Vaccinations in the News: Trump-Kennedy, Cleveland Clinic, Functional and Naturopathic Medicine … plus more

Vaccinations in the News: Trump-Kennedy, Cleveland Clinic, Functional and Naturopathic Medicine

The year 2017 began with what may become big news on regular medicine’s sacred cow: vaccinations. Robert “Bobby” Kennedy announced that then-President Donald Trump was planning to establish a Commission on Vaccination Safety and Scientific Integrity.¹ The announcement came within days of a fury over the same topic initiated when Cleveland Clinic integrative medicine and wellness leader Daniel Neides, MD,² wrote a post at Cleveland.com in which he spoke of vaccinations as a contributive factor in the toxic loading, and in autism.

Media reception to the commission idea tended to rank the new president’s interest with his antiscientific views on climate change. Neides was immediately chastised, disavowed his views,³ and was silenced on the topic by Cleveland Clinic leaders. The Institute for Functional Medicine (IFM), which has partnered in a rapidly growing center at the Cleveland Clinic, issued an official statement via Chairman Mark Hyman, MD, as reported in Holistic Primary Care: “IFM’s medical education supports the use of vaccinations. Vaccinations against a variety of diseases have been a critically important step forward in medical science. Vaccines have been studied extensively, and while continued critical evaluation and discussion about all medical treatments is the way science moves forward, vaccination administration is an important standard of care that is supported by IFM.”⁴

Meantime, the Naturopathic Academy of Primary Care Physicians (AAPCP), a specialty organization associated with the American Association of Naturopathic Physicians (AANP), took a strong stance late last year that was similarly in favor of the US Centers for Disease Control (CDC) current immunization schedule.⁵ The move—at odds with an as-yet indecisive stance of the AANP on this hot potato—was celebrated in the newsletter of the Seattle-King County Department of Public Health.⁶ In the Holistic Primary Care article noted previously, the AANP’s executive director, Ryan Cliche, is quoted as stating that he expects a new position statement from the AANP this year.

Comment: A shared characteristic of Kennedy, Neides, Trump, and apparently a large set of naturopathic doctors, is that although they question present vaccination policy, each clarifies a stance that is generally “provaccine.” Trump stated during the campaign that he is “totally in favor of vaccines, but I want smaller doses over a longer period of time.”⁷ Kennedy echoed the view, as did Neides. Sources close to the AANP have shared that the indecisiveness at the AANP is not because most naturopathic doctors are rabidly antivaccination. Rather, the membership’s view reflects a bell curve. A small set supports the AAPCP’s lock-step with the CDC (and apparently IFM), a similarly sized group that is hardcore antivaccination, whereas a quite large majority supports some vaccines but questions the schedule and the sheer number of shots presently required from the vaccine-happy CDC.

Yet, breath a word of dissent regarding policy in the dominant school and public health leaders and most medical reporters will quickly brand onto a group’s or individual’s forehead an “antivaccine” or “antiscience” label. There were signs after the Kennedy-Trump announcement that the Trump administration might succumb to such pressures and back off on convening the commission. If the commission is empaneled, medicine’s sacred cow will certainly be impaled by the javelins of heart-wrenching individual tales and photos of kids lost to regular life within hours or days of their vaccinations. Nobody on any side can forecast for certain what exactly the outcomes will be for the public health.

Research Initiatives at 2 Major Institutes for Integrative Health and Medicine Shut Down

The turn of the new year brought gloomy news for those monitoring the emergence of evidence on integrative health and medicine practices. In early December, participants at a Samueli Institute function learned that the prolific center, led by former National institutes of Health (NIH) Office of Alternative Medicine director, Wayne Jonas, MD, was shutting its doors.⁸ For 15 years, the institute has produced a steady stream of white papers, books, reports, and more than 700 peer-reviewed articles.⁹ The institute’s researchers have engaged multiple complex topics for which the NIH offer little or no funding: energy medicine, whole systems research, optimal healing environments, and community-wide health creation. Recently, the institute has been especially well known for its research on integrative strategies for members of the military and veterans, engaged via major congressional appropriations and other government grants.

ShortTakes.

► A Cleveland.com article provides an update on the evolving clinical model and new 17 000-square-foot space that will headquarter what is now branded as the Celia Scott Weatherhead Center for Functional Medicine at the Cleveland Clinic.¹⁰

► The American Board of Lifestyle Medicine has announced that it is about to board-certify its first set of medical doctors and osteopaths. A separate certification for other provider types is available through a sister organization, the American College of Lifestyle Medicine.¹¹

► A new version from the naturopathic physician team of Jared Zeff, ND, Pamela Snider, ND, and others of a paper on “The Hierarchy of Healing: The Therapeutic Order” that anchors that system of care has been made available to the public.¹²

► An organization that has become the leading player in policy for the licensed acupuncturists, the American Society of Acupuncturists, with its 24 state organizational members, has made its first annual report available to the public.¹³

► Researcher Jim Whedon, DC, MS, at Dartmouth and Southern California University of Health Science, has found that for users of chiropractic, the likelihood of filling a prescription for a high-risk drug of any type was 27% lower than that for nonusers. Whedon also found that chances of refilling a prescription for an opioid analgesic was 57% lower in the chiropractic-using population.¹⁴

► Naturopathic doctors gained licensing in Massachusetts, making that their 19th state and 22nd US jurisdiction.¹⁵ Credit the driving leadership of Amy Rothenberg, ND, for finally closing on this campaign that spanned 2 decades.

► A major chiropractic meeting on March 15 to 18, 2017, in Washington, DC, is expected to draw 1500 attendees and unites 3 organizations: the World Federation of Chiropractic, Association of Chiropractic Colleges, and the National Chiropractic Leadership Council.¹⁶

► UCLArts and Healing is producing what may be the nation’s most significant conference exploring the role of the arts in health care called “Creative Arts & Healing.”¹⁷

► The National Center for Homeopathy has published its plan to respond to significant challenges that field has recently faced from the US Food and Drug Administration and US Federal Trade Commission.¹⁸

► Those interested in state of the art practices for credentialing acupuncturists for work in large medical delivery organizations will find useful a new paper from the Academic Collaborative for Integrative Health and the National Certification Commission for Acupuncture and Oriental Medicine.¹⁹

Five weeks later, on January 13, 2017, Allina Health, the huge Minnesota network of a dozen hospitals and scores of primary care clinics, shuttered the research department at the Penny George Institute (PGI) for Health and Healing.²⁰ The department, led since 2007 by Harvard-educated researcher, Jeffrey Dusek, PhD, similarly produced a steady stream of reports on the outcomes of integrative strategies in Allina’s inpatient and outpatient care facilities. These were frequently the backbone of evidence-based presentations on the potential of integrative care in medical delivery organization. An example was a publicly available recent presentation at a conference in Colorado entitled, “Future Trends in Healthcare: An Integrative Approach to Health and Wellness.”²¹

Comment: It is hard to overstate the loss from these 2 moves. Each had a 10- to 15-year ride. Each was substantially backed by philanthropists: Henry and Susan Samueli and Bill and Penny George, respectively. I reported the changes at the PGI where the choices came from the parent, Allina Health. Allina was increasingly on the hook as the Georges cut back their philanthropy 3 years earlier. Financial issues were the chief concern in the research department-ectomy. The Samueli Institute’s site offers no reason, stating only that “now, after 15 years of service to the integrative health, health care, and military communities, Samueli Institute will cease research and programmatic operations in 2017.”

There is such thing as donor fatigue, which may have played a role in each of these moves. Credit the Samuelis and the Georges for all the learning they made possible. The Georges anticipated that the uptake of integrative care would be more rapid under the Affordable Care Act. Yet the move from volume to value, still a small fraction of payment, is expected to slow with the new administration’s antagonism toward the 2010 statute. In the Samueli case, congressional action to end earmarks put the writing on the wall. This funding dried up. Jonas and his team might take pride that their work helped stimulate the robust engagement with, and research on, integrative practices inside Veterans Affairs (VA) and the Department of Defense today. Dusek and the PGI team can similarly pride themselves on how many medical delivery organizations across the United States began integrative medicine programs after reviewing data from the PGI. Each is testament to how evidence can make a big difference is opening these services to greater access. Big thanks to each. Big sadness, also, that these streams of data will soon dry up.

Traditional Chinese Medicine Hospitals: First Chinese Government White Paper on Traditional Chinese Medicine

China, surprisingly, recently has issued what it calls its “first white paper” on traditional Chinese medicine (TCM).²² The nation plans to substantially increase investment in that minority fraction of the government-backed health care. China’s current investment already overwhelms that in any form of traditional or integrative care around the world. The authors estimate 910 million visits to government-sponsored facilities in China. These are registered in 3966 TCM hospitals and 42 528 TCM clinics. Inpatient visits totaled 27 million. The white paper also reports an additional 446 “integrated” hospitals and 7705 “integrated” clinics.

Driving China’s renewed interest are incentives linked to both cost and global ambitions. Internally, the government’s interest is backed by data that visits to TCM clinics costs 11.5% less, and those to TCM hospitals cost 24% less, than those in the nation’s biomedical hospitals. Globally, the government views expansion of TCM as both an important cultural campaign and an opportunity for business. The Chinese government has sponsored TCM programs in 10 countries and has cooperation agreements on TCM in 86. A total of 183 countries have some level of TCM programs. Some level of insurance coverage is available in 18. The white paper underscores that the Chinese government believes that TCM growth internationally will continue to create significant markets for exports of Chinese products.

Comment: For those tracking the governmental investment in integrative health and medicine in the United States, these numbers are, as Buzz Lightyear put it, “to infinity and beyond.” Nor is most of the US government engaging the potential affirmatively. A 2002 report of the White House Commission on Complementary Medicine Policy, which urged a multipronged federal engagement with integrative services, presently has 15 years of dust on it.

Where federal action has been engaged in this military, the much-heralded growth of integrative services in the VA produced 214 000 visits in the most recent count.²³ Other than chiropractic for low back pain, Medicare offers little coverage. Acupuncture and naturopathic medical services are included in only a few state Medicaid programs. The total number of TCM hospitals in China pushes up against the total number of hospitals of all kinds in the United States. No hospital in the United States is fully integrated. Few hospitals offer much in the way of integrative services outside of oncology. To the extent that the national burden of medical costs influences corporate competitiveness, the Chinese are likely to reap the rewards. Where ever else China may or may not assume ascendance in the 21st century, there is little doubt that it will keep its global leadership in formally investigating and promoting (lower cost) traditional, natural, and integrative services.