Political History of Integrative Medicine

The responsibility of the North Carolina Medical Board (NCMB) to regulate the physicians of North Carolina and ensure that citizens are protected from doctors who are incompetent or show a pattern of dangerous behavior that puts patients at risk. However, NCMB has historically misused their resources and powers to wrongly single out medical practitioners who practice alternative medical treatments. Not unlike other medical practices, such as the practice of washing hands before surgery, integrative medicine has been viewed with resistance and suspicion.

Recent surveys of doctors and patients who embrace integrative medicine have revealed widespread use. According to the 2002 edition of the National Health Interview Survey, well over half of all Americans use CAM therapies, and the American public spends an estimated $47 billion annually on these therapies, with most charges being paid directly out of pocket. The U.S. Board on Health Promotion and Disease Prevention, in a 2005 report titled “Complementary and Alternative Medicine in the United States”, estimated that more than one third of all Americans turn to CAM therapies on a regular basis ,and total visits to integrative medicine providers each year now exceed those to primary-care physicians. Use of CAM therapies continues to be consumer driven and usually outpatient focused.

Recent surveys indicate that lay people seek out integrative medicine practitioners for diverse reasons. For advanced cancers, the statistics for conventional treatment alone often indicate a poor chance of therapeutic success or long-range survival. Cancer patients often look to integrative medicine to help them better tolerate conventional cancer therapies and to maintain better health during and after treatment. Heart disease patients are looking for ways to actually feel better, not just to improve their blood lipid profiles. Diabetics are interested in strategies that reduce their dependence on medications while also preventing complications. Many consumers also seek out integrative treatment for those illnesses that are "medically unexplained" or for which conventional treatment alone has had limited success -- conditions or syndromes such as autism, Lyme disease, multiple chemical sensitivity, and fibromyalgia. A rapidly growing body of evidence suggests that the integrative medical paradigm -- using an individualized approach that addresses the patient's diverse needs -- is the most effective way to tackle these heretofore intractable conditions.

In 1985, The North Carolina Medical Board (NCMB) brought charges against George Guess, M.D., a homeopathic medical practitioner in Asheville, North Carolina. In the absence of any patient harm or complaints, the NCMB alleged that Dr. Guess failed to practice medicine according to the prevailing standards of practice in North Carolina and moved to force Dr. Guess to either abandon the practice of homeopathy or lose his license to practice medicine in North Carolina.

With the support of national homeopathic medicine organizations, Dr. Guess, over a period of many years, contested the NCMB's actions in state courts. Despite losses at the District, Appellate, and NC State Supreme Court levels, Dr. Guess' appeal was dismissed at the State Supreme Court level in a 2-to-1 decision, deciding that even in the absence of patient harm or complaint, the NCMB had a legal right to restrict or revoke a doctor's license for failure to comply with what the NCMB determined to be the standards of practice. As a result, the few remaining integrative medicine physicians in North Carolina realized that with Dr. Guess out of the way, it was a certainty that the NCMB would systematically eliminate every physician in the state that practiced differently from the "usual and acceptable standards of practice."

John L. Laird, M.D., a physician also from Asheville, had been under a nearly 10-year investigation by the NCMB at the time that the Dr. Guess decision was handed down by the State Supreme court in 1991. Within a couple of months, the NCMB began to re-activate their action against Dr. Laird by scheduling a license revocation hearing. Against this action, Dr. Laird organized a small group of individuals from around the state to begin legislative action intended to change the wording of the NC Medical Practice Act. This group consisted of about 15 people, including three medical doctors, health food storeowners, naturopaths, nurses, office managers, health consumers, political organizers, and one lobbyist. They decided to call their group Carolinians for Health Care Access (CHCA). CHCA expanded to 10,000 supporters and collected over $250,000 in the political campaign to change the medical practice act wording. This effort culminated eighteen months later in the changed wording desired:

"The medical board may not restrict nor deny medical licensure to an individual physician merely on the basis that a particular therapy is not consistent with the prevailing standard of practice, unless, by competent evidence, they can show that such a therapy is inherently more dangerous than the conventional therapy it replaces, or is generally ineffective."

This language effectively served as a deterrent to the NCMB and prevented actions against physicians who practice non-conventional medicine simply because of their practice. By the end of the legislative efforts CHCA had evolved into a patients’ rights organization.

This 1993 law decriminalized non-conventional medical therapies and gave basic rights to physicians when called before the Board with questions about their practice.

Since 1993 integrative medicine programs have emerged at North Carolina medical schools and treatment facilities continuing to increase the number of practitioners and options available to consumers. The formation of the consortium of Academic Health Centers for Integrative Medicine in 2000 reflected the surging interest in integrating diverse therapies within the context of evidence-based medical practice. In North Carolina by 2006, three academic health centers—University of North Carolina at Chapel Hill, Duke University School of Medicine, and Wake Forest University School of Medicine—were among the 36 members of the Consortium who use the term "integrative medicine" to refer to the evidence-based integration of diverse therapies into comprehensive care. Growing interest in integrative medicine has been reflected in CAM-related activities at the above-mentioned universities, which have been the source of substantial funded research and numerous peer-reviewed publications on these topics in recent years.

Moreover, insurance companies increasingly provide coverage for integrative medicine treatments, which has extended the marketplace and offers a growth opportunity for medical professionals whose services may be characterized as health supporting. However, insurers presently cover chiropractic, acupuncture, and biofeedback more often than dietary supplements, home remedies, or prayer—all of which are far more widely used by the general public.

In 2000, despite the academic and public acceptance of integrative medicine, the Board chose to again begin to initiate a string of actions against integrative physicians. As a result, CHCA (which had ceased operations within 6 months of their successful bill passage on July 2, 1993), was resurrected with the same goals as before: To ensure that the people of North Carolina have the right to receive a form of health care of their choosing and to force the NCMB to abide by the intent of the law that was passed in 1993.

In 2003 in response to the NC Medical Board reactivated harassment Integrative Medicine physicians and other health professional founded the NC Integrative Medical Society (NCIMS).

In the spring of 2003, the NCIMS facilitated the passage of SB 882/HB 886 in the NC legislature. This Due Process for Physicians Bill started the process of forcing the NCMB to abide by the 1993 gave basic rights to physicians who are called before the Board with questions about their practice. NCIMS secured these rights for every physician in this state. It is obvious that NCIMS must be persistence in defending the rights of citizens to integrative medicine.

Both the leadership of the North Carolina Medical Society (NCMS), as well as the legislators financially influenced by this organization, publicly vowed to reverse the bill passed in 2003, as well as the 1993 law. Medical professionals needed to step up to ensure that the healthcare services sought by consumers from licensed practitioners are available.

According to the 2002 edition of the National Health Interview Survey, well over half of all Americans use CAM therapies, and the American public spends an estimated $47 billion annually on these therapies, with most charges being paid directly out of pocket. A nationwide government survey sponsored by NCCAM and released in May 2004 indicates that 36 percent of U.S. adults aged 18 years and over use some form of CAM. Many people now refer to the combination of conventional and CAM therapies as integrative medicine. Moreover, the United States Board on Health Promotion and Disease Prevention, in a 2005 report titled “Complementary and Alternative Medicine in the United States”, estimates that more than one third of all Americans turn to CAM therapies on a regular basis, and total visits to integrative medicine providers each year now exceed those to primary-care physicians.

A 2007 survey of clinicians at a North Carolina academic medical center (Wake Forest University Baptist Medical Center, Winston-Salem,NC) indicated that most physicians are interested in integrative medicine and would like to see an integration of various evidence-based services at their institution. The greatest interest is in CAM therapies with which they had had personal experience or professional training included nutrition, exercise, and mind-body therapies. Additionally, in terms of specific areas of medical application, the highest level of support was for an integrated, comprehensive pain treatment program, followed by comprehensive programs for obesity and diabetes.

By 2008, the NCIMS evolved to expand its mission to increase educational opportunities for licensed health professionals. Also, NCIMS initiated a pro-active public educational campaign to shift the paradigm of the Medical Board to acceptance of the value of Integrative physicians.

In 2009 NCIMS sought further due process legislation in an further improve due process and remove personal bias from the regulatory process of the NC Medical Board. SB 958 improved due process for all physicians. It has been a long twenty-year process for the Board to realize that integrative medicine is here to stay.

Medical Malpractice

The North Carolina Integrative Medical Society (NCIMS) would like to see the NC Medical Board focus on decreasing the amount of malpractice suits by decreasing the amount of malpractice incidents. It is currently estimated that around 225,000 Americans die in hospitals annually from the side effects of medications or errors of hospital personnel. Of this number, 17% of intensive care "serious or fatal adverse events" are preventable, while 14% to 27% of deaths from acute myocardial infarction, pneumonia, or cerebrovascular accident are preventable

Public Citizen, a patient's advocacy group, has identified eleven physicians who have either been found guilty of malpractice or have agreed to settle prior to court. All of these physicians not only continue to practice medicine without any evidence of being investigated, but they have had no charges of misconduct filed against them or any action taken by the NC Medical Board. Only 18% of physicians with four or more malpractice payments have been disciplined. The NC Medical Board is instead directing its limited resources towards the repeated investigations of physicians who have had no complaints filed against them, or taking action against doctors who have caused only minimal harm and have not had any malpractice judgments made against them.

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	Political History of Integrative Medicine The responsibility of the North Carolina Medical Board (NCMB) to regulate the physicians of North Carolina and ensure that citizens are protected from doctors who are incompetent or show a pattern of dangerous behavior that puts patients at risk. However, NCMB has historically misused their resources and powers to wrongly single out medical practitioners who practice alternative medical treatments. Not unlike other medical practices, such as the practice of washing hands before surgery, integrative medicine has been viewed with resistance and suspicion. Recent surveys of doctors and patients who embrace integrative medicine have revealed widespread use. According to the 2002 edition of the National Health Interview Survey, well over half of all Americans use CAM therapies, and the American public spends an estimated $47 billion annually on these therapies, with most charges being paid directly out of pocket. The U.S. Board on Health Promotion and Disease Prevention, in a 2005 report titled “Complementary and Alternative Medicine in the United States”, estimated that more than one third of all Americans turn to CAM therapies on a regular basis ,and total visits to integrative medicine providers each year now exceed those to primary-care physicians. Use of CAM therapies continues to be consumer driven and usually outpatient focused. Recent surveys indicate that lay people seek out integrative medicine practitioners for diverse reasons. For advanced cancers, the statistics for conventional treatment alone often indicate a poor chance of therapeutic success or long-range survival. Cancer patients often look to integrative medicine to help them better tolerate conventional cancer therapies and to maintain better health during and after treatment. Heart disease patients are looking for ways to actually feel better, not just to improve their blood lipid profiles. Diabetics are interested in strategies that reduce their dependence on medications while also preventing complications. Many consumers also seek out integrative treatment for those illnesses that are "medically unexplained" or for which conventional treatment alone has had limited success -- conditions or syndromes such as autism, Lyme disease, multiple chemical sensitivity, and fibromyalgia. A rapidly growing body of evidence suggests that the integrative medical paradigm -- using an individualized approach that addresses the patient's diverse needs -- is the most effective way to tackle these heretofore intractable conditions. In 1985, The North Carolina Medical Board (NCMB) brought charges against George Guess, M.D., a homeopathic medical practitioner in Asheville, North Carolina. In the absence of any patient harm or complaints, the NCMB alleged that Dr. Guess failed to practice medicine according to the prevailing standards of practice in North Carolina and moved to force Dr. Guess to either abandon the practice of homeopathy or lose his license to practice medicine in North Carolina. With the support of national homeopathic medicine organizations, Dr. Guess, over a period of many years, contested the NCMB's actions in state courts. Despite losses at the District, Appellate, and NC State Supreme Court levels, Dr. Guess' appeal was dismissed at the State Supreme Court level in a 2-to-1 decision, deciding that even in the absence of patient harm or complaint, the NCMB had a legal right to restrict or revoke a doctor's license for failure to comply with what the NCMB determined to be the standards of practice. As a result, the few remaining integrative medicine physicians in North Carolina realized that with Dr. Guess out of the way, it was a certainty that the NCMB would systematically eliminate every physician in the state that practiced differently from the "usual and acceptable standards of practice." John L. Laird, M.D., a physician also from Asheville, had been under a nearly 10-year investigation by the NCMB at the time that the Dr. Guess decision was handed down by the State Supreme court in 1991. Within a couple of months, the NCMB began to re-activate their action against Dr. Laird by scheduling a license revocation hearing. Against this action, Dr. Laird organized a small group of individuals from around the state to begin legislative action intended to change the wording of the NC Medical Practice Act. This group consisted of about 15 people, including three medical doctors, health food storeowners, naturopaths, nurses, office managers, health consumers, political organizers, and one lobbyist. They decided to call their group Carolinians for Health Care Access (CHCA). CHCA expanded to 10,000 supporters and collected over $250,000 in the political campaign to change the medical practice act wording. This effort culminated eighteen months later in the changed wording desired: "The medical board may not restrict nor deny medical licensure to an individual physician merely on the basis that a particular therapy is not consistent with the prevailing standard of practice, unless, by competent evidence, they can show that such a therapy is inherently more dangerous than the conventional therapy it replaces, or is generally ineffective." This language effectively served as a deterrent to the NCMB and prevented actions against physicians who practice non-conventional medicine simply because of their practice. By the end of the legislative efforts CHCA had evolved into a patients’ rights organization. This 1993 law decriminalized non-conventional medical therapies and gave basic rights to physicians when called before the Board with questions about their practice. Since 1993 integrative medicine programs have emerged at North Carolina medical schools and treatment facilities continuing to increase the number of practitioners and options available to consumers. The formation of the consortium of Academic Health Centers for Integrative Medicine in 2000 reflected the surging interest in integrating diverse therapies within the context of evidence-based medical practice. In North Carolina by 2006, three academic health centers—University of North Carolina at Chapel Hill, Duke University School of Medicine, and Wake Forest University School of Medicine—were among the 36 members of the Consortium who use the term "integrative medicine" to refer to the evidence-based integration of diverse therapies into comprehensive care. Growing interest in integrative medicine has been reflected in CAM-related activities at the above-mentioned universities, which have been the source of substantial funded research and numerous peer-reviewed publications on these topics in recent years. Moreover, insurance companies increasingly provide coverage for integrative medicine treatments, which has extended the marketplace and offers a growth opportunity for medical professionals whose services may be characterized as health supporting. However, insurers presently cover chiropractic, acupuncture, and biofeedback more often than dietary supplements, home remedies, or prayer—all of which are far more widely used by the general public. In 2000, despite the academic and public acceptance of integrative medicine, the Board chose to again begin to initiate a string of actions against integrative physicians. As a result, CHCA (which had ceased operations within 6 months of their successful bill passage on July 2, 1993), was resurrected with the same goals as before: To ensure that the people of North Carolina have the right to receive a form of health care of their choosing and to force the NCMB to abide by the intent of the law that was passed in 1993. In 2003 in response to the NC Medical Board reactivated harassment Integrative Medicine physicians and other health professional founded the NC Integrative Medical Society (NCIMS). In the spring of 2003, the NCIMS facilitated the passage of SB 882/HB 886 in the NC legislature. This Due Process for Physicians Bill started the process of forcing the NCMB to abide by the 1993 gave basic rights to physicians who are called before the Board with questions about their practice. NCIMS secured these rights for every physician in this state. It is obvious that NCIMS must be persistence in defending the rights of citizens to integrative medicine. Both the leadership of the North Carolina Medical Society (NCMS), as well as the legislators financially influenced by this organization, publicly vowed to reverse the bill passed in 2003, as well as the 1993 law. Medical professionals needed to step up to ensure that the healthcare services sought by consumers from licensed practitioners are available. According to the 2002 edition of the National Health Interview Survey, well over half of all Americans use CAM therapies, and the American public spends an estimated $47 billion annually on these therapies, with most charges being paid directly out of pocket. A nationwide government survey sponsored by NCCAM and released in May 2004 indicates that 36 percent of U.S. adults aged 18 years and over use some form of CAM. Many people now refer to the combination of conventional and CAM therapies as integrative medicine. Moreover, the United States Board on Health Promotion and Disease Prevention, in a 2005 report titled “Complementary and Alternative Medicine in the United States”, estimates that more than one third of all Americans turn to CAM therapies on a regular basis, and total visits to integrative medicine providers each year now exceed those to primary-care physicians. A 2007 survey of clinicians at a North Carolina academic medical center (Wake Forest University Baptist Medical Center, Winston-Salem,NC) indicated that most physicians are interested in integrative medicine and would like to see an integration of various evidence-based services at their institution. The greatest interest is in CAM therapies with which they had had personal experience or professional training included nutrition, exercise, and mind-body therapies. Additionally, in terms of specific areas of medical application, the highest level of support was for an integrated, comprehensive pain treatment program, followed by comprehensive programs for obesity and diabetes. By 2008, the NCIMS evolved to expand its mission to increase educational opportunities for licensed health professionals. Also, NCIMS initiated a pro-active public educational campaign to shift the paradigm of the Medical Board to acceptance of the value of Integrative physicians. In 2009 NCIMS sought further due process legislation in an further improve due process and remove personal bias from the regulatory process of the NC Medical Board. SB 958 improved due process for all physicians. It has been a long twenty-year process for the Board to realize that integrative medicine is here to stay. Medical Malpractice The North Carolina Integrative Medical Society (NCIMS) would like to see the NC Medical Board focus on decreasing the amount of malpractice suits by decreasing the amount of malpractice incidents. It is currently estimated that around 225,000 Americans die in hospitals annually from the side effects of medications or errors of hospital personnel. Of this number, 17% of intensive care "serious or fatal adverse events" are preventable, while 14% to 27% of deaths from acute myocardial infarction, pneumonia, or cerebrovascular accident are preventable Public Citizen, a patient's advocacy group, has identified eleven physicians who have either been found guilty of malpractice or have agreed to settle prior to court. All of these physicians not only continue to practice medicine without any evidence of being investigated, but they have had no charges of misconduct filed against them or any action taken by the NC Medical Board. Only 18% of physicians with four or more malpractice payments have been disciplined. The NC Medical Board is instead directing its limited resources towards the repeated investigations of physicians who have had no complaints filed against them, or taking action against doctors who have caused only minimal harm and have not had any malpractice judgments made against them.