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New NCCAM Fellow Tilburt on BioEthics Issues in Integration PDF Print E-mail
Written by John Weeks   

NCCAM Fellow Tilburt on Bioethical Challenges in Integration

The NIH National Center for Complementary and Alternative Medicine (NCCAM) has recently named Jon Tilburt, MD, MPH as its first Fellow in Bioethics in Complementary and Alternative Medicine. The NCCAM publication, CAM at the NIH: Focus on Complementary and Alternative Medicine (April 2006) includes an intriguing interview on Tilburt's view of the field. Here is some of his commentary.


 "Relationships between
professionals"
is
identified by Tilburt
as one of CAM's top three
bioethical issues

.
Tilburt highlights "relationships between professionals" as one of the top three bioethical issues facing the field. He frames the question this way:
"To what degree are conventionally trained physicians open-minded toward CAM practitioners and treating them as valued partners in patient care?"
He later frames as "unsettled questions" the following:
"What do we do when the way of reasoning behind a CAM treatment does not make sense to our way of scientific theory, but a long history of practice and, in some cases, a small body of research suggest that the treatment might be safe and possibly beneficial? Should we require that a CAM treatment 'make sense' to us before we study it or use it?"


A kind of pragmatism-
based medicine
may be
the way ethical conflicts
are
resolved between
science and the
choices
patients and practitioners

are making.

Tilburt names as the two other top ethical concerns "communication issues" and "integrating values with science." The former centers on the need for patients to feel comfortable in disclosing their CAM use and the importance for conventional practitioners of gaining skills in being  open to the exchange. In Tilburt's framing, these issue may be viewed as closely related. He speaks of the importance a medical doctor must place on both respecting choice (patient-centered care) and respecting the science which might be at the core of a physician's view of importance.

Tilburt sees the resolution of this dichotomous situation in the pragmatism of the American character: "Even if (Americans) don't always agree on a theory behind a something, if it seems to work (by accepted standards), they are willing to be flexible." Tilburt sees this bond of pragmatism in conventional providers, CAM providers, and patients: "Most CAM and conventional providers are committed to do what is in the patient's best interest, even if the bodies of knowledge are different."

Tilburt believes the question of what we mean by "integration" must stay open and continue to be the subject of ongoing dialogue. He opposes both "wholesale acceptance" of diverse CAM health practices as well as "taking (them) over." From his perspectives as both medical

  Tilburt expresses
"cautious optimism" that
we
will see referral for
CAM treatments that have 

been proven safe and effective
as part of
"comprehensive,
whole-person medicine."


practitioner and as bioethicist, Tilburt expresses "cautious optimism" for integration. He frames it as "referral for treatments that have been proven safe and effective" as a part of "comprehensive, whole-person medicine."

New NACCAM Members:  In other NCCAM news, two new members of the National Advisory Council for Complementary and Alternative Medicine were announced: Ted Kaptchuk, OMD, LAc, associate director of the Division of Research and Education in Complementary and Integrative Medicine Therapies at Harvard's Osher Institute, and Joan Fox, PhD, a professor in the Department of Molecular Cardiology at the Cleveland Clinic's Lerner Research Institute.


Comment
:  Kudos to the NIH for bringing in a bioethics fellow who shows such an experienced, pleasantly level-headed view of the field. The optimism Tilburt sees, albeit cautious, appears to focus on a kind of CAM-grafting - though his focus on integrating diverse practices, rather than just therapies, is a refreshing awareness of the distinctions between the contributions of members of diverse disciplines.

I hope that in his tenure with the NIH that Tilburt will also explore the deeper ethical issues involved in transforming our medical system into one which focuses on health creation - which are broached by the integration dialogue. Too often the choice for a

  Here's hoping Tilburt
will venture into the
systemic challenges
begged by the so-called
"CAM" systems, before
the NIH's own stamp
began to define, and
limit, the dialogue.
 
practitioner is not even-handed. The practitioner could principally rely on a scientific base which has developed around the relatively easy to research single agents which are valuable in responding to, or suppressing, symptoms of disease. (This is the "choice" down which our currently payment and delivery system pushes one.) Or s/he could venture off that narrow path into the harmfully under-researched, multi-therapeutic, whole-person methods for working with patients to bring them to health. What to do, Doctor?

Here is hoping that what we have seen here is a landscape assessment, that will lead him deeper into the system challenges begged by the so-called "CAM" systems, before the NIH's own stamp began to define, and limit, the dialogue. (IBN&R thanks Sheila Quinn for forwarding the link to this interview.)


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