Thursday, February 25, 2010

Language is a Slippery Slope

By Marcia Prenguber, ND, FABNO

What Word are You?
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.

Friday, February 19, 2010

A Run for Your Money

Guest Post By Carol Rainville, N.D.

Sabbaday Falls, medium
Phoyo by pfly via Flickr, used under the Creative Commons License.

Looking for a fundraising venture for your state association? How about a running adventure? Reach the Beach Relay (RTB) is a marathon relay race that covers 200 miles in 24 hours! It starts at Cannon Mountain in the White Mountains National Forest and ends at Hampton Beach in New Hampshire. The breathtakingly beautiful course wends its way through mountains, foothills and quaint New England towns, past lakes, streams, pastures and wildlife to finish where the Atlantic surf meets the sandy shore.

All this and during foliage season to boot!

I know it sounds crazy and in many ways it is, but itʼs a sell out event that draws teams from all over the country, many that return year after year. Hereʼs how it works. There are 425 teams, most consisting of 12 runners, that rotate through 36 transition areas, which means each runner will run 3 legs of varying length and terrain. There is an ultra division with teams limited to a max of 6 runners, if youʼre really crazy. The teams travel in two large passenger vans to ferry runners between the transitions. They make up silly team names and decorate the vans, some wear costumes, some are serious competitors and some run just for the fun of it.

They all come for the sociability that starts with high spirits amongst team members and builds into a wonderful camaraderie between all the teams and the volunteers along the scenic route.

This is not a charity event though RTB does donate part of its proceeds to the New Hampshire State Parks and the volunteer groups that man the transition areas. The transition areas are schools, churches, libraries and state parks and because these volunteer groups are local, it feels like coming home. Many groups do additional fundraising by selling tasty homemade food that has earned its own reputation and runner loyalties.

Why would a bunch of naturopaths want to do this, you ask? Well, the very fact that we are naturopaths means that we love a challenge and this race is challenging on many levels. Then thereʼs the tremendous fundraising opportunity - ask your friends, family, patients and the general naturopathic community to sponsor you and youʼll have the money to hire that lobbyist! Itʼs also a wonderful team building exercise - you get to spend 24 hours packed into a van with 5 of your soon to be closest friends and all their smelly gear as you support and cheer each other on. And, of course, thereʼs the outreach opportunity - there are over 5000 runners who are just waiting to be educated about the virtues of naturopathic medicine. So, herd together a dozen naturopathic cats, designate a team captain, start running and donʼt stop until you Reach the Beach!

The 2010 event takes place September 17-18. Donʼt wait too long though, as we usually sell out by the end of April. For full race details, go to the web site I have been with this event since its inception in 1999 and am presently the Director of Volunteers so feel free to contact me with questions.

Wednesday, February 17, 2010

The Governance Model - What It Is And Why We Use It

By Carl Hangee-Bauer, ND, LAc
AANP President

Worshipful Master's Gavel
Photo by Mr. Bill via Flickr, used under the Creative Commons License.

Over the past several years, the AANP has been hard at work building its capacity, including solidifying our budget, building a talented and dedicated staff, expanding member services, increasing corporate sponsorships, improving and expanding Affiliate relationships, and solidifying our presence at the national and state level. A key force that has allowed this strategic growth is the adoption of a Governance approach to the Board/staff relationship. Unlike the “working” Boards most of us are familiar with, the Governance model empowers the Board to strategically envision, guide and steer the organization’s growth and direction while entrusting the Executive Director and staff to manage the day-to-day business and affairs of the organization. Allow me to further acquaint you with the work of the AANP Board and its relationship to the staff.

As a governance board, the AANP Board’s ultimate responsibility is to define, enunciate and enforce our organizational mission in alignment with the interests of our members. To do this, the AANP Board must be a visionary body that creates and continually refines what we call Ends, or impact statements. Our charge is to define meaningful and appropriate Ends statements, approve a work plan to accomplish the Ends, and continually evaluate our progress in accomplishing our vision and mission. The process is as follows:

Development of the Ends - In a Governance model, the Board must define and continually refine the strategic objectives of the Association. This process has led to the creation of four global Ends Statements about how the work of the Association will favorably impact People, Naturopathic Physician Members, Institutions, and the Planet.

Creation of the Work Plan - A Governance Board has the authority to delegate the work plan to the Executive Director and staff so the Board is not caught up in the day-to-day work of the Association. The Board’s responsibility is to continually assess whether the work of the Association is benefiting our members, communicate the Association activities to our members, and institute course corrections when necessary.

Strategic Vision and Direction - The Board engages in a rigorous process to evaluate our progress towards achieving these “End” results. Thorough assessment of our strategic objectives requires that every Board member actively engage in work that informs our planning. Most often this is work that extends beyond the boundaries of the naturopathic profession. Assessing the power of external partnerships, exploring the impact of naturopathic medicine from an international perspective, and evaluating how technology can be used to demonstrate the effectiveness of the medicine are just a few of the ways our talented Board members work to ensure we are always looking forward - creating the future, rather than reviewing the past. We are planning for a future where naturopathic medicine is the gold standard for care!

I look forward to serving all of you, please contact me if you have any questions or comments.

Friday, February 12, 2010

Horse Paths

By Jacob Schor ND FABNO

Cherry creek state park
Photo by MetroDenver via Flickr, used under the Creative Commons License.

This winter my dog Poppy and I started following the horse trails that lead off from the off-leash dog area at Cherry Creek State Park. With the snow, the hard freezes, and the lack of horse traffic, these paths have opened up a new world for the both of us. This is because hardly anyone knows they are there, just a few enterprising souls, enough to pack down narrow trails in the snow. Some of the trails we follow are not actual horse trails but narrow tracks made by deer. I get to see the white flashes of their tails between the trees and luckily, Poppy rarely sees them as she has her nose to the snow, schnuffeling along in her world of smells. It’s the white of these tails and also the red flash of tail feathers as our approach moves the hawks from their tree perches that highlight my memories of these solitary walks through woods and meadow.

There is a problem with horse trails though. Horses don’t mind trampling through muck, mud, wetland and swamp. They do not complain about wet feet. The hard cold spells we have had this winter have allowed me to forget these details about the ground underfoot. That is until yesterday. We’re in the midst of a thaw, the temperature reaching 60 degrees F for the last few days. Yesterday when we started our morning jaunt, the mud of the main dog walk area was still frozen but as the sun rose, we found ourselves in situations that might be described as, ‘up a creek without a paddle’ or better, without a boat; the sun and warmeth thawed the ice bridges that had allowed us to wander freely through wetlands and swamp.

This longer than usual walk gave me room to sort out some thoughts I’ve been having. In the practice of medicine, or at least naturopathic medicine, we are not following the main roads, the ‘medical standard of care.’ For various reasons our patients have either, out of necessity or personal habit chosen a ‘road less traveled.’ Some of our patients are in the habit of always choosing roads less traveled in all areas of their lives, to the point it almost seems pathological. Others will wander off onto horse trails only occasionally when the route offers advantage.

We have to remember that these alternative, less-used paths are just that. They may not be as dependable as the main roads, they may be subject to changes, with the weather, the time, or the season. These past summers walking this same area, Poppy and I have seen water levels rise by several feet when a thunderstorm adds water upstream.

These thoughts reminded me of a recent paper on macular degeneration. For years the science has suggested we use a complex of antioxidant vitamins and plant extracts to treat this condition. Almost every supplement supplier we do business with makes an, ‘eye formula’ containing almost the same ingredients. According to a review written by Elizabeth Johnson at Tufts University and published last week, we need to change our prescriptions. Both beta-carotene and vitamin E, ingredients found in every one of these formulas, not only don’t help, but may increase risk of macular degeneration. Whoops.

Reading this information creates about the same sensation as having an ice bridge give way and finding yourself knee deep in water and mud. Cold water.

If we are going to choose the less traveled paths in medicine we need to keep alert and watch our steps more carefully than those following the well worn standards of care. We cannot just follow the crowd. No one is going to post a big sign telling when we need to change course.

These thoughts remind me of the book, Mount Analogue. I read this book at a young and impressionable age. It was written, though never finished, by Rene Daumal who died in 1944 and then published posthumously in 1952. Daumal was one of a group of European intellectuals who were mountain climbers, writers and apparently drug users. Daumal and his peers apparently had a habit of utilizing unusual substances, the most notable being carbon tetrachloride, to generate transcendent experiences. Regular exposure to this substance that will not lead to a long life. This book used mountain climbing as an analogy to describe his mystical views. Leaving the details aside, there is one particular passage that has stuck with me for four decades. In it Daumal tells climbers of the importance of marking new routes with cairns, or what we in this country call ducks. In the high mountains two or three rocks piled atop one another stand out and say, ‘I’ve gone this way.’ He then tells climbers that it is their responsibility if the, ‘route proves to go nowhere,’ to trace back their steps and remove the cairns they have left.

I think of this image sometimes when I’m reading research. There are many of us exploring new routes, new ideas and new techniques. It is our responsibility to tell others what route we have taken. It is also our responsibility to come back and tell others if a route is a dead end.

In the meantime, though closed out from parts of our walk by these unseasonable temperatures, I look forward to the summer where the gravelly stream bed provides a new path to explore. The dog and I have a summer route through the park, wading knee deep in the stream, using it as a route through the woods. The only problem is remembering to bring a waterproof container for my phone as sometimes the water gets deep, suddenly. I want to be able to call someone if I get lost.

A post script:
The most well known quotations from Daumal’s book, one that was printed on the cover of a Sierra Designs catalog in the 1960’s is:

"You cannot stay on the summit forever; you have to come down again. So why
bother in the first place? Just this: What is above knows what is below, but
what is below does not know what is above. One climbs, one sees. One descends,
one sees no longer, but one has seen. There is an art of conducting oneself in
the lower regions by the memory of what one saw higher up. When one can no
longer see, one can at least still know."

— Rene Daumal

Curr Opin Clin Nutr Metab Care. 2010 Jan;13(1):28-33.
Age-related macular degeneration and antioxidant vitamins: recent findings.

Johnson EJ.

Wednesday, February 3, 2010

Haitian Rhapsody

By Bill Benda, MD

Haiti Earthquake
Photo by the United Nations Development Programme via flickr, used under the Creative Common's License.

Has anyone reading these words ever been to Haiti? Do you wish to go there now? Have the pictures and stories of the past few weeks stirred a deep sense of compassion, perhaps a recognition and appreciation of communal experience, that we may not have felt since the early days of our medical education and practice?

This current crisis has brought mixed past and present feelings up for me, including humility, anger, despair, hope, appreciation, love, and fear. All have chosen to make their latent appearance because of one rather peculiar, personal circumstance of which I rarely speak, but which has apparently burrowed its way back into my consciousness after 15 years of intentional burial.

You see, in the summer of 1994, after six months of intentional unemployment during my second (in a series) medical career burnout, I was asked to travel to a small, heretofore unknown country in central Africa to lend aid following a major disaster, this one created by as well as perpetrated upon humans. I believe my little team of one American physician, two French nurses, and a French engineer, all recruited by the non-governmental agency Medecins du Monde (Doctors of the World), was the first collection of Caucasians allowed to step back into Rwanda during the waning weeks of ethnic hostility. And like the month of March, I went in like a lion, full of confidence and half full of arrogance, only to leave like a lamb two months later, all vestiges of pride and prejudice stripped from my bones, not only by the anguish laid upon innocent people, but even more so by the incredible grace with which they met their undeserved destiny, grace that I rarely witness within the privileged population of my own country. Refugee camps of 30,000 living in squalor, 14 year-old children with automatic weapons manning checkpoints every five miles of road, emaciated babies, orphan upon orphan with machete scars upon their heads and bodies. The truth is I was not prepared to handle much of the trauma. Today I am still not prepared to handle many of the memories.

So I have watched the unfolding of the Haitian crisis with a different perspective than most, one that takes in not only the power and heroism of our humanitarian response, but also the confusion, and guilt, and positioning, and photo opportunities that often cloud the minds of medical and media rescuers who land upon its shores as yet untouched by the immensity of the suffering of an entire population. And I know that those who have chosen to travel will return different people, carrying part of the Haitian wound within their own souls. And that by this fact they will return better people, and better practitioners, for the experience.

So, you may ask, am I tempted to travel to this island country to join in the immediate relief efforts? The answer in no, not at the moment, as there are more than enough people and supplies and assistance piling up at the lone airport and on ships waiting to be offloaded. Given that I have slipped into a different state of mind since my own distant adventure, I believe our naturopathic duties to the people of Haiti instead lie ahead, months from now, after those better prepared and better funded take care of the acute, critical needs of the people. Just as our task in this country is the rebuilding of bodies devastated by disease and prevention of future depreciation, our role in Haiti will be to restore health and comfort and to teach sustainability after the first wave of emergency care has completed its mission. It is not that we aren’t needed; in fact we will be desperately needed. Within a few short months.

There are, however, NDs who are at this moment planning for such an effort. Natural Doctors International, born in 2003 with the goal of bringing naturopathic healthcare to underserved populations while creating socially responsible opportunities for naturopathic physicians, is preparing a humanitarian response to the Haitian crisis. We (I serve on NDI’s board) are currently serving as the primary contact for North American based relief efforts within the naturopathic community. One of our initial projects is to sponsor a site visit to the island led by Sabine Thomas, ND, a Haitian-American graduate of Bastyr University who has, and has lost, family members in the earthquake. NDI is considering future team missions to the country, as well as facilitating local naturopathic care for refugees who may find their way to the U.S. and Canada. The AANP, CAND, all North American medical colleges, NABNE, and NMSA have joined us this effort, and should you choose, you can as well.

Global needs require global response, and I am unabashedly asking for your help. Tax-deductible donations can be made on the NDI website at by clicking on “NDI Haitian Relief Effort.” Updates on our progress will be posted here as well as NDI’s Facebook page. A list of suggested in-kind donations will be posted as well, and can be sent to the Bastyr University Haitian Relief Effort at 14500 Juanita Drive NE, Kenmore, WA 98028.

The truth is that the vis medicatrix naturae is not just about the human body; it is about the human soul as well. We already know how to heal the former, and this is a chance to address the latter, both in ourselves and in our Haitian brethren.

Please join us . . .

Tuesday, February 2, 2010

Getting Ready To Celebrate The Foundation of Medicine

By Sara Thyr, ND
16th July 2008
Photo by gregoryjameswalsh, via Flickr, used under the Creative Commons license.

This is the time of year when I am knee deep in reviewing abstracts. This is one of the most time-consuming yet inspiring jobs that one can volunteer for. (Luckily, it’s fairly short-lived.)

The deadline for abstracts was January 15. And, of course, at least half of what we have to review came in at the deadline. I appreciate that. I’m a deadline girl. But I know that made our convention organizers work like crazy to get those out to the committee.

It is really difficult to select one over another. I am amazed at the diversity of presenters and topics. So many of them catch my eye and make me very excited to see their presentations in August.

The AANP has been working to continue to increase practice development assistance for members, and there have been several excellent submissions so far that will fall into that category. There are also some great talks on pediatrics, women’s health, and mind-body medicine, and even cannabis.

This year marks the 25th anniversary of the AANP, so we’ve selected the theme of “Celebrating the Foundation of our Medicine” and it is wonderful to see how many people are submitting talks that will fit into that theme, reflecting on the roots of our medicine and the recognition of the modalities that have been used by our forebearers.

Submissions have come in from all over the globe, and from presenters of many different disciplines. Of course, most of our abstracts come from the naturopathic community, but we also have submissions from medical doctors, and several other disciplines, such as chiropractors, business specialists, and mind-body medicine researchers and practitioners.

We are working very hard to make sure that there is no corporate bias in the continuing education program at our convention. It is more transparent to all committee members when a presenter has ties to any company. We have eliminated corporate sponsored research, striving to make sure that our attendees' continuing education is from the highest quality education sources.

The committee is as well-rounded as its ever been, with members from nearly all of the different naturopathic medical schools. We have also asked that people on the committee not submit abstracts for presentations this year, hoping that this will free the other committee members to be as frank as possible as we discuss every abstract submission. Our consensus will be what our attendees will most appreciate.

As I review what all of these professionals have written, I feel so blessed to be a part of this diverse, passionate and brilliant community. I hope to see you in August as we benefit from the fruits of their labor.

Monday, February 1, 2010

Getting Over It

Guest Post By Christopher Johnson, ND

Samuel Hanneman Memorial
Monument to Samuel Hanneman founder of the
homeopathic school of medicine. Photo by dbking
via Flickr, used under the Creative Common's License.

A group of so-called “skeptics” recently staged public relations events at various cities in Great Britain designed to discredit the science of homeopathy. Yawn.

These hooligans purport to stand up for scientific principles, while in fact their zealous dogmatism and denial of evidence would make Galileo’s persecutors proud. Score one for book burning and witch trials.

But me thinks thou dost protest too much.

They named their campaign “10:23”, a reference to Avogadro’s number. This number is significant to chemists in that it supposedly sets the limit below which no material elements are likely to be present in a given dilution. Homeopathic remedies are made with solutions far more dilute than Avogadro’s number.

Do these “skeptics” really think the public cares about Avogadro’s number when homeopathy has just significantly improved their toddler’s autism or offered help with any of a vast range of diseases which respond so well to homeopathic (and often not to conventional) treatment?

This is just another tantrum by the clueless wing of the scientific/medical community that can’t understand why the people don’t praise them for their ideological purity and courage, even when the fruits of their scientific labors rot like a brown banana. Note to protestors: maybe they’re just not that into you.

As Peter Fisher, personal physician to Queen Elizabeth II and editor in chief of the journal Homeopathy so eloquently pointed out in a letter to the Canadian Pediatric Society, “[you are] not alone among bodies representing the medical establishment in countenancing almost any explanation for the popularity of homeopathy except the obvious one – that it is effective!”