Integrator Forum: Does the Landmark Report Integrative Medicine in America Actually Portray Integrative Medicine in America?

Summary: The publication by the Bravewell Collaborative of Integrative Medicine in America: How Integrative Medicine Is Being Practiced in Clinical Centers Across the United States proved successful in generating substantial media attention for the emerging field. Yet the report looked only at the services in 29 clinics sponsored by health systems. Most are associated with academic health centers. However, the vast majority of consumer experience of “integrative medicine in America” is through community-based practices of holistic and integrative medical doctors, naturopathic doctors, functional medicine practitioners, holistic nurses, board scope chiropractors and others. Does this report correctly represent the field? Does it misrepresent? What would be different if a report focused on community-based practices? All responses will be included in an Integrator forum.

Would
you, as an integrative practitioner, guess that academic medical and other health
system-sponsored “integrative medicine clinics” reflect the typical,
community-based practice of integrative medicine?

Image

Bravewell’s landmark 2012 report: But does it report what it claims?

Consider
the question differently: Do you think a consumer or policy maker would get an
appropriate sense of “integrative medicine in America” by examining what mainly
academic medicine-sponsored clinics provide?

A
fascinating new report suggests that you and the consumer should anticipate significant
equivalence. The intriguing and useful document is entitled Integrative Medicine in America: How Integrative Medicine is Being Practiced in Clinical Centers Across the United States. It is available to read or download
at www.bravewell.org.

This
beautifully crafted report, sponsored by the Bravewell Collaborative of
philanthropists in integrative medicine, is based on surveys and interviews.
They chose to limit the survey to a hand-picked set of 29 hospital-sponsored
and often academic health system-sponsored clinics.

This
is the face of integrative medicine that the Bravewell favors. This group of philanthropists
substantially founded and has backed for a decade the now 51 medical
school-member Consortium of Academic Health Centers for Integrative Medicine.

But
does the title mislead readers? Does the
report reflect the services consumers are likely to receive if they follow an
advertisement or website that draws them to your own “integrative medicine”
services?

The
authors explain their selection criteria for the 29 clinics on page 53, just
before the appendices, under “Challenges and Limitations”.

The centers
selected to be surveyed were those that provided an integrative model in which
conventional medicine plays an essential role. While these centers do, to some
extent, provide care drawn from other health systems – including naturopathy,
chiropractic, Traditional Chinese Medicine, Ayurveda, or homeopathy – centers
whose sole orientation is to deliver healthcare from these non-conventional
medical systems were excluded. The authors acknowledge that the responses may
have been different if another cohort of centers was surveyed.

The
language does not catch how narrow was the sample they chose to report. Left out
of the study set is the vast majority of what is being called “integrative
medicine” these days.

Not
included, for starters, is the lion’s share of the nearly 800 M.D. graduates of
the Fellowship in Integrative Medicine at the University of Arizona. What are
these graduates offering in their clinics and practices? Nor can this sample
include but a very tiny percentage of the 1500 M.D.s and D.O.s who are board certified
through the American Board of Integrative Holistic Medicine.

No
doubt, “conventional medicine plays an essential role” for these M.D. and D.O.s
who are Fellows in Integrative Medicine, Board Certified in Integrative
Holistic Medicine, or both.

And
how does an honest survey of “integrative medicine in America” not include the
medicine practiced by another set of some 3000 licensed physicians. There have practices
in which conventional pharmaceutical prescription authority is combined with
delivery of a broad array of “complementary and alternative” natural therapeutics.
This number is an estimate of the licensed naturopathic physicians (N.D.s) in
those states where they have gained broad pharmacy rights. For instance, here is the scope language on the Washington Association of Naturopathic Physicians site:

Naturopathic physicians (NDs) are trained to provide primary care
and/or naturopathic specialty care to patients of all ages. NDs see
patients with acute and chronic conditions and employ all standard
conventional diagnostic tools including physical examination, laboratory
tests, and imaging. NDs may utilize additional physical and laboratory
procedures to assess nutritional status, metabolic function, and/or
toxic load, while considerable time may also be spent assessing mental,
emotional, social and spiritual status to assure any treatment plan is
comprehensive.

NDs use a variety of therapies to promote health and treat disease
including: dietetics, therapeutic nutrition, botanical medicine,
physical medicine, naturopathic manipulative therapy, lifestyle
counseling, exercise therapy, homeopathy, psychological and family
counseling, and hydrotherapy. NDs can perform minor office procedures
appropriate to a primary care setting, administer vaccinations, and
prescribe most standard drugs when indicated. Like other primary
doctors, NDs delegate to nurses and medical assistants and refer to
specialists when appropriate.

This looks like “integrative medicine” – and is worth noting in part due to the numbers. The two sets of integrative MDs noted above total fewer than the number of NDs with a scope like this. Does this study
reflect the “integrative medicine” consumers receive from these N.D.s?

Then
there are the subsets of broad-scope chiropractors, functional medicine
doctors, advanced practices nurses and licensed acupuncture and Oriental
medicine practitioners who, while clearly outside the study’s scope, sometimes present
themselves in their communities as part of “integrative medicine in America.”

Image

The financial energy behind the movement for IM in academic health centers


The
Bravewell report provides exceptional insight for anyone curious about health
system-sponsored integrative clinics. It fills huge gaps. One rifles through tables
of detail about the heretofore poorly-described phenomenon represented by these
clinics. One finds frequency of use charts for 34 separate therapies broken out
by 20 conditions. Another chart reports the types of practitioners likely to be
employed in these settings. Yet another shares the conditions for which the
authors found the least “differentiation of treatment.” Your guesses? The
former are “heart and hypertension” and “heart and diabetes”; the latter are
all acute pain related.

In
addition, business models are described. We see the chances that a given
service is paid via cash or through insurance. The authors explore “Core
Values”. For instance, how many of the clinics do you suppose agree that “we
use the least invasive and most natural remedies first”?

But
does one get what is promised in the title, Integrative
Medicine in America
?

Enjoy this report on Integrative Medicine
in Health System-Sponsored Clinics in America
. It’s a fascinating look into
a subset of mainstream medicine’s adaption to the consumer movement and
community-based practices that startled organized medicine nearly 2 decades
ago.


I invite
readers who practice “integrative medicine” or are familiar with
“integrative medicine” as offered in other venues to examine this study
and share whether it reflects community experience.
Are
these aligned with your practice or care you have received? Do you think this report
reflects what it promises in the title?

Take a look and send any of your
thoughts about this study to
johnweeks@theintegratorblog.com. I’ll compile and
report back.

Send your comments to
johnweeks@theintegratorblog.com

for inclusion in a future Your Comments Forum.
John Weeks Written by John Weeks

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