Role of the Natural Medicine Physician Within the New Health Care Paradigm - Joe Pizzorno


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Role of the Natural Medicine Physician Within the New Health Care Paradigm by Joe Pizzorno, ND.

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Role of the Natural Medicine Physician Within the New Health Care Paradigm - Joe Pizzorno

  1. 1. Role of the Natural Medicine Physician Within the New Health Care Paradigm Joseph Pizzorno, ND President Emeritus, Bastyr University Editor, Integrative Medicine: A Clinician’s Journal President, SaluGenecists, Inc. Copyright © 2011 1
  2. 2. Dr. Joseph E. Pizzorno, N.D. • Academic o Founding president of Bastyr University, first accredited, natural medicine university o Editor: Integrative Medicine: A Clinician’s Journal o Speaks worldwide to academic institutions, healthcare professionals, public and legislators o Textbook of Natural Medicine, 3nd ed. 2009; 4th edition now in process o Adjunct Professor, South Pacific College of Natural Therapies • Policy o Member Medicare Coverage Advisory Committee, 2003-2005 o Member White House Commission on CAM Policy, 2000-2002 • Public o Chair, Board of Directors, Institute for Functional Medicine, 2006- o Encyclopedia of Natural Medicine, 1998 (1,000,000 copies in six languages) o Encyclopedia of Healing Foods, 2005 • Example Awards and Recognitions o Juror for Roger‘s Prize - 2009 o Institute for Functional Medicine – Linus Pauling Award, 2004 o American Holistic Medical Association: Pioneer in Holistic Medicine, 2003 o American Association of Naturopathic Physicians: Physician of the Year, 2002 o Natural Health Magazine: Leading health educator in the past 30 years. 2001 o Alternative Healthcare Management: 1 of the 4 most influential CAM leaders, 2000
  3. 3. Overview1. Why do patients come to see us?2. Do we believe in wellness?3. How does a wellness orientation in primary care contrast with the conventional medicine approach to patients?4. How can this fundamental change in patient care impact the healthcare crisis?5. Is there any research to support a wellness rather than disease-centric approach?6. What are the political and insurance reimbursement hurdles that need to be overcome to provide an environment to not only allow, but nurture this better approach to healthcare.7. Finally, what does an optimal healthcare system look like and how does the natural medicine physician fit in? 3
  4. 4. Conventional Medicine: Many Successes• Huge success in acute illness, trauma and life- threatening disease• This was accomplished through: o Disease-treatment focus o Standardization of disease, diagnosis, therapy and, unfortunately, people o A huge investment of our country‘s resources o Active suppression of other ideas and practices• However o Many problems and limitations have surfaced (as predicted by natural medicine doctors a century ago)
  5. 5. Why Do Patients Come To Us?• Heavy DISEASE BURDEN o And it is getting worse…• High incidence of SIDE EFFECTS• Out-of-control COSTS• The MYTH of increased longevity
  6. 6. Heavy Disease Burden • Only adults: 18-64 yo Incidence of Chronic • Only 6 most common dzs Disease • Does not include ―ill- 50% health‖ 40% 3+ o Adds 15-20% 30% 2 • Those with the poorest 20% health habits develop 1 chronic disease 5 years 10% earlier and their disease is 0% twice as severe.Wilper AP, et al. A National study of chronic disease prevalence and access to care in uninsuredU.S. adults. Ann Intern Med. 2008;149:170-176Vita Aj, et al. Aging, health risks, and cumulative disability. NEJM 1998;338:1035-41
  7. 7. Despite Increasing Use Of Drugs And SurgeryPrescription drug use, past month Coronary artery stent procedures 1 in 7 restenose within just 1 year!
  8. 8. Surprising Incidence of Adverse Drug Reactions• Not anti-medicine, but real, undisclosed problems• Doctor: adverse event in 4-18% outpatient visits• Patient: 25% of 661 outpatients, 13% serious• Result: o 116 million extra physician visits o 77 million extra prescriptions o 18 million ER visits o 8 million hospital visits o 199,000 additional deaths o $77 billion extra costs (equivalent to diabetes) Wiengart SN, et al. Epidemiology and medical error. BMJ 2000;320:774-7 Gandhi TK, et al. Adverse drug events in ambulatory care. 2003;348:1556-64
  9. 9. Increased Longevity?
  10. 10. Out of Control CostsMarshall E. Science and the stimulus. Medicine under the Science. 2009 Nov 27;326(5957):1183-5. 813a5.htm 10
  11. 11. Walter Bortz, II, MD in Next Medicine• Symptoms of ―Current Medicine‖ o Excessive cost • Ex: Health insurance costs rising 4x faster than workers earnings o Injustice/Inequity • Although he advocates for universal health care, he is ―convinced that adopting a universal health insurance policy…..will by itself contribute only marginally to Americans‘ health‖ o Harmfulness • Annually, iatrogenesis causes equivalent of 3 747‘s crashing every day. o Corruption • Ex: Vioxx & Merck, unnecessary surgeries, etc. o Inefficiency o Irrelevance • This symptom he considers to signify a complete disconnect between our health and health care system
  12. 12. Walter Bortz, II, MD –Irrelevance of “Current Medicine”• ―Current medicine lacks the philosophical, moral, and scientific conceptual framework that would make it capable of helping‖ [diabetes, aging, and obesity]• ―It reaches into its black bag for a remedy. In the bag are the fundamental tools of the medical industrial complex: surgery and pills.‖• ―These two treatments represent nearly all of Current Medicine‘s $2.5 trillion annual budget, but they are powerless against aging and diabetes.‖• 72% of physician visits are now due to chronic conditions 12
  13. 13. Walter Bortz, II, MD• Mission of medicine is to assure and assert human potential• Calls for a new paradigm in medicine, which restores the balance between Hygeia and Panacea (health preservation and repair, respectively)• In legend, Hygeia is the daughter of the god of medicine, and is closely correlated with the origin of the vis medicatrix naturae. 13
  14. 14. Do We Believe in WELLNESS?• Is NATURAL MEDICINE about therapies? Or about concepts & intent?• Despite assertions of ―treating the person not disease‖, most therapies focus on selecting the appropriate herb, nutrient, manipulation, acupuncture technique, etc. No matter how natural, many still have a focus on disease.• Do we truly believe in the body‘s ability to heal, and does this not trump disease? Do we believe in wellness? 14
  15. 15. What Really is Nature Cure? • NATURE CURE is simply restoration of wellness—by whatever means most appropriate for each unique person—as this is how the body removes disease • Isn’t it our profound ability to recognize the inherent striving for wellness inherent in life that differentiates us? • And isn’t this what our patients are—often unknowingly—seeking? 15
  16. 16. Treating Symptoms With Natural Therapies is Still Allopathy• When a person is depressed, it is not due to a lack of Prozac.• Nor is it due to a deficiency of St. John‘s wort.• It could be due to a lack of sunshine, and vitamin D• Are they toxic, are they eating the wrong foods or not enough of the right ones, or is their life without meaning.• Isn‘t seeking and acting on this understanding the core of NATURE CURE? 16
  17. 17. Is a Belief in Wellness a Recognition of the Vis?• The VIS embraces VITALISM.• Natural medicine is fundamentally a vitalistic practice (vis medicatrix naturae)• The best doctors facilitate their patient‘s belief in their health and ability to get healthy o Placebo is still more effective than virtually every drug• Without understanding the vis, how do you know if your patient is actually improving rather than just suppressing symptoms? o Is the patient HEALTHIER after your treatment? 17
  18. 18. Pizzorno (2007) I have been involved in naturopathic medicine for 35 years, and I still can’t define it. Nonetheless, we can see the Vis in others—it is something we all sense. As a clinician, you watch the level of a patient’s vitality; when it increases you know youare on the path to cure, but if it decreases then you are only palliating symptoms and suppressing the individual’s expression of the Vis. 18
  19. 19. Bill Mitchell, ND• 1948-2007• Co-Founder Bastyr University• Inspiration teacher for 20 years• My friendThe following slides on Bill‘s philosophy used with permission from Leanna Standish, PhD, ND, LAc 19
  20. 20. Bill’s ConceptsVMN = the healing power of natureVNM = the self-organizing property‗The VNM functions in any given living system as the tendency to organize that system so as to maintain existence‘.The Vis is universal. ‗A fascinating assumption… is that life on other systems contains an internal intelligence for self- maintenance as well, meaning that the Vis exists universally and is a cosmological reality.‘ 20
  21. 21. But Bill Goes on to Say…The Vis is not weakened or strengthened by the weakness or strength of the individual. The VMN exists internally and universally.This is best thought of as an equation that exists during the life of the system….And while the inputs into an equation…can change the value of X, Y, or Z, the equation itself exists as a structure in which these values interact with each other.‘ 21
  22. 22. Wisdom from Dr. Standish• Naturopathic medicine distinguishes itself philosophically from mainstream medicine by its core principle Vis medicatrix naturae, the healing power of nature.• Its insistence on referring to the ‗vital force‘ has served to isolate, and perhaps sideline, naturopathic medicine from mainstream conventional and pharmaceutical medicine of the second half of the 20th century, which has been historically based exclusively on scientific materialism. 22
  23. 23. Dr. Standish Concludes• However, the experimental findings from quantum mechanics in physics, neuroscience, and the distant healing literature suggest that scientific materialism is an incomplete description of reality and thus cannot be the sole philosophy of modern medicine.• The findings of the ‗new science‘ support the concept of biological field effects, macro- entanglement, non-local interaction, and downward causation. A ‗new medicine‘ is emerging in the 21st century. 23
  24. 24. My Current Thinking Vis is the manifestation of the universalConsciousness in biological form. Our environment, beliefs, interactions with others, actions, lifestyle,diet, etc. modulate the manifestation of Vis as ourvitality, but Vis itself is immutable. As we harmonize with the Vis, our consciousness expands . 24
  25. 25. Jeffrey Bland, PhD• Conversation with Dr. Szyf @ McGill University: o ―Rather than these diseases being hard-wired into our genes ..our responses that give rise to disease are adaptive responses to an altered environment, in which the outcome over time, through the epigenetic modulation, becomes a disease. In other words, we dont have diseases wired into our genes, we have physiologic responses to environmental modulation wired into our genes that then creates an outcome thats later called our phenotype of health or disease..‖ FMU. November 2010 25
  26. 26. Wellness vs. Conventional Orientation in Primary Care• Former head of CDC and Surgeon General: ―We spend well over 90 percent of our national health budget treating diseases and complications—many of which could have been prevented in the first place…. ―• ―I hope that the day will come when all health care providers will write prescriptions for prevention for patients‖ Satcher D. The prevention challenge and opportunity. Health Aff (Millwood).2006;25(4):1009-11 Schroeder SA. Shattuck Lecture. We can do better--improving the health of the American 26 people. N Engl J Med. 2007 Sep 20;357(12):1221-8.
  27. 27. How Does Fundamental Change inPatient Care Impact Healthcare Crisis? • Reduced Disease Burden o Ex: Myocardial infarction & INTERHEART STUDY o Risk of myocardial infarction almost entirely attributable to modifiable risk factors, specifically lifestyle behaviors o Although genetic predisposition influenced physiological function and risk of disease, it was largely modifiable by how people lived o Preventable illness is thought to make up at least 70 percent of the burden of illness and the associated costs OKeefe JH, et al. Primary and secondary prevention of cardiovascular diseases: a practical evidence-based approach. Mayo Clin Proc. 2009 Aug;84(8):741-57. Fries JF, et al. Beyond health promotion: reducing need and demand for medical care. Health Aff (Millwood). 27 1998 Mar-Apr;17(2):70-84.
  28. 28. Change Cuts Health Care Costs Too• Reduced healthcare costs o Even a modest focus on prevention, early intervention, and behavioral change could save annually in treatment and productivity loss costs an estimated $217 billion and $1.6 trillion, respectively o Greater emphasis on primary care and health promotion, less specialty care• Greater function, longer healthspanA wellness initiative for the nation, 2008. 28
  29. 29. Research Supporting Wellness • Prospective study of over 20,000 men and women o Individuals that did not currently smoke, were physically active, moderate alcohol intake and plasma vitamin C indicative of at least 5 servings of fruits and vegetables a day have a 4-fold lower risk of mortality than the those with the least healthy behaviors. o Greater than a 2-fold difference in stroke risk o Equivalent to 14 years in chronological age • Diabetes Prevention Program Trial o High risk for diabetes, adopted minimal lifestyle change o Compared to placebo, lifestyle changes delayed the onset of diabetes by 11 years, metformin only 3 years o Lifestyle intervention was found to be $1,100 per quality adjusted life year (QALY), while metformin was $31,300Khaw KT, et al. Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospectivepopulation study. PLoS Med. 2008 Jan 8;5(1):e12.Myint PK, et al. Combined effect of health behaviours and risk of first ever stroke in 20,040 men and women over 11 yearsfollow-up in Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): prospective population study.BMJ. 2009 Feb 19;338:b349. doi: 10.1136/bmj.b349.Herman WH, et al. The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with29impaired glucose tolerance. Ann Intern Med. 2005 Mar 1;142(5):323-32.
  30. 30. How About Our Own Research?• Duke reports annualized $2,200/employee/year savings from integrative wellness program• t Ford plant indicates acupuncture, mind/body, chiropractic reduces back pain medication & costs• WA state finds CAM-using insureds with heavy disease burden cost $1,420/year less• Naturopathic medicine effective and saves $1,025/person for Canada Post employees• Australian government finds acupuncture and natural products lower healthcare costs• Tennessee Blue Cross Blue Shield finds 20-40% lower costs for LBP patients who see chiropractors first 30
  31. 31. Hurdles to Overcome• Pharmaceutical & device manufacturers have powerful lobbies to prevent change. o Penetration into all realms of medical care, including medical education, is extensive o Recent survey of health professionals: 88% thought commercial sponsorship of CME was biased, yet only 12% wanted to eliminate it, and less than ½ would pay higher fees o Also penetration into public perception about causes of health and disease Tabas, J. Clinician Attitudes About Commercial Support of Continuing Medical Education. Archives of Internal 31 Medicine, Vol. 171 No. 9, May 9, 2011
  32. 32. More Hurdles• Insurance reimbursement pays for drugs and surgery, not wellness medicine• Frequent changing of jobs/insurance company – not as much incentive to cover prevention/wellness• Loss of interest in primary care vs. specialized care• Dominance of teaching hospitals with focus almost entirely on specialist care• Efficacy research mostly based on single modality vs. outcomes o Wellness is about systems of healing, not isolated therapies)• Cherry picking of natural therapies without understanding of underlying concepts of health• Even minimal focus on prevention does not equal wellness, i.e. prevention versus early detection 32
  33. 33. Optimal Healthcare System• Fully embraces: o Basic sciences‘ remarkable advancements in understanding human physiology and pathology o Conventional medicine‘s incredible diagnostics and, at times miraculous, ability to cure many types of disease o Natural medicine‘s vitalizing healing wisdom and health promoting therapies o Public health‘s considerable effectiveness in fundamentally improving the environment and decreasing disease risk of populations. o Healing as our fundamental motivation 33
  34. 34. Optimal System – Role of Natural Doctor?• Currently broad support in the US for ―personalized medical home‖• Integrated acute care, disease prevention, wellness promotion, personalized care, core of which is primary care doctor• Allows for primary care providers to facilitate care by other providers, with wellness as central goal• Who better suited to be this bridge than the natural medicine physician? 34
  35. 35. Natural Medicine Physician of the Future• Fully understands and embraces the vis• Nature cure foundation o Whole foods (more than supplements) o Lifestyle, etc.• Excellent patient communication and behavioral change skills• Advanced personalization of care o Biochemical individuality o Diagnostic tools o Health informatics• Primary care family doctors• Experts in integration 35
  36. 36. Dramatic Change in Legislative Acceptance• Both the senate and house of the Washington State legislature unanimously passed a resolution honoring Bastyr University and natural medicine.• This is the same legislature where for decades we walked the halls as beggars knocking at the door pleading to not be made outlaws.• As I watched legislator after legislator stand and proclaim to their colleagues how naturopathic medicine had saved their life, helped them get pregnant or cured a treasured child the conventional medical system had failed,• The prophetic words of Dr. Bastyr came back to me: ―No matter the obstacles they place, the truth of our medicine will out.‖ 36
  37. 37. What is the Future of TheNatural Medicine Physician?The future IS NATURAL MEDICINEIt is not: o Green drug allopathy o Holistic medicine o Integrative medicine o Functional medicine o Anti-aging medicine• It is FULLY embracing the VIS 37
  38. 38. The Future of Natural Medicine• Changing healthcare by practicing true natural medicine is the future of natural medicine. And it has started.• The truth of our medicine will continue to inspire and transform healthcare.• Paraphrasing Margaret Mead, In fact, the truth of our medicine is the only thing that can change healthcare. 38