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I had the honor to sit down and chat with a leader in our field regarding public health policy and advocacy, John Weeks. What a tremendous force behind the movement of bringing integrative and functional medicine to the forefront of healthcare – and with his 40 years of insight, it was a gift to get a sit-down to discuss where we are, and where we’re going – and how we can get there together.
Listen in as we discuss how to create a collaborative and unified vision to light the path for the future of medicine – which will help patients, clinicians, and our entire community. The conversation left me invigorated and inspired and I’m confident it’ll do the same for you. Listen in, and let us know what you think by leaving a comment, review, or shooting us an email. Thanks as always, for the gift of your time. ~DrKF
The Future of Healthcare Policies & Advocating for Reform with John Weeks
Is the American medical system broken? Why is it that the healthcare model is incentivized around the wrong principles? How did this happen and what can we, as healthcare practitioners and patients, do to advocate for changes within this system? Our guest, John Weeks, has worked in integrative health and medicine for nearly four decades, is the editor-in-chief at the Journal of Alternative and Complementary Medicine, and has been a leader and guide in the field. In this episode of New Frontiers, he discusses the need for a collaborative effort and vision to reform public policy, the challenges of navigating the current medical and insurance models and shares a wealth of resources for taking an active role in advocating for change.
In this episode of New Frontiers, learn about:
- The importance of a unified vision to change public health policy
- How to support consortiums involved in reformation of healthcare policies
- The role of The Integrative Health Policy Consortium, The Institute for Functional Medicine, The Whole Health Initiative, and The Cleveland Clinic on shaping the future of healthcare
- A brief walk through the historical movements and thinking that led to integrative and functional medicine
- Changes in medical incentive structure from a disease care system toward value-based medicine
- How a reductionist model limits the underserved community
- The challenge of navigating insurance payment models versus alternative payment structures
- The push-back from insurance companies and the medical community about cost-savings associated with lifestyle medicine
- COVID-19 Support Registry for Traditional, Complementary and Integrative Health and Medicine practitioners
Dr. Kara Fitzgerald: Hi everybody, welcome to New Frontiers in Functional Medicine where we are interviewing the best minds in functional medicine and today is no exception. I am really excited as always as I am really every month. We have a new guest that just shines some really important light on our world and helps move our medicine forward.
Today, I’m talking to John Weeks. Likely, you have read his byline many times over the course of your career. He’s worked in integrative health and medicine since 1983 as an organizer, a chronicler, a speaker, and executive. He’s editor-in-chief at the Journal of Alternative and Complementary Medicine, and under his leadership, the impact factor has risen 53%. Congratulations for that, that’s a big deal, and downloads have risen by 200%.
For a quarter century, his Integrator Blog and related columns have been leading resources on policy and organizational activity in our fields. He has consulted with NIH, the WHO, and the Pan-American Health Organization, and numerous other organizations on medical delivery, academic, insurance, professional, and other organizations and policies.
He’s helped found the Integrative Health Policy Consortium, the Academic Collaborative for Integrative Health, and the Academy of Integrative Health and Medicine. He attended Stanford for three years studying history. Four academic institutions have granted Weeks honorary doctorates. He was honored in 2014 by three consortia in the field with a Lifetime Achievement Living Tribute Award.
He loves standup paddle boarding. He loves surfing. He and his partner in all of this, Jeana Kimball, who is an ND herself have managed to work from Costa Rica, Nicaragua, and Puerto Rico with their two now grown children for six of the past 18 years. John, welcome to New Frontiers.
John Weeks: It’s great to be here with you Kara. Thanks.
Dr. Kara Fitzgerald: Your work now, this conversation on the background of integrative medicine is extremely timely, and I’m glad that we’re having it now. There’s a lot going on in our world, in the greater world, in the global world. We’re in many transitions and our field is one of them. So, you’ve been paying attention to all things integrative medicine. You’ve been chronicling it for almost 40 years now.
In fact, I was thinking about it, John. I first reached out to you, I’m sure you don’t remember, very early in my career. I was in my post doc at Metametrics, and there was something that you were writing about that was timely to the lab. I was really trying to pull it out of my brain, and I couldn’t remember. It was on something laboratory science that required some dialogue. So, I was put in charge of reaching out and communicating with you back then, and I just found you to be warm, and accessible, and just a key player in our world. So, you’re not a clinician. What drew you to taking on this role?
John Weeks: Thanks for that question because it’s useful I think for listeners to understand who I am, and it also informs basically everything I’ve done. I came out of or into these fields truly based on recognizing that I was a person who wanting to do something in life that was related to change making that was organized around a set of values that I grew up with.
I knew I was going to be doing something of like that. I was introduced obscurely to what was John Bastyr College of Naturopathic Medicine in 1983 where Jeff Bland was on the board back then. When I met the people and went to school on what these really earliest integrative doctors, that we were setting a standard in the country. What we’re doing, I just saw basically so much that I wanted to see manifested more in the world in their work of health, healing, and medicine coming forward.
These are things like respecting both the science brain and the intuitive self, respecting the male and the female, respecting traditions from around the world and breaking out of the manorial and often quite abusive western male reductionist view that medicine had been caught, and a lot of the other thinking that our culture had been caught in. So, I came out of a worldview that wanted to see changed in those areas. I was not drawn to health and medicine in my life particularly.
I heard about a job at Bastyr, and went out, and then met the people and in many respects had been wedded to this process this entire time by finding myself able to meet and work with ever-expanding circles of very fine people who are similarly connected to and driven by a desire to see these sorts of values manifest in medicine, and I would say then through the world.
Dr. Kara Fitzgerald: So, we’ll get to this in a little bit, but it’s got to be satisfying for you to sit back and observe the expansion of this model?
John Weeks: I feel two opposite ways about all of this. Obviously, as we all sit and look at the medical industry in the US, it still remains organized around the wrong principles and with some truly horrendous outcomes. I mean, that’s just in terms of the level of waste that the National Academy of Medicine talks about it, puts in a third to 50% the amount of over treatment that goes on, the resistance to looking at things in non-reductive ways, and just the fact that as a patient, you just don’t get the kind of treatment you want to as you move through the industry. It behaves as an industry rather than as a healthcare system. So I looked at all that and say, “My God, what have we done?”
Dr. Kara Fitzgerald: Yes.
John Weeks: All this time, we haven’t really budged that thing. Then, I could sit back as you just were there and remember what it was to be externalized and turned into a quack and fraud in the way that the media, policy, everybody was turning us into that in the ’80s-
Dr. Kara Fitzgerald: Yes.
John Weeks: … when we were already articulating the same things that are coming forward and being adopted now. So, it’s really just kind of a split lens on the decision to move into this field. It turned to be my lifework.
Dr. Kara Fitzgerald: Right. That’s understandable. I could just continue at this. It’s a good line, but I want to just move through our structures so that we touch on all of I think the important points that you can bring to this conversation. So with that in mind, why do we as clinicians, most of my audience are clinicians, why do we care about paying attention to policy? Why do we care about our history in the various organizational activity in our movement?
John Weeks: I’ve come to realize that as you know and in anyone of the professions, whether that’s functional medicine, or naturopathic medicine, or acupuncture, or academic innovative medicine, there’s a subset of people who care about the organizational work and the political work.
Dr. Kara Fitzgerald: Yes.
John Weeks: What I discovered is there’s kind of a subset of them that cares to look beyond their own boundaries at the broader movement that each of these different professions is part of. Here’s my answer, is all of us operate in a context. We operate in a policy context. We operate in a payment context. We operate in a context of some, more, or greater, or lesser level of respect and authority. Typically, the changes that are made to that environments, those environments that shaped the amount of freedom and flexibility that we have rest on policy changes. Policy changes rest on counting votes.
Dr. Kara Fitzgerald: Yes.
John Weeks: Counting votes and getting the outcome you want is a result of organizational activity. It may be important to you, but what you’re able to do is, and who you’re able to reach, which is really an issue with functional medicine is how many populations have access to what it is you’re doing?
Dr. Kara Fitzgerald: Yes.
John Weeks: That has to do with changing policy and changing perspective. That work typically comes to organizational activity rather than individual activity.
Dr. Kara Fitzgerald: Right. So, the subset of the subset?
John Weeks: It’s still on this call, on the podcast.
Dr. Kara Fitzgerald: Herding us, this growing group of cats together so that we’re as unified as possible in our vision and can shape a policy as we were dialoguing about before with regard to racial integration, serving the underserved, and just making this the standard of care with you as clinicians, regardless of our wheelhouse, regardless of where our calling lay, we need to be supporting the folks who are doing this organization. Anyway, I just want to thank you for that.
John Weeks: I think that, that’s a good point is if you’re not going to give yourself, and this happens in regular politics. Do think about being a member of the organizations, honor them for what they do. It might not do everything you want them to do.
Dr. Kara Fitzgerald: Yes.
John Weeks: You might be upset what they’ve done at some point, but they’re actually your best voice. They’re a reflection of you, and what they do will reflect on you. The more that you’re anti in, the more that we behave as large groups. Let me give an example and explain something about why I have given a lot of my time in the last 20 years to try to form larger consortia of interests in the field.
So, some of us began to be engaged with the federal government in the late ’90s. So first, we finally got the Office of Alternative Medicine at the NIH, had a bit of a perch in the federal government then. Tom Harkin, who was a senator from Iowa and our champion, turned to a bunch of us at one point and said, “Listen. If you all want to have any influence up here on the Hill, it would be best if you all come together and figure out what your shared issues are and come together as a joint force, rather than us listening to just acupuncturists, or chiropractors, or naturopaths, or massage therapists. So, what is it that you have in common that you’re trying to advance in health and medicine? When you come forward in that format, you’re actually representing a much larger group.”
For the naturopathic community as you know, if you’re only back then, it was about 3,000 doctors. You’re not a very large force and they licensed only a few states back in the late ’90s. If you’re actually acting as part of a consortium with the other players in the field, then you’re actually talking about, thanks to how many licensed massage therapists are, about 500,000 licensed people. There, you’ve got some meaning.
If you start thinking about it, if that group of people can begin to work together and figure out how to access their patients together towards a joint goal-
Dr. Kara Fitzgerald: Yes.
John Weeks: … you’re talking about a real force. So, I don’t need to go to the details. We have a great deal of evidence of what we’ve been able to achieve through forming these consortia of professional organizations from multiple disciplines to move things forward.
Dr. Kara Fitzgerald: All right. So on our show notes, people, we will get links from John. John, just thinking about how those of us who are called to get involved, those of us who want to maybe just donate financially, where we would do that and how we would do that? Your thoughts, any kind of links? Do we do it through our respective professional organizations or is there a consortium or something?
John Weeks: I think that’s the place to start honestly-
Dr. Kara Fitzgerald: Okay.
John Weeks: … is to do that. Let them know that you like them playing the … The Integrative Health Policy Consortium, IHPC.org is really the place I would send you. They’ve got a really great executive director now and a great policy person. They are the main ongoing presence on the Hill for our professions, and so that’s where I would send you is IHPC.org.
Go take a look. Look at their actions. They’ve been at it a long time and have done a lot of good work. Placed integrative health into the Affordable Care Act, has six distinct separate inclusions of integrative health or complementary and alternative practitioners, which is the way we’ve been talked about at that in 2010 when the Affordable Care Act passed.
You got to show up first and be recognized, and IHP was able to do that in a number of ways. The dialogue changed. We’re now not talking from outside of the law. That we’re talking as participants to an extent in one of the recognized set of entities federally, and that makes the difference.
Dr. Kara Fitzgerald: Yeah, it’s extraordinary. So, I’m jumping around, and I want to get to all of our topics because we’ve got important stuff. I have to ask you this. You didn’t mention functional medicine, and functional medicine is … I’m a naturopathic physician, and I’ve been involved with IFM since the very earliest start of my career. Actually, when I was a resident and a post doc, I would do lunch and learns and so forth at various IFM conferences for the lab during my post doc. Then, I eventually became faculty.
So obviously, functional medicine is born of naturopathic physicians but it’s been a good place for medical doctors transitioning into our paradigm to rest their souls, actually come in for soul rejuvenation. It’s pretty extraordinary. So I just wanted you to talk about that, bringing MDs who represent the greater medical paradigm into our world and connecting, and I want to get your thoughts on.
John Weeks: Great question. So a couple of things, one reason I think I didn’t mention functional medicine there is that for a lot of the period from 2005 until recently, IFM has chosen for a variety of reasons to not be actively engaged in IHPC, and that’s an internal discussion that might be changing. Part of that as I’ve sensed it, it’s part of the strategy that IFM had is to say, “We may be able to move faster unencumbered by being connected to these other disciplines.” That’s a strategy, and it may have been a good strategy for IFM.
But by and large with policy things, I mean partly market, Hyman has been able to access people like the Clintons and others that he knows through his practice, which has been useful. IFM has not, I believe with Amy there now, there’s definitely a much higher level of exchange going on with IFM, and there are number of places that IFM is now involved with, integrative medicine for the underserved which is nice to see. They have a nice connection to the Academy of Integrative Health and Medicine. Anyway, so I think the connections are being made. It definitely is incredibly valued as a crossover discipline for medical docs.
I want to just add something since we’re on this. I had a conversation yesterday with some people at what’s called the Whole Health Institute, which is one of the most fascinating things that’s going on related to our fields. This is Tracy Gaudet who came out of the VA, which we can talk about, backed by Alice Walton who has a net worth of 54 billion dollars to set up this whole initiative to promote the concept of Whole Health nationwide. Perhaps, globally, you can talk that way if you have that much money.
Dr. Kara Fitzgerald: Right.
John Weeks: The reason I bring it up now is I just learned that Henri Roca, H-E-N-R-I, I think it is, who has been an integrative doctor who got into functional medicine. Then, actually went to the VA in Arkansas working as a functional medicine doctor there.
Dr. Kara Fitzgerald: Yes. I know him.
John Weeks: You know him?
Dr. Kara Fitzgerald: Well, I rode a taxi with him to the airport and he was amazing. He was really interesting but go ahead. I know him a little bit.
John Weeks: All of those things, I know him too. What occurs to me is that he would be an interesting guest potentially. The reason is he’s needing to learn how to be a functional medicine doctor in an environment that is not too fond of some of the tests a lot of functional doctors used. That doesn’t have access to a lot of supplements.
So, he’s had to try to figure out how to do that in that environment, which is basically he’s trying to answer the question how you get functional medicine to the less served, to the underserved? He’d probably a really interesting podcast for you.
Dr. Kara Fitzgerald: Yes. Well, it makes me think also too of Terry Wahls, who likewise has done some pretty extraordinary work.
John Weeks: Yes.
Dr. Kara Fitzgerald: Good. Yeah, absolutely. Well, Henri, or if anybody’s connected to him, if you’re listening, please ping me. I would love to hear what you’re up to.
John Weeks: I can get him for you.
Dr. Kara Fitzgerald: Okay. All right. Yeah, right. I don’t need to go any further than you. This is just great, John. I mean, you’re such a connector. In fact, we’ll talk about Ryan Bradley’s initiative when we get to the end and you can plug that, but I know that was what brought us into contact most recently about his COVID-19 Registry. All right, we’ll get there.
So, among the many leadership awards that you’ve been given, IHS honored you last February, which was the last time we were all, many of us were actually in person at a conference. It’s kind of bittersweet. So, you were given the Lifetime Leadership Award. Your talk as a recipient was Hope as a verb, 50 years in the furrows of integrative health and medicine. You presented it in five eras. I just want you to give an overview of that and some of the key points that our audience needs to hear.
John Weeks: Great. I think I can do the five eras pretty briefly. The beginning stage with the ’60s. The ’60s as everybody knows was the time … Who can remember? It was a time of a combustive activity with new values and ideas coming into the culture, many of them I talked about at the beginning of that work are moving through me. The mainstream culture call it counterculture. We called it affirming new sets of values that we want to be learning the culture. So, they popped up.
What I learned in phase two was that some people who were supportive of those values realized that if you want to take them from ideas into the cultures, you need organizations. The fascinating thing that happened is by the late ’70s, we saw suddenly a rebound, as I knew it in the naturopathic world when Bastyr was founded, Canadian College was founded. There had been no known schools in 23 years, and suddenly there were three schools in two years. Why that happened?
That same year, the Holistic Medical Association was founded. The year after, the Holistic Nurses Medical Association was founded. The first wellness movement was founded in ’77. The first publication that of academic medicine on mindfulness at the same time. So, you see that well-spring of ideas began to take form. Then, what we saw after that was each of these groups began to work in silos to set its standard, if it was a profession to expand licensing, to get its accreditation in order. Some moved with it, to put its feet down in the community with licensing and et cetera.
At the point in the ’90s, via consumers and a survey of consumers, it broke into the culture. It was a Harvard study led by David Eisenberg in 1993. Suddenly, all of the mainstream stakeholders looked and said, “These people we’d been calling quacks and fraud, a third of the people around us are using some of what they’re talking about, and it tends towards people of higher income and higher education who are doing this. Maybe instead of writing them all off, we got to start giving them more credit.”
This is media, this is politicians, this is insurers, this is hospitals who are trying to reach more people. They began to think, “Maybe we got to provide some product for them.” Inside of all those organizations, the individuals who knew there was value in doing things differently could look around and say, “My God, I’m not the only one here who’s doing this.” They could come forward with their ideas and they often became champions in these organizations.
What developed was a period that I called non-integrated integration. So classically, a hospital says, “Let’s throw a bone to the consumers who like this stuff. Let’s set up a clinic, but we really don’t want to have to bother our medical directors who think this is still hogwash. So, let’s set up a clinic out in the community someplace where there’s not really any direct interaction. So, we don’t have to deal with the conflict.”
So it wasn’t being used by insurers also to set up these separate products of coverage. It wasn’t being valued as something that could actually make healthcare better by sticking out when to use it, how to use it. It was something that was created as part of their industrial business model to get more patients, or clients, or subscribers.
When we reached that point, we moved into the fourth phase was, “Okay. Now, we’ve got a shot. We’ve got recognition. Now, how can we have the most impact?” This is where the consortia started to form up. In that 2002, 2003, 2004, really all at the same time there was a consortium of all of them, medical school programs that were forming up in integrative medicine. It was about 10 of them who came together in the late ’90s. There are about 75 now in the Academic Consortium for Integrative Medicine and Health.
The naturopaths, chiropractors, acupuncturists, massage therapists, the licensed so-called CAM disciplines, we brought them together. This was a core part of my work into a consortium, so they themselves could have a larger voice following what Senator Harkin had said, but also have a larger voice with the integrative MD community to make sure that frankly, they weren’t treated just as tools and therapies that could be ripped off and added to that Christmas tree where you get some of the core value structure of these practices, also in the integrative process.
The last phase really began with the Affordable Care Act, but it began with the change or reform effort in regular medicine towards from volume to value is what they call it. It’s value-based medicine. The idea to change the incentive structure so that we start thinking about health. The concept of health that they’ve focused on what it is as distinct from disease management began to come in to the dialogue at the American Hospital Association’s big aha moments. For us, we’re like, “Oh my God, finally you’re getting there.” This is the first thing I learned in 1983, but they’re getting there.
So I call this last era, the era of convergence because it is the first time where you’ve got the beginning of an incentive structure that’s being proposed by a subset of people in the mainstream of the industry that is now much more conducive to and open to the kind of values that we’ve been trying to bring forward along the way, and we’re seeing it flourish.
I just talked to somebody who is running an academic program, the Connor Integrative Network in Indiana, of all places. She said, “We started off 10 years ago with three referring physicians. We had 1,800 physicians in our network. We now routinely refer patients for our services.” This is a sea change, right? That’s convergence. That’s not non-integrated integration. That’s a value-based integration.
Dr. Kara Fitzgerald: Right. You know what? You are right about it. I think I was feeling my glass was a little bit emptier than yours. As I just reflect as a clinician, co-managing with physicians in the very conservative Connecticut, that dialogue, that exchange, the respect has certainly grown from when I first started practicing medicine.
John Weeks: The signs of change are as simple as Harvard Medical School changed its mission from merely saying, “We reduce suffering,” to saying, “We work to enhance well-being.” Small thing, it’s huge, right?
Dr. Kara Fitzgerald: It’s huge.
John Weeks: That is a paradigm shift.
Dr. Kara Fitzgerald: To successfully do that, to successfully carry out their mission is-
John Weeks: That’s a shift but you need to set the intent first, right?
Dr. Kara Fitzgerald: Yeah.
John Weeks: In that mission statement. We stumble all over ourselves frankly, and this is a whole other topic, but it’s very hard and we can bridge over to insurance here if you want to. It’s very hard in our current payment structure to bridge to health.
Dr. Kara Fitzgerald: I do want to get your ideas on that because what you’re saying is it’s just really terrific, and it’s really heartening. Most of us have to move to alternative payment structures. We have to move to cash. That by extension limits our ability to serve the underserved, who end up getting shuttled into the reductionist model that still exists.
Yeah, speak to that. Speak to insurers not being interested in embracing us even though the evidence of … It seems to me the evidence of cost savings is there, but you don’t think so?
John Weeks: There’s a lot of evidence cost. If you go to Integrative Health.org and look under the programs there, we can put in the notes afterwards. There’s a whole file of content about … I helped developed it, content about cost. That’s very, very useful. Anybody who wants to be making a case. So, I am naively in the late ’90s believed, “Okay, now that we’ve arrived, these insurers, they want to cut cost. They’re going to be our friends. They’re going to be all over, seeing how to best use us to do that.”
What I’ve learned is that while the insurer wants to keep costs down in a given premium year, once you’ve been paid your money, they want to spend as little bit as possible. That’s the short game for the insurer. The long game is that there’s an understanding. It’s not from God. It’s an understanding between business people. That an insurance company should be able to keep it around 20% of a premium for its marketing, it’s administration, and its profit. So, that’s been an accepted part of private medical insurance for years. That number floats from to eight to 30%, but 20 is sort of the number.
So, let’s imagine and a little math here. This is rough. Roughly 1983, ’84, a family of four was paying $1,500 more or less. 20% of that was 300 bucks that the insurer has to play with. The insurers are financial companies principally. They’re not healthcare companies principally. They like having money, right?
Dr. Kara Fitzgerald: Yeah.
John Weeks: So now, we’re at $15,000 we’ll just say for that family of four, but that’s not the real number, it’s actually more than that now. If you do the same division, now the insurer has $3,000 to play with, which amount of money would the insurer rather you’d be paying for your healthcare, right?
Dr. Kara Fitzgerald: Mm-hmm (affirmative).
John Weeks: They would rather you pay more. The way it works is that when cost go up, the insurer goes to the state which regulates them and says, “Hey, look. The costs are up. The hospital say they cost this much. The practitioners want this much. We need to be allowed to have rate increases.” So, it just keeps rolling forward. That’s the long game.
So if you’re the insurer, you’re better off if costs go up. Bottom line is, they are not incented to care about anybody who walks to the doors and says, “I can reduce your costs.” They’re not fundamentally incented in that direction. It’s counterintuitive to most of us.
Dr. Kara Fitzgerald: Those are fighting words. So, if you actually say, “Hey, look at all these data I’ve got from Study X on how you can save.” That’s nails on the chalkboard, I suppose.
John Weeks: They don’t care.
Dr. Kara Fitzgerald: Yeah, that’s right.
John Weeks: This is what Dean Ornish ran into when he showed he could turn around coronary artery disease with an integrative program that was just diet, lifestyle, meditation group, right?
Dr. Kara Fitzgerald: Mm-hmm (affirmative).
John Weeks: Basically fundamentally, what Cleveland Clinic has starting doing in some ways. When he started going to … I was very close to the people who were trying to roll this out for him nationally. They just kept getting the doors slammed on them. Why? The cardiologist says, “Why? What you’re saying is you can take my business away?” That’s on the delivery side. The insurers are the same way.
Dr. Kara Fitzgerald: Yup, go ahead.
John Weeks: Go ahead.
Dr. Kara Fitzgerald: Well, I’ve just got a couple of questions around this. Clearly, insurance has invested in a disease care system because it’s extremely profitable.
John Weeks: Yup.
Dr. Kara Fitzgerald: So, how do hospitals fit in this? They also stand to gain in this model, these massive hospital systems that incidentally I just came up against recently as I scheduled a colonoscopy. Oh my God, anyway.
John Weeks: So this is an interesting thing, and it’s useful for our field to think about it because a lot of people are opposed to single payer government programs. Here’s the logic. When a hospital sits down and there’s a budget every year. They talk about how much money they’re going to [make], How many procedures they’re going to do? How much money they’re going to make?
So, they’re actually figuring how many bypass? How many grafts? How many knee replacements? How many hip replacements? If they do more than the thing that they projected, “Hey, it was a good year.” Is that a good incentive?
Dr. Kara Fitzgerald: Right.
John Weeks: The way this shows up, is that power is in the very well-paid specialists. When power in healthcare, power in the industry is there because medicine is like an SUV car manufacturer. They would rather have an SUV sell than a Volkswagen bug because your margin is bigger, right?
Dr. Kara Fitzgerald: Mm-hmm (affirmative).
John Weeks: The margins are bigger in the high-end specialist than they are in primary care. If you’re caring about the healthcare, then you’re out focusing on the determinants of health, things like racism, access to jobs, education, things like that, you’re seeing yourself as a clinician connected to social policy in those areas.
Then as you bring people into healthcare, and then frankly, the VA has the best model for actually doing this. You first want to begin to how to figure out how to empower the human being. How to give them access to the least costly ways to work with their condition? You want to use groups because groups make a lot of sense. There’s a lot of great evidence. It’s efficient. It’s actually more effective even at Cleveland Clinic.
Dr. Kara Fitzgerald: Yes. That’s right.
John Weeks: They found out it was effective, right?
Dr. Kara Fitzgerald: Yes.
John Weeks: You move in to primary care, and then you move upstream. The industry wants to get you in sooner rather than later to the more expensive. Unfortunately, we’re still basically the fee for service. So, we’re just churning more and more procedures and the result is a third of what we do is waste, much of it harmful, and all of the over treatment.
Dr. Kara Fitzgerald: We could spend a long time talking about this. So part of it is going to actualize their mission, and if we’re going to continue to be able to practice. I mean, we can look what the VA is doing. In fact, I just had a nutritionist here. She did our nutritionist training program. She was working at the VA doing some pretty incredible work over there, bringing quality functional nutrition into the VA.
So, I see that there’s a little crack in it. Is that how we do this, just sort of one location at a time? How does this shift?
John Weeks: Here’s the main thing and this is not easy for a lot of the rebels in the integrative functional naturopathic space to hear. The reason that the VA is the most inclusive of any actual medical delivery organizations in the US of integrative whole person thinking and inclusion of … I mean, they’re calling it Whole Health, is that they are fundamentally structured differently, and they’re payment structure is different, and the employment structure is different.
The VA is like the UK system. That you not only have a single payer model, but you’ve also got employed practitioners. Once you have an employed practitioner, you’d get away from the churning model or you get away from at least part of it. So, you get out of that nasty over treatment incentive structure. Once you’re also looking at that whole population and the VA does this, the VA cares about housing and many things for its people as optimally a good healthcare system would do.
So, it’s been a conducive place for figuring out how to bring in massage, acupuncture, chiropractic, yoga, mindfulness, and to stage it in a way that you focus it really not around a billboard that says, “We’re patient-centered,” but programs, and educational programs, intention, practice, materials that are training people to actually locate their own sense of personal mission, so they’re more likely to want to do things as a practitioner. How important it is that somebody be engaged with why they want to live, right?
Dr. Kara Fitzgerald: Yes.
John Weeks: The VA has this built into their program.
Dr. Kara Fitzgerald: Yes.
John Weeks: There’s no reason that Swedish hospital here in Seattle or any other large medical delivery organization could not be doing that itself except that its payment and delivery structure is not like that.
Dr. Kara Fitzgerald: Let me just throw this out at you though. I want to hear your thoughts on this. I’m a Cleveland girl, even though I’ve been in Connecticut for most of my life. My family, the bulk of my family continues to live in Cleveland. Of course, they’re all going to the Cleveland Clinic Center for Functional Medicine. In fact, you can’t throw a stick in Cleveland without hitting, actually in Ohio itself, without hitting some sort of a Cleveland Clinics Center. They’re everywhere. They’ve just taken over the healthcare delivery I think in Ohio, by and large.
So my family is going to the Center for Functional Medicine, but the other fascinating thing that I’ve observed happen just because they talk to me about what’s going on with their healthcare is that they’re non-functionally inclined providers are pretty excited about what’s happening as well. There are rounds being offered to the greater Cleveland Clinic provider community that include functional medicine. Of course, there is the practice publication that’s coming out and then they had the other JAMA Network publication that came out which we’ll link too, folks.
So, it’s changing. It’s changing the way that Ohio is thinking about and practicing medicine. What are your thoughts there?
John Weeks: Yes. It is changing, and I would say part of the change is that even if it is still in many respects intentioned, there is a real deep dialogue being engaged around the Triple Aim, the Quadruple Aim around value-based medicine. So, all of thoughtful medicine is realizing that things need to change. So, that context is changing. That’s creating more openness.
The other context of change is researched-based, and we just know a lot more about integrative functional practices. That’s creating more interest because we can bring the evidence through the door. Then, there’s a bigger and bigger population that wants to do things differently.
Dr. Kara Fitzgerald: Yes.
John Weeks: So, there are a bunch of things. There’s a new gen coming up that’s just more open than the old generation was.
Dr. Kara Fitzgerald: Right.
John Weeks: This is going on in its Northern Indiana in the Connor Network. Oh, what’s it called? I don’t know, the larger system. I heard a very similar story. So, these things are happening. They’re relatively spotty, yes, yet they’re having that much of a spread. You know how much functional medicine there are. How many of all the hospitals in the US have a functional medicine program, right?
Dr. Kara Fitzgerald: How many-
John Weeks: It’s pretty small.
Dr. Kara Fitzgerald: You could probably still count it on one hand, maybe two.
John Weeks: How many have one that’s in any way robust like the Cleveland Clinic? Then, there’s really one. There’s some extraordinary history to how that happened. The Cleveland Clinic is inside of … It’s just like a 13 billion dollar operation, last time I looked. They’re able to have a very large experiment which in many respects, this is what this is, but it’s great to hear. I honor the work. I honor the model.
I love in particular the group work that they have done because that is right now the best route for functional, integrative, naturopathic doctors to be able to deliver their services in a way that it can be affordable to a broader population.
Dr. Kara Fitzgerald: Yes.
John Weeks: It could be more salable to an employer frankly who have done well to a standard eventually, more salable to any payers.
Dr. Kara Fitzgerald: Yes.
John Weeks: For you who haven’t studied it, what you need to know is that this is not giving less valuable healthcare to people. What they found in Cleveland Clinic is they found better outcomes, quicker in the early data anyway-
Dr. Kara Fitzgerald: Yes.
John Weeks: … with the group model than they did in the team model.
Dr. Kara Fitzgerald: I know.
John Weeks: Which is just totally astonishing but real.
Dr. Kara Fitzgerald: It’s astonishing, but it makes sense of because it’s a community engagement.
John Weeks: Right, totally.
Dr. Kara Fitzgerald: There’s connections. I mean, there’s just all sorts of powerful and beautiful things happening.
John Weeks: The power of the group. If you aren’t familiar with the work James Maskell has done, and actually James’ book on group. He’s talked to many of the best people in the group world from Jeff Geller, Paula Gardiner. Jeff and Paula have a program. If you look it up, we can have it on the research list. It’s a great direction.
Dr. Kara Fitzgerald: I have a podcast with him where we go into this, and we do talk about the Cleveland Clinic Study. I can’t wait for it to come out, but I appreciate you circling back to it because it’s a very important ball for us to have near. Now listen, so there’s a lot we can talk about. We’re overtime, but we’re going to just keep going because you’re an important brain for me to be picking here.
So, the other side of this is one of the interesting phenomena that I’ve seen and it happened in our world is those of us who are involved in training other professionals. I’m on faculty at the Institute for Functional Medicine, but there’s all sorts of good place as training, good offerings for post graduate medical training in this era or in this specialty.
The CME, the accreditation council for CME has really been challenging us. We’re under a microscope. So, it seems like it would seem in some level we’ve hit the bear. The successful Cleveland Clinic finally getting into JAMA. Functional medicine has a term being out there in the open more and more. It’s also scary to see or it’s irritating, maybe it’s not. I don’t know, to see these big powers really attempt to maintain the emperor.
John Weeks: I’ve written quite a bit about what the ACC. I mean, the accrediting agency for your CME has been doing and interviewed Graham McMahon who’s the executive director there. I’ve come to conclude that they have been intentionally targeting integrative functional medicine, and that they deny that they are targeting. So, we’ll get the links to you because I don’t think … Part of what you can act on is where you have control of your universe.
So, one of the things is, it’s my observation that we in these fields do play a little fast and loose with the science sometimes. You will hear speakers talking about an in vitro study as though it’s proven that it works in living humans, right?
Dr. Kara Fitzgerald: Mm-hmm (affirmative).
John Weeks: There will be a small study that got 10 people in each arm of a trial and it will have a positive outcome, and the speaker will act as though we know for sure that this is a done deal. That this works very well. So, I think there are ways that we can be much more conscious of what exactly we’re sharing because there’s always been this thing about. We’ve known that there’s been science behind what we’re doing, and yet these folks have not been recognizing it, and sometimes I think it’s not discriminating well enough.
I think that stepping forward as a group, this is a place where I think collaborative activity is real. If IFM has a problem and it’s trying to fight it out quietly, and Cleveland Clinic has a problem and other people who give CME are having problems and everybody’s on their own. It’s easy to pick you all off one by one.
I mean, IFM has done a good job of fighting it, but if it’s a generic issue against the field, then the field needs to stand up and actually go chest to chest on it and say, “You know what guys? This is not okay. You’re holding back something that has value to add here.” So, there’s a willingness to go public with who we are.
The real tough issue here and frankly around some of the FTCs issues with Covid is the fact that so many of our practitioners have pharmacies, sell natural products. As such, you’re no longer merely a clinician. You’re a retailer. In the rules around accreditation, in the rules around who gets to speak, you end up in a different category if you’re part of the business of selling pharma, which of course our practitioners are in the business of doing. Even if they’re doing something through a wholesaler and getting up a piece of change when the packet arrives in the mail, you still got an interest in selling the drug for the natural pharma.
This is something that I think we need to look at much more directly. If there’s a case to be made for the value and why this should be treated differently, we need to not be ashamed but be able to stand up and say, “This is why we say we’re the exception.”
Dr. Kara Fitzgerald: Which of course, we would argue that that is true.
John Weeks: Right. Then you got to stand up and say, “Okay. We do argue that I’ve heard it.” I’ve published on Maggie Beeson. She was rather wonderful naturopathic doctor. She had a very large clinic in Billings. She just said, “We don’t do procedures, and we need to make a living.”
Dr. Kara Fitzgerald: That’s right.
John Weeks: “What we have is this thing we do on the side.” I think that’s a very good argument honestly, but you got to bring it forward honestly and then you got to start thinking about what’s the structure around that, that can protect the public from people abusing that relationship because it can be abused also.
Dr. Kara Fitzgerald: Yes. Geez, that’s a very, very good, very provocative, very important point. We talk about that here. Yup, it has impacted. I was going to present at the American Nutrition Association, but I’m not because we’ve got a few products for sale on our website, not much but I won’t be this year. It’s something that we’ve thought about in our practice.
The other piece, so in addition to it being a revenue stream that’s essential for survival. The other piece is that there’s energy involved in vetting products and all of that.
John Weeks: Yes.
Dr. Kara Fitzgerald: But it is…
John Weeks: That’s the case, right?
Dr. Kara Fitzgerald: Yeah.
John Weeks: That’s the case. That’s the case that you need to make. In this regulatory context that we have around natural products, the best consumer needs of vetting support to make sure they get. You got to be able to make it. For those of you who follows that issues with the FTC and Covid, and the crackdown and the silencing of doctors, a lot of the silencing has to do with the silencing of the doctor as pharmacists. The doctor as a retail product seller because the FTC views you very differently.
If you are a doctor who is saying you should use vitamin D to limit your chances of getting Covid or having its worse impacts. If you then also sell that vitamin D and go right over here and get it, they don’t like you talking about it if that’s what’s going to happen next.
Dr. Kara Fitzgerald: Right. That’s right.
John Weeks: That’s their logic for the muzzling. That’s the issue that again as we get stronger, you do. As you started this out, as we’ve gotten stronger, we become more visible. There’s more pushback at a certain level.
Dr. Kara Fitzgerald: Yes.
John Weeks: It’s also calling on us to stand up for what we say is our distinction. We need to stand up for why we actually look at the use of science differently. That if you got suggested evidence of something that does not have harm attached to it, then we think we should try that. Well, that’s a paradigm and a way of thinking. That’s not what people are taught in medical school.
Dr. Kara Fitzgerald: That’s right.
John Weeks: So, we have to stand up. I think optimally as a fact of organizations, that all are representing the same philosophy here. Then, it’s much more meaningful even than if just IFM did it, right?
Dr. Kara Fitzgerald: Yeah. You’re making a really good argument for that, absolutely. Yeah, absolutely. If it’s all of us as individual providers going it alone against FDA and FTC, or just one small organization like AANP or IFM. The voice of many is stronger. I do agree with you though and want to underscore the importance that we really practice the best and most evidence-informed medicine, and that we don’t make claims. Then, we look at the literature carefully and critically, and present it accurately. I’m absolutely in favor of that.
I’m happy that IFM has really … We’ve always been actually pretty buttoned up and we are. It’s just continuing to just look at that. We try to practice that here in our clinic as well. It feels more satisfying, and we’re able to engage in a conversation with the degree of academic rigor when we adhere to a certain scientific structure, a certain set of known …
John Weeks: If I’m a patient and a doctor says to me, “This herb has some fascinating lab studies that shows its antiviral activity.” Let’s say, okay, maybe there’s some antiviral against Covid. We don’t know frankly how it is with humans, but we do know that. In that context, “I think because of the safety data we have, then it’s okay for us to give it a try but that’s where we are. Are you interested?”
Dr. Kara Fitzgerald: That’s right. I mean, there are human thinking about Covid and botanicals. Certainly, there are botanical studies that have occurred in China, in the SARS-CoV. The first SARS and there are historical uses of many of those botanicals. So, there are data but just not for Covid. Covid is in vitro. You’re right.
John Weeks: That’s the thing. Because it works for another virus doesn’t mean it works for this one. So, that’s just again respecting what we know and what we don’t know.
Dr. Kara Fitzgerald: Yes. That’s right. All right. Listen, we’ve come to the end of our time.
John Weeks: Beginning of the end.
Dr. Kara Fitzgerald: I know, but I’m going to take a few more minutes here. One is, I just want you to give a shout out to the COVID-19 Support Registry, and we will link to this on our site folks if you’re interested in submitting. Then, you’re stepping down. Your stopping publishing the Integrator Blog, and you’re stepping down as JACM’s editor at the end of the year.
So, I want to know what’s going on with you? Just what you’ve offered us today, just kind of the top of the iceberg of who you are and what you have in terms of just really chronicling our world for the last almost 40 years. So, I want to know what’s going with that and what your next adventure is? So, those two things.
John Weeks: Thanks. The first level of science and pre-science is actually just to know what’s going on out there. We know that around the world and in the US, many people are working with a variety of different natural agents, therapies, practices, relative to directly addressing COVID-19 and trying to prepare people so they are less likely to get it or helping them after they’ve gone through a tough bout to come back.
So, Ryan Bradley who’s a colleague of ours at University of Natural Medicine, set up a Traditional, Complementary and Integrative Health and Medicine COVID-19 Support Registry. For any of you have any of these patients, he’s just gathering basic data. It’s case data on what the person presents with, what did you do. You can go back in and add information later about what kind of affect may have been associated with it. How the patient’s doing? It’s the basic observational level of gathering information about what’s going on.
What’s been exciting is that there are some case reports coming in out of Japan through a link there. We linked the people in Iran, got a set of data coming in. There’s an Ayurvedic group. There’s a TCM group. There’s the naturopathic doctors with a core of it. Then, there’s a group out of IFM. Patrick Hanaway’s been involved and putting together the right language to help you inlay your data. So if you Google up, I would say Ryan Bradley. Actually if you do-
Dr. Kara Fitzgerald: We’ll link to it. It will be on our show notes.
John Weeks: Yes. Okay. The last thing, I’ve been in the field for 37 years in various forms, and it’s been really a wonderful place to, and a series of places to have found myself, and series of communities. Really, I’ve been blessed with more relationships of fine people than anybody could ever ask for. While one is working that hard for that long, one doesn’t have a chance to look at all the rest of the world. I just entered my 70th year. I’ve got a lot of other curiosities.
So I decided to leave JACM, the journal, and stop publishing the Integrator, after it will be 259 issues. Just kind of stop, see what rises from within, and putz around and do this and that, see what comes in from outside. Try to set myself up in the best way possible for the years that I have left.
I’ve been using the terms re-tire, which is to get new wheels for the next phase and that’s where I’m at. It’s been a real sweet and warm process after I’ve announced that, to be connecting with people. It ain’t easy to think about not going to the places where I see the people so often, but then who’s going to those places anymore, anyway?
Dr. Kara Fitzgerald: That’s right.
John Weeks: Anyway, I will let the spirits tell me whether or not I’ll be back involved with health and medicine. I suspect there will be some connection, but I’m opening myself up.
Dr. Kara Fitzgerald: Oh, it sounds absolutely exciting. Well, I hope that you let us know in one form or another. I’ll be really curious to see where the spirit guides you. You’re a treasure to our field. I appreciate what you’ve shared with us today and just giving this historical look. The exciting things that are happening now, our challenges, which we absolutely have the capacity to face and overcome. You’ve been a leader, and a guide, and a chronicler. So, thank you John.
John Weeks: Thank you very much. As you know, my closest adviser in all of this work is the person who I married 28 years ago who is a naturopathic doctor and MPH. She is a big fan of yours. So, I was particularly happy to be invited on because you come so highly regarded by my closest adviser.
Dr. Kara Fitzgerald: Well, I’m honored and I hope I have a chance to meet your closest adviser one day. Thank you so much for joining me.
John Weeks: Okay. All right. Take care.
Dr. Kara Fitzgerald: Bye-bye. All right. Good job. Thank you, John. That was great.
And that wraps up another amazing conversation with a great mind in functional medicine. I am so glad that you could join me. None of this would be possible, through the years, without our generous, wonderful sponsors, including Integrative Therapeutics, Metagenics, and Biotics. These are companies that I trust, and I use with my patients, every single day. Visit them at IntegativePro.com, BioticsResearch.com, and Metagenics.com. Please tell them that I sent you and thank them for making New Frontiers in Functional Medicine possible.
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John Weeks has worked in integrative health and medicine since 1983 as an organizer, chronicler, speaker and executive. He is editor-in-chief of JACM – Paradigm, Practice and Policy Advancing Integrative Health (The Journal of Alternative and Complementary Medicine) which, under his leadership has seen its impact fact rise 53% and the journal’s downloads rise 200%. For a quarter century, his Integrator Blog and related columns have been leading sources on policy and organizational activity in the emerging field. He has consulted with NIH, WHO, PAHO (pan American health organization), and numerous medical delivery, academic, insurance, professional, and other organizations. Weeks helped found the Integrative Health Policy Consortium, the Academic Collaborative for Integrative Health and the Academy of Integrative Health and Medicine. He attended Stanford University for three years, studying history. Four academic institutions have granted Weeks honorary doctorates. He was honored in 2014 by 3 consortia in the field with a Lifetime Achievement Living Tribute Award. He loves stand-up paddle boarding, and where there are waves, SUP surfing. He and his partner in all this, Jeana Kimball, ND, MPH, have managed to work from Costa Rica, Nicaragua and Puerto Rico with their two now grown children for 6 of the past 18 years. www.johnweeks-integrator.com
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