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.