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

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

"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."

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.

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

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.

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.

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

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. 

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

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

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!

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.

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

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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