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Also Inside:Cardiovascular HealthPractice ManagementJoint Health

A roundtable discussion of practitioners,educators and natural product providers on

how complementary health care modelsare changing Western medicine.

22 NATURAL PRACTITIONER WWW.NATURALPRACTITIONERMAG.COM JANUARY/FEBRUARY 2014

Dean of the Schoolof NaturopathicMedicine at BastyrUniversity.

Jane Guiltinan, ND

NP EditorialAdvisory BoardMember in privatepractice atSuncook ValleyChiropractic inNew Hampshire.

Adam Killpartrick, DC, CNS

CEO of Socialvite, asupplement providerbased in Minnesota,where 15 percent ofevery product orderis donated back intothe natural healthcare community.

Rebecca Bush, NDChief Medical Officerof the NationalCollege of NaturalMedicine (NCNM).

Regina Dehen, ND, LAc

The panel of experts that lent their insights to Natural Practitioner (NP) is:

By Kate Quackenbush

NP: What are the mainchallenges facing thecomplementary andalternative medicine(CAM) industry?Guiltinan: Regulation and oversight bystates is a major issue for naturopathic medi-cine and some other CAM professions. Thenaturopathic medical profession is licensedin 18 states and jurisdictions currently in theU.S. Efforts to increase the number of stateswho license and regulate naturopathic medi-cine are ongoing through state professionalsocieties and the national organization, theAmerican Association of NaturopathicPhysicians (www.naturopathic.org).

Reimbursement is also a major issue formost CAM professions. While governmentand private payers reimburse broadly forconventional medical services, that is not thecase with CAM services. Some states, such asWashington, have passed laws requiringinsurance companies doing business in thatstate to cover services provided by any kindof licensed care provider in the state (anycovered provider law). Efforts are beingmade now by many CAM professions toensure the enforcement of the anti-discrimi-nation piece of the Affordable Care Act(ACA), which prohibits discrimination ofany licensed health care professional in agiven jurisdiction.

Teitelbaum: The pharmaceuticalindustry and allopathic medicine have essen-tially bought a government-mandatedmonopoly. They are also one of the majoradvertisers in the media, which has allowedthem to push dysfunctional regulations onboth state and federal levels that often makeit illegal to even discuss research on naturaltherapies (see Senate amendment 2143 toS3187, where 78 Senators voted against mak-ing it legal to discuss research on naturaltherapies, and only 15 voted in favor).Meanwhile, media outlets such as CNN andUSA Today will ignore research showing thatthere are more than 30,000 preventabledeaths a year from arthritis medications, as

well as research showing natural options forarthritis to be more effective than thesemedications. At the same time, USA Todayran a 2.5-page spread pushing to make natu-ral remedies unavailable. This suggests amajor bias in the media, where pharmaceuti-cal medicine has the best positioning moneycan buy.

Dehen: Others have portrayed naturalmedicine practitioners in ways that haveworked against us professionally. We haveoften faced criticism for not providing rigor-ous scientific validation of the effectivenessof our CAM therapies. There is also a mis-understanding and lack of education aboutthe medical training of naturopathic doctorsand other CAM providers. This lack of com-prehension presented opportunities fordetractors to stereotype us as charlatans andquacks. These unflattering projections con-tain an underlying implication that NDs andother CAM practitioners are medically irre-sponsible and cannot be trusted as seriouspractitioners.

In recent decades, though, the naturalmedicine professions have countered suchmisunderstanding with appropriate govern-ment and educational milestones. The pio-neers persisted and the image of naturo-pathic physicians is transforming as we re-brand ourselves as the holistic primary carephysicians we are: Doctors who are educat-ed and trained to order labs, prescribe med-ications, perform minor surgery and,increasingly, design and conduct evidence-based research studies.

NP: Have you observeda shift in thetraditional healthcare model toincluding alternativetreatments?Guiltinan: Overall, there is more open-ness to CAM in the health care industrynow than there was 10 or 20 years ago.Some conventional providers, health caresystems and medical schools have begun to

teach and practice “integrative medicine,”which incorporates some of the principlesand modalities used by CAMprofessions. Some of these practitioners andhealth systems have incorporated CAMproviders into their clinics as well.

Dehen: I have observed a shift.Recognizing the overwhelming importanceof behavioral changes in preventing andtreating morbidity in the industrializedworld (IOM, 2001) has altered the exclusive-ly pharmaceutically based model. For exam-ple, it’s no longer acceptable to treat a dia-betic with insulin alone—nutrition is key.Diabetic patients now must receive nutri-tional and behavioral counseling. Cardiaccare patients receive exercise and physicaltherapy advice as soon as they are diagnosed.

Bush: The proverbial curtain has beenraised exposing the limitations of the tradi-tional health care model. I can point to threethings that made seismic changes to thepatient-doctor/patient-health care industryrelationship:

First, in July 2002 the Women’s HealthInitiative study discontinued their plannednine-year study on estrogen/progesteronetreatments due to the evidence that the ben-efits of the therapy did not outweigh therisks. Millions of women were on this thera-py at the time, and confidence in their doc-tors and the health care industry wasstrained as many sought alternativeapproaches for women’s health.

Second, as the diagnosis of autism sky-rocketed, the general public began their owngrassroots efforts to change how their chil-dren were treated, often looking outside ofthe mainstream for answers and hope thatwere not addressed.

Third, the internet provided easy access tomedical information, instant communica-tions and virtual support groups, which hascompletely changed the way patients interactwith their doctors. The more informedpatients are to their treatments, side effectsand alternative approaches, the greater themovement toward complementary and alter-native health.

Author, integrativehealth nurse anddietary supplementexpert, is the Chief ofScientific Affairs andEducation for supple-ment manufacturerEuroMedica inWisconsin.

Cheryl Myers

Founder of the UBPediatric & AutismClinic and Vice-President of thePediatric Associationof NaturopathicPhysicians, is an NPEditorial Advisory

Board Member in private practice atHarvest Park Naturopathic Medicine inConnecticut.

Jared M. Skowron, NDScience ResearchManager with sup-plement manufactur-er NOW HealthGroup/Protocol ForLife Balance basedin Illinois.

Rick Sharpee, PhD

Director of theFatigue andFibromyalgiaPractitionersNetwork; author ofthe iPhone &Android application“Cures A-Z,” as well

as several books, and NP AdvisoryBoard Member.

Jacob Teitelbaum, MD

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Myers: It is interesting to note that onMedScape—a physician-targeted news sitefrom WebMD for specialists, primary carephysicians and other health professionals—of the top 10 articles of 2013, five were onnatural health interventions (four positiveand one negative). While our headquartersare in the Midwest, I travel across the U.S.meeting with health care professionals. I seea distinct difference between urban areasand smaller cities, in that there is moreavailable integrative medicine and accept-ance (on average) by mainstream healthcare in these locales.

Skowron: Traditional health care isstill based on fear of death/disease, and fearof litigious implications. Physicians per-form unnecessary testing, treatments andsurgeries in fear of being sued. The shift, orpendulum swing, is from the patients, whoare realizing (with benefit of the internet)that traditional medicine is going to anextreme, and for their own health and well-being are looking for another solution.

In the 20th century, knowledge waspower, but with the internet, anyone canhave as much knowledge (or more) thanthe physician. The best strength the physi-cian now has is experience and, hopefully,wisdom.

NP: What role hasresearch played inchanging the view ofthe CAM model,including the use ofsupplementation?

Killpartrick: Research has played agreat role in reaffirming the

life-changing clinicalresults ‘alternative’

practitioners haveproduced formany of theirpatients for

decades. For those

types of practitioners, research is a bonus.For people who require studies, the researchhas the potential to prove the efficacy of thetreatment while also providing some con-text and clarity as to the physiologicchanges and therapeutic effect of a specifictreatment.

Teitelbaum: Research continues to helpadvance and support the importance andeffectiveness of CAM. Close-minded individ-uals continue to simply ignore the research,which puts them more out of touch with real-ity, while CAM physicians become increasing-ly effective in helping people. There are thou-sands of important studies, but one I wouldnote is my published double-blind, placebo-controlled study using an integrated CAMtreatment approach in CFS and fibromyalgiashowed a 90 percent average improvementrate (P < .0001 versus placebo).

Dehen: Research has been seminal to therise of awareness, acceptance and inclusionof CAM. Some noteworthy examples includethe many studies that demonstrate that theuse of fish oils can help reduce the risk ofheart attacks and strokes; studies that sup-port the ability to prevent and reverse type 2diabetes with diet, exercise and lifestylemodifications; as well as studies that demon-strate the use of meditation, support groupsand tai qi can improve outcomes in cancerpatients.

Data is the great equalizer—and for NDs,it’s empowering. Those who say they prac-tice evidence-based medicine must acceptdata that demonstrates value and effective-ness of therapies, regardless if the therapy isa new drug or tai qi.

Sharpee: Research has played a signifi-cant role in changing the perspective of inte-grative medicine approach to healthcare. For example, in a recent symposium“The Effectiveness of Natural Products andIntegrative Medicine for Pain Management”(www.naturalhealthresearch.org), practition-ers provided a summary of the evidence onthe effectiveness of multiple treatmentmodalities to relive pain as options to pre-scription drugs. Options included acupunc-ture, physical therapy and dietary supple-ments like boswellia, bromelain, curcumin,ginger, omega-3 fatty acids, corydalis, SAMe,MSM, scutellaria and acacia.

Myers:We have had many studies pub-lished on EuroMedica products or brandedingredients recently. In 2011, a study waspublished in Osteoarthritis Cartilage thatcompared BCM-95 Curcumin blended withBosPure Boswellia (found in our productRhulief Plus) to celecoxib, a generic ofCelebrex, the No. 1 prescription drug forosteoarthritis of the knee. The results

showed our blend was superior to the drugfor overall pain relief and distance walkedwithout pain, and equal on parameters ofimproved flexibility.

In 2012, a study published in PhytotherapyResearch compared our BCM-95 highabsorption Curcumin (found in CuraPro) todicolfenac sodium, a generic of the prescrip-tion drug Voltaren, in rheumatoid arthritis,and the improvements equaled that of thedrug, but without the problematic sideeffects.

And in 2013, Phytotherapy Research pub-lished another study comparing BCM-95Curcumin to fluoxetine, the generic ofProzac, in major depressive disorder. Thenatural product equaled the efficacy of theprescription drug.

When natural medicine companies canshare this level of scientific proof and docu-mentation, it is more difficult for main-stream medicine to be dismissive of theseimpressive results.

NP: Once the issueswith the AffordableCare Act (ACA) areresolved, what rolewill CAM (includingsupplementation)play in the new“traditional” model?

Dehen: The ACA is helping usher inchanges that have the potential to increaseaccess to natural medicine practitioners. Forexample, Senator Harkin inserted a sectioninto the ACA that states that insurers maynot discriminate against licensed health careprofessionals “working within the scope ofthat provider’s license,” including NDs andLAcs. This federal requirement may lead topowerful changes in health care—and howit’s viewed and practiced in our country.

In addition, most people are unaware of aprovision within the ACA that may have asignificant impact on how CAM therapiesare used. This provision came in response tocharges by conservative Republicans that theACA would lead to so-called “Death Panels.”The Death Panels, they claimed, could pre-maturely terminate the lives of elderly andcritically ill patients due to the exorbitantcosts of care associated with these popula-tions. As a result, Congress took action. Theywrote legislation into the ACA creating aPatient Centered Outcomes ResearchInstitute (PCORI).

PCORI’s mandate is to fund research thatputs patient needs and interests first whencomparing different treatment approaches toa given condition. PCORI is forbidden bylaw from considering financial cost as acomparator when considering two different

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treatments for the same condition. Instead,PCORI is invested in discovering whatpatients want and if the treatments are effec-tive, irrespective of whether the treatmentsare pharmacologic, surgical, alternative orsomething else. I sit on an advisory panel forPCORI; they intentionally seek input fromCAM practitioners, knowing that the publicwants alternative modalities to be availableto them. That’s what being “patient-cen-tered” means.

Sharpee: In my opinion, the currentissues with implementation of the ACA arenot affecting consumers’ view of integrativemedicine. However, delaying implementa-tion would delay a broader use of this “NewMedicine” and the use of dietary supple-ments to prevent disease. With implementa-tion, more consumers will come to under-stand that certain supplements can help toprevent or at least reduce the incidence ofmetabolic disease. This will only strengthenconsumers’ view of the benefits of an inte-grative medicine approach, but also thatsupplementation at preventive intake levelsin high-risk populations can reduce thenumber of medical events associated withheart disease, age-related eye disease, dia-betes and bone disease.

I understand that a major provision of theACA is prevention and personalization ofmedicine. This represents a clear opportunityfor integrative medicine to maximize a dis-ease prevention strategy through prescribingdietary supplements for a variety of chronicdiseases. Recently, the use of dietary supple-ments has been shown to provide significantbenefits as a low cost disease prevention strat-egy (see “Smart Prevention-Health Care Costsavings Resulting from the Targeted Use ofDietary Supplements” at www.supplement-forsmartprevention.org). With broader dis-semination of this and similar information onthe cost benefits of chronic disease preventionwith dietary supplements, the role of integra-tive medicine practitioners prescribing sup-plements will grow.

Bush: The ACA will increase funding foroutcome studies, place more emphasis onpreventative medicine and start the moveaway from fee-for-service reimbursements.CAM excels in these metrics and should finda greater role in our nation’s health careonce the playing field is flattened a bit more.

Further, CAM offers some of the best pre-ventative medicine at the most competitivecosts. Chiropractic medicine has proven costsavings in addressing common back prob-lems, naturopathic medicine has proven costsavings in treating the most common pedi-atric conditions, acupuncture’s effectivenessat reducing costs in managing patient’s pain,and studies have shown that incorporating

massage into conventional medical manage-ment shortens hospital stays and improvesoutcomes. Likewise, studies are showingeffectiveness of a number of supplementsmaking them viable alternative to moreexpensive medication (e.g. SAMe vs. SSRIs).

As our country shifts toward outcome-based medicine, it will be impossible toignore the health and cost benefits that com-plementary and alternative medicine offers.

Guiltinan: One of the changes in healthcare as a result of this law will hopefully be toput more emphasis on and resources towardwellness and health promotion. Naturopathicphysicians and other CAM providers are welltrained in these important areas and will beable to participate in a reformed system thatencourages and invests in wellness, preventionand health promotion activities and services.

Teitelbaum: If common sense, bothmedical and economic, is applied, then CAMwill play a larger role. I suspect, however, thatthe health care industry owns both sides ofthe debate at this point. I suspect this institu-tional bias against CAM will not change untilour health care system gets closer to bank-ruptcy and has truly absolutely no choice butto make rational changes or collapse.

NP: With the healthcare model evolving,how can practitionersbetter prepare toprovide the bestservice for morepatients, as well as beactive contributors tothe industry?

Bush: CAM practitioners should leveragetheir costs savings approaches to large localemployers as a way to save them health caredollars. Many practitioners are doing thisalready through corporate saving programs,but the market for these programs is in itsinfancy and will grow in the upcoming years.

Killpartrick: In addition to keepingcosts low for patients, expand therapeuticapproaches to include modalities that gener-ate tangible results. And consistently transi-tion patients from a reactive mindset to aproactive philosophy to their health.

Skowron: CAM practitioners need tospecialize. With so much information beingavailable on different illnesses, patients wantto go to the expert—whether it’s the pedia-trician or the natural pediatrician, the oncol-ogist or the natural oncologist.

Dehen: Today’s practitioners must com-mit themselves to continuous learning andprofessional development to stay abreast of

current research and trends in medicine.Clinicians need to accept that what theylearned in medical school is obsolete almostas soon as they begin to practice. They mustbe willing to continually update their knowl-edge, attitudes and competencies for as longas they remain in practice. They must also bewilling to participate in a system thatincreasingly requires practitioners to sharedata, chart notes and resources.

Guiltinan: In this era of massiveamounts of information, one important waypractitioners can better prepare themselvesto meet the population’s needs is by under-standing what an important educational rolethey can play for the patient. Helpingpatients navigate the overwhelming amountof material available about health on theinternet and how to identify reliable infor-mation will become increasingly important.Additionally, educating and motivatingpatients about how to most effectively takeresponsibility for their own health and well-ness is a skill all providers should develop ashealth care reform moves forward.

Teitelbaum: It’s important thatnaturopathic physicians continue to pushstate-by-state to get appropriate scope ofpractice rights based on their training. Inaddition, by increasing communicationbetween different CAM health careproviders (as is occurring at www.ffpnfo-rum.org), we can start to develop a moresane, healthy and effective health caremodel for our patients/clients. As the cur-rent health care system fails, having devel-oped a backup self-pay system that works,based on what is both safest and most effec-tive, as well as on realistic economic forces,we will be in position to offer an alternativethat is proven to work.

Our health care system is an incrediblydysfunctional dinosaur that is headedtoward a cliff. I choose to simply get out ofits way and offer those who come to me themost informed, effective, safe and compas-sionate care I can.

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■ Bastyr, (425) 602-3000, www.bastyr.edu■ Dr. Killpartrick,www.suncookvalleychiropractic.com■ Dr. Skowron, www.naturopathicanswer.com■ Dr. Teitelbaum, www.vitality101.com ■ EuroMedica, www.euromedicausa.com■ NCNM, www.ncnm.edu ■ Protocol For Life Balance, (877) 776-8610,www.protocolforlife.com■ Socialvite, (866) 290-9694,www.mysocialvite.com

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