Monday, October 26, 2009

All in a Day's Work

By Marcia Prenguber ND, FABNO

Sunrise Today
Photo by via Flickr, under the Creative Commons license.

All in a day’s work – a day of repeated inspiration. The challenge is how to record the events of the day, to savor the beauty, to reflect on the challenges, and process the losses. Starting the day with an early morning meeting referred to as Breast Clinic, the team of providers (pathologists, radiologists, mind-body counselors, naturopathic residents, medical, surgical, radiation, and naturopathic oncologists) sit in a darkened room to view scans and path slides. The details of the diagnoses of patients with newly diagnosed or recurrent cancers of the breast are presented, reviewing the pathologic nature of cells projected more than 200-fold on the screen in some ways give us a more real view of the enormity that these cancer cells play on an individual’s life. The stains that color these larger than life cells cast them in a friendly hue, but the meaning that those stains convey is not so good natured. I’ll admit, at first glance, this environment may not appear very inspirational. However…

The intensity of thought and depth of care that is evident during the discussion of the PET/CT scans, the path slides, and the Breast Surgeon’s review of each patient’s story as told to her by the patient is inspirational. The focus on the significance of each assessment, the conflicting information, the challenge to weigh the details appropriately make it very interesting, but inspirational? The details of each patient’s efforts to cope with the circumstances of the changes in their lives since the diagnoses, their lifestyle habits and all the rest of the information gathered by each of us in the time spent with the patients contribute to our understanding of the patients and fuels the fires of inspiration. Knowing these details about their lives gives us pause to reflect on what we do with our own moments in time. These patients inspire us to pay attention, to focus on the details, to bring to them the best that we can be, in whatever discipline we represent.

As a naturopathic physician, all of those details that patients bring to the cancer center matter to me. I look at this as winning the big prize – I get to use all that information in developing my treatment plan. And then to put icing on the cake, I get to spend time exploring these pieces of information with the patient – and just getting to know the patient. The most significant source of inspiration comes from learning who each patient is and how each one of them is dealing with this new challenge. What strategies do they each use? When and why do they choose not to know more? How do they deal with pressure from family and friends to try everything under the sun to try to treat the cancer? That these patients share this is such a privilege. Their courage, their strength, and their vulnerability inspire me. And makes me look a little deeper.

So, as the sun starts to come up in a spectacular sunrise and the morning meeting comes to a close, I am reminded that it is the start of another gorgeous day that I have the good fortune to go spend time with those patients. And to do so as a naturopathic oncologist – what a fabulous profession.

Tuesday, October 20, 2009

Monthly Payments Coming in 2010

By Carl Hangee-Bauer, ND, LAc
AANP President-Elect

I don't know about you, but I've always found it a bit of a financial stress for my business in January when my AANP membership renewal is due. With the last few weeks of December's cash flow slow due to the holidays and quarterly tax payments due in January on top of all my other bills, it can be tough to find the funds to renew my AANP membership for the entire year. That's why I'm happy to see the AANP move to a new dues structure where one can make monthly membership payments over the course of the year. Starting December 1, 2009, the monthly payment option will be made available to all AANP members. One can still pay upfront and receive a 16% discount, or stretch out their payments over the year to keep their cash flow running smoothly. I already do this with my state naturopathic and acupuncture associations and have found it to be an easy way to keep up my membership and support the important work of my professional associations.

There are more benefits to AANP membership than ever before. The popularity of, the AANP web site, has soared 400%, with traffic to "Find an ND" increasing 30% in the past year. If you haven't checked out the members page on Practice Development, please do so; there are many articles geared to helping you grow and maintain successful practices. Politically, The AANP has joined the debate on health care to make sure that the message is heard that true health care reform is not just about changes in the insurance system. With AANP input, the definition of naturopathic medicine has been dramatically revised by the US Department of Labor to more accurately reflect our profession. We are involved in coalitions with other health professional associations with common goals as well as the Coalition for Patients Rights to combat the AMA's efforts to limit our licensing and scope of practice. In the past year, the AANP has worked with American Health Journal to develop a 7-part PBS series on naturopathic medicine, launched a national public relations campaign, and the new Natural Medicine Journal. I could go on but I think you get my point: The AANP is working hard for you to be the successful naturopathic physicians you are trained to be and we need your active participation so we can meet our mutual goals.

In 2010, we will celebrate the 25th anniversary of the AANP. I attended the first convention in Scottsdale back in 1986, became one of the first members of the AANP, and have maintained my membership ever since. I strongly believe that my participation along with hundreds of others have helped this organization and profession grow in ways we could not have imagined back then. Membership renewal notices will be sent out soon. I encourage you to join the AANP, get involved, and help guide the naturopathic profession for the next 25 years.

Monday, October 19, 2009

Renewal in Nature

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

Photo by walknboston via flickr, under the
Creative Commons license.

As I sit looking out of my new window, or rather, the window of my new home in New Hampshire, at the early splashes of fall colors, I am elegantly reminded of the beauty and grace in this wonderful world. Nature, in particular, is such a resplendent display of richness, vibrancy, and creativity. I think, deep down, it is this intense celebration of nature that inspired each of us to become naturopathic physicians, natural product manufacturers, or holistic practitioners. I am convinced, in fact, that our individual and collective respect for nature is the main twine connecting us to one another. When I think about Nature, I think about the dandelions forcing their way up through cracks in the sidewalk. I think about the collective sigh from a grove of fir trees bending in the wind. I think about the sweet stillness of the sun setting over gently rolling hills. These recollections bring me into immediate presence – the beautiful here and now of this world. What a joy.

I know, without a doubt, that my inspiration from, and confidence in, nature and the beauty of this world is due, in large part, to being a naturopathic doctor. The philosophy and community of naturopathic medicine built and then buttressed my connection to nature. Without this medicine, I can’t really imagine how I would maintain my sanity in this chaotic world. Where would I be without my weeds, trees and sunset as equalizers? This gift – rich and poignant as it is- is a gift that is meant to be shared. How does one share a confidence and inspiration in nature? Quite simply by remaining an active part of the naturopathic community, the very community that builds this inspiration. I swear to you, that there is a direct and pulsating link between active membership in the AANP and being an inspired naturalist. Admittedly, I am biased by my own experience. I have been an active member of the AANP and volunteer in the naturopathic profession since my second year of naturopathic medical school. When I reflect back upon my volunteerism, every action – as challenging as they may have been at the time – solidified my belief in, and passion for, naturopathic medicine. Out of this passion, my love affair with Nature intensified and my sanity remained (more or less) intact. That is, perhaps, the most compelling and selfish reason for being an active part of the naturopathic profession. I not only admit it, I encourage you to take your share. Join, volunteer, gain inspiration, feel the tremendous vitality of this profession and of the stunning natural world around us.

Friday, October 16, 2009

Updates from Natural Doctors International

By Tabatha Parker, ND

A group meeting, at an NDI Clinic, in Nicaragua. Photo Via NDI.

NDI Now Offers 60 Hours of CE for Global Health Course:
In the world of international medicine, Natural Doctors International continues to pioneer and create inroads for naturopathic physicians and other health providers in global health. The very first Global Health Course of it's kind is now CE certified thru the OBNE! Yes, naturopathic doctors who participate in our courses will receive 60 continuing education credits, 3 of which will be granted as pharmacy credit. "This is a huge step for us", says Dr. Tabatha Parker, Executive Director of NDI, "as it will open up the doors for many doctors that want to do service work but must juggle the cost of other obligations like CE". CE courses will run throughout the year, and NDs are encouraged to sign up for the courses quickly as spaces are limited and sell out quickly. "This year we just finished our courses and graduated over 88 participants - creating a pool of naturopathic physicians that will be trained to be global health providers." You may find more information about our global health courses at

NDI Annual Auction
NDI is also reinstating their Annual Auction and Volunteer Appreciation Gala this December 4th of 2009 so mark your calendars and come celebrate in Portland, Oregon! If you would like to nominate a volunteer, intern, student NDI president or board member to receive an award, please email with your nomination.

CALLING ALL NDs - International Collaboration with Red Cross to Teach Locals Natural Medicine
When the Red Cross (Italy) decided to do a huge program on the island of Ometepe with over 90 classes in natural medicine, they naturally came to NDI to collaborate. This is very exciting news and very much in line with the idea set forth by NDI volunteer Anthony Trujillo who won $2000 and 1st prize for his natural medicine sustainability video. If you are interested in helping to develop basic classes in natural medicine for this project, please contact us immediately. We are looking for physicians to provide some basic powerpoints about natural medicine in general OR utilizing natural medicine to treat diarrhea, parasites, flu and cold, upper respiratory infections, heart disease, diabetes, and other diseases. The presentations will be edited for content and tailored for our audience here in Nicaragua and translated into Spanish. We will be selecting interns to help implement this program in early 2010.

Tuesday, October 13, 2009

Happy New Year: Welcome to the year 5770

By Jacob Schor, ND, FABNO

שנה מתוקה (A Sweet New Year)
Photo by RonAlmog via Flickr, under the Creative Commons license.

We celebrated the Jewish New Year last month and we have arrived into the year 5770. It is a little more than five and a half millennia since Genesis.

Denver’s annual Gem and Mineral show was held here in Denver several weeks ago. I had hoped to go Sunday but got caught up staining our deck and ran out of time. I was hoping to find a fossil for the office. It gives me pleasure to touch something that was alive hundreds of millions of years ago. Is the world 5770 years old or, as the geologists tell us, 4.54 billion years (109) years old? Or does it matter?

Much of the time it gives me pleasure to let these two different worldviews coexist in my mind. To paraphrase Whitman, “Do I contradict myself ?... I contain multitudes….”

We live in a world of plurality, where we coexist with people and cultures that see the world differently than we do and we learn to some extent or see the world from multiple viewpoints. Our modern view is informed by scientific principles, of hypotheses tried, proven or rejected. Yet retaining some part of other perhaps unscientific worldviews has its place. Doing so gives the world more dimension and makes it a more interesting place. I have no problem with the world being both 5770 years old and at the same time being unfathomably old.

Disregarding the newer scientific worldview in favor of other views may not be the best idea. We can certainly find examples of what happens when individuals cling too fixedly to a view that is wrong.

The first example that comes to mind is how South Africa’s former President Thabo Mbeki based healthcare policy on his opinion that HIV infection does not cause Aids. Current research suggests his denial and the policies it engendered are responsible for 365,000 premature deaths.

Or consider the slaughter of pigs in Cairo. Late last Spring Egyptian authorities slaughtered all the city’s pigs out of fear of the ‘Swine Flu.’ Never mind that the flu was spreading person to person already. The people raising the pigs were Cairo’s garbage collectors and without pigs to feed they now see no profit in collecting garbage. A little bit late, authorities in Cairo are wondering what to do with the garbage that has piled up on the streets since May.

An example closer to home; I wrote about the book Catching Fire several weeks ago. This is the book written by Harvard anthropologist Richard Wrangham who argues his theory that cooked food was the driving force in evolution of habilenes to homo erectus some 1.6 million years ago. One of my former newsletter readers did not like that I wrote about human evolution. She emailed asking to be removed from my mailing list writing, “I did not evolve from slime or from monkeys; I was created by God. I do not want to receive a newsletter from someone who believes otherwise.”

There is clear advantage to seeing the world in black and white, of having set and narrow views as to how things are. Unfortunately, these sorts of views limit scientists from exploring new ideas and more importantly for me, make the practice of medicine difficult. Although it is perhaps more comfortable and easy to stick with one’s view of the world undisturbed, it does not serve the care of one’s patients to hold so fast that we miss new developments.

These ramblings bring us to a study published in the August 19 issue of JAMA that suggests that estrogen may be a useful treatment in some types of breast cancer(1). Most breast cancer cells have estrogen receptors on their surface and when estrogen binds to these receptors it stimulates the cancer cells causing them to multiply. Tamoxifen has been used for 30 years to block these estrogen receptors. This is so basic an understanding after all these years that it is hard to imagine that estrogen might be useful in treating breast cancer. Yet it seems that at least in some breast tumors estrogen will also trigger apoptosis. Apparently in the years before Tamoxifen dominated treatment, estrogen like compounds, for example DES, were used to treat breast cancer. Somehow we forgot about this.

As many of us have sadly witnessed, estrogen blocking therapies used to treat women with breast cancer stop working after awhile. The tumors become insensitive to the hormone and grow without it. In this study, Matthew Ellis and colleagues report on their treatment of 66 breast cancer patients experiencing cancer relapse and showing no benefit from estrogen deprivation treatments. Half the women were given high dose estrogen, 30 mg/day and half low dose, 6 mg/day. After 24 weeks of treatment the tumors had stopped growing or shrunk in about one-third of the women in both groups.

The researchers say they found a way to predict which women were likely to respond. Using combined PET-CT scans with a tracer attached to glucose produced a specific reaction on the scan that predicted the responders with about 80% accuracy.

How many of us will be able to let go of the world view that estrogen is bad for breast cancer and how many will be able to see that, ‘estrogens effects on a tumor are not one-dimensional,’ but rather multi-dimensional? Can we let go of our long held view and adjust to this new information?

This is part of the reason why I keep the age of the earth variable in my mind. We need to stay flexible if we hope to keep up with the science.

1. Ellis MJ, Gao F, Dehdashti F, Jeffe DB, Marcom PK, Carey LA, et al. Lower-dose vs high-dose oral estradiol therapy of hormone receptor-positive, aromatase inhibitor-resistant advanced breast cancer: a phase 2 randomized study. JAMA. 2009 Aug 19;302(7):774-80.

Tuesday, October 6, 2009

Their Generation

By Bill Benda, MD

I’ve experienced an epiphany in the past few weeks, keeping in mind of course that one man’s epiphany is another man’s delusion. As I reach the end of a decade attempting to build bridges between various integrative/holistic/CAM vocations, I’m beginning to think that a true inter-professional coalescence of energies and efforts to change the foundations of our healthcare system may happen in my lifetime, but not via my generation. There are tremendous efforts, don’t get me wrong – ACCAHC and CAHCIM and IHPC and a veritable alphabet soup of organizations and individuals meeting and conferencing and symposiuming. But it seems like such a slog at times, with no cohesive voice yet to be heard above the “we need better insurance coverage” cacophony from today’s political parties.

Then I walk into a gathering of students, whether of the Naturopathic Medical Student Association (NMSA) or the American Medical Student Association (AMSA), or the chiropractic or the nursing schools, and all of a sudden issues such as competition and licensure and who gets the biggest piece of the pie are not even whispered, much less argued. Those coming after us are apparently fairly free of the baggage we tend to drag along behind us – baggage gathered over years of battle with the status quo or as the status quo. These young (and often not so young) people see the students of another healthcare profession as actual people, not adversaries - as fellow travelers on an academic sea with whom to commiserate rather than compete. For years AMSA has housed a Humanistic Medicine section, and three years ago established a Naturopathic Medicine Interest Group with an ND student from NCNM as chair. NMSA itself sits at the table with the grownups of AANP and ACCAHC and in the Naturopathic Coordinating Council. And when these scholars speak to us it is about how we are all alike, not disparate.

And another consequential point – among these student bodies are, by default if nothing else, our next AANP officers and board members, and medical school presidents and faculty, and industry leaders and lobbyists. What an amazing one-two punch – energetic youth without prejudice against traditional healthcare enemies already making inroads that their parent organizations can only long for. A virtual dream team in the healthcare game.

So this leaves us with both and opportunity and a challenge. An opportunity to move our campaign forward by giving our moral and financial support to the student cause, as it is our cause, only in a more pure state. A challenge to step back and consider that perhaps we in our later years are as blind in some ways as we are wise in others. That perhaps we should call in a less sophisticated perspective from a less “experienced” source.

I’m talking ‘bout their generation . . .

Thursday, October 1, 2009

Think Diet Doesn't Affect Your Immune System? Think Again.

By Sara Thyr, ND

I’m writing in response to Jennifer LaRue Huget’s article in The Washington Post, “Even Carefully Selected Foods Won't Make You Immune to the Flu”. I appreciate that the author wants to explore the possibility that nutrition might prevent illness, but she seems to have taken a rather short-sighted approach. Huget’s article investigates if one food can prevent the flu, instead of looking at the effect foods have on the body and the immune system, both positive and negative. Food has a profound effect on the body. It doesn’t take a PhD in biochemistry to figure this out. The cells of the body, including the immune system, all chug along using the fuel that they get from what we ingest. So if you are ingesting mostly Twinkies, you may have fewer necessary nutrients in your cells than if you are ingesting carrots.

But let’s not be too extreme. Really, how many of us are eating Twinkies these days? But if you eat sugar, let’s say delicious homemade cookies, or an iced mocha, it can depress your immune system for hours afterward. If you are having sugar all day long – even in small amounts – you will be much more likely to catch whatever is going around.

I’ve often marveled at the large offices with candies on many people’s desks. They are more likely to pass around illness just due to their proximity. Then add in lots of sugar – recipe for spreading the flu.

Huget draws bizarre conclusions about how foods affect disease. Take this paragraph:
"The immune system is the result of an extremely complex interplay of various functions within the body," said Darwin Deen, senior attending physician in Montefiore Medical Center's department of family and social medicine in New York. "We know that if the system is deficient, you're susceptible to infection. That's the case with HIV. But we also know that if the system is hypersensitive, you'll have allergies, and if it's turned toward the wrong tissue, you have autoimmunity" -- where the body turns on itself. So efforts to "boost" the system, even through diet, might produce unintended consequences.
Too many organic greens and blueberries and you’ll turn up with Lupus? That’s a really broad conclusion to draw - not to mention, completely counter intuitive.

Huget should have talked to people who actually believe in healthy food and prescribe it for their patients. There is good research showing that eating garlic, turmeric and maitake mushrooms does improve immune system function.

Not that I insist that my patients eat 10 cloves of garlic a day to stay well (although that’d probably do the trick). I think that food for us is a hotbed issue. And the trick is to eat whole foods, healthy foods, while avoiding the foods that suppress the immune system.

Don’t buy into the latest superfood that’s backed by a trade group? I’m not advocating for trendy natural foods eating – far from it. But you should keep in mind that, here in the fine capitalistic America, someone is bound to profit from your purchase. How do you think the whole food pyramid was built? Pretty much by the milk and bread industries.

What is most discouraging to me is that the millions of people who read the Washington Post weren’t encouraged to eat foods that are good for them. They are told to get the shot, wash their hands and hope for the best. The lives and health of Huget’s readers have so much potential to be improved – cavalierly tossed away.

In truth, the best option for readers hoping for an alternative to the flu vaccine, is to seek care from a naturopathic physician, who will likely assess your adrenals, make sure that you don’t have food sensitivities (which can really throw your immune system out of whack) and create a personalized plan to keep you well this flu season and all the seasons to come.