John Weeks has worked in integrative health and medicine since 1983 as an organizer, writer, speaker and executive. He is known to many for his chronicling, honoring, commenting and cajoling on policy and organizational activity in the evolving movement for integrative health, particularly through his Integrator Blog which he has produced in various forms with 1997 and is presently at http://www.johnweeks-integrator.com/posts/.
Weeks is editor-in-chief of JACM – Paradigm, Practice and Policy Advancing Integrative Health (The Journal of Alternative and Complementary Medicine), the longest-standing indexed journal in the field. Particularly satisfying in his work at JACM are collaborations with top researchers for special issues to focus attention on such topics as group-delivered services, whole systems research, integrative oncology, implementation science, and naturopathy.
Weeks has consulted with NIH, WHO, PAHO, the American Hospital Association, and with numerous academic, professional, payment and delivery organizations. He helped found the Integrative Health Policy Consortium, the Academic Collaborative for Integrative Health (where he served 8 years as executive director), was on the founding board of the Academy of Integrative Health and Medicine and is on the advisory board for Integrative Medicine for the Underserved.
Weeks attended Stanford University for three years, studying history. Four academic institutions have granted him honorary doctorates. In 2014, three integrative consortia collaborated to grant Weeks a Lifetime Achievement Living Tribute Award.
His partner in his work and life is integrative physician Jeana Kimball, ND, MPH, with whom he has two grown children. Weeks is particularly proud of having been able to live and work with his family 6 of the last 18 years from home offices in Costa Rica, Nicaragua, and Puerto Rico. He loves paddle boarding and, when waves are available, surfing on it. http://www.johnweeks-integrator.com
Contribution to the Videocongress on 20 June 2020:
Transcript of the Contribution:
Thank you, Tomas. It‘s a pleasure to join all of you here. Some of you I met last week, Bhaswati and I have met at conferences in New York, and Natalia I met when I was involved in the 2017 meeting in Managua that helped kick off the network and we‘ve had some chance to work together. It’s a real pleasure to meet with you.
I have been in the field for nearly 40 years and spent a lot of this time organizing for a change in a variety of capacities. I think a lot of what I‘m going to share with you has come out of a piece of my work which involves writing a newsletter that isn’t about the clinical advances, but about the policy and organizational activity that people have been involved with and have helped create. That has helped move the field forward and has ultimately increased the options of the public to have access to various complementary integrative services. So I‘m going to take you on a little ride for my 13 to 15 minutes here.
Situation in the United States
Regarding the context, some of it you’ll recognize and some of it‘s going to be very distinctive to the U.S. The idea here is that if you’re setting up a model for this development, you‘ll be able to see some options for your own nations and I think particularly as I talk a bit about the platform which I have been quite involved with, some thoughts about what you can do there also. I tell this story as convergence, because as Bhaswati said, there‘s more potential there‘s more inclusion happening in the U.S. at least, and you‘re going to see some of the work that lies behind it.
I always like to start with the false presentation of medicine via television magazines. In the U.S. it was always called the best medicine in the world, and that was ultimately a denial of how many people are actually killed through the regular practice of medicine on an annual basis and the amount of utter waste and unnecessary procedures performed. Inside that field, there were certain characteristics: it was a men‘s club, it was surgeons first… There wasn‘t much investment in primary care, it was absolutely not interprofessional, it was monocultural it was disdainful towards the rest of the world, reductive in its perspectives from research, and it focused on the U.S. Because we don‘t have a national system, it just focused on production, it was a very capitalist model.
I think most of us are old enough to remember the 60s and I think that this movement has really grown out of the set of values - an earlier speaker talked about that, and I think it maybe was you, Tomas - and kicking off and that‘s what you locate in bringing people together: the realization of what connects you.
And all of these movements occurred at once. They‘re not all about medicine per se, but they’re all influenced by this effort to move forward. What we observed is a fascinating thing; after those ideas entered the culture, many different people began to say: ‘If we want to actually make something substantial of this we need to form organizations’. Some of you are running such organizations.
1970s and 1980s
What I find really intriguing is this sort of found history - all of these things happened more or less between 1978 and the early 80‘s. Whether it was naturopathic medicine or acupuncture or holistic medical practice, holistic nursing practice. And then there was a group on the right with researchers in academic medicine, who were trying to link the mind and the body back together again. Their first productions of publications were coming out at roughly the same time.
So we had this time where the work - and I was quite involved with it - was advancing in silos and I happened to be working for a decade with the naturopathy doctors. The idea was that in order to play in the larger healthcare game, you have to get your current your papers in order. The rules of the game in the U.S. are to be considered a real part of the system that you have to have. You may have schools, but they need to be accredited by an accrediting agency and that agency needs to be recognized by the federal government. So, all of this work to set up national certification and then to expand licensing in the 50 states was going on independently in all of these fields. This was actually was one of the values here. Due to the fact that licensing is managed separately in each state, it was easier to travel to the capital and smaller groups of people could make things happen. There are cases where six naturopathic doctors could be working with influential consumers in a state and making changes.
What took that work out of the kind of alternative zone towards consideration in the mainstream was a study that is famous in the U.S. dialogue. The fact that the study was conducted by researchers from Harvard and that it was published in the New England Journal of Medicine helped. What‘s fascinating about this study is that it wasn‘t a systematic review, it was a it was a study of consumer use. The study found that all these people were using these therapies, and then all of the stakeholders began to think differently. People who worked at insurance companies or hospitals - who had been using these things quietly were empowered to say – ‘shoot, if a third are using it in a an intent toward people with higher education, and if I look around my hospital here a third of these people are doing it and hiding it too’. It encouraged people to get engaged.
Federal Government‘s Recognition
And at that time, the federal government began to recognize this at the NIH. We were very lucky that our main champion, Tom Harkin, was the best person to have as a champion. He‘s more or less the head of funding for Health and Human Services and oversaw the NIH. He tucked away the first two million dollars and then this number has kept increasing as it grew from an office to becoming a full center.
We’ve had access to a lot of money. Two of the people who were appointed as directors knew nothing about integrative or alternative practices. Antagonists is probably too strong of a word, but they were not friendly and didn‘t actually know what questions to ask. A sign of change was when another director, Helen, actually began asking some of the right questions. Our champion Tom Harkin retired in 2014 but he set up this commission which I had a great rapport with, and George Bush came in after that and we had a democratic rapport – then the Republicans came in and it was kind of forgotten but it was valued by a lot of us internally.
We all know that money makes things happen, and the fact that the NIH was giving money in these areas was a tool that helped wake up academic health centers; they knew that if they had a center in their school that was a member of this consortium, it would be easier for them to access the research money that was there. This consortium thus started to expand. There are now 75 medical schools Yale, Harvard, UCSF, Michigan, Duke…
These major schools now have integrative programs, some of them have clinical operations, naturopathic doctors, chiropractors, acupuncturists etc. Acupuncturists and massage therapists are the main people on site. They have mind-body therapists too. This then becomes a change agent - it‘s the big player in the field.
Mainstream of Medicine
Part of what has helped us move forward is that the mainstream of medicine inthe US has had to reconsider the idea of it being the best medicine ever.
The report To Err is Human was published and showed that there were a 100,000 deaths per year due to the regular practice of medicine. An update was published in the BMJ in 2016 by a Johns Hopkins researcher estimating that number to be 251,000.
This created a dissident group within regular medicine. It‘s not us in in the integrative world, but a dissident group in regular medicine has said: ‘We need to change what‘s going on’. They began to move away from volume, from this capitalist effort to do more and more and more. A third of our procedures and surgeries are unnecessary. Some say even 50 percent. That’s just capitalism trying to make as much money as possible off human bodies.
And there‘s this dissident group saying that we need a different structure. They call their movement Values-based medicine. These values in this new effort in the U.S. began to align with what we were bringing forward and that created receptor sites for what we were talking about, receptor sites that hadn’t been there before.
If you believe that using more integrative medicine can save money and you‘re trying to pitch this idea somebody in volume based medicine, who is trying to do more all the time, they don‘t have the ears to hear you. Once this change began, we began to see more receptivity and began see this convergence.
This language was referenced earlier – I think it was Madan who was talking about what creating health is and how different it is from disease management. Donald Berwick was head of our Centers for Medicare and Medicaid Services. He‘s actually a great friend of integrative medicine, but realizing that this moved to Green Health, he said it is a redesign that may be even more radical than we have imagined.
And Jonathan Perlin, who was head of the American Hospital Association, said: ‘I don‘t think anyone understands that recipe’. And the point is that they don‘t have any reason to know the recipe, because they have not been creating health. A lot of us have been involved in the work to create health. We know some of those ingredients.
Knowing this context was shifting, we began to realize that as long as each of our professions was working alone, we didn‘t have the power that we could have if we began to work together. In the U.S. there are five licensed fields in this area: acupuncture, chiropractic, naturopathic medicine, massage therapy and then direct entry midwifery that have all the papers they need. We began to bring them together and realized that, thanks to the size of the massage field, that there are 400,000 licensed practitioners (about 250,000 of these are massage therapists).
As a group, when we can bring our values together in a kind of platform such as you‘re seeking to create, and merge our voices and begin to make requests, we found that we could change some things. For instance, we created a political organization, the Integrative Health Policy Consortium.
We began to work heavily when Obama was going through the major health reform and, in doing so, we were able to inlay language in our federal law that had never been there before: integrative medicine occurs, and there‘s more appearance of complementary medicine. For the first time, these 400,000 practitioners began to be considered part of the workforce. I mean, they were obviously always part of the workforce, but the federal government had not previously recognized us, which it now began to do.
I had been working as the executive director of this academic collaboration for innovative health for about eight years as this change was happening. We realized that the triple aim here is a shorthand for value based medicine, as it pulls together the three of the values of lowering costs, saving money and creating better health. There‘s a fourth aim, which is creating more resilience in practitioners, but we decided to pull together all the evidence we have that can show how aligned we are, through those messages. If you go to https://integrativehealth.org/welcomepihta/ you can go through those three areas, enhance the patient experience - as all of the evidence that we have from various studies shows that we do that.
The other major focus, because it‘s huge, is cost. We often hear that you may have the evidence, but if you‘re not saving money then why should we talk to you? Therefore, we‘ve pulled together all of the studies that have shown the cost value, which really acknowledges the value of this platform and our use of it, Tomas.
The other major initiative we did on the platform, was realizing that our people needed to be educated regarding the language and practice of evidence, because that‘s the language of medicine - even if it‘s not what motivates it all the time, even if it‘s used as a tool of war rather than as a tool of healing. We developed a major project that helped to train the people and educators in our fields and the educators in our fields on strategies improve their skills when it comes to developing evidence, working with evidence, and understanding the language. I should say that the NIH actually grants supported development for a lot of this. So we began to work in collaboration.
The consortium grew and there was a collaboration of philanthropists that grew. But we then realized that we weren‘t meeting the needs of the underserved. We therefore started integrative medicine for the underserved. We finally started a professional association, the Academy of Integrative Health and medicine, which brought integrative medical doctors and all of these other fields into the same organization for the first time. In retrospect - shame on us that it took so long, but it was quite a step forward.
Don Berwick, the same man who ran our medicare/medicaid services, gave a talk a few years ago about this transition towards creating health. What was fascinating was that when he talked about who had mentored him in this thinking about salute-genesis, about health creation, all of his main mentors were from our fields! So our influence is actually shaping the dialogue amongst the dissenters in regular medicine.
At the same time, in the US, we have a single-payer system, the Veterans Administration - it‘s more like the UK in that they‘re employed practitioners also. This Veterans Administration started an initiative in an office called Patient-Centered Care and Cultural Transformation in 2011.
Tracy Gaudet is an integrative doctor who ran Andrew Weil programs, a pretty famous program, in Arizona and then ran the Duke Integrative Medicine program - she was the founder of it. Ben Cleaver has been the chair of the consortium and ran a New York program. He has done many other great things as well, and he is now directing the Duke program while Gaudet is doing some other wonderful work, which I won‘t get into now. So there‘s this whole effort inside of the VA. There are now 54 veterans hospitals that have whole health programs, that are bringing chiropractors, Tai-Chi, mind-body acupuncturist and others into care delivery around a very smart integrative strategy.
The work has begun to pay off The work is still hard, but it‘s begun to pay off. We can now be found in some guidelines - a number of pain guidelines - that people have been distributing and publishing, and there are integrative strategies in some of the oncology guidelines. Helen, who runs the NIH, comes from Harvard’s integrative medicine program and she‘s actually bringing this idea non-reductive way of looking at the whole health, the whole person into the NIH’s strategic plan and she‘s talking about the need to focus on restoration and rehabilitation, regeneration, resilience.
The last five years we‘ve been coming out of our insularity in North America and Europe and beginning to connect more with people such as Natalia and with the WHO to try to make our work more global and connect to that effort. We have a registry that‘s now global. If any of you want to know more about it, how you can get your people connected to it, I’d be happy to connect you.
I want to finish with a kind of ‘what can you do now?’. I urge you to use appropriate language, as Confucius says, there‘s good in managing diseases, there‘s good in suppressing symptoms, but neither of those are creating health. A system that manages disease is not a health care system, so I urge you - don‘t give them the language. At least in the U.S., most of our three trillion plus investment each year is not health care, it is something else.
So I took little longer than I think I was given, but that’s the end.