Washington Post mentions camlawblog in article on massage therapist and CAM credentialing

Jennifer Huget writes a wonderful blog on health care issues for the Washington Post.

Called, The Checkup, her health blog offers insights on a variety of health care topics, and is chock full of information from an unusual perspective -- that of a professional journalist who also writes as a patient, sensitive to all the mundane but critical concerns of anyone seeking health care services.

The Checkup recently featured a story entitled, "How Well Do You Know Your Massage Therapist?" The story rapidly moves from the news that a Bosnian butcher was reportedly practicing "complementary medicine" in plain sight, to questions about how to do due diligence about your CAM practitioner.

I had seen the article, and what struck me was the strange way words that tumble after one another seem to create linkages. Was this person practicing medicine, or "complementary medicine" as we know it in the U.S.? Wasn't the real point that he was allowed to go about his daily life untroubled, with the only disguise being a bushy beard and a pretension to practice medicine as an ordinary doctor?

Samantha Power allued in "A Problem From hell: America and the Age of Genocide" to complicity in letting war criminals go free - she suggests that a kind of deal was made with certain individuals based on a reluctance to intervene forcefully and a "policy" based on disinclination to get involved -- a latter-day implicit Monroe Doctrine. She writes compellingly that some have been writing poetry, having plays published, and practicing professions such as medicine openly, making a mockery of their victims. Whatever the truth of these charges, Power won a Pulitzer for her work.

But this is another topic. It's just to show that the tumbling words don't necessarily make a full picture. As the health care blog points out, just because someone who will be prosecuted for war crimes was reportedly practicing "complementary medicine" does not necessarily mean imply anything about anyone practicing any form of health care, complementary or otherwise. To back to the old Venn diagram, not all Ps are Q, and just because one P is a Q does not mean that all Qs are Ps.

When I asked what form of "complementary medicine" was being practiced, I was told, 'meditation and silence.' Well, you can turn to the Institute of Medicine Report on Complementary and Alternative Medicine and decide for yourself whether this is even CAM. Is a doctor who will sit in silence with a patient, sharing a moment in the black, velvety void, delivering an alterantive therapy?

Hard to say. Certainly not as clear as, saying, incorporating nutritional therapies into oncology or practicing an emerging standard of care such as, for example, including approaches from functional medicine.

No fault of the blog though, that is not the author's inquiry.

Here is the question The Checkup raises:

How well do I really know my massage therapist?

If, in fact, I had a massage therapist, I'm pretty sure she would have committed no crimes, let alone the kind of ghastly atrocities attributed to Karadzic. But there are tons of people practicing alternative and complementary medicine in the United States. How do we know if they're all on the up-and-up?

The short answer? We don't.

Whereas physicians practicing traditional Western medicine have to be trained and licensed and are subject to oversight by state medical boards, complementary and alternative medicine (CAM) practitioners in many fields of expertise can pretty much just hang out a shingle and start working with patients. Nor is there any overarching regulatory body with which to check a CAM practitioner's record and credentials.

None of this is to suggest that CAM practitioners are inherently less likely to be good citizens than traditional MDs; nor am I suggesting that every credentialed MD is a saint. All I'm saying is that, in light of the lack of comprehensive oversight, entering into a relationship with a CAM practitioner may warrant an extra dose of diligence.

Michael Cohen, Assistant Professor of Health Law and Policy at the Harvard School of Public Health and co-author of this article about CAM credentials, told me yesterday that "The world is basically divided into two groups: MDs and Everyone Else." The latter category, he explained, includes allied health professionals -- such as occupational therapists and physical therapists -- and CAM practitioners. The realm of CAM is further divided between licensed and unlicensed practitioners.

Checking a licensed CAM practitioner's credentials and performance is similar to checking an MD's, Cohen says. Your state regulatory board, like a state medical board, likely has a Web site on which you can look up a practitioner's name to see whether he has an active license and whether disciplinary action's been taken against him. Some will include a database listing malpractice claims, too.

An unlicensed practitioner may still be registered with the state; checking that listing might provide useful information. If your practitioner claims to be "certified," find out what organization issued the certification and, if possible, check with that organization.

The National Center for Complementary and Alternative Medicine (NCCAM) offers tips for selecting a reputable CAM practitioner. And here's something I lifted from the FAQ section of their Web site:

Requirements for licensure vary by type of CAM practice and by state. For some CAM therapies, licensure is required in some states and not in others. For other therapies, there are no formal requirements for practice. You may want to contact a nearby hospital, medical school, health licensing authority, or state medical board for CAM credential and license requirements in your state.

The Directory of Health Organizations lists professional organizations that outline standards of practice for certain CAM therapies and may offer information about the type of training required for a license. Search for the therapy or type of practitioner to find organizations that may be able to assist you.

This is good information, and the article includes a link to an article I co-authored on Credentialing CAM Providers that can help physicians interested in legal implications of referring to CAM practitioners, as well as patients and the practitioners themselves, better understand the world of licensure, scope of practice, and credentialing in complementary medicine.