Thoughts Ahead of the 2010 Convention and Elections

By Carl Hangee-Bauer, ND, LAc
AANP President

The days of summer are filled as we approach our annual convention and elect our newest AANP leaders.

As I write this, the AANP convention in Portland is only 3 weeks away! All over the country and especially in Washington, D.C., preparations are underway to make this one of our best gatherings to date. As I’m sure you all know, this year we mark our 25th anniversary as an organization and we plan to celebrate in a big way as we look back at the accomplishments the AANP has made and, more importantly, look to the future and imagine what we can accomplish in the next 25 years.

In the days before the convention opens, leaders from the naturopathic profession will gather in Portland to focus on business and planning. The AANP Board has a two-day meeting planned including a one-day board retreat to focus on how to increase our effectiveness as a team. The House of Delegates will meet and consider a variety of topics including ethics and standards of care. The Naturopathic Coordinating Council, a summit of leaders from across our profession, will come together at NCNM to develop a strategic vision for the viability, sustainability, and success of the naturopathic medical profession in the context of global health and wellbeing. These are but a few of the meetings held in advance of the big event.

On Wednesday, August 11th, the fun begins as our tribe comes together for four days of education, reconnection, and celebration. The quality of the continuing education sessions is outstanding, with many of our favorite speakers and teachers presenting, including Dr. Steve Austin, Dr. Jared Zeff, Dr. Joe Pizzorno, Dr. Michael Traub, Dr. Lise Alschuler, Dr. Dickson Thom, and a host of others who are very popular with our convention attendees. Personally I’m really looking forward to Drs. Schor and Bloom’s session on gelotology and hope my busy schedule allows me to attend as many sessions as possible.

As great as our sessions are, the reconnections we make each year (seeing old friends and making new ones) and the alumni events and receptions are what reinvigorate and inspire me the most. We are a relatively small profession, which makes it possible to know many of our peers on a very personal level. The friendship and intimacy we have as a group is very special and becomes especially evident when we come together.

There will also be more time for fun with a family picnic planned for Friday afternoon and, of course, our gala awards banquet and dance on Saturday night. We have quite an evening planned, where we will honor our leaders and pioneers as well as look forward to the potential this profession has in improving the health of our patients, the nation, and the world. This is an event not to be missed! As the Beatles would say, “A splendid time is guaranteed for all.” I hope to see you all there.

On July 24th, our voting opens for our next President-Elect as well as new board members. The AANP is a member-driven organization. We elect our leaders to represent our interests, and the officers and board members of the AANP consider this with every discussion and decision we make. We are here to serve you and to meet your needs as best we can, and your input into the elections process and your vote are crucially important in choosing our leaders and the direction the AANP takes.

I am very impressed by our list of candidates this year. All have demonstrated leadership and a desire to serve. We have two of our finest running for President-Elect: Dr. Tim Birdsall and Dr. Michael Cronin. Both have extensive leadership experience, are committed to the profession and the AANP, and have a clear vision as to how to move this profession forward. Please take the time to read the candidates statements and the responses to the weekly “Meet the Candidates” emails you’ve been receiving so you can choose who best fits your vision for the AANP.

And most importantly, VOTE. The voting is easy, will be online this year, and will close August 6th. Make your voice be heard!

I look forward to seeing you all in Portland at what promises to be a memorable event!

Order Matters

By Jacob Schor, ND

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

If order matters, what comes first?

The implications of a study published way back in February in Clinical Cancer Research have been stewing around in the back of my mind. It’s one of a growing cascade of studies in which researchers at fairly mainstream medical institutions reveal that they’ve been playing with stuff that’s standard fare on a naturopathic doctor’s dispensary shelves.

In this instance we are talking about researchers from the Mayo Clinic in Minnesota playing with various combinations of curcumin, an extract of turmeric and green tea, and seeing how they affect lymphocytic leukemia cells.

As much as we still occasionally hear and read the myopic criticisms of our profession that claim our therapies are not backed by research, this study is just one of many. A PubMed search just now of the National Library of Medicine’s published scientific literature on curcumin and cancer yields a list of 1,265 articles. A search on green tea and cancer yields 1,338 published papers in the peer reviewed journals.

This particular study was similar to many others; cancer cells were grown in a laboratory, exposed to the ‘natural’ ingredient, and the degree to which growth was slowed down or that cancer cells were inspired to drop dead was measured. In this particular experiment, chronic lymphocytic leukemia B cells were the targets. Nothing unique about this setup.

And no surprise that the curcumin was found potentially useful. Here let me quote from the results in the abstract and then translate the interesting parts:

“Curcumin induced apoptosis in CLL B cells in a dose-dependent (5-20 micromol/L) manner ...”

‘Apoptosis’ is when a cell decides life isn’t worth living and self-destructs. Curcumin convinces these leukemia cells to commit suicide. The more curcumin added to the cells, the more died.

“Coculture of CLL B cells with stromal cells … decreased sensitivity to curcumin.”

Adding some other cells, stromal cells, into the mix decreased the curcumin effect; fewer cancer cells died.

“When curcumin was administered simultaneously with EGCG [green tea], antagonism was observed for most patient samples.”

Adding green tea extracts along with curcumin to the mix of leukemia and stromal cells caused, what these scientists called ‘antagonism.’ That’s an odd term and you need to view the full text article to get an idea of what they mean by antagonism. Put simply, the combination of the two natural substances, green tea and curcumin, didn’t work as well as predicted: “… simultaneous culture had a less than additive effect.” That is if you measure the anti-cancer effect of each substance separately, you can add the two ‘effects’ together to predict what should happen when both are used simultaneously. It turns out they don’t work as well as predicted; they antagonize each other.

“In contrast, sequential administration of these agents led to substantial increases in CLL B-cell death ...”

When instead of adding both curcumin and green tea to the culture at the same time, the cells are instead exposed to one agent and then the other, the story changes completely. They tried treating the cells first with curcumin followed by green tea, and vice versa. To quote the authors, “… sequential administration led to dramatically more leukemic cell death than simultaneous administration.”

Not only did exposing the cancer cells to these substances one at a time matter, but order mattered as well. Green tea first, followed by curcumin, worked much better than if the cells were exposed to curcumin first.

Think about the implications this brings to our practices. Sequential administration of treatments may work better than simultaneous treatments. Order matters. In this case green tea works better first.

Typically in practice we pile a bunch of different substances into a patient’s blood stream on the assumption that each has a specific action and these effects will add together. This reminds me of those combination locks that have four or five parallel numbered rings and to open the lock. You line up a number on each ring, get all the right numbers in a row at the same time, and the lock opens.

This leukemia study makes that image obsolete. If sequence matters, just knowing the combination is no longer enough. This is more like the dial lock on a safe. Sequence is essential. Three turns to the left and stop on the right number, then turn the dial to the right past your first number and stop on another specific number. And so on…

Think about this: our cancer patients often take a long list of supplements. This study suggests that, at least in chronic lymphocytic leukemia, we should start them on green tea for a period of time and then switch to curcumin. What if it is a similar story with quercetin, resveratrol, sulforaphane, vitamin D, melatonin and so on? What if there is a ‘best sequence’ for all of these? What if that combination were to vary by cancer? By patient? Or even by dose?

This is worth stewing about. It makes me think of certain patients who tell me they vary what supplements they take day-to-day based the way a pendulum held in their hand swings. Though this sounds less than ideal, it can’t work any worse than flipping a coin to decide on a sequence, which for the time being may still be of some utility.

Now that this study has been published, we shouldn’t be surprised to see other studies up asking this question: “If order matters, what comes first?”

Ghosh AK, Kay NE, Secreto CR, Shanafelt TD. Curcumin inhibits prosurvival pathways in chronic lymphocytic leukemia B cells and may overcome their stromal protection in combination with EGCG. Clin Cancer Res. 2009 Feb 15;15(4):1250-8.

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 . . .

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.