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Comments on Natural Products & Practitioners: Patrick Hanaway, MD, and ND Student Esteves PDF Print E-mail
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!

Other articles in this Integrator dialogue:
1. David Matteson, on the "shared destiny," initiating this discussion

2. Perspective of managed care executive Adrian Langford
3. Integrator adviser and natural products specialist Michael Levin
4. Forum-Six Voices on the Theme
Slip Sliding Away: Bill Benda, MD on the Integrative Practitioner-Natural Products Industry Relationship

ABIHM, Genova, natural products, CAM practitioners
Patrick Hannaway, MD
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
NMSA, natrual products and natruopathic physicians
Vanessa Esteves, BSc, ND cand.
2.   Vanessa Esteves, 4th year naturopathic medical student

Vanesa Esteves, a 4th year naturopathic medical student at National College of Natural Medicine, was last seen here commenting on the August 2008 co-location of conferences for the American Association of Naturopathic Physicians and the American Holistic Medical Association. She has been a leader in fostering relationships between ND students and MD students.
"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) Liva and 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!

"Check out Pharm Free from the American Medical Student Association. I am sure the Naturopathic Medical Student Association will also have a stand on this as well in the future."

Vanessa Esteves, BSc, ND4
National College of Natural Medicine
Portland, OR
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