Health, Sustainability, and Time Banking

By Sara Thyr, ND

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

As a naturopathic doctor and a small business owner, I am always looking at ways to build my practice. As a permaculture enthusiast, I also search for ways to incorporate more sustainable practices into my life. An exciting find that does both is Time Banking.

As we face these difficult times, Time Banks can help build community, empower people of all ages and skills, and reduce our overall environmental footprint.

Time Banks were created in 1980, during a time of serious funding cuts for social services. With less money available for social programs, civil rights lawyer Edgar Cahn created a system where one hour spent helping someone else earns one Time Credit. People can earn a Time Credit for every hour they spend helping others or building community, and spend one Time Credit for every hour for which they receive help. I help you, you help another, and that person helps someone else down the line.

There are hundreds of Time Banks all over the world, in 33 countries and 36 states. The IRS has ruled that Time Banks are tax exempt, since it is not the same as the barter system, and a Time Credit does not have any attached cash value. Services exchanged are those that help build communities and healthy societies: homework help, housecleaning, oil changes, gardening, driving to appointments, cooking, office assistance, and naturopathic medical care.

The implications for the profession of naturopathic medicine are clear: help build community, increase awareness of how we improve health, treat those who otherwise might not receive care, and receive the services you need in return. People feel empowered because they are converting their own personal time into purchasing power by helping others and sharing their skills and talents. The effects of this system are beyond self-help – they are system change. The reasoning is simple: any efforts to address major social problems with social programs are more effective when they enlist and engage the target population as contributors and co-producers. Time Banking enables people and even organizations to create connectivity, reciprocity, trust, and informal support networks that remain even after the paid intervention is over. Regardless of services offered, whether it be childcare, eldercare, juvenile justice, housecleaning, auto repair, landscaping, family preservation, health care, or community development, programs and service professionals continue to be convinced that when participation from the clients is absent, initiatives fail to realize their true potential. When those who would normally be clients are moved into partners and co-producers, they not only earn the service, but also validation and empowerment as important contributors to society.

Naturopathic medicine has always been community medicine to me. It is more cost effective and empowering. It makes sense that communities will find it to be the most positive and sustainable form of health care available. Any effort to build relationships builds a stronger community and certainly a stronger practice. While I do not mind being absent from the game of insurance, I have often wished that there were a way to treat the people with limited income. Time Banking moves from the difficult systems of sliding scale or barter into one which will not only achieve the goal of opening the health care system, but also keeping the patients involved as partners in their health and in the building of their communities.

Thanks for help with Time Banking information to Anita Smith and http://www.timebanks.org/.

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.