Celebrating 25 years

During the week of August 8-15, 2010 the American Association of Naturopathic Physicians celebrated its 25th Anniversary in a series of business meetings, educational sessions, social events and dancing. The title was

Zeff: Known for nature cure

Pizzorno: Known for science based natural medicine

Pizzorno, perhaps the most visible modern leader of the profession, opened with the statement that "the future of naturopathic medicine is naturopathic medicine."

Comment: I received notes that I converted into these synopses from individuals who attended. I unfortunately missed Zeff's kick-off talk due to a required meeting in Seattle. Pizzorno's talk, called simply the Foundation for Tomorrow's Medicine, was on my schedule but I missed it when I got caught in the foundations for my own health care, namely an informal qi-gong session with a half-dozen friends led by Kevin Davison, ND, LAc in the backyard of the home of Rick Marinelli, ND, LAc where I was staying for the conference. I like the focus on core principles that came through in both of their talks, and in my session. I suspect that both Zeff's and Pizzorno's views were significantly influenced by the pre-conference senior editors' retreat of the Foundations of Naturopathic Medicine Project, noted below. 

Howard: 260% revenue growth since taking over

2.  State of the organization: Shrinking budget, increasing public interest

In a general membership meeting, the AANP reported a roughly break-even 2010 budget that is 3% less than 2009, at $1,615,176 in revenues. This is 261% higher than 9 years earlier when present executive director Karen Howard took on leadership of the organization. Revenue issues were front and center as both exhibitor and attendee revenues were off projections for the conference. The prior year was portrayed by treasurer Corey Resnick, ND as "a very challenging year" in which expenses needed to be reduced by nearly $250,000 to keep from further writing down AANP's accumulated reserves. Present year income is also off. Yet meantime, the AANP website has seen a 212% increase in hits on the website, members in some 2 dozen states are pressing for licensing and new graduate realities are begging for more acceptance as primary care and inclusion in federal loan payback programs.

In a short talk to members, Tim Birdsall, ND, a current NIH NACCAM member, pointed to 3 macro changes influencing the profession's future: the depressed state of the economy; the "opening of a crack" of opportunity at the federal level via the Obama-Pelosi health reform legislation; and the demise of the Clayton College of Natural Health. (The latter has been a source of tens of thousands of mail-order "ND" degrees over the past 25 years and has funded opposition to the expansion of state licensing for naturopathic physicians beyond the current 15 states.) Birdsall's sentiment was of a sober sizing up of shifting realities.

Briggs: Plenary focused on product research

3.  Keynoter Briggs chided for not focusing on whole practice research

More than one speaker in the 20-segment research track commented on the growing interest of AANP members in research led by naturopathic doctors. Roughly 60 to 100 participants - still a fraction of those in attendance - typically chose the track. This is up from just 5-15 attendees a few short years ago. The conference included a plenary presentation from NIH National Center for Complementary and Alternative Medicine director Josephine Briggs, MD. Briggs' talk was a version of her stump speech, focusing largely on single agent herb and dietary supplements, agents that naturopathic doctors use in a mix with other approaches in their whole person-oriented practices. After Briggs finished, questioner Mona Morstein, ND, well known inside the profession for her work as clinician-administrator of the main internet discussion group for licensed NDs, challenged Briggs:

"As a naturopathic physician, I am disappointed. The methodology (in single agent trials) has nothing to do with the way I practice. Have you considered that this mechanistic model you have is all set up [to have negative outcomes]?"

Morstein: Briggs' talk missed the mark

From informal discussions post session, Morstein seems to have captured a sense of many in the room, although some found Morstein's directness ungracious.

Comment: I was surprised that Briggs' presentation didn't speak directly to the interests of these whole person-oriented practitioners. Briggs' AANP talk would have been an ideal setting for her to directly deliver her perspective on whole practice, outcomes-oriented, pragmatic research. The setting would have been particularly appropriate given the recommendations from the AANP and the naturopathic council of colleges on NCCAM's new strategic plan. Interestingly, Briggs could have spoken directly of two recent NCCAM-funded projects involving naturopathic physicians as examples. I was reminded of these by NCCAM program officer Wendy Weber, PhD, ND, also in attendance. One, on naturopathic adjunctive care for breast cancer patients is led by Leanna Standish, PhD, ND, LAc and is noted here. The other, on diabetes with Ryan Bradley, ND, MPH in leadership, is mentioned here. The presentation was a missed opportunity for cutting the alienation that many NDs feel toward NCCAM's historic focus on basic research and single agent trials. Too bad.

Healy: Soeaker for a tough House session

4. House of Delegates: Renewed strength, but work product mostly invisible

The AANP's House of Delegates, under the leadership of Helen Healy, ND and Kevin Wilson, ND, is slowly taking on a more visible role with the organization after a period of quiescence. Two new specialty societies were approved, one related to naturopathic pediatric care and the other to post-graduate residencies.  A new code of ethics was adopted provisionally while an attempted revision of the AANP's standards of naturopathic medicine position paper was sent back to committee. The AANP does not, at this time, share the position papers that the House has passed with the public. This practice was a source of significant internal debate during the House meeting. A small faction that seeks to keep them out of the public eye prevailed on a procedural issue. The House

Comment: I have been aware of the position paper issue for some years. Some in the profession fear that one or more may be used against the profession in a licensing effort. My own view is: Why take a position if it's not public? Healy, who supported making the positions public, shared a definition of position papers during the meeting: "Position papers are formal statements on an issue of importance. Through the position paper, you announce to the world your position on a particular issue or difficult problem as the foundation for proposing solutions to the issue or problem." The NDs won't move far if they are afraid to let their differences with conventional medicine, as well as their common cause, be known.

Cronin: Winning candidate pushes change

5. In battle, Michael Cronin, ND, selected as AANP president-elect: New directions?

In what was the AANP's first contested election for the presidency in the history of the organization, Michael Cronin, ND was selected as president-elect by a 60%-40% margin. Cronin, a founder of the AANP and co-founder and founding president of the Southwest College of Naturopathic Medicine, ran as a candidate for change. Cronin challenged a highly regarded candidate with multiple contributions to the profession who was selected to run by the current administration. Pre-conference, an election battle raged on a 2000+ member ND discussion forum and via email lobbying. Past-presidents and current board members publicly endorsed each of the candidates. Cronin took the position that the AANP could do more than it has done with its resources to promote new licensing and to move NDs into federal policy. He also urged a more significant focus on scientific affairs and particularly whole practice research and

Comment: Following the banquet and awards dinner of the conference, I asked attendee and Integrator columnist Michael Levin for a short synopsis of his sense of the AANP at this moment in time. After thinking for a good while, Levin responded: "Divided and unfocused." Notably, a post-conference AANP blog post on the conference written by Howard did not mention the membership's choice of Cronin as president-elect. There was scarring in the campaign. Competing views of the association's direction are on the table. Naturopathic doctors profess belief in the concept of a healing crisis. The present struggle may rightfully be a sign of professional maturation. Perhaps this moment will be one from which the AANP emerges with new strength. I hope so.

Disclosure: As a past colleague, longtime friend and presently close associate of Cronin (see #9, below), I followed developments closely. Despite respect for his opponent's considerable accomplishments, I believe Cronin's win will prove best for the organization. Vamos a ver.

CCNM's Seely: Lead researcher for the study on Canada Post employees

6.  Exceptional positive study on whole practice naturopathic care reported by Seely-Herman team

Comment: I am among those who view this research, and more like it, as the key game-changing levers needed by the naturopathic profession. As argued in the Integrator feature on the research, the methods for researching this whole practice, individualized treatment are a model for all integrative practitioners, whether integrative MDs/DOs, broad scope DCs, AOM practitioners or other multi-modal care-givers for whom reductive trials fail to capture their practices. The model provides critical information for healthcare decision makers. This would appear to be just the kind of outcomes research US Senator Tom Harkin wanted when he laid out the mandate for NIH NCCAM. That we haven't seen more of this work makes me wonder, from time to time, if there are those who simply don't want to see whole disciplines elevated. Hopefully we'll see more of this kind of research soon. Kudos to the team, and especially Seely and CCNM president Bob Bernhardt, BSc, MEd, LLM, PhD for fostering and nurturing the relationship with Canada Post and the Canadian Union of Postal Workers. 

Church: Announces Bastyr move into California

7.  Bastyr University and California NDs announce plans for California naturopathic campus: Help meet primary care needs?

Dan Church, PhD, president of Bastyr University, chose an alumni reception as the event to announce a major move by his institution. Bastyr plans to open a branch campus in California with the first classes to begin as early as fall of 2012. In a subsequent news release, Church noted:

"We are thrilled to expand the University's presence and provide prospective students greater access to Bastyr's widely acclaimed naturopathic medicine program. We are grateful to the California Naturopathic Doctors Association (CNDA), which has worked closely with us to determine the best approach to our expansion. We believe that a Bastyr University campus will benefit both the naturopathic medicine community and the health and well-being of the citizens of California."  

Barker: California ND group partners with Bastyr

The release

Comment: A move such as this has been long discussed and explored. There is great potential benefit and definite risk to the school and profession in the move. California is the source of over a third of the students to all 3 of the ND programs in the West (Phoenix, Portland and Seattle). What impact will this branch campus have on enrollments elsewhere? The bigger question regarding this move is whether starting a new program is the best gambit, given the known, struggles of current graduates of Bastyr, and elsewhere, in making a go of it once they leave school. Many finish with $150,00-$250,000 of student loan debt yet the healthcare system is not yet very interested in employing them. For 20 years, I have joked to NDs, somewhat sardonically, that they have just enough societal and governmental recognition to go into debt, just not enough to get out of it. Average debt has tripled in those 20 years. The matter is no longer one for joking. Will a California campus for Bastyr be a positive factor in changing this reality? 

Snider: Leading the Foundations process

8.  Foundations of Naturopathic Medicine Project moves forward

Since 2005, a quietly growing influence in the profession's development has been the

• Myers: "We had an intense discussion on the interpretation and articulation of the fundamentals of naturopathic medicine that reached an international consensus. In reflection you realize that history is made in such moments."

• Sensenig: "This international editors panel reaffirmed classical principles that have been observed over many millennia and guide the healing art."

• Newman-Turner: "Thanks to the technology of webcam, I was pleased to be able to participate fully in the meeting of the Senior Editors in Portland at which we were able to reach some important policy decisions regarding the style and language of the Foundations of Naturopathic Medicine textbook - decisions that will enhance the clarity and wisdom of naturopathic medicine for the future."

• Warren: "It was an awesome experience sitting around a table with individuals who have taken many leadership roles in the profession with close to 200 combined years of naturopathic medical experience. The significant outcomes of such a meeting and lively interchange will ripple on for years to come."

• Zeff: "To sit around a table with Roger Newman Turner, Stephen Myers, Don Warren, Joe Pizzorno, Jim Sensenig, Pam Snider, and Erica Kubanek [a student support person], and talk about naturopathic philosophy, its finer points and their best articulation, was perhaps the high point of my year."

• Pizzorno: "This textbook promises to be the most important book about health and healing written in the last 100 years."
  

Calabrese: NPRI will explore the way NDs practice

9.  Formation of Naturopathic Physicians Research Institute announced to "explore the way we practice"

The conference marked the kick-off of a new not-for-profit organization in the field, the Naturopathic Physicians Research Institute (NPRI). The organization was created to focus the profession on "in-practice and whole practice research" according to founding executive director

Comment, and Disclosure: As many Integrator readers will know, from 1983-1993 I worked in the leadership of the re-emergence of the naturopathic profession, first at Bastyr then as the AANP's firts paid executive director. Those were early years of renewal. One significant area of my interest in both positions was promoting research and in particular an outcomes-focused research agenda. When my friend and colleague from those years Michael Cronin, ND, the profession's new president-elect, asked me if I wanted to join him in founding a new organization to do just this, I broke all vows to self and spouse and said yes. Helping empower Calabrese and the team he has assembled (which includes Seely, Herman, Birdsall, Standish and Bradly, all noted elsewhere in this report) to excite interest among practitioners in exploring the way the practice is good volunteerism.

My postulate is that NPRI is at least a "two-fer." On one hand, NPRI promotes development of the kind of data that can shift opportunities for new graduates with their awful debt load. The Seely-Herman report, noted above, is one example. Second, this focus can potentially break down the alienation many naturopathic doctors and other integrative practitioners feel from a typical, reductive research agenda in which they cannot see their own practices reflected. I hope the naturopathic profession will step up to this, as I hope other integrative practitioners and their organizations will embrace parallel missions. Calabrese likes to remind me that the core agenda is actually about practice improvement and, as the NPRI mission states, "improving the health of patients and their communities." Got any funding ideas?

Girard: Naturopathic Physician of the Year

10.  AANP Awards: Christine Girard, Susan Delaney, Steven Bailey and Naturopathic Doctors News and Reviews

A recent blog post on the conference from Howard, the AANP executive director, noted the following physicians who were honored at the conference, together with the association's corporation of the year. The copy, except the parenthetical sections and the links, is from Howard's posting:

• Naturopathic Doctors News and Reviews Corporation of the Year, for giving voice to the entire naturopathic community in a publication known for excellence. (Razi Ann Berry is publisher and David Tallman, DC, ND editor.) 
  

• Susan Delaney, recipient of The President's Award, whose presence in her state work and her mentorship deeply reflects the principles of naturopathic medicine.

• Steven Bailey, recipient of The Vis, our award created to honor the spirit of Dr. William Mitchell, for his work as teacher and his embodiment of The Vis Medicatrix Naturae. (Bailey,  the immediate past Speaker, played a major role in revitalizing the House of Delegates.)

• Christine Girard, Physician of the Year, whose visionary work will continue to inspire for years to come, especially for the students to whom she dedicated her award. (Girard, a vice-president at Southwest College of Naturopathic Medicine, was also recently honored as the featured interviewee for Alternative Therapies in Health and Medicine.)