucus and functions as a critical watchdog of the federal agencies overseeing America’s health and health research needs. IHPC envisions a world with no barriers to health and is focused on removing barriers to health and promoting a healthier world that incentivizes health creation for all individuals, communities and the planet.
The Academy of Integrative Health and Medicine’s (AIHM) annual conference is well known for many things, including an outstanding speaker program and prestigious awards that recognize deserving individuals in the integrative health community. But this year the real highlight of “People, Planet and Purpose” was about making new connections with other similar movements to look at the bigger questions of how to create a healthier world.
The big takeaway from the October conference, according to AIHM Executive Director Tabatha Parker, ND, is “how do we integrate our movement to start to think more strategically and thoughtfully partner with other like-minded movements, like sustainable agriculture and organic products.”
Parker noted that a key discussion during the four-day event was a panel featuring Zach Bush, MD, a triple-board certified physician, who has also worked to bring about radical change in big farming, pharma and Western medicine; Jeff Tkach of the Rodale Institute, who is responsible for expanding the institute’s influence to heal people and the planet through regenerative and organic agriculture; and David Bronner, the cosmic engagement officer (CEO) of Dr. Bronner’s Soap, a leading natural personal care brand that has pushed the envelope in standards for GMO labeling, hemp farming, organic certification and fair trade.
The session looked at how integral sustainable agriculture and organic products are to integrative health. “We have come a long way in bringing our groups together around health and health policy work and education. But we are now starting to see more crossover into other areas that are also trying to change the system. The transformation of health care is embedded in a larger transformation taking place in our society,” she said.
Another highlight of the meeting for Parker was the gathering of different leaders from the many integrative health organizations including IHPC, Integrative Medicine for the Underserved (IM4US), the Academic Consortium of Integrative Medicine and Health (ACIMH), Academic Collaborative for Integrative Health (ACIH), and the Alliance to Advance Comprehensive Integrative Pain Management (AACIPM), among others. “A couple of these organizations have brand new executive directors, so we met face to face for the first time. It was great to spend time with them and discuss how to support each other moving forward into 2020 and beyond,” Parker said.
The awards program is another way the association brings together people who have forged new trails in the area of integrative health. In keeping with its titled theme “People, Planet and Purpose,” the group presented three key awards including the lifetime Achievement Award (People), which this year was given to Daniel Asimus, MD, (a past IHPC board member); the Visionary Award (Planet), which this year went to one of the headline speakers, Deepak Chopra, MD; and the Change Maker Award (Purpose), which was presented to Liza Goldblatt, Ph.D., past chair and founding board member of ACIH for her work in the world of acupuncture. The awards are always very special, Parker said, because they are presented by the previous year’s winners, and most of the time the recipient is not aware they are getting the award. “So it is a surprise and a very special way to say thank you to the leaders of our community who have been working for decades to change health care.”
While a nonprofit organization’s life blood is its members and the passion behind its grassroots movement, it is also vital to acknowledge the importance of an executive director who works tirelessly to connect the dots and keep all the moving parts in order. With that in mind, IHPC is pleased to introduce Tracy Bowen, who was chosen from a list of nationwide candidates as its new Executive Director.
A seasoned nonprofit executive, Tracy has been hard at work since early September applying her experience in coalition building, advocacy, government affairs, communications, strategic planning, organizational development and fundraising, among other things, on behalf of IHPC.
Equally important, Tracy brings a passion for the mission of IHPC, which was sparked by her experiences during her first career as an emergency medical technician and has been nurtured through a lifelong commitment to integrative and whole person health. “I am honored to be a leader of IHPC at this time when its dedicated professional members are uniquely positioned to change national and state policies that will advance integrative health and wellness for all Americans,” she said.
Prior to joining IHPC, Tracy worked independently as a consultant and strategic advisor for numerous organizations including Center for a New American Dream, Campaign for a Commercial Free Childhood, Sustainable Water Resources Roundtable and Institute for Sustainable Infrastructure. Tracy spent 12 years as Executive Director of the Alice Ferguson Foundation, growing the organization ten-fold and launching the highly successful multi-sector, cross-jurisdictional Trash Free Potomac Watershed Initiative.
Tracy began her career in Washington, D.C., where she currently resides, as a political fundraiser on Capitol Hill. She holds a B.A. in International Relations from Michigan State University’s James Madison College and a Certificate in Nonprofit Management from Georgetown University.
“Tracy is enthusiastic, extremely passionate regarding integrative health, and possesses the experience and talent required to carry out the vision and mission of IHPC,” said IHPC Board Chair Leonard Wisneski, MD, FACP. “We are quite fortunate to have her as our Executive Director.”
In what is being called a great first step by the integrative health community, Congress has proposed bipartisan legislation to help manage costs and improve outcomes for Medicaid recipients with help on a state and community level. The Social Determinants Accelerator Act introduced in July 2019 proposes planning grants and technical assistance to help communities address non-medical needs that are linked to health, such as food security, employment and housing stability.
The proposed legislation, which has been endorsed by groups like the American Hospital Association and Aligning for Health, an association working to address such social determinants to health, suggests a growing recognition among political leaders that good health encompasses more than just addressing disease states and that social determinants like income equality, poor public transportation, and housing instability can also impact health and well-being.1
The new bill is a positive first step, according to Margaret Chesney, professor of medicine and former director of the Osher Center of Integrative Medicine, at the University of California, San Francisco School of Medicine, as well as a special advisor to IHPC. “This bill provides opportunities to reach out and encourage Congress to consider the importance of health in general and highlight a very important problem—that in many cases health is determined more by zip code than genetic code. Where we live, the schools in our neighborhood, the availability of low cost healthy fruits and vegetables, the presence of safe spaces to be outdoors, are all major determinants of our health status and longevity.”
While the bill is a step forward, it doesn’t go far enough, she added. The focus of the bill is more on addressing individual social needs such as food insecurity or lack of transportation. Facilitating access to these services is helpful but falls short of addressing the on-going needs. Actually addressing social determinants requires looking at the policies that create the conditions which lead to poor health, according to Sharad Kohli, M.D., IHPC Policy Committee co-chair. “Integrative clinics,” he noted, “including many federally qualified health centers, are uniquely situated to address all of the factors that influence health including working on an individual clinical level with patients using both conventional and complementary health approaches, by directly working with patients to address their specific social needs, and by advocating for policy change that can lead to healthier communities.”2
There are integrative medicine clinics and programs, for example, that not only strive to combine the best of complementary and conventional care, but also to help individuals, families and communities create social and physical environments that are conducive to health. Perhaps we can build on the interest of lawmakers in this bill to help them move toward taking bolder steps to address social determinants of health. Though the legislation recognizes the importance of communities and hospitals linking people to existing available resources, there are still significant gaps to address in these programs. For example, Chesney noted, the recent water problem in Newark, N.J., where the city delivered cartons of water to certain points in the city where contamination was a problem, but seniors in three-story walkup apartments couldn’t access it.
And the fact is, Americans are not getting the most efficient and cost-effective healthcare. Statistics show that among industrialized nations – Japan has the highest longevity – at 84.2 years and their health care cost is $4,766 per capita. In contrast, the U.S. life expectancy is 78.6 years and our health care costs are $10,586 per capita, more than twice that of Japan.3
“If we want to address the extremely high cost of healthcare, which is more than $10,000 per capita and our mortality rate, which is increasing rather than decreasing, then we have to look at the whole picture and need to make it possible to have a healthy lifestyle,” Chesney explained.
If people have to take three buses across town to get to the food bank, that is not going to address the need. A better approach is to place food banks in hospitals. Chesney noted the preventative food pantry program at Boston Medical Center. “You see the doctor and get your recommendations for diet, say for diabetes, and then you go down a few floors and get the recommended food from the food bank. That is integrative medicine!”
“Groups like IHPC are in an ideal position to advocate for bold ideas to help create healthier zip codes,” Chesney added. One such idea, she highlighted is the Morehouse Community Health Worker Training Program4 for High School Students and Young Adults, which offers youth skills that can be directly translated into a meaningful job and a career path for their lives. At the same time, these youth learn positive health skills that they can share with their peers and families. And that, Chesney added, will engage them in helping to change the world in which they live.
- Castrucci BC, Fielding J, Auerbach J. Social determinants of Health—health isn’t just bugs and bacteria. The Hill. 4 2019.
- Castrucci BC, Auerbach J. Meeting individual social needs falls short of addressing social determinants of health. Healthaffairs. Jan. 16, 2019.
- Organization for Economic Co-operation and Development, 2019. oecd/healthstat/life-expectancy-at-birth.htm and Data.oecd/healthres/health-spending.htm.
- Morehouse School of Medicine. Community Health Worker Training Program for High School Students and Young Adults. https://www.msm.edu/Education/PipelinePrograms/hscommunityhealthworker.php
HHS Pain Management Report offers unprecedented potential to support advancement of integrative pain management protocols
The recent release of Pain Management Best Practices Inter-Agency Task Force Report from the U.S. Department of Health and Human Services (HHS) is an unprecedented opportunity to shed light on the potential of integrative and non-pharmacological approaches to pain management, according to the Integrative Health Policy Consortium (IHPC).
Although the nation has been justifiably focused on the action of the pharmaceutical industry that has helped to perpetuate the opioid crisis by promoting drugs for pain that have known potential to cause addiction and harm, this report has received far too little attention, the Washington. D.C.-based non-profit organization said. “This document paints a path forward to effectively address pain with a multidisciplinary strategy utilizing non-pharmacologic approaches,” said IHPC Policy Committee co-chair Sharad Kohli, MD. “Many of the therapies recommended are not only safer, but more effective than opioids, will prevent unnecessary deaths, and will improve the quality of life for the millions of Americans currently suffering with pain.”
The report identifies gaps and inconsistencies in pain management and offers recommendations for improving pain management best practices. The task force emphasizes key non-pharmaceutical centered approaches to improve the lives of patients living with acute and chronic pain. They include individualized patient-centered care fostering a therapeutic alliance between patients and clinicians and multidisciplinary approaches using one or more treatment modalities and the biopsychosocial model for pain care. The report also considers special patient populations and comorbid conditions that accompany complex pain. The Task Force also recommended that the Centers for Medicare & Medicaid Services (CMS) and other insurers align their reimbursement guidelines with these findings.
The Inter-Agency Task Force Report is a welcome addition to the pile of reports generated by government agencies in the context of the opioid overdose syndemic, noted Robert Twillman, Ph.D., an IHPC at-large member and pain management psychologist at St. Luke’s Health System in Kansas City, MO. It is notable, he added, that the work resulting in the document was done by a select group of individuals directly involved with pain management in one way or another, and that it included a broad spectrum of such individuals, as mandated by the SUPPORT Act for Patients and Communities. “Asking those ‘in the trenches’ as people with pain, health care providers, and policymakers to survey the landscape and make recommendations for where we go from here is exactly the way such exercises should be carried out,” Twillman said. “Couple that with robust opportunities for public comment, both online and at the Task Force’s meetings, and you have a document that stands out as an example of the way things should be done.”
The Task Force’s recommendations span five broad treatment approaches to pain management: Medication, Restorative Therapies, Interventional Procedures, Behavioral Health Approaches, and Complementary and Integrative Health. They are reinforced by four cross-cutting themes critical to all treatment approaches: Risk Assessment, Stigma, Access to Care and Education. It represents a philosophical and cultural shift to addressing chronic and acute pain by using Complementary and Integrative Health Protocols, IHPC said.
It is gratifying, Twillman added, to see the task force recognize these ideas because previous guidelines and policies have given little more than lip service to these notions. “Many times non-pharmacological treatments for pain are recognized as preferred first-line therapy, but recognition of the tremendous access barriers to that kind of care is rare,” he said. “Those of us in the field know all too well how difficult it is for most people with pain to access non-pharmaceutical care, and for the Task Force to fully recognize this and recommend changes to coverage policies to promote access is very important.”
Twillman sees this report as a tremendous opportunity for the field of integrative health and medicine. “It is a foot in the door that is enabled by the country’s tremendous problems related to the opioid misuse, abuse, overdose, and overdose death syndemics,” he said. The tremendous opportunity here for integrative providers to demonstrate the value of these interventions can’t be ignored, and the integrative health community needs to do everything in its power to leverage this report to improve access, Twillman added. “Any time a good report is issued, we talk about not letting it just gather dust on a shelf, and far too often, that is exactly what happens. I’m not sure we’ve ever had an opportunity like this, and we can’t allow it to go unrecognized.”
You can read the full report and visit HHS’s accompanying toolkit here
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
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
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 get the research done.
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:
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.
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.
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.
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.”
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.
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.