In February, the Institute of Medicine (IOM) convened a "Summit on Integrative Medicine and the Health of the Public" in Washington, DC. This summit brought together about 600 researchers, practitioners, and leaders from many different aspects of health care, to consider the vision, models, economics, challenges, evidence base, education, and opportunities for integrative medicine in the US.
Participants were welcomed by IOM president Harvey V. Fineberg, MD, PhD. Ralph Snyderman, MD, chancellor emeritus of Duke University, gave the opening address. "What we currently have is not a health-care system, but a disease-care system," he said. "The summit will explore how science and a patient-centered, prospective, integrated approach to care can make a positive difference."
The meeting covered subjects such as the social determinants of health, mind-body medicine, outcomes measures, CAM modalities, workforce and education, the economic burden of chronic disease, behavior change incentives, and the rewards of integrative medicine.
Speakers included major players in health care, such as Senator Tom Harkin of the Senate Health Education, Labor and Pensions Committee and Donald Berwick, MD, president and CEO of the Institute for Healthcare Improvement. They included health professionals with a special interest in integrative medicine, such as Victoria Maizes, MD, executive director of the Center for Integrative Medicine at the University of Arizona, and Mary Jo Kreitzer, PhD, RN, founder and director of the Center for Spirituality & Healing at the University of Minnesota. There were economists and insurers who believe that care models emphasizing wellness, prevention, and focused management of chronic disease will ultimately reduce health-care costs.
Janet Kahn, MT, PhD, a researcher on massage therapy and integrated health care at the University of Vermont, spoke on behavior change incentives and approaches, as part of the panel on economic aspects of care. "Our current financial incentives encourage medical students to go into a specialty rather than primary care," she says. "Reimbursement patterns for hospitals incentivize the use of high tech equipment, rather than physicians talking with patients about what they can do for their own health. One of the strong messages coming out of the IOM meeting was the importance of reexamining our reimbursement patterns." Kahn is the executive director of the Integrated Healthcare Policy Consortium (IHPC).
Interprofessional Education is Key
Elizabeth (Liza) Goldblatt, PhD, MPA/HA, chair of the Academic Consortium for Complementary and Alternative Health Care (ACCAHC), served on the planning committee for the IOM summit, moderated the panel on workforce and education, and was a presenter on the wrap-up panel. "This was a gathering of some of the brightest, most innovative people in all of health care," she says. "Conventional and licensed CAM professionals came together and basically developed a consensus on how to create a health-care system that would be most beneficial for the patient." Goldblatt is the vice president of academic affairs at the American College of Traditional Chinese Medicine.
The IOM summit developed multiple areas of consensus, she reports. Everyone emphasized the need to focus on health promotion, disease prevention, lifestyle issues, and a team approach to treating chronic pain. There was consensus on using less-invasive treatments whenever possible, before more invasive approaches. In addition, there was a strong emphasis on taking these ideas out into the community, instead of waiting until people get sick and arrive at the doctor's office or emergency room.
Participants agreed that it's important to train health-care practitioners who understand the value of other disciplines and can work together in coordinated teams, a topic Goldblatt particularly emphasizes: "We must require interprofessional education. When you educate in a silo, then people practice in silos. Right now, each consumer has to pull together his/her own health-care team; the problem is, the practitioners generally don't talk to each other."
Goldblatt argues that nowadays each licensed professional has an ethical responsibility to understand other health-care disciplines. "It would be even better to train people from the start to use a health-care team approach, since several studies have shown this approach will reduce costs, improve patient satisfaction, and lead to better health outcomes."
What does she mean by a "team approach"? Well, Goldblatt says, look at our high rates of obesity, diabetes and prediabetes. Going to the doctor once a year isn't sufficient to deal with this epidemic. Instead, we need a varied series of options that might include exercise classes, stress reduction classes, a monthly visit to a health coach, or a series of visits to a naturopathic physician to address dietary and lifestyle issues. Patients benefit when a variety of choices is available, particularly since overeating can be due to so many different issues. "Anthropologists report that diet is one of the most difficult life elements to change," Goldblatt reflects.
IOM Summit Available Online
The financial support to make this summit possible came from the Bravewell Collaborative, a foundation dedicated to transforming the culture and delivery of health care. The conference was webcast online in real time. In addition, it is now available online, including all the speakers' presentations. The speeches and panel discussions are available in online video, handouts, and slides as PDF files.
Because of this, we all have a remarkable opportunity to absorb the atmosphere of this meeting, even though it took place several months ago in Washington DC and we're watching now on computer screens thousands of miles away. If you weren't there in person but you want to know what happened, and what the future may hold for integrated health care, the information is all available.
At the end of the conference, Erminia Guarneri, MD, medical director of the Scripps Center for Integrative Medicine, recalled how Scripps first opened its doors with the vision of "healing people and changing lives through science and compassion. We were ridiculed, we were called Dr. Guarneri's cult," she said. "How refreshing it is now to hear Senator Harkin say we are going to pass health reform legislation, shifting our system from a disease-care model to prevention and health. This will be a radical change in health care."
Michael M. E. Johns, MD, chancellor of Emory University, summed up the meeting when he said, "A coherent approach to care must pay attention to body, mind, and soul, considering each individual as a full and equal partner in the conversation." He called for care based on evidence, and noted, "we must consider reinventing the evidentiary model." Commenting on the extremely broad range of interests and backgrounds present at this meeting, and the shared passion for improving care, he said, "Over the past days, we've shaken hands, but the next time we come together, rather than shaking hands, we can hug." It is remarkable to observe the top leaders in health care interacting on this level. We can only hope that from these seeds, continuing changes will emerge.
For the summit agenda and presentation slides, go to http://www.iom.edu/?ID=52555.
For online videos of all the presentations, go to http://www.imsummitwebcast.org.
IOM will publish a summary report on the integrative medicine summit this November. A link to the report will be available on its website, www.iom.edu/integrativemedicine. It will also be available for online viewing and download through the National Academies Press, www.nap.edu.
Bravewell Collaborative: http://www.bravewell.org/transforming_healthcare/national_summit.
The Academic Consortium for Complementary and Alternative Health Care (ACCAHC) is a national organization representing the five licensed CAM fields; it includes the councils of colleges, accreditation agencies and national certification/testing agencies. For more information, go to http://www.accahc.org.
The Integrated Healthcare Policy Consortium (IHPC) is a broad coalition working for high-quality integrated health care, including access to a full range of conventional, complementary, and alternative care professionals, collaborating with one another on behalf of the patient's health. For more information, go to http://www.ihpc.info.
Elaine Zablocki has been a freelance health-care journalist for more than 20 years. She was the editor of Alternative Medicine Business News and CHRF News Files. She currently writes regularly for many health-care publications.