Sheila Quinn

1.  Sheila Quinn: "The only valid reason for the Board is to help patients"

Sheila Quinn has held a series of significant leadership positions in the integrative practice movement. She

"Just getting around to reading the submissions on the development of the ABIM. A few thoughts came to mind:

• "Just because a good reason exists to develop a new board doesn't mean that a whole host of other problems and/or benefits can't hitch a ride on the moving train."

  I love the irony of creating a medical specialty for an essentially non-specialized approach to care. One could say the same thing about family practice, which is essentially a specialty for generalists.

• IMHO, the best (and perhaps only valid) reason for developing a new board is to help patients make (better) informed decisions about their clinicians and their health. It CAN be useful for patients to identify practitioners who have met some standards in integrative medicine; otherwise (just as in unlicensed states with NDs), knowing which practitioners really have what you want is difficult.

• Just because a good reason exists to develop a new board doesn't mean that a whole host of other problems and/or benefits can't hitch a ride on the moving train. However, unless the problems seriously outweigh the benefits to the public, I would come down on the "pro" side.

• IFM [Institute for Functional Medicine], uniquely, offers their training and certification (not through a specialty board) to a very broad range of practitioners-those who (1) graduated from an accredited medical, osteopathic, chiropractic, physician assistant, nursing, naturopathic medicine, dietetics, acupuncture, pharmacy, dentistry, or nutrition program in the United States, Canada, or equivalent programs from other countries, (2) hold a current license to practice by the appropriate authority in the applicant's location, and (3) are in active clinical practice. So, there already IS something available for those folks who, by virtue of not having an MD or DO, are not eligible for ABIM. Of course, they do have to learn functional medicine.

• Acknowledging my own bias as a former staff member and now consultant for IFM, I also feel that the value of functional medicine is inherently far greater than that of integrative medicine because (a) it facilitates integration among practitioners and disciplines, not just therapies, and (b) it offers a sophisticated understanding of the causes of disease and presents an innovative set of tools and concepts for individualizing assessment, therapy, and prevention.

• 	"If conventional medicine does indeed coopt what we now think of as integrative medicine, the public will still find its way  to the disciplines it wants."

  If conventional medicine does indeed coopt what we now think of as integrative medicine, the public will still find its way to the disciplines it wants. If integrative physicians offer primarily conventional care plus a few add-ons in nutrition and botanicals, the discipline will not sustain a long life as a real alternative for those who want one. If, however, the development of a board creates greater respect for alternatives in medicine, fueling more research, integrating formal teaching in academic medicine, expanding reimbursement, and advancing integration of practitioners and professions in clinical settings, then I think that's a good thing, even if it blurs the lines between certain professions."

Daniel Redwood, DC

2.  Daniel Redwood, DC: "This is a fundamentally positive step"

"I initially refrained from offering comments about the American Board of Integrative Medicine (ABIM) out of a desire to think it through more deeply and listen to others' responses. Along those lines, I found your '20 Voices' article quite perspective-inducing. As a long-time chiropractic practitioner who has in various eras identified as holistic, alternative, CAM and integrative, and as a chiropractic educator for the last five years, I feel a stakeholder's sense of connection with the continuing evolution of integrative health care.

"Several thoughts:

	"The medical doctors are working to improve the medical and osteopathic  professions. I think this is a fundamentally positive step."

"1. ABIM is organized as a board certification program for MD/DO practitioners, not non-MD/DOs. While many of the people involved in its creation enjoy warm collegial relations with practitioners of various non-MD/DO CAM disciplines, they purposely chose not to set up an interprofessional board. Instead, they are working to improve the medical and osteopathic professions. I think this is a fundamentally positive step.

"2. It should be quite clear that expanding the ABIM certification process to include DCs, NDs, etc., would greatly complicate, if not outright destroy, the chances for ABIM to become an officially recognized medical or physician specialty.

"It is certainly possible that [the MDs] might use ABIM in an effort to control rather than collaborate with[non-MDs]. If so, we can respond as needed.  At present ...Turning our friends into enemies gains us nothing."

"3. Chiropractic, naturopathic, AOM and massage therapy practitioners need not respond with fear or pessimism to this effort by our holistic MD/DO colleagues to more solidly establish their position within the medical and osteopathic professions. It is certainly possible that in the short or long run, they might use ABIM in an effort to control rather than collaborate with us. If so, we can respond as needed.  At present, however, it is an unforced tactical error to assume the worst. Turning our friends into enemies gains us nothing.

"4. In the unfolding health reform process, 'integrative' or 'integrated' care has not yet been well-defined and its definition is likely to remain in flux for at least the next few years. The kind of CAM-friendly definition that ABIM will be advocating is far superior to models of 'integrated' care that involve, for example, integrating conventional rheumatologists, orthopedists, primary care physicians and radiologists, while marginalizing or ignoring chiropractors, naturopaths, acupuncturists and massage therapists for the treatment and/or management of pain. We would be well advised to see the relative pluses in efforts like the fledgling ABIM, rather than preemptively rejecting approaches that fail to meet all of our wishes, hopes and dreams.

"5. Regarding the notion of 'ownership' of holistic /integrative/CAM principles and practices, and concerns expressed by some of the '20 Voices' that the ABIM and its members may be, in effect, stealing something that is not rightfully theirs, now is as good a time as any to state forthrightly that this attitude represents a profoundly flawed approach to integration, holism, healing, health and health care. Whether it's a DC claiming that chiropractors should own spinal manipulation, an ND excoriating integrative MDs for muscling in on what he perceives to be naturopathic ownership of various holistic/integrative principles, or an MD asserting a monopoly on integrative care, such claims are rightly seen by those outside the immediate battlefield as doctor-centered turf protection rather than the kind of patient-centered collaborative model whose green shoots we should all seek to nurture wherever they break through into the light of day.

	"I suggest we give ABIM the chance to show its desire for mutuality and broad collaboration in its relations with other CAM disciplines."

"6. Therefore, I suggest we give ABIM the chance to show its desire for mutuality and broad collaboration in its relations with other CAM disciplines. This does not require that they make us members of their medical specialty group. It does require that they demonstrate, now and in the future, in word and deed, a sincere and openly acknowledged respect for what we all have to offer. This, along with the recognition that no profession has all the answers, that our patients need us to cooperate on a basis of equality rather than hierarchy or hegemony, and that true integration requires us all to stretch beyond our comfort zones on a regular basis."

Kjersten Gmeiner, MD

3. Kjersten Gmeiner, MD: "The ABIM should state an intention to work with CAM practitioners"
 
Kjersten Gmeiner, MD is a former member of the board of the American Holistic Medical Association. She last commented in the Integrator in

"The '20 Voices' is a terrific piece of reporting-- a great read.

"Of course, I notice the loss of 'holistic'. And the absence of an AHMA member on the new Board. And I do not see any of the Functional Medicine leaders. One of the key issues on the table is who will determine who can say they practice 'integrative medicine', and so far the Board is missing some key people.  

"As formulated currently, there is no reason at all to trust that this will be good for non-MD's, or for an integrated and mutually respectful community of diverse practitioners which has always been my ideal/goal."

"I also notice the absence of any non-MD's on the Board.  As formulated currently, there is no reason at all to trust that this will be good for non-MD's, or for an integrated and mutually respectful community of diverse practitioners which has always been my ideal/goal. 

"And I believe it is a realistic fear that empowering an MD integrated medicine specialty will result in decreasing the power of the CAM practitioners, analogous with the waning of the art of Osteopathic manipulation. I would like to see a stated intention for members of this new specialty to spend a significant amount of time, energy, and money empowering and supporting the people who have held and teach these CAM modalities to MD's. [Bolding in orifginal.]

"I will continue to support and promote those that are outside MD-dom (nice word, huh?!). The healing that matters to me these days happens almost exclusively outside/despite Western/orthodox medicine. I have always known I am not one to work inside the system." 

Comment: I am personally in alignment with Gmeiner inasmuch as I believe that this emerging discipline will be stronger if it declares its respect for collaborating with the licensed "CAM" disciplines and "holistic medical" movement out of which "integrative medicine" was born. Otherwise, the movement tends toward the disappearance of roots that, as Gmeiner said, has been the destiny of osteopathy."

Robert Anderson, MD

4.  Robert Anderson, MD: "Will they subscribe to the 10 principles of holistic medicine?"

Bob Anderson, MD, one of holistic medicine's stalwarts, was in touch this past week relative to his new book, Stories of Healing: A Family Doctor's Journal. Anderson is a founder of the AHMA, past executive director of the

"Re:  ABIHM and the "new" board. I haven't been in the loop on the negotiations. One of the issues raised at our last ABIHM board meeting was this:  Do the constituent bodies who would be covered under the new umbrella subscribe to the principles of holistic medical practice which we elaborated early in our existence? I'm sure you've seen them, but if not, I'll attach a copy. [See them at this link.]

"Some of us old-timers raised that issue, which raises the question: Are we substituting a new model (as we initially conceived) or instead addressing a variant of the old model? My Bastyr students call the latter 'green allopathy,' with the implication that the model hasn't really changed, and that we've only substituted neutraceuticals and botanicals for

Bill Manahan, MD

4.  Bill Manahan, MD: "Thanks for this series of comments"
 
Comments from

"Thanks so much for this really interesting series of comments, John.  I loved your comments and especially this one when you stated, 'This is not appropriate,' and 'lucrative is off target' and 'big egos are often associated with good things.' Way to say it like it is.

Comment: Cooper and others personalize their commentary around the persona of University of Arizona Center for Integrative Medicine (ACIM) founder Andrew Weil, MD. This is not appropriate. There are now 800 graduates of the University of Arizona fellowship. In ACIM executive director Maizes' reasonable telling, many of these were calling for this direction long before ACIM engaged it. Personalizing this as a move by Weil diminishes it. This is a classic step of an emerging discipline.

Cooper's focus on how 'lucrative' this is also strikes me as off target. Weil does not financially benefit from the Center. In fact, he donates roughly a quarter of a million a year to the program. He is investing in something that may swell the historic importance of his work. Big egos are often associated with good things. Who isn't seeking to have more rather than less positive impact?

	"My dream is that within ten years there will be thousands of small clinics with about 5 caregivers from different disciplines working together to help patients heal."

"Anyway, there is lots of room for a good discussion about this topic.  My dream is that within ten years there will be thousands of small clinics with about 5 caregivers from different disciplines working together to help patients heal.  The caregivers will be an MD/DO, an ND, some type of bodyworker, an energy worker, and and body/mind psychology type of practitioner. Then there could also be Ayurvedic or Chinese Medicine practitioners as part of the group. They will meet weekly to discuss patient cases and to learn from each other.

"We already have a few of these practices in Minnesota and I know that other states also have them.  The practitioners are happy and the patients are really pleased about them.  Working out payment systems and the crazy insurance system is now the biggest problem, but time and patient unrest will hopefully help heal that mess."