How Powerful Consumers Known as Bravewell Implanted Integrative Medicine in the System

By John Weeks

That alternative medicine is a consumer-driven movement is well known. The decisions to choose massage, acupuncture, chiropractic, and the services of holistic medical doctors and others did not originate with hospitals, insurers, employers, or any other stakeholder in regular medicine.

Rather—as anyone who has been around these fields will know—individuals desiring alternatives to drugs and surgeries created societal interest. The movement was forged by a million points of purchase.

It was only after Harvard’s David Eisenberg, MD, drew attention to the widespread use of “unconventional medicine” by intelligent beings (otherwise known as consumers) in the January 28, 1993 issue of New England Journal of Medicine that the mainstream began to change.

The medical industry saw that roughly a third of patients were using some sort of “alternatives” to what they did. Billions were being spent. These data woke up mainstream medical doctors and the chief financial officers of their academic centers and hospitals.

Within a few years, the term “integrative medicine” was coined to denote the intersection of “alternative medicine” with the mainstream. Integrative medicine clinics started appearing in hospitals and health systems like New York’s Beth Israel, the University of Maryland, Duke University, UCSF Medical Center, and the Allina Health System in Minnesota. Medical schools began courses.

A collaborative led by women in philanthropy

Less known or appreciated is how a focused group of consumers shaped the institutional uptake of alternatives to regular medicine. In the late 1990s a group of users of alternative services, mainly women, aged 50 – 65, formed the Philanthropic Collaborative for Integrative Medicine. They renamed it the Bravewell Collaborative in 2001. Their handprints are all over integrative medicine’s transformative work.

On November 8, 2013, this organization of consumers-as-philanthropists celebrated its fifth and final black tie gala in New York City. The collaborative has chosen to “sunset” its organization, believing that it has seeded what it intended and that a healthy and healing approach has been implanted in mainstream medicine.

Bravewell’s core is a women’s group comprised of spouses of very financially successful men. The organization’s dynamic duo of leaders gives you an idea. The initial president was Penny George—wife of former Medtronic chair Bill George—the key backer of the nation’s most significant inpatient/outpatient integrative medicine center at Allina. The second was, and is, Christy Mack—wife of former Morgan Stanley chair John Mack—who invested $10 million in Duke’s program. A half-dozen other women round out the basic team.

You begin to get the picture. These are women of means. More importantly, they brought to Bravewell’s work a hard-headed, strategic programming that has led to remarkable success.

Hard-headed, strategic program choices

At the recent New York gathering, Mack recalled her highest sense of achievement. Bravewell convened a dozen academic leaders interested in integrative medicine. Then, via startup grants and a five-year sustaining donation, they seeded what is now the 54-medical-school-strong Consortium of Academic Health Centers for Integrative Medicine. The Consortium, as it is known, is the engine of growth for the field.

Anyone who knows how intensely competitive the publish-or-perish battlefield of academic medicine can be will know what a remarkable achievement this is. Certainly Bravewell was also assisted by the collaborative ethic that characterizes many integrative medicine leaders.

Though the engine for change was in place, it was isolated from the people. The public knew about “alternative medicine,” but the “integrative” discussion was still a relatively rarified dialogue. To address this, these well-to-do consumers made a handsome donation to PBS to sponsor a widely-viewed documentary entitled The New Medicine. They subsequently added tactical investments to keep the show in front of the public. I, for example, attended a viewing at Seattle Town Hall. One of many such events around the country, it was organized by integrative health consumer and Microsoft millionaire Linda Stone, then a Bravewell member.

Imbuing the movement with intellectual authority

But how was the field to be quickly endowed with intellectual authority? Bravewell found one solution by donating $445,000 to the Institute of Medicine of the National Academy of Sciences (IOM) to host what became the 2009 Summit on Integrative Medicine and the Health of the Public. (The IOM is looked to as the nation’s guiding light in healthcare.)

The summit melded a rich mix of conventional icons like Donald Berwick, MD, with integrative medicine leaders like Kenneth Pelletier, PhD, and Yale’s David Katz, MD, MPH. “Integrative medicine” became part of the highest level of conceptual discussion about the future of medicine in the US. IOM president Harvey Fineberg, MD, and executive director Judith Salerno, MD, MS, each performed significant roles in the recent Bravewell swansong in New York.

Talk is one thing, but evidence is necessary for the advance of integrative medicine. Bravewell leadership used multiple means to skin this cat. First they sponsored the Bravenet research network to capture outcomes of hospital-based and academic-based integrative medicine centers.

Then, impatient with the slow timeframe for research results, they made a savvy decision to sponsor a survey of leaders of 28 integrative centers. The leaders’ perceptions of value and models for delivery were published as Best Practices in Integrative Medicine: A Report from the Bravewell Clinical Network. These views were widely picked up and reported in the media as though they were frank evidence of proven value. Brilliant!

Presently, one of Bravewell’s two “legacy projects” in their 2015 plan to sunset operations is a data registry dubbed PRIMIER: Patients Receiving Integrative Medicine Interventions Effectiveness Registry. They have provided a tail of donations to keep evidence coming.

Yet all of this is worth little if there are not medical doctors educated to a standard to lead creation of programs in mainstream systems.

Tools and training for agent provocateurs in the new era

Again this mainly female collaborative attacked the strategic problem in multiple ways. They developed the Bravewell Fellowship Program through which they provided scholarships to the Fellowship in Integrative Medicine at the University of Arizona Center for Integrative Medicine. Bravewell’s blessing helped the Arizona program become the de facto standard.

The investment has paid off handsomely. This educational core and the Arizona leadership have been a driving force in creating a new board certification in integrative medicine. In effect, Bravewell’s investment is helping define the new MD specialty.

The organization’s final legacy project is also meant to solidify the future of integrative medicine. The Leadership Program in Integrative Healthcare at Duke, now in development, aims to provide tools to help emerging leaders transform health systems to an integrative model.

There is much more to Bravewell’s legacy, which you can read about at bravewell.org.

Clearly the medical system has not yet been transformed by these powerful consumers. Yet if one turns around and looks at how many key thresholds for change have been met since Bravewell was founded, the organization’s impact cannot be overstated.

These visionary consumers-as-philanthropists imagined and fulfilled on a multifaceted, whole system strategy to implant integrative medical doctors inside the medical industry. Now we will see what these agent provocateurs can do without Bravewell’s strategic partnership.

 

John Weeks is the editor of “The Integrator Blog News and Reports” (theintegratorblog.com), a leadership-oriented news, networking, and organizing journal for the integrative medicine community, and a columnist for Integrative Medicine: A Clinician’s Journal.