Columnist Bill Benda, MD: Tough Love on Who Owns ‘Integrative Medicine’ and on Associated ‘MD-Bashing’

Summary: Bill Benda, MD, weighs in forcefully on the recent series of Integrator articles, guest columns and commentaries on who owns the term “integrative medicine” and some of the attendant name-calling. It’s been a little ugly, seeing the disparate perceptions, hurt feelings and psycho-spiritual-economic rifts between the diverse parties with a stake in the integrative practice movement. Benda focuses on two points he feels must be made, once and for all, regarding “allopathically-centered integrative medicine” and the need to end “MD bashing” by naturopathic doctors and other complementary healthcare practitioners. Benda’s addition to this difficult exchange reminded me of what may be the best therapeutic course for those wishing to take this healing seriously: the knowledge, skills and values in the 1994 Pew-Fetzer Task Force work on practitioner-to-practitioner relationships.

Columnist Bill Benda, MD: Tough Love on Who Owns “Integrative Medicine” and on Associated “MD-Bashing”

Summary: Bill Benda, MD, weighs in forcefully on the recent series of Integrator articles, guest columns and commentaries on who owns the term “integrative medicine” and some of the attendant name-calling. It’s been a little ugly, seeing the disparate perceptions, hurt feelings and
psycho-spiritual-economic rifts between the diverse parties with a
stake in the integrative practice movement. Benda focuses on two points he feels must be made, once and for all, regarding
“allopathically-centered integrative medicine” and the need to end “MD bashing” by naturopathic doctors and other complementary healthcare practitioners. Benda’s addition to this difficult exchange reminded me of what may be the best therapeutic course for those wishing to take this healing seriously: the knowledge, skills and values in the 1994 Pew-Fetzer Task Force work on practitioner-to-practitioner relationships.


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Bill Benda, MD – board member for both AANP and AHMA

The recent series of Integrator articles and guest commentary on who owns “integrative medicine” have strongly evidenced the disparate perceptions, hurt feelings, and psycho-spiritual-economic rifts between the diverse parties with a stake in the integrative practice movement. (See column by Peter Glidden, ND, commentary by Tom Ballard, ND, plus others noted at the bottom of this column.) These columns and articles provoked Bill Benda, MD to try to set a couple of things straight, once and for all.


Benda is in a unique position to weigh in on these issues. Nearly a decade ago, Benda decided to focus his integrative energy on policy – and specifically on bringing integrative medical doctors, holistic nurses, naturopathic physicians, holistic medical doctors and others into collaboration on policy. He was elected to the board of directors of American Association of Naturopathic Physicians and to the board of trustees of the American Holistic Medical Association. An Integrator adviser, Benda is also


associate editor of both the Journal of Alternative and Complementary Medicine and Integrative Medicine: A Clinician’s Journal.

_____________________________________



Clarifying a Point and Taking a Stand on Another

in the (Sometimes Acrimonious) Dialogue Over “Integrative Medicine”

– Bill Benda, MD

I’ve been following the thread on “integrative
medicine” over the past few issues, and I believe it is time to clarify one
particular point, and take a stand with regards to another.




The clarification point is that integrative medicine is, and
always will be, allopathically-centered, simply by the fact that it is the
unplanned, and often unwanted, child of our aging medical paradigm. It was conceived by allopathic physicians and
resides academically within conventional medical colleges. I was a part of its creation at the
University of Arizona, and have quite precise memories of the pain and
expectations surrounding its birth.

“The clarification point is that
integrative medicine is, and

always will be, allopathically-
centered, simply by the fact
that it is the
unplanned, and
often unwanted, child of our

aging medical paradigm.”

– Bill Benda, MD

Denunciations began immediately from conventional and unconventional
quarters, with one exception – the American public, who wanted then and is
asking still for us to stop complaining about each other and get down to the
business of providing decent healthcare.
No one is objecting that naturopathic medicine is
naturopathically-centered, or that Traditional Chinese Medicine is
Chinese-centered, or that homeopathic medicine is homeopathy-centered. The time has come to move beyond lamentations
and accusations and get on with the business of saving healthcare. King of the Mountain is a child’s game.



My second point is far more fundamental and obligatory to
embrace: The time has come to end this perpetual denunciation of integrative
medicine’s sire, conventional medicine.
Now. Yes, it is an indisputable
fact that a significant portion of allopathic care holds the potential, and the
reality, of great harm. It is also true
that our current healthcare paradigm has fallen under the sway of a
capitalistic economy, to its detriment and forthcoming decline. But paradigms fall because universal law
states they eventually must, not because they are inherently corrupt or
malevolent.


There is no truth to the preposition that allopathic
medicine is good only for trauma and a little acute care – or that naturopathic
or any other medicine is the only true answer to our healthcare crisis. Those who preach such risk becoming infected
with the internal pestilence that has brought conventional medicine to its
knees – human arrogance based on the fallacy of entitlement. The fact, the unequivocal fact, is that
medical doctors are for the vast part caring, intelligent, best-intentioned
people who perform as honestly and effectively to their level of training as
any other practitioner, whether in emergency medicine or homeopathic medicine,
radiology or Reiki. Allopathic medicine
holds exceptional beauty because it
holds exceptional risk – in my 30 years I have witnessed great miracles as well
as great injury. One really cannot ever
separate the two.


“Those who insist upon
hanging

on to an anti-MD polemic will
be the ones eventually going away

– there
is little use for such energy

in an already precarious world.”

– Benda


I find it quite distressing that members of professions that
have been marginalized throughout much of their history find the need to
marginalize another profession that is doing its clumsy best to take root and
grow. No, of course integrative
physicians do not, after five to ten years of intense conventional training,
possess the knowledge and learned skills of the naturopathic physician, or TCM
practitioner, or homeopathic clinician. Such training isn’t fully available yet
in our medical schools, nor would one necessarily have the freedom to pursue
four more years of study if it were. But
to employ such locution as “moron, sophomoric, watered-down,” as well as
“bearers of a long rifle and smallpox blanket” does not devalue integrative
medicine, but instead diminishes those who choose to cast forth such words of
animosity. If naturopathic medicine or
ayurvedic medicine or any other philosophy of healing and healthcare wishes to
serve the greater good, I suggest they step forward and help guide this new
experiment called integrative medicine – teach us how to provide quality care
rather then keep telling us we can’t, at least not as well as you. Because in the first place, we integrative
physicians are not going to go away. And
in the second, by the very virtue of choosing a path not yet accepted by the
profession that spawned us, we are the ones most likely and most willing to
support and defend you, our unconventional peers.


(for) naturopathic medicine, an
understanding of and forgiveness

for past sins, real and imagined,

is the only appropriate
response to medical
doctors …

– Benda

What will instead come to pass is that those who insist upon
hanging on to an anti-MD polemic will be the ones eventually going away – there
is little use for such energy in an already precarious world. Naturopathic medicine, as one exemplar, is at
the tipping point of its own success, and an understanding of and forgiveness
for past sins, real and imagined, is the only appropriate response to medical
doctors who are simply trying to find a way to practice a profession deserving
of respect while addressing internal wounds inflicted by their education. “They” are not the true enemy, my
friends. Just ask Pogo.




So enough rhetoric.
The time has come for all boards of directors, and presidents, and
executive directors, and members of our professional organizations, as well as
medical college presidents, and journal editors, and natural product
executives, to put an end to this destructive rankism whenever and wherever it
arises. Our students, in their maturity,
have already chosen to enter collaborative relationships with each other
regardless of title, so the bottom line is that this change is going to happen
within a generation, with us or without us.



I suggest we choose “with.”


_____________________________________


Comment
: Benda offers a kind of tough-love. Here are the facts. Live with them. There is much that is compelling in what he says. And,
as I have stated earlier in this discussion, the work to find our way through differences, without suppressing them, toward powerful collaboration, requires considerable healing. This takes us beyond opening ourselves to education about other disciplines – an area where we all fall down miserably, still. That’s a necessary but not sufficient step. To realize our potential as a powerful part of the change Benda references requires that we venture more deeply, into ourselves as as well as the other, and as individuals as well as professions. I credit Integrator adviser Carla Mariano, RN, EdD, BC-HN, for guiding me in this area.

The 1994 classic from the Pew-Fetzer Task Force, Health Professions Education and Relationship Centered Care, offers us a road-map. Go to the PDF file and open to the chart on page 36. Below are the knowledge, skills and values that that multidisicplinary Pew-Fetzer team identified for creating optimal practitioner to practitioner relationships.

________________________________
Table 3: Areas of Knowledge, Skills and Values
for the Practitioner to Practitioner Relationship

From Health Priofessions Education and Relationship Centered Care
Pew-Fetzer Task Force on Advancing Psychosocial Health Education

1994; page 36

Area
Knowledge Skills
Values
Self-awareness Knowledge

of self

Reflect on self
and needs

Learn continuously

Importance of
self-awareness

Traditions of
knowledge in health
professions

Healing approaches
of various traditions

Healing approaches
across cultures

Historical power
inequities across
professions

Derive meaning
from others’ work

Learn from experience
within healing
community

Affirmation and
value of

diversity


Building teams
and communities
Prespectives on

team-building from
the social sciences

Communicate
effectively

Listen openly

Learn cooperatively

Affirmation
of mission

Affirmation

of diversity

Working dynamics
of teams, groups
and organizations
Perspectives on

team dynamics
from the social
sciences

Share responsibility
responsibly

Collaborate
with others

Work cooperatively

Resolve conflicts

Opennes to
others’ ideas

Humility

Mutual trust,

empathy, support

Capacity for
grace

________________________________


Breathe deep and look at these recommendations. “Self awareness.” “Knowledge of historical power inequities across professions.” “Affirmation of diversity.” “Humility.” “Capacity for grace.”

Benda asks the naturopathic profession to move into such transformational depth when he asserts that for a positive future “an understanding of and forgiveness
for past sins, real and imagined, is the only appropriate response to MDs …” Medical doctors, integrative or not, nurses, chiropractors and other parties must go there as well.

We can wish that such forgiveness can come through self-will, or via decree that we’re over that now. I’d guess that years of directly and routinely incorporating these issues, and through directly including individuals from other disciplines in our academic training programs, in our continuing education, and in professional meetings, until “they” are “us,” will be a necessary antidote to the sins, real and imagined, that all parties are feeling. I’d give it more than one generation for its resolution, especially if we don’t get going now.

Credit Benda for action on that. He’s been bringing the disciplines together in numerous ways over the past 4 years. (See Political Clout from the AHMA-AANP-AHNA? The Vision of Bill Benda, MD, the Interlocking Director, June 5, 2007.)

________________________________


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