WHITE HOUSE COMMISSION
COMPLEMENTARY and ALTERNATIVE MEDICINE POLICY
MEETING ON THE ACCESS AND DELIVERY OF
COMPLEMENTARY AND ALTERNATIVE MEDICINE SERVICES
+ + +
+ + +
Monday, December 4, 2000
Hubert H. Humphrey Building, Room 800
200 Independence Avenue, SW
A F T E R N O O N S E S S I O N [1:35 p.m.]
DR. GORDON: This is the section for Public
Comment. We are going to have three panels of four persons
on each panel. I would like the first panel to come
forward. It is Francine Butler, Nancy Dolores Kolenda,
Diana Chambers, and Rustrum Roy.
Oh, we are going to get two panels together. This
is our logistician here. We would like the second panel to
come up. It will make life easier.
David Murray Blalwas, Kathleen Golden, Natalia
Egorov, and David Edgar Molony, please.
What we will do is we will have the first four
speakers and then we will have a time for questions from the
commissioners, and then the next four speakers.
Each speaker in public comment time has three
minutes, and we are going to be ruthless. So, we invite you
to make full use of your three minutes.
First is Francine Butler.
MS. BUTLER: Thank you. Good afternoon, everyone.
On behalf of the members of the Association for Applied
Psychophysiology and Biofeedback, I want to express thanks
to the Commission for inviting us to share some thinking on
access, delivery, training, and credentialing of CAM
I serve as executive director of the Association
representing an organization that is 32 years old, has 1,800
members in several disciplines. We are primarily
psychologists, I would say about 65 percent, physicians, and
nurses each represent 8 percent, social workers, physical
therapists, occupational therapists, dentists, chiropractics
represent another 12 percent, and the balance are students.
Biofeedback is one of the most well-established of
the CAM therapies. The efficacy of biofeedback for the
treatment of specific disorders compares favorably to
traditional medicine. There is a large body of scientific
work demonstrating treatment efficacy and absence of adverse
side effects. Only a month ago, HCFA agreed to recognize
biofeedback for the treatment of incontinence.
Nevertheless, biofeedback is not a household word,
nor is it an accepted word in traditional medical treatment.
The largest problem with access and delivery that patients
confront is denial by third-party payers because biofeedback
is still branded as experimental.
Individuals should not have to be forced to turn
to other procedures with high-risk factors when biofeedback
has virtually no associated risk factors for treatment, nor
should patients who are unable to afford services be
encouraged by physicians or insurance companies to use
medication or therapies that in some cases may be less
effective or simply treat the sympto
We recognize that more research is needed. Like
other CAM treatments, biofeedback has not been provided
adequate clinical research funding to conduct necessary
large-scale clinical outcome studies, so that treatment can
be evaluated as to efficacy and risk, but biofeedback and
other CAM applications should not have to be held to higher
standards than other medical protocols, of bearing the proof
of burden of efficacy either.
Access is more than just finding a practitioner.
It means responsible delivery of, and public access to,
quality information about the conditions for which the
treatment has efficacy.
It implies developing guidelines for good practice
management and delivery of service. It implies developing a
knowledge base and ensuring that practitioners have met at
least minimal criteria to deliver treatment.
I am proud to say that biofeedback has met all of
those criteria. APB, the membership association, has
developed practice guidelines and standards. We have
prepared white papers on efficacy, and we have developed
consumer information brochures.
Most importantly, we recognize the need for
identifying providers, and through the Biofeedback
Certification Institute of America, we developed a procedure
for credentialing practitioners.
Our goal is to see that this credential be the
recognized standard of practice in this field. Hopefully,
we can be a resource to the Commission and to other
colleagues as they develop these areas in their practice.
Despite these efforts, our work is not done, and
we are far from it. With the good officers of the
Commission and the NCCAM, we will have support to complete
the needed clinical research and remove the barriers to
acceptance in the third-party arena. In turn, cost
effective and efficacious biofeedback will contribute to
benefit our citizens' health and welfare.
DR. GORDON: Thank you very much.
Nancy Dolores Kolenda.
MS. KOLENDA: Good afternoon, everyone, and I
thank you for allowing me to be here and express some of my
ideas concerning advancing clinical research. I am the
director of the Center for Frontier Sciences at Temple
University, and in my 13 years there I have seen a real
revolution come about and acceptance of new complementary
and alternative medicine therapies.
The question that I raise today is what can be
done to expand the current research environment, so that
practices and interventions that lie outside conventional
science are adequately and appropriately addressed.
Well, my response to this question is the fact
that it is important that the major medical schools and
research centers throughout the United States have access to
funding to set up models to study various CAM therapies,
such as herbal medicine and homeopathy and acupuncture.
I believe it is important for the NCCAM and the
firms that are related to these various therapies to make
this funding available to these schools and institutions.
The idea that I really see fourth in this is that
when you review the latest figures as to what is being spent
on CAM therapies, you can see that there are firms
benefiting from these investments, and they, in turn, must
be willing to invest in furthering the research on such
I have really seen the importance in it right now
because our major medical schools I may say, speaking from
our own and Temple, are going through critical financial
crises right now in health centers, and I am sure they would
be more open now than ever to incentives to advance the
research in complementary and alternative medicine
therapies, and encourage that we help to find that for them
and make it accessible for them, and stimulate them to do
I thank you.
DR. GORDON: Thank you.
MS. CHAMBERS: Good afternoon. It is good to be
with you again.
Before addressing the issues of access and
delivery, I just want to pick up on the conversation that we
started in October on language and philosophy of healing,
because I have been thinking about it some more, and we have
been discussing it at length with different leaders in the
field what the options might be.
We have thought about matrix medicine or
multidimensional medicine, and all sorts of things, but at
this point, Friends of Health is recommending using the
phrase "whole person healing" as the phrase to best describe
the practices for which we are advocates.
"Whole person" moves us beyond the distinction of
mind and body, and allows for inclusion of the spirit
dimension, and "healing" is preferred over "medicine," the
latter being so associated in many people's minds with drugs
or a pill.
We are concerned to recognize that the practices
for which we advocate have their own long-standing
foundations, and they should not be defined over against
conventional allopathic medicine.
As far as philosophy is concerned, we want to
recognize that in integrative medicine we have the meeting
of two vastly different philosophies, with Western high-tech
medicine focused on fixing, fighting, and curing disease,
while whole person healing practices focus on prevention,
wellness, and health.
Probably the greatest distinguishing factor
between these two philosophies can be found at the point of
death. While Western allopathic medicine treats death as an
event always to be opposed and avoided at all costs, whole
person healing recognizes that death is part of the human
experience, and it is possible, and indeed a part of
healing, to die well.
So, Friends of Health wants to ask the Commission
to include within its work a very careful review of these
issues of language and philosophy, knowing that the ways in
which we name practices define them and affect their very
The language of CAM is clearly limited. Many of
the people testifying in front of this commission have
evidenced their frustration with the language, and these
limitations need to be addressed before the practices that
we care about lose their essential nature because of the
language that we apply to them.
I also want to say a couple words about access and
delivery. Friends of Health has a particular commitment to
the poor and underserved population, so I am delighted to
have an opportunity to say a couple of things for them.
The first question you raised was do patients and
health care providers have ready access to CAM practices and
interventions, and clearly from the perspective of the poor,
the answer is no.
The constituency with which we are concerned is
the poor, both urban and rural, and other than a few notable
exceptions, such as the wellness center at N Street Village
here in D.C., that offers whole person healing practices to
women who are in transition from drug and alcohol abuse and
were formerly homeless, there are almost no targeted
provision of such whole person healing services.
For those without insurance and who cannot afford
to pay out of pocket, there is no access at all to these
practices, and this must be addressed both for issues of
equity and also that this constituency places a significant
burden on the public purse, which could be alleviated
through preventive whole person healing practices. I have
some ideas as to what we might do about that.
DR. GORDON: Thank you.
DR. ROY: Thank you,
I bring a slightly different perspective from most
of our colleagues here, that of a working scientist, a
physical scientist, 50 years on the faculty at Penn State,
25 years directing its major physical science lab, and
deeply in the state about science today from nano stuff to
I am involved in the whole integrative medicine,
friends of whole person healing group through my mentor,
Linus Pauling, to my friendship with Norman Cousins and
Yvonne [Illich] and Chopra, and that is how I have gotten
into it for 25 years.
From that perspective, I am going to respond to
your questions about access. Access for whom? There are
three communities I want to identify, which have not been
touched on much. The first community is the half million
physicians in harness -- I am not talking about new medical
students -- in-harness physicians. Are they being given the
appropriate knowledge about whole person healing?
The second population is academic scientists or
the world of science, research scientists, and the third is
the general attentive public, which, in theory, we call the
The first one, how the present approaches are much
too small. You need real emergency education program for
the in-harness physicians. The consumer public is going to
them, and how are you going to attack him? I work with
Andrew Weil at the University of Arizona. We take four
fellows a year, and now we are doing CME stuff. Maybe we
will get 100, but that is piddling compared to the problem.
So, you have got to think of an emergency, not
making them into alternative providers, but making them into
knowledgeable about and how to guide people.
The second population is the world of science. In
science, we have moved beyond all this pettiness. We are in
a globalized world where we take information from China,
from India, from anywhere. Here, we are stuck in a Western
model. You have to get out of that. This is not the only
source of truth.
So, if the Ayatollah is running around telling
people what science is, and they have had the press up until
now, we really have to change that attitude among the
scientists with information.
We have collected a group of the highest powered
world scientists, and these people will be working now for
the next several years on presenting to show that science in
the best sense is not opposed to alternative medicine at
all. In fact, it may very well be the basis.
To the public I give you an example of a
newspaper, the Pittsburgh Post Gazette, as compared to the
Times or the Post or the Los Angeles Times, does a wonderful
job on educating its citizens in Pittsburgh about the kind
of stuff that alternatives do, a modest, balanced
presentation, so that we don't hear it occasionally as some
funny stuff over here, so we need that.
Now, I have got a recommendation. I worked with
the President. In Reagan's administration, we had zeroing
out of science education. What you need, I think what our
country needs is whole person healing education, a crash
program. The Congress took it from zero to 700 million now,
and we can have a modestly ramped-up science education
program, CAM education program.
DR. GORDON: Thank you.
MS. SCOTT: Thank you all for your presentations.
I was wondering if,
MS. Chambers, you could elaborate on
some of your thinking about access to those communities of
people who typically don't have access, and include some of
your recommendations for how you would make sure that this
population is included.
MS. CHAMBERS: Yes. Thank you. The question that
the Commission had asked was how can access to safe and
effective CAM practices and interventions be improved.
Well, for the poor, the real question is how such practices
can even be introduced, let alone improved.
So, I believe that the first step is to identify
the most prevalent conditions that threaten the health of
the poor, such as obesity, heart disease, diabetes, drug and
alcohol abuse, and determine which whole person healing
practices might be most efficacious, such as acupuncture for
the treatment of recidivism in alcoholics.
Then, given the culture of poverty, which is the
environment of the poor, I believe there must be a
tremendous commitment of quality resources to affect even
One basic step in this direction would be the
expansion of Medicare and Medicaid to cover whole person
healing practices and products with the associated financial
commitment to support this expansion, and then if provision
of whole person healing practices and products for the poor
were taken seriously, not only is the potential for
significant cost savings, and hence broader provision
through the release of resource, but -- I feel very strongly
about this -- is the knowledge that the poor have been
treated and welcomed as whole persons, a dignity that in the
field of health provision, the more privileged have been
able to claim for themselves.
So, for actual delivery to the poor, speaking from
my personal 10-year experience of working with inner city
programs that are concerned with the poor, I can testify to
the obvious, that religious institutions offer by far the
most effective systems for delivery to the poor of
information, encouragement, and group support practices.
These systems have been shown many times over to
be substantially more cost effective than federal and local
government initiatives, so I feel that a coherent strategy
for involving religious institutions in the provision of
whole person healing practices and products should be
DR. GORDON: Effie.
DR. Rustrum Roy, your concepts for the
first two was very interesting. What is your third, the
DR. ROY: The general public?
DR. CHOW: Yes.
DR. ROY: In the National Science Foundation where
we now have $700 million for science education, remember, it
was zero, it is $700 million per year, we do science
literacy. That is at the level of the general public, and
we do also science education for making scientists. Now,
let's address the population of the general public.
We need CAM literacy among the general public. It
is the kind of thing which the League of Women Voters did a
wonderful job in the seventies on educating about the
nuclear threat. It was very balanced, they got the best
advice from DOE, it was earlier in those days, and we can do
the same thing.
We can give balanced education for the general
public. We have an excellent model, and I propose that we
have a joint -- maybe the Public Health Service and NSF
NSF has a lot of experience in doing this kind of
getting science knowledge out to general public, which they
never use, by the way, and we spent $700 million on that,
and we now need CAM knowledge, so they can use it. A lot of
us know that wellness is going to be the most cost
effective. So, I would think that the model that we have is
existing, it is funded, I don't know, a few hundred million
bucks, in the NSF and the federal agency to do exactly what
I am talking about in the area of CAM.
DR. CHOW: If you have the model, is that possible
for you to send it in to us?
DR. ROY: Of course, of course, sure.
DR. CHOW: We would appreciate that.
DR. ROY: I will. Thank you.
DR. GORDON: Charlotte.
DR. LOW DOG:
DR. Roy, thank you for your
presentation, and all of you. I would like you to speak --
you can just go off from here because I know you can say a
bunch of things -- about the new science, the world science,
and the implications for research in alternative medicine.
DR. ROY: Well, it is not really new in a way.
When quantum mechanics was introduced, most of the people
missed the significance of it. You remember that Einstein
opposed it for 27 years. I have quoted him at least 20
times when he opposed quantum mechanics.
But the real implications of quantum mechanics
opened the door for many of the phenomena which we see. I
have come back on the red eye from Honolulu to get here in
time for this, and we had a whole groups of presenters in
Honolulu on this kind of topic about saying what is the
model of science which permits the interaction of humans
with so-called dead matter, and what are the models in which
we can see many of the phenomena manifest in Qigong
practice, that we used to say, well, this is all nonsense
Well, you know, acupuncture was also labeled that
way. Within science, there is nothing to say then. Science
from Aristotle to all the great, we have said, science is
based on fact, not on explanations. The facts are the first
principles of science. I am quoting [Nicho] Mccann Ethics
So, in a very real sense, science permits us to go
where man has never been before, women had never been
before. We can go to some of these new, well-established
scientifically validated and empirical data in China and
India, and so on. We should look at them. We don't stamp
them and say this is okay, but we should look at them.
DR. GORDON: Thank you.
DR. PAZ: This is for Francine Butler. I was
wondering if there is other areas besides the incontinence
issue that biofeedback would be real helpful for.
MS. BUTLER: Yes, indeed, there is a whole panoply
of applications for which biofeedback has been demonstrated
effectively. Just for fun I brought our notebook on white
papers with us, and this is a summary of probably 16
different applications, quick summaries with the kinds of
applications and the data used to support these
DR. GORDON: Buford.
MR. ROLIN: This is for
MS. Chambers. You gave an
example of acupuncture and how it could be used. Are there
models or do you have any data for other models that you may
submit to us?
MS. CHAMBERS: With regard to acupuncture
MR. ROLIN: Right, acupuncture or any of the other
areas that you mentioned.
MS. CHAMBERS: I can certainly get that
acupuncture materials for you. The traditional Acupuncture
Institute has been doing a study at -- I think it is called
Penn North -- Penn North in Baltimore, that has shown a lot
of advantages of the use of acupuncture and a lot of cost
savings, working with the disadvantaged population, so, yes,
we can get that to you.
DR. GORDON: Buford, there are two also at
Hennepin County where Pat Culliton works. They have done
work with alcoholics, and we can ask her for that, and in
New York, Michael Smith will be presenting on work with
addicts, that he really organized.
There are a couple hundred programs now around the
United States based on his original work with addicts, that
I think will be interesting. We can get those, as well.
MR. ROLIN: Thank you.
DR. GORDON: Any other questions?
DR. JONAS: I have an issue with the suggested
approach, Diana, that you had for approaching the whole
person healing. You took really what was a reductionistic
approach to a holistic phenomena by suggesting that we look
at the most common diseases and then see which treatments
would effectively alleviate them.
A whole person approach, in my perspective, would,
in fact, look at chronic disease in general, and look at
ways in which health can be promoted and thus a variety of
conditions alleviated including improvement in function and
this type of thing.
MS. CHAMBERS: Right.
DR. JONAS: It is a little bit difficult to then
conceptualize how to deliver that in a disease-oriented,
trained, reimbursed health care system, so I am just
wondering if you had any thoughts about how that might be
MS. CHAMBERS: I agree with you, Wayne. I think I
went that route because it is such an enormous field and
issue and concern, and to try to break it down and to pick
out a piece that might be doable was why I had gone that
I mean I feel like nutrition is a terribly
important area for the poor and disadvantaged, and if we
could work on nutritional health -- and we were talking a
little bit about that this morning -- that that would have a
massive impact on all these other diseases that we are
And yet I have been then thinking, okay, so how do
we do that. We have got to change the entire culture
because the poor eat at McDonald's, you know, and you are
not going to persuade them to go to Safeway and buy
vegetables, take them home and steam them. It is not going
So, that is why I had focused on a few things, but
I would love to see the nutritional emphasis be a primary
one, because I think it would have such a broad effect on
the whole person healing.
DR. JONAS: So, in that case, not focused on a
particular illness, but as general for health.
MS. CHAMBERS: Well, another way to look at it
would be that those other illnesses would have been affected
by the nutrition.
DR. JONAS: I had one brief question for Nancy
Kolenda. That is, a number of groups are now getting into
this field from the orthodox community, because there has
been some money available.
How can we go about sorting through which ones are
truly going to capture the spirit of whole person health or
how many are looking really at the bottom line, which is
getting redder and redder by the year? Is there a way to
MS. KOLENDA: I think that there is a way to
approach them. I know one thing, at our medical school now
I am getting more questions asked about is there funding for
different therapies. I have two doctors up at our medical
school now that want to set up studies on acupuncture, and I
said, well, you can apply to NCCAM, and they will give you
guidelines on how to file for a grant.
Our medical students particularly, they are hungry
for knowledge. They are upset that we don't have enough
elective courses, and nutrition like is one thing we had a
very big discussion on last month at our school that it is
so important, that they get so little training in this, so I
said that if they would do research on these different
issues and the importance nutrition plays in overall
wellness, I think we will be able to, you know, address
these and get their interest in it.
I know one thing, in fact, even I have talked to
two major representatives from pharmaceutical firms who are
also showing an interest to see what is out there, and the
definition they ask for is what are CAM therapies, and I
tell them what I know from my experience and what I have
read and researched to investigate, but they are interested
there, so I am hoping that funding will come about and see
the importance it will play in overall health and reduce the
cost of health care as a whole.
DR. GORDON: Thank you. We will move on to the
next panel. David Murray Blalwas.
DR. BLALWAS: Thank you. Good afternoon.
My name is David Blalwas. I am a nationally
board-certified licensed acupuncturist practicing in
Maryland. I would like to thank the Commission for this
opportunity to testify.
I am here today representing State Associations of
Licensed Acupuncturists from all across the country. My
testimony concerns two important points.
One. To present the Commission with data
concerning delivery of services and patient satisfaction
from a written survey of acupuncture patients conducted in
the State of Maryland. I have copies of the surveys for the
Commission's full consideration.
Two. In light of this evidence, to convince the
Commission to recommend nationwide outcomes-based research
studies on acupuncture and Oriental medicine as performed by
fully trained licensed acupuncturists, and to have this
research be the foundation for the formal governmental
recognition of acupuncture and Oriental medicine as a
medically effective, separate and distinct system of
medicine in America today.
The survey was created and conducted by
professional medical researchers. The written questionnaire
was designed to provide journal quality outcomes-based
research data on the care provided by fully trained licensed
The researchers received 1,004 completed patient
surveys. To our knowledge, this is the most extensive
acupuncture survey of patient satisfaction conducted in the
nation to date.
Here is a sample of the results from the survey.
When asked to rate the effectiveness of their acupuncture
care, 55 percent reported it very effective for back pain,
49 percent reported it very effective for arthritis, 54
percent reported it very effective for allergies, 68
reported it very effective for stress and tension.
When asked, "With acupuncture, do you think you
have been able to reduce your health care costs," 82 percent
of patients responding said it reduced their visits to
medical doctors, 73 percent said it reduced their use of
prescription drugs, 56 percent said they avoided surgery, 69
percent said it reduced coverage demands from insurance
When asked about a variety of lifestyle outcomes
associated with acupuncture, 56 percent strongly agreed that
it helped them work better, 56 percent strongly agreed they
have less pain, 49 percent strong agreed they were less
susceptible to illness.
When asked, "Who do you consider to be your
primary health care provider," 44 percent of patients said
medical doctor, 39 percent of patients said acupuncturist.
This outcomes-based format we used in this study
makes it possible to capture the full range of health
benefits received by patients of acupuncture. While single
variable double-blind studies can provide data on a single
effect, acupuncture care has long been known to provide
simultaneous multiple physical and emotional healing
We therefore strongly urge the Commission to
recommend that futures studies into the effectiveness of
acupuncture should take this outcome-based form. This
allows for the expression and evaluation of the full range
of health benefits patients receive from acupuncture
Lastly, let me stress that acupuncture and
Oriental medicine is a separate medical system. It is a
form of medicine whose history, philosophical approach, and
treatment techniques are wholly different from allopathic
care. It should not be viewed as simply a pain management
technique that can be incorporated into the Western medicine
system. It is a separate medicine that offers a much needed
complement to the allopathic model.
Simply put, the preventive, restorative, and
health maintenance medicine people receive from acupuncture
care is precisely what is missing from American's health
care system today.
DR. GORDON: Thank you very much.
MS. GOLDEN: Good afternoon and thank you for
having me here today. I am a licensed health care provider
of acupuncture and Oriental medicine in New York State. I
represent the Acupuncture Society of New York, which is a
professional organization representing the interests of the
practitioners and patients of New York.
As our focus today is access and delivery, I would
like to talk about an issue that I think affects access and
delivery for patients. Acupuncture and Oriental medicine is
a rich complex form of health care. I feel strongly that
Americans are obligated to preserve the integrity and
wholeness of the medicine.
It has been an unfortunate pattern in our country
to dilute the traditions of culture to suit an impatient
nation. I do not wish to see acupuncture and Oriental
medicine diluted to serve existing hierarchies of health
care in subsuming this medicine to augment the diminishing
financial returns currently experienced or to boost
professional all-controlling egos.
In this country, the acupuncture and Oriental
medicine profession has established national education
standards. These standards generally require graduation
from an accredited three-year Master's degree program,
passing a national board exam in acupuncture and/or Chinese
herbs, which is administered by an impartial third party,
and clean needle technique.
Completion of these standards enables a provider
to be licensed in their state. In many states, allied
health care providers are able to practice acupuncture with
a minimal amount of training.
For example, in New York, doctors, dentists, and
osteopaths can take a 300-hour training program in
acupuncture and then become certified to practice
In many other states, this is also the case. An
unfortunate consequence of this disparity in education is
that the public consumer is generally unaware of the
differences in education and quality of care that are
It is also true in many states, including New
York, that insurance companies will only cover acupuncture
administered by a certified acupuncturist. That is to say,
the Western doctor with 300 hours of training is eligible to
bill an insurance company for acupuncture services while the
licensed acupuncturist is ineligible. This is where the
issue of insurance parity comes in.
It is absolutely impossible to begin to comprehend
the depth of the scope of acupuncture and Oriental medicine
in a 300-hour course. Yet, in many instances, the patient
with limited financial resources has no option but to accept
treatment from the less educated provider.
This is due to archaic insurance company
reimbursement policies. Parity is not mandate. Mandate
forces an insurance company to cover acupuncture services.
Parity insures that if an insurance company chooses to
provide reimbursement coverage for acupuncture and Oriental
medicine, that all providers legally eligible to provide
that service under the laws of an individual state be
included in the reimbursement of that service. It is also
imperative that all providers be given fair and equitable
financial remuneration for their services.
There are many patients in America who can benefit
from acupuncture and Oriental medicine. It is important
that this medicine be available to all who seek its benefits
and that the patient seeking care under insurance coverage
be in a position to choose who will provide that care.
A patient should not be locked into settling for a
provider with 300 hours of training or less, when a provider
with three years of training is a possibility. It is
unacceptable that due to limited resources and/or limits in
provider entre that Americans be denied choice in deciding
access and delivery as concerns acupuncture and Oriental
I have recommendations and all, so pass this
around to the Commission for supporting materials.
DR. GORDON: Thank you.
DR. EGOROV: Thank you.
Members of the Commission, good afternoon. My
name is Natalia Egorov. I am a Pharm D., a CAM patient, a
CAM provider, student of Oriental medicine, clinical and
consultant pharmacist as a Pharm D., and chair of the
Education and Research Committee and Executive Board Member
of CSOMA which is California State Oriental Medical
My interest is in facilitating infrastructure
development for the appropriate and ethical integration of
CAM and conventional medicine.
As such, I am in a unique position in California
with CSOMA to witness and speculate on the multiple layers
of challenges and opportunities in providing greater access
and delivery of safe and effective CAM in general, and
Oriental medicine specifically, to our patient populations.
Many of these layers are as rich in their need for further
integrated scientific inquiry as inquiry into their
anthropologic humanistic and cultural aspects.
The primary concern of everyone that I have spoken
with, interviewing them in preparation for this testimony is
that these two different paradigms of healing in medicine,
by their very nature, if one is attempted to be integrated
into another, the paradigm is lost, and that is the greatest
concern of all CAM providers that I have spoken with, and
this is the greatest caveat of integrated medicine.
Indeed, I believe one would be courting abject
failure of optimized access and delivery of CAM without also
embracing soft, qualitative, evaluations of real-world CAM
systems of access and delivery, as these tools are also
evidence-based, as basic scientists have expounded on.
An example of this failure to meet the demands and
needs of the People of America for CAM is the current
inadvertent loss of the holistic paradigm through
fragmentation during validation studies and during attempted
integration as with managed care.
It is also clear to me that true, sustained gains
in integrative infrastructure development necessitate a
change in management paradigm similar to TQM and CQI
principles. I would be happy to go into that a bit more.
Being customer-focused, the consumer, and
empowering "front-line process owners," for example,
Oriental medicine practitioners, in a non-threatening,
multidisciplinary learning system nurtures a health care
system where true meeting of the minds, teamwork, and
innovation is powerful enough to overcome the current
unhealthy health system riddled with its ego-based
destructive inertia of turfing and distrust.
It follows, then, that the greatest incentive to
increasing the probability of successful access and delivery
of Oriental medicine, for example, is to include and empower
full-scoped, independently licensed Oriental medicine
practitioners in key processes.
Another is to support a Professional Doctorate in
Oriental medicine, which includes acupuncture. I have
details on how that can be done and what our profession has
done to increase access and delivery in California.
DR. GORDON: David Edgar Molony.
DR. MOLONY: Good afternoon.
My name is David Molony. I am a professional
acupuncturist and the Executive Director of the American
Association of Oriental Medicine. The AAOM was founded in
1981 and is the oldest and largest national organization of
acupuncture and Oriental medicine professionals.
We were instrumental in creating the national
certification and accreditation commissions for acupuncture
and Oriental medicine in the early eighties, and for passing
licensing statutes in many of the 39-plus states where
acupuncture is licensed.
Over one billion people in China have ready access
to surgical and pharmaceutical medicine of European origin,
as well as to acupuncture, herbal, and manual medicine of
The providers of these primary care services
include nearly three-quarters of a million doctors of
conventional medicine and over a half million doctors of
traditional Chinese medicine. These two different systems
of medicine co-exist harmoniously because Chinese citizens
have equal access to, and a basic understanding of, both
Their medical doctors were raised in a country
familiar with its own traditions, and their doctors of
traditional Chinese medicine have training that is an
evolving system of medicine that is balanced with a year or
more of conventional diagnostic and therapeutic principles
Both professions are thus reasonably well prepared
to help patients make informed decisions about their health
care options. We highly recommend looking at the Chinese
model for the harmonious co-existence of traditional and
modern, CAM and non-CAM therapies and professions.
The AAOM supports similar direct access to
Oriental medicine professionals in this country who are well
trained and licensed as primary health care providers, as
professional acupuncturists are in a growing number of
We also support direct access to Oriental bodywork
therapists, whose standards of practice leave little
potential for confusion of their services as a substitute
for comprehensive medical diagnosis and treatment. This
could also expand into other aspects, as well.
We suggest the Commission can reduce the cost of
health care on a national level by recommending direct
access to qualified Oriental medicine professionals through
federal programs and by suggesting to State Governors and
Secretaries of State on its use in public benefit programs,
such as Worker's Compensation and Medicare, as well as
private clinics, hospitals, and through state regulated
Oriental medicine has historically had a strong
tradition of preventative wellness and self-care, and we are
taught to serve as "guides" or "navigators." We communicate
from a functional and energetic perspective, as well as from
the conventional mechanical and biochemical perspective.
We have found that open and direct communication
increases patients' confidence in our care, improves patient
compliance, empowers patients to take more responsibility
for their own health, speeds recovery, and often reduces the
need for access to costly and possibly more dangerous
If prevention is to be recognized for its cost
savings, and its more obvious health benefits, then Oriental
medicine has a lot to offer.
Unfortunately, our profession faces constant
interference with patient access to our services from the
existing medical establishment, and we are asking for your
help to alleviate the situation.
I would like to thank the Commission for your
efforts to improve health care in America and to integrate
old traditions and modern innovations to create a new
medicine for the new millennium.
DR. GORDON: Thank you.
So, we have some time for questions from the
Tieraona, Ming, George, David. We will just come
around like this.
DR. LOW DOG: I like the whole concept in China
where traditional Chinese practitioner and also medical
doctors, they spend time actually learning from each other,
so that there is an understanding and there is less
animosity then, but would you agree that in some ways it is
more difficult here because there, they are not studying
homeopathy, anthroposophical medicine, Reiki, polarity, and
massage therapy, Western herbal medicine, Ayurvedic
medicine, biofeedback -- do you see what I am saying? Here,
because this country has so many modalities, not to even
discuss the [quidendesmo] or the traditional healing
practices of all the indigenous populations of this country.
It is just this vast, vast pool of healing
modalities that makes, I think, it more difficult in some
ways in this country, because it wasn't just one tradition
that we are asking people to look at, it is many, as has
been represented by so many people.
I guess my question is how do you think we can
best help fix this problem between Western physicians and
CAM therapists when it is so vast and it is so big, and the
paradigms are so at odds with one another often?
DR. MOLONY: I imagine you are asking me. I think
it has a lot to do with patient education more than anything
else and patient choice, because I do think that if the
patients are educated as to their choices, the people who
are familiar with the [Kodenderos] will choose the
[Kodenderos], and as long as those particular people have an
awareness of their limitations, which I think is an
important aspect of any CAM therapy, and should be in the
education of any CAM therapy, that that would be able to
expand in that way, but it all starts with people education
and making it so that they are aware of their choices in the
I mean you ask almost any patient before they are
exposed to acupuncture, which luckily for us is one of the
first alternative things people choose because of the pain
aspect of it, and they are totally unfamiliar with any
aspect of CAM, and also they believe they worship at the
altar of God of Science.
We have to recognize that science is not a god,
and science, although we need to look at fact, doesn't have
truth with a capital T.
DR. LOW DOG: So, basically, not to focus on
education of physicians, which is what I thought at the
beginning was about trying to cross, almost cross-training,
but your recommendation is primarily to education of
consumers, so that consumers can make educated choices,
which then comes to access, that any practitioner should be
available to provide any type of therapy?
DR. MOLONY: It is difficult for practitioners to
recognize their limitations especially in the Western
medical conundrum that they are stuck in, and I think that
it is important that we all recognize our limitations, and
that there is just so much information out there that we
have to really work at grasping where we stand with what we
are working with.
I worship conventional medicine, like I was a
month premature, and I am really happy I am alive, but I
think that the understanding has to work on understanding
limitations, as well as patient education I guess would it
DR. GORDON: One thing I want to remind everybody
is we only have a very few minutes for questions, so if we
are going to get the most questions from the most people, we
have to move it along, questions should be brief, and
answers as brief as possible.
DR. BLALWAS: I just wanted to add one thing to
David's statement, and I think it has to do with education
of consumers, but also education of medical professionals in
the sense of establishing a certain degree of equality for
people from CAM modalities who are licensed and fully
trained to be able to perform those services and to really
complement each other in terms of taking the strength of one
particular medicine and applying that to another medicine
which may not have that particular strength.
In the case of acupuncture and Western medicine,
the sort of preventive/restorative maintenance benefits that
acupuncture has been shown to have for 3,000 years,
combining that with the acute care and trauma specialties
that Western medicine does so well, really provides an
environment that serves the patients equally well, but I
think the lack of sort of the barriers and the turf battles
that have existed in this country so far are keeping that
education exchange from happening.
DR. GORDON: Ming, I think you are next in line.
DR. TIAN: The question is, what is Oriental
medicine, the definition, and if you can make a definition
because they are talking about acupuncture, which as I
understand we need a national standard for, non-physician
acupuncture plus the training requirements, and also it is
what is Oriental medical doctors, what is qualification for
that, what is training program, because the issue I brought
up this morning is we have so many herbal remedies or herbal
medicine we are using for medical professionals, do patients
need to ask Oriental medical doctors or medical
professionals who have the knowledge to instruct patients to
use that, because they have no idea which works and how
much, what is dosage.
DR. BLALWAS: Well, it is funny that you ask this
question. This is a question that is a very hot topic among
the acupuncture and Asian medicine community right now.
Several weeks ago, there was a task force convened by the
National Commission for the Certification of Acupuncturists
in Oriental medicine, and they brought a group of us
together from the world of acupuncture, from the world of
herbs, from the world of Qigong, Tai Chi, Asian bodywork,
and a number of other disciplines to actually try to began
to tackle this issue of what is Oriental medicine.
We weren't able to do that, not in that one
setting, but because of the wide range and diversity of what
is being called Oriental medicine now, this particular
organization felt it was necessary in order to address this
question now to serve the American public in terms of them
knowing which practitioners are qualified and who they are
DR. MOLONY: Simply put, Oriental medicine is a
way of looking at health and healing in the human body, and
it needs definition, a succinct definition within our
community, but at the same time, as opposed to conventional
medicine, it is a different field of medicine.
DR. GORDON: George.
DR. BERNIER: A question for
DR. Molony. It is
really great to hear that the Western and Oriental medicines
and disciplines have lived in such great harmony. Has it
been a coexistence status totally or has there been
intermingling of modalities with time?
DR. MOLONY: Well, as with any group of people,
there is always ego battles, but in traditional Chinese
medicine hospitals, one has access to conventional medicine,
testing processes. There is referral out to the
conventional medicine if indicated.
Conventional medicine hospitals also refer to in-
patient Chinese medicine hospitals and also usually have
outpatient acupuncture and herbal medicine programs in their
DR. BERNIER: So, you wouldn't be seeing people
who were sort of certified in both areas.
DR. MOLONY: Well, there always are people
certified in both areas either due to interest or to an
illness or to other reasons. I think
DR. Xiao Ming Tian is
certified in both.
DR. GORDON: David.
DR. BRESLER: This is for Kathleen Golden. Over
the years, traditional Chinese medical practitioners have an
abhorrence for what they call cookbook acupuncture. Yet, we
are here to talk about access and delivery.
For about 30 years I have been teaching anesthesia
residents at UCLA how to suppress the gag reflex just by
putting pressure on the large intestine 4 point. It works
better than 30 milligrams of diazepam. It is strictly a
cookbook approach, but I would much rather have them, if
they are having trouble intubating a patient, use a little
acupuncture than push more medications.
Do the acupuncturists see the possibility of there
being a level of acupuncture that is not TCM, that can
increase access and delivery, that we could train American
physicians to do?
MS. GOLDEN: Well, I do see that that is very
relevant and very helpful. I think my suggestion was that
in that setting, you wouldn't bring in a licensed
acupuncturist just to do large intestine 4, but what my fear
is that there will be this subsuming of our profession and
that that will become the only way that, for example, the
low income patients that we are talking about receive
acupuncture is with cookbook acupuncture.
I see that happening a lot and, you know, for me
in New York recently, the issue of podiatrists wanting to be
certified, so that they could, quote, unquote, "treat
bunions," a similar type of a situation, and I do have a
problem with that, because I do believe that the patient
population that they were talking mostly about, for example,
were the elderly, saying they could bring them in and just
treat those bunions, and our way of looking at it is if we
are going to have access to the elderly population and treat
them for their bunions, bunions is not just bunions in
Oriental medicine, which I use that term very broadly, we
are struggling with it in our profession, but it is an
umbrella term to discuss what we do.
We could work on the deeper issues that brought
about the bunions in the first place, and I think that that
is more relevant to access and delivery, to treat the whole
patient rather than just the bunion.
So, to get back to your idea of large intestine 4
in the operating room, I think that we would be willing to
work with the operating room staff and to work something
like that out.
I mean, for example, you said that Mike Smith is
going to testify in New York, and in New York, what we have
is people that just do the 5 needle protocol. That has
worked out very well for us, I believe, in my state, because
if you go to school for three years, you don't necessarily
want to just be doing those 5 needles all the time, but in
terms of access and delivery to that patient population
which needs it, which I have done a lot of that supervision,
it has been very, very helpful so I could see that model
working in the operating room in terms of large intestine 4.
So, I think if we had communication and we agreed,
okay, this is the setting where --
DR. GORDON: Excuse me, I am going to interrupt
because we really need to move along.
MS. GOLDEN: Sure, okay. I hope I answered your
question to a certain extent.
DR. MOLONY: I just wanted to mention that as long
as there is ethics involved, and the development of ethical
standards when people go outside of their scope, that's all.
MR. CHAPPELL: Kathleen Golden, please. Is the
vision for acupuncture in Oriental medicine to be kept away
from integrated systems, a stand-alone, or would you see
this still as a healing --
MS. GOLDEN: I do think that the idea of
integration is very relevant. I do think that, as David
pointed out, you know, we each have something very special
to offer to the health of the American public, and what I am
concerned with is what I have seen happening is sort of this
subsuming of our medicine, and it just becoming large
intestine 4, liver 3, when there is this rich complex
philosophy behind it.
I do think that the way that our country can most
benefit is to keep the paradigm special and for us to be
able to do our work and for Western medicine to be able, as
both Davids said, acute medicine, Western medicine excels at
that, and certainly for all of my patients, I feel that they
need to have their yearly checkups and if I can't see into
the body that diagnostic tests -- if we work together, see,
my issue is we are not quite working together right now, and
I would like to see us have more dialogue and more flow for
the benefit of our patients.
DR. GORDON: Effie. Again, time is of the
essence. We are already about 10 or 15 minutes behind.
DR. CHOW: Thank you very much, my associates. I
really appreciate it. There is sort of a gradation of the
large intestine 4, and then the whole cultural
identification, everything is valuable.
Are any of your organizations in particular,
David, is there any outstanding models that you know of now
in China -- I mean there is better ones and there is not so
good ones -- and also here in the United States, are you
aware of or can you get models to us that you can deliver to
us for using it as a model?
DR. MOLONY: Models for?
DR. CHOW: For integration.
DR. EGOROV: In California, I have come across
numerous groups of multidisciplinary CAM providers. A lot
of them are licensed health care professionals who also do
CAM mixed with straight CAM, we may call it, and I have been
very curious myself as to where is their portal of entry for
these patients, how do they do differential diagnosis as a
group, and do a care plan, and how does it work exactly.
So, I could provide you with some examples that I
have come across and within the structure that I work myself
as a CAM provider.
DR. CHOW: Those are the individual ones. What
DR. MOLONY: I will work with Natalie and get
DR. CHOW: Great. That is terrific. I think that
is really important.
MS. GOLDEN: Can I say something? I do work in an
AIDS day treatment program, and we have a wonderful
integrative model where we have Western medical staff, as
well as "holistic" medicine staff, and the way that we work
is that we communicate with each other all the time about
what is happening with the patients, and so that model, I
think, is very effective. I could get that model to you, as
DR. GORDON: That would be very helpful.
DR. CHOW: That would be great.
DR. JONAS: I have a question really for the panel
as a whole. In terms of the basis upon which access should
be delivered, I think, Kathleen Golden, you mentioned
insurance parity, and I think eventually it does come down
to who is going to pay in order to get access.
My question for the panel is what would you
recommend to be the basis for that insurance parity? For
example, should it be state licensing in which case then the
competition for the various types of professional
practitioners with each of the state legislatures becomes
the main focus, should it be outcomes research, such as what
was described in terms of patient satisfaction, in which
case probably the majority of CAM practitioners could
demonstrate that the majority of patients are satisfied with
their care, or should it be other types of approaches, any
suggestions or comments?
DR. MOLONY: I know in Australia, they did a study
and they found that as far as safety and efficacy, the more
training somebody received, the better the patient, the more
safe the patient was and the more effective their treatment,
and that is essentially a given.
I imagine there is a certain plateau at which you
reach, that continued training doesn't really -- it starts
to get more incremental, but --
DR. JONAS: So, should the basis be on the ability
to be trained or to demonstrate that the training is
effective, and if so, which way?
DR. MOLONY: I would imagine the development of
certification programs developed through psychometrics.
DR. JONAS: So, you would offer training then,
training and licensing should be the basis?
DR. MOLONY: Some CAM things don't require quite
the intensive training as maybe Oriental medicine does.
DR. JONAS: We have heard in the research panel,
for example, a number of suggestions along the lines of what
DR. Blalwas suggested, that we should do more outcomes-based
research, look at what practitioners' patients are, what
kind of benefit they are getting and how satisfied they are.
Is this the appropriate basis you think for
reimbursement or for insurance parity?
MS. BUTLER: Within biofeedback, we have taken the
route that certification is the pathway to go on, and that
came about for a number of reasons over a number of years.
Because it is a multidisciplinary organization and
people who use this methodology come from medicine,
occupational therapy, PT, et cetera, they have their own
licensing requirements, and to ask a physician to go get
another license in biofeedback or a psychologist to be
licensed in biofeedback, it just made no sense.
But certification is even across the board, and it
asks the candidate to demonstrate knowledge in that field
over a course of education and training and supervised
practice and examination. That evens the playing field.
There are probably other models.
DR. MOLONY: It also depends on if you are talking
sickness or wellness.
DR. BLALWAS: I actually think it is both. I
think the two points you make need to be complementary, to
coin a phrase, in gaining this access, because the first
thing is to quantify through this kind of research that the
medicine works for a variety of different health care
issues, and then make sure that the people who will be
delivering those services are fully trained enough to be
able to provide those services to patients.
DR. JONAS: Actually, I am suggesting that that
type of research is not going to advance us in terms of
being able to demonstrate, because all of the professions
will be able to demonstrate that they are effective and that
patients are satisfied.
However, you have helped, I think, a lot in terms
of what this commission needs in terms of training. We can
certainly address issues of training and this type of thing
whereas, we cannot address issues necessarily about a
licensing, which is a state-based thing, but as a federal
commission we could suggest some types of national standard
of training that then the states could use if they wished to
make decisions about licensing.
MS. GOLDEN: For our particular profession, those
are in place.
DR. JONAS: I understand.
MS. GOLDEN: So, that is sort of what I was
talking about, to base it on those standards.
DR. GORDON: We are going to have to end this
panel. Obviously, we are all very engaged. That's the good
news. Thank you very much. We really appreciate your
input. We may well be coming back to you to talk with you
about education and licensing, and those other issues that
Thank you very much.
Public Comment [Continued]
DR. GORDON: The next panel is Elaine Marie
Wallzer, Bhavna P. Bhut, Bruce Dooley, and Salvatore
Are the other panelists here?
DR. GORDON: Let's begin with Bruce Dooley.
DR. DOOLEY: Hi. I am Bruce Dooley. I am an M.D.
from a warm state south of here, whose name I was told not
to mention in Washington.
I am here to discuss a little bit something on a
different note. I have been involved with some issues that
have been involved with some CAM physicians being brought
before their medical boards across the United States and
somewhat brutalized in a disciplinary fashion.
I went to search for this because, of course, this
involves our livelihood, every M.D. and DO practicing has
over their head of their license being pulled by the Medical
I am here to tell you today that my investigations
revealed that there is an organization called the Federation
of State Medical Boards, which I think you need to be aware
This is a federation, it is a private corporation,
private organization, formed in 1912, an interesting time.
That is when Rockefeller got into the pharmaceutical
industry. It is when the Flexner Report came out, and that
is when the AMA's Quackery Committee went underground.
The Federation, as they call it, develops policy
at their annual meetings, which is then handed down to the
state medical boards to be enacted in their own states.
An example of this is the Special Committee's
report, which you have been given, or summary of them, on
Questionable and Deceptive Health Care Practices. This is a
blueprint for state medical boards to basically identify and
then crack down on complementary and alternative physicians
in their state. This is definitely a disincentive for other
physicians to enter this field, and therefore limiting
access to patients of these people.
They delineated in their definition we can't
decide whether it is complementary alternative medicine, so
we are going to decide to call it questionable medicine.
They also told the states to coordinate and collaborate with
the FTC, the FDA, HCFA, U.S. Postal, AMA, and many other
federal and state agencies to get their physicians.
They changed the definition of "harm" in 1996,
interesting. The mandate of the state medical boards is to
protect the public from harm. They added on, not just
"physical harm," but "economic harm" and "indirect harm,"
economic harm if the patients lost money on the procedure,
and indirect harm if they failed to go seek appropriate
They also controlled the testing of the national
medical boards and the FLEX exams and the PLAS. They
instruct the state medical boards -- and I was there and
heard this -- to resist state and national legislative
efforts to pass freedom of medical access bills. They are
actively lobbying against freedom of access medical bills
both on a national and on the state level.
They also maintain a physician data bank, which is
the disciplinary marks are never expunged once a physician
is given a disciplinary mark.
In summary, the Federation of the State Medical
Boards, one, develops strategies to curtail the expansion of
CAM, two, it lobbies federal agencies, state medical boards,
and legislatures on the implementation of these strategies,
and, three, indirectly and powerfully influences the course
the content of all new physician training via the medical
These anti-CAM activities and bias of the
Federation of State Medical Boards, only a fraction of which
are represented here, I believe warrant further
investigation by this commission.
Clearly, it is troublesome that a private
corporation should wield such influence on the members of
state medical boards and the physicians' means of
DR. GORDON: Thank you.
DR. D'ONOFRIO: Good afternoon and may God
continue to shed the grace of his light upon these
My name is
DR. Salvatore Anthony D'Onofrio. I am
not a medical doctor, I am a nutrapathic doctor and a Doctor
of Divinity. I am in service to humanity through natural
health principles in the name of God Almighty for the last
I do not practice disease symptom supplementology.
Please do not include natural health practitioners in
alternative or complementary medicine.
Commissioners, there is nothing alternative or
complementary to allopathic medicine about natural health
principles. God has created and given us a maintenance
responsive unit. Natural health principles are the primary
methods of maintenance through spiritual, mental, emotional,
and physical modalities since time immemorial.
Individually determined amounts of clean air,
water, and food have been the basis of natural health
principles since creation. The truth is the alternative or
complement to natural health practices is allopathic
I believe that natural health principles is a God-
given right, protected by the Constitution. It is not a
crime. I believe that the best way for medical doctors to
truly study natural health principles is to legally allow
doctors to practice natural health principles without attack
from misinformed medical boards.
Because people get well from what we do, medical
boards assume we practice medicine. We do not practice
There is a type of bill from Minnesota that would,
if we drafted it to include medical doctors, would allow
medical doctors to practice and learn and experientially
report from clinics on natural health principles in outcome
studies that medical science could accept.
I believe that doctors should do an internship
under a qualified naturopath from one of the state
accredited four-year colleges like Bastyr before practicing,
as I had to do.
You know, we each all have our own values, and we
should honor them through intelligent understanding. This
medical bill from Minnesota would be a real good model to
allow doctors to practice and experientially learn what we
You see, natural health practices is not
alternative medicine, and it is not a crime, yet we are
attacked all the time. We need to have God bless us with
understanding and cooperation through education.
We have natural health principles. You take a
couple of things like vitamin therapy out of it, and apply
it to a disease, that is alternative medicine, or you use a
drug, and that is allopathic medicine. So, we have three
different modalities. Keep them separate, educate ourselves
about them, and then integrate them.
DR. GORDON: Are there questions from the
DR. JONAS: So, you would suggest no licensing
DR. D'ONOFRIO: Well, I would suggest
accreditations first, and then licensing maybe by words that
know about what we do, definitely not licensing from a
medical board, because we don't practice medicine.
DR. GORDON: Yes.
DR. LOW DOG: What I am understanding you to say
is -- and I think that many of us sort of are talking around
it -- is that the fundamentals of health, I am not sure have
to be given by a licensed practitioner, they should start
when our children are very small, about how do you eat
properly, how do you handle your anger and your stress, how
do you move in ways that make you feel good, and those are
the things that would probably keep all of our patients out
of all of our offices, that those are the fundamentals of
health and that everything else besides that is actually
practicing medicine, however health oriented it is.
DR. D'ONOFRIO: Yes. And we need medicine. I
mean I am the first person to -- I refer people to medical
doctors every day. They refer people to me. I tell people
if you get your finger cut off, you don't want to see a
chiropractor or be popping pills, you want a surgeon.
If you have raging septicemia, you go get some
antibiotics, but as you were saying, as we teach our
children, a doctor means teacher, I teach natural health
principles to build health, not to fight disease.
It is like putting, in my mind, putting a fire out
with gasoline. I try not to focus on that. We teach them
to focus on health.
DR. GORDON: Any other questions?
DR. GORDON: I have one for
Winn appeared before the commission the last time we had
hearings, and he said very clearly to us that he was
interested in not only working with CAM research, but in
helping CAM researchers to develop IRBs, and I believe that
one of the areas he mentioned they had a particular interest
in working collaboratively with was the area of chelation.
So, I am wondering whether your information is up
to date. Have you talked with him recently?
DR. DOOLEY: I went to the April meeting, their
last annual meeting, and I can tell you just an example.
Larry Dixon, who is on Winn's advisory board, was a past
board member of the FSMB. The Senator from Alabama is
Executive Director of the Board of Medical Examiners, and he
was one of the speakers.
Here is what he said. "About the chelationists,
is there a Board present that has successfully prosecuted a
chelationist, revoked a license and made it stick? We find
that very difficult. We got the major chelationist in our
state but only when he branched out into other forms of
So, everywhere I was going --
DR. GORDON: But I wonder if perhaps you might
contact -- I am just curious about this -- you might contact
DR. Winn and perhaps indicate that you appeared here and
talked with us, and that we said to you that he had appeared
and that he was quite interested in working collaboratively.
I wonder if you would consider pursuing that as a way of
DR. DOOLEY: Sure, I would, but as I mentioned, I
was on the board of ACAM when our president, then Terry
Chappell, sent 23 letters to Winn, requesting ACAM, a 25-
year-old organization, you can't get older than that, and he
rejected every one.
DR. GORDON: We will be happy to supply you with
DR. Winn's testimony, and we will be interested to hear how
DR. DOOLEY: I would love to work with him if he
seriously means that.
DR. D'ONOFRIO: A point on chelation. I was just
at the California Medical Association's study on alternative
health, and they refused to study chelation therapy because
it is considered by them to be quackery because of one
anecdotal incident, a friend of the chairman of the board
was harmed by an improper application of chelation therapy.
So, what he is talking about is rampant. We need
to avoid these people.
DR. GORDON: My comments don't reflect on the
truth of what he is saying. I believe what he is saying.
Also, our hope is that things are changing and perhaps
changing significantly, and what we heard from
DR. Winn was
pretty clear, I think, about beginning to reach out and to
say we are going to do things differently.
We will be happy to give you both copies of his
testimony, and we hope that things can move ahead.
DR. DOOLEY: Great.
DR. D'ONOFRIO: Thank you.
DR. DOOLEY: I do have one thing to say, though,
that, you know, in a disease care industry, which is a
trillion dollar, quote, unquote, disease care industry, with
the major players being the hospitals and the pharmaceutical
cartel, if you will, all of that money comes through
disease, and it seems like if there is going to be any kind
of sense of fighting a single spot, laser focus would be the
M.D.'s and the DO's who actually write the prescriptions and
therefore are the source of their funding.
DR. GORDON: Thank you very much. Please keep us
posted. We are going to keep a five-minute break and the
next panel will then come up.
Session III: Use of CAM for Selected Health Conditions
DR. GORDON: Some of the people on this panel are
very good friends of mine, so I am very happy to welcome
them, as well as to welcome those I am just meeting.
This is a panel on the Use of CAM for Selected
Health Conditions. We have people who are offering services
and people who are receiving them, and people who are both
offering and receiving.
We will begin with Addiction and HIV with Howard
Addiction and HIV/AIDS
MR. JOSEPHER: Good afternoon. Thank you for
inviting us here. My name is Howard Josepher. I am the
Executive Director of Exponents, Incorporated, a not-for-
profit organization that functions in New York City.
The people that come to our programs are
overwhelmingly inner city individuals from minority
communities. They are also the people that make up the
majority of AIDS and new HIV infections both in New York and
in this country. They are people who have just come out of
prison or involved with the criminal justice system.
The needs that we are confronted with by our
clients are all-encompassing, and we have come to understand
that you cannot treat drug addiction, HIV infection, or AIDS
specifically without addressing other needs that stabilize
the individual and make health and healing possible.
Examples are for the people, our clients, our
patients, there is a need for primary care, there is a need
for food. There is a need for housing. There is a need for
health education, and, of course, stress reduction, and we
also feel that in looking at the individual, we also have to
take that holistic view of the economic and cultural
environment that our clients come from.
Conventional treatment for substance abuse or drug
addiction, excluding methadone maintenance, in this country,
are generally behavior modification or
psychotherapeutically-oriented models that focus on
Because of AIDS, we created an alternative
approach to engaging and working with drug addicts. This
approach did not require abstinence as a requirement for
This is important when you understand that one in
seven addicts in this country ever get treated and that the
treatment field has come to rely upon coercion and mandates
to get people into treatment progra
MS. So, the need to
create models that people who have problems with drugs and
AIDS, the models that they want to attend.
We created our program ARRIVE in 1988. Today, we
have over 5,300 graduates, many employed in the AIDS and
substance abuse field. The program runs for eight weeks,
three times a week, which means 24 classes. Each class is
two and a half hours.
While attending ARRIVE and some of the
postgraduate ARRIVE classes, topics cover both traditional
and alternative approaches to health and recovery. Topics
include or experiences include risk reduction for sex and
drug use, tuberculosis, the immune system, nutrition, and
vitamin supplements, aromatherapy, and environmentally
We also cover hepatitis, especially hepatitis C,
diabetes, stress management, and meditation, sound healing
for immune boosting utilizing crystal bowls, cognitive
psycho-education, relapse prevention.
We teach about infection control, cost mainstream
HIV and AIDS medications, and also complementary and
alternative treatments. We talk about and teach about
syringe cleaning and harm reduction. We do make referrals
to other progra
A brief meditation is practiced before, in the
beginning, and the end of every one of our ARRIVE classes.
Our work demonstrates the need for complementary and
alternative approaches to addiction treatment.
If the health of an individual is enhanced, and if
community safety for the larger community is assured and
maintained, then, health models like ARRIVE, not focusing
primarily and solely on abstinence, would be a valuable
expansion of the continuum of treatment for drug and alcohol
Did I get in under that? That was the first time
I have ever done that.
DR. GORDON: Good job.
MS. DRAYTON: My name is Denise Drayton. I am a
graduate of the ARRIVE training program, and I am currently
a staff member at Exponents, Assistant Director of Education
at the ARRIVE program, and I was asked to briefly describe
why I chose unconventional approaches to treat my health
condition and what health results I have experienced.
I am also HIV-positive, so alternative therapy has
been especially beneficial to me in dealing with the dual
disease. I was first introduced to holistic medicine when I
was admitted into a detoxification center for heroin
The method that was used for inpatient treatment
was conventional, but included acupuncture for stress and
pain. I continued with my acupuncture treatment in an
My next encounter with alternative therapy was as
a student in the ARRIVE program. We were taught
visualization and deep breathing meditation. I incorporate
several methods in maintaining my sobriety. I have been
clean for 10 years as a result of holistic treatment, faith-
based therapy, and self-help progra
I choose to use the holistic approach to dealing
with HIV in the form of massage, meditation, visualization,
acupuncture, and deep breathing. I also attend workshops
for stress management and burnout, because as an HIV-
positive person in the work force, it can be stressful at
I surround myself at work and home with a stress-
less environment. I have a crystal fountain at work, a
sound fountain at home, and a sound aromatherapy diffuser in
my office. So, when people step into my office, they are
all like they are in la-la land.
I also attend meditation workshops that help me
deal with the stress burnout pertaining to, like I said,
being positive in the work force, and I believe this has had
a positive effect on my health.
HIV sometimes affects my memory, and I feel by
playing meditative music in combination with aromatherapy, I
have experienced a more centered feeling in focusing on my
work on the job.
After testing positive, I wanted to quit smoking
to clear up my lungs, and I knew that pneumonia was a
possible opportunistic infection for people with HIV, so I
quit smoking with acupuncture. I actually joined a contest
and I figured I would cheat by taking acupuncture. I did
not win the contest, but I got back my lungs, so I was very
happy for that.
I had sessions, I took on sessions, and I have
been smoke-free now for eight years. Although I take
Western medicine for my HIV, I feel that therapies are
complementary. Sometimes the side effects of HIV medication
causes body aches, and massage is essential in relaxing the
body, and meditation helps me focus on something other than
They asked me what barriers and obstacles I face,
and still face, in trying to obtain care. I am fortunate to
have a workplace that incorporates and promotes healing
through alternative methods, employee activities, stress-
reducing devices, and conducting free alternative medicine
workshops and encouraging wellness care.
However, in my community, this type of therapy is
not readily available. The clinics don't offer other
methods, and if they do, it is not well promoted. It is
really not obvious to people that come into the clinic that
this is going on.
There is a natural distrust of anything that is
not tradition in my community. It is looked upon like
voodoo or something because of the lack of education that is
If it is perceived as not in accord with religion,
it is not well accepted. Many people have never experienced
some of the alternative treatments that are available. So,
my recommendation that I would like to see happen to make it
easier for me to receive care is I would like to see
expanded health care insurance to provide for alternative
I would recommend outreach to communities of color
that provide information and education on alternative
therapies and how they can work with HIV medications.
I would like to see doctors do some inner healing
when it comes to HIV, maybe get into CAM, some meditative
approaches that help them deal with their own issues, so
that they can attend to whatever affect before they can then
get involved with the healing process.
DR. GORDON: Thank you very much, Denise.
MS. ANDREWS: Hi. My name is Jeanne Andrews. I
am a wife, mother of four, former teacher, and presently a
student for the past 21 months.
Twenty-one months ago I was diagnosed with Stage
IV colon cancer. I had resection of my colon and underwent
six months of chemotherapy. When I was first diagnosed, a
friend of mine suggested massage therapy, and she said,
Jeanne, it is not a luxury, it is really beneficial for you.
I did start massage therapy, and then another
friend recommended seeing a nutritionist. I went to a
nutritionist and got a lot of guidance there. But it was
two months into my chemotherapy when I was first working
under the guidance of
DR. Fred Smith, oncologist, that I
said, you know, I don't feel in control here, what else can
I be doing.
Besides, I was experiencing the effects of the
toxins in my body, and I just felt that I had to be more in
control. It was then that he recommended that I contact
Gordon, and was given a book, Comprehensive Health Care. I
read that book within two days, and I was just amazed at all
of the information there that I had no knowledge of prior to
As a result, I contacted Jim's office, we met, and
I investigated some of their programs including their group
support system. I attended that, and as a result, I learned
deep meditation, visualization, and a number of other forms
I believe that my cancer, well, I believe that the
disease can be treated by Western medicine, but it is
treating the disease, and not the source, so I really felt
that I needed to treat the whole body.
Anyway, as I got into the various modalities,
various things worked for me, others did not, so I adjusted
along the way. Well, in April of this year, 2000, they
discovered another large tumor. It was too large to
operate, so they put me through a series of, well, just six
weeks of an experimental drug.
It ravaged my body and I was just beside myself,
so I again readjusted various nutrients and supplements, and
then I discovered Qigong. I traveled up to New Jersey three
weeks during the course of the summer, and went through
intensive medical Qigong.
In the meantime, I was also doing massage therapy,
Reiki, various other things, but the Qigong I believe really
helped me. You see, during this point of time, I had
completed the chemotherapy, the six weeks, and although the
tumor had shrunk, I then went into the Qigong, and the
cancer markers went from 31 to 15 under the Qigong.
Well, when I came back after the three weeks, they
did discover several weeks later a blockage occurred. To
make a long story short, they wanted to operate, perform
this radical surgery that would have been eight hours long,
kept me in the hospital three to five weeks.
I refused to go through that, and I went back once
more for Qigong. When I came back, I went in for the
operation because I had to have this obstruction cleared.
As it turned out, I was in the operating room two and half
hours later, when I woke up, I asked if I had the ostomy,
and the doctor said, "Jeanne, this is incredible." He said,
"What should have been the worst case scenario has turned
out to be the best case scenario." He said, "We didn't have
to touch your colon."
Well, they also took my blood, did some bloodwork
on me, and today, my markers are down to 0.6. I continue to
do medical Qigong, as well as acupuncture, working with my
supplements, massage therapy, and Reiki, and I truly believe
that all of this, the CAM treatments have been a tremendous
help to my whole system.
But again I also believe that there were obstacles
that I encountered, and that was, first of all, my medical
doctor not truly believing in CAMs, but yet he was willing
to give me this information.
In searching out the various treatments, I did
have to do a lot of footwork until I came across
and I continued to travel, though, different places, so
there was no central location for me to grasp all of these
My trip up to New Jersey three and a half hours
over three different times -- actually, four different times
-- you know, I wish my medical Qigong master was here in the
D.C. area. It would make my life easier. With the
exception of acupuncture, I discovered that this was getting
to be an expensive proposition. Acupuncture was only
covered by my insurance company if it is done through a
licensed medical doctor.
So, I thank you very much for inviting me here and
being able to share my story of hope.
DR. GORDON: Thank you very much, Jeanne. We also
have some written testimony from Barry [Cassilot], who is
Chief of the Integrative Medicine Service at Memorial Sloan-
Kettering, and we will be coming back to the issue of
integrative care for cancer probably when we deal with
reimbursement issues, which we will come back to later.
The next speaker is Richard Collins,
DR. COLLINS: Thank you, Jim. Good afternoon.
You have my bio in front of you. I don't think the audience
has that, so let me just give you a little background.
I am a cardiologist and Director of the Heart
Disease Reversal and Prevention Program in Omaha, Nebraska,
and nationally, maybe some of you don't know this, but I am
also known as the "Cooking Cardiologist" on Live with Regis.
Let me give you some sound bytes because you have
all of the information in front of you. Heart disease
remains the number one killer in America and while the death
rate from cardiovascular disease has dropped due to
technology, the absolute number continues to rise because of
new onset of disease.
The number is increasing in alarming fashion for
the African-American, Native American, Hispanic, and in
younger age women. It is American's most costly illness.
In this country, the approach to cardiovascular
disease management has been a
MR. Fix-it-up approach to
acute disease therapy. Little is spent on preventative
measures until after the fact, and even after the fact,
conventional therapy has not been shown to be cost effective
with 30 to 50 percent re-stenosis after angioplasty or stent
placement, revascularization after bypass after seven years,
and costly recurrent admissions for heart failure.
DR. Dean Ornish program for heart disease
reversal and prevention strikes at the very root cause of
the disease process, stabilizing plaques, reducing angina by
greater than 60 percent, reducing costly readmissions to the
hospital, and improving quality of life and well-being.
We, as cardiologists, can talk about new
angioplasty, widgets, balloons, but if we do not begin to
manage behavior and lifestyle in America, we will never
reduce the onset of newly diagnosed heart disease in this
Unfortunately, we, as cardiologists, are being
trained as firefighters rather than forest rangers.
The Lifestyle Residential Study, published in
1983, documented that heart disease can be managed by
intensive lifestyle control, again confirmed by the
Lifestyle Heart Trial in 1990 with a five-year follow-up.
The demonstration project with Mutual of Omaha in
mass controls was completed in 1998. The cost savings --
hang onto your placards, Commissioners -- it was $29,000 per
The findings also have recently been noted in High
Mark, Blue Cross/Blue Shield of Pennsylvania with their
embracement of the Ornish program. For the insurees in
Pittsburgh, a cost savings has been noted of more than
$17,000 per person, improvement in SF well-being scores,
outcomes, and reduction of angina.
Lifestyle behavior should be listed as a prudent,
first-choice medicine. The barriers to established heart
disease prevention programs are the same barriers that
actually continue to perpetuate coronary heart disease in
America - denial, time constraints, diet controversies,
risky lifestyle behavior, unwillingness to change, and
Our health care system in America is crisis
control and fix-up medicine. In fact, most preventive and
wellness programs across the United States have been cut due
to cost constraints. We are shooting our own feet.
We can't afford to treat heart disease on a crisis
basis, let alone afford to consider managing it on a chronic
A new model of disease management needs to be
created. I believe we are on the edge of seeing that model
with the introduction by High Mark, the first insurance
company to totally embrace heart disease management through
In regard to recommended policies, carefully
structured programs will need to be certified and policies
created to ensure compliance before reimbursement.
The Ornish program has already met those
requirements with over 20 years of experience in outcome on
research data. Embracing the Ornish program by accessing
this to all populations should be your next top priority.
DR. GORDON: Thank you very much.
MR. CZAPLIEWICZ: Good afternoon and thank you for
inviting me here today. My name is Walt Czapliewicz. I am
45 years old and a resident of Pittsburgh, Pennsylvania.
About 11 months ago, I became a participant in the
DR. Dean Ornish program for reversing heart disease offered
to me by High Mark, Blue Cross/Blue Shield.
I came to the program with a medical history of
hypertension and coronary heart disease. In fact, before I
joined the Ornish program I had three heart attacks, the
first one in December of '96, and the following year I had
two more heart attacks, and in October of 1997, I had bypass
I seemed to be doing well for about two years.
Then, in the fall of 1999, I started experiencing chest pain
again. The bypass was clogging up again. The pain became
more and more frequent, so I was taking nitroglycerin pills
several times a week.
I would get pain after walking, after meals, or
during times of stress. I could tell by how I felt that I
was probably going to have a fourth heart attack pretty soon
or need heart surgery.
As the new year approached, I saw a story in the
DR. Ornish's program. I asked my
cardiologist for his thoughts, and he recommended it. I
started the program 11 months ago, and right from the start
I followed it 100 percent.
Within the first 10 days, my chest pain diminished
greatly and was completely gone after six weeks. In fact, I
haven't had any chest pain since then. I have lost 64
pounds in the past 11 months. Even though I am eating more
food and more frequently than before, so I don't feel
deprived or hungry, because the food is low in fat, it is
also low in calories.
When I started the program, my stress test was
abnormal. After only six weeks, it came back negative, and
after just nine weeks of the program, my resting blood
pressure went from 160/80 to 128/72. My cholesterol is much
lower now, overall down from 196 to 114, and my
triglycerides down from 311 to 116.
All four of the program's components, diet,
exercise, stress management, and group support have really
been a true blessing for me. The results I have experienced
in the first weeks alone made me even more committed to the
I am fortunate to live in an area where my health
insurance company had the vision to make this program a
reality. In 1997, High Mark became the first health insurer
in the country to both provide and pay for the Ornish
program for their customers.
My experience with the program and the High Mark
staff has been nothing but positive. Many of the
participants are over age 65. In fact, I was the youngest
one in my group, but as we all know, heart disease can
strike any of us, young and old alike.
The older participants in the program are doing as
well as the younger ones. We share group meals, exercise
sessions, and perhaps most importantly, our life
experiences, all of which created a close-knit group working
toward a common goal, good health. I also manage stress so
much better than before.
The nutrition portion of the program also has
contributed to my improved health status and a more positive
attitude. The diet consists primarily of fruits,
vegetables, grains, beans, non-fat dairy and egg whites, no
added oils, which makes the diet about 10 percent fat. I
also was advised to take some vitamins and fish oil
I manage a catering company, so this was a big
change in my diet at first, but I have adjusted well to it.
The recipes in the program from appetizers to desserts are
delicious, nutritious, and easy to prepare, and I feel so
The program supervision is also very comforting.
We are guided through the program sessions by some very
skilled professionals including a medical director,
registered dietitians, exercise physiologists, stress
management instructors, behavior or health clinicians, and
nurse case managers.
All participants remain under the care and control
of their own physicians, who receive regular progress
reports and copies of all tests.
In closing, I would like to reiterate my dramatic
improvements in the
DR. Dean Ornish program. This program
reflects the commitment to offering innovative solutions
that truly improve one's health.
The program treats the underlying causes of heart
disease, not just the symptoms, and may spare some patients
surgery, and most importantly, improve the quality of life.
I think that just about everyone would benefit
from a program like this whether or not they had heart
disease. I hope this commission can find ways to make
programs like this more widely available.
Thanks to this program, I feel like I am 35 again.
I feel better, look better, and I am healthier than I have
been in years. Coming into the program, I knew I was going
to have another heart attack and need bypass surgery soon,
but now I don't, and now I don't have to endure that pain
I truly believe this program saved my life.
DR. GORDON: Thank you very much.
J. Donald Schumacher.
DR. SCHUMACHER: Now you want me to talk about
hospice care. You have never heard the expression "not
following the fan dancer?"
I want to talk with you a little bit about the
picture of hospice in the United States today and how it
does relate very much to the topic of complementary and
Dying in America has become a very difficult
grace. Fully 53 percent of all patients in the United
States die in the hospital, 24 percent of all Americans die
within nursing homes although most individuals would prefer
to be at home receiving the comfort, love, support, and
dignity of a competent support agency, as well as their own
While I see hospice care becoming more and more
necessary in our culture, unfortunately, I find us dealing
with more and more complicated and late referring issues
than I ever thought possible.
I think hospice care in many ways is the epitome
of what really good complementary alternative medicine is.
I am not talking about hospice according to the hospice
Medicare benefit, which has a very difficult six-month
prognosis to take a look at, but some of the basic core
issues of hospice care revolving around the fact that
patients and families have to have the benefit of good
quality support and choice while they are going through the
process of dying, whereas, most patients who are in hospital
settings and nursing homes, as you will, by interview find
out don't feel as though they have much choice at all.
What is the true picture of hospice right now in
our country? Well, unfortunately, one-third of the patients
that we take care of die within seven days. Most
individuals come to us essentially as train wrecks. They
have been living and dying in very difficult circumstances,
many of them in unrelenting pain with very complicated
symptoms that are not being able to manage by traditional
medicine, and they come into our program and unfortunately,
very late within our care.
We, in hospice care now, refer to what we are
doing in our jobs, as opposed to end-of-life care, we are
doing, in fact, brink-of-death care where patients come in
and die so soon that they don't get the entire benefit of
what hospice can actually provide. We are running, in fact,
hospice emergency roo
Many are living in pain for a long period of time
upon admission, and they have been in high-tech settings
that do not allow for patient participation in their own
choice of health care.
Self-determined life closure, one of the hallmarks
of hospice care and hospice support, one of the four
presented by the National Hospice organization often comes
at the very end of the patient's life.
Patients now are very used to having things done
to them as opposed to being able to choose things for their
own health and their own well-being.
How can complementary and alternative medicines
help? Well, many of the hospice programs that you will talk
with around the country right now really are searching for
new ways to support the traditional medicine that they are
providing to patients and families, because the traditional
medicine, largely around medications, do not work for many
Our program, I can tell you as a clinical
psychologist, that in addition to the alleviation of
symptoms, patients who are participating in their own
process of choice around death, grief, and loss, generally
have a better sense of well-being, are able to face what is
happening to them, around them, with much more courage and
much more comfort and support, and they end up feeling
stronger mentally and physically to battle whatever the
outcome of the disease might bring.
What do we actually use? Our program -- I was
very happy to hear several of the participants up here talk
about massage -- we use massage quite often for patients in
our programs, therapeutic touch for patients in our
Many of our nurses are trained in therapeutic
touch, and oftentimes engage, in addition to the traditional
therapy that they are providing to patients and families,
with some really, really good quality stress reduction
through those two methods.
We also use homeopathy quite often, good
chiropractic care and acupuncture. I was so happy to hear
the acupuncture discussion earlier. I think acupuncture is
a huge opportunity for all of you to really significantly
benefit patients and their families without having patients
engaging in longer term use of narcotics and very
Let me tell you right now we have a patient in our
program. She is 24 years old. She has metastatic disease.
She has many, many tumors that are on her spine. She has
two young children, age 2 and 4. For a long period of time
-- she was admitted into our program -- for a long period of
time she had been living in excruciating pain, and the
narcotics that she was being given to help reduce the pain,
helped to reduce the pain, but she was so out of it because
of the level that was necessary, that she was not able to
actively engage in the care of her children.
Through acupuncture, guided meditation and
visualization, we have been able to cut her prescription
medications and narcotics by half, and she is now much more
engaged in the care of her children than she ever had been
in a long period of time.
Remember for all of you that while we are sitting
here talking about how these things can help other people,
everybody in this room will die. We do not know if it will
be from HIV or AIDS, cancer, or heart disease, but at some
point in time, hopefully in a ripe old age, all of us around
these tables are going to be needing to have the benefit of
all kinds of choice in alternative therapies, and if many of
you are like myself, the very pushy baby-boomer, who is
going to demand a lot of things, death cappachino, death
latte, and a personal death trainer, we are on the right
track as health care providers trying to tailor a different
model of care for individuals who are going to be very
demanding as they age and die.
DR. GORDON: Thank you very much.
DR. GORDON: Thank you all, to use Jeanne's words,
for these stories of hope. We are very glad that you came
to share these with us.
Questions from the commissioners?
MS. LARSON: I worked in hospice for five years,
and my question to you is I saw the numbers actually
decreasing and decreasing in the last eight years,
referrals, you know, two days before death.
Now, we have a program that we know works. We
have access to the program, so we are interested here in
access and delivery. What changed?
DR. SCHUMACHER: The competing streams of revenue
for health care right now have become much more demanding.
As an example, in our community, we have two large health
care systems, both of whom own home health agencies, and
pretty much own, heart, body and soul, the physicians that
are supporting that hospital system.
Because of that, not to the benefit of the
patient, but to the benefit of the individual health care
system, more and more patients are being kept away from
external agencies, such as hospice care.
You would see an increase in some hospice programs
for or with those hospital systems that do have hospice as
one of their core programs, but those are few and far
between around the country.
I would hope that the Commission would recommend
some form of streamlined and untangling of these competitive
streams of revenue. Physicians are fighting with hospitals,
hospitals are fighting with physicians, there is such a
dearth of understanding of what patients need as they are
dying, it is absolutely unconscionable, but we have run into
that very situation.
Our median length of stay has gone from about 29
days down to 14 days, and that is absolutely wrong for
patients who need this care.
MS. LARSON: Let me say that briefly it is an
issue of capturing the money by certain parties.
DR. SCHUMACHER: Correct.
DR. GORDON: Before we go on to David and then
Effie and Bill, could you give us some documentation of what
you are talking about?
DR. SCHUMACHER: Sure, absolutely.
DR. GORDON: And give us a sense of where things
are going wrong and the kinds of recommendations you would
like us to make?
DR. SCHUMACHER: Be happy to, absolutely. I will
get that to Michele.
DR. GORDON: Thank you very much.
DR. BRESLER: Despite the hospice movement, far
too many patients are still dying alone on respirators in
DR. SCHUMACHER: Correct.
DR. BRESLER: What is the movement doing or how is
it going to help get access, greater access for these
patients to more humane situations in the hospital?
DR. SCHUMACHER: This morning I was at the Center
to Advance Palliative Care, a project that is being funded
by the Robert Wood Johnson Foundation. It is a very
exciting prospect because one of the topic areas that we
talked about this morning was the fact that many individuals
in hospitals are not able to make appropriate decisions
about getting off of ventilators and out of ICUs and cardiac
I think that through a lot of national hospice and
Robert Wood Johnson-sponsored organizations, it is our
attempt to work within each one of the hospital settings
now, to begin to work with the inpatient staff themselves to
recognize when a patient and family can make another choice.
I am not saying that this is easy. I know that
when it is going to my turn to die, I am going to be kicking
and screaming all the way and demanding all of those things,
but I do think that people, given a choice to recognize that
prior to it becoming absolutely totally unbearable, having a
choice about when you decide to stop the aggressive therapy
because it is no longer working, I think people, given
another day of peace, are more willing to do it.
It is just that right now they are not given the
choice, and some of that is because of the dollars that we
talked about. It is our hope that we can remove people from
those very difficult situations by working within the
DR. GORDON: Effie.
DR. CHOW: Thank you for the touching stories and
report. In regards to hospice, if the expense is growing
and there is diminishing funds, is there any way of working
with home care and expanding the hospice concept to home
care type, that it would be less expensive?
DR. SCHUMACHER: Eighty percent of our care is
provided at home. You are talking about home health care?
DR. CHOW: Home health care.
DR. SCHUMACHER: Home health care is also one of
the competitors for the federal Medicare dollar, and they
have done a really nice job pitting us against each other.
I think that there are some opportunities for us
to work collaboratively together, but I learned just this
morning of a couple of programs around the country who don't
quite see the benefit of being cooperative with other
hospice programs, and they are trying to manage, as I said
earlier, all of that end-of-life patient care within their
home health license, and it really is not the same kind of
One very important issue, and that is if you are a
home health patient being cared for at home, you pay your
own medications, you pay your own prescription drugs. If
you are hospice patient, those drugs are paid for by the
Most people don't recognize that until you are in
hospice care despite the marketing that we do. So, that is
a very large issue, home health-hospice dialogue is a very
DR. FAIR: My question deals with the two
presentations on the Ornish program, and I think,
Czapliewicz, what you mentioned, that this program is
probably good for everybody, and I think you are probably
right, we would get very little argument from that statement
from physicians about that.
My question to you and also
DR. Collins, is what
recommendations, if any, do you have, how do we get this to
influence the lifestyles of people before they get heart
attacks? I mean here is a cardiologist that sort of had
this epiphany after he got his heart attack, yet, I am sure
you knew all of this intellectually before you had your
It seems to me that that is the problem, and that
is really the big payoff, because it would be much more of
cost benefit than the figures
DR. Collins gave. So, through
your experience, both of you, do you have any
recommendations to the Commission about how we could get
this before the actual event occurs?
MR. CZAPLIEWICZ: Well, for myself, I think, you
know, this is kind of funny, but you have got to start
advertising pork as the other white meat. It all goes back
to educating people about what they are doing to their
That is what I went through in this program. They
taught me what I was doing wrong, and boom, and I think that
just has to be expanded somehow.
DR. FAIR: We have been doing this for a long
time. We have an epidemic of obesity, an epidemic of
diabetes in people in their 30s, I mean we are doing
something not right.
DR. COLLINS: We have in America, which I call --
you have heard about the French paradox -- we do have an
American paradox. We are the only country that drive to
exercise facilities, we are the only country that it takes
one calorie to roll down a car window to get a 700-calorie
breakfast, and we are the only country where we are obsessed
with diets, and yet we are gaining weight at lightning
speed. I call this the American paradox.
Our society is gearing it up to guarantee that you
get heart disease when you put your shoes on. We have taken
cultures that were here in this country well before us and
are giving them heart disease at lightning speed.
It is very difficult in America to get someone's
attention because heart disease happens to the other guy,
not you. I think there is some technology around the corner
to draw people's attention. The electron beam CT scanner,
as controversial as that is, with one breath hold you can
lay down and see if you are laying down plaque. That has
been shown to really get your attention, when your plaque
load is excessively high.
I picked up a number of patients in their 30s and
40s who thought they were immune to heart disease, they had
so much calcium in their arteries they looked like the
plumbing in an old house.
So, as a cardiologist, this is the hardest thing
that I have, is to get someone's attention. We need to
because heart disease is occurring at a much younger age.
If I were to give a cholesterol screening test today, the
people that would show up would be those that were 60 and
70. We need to get the 20-year-olds and the 30-year-olds.
DR. FAIR: I guess that is the gist of my
question, and maybe there is no answer, but I will share one
thing with you. When I lived in Manhattan and belonged to a
health club, I was amazed at the way people would stand in
line to wait to take the elevator for one floor to go up and
use the Stairmaster. It astonished me.
DR. COLLINS: That is the American paradox.
DR. GORDON: Joe.
DR. FINS: This is for
DR. Schumacher. Thanks so
much for so eloquently telling us that hospice care really
is the ultimate in integrative medicine and really blends
the best of both worlds.
I want to ask you two questions about funding.
One is the Medicare hospice benefit and to follow up on my
fellow commissioner's comments about decreasing access.
Could you comment on what the hospice benefit and
the regulations surrounding that has done, in your opinion,
to access the hospice and referral rates?
The second question is the stability of the
research funding. You mentioned the Robert Wood Johnson
Foundation. What percentage of funding for this integrative
practice comes from philanthropic sources versus from
government sources, and is there a role for increased
DR. SCHUMACHER: Oh, no, not at all.
DR. FINS: I am sort of leading the witness here.
DR. SCHUMACHER: We have seen a lot of that
recently, but what kind of role do you think the Federal
Government should have in funding this kind of research and
outcome studies and delivery system to optimize this
DR. SCHUMACHER: I think about this and talk about
this quite a bit. I think the largest difficulty with
hospice in this country is the six-month criteria, and no
matter how healthy or unhealthy we are as individuals, just
to face that as looming in your future, many individuals
One of the largest examples of where that is most
easily seen and understood is with children. We have 31
children in our program today. We have a program called
Essential Care, and we largely provide care to them through
a largely extended home health license as opposed to a
Kids and families will never accept hospice care
until the last day or two because everybody hopes for a
longitudinal life for their own child.
So, I think that is the largest issue, and as
treatments have become more sophisticated, and people are
more aware that more and more things can be done, there is
always this true or unrealistic hope that, gee, maybe if I
keep on trying this chemotherapy or this radiation, I will
be able to kick this and go forward and live my life. So, I
think that is the largest issue.
The Federal Government needs to develop 20
demonstration projects around the country that will do a
variety of different things. One, they will allow hospice
programs to provide care without a reimbursement cap. They
will allow hospice programs to provide care without a
criteria or prognostic cap.
They will give people opportunities to develop
different kinds of services, so that without a patient
having to walk in and say, yes, that I am dying, you can be
put in a care path or in a trajectory where you get the kind
of support that hospice provides, and you can receive the
chemotherapy and the radiation and the surgery without
hospice being a horrible choice for you, because that has
what we have been, I think, winnowed down to in our care
We are a horrible choice for people. Gosh, what a
great feeling, it's awful, and people make that horrible
choice very much at the end because as I probably, and so
will you, you don't want to do it until you absolutely have
So, I think the Federal Government ought to do 20
demonstration projects and really take a new look at
developing a seamless model of care from diagnosis, through
the bereavement of your family, so that you can go through
that trajectory without having to make terrible choices
throughout the process of your disease.
DR. GORDON: Wayne.
DR. JONAS: Thank you. I think that is excellent.
DR. SCHUMACHER: So, sign you up, right, you will
DR. JONAS: Sign me up now, absolutely, how do I
get in this, and where do I get reimbursed, right.
What percent of individuals enrolled in hospice
get identified CAM modalities? You have mentioned a number
in your program, but in my experience in taking care of
patients in hospice, a lot of times it is primarily kind of
pain control and this type of thing, and there isn't a lot
of acupuncture, aromatherapy. If individuals happen to know
something about music, they will bring that in, that type of
DR. SCHUMACHER: It helps if the CEO has used all
of these therapies because then you tend to promote it
within your organization. I think probably 15 percent at a
max I would say in hospice care would do that.
The thing that needs to be educated -- and this is
one of the things that the commission can do -- is hospice
CEOs and hospice managers need to recognize that they can
contract with these providers of service in their community
to provide this care under the hospice Medicare benefit.
Whatever the patient or family needs to reduce
painful symptoms, you can contract for those and provide
them, which is how we operate in our program, but it is a
low utilized piece of information right now.
DR. JONAS: One question to
DR. Collins. Is there
any data on the number of individuals that are eligible and
enter the Ornish program, that then do not do 100 percent
compliance, as you described, and either drop out or only do
20 percent compliance, and this type of thing, and what
percent that is, first of all, and any kind of effects on
DR. COLLINS: We have a careful screening
procedure. We really know what criteria guarantees your
success. That is number one. And once you go through that
hoop, and the anatomy is proper, we have an adherence rate
of 90 percent-plus.
DR. JONAS: I will reverse the question then. How
many individuals are screened and because of non-medical or
other reasons, because there is a better therapy around or
something, are not then entered into the program?
DR. COLLINS: It depends upon a chronic disease
basis. We have exclusion criteria, and that roughly is
about 1 in 10, that they might be excluded because they
continue to smoke or haven't really taken care of some
lifestyle problems, that really a lifestyle program of this
nature would not be ideal.
The anatomy, we are learning a lot more about the
anatomy. There is an element of the catheter-ocular reflex
in America, that if you see it, you want to balloon it or
We have realized that once an artery is touched,
lifestyle cannot control it. What you need to do is leave
an artery untouched and let lifestyle then take over and
reverse the process.
DR. JONAS: So, complementary with conventional
therapy may be problematic in this case.
DR. COLLINS: Well, what happens is not
necessarily so, because those arteries that need to be taken
care of, are taken care of, but the fact is that in the next
event, the next event that will happen to you will not be on
the one that was stented or angioplastied, but it was that
30 or 40 percent lesion that is just sitting there ready to
DR. JONAS: And that will not be then susceptible
DR. COLLINS: It is if it is untouched, yes, it
cuts down second events.
DR. JONAS: So, it is about 1 in 10 that get into
the program that are --
DR. COLLINS: No, no, no.
DR. JONAS: One in 10 are excluded.
DR. COLLINS: One in 10 are excluded.
DR. JONAS: Okay.
DR. GORDON: A couple of things that I think that
the program ARRIVE could shed some light on, that might be
really useful. One is in the area of prevention, and the
other is in the area of creating a healing community.
I wonder if you could talk a little bit about your
efforts to reach out into the jails and prisons, and how you
feel that works, and how that may help prevent recidivism,
as well as prevent increasing illness from HIV.
MR. JOSEPHER: We do a substantial amount of
outreach in the institutions in New York, primarily that you
want to engage them actually even before they come out into
the street, so a whole new area that is being developed in
addiction work with the criminal justice population is
transitional planning, where the idea is to engage people in
the institution and inform them of the various kinds of
services that are available out in the communities, so that
you can provide some kind of a safety net upon release, and
they don't just fall in the cracks, and then the whole cycle
of recidivism happens.
But it must be said that most of the innovation
and inroads that are happening in addiction treatment now
are happening because of HIV and AIDS, and that AIDS in the
drug-using community has required us to engage these
individuals sooner rather than later, to present alternative
models to work with them to stop the spread of AIDS and help
care for people who are already living, and that whole
school is something we call "harm reduction," but we have so
many barriers to any kind of innovation in the drug field
because it is completely surrounded with political messages,
and any other complementary or alternative approach is
looked at as radical and sends out the wrong message that
drugs are being tolerated.
But we are seeing again, because of HIV, that we
can get people, we can engage them while they are still
active, even though they are not even ready to get off of
drugs, we can bring them along at a different pace, at a
pace maybe that they are ready to work with, and I think
this widens our net substantially.
DR. GORDON: As a White House Commission, do you
see also recommendations that we could make that would make
it easier to create this kind of integrative treatment for
people who are positive or people who are coming out of
prison who are addicted?
MS. DRAYTON: What I wanted to say about
alternative treatments or alternative methods, I was
noticing that women are the highest population now being
incarcerated, and because the holistic approach deals with
mind, body, spirit, emotional health, mental health, as well
as physical help, I would like to see some inroads for women
incarcerated to have maybe alternative therapies,
meditation, positive affirmation, something that tells them
that they are not boxed into this life for the rest of their
life, that there is a way out or some sort of change
happens, some sort of relaxation, some sort of efforts made,
outreach to women, so that when they do get on the outside,
they have a little more positive attitude and can maybe deal
with life stress situations in a better way instead of going
back to some of the same stressors, and then reacting in the
same way using drugs or working the streets, or whatever it
was that made them feel those things.
MR. JOSEPHER: Just to quickly answer that
question, Jim, is that as Denise spoke about them, her
personal experience, that the utilization of auricular
acupuncture helped her substantially, not only in reducing
stress, so that she could deal with her HIV, but also with
dealing with her withdrawal from nicotine and cocaine. But
this is not a reimbursable function, auricular acupuncture,
in the substance abuse field.
You know, it all does come down to money, and if
there is money, there is going to be programs, and in that
way more people are going to be helped. In drug treatment,
it used to be you went into a treatment center for 28 days
to get your treatment. Because the HMOs have squeezed that
to such an extent now, you can only get seven days if you
are lucky that will be reimbursed.
So, basically, the treatment now for most of these
places is to teach people about 12-step programs, which are
certainly extremely valuable, but there is very little
treatment going on in these places for the people who do not
have private funds or even insurance for the people that we
DR. GORDON: Thank you.
DR. BERNIER: I wanted to ask a related question,
and that is, are there good studies that indicate there is a
real positive value of including the CAM medications in
individuals that are withdrawing or individuals who then
withdraw for a while?
I ask that not to question what happened in your
situation, but just has anyone tried to put that together in
an organized way?
MR. JOSEPHER: I heard in the previous session
here of Mike Smith,
DR. Mike Smith from New York City, who
developed auricular acupuncture. He has a substantial
documentation to the effectiveness of it.
Again, effectiveness of treatment doesn't mean
very much in the substance abuse field. We have had studies
galore showing the effectiveness, the reduction of crime,
reduction of recidivism, and we still do not invest, so I
don't know what will move that, but I do believe the
documentation is there both for complementary and
alternative methods and for traditional methods, but it is a
field that still prefers to treat drug use primarily through
DR. BERNIER: I would guess incarceration is a
very, very expensive way of trying to deal with a habit.
MR. JOSEPHER: Yes, but the expense is, that
really determines it, is where are we spending those
expensive programs, and they are, in New York State, it is
an industry to build institutions in rural areas which
generate employment in Upstate economies, when seven out of
eight people come from the inner city themselves, but these
institutions are upstate.
Many years ago, I think it was Eisenhower who
warned about the military industrial complex, well, we have
now a substance abuse institutional complex, and the
documentation is out there, the political will is not there.
DR. GORDON: Charlotte.
SISTER KERR: Denise, you really did some hard
things, in my opinion, to heal. I wanted to ask you, if you
had to say, if it is possible to say, what one thing most
helped you to heal yourself, what would you say, of all the
MS. DRAYTON: Immediately, I can point to
acupuncture. Actually, one thing led to another.
Spiritually, I was bankrupt, so when I came in to go into
detoxification, the first thing somebody said to me was you
are an African queen, you are a child of God, you are a
beautiful woman, you don't deserve this life.
So, right then I was swept in, you know, I bought
right into it because I hadn't heard that. So, there was
that spirit thing, and then right after they swung me right
into this fantastic acupuncture where my back was in
tremendous screaming pain from the detoxification, because
they take you gradually through methadone and then they ease
off the methadone, and then what - acupuncture.
So, it was like one blended into the other, and
the total experience was what helped me.
SISTER KERR: Did you have your acupuncture in a
group or did you meet in a group with other people having
MS. DRAYTON: Yes, it was in a group setting, in a
very comfortable chair with a very wonderful person, and
when the acupuncture needed assistance, it was with Tiger
balm and heated peat moss, massage therapy. It was
SISTER KERR: What I understand from that data and
particularly acupuncture is that when the community embraces
the whole process, that is when it is most effective.
What I had thought you might say was that someone
touched you at the level of the spirit, which is what you
said, and I don't hear us saying too much about that, you
know, and I would invite you to speak about that if you
speak again, because you spoke it even though you didn't
name it to me.
I thank you for bringing that up because it is
something we have to be looking at as a commission, I think,
and I would appreciate any other input on that. That you.
MS. DRAYTON: Thank you.
DR. FINS: This is also for
MS. Drayton. I was
struck by something that you said at the very end of your
testimony, that the people in the African-American community
have a distrust I think of things that are not traditional.
I would like you to say more about that, and what
does that really mean? Is there a perception that if it is
not traditional, it is somehow second rate, and yet what
this did for you was extraordinary.
MS. DRAYTON: Yes.
DR. FINS: It saved your life whereas traditional
therapies may not have been as successful.
MS. DRAYTON: Right.
DR. FINS: So, how do we get the message out,
through public education, the Public Health Service, and the
like, what kind of concrete recommendations can be do at a
national level that that individual practitioner did for you
when he or she was so complimentary and said you were a
child of God?
What can we do at a national level to bring others
MS. DRAYTON: I think what is influential to
people in my community is peer education. If it is coming
from someone who has experienced it and has a working
knowledge of it through first-hand experience, they tend to
Usually, if there is any kind of holistic healing
going on, it is in the little bodegas or the little tearooms
or whatever, and it is immediately kind of associated with
cult, voodoo, or something not quite in line with
traditional religious beliefs, Baptists, whatever, and so it
is looked upon not with -- it is distrusted.
So, I think if it was brought more out into the
light, not in the little backrooms, and more in the clinic
settings, if you had peer educators, while you are waiting
to see the doctors in the clinic, do a little talk on
holistic medicine and some of the benefits of it, that would
MR. JOSEPHER: May I add to that, that while I
think race is sometimes a barrier, if teachers had
information and have conviction, they transcend those
barriers. We have had the good fortune for the last 10
years to have an alternative expert come to our ARRIVE
program, teach five times a year. The guy lives in
Washington, D.C., and pays his own way up five times a year.
He is the chairman of this commission. He has brought
alternative medicine to the minority communities in New York
City. We are thankful for him.
DR. GORDON: Thank you.
I wanted to ask Jeanne one question before we
closed. Thank you very much, Howard. The other thing I
want to say to all of you is I love going there. It is a
spiritual uplift for me to go there. I feel so well used
and so happy to be there.
So, I think part of what we need to do from my
perspective is encourage all the young people who are in
health care to go out and serve, and to really serve where
they are being heard and they are being most useful. So,
thank you, too.
Jeanne, you began to say something, and I just
want you to say a little bit about it, about the whole
question of finances, and you said a little bit earlier at
lunchtime, too, that in your situation you had the
resources, but you started to point out, and I would like
you to underscore it a little bit, the things that were not
paid for and the things that you would like, even though you
had extremely good experience, all the things that were not
paid for and your effort to try to create integrative cancer
MS. ANDREWS: Well, I have done Reiki, massage
therapy, support groups, Chinese herbs, various vitamin
supplements, acupuncture, art therapy, and I believe that
all of those, the only thing -- well, I know -- the only
thing that has been covered has been acupuncture only when
done under a medical doctor, done by a medical doctor.
My Chinese herbs alone cost me, on a monthly
basis, $110 a month, and I take on an average of six to
eight supplements, two to three times a day, and many of
them are very expensive. So, it is a costly treatment, but
for me it has been working.
If I can just address that lady down, one very
important aspect that I forgot to mention is that prayer has
been a very important part of my healing, my own prayer, as
well as prayer from many individuals throughout the country.
In talking to Denise over lunch, again, if you
don't have hope or a faith, I think it is so hard to beat
something like this, and encouraging other people to
consider the prayer, the spirit is so much a part of the
whole healing process.
DR. GORDON: Thank you very much. Thank you all
We are going to have a break for about 10 minutes.
Session IV: Issues in Integrating CAM in Service Delivery
DR. GORDON: This panel is going to be beginning
in Tab O, and this is Session IV, Issues in Integrating CAM
in Service Delivery.
We will begin with Richard Miles.
MR. MILES: I will start out by saying I am not a
practitioner. I dropped out of the business world about 30
years ago and met several of the people in the room when I
was the organizer and manager of major conferences in the
early seventies including the first national symposium on
acupuncture at Stanford in June of '72.
We designed that event for 250 docs. We were
going to hold it in the Student Union, Nixon went to China,
James Reston wrote an editorial in the New York Times, and
1,400 doctors came to this conference, and away we went with
what has now become holistic health complementary medicine,
whatever we want to call it.
My interest in the whole arena, living in the Bay
area, the San Francisco Bay area, at that time in the late
sixties, early seventies, the San Francisco area was the
fountain of social change, shall we call it, and I was
interested in what was driving that and came to the
conclusion that what was happening was a major shift in
belief about how the world operated.
The management expert, Peter Drucker, wrote a book
in '67, called "Managing in the Age of Discontinuity," in
which he pointed out that all of the institutions of Western
culture were reexamining the assumptions upon which they
I think that is happening throughout the culture,
and I think medicine and health care are a major part of
that, and this shift of how we view the world is a major
driver of the development and interest in CAM.
When I talk to physician groups I say, or to other
health care professionals, I say that the focus that you
have talked about mostly is about what you do. The new
trend in what is happening is who you are while you are
doing it. The attitude of the past has been that we are
separate observers of the world, not participants in it.
My friend, Brendan O'Regan, who used to be the
Director of Research at the Institute of Noetic Science,
referred to that as the infinitely extrapolated mistaken
notion. We cannot be objective and separate observers of
the world, we are participants in a living system.
So, my particular interest in health and in this
whole arena, has been looking at it from the point of view
of living syste
MS. In your handout materials, toward the
back of the report that I wrote for the Institute for Noetic
Sciences, you will see a list of 12 factors in a person's
life that can affect their capacity for self-regulation and
The kind of general attitude of our medical system
has been that when you present disease, you are essentially
ill and need to be made well. The interventions will cure
The emerging perspective is that you are
essentially well and need to be made ill, and if you can get
the illness out of the way, if you can get the factors that
are contributing to this illness out of the way, the system
will heal itself.
The living system that we live in, including the
whole planet and the life system that we are part of, is a
self-regulating, self-healing system. That is my view of
What I do now as a business consultant is work
with organizations and programs that are trying to develop
this particular kind of concept. The one that I probably
spent the most time with, that some of you may be familiar
was, was the work of Arthur Kaslow in Santa Barbara, in the
late seventies and early eighties, wrote a book about his
practice called "Freedom from Chronic Disease."
Arthur said all of these chronic disorders that
are presented to me are the same problem, it is just the
weakest link in the system that is going down.
So, his whole practice was based on reestablishing
the function of the system, not on treating the disease, and
he would work with nutrition. He had a staff of five
people. He had an acupuncturist, he had a yoga teacher, he
had a nutrition counselor, and he had a psychotherapist, and
himself, and he was essentially a nutritionally-based
His whole point was that what we need to do is
turn this person's life around, not fix their disease, and
he had a very successful clinical practice in Santa Barbara
and in Denton Beach in San Diego.
I was on a panel about two months ago at a
conference in the Bay area on industrial ecology, which in
itself is kind of an oxymoron, but this conference, the
panel that we were asked to participate in was called
"Managing Living Systems," and the four of us who were on
the panel got in touch with the conference people and said
you cannot manage a living system.
So, the point that I would make here is that we
should listen rather than do to, we should be with, we
should care for people, and reestablish connections with
other people, with nature, and with the living systems, and
allow the diseases of this culture to heal themselves rather
than try to fix them.
DR. GORDON: Thank you, Dick.
MR. BEDELL: Michele, I requested that my
testimony together with copies of information on my
foundation be passed out.
My time has started, so I don't want to wait here
while she does that.
First of all, though, I want to thank you folks
for taking the time to be on this panel. This isn't in my
testimony, but I just appreciate this tremendously because I
think you have got a real opportunity. I don't know how
much the government is going to listen to what you are going
to have to say, but I have a feeling the press will, and the
people will, and it is my belief that the change is going to
come from the people rather from the press.
Some of you served with me on the advisory
committee to the Office of Alternative Medicine. The report
language establishing that office declared that it was to
"investigate and validate" alternative treatments for
Time after time our advisory committee passed
resolutions calling upon the Office to conduct what we
called "field trials," where we asked them to go out and
conduct scientific trials to "investigate and validate" the
treatments being administered at alternative medical
facilities around the world.
I believe the Director of the Office of
Alternative Medicine was supportive of those efforts.
Unfortunately, the Director and top bureaucracy at NIH would
not permit us to "investigate and validate" any alternative
Three years ago my wife and I decided since the
government would not investigate these treatments we would
try to do it ourselves. We formed the National Foundation
for Alternative Medicine to "investigate and validate"
alternative medical treatments. We are starting with
We are sending teams with a medical doctor on the
team to visit alternative cancer clinics and go over their
patient records. We are finding clinics in Europe
administering low-cost, non-toxic cancer treatments with
success that would not be expected at major cancer clinics
here in the United States.
These treatments are based upon a completely
different concept of how to treat cancer. They treat the
whole body, rather than concentrate all efforts on
destruction of the tumor. The tragedy is that some of the
non-toxic medications used in these treatments cannot be
administered here in this country.
In most areas of our society if one develops a
better product, the product grows in popularity, and the
inventor benefits. This is simply not true in medicine in
our country. It is no secret that employees of the FDA
leave their posts to take high-paying jobs with the
pharmaceutical industry and conventional medical community.
The Director of NIH, that was a party to
preventing the Office of Alternative Medicine from
"investigating and validating" alternative treatments, is
now President and CEO of Memorial Sloan-Kettering Cancer
The former Commissioner of FDA is now Dean of the
Yale Medical School. His deputy director took a job with a
I have a friend who was selling Deprenyl as a
supplement. He made the mistake of claiming that it could
help Parkinson's disease, which it does. He has a wife and
young son. He just been sentenced to 13 years in prison.
The government asked that he be sentenced to life. He has
hurt no one, only helped people.
As you know, I served 12 years in the Congress.
Most of the members of Congress are dedicated to doing what
they think is in the best interest of the people. Some of
them are fearless in that regard. However, they cannot be
completely informed on all matters.
Like most of our society, they are not aware of
the restrictions imposed by our government on anyone who
would develop a medication or treatment that might challenge
conventional medicine and the pharmaceutical industry.
One of your duties is to make recommendations in
regard to health policy. You have a unique opportunity.
You can take advantage of it or shrink from it. The public
is turning more and more to alternative medicine. I plead
with you to have the courage to recommend passage of The
Access to Medical Treatment Act.
This would make it possible for these non-toxic
treatments to be tried under strictly controlled
circumstances. You should also recommend that any medical
treatment that has been in use in a foreign country where
there is no evidence of it posing a danger to the patient be
permitted to be administered here in the United States. It
is a crime that our people do not have access to the non-
toxic treatments we are finding in Europe.
People all across the land are turning in
increasing numbers to alternative medicine. You are in a
unique position. You can have the courage to make a
statement that will be heard, or you can shrink from this
opportunity and come forth with a meaningless statement that
ruffles no feathers.
In the meantime, people in our country will
continue to die because we are unwilling to open up the
system to treatments that are being administered in other
DR. GORDON: Thank you, Berkley. Thank you as
always for your leadership and inspiration and for reminding
us of which way our noses are pointed. I appreciate it.
DR. KURTZ: Delighted to be here. I was intrigued
by the sessions all day. I suppose I am the token skeptic,
having been invited about a week ago. In any case I
represent perhaps the leading critic of alternative
medicine, The Committee for the Scientific Investigation of
Claims of the Paranormal, publisher of the Skeptical
Inquirer, and the Scientific Review of Alternative Medicine,
a new journal published by the Council for Scientific
Medicine. Perhaps we represent the so-called
"Establishment" in medicine today.
I have just returned from Australia where we had a
World Skeptics Congress on Alternative Medicine, and we
brought people from China, India, and other parts of Asia.
They were critical of Qigong. I didn't hear any of that
today. They prefer Western medicine, but pursued Qigong
because of the cost, and similar for the kind of healings in
In any case, we are committed to scientific
medicine because we submit, in deference to
MR. Bedell, that
this has been the most effective way of curing disease and
leading to human health.
What we want is coherent theories that are
falsifiable, randomized, double-blind clinical tests, and
tests of effectiveness. What I have heard today largely
were testimonials from patient and practitioners.
Now, I think much of what I heard or some of what
I heard I would agree with, but I would not call it
alternative medicine. I think that term is a misnomer. You
have packed everything into it.
For example, lifestyle management in cardiology, I
had a bypass, I do that. I don't know that that is
alternative medicine, nutritional therapy, and many other
things. There are plural methods of therapy. The main
thing is are they effective, and the only way to judge that
-- and you, as commissioners on this Presidential
Commission, have an obligation to see that these methods are
carefully judged by double-blind tests, that they are
coherent theories, that you can find mechanisms if they work
and why they work.
Now, I applaud the call for evidence-based
clinical tests that I have heard during the day. Let me
tell you why the skeptics are skeptical about alternative
First, if you are going to have double-blind
tests, they cannot be done simply by proponents. Now, we
have heard about the tests of acupuncture or homeopathy.
You need neutral observers, you need skeptics involved in
this, not people trying to get funding and trying to sell a
cause, and also there are a good deal of negative tests. I
haven't heard any testimony about the negative tests. There
is a good deal of literature where people are unable to
replicate these clai
One problem that we find is the failure of
replication, and a further problem is experimental bias.
Experimental bias enters into many fields, and particularly
into protofields where people are trying to establish a new
profession, and naturally, they want the results. So, the
tests must be done by neutral observers who are objective
and impartial, neither strong negative skeptics, nor strong
proponents, but people who are committed to scientific
One problem that we found continually in the field
of pseudoscience, and we have examined so many from
astrology to parapsychology, so many fields that claim to be
sciences, and one problem that we find is the protocol. The
protocol has to be very rigorous and very tight, and there
cannot be any sensory leakage.
Now, this commission is going to make
recommendations to the new administration, whoever it is.
Do we know who it is at this moment? I haven't heard.
Okay. It is vital that there be objective and impartial
tests, not special pleadings for funds for the government
for research or for insurance coverage. I mean what is at
stake really is the health and the welfare of the American
public, and you have an obligation to see that that is
Now, it may be that many of these pluralistic
alternatives that you have work. Okay. Let's have an open
and fair, impartial hearing. Let's not be biased pro or
con, and let scientific testing do the work.
It has been very effective in the last century in
extending the life of people and getting rid of infectious
diseases, many of the wonders of surgery. These powerful
methods ought to be extended, and not limited or reduced.
I submit that this commission should open its
panel to your critics, and that there be fairness, and that
you should invite those who disagree and can bring the
negative results and the contrary criticisms, so you can
You need a balanced position. I didn't find it
today. But, in any case, thanks for inviting me.
DR. GORDON: Thank you very much for coming. I
just want to say before we move into questions, we would
invite you to help us put together balanced panels of
researchers who would question in a honest, fair, and open
way some of the modalities that we are discussing.
DR. KURTZ: I think that is the best service you
can do to the public in investigating what is effective and
what is not.
DR. GORDON: We look forward to working with you,
and Steve Groft, our executive secretary, is very happy to
collaborate with you in putting together those panels. So,
thank you very much.
David, Tom, and Effie, to begin with.
DR. BERNIER: Well, as someone who has done
double-blind and triple-blind studies in the university
setting for a long time, I can tell you I wish it were that
simple. We have a document called the Physician's Desk
Reference. It contains some 10,000 medications that are
very commonly used by American physicians.
Do you know how many medications in that document
have ever been scientifically proven to be more effective
than placebo? Less than 10 percent scientifically. Does
that mean that those medications are not efficacious? Not
necessarily. It is just that the placebo effect is so
strong that it compares with many of the medications that
are used in the P
We use those medications in the P
DR. The language
that they use is very interesting. It says, "Possibly
effective in the treatment of --" which means it has never
been shown scientifically to be more effective than placebo.
Do you feel that the double-blind test is an
absolute acid standard for what should be utilized, what we
should write policy for, for access?
DR. KURTZ: Let me say first that we are critics
of medicine. Much of contemporary medicine falls short of
evidence-based medicine, so we would bring a similar
indictment against some of the traditional fields, and
surely in the area of medicine, there are constant revisions
and changes, which indicates that medicine is not fallible.
But I do think a double-blind test at least is a
first stage. The thing that intrigues us about acupuncture
-- and I know of many critics in China -- claims that it
works, is whether it is a placebo effect and whether it has
been tested by proponents or by neutral observers, but, of
course, the same thing applies to traditional medicine.
The other thing is do you have a coherent theory
and can you explain what is happening and why.
DR. BERNIER: Wait. Let me stay with this point
for just one second, if we could. In 1972, at UCLA, we did
a triple-blind study in acupuncture in which the people
sticking the needles in didn't know whether they were
sticking real or placebo points. The people receiving who
were receiving the treatment didn't know whether they were
being treated with real or placebo points, and the people
evaluating the data didn't know whether they were real or
The experimental team was kind of mixed about it.
Several of them were very skeptical, several were open, but
it didn't matter what their opinion was, because this was a
very tight scientific design, as tight as you could
When we analyzed the data after the study had been
conducted, we found quite reliably and repeatably and
predictably that when we would stimulate acupuncture points
we would get a reliable result, not so with the placebo. It
didn't matter what our biases were when we did that kind of
DR. KURTZ: Well, I hope that your account is
correct. The only way that you are going to persuade the
scientific-based medicine is if there could be independent
replications by totally neutral researchers without any
commitment either way.
I think that is true of science in general. You
have to replicate in any laboratory worldwide.
DR. BERNIER: But are you saying then that 90
percent of the medicines in the PDR, we should not have
access to those, those shouldn't be utilized because they
have never had that done?
DR. KURTZ: I am saying that medicine itself is
open to revision and reform. This is not a defense of the
medical establishment. As it is, it is a defense of a
method of inquiry, and that is the most effective method and
I think people who argue for alternative therapies should
appreciate this method and trying to use it. I reject the
claim here that we should abandon those methods. They have
been, by and large, effective where they are used.
DR. BERNIER: Just one other point as a scientist.
If we want to talk scientific method, the first thing that
we are taught as scientists is you can't prove the null
hypothesis, you can only reject it. Negative studies don't
prove anything, and I would take exception with your comment
that nobody is reporting negative studies. Because you
can't find the phenomenon, it doesn't mean it doesn't exist.
DR. KURTZ: But if you can't replicate it, why
should you accept it? You say negative studies. How many
studies have been done, have you reported in our literature
where an effort to replicate it turned out to be negative
completely? I mean you need that.
DR. BERNIER: It doesn't prove anything. You
cannot prove the null hypothesis, you can only reject it
with positive findings.
I am sorry, I will stop here.
DR. GORDON: I think the important thing here is
not so much to debate as to elicit what the ideas are of the
people who are presenting information to us.
DR. BERNIER: Okay.
MR. Miles, thank you for your very
thorough submission, and I want to expand on a couple of
questions that you ask here - should CAM be integrated with
You suggest that we actually should frame a
different question, and that is, should government policy
promote the appropriate availability of complementary and
alternative practices. Then, you talk about ways that we
can do that with better educational programs, legislative
relief, and benefit program redesign.
This is very helpful to my thinking because I
continue to, as a businessman, look to the consumer to
ultimately define choices, so I am in a different context
here with scientists, and I often have trouble making the
transference of what works in the marketplace with what the
world of "shoulds" are.
But I do want to just ask you to talk a little bit
more about whether you see CAM as a coexistence, a parallel,
or is it integration what we are looking for, is our role to
help promote and give sort of equal opportunity, equal
research, equal access, or is integration truly a valuable
goal in your opinion?
MR. MILES: The way I would approach that is that
our current system is based on competition, the different
practices are seen as competitive with one another. The
groups that I have worked with where they become
collaborative is where they get the best outcomes, in other
words, how can these practitioners work together, not as
competitors with one another.
So, I think that is a shift of model, and I think
that what you might call the corporatization of medicine in
the last 10 or 15 years is a move in the wrong direction,
because it tends to put practitioners into kind of a time
and motion study approach to doing the work, and I think
being with rather than doing to is a huge factor.
One of the drivers of that is the reimbursement
MR. CHAPPELL: Right. I mean health insurance is
not even the right name for reimbursement for promotion of
wellness. Health assurance is the right product.
MR. MILES: Well, we have lumped insurance
together with prepaid care, and prepaid care is not
insurance. So, I would try to figure out some kind of way.
The movement toward the medical savings account is
kind of a step in that direction, of separating routine care
from insurance, because people, when we introduced health
insurance back in the forties and fifties, we didn't
introduce it as insurance, we introduced it as benefits.
That is a totally different concept. You buy insurance on
your house or your car, you don't think of ways to collect
So, somehow, from my point of view, we have
created a public expectation that they can live their life
any way they would like to live it, and this insurance
system is going to rescue them, and somebody else is going
to pay for it.
I think until we deal with that straight out, I
think we are going to have a hard time integrating CAM,
integrating anything else, because the public expectation is
that they are a victim, and somebody will rescue them.
MR. CHAPPELL: That is what you call benefit
MR. MILES: Right, and if we don't deal with that
kind of basic belief system in the culture, I think we are
kind of plowing ourselves uphill.
MR. CHAPPELL: Thanks.
DR. GORDON: Effie, George, and then Joe.
DR. CHOW: Thank you very much. I have a couple
of questions, and, Berkley, I appreciate your whole
animation towards this and your pursuit of this in your own
personal dollars and time and everything.
You mention about accepting that which has been
practiced in other countries. Can you elaborate a little
bit, because we are seeking scientific evidence of this, and
what you are saying is that the existence of it, and the
value of it in the country is where it is, it has shown
value. It is enough that at least we can begin to use it.
Can you elaborate on that?
MR. BEDELL: I sure can. First of all, I think
MR. Kurtz' criticism is wrong. My God, how could you
invite anybody except him that would be more definitive in
objecting to alternative medicine? You are doing that. It
seems to me that you have done so.
But we come from a completely different concept.
Forgive me. I care about the patients and the people and
those that are suffering from disease, and I believe, maybe
you don't, I believe we don't have very good treatments for
most degenerative diseases. I don't believe we have got
very good treatments for cancer or Alzheimer's or Lou
Gehrig's disease, and right on down the list.
Under those circumstances, I think that if there
is a non-toxic treatment where it has been beneficial to
others, I believe that we are worrying about "scientific-
based medicine" where we say that the scientists, but we are
not really talking about the scientists, we are talking
about the pharmaceutical industry, the NIH, the FDA, the
AMA, the whole group, including my friend here or new
MR. Kurtz, who are all trying to say that you can't
do anything different until we spend years and millions of
dollars and go through a whole lot of tests to find out that
it satisfies the scientists. They don't worry about -- it
is not the people that have to be satisfied, it's the
scientists that have to be satisfied.
I would argue that we are a country here to help
the people, and I would argue that you were put on this
committee to be of help to the people, and I would hope that
you would recommend policies that made it possible at least
for those treatments to be tried.
That's all we need to do. We need to open up the
system, so that it can be tried. If we had a perfect system
of health care here, where everybody was doing well, that
would be fine, but I think you know we spend twice as much
as any other country in regard to our health care. In many
areas, we are right at the bottom of the list, if you really
look at measurements of life expectancy, all these sorts of
Under those circumstances, surely it makes sense
to remove the monopolistic system we have today and try to
make it possible for these things to be treated, and that is
my whole plea to you folks.
You know, you can do as you want to, and you can
say we ought to have this barrier and this barrier and this
barrier because the scientists want us to satisfy them. I
think you are here to satisfy the people.
DR. CHOW: Thank you. Just to clarify, I know you
are not against scientific research, what it is, is that you
just want faster action because you are seeing people dying
and that you want what has been used, to be used while we do
MR. BEDELL: That's right. Why should we only let
the people that have the money go to Europe to get these
treatments, and why shouldn't we at least, we are trying, as
I said, we are sending doctors in to check their records to
find out whether the things work or not. They have got to
submit those records to oncologists here to have them review
We are trying to find out, but you can be damn
sure I am not going to do some double-blind studies that
take seven years to find out. If you were my age, you
wouldn't want to do that either, Effie.
DR. CHOW: Well, at my age I would like to see
things expedited, but, of course, there is caution and there
is quality, and I know you are interested in that.
We would like to get what studies you have
already, Berkley, you know, that you find would be helpful.
MR. BEDELL: They are on the Internet, but we will
be glad to.
DR. KURTZ: May I respond to that?
DR. CHOW: May I make a statement, first of all.
DR. KURTZ: Oh, please.
MR. Kurtz or
DR. KURTZ: Either way.
DR. Kurtz --
DR. KURTZ: I am not an M.D., I am a professor.
DR. Kurtz, yes. I really appreciate
your point of view because when I get skeptics, I like open
skeptics, and that is what I feel you are is an open
skeptic, and I like your comment saying that you should have
not strong negative skeptics and not strong proponents
judging, and I think that is a very balanced view, so I
Now, I put in one thought, though. In CAM, and I
think maybe a lot of people don't understand that of CAM,
that it is not just another therapy, but we are talking
about that we treat individuals very individually and that
all the components that combine together doesn't add up to -
- one doesn't make two, it makes 10.
When you talk about double-blind studies, that is
what we are struggling with is a research that would be
suitable for this, and so how would you -- and maybe you
can't answer it here -- but do you think there needs to be
new research or revised research protocols that would be
acceptable to you as a research methodology?
DR. KURTZ: Well, first, I think the patient comes
first. Obviously, we are not concerned with pleasing
scientists per se, but helping patients, and what is the
best way of doing that?
We argue that the most effective way -- I mean,
for example, take laetrile, now, would you permit that in
this country verbatim, anyone can do it at any time, or are
there difficulties, shouldn't that be pointed out, and there
have been nostrums that have been used, that have been
injurious. I think the FDA being taken off herbal and
supplementary food in 1994, that was very unfortunate that
that act was repealed. I hope this commission will argue
that there ought to be some monitoring of herbal and food
But in any case, what is a protocol used, you need
tight protocol. You can't delude yourself that you have the
results. You want to see if they are effective. Now, maybe
five to seven years is too long, so perhaps if there is some
way of being fair to the science, I think that would be
useful, by all means. So, I think it has to be rigorous
protocol and replication.
DR. GORDON: Can we move along a little.
DR. CHOW: Thank you very much.
DR. GORDON: George, and then Joe, then Wayne, and
MR. DeVRIES: Actually, I think Effie touched on
what I was going to ask, but Berkley, you and I have had
discussions about the foundation and your organization.
Maybe you can describe some of the steps you are
taking and some of the outside, sort of third-party
organizations you are working with to help substantiate the
validity of the results that you are finding from the
various treatments in centers in Europe.
MR. BEDELL: We have visited 50-some clinics in 14
different countries, and there is always a medical doctor,
an M.D. on the team that goes in, and the main thing we are
looking for is to go through their patient records to see
what we can find.
We are using something that was used at the NIH
called Best Case Series. What we are really looking for are
a number of phenomenal cases that can be documented, and
what we are doing now, in fact, I just approved it today,
that we are now going to -- we have had those from two
clinics now translated into English, and we are now in the
process of having those submitted to oncologists here in the
We want to find out whether or not these things
work. We are not trying to sell laetrile or anything like
that, we are trying to find out. Where we have the
difference is that in my opinion, that if you have something
that is clearly non-toxic, and where there is evidence that
it is beneficial, that it should be more up to the patients
than it should be a bureaucrat at the FDA to decide whether
that patient can avail himself of that treatment.
We just plain disagree in that I believe we have
got such tremendous controls. When I was in Congress, I was
the chairman of a subcommittee, the Agriculture Committee,
and we had the same problem there, that it took more money
and more time to prove that crabgrass was effective than it
did -- to prove that a treatment for crabgrass was effective
than it did to satisfy that it was safe.
I said, "My God, you shouldn't worry about that."
I said, "If it doesn't work, people are going to quit
buying it anyway."
Now, it is a little bit different in medicine
because you might hurt people, but my argument on medicine
is that since it doesn't work very well for the crabgrass,
we maybe ought to be a little more open to letting them try
something if it doesn't hurt anybody or anything. That is
where we have got our big difference.
I don't know how well I answered your question,
George. I get too emotional about all this, but, you know,
people are dying, they are going to continue to die, and I
tell you I wouldn't be very happy for me to find out that a
friend had Alzheimer's -- which I just did -- or to find out
somebody has got pancreatic cancer, or this sort of thing,
and I think under these circumstances, it is time for us to
quit being so darned careful, careful, careful, careful,
let's do something about it, and I believe we had better do
something about it pretty quickly, and I believe you folks
have a tremendous opportunity here to recommend that the
system somehow be opened up with adequate safeguards, that
these things are not frozen out of our system.
DR. GORDON: Thank you, Berkley.
Joe, Wayne, Veronica.
DR. FINS: Congressman, I thank you for your
enthusiasm and your comments. I just want to ask you, and
DR. Kurtz can also comment on this, but it seems like
there is really not a fundamental disagreement, it is just a
matter of getting it done a little quicker, and I wanted to
ask you, Congressman, about the issue of what happens when
you have things that are maybe toxic, and maybe have an
element of risk, but also have benefit, what kind of
mechanisms can the government engage in - if you find
something in Germany in the clinic that has some associated
toxicity, it would seem to me that based on what you have
said and your prudential method, that you would want that to
be validated and have adequate safeguards, but from what
your testimony said, there was not adequate access at the
NIH and other federal agencies to conduct that in a
responsible way. Is that what you were --
MR. BEDELL: Well, I think that you have got a
completely different situation if you have a toxic
medication, assuming it is significantly toxic, you know, I
guess aspirin is toxic, but if you had any significant
toxicity, I think you have a completely different situation,
I think you have to be much more careful about what you do.
Fortunately, those that we have seen have had almost little
or not toxicity to the treatments we have seen.
DR. FINS: So, for more toxic therapies, you would
endorse going through the convention Phase I, II, and III
trials and the FDA process?
MR. BEDELL: Well, I wouldn't endorse anything the
FDA does probably, but the Access to Medical Treatment Act
that I talked to you about, that was one of the
requirements, that there be no evidence of toxicity, which I
I would not recommend that you people recommend
that toxic treatments can be used without further tests. I
believe it is a completely different situation when you have
something that is --
DR. FINS: Professor Kurtz, if I could just follow
up, using sort of the ethical doctrine of proportionality,
balancing risks versus benefits, how does that limited
recommendation of the congressman sound to you, where is no
toxicity and there may be benefit?
DR. KURTZ: How do you know there is no toxicity?
That is the real question, unless you submit it to some
kind of test. Take ephedrine -- I am not a pharmacologist -
- which apparently is very dangerous, can cause strokes and
heart attacks, how do you decide that it is toxic or not?
Who is to decide that? You listen to what the Germans say,
is that what you do, you have a German Commission, or do you
allow the FDA -- I think that act was a great mistake. I
don't think the free market is sufficient -- and I think the
gentleman here suggested it was -- for determining which
herbs or dietary supplements should be available.
MR. BEDELL: Could I reply to that?
DR. FINS: I would like you to if the chairman
would allow it. I would like the rebuttal, if it is
DR. GORDON: Sure.
DR. FINS: Thank you.
MR. BEDELL: I think you determine toxicity if you
have got enough patients that have been treated, and there
has been no toxicity. I don't know how else you would do it
any differently than that. It seems to me that is the best
way to prove it.
DR. FINS: Let me ask you, just to get concrete
for just a moment here. Would you both be in favor of some
recommendation from the Commission to set up a mechanism
within some federal agency to do the peer review in an
expeditious manner for things that had some evidence of
benefit and what we would classify as minimal or non-
existent toxicity just to expedite the process? Would both
of you gentlemen agree to that?
MR. BEDELL: No, I would not.
DR. KURTZ: I would.
MR. BEDELL: I don't trust the Federal Government.
I think that FDA is too tied to the pharmaceutical
DR. KURTZ: Well, do you trust the pharmaceutical
MR. BEDELL: No.
DR. KURTZ: Okay. Then, who is going to decide?
They manufacture the drugs.
MR. BEDELL: Wait a minute. I have been a
businessman. Business is motivated by profits and money.
Does anybody think that is different for God's sakes? Does
anybody here think the pharmaceutical industry is mostly
concerned about helping people rather than making money, if
there is some way they could help people and lose money,
that that is what they would do?
Do you think that they don't want to continue to
sell their products no matter what? That's just the
reality. That's not something radical, you know. I am a
businessman -- I was a businessman most of my life. We
tried to sell fishing tackles.
DR. FINS: So, we are not going to solve it this
afternoon, but I thank you both for your exchange. Thank
you so much.
DR. GORDON: Wayne.
DR. JONAS: Well, now, I am very confused.
MR. BEDELL: It is not the first time I have
confused you, is it?
DR. JONAS: I appreciate both your passion. It is
tremendous actually in finally, I think, getting at the
heart of a number of issues, literally at the heart.
Berkley, what I am confused about is are you a
Republican or a Democrat?
MR. BEDELL: You know what I am, Wayne.
DR. JONAS: Well, you seem to be shifting a little
bit, so I am thinking if we don't end up with a president,
maybe as a neutral party, you could step in and assist here.
In many ways you have answered a number of the
questions. I really do think good, rigorous science has to
be done. That is why I am involved in research. In many
ways, conventional medicine, for all the tips of the iceberg
of success it has, which are very good, there is a huge
carcass of failures, because they have not used good
scientific medicine and research, and actually they have
only recently figured out or begun to figure out how to do
it, and they still don't know all the ways to do it, and
that is why we are looking at a variety of methods.
Controlled trials, randomized, controlled trials,
never mind properly double-blinded ones, have only been
around about 50 years, so we are still trying to figure out
what they do and what they don't do.
I think the important thing is that we apply
proper rigorous methods to get the kind of information that
we need. We don't do laboratory research on new
psychotherapies in mice, for example, you know, nor can we
double-blind invasive surgical procedures, and so you have
to do the most rigorous methods you can for the particular
So, I think clearly differentiating those goals
and applying good research methods are important, and it
seems to me that often what happens is that there are
different audiences that prefer different types of
information even if they are all rigorously done.
What I am confused at, not from that, but from the
issue of what should the role of the government be in this
area, because on one hand, if we need a neutral party, if we
truly can't trust those with vested interests and biases,
then, I see no other place except the government that can at
least begin to do that kind of balance, but on the other
hand, I agree with Berkley that I am not sure if they can,
So, that is what I am in a dilemma about, do you
feel like the government should, in fact, have a role at
this, and if so, how should those priorities be set, should
we go after the controversial things, should we go after the
biggest killers in the society, should we go after the
things that are the most popular, or should we just leave
the government out of it and let the free market determine
it and pull off the government regulations?
I guess we could make recommendations from this
panel another way, couldn't we.
DR. GORDON: Response, Berk?
DR. JONAS: Perhaps
DR. Miles, maybe you would
like to address this.
MR. BEDELL: No, I think the government has to be
involved. I have been part of the government, I think they
have to be involved. I think the question is how should
they be involved, and my argument be that the government is
there to represent the people.
I think the people need access to non-toxic
treatments that may be better than what they are now
getting, and I think the government should be there to try
to help the people rather than to prevent them from getting
what might be best for them, particularly because of the
fact that in our capitalistic system, the system operates in
such a manner that the motivation for corporations is to
make money, and the motivation for corporations is to get
the government to do what they want them to do in order that
they can make more money.
I have been there. That is what it is. I think
you folks have, I would hope, should have a different
perspective of what you are here for. I don't think you are
here to make money, I think you are here to help the people,
and that is why I feel the way I do.
DR. JONAS: So, you do think the government should
be involved in trying to forward our understanding and
information in these areas.
MR. BEDELL: That's right, but mostly I think the
government ought to remove the roadblocks that they are now
placing in the way of having an opportunity to find out
whether there is a better way to treat disease than what we
are now doing.
DR. GORDON: Thank you very much for a very clear
answer on that.
MR. MILES: One of the factors in that is that
since most of these medical practices are regulated at the
state level, not at the federal level, there are a lot of
regulations at the state level that prohibit or limit the
ways that practitioners can work together, and they are
thought of in the terms that the only reason that
practitioners would work together is because they were going
to split fees or they were going to do something like that
to increase their revenue potential, but a lot of
practitioners are trying to work together now in
collaborative ways, and they are running into these kinds of
So, the recommendations around that kind of thing
can be --
DR. KURTZ: I wonder if I could add that I think
the general welfare of the people is one of the purposes of
the Constitution of this country, and we cannot abandon
that. Obviously, this is a free market economy, but
regulation is important and necessary. It has to be
prudential, so that we disagree on how much regulation, but
I would also -- I would not abandon the medical professions.
I have seen a strong indictment of medical
professions. People in the health care industry are
concerned about the public good, and have devoted their
lives to it and do the best they can, and we simply should
not say they are opposed to any further changes.
DR. GORDON: Veronica.
DR. GUTIERREZ: To change the pace here a little
bit, my question is for Richard Miles.
I noticed twice in your memo that you made
reference to the difference between routine health care and
catastrophic insurance, and what I am asking is that we are
having a meeting on this very subject in May 2001, and you
must have given quite a bit of thought to concepts of how to
separate the two, and I would like to have that information.
MR. MILES: Okay. I definitely can put some
thought to that, because I think if we don't separate the
two, we will perpetuate the public concept of benefits,
which means that I am going to get all these services and
somebody else is going to pay for them.
That is a major responsibility shift. Most of the
self-care lore in this culture has been lost in the last 40
years. We used to have all kinds of ways of taking care of
things with Aunt Maisy's remedies or whatever, that worked
to a certain extent.
A lot of that has been lost because the public
attitude is that I can go to a high-tech expensive
professional and somebody else will pay for it. That is a
huge attitude shift.
Another factor that I would add to the discussion
is most of the research that we are talking about is
research to validate technologies. That is not necessarily
research to improve someone's health.
If we could shift our research paradigm and say,
okay, what can we do to improve people's health, because
most of the technology validation research that we do is
product oriented, which feeds into the market economy that
we are talking about.
So, if you want to do something that is really
valuable for people and helps them improve their health, and
it doesn't develop a product, or doesn't develop something
you can market, there is a tremendous tendency not to pay
much attention to it.
One of the things that I mention in my document
there, that I didn't get a chance to talk about, is the
whole concept of a health advocate coordinator kind of
person that knew about CAM practices and knew about
I think a person like that out in the world would
change the system dramatically, simply people would have
somebody to go to talk to who could explain some of these
things and indicate the options, because I think that public
options and people having the decisions to make, having the
option to make the decisions about the kind of care they
want, would revolutionize the system. It doesn't work now
because the question is not will this help me, the question
is, is it covered.
DR. GORDON: Tieraona, did you want to ask a
question? I couldn't tell. I know Bill does, and then we
really need to end because we are running overtime again.
DR. LOW DOG: I guess I just want to clarify that
with DuShea, in 1994, it actually did increase access or
guaranteed access for dietary supplements and botanicals to
assure the American population that they would have access
to many, many substances.
Now, there were some problems obviously with the
FDA, because they have to prove harm, so it is sort of
things are already out in public, then, we have to come
back, which was some of things about ephedra.
But I guess the notion of non-toxic is always
something very interesting to me as somebody who deals with
botanicals and their pharmacology, is the notion of
something being non-toxic, I think it was [Paracelsus] who
said, "The dose determines the poison."
Toxicology is not real simple, and, you know,
women consumed alcohol during pregnancy for hundreds and
hundreds of years, and it took until 1972 to be able to
understand the fetal alcohol syndrome was caused by
consumption of alcohol during pregnancy.
That was a toxicity, a teratogenicity that was
never noted for more than a thousand years, so I think we
have to be diligent with new products and new substances
that we bring in. I think people need to have the access.
I think that is what the purpose of DuShea was,
but I think that we need to be careful when we talk about
toxicity, because was it in somebody who is pregnant, is
that in a 3-year-old, is that somebody with liver failure.
I think when we are talking about something going
out to the American public where you just go buy it off a
shelf, it is not going to be under the auspices of a health
care professional in Germany that is administering it, I
think that we do have some obligation to be diligent with
our admissibility of those products. Would you agree?
MR. MILES: Me?
DR. LOW DOG: Yes.
MR. MILES: Yes.
DR. LOW DOG: Good.
DR. GORDON: Bill.
DR. FAIR: I would again like to congratulate
Kurtz. I think that was a very open presentation and I
My problem -- and I don't know exactly how to
phrase this question -- but my experience of working for 16
years at a major cancer center was that we can always do
something. When Berk was impassioned there about people are
dying, we have to do something, I saw that all the time from
radiation therapists, from chemotherapists, you can always
take another bottle off the shelf.
Fortunately, surgery is getting a little bit more
restrictive because it was the oldest specialty, and we have
gone through all that nonsense about removing half the body,
and so forth, but the other cancer therapies are still to
that point, and that is what led us to things like
autologous bone marrow transplantation in women with breast
Insurance companies were sued, PPOs were sued, you
have to pay for this. Physicians testified this was the
only chance, one that we now have four studies, and we
showed that it doesn't have any effect at all.
So, my question is that this same kind of passion
that Berk evidenced there, given the fact that it is not
limited to complementary medicine, and that it is not just
avarice that is driving this, it is not the pharmaceutical
firms or the physician that is saying if I give more
chemotherapy, I am going to make more money, it is truly an
effort to try to do good.
But what kind of legislation would you recommend
that would cover those kind of unnecessary use in CAM
therapies, and yet we could extend it to conventional
therapies and protect the public in that way, because these
are toxic therapies, they are not benign therapies.
DR. KURTZ: Yes. I think public education. I
agree that preventative medicine is central, and there has
to be full public education from the earliest grade schools
on, so I would put health education in grammar school, high
school, throughout the colleges.
It is the informed citizenry in one sense. It has
to know whether or not he or she wants this treatment, so it
depends on informed consent at the same time. This is
changing. The state of the art is changing. I think people
do not recognize the fact that medicine itself is fallible.
There are great achievements and successes, but we need
always to be willing to revise the therapies at any one
Incidently, the hospice movement that was
discussed earlier, I don't know, is that alternative
medicine? I think we all support the hospice movement.
DR. GORDON: If you two would be very brief, we
are 10 minutes behind, so we will lapse a few more minutes,
if that is okay with everybody. Yes? Okay. Then, George.
DR. BERNIER: I have a question for
In your letter to us, you said that -- you sort of
held things back, I guess -- the question was should CAM be
integrated with conventional medicine, and why or why not,
you said, "I do not think it should be integrated. I
deplore the effort to do so."
DR. KURTZ: Yes.
DR. BERNIER: I guess my question is, if, in a
validation process, we found that a third of modalities in
fact survived a good scientific test, and recognizing that
there are a variety of skills that are involved in the
practitioners, would you then feel that CAM medications are
not to be part of the mainstream?
DR. KURTZ: Well, I said that merely using CAM as
a generic term, alternative medicine is a generic term, does
a great disservice because there are so many things under
I mean you have therapeutic touch, you have
psychic healing, so many things. Now, some of these
alternative therapies may very well work. Those that work
should be integrated, but those that do not -- and I think
you have a lot of enemies out there of alternative medicine
because they are afraid that if put this in, what seems to
perhaps have some evidence, that you have to put everything
That is why I am against the term CAM to include
everything on this list, and I think it is a great
disservice to do that.
DR. BERNIER: I would urge you to look at it as if
a great many may well get to be validated.
DR. KURTZ: Well, if they are validated, yes,
integrate it. That is part of scientific medicine.
DR. GORDON: Thank you. Tom.
MR. Miles, in this paradigm that
you are envisioning in your report, would you make room for
patents and exclusive marketing on discoveries?
MR. MILES: Well, that is a huge question.
MR. CHAPPELL: As you know, a natural substance
cannot be patented.
MR. MILES: Right.
MR. CHAPPELL: But I can add camomile to echinacea
and have a discovery that is patentable.
MR. MILES: The whole question of patenting and
the whole idea that is coming up in bioengineering and that
kind of stuff, just gets to the edge of, from my point of
view, a very dangerous place.
MR. CHAPPELL: Could you help the Commission on
MR. MILES: Because I think we ought to be getting
closer to nature rather than further away from it, and the
idea of taking things and manipulating them a little bit,
and then calling that a product that I can patent -- well,
perhaps the most dramatic example I am aware of right now is
a farm in Ontario where Monsanto has put this genetically
engineered corn in next to this guy's farm, and the pollen
is blowing over into his farm, and Monsanto has sued him for
stealing their patent.
He has sued them back for polluting his farm.
Well, that is the level that this thing is going to get to.
Again, as I said earlier, this thing of managing living
systems, we have this kind of hubris that we are going to be
able to manage life, and I think we have carried that about
as far as we can carry it, and we are up against some really
major barriers around that.
If you look at most of the major social
environmental problems that we have in this culture, it is
the result of that hubris. In other words, the air quality
is going down, the water quality is going down, the farms
are becoming contaminated, because we think we can take
science and technology and fix nature.
Well, we are not being very successful with that,
and my point, the same thing in the field of medicine, is --
well, I mention in my report that I see kind of a spectrum.
At one end of the spectrum is immediate, traumatic, crisis-
type care. The other end of the spectrum is chronic
As you move across that spectrum, you move away
from the effectiveness of conventional medicine and toward
its ineffectiveness, because chronic degenerative disorders
are systemic problems, they are not diseases. They are not
something that can be fixed.
So, when you get over to that end of the spectrum,
rehabilitating the system or rejuvenating the system, or
whatever you want to call it, can be a very effective way to
deal with some of those chronic disorders, but you don't fix
the disorder. You revitalize the person, so to speak.
DR. GORDON: Thank you. Thank you all three. I
think these are wonderful examples, each one of which
illuminates a certain area that we need to grapple with as a
commission. So I really appreciate your coming and sharing
and talking with us.
DR. KURTZ: Thank you for having me.
DR. GORDON: We will take a five-minute break, and
then we will have the final panel come out.
DR. GORDON: This is the second part of the panel.
With the first part of the panel, I hope you were able to
see that what we are trying to reach for and look at are
broader views, not necessarily views that agree with
another, or even views that complement one another,
necessarily, but differing views of how CAM can be
integrated into service delivery systems, really views that
have to do with world view and ideology even more than they
have to do with practical considerations.
So that is why we have asked these two groups of
panelists to come and to kind of expand our vision and help
us take a broader look, and raise some of the issues that
got all the discussion going.
So in that spirit, I would like to ask Donald
Kendall to be the first speaker.
DR. KENDALL: Thank you. I would just like to
clarify that I am a member of the National Guild of
Acupuncture and Oriental Medicine, which was set up under
the auspices of the Office and Professional and
International Union of the AFL-CIO. This is a professional
guild for licensed practitioners of Oriental medicine and
We are a new organization and what we are trying
to do is to get everything organized on a national level,
not to compete with our professional organizations, because
you have to be a member of one of those organizations to be
on the Guild. So the Guild thanks you for inviting us. I
would like to share some of our thoughts on integrating
complementary and alternative medicine into conventional
Now, of course, we are promoting health and well
being through the utilization of acupuncture Oriental
medicine, but one of our goals is to recognize the real-
world -- I am going to use the words -- "coherent theory" of
physiology on the physiological basis of acupuncture and
Oriental medicine that has been confused over the years
because of one interpretation of what the ancient Chinese
said, which was fundamentally flawed, and more recent, and
some older, interpretations that are more in line with
modern understanding of physiology.
Now, we submitted answers to five questions, and
after a little introductory march here, I am going to answer
those, but not in the same order. I want to answer Question
4 first, because it is the most important item of those five
Oriental medicine is a physiologically based
primary health care approach that historically, maybe 3,000
years or more, has always been part of world medicine, a
major base of world medicine. There is a very rich
diversity in this field, I mean, a wide range of modalities.
This is why there is sometimes some confusion on
who does what and different techniques or different
approaches. It involves herbal medicine, nutrition, heating
therapy. It involves manipulation, articulation of joints,
specialized massage and pressure techniques. It involves
other physical things like cupping and scraping, lifestyle
counseling, exercise therapy, rehabilitation, movement and
breathing exercises, movements like tai chi and gao lin
exercises, and breathing exercises like qigong, preventative
care, and then a very sophisticated needling therapy that is
called acupuncture in the West. This is totally a Western
Acupuncture is obviously used to treat ailments in
our system by stimulating certain critical locations on the
body in order to control and regulate many physiological
things, including the circulation of blood and vital
substances, regulating autonomic systems, and endogenal
mechanisms to restore physiological balance. This includes
restoring somatic, visceral, immune function and
homeostasis, as well promoting pain relief and tissue
So one of our primary goals is to try to put our
profession on a solid foundation that uses the same
recognized world body of physiology. There is only one
human physiology we know of. Now, the difference in Chinese
medicine, or in Oriental medicine, we have a different view
of it. We are looking at the organization of the body in
terms of visceral-somatic relationships, in terms of
somatic-somatic relationships, in terms of visceral-somatic
relationships, to explain how this works, and also how the
treat diseases, to restore function of the body.
Fortunately, acupuncture research and
neurophysiologic research over the past two decades have
provided us sufficient insight, enough information now that
we have been able to explain how the logical insertion of
needles can bring about a medically significant reaction in
the body, a restorative process in the body.
DR. GORDON: It's time, yes.
DR. KENDALL: Okay.
DR. GORDON: We will come back. We want to find
out how you are integrating this into your work with the
DR. KENDALL: Sure. No problem. Thank you.
DR. GORDON: Thank you.
MS. CAMPBELL: The American Preventive Medical
Association was founded specifically to lobby at the federal
level for health care freedom. We work to increase the flow
of information about CAM therapies to consumers and
practitioners, as well as increase access to those
We do not promote one type of practitioner over
another or one therapy over another. Our goal instead is to
increase patients' awareness and access to the full range of
health care options. We led the effort, for instance, to
pass the legislation that created the National Center for
Complementary and Alternative Medicine at NIH. We did that
for two reasons, first, because it was ineffective as an
office, and second, because we believe there is a crying
need for more and better research into CAM.
Part of that legislation created this White House
Commission, as you know. We were also painfully aware of
the fact that there was not coordinated, concerted effort to
achieve an integrated health care system. In fact, we
discovered that not only was the federal government not
doing everything it could to ensure that consumers have
access to a full range of treatment options, it was also
getting in the way of access and education regarding CAM.
People often call our office looking for help.
They want help finding a practitioner who uses natural
therapies, who knows about nutrition, who offers
alternatives. Typically, these people have already been
through the conventional system and they feel either abused
or disappointed. Often, they are angry because their
regular doctor didn't tell them they had other options.
Sometimes they share stories that break my heart.
A mother who is facing the loss of custody of her children
because she feeds them a vegan diet and doesn't want to
vaccinate them; a father whose daughter was killed by
radiation therapy for a brain tumor, even though the
hospital's Tumor Board was well aware of a safe, effective,
but experimental therapy undergoing clinical trials, and
knew that radiation had never worked in these types of
cases; or an elderly man faced with driving hundreds of
miles for a life-saving, off-label therapy that his own
physician is now afraid to offer because his colleagues in
that state have lost their licenses for doing so.
Physicians call us frequently, too. They call us
when their medicine board starts harassing them for using
alternative therapies or unconventional diagnostic tests.
They are harassed for getting kids off Ridalin, or for
daring to treat cancer patients with something other than
chemo and radiation.
Medicine doctors in this country who are using CAM
are running scared. It is pathetic. Instead of being
praised for getting people well, they are being harassed,
censured, and shut down. I am not talking about cases of
malpractice or quackery. I am talking about good doctors
doing everything they can to help patients, and their
patients are happy and healthy, and enjoying an improved
quality of life.
It is both embarrassing and frustrating to me that
in a nation such as ours, built on the bedrock principle of
individual freedom, built by founding fathers who risked
their lives to get the government off their backs, that we
are now beleaguered by a medicine dictatorship that is more
interested in maintaining its own power base than in seeking
out and incorporating the best the world has to offer
In my naivete, I used to believe that doctors or
researchers discovering and innovative therapy would be met
by colleagues, or the FDA, or NIH, saying, Hey, you could be
on to something here. Let's pursue it.
No. Instead, they hear, That is unapproved. That
is not what I learned in medical school. That is not the
way we do it here. Or, worse yet, if you keep doing that,
we are going to through you in jail and take away your
A significant part of the problem we are facing
today is due to the fact that we have created and are now
propping up a tremendously wealthy, powerful, successful,
and dare I say, monopolistic allopathic medical system that
is doing everything it can to stifle the competition.
Let's not encourage by sicking the federal
government on the competition. Let's not encourage that by
making criminals out of the people and the companies who are
doing their best to offer patients something better. Let's
take the high road and force the system to put patients
first by investigating and validating, and then
incorporating a more thorough range of health care options.
Let's make our anachronistic federal programs
reflect advancements in science. If the existing system
does not accommodate new products and therapies, let's
change the system, not abandon the products.
My hope is that this commission will seize the
great opportunity I believe you have. You can start by
recommending passage of the Access to Medical Treatment Act
that Berkley recommended. You can go further by
recommending that the FDA and the Justice Department be
prohibited from prosecuting practitioners or suppliers
unless there is evidence that they or their products have
been seriously harmful to patients.
Our health care system is confronting a huge
challenge. You have a chance to shift the health care
paradigm in ways that can ensure that Americans truly have
access to the entire toolkit, not just the hammer, for
health promotion and disease treatment, and I hope that you
will not miss this window of opportunity.
DR. GORDON: Thank you very much, Candace.
MS. FORZLEY: Good afternoon. Last but not least,
here I am, talking about the law and the business side of
CAM this afternoon.
I chair the American Bar Association Commission on
Complementary and Alternative Medicine. I really have just
two points to share here this afternoon. The first one is
that I want to bring to your attention that some
international law and related materials restrict what policy
recommendations can be made on access and delivery, or they
can be aspirational, and at the very least, they can be
extremely helpful reference material.
I have heard of a number of instances this
afternoon in discussion that I know you can find answers to
from other countries and systems of operation. An example
is the International Convention on Economic, Social, and
Cultural Rights, which is both aspirational and helpful, in
that, an international standard of health is enunciated and
access is defined.
The standard is that every human being is entitled
to the highest attainable standard of health conducive to
living a life in dignity. The United Nations Committee on
Economic, Social, and Political Rights, which administers
this treaty, is helpful by defining the elements necessary
to achieve the standard, one of which is access. The U.N.
defines access to include non-discrimination, physical
access, economic access, and information access.
Now, keep in mind that when the United States
ratifies an international treaty, that treaty becomes
domestic United States law. I have selected the area of
intellectual property rights as an example of how
international law can set an outside policy limit. I have
done so because right now an ethical, legal, and public
health debate rages with respect to access to drugs, most
notably in the news on AIDS.
That same debate, part of which is based on
intellectual property law, can arise with respect to
botanicals, herbals, and indigenous medicinals. Of the many
treaties that may have an impact, two that absolutely do are
the Tripps Agreement and the U.N. Convention on
Biodiversity. These define rules on plant variety and
exclusions from patentability for diagnostic, therapeutic,
and surgical methods of treatment.
I would urge the Commission, therefore, to
forthwith make an international analysis an integral part of
your work, not only on access and delivery, but for all
elements of the mandate of the Commission.
The second point I want to make is that access and
delivery of CAM are impeded by the lack of basic business
skills, governmental support services, and information on
capital formation and funding sources. I base this
statement on the results of the Business Model Pilot Study,
which I did in Boston earlier this year, and my 24 years of
experience in developing and teaching business courses.
I will explain in light of two study conclusions.
The study began with a question of whether any CAM
organization was making money, and, if so, under what model
did they function. First, there is confusion over what
people are delivering and the difference between and healing
and a business model; are they delivering wellness or
sickness treatment services, products or services, education
or health care.
No entity can succeed financially unless it
decides what it is delivering and who wants it, or basically
who wants access to it. In business parlance this is called
the five Ps of marketing, or Marketing 101.
Another study conclusion is in the area of
credentialing and licensing. Access and delivery will not
be fully implemented, if my study findings are correct,
until harmonized national standards are established. I
would add even that internationally harmonized standards
should be established.
I know of no other industry that would tolerate
such a hodge-podge of essential professional regulations as
licensing and credentialing. I think it is telling that no
respondent would share credentialing guidelines, claiming
them as proprietary. This is like saying, well, we want
employees, but we won't tell you what the job description
For this reason, I have invited JACO [ph] to
address the Conference on CAM Law and Regulation at this
summer's annual meeting of the American Bar Association.
The resources to fill the lack of basic training and support
services are already in place in the public and private
infrastructure. They simply need to be redirected toward
the CAM community. This was done in the 80s with the
entrepreneur. It was done in the 90s for companies going
global, and now it is health care's turn.
Thank you for the opportunity to share my views.
DR. GORDON: Thank you very much.
Do we have questions from commissioners? Who
would like to begin?
While you are collecting your thoughts, I want to
DR. Kendall, I would like you to address the way this
particular CAM benefit or acupuncture, and perhaps Chinese
medicine, is being integrated into programs for unions.
DR. KENDALL: For unions?
DR. GORDON: Yes. How is that happening? Can you
tell us a little bit about it?
DR. KENDALL: The parent union, the Office and
Professional International Employees Union has several
guilds, one of them for medicine doctors, one of them for
podiatrists, and one for, I think, some other health care
workers, and of course the new people are practitioners of
acupuncture and Oriental medicine.
The way they can help has to do with the fact that
they have a lot of experience in trying to integrate things
into the system. The AFL-CIO union, for example, has a 13-
and-a-half-million member base. If you include their family
members, they represent about 45 million Americans. They
are well trained in lobbying the federal government and
state agencies as well.
So one of the problems they have had in this field
of trying to get some kind of parody within the medical care
system, is lack of some hard core focus on the part of our
practitioners. A lot of different schools of acupuncture,
Oriental medicine, from minimal training from 1,000 hours up
to 4,000 hours. So we have had a wide range of standards,
when we really should have some kind of uniform standard.
So the thought was, when the union approached us -
- actually, not me; I am just a member, but approached
Preevy [ph] and
DR. Wright who is the vice president -- it
became obvious that this would be an opportunity to get some
voice in this medical field because it has been difficult.
We have been doing this for 25 years, and are
still really not into the system. Patients can't get
reimbursed for everything. Now some insurance companies are
starting to cover it. The federal programs, basically,
don't recognize it, don't cover it. All the research that
is done --
DR. GORDON: I am wondering, though, if you have
used the AFL-CIO, if the AFL-CIO has said, yes, we want this
to be included in benefits for our members, or if you have
negotiated with them about this.
DR. KENDALL: One of the things when they
approached us was -- in fact, I think the main insurance
carrier they have does include acupuncture. They have some
other ideas on how to make this Oriental medicine available
to their 45 million family members. Certainly this is one
of the ideas.
DR. GORDON: Is there an active movement among
union members to bring not only acupuncture, but other CAM
benefits, health promotion, into insurance plans?
DR. KENDALL: Well, we would have to talk to the
parent union, but I think the answer is there is definitely
a growing trend, that people want to have the ability to go
to alternative therapies, even though some of these may be
offered by medical doctors, simply because there is no
single medicine system that can cure everything because
people are just uniquely different.
DR. GORDON: I am wondering if there is somebody
at the level of the parent union whom we also could be
talking with to see what they are doing and the directions
they are going in.
DR. KENDALL: Yes. We can do that. We can get
you in contact with the -- in fact, I think the president of
the union is right here in Washington.
DR. GORDON: I would hope so. That would be
DR. KENDALL: We know it is the lobbyist center.
DR. GORDON: That is exactly the kind of thing we
would like to hear. We hear from your side what you are
trying to achieve.
DR. KENDALL: We are trying to do something from
the professional side, and then you are saying what about
the delivery side and the interest of the consumers.
DR. GORDON: That would be great if you could help
us with that.
DR. KENDALL: We will definitely give you some
contacts on that.
DR. GORDON: Thank you.
DR. KENDALL: In fact, might even set up a meeting
DR. GORDON: Joe.
DR. FINS: For
MS. Campbell, if I may. I was
reading through your testimony, and you used the phrase
about medical dictatorship.
DR. KENDALL: I didn't use that phrase, I think.
MS. CAMPBELL: I did.
DR. FINS: No,
MS. Campbell did.
DR. KENDALL: Oh, oh.
DR. FINS: You might have wished you used that
DR. FINS: But I want to ask you, just to get
beyond the rhetoric and all, there is a lot in your
testimony about self-regulation of CAM practitioners by CAM
How can we create a neutral body so that there is
an honest broker who is neutral? What would you envision,
sort of neutral regulation? Because I think, just to argue
the other side, the skeptics out there, some of whom you
have heard of from this afternoon, and other policymakers,
say, look, we have to maintain the safety of the American
public at the same time giving them access to CAM therapies.
So what kind of mechanism would you suggest us to
think about that would balance these conflicting needs,
access and regulation?
Obviously, you are not thrilled by the Federation
of State Medical Boards. Is there anything that can be done
with them? Are there alternatives?
MS. CAMPBELL: Well, I think there are two angles
to answer this. First of all, there is a trickle-down
effect from the federal government to the states. So
whatever the FDA does, the state medical boards tend to
abide by. So if you fix a problem at the federal level, you
tend to fix it at the state level, even though the states
have the constitutional right to regulate the practice of
medicine. The FDA has inserted itself tremendously in that
I think if you do things like get the federal
government, in this case specifically the FDA, out of the
business of withholding information, vetting how much and
when information can be shared, that would free things up
tremendously at the state level, solve a lot of problems for
You can look at ways that the federal government
discriminates against different types of practitioners. For
instance, there is a bill that I don't think has passed in
this Congress yet that would allow for Medicare
reimbursement for nutrition education for diabetics. It is
probably a great idea. It will probably save billions of
dollars, but the way the federal government has drafted that
bill, the way that the sponsors have drafted that bill, is
to restrict reimbursement only to registered dieticians.
I would argue that somebody with a PhD in
nutrition, maybe a chiropractor with training in nutrition,
should also be allowed to be reimbursed. So there are
little ways through the federal insurance program where we
could eliminate discrimination, which then would have a
trickle-down effect at the state level, with HMOs, with
DR. FINS: That is a good example to just kind of
get more specific. Who would set the standard of whether or
not -- a PhD gets accredited, gets reimbursed, but a masters
degree wouldn't, or a bachelors degree wouldn't, or someone
who has been practicing in a naturopathic way without any
kind of degree for 25 years and is esteemed in their
What kind of body would set the standard that
would allow us to say, that person gets reimbursed, that
person is credentialed. What kind of mechanism would be
MS. CAMPBELL: Typically, that happens at the
state level, and it should probably stay there. I think if
it is legal in a state, if someone is authorized to offer
health care services in a state, the federal government
should honor that. If a state decides that unapproved
therapies are accessible, then the FDA should honor that.
DR. FINS: So, would you be satisfied -- I mean,
some people have suggested this at our other sessions --
that the Federation of State Medical Boards, each state,
have some representation of CAM practitioners to kind of
balance? Or, do you think that would be inadequate to give
access to the practitioners that you represent?
MS. CAMPBELL: Well, I think I share the concern
of one of the acupuncturists who spoke earlier, who said
that it is very uncomfortable for, say, an acupuncturist to
be under the authority of a medical board, because whether
it is true or not, there is a huge perception that they are
not understood and they are second class citizens.
I understand that boards are normally a factor of
payment. If you don't have enough acupuncture in a state to
support a board, you have to be under the medical board. I
don't think that is an insurmountable problem, but I would
worry, I think, on the part of practitioners, that if they
are stuck under the Federation of State Medical Boards, they
are not going to get a fair hearing. So there would have to
be a separate body.
I think emerging professions need to do more in
terms of setting credentials for their own practitioners.
Again, it is not rocket science, it just hasn't been done
yet. In the past, the federal government has done a
tremendous amount to help this burgeoning allopathic medical
community. Those resources have not been dedicated to these
other types of practitioners. We wouldn't have the hospital
system, the internships, that we do now without federal
So if the federal government treated them fairly
equally and turned resources toward that, I think the system
would develop just as the allopathic did.
DR. FINS: Just, historically, it has been a 70-
or 80-year process.
MS. CAMPBELL: Right.
DR. FINS: With the evolution of the first medical
boards, I think, in the 30s. So there is a lot of catching
up to do here to get regulatory parity.
MS. CAMPBELL: It is not fair to expect the CAM
community to do it all on their own, because the biomedical
model was not developed with its own resources.
DR. FINS: Thank you very much.
MS. FORZLEY: I would like to talk about the word
"harmonization," which is something that is used in
international law, and it is used within the European
economic commission. It may provide a course of action.
There could be a federal body, whether it is Congress or
this commission, or some other entity, that establishes
guidelines for what should be the requirements for licensing
and credentialing at national level.
This is being done in Europe at this time. So
that, a German acupuncturist can qualify under the French
rules, under the Italian rules, and maybe the British rules.
So the methodology, legally, is called "harmonization."
It is not making the laws the same from state to
state, but it is harmonizing them. It also is very valuable
when you get to the discussion on education and training on
how to come up with a national system that doesn't remove
states' control over who practices what within their borders
but gives them higher level to work under. That is the way
of an international treaty, by the way.
DR. GORDON: Thank you. Effie.
DR. CHOW: I just have a simple question of
DR. KENDALL: Yes.
DR. CHOW: In here, you elaborated on the
organization is to promote health and well being.
DR. KENDALL: Yes.
DR. CHOW: And your definition of Oriental
medicine focused on the treatment. Can you elaborate where
is health promotion in there? Or, did I misread it?
DR. KENDALL: Oh, in the definition? Promotion
wasn't in the definition. The only reason I provided a
definition is, I know there may be some members on this
board, not you of course, that haven't heard of the wide
diversity of modalities that is included in Oriental
medicine, with acupuncture just being one of those.
So that was just a strict definition of that.
DR. CHOW: But, do you feel that Oriental
medicine, one of the primary function is health promotion?
DR. KENDALL: Oh, is, yes. Right.
DR. CHOW: I didn't see it in the definition. I
just wanted to clarify.
DR. KENDALL: Well, all of these are used to
promote health, all these modalities.
DR. CHOW: Thank you.
DR. GORDON: Wayne.
DR. JONAS: I had a couple questions. First, I
want to thank
MS. Forzley for this nice summary. It looks
like a very nice beginning, and I think it would be very
useful to have a systematic comparison of what goes on in a
variety of countries.
I assume this is an ongoing project and you are
looking at other countries like Australia, and perhaps some
of the Asian countries?
MS. FORZLEY: Yes. Actually, I didn't mention in
the report I wrote for today the Interview Project, which
has done some specific one-on-one interviewing with
providers from other countries. I have talked to the
aromatherapy industry in Australia, the physical therapists
people in Germany, and a psychiatrist that practices CAM in
I think a lot can be learned from that. Plus, the
group of lawyers I put together to try to move the
International Research Project forward have reported just
what happens in their own countries, just from their own
experience. That was another source of information.
I think there is a lot to learn there. Also,
because in many other countries, legal systems have had to
learn to incorporate cultural traditions without infringing
on them somehow, and so much CAM comes from cultural
tradition. We really walk a very funny road when we try to
regulate a tradition.
DR. JONAS: Right. I have a question, really, for
any of the panel members, related to this. And that is, a
lot of the attempts to regulate medicine, whether it be in
states or in other countries, is based around the idea that
unregulated medicine is harmful.
I am wondering if anyone has ever actually looked
at this, using good research methodology, to see what the
evidence is for harm in countries or in situations where
there is very little regulation and perhaps extensive,
should I say, free-for-all type of medical practice.
England comes to mind as a fairly unregulated
situation compared to other more regulated situations, to
actually see if harm actually occurs in those situations,
or, does the market and do the public do a fairly good job
of regulating themselves.
Has anyone actually looked at that systematically?
MS. FORZLEY: Well, the most systematic review of
this question I have taken so far is looking at the concept
of consent to treatment, and I compared it internationally
in other countries. Depending upon the type of legal system
in which you find yourself, there will be a different
analysis of consent to treatment. The Brits think very
differently than the Australians on this. The French think
even more differently.
The French think that we have a contractual
relationship between a patient and a provider, as opposed to
a consensual relationship. So you take everything out of
tort. So we don't any longer have a question of harm in the
negligence sense of the word. We have now a breach of
contract, which is a very different approach.
So I believe that further analysis of that
question would be very helpful, but it again, brings us back
to how cultural traditions treat things, because law and
health care, and some of the principles of it literally come
from our culture.
The other comment I can make is I think that we
really ought not to do everything ourselves, that there
should be some effort made to work in conjunction with our
brothers in the EC, and in other regions of the world
because I don't the United States grappling with CAM issues.
Lots of work is being done on CAM in other countries from a
In some countries, different entities are
regulated. Here, for example, if you take something like an
herbal preparation, it is not subject to the FDA anymore,
but you now have Federal Trade Commission regulations that
impact it. So that is an approach we can take, and if I can
ever get to the provider of it, I might have a claim against
What the French do, as an example, is they
regulate the dealer, they regulate the store. So herbs can
only be sold at herb stores. You can go to a pharmacy for
patented drugs, and then you go to an herb store for an
herbal product. The seller is regulated.
The Brits do things like, instead of regulating
the acupuncturist, they allow the local level of regulation
to limit what can be done. The only way you can open up a
shop to provide acupuncture is to go get a local license
from the London authorities, which I have described in my
paper, you have to demonstrate a national certifying board
that regulates before you can then get a business permit.
So I think there are a lot of approaches we can
take beyond what we now do. I don't think medical boards
are the only body that can do it.
DR. JONAS: I think it would be very interesting,
maybe, to take a limited number of conditions or patients
and try to systematically examine, is there increase,
decrease, alterations in harm specifically from of these
regulatory approaches which are quite radically different.
Candace, along those lines, do you know what is
going on in Minnesota? I don't.
MS. CAMPBELL: No, but Diane Miller does, and you
can ask her.
DR. JONAS: Okay. We will hear about that
MS. FORZLEY: I don't know that they have had
enough of a track record yet with that.
DR. JONAS: No, I don't think so.
MS. FORZLEY: But I know a lot of states are
DR. JONAS: I just wanted to get a clarification
of what the law actually is, because I have heard very
contradictory statements about it.
DR. KENDALL: With respect to your question on
harm, in regards to acupuncture, it is a surgical procedure
in the sense you are inserting a surgical device into the
human body. There were cases early in Europe, early use of
acupuncture where they had fatalities from inserting needles
that got into the organs.
There was, a few years back, a fatal pneuma thorax
in England. There have even been a few accidents in Japan,
a couple in China. The incidence is very low, but there is
always that probability if you don't understand the human
physiology, as far as what is under the skin, and you are
dealing with needles that are an inch long, two inches long,
three inches long, four inches long, 14 inches long. There
is possible risk.
Then there was one other incident that just
happened last year, where in Belgium they did research where
not using an herbal specialist included a toxic herb in a
kidney test research, and the subject ended up with kidney
DR. JONAS: It would be interesting, and that is a
good example, to see, for example, in countries where they
regulate the practitioner, compared to countries where they
regulate the needle, compared to countries where they don't
regulate it all, if it makes any difference in terms of
DR. GORDON: Candace, thanks as always for your
coming. I really appreciate hearing what you have to say,
as well as your efforts on behalf of moving health care
ahead. I had a specific question about what you were saying
about intervention by the FDA or the Department of Justice.
Do you have a standard that you would want to
share with us now, and maybe even elaborate on later, for
the kind of freedom that you think should be given to
practitioners, and when intervention is and is not
necessary, so we can consider it.
MS. CAMPBELL: You mean intervention on the part
of the FDA or the Justice Department?
DR. GORDON: The FDA or the Department of Justice,
MS. CAMPBELL: Well, I think I would agree with
Berkley and the broad picture that if we know that a
substance is non-toxic, for instance it has a history of
use, I think acupuncture is a perfect example. How many
years did it take us to change the classification of
acupuncture needles? I think they were in the same class as
heart-lung devices. There is not a lot of common sense, and
there is an awful lot of regulation.
I think it might be hard to change a huge
bureaucratic system that functions on a very rigid model of
testing. So what we might have to do is have a separate
body, not the FDA. If you are talking about non-patentable
substances that can't go through the drug approval process,
there is just no economic incentive for anyone to do that.
At some point, there will have to be testing,
there will have to be clinical trials. NIH can only do so
much, but you can leapfrog way over that dilemma. If
something has been used for 30 years in Germany safely, why
does that same company have to go through 10 years, $300
million to get FDA approval?
There ought to be something in between that can
address access without all or nothing. Right now, we have
all or nothing.
DR. GORDON: I guess what I am looking for is, not
necessarily on the spur of the moment, but your guidance
about what kinds of regulation. And again, raising the same
question that Wayne and Michele Forzley were talking about,
should it be regulation of the practice, or the
Because the Access Act, in my mind, seems to focus
on regulation or freedom for the practitioner and the
patient, and does not focus so much on the modality or the
practice that is being used.
MS. FORZLEY: The Access bill really leaves it to
the practitioner to determine. The latest version of the
bill has a lot more language about what level of proof there
must be for a practitioner to safely offer an unapproved
therapy, and I think that is a question worth answering. We
can't just throw it wide open because everyone will have a
different level of what they feel safe using.
But I would be happy to give you some feedback on
what we think would be a feasible solution to that.
DR. GORDON: I think that would be particularly
useful, especially in the spring as we come to issues of
licensure, focusing on education and licensure. Then again,
coming around to reimbursement.
MS. FORZLEY: In terms of the Access bill, if I
can add one thing quickly, there is already plenty of
regulation of MDs doing alternative therapies. There is the
threat of malpractice, there are the state medical boards.
I am not really worried about what would happen to an MD who
crosses the line. There is more than enough disincentive
there for someone who would think of it. It would be
One of the things the Access bill does that is
critical to this increasing flow of products is, get the FDA
out of the business of stopping interstate shipment, because
right now that is a huge barrier. Sure, they are not
regulating the practice of medicine, but if you can't ship
something across state lines, you have to live in the right
state. Interstate shipment may only be the label on the
bottle that qualifies it as interstate. So that is a huge
barrier right now, that is the FDA's.
DR. GORDON: Joe, did you have your hand up?
DR. FINS: I just wanted to talk about something
MS. Forzley said a few moments ago about the different
countries having different cultures and the relationship of
regulation to those national cultures.
Just again, to make a plea for us as a commission
to probably ask some anthropologists to talk about the
anthropology of CAM therapy in the United States and the
regional differences across the country to make sense of
what this phenomenon is.
Your legal analysis here has really demonstrated
there is heterogeneity from different European countries,
and I think we just need to be comprehensive to make some
better sense of what motivates this and how we can be
responsive to the people and do it safely.
It was reminder to remind us. So thank you for
DR. GORDON: Any other questions? We are going to
close in a couple minutes.
DR. GORDON: Okay. Thank you. Thank you very
much. Thank you all.
We will adjourn for today. We will begin again
tomorrow morning at 8:00, and we look forward to seeing you
[Whereupon, at 6:10 p.m., the meeting was recessed
to reconvene the following day, Tuesday, December 5, 2000,
at 8:00 a.m.]
+ + +
This is to certify that the attached proceedings
BEFORE: White House Commission on Complementary
and Alternative Medicine
HELD: December 4-5, 2000
were held as herein appears and that this is the official
transcript thereof for the file of the Department or
DEBORAH TALLMAN, Court Reporter
Silver Spring, Maryland
Phone: 301.871.0010 Fax: 301.871.0020