Amidst of the waves of information on local, national and global developments related to COVID-19, efforts stand out of a few organizations to capture and bundle content that targets the integrative practice communities. Among the entities that have established resources pages are the University of Arizona Andrew Weil Center for Integrative Medicine, the American Association of Naturopathic Physicians, and the American Nutrition Association. In contradistinction to the advisories of the United States’ federal agencies and state governments, these organizations have in common that their leaders believe that there is more that an individual can do than “healthy waiting” (sleep, exercise, don’t smoke, limit sugar) as the virus continues its course through their communities. Each organization directly suggests multiple steps that might be indicated, and the science supporting it.
When members of Congress established what is now the NIH National Center for Complementary and Integrative Health, they cared about whole things. Eight times in two pages, the new Center was charged to examine not just basic research or reductive trials on individual modalities. They pointedly sought to turn the NIH’s attention to the value of complementary and alternative “systems and disciplines … in health care delivery systems in the United States.” This shift of focus was resisted. The first director Stephen Straus, MD famously shouted down his former NCCIH advisory council member Carlo Calabrese, ND, MPH when Calabrese courageously asked for research whole disciplines and whole practices like those of licensed naturopathic and traditional Chinese medicine practitioners. All integrative disciplines urged Straus’ successor Josie Briggs, MD to focus her 2011-2015 strategic plan on “researching the way we practice”. Briggs showed interest but showed no one the money to engage these questions. So when the NCCIH’s current director Helene Langevin, MD opened the NCCIH 2021-2025 strategic planning process with a February 18, 2020 video-cast webinar by focusing on “whole person health,” there was, among many, a great deal of anticipation and pent-up-demand. What might this mean?
First, some self-declarations. Since 1992 I have benefited financially from in-office sales of dietary supplements via the integrative medical practice of my spouse. On multiple occasions over 30 years, I have helped mount or been associated with medical conferences in which the business model relied on exhibits from dietary supplements companies. I have in multiple instances secured grants from natural products companies to support initiatives of various professional organizations, research projects, and for The Integrator Blog. Such relationship are often the rule across the functional, naturopathic, integrative, chiropractic and traditional Chinese medicine communities. What’s new now is that those involved in integrative and functional medicine continuing medical education are increasingly in the spotlight of the Accreditation Council for Continuing Medical Education (ACCME) via new application of old rules, and new ACCME rules under consideration. These may – for better and for worse – shake-up the way integrative CME is offered, and potentially not only for medical doctors.
Should accredited continuing medical education providers for integrative medicine be prohibited from training medical doctors to practice integrative modalities that aren’t “generally accepted within the profession of medicine as appropriate for the care of patients”? What impact might this have on efforts – for instance – to shift chronic pain treatment toward non-pharmacologic approaches that most of medicine doesn’t “generally” include? Might giving arbiters of science in a disease model this power put the brakes on efforts to shift clinical care from managing disease to creating health? These other significant questions are on the table for the integrative health field as the Accreditation Council for Continuing Medical Education (ACCME) posts its draft revision of accreditation standards. The changes, targeting issues throughout CME, have particular challenges for the integrative medicine field. The comment period closes February 21, 2020.