Forum onCAN/IM Practitioners-Natural Products Industry Relationship: 6 New Voices
Written by John Weeks
Forum on CAM/IM Practitioners-Natural Products Industry Relationship: 6 Voices
Summary: With six new voices, the Integrator conversation on the optimal relationship is enriched. Interestingly, 5 of the 6 wrote as educators. Commenting are Morgan Martin, ND, chair for natural childbirth at Bastyr University; Bill Manahan, MD, co-founder of the American Board of Holistic Medicine; James Winterstein, DC, president of the National University of Health Sciences; Sherman Cohn, JD, professor of law at Georgetown University Law Center; Lou Sportelli, DC, president of Integrator sponsor NCMIC; and an anonymous naturopathic physician. This is a rich selection of diverse perspectives.
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In the third part of this dialogue on practitioner-industry relationships, I concluded with a serious question which began with wonderment about why few were responding. This set of responses is rich! When my colleague David Matteson - who works with both industry and professional clients - and I cooked up the idea of this forum, this is what we were hoping to stimulate. Practitioners and industry are mutually dependent. They are in bed. And as one discussant says, the earlier in the bedroom dance the better for being clear and direct in trying to forge an optimal relationship.
1. Ignoring this issue is like a diabetic not checking his/her PSA
Morgan Martin, ND, LM
Morgan Martin, ND, LM, chairs the natural childbirth department at Bastyr University. Martin was last referenced here in her battle to keep her program secure at Bastyr, and to keep midwifery secure in the naturopathic profession. (The NDs are close to ending all their midwifery programs despite the profession's argument that it should be considered primary care.) Martin provides a
useful image for this natural products-practitioner dialogue, responding first to my qeustion about whether there is shame here..
"It
is an honorable issue to explore and the earlier in the bedroom dance the
better.
"I would encourage the creation of safe venues for exploration of this
and related issues. Seems like professional conferences are the natural place
to begin, since that’s where the representatives gather together. It would take
an outside entity to create the forum, as neither party would be inclined to do
so themselves. Keep writing on it. We all need it.
"What would be a good
analogy? Like… ignoring this issue is like not checking your PSA or hemoglobin
A1c when there is a family history of disorders in this area. If I don’t know
I’m becoming diabetic, I can continue to enjoy those daily desserts and not
feel bad about it."
Morgan Martin, ND, LM
Bastyr University
Comment: And one thinks of the frog in slowly boiling water ... I confess to have been a happy beneficiary of the more expensive foods one sees laid out during breaks at conferences with pharmaceutical sponsorship.
2. Important, but, I am embarrassed to say, boring to me
Bill Manahan, MD
Integrator advisor Bill Manahan, MD, is an individual who has been a mentor to me in a number of ways. It doesn't appear he's going to be providing much guidance on this topic.
"In this (latest) Integrator Blog,
you asked why there is not more attention given to the relationship
between CAM practitioners and the natural products companies. Excellent
question. Probably every reason you listed as a possibility combines to
make sure the topic stays on a back burner.
"Personally, I am
embarrassed to say, it is a topic that is boring to me. Is it an
important topic? Definitely. Are natural healers influenced by
advertising and product endorsements in the same manner as medical doctors
have been? Probably. Do CAM practitioners enjoy making a profit
from nutraceuticals they prescribe and then sell to the patients? The
practitioners that I have observed doing that certainly do enjoy making a
profit on the products they sell to their patients. Is it ethical to do
that? I suspect that is a topic for an entire other discussion.
"I certainly do not know
the answer, John, but I do appreciate you at least bringing it into our
consciousness. Thank you."
Bill Manahan, MD
Co-Founder, American Board of Holistic Medicine
Minneapolis, Minnesota
3. University policy: whatever is given must be given without strings
Jim Winterstein, DC
Jim Winterstein, DC, president of National University of Health Sciences, is a leader among chiropractors in promoting and educating students toward a broad scope practice. This includes the use of vitamins, nutrients and botanicals, much like naturopathic doctors and integrative medical doctors. He has expanded NUHS's service offering to include programs in acupuncture and Oriental medicine and in naturopathic medicine. Winterstein's vision was the focus on an interview in the Integrator last year.
"I recently had the opportunity to read the column by Michael Levin and I think
his proposal on a 'Statement of Purpose' for integrative medicine is excellent
and we should all adopt it. More than a decade ago, the chiropractic
college presidents met and developed a so called 'chiropractic paradigm' which
I signed at the time although there was much with which I did not agree. One
aspect did stand out for me and it was our 'Statement of Purpose,' which said
rather simply, 'Our purpose is to optimize human health.' Now if we add
Michael’s part we really have it with 'and reduce healthcare costs.' This should be a statement of all practitioners, all professions and all
supporting commercial enterprises.
"But, on to the second part which deals with
the relationship between professions, or institutions or practitioners and commercial
enterprises which provide service and products to those entities. Here at
(National University of Health Sciences) we have a basic policy which says 'we will accept and encourage
support from all businesses which support our mission and are inclined to be
philanthropic toward us, however whatever is given must be given without
strings.' We do see other institutions getting money we do not get, but we are
ethically bound not to follow that pathway. Our clinicians, for example, in our
clinics must be free to chose those products and services that will best serve
their patient – not the company from whom a particular product comes. We think
this is the only to keep the process clean. "All not-for-profits must solicit donations from many sources and often one
reads of attached strings. We strive not to let that happen here, and so far we
have been successful even as we see ourselves passed by on some occasions. We
sleep well, however!"
Jim Winterstein, DC, President National University of Health Sciences Lombard, Illinois
4. As a board member, I recently discussed how to convince companies to contribute ...
Sherman Cohn, JD
Sherman Cohn, JD, is a professor of law at Georgetown University. This former Watergate lawyer has held numerous positions in the leadership of acupuncture and Oriental medicine over the past two decades. He was last seen in the Integrator commenting on ???.
"You have not heard from me because I have agreed with all
that has been said. Fortunately or unfortunately, as a current member of a board
that needs money, I recently participated in a discussion of how to convince
the Natural Product Companies to contribute. And as a past officer and
member of other boards of organizations that held annual conferences, it was
clear that but for exhibitors paying a part of the freight, the conferences
could not have been held -- at least not without increasing the price of
registration significantly and thus, we thought, reducing
attendance. Unless membership is willing to support organizational
work at its true cost, without soliciting from providers who make money through
the work of the profession, some relationship is a part of necessity. "In neither the legal profession nor in the CAM/IM
professions with which I am familiar, is membership willing to bear the full
freight through a dues structure. Or, to put it another way, in none of
these professions has leadership (including myself) had the courage to raise 'dues' or registration fees to the level necessary for solicitation
of support to become unnecessary. Thus, if we are going to make a
change in the 'natural order' of things as we have experienced it, we
must start with convincing leadership to have the courage to be honest with
membership as to what it costs to run a successful organization, including
conferences, with subsidization or other support -- including ads in journals
-- and to price membership accordingly. "While we are looking at this issue, let us not forget
nonprofit and governmental sources of money. Once any cause becomes
wedded to receiving money from another source, there is potential of becoming
addicted and thus subject to strings. (Thus, the Golden Rule: 'He who has the Gold, sets the Rules!') An easy example is the
federal government. A great threat -- perhaps the greatest -- that
has come to the 'independence' of state and local government arose
when President Richard Nixon proposed, and Congress enacted, 'revenue
sharing.' At first it was free money, but once the states and
local government were addicted, strings began appearing. A great example
today is education. Once it was wholly a state area of governance.
But then the federal government began to throw money at it. The states
eagerly accepted -- only to find that the federal government began to
"regulate" by setting requirements to continue to receive the
money. This happened with higher education once the federal
government began to insure loans to students. Today, no university,
college, or other school of higher education could survive if their students do
not receive federally insured loans -- much less Pell grants. But,
more and more, the federal government, through the accreditation agencies --
which must be approved by the federal government -- puts conditions upon what
schools must do to remain accredited. "Thus, the picture is a big one and quite
complicated. To simply say that 'we,' whomever we are,
will remain completely independent of all outside influences means that 'we' already are completely financially independent, perhaps through
some great, disinterested donor (are there such people?), or through a membership
that supports the entire profession and all of its activities through
dues. If there be such an organization, I have yet to find
it. "None of these remarks take away from the very important
comments of David Matteson, Adrian Langford, and Michael Levin. Each gives
us cautionary signals. As we make our pitches for financial support, we
should do so conscious of the potential pitfalls -- many of which we recognize
that others have fallen into. That, too, is your point, John, and it is
well taken."
Sherman L. Cohn, Professor of Law
Georgetown University Law Center
5. And when Big Pharma owns the entire natural products industry?
Lou Sportelli, DC
Lou Sportelli, DC, who has been an observer of healthcare trends for decades, focuses his comments on how the relationship question may shift as Big Pharma buys into the field more.
"Maybe it is early in the
morning, maybe I am in one of my very rare cynical moments, but there is or
should I say there will be very little difference in any pharma
company. As soon as natural pharma, vitamins, etc. become an economically
viable product, the drug companies will simply buy them and incorporate them
into their business as a subsidiary or another product line. Drug
companies are simply too large and have too much money to spend, not to own the
entire industry.
"Not much different than the oil companies owning
all the alternative fuel companies. Same product line extension.
"The drug companies then will have a different
interest in education and promotion of their products to all alternative
practitioners and direct to consumer advertising making it now 'OK'
to take everything from Ester C to Centrum Z.
"If this comes as a shock to
anyone there needs to be a conference on awakening from the sound sleep
such alternative practitioners have obviously been in for the past 15 years.
"There needs to be a recognition of the value of
these products, more research into their mechanisms, and a guard against exclusivity
of use - of mechanism which would exclude alternative health care professions which
have fought the fight to get them recognized in the first place.
"Eternal vigilance."
Lou Sportelli, DC, President
NCMIC
6. Doctor Anonymous, ND Type, on all 6 questions I posed ...
Doctor Anonymous, ND, a practitioner and educator, sent these comments saying asking to remain anonymous. It is not my favorite to have someone be anonymous, but, yes, I choose to use them because they are good. The respondent took my questions one at a time. Here is the interview, based on the questions which I posed following Integrator advisor Michael Levin's column on the topic.
Integrator: I am personally intrigued by the relative
lack of interest readers have in this question, as I survey my tracking of
page views. Is it a dead
topic?
Dr. Anonymous, ND: It's a very relevant topic. Integrator: Is it just
too difficult to get out of the box? Dr. Anonymous, ND: This is an issue that I discuss occasionally with students in the context of being
rational in our
discourse. One of the major points is that it is
hypocritical to lambaste the
conventional medical world for being 'in the pockets' of
big pharma while
the natural products industry and ND education has the
same relationship,
with similar financial ties, though the absolute dollar
values are
magnitudes of order less. I give them examples of my own
experience working with educators in naturopathic, conventional medicine and other forums - one lecture sponsor asks me if he can
have stage time,
product reps sponsoring lunches, my need to refuse meetings with
salespeople, etc. I
try to teach them the value of assessing the credibility
of clinical
information. Much of this discussion comes in the context
of reading
relevant research and what the implications of funding
and sponsorship
entail. I try to teach them to recognize 'fuzzy thinking' by salespeople, pro-CAM arguments,
and anti-CAM
arguments. Integrator: Is the nature
of the relationship considered a done deal? We've made
our beds, now we're sleeping in them? Dr. Anonymous, ND: As the field
grows, and the naturopathic and other complementary healthcare schools mature and gain other funding sources, I believe that
the relationship can grow more distant. With more federal funding, at least on the research end,
better independent assessments
of product quality and efficacy can occur. Integrator: Do you think
that the clinical and educational directions of natural
medicine practitioners are not shaped in any way by
natural pharma
relationships? Dr. Anonymous, ND: They are, absolutely. Lectures are sometimes given by product
salespeople with free
lunches. I boycott attending them. The students
then are
recommending these things next week in clinic... Integrator: Is this a
holier than thou thing? No karma in (natural) pharma? Dr. Anonymous, ND:
I feel that I would be accused of being 'holier than
thou' if I discuss
these issues in public. Integrator: Is it not
okay to talk about money? Dr. Anonymous, ND: It's important to talk about money.
When I shared my concerns with administration a few years
back regarding lecture sponsorship, I was told that, while they
understand my concerns,
little pharma (natural pharma) contributed substantially to something else at the school which no one else had stepped up to fund. So my
solution has been to teach students to see
through the marketing half-truths and unsubstantiated
claims of the typical
product rep, no matter what 'credentials' they have after
their name. Integrator: Is there
shame? Are you silent because this is in the shadow? Dr. Anonymous, ND:
This is a shame in our education. I try not be silent
but I do understand the hardship of being free of these relationships, both
institutional and individual. We
don't sell supplements at a clinic where I sometimes work. We asked as local store to set up an
account with a distributor so we can send patients to
purchase supplements. This was done for ethical reasons.
There is a conflict
of interest when one is profiting from products that they
recommend. I don't
have a solution to those whose majority of incomes derive
from product
sales; but I am very thankful that I don't have to. Integrator: Or is the
subject just plain boring? Dr. Anonymous, ND:
Not boring to me. On my reading list is Marcia Angell's The Truth About
Drug Companies. I am fascinated by Adrienne
Fugh-Berman's research as well
and recommend it to others with the intention to learn
lessons and make
analogies with the natural products industry.
Comment: Now we're getting somewhere. It would be great to hear from some on the supplier/industry side, from publishers, and from some in professional association leadership, whose organizations are typically very connected to product revenues. We also haven't seen much creative thinking about how a good relationship can be forged, that involves the product companies with which we (witness my masthead) are undeniably in partnership. What role should practitioners groups play relative to product quality issues? Dream a bit here. What would you want, ideally, to see?
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