"Integrative Medicine" Definition Changed by Conventional Academics in Dialogue with CAM Academics
Written by John Weeks
Sunday, 26 November 2006
"Integrative Medicine" Definition Changed by Conventional Academics at Request of CAM Academics
Summary: In December of 2004, members of the Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) reached a milestone in their development as a young organization. They formally adopted a guiding definition of "integrative medicine" (IM). Yet within months a younger consortium representing educators from alternative healthcare disciplines, the Academic Consortium for
Complementary and Alternative Health Care, asked them to change their self-definition. The core issue had to do with whether IM was focused on integrating therapies or providers. CAHCIM responded positively to the suggestion and put a new multi-disciplinary face on their self-definition as "integrative medicine." The story, largely unreported, deserves telling as we in the northern hemisphere nudge toward the season of the coming of the light ...
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The Consortium of Academic Health Centers for Integrative Medicine (CAHCIM) was formed in 2001 as the brainchild of educators from a dozen medical schools and was quickly supported by a group of philanthropists led by Penny George. CAHCIM's evolution is a reversal of typical professional
development. Usually, professionals come together to form educational
institutions, and then accrediting bodies. In the case of CAHCIM, a group of educators in powerful, established institutions began birthing the profession of
"integrative medicine." (1)
Five years later, CAHCIM has grown to 36 members, representing over a quarter of the 125 US medical schools. Few observers will doubt that, small as the organization is in the broader field of academic medicine as represented by the Association of American Medical Colleges and the Association of Academic Health Centers, CAHCIM has become the spokes-organization and defining agency in the emerging field of "integrative medicine."
Reaching the Milestone of a Shared Self-Definition
A classic benchmark in a
profession's development is creating a consensus-based definition. AOM practitioners, holistic medical doctors,
holistic nurses and naturopathic physicians are among those in the
shared and overlapping space of integrated health care who have engaged such a process. CAHCIM, which had grown to roughly 20 members by late 2004, was at the final stage of coming to consensus on a clear definition of "integrative medicine."
CAHCIM founding vice chair Haramati
In December of 2004, at CAHCIM's annual membership meeting, the assembled academics endorsed this definition:
"Integrative Medicine is the practice of medicine that reaffirms the importance
of relationship between practitioner and patient, focuses on the whole person,
is informed by evidence, and makes use of all appropriate therapeutic approaches to achieve optimal health
and healing." [Bold added.]
A milestone achieved, and a cause for celebration, if only because this important piece of tedium was behind them! This is what we are. This is what we stand for. We are united in this.
Meanwhile, Back at the Multi-Disciplinary Collaboration ...
At the time CAHCIM crossed this threshold (mundane in retrospect only), many of its leaders were volunteers in a six-month-old, ground-breaking, multi-disciplinary academic initiative. In this project, principally funded through Lucy Gonda, the educators from conventional medical schools were working side-by-side with educators from nearly a dozen other healthcare disciplines.
The project is the National Education Dialogue to Advance Integrated Healthcare (NED): Creating Common Ground,organized through the Integrated Healthcare Policy Consortium. Among the CAHCIM leaders active on the NED planning team were CAHCIM's founding vice Chair, Adi Haramati, PhD, and the present vice chair, Mary Jo Kreitzer, RN, PhD, and the founding co-chair for CAHCIM's education working group, Ben Kligler, MD, MPH. Their multi-disciplinary colleagues in NED included leading
educators in the complementary and alternative medicine
fields, plus selected educators in holistic nursing, holistic medicine and public health.
ACCAHC exec Snider
Part of the NED process included the seeding of a new consortium, the Academic Consortium for Complementary and Alternative Health Care. ACCAHC consists, at its core, of representatives of the councils of colleges and accrediting bodies of the five disciplines with federally-recognized accrediting agencies: chiropractic medicine, naturopathic medicine and acupuncture and Oriental medicine, massage therapy and direct-entry midwifery.
When these collaborators with the CAHCIM leaders heard the CAHCIM definition, they were not, typically, in such a celebratory mood. First, none of them, nor members of their professions, were consulted on the definition. The message: "integrative medicine," so-defined, belongs to MDs and conventional academic medicine and not to the rest of those integrated in integrated health care. But the concern ran deeper than this.
Theft of the Family Jewels, or, Where am I in this?
If one is to summarize the most significant fear the distinct natural health care disciplines have with "integrative medicine," it is that medical doctors will skim off a few natural health therapies and announce to the public that now they've got it all. We're integrative doctors. We integrate the best of all approaches. Subtext, to the natural health practitioner: You don't need those alternative medicine people any more.
The fear is that MDs will steal the family jewels. The fear is that MDs will view their distinct disciplines as a few therapies which can be added to MD practices rather than recognizing the value of their whole practices.
Associated with this profound (and historically reasonable) guild instinct is a more sublime concern. Patient care could suffer. Many believe that MDs will, through their skimming process, give patients a watered-down, less powerful version of the "approaches" that the distinctly licensed provider has come to embody through years of professional education. The political and economic power of MDs could then mean that patients would think, for instance, that using needles for pain represents the full value of acupuncture and Oriental medicine.
The members of ACCAHC chose not to grouse about the situation, but seek to remedy it. Under the leadership of Reed Phillips, DC, PhD, executive director Pamela Snider, ND, they accepted that this "integative medicine" definition could be considered a self-definition for CAHCIM. Still, they requested, through the NED process, that CAHCIM consider add recognition of the needs of integrative MDs to work with other "providers and disciplines." The amended definition then read:
"Integrative Medicine is the practice of medicine that reaffirms the importance
of relationship between practitioner and patient, focuses on the whole person,
is informed by evidence, and makes use of all appropriate therapeutic approaches, providers and disciplines to
achieve optimal health and healing." (Bold added.)
Current CAHCIM vice chair Kreitzer
The message was clear: An integrative MD's job was not just to integrate "approaches" or therapies. To be successful as care providers, each would need to engage the expansive, multi-cultural work that would allow them to engage with practitioners from diverse healthcare fields. Optimal health and healing required it.
Quick Agreement and Inclusion, with a Minor Amendment
The response of the CAHCIM leaders at the February 2005 NED planning team conference call was swift and supportive. Haramati noted that the Institute of Medicine of the National Academy of Sciences had argued for this kind of multi-disciplinary approach in their report on CAM in the United States published a month earlier.(3) Kreitzer affirmed the view. They agreed to take the request up with their CAHCIM colleagues at the May 17, 2005 Steering Committee meeting meeting, which they did. This was the language adopted:
"Integrative
Medicine is the practice of medicine that reaffirms the importance of
relationship between practitioner and patient, focuses on the whole person, is
informed by evidence, and makes use of all appropriate therapeutic approaches, healthcare professionals and
disciplines to achieve optimal health and healing. (Bold added.)
ACCAHC chair Phillips
Within a few days, the definition of integrative medicine on the CAHCIM site was changed. Now any medical student, or academic or researcher newcomer to the field of "integrative medicine" who goes to the CAHCIM site will discover themselves working in a different sort of landscape. Their jobs, as researcher, as educators or clinicians, now has a new set of dimensions should they wish to "achieve optimal health and healing." They must learn how to understand and utilize not just the non-human "approaches," but also how to incorporate all appropriate healthcare professionals and disciplines.
Snider, the ACCAHC executive director, expressed the gratitude of
ACCAHC's leaders: "Our CAM educators were very pleased with how quickly
the conventional academic consortium embraced the amendment to their
definition and emphasize collaboration between disciplines." Then Snider
added a touch of self-responsibility: "Now it is incumbent upon us in
the CAM fields to see that our own definitions highlight the importance
of how and when to work with others."
Now when a newcomer to integrative medicine holds up the mirror of this endorsed self-definition, they will see other healthcare professionals and disciplines in their reflection.
Comment: As a participant in the NED and ACCAHC work, I had the pleasure of witnessing this collaboration between members of a dozen disciplines. I found it a satisfying and hopeful moment, a classic pebble in a lake, sending ripples where we cannot see.
Too much can be made of it, of course. It's only a definition, after all. Yet I relish the image of a newcomer to "integrative medicine" holding up the mirror of this self-definition, and seeing other healthcare professionals and disciplines in that reflection. This is good for health care.
For our colleagues in "integrative medicine" who state, elsewhere on their site, that they are committed to transforming health care, this amendment says: What better place to start than to declare that good healthcare requires respectful collaboration with non-MDs?
12 Months Later, May 2006 - Historic meeting: Conventional (*) and CAM Consortia (^) exec teams gather in Edmonton: Back row - Adam Perlman, MD, MPH*, Don Warren, ND, DHANP^, Brian Berman, MD*, David O'Bryon, JD^, Kathleen Healy, David Eisenberg, MD*; Middle row- Reed Phillips, DC, PhD^, Adi Haramati, PhD*, Bradly Jacobs, MD, MPH*, Janet Kahn, LMT, PhD^, Mary Jo Kreitzer, RN, PhD*, Rita Benn, PhD*, Vic Sierpina, MD*; Front row - Pamela Snider, ND^, Susan Folkman, PhD*, John Pan, MD*, Anne Nedrow* MD*, Liza Goldblatt, PhD^; photo - John Weeks, National Education Dialogue
(1) Members of CAHCIM like to refer to their organization as "the Consortium," a better handle than the somewhat scatological "CAHCIM." Yet it denies the existence of the other consortium of CAM educators, the also scatologically resonant "ACCAHC." (2) To be a member, the institution must have
integrative medicine activity in at least two of academic medicine's
three focal areas: education, clinical services and research. In
addition, the internal champions for integrative medicine much have
support from the Dean's level or above.
(3) Stuart Bondurant, MD, who chaired the IOM committee which produced the report, subsequently said of the NED project that "this great collaborative work is one of the most important things anyone can do to implement this report." Disclosure note: As mentioned, I was a participant in some of this work reported here.
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