By Ben Kligler, MD - 2018
For the past two years, in addition to my work at The Deirdre Imus Environmental Health Center®, I have had the privilege to work as the National Director for Integrative Health at the Veterans Health Administration. The VA is the largest national health system in our country, with over 330,000 staff at more than 150 hospitals serving 9 million veterans. The challenges some of our veterans face—chronic pain, PTSD, depression—are huge, and the strength and courage one sees from VA patients and staff is inspiring. It’s hard to imagine a population more deserving of the highest possible quality of care we can deliver. And despite all the bad press we sometimes see about the VA system, it really is delivering that quality care.
Over the past few years, the VA has made a strong commitment to making complementary and integrative health (CIH) services like acupuncture, meditation and yoga available to our veterans. Because so many of the problems they face, especially chronic pain and mental health issues, are not adequately treated by conventional medicines, there has been a huge demand from both veterans and VA staff—and even from Congress—for more and more of these therapies. And the problem we have seen over the past few years with overuse of opioids, resulting in huge increases of overdose and suicide deaths across the country, has made the need for access to natural alternatives even more urgent. Amazingly, in May of last year, VA instituted a national policy making the evidence-based CIH approaches—those that have enough published research to show promise of real benefit—part of the standard medical benefits coverage for veterans. Although it will take us a while to get there, this means that every veteran at every VA across the country will eventually have access to CIH for managing their pain and other health concerns. The therapies approved for this new benefit so far are acupuncture, yoga, tai chi, meditation, massage therapy, guided imagery, clinical hypnosis, and biofeedback. Chiropractic, which also has very good evidence of effectiveness in the treatment of pain, has already been available in the VA since 2005.
One major part of our strategy in the VA is to strongly encourage Veterans to take advantage of the CIH approaches which offer new skills to manage one’s own health—like yoga, meditation and tai chi. Our feeling is that an approach to treatment which combines more passive therapies like acupuncture or massage with active experiences that teach lifelong self-care skills—whether for pain, PTSD, depression, or insomnia—will be the most effective for our patients in the long term. Also important is that as part of this new integrative approach to care in the VA, we are carrying out a large scale outcome evaluation with our colleagues from the VA Office of Research and Development to measure the impact of the CIH therapies on health and wellbeing. Our hope is that the lessons learned from this expanded access to CIH and from our evaluation process can help bring effective strategies for expanding our toolbox and broadening our view of health and illness to the rest of the American healthcare system.
Dr. Kligler is the Medical Advisor for The Deirdre Imus Environmental Health Center®. He is also the National Director of the Integrative Health Coordinating Center for the Veterans Health Administration and Research Director for the Center Institute for Research and Education in Integrative Medicine. He is Co-Director of the Beth Israel Fellowship Program in Integrative Medicine, and teaches in the Beth Israel Residency Program in Urban Family Practice. Dr. Kligler is the author of Curriculum in Complementary Therapies: A Guide for the Medical Educator, and co-editor of Integrative Medicine: Principles for Practice, a textbook published by McGraw-Hill. He is also Co-Editor-in-Chief of the peer-reviewed journal Explore: The Journal of Science and Healing.