I found the complete report at
http://pediatrics.aappublications.org/c ... 1374?rss=1
I notice that Medscape gives .25 continuing education credits for
reading its news report about the report.
To get the credit, it is necessary to answer only two questions, one
about which treatments are most commonly used, and the other about
whether to ask patients whether they use them. I disagreed with the
answer to question #2. Medscape should subtract .25 credits for
reading its article.
AAP Addresses Use of Complementary and Alternative Medicine CME/CE
News Author: Laurie Barclay, MD
CME Author: Penny Murata, MD
Disclosures
Release Date: December 5, 2008; Valid for credit through December 5, 2009 Credits Available
Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™ for physicians;
Family Physicians - up to 0.25 AAFP Prescribed credit(s) for physicians;
Nurses - 0.25 ANCC contact hours (None of these credits is in the area of pharmacology)
To participate in this internet activity: (1) review the target audience, learning objectives, and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation; (4) view/print certificate View details.
Learning Objectives
Upon completion of this activity, participants will be able to:
Identify common types of complementary and alternative medicine therapies used in children.
Report strategies to discuss complementary and alternative medicine with children and families.
Authors and Disclosures
Laurie Barclay, MD
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
Penny Murata, MD
Disclosure: Penny Murata, MD, has disclosed no relevant financial relationships.
Laurie Scudder, MS, NP-C
Disclosure: Laurie Scudder, MS, NP-C, has disclosed no relevant financial information.
Brande Nicole Martin
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.
December 5, 2008 — The American Academy of Pediatrics (AAP) has issued a clinical report that addresses the use of complementary and alternative medicine (CAM) in children and has published it in the December issue of Pediatrics.
"The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (NIH) defines...CAM as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional Western medicine," write Kathi J. Kemper, MD, MPH, and colleagues from the Task Force on Complementary and Alternative Medicine and the Provisional Section on Complementary, Holistic, and Integrative Medicine. "Complementary medicine is used in conjunction with conventional medicine; for example, massage, guided imagery, and acupuncture may be used in addition to analgesic medications to help decrease pain. Alternative medicine is used in place of conventional Western medicine; for example, some adolescents use herbs rather than antidepressant medications to treat depression."
Recognizing the increasing use of CAM in children, the AAP also saw the need to provide information and support for pediatricians regarding this field of practice. From 2000 to 2002, the AAP convened the Task Force on Complementary and Alternative Medicine to address issues related to the pediatric use of CAM and to develop resources to educate clinicians, patients, and families.
The present AAP clinical report describes CAM services, current levels of utilization and costs, and related legal and ethical issues. Given the breadth and range of CAM, the task force concluded that an in-depth review of each modality was beyond the scope of this report.
The aims of the report were therefore to define terms; to review the epidemiology; to list frequently used CAM modalities; to discuss medicolegal, ethical, and research implications; to describe education and training for CAM providers; to offer resources for additional learning regarding CAM; and to suggest communication strategies that clinicians may find helpful when discussing CAM with patients and families.
Now that many CAM modalities, such as guided imagery and massage for pain treatment, have been formally tested and integrated into standard practice, the distinction between CAM and mainstream medicine has become less apparent. The terms holistic medicine or integrative medicine is being increasingly substituted for CAM.
"Holistic medicine refers to patient-centered care that includes consideration of biological, psychological, spiritual, social, and environmental aspects of health," the Task Force writes. "Integrative medicine is relationship-based care that combines mainstream and complementary therapies for which there is some high-quality scientific evidence of safety and effectiveness to promote health for the whole person in the context of his or her family and community. Integrative medicine also reaffirms the importance of the relationship between the practitioner and the patient, emphasizes wellness and the inherent drive toward healing, and focuses on the whole person, using all appropriate therapies to achieve the patient's goals for health and healing."
The Kemper model of holistic care recognizes 4 main components of therapy. Biochemical components include medications, dietary supplements, vitamins, minerals, and herbal remedies. Lifestyle and nutritional interventions include recommendations for exercise and/or rest; environmental therapies including heat, ice, music, vibration, and light; and mind-body treatments such as behavior management, meditation, hypnosis, biofeedback, and counseling.
Biomechanical components include massage and bodywork, chiropractic and osteopathic adjustment, and surgery. Bioenergetic therapies may include acupuncture, radiation therapy, magnets, Reiki, healing touch, qi gong, therapeutic touch, prayer, and homeopathy.
Clinicians caring for children need to advise and counsel patients and their families about appropriate, safe, and effective health services and treatments regardless of whether they are considered mainstream or CAM. Clinicians should specifically ask about all treatments the family is administering to the child because most families use CAM services without spontaneously notifying their clinician.
To provide useful counsel regarding use of CAM and integrating these therapies into the child's treatment plan, pediatricians should stay informed and updated regarding therapeutic options available to their patients. Clinicians should address and counsel their patients' families regarding the safety, appropriateness, and advisability of specific CAM services used by individual patients.
A common-sense approach to advising families regarding use of CAM modalities is that those treatments shown to be safe and effective should be encouraged, those treatments that are safe but ineffective may be tolerated, those modalities that are effective but raise safety issues should be closely monitored or discouraged, and those therapies that are neither safe nor effective should be discouraged.
For patients being treated by a CAM provider, the pediatrician should seek permission of the patient and family to include the CAM provider in the overall management plan.
Helpful communication strategies may include asking about different therapies the patient is using; recognizing and respecting the family's perspectives, values, and cultural beliefs; working together with the parents as a team; and actively listening to families and patients.
The patient's response to treatment should be monitored with use of measurable outcomes, such as specific goals for symptom relief and remembering to "first do no harm."
"A growing number of pediatric generalists and subspecialists have begun to offer complementary therapies and advice as part of their practice," the task force concludes. "In addition, there is a growing number of academic pediatric integrative medicine programs and new initiatives to promote systematic sharing, support, and dissemination of information to improve collaborative and comprehensive care."
All AAP clinical reports automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time. Coauthor Sunita Vohra, MD, has received salary support from the Alberta Heritage Foundation for Medical Research and the Canadian Institutes of Health Research.
Pediatrics. 2008;122:1374-1386.
Clinical Context
CAM is described as a set of medical and healthcare practices that are not currently part of conventional Western medicine, according to the National Center for Complementary and Alternative Medicine of the National Institutes of Health. Complementary medicine is used with conventional medicine, whereas alternative medicine is used instead of conventional medicine.
Newer terms for CAM include holistic medicine to describe patient-centered care involving biological, psychological, spiritual, social, and environmental considerations and integrative medicine to describe relationship-based care combining mainstream and evidence-based complementary treatment.
The AAP convened the Task Force on Complementary and Alternative Medicine in 2000 and the Provisional Section on Complementary, Holistic, and Integrative Medicine in 2005. This report from the task force, with contributions from the provisional section, describes complementary and alternative medicine therapies in children; the medicolegal, ethical, and research issues; education and training for providers; and communication strategies for clinicians to use with patients and families.
Study Highlights
CAM is used in 20% to 40% of healthy children and in more than 50% of children with chronic, recurrent, and incurable conditions, including asthma, attention-deficit/hyperactivity disorder, autism, cancer, cerebral palsy, cystic fibrosis, inflammatory bowel disease, and juvenile rheumatoid arthritis.
66% of caregivers did not tell their child's clinician about CAM use.
CAM is not consistently linked with parent income, sex, or usual source of care.
Reasons for CAM use include word of mouth, effectiveness, fear of drug adverse effects, dissatisfaction with conventional medicine, and more personal attention.
Barriers to health insurance coverage of CAM include variable credentialing, accounting issues, and lack of Current Procedural Terminology codes.
Dietary supplements do not need proven safety or efficacy for marketing.
Biologically based therapies include botanicals, animal-derived extracts, vitamins, minerals, fatty acids, amino acids, proteins, prebiotics, probiotics, whole diets, and functional foods:
Multivitamins are the most commonly used in children (up to 41%).
Of teenagers using CAM, approximately 75% use dietary supplements and herbs.
The ketogenic diet is an accepted treatment of seizure disorder.
Quality is affected by portion of plant, time of harvest, handling, and identification.
Manipulative and body-based therapies include chiropractic and osteopathic manipulation, massage, reflexology, Rolfing, Bowen technique, and Trager approach:
Chiropractors are the most common CAM providers for pediatric patients.
Massage is beneficial for preterm infants and alleviates symptoms of asthma, insomnia, colic, cystic fibrosis, and juvenile rheumatoid arthritis.
Common mind-body therapies in children are meditation, prayer, hypnosis, biofeedback, and progressive muscle relaxation:
Guided imagery, hypnosis, and biofeedback complement medical therapy for pain, anxiety/stress disorders, enuresis, encopresis, sleep disorders, autonomic nervous system dysregulation, habitual disorders, attention/learning disorders, asthma, cancer, and diabetes.
Two thirds of parents use prayer for their children.
Biofield therapies include acupuncture, homeopathy, polarity therapy, magnet, Japanese Reiki and Johrei, qi gong, therapeutic touch, healing touch, and spiritual healing:
Acupuncture is possibly effective for recurrent headaches, nausea, pain, and allergy.
2% to 10% of children use homeopathic therapies for respiratory conditions, teething, or otitis media.
Special populations using CAM include adolescents, children with chronic illness or disability, and ethnic and cultural groups.
CAM research issues include the more likely publication of negative studies in well-known journals and positive studies in foreign-language journals, heterogeneous products and practices, need for more randomized controlled trials in children, few serious adverse effects in children, and lack of priority listing for children.
Pediatric CAM training for providers and clinicians is variable or lacking.
Clinicians should understand local and state regulations for CAM provider licensure and specific CAM therapies.
Ethical issues include need for evidence-based safety and effectiveness information about CAM therapies and therapists, risk/benefit analysis, respect for patient autonomy, nonmaleficence, beneficence, and justice.
Clinicians should routinely ask about specific CAM therapies and stress management; respect the family's values, perspectives, and cultural beliefs; reevaluate treatment if no or negative response; and maintain evidence-based knowledge about CAM therapies.
Pearls for Practice
Common types of CAM therapies used in children include multivitamins, herbs and other dietary supplements, chiropractic care, massage, prayer, progressive relaxation exercises, meditation, biofeedback, hypnosis, and acupuncture.
Strategies to use in discussing CAM with children and families include routinely asking whether the child uses vitamins, home remedies, or other services and about stress management; showing respect for values and cultural beliefs; reevaluating therapy if the measured outcome to treatment is inadequate; and maintaining knowledge about CAM therapies.
CME/CE Test
Questions answered incorrectly will be highlighted.
The use of CAM is common in adults. Which of the following forms of CAM is most likely to be used in children?
Herbs
Massage
Chiropractic therapy
All of the above
None of the above
In your practice, you note that only a few parents have reported the use of CAM therapies for their children. Which of the following strategies is most appropriate to address the use of CAM in children?
Post a notice in your office that states CAM should not be used in children
Routinely ask parents if their children use herbs or other supplements
Do not read about CAM therapies because most of your patients do not use them
Discourage cultural practices that vary from conventional medical treatment
All of the above
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Published online December 1, 2008
PEDIATRICS Vol. 122 No. 6 December 2008, pp. 1374-1386 (doi:10.1542/peds.2008-2173) This Article
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CLINICAL REPORT
The Use of Complementary and Alternative Medicine in Pediatrics
Kathi J. Kemper, MD, MPH, Sunita Vohra, MD, Richard Walls, MD, PhD the Task Force on Complementary and Alternative Medicine the Provisional Section on Complementary, Holistic, and Integrative Medicine
ABSTRACT
TOP
ABSTRACT
INTRODUCTION
COMMON CAM THERAPIES
SPECIAL POPULATIONS
RESEARCH ISSUES
EDUCATION AND TRAINING
LICENSING
MEDICOLEGAL AND ETHICAL...
CONCLUSIONS
TIPS ON TALKING WITH...
TASK FORCE ON COMPLEMENTARY...
LIAISONS
CONSULTANTS
STAFF
PROVISIONAL SECTION ON...
STAFF
REFERENCES
The American Academy of Pediatrics is dedicated to optimizing the well-being of children and advancing family-centered health care. Related to these goals, the American Academy of Pediatrics recognizes the increasing use of complementary and alternative medicine in children and, as a result, the need to provide information and support for pediatricians. From 2000 to 2002, the American Academy of Pediatrics convened and charged the Task Force on Complementary and Alternative Medicine to address issues related to the use of complementary and alternative medicine in children and to develop resources to educate physicians, patients, and families. One of these resources is this report describing complementary and alternative medicine services, current levels of utilization and financial expenditures, and associated legal and ethical considerations. The subject of complementary and alternative medicine is large and diverse, and consequently, an in-depth discussion of each method of complementary and alternative medicine is beyond the scope of this report. Instead, this report will define terms; describe epidemiology; outline common types of complementary and alternative medicine therapies; review medicolegal, ethical, and research implications; review education and training for complementary and alternative medicine providers; provide resources for learning more about complementary and alternative medicine; and suggest communication strategies to use when discussing complementary and alternative medicine with patients and families.
--------------------------------------------------------------------------------
Key Words: complementary • alternative • patient-centered • communication • ethics • epidemiology • health services • integrative
Abbreviations: NCCAM—National Center for Complementary and Alternative Medicine • NIH—National Institutes of Health • CAM—complementary and alternative medicine • AAP—American Academy of Pediatrics • TCM—traditional Chinese medicine • FDA—Food and Drug Administration • DSHEA—Dietary Supplements Health and Education Act • RCT—randomized, controlled trial
INTRODUCTION
TOP
ABSTRACT
INTRODUCTION
COMMON CAM THERAPIES
SPECIAL POPULATIONS
RESEARCH ISSUES
EDUCATION AND TRAINING
LICENSING
MEDICOLEGAL AND ETHICAL...
CONCLUSIONS
TIPS ON TALKING WITH...
TASK FORCE ON COMPLEMENTARY...
LIAISONS
CONSULTANTS
STAFF
PROVISIONAL SECTION ON...
STAFF
REFERENCES
The National Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes of Health (NIH) defines complementary and alternative medicine (CAM) as a group of diverse medical and health care systems, practices, and products that are not presently considered to be part of conventional Western medicine.1 Complementary medicine is used in conjunction with conventional medicine; for example, massage, guided imagery, and acupuncture may be used in addition to analgesic medications to help decrease pain. Alternative medicine is used in place of conventional Western medicine; for example, some adolescents use herbs rather than antidepressant medications to treat depression.
The distinction between CAM and mainstream medicine has lessened as many practices have undergone rigorous research and have been integrated increasingly into mainstream care. For example, guided imagery and massage have been proven to be effective in the treatment of pain and are now included in many tertiary care settings.2–5 Since the American Academy of Pediatrics (AAP) convened the Task Force on Complementary and Alternative Medicine in 2000 and since the creation of the NCCAM, these complexities inherent in the definition of CAM have become more problematic. Given the wide usage and general understanding of the term "CAM," it will be used throughout this report. However, the term "CAM" has been replaced increasingly with "holistic" or "integrative" medicine. Holistic medicine refers to patient-centered care that includes consideration of biological, psychological, spiritual, social, and environmental aspects of health. Integrative medicine is relationship-based care that combines mainstream and complementary therapies for which there is some high-quality scientific evidence of safety and effectiveness to promote health for the whole person in the context of his or her family and community.1 Integrative medicine also reaffirms the importance of the relationship between the practitioner and the patient, emphasizes wellness and the inherent drive toward healing, and focuses on the whole person, using all appropriate therapies to achieve the patient's goals for health and healing.6
The AAP Provisional Section on Complementary, Holistic, and Integrative Medicine, established in 2005, also contributed extensively to this report.
Epidemiology
The use of CAM in Western medicine has grown dramatically in recent decades. Many CAM therapies, such as herbal remedies, are mainstream or traditional in many parts of the world. The World Health Organization estimates that most of the world's population regularly uses "traditional medicine" such as traditional Chinese medicine (TCM), Ayurvedic medicine, and Native American healing practices.
In the United States, more than one third of adults have used CAM.7 The total number of visits to CAM providers increased by 47.3%, from 420 million visits in 1990 to 629 million visits in 1997.8 The number of visits to CAM providers in 1997 exceeded the total number of visits to primary care physicians in the same year.8 Estimated expenditures for CAM services for adults increased by 45.2% between 1990 and 1997, with a conservative estimate of $21.2 billion spent in 1997. Of that total, out-of-pocket expenses were estimated to be $12.2 billion. This figure exceeded the 1997 out-of-pocket expenditures for all US hospitalizations.8 More recent studies have described CAM use among adults as high as 62%,9 with 41% of adults using 2 or more CAM therapies in a 12-month period.10
Children and adolescents also are using CAM therapies increasingly. Weighted estimates of the amount paid for pediatric expenditures on CAM visits and remedies were $127 million and $22 million, respectively.11 An analysis of the 1996 US Medical Expenditure Panel Survey indicated that only 2% of the pediatric population uses CAM.12 However, an early study of Canadian children reported 11% use of professionally provided CAM therapies, with chiropractic, homeopathy, naturopathy, and acupuncture accounting for 84% of CAM use.13 Approximately 20% to 40% of healthy children seen in outpatient pediatric clinics14–17 and more than 50% of children with chronic, recurrent, and incurable conditions use CAM, almost always in conjunction with mainstream care.18–20 The use of CAM is considerably higher in certain groups of children, including children with special health care needs21 and homeless adolescents, who have a reported use as high as 70%.22 Use tends to be most common among patients with asthma,23–25 attention-deficit/hyperactivity disorder,26–28 autism,29–31 cancer,32–36 cerebral palsy,37 cystic fibrosis,38 inflammatory bowel disease,39,40 and juvenile rheumatoid arthritis.41 Presently, there is little research on the effectiveness of most CAM therapies for many of these conditions.42 The NCCAM funds various studies, but to date, they have not addressed the pediatric population as a priority focus area for research.
Most pediatric patients who receive complementary therapies also receive conventional care.13 This fact underscores the importance of pediatricians being aware of the necessity to have an open, respectful relationship and clear communication with families. A 2001 policy statement from the AAP Committee on Children With Disabilities, "Counseling Families Who Choose Complementary and Alternative Medicine for Their Child With Chronic Illness or Disability,"43 recognized that the use of CAM is increasing and provides information and guidance for pediatricians when counseling families about CAM.
Patients’ Characteristics and Reasons for Using CAM
Children who use CAM are more likely to be seeing their pediatrician for an illness, take medication on a regular basis, and have ongoing medical problems.14 Approximately half of parents/caregivers of children who used CAM saw a CAM provider for themselves. The majority (66%) of parents/caregivers of CAM users had not informed their child's doctor of the use of CAM for their child.14 There has been no consistent connection between CAM use and parent income, children's gender, or usual source of care,13,14,16–19,44 and there have been mixed findings connecting CAM use and parent education level, family ethnicity, insurance coverage, and child's age.13,16–19,44,45
There are various reasons for the growing use of CAM. Many users of CAM reported use "not so much as a result of being dissatisfied with conventional medicine, but largely because they found these health care alternatives to be more congruent with their own values, beliefs, and philosophical orientations toward health and life."46 Parents’ reasons for seeking care for their children from CAM providers included, in decreasing order of frequency, word of mouth, particular treatment was considered effective, fear of drug adverse effects, dissatisfaction with conventional medicine, and the need for more personal attention.13 In addition, many cultural groups may use CAM because of cultural values and beliefs.
Insurance Coverage
Many insurers offer coverage for CAM services. A 1996 survey of managed care organizations reported that 70% of surveyed plans have experienced an increased demand from members for CAM services and that 58% intended to offer some services within the next 2 years.47 A 2004 Kaiser Family Foundation employer survey revealed that 87% of covered employees had chiropractic coverage, and 47% had acupuncture coverage.48 The Landmark Report II on Health Maintenance Organizations and Alternative Care reported that 67% of health maintenance organizations offer some type of alternative care.49 In addition, many Medicaid programs pay for the use of some CAM services. Of 46 reporting states, 36 (78.3%) Medicaid programs provide coverage for at least 1 alternative therapy,50 most commonly chiropractic care (reimbursed by 33 programs), biofeedback (reimbursed by 10 programs), acupuncture (reimbursed by 7 programs), and hypnotherapy and naturopathy (reimbursed by 5 programs each).50 Because state Medicaid benefits packages change frequently, pediatricians are encouraged to become familiar with their state's list of covered services.
Some states require coverage for CAM services. In 1996, Blue Cross of Washington launched a plan called AlternaPath in response to the passing of a Washington state law in the same year mandating that all commercial health insurance companies cover the services provided by every category of licensed provider.51 Currently, most states require coverage of chiropractic care, and more than 50% of all health maintenance organizations cover these services.47 Although very few states mandate coverage of acupuncture or massage therapy, these services are quickly becoming part of many insurers’ benefit plans. The scope of services covered by insurers varies considerably; most coverage is disease-treatment oriented, with limited (either by scope or by number) visits allowed per diagnosis. Many plans offer a separate rider for purchase by either the employer or employee at an additional cost, and other plans offer CAM coverage as an embedded benefit to everyone in the program. Another type of program is an affinity discount network, in which certain CAM providers are designated as members of the network. Members of the program pay providers directly at a discounted fee.52
In a 1998 survey, the most common treatment modality covered by insurance plans was chiropractic care, with coverage ranging from 41% to 65%. By contrast, homeopathic treatments were covered by only 4% to 11% of all plans; acupuncture was covered by 9% to 19%; biofeedback was covered by 4% to 10%; and massage therapy was covered by 6% to 10%.52
Despite the public's increasing use of CAM therapies and willingness to pay out-of-pocket for these services, health insurers have had difficulty including them in their plans because of variation in credentialing, difficulties with accounting, and because there are so few Current Procedural Terminology (CPT) codes that cover these services.52 Although there are CPT codes that cover some CAM techniques, CAM providers may find them difficult to implement because of philosophical differences with a system that singles out disease states or organs from the whole person. Some CAM providers use a separate coding system of more than 4000 codes for CAM procedures and supplies, known as the alternative billing concept or "ABC" codes.53
Government Response
The Office of Alternative Medicine was established as part of the NIH by congressional mandate in 1992. In 1998, the Office of Alternative Medicine became the NCCAM. The NCCAM has increased its fiscal-year appropriations from $50 million in 1998 to an estimated $123 million in 2006.1 Total funding by all institutes and centers of the NIH for research and training on CAM and the training of investigators to study CAM exceeded $225 million in 2006, with additional funding being provided by other agencies and philanthropic foundations.1 Of the approximately 360 NCCAM-funded research projects in 2006, fewer than 5% were related to pediatrics, including research on the effects of massage for preterm infants, probiotics, omega-3 fatty acids, and food allergies.1 In 2007 and 2008, the AAP Provisional Section on Complementary, Holistic, and Integrative Medicine urged the NCCAM to consider increasing their priorities and funding for pediatric research, education, and information dissemination (Harry Gewanter, MD, verbal communication).
In 2000, the US President and Congress assembled and mandated the White House Commission on Complementary and Alternative Medicine Policy to make administrative and legislative recommendations to maximize the benefits of CAM for Americans. Comprising 20 physicians and other clinicians, CAM providers, and other experts, the commission was charged with developing a report to address the following:
education and training of clinicians;
research to increase knowledge regarding CAM;
provision of reliable information to clinicians and the public; and
guidelines for appropriate access to and delivery of CAM.
In March 2002, the commission issued its report, which addressed these charges and examined the relevance of CAM to national efforts to promote health, and created a central coordinating office. The report included 29 recommendations and more than 100 action items for federal agencies, Congress, state government, and other groups.54
In 2005, at the request of the NIH and the Agency for Healthcare Research and Quality, the Institute of Medicine released the report Complementary and Alternative Medicine in the United States. The report assessed what is known about Americans’ reliance on CAM therapies and assisted the NIH in developing research methods and setting priorities for evaluating such products and therapies.55
The US Food and Drug Administration (FDA) also has weighed in on CAM-related issues. The Dietary Supplements Health and Education Act of 1994 (DSHEA) amended previous FDA statutes to encompass dietary supplement–specific provisions, including the definition of a "dietary supplement," product safety, nutritional statements and claims, ingredient and nutritional labeling, good manufacturing procedures, and the classification of "new" dietary ingredients.56
Under the DSHEA, a dietary supplement is:
a product (other than tobacco) intended to supplement the diet that bears or contains 1 or more of the following ingredients: a vitamin, a mineral, an herb or other botanical, or an amino acid;
intended for ingestion in pill, capsule, tablet, or liquid form;
not used as a conventional food or as the sole item of a meal or diet; and
labeled as a dietary supplement.
This classification of dietary supplements is specifically separate from food or drug categories and, as such, lies outside the jurisdiction of many of the safety and regulatory rules that cover food and drugs.56
According to the DSHEA, manufacturers bear the burden of proof of ingredient safety of dietary supplements. However, unlike pharmaceutical preparations, dietary supplements can be marketed without proven safety or efficacy. A manufacturer does not have to provide the FDA with the evidence on which it relies to substantiate safety or effectiveness before or after it markets its products. For new ingredients, the manufacturer is only required to provide evidence to the FDA that the product is "reasonably expected to be safe."56
Manufacturers of supplements are not required to report any data on adverse events to the FDA. The FDA can demonstrate that a supplement is unsafe only after it reaches the market. The FDA must prove that the product is unsafe before it can restrict a product's use or take other legal action. The FDA largely relies on the MedWatch voluntary reporting system to collect safety data on dietary supplements.57
The DSHEA also regulates third-party literature regarding dietary supplements. Informational materials (ie, articles, fact sheets, etc) may be displayed in commercial retail sites provided they are displayed separately from the product, do not contain false or misleading information, and do not promote a specific brand of supplement. Most important, the DSHEA regulates the labeling of dietary supplements. Under this provision, any claims to prevent, treat, or cure a specific disease are expressly prohibited (unless approved by the FDA). Labels can include statements describing the supplement's effects on the "structure and function" or general "well-being" of the body as long as they are truthful and bear the statement, "This statement has not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease."56
Finally, like food products, dietary supplements are allowed to have suggested dosages on the label and must bear nutritional labeling. The label must include the name and quantity of each dietary ingredient, and if the ingredient is botanical in origin, the label must state the part of the plant from which the ingredient is derived.56
Physician Awareness, Attitude, and Perception
In 1995, the American Medical Association passed a resolution suggesting that its 300 000 members become better informed regarding the practices and techniques of CAM.57 Many primary care physicians, including pediatricians, recommend and refer patients for complementary therapies.58,59 In the 2001 AAP Periodic Survey 49, "Complementary and Alternative Therapies in Pediatric Practice," pediatricians reported that they recognize patients’ frequent use of CAM therapies and expressed a strong desire for additional education on CAM topics.60 Topics of greatest immediate interest included herbs, dietary supplements, special diets, and exercise. More than one third of the pediatricians reported that they or their families used some type of CAM therapy. Of those reporting CAM use, 70% used massage therapy, 21% received chiropractic care, 13.5% consulted a spiritual or religious healer, and 13% had used acupuncture.60
A growing number of pediatric generalists and subspecialists have begun to offer complementary therapies and advice as part of their practice. In addition, there is a growing number of academic pediatric integrative medicine programs and new initiatives to promote systematic sharing, support, and dissemination of information to improve collaborative and comprehensive care. These initiatives include the AAP Provisional Section on Complementary, Holistic, and Integrative Medicine61; the International Pediatric Integrative Medicine Network; and the Pediatric Complementary and Alternative Medicine Research and Education Network.62 However, these initiatives may be insufficient to ensure consistent, quality education across the spectrum of medical education. Standardized curricula or content specifications for physician education on CAM therapies should be considered for medical school, residency, and continuing medical education activities.
COMMON CAM THERAPIES
TOP
ABSTRACT
INTRODUCTION
COMMON CAM THERAPIES
SPECIAL POPULATIONS
RESEARCH ISSUES
EDUCATION AND TRAINING
LICENSING
MEDICOLEGAL AND ETHICAL...
CONCLUSIONS
TIPS ON TALKING WITH...
TASK FORCE ON COMPLEMENTARY...
LIAISONS
CONSULTANTS
STAFF
PROVISIONAL SECTION ON...
STAFF
REFERENCES
As a means of understanding and integrating different modalities encompassing complementary and mainstream therapies, the Kemper model of holistic care (Table 1) has been widely accepted.63 This paradigm integrates complementary and mainstream therapies into a coherent construct of treatment options.63 Another model for understanding CAM therapies has been developed by the NCCAM. This framework focuses on CAM rather than integration of therapies. The most common CAM therapies used by infants, children, and adolescents within the NCCAM framework follow. A complete description of all therapies and scientific evidence regarding each of them is beyond the scope of this report.
View this table:
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TABLE 1 The Kemper Model of Holistic Care
Biologically Based Practices (Use of Vitamins, Herbs, Other Dietary Supplements, Diets, and Foods)
According to the NCCAM, biologically based practices include the use of botanicals, animal-derived extracts, vitamins, minerals, fatty acids, amino acids, proteins, prebiotics and probiotics, whole diets, and functional foods.1 Of these, multivitamins are the most frequently used CAM products by children, with up to 41% reported usage.14,15 Among teenagers who use CAM, nearly 75% use herbs and other dietary supplements.64 Controlled studies have investigated the use of dietary supplements for various conditions including asthma, upper respiratory infections, diarrhea, depression, anxiety, and attention-deficit/hyperactivity disorder.65–67 Several studies are in progress, and the research literature is expanding rapidly. For example, the use of probiotics was considered complementary in the mid-1990s but has become mainstream practice in the 21st century as many gastroenterologists recommend and use them in daily practice for patients with inflammatory bowel disease.
There are a number of excellent review articles on the use of herbal products in pediatric populations64–66,68,69 as well as data on potentially toxic herbal products and herb-drug interactions.70–79 Because of regulations differing from those governing the use of pharmaceuticals, there are concerns about the purity and potency of herbal products and other dietary supplements sold in the United States. Product quality is influenced by many factors, including which portion of the plant is used (ie, root, stem, leaves, flowers), the time of harvest (ie, young versus old plants), the handling of the product, and proper identification of the plant. Furthermore, labeling is often inaccurate.80–82 To conduct research, the quality of product must be guaranteed, and to compare clinical trials, the similarity of product must be ensured.
Dietary therapies such as the ketogenic diet in the treatment of seizure disorders83 have become an accepted practice for some health conditions. However, the popularity of other diets has risen to a new level as the prevalence of obesity and metabolic syndrome has increased and traditional exercise and diet "prescriptions" have failed. The macronutrient content of these popular diets varies widely.1
Manipulative and Body-Based Practices
As defined by the NCCAM, manipulative and body-based practices include chiropractic and osteopathic manipulation, massage therapy, reflexology, Rolfing, Bowen technique, and Trager approach.1
Chiropractic care is one of the most common professionally provided CAM practices. It focuses on the relationship between body structure (primarily that of the spine) and bodily function and how that relationship affects health. With more than 50 000 chiropractors licensed in the United States, the number of children visiting chiropractors is substantial and increasing.84 Recent studies have confirmed that up to 14% of all chiropractic visits were for pediatric patients14,15 and that chiropractors were the most common CAM providers visited by children and adolescents.14 Few randomized, controlled trials (RCTs) have demonstrated significant clinical benefits of chiropractic practices among pediatric patients85; additional studies are needed, and parents need to be cautioned not to rely on chiropractic care as the primary treatment for serious conditions such as cancer. Although anecdotal data suggest that severe complications are possible with chiropractic treatment of infants and children, such adverse effects seem to be rare.86 Further systematic studies are needed to determine the costs, benefits, and safety of this widely used practice.
Massage is another common manipulative practice that is frequently provided at home by parents and by licensed massage therapists and nurses in clinical settings. Massage is now routine practice in many NICUs to promote growth and development in preterm infants.2–4 Massage also has been demonstrated to be beneficial in alleviating symptoms from asthma, insomnia, colic, cystic fibrosis, and juvenile rheumatoid arthritis.87–92
Mind-Body Medicine
As defined by the NCCAM, mind-body medicine includes diverse practices such as relaxation, visual imagery, tai chi, qi gong, yoga, meditation, prayer, hypnosis, biofeedback, diaphragmatic breathing, progressive muscle relaxation, and cognitive-behavioral therapies. Many of these practices, particularly prayer, are commonly used among adults.11 In children, popular techniques include prayer, progressive relaxation exercises, meditation, biofeedback, and hypnosis.14,15 Hypnotherapy encourages the child to use his or her imagination to improve health and health behaviors.
Guided imagery, hypnosis, and biofeedback have been shown to be effective adjuncts to medical therapy for such common conditions as chronic, acute, and recurrent pain; anxiety and stress disorders; enuresis; encopresis; sleep disorders; autonomic nervous system dysregulation; habitual disorders; attention and learning disorders; asthma; cancer; and diabetes.5 These therapies generally have few or no adverse effects.5
Spiritual healing includes prayer and is the most prevalent complementary therapy in the United States.9 Spiritual healing is sometimes included under the rubric of mind-body therapies and sometimes under the rubric of biofield or bioenergetic therapies.1 Eighty-two percent of Americans believe in the healing power of personal prayer, 73% believe that praying for someone else can help cure their illness, and 77% believe that God sometimes intervenes to cure people who have a serious illness.93 Prayer is used by up to two thirds of parents for their children.14,15
Studies have suggested that spiritual/religious beliefs and practices may contribute to decreased stress and increased sense of well-being and enhanced immune system functioning.93 RCTs of the clinical therapeutic effects of prayers in pediatrics are lacking. Some states have pursued legal measures against parents seeking to use prayer or spiritual healing as an alternative to conventional medical therapy for children with serious medical problems such as cancer. However, most families view spiritual healing as a personal practice that is complementary to medical care rather than a replacement for it.
Biofield Therapies
According to the NCCAM, biofield therapies are "intended to affect energy fields that purportedly surround and penetrate the human body." These therapies "manipulate biofields by applying pressure and/or manipulating the body by placing the hands in, or through, these fields."1 Biofield techniques include acupuncture, homeopathy, polarity therapy, magnet therapy, Japanese Reiki and Johrei, Chinese qi gong, therapeutic touch, healing touch, and spiritual healing.
Perhaps the best known of the noninvasive biofield therapies is therapeutic touch, which is taught in more than 80 nursing schools and provided in numerous hospitals in the United States. Therapeutic touch is a form of energy medicine that has been developed by nurses on the basis of the premise that healing is promoted when the body's energies are in balance. Nurse-healers are trained to identify and treat energy imbalances to improve the patient's well-being.94
Studies on the effectiveness of biofield therapies in pediatric populations have been limited, but the therapies are generally safe.95,96
Acupuncture
Acupuncture has been one component of TCM, which also includes herbal remedies, diet, massage, and lifestyle. Today, acupuncture describes a family of procedures involving stimulation of anatomic points on the body by a variety of techniques. American practices of acupuncture incorporate medical traditions from China, Japan, Korea, and other countries. The acupuncture technique that has been most studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by hand or by electrical stimulation.1 Variants of needle therapy include stimulation of acupuncture points by vigorous massage (shiatsu), heat (moxibustion), lasers, magnets, gentle massage or pressure (acupressure), or electrical currents.
Acupuncture is used by an increasing number of pediatric patients. A meta-analysis of the use of acupuncture in the treatment of recurrent headaches suggested potential benefit.97 Additional applications for acupuncture may include nausea, pain, and allergy.98–101
Whole or Traditional Medical Systems
Whole medical systems involve complete systems of theory and practice that have evolved independently from or parallel to conventional Western medicine.1 They include homeopathy, naturopathic medicine, TCM, Ayurvedic medicine (India's traditional system of medicine), and healing systems of American Indian/Alaska Native, African, Middle Eastern, Tibetan, and other indigenous populations.
Homeopathy
Developed by Samuel Hahnemann in 1790, homeopathy is based on the theory that "like cures like," meaning that small, highly diluted quantities of medicinal substances are given to cure symptoms, when the same substances given at higher or more concentrated doses would actually cause those symptoms.1 Unlike classic pharmacology, homeopathy follows the theory that the greater the dilution, the greater the potency of the product. In the United States, an estimated 3000 clinicians, including physicians, nurses, chiropractors, naturopaths, and dentists, use homeopathy in their practices.101 A range of 2% to 10% of children use homeopathic remedies, most often for respiratory problems, teething, otitis media, and other conditions related to the ears, neck, and throat.14,15
SPECIAL POPULATIONS
TOP
ABSTRACT
INTRODUCTION
COMMON CAM THERAPIES
SPECIAL POPULATIONS
RESEARCH ISSUES
EDUCATION AND TRAINING
LICENSING
MEDICOLEGAL AND ETHICAL...
CONCLUSIONS
TIPS ON TALKING WITH...
TASK FORCE ON COMPLEMENTARY...
LIAISONS
CONSULTANTS
STAFF
PROVISIONAL SECTION ON...
STAFF
REFERENCES
Adolescents
Numerous reports have described the frequent use of CAM by adolescents.44,102–106 In Seattle, Washington, 70% of homeless adolescents reported using some form of CAM,22 and among 9th- and 12th-grade students in Massachusetts, herbal remedies were used by up to 20% of respondents.107 In a survey of New York teenagers, the most frequently used therapies were massage, prayer or faith healing, herbs, vitamins, performance-enhancing supplements, and special exercises.105 Many adolescents use supplements to improve their body image or athletic performance. As many as 4.5% of boys and 0.8% of girls in secondary school used creatine108; of those, 73% were student athletes.
In general, adolescents seem to be more open than adults are to using CAM therapies, and adolescents are more inclined to use CAM if their parents also use these therapies.103 Adolescence is characterized by increasing cognition, independence, increased desire for privacy and autonomy, and higher incidence of risky behavior. In addition, as they begin to take responsibility for their own health needs, adolescents also may use CAM therapies as self-treatment. The Internet is also becoming a larger influence on the lives of teenagers. Many dietary supplements are promoted on the Internet and promise relief of adolescent concerns such as acne and obesity, or they promise enhanced energy and sports performance. Some pediatricians refer patients to CAM providers or provide complementary therapies themselves, integrating them into conventional medical practice.
Children With Chronic Illness or Disability
Children with special health care needs are frequent users of CAM. The rate of CAM use for this population is estimated to be 30% to 70%.21,29–41 In a recent survey of families of children with developmental disabilities, families wanted their clinicians to be able to counsel them about CAM options.109 An overview of these issues and recommendations for counseling children with special health care needs and their families is outlined in a 2001 AAP Committee on Children With Disabilities statement, "Counseling Families Who Choose Complementary and Alternative Medicine for Their Child With Chronic Illness or Disability."43
Ethnic and Cultural Groups
Use of CAM therapies varies among different ethnic and cultural groups. Excluding prayer, CAM is used less commonly by Hispanic and black individuals than by white individuals, and its use by Hispanic and black people is less likely to be disclosed to clinicians.110 Families of different cultural backgrounds use different herbs, over-the-counter remedies, and other items traditionally used for cooking as home remedies.111,112 Many ethnic and cultural groups also use traditional healing practices such as TCM, Ayurvedic medicine, and American Indian/Alaska Native healing practices, which can include a variety of diverse therapies and native healers within a coherent cultural belief system.113,114 Use of these remedies is often integrated with conventional medicine but may not be reported unless the clinician specifically inquires about them.110
RESEARCH ISSUES
TOP
ABSTRACT
INTRODUCTION
COMMON CAM THERAPIES
SPECIAL POPULATIONS
RESEARCH ISSUES
EDUCATION AND TRAINING
LICENSING
MEDICOLEGAL AND ETHICAL...
CONCLUSIONS
TIPS ON TALKING WITH...
TASK FORCE ON COMPLEMENTARY...
LIAISONS
CONSULTANTS
STAFF
PROVISIONAL SECTION ON...
STAFF
REFERENCES
Although many CAM therapies have not yet been evaluated formally in children, a 2002 review identified more than 1400 RCTs and 47 systematic reviews of pediatric CAM.115 Formal evaluation has suggested that the quality of RCTs of CAM is as good as that of RCTs of conventional medicine,116 and the quality of systematic reviews of CAM exceeds that of systematic reviews of conventional medicine.117 It should be noted that publication bias in CAM research is opposite that of conventional medicine; that is, negative studies are more likely to be published in well-known journals, and positive studies are more likely to be published in foreign-language journals.118 Those interested in promoting an evidence-based approach to the use of CAM therapies must be cognizant of the bias created by applying language restrictions in their search strategy. Other approaches to evidence-based CAM include n-of-1 evaluation, whereby methodologic rigor (eg, blinding, randomization) is combined with an individualized approach fundamental to many CAM therapies.119
There are some unique considerations when examining the efficacy of CAM, including heterogeneity of both products and practices. Lack of regulation of many commonly used practices exacerbates heterogeneity, making treatment effect difficult to measure. The relative lack of CAM expertise in conventional institutions results in inadequate peer review and undue difficulties when attempting to obtain institutional review board approval to study CAM in children.
Although CAM use is common in children, there have been few reports of serious adverse effects. Most current safety data come from case reports. Some population-based surveillance studies to monitor adverse events have been conducted in adults receiving acupuncture, and the resulting data are reassuring.120 The need for rigorous safety evaluation is questioned by some who perceive "natural" to be equivalent to "safe." More complete data about safety in children would require prospectively gathered, population-based studies, which are expensive to conduct.
There are numerous challenges inherent in all clinical research, and these difficulties are compounded when performing research in children and on therapies based on different cultural concepts of what causes or constitutes disease and health. The NCCAM has identified women and minority populations as priority groups for federally funded research on CAM, but it has not yet added pediatrics to this priority listing.
EDUCATION AND TRAINING
TOP
ABSTRACT
INTRODUCTION
COMMON CAM THERAPIES
SPECIAL POPULATIONS
RESEARCH ISSUES
EDUCATION AND TRAINING
LICENSING
MEDICOLEGAL AND ETHICAL...
CONCLUSIONS
TIPS ON TALKING WITH...
TASK FORCE ON COMPLEMENTARY...
LIAISONS
CONSULTANTS
STAFF
PROVISIONAL SECTION ON...
STAFF
REFERENCES
The number of CAM providers is increasing. The number of CAM providers in the United States is projected to increase 88% between 1994 and 2010, compared with a 16% increase in the number of physicians. However, few CAM providers undergo extensive education or training specific to pediatric populations. For example, although chiropractic training typically lasts 4 years, pediatric certification in chiropractic requires only a 10-module, 120-hour certification program.121 Naturopathic training at the 4 US colleges also typically requires 2000 hours of training over 4 years, which includes clerkships in dermatology, family medicine, psychiatry, medicine, radiology, pediatrics, obstetrics and gynecology, neurology, surgery, and ophthalmology.122 Some CAM training programs do not offer any specific training for diagnosing or treating pediatric patients.
Many CAM providers seek additional training in pediatrics.123 Likewise, many physicians seek additional training in CAM. As of 1998, 64% of US medical schools reported having CAM curricula,124 and 18 of the 19 colleges of osteopathic medicine offered CAM instruction.125 These programs have a wide range of content and quality. Although many medical schools and residency programs offer survey courses on CAM,126,127 the extent to which pediatric residencies and postgraduate courses address educational needs about CAM are unknown.128–131 However, there have been significant gains in the growth of academic integrative medicine since the establishment of the Consortium for Academic Health Centers for Integrative Medicine in 2000. There are also well-established training programs for physicians in specific modalities such as hypnosis and acupuncture.
LICENSING
TOP
ABSTRACT
INTRODUCTION
COMMON CAM THERAPIES
SPECIAL POPULATIONS
RESEARCH ISSUES
EDUCATION AND TRAINING
LICENSING
MEDICOLEGAL AND ETHICAL...
CONCLUSIONS
TIPS ON TALKING WITH...
TASK FORCE ON COMPLEMENTARY...
LIAISONS
CONSULTANTS
STAFF
PROVISIONAL SECTION ON...
STAFF
REFERENCES
Licensure of CAM providers varies significantly from state to state. Licensing does not mean that CAM providers can practice medicine. In some states, CAM providers must have clients sign a form acknowledging that they understand the provider is not a physician and not practicing medicine. As of the writing of this report, chiropractic medicine is licensed in all states, acupuncture and massage therapy are licensed in more than half of the states, and naturopathy and homeopathy are licensed in less than one third of the states. Lobbying efforts by CAM providers to win licensure and expanded scopes of practice are ongoing in many states. It is essential for physicians to understand local and state statutes and regulations governing specific therapeutic modalities. If a CAM provider is unlicensed, then he or she may be engaged in the unauthorized practice of medicine, and if a physician refers a patient to an unlicensed provider, the referring physician may be liable for negligent referral. If a CAM provider is licensed, then he or she must be practicing within his or her "scope of practice" as defined by local and state statutes and regulatory boards.132 Similar to physician licensing, licensing information about other health care professionals is maintained by state licensing boards.
MEDICOLEGAL AND ETHICAL CONSIDERATIONS
TOP
ABSTRACT
INTRODUCTION
COMMON CAM THERAPIES
SPECIAL POPULATIONS
RESEARCH ISSUES
EDUCATION AND TRAINING
LICENSING
MEDICOLEGAL AND ETHICAL...
CONCLUSIONS
TIPS ON TALKING WITH...
TASK FORCE ON COMPLEMENTARY...
LIAISONS
CONSULTANTS
STAFF
PROVISIONAL SECTION ON...
STAFF
REFERENCES
Medicolegal
CAM poses a challenging risk-management issue with the potential for either a medical malpractice lawsuit, disciplinary proceedings from state licensing boards, or fraud and abuse actions from federal or state regulators.133,134 The use of some types of CAM in adults has been judicially held to be below the standard of care constituting medical negligence135; that is, use of complementary therapies in and of themselves does not constitute negligence. In terms of practicing within the standard of care, more clinicians are willing to offer CAM, and more insurers are willing to pay for it.136
Clinicians need to be aware of individual state laws relating to CAM, because medicine is regulated by state rather than federal laws.137 In its database of closed pediatric malpractice claims from 1985–2005, the Physicians Insurers Association of America reported that the average indemnity payment for all CAM claims was $358 333, which was 37.1% higher than the average for all pediatric claims ($261 321).138 A proposed risk-management model limits liability for the use of CAM if the physician is recommending, accepting, or avoiding CAM depending on availability of evidence relating to safety and/or efficacy.139
Some CAM modalities may need to be included in discussions about informed consent for treatment. The informed-consent process may potentially require a discussion about possible risks of CAM, notwithstanding the ability of a patient to acquire CAM without the involvement of the pediatrician (eg, dietary supplements and their interaction with prescribed medication). Case law has placed a burden on clinicians to at least discuss viable options of treatment even though he or she may be unwilling to offer the therapy.140
Pediatricians need to be aware of the use of alternative therapies as a substitute for conventional medical care for children with life-threatening conditions and whether they believe such treatment is reportable under state abuse and neglect laws. Another legal duty of pediatricians relates to the assurance that seeking reimbursement for CAM therapy does not trigger a potential violation of fraud and abuse laws for therapy deemed "medically unnecessary." It is prudent to be cautious about any representations or guarantees.
Ethics
There are several ethical challenges to integrating CAM into mainstream pediatric practice. There is a lack of systematic pediatric education about the safety and effectiveness of CAM therapies; uncertainty about the scope of practice, licensing requirements, and credentialing of nonphysician CAM providers; concerns about patient safety and legal liability when recommending CAM therapies or therapists; and uncertainty about how to translate principles of medical ethics into CAM.141
The first guideline of ethical practice is to seek reliable, evidence-based information about the safety and effectiveness of specific therapies and therapists. Indeed, the 2001 AAP policy statement "Counseling Families Who Choose Complementary and Alternative Medicine for Their Child With Chronic Illness or Disability" recommended that pediatricians seek information, evaluate the scientific merits of specific therapeutic approaches, and identify risks or potential harmful effects.43
It is also prudent to apply common sense to balancing risks and benefits when making therapeutic decisions (see Fig 1). 142 The specific ethical questions in clinical practice vary in different clinical situations. If a therapy is both safe and effective, the pediatrician is ethically obligated to recommend and encourage its use as he or she would for any other such therapy in conventional care.
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FIGURE 1 Guide to CAM treatment recommendations. (Reproduced with permission from Kemper K, Cohen M. Ethics meet complementary and alternative medicine: new light on old principles. Contemp Pediatr. 2004;21:65.)
Factors to be included in a risk/benefit analysis when considering CAM therapies include the severity and acuteness of illness; curability with conventional care; degree of invasiveness; toxicities and adverse effects of conventional treatment; quality of evidence for efficacy and safety of the complementary therapy; and the family's understanding of the risks and benefits of CAM treatment, voluntary acceptance of those risks, and persistence of the family's intention to use CAM therapy.139 Thus, the level of evidence required for evaluating efficacy can be small when there is little to no risk of harm from a therapy, especially when other therapies are likely to be futile. Likewise, the level of evidence for efficacy required to endorse a particular complementary therapy would be quite high when that therapy is risky and safer, more effective therapies are available.
Situation-specific variables can also affect ethical decision-making. Situation-specific variables include the patient's and parents’ personal beliefs, cultural values and practices, and therapeutic goals; the type and severity of illness; and the lack of efficacy and safety data in a specific patient. Even when such data are known for other populations, ap
CE credits for promoting non proven medical care
24 posts
• Page 1 of 2 • 1, 2
CE credits for promoting non proven medical care
by malernee » Sun Dec 07, 2008 8:24 am
- malernee
- Site Admin
- Posts: 462
- Joined: Wed Aug 13, 2003 5:56 pm
Reply e-mail regarding CE credit from Fla state vet board
by malernee » Wed Aug 05, 2009 7:59 am
Art,
Thank you for your e-mail regarding CE credit for attending a board meeting. It is the policy of the board to award 5 hours of continuing education for attending a board meeting by signing in at the beginning and staying until the meeting is adjourned.
Please contact me if you have any questions.
Regards,
Linda
--------------------------------------------------------------------------------
From: artjamie@aol.com [mailto:artjamie@aol.com]
Sent: Tuesday, August 04, 2009 2:43 PM
To: Tinsley, Linda
Subject: Approved CE requirements
Linda, I took as much of a day off work to travel to attend our veterinary board meeting held in Ft Lauderdale as I could. I had questions to ask someone in attendance there about "approved" CE requirements. The meeting had been promoted as a day long event to me when I made phone calls. It turned out to be a morning only event. I was under the impression those who attended the board meeting would get what had been called "approved" CE hours. I arrived at the hotel late morining only to find out the meeting had already ended. Can you find out for me how many approved CE credits the board issued for the ft Lauderdale meeting and how it is determined how many CE credit hours to give Florida vets who show up for board meetings. Do the approved number of CE hours from the meeting equal the hours of the meeting? If not how are the approved hours detemined?
Art Malernee dvm
fla lic 1820
Thank you for your e-mail regarding CE credit for attending a board meeting. It is the policy of the board to award 5 hours of continuing education for attending a board meeting by signing in at the beginning and staying until the meeting is adjourned.
Please contact me if you have any questions.
Regards,
Linda
--------------------------------------------------------------------------------
From: artjamie@aol.com [mailto:artjamie@aol.com]
Sent: Tuesday, August 04, 2009 2:43 PM
To: Tinsley, Linda
Subject: Approved CE requirements
Linda, I took as much of a day off work to travel to attend our veterinary board meeting held in Ft Lauderdale as I could. I had questions to ask someone in attendance there about "approved" CE requirements. The meeting had been promoted as a day long event to me when I made phone calls. It turned out to be a morning only event. I was under the impression those who attended the board meeting would get what had been called "approved" CE hours. I arrived at the hotel late morining only to find out the meeting had already ended. Can you find out for me how many approved CE credits the board issued for the ft Lauderdale meeting and how it is determined how many CE credit hours to give Florida vets who show up for board meetings. Do the approved number of CE hours from the meeting equal the hours of the meeting? If not how are the approved hours detemined?
Art Malernee dvm
fla lic 1820
- malernee
- Site Admin
- Posts: 462
- Joined: Wed Aug 13, 2003 5:56 pm
Reply letter to linda about board awarded CE
by malernee » Wed Aug 05, 2009 9:29 am
It is the policy of the board to award 5 hours of continuing education for attending a board meeting by signing in at the beginning and staying until the meeting is adjourned.
Please contact me if you have any questions.
Regards,
Linda>>>>
Linda,
I talked to a vet at the hotel. I have in the past paid this vet to provide me "board awarded CE". He had me sign back in after lunch at his board awarded CE meetings to get a five hour award . The vet told me the board meetings currently never last past noon. How can I can promote to the board I got an hour of "awarded" continuing education without violating the FDA definition of Health Fraud? Board awarded CE smells like "certified" organic food only I am required by law to produce it. Is promoting required by law board awarded CE an exception to the law?
see
http://www.ebvet.com/forum/viewtopic.ph ... =education
FDA definition of fraud quoted in Sept/Oct 93 NCAHF Bulletin Board: The deceptive promotion, advertisement, distribution or sale of articles, intended for human or animal use, that are represented as being effective to diagnose, prevent, cure, treat or mitigate disease (or other conditions), or provide a beneficial effect on health, but which have not been scientifically proven safe and effective for such purposes. Such practices may be deliberate, or done without adequate knowledge or understanding of the article. (Quoted from a letter from M L Frazier - Director, State Information Branch 6/18/93).
Art Malernee dvm
fla lic 1820
Please contact me if you have any questions.
Regards,
Linda>>>>
Linda,
I talked to a vet at the hotel. I have in the past paid this vet to provide me "board awarded CE". He had me sign back in after lunch at his board awarded CE meetings to get a five hour award . The vet told me the board meetings currently never last past noon. How can I can promote to the board I got an hour of "awarded" continuing education without violating the FDA definition of Health Fraud? Board awarded CE smells like "certified" organic food only I am required by law to produce it. Is promoting required by law board awarded CE an exception to the law?
see
http://www.ebvet.com/forum/viewtopic.ph ... =education
FDA definition of fraud quoted in Sept/Oct 93 NCAHF Bulletin Board: The deceptive promotion, advertisement, distribution or sale of articles, intended for human or animal use, that are represented as being effective to diagnose, prevent, cure, treat or mitigate disease (or other conditions), or provide a beneficial effect on health, but which have not been scientifically proven safe and effective for such purposes. Such practices may be deliberate, or done without adequate knowledge or understanding of the article. (Quoted from a letter from M L Frazier - Director, State Information Branch 6/18/93).
Art Malernee dvm
fla lic 1820
- malernee
- Site Admin
- Posts: 462
- Joined: Wed Aug 13, 2003 5:56 pm
no reply yet from board. Sent another letter.
by malernee » Sat Aug 08, 2009 9:41 am
Linda,
I have not had a reply from you and it has been a few days. I would request at least a reply from you that you have received my email. Maybe you did not understand my problem. Communication in the kings English is not my speciality that's why I like medicine to measure something. My understanding is the board requires and produces hours of CE at the board meetings. I "believe" those hours of credits are not measured in time. I have checked the opening and ending meeting times the board has posted on the Internet. In the last two years I have yet to find a board meeting that lasted 5 hours. As you can see below I am required by the board to produce CE "hours" every two years.
BOARD OF VETERINARY MEDICINE
FREQUENTLY ASKED QUESTIONS AND ANSWERS
BOARD INFORMATION
1. What are the functions of the Board of Veterinary Medicine?
The Board of Veterinary Medicine regulates veterinarians, premise permits, veterinary establishments and limited service clinics.
2. Does the board have a website?
Yes: www.MyFloridaLicense.com
RENEWAL INFORMATION
1. When is my license up for renewal?
Every veterinarian is on the same renewal cycle. The cycle ends May 31 of even years.
2. How many continuing education credits do I need for renewal?
You are required to take 30 hours every biennium, with two of those credits in Drug Dispensing.
Linda,
If the board does not measure its awarded CE in hours how can vets produce it in hours every two years? This all sounds like so called "tooth fairy medicine" to me. If the board has some math formula for converting required hours into something that can be measured. I would like to see the board post that formula on the Internet for veterinarians.
Art Malernee dvm
fla lic 1820
In a message dated 8/5/2009 8:49:08 A.M. Eastern Daylight Time, Artjamie writes:
It is the policy of the board to award 5 hours of continuing education for attending a board meeting by signing in at the beginning and staying until the meeting is adjourned.
Please contact me if you have any questions.
Regards,
Linda>>>>
Linda,
I talked to a vet at the hotel. I have in the past paid this vet to provide me "board awarded CE". He had me sign back in after lunch at his board awarded CE meetings to get a five hour award . The vet told me the board meetings currently never last past noon. How can I can promote to the board I got an hour of "awarded" continuing education without violating the FDA definition of Health Fraud? Board awarded CE smells like "certified" organic food only I am required by law to produce it. Is promoting required by law board awarded CE an exception to the law?
see
http://www.ebvet.com/forum/viewtopic.ph ... =education
FDA definition of fraud quoted in Sept/Oct 93 NCAHF Bulletin Board: The deceptive promotion, advertisement, distribution or sale of articles, intended for human or animal use, that are represented as being effective to diagnose, prevent, cure, treat or mitigate disease (or other conditions), or provide a beneficial effect on health, but which have not been scientifically proven safe and effective for such purposes. Such practices may be deliberate, or done without adequate knowledge or understanding of the article. (Quoted from a letter from M L Frazier - Director, State Information Branch 6/18/93).
Art Malernee dvm
fla lic 1820
--------------------------------------------------------------------------------
I have not had a reply from you and it has been a few days. I would request at least a reply from you that you have received my email. Maybe you did not understand my problem. Communication in the kings English is not my speciality that's why I like medicine to measure something. My understanding is the board requires and produces hours of CE at the board meetings. I "believe" those hours of credits are not measured in time. I have checked the opening and ending meeting times the board has posted on the Internet. In the last two years I have yet to find a board meeting that lasted 5 hours. As you can see below I am required by the board to produce CE "hours" every two years.
BOARD OF VETERINARY MEDICINE
FREQUENTLY ASKED QUESTIONS AND ANSWERS
BOARD INFORMATION
1. What are the functions of the Board of Veterinary Medicine?
The Board of Veterinary Medicine regulates veterinarians, premise permits, veterinary establishments and limited service clinics.
2. Does the board have a website?
Yes: www.MyFloridaLicense.com
RENEWAL INFORMATION
1. When is my license up for renewal?
Every veterinarian is on the same renewal cycle. The cycle ends May 31 of even years.
2. How many continuing education credits do I need for renewal?
You are required to take 30 hours every biennium, with two of those credits in Drug Dispensing.
Linda,
If the board does not measure its awarded CE in hours how can vets produce it in hours every two years? This all sounds like so called "tooth fairy medicine" to me. If the board has some math formula for converting required hours into something that can be measured. I would like to see the board post that formula on the Internet for veterinarians.
Art Malernee dvm
fla lic 1820
In a message dated 8/5/2009 8:49:08 A.M. Eastern Daylight Time, Artjamie writes:
It is the policy of the board to award 5 hours of continuing education for attending a board meeting by signing in at the beginning and staying until the meeting is adjourned.
Please contact me if you have any questions.
Regards,
Linda>>>>
Linda,
I talked to a vet at the hotel. I have in the past paid this vet to provide me "board awarded CE". He had me sign back in after lunch at his board awarded CE meetings to get a five hour award . The vet told me the board meetings currently never last past noon. How can I can promote to the board I got an hour of "awarded" continuing education without violating the FDA definition of Health Fraud? Board awarded CE smells like "certified" organic food only I am required by law to produce it. Is promoting required by law board awarded CE an exception to the law?
see
http://www.ebvet.com/forum/viewtopic.ph ... =education
FDA definition of fraud quoted in Sept/Oct 93 NCAHF Bulletin Board: The deceptive promotion, advertisement, distribution or sale of articles, intended for human or animal use, that are represented as being effective to diagnose, prevent, cure, treat or mitigate disease (or other conditions), or provide a beneficial effect on health, but which have not been scientifically proven safe and effective for such purposes. Such practices may be deliberate, or done without adequate knowledge or understanding of the article. (Quoted from a letter from M L Frazier - Director, State Information Branch 6/18/93).
Art Malernee dvm
fla lic 1820
--------------------------------------------------------------------------------
- malernee
- Site Admin
- Posts: 462
- Joined: Wed Aug 13, 2003 5:56 pm
Reply from FLA vet board about measured CE
by malernee » Tue Aug 11, 2009 6:47 am
Dr. Malernee,
I apologize for not responding sooner to you e-mail. I wanted to consult with board counsel and she was out of town last week. In accordance with board rule 61G18-16.002 (2) (a), F.A.C. Continuing Education Requirements for Active Status License Renewals, One (1) hour equals a minimum of fifty (50) minutes and a maximum of sixty (60) minutes. Total hours of lecture time cannot be added up and divided into fifty (50) minute intervals to obtain 1 hour credit for each 50 minute interval. Continuing Education hours are based on this rule. If the meeting is from 8:00 a.m. to 12:00 p.m. the continuing education credit would be 4 hours.
Please contact me if you have questions or would like to discuss. My phone number is 850.922.7154.
Thanks
Linda
--------------------------------------------------------------------------------
From: Artjamie@aol.com [mailto:Artjamie@aol.com]
Sent: Saturday, August 08, 2009 10:37 AM
To: Tinsley, Linda
Cc: Artjamie@aol.com
Subject: Re: Approved CE requirements
Linda,
I have not had a reply from you and it has been a few days. I would request at least a reply from you that you have received my email. Maybe you did not understand my problem. Communication in the kings English is not my speciality that's why I like medicine to measure something. My understanding is the board requires and produces hours of CE at the board meetings. I "believe" those hours of credits are not measured in time. I have checked the opening and ending meeting times the board has posted on the Internet. In the last two years I have yet to find a board meeting that lasted 5 hours. As you can see below I am required by the board to produce CE "hours" every two years.
BOARD OF VETERINARY MEDICINE
FREQUENTLY ASKED QUESTIONS AND ANSWERS
BOARD INFORMATION
1. What are the functions of the Board of Veterinary Medicine?
The Board of Veterinary Medicine regulates veterinarians, premise permits, veterinary establishments and limited service clinics.
2. Does the board have a website?
Yes: www.MyFloridaLicense.com
RENEWAL INFORMATION
1. When is my license up for renewal?
Every veterinarian is on the same renewal cycle. The cycle ends May 31 of even years.
2. How many continuing education credits do I need for renewal?
You are required to take 30 hours every biennium, with two of those credits in Drug Dispensing.
Linda,
If the board does not measure its awarded CE in hours how can vets produce it in hours every two years? This all sounds like so called "tooth fairy medicine" to me. If the board has some math formula for converting required hours into something that can be measured. I would like to see the board post that formula on the Internet for veterinarians.
Art Malernee dvm
fla lic 1820
In a message dated 8/5/2009 8:49:08 A.M. Eastern Daylight Time, Artjamie writes:
It is the policy of the board to award 5 hours of continuing education for attending a board meeting by signing in at the beginning and staying until the meeting is adjourned.
Please contact me if you have any questions.
Regards,
Linda>>>>
Linda,
I talked to a vet at the hotel. I have in the past paid this vet to provide me "board awarded CE". He had me sign back in after lunch at his board awarded CE meetings to get a five hour award . The vet told me the board meetings currently never last past noon. How can I can promote to the board I got an hour of "awarded" continuing education without violating the FDA definition of Health Fraud? Board awarded CE smells like "certified" organic food only I am required by law to produce it. Is promoting required by law board awarded CE an exception to the law?
see
http://www.ebvet.com/forum/viewtopic.ph ... =education
FDA definition of fraud quoted in Sept/Oct 93 NCAHF Bulletin Board: The deceptive promotion, advertisement, distribution or sale of articles, intended for human or animal use, that are represented as being effective to diagnose, prevent, cure, treat or mitigate disease (or other conditions), or provide a beneficial effect on health, but which have not been scientifically proven safe and effective for such purposes. Such practices may be deliberate, or done without adequate knowledge or understanding of the article. (Quoted from a letter from M L Frazier - Director, State Information Branch 6/18/93).
Art Malernee dvm
fla lic 1820
I apologize for not responding sooner to you e-mail. I wanted to consult with board counsel and she was out of town last week. In accordance with board rule 61G18-16.002 (2) (a), F.A.C. Continuing Education Requirements for Active Status License Renewals, One (1) hour equals a minimum of fifty (50) minutes and a maximum of sixty (60) minutes. Total hours of lecture time cannot be added up and divided into fifty (50) minute intervals to obtain 1 hour credit for each 50 minute interval. Continuing Education hours are based on this rule. If the meeting is from 8:00 a.m. to 12:00 p.m. the continuing education credit would be 4 hours.
Please contact me if you have questions or would like to discuss. My phone number is 850.922.7154.
Thanks
Linda
--------------------------------------------------------------------------------
From: Artjamie@aol.com [mailto:Artjamie@aol.com]
Sent: Saturday, August 08, 2009 10:37 AM
To: Tinsley, Linda
Cc: Artjamie@aol.com
Subject: Re: Approved CE requirements
Linda,
I have not had a reply from you and it has been a few days. I would request at least a reply from you that you have received my email. Maybe you did not understand my problem. Communication in the kings English is not my speciality that's why I like medicine to measure something. My understanding is the board requires and produces hours of CE at the board meetings. I "believe" those hours of credits are not measured in time. I have checked the opening and ending meeting times the board has posted on the Internet. In the last two years I have yet to find a board meeting that lasted 5 hours. As you can see below I am required by the board to produce CE "hours" every two years.
BOARD OF VETERINARY MEDICINE
FREQUENTLY ASKED QUESTIONS AND ANSWERS
BOARD INFORMATION
1. What are the functions of the Board of Veterinary Medicine?
The Board of Veterinary Medicine regulates veterinarians, premise permits, veterinary establishments and limited service clinics.
2. Does the board have a website?
Yes: www.MyFloridaLicense.com
RENEWAL INFORMATION
1. When is my license up for renewal?
Every veterinarian is on the same renewal cycle. The cycle ends May 31 of even years.
2. How many continuing education credits do I need for renewal?
You are required to take 30 hours every biennium, with two of those credits in Drug Dispensing.
Linda,
If the board does not measure its awarded CE in hours how can vets produce it in hours every two years? This all sounds like so called "tooth fairy medicine" to me. If the board has some math formula for converting required hours into something that can be measured. I would like to see the board post that formula on the Internet for veterinarians.
Art Malernee dvm
fla lic 1820
In a message dated 8/5/2009 8:49:08 A.M. Eastern Daylight Time, Artjamie writes:
It is the policy of the board to award 5 hours of continuing education for attending a board meeting by signing in at the beginning and staying until the meeting is adjourned.
Please contact me if you have any questions.
Regards,
Linda>>>>
Linda,
I talked to a vet at the hotel. I have in the past paid this vet to provide me "board awarded CE". He had me sign back in after lunch at his board awarded CE meetings to get a five hour award . The vet told me the board meetings currently never last past noon. How can I can promote to the board I got an hour of "awarded" continuing education without violating the FDA definition of Health Fraud? Board awarded CE smells like "certified" organic food only I am required by law to produce it. Is promoting required by law board awarded CE an exception to the law?
see
http://www.ebvet.com/forum/viewtopic.ph ... =education
FDA definition of fraud quoted in Sept/Oct 93 NCAHF Bulletin Board: The deceptive promotion, advertisement, distribution or sale of articles, intended for human or animal use, that are represented as being effective to diagnose, prevent, cure, treat or mitigate disease (or other conditions), or provide a beneficial effect on health, but which have not been scientifically proven safe and effective for such purposes. Such practices may be deliberate, or done without adequate knowledge or understanding of the article. (Quoted from a letter from M L Frazier - Director, State Information Branch 6/18/93).
Art Malernee dvm
fla lic 1820
- malernee
- Site Admin
- Posts: 462
- Joined: Wed Aug 13, 2003 5:56 pm
board rule 61G18-16.002 (2) (a), F.A.C. dbpr letter
by malernee » Wed Aug 12, 2009 8:14 am
In a message dated 8/10/2009 12:37:39 P.M. Eastern Daylight Time, Linda.Tinsley@dbpr.state.fl.us writes:
Dr. Malernee,
I apologize for not responding sooner to you e-mail. I wanted to consult with board counsel and she was out of town last week. In accordance with board rule 61G18-16.002 (2) (a), F.A.C. Continuing Education Requirements for Active Status License Renewals, One (1) hour equals a minimum of fifty (50) minutes and a maximum of sixty (60) minutes. Total hours of lecture time cannot be added up and divided into fifty (50) minute intervals to obtain 1 hour credit for each 50 minute interval. Continuing Education hours are based on this rule. If the meeting is from 8:00 a.m. to 12:00 p.m. the continuing education credit would be 4 hours.
Please contact me if you have questions or would like to discuss. My phone number is 850.922.7154.
Thanks
Linda
Linda, None of the local CE courses I have been to in the last two years measure CE in real time as defined in board rule 61G18-16.002 (2) (a), F.A.C. Unless you can count the time getting food and drinks before the meeting starts and things like liquor raffles after the speaker stops. Since the board publishes the starting and stop time of their meetings with the minutes of the meeting on the Internet the public can see the board is not meeting its own requirements. The large corporations and small businesses like a compounding pharmacist that sponsor our CE meetings in the state locally do not publish the minutes of approved CE meetings. The public has no idea if a 2 hour pharmacy CE meeting is meeting board requirements. The vets at the meeting are required to produce the CE hours when nothing has been measured in hours.
art malernee dvm
Dr. Malernee,
I apologize for not responding sooner to you e-mail. I wanted to consult with board counsel and she was out of town last week. In accordance with board rule 61G18-16.002 (2) (a), F.A.C. Continuing Education Requirements for Active Status License Renewals, One (1) hour equals a minimum of fifty (50) minutes and a maximum of sixty (60) minutes. Total hours of lecture time cannot be added up and divided into fifty (50) minute intervals to obtain 1 hour credit for each 50 minute interval. Continuing Education hours are based on this rule. If the meeting is from 8:00 a.m. to 12:00 p.m. the continuing education credit would be 4 hours.
Please contact me if you have questions or would like to discuss. My phone number is 850.922.7154.
Thanks
Linda
Linda, None of the local CE courses I have been to in the last two years measure CE in real time as defined in board rule 61G18-16.002 (2) (a), F.A.C. Unless you can count the time getting food and drinks before the meeting starts and things like liquor raffles after the speaker stops. Since the board publishes the starting and stop time of their meetings with the minutes of the meeting on the Internet the public can see the board is not meeting its own requirements. The large corporations and small businesses like a compounding pharmacist that sponsor our CE meetings in the state locally do not publish the minutes of approved CE meetings. The public has no idea if a 2 hour pharmacy CE meeting is meeting board requirements. The vets at the meeting are required to produce the CE hours when nothing has been measured in hours.
art malernee dvm
- malernee
- Site Admin
- Posts: 462
- Joined: Wed Aug 13, 2003 5:56 pm
e-mail regarding continuing education audits.
by malernee » Thu Aug 20, 2009 3:01 pm
Dr. Malernee,
Thank you for your e-mail regarding continuing education audits. I have contacted the appropriate department and I will get back to you as soon as I receive the information.
Regards
Linda
From: Artjamie@aol.com [mailto:Artjamie@aol.com]
Sent: Thursday, August 20, 2009 11:21 AM
To: Tinsley, Linda
Subject: Re: Approved CE requirements
Linda,
Please reply that you have gotten this email. I have been doing some national CE research including what happened in Texas when the non vet board branch of government found the vets in Texas were making up their hours (what science based doctors call tooth fairy medicine). I have been reading on vet only newsgroups where vets gather in private to get CE. These vets write that members of the Florida VMA executive board are telling other vets at CE meetings the reason our board is not measuring CE hours is because the board is making the claim it is not necessary because our veterinary CE compliance is the highest for all professional bodies. These vets are saying roughly 95%. (Based on regular auditing). The vets say this is why Florida doesn't require measuring that would insure hours of board CE provided by the board are measured in hours. Can you provide me the data from any auditing done by the state? I am skeptical that any 95% figure was measured in real hours. I suspect they are imaginary hours that we are producing.
Thank you for your e-mail regarding continuing education audits. I have contacted the appropriate department and I will get back to you as soon as I receive the information.
Regards
Linda
From: Artjamie@aol.com [mailto:Artjamie@aol.com]
Sent: Thursday, August 20, 2009 11:21 AM
To: Tinsley, Linda
Subject: Re: Approved CE requirements
Linda,
Please reply that you have gotten this email. I have been doing some national CE research including what happened in Texas when the non vet board branch of government found the vets in Texas were making up their hours (what science based doctors call tooth fairy medicine). I have been reading on vet only newsgroups where vets gather in private to get CE. These vets write that members of the Florida VMA executive board are telling other vets at CE meetings the reason our board is not measuring CE hours is because the board is making the claim it is not necessary because our veterinary CE compliance is the highest for all professional bodies. These vets are saying roughly 95%. (Based on regular auditing). The vets say this is why Florida doesn't require measuring that would insure hours of board CE provided by the board are measured in hours. Can you provide me the data from any auditing done by the state? I am skeptical that any 95% figure was measured in real hours. I suspect they are imaginary hours that we are producing.
- malernee
- Site Admin
- Posts: 462
- Joined: Wed Aug 13, 2003 5:56 pm
government funding for teaching FDA defined health fraud
by malernee » Thu Sep 10, 2009 10:09 am
still trying to get the fla state vet board to do something but have not heard back and its been weeks
I saw quote below in the NYT this morning that reminded me of the CE liquor raffle I won at the last pharmacy CE meeting.
"In hopes of enticing more gamblers, New Jersey lawmakers have repealed a smoking ban, and in Illinois they are considering allowing free drinks on riverboat casinos."
here is some more government funded stuff thats worse than the free drugs we may get from the government for gambling what ever money we have left after paying for health care . What could be worse in a government health plan than government funding to teach doctors how to be quacks?
NCCAM promoting quack teaching
Two investigators have found that the National Center for Complementary and Alternative Medicine is funding low-quality educational programs in schools that train health professionals. From 2000 to 2003, NCCAM awarded 5-year education grants to 14 such schools in the United States and to the American Medical Students Association Foundation. The stated purpose of the grants was to integrate evidence-based information about "complementary and alternative medicine" ("CAM") into the curricula. After examining Web sites operated by grantees, the investigators concluded that their teachings about herbal remedies, chiropractic, acupuncture, and homeopathy were severely biased toward CAM and lacked appropriate criticisms. In several cases, they base positive conclusions on low-quality clinical trials without mentioning that larger, high-quality trials reported negative results. The investigators concluded that the programs they reviewed had failed to uphold educational standards and lack appropriate oversight. [Marcus DM, McCullough L. An evaluation of the evidence in "evidence-based" integrative medicine programs. Academic Medicine 84:1229-1233, 2009]http://www.ncbi.nlm.nih.gov/pubmed/19707062 The bottom line-through not explicitly stated in the article-is that NCCAM should stop funding programs that promote worthless methods to professional students.
=art malernee dvm
I saw quote below in the NYT this morning that reminded me of the CE liquor raffle I won at the last pharmacy CE meeting.
"In hopes of enticing more gamblers, New Jersey lawmakers have repealed a smoking ban, and in Illinois they are considering allowing free drinks on riverboat casinos."
here is some more government funded stuff thats worse than the free drugs we may get from the government for gambling what ever money we have left after paying for health care . What could be worse in a government health plan than government funding to teach doctors how to be quacks?
NCCAM promoting quack teaching
Two investigators have found that the National Center for Complementary and Alternative Medicine is funding low-quality educational programs in schools that train health professionals. From 2000 to 2003, NCCAM awarded 5-year education grants to 14 such schools in the United States and to the American Medical Students Association Foundation. The stated purpose of the grants was to integrate evidence-based information about "complementary and alternative medicine" ("CAM") into the curricula. After examining Web sites operated by grantees, the investigators concluded that their teachings about herbal remedies, chiropractic, acupuncture, and homeopathy were severely biased toward CAM and lacked appropriate criticisms. In several cases, they base positive conclusions on low-quality clinical trials without mentioning that larger, high-quality trials reported negative results. The investigators concluded that the programs they reviewed had failed to uphold educational standards and lack appropriate oversight. [Marcus DM, McCullough L. An evaluation of the evidence in "evidence-based" integrative medicine programs. Academic Medicine 84:1229-1233, 2009]http://www.ncbi.nlm.nih.gov/pubmed/19707062 The bottom line-through not explicitly stated in the article-is that NCCAM should stop funding programs that promote worthless methods to professional students.
=art malernee dvm
- malernee
- Site Admin
- Posts: 462
- Joined: Wed Aug 13, 2003 5:56 pm
no reply from linda from fla state vet board in weeks
by malernee » Thu Sep 17, 2009 8:36 am
Linda,
I got a email from you that you were out of the office so I wanted to make sure the lines of communication were still open. Have you heard anything from" the appropriate department"? It has been a few weeks since I have heard anything from you.
art malernee
fla lic 1820
Dr. Malernee,
Thank you for your e-mail regarding continuing education audits. I have contacted the appropriate department and I will get back to you as soon as I receive the information.
Regards
Linda
From: Artjamie@aol.com [mailto:Artjamie@aol.com]
Sent: Thursday, August 20, 2009 11:21 AM
To: Tinsley, Linda
Subject: Re: Approved CE requirements
Linda,
Please reply that you have gotten this email. I have been doing some national CE research including what happened in Texas when the non vet board branch of government found the vets in Texas were making up their hours (what science based doctors call tooth fairy medicine). I have been reading on vet only newsgroups where vets gather in private to get CE. These vets write that members of the Florida VMA executive board are telling other vets at CE meetings the reason our board is not measuring CE hours is because the board is making the claim it is not necessary because our veterinary CE compliance is the highest for all professional bodies. These vets are saying roughly 95%. (Based on regular auditing). The vets say this is why Florida doesn't require measuring that would insure hours of board CE provided by the board are measured in hours. Can you provide me the data from any auditing done by the state? I am skeptical that any 95% figure was measured in real hours. I suspect they are imaginary hours that we are producing.
-----Original Message-----
From: Tinsley, Linda <Linda.Tinsley@dbpr.state.fl.us>
To: Artjamie@aol.com
Sent: Thu, Aug 20, 2009 3:12 pm
Subject: RE: Approved CE requirements
Dr. Malernee,
Thank you for your e-mail regarding continuing education audits. I have contacted the appropriate department and I will get back to you as soon as I receive the information.
Regards
Linda
From: Artjamie@aol.com [mailto:Artjamie@aol.com]
Sent: Thursday, August 20, 2009 11:21 AM
To: Tinsley, Linda
Subject: Re: Approved CE requirements
Linda,
Please reply that you have gotten this email. I have been doing some national CE research including what happened in Texas when the non vet board branch of government found the vets in Texas were making up their hours (what science based doctors call tooth fairy medicine). I have been reading on vet only newsgroups where vets gather in private to get CE. These vets write that members of the Florida VMA executive board are telling other vets at CE meetings the reason our board is not measuring CE hours is because the board is making the claim it is not necessary because our veterinary CE compliance is the highest for all professional bodies. These vets are saying roughly 95%. (Based on regular auditing). The vets say this is why Florida doesn't require measuring that would insure hours of board CE provided by the board are measured in hours. Can you provide me the data from any auditing done by the state? I am skeptical that any 95% figure was measured in real hours. I suspect they are imaginary hours that we are producing.
I got a email from you that you were out of the office so I wanted to make sure the lines of communication were still open. Have you heard anything from" the appropriate department"? It has been a few weeks since I have heard anything from you.
art malernee
fla lic 1820
Dr. Malernee,
Thank you for your e-mail regarding continuing education audits. I have contacted the appropriate department and I will get back to you as soon as I receive the information.
Regards
Linda
From: Artjamie@aol.com [mailto:Artjamie@aol.com]
Sent: Thursday, August 20, 2009 11:21 AM
To: Tinsley, Linda
Subject: Re: Approved CE requirements
Linda,
Please reply that you have gotten this email. I have been doing some national CE research including what happened in Texas when the non vet board branch of government found the vets in Texas were making up their hours (what science based doctors call tooth fairy medicine). I have been reading on vet only newsgroups where vets gather in private to get CE. These vets write that members of the Florida VMA executive board are telling other vets at CE meetings the reason our board is not measuring CE hours is because the board is making the claim it is not necessary because our veterinary CE compliance is the highest for all professional bodies. These vets are saying roughly 95%. (Based on regular auditing). The vets say this is why Florida doesn't require measuring that would insure hours of board CE provided by the board are measured in hours. Can you provide me the data from any auditing done by the state? I am skeptical that any 95% figure was measured in real hours. I suspect they are imaginary hours that we are producing.
-----Original Message-----
From: Tinsley, Linda <Linda.Tinsley@dbpr.state.fl.us>
To: Artjamie@aol.com
Sent: Thu, Aug 20, 2009 3:12 pm
Subject: RE: Approved CE requirements
Dr. Malernee,
Thank you for your e-mail regarding continuing education audits. I have contacted the appropriate department and I will get back to you as soon as I receive the information.
Regards
Linda
From: Artjamie@aol.com [mailto:Artjamie@aol.com]
Sent: Thursday, August 20, 2009 11:21 AM
To: Tinsley, Linda
Subject: Re: Approved CE requirements
Linda,
Please reply that you have gotten this email. I have been doing some national CE research including what happened in Texas when the non vet board branch of government found the vets in Texas were making up their hours (what science based doctors call tooth fairy medicine). I have been reading on vet only newsgroups where vets gather in private to get CE. These vets write that members of the Florida VMA executive board are telling other vets at CE meetings the reason our board is not measuring CE hours is because the board is making the claim it is not necessary because our veterinary CE compliance is the highest for all professional bodies. These vets are saying roughly 95%. (Based on regular auditing). The vets say this is why Florida doesn't require measuring that would insure hours of board CE provided by the board are measured in hours. Can you provide me the data from any auditing done by the state? I am skeptical that any 95% figure was measured in real hours. I suspect they are imaginary hours that we are producing.
- malernee
- Site Admin
- Posts: 462
- Joined: Wed Aug 13, 2003 5:56 pm
To: DBPR.Communications@dbpr.state.fl.us
by malernee » Tue Sep 29, 2009 10:17 am
-----Original Message-----
From: artjamie@aol.com
To: DBPR.Communications@dbpr.state.fl.us
Sent: Tue, Sep 29, 2009 11:11 am
Subject: Re: Hours of CE question
Mary,
I have already contacted the Board of Veterinary Medicine about this. They told me they would need to contact the dbpr for an answer and then get back to me. I just wanted to be sure they did contact you. If their solution is to contact you and your solution is to contact them how do i get an answer to my question?
art malernee dvm
fla lic 1820
Good morning Mr. Malernee,
Thank you for sending your question. I will have staff from the Board of Veterinary Medicine contact you to assist on your Vet CE questions. However, the Florida Board of Pharmacy is under the Department of Health and you will need to contact them to help provide answers to your CE questions for pharmacy. You can contact them at 850.488.0595. Their Web site is http://www.doh.state.fl.us/mqa/pharmacy ... hives.html.
Someone from our department will contact you in the next couple of days to answer your questions on Vet CE credits you receive when attending the board meetings.
Thank you and have a wonderful day!
Mary Alford
Office of Communications
Department of Business and Professional Regulation
850.922.8981 (phone)
850.921.9019 (fax)
-----Original Message-----
From: Communications, DBPR <DBPR.Communications@dbpr.state.fl.us>
To: artjamie@aol.com
Sent: Tue, Sep 29, 2009 9:34 am
Subject: RE: Hours of CE question
Good morning Mr. Malernee,
Thank you for sending your question. I will have staff from the Board of Veterinary Medicine contact you to assist on your Vet CE questions. However, the Florida Board of Pharmacy is under the Department of Health and you will need to contact them to help provide answers to your CE questions for pharmacy. You can contact them at 850.488.0595. Their Web site is http://www.doh.state.fl.us/mqa/pharmacy ... hives.html.
Someone from our department will contact you in the next couple of days to answer your questions on Vet CE credits you receive when attending the board meetings.
Thank you and have a wonderful day!
Mary Alford
Office of Communications
Department of Business and Professional Regulation
850.922.8981 (phone)
850.921.9019 (fax)
From: artjamie@aol.com
To: DBPR.Communications@dbpr.state.fl.us
Sent: Tue, Sep 29, 2009 11:11 am
Subject: Re: Hours of CE question
Mary,
I have already contacted the Board of Veterinary Medicine about this. They told me they would need to contact the dbpr for an answer and then get back to me. I just wanted to be sure they did contact you. If their solution is to contact you and your solution is to contact them how do i get an answer to my question?
art malernee dvm
fla lic 1820
Good morning Mr. Malernee,
Thank you for sending your question. I will have staff from the Board of Veterinary Medicine contact you to assist on your Vet CE questions. However, the Florida Board of Pharmacy is under the Department of Health and you will need to contact them to help provide answers to your CE questions for pharmacy. You can contact them at 850.488.0595. Their Web site is http://www.doh.state.fl.us/mqa/pharmacy ... hives.html.
Someone from our department will contact you in the next couple of days to answer your questions on Vet CE credits you receive when attending the board meetings.
Thank you and have a wonderful day!
Mary Alford
Office of Communications
Department of Business and Professional Regulation
850.922.8981 (phone)
850.921.9019 (fax)
-----Original Message-----
From: Communications, DBPR <DBPR.Communications@dbpr.state.fl.us>
To: artjamie@aol.com
Sent: Tue, Sep 29, 2009 9:34 am
Subject: RE: Hours of CE question
Good morning Mr. Malernee,
Thank you for sending your question. I will have staff from the Board of Veterinary Medicine contact you to assist on your Vet CE questions. However, the Florida Board of Pharmacy is under the Department of Health and you will need to contact them to help provide answers to your CE questions for pharmacy. You can contact them at 850.488.0595. Their Web site is http://www.doh.state.fl.us/mqa/pharmacy ... hives.html.
Someone from our department will contact you in the next couple of days to answer your questions on Vet CE credits you receive when attending the board meetings.
Thank you and have a wonderful day!
Mary Alford
Office of Communications
Department of Business and Professional Regulation
850.922.8981 (phone)
850.921.9019 (fax)
- malernee
- Site Admin
- Posts: 462
- Joined: Wed Aug 13, 2003 5:56 pm
more email between board and dbpr trying to get answers
by malernee » Wed Sep 30, 2009 7:24 am
-----Original Message-----
From: artjamie@aol.com
To: DBPR.Communications@dbpr.state.fl.us
Sent: Tue, Sep 29, 2009 8:27 pm
Subject: Re: Hours of CE question
<<<Mr. Malernee,
Did the board members of the Veterinary Medicine Board tell you they would need to contact DBPR?>>>>
Mary, here is the letter from linda tinsley saying she would contact the department. .
art malernee dvm
fla lic 1820
******
Dr. Malernee,
Thank you for your e-mail regarding continuing education audits. I have contacted the appropriate department and I will get back to you as soon as I receive the information.
Regards
Linda
From: Artjamie@aol.com [mailto:Artjamie@aol.com]
Sent: Thursday, August 20, 2009 11:21 AM
To: Tinsley, Linda
Subject: Re: Approved CE requirements
^^^^^
I send all citizen inquiries to the Director of the divisions; your request was sent to the Division of Professions which houses the Board staff, not the board members. They also have the Bureau of Education and Testing under the Division of Professions. I assure you that someone from the board staff or the bureau will be contacting your regarding your question.>>>
I track all inquiries and response, so I will make sure someone responds to you with the answers to your question.
Thank you,
Mary Alford
Office of Communications
Department of Business and Professional Regulation
850.922.8981 (phone)
850.921.9019 (fax)
-----Original Message-----
From: Communications, DBPR <DBPR.Communications@dbpr.state.fl.us>
To: artjamie@aol.com
Sent: Tue, Sep 29, 2009 11:44 am
Subject: RE: Hours of CE question
Mr. Malernee,
Did the board members of the Veterinary Medicine Board tell you they would need to contact DBPR? I send all citizen inquiries to the Director of the divisions; your request was sent to the Division of Professions which houses the Board staff, not the board members. They also have the Bureau of Education and Testing under the Division of Professions. I assure you that someone from the board staff or the bureau will be contacting your regarding your question.
I track all inquiries and response, so I will make sure someone responds to you with the answers to your question.
Thank you,
Mary Alford
Office of Communications
Department of Business and Professional Regulation
850.922.8981 (phone)
850.921.9019 (fax)
From: artjamie@aol.com [mailto:artjamie@aol.com]
Sent: Tuesday, September 29, 2009 11:12 AM
To: Communications, DBPR
Subject: Re: Hours of CE question
Mary,
I have already contacted the Board of Veterinary Medicine about this. They told me they would need to contact the dbpr for an answer and then get back to me. I just wanted to be sure they did contact you. If their solution is to contact you and your solution is to contact them how do i get an answer to my question?
art malernee dvm
fla lic 1820
Good morning Mr. Malernee,
Thank you for sending your question. I will have staff from the Board of Veterinary Medicine contact you to assist on your Vet CE questions. However, the Florida Board of Pharmacy is under the Department of Health and you will need to contact them to help provide answers to your CE questions for pharmacy. You can contact them at 850.488.0595. Their Web site is http://www.doh.state.fl.us/mqa/pharmacy ... hives.html.
Someone from our department will contact you in the next couple of days to answer your questions on Vet CE credits you receive when attending the board meetings.
Thank you and have a wonderful day!
Mary Alford
Office of Communications
Department of Business and Professional Regulation
850.922.8981 (phone)
850.921.9019 (fax)
-----Original Message-----
From: Communications, DBPR <DBPR.Communications@dbpr.state.fl.us>
To: artjamie@aol.com
Sent: Tue, Sep 29, 2009 9:34 am
Subject: RE: Hours of CE question
Good morning Mr. Malernee,
Thank you for sending your question. I will have staff from the Board of Veterinary Medicine contact you to assist on your Vet CE questions. However, the Florida Board of Pharmacy is under the Department of Health and you will need to contact them to help provide answers to your CE questions for pharmacy. You can contact them at 850.488.0595. Their Web site is http://www.doh.state.fl.us/mqa/pharmacy ... hives.html.
Someone from our department will contact you in the next couple of days to answer your questions on Vet CE credits you receive when attending the board meetings.
Thank you and have a wonderful day!
Mary Alford
Office of Communications
Department of Business and Professional Regulation
850.922.8981 (phone)
850.921.9019 (fax)
From: artjamie@aol.com [mailto:artjamie@aol.com]
Sent: Monday, September 28, 2009 6:31 PM
To: Communications, DBPR
Subject: Hours of CE question
I have a question about the hours of CE the florida state veterinary board provides for attending the board meetings and the approved CE hours required for pharmacy. Is there someone who might answer my question?
art malernee dvm
fla lic 1820
From: artjamie@aol.com
To: DBPR.Communications@dbpr.state.fl.us
Sent: Tue, Sep 29, 2009 8:27 pm
Subject: Re: Hours of CE question
<<<Mr. Malernee,
Did the board members of the Veterinary Medicine Board tell you they would need to contact DBPR?>>>>
Mary, here is the letter from linda tinsley saying she would contact the department. .
art malernee dvm
fla lic 1820
******
Dr. Malernee,
Thank you for your e-mail regarding continuing education audits. I have contacted the appropriate department and I will get back to you as soon as I receive the information.
Regards
Linda
From: Artjamie@aol.com [mailto:Artjamie@aol.com]
Sent: Thursday, August 20, 2009 11:21 AM
To: Tinsley, Linda
Subject: Re: Approved CE requirements
^^^^^
I send all citizen inquiries to the Director of the divisions; your request was sent to the Division of Professions which houses the Board staff, not the board members. They also have the Bureau of Education and Testing under the Division of Professions. I assure you that someone from the board staff or the bureau will be contacting your regarding your question.>>>
I track all inquiries and response, so I will make sure someone responds to you with the answers to your question.
Thank you,
Mary Alford
Office of Communications
Department of Business and Professional Regulation
850.922.8981 (phone)
850.921.9019 (fax)
-----Original Message-----
From: Communications, DBPR <DBPR.Communications@dbpr.state.fl.us>
To: artjamie@aol.com
Sent: Tue, Sep 29, 2009 11:44 am
Subject: RE: Hours of CE question
Mr. Malernee,
Did the board members of the Veterinary Medicine Board tell you they would need to contact DBPR? I send all citizen inquiries to the Director of the divisions; your request was sent to the Division of Professions which houses the Board staff, not the board members. They also have the Bureau of Education and Testing under the Division of Professions. I assure you that someone from the board staff or the bureau will be contacting your regarding your question.
I track all inquiries and response, so I will make sure someone responds to you with the answers to your question.
Thank you,
Mary Alford
Office of Communications
Department of Business and Professional Regulation
850.922.8981 (phone)
850.921.9019 (fax)
From: artjamie@aol.com [mailto:artjamie@aol.com]
Sent: Tuesday, September 29, 2009 11:12 AM
To: Communications, DBPR
Subject: Re: Hours of CE question
Mary,
I have already contacted the Board of Veterinary Medicine about this. They told me they would need to contact the dbpr for an answer and then get back to me. I just wanted to be sure they did contact you. If their solution is to contact you and your solution is to contact them how do i get an answer to my question?
art malernee dvm
fla lic 1820
Good morning Mr. Malernee,
Thank you for sending your question. I will have staff from the Board of Veterinary Medicine contact you to assist on your Vet CE questions. However, the Florida Board of Pharmacy is under the Department of Health and you will need to contact them to help provide answers to your CE questions for pharmacy. You can contact them at 850.488.0595. Their Web site is http://www.doh.state.fl.us/mqa/pharmacy ... hives.html.
Someone from our department will contact you in the next couple of days to answer your questions on Vet CE credits you receive when attending the board meetings.
Thank you and have a wonderful day!
Mary Alford
Office of Communications
Department of Business and Professional Regulation
850.922.8981 (phone)
850.921.9019 (fax)
-----Original Message-----
From: Communications, DBPR <DBPR.Communications@dbpr.state.fl.us>
To: artjamie@aol.com
Sent: Tue, Sep 29, 2009 9:34 am
Subject: RE: Hours of CE question
Good morning Mr. Malernee,
Thank you for sending your question. I will have staff from the Board of Veterinary Medicine contact you to assist on your Vet CE questions. However, the Florida Board of Pharmacy is under the Department of Health and you will need to contact them to help provide answers to your CE questions for pharmacy. You can contact them at 850.488.0595. Their Web site is http://www.doh.state.fl.us/mqa/pharmacy ... hives.html.
Someone from our department will contact you in the next couple of days to answer your questions on Vet CE credits you receive when attending the board meetings.
Thank you and have a wonderful day!
Mary Alford
Office of Communications
Department of Business and Professional Regulation
850.922.8981 (phone)
850.921.9019 (fax)
From: artjamie@aol.com [mailto:artjamie@aol.com]
Sent: Monday, September 28, 2009 6:31 PM
To: Communications, DBPR
Subject: Hours of CE question
I have a question about the hours of CE the florida state veterinary board provides for attending the board meetings and the approved CE hours required for pharmacy. Is there someone who might answer my question?
art malernee dvm
fla lic 1820
- malernee
- Site Admin
- Posts: 462
- Joined: Wed Aug 13, 2003 5:56 pm
may be on vacation or sick email
by malernee » Wed Sep 30, 2009 7:25 am
-----Original Message-----
From: artjamie@aol.com
To: Juanita.Chastain@dbpr.state.fl.us
Sent: Wed, Sep 30, 2009 8:22 am
Subject: Re: board of veterinary medicine approve CE
Juanita, Please review the email between
From: Artjamie@aol.com [mailto:Artjamie@aol.com]
Sent: Thursday, August 20, 2009 11:21 AM
To: Tinsley, Linda
Subject: Re: Approved CE requirements
Juanita, The last email I got from Linda was she was going to contact the department but I am not sure if she did contact the dbpr. I got an email from Linda's email account saying she would be out of the office for some time. She might be on vacation or sick.
Art Malernee dvm
fla lic 1820
Dear Dr. Malernee, thank you for your recent email. I would be happy to speak with you about the continuing education hours granted for board meeting attendance. You may contact me by email or telephone at 850.921.8690.
Sincerely,
Juanita Chastain
Executive Director
Board of Veterinary Medicine
-----Original Message-----
From: Chastain, Juanita <Juanita.Chastain@dbpr.state.fl.us>
To: artjamie@aol.com
Sent: Tue, Sep 29, 2009 4:31 pm
Dear Dr. Malernee, thank you for your recent email. I would be happy to speak with you about the continuing education hours granted for board meeting attendance. You may contact me by email or telephone at 850.921.8690.
Sincerely,
Juanita Chastain
Executive Director
Board of Veterinary Medicine
From: artjamie@aol.com
To: Juanita.Chastain@dbpr.state.fl.us
Sent: Wed, Sep 30, 2009 8:22 am
Subject: Re: board of veterinary medicine approve CE
Juanita, Please review the email between
From: Artjamie@aol.com [mailto:Artjamie@aol.com]
Sent: Thursday, August 20, 2009 11:21 AM
To: Tinsley, Linda
Subject: Re: Approved CE requirements
Juanita, The last email I got from Linda was she was going to contact the department but I am not sure if she did contact the dbpr. I got an email from Linda's email account saying she would be out of the office for some time. She might be on vacation or sick.
Art Malernee dvm
fla lic 1820
Dear Dr. Malernee, thank you for your recent email. I would be happy to speak with you about the continuing education hours granted for board meeting attendance. You may contact me by email or telephone at 850.921.8690.
Sincerely,
Juanita Chastain
Executive Director
Board of Veterinary Medicine
-----Original Message-----
From: Chastain, Juanita <Juanita.Chastain@dbpr.state.fl.us>
To: artjamie@aol.com
Sent: Tue, Sep 29, 2009 4:31 pm
Dear Dr. Malernee, thank you for your recent email. I would be happy to speak with you about the continuing education hours granted for board meeting attendance. You may contact me by email or telephone at 850.921.8690.
Sincerely,
Juanita Chastain
Executive Director
Board of Veterinary Medicine
- malernee
- Site Admin
- Posts: 462
- Joined: Wed Aug 13, 2003 5:56 pm
government wants to talk by phone rather than publish
by malernee » Wed Sep 30, 2009 10:29 am
-----Original Message-----
From: artjamie@aol.com
To: Juanita.Chastain@dbpr.state.fl.us
Sent: Wed, Sep 30, 2009 11:21 am
Subject: Re: board of veterinary medicine approve CE
Juanita, Is there some reason why you cannot answer my questions over the internet via email so I have a written record of my conversations ? I have no way to record any phone conversations that I make.
art malernee dvm
fla licence 1820
Dr. Malernee, Linda is with the Board of Veterinary Medicine, DBPR. Please provide your telephone number and I will call you to discuss.
Thanks.
Juanita
-----Original Message-----
From: Chastain, Juanita <Juanita.Chastain@dbpr.state.fl.us>
To: artjamie@aol.com
Sent: Wed, Sep 30, 2009 10:52 am
Subject: RE: board of veterinary medicine approve CE
Dr. Malernee, Linda is with the Board of Veterinary Medicine, DBPR. Please provide your telephone number and I will call you to discuss.
Thanks.
Juanita
From: artjamie@aol.com [mailto:artjamie@aol.com]
Sent: Wednesday, September 30, 2009 8:22 AM
To: Chastain, Juanita
Subject: Re: board of veterinary medicine approve CE
Juanita, Please review the email between
From: Artjamie@aol.com [mailto:Artjamie@aol.com]
Sent: Thursday, August 20, 2009 11:21 AM
To: Tinsley, Linda
Subject: Re: Approved CE requirements
Juanita, The last email I got from Linda was she was going to contact the department but I am not sure if she did contact the dbpr. I got an email from Linda's email account saying she would be out of the office for some time. She might be on vacation or sick.
Art Malernee dvm
fla lic 1820
Dear Dr. Malernee, thank you for your recent email. I would be happy to speak with you about the continuing education hours granted for board meeting attendance. You may contact me by email or telephone at 850.921.8690.
Sincerely,
Juanita Chastain
Executive Director
Board of Veterinary Medicine
-----Original Message-----
From: Chastain, Juanita <Juanita.Chastain@dbpr.state.fl.us>
To: artjamie@aol.com
Sent: Tue, Sep 29, 2009 4:31 pm
Dear Dr. Malernee, thank you for your recent email. I would be happy to speak with you about the continuing education hours granted for board meeting attendance. You may contact me by email or telephone at 850.921.8690.
Sincerely,
Juanita Chastain
Executive Director
Board of Veterinary Medicine
From: artjamie@aol.com
To: Juanita.Chastain@dbpr.state.fl.us
Sent: Wed, Sep 30, 2009 11:21 am
Subject: Re: board of veterinary medicine approve CE
Juanita, Is there some reason why you cannot answer my questions over the internet via email so I have a written record of my conversations ? I have no way to record any phone conversations that I make.
art malernee dvm
fla licence 1820
Dr. Malernee, Linda is with the Board of Veterinary Medicine, DBPR. Please provide your telephone number and I will call you to discuss.
Thanks.
Juanita
-----Original Message-----
From: Chastain, Juanita <Juanita.Chastain@dbpr.state.fl.us>
To: artjamie@aol.com
Sent: Wed, Sep 30, 2009 10:52 am
Subject: RE: board of veterinary medicine approve CE
Dr. Malernee, Linda is with the Board of Veterinary Medicine, DBPR. Please provide your telephone number and I will call you to discuss.
Thanks.
Juanita
From: artjamie@aol.com [mailto:artjamie@aol.com]
Sent: Wednesday, September 30, 2009 8:22 AM
To: Chastain, Juanita
Subject: Re: board of veterinary medicine approve CE
Juanita, Please review the email between
From: Artjamie@aol.com [mailto:Artjamie@aol.com]
Sent: Thursday, August 20, 2009 11:21 AM
To: Tinsley, Linda
Subject: Re: Approved CE requirements
Juanita, The last email I got from Linda was she was going to contact the department but I am not sure if she did contact the dbpr. I got an email from Linda's email account saying she would be out of the office for some time. She might be on vacation or sick.
Art Malernee dvm
fla lic 1820
Dear Dr. Malernee, thank you for your recent email. I would be happy to speak with you about the continuing education hours granted for board meeting attendance. You may contact me by email or telephone at 850.921.8690.
Sincerely,
Juanita Chastain
Executive Director
Board of Veterinary Medicine
-----Original Message-----
From: Chastain, Juanita <Juanita.Chastain@dbpr.state.fl.us>
To: artjamie@aol.com
Sent: Tue, Sep 29, 2009 4:31 pm
Dear Dr. Malernee, thank you for your recent email. I would be happy to speak with you about the continuing education hours granted for board meeting attendance. You may contact me by email or telephone at 850.921.8690.
Sincerely,
Juanita Chastain
Executive Director
Board of Veterinary Medicine
- malernee
- Site Admin
- Posts: 462
- Joined: Wed Aug 13, 2003 5:56 pm
attempt to contact the dept of heath about hours of vet CE
by malernee » Fri Oct 16, 2009 5:37 am
notice the board of health contact box does not give you a choice of no opinion and defaults to the Excellent box. <G> I could not copy and paste my request for them to email me in the contact box and health dept webpage but if I get an email reply will post here.
put in heath dept contact box today
I was given the link below by the dbpr to the pharmacy board but the link is broken. Is there someone from the pharmacy board or fla health dept who can answer my question by email about Pharmacy CE hours of credits provided by licensed Pharmacist to Fla licensed veterinarians?
From: Communications, DBPR <DBPR.Communications@dbpr.state.fl.us>
To: artjamie@aol.com
Sent: Tue, Sep 29, 2009 9:34 am
Subject: RE: Hours of CE question
Good morning Mr. Malernee,
Thank you for sending your question. I will have staff from the Board of Veterinary Medicine contact you to assist on your Vet CE questions. However, the Florida Board of Pharmacy is under the Department of Health and you will need to contact them to help provide answers to your CE questions for pharmacy. You can contact them at 850.488.0595. Their Web site is http://www.doh.state.fl.us/mqa/pharmacy ... hives.html. ;
Someone from our department will contact you in the next couple of days to answer your questions on Vet CE credits you receive when attending the board meetings.
Thank you and have a wonderful day!
Mary Alford
Office of Communications
850.922.8981 (phone)
850.921.9019 (fax)
Art Malernee dvm
fla licence 1820
Department of Health Feedback Your feedback for Department of Health Feedback will be sent via Email to: Health@doh.state.fl.us Questions and Comments What kind of comment would you like to send?
Praise Suggestion Problem or Question Complaint
Enter your comments or questions in the space provided below:
Please rate our site:
Excellent Good Fair Poor
Tell us how to get in touch with you:
Name
E-mail
Telephone
Street Address
City
State
Zip
FAX
Please contact me as soon as possible regarding this matter.
Mail me more information.
put in heath dept contact box today
I was given the link below by the dbpr to the pharmacy board but the link is broken. Is there someone from the pharmacy board or fla health dept who can answer my question by email about Pharmacy CE hours of credits provided by licensed Pharmacist to Fla licensed veterinarians?
From: Communications, DBPR <DBPR.Communications@dbpr.state.fl.us>
To: artjamie@aol.com
Sent: Tue, Sep 29, 2009 9:34 am
Subject: RE: Hours of CE question
Good morning Mr. Malernee,
Thank you for sending your question. I will have staff from the Board of Veterinary Medicine contact you to assist on your Vet CE questions. However, the Florida Board of Pharmacy is under the Department of Health and you will need to contact them to help provide answers to your CE questions for pharmacy. You can contact them at 850.488.0595. Their Web site is http://www.doh.state.fl.us/mqa/pharmacy ... hives.html. ;
Someone from our department will contact you in the next couple of days to answer your questions on Vet CE credits you receive when attending the board meetings.
Thank you and have a wonderful day!
Mary Alford
Office of Communications
850.922.8981 (phone)
850.921.9019 (fax)
Art Malernee dvm
fla licence 1820
Department of Health Feedback Your feedback for Department of Health Feedback will be sent via Email to: Health@doh.state.fl.us Questions and Comments What kind of comment would you like to send?
Praise Suggestion Problem or Question Complaint
Enter your comments or questions in the space provided below:
Please rate our site:
Excellent Good Fair Poor
Tell us how to get in touch with you:
Name
Telephone
Street Address
City
State
Zip
FAX
Please contact me as soon as possible regarding this matter.
Mail me more information.
- malernee
- Site Admin
- Posts: 462
- Joined: Wed Aug 13, 2003 5:56 pm
CE Broker
by malernee » Mon Oct 19, 2009 7:14 am
Its been about a week and so far no reply from the fla dept of health contact box i filled out asking if they could help me. I contacted the company below this morning using their internet contact box to ask if veterinarians are included in their 7day free trial. If I can get a free trial maybe they can help me.
******
Hosted Solution with Help Desk _ Tracking 466,000 Healthcare Professionals
The CE tracking project was established to enhance the Department's CE compliance activities and significantly reduce enforcement activities related to non-compliance issues. Prior to implementing this new system, the continuing education non-compliance rate for Florida healthcare professionals varied, depending on the Regulating Board, from a low of 7% to a high in excess of 30%.
The Florida Department of Health will use CE Broker to conduct audits of CE compliance electronically instead of continuing the manual post audit system. The Department's goal is 100% audit of all licensees' continuing education compliance.
Section Menu
The Solution
Licensee Features
CE Provider Features
Regulating Board Features
Technology & Architecture
Help Desk
THE SOLUTION
CE Broker was deployed in January 2004 for the Florida Department of Health. As opposed to prior implementations, the Florida Department of Health did not purchase and install the software. Instead, the Florida Department of Health entered into an outsourcing agreement with ISF to track and determine compliance for 466,000 healthcare licensees.
We provide the Florida Department of Health continuing education compliance determination and tracking services through the use of our proprietary and other outsourced services. The outsourcing agreement includes the software, technology support, the help desk, the collection and remittance of Regulating Board fees, and supporting services. Since each Regulating Board creates their own rules and policies concerning continuing education compliance, our system accommodates they way each of the 28 Regulating Boards regulates the 67 professions tracked.
We work with the Department, the board staff, CE Providers, and licensees to provide seamless integration. Florida Department of Health licensees, CE Providers, and board staff access www.CEBroker.com for their specific data. Florida Statutes require approved CE providers to electronically report course completions.
LICENSEE FEATURES
CE Broker is the system the Florida Department of Health uses to determine if a Florida healthcare professional has fulfilled his/her continuing education requirements. At the same time, this Internet-based system is designed to provide healthcare professionals a full array of interactive tools to help them manage State of Florida Mandated continuing education.
View your CE Transcript(s) and compliance determination(s)
Search for approved, upcoming courses by Subject Area, CE Provider, Location, Schedule, etc.
Know if a course's hours, and how many, count toward continuing education for license renewal before taking the program
Link your Florida Department of Health licenses so CE hours may post to all of them simultaneously, if applicable, even if only once license number has been reported by the CE Provider
Self-submit CE taken out-of-state, as allowed by the Regulating Board
Submit special scenarios, such as instructor of a course
Search for authorized Florida CE Providers
Link to CE Provider website(s) and registration phone numbers
Research how a course will count toward renewal requirements
Set-up personalized alert notifications of upcoming courses meeting specific requirements
Access FAQs providing answers to all Profession-specific continuing education requirements
Set automatic renewal reminder notices
Use Complete Click , a customizable, automated search results list of courses that meet your outstanding CE requirements
Set/Edit Complete Click preferences
Receive a message each time completed courses are posted by your CE Providers
View your Chronological Course History for a real-time display of every CE program completed and reported
Sent an online message to an authorized Florida CE Provider
Obtain pre-approval for self-submitted CE, as allowed by the Board. Submit pre-approval fees online when required by Board
Check your Message Box to retrieve messages from CE Providers and system messages from CE Broker
Send an online message to the CE Broker Help Desk
CE PROVIDER FEATURES
Each CE Provider has their own secure online site for submission of courses, offerings, renewals, and completed continuing education. The following is a highlight of the major CE Provider System Functions:
Applies to become a CE Provider and pays application fee
Simplified registration process for pre-approved CE Providers
System processes application fee via Visa, MasterCard, electronic check, or mailing a check
Automatic notification to CE Provider of Regulating Board decision
Submits Course to Regulating Board
System automatically notifies CE Provider of renewal requirements
System processes renewal fee via Visa, MasterCard, electronic check, or mailing a check
Any approved CE Provider may submit completed course credit for approved courses and offerings. Six submission options are available:
Direct online entry
Text file upload (created from a system export)
Excel file upload (created from a system export)
System-to-system interfacing
Simplified Excel file upload (created manually)
Scan card
When completed course credit is posted, each licensee may be notified via Message Box (and e-mail if requested) of the CE Provider name, course, date(s), and amount of credit posted.
Add users on a function-by-function basis.
Routing Set-up allows the CE Provider to select the system user to whom messages are to be sent
Online publication of course schedule
REGULATING BOARD FEATURES
Each Regulating Board has its own secure access to CE Broker. Add users on a function-by-function basis
The CE Provider applications, CE Provider renewals, new courses, new instructors, and licensee self-submissions that the Board needs to approve are routed electronically to the designated Board user's Message Box
The CE Provider applications, CE Provider renewals, new courses, new instructors, and licensee self-submissions that the Boards do not wish to approve are automatically approved by the system, following requested edit checks
CE Providers have the ability to attach electronic documents
100% paperless processing is available between the Board and CE Providers
Ability to request more information from CE Providers. When response is received, the new information becomes part of the original submission
Ability to electronically re-route CE Provider applications, CE Provider renewals, new courses, and new instructors to other Board users
Workflow routing with the ability to electronically share CE Provider applications, CE Provider renewals, new courses, and new instructors with Board members or others granted access and receive feedback
Collection and remittance of CE Provider and Licensee fees
Modifications required by the Board are accomplished by simply calling the Help Desk
All data collected from CE Providers and licensees is customized to each Board's needs
TECHNOLOGY & ARCHITECTURE
CE Broker was developed using a 3-Tier information systems framework:
Tier 1: Presentation Tier. This Presentation Tier is responsible for displaying information to the users, capturing user input, and accepting incoming continuing education batch files. Application security was custom built and integrated. Any business logic or database access is prohibited, which guarantees the integrity of the system. This user front-end was built using Active Server Pages (ASP) and Secure Sockets Layer (SSL). We recommend Internet Explorer 5.5 or higher for best viewing.
Tier 2: Processes or Business Logic Layer. This Business Logic Layer is responsible for delivering information to the presentation tier. Business rules are executed using ASP objects and Visual Basic components.
Tier 3: The Database. Most every screen in CE Broker is database-driven. CE Broker has a powerful Oracle database.
CSX Technology (CSX TECH) Advanced Information Technology Center serves as our site hosting provider. CSX has a complete business unit that meets our high expectations of security, as well as capacity to ensure CE Broker has 24 x 7 level of service.
HELP DESK
CE Broker maintains a help desk from 8:00am to 5:00pm EST Monday through Friday, except State of Florida holidays. First level support is provided for all help desk calls related to the CE tracking and compliance determination system. First level call resolution: All help desk personnel provide first level support. Each help desk person will try to resolve the call that comes to him/her. There should not be the need to pass the call to another person for support. The caller should only have to describe their problem once _ to the person who will be handling it.
In addition to phone calls, questions may be sent online to the Help Desk at any time. Questions sent electronically are usually answered no later than the next business day. Some questions need additional investigation and take longer to answer. If this is the case, you will be notified by the Help Desk that we are researching your question.
The Help Desk will assist with technical issues and will take users to the help text and frequently asked questions (FAQs), when appropriate.
Help text is provided for each screen.
Extensive online FAQs gives information concerning the governing entity's rules, policies, and procedures.
Making the caller aware of the information available online not only makes the caller more self-sufficient in the future but also provides written information for consistency and to avoid misunderstanding.
******
Hosted Solution with Help Desk _ Tracking 466,000 Healthcare Professionals
The CE tracking project was established to enhance the Department's CE compliance activities and significantly reduce enforcement activities related to non-compliance issues. Prior to implementing this new system, the continuing education non-compliance rate for Florida healthcare professionals varied, depending on the Regulating Board, from a low of 7% to a high in excess of 30%.
The Florida Department of Health will use CE Broker to conduct audits of CE compliance electronically instead of continuing the manual post audit system. The Department's goal is 100% audit of all licensees' continuing education compliance.
Section Menu
The Solution
Licensee Features
CE Provider Features
Regulating Board Features
Technology & Architecture
Help Desk
THE SOLUTION
CE Broker was deployed in January 2004 for the Florida Department of Health. As opposed to prior implementations, the Florida Department of Health did not purchase and install the software. Instead, the Florida Department of Health entered into an outsourcing agreement with ISF to track and determine compliance for 466,000 healthcare licensees.
We provide the Florida Department of Health continuing education compliance determination and tracking services through the use of our proprietary and other outsourced services. The outsourcing agreement includes the software, technology support, the help desk, the collection and remittance of Regulating Board fees, and supporting services. Since each Regulating Board creates their own rules and policies concerning continuing education compliance, our system accommodates they way each of the 28 Regulating Boards regulates the 67 professions tracked.
We work with the Department, the board staff, CE Providers, and licensees to provide seamless integration. Florida Department of Health licensees, CE Providers, and board staff access www.CEBroker.com for their specific data. Florida Statutes require approved CE providers to electronically report course completions.
LICENSEE FEATURES
CE Broker is the system the Florida Department of Health uses to determine if a Florida healthcare professional has fulfilled his/her continuing education requirements. At the same time, this Internet-based system is designed to provide healthcare professionals a full array of interactive tools to help them manage State of Florida Mandated continuing education.
View your CE Transcript(s) and compliance determination(s)
Search for approved, upcoming courses by Subject Area, CE Provider, Location, Schedule, etc.
Know if a course's hours, and how many, count toward continuing education for license renewal before taking the program
Link your Florida Department of Health licenses so CE hours may post to all of them simultaneously, if applicable, even if only once license number has been reported by the CE Provider
Self-submit CE taken out-of-state, as allowed by the Regulating Board
Submit special scenarios, such as instructor of a course
Search for authorized Florida CE Providers
Link to CE Provider website(s) and registration phone numbers
Research how a course will count toward renewal requirements
Set-up personalized alert notifications of upcoming courses meeting specific requirements
Access FAQs providing answers to all Profession-specific continuing education requirements
Set automatic renewal reminder notices
Use Complete Click , a customizable, automated search results list of courses that meet your outstanding CE requirements
Set/Edit Complete Click preferences
Receive a message each time completed courses are posted by your CE Providers
View your Chronological Course History for a real-time display of every CE program completed and reported
Sent an online message to an authorized Florida CE Provider
Obtain pre-approval for self-submitted CE, as allowed by the Board. Submit pre-approval fees online when required by Board
Check your Message Box to retrieve messages from CE Providers and system messages from CE Broker
Send an online message to the CE Broker Help Desk
CE PROVIDER FEATURES
Each CE Provider has their own secure online site for submission of courses, offerings, renewals, and completed continuing education. The following is a highlight of the major CE Provider System Functions:
Applies to become a CE Provider and pays application fee
Simplified registration process for pre-approved CE Providers
System processes application fee via Visa, MasterCard, electronic check, or mailing a check
Automatic notification to CE Provider of Regulating Board decision
Submits Course to Regulating Board
System automatically notifies CE Provider of renewal requirements
System processes renewal fee via Visa, MasterCard, electronic check, or mailing a check
Any approved CE Provider may submit completed course credit for approved courses and offerings. Six submission options are available:
Direct online entry
Text file upload (created from a system export)
Excel file upload (created from a system export)
System-to-system interfacing
Simplified Excel file upload (created manually)
Scan card
When completed course credit is posted, each licensee may be notified via Message Box (and e-mail if requested) of the CE Provider name, course, date(s), and amount of credit posted.
Add users on a function-by-function basis.
Routing Set-up allows the CE Provider to select the system user to whom messages are to be sent
Online publication of course schedule
REGULATING BOARD FEATURES
Each Regulating Board has its own secure access to CE Broker. Add users on a function-by-function basis
The CE Provider applications, CE Provider renewals, new courses, new instructors, and licensee self-submissions that the Board needs to approve are routed electronically to the designated Board user's Message Box
The CE Provider applications, CE Provider renewals, new courses, new instructors, and licensee self-submissions that the Boards do not wish to approve are automatically approved by the system, following requested edit checks
CE Providers have the ability to attach electronic documents
100% paperless processing is available between the Board and CE Providers
Ability to request more information from CE Providers. When response is received, the new information becomes part of the original submission
Ability to electronically re-route CE Provider applications, CE Provider renewals, new courses, and new instructors to other Board users
Workflow routing with the ability to electronically share CE Provider applications, CE Provider renewals, new courses, and new instructors with Board members or others granted access and receive feedback
Collection and remittance of CE Provider and Licensee fees
Modifications required by the Board are accomplished by simply calling the Help Desk
All data collected from CE Providers and licensees is customized to each Board's needs
TECHNOLOGY & ARCHITECTURE
CE Broker was developed using a 3-Tier information systems framework:
Tier 1: Presentation Tier. This Presentation Tier is responsible for displaying information to the users, capturing user input, and accepting incoming continuing education batch files. Application security was custom built and integrated. Any business logic or database access is prohibited, which guarantees the integrity of the system. This user front-end was built using Active Server Pages (ASP) and Secure Sockets Layer (SSL). We recommend Internet Explorer 5.5 or higher for best viewing.
Tier 2: Processes or Business Logic Layer. This Business Logic Layer is responsible for delivering information to the presentation tier. Business rules are executed using ASP objects and Visual Basic components.
Tier 3: The Database. Most every screen in CE Broker is database-driven. CE Broker has a powerful Oracle database.
CSX Technology (CSX TECH) Advanced Information Technology Center serves as our site hosting provider. CSX has a complete business unit that meets our high expectations of security, as well as capacity to ensure CE Broker has 24 x 7 level of service.
HELP DESK
CE Broker maintains a help desk from 8:00am to 5:00pm EST Monday through Friday, except State of Florida holidays. First level support is provided for all help desk calls related to the CE tracking and compliance determination system. First level call resolution: All help desk personnel provide first level support. Each help desk person will try to resolve the call that comes to him/her. There should not be the need to pass the call to another person for support. The caller should only have to describe their problem once _ to the person who will be handling it.
In addition to phone calls, questions may be sent online to the Help Desk at any time. Questions sent electronically are usually answered no later than the next business day. Some questions need additional investigation and take longer to answer. If this is the case, you will be notified by the Help Desk that we are researching your question.
The Help Desk will assist with technical issues and will take users to the help text and frequently asked questions (FAQs), when appropriate.
Help text is provided for each screen.
Extensive online FAQs gives information concerning the governing entity's rules, policies, and procedures.
Making the caller aware of the information available online not only makes the caller more self-sufficient in the future but also provides written information for consistency and to avoid misunderstanding.
- malernee
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