Shark Tank pitch idea: academic integrative medicine center

Shark Tank pitch idea: academic integrative medicine center

According to a recent article in Academic Medicine, more than half the medical schools in the U.S. and Canada, and 30 academic health centers, currently deliver "multidisciplinary IM care." One marvels at the penetration of integrative medicine into otherwise responsible medical education and training institutions considering the many deficiencies in the concept.

First, there isn't even an agreed-upon definition of "integrative medicine" and what is does, or doesn't, or should, or shouldn't include. It certainly includes plausibility-free and evidence-free treatments, like reiki and cranial-sacral "therapy," leading me to believe, whatever the standards might be, they are awfully low.

As has been mentioned in posts over on SBM, other things we don't know about integrative medicine are:

  • Whether it produces better outcomes;
  • Whether it is cost-effective;
  • Who should lead the IM team: should the medical doctor be the boss, or should it be more "collaborative," with the acupuncturists, naturopath, chiropractors and MD all having an equal say-so;
  • Whether it must include CAM at all, and, if not, why is it "integrative" and not "conventional;" and
  • How we should go about researching it and, if we do, whether is there any possibility that the research will prove beneficial.

You'd think this lack of detail would spell doom for the whole idea, especially since integrative medicine and its family members – alternative medicine, complementary medicine, alternative and complementary medicine (CAM), complementary and integrative medicine (CIM) – have been around for about a quarter century. Medical Genetics and Genomics has been a recognized medical specialty for about the same time. Imagine if they were still asking questions, such as whether medical genetics produces better outcomes or whether research in the field would possibly be beneficial. Wouldn't the medical profession be asking them questions, like: Why are you still here?

But IM's proponents, who seem to consist in the main of those who make a living at it, are not giving up so readily. Since there's so much confusion going on, the authors of "Establishing an Integrative Medicine Program Within an Academic Health Center: Essential Considerations," offer some tips on how to construct your own IM center based on their experience in creating and running the Osher Clinical Center for Integrative Medicine at Brigham and Women's Hospital and Harvard Medical School, or "OCC" for short. And -- wouldn't you know it – as it turns out there are even more questions we don't have answers to.

Such as: should CAM practitioners participate in the EHR system? If so, the authors note,

A considerable amount of effort may be necessary to establish a lexicon which can be readily understood by both "conventional" care practitioners and CAM professionals. Without such attention, office "notes" of some CAM professionals (e.g., acupuncturists) may be unintelligible to the average conventional medical colleague who is caring for the same patient.

I think the issue is bigger than these authors let on. It's not just the office notes that are the problem. I'd venture that all of acupuncture is "unintelligible" to the "average," or even above-average, conventional medical doctor because it doesn't make any sense whatsoever.

Yet no amount of effort or expense seems to have been spared in trying to solve this one:

An extensive lexicon of terms, definitions, and standardized EMR templates and forms was developed, and all IM team members were required to document all clinical encounters on the hospital's shared EMR system.

Unfortunately, much to my colleague Dr. Mark Crislip's chagrin, I'm sure, we aren't given a single example of this triumph over common sense, which would most certainly have raised the question: why go to all of this trouble if there is no evidence that acupuncture is effective for anything?

The authors then get into the sticky wicket of deciding what the CAM providers scope of practice will be and what procedures they can and cannot do. What is clear here, although not specifically stated, is that no CAM provider is going to be allowed to practice to the full extent of his legal scope of practice under state law.

Apparently, their liberal attitude toward evidence does not extend to practices that might actually cause patient harm, as opposed to their being merely ineffective and "unintelligible." By way of example, they say, some medical institutions' clinical leaders oppose the chiropractic manipulation of the cervical spine owing to concerns about elevated risks of cerebrovascular accident.

Good call. Unfortunately, the OCC didn't see it that way. They allow it but limit it. (Presumably, for example, cervical manipulation for "wellness" wouldn't be allowed.) And they require "hospital-approved informed consent" even though chiropractors argue there isn't a risk and informed consent is unnecessary.

The article ends with a recognition that we don't know if these IM centers produce an enhancement in clinical outcomes and a reduction in overall costs, or, at least, at comparable costs. But first things first. The authors say all the IM centers need to get together and decide "how IM models are to be organized, replicated and evaluated," admitting that "we are still in the early days of organizational development and consensus building." And, for that, you need data, which the IM centers are just beginning to share.

So, they argue, we need

a commitment from advocates and skeptics of this controversial area to jointly describe and evaluate integrative care model more precisely in an effort to prove or disapprove their comparability, replicability, clinical effectivity, and costs-effectiveness (or lack thereof) for a range of patient populations.

And for this IM centers need "resources" (i.e., money) from the public and private sectors to sponsor "best practices" research so they can be standardized. It is only then, the authors say, that we can apply "rigorous cost-effective evaluations."

So, basically, these people want to decide on an optimal product delivery model and then decide whether the product works. Who does things that way? And they want the participation of us skeptics and more of our taxpayer money to figure it out. No thanks. Instead of declaring that you have created a specialty and providing specialty care to patients and then deciding whether it's a good idea, why don't you go about it the way everyone else does: first, let us skeptics decide whether you have a good idea. Or, better yet, pitch it on Shark Tank. Otherwise, you're wasting everyone's time and money.

Points of Interest 04/04/2016
Points of Interest 03/31/2016