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The Integrator Blog. News, Reports and Networking for the Business, Education, Policy and Practice of Integrative Medicine, CAM and Integrated Health Care. - Your Comments: 16 on Integrator Themes - 2 RNs, LAc, 4 DCs, 2 MDs, an MPH, a Lobbyist, plus
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Your Comments: 16 on Integrator Themes - 2 RNs, LAc, 4 DCs, 2 MDs, an MPH, a Lobbyist, plus PDF Print E-mail
Written by John Weeks   

Your Comments: 16 on Integrator Themes - 2 RNs, LAc, 4 DCs, 2 MDs, an MPH, a Lobbyist, plus

Summary: This is a catch-up on some comments sent recently from Drisko, Quinn, Foley, Korn, Sportelli, Whedon, Zabik, Hoagland, Clay, Matteson, Bark, Pannozzi and Patel. The themes are the IOM coverage, NCCAM on use, research focus and NCCAM defensiveness, advance of certified homeopaths, Gawande's influential New Yorker article on how economic structure's create use patterns, the practitioner-industry relationship in integrative medicine, the value of a DC lobby-day experience, homeopathy in Wikipedia and more. Enjoy these voices of 2 researchers, 3 DCs, 2 RNs, a community LAc, 2 MDs, 3 organization leaders, a student and a lobbyist.
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for inclusion in a future Integrator.

Apologies to respondents and readers: I have lately dropped the ball on posting general "letters-to-the-editor," the old-fashioned from of commentary which is continued here on this newsletter mis-named a "blog." This collection is a smorgasbord catch-up of various comments in recent months. I'll get back on top of this and look forward to your commentary.

Seeking a place for certified homeopaths in healthcare reform
1.  Homeopathy leader on efforts to have "certified practitioners" in federal healthcare legislation

National Center for Homeopathy has stepped up its advocacy for homeopathic practitioners under the leadership of its president, Nancy Gahles, DC, CCH, RSHom (NA). An Integrator article on efforts of the Integrated Healthcare Policy Consortium to insert inclusionary language for licensed complementary healthcare practitioners stimulated a phone call, and this follow-up note.
"Thank you for the time you shared with Nancy Gahles, president of the National Center for Homeopathy, in her and our quest for the inclusion of homeopathy, a 200+ system of medicine in forming health care plans.  (I've used it with our family of six for more than 50 years and the children continue to rely on it).   We now are working to have the wording read "licensed or nationally certified practitioners" as that would be most inclusive.  We thank you very much for your part in assisting us. We are most appreciative. "

Jean Hoagland, Treasurer
National Center for Homeopathy
Alexandria VA
Comment: The homeopathic community has a couple of hurdles, short of making a real push for inclusion. One is to get their schools together to come up with agreed upon standards for accreditation that are recognized by the US Department of Education. The second is to come to some agreement on a standard for certification, then get that agency's certification accredited through the National Commission for Certifying Agencies. Some action is underway in both these area. But short of success, any elected official with concern for the public health would be unlikely to formally enshrine any practitioner type in health reform legislation.

Drisko: The Integrator's IOM focus was it's best issue yet
2.  A little self-congratulatory inclusion: comments on the IOM Summit reports

Integrator issue #61, published April 8, 2009, was almost entirely devoted to perspectives on the most influential event in the history of integrative practice: the Institute of Medicine Summit on Integrative Medicine. Two individuals I respect a good deal wrote brief notes of thanks following that issue.

"What an amazing and wonderful resource this issue on the IOM summit is! I particularly enjoyed Sarnat and Goldman—Sarnat, for his well-reasoned, thorough, and forward-thinking analysis, and Goldman for his cut-through-the-bullshit, where-are-the-emperor’s-clothes notes about what was missing. Well worth the time it took to read through everything. Thank you SO much!"

Sheila Quinn, Chair
Integrated Healthcare Policy Consortium

"This is the most significantly important blog you have published to date. I hope it can be disseminated widely. Hope you are well!"

Jeanne Drisko, MD, Director
University of Kansas Medical Center/Integrative Medicine

Comment: Those of you who like anything you read here, or find it valuable, please take a look at the logos at the upper right of this web page. This is not a labor of mere love. These companies pay me, in most cases entirely out of a sense of service to the integrative practice community. I thank them for the opportunity! 

Korn: Correction on Gonzalez piece
3.  Leslie Korn, MPH: Clearing up an error on the cancer trial of Gonzalez and crediting his work

Indigenous practices researcher Leslie Korn, PhD, MPH wrote to correct a screw-up in the Integrator article on the Gonzalez trial. It has been cleaned up. Thanks Leslie!
"There may be a typo-the Gonzalez trial is Pancreatic cancer, no prostate as stated in the first page of the Integrator. I am glad you presented this. I know Gonzalez work first hand  personally and professionally and  have no doubt that his research has been obstructed. Thanks!"

Leslie E. Korn, PhD, MPH, RPP, LMHC
Center for Traditional Medicine Health Alternatives, LLC
Center for World Indigenous Studies

Zabik: NCCAM study on use provokes sharing on slowing increase in LAcs
4.  Tucson Acupuncturist Keith Zabik, LAc: Are licensed acupuncturists leaving their profession?

Community acupuncturist Keith Zabik, MAc, LAc responds to the Integrator Special Report on August 4, 2009 which questioned the conclusion of the NIH NCCAM that use of CAM practitioners has fell by 50% in the last decade. He shares intriguing data from the acupuncture world.    

"I enjoy reading your blog. I just finished this one you wrote: 'Is CAM Practitioner Use Down 50% Since 1997? NCCAM's Report on Costs of CAM and Visits: An Analysis.'

"Slogging through the numbers to try to figure anything out can be tedious and fun at the same time. It's frustrating to me that many times we are just left with more questions even after having extensive survey data. I thought you may be interested to take a look at the latest L.Ac. numbers, and see if you had any thoughts. I have been discovering that acupuncturist demographic data is sometimes hard to pin down."

Keith Zabik, MAc, LAc
Tucson Community Acupuncture

Comment: This fine submission deserves special treatment, which I plan to do in the next Integrator Round-up. Bottom line, Zabik provides evidence of declining rate of growth in the licensed acupuncturist domain: "So, we can see that from 1993 to 1998, the ranks of licensed acupuncturists had a net gain of about 1000 per year (5000 over 5 years). From 1998 to 2007 the number of LAcs in the U.S. has basically grown at a net rate of 2000 per year (17000 over 8 1/2 years). In the last two years, the net gain so far is about 200 LAcs per year." Take a look at the data he assembles. Is he off, or spot on? Thanks, Keith.

Sportelli: business structure shapes patient relationships
5.  Lou Sportelli, DC on Atul Gawande's New Yorker piece: employed physicians and the historic incentives that inform non-integrated practices

The Integrator piece on the influential article by Atul Gawande, MD in the New Yorker that examined the factors in the highest cost areas for health care in the United States with the lowest cost areas, typically where physicians are employed such as with Mayo Clinic, sparked an exchange with Lou Sportelli, DC, a chiropractor for 45 years who is president of Integrator sponsor NCMIC Group. I asked him: "How do you deal with Gawande's point that it seems to be where we have employed physicians where we have the right incentive structure?" Sportelli responded as follows, with a little reflection on history on alternative practices.

"I do not think there is an issue with (Gawande's) conclusion. Remember, alternative practitioners only a short time ago, less than 50 years, were not included in the system. There was no reimbursement so what did they have to do was focus on taking care of their patients (WOW what a concept), provide value, ensure outcomes, be cost effective and provide PATIENT SATISFACTION. So alternative practitioners care for patients, not predicated on economic gaming of the system, but rather upon value to the patient in order to provide economic survival.   

"The (conventional) medical profession
on the other hand went from CARING
for the patient to CODING for
reimbursement. Somehow the patient
was lost to the private system."
"The (conventional) medical profession on the other hand went from CARING for the patient to CODING for reimbursement. Somehow the patient was lost to the private system.  Those entities (like Mayo) which employed doctors removed the economic motivation, and restored the real purpose of being a doctor which was to care for the patient whether they needed an aspirin or major surgery. 

"Once you remove the economic incentives by providing a fair salary, and beneifts (which include malpractice coverage, paper work support and a culture of caring) you have the best of all words. There is something very valuable in having the patient and the provider as partners. The payor really has become the bully and the payor is also motivated by profit. All of these factors simply are 'oil and water' in a health care system that is already fraught with barriers to entry for those who need care, and barrier to effective management for those who provide care."

Lou Sportelli, DC, President

Whedon: Gawande's work stemmed from Dartmouth's Atlas
6.  Dartmouth researcher Jim Whedon, DC, on
Atul Gawande's New Yorker piece

The Integrator coverage of Gawande's article, noted above, also stimulated this note from a researcher at Dartmouth where the best, original research on variability in care (and cost) was developed. 
"It's great that Dr. Gawande's article in the New Yorker has received so much attention, particularly from Obama. What may not be clear to everyone is that probably 99% of the data upon which Gawande's article is based came out of research done at Dartmouth. Gawande is not the expert. He's a reporter in this case.  For the authoritative information on regional variations in healthcare costs, the place to go is Elliot Fisher, Dave Goodman and others whose research forms the basis for the Dartmouth Atlas of Healthcare.

"By the way, under a grant from NCCAM, I will be applying those same Dartmouth Atlas research methods to study the utilization of chiropractic care."

Jim Whedon, DC
Instructor, Dartmouth Institute for Health Policy
& Clinical Practice Health Services Research
Trauma Registrar, Trauma Program
Dartmouth-Hitchcock Medical Center Lebanon, NH
Comment: The Nobel for medicine or for economics or both should have gone to the Dartmouth team long ago. Interestingly, Gawande's thesis is somewhat different. He notes the Dartmouth work, but doesn't quite buy it. My own view: Employ doctors or forget about health reform. We need to reverse the incentives in the system and that's the way to do it!

Foley: Regulators don't get what it is to be in the trenches of patient care
7.  Integrative medicine pioneer Chris Foley, MD blasts "euphorian togetherness" as he weighs in on naturopathic doctors and the Weil action plan

Chris Foley, MD lead one pof the first health system-sponsored integrative clinic, partnering with the HealthEast system in Minneapolis in the mid-1990s. He continues to practice integrative medicine at Minnesota Natural Medicine, and to play competitive handball which gave him his rather startling AOL-handle in early internet days: killshot.  
"Very nice journalism.  Andy Weil's suggestions, and the other folks with a couple of exceptions, sound so familiar to the voices of 20 years ago. 'Changing the culture' sounds like stuff that the Soviets tried. The more regulated, the less creative. The more we decry 'turf battles,' the less we compete. Why is everyone so afraid of competition when it comes to serving the customer?  Why do we have to have wage and price controls?  All this 'togetherness' is a bunch of doubletalk.  It's been heard before and simply promotes the ongoing effort to regulate those who minister care.  I have been through the euphorian, self-appointed, pontificating stuff many times, and I have no faith in its promise.  

 "Being a physician, nurse, ND, DC,
LAc, or LMT, in the trenches and
ministering the art and science is what
counts. Leave it alone or ruin it."

"I did like the anti corruption sentiment, but it is as prevalent in the healthcare (and CAM) cultures as it is in the congressional one. Take baseball. Branch Rickey, Ford Fricke, Bill Veeck, Ken Burns, and even George Will have all been involved in regulating, 'changing the culture,' producing movies and writing books about it.  But none of those folks ever played the game, and those who do, could not care less about them.  At the end of the day, it is the magic of a Mantle, Feller, Gibson, Clemente, Mays, Nolan Ryan, or Joe Mauer that defines the game.  That aspect cannot be 'regulated.'  It can only be discovered and nurtured by those who play the game or played the game.  Being a physician, nurse, ND, DC, LAc, or LMT, in the trenches and ministering the art and science is what counts.  Leave it alone or ruin it.

"I would simply close with my Tom Jefferson quote:
"If people let the government decide what foods they eat and what medicines they take, their bodies will soon be in as sorry a state as the souls who live under tyranny." But Jefferson et al would be pretty disgusted with the direction of the entire country today."  

Christopher M Foley MD
Minnesota Natural Medicine

Comment: Alas, I think there is a role for government and have been actively messing in and around policy related to standards, licensing and regulating healthcare services for 25 years. So I guess I am in the target zone for much of Foley's vitriol. Given your handle on AOL, Chris, I promise that I will never get into a handball court with you!

8.  One more from Foley
: On whether IM is "about relationships" plus bootcamp for integrative practitioners

Foley responded earlier to an exchange in which Tom Ballard, ND argues that "We need more than relationships in integrative medicine."
"Read this stuff, and I must say that Ballard is far closer to where we are going. Ballard and others like him pass the real test: Do you care about trying to help a patient unconditionally?  In the throngs of administrator wannabees with whom I have had the distress to work, a common thread is that they would rather sit around and be self indulgent instead of working the trenches of patient care.  Upstream we go, yes. Less reductionistic, hurrah. But please, let the system be driven by professionals with a passion for caring and fixing and leave the health care Pharisees out of it. 

"Gordon's little group's recommendations (for healthcare reform) were interesting though mostly a little naive. However, the military allusion was interesting.  I wonder how many of them attended boot camp?  Possibly one of the best things about medical training is the boot camp of internship and residency. It at least allows some 'hardening' for people who are too 'soft' to actually be professional caregivers.  The focus on disease needs amending, yes.  But, tho imperfect, it did weed out a few who are less than 100%.

"The centralization of a payor system will force many to 'opt out,' then the real revolution will begin because the new paradigm as Gordon describes cannot be linked to a 3rd party payor system. The corruption of the relationships and professionalism will never end otherwise. (Peter) Chowka has it right."

Chris Foley, MD
Minnesota Natural Medicine

Clay: NCCAM needs to assert its value
9.  Lobbyist Beth Clay on NCCAM's presentation of it's CAM use data: Would the NCI director have been defensive?

Beth Clay is an observer-critic of the NIH NCCAM who formerly served in the predecessor NIH Office of Alternative Medicine and as a Congressional staffer. Clay was last seen here in an article on the handling of the controversial NCCAM-funded research into the alternative pancreatic cancer regime of Nicholas Gonzalez, MD.
"I am just now getting around to reading your story on the NCCAM survey. Thank you for bringing the numbers to life for your readers and for pointing out the many questions many of us have when looking at this study. Sadly, we cannot count the weaknesses in the study to ignorance to the topic since Dr. (Richard) Nahin has been around the topic for 15 or more years and should by now understand the nuances of the field.  I hold Dr. Nahin in high regard, so these survey being his work is disappointing.

"It is very telling that Dr. Briggs statement specifically ties spending to safety and efficacy: 'With so many Americans using and spending money on CAM therapies, it is extremely important to know whether the products and practices they use are safe and effective,' said Josephine P. Briggs, M.D., director of NCCAM. 'This underscores the importance of conducting rigorous research and providing evidence-based information on CAM so that health care providers and the public can make well-informed decisions.'

"Can you imagine the director of the NCI making a similar statement like: 'We just spent your tax payer dollars asking cancer patients which cancer treatments they are using so we can determine what is safe and effective.' NEVER. And really how is a survey going to help us understand what is safe and effective. One has nothing to do with the other in truth.  If the survey is faulty, which by all accounts this one is, we do not truly know how much is being spent, but we do have an extrapolation of a minimum being spent on certain areas. Consumer use or decreased use tells us nothing about safety and efficacy.  (Except that if we don't have reports of people dying or being ill from something we have some presumption of safety.) 

"What has the NCI Director said lately? Dr. Niederhuber states: 'Five years ago, NCI launched the cancer Biomedical Informatics Grid (caBIG) as a pilot program to develop an electronic data infrastructure system for cancer research. It was an ambitious vision to create the world's largest biomedical research 'highway.' The same press release includes the following: 'Cancer is in many ways a model for the study of all disease. It is, then, no surprise that caBIG is helping to lead biomedicine into the digital age. Aneesh Chopra, the nation's first chief technology officer, remarked at the caBIG meeting that collecting information on all patient encounters and outcomes is essential to truly understand the drivers of disease and drug response and to develop innovative and new approaches to treatment and prevention. We owe it to the patients we serve to ensure that the larger biomedical community learns from their diagnoses, treatments, and clinical outcomes so that the whole of cancer research may move forward."

The way the NCI director
presents NCI's value

"Cancer is in many ways a model
for the study of all disease. It is,
then, no surprise that (our research)
helping to lead biomedicine
into the digital age." 

"I believe the public deserve better use of their tax payer funds than a survey which while interesting has huge gaps in what was asked and what should have been asked. Further, the entire continued use of federal dollars to survey the public on their health care usage is really something that deserves broader discussion.  Is this a wise use of limited resources?  What does anyone really take away from the study except that the most used of the investigated CAM therapies were manipulation. If one is going to survey 23,000 people, one certainly should have included questions not just on out of pocket payments but on covered benefits, on the same therapies covered in the earlier study and used the same protocol.  After all, the point of a survey was to gain updated information on the topic, not create a new baseline. 

"With the billion dollars that has already been invested in CAM research at the NIH, what do we really know?  If we go back to (former Congressman) Berkley Bedell's original vision and the originating language, what CAM therapies have been 'investigated and validated'?  I can think of only a handful - acupuncture, biofeedback, relaxation techniques and to some degree hypnosis for pain associated with cancer. All of those were accomplished before NCCAM was even founded.

"I am not a negative person, instead I try to give the benefit of the doubt to people  I always hope that government employees will not be satisfied with mediocrity but will rise to the true challenge of public service and the needs of their constituency. The challenge I believe may be that NCCAM does not see itself as serving the constituency of the CAM community, but of the conventional medical world.  In their attempt to make sure they have not endorsed anything CAM, they undermine themselves and the work of the grantees by always including cautionary statements which become the focus rather than the caveat."

Beth Clay
Senior Vice President
Capitol Strategy Consultants, Inc.

How NCCAM, with a new focus,
could assert its value

"Studying the effectiveness of integrative
practices is in many ways a model for the
study of all chronic disease since we are
looking at multiple inputs and focused
on functionality. 

"It is, then, no surprise that NCCAM is
helping to lead research into the age
of health creation."

Comment:  First, I do not think that NCCAM director Briggs was making the connection Clay asserts at the top of her commentary.

That said, what struck me as particularly valuable in Clay's response was to think about how NCCAM might present itself as assertively and confidently as the NCI does here.  Assume for a minute that NCCAM was actively engaged in the best and most fitting work with which it could be engaged, that is, figuring out how to examine the effectiveness of whole practice, multi-agent and multi-practitioner integrative care. The is what the recent report from the King's Fund on assessing CAM recommends. To paraphrase and apply the sentiment expressed by the NCI director, NCCAM Briggs could have said: "Studying the effectiveness of integrative practices
is in many ways a model for the study of all chronic disease since we are looking at multiple inputs and focused on functionality. It is, then, no surprise that NCCAM is helping to lead research into the age of health creation." Wouldn't that be fun!  Anyone (else) for promoting this as the core of NCCAM's next strategic plan? 

Fonfa: skeptical about RCTs
10.  Consumer Ann Fonfa:
RCTs "produce evidence like lace or cheese - full of holes!"

In an article I cannot presently re-locate, I opined: "Can one even imagine a level playing field for an evidence-based inclusion of integrative, natural therapeutic approaches?" Ann Fonfa, volunteer head of the 10-year-old Annie Appleseed Project wrote the following in response.
"I serve as a Consumer reviewer for Cochrane Collaboration protocols and meta-analyses.  Many of the papers I choose to review are in CAM - the finding is almost always the same.   The intervention has not been shown to be effective with the reason that more studies are needed.  Too few are 'conducted' in a randomized way - or there are problems with randomization, or another issue of methods.

"Thus few CAM treatments are judged on their actual merits.  And that's a shame for consumers and others.  We really ought to either 1) find the BIG bucks to conduct RTCs perfectly (unlikely) or 2) figure out a way to promote the results we do have, and value them.

"Do people even realize there were NO randomized trials of laetrile, yet it was tossed out completely, with oncologists to this day told it did not work in trials. I respect evidence but we all know the gold standard of randomized clinical trials produces evidence like lace or cheese  - full of holes!"

Ann Fonfa, President
Annie Appleseed Project

11.  Jim Blumenthal, DC on the roles of practitioners relative to the natural products industry

Many moons ago the Integrator began a multi-article dialogue, begun by David Matteson of Early Edge Communications, which explored his view that the future of the practitioner fields and the natural products industry are inextricably connected. Jim Blumenthal, DC of the Applied Kinesiology Center of Los Angeles just came upon the dialogue and had this to add:

"I happened on the discussion of Clinicians vs Suppliers that included Patrick Hannaway and Vanessa Esteves. I realize that it is over a year old and that it may be done, but if you would like, I had a few thoughts to share on the topic.

"The discussion of relations between clinicians and supplement companies has been interesting. My perspective is that of a seasoned clinician and educator who maintains a clinical nutrition based practice.

"Questions regarding the ethical
foundations of various companies
have, do, and will exist.

"This is as true in nutraceuticals
and pharmaceuticals as it is in
website designers, auto
manufacturers, and other industries."

"There will always be a range in the quality of components and formulation, issues around excipients and binders, value for the price, honesty and accuracy of marketing. Questions regarding the ethical foundations of various companies have, do, and will exist. This is as true in nutraceuticals and pharmaceuticals as it is in website designers, auto manufacturers, and other industries. As Dr. Esteves explained in her post, there is a deep need for education among providers. The most powerful force in the market is the market. The better trained and more knowledgeable doctors are regarding the function of micronutrients, enzyme pathways and processes, and interaction of micro- and macro-systems, the easier it will be for them to understand what to use where and when... And to vote with their pockets, since before a patient buys a product from their doctor, the doctor has to choose to buy and stock that product from a supplier.

"Few doctors come out of school knowing their functional biochemistry well enough to make consistently brilliant diagnostic and therapeutic choices. But many can be conscious of the role that given nutrients play and build on their knowledge over time. This is why we are in one of the few remaining professions where the wisdom of years is still highly regarded. Much of what I know has come from sharing with and learning from colleagues. Some has come from the old-fashioned process of 'hitting the books' and some has come from training provided by the labs (including Genova) and the supplement companies.

"Discernment becomes key in choosing sources as well as in choosing what to believe from those sources. Most companies will provide information which reveals themselves in the most desirable light. Listening to them through the skepticism of that lens will usually advance our scientific and clinical skills. But NOT listening to them at all will only perpetuate ignorance. This is true of supplement companies, clinical laboratories, equipment manufacturers, seminar providers, etc. Integrating new information with old and measuring for the fit is as good a BS detector as we are likely to find. 

"There is a wide range of refinement among supplement companies. Health food store and MLM brands will generally use the least expensive, and often least bioavailable, forms of a given nutrient. Even among 'professional brands' we see a range of quality and the effects of advertising. 

"Hydrochloride forms of vitamins B1, 2, and 6 do not work like the phosphorylated forms. Zinc oxide keeps lifeguards' noses from burning, magnesium oxide makes great grinding wheels, and calcium carbonate may be fine as oyster shell or limestone but physiologically they are virtually useless as supplements. And depending on the pathway or function that the doctor is trying to affect, there may be significant differences even within functional forms of a certain nutrient. Seleno-methionine is a fine form of selenium in its place, however only seleno-cysteine will support the glutathione peroxidase and tyrosine deiodinase enzymes. Knowledge is power and here, as much as anywhere, knowledge is key.

  "When doctors are uninformed and
simply guided by profit to sell products
which will generate a return on income,
that is bad medicine; a violation of the
public's trust and their professional oaths."
"When doctors are uninformed and simply guided by profit to sell products which will generate a return on income, that is bad medicine; a violation of the public's trust and their professional oaths. However, when a doctor is knowledgeable, understands their patient's needs, and capably recommends a particular product because of its components and overall effect, that is a manifestation of the best healing relationship.

"There  is a difference between "self-interest" and "enlightened self-interest". As a clinician, I have a primary responsibility to put my patient's needs and welfare first. I also have a responsibility to promote and run my office in a manner that keeps our doors open, my staff's salaries paid, and a roof over my family's heads.
 "The keys are to first develop the
knowledge to give consistently brilliant
guidance to our patients and second
to remember to always put their needs
ahead of our own where commerce
is concerned."

Although volumes have been written about the ethical issues of charging vs. not charging patients, most of this is 'dancing angels on pinheads' since few of us can afford to run entirely pro bono practices, anyway. While there are certainly easier ways to make a living than investing 5-10 years and hundreds of thousands of dollars to reach the starting line, we who have chosen to dedicate ourselves to the task of reducing human suffering also have the right to make a decent living. Most patients expect to pay for their care and for their supplements or drugs. Our responsibility is to guide them compassionately to the correct remediation as professionally and accurately as we can. Being compensated for our knowledge, services, and products does not violate any of this unless we put the commerce before the healing.

"The keys are to first develop the knowledge to give consistently brilliant guidance to our patients and second to remember to always put their needs ahead of our own where commerce is concerned. If we accomplish these two intentions, then everything else falls into its proper place." 

James P. Blumenthal, DC, CCN, DACBN, FACFN
Brain Performance Center
Applied Kinesiology Center of Los Angeles
Comment: And, it is my bias that profiting from sales of natural products will always influence prescribing. That said, I am open to the view that, given the current economics of the general practice of natural medicine which is not procedure-based (that is, doesn't have a schtick which is handsomely paid by insurers) making money off of product sales. This helps makes the economics of the practice work out.

12.  James Pannozzi on Dana Ullman's comments about homeopathy's trials in Wikipedia

Author and blogger Dana Ullman, MPH, shared information on his experience in seeking to load information in Wikipedia which, in his view, appropriately describes the science behind homeopathy. (See Where is Your Definition Tonight? Dana Ullman on the Virtual War in Wikipedia over Homeopathy.) Student of natural medicine James Pannozzi came across the piece and shared this.
"I agree with Dana Ullman's complaint against Wikipedia regarding the rapid disappearance, often within minutes, of pro Homeopathy information in the Wikipedia article on Homeopathy.

"In addition, I have seen, for example, in one article about pharmaceutical researcher M. Ennis, who is not even a Homeopathist (she did research which might offer the start of a theory regarding Homeopathy mechanisms), the Wikipedia article wrongly stated that her key experiment on Basophil cells (published in Journal of Inflammation Research (volume 53, p. 181) had been 'refuted' during a BBC Horizon TV documentary on homeopathy. In fact, Ennis spent months emailing the producers of that program, seen by millions and they eventually sheepishly acknowledged that they had never intended their experiment to be a repeat of hers. In fact, the researcher in the program added a chemical which killed Basohpil cells, thereby ruining the results of the experiment and guaranteeing failure either by design or incompetence. Ennis' research has been confirmed in recent research by French researcher St. Laudy. I have not bothered attempting to update the Wikipedia entries."

James Pannozzi
Student of Oriental Medicine, Classical Chinese
Reader in Homeopathy

Bark: Appreciated the heads up on lobby day
13.  Miscellaneous commentary and notes

Below are a selection of a few short comments that I saved along the way.

  • Shradhdha Patel, BSN, RN, a member of American Holistic Nurses Association and a graduate student at Drexel University for FNP program sent a brief note to Integrator writer Daphne White following White's articles on clinical effectiveness research:  "Thank you for speaking up for CAM modalities and need for research. It would be interesting to open the minds of people to see how much $$ they can save by using side effects free healing CAM modalities.  We do not need to push drugs in healthy people's body. CAM modalities are great for prevention and management for chronic diseases." See Daphne White: The Kabuki Play of Monied Interests Around Comparative Effectiveness Research, April 28, 2009.

  • David Matteson of Early Edge Solutions sent the following on reading Issue #67: "Great issue, John. I continually marvel at your mind's ability to track not only the individual stories, but their intertwining. Your contribution to this entire field is unique and incalculable." Thanks, David - and, again, the contribution of the Integrator sponsors allows whatever value I create.

  • The Integrator feature on the Summit on Integrative Medicine, sponsored by the IOM and the Bravewell Collaborative, reported Bravewell's key points. Ventura, California chiropractor Kristofer Young, DC wrote: "Bravewell’s eight key points ARE aligned with my views of 'integrative practice.'"

Comment: Thanks all for your comments - and I will work to keep on top of these in the future!
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