Likewise, most holistic providers did not have a sufficient understanding of conventional medicine and its resources, including those support systems in the community around various diseases. Given the typical lack of communication among all of these providers, we felt it was important to teach providers about the skills and scope of offerings of each other, and how to communicate about and manage the diversity of options to the patient. This was especially the case since the therapeutic relationship of the provider and patient is the most important influence in creating positive care. Indeed the provider is one of the "means" of treating the patient and creating effective behavioral change, along with any therapy or form of medication. This positive therapeutic relationship while even using a placebo is more powerful than a less gifted physician using an active drug.2 This is true in most non-medical emergency situations. The practitioner can be the primary factor in positive change. While we have made strides since 2009, and acupuncturists have an opportunity to move even further with our role in the opioid crisis, there is still much we need to do to ensure we play a key role in the growth of integrative medicine. While the 2009 paper's list of action items list recommendations, key actors and examples or needs for what will help make changes that involve other players, acupuncturists can still take part in the list. These deliverables include: Aligning incentives so that they support health Developing systems that recognize total costs, including costs of benefit and harm Passage of congressional mandates to required insurers to fairly reimburse providers for longer more therapeutic visits Creating competencies among health care providers to better understand each others fields, patient communication, coaching and referral Competencies for CAM providers on critical health issues, prevention and screening, and health care Establish credentialing and privileges for CAM providers in conventional settings, especially in primary care teams Fund outcomes studies on cost and clinical effectiveness of integrative medicine Create societal incentives to sup-port and educate patients Create insurance incentives to maintain continuous healing relationships with practitioner and health teams Health care providers practicing self-care Whether we work on the global level with our associations to make change, we can also as individual practitioners help move the dial in the right direction.
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