Panel 6 Ė cont.
Panel Coordinator, Corinne Axelrod
EFFIE CHEN:† And similarly with the sports, are there studies that you have collected on the value of like yoga or Chi Kung (Chi Kung) and all these natural studies?† How can you foster, so the next level is marketing, like fostering marketing of the sports person who is top notch and have used these methods, instead of just always the drug that was the negative part?
SHINNICK:† Well, we really have two sides.† We have the synthetic drug scene, and we . . .
GORDON:† Phil, come closer to the mike, please.
SHINNICK:† Actually, we have those two sides.† We have the anabolic steroids and myself, who was an Olympian, only used yoga.† And I still compete on a swim team and Iím fifty-seven and I still do yoga three times a week, and gung fu.† There are studies, mind and body, doing yoga that are existing.† I think that what we really need to do is to create some sort of mechanism where this information can get out to all the people and the public at large.† Itís a tremendous thing.† Chi Kung (Chi Kung) is a tremendous thing for anyone at any field.† I think that the whole area of CAM and this drug thing have to be combined.† On the one hand, we say we donít like this.† On the other hand, weíre talking about the increase in human potentiality, which doesnít require anything more than synchronizing.
CONNOLLY:† To partially answer your question, with the existing organizations that do test and have been collecting this data, we need to get them to publish it, but it isnít publishable because these tests were punitive drug testing.† So Iíd like to see that this information be publicized by gender, by race, by geographic area, not for the purposes of punitive testing, but just to know how many athletes in Sydney were using substances that looked like banned substances or were asthmatic or were using those things.
GORDON:† All right, thank you.† Thank you very much.† Thank you all very much.
Panel Coordinator, Kenneth D. Fisher
GORDON:† Weíll begin with the panel now with Renate Siekmann.† Okay, please.
SIEKMANN:† Good afternoon.† I come today as a mother of four children.† All of my children . . .
GORDON:† Come closer to the mike, please.
SIEKMANN:† I come today as a mother of four children.† All of my children have benefited tremendously from alternative forms of medicine, especially homeopathic treatment.† One of my sons came down with a double ear infection and double conjunctivitis when he was just a toddler.† He was given a powerful antibiotic by our pediatrician.† The result was such bad diarrhea that he began bleeding from his anus.† For a year and a half after that he had daily stomach cramps, diarrhea, and vomiting.† My pediatrician had no solution.† I finally found a homeopath who was able to cure him and return him to the old self he had been before his ordeal began.
††††††††††† Another one of my sons came down with a bad case of eczema as an infant.† My pediatrician suggested using hydrocortisone cream, an option unacceptable to me.† I would not use that type of medicine on myself and I will certainly not put it on my three-month-old son.† Again, homeopathy came to the rescue, and within ten days of treatment, all eczema disappeared.† I would be happy to give you many more examples where homeopathy in particular has been a wonderful and effective form of treatment for my family and myself.†
I feel that allopathic medicine is doing a wonderful job in trauma care, and we would certainly never want to be without everything it has to offer.† However, there are many illnesses where treatment is either ineffective or can even be harmful.† There are wonderful gentle alternative therapies, which have survived the test of time.† Homeopathy, for example, has been used successfully in Germany for over two hundred years, longer than most forms of allopathic treatment.† In Germany, as well as many other countries in the world, natural alternative forms of treatment are available to the patient by specialized practitioners as a compliment to allopathic medicine.† It is up to the patient to decide which type of treatment he or she prefers.† Freedom of choice is what itís all about.
I feel that it is important that the patients are given the choice.† Let the different forms of medicine work hand in hand and allow the consumer to choose freely without breaking the law.† Let the trained practitioners practice freely without breaking the law.† This type of system works beautifully in many other countries, and it can work in this country as well.† Letís all work together towards one common goal, a healthier population.
GORDON:† Thank you very much, and thanks for the pictures of your children.† If you donít need any of them, Iíll be happy, oh, theyíre yours.
SIEKMANN: †Was mine.
GORDON:† Iíll be happy to take those home.† Sheldon Lewis.
LEWIS:† Thank you.† As a journalist, Iíve covered alternative and complementary medicine for more than twenty years.† As a parent, Iím the father of an almost seventeen-year-old young man with special needs, who, depending on the label of the moment, and the labeler, has been diagnosed with pervasive developmental disorder, Asperger syndrome, Turrets, ADHD, and many more.† For seventeen years, my family and I have dealt with pediatricians and medical specialists, who, for the most part, know little about human development.† By which I mean the development of the whole person, not just his or her body.† And they know even less about healing, and by that I mean changing our relationship as individuals, families, communities, and society with illness and disability and health and ability.
††††††††††† On our own as case managers, driven by hope and desperation, my wife and I sought help from other approaches to health and healing.† Homeopathy, chiropractic, craniosteopathy, nutrition, environmental medicine, reiki, meditation, prayer, social therapy, movement therapies, and many others, most of which were helpful.† But most parents donít have the resources, the knowledge, or the finances to get the help they need.† Just as a medical model is limited, so, too, is a scattershot approach to alternative and complementary medicine. †In both cases, youíre searching for a magic bullet where none is available.† In our case, conditions havenít been cured, problems havenít been fixed.† What has ultimately been the most healing has been the journey, the conversations, the love, the interactions with caring people, and building a life for both our sons and our family.
††††††††††† Children donít develop medically.† They donít develop homeopathically.† And they donít develop chiropractically.† They develop socially, intellectually, emotionally, and spiritually, as well as physically.† Unfortunately, in the current climate, physicians, educators, therapists, healers, and parents generally operate independently of one another, which results in a fragmented anti-developmental non-holistic model.† One of the great triumphs for my family has been to get a school psychiatrist to talk with a neurologist who prescribes essential fatty acids, to get a Freudian school social worker to talk with a performatory psychotherapist, and to get everyone to talk to us, the parents, and most of us to talk to and listen to our son.† He is the one truly holistic member of our team.† He talks to his doctors about prayer, amino acids, and blue green algae.† He teaches his therapist and friends to do deep breathing and other mind body techniques, which he calls preventions.
††††††††††† We need to follow his example and create new models that include every aspect of a childís development, including the family, the school, and the community.† We need to make information, support, and care of all kinds available, accessible, and affordable to all parents so that they can make informed choices for their children and their families.† We need to build new models so that people who raise and teach and treat and heal and help children and their families can talk to each other and listen to each other and learn from one another and work together for the collective healing and development of ourselves, our children, our health care and educational systems, and the world we all live in.† Thank you.
EKAIREB:† I passed the photographs because I feel that Iím here in front of you as a mother of two children, but representing all children.† And I hope that their image will give us a focus today for why weíre here.† Iíve added to what I have to say, the acceptance speech to the Swedish Parliament at the presentation of the right livelihood awards by George Vitholkiss(?).† He is a homeopath with four decades standings and a world renown.† Iíd like to start with his definition of health, which is that health can be defined best by the word freedom.† Freedom from pain on the physical level, having a feeling of well being.† Freedom from passion on the emotional level, having a feeling of dynamic serenity and calmness.† Freedom from selfishness on the mental and spiritual level, the individual having a connection with truth or God.†
††††††††††† As I look at my background, I think of my grandparents, who were Christian Scientists and enjoyed the freedom of religion in this country.† From them I learned that physical disease stems from an unhealthy mental state.† I questioned whether we know look at the freedom to choose on medicine in this country.† Because what happened in my history is my father developed fibromyalgia thirty-five years ago.† He did not have choice.† He did not have information.† They did not diagnose it properly so they just medicated it.† He went on a narcotic for over twenty-five years named Talwin(?), and about two years ago, as his body was breaking down from all of the medication and it was not working, they switched him over to methadone, which he now takes twice daily for the rest of his life.
††††††††††† I ended up marrying a man, who is now a recovering addict.† He started with the antibiotics and other kinds of drugs, but his major drug of choice was marijuana.† Why?† He suffered from a restless state in his body, his legs and fingers, that always moved in a hurried mind.† His problems have never been addressed.† From this genetic background, two children were born.† Rachel is now ten and David is seven.† Rachel developed secondary infections with each viral infection she caught, virtually from her first year.† By her third year, she was on antibiotics to such a degree that the pediatrician had me give her a daily dose throughout the winter months.† I needed to find another solution.†
I went outside the typical realm of medicine and I found homeopathy.† I was drawn to it because homeopathy can cure viral infections and, therefore, before bacterial infections.† She has now been free of all bacteria and strep infections for three years.† I hope youíll listen for a moment for my son.† My son David was born in a lower state of health than his sister.† He had immediate lung and digestive and neurological problems.† It was clear, from early on, that his neurological system had problems that resulted in strong over sensitivity to his environment, noise, touch, and light.† Yet on other levels, he had no sense of boundaries or pain.† From the night he came home from the hospital he woke screaming with terror.† Holding him gave him no sense of comfort.† Most often he would scream as someone tried to approach him, and then when they withdrew, he screamed louder as being alone was even more terrifying.† There would be a wild vacant look in his eyes, and it would take about twenty minutes of just being with him before he would become calm.†
We started weaning him from naps at eighteen months because this transition from sleep to consciousness was so terrifying for him and so painful for us to watch.† I felt so helpful to comfort him, and it was so clear that he did not have that sense of security and safety that is so vital to a young child.† His deep state of mental terror was expressed physically by lack of impulse and hyperactivity.† His emotions were extreme and easily triggered.† He was crawling by five months and running by nine months.† He was the textbook model of the difficult child, and quickly labeled by adults as ADD or ADHD.† His behavior became more hostile.† He became more difficult to control and hitting, biting, scratching, and screaming were daily events.† He required enormous energy from me and his teachers.† Keeping other children safe was often a major issue.† There were days when I thought I would lose my mind.† The constant stress of his behavior affected the entire family.
GORDON:† Excuse me, Iím sorry to interrupt.† But I wonder, I promise, and we all will read the testimony.
EKAIREB:† May I just tell you that he was given a homeopathic remedy two years ago.† You can look at this child today.† His terror is gone.† He remembers his dreams.† In fact, this week, he dreamt of a little girl that he has a crush on.† He is at the top of his class.† He can behave like a normal child.† Twenty-five percent of the children in my daughterís fifth grade class were tested for ADD and such things.† Parents are looking for options and solutions.† I can refer them to homeopaths, but these people are practicing outside the law.† Please help us to get solutions for these children.
GORDON:† Thank you.† I appreciate the testimony, and when it comes time for questions, we will come back.† I appreciate all of you, all parents, coming here and talking about these issues.† And we want your guidance, and we will be asking for it when everyone is finished in what kinds of recommendations, what kinds of regulations, what kinds of congressional activity, which is really our domain, we should be encouraging to make it possible for your kids to receive therapies that are safe and are helpful for them as well.† So, thank you.† I realize the emotional power for everyone and for all of us as well.† Itís important that we hear the testimony and itís important that we try to formulate together ways to act.† Thank you.† Jordana Sontag.
SONTAG:† Before I begin, Iíd just like to ask the commission to take a peek at the back of the room and acknowledge my son, Jacobís, attendance.† Of no insult to any of us, heís decided to take a nap, but I do want him to be acknowledged.
††††††††††† My story begins in 1996 when my son, Jacob, was born and then six months later diagnosed with Canavan disease, a fatal neurological genetic disorder.† After being told Jacob would never hold up his head, sit, crawl, walk, or say a single word, I was horrified to further learn that he would develop seizures, lose his ability to see, hear, swallow, and would die within the first decade of his life.† Even worse than the diagnosis was the reality that there was no treatment to save my baby.†
What I thought would be an endless journey to search the world for any hope of a treatment was not that at all.† Within a month I had located researchers from Yale University in the Auckland School of Medicine, who had successfully treated two Canavan children with gene therapy in New Zealand, and were planning to treat fifteen Canavan children in a U.S. phase one clinical safety trial.† Jacob was enrolled.† In January of 1998, after an extremely lengthy review process through the NIH, FDA, and the internal review boards at Yale, Jacob was finally treated and treated once more in September of 1998.† Jacob improved dramatically, but most impressive was his ability to generate new white matter in his brain.
As I sit before you today, Jacob, again, waits for the approval of yet another gene therapy protocol that, according to the researchers, is safer, less toxic, and technologically advanced.† Whether prior therapy successfully reached a few areas of Jacobís brain, data indicates that the new procedures will deliver the gene critical in saving Jacob to all the areas of his brain.† With the excitement of this potential treatment comes the reality that Jacob deteriorates before your eyes as we wait for a review process that began back in May.† While I am told by FDA officials that the review process is to ensure the safety of my child, I often respond by saying why isnít the FDA equally concerned that Jacob could die because of lengthy reviews.
Because of the orphan disease status of Canavan, there is zero federal funding that supports research in this horrific disorder.† In addition to the emotional and physical toll taking care of my child has taken, Iíve also been given the responsibility of raising the funds necessary to support research with the potential of treating Canavan.† For an agency that prides itself on working hard to provide the public with safe effective treatments, Iím amazed at the snailís pace and lack of regard the FDA has for terminally ill patients and their families, who have no alternatives.† They seem at rest with the fact that because they are taking an unethical amount of time to ensure safety, and patients may die while doing so, there is some sort of justification.† I can assure you there is never justification for a parent who must bury a child.
In my summation, Jacobís ethical right to receive a treatment that may stop the progression of Canavan, improve his quality of life, and potentially treat or cure him is denied with each passing day he waits for an approval from the FDA.† It is my belief that protocols involving terminally ill patients must be reviewed more expeditiously and with different standards.† I would propose the following: for experimental research and preparation for clinical trials involving patients quickly deteriorating from terminal illness, there must be prior knowledge of the FDAís demands, a review process that begins prior to submission.† Researchers and patients and patient representatives should be able to have open dialogue with the FDA to discuss protocol intentions, collection of data, risk benefit ratios.† The FDA needs to have more interaction with the patients, or the protocols theyíre reviewing, to understand the magnitude and the necessity for treatment, the patientís knowledge of the alternatives, and the desire of the patientís choice of treatments.
Upon submission, the FDA should be required to respond within two weeks.† If there are further requests from the FDA that the researchers and patients deem unreasonable, and we create an unnecessary delay, then the patients or family members should be able to waive the approval from the FDA and sign an informed consent to proceed with the treatment.† An oversight committee must be created to protect patients and oversee the FDA.† There must be a balance.† As stated by our local congresswoman, Nita Lowy, if there is a level of comfort, parents or patients are informed and know the risk, and there are no other options, then we must move ahead and treat the patients.† I thank you for this opportunity to share with you my precious Jacob and the struggles we live through every day.† I hope that our testimony will make a difference and, most important, save lives.
GORDON:† Thank you very much.† James Navarro.
NAVARRO:† Distinguished panel, if you will notice, there is nothing in front of you written from me, and I have maintained this posture even with Congress because itís very hard to put seventeen months of struggle onto paper.† I will, however, be submitting a written testimony by e-mail later.† I am Jim Navarro, the father of Thomas Navarro, who is a terminally ill five-year-old child suffering from medulloblastoma.† And as Iíve listened to the speakers today, the one thing that keeps coming back in my mind is freedom.† We have no freedom.† As Americans, as occupants of the country that claims to be the bravest, the greatest, and the freest, we have no medical freedom.†
††††††††††† We learned early on, in September of í99, when my son was stricken, and, by the way, only days away from death, that after he had been admitted to a hospital for treatment that we, as parents, had no legal right to be involved with the doctors or the treatment process.† That, in fact, if we stood in opposition to a suggested treatment, or method that the doctors wanted to do, that we could be imprisoned for child abuse and medical neglect, and our child taken and treated against our will.† But the greater horror to this was the fact that if, in the process, our son died that there was no civil or criminal liability on the part of the doctors or medical institution.†
††††††††††† I find it a great tragedy that today, with our abilities in technology, science, and medicine, that we are still administering a failed therapy.† And I say failed therapy because of the fact that, for those of you that are doctors, if you have ever read the insert to the chemo drugs used on children, it says there, in plain English, that it has not been proven safe or effective in pediatric application.† So I pose this question.† Why, then, are we forced, why are we herded like cattle, to subject our children to these treatments that could cost them their lives?† Who will replace my son when he dies?† The question boils down to this.† Who decides?†
Iíve testified a number of times before Congress, and some remember that when I testified and the doctor from the FDA, who had sat in opposition to us, and, in fact, refused six appeals for Thomas to receive treatment, admitted that he didnít even have knowledge of my sonís illness or any background history.† And in that moment in time, I had greater understanding and knowledge of my sonís disease than the person that were allowed to sit in judgment over us.† So I think before we can embrace new veins of medicine, or types of medicine, we must first recapture our freedom.†
GORDON:† Thank you very much, Jim.† Jordi Ross.
ROSS:† I want to thank the commission and Jim Navarro for inviting me to speak here today.
GORDON:† Come a little closer.
ROSS:† I feel a little out of place among such a distinguished group of panelists, but I hope my perspective as a filmmaker can be of some benefit to your mission.† For the last year, I have been working on a documentary about cancer.† I call it The War.† It is the story of how Jim and Donna Navarro have fought to keep their son, Thomas, alive.† In my fifteen years in the film business, no story has moved me as much as the plight of Thomas.† As a studio executive in Hollywood, I was involved with three films of which I am proud, Kundun, the story of the Dalai Lama and his struggle for his homeland, the Insider, the story of how tobacco executive Jeffrey Wigand testimony helped to break the tobacco lobby, and a Civil Action, the story of attorney Jan Schlichtmannís litigation against polluters in Massachusetts.† I donít know if you have seen any of these films, but they share with the story of Thomas the belief that the courage of one individual can have a positive affect on the lives of many.
††††††††††† I believe the courage shown by Thomas Navarro and his family, their willingness to go up against the FDA, and the medical establishment will be seen as an important turning point in the project that brings all of you here today.† I want to share a brief story with you.† When I began filming this documentary, and I hadnít met Thomas yet, I used to do this little experiment.† I would go up to random people in the street and ask them to do a word association game with me.† Iím sure youíre familiar with the game.† I would rattle off a number of words, and about seven or eight words in, I would drop the word cancer.† Iím sure you can guess what I got back in response.† I would say that eighty percent of the time the word I got back was death or pain or dying or something to that effect, and I think that is significant.
††††††††††† Now, this was not a controlled experiment and it was not a random sampling, so Iím sure itís of no real value and it will definitely not get published.† But as a filmmaker, I was intrigued.† To me this meant that a large number of us are walking around, and when one out two or one out of three, or whatever it is, I donít know what the numbers are, are diagnosed with cancer in the future, many of us will believe that we have been handed a death sentence or at least a long period of time with a torture.† I wouldnít say that this is a healthy state of affairs in a country whose medical expenditures dwarf the GNP of most other nations.
††††††††††† So when I first started the documentary, I said to myself that if I could change even one personís belief, that a cancer diagnosis did not have to equal death, I would have done my job.† And then I met the Navarros and I realized that nobody could make my case more eloquently than this family, who have defied all the odds and who believe that the power of love and the power of a parentís love for their child, more than money and more than drugs and more than high tech cures, can keep a child alive.†
GORDON:† Thank you very much.† Would any of the commissioners, yes, Joe?
JOSEPH FINS:† Ms. Sontag.
GORDON:† Joe, come close to the mike.
FINS:† Ms. Sontag, itís a pleasure to meet you and I read the article in the New York Times magazine section a couple years ago, and itís nice to meet you and your family.† What would you recommend as a policy or some sort of recommendation for the FDA?† Should there be an ombudsmen, someone who could represent family interests in the federal bureaucracy?† You know, when you have to interface with this massive building and no one knows whatís going on, someone who can sort of be your advocate, the peopleís advocate in the face of the bureaucracy.† What kind of concrete recommendations can you help us with so that you donít face an impersonal bureaucracy?
SONTAG:† Well, I think your point is well taken.† Since waiting since May for this review process, which, I will say, has been politically driven.† There have been some recent events in the gene therapy field that have caused some delays, and my son is being tangled up in that tidal wave of a bureaucratic nightmare.†
GORDON:† Jordana, come a little closer to the mike.
SONTAG:† I donít have anyone to turn to.† I have nothing to do, but to wait.† There is no agency.† There is no commission.† There is no parent representative.† That is there is nothing set up to help patients that are fighting this fight and just simply trying to save their childrenís lives.† So, yes, I agree with you.† If there was some type of oversight committee that would keep the FDA in check and to watch over my sonís ethical rights to a treatment, then, yes, I wholeheartedly agree with that.
GORDON:† Thank you.† Iíd like to open the question that Joe just asked up to all of you.† Are there other suggestions, Jim, or any of you might have for making it possible to have access to some of these therapies.† Yeah, please.
EKAIREB:† There has to be the freedom for people to be educated and to practice these disciplines with freedom in this country.† Today weíve just heard from a panel of what sound to be very qualified doctors, who have been persecuted for helping.† I mean, the intentionality of these people was so strong, and yet what weíre finding is there is something about the way the system is operating that theyíre being closed down.† And I, as a mother, and I hear this, I am so lucky that I have the finances that I can go to a homeopath that is legal, but I talk to people.† They canít afford $700 for an initial consultation.† This should not be the way it works.† We need to get good schools with licensing and certification.† We need to have people be able to explore these disciplines with freedom the way they do in other countries.† And the whole background of education because doctors are so burdened with what they learn.† I mean, itís phenomenal the amount of information that goes into the medical community and into the pharmacology that we have today.† But then there are whole other realms that are outside that domain and they need to be stimulated and flourished because the pain you heard from me is what I hear from too many other parents today.
GORDON:† Thank you.† Jim, were you?
NAVARRO:† Yeah, one of the things, Dr. Gordon, that Iíd like to bring up is during this seventeen months with Thomasí struggle, I took the time to educate myself.† I donít think itís an issue where weíre denied access to education.† I think what we have to do is break the chokehold of the old guard.† If thereís going to be any type of a review panel with the FDA, or even amongst yourselves, it must, in fairness, include parents like us that are living this nightmare.† One of the things that changed the dynamics of my relationship with the FDA was the fact that I made it a point to bring Thomas to the doctorís attention.† Thomas was no longer a number.† He was no longer a name on a piece of paper.† When I put Thomas in front of him, and there had to be physical contact and he had to look in his eyes, it changed the dynamics.† So often they shield themselves.† Itís a disservice to those of us that are out there struggling.† The panel definitely needs to be a reality, and it needs to happen now.
††††††††††† Itís interesting that when Jordana and I first met, one of the first things you do is compare illnesses.† And it was interesting that the common denominator between our children is that theyíre both terminally diagnosed.† Also the fact that neither one of them, according to standard knowledge that is available now, will survive their illness.† But I found myself becoming envious of her in that, whereas Thomas is alert and appears to function as a normal child that Jacob will live five times longer.† Thomas is now in the last months of his life unless we change this.
GORDON:† Thank you, Jim.
LEWIS:† My wife and I were also threatened by a physician who was going to take legal action against us because we wouldnít let them cut our son open and insert a tube so that he could, because he wasnít gaining weight when he was very little.† We had quite a fight on that, but we instead took him to someone who put him on an elimination diet, and we went to a homeopath, and he started gaining weight.† We get, my wife and I get, calls from friends of friends of friends and relatives or relatives on an almost weekly basis asking for information.† People donít know where to turn.† We need to create some kind of parent information network or a way that parents can support one another because really most of the medical specialists that you go to when you have a child in a life threatening situation donít really have this information.† The experts are really the parents and the complementary practitioners who have been working with children and their families.
GORDON:† Thank you.† George, I think you had a question.† Did you have a question?† I, on behalf of all of us, I really want to thank you all for coming.† I think itís, my hope is that out of the pain that you and your families and your children have suffered and are suffering that somehow all of us will learn what we need to learn, and it will help us have the force and the energy and the wisdom to open this system up so that whatever we have available that may be helpful is available to everyone.† Thank you very much.
MAN:† Thank you for including us.
Panel Coordinator, Dr. Kenneth D. Fisher
GORDON:† One thing I did want to say as weíre getting ready for this panel is I do feel itís so important for all of you, not only who are speaking with us, but who are working to change and enlarge and improve the health care system to bring . . . real human face of these issues to the people who have power to make those changes.† Iím definitely going to keep this picture on my bulletin board.† So, thank you.† Next panel, Robert Schiller.† Hello.
SCHILLER:† Thank you for this opportunity.† I just want to comment on the previous panel, and I think, although Iím going to address certain issues related to larger systemic problems, I think itís important for all of us, either as practitioners or people who access the system, to understand that the driving force of a lot of this is what the peopleís personal lives and personal struggles around health care and how this country really needs to address these issues and involve all of us as people who have to use the system and suffer with its limitations.†
††††††††††† I want to address the issue of public health and how we can try to heal the system, in addition to how we attempt to heal our patients.† The recent expansion of complementary and alternative medicine to various medical settings has brought profound benefits to many sectors of the health care system.† However, these achievements have benefited only a fraction of the population.† People with inadequate health coverage have little or no access to these therapies.† Ensuring equal access to CAM for all citizens should be of the highest priority for health care reform.† I believe there is a tremendous opportunity to bring the reform of public health care policy, together with the expansion of the practice of CAM, in an effort not only to correct this inequity, but to address many of the other problems of the health care system.†
††††††††††† As complementary medicine has reintroduced healing in the mind body connection into conventional medicine, so can these practices bring public health back into the sphere of the medical mainstream.† The key to bringing public health and medicine together exists in strengthening the system of primary care and enhancing these services with the integration of complementary medicine.† I am a family physician with over fifteen years of experience, mostly practicing in lower Manhattan.† Although Iíve received training in acupuncture, I currently practice mostly homeopathy with general family practice patients.† I have learned from various practice experiences that it is essential to build complementary therapies upon an existing successful primary care practice.† Primary care is the most efficient and effective way that people access the health care system.† A primary care team is a model of collaboration and integration of services.† And complementary therapies can be part of the routine referral network for this practice.
††††††††††† From my early years as a resident until now, I believe that beyond broadening the therapeutic options for the patient, the real potential for CAM is in its ability to potentially radically transform the health care system.† Many of us were drawn to learn about these methods because we knew of the fatal flaws in our training and in the practices where we cared for our patients.† We hoped, even expected, that the widespread use of these therapies would promote a more caring system, one that would be devoted to healing and encourage the curious critical use of new or ancient unconventional therapies.† The excitement, enthusiasm, and positive results of CAM practitioners experienced in the exam room need to be extended to the surrounding community in the form of health education, health promotion, and health care reform.† Racial and economic disparities in providing even adequate care has been highlighted among the more important health care issues in this crisis.† Now it is time to correct these disparities and access to CAM.
††††††††††† If I could just conclude with certain recommendations, I suggest that people without health insurance or inadequate coverage are entitled to equal access to CAM therapies.† HCFA and state legislatures should provide a basic package of coverage.† These basic Cam clinical services need to be defined and based upon principles that permit local and regional variation.† Training of health care providers, both physician and non-physician providers in these basic therapies is essential.† And financial support for this initiative is the most challenging problem.† With a fixed health care budget other services and training may have to be reduced and eliminated.† This is a crucial role for public health care policies.† Supporting programs that provide the greatest health care benefit to given communities will assist in these decisions.† And Iíll conclude.† Thank you.
GORDON:† Thank you.† Ellen Paula Tattleman.
TATTLEMAN:† Hi.† I appreciate this opportunity to speak with you about medical education.† Iím a family doctor working at Montefiore Medical Center and a faculty member at Albert Einstein College of Medicine.† For the last fifteen years, as a clinician, Iíve been integrating a number of different CAM approaches into primary care, mostly with the medically under served in the Bronx and lower Westchester.† As a teacher, Iíve been presenting these modalities and their underlying philosophies to residents and medical students.† Presently, I chair a group on CAM for the medical schoolís Department of Education, and weíve begun to integrate CAM education into all four years of the curriculum.
††††††††††† My experience has shown me that CAM education is critical to the education of health care professionals, but we must acknowledge that this education presents a significant challenge to our present medical and educational systems.† Many schools now offer electives in CAM, but we need this training to be required and integrated into all areas of the curriculum.† Often students here an introduction to CAM, but they may here this introductory talk many times without it going any deeper.† We need to teach some specific techniques to the students.† Which areas of CAM you choose to teach, whether it be mind/body or . . . or herbs, that is less crucial than approaching the techniques in a hands-on way, emphasizing self care is crucial to health and healing.† Use the best teachers you have available and let them teach from their expertise.
††††††††††† What is really important is that we donít just substitute one of these techniques for a western medical one.† We donít just use an herb in place of a drug.† We need to integrate conventional and unconventional medicine, and we need to change the whole approach to patient care. †We need to teach the deeper philosophical base of CAM.† Teach about health and healing, about working with another person to let the body heal itself in order to reach the harmony of mind, body, and spirit.† When we bring CAM to medical education, we need to bring a change in the paradigm of conventional medicine.† We need to move away from the focus on curing diseases to one of healing individuals within the context of their community and family network.† We should encourage research and evidence based CAM practices, but we also need to endorse the connection between patient and provider that many people seek when they turn to CAM practitioners.† We need to emphasize, along with CAM techniques, the compassionate and loving embrace of each individual by the health care professional.† This provides the basis for healing to occur.
††††††††††† In conclusion, we must acknowledge that we need to change the paradigm of conventional western medicine, and CAM education needs to be a required, not elective, part of health care professionals curriculum.
GORDON:† Thank you.† David Katz.† Youíre not David Katz.† Okay, William Prensky.
PRENSKY:† That I am.
GORDON:† All right.† I got it.
PRENSKY:† Thank you.† My name is William Prensky.† I am the director of the graduate program in acupuncture and oriental medicine at Mercy College in Dobbs Ferry New York, and also chief of the division of acupuncture at Sound Shore Medicine Center in New Rochelle New York.† Iím here to speak with you not about a monolith of CAM, but about a discipline specific medical system, traditional, acupuncture, and oriental medicine.
††††††††††† Mercy College was the first regionally accredited comprehensive graduate institution to integrate the discipline of acupuncture and oriental medicine into its offerings in allied health and professional health sciences.† In 1996, we merged that study into the general study . . .
††††††††††† . . . Vision of health sciences and began a collaboration, a unique collaboration, with Sound Shore Medical Center of Westchester, an accredited teaching hospital with five accredited residency programs, to educate and train acupuncture and oriental medicine licensed independent providers in a conventional hospital setting.† As you are undoubtedly aware, the barriers to the integration of these practices, which have demonstrated a clear value to contemporary health care, remain in place long after the evidence of their value has been presented.
††††††††††† Many things contribute to the reluctance of the system to accept new modalities and systems of thought.† Chief amongst these barriers are the inequities and inefficiencies and insufficiencies in the education of professionals in all branches of medicine and health care.† Isolation has been one of the major factors, which has prevented barriers from going down.† Up until now, acupuncture and oriental medicine have been taught only in stand alone, small schools built upon a technical training model.† There has been no strong academic infrastructure support and no buy in by academic medicine or by academic allied health care.† That acupuncture and oriental medicine offer us a unique opportunity to revisit both the nature of allied health care education and the relationship of allied health care to medicine, both in practice and in academics.
††††††††††† The students in our program earn a masters degree in acupuncture.† And in order to do that, they must spend twenty months in education inside the hospital setting.† And, in addition, they must complete a formal research thesis, which generally consists of designing and implementing an original research project.† Because of this, they participate on an equal footing with gaining evidence, which indicates the efficacy of their own medicine within the hospital setting, and in creating relationships, which help to bring these barriers down.† In order to complete that process, we are now beginning to develop a postgraduate fellowship program, which will provide clinical specialist education for the practitioners in our field inside the hospital setting.†
††††††††††† So Iíd like to give you a list of six policy changes, which I think would be helpful in helping to continue this process.† We need enhanced federal support for acupuncture and oriental medicine education and other discipline specific education at the highest academic levels.† We need federal funding for hospital-based residencies in other forms of medicine.† We need federal support for research aimed at providing answers and innovative means of asking questions that are discipline specific.† We need training grants, as well as research grants.† We need the educational infrastructure of all other forms of medicine to begin to move towards the academic excellence which conventional medicine has attained.† And we need federal policy which opens Medicare and Medicaid reimbursement to acupuncture and oriental medicine, and other forms of medicine, which are not currently practiced.† Thank you.
GORDON:† Thank you.† Kenneth Gorfinkle.
GORFINKLE:† Thank you all for giving me the chance to speak to you.† Iím a pediatric psychologist working at the bedside of critically ill children.† We provide treatment that is both alternative and complementary to allopathic, medical, and surgical care in a larger tertiary care teaching hospital.† We do so with full cooperation and usually close involvement with the medical and surgical, as well as nursing, staff.† For over twenty years, our field, in our field we have attended to childrenís quality of life needs.† While our medical colleagues attend to pathogen and disease, we focus on pain, fears, and many of the unintended side effects of medicine, surgery, and radiation.† This includes pain, nausea, weight loss, fatigue, immune compromise, not to mention loneliness and despair.
††††††††††† The tools of our trade are, unlike suture and scalpel, friendly to children.† They involve harnessing the childís imagination and natural tendencies to joy and playfulness, and using that to transform the meaning of the hospital stay from nightmare to feelings of mastery and understanding.† Because we work elbow to elbow with medical and nursing staff and trainees, they, too, inevitably, adopt an increasingly integrative holistic approach to care.† Our role in providing complementary care to sick children is hard won.† We are committed to put our treatment methods to rigorous test and evaluation that you might expect of an intervention with any critically ill patient.† That commitment has been instrumental in forging a working alliance with our medical colleagues.† Iíd like to see academic medical institutions welcome practitioners who wish to integrate traditional, naturopathic, and oriental approaches with our current technological focus.†
But these approaches clearly, they offer a great deal to children, and they have not been available for a number of reasons.† Some including that such approaches donít easily lend themselves to empirical examination.† Two, there are few satisfactory ways to establish qualifications and standards of practice in most modalities.† Itís difficult, but essential, to question how a child can provide informed consent for alternative and complementary interventions.† Weíre reluctant to lay our hands on other peopleís children, even in the hospital, and even when theyíre healing hands, lest someone interpret it as a breach of medical ethics.
††††††††††† In conclusion, child psychologists, pediatric psychologists, are uniquely suited to the task of bridging the gap between eastern medicine approaches and those of the American physician.† Key steps to take include the establishment of qualifications of practitioners, in whose hands parents must place their childrenís care and safety.† Better educational information is needed for parents and pediatricians alike to render informed consent on behalf of their minor children as they expose them to traditional and complementary medicine.† And, finally, as a parent, I would wish to know a great deal about any method or approach employed on behalf of my own children.† So Iíll stop there. †Thank you.
GORDON:† Thank you.† Constance Park.
PARK:† Iím Connie Park.
GORDON:† Connie, bring the mike toward you.
PARK:† Iím an endocrinologist internist at Columbia, and also the education director of the Rosenthal Center.† I just want to make one brief comment about research, which is that as part of a CDC grant looking for promising unconventional therapies for cure or life threatening illness, we, in interviewing practitioners, have found practitioners asking us to please help them figure out how to do case reporting.† Which are the key features of the patient that are important, in terms of the illness the patient has?† Whatís the burden of proof?† Whatís the evidence they should have?† This is the . . . how should they describe the intervention?† How should they describe the effect?† If people donít know how to report their own individual cases, then thereís a lot of very lost information thatís very important.† And when we go around looking for those cases, it would be wonderful if people could just put them forward and eventually, perhaps, the commission could have a mechanism for case reporting that would partially relieve the burden, to some extent, from people like the parents weíve just heard to feel that there is no mechanism at all to look for that one case that might have a meaningful impact for them.† So that would be my first point that relates to medical education because we teach by cases, as you know.† And the more interesting cases that we have that relate medicine in hand with biomedical, whatever, the better, more effective teaching theyíll have.
As somebody who has been involved in medical education for twenty-two years, some with the nursing school, mostly with the medical school, Iíve always been bringing in the peripheral curricula on ethics, on patient interviewing, on whatever.† So I can tell you that there is a growing body of information within medical schools about the importance of the total person perspective, and there are huge numbers of courses, as you all know who were in medical school, that at least address this.† Itís the low status teaching.† I have my high status teaching when Iím speaking about endocrinology . . . preferably molecules, and then my low status teaching when Iím speaking about human beings.† But we have enormous amounts of curricular time from the point of view of the already packed curriculum that relates to those things, and itís very important for CAM people to recognize that.†
So we would like people to build on whatís already internal, and to eventually not have something . . . is the CAM practitioner with the CAM approach and the biomedical practitioner with the biomedical approach.† But if they could together work on questions of basic epistemology, how do we know what we know?† What are the rules of evidence?† Basic definitions: what is health?† What is healing?† If we could present a case where we show the people going the healers going out into the rainforest in Costa Rica, collecting the leaves, bringing them back to the village.† The leaf comes to the botanical gardens.† Itís ground up.† Itís put in the machine, an active agent is found.† Pill bottles distributed in clinic.† Many people feel better.† We could see what the gradient is of whatís gained as we go down this reductionist approach, but we could also see whatís lost, and we could have a group of people, who are scholarly, and having open minds and intellectually creative rather than, and looking at the whole truth rather than having fragmented groups.† These are the people I would hope to help train with trained medical students.
GORDON:† Thank you.† I wanted to ask one question, which is really in a sense turning a question back to you.† Which is what are you all doing, particularly those of you who are working, four out of five of you, who are in conventional medical schools, what are you doing to help move ahead the agenda that you have, the perspective you have, within the community of medical schools, and particularly with the AAMC?† What are your efforts?† What are the difficulties?† Where would you like to go?
TATTLEMAN:† I have not gotten involved with the AAMC, but I know there is a group, a CAM group, at the AAMC.† Itís a special interest group.† It isnít one that was sanctioned, but a small starting group that is beginning to look at this.† I know a few people on that committee, but I donít think it has moved very far yet.† They are looking at it, but itís slow.
GORDON:† Let me ask you, at the risk of being personal or impertinent, but because itís really an important question.† Why arenít you involved in that committee?
TATTLEMAN:† Itís mostly time.† Just being pulled in many different directions.† I think youíre right.† It is very important that we get there and we move this ahead and this be across all medical schools.† But, at that moment, that hasnít been possible for me.
SCHILLER:† I think that the participation in the professional organizations is crucial.† One member of our faculty, Ben Klegler(?), was responsible for getting the Society of Teachers of Failing Medicine to actually pass a core curriculum in this area.† However, itís my experience at the institution that I work, and also when I was previously at Montefiore, that what really gets physicians to change their mind are not blue ribbon panels, but the patients that they work with, getting their colleagues to begin to ask the questions.† So when we started an acupuncture program in this clinic that served people in lower Yonkers, and started doing acupuncture, there was a lot of resistance at the institution. †They were concerned about liability issues and exposing the residents and medical students to this type of practice that was unproven.† It turned out that when these physicians heard about the results from these patients, those faculty members, who were the most critical, began to refer their most difficult patients to us.†
††††††††††† So thatís why I think although the work has to be done within the professional organizations, the resistance to change in those organizations, and the other issues theyíre faced with in their professions, really makes it difficult to get high on their agenda.† Itís really the bottom up effect, and that was sort of my point about public health, and particularly those of us in primary care are really in the best position.† I mean, family physicians across the country have really embraced a lot of these, much more than other disciplines.† And I suspect there are a variety of specialty organizations have put CAM on their agenda, but not really focused on the practical ways in which you can introduce and implement some of these practices so that those practices become the laboratories for students and residents to learn.
GORDON:† Connie, did you want . . .
PARK:† Well, I think it is important to work within the professional organizations.† Certainly, it shouldnít be ignored.† The Society of General Internal Medicine has had large amounts of units related to total patient medicine, including forays into CAM, etc.† The ACP panels last year, there were several related to CAM.† And I think itís very important to acknowledge whatís being done that can be built on for cross-fertilization.† I think there is a huge danger with this term integrative medicine that CAM is saying this is health and healing, this is total patient medicine as if only people who come at medicine from that direction are doing that.† There will never be any meeting of the minds at the medical center with that.† Thereís a huge literature of patient centered medicine, the bio-cycle social model.† Thereís lots of other literature that should be there, and this should be a meeting where eventually we look at the truth.† We look at the issues.† We donít . . . where they came from, and Iím upset by that, the integrative, the implication in there.† We all are involved in health and healing, and we shouldnít see ourselves as one or another.† I like to see myself as an open minded intellectually curious person trying to have intellectual honestly, humility, about the limitations of what I can do.† And I would like to, as much as possible, instill that in students and then they would make choices among all the actual options that do exist, knowing limitations of certainty when they do exist.
GORFINKLE:† Iíd just like to highlight a research project at Babies and Childrenís hospital that was conducted by Dr. Kara Kelly, a pediatric oncologist, that has really had a grass roots effect that may or may not have been intended.† And that was we questioned parents of all pediatric oncology patients, how much they were using alternative and complementary treatment approaches with their children.† And a large sample showed that upwards of sixty seventy percent of parents were using these approaches, many of whom, unless we had asked them, werenít going to tell us.† Werenít going to tell their pediatric oncologist or their nurses because they were afraid it would be disapproved of.† One of the nice side effects of this research project was that it really has opened up a nice dialogue between the patients, their parents, and me, the clinical psychologist, and also the medical staff.† I think that hopefully that will spread through the pediatric oncology group.
GORDON:† Iíd very much welcome a copy of that study.
GORFINKLE:† Iíll get that for you.
GORDON:† Iíll get that for you.† Yes.
PRENSKY:† In spite of the fact that Iím not teaching in a conventional medical school, Sound Shore Medical Center is a teaching hospital and a major teaching affiliate of New York Medical College.† So Iíd like to speak to the question if I might.† Every aspect of the mutual respect, which needs to be built, is built upon relationship.† So every resident, in the five residency programs at Sound Shore Medical Center, spends time with us in our teaching facility at the hospital in which discipline specific licensed independent providers of acupuncture and oriental medicine are educated.† Every medical student who does any rotation through Sound Shore Medical Center, from any medical school, spends time with us in the same way.†
We do in-service training for all aspects of the house staff, all elements of the house staff.† And they, in turn, do in-service training for us.† Our students are paired with residents as preceptors, and residents come to us in order to learn about our medicine.† So there is an aspect of this integrative education, which doesnít need to be formalized into the undergraduate medical curriculum, but into the relationship building that takes place in the graduate medical curriculum.
GORDON:† Do you have a description of that, of the program, that you could give us?
PRENSKY:† Yes, yes I do.† Some of it is in what I have given.
GORDON:† Iím just curious if you can tell us one or two of the most, how did this come about, especially, importantly, what does everybody else have to learn from your experience?
PRENSKY:† It came about because we had the unique opportunity to pair two regionally accredited institutions that were similar in size and in academic point of view.† So both institutions felt comfortable with one another.† And there were faculty and personnel in both institutions who were pioneers in desiring to do this.† So thatís one of the key things.† There has to be a champion in both institutions that wishes this.† Some of the things that weíve learned about it, however, are extraordinary.† I can share a story with you.
††††††††††† Our students spend twenty months in the extended care pavilion at Sound Shore Medical Center, treating patients whom acupuncture and oriental medicine students almost never see, bedridden patients, terminally ill patients, chronically ill patients.† At one point, one of the gerontologists was speaking with a patient, and said to the patient, well, I donít know what more you want us to try and do for you.† Weíve brought everything we have.† We have the anesthesiologist, the pain fellow.† We have the physical therapist.† We have the psychologist.† We have the acupuncturist.† They were all seeing you every day.† And at that moment, we knew that we had entered into the tapestry.† We had seamlessly integrated.†
††††††††††† When we first began, in 1996, there used to be cartoons put up in the medical lounge and in the medical dining room about our presence there, and it was a tremendous resistance to us being there.† I would say there were ten percent of the physicians who welcomed us, twenty percent who tolerated us, and the rest who actively disparaged us.† At this point, there is no member of the admitting or house staff at the hospital who does not regularly refer to acupuncture and does not call for consultations.
GORDON:† Thank you very much.† Thatís extremely helpful.† I think weíll be asking you for more information, especially for our February panel on education and integration and bringing together the different fields.† Other questions?† Charlotte, yeah.
CHARLOTTE KERR:† Dr. Park, I appreciated your last comments.† In light of that, though, I wanted to speak to Dr. Tattlemanís comment about the need for the philosophical review in the education.† You spoke of epistemology.† And Iím wondering do you think we need to have more of an emphasis than we usually do when weíre talking about the incorporation of CAM therapies?† Would it help us in this paradigm shift you speak of?
TATTLEMAN:† I believe itís really crucial.† I agree with Connie that any physician can have a health and healing relationship with a patient, and can promote that.† But I donít think our medical schools are doing a very good job of creating physicians like that, even as weíve added patient centered talks and, you know, added other things, having artists come talk to medical students.† It doesnít seem to be making the kind of change we need to see.† I think that what you talked about, and what you talked about, the relationships are very important.† But the point about the AAMC, I think it does have to come from a professional organization in order to see that kind of change, and it needs to be very deep.† It needs to have the philosophy.† It needs to, I happen to be in a medical school that is very open and has embraced the idea of integrating CAM throughout the four years, but thatís not true across the board, obviously.† Iíve had no resistance.†
So the professional organizations that really dole out the time for the different things that are required do need to get involved.† And I think, as I said, it needs to be on that deeper level because these talks that weíve had, that weíve incorporated, people have been listening.† Theyíve been talking about patients and about listening to patients and interviewing patients, but it doesnít seem to be.† The minute they get into the hospital and on the wards, where the things that are reinforced are not sitting and listening to a patient, but rattling off information . . . unless that changes and unless what is reinforced throughout the four years changes, weíre not going to see the deep change we want to see.
PARK:† Thatís definitely true, and thatís really harks back to another involvement at the Rosenthal Center, where we have one of the NIH funded research centers.† And part of that is supposed to be career development for research in complementary and alternative medicine.† While we would be happy to take fellows who are going to, in fact, find that phytochemical and feed it to women and show that their bone mineral density has gone up.† In reality, that person could have been trained strictly in biomedicine.† So we, with our fellows, donít want to just put them into those kinds of projects.† We want to have them exposed to other systems of medicine with other paradigms.† We want them to have that type of open mind that looks at rules of . . . looks at ways of knowing just because thereís not this type of evidence doesnít mean itís not a legitimate form of knowledge.† But letís say what form of knowledge it is.† If a healer wants to say that this is something that I just feel is right and, Iím sorry, Iím not interested in your randomized clinical, thatís something to look at.† Thatís not something to just set aside.† Thatís a way of knowing. †Patients have ways of knowing.† Clinicians have ways of knowing.† The dyad has ways of meeting or not that are subtle.
GORDON:† Thank you all very much.† Itís very helpful for us.
Panel Coordinator, Corinne Axelrod
GORDON:† Mark Hoch.
HOCH:† Hi.† Thank you for the opportunity and privilege to address you and for all the hard work that you are doing to advance health and medicine in this country.† Very much needed.† Iíll focus my remarks on the education of physicians with regard to complementary and alternative medicine.† Just as a way of background, Iím the secretary of the American Holistic Medical Association, and I have extensive practice and teaching experience, both in conventional and in holistic and complementary medicine.
††††††††††† From my perspective, I feel itís critical for physicians to be well trained in CAM.† This needs to begin from the beginning of medical school.† Students need to learn the history, and also the core philosophic constructs of various disciplines that make up CAM.† And they need to know the diagnostic and therapeutic strengths of each discipline.† Itís also important for them to know the toxic effects of the therapies and the potential harmful interactions between mixing modalities.† Itís also important for them to be taught how to evaluate the literature in various disciplines and where to find that literature.† And they need to have an understanding of the language of the discipline so they can communicate effectively with their patients and also with the other practitioners that theyíll be working with in the system.
††††††††††† Also of critical importance is for much of their training to be given by teachers, who not only have a solid intellectual grasp of the above, but who can effectively practice those disciplines.† This means the students need to be afforded a meaningful clinical experience so that when they actually are trying to do something, theyíll be effective at doing it and theyíre much more likely to put patients in harms way.† However, I think the most important thing that Iíd like to say today is that we need to go way beyond the common concepts of complementary and alternative medicine, and we have to be very careful not to CAM up the current fatally flawed system of disease management that we have.†
If our goal is to really improve the health of this nation and the people that make it up, we need to build a new foundation and one that acknowledges, honors, and values health and the profound ability we have to heal ourselves and others.† I think we need to teach this to our children and to society and especially to students of health professions.† We need to empower people to be self-responsible and to learn to care for themselves.
Along these lines, I think itís very important for us to work with the pioneers who have already blazed the trail and not to dilly around here.† We need to work with organizations such as the American Holistic Medical Association, which will be putting on its twenty-fourth annual scientific conference this spring, and has already co-sponsored several three and four day conferences in the art, science, and practice of holistic medicine with the departments of family medicine at several medical schools around the country, and with the newly founded American Board of Holistic Medicine, which gave its first national certification exam in December.† These organizations are not only teaching positions about how to practice quality medicine, but also . . . beginning to set evidence based standards and guidelines of practice.† And we also need to honor and utilize the gifts of the worlds many traditional medicines that have really brought high levels of care to us for a millennium.†
And, in closing, just four points Iíd like to make.† One is that physicians need a thorough education in this area, and they need to get it in medical school.† Itís critically important that they get this education also with a clinical practical background so that they can actually go out and practice.† Again, I think we need to build on the base of the pioneers that have gone before us, the organizations that we have now, and the traditional medical systems.† And, most importantly, we really need to get to a health based system so that weíre really meeting the needs of people and not, again, just throwing some other Band-Aid on the horse that already ran out of the barn, was lost, and sick and dying.† Thank you.
GORDON:† Thank you.† Is Fran Catherine Starr here?† Yes, okay.† You confused me because youíre sitting at that table.† Thatís fine.
STARR:† Iím sorry.
GORDON:† Thatís all right.† Iíll get over my confusion.
STARR:† Iím a holistic RN that practices, teaches, and develops programs on holistic nursing and medical Chi Kung.† Medical Chi Kung, I have to say, medical Chi Kung being my first love.† I had the honor of speaking at the World Congress on Chi Kung, organized by our esteemed Dr. Effie Chen, just recently and coming again in the spring.† I wish to present three separate statements to the commission on behalf of a public hungry for access to alternative practices with integrity and freedom, and on behalf of nurses that want to heal the body, mind, and spirit with integrity and freedom, as one who personally benefited from complementary and alternative modalities myself.
††††††††††† Topic one in brief, promoting integration of CAM practices with traditional medical professionals, with the objective of educating and promoting CAM to allopathic professionals.† There should be readily available concise scientific and factual based literature written in a context that would appeal to the medical professional.† Some of the facts that should be included would be statistics on the popular demand of a complementary practice by the public at large.† We also need more co-representative represented conferences, where CAM practitioners and traditional and medical practitioners can share information side by side, combining the best of both worlds and encouraging and promoting the acceptance of CAM by medical professionals in a friendly setting.† These conferences should be composed of well-known practitioners of both traditions.
††††††††††† Topic number two, the American Holistic Nurses Association was established in 1987 in an effort to organize and support nurses who believe in treating the body, mind, and the spirit, incorporating the various CAM practices, with the guidance and provisions to assist in providing and promoting the maintenance of professionalism that would uphold using these approaches, and provide guidelines for practice with integrity.† We need more funding for individuals; financial support provided to aid and promote education in college courses about CAM within the institutions of higher learning.† And we need more funding that would make it easier for nursing CAM practitioners to promote and participate in CAM practice models for research, without the criteria being attached to an established institution.† In other words, funding for private practitioners to do research that can develop a comprehensive plan.
††††††††††† Topic number three, there is one brief statement I would like to have noted by the commission regarding practitioner guidelines.† And that is simply that it does not take a bachelors or doctorate to practice CAM, but should involve some basic knowledge of anatomy, physiology, and simple understanding of the disease process of the body.† There is so very much to consider in these processes.† My proposal to you, in closing, is that along with considering all things, we need to bring CAM up to the acceptance level we desire.† We also must consider that it should be done in a timely and expeditious manner.† Thank you for your time and attention.
GORDON:† Thank you.† Sally Bishop.† Bhaswati Bhattacharya.
BHATTACHARYA:† Thank you for the right to testify.† I have four recommendations on education and training, which come from my perspective as a public health professional, a preventive medicine doctor, and a holistic healer.† My concerns are for the patients who are in the vulnerable position of having to depend upon another being to heal.
††††††††††† My first recommendation is for people who practice holistic medicine or integrative or complementary or alternative medicine to know the evidence thatís out there.† For the last ten years, I have been working to unite programs and educational courses, which are trying to teach that kind of evidence.† There are databases, there are directories of databases, there are collections of directories of databases, and yet many patients and doctors and healers do not know the scientific as well as the anecdotal evidence that is out there.† There are books.† There are online written evidence based texts.† And we need to make sure in our policies that those kinds of evidences are paid attention to, both for legal, medical, regulatory, insurance reimbursement, as well as educational purposes.
††††††††††† When a person does a Ph.D., they are required to take a qualifying exam, which shows that they have evidence in their field, they have knowledge of the evidence in their field, before they can even start doing a thesis.† As far as I know, most MDs do not need to show that they have evidence and knowledge of CAM before they start to practice CAM.† MDs are allowed to do whatever they like, in terms of practicing certain forms of CAM, and I have found doctors who barely know how to pronounce ayurveda who are calling themselves ayurvedic doctors.† People who have just learned the difference between homeopathy and allopathy to say that they are practitioners because they have an MD.† I happen to have the accolades and the trainings from the best institutions, and Iíve gotten that access so that I have the right to practice what I do.† I do energy work, and my main work as a healer and as an educator comes not from the institutions where Iíve been granted my degrees, but rather from the forests and the bush and the mountains the places where the healers actually teach people who will sit at their feet and learn.
††††††††††† I would like for our second recommendation to examine how we decide who will teach us.† Will we listen to the grandfathers who know how to practice holistic medicine, people at the AMHA, people who have been practicing for thirty or forty years?† Or will we pay attention to the doctors who have just gotten two months certification courses and now decide that they can be the head of a department of CAM?
††††††††††† The third recommendation is that we are vigilant on how we decide who is ďgood enough.Ē† And this requires us to look at how we credential, how we decide who is good enough.† For example, a man who knows how to, a man who cannot sense Chi or disbelieves his existence can be a chairperson at a CAM center.† And yet a cardiologist who couldnít understand how to hear a heart murmur would never be allowed to be a chairman of cardiology.†
††††††††††† The fourth recommendation is that we include students and patients when we look at how we design our education policies because it is the students who know how they want to learn.† It is the patients, and parents of patients, who know what evidence is really out there.† Thank you.
GORDON:† Thank you.† Pamela Miles.
MILES:† When I refer to . . .
GORDON:† Come closer.
MILES:† When I refer to traditional or natural medicine, I just wanted to clarify that I mean those medical systems and therapies that developed before science.†
GORDON:† You may have to bend a little.
MILES:† I speak to you as a consumer who has used medical, natural medical intervention since childhood, as a mother who has raised two children with the required annual medical exams and occasional x-rays, but without ever having to use any conventional medical interventions, and as a traditional practitioner with thirty years experience, who only works with clients who are using medical care as well, and as an educator.† I am the founder of the Institute for the Advancement of Complementary Therapies to raise public awareness of the value of these therapies and to make them more accessible.† I, myself, have no medical credentials, but I have worked extensively in medical environments and I have excellent working relationships with a number of physicians, many of whom I have trained in healing techniques.† I come from three generations of nurses.† My parents used physicians, but never assumed that a doctorís visit alone was adequate to ensure health care.
††††††††††† Twenty years ago, when my son was born, it was very difficult to find pediatricians who would work with me, and I was continually reminded that there would be trouble if it ever appeared that my children were not cared for properly.† Over the years, Iíve developed good working relationships with my often-astonished pediatricians, who would acknowledge that we got faster results with natural techniques than they could have gotten with conventional ones.† I didnít find choosing natural practitioners any more difficult than choosing a good conventional doctor.† What has been difficult is knowing that most services that we depend on, and all of the services that I provide as a practitioner, are actually illegal because the government does not separate natural, noninvasive health care practices, many of which are really lifestyle interventions, from the practice of scientific medicine, which clearly requires a high level of expertise.
††††††††††† Patients who are treated with natural medical techniques by conventional medical professionals are most likely not getting the best traditional care.† Conventional medicine rests on science, is highly technical, and requires rigorous training.† Natural medicine rests not only on traditional knowledge, but also on intuitive skills and wisdom.† The best traditional practitioners have meditative skills that are built with years of practice.† Very few people are able to take both conventional and traditional medical practice to a high level of expertise.
††††††††††† Please use your influence to create an environment of diversity and freedom in health care.† Nowhere, not even in our chosen worship, do we enact our beliefs the way we do when choosing our health care.† We need to be able to follow our passionate commitment.† Most people who use natural therapies do so as a not adjunct to conventional medicine.† But there are those, like myself, who, through living with traditional values and lifestyle, will avoid the need for much of the medical care that Americans use routinely and think is irreplaceable.† Please remember us and include our well being in your recommendations.† And Iíve attached specific recommendations in my written comments.† Thank you for your time.
GORDON:† Thank you.† Brian MacNamara.
MACNAMARA:† Hi.† Dr. Gordon, commission members, and fellow citizens, I come to you today very honored, and I thank you for the opportunity, both as a consumer and a nutritional consultant, and Iím also a student.† In 1929, an act of Congress declared naturopathy a distinct and separate branch of the healing art on the same basis as medicine, osteopathy, and chiropractic, and that it was self-definitive.† The authority for this Congressional legislation came from codified le scripta(?), the herbalist charter, under Henry VIII as common law.† Both the SSA and the IRS recognized naturopaths as legitimate health care providers as federally defined in the Department of Laborís code #079101-014, continuously listed since 1939.
††††††††††† States must yield to federal law when in conflict.† Subsuming naturopathy into medical regulation goes against Congressional legislation and intent.† Integrating all modalities into the current system does not serve the majority of holistic practices.† Traditional forms of regulation do not fit natural modalities, many of which reach proficiency through nontraditional methods, including practicums, apprenticeships, distant learning, and study with the masters.† For instance, I had the privilege of working with world-renowned clinical nutritionist Dr. Bernard Jensen, actually studying with him on the tenants of replenishment, nutrition, and iridology.† However, this experience wonít show on any curriculum transcript.† Distant learning courses offered by Westbrook, Trinity, and Clayton are but a part of oneís education as a nutritional or health consultant or classical naturopath.† Many already have degrees from traditional schools and are seeking additional related coursework from traditional colleges.
††††††††††† In my opinion, naturopathic physicians are first and foremost medical doctors and must be licensed medical doctors.† They are already regulated by current means.† Naturopaths are not medical doctors.† They do not practice medicine, and the nutritional supplements and herbs they use are not drugs.† Therefore, the effort to subsume naturopaths into medicine and current medical regulation should be stopped.† Physicians, naturopathic or otherwise, are already MDs and must adhere to current law and regulation.† The governmentís acceptance of professional organizations, such as the ANMA, will allow consumers to obtain information about modalities and practitioners.† To abolish the non-medical naturopath, nutritional consultant, or health counselors right to exist and homogenize naturopathy into the current medical establishment would not only be unethical, but I believe unconstitutional under the previous Congressional references, as well as the 9th Amendmentís protection of enumerable rights we all hold precious.† Thank you.
GORDON:† Thank you.† Questions from the commissioners?† Any questions?† Yes, go ahead, Conchita.
CONCHITA PAZ:† This is to Dr. Bhattacharya.† If you can tell us how you would go about trying to find a system for determining practitioners competence with their level of training would be real helpful, with the different types of therapies.
BHATTACHARYA:† You and I both know thatís a very difficult question.
PAZ:† It is.
BHATTACHARYA:† It depends who is sitting on the panel of judges.† I believe that having a panel of judges that is more holistic, meaning MDs, RNs, all the licensed health practitioners, as well as patients, students, parents, consumers, regulators.† That kind of panel is, obviously, difficult to assemble, but itís one which, I think, would be more objective than a group of doctors would be, or a group of any one particular type.† There are certain baseline standards which have been attempted to be collected by groups such as, Rob Schiller mentioned there was someone, Ben Klegler, who had put together a core curriculum.† Patricia Musim(?) at the AAMC has put together a group of documents.† People at the APHA, which Joe Kaczmarczyk is involved with, have put together a group of recommendations.
††††††††††† There was a blue ribbon complementary panel.† All these panels, there are about ten or fifteen that Iíve collected, that have put together a group of recommendations.† Using those as a baseline would be a good place to start with a core curriculum.† There are, obviously, going to be arguments about which of those things should be and should not be included, but at least people judging should know the basic terminology that is included in those basic recommendations.† Iím sure that every member of your panel is not equally educated about CAM, but to have a baseline, well, maybe Jim knows everything.† There is a baseline that I believe people need to know in order to consider themselves knowledgeable in CAM.† Just as when I . . . my Ph.D. in pharmacology, there was a basic amount of pharmacology I needed to know, even though I didnít know the particulars of every single subdivision of pharmacology.† That kind of basic level of complementary medicine needs to be known.
††††††††††† The one thing that I would say is mandatory is to understand what she is.† There is someone amongst us, who has said commonly that he doesnít know what she feels like.† For that person to be a director of a CAM center, I think, shows us that we allow doctors to not know the basic concepts and to still say that they are CAM experts.
GORDON:† Any other questions.† Okay, thank you very much.† Thank you all.† Iím going to take a brief break . . . ask Dr. David Bresler if he would chair while Iím gone.† Iíll be back in a few minutes.
Panel Coordinator Ė Corinne Axelrod
BRESLER:† Okay, are we ready?† Andrew Rubman, please begin.
RUBMAN:† Iím, again, honored to address the commission on matters related to my profession.† Iíll briefly detail proposed steps to craft federal guidelines for curricula standards in education to apply to all medical training in the United States.†
Individuals functioning as physicians in our society need to be formally trained in the sciences and philosophies, what Dr. Gordon refers to as the new medicine.† As curricula at allopathic and naturopathic medical schools become progressively similar, our efforts need to focus on providing access to the philosophical differences in the disciplines that make these two branches of medicine inseparable, immiscible, and of equal value to this society.† I submit for the commissionís information comparative curricula and medical school data, generated by the AANP in 1998.† As allopathic philosophy emphasizes the identification and suppression of pathology, naturopathic philosophy stresses the appreciation and enhancement of normal physiology.† In order to understand the value of naturopathic medicine, allopathic basic and clinical medical science curricula need to be reworked to include these philosophical elements.† In order to practice naturopathic medicine, these components need to be at the core of all formal medical education . . . that the new medicine include enough crossover within the two disciplines to allow both the appreciation of the value of the other and to allow for the seamless referral and patient co-management.† This should not encourage one to practice the others craft.† To do so would be to act irresponsibly.†
This conjoint approach needs to be available for the public in all medical delivery facilities, including primary care and hospitals.† Allopathic medical schools need to have naturopathic physicians on staff providing curricula oversight and classroom instruction in the disciplines.† MDs and DOs should not be asked to provide this component.† David Studdart(?) of Harvard, writing in JAMA, emphasizes that patients need to be completely informed of the risks and the benefits of these alternative and complementary intercessions before the therapy is allowed.† How can someone who is not formally trained do so?
The obstacles that exist to this necessary deregulation of medicine are those of ignorance, greed, and misconception.† The appointment of naturopathic physicians to all agenciesí committeesí dealings with medical school curricula, hospital practice, and public health information dissemination will move to correct this.† A good step might be to consider this commissions purview, that of traditional medicine not complementary and alternative.
In closing, I provide the commissioners a copy of a picture of the 1902 graduating class of the American School of Naturopathy in New York City.† These were truly traditional naturopathic physicians practicing traditional medicines.† Thank you.
BRESLER:† Thank you.† Mark Garber.
GARBER:† Thank you.† Iím a full time emergency medicine physician in Connecticut.† I see patients every day and have for almost the last twenty years.† I went to a four-year medical school.† I went to a three-year residency in emergency medicine.† And before that I was a human being and I was very interested in natural medicine, in the Ď60s, as many of us grew up.† I got all the Jethro . . . back to Eden and Iíve never turned back.† Iíve been interested in botanicals and herbal manipulation, and Iím self-taught and Iíve learned from others.† So I incorporate these alternative therapies in emergency medicine, which is a strange thing to do.† In the golden hour of emergency medicine, if youíre having trouble breathing, youíre having a heart attack, or youíre really having a life-threatening situation, I do not use traditional alternative therapies so much as I use the traditional medical therapies.† And most people would want someone to do that for them.
††††††††††† After that golden hour, my patients get alternative therapies as well as traditional ones.† Iím faculty at the University of Connecticut Medical School, as well as being faculty at the University of Bridgeport Naturopathic School, and I teach students from the Canadian College of Naturopathic Medicine as well.† Iím an allopath teaching at naturopathic school, and there is really no counterpart at the allopathic schools teaching people about natural or naturopathic medicine.† So who is a doctor?† And a doctor is a healer.† A parent can be a healer.† But who is a licensed physician in a first world country like the United States?† And thatís a medical doctor.† As medical doctors, we have a responsibility to know about alternative therapies.† I agree with everyone on the panel who said from day one of medical school in an allopathic or osteopathic school we need to incorporate these modalities.† It has to be done, and I think itís being done, and there are good people to teach this.
††††††††††† However, again, my counterpart, I think, is a trained naturopathic physician, an MD.† I am very fortunate because I live in Connecticut, one of the eleven states where naturopaths are licensed and they have a four-year school.† Iím very involved in the four-year program that naturopathic physicians go through, and itís really quite similar to allopathic curriculum.† Iíve been very impressed with that.† One of the problems is that my students donít get enough clinical training with sick patients.† And what we worry about is can a naturopath, who is using alternative therapies, and usually wonít hurt someone if they know about drug interactions, and Iíve got to reiterate for the community everything you get is a drug.† A botanical, everything you do is a drug that has side effects and can hurt people.† But if someone misdiagnoses someone and treats them with so-called alternative therapies, people can be hurt.†
The naturopathic physician, in one of these fortunate states where theyíre licensed and trained adequately, really has a good background to work together with the MD as either consulter in a primary role doing alternative therapies to get us together to go ahead and treat these people.† And I feel like naturopathy really has a future in the licensed physician stage.† I think working together and integrating these therapies we can do very well for the public.† The public demands these things.† Theyíre going to a health food store, which, to me, is a pharmacy where everybody can get any drug they want without a prescription, and thatís what a health food store is, and these drugs are dangerous.
One quick anecdote, when I give somebody antibiotics, and I donít do it very often, they get a prescription to go to the pharmacy and get the antibiotic.† I give them a prescription to go to the health food store and get probiotics at the same time to not ruin their immune system.† And we can all do these things.† Thank you.
BRESLER:† I agree.† Thank you very much for your comments.† Bronner Handwerger.
HANDWERGER:† Yes, Iím delighted to address the commission today on matters concerning licensing and naturopathic education.† Iím a fourth year medical student at University of Bridgeport College of Naturopathic Medicine, which is a regionally accredited four-year post-graduate medical program with admission requirements comparable to those of conventional medical schools.† As primary care physicians, we are rigorously trained in basic medical sciences.† Our clinical training, in part, includes the study of acute and chronic pathology, clinical physical diagnosis, minor surgery, emergency medicine, medical genetics, and laboratory diagnosis.† Instructors of conventional medicine from Yale and University of Connecticut teach many of our required courses, and we spend time at local hospitals.
††††††††††† The Council on Naturopathic Medical Education recognized by the U.S. Department of Education, accredits our program at University of Bridgeport, as well as those offered at National College, Bastille University, and Southwest College.† In order to sit for licensure, naturopathic medical students are required to have graduated from an accredited program . . . completed all appropriate board exams and clinical residencies.† Naturopathic medicine is at the forefront of the alternative and complementary health care movement as it evolves today.† Naturopathic physicians are the most comprehensively trained doctors of natural medicine, and are thus the most suited to help integrate the health care industry in the transition to what Dr. Gordon refers to as the new medicine.
††††††††††† Because currently naturopathic medicine is not a regulated profession in thirty-nine states, some individuals who call themselves naturopaths in those states do not meet our professional standards of education.† Such individuals often obtain degrees or diplomas from correspondence schools or weekend seminar programs.† The public needs to be protected from the consequences of misdiagnosis, non-diagnosis, and inappropriate medical treatment that may be offered by such individuals calling themselves doctors.† Without standardized laws, individuals are being denied their basic freedom to access responsible health care of their choice.† Untrained or under-trained persons calling themselves naturopaths may put individuals at risk by delaying the diagnosis of a critical condition needing conventional care.† The science-based medical school trained naturopathic physician uses standard diagnostic methods and is taught when it is appropriate to refer to specialists.†
Licensure of naturopathic physicians throughout the country would ensure public safety by requiring the highest level of education, training, and accountability.† As more consumers turn to natural medicine, they need to be assured of the standards of care and practice.† Globalization of health care information, due to the Internet, has raised some interesting questions and challenges as to how we may protect the public from misrepresented health care claims.† It is difficult for the average consumer to navigate this increasingly complicated maze.† The naturopathic model of health and healing incorporates conventional diagnosis and treatment with the understanding of the clinical use of preventive medicine and natural pharmacy from a philosophical perspective of enhancing wellness.† It will be well to recognize this training as the experts standard within the so-called CAM disciplines.† Thank you.
BRESLER:† Thank you for your comments.† Jonathan Daniel.
DANIEL:† Thank you for having us appear here.† First of all, I would say about, Iím a practitioner of Chinese medicine and Iím also a chiropractor, and Iím a teacher at the Pacific College of Oriental Medicine here in New York.† First of all, I would say that Chinese medicine works within its own paradigm, and itís best that it works within its own paradigm.† I heard, in the telephone conversation that we had before this panel began, that the standard was going to be western medicine, the standard for working with CAM.† But I think itís very important that Chinese medicine work within its own paradigm.† It developed its own modalities to fit within that and it has its own understandings of how diseases divide it.† If that is not applied, then you donít get the same kinds of results.
††††††††††† However, at the present time, we are also trying to develop some kind of integration . . . taking place both in China and in the United States.† There is an attempt to integrate western understandings with traditional Chinese medical understandings.† I think this is a possible thing to do, but I think that this is a very long and difficult process.† And to practice Chinese medicine this requires an understanding on the part, a long understanding on the part of those who are trained for it.† At the present time, in the United States, the training of a Chinese medicine practitioner in most, if not all, schools requires more than three thousand hours, over an average of four years.† This training includes not only courses in Chinese medicine, but also western physiology, anatomy, biochemistry, and pharmacology.† At PCOM in New York, these courses are taught by professors who are medical doctors, chiropractors, and others who hold Ph.D.ís in chemistry, anatomy, and microbiology.† One of our professors has actually been selected as teacher of the year at Cornell University Medical College, where he continues to teach.†
Any educational standards, which are set now or in the future, should be established by the schools and not by an external body.† The minimum criterion is the ability of the graduates to pass the national certification exam, which is administered by NCCAOM, but most of . . . schools do exceed this minimum.† Also, I would say that itís important to realize that, with herbal medicine, in most states herbal medicine is not regulated.† But I think itís important to recognize that in the controversy that has arisen over the use of certain herbs, that most of the time when this has happened this has been using the herbs by people who are not qualified to administer those herbs.† If the herbs are administered by a qualified practitioner, then the results have not been bad, most of the time.† Thank you.
BRESLER:† Thank you for your comments.† Steven Schenkman.
SCHENKMAN:† . . .
BRESLER:† Microphone, please.
SCHENKMAN:† Good afternoon.† Thank you for the opportunity to speak.†
BRESLER:† Could you move a little bit closer, so that the back can hear, too.
SCHENKMAN:† My name is Steven Schenkman, and Iím the president emeritus of the New York College for Wholistic Health Education and Research.† Iím here today to speak very briefly, based on my experience as president of a CAM college for twelve years and a CAM practitioner for more than twenty years, on what I see as the main difficulty of integration with conventional medical institutions and practitioners.
††††††††††† Conventional medical intervention, while giving people the opportunity to live longer lives, increasing quantity of life, rarely guarantees a better quality of life.† Conventional medicine excels in many procedures for acute and emergency health care, as well as in its advanced diagnostic techniques.† However, when it comes to preventative medicine and the treatment of chronic degenerative diseases, more often than not, CAM medicine is better suited.† And this is exactly what consumers have begun to slowly discover for themselves, and why the White House Commission was formed.
††††††††††† I believe that the greatest potential for the future of medicine may be the true integration of these two fields.† However, as leaders in institutions of conventional medicine seek to adopt different CAM disciplines, they cannot continue to ignore learning its theory, principles, philosophy, values, and the rich histories of these systems.† Although there has been some positive movement of late to understand, I have, for more than twenty years now, experienced the so-called growing interest of university and private hospitals and their conventional medical faculty and practitioners miss the mark because of their true lack of understanding of the foundation of CAM systems and their disciplines, and the profound healing they provide to their patients.† This had led to ignoring and minimizing valid results gained by thousands of patients of CAM practitioners, often relegating these powerful and valid CAM techniques and disciplines to trivia.†
††††††††††† Until there is some real effort on the part of conventional medical practitioners and their educational institutions and organizations to really study and understand the foundation and underlying theories of CAM practices that have proven successful, and come to value them on their own terms, there can never really be a true marriage, and patients will never reap the possible benefits of such an integration.† And by study, Iím not referring to research, which I believe should also be occurring.† Iím referring to the undertaking of formal study of these areas, at least by those who will be in a position to make the decisions and policies, so when they are made, they are made from a foundation of understanding.
††††††††††† I believe that such decisions in policies would be much different than those which result from the conflicted position of conventional medical practitioners without any, or only a trifle, understanding, trying to decide on policy about the future of their own field by listening to the input of CAM practitioners.† Without true understanding of all sides, how can it really be possible, at least on a grand scale, to come to an understanding of how these different worlds of medicine can properly be combined to the best interest of the patient rather than for ones own personal interest?† It would seem that there need be some serious efforts made in conventional medical schools to educate future practitioners to a depth of understanding.† I have something about policy recommendations, which Iíll submit.
BRESLER:† Great.† Thank you very much for your comments.† Commissioners, questions?
XIAO-MING TIAN:† Question for Dr. Daniel.† In your recent testimony, you . . . that most states regulate practitioner of Chinese medicine.† What do you mean by that?
DANIEL:† What I mean is that there is licensure . . .
BRESLER:† Microphone, please.
DANIEL:† What I mean is that there is licensure for acupuncturists inmost states at the present time.† Thatís in comparison to, for instance, naturopathy, which I think is licensed in eleven states, whereas for acupuncture, itís licensed almost everywhere now, thirty-five states.† As far as herbal medicine goes, though, itís only licensed, Chinese herbal medicine is only licensed in, I think, three or four states at the present time.
TIAN:† In which state?
DANIEL:† California, Oregon, Massachusetts, and thatís it I think, maybe Connecticut as well.
TIAN:† Is that regulated as a medicine or herbal remedies?
DANIEL: †As a profession.
TIAN:† As a profession.† Do you believe that there must be a regulation better for . . . or medical professionals to . . . herbal medicine and herbal remedies?
TIAN:† Thank you.
BRESLER:† Other questions from commissioners?† You know, one of the things that would be helpful to us as a commission, weíve heard from a lot of different advocacy groups who say that mental health professionals would be good people as sort of gatekeepers, naturopaths, nurses, acupuncturists, and so forth.† And we know that, to a large extent, itís a matter of risk benefit.† We want to provide the greatest benefit to the public, but we also want to protect them from risks.† And I wonder if you could provide us, just your opinion or recommendations, as what the unique benefits of having naturopaths involved in triaging and screening, and what also some of the potential risks might be, in terms of what they might miss and things of that sort?† If you comments now, that would be helpful or you could submit that to us later on . . .advocacy group.
RUBMAN:† Very very briefly, we have the benefit of being classically trained in medicine in the same basic and clinical sciences that are provided in medical schools of all denominations in the United States.† And part of that is recognizing acute pathology, the necessary for heroic(?) intervention, the necessary to refer to EMS, what have you.† Thatís core to our discipline, and we believe if weíre going to consider ourselves physicians, then the public needs to have that sort of understanding with the kind of service that we provide.† But perhaps over and above that, weíre also educated at the same time in the philosophy of enhancing human physiology.† In other words, trying to educate people in terms of improving their wellness to decrease their illness, and in doing so, we are quite dissimilar from the allopathic profession.† Iím not suggesting that we replace the allopathic profession.† Iím suggesting that they donít try to do what we do better.† Iíll give that over to Dr. Garber.
GARBER:† I think . . . a well trained naturopathic physician, who is licensed and has taken a four year course of study, has taken many of the same courses that the medical students do to become licensed physicians.† In terms of clinical training, they donít have the exposure to the acute patients in the volume that a medical student does.† Remember, in healing, in traditional and any type of medicine, itís an apprenticeship.† You learn by seeing patients.† What you learn is what you should do, what you should not do, and, frankly, we learn a lot by our mistakes as well as we learn from our mentors.† And in naturopathic medicine, I think what theyíre trying to do in the licensed areas with the registered schools is that these are people who are working along with the same basic background that the MD has, where they can go ahead and expand on this background.†
Weíre at a crossroads now.† Should MDs do a residency in natural medicine, and will that make them qualified to do this?† Is their training based in medical school enough?† I donít think it is.† The naturopath, who has all these modalities together can help us.† When I want, I know how to do manipulations.† I know botanicals.† I know homeopathy, but . . . I really want to use these things in the hospital, I refer to the person to the person I think can do it best.† Iíll refer to an acupuncturist.† Iíll refer to a naturopath.† Iíll refer to a chiropractor.† And we all refer to other specialists.† I think a naturopath is another specialist, and the question right now is I donít think the allopathic community should try to take over natural medicine.† That CAM should not be the purveyance of just the allopathic community. †I think we need these other people to work with us.
BRESLER:† Comment?† Yes, Effie, and then weíll need to stop.
CHEN:† I like your cooperative exchange ideas very much, and you talk about the medical doctor and the naturopathic medicine practitioner or others.† How do you see the role of other health practitioners, such as the nurse or physiotherapists and all the other . . . being part of this interchange?
GARBER:† Weíre all healers to some extent, from parents to family members.† The title doctor, although in the United States and in other so-called civilized countries, has a unique connotation that it doesnít in other less civilized countries.† But in terms of reimbursement and licensure, the physician is usually the person who is the originator of most health care policy, who really does most of the health care treatments, and usually gets the best billing for it.† Now, how do we do this?† We have a bi-level society, where people who are wealthy can access the Internet, find out information about alternative therapies, and go to these people.† And if they donít get reimbursed, they can afford to get these treatments, but the huge bulk of society cannot.† Weíve got to try to remedy the system by utilizing every member.† And, as I said, Iím more than happy to consult an acupuncturist, a massage therapist, all the time, and these people are wonderful in healing my patients.† They do things I canít do.† So we need to work together . . . ensure that the federal government and at the state level everybody is reimbursed for their services, so not only the wealthy are getting the benefit of these therapies.
CHARLOTTE KERR:† The last, Steven, I wanted to speak to you.† At the last panel I was talking about philosophy and the epistelogical underpinnings of the CAM therapies.† You spoke about the need for the emphasis of the foundations of CAM to be taught.† You have a sense of history here.† You have twenty years of commitment.† My sense was you didnít see it not only getting better.† It might either be the same or getting worse.† How much should we emphasize that in our recommendations?† Is it imperative?† Can we slide?† Whatís the deal?
SCHENKMAN:† On one hand I was glad to hear today that there was at least a theme, where more and more education was being done.† But my experience, over and over again, as an educational institution specializing in these areas, we were approached over and over again by interested colleges and other hospitals and universities to do some kind of collaborative effort.† And, usually, it was with some of the administrations of those institutions and perhaps maybe it was just because it was cutting edge and they were looking to be different than other hospitals.† But once we began the negotiations, we continually ran into road blocks with the medical boards and with the so-called, I think one of the other doctors earlier had leaders of their complementary and alternative medicine program . . . who had perhaps the two month training, and literally had no real understanding.† So, over and over, we run into the issue of trying to put something much bigger and squeeze it into this box.† It wonít work.† It hasnít worked.
††††††††††† A large university on Long Island, Public University, one of the top in research, had created a complementary and alternative medicine center.† It was done after a survey on Long Island to look at the interests of the population.† And within about, the hard, who I consider pretty, someone who is pretty adept and well trained in the area of CAM, and within a matter of probably a year and a half, the faculty of the medical institution, the faculty of the hospital, became such a political hotbed it just closed.† So, there you have it.
BRESLER:† I want to thank all of you for being here today and for offering your comments.† Weíre, again, very open to additional recommendations or suggestions that you have.† Feel free to forward them to us, to the commission.† Thank you so much for being here today.
BRESLER:† Kathleen Ann Golden, please start.
GOLDEN:† Good afternoon.† Welcome to New York.† I will offer testimony on the topic of standards of education and the profession of acupuncture and oriental medicine.† I think some of this may be slightly repetitive of what we just went through, but I think itís important to go over it again for the commission.
††††††††††† The national minimal standards for licensed acupuncture training require a three-year masters level professional program with at least one thousand seven hundred and twenty-five hours, passage of the NCCAOM national exam in acupuncture or Chinese herbal medicine, demonstration of competency in point, location, and clean needle technique.† In New York and many other states, schools exceed the one thousand seven hundred and twenty-five hours.† In many cases, the training will approach three thousand hours.† These accredited programs draw on an international pool of the worldís most experienced talented acupuncturists and herbalists, educators, and clinicians.†
††††††††††† The profession is proud of the level of education it provides for the practice of acupuncture and oriental medicine in this country.† The profession is constantly striving, through internal discussion and dialogue, to enhance the level of education available to the student of acupuncture and oriental medicine.† The profession has currently evolved in creating the requirements for clinical doctorate in acupuncture and oriental medicine.† The commission may hear testimony from other health care providers in this country that given a professional education in biomedicine, chiropractic, nursing, physical therapy, or podiatry, and the many hours spent practicing the chosen medical art, that this is a basis for taking abbreviated training programs in acupuncture, and incorporating it into an extent practice of medicine.† This is simply not true.
††††††††††† Acupuncture is not a single or simple technique or modality that can be added to a health care practice with an abbreviated survey like course.† It is a health care system with detailed complexity and subtlety requiring long and serious study.† I find it professionally and culturally insensitive that abbreviated training programs publish these words in their brochures, ďby eliminating the multitude of superfluous non-practical concepts surrounding the myth and folklore, which abounds in the usual acupuncture program.Ē† This reference to myth and folklore is an implication that the medicine, so generously shared by the Chinese, and carefully cultivated over thousands of years, has no basis in theory.† This insults a complex form of medicine, based on the dow(?), and their early observation of nature and the interrelatedness of all things on this earth.
††††††††††† Iíve encouraged Ms. Tsao-Lin Moy to testify here today.† Ms. Moy presents a unique opportunity for the commission to gain insight into the specifics on an education in acupuncture and oriental medicine.† It is clear from the many hours of study Ms. Moy and her fellow students invest in their education that this is not an educational process that should be abbreviated.† To do so insults the profession and destroys the integrity of the medicine.† I believe it also inhibits the hope of the students to help . . . medicine, to look forward to practicing with equal opportunity for an equitable livelihood.
BRESLER:† Thank you.† Donald DíAngelo.
DíANGELO:† Mr. Chairman, fellow commissioners, thank you for being . . .
BRESLER:† Please come close to the mike, okay.
DíANGELO:† As a physician and board member of the American Society of Acupuncture, I would like to briefly comment on . . .
BRESLER:† Youíve got to come much closer and speak a little louder.
DíANGELO:† As a physician and board member of the American Society of Acupuncture, I would like to briefly comment on the education and training of health and care practitioners in complementary and alternative medicine.
††††††††††† As part of a physicianís education, they complete four years of graduate level medical training and four years of postdoctoral training.† This amounts to a minimum of thirty-five thousand hours studying the human body and its processes, based on a conservative estimate of twelve hours a day over a period of a year.† Additional continuing mental education credits are also mandated by state and local agencies as minimum requirements for maintenance of good standing in licensure.† Furthermore, physicians and dentists are required to complete three hundred hours of training as a minimum for certification, specifically in acupuncture alone, as well as recommendations by . . . for ongoing continuing education.
BRESLER:† I think youíre going to need, youíre going to have to get a little more, little more . . .
DíANGELO:† It would be somewhat disingenuous to think . . . prior medical training is without significance with regard to the understanding of practice of complementary and alternative medicine.† New York State was the first state to set . . . regulating the practice of acupuncture for physicians and dentists.† And, in 1972, the New York Society of Acupuncture was the first professional organization designed to provide comprehensive training in acupuncture, both . . . and clinical, to physicians and dentists who wished to incorporate this modality into their practices.† Therefore, I feel that physicians, who have completed . . . training are more than qualified to provide not only safe, but efficacious, care in the area of complementary and alternative medicine, and are able to bridge the gap between eastern and western medical practice, which, when used in concert, provide the most comprehensive approach to medical care with the greatest benefit to society.† Thank you.
BRESLER:† Thank you.† Tsao-Lin Moy.
MOY:† Hi.† Good afternoon, members of the commission.† Thank you for your attention today.† My name is Tsao Moy.† I am a second year student at Tri-State College of Acupuncture.† I will be offering the commission testimony and insight on the standards of education in an accredited acupuncture and oriental medicine program.
††††††††††† What has been most challenging for me, as a student of acupuncture and oriental medicine, is learning to open my mind, to put aside my cultural biases, and develop creative and abstract thinking.† An accredited program is three to four years, approximately twenty-two hundred hours of study and training.† More than fifty percent of those hours is devoted to hands-on skills and supervision, observation, and clinical experience.† The remaining hours are for lectures, electives, and independent studies.† First year lectures in Chinese philosophy provide the philosophical basis of acupuncture and oriental medicine.† Describing and distinguishing which of the five filters a practitioner uses for arriving at an acupuncture diagnosis.†
Skills review and hands-on contact include palpation of meridians, point location . . . evaluation, tongue and pulse, in small supervised groups with practiced basic techniques of needling, moxibustion, wasa(?), cupping, ariculotherapy, and clean needle technique.† As part of our clinical experience, we observe and learn from senior acupuncture practitioners treating actual patients.† At Tri-State, we are exposed to a unique synthesis of various traditions in acupuncture from Dr. Mark Seem(?), Kiko Matsumoto(?), Aria Neilson(?), David Legae(?), and Dr. Richard Tan(?).† In the second year, a much deeper understanding of the philosophical basis of acupuncture and oriental medicine is applied.† To recognize signs and symptoms and learn appropriate treatment strategies in each individual case, rather than just memorizing a set of points from a textbook pattern.
During the third year, training, knowledge, and experience comes to fruition.† Students plan treatment strategies and treat patients in clinic under the supervision of senior acupuncture practitioners.† Having access to senior practitioners for advice in clinic is an invaluable clinical experience.† The Tri-Stateís acupuncture and oriental medicine program is representative of the standard of education in an accredited program, and the minimum requirement to practice as a competent provider in acupuncture and oriental medicine.†
I recommend that the commission look to the existing credentialing bodies for guidance and support the standards of education in acupuncture and oriental medicine that have been established by the NCCAOM, the ACCAOM, and the state education department of New York.† I recommend that the commission not support abbreviated training programs, and that these greatly diminish existing standards of competency and training, and ultimately diminish the quality of care available to the general public.† Thank you for your time today, and Iím available if you have questions.
BRESLER:† Thank you very much.† Huaihai Shan.
SHAN:† My name is Huaihai Shan.† And Iím very pleased at . . . giving opportunity to speak . . . Chi Kung and psychiatry.† Iím a psychiatrist, so, right now, Iím a visiting professor at UMDNJ, and Iím from China.† Today what Iím going to say . . . how to application of traditional Chi Kung in China.† As we know, thatís complementary and alternative medicine, including . . . therapy and some . . . techniques, and also some . . . that has been used for many many years in psychiatry.† For example, you can use acupuncture for depression . . . other methods.† But, so when Iím . . . to United States, so I . . . about promote the traditional Chi Kung because I have practice Chi Kung in China for about thirteen years.† Iíve been treating traditional university in China.† I . . . involved in the research about psychiatry and traditional Chi Kung for about fifteen years.† So when I . . . China . . . concern.† So we have been considered.† So in order to properly . . . of traditional Chinese Chi Kung is psychiatry.
††††††††††† The first question is . . . right now many Chi Kung masters.† They donít know what is the disease.† They donít know whatís acknowledge(?).† Theyíre using the Chi Kung to treat the medications, and thatís the same in China.† The second problem is, so right now some medical . . . evidence of fixing, itís not accepted by conventional medicine because it makes the . . . especially in the United States, also in . . . China.† The third problem is what Iím concerned.† That is so Chi Kung . . . the name has been misused in all of the world . . . for example, when I come to the United States, see, I found some lots of Chi Kung master come to the United States.† The establish . . . a Chi Kung company.† They treat some patients.† But right now you canít do it in China.† Thatís a different tradition . . . Iím sorry.† Thatís different than traditional . . . traditional . . . that is my body . . . that is my body . . . that is the traditional Chinese medicine.† So something like this . . . included . . . still Chi Kung . . . Chi Kung masters . . . working in United States, though thatís different.† So thatís what Iím saying.†
So I hope . . . three things.† The first thing is I hope to . . . United States . . . establish a Chi Kung research center and to we give . . . some patients for some practitioners training of . . . community and in the school.† So . . . right now we donít have . . . for this.† Thank you . . . thank you very much.
BRESLER:† Thank you.† Christopher Kent.
KENT:† Good afternoon.† My name is Christopher Kent.† Iím a chiropractor and Iím president of the Council on Chiropractic Practice.† The Council on Chiropractic Practice is a nonprofit apolitical organization, committed primarily to the development and distribution of clinical practice guidelines.† The clinical practice approach that we elected to use was evidence based.† An evidence based clinical practice is defined by Saket(?) as the use of the current best evidence in making decisions about the care of individual patients.† It is not restricted to randomized trials and net analyses.† It involves tracking down the best external evidence with which to answer our clinical questions.† This concept was embraced by the Association of Chiropractic Colleges in their position paper, which states chiropractic is concerned with the preservation and restoration of health, and focuses particular attention on subluxation.† A subluxation is a complex of functional and/or structural and/or pathological auricular changes that compromise neural integrity and may influence organ system function and general health.† A subluxation is evaluated, diagnosed, and managed through the use of chiropractic procedures based on the best available rational and empirical evidence.† And, indeed, that was the challenge.
††††††††††† How can we acquire this evidence because much of it was not available on computer databases?† Much of this evidence is not available in . . . journals.† Some of it is privately published and some of it is simply passed on by word of mouth.† So we used the following methodology.† We began with a comprehensive computer and manual review of literature, using such databases as Index, Medicos, Mathis . . . etc.† We had a technique forum, where we invited developers of chiropractic techniques to present oral evidence and any written support for their procedures, and the panel members had an opportunity to question these individuals.† We then held an open forum because we found the practitioner acceptance of clinical practice guidelines was very poor unless they were actively involved in this practice.† So to involve them in our process, we held an open forum where anyone who wished could present oral testimony, could present written evidence, and could interact with the panel.
††††††††††† The panel itself was multidisciplinary in character.† It consisted primarily of chiropractors, but also included medical physicians, basic scientists, attorneys, and a consumer member.† The important thing to remember in the guideline development process, in my opinion, is that it must be open.† It must examine the best available clinical evidence, not placing itself in a sort of epistemological straightjacket by limited the work to randomized clinical trials.† And it must be designed to empower the individual clinician by providing the best available information and not serve as a replacement for clinical judgment or a default to a cookbook type clinical approach.† Iíve provided copies of the guidelines to the various panel members, as well as some resources, and thank you very much for your time.
GORDON:† Thank you.† James Dillard.
DILLARD:† Dr. Gordon, esteemed members of the commission, as an acupuncturist, chiropractor, and medical doctor, Iíve had the opportunity to teach, the privilege to teach, in all three training programs over the last ten to fifteen years.† And I think Iíve been able to see some things that are a little unusual.† I think that CAM and non-CAM schools have a lot to teach each other.† I think that the CAM trained professions have a lot to remind us, and I would agree with Dr. Park that this literature does already exist, has a lot to remind us about patient centric treatment, about the relationships of the heart, and about connections with patients, about resisting depersonalization.† Likewise, I think that medical schools can teach CAM training programs a lot about the pursuit of scientific rigor, case reporting, vigilance for adverse reactions, and recognition of treatment failure.† Iíd like to make a few comments about that.
††††††††††† You know, when I was in chiropractic school, I was really taught to be a lone wolf.† I was not taught to be a team player.† I learned to go out and start a practice and see my patients.† They were my patients.† I didnít really want to work well with other; I didnít want to play well with other students. †I would not have gotten good grades in Kindergarten.† And I think that thatís part of the attitude about being able to teach CAM practitioners to work more as team players.† I certainly didnít learn that in chiropractic or acupuncture school as well as I did in medical school, and thatís one aspect, I think, that can certainly make a difference.
††††††††††† The other thing that I see in teaching in CAM schools is I think there can be a lot more emphasis on looking for adverse reactions.† You know, when I was in chiropractic school, one of the senior chiropractors said to me that he was pretty sure he got all his patients well because, after a few visits, they didnít come back anymore.† They either felt much better or they just didnít come back, which meant that they were cured.† This is a true story.† Likewise, my acupuncture students are still looking for the right Chinese diagnosis, changing the position of their pins, still trying to find the thing thatís going to cure them.† I recently reviewed a case in which there was actually a loose body . . . being treated with multiple acupuncture modalities.
††††††††††† So I think we need to be a little more careful with looking for adverse reactions, looking for treatment failure, and what are we going to do with treatment failure because thatís not being recognized enough.† I do not believe we should medicalize CAM schools, except for the issues of basic patient safety, and I do not think that we should CAM-ify medical training, except for issues of heart, which the CAM movement should remind us of those things.† Thank you very much.
GORDON:† Thank you very much.† Questions from the commissioners?† Yes, George.
GEORGE DEVRIES:† Dr. Dillard, would you expand upon your comments that we should not medicalize the CAM schools, I believe you said, or CAM-ify the medical schools?
DILLARD:† Iím sorry, I donít want to try to create . . . here, but I think there have been a number of other speakers that have addressed you all today that have made this point.† And that is I would not like to see a big sort of a glob made of medicine and the CAM professions together.† I think that they have to be, indeed, separate individual training programs, which gain the strengths of the other forms of training programs.† So I think that there needs to be more exposure in acupuncture schools to what chiropractors do.† And I teach this class right before these acupuncturists graduate.† What do chiropractors do?† What do nurse practitioners do?† There needs to be more communication between the training programs, but I also donít think that you can train medical doctors to do a lot of this stuff.† God knows itís hard enough to be a competent medical doctor, with the ever-expanding amount of technology that we have and the medications we have.† We canít train all these people to do all these things.†
So it doesnít make sense to try to make too much of a crossover between the CAM professions and the medical professions.† Rather sharing students, sharing faculty, I think this is where it can be valuable.† Where you have faculty that will be shared between these different institutions, and students that could attend lectures.† I know Yale, David Kass was not able to present to you today.† He brings . . .
. . . Into the lectures at Yale.† I think thatís the model.
GORDON:† Thank you.† Effie.
EFFIE CHEN:† Thank you so much.† I have a question to Dr. Huaihai Shan.† Thank you for your comments on Chi Kung.† I think itís very important.† Perhaps, you know, anything new, Chi Kung is sort of the new baby of Chinese medicine in the west right now.† It was acupuncture and then herbs and now Chi Kung.† We do have to watch its introduction to the west.† Itís very powerful, as you say.† So are there models in China that you know of that can be served as models here, one for research and then setting up as a center, as you mentioned?
SHAN:† . . . Students . . . from China for research.
CHEN:† Yes.† There has been lots of research done, and, of course, research . . .
SHAN:† I remember we have tremendous research . . . Medical University.† Thereís a Professor . . . she has . . . she has . . . twenty years for . . . hypertension.† There has been vast research has been published . . . but that is research . . . so interest in . . . Chi Kung . . . research . . . thatís a problem.† But especially for what we . . . right now . . . including the United States.† Thereís a few psychologists and a psychiatrist involving the research . . . Chi Kung.† So if we need more, if we lost the Chinese, lost the psychologist, and a psychiatrist . . . involving the Chi Kung, so we can avoid . . . mistake something like China . . . United States.† Thatís my question . . .
CHEN:† Thank you.
GORDON: †Ming and then Veronica.
XIAO-MING TIAN:† Regarding the Chi Kung, regarding the Chi Kung research.† Definition of the Chi Kung you are talking about Chi Kung basic learning, teach patient . . . Chi Kung, or youíre talking about external Qi, which study should be done?
SHAN:† Okay . . . in order to research what is the Qi, what is the Chi Kung, and that is . . . we want to individually . . . traditional . . . Chi Kung . . . conventional medicine . . . acupuncture or . . . herbs . . . to we want Chi Kung . . . as we have to use it so conventional.† Modern scientific methods to research for what is the Qi.† So what is the Chi Kung?† Thatís what we have to interpret.† Thatís the traditional Chinese medicine and then combined with conventional medicine.† Thatís very important to research for Chi Kung.
TIAN:† Thank you.† Iíll talk to you later because too many details.
VERONICA GUTIERREZ:† My question . . . comment to Dr. Kent.† I want to thank you for bringing the subject of guidelines to the table.† We have not, to my knowledge, had any testimony on that, and there is a lot of professions that have been presenting information that donít have guidelines yet.† So Iím wondering if youíd comment on the implications, reimbursement, legal, any other applications that the guidelines have been helpful with.
KENT:† Absolutely.† In other words, to me, the primary value in the guidelines is not to tell a person how to practice, but to provide them with resources that allow them to make more effective clinical decisions. †Byproducts of guideline development include defining research objectives.† By identifying areas where, perhaps, the evidence based is weak, but could be improved.† Another is to help . . . define public policy in terms of what procedures might be reimbursable and whatís the level of the evidence based for those various procedures.† I think that the basic methodology that we employed could be used by a lot of CAM procedures because they suffer from many of the, I wonít say shortcomings, but let us say cultural characteristics of the body of evidence in chiropractic.† And that is, for a long time, we had few, if any, refereed peer review journals.† Weíre just beginning to see those journals appear in the indexes.† Weíre just beginning to centralize the availability of these bodies of knowledge.† For example our guidelines are online on the National Guideline Clearinghouse, and theyíre available to other practitioners and individuals outside the profession as well.† So they help to define the level of knowledge and nature of contemporary clinical practice as well.† So I think a lot of folks could follow our methodology.† The thing that I would want to emphasize is that it should be an open process, that your goal is to find the best available clinical evidence, and you should arbitrarily exclude evidence because it doesnít meet a preconceived threshold.
GORDON:† I wonder, somewhat along that line, if youíve developed some ways of collaboration among CAM professions?
KENT:† We havenít as yet, but I think itís a great idea.† In other words, weíve learned a great deal in this process because Iíve been involved in, I think, five different guideline development processes, and learned a lot from the mistakes of my predecessors and my own earlier mistakes.† And I think that that basic process, that basic procedure, could be essentially cloned and made available to other professions.† Iíd be more than happy to do that, as would the Council.
GORDON:† That would be very helpful for you to share that, share at least an outline of that process with us.
KENT:† Yes.† In the guideline document itself, we go over the methodologies.† So I provided the panel with various Web sites, including the full text document, a print copy of the full text document, and an outline of the methodology, which is in the beginning of the text.
GORDON:† Thatís great.† You ought to come back more often.† Thank you very much.† We really appreciate all of you coming.† Weíre going to take a fifteen-minute break at this point.† So itís now, by our clock, twelve of 3:00.† So two minutes after 3:00 weíll begin the next panel.
Panel Coordinator, Geraldine Pollen
GORDON:† Weíd also like to ask, while these panelists are coming up, if the speakers, future speakers, if you could sit in the first few rows, that would be very helpful to us.† This is panel twelve, and weíll begin with Barrie Cassileth.
CASSILETH:† Thank you, Dr. Gordon.† Good afternoon everyone.† It really is a great pleasure to see so many old friends, and a pleasure to participate in this very important meeting.† Iím happy to describe the program at Memorial Sloan-Kettering Cancer Center, which is called an integrative medicine service.† The service is quite new.† We have been seeing patients for approximately one year, and the first question that you posed to us was to describe our treatment program.†
††††††††††† Our treatment program is one of four major activities in the integrative medicine service.† We offer a wide range of complementary therapies, both on an inpatient and outpatient basis.† Iíd like to make a distinction, however, between alternative and complementary therapies because we offer a wide variety of complementary therapies, but no alternatives.† In cancer medicine, this distinction is particularly crucial because there are so many unproven methods that are promoted as cancer treatments and cancer cures.† We do not use those.† In fact, we encourage patients not to get drawn into them.† Instead we offer adjunctive complementary therapies, which are used along with, not instead of, mainstream cancer care.† These include mind body therapies, many different kinds of massage, acupuncture, classes in yoga, meditation, tai chi, pilates, mat(?), chair aerobics, and a variety of music therapy, art therapy, and a variety of other things.†
††††††††††† Our inpatients are generally interested primarily, remember our inpatients tend to be very sick, and they are interested primarily in music therapy and sometimes massage.† Our outpatients are interested in almost everything that we offer it.† Thatís why we offer it.† We are very responsive to patients needs.† We will drop particular therapies that patients are not interested in.†
††††††††††† The other point Iíd like to make is about research and the importance, from my perspective, of conducting very methodologically sound good research in CAM.† We need it very much.† We need it in order to be accepted in mainstream medicine.† We need it in order to be respected by scientists and others who provide care to cancer patients and other patients who are ill with various diseases.† I would encourage the commission to think about this as a very major issue, not only research, but high quality research that we can proud of and that people will not quarrel with.† I thank you very much for your attention.
GORDON:† Thank you very much, Barrie.† Is Ray Chang here?† I saw him earlier.† Weíll move on then.† Janice Pingel.
PINGEL:† Thank you.† Good afternoon members of the commission.† My name is Janice Pingel and I am from Scarsdale New York.† I have had two bonafied cures with the help of acupuncture.† Of that I am certain.† In 1990, after eight years of excruciating lower back pain, which no medical doctor could help me with, I turned to alternative medicine, which was acupuncture.† I turned to it, but with very little expectations of success.† Six sessions later, I left that office pain free.† I have never had another seizure, and that was eleven years ago.†
††††††††††† In 1996, I suddenly developed severe leg pains.† This time I went directly to acupuncture and to my present doctor. Dr. Doreen Chen.† After eight treatments and consumption of Chinese herbal tea, I left her office healed with no further problem.
††††††††††† Now, to my present situation.† In 1997, I was diagnosed with incurable neuroendocrine cancer of the lung, with metastases to the liver.† I began very aggressive oncology treatment with Dr. Sarah Sudan and, at the same time, I returned to Dr. Chen for bi-monthly needle treatment to support my immune system.† At that point, my oncologist would allow no consumption of herbal tea from Dr. Chen.† A small remission occurred and I was out of treatment for about six months, but I continued with Dr. Chen and was now able to drink her tea, since I was no longer taken this extreme oncology medication.† And that was in 1998.† In October of 1999, I returned to Dr. Sudan for weekly treatments of taxol, which continues to this day.† At the same time, a new tea, cordiceps militares(?) was released in China for treatment of lung, liver, and kidney cancer.† This time I prevailed upon Dr. Sudan to allow it to be part of my treatment.† She was very open minded to this request and agreed.
††††††††††† CAT scans are given every three months.† In September of 2000, my scan showed all lesions in the lung are gone, and cancer growths, which had covered the liver, were decreasing.† Both Dr. Sudan, who has written testimony on my case to my insurance company, and Dr. Chen believe, as I do, that the combination of allopathic and homeopathic medicines are having a curative effect on my kind of cancer, at this present time.† My January 10th CAT scan also showed very positive results in tumor stabilization.† Thank you very much for allowing me to share my story.
GORDON:† Thank you very much.† Raymond Chang.
CHANG:† Commissioners, ladies and gentleman, appreciate the opportunity to give testimony here.† I am going to specifically comment on, I think, what some of the hurdles are for complementary and alternative medicine practice and what some of my proposals would be, but in a very general way.
††††††††††† In practice, I find that in order to enable complementary and alternative medicine to become more accessible and transparent, we really need to win the complete trust of the conventional medical community, as some of the previous testimonies have indicated.† There is still, I feel, widespread suspicion, if not outright hostility, in many instances and on many occasions.† And, personally, since I work with many conventional physicians who will refer patients to us, I sense that degree of resistance, and that hampers quality care.† It needs to be clear to the conventional medical community that although CAM practices may be considered unconventional and the mode of action in many cases, such as acupuncture or certain herbs, the principle of action may not be fully accountable by current biological sciences, but we should pay attention to outcome and results.† Quality clinical data is extremely costly to come by.† I feel that because of the trickle of public and private funding thatís available for formal trials that the data will not be available any time soon.†
††††††††††† Another important issue is that of education.† Although basic introductory CAM education has been introduced in most medical schools over the past five years, it is sorely lacking at the postgraduate level:† internship, residency, and fellowship.† I think that it is important that appropriate rotations in CAM during postgraduate training be introduced to allow younger physicians to appreciate and to develop the consciousness of what CAM practice means at a deeper level.† It is imperative, then, that the new generation of doctors develop this awareness in order for them to learn, accept, and practice it for the health and well being of the patients.
GORDON:† Thank you very much, Ray.† Joan Runfola.
RUNFOLA:† Thank you.† The remarks Iíll be saying today are based both on my experience as an oncology social worker at Cancer Care, of having counseled patients about medical decision making for the last twenty plus years, as well as my experience as a breast cancer survivor, where I used integrative medicine.† In fact, I saw Dr. Chen over there.†
††††††††††† We all know that the reported use of CAM ranges up to eighty to eighty-five percent, and that information about CAM is highly available to the public these days, particularly through the Internet.† However, one of the concerns I have is I have people come to me, trying to make decisions about CAM as well as conventional treatment, is that a lot of times their decisions are not based on having all the information.† Very often they are going based on anecdotal evidence, hearing information from family and friends.† They have complete or inaccurate information, which is not evidence based in any way.† And sometimes they solely base their decisions about CAM use on personal beliefs or preferences.† This is compounded by the fact that thirty-five to seventy-two percent of people donít discuss their use of CAM or intended use of CAM with their physicians, and that most physicians, as weíve discussed, lack adequate information to be able to guide the patients through the decision making process.†
††††††††††† So what I propose is that the commission advocates the use of a Web site, either its own, something like its own or that of the Center of Complementary and Alternative Medicine, which includes a listserv where physicians, other health care professionals, and the public can have ongoing access to a variety of different pieces of information.† This would include the latest facts about the proven effectiveness of various CAM modalities, including the type of research that has been done to reach these conclusions, the methods by which the treatment or modality is administered, any potential risks, and indications and contraindications.†
††††††††††† Secondly, the site or the listserv could also include questions that one can ask a practitioner when considering a particular CAM approach.† And you see in your packet there a sample brief about making decisions about CAM.† And, also, information about practical considerations that one should look at, such as cost and impact on lifestyle.
††††††††††† Thirdly, I suggest listing resources where one can locate qualified CAM practitioners.† You can see the handout Iíve given you is as a sample of national organizations that will describe what qualifications one should look for in a practitioner, as well as referring to qualified practitioners.
††††††††††† And then fourthly, listing guidelines for both health care professionals and patients to use to communicate with each other about the use of CAM.†
††††††††††† Because weíve talked about the medical profession not being as involved as weíd like with the CAM information, I also recommend that states are urged to revise their continuing education requirements to include CAM, and that there is consideration of instituting a standardized model, such as the EPIC(?) program, which is used for end of life issues, which would be about CAM.† Thank you.
GORDON:† Thank you very much.† Barbara Sarah.
SARAH:† Hi.† I address you today wearing three hats.† One as the co-chair, with Joan, of the National Association of Oncology Social Workersí Complementary Alternative Medicine Special Interest Group.† My second hat is as the chair of the complementary medicine committee and coordinator of the oncology support program at Benedictine Hospital, up in Kingston New York.† And third as an eight and a half year breast cancer survivor.
††††††††††† Itís getting late in the afternoon, so this is my first afternoon.† Thought weíd have a little fun here.† Itís all so heavy.† Wearing my first hat, Iím in contact with professional oncology social workers from around the country, who are flooded with questions from patients about what CAM treatments and procedures to pursue.† This is especially true at that point in time when they have to make decisions about whether to conform to conventional treatments only, or after conventional treatment is finished and they want to be able to do something to maintain good health.
††††††††††† In my second hat, Iím working at a small upstate New York hospital, where doctors and patients alike need more information to stay up to date with current research and practice.† Our hospital wants to set up a CAM center, and we want to be able to offer our patients reliable services to help them stay healthy.† Consistently, the most popular of my support group programs is our regular complementary medicine discussion group, where patients share information and practitioners come to make presentations.† People are hungry for information, yet I have to post disclaimers before our presenters speak because I cannot necessarily endorse the information that is offered.†
††††††††††† In my third hat as patient, I made a decision following my lumpectomy and axcillary node dissection, and after doing research, and asking a lot of questions, not to do any conventional . . . treatments of chemotherapy radiation that were recommended.† I did do acupuncture and yoga, mistletoe and supplements, all out of pocket costs.† I began to meditate. I got involved in an immune system study at a medical center.† I altered my diet.† I changed jobs and began working as an oncology social worker and became a passionate breast cancer advocate and activist.† I became a personal example of the use of CAM.
††††††††††† In all three roles, I face daily a quagmire of information about complementary medicine.† Doctors, patients, other health care professionals, and I myself have questions about the reliability of information flooding us from all sides.† We need to have regular contact with a trustworthy scientific national source that evaluation promulgates this information and makes it available to us on a regular basis.† We need doctors who are educated about the use of CAM and can spread the word to their colleagues.† Patients are reluctant to tell their doctors about their use of complementary medicine because so many doctors have insufficient training on the subject.† We need updates on CAM through the Internet or hard copy bulletins to other health care professionals, such as social workers and nurses.† They are the people who are in daily contact with patients.†
††††††††††† I propose that we have a complementary medicine advocate corp. be established . . . composed of designated, educated, and trained representatives from the above mentioned groups, who would then be regularly updated by the national office on CAM.† These people could then disperse this information to their respective networks, through existing publications, e-mail . . . gatherings of their special interest groups.† Letís enlist those of us on the front lines to get that accurate information out to the public through an organized system of networking.
GORDON:† Thank you.† Virginia Mae Langley.
LANGLEY:† Thank you for allowing me to speak here today.† I am both a certified nutritionist and a cancer survivor.† I am not a guinea pig.† I am not a statistic.† Being told that a blood test indicated a second bout of cancer was upon me led me to study nutrition.† Putting this information, the information I obtained during my studies, in to practice saved my life.† No allopathic treatments were used or to accomplish this.† I share the reason for my good fortune, the macrobiotic diet and lifestyle, with everyone who will listen.
††††††††††† Macrobiotics has been used for thousands of years to successfully treat many illnesses.† The health benefits of diet are substantiated by the work of such famous medical doctors as Dr. Sherry Rodgers, Dr. Dean Ornish, Dr. Lorraine Day, and Dr. John McDougal.† It saddens me to know that some oncologists totally disregard diet and nutritional supplements as being effective tools in the cancer battle.† For doctors to make such remarks to patients, who are counting on them to have all the answers, is biased arrogance, bordering on criminal behavior.† If my source of information is correct, cancer is the number two cause of death in the U.S.† Drug reactions are number three.† First do no harm?†
I have witnessed the prescribing of Prozac for an individual with extreme chemical sensitivities simply because the doctor did not know what else to do.† My own daughterís elementary school psychologist recommended my daughter be put on Ridlin when she had a hand eye coordination problem, which was cured by doing eye exercises.† No drugs were or are being taken my daughter.† She is now a second year college student with a B average.
Though I graduated from the National Institute of Nutritional Education, I am not allowed to legally call myself certified nutritionist in New York State, while in most other states I can.† The American Dietetic Association feels they should be the only kid on the block when it comes to nutritional information and education.† For a more uniform ruling on the credibility of certified nutritionists is sorely needed.† The American diet is nutrient deficient, but medical doctors have little or no nutritional education.† The public needs more information on the benefits of healthy diet and nutritional supplements.† Ideally, nutritional education should begin in elementary school.† School lunches should reflect the knowledge of healthy eating practices.† At the present time, French fries are the number one seller in school cafeterias.
What has happened up to now proves that common sense cannot be legislated or drug induced.† Without question, the medical profession does an excellent job when it comes to dealing with acute emergency care.† It is also obvious that the medical profession is in need of help when it comes to dealing with degenerative diseases, and I am positive alternative medicine therapies can provide what is needed.† Thank you.
GORDON:† Questions from the commissioners?† I have one question; actually I have several.† Iíll start with one and then see if others have others.† Several of you, Barrie and Ray in particular, and Janice Pingel talked about issues related to combinations of chemotherapy and Chinese herbs, or the possible combinations of chemotherapy and Chinese herbs.† You didnít speak specifically about it, Barrie, but Iíd like your thoughts about it.† In a number of the Chinese studies, in particular, show very good results with combinations.† And Iím wondering if you have proposals, and the reason Iím bringing up this specific issue is because I think itís an important issue specifically, but I also think there may be some general principles involved.† So Iíd appreciate any of your comments about the kinds of studies that should be designed, the kinds of services that either youíre providing or thinking of providing, and what your concerns or considerations are about it.
CASSILETH:† Well, you have hit upon what is closest to my heart.† We do two types of research in the integrated medicine program at Memorial Sloan-Kettering Cancer Center.† One is quality of life evaluations of benefits of acupuncture, massage therapy, and other type therapies, and the other is a study or primarily Asian botanical remedies.† We already have a program up and running.† We work in collaboration with various senior investigators, both basic science and clinical researchers.† What we have done is to go back to the Chinese literature and, fortunately, we have several Chinese physicians with us who can actually translate this.† And we have picked up those herbs or combination of herbs that have been recommended for use over a long period of time and that logically seem worth pursuing.† So we have started out with laboratory test tube investigations, where we take these herbs, usually one particular herb in its entirety.† We donít look for an active component necessarily because we believe in the synergy of the various components of a particular herb.† And put that herb into several dozen test tubes, each one containing a different cancer cell line.† So one would be breast cancer.† One would be color cancer, etc.
††††††††††† In doing this, we have found six or seven botanicals that are so exciting looking that we are going to bring them to clinical trials, and weíre in the process of doing that.† I think that this is the kind of thing that needs to be done.† I think before we start doing clinical trials and experimenting with botanicals, along with chemotherapeutic agents in people, we need to do it at a test tube level.† Itís very easy to screen and find out which ones look really promising and which ones donít.† But this is an area that I would hope the government would look at and be willing to fund more research in because I think itís tremendously exciting and potentially very very powerful.
CHANG:† I think one, again, cost effective area because, as I said, I think good clinical trials are expensive to run, and without clear backing from drug companies, etc. good quality trials and results are expensive to come by.† Without reinventing the wheel, there is a huge literature already available, and a lot of research has been conducted in China, Japan, Korea, and the rest of Asia, Taiwan, Singapore, and now in Hong Kong.† Itís very useful.† A lot of it, unfortunately, is published, like the Japanese literature is usually published, a lot of it is published in . . . in Japanese cancer literature.† And the same thing with the Chinese.† There may be methodological issues.† The quality may not be as rigorous as we would like to see . . . RCT trials, etc.† But a lot of work has been done, both at the in vitro level, at the pre-clinical animal testing stage, and also clinical trials have been conducted, which would lend a lot of insight.† So without totally reinventing the wheel, it would be very cost effective to try to obtain that information either through meetings, conferences, translations of existing literature.† Although itís not in the English language, itís not abstract . . . etc., but there is a huge body of literature.
GORDON:† Thank you.† Other questions from commissioners?† Charlotte, yeah.
CHARLOTTE KERR:† Iím not quite prepared to ask my question, so first Iíd like to acknowledge the three-hat lady and say please talk to the parents about the networking.† Iím so edified when all of you speak.† Iím breathless.† I want to talk about nutrition and the role of the commission.† When we talk about public health, which weíve done this morning, we understand thatís treating the body politics.† So weíre talking about air and water and food.† And no matter what anyone is doing, we often talk about food, but weíre not actually talking about it all the time.† We know that children having Pop Tarts all day, and sodas, arenít going to have quite a healthy brain.† Where do you think, what do you want us to say about it?† What can we do?† And I open this to everybody because Iím sure all of you would be talking about this in your care.† So thatís the best I can get on my question.
LANGLEY:† Thatís a very good question.† Iíve done a lot of thinking about this issue, and my feeling is that you have to start at the very bottom.† Instead of having women sit in a gynecologistís office waiting for their turn, which Iíve been in that experience, it takes two or three hours.† They will put a video in front of you to watch that will sell Pampers and all sorts of different things for babies, but they donít address the issue of properly feeding your child from the beginning.† A lot of research has shown that children are getting asthma, very very large numbers.† Theyíre getting diabetes.† Theyíre getting blocked arteries, and this is ridiculous.† Itís absolutely ridiculous.† You didnít see this a hundred years ago.† You didnít see it fifty years ago.† I blame the food industry.† Iím sorry, but I think thatís where it lies.† That and the fact that we are not educated, as I said in my speech, weíre not educated in nutrition at all.†
My daughters go to school, and Iíve questioned them about what theyíre being taught in school.† There is no nutritional training at all.† But my daughters have learned through me that things like dairy products are being pushed, and dairy products do not provide the body with calcium.† Dairy products are very harmful to the breast.† Very harmful to the prostate.† Very harmful to the heart.† And yet we continue to allow the dairy industry to be in your face.† Itís the milk mustache.† Every child in school has to drink their milk.† Itís these types of issues that we need to address.† We need to address the fact that the mothers donít know how to start out with feeding their children.† They donít realize that whole grains and beans and minimize the meats.† Get the junk food right out of the kitchen.† Donít even buy it.† Donít allow it in your house.† Obviously, theyíre going to get it when they go to school, but if you start them out with a taste of whatís healthy, then theyíre going to be a little bit more likely to lean that way, I believe.† And then when they get in school, donít offer them French fries.† Donít offer them cookies and puddings and things like that.† Offer them the healthy foods.
GORDON:† Thank you.
LANGLEY:† Thank you.
JOSEPH FINS:† Yes, for Dr. Chang.† Itís good to see you again.† Drawing upon your experience having worked, I believe, at Memorial in the past, and knowing that kind of culture of an academic medical center, perhaps you could say something about delineation of the scope of practice, privileges, and how do we delineate who does what when so many different practitioners may be providing the same service, such as pain management, which could come in from anesthesiology, a pain . . . care service, an alternative practitioner?† And maybe Dr. Cassileth could also comment on this, but how do we delineate, in a complicated environment, scope of privileges and practice?
CHANG:† I think that is an evolving issue for most institutions who have to enroll and place in practitioners who were previously not in the system.† And how do you accredit certain practitioners?† There are formal national organizations and certification processes for certain arts, such as acupuncture, whereas there is state licensing requirements.† But for other things, itís more, I think the institution will have to evolve its own rules.† In some places, for example, where acupuncture can be offered on an inpatient service, perhaps they cannot do it as, I meant on the outpatient service.† They may not be able to offer it to inpatients.† And there are issues like that.† I think each institution will develop such credentialing processes within itself, and insurance companies, as they look to cover some of these services, will have to do the same.† A similar issue will be related, I think, to herbals.† How do you standardize?† How do you introduce it to the formulary, etc?
CASSILETH:† I think the issue of accreditation and credentialing of practitioners is really a national problem.† Right now, we have a number of bizarre situations . . .
††††††††††† . . . We are doing it because Kimora(?) was very committed to having an integrated medicine service.† But I get calls from people all over, frequently, that this is a very serious problem.† They canít figure out how to fit someone, like an acupuncturist, into the mainstream of the practice of that hospital.† And I agree with Ray, this is going to be a matter for individual hospitals to figure out, but it would be greatly aided if the commission could push whomever to help us get to a more similar series of practices and credentialing approaches across the board, across all states, or perhaps some national procedures.
GORDON:† I just wanted to be clear on that.† So you think it would be helpful, generally, Barrie, as youíve gone around looking at other programs, for us to help establish some national guidelines.
CASSILETH:† I think it would be enormously helpful to push the states to be consistent in their guidelines and for them to have guidelines.† You know, there are some guidelines that are in existence, which I think are terrible.† For example, in acupuncture, if you are an American physician, you can take two or three hours of acupuncture study and youíre an acupuncturist.† That doesnít quite cut it when acupuncturists trained in China will train for years.† There is a vast difference between the two.† Those kinds of discrepancies and absences, I think, are very problematic.† And I think anything that the commission can do to help alleviate the problem and encourage states to produce seriously rationale accreditation concepts would be helpful.
JOSEPH FINS:† Could you also follow up on the question of herbals and on pharmacy and therapeutic committees and formularies?
CASSILETH:† Iím not sure how to answer that.† I mean, I know what we do, which is we have a variety of people, including basic scientists and a pharmacist, look at herbs when they havenít been so examined in their country of origin.† I think thatís going to have to be done until we reach some different level with some of these herbal products.† Even those that have been carefully studied in Asia have not necessarily been studied for a long enough period or in quite the way that is acceptable in this country.† And we are actually working with some groups, some pharmaceutical companies, I donít know if you call them pharmaceutical companies, but companies that manufacture a botanical product, in China, on products that have been in use there for a long time, to bring them into the mainstream of analysis here so that they can then be properly utilized.
GORDON:† Thank you.† Weíre going to have to end the panel now. I just wanted to say to Joan Runfola and Barbara Sarah that I personally look forward to talking with you more about some of your efforts and what youíre doing in terms of education and networking.† We look forward to hearing more about how your work develops as well.† Thank you all very much.† I just want to put in a thanks to you, Michelle, for assembling the panels.† Once again, I see a wonderful coherence.
Panel Coordinator, Dr. Joseph Kaczmarczyk
GORDON:† Because Robb Burlage is on a mission of mercy, picking up four children, weíre going to ask Sezelle Gereau-Haddon to speak first, if she would, and then hopefully Robb will come and weíll have him speak at the end.†
GEREAU-HADDON:† Thank you.† Iím a physician.† Iím currently the coordinator or the Wellness Center at the Riverside Church.† The Riverside Church is an interdenominational church that is on the upper west side, West Harlem and Morningside Heights community.† We offer a number of complementary and alternative modalities for our parishioners and people in our neighborhood and participants of our programs.
GORDON:† Sezelle, come a little closer.
GEREAU-HADDON:† I am also currently an associate fellow, going through a program, the first ever program offered by Dr. Andrew Wile and the University of Arizona in integrative and complementary medicine.† Thank you for listening to my comments today.
††††††††††† With millions of dollars being spent every year on alternative medicines, this is fast becoming a field that is affordable only to the very rich.† Complementary and alternative medicine, though, has much to offer those who canít afford to pay out of pocket for these modalities.† In these less affluent communities, there are high death rates from cancer, heart disease, and other chronic illnesses, in which lifestyle plays a great role in their cause and treatment.† Complementary medicine often begins with healthy lifestyle changes and emphasizes maintenance of health by changes in diet, exercise, stress reduction, and use of supplements.† Once disease does occur, use of alternative modalities can often be cheaper and its effects more generalized to overall good health and well being than allopathic remedies that are aimed at specific illnesses.† As such, use of alternative therapies in poorer communities could result in general better health at less cost.† Here, indeed, an ounce of prevention is worth a pound of cure.†
The question then becomes how to provide access to complementary and alternative medicine in the most cost effective way, one that will reach many people in need.† I sit before you today to propose that faith-based communities are well suited to assist in this regard.† Here are some of the factors that make these communities prime for this role.† Congregations begin with the same premise that drives alternative medicine, that the patient is intrinsically a curable entity and that access to this cure stems from within the patient themselves, not from an externally applied medication or treatment.† Alternative medicine seeks, in many instances, to balance imbalances and, as such, restore an individual to wholeness and health, not solely to cure a disease.† Churches, synagogues, and masques, in many ways, do the same in addressing the person as a whole entity, mind body and spirit, in the context of a community.
Second, faith-based communities have a wide audience of individuals that use the facility, from parishioners to people who access these for social services, such as food, shelter, or clothing.† They also provide an environment in which the patient feels safe, unlike hospitals, which can be stress inducing in and of themselves.† Here is a captive audience in a space that lends itself to healing.† Thirdly, congregations have their own resources that might be used to offer alternative therapies to patients.† Riverside offers a variety of modalities: meditation, massage, therapeutic touch, support groups.† I could name a number of them.† Also, many congregations have parish nurses, who serve in various capacities.†
If alternative medicine is the new wave, letís not let this wave pass by some of those who could use it most.† I encourage you to consider using faith-based communities as allies in this quest.† Thank you.
GORDON:† Thank you.† Swami Sada Shiva Tirtha.
TIRTHA:† Mr. Chairman, commission members, my name is Swami Sada Shiva Tirtha.† Iím the president of the Ayurveda Holistic Center and the School of Ayurveda on Long Island.† I hold a doctorate of science in ayurvedic medicine.† It is the spirit that I come to talk to you about today, not herbs, not drugs, not medicine.† Spirit is the core therapy.
††††††††††† Ayurveda, unlike other sciences, offers a spiritual dimension.† Love, care, compassion are the essence of ayurvedic healing, more than mundane therapies.† Health care must fit into a spiritual paradigm.† We cannot mold traditional medicines into the allopathic system without destroying its spiritual effectiveness.† Therefore, itís crucial that an ayurvedic expert be represented on the commission, or at least on a secondary panel.† If youíre to be effective, the commission must include representatives of the original healing sciences or run the risk of overlooking the essences of spirituality in health care.†
Along with love, come care and compassion.† Ayurveda contains a complete and profound science.† It diagnoses the root cause of illness with unique pulse taking methods.† It treats individualized therapies with herbs, nutrition, aromatherapy.† And there are more than two thousand research studies done throughout the world on ayurveda, proving it effective, safe, and inexpensive.† In our center, we have consistent success in many areas: for OB/GYN with PMS, menopause, bone loss, hormone balancing; for seniors with age reversal memory loss, brittle bones, and arthritis; and with special conditions, such as Parkinsonís, MS, and fibromyalgia.†
Ayurveda is cost effective.† Medicare and Medicaid patients wonít have to choose between paying for food or for medicine.† In my pilot research study on seasonal allergies, we found a savings of $2 billion for just a six-month seasonal allergy period in one year.† If you apply the ayurvedic cost comparisons to just digestive disorders, we could save hundreds of billions of dollars in a year.†
There should be as much press coverage for alternative medicine as there is on allopathic drugs.† Pass an equal airtime bill.† In a time when western medicine has no answers for many diseases, causes deadly side effects, and exorbitant pricing, itís a crime that people canít hear more about alternative medicine successes.† Create a proactive holistic health care law.† Donít just fight unfair labeling and freedom of information law attempts, but try to create bills that punish the truly criminal injustices of current health care.† Set up a Web site database for practitioners to submit their case studies and research findings to inform practitioners and citizens.† And use these databases to report to the press.
I encourage a national and state practitioner regulatory committee based on the Minnesota model.† In New York State, weíre not allowed to practice ayurvedic massage without a license, without undergoing lengthy costly study in Swedish massage, but a Swedish masseur can practice ayurveda with just a little bit of training.† Thank you.
GORDON:† Thank you.† Ellen Schaplowsky.
SCHAPLOWSKY:† Yes, thank you.† My name is Ellen Schaplowsky.† Iím vice president of the Traditional Chinese Medicine World Foundation and executive editor of our newspaper.† Our goal has been to build bridges of understanding between the east and the west in the areas of authentic, beneficial, and sound traditional Chinese medicine.† And we do this through a variety of means.† We have a newspaper, which I believe you have a copy of, which looks like this, called Traditional Chinese Medicine World.† This paper now has a circulation of approximately two hundred thousand people.† Itís in three hundred and fifty hospitals with complementary and alternative practices.† It is in libraries, the Yale Library, Indiana University, and Stony Brook, and itís in all the New York public service libraries.†
Weíve produced three books on traditional Chinese medicine.† One with Dr. Nun Lu(?), who is our founder, one on breast cancer, one on menopause, and one on diet and stress.† The hunger for this information is tremendous, as evidenced, on the Barnes and Noble Web site, there are seven hundred and seventy-seven books on breast cancer.† We are number twenty-five.† We are the second book in traditional Chinese medicine.†
It is critical that we provide authentic traditional Chinese medicine information to the general American public.† We cannot feed them the short form answers.† They have to understand the difference between western medicine and Chinese medicine.† It is the difference between quantum physics and science.† It is not an either or, but an and, and it is very important that we shy away and discourage the suspicion, the fear, and the aversion therapy that goes on in western medical offices when women who are dying for this kind of treatment, and I mean literally are seeking help, kindness, nurturing, and loving attendance to their health and not to the financial bottom line.
One of the things that we know is, in our next issue, we are producing an article by a highly regarded researcher at Mt. Sinai, who will publish a landmark study in a prestigious western medical journal about asthma and TCM formulas for asthma, which have been in use for centuries.† She has produced a remarkable piece of work.†
I suggest to the panel that you support public service announcements, in general.† I suggest you do syndicated radio programming, which you fund and . . . the quality of.† And I suggest that you personally take an active role in ensuring that the finest quality of educational material gets to the American public.† I think this is essential, and I think that east and west can coexist beautifully together for the preventive good health of every person in America.† And I thank you so much for listening to these comments.
GORDON:† Thank you as well.† Ming Jin.
JIN:† My name is Ming Jin.† Iím a licensed acupuncturist in New York and New Jersey.† Iím a medical director of the MingQi Natural Health care Center.† So I present here for AAOM, advisory board member, and I also present for the National Association of TCM.† Here, because there time limited, I think of the major concern . . . talking about the Chinese herbs.† Chinese herbs, I think, I spend eleven years in China in our college, you know, university, study for Chinese medicine.† I think now all the, in this society, all the people will know the Chinese medicine already.† They will use it for all different . . . preventive care.† The major part, I think, Chinese medicine for treatment . . . we need more research and . . . for support all evidence.† Just like we heard about the Chinese herb that treated cancer, Chinese herb lower the PSA level.† Chinese herb, like myself, I do the research for Chinese herb to shrink the uterus of fibroids.† We have so many cases in the clinic already, but we cannot say, you know, we cannot publish it . . . just need more evidence, more research, and then the lab research here to support us to say this . . . for the treatment.† So I think there will be the chance to tell, you know, present our ideas.† Say we need like more support from the NIH, from the White House, from you all commissioners give us, and more . . . funding to do this kind of research to make it like really . . . to approve that.
††††††††††† And, also, I want to talk about the Chinese herb is so many . . . for the Chinese herbs.† There are side effects, like Mahwah(?).† Mahwah is a very important herb of . . . to treat the asthma, but because we didnít use it properly and then you have a lot of problem here.† So usually in the . . . eight hundred years documenters say the Mahwah cannot use as a simple herb.† It cannot overdose.† It has to be preserved with honey.† They have to use . . . certain herb as their formula.† And, also, for the patient . . . like heartbeat too fast, they have the bleeding problem, over sweat.† They all cannot use Mahwah.† Theyíre all documented in our book for over, like almost a thousand years.† But here they use the Mahwah for simple, you know, the concentration for lose weight.† Of course, there will be the problem.† I just used this as an example to say maybe if we can have the, like a panel, really have some professional doctor can handle this kind of problem and can make an herb work better in this society.† Thank you very much.
GORDON:† Thank you.† Thomas Leung.
LEUNG:† My name is Thomas Leung, and I stand here today, or sit in this case, representing the Association of Chinese Herbalists of New York.† Our organization has been in existence for over twenty-five years, and has a membership of over three hundred TCM . . . practitioners.† I would like to begin by thanking the commission for the hard work and making today possible.† In particular, Commissioner Tian for encouraging traditional Chinese medicine organizations, such as ours, to participate in this movement.
††††††††††† The Association of Chinese Herbalists would like to address the commission on two areas.† The first is regarding the differences in the training of herbal practitioners and acupuncturists.† And, second, the distinction between traditional Chinese medicine and Chinese herbs.†
It is important that a distinction be recognized between the practice of acupuncture and the practice of traditional Chinese herbology.† There are two distinct disciplines that share some common theories, but are very different in their practices and training.† The practice of acupuncture does not necessitate the knowledge of TCM herbal medicine.† An acupuncturist can treat patients very successfully with acupuncture techniques alone.† As a matter of fact, most academic institutions in the United States, as well as Mainland China, do not require students of acupuncture to take any TCM herb classes in the curriculum.† Further, it is not an educational or licensing requirement in the state of New York, or any other state, for an acupuncturist to study TCM herbology.†
The reverse applies to an herbalistís training.† He or she does not have to have any training in the discipline of acupuncture.† Therefore, it would not be in the publicís best interest to have practitioners of either discipline to treat patients in the modalities to which they are not trained.† I would urge that licensure in the use of herbs be implemented in all states to ensure that their usage will be by qualified practitioners of oriental medicine, who have been trained in their use.† This will ensure the publicís safety.† Our association recommends to the commission that these two different disciplines of TCM should be of two separate licenses with different educational requirements.† They should not be lumped together as one practice under TCM, traditional Chinese Medicine.
The second subject is the importance of recognizing the roles of Chinese herbs in traditional Chinese medicine and Chinese cultural in general.† A practitioner of TCM herbology may use Chinese herbs in its practice.† However, Chinese herbs are not limited to its role in TCM.† They may also be used as a spice as well as a food.† Food as medicine is a concept that is deeply embedded in Chinese culture.† Often there is a very fine line between food and medicine.† Therefore, it is important that we recognize that aspect of Chinese herbs.† We must balance the issues of public safety and the publicís right to have access to foods that are part of their culture.†
Our recommendation to the commission is that we should recognize the different roles of Chinese herbs.† It is not restricted to its medical use only.† Restricting access of Chinese herbs by legislation would not serve the best interests of the public.† Thank you.
GORDON:† Thank you very much.† Are the children okay, Robb?† Robb Burlage.
BURLAGE:† Thank you.† This is the way I wanted it anyway.† My colleague, I think youíve heard, Dr. Suzelle Gereau-Haddon, who I think has made some specific observations about the needs of our communities and congregation based health and wellness programs.† So I want you to permit me, not only to be late, but to give a more global testimony from my position and experience with the National Council of Churches Health Justice Ministry . . . consultant to the . . . Church Health and Wellness Ministry.†
††††††††††† The National Council of Churches and the Riverside Church share a strong faith-based advocacy of universal health care as a human right and system efficiency.† We also have been part of the spiritual, scientific, and policy quest for a truly holistic health care and integrated medicine.† We hearken back to the pioneering sermons in the 1930s and 1940s of Riversideís founding senior minister, Dr. Harry Emerson Fosdick(?), on religion, science, medicine, health, and mental health, as well as our senior minister, Dr. James Forbes, who shared his pulpit a year ago with the surgeon general, Dr. Hatcher, about the blending of the spiritual, the medical, and public health.
††††††††††† Former Congressperson, NCC president, Reverend Dr. Andrew Young, of Atlanta, is a member of the surgeon generalís steering committee, the campaign against racial and ethnic disparities in health and health care.† The moral disgrace, human suffering, and social cost of forty-five million Americans and more without basic health care coverage, including complementary and alternative medicine and holistic modalities, and a hundred million more vulnerable and at risk . . . seriously under insured, is an international scandal.† As representative of the National Council of International . . . are constantly confronted throughout the world.† We should consider the fact that the U.S. is the only industrialized nation in the world without such universal health care coverage, including at least some complementary and alternative and holistic modalities.† Even a unit of South Africa, with a heartbreakingly widespread epidemic of HIV AIDS, and a bitter history of Aparteid, and severe research shortages have made that commitment.†
††††††††††† The interfaith health seminar, co-sponsored monthly by Riverside Church and the National Council, has emphasized, over the last five years, topics regarding the politics of universal holistic health care.† Our recurrent theme is our communityís right to universal holistic health care.† The underlying quest is for community congregation based action to improve public resource support and scientific development toward access for all, to the emerging integrative medicine holistic health care, with an emphasis on the truly holistic, including spiritually linked prevention, health education, and public health.
††††††††††† As a health care systems analyst teacher and researcher, with training in public health and urban planning, I believe we need a major and expanded U.S. public resource commitment, both to ensuring universal access to holistic care and a scientific evaluation of the effectiveness of all health care modalities.† Even more serious funding for the Center for Alternative Complementary Medicine Research . . . health is required, effectively to encompass all utilized and potentially useful modalities.† Yet, in fact, the major cost danger and unfulfilled benefit of health care today is the global monopoly of clinical, primarily allopathic, prescription drugs.† Research, production, marketing, and pricing, and the lack of effective coverage in the U.S., and particularly with the tens of millions of our Medicare eligible older adults and people with serious chronic illnesses and disabilities.† Over forty percent of the cost increase in health care overall in the U.S. last year was due to the price of prescription drugs.
††††††††††† The major scientific health care evaluation gap, as well as socioeconomic coverage gap in the U.S. and internationally, is not regarding complementary and alternative medicine and holistic modalities, but is in fact . . .
BURLAGE:† Cut, okay.† Can I conclude?†
BURLAGE:† Let it be stated that the quest for our communityís right to universal holistic care, particularly from across the hundred and thirty-two thousand American faith congregations and communities, encompassing an overwhelming majority of Americans, requires comprehensibly vigilant action for better public policy and resource support.† The mission of this White House commission we salute and promise full partnership.
GORDON:† Thank you very much.† Ming.
XIAO-MING TIAN: †I have a question for Dr. Ming Jin regarding your treating OB/GYN disorders with very successful rate, eighty percent, using Chinese herb.† I just wanted to understand, have you published those data with your OB/GYN collaborators?
JIN:† Yes, I do publish this report, but this is in China, where I study for Ph.D.† This is a special study for Chinese herb treating uterus fibroids.† Also, itís for ovarian cyst.† I do publish for that, yes, in my research.† Yeah.† Thatís why I said, but this type of material I cannot use here because I just want to say I would know this type of medicine, or herbs, use very well, but we need the more labor research, everything, can work here and then get all this done and get approved.† So this is, I think, not only for my study.† I think of for all the professional Chinese and medical doctor, so for this kind of study can make so many different things get approved.† We need NIH to give more whatever the funding or the supporting for this kind of research.
TIAN:† So you also have successful case in this country, too?
JIN:† Yes, especially for the uterus fibroids.† We have almost like eighty percent.† Yeah.†
TIAN:† Thank you.† The second question is for Dr. Leung, if I may.† You mentioned that, I understand your group, your profession as a traditional Chinese medical doctors, you practice herbal medicine thatís called herbal remedies.† And the people purchase from your store and also your clinic.† May I ask number, every year, and how many buyers that buy, or patients that buy your herbs and what is percentage and you might have a complaint.† Have a complaint means some patients took your herbs . . . report and I donít feel well, side effect . . . toxic . . .
LEUNG:† Let me start by saying that there is a good, we have a good number of patients who are Chinese, as well as non-Chinese, and I would have to say that most of the, we have very few complaints of people, of patients complaining that they donít feel well after taking remedies.† I think when herbs are being given by practitioners of, you know, trained professionals who study herbal medicine, the chances of complaints, or the incidents of complaints, should be very low.† Itís usually the problem is when practitioners who are not trained in herbal medicine, and theyíll . . . practice traditional medicine.† Thatís when usually problems occur.
TIAN:† Letís see if I want to buy some aroma . . . from your store, what kind of advice you could give me?
LEUNG:† First of all, we would probably discourage the sale of Mahwah, discourage you from buying it.† I think it would be bad business practice to sell it.† In the long run, it would cause more problem.† It would not be good business practice.† It would not be good for the field to sell Mahwah because I think itís one of those herbs that should not be used by the general public indiscriminately.† I think it should be used by practitioners who have training in herbal medicine.† There are certain herbs that are very strong, the dosage range is quite, the window is small, and should not be used by the general public indiscriminately.
TIAN:† Thank you.
GORDON:† I have a question for Robb and Suzelle.† Having spent some time at Riverside Church with you all and seen the program, and having a sense of how itís developing, Iím wondering what the response is as you contact other church groups.† Is there interest or are there developing programs in other faith-based organizations?† And if so, or even if not, are there efforts youíre making to organize and to bring people together to take a look at what faith-based communities can do?
BURLAGE:† There actually are two organizations.† One that has existed for a long time . . . Harlem Congregation for Community Improvement.† But especially in dealing with HIV AIDS from treatment and prevention has relied increasingly on holistic modalities as part of that practice and support.† The Harlem directors group endorses this.† And they are beginning to bring that to the front of their agenda, and weíre trying to get them involved in our seminars.† Dr. Forbes has actually formed or helped form an organization called The Harlem . . . Community Health Alliance, which is organized essentially by clergy and by congregation leadership across northern Manhattan, which is half a million people.† And Iím talking about Harlem, or weíre talking about west central and east Harlem, Washington Heights.† And that organization is committed to doing outreach and in-reach congregation based community . . . outreach workers that will have training . . . holistic modalities as well.
GORDON:† If there is any kind of information you have about those efforts, we would really appreciate that.† How about nationally, is there an attempt to reach out nationally as well?
BURLAGE:† Well, I mean, the National Council of Churches, we realize that there is incredible activity across the country in congregations, very little of it coordinated . . . communication . . . and by different denominations and, indeed, Jewish Synagogues, even Masques, obviously, behind other religious faiths.† However, to correlate that, and to communicate that, I think is an important task.† Weíve been trying to develop, even catalog, what some of the activities are by denomination.
GORDON:† Thank you.† Joe.
GEREAU-HADDON:† Can I comment on that, also?
GORDON:† Yes, please.
GEREAU-HADDON:† We have thought about more recently than whether or not this is a ďclonable concept,Ē and have just started dialogues to reach out to a church in the south Bronx that works with at risk youth.† And Columbia Presbyterian has been helping us to make inroads to that to see whether or not this is something that we really can put into action in other faith-based communities.† So, on the global level, yes.† And on the smaller level, weíre also working on that.†
GORDON:† Great.† Thank you.† So weíll have Joe and Effie.
JOSEPH FINS:† Dr. Burlage, just a quick question on the disparity issue from the other side of the equation.† Do you have any evidence that the lack of insurance, that moral outrage that you eluded to here in your written testimony, has any impact on people who are in the underserved communities, using CAM modalities as an alternative, a low cost alternative?
BURLAGE:† Thereís not enough evidence, I donít think.† There is certainly plenty of evidence about lack of coverage in general.† The uninsured, especially those who have more health problems, more at risk . . . lot of demonstrated lack of . . . of that.† However, I think holistic modalities havenít been evaluated enough in that sense, but I would actually urge that there not only be this emphasis on evaluation of modalities, but on utilization and what its impact is.
EFFIE CHEN:† Hi.† My question borders on a spiritual and cultural aspect.† Chinese medicine, whether itís herbs of acupuncture or ayurveda medicine, itís a practice from a different country, and coming to this country, do you find that you have to adjust some of your thinking and your approach to the population because of our lifestyle and so forth?† Adjustments to the practice here?
TIRTHA:† Yeah, thereís quite a big difference between the way ayurveda is practiced in India and the way itís practiced in America.† Ironically, in India, itís practiced very much with an allopathic mental think.† The patient comes in, they take the pulse, they write a prescription of herbs, and send them on their way.† Partly thatís because their lifestyle is already, their nutrition is very similar to what we have to educate people who are in this country.† But in this country are really more about education, education about nutrition, education about lifestyle, education about life purpose, and we spend much more time.† Weíll spend half an hour or an hour or longer with a patient for that.
SCHLAPLOWSKY:† Yes, Iíd like to make a comment on that.† If Dr. Nun Lu was here, he would say definitely without knowing and understanding that the basis, the fundamental basis of Chinese medicine is how vital energy or chi moves through the body, you simply do not understand Chinese medicine.† And everything ensues from that philosophy, and that obviously accrues to the herbal and the acupuncture and the acupressure.† And to mistake acupuncture for the totality of Chinese medicine is something that we do here in the west, and we must broaden our purview and understand what is Chinese medicine before we can successfully apply.† We cannot try to catch up and pretend that itís as good as western medicine.† It is equal to and in some cases far outstrips the ability because it is dealing with the intangibles of wellness.† I think that we have to incorporate that into our thinking when we are educating the American public.
GORDON:† Okay.† Thank you all very much.†
Panel Coordinator, Dr. Joseph Kaczmarczyk
GORDON:† Weíll begin with Frances Brisbane.
BRISBANE:† I am a passionate advocate for CAM becoming its own mainstream and for CAM not standing for co-opting alternative medicine.† On November 2, 1999, there was an advertisement in the New York Times by one of the major insurance companies that said alternative medicine has been around for over five thousand years.† Isnít it about time someone made sense of it?† I thought how arrogant.† I reflected on my grandparents and how they had made sense of so-called alternative medicine and therapies more than two thousand years before they became known as alternative to modern medicine.† And, of course, many decades before, while they were still in Africa, they used medicine from the land, which my ancestors call root medicine and teas.† The name herbal medicine was not part of their language.† That, too, is a modern day adaptation.† They also fashioned all manner of lying on of hands to make people in the villages well.
††††††††††† I refer to CAM as ancestral medicine, as a way to preserve the intellectual property of many things my ancestors and the ancestors of each one of us in this room used decades, and in some instances, centuries before modern medicine came on the scene.† I have heard some people call CAM granny medicine, including the esteemed Dr. James Gordon, when on March 26, 1999 he said sixty percent of my practice was composed of granny medicine.† I believe that his success and the success of everyone who practices CAM or granny medicine, especially among African ancestral people, must have a one hundred percent granny attitude.† One of caring, concern, and commitment to a relationship with his or her patients.†
African ancestral people find ancestral and granny medicine appealing because for us it is based on relationships and faith.† Something Iím not quite sure double blind studies and the rigors of research will be able to prove CAM effectiveness among African Americans if the research blindly focuses on the product, such as St. Johnís Wort, Echinacea, garlic, etc., rather than on the mind body connection as a major cause of effectiveness.† Our faith and, yes, our religious backgrounds, among perhaps the majority of African ancestral people make it easy for us to believe in energy medicine.† For example, Chi Kung, therapeutic touch, massages, meditation, and acupressure among other things.† But none of this will work with us unless we have a relationship with the practitioner and faith in her or his ability to bring healing and health to not only our bodies, but to our lives.† When we are sick, our lives our sick.† And the rest of my comments, oh, you have them.
GORDON:† Thank you, Frances.† I canít think of anyone I would rather by quoted by.† Ora Bouey.
BOUEY:† My name is Ora James Bouey.† Iím a nurse practitioner and faculty at the University of Stony Brook.† I thank you for the opportunity to present testimony regarding the complementary alternative medicine or traditional integrative health care therapies, as it is also known, which, to us, is ancestral medicine.
††††††††††† My experience is that of a health care provider and user of traditional medicine.† I was employed for several years in an emergency department of a major teaching hospital is the Nassau-Suffolk County region that treated, then and now, more patients in the emergency department than any other hospital in the surrounding area.† According to data collected year 2000, the same hospital had over eighty thousand patient visits.† While I do not recall exact numbers of patient visits annually while I was there, it was proportional to the population at the time.
††††††††††† I began the rudiments of data collection regarding the use and efficacy of traditional therapies, ancestral medicine, from information elicited from taking a health history.† My sample size was huge because of the patient population.† Patients were from a multicultural and ethnic population.† My questions were basic so as to be understood with minimal clarification to the patient and/or to the historian or significant other.† The questions that I asked then, and the questions that I ask now are what is the problem as perceived by the patient or the historian, may it be parent, guardian, significant other.† What did they use to resolve the problem?† How was the ailment treated?† It was significant to ascertain why they used what they used when they used it.† Also significant to understand how they used it.† Itís very easy for us to ask the question about their usage without fully understanding the reasons behind the usage.
††††††††††† For example, asking a patient if they use, a patient what they use, and they said they use tea bags with water.† Tea bags with water may be used as a drink, but it also may be used as a . . . where they used it was equally as important.† Was it by mouth?† Was it by inoculation?† Was it a salve?† A liniment?† Or was it the famous vapor rub that we now see in strips that are being sold to place across your nasal bridge of your nose to inhale and to open your bronchials, if you will?† When did they use it?† For persons with a history of using traditional medicines, there are select times to use intervention.† So chronobiology and chronotherapeutics are equally as involved here.† What made it better, what made it worse, was my way of ascertaining not only the efficacy of the treatment.† It was also my way of seeking information regarding therapies that augment or serve as antagonists to the treatment that will be ordered by the physician.† Am I towards the end?
GORDON:† A concluding thought or two.
BOUEY:† Okay, I did submit a paper.† If you will indulge me, I offer to you what can be done to expand the current research environment so that practices and interventions . . .
††††††††††† . . . Conventional science adequately and appropriately addressed.† I have been collecting data, anecdotal reporting, since 1954, when I went into nursing practice.† I teach my students to collect the data while taking a health history.† This can be systematically incorporated in data collected by health care providers throughout the country.† Retrospective studies may be employed, especially examining what treatment is effective for the little people, pediatrics, so that we may begin early in life with prevention, promotion, and maintenance of health.† I thank you for your attention.
GORDON:† Thank you. †Elsie Owens.
OWENS:† Thank you for inviting me.† My name is Elsie Owens and Iím the chairperson and founder of the Elsie Owens Health Center in Suffolk County on Long Island.† I know that there was a need for health care and so I worked very hard to get health centers for all of the people on the Island, but I never forgot about growing up with a mother of twelve children, with no family doctors to attend our needs.† No matter what the health needs were, my mother was able to take care of them with her herbs and her homemade remedies.† I remember I had a fall, and I fell and had a very bad cut on my leg.† My mother used something called a butterfly to kill the . . . to cure the wound, and it healed leaving very small scars.† As I got older, I got high blood pressure and I had very bad arthritis.†
I have a family doctor at my health center, and I really love her.† I trust her very much, but I never forgot about my motherís remedies.† They donít have doctors like we used to have that would sit and listen and talk to you about your family problems.† As I grew older, I began to feel tired and lost my energy.† The pains was gone, but I always was tired, and I remembered my motherís remedies.† So I visit a CAM doctor center.† I started to take vitamins and herbs, and I began to feel better.† My pressure was lowered.† I felt better.† Iím able to walk two or more miles a day.† Iím not feeling tired at the end of the day.† Iím seventy-three years old, able to do and to be active in my community.†
Many people in my community visit my health center, but they do not tell the doctors that theyíre taking herbs or vitamins.† And the reason for that is that they do not want to be cut off from a health center.† And so I think that itís very important that people know that we will take those vitamins, most of us, because weíre old and we know that itís active, but we also will visit our doctors when the pain is too pressure.† Thank you.
GORDON:† Thank you.† Eliza Townsend.
TOWNSEND:† Thank you.† My name is Eliza Townsend MD, proprietor of the . . . a holistic practice located in Wyandanch New York.† As an alternative health care provider, I teach lifestyle change and recommend the use of all forces, which are found in nature, such as light, water, air, plants, and food to stimulate the bodyís natural healing abilities.† These services are not medical, nor are they intended to replace medical treatment.† My practice, primarily, is word of mouth, referrals from alternative care practitioners, and sometimes medical doctors for a special need.† I do not advertise or solicit.† I receive calls from people when they feel they have run out of options.† My clients do not tell their primary care physicians that they are seeking alternative services due to often negative feedback and warnings that these services have not been validated.
††††††††††† Why do people come to me?† When asked this question, one of my clients responded I feel very comfortable with your services.† I get results.† You spend time answering my questions.† After the cleansing, my skin cleared up.† As an American citizen, I have the right to make choices about my health care.† Weíre all aware of the fact that natural remedies have been part of our culture for hundreds of years without side effects.† As a practitioner, I bring a valuable service to the table, and I should be recognized as a valid acceptable service provider.†
The challenges I face as an alternative . . . provider, number one, constant criticism from the medical profession.† Number two, lack of health insurance company coverage.† Number three, to publicly advertise my services as an acceptable alternative cure service.† The federal and state government should provide policies that are inclusive and not exclusive in providing alternative health care to our ever-changing society.† Thank you for listening.
GORDON:† Thank you.† Charles Robbins.
ROBBINS:† Thank you for this opportunity.† Iím the associate dean of our School of Social Welfare at Stony Brook and chair the Center for Health Promotion and Wellness.† Iím also the director of social work in our academic medical center and co-chair of our institutional ethics committee.† There are several areas in which the federal government has responsibility to act as it impacts public health education.† The first of these is to ensure that the public has access to the information thatís currently available about the products and services which they are using.† It is the governmentís responsibility to see to it that individuals have the necessary information to make an informed decision.† The government must ensure that allopathic physicians and health care providers are aware of the practices that individuals from different parts of our country and from throughout the world are likely to be utilizing.† They must be educated about the importance of engaging in non-judgmental communication about these practices.
††††††††††† Allopathic physicians, and other health care providers, must be educated to understand that their way is not the only way.† Likewise, the public must be educated that simply because something is said to be natural does not mean that taking it is without consequence.† Individuals would not take substances that they believed to be inert, as they would produce no effect.† Therefore, the government must provide accurate information for the public on the risks and benefits of so-called natural substances.†
††††††††††† There are two additional areas in which I urge the commission to take action.† The first has to do with the regulation of the supplement industry.† I am not suggesting that the government dictate what supplements are available to the public or even evaluate the outcome claims made by the manufacturers.† What I am suggesting is that the government does have a responsibility to ensure that what is on the contents label of a supplement package is in fact what is in the package.† Today one does not know anything about the strength or purity or even if the substance they are ingesting is in fact the product on the label.† It is time to tell this multimillion dollar industry that acceptance of this minimum level of regulation is simply part of the price of doing business.
††††††††††† And, finally, an issue that is potentially a huge public health problem in this country.† This has been highlighted by Dr. David Eisenberg, in his two national studies, as well as in virtually all other professional literature in this area.† I am referring to the lack of communication between patients and allopathic health care providers about CAM practices they are utilizing, as well as lack of communication between CAM providers and their patients about allopathic treatments they are using.† As we see an exponential rise in the use of what we refer to as CAM practices, there is going to be an unfortunate explosion of negative drug supplement interactions, as well as unforeseen consequences on specific health conditions by taking supplements.†
There are two areas in which I believe the government must act if we can head off this crisis.† The first is to require that all allopathic health care providers are educated about the supplements and practices their patients utilize.† The next step would be for the government to launch a public health education campaign utilizing public service announcements, television commercials, and print media to underscore the importance of patient and practitioners communicating.† Thank you.
GORDON:† Thank you.† Dan Kamofsky.
KAMOFSKY:† I represent Care for the Homeless, a nonprofit organization that sponsors health teams that provide medical and social services to twenty-four outreach sites in New York City.† We cover a wide spectrum of facilities, including family residences, single adult shelters, soup kitchens, and drop in centers.† In 1999, medical care was provided to approximately ten thousand clients, of which over three thousand were children.† Fifty-five percent of our patients had no medical insurance coverage, forty-three percent had Medicaid coverage, one point three percent had Medicare, and zero point five percent had VA insurance.† Clearly, Medicaid is a major determinant of what kind of medical care our clients received.†
††††††††††† Medicaid restraints often make providing alternative or complementary treatments a challenge.† For instance, I recently evaluated a forty-year-old woman for Puerto Rico, who lives in shelter with her four children.† Leaving out the clinical details, this woman presents with a classical case of seasonal effective disorder, which is a pattern of regularly recurring episodes of winter depression, seemingly caused by the dearth of sunshine in winter.† Significantly, I believe this disorder led to the loss of her job, her husband, and, finally, her home.† There is a very broad consensus among psychiatrists that the treatment of choice for seasonal effective disorder is light therapy with a light box.† However, New York State Medicaid will not pay the $200 needed to buy it.† The only state Medicaid program which will pay for a light box is Maine.† Medicaid did pay for the antidepressants, Effexor and Prozac, which gave some minimal relief and cost a little less than $200 per month.† Thus, we have Medicaid spending almost $200 a month to provide an inferior treatment, when the same $200 could provide an alternative treatment that is universally accepted as the preferred one and which could assist not just for one month, but for many years.
††††††††††† Other examples of New York State Medicaid not reimbursing effective or promising alternative or complementary treatments involve the prescription policies for nutritional supplements.† Although Medicaid covers many supplements, such as Vitamin C, folic acid, and calcium, it will not pay for many others, such as Vitamin E, omega three fatty acids, and magnesium, even though there is good evidence that these supplements can, respectively, be useful in slowing the progression of Alzheimerís Disease, stabilizing a manic depressive disorder, and treating diabetes.† Efforts to more favorably affect Medicaid coverage will permit much more of the homeless population access to alternative and complementary approaches.
††††††††††† Finally, more attention needs to be focused on the thousands of children living in homeless shelters, many of whom remain in the system for more than a year.† These children may have nutritional deficiencies, learning problems, and psychosocial injuries that might be amenable to alternative or complementary techniques.†
GORDON:† Questions?† Well, Iíll go ahead with one I have.† I was intrigued and disturbed and, unfortunately, not too surprised by your saying that if people talk about using some of these therapies, traditional therapies, they might be cut off from their health center.† I wonder if you could, any of you, Elsie, you were the one who said this, I believe, but I wonder if you could talk about it and if others could talk about it as well?
OWENS:† Well, I remember when I did tell my doctor, although my pressure had lowered a lot, that I was on vitamins and taking herbs.† And she kind of said that maybe I had better stick with my traditional medicine rather than to do that because she was afraid of what might happen, and I think lots of people feel that way.† They come to health center and you talk about using vitamins and herbs.† I donít remember them turning anyone away, but that might happen.† And the fear of that is that they wonít tell.
GORDON:† Anyone else?
BRISBANE:† Iíve not seen anyone actually turned away, but I have seen individuals ďshut down.Ē† Patients, parents, guardians, historians, or especially people of certain ethnic groups are natural storytellers.† We have limited time to elicit a health history from a patient, given the reimbursement code that we currently have.† If a person starts telling a story thatís going to take more than a few minutes, immediately the patient, the significant others, can see that the shade has been pulled down and theyíve been shut out and youíre no longer listening to them.† That, in and of itself, is a turnoff.† Much of the information, of course, that theyíre willing to share is information that could be helpful to them, and certainly very helpful given whatever it is that the physician is going to prescribe.
GORDON:† Iím wondering, based on your experience, if you have any suggestions about ways to change the situation, change the lack of receptivity either to traditional cultural forms of healing and/or traditional forms of expression.† What would you suggest as a sort of policy recommendation that we could think about?
OWENS:† I think one of the most important things is in every clinic and every place that we can possibly have an integrated team, and once the team is integrated, then that symbolizes to the person who comes that there is a healthy respect for both forms of medicine.† I also want to just mention about the earlier question that you asked.† I remember telling someone that I had a prayer vigil, and African American people often have what we call prayer vigils when you have an illness.† I told this to my doctor and I said that my kidney really was fine since I went to the prayer vigil.† And before I could leave, she worked around to tell me I should see a psychiatrist, but I was strong enough not to let her throw me, but there are too many people who would not have even said that to her.† And I said it because Iím an advocate for CAM, and I was really trying to educate her, but so many people would never have said that.
GORDON:† Thank you.† Effie and then Joe.
EFFIE CHEN:† Thank you, SUNY Stony Brook and also Center for Homeless.† Our concern has been that CAM may be just reaching the upper middle class, and the cultural and deprived financially, and I wonder if you would speak to that.† How can we reach out more to that population?† What is some resolution?
KAMOFSKY:† I think the reality is that all of the studies that have been done and the data that has been collected have been collected on a very middle class, very white, or upper middle class population.† And I think the reality is that the practices are going on in the communities, particularly in communities of color, but they donít consider them complementary or alternative.† Theyíre, in fact, traditional medicine.† So when you start collecting the data and using the language, I think that part of the problem is that weíre talking about one thing and then the folks weíre talking to are talking about something else.† I think that understanding what weíre trying to collect data on, again, public education as well as practitioner education about what people are doing, and particularly as people from throughout our country settle in different communities, people from throughout the world settle in different communities, and bring those practices with them, itís critically important.†
††††††††††† In answer to Dr. Gordonís first question, I think there are two other factors that play, too.† One is that, particularly in communities of color, there is a general mistrust of institutions, including health care institutions.† So we have to understand that and then first deal with that before weíre going to get to the next step.† And the other thing is that when you go to conferences and meetings and professional sessions, there is, more often than not, nothing on culture.† Somehow there is a belief that what people are now coming up with as complementary and alternative medicine is something new.† And I think that we need to begin to build into the national conferences, to build into the educational sessions an understanding that, as Dr. Brisbane said, that the intellectual property rights of this really go back a lot further than most of us are willing to give credit for.
BRISBANE:† One of the things, too, that I think is real important is the fact that we believe that the answer to do we use these things is no because we donít want to be seen as not having respect for conventional modern medicine.† So the answer is no.† So even when you ask us, so if youíre going to get a true picture of our use of it, which is very very widespread, youíve got to have people asking the questions that are answerable and they have some faith in.† And we donít respond well to any telephone.† So most of the studies have been done through the telephone.† We donít know who you are on that telephone.† So if we donít have a face to face with you, we have every reason in the world to be suspicious.
ROBBINS:† With regard to this issue, I think more research needs to be done in certain areas.† For instance, with the many children that are in the shelter system.† I wonder what sort of, what their nutrition is like, whether they have nutritional deficiencies.† For instance, a pet project that Iíd have an interest in is, letís say, to look at omega three fatty acids, vitamin A, and vitamin D to do blood levels for this.† We hear that rickets, now, the prevalence is going up because children are drinking less milk products and theyíre spending less time in the sun, and weíre just beginning to learn how important omega three fatty acids for the development of the brain.† Well, letís say we look for those three nutrients.† We find amongst the children in the homeless shelters.† Perhaps we could treat those individuals very simply by recommending an old supplement that was given by our grandmothers, simply cod liver oil.† So itís things like this.† I do think that some basic research could be very helpful in this area.
JOSEPH FINS:† Dean Brisbane, as a social work educator, and I was really struck by this notion of ancestral medicine.† It puts it back into the heart of the person and their history and all.† One of the, perhaps, failings of allopathic medical education is the failure to get to know the person as a person.† We get to know your biology, but not you as a person.† What lessons are there from social work education for allopathic training, vis-ŗ-vis what we can do to get that richer history about CAM therapies the meaning of these modalities and ones spiritual and family life?
BRISBANE:† What we do, at our school, we teach exactly what weíre talking about.† We have a whole curriculum around this, and I lose no opportunity to be on every national social work conference talking about this issue as an advocate for maintaining the intellectual property of this, as a part of what your ancestors brought to this country and brought to this particular subject, and my ancestors, and so forth.† And we also teach our students how to help their clients to know the options that they have, and to also talk to them in ways to elicit from them some of their beliefs about ancestral practices, and to let them know, because they respect us, to let them know that we respect what they do and that it is all right.† So we also use them to teach other people in their communities about these kinds of things.† Thatís why we stay abreast of it.
FINS:† If you could share that with us, because we have to make recommendations about medical education across the board in this arena, if you could share that curriculum with us, weíd be most grateful.
BRISBANE:† Weíd be delighted.
FINS:† Thank you.
GORDON:† Thank you.† Thank you all very much.† It was very important for us to hear from you today.†
Panel Coordinator, Corinne Axelrod
GORDON:† †A panel of old friends, at least some very old friends.† Maria Josepher.
JOSEPHER:† Jim, I just want to say I really thank you for the single pointedness of your vision.† Iíve known you sixteen years and this is all Iíve ever heard you talk about.† My name is Maria Josepher, and Iím the deputy executive director of Exponents Inc., an organization which is dedicated to serving substance users, their families, the homeless for twelve years now.† As an organization, we have attempted to create and conduct stress management education, meditation and conscious breathing sessions in the Rikers Island prison, one of the largest jails in the United States.† And we had incredible benefit that we saw in rage reduction of the inmates, but we had to stop those classes because we could not get any cooperation with the prison escorts, nor could we get any private training rooms, because we were working with HIV positive inmates, and we really needed their confidentiality to be maintained.† So that had to be stopped.
††††††††††† As an organization, weíre very committed to utilizing the person with the history of addiction to provide direct client services.† And doing this really led us to have to deal with the conditions which present themselves as an aftermath of addiction in our employees.† Things like HIV, hepatitis, depression, diabetes, and that if we really wanted these individuals to be giving care on any basis, that we would really need to deal with their wellness first.† And that is what we have done.† We have created not only programs for our employees, but policies such as catastrophic sick time, and utilizing sick time for well visits to their physicians.†
††††††††††† Our offices are also equipped with CDs and audio equipment, and many of our staff utilized CDs, which are embedded with brain synchronizing technologies, and theyíve had great benefit from that.† Weíve also addressed the smoking cessation among our staff, and by doing this, just by educating them, half of our staff has already quit smoking, and that has just happened through an education process.† I see CAM as the cost effective way of dealing with prevention and illness, and we do need policies, which will help our prison system to cease being a warehouse of humanity and start becoming a center of re-education for a very captive audience.†
GORDON:† Thank you.† John Tribbie.
TRIBBIE:† Good afternoon.† My name is John Joseph Tribbie.† Iím the assistant vice president of Greyston Health Services in Yonkers New York, where we are entering our fourth year of providing medical and social services, including a wide array of complementary and alternative therapies to persons living with AIDS.†
††††††††††† As the AIDS epidemic enters the 21st century, persons living with AIDS, through increased education about their illness, are making more informed decisions about their course of treatment.† Approximately twenty-five percent of our patients consistently access holistic services on a weekly basis.† While approximately fifty percent access these services at least once each month.† Medicaid, which is our primary funding source, does not cover these sources.† Therefore, additional funding sources would enable programs such as ours to enhance service provision and increase our research efforts to report more precisely the effects of complementary and alternative therapies on special populations, such as persons living with AIDS.
††††††††††† It is expected that enhanced treatments, vaccines, and, perhaps one day, a cure for HIV and AIDS will be the result of western based medical research.† However, the person living with the virus cannot be ignored.† In utilizing holistic therapies, we work with the body, the mind, and the spirit to restore and strengthen the whole person, whereby the immune system, along with other bodily functions, is better supported.† Our patients often comment on the healing component of alternative health care, and itís ability to promote wellness, to relieve stress, which studies have shown can weaken immune response, and to assist the body in stabilizing and managing an impaired immune system.†
††††††††††† Through a partnership involving both holistic and standard medical approaches, we address not only HIV infection, but other health issues affecting persons living with AIDS, such as hepatitis C, depression, fatigue, physical rehabilitation, substance use, and cognitive skills.† As a result, we have seen increases in T cells and decreases in viral loads.† We have seen a lessening of anxiety and stress.† We have seen a decrease in drug use.† We have seen patients, who have an inability to trust and difficulty in being consistent in their treatment, come back again and again and again.† And we have seen a community form, and we continue to see this community grow and flourish.†
††††††††††† Now, how much do alternative therapies play a part in this development?† Well, we know that our attendance is higher on days when we offer alternative therapies, so we know our members believe in the course of treatment they have chosen, which is a core issue in learning to care for ones self.† Learning to take better care of your own well being.† The healing process begins in the mind, moving into a contemplative state, and from there into a position of action.† Our experience has shown us that the integration of standard medical procedures, with complementary and alternative care, can greatly enhance a personís ability to move in this direction.† To continue to enable our patients to get to that point, we must provide them and ourselves with the largest array of ammunition possible.† Thank you.
GORDON:† Thank you.† Anthony Vera.
VERA:† Good afternoon.† A funny thing happened to me on my way to this forum.† I forgot the statement, but someone brought it in.† So Iíll pass . . .
††††††††††† My name is Anthony Vera.† Iím a director of planning and development at Betances Health Center.† And Iím really here to express the sentiment, not only of our executive director, Wanda Evans, but also our management team, who endorsed the statement you have been given.
††††††††††† Complementary or alternative medicine, in the form of home remedies or use of care discoveries amidst the cultural diversity of New York City has for generations been the first line of care for the many Latinos and African Americans served by Betances Health Center.† Weíre located in the lower east side, New York Cityís traditional settling community for new immigrants.† Betances, therefore, provides health care with thirty years of service commitment to integrate the healing wisdom of eastern and western cultures.† Ninety-one percent of our three thousand eight hundred and forty patients are Latino and African Americans.† And our experience has been that all have utilized at least one complementary care remedy for acute or chronic conditions.† Last year, one thousand ninety-six patients made an estimated three thousand eight hundred and twenty-two visits for acupuncture, massage therapy, and nutrition counseling that included dietary supplementation.†
These visits, however, were made for medical necessity, and only two percent of the visits were paid directly by patients out of their own pocket.† That is to say that the bulk of these services were paid for either through grant sources or just the sweat of our staff to give extra time to provide services because, as Iíll indicate later, Medicaid is not very helpful in this area.
Betances also provides primary care services to approximately four hundred Latinos and African Americans with HIV and AIDS.† About four percent of our HIV patients have opted for complementary care for a variety of reasons.† For many African Americans, choosing a complementary care is their way of responding to medical treatment fears rooted in the legacy of the Dashiki study.† Among a significant number of our HIV patients, complementary care is consistent with a belief system that embraces holistic health and self-healing.† Our experience with complementary care also confirms the finding, by they way, itís one of your commissioners Iím relying on here for this information.† The findings that Latinos adopt traditional patterns of use when it comes to herbal remedies compared to the faddish appeal such remedies have for non-Latino white populations.† Among Latinos, for examples, the botanical continues to be more than a place for spiritual healing.† One where herbal remedies are intricately connected to belief systems that are only now being uncovered by conventional medicine to be a critical predictor of positive medical outcomes.
It is, therefore, very easy for Latinos to accept healing practices, such as acupuncture, massage therapy, or therapeutic touch along side conventional medical remedies.† Regrettably, the barriers posed by western medicine are complicated by a marketplace culture that unrelentingly promotes complementary care the way it peddles beauty and fashion.† There is no scientific method behind culturally driven remedies that show the . . . with the power of tradition and countless use over countless generations.
GORDON:† Iím wondering if you could move directly to
VERA:† Let me just summarize by saying that if weíre going to make any meaningful change in this area, with this paradigm shift thatís required with the dominance of western medicine, it is that there be two systemic changes brought about.† One is that standards of care should be established that will permit patients to receive acupuncture, massage therapy, nutrition therapy, and other remedies as medical services within state licensed medical care facilities with adequate Medicaid and Medicare reimbursement rates.† And, secondly, managed care plans should treat complementary care services as a carve out product that supports self care and wellness benefits such plans promote as health maintenance goals.† Thanks very much.
GORDON:† Thank you very much.† Anne Markowitz.
MARKOWITZ:† Hi.† Iím a therapist in two grant programs at Harlem Hospital.† I work with abused women, sometimes abused men, and their families.† Itís a very high stress population.† There are four points Iíd like to raise about which Iíve become increasingly concerned over the last twelve years.†
The first area of concern is nutrition, which has been mentioned before, but I think there is a particular race and money issue involved in the way our society distributes its food, although the entire country seems to be going in the same downward direction.† The hospital is a designated heart center, Harlem Hospital, because the community has an extraordinarily high rate of heart disease, stroke, diabetes, and other diet related health problems.† Despite this, the city hospital has given the lobby restaurant franchise to McDonaldís.† This, despite the fact that there is a McDonaldís one block away.† Every day lines form out into the lobby as staff people, patient visitors, and patients themselves buy unhealthy food.† There has been, to my knowledge, no serious community effort to organize any guidance toward healthier eating, despite the fact that there is no question their diet is killing people.
The second area of concern is an inordinate number of black boys, ages five to fifteen, are being diagnosed with attention deficit disorder or other related disorders and prescribed Ridlin or some other drug.† I would guess that seventy-five percent of the boys in this age range, whose mothers have been my clients, have stated that their children were acting up in school, usually as a result of the chaos at home, and had been tested and treated for ADD.† I recently spoke with a pediatrician in a white middle class upper west side private practice, who told me that his estimate of the percentage of boys he sees with ADD is five or seven percent.† Two boys, who were in danger of this diagnosis, but who entered weekly individual and family therapy in our program, are no longer thought to be at risk for ADD.† This suggests to me that if many of the boys, who are acting out at school or at home, were given therapy, better attention at school, or some other kind of intervention, they could avoid the special education route, which in the inner city is often the first step toward dropping out.
The third are of concern is the widespread use of antidepressants and anti-anxiety drugs that I see.† The women who come into our program are in crisis.† They are often leaving abusive relationships or simply unable to cope with them anymore.† They are often depressed.† However, when theyíre referred to psychiatry, they are usually given antidepressants, little or no therapy, and sent on their way, often with a referral, but without follow up or outreach.† Several women, who came into our program after a referral from psychiatry, were on antidepressants, but stated that they were numbed and mentally a little unclear from the drugs.† Itís very hard to compare cases, but if I could generalize about the women Iíve seen, those who arrived depressed, but unmedicated, made faster and better progress in therapy than those who were on antidepressants.
The fourth problem I wanted to mention is the shortage of batterers programs in the community and the city in general.† Anger management classes, batterers programs, which are two very different things, and other organized approaches to reducing stress, increasing insight, and making behavioral changes should be part of the core of any health organization, including a hospital.
And one thing I wanted to mention just on one of Ms. Brisbaneís points was that a lot of the home remedies that we see in the older population in Harlem have been completely lost to the younger generation.† The younger generation comes in and they have no home remedies, even though they are close with their grandmothers or whatever.† They are just turned off to the whole idea.† And it seems to me that that could be worked out within the community.† That there could be encouragement of intergenerational . . .
GORDON:† Thank you.† Questions from commissions.
EFFIE CHEN:† My question is . . . we talk about other people using CAM therapy.† What you people presented, youíre under duress.† I mean, youíre treating a really difficult group of clients.† And how about yourself, is CAM therapy utilized there in your own dealing with the stress?
TRIBBIE:† Well, one of the things that I do for my staff . . .
CHEN:† Yes, well, thatís what I mean, your staff, because attrition rate must be terrible with it.
TRIBBIE:† You tend to go through periods where, you know, stress is sort of like an elevator, it goes up and down.† So during periods of high stress . . .
GORDON:† Speak a little closer, please, to the mike.
TRIBBIE:† We try to make those services available to the staff.† Give them the opportunity to either access acupuncture, massage therapy, whatever their choice is.
JOSEPHER:† Weíve actually been very fortunate in that weíve gotten some private grant monies to create a meditation room, and we purchased an entire set of the quartz crystal bowls for all the shakras.† And every Friday, we were, it has stopped now, but every Friday we were conducting full hour and a half meditation for any staff that wanted to attend.† They really saw the benefit in leaving the anxiety and the stress at the office, especially for the weekend.† I myself, I mean, Iíve been a meditater for about twenty-five years.† So if I donít meditate, there is a major difference, especially in dealing with the populations that we deal with.† Itís so important.
MARKOWITZ:† And I would say, at Harlem Hospital, absolutely not.† There is nothing utilized.† The staff is as nutritionally challenged, I would say, as the patients.† And there is a kind of air of depression over a lot of the work that goes on because the resources are so poor.
GORDON:† I just wanted to say a word about Exponents because I have worked with the program from the beginning, and itís an extraordinary program.† We just didnít have time yesterday, but I would really suggest to the commissioners that if you have an opportunity, if itís not too much of an imposition, that sometime you come and see the program if youíre in New York.† One of the amazing things about is about eighty percent of the staff came through the program.† Wasnít it about eighty percent or more?
JOSEPHER:† All of the direct services staff.† Out of forty-five staff members, thirty-eight, who are direct services staff, were ex-offenders or are ex-offenders and have a personal history of addiction.† So that is why our employee wellness program was so important to us because we want to keep them.† And dealing with some of the difficulties and the aftermath of addiction, we would have no longevity on our staff if we hadnít done something about it, and thatís why we did.
CHEN:† My point is that in practicing CAM, we canít be hypocritical.† We sort of have to practice what we preach.† So Iím glad to hear that.† Thank you.
GORDON:† One other thing I want to say about the program is itís an extraordinary example of a holistic approach, of which CAM therapies are a significant part, as well as using videos to help people go for job interviews, as well as having small group work and a lot of very practical instruction about nutrition, and about dealing with welfare agencies, and dealing with anger has helped to transform people who have been, essentially, crippled and dependent on the system.† Most of the time jails, but also health and mental health system, and have helped people become independent at a relatively low cost.† Do you want to say something about the cost?
JOSEPHER:† The two months of a sixty-hour training costs about $700.† With what they learn in the training, if we keep them out of the hospital for less than a day, it has already paid for the training.† We have a very very high employment rate as well, so that one can easily extrapolate if one gets a job, and gets off of welfare, it immediately pays for the cost of the training.† Weíve been able to keep it at a very low cost for the last twelve years.
JOSPEH FINS:† It would be helpful if you could supply that cost benefit analysis information.
JOSEPHER:† . . . Package.
FINS:† Okay, I didnít see it.† Also, if you could perhaps think of maybe now what kind of demonstration projects should the federal government engage in to sort of replicate and amplify the kind of work that you guys are doing in other places, in other venues?
JOSEPHER:† This was actually Oneida funded grant.† The research started twelve years ago.† We designed the program, Arrive, so that it could be replicated anywhere.† Everything is totally documented.† The standards of training and practice within the organization are totally documented so that it, and there are a lot of other organizations in New York, who are doing this type of work.† The AIDS Institute was one of the first in the State Department of Health to interview organizations like ours and have put those standards in the RFPs that they are putting out to the community.† So itís that type of thing that if we did that nationally, and in the prison system as well, would be extremely helpful.
GORDON:† Any other questions?† Anne, I just wanted to ask you if you had some thoughts about what would make sense as a program, not even so much as a program, but what kinds of things you think we could do as a commission to address some of the needs of the people with whom you work, who are clearly getting a few of their needs met, but meanwhile are being compromised in other ways.
MARKOWITZ:† Right.† I think a nutrition program, a real blitz of a nutrition program for the whole hospital.† All kinds of, you know, there should be a nutritionist as part of each of these programs, certainly a consultant, and to do some kind of big program in the hospital to encourage the staff to start teaching so that they donít bring up a McDonaldís breakfast and have it on the nurses station when the patients come by.† You know, contests, Weight Watchers, any kind of organized program for nutrition.† I remember when I was working in OB/GYN . . .