The Honorable James Gordon: We're adjourning now and we'll be beginning again tomorrow morning at 8:30, and we'll go till 2:00. And we look forward to seeing you and please encourage others to come. We welcome everyone. Thank you. Thanks.

Okay, good morning everybody. We're going to get started now and we'll begin at the beginning, that is, with a moment of silence. Okay. Thank you very much. I just want to say a word of, what a pleasure we've been talking about it among ourselves, what a pleasure it was to be with you all and to listen and to have a chance to talk with you all today, yesterday evening and coming in this morning. It's wonderful to see and feel the energy around what you've been doing for all these years, the intelligence and energy you bring to this discussion with us. So thank you all very much.

We're going to, we'll begin now with the first panel. We'll be going. You want to bring that person up with the rest of the people. We'll begin with the first panel. We'll be going till about, till 2:00 today. And we're on a strict timetable because apparently the room gets cleared out and the place gets closed up not too long after 2:00. So we'll make every effort to end by 2:00 2:10 anyway. Michelle.

Michelle: We're actually going to start bringing up the first panel and we'll begin with Katherine Schmidt from the Bellevue Massage School and how she waited patiently all day yesterday only to miss her panel when she had to go move her car. So if Katherine Schmidt would come up with the following Paul Saunders, Karta Purkh Khalsa, Jennifer Jacobs and Emma Bezy.

The Honorable James Gordon: So we'll begin with Katherine Schmidt. The last, the last shall be first right?

Katherine R. Schmidt, Bellevue Massage School: Mr. Chairman, commissioners, I wanted to first start off by thanking all of you for being here in this capacity for this is a very exciting time of expansion and growth. And I know I'm excited as probably many of us are here. And I appreciate your inquiries, your questions and just the focus on this very important issue that's before us. Thank you.

My name is Kathy Schmidt and I'm Co-Director, along with my husband Jim, with the Bellevue Massage School. I'm also a strong advocate for education in CAM and am currently a certified reflexologist and touch for help kinesiology instructor at our school as four other community colleges. I also feel strongly that CAM practices and interventions should be accessible to everyone including people with low income, a system whereby people seeking health care options can choose from wide range of CAM or conventional medicine practices. And have it be reimbursable through federal programs or health care coverage and not just accept treatment on the basis that their health care coverage is limited to what it will cover.

When I was twenty years old and suffering from chronic condition, I was told by a doctor I would probably have this condition for the rest of my life, and that I would be on medication for it for the rest of my life, which I was having reactions to. And I started looking into other options, thus started my journey into health. It included chiropractic, also kinesiology, homeopathy and reflexology. And I'm glad to be living in the state of Washington, where most of these services were covered by insurance. They had not, had they not been I would have not had these options available. And I feel they were largely responsible for some of my healing process.

A lot of people giving testimonies have addressed some important issues such as collaboration, bridging the gap between conventional medicine and CAM, quality of life, cross-training. But I would also like to bring up four other important points. Intention, referral, preventative care and empowerment. I mention all three of these in my natural healing classes. Intention is for the best outcome when acting as the facilitator for someone's healing process. I think it's so important, a very important part of the healing process is our attitude towards someone that we're helping. 2) knowing when it's not in your scope of practice to be able to refer to another provider. Again I really encourage that. And that is a very important thing to remember. 3) teaching people to work on their health maintenance from preventative approaches and not wait until they're suffering from a particular condition or wait until they're thinking of contacting or using, you know, a health modality when they're in acute stage. So I feel these are really important.

I have three people in mind right now that stand out in my mind that were deeply affected by these. A woman in her seventies that wanted to learn how to work on her husband's hands and feet who had quadruple bypass surgery, congestive heart failure, is recovering from an abscess around his pacemaker and reacts to many of his medications. A mother wanting to learn reflexology for her thirty-year old son diagnosed with MS. And my mother diagnosed with breast cancer that had metastasized to her lung and brain.

The Honorable James Gordon: Time is up.

Katherine Schmidt: Okay, I'll just finish real quick. Lost her eyesight during radiation treatment. I have something to look forward to besides her pain medication. I did reflexology on her on a regular basis towards the end of her stages of cancer. So I, all these people were deeply touched by CAM. Thank you.

The Honorable James Gordon: Thank you very much. Paul Saunders.

Paul Saunders, ND, Ph.D.: I want to thank the commissioners for allowing me to present this morning and to come from Canada to do this. I'm employed as a Naturopathic physician and a Chair of [inaudible] at the Canadian College of Naturopathic Medicine in Toronto. And today I'm representing the Office of Natural Health Products as a member of the transition team of the Office of Natural Health Products and as a member of the Expert Advisory Committee in that capacity.

The theme that I want to talk about is the regulation of natural health products and the way we've approached it in Canada and it relates to item three in President Clinton's recommendations with respect to access and delivery of CAM services. The issue that we faced in Canada is a lack of access to a lot of health products, the fact they were either regulated as drugs or foods and not really accessible to many of the practitioners who use them or to the public. And there have been significant problems with respect to the quality of materials available. As a result of this, there was a strong public movement within Canada which led to the development of a parliamentary committee on natural on health.

And this parliamentary committee made up a variety of recommendations to the Minister of Health in a publication consisting of fifty-three specific recommendations in order to create a new office of natural health products that would actually regulate these and take these products out of the drug category. And out of the food category and give them separate recognition.

In November of '98, the Commission released it's report, and in March of '99 the Honorable Minister Allen Rock accepted all three, fifty-three recommendations which is unheard of in Canadian government politics, as I'm sure it is here. The fifty-third recommendation was to establish the transition team in order to create the framework for this new office. That transition team was established and met a week a month from May of '99 to March of 2000 and released a report called a new vision in which it set out its framework. And the seventeen members consisted of government members, pharmacists, Naturopathic physicians, medical doctors, members of the public, people in the manufacturing, members of traditional Chinese medicine and the public and produced this report. They also were given the mandate to hire an individual to head this office, and that Office Director was Dr. Phil Waddentuden, who is a naturopathic physician.

That office has now created, gone ahead to do public hearings over the last three months and will be putting together regulations, which will go forward into Canada because that one in the early part of 2000 and based on public response to those will lead to a final set of regulations in Canada Gazette II, which will be released some time in late 2001 and 2002. And this will then make accessible a variety of products which are quality, which will have regulation with respect to labeling, content, advertising, manufacturing and licensing, and will make these available to the public, to the patients and to the practitioners of these therapies.

The Honorable James Gordon: Thank you very much. Karta Purkh Khalsa.

Karta Purkh Khalsa, AHG, CN: Distinguished commissioners, thank you for inviting me today. I am submitting these initial comments on behalf of the American Herbalist Guild. The American Herbalist Guild is the only purview organization in the United States for the community of practicing herbalists specializing in the medicinal use of plants. The AHG maintains a basic policy of full disclosure and informed consent. Public health policy must ensure that herbal practices are utilized in a way that promotes patient safety. Herbal medicines are notably safe. CAM policy can best be developed by recognizing each individual modality on its own merits and by actively creating opportunities for interfacing at length with the professional leaders of these communities of practice including herbalists, such as you're doing today.

Let me discuss reimbursement issues. Reimbursement is currently available for some herbal practitioners primarily naturopathic physicians and traditional Chinese practitioners who are licensed. There is currently on reimbursement for direct entry herbalists. At the lease reimbursement programs should be developed for herbal practitioners in states with existing practice standards. Proper reimbursement programs should also be investigated and encouraged for traditional healers in ethnic communities of practice and for direct entry herbalists. Herbal supplements are not currently reimbursed under any health care program. The exception is a few private insurance carriers who have instituted small experimental pilot programs.

Current policies of drug reimbursement do not adequately address the issue of herbal medicines. Reimbursement programs should be established for herbal products that are prescribed by recognized herbal practitioners including specific preparations that are approved for specific indication. The use of botanicals as specific medicines does not sufficiently represent the practices of the emerging body of knowledge of herbal medicine. None the less, it can offer a beginning for making determinations about reimbursement. The reimbursement process must include botanical preparations that are used for illness, acute and chronic and those that may be prescribed preventively. In most cases, health professionals in the given community of practice should be relied upon to make that determination.

Herbalism has existed as a respected profession for many centuries and is the backbone of both self-care and professional natural healing in well-established systems such as [inaudible] and traditional Chinese medicine. Today there is a critical shortage of well- trained herbalist. There are increasing number of people who desire to become direct entry herbalists. It is essential that these students be afforded the opportunity to finance their education in a manner similar to that of other health professions.

The HG has established educational guidelines for programs of study in herbalism and is instituting a school assessment program. In the process of developing herbal education services it is important that CAM practices not be overwhelmed by conventional sciences thereby losing the essence of the CAM practices. It would be appropriate to convene an advisory panel of CAM and professional practitioners to review the level of science requirement in herbal and CAM education. Thank you for this opportunity. We appreciate your invitation and we look forward to communicating with the commission in greater detail as development progress.

The Honorable James Gordon: Thank you very much. Jennifer Jacobs, good morning.

Jennifer Jacobs, MD, MPH, American Institute of Homeopathy: Hi, Jim. I'm here as a conventional family physician, who has been using homeopathy in my practice for nearly twenty five years. I also do clinical research at the University of Washington here. I have seen many patients helped by this practice without the high cost and dangerous side affects of conventional medications. I believe that the best way for homeopathy and other CAM modalities to be integrated into the health care system is train physicians like myself to use it in their medical practices.

Homeopathy is the primary care modality being used in Europe. In the U.S. homeopathy has increased five-fold in the past ten years. Homeopathy is used mostly by upper-middle class patients for chronic health problems not helped by conventional medicine. Except for three states there is no licensure for homeopathy. It is practiced by a wide variety of licensed practitioners--MDs, DOs, physicians assistants, nurse practitioners, chiropractors and naturopaths. There are a growing number of non-licensed homeopathic practitioners whose legal status is undetermined. There are three certification boards for homeopathy. Some health insurance companies offer optional coverage for homeopathy but most patients pay out of pocket.

Homeopathy is not taught in any U.S. medical schools although it is often included in CAM courses. It is taught in Naturopathic schools. Most practitioners study homeopathy in post-graduate courses run by private institutions. The American institute of homeopathy is the professional organization for medically trained homeopaths and sponsors educational programs research and interfaces with government agencies. Research opportunities for homeopathy in the U.S. are few due to the generic nature of the medicines which cannot be patented. The NIH has funded several studies and is now considering new proposals. Currently I'm heading up a study of homeopathy for hot flashes in breast cancer survivors at Providence Medical Center here in Seattle.

Actions that can improve access to homeopathy include: establish departments of CAM in medical school and residency programs, cost effectiveness research to document the fifteen percent cost savings of homeopathy found in France, reimbursement policies that allow adequate time for homeopathic consultations, inclusion of homeopathy in low income clinic, hospital privileges for homeopathic physicians, and licensing of non medically trained homeopaths to work legally under the supervision of a physician. As the President of the American Institute of Homeopathy I hope to speak with you at more depth at a later meeting. Thank you.

The Honorable James Gordon: Thank you very much. Emma Bezy.

Emma Bezy, MA, Spirituality Program, Bastyr University: Good morning. I'm Chair of the Department of Spirituality Health and Medicine at Bastyr University and I'm going to share with you today some of the things that we have discovered that have worked and that do provide a replicable model for.

The Honorable James Gordon: Speak a little closer to the mic please.

Emma Bezy: For the integration of spirituality into health care. Should I repeat any of that for you? Okay. We're building upon the groundwork here that's been laid by the palliative care and the hospice movements which really opened the door for the inclusion of spirituality into medical and health care practices. The program we have is two hundred and forty hours, ten weekends from September to June. And a wide variety of health care professionals come to this program--MDs, NDs, nurses, nurse practitioners, counselors, social workers, clergy. And they have a very intense experience working with one another. They travel from as far as southern California and Alaska to be part of this program because they haven't found anything like it anywhere else.

So what I recommend to you that has worked in our program is providing such health care professionals with a time and a place like this, in which they can study these subjects with an interdisciplinary group of peers and colleagues. Where they can learn the skills to comfortable non judgmentally discuss spirituality with patients who want this to be part of their health care, where they can learn how to include spirituality in advanced directives and other end of life planning issues. Where they review the research about how and why prayer and meditation is an effective aid to health and longevity, and also how to access the soundness of research studies being done in these areas, that they can also learn how spirituality can help them as professionals recover from burnout, and revitalize their original calling into health care. Our graduates continue to serve as mentors and role models in the community building bridges between professions and present at conferences throughout the region and the country.

So I encourage and recommend that you encourage other professional organizations to support the inclusion of the spiritual dimension in practice. I was asked to help the state social work conferences last year included and including this and mind body medicine. And their theme drew many more people than they had ever had before and the professionals were most grateful to have the permission and the encouragement to as they said, come out of the closet and discuss what they were already doing in their clinical practices. I would hope that you would encourage HMO's to follow the model of Sloan's Lake in Colorado. They're the only HMO I know that is covering spiritual advising as a legitimate health care benefit. And that you continue to encourage research studies and encourage collaborations and partnerships that increase the opportunities for this kind of training. Thank you.

Male Participant: Thank you. Emma, thank you so much for all the good work you're doing in training practitioners to care, perhaps our most neglected and most vulnerable population, those who are terminally ill and their families. What recommendations would you make for us in our in our report to improve the care of the dying and having a very integrative approach to the need of this population? What would be on your wish list?

Emma Bezy: I think one easy and definite thing would be for hospitals that already have hospice services available or as part of them to really look to their hospice staffs for in house training and encouragement of other practitioners to do the things that are already working more extensively throughout the departments and other parts of hospitals and clinics. To encourage them to look at what Jaykell is already encouraging about including this and put those processes to work and to just continue to ask patients to guide it. It's the patients that are really driving this--patients and families who are saying they want this and it gives them great comfort and great ease in dying. To really listen to their consumers and take guidance there.

The Honorable James Gordon: Thank you.

Male Participant: I have a question for all of you regarding the herb. If you can suggest, first of all if we go as a consumer, if we go to a vitamin store or nature food store, dietary supplement you have so many. And also I'm a believer of a herbal medicine and a food supplement. I think it carries a lot of value for patients. How can we tell the consumers and also we can summarize a report, what are the most, let's see, the first twenty herbs? It doesn't matter from which culture is generally considered as safe and effective. Then we can give the information to the public.

Paul Saunders: One of the things, if I may in answer to that question, one of the things that we've done in Canada is a joint venture between the Canadian Pharmacy Association and the Canadian Medical Association. And I was the naturopathic physician on this board. And we actually published this spring in March of 2000 a book called Earth: Everyday Guide for Health Care Professionals. And it actually has the top fifty-seven herbal substances, mostly herbs in it. They are peer reviewed individual articles. They are geared at the level of medical professionals. They're geared for medical students, pharmacists and physicians to be able to use so that if a patient comes in and, let's say, they're on Ginkgo or Echinacea or one of these top things, they could read about it. They could know about the interactions, they could know about the clinical trials and they can be aware of what are the positive or the negative side benefits with respect to those top sixty substances.

Karta Purkh Khalsa: Well, to second those comments, there, much of this documentation in fact already exists. The American Herbal Products Association has established extensive documentation on exactly that issue. The American Herbalist Guild from the clinical side has established guidelines of practice. And I think what we need to do is get these groups together, have serious discussion in implementing some policy.

Jennifer Jacobs: Yes, I'd also like to add some comments. I would suggest that the herbal profession take a leaf from the book that the homeopaths have been using for the past sixty years. There is an official homeopathic pharmacopoeia of the U.S., which was established in 1939 by the Food Drug and Cosmetics Act, which runs parallel to the pharmacopoeia of conventional medical drugs. Because of this homeopathic medications are all standardized, they're manufactured in the same way. If you buy different medicines from the same company you can be assured that they contain the same proportion of medications. It has been suggested by others, and I second this suggestion that the herbal community also establish a similar pharmacopoeia with standardization and regulation of manufacture of their products.

The Honorable James Gordon: I'm wondering is that something you've done in Canada?

Paul Saunders: That's well, we have, the regulation are coming in place and that's something that will happen certainly. [inaudible] around 2002 or so that'll actually be in place to occur.

The Honorable James Gordon: I'm wondering if you could send us the book that you're talking about and any other, any other guidance about how you've taken these steps.

Paul Saunders: I'm going to make an electronic submission and I'll have that, I'll have that in there.

The Honorable James Gordon: Great, thank you.

Female Participant: I have a question for Dr. Jacobs and I might have misunderstood so I want to just clarify. We talked about the, the history of homeopathy and I thought I heard you say that you felt that homeopathic physician should practice under the direction of medical doctors. Were you talking about independently licensed homeopaths or were you talking about someone who might have taken some weekend training courses?

Jennifer Jacobs: There are not independently licensed homeopaths in this country. That is one of the problems that we have. At the current time homeopathy is practiced by people who have other licenses that allow them to practice medicine such as MDs as myself, chiropractors, naturopaths, and so forth. There is a large number of non licensed people who are practicing homeopathy in a very gray area of the law. Some of these have been prosecute in some conservative states. Other places they're allowed their kind of a liaise fare attitude towards them.

But this is a big problem we need to solve. Should people without medical training be treating sick people. The consensus of our group is that there should be a new licensure created for non-medical homeopaths, who would practice under the supervision of a trained medical person. This could be a physician, it could be a naturopath, it could be a physician's assistant. But we feel that people who are treating sick people need either their own medical training or supervision by someone who has medical training.

Female Participant: A simple question is, is there a certification for or licensing for practice of herbs? The National Commission, the National Certification for Commission on Acupuncture and Oriental Medicine has that in place for oriental herbs. But what about the other aspects of herbs?

Karta Purkh Khalsa: [inaudible] herbalists now undergo a peer review process that investigates their qualifications and allows them membership in the professional association at a professional level. The national certification is almost established. Within a year that'll be in place and there will be a two tiered exam for professional basic certification and board certification, very similar to the acupuncture model.

Female Participant: Thank you. May I just, one more? You talk about research and spirituality. I appreciate the topic area because the aspect of spirituality had not really been brought up in many of the testimonies. And you mentioned about research. What kind of research and do you have collective database that you could share, not right now but--

[cross-talking]

Emma Bezy: Yes ma'am, I would be glad to do that. And certainly people like Dr. Larry Dassie have been taking the lead in this for a number of years and really bringing the research that has been done forward into the mainstream consciousness. So for us, what that means are studies that can be done, classic double-blind studies even that will pay control groups. And look at what happens when a group of cells in a petri dish or a group of people in a room are prayed for at a distance or are prayed for directly in the presence of another person? And what happens physiologically and mentally and emotionally with their health conditions, what can happen on a cellular level with some of these things. So it's research on all of those areas that helps build a bridge between the hard sciences and people who are believing by faith that these things work so that the two can talk to one another and there's not such a split there anymore.

Female Participant: Thank you.

Female Participant: Thank you for all you testimony. Just for the purpose of disclosure cause a woman asked. I'm a member of the American Herbalist Guild, a professional member, was the former President of the American Herbalist Guild and now sit on their Admissions Board. And I just want to say the AHG is doing a lot of work. One of the questions I have for the commission, for us, is that amongst herbalists there continues to be a concern on the part of many lay herbalists direct entry who don't really have medical training but are recognized in their communities as caretakers and as healers. How, how would you best advise this commission on how to address their concerns that licensure, reimbursement, that these things may actually affect their ability to use herbs and to be able to continue to practice? You know the fifty-five year old woman in Appalachia or the -- you hear what I'm saying. So, do you have any words of wisdom for the commission on how we can take that group into consideration?

Karta Purkh Khalsa: Well as a professional organization the American Herbalist Guild has been addressing this issue for twelve years. And we've taken the policy from the very beginning that herbalism is the medicine of the people and that people need to have access to traditional herbal remedies used in the traditional way. So we understand that nothing that we do from a legitimization or legalization prospective is to exclude these people who want to make sure that ethnic or community caretakers continue to be allowed to have access to their medicine, access to their patients and to have the role in their, in their community. Nonetheless, we recognize that things are moving on. Herbs are being used by people with possibly medical training but very little herbal training; that herbal medicine is working its way into conventional settings very quickly and that we need to have a role in that and a participate in shaping policy. So both need to be considered.

Male Participant: A couple of questions on the subject of herbs. How can we as a commission help you protect the integrity of your teachings culture by culture? Because herbalism is not a uniform methodology. It's a function of different cultures and I'm just wondering what standardization of licensure really accomplishes for your particular modality.

Karta Purkh Khalsa: Well let me suggest that as an organization, the American Herbalist Guild does not support licensure for herbalists. We support voluntary standard setting and national, national certification so that people can identify excellent and well trained herbalists. There still needs to be certification mechanism for, for traditional knowledge. That's what we have now is the peer review situation. Because we have, and Dr. Low Dog is involved in that, because we have people with training from all, every paradigm around the planet who are qualified and need to be able to see their patients and take care of them. So that, that has to remain in place.

We're also concerned that as these professions become more and more formalized, it seems that the trend is that each step of formalization and education is adding more hours of western scientific study at the expense of less and less clinical practice hours and the actual modality that people are there to study. So we want to have a role in fashioning educational criteria. We've established the appropriate educational criteria in our educational guidelines. And they do include appropriate background in western sciences. We just want to make sure that those two are balanced.

Male Participant: Thank you. May I ask one more question of Dr. Saunders? How did the transition team deal with the efficacy of the botanical products for consumer?

Paul Saunders: A very good question. The way that we've dealt with the efficacy issue is that there are different levels of evidence that can be used. We can use traditional sources such as the, you know, the western botanical literature, or the traditional Chinese Medical, or the Aerobatic literature. There can also be references with respect to a consensus group meeting around discussing the use of the herb all the way up to double blind placebo cross-over kind of trial studies. And all of those levels of efficacy would be, would be accepted for making different kinds of levels of claims.

If you wanted to make a traditional claim, for example, you might cite Kings or Mrs. Greaves or one of those things. If you wanted to make a traditional Chinese claim then you might cite the Yellow Emperor or something like that and show its use in that respect. Or if you want to use a recent study that's been done with Hyperic [inaudible] St. Johns Wort, comparing it to, you know, trycyclic antidepressant then you could cite that and make that. That would then allow you to make a label claim, which would say this is, this is as effective as an antidepressant or this has a long history of being used for antidepression and could put that on the label.

Male Participant: So short of clinicals -

Paul Saunders: Right.

Male Participant: Your country is providing an opportunity for herbal blends to be marketed with a claim?

Paul Saunders: With a claim. That's right.

Male Participant: As far as I understand that's unique. Is that correct?

Paul Saunders: Yes that is, that is unique. And that's what would come before the office to determine, and if the office needs advice then they would send it to the Expert Advisory Committee to actually look at that and help them make some adjudication on that.

The Honorable James Gordon: Thank you all. One thing I want to say just in in closing is that I'm observing once again that the kinds of comments that you're making are not only helpful to us now. They and the materials you provide are going to reverberate throughout our, our meetings. And Michelle and I were just thinking about certain topics and certain speakers for certain topics. So we, we may be getting back to some or all of you. And that goes for all of, all of the speakers. This is really a, an ongoing process. And thank you very much for working with us.

Michelle: Okay if we could have the following speakers come up. Tom Shepherd, Robert Anderson, Charlotte Coon and Jeffrey Goin. And as well at this time could we bring up the following. Barbara Mitchell, Mark Tomski, Christa Louise and Todd Richards. Thank you.

The Honorable James Gordon: Wonderful. Good morning Tom.

Tom Shepherd, DHA, Bastyr University: Good morning, and good morning everyone. My name is Tom Shepherd. I'm the President of Bastyr University. The Pacific Northwest is on the road to integration but we're not there yet. What you have seen is a shared vision of those who have collaborated or worked together to try to create a true health care system, not just a disease treatment system. Bastyr has been mentioned in numerous initiatives. This was not due to funding being available to do these things but this was due to it being the right thing to do. At Bastyr and other co-collaborators have dedicated resources and sometimes scarce resources to make it happen. Our relationships with all those with whom we are working jointly are maturing in this point in time and the possibilities are endless. Particularly with appropriate funding that could help escalate the collaboration efforts that are ongoing at this time.

I have three observations and three recommendations.

Observation 1) CAM is about systems of healing not isolated therapies. Natural medicine is defined by a philosophical system not modality. And this system changes the way we think about and provide health care. Dr. Effie Chow said yesterday that in China the doctor keeps the patient well. And this is a paradigm shift that we are dealing with today.

2) Consumers are ahead of government and providers in their demand for CAM. Why a White House Commission? Why in CAM? Because the consumer demand has been there for this past decade and they were willing to pay for it out of their pockets. But being ahead of baseline, being ahead of the government and providers and having a lack of baseline regulations has a potential to lead to a) consumer fraud, b) inability of poor and underserved to access care, and c) the grafting of certain modalities into the current system without recognizing the paradigm shift that is taking place. A quick shift is not sufficient.

3) Systems are trying to define CAM and CAM curriculum without going to the source. CAM educators CAM researchers and CAM providers. Collaboration is necessary of true integration is going to result. CAM professionals should be at the table at all levels of discussion. Medical schools should be breaking down the doors of Bastyr for development of CAM curriculum. And yet they are currently receiving funding to develop CAM curriculum themselves alone. The same applies to research.

Recommendation

1) If we truly want integration we need to fund CAM institutions at the earliest level of medical education. We need to provide accredited CAM schools access to funding to allow for collaboration between medical schools for joint training programs and clinical experiences for graduate and post graduate training. We also need to provide access to loan forgiveness in underserved areas for CAM graduates.

2) We need to invest in research infrastructure at CAM institutions and include CAM credentialed experts in research design and policy decisions.

3) we need to recommend guidelines to the states for credentialing and licensing of CAM providers. This is not a monopolistic system to exclude providers but this is a public health and safety issue that provides the public the confidence that their provider is adequately trained to render the services needed. If I was to be in a car with, was in a car accident this morning, I would have the confidence that whoever in the emergency room was rendering treatment to me knew what they were doing, they were credentialed, they had the educational and the experience to treat me. I would expect the same if I went to a CAM provider or a conventional medical doctor to manage my diabetes. I would expect that they would have the necessary experience and education and there would be no harm to me in going to them for care. The public expects this and the public deserves it. Thank you.

The Honorable James Gordon: Thank you very much. Bob Anderson. Good morning Bob.

Robert Arthur Anderson, MD, American Board of Holistic Medicine: Good morning Jim. Thank you for the opportunity of contributing to these proceedings. My name is Bob Anderson. I'm the President of the American Board of Holistic Medicine and the founding member and the Past President of the American Holistic Medical Association.

The American Board of Holistic Medicine was incorporated in 1996 for the purpose of evaluating the candidacy of applicants desiring certification to specialists in holistic medicine. Candidates must currently be licensed medical doctors or osteopathic physicians. Several hundred enthusiastic candidates will be sitting for the initial certification examination, which will take place this December in Denver Colorado. The holistic medical organizations are identified by an integration of the art and science of 1) caring for the whole person, body mind and spirit to treat and prevent disease and 2) empowering patients to create a condition of optimal health far beyond the mere absence of illness. Both outside and inside the medical profession this concept of medicine to the whole person is gathering increasing support. The body mind spirit approach integrates many disciplines and modalities including physiology, bowel chemistry, nutrition, exercise, environment, emotions, attitudes, beliefs, social relationships, manual medicine, biology, homeopathy, energy medicine, acupuncture, meditation, prayer, biofeedback.

Holistic medicine is based on the core belief that an unconditional caring approach to Dr. patient relationships releases powerful forces of healing. At it's essence the practice of holistic medicine embraces a spirit of interdisciplinary and physician patient cooperation. It balances the mitigation of causes with the relief of symptoms, integrates conventional and complimentary therapies and facilitates the experience of being fully alive. Our concerns have revolved around issues of

1) Assembling a database of published medical, psychological and alternative studies in these fields of interest. To date, over four thousand citations have become the core of this database.

2) Providing opportunities for continuing medical education for practicing physicians who have an interest in the field.

3) Presenting a peer review process for certification to establish standards in the field and the upcoming examinations in the culmination of this process.

4) [they said number 3] Cooperative reidentifying opportunities to provide for training of students and residents in the field, and

5) Identifying successful examples of collegial interdisciplinary practice models in which conventional and alternative approaches to medical care are more optimally combined.

Holistic physicians will ideally work in groups which include Naturopaths, chiropractors, nutritionists, counselors, acupuncturists, exercise specialists and others from the many disciplines. As an organization, we wish to be involved in the process, which appears to have been envisioned of the formation of the office of complementary and alternative medicine. We are ready to contribute our professional experience and willingness to bring together elements, which I have touched upon above. With the intent of providing a wider array of informed practitioners thoroughly trained to meet the interest of the consuming public which is recognized by everyone involved in these proceedings. I appreciate the opportunity to contribute to your hearing this morning.

The Honorable James Gordon: Thank you. Charlotte Coon.

Charlotte Coon, Hellerwork International: Hi, Good morning. I'm really encourage sitting here listening this morning that most of what I'm going to say you're already hearing. I'm a Hellerwork practitioner. I'm not the president of the organization or any part of it. But I do practice an alternative form of medicine and I participated, I'm a consumer of it. So I'm here today to speak to both. Hellerwork is an eleven series of structural integration that includes the mind body dialogue and the movement reeducation, works hands on with the soft tissue of the body to bring alignment and balance to the structure. So that gives you a little idea of kind of what I do as a practitioner perhaps.

But what I really want to say is that these alternative practices complementary alternative practices, Hellerwork included, I think is attempting to bring back to medicine what medicine left behind which is the patient as a whole person. The heart of any health care practice needs to be the patient and certainly not just his symptoms or his wallet. Many CAM practitioners see the patient for twenty to thirty minutes at a minimum compared to the average eight to ten minute doctors office visit. And while any, while most of us come to an alternative practice with an illness or a discomfort initially including my Hellerwork practice, what they leave with is often a more empowered sense of who they are in relation to their health care, with skills and knowledge they can use in everyday life to reduce their need for health care [inaudible]. As deliverers of CAM we should be, we should not be so eager to join the current playing field of insurance, dollar driven health care where the consumer remains unempowered. And that my feeling is many physicians have remained frustrated where more and more often nobody is winning and an increased at an increasingly high cost to all of us, if not an insurance cost then in litigation.

As the Hellework practitioner I touch not just the myofacial system but also the heart of the patient. I listen to the total life of the person who sits in my office asking for relief from shoulder pain. I deliver a type of care, which acknowledges that neither I nor my system of body-work is the miracle here. The human body and the spirit that animates it is the miracle. I am simply assisting that natural process back towards more balance and integrity. This used to be what all medicine was about.

While we're all clamoring for more attention from insurance companies and for more research dollars let us not forget what the American public has by choosing CAMs in an every increasing number is already mandated, that wherever the current system is lacking they will seek out methods that work better. Let us remember that what drives up the cost of health care, western or alternative, is the mistaken believe that the consumer is passive in the process and that every aspect of health care delivery should be paid for by insurance dollars. I'm saying again in case it was misunderstood that's what I believe should not be happening. We need to stop insuring our nation to death. So I encourage the commission to move boldly and swiftly to what the public is already clearly saying at once, more choice for the health care and a return to more human methods of its delivery. Thank you.

The Honorable James Gordon: Thank you. Jeffrey Goin.

Jeffrey Goin, Coalition for Natural Health: Mr. Chairman, members of the Commission, my name is Jeff Goin and I'm President of the Coalition for Natural Health which is a grassroots organization that represents over twenty two hundred natural healers nationwide. Over the last couple of days I've noted a few points relating to the misuse of CAM terminology and philosophy. I'd like to use the bulk of my three minutes to, to try and clarify some of those matters.

Throughout this town hall meeting both speakers and members of the commission have been using the terms "naturopathic medicine" and "naturopathy "interchangeably. It's imperative for the members of the commission to understand that traditional naturopathy involves natural non invasive modalities that serve to stimulate the body's own intrinsic self healing capacity without the use of drugs. Naturopathic medicine on the other hand is a hybrid approach to health that combines traditional naturopathic modalities with allopathic procedures such as prescription of drugs and us of surgery. There's a very material and a very important difference between naturopathy and naturopathic medicine. Similarly throughout the two days of meetings the titles naturopathic physician and naturopath have been treated as though they're synonymous.

Furthermore, some speakers, most speakers, some inadvertent, some not, have implied that naturopathic physicians comprise the entire universe of qualified naturopaths. This is most assuredly not the case.

I'll give you my organization's take on the naturopathic universe. There are naturopathic physicians and then there's everybody else. The everybody else in the field of naturopathy is the constituency that my organization represents. And the everybody else is comprised of generational healers, Mexican American kieranderos, Native American tribal healers and yes naturopaths educated through distanced learning. And by the way, I'd like to say that I think distance learning is a more respectful term to use than mail order diplomas which is the moniker of choice used by Dr. Labriola yesterday and the three Bastyr students who were here [inaudible]. But lest I digress, please let me make one point very clear, in the entire naturopathic universe naturopathic physicians are the minority.

The distinction between titles and terms becomes very important when considered within the context of licensing and regulatory activity that this commission may be considering. I'm almost out of time so I'll give you my organization's abbreviated recommendations. It invites you to review them in more detail with written testimony that I provide to you.

Recommendation

1) is to please distinguish between the terms, between the fields of traditional naturopathy and naturopathic medicine.

2) is to differentiate between naturopaths and naturopathic physicians, and

3) should the commission concern itself with the matter of regulation an licensing matters, something that I'm not sure is at all advisable or appropriate, I would respectfully ask you to please develop an approach that serves the needs of consumers and practitioners and not one that is exclusionary. Thank you for your time.

The Honorable James Gordon: Thank you very much. Tom, would you like to begin?

The Honorable Tom Chappell: I do have questions, could you come back to me?

The Honorable James Gordon: Sure, of course. [inaudible].

Female Participant: Mr. Goin, thank you actually for some of that clarification. I'm not sure that was clear to all of us. In the state of Washington where there are licensed naturopathic physicians, is that the same for those that you represent or people who have done distance training are they also reimbursed? Are they licensed just as the, for instance, graduates at Bastyr are?

Jeffrey Goin: No, my, Mr. Chairman, commissioner, my constituents are not permitted to practice naturopathy in the state of Washington and as such are not eligible for third party reimbursement.

Female Participant: They're not allowed to, they can practice but they're not reimbursed? Is it legal for them to practice?

Jeffrey Goin: There are, there laws in eleven states, as I'm sure you're aware, as I'm sure you're aware and they differ from state to state. So, I'm not as familiar with the state of Washington as a lot of people in this room are, but a standard naturopathic physician licensing bill precludes non-naturopathic physicians from practicing modalities that are considered to be naturopathy or naturopathic medicine, and likewise are not allowed to refer to themselves as naturopaths, naturopathic practitioners, doctors of naturopathy or naturopathic physicians. So by virtue of the, of the law in Washington as I recollect they are not allowed to offer their services and if they do so, if they hold themselves out to be a naturopath they are subject to, to incarceration and and monetary fine.

Female Participant: Could I have one more?

The Honorable James Gordon: Sure.

Female Participant: Mr. Shepherd, you know one of the collaborations we talk about this so much, the argument that always seems to come up is in western medicine or allopathic medicine more and more research based, evidence based medicine is being required and we're finding many of the things that we do aren't based on good evidence so we're changing things around. And there is the argument that much of what CAM practitioners or naturopathic physicians do is not evidence based. Colonics, hypertherapy, some of the use of botanicals, yeah, yeah, yeah. So there's there's a lot of this. And so it's one of the reasons, excuses whatever that is used to sort of keep this integration and collaboration from occurring. How would you respond to that? If I was like the dean of a medical school and we were talking, how would you respond to that in a way that would maybe help breakdown these barriers?

Tom Shepherd: I think the Bastyr was founded twenty two years ago. It was science based and that was basically the tenet that that draws the research and the education that is going on there today. We do need outcome data. We do need research in a lot of areas in order to show the efficacy of what has been passed on either from generation to generation or word of mouth. If I was speaking to a dean of a medical school I would seek to collaborate from the standpoint of a) they have the infrastructure for doing the research science based and b) we have the education, the knowledge and the client base in order to seek a truly collaborative effort in research. And I think it would benefit both of us to a) understand what's going on and seek a closer relationship and b) to get the research done.

Female Participant: And funding.

Tom Shepherd: And funding, yes.

Female Participant: I'm just delighted with this panel's presentation on the overall vision and philosophy and which we haven't touched very much on. We've been in focus on like therapies and integration of therapies. But so there's a question whether CAM then and I want comments on this. Is CAM to be integrated into a medical model or is it a separate system that's going to be developed, or an integrated model? How do you see this? And how does energy come into this? I don't see energy being expressed in most of the, you know, presentations. And so I'd like to see what your vision or view is on the integration of CAM. Is it a model, a health model is it both or, you know?

Male Participant: I believe we have a system right now of health care which has been very good for the United States which is an interventional type of system. You wait for a symptom, you wait for a disease, you wait for some trauma. And then we intervene. That's very expensive but it's also yielded some very good results over the past century. What we're talking about with CAM though is not the interventional type of system. But what we're talking about is wellness. We're talking about what the HMOs talked about twenty years ago in saying, fund us, help us to get started and we will seek preventative care, and wellness and quality of life versus just interventional care. Well the HMOs basically have gone to the medical model and have not been true to the traditions of what they sold twenty and thirty years ago. And that is a key component of when you're talking about integration.

The practitioners you have heard from over this past day and today are very principled people. They believe in dealing with the whole person--mind, body and spirit. They believe in dealing with the energy of the individual and the body and it's its ability to renew itself. And they will not sell out their principles in order to become mainstream. This is a basic tenet of this heath care system. And this is a tremendous paradigm shift. And this part of the reason why integration has become a problem, because there is a real difference in models there now. Can these two systems collaborate together and become complementary medicine versus alternative medicine? I believe they can. I believe part of the problem with, such as with licensure and credentialing is when a patient has been seeing a CAM provider for a number of year and ends up with something that is drastic and goes into the hospital.

There is no continuum of care. Alternative practitioners are not allowed into the hospital, and I have managed hospitals for twenty-eight years so I know what goes on. They are blocked from entering and there is totally separate system of care that is rendered for a week or two weeks until they come back out and then they're released back to their other provider. And where we're really missing the boat is that continuum of care and the collaboration between these two systems.

Robert Anderson: I think the question is very apropos and I would say that the question of how integrated these systems will become is not so much dependent upon the attitudes and position of the holistic community as it is listening to what the conventional community eventually will do. And as you know the conventional community has an attitude towards a holistic approach, which varies from great resistance to tentative acceptance. And the holistic philosophy at least that espoused by the groups to which with which I've been associated views sort of three areas 1) acute care in which American conventional medicine probably has no peer around the world in a chronic disease which is not well handled by conventional medicine but to which holistic and CAM approaches grant a great deal of [inaudible] answers and finally the preventive or health promotion aspect in which as I stated it earlier it's our intent to help people experience the issue of being full alive.

And so the latter two are the areas in which holistic medicine has much to offer and medical and osteopathic licensed practitioners are imbued with the responsibility of doing their best to integrate both approaches. And it's not that either is bad or good but we wish to take the best from both. And we think that can be done but whether or not this eventually becomes mainstream is not so much dependent upon our viewpoint but how the conventional community eventually decides to respond.

Female Participant: Thank you very much.

The Honorable James Gordon: I just want to say to the commissioners, we're going to have to do one question at a time. So I was, slipping a little bit behind time. The answers are great it has nothing to do with that. So please.

Female Participant: My question is to Dr. Shepherd and is based on the testimony of Mr. Goin. and I'm wondering as we move ahead and design a new paradigm for health care and wellness, do you see naturopaths are licensed in thirteen states I understand, and as licensure goes forward, do you see more of an effort to be inclusionary rather than exclusionary when addressing the naturopathic approach to health?

Tom Shepherd: Yeah, I don't think licensure and credentialing is exclusionary to the standpoint that if someone has a basic educational background and has the experience and the clinical expertise to deal with a number of issues and either diagnosing or treating people that that's exclusionary if you have the credentials to do that. If you do not, if you can't pass say a national test or you can't meet the qualifications of peer review then yes that would be exclusionary. Being in hospitals for twenty-eight years there are levels of expertise within the hospital. An anesthetist is different than an anesthesiologist in their training. An ophthalmologist is different than an optometrist in their training. And there's different levels to be able to differentiate what is their scope of practice and what are they able to do. So if it's exclusionary to the point that someone is not trained or capable of treating a variety of illness or wellness, then yes that would be exclusionary. But my point is it's for a matter of public health and safety that the consumer knows what they're getting when they walk in the door.

The Honorable James Gordon: Got to be very brief. The reason we're having this discussion is because we're already lapsing behind about fifteen minutes. And it's not that the discussions aren't good it's just that it takes time.

Female Participant: Are you suggesting then that bands of competency might be an appropriate approach?

Male Participant: Bands of competency?

Female Participant: You're not familiar with that? Okay.

Female Participant: Really, briefly Dr. Anderson, is were CAM practitioners involved in writing the guidelines for this test in December of 2000?

Robert Anderson: Yes we have had a variety of inputs from from different disciplines.

Male Participant: Dr. Shepherd, first of all thank you for your hospitality last night at Bastyr. We all enjoyed it very much and it was a really lovely experience. I got to meet your, many of your students and it was a real pleasure. I want to ask you about the question of the false dichotomy and not demonizing the other side. And how do we avoid that? Cause I saw at Bastyr last night that you were really trying to reach out and trying to blend the best of science and the best of CAM and trying to create a new synthesis. But you did say in your testimony that there's a whole new paradigm out there. That it's really a paradigm shift, that you're doing something different. There are progressive elements of medicine that embrace patient centered care. There are venues like hospice, palliative care where things that happen there are perceived by what traditional practitioners as being alternative but it's mainstream and they're they're bored [inaudible]. So how do we avoid inculcating in the CAM practitioner a sense that that there really is something unprincipled about traditional medicine and avoid that sort of educational inculcation? When in fact there are pockets of people who share the values that were espoused by your students last night.

Tom Shepherd: Yeah, that's a good question. The, I think that one of my recommendations pointed to the fact of having both graduate and post graduate training be done jointly between CAM practitioners and medical students. Because there is a vast void of ignorance between both parties. And what that leads to is, when you go out in practice and you have not had any collaborative efforts, you will not affiliate with anybody on the outside because of that ignorance and failure to recognize or even have -- I forgot the word I was looking for, but they won't be able to work together collaboratively. If you train together, you'll work together. And, for instance, we have a program we're in the discussion now with Children's Hospital, University of Washington, to have our, their medical students and our medical students, they have to make grand rounds together, take up case studies and then differentiate how each practitioner would deal with that particular disease entity so that there's a knowledge base and a real working relationship that is developed on the front end versus the back end when you're actually out in your practice.

Male Participant: If you could provide to us any examples of structural ways to promote that collaboration, curricula, shared transcript that would be very helpful because we're trying to understand how to bring the two camps together.

Tom Shepherd: We will do that and I think you've seen that we, we really do want to work in an integrated system. Fighting each other is not helping the patients and the families at all.

Male Participant: Dr. Shepherd and Dr. Anderson, I want to explore this term collaboration at a deeper level for my understanding of where you are. I'm assuming that philosophy is driving the differences in the health care total realm. Consumers are making choices about those philosophical orientations. And so when you, when I think as a consumer about the idea of integration, I'm wondering what's been gained for me as a consumer with the word integration. I'm wondering if what we're really talking about a CAM as a free standing and interdependent reality rather than one that is in any way dependent. And so the vision that we are talking about it would help me to understand what your motives are for integration. Are you thinking about the consumer? Do you believe we can integrate two very different orientations? That's all I'm really pressing for what it is, what's the outcome you want to see? I mean obviously equal opportunity to access and licensing and funding and so on, but just how far to you want to push this collaboration and integration?

Tom Shepherd: I do believe that the two systems can work together both interdependently and dependently. I think when you look at the total aspect of the total aspect of health care in the United States where we spend more per capita than any other country in the world and we're ranked thirty seventh in our health indices, that there is a significant problem. And the problem is our total system up until the last ten years at least has been based on an interventional type of system which is expensive and we need to get on the front end of that. The consumer wants to be healthy. The baby boomers like me are reaching out for natural health products, for natural health practitioners. We want to live healthy, we don't want to go through our last stages of our life like our parents did or we have experienced. And so that is where this whole paradigm shift is taking place. And we need to capture that and get on the front end of that or we will lose the initiative. We will lose the point in time that we have to integrate our health care system, both the CAM providers and the allopathic system that we have. And the end result is a better consumer, a better educated consumer, they take more active choice in what they're doing. And lower cost.

The Honorable James Gordon: Thank you. I want to say one more about. Go ahead.

Male Participant: Very briefly, what I see is is a collegial kind of outpatient clinic where eighty percent of chronic disease is cared for in which practitioners of different disciplines are philosophically recognized as equals. And I think it is consumer driven. I think it gives the consumer the choice and I think equal funding for all practitioners involved in such an interdisciplinary clinic is the eventual goal. Thank you.

The Honorable James Gordon: Thank you. I would like to see from each of you actually, you were representing different stages of evolution in a sense, different kinds of practices and different groups of practitioners. So I'd like to see some statement from you if you could provide them, both documentation you already have and any thoughts in writing. Cause I think one of the reasons we've gotten into such a long discussion is cause these are very complex, interesting and fundamental issues that we're talking about here. And so I've been loathed to cut off the time and we have to move ahead.

What would be very helpful to us is for each of you to explore the cutting edge of your evolution as organizations or people representing organizations and some of the most difficult issues that are coming up. So for example, Bob from you I'd be very interested in the whole issue of creating this board. How, what does this mean? How is it going? What does it suggest for the future for physicians? What are the issues with CAM practitioners that have come up from your side?

And Tom, same thing from you, something about where, where you see yourself going. Here's a time when you're on the one hand dealing with more organized courses of medicine and on the other hand you're dealing with community practitioners that Mr. Goin represents. So what are the issues for you?

And Mr. Goin, the same thing. What are the issues? I've worked with traditional healers in many societies who are facing the same kinds of issues. So I'd like, I think you spelled out nicely some of your concerns. I'd also like to see some of the larger, some of the issues and the larger solutions that you think we ought to be paying attention to. How do we work with a group of people who are define themselves as naturopaths and another group that defines themselves as naturopathic physicians? What differences are there? What do you really think about licensure? Cause I understood there's an ambivalence about it. So I'd like to hear both sides from your point.

And if you have, if you'd like to contribute from, you know, your Hellerwork practitioner, you know, you're not a social worker, you're not a psychologist. So from your point of view what insights do you have that you can share with us? Thank you very much all of you. Barbara Mitchell.

Barbara Mitchell, JD, LAc, MAc, Standards Management, Inc.: Good morning. My name is Barbara Mitchell. I'm a licensed acupuncturist and an attorney. I served as the national Certification Commission for Acupuncture and Oriental Medicine chair for eight years. I write the book on state laws as well as for [inaudible] field of acupuncture and oriental medicine. And I chair the [inaudible] Acupuncture and Oriental Medicine Commission that is MDs, PTs, LAcs, etc. that have been meeting across North American for the last six years. One of my jobs for the last nineteen years has been to go out into various states and work for acupuncture licensure, which has been a truly entertaining thing to do. I have the following six recommendations for you.

1) Several CAM professions at this point in time have externally validated standards of certification and accreditation. I believe that if this commission issues a recommendation that states move forward to use these to adopt laws, that this would indeed be a very powerful statement. By externally validated, I mean they are accredited by the U.S. Department of Education. The meet American Psychological testing guidelines. They may have been accredited by the National Organization of Competency Assurance.

2) For those emerging professions that have not developed these standards and there are a slew of them behind us, I strongly recommend that we establish a task force to give them guidance from those of us who have reached this area. They need to know how to develop these standards and they need to know how to develop a flexible model bill so that they can go into states and work with options and ramifications. I have submitted copies that the acupuncture world developed eight years ago. So that if I go in where the MDs are wanting supervisional referral which is guaranteed to tie up access I can counter with as suggestion of prior medical diagnosis within the previous six months. There are ways of working with the constraints of having very few practitioners in a state.

3) The third recommendation is that we get out of the turf discussion and get into a competency discussion. We need meetings of all practitioners, western and all CAM professionals to discuss what it is that can be incorporated into western medicine, what is the curriculum that they need to be able to do this? When they should refer an appropriate title distinction so that the consumers can tell the difference between a DC with a hundred hours and a licensed acupuncturist.

4) The inclusion of CAM practitioners in any discussion regarding botanicals is essential. We are about to lose access to our botanical medicines by licensed providers because western medicine does not understand that the use of a whole herb is different than the active ingredients.

5) That we include CAM in Medicare because I believe that this would open up state licensure, ad the last one is,

6) That we develop a series of continuing education seminars for western medical providers so they begin to understand who we are, what we do, when they can appropriately refer and what they can expect when that happens. We need to start talking about medicine and not about CAM and western medicine. Thank you.

The Honorable James Gordon: Thank you very much. Is Mark Tomski here? Would you come forward if you are? I'm sorry he's what.

Male Participant: [inaudible]

The Honorable James Gordon: Okay, thank you very much. Christa Louise.

Christa Louise, MS, Ph.D., North American Board of Naturopathic Examiners: Hi, commissioners, I'm the Executive Director of NAMNE, the North American Board of Naturopathic Examiners. The demand for CAM is currently being address by three types of practitioners. First of all they're licensed and certified cam practitioners. They're unregulated practitioners and there's an existing medical or allopathic profession.

In regard to the first, licensed practitioners are not universally available as not all states regulate the practices. In regard to the second, unregulated practitioners pose a potential threat to public safety. In regard to the third, not all CAM practices can simply be added to existing allopathic systems because this assumes that the foundation of allopathic medicine is compatible with the underlying CAM philosophy. This is not always the case. CAM modalities can be used allopathically. For example, the use of Hyperaphin as a substitute of Prozac, or they can be used within a system of treatment that is based on a different underlying philosophy.

CAM education, the CAM education that conventional providers receive is often not sufficient for effective and safe practice. Patient outcomes will vary depending on both the qualifications of the practitioner and also on the appropriateness of the modality within the larger treatment philosophy. Because of this variability of practitioner effectiveness credentialing and licensing standards must be specific and consistent so the consumers can evaluate the legitimacy of a practitioner who claims expertise of CAM practices.

Take the case of naturopathic medicine. To become a licensed naturopathic physician an individual must be qualified first by education, and then must pass the naturopathic physician's licensing examinations or the NPLEX. NPLEX was established fourteen years ago to produce national board licensing exams that qualified naturopathic physicians must pass in order to practice in any state that regulates the profession.

The North American Board of Naturopathic Examiners or NABNE was formed because states were not consistent in applying credible criteria for qualifying applicants to take the NPLEX. NABNE ensures uniform standards of qualification and exam administration in order to protect public safety in the eleven states that license naturopathic physicians. In the other thirty-nine states the public has no reference against which to judge the qualification of an individual who calls him or herself a naturopathic physician or a naturopath.

In an uneven regulatory environment there needs to be some means 1) for consumers to evaluate the qualifications of practitioners; 2) for members of the health profession to feel confident referring to them, and 3) for insurance companies to determine which practitioners they should reimburse.

So our recommendations are: 1) for sponsorship of a national conference of CAM practitioners to explore options for levels of national credentialing standards. 2) federal support of these national standards that would give consumers, insurers and other health care professionals a criterion against which they could access a CAM practitioner's legitimacy, and 3) finally support for the development of credible structures such as NABNE and NPLEX for other CAM systems and modalities. Thank you.

The Honorable James Gordon: Thank you very much. Todd Richards.

Todd L. Richards, Ph.D., University of Washington: I'm Todd Richards from the University of Washington and I am a neuroscientist. I do research on neurological disorders such as multiple sclerosis and learning disabilities. We do research on both conventional treatment and alternative treatment. But I have to say at the medical school there, I'm sometimes in a hostile environment trying to test some of these new alternative treatments. But I have been involved in clinical trials for, example, testing magnetic therapy and mind over body medicine and energy medicine. So we've been testing these different treatments. We've been using techniques such as magnetic resonance imaging and we're also interested in developing new diagnostic tools that rely on the subtle energies coming from the subject. So I really believe that the current medical system of their diagnostic ways to figure what illness is needs to be revised. The whole system needs to be revised. We need to look at the more subtle energies to find out the early signs of illness.

But the question that I'd really like to address is how can we move our alternative treatments to mainstream medicine? And since I've been involved in so many clinical trials, I know what the FDA wants to see. If we want to move a alternative treatment to be accepted by the AMA and the FDA it needs to be, there needs to be a trial and there needs to be a proven efficacy of this treatment if it's going to be accepted by the regular medicine. So, as an example, we've used outcome measures in our trials that are very recognized by the medical community. And when we did a trial on multiple sclerosis we were using outcome measures such as a twenty five-foot walking test. And there was a cognitive test. And then there was a hand function test. So we need to prove efficacy using outcome measures that are accepted by the medical community. And I'm open to new outcome measures and I'm very receptive to new kind of outcome measures that involve say spirituality or subtle energies coming from the subject. So my, my main message is that if we want to get to the medical community we need to use recognized outcome measures. Thank you.

The Honorable James Gordon: Thank you very much. Tom do you want to begin?

The Honorable Tom Chappell: Yes, I wonder if you could give us your three recommendations that would provide freedom and equal opportunity for CAM, CAM modalities.

Male Participant: In order to, for CAM modalities, I think that there.

The Honorable Tom Chappell: Or practitioners, medicine, however. How do you in your mind bring the kind of equal opportunity to the CAM orientation that exists presently with the conventional orientation? You've been in clinical trials. You see the orientations. What do we, what are your recommendations of how we bring equal opportunity to CAM?

Todd L. Richards: In order to have equal opportunity you need to be have the same standards that the medical research is expecting. Now it doesn't always need to be expensive. Sometimes some of the tests or the trials they don't need to cost millions of dollars like they do in the pharmaceutical companies. But you do need to use outcome measures that are accepted by the medical community. And some of those can be very simple. Like I was saying like the twenty-five foot walking test. That's very simple, very inexpensive. There's other tests that the physicians can use in their clinical practice either as a sometimes the practitioners can't always use a double blind trial. And I understand that. But they need to establish some sort of outcome measure that they can use and test in a very unbiased way.

Male Participant: Another recommendation?

Todd L. Richards: So the, in order to establish efficacy I think equality means that you need to be on the same footing with the other medical community and you need to have standards in their practice that are up to the same standard as the rest of the medical community.

Male Participant: Thank you.

Female Participant: Thank you for all your testimonies. My question is for Dr. Louise. Yesterday we were told that one of the commissioners asked the question about difficulty of obtaining licensure for naturopaths in some states. And that one of the respondents felt that this may be in part due to those who've gone through distance learning sort of lobbying against. So today that became a little bit more clear as within our own almost group, those who've been to four year training programs and those who've chosen an alternative pathway are now almost battling one another in states which is keeping, which isn't benefiting anybody. And you know I understand the problem because, you know, if my mother was going to see somebody and five different groups had MD behind them. How would she know who had what training. So I think that that's something that needs to be address. How are you, have you thought about how you're going to address that and what sort of collaboration or how can you get that? Because that seems like a very bizarre stumbling block that's preventing you from getting into some states where we sure could use more naturopaths.

Christa Louise: I agree it's not, shouldn't be a turf issue, it should be a qualifications issue. So if you set national standards for levels of credentials, whether you call a naturopathic physician and then somebody else who's got training in natural medicines that kind of thing. I think you need to set some national standards so that people can look at well what is an ND and what is a naturopath and what is somebody who has training in natural methods of healing?

I think it's also important to understand that there is, that naturopathic medicine is talking about a system. It's not just a bunch of modalities stuck together. It's really based on a system and it's important that that be differentiate from somebody who just uses natural methods of healing, so.

Female Participant: From an outsider's point of view I think also one of the difficulties that naturopathic physicians have had is that they have the title doctor and they also go in as primary care acupuncturists and some of the others have not done that and we have not encountered as great a resistance from the western medical community. So there's several pieces to that.

Female Participant: I appreciate your presentations. And Dr. Richards, you specifically mentioned about new diagnostic tools and subtle energy and I think in our CAM this is the dimension that is very important that makes it different from just integrating another modality, you know, into the system. And do you have the diagnostic tools at the university or do you know of diagnostic tools? We certainly would be interested in in that.

Todd L. Richards: We've been testing. We actually have a new detector that's been developed for [inaudible] some of the subtle energies that come from the body. This detector was developed by a company up in Canada called Energy Medicine Developments. And we have been testing this detector on various states and there's a lot more research that needs to be done but we do have this detector that's very scientific and can measure signals coming from the body.

Female Participant: That's one measurement, instrument, instrumentation.

Todd L. Richards: And then another instrumentation we have is using heart rate variability. And it's in some ways it's an old measurement. But the new aspect of measuring heart rate is that there's some subtle autonomic features of the heart rate variability that can be detected that are very sensitive to the state of consciousness of the individual. So that's another very simple inexpensive tool that we've been researching that can be easily applied in the clinic.

Female Participant: What's your attitude towards thermography and like curtionics [inaudible] developed in Russia? Or are you familiar with? [cross-talking]

Todd L. Richards: I'm very familiar with it. I'm very interested in new of these new cameras that can measure the aura. I'm very interested in those and I think that more research needs to be done. We need more funding to test these new kinds of cameras, new scanners. I mean, I want to see new scanners in the clinic that measure either the subtle energies, the aura field, cralian [inaudible] photography. I think they all need to be integrated to measure these, possibly very early signs of illness.

Female Participant: [inaudible] This is what is exciting about energy medicine, getting the early sign. I'd really appreciate if you have more information and can provide us with more information in that aspect.

Todd L. Richards: I can send you more information on this.

Female Participant: Yes, and then I think how to overcome the medical resistance that you speak of.

Todd L. Richards: Right.

Female Participant: That would be very helpful.

Todd L. Richards: Okay, I'll send you some more information.

Female Participant: Thank you.

Male Participant: I have a question for Dr. Barbara Mitchell. And I appreciate the work you have done for nineteen years to set up the standard of acupuncture and also herbal medicine. So you and NCC offering acupuncture certificate and also Chinese herbal certificate. Are they acceptable, totally accepted in all the states or what's going on now?

Barbara Mitchell: Right now, the thirty-nine states plus the district, the NCCOM [inaudible] certification in acupuncture is used in every state except California and Nevada which have developed their own exams and Louisiana which has none. With respect to herbal medicine within the oriental medicine field and frequently we use that to denote acupuncture and Chinese herbalogy from all various traditions, Japan, Korea, Thailand, China, etc. Right now there are five states that require either examination or competency in herbs before you can do it. I believe that two of those use the NCCOM examination and the others do not. One state has said that if you are an acupuncturist and you wish to do herbs, then you must demonstrate competence.

[End of tape.]

Female Participant: Actually, the best model to be used.

The Honorable James Gordon: Thank you.

Male Participant: Dr. Louise, a question. Professions have always been self-regulating and then the right examinations and accreditation's for their practitioners and they say this person is best. What kind of assurances do we need to know about to say that a board exam is legitimate? Because an illegitimate board would confer illegitimacy upon the practitioner who passed it. So, what kind of criteria should we look for as we, the other fields that are downstream that you suggest, very intelligently, we have to help them come aboard, but, what would be the criteria of a legitimate exam? Either one of you.

Dr. Christa Louise: The National Organization of Competency Assurance in Washington, DC is a voluntary organization that has set standards for accredited certification agencies and beyond just healthcare. They look that your eligibility criteria must reflect training. They look for a variety of standards with the examination itself. It should be based on practice and not on academic theory. This should be a competency-based examination. They have a number of standards that the certification agency should be independent from your professional association. Because otherwise you are in danger of getting swayed too much by the professional association. They have standards regarding reporting on the field, what it takes to change eligibility criteria. And, interestingly enough, for some of the discussions that have come earlier, that if there is a route of training outside standard schooling, for example, through apprenticeship, that the certification agency must demonstrate that this is not feasible to use as a route of eligibility before they can eliminate it.

So, for those traditional healers who may have apprenticeship or years of experience, a certification can validly set that as a route of eligibility to sit an examination. So, I can have Noka [sp.] send you all copies of their handbooks. And, I think they actually have done a very good job in setting standards of certification.

Male Participant: Great. Thank you.

Male Participant: Thank you. Thank you all very much.

Female Participant: Okay. We can have the last panel before we break. Lisa Alschuler, Jeff Novack, Sevak Kroesen and Robert Shook.

The Honorable James Gordon: While they are coming up, I want to not a couple of things. These proceedings have been taped and they may be broadcast at a later time. And, also, we will be, we do have transcripts of previous meetings and will have transcript of this meeting on our website. So please keep up with us. And, also, keep communicating with us, both those of you who have had a chance to speak formally, and those of you who haven't. You can send us communication by email. We are very happy to receive it.

One final announcement to, I suppose, prepare for, we are going to be, because of the, sort of, interest, the high interest of the Commissioners in asking questions, we are going to have to take a shorter lunch break. So, the lunch break will only be about 20 minutes. So, we understand that some people may not be back and we don't want to hurry people through their lunch. So, I just wanted to let you know that we will take a shorter lunch break. And that is really in the interest of making sure that we have full time, both for everybody who is on the formal program and for also all the members of the public who have signed up who also want to speak to us. And yet, we do have to be out of here before 3:00. So, we are trying to be flexible within constraints.

First speaker will be Lisa Alschuler.

Lisa Alschuler: Good morning. I am an atroapathic [sp.] physician and I am the Clinic Medical Director at the Bastyr Center for Natural Health, which is our training clinic. I'd like to discuss, this morning, the type of training and training resources which are needed to facilitate appropriate referral and co-management techniques among conventional and CAM providers.

The basis for building successful relationships is the establishment of mutual respect and openness to new ideas. The foundation of a functioning referral network between CAM and conventional medicine providers is a better understanding of each other's language and philosophies. These values and concepts must be integrated into educational training models for all providers. Recognition of areas of mutual interest should be made explicit, while areas of divergent needs and priorities should be acknowledged and engaged constructively.

Research is a top priority. Research is needed to develop clinical guidelines and condition specific care pathways that will assist CAM providers in conveying rationale to conventional providers. We need to initiate pilot projects to study the role of practice guidelines in determining the entry points for referral. We need to gather outcome data on best practices based on tracking patients who have received specific therapies for specific conditions. We need to conduct comparative outcome studies for different CAM approaches, conventional approaches and multi-disciplinary care. And we need to enhance funding on a national, state, local and private sector level for research on CAM clinical efficacy and cost effectiveness.

The training of providers must emphasize several areas. CAM and conventional medical training must stress the development of multidisciplinary integration in the management of specific conditions. CAM and conventional medical training must delineate appropriate criteria for referral and for coordination of care, in order to decrease the redundancy of interventions. Conventional medical training must include discussion of credentialling and care standards for licensed CAM providers, particularly related to scope of practice.

In sum, a foundation of trust and openness will form a collaborative relationship between CAM and conventional providers. This relationship will utilize national and local funding to research CAM, clinical efficacy, cost effectiveness, and referral criteria in order to promote the coordination of care. The training of CAM and conventional providers will promote cross-fertilization and understanding of multidisciplinary care.

And, finally, the promotion of health and well-being of the patient remains the basis of all forms of healthcare.

Thank you.

The Honorable James Gordon: Thank you. Jeff Novack.

Jeff Novack: Good morning. A couple of things I'd like to cover today. First of all, I'm from Bastyr, but I'm a Ph.D., not an ND. And, secondly, I want to pickup on Dr. Shepherd's theme of science-based medicine a little bit. And, I want to talk particularly, today, about drug/herb interactions and training and research that needs to go into this field because I think it is crucially important that so many people are using drugs, so many people are using herbs and there is going to be more interactions. We need to know and we research them in a systematic way. And, that is not being done now.

So, let me give you a little bit of my background first. I am, a have a Ph.D. in pharmacology from the University of Washington School of Medicine. I've done post-doctoral research in immunology and psidacon [sp., sounded like he said si-da-con] signaling in at Fred Hutchinson [sp.]. Cancer Center. I am currently an Associate Professor at Bastyr. And, I've taught courses in drug/herb interactions and pharmacology. I am currently conducting research on Chinese and Western herbs, trying to design an herbal combination for HIV aides and tuberculosis by examining specific psidacons. That is a little bit of my background.

What I am interested in is what can we do to increase the knowledge of drug and herb interactions? What I see out there, unfortunately, is an appalling lack of data in this area. Most of the data is either theoretical and is often contradicted by actual practice. And, the other is anecdotal. That is, negative interactions tend to get reported into the literature.

And so, let me give you an example of that. It is commonly reported that, as long as we are doing St. John's Wort here, it can interact with so-called SSRI's, such as Prozac, Zoloft, Paxil. And, if you examine some of these actual case reports that are in the literature, you see that it turns out that, at least in a couple of these, somebody was using an MAO inhibitor and an SSRI, which are two drugs that should never be used together to begin with anyway, and the herb too. And, of course, what is reported then, is the herb causes interaction. And, so, I find that to be a major problem. And so, one of the solutions I see is, we need specific funding to be earmarked for CAM institutions, people who can look at this. And, it can be done in a collaborative way, but we need specific funding for researchers who are more familiar with herbs. We also need funding for people to look at Chinese herbs and Western herbs together. That has not really been done.

And, also, what I find is, there is a lack of research on the positive interaction between drugs and herbs. What is typically done is the negative interactions are looked at. So, that is the second thing I'd like to point out. And then, finally, we need to take this research and apply it. So, people need training, both CAM providers and medical doctors need more training in what the potential interactions are for safety of the patients.

The Honorable James Gordon: Thank you very much. Sevak Kroesen.

Sevak Kroesen: Good morning. Thank you for the opportunity here to address this Commission. You guys have got an incredible job, a burden here, before you. My comments this morning are directed towards, specifically, towards the question that you asked in your proposal to speak here, is what types of CAM practices and interventions should be reimbursable through federal programs or their healthcare coverage systems.

Wow, I mean, just a big question. And the ones that come to mind here are the practices that have been identified under the CAM guidelines.

Now, CAM is a hot word in some circles, chiropractors, in particular, oh which I am one, do not believe that we practice alternative medicine any more than medical doctors practice alternative chiropractic. So, there are some issues here with words and we can get lost in these words and I think that that's a waste of time and energy. We have a basic understanding, a definition in this direction we should pursue is, looking at all systems of (inaudible) and their efficacy and do they work and how do they work and how are they reimbursed.

Interventions that I feel should be reimbursable are osseous- manipulative therapy, supplements that have been certified to consistency and quality via independent laboratory assays, homeopathy, physical medicine modalities. And, probably, the list could go on and on and on, things that I am not qualified to speak specifically too.

Concerns that I have, concerns involve education to eliminate professional bias. And, education to maintain the highest professional standards utilizing deferential diagnosis. Barbara Mitchell and Dr. Louise, I think, spoke to this very eloquently in pointing out the fact that we need national credentially standards. And, I think, that is in the best interest of the patient. Because the bottom line is, as we have already discussed here, who is this serving? And the needs of the patient must come first. And, one way of doing that is through national credentially and making sure that a practitioner is coming up to at least a certain standard of awareness about a person's health.

Thank you.

In closing, I'd just like to mention that CAM is bastardized when it is formulated within the Cartesian logic model, which is the foundation of conventional medicine. In other words, we are looking at something with a different type of lens. Alternative medicine, for lack of a better phrase at the moment, is exactly that. It is alternative. It is different. There is a difference between treating disease and healthcare. And that needs to be addressed and that is an overwhelming concern for all positions, I'm sure.

Thank you.

The Honorable James Gordon: Thank you very much. Robert Shook.

Robert Shook: Good morning Mr. Chair, members of the Commission. My name is Robert Shook. I am the President of the Northwest Institute of Acupuncture & Oriental Medicine here in Seattle. Our Institute is the oldest and the largest school exclusively devoted to the education training of acupuncture and oriental medicine. We are actually celebrating our 20th anniversary this year. Approximately 20 years ago we graduated six students to the Seattle area. Currently, we are graduating between 60 and 70 students a year. We've had a strong history and tradition and have been able to influence other training programs across the country, stimulated growth of alternative medicine practice at the northwest and nationally. We have a tremendous growth in enrollment, student interest, increasing strong interest by patients.

And, my concern, as a healthcare administrator and academician, is our ability to continue to train practitioners to meet this increasing demand for services. My concern is funding for education and training of future CAM practitioners.

For the last 20 years, I have worked in large healthcare systems, western medicine, multi-hospital systems, managed care systems, and I have spent one year as President in a CAM institution of training, so I am new to this field. And my, I think, awareness and disappointment in moving to this field was the lack of funding. Working in large western hospital systems with interns and residents, there was often, and many times, no lack of funding for medical residents. However, in CAM practitioners, I find that there is a tremendous lack in funding.

Specifically, I'd like for you to look at, in your deliberations, the expansion of the accreditation counsel for graduate medical education. Which is, some of you know, is specifically designed for residency programs, both for inpatient and ambulatory care services. I'd like you to consider expanding that to include training of, in schools, for CAM practitioners.

We have 14 clinics throughout the Seattle area, low-income clinics, that are funded primarily by students. I would like to suggest that this be shifted to a national funding base to include demonstration models to fund low-income clinics that our students can work in these clinics under supervision with licensed practitioners.

So, specific recommendation would be for you to review existing funding opportunities, develop a funding model of medical education, support clinical services and review and develop grant and aid programs for demonstration models, especially in application of clinical services for training and education of CAM practitioners.

Thank you for your time today and thank you for taking your time out of your busy schedules to devote to this important and exciting initiative.

The Honorable James Gordon: Thank you. And thank you all for your specific suggestions. These are, we are writing notes, and these are extremely helpful to us.

Joe, do you want to begin?

The Honorable Joseph Fins: For Dr. Novack, you, sort of, straddled the fence and you lived in both worlds. When you have a publication that you want to get out about a drug/herbal interaction, what journals do you like to publish in and what has been your experience with the traditional journals? How receptive have they been? And, what can we do to promote dialogue with the mainstream medical journal editors to help get words out?

Jeff Novack: If you look at the research that is being published, you will see that a lot of it is on specific constituents. And the way that people are using these herbs is mostly whole herbs. And, while I agree that it is useful to know what the active constituent is for standardization, it is also useful to understand what the whole herb is doing and that is the way it is usually used. The problem is that that is not looked at kindly when you submit something on the whole herb, or herbal combinations. And, in particular, nowadays, for tuberculosis, for aides, we are using four, five different drugs. But if you try to use four or five different herbs in a combination, it is not looked at kindly. It is criticized, you don't know what's in there. There could be interactions. A lot of different things like that. So that is one of the major problems.

And, so, it is difficult to get published in more mainstream journals. Even if you are going after some of the latest psidacons or the newest things that are involved in particular diseases like betachemakinds [sp., sounded like he said, beta-chema-kinds] and aides or anything like that, you still are criticized because you are using multiple herbs. When, in fact, we know, for drugs, that is probably the most effective way of dealing with things at multiple sites.

Male Participant: I have a question for Dr. Robert Shook regarding acupuncture. Your program graduate is the school and this [inaudible] acupuncture has graduated. They got covered by licensed acupuncture in this state, are they covered the same as a physician covered?

Robert Shook: Regarding?

Male Participant: License in acupuncture in this state.

Robert Shook. Yes, the licensed, and what was the question?

Male Participant: The question was whether the insurance cover the service provided by licensed acupuncturists graduated from your school?

Robert Shook: As you know, the state of Washington is pretty progressive in that respect in the licensure. and, included in most of our health plans, if that is your question, specifically.

Male Participant: And you have doctorate degrees also, program, your school?

Robert Shook: We do not have a doctor degree, currently. The Accreditation Commission is currently going through those discussions and, I believe, there will be a couple of schools in the next couple of years that will start offering doctoral programs. Specifically, our school may be interested in the next three or four years. But, I think in the next year or so, we will see some schools offering doctorate programs.

Male Participant: Thank you.

Female Participant: Dr. Kroesen, I'm wondering what the model is at your integrated healthcare center and if any of the services provided require referral within your system?

Sevak S. Kroesen: The model that I utilize in my practice is one that looks at all systems of healthcare, conventional medicine, atroapathy [sp.], chiropractic, acupuncture, nutritional medicine, also known as functional medicine. And, yes, it does require tremendous amount of referral. I worked with medical doctors, acupuncturists, massage therapists, psychotherapists, naturopaths, and, we do a lot of referring back and forth, inter-referral, referral to practitioners that I may not even be familiar with sometimes, if I feel that it is in the best interest of the patient. And, that is a big process in terms of analysis and figuring out what's best for the patient. Sometimes the patient is the best indicator of that. That is a very important part of my practice. Does that answer your question?

Female Participant: Yes. Thank you.

Female Participant: I appreciate your comments and I am directing my question to Jeff Novack. In terms of whole herbs, what is your experience and your concept about isolating factors in herbs? In Chinese medicine we feel that the whole medicine and its environmental relationship has a lot to do with the effectiveness of the herb, and there is a movement on isolating certain factors, just like in medicine. Can you comment on that?

Jeff Novack: Well, I think this is similar to the last question which, basically it is useful to have some constituents for standardization if you know they are the major active components. But, I think most, as you said, most medicines that use herbs tend to use the whole herbs, or, many Chinese medicines tend to use combinations of herbs. And, so, I think we should be doing research on how things are used as opposed to, well, there should both. There should be both constituent and active constituent isolation. I mean, that, and also, but, there should be research on whole herbs and combination of herbs, the way they are used, to test their effectiveness. So, I think both should be done.

Female Participant: Dr. Novack, thrilled with this whole area that you are interested in. I think, you know, with botanical sales down now 38% from last year, industry is falling flat, there has been an 8 to 1 negative media campaign. So, for every one positive report on botanicals there are eight negatives. A lot of articles being written by people who don't know anything about botanicals. And yet, on the other hand, St. John's Wort, and a couple case reports of rejection of heart transplant that was reported through Who [sp.] and now we are having reports on Kava through Upsala [sp.]. You know, the whole thing about botanicals is that they are already out of the barn. You know, a drug has to go through all of these things before it is entered into the market, and then there is post-surveillance. Have you considered working or making a proposal from Bastyr to NCAM, or to be one, because, they just were pointed four sites for botanical medicine. You know, with a proposal to study P450's and effects on, the sub-enzymes and protein displacement pharmaco kinetics, all of these things which, for most botanicals, we have nothing? Have they contacted you?

Jeff Novack: No, they are not out there contacting me. But, yes, we have our own research ideas and things we are working on and we have our research department at Bastyr. We are very interested in research on herbals and botanicals in whole and combinations and we are trying to do that. I think that is true. I agree with what you are saying that there is a lot of negative publicity. That is part of the way things are reported in an anecdotal manner in the research. That is, what gets reported is a single case report of somebody and that is what gets published. What doesn't get published is the 100,000 other people who are using the drug just fine, or the herb just fine.

And, drugs do have their problems. I mean, just because a drug has been tried for four weeks and found safe in the clinical trial, doesn't mean it is safe to use for the rest of a person's life and so that was never tested either. So, I look at things from both sides. There are problems either way. And, the more research we can do, the better. And, we need to do research on the way people are using them now.

Female Participant: Are you looking at foods too, since, I mean, there was a great call in the U.K. to ban St. John's Wort, but I didn't see anybody who wanted to take grapefruit juice off the market?

Jeff Novack: [Laughter] That's a good point.

The Honorable Tom Chappel: Dr. Alschuler, your perspective to the differences in orientation to healthcare, that being research, I'm interested in the pragmatism of being in the trenches of collaborating. I hear you talking about learning one another's vocabularies, aims, goals, philosophy's and develop, a process that is developing mutual respect. Is that what I'm hearing? And, so, out of this practice, different philosophies evolve into a pragmatic mutuality of all being part of the same system and each one just having different ways of contributing?

Lisa Alschuler: I definitely spoke from a futuristic perspective.

The Honorable Tom Chappel: Oh, you did. Okay.

Lisa Alschuler: In a sense. I think, right now, what's happening is parallel medicine so that from the perspective of a patient, and I'll speak from my own experience as an atroapathic [sp.] physician. We see patients and we may refer to a conventional provider or we may get the patient referred to us from the conventional provider. But, essentially, what's happening, is the patient is experiencing therapies from each provider set, from each philosophical set. And, integrating those therapies in their own body and psyche. The providers themselves are not coming from an integrated perspective at the outset. So, I think that, and, actually, that is the first step. I think that parallel medicine is probably okay at this point. I think that as we do that and gain familiarity with one another and the paradigms start to touch in the patient, over time that will actually develop into true integration. And I don't think that is happening in but a very few rare cases.

The Honorable Tom Chappel: Thank you.

The Honorable James Gordon: Thank you. One thing I'd ask the three of you who are involved with clinical programs to do for us, if you would. And, this is raised by the last question that you just asked, Tom, is, if you would give us some criteria, in writing, by which you refer, especially to conventional MD trained physicians, give us a sense of how those decisions are made. And, even, we'll go more into this when we come to our education, specific panel on education, but we'd appreciate your help and others in the audience as well. What kind of training in conventional, medical diagnosis and therapeutics is required by CAM professions and what else do you think should be required? So, any thoughts about that, we would really appreciate, we could use those in preparing for our next sessions.

Male Participant: Jim, can I make an additional request? What do you folks think the traditional medical student should know about CAM in a very, you know, truncated form, just familiarity.

The Honorable James Gordon: Thank you very much. We are going to take a 15 minute break and we'll start then.

[BREAK]

Female Participant: If there are any Commissioners in the hall, could they come back up to the stage. I am going to run and get the rest of them. And, if the rest of you could take your seats and I'll go ahead and call the first panel up. Would Tommy Lewis, Ralph Forquera, Graham Patrick, Wayne Topping come up please? And, also, if Wendy Weber, Heida Brenneke, Paul Reilley and John Daley, please come up also? And, I would ask the Commissioners to come back up to the stage please. I'm going to go run and get the other ones.

The Honorable James Gordon: Thank you very much. The wonders and horrors of modern technology. Okay, first is Tommy Lewis.

Tommy Lewis: Thank you. Mr. Chair, members of the Commission, my name is Tommy Lewis. I am President of Northwest Indian College located in Bellingham, Washington. Northwest Indian College is known as a tribally controlled college, located in the northwest. Our mission is to serve the northwest Indian tribes with higher education opportunities. There are 32 tribally controlled colleges throughout the country and Northwest Indian College is one of them in this region. I am a Navajo tribal member from Arizona. I recently moved to this area to work with the schools. I want to thank you for this opportunity to share with you, today, how the native American educational system approach to teaching and learning lends the best of the new ways with the old ways from my Indian people.

Earth, each place has its own culture, language, food, medicines, lifestyle and ways of transferring the knowledge from the elders to the newest members of the tribe, whether it is in the United States, South America, Australia or Africa or where there are envisionist people. Each place is different and adds to the magnificent diversity of the world's peoples. The Indian way, in each of our different ways, the basic principles of achieving harmony and peace within ourselves and others with the forces of the Earth and all living things, are what guide our daily lives. Our teachings include knowing about four elements of Earth, air, fire, water. As we learn about each, we learn how they relate to each other and how they are balanced. Throughout the circle of life, we are influenced by time, space and direction.

These are the basic elements of our learning. This planet maintains its relationship with the greater universe through forces that are governed by time. The gifts of this Earth, both living and innate, are interrelated, non-changing in mass, but always changing their form with time. The people have special ceremonies throughout the time cycle honoring the daily blessings, the monthly changes and the completion of the annual cycle fulfilling sacred events on the continuum of time. This is what we teach our children. The indigenous people have their stories of how and where they began. Their places of origin are where they must spend their lives. If they go away for a while, they must return. They must take care of their space, their park of Mother Earth.

We are taught that there is sufficient space for everyone and that everyone is responsible for their space. Our spaces are hogonts [sp.], log cabins, teepees and other structures that are adapted to our lands. We have, around our living spaces, fragrant soil of gardens, pure water for growth, cleanse in wind and air and seeds of life. We balance all of these in our time on Earth. We teach our children to honor the different director, for they each guide our life ways. From the east, morning, we receive the praise and the early life. From the south, noon, we receive the praise and warmth. From the west, the twilight, we receive the honor of the closure of the day. And, from the north, we receive wisdom.

There are a lot of ways that the Native American people can contribute to the world's society. We have sacred ceremonies for healing. We have sacred prayers to heal the mind, body, soul and the spirit. These are all a part of our tradition. These are something that we were brought up with from beginning of time. We also have the Native American church, using the peyote sacrament, which is a very powerful ceremony to heal the mind, body, soul and spirit. I believe that western society need to understand these and appreciate the way we do things. And, I'm sure we can make a contribution to the bigger world that we all live in.

Thank you very much.

The Honorable James Gordon: Thank you very much. Ralph Forquera.

Ralph Forquera: Good morning. My name is Ralph Forquera. I am the Executive Director for the Seattle Indian Health Board. It is a community health center located here in Seattle. It serves, primarily urban American Indians, Alaskan natives. My presentation is going to be a little bit different, I think, than most of the other people that have presented here because I wanted to talk a little bit about how we are using traditional Indian medicine within the context of our community health setting.

For many urban American Indians, western medicine might be considered alternative or complementary. The majority of urban Indian people we serve, use some form of traditional medicine. Thus, in recognition of this fact, my agency established, back in 1971, a position that we call our traditional health liaison. Seattle King County has about 250 different Indian tribes represented in our service population. So, the ability to provide a single individual to be able to provide all of the different ceremonies and other healing practices of Indian life would just not be something that would be practical. So the position was created, specifically, to act as a liaison between the Indian community itself that is seeking these services and traditional healers in the area that prefer a particular type of tribally specific interventions.

As a GCHO accredited institution, we also chose to take our traditional health person and treat them as any other healthcare practitioner within the agency. So, therefore, we established a group of local Indian leaders that were recognized in the area who established criteria. And, our traditional health person is both credentialled and privileged by the agency to provide certain ceremonial activities, run [inaudible] to a variety of traditional activities on behalf of the patients that we serve.

In 1994 we also established a family practice physician residency-training program in conjunction with the University of Washington and Providence Hospital. And, through that residency program, we also expose our residents to traditional healers and learning a little bit about traditional medicine. Learning also about how to work with patients themselves and asking questions about traditional medicine. In some situations, actually participating in traditional healing activities when it is appropriate. And, it is not always appropriate so it is important they know when they should be there and when they shouldn't be there.

Thank you.

It is important to note that we don't train traditional health practitioners. We can't. These are people that are sanctioned by the tribes themselves and by the communities themselves, people that have acquired skills over a long period of time. Our real purpose is to try to better integrate an understanding of these two forms of medicine and how they can complement each other and how they can work collaboratively. Traditional health liaison position has been an important piece of our ability to both engage our community, which is very dispersed, very, very difficult to deal with. Engage our community in a way that we can use the western approaches that we think are beneficial and the traditional approaches that we use as a way of trying to address long-term health disparities that exist in our population.

I'm out of time, so, I'll submit some written testimony later that I hope will clarify a little bit more for you the role that we try to incorporate into our agency.

Thank you.

The Honorable James Gordon: Thank you. Graham Patrick. Graham Patrick is not here. Okay. Wayne William Topping.

Wayne William Topping. Mr. Chairman, members of the Commission, I am an instructor in a number of kinesiologies [sp.] [inaudible], bio-kinesiology [sp.], brain gem, and I've established 14 courses under the umbrella, wellness kinesiology and have taught these in 21 countries. I am basically an educator, former geology professor, who got more excited by what was happening in holistic health. Recently, I was appointed by the International Kinesiology College based in Zurich, Switzerland, to become one of three [inaudible] instructor trainers for the United States. So, I am shifting more of my emphasis into the United States. Fortunately, I live close to Seattle. I am in Bellingham, also.

Just by way of background, Dr. George Goodhart [sp.], a chiropractor from Detroit, Michigan, established applied kinesiology in the middle '60's using muscle testing to identify how the body was out of balance. And, using techniques drawing from chiropractic, osteopathy and know knowledge of trans-acupuncture system in order to bring the body back into balance. People that have become applied kinesiologists have a license to diagnose. Most of them are chiropractors, some are naturopaths, some are medical doctors and psychiatrists. However, Dr. John Thie [sp.], a chiropractor from southern California became really intrigued with kinesiology, recognized its value for the lay public and packaged a lot of applied kinesiology under the title of touch for health and has been busy training lots of people. There are many, tens of thousands that's been trained as instructors to go out there and teach touch for health. And, a lot of other kinesiologies have spun-off from this within a holistic paradigm that is from an energy perspective.

Overseas, there has been an evolution occurring. This training has now happening a lot more through schools, a number of which are government approved, in Australia, United Kingdom and Switzerland, among others. A lot of the other countries are developing extensive programs, 600 to 1,500 hours in duration. And, right now, we are the at the very initial stages of setting up a school, a program in the Seattle, Bellevue area through the Bellevue Massage School to start offering America the same opportunity. So we are working an educational, energetic paradigm where the intent is to balance the body to eliminate stress, relieve pain, improve posture, improve athletic and academic performance. We are not interested in having license, degrees to diagnose. I would have become a medical, sorry, a naturopath if I'd wanted to do that, but, we need to carve out a niche in the marketplace where there are people there that can be educational, primarily, oftentimes, one on one.

Double-blind studies really don't apply to what we are doing. Where I see the research going best would be if we could get into the rest homes where you have an older population such as we heard about very eloquently from Sheila yesterday. We have people with 29 different medications. We could go in there with very simple techniques and make a significant difference.

The Honorable James Gordon: Thank you. Thank you all three. And, thank you, particularly, for reminding us of the, sort of, gravity of the Indian way and of the connection between health and the world around us and the spiritual world, as well. It felt very good to have that strong reminder. Thank you.

Tom?

The Honorable Tom Chappell: I'm sorry, I lost your name, but I'd like to address my question -

Everyone: Tommy Lewis.

The Honorable Tom Chappell: Yes, Tommy Lewis. Thank you. In your tradition, do you have people who have specific roles that are practicing the traditions for healing? That is my first question.

Tommy Lewis: Yes, there is. These people are gifted.

The Honorable Tom Chappell: Gifted?

Tommy Lewis: And have the ability to understand the symptoms using various ways to connect with The Great Spirit to diagnose the problem and to find ways the individual can come back into balance and to harmony. An illness, a problem, occurs through the human body when something within the spirit is off balance. So, there could be a ceremony. There could be a prayer. There could be some other thing that is needed. It is not always the aspirin. It is not always the x-ray that helps a person.

The Honorable Tom Chappell: And are these, people who are gifted, economically provided for by your culture for their specific role, or?

Tommy Lewis: No.

The Honorable Tom Chappell: No, they just, people just recognize them and go to them in time of need.

The Honorable Tom Chappell: Good. Thank you. Female Participant: I guess the question is maybe about reimbursement and, sort of, I know that on the Navajo, some of the ceremonies can get quite expensive for the families. And, in a state that is looking at reimbursement for naturopathic medicine and acupuncture, should there be a role, also, for reimbursement of traditional healers that are recognized by their communities? And, that also have to pay electric bills and pay for food if we are covering other types of healing modalities. I'd like to hear from both of you. Has this been addressed in Washington? And, is there reimbursement for traditional healers?

Male Participant: One of the reasons that we decided to credential and privilege our traditional health person was to legitimize them, so to speak. And, Carl has permission now to actually do ceremonial work and other kinds of work in hospitals. And, he is being, we are getting referrals not only from our own providers, but from other providers in the community outside of the Indian community who have worked with us or worked with our traditional person over the years. And, are asking him to come in and do certain kinds of work in hospitals. At this point, we haven't been reimbursed for that. It is kind of a specialist/consultant kind of a position.

Although I had some discussions with Group Health Cooperative a few years ago, there are a couple of physicians that work for Group Health that used to work for us. We train a lot of Group Health doctors. And, we did have some discussions about the possibilities of doing that. I was actually asking them, you know, even if you just paid us $10.00, it is the idea of legitimizing this as a, I mean, if a doctor is making a referral to us, there is obviously some efficacy in what they are asking them to do. So, we were trying to use the methodologies that medicine seems to understand, credentialling, privileging, those kinds of things, defining the position in a way, as a specialist, consultant, that somebody might be able to, be able to get a handle on enough. What they actually do is very difficult to describe because it is so encased in the culture and in the history of the people themselves. It is not just the individual, it is the family and the community that is involved in this.

So, it is hard to describe it in the way like you would a penicillin shot or other kinds of treatments. But, my experience has been, it is as legitimate as anything else. I can't quantify that. But, I've worked in this field for 20 years and I can tell you that people

[END OF SIDE A]

[SIDE B]

Male Participant: In our agency, anyway, when they get a combination of the western medicine and the traditional medicine in combination, they are healthier, they take care of themselves better, they are more engaged. And, I believe that our providers become better providers when they have the exposure to and the opportunity to consult back and forth in the provision of that kind of service.

Female Participant: I've had the great opportunity of working with the North American Indians in Canada and the United States, and exchanging about Chinese medicine and Native American healing. And, you mention that people are born with special skills. Then, in our discussion, and direction to license and credential and also non-Indian, non-Natives, interest in healing, you see some problems with that. Can you speak to some of those problems and what needs to be considered? I know, in the Chinese system, there is a tremendous amount of, acupuncture is easy to see, it is a needle, [inaudible] and all the energy concepts that which you people talk about, can you express some of that?

Male Participant: My feeling is, I don't think it is possible, at this point in time, to credential at a national level, or even at a state level, a traditional health person. I believe that that is really something that the community themselves have to accept. Part of the reason that we are able to establish this position was we had a person who happened to be working for me as a drug and alcohol counselor. Who, I found out, was doing these things after hours and on weekends and was extremely well recognized by the community. I've learned over the years, there is a lot of [inaudible] in this business also. You have to be really careful about who you choose to do these kinds of jobs. So, I spent a great deal of time checking out the credentials of this particular individual.

And, one thing that I've learned, in the Indian world, anyway, Indian healers, true Indian healers, know other Indian healers. It is an unwritten society, so to speak, but it exists. And, in checking out Carl, I found him, all over the country, to be a recognized individual. And so, it was possible to create this particular kind of position. I don't think in other places that is replicable. In our particular situation it has worked and it has worked extremely well for us, I believe. But, I don't, again, what they do is not something that you can quantify well enough, I don't think, to create criterion for some kind of a credentialling procedure.

As Dr. Lewis mentioned, this is really something that people were born with. I mean, they are born with this gift and it is recognized and then they are directed in the direction of the people that mentored them, the rest of their lives. They don't just go to school, learn some skills and then go do this stuff. They are constantly being taught. Our traditional person is constantly involved with his mentors. And so, it's not something that, I don't think, I don't think could be easily transferred into that kind of an agenda.

Tommy Lewis: I would agree. It is a lifelong learning process. And it is all about the mind, body, soul and spirit. There is a [inaudible] that goes with it, a connection with a higher power to deliver the message. The knowledge that is needed to understand what is ailing the person, I think that is a gift that the individual has. And to ask to demonstrate this and see how it is done, I think, from an outsider, it would be very impossible. So, you have to be in tune with the Indian community, with that individual's way of life, in order to make that connection.

Female Participant: I hope you will provide us with some written material so that we can take this into consideration with the work of the Commission. I'd appreciate it. Thanks.

Male Participant: Mr. Forquera and Dr. Lewis, what is the line between religion and CAM? If one is regulation CAM, there are certain prerogatives that a government could have. But, the regulation of religion, of course, would be unconstitutional. So, where do we draw the line? Because a lot of what you are describing has deep spiritual implications. And, we would not want to do anything that would compromise the ability of any group to express their religious beliefs and their heritage.

Ralph Forquera: I don't see traditional Indian medicine as being religious at all. It is spiritual in nature because it is geared, it is based upon a history and culture that's evolved over a period of time, and certain belief systems that have been established. That's different, very different, in my opinion, than religion. So, I don't necessarily see them as being similar at all.

Male Participant: And, is that a view that these people are not seen as spiritual leaders?

Ralph Forquera: They are seen as spiritual leaders, but not as religious l