[8:09 a.m.]

DR. GORDON: We are going to get started this morning. If we could, just again, sit quietly together for a moment and relax, and be present with ourselves and with each other.

[Moment of silence observed.]

Opening Remarks

DR. GORDON: Okay, everybody. This morning and today, our task is really to try to understand some of the issues that are remaining in terms of delivery of services and reimbursement, and issues related to research, and then development of the Interim Report.

As part of that work, there is a general sense that I have heard from a number of people, both in the meetings, and informally outside the meetings, that we need to deepen our common experience of our world view of our perspective of ourselves and of our connection to CAM, especially as we move into making recommendations and creating a tone and a feeling and a perspective for the Interim Report. In line with that, Tom Chappell came up with a suggestion for working on this morning's program.

Tom, I would like to give the floor to you.

MR. CHAPPELL: Thank you, Jim.

To elaborate, there are a number of us who have wanted to do this homework and we haven't had the time. So, in a brief workshop design this morning, which we planned out with some facilitators, in small groups of six Commissioners per group, we will have a chance, in an hour, or hour and 15 minutes, to get down on paper what it is we deeply care about in the consideration of CAM products and services, or the whole orientation of CAM.

We could call these our core values. We could call this who we are, but it will, as Jim said, provide a context of our common experience as we come from different perspectives, different professions, different ways of thinking about how CAM can help the world.

So the question will be simple in the small group. It will be one question. We would ask each of the Commissioners to participate fully. There will be some prioritization, light prioritization, of your responses, and we will come back into full group and share what each of the three groups has come up with, and then turn that material over to the team and the staff for inclusion and drafting in the Final Report.

Yes.

DR. GORDON: I just wanted to check and see if the Commissioners feel this is a good exercise and an important one to do, just check in with everybody and get a consensus on this, and I am seeing a lot of nodding heads. So I would like to proceed, then, with this.

As Tom says, it has been something that we have worked with some earlier, but clearly, we need to keep on working and deepening our experience of why we are here and what we are about.

So please continue, Tom.

MR. CHAPPELL: We will just go around. There will be three facilitators: Wayne, Charlotte, and myself. I will work with a group in this room, Charlotte and Wayne will be across the way in two small groups. There will be newsprint for each group, a scribe for each group, and we will simply answer the question: In considering CAM products and services, we believe deeply that.

It has to be presented as a "we believe" because you have to have a sense of our brothers and sisters in this circle, yet, owning what it is you deeply believe in, and respecting what your Commissioners also deeply believe in.

Out of this, we will get a set of values, a complexity of values that we will try to own and hold as we go forward into the strategy, the goals and everything else that we do. So this will be the grounding.

So if we could go around the room, Commissioners only, responding to the count. I will be one, you are two.

Okay. Would the ones join me?

DR. GORDON: Let's do a timetable on this, first of all.

MR. CHAPPELL: Forty-five minutes in the group. We will see you back here in --

DR. GORDON: Each group will be 45 minutes, and then come back to this room within five minutes after that, please. Then what we are going to do is, we will rearrange the schedule some, or we will shorten the schedule.

Our belief is that if we clarify some of these issues, our work, particularly in the area of -- I want to make this clear, we are going to be covering all the topics: reimbursement, delivery of services, any topics remaining from research, wellness, as well as the Interim Report. The idea is, we will be able to cut down the time, particularly, we hope, the time we spend on the Interim Report, by clarifying core values.

So that is the purpose of this. We will get to everything, and there will be time for all the work that we are doing. So 45 minutes in the group, a 5-minute break after that, and then please come back in here right after that so we can begin with the discussion of the presentations from the group, and then moving into the rest of the program.

Members of the public are welcome to sit in and observe as we have these groups. All aspects of this meeting are open, so please feel free to do that in either of the groups in the next room or to stay in this room.

[Small group discussions convened.]

DR. GORDON: Okay, we will hear from each of the groups, then if there are other comments around the table, briefly give people a chance to talk.

Do you want to talk before that, Dean, or do you want to talk after that?

DR. ORNISH: I just want to say a couple words, that, having spent most of my professional life fighting for the kind of values that I think most of us share, I found myself yesterday in this kind of curious position of being the identifier of red flags, almost like the school marm, and that is not a role I am particularly comfortable in.

I think, out of a shared desire not to make a report that is boring, but rather to make an Interim Report that is going to not get shot out of the water, to try to be skillful about it. It may be that I have just been sensitized in the seven years of dealing with Medicare, trying to get them to pay for our program, that I have a real good idea of the kinds of red flags, certainly that I have dealt with. It is out of that loving, conscious desire to try to come up with a report that really ultimately makes a difference in the lives of people.

I think we can talk about our values as we have done this morning, which I thought was incredibly useful, without pushing people's buttons. I think that is different than pushing people's buttons in the kinds of ways that we were talking about yesterday.

So I just want to make it clear that we are not, certainly Tom and I and others, are not on opposite sides. I think we have the same shared values. It is just a question of strategy.

DR. GORDON: Thank you, Dean.

Let's move, then, with each of the group leaders, in turn, talking about the experience and the beliefs.

Presentation: Small Group No. 1

MR. CHAPPELL: We believe deeply that CAM is an important and an essential part of health care; Number 2, for wellness, that it is an important and essential part for wellness; Number 3, that CAM has scientific validity and needs strengthening of evidence; Number 4, requires universal health education starting at kindergarten; Number 5, greater awareness and knowledge of CAM by medical practitioners so that they can refer appropriately.

So we need to provide greater awareness and knowledge for medical practitioners so that they can refer appropriately. That is as opposed to trying to bring medical practitioners, conventional medical practitioners, up to some degree status of CAM services.

Number 6, CAM is both transforming and re-orienting the entire health care system, that CAM brings an awareness of the uniqueness of each person. It brings a new world view to health, wellness, prevention, and that is largely through an awareness of self-care. We need to use other methods, as needed, to healing self, and that illness is, in fact, a journey that has its benefits of creating self awareness and mutual understanding.

Number 7, CAM optimizes lifestyle systems and living, all aspects of life. It brings to light all aspects of our living and our lifestyles, that optimal health encompasses all aspects of living, not just self-healing but also the disease of living. CAM offers approaches to higher, more holistic and fuller life of persons and societies.

Number 8, it offers ways to answer the question, who am I; why am I here. CAM is holistic. It is a life system within a context of living. Number 10, we Commissioners believe deeply in healing of all approaches, which includes CAM, allopathic medicine, spirituality, et al. We have a deep belief in the integration of all these different approaches. We have a deep belief in science and the scientific method. CAM is one of the many approaches to health, wellness and lifestyles, to which all aspire.

Number 13, CAM can make valuable contributions to health care, particularly the vulnerable populations. CAM is value-added, complementary, not alternative. It is an evolving, moving, dynamic model of encompassing diversity of disciplines. It has much to contribute to health care and medicine. It is inclusive of many different disciplines, all of which may and can have their respective leaders of teams. It is accountable for safety. CAM products and services are accountable for safety and efficacy.

CAM needs objective, inclusive overview of origin and evolution in the context of our culture and societal history. We need to minimize impediments to access and delivery. We need to demonstrate cost-effectiveness.

DR. GORDON: Would anyone else in the group like to say anything at this point, before we go on to the next group? These are a statement of beliefs, each articulated by different people in the group.

[No response.]

DR. GORDON: Okay. Let's go on to the next group.

Presentation: Small Group No. 2

DR. JONAS: We not only laid out some core values and prioritized them, we also color-coded them for easy communication.

One of the questions that came up in the middle of the conversation, but proved to be, I think, a core issue is, what are we advocates for; what do we want to see; what is this Commission really for; is it promoting something.

I think we agreed that it was promoting something, and what we decided it was promoting, it was written in red here as the overarching goal of the , which is to develop policies or recommendations for improved health of Americans by assuring the availability of safe and efficacious CAM services and products.

So the goal is not on an advocacy for any CAM services or products, it is an advocacy for improved health using safe and efficacious, as have been described and determined of these areas, these particular areas.

So that, we felt, was the overarching of what we want to see happen out of this Commission.

Now, what are the core values that go into providing that? I think we came up with really four main ones, actually seven, but four core ones. Those are in blue. The first one basically is a recognition that healing, self-healing, is the core aspect of what we want these services and products to provide and produce.

So the wording, we could play around with, but basically there is a remarkable capacity for healing that can be facilitated by addressing the underlying causes or by using services and practices that stimulate and support those healing processes. So an emphasis on healing is a core issue.

The second emphasis is holism. We think that what we really value in these types of practices is the emphasis on the whole person, the mind/body/spirit, and addressing that. You will see in some of the subsequent ones how we are addressing that.

Number three is really the issue of freedom of choice, that individuals should have freedom of choice among practitioners, products and services, provided there is accountability along with that. There has to be accountability along with that.

We debated whether we should split these up into two different areas and decided no, that they really were linked, and they should stay together.

Four was that this is a consumer-driven process and we need to pay attention to why the consumers are seeking these things, and we need to let the consumers be integrally involved in that process, and this occurs on several levels, as is outlined in the , certainly in terms of freedom of choice of particular things that they would like to have in terms of products and services, but also in terms of how the health care delivery system executes those and how research is conducted on those.

So, in other words, also on policy levels, not just on individual health care. The consumer needs to be more involved in policy decisions about the health care system and research.

The ones in green were ones that came up afterwards. They support, I think, many of these core ones, that how various services are delivered is extremely important. There should be a keen context for the provision of health care.

Those are kind of the terms that we came up with, and that incorporates things like respect, dignity, trust and core values in how health care is delivered, and an emphasis on, my term was gentleness, gentle types of intervention, but we basically translated it into less toxic and the least invasive alternatives that are safe and efficacious. End of story.

[Applause.]

DR. GORDON: Great. Thank you, Wayne.

Any other comments from that group at this point?

[No response.]

DR. GORDON: Okay. Third group, please.

Presentation: Small Group No. 3

SISTER KERR: Let me know if you can hear me, because my voice may be a little softer.

Number three was the honorable group of Tieraona, Buford, Veronica, Xiaoming, Linnea. Corinne was our humble scribe. Thank you.

We spoke specifically and dominantly out of the belief and value statements. First, was that we believe the body/mind has the right and power to heal itself.

The second, is we believe health is more than the absence of disease. It is the active integration of spiritual, emotional, social, physical, and I personally included ecological self.

The third, was healing is being in right relationship with self, others, community and the cosmos.

Four, we believe people want to be cared for, to be heard, to be able to choose, have better care and access to health care services.

We believe there is no exclusive domain for healing. Healing is not the exclusive domain of complementary and alternative medicine.

We believe partnership is integral to the process of healing.

We believe all human beings have a right to feel cared for and to have access to their practitioners and modalities of choice.

We believe in the value of relationships that are marked by respectful recognition of the practitioner's skills.

We wanted to put a little footnote of particular concern, that people sometimes often use holism to cover up non-thoughtful, unsystematic health care practices.

Thank you.

DR. GORDON: Thank you.

[Applause.]

DR. GORDON: We can have some discussion. I want to say how useful, Tom, how much I appreciate your spearheading this process, and that of everybody who is participating in it.

It feels to me like what we put up on the board are really the shaping principles which will frame the Interim Report, and frame what we are doing as we move toward the Final Report, and that what we have done is to supply the impetus, the reason, in a sense, the reason why we are here, as well as the context for any specific recommendations that we are going to make. So I think it is great.

MR. CHAPPELL: I want to thank Tieraona and Charlotte and Wayne for their help with all of this, and the inspiration for it.

DR. GORDON: So, any other comments about either this process or issues that are sort of here at this point? We can come back to this, of course, as we discuss the Interim Report, but if there are issues that come up now, we can also talk about them. Any other concerns that are not articulated here that we need to discuss right now?

Wayne?

DR. JONAS: One of the motivations for doing this was to come up with a consensus. I mean, come up with at least the core issues, and I am just wondering if we need to do that at this point. We split up for a variety of reasons, but it really has to be from the whole group. I am wondering if there is a process for doing that, or, if we should do that at this point.

DR. ORNISH: I guess, for me, the question is, how much of this is implicit, that is, the subtext for the recommendations, and how much of it actually becomes recommendations, or is explicitly stated in the report.

I am not taking a position, I am just raising the question.

DR. GORDON: I think that is a question, and the process issue is whether we want to address that now or as we move through the report. That is the first question on the table here. We will have time as we talk about the report.

For me, much of this is the introduction and the context. Some of it is definitely going to influence some of the recommendations as well, and I think that what, exactly where, and how, is going to be subject to discussion among us all.

Joe?

DR. FINS: At the risk of opening up Pandora's box here, I think this was incredibly helpful, and I thank all the people that were behind it. I think that this was essential for us to make the diagnosis before we prescribe the treatment. I feel we have written the treatment, we have written the prescription in the report here, and we haven't made the diagnosis. This is the diagnostic, and everything else should follow from this.

I think there are lots of things that are implicit here that are not explicit in the Interim Report, and I was just wondering if it would be possible for us to delay the Interim Report, which I understand is not statutorily required, and to have an opportunity to have more ownership of the Commission in the actual Interim Report, which is so important.

It is our introduction to other policymakers, and I am just wondering, what is the basis for the deadline, and is it compelling? Because I think it is more important to do it right than to do it quickly, and I think that this is the formation of the consensus.

I think most of us could sign on to most of what is on this board, but some of us would have a hard time in agreeing on the particulars and the nitty-gritty that is in the Interim Report because of balance and tone. I just put that out for your consideration.

MR. CHAPPELL: Methodologically, this is the starting point, these are your beliefs, and then your actions arise out of those beliefs. So you have got a harmonization of internal and external, and that is where the integrity comes from.

So the first thing I want to respond to in terms of method is, this is the grounding, and then all of the recommendations and actions flow out of that. These are not recommendations, these are beliefs, and they need to be presented.

Secondly, I just want to say that I have done a lot of this, and I know that there is enough trust in this group and enough similarity of content that I believe that Jim and the staff can scribe very close to some common points of interest here, and so I am not feeling that we need a heavy editing process, either today or later.

I think there is enough intuition, and if we have an editing committee that Jim wanted to appoint, I think we could come up with that product. What we need is a product, and it is called a statement of beliefs, but I don't think we need more time to do it.

DR. GROFT: Last July 14th, at that meeting, a request was made to the Commission that we have an Interim Report. I think we were nine months late getting started from when the Commission was not officially established by the Executive Order, but cast into the Appropriations bill.

At that point in time, the request was made by then-Secretary Shalala that we have an Interim Report available a year from the meeting dates, and we took that to be July 15th of this year.

I must admit there is no urgent request for this report to be submitted on that date. However, I think in all reality, if you want things to happen in this fiscal or next fiscal year with any thought of appropriations coming to any of the tasks that you identify, this cannot be delayed more than two weeks. Anything beyond that, I think we are starting to look at late August, early September.

The appropriations committees will be getting back together and they will be looking at this. We will have had time to meet with the caucuses, as we have been asked when we would be available to supply them with information about the Commission's recommendations and directions.

So I think, realistically, a delay longer than two weeks, we are starting to jeopardize whatever might be done in the next fiscal year's budget, not that it cannot be done in September, but I think people need time to look at what you are suggesting and to analyze it from their perspective, both administratively and legislatively.

DR. GORDON: One thing that occurs to me. I do not think it would be a disaster to make it somewhat later, I would agree with Steve, but not too much later. We have said we are going to have a report, and I hate for us not to do what we say we are going to do. If we say we are going to have something by July, I think one of the things that we need to stand on is our integrity. If we say we are going to do something, let's do it.

And so, that is why I think, as Steve is saying, a couple weeks' delay will not change the appropriations process, but we have said to the Secretary, we have said to Congress, we have said to Senator Harkin, we will have the report by then, and I don't like to back off that.

DR. ORNISH: What are we going to do with the extra two weeks, anyway? It is not like we are going to be meeting, so how would we use the time even if we did that?

DR. GORDON: What I would like to do, what I would like to suggest, is that we spend the time that we need now going over the report. Personally, as somebody who has participated in writing the draft and participated in this process, I feel like this process is very much informing the draft. I think the draft spent too much time looking at some of the specifics.

I think Joe's analysis is not unfair, that there wasn't enough of a diagnostic and descriptive process at the beginning. I think we can easily incorporate that, because these are the shared values that should shape what we recommend.

The idea of the process is to do as much as we can today and then get it back, to have an agreement, first of all, an agreement about tone, an agreement about context, and an agreement about recommendations, and if there are words that are buzz words, to deal with those and eliminate those, and to bring in the kind of language that we want, and then to send it back to everybody and get input.

If we find that there is substantial disagreement and concern, we can go through the whole process again and put it off. I would like to shoot for that date of the 16th.

Yes, Wayne?

DR. JONAS: I think since there is a date we have to have some kind of report, and there is flexibility in terms of what actually goes into that report, that the time we have is right now, and we don't have any other time. I think we need to clarify these issues. I am not sure we have had enough discussion of these issues so that we as an entire group can come up with at least a few fundamental consensus items that should go into that.

And then, I think we should go right into the report and start discussing it so that we can actually see what are we going to produce, and then we can circulate something around that we have all had at least some time to start with.

DR. GORDON: Yes, Charlotte?

SISTER KERR: I just want to say that I agree with what has been said, and I feel that the statements, the philosophical underpinning statements or vision statements are calls to attention. They are requests for listening, and they are the energetic needle put into the Congress for the listening and the focus. It is absolutely mandatory we get clear on it, that we have our process of diagnosis right before we make any prescriptions, plans or evaluations.

Thank you.

DR. GORDON: You're welcome.

Bill?

DR. FAIR: Well, this may be accused of being a surgical approach, but I think we ought to go ahead. I mean as Steve articulated very well the reasons for doing so, I think we would damage our credibility if we didn't, and there will never be 100 percent agreement on it, no matter what we do. And I would just like to close with a comment, one of my favorites, from Sir Winston Churchill: "Action based on perfection is paralysis." I think we can't afford that.

DR. LOW DOG: Well, this is an interesting process, but if we don't conclude it, that is all it was, was an interesting process. So I think that there has not been closure yet on this, and I don't think we want to have 50 beliefs, that many of them are overlapping.

I think we need to have just a few, and we need to go through now. We can do it quickly, but I think we need to go and try to get some consensus on a few of them while we are all still here, because I think what the Interim Report must have is, it must have the core beliefs or goals of this group that feeds through the entire Interim Report, and go, then, to the report.

DR. GORDON: Okay. Other comments?

[No response.]

DR. GORDON: Okay, is there a general consensus that the group as a whole would like to go through these beliefs, and to select out the core beliefs that will animate the entire Interim Report and shape our deliberations? Yes? Do we have a consensus on that?

DR. JONAS: Provided we go then to the report directly, and we have a timeline for it.

DR. GORDON: Okay. Well, let me provide -- Wayne, I'm sorry?

DR. JONAS: Provided we have a timeline for the report.

DR. GORDON: Okay. Let me just say something related to that.

DR. ORNISH: Some of these are not values, some of these are actually recommendations, like requiring universal health education. I think we need to be careful about separating those.

DR. GORDON: Okay. Let me just make a point. If we are going to do what Wayne, in particular, is suggesting, and what others seem to agree to, we are not going to have time to go into some of the other issues that we have, or we may not have time.

Does everybody understand that we are not going to be able to go into the kind of detail with reimbursement, access and delivery, and wellness and self-care that we have with the other subjects, although we will address them in the context of going over the Interim Report?

I just want everybody to understand that we are making a choice, and that is a perfectly good choice, but we are making a choice.

DR. FINS: And I think it is legitimate, because people make value statements that will guide that and will make that easier downstream.

DR. GORDON: Okay. Everybody okay with this process? Tom?

MR. CHAPPELL: I just wanted to see if I have clarity about the next steps here. Are you suggesting that 18 of us deal with 30 beliefs on an open team?

There are some designs that would work. If you want prioritization, for instance, there is a tool I can offer of how we could arrive at greater prioritization.

DR. GORDON: What I first want to get is agreement that this is what we need to do, and then we can talk about the specific tools that we are using.

Is that the agreement, consensus?

[No response.]

DR. GORDON: Okay. So then, what we are going to be doing is we are going to go through the beliefs. I think Dean's distinction is important, the difference between beliefs and recommendations. What we want to focus on is core beliefs and values that will animate the report and will be included in the language of the report, in the introduction, and will also be part of the body of the report at appropriate places.

Then we will move into a discussion of the elements of the report in order.

Yes, Tom?

MR. CHAPPELL: It is important not to discard something that looks like an action, but to restate it as a belief, because there is a belief substance in every actionable statement.

DR. GORDON: Okay. Duly noted.

Joe?

DR. PIZZORNO: I have a two-process recommendation. One is, I think we should, before we do this, put on the vote here a timetable for the rest of the day so we are clear about how we are allocating time. And second, is a process that we have used for this kind of activity, is, give everybody five little stickies and you put it on the ones you think are most important, and immediately it pops out where the commonality is.

We may not have any of those little stickies, but maybe we could take a 15-minute break and staff could buy a batch and we can put them up there. Or, we could just put a mark with a pen. We can't do more than five.

DR. GORDON: Okay. Is that a process? Tom, is that --

MR. CHAPPELL: That is what I was looking at.

DR. GORDON: Okay. So I think what we should do is take -- well, Joe is suggesting doing it by balloting, but I think it may be easier to take the action. It just may work out. So you are suggesting putting five marks, each person puts five marks by the recommendation.

I think it is important, as we look at the recommendations, to remember that the process by which they were arrived at was different in the different groups.

So, for example, in the group that Wayne was chairing, there was an attempt to get consensus about specific recommendations, and in the group that Tom was chairing, clearly each recommendation represents an opinion of one person. I am not quite sure, Charlotte, was yours a consensus?

SISTER KERR: Yes.

DR. GORDON: Yes. So there are two different methods that are being used. If what we do is put those marks up, then we will take the ones that come closest to the top, and we will begin discussing them. I think what we will also find is that a number of the recommendations from different groups are very similar among the groups.

So with all of that in mind, what I would like to suggest is that we take a 15-minute break, and that in the course of that time, everybody will have a chance to put their marks up beside the numbers, and then we will come back.

Michele?

MS. CHANG: Just a process question. Are we clear on what the mark represents? Is it, those are the things that we are now going to discuss for what purpose? Are we discussing them as recommendations, or as what?

DR. GORDON: Let me just make clear that what we are going to be discussing are core beliefs and values.

Is that correct, everybody, at this point? William?

These are core beliefs and values. These are not recommendations.

DR. ORNISH: I am a little uncomfortable. I just want to raise this as a question, and you all can shoot it down.

There are two different approaches here. One is that we get clear about what our core values are, so that we can then use that as a context, as I mentioned earlier, for our recommendations. The other is, is the intention of this, what we are about to do, to decide which of these core values that are actually to go in the Interim Report?

I just want to raise the awareness that there is a risk of doing that. There is, on the one hand, an opportunity to do that, but there is also a risk that if you have core values that are very different from other people's core values and they end up in the Interim Report, then they become red flags for people.

We may say, well, that is just too bad; that is just the way it is and we don't care, but I think we need to go into that with our eyes open and make a real choice about that.

DR. LOW DOG: I think the point, though, is that we are trying to do consensus, and there is a very diverse group of people here. As long as they are true to themselves about what they believe, because if we don't have consensus, it won't go in.

So I think everybody just needs to be real true to themselves and put up there what they can live with. When we come to consensus, I think if we can all agree, then I think that there are not going to be big land mines.

DR. ORNISH: But that is where I am trying to make a different point, which is that we can all agree on something and it can still be a land mine. That's all. I think that that is okay as long as we are clear about that, but just because we agree on something doesn't mean that it is not going to push people's buttons.

MR. CHAPPELL: I think the cost of perhaps disenfranchising a couple of core beliefs that don't make a hit list can be avoided by our agreeing that we are not going to have 30 beliefs. We want to have this list around eight to 10 beliefs, and there are lots of common threads in here.

So I think if we were to go for more than five, I am thinking seven, we will be less disenfranchising.

DR. PIZZORNO: All right, seven.

DR. GORDON: Any other comments on this?

MR. CHAPPELL: Seven is a CAM number. I mean, it is spiritual, it is traditional.

DR. GORDON: I know. This is exciting.

What I would like to do is to give us the chance to see what the leaders are in these beliefs, and then we can talk about them. My sense is that they are going to be incorporated in different ways, that ones for which there is full and enthusiastic consensus will be stated very much up front as core beliefs. Others may influence some of the tone and some of the recommendations.

We will have an opportunity to discuss possible land mines, and we will have an opportunity to discuss exactly how many numbers, land mines, or fireworks, gold mines. Thank you.

Joe? Go ahead. We have a couple more comments.

DR. PIZZORNO: One more small detail, just to make it easier. If we stick some crosses, just put a line down. If you see four, put a cross; make it real easy for people to count afterwards.

DR. GORDON: Effie?

DR. CHOW: I am concerned about the repetitions, the duplications. There are a lot of things there. If you select five, does that mean all the others go out, or will there be a process where you take the rest and kind of integrate it?

DR. GORDON: What we will attempt to do, what all of us will attempt to do collectively, is to take a look and see what we have done, once we have done it, and then we will try to integrate. We may not have the exact wording of each statement, but we will have the basic principle there. If there are a couple, or three or four, that are very similar, we will try to work them together. Okay?

So I think we need to see how it falls out before we move any further. So let's take a 15-minute break and do this process.

[Recess.]

Discussion Session IV: Core Beliefs

DR. GORDON: Okay. Before we begin the discussion of the tally, what I have done is, I have tried to group some of the responses that are similar with one another. So we will go through the ones that have the most assent from the group, but before we begin, Linnea wanted to read a poem that will help us get centered. It was a poem she was going to read before she led her session on access and delivery, but it is a good time to read it now, too.

MS. LARSON: I thought that this would enable us somehow to get focused, and it is from a book of poems by a poet named David Whyte, and the book is titled "The House of Belonging," and the poem's title is called "Working Together."

"We shape ourself to fit this world, and by the world are shaped again, the visible and the invisible working together in common cause to produce the miraculous. I am thinking of the way the intangible air casts its speed 'round a shaped wing, easily holds our weight. So may we in this life trust to those elements we have yet to see or imagine, and look for the true shape of our own self by forming it well to the great intangibles around us."

DR. GORDON: Thank you very much. Very apropos.

What I have tried to do here is to tally the marks, and then to group according to similarities. What is interesting is that there are a number of similarities.

Does anyone know where Wayne is? It would be good to have him here.

COMMISSIONER: He is on the phone.

SISTER KERR: I will go get him.

DR. GORDON: Why don't you get him.

The first statement, which is a kind of restatement of the mandate for the Commission, is this one here and is the one with the single most number of marks besides it: "The Commission is for the improved health of Americans by ensuring the availability of safe and efficacious CAM services and products." So this is the one to which there is the most general assent.

Second, is this one here: "Individuals should have freedom of choice among practitioners with accountability." This one is not directly stated anywhere else, but it is echoed in some of the others here. For example: We believe in healing, of all approaches; CAM is has been evolving and moving to dynamic models; a diversity of disciplines; We need to minimize impediments to access and delivery.

So all of these have some relationship to this one here. Let me repeat that one: "Individuals should have freedom of choice among practitioners with accountability." Then there are a variety of others that come under this.

DR. FINS: I think it is really important that we don't editorialize and spin it. I mean, I can see differences. I think people who voted for that may not endorse that.

DR. GORDON: Understood. Understood. I am just saying that there are others that have been put up that may be similar, although this is the primary one. Okay?

SISTER KERR: Just also to say, the second part of the one that has a lot of -- is similar to that one.

DR. GORDON: I'm sorry. This is the same one. Thank you, Charlotte. This is the same one as Number 1, really.

SISTER KERR: Number 2.

DR. GORDON: Number 2, sorry. This one here: "All human beings have a right to be cared for and to have access to their practitioners and modalities of choice." What we are looking for is a general feeling.

Would you agree that that is pretty much the same as Number 2?

SISTER KERR: Yes.

DR. GORDON: What we are looking for is the general feeling. Joe, I appreciate what you said, but I am trying to give a sense that these may have something to do with that, but they may not be as clearly marked up.

Number 3: "The body has a remarkable capacity for healing that can be facilitated by addressing underlying causes of illness and suffering."