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[1] 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[2] in the course of their antitrust suit against the American Medical Association (AMA) in 1976.[3] 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.[4]
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,[5] which resulted in the virtual destruction of the practice of homeopathic medicine in the United States.[6]
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)[7] 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 physician must 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 committee.
“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.[8] 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 deductible.
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.
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.
[1] 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 Here.
[2] 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.
[3] Agocs, Steve. "Chiropractic’s Fight for Legitimacy." Virtual Mentor 13.6 (2011): 384.
[4] Download here downloaded 6/18/2017.
[5] Flexner A. Medical Education in the United States and Canada: A Report to the Carnegie Foundation for the Advancement of Teaching; Bulletin No. 4. New York: Carnegie Foundation for the Advancement of Teaching; 1910.