by Dr. Scott Shannon
The last twenty years has witnessed the emergence of Integrative Medicine, a new specialty in health care. Originally called Complementary and Alternative Medicine (CAM), this field exploded with the 1993 NEJM article by David Eisenberg, MD of Harvard that documented the level of interest and utilization of CAM in the US. For example, most people were shocked to discover that Americans had more visits (in 1991) to CAM providers than to primary care physicians with that number growing in disparity each year.
In 1994 Andrew Weil, MD initiated a post-graduate fellowship program in CAM at the University of Arizona and called it Integrative Medicine (IM). The philosophy centers on the integration of safe and effective treatment modalities from all traditions. Typically, it includes a focus on evidenced based treatments from areas such as nutrition, lifestyle change, mind-body medicine, herbal medicine and traditional practices (such as acupuncture). The goal is to bring the scrutiny of western medicine to the exploration and integration of other practices that may have much to offer. The push for IM is being driven by rising consumer demand and interest.
Now, 46 medical schools have academic programs in Integrative Medicine with the number growing every year. These universities, including University of Colorado, have formed an organization called CAHCIM (Consortium of Academic Health Centers in Integrative Medicine). CACHIM sponsored an International Conference on IM Research that drew over 700 physicians from around the globe last year. Lisa Corbin, MD, an internist, leads our clinical program at CU. Children’s Hospital in Denver has also begun development of an Integrative Pediatrics program under the leadership of Rachel Workman, MD.
As the number of physicians working in this arena explodes, the field is making efforts to validate and certify training. The American Board of Integrative Holistic Medicine (ABIHM) was founded in 1996 in an effort to develop validation and bring educational consistency to this field. Currently, over 1300 MDs and DOs have been board certified. The ABIHM (www.holisticboard.org) offers a five-day board review course that is provides an excellent overview of this field. The grandfathering period for licensed physicians appears to drawing to a close for those who have not completed a formal training program in IM. As more and more IM training programs come on line the field moves in the direction of formal ABMS recognition.
Integrative Psychiatry (IP) functions as a subset of IM and is relatively new on the scene. The APA has had a caucus on IP for about 4 years lead by James Lake, MD, author of two textbooks in this new arena. The AACAP recently (2/10) announced the formation of a new committee on Integrative and Complementary Psychiatry and we will have our first formal meeting in New York in October. The University of Arizona hosted the first annual conference on Integrative Mental Health in Phoenix this past March. Daniel Siegel, MD and I represented Child Psychiatry on the program. As a sign of the intense interest in this new field, the conference sold out two months prior with over 700 professionals registered. Plans are underway for the second installment of this conference next year.
Closer to home, the child and adolescent psychiatry residency at CU/Children’s has been a national leader in integrative programming for years under the supportive leadership of Marianne Wamboldt, MD. Yoga classes there have been very successful for children with somatic and chronic pain issues. In that setting I have offered an elective in Integrative Child Psychiatry for four years. This year long elective highlights the application of evidenced based nutritional and herbal interventions in an outpatient setting. Three of the four residents that completed this elective have entered private practice with an integrative approach to patients. In Fort Collins, Mike Mullin, MD and I are expanding our practice and will open a large interdisciplinary Integrative Child Psychiatry clinic this fall called Wholeness Center.
As you can see this is a rapidly expanding field, still in its infancy that is driven by huge patient demand. The educational opportunities are manifold, given the fact that most psychiatrists encountered little formal training on these topics. Concomitantly, the research base is also exploding with an escalating number of studies being released each year. If you would like to learn more, following this article is a brief list of some useful resources.
Kaplan, Bonnie and Shannon, Scott “Nutritional Aspects of Child and Adolescent Psychopharmacology” in Psychiatric Annals, 37:7, 519-528, 2007
Kemper, K and Shannon, Scott “Complementary and Alternative Therapies in Pediatric Mood Disorders” in Pediatric Clinics of NA, 54, 901-926, 2007
Lake, James Textbook of Integrative Mental Health Thieme, 2008
Lake, James and Spiegel, David Complementary and Alternative Treatments in Mental Health APPI, 2007
Newmark, Sanford ADHD Without Drugs Brigham, 2010
Shannon, Scott Handbook of Complementary and Alternative Therapies in Mental Health, Academic Press, 2002