Natural Practitioner (NP) convened a panel of experts to discuss this movement toward a more shared practice and asked them their thoughts on what 2015 might hold as the CAM model continues to move in that direction.
• Emily M. Gonzalez, ND, Senior Scientific Development Associate, Life Extension
• Gillian Hanson, ND • Holly Lucille, ND, RN, The Body Well
• Shidfar Rouhani, ND, DC, BSE-MS, NR-EMT, Core Faculty, Bastyr University California and Clinical Faculty Member, Bastyr University Clinic
• Amber Lynn Vitse, BA, LMT, CN, Northeast Educator for Garden of Life
As we usher in 2015, and the cost of health care continues to rise rapidly in the U.S., the health care model is beginning to feel a seismic shift as complementary and alternative medicine begins to take its place among more traditional Western medicine models. The key word moving forward appears to be “collaboration” among health care practitioners, who now seem more eager than ever to share their knowledge and break down the barriers that have separated the two sides for far too long. In fact, recent numbers have shown that nearly 40 percent of adults report using complementary and alternative medicine, prompting many physicians to embrace CAM therapies and move toward combining them with more mainstream medical therapies.
NP: What are some of the biggest challenges facing CAM practitioners in 2015? Did the industry meet or exceed the biggest challenges of this part year?
Gonzalez: In the dietary supplement industry, continuing to provide products with innovative ingredients that have clinical research to support them is especially important to the modern consumer. Consumers have a wide-range of options to choose from, with retail, professional-only and online brands all vying for space in the marketplace, and they are savvy about the quality and effectiveness of their supplements. Products backed by solid research with quality ingredients are key.
Hanson: One of the biggest challenges the industry has faced this year, and continues to face currently, is the rising cost of education. Naturopathic medical students pay the same exorbitant costs for education as conventional medical students, and, yet, make significantly less money than their conventional counterparts, have access to very few salaried positions, and have next to zero opportunities toward public service loan forgiveness. If we want to continue drawing bright, dedicated people to our profession, we need to create more opportunities for our graduates to thrive. We are making terrific strides in establishing an increasing number of residency positions for our grads, but we have a long way to go.
Lucille: I think one of the main issues that continues to be a challenge is our identity. Too many people still think it is “out of pocket” and that they are tied to their insurance based doctors and don’t understand that it is about partnership, wellness and the approach, not the agent. It is not just about Prozac vs. St. John’s wort… it is so much more. There is also the problem of marketing and the outrageous claims from subpar manufacturing companies that simply wait for Dr. Oz to say something and then make it and sell it with no intention or integrity.
Rouhani: I see the CAM world plagued with a lack of collaboration. I spend a great deal of time explaining naturopathic medicine to fellow herbalists, chiropractors, and other healing art practitioners; halfway through our conversation I get an almost universal response of “we should collaborate” on this or that. In the conventional medical world the area of expertise for a medical specialist is clearly defined and MDs are trained to refer and collaborate with other specialist. For example, if your primary care doctor is having trouble determining the cause of your abdominal pain, then you are likely to get a referral to a gastroenterologist (GI) with the specialty training to help you. In contrast, a homeopath or herbalist may never consider that your case is complicated by underlying musculoskeletal issue that would improve with chiropractic care or physical therapy. I think the CAM world is still a few years out from meeting this collaboration challenge, but I’m glad to see that we are headed in that direction.
Vitse: I imagine my perspective may be a bit different from some practitioners, though I’m sure we can all agree that educating our clients/patients is a big necessity. I really believe we are still in a place where we have to further create our market through education. I’m still amazed at the number of well-educated people I come across who know very little about real health. We still have a lot of work to do, maybe in a savvier way, to educate the mainstream.
NP: Is the blend of traditional Western medicine with alternative medicine becoming more commonplace? Is this a trend you expect to continue?
Gonzalez: More and more doctors are using an integrative medicine approach in their practices. There are a multitude of integrative medicine training programs across the country and the world. Doctors everywhere are breaking free of the conventional one-size-fits-all approach to disease management. In the dietary supplement world, novel formulas with scientific research are now available from forward thinking organizations. These products provide meaningful benefits for integrative practitioners and their patients.
Hanson: Yes, I certainly see the integrative concept becoming more widely accepted. I find this to be especially true around diet, exercise, acupuncture and specific forms of bodywork like massage. I see more conventionally-trained doctors becoming increasingly disenfranchised with the medicine they can provide on a “seven-minute appointment” schedule. That, coupled with the fact that their reimbursement is moving toward an outcome-based model, seems to make them more open to alternative therapies that will safely produce positive results. This provides an enormous benefit for the patient. As CAM becomes more commonplace, this also leads to greater communication between providers and more options for the patient.
Lucille: I would say it is more “conventional” Western medicine. But yes, I think I see more of a blend for sure …the benefits are that there is truly value in both systems but it is about empowering the user to understand the difference.
Rouhani: I have noticed an amazing shift over the last decade toward an increase in the blending of Western and alternative medicine. Increasingly, you find that medical centers and large groups of medical practitioners have CAM practitioners on staff to provide their patients with a holistic approach to their healthcare. One really great example of this is the holistic model at the Cancer Treatment Centers of America, where a cancer patient is cared for by a team of people that would include an oncologist, a naturopathic doctor, a nutritionist and many other CAM specialists.
Vitse: It depends on where you live. I just moved to Brooklyn. Finding integrative practitioners, especially trying to match up insurance plans and locale, is challenging. Again, I think in part it’s because we just aren’t as savvy about our marketing. We aren’t as visible because that is “not our department.” We just want to help people. Most patients and clients tie together several different practitioners in different areas. I’d love to see more combined practices that are truly affordable.
NP: As health care costs continue to rise, do you expect the role of CAM practitioners to gain greater acceptance?
Gonzalez: Complementary and alternative medicine is based on prevention of disease through lifestyle and dietary means, along with proper use of nutritional supplements. These kinds of interventions are inexpensive compared to most prescription drugs, surgery and hospitalization. With the realization that many of the most common diseases we battle today (heart disease, cancer, depression) are lifestyle diseases, a medical paradigm that helps prevent these diseases is what is needed.
Hanson: Health care costs continue to rise, and perhaps more importantly, insurance plans seem to have higher and higher deductibles, even employer-sponsored plans. As patients bear more of the cost of their own care, they inevitably become more price-sensitive. Because many CAM providers are not contracted with insurance providers, their prices are generally far lower than the astoundingly marked-up costs we see from traditional providers who are contracted with insurers. As a result, I think CAM providers that provide primary care services will see more patients willing to pay reasonable out-of-pocket rates. So I think there will be more acceptance toward seeing CAM providers in that respect. Also, the momentum continues for a greater push toward the prevention model of disease, of which diet, lifestyle, and stress reduction plays a huge part. We need to be more vocal and specific about what CAM has to offer in this regard, and continue providing high-quality studies to back up our claims.
Lucille: Yes and no. People might cling to what they can get from their insurance or if we do a good job, we can help them actually take better care of themselves and their families.
Rouhani: Complementary and alternative medicines are amazingly effective and by their very nature of efficacy are gaining widespread acceptance despite rising health care costs. I will never forgot what a patient of mine once said as he was about to leave my medical center in Portland, OR; “Doc, it is cheaper for me to pay you out-of-pocket for the visit or two I need each month than for me to try to pay for insurance.” The work I do as a naturopathic doctor gets people feeling better faster so they don’t have to be seen so many times for so many years.
Vitse: Well, I don’t know about anyone else, but I was disappointed to find I could not actually choose to pay a small amount for mere catastrophic-level health care and save my money to spend the way I wished. On the other hand, if there are tests, medications and therapies that are not covered or too expensive for patients, I do think they will seek alternatives. Like in Europe, it can be prohibitive to get into your MD, so many people find alternatives, “The People’s Medicine.”
NP: Does the CAM model need to change moving forward? In what ways specifically?
Gonzalez: Instead of thinking of this form of medicine as complementary and alternative, the paradigm needs to change so that this form of preventive medicine is thought of as the foundation for health and wellness. This can save both money and lives.
Hanson: This is a small part of the CAM model, but I’m concerned about how often our profession is associated with an ascetic style of living, particularly around diet. It scares people off, and it lends itself to a considerable amount of shaming and guilt that truly serves no one. Specifically, I think we need to shift our dialogue away from messages like “gluten free,” “diary free,” etc., and more toward an emphasis on flexibility and abundance with messages like “veggie full.” I feel very strongly about getting away from a good/bad paradigm of food choices.
Lucille: We need to be more patient-specific, more approachable and patient-oriented, and less profit-oriented for things other than our time, knowledge and service.
NP: Are you seeing any major shifts ahead in the CAM industry?
Hanson: I believe technology will play a greater role in how CAM providers engage with their patients, specifically through the use of wearables, apps and other monitoring devices. Making diet and lifestyle changes is very, very hard. These technologies provide tools to engage the patient in their health during all those moments when they are not sitting right there in your office, i.e. at those times when it’s much more challenging to focus on healthy choices. It’s the ultimate way to meet people where they are at. They help provide objective metrics to track progress. Lastly, change can be painful and apps and wearables can make the process truly fun. Having fun leads to engaged, healthier patients invested in their well-being.
Lucille: I hope so but I’m not sure. We need to continue to educate the consumer!
Rouhani: I think growth hormone (GH) will be a hot trend in 2015. I’ve seen exponential interest in it’s many uses over the last decade for everything from anti-aging to getting tissues to heal years after injury. I know it is a little taboo given the overuse in sports, but in lower/clinical doses I have used it to do amazing things.
NP: Will the role of natural practitioners changes in the year ahead?
What can they do to continue to ensure the best care for their patients? Gonzalez: As the Affordable Care Act is enacted and natural practitioners see how this legislation is regulated in their state, it may shape how they can provide care. Natural practitioners from accredited schools have extensive training that allows them to provide effective primary care. Now through certain language in the Affordable Care Act (Section 2706 – the “non-discrimination” provision of the Affordable Care Act), there may be greater insurance coverage that will help patients find an integrative practitioner and help the country fill the primary care gap. To ensure the best care for their patients, integrative practitioners should use science-based dietary supplements that provide proven benefits.
Hanson: My hope is that the role of the natural practitioner continues to shift from a solo voice on the periphery to a trusted, valued voice as part of the patient’s health care team. The best thing we can do for patients is to be in communication with the rest of the team. Now, I’m biased—I’m part of the founding team of a San Francisco-based start-up, PicnicHealth, that helps patients collect and electronically organize their medical records, and keep all providers up-to-date on what the others are doing. I strongly believe that truly holistic medicine means that all providers are on the same page, and this is the best thing we can do to ensure the best care for our patients.
Lucille: Try to get them (patients) not to need us (practitioners).
Rouhani: Patients continue to expect more and more from natural practitioners. One area where I see an expansion of my role is providing customized medicines. I have never been one for stocking my office shelves with lots of products. Rather, I see that I can ensure the best care for my patients by making them a customized medicine. For my practice this includes the gambit from custom encapsulations, to botanical tinctures, to customized creams and salves. No two patients of mine have the exact same need, so no two of my customized preparations are the same. In my opinion, this is the best method for treating every patient for his or her unique case.
Vitse: We must expand and deepen our offerings, expand our referral lists, work together in more collaborative networks and keep up to date on the latest information and research. So many truths we have told for so long to our clients and patients, truths that were demonized by the conventional establishment, have been proven in the last few years.(Importance of D3, importance of K2, microbes and gut health, leaky gut and autoimmune diseases as well as cognitive function, fluoride in water, etc.) If we keep up and remain diligent, we will continue to reveal profound and important information and gain stronger footing among all practitioners.