The Bravewell Collaborative is bidding a fond farewell to the integrative medical world it has helped foster.

At its recent awards dinner in New York City, the philanthropic group formally announced that it will sunset over the next year, following a decade of setting the pace for integration of holistic principles and practices in mainstream healthcare.

The group will phase itself out by 2015 – but only after certain key projects are on firm-footing.

“From the very beginning, our vision was that one day Bravewell would not exist,” said Christie Mack, one of the founders of the Collaborative, and its voice and guiding spirit.

Speaking to an assembly of donors, thought-leaders, and recipients of Bravewell’s grants, Mrs. Mack said the founders never intended to create an ongoing establishment, but rather, a catalyst for change, “working strategically to transform culture the of medicine and improve the health of the public through integrative medicine.”

One of the group’s main goals was to define core principles of integrative medicine and then seed programs at medical schools throughout the country, a goal it successfully achieved.

Small Steps To Big Change

The Collaborative began in 2001 as a conversation between John and Christie Mack, Bill and Penny George, and other philanthropists who wanted to see a shift from fragmented, procedure-oriented disease care, to a more humanized, prevention-oriented approach to healthcare.

Over the last decade—a period characterized by unprecedented turbulence in medicine—the Collaborative engaged hundreds of individual and institutional donors, and invested millions into reshaping how medicine is taught and practiced. Key initiatives include:

• Bravewell Clinical Network: Since 2003, Bravewell has funded research and clinical care at 10 centers. Combined, these centers—most at major universities–provide comprehensive holistic care for thousands. The centers also serve as research loci and incubators for new models of care delivery
• Consortium of Academic Health Centers in Integrative Medicine (CAHCIM): Founded in 2002, the Consortium now represents 56 academic centers in the US and Canada committed to reshaping medical education through greater focus on prevention, nutrition and the core principles of integrative medicine (www.imconsortium.org). The consortium has developed a comprehensive curriculum that can be implemented in training programs nationwide.
• Bravewell Fellowship Program: Since 2005, the Collaborative has funded 88 young physicians to complete the 2-year University of Arizona Fellowship in Integrative Medicine. The program, headed by Drs. Andrew Weil and Victoria Maizes, provides extensive hands-on clinical experience as well as didactic work, and has fostered a new generation of leaders, including Drs. Tracy Gaudet, Jeff Gladd, Shilpa Saxena, Erin Martin, David Rakel, and many others.
• BraveNet: Based at Duke and involving 10 academic centers, BraveNet is a practice-based research network that enables the integrative practitioners to collaborate on clinical research. The network’s first study, published in 2012, involved more than 3,600 patients and documented what types of patients seek services at integrative clinics. A second project, the Study on Integrative Medicine Treatment Approaches for Pain (SIMTAP) was published earlier this year. (http://www.bravewell.org/current_projects/bravenet/) .
• The New Medicine Program on PBS: In 2006, more than 500 PBS TV stations aired a two-hour program funded by Bravewell and exploring the emerging world of integrative medicine. The New Medicine has aired several times in the last 7 years, and has been seen by over 4.2 million people.
• The Institute of Medicine Summit on Integrative Medicine & the Health of the Public: In 2009, Bravewell collaborated with the Institute of Medicine and the National Academy of Science, to sponsor an historic gathering of more than 700 clinicians, academicians, researchers, policy-makers, and business leaders to explore the pubic health impact of integrative medicine. Held at the height of the reform debates, the Summit was the first time the holistic/integrative disciplines stood together to offer meaningful solutions to the nation’s health care crisis (Read our coverage of the IOM Summit on www.holisticprimarycare.net).
• Integrative Medicine in the Military: Over the last 4 years, Bravewell has met with leaders in military medicine to discuss how holistic/integrative therapies could be brought into the care of wounded personnel and veterans. With a particular emphasis on pain management, the meeting resulted in a commitment from the Department of Defense and the Veterans Health Administration (VHA) to implement integrative pain management throughout military systems. Dr. Tracey Gaudet, former director of Duke Integrative Medicine, is leading that effort, as inaugural director of the VHA’s new Office of Patient-Centered Care & Cultural Transformation.
• Bravewell Leadership Awards: Established in 2003, the awards honor physician-leaders that have advanced integrative medicine with gifts of $100,000 intended to support their work. Recipients include: Drs. Ralph Snyderman, Brian Berman, Larry Dossey, James Gordon, Jon Kabat-Zinn, Dean Ornish, Rachel Naomi Remen, Andrew Weil, and Mimi Guarneri. The 2013 winners are Dr. Gaudet and Dr. Myles Spar, director of integrative medicine at the Venice Family Clinic, the largest free clinic in the US, and director of men’s health at Akasha Center for Integrative Medicine in Santa Monica, CA. (Read interviews with this year’s award winners at www.holisticprimarycare.net)

“Bravewell liberated the vision & launched the transformation. Now it is our responsibility to move this forward,” said Dr. Gaudet. “We need to be more focused, more intentional, and more intense in our actions toward true sustainability and transformation.”

A Vision Liberated

Dr. Gaudet, former director of the Duke Center for Integrative Medicine, said that part of her role at the VA is, “to try and do what the private healthcare sector can’t or won’t do.” The VA has over 300,000 employees, including 100,000 clinicians who care for over 6 million veterans. It represents one of the largest healthcare systems in the world.

In an interview with Holistic Primary Care, she said VA top brass is frustrated with the limitations of conventional drug-based approaches, and supportive of therapies like acupuncture, as well as self-care modalities meditation and yoga. To military leaders, finding better approaches to managing pain and trauma, and to improve overall health is not just a nicety, “it is a matter of national security.”

Dr. Gaudet–who’d never had a “government” job before—said training in and implementation of integrative medicine is already being piloted in five VA facilities, with 19 more to come in the next few years. Owing to the nature of the VA—salaried clinicians, single-payer, military-style management–once best practices are clearly defined, they tend to be widely and rapidly deployed across the entire system. “The potential here is huge!” said Dr. Gaudet.

A Lasting Legacy

Ms. Mack said Bravewell’s work will culminate with two “parting gifts”– legacy projects that will extend influence far beyond the lifetimes of the collaborative or its individual members.

The first is the PRIMIER (Patients Receiving Integrative Medicine Interventional Effectiveness Registry) project, a national database of clinical outcomes from comprehensive integrative medicine.

By creating a uniform data registry accommodating patient self-evaluation, clinician assessment, and EMR data, PRIMIER will enable rapid aggregation of outcomes from centers across the nation. The ultimate goal is to enable clinicians to compare the impact of integrative therapies, and to document their public health potential.

The second legacy project is the Leadership Program in Integrative Healthcare at Duke, a post-graduate, mid-career program that combines MBA-level business training with in-depth practical and conceptual study of integrative medicine. Led by Adam Perlman, MD, the objective is to cultivate a core of physician-leaders who are not only clinically skilled but also versed in the logistics of bringing integrative care into complex academic, institutional, and business settings.

The Road Ahead

Andrew Weil, MD, founder of the Arizona programs, and one of the first Bravewell awardees, applauded the group’s accomplishments. At the same time, he voiced frustration at the slow pace of progress.

“Our center has now graduated over 1,000 physicians. Demand for the fellowship is increasing–we increased the class size to 70, and we’re still turning people away. Our fellows are moving into leadership, they’re writing the textbooks. But for the most part, we train fellows and turn them out into world where everything is stacked against them. As a society, we pay for surgery and drugs. We do not pay doctors to sit with people and talk about nutrition and lifestyle.”

Preventive medicine, said Dr. Weil, is not prospering, despite the massive need and the obvious know-how, simply because it does not pay.

“As dysfunctional as American healthcare is, it is generating rivers of money that are flowing to a few pockets. Those vested interests want nothing to change, and their lobbying power is enormous. You cannot get elected to public office without making deals with those vested interests.”

True transformation, says Dr. Weil, will only come about, “when enough people get loud enough and angry enough.”

Ultimately, Dr. Weil believes the fate of integrative medicine will depend on demonstrating it’s economic value. “How do we convince people who pay that it is in their interest to pay for this approach? We can’t just say it’s morally or philosophically or clinically right. We have to show it saves money.”

In the post-Bravewell world, this needs to be a major priority.

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