$250,000 Dr Rogers Prize to University of Toronto Integrative Leader Heather Boon, PhD

 Heather Boon, BSc, Phm, PhDThe $250,000 Dr Rogers Prize was awarded to long-time integrative medicine researcher and organizer Heather Boon, BSc, Phm, PhD (pictured). A Vancouver Sun article notes that Boon is a cofounder of and has been the co-chair of the Canadian IN-CAM network. She also was one of the visionaries who saw the value in an international organization for researchers in the field and formed the International Society for Complementary Medicine Research (ISCMR), for which Boon is the immediate past chair. Boon’s academic work includes a textbook on natural health products and some 150 academic articles that focus on the safety and efficacy of them. She is now dean of U of T’s Leslie Dan Faculty of Pharmacy. Boon has been a leader in the university’s effort to create a Centre for Integrative Medicine.

The article notes that Boon is not afraid of controversy. She was recently lambasted by 90 of her academic colleagues for undertaking research on homeopathy for children with ADHD. She came back at critics with this balanced response, according to the Sun account: “I don’t think the criticism was warranted. I think that we have a phenomena, people claiming they’re getting better, and so like any scientist I’m curious about what’s going on.”

The Dr Rogers Prize, first awarded in 2007, is granted every 2 years to a Canadian who is a leader in complementary and alternative medicine. The Dr Rogers prize is named for an early integrative oncologist, Roger Rogers, MD, who practiced in British Columbia. As noted in the Sun, the award is backed by the Lotte and John Hecht Memorial Foundation.

Dr. Rogers PrizeComment: One of the areas where Boon has been impactful has been in the promotion of what some of us call “researching the way we practice;” that is, finding the right methods to look at whole-person and whole-system interventions. (This is the core of the GAHMJ mission.) She’s been a leader for more than a decade of a group of international researchers who have worked to define and promote whole-systems research for integrated care through a series of publications. Another area of Boon’s influence, not unrelated, is in looking at the whole systems from a horizontal, interprofessional approach.

An anchor document for the field that Boon took the lead in developing is a project that led to a widely cited paper entitled Integrative Healthcare: Arriving at a Working Definition. Notably, the second author on the piece is Marja Verhoef, PhD, Boon’s close colleague with IN-CAM and ISCMR who was awarded the Dr Rogers’ Prize in 2011. At that time, I was surprised that the award wasn’t jointly presented to the two of them, given the multiple close collaborations of the Verhoef-Boon team. Yet given each of their substantial individual commitments, the choice to honor them separately makes a great deal of sense. Congratulations, Heather! Well-deserved.

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Heather McLeod Reports from New Zealand on Palliative Care and the Rongoa Maori

New ZealandNot long after Cancer Control New Zealand chose to explore palliative care a half-decade ago, they brought in Heather McLeod as an adviser. McLeod is an actuary by professional education and practice who developed a passion for integrative health and medicine and founded Integrated Healing in 1998. The CCNZ closed the palliative care initiative in August with the explanation that “its role was superseded by the progress made in improving cancer services for New Zealanders.”

This closure came after McLeod, as she noted in an email to the Global Integrator, helped produce “a series of working papers on the topic” for CCNZ. These are available via the CCNZ site. Notably, the reports appear to have little mention of these complementary and alternative therapies that many use in their “time of love” or “time of compassion” (from Te Wa Aroha, the Maori term). The chart on page 77 of this report found that just 8 of 21 locations “could” provide a “complementary therapist.” For comparison, 5 offer a dietician and 16 a “cultural officer.” McLeod shared that the current government does not appear to have much interest in integrative approaches.

Rongoa MaoriWhere McLeod sees activity with integrative care in New Zealand is around the traditional populations, via the “Rongoa Maori”—a term that encompasses “herbal medicine made from plants, physical techniques like massage, and spiritual healing.” It is described as “a wellbeing oriented practice,” and “a specialty based on a body of knowledge . . . that is applied in totality to bring about wholeness or interconnectedness of body, mind, emotion, spirituality, energy, society, culture, relationships, and environment. It is a way of being in the world and sharing the appropriate knowledge to help restore balance.”

McLeod notes that the attention is required due to “commitments to Māori under the 1840 Treaty of Waitangi,” which is considered the founding document of New Zealand. Evidence of the New Zealand Ministry of Health’s work in this area is the 2014 Tikanga ā-Rongoā, a guide to “proving safe and quality rongoā care to tūroro [which] is paramount to the wellbeing of our communities.” The publication is described as “a collaborative journey with representatives from the rongoā sector that defines a benchmark of excellence to deliver safe and quality rongoā services.” The standards set are presented as voluntary. The report comes with 5 “toolkits” that help provide guidance to the text.

Comment: The prevalence of integrative approaches in New Zealand makes the attention to natural approaches surprisingly low. This is particularly so given the fact that an adviser to the project had McLeod’s own interests in integrative approaches. Meanwhile, while there is no direction connection between the 2 parts of this post—the closure of the palliative care initiative and the traditional except that McLeod coupled them in the e-note on integrative-related activities—anyone reading into the Tikanga a-Rongoa might wonder where the palliative care report would have gone had it guided by those principles of the 10% of the population that is Maori or Pacific Islander. Thanks for the update, Heather!

Reports and Action on African Traditional Medicine Day 2015

Traditional healers in Cameroon “called on the introduction of [both] modern medicine and healer’s practices into formal education system at various levels.” They were promoting regulation and formal standing and asked for a “collaborative partnership based on mutual trust and mutual respect of both systems as well as the judicious introduction of traditional medicine in the national health systems of Cameroon.”

Traditional healers in CameroonThe action in Cameroon paralleled that of traditional healers across the continent on the occasion of the August 30, 2015, Africa Traditional Medicine Day. The day is declared and backed by WHO as part of their campaign to achieve recognition of traditional medicines and healers in the all-out effort to assure primary care for all. Dr Matshidiso Moeti, the WHO’s regional director for Africa, issued a letter celebrating the day: “The benefits of traditional medicine are evident to all, [but] there is no doubt proper regulation is essential to the provision of quality, safe and effective health care products and services.”

WHO’s Regional Office for Africa is working to bring a regulatory framework to traditional medicine including through the 2010 “Guidelines for Registration of Traditional Medicines in the African Region.”

Eighteen African nations in Africa presently have regulations in place. Celebrating Africa Traditional Medicine Day, Nigerian practitioners called for more education of the public while another focus was a strong push to weave traditional healers into government agencies. A perspective from Ethiopia notes regulatory steps in place but urges more, including establishing a research institute. The day prompted this article from Botswana in which it was asserted that regulation is news. Ekurhuleni officials in South Africa urged Herbal/Traditional Medicine Productsthat “every traditional healer in the area registered with the local government to stop impostors from operating in the metro.” In Rwanda, there is a network of 14,000 traditional healers and their efforts, including on Africa Traditional Medicine day, to organize: “Gafaranga said it was time for conventional health providers to build mutual trust with traditional healers as they both play a role in treating various diseases.” In Liberia, the celebratory events “started with a public parade by participants and also featured an exhibition of Herbal/Traditional Medicine Products” (see photo).

Just after, from the 3rd to 4th of September 2015, Gambia hosted the Seventh Scientific Congress of Traditional Medicine Practitioners and Conventional Medicine Practitioners. The meetings was convened by the West African Health Organisation (WAHO) in conjunction with the government of the Gambia, through that nation’s Ministry of Health, and Social Welfare. The Congress’ aim was said to be “to keep up with the objective of WAHO to support the ECOWAS [Economic Community of West African States] Member States to promote dialogue between the practitioners of traditional medicine and conventional medicine.” Gambian Minister of Higher Education Research, Science and Technology, Abubacarr Senghore, MD, states that “our aim therefore as a country is to successfully incorporate traditional medicine into the national health system with a view to sharing best practices and processes with other African member states.” WAHO funded the meeting.

Comment: The ceremonial day’s activities creates an opportunity to see, at once, the consonance of activity across the continent. Repeat themes were calls for basic regulations and also, in more mature nations, for opening up and strengthening communication between conventional and traditional practitioners. The traditional healers have their work ahead of them to prep for more inclusion. Meanwhile, I am reminded of the remarkable recent summit of traditional healers covered in South Africa Summit Models Inclusion of Traditional Healers in HIV, Tuberculosis Campaign. The conventional and bio-medically-focused NGO community can certainly stimulate this integration by extending themselves with mutual trust to routinely engage and include the traditional medicines and practices that 60% to 80% still use for much of their basic healthcare.

Canadian Naturopathic College Partners with Rwanda Researchers to Show Benefit of Selenium in People With HIV

Map of RwandaAIDs, the official journal of the International AIDS Society has published a recent article that found that daily supplementation of selenium significantly reduces the rate of CD4 cell count decline. According to a release from Canadian College of Naturopathic Medicine (CCNM), the 2-year randomized controlled trial involved 300 HIV+ patients who had not begun antiretroviral therapy (ART). The results showed a 43.8% decrease in the rate of CD4 decline.

The research effort was a collaboration of Canadian and Rwandan teams. Information on the trial and parameters is here. The project was initiated by naturopathic doctor Don Warren, ND, a co–principal investigator, through the research department at CCNM. In the Rwandan capital of Kigali, Julius Kamwesiga, MD, MS, with the National University of Rwanda, led the local medical teams. The opportunity developed out of a small 2007 positive pilot in Kenya that was led by James Farquarson, ND.

Logo for Canadian College of Naturopathic MedicineExplains Warren: “After seeing remarkable results with routine daily selenium supplementation in a small group of AIDS patients in one of the slums of Nairobi, Kenya, and after reading the current literature on selenium and HIV/AIDS, I had the opportunity to present this information to physicians within the Rwanda Health Ministry. They responded with great interest and recommended that we conduct a fully randomized controlled study and provided several of their medical staff to participate in the trial.” The release from CCNM notes that, according to UNAIDS, there were 200,000 people living with HIV in Rwanda in 2007, half of whom are women. There are 4,500 deaths per year due to AIDS-related illnesses.

University of RwandaThe researchers close with a note that “the main source of selenium in the body comes from food; the amount of selenium in food depends on where the food is grown or raised. The levels of selenium in soils varies significantly around the world. Additional study will be required to see if similar benefit occurs in regions that are not naturally selenium deficient.”

Comment: This work has truly been a labor of love for Warren, whose professional portfolio also includes a stint as CCNM president and as head of the Council on Naturopathic Medical Education. The CCNM collaboration is also a remarkable transcontinental collaboration and, to my knowledge, a first such for any of the accredited naturopathic medical schools. CCNM was the project sponsor. The results, as Warren says, are remarkable—especially for a natural product that, according to this site, costs as little as $.14/g.

Nordic Integrative Medicine Sponsors the 8th European Congress on Integrative Medicine and a Policy Day: September 25-27, 2015

ECIMThe conference lineup is powerful: participants from 29 countries, 45 universities, and more than 100 scientific presentations. All are part of the upcoming 8th European Congress for Integrative Medicine’s Global Summit on Integrative Medicine and Health Care, September 26-27, 2015, in Copenhagen, Denmark. The meeting will be convened by a 2-year-old integrative medicine player in the Northern European landscape, Nordic Integrative Medicine (NIM).

NIMNIM is also producing an “Invitational Policy Roundtable on Nordic Models of Care.” Participating in the latter are such notables as Torkel Falkenberg, PhD, from the Karolinska Institute; Victor Dzau, MD, the president of the USA National Academy of Medicine; and George Lewith, PhD, the policy meeting’s chair. Dzau will also provide the opening keynote to the Global Summit, which will be closed by Victoria Maizes, MD, the director of the University of Arizona Center for Integrative Medicine. All speakers are here. Conference manager Per Ankaer told the Global Integrator Blog that roughly 200 people are expected to attend.

Shelly NobleTo an electronic interview query, NIM founder Shelley Noble-Letort, PhD, E-RYT 200 (pictured), responded, “We are pioneering Integrative Medicine in the whole Nordic Region so there is a lot of education that is required.” The organization has chosen to position itself as “a work of science and a work of service.” The focus is on being a “green” healthcare model and on patient-centeredness. The mission: “Move healthcare into sustainability.” The profile on the site is both hi-tech and hi-touch, with an emphasis on the environment and “keeping a sharp focus on the patient’s mindfulbody.™” To reach throughout the region, NIM is establishing a Nordic Council with the 3 of the 6 national representatives already named.

WTCBNoble-Letort and her board of directors must raise 300,000 DKK (roughly $45,000 US) to gain status for their foundation, before receiving government support. A transplant to Denmark from California with her Danish spouse, Noble-Letort speaks to the challenges of raising money in Denmark’s socialist environment. NIM gained “small starting funding for education” from the USA-based Weil Foundation, founded by Andrew Weil, MD, who also founded the integrative medicine program represented by Maizes, above. Noble-Letort notes that World Trade Center WTC/Ballerup is helping out significantly with 3,000 square meters of donated start-up space—with potential for more than doubling the size—and is also sponsoring the pre-summit Nordic Roundtable. An international set of a dozen conference sponsors are on page 14 here.

The NIM site notes that its other most significant initiative—besides the conference and raising start-up funding—is related to corporate health. Asked about progress, Noble-Letort shares that “We are in dialogue with PFA Pension and LEO Pharma (both sponsors of summit) as well as Danica Pension who is interested in a pilot program that focuses on Stress and Integrative Health. No agreements yet.”

Comment: NIM is an ambitious, groundbreaking endeavor. It IS Intriguing to consider what finding philanthropic partners must be like for Letort as a non-national, relative outsider. Add to this the context of a socialist nation in which governmental support is more frequently anticipated than in the United States, for instance, where not-for-profit agencies must routinely pick up the pieces of a faulty governmental safety net. Letort and her team have their hands full. Hopefully this conference and the preceding policy day will prove to be the platform that catapults NIM toward additional fulfillment of its substantial mission and set of planned initiatives.

Study Finds Critical Need for Clinical Nursing Research in Africa: Possible Opening via Melinda Gates?

Nursing studiesAn adverse consequence of the fundamental nursing shortage in Africa came clear in detail with a recent publication in the International Journal of Nursing Studies (logo pictured) entitled “Clinical nursing and midwifery research in African countries: A scoping study.” The Columbia University–based team searched for studies involving nurse researchers on clinical topics. They found and reviewed 1,091 papers in the 2004-2014 window of time. Of these, just 73 the met their inclusion criteria.

The lead topics “were associated with major funding sources.” A top concern was HIV. Others were midwifery/pregnancy/child health and “patient experience.” “Major and common health care problems” like hypertension, diabetes, malnutrition, and diarrheal disease received very little attention across this decade. The team concluded that there exists a “clear gap between health care needs and problems and the focus of the majority of clinical nursing research.” They share that they did find 90 studies “about the role of nurses in African countries that were carried out by researchers other than nurses.” Yet, while honoring the value in such studies, they note that ”nurses spend more time with patients than other healthcare professionals positioning them to make important discoveries that otherwise may go unnoticed.” The authors note that the dearth of studies may be due in part to capacity issues associated with both the endemic brain drain that washes qualified nurses out of Africa into the industrial world and the lack professionals with nursing doctorates who are educated and skilled in research.

Comment: One cannot read this report without encountering the cascading crimes of global resource inequities. These favor investment in the acute over chronic; products over people; medical doctors over nurses; and industrial over less economically developed nations.

Bill and Medina GatesFunder-bias shapes research—and practice itself—everywhere. A small hint of a course correction from a major player might be imagined on reading the Nicholas Kristof interview with Bill and Melinda Gates (pictured) on the recent occasion of their foundation’s 15th birthday. Kristof writes: “So what mistakes did they make in their philanthropy? They say they started out too tech-focused. Now some of the measures they promote are distinctly low-tech—like breast-feeding, which could save the lives of more than 800,000 children worldwide each year.”

Nice to see these new foci coming around to possibly bolster investment in research by and about the care of nurses and midwives in Africa. Kristof’s column offers tactical guidance for prospective grantees. Melinda is clearly the access point. While Bill is said to favor meetings with policy makers, Melinda’s the one of the two most likely to go out into the field to encounter human-to-human conditions, and thus to witness the shortages and potential additional contributions of a more empowered nursing workforce.