Complementary and alternative medicine (CAM)
CAM or integrative medicine doctors have had their problems with the state medical boards. And CAM organizations have had their run-ins with governmental agencies. However, the groups have always survived in large part because they have had a steady income from membership dues and from their annual conferences, where their members learn the latest and greatest from their thought leaders. But the CAM organizations' income stream is now in jeopardy and, thus, so is their existence, based on what looks to be well-planned, systematic effort to put CAM groups out of business and stop the dissemination information about CAM therapies. AND THAT MY FRIENDS IS A VERY BIG DEAL.
Here Is What's Going On
For months, at least two CAM groups have been under review/investigation by the primary private CME accrediting company, the ACCME (Accreditation Counsel for Continuing Medical Education). Recently, the ACCME has determined that a significant portion of the groups' prior year's CME courses does not meet various ACCME standards. ACCME is demanding that everyone involved in these courses be informed that "they were presented invalid information…" and that the groups "instruct them [everyone] to avoid making any clinical decisions for testing and/or treatment based on what was presented, and direct the registrants to accurate and valid sources of information for the problems or systems presented."
I should point out that this "incorrect" information came from some of the most accomplished, respected, and published thought leaders/teachers in the CAM community. These folks have been giving CME courses without incident for decades. Further, in terms of future CME courses at their conferences, ACCME has informed these groups—and this is the key to understand what this is all about—the following:
…recommendations involving clinical medicine must be based on evidence that is accepted within the profession of medicine as adequate justification for their indications and contraindications in the care of patients and all patient care recommendations must conform to evidence emanating from guidelines and data that meet generally accepted standards of experimental design, data collection, and analysis.
In short, ACCME is trying to require these groups to only teach mainstream medicine! This is crazy and a huge deal!
Furthermore, the effect on the members of these organizations who attended the conferences last year and who used these courses to satisfy their state CME requirements is unclear.
I am not familiar with ACCME's inner workings or guidelines, but it doesn't seem out of the question that ACCME could contact state boards about these groups' "noncompliance" and the retroactive withdrawal of CME credits. That could cause the state boards to retroactively hold the doctors non-CME compliant. I'm not saying that this will happen, but only that it's a possibility. But I am saying that if the idea is to delegitimize CAM and cause problems for its practitioners, notifying the state boards would certainly advance that goal.
A Specialty Interest Group Also Gets the Same Treatment
Beyond these two professional groups, a disease-based group has recently been informed that its CME status for future conferences has been rescinded by its CME intermediary. The intermediary denies that it received any pressure or orders from ACCME.
In the last few months, three CAM groups, which have previously received ACCME course certification without any undue problems, have had their prior CME course approval rescinded and/or their future CME approval withdrawn or placed in serious doubt. Is this all a coincidence? Not a chance in hell.
My guess is that more of the same has or is going to happen to other CAM groups.
What to Do?
At this stage, these groups need information about what's behind this campaign to deny CME credit and delegitimize CAM teachings.
We need to get the word out to the CAM community. Why? Someone out there has to know something or know someone who knows something about how this came about, and who or what group is behind it. (My guess is that ACCME is the vehicle not the originator.)
I think there is a smoking gun out there, and if we find it, we can probably reverse ACCME's decision quickly, so my suggestion is that all the CAM groups and interested parties get the word out to search for the smoking gun.
But let's dig in to this and see if there is anything else that can be done. A logical place to start is to consider the following: What exactly is the ACCME and what does it do?
I don't have any special info on ACCME, but here is what it says about itself:
CME ACCREDITATION OF, BY, AND FOR THE PROFESSION OF MEDICINE.
The ACCME was founded in 1981 in order to create a national accreditation system. It is the successor to the Liaison Committee on Continuing Medical Education and the American Medical Association's Committee on Accreditation of Continuing Medical Education. The ACCME's purpose is to oversee a voluntary, self-regulatory process for the accreditation of institutions that provide continuing medical education (CME) and develop rigorous standards to ensure that CME activities across the country are independent, free from commercial bias, based on valid content, and effective in meeting physicians' learning and practice needs. The ACCME accreditation process is of, by, and for the profession of medicine.
The ACCME's founding and current member organizations are the American Board of Medical Specialties, the American Hospital Association, the American Medical Association, the Association of American Medical Colleges, the Association for Hospital Medical Education, the Council of Medical Specialty Societies, and the Federation of State Medical Boards of the United States.
Throughout its history, the ACCME has been dedicated to maintaining a relevant and responsive accreditation system that supports CME as a strategic asset to US health care quality and safety initiatives.
Very noble and reassuring, isn't it?
Basically, it's a bunch of health care trade associations, organizations in charge of medical education and specialization credentialing. (Ironically, the medical specialty societies are the reason it's illegal for practitioners to advertise their CAM board certifications.) And last but not least is CAM's long-time adversary, the Federation of State Medical Boards. So maybe not so reassuring.
Did you know that the ACCME is accountable to the public? Yeah, just ask them and they will tell you so. Here is what it says about that:
Accountability to the Public
The ACCME is accountable to the public for setting and maintaining accreditation requirements that are designed to ensure that CME accredited within the ACCME system is based on valid content, is free from commercial influence or bias, and contributes to the quality and safety of health care. As the US health care system continues to evolve, the ACCME will respond by making changes to its requirements or processes that are necessary to assure that CME serves the best interests of the public.
I'm still not clear exactly how it is accountable to the public, and nothing in its web site gives any further elucidation. I do have a couple ideas of how it might actually be made accountable to the public.
Some Basic Facts
It's obviously a matter of individual state law what type of courses a state medical board will accept as acceptable CME. The ACCME might be the primary CME credentialer, but it is not the only one. For example, here is the Texas law regarding CME accreditation; it is Board Rule 166.2 and it requires the following:
(1) At least 24 credits every 24 months are to be from formal courses that are:
(A) designated for AMA/PRA Category 1 credit by a CME sponsor accredited by the Accreditation Council for Continuing Medical Education or a state medical society recognized by the Committee for Review and Recognition of the Accreditation Council for Continuing Medical Education;
(B) approved for prescribed credit by the American Academy of Family Physicians;
(C) designated for AOA Category 1-A credit required for osteopathic physicians by an accredited CME sponsor approved by the American Osteopathic Association;
(D) approved by the Texas Medical Association based on standards established by the AMA for its Physician's Recognition Award; or
(E) approved by the board for medical ethics and/or professional responsibility courses only.
Other states have similar types of CME rules. The bottom line is that ACCME is a very important source of state-approved CME accreditation, especially for everyone other than the major national and state medical trade groups. But there's another way of looking at it. Without a state accepting its accreditation, ACCME doesn't have much of a purpose or job.
What About CAM Laws?
Texas, California, and some other states recognize the rights of patients to receive CAM therapies. Texas, for example, provides the following:
The purpose of this chapter [Texas Board Rule Chapter 200] is to recognize that physicians should be allowed a reasonable and responsible degree of latitude in the kinds of therapies they offer their patients. The Board also recognizes that patients have a right to seek complementary and alternative therapies." (Board Rule 200.1)
What are CAM therapies in Texas?
Complementary and Alternative Medicine–Those health care methods of diagnosis, treatment, or interventions that are not acknowledged to be conventional but that may be offered by some licensed physicians in addition to, or as an alternative to, conventional medicine, and that provide a reasonable potential for therapeutic gain in a patient's medical condition and that are not reasonably outweighed by the risk of such methods.
Conventional medicine is defined as "Those health care methods of diagnosis, treatment, or interventions that are offered by most licensed physicians as generally accepted methods of routine practice, based upon medical training, experience and review of the peer reviewed scientific literature." (California has a similar definition of CAM at B&C code 2234.1)
So, Texas gives practitioners the right to provide non-conventional, not generally accepted therapies to patients; and patients have the right to receive these CAM or non-conventional therapies.
But even though Texas docs can provide CAM or non-standard therapies to Texas patients, ACCME now takes the position that Texas physicians can't obtain CME credit for learning about these Texas-sanctioned treatments. How can the ACCME be acting consistent with Texas law by its insistence that CAM medical groups can only teach "…recommendations involving clinical medicine…based on evidence that is accepted within the profession of medicine…." My view is that ACCME's position is inconsistent, if not in violation of the Texas CAM Rule (and the California CAM statute) and probably every other state that has a CAM law.
What to Do? Complain to ACCME? Won't hurt, but it won't help. It's doing what it's doing intentionally, and some external pressure has to be brought forth. Complain to the boards? Maybe, but it would take a lot of complaints.
In all the big CAM states like Texas and California, I know there are legislators who are pro-CAM. My suggestion would be to identify who they are (not hard in Texas). I think the boards in a few of these states need to hear from some legislators about how ACCME is undercutting board rules (in Texas) or the CAM statutes (like in California).
These legislators should copy ACCME on their concerns expressed to the boards. If one of them is on a legislative health committee, even better. Better still would be for a couple states to start an investigation on ACCME's motives. Maybe even an invitation to appear at a specially called hearing. Legislators can hold hearings for all kinds of reasons. So, can federal legislators. I think with all the politically connected CAM docs out there, multiplied by their politically connected patients, well I think there's a heap of trouble that could be stirred up for ACCME.
It doesn't have to happen in every state, or even many states, just a couple of the big ones. The story is going to get out, and questions are going to be raised. The widespread dissemination of ACCME's action might even turn-up that smoking gun I mentioned earlier. And once the nefarious motive and scope of the conspiracy publicly surfaces, I think ACCME will be forced to rescind its actions. So, we need to shine some light on these jokers.
This could all happen pretty quickly if there's a big enough outreach to the CAM community.
Something to think about anyway.
Rick Jaffe, Esq.