NATO – TCIM for Higher Efficiency in Care

The North Atlantic Alliance and TCIM

The North Atlantic Alliance (NATO) is another significant multinational organization (the Czech Republic is also a member) which reflects the global developments in the field of healthcare when it comes to the increasing use of TCIM methods.

The Science and Technology Organization (STO) was created within the North Atlantic Alliance. It is a NATO subsidiary which has the same legal status as NATO and was created within the framework of the North Atlantic Treaty. The STO was established with the aim utilizing the collective scientific and technological needs of NATO, NATO nations and partner peoples in the best way possible. It operates under the auspices of the North Atlantic Council, which delegates activities to a board of directors. The board is composed of S&T leaders from NATO states and is chaired by a NATO senior scientist, a highly respected head of the NATO S&T Department, who is permanently assigned to the NATO Headquarters in Brussels, and is also NATO’s chief scientific adviser. (111)

In 2010, the Human Factors and Medicine Panel Research Task 195 (HFM-195) was established within STO and was commissioned with the study Integrative Medicine Interventions for Military Personnel. HFM-195 consists of integrative medicine experts from France, Italy, Hungary, Germany, the Netherlands and the United States, as well as guest experts from Great Britain and Korea. (112)

The aim of the group was to obtain and evaluate data from the individual countries on: the use of CAM among military personnel (reasons, frequency, accessibility); the extent to which the management of military organizations accepts CAM; and to assess the current legal status of CAM regarding its use and implementation. The group was established as an initial step. It is to be followed up by the work of other research groups, and conferences and symposia focused on the implementation of selected CAM methods throughout NATO, including a simultaneous analysis of the efficacy, cost-effectiveness, suitability and adoption of these methods. (113)

The output is a comprehensive technical report called Intervention of Integrative Medicine for Military Personnel, published in 2017. The report documents the current state of complementary and alternative medicine in the NATO states, the possibilities for military staff to utilize CAM, and its acceptance among military personnel. (114)

The report is almost 250 pages long. It details the possibilities of using Integrative Medicine as part of NATO’s healthcare for military personnel. It evaluates individual healing methods (e.g., acupuncture, meditation, mind-development programmes, biofeedback, spirituality, etc.), as well as entire healthcare systems (e.g., traditional Chinese medicine, Ayurveda, Tibetan medicine). It further discusses their historical and cultural background, the use of integrative medicine within NATO member states’ medical practice, and the US Department of Defense’s experience of integrative medicine. (115)

The study was conceived due to the following reasons, e.g.:

The popularity of CAM, or integrative medicine, is increasing both among the civilian population and military personnel, which is increasingly taking responsibility for its health. Due to the current dissatisfaction with the current health care system and the side effects of medication, people are increasingly favouring non-conventional treatments. Military personnel are reported to use CAM as often, or even more often, than civilians; “Data show that more than 50% of the military population, including dependents, has used CAM interventions in recent years …”. (116)
The cost of healthcare is growing while military budgets are being reduced. This may jeopardize the sustainability of military healthcare systems, which, therefore, need to adapt and be re-evaluated. (117)
NATO’s educational aspect and international environment must be taken into consideration when training leading military and health professionals in the field of CAM and integrative medicine so that these options are also available internationally. (118)

In addition to conventional medicine, there are other treatment systems – both old and new – that are very popular. “According to the National Health Statistics Report, 2002, up to 62% of patients in the USA used CAM treatments in the preceding 12 months”. (119) The report shows it would be beneficial to consider the possibility of integrating these treatments into the healthcare system. The holistic approach based on integrative health and treatment is attracting more and more attention. New paradigms need to be explored and the possibilities for conventional medicine and alternative medicine to collaborate must be assessed. (120)

This view is based on a number of facts. One of them is the dissatisfaction patients feel with due to the impersonal, automated approach of diagnosis and medication. The report states that “… death due to iatrogenic causes is the third leading cause of death in the United States with nearly 50% of the drug errors and adverse reactions preventable …” (119)

Cost effectiveness is often commonly mentioned and is increasingly affecting health care systems. “Healthcare costs are over 17% of the GNP in the United States and expected to rise to nearly 20% by 2024 (119) and “The annual cost of U.S. Military Healthcare has more than doubled from $17 to $35 billion dollars over the period of 2001 through 2007. By 2015, it was expected to nearly double again. This will represent 12% of the U.S. defense budget.” (121)

One of the main reasons for rejecting CAM systems is the claim that conventional medicine is "evidence-based" while CAM is not. “… when the PubMed key word is “research”, there are only 3% of the nearly 450,000 citations listed as RCTs. Not such a good story either.”(122)

There is also evidence that brings the following practice to light: “Nearly 75% of pediatric medications are prescribed off-label. This leads you to wonder if our children are not guinea pigs for prescriptions. The Archives of Internal Medicine reported that overall 73% of off-label use has little or no scientific support.”(122)

Based on these facts, the report considers whether, for example, the practice of "off-label prescription" is not already part of alternative approaches: “Perhaps what is being witnessed is a double standard of the expectation that CAM modalities must be evidenced-based, when in reality most conventional treatments are not.” (122)

The report also points to the need to differentiate invasiveness of the methods and the possible consequences the patient may experience due to the treatment. Treatments can be more or less invasive and this fact should also be considered in research efforts. “A simple meditative breathing technique shouldn’t require the same level of evidence as that needed for cardiac shent placement. The breathing technique results in little to no harm to patients. Therefore practitioners can use it at the same time research is conducted.” (123)

The worldwide trend towards the introduction of CAM into healthcare systems is also reflected by the fact that, in the US, there are many initiatives on the federal level concerning CAM research and the introduction of CAM into healthcare systems. For instance: (124)

In 1993, the Office of Alternative Medicine (OAM) was established within the National Institutes of Health (NIH), USA. This office, later renamed the National Center for Complementary and Integrative Health (NCCIH), has increased its annual research budget from approximately $1 million (in 1993) to more than $123 million in 2014. This led to a 25% increase in the number of citations in PubMed annually;
In 1999, the first Consortium of Health Centers for Integrative Medicine was established. Today there are 60 institutes working on the curriculum for medical education, standards for integrative medicine research, and the integration of alternative methods into clinical care;
The key initiative of the US Army Telemedicine & Advanced Technology Research Center (TATRC) works on developing integrative medicine services with a focus on optimizing the treatment environment, as well as treating of progressive pain and resistance;
The National Intrepid Center for Excellence (NICoE) in Bethesda, in cooperation with the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, opened a holistic integrative centre for treating soldiers;
In 2014, several high-ranking federal health authorities included integrative health and treatment methods into their systems;
The US Department of Veterans Affairs is working on implementing the White House Commission's recommendations for a complementary and alternative medicine policy;
In 2014, the United States Department of Defense published a report to congress on Integrative Medicine in the Military Health System, which states that 120 (29%) of 421 military healthcare facilities offer 275 CAM programmes. The overall recommendation of the report was that the military health system should assess and consider extensively implementing cost-effective CAM programmes that meet the guidelines on safety and efficacy.

CAM's popularity in the US Department of Defense facilities is also demonstrated by a survey (2005–2009), which showed a significant increase in the integrative medicine services they provided. For example, during this period, the availability of spiritual treatment increased by 500% and the number of integrative medicine providers by 400%. According to a survey by the US Department of Veterans Affairs, 88% of facilities under the Veterans Health Administration provide integrated medicine services either on site or on recommendation. (125)

The research team also evaluates the potential of the selected treatments, and considers energy practices to be a self-care techniques. Energy practices are an emerging field of science based on the energy of living organisms (known as life energy, vital energy, prana, life force, etc.). This type of treatment can only be performed by individuals who have undergone proper training. (126)

This technical report offered a new perspective on healthcare and recommends taking further steps towards effectively integrating integrative medicine methods into NATO’s military health systems. The report suggests conducting reviews and assessing integrative healthcare and treatment focusing on implementing certain practices; educating patients, providers and policymakers; analyzing clinical outcomes and identifying the best practices; setting up joint cost-efficiency research initiatives, and taking into account new paradigms and models of care. (127)