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1. Integrative Medicine: The “New” Standard An Introduction to the Colorado Integrative Medicine Consortium John C. Hughes, D.O. Aspen Integrative Medicine May 24, 2010 Sponsored by Fairway Physicians Insurance Company

2. Integrative Medicine: The “New” Standard  Integrative Medicine: A Test of Roots  Integrative Medicine: A Standard  What is considered integrative medicine?  Who is practicing integrative medicine in Colorado?  National organizations promoting integrative medicine  Legal ramifications of practicing integrative medicine

3. Integrative Medicine: A Test-Q1  Where did this statement come from?  Nondrug therapeutic intervention is indicated in all patients with sustained hypertension and probably in most with labile hypertension…these measures include the 1) relief of stress 2) dietary management 3) regular aerobic exercise 4) weight reduction (if needed) 5) control of risk factors contributing to atherosclerosis

4. Integrative Medicine: A Test-Q1  A) Eight Weeks to Optimum Health by Andrew Weil, MD  B) Integrative Cardiology by Vogel and Krucoff  C) Program for Reversing Heart Disease by Dean Ornish, MD  D) The Arginine Solution by Fried, Merrell, and Thorton  E) Nutritional Medicine by Alan Gaby, MD  F) Harrison’s Internal Medicine by Kasper etal

5. Integrative Medicine: A Test-Q2  Where did this statement come from?  While it is not possible to measure the antioxidant protection in individual patients, two measures may be helpful. The first is to maintain the recommended daily intake of selenium (70 ug/day for men and 55 ug/day for women) and the second is to monitor and correct deficiencies in Vitamin E stores.

6. Integrative Medicine: A Test-Q2  A) Eight Weeks to Optimum Health by Andrew Weil, MD  B) Integrative Cardiology by Vogel and Krucoff  C) The ICU Book by Marino and Sutin  D) The Arginine Solution by Fried, Merrell, and Thorton  E) Nutritional Medicine by Alan Gaby, MD  F) Harrison’s Internal Medicine by Kasper etal

7. Integrative Medicine: A Test-Q3  Where did this statement come from?  After appropriately treated for Lyme disease, a small percentage fo patients continue to have subjective symptoms primarily musculoskeletal pain, neurocognitive difficulties, or fatigue. This chronic Lyme disease or post-Lyme disease syndrome is a disabling condition similar to chronic fatigue syndrome or fibromyalgia.

8. Integrative Medicine: A Test-Q3  A) Cure Unknown: Inside the Lyme Epidemic by Pamela Weintraub  B) The Lyme Disease Solution by Kenneth B. Singleton M.D.  C) “It’s All In Your Head,” Around the World in 80 Lyme Patient Stories: Valid Reasons to Debate Current Treatment Guidelines by PJ Langhoff  D) “Chronic Lyme Disease” NIH Guidelines by Madison etal  F) Harrison’s Internal Medicine by Kasper etal

9. Integrative Medicine: Test Answers  Q1 “Approach to the Hypertensive Patient,” Harrison’s Internal Medicine. Kasper etal, p. 1471  Q2 “Promoting Antioxidant Protection,” The ICU Book. Paul L. Marino, Kenneth M. Sutin, p 416  Q3 “Infectious Diseases: Lyme Borreliosis,” Harrison’s Internal Medicine. Kasper etal, p. 998

10. What is considered “integrative medicine”?  As defined by the National Center for Complementary and Alternative Medicine at the National Institutes of Health, integrative medicine “combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness.” (http://www.drweil.com/drw/u/ART02054/Andrew-Weil- Integrative-Medicine.html)

11. What is considered “integrative medicine”?  Abraham Verghese, M.D., summed up this orientation well, stating that Dr. Weil, “doesn’t seem wedded to a particular dogma, Western or Eastern, only to the get- the-patient-better philosophy.”

12. What is considered “integrative medicine”?  Some of the principles of integrative medicine:  A partnership between patient and practitioner  Appropriate use of conventional and alternative methods to facilitate the body’s innate healing response  A philosophy that neither rejects conventional medicine nor accepts alternative therapies uncritically

13. What is considered “integrative medicine”?  Some of the principles of integrative medicine:  Recognition that good medicine should be based in good science and be open to new paradigms  Use of natural, effective, less-invasive interventions whenever possible  Involves the promotion of health and the prevention of illness as well as the treatment of disease (from http://www.drweil.com/drw/u/ART02054/Andrew- Weil-Integrative-Medicine.html)

14. What is considered “medicine”?  If all of the above principles describe “integrative medicine”, what is the difference its philosophy and the philosophy behind “good medicine” in general?  ???  It may be easiest to say that “integrative medicine” is medicine that is faithful to the rational, scientific, and Hippocratic principles inherent to all virtuous medical practice

15. What is considered “medicine”?  Anything less than the standard of integrative medicine might be considered less than “good medical practice”  As the etymology would indicate, “integrative medicine” is medicine with integrity to that which is medicine qua medicine

16. Who is practicing integrative medicine in Colorado?  Anyone who upholds the principles of integrative medicine to the best of his or her medical knowledge and skills  No medical practitioner is excluded from the potential to uphold the standards of integrative medicine  Select practitioners have devoted their entire medical practice to this higher standard

17. What is the Colorado Integrative Medicine Consortium (CIMC)?  Mission: promote the highest standards of integrative medicine through the education, validation, and association of integrative physicians in the state of Colorado  Why needed?  Current standards of medical care fail to serve patients  Patients need to be informed of better alternatives than the status quo medicine now offered

18. What is the Colorado Integrative Medicine Consortium (CIMC)?  Why needed? (continued)  Integrative medical practitioners offer, in general, safer, economical, and more effective medical treatments than those who fail to adhere to the principles of integrative medicine  A state-based association of integrative medical practitioners offers legal, educational, and medical validity to individual physicians who choose to practice a higher standard of medical care

19. What is Colorado Integrative Medicine Consortium (CIMC)?  Vision:  Creation of the CIMC board  Membership for interested physicians (MD, DO) who meet the standards of set by the board  Certification ratings of all physicians, medical groups, or hospitals in Colorado  Educational and research opportunities for members, potential members, and patients  Legal support and counsel for members

20. What is Colorado Integrative Medicine Consortium (CIMC)?  Vision (continued): Certification ratings of physicians, medical groups, or hospitals in Colorado  Creation of a database similar to “Healthgrades” that can be accessed online by patients to determine how well a physician upholds particular standards of integrative medicine  This certification might be akin to current food labeling  “Wild raised,” “non-gmo,” “free range”  “No or minimal antibiotics used,” chemical-free (chemo-free) “sustainable”  Rating: “Organic” (Integrative), Tier 3

21. National Organizations Supporting Integrative Medicine  Integrative Medicine Consortium (IMC):  ACAM (American College for the Advancement of Medicine) www.acam.org  IFM (Institute for Functional Medicine) http://www.functionalmedicine.org/  AAEM (American Academy of Environmental Medicine) http://www.aaemonline.org/  American Association of Naturopathic Physicians (AANP) www.naturopathic.org

22. National Organizations Supporting Integrative Medicine  Integrative Medicine Consortium (continued):  American Holistic Medical Association (AHMA) www.holisticmedicine.org  International College of Integrative Medicine (ICIM) www.icimed.com  International Hyperbaric Medical Association (IHMA) http://www.hyperbaricmedicalassociation.org/  Pan American Allergy Society (PAAS) www.paas.org

23. National Organizations Supporting Integrative Medicine  Integrative Medicine Consortium (continued):  These member organizations have all come together to provide education and validation to their members  Interesting: They all do some of the same things– offering scientific wisdom on nutritional supplements, detoxification, chelation, hyperbaric medicine, mind- body medicine, prolotherapy, Lyme disease and even cancer.

24. National Organizations Supporting Integrative Medicine  Integrative Medicine Consortium (continued):  Why do all these organizations exist?  T/F: It was a way to make a lot of money from the innovative treatments and scam the public  T/F: They formed because the individual physicians from all areas of the world found that this medicine (detoxification, chelation, nutrition, etc) actually worked better than conventional medicine (in most circumstances)  Why isn’t every physician doing some form of the “integrative” medicine promoted by the IMC?

25. National Organizations Supporting Integrative Medicine  ANH (Alliance for Natural Health (ANH-USA) www.anh- usa.org  Legal and Consumer rights organization to improve public access to scientific medicine  The Legal Quartet  highly-skilled attorneys who provide legal support to IMC. Jacues Simon, Alan Dumoff, Rick Jaffe and Algis Augustine  Fairway Physicians Insurance www.fairwayphysicians.com

26. Legal Ramifications- Practicing Integrative Medicine  A few ways of proceeding legally have pervaded most integrative medical practices in the past 4 decades  “Under the Radar”  “Blatant, aggressive ego approaches to proving legitimacy of a medical therapy”  Neither has been very effective or helpful for practitioners or integrative medicine as a whole  Judiciously staying within the authoritative and legal parameters proves now to be more beneficial

27. Legal Ramifications- Practicing Integrative Medicine  ANH-USA publications:  Ranking of Medical Boards: explains how medical boards deal with integrative medical practices (http://www.anh-usa.org/wp-content/uploads/2010/12/Know-your- state-medical-board1.pdf)  The Colorado Medical Board, for example, supports  Unprofessional conduct cannot be based solely on the practitioner’s use or incorporation of CAM.  Practitioners may use or incorporate CAM.  Statutory or regulatory language expressing respect for patient choice in health care.

28. Legal Ramifications- Practicing Integrative Medicine  ANH-USA publications:  “Protect Your License” Report (published by Alliance for Natural Health)  basically tells you to keep good records, be kind to disgruntled patients, and not let any authorities come to your door without consulting an attorney

29. Legal Ramifications- Practicing Integrative Medicine  Final Notes:  A critical legal aspect of the CIMC and partner organizations is the creation of a new standard of care based on the integrous practice of medicine  When integrative medicine becomes “that which is usual and customary” for all physicians, then the legal challenges will remain only for those who truly harm their patients with unsafe or negligent medical practices

30. Legal Ramifications- Practicing Integrative Medicine  Final Notes:  For the future of medicine, it is key that integrative medical practitioners set standards for and self-regulate themselves along with those who attempt to practice the integrous (good) medicine demanded by conscious patient population  The CIMC aims to be an organization that can spearhead the self-regulation of integrative medicine in Colorado

31. Legal Ramifications- “If You Can Keep It”  “Well, Doctor, what have we got—a Republic or a Monarchy?”  “A Republic, if you can keep it.” –Benjamin Franklin, emphasis added  (The response is attributed to BENJAMIN FRANKLIN—at the close of the Constitutional Convention of 1787, when queried as he left Independence Hall on the final day of deliberation—in the notes of Dr. James McHenry, one of Maryland’s delegates to the Convention). http://www.bartleby.com/73/1593.html [accessed online 5-23-11]