Your Forum: Comments from an MD, DC, 2 NDs, Holistic Nurse, Yoga Teacher and 2 Business Types

Summary: Karen Lawson, MD, on the value of functional medicine for opening conventional MDs to integrative practice; educator Beth Wooten Pimental, ND, on  educational issues begged by the column by Marty Rossman, MD; Linda Bark, RN, notes the absence of integral nursing in the upcoming IHPM employer conference; James Winterstein, DC, gives kudos to acupuncture physician James Saylor, AP, for comments on patient -focused care; Jacob Schor, ND, FABNO on a previous reference of Winterstein to what is properly called the "whole Megillah;" CAM entrepreneur Taylor Walsh fills out the Integrator Top 10 with an excellent post; and then, non-typical Integrator fare from adviser Michael Levin and Jessica Noggle, PhD, RYT regarding emerging research in contamination of our water supply.

Karen Lawson, MD: functional medicine as bridge

1.    Karen Lawson, MD: The bridging role of functional medicine for conventional MDs

"I just finished reading John Weeks’ most recent newsletter with the Expanding the Family: More Comments of Holistic MDs and Naturopathic Leaders on Co-Convening in 2008 (February 24, 2008). It was great to read all of the comments.

"Additionally, I just returned from spending the week at the latest Institute for Functional Medicine (IFM) conference in LA.  Patrick Hannaway [MD] and Bethany Hays [MD] were among the excellent faculty members. While I have been resistant to Functional Medicine for years (as a recovering biochemist) I must admit to being pleasantly surprised by the heart and wholeness demonstrated in both their institutional philosophy and in the individual’s presentations. 

	"It was a revelation to me that functional medicine may be just the stepping stone, being very physical and scientific, that may allow volumes of physicians to begin to step away from the reductionistic paradigm." - Lawson

"It also was a revelation to me that functional medicine may be just the stepping stone, being very physical and scientific, that may allow volumes of physicians to begin to step away from the diagnosis-based, reductionistic paradigm that continues to be the basis for conventional medical training and practice.  It is a relatively easy step into a practice that naturally lends itself to interdisciplinary, integrative practice styles—and ultimately holism. 

"Given the recent move of the Board [of the American Board of Holistic Medicine] to rename [it as American Board of Integrative Holistic Medicine-ABIHM] which I think is a good one, and with Patrick [Hannaway] as the Pres. Elect of ABIHM, I think this would be really good time to include IFM in the organizations that AHMA is building bridges with.  The leaders of IFM, David Jones [MD] and Dan Lucazer [ND] would, I believe, be very interested.  It also is really another population of docs who, in the majority, have not heard of the AHMA at all."

Karen Lawson, MD
Center for Spirituality and Health
University of Minnesota School of Medicine

Beth Wootne Pimentel, ND: implications for quality integrative education

2.    Beth Wooten Pimentel, ND: Rossman suggests direction in practitioner education

"A wise doctor once told me that the healing interaction between a doctor and patient has very little to do with the letters behind your name and everything to do with who you are as a person.  Dr. Rossman captures this concept beautifully when he describes the healing effect deriving from 'the interacting belief systems of practitioner and patient, which is held, molded and supported by the  nature of their relationship on both human and archetypal levels.' As I read his comments, I found myself nodding in agreement and, yet, all the while I was thinking, as you reflected, that if this is 'real, human, integrative health care,' then how do we translate these concepts into the education and training of integrative health practitioners?  This question has dogged me for years, first as a naturopathic/midwifery student at Bastyr [University] and, currently, as an instructor at University of Bridgeport. 

	"The current educational paradigm does not support the kind of experiential learning that may be more conducive to integrative medicine." - Pimentel

"While I by no means have the answer, I do have a couple of thoughts on the matter.  The first is that the current educational paradigm does not support the kind of experiential learning that may be more conducive to integrative medicine. Case-based learning and other interactive teaching methods take time – both on the part of the student and instructors – something which may not be allowed for in the program.  And yet, I think these are important strategies to bring into the classroom. Wellness, preventative, and other outpatient-based practices do not necessarily provide the structure within which 'rounds' can be conducted - a key element of conventional medical education. A radical shift is needed, but where to begin? 

"Secondly, there is little, if any, attention paid to practitioner preparation - supporting the processes of refinement, self-inquiry, and becoming rooted in the medicine. While we excel, to varying degrees, in teaching the material and modalities involved in the practice of integrative medicine, we neglect the vessel through which the medicine will be practiced. The more we foster the grounded-ness of the practitioner, the more the practitioner is able to hold the space for the patient’s innate healing abilities. Along the same lines, I recently read an article about teaching children how to play chess.  The instructor suggested having the players sit on their hands to minimize the chances of making impulsive moves. This is a no-brainer for midwives who know how to sit on their hands and patiently wait for nature’s wisdom to unveil her mysteries.  Just because we have the tools doesn’t mean that we have to use them.  The healing effect is there in spades if we can bring ourselves to be still, be present, and let be. 

"Thanks for opening the dialogue - I eagerly await the wisdom of your readers."

Beth Wotton Pimentel, ND
University of Bridgeport, Naturopathic Medicine
Bridgeport, Connecticut

Linda Bark, RN: integral coaching

3.    Linda Bark, RN: Why is integral coaching not in the employer conference?

"Where is holistic/integral coaching in your conference? (IHPM Conference to Cross-Fertilize Employer and Integrative Health Care: March 31-April 2, Orlando, February 4, 2008). Companies have been and are hiring coaches to work with those most at risk for disease and having some success.   Kaiser's only slogan now is "Thrive" and they have health educators providing services at most of their clinics.  Coaching for prevention and for high risk would seem like a key intervention in the type of health care that you are exploring."

Linda Bark, RN
AsOne Coaching Institute

James Wintrestein, DC

4.    James Winterstein, DC: "Take care of your patients and they'll take care of you"

"What a breath of fresh air reading what [acupuncturist] James Saylor has to say about caring for patients:

'Our thing in our office is, get the patient better, don't worry about the money. Most of these people are considerably different than our usual, cash patients. They wouldn't have an opportunity to see us if it weren't for the program. I came from a family that didn't have access to any of this. I never turn away a client that can't pay me." [Then he corrected himself]: "I only would if the patient was non-compliant and didn't show up."

"If all healers returned to this kind of thinking, the world would be a different place. Additionally, the healers would be well taken care of in the process. It is a basic principle that we used to understand, but which seems lost by many today.

"I spoke recently with an alumnus (chiropractic physician) of National University from the 50s. He practices in Kentucky in a small town of 450 people. He has been there for 48 years and has provided over 400,000 patient visits. He still charges a simple office call which has finally reached the price of $20.00. He has, over the years accumulated significant land which he intends to leave in the hands of a major university for their agricultural program. His concern continues to be for the people he serves and is setting up a not-for-profit foundation to assure that his clinic remains viable after his passing.

"Take care of your patients and they will take care of you."

Jim Winterstein, DC, President
National University of Health Sciences
Lombard, Illinois

Michael Levin

5.    Jacob Schor, ND, FABNO: a little education on the "whole Megillah"

Some time back, Winterstein, who wrote the prior comment, above, added his perspective on a prior posting on whether or not naturopathic physicians should speak of their academic training as "medical school."  This stimulated one of his fellow commentators, Jacob Schor, ND, FABNO, to give many of us a little education. Schor also writes an excellent, thoughtful newsletter, available on his practice site.

"These 'blogs' of yours are just getting more and more entertaining. 
 
"Since this entire line of discussion is about semantics, I had to laugh though at the comment of the eminent Dr. Winterstein who suggested that: 'NDs should go for the 'whole magilla' and brook no interference from anyone. They are part of the medical profession just as we are. We just function in 'adjectively defined' areas that are different than allopathy.'
 
"As much as I appreciate the sentiment, the good doctor is apparently mixing up his tamales with his megillahs. The later term comes from the Hebrew Megillah, shortened to the Yiddish megile, referring to a scroll, usually the scroll of the story of Esther.  The story or scroll is read on the holiday of Purim.  It's a long story. Once the 'whole Magillah' is read, the real party begins. In slang, the whole magillah, refers to the whole story.  Getting the whole magillah is hearing the whole story, sometimes in more detail than one needs.
 
"A tamale on the other hand is a traditional Mexican food made by wrapping a corn meal mush made from ground corn and lime, some filling (typically spiced meat) in a dried corn husk and then steaming the stuff. Or perhaps it's the whole Burrito.  All nine yards of it.
 
"Keep up the entertaining and good work."

Jacob Schor, ND, FABNO
Denver Naturopathic Clinic
Denver, Colorado

Taylor Walsh nominates Health 2.0

6.    Walsh provides #10 to the Integrator Top 10, plus Oprah, an Uncle and a flattering nomination

"The web presence of alternative and integrative health will emerge from the depths of the best known health portals like WebMD and EverydayHealth to amplify what we've seen in recent months with the Oprah/Oz collaboration that John noted and last week's cover story in US News & World Report. (And about 10 minutes ago on NBC I watched Al Roker observe an Ayurvedic treatment.)  
"The health-web-consumer dynamic is coalescing into what is being called 'Health 2.0,' and is sporting the clever tag line 'User Generated Healthcare' (a borrowing from 'user generated content' which defines all Web 2.0 sites like FaceBook). At the moment this emerging community and its agenda include little explicit reference to integrative health, but this is a cohort of webified practitioners who love to blow up - in a positive way - recalcitrant industries. http://www.health2con.com/sandiego.html 

"It would be worthwhile for the CAM/IM community to lash itself to the Health 2.0 crowd, many of whose people have alternativity in their DNA, in order to strengthen the bond between practitioners and patient/client consumers."

"Some great stuff this past issue, especially the Integrator Top 10, which allows greater exposure of your style and personality - always a good thing in my humble opinion. But then I'm prejudiced."

Thomas Roland, MD
Oxnard, California

"The National Parks Services recently published the results from a 6 year, multi-agency study of airborne contaminants found bioaccumulating in western US national parks. It was initiated to determine risk to ecosystems and food webs. The press release and access to the final report (>25 megs) can be found here. 

"Of 100 persistent organic pollutants (POPs) studied, 70 were found to be widely distributed. Mercury, dieldrin and DDT (neurotoxins, reproductive toxins and immune suppressants) were found even in the most remote places studied. Mercury concentrations found in fish in Alaska’s Noastak National Preserve were above the EPA human health threshold for consumption. Dieldrin concentrations in Rocky Mountain, Sequoia, Kings Canyon and Glacier exceeded the health threshold for recreational fishermen (i.e, 2.3 meals/month). Average DDT concentrations in fish exceeded the human risk threshold for subsistence fishers at Sequoia, Kings Canyon and at one lake in Glacier National Park.

	"This report details widespread bioaccumulation of these toxins in our 'pristine' wilderness areas." - Levin

"This report details widespread bioaccumulation of these toxins in our 'pristine' wilderness areas. What about our cities? What about our food supply? To what degree are these persistent toxins impacting public health?

"Mindful practitioners of integrative medicine have been aware of these environmental challenges for years. Yet, this remains a generally under-recognized issue on Main Street, USA. In my little corner of the universe, this report underscores the need for rigorous inspection of dietary ingredients used to manufacture dietary supplements.

"Consider: Dieldrin was banned from use in the US in 1987. DDT was banned in 1972 but was still produced and used in China, as of 2004. Why? 'China can produce some alternatives to POPs but farmers and businesses are reluctant to use them because the prices are too high' said Zhang Qingfeng, an official with China’s State Environmental Protection Administration (SEPA).

"Let the buyer, and wilderness fishermen, beware."

Michael D. Levin, Founder
Health Business Strategies
Clackamas, OR  97015

"I thought you might find [this news story]an interesting reason to garner support for the CAM movement. Big Pharma may not like it, but I'm sure they're already against CAM from the beginning! 

"In grad school I worked at a USGS center that participated (still participates) in the fish collections and analyses at Lake Mead, and I'm a member of SETAC (the prof. society referenced in the article) where there are increasing numbers of studies reported on environmental effects of pharmaceuticals.  I also know the group who conducted the ethinyl estradiol lake experiment, they do top-notch research for Environment Canada.  I should caution that the work on pharmaceuticals is relatively new, so the puzzle is still being pieced together."

Jessica J. Noggle, PhD, RYT