Browsed by
Category: ACCME Attack on CAM

The CME certification powers-that-be go after the other big dog in Integrative Medicine

The CME certification powers-that-be go after the other big dog in Integrative Medicine

The original version of this Post incorrectly stated that IFM’s CME status was revoked by the ACCME. THAT WAS INCORRECT! Sorry about that.

However, the highly respected Institute for Functional Medicine (IFM) has had some issues with its CME course accreditation, via the Family Practice physicians’ group. It’s complicated, so see my post at:
http://wp.me/p7pwQD-d3

Previously, the ACCME had initiated revocation proceedings against other organizations.
See:http://wp.me/p7pwQD-9q

The ACCME has taken on the other big dog in the IM (Integrative Medicine) community: A4M, or more specifically, its subgroup, the Metabolic Medical Institute (“MMI”).
A4M isn’t itself ACCME accredited; it partners with an independent ACCME accredited entity. Recently its accrediting partner, Global Education Group sent a warning letter to practitioners who attended a learning activity entitled Module IV: A Metabolic and Functional Approach to Gastroenterology, that took place September 14-16, 2017 in Chicago, IL.

Here is the warning with the “corrected” information and recommendations:

“As an accredited ACCME Provider, Global Education Group strives to provide cutting-edge, innovative, quality accredited CME content to our learners. This activity you attended did not meet with our high standards of excellence. Of particular note, some of the information presented at Module IV: A Metabolic and Functional Approach to Gastroenterology did not meet the ACCME’s Clinical Content Validation requirements, which requires content include recommendations involving clinical medicine to be based on evidence that is accepted within the profession of medicine with adequate scientific justification. As such, we advise you to proceed with caution regarding the implementation or treatment approaches that were discussed and/or recommended during this activity.

Patient safety is critical. As such, we are providing you with FDA/Government guideline sources regarding treatment and testing concerning gastrointestinal dysfunction and disease. For information regarding appropriate and safe approaches for the problems or symptoms presented during this symposium, please consult the list of scientifically validated sources below:

Appropriate Stool Testing to Establish Effective Intervention:
DPDx – Laboratory Identification of Parasites of Public Health Concern. (2016, May 03). Retrieved April 6, 2018, from https://www.cdc.gov/dpdx/diagnosticprocedures/stool/index.html

Humphries, R. M., & Linscott, A. J. (2015). Laboratory Diagnosis of Bacterial Gastroenteritis. Clinical Microbiology Reviews, 28(1), 3-31. doi:10.1128/cmr.00073-14

Barr, W. & Smith, A. (2014). Acute Diarrhea in Adults. Am Fam Physician, 180-189.

What Is a Stool Culture? (2017). Retrieved April 16, 2018, from https://www.webmd.com/a-to-z-guides/what-is-a-stool-culture#2

Use of Vitamins & Health Supplements:
American College of Medical Toxicology and The American Academy of Clinical Toxicology. (2015). Retrieved April 16, 2018, from http://www.choosingwisely.org/societies/american-college-of-medical-toxicology-and-the-american-academy-of-clinical-toxicology/

Evidence-Based Clinical Practice Guidelines:
AHRQ’s National Guideline Clearinghouse is a public resource for summaries of evidence-based clinical practice guidelines. Retrieved April 8, 2018, from https://guidelines.gov/

Additionally, please utilize this link which includes recommendations from the Choosing Wisely campaign, organized by discipline/body system. This resource provides key clinical recommendations for physicians that promote best practices and help avoid unnecessary medical interventions. The campaign is sponsored by the American Board of Internal Medicine Foundation, including several medical specialty societies.

If you have additional questions or concerns, please contact Global Education Group at 303-395-1782 or cme@globaleducationgroup.com “

More to Come

A4M and the IFM are the two biggest and institutionally most successful IM organizations on Planet Earth. By going after them, it’s pretty obvious that all IM groups are going to be hit with the same DE legitimization tactics, namely CME revocation process for those groups who are direct ACCME accredited, pressure on the accrediting partners like here, plus forcing the seminar providers to publish retractions of IM clinical guidelines based on lack of evidence based support. So if you’re an IM group and haven’t been contacted by the ACCME or your accrediting partner, my guess is that you will be.

What to do about it?

I’ve previously advocated for group consultation and joint action by all the IM groups, but now I’m not so sure. I think there’s going to be some survival-of-the-fittest action that will come into play in the intermediate term. The smarter, more agile groups will figure out how to make their content more resistant to these ACCME challenges.

Having gone to IM conferences for several decades, frankly, I think that some content providers don’t go a good enough job in conveying the importance or context and meaning of the information/studies being talked about. As much as it pains me to say it, there might possibly be some small element of truth supporting the ACCME’s position in some cases. But, I think those kinds of problems are resolvable by creative solutions and more and smarter internal oversight and clearer standards.

So what’s the big takeaway from the all these ACCME’s actions?

The days of any health care professional saying anything they want in a CME accredited seminar are over or coming to an end. Like it or not, those that don’t realize it won’t be providing CME accredited courses. Those who do and can adapt to the new oversight environment will survive and even prosper.

Richard Jaffe, Esq.
www.Rickjaffe.com
rickjaffeesquire@gmail.com

A Bad Decision on IFM’s CME battle

A Bad Decision on IFM’s CME battle

I’ve previously discussed the ongoing efforts by the AACME (the main CME accrediting agency) to revoke the CME granting status of various unnamed integrative medical groups. See post at:

http://wp.me/p7pwQD-9q

But the ACCME isn’t the only organization which grants CAM groups CME course accreditation. The AAFP (American Association of Family Practitioners) does also. The AAFP used to give the Institute for Functional Medicine (IFM) CME status for all its courses. But that changed in 2014 when its CME status was suspended pending a full review. Recently that review has been completed. Although the result could have been alitte worse, it’s not acceptable and underscores why all the CAM groups need to get together and find another solution to this concerted attempt to delegitimize if not eradicate these organizations and the modalities they teach.

Here is the operative language from the decision, as reported by the IFM to its members:

• The COCPD’s topic-specific guidance on functional medicine now says: “Activities and sessions eligible for credit are limited to those that provide clinicians with an overview or scope of Functional Medicine and the techniques that functional medicine practitioners use, so family physicians can educate interested patients about the topic.
• “Activities and sessions for credit that are ineligible include those that teach clinicians how to perform techniques, modalities or applications of functional medicine in their clinical practices.”

Translation: a doc can get CME credit for an introductory course about functional medicine, but not for learning how to use it in a medical practice. Practically speaking, most of the IFM conferences will be non CME, with all the bad for the group and the doctors that entails.

IFM valiantly tried to put the best face on the disspointing decision by noting that:

“While this wasn’t the exact outcome we had hoped for, there are some positives that should not be overlooked:
• In response to the groundswell of support for Functional Medicine both within and outside our community, we are thrilled to see AAFP take a step forward and recognize the merits of Functional Medicine.
• The decision demonstrates that the patient demand for Functional Medicine continues to grow and supports IFM’s efforts to introduce clinicians to the model to help answer patient questions.”

Seems a stretch to me, but I understand the attempt to see the positive in a bad result. Hopefully, this might cause IFM and other groups to start to meaningfully explore other options.

Richard Jaffe, Esq.
Rickjaffeesquire.com
rickjaffeesquire@gmail.com

A Bad Day for CAM and patients: First CAM Group Caves-in to ACCME’s Extortion/Re-education

A Bad Day for CAM and patients: First CAM Group Caves-in to ACCME’s Extortion/Re-education

Regrettably, members of a heretofore prominent CAM (Complementary and Alternative Medicine) physician group who attended its 2016 conference will soon be advised that they received “invalid information” from several of the lecturers, and that the incorrect information should not be used to make clinical recommendations. The “incorrect” information comes from some of the most respected, best credentialed and most published practicing physicians and educators in the CAM field.

Because I was given this information in confidence, I cannot reveal the name of the group, but once the group’s members receive the letter, the cat will be out of the bag.

The members will also be provided with materials constituting the “best practices” based on “national guideline clearinghouse (guidelines.gov), recent review articles from high-impact journals from organizations such as the national Institutes of Health, the Agency for Healthcare Research and Quality, and the Centers for Disease Control and Prevention.”

In other words, standard failed treatment recommendations for chronic and intractable conditions.

You will also informed:
“Important: In the absence of established resources, inform your learners that appropriate evidence-based resources are not available.”

I guess that means practitioners should decline to offer to treat patients unless there are the abovementioned evidence based medicine sources or treatment recommendations.

You also will be provided a survey to identify whether you have used this “incorrect” information in clinical decision making and asking a few other questions.

Needless to say, this is bad on so many levels. What’s the point of going to future seminars for a CAM group which is only going to teach the so called “best practices,” “high impact journal” and national guidelines based information? You might as well just go to AMA or your specialty board conferences to get the same recycled guidelines.

Surely, there is a place for protocol medicine, as it is curative or at least beneficial for many. It would be crazy to give unconventional care to a CML cancer patient because the disease is virtually 100 % curable with Gleevac, or giving CAM care for simple infections which are easily resolvable by common drugs.

The problem of course is that most CAM physicians work with patients with chronic diseases, where the “best practices” didn’t work, meaning you basically work in the realm of protocol medicine failures. And that’s obviously where the treatment options from high impact journals and national guidelines don’t help. It’s well and good for a non-clinical practice organization like ACCME to recommend that physicians advise patients that there is no evidence based solution, but what is the doc supposed to do?

It’s like the dental monitor ad I discussed in the last post. “You’ve got a terrible problem. Yes I’m a licensed health care practitioner who deals with this type of problem, but I can’t treat it because there is no accepted national consensus on a curative treatment, so we’re done here.” These ACCME idiots have to know that medicine and medical innovation doesn’t work that way. But CAM gets special treatment. Thanks!

But I’m preaching to the choir.

So what to do?

1. For the docs who gave the lectures which the ACCME calls incorrect?

That’s easy: If the group asks you to retract your presentation, my advice: Don’t. Further: tell the group that you stand by your presentation that it is cutting edge and literature based (because you wouldn’t have presented it if it wasn’t literature supported which you considered valid and sufficient to rely on).

There’s no good that will come to you if you agree to retract your presentation. If you do accede to the group’s request, your credibility is shot in the field in general, and certainly as a future expert witness, if that matters to you.

Much more importantly, go explain to your medical board, your insurance carriers (both health insurance plans in which you participate, as well as your malpractice carrier) or your patients why you are using treatment methods which you presented and retracted because they are too dangerous to teach and to be used. This is not something you want out there. Consenting to the group’s request that you retract is possibly the beginning of the end of your clinical career.

Obviously, you won’t be presenting at any future conferences for that group, but so what. Any group that asks its lecturers to retract because the material is not supported by the so called best practices (and all the rest of that crap), and agrees to only provide the best practice stuff in the future, probably doesn’t have much of a future.

2. Advice to the members of the Group(s) who retract presentations because they are not “evidence based”

Object: Tell your group that you think they should stand by their speakers, against the ACCME’s position that the presentations are not sufficiently evidence based. Find out if all future conferences with be in accordance with the ACCME new views, and if so, plan on finding another source for clinical practice information for 2017, and communicate your intentions to the group. They need the feedback.

3. For the Other CAM groups not yet the target of ACCME Action

Alert your members of what’s happening and what may be coming. Recommit to providing the most up-to-date literature supported information. Look for information amongst your members about who is really behind this new attack and identify allies or people or organizations who can help beat this back.
Prepare for the ACCME to come after you. How? No substantive changes to the content, but maybe have your lectures identify what the community standards are (or that none exist) and the problems with the standards. Maybe make clear that the recommendations are based on new literature, or individual practices which haven’t been adopted by mainstream), which is basically everything you teach anyway, and be prepared to fight for what you folks believe in.

I’d also like to see a massive increase in published case reports by the community. There is a whole new on-line open medical literature. I believe we are in a transition period which will end the stranglehold of the so called “high impact” journals. They are way too slow in the age of instant information. Medical issues which have been resolved by non-standard approaches need to be quickly disseminated. As more physician try these novel treatments, the high impact journals will eventually be relegated to something between review article journals and textbooks. Eventually, there will be new forms of publications based on big data analyses, which will further debase these 20th Century means of communicating new treatment information.

4. For the CAM groups who have knuckled-under or about to

I feel your pain. You don’t have any good choices. It is understandable that you want to protect your organization and make sure that all prior CME credits are not rescinded. But keep in mind that you exist and serve at the pleasure of your members. Their primary interest is that they receive the best and newest information possible to make clinical decisions. If you’re not going to do it, what’s the point?

Now that you are sending the retraction notice, your biggest, and indeed existential problem is convincing your members that despite the retraction of lectures from the best and brightest lights, your future conferences will continue to present cutting-edge, innovative research which should be implemented in clinical practice. I wish you good luck.

I’m still hoping that there are some politically connected CAM docs or supporters out there to get to the medical boards or the legislatures’ health committees involved and force the ACCME to back off. At some point, a direct response may be necessary.

You know the homeopaths were a major force in the national health care in the nineteenth century, and then they weren’t.

Rick Jaffe, Esq.
rickjaffeesquire@gmail.com

The Next Big CAM Battle is Here and it’s Ugly

The Next Big CAM Battle is Here and it’s Ugly

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 – that:

“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.

Three CAM groups which have previously received ACCME course certification without any undue problems who in the last few months 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:

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? Yea, 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’s Board Rule 166.2 and it requires:

(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 that:

“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?

“(1) 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.”

Convention 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 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.”

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.

So, 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, mulitipled 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.
rickjaffeesquire@gmail.com