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 ...

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

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

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: 

"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."

Ann Fonfa, President
The Annie Appleseed Project

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

"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

Send your comments to
for inclusion in a future Your Comments forum.