Comments on Natural Products & Practitioners: Patrick Hanaway, MD, and ND Student Esteves
Written by John Weeks
Comments on Natural Products & Practitioners: Patrick Hanaway, MD, and ND Student Esteves
Summary: The ongoing Integrator discussion of the optimal relationship between the natural products industry and the natural health and integrative practitioners who use these products offers two fine new voices here. Patrick Hanaway, MD, is the president-elect of the American Board of Integrative and Holistic Medicine and chief medical officer for Genova Diagnostics, one of the pioneeriing diagnostics firms for integrative practice. The other voice is from naturopathic medical student Vanessa Esteves, ND (cand. '08) who offers a straight solution.
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On October 16, 2007, David Matteson kicked off on Integrator discussion with an assertion that, like it or not, from the view of the consumer and elected officials, the so-called "CAM" or integrative practitioner and the natural products industry are inescapably linked. Matteson's assertion is that they have a shared destiny. If so, better off that we be conscious and smart about it. Given the problematic influence of pharmaceuticals on mainstream medicine, our conscious grappling with this is critical.
Here are two new voices - one rich with experience in conventional medical education, integrative practice leadership and corporate experience in integrative diagnostics, the other a naturopathic medical student who is about to graduate. Enjoy!
1. Genova Diagnostic's vice president and ABIHM board member Patrick Hanaway, MD
Patrick Hanaway, MD is the vice president of Genova Diagnostics. he is also a member of the board of directors and president-elect of the recently renamed American Board of Integrative Holistic Medicine.
"First of all, thank you for the conversations that you foster and, in
particular, for publishing Marty Rossman’s 'little rant' on the Heart of
Integrative (Holistic) Practice.
"On the questions and comments of your Jan 12th
blog, I wanted to offer some additional perspective, as you requested. I am in
a unique position as a practitioner [trying to maintain financial viability in
practice], a teacher [former Associate Professor @ the University of New Mexico
School of Medicine & President-elect of the American Board of Integrative
Holistic Medicine] and the Chief Medical Officer of Genova Diagnostics
[formerly Great Smokies Diagnostic Laboratory].
"During medical school and family practice residency, I was a
big proponent of limiting access to pharmaceutical reps. Clearly the effect of
sales reps driving a change in prescribing practices was effective, though not
as effective as the now ubiquitous consumer-oriented sales messages. I did and
do need to learn tools of discernment and the ability to assess clinical
validity of information. It is incumbent upon me as a teacher to help students
to understand how to read the medical literature, the natural products
literature, and any promotional material. I have learned
incredibly useful lessons from practitioners who were promoting integrative and
holistic tools for health and healing. Much of what I read and hear is ‘bunk’,
but that does not mean that I should avoid all of it and wait until it is
researched in a double-blind randomized cross-over clinical trial or reviewed
by the Cochrane Collaborative. In fact, I recognize that a new approach takes
~17 years (Office of Technology Assessment) before it is validated and
incorporated into clinical practice.
"It wasn’t until I found my patients
being persuaded to purchase the sale item from the ‘Health & Beauty’
section of our local natural foods store that I realized that my knowledge of
products and my assessment of quality required me to make these
products available to my clients/patients."
- Patrick Hanaway, MD
"In practice I initially resisted the idea of selling
nutraceutical products through my office. It wasn’t until I found my patients
being persuaded to purchase the sale item from the ‘Health & Beauty’
section of our local natural foods store that I realized that my knowledge of
products and my assessment of quality required me to make these
products available to my clients/ patients – anything less was abrogating my
responsibility as a physician. I have chosen not to make this part of my
practice a significant revenue-enhancer (being concerned about moral and
ethical considerations) and I choose to give my clients/ patients a choice in
the process.
"One colleague of mine laughed when I shared my internal angst
about this, citing that 'scheduling a follow-up visit is a conflict of
interest!' The current health care reimbursement structure does not adequately
value the time that many of us take to understand and connect with patients on
a deeper level. Expanding our business models to shift the revenue from less
valued services (visits) to more-valued products (nutraceuticals, spas, etc)
provides an opportunity for Dr. Weil’s ‘good medicine’ to be offered more
broadly. In this process we must continue to embrace the ‘Heart of Healing’
that Marty Rossman highlighted. There is no ‘either/or’ in this discussion; it
is a ‘both/and’ proposition.
"In my role as the Chief Medical Officer of Genova
Diagnostics I have an additional consideration. My job is to help identify and
bring to market new diagnostic tools to help clinicians treat patients. To me,
‘the proof is in the pudding.’ Using these new tools to understand the
importance of digestion & absorption, personalizing nutraceutical
recommendations, or assessing genomic predisposition to disease is the fruition
of this process. I have opportunities to educate health care practitioners
through many venues. Ultimately, my goal is to increase the awareness of
naturopathic, functional, holistic, whole systems, integrative, and good
approaches to healing. I found in practice that I needed this additional
education to support me as I viewed by clients/ patients through a different
lens than I learned in med school; one that focused on correcting imbalance,
rather than suppressing the symptoms of disease [i.e. ICD-9 code]. I do agree
that increasing the research foundation to make these assessments more
objective will be in the best interest of everyone involved. Until that time,
let us work together to provide the best tools for diagnosis and treatment of
our patients.
"Thus, I feel that diligence, awareness, discernment, and
honest communication are the benchmarks of this process. Thank you again, John,
for facilitating this conversation."
Patrick
Hanaway, MD, ABHM Vice President/Chief Medical Officer Genova
Diagnostics, Inc
Vanessa Esteves, BSc, ND cand.
2. Vanessa Esteves, 4th year naturopathic medical student
"This is a great topic, interesting, it has been coming up lately. And the fact
that the initial dialogue lacked some abundant response does not surprise
me. So I wanted to just give some perspective on the ND student side of
things, as I observe my school get in that bed, sleep in it...and then proceed
to make breakfast. As well I take personal interest in this topic as I
feel we can have an optimal relationship with companies. It just has to begin
with the education in our schools.
"As a student I have no academic or clinical training in making decisions on
which natural product to use. I want to see these companies dedicate
their resources to creating products that I choose to use because they
are effective, not because they are effectively marketed. The market for
supplement companies in the alternative medicine world per a business perspective is heaven! Minimal regulations needed to get the product on
the market, minimal funding necessary and influential control over the
population once you offer a satisfactory compensation package for the selling
product - especially if you aren't making that much money to begin with as a
practitioner (a whole different topic).
"As a
practitioner, I
foresee a possible
solution in the
pharmacy model."
- Vanessa Esteves,
BSc, ND (cand.)
"So my optimal relationship: I want my school to teach me the ethical
implications of creating a relationship with natural product companies. I
want to learn from the companies their specific QA procedures, research, about
raw materials and testing (all the great things Dr (Rick) Livaand the IMJ (Integrative Medicine: A Clinician's Journal) write in
their monthly journal) I want to be educated to make my decisions based
on fact not on advertisement flash. Many companies would be having
a little cry if we as a profession demanded this expose from their labs and
data, good thing we rarely ask for it (sarcasm).
"As a
practitioner I foresee a possible solution in the pharmacy model. As a
doctor I recommend to my patients Vitamin B, not a brand, my pharmacist that is
trained in the ethics, product development of natural products has stacked the
pharmacy based on quality versus compensation, I stay out of the branding
loop. As of right now I learn a great deal on nutrients that is what I
recommend to optimizing the health of my patients. I am a doctor not
pharmacist, so I think I will bring my own lunch!
