Dr. Jonas, you asked why we do not have as much in peds out there in the world and it is because they do not have as big a voice and so I am here for that voice.  Okay.

I also want to synthesize -- so I am deferring from what I gave you.  I want to synthesize today a little bit of what I have heard but I want to get in the components I think that are essential for an effective complementary and alternative medicine program in a health care setting and those components are fourfold. 

Provision of clinical services and integrative therapies.

Education and information services, and Pam is going to talk about that.

Research in specific pediatric integrative therapies.

And then integration of cultural care practices.

And the only thing I want to say a little bit differently from what I have heard here today is I think one of the failures of the current CAM delivery system has been the segregating of CAM services into stand alone clinics.  What we have done at Children's is from the get go incorporated it into both inpatient and outpatient approach.  And so staff has seen it being delivered.  They have learned about it.  They have participated in it themselves and they have been referred to it.

The part about the research, the information piece, it is pretty self-explanatory.  I guess I want to take my time a little bit to talk about the law that we were just talking about.

I am a nurse and I do not like the law.  I was instrumental in -- well, I was not instrumental.  I started in the beginning of the Minnesota Natural Health Coalition meetings and I liked what I heard but it is very concerning to me as a nurse who works in a health care setting where most nurses work and as a director of a program of an integrative clinic or health care program that as a licensed practitioner I cannot utilize my nurse, my nurse credential, and also my holistic or my alternative complementary modalities.

And so for me and for me as a director it is going to be harder for us to practice or to get providers in a health care setting that practice CAM services and not have them take their hat off as a nurse or as a physician or as a psychiatrist or as a psychologist and that is the concern I have with the bill.

I cannot in my 25 years of nursing divorce that paradigm from myself.  I cannot take that hat off.  It is just who I am right now and so to take a hat off as a nurse to be a healing touch practitioner is basically impossible for me to  do.

So in closing I just want to say the four components that I think are absolutely imperative for an integrative medicine program is delivery of clinical services, education information, research and integration of cultural care practices.

Thank you.

COMMISSIONER GORDON:  Thank you. 

Pamela Ahrens?

                                                                     PAMELA AHRENS, MA

                                                                          LIBRARY SCIENCE

                                                      CHILDREN'S HOSPITALS AND CLINICS

We know that the public has immediate direct access to health information medicine and medical products online and they readily use whatever they find with their children.  Over 70 percent of Minnesotans have access to the internet, over half of all adult internet users are searching for health information, and the top ten subjects that are searched include children's health and CAM.

In our clinics at Children's, 52 percent of the surveyed patients' families already use CAM therapies with their children, 49 percent of a specific survey group want CAM information provided through Children's, and the top five subject areas wanted are herbals, homeopathy, acupuncture/acupressure, aromatherapy and megavitamins.

My integrative medicine role is to facilitate the sharing of quality CAM information with health professionals and patients' families throughout the patient care process.  On a daily basis, I am asked for information on CAM clinical trials, dosing, adverse effects or interactions, treatment guidelines or options, herbs, vitamins, supplements, immune boosters and other CAM products and therapies specific to children.  Examples of these requests are:

A pharmacist with an ICU patient whose parent wants to mega-dose the child with an immune booster supplement.

A mom who wants to know about holistic therapies for colic because nothing else is working.

An ER manager who needs to know what might be in a five-powders mixture that was fed to a comatose patient.

A parent and pediatrician who want information on a fat reducing product for a depressed adolescent.

A surgery team working with a mom who wants to use magnet therapy pre and post-op.

A non-English speaking family who wants information on ADHD because of their child.

A grandparent of an inpatient who wants to give aloe vera juice to her grandchild.

The millions of health-related information sources that the public accesses everyday cannot be ignored by providers who are often put into a position that is just having to react, even though it is extremely time-consuming to quality-filter that kind of information because health consumers are readily buying and using unconventional products or therapies for themselves and for their children based on whatever information sources they access.

Physicians and other health professionals expect to find the same kind of information support that is out there for mainstream medicine, and are accustomed to the quick Medline-type retrieval of applicable research data, reviewed literature and protocols, and drug/product/treatment evaluation, but this is still very limited in CAM and especially pediatric CAM. 

I, as an information professional, who routinely searches a vast number of databases, web sites, print and nonprint materials, and evaluate for criteria-based CAM information still struggle with the critical review of difficult information or produce sources, background checking and experiential data, or trying to uncover what might apply to children.

Health professionals at Children's and elsewhere need to get actively involved in quality-filtering and offering reliable pediatric CAM web information and materials because families are asking for it. 

For health professionals and consumers alike, help is needed in providing access to tools, training and support for evaluating information on health resources and experts, therapies and techniques, produces and manufacturers, and health on the net, and the pediatric world needs more evidence-based information and research on CAM for kids.

COMMISSIONER GORDON:  Okay.   Thank you.

Bob Barron?

                                                                     BOB BARRON, RN, ADN

                                                                    WELLNESS EDUCATORS

Today I wish to speak to you about two subjects related to the topics under discussion.  The first being the necessity of educating health care professionals in the recognition --

MS. CHANG:  Would you come closer to your mic, please?

MR. BARRON:  I am sorry.

MS. CHANG:  Closer to your mic.

MR. BARRON:  Should I start over?

MS. CHANG:  No.

MR. BARRON:  Okay.  I wish to speak to you about two subjects related to the topics under discussion.  The first being the necessity of educating health care professionals in the recognition of complementary and alternative medical practices.  And the second, in looking at those same practices as a means of helping to alleviate the rising prescription drug costs for the elderly in our country. 

My background in these subjects includes over 30 years of experience in using complementary and alternative medicine and over 12 years experience as a registered nurse in settings that include hospitals and home care.

Whatever your stance on the use of complementary and alternative medicines, there can be no doubt that the American public is spending millions of dollars yearly on them.  During the last half of the 1990s I began to see an increasing number of the patients I encountered in their homes and in hospitals using CAM products that included herbal and homeopathic preparations, and nutritional supplements, among others.

In many instances patients concealed their use for fear of being ridiculed or interfered with by their care givers.  Only by building trust between us were some patients finally comfortable enough to openly discuss their own involvement in CAM.  During these discussions I often found that the patient made his or her choices based on inadequate or erroneous information.  A very few people were well informed and understood the possible interactions between CAM and the more conventional treatments they were receiving.  Most were not.

At the same time, the professional care givers charged with advocating for and protecting those patients were usually even less informed.  Reasons for that include a lack of exposure and information, their own biases, and a lack of appreciation for how thoroughly CAM has permeated our society.

If we as health care professionals are to continue to deserve the trust and responsibilities to educate and protect that come with our role, we must become more informed about CAM practices now. 

Moving to the subject of prescription medicines: 

Studies released this week show that the cost of prescription drugs is the fastest rising portion of health care costs in our country.  The elderly are among the largest consumers of these drugs and the hardest hit by their rapidly rising cost.  Perhaps there will be some solutions found in economic and political maneuvering but such huge economic interests will be difficult to sway.

I recommend that we look to the many CAM practices available that would help any number of the ills the elderly are prone to and do so inexpensively and safely.  I would especially promote the use of herbal and homeopathic remedies.  An herbal diuretic prescribed for hypertension, for instance, may provide effective relief for just pennies rather than its more expensive counterpart.

To counter the claim that many of these remedies are unproven, it is easy to point to the many that are using any measure of science found in this country or in Europe.

If we had the will to do so we could offer these affordable alternatives to our elderly population soon. 

COMMISSIONER GORDON:  Thank you.

Kate Birch?

                                                    KATE BIRCH, AS, RS Hom(NA), CCH, CMT

                                                MINNESOTA HOMEOPATHIC ASSOCIATION

My understanding of --

COMMISSIONER GORDON:  Come a little closer to the mic, please.

MS. BIRCH:  My understanding is that the public has been limited to the access to CAM practices through these educational systems.  The absence of curriculums designed to embrace CAM healing concepts limits our exposure to the possibilities in our own health choices.  Our educational system is based on a reductionistic and mechanistic view of life.  Furthermore, as there is a separation of church from state, this education system negates any understanding into the development of the human spirit.  Tragically this mechanistic view of the world has been fully developed into the existing medical model.

I will just say the first point here that from allopathic perspective most disease processes are viewed as mechanistic and physiological phenomena in the body.

And continue on to say that at this moment healing modalities are becoming more and more wide spread but the biggest limit for the consumer to them is education.  Superstition, fear, ignorance and naivete rooted in the public education system about concepts having to do with spirituality, energetic understandings about life, or the true nature of our internal healing mechanism is limiting the public's right to the healing modalities that respect them as an integration of mind, body and spirit.

Contrary to conventional medical practices, most CAM practices operate under the following principles:  And I will just read the first one I have here.

That is that the dynamic force that regulates health and disease is a piece of most CAM practices. 

One only has to look at the crisis within the public education system to see there is something inherently missing in an education system that denies vitalistic principles and sees people as mere protoplasm and negates any spiritual recognition of the individuals that get churned through the system.  The increased occurrence of hyperactivity, ADD, violent and abusive behavior, marginalized academic and social skills, apathy, indifference, alienation and defiance, which are all common mental and emotional disorders in school age children mark the expression of an individual who's soul and character has not been recognized in their educational environment. 

Remedying the educational system to incorporate some of the following solutions will have an effect of not only exposing the populace to CAM theories but would also be therapeutic in itself and reduce the need for palliative conventional medical treatment.

With this understanding, I offer some solutions: 

Education at the primary, high school and collegiate level to include:

(1) Theory behind vitalism and healing.

(2) That the history of medicine be reviewed in encyclopedias and amended to include more comprehensive and unbiased material on the great physicians or trends of thought with regards to healing practices that have otherwise been omitted, disregarded or disparaged as they offer ideas or conclusions contrary to allopathic medical practices.

There are many examples here.

(3) Design curriculums where concepts of mind, body and spirit are discussed and incorporated into learning strategies.

(4) Have courses open as to metaphysical science and practices, meditation and hands on healing practices.

(5)  Explore and apply principles for anthroposophical education in the public school system.

COMMISSIONER GORDON:  Okay.

MS. BIRCH:  Thank you.

COMMISSIONER GORDON:  Thank you. 

Ann Richtman?

                                                                        ANN RICHTMAN, JD

                                          NORTHLAND NATURAL HEALTH RESOURCES, INC.

You have my written remarks.  I am going to, I think, skip the first and come back to that if there is time and go to the second.

The second is about informed choice.  The third is about informed consent, which we know of in a legal context. 

And the recommendation that I have is based on the fact that I have read all of the written testimony that is available of your proceedings to this point in time and that has been really informative to me.                 And with that as a backdrop, I make these remarks on informed choice and informed consent.

As I read through that testimony, I asked myself what is the key issue here and how is it being addressed.  To quote Harris Coulter, "Therapeutic doctrines have important economic aspects.  People are sick and tired and increasingly they are more sick and tired." 

In our region, which is Northern Minnesota and Wisconsin, revenues from the medical services industry are second only to iron ore and we will see that change very quickly.  In the nation, they are the largest sector. 

Our local hospitals have an advertising budget that is unrivaled only by the pharmaceutical companies.  Between them there is a constant and pervasive multi-level marketing of acute care services and prescription medications in our community.  More and more packaged as news stories and public service announcements. 

In America we have an insidious enculturation process from industry and governmental policies that normalizes an expectation of pathological outcome and compartmentalizes self-care as a programmatic option.  How will the medicalization of our society be addressed in your report?  Will you make available to us not only the testimony that has gone before you but also the accompanying written documentation and research provided to you so that we can better inform the public of the wealth of information that you are reviewing and so that we can make an informed response to your recommendations.

Secondly, informed consent.  You are aware that the doctrine of information consent springs from tort law, although there are those who see its importance in contractual application also.   The U.S. Supreme Court has told us that we have a constitutional right to refuse treatment but it has also told us that government may substitute its judgment for our's when it comes to having access to treatment that we think most suitable to our individual health needs. 

Our interests are further compromised by a statutory or judicial requirement that medical doctors advise their patients of alternative treatments -- this is the language -- but that those are not in any way inclusive of those alternatives known to you, known to us and known to many others outside the narrow confines of conventional medicine.

Is patient consent truly informed without disclosure of documented beneficial alternatives? 

So again I would like to ask that all of the information that you get be made available to us so that the money and the effort and the energy that is going into your process can then be passed on and perhaps we can see some changes in these other areas.

(Applause.)

COMMISSIONER GORDON:  Thank you very much. 

Tenby Owens?

                                                                             TENBY OWENS

                                                             MASTER OF PULSE DIAGNOSIS

                                            ST. LUKE'S CENTER FOR HOLISTIC HEALTH CARE

I am going to talk about data collection as a tool to create some validation between the interface of contemporary Chinese pulse diagnosis and allopathic medicine.

I have been a student with Dr. Leon Hammer for more than five years.  He is a retired psychiatrist.  In the course of his career he shifted away from his allopathic training to address his patients' ailments to methods based on Chinese medical physiology and practice, acupuncture and herbal medicine.  A genesis of his lifelong exploration has been his development of what is now known as contemporary Chinese pulse diagnosis. 

This is a specialized method of pulse taking that is not taught in Oriental medical and acupuncture training programs.  I am one of a group of practitioners who are faithful to this diagnostic method used for developing treatments for my patients.  I am an herbalist. Others who use this method are practicing acupuncturists.  Robert Heffron, MD, has been teaching this method to a handful of medical physicians, most of who work in Europe.  This system lends itself to an apprenticeship method of teaching and learning so we study with Dr. Hammer twice a year to refine our pulse taking and interpretation skills and share our experiences on an ongoing basis.

It has become clear in this five year period that this inexpensive and noninvasive diagnostic method shares a fascinating and important interface with allopathic medicine, namely that all of us are finding what are undiagnosed significant health problems of patients who have come to us for services.

Some examples of this include undiagnosed diabetes, cancers, heart disease, hepatitis, duodenal ulcers, and brain abnormalities such as strokes.  We are seeing the correlations between our pulse findings and Western diagnoses because our findings are later confirmed by relevant allopathic tests.

We have concluded that it is important for us to take a first step in compiling our findings; that is creating a database so that we are systematically documenting these occurrences.  The importance of this systematic collection is to demonstrate that a finding of mine is not an isolated event or for that matter of any one of us who happens to be using this practice.

Our belief is that we can later access this data so as to create a body of knowledge that correlates pulse findings with Western disease diagnoses in such a way that it will be meaningful to the allopathic medical community.

Research monies are not readily available to practitioners and schools of thought that are not already a part of the mainstream of health care.  Understanding the benefit of a diagnostic method such as contemporary Chinese pulse diagnosis is not going to happen in an environment of skeptics such as mainstream medicine.  Rather it will grow out of the community of practitioners who use it and understand its importance and who are then able to bring it to that skeptical community in a systematic way.

We ask that you recognize this and recommend widening the scope of how funds are made available to practitioners of so-called alternative medicine.

Thank you.

                                                                               DISCUSSION

                                                COMMISSIONER GORDON:  Thank you.

Questions?

George?

COMMISSIONER DeVRIES:  I will pass for a moment.

COMMISSIONER GORDON:  Okay. 

Wayne?

COMMISSIONER JONAS:  One quick question for Ms. Owens.

You are in the process now of trying to verify -- in other words, look for correlations of this process with standard diagnostic methods?  You say you can diagnose diabetes early, for example.  Has that been -- have you looked at that?  Do you know what the accuracy of that is?

MS. OWENS:  I do not think that is exactly what I said and I do not -- I would -- what I described was instances where we are finding cases where people have a health condition, a full-fledged health condition such as diabetes, and their physician has not picked that up for some reason or another.

COMMISSIONER JONAS:  That is not the same as being able to detect diabetes?

MS. OWENS:  It is not necessarily early stage diabetes.  That was the phrase you used.

COMMISSIONER JONAS:  Oh.  It can be actual flagrant diabetes.

MS. OWENS:  It can be actual diabetes.

COMMISSIONER JONAS:  Okay.  So what is the accuracy of that?

MS. OWENS:  Well, my point is --

COMMISSIONER JONAS:  That is even easier.

MS. OWENS:  That is a good question because my point is it has only been in the last couple of years because there are a number of us who are doing this particular pulse system and because we get together on a regular basis, we have had the opportunity to begin sharing our case notes that cover, you know, the six months before we get together for a meeting and we are starting to notice, and we have started to notice that there clearly are patterns to -- we know the pulse pattern for diabetes, for example, and we are noticing not that we notice that it is diabetes but that we are picking up things that you would hope that physicians would. 

So -- and that is very important to us, that we can provide that information to a physician that he is missing something if you know what I mean.

COMMISSIONER JONAS:  So there is a pattern that correlates with diabetes.

MS. OWENS:  Yes.

COMMISSIONER JONAS:  That you should be able to take a group of diabetic patients, look at the pulse pattern, look at the diabetes, see what the correlation is.

MS. OWENS:  Yes.

COMMISSIONER JONAS:  And see what the accuracy of that is?

MS. OWENS:  Yes, you should.

COMMISSIONER JONAS:  Yes, okay.  That would be very interesting.  I would think that the national center would be willing to fund a study if it was properly executed and there are ways to do that.  If any of your group is interested I can refer them to the individual --

MS. OWENS:  I think, too, there is a broader issue that I am describing, which is there are lots of pulse qualities that correspond with lots of things.  You know, if someone happens to have an interest in diabetes, that is well and good.  It kind of misses a bigger picture, which is this is a tool that has tremendous potential for augmenting what doctors do diagnostically, you know.

COMMISSIONER JONAS:  Right.

MS. OWENS:  And it has -- not simply about diabetes but it has a lot of application.

COMMISSIONER JONAS:  Right.  I am concerned a little bit about these systems and kind of what I consider premature statements about their ability to detect things because there are a number of -- I am not picking on you.  I do not know your system actually.  It is the first time I have actually heard of it but there are many, many systems that involve early or even established diagnostic tests that when actually tested do not correlate with what the practitioners think they correlate with and yet they are used to communicate to the patient that they have a disease and, therefore, they need a treatment of some type, and they may not use those terms in Minnesota now but in any case that is the implication.  And the result is the fabrication of illness, you see, which is in itself risky and this is not confined to complementary medicine. 

We did this in conventional medicine and continue to do it in conventional medicine but are learning that there are ways to try to get around this and I just want to make a general statement that this is part of why good research is important in diagnostic areas and that it is very important that those studies be done before one implies that one can identify an illness of some type because a lot of times it turns out not to be the case.

I did have a question and that has to do with the information.  Do you have a lot of requests for specific complementary medicine information in your center?  I mean, do you -- 52 percent of people are using it.  Are they aware that you provide services, for example, to them?

MS. OWENS:  That was the incentive for the components of our program.  We wanted to make sure that the assessment of information need was part of intake, was part of assessment, was part of treatment, and was part of evaluation.  And to be able to be a part of facilitating physicians, families, community practitioners, anyone who is looking for applicable pediatric CAM information for a given situation that we have a way of offering that kind of service.

COMMISSIONER JONAS:  Has there been a big demand for that?

MS. OWENS:  Yes. 

COMMISSIONER JONAS:  I mean, do you have -- how many people do you have providing and working on that?

MS. OWENS:  We are just in the process of loading into a database all of our client information but on an average day I would say two or three requests. 

COMMISSIONER JONAS:  Two or three requests.  And then are you providing information where they can access some of that themselves and get information in a way that communicates to them what the issues are?

MS. OWENS:  Yes.  And I am not quite sure what you are getting at.  We have collections of materials that we are putting together.  We have fact sheet information that we are putting together based on research that we are in the process of doing as well as responding to specific information requests that families may have to explore what options that are out there that might be valuable to them or useful to them.

COMMISSIONER JONAS:  I think this would be an essential service not only for the patients but also for the physicians who when they begin to ask --

MS. OWENS:  It is.

COMMISSIONER JONAS:  -- their patients what they are using and find out they are not quite sure what the implications are.

MS. OWENS:  Right.  Typical, you know, I have a chemo patient and the parent is giving him a mushroom and I do not know anything about this mushroom.

COMMISSIONER JONAS:  Right.  Very, very good.  That is very important.  I think we are having a session on information systems later and it might be useful to get details about actually how you go about doing this and putting the information together.

COMMISSIONER LARSON:  He asked my questions.

COMMISSIONER GORDON:  Okay.  Ann Richtman, I wanted to respond to your request for the information.  We have on our website all the transcripts of all the meetings -- although -- do we have all the transcripts of all the town halls as well or summaries of some of the town halls?

MS. CHANG:  No, they are actual transcripts.

COMMISSIONER GORDON:  We have -- so we have transcripts of every sort of public meeting that we have had.  We have also been sent thousands, maybe tens of thousands of pages of material.  The way to access that -- because we do not have the resources to put everything -- make everything available and the way to access that is through Freedom of Information Act.  There is no other way that we can do it and to ask for specific things that you have a particular interest in and we try to respond to that. 

It is an --

MS. RICHTMAN:  That is the --

COMMISSIONER GORDON:  I am sorry.

MS. RICHTMAN:  That is the only way you can make it available?

COMMISSIONER GORDON:  There is no -- that is -- it is a request.  I mean, that is the request, yes.  Because there is such a huge amount of material and we do not have any -- we do not have the resources to catalogue everything and make it available and it is a major -- you know, let's say there are 10,000 pages around.  Now what has happened is that we have -- we sort of go through it.  We look at it. 

We look at -- you know, somebody may send us 300 pages that are not particularly relevant to the question that we asked so we try to look at what is relevant to the questions that we are asking and then different staff members look at it and try to use it as background material.

MS. RICHTMAN:  The sort of thing I am referring to is that you had -- and I forget his name now but a person come in and make reference to 193 studies on how guided imagery and other techniques were useful in facilitating healing and someone asked if he would make those available.

COMMISSIONER GORDON:  Right.

MS. RICHTMAN:  And he said yes, he would.

COMMISSIONER GORDON:  Right.

MS. RICHTMAN:  So, I mean, that is really information I think that is important for us without having to go out and duplicate it.

COMMISSIONER GORDON:  Right.  Then the way would be to say that -- to make a request for the information provided by that person.  Every time we ask for information that is in the transcripts that are publicly available.

MS. RICHTMAN:  Okay.

COMMISSIONER GORDON:  So let's say, you know, we asked you for information about the law, you send it to us, somebody is going to see that a commissioner asked Ms. Richtman for information, and they will read that and they will say, "Oh, if I want that then I am going to --"

MS. RICHTMAN:  So I am limited to what I can identify from the testimony.

COMMISSIONER GORDON:  That is sort of the way it has to be, yes.

MS. CHANG:  I am sorry.  You are not limited.  You can ask for whatever you want but -- and we -- and just a clarification.  We will catalogue.  We are cataloguing everything.

MS. RICHTMAN:  Okay.

MS. CHANG:  We are a little behind but we are cataloguing everything.

MS. RICHTMAN:  That is helpful.

MS. CHANG:  So that will be helpful.

COMMISSIONER GORDON:  Yes.  But it is -- but I think that whatever you ask for is going to take some time to get.

MS. RICHTMAN:  Right.

COMMISSIONER GORDON:  It is not -- there is no withholding.  It is just coping. 

(Laughter.)

COMMISSIONER GORDON:  Other questions?

Joe, Linnea?

Okay.  I -- Yes, George?  Sorry.

COMMISSIONER DeVRIES:  I have a question. 

Ms. Hageness, just regarding Children's hospital, you talk about, you know, interest in CAM, use of CAM, help us a little bit specifically with Children's hospital, is it delivering CAM services?  Do you have chiropractors, acupuncturists, other, you know, CAM clinicians and medical physicians in integrated medicine actually providing services at Children's hospital?  How are you -- how or if actually delivering services within Children's hospital?

MS. HAGENESS:  Yes.  That is one of the important components.  We are delivering.  We do not have chiropractic.  We have massage therapy, infant massage, healing touch, clinical aromatherapy, guided imagery, biofeedback.  What did I forget?

MS. __________:  Hypnosis.

MS. HAGENESS:  Hypnosis, yes.  And we do it both inpatient and outpatient.

COMMISSIONER DeVRIES:  Okay.

MS. HAGENESS:  So we will get an order from -- often times it is in the cancer population.

COMMISSIONER DeVRIES:  Sure.

MS. HAGENESS:  For a massage or for healing touch or for aromatherapy.

COMMISSIONER DeVRIES:  Do you have a sense what percentage, just roughly, of your patients are receiving CAM services?  Five percent, 50 percent, 75 percent, within the -- through Children's Hospital?

MS. HAGENESS:  No, I do not right now.

COMMISSIONER DeVRIES:  Just roughly.  Okay.  Thank you.

COMMISSIONER GORDON:  I had two other thoughts.  One is on this information issue.  I think that what is going to come out of our next hearing pretty clearly and it has already come out in many of the town halls is a need for a central federal repository for information.  Our information does not necessarily follow -- it is not systematic. 

And I think that although you are welcome to it, the real need is that we have discovered and heard about is for really systematic and easy access to all this information,  and that is what we are hoping to -- that kind of recommendation is pretty clearly emerging from everything that we have heard and I have a feeling that it will only become stronger after our information hearing.

MS. __________:  One thing that is important about it, whether you intend it or not, is the fact that you give it legitimacy.  So that, I think, is really important for us particularly when we are dealing with multilevel mass marketing that we can say, you know, either this information came to the White House Commission or it came out of the White House Commission, and then, you know, whether it is the local TV station or the newspapers or doctors or whatever, people, I think, take closer look at it because it was important enough to come to you and you are --

COMMISSIONER GORDON:  The problem there -- I do not -- I think it is important not to misrepresent it --

MS. __________:  Right.

COMMISSIONER GORDON:  -- anybody can send us anything.

MS. __________:  I know that.

COMMISSIONER GORDON:  So we -- just because we receive it, does not mean that we validated it in any way so that is important as well.

One of the things that we will do when we do our -- not so much in the interim report, which is really going to be a series of recommendations with brief introduction but in our final report it will be very heavily referenced so that all that we have drawn on to make the recommendations, all those -- we are going to make sure that all those references will be there and that report should be available.  It will be presented to the President in March 2002 and, hopefully, within a few months after that, one hopes, it will be available to -- widely available and hopefully inexpensively available as well. 

One other thing, at the risk of revisiting this whole licensure question, and the law, I cannot for the life of me figure out why you would not be able to continue doing the practice as you have been doing for many years as a nurse, therapeutic touch or relaxation therapies or imagery.  I do not see how the licensure law can in any way get -- I mean, the new -- it is not licensure law but the Freedom Act can get in the way of that.

MS. __________:  Well, the way I understand it is if I hold myself out as a nurse, I am accountable to the Board of Nursing and right now the Minnesota Board of Nursing does not have a statement that talks about what holistic practice is or complementary alternative medicine practice is for a nurse.

COMMISSIONER GORDON:  Right.

MS. __________:  So the fact that I practice healing touch as a nurse, and hold myself out as a nurse, healing touch practitioner, does not -- I am not covered under this new bill or this new law.

COMMISSIONER GORDON:  Right.  But you were not covered before either.

MS. __________:  That is correct.

COMMISSIONER GORDON:  Okay.

MS. __________:  But it is out there in the open now and we are seeing how more and more facilities are integrating complementary and alternative medicine so the fact that it is out there -- it is concerning for me as a director of a program, too, who works in a hospital as to how to -- you know, what do you do there?  You know, do you say to a nurse you cannot have RN on your card or --

COMMISSIONER GORDON:  I do not see why that would apply because it has been part of your  scope of practice before and it continues -- or not part of your scope of practice.

MS. __________:  It is not --

COMMISSIONER GORDON:  So it was never part of your scope practice.

MS. __________:  It is not.

COMMISSIONER GORDON:  So you were always vulnerable.  Okay. 

MR. __________:  May I also add a comment on that, is I called the Board of Nursing and talked to a legal representative and said, "Can I advertise myself as an RN in addition to my practice in the Bach flower therapies and she said, "No." 

Okay.  The concern I have about that is I had an experience once where a client came to see me for a Bach flower therapy and using my RN assessment I determined that this patient had sepsis and I said, "You do not need to see me.  You need to get in a cab and get down to the emergency room." 

So by not allowing the public to choose someone with those assessment skills, we are depriving them of one extra layer of protection and that is my concern about this bill.

COMMISSIONER JONAS:  Well, doesn't it make sense for -- to begin to expand the scope of practice for nurses or for all the professions?

MS. __________:  That is the issue.

MS. __________:  Oh, absolutely.

(Laughter.)

COMMISSIONER JONAS:  And, of course, the flip side of that, if I am now going to a -- and I will pick on homeopathy because I know it the best, if I am going to a homeopath and they say, "Oh, you are just having an aggravation," and they have sepsis but the individual fails to recognize that they have sepsis, then they are not delivering a toxic therapy but on the other hand they do not have the clinical skills to make a judgment about something that could be quite adverse consequences.   And this again is one of my major concerns about the whole kind of freedom of scope of practice for unlicensed as to what standards are there for addressing number "Y", which is failure to refer to a doctor when appropriate.  I do not know if that has been discussed.

COMMISSIONER GORDON:  We are going not have to stop in 12 seconds.  Do you have something in 12 seconds?

MS. __________:  The concerns that you have, Dr. Jonas, are addressed in case law throughout this country and they may vary from jurisdiction to jurisdiction.  So, for instance, in Wisconsin the courts may have decided that it is not within the scope of practice for a chiropractic to make a medical diagnoses and, therefore, he is not falling below the standard of care if X happens to the patient.

So there are other ways of determining what is the scope of practice and what is the standard of care for a health provider without it meeting the same standard that a medical doctor would.

And I would also add that what is good for the goose is good for the gander.  Let's look at the extent to which medical doctors are unable to diagnose.  Let's be honest about that, too. 

(Applause.)

COMMISSIONER JONAS:  But there are established methods in which that occurs right now and we have data on that actually.

COMMISSIONER GORDON:  We are going to have to end this.  Thank you very much, all of you.

                                                                                    * * * * *

                                                                 OPEN SESSIONS (Continued)

MS. CHANG:  That would be Howard Fidler, John Toft, Marilynn Anderson, Chu Wu, Jeff Dusek and Richard Pavek.

COMMISSIONER GORDON:  One of the things we are trying to do and I hope I am not abrupt -- too abrupt, firm I suppose, is because we really -- we are already running about 20 minutes behind time and we would like to end pretty much on time and give everybody the same amount of time and make it possible for people who have to go but who want to be here for the whole time to leave not too late.

Okay.  First will be Howard Fidler.

                                                                      HOWARD FIDLER, DC

                                                  AMERICAN CHIROPRACTIC ASSOCIATION

Federal statutory requirements that impede the use of proven CAM services in federal health care programs must be relaxed.  Currently many federal programs do not reimburse for complementary and alternative treatments.  These statutory limitations are impeding research by not allowing CAM practitioners to participate in federally sponsored coordinated-care research efforts.  In addition, doctors of chiropractic and other CAM practitioners are further impeded by statute from providing their services to the general public through the National Health Services Corps.  By not being recognized as providers under these programs, doctors of chiropractic as well as other CAM providers are not provided the opportunity to prove the cost effectiveness and efficacy that their services provide.  Statutes must be changed to allow for all proven CAM providers to participate in all federal programs.

Patients should be afforded the ability to seek treatments by proven complementary and alternative providers without the referral of a medical gatekeeper.  Currently, MDs are not trained and educated to appropriate refer patients to CAM providers.  Also, there is an issue of competition and a history of bias.  In addition, both private and federal insurance programs should not limit a practitioner's practice.  Proven and/or licensed CAM practitioners must be recognized and reimbursed for all reasonable and necessary services provided to their patients.

Recommendations should be made to ensure that CAM providers not be reimbursed at a lower rate or be discriminated against in any fashion based on their training and licensure.  A consumer's freedom of choice to select among all state-licensed health care providers is an essential attribute of any effective and responsible national health goal.  A mandate of nondiscrimination ensures that one class of provider will not be given a competitive edge over other providers for the service.

While the ACA applauds the commissions interest in educating medical school students on the merits of CAM therapies, care should be taken that these courses are not misinterpreted as teaching a specific CAM procedure.  These courses should merely provide the medical school student with exposure to the principles and practices in order to refer when necessary.

The commission must provide specific recommendations to address the current problem with reimbursement disparities that is occurring at an alarming rate with private insurance.  The commission must recommend that federal agencies work with the complementary and alternative therapy communities in the development of policy by contracting or hiring CAM provider as part of their health care policy teams.  Unless federal agencies begin to look outside the medical model and begin to embrace wellness and prevention, federal laws will continue to be ineffective in providing consumer access to proven CAM practices.

Thank you for the opportunity to present the views of the American Chiropractic Association.  I would be happy to answer any questions. 

COMMISSIONER GORDON:  Thank you.

John Toft?

                                                                            JOHN TOFT, DC

                                            FUNCTIONAL MEDICINE CHIROPRACTIC CENTER

I am practicing a model of health care that combines my primary care chiropractic training with the most current, cutting edge, medically based and referenced research of functional medicine, delivered through a very specialized arena of chiropractic, applied kinesiology. 

This is essentially the model that is being used at Alternative Medicine, Incorporated, in Chicago, that is performing in a pilot project with Blue Cross/Blue Shield of Illinois.

In speaking with Dr. Steven Groft, I believe you folks are aware of this pilot project, but may not have seen the most recent numbers.  They are now showing after two years of treatment a 66 percent overall health care cost savings.  Dr. Richard Sarnat will be coming to you in Washington next month to speak about this program and I hope you will give him very special attention.

One major item to me that has not been previously discussed is what makes this group of specially credentialed physicians so effective and that is the very specialized technique of applied kinesiology, which the majority of the DCs in the group are using.

Applied kinesiology or AK for short is a system of analysis that aids in the diagnostic process.  This technique has been evolving over the past 35 years and gives a practitioner the ability to much more effectively find and fix the underlying causes of musculoskeletal problems and also allows us to very specifically find nutritional deficiencies, food allergies, toxic conditions, and also emotional issues that thereby give us the ability to improve organ system functions; where organs have lost their organ reserve energy and are on the downhill slide towards an eventual disease state, usually decades in the future.

The Human Genome Study has shown that disease exists on the genes.  What Dr. Jeff Bland's work has already shown years ago is that the combined effects of environment and lifestyles is affecting communication molecules that turn the diseases on or off at the level of the chromosomes.  The expression or phenotype of the genes is controllable.

I have included a work product of mine on ten floppy cassettes, nearly 500 cutting edge, medically referenced articles in 44 categories of disease that educate one on how the whole body works together in health and disease.

I feel that this is the most exciting time there could ever be in health care.  We are showing an absolute revolution and a paradigm shift in the health care delivery process; from a disease care model to a truly preventative model that can find and fix organ system weaknesses before disease has had a chance to develop.

I have included several additional writings of mine and will be more than willing to assist you in any way I can.

Thank you.

COMMISSIONER GORDON:  Thank you. 

Marilynn Anderson?

                                                                    MARILYNN ANDERSON

                                             THE FELDENKRAIS GUILD OF NORTH AMERICA

Feldenkrais practitioners meet people in whatever state of functioning and health that they are and assist them to move gently and easily towards where they want to be.  Those desires may be as basic as breathing more fully in a wheelchair or as complex as surviving a day comfortably while sitting attentively perhaps at a meeting. 

Through a series of guided, often developmental, movement sequences, either privately or in a group setting, the Feldenkrais practitioner encourages fluid systemic movement patterns.  The client learns how to notice how they interfere with and detour from their intention, while learning how to safely experiment and discover alternative routes and strategies that are both more comfortable and fruitful.  This same process holds true for the person recovering from a stroke and a high performance athlete.

The Feldenkrais method and other somatic education modalities are an essential component of the health and health education systems.  However, we are not part of the medical system as it is conventionally defined.  Now it often happens that through the Feldenkrais process, as the client becomes more self-integrated and organized, that a shoulder may unfreeze, a knee stops swelling, a jaw softens, an ankle quits chronically spraining, blood pressures lowers, or a back aligns better. 

These sympatomica events create interesting borderlines between the medical system and the somatic education systems and warrant exploration and research.  but to a Feldenkrais practitioner, these would be merely incidental asides to the successful functional acts of a person spontaneously playing with a grandchild on the floor, delighting in a walk around a lake, simply rolling over in bed, sleeping well, shoveling snow without a three-day recovery, or comfortably persisting at a computer until the book is complete.

People productively follow their dreams with pleasure when functioning fully and confidently in their lives.  They are healthy.

Whatever policies arise from this commission, the Feldenkrais Guild requests that you approach each modality respectfully and in consultation with its professional organizations.  Please be cautious about placing nonmedical practices into a medical framework. 

The most healthful practice around may be a walk on the beach but certainly no one wants to need a prescription to do it along with a qualified walker. 

We have an enormous amount to contribute towards the healthy functioning and injury prevention of the citizenry.  We welcome the shift in the medical system towards the health and health education systems, and look forward to a continued blossoming relationship within that context.

COMMISSIONER GORDON:  Thank you.

Chu Yongyuan Wu.

                                                                  CHU YONGYUAN WU, MA

                                                     HMONG SHAMAN RESEARCH PROJECT

I am one of the young considered healer being chosen so I appreciate to be here today to talk about Hmong Shamanism in America.

Shamanism is one of the oldest spiritual healing that is still practiced by some indigenous people around the world.  Shamanism is very much alive with the Hmong people here in Minnesota.  The new immigrants in the United States.    To the Hmong people, Shamanism is an ancient method of healing but to the Western mind it is a new alternate method of treatment.

According to the Hmong Shaman belief, all living species have a body, soul and spirit.  When a person becomes ill, the shaman believes the problems are either caused by organic disease, lost soul or because the spirit of the person departs from the body.  The human body is somehow out of balance; therefore, it needs the medicine healer to conduct healing ceremonies in which to determine the cause of the problems.

A shaman is someone who is chosen by the Creator and possesses the power to heal throughout his or her lifetime.  No one decides to be a shaman.  When the spirit enters into the person, other shamans come to assist him or her in starting the process for one or two days.  He or she begins to practice the ceremonies within the family and then eventually is invited to help others in the community. 

The shaman's role is to cure the soul and the spirit, to drive the demons out of the body and out of the family, and then to help in bringing back the spirit and soul to the body in order for the person to become well again.

Almost all the shamans I have known during the last 20 years and those whom I interviewed in the "Shamanism in Minnesota and Patient Choices" research project are working to cure the soul and spirit, not the disease.  He or she is not a medical doctor that attended school, learned about the subject or obtained a degree.  Their knowledge and skills are gifts from God.  Their services are voluntary and free.

I recommend that health care in this country should be more open to alternative medical treatments and recognize the important values and healing systems of all cultural practices.  We need more study about the different types of treatments in order to develop more available resources for human needs before some of those valuable healings are lost forever.

Health care providers and churches in this country should not abandon the different types of religious treatments, herbal medicines and cultural practices, but they should work together to save lives.  Shamanism is alive and still has much to offer to the modern world.  We need to find ways to balance the system and to invite other healers to be part of the medical treatment team.

Thank you.

COMMISSIONER GORDON:  Thank you very much.

(Applause.)

COMMISSIONER GORDON:  Jeffrey Dusek?

                                                                       JEFFERY DUSEK, PhD

                                                          MIND/BOND MEDICAL INSTITUTE

The Mind/Body Medical Instituted is located in the Beth-Israel Deaconess Medical Center, one of Harvard Medical School's teaching hospitals. 

Over the past decade, researchers at the Mind/Bond Medical Institute have been conducting evidenced-based research examining the medical interaction between mind and body, including a current HCFA demonstration project.

Over the past decade, two national surveys indicate that Americans are increasingly relying on the use of alternative medicine treatments alone or as a supplement to traditional medical treatments. 

Given that many Americans are already using alternative treatments that have not been adequately tested, researchers must continue to explore the safety and proposed efficacy of these treatments.

To do adequately achieve this aim, my recommendations are as such:

(1) CAM therapies must be required to adhere to the same scientific rigor expected of traditional medicine.  Contrary to the belief of some CAM practitioners, current clinical research tools can be used to objectively and fairly examine the efficacy of CAM treatments.

(2) In this process, it is imperative to examine whether the CAM treatments themselves are effective in treating illness, or whether the belief in the CAM treatments plays a fundamental role in treating illness.

(3) Until clear scientific evidence of safety and efficacy of CAM treatments is obtained, safeguards should be implemented to protect Americans from potential harm.              

I am concerned that not all users of CAM are as well informed of the risk of CAM as are my esteemed co-presenters.  Simply accepting the treatment as a safe -- simply accepting that a treatment is safe based on anecdotal and not clinical evidence is not only unacceptable, it is dangerous.

(4)  Specifically it will be important to determine the safe and effective doses of treatments, an acceptable duration of treatment, and identifying which patient population may be best suited for a given treatment.

(5) Mind/body medicine is an excellent example of how nontraditional research can adhere to the scientific method employed in traditional medicine.  Positive results from mind/body medicine research are based on scientifically collected evidence, not anecdote.

(6) Although the National Center for Complementary and Alternative Medicine's budget has dramatically increased over the last several years, additional and adequately funded research initiatives are desperately needed to carry out this important work.

I have added on based on what I have listened to today.

It may be worth reminding ourselves that the goal of the clinical trial is to examine the efficacy of treatment for use in future patients. 

The goal of clinical treatments provided by practitioners is for current treatments or for current patients.  Coming to grips with those -- reconciling those differences between future patients and present patients, I think, is part of the difficulty we are having with research applied in this modality.

Thank you.

COMMISSIONER GORDON:  Thank you.

Richard Pavek?

                                                                           RICHARD PAVEK

                                                            THE SHEN THERAPY INSTITUTE

There are two major groupings of complementary and alternative health practices; each has different goals.  The more established, such as acupuncture, chiropractic and homeopathy are attempting to convince medical science that they are effective so that they may be accepted into mainstream medicine.  This will require a great many expensive double-blind controlled clinical trials.  This need is slowly being met at the insistence of Congress and the American people, by the National Center for Complementary and Alternative Medicine in association with other centers.

However, a number of health care options by their very nature can never be brought into mainstream medical practice.  Some require more time than licensed practitioners could provide, some are highly individualized to the client and others defy accepted medical explanation, relying on empirical evidence of effectiveness for proof.  NCAM has limited funding and few of these options are even on NCAM's list of possible candidates for investigation.  Most will never be studied. 

For years, mainstream medical science has, without proof, dismissed these methods as being merely the results of imagination or placebo.  The public, being unversed in medical dogma, uses what works; whether it works by a valid physical effect presently unrecognized by medical science or by imagination, placebo, the practitioner's personality or hair coloring is of little matter.  The fact that it works is enough.

Many of these systems, such as my own, SHEN therapy, work to promote emotional health, noticing that when emotional health improves, physical health improves.  A principle vaguely understood in medicine but which conventional medicine has no means to effect.  Maintenance of emotional health is not a part of the standard medical curriculum.  These CAM therapies fill that gap.

All CAM therapies lie in a vaguely defined area surrounding mainstream medicine's excessively broad and monopolistic territory.  When CAM options have been effective enough to be noticed by the medico/legal authorities, they are often fined and put out of business, not for causing harm or endangerment but because they were in competition with, and sometimes more effective than standard medical practice.

Minnesota's Health Freedom Act protects the rights of its citizens to receive the health care options each of them determines suits them best.  The act appropriately defines what the unlicensed health care practitioner may safely do and not do, and legally enforces ethical responsibility and full disclosure, actions not presently required of the medical profession.

Freedom of health care choice should be the personal right of every American citizen but without protecting the practitioner's freedom to deliver CAM practices to those who desire them, the public's freedom to exercise their health care options will be lost. 

I have returned here to my home state from my current home in Sausilito, California, to urge this commission to strongly endorse national legislation similar to the Minnesota Act.  It is vital to the future of these health care options and clearly is in the best interest of the American people. 

Thank you. 

(Applause.)

                                                                               DISCUSSION

COMMISSIONER GORDON:  Thank you, Richard.

Questions?  Linnea?

COMMISSIONER LARSON:  No.

COMMISSIONER GORDON:  No.

Joe?

COMMISSIONER PIZZORNO:  I do have one question. 

The applied kinesiology is an interesting procedure and I have heard assertions that there is research documenting its efficacy.  Could you review what the research is in AK and how it has been tied to conventional diagnostic procedures?

DR. __________:  There is not nearly enough research specifically to applied kinesiology --

COMMISSIONER GORDON:  Come close to the mic, please?

DR. __________:  There is not nearly enough research in applied kinesiology directly relating to diagnostics.  There are some research studies that have been done and one of the things that I would like to see come out of this is some specific additional research studies.  The outcome studies in Chicago, I think, are huge.  They are monstrous.  Sixty-six percent overall health care cost savings.  That speaks an awful lot.

COMMISSIONER GORDON:  Both of those -- I do not -- I was not sure.  Are there studies on -- that is a question I have had in my mind, too.  Are there studies on applied kinesiology and verifying its diagnostic accuracy in Western diagnostic terms?  Because I have not seen them either and --

DR. __________:  There are some studies and I will send those to you.

COMMISSIONER GORDON:  If you have them, that will be interesting. 

And the other -- say again the clinic in Chicago that you are mentioning.

DR. __________:  The Alternative Medicine, Incorporated.  They are working with Blue Cross and Blue Shield.

COMMISSIONER GORDON:  Okay.   We should -- can you give us a way to get in touch with them?

COMMISSIONER DeVRIES:  I think we have it.

COMMISSIONER GORDON:  We have that.  Okay.  That would be great because again we are very interested in cost-effectiveness and cost-benefit data so that will be helpful for us.

DR. __________:  I have spoken to Dr. Groft about it and they are well aware of their work.

COMMISSIONER GORDON:  Okay. 

George, you know about it.   Great.

Any other questions?

George, questions?

I have a question, what is the HCFA study?  The Health Care Financing Administration study that you are doing?

DR. DUSEK:  I am not directly involved in that study but from what I know from colleagues it is comparing Dr. Dean Ornisch's program and the Cardiac Wellness Program developed at the Mind/Body Medical Institute looking at effectiveness.  Not efficacy but as what is done in the HCFA's demonstration project's effectiveness --

COMMISSIONER GORDON:  Do you want to explain the difference between efficacy and effectiveness?

DR. DUSEK:  Efficacy is usually the purview of the clinical trial where you are looking to determine if a particular agent or treatment is -- reduces illness, shortens hospital stays, many outcomes you are looking at.  Effectiveness, you are looking -- you are understanding that efficacy is already there.  You are looking to look at cost-effectiveness or you are looking to determine if you can get the treatment to the people that actually need it.

COMMISSIONER GORDON:  All right.  So this study is comparing those two approaches to coronary heart disease?

DR. DUSEK:  That is right.  That is right.

COMMISSIONER GORDON:  Great.  And how long -- how far along is it?

DR. DUSEK:  I believe it started in -- well, we have been working since last fall or the people at the institute have been working since last fall on developing it.  I believe the funding came through in -- last October.  I guess October 1st.  So it is in the start up phases right now.

COMMISSIONER GORDON:  Okay.  All right.  Thank you very much.

I had a question about the -- about the Hmong Shamanic practice.  How -- can you give us a little bit of a sense of how your work and your community's work -- what the scope of it is and how it relates or does not relate to the medical -- conventional medical system?

MR. WU:  It is related to the medical ill.  I can give you an example.  Some of the -- my aunt, she went to see medical doctors and they could not diagnose her illness and then they went -- she went back again for the second time and they could not really find what is the cause.  From her story because she converted to Christian and she refused to seek shaman, so one of the family asked her to consider for a second -- a third chance is to seek a healer, which is Hmong shaman and she went. 

Well, to give you the story short, the shaman discovered that because her illness was her loneliness and her spirit had departed from her body and she is going to, you know, the -- continued to be illnesses for a while until, you know, she find a way to be reunited with her spirit.  And with her story she went to the shaman, you know, ceremonies and after that she recovered her, you know, illness.  Well, she went back to see a doctor again for the third time and the doctor could not detect any of the problems.

So that is one of the cases.  You know, I could give you an example why it is related to -- and then another case is a child have ligament on his eye.

COMMISSIONER GORDON:  A child has what?

MR. WU:  Have a ligament in his eye and, you know, the cases -- you know, the doctors recommended that the child had to, you know, remove on of the eyes and, you know, because the grandfather is a shaman, and the grandfather know that when he -- you know, finishes his term he is going to pass, you know, the tradition to the grandchild and the doctors, you know, took the case to court and, you know, they lost the cases.  The judge sided with the doctors and, you know, the child's eyes were removed but eventually, you know, the child came back to the family and now the family have a hope that, you know, this child is going to be, you know, a shaman one day. 

And this is an example of cases where, you know, medical doctors, you know, does not understand, you know, that there is, you know, an issue, you know, between human spirit and body and wonders, you know, you cannot define what to cause, you have to seek alternate, you know, treatment, and some of those treatments help because, you know, with the healing.

COMMISSIONER GORDON:  I see.  So, in fact, in this instance what you  are suggesting is conventional doctors are incapable of either the diagnosis or the treatment.

MR. WU:  Right.

COMMISSIONER GORDON:  Because they do not recognize the cause or the therapy.

MR. WU:  Right.  And a lot of doctors, you know, here in Minnesota, you know, I can only speak here because they -- this is a new experience to them and, you know, they are not aware of, you know, others alternate treatments because, you know, what some herbal medicines that also, you know, be able to cure some of this, you know, disease. 

Another example is the one of the man I interviewed.  He is also a shaman and he is dying of cancer and the doctor is telling him that he has only got four weeks to, you know, two months left to live.   So anyway he came home and took all the -- you know, find any herbal medicine that he could find and to this day he still lives.  So, I mean, that is one of the stories, you know.  Sometimes doctors, you know, may miss, you know, interpret what is the cause and, you know, with this experience, you know, doctors and, you know, shamans can work together to diagnose someone's problems.

COMMISSIONER GORDON:  Is that happening here?  Are doctors and shamans working together in any of the clinics or getting to know each other's way of looking at the world?

MR. WU:  I know that United and Children's Hospital here in St. Paul began to work together.  However, other, you know, hospitals are still very, you know, skeptical about the practice because, you know, throughout history when, you know, the Native American have one practice and they thought it was one of those voodoos, you know, evil things.

COMMISSIONER GORDON:  Right.

MR. WU:  And they did not believe it and so they, you know, still very skeptical but now with this research it will help, you know, a lot of this, you know, medical doctors to understand about others, you know, healing process.

COMMISSIONER GORDON:  Right.  Thank you very much.

Any other questions? 

Okay.  Thank you, all.

                                                                                    * * * * *

                                                                 OPEN SESSIONS (Continued)

                                                COMMISSIONER GORDON:  Larry Caldwell?

                                                                     LARRY CALDWELL, MS

                                                                       ORIENTAL MEDICINE

                                             ACUPUNCTURE ASSOCIATION OF MINNESOTA

I am a doctor of Oriental medicine and a licensed acupuncturist, and the President of the Acupuncture Association of Minnesota.

On behalf of the members of the Acupuncture Association, I would like to present the following comments regarding the useful, reliable and updated information on the practice of Oriental medicine, otherwise known as acupuncture in the State of Minnesota.

COMMISSIONER GORDON:  You are going to have to speak closer to the mic.  People are having trouble hearing.

DR. CALDWELL:  Okay. 

Currently there is considerable confusion regarding the scope and practice of acupuncture here in Minnesota.  I use this word because it has become the household term to describe the complex and comprehensive field of medicine which is founded on traditional Chinese medicine.

Acupuncture has been used to describe the use of needles placed into the body to relieve pain and treat other maladies. 

Upon further inspection you will see that there is an entire infrastructure of medicine designed to produce far more profound results than pain relief.  That infrastructure includes private graduate level schools, state testing programs and national accreditation programs to ensure the quality and high standards for competent and well-educated practitioners to utilize the full potential of Oriental medicine. 

Our association is dedicated to promoting education and literature to the public indicating the differences in programs offered to others who use the term "acupuncture" in their practices. 

We feel that it is a public safety issue when practitioners are using a tool which is a component of a complex medical paradigm with little or no training.

Our education and regulation system has evolved over the years to provide the public with quality practitioners who can deliver an alternative form of health care.

The key here is the use of the word "alternative".  Our medicine provides a necessary option to the public for wider scope of health care. 

We do not believe that our medicine is meant to act alone but is a component of a larger system which allows for the individuality of each system in order to promote the most effective and safe health care to the public. 

Through the use of our medical paradigm we have been able to help many who have come to us as a last resort.  These people who seek out alternative medicine have utilized conventional medicine without satisfactory results. 

They pay for treatments out of pocket because of the lack of the third party reimbursement participation.  This is an indication that one system does not work for all. 

For instance, in Minnesota, acupuncture is reimbursable if administered by a medical doctor or a doctor of chiropractic but not a licensed acupuncturist by many third party payers.

It is ironic that the practitioners who have the most knowledge and day-to-day experience cannot partake the conventional system. 

Our association has produced a membership directory, newsletter and now a website to inform the public on what Oriental medicine is designed to do, who can practice the medicine and what level of education the practitioner has to have to practice acupuncture.

We would like to see a refinement and a more precise definition of the information the public is receiving under the moniker "acupuncture."

It is hoped that through these testimonies you will see there is more to our medicine than simply placing needles into the body.

Thank you for this opportunity to express our views.

COMMISSIONER GORDON:  Thank you.

Zhaoping Li?

                                                   ZHAOPING LI, MB (China), LAc (Minnesota)

                                                   MINNESOTA COLLEGE OF ACUPUNCTURE

                                                                 AND ORIENTAL MEDICINE

My mother is a retired Western medicine gynecologist in China and also has had TCM training.  Because of excellent TCM results with her patients, she encouraged me to study and practice TCM.  My uncle is also a well-known TCM doctor and president of Acupuncture Institute in China.  I have been trained by him and helped him to train many international students.

In China, Western MDs and the TCM doctors always work together as a team.  One example is for cancer patients, TCM is very good at dealing with the side effects of chemo and the radiation therapies, especially nausea, vomiting, fatigue and the lowered white blood cell count. 

We tried this medical model at Health East Healing Center here in Minnesota.  The patients benefitted greatly from this combination of treatments but because of insurance reimbursement issues for TCM the center closed after one year.

TCM is beneficial to both patients and the insurance companies.  I have many patients who are advised to have a hysterectomy because of heavy menstrual bleeding.  With TCM their symptoms so lessened that they were able to cancel their surgeries.  I recently have been treating a 14-month old baby with glycogen storage disorder.  The parents were told that there was no hope.  They were advised to put the baby on the Hospice care.  His muscles too weak to breath normally.  There was no movement in his limbs and he was constipated.  After two -- just two treatments with TCM he now has significant movement, regular bowels, responds more and even smiles.  Unfortunately, again the insurance companies will not cover TCM treatments for this baby. 

This is a very important point.  TCM patients must have access to reimbursement from insurance companies.  It is time for TCM treatments that work effectively to be recognized as valid by the insurance industry.

Thank you for listening.

COMMISSIONER GORDON:  Thank you.

Changzhen Gong?

                                                               CHANGZHEN GONG, PhD, MS

                                                  AMERICAN ACADEMY OF ACUPUNCTURE

COMMISSIONER GORDON:  You have to come closer to the mic, okay?

DR. GONG:  -- not just a few health problems.  It is in the best interest of both the professionals and the public to preserve the integrity of this time-tested medicine, keep a high standard of professional training and develop valid research protocols on acupuncture and traditional Chinese medicine.

The vitality of traditional Chinese medicine relies on the holistic foundation, pattern differentiation and clinic effectiveness.

Chinese medicine views the human body in a very different way from other medicine.  The system is internally consistent, coherent and built practically upon the cosmological basis of Yin/Yang and Five Elements.  This also provides the basis for Chinese medicine to be able to offer many unique and highly effective therapies for many conditions.

Stressing treatment of different individuals based on their specific clinical manifestations and response to diseases serves as the core of Chinese medicine diagnosis.  Any simplification by giving up pattern differentiation will reduce the clinical effectiveness.

Clinical effectiveness has made the Chinese medicine flourish and thrive several millennia.  This depends on the consistency of the theory, treatment principles and treatment modalities.  Without a systematic knowledge of Chinese medicine, it is impossible to provide the best Chinese medicine care with the maximum effect.

NCCAOM has developed a certification standards in acupuncture and Chinese herbology.  We support that NCCAOM certification standards should be used as a general standard for the professionals who provide acupuncture and Oriental medicine services.

World-wide, only the system of traditional Chinese medicine, its institutional establishment and educational structure are parallel with and equivalent to modern Western medicine.  Practice-oriented doctors of Oriental medicine should be able to analyze and treat common and complicated health conditions with major traditional Chinese modalities, based on a solid and complete knowledge of Chinese medicine theory.

Western medicine based research provides some insight toward demystifying this thousand year healing tradition.  But this research is limited in discovering the working mechanism of Chinese medicine, which is rooted in the holistic concept and pattern differentiation.

Beyond the traditional Chinese medicine research tools and Western medical tools, researchers should develop new research protocols to validate those effective treatment procedures.  Those research methods should incorporate the fundamental principles of Chinese medicine:  Holistic concept and pattern differentiation. 

There is also a translation need for the healing literature to move from China to the United States. 

Thank you. 

COMMISSIONER GORDON:  Thank you. 

Jennifer Blair?

                                         JENNIFER BLAIR, DIPLOMA IN ORIENTAL MEDICINE

                                             ACUPUNCTURE ASSOCIATION OF MINNESOTA

Herein lies the problem:  I diagnose and treat patients according to a complete and logical system of medicine, developed and refined over thousands of years of clinical observation.  Yet the state licenses me and the public defines me based on a single tool in my medical practice.  In the struggle for acceptance, our professional organizations, academic institutions and private clinics have even conceded to label themselves in this limited way.

The terms "complementary and alternative" limit our progress in providing a health care model that benefits the patients we serve.  They are the result of cultural and political biases that place biomedical medicine, a system with a relatively brief history, at the center of our medical dialogue.  As a result of this limited perspective, we borrow tools from other medical paradigms without understanding them contextually.  Using the sharply focused lens of biomedical disease differentiation, we all too often find that the adopted tools are reduced in their scope and efficacy. 

They simply do not fit neatly in our paradigm and become easily discarded, misused or disparaged.  Not recognizing the importance of a medical language different from our own places us at the same risk that any other isolationist behavior would.  We must find models with which we can communicate between our paradigms for the most effective outcomes for our patients.

Chinese medicine is a complete and distinct system of medicine that has an important place in the health care landscape of this country.     Chinese medical diagnosis offers a truly holistic view of the body, providing patients as well as practitioners with an understanding of how disparate symptoms within their body interact to create a complete picture of health.  The resulting diagnostic clarity leads to more effective treatment outcomes, whatever tools are applied. 

I am not a technician.  I do not simply use herbs and acupuncture to treat patients.  By using the diagnostic perspective of Chinese medicine, a different medical language, I am able to apply diagnostic clarity and effective treatment to promote health.

By forcing other paradigms to be measured by biomedical standards, we risk losing valuable wisdom in a morass of misleading statistical analyses.  While I recognize that there are no easy answers for insurance reimbursements, research or educational models, I believe we must embrace the value of other paradigms before we can make substantial headway on the complex issues that face our health care system.

Working with representatives from our national adn state organizations, the NIH can serve the public as a sort of health care United Nations.  We need voices within the NIH and other governmental agencies that speak from the perspective of Chinese medicine, Ayurvedic medicine and other complete systems.  It is not enough to have Western trained MDs with knowledge of the tools of other paradigms.

Regardless of what the government decides in terms of public policy, it is clear that Americans no longer believe that biomedical medicine has all the answers.  We can ignore that 65 percent of the population is seeking alternatives to the biomedical model.  We can try to control dispensation of health care alternatives to the biomedical model.  We can try to control dispensation of health care to the financial constraints or we can choose to find ways to support what our patients are telling us. 

I believe we all can win and our patients benefit if instead of co-opting the tools of other paradigms, we instead focus on finding ways we can communicate between our paradigms.

Thank you.

COMMISSIONER GORDON:  Thank you.

(Applause.)

COMMISSIONER GORDON:  Ike Rodman?

                                                                         IKE RODMAN, PhD

                                           NORTHWESTERN HEALTH SCIENCES UNIVERSITY

I know that you have heard that Oriental medicine is growing to be a well developed profession in this country with national accreditation of education, national certification of practitioners, state licensing of practice in most states, and I will not dwell on those issues right now.

I am heartened by references today to referral rather than assimilation.  We in Oriental medicine feel that the use of acupuncture needles by practitioners who have not been trained in the complete paradigm subjects the public to ineffective treatment and confuses the public about what acupuncture and Oriental medicine are. 

This may be one result of naming a treatment for the tool and leaving diagnosis the heart of the medical care out of the definition.  There is confusion among Congress and third party payers about qualifications of different providers who use acupuncture needles.

A bar to congressional consideration of access to and wider third party reimbursement for acupuncture and Oriental medical treatment is the lack of agreement among practitioners about who is competent to use acupuncture needles.  In order to learn which providers are competent to help what patients, I recommend that a study be funded to compare courses of study and outcomes skills of medical acupuncture and ACAOM trained providers.   Find the areas that are unique to each, the areas they have in common, and their levels of competency and safety. 

Practical clinical skills and patient outcomes must be assessed.  This is not easy but it will lead to understandings that will enhance possibilities of cost-effective integration of patient care. 

For this study, you must find a committee of people with disparate views and interests.  The members must all be strong people who will insist on the integrity of their paradigms but who agree to agree on what can be agreed upon.  People who can examine their own assumptions in good humor and appreciate the assumptions of others.                 This group will not be easy to find but it must be found.               A philosopher of language should perhaps be included because deciding upon definitions will be central.

I believe that mutual respect and increased referral will result.  Whatever the results, I am ready for them in my belief in the value of the search for understanding. 

I also have some recommendations for clinical research and a policy level recommendation to enable that to happen.

I recommend that the NCCAOM review of applications lose the nature of the troll at the bridge scene if the applicant can speak the shibboleth of the dominant medical delivery system and instead realize especially in a medical delivery system 2,000 years old with a record that has been developed empirically of helping patients that we all have the patient's interest in coming together to determine how to determine efficacy and that the NCCAOM office can become the friend of research, the promoter of research, rather than the stern judge of whether an proposal meets the current language requirements.

                                                                               DISCUSSION

COMMISSIONER GORDON:  Thank you.

George, questions?

COMMISSIONER DeVRIES:  Yes. 

Ms. Blair, you had really discussed the concern that the licensure statute that you operate under in Minnesota recognizes acupuncture and does not really recognize the broad range of traditional Oriental medicine, is that a fair statement?

MS. BLAIR:  Yes.

COMMISSIONER DeVRIES:  Is there a consideration by your organization for attempting to broadening the licensure statute in Minnesota to make it the practice of traditional Oriental medicine rather than just acupuncture?

MS. BLAIR:  I would like to make a brief comment and then refer you to both Larry --

COMMISSIONER GORDON:  Come closer to the --

MS. BLAIR:  I would like to make a brief comment and refer you to both Larry Caldwell and Ike Rodman, who might be able to better speak to this.  The licensure in the state was hard fought and we are governed under the medical board and it was hard fought because we were recognized as wielding a tool.

We are in the adolescence of our affiliations and organizations trying to pull ourselves together to gather funding to approach the legislature again and change our licensure but there are a lot of issues of it and, yes, we are working on it and we are trying but, as you know, we are considered complementary and alternative and we have funds that match that definition of us.  So it is a hard fought battle.

COMMISSIONER DeVRIES:  Mr. Rodman?

DR. RODMAN:  The state law recognizes the practice of what is called licensed acupuncture here as a comprehensive health care delivery system based on the unique diagnostic perspective of Oriental medicine.  So in a way we have free rein within our paradigm, which is just what we want.  And I, for one, am pretty happy about the oversight of the medical board here.  It is enlightened and it is triggered by patient complaints, of which I am happy to say there have been virtually none. 

COMMISSIONER DeVRIES:  We had -- at the White House Commission in a previous hearing we had discussed the concept of that -- you know, obviously health care is not regulated on a federal level.  It is regulated on a state level and it is the states who enact the statute regarding licensure but potentially what the White House Commission can do is recommend minimum, shall we say, criteria for licensure statute and maybe differentiating between traditional Oriental medicine and acupuncture may be a way of making a recommendation that the states would look to, to -- as they enact or change their licensure statutes to making sure that they are adequately broadened.

 MR. __________:  Another way that Minnesota is enlightened, as are most of the states, is that it uses the certification examination, the national board examination of competency given by the National Commission for Certification of Acupuncture and Oriental medicine, which is a nationally accredited professional accreditation -- certification as the basis of their licensure.

And I would advise the commission to work as much as possible to make the national board examination the standard of licensure in most states through what influence you can bring to bear by perhaps gathering the legislators from various states.  States are prone often to reinvent the wheel and that actually imposes a hardship on practitioners. 

 There is one eminent practitioner in this town who has been in practice so long that she did not go through the masters level of education that is now available.  She would like to move to a particular state where she could take care of her mother and she would not be able to practice there and there is no way for her to qualify in that particular state.

COMMISSIONER GORDON:  Other questions? 

Linnea?

 COMMISSIONER LARSON:  Yes.  Just a real quick one.  Did you say, Mr. Caldwell, that the reimbursement for acupuncture is upon referral from a physician?  That somebody cannot come to you and get reimbursement, get treated and then reimbursed through their insurance company because they do not have a referral from a physician?

 MR. CALDWELL:  The way it works -- it addresses to the scope of practice in the State of Minnesota -- is that medical physicians and doctors of chiropractic are allowed to practice acupuncture in their practices and so what the law has done is allowed them to be reimbursed because the medical establishment and the chiropractic establishment since we are so young at this, they do not recognize us in the same vein.  So for most third party payers, they do not recognize our expertise in the field and, therefore, they only recognize the medical practitioners or the chiropractic.

COMMISSIONER LARSON:  Okay.  So what you are saying is it is not a law.  It is the insurance industry's rules.

 MR. CALDWELL:  Well, the way our scope of practice is set up as a law, it allows for medical physicians and doctors of chiropractic to use acupuncture.  That is where we have a problem in that the use of acupuncture is defined under a narrow scope.

 COMMISSIONER LARSON:  I guess -- no.  You do not -- somebody can go to you on their own.  They do not have to have a physician referring.

 MR. CALDWELL:  That is right.

COMMISSIONER LARSON:  Okay.  That is what I wanted to get clear. 

 MR. CALDWELL:  Under certain circumstances.

COMMISSIONER LARSON:  Because in the State of Illinois that is very different.  Okay.

Now reimbursement is a different issue than, you know, the scope of practice --

MR. CALDWELL:  Right.

COMMISSIONER LARSON:  -- that a physician has.  You are saying that because they are a physician or a chiropractor already under their scope of practice they can get reimbursed through the insurance company because of their first degree?

MR. CALDWELL:  Yes.

COMMISSIONER LARSON:  Okay.  Whereas you, just the acupuncture, are less likely to get insurance reimbursement?

MR. CALDWELL:  That is correct.

COMMISSIONER LARSON:  That is all I wanted to know. 

COMMISSIONER GORDON:  Yes, please, go ahead.

MS. __________:  Could I respond also to that?

COMMISSIONER GORDON:  You have to come close.

MS. __________:  I have an example of a patient who came into my practice who received acupuncture through a medical technician -- through an MD in an MD's office and the care was less than satisfactory, although it was reimbursable.  She had marks on her.  She suffered pain.  And I explained to her that the MD in this office was given basically a weekend course and then can use that -- the tool of acupuncture.  We have four years of training and the way we wield the tool can be quite different but as a result of reimbursement and acceptance by MDs we end up getting a bad name.

You know, if someone has a bad experience with acupuncture in an MD's office, we suffer. 

COMMISSIONER GORDON:  Yes?

MS. __________:  And as we all know, when we --

COMMISSIONER GORDON:  Come closer, please.

MS. ___________:  When we play piano we have to have a -- a meeting in our mind to play the piano and use your ten fingers.  But with the recipe you can use one finger and hit each key to make the sound but it is really totally different.

(Applause.) 

COMMISSIONER GORDON:  Okay.  I think we will end on that note.  Thank you very much.

(Applause.)

                                                                                    * * * * *

                                                                 OPEN SESSIONS (Continued)

MS. CHANG:  And our last but certainly not least panel would be Gregory Schmidt, Leo Cashman, Amrit Devgun, Gayle Bowler, Jeanne Hollingsworth and Nancy Hone.

COMMISSIONER GORDON:  I have an announcement before this panel begins.

Everybody either appeared or in a couple of instances set a substitute.  That is a new record for our town halls so I want to really commend this community for being here and for giving us such good testimony through this long day.

(Applause.)

COMMISSIONER GORDON:  Gregory Schmidt?

                                                                  GREGORY SCHMIDT, MFA

                                  MINNESOTA NATURAL HEALTH LEGAL REFORM PROJECT

COMMISSIONER GORDON:  Could you come closer to the mic, please?

MR. SCHMIDT:  I am here because:

(1) I believe natural health practitioners recognize, in fact celebrate, the uniqueness of the individual and the body's own healing abilities and because they recognize that we are not interchangeable machines with interchangeable parts.

(2) Because I am ultimately responsible for my own health and well-being.  I will be the judge of where I will go, what path I will choose, and who I will work with in that pursuit.

I believe I am qualified to speak about these matters because I am a person and because it is we the people who should be in charge, not the associations, not the boards, not the schools, not the HMOs, not the doctors, not even the natural health practitioners.  It should be "We, the People."

(Applause.)

I believe I am qualified to speak because my experiences in my degreed field and also in my business relate to two of the main questions that were constantly asked of us during our legislative endeavors.

(1) Standards.  What about standards?

(2) Fairness.  Well, under this bill, anybody can just hang up a shingle and call themselves a natural health practitioner and all of these other professionals have all of this education and all of this training, and all of the liability, and is that fair?

I believe I am qualified to speak because we the people did pass a bill that at least partially guaranteed our freed of access.

The commission has asked us to present ideas on what we learned from that process and how to duplicate it.  In other words, where do we go now? 

The questions about standards:       Where did this seemingly unquestioning reverence for standards come from?  Is it our birthright or responsibility as humans or is it a byproduct of the industrial age and machines and mass production and marketing?

My goal as an artist or a carpenter is to do the best I can, to treat others like I would like to be treated.  It may sound quaint, but if I do not respect myself, my work, and my clients, and if humility, openness, fairness, honesty and love are not enough, how can one do more? 

I am six feet, two inches, and I will never be six foot, six inches, no matter how hard I try, how much education I get or what governing body may wish otherwise.  Until people are standardized, I do not see how any relationships between them can be standardized either.  Each interaction is totally unique and special in its own right.

Regarding fairness:  The focus should be on the clients.  This should not be about one group or one belief or one schooling versus another group's belief or schooling. 

This reminds me of the story of the farmer who paid the workers hired later in the day the same as the workers hired earlier in the day even though the workers hired earlier in the day had agreed to their wages.  The workers hired later in the day complained the workers hired earlier in the day got the same pay and it was not fair. 

It is not about the pay or the work.  It is about the commitment to help.

COMMISSIONER GORDON:  Thank you.

(Applause.)

COMMISSIONER GORDON:  Leo Cashman?

                                                                    LEO CASHMAN, BS, MA

                                                                                DAMS, INC.

                                  MINNESOTA NATURAL HEALTH LEGAL REFORM PROJECT

What we have to tell people sometimes is that toxic dentistry is a major cause of numerous health problems largely because mercury used in dentistry is not stable in the fillings and does escape and it does accumulate in the brain, kidneys and other vital organs.

What we have to tell people is that dentistry is very often the source of most of their mercury exposure and even according to the U.S. Public Health Service, it can account for 75 percent or more of a person's personal mercury burden.           And the consequences in some cases are severe autoimmune diseases, cardiovascular problems, chronic fatigue, mental illness, depression, and among the victims are the dentists themselves.

So -- and to perpetuate the problem of this, we have had poor regulation on the part of state licensing boards, which have often been dominated by the American Dental Association, which has been the heart of the cover up of these problems and has not only ignored the complaints coming in from victims who realize they are harmed by toxic dentistry but also has seen fit to intimidate and harass the holistic dentist and many times forcing them out of their profession, losing everything they have invested.

So what we call for, I think, is going to have to be quick here but congressional hearings on the scope of this immense problem, hopefully leading to a ban on mercury and other toxic metals used in dentistry, regulating health plans so they do not push people to use toxic materials and they can use the nontoxic things that they really want to have.  We know people want nontoxic dentistry as soon as they learn about it.

$200 million fund, federal fund, to help the victims recover and get their lives back, get their health back, detoxify, retrain dentists in safe alternative practices, including being able to replace amalgam fillings safely. 

Finally, a ban on mandatory water fluoridation, end the fluoridation scam.  In ten days there will be a new report out by a Dr. Fritz Lorscheider linking -- further linking amalgam filling and mercury to Alzheimer's disease so look for that in ten days.

(Applause.)

COMMISSIONER GORDON:  Thank you.

Alan?

                                                                        AMRIT DEVGUN, ND

                                                               SANTULAN HEALTH CENTER

                                                       AS PRESENTED BY ALAN ANDERSON

DR. ANDERSON:  Thank you. 

I was called late last night by a sick mother with a sick child to fill in for her so I will do my best and you will get my notes later over the internet.

I am Dr. Alan Anderson.  I am a licensed naturopathic physician from the State of Arizona and have practicing in Minnesota for approximately six-and-a-half years, and I have gained some insights having come from a licensed state to a nonlicensed state but what I would like to talk about is the quality of naturopathic medicine and what it has to offer today that is better than ever before.

For one thing, naturopathic medicine serves as a true bridge between systems.  Doctors of naturopathic medicine are trained both in Western and traditional therapies and continue to expand that scope of education.  This is a profession that promotes breaking out of the box rather than living in the box and doing it with quality and standards.

As a graduate from a four-year naturopathic college, I had the pleasure to watch in the State of Washington a university become accredited and be a part of the political effort, and look at the energy that is required to move anything good forward.  There is always resistance on all sides and yet always something comes through that is better for the people. 

The example of what goes on in King County, Washington, is a perfect example to see where naturopathic medicine integrating with the conventional system blesses all the people involved and does not put us against them but puts all of us on a team.  This is the same benefit that comes from bringing in the acupuncturists, the chiropractors adn the other health care professionals who have already established those standards.

With standards, with education and with accountability the public has the opportunity to know what they are getting.  No one profession has all the answers and never will but we have the opportunity to move forward.  As the members of a commission it is your job to discover and get together ideas what can move health care forward, and that is not to move any one profession forward but what can help the public at large.

The opportunity to save money, lowering insurance costs through preventive medicine we know is the only way to take care of the problems that we are faced with.  The profession of naturopathic medicine is trained to both educate the public and actually may be the one profession that takes the time to listen to the patients, which is the one thing I am told whenever people come to me when they are not getting help.  People want to be heard and they need to have people who know how to hear them and answer those questions.

My recommendation is as we look forward to the future and what can be done to improve health care in America that we look at what is going on in naturopathic medicine as well as all other fields and move forward with that.

COMMISSIONER GORDON:  Thank you.

Gayle Bowler?

                                                                            GAYLE BOWLER

                                                MINNESOTA NATURAL HEALTH COALITION

The problems I encountered in my healing journey are what I hope lawmakers will protect other health seekers from.  There was a period when a local dentist and homeopath were being harassed in a manner with lots of publicity and no unsatisfied clients. 

This put me in fear of discussing my treatment plan with my MD.  Would my traditional doctor set in motion political terrorism of my herbalist? 

As I participated in a class of energy healing, the MD sitting next to me said he would lose his license if his colleagues saw him there.  Licensed doctors should be allowed to access information about complementary practices and use those techniques with patients when appropriate.

I sought information about nutritional supplements and spent hours reading labels in health food stores trying to intuit what something was good for.  I resented rules that made that information hard to obtain. 

I am afraid when I hear demands from some to protect the public by banning or controlling all herbal substances.  The prescription drugs that are the alternative are advertised with the side effects that often sound worse than the symptoms being treated.

Objective research should be conducted on the effectiveness of nutritional supplements and other products and practices. 

I have heard research workers tell how the results of studies by drug manufacturers are suppressed if they do not have the outcome in the financial interest of the company that funded the research.  This reminds me of the cigarette scandals where the knowledge of health risks were hidden from the public for decades.  I would support tax dollars to conduct research.

The new Minnesota law provides the protections that I need as a consumer.  I am pleased that there are not standards for licensure as many of the modalities are best taught person to person rather than in a structured class. 

I note that the law passed in Minnesota without much opposition in the final form.

It is important that the allopathic and the complementary healing arts not be competitive.  There is a need for both.  There never is an excess of good health. 

Information to the consumer is needed so that they can make informed choices about the health care received by their families.

(Applause.)

COMMISSIONER GORDON:  Thank you.

Jeanne Hollingsworth?

                                                                 JEANNE HOLLINGSWORTH

                                                MINNESOTA NATURAL HEALTH COALITION

As a consumer and a natural health care bodyworker I strongly believe that all people have the right to go to the natural health care practitioner of their choice regardless of that practitioner's academic training.  I believe people have the right to full access to all natural health care modalities so that they may choose those which best facilitate their healing process.

I believe my health care is my own personal choice and responsibility.  It is one of the most personal choices that I make.

From my own experience, I know that a person with a lot of academic training may not be the most appropriate one to assist with certain health issues.  I have found that someone with a natural gift for healing or who has studied with a mentor can be far more effective in my healing process than a person with only academic training.

In my 19 years of experience with natural health care, I have found that it produces good results in a safe and noninvasive manner.  I do not need any protection from it.

I fully support Minnesota Statute 146A, the Complementary and Alternative Health Care Freedom of Access Bill because this is a good solutio not the concerns of consumers and practitioners alike.  It requires that all practitioners disclose their education and training along with information about the modalities and care that they give.  This helps people make well-informed choices regarding their health care.

I do not see that licensure is necessary or appropriate for natural health care from my own personal experience for many years.

This bill provides consumers freedom of access to all health care practitioners while holding those practitioners accountable to the Minnesota Department of Health.  Appropriate consumer protection and health care access are provided simultaneously.  This bill is exactly what we need and is an excellent model for the needs of the expanding natural health care industry.

I also have had -- I am thankful to say that I have had opportunities to receive and be a part of natural, traditional, cultural healing and in my experience of that -- of the model, the clinical model, the academic model does not apply in any way.  I have seen more of what is more taught generation from generation passed on.  There is an accredible wealth that is taught through the traditional oral traditions that is not about books and academic training but has incredible value for people in their healing and I ask that you seriously consider those people and all of us and our freedom in our health care.

And I thank you for your time and attention regarding this important matter.

COMMISSIONER GORDON:  Thank you.

Nancy Hone?

                                                      NANCY HONE, BA NURSING AND MAT

                                                MINNESOTA NATURAL HEALTH COALITION

(Laughter.)

My name is Nancy Hone and I am the co-founder of the Minnesota Natural Health Coalition and the Minnesota Natural Health Legal Reform Project.

The number one thing we learned passing health freedom legislation in the State of Minnesota is that thinking outside the box is good and it is okay.

We learned that it is generally accepted in our society that licensure and registration exists to protect the public.

We learned through research that occupational licensure or registration does not protect the public and, in fact, gives citizens false confidence.

We learned that the citizenry was not asking to be protected from something dangerous.  They see natural health as nontoxic, safe and noninvasive.  They just want freedom to decide who they go to for their health care, period.  They just care that the practitioners have a track record of helping people.

We learned through research that licensure and such regulation is always brought by special interest groups to protect their economic base and form a monopoly. 

We learned that you have to tie a natural health care provider to a chair with duct tape to keep them from learning.  They are only limited by their time, money and energy.  They are very unique in this way.  They tend to be rabid learners eagerly paying out of their own pockets. 

We learned that people care about practitioners' training but care mostly that practitioners help people.  They just want the practitioner to tell them how they studied, that is all. 

We learned that these discussions that should be about mutual respect and cooperation are really about turf battles.

We learned that the medical monopoly puts doubts in legislators' heads because of the power and the position they hold and the big lobby monies that they have. 

We learned that if you band together as citizens and work hard, you can effect change in the government.

What could make this process easier, better and more equitable?

(1) The free wheeling power of the medical, dental and other health boards must be reined in to make the process easier. 

(2) A huge societal shift must happen:  People must take back their power and demand change.  We must let the citizens know that they can be successful. 

Funds are needed to educate the American people about how to preserve and promote their health with better health habits.  This will make a bigger and better mass mentality so that legislative change is not so hard.

(3) On a state and federal level we must move ahead with great care to ensure that any laws that are passed serve only to protect the very existence of our ancient wisdoms and do not serve to restrict practice of them by anyone through the establishment of educational standards either by law or by professional organizations.

There are many, many, many ways of learning.  These must be preserved and respected.

(4) Governments must stop trying to protect people from themselves.

Finally:  Natural therapies are ancient and safe.  They have been around since the beginning of time.  This wisdom and the writings documenting them should be held in a place of honor and respect that they deserve with people having free and legal access to them. 

These are not new upstart professions that have now just been discovered so that they need to be regulated with educational standards to protect the people of American from harm.

How can the process be made more equitable?  Give us, the citizens, and all citizens, all cultures, including the White people who do not have a particular culture, our freedom.  After all, this is the United States of America and that is what we stand for.  Freedom.  Freedom for the people and the citizens.  Let me them choose.

(Applause.)

                                                                               DISCUSSION

COMMISSIONER GORDON:  Thank you.

Linnea?

COMMISSIONER LARSON:  Just one clarification.  Is the Natural Health Coalition a national?

MS. __________:  No.  The Minnesota National Health Coalition.

COMMISSIONER LARSON:  It is in Minnesota.  Okay. 

Just a clarification question is did this coalition work to defeat the licensure of naturopathic medicine in this state.

MS. __________:  No, that is the national health coalition.

MS. __________:  No.  Well, no, honestly we did.  We did -- see we started out -- we are very supportive of Helen.  We rallied around her.  I personally brought her flowers every week and rescue remedy.  We did everything to help her for the first nine months or eleven months.  And then one day we were at the legislature and we said, "We better look at this bill because we never saw the bill."  Helen, who is our friend and we love Helen very much, and we love all the four year naturopaths and we want to help them with further legislation, believe me.  However, we thought she had not showed us the bill.  Why is that?  And we were leading our leaves and lobbying at the legislature not being able to practice and do our own lives while we did not see this bill because we trusted it. 

So we get over there one day and I said, "Jerry," I said, "We better check out this bill because I was naive in this process."  And we saw it and we said, "Oh, my goodness, this is not going to help everyone.  We must stop this."  And we took -- the legislature must have thought we were crazy because we went over there with a never mind, now we want to oppose it, and we did oppose it because we wanted to come back and make freedom for everyone. 

Once you have done that, if you start at the top and just get the doctor's okay and then the -- four year naturopaths okay, then the rest of the little people, they are going to say, "Oh, we serve natural health.  What are you doing here?"

So we wanted to start for all the practitioners first, then build our base.  We go will back and get the four year naturopath in another way.  We have very, very, very creative ideas on how to help them provide legal status that is not in the way that they think they want to get.  And then we want to come back and get the medical doctors' freedom from the board, the dentists, who have been prosecuted, and the veterinarian.  We had a veterinarian that they went after. 

MR. __________:  I would just like to clarify something.  There are two local groups that have similar names and the group that was active at the legislature is the Minnesota Natural Health Legal Reform Project and that is an action organization that could lobby and the other organization is a 501(C)(3), the Minnesota Natural Health Coalition, and that organization did not spearhead lobbying.  So we have trouble.  We need to clarify that sometimes and it is important. 

And I think -- I agree, Nancy, we -- we originally supported the licensure bill but there were a lot of concerns that we started hearing about those who were left out of that, other naturopaths.

And so then I think officially we moved to a neutral position but a lot of individuals in our organization, you know, actively opposed the passage of the licensure bill because of those concerns so, you know, but there are ongoing legitimate issues as far as the reform we finally did pass did not really fit the naturopathic physicians because they are able to draw blood and do episiotomies and so on, more invasive things, and they did not come in as being protected under our bill for doing those things. 

So there are some legitimate issues, unresolved issues, and we are their friends and want them to have the freedom they deserve to enjoy it.

So thank you for asking that question.

MS. __________:  It is a hot issue here.

COMMISSIONER GORDON:  Joe, any questions?

George?

Well, I --

MS. __________:  Can I make one more comment?

COMMISSIONER GORDON:  I am sorry.

MS. __________:  Can I make just one more short comment?

COMMISSIONER GORDON:  Can you say something?

MS. __________:  Can I say something real quick?

COMMISSIONER GORDON:  Why not?

MS. __________:  Well, the bill -- I just want the commission to know that the bill we introduced is not what we ended up with and many of the failings that are in the bill that we do not like -- I mean, sometimes we think, "Oh, ICK, what did we pass?"  It is because we were forced into it by the legislatures and the medical monopoly who looked at -- you know, forced legislators into some of these questions.

We did 58 to one in the senate and 112 to 23 in the house.  It was a land slide but it was a lot of work to do so against the biggest power and money in the world but we want the world to know that this is not what we started out with.  It is not the perfect bill but it is the door that is opened now.

COMMISSIONER GORDON:  Well, I appreciate all of you opening a variety of doors to us on this bill and also on the practices of integration and the practices of traditional systems that are going on here in Minnesota so we are really very grateful to you. 

I want to thank my loyal colleagues, Linnea Larson and Joe Pizzorno and Joe DeVries, who have been here, and Wayne Jonas had to leave a little early, and also Michele Chang, our executive secretary, who has stood by and made sure we moved ahead, and Doris Kingsbury, who has been with us the whole time.  

(Applause.)

COMMISSIONER GORDON:  It has been a wonderful day and the promise of coming out here for us has been more than fulfilled by all of you so I want to congratulate you on the wonderful work you are doing and thank you very much for coming, all of you, all those of you who have spoken and those of you who have come to just be part of this gathering.

Thank you very much.  We are going to take to heart what you say in the heartland and bring it back to Washington, D.C.

Stay in touch.  Thank you.

(Whereupon, the proceedings were concluded.)

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