Holistic Medicine: A New Medical Specialty? New Certification Exam Signifies Maturing Field

Dr. Robert Anderson, President of the American Board of Holistic Medicine (ABHM), addresses attendees at the American Holistic Medical Association annual meeting.

Will holistic medicine become a distinct medical specialty?

The members of the American Board of Holistic Medicine certainly believe it will. So do the roughly 200 doctors who will converge on Denver this December to sit for the first-ever Holistic Medicine Certification Examination. Groundwork for a new specialty is clearly being laid, and it is possible that in the coming years, holistic medicine will take a place among the 22 disciplines officially recognized by the American Board of Medical Specialties.

"The philosophic basis for holistic medicine, as well as the variety of procedures and approaches incorporated from other disciplines such as Ayurveda, traditional Chinese medicine and the like, are sufficiently distinct that holistic medicine should be distinguished from conventional medicine, and deserves to be recognized as a separate entity," said Dr. Robert Anderson, a family physician from Washington state, and president of the American Board of Holistic Medicine (ABHM).

The Board, which now has 13 physician-members, was incorporated in 1996 to define a conceptual framework for holistic medicine, a core curriculum, and essential competencies on which to base a certification exam.

The goal, he stressed, is not to turn MDs and DOs into masters of traditional Chinese herbology or expert massage therapists. "We don't necessarily hold that physicians who are taking the exam would be able to pass a comprehensive course in, say, homeopathy. But they will have a great enough sense of it to know what its potential place is in the total picture."

So, just what is "holistic" medicine according to the new Board? In an interview, Dr. Anderson defined it as, "that aspect of medicine which considers the whole person—physical, mental, emotional, and spiritual—within the setting of their physical and social environment, and which utilizes all safe means for diagnosis and treatment, emphasizing those aspects of practice which promote optimal health."

Sound a bit like Family Medicine? There is clearly some overlap, but Dr. Anderson believes holistic medicine's emphasis on psychoneuroimmunology and spiritual aspects of health and illness—not to mention its openness to techniques outside the Western mainstream—put it on a very different footing.

Within its broad framework, ABHM includes botanical medicine, nutrition, physical modalities such as massage and spinal manipulation, mind-body techniques like hypnosis and guided imagery, and treatments deriving from non-allopathic traditions like Chinese, Indian, and Native American medicine.

The five-hour certification exam, to be given on December 7, will be preceded by a 4-day intensive review course co-sponsored by the University of Colorado School of Medicine. ABHM's curriculum has a primary care/general practice orientation, and constellates around five core fields: nutrition, environmental medicine, behavioral medicine, exercise, and biomolecular medicine. The latter covers use of antioxidants, botanicals, and bioactive compounds like melatonin and coenzyme Q10. It also includes controversial modalities such as chelation therapy.

These are subjects about which, "all holistic doctors should be quite conversant. They either should practice them themselves, or be familiar enough with them to know when they are appropriate, and to have resources for referrals," said Dr. Anderson, editor of The Scientific Basis for Holistic Medicine, a compendium of clinical data.

He emphasized that ABHM is diligently avoiding the divisive "alternative" versus "orthodox" dynamic. "We don't say conventional allopathic medicine is bad. All of us who do holistic medicine are blending the two together. There are certainly instances when it is very nice to have the latest antibiotics. There are many things we can do to obviate the need for them, but when you need them, it is nice to have them." ABHM certification is only open to MDs and DOs who have been in practice or academia for at least 2 years.

It is one thing for a group of like-minded physicians to declare themselves a specialty; it is another thing entirely to be recognized as such by the profession at large. Dr. Anderson acknowledged that in seeking specialty status, ABHM has much work still to do.

According to Dr. Stephen Miller, executive vice-president of the American Board of Medical Specialties (ABMS), any would-be specialty must convince members of the ABMS liaison committee (made up of representatives from ABMS and the AMA) that it represents a distinct field of practice addressing distinct medical concerns; is based on substantial advancements in science; has in-depth, standardized curricula and residency training programs that meet Council on Graduate Medical Education criteria; and has broad professional support.

In an interview, Dr. Miller said that in principle, he applauds the efforts of the holistic medicine board. "All their motivations sound right. We certainly support the development of standardized curricula and practice standards. That is a worthy goal for all boards, not just the ABHM." He said there is no inherent bias within ABMS against a holistic specialty, so long as it meets established criteria.

That, admitted Dr. Anderson, could take some time. "One big stumbling block is they require there to be at least one residency program. At this point, there's no such animal, so we would not even have a ghost of a chance."

But he predicted a holistic residency will soon emerge. Over 100 medical schools now have coursework in complementary medicine, and there are at least a dozen academic medical centers or major hospitals with integrative departments or clinics. He added that the American Holistic Medical Association gets hundreds of calls each year from medical students seeking holistic residency training. Clearly, there is interest among the physicians of the future.

Doctors who pass the ABHM exam will receive a certificate recognizing them as diplomates of the Board, enabling them to, "much more legitimately describe themselves as holistic physicians." Even without ABMS recognition, passing a standardized exam based on a well-defined curriculum will likely hold weight with third party payors, disciplinary review boards, courts and legislative bodies, and within academia, Dr. Anderson said.

Not all advocates of holistic medicine believe specialization is the ideal way to implement the new paradigm. Some, like Dr. Victoria Maizes, a family physician who is interim medical director of the University of Arizona's post graduate fellowship in integrative medicine, would prefer to see a more holistic orientation in all areas of medicine.

The issue of specialization, "has been a real dilemma in integrative medicine. Most people here felt that the goal is really to shift the whole way medicine is practiced, not to create a new specialty," said Dr. Maizes. "Our idea is, how do you help cardiologists become more integrative, how do you help dermatologists, and the whole gamut of specialties and subspecialties become more integrative." The University of Arizona program emphasizes cross-disciplinary collaboration, and does not provide specialty certification.

Dr. Anderson allowed that the virtues of specialization can be debated. But in the long-run, he believes the move will facilitate acceptance of the holistic approach by the medical mainstream. "There needs to be some kind of standards in this whole new field, and the essence of that is to have training programs which set these standards, and some kind of testing procedure which identifies individuals who have met them."

For more information on the ABHM review course or the certification exam, contact the University of Colorado School of Medicine, Office of CME, Tel: (303) 372-9050; Fax: (303) 372-9065.

 
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