Article    Table of Contents                    Full Text of this article    PDF of this article (PDFs free after 6 months)    Figures/Tables List  Services    Send comment/rapid response letter    Notify a friend about this article    Alert me when this article is cited    Add to Personal Archive    Download to Citation Manager    ACP Search                            Get Permissions  Google Scholar    Search for Related Content  PubMed Articles in PubMed by Author:    Eisenberg, D. M.    Cooper, R. A.    Related Articles in PubMed    PubMed Citation    PubMed

ACADEMIA AND CLINIC

COMPLEMENTARY AND ALTERNATIVE MEDICINE SERIES

Series Editors: David M. Eisenberg, MD, and Ted J. Kaptchuk, OMD

Credentialing Complementary and Alternative Medical Providers

David M. Eisenberg, MD; Michael H. Cohen, JD; Andrea Hrbek; Jonathan Grayzel, MD; Maria I. Van Rompay, BA; and Richard A. Cooper, MD

17 December 2002 | Volume 137 Issue 12 | Pages 965-973

Since the late 19th century, state legislatures and professional medical organizations have developed mechanisms to license physicians and other conventional nonphysician providers, establish standards of practice, and protect health care consumers by establishing standardized credentials as markers of competence. The popularity of complementary and alternative medical (CAM) therapies presents new challenges. This article describes the current status of, and central issues in, efforts to create models for health care credentialing of chiropractors, acupuncturists, naturopaths, massage therapists, and other CAM practitioners. It also suggests a strategy of CAM provider credentialing for use by physicians, health care administrators, insurance companies, and national professional organizations.

The credentialing debate reflects fundamental questions about who determines which providers and therapies will be accepted as safe, effective, appropriate, and reimbursable. More nationally uniform credentialing mechanisms are necessary to ensure high standards of care and more generalizable clinical research. However, the result of more uniform licensure and credentialing may be excessive standardization and a decrease in individualization of services. Thus, increased standardization of credentialing for CAM practitioners may alter CAM practice substantially. Furthermore, even credentialed providers can deliver ineffective therapy. The suggested framework balances the desire to protect the public from dangerous practices against the wish to grant patients access to reasonably safe and effective therapies.

Author and Article Information

From Harvard Medical School, Boston, Massachusetts; University of Massachusetts Medical Center, Worcester, Massachusetts; and the Medical College of Wisconsin, Milwaukee, Wisconsin.

Information on the various health professions changes rapidly. The figures in this article represent a snapshot of the profession [as reported by the professions or their representatives] at various dates before acceptance of this article for publication.

Acknowledgments: The authors thank Edward H. Chapman, MD; James Dillard, MD, DC; Janet Kahn, PhD, NCTMB; Barbara Mitchell; Joseph E. Pizzorno Jr., ND; Lou Sportelli, DC; and David Studdert, JD, for their assistance with the preparation of this paper. They also thank John C. Wilson for his research and administrative assistance.

Grant Support: By grants from the National Institutes of Health (U24 AR43441 and AT00144); American Specialty Health, San Diego, California; and Medtronic Foundation, Minneapolis, Minnesota. The funding institutions had no editorial input into the paper, and the views expressed in this article do not necessarily represent those of the funding institutions.

Requests for Single Reprints: David M. Eisenberg, MD, Division for Research and Education in Complementary and Integrative Medical Therapies, Osher Institute, Harvard Medical School, Suite 22A, 401 Park Drive, Boston, MA 02215; e-mail, Osher_Institute{at}hms.harvard.edu.

Current Author Addresses: Dr. Eisenberg, Mr. Cohen, Ms. Hrbek, and Ms. Van Rompay: Division for Research and Education in Complementary and Integrative Medical Therapies, Osher Institute, Harvard Medical School, Suite 22A, 401 Park Drive, Boston, MA 02215.

Dr. Grayzel: Department of Emergency Medicine, University of Massachusetts Medical Center, 72 Pointe Rok Drive, Worcester, MA 01604.

Dr. Cooper: Health Policy Institute, Medical College of Wisconsin, PO Box 26509, 8701 Watertown Plank Road, Milwaukee, WI 53226-0509.

This article has been cited by other articles:

				C. C. Rosenbaum The History of Complementary and Alternative Medicine in the US Ann. Pharmacother., July 1, 2007; 41(7): 1256 - 1260. [Full Text] [PDF]

				A. Bardia, D. L. Barton, L. J. Prokop, B. A. Bauer, and T. J. Moynihan Efficacy of Complementary and Alternative Medicine Therapies in Relieving Cancer Pain: A Systematic Review J. Clin. Oncol., December 1, 2006; 24(34): 5457 - 5464. [Abstract] [Full Text] [PDF]

				J.-Y. Wang, H.-N. Chuang, J.-H. Chiu, S.-L. Fu, T.-H. Tsai, A.-P. Tsou, C.-P. Hu, C.-W. Chi, S.-F. Yeh, W.-Y. Lui, et al. Effects of Scutellaria baicalensis Georgi on Macrophage-Hepatocyte Interaction Through Cytokines Related to Growth Control of Murine Hepatocytes. Experimental Biology and Medicine, April 1, 2006; 231(4): 444 - 455. [Abstract] [Full Text] [PDF]

				A. Busato, A. Donges, S. Herren, M. Widmer, and F. Marian Health status and health care utilisation of patients in complementary and conventional primary care in Switzerland--an observational study Fam. Pract., February 1, 2006; 23(1): 116 - 124. [Abstract] [Full Text] [PDF]

				C. L. Taylor State-Controlled Licensure and Interstate Mobility: Questions From Katrina Communication Disorders Quarterly, January 1, 2006; 27(4): 232 - 239. [Abstract] [PDF]

				M. Ruggie Mainstreaming Complementary Therapies: New Directions In Health Care Health Aff., July 1, 2005; 24(4): 980 - 990. [Abstract] [Full Text] [PDF]

				A. J. Cohen, A. Menter, and L. Hale Acupuncture: Role in Comprehensive Cancer Care--A Primer for the Oncologist and Review of the Literature Integr Cancer Ther, June 1, 2005; 4(2): 131 - 143. [Abstract] [PDF]

				K. J. Sherman, D. C. Cherkin, D. M. Eisenberg, J. Erro, A. Hrbek, and R. A. Deyo The Practice of Acupuncture: Who Are the Providers and What Do They Do? Ann. Fam. Med, March 1, 2005; 3(2): 151 - 158. [Abstract] [Full Text] [PDF]

				M. H. Cohen and K. J. Kemper Complementary Therapies in Pediatrics: A Legal Perspective Pediatrics, March 1, 2005; 115(3): 774 - 780. [Abstract] [Full Text] [PDF]

				K. Wilson, J. W. Busse, A. Gilchrist, S. Vohra, H. Boon, and E. Mills Characteristics of Pediatric and Adolescent Patients Attending a Naturopathic College Clinic in Canada Pediatrics, March 1, 2005; 115(3): e338 - e343. [Abstract] [Full Text] [PDF]

				M. H. Cohen, A. Hrbek, R. B. Davis, S. C. Schachter, and D. M. Eisenberg Emerging Credentialing Practices, Malpractice Liability Policies, and Guidelines Governing Complementary and Alternative Medical Practices and Dietary Supplement Recommendations: A Descriptive Study of 19 Integrative Health Care Centers in the United States Arch Intern Med, February 14, 2005; 165(3): 289 - 295. [Abstract] [Full Text] [PDF]

				P. Curtis and S. Gaylord Safety Issues in the Interaction of Conventional, Complementary, and Alternative Health Care Complementary Health Practice Review, January 1, 2005; 10(1): 3 - 31. [Abstract] [PDF]

				J. Ness and N. Nisly Cracking the Problem of Back Pain: Is Chiropractic the Answer? Arch Intern Med, October 11, 2004; 164(18): 1953 - 1954. [Full Text] [PDF]

				B. R. Cassileth and G. Deng Complementary and Alternative Therapies for Cancer Oncologist, February 1, 2004; 9(1): 80 - 89. [Abstract] [Full Text] [PDF]