WASHINGTON, D.C. -- On Thursday, March 18, I was privileged to be the sole chiropractor at a meeting with representatives of the White House Health Care Task Group, which is under the ultimate control of First Lady Hillary Rodham Clinton. Let me first state that I was unutterably surprised to listen to a message on my answering machine from the White House Task Group asking if I might attend a meeting in Washington with members of the Task Group; the meeting was to include, in their words, credible members of alternative medicine for the purpose of providing input to the Commission. When I called the number they left, I was put in contact with the office of the first lady, where the invitation was confirmed.
Lest it seem as if this might have occurred out of thin air, the invitation relates to a second exciting development in Washington. A new group has been established within the National Institutes of Health (NIH). Known as the Office of Alternative Medicine (OAM), it is under the leadership of Dr. Joe Jacobs, a medical doctor with a background in Native American healing; Dr. Jacobs was featured in a recent Time magazine article detailing the new office1 (see also "Office of Alternative Med. Gets $2 Million in Funding" in March 26 issue of "DC"). There is to be a chiropractic representative to OAM via an advisory panel being set up. At present the advisory panel is an ad hoc panel awaiting approval from NIH after providing NIH with a compelling rationale for its existence. The ad hoc advisory panel is scheduled to meet April 1-2 to discuss methods for meeting presidential executive order 12838, which deals with termination and limitation of federal advisory panels. In short, the panel needs to justify its existence. One justification concerns issues of national health interest, and the panel feels such an argument can easily be made. As a chiropractic member of the ad hoc panel, my name was one given to the White House for the meeting on March 18.
The meeting, held at the old Executive Office Building next to the White House, was chaired by Michael Lux, special assistant to the president as liaison. He discussed the current series of meetings and debates that were occurring around the country and in Washington, and also made mention that the basic framework being devised was that of managed competition. Within that framework, he was primarily interested in discussing what needed to be included in a comprehensive basic benefits package for the American public. He mentioned that the president was seeking to be inclusive rather than exclusive in developing his health care policy, and also mentioned that the president and first lady were certainly interested in alternative medicine. Apparently the first lady has seen an acupuncturist and the president's mother regularly sees a chiropractor. Thus, they were not biased against the professions represented at the meeting.
Mr. Lux then introduced leaders of various working groups involved in the process of gathering the vast amounts of information necessary to draw up a comprehensive health care plan. These working groups, of which 34 exist in total, included Workforce, Quality, Mental Health, and Benefits Coverage subcommittees at our meeting.
Of particular import here was the Benefits Coverage subcommittee, under the direction of Linda Bergthold. She informed the group that her committee placed the highest priority on two issues: prevention and primary care. She also emphasized the subcommittee's desire to seek broad coverage in their deliberations. I found this heartening indeed given the recent formation of the ad hoc alliance of chiropractic colleges, and the desire of our national and state organization to stress those very same issues in their meeting in February (see "Chiro Educators and Assoc. Reps Forge Coalition in the March 26th issue of "DC").
Finally, the meeting was turned over to an open forum discussion from the attendees, with Mr. Lux asking us to focus on benefits coverage; what should be included in the basic benefit package? My statement stressed that chiropractic was a basic benefit, that chiropractic was a primary-care provider, and that were chiropractic not to be included in the health care benefits package, the ultimate result would be to (1) prevent Americans from having access to those best able to treat their health care problems, and (2) drive up costs, since study after study had shown that chiropractic was able to manage health care problems at a fraction of typical medical costs. If this sounds suspiciously like those statements made in chiropractic's five-point ad hoc alliance statement, let me please give credit where it is due. Why say it differently when the ad hoc alliance stated it so well. I also noted that chiropractic was ready to act in any managed care network under consideration. We are the best at what we do, and we have a record of success unmatched by anyone in doing it.
Other comments concerned access to information and the chance of setting up a central repository of literature, since it was apparent that people working in disparate fields were unaware of the research published outside their own fields. One of the attendees was Dr. David Eisenberg, who recently authored a paper in the New England Journal of Medicine showing the use of alternative medicine in the United States2 (see also "Nat'l Survey: Alternative Health Care on Rise," March 12 issue of "DC"). I noted that we in chiropractic were not surprised by those findings, but we were rather upset with the accompanying editorial by Dr. Campion where he essentially dismissed chiropractic (and other forms of alternative health care) as patently unscientific.3 I noted that it was hard to understand how Dr. Campion could make such statements given that, for example, there were so many studies of manipulation for treatment of low back pain. This indicates how difficult it may be for other disciplines to locate information they may not be familiar with, and points out yet again why we need to index our literature and take care with what we publish.
Mr. Lux closed the meeting by noting that it was certainly impossible to say all you wanted to within the confines of a 90-minute meeting. The process mandated that further contact be made, and he implored us to send information to him with the guarantee that it would be read and not lost in the volumes of mail being received at the White House (currently over one million pieces of mail per month, with over 3,000 per day of them dealing specifically with health care). I am now the proud owner of a White House fax number for that purpose.
The people I spoke with seemed sincere in asking that input be made to them, and they are actively seeking input for use in drafting the final policy. I would implore the profession to write to the White House, either to Mrs. Clinton, Ira Magaziner (manager of the Task Force), or Michael Lux. We are on a short time table here, since the president intends the policy to be ready by May 1.
In the meantime, the Office of Alternative Medicine is moving forward in establishing itself as a federal advisory panel. When it does, it will oversee grants for research in alternative medicine. Chiropractic input will be necessary. Already Dr. Tony Rosner, research director of the FCER, is a co-chair of one of the subcommittes of OAM.
Let me close by listing the attendees of the White House Task Group meeting:
Fran Barker: company group chairman of Johnson and Johnson Health Management, Inc.
Hon. Berkely Bedell: Advisory Panel to Office of Alternative Medicine, NIH
Dr. Herbert Benson, MD: president of the Mind/Body Institute and author of The Relaxation Response
Dr. Brian Berman, MD: homeopathy and acupuncture, director of the University of Maryland Pain Center and the Laing-University of Maryland at Baltimore Project.
Dr. Ted Chapman, MD: American Institute of Homeopathy
Larry Dossey: co-chairman of panel, Office of Alternative Medicine, NIH.
Robert Duggan: president, Traditional Acupuncture Institute, Inc.; chairman, Acupuncture Advisory Council to the Maryland Board Physician Quality Assurance; commissioner, National Accreditation Commission for Schools and Colleges of Acupuncture and Oriental Medicine.
David Eisenberg, MD: instructor in medicine, Harvard Medical School; Beth Israel Hospital.
Karen Fennell: nurse/midwife; senior policy analyst, American College of Nurse Midwives.
Viola Frymann, DO: American Osteopathic Association; American Academy of Osteopathy; Osteopathic Physicians and Surgeons of California.
Eliot Greene: president, American Massage Therapy Association.
Linda Griffith, MS: director, Washington Senior Wellness Center, project of D.C. Office on Aging and the SE Center for Aging.
Dr. Joe Jacobs, MD: director, Office of Alternative Medicine, NIH.
Dr. Rena Johnson, MD: preventative medicine/surgeon; masters student, George Washington University School of Public Health; on staff, Holy Cross Hospital in Department of Surgery.
Dr. Dana Lawrence: editor, Journal of Manipulative and Physiological Therapeutics; Director, Department of Editorial Review and Publication, National College of Chiropractic; professor, Department of Chiropractic Practice, NCC.
Robert Lehman: Foundation Researching Mind, Body Health; president, Fetzer Foundation.
Antonio Martinez: Nutritional Health Alliance.
Joseph Pizzorno: chairman, National Affairs for American Association for Natureopathic Physicians.
Dr. Beverly Rubik: biophysics and bioelectrical magnetic research; advisory panel to Office of Alternative Medicine, NIH; director, Center for Frontier Sciences.
Dr. Sharon Scandrett-Hibdan, RN, PhD: president, American Holistic Nurses Association; College of Nursing, University of Tennessee, Memphis.
Janet Smith: president, National Wellness Coalition.
Fran Toler: chairperson, National Health Care Commission of Midwives Alliance of North America.
Dr. Stephen Weiss: senior scientific advisor for National Institute of Mental Health; Preventative Medicine Research Institute.
References
- Toufexis A: Dr. Jacob's alternative mission. Time, March 1, 1993: 43-44.
- Eisenberg DM, Kessler RC, Foster C, et al: Unconventional medicine in the United States: Prevalence, costs and patterns of use. N Engl J Med 1993; 328:246-252.
- Campion EW: Why unconventional medicine? N Engl J Med 1993; 328:282-283.
Dana J. Lawrence, DC
Lombard, Illinois
Dana Lawrence, DC, M. Med. Ed., MA, is the senior director for the Center for Teaching and Learning at Palmer College of Chiropractic and interim senior director for continuing education and events.
Dr. Lawrence is past editor for several professional scientific journals for the chiropractic profession, and has published a number of textbooks. He serves on numerous editorial boards. He was a member of the Alternative Medicine Program Advisory Council of NCCAM.
In addition to his DC degree, Dr. Lawrence has earned master's degrees in medical education (M. Med. Ed.), and bioethics and health policy (MA). He is a co-investigator on Palmer College's R25 grant, "Expanding Evidence-Based Medicine Across the Curriculum," for which he has helped coordinate faculty training designed to enhance the use and understanding of evidence-based practice by both faculty members and students. In addition, he also teaches a course in evidence-based chiropractic practice.
In 2013, Dr. Lawrence was named "Academician of the Year" by the American Chiropractic Association for his service to the profession.