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Integr Med (Encinitas). 2016 April; 15(2): 16–18.
PMCID: PMC4898277

The Leadership of the Naturopathic Profession in the Emergence of Integrative and Functional Medicine … plus more

The Leadership of the Naturopathic Profession in the Emergence of Integrative and Functional Medicine

The modern rebirth and standard-setting of the naturopathic medical profession in the late 1970s and 1980s predated the emergence of the 2, MD-dominant fields of “integrative medicine” and of “functional medicine.” The naturopathic profession had only approximately 600 licensed doctors in 1985, a figure that has slowly grown to 5000 nearly 3 decades later. Yet as detailed in a Huffington Post column1 and in a related piece at the Integrator Blog,2 the roles of this vanguard in the emergence of these 2 movements has been huge. Naturopathic doctors are the core staff educators at the Institute for Functional Medicine (IFM) and the Academy of Integrative Health and Medicine (AIHM). At Cancer Treatment Centers of America, they pioneered integrative oncology. Members of that profession, as successive presidents of the Society for Integrative Oncology, led developments of the gemstone publication for that organization, guidelines for integrative treatment for women with breast cancer.3 The nation’s blueprint for pain treatment as published by the Institution of Medicine in 2011 was substantially influenced in an integrative direction by a naturopathic physician acupuncturist.4 Also on the clinical side, naturopathic physicians are on the front lines in modeling integrative patient-centered medical homes.5

The list goes on. The first science-based, heavily referenced textbook on the natural medicine field was coauthored and edited by 2 naturopathic physicians, one of whom serves as editor of this journal. The first hospital-based natural products formulary was developed by a naturopathic doctor at North Hawaii Community Hospital. The top integrative care research economist, presently at the RAND Corporation, is a naturopathic physician. The field birthed leading advocates of, and formulators for, for whole systems, outcomes research models. Graduates of naturopathic schools steered European standardized extracts into the US botanical market. A global service learning model for integrative practitioners was developed by the naturopathic physician founders of Natural Doctors International. In addition, the most significant, successful interprofessional collaborations in the field—the Integrative Health Policy Consortium and the Academic Consortium for Complementary and Alternative Health Care—were substantially shaped by naturopathic physicians and individuals whose careers included long periods in early leadership of the field’s emergence.

The Huffington Post article asked what the optimal position of the profession should be going forward. Should they focus on guild advancement knowing that due to their small numbers, only a tiny minority of patients will ever receive care from a naturopathic doctor? Or should they build on this pattern to continue to educate members of other professions to their care, model, their clinical principles, and their therapeutic order?

Comment: Okay, as a person who spent 1983 to 1993 with the naturopathic profession and had a hand in some of this, I am a deeply biased reporter. Tough questions. The best direction I have heard yet came out of a mid-January breakfast meeting with an energetic and activist 5th-year naturopathic student who was about to graduate with $293 000 in student-loan debt. We began turning over in our minds the idea of a profession-wide reconciliation process. My electronic dictionary teaches me that this powerful word with deep resonance in postapartheid South Africa has multiple useful meanings. On the one end: “To resign, submit, accept—as in reconcile to one’s fate.” Then there are these: “Accommodate new results with existing theories.” Better yet: “To harmonize, bring into consonance or accord—as in one’s goal with one’s abilities.” The last definition offered: “To patch-up or make-up.” If we drop all guild consideration and view this simply from a public health perspective, what is the highest and best use of this powerfully accomplished naturopathic profession for fostering human health?

A Step Forward and a Pause as Oregon Begins to Put Nonpharma Approaches First in Pain Care

Under Oregon’s former physician governor John Kitzhaber, md, the state’s Health Evidence Review Commission convened an interprofessional task force to set a strategy for back pain care in the state’s Coordinated Care Organizations (CCOs). Included with a group of pain leaders from dominant institutions were long-time chiropractic policy leader Vern Saboe, dc, and the former president of her state’s acupuncture association, Laura Ocker, lac. The goal: Set a plan to reduce the state’s record-breaking use of opioids.

ShortTakes

  • [triangle] At a December, 2016 hearing for the Congressional Dietary Supplement Caucus, Congressional staffers heard fears of dietary product safety debunked by University of Minnesota Clinical Professor Richard Kingston, pharmd.6
  • [triangle] The American Chiropractic Association has commended the Centers for Disease Control (CDC) for including “conservative approaches” in the draft guideline on opioid prescribing.7
  • [triangle] Speaking of pain treatment, the boards of medicine, nursing, and pharmacy in Minnesota have jointly passed a “Joint Statement on Pain Management” that focuses on interprofessionalism and multimodality approaches, and it includes nonpharmacologic approaches.8
  • [triangle] The “Medscape Lifestyle Report 2016: Bias and Burnout” reports that burnout rates for all physician specialties are higher than last year, as is the reported severity of their burnout.9
  • [triangle] Nan Sudak, md, is stepping down as coexecutive director at the Academy of Integrative Health and Medicine (AIHM). Sudak is the former long-time leader of the American Board of Integrative Holistic Medicine.10
  • [triangle] The $14-million integrative center at Jefferson University funded by Home Depot Founder Bernie Marcus has opened its doors.11
  • [triangle] Glenn Sabin and FON Consulting have published an amendable list of integrative health and medicine meetings for the coming year.12
  • [triangle] Speaking of AIHM, the organization announced that its interprofessional Fellowship in Integrative Medicine has gained approval from the American Board of Integrative Medicine of the American Board of Physician Specialties.13
  • [triangle] Evolution of Medicine/Functional Forum has produced a podcast on a “winner’s history” of integrative health and medicine from chronicler John Weeks.14
  • [triangle] Behind the scenes, integrative health and medicine influencer, Dan Seitz, jd, edd, has been appointed to serve on the National Organic Standards Board as a public interest/consumer member. Seitz has served in leadership capacities on national agencies for NDs, LAcs, yoga therapists, and nutritionists.15
  • [triangle] The founding director of the most significant, civilian, medical delivery organization-based integrative initiative, Lori Knutson, rn, bc-hn, has taken the integrative health leadership position with New Jersey’s Meridian Health. Knutson formerly led the Penny George Institute/Allina Health initiative.
  • [triangle] Dynamic Chiropractic has named Christine Goertz, dc, phd, as its 2015 Person of the Year. The vice-chancellor at Palmer College is on the PCORI Board of Governors and on the National Advisory Council of the National Institutes of Health (NIH) National Center for Complementary and Integrative Health.16

The strategy recommended then approved for implementation on January 1, 2016, was a remarkable turning point for US pain treatment.17 In “From Pills to Pins,” an Oregon official explains, “The only thing that might have been covered in the past was narcotics. But treatments such as acupuncture, chiropractor, massage therapy, physical therapy, and rehab would never have been covered.”18 These practitioners would be covered Medicaid providers in CCOs and the goal was to use them early instead of as an afterthought.

Just before the plan was to go into effect, officials stopped the train. Why? Ocker shared that “the only thing I’ve heard is that this is a delay in implementation only, due to need for a fiscal analysis. I’m not sure why. At the last minute, when things were all rolling forward and about to go into effect, suddenly someone came in and said ‘we need to do a fiscal analysis,’ but the folks I’ve talked to on the state level are still thinking of this as an implementation delay only.” Saboe suggested that the postponement of implementation might be linked to examining a new opioid replacement strategy believed to potentially cost less. Ocker says she “remains optimistic” that the recommended nonpharmacologic strategy will be put in place.

Comment: The excitement in the Oregon possibility is that a governmental unit it not merely stating that nonpharmacologic approaches may be useful. Rather, they would be using more conservative strategies first, as the chiropractors advocate. Or, to reiterate the phrase favored by the naturopathic doctors and noted above, the recommendation would be changing the therapeutic order by guiding people first to nonpharmaceutical strategies. Here’s hoping the opportunity opens shortly, that data are collected, and that the chips fall where human-centered care—versus pharma-centric—would like them to fall! I show my bias.

Integrate With This: Will Berwick’s 9 Steps Set Regular Medicine on the Right Path?

Perhaps the most outspoken voice promoting the shift of the dominant medical industry toward a value-based system is former Centers for Medicare and Medicaid Services administrator, Don Berwick, md. Berwick recently used his annual keynote at the Institute for Healthcare Improvement (IHI) to push the assembled leaders in new directions. He urged 9 steps19: (1) stop excessive measurement; (2) abandon complex incentives; (3) decrease focus on finance; (4) avoid professional prerogative at the expense of the whole; (5) recommit to improvement science; (6) embrace transparency; (7) protect civility; (8) listen—really listen; and (9) reject greed. The comments on the last 2 provide some of the flavor. For “listen really listen” he clarifies: “These terms—coproduction, patient-centered care, what matters to you—they’re encoding a new balance of power: the authentic transfer of control over people’s lives to the people themselves.” And regarding greed: “For whatever reason, we have slipped into a tolerance of greed in our own backyard and it has got to stop. We cannot ask for trust if we tolerate greed. The public is too smart.”

Comment: The act of advancing the integrative health model requires finding values alignments with which one can dance. Berwick’s views are always provocative. At the 2009 Summit on Integrative Medicine, he crossed over from the mainstream and confidently propounded “8 Principles for Integrative Medicine.”20 Four years later, he drew from what he called “mentoring” from a set of integrative health and mind-body leaders in his annual IHI 2013 talk.21 He urged the field to look beyond value-based care to “salutogenesis.” He called for a 30-year plan and began to create an image of true health-focused systems in a mission of health creation. Now, 2 years later, these 9 steps.

What are we to make of them? A cluster of these moves related to the damning influence of capitalist medicine (financing, incentives, greed, and, likely, transparency and professional prerogative). Another pirouette is required for the challenges for the MD guild of stepping down from deification into team care (civility, listening, definitely professional prerogative, and, likely, transparency). A challenging 2-step is required by the demoralization from present management strategies (excessive measures, complex incentives).

As a set of dance steps, there is much here that can keep one excited, and off each other’s toes. Yet overall, the tone feels like that of a practitioner who, when the patient is already shuffling toward the exam room door, advises: Stop smoking, reduce meat, walk more, add fiber, find a hobby, take yoga, spend less time at work, and try nonviolent communication. Is anyone really listening?

Footnotes

This column is offered in collaboration with The Integrator Blog News & Reports (http://theintegratorblog.com), a leadership-oriented news, networking, and organizing journal for the integrative medicine community. For more information on these and other stories, enter keywords from the articles in the site’s search function.

References

1. Weeks J. Chronicles of health creation: The naturopathic profession’s impact on integrative and functional medicine. Huffington Post. [Accessed February 27, 2016]. http://www.huffingtonpost.com/john-weeks/chronicles-of-health-crea_7_b_8877798.html. Published January 5, 2016.
2. Weeks J. Integrative medicine, complementary and alternative health and medicine round-up #99: January 2016. The Integrator Blog Web site. [Accessed February 27, 2016]. http://theintegratorblog.com/index.php?option=com_content&task=view&id=1005&Itemid=189. Published January 2016.
3. Greenlee H, Balneaves LG, Carlson LE, et al. Clinical practice guidelines on the use of integrative therapies as supportive care in patients treated for breast cancer. J Natl Cancer Inst Monogr. 2014;2014(50):346–358. [PMC free article] [PubMed]
4. Weeks J. In Memoriam: Rick Marinelli, ND, LAc (1954–2013) The Integrator Blog Web site. [Accessed February 27, 2016]. http://theintegratorblog.com/index.php?option=com_content&task=view&id=859&Itemid=93.
5. Weeks J. Integrator special: Prototypes of MD-led and ND-led integrative patient-centered medical/health home. The Integrator Blog Web site. [Accessed February 27, 2016]. http://theintegratorblog.com/index.php?option=com_content&task=view&id=999&Itemid=189.
6. American Herbal Products Association. Product safety expert debunks research questioning the safety of dietary supplements at Congressional briefing. [Accessed February 27, 2016]. http://www.ahpa.org/News/LatestNews/TabId/96/ArtMID/1179/ArticleID/585/Product-safety-expert-debunks-research-questioning-the-safety-of-dietary-supplements-at-Congressional-briefing.aspx. Published December 11, 2015.
7. American Chiropractic Association. Chiropractic physicians applaud CDC’s draft guideline for opioid prescribing. [Accessed February 27, 2016]. http://www.acatoday.org/News-Publications/News/News-Releases/Chiropractic-Physicians-Applaud-CDC-Draft-Opioid-Prescribing-Guideline. Published January 19, 2016.
8. Minnesota Boards of Medical Practice, Nursing, and Pharmacy. Join statement on pain management. [Accessed February 27, 2016]. https://mn.gov/boards/assets/Joint_Stmt_Pain_Mngmt_12_2015_tcm21-90796.pdf.
9. Medscape. Medscape Lifestyle Report 2016: Bias and burnout. [Accessed February 27, 2016]. http://www.staging.medscape.com/features/slideshow/lifestyle/2016/public/overview#page=1. Published January 13, 2016.
10. Academy of Integrative Health and Medicine. News of change. [Accessed February 27, 2016]. http://us2.campaign-archive2.com/?u=c0d1c54ffaa88beb9fc88ac2a&id=3429ea2cf0&e=b2741922c3.
11. George J. Jefferson’s $10M integrative health center readies for debut. Philadelphia Business Journal Web site. [Accessed February 27, 2016]. http://www.bizjournals.com/philadelphia/morning_roundup/2015/12/jefferson-villanova-myrna-brind-med-center-pet-mr.html. Published December 4, 2015.
12. FON Consulting. integrative health conferences. 2016. [Accessed February 27, 2016]. http://fonconsulting.com/resources/integrative-medicine-conferences/
13. PR Web. AIHM Fellowship Officially Recognized and Approved by the American Board of Integrative Medicine (ABOIM) [Accessed February 27, 2016]. http://www.prweb.com/releases/2015/12/prweb13139747.htm. Published December 22, 2015.
14. Evolution of Medicine. Functional forum: IHPC Part 1: How integrative medicine won. [Accessed February 27, 2016]. http://functionalforum.com/ihpc-part-1-how-integrative-medicine-won/. Published December 3, 2015.
15. United States Department of Agriculture. Dan Seitz. [Accessed February 27, 2016]. http://www.ams.usda.gov/rules-regulations/organic/nosb/current-members/dan-seitz.
16. Dynamic Chiropractic. Our 2015 Person of the Year: Dr. Christine Goertz. [Accessed February 27, 2016]. http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=57576. Published December 15, 2015.
17. Oregon Health Authority. Changes in coverage for back conditions. [Accessed February 27, 2016]. http://www.oregon.gov/oha/herc/FactSheet/Back-policy-changes-fact-sheet.pdf. Updated November 13, 2015.
18. Foden-Vencil K. From pills to pins: Oregon is changing how it deals with back pain. Kaiser Health News Web site. [Accessed February 27, 2016]. http://khn.org/news/from-pills-to-pins-oregon-is-changing-how-it-deals-with-back-pain/. Published September 22, 2015.
19. Stempniack M. Don Berwick offers health care 9 steps to end era of ‘complex incentives’ and ‘excessive measurement’ Hospitals and Health Networks Web site. [Accessed February 27, 2016]. http://www.hhnmag.com/articles/6798-don-berwick-offers-health-care-9-steps-to-end-this-era-of-greed-and-excessive-measurement?utm_source=daily&utm_medium=email&utm_campaign=HHN&eid=257849055&bid=1255143. Published December 11, 2015.
20. Weeks J. IOM’s inviting report on the Summit on Integrative Medicine, uh, “Health Care” The Integrator Blog Web site. [Accessed February 27, 2016]. http://theintegratorblog.com/index.php?option=com_content&task=view&id=611&Itemid=1.
21. Weeks J. Hooking up: Don Berwick, integrative medicine and his call for a radical shift to ‘health creation’ Huffington Post. [Accessed February 27, 2016]. http://www.huffingtonpost.com/john-weeks/don-berwick-integrative-m_b_4781105.html. Published February 18, 2014.

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