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CAM practitioners react to Andrew Weil’s proposal for a board certification for integrative medicine. It isn’t (all) pretty.

About a month ago, I discussed a rather disturbing development, namely the initiative by Dr. Andrew Weil to set up something he was going to call the American Board of Integrative Medicine, all for the purpose of creating a system of board certification for physicians practicing “integrative medicine” (IM), or, as I prefer to call them, physicians who like to integrate pseudoscience with their science, quackery with their medicine. Harsh? Yes. Accurate? Also yes. Unfortunately, many medical centers, both academic and community, are hopping on the IM bandwagon while more and more medical schools are “integrating” pseudoscience into their curricula. While one might expect Josephine Briggs of the National Center for Complementary and Alternative Medicine (NCCAM) to be cozy with IM, depressingly, even current director of the National Institutes of Health, Francis Collins, seems to have fallen into the trap.

As was admitted by Dr. Weil and his colleagues, this decision to create a board certification in IM was a huge about-face in that Weil had always argued that IM should be infused into all specialties of medicine. What happened, of course, is that once again marketing won out over idealism. Dr. Weil was concerned that there were lots of physicians and practitioners out there claiming to practice “integrative” medicine, many of whom had no qualifications in the field. At this point, the wag in me can’t resist pointing out that, given that IM “integrates” pseudoscience with science and that there really are no standards, scientific or otherwise, to guide IM practitioners (mainly because so much of IM is rank pseudoscience), why would this matter? The answer, again, comes down to branding and turf protection.

All of this is why seeing the reactions to Dr. Weil’s initiative from members of the “complementary and alternative medicine” (CAM) and IM community is very instructive. Fortunately, John Weeks of the Integrator Blog has come through again, quoting over twenty different people, including physicians, naturopaths, chiropractors, journalists, and other IM practitioners in an article entitled, appropriately enough, Integrator Forum: 20 Voices on Weil/U. Arizona and the American Board of Integrative Medicine. Yours truly is even mentioned (disparagingly, of course).

Uncharacteristically (for me), I’ll cut to the chase and tell you the results before I show you some of the quotes (with, of course, my own translation of what the IM-speak really means). Basically, physicians practicing IM tend to love what Dr. Weil is doing. All other practitioners (chiropractors, naturopaths, etc.) hate it. Of course, that’s not a big surprise given that Weil’s plan would in essence cut out all non-physician IM practitioners from being able to call themselves “integrative physicians” or, at the very least, to relegate them to a lower, non-board-certified rung in the practice hierarchy, which, I suspect, was the point all along. Andrew Weil wants IM to be “respectable,” and to him it will only become so if the riff-raff (i.e., non-physicians) are excluded.

A typical reaction from MDs can be found from doctors like Patrick Massey, MD, PhD, the medical director for complementary and alternative medicine for the Alexian Brothers Hospital Network. (Remind me never to use an Alexian Brothers-affiliated hospital) In any case, Dr. Massey, a graduate of Dr. Weil’s IM residency, is very happy:

Certification is a topic that is long overdue.

Integrative medicine is a complex area of medicine that incorporates many aspects of traditional and nontraditional medicine: formal education is important. Considering how many people are blending medicine on their own, it is important for them to have qualified physicians to make sure they are not doing anything dangerous.

It cannot be done by primary care physicians. They are barely able to keep abreast of the recommendations for diabetes, HTN and CAD. Integrative medicine is not remotely in their sphere of expertise, nor the expertise of PAs and NPs, unless specifically trained in integrative medicine.

Again, one wonders what science-based standards exist to guide IM practitioners. I’ve asked the question before many times: When do you choose acupuncture versus, say, homeopathy? Or will MD IM practitioners finally admit that homeopathy is nothing more than pure quackery with no basis in basic or clinical science but a huge basis in prescientific magical beliefs? Or how do you know what herb you should use? Or when is chiropractic more appropriate than other therapies? They don’t know. There’s no real science behind many of the modalities that fall under the rubric of IM.

One physician, Richard “Buz” Cooper, MD, pointed out something that, quite frankly, hadn’t occurred to me but should have:

This is just one more of example of Weil’s entrepreneurial reach. It will enhance his 1,000 hour costly and profitable training program. He is pursuing it through a rump group, the American Board of PHYSICIAN Specialties [ABPS], which “certifies” a few marginal specialties (e.g., urgent care), rather than through the American Board of MEDICAL Specialties [ABMS], the recognized authority, which certifies legitimate specialties and which apparently has turned down the idea of certifying Weil’s Integrative Medicine. Tainting the emerging discipline of Integrative Medicine with ‘Weil’s Entrepreneurism’ will push it in the wrong direction and be a disservice to generations of patients.

You know, I really should have thought of this one myself when I wrote my first post on this issue. Dr. Cooper makes a devastatingly accurate point about how Dr. Weil has chosen to seek board certification for IM through a less-than-respected board, namely the American Board of Physician Specialties. It’s very obvious that the ABMS wouldn’t be interested in Dr. Weil’s plan; so he looked elsewhere. Weeks, ever the Weil apologist, criticizes Dr. Cooper for “personalizing” his commentary against Dr. Weil. While this is to some extent a legitimate point, it’s also legitimate to point out that Dr. Weil’s residency program in IM would become a whole lot more desirable, both to graduating medical students and, more importantly, to the medical schools and residency programs to which Weil franchises his program, if IM became more respected as a specialty and especially if there were a real board certification in the specialty. (The two, of course, often go together.) Moreover, there’s more to personal interest than just money. Weil is an ideologue who wants to spread his “faith” of IM to as many people as possible. Indeed, Weeks basically admits this in response to Dr. Cooper when he points out, “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?” And IM is lucrative, as are Weil’s many, many other business interests related to IM.

Interestingly, and perhaps not surprisingly, those most vociferously opposed to Dr. Weil’s program were all chiropractors. I say “not surprisingly” because of the history of battles between chiropractic and the American Medical Association. For example. chiropractor Lou Sportelli comments:

Look at the Medical board of this proposed group, I care not who they are, but what they know. It will take a lot of convincing to get me to believe that this is nothing more than the old medical model at work in three stages.

  1. Condemn
  2. Investigate
  3. Take over

The AMA was notorious for doing this to any thing that was not allopathic. This is their modus operandi and they had been successful with it until folks got wise.

Dr. Weil and his new idea are not so novel, but are highly suspect. Sounds like a lot of hype and no substance

Chiropractor James Winterstein:

[This is] an interesting move on their part. Down deep, I fear it is more of the same – dominance at all costs – in a circumstance over which they have had little control (the interest by the public in alternative medicine). Now, they form a specialty and take it [over]. I hate to say it, but I think that is a likely probability. We have already seen them work toward usurping our ‘tools.’ I don’t like the sound of this, John.

Chiropractor and homeopath Nancy Gahles:

You KNOW [the MDs] will get the juice because they are the REAL doctors. The ones you can trust. What do they even study to make them ‘integrative’? Homeopathy? NO. Functional medicine…betcha! Little nutraceutical is now the new Big Pharma. Please tell me I am dead off base here, please!

My comment is that this looks like a duck, walks like a duck and acts like a duck: co-opting integrative healthcare, calling it integrative MEDICINE and creating a Board Specialty will identify integrative healthcare with medical doctors and they will own it, be reimbursed for it and thereby drive consumers to use them only as they will get insurance for it.

One notes that Gahles is described as someone who “has been the modern leader in pushing the field of homeopathy into the nation’s health policy dialogue” as the president of the National Center for Homeopathy. I never thought I’d be in partial agreement with a homeopath, but what Gahles says is more or less what I said in my previous post when I pointed out that Weil’s desire to infuse all medical specialties with his woo apparently can’t stand up to the cold, hard reality of how medicine really works. I’ve also pointed out that excluding the real woo, such as homeopathy, from IM is but a tiny first step in trying to make the specialty into something respectable.

Perhaps the most amusing retort from a chiropractor comes from Stephen Marini. Unfortunately, it’s not amusing because it’s a devastating criticism of Andrew Weil and the concept of board certification for IM. It’s unintentionally hilarious because…well, just read for yourself how he describes himself as “a vitalist trained in classical science and conventional medicine” who appreciates “the role of energy/information on an individual’s health and healing processes.” Also note that the link to information on Marini used by Weeks comes from an entry on that repository of all pseudoscience and conspiracy theories Whale.to and that Marini is on the board of directors for the International Chiropractic Pediatric Association (ICPA). With that background, you can truly appreciate Marini’s criticism of Dr. Weil in its proper context:

The concept of a medical specialty in integrative medicine is inherently contradictory. The paradigm of conventional medicine is reductionistic, hierarchical, & mutually exclusive to other paradigms of health and healing. So to ponder the concept of such a medical doctor would require drastic changes on a medical, anthropologic, sociologic, political levels etc…..

What is needed within a complementary system is a new species of health care provider that can appropriately triage a patient with regard to Era 1, Era 2 & Era 3 health care components.

If Era III reminds you of this, you will be forgiven. So what does Marini mean by “Era 3″? Apparently this:

  • Era I Medicine: Allopathic Therapies. Paradigm: CHEMISTRY – STRUCTURE – FUNCTION
  • ERA II Medicine: Holistic/Holoenergetic Therapies. Paradigm: ENERGY – CHEMISTRY – STRUCTURE – FUNCTION
  • ERA III Medicine: Intercessory Therapies. Paradigm: UNIFIED – ENERGY – CHEMISTRY – STRUCTURE – FUNCTION FIELDS

I say this in particular because following another link from the Whale.to entry on Marini leads to a statement that Marini provided to Jochim Shafer, who apparently wrote a book entitled The Trial of the Medical Mafia, in which Marini states bluntly that there ” is no credible scientific evidence to negate the hypothesis that vaccines cause immediate or delayed damage to the immune and nervous systems of children resulting in a rise in auto-immune and neurological disorders including asthma, learning disabilities, hyperactivity, autism, chronic fatigue syndrome, lupus, diabetes, epilepsy, multiple sclerosis, Guillain-Barre Syndrome, and other diseases.” He concludes that the “universal compulsory vaccination of all healthy children should be halted.”

You know, I think I’ll stick with Era 1 medicine, thank you very much, especially if in Era 3 medicine I have to rely in intercessory therapies and am not allowed to vaccinate children against infectious disease. After all, intercessory prayer has been shown more than once not to work, and vaccines have arguably saved more lives than all other science-based medical interventions combined. Say what you will about Andrew Weil (and we at SBM have certainly said a lot), I’ve never perceived him as being anti-vaccine. Marini clearly is.

In the five weeks or so since I wrote the first installment about Dr. Weil’s initiative to develop a board certification for IM, I’ve thought a bit about what the intent might be and what the consequences might come to be. The more I think about this, the more I think that the chiropractors and naturopaths who don’t like the plan are probably perceiving it quite correctly. It is a dagger aimed right at their hearts, and it is MDs who are holding the hilt. Dr. Weil’s denials notwithstanding, led by Dr. Weil, the pro-woo physician contingent is trying to make sure that no non-physician specialty can claim to be “integrative physicians.” It’s a big deal, too. If you don’t believe just how much it matters to non-physician CAM/IM practitioners to be able to claim the title “physician,” read this revealing article by John Weeks himself.

As I said before, this in and of itself might not be that bad a thing in that many of the practitioners being targeted base their practices on nothing more than prescientific vitalism tarted up with science-y-sounding language. Certainly acupuncturists, chiropractors, homeopaths, and, yes, naturopaths do this. Making it harder for them to practice their non-science-based placebo medicine is probably a good thing, as would be increasing the scientific rigor of what passes for “integrative medicine” now.

Unfortunately, I don’t see that happening. What I do see happening is that, like the Thing in John Carpenter’s famous 1982 movie of the same name, Weil will try to kill off the non-physician “integrative” practitioners but after doing so he will take on their appearance, just as the monster in The Thing took on the appearance of the people it killed. (Hey, it’s Halloween; I had to pick a horror movie metaphor.) In doing so, he will then permanently infect the entire body of academic medicine with the virus that is IM. At least, that is his plan. He has, after all, said as much.

Posted in: Politics and Regulation, Science and Medicine

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10 thoughts on “CAM practitioners react to Andrew Weil’s proposal for a board certification for integrative medicine. It isn’t (all) pretty.

  1. daijiyobu says:

    For those interested in that oh-so-archaic essential vitalism which defines naturopathic medicine, here’s a list I have going of North American AANP-CAND types’ state organizations affirming such:

    http://animatisticnapantheisms.blogspot.com/

    I called the page, in 2006, “animatistic new age pantheisms” because, in fact, when I was in naturopathy school we were taught that that “vital force” or “vis medicatrix naturae” within you is also “god power within you.” Yes, in a school labeled of “health sciences” and “not a belief system”.

    Vitalism relates to animatism (see http://en.wikipedia.org/wiki/Animatism ), since supposedly that power running your body is a spirit force you can manipulate [or at least an ND / NMD can], and since that is equated with god and supposedly vital-force is everywhere, therein pantheism (see http://en.wikipedia.org/wiki/Pantheism ).

    Anywho, not science or supported by science in any manner — and the heart of naturopathy according to their Textbook of Natural Medicine which is still up in full on scribd.com, though I wont’ put the link here since I’m not sure that that downloadable version violates copyright. ;)

    -r.c.

  2. nybgrus says:

    It is a dagger aimed right at their hearts, and it is MDs who are holding the hilt. Dr. Weil’s denials notwithstanding, led by Dr. Weil, the pro-woo physician contingent is trying to make sure that no non-physician specialty can claim to be “integrative physicians.”

    this is actually interesting. The oft mentioned IM professor at my school of medicine and I had an after lecture convo once. In very brief, I basically asked him what the hell he was doing and why. His response was that he wanted to co-opt all the “CAM” that “works” and drive all those shysters and their woo out of business. He felt that the best way was from within. In essence, it really was exactly like your characterization of Weil in this article. He then proceeded to tell me he thought there was “something” to reiki and that acupuncture was for sure awesome. So he lost me there. When I called him on the evidence, he asked my name, said I was a smart kid, and then suddenly had a meeting to run to.

    I agree though, that while completely co-opting CAM by MDs would be a death knell for sCAMsters, it is certainly NOT a good idea. We need to stand for rigor and evidence in our profession, and such a Machiavellian undertaking (intentional or not) has no place amongst us. Besides, I doubt that it will happen, drive sCAMsters away and then Weil et al will pop up and say “Haha! Just kidding! This stuff is garbage… we just wanted to drive you out and prove it.”

  3. ConspicuousCarl says:

    Why does Marini set his standard so low? What we really need to work towards is Era IV: Time Cube!

    The whole concept of “integrating” CAM and real medicine is crazy not just from the science point of view, but from the CAM point of view as well. If energy medicine or homeopathy were real, there wouldn’t be any reason to get an MD.

  4. daedalus2u says:

    I think this is a great idea. Of course only MDs can practice Integrated Medicine. If you are going to integrate something with Medicine, first you have to understand Medicine and then you can figure out what aspects of CAM can be integrated into Medicine.

    What is needed is some reliable testing to see which MDs are competent to be the gate keepers of the whole of CAM to the medical community, and who then sets what the “standard of care” for CAM actually is.

    I can think of several MDs (Drs Gorski, Atwood, Hall, Novella, etc.) who are already expert across the whole spectrum of CAM and so would be eminently qualified as to when and for what conditions a particular type of CAM is the “standard of care” treatment (that would be none, so far as has been determined by reliable testing, but who knows what future testing might indicate ;) ).

    Once there is a “standard of care” for CAM, and that “standard of care” is determined by MDs, then using CAM when there is a superior allopathic treatment is malpractice. Even suggesting CAM when there is a superior allopathic treatment is malpractice. There could even be stings, where patients go to MDs, get prescribed CAM instead of real medicine, complain and get payouts.

    The lawyers will be chasing CAM pushing MDs and not just patients with bad outcomes.

  5. pmoran says:

    This IS weird, because “alternative” medicine is at heart reactionary, anarchic, “of the people”, always ready to challenge the established order, “give everyone a fair go”, “try it for yourself and see”. Integrative medicine is, in effect, going against the “mainstream” of CAM, a new idea for me too.

    Is Weil’s idea a good thing or not? I suspect it hardly matters. Any adverse effects through conferring a little legitimacy on some of the softer and fluffier aspects of CAM will probably be offset if it leads to more level heads having a greater influence within CAM.

    Says Weil on cancer: ” If you’re dealing with cancer, I urge you to first determine what conventional therapies have to offer.” I can forgive a lot for that.

  6. ConspicuousCarl says:

    pmoran on 31 Oct 2011 at 7:59 pm

    Says Weil on cancer: ” If you’re dealing with cancer, I urge you to first determine what conventional therapies have to offer.” I can forgive a lot for that.

    We should be careful not to lower our standards in response to the irony of someone like Weil making that recommendation.

    If a patient asks a doctor, “what should I do if I have cancer?”, it would be absolutely CRIMINAL not to tell them to first look for treatment based on a 21st-century understanding of the disease.

    And even if it weren’t a doctor who was asked, it isn’t uniquely helpful advice. Weil’s statement which you quoted could be made by almost anyone of any education level without promoting bunk on top of it. In fact, if not for the common promotion of the kind of nonsense which Weil promotes (as softly as he may do so), it wouldn’t even be necessary for him or anyone else to tell cancer patients to try real medicine instead.

  7. geack says:

    I followed the link to Weeks’ article on the use of the title “Physician”. Revealing is the right word. Greed is everwhere, of course, and the greed of the true unabashed quacks of the world is expected. But it was jarring to see someone who claims to represent the professional side of CAM write things like:

    “Professions so denominated stand at the top of the hill, waving about highfalutin reasons why their recognition as such is in the public good. The sub-text includes the know motivator that the title lands one on the road to the bank… Perhaps Webster can help us sort this out. I read 2 definitions while writing this column. Notably, neither states that “physician” denotes a practitioner who stands at the receiving end of medicine’s money shoot (sic).”

    I assume he meant “chute”.

    In reading the whole thing, it becomes clear that these people sincerely believe that scientific medicine is wholly and entirely a protection racket. The shallowness of this view of the situation explains a lot.

  8. OkieBlue says:

    You know this certification thing is a problem for voodoo practioners, psychics and witch doctors too. How do you know if they’re fully qualifed unless they have been certified and licensed by the state?

  9. Werdna says:

    From where I sit, there are three possible outcomes here:

    1) A pretense of an standard of evidence will be raised for IM. In other words, we all know you can’t subject IM to SBM and EBM standards without eliminating or relegating it to a position subordinate to standard care. So the only way to include any of these things is to relax evidence standards or provide ridiculous equivalencies (i.e. 100 yr old Chinese textbooks are equivalent to RCT’s)

    2) Ostensibly no standard of evidence which will simply provide the thinnest facade of respectability to IM practitioners.

    3) Nothing.

    I would be willing to bet on 1 – partially because I’m always surprised how much people want to both embrace evidence but are willing to sacrifice their pet theories and it reminds me what Canada did with it’s NHP legislation.

    I recently looked at the requirements for a local place that certifies “Registered Nutritional Practitioners” – http://www.instituteofholisticnutrition.com/ – the course load (and obviously the content) is laughable. It’s four hours a day, four days a week for a year. Only one course in biological chemistry – and it’s 32 hours long (the courses run over lunch so I wonder if this is straight four hours of work). This is less than a high-school course in biology or chemistry and there are no pre-requsites.

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