MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

I recently received this unexpected and surprising email:

Dear Friend,

I wanted to point out an article that published last month in the New England Journal of Medicine Catalyst that gets to the root of why we are not solving the nation’s current epidemics of chronic pain, obesity, opioids, suicide, and cardiovascular disease.

My co-authors included Dr. Eric Schoomaker, the former surgeon general of the Army; Dr. Tracy Gaudet, who leads cultural transformation at the Veterans Health Administration; and Dr. James Marzolf, the chief health and data analyst in Dr. Gaudet’s office.

In the article Finding the Cause of the Crises: Opioids, Pain, Suicide, Obesity, and Other “Epidemics”, we show how our nation’s response to our current epidemics are tackling the wrong problems.

For example, take the opioid epidemic. The response has been to restrict opioids and focus on other drugs. This narrow approach is compounding the problem. The root cause is that we don’t manage chronic pain appropriately. We need a major roll out of non-pharmacological approaches for pain.

Instead of treating pain with a pill, we need to pay attention to the whole person in mind, body, and spirit. When we do this, we may find that non-drug approaches to treating the person are more appropriate, and treat not only the pain, but the suffering that often accompanies it.

The article describes how systems like the Military and Veterans Health Administration are doing this with transformative approaches that embrace whole person, integrative health.

The good news is that the answers are out there. The entire nation can do this, and we can start now.

Be well.

Dr. Wayne Jonas

______________________________________________________

In case you don’t know who my ‘friend’ Wayne is (I did mention him before here and here, for instance), here is a concise summary of his background. As you doubtlessly do know, the NEJM is a (perhaps even the most) respected medical journal. I therefore tried to find the article there and was amazed not to find it. Then I realised that Wayne said it was published not in the NEJM but in the ‘New England Journal of Medicine Catalyst’, a very different proposition.

The New England Journal of Medicine Catalyst brings health care executives, clinical leaders, and clinicians together to share innovative ideas and practical applications for enhancing the value of health care delivery. From a network of top thought leaders, experts, and advisors, our digital publication, quarterly events, and qualified Insights Council provide real-life examples and actionable solutions to help organizations address urgent challenges affecting health care.

But what about the paper that Wayne so warmly recommends? It turns out to be little more than a promotional stunt for integrative medicine. Here is an excerpt from it:

It is often a surprise to people that two of the largest health care systems in the country are trying to radically redesign what they do to provide more whole-person and integrative care. These two systems are run by the Department of Defense (DoD) and the Veterans Health Administration (VHA) and collectively care for over 20 million people. The nation can learn from their efforts.

The need for reform emerged after the turn of this century when leaders in the DoD and VHA began to hold informal meetings under the title “From Healthcare to Health.” Over the course of those meetings, the participants recognized the failure of their health care systems to get at the underlying causes of chronic disease. In 2009, they secured the support of the Chairman of the Joint Chiefs of Staff to change overall military doctrine and guidance to a radically holistic approach called “Total Force Fitness,” which subsequently led to health and community innovations. An example of these redesign innovations was the Defense and Veterans’ Pain Management Task Force and Report and the resulting strategy that preceded the National Academy of Medicine’s report on pain in America.

Other innovations included the Healthy Base Initiative and the Performance Triad, the latter of which focuses on the importance of asking all patients about their sleep, nutrition, and physical activity. All services — Army, Navy, Air Force, Coast Guard, and Special Forces — continue to shift to whole-person models that seek to implement behavioral and complementary approaches. For example, >6000 providers have been trained in and routinely use Battlefield Acupuncture for pain.

The transformation currently underway in the VHA, which goes under the name “Whole Health,” is also an offshoot of that leadership dialogue from 20 years ago. In the Whole Health approach, the emphasis is to empower and equip people to take charge of their health and well-being. In this approach, trained peers help veterans explore their sense of mission and purpose, and well-being programs focus on skill-building and support for self-care. These elements, in addition to person-centered, holistic clinical care, create the Whole Health delivery system. VHA facilities are shifting from a system designed around points of clinical care (in which the primary focus is on disease management) to one that is based in a partnership across time (in which the primary focus is on whole health). Clinical encounters are essential but not sufficient. This health system is designed to focus not only on treatment, but also on self-empowerment, self-healing, and self-care.

This radical redesign is built on decades of VHA work enhancing its integrative approaches with innovations such as Patient-Aligned Care Teams, Primary Care Mental Health Integration, peer-to-peer support, group access to mental health services, and the increasing use of complementary medicine approaches. These changes laid the groundwork for the kind of radical redesign now underway in the VHA and that is needed in all national health care delivery systems.

In 2011, the VHA established an Office of Patient Centered Care and Cultural Transformation to further redefine health care delivery and to oversee this unique approach. Whole Health has begun rapid deployment across the entire VHA system, starting with 18 VHA medical centers in 2018 and with a planned expansion to all VHA medical centers by the end of 2022. System-wide implementation will require an estimated $556 million over 5 years.

When fully implemented, operating costs for this shift are projected to represent 1% of the VHA annual budget. This implementation will involve hiring almost 6,400 new staff, the majority for positions that did not previously exist in the VHA, including health coaches and peer health partners, nutritionists, acupuncturists, and yoga instructors. Whole Health is building access through group visits, peer-to-peer support, and the development of Personal Health Plans for every veteran — something everyone in the country could use. In addition, new payment codes have been created, allowing providers to capture and cover their time and efforts using relative value units (RVUs) and to track productivity.

Will Whole Health help to cure what ails health care? Current models suggest that it will. With improvement in health outcomes, there will be a reduction in the need for existing clinical and biomedical services. These models predict increased access and more proactive population health management. With the addition of these new Whole Health services, we project a 24.5% increase in access when fully deployed — without the addition of a single hospital bed or medical specialist. In addition, Whole Health exceeds cost neutrality and is conservatively estimated to return $2.19 for every dollar invested over 6 years.

These returns reflect net cost avoidance and are derived from reductions in the need and demand for existing clinical health services — exactly what the nation needs in order to reduce chronic disease crises and contain costs. The per capita savings or cost avoidance is modest, averaging $535 per veteran annually over the 6-year period. Cumulatively, however, this totals over $6.2 billion in cost avoidance. Given that the Whole Health approach will improve the health of veterans, many of whom are dealing with complex issues such as chronic pain, mental health conditions, and opioid use at a cost of about $1 per day per veteran, it is a financially sound, cost-effective change from the current health care paradigm.

_______________________________________________________________
So, does this change my mind about integrative medicine?

I’m afraid not! And Wayne fails to provide the slightest evidence that his concepts amount to more than wishful thinking (note how he first mentions predictions of cost savings and, in the next paragraph, pretends they are a reality). I simply do not believe that adding a few unproven therapies to our routine healthcare and wrapping the mixture into politically correct platitudes will improve anything. This cannot work from a theoretical standpoint and, crucially, there is no empirical evidence that it does improve anything else but the income stream of charlatans.

If healthcare needs reform, then let’s reform it! Adding cow pie to apple pie is not a solution, it merely spoils what we have already. I am saying this now since 17 years when I published my first comment on integrative medicine. It was entitled Integrative medicine: not a carte blanche for untested nonsense. I do still think that it sums up the issue succinctly.

16 Responses to Integrative medicine for the US military. A letter from Wayne Jonas

  • You are slipping Doctor. I caught the NEJM Catalyst on second reading. I thought there was a full stop between NEJM and Catalyst and then realized there was not. But on the other hand I am always on the look-out for bottom–feeding publishers so maybe I am just naturally suspicious.

    Overall, what a load of codswallop. If any of these statements about medical treatment are true, any American looking for a military career they might be well advised to pretend they are Swiss and join the Papal Swiss Guard.

    I may be overly suspicious but that National Academy of Medicine’s report on pain in America link seems suspicious. it has an nih.gov in the address indicating a US Gov’t site but the Institute as a non-govt organization does not use that ending. I am probably just imaging thing but it seems a red flag.

    The Institute of Medicine has been renamed. The report may well have been renamed after the report was published but after the NEJM trick, I wonder if there was a spare name lying around and someone snapped it up.

    BTW that wiki on Jonas says he is on faculty at Georgetown Uni but a quick check did not find him listed though the faculty listing is were brief and seems to only programme heads so I likely missed him.

    This is definitely not a person that one should buy a used car from.

  • Bioterrorism Homeopathy and Wayne Jonas MD

    With the exception of the mention of battlefield acupuncture, this article is relatively boring compared with the amazing study Wayne Jonas, MD did with chemist Debra Dillner at the US Naval Academy two decades ago on the feasibility of using homeopathy to immunize against a bioterrorist attack, which appeared in the Journal of Scientific Exploration, Vol. 14, No. 1, pp. 35–52, 2000 entitled Protection of Mice from Tularemia Infection with Ultra-Low, Serial Agitated Dilutions Prepared from Francisella tularensis -Infected Tissue.
    If this doesn’t jab skeptics in the eyes with a hot poker, nothing will.
    They concluded “The results in this series of experiments did not confirm the null hypothesis that ultra-low, SAD dilutions [Serially Agitated Dilutes, i.e. “homeopathic remedies] prepared from infected tissue acted like chemically identical controls in their ability to protect against subsequent bacteria l challenge by the same organism. SADs reduced overall mortality by 22%, delayed death by 5 days, and tripled the number of organisms required to kill 50% of the animals. Two SADs (30c and 200c) stimulated the production of specific anti- tularensis antibodies in animals after 1 month of exposure. No protein was detected in SAD preparations, but they could be distinguished from control solutions with 1H NMR-spectroscopy. All SAD preparations, except the 1000c, consistently imparted some protective effect . .
    Jonas undoubtedly is and has been the military’s go to guy regarding homeopathy and the use of supramolecular medicine and prophylaxis. He is a former director of the U.S. National Institutes of Health. His current position as the director of the Samuelis Institute, I presume gives him the license to pick up the phone and speak directly to billionaire homeopath Susan Samuelis, who btw recently shoveled $220 million on the University of California at Irvine to integrate homeopathy with straight medicine.
    I might take special glee in redirecting skeptics attention to the raw use of NMR as a physical investigation into finding a chemical distinction in the serially agitated dilutes (SADS), which are the supramolecular homeopathic materials used in this study.
    These studies of physical distinctions in the chemistry and structure of supramolecular solutions are a cold, wet blanket on naked skeptic arguments that homeopathic solutions are nothing more than plain water, which I might point out in the basking presence of the truth, skeptics could easily see, or should say, that considering the transmogrification of hydrogen and the amount of oxygen in water, that have dramatic, if not drastic effects of burning solvency, it would be just as stupid to say that hydrogen peroxide and heavy water, Tritium, are also just plain tap water as well.
    I mean, is it really this difficult for you boneheads to grasp the hard cold fact pried from your dead cold hands, that these materials you are squabbling over, can have profound biochemical effects and trigger serious consequences of life and death?

    • thank you for once again discrediting yourself through ad hominems

    • “I mean, is it really this difficult for you boneheads to grasp the hard cold fact pried from your dead cold hands, that these materials you are squabbling over, can have profound biochemical effects and trigger serious consequences of life and death?”

      Only in your febrile fantasies, John.

      Oh, and “billionaire homeopath Susan Samuelis”?

      How about “AltMed loon Susan Samueli who happens to be married to billionaire convicted financial fraudster Henry Samueli” which is a far more accurate description.

      And “Journal of Scientific Exploration, Vol. 14, No. 1, pp. 35–52, 2000” Oh, John. A nonsense publication by a bunch of fruitcakes which is utterly devoid of any credibility. And that study is from 2000. So they’ve had LOTS of time to replicate the results with bigger and better studies and get them published in a proper journal so their revolutionary findings can be accepted by the scientific world. Any idea why this hasn’t happened, John? You might not. I have.

      • How does that compare with the “scientific investigations” of Shermer, Randi, Ernst et al? To say the least, we have two positive biochemical tests of supramolecular solutions (Davenas and Hirst, yes Hirst found positive results) pub’d in Nature; metas in the Lancet and BMJ concluded against placebo and null, we have two centuries of pub’d clinical observations and all you got is crap and whine in disbelief in Skeptic rags and blogs like this one.

        • “all you got is crap and whine in disbelief in Skeptic rags and blogs like this one.”

          Really, John? Is that all we’ve got? Let’s see what some national agencies have to say, shall we?

          1. ‘The principles of homeopathy contradict known chemical, physical and biological laws and persuasive scientific trials proving its effectiveness are not available.’
          Russian Academy of Sciences

          2. ‘Homeopathy should not be used to treat health conditions that are chronic, serious, or could become serious. People who choose homeopathy may put their health at risk if they reject or delay treatments for which there is good evidence for safety and effectiveness.’
          National Health and Medical Research Council, Australia

          3. ‘These products are not supported by scientific evidence.’
          Health Canada

          4 “Homeopathic remedies don’t meet the criteria of evidence based medicine.”
          Hungarian Academy of Sciences

          5. ‘The incorporation of anthroposophical and homeopathic products in the Swedish directive on medicinal products would run counter to several of the fundamental principles regarding medicinal products and evidence-based medicine.’
          Swedish Academy of Sciences

          6. ‘We recommend parents and caregivers not give homeopathic teething tablets and gels to children and seek advice from their healthcare professional for safe alternatives.’
          US Food and Drug Administration

          7. ‘There is little evidence to support homeopathy as an effective treatment for any specific condition.’
          National Centre for Complementary and Integrative Health, US

          8. ‘There is no good-quality evidence that homeopathy is effective as a treatment for any health condition.’
          National Health Service, UK

          9. ‘Homeopathic remedies perform no better than placebos, and the principles on which homeopathy is based are scientifically implausible.’
          House of Commons Science and Technology Committee, UK

          10. ‘Homeopathy has not definitively proven its efficacy in any specific indication or clinical situation.’
          Ministry of Health, Spain

          11. ‘There is a constant increase in the quantity of evidence and the conviction of the scientific community in medicine, that homeopathy should be treated as one of the unscientific methods of so-called “alternative medicine”, which proposes worthless products without scientifically proven efficacy.’
          National Medical Council, Poland

          12. ‘From a purely clinical perspective, the fact remains that there is no valid empirical proof
 of the efficacy of homeopathy (evidence-based medicine) beyond the placebo effect.’
          Federaal Kenniscentrum voor de Gezondheidszorg, Belgium

          You, meanwhile, have some anecdotes from your fellow quacks and a bit of shabby evidence tortured out of some data noise.

          • All comments sewn in your response, Lenny, are made by political agencies of government, nothing in response to actual lab tests like Jonas’, tests easily replicated that show organic action and inorganic distinctions in the diluents, contradicting your plain tap water null hypothesis. Where’s the science you worship that backs up your missing in action reports? You’re not really investigating anything, you’re just muttering the political guffawing of hacks, the skeptic’s echo chamber. reviews of reviews of “systematic” reviews.
            This is all the objection to homeopathy has ever been, and the fundamental point has been lost in the squabble: Homeopathic diluents can be prepared quickly, convey immunity and save lives
            When you actually start digging into the lab tests, a whole different picture emerges, quite a turn from your Alice in Wonderland dream sequence, vague prattlings of fraud and placebos.
            If supramoleculars are not the specificity of Tritium, how is it that dozens of biochemical tests show basophils degranulating their antibodies in pursuit of the pathogen when triggered by diluents of bee venom? How is it mice reportedly acquire an immune response to rabbit fever when administered a tularemia diluent? Like every skeptic down the line, you’re not asking the questions you need to ask, you’re not putting anything to a test. With nothing more invested than the name “Lenny” you’re just repeating political statements from unnamed “investigators,” you’re not investigating anything for yourself, you’re just sitting there as an anomynous spectator of what you take as a game with what looks like a beer in your hand, looking off to the sidelines, which is where you have always been and always will be until you put the beer down, get up on your hind legs and take action to see and feel for yourself what these homeopathic diluents really are, so the next time you have an opinion to venture, attach your full name to it and make it your own, acquired with your own hands, feet and six senses. .

          • personally I prefer sound systematic reviews of the clinical evidence to lab tests when deciding whether a treatment is bogus or not; don’t you John?

          • Basophils degranulating, John? The repeated experiments were unreplicatable nonsense.

            https://www.ncbi.nlm.nih.gov/pubmed/16036166

            Homeopaths’ lab experiments counting angels dancing on pinheads in a vain attempt to add credibility to their wishes of efficacy will only make us laugh, John.

            200 years is a long time. If homeopathy worked, you’d have thought that by now the homeopaths would’ve been able to come up with something unarguable to present to us. A few Nobel prizes would’ve been handed out.

            Hasn’t happened. It remains nonsense now as it did then when Mad Sam first pulled the idea out of his arse and those who believe in it remain cranks and fools.

            Continue to post your nonsense, John. We’ll continue to laugh at it.

    • He is a former director of the U.S. National Institutes of Health.

      Correction, John. Jonas was the director of the Office of Alternative Medicine (since renamed the National Center for Complementary and Integrative Health), a branch of the National Institutes of Health.

      But it’s good to see you’re maintaining the usual high standard of accuracy in your comments.

    • @comic John: I have recently been reading Dianetics and the Wikipedia-page on Xenu, Hubbard’s flight of drug-induced fantasy regarding alien beings being implanted from volcanos into humans…who had been transported to earth in DC-8 like crafts millions of years ago. Reading your blog entry leads me to think you have not only been reading and digesting this….and perhaps taking the same drugs, but attempting to emulate him ?

  • I say double down on opiodes! Go for it! Good for the health of the pharmaceutical industry.

  • It occurs to me that a wounded soldier who has someone practising Battlefield Acupuncture on them rather than administrating a strong painkiller might be tempted to reciprocate by practising battlefield acupuncture on the guy with the needle with a bayonet.

  • That reminds me, I said here you could kill a man with homeopathy, so at last here’s “The Final Ad Hominem Proof for Homeopathy,” as promised . . sorry for the delay . .
    https://johnbenneth.wordpress.com/2019/06/08/murder-by-homeopathy/

  • oh god, my eye, seduced by “US military”, read “John Wayne”……..

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