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 Integrative Medicine and Integrated Healthcare Round-up: February 4-March 6, 2010 
 
The following is one in an ongoing series of columns entitled Integrator Blog by . View all columns in series
Summary: McCain-Dorgan bill stirs battle over supplement regulation McCain backs off ... Action urged to support "licensed integrative practitioners" in federal legislation ... Senator Mikulski salutes Integrative Healthcare Symposium attendees ... Bill George pushes reform at personal and state levels .. Brent Bauer, MD reports on Mayo's growing integrative medicine initiative ... True North patient survey featured in American College of Physicians' publication ... Naparstek's Health Journeys CD sent by DoD to help soldiers in war zone ... Acupuncture accreditation agency moves ahead with "first professional doctorate" ... A first: Chiropractic faculty members credentialed to teach in VA facilities via NYCC relationships ... Washington state legislature announces annual Bastyr Day ... Oregon naturopathic doctors included in loan-forgiveness program for service to the underserved and in rural areas ... Chiropractors explore role in public health ... NJ chiropractors add homeopathy, nutrition to practice; Gahles comments ... Hawai'i medical association seek to strip scope additions of state's naturopathic doctors ... AMI seeks expansion of integrative Medicaid pilot into Arizona ... ABC blasts peer-reviewed piece on drug-herb interactions ... Newsweek rips anti-depressants as "Tic tacs" ... Stargrove and MedicineWorks release electronic interactions guide ... Olympic athletes sponsored by supplement lines ... Profootball chiropractic association in 4th conference ... Integrative Healthcare Symposium up 31%, gains status as community gathering ... Arizona Center's integrative mental health conference sells out ... Ann Fonda reports on the Annie Appleseed Project ... Pelletier takes vice president role at American Specialty Health ... Miller-Read takes over as AMTA president ...

Policy

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US Senator John McCain: Attacks and backs-off
McCain-Dorgan bill aims to change dietary supplement regulation, industry raises strong opposition; McCain backs away

US Senator John McCain (R-AZ)and US Senator Bryan Dorgan (D-ND) introduced the Dietary Supplement Safety Action of 2010
that would significantly impact the regulation of dietary supplements. The bill was greeted with significant opposition by industry, practitioner and consumer organizations. These argue that the bill will drive up costs and limit access to consumers for products that are already safer than most drugs. The Council for Responsible Nutrition position is linked here and that from the American Herbal Products Association is here. The American Association of Naturopathic Physicians generated 2000 practitioner letters. The Alliance for Natural Health-USA has stirred up vigorous opposition, eliciting over 80,000 pieces of electronic mail, according to Gretchen DuBeau, the organization's executive director. Asserts DuBeau: “If passed as written, this bill would likely result in the disappearance from store shelves of many supplements currently on the market, and unbridled authority would be handed to the FDA, an agency that needs a top to bottom overhaul, not ever more power over our lives." McCain is aware of the antagonism and has responded with a statement on the Senate floor. He states that the bill was introduced based on requests from numerous professional and amateur sports organizations. The debate breaks over whether the bill fundamentally shifts regulation of supplements and will limit consumer access; McCain says yes, the industry and related groups say no. A thoughtful column on the bill by Integrator columnist Michael Levin in which he poses a potentially useful regulatory strategy is posted here. [Note: At publication, ANH sent a note to their list indicating that following a meeting with US Senator Orrin Hatch, McCain has backed away from his advocacy. Dorgan's next steps are not known.]
Comment: Asked if McCain's bill would significantly impact consumer access to dietary supplements, policy panel members at the February 25, 2010 session of the Integrative Healthcare Symposium unanimously agreed that it would, with additional commentary that there are reasons to better regulate the industry. The mantra from opponents, including Levin, is that rather than a new law, better to enforce the Dietary Supplement Health and Education Act (DSHEA). The Alliance for Natural health campaign is here. McCain's quick reversal following his passionate advocacy and warning of deaths from supplements makes one recall what a flip-flopper he was in his presidential candidacy.
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Newsletter urges letters to Congress for licensed integrative practitioners
Action letter calls for support of "licensed integrative practitioners" in federal legislation

The Oregon Collaborative for Integrative Medicine. Health Action and Healer Within founder Roger Jahnke, OMD. The national massage business Associated Bodywork and Massage Professionals (ABMP). These are among the respondents to a recent action letter in the Integrator and posted at Integrative Practitioners Online asking members of the integrative practice community to contact members of Congress to include integrative practices and integrative practitioners in healthcare legislation. The campaign was stimulated by integrative health entrepreneur Richard Sarnat, MD, who believes that, despite the challenges of any reform efforts, that relationships with Congress are key. Since "licensed integrative practitioners" have been included in multiple places in drafts of reform legislation, he argues that we must advocate for this inclusion. Among the sections in which licensed integrative practitioners are included are workforce planning, comparative effectiveness research and medical homes. (See details
in the call to action.) The call to action also notes relevant sections relative to health promotion, wellness and non-discrimination. ABMP posted their own call to action here.
Comment: Sarnat stimulated me to get over my own cynicism about reform this year and realize that this kind of inclusion is key regardless of whether a huge reform bill is passed or sections are taken up independently. To the extent that change can come via such inclusion, action will rest on relationships. Sarnat is right when he says we need to be in the habit of contacting our members of Congress. So, start now! Send a letter. I timed myself. Using the model letter, which I slightly adjusted and personalized, I spent under 15 minutes to send to both US Senators from my state of Washington (Murray, Cantwell) and my member of the House (McDermott). Feels good to have done it.   
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US Senator Barbara Mikulski: Honoring IHS participants
Senator Mikulski letter greets participants at Integrative Healthcare Symposium


The IntegrativePractitioner.com website includes an unusual posting as of February 25, 2010, the first day of the Integrative Healthcare Symposium (IHS). US Senator Barbara Mikulski (D-MD) sent an official letter to participants in the symposium "applauding them for their participation." In the letter, Mikulski notes that "I am a longtime advocate of integrative health and commend all of the work that you do." She states the "integrative health is a vital part of our delivery system," then ticks off sections of proposed legislation where she was actively involved, including workforce planning and comparative effectiveness research. The letter was provoked by a late decision by one of Mikulski's staff to stay in D.C. on the day of the February 25, 2010 Obama healthcare summit rather than participate in an IHS panel on integrative healthcare and US health policy.
Comment: Nice to see this kind of support from an extremely influential member of Congress. Credit Mikulski's Maryland constituents like Robert Duggan, LAc and the Tai Sophia Institute and Brian Berman, MD and the University of Maryland program in integrative medicine, for building a relationship with Mikulski through the years.
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Bill George: CEO, Harvard faculty and integrative medicine philanthropist
Bill George urges shift to state focus for health reform via column in Minnesota Tribune


In a column in the March 6, 2010 Minnesota StarTribune, integrative medicine philanthropist and former Medtronic chair Bill George urges that his state take the lead in health reform rather than focusing at the federal level. "Rather than waiting for Washington to devise the ideal national system, what should Minnesota's leaders do to transform the state's health care?" George urges as a general principle that "each of us should take responsibility for our own health, supported by our health care team, composed of physicians, nurses, health care and wellness professionals." The teams would include complementary healthcare practitioners. He notes that the federal efforts focus on insurance coverage and access: "Virtually overlooked at the federal level are three equally important aspects of health care: cost, quality and personal responsibility. Addressing these essential areas, the health care crisis cannot be resolved." George underscores that we "have not health care system in this country." He points to perverse incentives in our payment system as an obstacle, and personal responsibility, community medicine, team care, primary care and wellness expansion as directions to resolve the situation in his home state. Minnesota is a recognized national leader in health care. (Thanks to Mary Jo Kreitzer, PhD, RN for alerting me to this column.)


Integrative Practices

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Brent Bauer, MD: Growing the Mayo program
Brent Bauer, MD's short report on advances in Mayo integrative medicine program

Brent Bauer, MD
provided this quick glance into developments in integrative medicine at Mayo Clinic:
"The biggest recent news was the release of the iPhone meditation app last month (Mayo Clinic Meditation) that has received national attention as well as internal notice. A new edition of the Time book Mayo Clinic Book of Alternative Medicine will be out at the end of march or early April. We are just reviewing the data but our stress management and resiliency training program is showing statistically significant benefits in physicians at risk for burn-out and in breast cancer survivor advocates. This strategy is the focus of our Mind Body Medicine initiative being led here by Amit Sood, MD, Sc."

Bauer continues: "
We also had a series of massage papers accepted in 2009 all showing beneficial outcomes and all leading to practice change. For example, massage therapy is now included as part of routine aftercare for patients undergoing open heart surgery. Animal assisted therapy is on the rise here - trying to raise funding to move it beyond the current volunteer status. Lot's of interest as one of our key dogs ('Jack') was featured on Animal Planet and is having a children's book written about him. The book should be out in 1-3 months. All the usual stuff (acupuncture, massage, meditation training) continue to grow, driven by practice demand, so well integrated and doing well even in these uncertain economic times." Bauer adds: "Hate to sound too Pollyanna-ish but definitely in the right place, doing purposeful work with people I love. Doesn't get much better than this!" (For a 2006 feature on Mayo's program click here.)
Comment: I had the pleasure of an early association with this program when the work of Bauer and his colleagues was boosted by a significant grant from my colleague Lucy Gonda in 2001. It is remarkable to see these stepwise changes via the persistence in following Bauer's strategic vision of the Mayo way for advancing patient care. Mayo's reputation as a national leader means these integrative steps resonate widely. Note the sudden elevation of Jack, from quiet therapist to national celebrity.
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IM clinic featured for patient survey
True North integrative clinic featured in ACP Internist for patient survey work

The True North integrative clinic was featured in the February 2010 issue of the ACP Internist for use of the American College of Physician's (ACP's) patient assessment survey for care outcomes. The True North team team includes 28 practitioners, from medical doctors to, in the article's language, "
advanced practice nurses, mental health practitioners, pharmacists, chiropractors, life coaches, fitness trainers, naturopaths and other credentialed integrative practitioners." (See Integrator feature on True North's distinctive "Decision Circle" clinical model here.) ACP member Joseph Semmes, MD, the not-for-profit clinic's director of research, had access to the survey and received permission to modify the 29 question tool to include 16 additional questions. The additional 16 are, according to a February 9, 2010 True North release, "not only uniquely relevant to True North’s integrative approach but also key to true prevention, healing and wellness." The ACP Internist article includes this general finding: "The group found that patients had improved their level of fitness but not as much as they had improved in other key areas such as nutrition and sleep patterns."
Comment: I will contact True North for more information on their outcomes, as well as their choices on the additional 16 questions.
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Belleruth Naparstek, LISW: Mind-body CDs heading to troops
Department of Defense expands use of Health Journeys' integrative wellness tools


The Dept of Defense continues to demonstrate steady interest in distributing integrative wellness tools for its active troops. Beginning in March, 1500 guided imagery audio recordings designed to help with sleep and stress will be shipped to Iraq and Afghanistan, according tob a note to the Integrator from Belleruth Naparstek, LISW, from Health Journeys. The DoD interest is in helping "U.S. fighting forces access mind-body skills for increasing relaxation and emotional resilience." The guided imagery tools were created by Naparstek with music by Steven Mark Kohn, is produced by Health Journeys Inc of Cleveland, Ohio. Naparastek not4es that the content is loaded onto PlayAways, a newly patented 2-oz players that comes complete with ear buds and batteries, and requires no downloading or USB charging. The recordings are ordered through the Army’s Department of Morale, Welfare and Recreation. Naparstek’s imagery has been tested in outcome studies at Duke, Scripps and the Phoenix V.A. with subjects suffering from posttraumatic stress and traumatic brain injury. Naparstek notes that she hopes that these tools "might alleviate warrior stress and sleep deprivation to the extent that some of the more severe symptoms of combat can be averted." Additional information is available through Health Journeys and through the DoD's PlayAlways site.
Comment: I was once involved with a day-long retreat in which one of the questions quietly broached was the ethics of providing healing healthcare that will enhance the ability to pursue wartime activities. Ought one remain calm, relaxed and balanced in the midst of killing? Were I 25 again I would have an absolute and authoritative clarity about what one should and should not do relative to war. Ethics aside, it remains intriguing that the military, like performers and professional athletes, are leading adopters of integrative practices. Naparstek's dogged work is expanding access in multiple environments.  

Education


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Accrediting agency pushes ahead with first professional doctorate
AOM accrediting body chooses to go ahead with "First Professional Doctorate, opponents organize


The Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) has chosen to go ahead with planning toward its controversial "First Professional Doctorate" (FPD)according to a statement from the accrediting body following its February 2010 meeting. The agency, which reviewed over 3000 letters and comments, concluded:
"Based on this review the Commission, in its exercise of professional judgment, is satisfied that there is sufficient support to justify the further development of first-professional doctoral standards. Accordingly, the Commission voted to authorize the ACAOM Doctoral Task Force to complete its work in developing standards for accrediting first-professional doctoral programs in AOM for the Commission’s review and consideration. In taking this action, the Commission does not take any position on whether or not the first professional doctorate should be the required educational requirements for professional practice in AOM,which is the prerogative of state legislative and AOM regulatory authorities." 
The ACAOM plans to reconvene its task force to refine the first draft of its proposed standards. These will then be sent out to the AOM community for review. The decision has already created a stir. The depth of opposition and challenges ahead for the profession are evident in this post from Lisa Rohleder, LAc, a co-founder of the Community Acupuncture Network (CAN). Rohleder's post stimulated scores of responses, all opposed. The tenor is not friendly.
Comment: I continue to be torn by this issue, with strong internal, personal and professional pulls both pro- and con, as expressed at the bottom of this compilation of various perspectives on the FPD. Frank Ervolino, ND, LAc, a member of the first national commission on the FPD who presently opposes the move "at this time," helps clarify some of the opposing interests inside the AOM community in this Integrator posting. The post is clarifying, if shaped by Ervolino's present opposition. The best news for those worried about aggravations to the historic divisions in the field is that ACAOM is merely entering a new phase in a long process. Any Battle Royale that may be pending will be put off for a period.
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New York Chiropractic College faculty create breakthroughs with VA
New York Chiropractic College faculty member credentialed to teach in VA system


A bit of history was made in November 2009 when two chiropractic radiologists who are assistant professors at New York Chiropractic College earned clinical teaching privileges in the nation’s veteran’s hospital system. Jean-Nicolas Poirier, DC, DACBR, CCPS and Chad Warshel, DC, DACBR are the first chiropractic radiologists to have received credentialing by the United States Veteran Affairs system to teach radiology to chiropractic students and residents enrolled in a Masters of Science Degree in Diagnostic Imaging residency. The appointments are for 2 years. The teaching will take place at the Canandaigua Veteran Affairs Medical Center where the two faculty members will work with chiropractic doctors and review radiological images of their patients with NYCC interns and NYCC diagnostic imaging residents. NYCC's January 2010 release on the subject notes that "this new arrangement will enhance the radiological experience of NYCC interns and residents by increasing the variety of conditions seen by the students using multiple advanced imaging modalities." The Canandaigua VA Medical Center, part of VA Healthcare Network Upstate New York, is located 30 miles southeast of Rochester in Canandaigua, New York. New York Chiropractic College has developed a series of VA affiliations with VA programs.
Comment: Accepting "licensed CAM" professionals as members of clinical teams in conventional medicine is becoming familiar, if not yet standard. Formally granting these distinctly licensed practitioners authority as teachers in these institutions is more rare. Credentialing them to teach medical doctors, which apparently is not part of this agreement, is even more rare. Still, to allow faculty members from the accredited institutions, like NYCC, to formally teach in hospitals and health systems, is an important step toward resolving health care's guild divisions.
Washington legislature initiates annual Bastyr University Day

February 24, 2010 was the official Bastyr University Day
for the Washington State Legislature according to resolution SR 8693. According to the resolution, the recognition of Bastyr contributions is to happen annually. A prime mover behind the resolution, State Senator Paull Shin (D), is a Bastyr University trustee. Bastyr has over a dozen undergraduate and graduate academic programs (ND, LAc, DAOM, midwifery, whole foods dietetics, etc.). The resolution honored Bastyr for it's "commitment to a sustainable health care model, the University's role in minimizing its environmental impact through green building practices, and its instrumental role in increasing research activity in the natural health sciences." The comments can be accessed by clicking here and advancing the video to 11:00.
Comment: While this is a good sign for the institution, I imagine Bastyr's leadership would be happy to see the special day go away if Bastyr were instead thoroughly integrated into the state's higher education and healthcare funding practices.

Professions


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Laura Cuilbertson Farr, OANP executive director
Oregon naturopathic physicians approved for rural health and underserved area loan forgiveness program


A key 2009-2010 objective of the Oregon Association of Naturopathic Physicians was reached in late February when the Oregon State legislature passed a bill to include naturopathic doctors in the state's Rural Health Services Loan Repayment Program. Laura Culberson Farr, OANP executive director shared with the Integrator that the program "was also expanded to include medically underserved communities" together with rural communities. A model for the program is an existing program in which naturopathic physicians have served for over a decade in Washington State. The program would cover up to $25,000 in loans with a 3 year commitment of service. Farr notes however that the vote was merely "a policy victory" because, given the Oregon's challenged fiscal status, the program in its entirety, including loans for MDs serving similarly, is presently unfunded. States Farr: "(Getting the funding back) will be the next step of the battle." An OANP representative shared that "an important point is that the Oregon Medical Association did not oppose our inclusion." The OANP has "been working hard to build relationships with that organization and forge common ground. As a result, we have a strong coalition moving forward to fund the program in 2011."
Comment: This level of collaboration between medical doctors and naturopathic doctors to help serve the underserved is remarkable, especially given the AMA's Scope of Practice Partnership through which the national organization is seeking to stop greater inclusion of naturopathic services. The process of the bill's passage wasn't without typical turf skirmishes, however. At one point such jockeying provoked committee chair Mitch Greenlick (D-NW Portland) to make a statement which should be tattooed on the foreheads of all guild warriors who forget that patients must come first:
“We have created these silos, and created such heavy bricks around them, that it seems very hard for professions to see beyond the threat of somebody else coming into their territory. And it just seems to me that as long as we are blinded by this kind of inter-professional rivalry and silos, we are going to have a very difficult time creating the workforce of the future.”
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Chiropractic organization examines role in public health
Chiropractors  engage member survey on DC roles in public health


The American Chiropractic Association has recently asked its members for feedback on "Chiropractors Attitudes and Involvement" in the public health. The
explanatory note reads: "In a health care system that has been overly focused on curing acute diseases, providers are increasingly expected to practice health promotion and disease prevention. Promoting wellness has always been a part of chiropractic philosophy. Until recently, however, public health has been taught in chiropractic colleges only to a limited degree. Tell us about your view on how chiropractors should be involved in public health, and let us know how you currently participate in disease prevention and health promotion." A subset of chiropractors have been significantly involved in the public health through the American Public Health Association which has a chiropractic healthcare section.
Comment: Most integrative practitioners and licensed complementary and alternative healthcare professionals feel a philosophical kinship with the health-promoting and wellness functions the public health. Yet these practices are poorly articulated with formal public health programs. It will be interesting to see what the ACA finds through this survey.

Regulation


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Nancy Gahles, DC, CCH, RS (Hom): Exploring the values of therapies, and of distinctly trained professionals
New Jersey chiropractors add homeopathy, nutrition to scope; DC-homeopath Nancy Gahles comments


I received a note recently from Nancy Gahles, DC, CCH, RS (Hom) notifying me of a practice change in New Jersey in which homeopathy and nutrition were added to the scope of practice for chiropractors in New Jersey. She noted her concern, as both NJ-licensed chiropractor and a homeopath who is presently president of the National Center for Homeopathy, that homeopathy may not be appreciated for its full value. I asked her for comments. She wrote:
"As a Chiropractic Physician licensed in the state of New Jersey, expanding scope of practice to include nutritional counseling and homeopathy serves to add to the pool of primary care providers that we so desperately need in the fields of CAM where prevention and wellness paradigms already exist in both philosophy and practice.

"As first portal of entry physicians, chiropractors see their patients on a more frequent basis than do medical doctors and the opportunity arises for more detailed analysis of etiology and co-morbidities associated with the neuromusculoskeletal issues such as low back pain that the majority of patients present with.

"Having access to more tools in the toolbox is always an advantage in a wholistic practice and , when dealing with whole people we do know that one size treatment does not suit all.  Research shows that lifestyle choices in diet, nutrition and exercise positively effect changes in chronic disease relieving the costly burden on the healthcare system and increasing quality of life.

   
"Homeopathy does not lend itself
to a weekend course that allows
you to practice quality homeopathy
on Monday morning.  As President
of the National Center for Homeopathy,
it is incumbent upon me to preserve the
integrity of the homeopathic profession."
 

 
"The inclusion of homeopathy into scope of practice presents a challenge along with a victory. Homeopathy is a stand alone system of medicine with its own Pharmacopoeia of homeopathic medicines regulated by the FDA. Homeopathy does not lend itself to a weekend course that allows you to practice quality homeopathy on Monday morning.  As President of the National Center for Homeopathy it is incumbent upon me to preserve the integrity of our profession. That being said, while we are awaiting promulgation of the regulations, I am in direct contact with the appropriate DOE college to ensure curriculums leading to nationally recognized certification standards such as the CCH are made available to DC's in NJ.

"The victory is that homeopathy is a system of medicine that is directly in alignment (pardon the pun) with chiropractic philosophy. As both a chiropractor and a homeopath, I feel that  the intimate, complex relationship of body, mind and spirit is addressed  most eloquently when a combination of both of these dynamic therapies are employed.

"It is also true that many professionals, while understanding the need for nutritional counseling and homeopathic care, do not want to undertake the studies required for them to become practitioners themselves. This opens the door for integrative practice among chiropractic colleagues as well as CAM professionals outside of chiropractic.

   
   "As both a chiropractor and a
homeopath, I feel that  the intimate,
complex relationship of body,
mind and spirit is addressed 
most eloquently when a combination
of both of these dynamic therapies
are employed."

"The fact that homeopathy is not covered by insurance brings the patient responsibility factor into play, one that was spoken about at the IOM summit as a necessary factor in the emerging patient-centric healthcare model. Self-pay brings Health Savings Accounts squarely to the fore and the changes in language necessary that will allow people to use their tax free dollars for the CAM services they want. Freedom and choice do not come without some work. When legislation is enacted, invariably there are other components that flow from that.  Both practitioner and patient need to tell their legislators what they need and what they want. With the insurance industry crippling small businesses with their outrageous increases ( Blue Cross some 37% and Healthnet 48%), doctors need a revenue stream outside of those paid for by insurance.  Consumers of healthcare may be better off paying fee for service from their own HSA's. Safe, effective and cost saving therapies like homeopathy may be just what the doctor ordered.

"With the proper education and inspiration, expanding scope of practice for chiropractors is a win-win situation."
Comment: Licensed "CAM" practitioners frequently question the clinical skills in complementary modalities of integrative medical doctors who typically have significantly less training in a specific modality or system than the distinctly licensed integrative practitioners have through their recognized educational programs. The same issues break between and among these licensed disciplines. In my work with the multidisciplinary Academic Consortium for Complementary and Alternative Healthcare (ACCAHC), we call these "hotspots." The challenge across the board is to know when to use the therapies but know also when patient care will be better via referral to professionals who are more deeply schooled in a given system of care. This distinction was behind the development of ACCAHC's Clinicians' and Educators' Desk Reference on the Licensed Complementary and Alternative Healthcare Professionals. Our view is that practitioners may need a handy way to know about their prospective colleagues and team care members, just as they need one to know about drugs, herbs, nutrients and needles.

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Michael Traub, ND, DHANP: Florida MD association seeks to roll back ND gains
Hawaii Medical Association seeks to squash new pharmacy rights for naturopathic doctors


Michael Traub, ND, DHANP, a long-time leader of the naturopathic profession in Hawai'i shares with the Integrator that organized allopathic medicine in his home state is seeking to repeal significant portions of a modernization of naturopathic practice in 2009. States Traub: "Our bill passed nearly unanimously, but no sooner had it passed than
the Hawaii Medical Association requested several bills be introduced that would repeal these very advances."  In an article prepared for his regular column in Holistic Primary Care, Traub writes: "Furthermore, the AMA and HMA refuse to recognize the high standards of education and training of NDs, and the safety and ethical record of NDs which is far better than that of MDs and DOs." Traub makes his case based on data from existing practices of NDs in many other states where they have been practicing with significant pharmacy rights.
Comment: Time to brand the forehead of the HMA with the mark of the guild recommended in the article, this issue, on the naturopathic physicians in Oregon.
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Richard Sarnat, MD: Seeking to expand Medicaid pilot
Alternative Medicine Inc. promotes Florida Medicaid-like project in Arizona


Alternative Medicine Integration Group has sent its network of chiropractors notice that the firm is seeking to establish in Arizona an integrative pain pilot such as it has successfully operated under Florida Medicaid. The e-letter notes that co-founder Richard Sarnat, MD testified before the Arizona legislature to expand inclusion of chiropractic in that state's Medicaid program. This legislative effort is a precursor to efforts to create an integrative pain program such as the firm has managed though Florida MediPass.
Comment: The challenges in helping an integrative pilot in one state go national, such as AMI's ground-breaking integrative pain initiative in Florida, are even more challenging than one may appreciate. For instance, how about the challenges of first talking a legislature into including a profession (in this case chiropractic medicine) in Medicaid. Credit Sarnat and AMI, an Integrator sponsor, for their perseverance.

Natural Products

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Educational organization schools article writer
American Botanical Council dissembles drug-herb interaction article in Journal of the American College of Cardiology


Calling a toad an herb. Referencing Chinese products not available in the United States. Including grapefruit extract as an herb. Failure to use clarifying Latin names. Failure to clarify the appropriate herb species. These are among the damaging errors in an article on drug-herb interactions in the Journal of the American College of Cardiology
according to a release from the American Botanical Council. The conclusion of the ABC writers: "This particular article has so many flaws and errors that it is difficult to know where to begin to critically review it." The article, entitled Use of Herbal Products and Potential Interactions in Patients with Cardiovascular Diseases, was widely picked up as a news item in diverse medical media. (A perspective from Natural Standards and related blog commentary is here.
Comment: Among the chief errors in science, along with those of omission and commission, are those of utter disrespect and ignorance. This article, on a potent political-clinical issue, appears to be an exemplar in this category. Because herbs and the basket called "complementary and alternative medicine" are under-valued by many researchers in conventional medicine, one encounters an abundance of such errors such as typified early herb trials at the NIH National Center for Complementary Medicine. Credit ABC for its quick response.
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Article challenges multi-billion drub segment
Of placebos and the anti-depressant industry: Newsweek weighs in


Reader and journalist Elaine Zablocki sent note of a late February 8, 2010 Newsweek article entitled "The Depressing News About Anti-Depressants." The subhead tells the story:
"Studies suggest that the popular drugs are no more effective than a placebo. In fact, they may be worse." The focus is a confirmatory study by Irving Kirsch and others that concludes that "the lion's share of the drugs' effect comes from the fact that patients expect to be helped by them, and not from any direct chemical action on the brain, especially for anything short of very severe depression." Kirsch's Huffington Post blog on the study is called "Anti-depressants: The Emperor's New Drugs." The anti-depressant market reached $11-billion in sales in 2008.
Comment: If, as the Newsweek writer suggests, anti-depressants "are basically Tic Tacs," then one might assume that one should choose a Tic Tac with fewer adverse effects than the typical anti-depressant. Bring on the St. John's wort. Shoot, the herb may well have inherent value, too, if used appropriately.
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Exceptional database made available electronically
Stargrove and MedicineWorks announces new InteractionsGuide


Oregon-based MedicineWorks™ has announced the release of InteractionsGuide™, a web application and online database designed to support practitioners and pharmacists in evaluating interactions between prescription drugs and herbs, vitamins and minerals and managing their clinical implications. (Users have free access to the Guide until March 11, 2010.) The application allows users to access content in Herb, Nutrient and Drug Interactions: Clinical Implications and Therapeutic Strategies, reviewed here in the Integrator. The book, and the guide, are an inter-disciplinary collaborative effort by Mitchell Bebel Stargrove, ND, LAc, Dwight McKee, MD and Jonathan Treasure, MA, MNIMH, RH. The team seeks to approach the interactions issues "from an integrative perspective, rather than a 'pharmacocentric' one," according to a release.  As such, the application includes both adverse and beneficial interactions beneficial interactions, where there is a potential clinical benefit that can be obtained from combining nutrients and herbs with conventional drug therapy." MedicineWorks received "an enthusiastic response" during February when it offered free, limited access, reports Stargrove, "including lots of high profile users." He adds: "Quite satisfying." The web application culminates nearly 25 years of work led by Stargrove to provide comprehensive information to help professionals develop integrative approaches to treatment, including collaboration with other professionals. The Council for Responsible Nutrition partnered with MedicineWorks and made the InteractionsGuide available to consumers as part of 'Wise Consumer Health Month."
Comment: The distinct value of this guide is that Stargrove and his team are non-reductive and clinical in their approach. As such, they and their book are more likely to explore potential value than the typical researcher and reviewer who will typically err on the side of non-inclusion of anything new. Hopefully you have received this before March 11 and can access the Guide to review it.


Sports and Health

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Joannie Rochette: Figure skater sponsored by supplement firm
Olympic athletes sponsored by supplement companies; Ohno's supplement line, Miller's organic farm

The February 25, 2010 post at the Natural Foods Merchandiser site tells of 6 Olympic athletes who are sponsored by supplement companies (see Olympic athletes boosted by natural products industry).
The story begins: "For some Olympic athletes, winning comes naturally. Speed skaters Clara Hughes and Katherine Reutter, skiers Chris Del Bosco and Shannon Bahrke, figure skater Joannie Rochette and biathlete Lanny Barnes are all proponents of the natural products industry through sponsorships and by using different products aimed at improving their performance." Big players are COLD-FX and Bioenery Ribose, which sponsored 3 and 2 athletes, respectively. Biggest name athlete is COLD-FX's Canadian skater Joannie Rochette who took Bronze, despite her 55-year-old mother's sudden death from a heart attack after arriving in Vancouver for the games.  The larger supplement story is that record breaking medal winner Apolo Ohno's, has his own Official 8 supplement line. A related story on the Merchandiser site notes that skier Bode Miller, a double-medal winner in 2010 after supplementing his racing with perhaps too much partying in 2006, is an organic farmer and donor to sustainable agriculture.
Comment: I wrote this up merely to prolong the pleasure of connecting with the sporting artistry of the Olympics, a significant family indulgence in our home. 
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Logo org uses for chiropractic in professional football conferences
A note on the Professional Football Chiropractic Society, plus chiropractors and rugby


A notice arrived in my in-box in mid-February regarding the 4th annual meeting of the Professional Football Chiropractic Society. The goal of the organization is to offer best practices and coordination as appropriate among chiropractors serving teams in the league. According to the site, relationships between teams and chiropractors are both significant and vary widely: "
The average pro football chiropractor renders 30 to 50 treatments per week during the season. With the in-season (game-playing) duration lasting 16 weeks (not including quarterback camp, mini-camp, and pre- and post-season), 34 chiropractors conservatively give 16,320 to 27,200 adjustments to America’s superstars in just 120 days."

This followed a link sent two months earlier to a New York Times article entitled "Chiropractic College's Rugby Team is Good for Business." The article focuses on the rugby teams at Life University College of Chiropractic. The somewhat tongue in cheek feature
notes that "although rugby proponents may reject the label of most dangerous sport, players’ out-of-whack spines afford an assembly line of bodies to press on." The penultimate statement: "Between pregame player adjustments, David Ward, the sports performance director at Life, said, 'Rugby seems to be a match with chiropractic.'" The journalist's final remark was that the game which followed was a "spine-tingler."
Comment: This article might have better been paired, not with the Olympics, but with an article on the role of healing strategies in military medicine. (See "integrative practices" brief, this issue.)

Research


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New advisers named
Five new members appointed to NCCAM advisory council

Five new members have been appointed to the NIH National Center on Complementary and Alternative Medicine. The five include:
Susan Folkman, PhD, a behavioral health expert; University of Virginia and Dean of the School of Medicine Steven T. DeKosky, MD, associated with an herb trial; Gary Curhan, MD, ScD, a Harvard researcher known for his work in population epidemiology; Janet Kahn, PhD, a massage therapist and manual therapies researcher; and Adam Burke, PhD, MPH, LAc, a professor in the Department of Health Education at San Francisco State with strong public health and undergraduate education interests. The NCCAM notice is here.
Comment: The new appointees include two apparently brought on for their non-CAM research expertise (DeKosky and Curhan), one conventionally-based researcher Folkman with depth involvement with the integrative medicine field and two (Kahn and Burke) from the licensed CAM disciplines, one of whom has significant research experience. The National Advisory Council for Complementary and Alternative Medicine now has 5 of its 18 members who are from the licensed CAM fields. The Congressional mandate states that the council is to include "at least half" who are "practitioners licensed in one or more of the major systems with which the Center is concerned." NCCAM's leadership has taken the position that a licensed medical doctor meets this criterion. While I believe that the overwhelming evidence (including the make-up of the original council, on which Kahn also served) suggests a more focused reading of Congressional intent, at least three of these appointments are steps in the right direction. Interesting to see the expertise in Alzheimers (DeKosky), behavioral health (Folkman) and pain (Kahn).

Conferences

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Symposium gains status as annual community gathering
Integrative Healthcare Symposium attendance jumps 40%

One would not know that we are in a down economy from the looks of two integrative practice meetings within a month of each other. The February 25-27, 2010 Integrative Healthcare Symposium in New York City saw registration jump 31% from the meeting the prior year. Conference organizer Liz Plizga shares with the Integrator that the conference's sponsor Diversified Communications is happy with the meeting and is planning to move forward with a 2011 event. The conference has become the most significant multidisciplinary gathering place for the integrative practice fields. The total number of participants, including exhibitors, climbed to roughly 1534. Honored this year were holistic nursing pioneer Barbara Dossey, RN, PhD and integrative medicine and women's health author and clinician Christiane Northrup, MD.
Comment: The Integrative Healthcare Symposium, hosted through a private business entity, has increasingly gained stature as a place "where the integrative practice community meets." Credit Plizga, Marnie Morrione, Woody Merrell, MD and the other organizers for managing to act and feel like members of the community over the years of the evolution of the meeting from its original, poorly named "CAM EXPO" origins. (Alignment of interest note: The Symposium is an Integrator sponsor and I assist them with policy-related content.) The deliberate, multidisciplinary approach creates a unique, diverse audience. Happily, the business model seems to be working. Credit Diversified Business Communications, the developer of the conference, for its patience!
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Integrative mental health conference sells out
University of Arizona's seminal Integrative Mental Health conference maxes out


Meantime, inside of the integrative medicine field, a conference on Integrative Mental Health at the University of Arizona Center for Integrative Medicine, to be held March 22-24, 2010,  has announced that due to limits at the venue, no more registrations can be taken. Registration was over 500 by early February. The conference, the first of its kind, has both organizing and educating goals. The organizers, led by Andrew Weil, MD and Victoria Maizes, MD, MPH at the Center, promise that one outcome will be to 
assemble leaders in integrative mental health (IMH), creating a new field and framework with which to promote mental well-being." A newsletter sign-up is available on the site for those who want to be kept apprised of future events.
Comment: The big surprise about the Integrative Mental Health conference is why no one jumped on this theme before. Credit Maizes and the U Arizona team for seizing the community organizing component to their work. Hopefully future iterations will include contributions from outside the MD/RN/Psych professions.
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Ann Fonfa: Update on her consumer-focused project
Ann Fonfa's report on 3rd annual Annie Appleseed Project integrative cancer conference

Ann Fonfa is a leading consumer advocate for integrative health care nation wide. Her 501c3 charitable organization, Annie Appleseed Project has hosted a series of atypical, Evidence-based Complementary/Alternative Cancer Therapies Conferences. Each is multidisciplinary and always includes a more significant consumer presence than many conferences. The most recent gathering was on January 7, 2010. Fonda provided this report on the meeting and the labor-of-love that is her organization:
"Although it was a difficult year financially - a $10,000 grant came in December 24, 2009 for a January 7, 2010 event, the numbers held up. We did more outreach to Floridians because we understood so many out-of-state people would not be able to afford to come.  Our focus remains providing talks from many disciplines, including patients and their caregivers. We like to have talks that cover the five themes our organization promotes: healthy eating, physical movement/exercise, relaxation/de-stress, detoxify/cleanse home and self, and supplementation/herbs.  Therefore we have speakers on nutrition, yoga, qi gong and Lebed classes, mind-body-spirit connection, cleansing and safer products (both HBA and house-cleaning) and speakers on dietary supplements, Chinese and Western herbology. We also ask physicians to speak about their protocols and programs. March 3-5, 2011 will feature (we hope ) Nicholas Gonzalez, Ralph Moss, Jeanne Drisko, and many others.  As always, we serve all organic food (everyone notices and remarks on the freshness and taste), offer networking opportunities galore, and a warm and welcoming environment." 
Comment:  Despite the consumer base of the integrative practice movement, most of our meetings are only poorly connected to consumers. (I am among the guilty in helpign create meetings that are disconnected from our base.) Fonfa's work is to be honored for maintaining and promoting this connectivity.


People


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Kenneth Pelletier, PhD, MD (hc): Takes role as vice-president at ASH
Pelletier takes position as vice president with American Specialty Health


Kenneth Pelletier, PhD, MD(hc) has joined American Specialty Health (ASH) as vice president of health services. Doug Metz, DC, the firm's chief health services officer notes that Pelletier "is an exceptionally valuable team member and we are very fortunate to have his contribution to the work of ASH Health Services.” Pelletier has had a long affiliation with ASH in a consulting capacity. An ASH statement for the Integrator on the appointment notes that Pelletier "provides support to consumer health content development, product research and innovation, and provides clinical training to the management staff of the Healthyroads Health Improvement Program." He also supports ASH's research initiatives, business activities, and professional outreach. Pelletier will continue with his academic appointments and his leadership role as the director of the Corporate Health Improvement Program (CHIP. George DeVries, ASH chairman and CEO states: “I have worked with Dr. Pelletier in various capacities over the past 15-years. He is clearly an expert in his field and his new role with ASH will only enhance and broaden his contribution to our health improvement products." Pelletier, an Integrator adviser, is also author of “New Medicine” and “Best Alternative Medicine” and a clinical professor of medicine and professor of public health at both the University of Arizona School of Medicine and the University of California School of Medicine (UCSF).

Miller-Read takes over presidency, Moyle to president-elect for American Massage Therapy Association

Kathleen Miller-Read, LMP of Shoreline, Washington has taken on the presidency of the American Massage Therapy Association (AMTA). Glenath Moyle, LMT of Portland, Oregon was elected president-elect. Moyle was trained as a nurse in New Zealand has years of experience in the leadreship for massage in Oregon and on the massage Therapy Foundation. Moyle takes office on March 1, 2010, and will serve until February 28, 2011, when she takes over from Miller-Read. The AMTA is the nation's largest not-for-profit organization representing massage therapists.


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 About The Author
Resumes are useful in employment decisions. I provide this background so that you may understand what informs the work which you may employ in your own. I have been involved as an organizer-writer in the emerging fields......moreJohn Weeks
 
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