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Reader Forum: Knutson, Stargrove, Gmeiner, Redwood, Sommer, Esteves, Ullman, Swift & Sudoo PDF Print E-mail
Written by John Weeks   

Reader Forum: Knutson, Stargrove, Gmeiner, Redwood, Sommer, Esteves, Ullman, Swift & Sudoo

Summary: Lori Knutson, RN, HN-BC on the importance of clinical interests in federal panels and health coaching; Mitch Stargrove, ND, LAc on Consumer Reports' "Dirty Dozen" supplements; Kjersten Gmeiner, MD on RWJF's sobering inter-professional education project; Vanessa Esteves, MBA, ND responding to Margaret Beeson, ND with a recommended policy for practitioners selling supplements in their offices; Daniel Redwood, DC and Beth Sommers, PhD, LAc on the negative comments from Integrator readers toward CMS head Don Berwick, MD; Dana Ullman, MPH on why Oxford Journals let go of eCam; Kathie Swift, MS, RD, LDN on the changing dietetics landscape; and Andree Sudoo on antagonism toward the Clayton School from licensed NDs. 
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Knutson: Clinicians' views are key
1.  Lori Knutson, RN on who we need on federal panels and what we need in health coaching


I was recently in an e-dialogue with Lori Knutson, RN, HN-BC about two policy-related issues that are quietly steaming around the integrative practice community these days. Knutson is the director of the nation's largest integrative healthcare initiative in the Allina Hospitals and Clinics. I found her thoughts insightful, especially given her position and experience, and asked if I might share. She responded:
"Yes. Please note that this is not about being confrontational or adversarial.  My intent is to express the less active voice of the clinical environment where the vulnerability and potential for individual health transformation can take place. I wish to advocate for more active input from the purely clinical provider perspective (and perhaps the clinical administrative perspective). Often clinicians with no academic or political association do not advocate for advancing their world; partly because they are just so busy doing the work."
Her first comment regards the individuals who will serve on the advisory panels to the new integrative care-related aspects of the federal healthcare reform:
"There is a challenge, from my clinical perspective, that these panels will be very heavy on the academic represented side and minimally represented by the non-academic clinical environments of private and public hospital's/health care systems. The potential disconnect between policy, academia, and the lived clinical environment is concerning to say the least.  Equal representation in areas of expertise is the desired outcome for true transformation."
The second regards developments related to health coaching, a concept that is close to much integrative practice. A summit is presently being planned to develop standards in clinical health coaching. Knutson's operation uses coaches. Here is her comment.
"Regarding the Health Coaching summit, we currently have 5 health coaches on staff and have taken the University of Minnesota Center for Spirituality and Healing Health Coach students for semester clinical experiences. We have created a healthcare motivational coaching curriculum which focuses on the activation of an individual to sustain lifestyle changes which is not typically part of a health coach curriculum. I am also aware that 3rd party payers are training their own coaches with the focus on helping their members achieve the outcomes determined by the insurance company as pertinent. 

"I share this to demonstrate a little of the variety in the yet determined field of health coaching. What needs to be part of the curriculum development is a focus on what the gap is in individuals knowledge, skills and level of confidence to activate sustainable healthy lifestyles. Much of what I am seeing right now in health coaching approaches are based on the particular institutions goals are (often based on health care cost/utilization) instead of what will transform the conciousness that needs to occur for a healthy nation."

Comment: My own strong bias is that any integrative practitioner who is not actively, deeply engaged in coaching a person toward health, whether via practices learned via special certification of one's own discipline, is missing the boat. Green pharmacy, command of obscure biochemical pathways, needles, adjustments and mind-body practices, alone, significantly limit whatever transformational power the idea of integrative practice has. I am surprised there is not more content about this powerful pedestrian work in the continuing education of integrative clinicians. 


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Stargrove: Better resources on interactions
2. Mitchell Stargrove, ND, LAc: On Consumer Reports' Dirty Dozen supplements


Mitch Stargrove, ND, LAc is a national expert on herbs and supplements, and particularly their interactions. The Integrator review of his Herb, Nutrient and Drug Interactions text is posted here. HGe responded to the Integrator Round-up mention of a recent Consumer Reports article which listed the "Dirty Dozen" supplements with this note:
"I posted this on Facebook: Much of what they claim as dangerous is simply irrelevant to standard practice - nobody prescribes a lot of these substances, or if they are going to they need to be trained and experienced and manage the case well.

"The Natural Medicine Comprehensive Database has lots of good information but fails in contextualizing and often spreads misinformation.

"Next time they should try using InteractionsGuide.com as their source - a clinical guide written by practitioners who actually use herbs and nutrients with patients and frame the research literature according to the models of natural medicine .
Comment: A repeat theme here, with Knutson: Leaving practitioners out of healthcare planning and policy processes is done at our peril. The remarkable aspect of Stargrove's work is how deeply he brings a clinical perspective into the guidance his Interactions book and internet-accessible programs offer.   


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Gmeiner: Experience of holistic MDs and nurses in 2006 conference
3.  Kjersten Gmeiner, MD: On inter-professional education and some AHMA


Kjersten Gmeiner, MD is a former board member of the American Holistic Medical Association (AHMA) who has also been a leader in promoting group-focused practice models. (See Integrator article on her work.) She commented on the Integrator article on the Robert Wood Johnson project that elaborated sobering challenges relative to inter-professional education. Her reference is to a 2006 meeting co-sponsored by the AHMA and the American Holistic Nurses Association (AHNA).
"Nice article on inter-profession.  As you know, this is some of my heart's turf...  I am not sure if they exist, but I think it would be interesting for you to listen to tapes of the keynote panels of the 2006 AHMA/AHNA collaborative conference. (Boy do I have a lot more to say on that.) Each of the panels had 3 organizations presenting their integrative delivery model: one panel of small clinics, one of clinics that are part of larger organizations, and one of hospitals.  I think as of that point in time we captured a considerable breadth of the integrative practice models that were working at all."
Comment: As of this moment, Gmeiner has not been able to ascertain whether or not tapes from those sessions are available. I do seem to recollect that some of the historic MD-nurse challenges, found in the Robert Wood Johnson Foundation-funded project I reported, reared their ugly heads even among the holistic collaborators in that meeting. Kjersten, what would you (or any of the rest of you involved in that conference) say about that? I sometimes live with the hope that integrative practitioners naturally engage this inter-professional work with a kinder, more respectful model. Evidence doesn't always support these being more elevated beings.


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4.  More on CMS head Berwick: Daniel Redwood, DC and Beth Sommers, PhD, LAc

 
The Integrator column in support of Barack Obama's appointment of Don Berwick, MD for Centeres for Medicare and medicad Services (CMS) provoked 3 strong letters of antagonism toward the appointment. This led to two short notes on those postings, and Integrator comments associated with them.

Daniel Redwood, DC is a professor at Cleveland Chiropractic College and editor-in-chief of Health Insights Today. He is also an editorial adviser to the Journal of Alternative and Complementary Medicine. He comments in particular on the invocation of a 20th Century tyrant by Cindy Krueger, MPH.
"I appreciate your providing a forum for divergent views and I also appreciate your sticking to your principles in forthrightly stating your own position. Yelling Hitler in a crowded theater is always a sure-fire conversation-closer.

"The complete silence about those not covered by insurance speaks louder than words." 
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Beth Sommers, PhD, LAc is the director of research for Boston-based Pathways to Wellness/AIDs Care Project. The Pathways Center was noted here in a past Integrator Top 10 article.
"Thanks once again for your rational, holistic and educated perspective on the issue of Berwick's nomination.

"While it's important to have free-flowing dialogue on this topic, the critics who responded to your endorsement seemed to use ad hominem attacks and other extremist rhetoric to justify their criticism of Berwick.

"Your thoughtful comments were sublimely informative and free of any backlash, which I fear may be what the writers were trying to provoke. 

"I support the Integrator's stand on this issue and commend you for your principled explanation and contribution to the discourse of the issues surrounding Berwick's nomination."
Comment: I debated at length whether or not to post the Krueger piece, feeling that the aspersions and name-calling were so far off the mark that they didn't bear reporting. However, my experience leads me to believe that Krueger is not the only strong supporter of integrative care who is at great, polarized odds from the Obama administration. Thus, the publication. 
 

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Esyteves: A strategy for selling supplements in office
5.  Vanessa Esteves, ND, MBA: Response to Beeson on practitioners selling supplements


Vanessa Esteves, MBA, ND, a past member of the board of directors of the American Association of Naturopathic Physicians, practices in the Pearl Health Center and Healing Clinic in Portland, Oregon. She writes in response to a column from Margaret Beeson, ND on the issue of doctors profiting from supplement sales in their practices.
"Thank you to Dr. Beeson for her article that explores this meaningful topic of the complex physician-industry relationship.  In 2007 I was inspired by AMSA PharmFree, a ‘national movement to reduce conflicts-of-interest at medical schools and academic medical centers.' The campaign invigorates conversation regarding the ethical nature of the often controversial, and at times unavoidable interactions with the pharmaceutical industry. 

"Integrative care providers profiting from the sale of products in their own offices generates a situation that necessitates similar ethical considerations.  As we move forward with collaborative care, accepting private and state/federal insurance plans and grow in volume we must be conscious that this topic is creating public scrutiny and state and federal laws are being enacted in conventional medicine...how close are we to follow?


"Patients benefit from knowledgeable physicians that make the choice to offer high quality physician grade dietary supplements safely and conveniently.  The choice to establish a dispensary parallels with the responsibility to ensure that our decision to prescribe specific nutraceuticals to our patients is based on need, supported clinical efficacy and quality.  Profiting from dispensing products complicates this scenario, and it has been my experience that very few patients are knowledgeable that their physician financially gains from their purchase.  Would patients loose trust with physicians knowing they are making a profit from their health treatment plan?

A Potential Model to Change the Paradigm

"At Pearl Health Center we have adopted a model of transparency and full disclosure which includes not generating a profit from our natural pharmacy.  We have clear publicly visible signs in our office that notates where the money our patients spends on our products goes and discloses that none of our clinicians have any financial ties with the industry.   When a patient purchases a product a portion of the funds goes to re-stock the shelf and the rest of the funds goes into a restricted line item.  Once a threshold revenue has been achieved in the account patients may apply to utilize the funding to purchase products that they cannot afford but are necessary for their health.  The cycle begins again.

"Obviously this is only one potential scenario that is neither correct nor optimal in many clinical practices.  The goal here is to continue the conversation and explore opportunities and innovative solutions through educating one another and do our best to learn from the history of Big Pharma and not repeat its faults.
Comment: I asked Esteves, in a follow-up note, how the policy is working. Esteves replied that the policy "has been in place only since I began working there, August 2009, very new and tweaks and edits still necessary to improve as we learn from our experiences." She adds: "The restricted line item holds the remainder of the funds (after % taken to re-stock) for patients to utilize to buy products. I am considering moving these funds into an ING high interest account for the next 6 months to gain more value."


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Ullman: What was behind Oxford's move?
6. Dana Ullman, MPH: What's behind Oxford Journals  letting go of eCAM?


Homeopath and author Dana Ullman, MPH sent a note regarding the decision of Oxford Journals to stop publishing eCAM noted in the July 2010 Integrator Round-up. in which he also commented on the apparently widening battled over homeopathy on the Continent.
"I personally sense that the skeptics/medical fundamentalists got to Oxford and twisted their arms to let go of eCAM. I have talked with people close to the publication and while I sense care being taken to not confirm that any pressure was behind the move, I did learn that skeptics have been hounding the publication for a while." 
Ullman, ever the advocate and publicist for his field, then provided a few factoids that may be of interest to you.
"You may also have heard that the attacks against homeopathy have now reached Germany.  According to a new article in the BMJ (see attached), the German Medical Association is supporting the homeopaths (!) and supports the ongoing reimbursement for physicians who practice homeopathy.  It is also amazing to note that the BMJ acknowledges that 57% of Germans (!) use homeopathic medicines.

"Even more amazing is the fact that 92% of German doctors who treat professional soccer players use homeopathic medicines, according to an article by Deutsch Welle, the equivalent to Germany's BBC (the country's largest broadcaster). I am consistently shocked by the fact that Big Media is repeating the LIE that the "medical fundamentalists" have spread that suggests that "there is no research that confirms the efficacy of homeopathic medicines."  An impressive review of articles on homeopathy and hormesis (low-dose effects) was just published in the journal, Human and Experimental Toxicology, July 2010. Free copes of the articles are available here.
Ullman recently co-authored a review of research on homeopathy for respiratory allergies with a professor at the Medical University of Vienna. The review is available here.


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Swift: More on the emergence of functional dietetics
7.  Kathie Swift, MS, RD, LDN: Follow-up on the changing landscape of the integrative dietetics movement


The August 2010 Integrator Round-up included a brief account of the evolution of the
Dietitians in Integrative and Functional Medicine (DIFM) Dietetic Practice Group of the American Dietetics Association. Kathie Swift, MS, RD, LDN, the immediate past chair, wrote with additional information. Swift works with Mark Hyman, MD at his Ultrawellness Center.
"Thank-you for highlighting the Dietitians in Integrative and Functional Medicine (DIFM) Dietetic Practice Group and for the work you do in promoting Integrative Medicine to the world community.

"It has been quite a journey in working towards this change in our profession which has been in place for well over a decade.  I am publishing an article about this entitled: "The Changing Landscape of Dietetics" in an upcoming Integrative Medicine: A Clinician's Journal article.

"Interestingly, I have been tracking the 'language' of Integrative Medicine for many years and rarely, has the word Dietitian been included in the conversations, other than to have some leaders in the field negate our value and unfortunately, judge the entire profession in a negative manner.  In the past few years, many members of our group have worked very hard to change this.  And fortunately, the needed 'climate change' is taking place!

"Thanks again for helping us to spread the word - We are moving full throttle ahead with some strategic endeavors to share our expertise and enthusiasm in Integrative Medicine."
Comment: Swift's comments about the language of integrative medicine go straight to memory banks in which the ADA is associated with endorsing pizza slop in school lunches and dead food in hospitals. Swift's work, and that of her colleagues, are testament to how much the landscape is beginning to change.  Swift and her colleagues have work ahead of them, even if changes are visible. The pizza slop and crappy institutional nutrition still reign. I am sure that the world would be a better place if a few present ADA leaders were, to follow a Maoist protocol, taken out to the countryside for re-education, or perhaps, in this case, to Hyman's center where Swift works.


8.  Andree G. Sudoo: In defense of the Clayton School mail order ND education
 
The August 2010 Round-up included an article on the demise of the Clayton College of Natural Health, a mail order school where the owners led the fight against expansion of licensing for naturopathic physicians. I received a response from an individual, Andree G. Suddoo who received her certificate declaring her an ND from Clayton (2002). An unlicensed practitioner from Fort Washington, Maryland, Sudoo provided this background:
"Started my studies in France and continue in the States. Completed four years studies online with Clayton College and enjoyed every minute of it. I will be 53 years old  and without health insurance since 1991 and going strong due to my great interest in health. Actually, I am still learning and write updated & researched report for private client in demand, and for examiner.com as DC natural health examiner.".
She wrote: "In reference to [my reference to] an article by Andrew Lange, ND, a Bastyr-educated naturopathic doctor, captured his profession's view in a Huffington Post article The Biggest Quack School in Natural Medicine Closes:
"I need to disagree with Andrew Lange, ND, concerning Clayton College. I have graduated from the school in 2002 and I have, prior my inscription, nine years in conventional medicine hospitals and graduated in life science. and since then, I am glad, I did take the online course. I am healthy and my saving, today, is more than $75,000.00.
 
"Indeed, Clayton College was offering a great academic program (life science, chemistry, biology psychology, etc), and an excellent introduction to herbal medicine, nutrition , homeopathy medicine, etc, at affordable price. In a country, without health care insurance (who need it?), industrialized hospitals and staff, prescribed medicine errors and so on, even an academic background can go a long way to health and not hell like Andrew Lange imagine. Yes, Andrew Lange is difficult to stand in competition but it is not by 'trashing' people than 'one get ahead of the game'."
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