Different from Integrative Medicine in other states of the Union.
Most doctors consider Integrative Medicine to be the same thing as Complementary
and Alternative Medicine (CAM) – i.e. the use of a few supplements
(if they don’t interfere with pharmaceutical drugs) and perhaps
acupuncture and meditation.
One Integrative Medicine researcher, Iris Bell, MD, MD(H) describes this
limited concept as “combination medicine” – CAM added
to conventional – and states categorically that this is NOT Integrative Medicine.
The concept of Integrative Medicine has become a political football in
the present medical climate.
An excellent report issued in 2015 by the RAND Corporation was written to address the political issues of CAM/Integrative Medicine.
The first paragraph of the report really defines the dilemma – the
whole concept of CAM is defined politically by its treatment modalities,
and not by its paradigm.
So the first task is to
define the paradigm of Homeopathic and Integrative Medicine.
Homeopathic and Integrative Medicine aims to treat the whole person, body,
mind and spirit, through the application of a multitude of modalities
with the aim of healing the whole person, not simply managing the person’s
disease. The environment (including the family environment), the body,
the mind and the Spirit all play equally important parts in the health
of the individual. True Integrative Medicine operates on the principle
that healing may be accomplished on any level and will affect all other levels.
This is a far different idea from the concept that the allopathic paradigm
is fundamental, and everything else simply modulates that paradigm.
Treatment of the whole person steps outside the “silo” approach
of traditional allopathic medicine, with its practitioner specialization
and concerns for who is sufficiently “trained” to do what
kind of procedure, or to use what kind of medicine.
Some of the challenges for practitioners of Homeopathic and Integrative
Medicine are indeed political, associated with coverage, licensure, scope
of practice, institutional privileges, and research support.
Other challenges include training. Most licensed Homeopathic and Integrative
Medicine doctors did not receive the additional training in either medical
school or in their residency and fellowship programs. They developed the
modalities, or were trained by those who developed the modalities, in
much less traditional venues – private offices, hotel conference
rooms and the like.
Entire Integrative Medicine Societies have emerged, to address the issue
of training new practitioners – the Institute for Functional Medicine,
the American College for Advancement in Medicine, the American Association
of Environmental Medicine, the International Organization of Integrative
Cancer Physicians, the International College of Integrative Medicine,
the American Medical College of Homeopathy, the British Institute of Homeopathy,
Unipathic Medicine – to name just a few of these organizations whose
focus is on education.
Policies that define a profession only in terms of its modalities or procedures
significantly impact patient access to care. “Where the profession
does have full legislative recognition as a profession but is prevented
from exercising the privileges associated with that recognition, a case
could be made that the legislative intent is being thwarted.”
What is the difference between a profession and an occupation that requires
skill to practice? The chiropractors defined a profession in the course of their antitrust suit against the American Medical Association
(AMA) in 1976. The Rand article quotes: “A profession can be defined sociologically
as a social group that has exclusive access to knowledge and skills, is
autonomous, self-regulating, has authority, controls entry, is regulated
by the state, and has exclusive powers and/or rights. A nonprofessional
(skill) occupation may have some of these characteristics, but not all,
and not to the degree of the profession.” The history of this conflict
was published in the AMA Journal of Ethics in 2011.
Professions arose historically from guilds, and have historically been
given extensive powers of regulation by the state, in return for political
recognition. In the health field, these powers include control over who
can enter the profession, how the profession may be taught, and by whom,
the power of discipline over members of the profession, the power to persecute
those who are not members of the profession who encroach on modalities
claimed to be exclusive to the profession.
In return, the recognized profession agrees to certain responsibilities
– mainly the welfare of the people treated by members of the profession
and the regulation of said members.
That regulatory power was granted to the allopathic medical profession
and enabled it to commission the historic Flexner report, which resulted in the virtual destruction of the practice of homeopathic
medicine in the United States.
The balance between the professions and the State seems to wax and wane.
Currently it appears that the pharmaceutical industry exercises the most
power in the present-day climate of medicine.
Since CAM practitioners overlap with conventional allopathic medicine practitioners
both in scope of practice and in business models, any granting of privileges
to CAM practitioners may be interpreted as taking away from the scope
of practice of allopathic medicine practitioners. The allopathic pie gets
smaller in the view of the allopathic profession.
In the view of the patients, of course, the patient pie gets larger, the
more modalities of treatment and types of practitioners they have access to.
Guidelines tend to refer to procedures rather than to the intelligent use
of modalities by the various professions. The Arizona Medical Board (AMB)
defines Complementary and Alternative Medicine (CAM) in both ways. They talk about varying philosophies without in any way
defining them, and then about the practice of CAM in terms of modalities.
CAM refers to a broad range of healing philosophies (schools of thought),
approaches and therapies that mainstream Western (conventional) medicine
does not commonly use, accept, study, understand, or make available. A
few of the many CAM practices include the use of acupuncture, ayurveda,
herbs, homeopathy, naturopathy, therapeutic massage, and traditional Oriental
medicine to promote well-being or treat health conditions.
The guideline goes on to state:
The standards used in evaluating health care practices must be consistent,
whether such practices are regarded as conventional or CAM… The
design the treatment plan to timely and effectively treat the patient’s diagnosis…
And therein lies the real rub. Allopathic medicine follows a different
paradigm from homeopathic or integrative medicine. The paradigm in allopathic
medicine involves examination and testing to establish a diagnosis, followed
by the correct guideline-established use of surgical, radiation or pharmaceutical
modalities to treat that diagnosis. Allopathic medicine seems to leave
out the part about determining the metabolic dysfunction or the root cause
which may have resulted in any one of a number of diagnoses, depending
on the individual patient, and treating that dysfunction to effect healing.
Allopathic medicine treats the patient’s diagnosis, not the patient.
In the determination of whether a treatment is both safe and effective,
the guidelines state that the therapy must have “demonstrable and
credible scientific evidence of efficacy”.
The only loophole allowed in the AMB definition of acceptable treatment
is found in this sentence: “The use of
unsafe and not demonstrably effective treatments is experimental in nature and a physician who wishes to use
such a treatment should only do so under rigidly controlled conditions
that meet all State and National standards and protocols for research
including submission of the proposed treatment to an Institutional Review
Board for approval.”
There is no definition of treatments declared to be “unsafe and not
demonstrably effective”. However, based on the AMB statutes, the
use of chelation therapy for heart disease, peripheral vascular disease
or chronic inflammation would fall into this loophole category. These
modalities are used by both Homeopathic and Naturopathic Physicians in
Arizona and are within their scope of practice.
The AMB statutes list the following as being unprofessional conduct:
With the exception of heavy metal poisoning, using chelation therapy in
the treatment of arteriosclerosis or as any other form of therapy without
adequate informed patient consent and without conforming to generally
accepted experimental criteria, including protocols, detailed records,
periodic analysis of results and periodic review by a medical peer review
“A physician may not claim that a particular treatment can cure,
alleviate or ameliorate a disease or condition unless the claim is supported
by valid, conventional science. A physician’s personal experience,
patient testimony and other anecdotal evidence is not sufficient evidence
to support a claim of a treatment’s efficacy and safety.”
“The Board will continue to protect the public by ensuring that all
allopathic physicians, whether practicing conventional medicine, CAM or
both, meet the standards of care the community expects of allopathic practitioners.”
This statement puts those physicians who practice both allopathic (osteopathic)
and integrative medicine techniques at significant risk of discipline
from their licensing boards, simply because they may use a technique not
recognized by the Board as “standard of care”. Such treatments
will include therapies such as low dose metronomic chemotherapy for a
cancer patient who chooses not to undergo conventional chemotherapy, where conventional
medicine would require an oncologist to administer standard dose chemotherapy.
When insurance dictates which modalities are “covered benefits”
for which conditions, then the line between medicine and business becomes
very blurred. For instance, California’s Kaiser Permanente covers acupuncture
services “when a participating acupuncturist finds that the services
are medically necessary to treat or diagnose neuromusculoskeletal disorders,
nausea or pain.” Nor does the insurance co-pay apply to the plan
Medicare does not recognize any healthcare practitioners other than allopathic,
osteopathic and chiropractic (only for manipulative services of specific
numbers of regions on the spine) and will not reimburse for either services
or testing ordered by homeopathic or naturopathic doctors, even those
practicing within their scope of practice.
The Arizona Board of Homeopathic and Integrated Medicine (ABHIM) has a
much broader definition of Integrated Medicine. The paradigm is one of
treatment of the whole patient, including all the patient’s organ
systems, as well as their emotional well-being and their spiritual aspirations.
The definition of physical modalities includes Orthomolecular and Nutritional
Medicine, as well as acupuncture, electroacupuncture and bioelectric modalities,
herbal medicine, pharmaceutical medicine, minor surgery, manipulative
medicine and chelation therapy.
Nothing less begins to approach adequate for treatment of the whole person.
The paradigm of whole person therapy is far different from the paradigm
of treating a diagnosis.
Integrated Medicine is a far different concept from the application of
a few modalities of therapy upon conventional medical treatment.
Integrated Medicine is a different way of life, a different philosophy,
one that can envision that each of us is a part of a vast Whole, a cell
in a Body larger than any of us, a molecule in a vast Universe of Light.
To that end we dedicate our lives. We have all taken the Hippocratic Oath
when we graduated from Medical School. And for benefit of that Whole of
which we are each a tiny part, we have, in the State of Arizona, the Arizona
Board of Homeopathic and Integrated Medicine.
 Herman PM, Coulter ID. “Complementary and Alternative Medicine:
Professions or Modalities?” with subtitle
Policy Implications for Coverage, Licensure, Scope of Practice, Institutional
Privileges, and Research. Downloaded 6/18/2017 from
 R. D. Mootz, I. D. Coulter, and G. D. Schultz, “Professionalism
and Ethics in Chiropractic,” in Principles and Practices of Chiropractic,
S. Haldeman, ed., New York: McGraw Hill, 2005, pp. 201–219.
 Agocs, Steve. "Chiropractic’s Fight for Legitimacy."
Virtual Mentor 13.6 (2011): 384.