Archive
WHITE HOUSE COMMISSION
on
COMPLEMENTARY and ALTERNATIVE MEDICINE POLICY
MEETING ON THE ACCESS AND DELIVERY OF
COMPLEMENTARY AND ALTERNATIVE MEDICINE SERVICES
+ + +
Volume II
+ + +
Tuesday, December 5, 2000
(Afternoon Session)
Hubert H. Humphrey Building, Room 800
200 Independence Avenue, SW
Washington, D.C.
A F T E R N O O N S E S S I O N [1:40 p.m.]
Public Comment
DR. GORDON: We are going to have time for public
comment now. We have a couple of additional speakers. I am
going to call the panels in groups of five. Bruce
Nordstrom, Neal Barnard, Doreen Chen, Gary Sandman, and
Danny Freund.
Each of you will have three minutes to speak, and
then the Commissioners will have a chance to ask some
questions.
So we will begin with Bruce Nordstrom.
DR. NORDSTROM: Good afternoon. Thank you for
allowing us to come.
On behalf of the American Chiropractic
Association, this afternoon, I would like to encourage the
Commission to focus on wellness. The key principle behind
chiropractic care as well as many other complimentary and
alternative therapies is wellness. CAM practices such as
chiropractic have a history and a focus of promoting health
and increasing the quality and span of life.
Unfortunately, there remains the challenge of how
to encourage insurers to recognize and reimburse CAM
providers for health promotion. Increasingly complex
lifestyles, flaws in workplace ergonomics, and longer life
spans have created an inherent need to move from injury and
disease management to a more primary role that is more
wellness oriented and focused on preventative care.
Insurance companies are slow to move in this direction.
Third party payers must be encouraged to offer preventative
alternative therapies as paid benefits rather than a
patient-paid responsibility.
By providing early conservative chiropractic
intervention, it is hypothesized that we can prevent many
conditions that have a neural musculoskeletal origin from
becoming chronic and requiring more invasive procedures. In
many instances, chiropractic care can reduce the risk of
certain iatrogenic diseases from some certain medicinal and
surgical interventions.
Payers as well as policy makers need to understand
that illness/injury prevention and wellness care can, in
many instances, minimize losses in productivity and increase
the quality of life, and thereby decrease the overall cost
of health care.
The value of health care delivery in the context
of a wellness paradigm has been virtually lost in budget
neutrality wars, administrative benefit cuts, and other
scenarios, leaving this yet again as another patient-paid
benefit. Once payers and policy makers begin to see the
bottom line savings involved in wellness in the promotion of
health, one would hope that they would embrace early and
regular interventions as a viable option.
An example of how prevention is cost effective can
be found in an organization called Alternative Medicine,
Inc., AMI. It is a fully integrated medical delivery system
that utilizes doctors of chiropractic as traditional
gatekeepers in one Illinois HMO. AMI stresses prevention,
and where possible, the use of conservative treatments
first, and pharmaceuticals and surgery last. Patients are
encouraged to see either chiropractic regularly once every
few weeks.
Although the program is still in its infancy,
according to AMI president,
DR. Surnod [ph], AMI has reduced
the rate of hospitalization by about 75 percent.
DR. GORDON: Okay, thank you. We are going to be
pretty strict with these time limits, because we need to be.
Neal Barnard. Welcome.
DR. BARNARD: Thank you. Good afternoon. I am
Neal Barnard. I am president of the Physician's Commission
for Responsible Medicine, and I appreciate the opportunity
to speak with you this afternoon.
Nutrition is the most fundamental medical
treatment. Everyone eats, and as they do so, they tip the
balance either for health or against it. Research proves
that when patients change their diets enough, often in
combination with other lifestyle changes, they can reduce
cholesterol levels, reverse heart disease, improve and
sometimes even cure Type II diabetes and hypertension.
These treatments are so safe and effective that
they should be our routine forms of therapy with medications
considered alternatives. Among patients' greatest
difficulties, however, is finding a physicians equipped to
recognize the need for nutritional interventions, let alone
prescribe them.
Doctors know not much more about nutrition than
the average person on the street. In my own medical
training here at the George Washington University, nutrition
teaching was so limited, we really had no tools applicable
to our patients.
So let me recommend the following three-point
plan. First, we ask that the White House sponsor
initiatives to integrate nutrition into the core curricula
at American medical schools. This means (a) working with
the Association of American Medical Colleges; (b) working
with textbook publishers; and (c) providing grant support
for curriculum changes through the Public Health Service.
It also means teaching nutrition that actually
works. Heart disease and cancer are the leading causes of
death. So doctors need a good grounding in the vegetarian
and plant-based diets that have been shown to help prevent
them or to be useful in treating them. Vague notions about
eating right are useless, and not much better are the weak
diets that are based on the presumption that Americans won't
really change.
For example, the National Cholesterol Education
Program Step II Diet lowers cholesterol only a pathetic 5
percent, and the Dash Diet reduces blood pressure modestly
as well. These diets focus on minor changes, such as
switching from red meat to white meat.
Americans now consume about a million chickens per
hour, and we are in the worst shape than we have ever been
in our nation's history. Much more effective are diets that
eliminate animal products, along with the saturated fat and
cholesterol they harbor. These diets work, and if they are
offered, patients often accept them, in most cases, in our
research, do accept them.
Secondly, we suggest that White House direct the
Public Health Service to issue a request for application for
research on the use of vegetarian and vegan diets for the
following applications: breast, prostate, and colon cancer;
macular degeneration; inflammatory and non-inflammatory
intestinal disease; and diseases of children, particularly
Type I diabetes.
Third, we suggest a Department of Agriculture
review of federal policies that conflict with nutritional
goals. A generation ago, the U.S. Department of Agriculture
was concerned about tobacco but was also promoting it.
Today, we have the same problem with the meat and dairy
industries. A thorough review could ferret out these
conflicts. Thank you.
DR. GORDON: Thank you. Doreen Chen.
DR. CHEN: My name is Doreen Chen. As the chair
of the Chinese Medicine Advisory Council of the American
Association of Oriental Medicine, and the vice chair of the
National Association of Chinese Medicine, and also the
honorary chair of the United Alliance of the New York
Licensed Acupuncturist.
I would like to take this opportunity to present
my view on Oriental medicine. I myself have received eight
years Western medical education in the United States as in
China and earned an MD degree. I also received training in
traditional Chinese medicine in China, and have been
integrating Eastern and Western medicine in the treatment of
all kinds of health problems, clinically as well as doing
research and teaching for more than 40 years.
My personal experience taught me that integrative
medicine would be the future development of medicine so as
to serve the people in full capacity. Let me just
illustrate to you a few cases of my own practice in the
United States, and -- a movement leader in Rome,
DR. McKeedy
[ph]. He has a condition of co-crisis, in Western medicine
identified as thermal regulation problem, but cannot address
the problem.
Six years ago, he came to see me in the summer.
He had to wear two layers of heavy sweater and pants, and
also two pairs of very heavy socks. He still felt cold
inside and was very prone to catch a cold. His condition,
in Chinese medicine, is a typical pattern of yang deficiency
and qi deficiency. So I offered him Chinese herbal tea to
replenish his kidney yang and chi. After taking herbal tea,
he definitely experienced the difference of his body.
Every three to four months, we communicated
through email and phone, and I adjust my tea and sent it to
Rome. Following is his testimony:
"Since I started following your herbal therapy,
the main result has been a reduction of my work impairment
from 50 to 60 days per year to five to six days per year.
At present, I consider my co-crisis practically disappeared.
Dear
DR. Chen, in summary, this is my medical history and
benefits from the treatment you gave me. For this, I would
like to express to you once again my gratitude."
My second case is a young man in his 40s that has
suffered with ulcerative colitis for 20 years and has to be
on cortisone all his life. His diet is so restricted, even
a touch of tomato sauce would cause him diarrhea. He
started to lose weight and became weak, and lost a job.
He then turned to seek help from Chinese medicine.
According to the TCM diagnosis, he has yin-yang deficiency.
So I rendered him acupuncture and accupressure with herbal
tea. I will make it short, that by six months, he leveled
off the cortisone and solely taking TCM treatments, and he
is leading a very happy life. His testimony says:
"Chinese medicine has displayed --
[Alarm.]
DR. CHEN: Oh, my. Oh, my god. I will just make
my conclusion, then. All right?
So in brief, I would like to conclude in words as
follows: Oriental medicine has come to the immediate health
of the people in the world. Oriental medicine has its own
identity and unity. It follows the philosophical laws of
nature and develops its own principle and theory to balance
the body.
The modality of Oriental medicine includes Chinese
herbal tea, acupuncture, touch, massage, qigong, tai chi,
and many other ancient techniques. In our country we need
really good Oriental medical physicians to serve our people.
To train a good Oriental medicine requires five years
education, including internship.
This service rendered by an OM physician should be
covered by any health insurance, federal or private. This
is the kind of policy that our country should establish
which will serve the people well.
DR. GORDON: Thank you. Gary Sandman.
MR. SANDMAN: Thank you, Jim. Thank you for
allowing me to address this commission.
I have been involved in the field of alternative
medicine for almost 30 years, since 1972 when I founded a
community-based alternative medicine referral service in the
Washington, D.C. area. Our network contains approximately
180 holistic and alternative practitioners who are fully
credentialed, and where approximate, licensed.
Callers are counseled by us to provide them with
information so they can make educated choices to use the
most appropriate modality of alternative care they need.
Then we provide them with references to the credentialed
practitioners.
We have expanded our company also to develop local
educational progra
MS. We hold two large conferences every
year, one on alternative medicine and natural health in
general, another on integrative approaches to cancer
therapies here in the Washington area.
We are also in the process of publishing a CAM
credentialing reference guidebook on the top 50 fields of
alternative medicine. We have developed, with our team of
practitioners, integrative approaches to chronic illnesses
and helped cross the lines and the barriers between
different modalities of health care.
We developed the Hospital Massage Therapy Network
in Baltimore through the MedStar Health Plan, and we are
developing and getting ready to launch a natural product
certification program. We have also just finished shooting
a pilot for a television series on alternative medicine and
cancer survivors.
In counseling over 10,000 individuals who have
called our service, we have noticed that patients tend to
fall in a continuum from feeling victimized by their health
to being empowered. CAM tends to teach empowerment, and
individuals that are empowered tend to heal.
We have seen also that illness has a spiritual
aspect, as has been mentioned here before. A majority of
our practitioners as well as the survivors of cancer and
other kinds of illnesses look at their illness as a wake-up
call that gives them the opportunity to reevaluate their
life purpose and live their life more in alignment with that
purpose.
It seems like our practitioners, as they start to
bridge that conversation with individuals, that people want
to hear that and know that that is one of the major keys to
healing. People also want safety of care delivered in a
holistic attitude. When people call us, they want Andy
Weild. They want Andy to do things that Andy doesn't even
know how to do. So we try to counsel them to work with the
MD as well as alternative practitioners that are fully
qualified.
Research in general indicates that most
individuals don't feel responsible for their health, even
though our health is affected their emotions, our thoughts,
and our environment. We need to have an education program
outside the CAM practitioner's office to verify and validate
that people directly have an effect on their own health, and
to learn, possibly with the Genome Project, to determine
what each individual's Achilles heel is so that we can
strengthen that weakness and not be a victim to it.
I would propose to the Council that we develop a
20-year plan to integrate conventional medicine into
patient-centered whole person health care. This was the
length of time needed for doctors to comply with washing
their hands before surgery. I have other suggestions that I
would like to offer.
DR. GORDON: Thank you. Danny Freund.
MR. FREUND: Thank you. My name is Danny Freund.
I am coming from a different perspective, but first I
wanted to say timing is perfect because you touched on a few
of the issues that I want to address.
I am coming to you from the perspective as a
cancer survivor. I have since become an honor student at
Penn State University under the direction of Rustum Roy who
spoke yesterday. I am really nervous right now. I want to
share with you how I gained access to alternative medicine.
I was sick with cancer four years ago, and about two weeks
after I heard that I had cancer, I was given a paper that
says, will you sign this paper that says we can amputate
your right leg.
So that really woke me up to a lot of the issues,
but I wouldn't have heard about it if my mom didn't tell me
about it. So I think that is a really important aspect.
The doctors kept telling me to take aspirin and
that would get rid of the pain that was being caused by the
tumor in my leg, but my mom kept saying, go to acupuncture
and try some of these alternative therapies because they
might work, too.
Since then, I have tried numerous things from
applied kinesiology to hypnosis to get rid of pain, and also
living in a holistic community at the Omega Institute in
Rhinebeck, New York. I also went to a spiritual camp for
Jewish kids that had cancer, which was phenomenally helpful
in my recovery. It really got me in touch of aspects of
spirituality that I had no idea about before. I always
rejected them as a younger person when all of my friends
were kind of anti-religion. I learned that there were
important issues for me, too.
Since then, I have gone on to Penn State and I
have organized a number of things. I have given a number of
presentations on my experiences with alternative medicine,
and I have tremendous feedback from those and a great
turnout. I have also organized a course on alternative
medicine. It is not called that, but it is relating to the
sociopolitical issues relating to CAM, and that will be
offered next semester. That class was filled up within a
few days. So I was excited about that.
I think that this course should be offered as a
general education course at the undergraduate level, because
that is one of the ways that people find out about it. One
of the problems I encountered is that there aren't any of
these great journals that I have encountered at Penn State.
There are a number of journals that you probably are
familiar with. I wish we had them.
Also, and I will make it really brief, I did a
search on Amazon.com the other day about alternative
medicine, and there are 250 books about alternative
medicine, but who knows which of these to use. A lot of my
friends are interested, but they are not knowledgeable about
it. So I think we should have a peer review of which are
the better books.
One last thing, and I know I have three seconds,
but I want to say that I have also gotten involved in
DR.
Gary Nall comes to speak. He has been doing a whole year-
long program in northern New Jersey where he comes twice a
month, or his associate comes. That has been really helpful
because instead of just saying, this is what I believe, he
is actually helping to make a difference in our community.
He has had tremendous support, too. So thank you.
Panel Discussion
DR. GORDON: Thank you. We have some time now for
questions from the Commissioners.
Yes. Veronica.
DR. GUTIERREZ: My question is for
DR. Nordstrom.
The Association of Chiropractic Colleges' Position Paper
goes on to say that chiropractic is concerned with the
preservation and restoration of health, and focuses
particular attention on the subluxation. Yet, I noticed
subluxation is not mentioned anywhere in your presentation.
I have a bit of a concern about chiropractic, the
patients accessing appropriately, because neck and low back
pain seems to be the niche that they want to put us in.
And then, I am wondering if you would address the
relationship between subluxation, health, wellness, and
quality of life.
DR. NORDSTROM: I don't think I have enough time
to answer that to the depth that you would like, but
certainly the nexus of chiropractic care is spinal
manipulation. The term that we call the spinal manipulative
entity is subluxation. It has been described by a variety
of different people, different terms, and in and of itself,
needs more research. I think Veronica is asking a
philosophical question that is a debate within my
professional itself.
But in general terms, clearly, what we do,
Veronica, is adjust the spinal lesion we call the
subluxation. That is the primary goal of chiropractic care.
The effect of that care, as I think has been
talked about Drs. Meeker and Rosner earlier, has some
research in the area of low back pain, some fairly good
research. Its effect on other kinds of conditions, be it
asthma or other health-related conditions, obviously needs
more research, and we are 100 percent behind good science.
We need it, a lot more of it.
DR. GORDON: Tom, then Tieraona.
MR. CHAPPELL: Gary, could you explain more about
the Natural Product Certification Program.
MR. SANDMAN: It is a five-point program where our
practitioners have gotten together and are concerned about
the quality of natural products, because issues arise that
tell a patient to take saw palmetto, and it may not be saw
palmetto that they are purchasing at the store.
So we are developing a criteria where it involves
assaying the raw material. It is a validation verification.
It is not setting standards, it is just disclosing. So
that, is it a standardized extract or is a raw material. If
it is a raw material, is it organic. Where is the source of
it.
Then the manufacturing procedures for the FDA, are
there quality controls in place. The aspect of assaying the
product when it comes off the line as well as off the shelf
to determine what is in the jars, on the label, and vice
versa.
A label review to make sure that what is said is
proper and within the law as well as within the scope of the
product. Then having a review board to be able to publish
research that connects the ingredients with scientific
evidence as well as tradition to show that there is a
benefit to it.
MR. CHAPPELL: That is a lot.
MR. SANDMAN: Yes.
MR. CHAPPELL: Congratulations to you. That is
funded by fees that -- people send you their products?
MR. SANDMAN: Yes. We are about to launch that to
do that as well as -- what we want to do to add strength to
it is gain acceptance amongst the various disciplines that
this is a plan that they would accept as well, and then make
those types of changes, so that a certain subgroup wants
this to make sure that it develops even stricter codes, we
are open to that. We want to gain consensus so that it
holds weight to say that practitioners won't recommend a
product unless the seal is on it.
So that is our process.
MR. CHAPPELL: Thank you.
DR. GORDON: Tieraona, Don, and me.
DR. LOW DOG: Yes. I do hope that you are working
with other organizations since there is a number of them
that are attempting this validation that have got a lot of
work. Building bridges, I think, is important so everybody
is not reduplicating work. There has been a thousand seals
out there that nobody knows if it means anything.
Neal, again, I just want to appreciate the --
thank you for the conciseness, and your very specific
recommendations, which I think are so important. One of my
questions is, until we sort of get this into the medical
schools, how much do you think we can interface, or be
interfacing, with registered dieticians, who actually are
sort of somewhat underrepresented in this whole discussion
of complimentary and alternative medicine.
The new food pyramid is based on about 70 percent
plant-based material. So I mean, we are moving in the right
direction. We are moving toward a much more plant-based
material, but it is going to take a while to implement some
of these things.
Do you interface with registered dieticians? Do
you work with registered dieticians? How do you see their
role in this?
DR. BARNARD: Yes. We have registered dieticians
on our staff at the Physician's Committee, but diseases walk
in the door of a medical office, as hypertension, as
diabetes, as atherosclerosis, or whatever. The physician
may not know to even refer to a dietician. When they do,
they often don't know what sort of treatment to prescribe.
A doctor can send a patient to radiology, and they
know what they are looking for. They know what they are
going to get back. When they send a patient to the
dietician, that is a sophisticated enough move there, but
they often have no clue what they are looking for. They
ought to know that you can have a realistic chance of
actually reversing existing atherosclerosis, and that is
your goal. If you are sending the patient there, you are
sending them for an Ornish type of regimen.
I am glad you raised this because we need also to
work with dieticians and not assume that they are current
with current treatments. The hairy hand of industry has
played its role at least as aggressively in the dietetic
community as it has in the medical community. I am speaking
specifically of the meat industry, and the dairy industry
probably the worst of all.
DR. GORDON: Don?
DR. WARREN: We talk about education and including
nutrition into the curriculum of medical schools, and in my
case, dental schools, but the educational system so crammed
with information you have to have to pass your boards, to
pass licensure.
Where do you propose putting this? Are we going
to add another year to the training to each one of these
professions?
DR. BARNARD: No. I think for everything that
goes in, something has to come out. We clearly have to
prioritize, and there is no medical educator, I don't think,
who really envisions that you are going to learn medicine
with a capital M in the four years of medical school. You
are going to learn the basics, and you are going to see them
applied during residency, and you are still going to have an
awful lot to learn when you get into practice.
But if we don't know that you can get most people
off their anti-hypertensives or off their Type II diabetes
drugs if you change the diet and lifestyle enough, then we
haven't taught students their most important thing.
At some medical schools, they are still practicing
surgery on rabbits and dogs and so forth in the first or
second year of medical education; utterly pointless at that
stage. You will learn your surgical technique later. You
need the learn the basics about what keeps a person well.
MR. WARREN: One more question here.
Chiropractic. We talk about access to services. If my
figures are correct, chiropractic deals with about 7 percent
of the population now, and it was 7 percent of the
population 20 years ago.
How has chiropractic improved access to its
services at this point, and what can be done in the future
to improve access?
DR. NORDSTROM: Well, a lot of figures. I have
seen figures that have gone from approximately 4 percent, I
think, in the late 70s, early 80s, to maybe as much as 10 or
12 percent. So I think there is a change.
Education, research. Research has opened a lot of
eyes. When the AMA was stopped from boycotting chiropractic
cooperation with medical doctors, that changed a lot. I
think as we see some of the data that is coming out as an
example at this Illinois practice where chiropractors are
seeing their patients regularly and there is a significant
reduction.
We are looking at some data now that is suggesting
that the average Medicare patient costs Medicare about
$7,000 a year. I don't know if we have indexed for severity
yet, but it looks like maybe the average chiropractic
patient is going to cost Medicare about $4,000 a year. We
are doing some more research into that.
So finding good information that shows that things
like diet, things like all of these things, that promoting
those things, that the information is spread to the
practitioners, and the insurance companies stop looking at
administrative bottom lines, but looking at health outcomes,
seeing those kinds of realities and looking for that
information, like we are having to look for it ourselves
now, but the insurance companies start looking for it, and
they change their focus. I think that is going to make a
big difference.
DR. GORDON: Ming, and then Charlotte.
DR. TIAN: I have a question for Neal and Gary
regarding the organic food. I go with you. I think organic
food is more delicious. There is no doubt about it. If we
eat one million chickens every day, I guess 99 percent are
not organic. We have enough data to show organic food, or
organic meat, does prevent disease.
We need what kind of study to prove it?
DR. BARNARD: There are limited data on organic
produce, showing two things. One, what you would expect,
there are fewer residues of toxic substances, particularly
organichlorines. There are also, though, which is a little
bit of a surprise to people, higher levels of some
nutrients, particularly minerals, which is important.
I don't think that that translates, though, into
saying that organically raised animals, chickens or others,
are necessarily going to be any lower in saturated fat or
cholesterol and so forth. The studies really are on
produce, and I think we have got still further to go in
exploring that.
MR. SANDMAN: What we have seen is that if a
practitioner prescribes that and educates the individual,
than that is moving the patient further into using organic
vegetables.
We are building a national website in conjunction
with a group of organic farmers that will allow people
coming from our site or their site to find the closest
organic farmer to make it more accessible, and juxtaposition
those two together. Also, that has a rub-off effect, that,
yes, this is a healthier way to go. And then, where do you
find it that is not so expensive. What we want to do is
drive people to go right to the farmer that is located near
them.
MR. TIAN: My second question is for
DR. Chen.
I understand you have treated a lot of successful
cases using acupuncture and Chinese herbal medicine, or
herbal remedies.
Do you think it is necessary for all the patients
to use both acupuncture plus herbal medicine? If the money
is not an issue, then certainly the patient can have both.
More CAM therapies for the same patient, if the patient is,
let's say, not reimbursed, how do you handle those kinds of
patients?
DR. CHEN: Well, because of my background, both in
Western medicine and in Chinese medicine --
DR. GORDON: Speak into the microphone, please.
DR. CHEN: Oh, I'm sorry. Because my background
is both Western medicine and Chinese medicine -- I have been
practicing integrative medicine for 40 years -- my personal
experience taught me is that both medicines have their own
approaches, but it is very different. And yet, both have
their shortcomings and advantages and disadvantages. So the
best is to integrate the two, to take advantage of both and
get the best result for the patient.
Now, what is the best result? Then by practicing
it, you will know some of the elements that you have to go
for Western medicine, and some of the problems, maybe,
Western medicine cannot address, and the Chinese Oriental
medicine can take care of it. So this is what the
indication is.
Now, we need experience and we need publication.
We need to do research to let the public know what kind of
problem to search for. This is only the first step, I
think, in this country because most of the patients, they
are exhausted with the Western medicine approaches, and they
come to see me. Most of them are like that, my cancer
patients, my infertility patients.
I have a lot of patients' testimony that I don't
have time, but I would like to present for your reference.
I think it is an indication.
DR. GORDON: Charlotte and Bill next.
Let me just say to the Commissioners, that
obviously the panelists are interesting and interesting to
us. If we continue at this rate, we will be cutting into
our time for discussion at the end of the day. If people
want to leave by 5:00, we really can't do that.
MS. CHANG: [Off mike.]
DR. GORDON: Okay, so we need to stop right now.
Thank you. This is no reflection on the panel. In fact,
just the opposite. Thank you very much.
MR. SANDMAN: Okay. Bye.
DR. GORDON: With everyone's permission, I will
control the time strictly.
DR. FINS:
MR. Chairman, can I just ask that
MR.
Freund's syllabus get entered into the record?
DR. GORDON: His what?
DR. FINS: His undergraduate syllabus.
DR. GORDON: Yes.
DR. FINS: That it be officially requested.
DR. GORDON: Yes.
DR. FINS: Thank you very much.
DR. GORDON: Melinna Giannini, Jane Hersey, Boyd
Landry, Lawrence Auburn Plumlee, and Michael John
Rohrbacher. We will have 15 minutes. Each person will
speak for three minutes, and then we will have 10 minutes
for discussion, for questions, from our group. I will cut
it at that 10 minutes.
The first person will be Melinna Giannini.
MS. GIANNINI: Thank you and good afternoon. I
come to you from the perspective of the insurance industry.
I used to design, sell, and monitor self-funded medical
plans for large employer groups.
I created a company called Alternative Link. We
have developed about 4,000 codes that describe what is said,
done, ordered, prescribed, or distributed by alternative
care practitioners, and each one of these codes has a
relative value unit attached to it so that a rate can be
developed for each procedure.
This is important because having this system
allows comparative analysis between statistical information
from conventional medicine and statistical information from
CAM.
The code set has been published in the Unified
Medical Language System at the National Library of Medicine
in 1998. They were added to the American National Standards
Institute X(12) standard for electronic commerce in 1999.
They have been recognized by the American Nurses
Association, and they are currently before the Department of
Health and Human Services for consideration as a standard
for electronic claims processing.
I respectfully suggest that the Commission
consider its influence to cause in-CAM funded research to
incorporate this code set so that cost-effective CAM
treatments can be identified as a solution to escalating
health care expenses, especially where these procedures
could have an impact on Medicare/Medicaid recipients.
A key barrier to viable CAM coverage is vast
differences in state scope-of-practice laws. Alternative
Link has a fully developed database to identify legal
treatments in each state. I respectfully suggest that the
Commission review this information as it pertains to
assuring CAM compliance with state laws. This information
is key to viable CAM insurance reimbursement because payment
of claims outside scope of practice triggers fines as high
as $10,000 per line item for payers and providers who are
outside of compliance.
This code set and associated scope-of-practice
database can assure that data for CAM is viable for future
reimbursement. I am leaving a copy of the code set for the
Committee's review, and I want to thank you for the
opportunity to give this testimony.
DR. GORDON: Thank you very much. Jane Hersey.
MS. HERSEY: Thank you. I am director of the non-
profit Feingold Association.
What I would like to talk about is the fact that a
simple elimination diet is among the oldest and most
conservative forms of medical treatment, but in the United
States this is viewed as an alternative.
For a quarter century, the Feingold Association
has shown families how to reduce or eliminate many behavior,
learning, and health problems by making simple adjustments
in their grocery shopping by selecting familiar brand name
foods that are free of synthetic dyes, artificial flavors,
and certain preservatives.
This is an inexpensive, effective technique that
any family can easily implement. We have a 25-year track
record of considerable success, and the scientific validity
of this program is supported by double blind placebo-
controlled studies published in peer review journals.
Despite the potential of this healthy option to
help medical and social problems, and despite all of the
supporting evidence, it is opposed, ignored, or
misrepresented by the very government agencies and
professional organizations that should embrace it. I would
refer to Center for Science "In the Public Interest" report
that verifies this.
The sad fact is that a doctor who suggests diet
rather than drugs as a first option to help children risks
losing his license. I am sure you are familiar with the
case of the doctor in San Francisco, and I believe Karen
Scott, one of his patients, will be testifying at one of
these hearings.
We have lots of practical information that a
family can use, understand easily, and put into practice
immediately. We have our book "Why can't my child behave,"
and I brought along a sample of the material that we provide
to parents.
They don't have to make drastic changes in their
eating or shopping habits, but sometimes something as simple
as cutting out petroleum-based dyes, artificial flavors, and
the petroleum-based preservatives can and does make an
enormous difference in a child. Once a family understands
that food really matters, that nutrition matters, then they
go on to further refine and improve their diet.
If there were something that we could ask for on a
wish list, one would be that the National Institutes of
Health follow their own recommendations suggesting that new
research is warranted. This has not happened, and that
people take a close look, that the Department of Agriculture
take a close look at the exciting study that was conducted
in the New York State schools.
MS. CHANG: Thank you. You are out of time.
MS. HERSEY: Thank you.
DR. GORDON: We are having some mechanical
difficulties.
MS. HERSEY: I was watching this, and it didn't
get red yet.
DR. GORDON: Thank you. We would very much
welcome those reports. I don't think you have given them to
us.
MS. HERSEY: No, I haven't. I didn't have any to
bring. I will provide the additional ones.
DR. GORDON: Thank you. Boyd Landry.
MR. LANDRY: Good afternoon. Thank you for having
me again to provide public comment. My name is Boyd Landry,
and I am executive director of the Coalition for Natural
Health headquartered here in Washington, D.C. and in another
office in Missoula, Montana.
After sitting for the day and a half, and the two
days back in October, I too believe that you have a great
opportunity to do great things. Unfortunately, as the
meetings continue, I believe that the Commission is not
seizing on an opportunity to look outside the box, but
instead figuring out a way to fit CAM inside the box.
If our system of health care worked in this
country, we wouldn't be here today. If we didn't have all
the problems that precipitated this discussion, why would we
be here?
So I think that is important to keep in the back
of your mind as you go through this process. A way to work
through that process is to bring about and encourage
practitioners of modalities that don't have one foot in the
box, or even two feet in the box, to come forward and
provide you information about their practices and the good
things that they do.
One most important voice that is going unheard by
this Commission is the voice of consumers, how they want it
delivered to them, what kind of access are they looking for.
That is what the fundamental purpose, I believe, that this
commission should center itself around, is access and
delivery, and what do consumers want, not what practitioners
want, but what do consumers want.
I don't know that you can get it in a town hall
meeting, or even in this setting here, unless you actively
seek out their input. There are many ways to do that, from
polling data to running full-page ads in the newspapers
where you are going to have town hall meetings, to encourage
that to be brought forward.
On the issue of who will pay, if access were
opened up to the market for everybody, then the market would
deliver on every level, from the low-income side to the
high-income side by virtue of the fact that the market
forces would work to provide that.
A recommendation by this commission to add
inclusive language in the federal programs will only stifle
these organizations and these practitioners with cost
control measures that force the problems that we have today,
by allowing inclusive language into the federal insurance
roles or third-party reimbursement programs --
MS. CHANG: Thank you. I'm sorry, you are out of
time. Thank you.
MR. LANDRY: Thank you. Well, can we get a 30-
second warning?
MS. CHANG: Well, we do, but the thing is broken.
DR. GORDON: We will give you 30 more seconds.
MR. LANDRY: Okay. Let me just sum up real quick.
Finally,
DR. Jonas, yesterday, came close when he asked
Michele Forzley from the Bar Association, the relationship
between harm and regulation.
Let's just suppose for a second, so you can see
how the unregulated practitioners live and practice, that
conventional medicine was immediately deregulated. What
would happen? How would our society function? If you close
your eyes and thought about it, you can pretty much see a
changed dynamic from systematic care devoted to disease to
systematic devoted to wellness.
DR. GORDON: Thank you.
MR. CHAPPELL:
MR. Chairman, may we give
MS.
Hersey 30 seconds? We shut her off simply without warning.
She didn't get her 30 seconds.
DR. GORDON: Why don't we give her 30 seconds when
everybody else is finished and let her make a statement. We
are sort of wrestling with these mechanical difficulties
here.
The next speaker will be Lawrence Auburn Plumlee,
and for 30 seconds, Michele will rise up.
[Laughter.]
MS. CHANG: I will give you a one-minute warning.
How is that, okay?
DR. PLUMLEE: I am Lawrence A. Plumlee, a
physician, formerly medical science advisor at the U.S.
Environmental Protection Agency, and now the president of
the National Coalition for the Chemically Injured.
We are concerned that chemical pharmaceutical
industries have turned toxicology into a laboratory
specialty designed to rapidly move new products to market,
while asserting that many chronic manifestations of toxicity
are psychogenic in origin.
Such manifestations of chronic toxicity include
many cases of multiple chemical sensitivities, auto-immune
diseases, fibromyalgia syndrome, and chronic fatigue
syndrome. There is a great need for much research to
investigate the role of toxic chemicals in these syndromes.
By failing to do this, patients are subjected to dangerous
and ineffective psychiatric drugs which prolong the
illnesses, thus selling more drugs because the causes are
not recognized and eliminated.
Furthermore, because the medical profession is so
heavily influenced by these industries, there has also been
a lack of research to investigate the role of nutritional
supplements in enhancing improved metabolic function in
these syndromes. Even when scientific double blind studies
have found associations such as the benefits of the fatty
acid icosopantanoic acid in migraine, rheumatoid arthritis,
and ulcerative colitis, there is failure to communicate such
nutritional data to physicians, and thus, to enable most
patients with these diagnoses to receive such less toxic
effective treatments.
Another area requiring scientific research and
better medical education is the induction of mild
immunodeficiency by some toxic chemicals with resultant
super infections by viruses, bacteria, parasites, and fungi.
Often appropriate diagnosis and treatment of these
infections will enable substantial gains in health.
MS. CHANG: One minute.
DR. PLUMLEE: Even though -- how much?
MS. CHANG: One minute.
DR. PLUMLEE: Even though the body burden of
chemicals or their damage may remain uncorrected. Again,
the effect use of anti-fungals for treating chronic fatigue
syndrome and asthma has been shown in several double blind
studies. Yet, the medical profession is not adequately
educated about these studies to lead to changes in usual and
customary treatments.
Government medical education is needed to balance
the extraordinary influence of the pharmaceutical industry.
It will be difficult to achieve this when the government
itself is so heavily influence by this wealthy industry, but
idealistic persons can often make a difference by acting in
the public interest when it places their own careers in
jeopardy.
Persons receiving public funds owe the public
nothing less than this. When satisfactory grant proposals
are not forthcoming, contracts must be let to accomplish the
support.
DR. GORDON: Thank you very much. Michael John
Rohrbacher.
MR. ROHRBACHER: Good afternoon. My name is
Michael Rohrbacher. I serve as director of music therapy at
Shenandoah University in Winchester, Virginia. On behalf of
the Certification Board for Music Therapists, I wish to
thank the Commission for the opportunity to present the
following five points regarding the profession of music
therapy and its credentialing process.
(1) Definition. As defined by the American Music
Therapy Association, music therapy is the use of music in
the accomplishment of therapeutic gains, the restoration,
maintenance, and improvement of mental and physical health.
Music therapists work with individuals of all ages who
require special services because of behavioral, social,
learning, or physical disabilities.
Over 3,700 individuals currently hold AMTA
membership. The AMTA sets standard and identifies
competencies for the practice of music therapy and
establishes criteria for the education and training of
future music therapists. Nationwide, there are 69
undergraduate music therapy programs, 25 graduate programs,
and 159 internship sites approved by AMTA.
(2) Credentials. The Certification Board for
Music Therapists was created in 1983 to serve as the
credentialing body for music therapists. CBMT is
administered and financially independent of the American
Music Therapy Association. The mission of CBMT is to
evaluate individuals who wish to enter, continue, and/or
advance in the discipline of music therapy through a
certification process, and to issue the credential Music
Therapist Board Certified to individuals who demonstrate the
required level of competence.
(3) Accreditation. CBMT is a member of the
National Organization for Competency Assurance. CBMT is
accredited by the National Commission for Certifying
Agencies. The NCCA accreditation standards address areas
certification boards must adhere to, including
organizational structure, exam development and
administration, test validity and reliability, and a number
of other ite
MS.
(4) Representation. Persons holding the
credential MBTC have successfully passed the CBMT
certification examination, demonstrating the knowledge,
skills, and abilities necessary to practice at the entry
level of the profession.
To be eligible to sit for this national exam,
candidates must have completed an undergraduate degree in
music therapy or equivalent, including the six-month
internship from a program approved by AMTA. The CBMT exam
is now offered at over 100 computer-based testing sites
throughout the United States. The exam itself is updated
every five years to remain current with the profession.
The CBMT also offers a re-certification program
where music therapists must accrue over 100 continuing music
therapy education units.
(5) Use. Increasingly, MTBC is used by consumers,
employers, personnel boards, and facilities to identify
competent music therapists. I will mention quickly that the
States of Michigan, Wisconsin, and Virginia all turn to MTBC
to identify competent music therapists.
Thank you.
Panel Discussion
DR. GORDON: Thank you very much. Thank you all.
Jane Hersey, did you want to make a final comment?
MS. HERSEY: Yes, just very quickly. I just have
one copy. I will be happy to give more. There was a major
study that took place in the New York City school system
back in the 80s. This involved over 800 schools. By making
simple changes in nutrition, they were able to bring up the
test scores quite significantly. In fact, the test scores
over a four-year period increased over 15 points on the
California Achievement Test.
Unfortunately, after the director of Food Services
retired, the schools went back to the same old stuff. So I
think you might see the potential for some dramatic examples
of how nutrition can affect people, if there were ever any
interest in more studies like this.
DR. GORDON: We are interested. We would very
much like to receive that information, especially in the
panel specifically focused on wellness. I think it would be
very appropriate for us to spend a good deal more time on
some of the nutritional interventions that we have heard
about today, and other times as well.
So let's begin. Joe, Effie, Tom, Wayne, and
David. We are going to cut it at 10 minutes.
DR. FINS:
DR. Rohrbacher, thank you for your
comments. I am pleased to see somebody from my mother's
hometown, Winchester, Virginia. I spent a lot of time there
as a little kid, and it wasn't musical time.
I want to ask you about --
[Laughter.]
DR. FINS: It was. It was a wonderful time.
I want to ask you about the penetration access of
music therapy in hospitals. What percentage of hospitals
have it? What is the Joint Commission doing as far as
incorporating these kinds of important therapies into the
hospital mainstream? And, any problems or challenges that
we might be able to help you guys with?
DR. ROHRBACHER: Sure. A study by Paul Nolan at
Hahneman University identified 100 music therapists in the
nation who are practicing medical hospitals. At least half
of those are connected to university settings. So the
number is quite low in terms of music therapists who are
credentialed and engaged in hospital settings.
However, the research is very significant. For
example, Jane Stanley at Florida State University has done a
wonderful meta-analysis of music therapy in hospital
settings. We are side by side, often, with musicians, music
practitioners, persons who use music at beside, for example.
But I am pleased in terms of the progress we are
making, at music therapists presenting the full range of
what is possible in a hospital setting.
DR. FINS: Just quickly, who pays for the
intervention? How does it get reimbursed?
DR. ROHRBACHER: It is often the case that through
such programs as Therapeutic Recreation, Child Life, the
money that is beyond what is collected through DRG often
funds activities such music therapy. We are not a fee-for-
service at this point.
DR. GORDON: Effie.
DR. CHOW: Thank you very much for all your
remarks.
Neal, I want to thank you for bringing back a very
important issue about bringing the consumer --
MR. LANDRY: Me?
DR. GORDON: Boyd.
MR. LANDRY: Oh, okay. You said Neal.
DR. CHOW: I'm sorry, Boyd Landry. Boyd, Hi.
Thank you for bringing that aspect into it. I think that is
very important. Perhaps, can you tell us how we can access
better?
I mean, I know we should go out to them. Perhaps
you have some thoughts on that.
MR. LANDRY: Well, I think the past year and a
half, at least maybe even the last eight years, policy in
this country has been driven by public opinion. Whether it
is the Executive Branch or the Legislative Branch, the
utilization of polls and focus groups and things of that
nature have been a driving force behind policy.
One thing we know for sure is people are already
voting with their feet, because over 50 percent of the
population is already utilizing these services to the tune
of $60 billion a year. I think once we already stipulate to
that fact, then let's take it a step further and find out
how they want it, the access, the delivery, whether or not
some of these issues even matter to them, because they are
the ultimate consumer, for a pun on words.
MR. CHAPPELL: Jane Hersey. The Feingold
Association has been helping families for over 30 years, if
I remember.
MS. HERSEY: Well, actually,
DR. Feingold began in
1965, and we have been around for 25 years. So yes, you are
very close.
MR. CHAPPELL: How is it funded? Is it fees?
MS. HERSEY: Yes. It is funded through membership
fee, primarily, which is $69 for a family, and they receive
a lot of material, constant updates through our newsletter.
People they can call, et cetera, lots and lots of support.
We do get donations. Unlike some ADD groups, we are not
funded by the drug industry. Primarily, it is donations and
membership fees. Yes, we could use a little more.
May I just point out one thing. I am delighted to
see all these modalities and all things represented. I
think we are unique, in that, in our program the parents
handle it. The parents can do it themselves at home. We
all value alternative practitioners, but this is one thing
that a parent doesn't even need to go anywhere or seek out
any help.
MR. CHAPPELL: Our family has used your
association.
MS. HERSEY: Successfully, I hope.
MR. CHAPPELL: Yes.
MS. HERSEY: Great.
MR. CHAPPELL: You also recommend a great
toothpaste.
[Laughter.]
MS. HERSEY: Okay, now I know who you are. We
knew early on when one of the children ate a whole tube of
it, and it was fine, that we had no proble
MS.
[Laughter.]
DR. BRESLER: Very quickly, for Jane and for
Lawrence. Are your organizations doing anything to address
the PTSAs with your information, get to the parent
organizations and schools and elsewhere, and alert them if
their kids are having problems, it could be chemicals, it
could be food sensitivities?
MS. HERSEY: We try to. I do workshops all over
the area. I am happy to go to any school or group. I just
need two ears, and then I will talk. I like to focus on
showing families really, really simple things that they can
do. I can teach a group of people in 30 minutes how they
can make dramatic changes in their grocery shopping and cut
out some of the worst of the additive.
DR. BRESLER: But that is just you. Does your
organization really putting energy behind that?
MS. HERSEY: We try, but it is very difficult
because the drug-funded literature, the schools have been
flooded with pro-Ridalin information. So it is hard for us
to get in in some cases.
DR. PLUMLEE: I would have to say that we are not.
We are a coalition of groups from all over the country.
There are some initiatives locally, but primarily because we
are coalition of patients who have been chemically injured
and can oft be demonstrated as having brain damage on SPECT
scans and other sensitive measures, people are not able to
be as active as they would like to be if they were healthy.
DR. GORDON: Thank you. Wayne.
DR. JONAS: I just wanted to clarify a little bit
about the need for data in looking at what happens if you do
not regulate medical practices. I don't want you to
misinterpret my question about that. I think we need data.
I don't know if any has been collected on that.
When I close my eyes and imagine a world like
that, the first thing I imagine is before the Flexner Report
in which there was major harm from unregulated practices,
both regular and irregular, and I don't think we want to
return to that.
I did have a question, both for
MS. Hersey and
DR.
Plumlee, about multiple chemical sensitivity. I know there
has been a large debate and many panels, official and
unofficial, that have looked at this over a number of years,
and it always seems to come back to the same issue. It is
very difficult to identify any specific toxin or chemical
associated with any particular type of damage or condition.
They re-resurrected this problem in looking at
Gulf War syndrome. Certainly, a number of people are very
sick, but they can't really identify why in terms of
particular chemicals.
I wonder if you would want to comment on that
area.
MS. HERSEY: I would very much like to comment.
Our program is sometimes considered to be much too simple,
and it really is very simple, but it is also very effective.
We start out with a small group of chemicals to identify
and remove, and it is not because we think they are the only
ones, but they are very obvious, they are very easy to get
rid of, and our results have been excellent.
So we take a focus on synthetic dyes, artificial
flavors, and a group of preservatives, as well as aspartame.
Now, we understand there are lots of toxic chemicals in the
world, but a family has to start somewhere. I jokingly say
that some of the people who call us are the folks who
consider Taco Bell to be one of the four food groups.
Now, when you are working with people like that,
you really have to make it very simple and doable. These
folks, even though their diet is far from perfect, and they
may be exposed to all sorts of toxins, when they take away
the Skittles and the Kool-Aide and the Jello, and their kids
aren't eating petroleum-based dyes and other things like
that, invariably, there is a significant change, a
significant improvement, and then that gets them started.
Larry would be sort of in the graduate school area
of what we are doing. We are kindergarten. You know,
kindergarten isn't everything, first grade isn't everything,
but it is awfully important.
DR. PLUMLEE: Well, I would like to speak to that.
I think that part of it is that, as my first reference
indicates, the genetic variability of sensitivity to
chemicals in the population is greater than can be accounted
for by homogeneous strains of rats and mice on which the
toxicology studies are done before chemicals are brought to
market.
Also, we know that certain pesticides alter
sensitivity. That is, that repeated exposures lead to
exquisite sensitivities.
[Alarm.]
DR. PLUMLEE: Is that for me?
DR. GORDON: We will go to the end of this
question. Then, Don, we will have to let it go after that.
DR. PLUMLEE: But since we have been able to
reproduce some of this in rats, it does seem quite clear
that this is a real phenomenon and not a psychogenic one.
DR. JONAS: I was happy to see that there is a rat
study, though not for the rats.
DR. PLUMLEE: Part of the difficulty, again, has
been that the studies sponsored by the chemical industry
have been the ones that have found psychological
characteristics of the patients with chemical sensitivity.
DR. GORDON: Thank you.
Incidentally, we do welcome any suggestions that
you may make as far as research, the kind of research, that
we ought the be encouraging. So please forward that to us
and we will certainly consider that as well.
Thank you very much. We will go on to the next
panel.
The next panel is Andrew Rubman, Marshall Sager,
Diana Miller, Courtney Banks, and Richard Pavek.
We will begin with Andrew Rubman.
DR. RUBMAN: Yes. Good afternoon. The AANP and I
welcome the opportunity to present observations and
concerns.
In your book,
DR. Gordon, "Manifesto for New
Medicine," you elegantly address many of the concerns that I
would raise, and I applaud you in that.
What distinguishes traditional medicine from CAM
is its reliance not only on the CAM therapeutic modalities,
but the underlying principles of enhancing normal physiology
to decrease the emergence of pathology. This notion is
inculcated in naturopathic medical training and makes us
fresh and unique in this.
We are the only physicians licensed to practice as
primary care providers in the United States, and formally
trained in the basic and clinical medical sciences, who are
additionally trained in the science and philosophy of
traditional medicine. In the State of Connecticut, where I
have been licensed to practice for 18 years and had the
privilege of lecturing for NIDDK and for Yale on a number of
occasions, the terms "naturopath" and "naturopathic
physicians" are used synonymously in state statutes where
our licensing act dates back to 1930.
It is the opinion of Connecticut state senator
George Gunther, himself a naturopathic physician, that
naturopathic Medicare may be added to Medicare language to
correct a drafting oversight, and much the same access can
be granted to the military by modifying DOD revisions
currently being contemplated.
In a published news release, the American
Osteopathic Association stated that doctors of chiropractic
care, for various reasons, should not be given a full scope
of practice in their interactions with the military.
Without passing judgement on that opinion, I would say that
no physician in this day and age should be considered fully
licensable in all arts. The present needs of our citizens
and the enormous body of emerging medical information leaves
us no choice but to produce a better model where no one
approach to medical care is forced to stand in judgement of
others.
Insufficiently trained providers may actually be a
threat to public safety. The time has come for us to study
and implement the model that
DR. Gordon so insightfully
crafts, but to do so with the participation of the
naturopathic physicians. Incorporating naturopathic
medicine as a guiding principle to help shape and implement
the new medicine will allow our citizens to become better,
more objective consumers, limiting high-priced procedures
and pharmacy by increasing their wellness and thereby
avoiding disease.
The medical doctors and osteopaths have enough to
do staying current within their discipline. Let's not try
to produce a single specialty renaissance physician. Let us
instead modify medical delivery and provide the oversight of
a multi-disciplinary tribunal. It is my wish that a
naturopathic physician be appointed to this commission to
help make this dream of improved, responsible health care a
reality.
As a professor of clinical medicine at the
Naturopathic College University of Bridgeport, I certainly
welcome your next topic as well, embracing education as a
next focus.
Thank you very much.
DR. GORDON: Thank you. Thank you for the nice
words as well. Marshall Sager's testimony, everybody here,
Roman numeral VII, Tab 6.
DR. SAGER: Good afternoon, ladies and gentlemen.
I am Marshall Sager,
DR. Marshall Sager, and I am pleased
to speak with you today as president elect of the American
Academy of Medical Acupuncture and chair of the American
Board of Medical Acupuncture, which administers a
comprehensive examination leading to board certification of
physician acupuncturists.
My address today is an abbreviation of our
complete submission, which I trust you will read in its
entirety. Medical acupuncture, which is the practice of
acupuncture by fully trained and licensed physicians, falls
within the scope of the practice of medicine. By combining
Western and Eastern medicine, the medical acupuncturist
fills a unique and critical role in patient care.
In other words, the best of both worlds. The AAMA
adamantly believes that the rules and regulations governing
physician acupuncturists must, as in the case of any other
medical specialty, fall under the purview of the respective
state medical boards. Reimbursement for medical acupuncture
services in this country is sparse, and usually limited to
those patients who can afford to pay out of pocket.
While physicians are routinely reimbursed by third
party payers for conventional Western medical-related
services, such as evaluation and management, rehabilitation,
inoculations and the like, payment for and access to the
ancient and effective practice of medical acupuncture is
generally denied. This is illogical and disturbing,
especially when we consider caring for our elderly, those
who could benefit significantly from medical acupuncture
therapy.
Never forget that, as physicians, we are held to a
high level of accountability and responsibility. Those of
us who care respectfully request -- no, insist, that this
inequity be remedied. The fact that most health care plans
do not reimburse for physician acupuncturists services has
forced patients from their primary medical care providers
and out of the health care system. This fractionalizes
health care. Furthermore, this disparagement in health care
delivery borders on discrimination because poor patients
with limited out-of-pocket resources are unable to
participate.
Unfortunately, there is no quick fix to this
problem. Medical students and physicians must be educated
about the use and effectiveness of all complimentary medical
modalities, especially medical acupuncture. They must
understand that medical acupuncture is not a threat to their
practice. It is an enhancement to their success.
We must change the sad fact that medical
acupuncture is virtually non-existent in hospitals where
patients would benefit enormously from medical acupuncture
to alleviate pain and expedite recovery. Medical
acupuncture saves money and creates win/win scenarios.
Patients benefit by speedy recovery and reduction
of biopharmaceutical use; surgeons benefit because their
patients heal faster; hospitals benefit because of shorter
hospital stays; and the public benefits because of reduced
health care costs. A win/win all around.
DR. GORDON: Thank you very much. Diana Miller.
MS. MILLER: Hello. Thank you for letting me be
here to testify today as a public commentor.
I am an attorney and I am committed to legal
research, education, and designing laws that take away the
barriers for consumers for access to alternative health and
other kinds of health care that they deem necessary for
their healing.
[Alarm.]
MS. CHANG: Sorry. Sorry.
MS. MILLER: I have been involved in a lot of
cases where practitioners have been prosecuted or consumers
are trying to get access, child protection cases where
parents want to take the child to CAM providers, licensed
people who are being disciplined in front of their boards,
lay people who are being prosecuted criminally for the
practice of medicine without a license.
I have worked on task forces for ALINA, which is a
19-hospital system in Minnesota, trying to set up
credentialing for integration in that system.
In my younger years, I was a chemist and did a lot
of National Science Foundation research in organic
chemistry, but I think the final thing that really made me
dedicate my life to alternative health was that I was
totally disabled for three years and kind of sent away to,
whatever, look out the window in my rocking chair and wait
to die. So I learned a lot about alternative health care in
a very short period of time, and I am here to tell about it.
I am very excited about it.
My goal now is to find a way for the healing
energy, healing truths, healing light or path of any
consumer to come to as many of us as possible in as many
ways as possible. So I am quite unintimidated by the laws,
and I want to encourage you to think outside the box. I
will support Berkley Bedell in his request of you to take
some risks.
I have been working in Minnesota for the last four
years, creating a law there that would find a balance
between the government's duty to provide protection to the
public, and the consumer's right of privacy and to make
their own decisions about their health care. The current
system is disempowering consumers. Anything that you do to
disempower a consumer will make it more expensive and will
not get consumers well.
Minnesota believes consumers have the right to
access any person or treatment they deem helpful to bringing
them to full health. Consumers are their own best resource
and friend, and can make good decisions regarding healing
decisions. Consumers benefit from an informed environment.
Empowering consumers in their healing process is the
bedrock of healing.
DR. GORDON: Thank you very much. I think you may
know that we are planning to have a town hall in
Minneapolis, and we would like to be in touch with you
before then so you can help us discuss who would be good to
have participate in that town hall.
So thank you very much.
Next is Courtney Banks.
MS. BANKS: Hi. My name is Courtney Banks and I
am 33 years old. I am here to tell you how alternative
medicine and therapies have changed my life, and, I believe,
have saved my life.
Up until I was 26 years old, I thought I lived a
very healthy lifestyle. I exercised, I ran five days a
week, I ate lots of fruits and vegetables, I took very good
care of myself. I also would take antibiotics when I had an
infection or a bad cold. I would take aspirin or Tylenol
when I had a headache, which was normal to me.
When I was 26, three months after I gave birth to
my daughter, I found a lump in my neck and found out I had
Hodgkin's Disease. I had five weeks of radiation therapy,
which got rid of the Hodgkin's, but I knew I had to look at
my whole life and, what was I doing or not doing that
enabled my body to get so sick.
So I started reading everything I could, and
luckily I was introduced to
DR. Gordon who became my doctor,
and he began helping me get focus and get on my path. I
have done acupuncture with him, and in the last seven years
I have changed my diet. I eat only organic fruits and
vegetable. I eat whole foods. I don't eat foods that are
filled with preservatives and other chemicals. When I get a
cold or my daughter gets a cold, we use homeopathy.
I can truly say, in the last seven years, I have
never felt healthier, had more energy and a more positive
outlook. I have one other testimony of how it has worked.
Three years ago, I had an abnormal PAP smear that came back
with cervical dysplasia. After talking to several friends
of mine, five of them had all had it, and all had done what
the doctor recommended, which was chirosurgery. I am not
quite sure I am saying that right.
My doctor said the same thing to me. I went to
DR. Gordon and I said, I have mild to moderate dysplasia and
he wants to freeze them off. And he said, Do not do this.
You need to do this and this and this, and there are
different alternative treatments, which I did. Six months
later, the dysplasia was gone and I have had normal PAP
smears ever since.
So I know that these work. It is not alternative
to me, it is going back thousands of years ago, which I know
many of you know, to being natural. I guess my two main
wishes are that there are more
DR. Gordons that people could
go to help guide them, and that people need to be educated
about health and really truly healthy living because I
thought I was living healthy, but not until I learned about
natural living, that that is really healthy. So I thank
you, and thank you for this opportunity.
DR. GORDON: Thank you, Courtney. God bless you.
Thank you very much.
Richard Pavek.
DR. PAVEK: Thank you. I am Richard Pavek from
the Biofield Research Institute. I wish to raise a point
that has not yet been addressed. Much of what has been
presented in these conferences is focused on the integration
of CAM into conventional medicine. When it is integrated,
who will control its future? What will happen to the
alternative practitioners who are not MDs?
DR. GORDON: Richard, come a little closer to the
mike.
DR. PAVEK: Is it on?
DR. GORDON: Yes. That's it.
DR. PAVEK: Oh, okay. Sorry.
I would like to remind you that every alternative
practice, teaching, method, or philosophy was developed
outside of conventional medicine. What will happen to the
developers of alternative therapies, the alternative
thinkers?
Conventional medicine has a long history of
persecuting and repressing any thinker and any system that
lies outside the biochemical, soulless model of the human
being upon which conventional medicine is currently
grounded.
One of the earliest examples of continued
persecution is that which was given to friends, Antoine
Mesmer, his theories of a subtle energy field, which he
called animal magnetism, and the treatment system utilizing
the animal magnetism from his hands.
In 1784, he proposed, as
DR. Atkins did this
morning, matched groups of patients, one group to be treated
conventionally, the other by his method, the results to
prove efficacy. The medical association refused and said
his effects were all because of belief and suggestion.
Conventional medicine could not accept the idea of
a subtle energy field, and for over the next 50 or so years,
medical societies banned their members from associating with
animal magnetizers. Medical journals threw papers submitted
for publication into the trash, and that is recorded
historically, and publicly denounced the process as
superstition.
Does this sound familiar? Mesmer's work, which
has risen again in the form of therapeutic touch, healing
touch, SHEN therapy, and the other forms of biofield
therapeutics has been so erased from history, that his
history is not even known to many current practitioners.
History teaches us that every discipline, every
theory, has eventually rigidized, coalescing into a concrete
icon that cannot be moved without the aid of dynamite, or in
some cases semtec [ph]. This happened to conventional
medicine and will happen to it again if we are not careful.
What will we do in the future if we do not protect and
nurture alternative medical thought?
I urge you to recommend that alternative
practitioners be enfranchised with as much legal right to
practice as possible, or the seed beds of future new thought
and medical/health possibilities will be destroyed.
I yield back 29 seconds. That is a record for me.
Panel Discussion
DR. GORDON: Thank you very much, Richard, and for
your generosity as well.
I want to make sure that all of the panelists, all
the people who are speaking on these public panels, if you
would just check at the desk to make sure we have all your
contact information, names, address, phone, email, wherever
applicable, because one of the things I want to say people
is that people who have spoken at public panels and people
who have spoken at town halls have given us a tremendous
amount of guidance, and we are in touch with them.
A number of the people who are speaking here today
are people we met first at the Town Hall in Seattle. So we
regard you as ongoing partners with us in this journey we
are taking.
Questions from Commissioners. Any questions?
Joe.
DR. FINS:
MR. Sager, I am not a real expert in
any way in acupuncture, but it strikes me there are lots of
organizations that have competing names and objectives and
goals.
If one of the overall objectives is to ensure
access to safe and standardized care, how would one propose
bringing all these groups together in a way that would allow
regulation?
DR. SAGER: Well, I speak for the physician
acupuncturists, primarily, since I am a physician and I am
an acupuncturist. Actually, I am an osteopathic physician,
so I am a triple threat.
The American Academy of Medical Acupuncture is the
primary professional organization that represents physician
acupuncturists across the country, or in North America.
There is no other organization that is primarily physician
acupuncturist. There are other organizations that represent
other physicians, non-physician acupuncturists, and there
are some that represent a mixture of two, I understand.
If your question is, how do we get all of them to
act in concert, I think that is a good question. I don't
have the answer. They don't seem to be too friendly at
times, and it becomes a problem with respect to turf,
basically. I would like to see more friendly relationships,
too.
DR. FINS: Because it seems like it is a generic
problem for all of the practitioners because --
DR. SAGER: Well, it is; and it isn't, in the
sense that physician acupuncturists are trained in multi-
paradigms of acupuncture, basically -- and that is not 100
percent thing -- and non-physicians have their own TCM
approach.
DR. FINS: But what I am saying is that we have
multiple practitioners with different degrees of experience
and different kinds of training doing similar tasks on the
same patient population. So it seems like it is a generic
kind of issue that we are going to figure out how to do.
DR. SAGER: Well, yes and no, again, in the sense
that when you are dealing with a physician acupuncturist, he
or she is bringing in the Western medical training also. So
the application of the acupuncture might be similar in the
sense that it is acupuncture, but it might be taking a
different as an adjunct or as a primary mode of therapy.
DR. GORDON: Joe, I think it is an issue, and I
was actually talking about it earlier with several different
groups of non-physician acupuncturists.
I think what we would ask is, where possible, if
different groups that have interest in the same general area
could get together, and if you want to talk with us, could
come together and share different perspectives
simultaneously with us, and share common perspectives, that
would be helpful as well.
We hope that, just as in Seattle, one of the ways
our being there seemed to work, is to bring different groups
of people together to talk to one another, as well as to
talk to us. We really want to encourage that. We are not
trying to discourage pluralism. We are trying to encourage
collaboration, though.
George, and then Wayne.
MR. DeVRIES: A question for Diana Miller.
Diana, maybe you can just highlight for us. We
have talked today about access to CAM services, and we have
talked at a level, I think, principally about access to CAM
services for adults versus access to CAM services for
children. I think specifically you had mentioned issues
related to Child Protective Services. I am thinking,
particularly, of the Navarro case.
Maybe you can highlight, from your perspective,
what you think some of the issues are in terms of parental
choice when they want to make the choice of CAM for their
child, perhaps, like the Navarro family did.
MS. MILLER: I think that is a difficult issue,
depending on which state you are in. I think it is an
important issue. First, I will just say that state law is
very specific to the culture there. So I will speak for
Minnesota. How does that sound? Because child protection
issues are very different from state to state, and we want
to protect that pluralism. We don't want a federal standard
for child protection, but we want kids to be safe.
So in the context of the culture of that state,
and I can talk for Minnesota, there are child protection
standards and it says necessary medical care. Then you get
into a fact situation about what kind of medical care and
what kind of evidence is brought forward; and if it is a
divorced couple; did they bring an expert homeopath on the
stand; or if they even allow a homeopath instead of a
medical doctor.
So the courts are dealing with this, and part of
the legal reform necessary, which we were working with, is
the legal reform to give the court some direction in terms
of the expert witness testimony. But in general, it is the
appropriate medical care standard. For the new legal reform
in Minnesota, we just went with the basic standard and did
not change the child protection laws.
So it will still be a fact case for the judge to
decide. Even in a non-CAM situation, like a surgery versus
an antibiotic, that is always a fact situation that is very
difficult for the judge to decide, especially if it is
between divorced parents.
DR. JONAS: In terms of who is going to deliver
what services, which we have been touching on, I think,
around here.
MS. Miller, thank you for giving us this
description of the Minnesota law. A lot of what is talked
about is opening up access and kind of removing licensing
regulations and this type of thing.
DR. Rubman said something that I thought was very
intriguing, which is, no physician should be fully licensed
for all arts, which would imply, maybe, the opposite of
that, that we should go in and perhaps more precisely
regulate scope of practice and what could be delivered, even
to the point of saying physicians cannot practice certain
types of things, which, right now they are not restricted
to, such as acupuncture, for example, without certain types
of credentialing and training.
I am just wondering if any of you would like to
comment on that. Is this what is going on in the states,
where there is more fine-tuning of the regulation of who can
deliver what types of services?
DR. SAGER: To the contrary. The move has been,
specifically with your last comment about maybe physicians
not practicing acupuncture or being limited in their scope,
the trend is toward allowing -- there have been a handful of
states that were reticent to allow physicians to do
acupuncture under the scope of their license or with some
training that is reflective of the World Health Organization
recommendations.
It is difficult to tell a physician that he or she
can't put a solid needle, which no medication is applied to,
into the skin when they are using all these other drugs and
these larger needles. That, I think, is a difficult
example. Maybe there are some others that you wanted to
use, but I have to defend that situation.
MS. MILLER: There is a difference in a
jurisdiction law and an exclusive scope-of-practice law. In
Minnesota, we had to discern a lot about -- there is a lot
of healing that all practitioners do that medicine, that
nursing, the chiropractors, that everybody does. Then there
is a lot of healing that a lot of them don't know about.
So to create models that allow rights and don't
provide exclusive scopes of practice so that if someone can
practice another modality they can have that opportunity, is
a very different model than the licensing scope because it
doesn't follow the five elements of a licensing statute. So
to change the legal model of how to make that work and still
keep the safety in mind is what needs to be --
DR. JONAS: Andrew, do you want to clarify?
DR. RUBMAN: Yes, okay. Thank you, Wayne.
I think there are a number of issues here that are
interesting to reflect upon. I have yet to meet a
renaissance physician. I have met some very gifted
physicians, but the more years I spend in clinical practice,
the more I realize not only what I don't know, but also what
others don't know.
I think that what we need to do is, of course,
first and foremost, hold public safety tantamount, do what
we need to do in order to craft criteria bars to clear, ways
of assessing and measuring the didactic and the practical
knowledge that an individual possesses so that, first, they
do no harm, and secondly, they provide a legitimate cost
effective service to the population that they serve.
I think if we hold these criteria central to this
investigation, then we will make very few false steps.
DR. GORDON: Thank you. We have to end the panel
now. One thing I wanted to say, earlier in our informal
discussion we were talking about conceptualization. I think
that the whole issue that we have just been raising, with
these last few questions and responses and with this panel,
is partly, how do we somehow get beyond the guilt mentality
at the same time that we teach an appropriate respect for
what is possible, professionals as well as non-
professionals, and also an appropriate respect for what all
of our limitations are.
That is a kind of conceptual issue that is so
clearly raised by this kind of discussion; what are we
capable of, and, how do we know our limits, and, how do we
encourage people to both go to their limits and understand
those limits at the same time.
Thank you again. Look forward to continuing to be
in touch with you.
We are going to take a 10-minute break, and then
we will have the next panel. This is the last panel of
today. After this panel, we will have time for questions
and discussion. Then there will be a discussion among the
Commissioners about some of the ideas, some of the concepts,
some of the perspectives that have been generated by these
two days of discussion. That discussion, of course, is open
to the public. So you are welcome to listen in on us, as it
were.
[Recess.]
Session VI: CAM Integration in Existing Delivery
Systems
DR. GORDON: We have two people who have helped to
integrate the integration of CAM approaches and therapies
and research in two very significant syste
MS. We will be
having others who represent other systems in the panel on
reimbursement, but we wanted to begin this discussion now.
The first speaker will be Alan Trachtenberg.
Welcome.
DR. TRACHTENBERG: Thank you. Thanks very much,
Jim. It is a pleasure and an honor to be here. I want to
thank all of you Commissioners and the staff for having me.
My name is Alan Trachtenberg. Some of you may
remember me from the NIH Office of Alternative Medicine,
which I ran from '94 to '95, or from the NIH Consensus
Conference on Acupuncture, which I organized in '97.
Currently, I am the medical director for the
Office of Pharmacologic and Alternative Therapies, or OPAT,
at the Center for Substance Abuse Treatment, CSAT, of the
Substance Abuse and Mental Health Services Administration.
SAMHSA is an agency of the Public Health Service at the same
level as NIH, FDA, or CDC, and is the primary public health
service agency responsible for federally funded mental
health and substance abuse treatment.
A vital part of our mission is the full
integration of these services with the rest of the public
health and medical care system. So it is particularly
appropriate we be here at this panel here on integration,
for which I again thank you.
Within SAMHSA, we have three centers, the Center
for Mental Health Services, the Center for Substance Abuse
Prevention, and the Center for Substance Abuse Treatment, or
CSAT. The bulk of my activities at CSAT are currently
involved with taking over from FDA in the regulation of
opiate addiction treatment providers.
A group from Yale that recently published in the
Archives of Internal Medicine performed their highly
significant randomized trial of ear acupuncture for cocaine
addiction in the kind of clinic that we are dealing with now
at our office at CSAT.
Since treatment of opiate addiction with agonist
medications like methadone is highly effective against
heroin addiction, but has little activity against cocaine,
this kind of clinic offered the perfect setting to integrate
a complimentary treatment against cocaine. I will say a
little more later about some acupuncture activities my
office hopes to be undertaking in the near future.
I was asked by staff to provide answers to four
questions today, which I will try to do. I was asked by
staff, what CAM practices does my agency support; how were
they selected; where and how are they provided.
Well, we support a variety of alternative
practices that maybe included as elements of comprehensive
treatment progra
MS. These include acupuncture, meditation,
and culturally-specific healing practices, such as sweat
lodge and traditional Hawaiian medicine.
The specific practices are chosen based on needs
as determined by the local or state level. Because CSAT
funds are provided directly to the states in our block
grants, we are working with the National Association of
State Alcohol and Drug Abuse Directors, or NASADAD, to gain
a more complete picture of the alternative therapies that
are being used in publicly funded drug treatment progra
MS.
We were asked to make the delivery of CAM more
culturally appropriate. Alternative therapies and
traditional healing practices have been included in our
programs, primarily as culturally relevant elements of a
comprehensive treatment and outreach program. The cultural
and linguistic appropriateness of the specific alternative
or complementary health practices for communities served by
these grantees is itself the primary impetus for the
inclusion of the complementary practices in the progra
MS.
Is the delivery of CAM to our agency's target
populations accomplished as a stand-alone system, or
integrated with conventional care, and why?
All therapies for drug abuse treatment, be they
alternative or conventional, psychodynamic or medical,
should always be included in an integrated matrix of
services that are as comprehensive as possible and tailored
to the specific needs of the patient and the community.
In the drug abuse field, we recognize many
elements of our treatment programs, just like many
conventional medical practices, are based on less than
perfect evidence. However, in the drug abuse treatment
field, we have much evidence that our patient's outcomes do
better in direct association with increasing amounts of time
spent in treatment settings.
If an alternative therapy brings patients into the
treatment setting and keeps them coming longer, then it has
utility over and above whatever specific efficacy it may
have. This would not be the case, obviously, for a single,
stand-alone therapy, be it alternative or conventional.
At this time, my office is requesting funds to
assemble a consensus panel to make recommendations about how
acupuncture should be incorporated into more existing drug
treatment progra
MS. This would be an obvious next-step to
follow up on the 1997 consensus statement on acupuncture
which said, in part, that "Acupuncture treatment for many
conditions such as asthma or addiction should be part of a
comprehensive management program."
My personal view is that the treatment guidelines
the come out of such a process would most likely include the
protocols of the National Acupuncture Detoxification
Association, or NADA. This is the ear acupuncture in a
group setting approach developed at Lincoln Hospital in
Bronx, New York, and used by over 400 drug treatment
programs, 40 percent by drug courts, and by almost all
addiction researchers studying acupuncture in the USA.
I brought copies of my complete testimony, which I
have left at the back, and an accompanying of a study that
was funded by the Center for Substance Abuse Treatment on
Acupuncture in drug treatment progra
MS.
Thank you.
DR. GORDON: Thank you, Alan, for coming back.
Milton Hammerly.
DR. HAMMERLY: Thanks for inviting me to share
CHIs perspective on how to foster a more integrative
approach to health care. As you can imagine, in a system
that is in 22 states, over 100 facilities, 75,000 employees,
there is a great diversity of services being offered, a
great disparity in the levels of understanding, the level of
sophistication.
It has been an evolutionary process. Early on,
there was a steering committee, basically, that was a
homogeneous group of believers trying to promote CAM
integration, and that was not met with a lot of success.
Since then, we have opened that up to a more heterogeneous
cross-section of the organization, including skeptics, and
we have also defined a compelling philosophy of integrative
health care, asked the why and how questions.
I am glad to report that now we have, basically,
unanimous organizational buy-in and support of that
philosophy. The difference being on what that looks like
based on specific market variables, what the consumer
readiness and expectations are, what the availability of
services are, what the medical staff of readiness is.
We are very interested in research. So far, what
we have is very limited data. It is soft. It is
qualitative. In an effort to facilitate data collection, we
have created a comprehensive care assessment tool, a
holistic mind-body spirit evaluation intake that seamlessly
imbeds the SF-36 so that it makes data extraction easier
later down the road.
We have not been successful in accessing research
funding which seems to be mostly finding its way to academic
centers. In an effort to remedy that, we have approached
pharmaceutical companies with synergistic combinations of
supplements and pharmaceuticals which are, in fact,
patentable, now providing an incentive for them to want to
pay for the research.
We are under no illusion about their motivations.
Clearly, their motivations are profit-driven. However, I
think that whatever the past history of pharmaceutical
companies has been, they can be recruited as part of the
solution, as part of important stakeholders to help forward
integrative health care.
So we are looking to make a sustainable research
funding mechanism that could potentially be far greater than
actually existing government funding. In the handout, we
have identified several sources of opposition, and also
several sources strategies for overcoming opposition.
First, is embracing the opposition, addressing the
legitimate concerns and making them part of that
heterogeneous group. Second, is finding the common ground.
I think cost is the lowest common denominator. I think
patient advocacy, patient safety is the highest common
denominator. That is something that people can get
passionate about. I have heard a lot of passion about
therapy advocacy. I think we need to be dispassionate about
therapy advocacy and passionate about patient advocacy.
That is the essence of our philosophy, which is to
provide comprehensive mind-body spirit care which
personalizes care and which has to be, of necessity,
collaborative. In the handout, I spent a full 10 pages
devoted to the why and the how of the CHI definition and
philosophy of integrative health care, talking about
evidentiary standards, talking about a risk-stratified step-
care model, talking about the primary importance of safety
and the overarching philosophy.
Another way of stating the philosophy of
integrative health care, CHI, is to say it is about patient
advocacy and not therapy advocacy. It includes CAM, but it
is not about CAM. As a result, we have had a tremendous
support for that.
The last barrier that I will address is the issue
of finances, which is a recurrent theme. I think the only
reason it is a barrier is because we are stuck in the old
assumptions. I think if we can move past those, it will be
very helpful. I think we are still putting the new clinical
line of integrative health care in the old reimbursement
skins. Similarly, we are doing the same, I think, with the
old research skins and the old regulatory skins and so on.
I think we can all be instruments of healing,
whether we are chiropractors, whether we are massage
therapists, naturopaths, acupuncturists. When we work
together we create an orchestra, and the music that that
orchestra can play is far greater than the music we can play
as individuals. I think that the Commission, by helping to
break down those silos, those barriers in reimbursement in
clinical areas, can actually help lead that orchestra.
Panel Discussion
DR. BRESLER: This is for
DR. Trachtenberg.
First, I want to congratulate you on all your extraordinary
efforts in both the LAM and Consensus Conference. These are
really useful, helpful activities that are going to make a
real big difference, we think. Thank you very much for
that.
DR. TRACHTENBERG: Thank you.
DR. BRESLER: The question comes up, it seems to
me a real big issue in chemical dependence now is dealing
with the compulsion aspect, not just dealing with withdrawal
issues, but looking at the compulsive nature of this
problem.
Is there active research going on now looking at
CAM interventions that deal with the compulsive issue?
DR. TRACHTENBERG: I am glad you raised the issue
of compulsion, and with craving that goes along with that,
which in fact, is the core of the problem with addictions.
It is not withdrawal. I mean, we were mistaken in thinking
that it was about withdrawal and that an addict would be
cured once they were detoxed. We went awry with that. In
the last 10 to 20 years, we have understood differently.
You know, it is very interesting, in that,
addiction treatment has in this country, even in fairly
conventional circles, had a spiritual dimension. Perhaps
because of the lack of much else to offer, spirituality was
allowed into the treatment setting. In that sense, bringing
the two together in terms of the new-age complementary and
alternative medicine kind of spiritual dimension coming in
with the rest of medicine is, in some ways, old hat in
addiction treatment.
Now, the interface of the issues of spirit, plus
the neurophysiology of craving and compulsion and a reward,
I think it opens a lot of research questions which deserve a
lot more attention than they have gotten, and I am hoping
that perhaps the Commission will urge us on more in those
areas.
DR. BRESLER: Is there any active research being
done with CAM modalities on compulsion that you know about?
DR. TRACHTENBERG: I am no longer from a research
agency, so perhaps your question would be better directed to
some of the National Institutes of Health.
DR. CHOW: This is also for Alan. I also commend
you on all that you have accomplished.
I have to turn this way. I want to also commend
you on your accomplishments and all that you have done. In
here, you said there were 13 million individuals being
treated, and approximately 10 million are not receiving it.
So this talks to accessibility and eligibility.
Can you say something about that number that we
are not reaching. And, what is it you recommend that can be
done, besides resources? Having money would help, but are
there other thoughts on that?
DR. TRACHTENBERG: A number of things. Probably,
as
DR. Chavez commented here in the same quote where you got
the 13 million who need treatment to only 3 million of whom
are actually receiving it, a lot of it has to do with
stigma, with our willingness as a society to cast aside
people with this range of problems, to blame the people for
their problem because of the vagaries of history, that we
put such a moralistic judgment on this particular category
of illnesses, much more so than we currently do on other
aspects of health.
Four- or 500 years ago, if you got tuberculosis,
that was felt to be the wrath of God. It was your own damn
fault, and we still feel that way about addictive disorders
in particular, and to some degree about mental health
problems in general.
So that, I would say stigma, besides resources and
the lack thereof, and possibly intertwined with and causing
the lack thereof, has much to do with that treatment gap.
DR. CHOW: So your recommendations, then, would be
education?
DR. TRACHTENBERG: More than just education. I
have to be careful what I say here in Washington. I think
we should encourage each other to find -- you know,
complementary medicine, to some degree, has brought this
message into the rest of American medicine. We should try
to find the human in all of our fellows, try to find
ourselves and see ourselves in our fellows.
How to implement that as a program, I couldn't
tell you, various ways. We all should try to do our part.
DR. GORDON: Joe.
DR. FINS:
DR. Hammerly, thank you for your
excellent submission. I just want to make an observation
that will lead to a question.
DR. Quevado, who spoke
earlier, I believe was from a Catholic hospital. You are
from a Catholic hospital system. Their mission, their
values; there is kind of a core sensibility.
What impact has that had in developing a consensus
downstream? And related to that, on page 22 of your
testimony, which was about taxonomy, which I thought was
incredibly helpful, you talked about grouping therapies
according to how we think they work.
I was wondering why you had a means versus an ends
approach, because you could have also said, let's group them
based on what they accomplished versus mechanism of action.
So those are two related questions.
And then one request on behalf of the Commission.
There is a big table of contents here of what I presume is
a book or a binder, or something. If you could furnish
several copies to the Commission, it would be very helpful
to us if you would be willing to do that.
DR. HAMMERLY: Okay.
DR. FINS: Great.
DR. HAMMERLY: On the issue of Catholic health
care systems, there is a commonality in terms of wanting to
provide holistic mind-body-spirit care. The theme that
DR.
Quevedo kept mentioning, that beliefs matter, I said it in a
different way. I said that we can no longer afford to treat
patients despite their beliefs. I think that that makes it
a lot easier to get that unanimous support when we agree
that providing this comprehensive care is essential to who
we are and the kind of care that we want to deliver.
On the question of taxonomy, my approach is to
say, if we don't have at least a theory about how it works,
then how are we going to utilize it, because I think our
understanding drives what we do with it. In terms of using
a taxonomy that is entirely based on mechanism of action,
there is the danger of becoming mechanistic and losing the
totality, perhaps, of a more systematic approach.
I have heard several comments about using CAM as a
term being a disservice, as a generic term. I think using a
system of medicine is somewhat of a disservice because that
system of medicine has several different modalities with
several different mechanisms of action. So we need to, if
we want to know how to apply it, have an idea of how it
works.
DR. FINS: There is also an instrumental value in
clumping things together, because it shows areas of overlap,
how you can departmentalize it, how you can organize it, how
you can have the psychotherapist working with other similar
kinds of mind-body practitioners in a way that allows for
organizational structure to occur.
Was that something that happened because of this
clumping?
DR. HAMMERLY: It gives us a clinical strategy.
The other thing it does, in terms of a classification
scheme, it helps identify similarities, differences, and
where it could be applied. It also can be, actually, a
diagnostic tool where we say, okay, what is going on in the
biochemical category; what is going on in the structural
category; what is going on in the energetic category.
So it actually can be like a pneumonic to help us
remember to be thorough in our evaluation of patients. In
fact, the comprehensive care assessment tool that I
mentioned is based on that and addresses all those
categories so that nothing is left out.
DR. GORDON: Wayne, and then Tieraona, and then
Tom.
DR. JONAS: Alan, I want to also thank you for
your long-term and ongoing, even now, continuing work in
these areas. You have contributed, I think, to these areas
in a number of ways, a number of avenues, and I really
appreciate that.
I know that SAMHSA is not a research organization.
However, they do do demonstration projects. Isn't that
correct?
DR. TRACHTENBERG: Correct.
DR. JONAS: I am wondering what the possibility
would be. Would it be reasonable, or is there an
opportunity, perhaps, in SAMHSA to do an integrated systems
demonstration project that looked at a number of addiction
types of treatments. It would have to, obviously, build off
of the current successful practices, and look at add-ons,
for example. You can incorporate in spirituality,
acupuncture, biofeedback, this type of thing.
Is that something that SAMHSA, you think, a good
place to do, or could do that, or would be in a position to
do that?
DR. TRACHTENBERG: Well, at least CSAT, the part
of SAMHSA that I work in, Center for Substance Abuse
Treatment, I think would welcome the collaboration, and
especially the resources to do projects like that.
DR. JONAS: Yes. They would be open and able to
set up such a project, probably, if there were resources and
a request for that.
DR. TRACHTENBERG: Yes.
DR. JONAS: I am always struck with the
contradiction, not just in this area, but I am going to use
this area as an example. If you go over to NIH and NIDA,
and you say, are there any specific, effective treatments
for addiction. The answer I get is no, we really haven't
found any good treatments for addiction. Yet there are a
number of them being delivered.
I am just wondering, is this a definitional issue
in terms of looking at specific efficacy and clear
demonstration in independent trials on one hand, with
mechanisms, or basing it on outcomes research on the other
hand, or something like this?
DR. TRACHTENBERG: I think perhaps you just
haven't been talking with the right people at NIDA and
NIAAA, because --
DR. JONAS: This is prior to the NIDA director,
but it was the NIDA director, in any case.
DR. TRACHTENBERG: There are very efficacious
pharmaceutical modalities for the treatment of heroin
addiction, for the treatment of alcohol addiction.
DR. JONAS: Sure. Withdrawals, yes.
DR. TRACHTENBERG: Excuse me?
DR. JONAS: Withdrawal, right.
DR. TRACHTENBERG: Oh, no, not withdrawal. Heroin
addiction is extremely well and effectively treated with
opiate agonist maintenance.
DR. JONAS: With methadone.
DR. TRACHTENBERG: With methadone or LAM, or
probably with bupamorphine, a new pharmacotherapy. If you
have cocaine problems along with that, acupuncture added to
that regimen can be highly helpful, as was demonstrated by
Avants [ph] and Margolin from Yale, which, the article I
referred to, and I have the reference cited from Archives of
Internal Medicine a couple of months ago.
DR. JONAS: Yes, I see that. Okay. I understand
there are studies out there, but it wasn't on the Consensus
Conference list. It seems like there are, maybe, a few but
not a lot of actual effective treatments in these areas.
DR. TRACHTENBERG: I think people generally don't
recognize what effective treatments there are in this area,
possibly, again, related to stigma and those issues.
DR. JONAS: Okay. I am wondering if some kind of
demonstration would be useful in this particular area.
DR. GORDON: One of the things I was thinking as
you were talking, Alan, and Wayne, as you were as well, is
whether we shouldn't be thinking of integrative
demonstrative projects, both in the area of addiction and
also in the area of mental health.
DR. JONAS: Yes.
DR. GORDON: I am sorry you weren't here yesterday
when people from ARRIVE presented what is really an
integrative program to dealing with addiction and HIV. It
might be really interesting for you to go to New York. I
can introduce you to them, and you can see what they are
doing, combining a variety of different modalities.
DR. TRACHTENBERG: Yes. I was sorry to have
missed that. In fact, I would have been here, but I was
still chasing down clearance for my testimony, which I only
got at 6:00 p.m. last night.
But if they had a handout of their testimony that
you could share with me, I would much appreciate it. I will
bring it back with me to CSAT.
DR. GORDON: Yes.
DR. JONAS: Can I ask a brief question to Milton.
That is, you describe in here a data collection system. I
know you have been working on an ongoing data monitoring
collection system.
What is the status of that? Has that been looked
at? Is there any data coming out of that, at this point,
related to CAM interventions?
DR. HAMMERLY: We have that comprehensive care
assessment tool, which has the SF-36 embedded in it, again.
So it is a tool, but so far, with the lack of research, we
haven't actually started collecting data. We have it there
and are starting to utilize it at some sites, but we have
not yet collected the data.
DR. GORDON: Tieraona, Tom, and then Charlotte.
DR. LOW DOG: Thank you both for those
presentations.
Alan, just in brief passing, you mentioned a
traditional North American, Native American practice of the
sweat lodge, which, as we have talked about Ayurvedic and
Chinese and many other modalities, we really haven't
mentioned much of our own indigenous practices here. In New
Mexico, they have introduced the sweat lodge there now in
the prison systems out there, and they are being used quite
extensively in addiction programs as well.
I just wanted to know if you could talk a little
about how you have integrated that. Have you used
indigenous peoples to run the lodges? And, how has that
worked or fit in?
DR. TRACHTENBERG: Generally, those are parts of
community-based treatment programs that are serving specific
Native American communities. The leaders from the
communities themselves being served usually provide the
culturally resonant aspects of the overall treatment
program, be it sweat lodge, be it vision quest.
There is a program that is funded in Hawaii that
used traditional Hawaiian Huna medicine. That was under a
rural, remote, and culturally distinct communities program.
That was a grant program from CSAT that started in about
'93. In fact, those grants were going to fund things like
acupuncture in drug treatment and sweat lodge before the
first grants came from the NIH Office of Alternative
Medicine.
So I just wanted to point out SAMHSA does lead,
even if not in research. But those are done very much in
concert with the communities that they are serving. That is
kind of how they get in there.
DR. GORDON: Tom.
MR. CHAPPELL: Again, Alan, you mentioned the
spiritual aspects of addiction therapy. I am just wondering
how intentional you have been with your group to understand
that more. There are plenty of 12-step programs out there.
Is that something that you try to understand
better?
DR. TRACHTENBERG: Well, in terms of how to use it
to improve clinical outcomes, certainly. You know, there
actually are manuals, for instance, published by the
National Institute on Alcohol Abuse and Alcoholism on what
is called 12-step facilitation therapy.
Twelve-step groups are not professional therapy.
They are self-help, peer-counseling kinds of things. So
there are manuals to help health professionals use those
groups in order to improve their patients' outcomes and to
support their patients' work in the 12-step groups.
Whenever you talk about scientific research of
spiritual topics, that is obviously a very touchy area. It
is kind of an ambiguity in drug abuse treatment we learned
to live with, and perhaps that is why many of us in drug
abuse treatment are more comfortable with alternative
medicine than in some other medical areas. I don't know.
MR. CHAPPELL: So even in this world of CAM, it
hangs out there as something other than a CAM therapy.
DR. TRACHTENBERG: Well, we didn't think it was
terribly alternative until we saw David Eisenberg count AA
and other 12-step self-help groups as alternative health
practices when he did the first survey. Then the addiction
treatment field in general discovered that we were
alternative.
DR. GORDON: Charlotte.
Tom, are you finished? Tom? Or, you want to go
into it a bit?
MR. CHAPPELL: I'm finished.
SISTER KERR:
DR. Hammerly, thank you so much for
the qi work, and particularly your report here, and all the
work that Sister Diana chaired and got moving, along with
all of you. So I congratulate her.
One of my concerns always is -- and if you have
been here all day, you would have heard it -- is that we do
add-ons, and this is a going to be a shorthand conversation
of adding on modalities. The conversation has gotten
bigger, and we understand it so much about a new
consciousness and a new paradigm shift, and all the things
that have gotten trendy language.
One of my things about the hospital that concerns
me at times, and I see the process and unbelievably doing
great things. I will give you an example. I once worked
with Tom Berry in Assisi, and the students were so into
cleaning the rivers and streams, and everybody was excited
for the ecological cleanup, but there was never an
association between drinking 12 Coca-Colas a day and their
own rivers and strea
MS.
One of my concerns in the hospitals with an
ecological paradigm is that sometimes, for example, I will
talk about food in hospitals. When we get an ecological
paradigm, it gets real hard to give Jello to everybody on
liquid diets. This is when, as you said -- I forget the
word you used, and I should know it -- of how you have your
little check consciousness to see where the new paradigm is
going through all the services and departments.
But for me, and I just wanted to say this, and
then give me some input, is I often see the implications at
the architectural level, you know, the environment. Do we
have trees, things that even I see, used and identified a
while ago, with light and clocks, the crazy TV that is on in
all the OPDs, which is the most mental-level garbage at such
a critical time.
I guess because I have a unique expectation of qi,
because I know they are doing it and it is consistent with
the mission, can you fill me a little more on that aspect of
how the environment of the hospital is consistent with the
ecological paradigm. Even the disposable and recycling, the
challenge is incredible for a health care system.
DR. HAMMERLY: Thank you. There is an awareness
of that as we are trying to integrate this philosophy at
multiple levels, financially, with healthy communities, with
educational strategies and so on. The environmental
facility definitely needs to be addressed as well. The
fluorescent lights and the food, and all those other issues
definitely need to be addressed. Plant therapy, having
plants in the rooms, I think, would be another useful thing.
There is no organized initiative around this, but
several of the hospitals have this Healing Environment
Committees and are looking at models that are changing the
environment to more holistic, and not as sterile a setting.
DR. GORDON:
DR. Hammerly, it is wonderful to see
what is happening in your hospital system. I am wondering
what you see, first of all, the deepest lessons you would
like to teach us, the obstacles you have to moving in a more
comprehensive and integrative direction, and what your hopes
would be, in two minutes.
DR. HAMMERLY: In two minutes. The primary
obstacle has been philosophy. Everyone has talked about
physicians wanting data on safety and efficacy. Some
physicians, you can stack the studies up and they won't
listen. They won't be bothered with the facts.
So we need to address philosophy, and that is why
we spent so much effort on that, defining why on earth you
would want to do it, creating a rational strategy of how you
would do it, and then making sure that it is consistent with
the organizational mission and values. If it is not
coherent, and you have organizational dissonance, it is
going nowhere.
The other, is that it needs to be very much
tailored to the specific location and environment. It can't
be a one-size-fits-all approach. So you need to be
sensitive to, again, consumer interests and readiness,
availability of services, physician readiness, politics.
There are a lot of factors that come into play that need to
individualize that model.
But if the overarching philosophy is solid, then
that organization will find ways of providing that more
comprehensive, collaborative, individualized care. I did
include one quote that I think is very illustrative of the
collaborative philosophy that was attributed to Mother
Theresa, and it says, "You can do what I can't; I can do
what you can't; Together we can do great things."
DR. GORDON: I just wanted to come back, for a
moment, to where you would like things to go. Here you are
speaking to 70 different hospitals, approximately.
Where do you see things going, and how can we help
move the process ahead for these 70 hospitals and for
others?
DR. HAMMERLY: I didn't spend a lot verbally
talking about the financial issues, but it is really a
concern. As much as we have a mission to provide this type
of care, there reaches a point where you can only subsidize
it so long, where it needs to be able to support itself.
So I think being creative and coming up with new
models to fund research, new models, reimbursement models
that aren't trapped in the old assumptions, I think, would
be very important. Right now, it is subsisting on
subsidies, for the most part. It is not self-sustaining. I
think creating the mechanisms to make it self-sustaining is
very important.
DR. GORDON: Do you and those you work with have
some ideas you could share with us as we move ahead toward
thinking about reimbursement?
DR. HAMMERLY: Yes, absolutely.
DR. GORDON: That would be very helpful.
One final question, and then we need to go into
our own discussion.
DR. FINS: It follows Jim's last set of questions.
I was wondering if you have the sense of the economic
implications in real dollars, sort of following Tom's
question of
DR. Dillard from Oxford.
I mean, what percentage of your cost structure, or
your fed tax, or your per diem, or whatever your denominator
is, would be ascribed to CAM as it is currently practiced,
as it might be practiced in five years, and what your long-
term goals would be, because I think that if we are talking
about funding strategies and reimbursement strategies, we
need to know what the number is.
So you would have an experiment in progress with
70 hospitals, and it would be really helpful for you to give
us some spreadsheets and economic projections, because I
think we can multiply that and use it as a proxy for data
that would be very hard to obtain in other settings.
So if you could provide that to us, it would be
immensely helpful.
DR. GORDON: Thank you very much. Thank you both.
How many people here on the Commission have to
leave at 4:45?
[A show of hands.]
DR. GORDON: Okay. What I would suggest is we
literally take three minutes, and then we come and focus.
We will go beyond 4:45, but we would like to hear from those
who have to leave first, your thoughts, your considerations,
so you have an opportunity to get your voice heard before
you leave.
So let's take a three-minute break, literally.
[Recess.]
DR. GORDON: Some of you have to leave at 4:45.
The bus is coming to take people back to the prison at --
oh, to the hotel at 5:00.
[Laughter.]
Session VII: Commission's Discussion
DR. GORDON: This is going to be very much an open
discussion. We would like everyone to have a chance to
share your thoughts, share your observations, share the
concepts that are coming up as a result of this discussion,
thoughts about the future and future directions, whatever
has come up for you in these last couple of days. So,
please, just go for it, each person.
Oh, Michele has an announcement first.
MS. CHANG: If the Commissioners will go to Roman
numeral VII in their tomes, you will notice there is a Top
of Mind, these sheets here that you can write down your
thought that you want us to capture. This is what you
suggested last time. Hand them in to me before you leave
today, or just fax them to us when you get home, but this is
a way just to capture them. Then we will put them in all
one document for the next meeting.
DR. GORDON: Okay. So let's just go for it.
Tom?
MR. CHAPPELL: I have a couple of thoughts. One,
I am thinking about the overall goal and vision of where we
want to be pointing ourselves, and I think we do need to
affirm the equal importance of promoting wellness as over
and against healing, if you will. Once we create that equal
value, then I think we need to see CAM as having two
charges. One is equal rights, and the other is equal
accountabilities.
DR. GORDON: Okay, great. Thank you.
MR. CHAPPELL: I would like to comment. The
reason I am talking about equal rights, equal
accountabilities is that it is not clear to me that all
aspects of CAM want to be integrated or can be integrated,
but if we create equality, then the marketplace can
integrate if it wants to, integration can occur wherever it
is natural.
But I am not sure integration is what we should
force. We can create the possibility of that in the
marketplace by simply striving in our goal to create
equality for CAM practitioners.
DR. GORDON: David?
DR. BRESLER: Well, another thing that seems to
come up a lot is about early education, letting people know
two things: No. 1, what they are doing that is deleterious
to their health, whether it is chemical sensitivities or
lifestyle kinds of behaviors; and No. 2, letting people
early what they can do in order to enhance and improve their
health.
I think it is probably elementary school, junior
high school level, if not earlier, that we probably need to
start. This is an area that I would like to see addressed
at some of our future meetings.
DR. GORDON: Great. Thank you. Other thoughts?
Veronica. Please turn on the mike.
DR. GUTIERREZ: What I think would be very
helpful, for me, as I tried to understand more about the
different CAM services is to have from each group a
statement of intent and purpose.
For example, I heard Chinese acupuncture is
different than the licensed medical physician who practices
acupuncture. If I knew what the intent and purpose of each
provider group, that would certainly help me understand when
something might be appropriate.
As far as chiropractic goes, there are a lot of
professions that do manipulation, and I have no problem with
that. I wouldn't interfere with anybody's attempt to secure
it, but for me it is important that people understand that
adjustment is different than a manipulation. It is a
different intent and purpose.
So it would help me, as well, to educate my
commission members and the public.
DR. GORDON: Thank you. Yes, please.
MR. ROLIN: I know we talked about access at this
meeting, and we are going to be talking about reimbursements
and all these other legal issues, all that in the future
before we complete a report, but I just want to emphasize
again, and we have heard it brought out so many times here,
is we want to remember the underserved, those that aren't
being served. We want to continue to remember that and make
sure that we address those issues.
This is wonderful to be able to have this new
issue of CAM. I hope it gets, certainly, and I know it will
be, introduced on our reservations for our Indian tribes
because I can see a vast improvement there happening within
those communities if we utilize that.
So I would hope that we would continue to address
those issues and remember in that perspective the people we
are here to serve, and I know we will. I just wanted to
reiterate that.
DR. GORDON: I have a question back for you. Are
there groups, especially among the tribal groups, that you
would like to have come talk with us?
MR. ROLIN: Well, I am working on that right now.
MR. Leo Nolan was here from the IHS this morning. I spoke
to him and I spoke to other folks, and we are working with
that. Hopefully, I am going to have a group at the Town
Meeting in New York.
DR. GORDON: Terrific. That's great. Charlotte.
I am just reading your mind.
SISTER KERR: You did a good job, only I am not
very clear here. I want to share some thinking, and I want
to affirm what has gone before.
One of the outcomes, for me, today has to do with
what I think I want to hear in the future. I will give you
an idea so that you can help me with it. For example, when
we talk about nutrition, I want to know why the Department
of Agriculture is not here on the same panel, or why the
environmentalists are not here on the same panel.
Let's assume we want to have this panel on
rethinking economics. I want some Fortune 500, some
multinationals here, and the pharmaceutical companies. I
believe most people are good, along with Anne Frank. I
still believe that. It is like the docs and the nurses,
they were called to healing, and they are frustrated because
they are not getting to do their vocation. Most of the
time, I think that is what a lot of the frustration is
about.
I think these companies want to be called to
service. The research in fibromyalgia, in the toxic
chemical crowds, they said the company that did the one that
found out they were psychogenic was done by the chemical
companies. I think that part of our job is seeing that this
is cutting through all the disciplines. How do we do that?
We can't talk about health care. It is like talking about
sick buildings. This is one of the ones that was labeled a
couple years ago, wasn't it? They had to redo a whole lot
of stuff.
But I think it is really asking us to stretch on,
how will we recreate some new panels across these
disciplines. I mean, Monsanto, maybe, needs to be here. Or
else, you all don't think that makes much sense.
DR. GORDON: Would you like some feedback?
SISTER KERR: Yes.
DR. GORDON: I think it is an important enlarging
of our mandate, and I think we should have some discussion.
It would be good to hear from people.
Do you want to address that, Effie? Joe?
DR. CHOW: Actually --
DR. GORDON: Please put on your mike.
DR. CHOW: I'm sorry.
[Laughter.]
DR. CHOW: Project, project.
Really, it was sort of what I thinking about,
because we are not talking about just health care. We are
talking about life. So therefore, all that you mentioned,
like the big business and economists and environmentalists,
and all of that, including the schools, the school
representation and children, because that is where we are
going to be starting, the education, if not in utero.
I think what was impressive about some of the
things that were brought up is that it was going beyond the
methodologies and the techniques. Quite a number were
talking about before that really lifestyles, not just
techniques including CAM into the system. I think what Tom
was mentioning was, maybe they are not all to be integrated
because what we are talking here, I am concerned, is
integrating into the medical system as it is, and being
judged by FDA as it is. There were a few that mentioned,
maybe we need to look at other paradig
MS. I think we need
to really, really keep that in the forefront.
The other too, that spirituality is really
important. It is sort of links up somewhere, but I think it
pervades throughout. And then, subtle energy. The subtle
energy is what makes CAM different, if we are going to call
it CAM. And I really don't even know whether CAM is a good
term or not. We should look at that and see what it is.
So I agree, expanding that area and invite others.
I would like to see a panel of the skeptic, too, as well.
DR. GORDON: Okay.
SISTER KERR: I just have one response. A group I
left out, because we may need names and I don't have them.
The more I hear us speaking in the wellness model -- and my
own bias is what is traditionally called the public health
model -- I think we need to look for some public health
people who are also CAM people because I think we are
heading that way. Thank you.
DR. GORDON: Great. Joe, you want to say
something?
DR. FINS: First of all, I want to just thank
everybody on behalf of everybody.
[Laughter.]
DR. FINS: Because I just think as the group gets
bigger and bigger, it just gets better and better. I just
think we are really coming from different places, and I
think we are just getting along terrifically and it is just
wonderful to be part of this group. I thank you all for
your friendship and your collegiality.
COMMISSION MEMBER: Joe for president.
DR. FINS: No, no, no.
[Laughter.]
DR. FINS: Thank you. Thank you. Well, if I am
nominated by my party.
Let me just endorse what Charlotte said, and I
think maybe we can take advantage of that in New York with
some of the corporate leaders, and maybe Tom can help build
bridges there, we can get some people to testify.
I had a few points, just off the top of my mind in
response to Buford about the access issue. I think that one
important issue is that we were talking about access, for
the most part, in the last couple of days, in the context of
people who had insurance. I find it ethically troubling to
talk about access to CAM therapy when we don't have access
to therapy, whatever it is.
I think the universal health care should be
something that is a basic right of an American citizen. I
think it is going to be ethically difficult to argue for
therapy of one sort when people don't have a basic health
care package.
This is sort of stream of consciousness here, but
when we talk about our report, I think there really are two
stages. There are broad articulation of principles that I
think we need to make, which will set the agenda for 5, 10,
15, 20 years, and then there are concrete recommendations.
I think sometimes we get into disagreements because we are
confusing a principle with a concrete recommendation. I
think we have to have clarity about that.
Fourthly, I think that we have to have a better
sense of the sociology of CAM. I think it is going to be
important to make the case to those who are somewhat more
skeptical than the people we have had visiting with us over
the last several months. I think we have to understand the
fonts of this enthusiasm and interest.
Finally, I was very impressed by, again,
DR.
Quevedo's work at his hospital. I think that this
Commission is going to start a process of dialogue, and we
have to think about mechanisms that sort of institutionalize
conversation and dialogue, neutral mechanisms that everybody
finds trustworthy, even those who are skeptics of
regulation, because what
DR. Quevedo did in his hospital,
bringing everybody together onto the same page, we need to
do nationally, appreciating a variety of constituencies,
people who will live for this and die for this, and people
who will die trying to have this never happen.
So I think we have to think about mechanisms and
agencies and collaborations that allow dialogue to follow us
when we are no longer here.
DR. GORDON: Terrific. Thank you. Conchita and
George.
DR. PAZ: Well, in looking over the last
couple of days, one of the things I had thought about also
was, since this was our topic, access, I think access
definitely for the diverse cultures that we have, not just
Hispanic, not just Indian, not just black, but also all the
different Asians.
I mean, our culture here in the United States has
become incredibly diverse. So as you start looking at the
different alternative therapies, actually the list can go
on, and what we are just doing is just talking about some of
the more common known ones that as time goes on and this
gets to be developed, it will grow from there.
What I do want to see is that they do become
available and if someone feels like they need to access
that, it is available to not just you and I but also the
impoverished. I think that is incredibly important.
But not just that. We know that our patients that
access alternative therapy, and so we want to also know what
they are doing to their bodies as part of the health care
that we provide for them.
So they talked about, in some cases, where it was
separate from their regular health care, and I am looking at
it to see, is it something that would be more integrative
like what some of the other clinics have mentioned. So I
thought that that was very important to see that, to see how
successful some of the integrative medicine was going. I
would like to promote that as well.
DR. GORDON: Great. Thank you. George.
DR. BERNIER: It has really been a fantastic
couple of days, and I want very much to complement the staff
that put together the program and all the participants.
DR. GORDON: Yes.
[Applause.]
DR. BERNIER: In many ways, I thought it was in a
class by itself compared to the prior two, but maybe it is
just that we are all much more comfortable with each other
and we talk about our dirty linen, et cetera.
But one of the thought I am taking away from it is
that the time is so ripe now for a major step. I see this
as my own institution where nobody knew how to spell CAM,
and how everybody is one.
[Laughter.]
DR. BERNIER: But there remains, clearly, some
issues. One of them is that it is only going to be, to my
mind, by guaranteeing the safety and efficacy of treatments
of all types that we are going to be able to get buy-in by
the medical community. I personally really hoped that the
medical community is going to be able to buy in, but to have
the guidance that was laid out for us with the President's
charge.
One of the problems is that the name "CAM" means
so many different things, and I am not so sure that a whole
lot of individuals who are in CAM disciplines are eager to
see an integration with traditional medicine. We certainly
heard that today many times over.
So I think we have come a really long way. I feel
I have come a long way, for one, and I do think that the
time is ripe for making a major step.
DR. GORDON: George, a couple things come to me.
One is, I wonder if you can work with us -- we have been
talking about this some -- in bringing in even more of the
traditional medical community, particularly the AMA, AAMC,
and working to involve them in our deliberations.
DR. BERNIER: Yes. I would be very happy to do
that, and I have begun to do that on a different canvas.
DR. GORDON: Great. The other thought that is
still hanging in the air that I wanted to ask about is the
issue of universal health care.
I just want to check in with everybody and see if
the feeling is as strong as I think it is about addressing
this issue and not just addressing CAM in that context, the
issue of making some kind of statement as a commission or
taking some kind of testimony about the need for universal
health care and different ways of providing that.
SISTER KERR: [Off mike.]
DR. GORDON: I am asking, are you as commissioners
interested in that issue, interested in exploring it with
the possibility of an imprimatur.
SISTER KERR: [Off mike.]
DR. GORDON: No. I understand. I am not asking
for a decision. I am asking for an intent to explore the
issue, which Joe raised.
DR. BERNIER: Jim, I would be very much in favor
of that. I think it is going to be so hard, it would be
almost impossible to get the one without the other.
MS. SCOTT: [Off mike.] Is it on? But to me,
universal health care means making a very firm statement
about our belief that health care is a right, wellness is a
right. I think CAM fits in very well with that.
I am not as comfortable with the marriage of
conventional medicine and CAM yet, although I understand
politically we may have to make a statement toward that.
But I think just having a statement that says that we
believe that this is a right, and as a right, it is a right
for all citizens, and to really look at the issues of
access, and especially the affected populations.
So personally as a commissioner, I would like to
see many more African-Americans, both as panelists and
speaking at the open debate, because I see that as a real
gap. I think the job we have been given is enormous, and I
think it is really going to be hard, over the next several
months, to really figure out what, of all of this, we might
be able to speak in any substantive way.
So as we do that, for me, the concern about access
and making sure all citizens are going to have access to
this is paramount for me.
I do get concerned about some of what I have been
hearing. In some ways, I think people see CAM as sort of a
second class, and see it as something that might be okay for
conditions that are mainly seen as affecting those people
who are not as valued in our community, such as for
addiction. We are willing to experiment and maybe put a few
dollars in that whole area, mental health.
So making sure we deal with it from a wellness
perspective in terms of being well physically, mentally,
spiritually, and economically, I think we have to keep
broader umbrella out there.
DR. GORDON: Tom. George has been waiting
patiently. George, do you want to say something, and then
give it to Tom?
MR. DeVRIES: Oh, go ahead, George.
MR. CHAPPELL: Tom, go ahead. Then I will go
next.
MR. DeVRIES: Oh, thanks. I wanted to affirm what
Julia was just saying about the broader scope of wellness
than the term "universal health care." I want to be careful
that we don't buy into political language that take us off
the mark. That's all. I am for getting to where you want
to get, but I want to get there in a more circumscribed
manner of wellness.
Now, what we need right now for CAM is liberation
theology, which is what women have done on the globe. It is
what minorities on the globe, and it is a process of
affirming the essential inherent worth of the entity
involved.
By affirming the essential inherent worth, there
is nothing more ultimate. It is raising it to that ultimate
level and saying to the men, women are equal, and saying to
the Western medical community, this paradigm is equal.
That is the first thing we need to do in terms of our
strategy, is raise it up, affirm it, because it needs to be
affirmed and it needs to be raised up by some group, and we
are the group.
So that, for me, is, again, the starting place,
the equality, the raising up, the affirmation. Then a lot
falls into place after that. I think we have to get there
first, and then work backwards.
MR. DeVRIES: I would agree, Tom, with your
comment in the sense that we have to raise, shall we say,
the perception of CAM to one, certainly, of equality.
I think, one, I would also caution the Commission
that whatever recommendation we go forward with can be
applied on multiple tracks, that with universal health care,
the current private sector system, there are influences
beyond this commission that ultimately will make those
determinations as we go forward.
Yet, the work that is happening here is so
important for the future of CAM that we don't want it tied
to one political solution that may or may not happen. Yet,
I believe the recommendations we can make can be applied to
multiple tracks, regardless of where our nation decides to
go in terms of a policy of health care coverage.
I mean, we have heard testimony here in the last
couple of days that have talked about chiropractic, in
particular, even though it is not mandated as a benefit, is
perceived to be more mainstream because they are covered so
routinely. I personally have seen studies that just
recently have come out that said the majority of employers
anticipate, over the next five years, adding broad-range CAM
benefits -- not chiropractic; beyond chiropractic -- for all
their employees.
So I guess my encouragement is that as we go
forward and we create our recommendations, that they can be
applied to multiple tracks, regardless of which way our
country moves forward with its health care policy, and that
they can be applied in either or both scenarios because we
really don't know the outcome of our country's future.
Ultimately, those issues are really based on what
we are talking today. It is the issues of research, it is
the issues of education and licensure, it is the issue of,
really, how to lift up these provider groups that we are
talking about into one viewed on a level of equality based
on the safety and efficacy.
DR. GORDON: Tieraona, Bill, Joe.
DR. LOW DOG: I am trying to collect my thoughts.
For myself, I don't want to get, just, hung up in
modalities about all the different practices out there, that
there seems something far more fundamental than that, even
more fundamental than universal health care.
We get glimpses of it. You get glimpses of it
every day when you are sitting in your office with your
patients, that it is kind of foolish to think that you are
going to have a health individual if they are not living in
a healthy family, and that healthy families can't survive if
they are not in healthy communities, and that there have to
be social policies in place that allow for healthy
communities and healthy families and healthy children.
We talk about diet and we talk about nutrition,
something so fundamental, yet it seems so difficult for so
many of my patients, and it really does because they are so
stressed.
Single parents with three kids. Getting them up
in the morning and trying to get them all out to school.
Getting to work late, and you are in trouble with your boss,
and then running out for the Big Mac at lunch time, and
having a quick Snickers in the afternoon because you are so
tired. Then you go run and pick them up, and you have got
to get him to Boy Scouts, her over to soccer. You come home
and whip up the macaroni and cheese, and you help them out
with their homework. Then you throw them in bed, and you do
the laundry, and you go to bed, and you are exhausted.
I mean, it is so big. You see what I am saying.
It is so big trying to make changes. Well, it was
exhausting just listening to it.
COMMISSION MEMBER: We are all exhausted.
DR. LOW DOG: It is people's realities, though.
That is the reality of their life, and that is the reality
of the patients I interact with. Even as a physician, I am
told by my office manager, Tieraona, you either have to cut
back on Medicare patients or you have to see them in a
shorter time because we can't sustain a practice of 65
percent Medicare and Medicaid when you take 30 minutes with
a patient.
So I have to change the way I practice or we can't
survive. So I am questioning the whole reimbursement issue
a little bit, because under the system it is right now, it
is very hard to survive. I think that I am in favor of
trying to come up with the very essence of what all medicine
is about, which is really public health, to me. I mean,
much of this comes back to public health, education,
education on health and wellness, nutrition, diet, exercise,
movement, music, healthy work policies, all of those types
of things, and then health care for everybody.
You know, it is nice to talk about nutrition, but
when you go out on some of the reservations, you go out to
some of the rural areas where kids tell you that the only
way that for sure they are going to get lunch is if they go
to school. Before I get to wanting to reimburse for
everything, I want to make sure there are some real
fundamental aspects of health that we take care of.
So I hope that when we are talking about all of
these things that we don't lose track, that that is part of
the voice that I hope that we can have. Then all of these
other things begin to fall into place, but we still have a
long way to go just to get the basics down.
DR. GORDON: Great. Thank you.
DR. FAIR: Well, I would just like to perhaps add
a mild dissenting vote against the universal health care
thing because I am afraid that would be a balloon that
people would shoot at and miss our main message.
We have heard two days of talking about what CAM
can do in both treating chronic disease and preventing
chronic disease, and you all got tired of hearing me ask the
same question, what is the solution to use this, whether it
is to prevent heart attacks or cancer or whatever, and it
was education. Yet, we heard nothing concrete about how we
increase education. Private groups have been trying to
educate people about various diseases for decades, and it
hasn't made much of an impact.
I guess my comment would be, I think we ought to
come down. We ought to really stress developing a plan for
universal health education, not necessarily universal health
care, because I think if we educate people universally, the
family improvements will follow, the community improvements
will follow, when people are aware of how much this means to
them as individuals. By extension, it will go to their
community.
I think, Jim, I would like to see in the future.
Maybe this is really walking on thin ice, but I would like
to get some input from someone like Senator Harkin. I mean,
is it absolutely impossible to even consider making
recommendations that there should be legislation for health
education every --
DR. GORDON: Let me answer that right now. I have
spoken with Senator Harkin. He and I have spoken precisely
about this. I said to him that this is one of the areas
that I was particularly interested in, and as I was talking
with other commissioners, I had the feeling there were a lot
of other people who were interested as well. He is
definitely interested.
DR. FAIR: Good.
DR. GORDON: I think that is within our purview.
The other thing I want to address is that we had some on
health education here. For example, ARRIVE is basically a
health education program. We are going to be focusing in
the next two meetings on professional education and on
public information, which includes -- I see it very strongly
-- education in the schools and in other places as well.
So again, I hear the strong focus on education and
on public health.
DR. FAIR: I mean, I think we have to have a
mandatory thing in schools.
DR. GORDON: We can talk about it. We can bring
people in, and we can make up our minds. If that is where
we come down, and it sounds like it may be, I think that
will be a recommendation. We have to think about how to
manifest that in legislation, but I think it is a basic
principle of it. If it is one that we are accord with, we
will put it forward.
DR. FAIR: I think innovative thinking also. I
did it, say, tongue in cheek drawing the analogy between if
you can get a preferential insurance rate for your
automobile because you take a course in safe driving, why
can't -- I mean, seriously, why can't you get preferential
insurance rate on your personal insurance if you take a
course in how to maintain your health. I mean, that doesn't
seem too far fetched.
COMMISSION MEMBER: If you don't smoke, you
get --
DR. FAIR: If you don't smoke, that's right, but
you can eat 10 cheeseburgers a week. I mean, I don't know,
it is just one of the things to think about.
The other thing is that I think that -- well, we
will talk about reimbursement another time. I also would
like to hear, in the future, something about spirituality in
CAM, how we incorporate it, because I am not clear how to do
that, although I have heard a lot of speakers talk about it.
And the last thing. I heard here today something
that -- I don't think I was paranoid about it
-- but the comments about research within academic centers
almost vis-a-vis non-academic centers. We heard
DR.
Quevedo's excellent presentation. I think that research on
CAM in an academic center is very difficult to do. I think
that properly designed studies on people like he is talking
about, I think you can do better research and non-life
threatening CAM modalities outside of academic centers than
you can do inside, perhaps.
So I would think whatever our recommendations
would be with research, we ought to have it broad enough,
and we ought to talk about it in the future so it could
allow research in both areas, both venues.
DR. GORDON: Terrific. I think we can certainly
shape the next research panel to reflect some of these
concerns. I don't mean to be sort of answering the
questions as if to put them to bed, but we have been
thinking about including spirituality very much as part of
the wellness meeting as well.
Joe.
DR. FINS: You know, I think that CAM is not the
diagnosis. It is a symptom of the problem. Why is there so
much interest in CAM? It is because the health care system
hasn't been as caring or accessible as it needed to be.
So I totally agree with health education. I don't
want to get mired in the debate about what we are going to
call the health care entitlement, but I do think that it
becomes very difficult to articulate a benefit in one
context when we don't have the benefit in the other context
because it kind of gets to be like a Plessy v. Ferguson
thing, you know, separate but equal.
We have to overturn that way of thinking. We have
an opportunity here, as you said so eloquently, to have a
new manifesto for medicine. We don't want to recapitulate
the old problems by creating those who have and those who
don't have. So I think the theme here should be to respond
to the needs of the people who are crying for help. It
becomes, I think, philosophically impossible to grant access
to some modalities while you are saying you are not
enfranchised for other modalities when we are saying the
whole goal here is to integrate modalities, not to give
people entitlements but to promote human good.
So I think that I agree with Tom and others, I
don't want to get mired in the political discussions of
1994. I don't think that is going to be productive, but I
do think we have to talk about access to care. Care should
be the goal here. There are educational components, there
are environmental components, there are agricultural
components to this, and there are health care benefits that
are integral because what they do is they allow people to
live more fully.
So I want to just be very clear that it is not to
politicize the discussion, but just to make the argument
ethically cogent because if we don't include both ends, we
are going to have problems justifying one entitlement and
not the other.
DR. GORDON: Wayne, Tieraona, Tom, and Don. Did
you want to speak, Don? Ming definitely wants to talk.
DR. JONAS: Actually, I would take one step
further back and say probably the most effective use of
resources would be health care advertising, maybe even more
than education, and perhaps we should advocate that.
I mean, part of the lifestyles dilemmas that we
are in have to do with the very effective marketing strategy
for things that aren't very helpful for you. That is the
way that values are currently communicated in our culture,
or the majority of them.
I want to get to a word that hasn't been used,
that actually was the word that I suggested originally for
this part of our discussion, but before I get to that, I
want to say that I think that our discussion is and needs to
be grounded in values and philosophy issues. I think the
term "wellness" is one that is used and begins to capture at
least a values issue that we would like to see, but then
that needs to be translated in a way that can be
communicated to all kinds of health care activities, whether
those are prevention or treatment in a model.
To me, the two types of things that can lead to
more specific things that deal with wellness are the area of
health support and health promotion. Those are particular
activities. We heard a number of examples of those over the
last couple days. Health support is a particular set of
activities, health promotions or types of interventions that
are different than treatment, or at least different than
interference, and that these should be the basis for both
treatment and prevention.
It is going to be extremely difficult to get data
on prevention. However, if you use health promotion, if you
look at health promotion methods for treatment, that can
give you at least some indications of prevention and
treatment as an integrated phenomena. This is why I
suggested before we not just look at cost effectiveness, but
cost benefit because it brings in the value issues.
There is going to be a big dilemma. Then we saw
many of the contradictions here in the last couple days
between wants, needs, and behaviors. What are patients'
wants? Well, they want good care, they want a massage, they
want somebody to pay for it.
What are their needs? Maybe they need to have
some food. Those that do not have access to even standard
medical care, health care is way down on the list. I mean,
it is not a value for them. Yet, they may need those other
types of things. There may be behavioral changes we need to
implement to try to treat people in a health promotion that
they want fast food medicine and this type of thing because
that is delivered. That is something that will have to be
dealt with.
All right, now I am getting to the word. The word
is "accountability." I think we really should call this
Access and Accountability, because if we don't deal with
accountability, then we will not, in fact, get buy-in from
those that control the power to current access.
Accountability includes accountability of care and
services. Many of these practices, the way they are
delivered do not deliver good quality services. You don't
get your PAP smear, therefore, when you need it.
Accountability in terms of products, we heard about that
before. Also, accountability in terms of information.
Where is the data that shows that this is actually going to
work.
I don't mean to pick on chiropractors, but does
subluxation help your wellness? Does it prevent disease? I
have never seen any data on that. Okay, maybe we have some.
So I think access and accountability really need
to be paired if we want to see things move forward. We need
to bring groups in if we are going to be saying, what are
the accountability standards that are going to have to be
met, because if we don't do that, we can make all the
recommendations we want, and those will continue to control
the power.
DR. GORDON: What groups are you thinking of,
Wayne?
DR. JONAS: Well, I think Charlotte mentioned some
of them, and you mentioned some of them, the American
Medical Association, HCFA, the individuals that control the
actual delivery services. Perhaps, we will do that
subsequently.
DR. GORDON: Hopefully, we will be doing that.
Tieraona, Tom, Ming, Charlotte, and maybe Don. I
am not sure.
DR. LOW DOG: I think that part of it was actually
dovetailing on you a little bit, because when we were
talking about access and reimbursement -- we had this
conversation last night -- if you have access to things,
there is a difference. If you have access, does it have to
be paid for?
I think those are different issues. They are
related, but they are not necessarily the same. If a
naturopath is licensed to practice in 14 states, there is a
board that supervises them, there is licensure, there is
four years of training, there is all of this, why is it
illegal for them to practice in the other states?
You know what I mean? It seems like with
acupuncture, most states allow it. And yet, with
naturopathy, you are practicing illegally, basically.
I do think there is something to be said for
access, people's right to choose who they want to see as
long as there is accountability, there is an appeals
process, there is somebody to complain to if things go
wrong. All of those things should be in place, but I think
that access is different than how much everybody is going to
pay for.
Then it gets into the issue of, are we
disenfranchising groups, but I would say as the evidence
becomes available, as it does become available, then more
things should be included, but I am not sure that we should
just include everything. And I can only speak for
botanicals. I can only speak for botanicals, but I tell you
when you review the research on botanicals, 95 percent of it
is not really worth the paper it is printed on. It doesn't
mean they don't work. It just means that the research is
not there to really show that it does.
So I hope that this commission looks at access as
having people the freedom to seek the practitioners they
want as long as there is some type of accountability. That
is their access and their right to choose. However, I think
we want to be careful on the recommendations we make about
reimbursement when there is little evidence that that works
for a particular problem.
DR. GORDON: Great. Thank you. Tom.
DR. JONAS: Can I just follow one thing?
DR. GORDON: Yes.
DR. JONAS: Accountability, I think, should be
universal accountability standards for the values issues
that we start with. So that includes accountability for
caring/delivery or in caring/services. That should be
applied irregardless of the modality of the health promotion
system.
MR. CHAPPELL: Two points I want to raise. We
have been encouraged to do more listening to the consumer.
If you would like to have some focus groups, we can arrange
that.
DR. GORDON: Like to have some?
MR. CHAPPELL: Focus groups of the consumer who is
buying CAM services. When you come to Maine, for instance,
we have built in groups that are consumers of this very kind
of market.
DR. GORDON: I would like to have -- and this is
something that we have been trying for, and we want
everybody's help -- I would like to have more consumers here
every time.
MR. CHAPPELL: Whichever way you want to do it, I
think we need to be more intentional about it.
The other thought I had is, I would like to stop
thinking about reimbursement for a moment, and switch it to
affordability. One of the goals that I can imagine us
having as a group is to bring -- let's work with Wayne's two
components of wellness -- let's bring health promotion and
health support to the public in an affordable way.
Now, if you start looking at it that way, there
are lots of ways you can begin to solve the problem, but it
is putting the control back into consumers' hands. My
concern about the discussion about reimbursement is that it
is not in the control of the consumers' hands. So
affordability is the language to use as a goal to try to get
that.
DR. GORDON: Tom, if you have some suggestions
about how to introduce that into the discussion about
reimbursement as another perspective on the whole situation
of the exchange of money, that would be great.
MR. CHAPPELL: Who do I work with on that?
DR. GORDON: Who do you work with?
MR. CHAPPELL: Steve?
DR. GORDON: All of us.
DR. GROFT: And then the Planning Group.
DR. GORDON: Yes. Just be part of the Planning
Group.
MR. CHAPPELL: Okay.
DR. GORDON: Ming?
DR. TIAN: I think for us to learn for each
professional society, we have so many things together. I
think just like a textbook, for each one, you have the
chapter. For Chapter 1, the first sentence, you have to
tell what is definition. This is not quite clear yet. We
seem to be including everything here, and we need clearly to
tell what is that.
For instance, like Oriental medicine. Oriental
medicine is a system. Let me share my knowledge with you,
and my experience. First of all, herbal medicine is No. 1.
In oriental countries, including China, 99 percent of the
patients are people using herbal medicine and herbal
remedies. They might need a recipe, they may not, but it is
No. 1.
No. 2 is acupuncture. It is about 20, 25 percent
of the people using acupuncture. Now, when we talk about
Oriental medicine, at least I am confused. What are you
talking about? Are you talking about the whole system,
whole philosophy, whole approach? Or, are you talking more
specifically?
In this committee we have to answer the question
more specifically. We can say, oh, this is Oriental, it is
philosophy. Certainly, we want to learn good philosophy for
each culture, each tradition, but as professional people we
need to answer the question.
So just like in 1997, at NIH they answered the
question regarding acupuncture: what is the definition of
acupuncture; then, what are the data available; what we
should go. The answers to three questions: where we are;
where we are going; and how to get there. I think we can
clarify this. We can ask each group, each professional to
do their homework, including answer the questions I
mentioned, if it is possible.
No. 2, I suggest that, if we could, as I
mentioned, we should invite FDA people to come, as well as
consumers, to sit and talk, because when we talk about
herbal nutrition, a lot of these are controlled by FDA
policy. If they don't join us, we can't go too far.
DR. GORDON: Thank you.
SISTER KERR: I would like a new listening from
where we have just been. It pertains to what Tom said about
liberation theology, and what Joe said. So it is a little
bit different here, what I want to say, or try to say.
Joe, I believe I understood you to say that CAM
really was the diagnosis, a symptom as a result of the
health care system not working. I want to say this. I
think that is so, but there is another level. That level is
that, because people are unhappy or out of relationship,
which is what I think is healing, they get a symptom. They
go to the traditional health care system, and there is no
longer a priest there, there is no magic, there is no
wizard, there is no healing. Even St. Augustin said, "The
purpose of life is happiness."
So what happens is, we are, me, am looking for
myself when I am looking for healing. Now, here is the
practical implication along with the philosophical. If we
are looking for ourself, and joy and happiness, and we are
given only a modality, we have not accomplished the
objective of the person who comes to us.
So now we are talking at the level of purpose and
meaning. I think either we will agree with that as a group
or not, but if we do agree with that as a group, that has
big time implications and a statement. I mean, maybe Bill
Bennett has got a lot to say. Maybe we need the "Book of
Virtues" in the waiting room. I think this is very
important for us to examine. For me, it is very important.
Every modality, if it is acupuncture, if I stick
in a needle and do nothing else, I don't think I have done a
heck of a lot for healing. I think we will just be creating
another system that is inefficient and doesn't get the job
done. The question is, is that we are about, though. I
mean, are we taking that on, are we taking that conversation
on here; what is healing.
DR. GORDON: George.
MR. DeVRIES: We have talked a lot today about
access. One thing I want to encourage, there are a lot of
important aspects, I think, the Commission -- directions
they can go, but one encouragement is that the issue of who
pays, whether it is government, whether it is private health
plans, insurance companies, one common thread there is
licensure.
One reason I believe chiropractic has done well
with HCFA and various state agencies, as well as private
payer systems, is they are licensed in all 50 states. One
critical issue we need to remember is that it is the
individual states, not the federal government that regulates
the individual licensures of providers.
One critical things, I believe, the White House
Commission can do is consider -- it is a monumental task --
but consider recommending licensing statutes for
acupuncture, massage, naturopathy. I mean, if you look at
these three provider groups, for example, acupuncture, the
variation in licensing statutes between states is really
significant, to the extent of where it is really a mixed
model if you are trying to deliver acupuncture benefits in
50 states. The same with massage, naturopathy is only
licensed in 13 states.
So is we were able to, the White House Commission,
recommend licensing statutes based on what appeared to be
strong models out there, educational curriculum, then in
terms of those particular provider groups, I believe there
would be a significant enhancement in access over time,
giving those individual states a credible foundation to look
to that they can act on, where they can enact these
licensing statutes and create the ability to access
benefits.
DR. GORDON: It is now 5:00. I have really
appreciated this discussion as well as the last two days.
It is really time for us to close. I want to say just a
couple things that I have heard.
What, Julia? You want to go on?
MS. SCOTT: No. It is just everybody is packing
up, so I am saying talk fast.
[Laughter.]
DR. GORDON: Somebody very early said that we are
really working at two different levels, or in two different
ways which complement one another. One is that we are
articulating the deepest principles of healing, and health
care, and of living, and of our lives here together. It is
wonderful to hear and feel the energy in this discussion.
The other is that those principles are going to
help us to articulate specific kinds of recommendations. We
are also clearly beginning to have some ideas about those.
I feel great about this meeting, about everybody's
participation, about all of us working together, and of
course about the work the staff has done to make this
possible.
Again, I think clearly we are cooking here. We
are working from many different ethnic traditions and many
different backgrounds. We are really cooking and beginning
to create this wonderful preparation, this wonderful stew
that we are all about.
The Planning Group for this meeting. I received a
transmission. The Planning Group for this meeting included
Julia Scott, George DeVries, Joe Fins, Tieraona, Conchita,
myself, and the staff, and with Joe doing a tremendous
amount of the legwork.
[Applause.]
DR. BRESLER: Joe, on behalf of the Commission, I
think we also want to thank you for an outstanding job of
putting this all together.
[Applause.]
DR. KACZMARCYZK: Well, I can only, with all due
respect, accept part of that because each and every member
of the staff contributed an indispensable part of this
meeting. Without one of those members, this meeting would
not have happened. Thank you.
[Applause.]
DR. GORDON: Thank you all. We look forward to
seeing you again. Please participate in all the planning
groups with us. Let's move it ahead together. Thank you.
[Whereupon, at 5:05 p.m., the meeting was
adjourned.]
+ + +
CERTIFICATION
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
Commission.
SONIA GONZALEZ, Court Reporter
PERFORMANCE REPORTING
Silver Spring, Maryland
Phone: 301.871.0010 Fax: 301.871.0020