CAM-IM Responses to AMA Scope Campaign; Coalition Plans Next Steps

Summary: The AMA's Scope of Practice Partnership (Resolution 814) and the ANA-led opposition, the Coalition for Patient Rights (CPR), are proving to be among the most galvanizing of political events that the worlds of complementary, alternative and integrative medicine (CAM-IM) have seen in recent years. This article updates actions of the CAM-IM fields: a national integrated healthcare policy group, a CAM educator consortium, and moves of national associations representing acupuncture and naturopathic medicine. Meantime, the Coalition is planning an August 15 meeting which will include developing its strategy around broadening the Coalition membership.

Breaking News (August 15) - Complementary, alternative and integrative medicine organizations (CAM-IM)  were invited to participate in the Coalition for Patient Rights meeting to be held today. More news as it breaks.

The Scope of Practice Partnership (SOPP) of the American Medical Association is raising ghosts of the great medical battles of the past century. Acupuncture leader Will Morris, DAOM, MSEd, LAc, asserts that the campaign carries the energy of the Flexner Report, issued at the turn of the 20th century as a tool which suppressed alternatives to approaches not grounded in Western reductive science. Others call the campaign a gentrified version of the AMA's anti-chiropractic and anti-quackery campaigns from the 1960s. (See initial article on SOPP.)

While the AMA campaign has evoked these ghosts, a great hope is also arising for a more powerful coalition for health, represented by the Coalition for Patient Rights (CPR) led by the American Nurses Association. Here are some actions of CAM-IM groups, followed by a look at the current direction of the Coalition. (See earlier article on CSR.)

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CAM Educator Consortium Notes Educational Issues, Moves to Join CPR

The Academic Consortium of Complementary and Alternative Health Care (ACCAHC) has affirmed basic agreement with the Joint Statement of the founding Coalition for Patient Rights. ACCAHC's core membership consists of representatives of national councils of colleges and accrediting agencies for the licensed CAM disciplines. ACCAHC is seeking to join CPR's rolls.

Why is an educational organization active in a campaign related to scope of practice? Pamela Snider, ND, ACCAHC's executive director states: "The AMA Resolution declared an intent to look at educational standards in terms of competencies and qualifications of practitioners. This is directly the purview of academic agencies. Our members felt it their obligation to be involved."

Snider adds that CPR's position paper opposing SOPP "brilliantly and compellingly stated how, rather than attacking each other, we should be working together." She adds her perception that "our community of healthcare practitioners is looking at how to renew and improve our practices across the board. That's the real issue we need to be dealing with. That's what the Coaliton's statement articulates."

ACCAHC has contacted the CPR leadership to register their support. Snider notes that they were told that the Coalition will be sending a letter to all organizations which have taken the initiative to share their solidarity. Snider adds: "My impression was they were not prepared for how much interest they would receive."

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CAM-IM Policy Organization IHPC Endorses Coalition Effort

The Integrated Healthcare Policy Consortium (IHPC), formed in 2002, is a national organization which represents both conventional and CAM organizations which are working to advance integrated health care. The IHPC Steering Committee has voted to "approve and endorse" the CPR, according to Janet Kahn, PhD, IHPC's executive director.

Kahn explained: "The AMA has been at the center of a healthcare system that doesn't work, and part of what doesn't work is territoriality." Kahn reflects:

" There is a real difference between standards and exclusion or domination.  IHPC is very concerned about safety, and therefore about standards. We would welcome a broadly representative body examining that issue from the ground up, but that does not seem to be what this AMA/SOPP move is about.  

"A fatal weakness in American healthcare right now is the extent to which conventional biomedicine is equated with health care, rather than being seen as one approach within it.  Territoriality has been an AMA push from early in its history.  What we need to focus on now, is how to offer patient-centered care that pays at least as much attention to illness prevention and health promotion as it does to the heroic measures that are conventional medicine's real strength. 

"By some measures we have a health care provider shortage in this country.  And by every measure, we are not getting our money's worth for what we spend per capita on health care.  That is where our attention should be, and I hope that the coaltion that is growing in response to this misguided move on the part of the AMA will be able to turn our attention there shortly."?

 

IHPC has been in touch with CPR to announce its support. Because IHPC is not a single-practitioner organization, the organization is not sure if it can be a member. Kahn says IHPC is "in converation with (the Coalition) about that."

American Association of Naturopathic Physicians Issues Statement

I contacted Jane Guiltinan, ND, president of the American Association of Naturopathic Physicians, to see whether her organization had a formal position on the AMA'S SOPP campaign. The AMA has opposed ND licensing laws in various states, including pending actions in New York and Illinois. Guiltinan sent this statement from the AANP:

"The AANP fully supports the AMA's stated goal of providing the highest quality of care for patients. Indeed, that is why the AANP is committed to passing licensing laws for naturopathic physicians in all 50 states. Passage of naturopathic licensing laws that clearly define scope of practice ensure patients have access to trained professionals who are held accountable by regulation with oversight from state agencies.

"The AMA's opposition to licensing NDs actually places patients at greater risk for misdiagnosis and treatment from those who call themselves naturopathic doctors but who, one, have not attended institutions accredited by agencies recognized by the US Department of Education, or two, received the clinical training required to diagnose and treat.

"To assert that no other health professionals in this country, be they nurses, chiropractors or naturopathic physicians, is trained to provide medical care exemplifies the very heart of what ails this Nation. Today's healthcare system as defined by the AMA and its specialty societies is rooted in the management of disease and the enormous resources required to finance that care. Their need to contain health care to the current reimbursement model is in direct contrast to the collective interests of practitioners who want to improve health and reduce dependence on this system by empowering patients.

  -- American Association of Naturopathic Physicians, July 2006  

The AANP announced to its membership in their July e-newsletter that the organization has joined CPR.

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Acupuncture and Oriental Medicine Organizations: Ready for Examination

The July issue and August issue of Acupuncture Today each offer thorough stories on the AMA's SOPP-related initiatives. The first article included  statements solicited from the American Association of Oriental Medicine (AAOM) and the Acupuncture and Oriental Medicine Alliance on the issues. Leaders of both organizations point out how readily information about educational standards is available, if the AMA would simply ask.

Michael McCoy, executive director of the Alliance opines: "This sudden interest and concern on the part of the AMA is actually a positive sign for AOM. When they are ready to spend significant money on issues related to our 'scope of practice,' it suggests that they are concerned about the public turning in droves to this medicine ... People want something better than what is offered by the mainstream medical establishment. We are here to stay."

The AAOM levels a challenge which is more generally articulated in the CPR'sJoint Statement. The CPR document states that any study which looks at education and scope "should include an evaluation of whether (MD) scope is overbroad." Here is the AAOM language:

"The AAOM calls for an unbiased group with no conflicts of interest or economic incentives related to the outcomes of the study to evaluate the following: qualifications, education, academic requirements, licensure, certification, independent governance, ethical standards, disciplinary processes and peer review of qualified professional providers of acupuncture and Oriental medicine."

Will Morris, DAOM, MSEd, LAc, president of the AAOM shared that his organization's approach was first to send out an information sheet to members with a call for input on what the association should do. Of 150 quick respondents, 147 were strongly in favor of opposing the SOPP. "I have an affirmative vote from my board to join the Coalition," notes Morris. He said that the AAOM is working with other AOM groups to organize a nationwide grassroots effort again the AMA's campaign.

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Next Steps for the Coalition for Patient Rights

I reached the ANA's Carol Bickford, PhD, RN, on August 2, shortly before posting this article. She was in the process of drafting the letter to interested organizations which Snider referenced. She shared that Pam Hagan, RN, the chief program officer for the ANA will be the key point person for the ANA on CPR issues.

Bickford shared that the Coalition has decided to hold a second meeting, August 15. Among other topics will be decisions about taking new members. She was not specific about the number of queries which have come in about joining the Coalition.

I asked whether there are members of the Coalition who are resisting sharing letterhead with some of the CAM fields who are knocking at the Coalition's door. She responded indirectly: "The ANA specifically looks at actions and solutions. Who is taking care of patients? Who is behind the scenes helping someone to access services? How do we help the person who is the primary focus of our care." I chose not to press further.

Then Bickford added, thoughtfully: "The agenda is in negotiation. We're sort of in the input moment, letting the tincture of time synthesize how we do it. I'm looking forward to our next meeting. We accomplished a lot with the first."

Comment:  Credit the AMA for so boldly illuminating the wrong road to reform so that a better road might light up. But will all these potential collaborators find their way into the coalition?

The August 15 Coalition meeting will be telling. There are certainly a number of members of the Coalition who, with an affirmative decision to open themselves to these disciplines, would be dancing with the likes of naturopathic physicians and acupuncture and Oriental medicine practitioners for the first time.

The questions before the Coalition do certainly have something of "action and solution" in them, to appropriuate the phrase used by the ANA's Bickford. Among the questions:

• Would opening their doors to CAM-IM groups strengthen what they want to accomplish?
• Will CAM-IM partners be perceived as a liability?
• What would the CAM-IM partners contribute?

Shutting the door might be considered the creation of a sort of  "scope of practice partnership" of its own. Such action, if it should happen, would at best be understood as an expression of ignorance among current Coalition members. Perhaps education needs to be done on the hard battles won by these CAM-IM groups already. Each has a history of setting standards, creating accrediting agencies, gaining federal recognition, and fighting for licensing. These have worked to do what is necessary to have a legal scope of practice that allows them to meaningfully participate in the healthcare system.

Understood at worst, to exclude would express the very sort of "territoriality" - to use the term the IHPC's Kahn used - which the Coalition was formed to fight.

But if the patient is first, and a spirit of patient-centered collaboration informs the Coalition's decision process on August 15, we may yet have a chance to see whether the straw of shared antagonism to the AMA's SOPP will convert into the gold of some robust, shared proactivity.

Disclosure note: I serve in the leadership of both IHPC and ACCAHC. While I helped inform these groups of AMA and Coalition activities, through forwarding resources gathered for the Integrator, leadership on these issues inside these organizations is managed by others.