Guest Column: David Matteson on the Shared Destiny of Integrative Medicine and the Natural Products Industry

Summary: How connected is the growing natural products industry and the industry that is represented by the vast expansion of complementary, alternative, integrative and holistic practitioners? Does the public separate the two? Do elected officials? Are their destinies intertwined? What is the optimal relationship between these two entities? David Matteson, a consultant and strategic thinker with deep connections in both these universes, has given a good deal of thought to the "parallel play" of these two natural health care forces. His guest column opens an Integrator dialogue on the optimal relationship between these two entities.

David Matteson, MPM, MURP, MS

Parallel Play or a Potent Alliance?
Alternative Medicine Practitioners and the Natural Products Industry are Stronger Together

 - David Matteson, MPM, MURP, MS

"The Natural Products Industry (NPI) and the complementary and alternative medicine (CAM) industry are each in the midst of a major transformation. Their ability to learn how to 'play' together may be crucial to how well these industries grow and succeed over the next few years. 

"There is a natural relationship between these two industries. Many policy makers and many consumers see them as flip sides of the same coin. Yet, these two industries have not really acknowledged their interconnectedness, let alone taken active steps to collaborate on their common political and market interests.

	"There is a natural relationship between these two industries. Many policy makers and many consumers see them as flip sides of the same coin. "Yet, these two industries have not really acknowledged their interconnectedness, let alone taken active steps to collaborate on their common political and market interests." - David Matteson

"If you have ever observed two toddlers engaged in something called 'parallel play,' you would have noticed how the way they interact is quite different than how two older children might play together. Each baby knows that the other one is there. They play side-by-side, but they never directly interact. And yet, each of their behaviors is influenced by the other. They are in relationship.

"The relationship between CAM and the NPI can be likened to the parallel play of two toddlers. They both know the other one is there, and they 'play' side-by-side. But they never really interact. And yet, each of their behaviors is influenced by the other.

"Each of these industries has emerged and evolved in adjacent market spaces over the past 30 years. Each has benefited from increasing public demand and increasing acceptance from regulators over that period.  Consumers in one industry tend to be consumers in the other. There has been a version of parallel play going on.  Each industry tended to think of itself as novel and independent, yet the success of one industry certainly impacts the other.

"From outside each of these industries no one paid much attention, until in the early 1990s data about the economic impact and consumer use began to cause people to take notice.  When people did notice, they tended to line up for or against some vague notion of 'natural health.'  Policy makers, thought leaders, and regulators supporting one industry have tended to also be supportive of the other. 

"As each has matured and market penetration has increased, these two industries have begun to experience new market and regulatory pressures. Many of these pressures come naturally as part of the maturing of any business cycle.  Each is experiencing increased regulatory scrutiny, increased competition from big players in the traditional health and nutrition sectors, increasing sophistication from oppositional view points, and increasing demands for validation and accountability.

"Like most successful ventures, each of these industries is now moving into a business cycle where it has to defend its success as well as advance it.   Traditional medicine is challenging CAM’s advocacy for a place in healthcare reform.  Big food and big pharma are circling the NPI sniffing out opportunities to control the NPI to their market advantage. Policy makers and regulators are asserting stronger scrutiny to reign in the mavericks and clean up shoddy practices within each industry.

"What happens to one industry very much affects the other, and vice-versa. These two industries sit side by side. The public sees them as part of the same family. - Matteson

"They might see themselves as separate but they aren't separate in the realm of perception by outside audiences. What happens to one industry very much affects the other, and vice-versa. These two industries sit side by side.  The public sees them as part of the same family. And the public does this despite the fact that these are two siblings of the same consumer movement have paid little attention to each other up to this point.

"It is too simplistic to say that these groups don’t interact. But their interaction has been quite limited.  In my experience, NPI companies are more conscious of their relationship with CAM practitioners than the other way around.  NPI companies exhibit at CAM convention. They are often members of CAM associations. They support naturopathic doctors and acupuncturists and massage therapists and integrative physicians on various issues, such as support for state licensing and efforts to protect the right of medical doctors to integrative practice.

"This action of natural product companies is linked to their vested marketing interest in the practitioners and their patients. Practitioners buy or recommend natural products. 

"In contrast, practitioners seem to have difficulty seeing natural product companies as something related to them. Even though most CAM conventions have exhibit halls filled with natural product companies, many practitioners tend to view these companies as no more than vendors trying to sell them something that they don’t necessarily want or need. They do not relate to natural products companies as partners in the success of CAM or as entities whose actions could have negative consequences for them.

"Interaction and collaboration between the two industries has been even less on the legislative and public policy front. Recent governmental attention on natural health, such as the White House Commission on Complementary and Alternative Medicine Policy, the FDA’s recent CAM Guidance document, and the recent current Good Manufacturing Processes, to name a few, has lumped discussions of the two industries into the same conversation. Yet, the two industries have consistently failed to coordinate strategies and testimony.

	"If there could be a tighter definition or declaration of the synergy between the two, perhaps both CAM an NPI can have a greater voice in what they become." - Matteson

"Perhaps necessity is driving these two industries into working more closely together.  One notable effort is the recent addition of the American Association of Naturopathic Physicians (AANP) to the board for the Coalition to Preserve DSHEA (the Dietary Supplement Health and Education Act of 1994).  This landmark piece of legislation ensures broad consumer access and choice to supplements, vitamins, herbs, and botanicals, which is critical to the successful practice of several CAM professions.  Not only would consumers potentially have difficulty purchasing products as part of a natural medicine regime, but tightening the regulation might be problematic for practitioners who make revenue by selling products out of their clinics. The AANP is the first practitioner group to openly support NPI in its legislative efforts.

"Likewise, restriction of access and choice to CAM services could adversely affect the NPI.  Consider the Scope of Practice Partnership (SOPP), a coalition that the American Medical Association announced in April of 2006 to assist various physician organizations facing scope of practice 'battles.' SOPP basically advocates that MD physician organizations should determine what is best for other licensed healthcare professionals. SOPP is considered by many CAM providers to be divisive because it will likely impede patient access to CAM practitioners. A portion of the campaign directly seeks to limit licensing of naturopathic physicians in new states. Is it mere coincidence that this happened right after the naturopathic profession passed a licensing law in California over the objections of the California Medical Association? Some find this to be further evidence that the AMA is on a mission to discredit CAM and limit its expansion.  If patients have to depend on conventional medicine alone to educate them about alternative medicine and natural products, there is little doubt that this will also impact NPI.

"Perhaps the greatest question is how well each of these industries succeed in sustaining their growth and securing a place on the changing landscape of health and healthcare.  Natural products seem to be caught in between being defined by big food or big pharma. CAM hasn’t found a successful way to collectively define itself, so insurance companies and regulators are defining what their professions are and how are they regulated. If there could be a tighter definition or declaration of the synergy between the two, perhaps both CAM an NPI can have a greater voice in what they become. They are a continuum from service to product. This could be used for leverage, if they could only learn to play together."