accme-logoThe Integrative Addiction Conference 2015 (“A New Era in Natural Treatment”) starts tomorrow in Myrtle Beach, SC. Medical doctors, doctors of osteopathy, naturopaths and other health care providers will hear lectures on such subjects as “IV Therapies and Addiction Solutions,” given by Kenneth Proefrock, a naturopath whose Arizona Stem Cell Center specializes in autologous stem cell transplants derived from adipose tissue. Proefrock, who was disciplined for using prolotherapy in the cervical spine without proper credentialing in 2008, claims that stem cells treatments are an “incredibly versatile therapy” and uses them for variety of conditions, such as MS and viral diseases. At the same time, he admits that they are not FDA approved and he is not claiming they are effective for anything (and he’s right), which leads one to wonder why he employs them.

Proefrock also offers a typical naturopathic mish-mash of services, from oncology to urology to “naturopathic endocrinology,” and claims he specializes in treating influenza, high blood pressure and kidney stones, as well as addiction. In other words, he doesn’t seem to be the sort of expert you’d find speaking at a science-based conference on addiction medicine.

You’ll find similarly troubling bios of some of the other speakers, as well as dubious treatments for addiction, on the conference website. Here, for example, are speaker Giordano’s and Eidelman’s websites.

Dalal Akoury, MD, is the “Title Sponsor” of the conference and appears to be running the show. Although she is listed by the S.C. Board of Medicine as board certified in pediatrics, she is the founder of the “Integrative Addiction Institute” and runs the “AwareMed Health and Wellness Resource Center” in Myrtle Beach. Like the Arizona Stem Cell Center, it offers a range of treatments that defy categorization as any particular specialty: addiction recovery, “adrenal fatigue” treatment, stem cells, “anti-aging,” weight loss, “functional medicine” and “integrative cancer care“. Yet, only Akoury and one licensed practical nurse are on the staff of the Center. Again, it is questionable whether she is has sufficient qualifications in addiction medicine to run a conference on the subject.

Regular readers of this blog won’t be shocked that this sort of conference goes on. But what we should find disturbing is that a medical doctor can get continuing medical education credits for conference attendance. Why? Because it is sponsored jointly by Continuing Education, Inc. and the Southwest College of Naturopathic Medicine (no surprise there). Continuing Education, Inc. is accredited by the American Council for Continuing Medical Education (ACCME) as a provider of continuing education for physicians. Continuing Education, Inc. has designated this conference for a maximum of 19.75 hours of AMA (yes, that AMA) PRA (Physicians Recognition Award) Category 1 Credits, a decision it is empowered to make because of its ACCME accreditation.

The American Council for Continuing Medical Education

A bit of background (bear with me here): Like other professionals, such as lawyers and accountants, medical doctors must earn a certain number of continuing education credits to keep their state licenses current and to retain a specialty board certification. State medical boards and specialty boards (such as the American Academy of Family Physicians and the American Board of Internal Medicine) set the number of hours and sometimes the subject matter of these courses. They also decide which courses they will accept as valid CME hours. Some of these accept courses offered by CME providers accredited by the ACCME. Others may not accept certain ACCME-accredited providers directly, but will accept hours approved by other entities that do. For example, my state, Florida, will accept courses approved for the AMA Physician Recognition Award.

Putting this all together, the Integrative Addiction Conference is presented by an organization accredited by the ACCME and qualifies for AMA PRA credit. In turn, because it is eligible for AMA PRA credit, it will be accepted by the Florida Board of Medicine.

The ACCME accredits organizations, not individual courses, based on set criteria. Once the organization is accredited to provide CME, it must maintain recognition through a continuing compliance process. ACCME member organizations include the AMA, the American Hospital Association, the American Board of Medical Specialties and the Federation of State Medical Boards of the U.S. There are a total of 2,100 organizations accredited by the ACCME, conducting 125,000 events annually. In other words, if you take a CME course in the U.S., your getting credit for it likely involved the ACCME.

Here’s how the ACCME explains its work:

The Accreditation Council for Continuing Medical Education (ACCME®), a nonprofit corporation based in Chicago, is responsible for accrediting institutions that offer continuing medical education (CME) to physicians and other health care professionals. . . . The ACCME’s mission is to identify, develop, and promote rigorous national standards for quality CME that improves physician performance and medical care for patients and their communities. [Emphasis added.]

According to ACCME policy:

Accredited providers are responsible for validating the clinical content of CME activities that they provide. Specifically,

  1. All the recommendations involving clinical medicine in a CME activity 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.
  2. All scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to the generally accepted standards of experimental design, data collection and analysis.
  3. Providers are not eligible for ACCME accreditation or reaccreditation if they present activities that promote recommendations, treatment, or manners of practicing medicine that are not within the definition of CME, or known to have risks or dangers that outweigh the benefits or known to be ineffective in the treatment of patients. An organization whose program of CME is devoted to advocacy of unscientific modalities of diagnosis or therapy is not eligible to apply for ACCME accreditation. [Emphasis added.]

I’m not a physician, but I think the Integrative Addiction Conference 2015 falls a bit short of these standards, don’t you?

Boning up on pseudoscience

Let’s look at a few other courses from ACCME-accredited CME providers and see how they measure up.

The Institute for Functional Medicine (IFM) is an ACCME-accredited CME provider as well. For those of you who aren’t familiar with Functional Medicine, we’re not sure we can explain it either. As David Gorski said:

what constitutes functional medicine has never been clear to me, although it’s clear that a lot of it is pseudoscience. . . . It postulates “imbalances” in hormones and neurotransmitters, oxidation-reduction, detoxification and biotransformation, immune function, inflammation, and cell structure. It’s all so vague that these “imbalances” could mean almost anything, and when practitioners of “functional medicine” refer to them, they usually do. Arguably the most famous practitioner of “functional medicine” is Mark Hyman, known for creating “Ultrawellness,” the very name of which should tell you pretty much all you need to know about functional medicine. Indeed, it just seems to be a label used to encompass a whole lot of alternative medicine practices being “integrated” with real medicine.

The theme for IFM’s Annual International Conference, held this past May, was “The Omics Revolution: Nature and Nurture,” for 19 hours of CME. I’ll wager this is the type of “omics” that could be categorized as “Woo-Omics.”

On the faculty were:

Jeffrey Bland, PhD, the “father of functional medicine,” whose outsized claims for his nutritional products got him into trouble with the FTC in the early 1990s.

Paul Anderson, a naturopath whose clinic in Seattle offers hyperbaric oxygen therapy and IV therapy delivering “micronutrients and pharmaceuticals” for, among other things, “support for detoxification” and “heavy metal chelation.”

Yousef Elyaman, MD, a Florida functional medicine practitioner and author of the upcoming book, Your Healing Power, “a guide to mastering one’s genes to reverse disease.” (Who knew?)

If you missed the May conference, there are several other opportunities on the horizon to earn CME credits from the IFM. In November, the IFM will be presenting “Energy: Illuminating the Energy Spectrum: Evidence and Emerging Clinical Solutions for Managing Pain, Fatigue, and Cognitive Dysfunction,” for which the physician can earn 20 CME credits. The descriptions of the program and its presentations are so full of word salads you could open a restaurant with them.

For example:

Energy drives all biologic activity—within individual atoms and molecules, as part of cellular physiology, up through organ-system and whole-person functioning, and, ultimately, the entire biosphere. The last 20 years have brought us dramatic breakthroughs in understanding about how mitochondria work and what they require for enduring optimal function. Genetic and epigenetic vulnerabilities have been discovered; the effects of toxic environmental exposures on energy production have been revealed; and connections between dysregulation in energy production and many clinical conditions have been described.

And:

Physiology is one side of the coin, but we are also learning about the larger energy landscape, including the mechanisms underlying the clinical effects of magnetic fields and microcurrent, hands-on therapies such as manipulation and craniosacral, acupuncture, and the profound power of the therapeutic partnership.

As for those “clinical effects of magnetic fields,” a “post-module activity” includes “Identifying Clinical Manifestations of EMF/RF: Adverse Impacts Including Electromagnetic Hypersensitivity Syndrome,” (a fabricated condition), by Devra Davis, PhD, a cell phone radiation alarmist who warns against keeping your cell phone in your bra due to an increased risk of breast cancer (another fabrication).

IFM is big into “detox.” Just this past July, it offered 19 CME credits for a sold-out conference styled “Detox: Understanding Biotransformation and Recognizing Toxicity: Evaluation and Treatment in the Functional Medicine Model.” And who better to teach MDs about detoxification than naturopaths, of which there were several on the faculty.

Also on the faculty is a chiropractor, Richard Mayfield, who lectured on “Ensuring a Safe Detox Program: Applying Oral Chelation Therapy to Reduce an Elevated Heavy Metal Burden with Case Studies,” one of 6 courses he teaches at the IFM “Detox” conference.

Mayfield’s own practice reveals a truly impressive array of such quackery, including chiropractic “adjustments” to remove “nerve interference,” bioidentical hormones, something called BioCranial treatments, and screening for “undiagnosed gluten intolerance,” among others. He treats autism spectrum disorder with a “biomedical approach” and is a former DAN! practitioner.

To be fair, the pseudoscience was not confined to ND and DC presenters. There were MDs and a dentist as well. The latter was Mary Ellen Chalmers, DMD, whose practice offers removal of mercury amalgam fillings, a totally unnecessary and expensive dental procedure that is based on the unproven “theory” that they are “toxic” to everyone.

One would be hard pressed to find better exemplars of CME courses “devoted to advocacy of unscientific modalities of diagnosis or therapy,” as the ACCME puts it, than these IFM conferences.

Or, maybe not.

If, unlike IFM, your organization does not have its own ACCME accreditation, you can glom onto one that does to present your pseudoscience for CME credit. For example, the American Academy of Integrative Health & Medicine offered CME for its 2015 conference under the auspices of Scripps Health, in the form of the pretentiously titled “People, Planet and Purpose: Global Practitioners United in Health and Healing.” (Interestingly, for all of its chumminess with DCs and NDs, there doesn’t seem to be either on the Scripps staff.) Here the speakers include:

Deepak Chopra, MD, who is famous for loony sayings, like:

chopra-quote-go-with-your-passions

I know people who ascribe to this philosophy. They are called “toddlers.”

John Weeks, a relentless promoter of integrative medicine, who believes that chiropractors and naturopaths are capable of practicing as primary care physicians.

Bill Wolfe, a speaker on “biological dentistry,” another dentist who advocates the removal of mercury fillings and believes “any degenerative condition in the mouth is a potential energetic disruption of the associated energy meridian.” And apparently believes that having two different metals in the mouth (e.g., gold and mercury) generates an electric current capable of disrupting one’s “energy meridians.”

Bill Reddy, an acupuncturist, who lectured on “Leaky gut.” (It must be awfully easy to master the understanding and treatment of “leaky gut” if your education as an acupuncturist is sufficient to lecture on it.)

Joseph Pizzorno ND, talked about “Assessing Body Burden” and “Detoxification.” There is not a detailed description of these courses available, so I’m not sure what he will say about “assessing body burden,” but I found a hint in The Encyclopedia of Natural Medicine, of which Pizzorno is co-editor. This Encyclopedia tells us that 25% of the US population suffers from heavy metal poisoning. The preferred method of assessing this mythical burden is provoked urine testing.

Amy Rothenberg, ND, spoke on “Clinical Applications of Homeopathy.” She memorably testified at the recent FDA hearing that homeopathy’s mechanism of action (of which there is none) can be explained by hormesis (a “theory” shot down here). She also said she uses homeopathy to treat autistic children.

I note that the listed conference speakers recommend all of the Five Things Patients and Physicians Should Question, according to the American College of Medical Toxicology and the American Academy of Clinical Toxicology. Doesn’t sound like “recommendations involving clinical medicine . . . based on evidence that is accepted within the profession of medicine,” per ACCME policy.

Integrative Practitioner, John Weeks’s organization, is also able to offer CME courses by attaching itself to a medical school. In 2015, it teamed up with Mount Sinai/Beth Israel, to present the Integrative Healthcare Symposium Annual Conference, at which the physician could earn 17.75 CME credit hours. The keynote speaker was Nick Ortner, CEO of the Tapping Solution, LLC, a company with a mission to bring “simple, effective, natural healing into the mainstream through Emotional Freedom Techniques (EFT)” or “tapping.” According to Ortner, tapping is a healing modality that combines ancient Chinese acupressure and modern psychology which:

utilizes the body’s energy meridian points by stimulating them with your fingertips – literally tapping into your body’s own energy and healing power.

No, not “literally,” Mr. Ortner. Ortner is also the author of a “revolutionary” book about tapping. As well, he:

created and produced the breakthrough documentary film, The Tapping Solution, which follows ten people who used tapping to overcome tremendous challenges, including 30 years of chronic back pain, fibromyalgia, insomnia, devastating grief and more.

No shortage of superlatives in his bio. EFT is, of course nonsense.

Sadly for the integrative MD, someone thought to exercise some discretion here and Ortner’s talk could not be included in the attendee’s CME credits. Also not approved for credit was Dr. Devra’s talk: “Experimental and Clinical Observations on the Impact on Reproductive Health of Wireless Radiation from Cell Phones and Other Devices.” It was, however, approved CE for chiropractors, naturopaths, acupuncturists, and (unfortunately) nurses.

There were a lot of functional medicine presentations, including a naturopath’s discussion of how foods can “reduce our toxic body burden” and another presentation by a naturopath who claims that a simple urine test can find two different markers reflective of both the amount of hydroxyl radical damage to the DNA, and the ability of the DNA to repair this damage as well as indicate whether a person is under “oxidative stress.”

Another Integrative Healthcare Symposium, “Focus On: the Microbiome,” teams up with the University of Miami medical school and “has been reviewed and is acceptable for up to 12.00 Prescribed credit(s) by the American Academy of Family Physicians” (AAFP).

Conference chair is David Perlmutter, MD, author of “Grain Brain.” Here, attendees, among other things:

Appreciate how leading edge novel techniques to restore a healthy microbiome may pave the way for meaningful treatment of autism, autoimmune conditions and inflammatory disorders

Perlmutter got his equivalent of an Oz takedown in a recent New York Magazine article by Alan Levinovitz, author of The Gluten Lie (a book highly recommended by SBM’s own Clay Jones.) It’s an excellent exposé and well worth reading.

On its website, The AAFP offers this disclaimer regarding CME for integrative medicine courses:

[The AAFP] maintains there is value in providing information about integrative medicine (also referred to as complementary and alternatve [sic] practices and other terms) to help family physicians respond to patients who use these therapies and who would consider using them. Family physicians need to understand new medical practices and products including integrative approaches to effectively counsel patients, understand potential drug or treatment interactions, and better evaluate patient outcomes.

Continuing Medical Education (CME) activities that include information about integrative medicine must meet all existing AAFP CME Credit Eligibility Requirements. Among these is the requirement that clinical content that is not considered to be evidence-based or customary and generally accepted medical practice must be deemed neither dangerous nor proven ineffective by the Commission on Continuing Professional Development (COCPD). The COCPD relies on its collective clinical expertise, as well as findings (meta-analyses or systematic reviews) reported by sources it deems acceptable. The COCPD considers diagnostic and therapeutic interventions in which the risks substantially outweigh the benefits to patients to meet the definition of “dangerous.”

Yes, of course family physicians need to know about integrative, complementary and alternative medicine, but there are better ways than sending them to conferences that teach them how to practice sub-par medicine. And there are more risks than a treatment being “dangerous” or proven ineffective. Does it not matter that the patient is being ripped off by a physician who fails to use “evidence-based or customary and generally accepted medical practice.”

But wait, there’s more . . . quackery!

Before we end, here are a few more questionable, but CME-approved, courses:

Aromatherapy & Health: An Introduction” (4 hours CME credits), from the University of Arizona Center for Integrative Medicine.

Bioidentical Hormone Replacement Therapy Symposium,” sponsored by the American Academy of Anti-Aging Medicine, which seems to fit nicely into Kimball Atwood’s Pseudomedical Pseudoprofessional Organization category. (27 hours CME credits)

Auricular Acupuncture, from the University of Miami Miller School of Medicine; (14 hours CME credit):

Auriculotherapy is effective for a wide range of health problems, including musculoskeletal pain, addiction, respiratory and gastrointestinal issues, skin problems, eye-ear-nose-throat disorders, control of blood pressure & many others.

“And many others?” Somehow I doubt that these claims of effectiveness are based on research that, again quoting the ACCME, “conform[s] to the generally accepted standards of experimental design, data collection and analysis.”

It is unfortunate to see the continued normalization of quackery as accepted medical practice. And it is unfortunate that the AMA and state medical boards, with the help of the ACCME, are facilitating that process by allowing CME credit for courses in pseudoscience. If these courses are “based on evidence that is accepted within the profession of medicine as adequate justification” for their use in patient care, then that standard has no meaning.

 

 

Posted by Jann Bellamy

Jann J. Bellamy is a Florida attorney and lives in Tallahassee. She is one of the founders and Board members of the Society for Science-Based Medicine (SfSBM) dedicated to providing accurate information about CAM and advocating for state and federal laws that incorporate a science-based standard for all health care practitioners. She tracks state and federal bills that would allow pseudoscience in health care for the SfSBM website.  Her posts are archived here.    

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