AAFP CREDIT SYSTEM RECONSIDERS FUNCTIONAL MEDICINE TOPICS

Background

The Cleveland Clinic’s Center for Functional Medicine defines functional medicine as “a personalized, systems-oriented model that empowers patients and practitioners to achieve the highest expression of health by working in collaboration to address the underlying causes of disease.”

In 2013, the AAFP’s COCPD, which oversees the AAFP Credit System, recognized that CME provider organizations applying for credit for activities and sessions about functional medicine were receiving inconsistent credit determinations.

In response, the COCPD conducted a literature review on functional medicine, and based on this review, the group determined at the time there wasn’t sufficient evidence to award AAFP credit to activities and sessions on the topic. So, a moratorium was placed on functional medicine in February 2014. That moratorium expired in 2016, at which time another evidence review was conducted and the COCPD extended its moratorium based on similar reasoning. This most recent moratorium expired in February of this year.

In anticipation of this expiration, the AAFP Credit System issued a call for comment on functional medicine in September 2017 to AAFP members, CME provider organizations, functional medicine stakeholders and other national accreditors. The request for feedback included a call for evidence on functional medicine’s efficacy in the application of family medicine and any additional supporting evidence and/or literature.

The information received was objectively reviewed and summarized in a report by a third party and presented to the COCPD. That information, along with several literature reviews and results from the AAFP Member Survey, informed the commission’s decision to lift the moratorium on functional medicine. The change went into effect after it was recently approved by the AAFP Board of Directors.

Family Physician Expert’s Perspective

COCPD Chair Melody Jordahl-Iafrato, MD, of Tucson, Arizona, told AAFP News that although the moratorium has been lifted, activities or sessions covering functional medicine must comply with the AAFP Credit System’s eligibility requirements and with the topic-specific guidance issued by the COCPD.

Under the newly issued topic-specific guidance, for example, Jordahl-Iafrato said a session that provides an overview of what functional medicine encompasses would be eligible for credit.

“This may include some examples of techniques, but not teaching how to do these techniques,” she said. “However, a session that teaches how to treat a specific disease—such as neurological or gastrointestinal disease—with functional medicine principles would not be eligible.”

After the literature review in 2014, the COCPD did not find sufficient evidence to support the use of functional medicine in family medicine and, in some cases, determined the claims being made to be potentially dangerous, Jordahl-Iafrato explained.

The commission followed a similar evidence review process in 2016 with the same results, she added.

“The COCPD acknowledged that while sufficient evidence does not exist, patients still may be utilizing or asking about functional medicine; therefore, it’s important for members to be informed on the concept of functional medicine and what patients might be asking about regarding their health care and treatment options,” Jordahl-Iafrato said.

However, she noted, given the current lack of evidence, the COCPD does not deem it appropriate to learn how to practice functional medicine or implement related techniques within an AAFP-certified CME activity.

“The COCPD understands that many family physicians have an interest in functional medicine and we’ll continue to review this topic as more research is done,” Jordahl-Iafrato said. “The AAFP Credit System strives to certify CME that is evidence-based, objective and balanced, which means benefits have been proven and all possible risks, side effects and negative outcomes should be acknowledged.

“Ideally, CME includes fair, balanced consideration of all usual and customary approaches and not only the approach preferred by the CME provider.”

Questions about functional medicine may be submitted to the AAFP Credit System at cmecredit{at}aafp.org; inquiries on claiming CME credits should be directed to the AAFP’s Member Resource Center at 800-274-2237.