A recent report from the RAND Corporation explored this provocative question: “Complementary and Alternative Medicine: Professions or Modalities?” The report, led by Patricia Herman, ND, PhD, and Ian Coulter, PhD, provoked me to reflect on a broader question in a column in the Huffington Post: Chronicles of Health Creation: RAND Report Begs New Look at Integrative Medicine and Health Professionals in the Triple Aim Era.
In the United States, the first era of “integration” of these “professions or modalities” was all about modalities. The interest was engaged during the mid-1990s when the central motivation in the medical industry was production of procedures and revenue enhancement. Usefulness was linked to a single procedure. For instance, a licensed acupuncture and Oriental medicine professional, trained in general practice using multiple modalities in a relationship-centered care, was typically reduced to the status of a technician to apply needles. Similarly, a chiropractor was not valued for his or her ability to evaluate and manage a patient and to offer counseling and lifestyle change ideas or give advice on ergonomics. Instead, the chiropractor was typically paid merely for the application of spinal manipulation for lower back pain.
My thesis was simple. The USA is moving to a “values-based” era with less focus just on the production of services that has created a $3 trillion–per-year industry. Isn’t it time to look at the potential contributions of these integrative health practitioners as professionals rather than technicians? This would seem to be especially so given the emerging evidence of their value in enhancing patient experience and their value in lowering healthcare costs. These are Triple Aim targets. Is it time for a reboot? What are the optimal uses of licensed chiropractors, naturopathic doctors, and practitioners of acupuncture and Oriental medicine not in making a buck but in creating health?
Comment: Now frame this thesis in the traditional medicine context. The question is whether the consideration of potential value is (merely) in the plants. Should the motivating interest be only the potential business contributions of a botanical medicine industry or herb-inspired pharmaceuticals? Or are traditional medicine professionals being approached to evaluate their contributions as valued parts of the regular medical enterprise?
We see growing indications of the value of the professionals, particularly in public health matters. In Uganda as reported here, a leader from PROMETRA (Promotion of Traditional Medicine) argues that “herbalists are ready to take part in the prevention of AIDS infection among the young girls.” In South Africa, traditional medicine practitioners were invited to a summit to foster collaborating in controlling a broad set of infectious conditions: South Africa Summit Models Inclusion of Traditional Healers in HIV, Tuberculosis Campaign. A recent Global Integrator Blog explored similar public health contributors in Sierra Leone: Traditional Healers Are Honored for Key Role in Responding to the Ebola Outbreak.)
In each, the respect for the professionals is limited to their potential role in averting the spread of infectious diseases. The most significant national activity in recent years to fully include traditional professionals as service providers in a national system is in India. There, under the elevated status of AYUSH begun in September 2013, robust activity is underway to explore how Ayurvedic practitioners, for instance, can help meet primary care needs in that country. These are good starts to a values-based look at integration of traditional medicine professionals.