Endorsement Invited for Global “Berlin Agreement” on Self-Responsibility and Social Action in Integrative Health … plus more

Endorsement Invited for Global “Berlin Agreement” on Self Responsibility and Social Action in Integrative Health

Global leaders in integrative health from 13 nations have developed and published “The Berlin Agreement: Self-Responsibility and Social Action in Practicing and Fostering Integrative Medicine and Health Globally.” Already a dozen integrative health organizations from multiple countries on 3 continents have endorsed the document. Others are being invited to do so. Among those in the United States that have done so are the Academy of Integrative Health and Medicine, the Integrative Health Policy Consortium, the Academic Collaborative for Integrative Health, and the Academic Consortium for Integrative Health and Medicine.¹

The agreement is being viewed by some as a modern version of the Hippocratic Oath. The 2-page document includes short statements in the following areas: “Model health”; “Engage patients”; “Promote inter-professionalism and team care”; “Recognize the importance of traditional medicine in health care”; “Commit to evidence-informed dialogue and practice”; “Foster whole systems research”; “Bridge clinical care with prevention, community and public health”; “Stimulate collaboration”; and “Engage as change agents.”

A spirit of activism—both in personal action and social responsibility—pervades the document. One is asked to engage one’s own health and actively assist patients toward theirs. Practitioners are urged out of their silos to team up with those from other professions and other world traditions. Those involved in the movement are urged to extend themselves from strictly clinical interests to work with communities and public health to begin to impact other determinants of health. In addition, the “integrative medicine” community in Europe and the United States is asked to connect with the global movement for integration of traditional medicines as urged in the World Health Organization’s (WHO’s) 2014-2023 Traditional Medicine Strategy.²

Comment: Part of the inspiration for the Berlin Agreement came from the 2016 Stuttgart Declaration,³ backed by the Academy of Integrative Health and Medicine and others, that urged governments and nongovernmental organizations such as the WHO to adopt an integrative strategy. This one focuses on personal action. I have been deeply involved in this and would happily field your questions if your organization is interested in endorsing. Please contact me at johnweeks@theintegratorblog.com/.

“Acupuncture and Chiropracty”—Food and Drug Administration Pain Blueprint Takes First Stab at Including Integrative Practices

Much excitement among integrative leaders when word hit that the Food and Drug Administration (FDA) appears to be opening itself to integrative practices. The subject was this May 2017 issuance of a draft “Education Blueprint for Health Care Providers Involved in the Management or Support of Patients with Pain.”⁴ In agreement with the 2016 Centers for Disease Control and Prevention (CDC) guidance on opioid prescribing, the FDA urges the use of nonpharmacologic approaches first. This was the language: “Nonpharmacologic therapies–includes psychological, physical rehabilitative, surgical approaches; and complementary therapies.” A subsequent section of the document on nonpharmacological approaches also lists “complementary therapies.” These are again at the tail end of the same set of considerations, following psychiatric, rehabilitation, and surgery. This section does, however, get more specific in what it means by complementary therapies. The agency gives “acupuncture and chiropracty” as examples. The bulk of the 10-page document (7 of the 10 pages) is then devoted to suggested educational content relative to pharmacologic approaches. No comment period has been announced on the draft.

Comment: Explicit reference by the FDA—even using an archaic term for chiropractic—is good for those called out. Yet the draft document recalls an eerie 2016 policy move. The draft CDC guideline similarly called for complementary therapies and explicitly mentioned chiropractic—with a modern term—acupuncture, massage, and others. However, these were struck from the CDC’s final document for reasons never made known. The integrative community must be vigilant to hold this hopeful ground. As noted, however, as of this writing, the FDA has not announced a comment period.

ShortTakes.

• ► To support practitioners who offer in-office compounding of herbs, the American Herbal Products Association (AHPA) has published a 20-page document entitled “Good Herbal Compounding and Dispensing Practices.”⁵ AHPA is also soliciting feedback.

• ► Benjamin Kligler, MD, MPH, director of the Integrative Health Coordinating Center at the Veterans Health Administration, was awarded the 2017 Bravewell Distinguished Service Award at the 2017 meeting of the Academic Consortium for Integrative Medicine and Health.

• ► A distinctive integrative pain model developed via the University of Bridgeport chiropractic residency program with Connecticut community health centers is expanding in that state.⁶

• ► Debates sometimes break out in integrative policy dialogues about the extent to which research can shift the biases and culture of decision makers. A recent Society for Acupuncture Research conference featured a presentation by Oregon acupuncture leader Laura Ocker, LAc, that is a remarkable tale of how emerging evidence was put to work to expand the role of acupuncture in Oregon Medicaid.⁷ Ocker provides tools for anyone else interested in either expanding coverage of integrative services, or those specifically interested in acupuncture.⁸

• ► Memorials for integrative medicine and women’s health researcher Fredi Kronenberg, PhD, have been widely published and shared since her passing in April 2017. The researcher with dual posts at Columbia and Stanford was known for her early work on hot-flashes.⁹

• ► A study by James Whedon, DC, MS, of New Hampshire, contains data suggesting that insurers are violating the “Non-Discrimination in Health Care” (Section 2706) of the Affordable Care Act.¹⁰

• ► Geo Espinoza, ND, has gained appointment as Clinical Assistant Professor at New York University School of Medicine. He is among the first NDs with such clinical appointments at a mainstream academic institution.

• ► Bastyr University has acquired Texas-based and regionally accredited AOMA-Acupuncture and Oriental Medicine of Austin.¹¹ Bastyr already has a San Diego campus.

• ► The Academy of Integrative Health and Medicine’s Interprofessional Fellowship is seeking a full-time fellowship director who will contribute their expertise of integrative medicine and academia “to one of the most exciting blended learning Fellowship programs in the world.”

• ► Long-time nutrition reporter and author Jack Challem has died.¹²

• ► A recent article highlights the pioneering use of a licensed acupuncturist in an emergency room. The practitioner, Adam Reinstein, LAc, is now in his fourth year at Minneapolis’ Abbott Northwestern. The position is part of the legacy of the Penny George Institute for Health and Healing.¹³

• ► The first formal, direct recognition of the naturopathic medical profession by the Center for Medicare and Medicaid Services has come via work of the Oregon Association of Naturopathic Physicians. With strong support from the Oregon Health Authority and US Senators Jeff Merkley (D-OR) and Ron Wyden (D-OR), the NDs convinced the agency to include them in a program that subsidizes costs of moving practice management to electronic medical platforms.¹⁴

The FDA’s document presents a more significant opportunity, and challenge, for the integrative health community. This is the damning-with-faint-praise nature of the appearance of integrative practices and all other nonpharmacologic approaches in this and other emerging pain guidance documents. The recommendation is that they come first, yet these educational recommendations do not begin to respect what would effectively be a massive paradigm shift in pain care. Instead, 70% of the content is focused on drug dispensing.

This is the time for the integrative community to educate the FDA. Sample topics to build into the “Education Blueprint”: (1) strategies on how to educate patients to integrative options; (2) explicitly note many other integrative possibilities, such as are mentioned in the recent American College of Physicians (ACP) guideline on back pain¹⁵; (3) drive practitioners to specific resources, including the ACP guidelines and the Joint Commission’s pain standard; (4) include a section on partnership with complementary practitioners such as the National Pain Strategy has recommended¹⁶; etc. If the nation is to shift the therapeutic order in pain management, it is going to need more education than the few short lines the FDA included. Meantime, perhaps the agency will learn how to say chiropractic.

Integrative Group Prompts National Academy of Medicine to Tackle Health, Well-Being, and Resilience

Save the dates: April 26–27, 2018. The National Academy of Medicine (NAM) will hold a workshop open to the public that goes to the heart—and the periphery—of the myriad ways that well-being and resilience are driven out of medicine. The workshop’s working title is will “A Systems Approach to Alleviating Work-induced Stress and Improving Health, Wellbeing, and Resilience of Health Professionals Within and Beyond Education.”¹⁷ A goal is to stimulate positive change that diminishes stress and burnout and is more welcoming to health and wellness. The meeting will be open to the public both onsite and via webinar.

The integrative health community was a prime-mover in instigating the project. Members will have key roles in its development. For example, the Academic Collaborative for Integrative Health (ACIH)—made of representatives of academic organizations from the chiropractic, naturopathic, acupuncture, massage, midwifery, and other fields—has promoted these and other integrative health values as members of NAM’s Global Forum on Innovation in Health Professional Education. ACIH will be well represented in the 16-member planning team. The cochair will be Mary Jo Kreitzer, PhD, RN, FAAN, the founder of the Center for Spirituality and Healing at the University of Minnesota. She will be joined on the committee by Georgetown Integrative medicine leaders Aviad (Adi) Haramati, PhD. Each is a member of the ACIH Council of Advisers. ACIH’s present and past executive directors were also invited to serve on the committee, Elizabeth Goldblatt, PhD, MPA/HA, and John Weeks, respectively. ACIH also assisted in bringing the influential integrative medicine philanthropic organization, The George Family Foundation, to financially support the workshop.

The ACIH Global Forum, known as NAM’s most extraordinary interprofessional initiative, will be joined by representatives from a separate but related, MD-driven “Action Collaborative on Physician Well-being and Resilience”¹⁸ led by the president of the National Academic of Science Engineering and Medicine, Victor Dzao, MD. The partnership is anticipated to draw attention and energy to the workshop.

Comment: This workshop has echoes of the 2009 “IOM Summit on Integrative Medicine and the Health of the Public”¹⁹ for which the George Family Foundation was also a key backer. Only this time, instead of a workshop about an emerging field, this workshop reflects integrative health and medicine values at work as healing agents in mainstream education, payment, and delivery. One sign: the whole-systems approach.

The motivators for the meeting reflect the 2 paradigms. ACIH has promoted the health and well-being direction as an end in itself—an optimal focus of health professions for which curricula and practice are typically mired in reactive disease processes. For conventional players, the focus tends to be on stopping the bleeding. Here is a recent American Hospital Association Publication, describing some of the NAM interest: “Slowly and surely, we’ve been burning out a generation of doctors and nurses. The numbers are startling: Over 50 percent of physicians report one or more symptoms of burnout. Over 50 percent of nurses are emotionally exhausted, and 25 percent are clinically depressed … to numerous observers, the problem is getting worse.”²⁰

An opportunity to influence is here. The Planning Committee “will seek to identify examples drawn from around the world that demonstrate how different professions cope with the stresses of educating health professionals under current health and educational structures, and how adjustments in policies and incentives might move organizations to adopt a more welcoming environment for testing and implementing individual stress-reduction and resilience-building strategies.” Got any suggestions?