We value the lively, productive exchange that occurs when experts from disparate fields come together to address important and useful questions. Join us at one of our upcoming forums.
Institute Scholar Claudia Witt, MD, MBA, presented a plenary session on International Perspectives on Acupuncture Research – Where Do We Stand, Where Should We Go? based on the acupuncture effectiveness guidance document generated by the Institute’s July 2011 forum in Santa Fe, NM.
The Institute is sponsoring Sean Tunis, MD, presented a plenary session on Developing a Methodological Framework for Comparative Effectiveness Research in Integrative Medicine. This work comes out of the forum co-sponsored by the Institute and the Center for Medical Technology Policy in November 2009.
Institute Scholar Richard Hammerschlag, PhD, co-chaired a symposium at the congress with Shamini Jain, PhD (Samueli Institute): Toward an Integrated Understanding of Scientific and Methodological Issues in Biofield/Bioenergetic Therapies.
The symposium examined the evidence for biofield healing, for biofield therapy-related changes in healers and healees, and for physiological mechanisms related to endogenous and exogenous electromagnetic fields.
The Institute for the Advancement of Minority & Multicultural Medicine convened a summit on “Enhancing Health Status and Achieving Health Equity at Lowest Cost” to correspond with the unveiling of the MLK Jr. National Memorial in Washington, DC. The Institute was invited to collaborate by presenting a panel entitled “Integrative Health – Integral to Health Equity.”
The discussion defined integrative health and illuminated the integration of mind, body and spirit into the African American cultural understanding of health. Additionally, the panel discussion placed traditional African American folk healing within the larger context of health, and highlighted several current integrative medicine initiatives that address health disparities in both direct patient care and health professional education.
Interdisciplinary Consensus Workshop on the Development of an Effectiveness Guidance Document (EGD) for Acupuncture Research, Santa Fe, NM, July 2011
Interdisciplinary Consensus Workshop on the Development of an Effectiveness Guidance Document (EGD) for Acupuncture Research, Santa Fe, NM, July 2011
This workshop is an outcome of the Stakeholder Symposium on the Evidentiary Framework for Complementary and Integrative Medicine, sponsored by the Institute together with the Center for Medical Technology Policy, in Baltimore, MD, November 9, 2009. The aim of the workshop is to develop a comprehensive consensus document to guide design of comparative effectiveness research (CER) on acupuncture. This effectiveness guidance document (EGD) will take existing research design guidelines into account and will also outline areas where aspects of health economic analysis may be integrated.
EGDs provide specific recommendations on the design of prospective studies that will inform decisions by patients, clinicians and payers. The recommendations are written for clinical researchers conducting studies of specific types of interventions or clinical conditions. EGDs are intended to be analogous to Food and Drug Administration guidance documents, but are focused on design elements intended to support clinical and health policy decision making. The recommended methods aim to achieve a balance between internal validity, relevance, and feasibility. These documents are developed through an extensive consultative process involving a broad range of experts and stakeholders.
The outcome of this workshop will be an EGD for use in designing CER studies of acupuncture used as a single CAM therapy. Findings from CER are intended to be directly relevant to actual clinical decision-making, and therefore directly relevant to improving patient care and patient outcomes.
The Epidaurus Project was begun in 2001 by Frederick Foote, MD (Uniformed Services University of the Health Sciences), as an initiative to strengthen the holistic practice of medicine in the United States Military Health System. Project phases I and II focused on the built-environment of health, defining core principles of patient-centered care and determining architectural elements that promote and embody such care. These principles and elements are now being realized in the new Walter Reed National Military Medical Center in Bethesda, MD, conceived and taking form as a healing environment.
The Institute for Integrative Health is a collaborator in Epidaurus Project II, engaged in studying the strategic question, “What mathematical constructs might express the effects of holistic interventions?” Can outcomes of “whole-person” care – mind, body, heart and spirit – be measured according to valid, scientific standards, so that such care can be evaluated, improved and disseminated? During the year 2010-2011, the Institute is convening a select working group to focus on this core question. A final consensus statement will describe a range of potential metrics, identify four or five for testing, and propose a study to evaluate the metrics in parallel in a population of patients receiving holistic care in civilian and federal facilities that practice integrative medicine.
Epidaurus, a city in ancient Greece, was revered as a healing center throughout the classical world for over 600 years. The present Epidaurus Project aims to develop to modern scientific standards the knowledge base, physical environment, and clinical expertise that will create a model for future healthcare systems, both military and civilian.
Stakeholder Conference on Collaboration for the Ongoing Work of Healthcare Reform, Washington, DC, September 27-29, 2010
The Patient Protection and Affordable Care Act of 2010 includes significant provisions in support of integrative health, wellness, prevention and patient-centered research. Passage of the bill, however, is only one step toward putting the law into effect. Yet ahead is the rule-making process needed to implement the law, as well as planning for a research agenda on patient outcomes and healthcare delivery systems. The Institute for Integrative Health collaborated with the Integrated Healthcare Policy Consortium (IHPC) and the Palmer Center for Chiropractic Health Policy to host a meeting addressing this critical opportunity. A wide range of integrative healthcare stakeholders were invited to strategize a comprehensive engagement in the healthcare reform process.
The Institute for Integrative Health is committed to the goals of this meeting:
To understand clearly what is and is not in the Patient Protection and Affordable Care Act of 2010, and what latitude is possible during implementation;
To strengthen the collaborative capacity of the complementary, alternative and integrative healthcare community;
To strategize collaboratively to make the most of each relevant provision in this bill;
To ensure that complementary, alternative and integrative healthcare clinicians, educators and experts are on the various commissions and advisory boards initiated through this bill; and,
To establish ourselves as a resource to:
- The agencies overseeing rule-making on each provision,
- Legislators interested in this issue,
- The White House, and
- Other concerned groups and individuals.
Outcomes will include dissemination of a conference report and legislative briefings. As well, these discussions are an important platform for collaboration in phase two of healthcare reform, to focus on a redefinition of health and further restructuring of our healthcare delivery systems.
During recent national discussions of healthcare reform, the new profession of “health and wellness coach” was often positioned as a key strategy for helping people to make lifestyle changes, become more responsible for their health, and integrate complementary therapies into personal plans for health and well-being. Over the last decade, professionals called “health” or “wellness coaches” have been providing a wide range of services, both independently and under the auspices of third-party payers and employee benefits companies. Among these professionals, there is great variability in the depth and content of training and skill, as well as in the services provided. Some have conventional health professional education, while others come from a general coaching background with minimal healthcare knowledge.
In response to the need for and the variability of these services, leaders in integrative medicine began to collaborate with leaders in the field of health and wellness coaching, to define this new type of healthcare professional, focused on lifestyle change. The result is the Integrative Health and Wellness Coaching Invitational Summit, sponsored by The Institute for Integrative Health in conjunction with Harvard University and the University of Minnesota Center for Spirituality and Healing, to take place September 26-27, 2010, in Wellesley, MA.
The goal of the Health and Wellness Coaching Summit is to clarify terms and definitions, agree on levels of training and competencies, and propose a plan of action to establish national certification. Health and wellness professionals from around the country are now being invited to participate in the summit, including stakeholders from institutions with health coaching programs, corporations that offer health coaching services to employees, corporations that provide health coaching services, third-party payers, and experts in certification best practices. The intention is to maximize creative input from the entire group and generate practical recommendations for advancing the health coaching field. A summary document will be produced for submission to the journal, Alternative Therapies in Health and Medicine.
We are pleased to be the sponsor for this innovative summit. The emerging field of health and wellness coaching presents a hopeful opportunity to improve the health of the nation and the world.
As follow-up to the Stakeholder Symposium on the Evidentiary Framework for Complementary and Integrative Medicine (CIM), co-sponsored with the Center for Medical Technology Policy in November 2009, the Institute hosted a three-week online discussion, April 12-30, 2010. The intent was to invite a multidisciplinary range of stakeholders – integrative medicine researchers and clinicians, public health experts and policy-makers, payers and the public – to engage online together in three major areas:
Stakeholder Needs – When making healthcare decisions, what information do we stakeholders want and need? What outcomes matter to us and therefore should be measured? Are we able to compare treatments – for example, can we compare conventional and CIM approaches – and have confidence in the information we’re using? How can we get high-quality comparative effectiveness research (CER) to support the healthcare decision-making needs of all stakeholders?
Research Methods – If commonly used research methods aren’t giving us the kinds of information and the comparative data we need for decision-making, then what other innovative research designs can help to provide it? If these new methods are considered less ‘rigorous’ than randomized controlled trials, is it possible to achieve both rigor and relevance in clinical research? How can we balance the internal validity and the external validity – the practical application – of clinical research?
Cost-Effectiveness – Potentially, CER can give us comparative data on the cost-effectiveness of different medical options. What do we know about the cost-effectiveness of the CIM approach to healthcare? How can CER be used to help us understand the potential of integrative medicine to lower the national healthcare bill? Can CER give CIM a place in the coverage and reimbursement system?
The full discussion from this online event (now closed to further comment) can be reviewed online at The Symposium Information and Access Page. User ID and password are both: tiihguest.
This three-week event showed that a wide array of researchers, clinicians, policy experts and the public want to engage in timely discussion of important healthcare topics and that the Institute plays a valuable role as online convener. This form of discussion will be integral to future Institute Forums.
Stakeholder Symposium on the Evidentiary Framework for Complementary and Integrative Medicine, Baltimore, MD, November 9, 2009
In February 2009 the Institute of Medicine and the Bravewell Collaborative sponsored a three-day Summit on Integrative Medicine and the Health of the Public. At this meeting, Dr. Sean Tunis stated that integrative medicine experts had been substantially absent from the ground-breaking discussions of comparative effectiveness research that were taking place within conventional medicine. As a result, integrative medicine research was unnecessarily limited in both methodology and clinical usefulness. Recognizing the seriousness of this issue, the Institute for Integrative Health partnered with Dr. Tunis and the non-profit Center for Medical Technology Policy (CMTP), to convene in November 2009 the Stakeholder Symposium on the Evidentiary Framework for Complementary and Integrative Medicine. Focused on the timely issue of comparative effectiveness research, the Institute and CMTP brought together 45 diverse experts and stakeholders to examine opportunities and obstacles in carrying out rigorous, clinically useful studies in integrative medicine.
The symposium summary is available as a PDF by clicking on the image of the cover below. The video below is from a concluding round-table discussion after the symposium (35 minutes).
A white paper for publication is in progress, and a follow-up working group will draft guidelines for the design of patient-centered, clinically relevant integrative medicine research.
The Middle East Cancer Consortium (MECC) is an intergovernmental organization established in Geneva, Switzerland, by the Health Ministers of Cyprus, Egypt, Israel, Jordan, the Palestinian Authority and Turkey, with support from the United States National Cancer Institute. Since 2008, the Institute for Integrative Health has been a sponsor of the MECC conferences as well, held annually in Larnaca, Cyprus.
Institute director of academic programs Adi Haramati, PhD, and colleagues Nancy Harazduk, MSW, MEd, and Michael Lumpkin, PhD, have traveled each year to Cyprus to offer didactic and experiential training in mind-body medicine to the approximately 60 conference attendees. These oncology nurses, physicians and social workers come together from countries with long histories of tension and strife, and yet within the group experience of meditation, guided imagery and mind-body training, participants discover they are able to feel open and safe.
As a Jordanian participant wrote, “I don’t think I’ve ever been moved so deeply as I was by the personal stories we shared, not as Jordanians or Israelis or Egyptians, not as Jews or Arabs, but as human beings. The safety of the mind-body medicine group allowed this to happen.” According to MECC executive director Michael Silbermann, MD, “It is not a secret that [the mind-body] sessions are the most efficient and successful glue to bring together all these people from such different cultures and backgrounds. The feedback cannot be more complimentary.”
The Institute is honored to be a part of this healing.
Applying Principles from Complex Systems to Studying the Efficacy of CAM Therapies, Washington, DC, October 8-10, 2007
The domain of complementary and alternative medicine (CAM), or integrative medicine, encompasses a wide range of systems and practices, often used in combination and in non-standard, individualized courses of treatment. Practitioners have often called for studying integrative care, not as single modalities, but in the flexible way it is actually practiced. Though this presents a theoretical and practical challenge, nevertheless, the emerging field of complexity science may offer helpful concepts and analytic tools. To explore this possibility, in October 2007 the Institute partnered with the National Institutes of Health, National Center for Complementary and Alternative Medicine and the Georgetown University School of Medicine to present an expert conference on complex systems and CAM research. The agenda is posted here.
A peer-reviewed white paper was published in August 2010: Applying Principles from Complex Systems to Studying the Efficacy of CAM Therapies. Ahn AC, Nahin RL, Calabrese C, Folkman S, Kimbrough E, Shoham J, Haramati A. J Altern Complement Med. 2010 Aug 17) It is available here.