CAM Implementation

Background
Since its inception over 100 years ago, Scott & White has consistently sought to provide patients with the best healthcare available anywhere. To do so, our organization has often had to be innovative and forward thinking; such as Dr. Arthur C. Scott's use of electric cautery in 1911 and the creation of our own health plan in 1980. More recently we have also seen major improvements in medical related technology, medical informatics, as we move closer to a fully digital medical record. Another area in which we are seeking to innovate is with Complementary/Alternative Medicine (CAM).

What is CAM?
CAM has been defined as "those therapies and practices not generally taught in most U.S. medical schools." However, since the landmark article on this subject by David Eisenberg in JAMA in 1993, this definition is quickly becoming invalid. In 1998, 64% of medical schools in this country, including Harvard and Stanford, reported offering courses pertaining to CAM. This trend also reflects the tremendous consumer interest with an estimated 40% of U.S. adults using some form of alternative therapy each year, such as herbals, acupuncture, and chiropractic.

A booming area
In addition, many other prestigious medical centers have been aggressively establishing departments or centers of CAM. This has, in part, been due to the tremendous research potential in this area. The National Center for Complementary and Alternative Medicine (part of the National Institutes of Health) has budgeted millions of dollars each year for research grants in this field. Some recent awards include $6.6 million to the University of Utah School of Medicine for the study of glucosamine for knee arthritis, $15 million to the University of Pittsburgh School of Medicine to study ginkgo biloba, and $4.3 million to Duke University for St. John's Wort.

An organized approach to alternative medicine
While in the past a few therapies at Scott & White may have qualified as "alternatives", such as hypnotherapy, biofeedback, and the occasional osteopathic manipulation, no organized approach to this field had been undertaken until recently. In May of 1999, the Complementary/ Alternative Medicine Interest Group was formed. Its mission is to review the pertinent literature, research the various forms of therapies available, gauge consumer interest, and make recommendations to Scott & White leadership regarding future efforts in this area.

This group is lead by Terry Rascoe, M.D. (Medical Director of the Northside Clinic) and Tricia Meyer (Assistant Director of Pharmacy) as chair and vice-chair, respectively. It is composed of physicians, members of pharmacy, nursing, marketing, the Health Plan, and others.

The future of CAM
Scott & White is seeking to include other appropriate CAM therapies in our offerings to patients. Currently, several physicians have been trained in Medical Acupuncture, and massage therapy is being offered by some departments on a "fee-for-service" basis. In addition, several of our Osteopathic Doctors (D.O.s) use spinal manipulation for musculo-skeletal problems. We are also looking to expand our Mind-Body therapies for certain chronic conditions such as pain. Efforts are also ongoing to better inform our staff regarding herbal products and other dietary supplements.

It is very likely that one day we will all view therapies no longer as conventional versus alternative, but as simply ones that work and ones that don't.

written by Terry Rascoe, MD

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