Village People

By Bill Benda, MD

Photo by ArizonaMentor via Flickr, used under the Creative Commons License.

I have a sort of interesting gig. I teach emergency medicine, my particular specialty for the past 35 years, to students at Southwest College of Naturopathic Medicine. 20 hours the first term, 30 hours the second, bopping down to Phoenix from Big Sur every month or two to impart information based more on experience than textbook teachings to future clinicians who may, or may not, someday witness a patient in the throes of a myocardial infarction or anaphylactic shock. This has given me a unique, and most valuable, insight into the machinations of naturopathic medical education, and an appreciation for both the similarities and differences between your students and ours (I’m an MD).

Each term I elect to spend a bit of time discussing health care politics once the “required” information is neatly tucked away in their inquisitive minds. The topics range from D.C.’s recent legislation, to the AMA, to the AANP, to the NMSA, to the AHMA, to the medical school SGAs, and all acronyms in between. It’s amazing how the energy in the room shifts from somewhat bored attention to intellectual engagement – instead of two or three in the audience raising their hands in response to some clinical query, half the class at any one time vie to be called upon to state their personal perspectives on all things non-clinical. These young (and not-so-young) scholars are hungry for real-world social and political discourse, a very good omen for the future of the field.

But something is missing. This hunger for information as to how the real world actually works is actually a referendum on where we have fallen a bit short as mentors. Yes, there are caring, passionate practitioners willing and available to impart clinical knowledge, and a cadre of political junkies at the state and national level available to provide direction if asked. The AANP and NCC (Naturopathic Coordinating Council) have both invited the president of the NMSA to sit at the boardroom table, and the AANMC is working to ensure fiscal support to the national student organization. But resources are stretched to their limits, and each aforementioned soul who volunteers their time and energy to students also has a medical practice and teaching duties and family and financial responsibilities. There simply is not enough human resource to shepherd this profession through the national and state and local and academic labyrinths, and still find the time to parent our students as we do our own children.

The thing is, though, they are our virtual children, as well as the future of naturopathic medicine. And to be quite honest, their inexperience is a stumbling block on their path to becoming our legacy and future leaders. So I believe this to be an opportune moment for those of you reading this blog to consider what it is you might contribute to their, and your, coming success in navigating this big, confusing world of ours. If you live near a medical college, volunteer your clinic or office and have them shadow you on your rounds. If you are part of a state association, invite them to your next meeting and solicit their input. If you are a national leader, push for fiscal and political support for their fledgling organizations.

It takes a village, people . . .

Our Path to Integration

Carl Hangee-Bauer, ND, LAc
AANP President

Dr. Hangee-Bauer with Dr. Mehmet Oz and Lisa Oz.

May was an interesting month for me, and I want to share a few of my recent experiences with you. I’ve found that my role as AANP President has given me many opportunities to be curious about different facets of the naturopathic profession and have experiences which are not so common in my day-to-day practice.

One of my goals during my two-year presidency is to visit each of the naturopathic medical colleges. I want to understand better the questions, dreams, aspirations and fears our naturopathic medical students have as they envision their futures as naturopathic physicians as well as understand the challenges and successes of the naturopathic colleges.

Last week I had the honor of being invited to Bastyr University to attend a celebration where Dr. Mehmet Oz and his wife Lisa Oz were given honorary doctorates from Bastyr for the work both have done to improve people’s health and educate and empower them to make better health choices. They are a remarkable couple to meet: charming, obviously intelligent and we had a nice conversation around building bridges between naturopathic and conventional medicine. The Bastyr community welcomed the Ozes with open arms and open hearts.

I spent the rest of my time at Bastyr touring the campus and clinic, having a brown bag lunch session with students, and getting a tour of the new LEED Platinum-certified student housing. It was a remarkable experience for me. When I graduated from Bastyr in 1984, we were housed in an old elementary school in North Seattle, and the school had a small clinic in the University district. It had been at least five years since my last Bastyr visit. I am so impressed at the many ways the college and community have grown and matured since my time as a student there. Between the state-of-the-art clinic facilities, the expansive campus, and the great dialogue I had with the students, I came away impressed at how far our profession has grown since my days as a student in the early 1980s.

It’s a funny thing. When I was a student, we knew instinctively we were on to something, even though hardly anyone knew what naturopathic medicine was at the time. I have to say it is truly remarkable how this profession has grown both in size and respectability, and it only makes me wonder how we will continue to evolve and grow in this era of health care change as we continue to expand our presence and the impact of the medicine.

Which brings me to another experience I want to share with you. I was in New York in February at the Integrative Health Symposium where I met a young (to me) ND who had graduated from Bridgeport in 2003. He was in San Francisco a few weeks ago attending a urology conference and we met for lunch. He told me about his journey from naturopathic school to his present position as a naturopathic doctor in a urology practice in New York City. It was fascinating to hear. When I got out of school, opportunities for NDs were fairly limited. Most went into private practice, mostly solo or small groups, or went into teaching or to work for supplement companies. He described to me how it works in his office and how his training and treatment focus meshes with those of the surgeons and urologists with whom he works. It’s a win-win-win situation. He has a good job that keeps him busy in a specialty practice he enjoys and at which he is successful, the medical doctors have an ND to whom they can refer patients, their group practice benefits from the naturopathic services offered, and patients of this practice have more treatment opportunities.

I strongly believe that we are entering an era of integration as opposed to separation, where health care providers of different training and skills come together with mutual respect and understanding to improve the health of people and our planet. In his book Nature Cures: A History of Alternative Medicine in America, author James Whorton makes this case quite effectively and succinctly. The old ways are dying, and there are great opportunities for naturopathic medicine in this paradigm shift. There are ever-increasing examples of how our graduates can utilize their skills in a variety of settings. We can continue to emphasize our differences from other health professions or we can seek ways to come together. It is up to us.

My experiences in May have reinforced this for me and have given me much to think about as the naturopathic profession moves forward into the next phase of our evolution.

The Problem with Research

By Tim Birdsall, ND, FABNO
2009 AANP Physician of the Year

Photo by US Army Africa via Flickr, used under the Creative Commons License.

I’ve been out of the office for a few days, and was way too busy catching up on all of the countless things which don’t get done when you’re not there attending to them. So perhaps I can be forgiven for not seeing it immediately. But, at the end of the day, there it was in my Inbox, leering at me, daring me to open it up. “Selenium Does Not Benefit -- and May Harm -- Most Patients With Non-Small-Cell Lung Cancer.” What? Not again… Yet another study showing that antioxidants may do more harm than good. First it was beta-carotene. Then vitamin E. Now selenium. And that’s just the antioxidants.

To top it off, the reason I was out of the office last week was that I was attending the National Advisory Council for Complementary and Alternative Medicine, the advisory body to NIH’s NCCAM. On that council, we have talked about just this issue – why do therapies which seem to make biological and physiological sense, which have some epidemiologic data to support their use, and which naturopathic physicians (and other alternatively-minded practitioners) have been using for decades (or much longer), seem to fail in double blind, randomized clinical trials?

The reasons are multiple, complex, and often convoluted. And conventional medicine is all too willing to accept a negative study of a natural therapy, proclaim that “it doesn’t work,” and wash their hands of the entire mess, while leaving the public with the impression that alternative medicine isn’t really worth much. In reality, these therapies often fail in clinical trials because those trials are designed to answer simple, straightforward questions, and as anyone who has provided care to patients can attest, clinical medicine is anything but simple and straightforward. The typical randomized, placebo-controlled, double-blind study can only answer a limited set of very specific questions, and if the wrong question is being asked, or if it is being asked in the wrong patient population, the answer may be equivocal, confusing, or just plain wrong.

In the lung cancer study I saw today (J Clin Oncol 28:7s, 2010 (suppl; abstr CRA7004)), selenium actually appeared to show benefit in one sub-group – those who had never smoked. True, that finding did not reach statistical significance, but then neither did the finding of potential harm (P=0.15). But which one made the headline? You already know the answer.

And so I began to ponder the question, “What’s wrong with research?” A part of me becomes enraged at the reductionistic, allopathic, biomedical model, which breaks things down into components so small that all synergism, all interdependence is stripped away, and then declares those components to be ineffective. Another part argues that the wrong component was selected, or was a synthetic form (although in the lung cancer study, they used selenium yeast). But ultimately, I find myself becoming offended because I believe that these therapies work… Whoa! Believe? OK, but where is the role for evidence? I used to believe that stress caused gastric ulcers. And then along came Helicobacter pylori, and I had to change my belief to match the evidence.

For naturopathic medicine to survive and thrive in the 21^st century climate of evidence-based medicine, I think at least three things must happen. First, we should be willing to judge ourselves critically and objectively, and subject our therapies (and ourselves) to scientific scrutiny. Scary and intimidating? Perhaps. Essential? Absolutely.

Second, we need to step up and recruit and train naturopathic physicians to be world-class researchers. We make great doctors – our patients tell us so every day. We have yet to prove that we can also make great researchers, although we have begun to lay the groundwork to create this success. We are playing catch-up with academic institutions that have a 50-60 year head start, but we have the advantages of being able to learn from their mistakes and of having a public who demands the type of care we provide. While the schools will bear much of this burden, it will require the concerted effort of the entire profession to create the infrastructure necessary to make this reality.

Third, we should collaborate with other professions and institutions to craft the research models necessary to adequately perform “whole systems” naturopathic research. There are examples of this type of approach already existing in the health systems research literature which can be adapted to our needs. In the end, we must create and validate the tools to dethrone the randomized controlled trial as the gold standard, and construct new ways to validate clinical approaches to health issues. Much as the homeopaths of 2+ centuries ago created the proving as a way to better understand and utilize their remedies, we must refuse to be limited by the way conventional medicine views health and disease.

We must boldly strike out to create the systems needed to transform both our research questions and the systems we use to generate the answers. Only then will we be able to use the tools of research to promote and defend naturopathic medicine, instead of feeling beaten over the head by them. Research as an advantage, instead of an impediment. Imagine that.

Inherently Political: Student Leadership and Legislative Success

By Carrie Runde, 2011 ND Candidate
AANP Student Representive for Bastyr University

Drs. Jamey Wallace and Jane Guiltinan (center) with the entire student
contingent from Bastyr University at the 2010 DC FLI.
Photo by Clark Porter.

This May marked my 3^rd year attending the AANP’s DC Federal Legislative Initiative (DC FLI), and I am excited to report that this year’s event was the best by far. I was proud to lead the group of 34 Bastyr ND students, from all years in the program, to Washington, D.C. Our crew had been tirelessly fundraising since last fall, generating over $15,000 to offset the travel and accommodation costs associated with the trip. I am incredibly impressed by the effort all members of the group contributed to our cause. Despite the distance from Seattle and the trip’s proximity to midterm exams, I heard only positive feedback from the Bastyr students who attended. Everyone was so glad to have made the trip, as it was a truly unbelievable learning experience.

When talking to students about participating in the DC FLI, I commonly hear claims that they are uninterested in, or overwhelmed by, general politics. My response to that is simple: the FLI teaches us about specific legislation and political issues pertinent to naturopathic medicine. Once they learn about the politics that directly affect them as students (such as loan repayment programs), as future physicians (like state licensure and scope of practice), and their patients (such as access to supplements), students become interested in the political work of the AANP and our home state affiliates. The first two days of training sessions ignited the students with a curiosity that translated into very effective lobbying on the third day of the DC FLI.

One thing that resounds clearly at each DC FLI is that students have a powerful voice in the legislative process and the future policies of naturopathic medicine. The passion, intelligence, and perspective that we bring to conversations on health care are true mediators for change. The work that we have done in the past is paying off. As AANP President Dr. Carl Hangee-Bauer pointed out in a previous post, this year’s FLI was remarkable because healthcare staffers on Capitol Hill now know the AANP. We spent less time educating them about naturopathic medicine, and more time discussing how we can best be utilized in our nation’s healthcare system. I have specifically experienced this over the last three years in meetings with Massachusetts Senator John Kerry’s health care staffer, who is encouraged by visits from a positive group of people so dedicated to health and wellness.

The student presence at the FLI is, in my slightly biased estimation, the most important. This year, 100 of the 171 participants were ND students representing four U.S. naturopathic schools! We need to continue to increase our numbers at the event each year. The FLI has a greater political impact because students represent many home states, thus allowing us to deliver our message to as many representatives as possible. The FLI helps students as well. It allows us get outside of our medical school bubbles and into the real environment in which we will someday practice our medicine. Despite the challenges associated with missing class and clinic rotations, the FLI gives a new perspective on naturopathic medicine and recharges students when they return to the daily grind of medical school. The FLI also acts as a catalyst for involvement with the AANP, setting students up to be leaders at our respective schools and to become involved in state legislative work early in their careers.

The work that the AANP does for our profession is invaluable, and my personal goal is to increase student involvement in the organization. The more students that have the opportunity to attend the DC FLI and get involved with the AANP, the stronger the AANP will be in the future. The success of our professional organization has a huge impact on our future as naturopathic physicians, and students are a vital part of the equation. I hope that political work, like that done at the DC FLI, will become part of the naturopathic curricula at all schools because, as Dr. Bastyr was known to say, being a naturopathic physician is inherently political. Each year the FLI leaves me with the oft-quoted Margaret Mead adage in my head: “Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.”

Carrie is a 3^rd year ND student at Bastyr University and is originally from Baltimore, Maryland. Carrie is the Bastyr student representative to the AANP and can be contacted at AANPrep@bastyr.edu.

Two Schools

By Jacob Schor, ND, FABNO

Curcumin is the principal curcuminoid of the popular Indian spice turmeric, pictured above.
Photo by FootosVanRobin via Flickr, used under the Creative Commons License.

There were two distinct schools of thought regarding the dosing of herbal medicines when I was a student at National College of Naturopathic Medicine during the 1980s, a couple of decades ago. Most of our teachers in Portland thought in terms of what I now regard as low doses of botanical medicines. We would often prescribe doses of just several drops of tincture diluted in water.

Apparently those at Bastyr University held a different view. This was brought home when Dr. Silena Heron came down to Portland from Seattle one rainy day and lectured our class. She didn’t talk of drops but instead talked of doses in milliliters and teaspoons. She was dosing herbs to get pharmacological effect while we were looking for homeopathic effects.

These thoughts are on my mind because of a study I came across recently about curcumin and cholesterol. Over the years a number of papers have looked to see if curcumin or turmeric lowered cholesterol. Some report benefit, others not. But this paper reports something I would have not predicted. Let me tell you more about it.

The paper, authored by Alwi et al., was published in 2008 in an Indonesian medical journal and looked at the effect of curcumin on lipid levels in patients with acute coronary syndrome. This is a broad term, referring to most any situation in which the heart isn’t getting enough oxygen. For a year, between May 2005 and May 2006, the researchers enlisted patients at several hospitals to participate in a randomized double blind controlled trial. They administered curcumin in escalating doses that ranged from a low dose of just 15 mg/ 3 times per day, up to 60 mg/ three times a day, on the participathing patients’ lipid profiles. The researchers tracked total cholesterol, LDL, HDL, and triglycerides along with other common blood parameters in 63 patients who completed the study.

The researchers report that they saw lipid improvements stemming from the curcumin that varied with the doses and that in regard to, “… the effects of curcumin on total cholesterol level and LDL cholesterol level, there was a trend that the lower the dose of curcumin, the higher the effect of reduction. For HDL cholesterol level, there was also a trend that the lower the dose of curcumin, the higher the effect of increase in HDL cholesterol level.”

Let me make sure you are reading this right. They are telling us that 45 mg of curcumin per day worked better than 180 mg per day. Neither of these are particularly high doses. The smallest capsule we have on our pharmacy shelf contains 250 mg of curcumin and that product in particular claims enhanced absorption so that it is equivalent to a dose of 2,000 mg. Our standard curcumin product comes in 750 mg capsules. If we believe this Alwi study, we should divide those 750 mg capsules and spread it out over a two week period.

Perhaps we need to rethink our ‘more is better’ assumptions and even re-examine our earlier habits of using tiny doses when it comes to prescribing some botanical medicines.

The late William Mitchell would sometimes use a specific word to describe how a botanical extract affects an organism. He would say that it “informs” the body or the mind or the vital force. I don’t pretend to understand exactly what Dr. Mitchell meant by the word ‘inform,’ but I’ve taken it to mean that the particular molecules isolated from the plant bring information, that teaches or shows by example, a different pattern of behavior and function to the organism. Thus botanical medicine can act as a catalyst to change function.

We certainly have some unpleasant examples with which we might illustrate this idea. Certain addictive drugs appear to trigger permanent changes in brain chemistry after even a single exposure. Even if we aren’t talking about crack cocaine, it is not unreasonable to think that other more benign plant extracts will also cause lasting permanent changes in function. Botanical medicine, when well practiced, is perhaps more like the automatic software updates that my computer routinely downloads. They teach the system how to work better and update it so it understands how to respond to new challenges.

If we are using the analogy that herbs act like catalysts, then it makes sense that relatively small doses are all that’s needed to turn the trick. Maybe we only need the large doses when we are using herbs as drugs and not as information carriers. Perhaps drugs deliver orders to the body, while herbs deliver knowledge. [If I keep up this kind of train of thought I may have to move back to Oregon and eat granola again.]

These are the sorts of discussions we engaged in decades ago as naturopathic students. We hear these kinds of arguments less often these days. I often just reach for standardized plant extracts whose chemical actions have been multiplied by refining, distillation and concentration. More is better and stronger is better; these have become our quiet mantras. We once condescendingly attributed this type of thinking to medical doctors (especially those claiming to practice natural medicine) and considered it to be an inferior approach to treating the patient. We allowed that some one in our profession might out of necessity fall back and prescribe botanical medicine like this out of desperation but it wasn’t the preferred path of treatment, the way a real naturopathic doctor worked. We were such idealists.

Luckily many of us still are idealists and this paper on curcumin should serve as a reminder. Sometimes less is more. Sometimes what we need is a tiny nudge from something so small as to seem like magic. Or perhaps, in our rush to keep up with all the new science, we have to leave a little space in our understanding for the magic in our medicine to do its work.

Double Vision

By Bill Benda, MD, FACEP, FAAEM

Photo by Lomo-Cam via Flickr, used under the Creative Commons License.

“Visionary.” Now there is a word we’ve all heard countless times as we meander the naturopathic path. Merriam-Webster defines the term as “one having unusual foresight and imagination.” We tend to view our visionaries as those among us who can see into the future, imagine unimaginable realities, lead us to promised lands if we are intrepid and willing enough to follow. We laud our visionaries, follow their writings, award them at our banquets.

As we should, should we hold to that particular definition. But from my boundless perspective, and limited experience, a visionary is not necessarily a prophet or clairvoyant, but rather someone who can actually discern the truth of the present moment – a point of view requiring far more courage to express than any tale of potential future pleasantries. Visionaries who can discern reality are fewer in number than the prescient variety, and those with the courage to voice their views are fewer still, given the political price that must invariably be paid, because the reality of our culture -- and of our healthcare system, and of our profession -- is not always pretty, and definitely not as pretty as our conference and clinic brochures tend to proclaim.

Now do not misinterpret these words –- the underlying beauty of the naturopathic and holistic and integrative et al. philosophies and therapies is alive and well, and more than worthy of love and support. But we in our optimistic, energy-medicine, “hugs heal” mentality are often more than hesitant to take a long, hard look at our internal dysfunctions, dysfunctions that are an essential part of our very humanity rather than an unwanted and obnoxious uncle who has overstayed his welcome. We hold onto historical injuries that are no longer relevant. Our organizations avoid dealing with whispered dissent from their membership. Industry fails to note that their journal advertisements and promises of health are not that much different than those of the conventional brethren we condemn.

And why am I writing these words on this particular blog at this particular time? Because as an AANP board member and associate editor of your journals and adjunct faculty at one of your medical colleges, and especially as a non-ND, I believe your profession is at a crossroads, an adolescent-to-adulthood moment of your evolution when it is time to let go of the past and create a new future. And this shift cannot, and can never, occur without first making a difficult and objective assessment at what is real in the present.

So the next time one of your fellow professionals or employees or students or board members stands up and points out the pachyderm in the pad, see if you can refrain from withdrawing from the inevitable discomfort and instead take a long, hard look at the actual information being presented. You may well find that you have a bona fide visionary in the room.

Food Allergies: Fact or Fiction?

By Sara Thyr, ND

Photo by viZZZual.com via Flickr, used under the Creative Commons License

I recently read an article in the New York Times that said that many people who have been diagnosed with food allergies don’t actually have them. They felt that perhaps only 8% of children and less than 5% of adults actually have them.

I feel that quite the opposite is true. In my practice, I see many people who have undiagnosed food allergies, and they often don’t associate their symptoms with foods. But once they avoid the reactive foods, they find myriad of symptoms that they have struggled with, for either weeks or years, disappear. Symptoms affected by food allergies are wide ranging – from making seasonal allergies worse, to ear infections, fatigue, headaches, eczema, heartburn and other digestive disorders – even high blood pressure.

Their distinction of food allergies versus food intolerance did make sense. A food allergy is actually activating the immune system. This involves antibodies. Conventional allergists often test for food allergies using the skin prick test, where a small amount of a serum with the food is injected under the skin to see if a reaction forms around the area on the skin. The antibody that is active in this type of testing is called IgE (which stands for immune globulin E). Some practitioners do a blood test, which often looks at another immune globulin called IgG (as above, immune globulin G). IgG is better at finding the undetected food allergies, as it is more prevalent in delayed hypersensitivity reactions. IgE is the mediating immune globulin for more immediate sensitivities, like those that cause inhaled allergies – like when you get itchy eyes from petting a cat, or the more serious anaphylactic reaction from eating a peanut.

A food intolerance is more common. Many people are lactose intolerant – they cannot digest the sugar in milk, and find themselves with symptoms such as upset stomach and loose stools. Reacting to sulfites in red wine is also an intolerance, rather than a food allergy.

For many people, the distinction is immaterial. They feel better if they avoid the food. So avoid the food.

One reason I like to make the distinction is that most people with food allergies are likely to also have intestinal permeability (also known as “leaky gut”). With this in mind, there are a number of therapies that can help to heal the digestive tract. Along with food allergy avoidance, healing the digestive tract can improve health, including eliminating symptoms caused by the food allergies, as well as mitigating reactions when they have any of their allergenic foods.

Whether you think you have food allergies or just an intolerance, it is wise to see a naturopathic doctor – a specialist in finding and treating the cause, as well as treating illness with the most nutritive elements nature has to offer.

Federal Policy Priorities for the Naturopathic Community: Reflections on the DC FLI

By Carl Hangee-Bauer, ND, LAc
AANP President

The Cannon House Office Building on Capitol Hill.
Photo by cliff1066^TM via Flickr, used under the Creative Commons License.

Here it is, mid-May already, and it’s been a busy time at the AANP.

I’m sure you have read Karen Howard’s report on this year’s DC FLI. It was a busy four days in Washington, D.C., as over 150 people, including more than 100 naturopathic medical students, met on Capitol Hill to refine our leadership skills, meet with legislators and their staff, and create a visible presence in our nation’s capital. For a profession as small as ours, we have managed become known in the Halls of Congress. This year was my 3rd DC FLI, and I noticed that we spent much less time explaining what naturopathic medicine is and who we are and more time discussing issues important to our profession, our members and our patients.

One of our key messages involved inclusion of naturopathic doctors in various loan repayment programs created or extended under the new Patient Protection and Affordable Care Act. It’s ironic really. Both the Department of Education and the Carnegie Institute classify the ND degree as a First-Professional Degree on par with MDs and DOs. All naturopathic medical schools are accredited by the CNME which is recognized by the Department of Education and each of our schools are regionally accredited by authorities recognized by the Dept. of Ed. Naturopathic medical students are eligible for the same federal loan programs as MDs and DOs. Yet, naturopathic doctors are not named in a number of federal programs which allow us to serve in underserved communities and are excluded from participation in all federal loan repayment programs, including the Public Health Workforce, the National Health Services Corp, and the Indian Health Care Improvement Act. This is clearly unfair and is a significant barrier to NDs participating in federal programs, and in the meetings I attended, this was clearly heard by the health staff people with whom we spoke.

Our doctors and students also advocated for a consensus definition of “Integrative Health Practitioner,” a term used but left undefined in the health care reform language, and reminded legislators of our support for DSHEA, which frequently comes under attack from various legislators and agencies.

I think that at least as important as our messages and issues discussed is our presence in D.C. and the building of relationships with legislators, their staffs, and the various regulatory agencies that oversee the transformation of bill language into laws.

On another note, members of the AANP should be receiving their elections packets from the AANP very soon. This year a number of candidates have stepped up for Board positions and for the first time ever we have a competitive election for AANP President-Elect. I am impressed by the quality of our candidates and the wealth of experience, knowledge and dedication to the profession that they all bring to their candidacies. Please read over the candidates' statements and vote for your choice of our next AANP leaders. Your interest and participation are critical to the future of the AANP.

Finally, watch for materials coming soon about the AANP convention in Portland, August 11th-15th. It should be a great one as we celebrate the AANP's 25th anniversary, learn from some of the elders in our profession, and spend time with old and new friends. I hope to see all of you there.

AANP's DC FLI Sets New Records

By Karen Howard
AANP Executive Director


This year's annual Federal Legislative Initiative (DC FLI) topped all records.

• Over 170 visits to Congressional offices representing 38 states and the District of Columbia.
• 171 attendees of whom 100 were naturopathic medical students.
• 1,500 emails were sent in one day from 'virtual' lobbyist across the country using our electronic CapWiz program to write to their Members of Congress.

A special recognition goes to the students of the University of Bridgeport for winning the "Bring a Founder to the FLI" contest and receiving the AANP's first traveling trophy for school spirit.

This year we focused on how Congress can address the critical shortage of primary care physicians by accessing naturopathic medicine. Our specific requests included inclusion in all federal loan repayment programs and defining the term "integrative health care practitioner."

The term, "integrative health care practitioner" is used throughout the health care reform law and is not defined in the statute. Our objective is to encourage Congress to ensure Americans have access to the best, most qualified providers - many, if not all, of whom are underutilized in federal programs. As you may recall, the Coalition for Patients Rights, of which the AANP is a member, represents 3.3 million such practitioners. Our proposal uses language from the original H.Con.Res 406 and H.Con.Res. 58 (introduced by Congressman Langevin) and reads as follows:

"An Integrative Health Care Practitioner, acting within the scope of that provider's license or certification under applicable State law, addresses the underlying causal factors associated with chronic disease; improves individual health and increases individual capacity to engage in activities of daily living through lifestyle change, including strategies relating to diet, exercise, smoking cessation, and stress reduction; and provides patient-centered care that:

1. addresses personal health needs;
2. uses a multidimensional approach to encourage patients to improve their own wellness through lifestyle changes and the use of scientifically based therapies and outcomes based treatments that facilitate the inherent ability of the human body to maintain and restore optimal health; and
3. utilizes clearly defined standards to determine when the implementation of wellness and health promotion activities will be useful for each patient based on the diet, exercise habits, individual health history, and family health history of the patient."

What happens now? Staff is working to mine the reams of data from these very valuable visits on Capitol Hill and will work directly with several of our state contingencies of NDs to create a successful strategy for our efforts. Capitol Hill is a tad weary on the topic of "health," in general, but preliminary work is beginning on what will constitute a technical amendment bill - and the appropriations process is also available as a possible vehicle for these changes. Our relationships continue to grow and deepen on Capitol Hill and our presence is clearly having an impact.

Naturopathic Leaders and Leadership

By Carl Hangee-Bauer, ND, LAc
AANP President

Photo by Tim Green aka atouch via Flickr, used under the Creative Commons License.

Earlier this month, I attended three meetings in three days in Portland, Oregon. The first was our AANP Board meeting, bringing together 13 Board members elected by the membership to represent their interests and guide the direction of the association. The second day was a meeting of the Naturopathic Coordinating Council (NCC), a diverse group representing the AANP, the schools and colleges, the CNME, NABNE, and other established and recognized organizations representing the naturopathic profession in North America who collaborate in planning and coordinating action toward a vibrant and successful naturopathic profession. The third day was a meeting of the American Association of Naturopathic Medical Colleges (AANMC) where representatives from the seven naturopathic medical schools met to discuss topics of mutual interest and promote successful programs and improve student education.

As I sat in these 3 days of meetings, it struck me that, by and large, I was spending time with most of the current leaders of the naturopathic profession, a relatively small group of people who through their hard work and dedication, are advancing naturopathic medicine and in their small ways, changing the world.

It is currently estimated that there are about 6000 licensed NDs in the United States and Canada. My guess is there are around 100 people who are in key leadership roles. Some are employed by various organizations to do their work (the schools and colleges come to mind), but many are volunteers who are members of Boards or officers in their state associations. What all have in common is a vision of where naturopathic medicine can go and what it can do to improve the health of the public and influence the course of health care policies that affect us all.

It’s a funny thing. I think that when most of us became students of naturopathic medicine, we were focused on our studies, learning about how this medicine can benefit our patients as we go out into the world and establish our practices. Little did we know how important it would be to get involved in politics, both at state and federal levels, to expand access to naturopathic care, assure scopes of practice to reflect our training and education, and to dispel much of the ignorance and misperceptions around the naturopathic profession.

While on vacation last month, I ran into a ND at the Kona Farmers Market. We chatted a bit, and I found out she had become involved in the Hawaii association during its recent successful effort to update the scope of practice for Hawaii NDs. She mentioned that she had not planned to get involved in these political doings, but that she felt she had to because of the effects on her practice and her abilities to be of benefit to her patients. I think many of us can relate to her experience. Whether we expected it or not, many of us have found that to do our work well, we must become involved in big picture thinking and join with others in cultivating and growing the profession.

As I write this, the AANP has sent out its call for nominations for the 2010 elections. This year, we will be choosing a new President-Elect for the 2012-2013 term as well as 5 new board members. The AANP is a member-driven association; candidates are nominated by the membership and elected by a majority of the members votes. Your participation in this process is vital to the direction and future of the AANP.

This election promises to be an exciting one. I know of some candidates who plan to run and am impressed by the experience and professionalism they bring to the ballot. It is very likely this years elections will be competitive, with more candidates running than there are available positions. This means choices for AANP members to influence the direction and goals of the association.

My charge to you is simple: Get Involved! Vote! Read the candidates statements and decide who best speaks for you and your concerns and desires. For those of you with leadership experience and interest, consider running for a Board position.

With your voice and your vote, you have the power to grow and guide the naturopathic profession as it gains its rightful place in the healthcare system.

My Final Message as AANP President

By Lise Alschuler, ND, FABNO
AANP President
Vice President, Quality and Education, Emerson Ecologics


Photo by Dare*2*Dream via flickr, used under the Creative Commons License.

This is my last message as President of the AANP. Thank you for giving me the opportunity to share my ramblings with you in this venue over the past two years. As my last one, I am taking some liberty and exceeding my word limit just a bit. I have a lot of gratitude to share. As I sit here reflecting upon my time as President, I feel good. We have done a lot! Despite the turmoil of the past many months in our economy, our globe citizenry, and our national health, the AANP has thrived. Naturopathic medicine is more visible in proposed Federal legislation, we have a multi-series documentary on naturopathic medicine and an intricate PR campaign about to launch around it, we have a stellar on-line journal, we have more and deeper alliances with other professional and trade associations. The AANP is actively advancing its mission, has added new members, and has expanded its corporate support. The AANP has matured into a governance model which facilitates visionary leadership. So, as my tenure as President of the AANP draws to a close, I am filled with gratitude and optimism. Let me dwell on these for a moment…

I am grateful for many, many things. I am grateful for the incredible integrity and intelligence of my fellow Board members. The AANP Board has thoughtfully and gracefully transformed itself into a Governance Board. This model has allowed the visioning and leadership activities of the Board to blossom. I am also grateful for the exceptional dedication, passion and talent of the AANP staff and consultants. We are extremely fortunate to have such a capable staff implementing the work of this Association. I am deeply appreciative of all that I have learned from the staff and for their friendship over these past years. I am grateful to every member of the AANP. These doctors understand the criticality of supporting the national association of naturopathic physicians in order to both solidify and grow naturopathic medicine. I am also grateful to those companies who are our corporate sponsors. They understand the integral role that naturopathic physicians have in optimal healthcare and are investing in our future. Finally, I am grateful for the patients that have sought care from naturopathic physicians. Not always an easy thing to do, these individuals have stepped out and sought a different kind of healthcare. Their willingness to experience the benefits of naturopathic medicine is the bedrock of our profession and our continued success is absolutely dependent upon our patients.

My optimism emerges from the confidence that I have in people who comprise the AANP and in the future landscape of healthcare. There is a place in healthcare for naturopathic physicians, and while this place has always existed, more and more people outside of our profession now recognize this place and want it to be larger and more visible. I can think of nothing more exciting than knowing that soon, in my lifetime, many more people throughout this country will enjoy access to naturopathic doctors.

I want to thank you for allowing me to serve at the President of the AANP. I carry the honor of this service deeply. I hope that I contributed to the profession’s well-being and made it easier in some way for each member to be more proud about the AANP and about our profession. Everything I have done is the result of the work of the entire board. I want to thank Dr. Vanessa Esteves, Dr. Chad Aschtgen, and Dr. Steve Bailey for their service as Directors on AANP Board. Their terms have come to a close and these individuals have enriched the Board with their perspectives and have donated extraordinary amounts of their time to this profession, often at the expense of time with their loved ones and other professional endeavors. I also want to extend my deepest gratitude to the current board members, who, as immediate past-President, I will have the pleasure of continuing to learn from and work with. Drs. Michelle Clark, Bill Benda, Tabitha Parker, Sara Thyr, and Michael Cronin. Leaving the role as President is easier with such a fabulous next President in the waiting. I welcome Dr. Carl Hangee-Bauer as our next AANP President. I cannot imagine anyone I would rather hand the baton to. He brings his immense talent, huge passion and great integrity to this role. Dr. Carl, at 12:01 EST January 1st, 2010, it’s all yours! I bow to all with immense respect and love in my heart.