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 Integrator Forum: Does the Landmark Report Integrative Medicine in America Actually Portray Integrative Medicine in America? 
 
The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series
Summary: The publication by the Bravewell Collaborative of Integrative Medicine in America: How Integrative Medicine Is Being Practiced in Clinical Centers Across the United States proved successful in generating substantial media attention for the emerging field. Yet the report looked only at the services in 29 clinics sponsored by health systems. Most are associated with academic health centers. However, the vast majority of consumer experience of "integrative medicine in America" is through community-based practices of holistic and integrative medical doctors, naturopathic doctors, functional medicine practitioners, holistic nurses, board scope chiropractors and others. Does this report correctly represent the field? Does it misrepresent? What would be different if a report focused on community-based practices? All responses will be included in an Integrator forum.

Would you, as an integrative practitioner, guess that academic medical and other health system-sponsored "integrative medicine clinics" reflect the typical, community-based practice of integrative medicine?

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Bravewell's landmark 2012 report: But does it report what it claims?
Consider the question differently: Do you think a consumer or policy maker would get an appropriate sense of "integrative medicine in America" by examining what mainly academic medicine-sponsored clinics provide?

A fascinating new report suggests that you and the consumer should anticipate significant equivalence. The intriguing and useful document is entitled
Integrative Medicine in America: How Integrative Medicine is Being Practiced in Clinical Centers Across the United States. It is available to read or download at www.bravewell.org.

This beautifully crafted report, sponsored by the Bravewell Collaborative of philanthropists in integrative medicine, is based on surveys and interviews. They chose to limit the survey to a hand-picked set of 29 hospital-sponsored and often academic health system-sponsored clinics.

This is the face of integrative medicine that the Bravewell favors. This group of philanthropists substantially founded and has backed for a decade the now 51 medical school-member Consortium of Academic Health Centers for Integrative Medicine.

But does the title mislead readers? Does the report reflect the services consumers are likely to receive if they follow an advertisement or website that draws them to your own "integrative medicine" services?

The authors explain their selection criteria for the 29 clinics on page 53, just before the appendices, under "Challenges and Limitations".
The centers selected to be surveyed were those that provided an integrative model in which conventional medicine plays an essential role. While these centers do, to some extent, provide care drawn from other health systems - including naturopathy, chiropractic, Traditional Chinese Medicine, Ayurveda, or homeopathy - centers whose sole orientation is to deliver healthcare from these non-conventional medical systems were excluded. The authors acknowledge that the responses may have been different if another cohort of centers was surveyed.
The language does not catch how narrow was the sample they chose to report. Left out of the study set is the vast majority of what is being called "integrative medicine" these days.

Not included, for starters, is the lion's share of the nearly 800 M.D. graduates of the Fellowship in Integrative Medicine at the University of Arizona. What are these graduates offering in their clinics and practices? Nor can this sample include but a very tiny percentage of the 1500 M.D.s and D.O.s who are board certified through the American Board of Integrative Holistic Medicine.

No doubt, "conventional medicine plays an essential role" for these M.D. and D.O.s who are Fellows in Integrative Medicine, Board Certified in Integrative Holistic Medicine, or both.

And how does an honest survey of "integrative medicine in America" not include the medicine practiced by another set of some 3000 licensed physicians. There have practices in which conventional pharmaceutical prescription authority is combined with delivery of a broad array of "complementary and alternative" natural therapeutics. This number is an estimate of the licensed naturopathic physicians (N.D.s) in those states where they have gained broad pharmacy rights. For instance, here is the scope language on the Washington Association of Naturopathic Physicians site:
Naturopathic physicians (NDs) are trained to provide primary care and/or naturopathic specialty care to patients of all ages. NDs see patients with acute and chronic conditions and employ all standard conventional diagnostic tools including physical examination, laboratory tests, and imaging. NDs may utilize additional physical and laboratory procedures to assess nutritional status, metabolic function, and/or toxic load, while considerable time may also be spent assessing mental, emotional, social and spiritual status to assure any treatment plan is comprehensive.

NDs use a variety of therapies to promote health and treat disease including: dietetics, therapeutic nutrition, botanical medicine, physical medicine, naturopathic manipulative therapy, lifestyle counseling, exercise therapy, homeopathy, psychological and family counseling, and hydrotherapy. NDs can perform minor office procedures appropriate to a primary care setting, administer vaccinations, and prescribe most standard drugs when indicated. Like other primary doctors, NDs delegate to nurses and medical assistants and refer to specialists when appropriate.
This looks like "integrative medicine" - and is worth noting in part due to the numbers. The two sets of integrative MDs noted above total fewer than the number of NDs with a scope like this. Does this study reflect the "integrative medicine" consumers receive from these N.D.s?

Then there are the subsets of broad-scope chiropractors, functional medicine doctors, advanced practices nurses and licensed acupuncture and Oriental medicine practitioners who, while clearly outside the study's scope, sometimes present themselves in their communities as part of "integrative medicine in America."

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The financial energy behind the movement for IM in academic health centers
The Bravewell report provides exceptional insight for anyone curious about health system-sponsored integrative clinics. It fills huge gaps. One rifles through tables of detail about the heretofore poorly-described phenomenon represented by these clinics. One finds frequency of use charts for 34 separate therapies broken out by 20 conditions. Another chart reports the types of practitioners likely to be employed in these settings. Yet another shares the conditions for which the authors found the least "differentiation of treatment." Your guesses? The former are "heart and hypertension" and "heart and diabetes"; the latter are all acute pain related.

In addition, business models are described. We see the chances that a given service is paid via cash or through insurance. The authors explore "Core Values". For instance, how many of the clinics do you suppose agree that "we use the least invasive and most natural remedies first"?

But does one get what is promised in the title, Integrative Medicine in America?


Enjoy this report on Integrative Medicine in Health System-Sponsored Clinics in America. It's a fascinating look into a subset of mainstream medicine's adaption to the consumer movement and community-based practices that startled organized medicine nearly 2 decades ago.


I invite readers who practice "integrative medicine" or are familiar with "integrative medicine" as offered in other venues to examine this study and share whether it reflects community experience. Are these aligned with your practice or care you have received? Do you think this report reflects what it promises in the title?

Take a look and send any of your thoughts about this study to johnweeks@theintegratorblog.com. I'll compile and report back.


Send your comments to johnweeks@theintegratorblog.com
for inclusion in a future Your Comments Forum.
      
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 About The Author
Resumes are useful in employment decisions. I provide this background so that you may understand what informs the work which you may employ in your own. I have been involved as an organizer-writer in the emerging fields......moreJohn Weeks
 
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