Saturday, May 23, 2009


Well I'm back from Tucson, the hub of IMR and Andrew Weil. The trip there was an example of Murphys law in effect, but that is another story. First, this was my first trip to Tucson and it is a beautiful city. A lot to do surrounding the city and I recommend visiting the desert museum. But again that is another story. Right off the bat I would like to say their were some things I liked and some I did not. The people were friendly and professional. They were not wearing tie dyed shirts, sandels and head bands. We did not meet Andrew Weil or they even mentioned him at all. Pat the director of program was a pyschiatrist, then did a residency in Family Medicine. She is from Argentina and has delightful accent. She did the fellowship in integrative medicine. She was also the former Director of U of A Family Medicine residency. We also met Sally who has good creditionals in research. I initially thought she was psychiatrist or psychologist. Her PhD is in Sociology. Beside the ancillary staff, who were all gracious and helpful, we met Randy who was from Wisconson and is an internist and did the fellowship and is now on staff. He is also an allergist. My impression of him is knowledgable and likable. They are doing a lot of data gathering on their pilot site residencies. All are Family Medicine residency sites. They are developing a 200 hour curriculum to be added to traditional family medicine. The sites are Beth Israel, Carolinas Medical Center, Hennepin County Medical Center, Maine Medical Center in Portland, Maine Dartmouth at Augusta, University of Arizona, University of Connecticut and University of Texas Medical Branch. They have done a lot of work developing the web site used by residents. They also have five sites that are controls, but do not involve their residents in the programed learning. Their goal is to then sell the program to other residencies. Their hope is show that there is a group of students that will choose FM residencies with IM and those residents well being will be improved over the control. They published a paper this May 2009 in Family Medicine with the following conclusions. 1. implementing the program increased acceptance of Integrative Medicine. 2. It did not affect the fill rates of residencies. 3. There was an increased us of IM in clinical practice. and 4. involved the evaluation of how effective their strategy for documenting the effects of the new program. There own definition of Integrative Medicine is "healing -oriented medicine that takes into account the whole person-all factors that influence a patient's health, wellness, and disease are taken into consideration, including body, mind, spirit, lifestyle and community. An IM practitioner uses all appropriate therapies, both conventioanl and alternative, to facilitate the body's innate healing response. ...IM emphasizes the therapeutic relationship between practitioner and patient. IM neither rejects conventional medicine nor accepts alternative therapies uncritically. Instead, they are taught that good medicine is based in good science; it is inquiry driven and open to new paradigms. Alongside the concepts of treatment, the broader concepts of health promotion and the prevention of illness is paramount." This is from their own brochure. One interesting event was the conference where the fellow in the program presents one or more patients that he has seen and gets advice on treatment plan. Residents, psychologists, dietiticians, faculty and on this occasion a Naturepath was present. Psychiatric concerns are addressed, what conventional medicines could be used or should be and what alternative modalities could be offered. The CAM (Complementary and Alternative Medicine) modalities seem to center around supplements, vitamins etc. Only briefly did it involve massage therapy. I did not hear at this conference using any other CAM. However, Randy did mention that one time he had good outcome with refering a patient for accupuncture. Pat did in a conversation wasn't sure about the effects of CAM herself, but believed it was a lot of placebo effect, which I agree it probably is. Sally went to CAM meeting in Minnesota recently and came away impressed with the studies. She is the newst member and is currently learning what IM is. She mentioned energy therapy at one point. They did say they would like to do outcomes studies on patients to know if any of this really works or is worthwhile. My colleague said I sometimes like to lecture, however, I was questioning or trying to get a response as to what they really knew of these other modalities, like their history and theories. My impression is they don't know the histories of accupuncture, homeopathy etc. They think a large part is placebo, but their could be effects. Then they all state the party line that big medicine and big pharma are out to protect their turf. I said I disagree as all the CAMs are really trying to sell their products and have no science to back it up. On that point they usually kept quiet, either in respect, dont know what to say, or oh oh we have a skeptic and better not rock the boat. Another point is most of their intakes take 2 to 2 and half hours to do. Not cost effective and they aknowledge that. All in all there are some things I like with the program they have done a lot of work. But the uncritical thinking on some things and the openiness to all possibilities fuzzes things. I made a remark that one actually laughed at. I said one should not be so open minded that his/her brains fall out on the floor.

Skeptical DoDo

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