Untitled

Archive

White House Commission on

Complementary and Alternative Medicine Policy

January 23, 2001

New York, New York

Opening Remarks

GROFT: Good morning everyone. If you could please take your seats we'll get started on this unbelievable agenda and list of speakers that I think will keep us busy. We're hoping to get out of here around 9:00 tonight, but we're not sure. So with respect to the people that are coming at the tale end of the day, we'll get started real briefly.

I'm Steve Groft and I'm the Executive Director of the White House Commission, and it's hard for me to welcome you, but thank you for coming out because without you we wouldn't be here. And the overwhelming response I think has led us into a number of situations that will be a little bit different. First we felt we could give everyone about five minutes of presentation time, but we're going to have to reduce it to three, as you've been informed. But we do look forward to your expanded comments, if you could either give them to us today or send them in to the office after today's meeting. So we would appreciate them. And any other supporting information or any other information you'd like the commission to look at, at that point please enclose that as well, because that does become part of our record that we will review as we prepare the report.

The report is going to come in two phases. The first one will be an interim report in July, that we hope about mid-July we'll have an interim report; primarily the recommendations. So we'll just have you take a look and follow out Web site. I think we've got information on the Web site within the background information. Please look at it. We'll have the highlights of the meetings and the agenda for all the meetings, so please just keep up with it. And if you have any questions, there's a section there, if you could send us a message. But after the interim report we are looking for comments from you, the public, about the recommendations, so please let us know what you think.

We are required to be out of business by March 7, 2002, so that will mean in all likelihood we should have the report done in early January of that year. So there will be a lot of creative writing between this time and that time next year. But all of a sudden we started last June and the seven months that have transpired since that time have just flown by. So I know how busy it's going to be the rest of the way. And with a series of meetings to come in Washington, we do have a bit of a revised schedule of meetings. On February 22 and 23 will be the next full meeting of the commission. And then there will be a meeting on March 26 and 27, tentative, but it's looking like they are the dates. Then May 14 through the 16th. So just keep tabs on the Web site.

Today, since we do have so many speakers, we're going to break you into panels, and you all received the agendas. And we do have a panel coordinator from the staff. They're floating around, so if after the meeting at any time you would like to speak with anybody, use the panel coordinator as your point of contact to get into the office. I think we'd like to establish that relationship, so please check in with them. And if you need to speak with me or Michelle Chang, the executive secretary, who just disappeared, we'll be happy to help you however we can. So please think about that.

We've reserved seats here in the front of the auditorium for the speakers. And there's going to be a lot of motion as the day goes on. And these seats are reserved for you as speakers for just the session until we break. After that, if you're going to stay, we just ask you to move to the back of the room and make room for the next group of 50 or 60 speakers. So it's going to be really, really hectic. And we do have the timer here. We're going to flash to you, and Michelle and I have a one minute warning that we'll put up. So we'll ask you just to respect the time. And as your presentation goes on, please focus on the recommendations. We'd love to hear more about you and your institution or organization, but we really need to hear about the recommendations. The time, three minutes goes by awfully fast, but if you use it wisely you can get everything in that you have to. So we ask that.

There will be a ten minute follow-up session of questions that, oh, five minutes. They're compressing me. So we'll be speaking quickly and we ask the commission members to make a very very brief questions to you and then for your response to be very brief as well. And then you can expand on that after the meeting as well. So it will take an awful lot of cooperation if we're to hear from everyone. It's going to be a very busy day. I think there's a lot of enthusiasm, even though the audience isn't large right now, I think the sum of the entire day you're going to find that there are a lot of people who will be coming through the door as we go on here. And so we ask you to bear with us and we're looking for a cooperative spirit here today, I think that will carry us through.

And I would just like to introduce Dr. Jim Gordon who is the chair of the commission. He'll take care of the rest of the introductions and get us started. Thank you very much for coming out and supporting our activity. We really do want to hear from you, and we need to hear from you. Thank you.

GORDON: Thank you very much, Steve. One of the things that we do at the beginning of the commission meetings is we take a moment just to sit quietly in silence and center ourselves. So if we can all begin that way, just sitting together in this space together and breathing together. Thank you very much.

I'm going to introduce my fellow commissioners and speak for a few moments, but first I would like to introduce Dr. Gilberto Cardona, who is the Acting Regional Director of the Department of Health and Human Services here in Region II. Dr. Cardona.

CARDONA: Thank you. I needed that. I'm sorry I came late. It took me over three hours to travel 20 miles from northern New Jersey, the George Washington bridge was impossible today.

GORDON: Deep breathing is essential.

CARDONA: Thank you. I'm going to be brief because I'm late and because there is important business to be transacted. So on behalf of the Region II of the regional office number II New York, the Department of Health and Human Services, please receive our welcome and greetings. Our special thanks to the commission for meeting in our jurisdiction and to all the participants in the hearing.

The charge given to the commission is one of great importance, given the proliferation of complementary and alternative remedies in the market today. It is an industry with very little regulation and open to . . . claims that are of doubtful validity. On the other hand, we need to be open to legitimate alternative approaches to patient treatments. Certainly I look forward for an exchange of information that will help us have a better understanding of the benefits and the risk of these interventions.

As a pediatrician I have been witness to a number of occasions in which these remedies have done more harm than good. A case in point, some medications coming through Texas that have high contents of lead, after the use, lead intoxication in a number of children, one of which had to be treated quite aggressively. So, but on the other hand, there are potential beneficial uses, so I do not want to prejudge the outcome of this meeting. But I welcome everybody to our region. We comprise the states of New York, New Jersey, Puerto Rico, and the Virgin Islands. And being a native born in Puerto Rico, I'm used to complementary medicine and alternative medicine, because that's part of our culture.

So greetings, again, to all of you, and I look forward for a very productive day.

GORDON: Thank you very much Dr. Cardona. And we are very interested in public health concerns about complementary and alternative medicine, as well as the effectiveness of the therapies, so we'll be in touch and we look forward . . .

CARDONA: I'm going to sit with . . .

GORDON: Wonderful. Thank you very much.

Let me begin by introducing the other commissioners. The total number of commissioners is 20, and at first we thought we were just going to have a few at the New York meeting, but everyone wanted to come. And so the people here are all extremely eager to be here and to listen to everyone. And they knew ahead of time it was going to be a long day, as well. And they're a distinguished group, and you can, Steve, they have access to the bios of the commissioners.

GROFT: Yes.

GORDON: So you can look at the bios. We don't have time to introduce everybody in depth, so I just want to make sure you know who they are. And you can check the bios out. And in addition to having the opportunity to speak today and to listen today, you can also, if you want, get in touch with the commissioners through the office, through the White House Commission Web site. To my extreme right, and that has nothing to do with political orientation, Dr. Effie Chow. And next to her, Dr. David Bresler. And next to him, Charlotte Herr, Linnea Larson. And you've met Dr. Steve Groft and Michelle Chang. And Dr. Conchita Pasz, Dr. Joe Fins, Dr. Ming Tian, George DeVries, and Dr. Veronica Gutierrez, at the extreme left.

And the way we're going to be working today is we're going to have each group of six or so will come up. Each person, as Steve said, will have three minutes. And then we'll have five minutes to ask questions. And we're going to choose only two commissioners probably will have a chance to a question of each panel. And if there, as Steve said, if there are other information you would like us to have beyond what we've said, please make sure you submit it to us in writing and be in touch with us. And again, the way to be in touch with us is through, and I'll be mentioning this throughout the day, so you'll forgive me if there's repetition, but as new people come in, there will be a commission staff member. And the staff are really the heart of the commission. They're the ones who make it possible for all of you to come. They, and for this meeting in particular, Michelle Chang, arrange people for the panels, and contact you all, and they will be your conduits to the commission. And so each of you will have an opportunity to meet with staff. For those of you who are not speaking, you can get in touch with us directly through the White House Commission office.

I just want to say a couple of words about us being here in New York. This is the one, two, three, the third of our town hall meetings. And we have two kinds of meetings. We have meetings of the full commission in Washington, D.C., where to a significant degree, to a major degree we set the agenda. For example, our next meeting is on professional education, licensure and credentialing on February 22 and 23 in Washington, D.C. So we decide pretty much who is going to come in. We ask people for written testimony, as well as to come and appear publicly. We have a particular focus on that topic. We also, incidentally, do have time for public comment on any aspect of the commission's work at all of our meetings.

The town halls are somewhat different. In the town halls, you all set the agenda. We have some thoughts, we have ideas, we know people in the community, we invite those we know. And we thought we would invite the people whom we had in mind to come, and we would have plenty of time left for the occasional person who might also want to talk. So we invited about 60 people, I believe, and there are about 70 or 75 more who have said, we want to talk, which is wonderful. This is exactly the process that we want. We want to hear from you, whether you're a practitioner or somebody who is coming for health care or an interested citizen or an advocate, whether you think that these therapies and these approaches have something wonderful to offer or whether you're extremely critical of them. We want to hear all the voices.

And the recommendations that we make, Steve spoke about our interim report. The interim report is going to be focused on a relatively small number of recommendations to the President and to Congress about legislation. And we want your input on those issues. But it's not only that we want your input, we want to remind you that legislation doesn't happen unless you want it to happen. That the reason there is an office, and now a national Center for Complementary and Alternative Medicine, the reason there is funding at the federal level, there reason there is a White House Commission is because people want it to happen. Because so many Americans are using these therapies, practicing these approaches, because people want a more effective, a more inclusive, and a more humane approach to health care. And if the recommendations that we make are going to go anywhere, it means that you all have to be our, not only activists on behalf of us, but activists on behalf of yourselves. You're the ones who have made it possible for there to be a commission, to be a national center, and you're the ones who are going to make it possible for the kinds of recommendations that we make based on what you tell us to become law. So this is a completely collaborative piece of work that we're all doing together.

And we look forward to continuing the collaboration. We hope that when we issue the final report, which Steve said will appear in March, that that will be a kind of synthesis of everything that we've heard, and we hope a blueprint for widespread change. So we look forward very much to this day. And as Steve said, again, we want especially, we want to hear your recommendations. That's what we're looking for. We want to hear a little bit about the situation that you're in. About where your knowledge and where your wisdom comes from, the experience that's brought it out, and especially we want you to tell us what you would hope that we would urge Congress and the White House to enact and why you would hope that we do that. So without further adieu, let's dig in with the first panel. Thank you very much.

Panel 1

Panel Coordinator, Dr. Joseph Kaczmarczyk

CHANG: Thank you. Would the following panelists please come up to the stage. And note also that Dr. Joseph Kaczmarczyk is the panel coordinator for this panel. So if you have any questions or comments, panelists, you need to see him afterwards. Dr. Ansel Marks, Margaret Buhrmaster, Caroline Rider, Stephen Lockwood, Simone Charlop, and Martin Rossman. Thank you.

GORDON: And when I call the panelists, I'm just going to go down the list as it is in the agenda. So we'll begin with Dr. Ansel Marks please.

MARKS: Dr. Gordon, distinguished commissioners, speakers, and guests, thank you for inviting me today to speak about the work of the Board and Office of Professional Medical Conduct. I do not speak for Commissioner Novello, however I can tell you that the commission has given us strong support in the work we have done.

The mission of the Board and Office is enumerated, and I've provided you with copies. But in part, the mission includes the following verbiage: to protect the public from medical negligence, incompetence, illegal, or unethical practices of physicians, physicians' assistants, and specialists' assistants. To deter the incidence of professional misconduct by physicians, to promote and preserve standards of medical practice which conform with applicable laws and regulations, and to respond to express public questions and concerns over the quality of medical care, which is a good segue into what we're doing here today.

The Public Health Law Section 230 provides for a board for professional medical conduct. The board consists now of 186 members. It is the largest board in the world of its kind. And the reason for its size is in part the law itself, which provides for extensive due process rights of physicians who are alleged to have committed acts of misconduct. The board is very diverse. It includes approximately two-thirds physicians and one-third public members. It's ethnically diverse. It is geographically diverse. It's diverse as to physician's specialty. As a matter of fact, this underscores the fact that the whole process includes the entire medical and lay communities in its work. This board and the law is sensitive to complementary and alternative medicine. As a matter of fact, the law provides that at least two members of our board be physicians who provide complementary and alternative medical care. And actually there are more than two, and we are currently soliciting additional qualified candidates to serve on the board.

At a recent annual meeting, an entire seminar was given to alternative medicine with distinguished members of the alternative medical community making presentations to our board, which meets in plenary session, at that time annually, now bi-annually.

This Board and Office is a reactive board. We have no agenda where we go after certain types of misconduct, other than for major fraud cases. So since we are reactive, in the year 2000 we received approximately 7,000 complaints.

My time's up?

MAN: Yeah.

MARKS: I will leave it with the thought that this Board and Office is very responsive to the agenda today. We're here to listen and learn and also to answer any questions.

GORDON: Thank you Dr. Marks. Three minutes is indeed very brief for everybody. And we're really sorry about that. And we welcome, as I said before, we welcome any of your thoughts. And as you look, as you, Dr. Marks in particular, and as others look at what appears on our Web site, we welcome your comments and your thoughts. So I think particularly in this area of licensing, of credentialing and disciplinary actions, we're going to be having a whole meeting on the 22nd and 23rd, so anything else you'd like to call, or if you'd like to call me personally I'd very happy to talk with you.

MARKS: Thank you doctor.

GORDON: Thank you. Next is Margaret Buhrmaster.

BUHRMASTER: Good morning, and welcome to New York State. As the old saying goes, I'm from the state and I'm here to help you. And I mean that.

I'm Margaret Buhrmaster. I'm Director of the Office of Regulatory Reform, New York State Department of Health. The Office of Regulatory Reform was created four years ago in an effort to mediate and facilitate the processing of health regulations and make them more user friendly, more outcome based and to try and develop sensible, rational regulations without overregulating people in the health care industry.

A year ago our office agenda was expanded to take a look at complementary and alternative medicine. And we expect over the upcoming years to be the facilitator and researcher in this process in New York State. We've received a number of inquiries in our office over the last year with very serious interest in this subject. And they've been received from all sectors of the health care industry, CAM providers, traditional medical doctors, facilities, educators, and, of course, consumers. And what we have learned is this is an area of health care with a great deal of conflicting information and the subject elicits a great deal of emotion, as we all know.

Today I'm not prepared to discuss specific recommendations, but I did want to say that we're looking at this from the perspective from what the state's role, the state government role should be in regulating or, as the case may be, not regulating CAM techniques or anything in the complementary area.

There are several areas that we're giving very definite attention to. One is CAM education curriculum. We've been working with some of the medical schools and realize that there is a genuine interest in providing adequate CAM education for new doctors, and also a continuing education for doctors. One of the big problems is finding the proper or appropriate education. And that's the credibility of the information that is being passed on. And I think that's discussed by people who have varying opinions on the subject. That how do you get credible information.

We found that probably the area with the broadest interest of concern is the issue of safety and education information on herbs and nutrients. And we really feel that that should be handled at the federal issue, but we're trying to become informed on it. We hope that we'll be able to dialog back and forth with you and collaborate on this process.

GORDON: That will be wonderful. Thank you very much. Caroline Rider.

RIDER: Thank you very much. Thank you for all the time, effort, thought, and concern you're giving to this project. It is very important for America. Second, the most important thing I have to say is please do what you can to help us as consumers get, if we are in a state where we don't have it, or retain if we are in a state where we do have it, the freedom to purchase complementary and alternative health care services through providers that we choose, trained the way we want them to be trained. Please, please don't advocate the spread of the traditional regulatory model for these services. Please don't try to apply uniform standards of education, training, or licensure to all CAM practitioners. Let the practitioners disclose their qualifications to me as a consumer and let me choose. Our present regulatory tools are clumsy, expensive, and not tremendously effective. Moreover, they take away the consumer's right to make a choice, informed or uninformed as the consumer chooses.

Although I can sort of see the logic in theory of having some specialist who is going to cut me open with a knife and do fancy things to my insides be qualified and overseen by other similar specialists who work for the state and have the power to license and de-license. In practice, in my experience that power operates more to limit the supply of practitioners and increase their costs than it does to uphold the quality of the work done, albeit the regulation is done with the best of intentions. And it certainly does not prevent the actrogenic(?) illness or death. How much less sense then does it make to apply that clumsy, expensive approach to those complementary and alternative health care services which have low risks of direct harm and/or side effects. Please, let my CAM practitioners be legal. Let them disclose their qualifications to me when I go to see them in their office, and then get out of the way and let me choose for myself. In the same vein, then, please don't have government required education and/or training for each modality. Let the practitioners themselves figure out what they should do. Let their professional associations debate these questions. Let the public vote with their feet. There's a very low risk of harm, so big brother is not needed. And the complementary and alternative health care field will develop, evolve, and blossom into ever more effective ways of helping people heal and be well, much faster and less expensively if the government does nothing more than make them legal and mandate disclosure.

Performance standards and practice guidelines set and supervised by regulatory authorities are not needed for the CAM community. As in many other fields, practitioners and their professional societies will develop peer certification, will publicize them. Over time the public will choose some certifications as being more valuable than others. The government should let this process take care of itself.

I do not have the ready unfettered access to complementary health care services that I would like to have. Because of a threatening regulatory climate there are too few practitioners in the Hudson River Valley where I live. Let me emphasize that I'm not some irrational wild woman or some knee jerk anti-science gook. Indeed, my undergraduate degree was in biochemistry with honors. I did my own research on the ATP . . . activity of dystrophic muscle in the mouse. Though I am now a practicing attorney and a ten year professor of management, I still subscribe to and read Science News. I think that western methods of scientific research are very useful for some problems and not for others.

GORDON: Stephen Lee Lockwood.

LOCKWOOD: Thank you Dr. Gordon and distinguished commissioners. I'm here to speak in support of federal legislation to protect CAM, or complementary and alternative physicians. I'm an upstate New York health care attorney, and I've represented several CAM physicians. The problem is that the state schemes that are set up to regulate physicians have a discriminatory impact upon CAM physicians, mainly because the regulatory staffs are uninformed and uneducated on complementary and alternative treatment modalities. And so they view CAM therapies as being different from conventional therapies and then prosecute the CAM physicians.

The effect of these disciplinary proceedings has a chilling effect on the patient's right to access CAM therapies. And I think what this legislation would really promote is the people's and the patient's constitutional right to choose what kind of treatment modalities they want. Now we all know here that there's two different paradigms, the conventional and the alternative paradigm. The one doesn't accept the other, certainly conventional doesn't accept often the alternative paradigm.

I'd like to give the New York State as an example. In 1994 New York State passed the Alternative Medical Practices Act which was widely hoped by many of us to settle out the situation. But it really hasn't. Although the Act mandates, and as Mr. Marks said, that at least two complementary and alternative physicians be on the Board of Professional Medical Conduct, it does not mandate that any CAM physicians serve on either the investigatory panels or in the hearing panels that assess the disciplinary proceedings of CAM physician. So it's just flawed because you're not being evaluated by anybody that knows anything about your therapy. And it's tremendously costly to defend, and it just raises havoc with a physician's life, his family and his patients. And in these types of proceedings too, and this not only affects CAM physicians, but no one ever knows who raised the complaint, who your accuser is. If you're charged with a crime you get to face your accuser. Not so in these disciplinary proceedings. I'm encouraged to see that the state is aware that it needs to educate itself as to CAM therapies, but I think federal legislation is necessary because only a few states have enacted laws to protect complementary physicians, and they're really not sufficient, as New York's is a good example. If you pass federal legislation it could be part of a patient's bill of rights. It could design to protect CAM physicians from discriminatory disciplinary actions, it could mandate education in CAM therapies for regulatory bodies and physicians. And it could require that CAM physicians serve on the investigatory panels and on the hearing panels that assess.

GORDON: Thank you very much. Simone Charlop.

CHARLOP: Good morning . . . I am Simone Charlop. I have been a recipient of alternative health modality for many years.

PEOPLE: We can't hear.

CHARLOP: How about now? I have a recipient of alternative health modalities for many years. I have seen remarkable results, both personally and with other people who avail themselves to these procedures. Some of the results were practically instantaneous, and some times it took a few weeks, and sometimes there were no observable benefits. But the same can be said of allopathic medicine. But the alternatives to which I refer achieve their results without harm and without leaving chemical residues in the body or using invasive techniques. I believe that methods which facilitate the flow of block energy or offer harmless supplements to enhance wellness are the methods I want for my body and for my family. As to a definition of harmless, the easiest way to determine what is acceptable to your body is muscle testing, a procedure developed by a chiropractor many years ago. And for those of you not familiar with this technique, I would suggest that you avail yourself of learning that.

And I know I am capable of deciding which practitioner is best for whatever the particular problem may be. I want to continue making these decisions for myself without any interference from anyone. That is the real issue. I decide. It is not of interest to me if the person I choose to see is licensed or registered or sanctioned in some way. In fact, I have no idea how you could possibly develop any standards or definitions that would cover people who do this work. Many combine many different modalities and then add their own particular tweaks and embellishments. That is what is so exciting about the field. Everything is individualized since every person brings his or her own history.

I, of course, do research before I see a practitioner. I learned about his or her training and years in practice. I speak to other clients and have a consultation with the practitioner. Then if the person seems right for me we work together. One of the questions people ask me is, do I see a regular doctor? The answer is yes. When I broke my leg it was set by an orthopedist.

But the important point is that I made the choice about that care. I would like to acknowledge and praise the focus of this hearing. The new recognition of alternative practices and complementary medicine is a step forward. It should be encouraged, but it should not be an excuse for the development and promulgation of new regulations which limit or deny access to methods used with success for hundreds of years and for stifling creative healing. Thank you and blessing.

GORDON: Thank you. Martin Rossman.

ROSSMAN: Dr. Gordon and distinguished commissioners, thank you for doing your work and for allowing me to speak to you. I'm speaking today on behalf of the Academy for Guided Imagery, a post-graduate training organization co-founded and directed by Commissioner David Bresler and myself. We've been doing research over the last couple of years on mind/body/spirit interactions in medicine, which has come under the CAM rubric, although we feel that it belongs in a much wider arena.

And our research indicates that there's a pressing need to provide education about mind/body/spirit effects at all levels of the American health care system. We believe that mind/body/spirit effects differ in important ways from other modalities currently considered in the CAM arena. First, because it's not a modality. It's really the context in which all other therapeutic interactions must work. It's inherent and immediates all therapeutic interactions. Secondly, there's already a significant body of published peer reviewed research that clearly demonstrates that mental, emotional, and spiritual factors significantly affect a person's health and well-being. The resistance to disease, the progression of their illnesses, the amount of suffering that they experience in the outcome of medical interventions.

Over the past two years we've been reviewing and assessing this literature and feel that literature already exists to support the following statements:

1. That the accuracy and completeness of information a patient is given and how they interpret it significantly affect their medical outcomes;

2. The way a health care professional communicates and interacts with patients can have significant affects on their medical outcome;

3. That a person's attitude that believes expectations and hopes about illness and healing materially affect their medical outcomes;

4. A sense of connection with people, nature, and something larger than themselves has significant effect on health outcomes; and

5. The skills of relaxation, imagery, stress management, meditation, assertiveness, and the ability to manage emotions can directly influence all of the above and it can be easily and inexpensively taught.

Because this literature is so strong yet unknown to most medical doctors, and even other CAM practitioners, we'd like to submit the following policy recommendation to the commission. That:

a. This literature be collated and reviewed by an independent panel and if it's agreed that these statements have already been proven, that an emphasis be placed on educating health care professionals and the public about what is already known in this field if choices have to be made about spending resources on education or research.

In the past 12 years the Academy has developed effective educational and evaluation methods in this field to teach both professionals and the public to work with consciousness in a way that honors both what is already known, and the underlying mystery of mind/body/spirit interactions. We would like the commission to know that we stand ready to assist the educational effort we recommend in whatever way we can.

GORDON: Thank you very much. I have a specific request, Marty. Please, feel free to applaud. I have a specific request. Is if you've put together that information, if you could submit that to us.

ROSSMAN: We will submit it. It's a bibliography of 193 selected articles that are appended to each statement, and we'll submit it to you.

GORDON: Wonderful. That would be very helpful.

ROSSMAN: Thank you very much.

GORDON: We have time for questions. So who would like to ask any of the panelists a question, real quickly? Anyone? A question. Yes, Effie.

CHOW: The gist of this panel, thank you very much for the enlightening delivery, seems to recommend independency, the general gist. And so do you see education, if you see legislation and regulation as not necessary, what about education of people who will know how to choose then, if you think that is, make comment about that?

RIDER: Yes. Actually, the one, if I could append one comment, I appreciate it and I applaud and I support the comments that have been made on this panel about a light hand on regulation of interventions that have been time tested and that are generally safe. And also I do think that good education and some form of evaluation and training is also necessary, because even these techniques, in unskilled hands or incompetent hands or unethical hands can be harmful.

CHARLOP: I would say that that's certainly true. On the other hand, education doesn't necessarily have to mean government required education, government specified education. I think if you take the situation of acupuncturists before they were generally licensed, it would take a bold person to assert that they were neither trained nor educated and that they were not evaluating themselves and each other. I think that they were doing that, and that was part of why they have been early recognized. So I think that education is, of course, necessary, but I think that all responsible professionals do that, will do that. And if it's clearly legal, they will also reach out to educate the public.

RIDER: I think also that there are many people who know about many methods and this information keeps spreading. And as practitioners become comfortable, if the imprimatur of being, practicing medicine is removed, then more and more information is going to get out there and is going to circulate. And I'm not sure that it needs anything formal. I think people are very smart and there are articles that are in mainstream publications now. There will be more and more of those, and people will learn.

GORDON: Other questions from other commissioners?

LOCKWOOD: May I respond to that real quickly?

GORDON: Sure, please.

LOCKWOOD: Thank you, Dr. Gordon. I think we should recognize that the relationship between the patient and their physician, or their healer, it doesn't have to be a physician, is really sacred. And that they should be allowed together to determine what the evaluation and treatment modalities are, and we really ought to keep government out of this, for the most part, except to promote a patient's right to choose and promote these therapies. These physicians, CAM physicians, are very brilliant people. And they've developed these techniques. They know. So the patients can learn from their physicians, and vice versa.

GORDON: I have a question, Dr. Marks. What's the major concern that you have about CAM therapies and CAM practitioners, sort of part one. And the other is, what about the concern that was expressed by one of the other panelists about not having these CAM practitioners on the disciplinary boards?

MARKS: Let me answer the second question first, and I address this to Mr. Lockwood's comments. We make every every effort to have on investigative groupings alternative medical physicians. We have a cadre of over 750 experts, physicians, in the state of New York, including many credentialed and qualified alternative practitioners. We call upon them to review cases with us. Additionally, we make every effort, when there's a judicatory panel, a hearing panel, although the law doesn't require it, to include as one of the two physician members on a three person panel, to include an alternative medical practitioner, if possible. So we do address those concerns.

Regarding the issues of concern that our office has concerning alternative medicine, I would say that we hold all physicians in the state of New York to national standards of appropriate practice. These standards are promulgated by experts in the field. We rely very heavily on these external experts to establish the appropriate guidelines to practice. One of the underlying themes that we do worry about is when an alternative medical practitioner diverts a patient from traditional medicine, instead of complementing traditional medicine, diverts them from traditional medicine with adverse results. That concerns us deeply. When an alternative practitioner complements traditional medicine, certainly we're highly supportive of that action.

GORDON: Let me as you a follow-up question. There are certain areas, for example, many different kinds of chronic illness, where conventional medicine may have some benefit, but you may come to the end of the benefits, or there may be areas where there is real disagreement as this whole new field emerges of complementary or alternative treatments. And so there may be people who elect, given the choice between the treatment that doesn't seem to have too much effectiveness or hasn't proved to effective that's conventional and that's regarded as standard of care, and another treatment offered by a physician that may not be standard of care, but is a nontoxic treatment that may be helpful. Does the board try to accommodate, to make that kind of choice more possible for consumers?

MARKS: Yes. We are sensitive to the issue that you raised. We recognize that patients have rights, inherent rights that transcend other statutory mandates, if you will, even transcend that. So we have to deal with this conundrum, and there are countervailing forces that are operative. And we have to take both the patient's right to select the kind of therapy they want from the practitioner they want, and our requirement under the law, under the police powers of the Constitution of these United States, to make sure that patients get appropriate medical care as measured by national standards. So we have those countervailing forces that impact on us. And it is a conundrum that we have to deal with, and we deal with every day, and we try to deal with it fairly.

GORDON: I think it would be very useful for us if you could give us some, I don't mean here, because it's too long, give us some examples of these conundra. And if you have any thoughts about what kind of suggestions we might make, not only to you but to other, what kind of guidance would be helpful to you, and perhaps to other boards as well.

MARKS: I certainly will do that, doctor.

GORDON: Great. Thank you very much. Thank you all very much, and we look forward to hearing from you again.

CHANG: Would the panelists who are leaving, make sure you touch base with Phil Kaczmarczyk if you have any further comments, and the same with our commissioners. If there are questions for this outgoing panel, to see Dr. Joe.

Panel 2

Panel Coordinator, Dr. Joseph Kaczmarczyk

CHANG: The second panel, would you please come up now. Grace Marie Arnett, Camilla Rees, Joseph Loizzo, Kevin Chen, and Leo Galland. Again, this panel being coordinated by Dr. Joe.

GORDON: We'll begin. Grace Marie Arnett.

ARNETT: Thank you Dr. Chairman, members of the commission and the excellent staff that you all have. My name is Grace Marie Arnett and I'm President of The Galen Institute, a public policy research organization based in Alexandria, Virginia, that's devoted to ideas that advance a more vibrant consumer-driven health sector. Many Americans are increasingly frustrated with the U.S. health care system because they face barriers to care. Access to care . . .

GORDON: I think you ought to come a little closer to the mike, they may be having a little trouble.

ARNETT: Is this a little better?

GORDON: Yes.

ARNETT: Thank you very much. Many Americans are increasingly frustrated with the U.S. health care system because they face barriers to care. Access to the care consumers want, sometimes complementary and alternative health treatments, is often blocked by either financial obstacles or by a lack of information about the full range of treatments available. Americans are frustrated with a system that puts someone else, either private or public sector bureaucracies, in charge of deciding what health they will or will not receive.

In addition to oppressive regulation and licensure requirements, one core problem is the way we subsidize health care in this country. Because of the way subsidies are structured, we literally give control over life and death decisions to bureaucrats and politicians who have never met us and who care more about a balance sheet than about our health and well-being. Until we get financial power back into the hands of the American people, these frustrations will continue to grow.

Let me explain about what I mean about subsidizing care. People who are either poor or old or young are very likely to qualify for one of several government programs, Medicare, Medicaid, or the State Children's Health Insurance Program. In these programs government officials make up lists of what treatments those who qualify are entitled to receive. Those who have health coverage through the workplace are eligible for the health plan, or if they are lucky, the health plans their employer selects for them and the benefits that those plans provide. It's virtually impossible for even the smallest plan to provide coverage that suits a particular need of each employee. We are at a critical point when real policy changes are possible that will begin to put power and control back into the hands of individual consumers. President Bush is proposing a tax credit worth nearly $2,000 to families to purchase their own health plans. This is the first time that individuals, rather than bureaucracies, will have a chance to decide the shape of their health coverage. It would dramatically increase opportunities for patients to have access to CAM treatments and to seek out information about them.

My primary recommendation would be that the commission investigate changes in tax policy that would lead to greater access to CAM in a new world, instead of having bureaucracies decide what treatments are and are not covered, people would be able to choose for themselves.

GORDON: Thank you very much. Camilla Rees.

REES: Good morning, and thank you very much for this opportunity. My name is Camilla Rees. I speak to you today from the perspective of a patient who has had chronic illness for over five years. I was very surprised when I learned being a patient in our health care system, especially the crushing realization that the insurance premiums I'd paid bought me and millions of others with chronic illness little value. Most of what was helpful would fall into the category of CAM. I suspect most individuals, including policy-makers, unless they have had experience with serious or chronic illness, do not realize there are deep rooted, misguided orientations in the health care system today that fuel costs and that contribute to poor outcomes that further fuel costs.

I will focus today on five issues I found to contribute to inefficiency and waste. My overriding policy recommendation to you is to see that these qualitative issues become quantified. I firmly believe the dialog with policy-makers needs to focus on the economic ramifications of the quality of care today, the root of the problem, and to associate CAM with the solution. The five issues are:

1. Doctors seem to have very little education about to support health and focus narrowly on drug solutions. Patients need information about how the human being works, not medical consensus on how to live our lives, but on what supports life across all dimensions and why.

2. The health care system is not oriented to looking for root causes of serious illness, including environmental causes that are very significant. We need to have courage to work at the root level.

3. There exists a slow serial approach to treatment, based on a single practitioner's limited knowledge, instead of on a much broader body of knowledge that exists. We need to lay out information as broadly as possible for each condition covering multiple perspectives and acknowledge the patient's wisdom and intuition are then crucial aspects of choosing the right solution. We need acknowledgement of the value of multiple perspectives and then investment in information infrastructure.

4. Physicians who practice outside orthodox norms are marginalized, if not investigated, resulting in a fear base culture, patient hesitation and confusion, and often unnecessary duplication of medical support. We need to stop private medical and dental associations from essentially using the power of the state through licensing boards to enforce narrow medical protocols, stifling competition in the name of fighting fraud.

5. The health care system is not . . . to results. There is no health goal in health care and no accountability. We need independent leadership in this sector to honestly highlight the structural flaws in the system, shine a light on their sources, understand their economic implications, and create vision for what the health care system could become. Again, I firmly believe the dialog of policy-makers needs to focus on the economic ramifications of the quality of care today, the root of the problem, and associate CAM with a solution.

Thank you very much.

GORDON: Thank you. Joseph Loizzo.

LOIZZO: Thank you, Dr. Gordon and distinguished commissioners, for coming up and for inviting all of us to speak with you. I speak with you as a complementary psychiatrist and founder of the Center for Meditation and Healing and Health Educational Center at the Columbia Presbyterian Department of Psychiatry.

And I'm just going to read a brief canned statement which I think is, for some of you, will be preaching to the converted. I think you already heard most of it, but. From the vantage of complementary psychiatry, the single largest source of waste in American health care today has been neglect of complementary methods of teaching consumers and providers time-tested, evidence-based practices of self-healing and health promotion, such as stress reduction and meditative practices.

The disease fighting strategies and provider driven interventions of American medicine are best incomplete and at worst inherently wasteful because they are reactive rather than preventive, and because they systematically ignore the single most important variable in disease prevention and health promotion, consumer health behavior.

While mainstream medicine has made remarkable strides in its fight against the obvious killers of modern civilization, heart disease, substance abuse, mental illness, and cancer, it has hardly begun to face the insidious killer behind all these masks, our own stress-driven, diseased-prone habits. Fifty years of stress research have shown beyond any reasonable doubt that disease-prone habits of mind and action exert a pervasive corrosive effect on mind and body by destroying natural systems of health and healing, of defensive healing, and leaving us prey to diseases of all kinds. Fortunately, stress research has also shown that stress reduction methods contain the healer, the killer within, and teach methods to unlearn disease-prone habits and build the natural stress, the natural self-healing competence of our body and mind.

The most effective methods of stress protection to help promotion to emerge from the new mind/body medicine, such as Dr. Gordon's own memo, "Body Skills . . ." Herb Benson's "Relaxation Response," John Cabisens(?) MBSR(?) and so on. Distill time-tested traditions preserved in Asian health care systems, such as Arivada(?), Chinese and Tibetan medicine, that were developed in societies without high cost, high technological medicine. These deserve to be singled out as the cutting edge of complementary and alternative methods because they've been shown to be among the safest and most evidence-based of CAM practices, and also because they directly target the largest source of waste in American health care, the systematic neglect of the patient's responsibility and right to act in pursuit of his or her own health care.

And my recommendations are briefly that in the short run that insurance reimbursement for mind/body programs that teach self-healing methods be pursued. And in the long run, that public and professional awareness at all levels be pursued by building in stress reduction and self-healing education into all professional health education.

GORDON: Thank you very much. I want to make sure, is the level of sound okay for everybody? A little louder? Okay. Great. Kevin Chen.

CHEN: Thank you, Dr. Gordon and commissioners. I'm a research scientist who is interested in CAM research and also especially Chi-gong(?). In the past few years I have witnessed many miracles among Chi-gong practitioners, such as disappearance of breast tumor in minutes, an incurable leukemia completely cancer free in two months. And chronic arthritis pain disappear in one treatment. I was really feel challenged by those miracles. However, when I start theories in these . . . phenomenons in terms of research I found myself in a very disadvantaged situation.

Because there are huge obstacles there for us to conduct research in CAM. That including first: fear of losing credibility among peer and . . . agency. Scientists, that other people tend to believe only what they consider reasonable and acceptable, and have a lot of prejudice and discrimination against the nonconventional medicine.

Second, lack of minimum funding to conduct . . . research. If you are serious about effectiveness of CAM, you may have to use your own time and the money to do research. Because . . . lack of minimum funds to do your research. And even though we have $90 million of budget for in CAM this year, but that is only one half of one percent of $20 billion NIH budget.

Third, lack of physical training and the knowledge of CAM among scientists. Most of scientists don't know what they're looking for in CAM research.

Fourth, it is very risky for original medical scientists to make a career transition from conventional scientific research to CAM research. You may lose opportunity to publish, lose opportunity to get a grant, and to getting promotion. You might even lose your job if you . . . in this area.

And please allow me just to remind you of a fact. If one-third of the university budget comes from the pharmaceutical company, just who will not risk lose those funds by supporting research that might conflict with those pharmaceutical industry.

So in short, it is still very risk for scientists to get involved in CAM research. So my recommendation will be dramatically increase the budget of funding the CAM research. Both consumer and scientists need it. The second, to avoid the influence of the various interests group . . . CAM into a different research institute, or add a special office for each institute to support CAM research.

Third, establishing more centers for the study of CAM funded . . . so they can play actively in both education and research. And decide what to do research independently.

Fourth, establish some special mechanism to founding an NIH to encourage more scientists to make a career transition to become a specialist in CAM research.

The last, pay more attention to education and training, and educate the current and the future scientists and the medical practitioner about various CAM therapies. The CAM therapies really work as other . . . medicine and medical education. Thank you.

GORDON: Thank you. Thank you for making so many succinct recommendations. We appreciate it. Leo Galland.

GALLAND: I'd like to thank the commission for giving me this opportunity to speak. Unfortunately I didn't receive the E-mail requesting me to bring copies of my presentation. I'll be happy to send those afterwards, and I'll speak just directly without notes, which is the way I prefer to do it anyway.

Briefly, there are two kinds of points that I'd like to make. First I would like to support what I think is going to be the general tenor of the commission's recommendations, which is the recognition that what we're really talking about here is holism in health care in the real sense of the word, rather than the integration of techniques that are considered exotic into conventional medicine. The aspect of conventional medicine, which I think is responsible for everyone being in this room is a particular perspective, which is the source of what alarms most of us about conventional medicine. I'm a practitioner and a teacher, an M.D. Which is the perspective that equates illness with disease. It makes the disease the focus of intervention and is inherently depersonalizing. And out of this perspective comes not only the depersonalization and the lack of respect for privacy, but the tendency for conventional medicine to be overly invasive. And there's just a whole range of effects, including the lack of respect for the process of dying that come out of this disease oriented focus.

All alternative healing systems, whether they're ancient or modern, no matter how much they differ among themselves, share one perspective, which is the view that illness is the result of imbalance or disharmony. And that's a perspective that is consistent with science and really needs to be incorporated into the approach that's taken.

Two concrete recommendations. Number one, with regard to medical education, students need to learn about CAM modalities from the perspective of this alternative; that is, these are about restoring harmony and balance, they're not about treating disease. When it comes to research, we can't allow CAM research to follow the rules that have been established to support the disease centered model. Now with conventional clinical trials there are many patients that are excluded because of comorbidities. After all, you can't have somebody with too many different diseases, it muddies the water. Those are the patients that should be specifically selected for CAM research. Those people have a lot of comorbidities.

Thank you very much for your attention.

GORDON: Thank you. I said it to Dr. Chen, but I want to say to the whole of you that we really appreciate your concision and the recommendations. One of the things that I'm experiencing listening here this morning is the reinforcement and the elaboration of many themes that we've been hearing over the last seven or eight months. And I think that it's, some people have said, well, three minutes isn't very much time to talk. But I think for those of us who've been hearing so many people over this period of time, it's helping us immeasurably to get clearer about what the fundamental kinds of recommendations. As we hear them again and again, worded slightly differently, with slightly different perspectives and slightly different information and glimpses of very power experience, I think it's shaping all of our perspectives and will be very important to us.

We have some questions from the commissioners.

BRESLER: For Dr. Galland. When you say doing comorbidity research, do you have concerns that if we're using multiple modalities, multiple orientations and so forth, what kind of conclusions we can draw based on that?

GALLAND: I think the conclusions, the end points should be global indices of health and quality of life, rather than surrogate end points that are narrowly defined, which is what tends to happen in conventional medical research. And if you use those there may be issues about how do you compare one group with another, how do you control it. I think those need to be dealt with, but I think it's possible to do it.

In rheumatoid arthritis research, 90 percent of patients with rheumatoid arthritis are excluded from conventional research because of their comorbidities, and it doesn't make any sense that you then draw conclusions about the best treatment for the disease from the ten percent of patients who are permitted into the study and then try to apply that to the 90 percent who are excluded.

GORDON: Do you have any statistics on the, have you taken, I know it's a general impression, but I'm wondering if you pulled together any data on those exclusion criteria that you could?

GALLAND: I can get those.

GORDON: I think that would be very helpful for us. Other questions. Just raise your hands if you have a question. Anyone? We have time.