Your Comments: On integrating ABHM faculty, CAM ghettos, arguments that CAM is poised for growth
Written by John Weeks
Your Comments: On integrating the ABHM faculty, CAM ghettos and an argument that CAM is poised for rapid growth
Summary: Bill Manahan, MD, a former
president of the American Board of Holistic Medicine (ABHM) believes it's time
for the ABHM to integrate its faculty ... Bill Wulsin, ND, LAc, MPH
(cand.) questions whether the arguments made in an Integrator article
by author Paul Loeb (The Impossible Will Take a Little While) will
convince anyone of the value of an alliance of CAM disciplines which
they see as a "CAM ghetto" ... Integrative oncology organizer Ann Fonfa wonders at the ghetto created when separate officers were set up in the NIH ... Entrepreneur Taylor Walsh, makes a case for the complementary/integrative space being poised for lift off ...
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1. American Board of Holistic Medicine co-founder: Now is the time to begin integrating faculty
Bill Manahan, MD
The Integrator recently commented on the non-integrated faculty of a conference which prepares MDs/DOs to be certified in "integrative holistic medicine." This stimulated an explanation from Lee Lipsenthal, MD, a current member of the board of the American Board of Holistic Medicine (ABHM) the certifying group. This provoked a note from Bill Manahan, MD, an Integrator adviser who is a past-president of ABHM and a past faculty member at the ABHM meetings.
"I agree with John
Weeks' statement in his comments that
for true practitioner integration to begin, it would be a good idea to
have other than MD/DO presenters at the American Board of Holistic Medicine
Review Course in San Diego. The course is now titled The 9th Annual Science & Clinical
Application of Integrative Holistic Medicine.
"For this
year's October 28 to November 1 course, there are 19 presenters with 18 of
them being MD's or DO's. Having been an original course planner and until
recently a ABHM faculty, I know that these 18 presenters are fabulous
clinicians and presenters. At the same time, I suspect that
if some of those presenters represented other disciplines, it would
be an improved and remarkable demonstration of a truly 'integrative'
and 'holistic' conference.
"I realize that one
purpose of the course is to act as a review course for MD's and DO's
planning to take the ABHM Board Certification Exam. Therefore, our
original thinking was that it made sense for MD's and DO's to be the teachers of
the course material. What I am now suggesting is that maybe it is
now time for the ABHM to reevaluate that idea and to gradually introduce
other CAM speakers into the program. The positive
results of these types of partnerships can hopefully be well worth
any risk that is involved by doing so."
Bill Manahan, MD Past-President American Board of Holistic Medicine
2. Naturopathic doctor/acupuncturist reflects on the "CAM ghetto"
Willioam Wulsin, ND, LAc, MPH (cand.)
Some leaders of chiropractic and
naturopathic professions deride formal association with other
complementary and alternative medicine professions as little more than
willfully entering a "CAM ghetto." I interviewed social action expert
and speaker Paul Loeb (The Impossible Will Take a Little While, Soul of a Citizen) on the subject for an Integrator article. Loeb described the value in alliance, which provoked this response from William Wulsin, LAc, ND, MPH (cand.)
"Regarding
the 'CAM ghetto,' the term ghetto often
invokes an image of Warsaw, Harlem or Soweto, yet it is conventionally defined
as: "ghetto is an area where people from
a specific racial or ethnic background (or economic - mine) live as a
group in seclusion, voluntarily or involuntarily." (Wikipedia)
"I
found Paul's observations cogent yet likely not very compelling for the ND 'leader(s)' who 'blasted' you. I wonder if she/he was
not reflecting the limitations of scarce resources in time, funding and
strategic objectives, in other words, divergent priorities. I find that people
usually only want to get together when it involves some aspect of their self
interest, whether
"Coalitions only seem
to last as long as the
participants are
receiving a tangible
value for their efforts."
-- William Wulsin, ND, LAc
that be altruistic, power focused, profit motivated or simply
to play. Coalitions only seem to last as long as the participants are
receiving a tangible value for their efforts. Perhaps this is why the
American people have yet to sustain a voice that effectively influences their
leadership and governments actions whether it be regarding healthcare
policy or Iraq. As individuals we do not identify investing time in
those (e.g.)the war/our health) issues as vital until we experience that our
own blood is being spilled. Iraq is far away and most in America die
alone.
"Our
cultural 'system' effectively reinforces isolation through the
distractions of work, relationships, entertainment, sports, substance use,
imprisonment/slavery and technology. A consequence is that we don't
notice the hemorrhaging, or at least enough to combine resources and do
something about it. The blood loss often results in anemia (individual
and collective) which manifests fatigue, malabsorption and malaise before more
chronic debilitating conditions set in.
"As
you know better than I, building a community through a blog is a full-time
piece of living work. It is also a risk as to whether that investment
will pay off, with costs that must be paid. At the end of the day we
participate when it looks or feel like a good bet, whether we are conscious of
it or not.
Bill Wulsin, ND, LAc, MPH (cand.) Seattle, Washington
3. Integrative cancer organizer on CAM ghettos and integration challenges
Ann Fonfa, integrative oncology organizer
For many, the very grouping
of disciplines as "CAM" stinks of the worst of ghetto-ization. The Integrator article which looked at issues around a "CAM ghetto" stimulated
this response from integrative oncology advocate Ann Fonfa, president of the Annie Appleseed Project. The project is holding a meeting in West Palm Beach, Florida on January 10-11, entitled: Evidence-based
Complementary/Alternative Therapies (CAM) for Cancer Advocates. The program targets patient advocates and Fonfa says it is looking for some scholarship support for attendees who serve underserved communities. http://annieappleseedproject.org/evcamforadc.html
"Many years ago I chose
to start attending medical, scientific and research meetings among mainstream
oncology professionals.
"When I raised issues
that were recognizably CAM, I was often told: 'We have that office'
(now NCCAM), or 'NCI has the office' (NCI-OCCAM), meaning that the
issues I raised needed to be addressed within those offices.
"With all due respect,
the idea of integrative oncology is that the CAM modalities and
methods will eventually become part of the oncology community's
practices. Isn't that the point of integrative medicine?
"So when a 'ghetto'
was
created, one
unintended consequence
was to make the very
idea of integrative
oncology take a back seat."
- Ann Fonfa
"So when a 'ghetto' was
created, one unintended consequence was to make the very idea of integrative
oncology take a back seat.
"Now there is an
organization called the Society for Integrative Oncology which is actually
combining some modalities with conventional oncology - a long and difficult
task it seems to me. But I actually do see some gains. The two main
problems for me as a patient advocate is 1) patients still have to face their
uninformed oncology team and ask questions about matters the docs and staff
know NOTHING about and 2) docs and staff are awaiting Level 1 studies which may
never get done - patients are not waiting, it would be a very long wait
indeed.
"Why don't we know if
chemotherapy or radiotherapy can be made more bearable by combining
antioxidants or other nutrients? This remains the number one question
that people with cancer ask - and I have been trying to get studies done since
1995."
4. Does complementary healthcare have features which suggest an economic breakthrough?
Entrepreneur Taylor Walsh
Former dot.com entrepreneur Taylor Walsh, not undertaking a complementary healthcare-related start-up, wrote the Integrator with this heading: Subject: Lisa Rohleder's assessment. He was intrigued the recent Integrator column written by Rohleder, a licensed acupuncturist whose Community Acupuncture Network is stirring up a debate about making a living in complementary healthcare fields.
"Lisa's article was another outstanding glimpse of the world
of CAM and another reminder of the pre-Internet days of online services.
Is it true that, as Dr. Gmeiner noted, 'CAM does not have a
patient empowerment focus'...? If so, can someone stick a probe into
CAM's 'let's get going' synapse? Out here, the pent up demand
for non-traditional health solutions is a rising tide. It would be regrettable,
although understandable, to see a next generation of entrepreneurs arrive with the
financial wherewithall to move CAM to its potential, and not bring the first
generation of CAM practitioners along with it.
"In my own experience, the last time I saw this, several billions
of investor dollars went into dot.com companies, only to find that there was no
market there (i.e. no customers) to justify such absurd funding levels. The investors and sleep-deprived 26-year old CEOs who drove into that
canyon were not inclined to bring with them practitioners of the online trade
who'd spent a decade or so creating and selling digital information
services.
"The same disconnect
doesn't exist for CAM.
Multiple
millions of
consumers are out
there, and very open
to any patient
empowerment
focus
one cares to establish."
- Taylor Walsh
We knew how many customers were out there, a number far lower
than described in the doomed business plans of the time. But we were seen
as part of the 'old' online world. They were part of the 'new' web world. Insane, but it happened that way.
"The same disconnect doesn't exist for CAM. Multiple
millions of consumers are out there, and very open to any patient empowerment
focus one cares to establish. This is not to diminish the need to earn a
living, by any means. But I don't think the financial adjustments will be
made because the traditional medical and financial structures finally welcome
CAM into the fold. It will happen because consumers demand that it
happen. And that surely can't happen if Lisa is accurate that, 'We don’t, honestly, have very much interest in patients.'"
Taylor Walsh, CEO Life Pages
I shared Walsh's thoughts with Rohleder who asked Walsh for some clarity.Here is Walsh's response, which he ended with
"let me know if I can translate the translation."
"Sorry,
I guess that was a little abstruse. I continue to see parallels
between where CAM is today and where the Internet was in the early 1990's, in
terms of a position prior to rapid growth and adoption. The comparison is
inexact obviously because of the financial constraints in healthcare, but the
following elements I find striking.
The pre-Web online service consumer base was about 12 million people who paid 'out of pocket' (i.e., by the minute) for email and online news/info
services. CAM surely has millions of patrons paying out of pocket.
Both these populations wanted more and better services.
Federal funding helped underwrite the earliest expansion of both. We
can't equate the money DoD and NSF put into the Arpanet and first national
research networks to what NIH has put into CAM, but it has been critical in
both instances and more importantly reflects public investment in an activity
that is perceived to be beneficial to the public.
A national intellectual/information infrastructure arose in both cases:
For the Internet, this was the consortium of academic computing centers and
labs that housed networked regional Internet resources, plus the campus
technologists and later librarians and end-users who created precursor ISPs,
search engines, and social networks and formulated access and use policy
issues. In CAM it is your CAHCIM and others like Hopkins, plus the
hospitals' first forays into CAM. I'd also add the private funders and
commercial clinics like John Pan's here in DC.
Seemingly impervious and entrenched industries have been changed forever by the
Web: publishing and telecommunications among the two prime examples, but
investing and software development can't be far behind. Maybe CAM
will play that kind of role in health. I think it probably already
has, but as I mentioned to John, it is looking for its version of Netscape.
"We
can't equate the Internet, as an almighty worldwide information infrastructure,
to CAM, which is a part of the far larger health and medical enterprise. But these conditions suggest to me that CAM is poised to move to another
level. If that is true, we'll see more outsider(like
me!) appear on the scene to figure out the business models and relationship
building that I know has been at the center of John's work for many moons. And that will take place partly in the context of the rapid
assembly of web-centric healthcare operations like Revolution and others
getting ready to help get our electronic health records into online vaults and
lord knows what else. Esther Dyson is putting her health records and her
DNA on the web, for heaven's sake."
Regards, Taylor
Comment: I have counseled Walsh, who is new to this field, that this kind of logical construction of case thinking led to scores of poor business plans a decade ago. Am I missing something? What do you think?
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