Institute of Medicine Committee Meeting

[Guest guest]

Report on the

Institute of Medicine Committee Meeting

on the

Use of Complementary and Alternative Medicine

December 11, 2003

 

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by Randall Neustaedter, LAc, OMD, CSOMA Director

 

Greetings Colleagues:

 

I was surprised and encouraged by the tone and intent of this meeting.

The committee clearly intends to recommend integrating alternative

medical practices into mainstream medicine. They are examining ways to

accomplish this. The previous meeting focused on medical institutions

that integrate CAM practices. This meeting focused on the integration

of alternative medicine into the medical school curriculum, and current

research projects supported by the IOM in the fields of alternative

medicine. The public observers at the meeting were predominantly from

the fields of homeopathy, naturopathic medicine, and oriental medicine

with representatives present from the NCH, CHC, CHE, AIH, AAOM, CCAOM

(council of acupuncture colleges), AANP, CNME (naturopathic medical

education), ACA (chiropractors), and AHMA (holistic MDs). The meeting.

I was impressed by the openness of the committee members and

presenters, all of whom were from the allopathic medical world, to the

various alternative practices. Their desire to incorporate new ideas

was obvious, and they are genuinely concerned and confused about how to

accomplish true integration.

 

Most of the presenters considered CAM a misnomer because most of the

therapies included in definitions are no longer outside the mainstream

of medicine. They preferred to use the term “integrative medicine.” The

concept of evidence-based medicine was frequently discussed with the

clear recognition that most of conventional medicine is not

evidence-based. However, there is a consistent refrain that peppers

their attitudes and presentations that evidence-based integration is

best, i.e. incorporate those aspects of therapies that have been proven

by research. Insurance companies and HMOs are already limiting

acupuncture, for example, to a limited number of diagnoses where

efficacy has been demonstrated in research studies, e.g. back pain,

nausea of pregnancy. A particularly bothersome point to me is the

lumping together of medical systems like oriental medicine, and

homeopathy with techniques such as relaxation/meditation, massage, and

herbs. Naturopathic medicine is seldom given recognition and

chiropractic therapy is often discounted as well. This focus on

particular modalities rather than professions could limit an equitable

relationship between the mainstream medical world and the other major

medical primary care providers.

 

A few interesting points presented – the budget of the NIH is $277.8

billion (more than the entire budget of South America), more than 50%

of medical students want to learn about acupuncture, and more than 40%

want information about homeopathy, 16.7% of hospitals offer CAM

services, and 24% have plans to offer CAM.

 

One slide, which deplored the emotional dynamics and acrimony in the

debates about alternative practices, particularly revealed the uphill

battle of integration.

 

“Physicians consider CAM practitioners to be frauds with worthless or

dangerous treatments pushed on the vulnerable, ill-informed, and

desperately ill. CAM practitioners say that doctors only treat

diseases, not people, with painful therapies, harmful drugs and

regimens, and never go to the root causes.”

 

A great deal was made about the desire of alternative practitioners to

get back to an older style of the caring physician who is willing to

listen to patients, empathize, show genuine interest, view the whole

person, and act as a role model for patients. The Committee chairman

cited an article that traced these sentiments through the medical

literature, finding that physicians in 1968 thought medicine was too

technological and a more caring attitude was needed, like in the good

old days, same in 1948, same in 1928, tracing this back to one of the

founding principles of the AMA in 1848 which called for a renewal of an

older model of the attentive, caring physician who was less dependent

on technology. My view is that this is a cop-out on the part of doctors

and a way to dismiss time-honored and profound alternative medical

systems, and I said so.

 

Here are the important points discussed about integrating alternatives

into the medical school curriculum. There is no time in the training

for additional courses, and medical students do not want additional

courses. Physicians must learn about alternative methods because

patients ask about them and physicians have completely inadequate,

inept, and uneducated responses. The only effective ways to learn

integrative medicine is to present one medicine (not a belief system),

to retain an open-minded skepticism, to make CAM practices part of the

required curriculum, and to involve CAM practitioners in

interdisciplinary activities. This means CAM practitioners need to be

present in medical schools to teach and to give hands on patient care.

CAM should be integrated into every core area including anatomy

(acupuncture anatomy), pathology (models from oriental medicine), and

treatment. This needs to happen despite the hostility of faculty, the

inevitable conflict with an evidence-based approach to teaching, and

time constraints. The dehumanization of eager and idealistic medical

students in their training programs was discussed at length with the

conclusion that medical students required exposure to CAM in clinical

practice for the benefit of their own healing and mental/spiritual

health. A director of medical education at Georgetown University and

the dean of medical education at Mt Sinai medical school actually said

this.

 

The director of the National Center of CAM Research (NCCAM) at NIH

summarized the studies completed and in process. These can be viewed at

their website www.nccam.nih.gov. He stated that optimal research models

exist to study any CAM modality. Placebo controls are not necessary (as

in surgery, body work, acupuncture). Randomization is not always

possible (e.g. patients who refuse to be part of a group). Even prayer

can be studied. He states that it is “disingenuous for individuals to

say they cannot conform to our guidelines.”

 

Tim Birdsall ND, in his short presentation on standardization within

naturopathic medicine, recommended that a federal Office of Integrated

Healthcare be established to define qualifications and scope of

practice of practitioners because of the variation in state licensure

and the absence of licensure for various professions in many states.

 

In general, committee members seemed extremely favorable to a

considered and reasonable inclusion of alternative therapies into an

integrative medical model. Clearly, most of the committee would place

themselves within the group of 40 to 100 percent of Americans who avail

themselves of alternative practices. It remains to be seen what

practices they will recommend and who they will recommend to include

within specific programs of practice and education.

 

 

 

Chinese Herbs

 

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