After publishing on challenges the Accreditation Council for Continuing Medical Education (ACCME) is presenting to the integrative and functional medicine continuing medical education (CME) providers, I sent links to Graham McMahon, MD, MMSc, the organization’s president and CEO to request an interview. Multiple integrative CME providers with decades delivering integrative CME have lost or are facing potential loss of recognition. They have shared serious questions of transparency and intent on ACCME’s part. Some efforts to connect with ACCME have been rebuffed. Is integrative medicine being targeted? In my request for an interview, I provided McMahon some background on concerns. McMahon responded immediately, and affirmatively. We spoke for over 30 minutes via zoom on February 5, 2020. His responses included a surprising assertion that he believes the present ACCME is aligned with integrative medicine principles and practices. He committed to open dialogue in ACCME’s move “from cop to coach.” He underscored that the new proposed language is yet open for comment. I assembled our exchange in the following interview format and sought his edits and written replies to additional questions, then secured his approval prior to publication.
Long-timers in the integrative trenches will know the paradoxical feelings of dismay at how messed up health care still is and at the same time satisfaction at just how far “integration” has advanced. Evidence for the latter comes from not one but two recent moves in the career of chiropractor and health services researcher Christine Goertz, DC, PhD. Place yourself in 1988. The chiropractors were just concluding their decade-long, successful Wilk vs. the AMA anti-trust suit. Most of medicine and much of the media – in part because of the AMA’s economically-driven attacks – equated “chiropractor” with “quack”. Now consider where Goertz has arrived via her health services research and policy career that focused on safety, effectiveness and quality issues. She was recently named by the General Accounting Office as Chairperson, Board of Governors, for the Congressionally-funded, quasi-public Patient Centered Outcomes Research Institute (PCORI). And Goertz just began a new role as Professor and the Director of System Development and Coordination for Spine Health at Duke Health in the Department of Orthopaedic Surgery. I reached Goertz to talk with her about her dual ascension.
The idea that “the first is the last and the last the first” was a value in my liberal Protestant upbringing. It likely had some noblesse oblige in it too. The concept can be challenged as an entrapping promise that good will come of waiting. Regardless, in some the call to work with the least-cared-for becomes a guiding mission. Self-preservation of the integrative field may be another motivator of such a mission. A past head of the NIH agency that researches integrative practices has challenged the main body of clinical research as un-generalizable due to the research being on upper income, well-educated, white, female patients. For a multitude of reasons, Integrative Medicine for the Underserved (IM4US) has emerged as the leading edge of the movement for integrative health.
Environmentalism as a value pulled me toward the job that drew me into integrative medicine 35 years ago. Part of the magnetism was learning that a primary charge in the field with which I was deciding whether to become involved was to aid and abet the healing power of nature. I surmised that such teaching would make patients of such doctors acolytes of the environment if they weren’t already. For this and other reasons, the environmental movement’s still limited embrace of the broader integrative domain as a core ally has continuously surprised me. If it is science one needs to bind these together, a recent Grand Rounds at Harvard Medical School included intriguing arguments. Peter Wayne, PhD, the interim director of that institution’s Osher Center for Integrative Medicine locked the two movements together through an array of existing, emerging and suggestive evidence.