Your Comments: Aagenes/US Senator Tester, Levin/Value of NCCAM, Nicholson/Yoga's Caveat Emptor, Kaminoff/Yoga Therapy Rx. Betz/Payment Issues 

Summary: Nancy Aagenes, ND, LAc with a post-election de-brief on new friend in the US Senate for natural health care, Jon Tester (D) ... Integrator advisor Michael Levin on cost savings from dietary supplements which are not likely to be found if NIH NCCAM is ditched as NBC health reporter Bazell recommends ... Yoga therapists Susanna Nicholson in the integrative medicine program at Martha Jefferson Hospital comments on Yoga leader Kaminoff's view on outside regulators, and Kaminoff clarifies his view of Larry Payne's Yoga Rx program ... U Tennessee professor emeritus Michael Betz, PhD, weighs in on the Integrator dialogue on what insurance coverage does to CAM disciplines ...

1.   Montana ND-LAc Aagenes on John Tester's US Senate Victory

Incoming US Senator Tester with aide, Mark Aagenes, son of the comment writer Nancy Aagenes, ND, LAc

Last July my longtime friend and colleague, Nancy Aagenes, ND, LAc, emailed to let me know that her son, Mark, was working on the US Senate race of Jon Tester (D), that Tester was a good man, and had a chance to win against incumbent Conrad Burns (R).  She wondered if I might interview him, especially since Tester, an organic farmer whose family has personal, positive experience with naturopathic medical care, might prove to be a friend of good healthcare in the US Senate. Besides, we might be able to scare up a little support for his campaign.  I interviewed Tester, and wrote up an article available here. Some of you, I know, sent Tester some support. (Thank you!) And, lo and behold, Tester won. Aagenes, a long-time politico herself, sent this the Thursday morning after the election.

A Montana note for the next Blog 

"On this Thursday morning, November 9, three term incumbent US Senator Conrad Burns has not yet conceded. Those counting the votes at our Secretary of State's office say that State Senate President Jon Tester's margin of victory is beyond the number that can trigger a recount, even if Senator Burns were willing to pay for it.  Only about 800 votes beyond the number.  My assumption is that the national Republican directive to Conrad is to lay low.  With Allen's concession in Virginia, an irregularity here is the last slim wisp of a chance for the Republicans to maintain control of the US Senate. I'm told the planes in Helena are unloading DC lawyers this morning. Nonetheless the margin is large enough that Tester's victory is secure.

Tester, down on the farm

"It's been a humbling experience to participate with Senator Tester's campaign.  A growing number worked hard for the last 18 months to bring this victory to Montanans and to contribute to a Democratic majority in the US Senate.  Nonetheless, we watched a two-digit lead in September dwindle in the face of withering assault. More significantly we have to be looking in the mirror and asking what we could have done better.  And we have to be willing to find common ground with those whose opinions differ. The margin was narrow enough that no victory celebration could happen--disappointing, but perhaps appropriate.  AP declared the race for Tester at about 10:30 am Wednesday morning.

"The good news for The Integrator Blog reader is that complementary and alternative medicine policy concerns have a new ear in the US Senate. [Bold added.] Senator Tester with his flat top hair cut and big belly hanging over his belt, may not look our part. But he is the real McCoy, coming to health care issues with intelligence, uncommonly good sense and a proven track record as a coalition builder. He has indicated to us his willingness to consider participation in the CAM caucus led by Harkin and Hatch. 

"To those of you who sent money to the campaign and messages to your Montana friends, thank you. We obviously needed every possible advantage to elect him.  We are grateful for your help."

Nancy Aagenes, ND
Past President, American Association of Naturopathic Physicians

2.   Potential Cost Savings from Supplements if Bias Does Not Undermine Research Efforts

Michael Levin, Integrator editorial advisor

The challenge to NIH National Center for Complementary and Alternative Medicine ("NBC Science Correspondent Takes Editorial Clamor Against NIH NCCAM to the Popular Media," October 27, 2006; see article here) stimulated Integrator editorial advisor Michael Levin, a past executive with both natural products and pharmaceutical firms, to quantify the losses that can come if we fail to explore the cost saving potential of dietary supplements - St. John's Wort and fish oil in particular. Levin was last seen here commenting on the Quality Assurance strategy promoted by Enrico Liva, RPh, ND, in Integrative Medicine: A Clinician's Journal (see his comment here).

"I was dismayed to read this article regarding NBC's chief science and health correspondent calling for a reduction in spending research dollars on dietary supplements - ('Ignoring the failures of alternative medicine'). Thanks for sharing. (See Bazell's column here.)

"To your comment regarding 'bottom-feeders' in the supplement industry - Yes, there are bottom-feeders in the industry, and I'm not opposed to using my tax dollars to fund their jail time. Let 'em rot.

"But to put a fine economic point on Bazell's argument, let's take his example of St. John's Wort. The news story that reduced St. John's Wort consumption by 30% in the United States within 4 weeks in 2002 ran with the headline 'NIH Study: St John's Wort Ineffective for Treating Depression.' We should never lose sight of the fact that the NIH press release of 4/9/2002 stated: "St Johns Wort Ineffective for Major Depression of Moderate Severity." [Levin's bolding added.] This study wasn't about depression, per se, but rather a more severe form of the disease. Respecting therapeutic order, just as one should not treat a raging sepsis with echinacea, one should not treat major depression of moderate severity with SJW.

Beneficiaries of Bias Levin's Cost Data on St. John's Wort, and the $12.5 Billion Anti-Depressants Industry Prescriptions for Anti-Depressants: 189.9 Million (2005) Total Sales of Antidepressants: $12.5-Billion (2005) Economic Costs of Depression (1999): $44-Billion Fall in St. John's Wort Sales in 4 Weeks ater Article Shows Failures with Major Depression: 30% Estimated Savings if St. John's Wort is Used Where Indicated for Mild Depression: at Least $2-Billion/Year

"Research reviews on SJW strongly suggest that SJW is effective in the treatment of mild to moderate depression. The NLM/NIH concurs: 'Overall, the scientific evidence supports the effectiveness of St. John's wort in mild-to-moderate major depression.' (See article cited here.) It's unfortunate that the industry failed to make this important distinction clear in 2002.

"What about the numbers? In 2005, IMS reports 189.9 million prescriptions for antidepressants were dispensed, which represented $ 12.5 billion in sales (total economic costs of depression were estimated by the NDMDA to be $44 billion in 1999 - www.ndmda.org). According to friends in the pharmacy benefit management industry, patients often rotate from one drug to another every 9-12 months. Absent hard data, I conservatively assume that 10-20% of the antidepressant prescriptions are for mild forms of the disease. If true, SJW used in that population could reduce annual drug spending by up to $2 billion dollars/year. That's serious money, and could be put to better use by putting bottom-feeders in jail.

"While we're at it, we should look at another well-known & widely used supplement, omega-3 fatty acids (fish oil). This product has the distinction of also being marketed as a safe and effective prescription drug for the treatment of hypertriglyceridemia (high triglyceride levels). It's brand name is "Omacor" (www.omacorrx.com) and - no surprise here - the pharmacy acquisition cost is more than twice the retail price paid by consumers for equipotent doses. Hmmm.

"Perhaps of greater interest is the fact that this same product is approved as a drug in Canada and in the UK for the prevention of second heart attacks. The US spends $100 billion/year on 400,000 bypasses and 1 million angioplasties - I wonder what sort of cost reduction we might realize if omega-3 fatty acids were approved to prevent second heart attacks? If Mr. Bazell has his way, we'll never find out."

Michael D. Levin
Health Business Strategies
Clackamas, Oregon ( )

3.    Two on Yoga's Role: The Standard is Caveat Emptor, and Kaminoff on Larry Payne's Yoga Therapy Rx

Susannah Nicholson, CMT

The interview with Yoga leader Leslie Kaminoff drew significant interest from his active blog when I posted

"Leslie's comments are right on the mark. There can be no consistency in training between various schools of yoga which operate under quite different underlying premises.  The models for healing and transformation are completely different in the two main branches, ad. vedanta and samkhya.

"As Leslie states Yoga Alliance (YA) can't do anything tangible to guarantee consistent results for our students. The general guidelines for content and teaching in the YA 500 hour program model have been helpful as a starting point for credentialing.  But out here in the real world you can see that they are obviously insufficient to teach Yoga at a very high level required in the context of complementary medicine.  If we upgrade the program, there will be no end in sight. How far to go to create a 'good enough' therapist?  How do we give credit for the work done in total isolation ... the personal practice of the teacher, which is the platform from which all healing for the student begins ... how do we begin to measure and verify THAT?  

"Yoga therapy, like other practices of integrative medicine, will almost always hinge on a 'good fit' between teacher and student. That can't be quantified or measured.  And in Yoga as in other fields of integrative medicine, I see no alternative but the current standard 'caveat emptor.'"

Susanna Nicholson CMT
Member, Integrative Medicine,
Martha Jefferson Hospital

Leslie Kaminoff, straight-speaking Yoga leader and e-Sutra blogger

Kaminoff, whose own e-Sutra blog was born of the field of Yoga's internal dialogue over standards, offered this clarification of his view of the work of Larry Payne, PhD

"I am writing to clarify my views, lest anyone comment on the seeming conflict of my teaching in Larry Payne's Yoga RX program - based on his apparent embrace of licensing and insurance payments for Yoga Therapy. According to your Integrator post, Larry 'readily embraces a world in which programs like his exist throughout the country, where Yoga therapy is licensed, and is more widely included in the insurance system.'

"Larry is one of my oldest Yoga friends, and I owe him a deep debt of gratitude for being the first person to introduce me to the work of T.K.V. Desikachar.  I respect his pioneering work in the field of Yoga Therapy.  I also respect his right to express his own, personal perspectives, however much I may disagree with them.  The graduates of Larry's program are, of course, also free to have their own views, and to work in whatever environments - and for whom - they choose.

"It is precisely this freedom to choose that needs to be preserved. This is why I am intransigently opposed to any attempt to take these sorts of decisions out of the hands of individuals by relegating them to a professional organization that has assumed the task of representing Yoga Therapy as a singular profession. This is exactly what licensing would do, and this is why I argue against it so strenuously.

"Personally, I will never have any direct dealings with insurance carriers or government regulators - nor will I ever become the employee of a doctor or medical institution.  I will continue fight any initiatives that would compromise my right to avoid such relationships, and I will continue to voice and defend these views to leaders in our field like Larry Payne, and to the leadership of (International Association of Yoga Therapists) and the Yoga Alliance.

"Thank you John and IAYT for creating this forum in which we can discuss these vital issues."

Leslie Kamionoff, President
The Breathing Project
e-Sutra; The EWorldwide Yoga List

Note: These two comments were in response to articles written as a part of a series on The Future of Yoga Therapy, sponsored by the IAYT.

4.    Reaction to 3rd Party Payment, the CPT and the Integration of CAM

Authored by Michael Betz, PhD

"I wish to react to '3rd Party Payment, the CPT and the Integration of CAM' with Kevin Wilson, Bruce Milliman and Tino Villani. I believe the issue of integrating complementary and alternative medicine (CAM) is both cultural/legal and organizational as my 2-page comments show."

Betz' comments, on which he elaborates in his book, Enriching Health: Pathways to Complementary Therapies, include the following:

"One huge obstacle to integrating CAM is a medical mind-set and the tools of language and coding systems that reinforce this mind-set. The inability to think outside a medical model causes misuse of language and confusion about what medical care delivers, whose codes are used on insurance forms, and whether insurance will reimburse.

"A cultural mind-set arose in the early 1900s in the US with state medical practice acts establishing monopoly control by physicians. This mind-set is complicated further by misappropriating the term health. Health care is the holistic practice of enhancing physical, mental, and social well-being. Medical care is the practice of using outside agents to counter disease and restore health after disease descends.

"In America, medical care is called healthcare, i.e., about doctors and services that restore health after the onset of a disease. By referring to disease-care as healthcare, no appropriate words are left in the “well-of words” to distinguish health enhancers from disease terminators. The term health care somehow got misappropriated in describing medical or disease care services. A disease-centric model dominated America during most of the 20th century."

Betz continues with reference to the development of CPTs, and the ABC Codes developed by Melinna Giannini and Alternative Link. he notes a model for care proposed by Medimerge, which to his mind exemplifies a more health orientation. Betz concludes:

"The above points reinforce John Weeks' assertion that a clinical orientation to wellness is difficult, especially for those who think within a disease-centric model. And as Weeks wrote back in Sept 9/06, 'In classic, strategic war terms, research is one of the narrows in integration’s river. Control the narrows and you control the commerce that flows up and down the river ... Control the narrows and you [control] whether single [therapeutic] agents advance or whole practices' [which include both health promotion and emergency medicine]. Thank you for your good work in informing us on this important 'cultural movement'."

Michael Betz, PhD, Professor Emeritus
University of Tennessee
Author, Enriching Health: Pathways to Complementary Therapies