The Cream Rises to the Top

By Carl Hangee-Bauer, ND, LAc
AANP President

Photo courtesy of psdGraphics.

In my daily practice life as well as my "political" life as AANP President, I am always on the lookout for trends and conditions in my communities, both local and national, that have effects on my practice and my profession. I came across some news recently that caught my eye and has had me thinking about its ramifications.

Along with being licensed as a naturopathic doctor here in California, I have also carried an acupuncture license since 1989 and have been a long time member of the American Association of Acupuncture and Oriental Medicine (AAAOM) as well as my state acupuncture association. Recently, the AAAOM published a study of the acupuncture profession that found, among other things, that despite the prevalent use of acupuncture in the United States, the demonstrated cost-savings and effectiveness of acupuncture treatment, and the wide reimbursement by third party payers, many licensed acupuncturists are finding it hard to make ends meet.

In John Week's Integrator Blog, he quotes Lisa Rohleder, LAc and co-founder of the Community Acupuncture Network, who concludes that "Acupuncture education, and the conventional acupuncture business model, ought to come with a warning label, the way cigarettes do: NOT SUSTAINABLE. May take years of your life and leave you with nothing, except huge student loans."

In short, licensed acupuncturists graduate and get licensed, but then struggle for years to pay off student loans and get paid appropriately for their education and skills.  Many encounter barriers in third party reimbursement.  Many fail.

Sound familiar?

As naturopathic physicians, many of us feel that one of the reasons it is hard to make a decent living is that many people out there just don't know what an ND is. But is that truly the case? It seems to me that most if not all people know something about acupuncture -- what it looks like, what it's good for (at least pain, anyway). And yet acupuncturists are dealing with some of the same frustrations and challenges that affect the naturopathic profession.

As I said before, this has given me much to think about, and I've come to some conclusions.

First, the good news: we are not alone. If LAcs are struggling with these issues, you can bet that it's affecting other "CAM" providers. We tend to think we are unique, but maybe not so much.

Next, knowing that these challenges exist, we can and must do better on all levels. Our colleges have to do a better job at preparing our graduates to enter the healthcare marketplace. The AANP has to be more active at developing programs and resources for our member physicians in order to help them excel in the business of naturopathic medicine. Our state organizations must help build awareness of our profession and, together with the AANP, "brand" naturopathic medicine as a desired choice for patients. The AANP and the states must work together better to strengthen laws and policies that allow access to naturopathic care via state and federal programs and remove the unfair barriers to naturopathic physicians in federal and state health programs. For example, did you know that while the Department of Education recognizes ND educational programs as on par with MD and DO training, we are still effectively shut out of loan repayment programs for our ND graduates? If this is not unfair, I don't know what is.

Our graduates (you) have to take the individual initiative to learn the elements of successful practice and focus on the business of our medicine as well as its practice. There are pages devoted to practice growth and success on the AANP website.  Log-in and then visit select "Practice Resource Library" after clicking on "Practice Tools."  There are several courses taught by successful NDs that will help new graduates learn the tools to be successful.  The resources are out there and we must take the responsibility to use them.

When I graduated from Bastyr in 1984, there were few choices for people entering the profession. One could go into a solo practice, perhaps join a small group practice, teach at one of the schools, or maybe work for a supplement company. Now I'm amazed at the choices graduates have, and I am particularly excited to see the increasing opportunities in integrative medical settings for us to take our place alongside our "mainstream" colleagues. I, for one, think our profession could do much more to prepare our graduates to enter these new medical settings.

I can tell you that, both individually and collectively, we are up for these challenges. "The cream rises to the top," it's said, and naturopathic medicine is the gold standard for people seeking new choices and new directions for their healthcare.

Fall Cleansing: Perfect Timing and Optimal Process

By Sara Thyr, ND

Photo by Pink Sherbet Photography via Flickr, used under the Creative Commons License.

Have you heard that spring and fall are ideal times to do a cleanse? In the spring, new buds signal a time of growth, and people are inspired to do spring cleaning. In the fall, as the growth season winds to a close, a cleanse is an ideal way to prepare for winter, the holidays and hibernation.

A biannual detox is a welcome addition to one’s healthcare regimen.

If you are living on this planet, even under the best of circumstances, you are exposed to toxins. They are present in many situations, and we easily absorb them into our bodies. Toxins are prevalent in pollution, and in average automobile exhaust. Just driving your car or walking down the street can add to your toxic burden. Everything from our food and medications to our homes and personal care products, such as lotions and aftershave, can add toxins to our bodies.

People come to do a detox for a variety of reasons: hormonal symptoms – such as PMS or perimenopause, skin issues, fatigue, headaches, infertility, autoimmune disorders, elevated cholesterol, and a variety of inflammatory disorders. Once people are aware of the many toxins in our environment, even those who eat organic and keep their cleaning products as clean as possible often want to detoxify a couple of times per year as a good preventive strategy.

Organs in our bodies that assist us in detoxification on a daily basis include the liver, lungs, kidneys, digestive tract and skin.

Many of the over-the-counter detoxification kits include intestinal cathartics – even natural ones like senna and cascara – which can induce explosive bowel action, cramping and discomfort in many people. Having optimal digestive function is critical for proper elimination and detoxification, but this type of abrasive action is not recommended. (If someone is continually constipated, then they likely need a detox more than most people, since their detoxification action in the digestive tract is limited. They may benefit from cathartics, but should use them only in the short term. Constipation can be resolved by treating underlying causes, not just depending on laxatives.)

While all of the organs of detoxification are important for optimal health, focusing on the liver and assuring excellent elimination makes the most sense. The liver is really the powerhouse of detoxification in the body. Most medications have to pass through the liver in order to be eliminated. Our liver function affects our hormones and our ability to clear other toxins to which we are exposed.

An ideal plan for detoxification includes diet changes, such as eliminating alcohol and caffeine, sugar, refined carbohydrates and any known food allergens.

Supplements that may be helpful will provide nutrients and herbs for liver support and a fiber source to improve elimination.

Saunas, steams and massage will also aid in the body’s detoxification process.

The type of cleanse that is best for an individual will depend on one's symptoms and personal goals. A licensed naturopathic physician can tailor a plan to their specific needs.

Language is a Slippery Slope

By Marcia Prenguber, ND, FABNO


Photo by powerbooktrance via flickr, used under the Creative Commons License.

LANGUAGE – it seems like such a simple thing, we all learn it to one degree or another, starting at a very early age, and we use it to communicate simple needs, ideas, and interests. But can anything be more complicated, used to abuse, and be misinterpreted? It’s not always easy to say what we mean, to hear what is meant, or to repeat what was said.

Perhaps a few examples might better illustrate my thoughts. Recently, a local journalism student interviewed a number of health care providers about detoxification diets, and published her report. The article, as so many interviews go, reflected the journalism student’s understanding of what was said and what her own ideas were about the topic, but was not completely reflective of the intent of those interviewed. We see this often, as so many of you I am certain have experienced. The wealth and breadth of language is sweet, and also the door to the chaos of interpretation.

Another example is the interpretation of a patient who was informed that he would receive some of the health care services at no cost to him. His response was that if there was no cost, the value of the service must be limited. Hence, cost equals value. I admit, I have often hinted at something similar to that when discussing the quality of supplements with patients. This sadly sends me to thinking about health care reform, health insurance… I am not entirely clear about my thoughts on these issues, what with all the rhetoric we are subjected to on a daily basis. These are very complicated issues, and it is not just language that is abused in the attempts to “win” the arguments. It is however, another example of the twisted use and dark side of language.

I recently was given, by a friendly, supportive surgical oncologist, a copy of the January edition of Clinical Oncology News which contains an article about the Children’s Oncology Group (COG) multi-center double-blind placebo controlled trial using Traumeel for mucositis. I don’t want to debate the study itself here, but rather to illustrate the use of language to communicate. The second sentence states that “the study was a rare effort to subject alternative medicines, which are now widely used by cancer patients, to the same rigorous, evidence-based examination used for conventional treatments.” I get that “rare” is used here to communicate relatively uncommon from his perspective, but the more common interpretation is that it is highly unusual. While I agree that we certainly need to be more demanding in our evaluations of “alternative” approaches, I think that “rare” simply reinforces the common perception that “alternative” approaches are almost never researched and are certainly not evidence-based.

To be fair, the article’s author did communicate some of the challenges in conducting trials of this type, testing “homeopathies”. He also mentions the wide use of this therapy by “homeopathists” to treat inflammatory diseases. But where is the information from the providers who know this medicine and the language to make clear the details about the therapy? There are many things that I appreciate about the article, but the author’s use of the language that influences readers should be edited with the support of those who speak that medicine’s language, for the sake of clarity.

I have a number of other examples of the misuse of language to communicate our ideas, and I tend to be most sensitive to those misappropriations of language in the field of health care, politics included. But I won’t trouble you with them today. I’ll just turn my attention to the television coverage of the Olympics. Surely the reporters there are unbiased and objective.