Your Comments: Time Column, CTCA's Model,  CHP's Payments, NYT on Supps and a Thoughtful Look at LAc $$, plus ...

Summary:  The coverage of the Time magazine blast against integrative medicine doctors provoked responses from Bill Manahan, MD, Gary Sandman and an anonymous health system leader ... Naturopathic physician Julie Chinnock, ND questions thoroughness of the reporting in the article on CAM network firm Complementary Healthcare Plans ... Vic Sierpina, MD wonders if the oncologists with CTCA view the care as being as integrated as was presented in the Integrator story ... Michael Levin tilts the windmill of journalist integrity of the New York Times on dietary supplements, again ...  Chris Foley, MD, with a pithy comment on 3rd party payment ... and Laura Ocker, LAc, presents a very thoughtful, detailed look at payment issues in acupuncture practice.

"Scott Haig has such a tiny piece of reality in his article in Time Magazine that he makes George W. Bush seem quite honest and realistic regarding his view of how the war in Iraq is going."

"Excellent coverage. It is interesting to compare this kind of economic 'entrepreneuring' (in integrative medicine) with the movement to MD-owned free-standing surgery centers. The latter is much more rampant, with documented risks to patients. So much of it is about financial profits!"

Gary Sandman: time to look inside

Gary Sandman, a long-time entrepreneur himself in the integrative medicine space, had a different take altogether on the article, wondering if we are not calling this negativity to ourselves by failing to look within at how we are configuring the world. Sandman has headed an integrated provider network, mounted conferences and now is founder and CEO of Signature Supplements.

"It sounds like we as a whole – i.e. integrative practitioners and administrators  - are not following our own belief system – according to the popular The Secret video, and using it as a representation of our belief system, where by the universe responds in kind according to our own beliefs. If we keep getting these negative NYT and other media responses we are, at some level co-creating this negative response.

"Isn’t time we applied our own remedies and spent some time inside to examine and heal our 'lack consciousness' 'arrogance' and get over our quest to be accepted by 'Dad' or the authorities of modern medicine who are operating with a completely different belief system and health system than we are providing. At the sake of getting too metaphysical - life is a feedback loop – it is time we looked inside and stopped blaming the 'enemy' and instead acknowledging our own 'stuff' that is showing up in the press and from medicine’s authorities as a reflection of our own insecurities and poverty consciousness.

"Let’s us use our tools to heal ourselves. I know personally that 20 years ago I felt the arrogance of medical doctors as I promoted and educated doctors and the public on alternative medicine. It wasn’t until I removed my own arrogance about my beliefs that I have never met a arrogant doctor again in my work. Change begins within. It is time for personal change."

Gary Sandman, CEO
Signature Supplements

Vic Sierpina, MD: Are CTCA's oncologists bought in?

The Integrator article on the state of Washington's denial of a certificate of need to Cancer Treatment Centers of America provoked a series of responses and a discussion of what we mean when we say "integration." (See

"Great edition. While I am equally appalled by the Washington ruling, my colleagues who have actually visited CTCA found it not to be all that integrated.  Oncologists are drawn to work there by top end equipment and facilities. Naturopathic and interdisciplinary teams seemed to be an 'add-on' largely ignored by the oncologists though very prominent in marketing and in public appeal.

"I was very impressed by Tim Birdsall, ND who presented at the AHMA/AHNA (American Holistic Medical Association/American Holistic Nurses Association) last year on CTCA. I wrote up some of their work in the Houston Medical Journal.

"It may, in sum, be a matter of more direct competition with the (Fred Hutchinson) and other established cancer treatment programs in Washington and the ruling covered by the supposed opposition to an integrative approach.

"I could be mistaken, of course. But since they seem more mainstream than they really are, perhaps opposition has to do with their marketing."

"Finally, I haven't actually visited their center but discussed it with a couple very credible colleagues who did and who left with that impression. As I said, Birdsall was very impressive in presentation but the question remains if the naturopathic/integrative vision is truly embraced by their oncologists. You should invite Tim's response." 

Victor S. Sierpina, MD, ABFM, ABHM
WD and Laura Nell Nicholson Family Professor in Integrative Medicine
Professor, Family Medicine
University of Texas Medical Branch

"Thanks for the blog.

"Was there a reason why you didn't inquire with CHP about practitioner reimbursement fees and contracts? In addition to access to services by patients, this area may be one of the greatest financial challenges/decisions to a "CAM" practitioner.

"I am unaware of the actual fees provided for reimbursement, but the buzz from most ND's I know is that accepting CHP and even more so with American Specialty Health is not worth it in the end because of the pitiful amount of reimbursement provided.  It may get people in the door (which is why alot of new docs are enticed by the contract), but in the end it can actually cost you to see them.

"I do not contract with CHP, but if this is true, companies like CHP are able to get a free ride on the 'CAM' propaganda train without any true benefit to the providers who make up their network. These issues of disparity in provider (especially PCP) reimbursement need to be addressed if these professions are to survive."

Julie Chinnock, ND
Oregon

Levin: correcting the correction

The Integrator has been following advisor Michael Levin's efforts to get the New York Times to admit to the extent of error in the article written by its own journalist Dan Hurley, based on his supplement bashing book (

"Dear Sirs:

"With all due respect, your correction did not include two important facts essential to the risk assessment associated with vitamins, minerals, herbals (dietary supplements). While you correctly reported that the database reports "exposures" and that all exposures do not result in an adverse outcome, you omitted these facts which are essential in presenting an objective, unbiased view of the data:

1) The database distinguishes between "intentional" and "unintentional" exposures. This is an important distinction! Intentional exposures consist of intentional suicide, intentional abuse, and intentional for unknown reasons (pages 810-811). 12.6% of all human exposures were "intentional acts" (p. 811). 89.6% of all adolescent deaths and 76.6% of all adult deaths were "intentional".

2) All deaths associated with vitamins/minerals/supplements (table 21) were intentional acts, all of which included multiple agents (eg, drugs).

"Absent these important facts, it is impossible for any reader to reach an informed conclusion regarding supplement safety within the context of appropriate use (ie, as directed or prescribed). I would hope that you will agree to publish yet one more clarification in order to give your readers the opportunity to make a truly informed decision.

"To underscore this point, I would hope that we never see an article published in the NYT based on the CDC report of 3,306 unintentional drownings during 2003, suggesting that water is more dangerous than dietary supplements." (bold added)

Michael D. Levin
Clackamas, Oregon

"Hey John…Just a note to remind you that 3rd parties have no place in CAM. Insurance is for acute and severe medicine (which can be protocoled and templated). The rest should be between 2 consenting adults or their representatives, not 3."

Chris Foley, MD
Minnesota Natural Medicine

"Wow! I am so glad that you all have started this conversation about pay rates of licensed acupuncturists working in the public health arena (or any arena). I look forward to continued discussion and debate.

"I love my work as a licensed acupuncturist with Virginia Garcia Memorial Health Center in Hillsboro, Oregon. It is amazing to me to see the results that we can get with Chinese medicine.  I love taking a moment to pause and look around at the relaxed faces of the clients in my group treatment room. I wish I could describe them to you, paint an image for you of the intensely beautiful mosaic of culture, ethnicity, and life experiences of the families and individuals who find relief in our acupuncture clinic. I have also valued my work as an on-call L.Ac. at Portland Alternative Health Center, Hooper Detox, and Washington County Community Corrections Center. Working in the field of public health, providing care with acupuncture and Oriental medicine, is an extraordinarily gratifying way to make a living.

"I am a 37 year-old mother of two children and a licensed acupuncturist, residing in the Portland Metropolitan area. I have a few observations based on personal experience:

"On student loans:

"If you ignore your student loans for several years, they do not go away ... " ... buying lottery tickets is usually not a practical solution."

If you ignore your student loans for several years, they do not go away. In fact, they increase quite a bit. By purchasing several lottery tickets every week, you can nicely maintain the fantasy of being able to take care of your student loans with one sizable payment. However, it is usually not a practical solution.

"On living expenses:

If you work part time as a licensed acupuncturist at a public health clinic and you are not eligible for benefits, and if you do not have health insurance coverage through your spouse or partner, and if you make just enough money as a family to not qualify for public assistance, you might find yourself pregnant and uninsured.

"On pay rates of health care professionals:

In some cases (I wonder how many), RNs with a 4-year degree earn more money than licensed acupuncturists. Acupuncturists are required to have a Master’s level education in order to practice. I’m not saying that L.Ac.s are more valuable than RNs. That’s just stupid. Everyone knows that RNs are phenomenal and the backbone of most health institutions. But L.Ac.s do pay quite a bit more for their education, and somewhere along the line, this has to get paid off. Consider the level of education and responsibility required to work as a nurse practitioner or physician assistant. Where should the pay rate of a licensed acupuncturist fall?

A.    Less than an RN?
B.    Somewhere between that of an RN and an Nurse Practitioner or Physician Assistant?

C.    Equal to or greater than a Nurse Practitioner or Physician Assistant?

"On the number of L.Ac.s practicing in the Portland Metropolitan area:

"Pay the acupuncturist a minimal amount, don't offer benefits, and charge  the clients a minimal amount. That's what makes the equation work in too many cases. "Unfortunately, the result is devaluing our profession."

Tonight I discovered more than 50 Licensed Acupuncturists are in private practice within 5 miles of my home in S.E. Portland (according to membership data from the Oregon Acupuncture Association website). So, honestly, we Portland acupuncturists are relieved to be earning anything for our services. But can we really build the viability of our profession by devaluing our services? And can we adequately support ourselves and our families?

"On public health and TCM:

I believe that working in public health is an honorable thing to do, not to mention immensely rewarding. I would like to see a much greater spectrum of our population have access to quality health care, including regular acupuncture treatments. It is easy to argue that keeping the pay rate low for acupuncturists in the public health arena makes it possible to serve more people. Pay the acupuncturists a minimal amount (somewhere between $16 and $23), don't offer benefits, and charge the clients a minimal amount. That's what makes the equation work in too many cases. Unfortunately, the result is devaluing our profession. There’s got to be a better answer. What is it?"

Laura Ocker, LAc
Portland, Oregon