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Your Comments Forum: CAM in in CAHCIM, ND/"medical doctor", Pimp My Ride, CAM Ghetto, plus PDF Print E-mail
Written by John Weeks   

Your Comments Forum: CAM Practitioners in CAHCIM, ND as "medical doctor", Pimp My Health, CAM Ghetto, plus

Summary:  University of Colorado integrative medicine leader Lisa Corbin, MD on DC and LAc participation in the conventional academic consortium ... Nancy Aagenes, ND, on health care's version of "pimp my ride" and the possible value to humanity of sterilizing outspoken natural healers  ... Three MDs, two anonymously, look askance at the recent American College of Physicians' low back pain guideline ... An ND, an MD and a DC weigh in on whether the education of naturopathic doctors should be considered "medical schools" (and the practitioners "naturopathic medical doctors") ... A clarifying note on the earliest integrative activity at Yale ... and a question about whether iridologists are welcome in the "CAM ghetto"
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1.    Conventional academic consortium also welcomes LAc and DC from University of Colorado

University of Colorado integrative medicine, integrated clinic team, acupuncturist and chiropractor CAHCIM
Integrated U Colorado team: (left-right) Bennett Leslie, PsyD, Lisa Corbin, MD, Brian Enebo, DC, PhD, Mel Drisko, LAc
In the article on the inter-disciplinary work led by Anne Nedrow, MD, at Oregon Health & Science University, I noted that she selected naturopathic physician Lynne Shinto, ND, MPH to be OHSU's representative to the clinical working group of the Consortium of Academic Health Centers for Integrative Medicine. Shinto was one of two naturopathic doctors who I knew who had participated. Integrative medicine director at the University of Colorado, Lisa Corbin, MD, FACP, notes that it is not only NDs among the non-MD disciplines who have been welcome.
"Hi John – this was a great article!  I would love to be able to do something like what Anne has done w/r/t partnering w/ local MT schools, etc in the future. 

"Just one comment – we are also part of the Consortium, and since I’m the only MD in our center we had to be able to have non-MDs represent us on the various working groups and at steering committee meetings that I couldn’t attend.  Our chiropractor [Brian Enebo, DC, PhD] sits on the Research Working Group, one of our psychologists [Bennett Leslie, PsyD] represents us on our Clinical Working Group, and both of these folks as well as one of our TCM acupuncturists [Mel Drisko, LAc] have represented us at Consortium steering committee meetings. They were accepted no problem!"

"Thanks for the great work you do with the blog.  I enjoy it."

Lisa Corbin, MD, FACP
Medical Director, The Center for Integrative Medicine

Associate Professor, Departments of PM&R and GIM

University of Colorado Hospital and Health Sciences Cente
2.    In which an outspoken, menopausal ND-LAc attends the Montana Healthcare Forum

Montana Healthcare Forum, acupuncutre, naturopathic physician
Past AANP president Nancy Aagenes, ND, LAc
Helena, Montana-based Nancy Aagenes, ND, LAc, a past-president of the American Association of Naturopathic Physicians recently attended the meeting of the Montana Healthcare Forum on behalf of her state association, the Montana Association of Naturopathic Physicians. Aagenes, a former secretary of the Montana State Senate, co-led the campaign that established licensing for naturopathic medicine in Montana the year after she graduated from naturopathic medical school. She is also the mother of an activist politico in her state, Mark Aagenes, who was noted in an article here on then candidate and now US Senator Jon Tester. Aagenes is also, I am proud to say, a regular financial contributor to my ability to report the news I write here. I got her permission to share this humorous anecdote she sent me on her encounter with mainstream health reform initiatives as displayed there.
"I just spent two days at the Montana Healthcare Forum sponsored by Carroll College and the Montana Blues.  It had a plethora of national speakers and I was fascinated and learned a ton about the conventional culture of the ever changing face of practice and politics. 
"Ian Morrison is a great futurist thinker. He and Richard Lamm, former three term governor of Colorado, were the best visionaries there. I talked with Morrison quite a bit personally and really liked him. One of his discussions was called 'Pimp my ride.' It's apparently an MTV program where the team finds a person with a terrible looking car. 'Rusted out old Pinto's are popular,' he said. They come in and do all the body work, put in entirely new upholstery, sound systems with 11 years of music on them etc etc and send the person away with this great looking car.  But they do no work on the chassis or engine! He likened that to the current health care system and concluded that health is not about health care. 
"Isn't that a great image?
"Interestingly, they had not a single speaker in complementary and alternative medicine. 
 "At the wrap up section
I joked with them. 'I know
we're a disruptive influence.
As a direct woman myself
I've always appreciated
the comment of an old
MD I love when he said,
 "for the sake of future
humanity, I hope your
kind are sterile."

-  Nancy Aagenes, ND, LAc

"At the wrap up section I joked with them. 'I know we're a disruptive influence. As a direct woman myself I've always appreciated the comment of an old MD I love when he said, 'for the sake of future humanity, I hope your kind are sterile.'  It got a sort of laugh from the crowd.  I think they were startled.  But it made them listen up.  And feel un-threatened.

"I went on to take the blame for my profession of naturopathic medicine being as likely to polarize as any.  I talked about how difficult it is for my kind to not be reactive in the face of the juggernaut of conventional paradigms.  I talked about how far behind we are in quality control and measurement and that we need to learn that from their models.  I asked them to make places at every table for us because if they want alternatives to the current mess so richly described in the last days, they need alternative thinkers.  I reminded them that more than 1/3 of patient visits are to us and that working better together could only help.

"Then I concluded with, 'Okay, I have two kids so I haven't been sterile.  But you can take heart in knowing I'm menopausal.'  Then they really laughed a lot."
Comment: Wishing that powerful natural healthcare practitioners are sterile may be the mirror imagine of the sentiment in that postulate about how paradigms change: when the old finally die. Can we conclude that death wishes are the alpha and the omega of integration activity?
3.    Regarding the ACP Low back Pain Guidelines: Two MD Comments, Not for Attribution

One medical doctor, Kjersten Gmeiner, MD (see comments below on the ND/NMD issues) wrote a brief note which only said "nice piece on the pain guideline."  She was referring to an article which looked at the American College of Physicians' guideline for low back pain. In a second, I interviewed the lead author of the guideline, Roger Chou, MD. I asked two medical doctors with background in pain medicine for their responses. Neither wished to speak on the record.
"Yeah, my responses are unpublishable. As a Northwestern internist (not even a pain specialist), it's clear that Chou doesn't know [much] about anything other than utterly conventional medicine.  It also appears that he has never read any of Eisenberg's or others surveys of the prevalence of the use of CAM for painful conditions.  He's happy to ignore all that, because it's not in his narrow worldview. Pathetic.  And he misrepresents the strength of the evidence.  Acupuncture for knee pain, for example, has MUCH better evidence that all the expensive stuff that docs and PT's throw at it - that doesn't work.  Gimme a break..."
Apparently the integrative medicine discussion can still engender strong opinions. The other pain MD was not quite as harsh, distinguishing between an academic perspective and a clinical one:
"I looked over the guideline and the comments on your site regarding the pain document. I am being brief and blunt. I agree that the model in the guideline represents standard medicine, which is unfortunately ignorant/clueless about much of pain, and that the basis of the guidelines is the standard medicine way of presenting what you can justify at grand rounds at Harvard. To be clear, I presented my own view at an orthopedic grand rounds at Methodist hospital, and nobody walked out. Here they are:

"Most of pain in the body by my experience with about 10,000 people (from headache to foot pain) is myofascial. Many types of body work are helpful, myotherapy, trigger point injections, chiropractic, massage are at the head of my list, and anti-inflammatory meds are at the do not use level. Trigger point injections, myotherapy, and chiropractic are my most successful first line, along with opioids for pain." 
4.    On the Yale Integrative Medicine Effort

I received a note from Jeanne Crawford,
MA, MPH, executive director of the American Holistic Nurses Association, who wrote briefly regarding the Integrator feature on the recent emergence of integrative medicine inside the Yale School of Medicine:
"It may (or may not) interest you to know that Yale had a kind of Integrative Medicine Clinic in the 80s…we just didn’t use the same terms in those days…it was called the Yale Behavioral Medicine Clinic then.

Jeanne Crawford, MA, MPH
Executive Director, AHNA
William Wulsin, ND, LAc, MPH (cand.)
5.    Regarding NDs and "Medical School" and "Naturopathic Medical Doctors"

The Integrator Your Comments Forum with 4 voices on the theme of whether naturopathic physicians' education should be positioned as "medical school" produced a couple responses.
"I find myself rationally aligned with the logic of your 'anonymous' respondent, yet cannot withhold a chortle for the ubiquitous Dr. Glidden-Green.  Perhaps if we spent more time cultivating our passions for professional, personal and recreational applications, the fear within turf labeling would abate.  

"On a more serious note, choosing language that clearly communicates where we are coming from, what our intentions are and how we can connect with potential collaborators will in the long run be more helpful than defending semantics. Is that art not one that requires daily practice?"

William Wulsin, ND, LAc , MPH (cand.)
Seattle,  WA
Comment: I think Wulsin's postulate that less stress may limit turf battles between the disciplines is worth exploring. I suggest that the presidents of all the healthcare professional associations be immediately sent to an equatorial island. At the least, there is clearly untapped reality TV potential here.

Kjersten Gmeiner, MD
An educator wrote and said that the discussion had come up in a class and the feeling were split. A leader of the American Association of Naturopathic Physicians, said that the discussion had stirred some interest. Responding from an observer's perspective was this board member of the American Holistic Medical Association:
"I LOVED the piece on the terminology about naturopathic physicians.... I think you will never run out of material for that debate, and what you presented was diverse and thought-provoking.

"Of course, my stand is you call people what they want to be called... but as you showed, they do not have consensus on that.  Loved Shor's point of view: there is a huge chasm between the experiences/views of the ND's who practice in licensed and un-licensed states (for good reason)."

Kjerseten Gmeiner, MD
Seattle, Washington
Then chiropractor and educator James Winterstein, DC, president of National University of Health Sciences wrote with guidance for the naturopathic medical profession.

"John, I think the naturopathic profession should learn an important lesson early on. Too often, the chiropractic profession chose to 'take what they could get' in an effort not to provoke.  In our time there was no such thing as being "politically correct” (thank God), but we got too little and have been living with it ever since.

"NDs should go for the 'whole magilla' and brook no interference from anyone. They are part of the medical profession just as we are. We just function in 'adjectively defined' areas that are different than allopathy. (Yes, 'allopathy' was considered to be a pejorative term, but the vast majorities of MDs accept that they are allopaths.)"

James Winterstein, DC, President
National University of Health Sciences
6.    Regarding the so-called "CAM Ghetto" of intentional cross-disciplinary CAM collaboration

Reed Phillips, DC, PhD, wrote a note on the debate over whether CAM disciplines collaborating together former a "CAM Ghetto" that might be harmful to the advance of the disciplines and breaking down of barrier.
[Citing Phillips] "'No one in the CAM community is so far removed from the 'CAM Ghetto' that they can absolve themselves of a responsibility to work for the good of all.' 

"I disagree. Does that mean acupuncturists need to defend iridologists or crystal healers because they are both unconventional? This sounds like tribalism, or the enemy of my enemy is my friend." 

Ather Ali, ND, MPH
Yale University

Comment: I have worked work closely with Phillips over the years and, while I cannot put words in his mouth, offer that the focus of our work between and among the disciplines is with those that have developed internal standards of education, accreditation, licensing, or are exploring these kinds of value additions. As far as I know, neither iridology not crystal healing are aspiring to these levels of self-regulation or inviting these levels of scrutiny.

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