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? 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?
By John Weeks
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?
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. Does this study reflect the “integrative medicine” consumers receive from these N.D.s? hen 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.”
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? I invite readers of this column who practice “integrative medicine” or are familiar with “integrative medicine” as offered in other venues to take a look at this study and share whether it reflects your experience. For instance, do these findings reflect community practice?
- Of the 20 conditions for which Clinic directors “believed their practitioners treated most successfully with integrative strategies,” the following were most frequently listed in the top 5: chronic pain (75%) followed by gastrointestinal disorders (59%), depression/anxiety (55 %), cancer (52%) and stress (52%).
- Of the 20, the bottom quartile of those conditions being listed in the top 5 are arthritis (14%), heart disease (13%), ADHD (11%), asthma (9%) and hypertension (7%).
- 62” offer “lifestyle change programs” and in 28% “health coaching” is an option.
- “Food/nutrition” and “supplements” rank #1 and #2 for the frequency of use across all 20 conditions. These are followed by Yoga, meditation, TCM/acupuncture and massage.
- Among all therapies, pharmaceuticals” hold the seventh place in frequency of use.
Are these aligned with your practice or experience? 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 firstname.lastname@example.org. I’ll compile and report back.
Meantime, 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.