Dr. Casey Kelley and Integrative Medicine

There’s a most exciting development at WholeHealth Chicago this week, but first let’s take a brief look at the 20-year arc of what we know as alternative medicine.

Since the early 1990s, when data started appearing about the unexpectedly wide use of alternative therapies by the US public, there’s been a nonstop conversation about what exactly constitutes “alternative medicine” and who practices which type. Not surprisingly, the vast majority of conventionally trained physicians still shut their eyes and plug their ears rather than express any curiosity about the 90+ variations on alternative therapies. Their stance seems to be, “If I didn’t learn it in medical school, then it isn’t real.”

With nearly a million physicians in the US (roughly 350,000 in primary care), you’re going to have some outliers, doctors like me who thought alternative medicine was compelling and had possibilities. In fact, there are enough of us to merit some interesting physician associations, like the American College for Advancement in Medicine, the International Society for Orthomolecular Medicine, and the American Holistic Medical Association (AHMA). Each has its own special focus, but what defined them all was their being outside the mainstream. They’re also regularly subjected to some really harsh criticisms from conventional medicine groups, many of which protested vigorously when the NIH established a division to study the possible benefits of alternative therapies.

In 1996, the AHMA created the very first certifying examination in a new specialty called Holistic Medicine. They began by offering intensives, courses to teach interested practitioners from all fields something about each other’s practice. Attending were MDs, including osteopathic physicians (DOs), chiropractic physicians, and naturopaths. It was quite gratifying to the AHMA founders that ultimately hundreds of physicians came on board. The certification gave added credibility to the field.

Andrew Weil, MD, leads the way

Probably no physician has done more to promote the blending of conventional and alternative medicine than Harvard-educated Andrew Weil, MD, now director of the Arizona Center for Integrative Medicine within the University of Arizona School of Medicine. Working separately from the AHMA, he actually convinced a very conventional medical school to create a fellowship for physicians (MDs and DOs) in what he himself christened “integrative medicine.” He chose this term to help break down the barrier between conventional medicine and alternative/complementary medicine, which had to date defined the situation.

You may already know about physicians and fellowships. An internist, for example, can choose to take a gastroenterology fellowship and become a board-certified gastroenterologist. Fellowships are periods of intensive post-graduate training available to physicians who want more specialization. Dr. Weil established the first Fellowship in Integrative Medicine.

To no one’s surprise (except perhaps the University of Arizona’s), the program was successful from the start. Currently the fellowship itself is a combination of a limited residency requirement–the candidate spends some time on-site with Dr Weil–and a lot of online learning. The residency requirement can be waived if the candidate has had actual clinical experience in integrative medicine.

Dr. Weil’s ultimate goal was to develop a set of board examinations that would certify a physician as a specialist in integrative medicine. This was a nervy thing to do and also managed to ruffle feathers on both sides of the conventional/alternative fence. Predictably, most conventional physicians protested that Weil had given credibility to snake oil salesmen. “Board-certified quackery,” they called it.  Then, chiropractors, naturopaths, and acupuncturists–in fact just about everyone practicing in the then-labeled “alternative” field–were angry because they’d been excluded from both training and certification.

From Dr Weil’s point of view, “integrative” meant a working knowledge of both conventional medicine (including drugs and surgery) and the various fields of alternative medicine. He’d established that an integrative physician didn’t have to actually practice chiropractic or acupuncture, but needed to know what they were and when to recommend them.

2008 paradigm shift

Then, in 2008, a major shift occurred. The American Board of Holistic Medicine agreed to follow Weil’s guidelines, changed its name to the American Board of Integrative and Holistic Medicine (ABIHM), and agreed to limit certification to MDs and DOs. By restricting certification to these two physician types the new field of integrative medicine could be officially classified as a medical specialty.

Now let me insert here that the certifying exam is tough. You have to study nutritional medicine, herbal medicine, Chinese medicine, manipulative medicine, functional medicine, and homeopathy. You start by taking a very intensive review course and receiving more than 700 pages of study materials. You write a paper about your journey as a physician and your interests in integrative medicine and ultimately you take a four-hour exam and keep your fingers crossed.

Once you’ve been certified, you must maintain your certification by taking 120 hours a year of continuing medical education (CME) credits, 60 of which must be in integrative medicine.

Let me pause here and insert Dr. Weil’s own definition of integrative medicine:

Integrative medicine is healing-oriented medicine that takes account of the whole person (body, mind, and spirit), including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all appropriate therapies, both conventional and alternative.

The principles of integrative medicine:

• A partnership between patient and practitioner in the healing process.
• Appropriate use of conventional and alternative methods to facilitate the body’s innate healing response.
• Consideration of all factors that influence health, wellness, and disease, including mind, spirit, and community as well as body.
• A philosophy that neither rejects conventional medicine nor accepts alternative therapies uncritically.
• Recognition that good medicine should be based in good science, be inquiry driven, and be open to new paradigms.
• Use of natural, effective, less-invasive interventions whenever possible.
• Use of the broader concepts of promotion of health and the prevention of illness as well as the treatment of disease.
• Training of practitioners to be models of health and healing, committed to the process of self-exploration and self-development.

I personally find these principles deeply moving and inspirational. And I’d breathe a whole lot easier if all the super-specialists at our big medical centers around the country, their prescription pads and scalpels poised for action, were to say in unison, “Hey…these are good principles for all of us to follow.”

And now that you know the back story, our announcement. The big news this week is that Casey Kelley, MD, received word she’d passed her examination and is now board certified in Integrative and Holistic Medicine (she was already board certified in Family Practice).

As I said earlier, there are about a million physicians in the US and of that group just 1,600 are ABIHM-certified. We’re delighted that Dr Kelley is their newest member.

Be well,

David Edelberg, MD