AMERICAN NATUROPATHIC RESEARCH INSTITUTE
NATUROPATHIC ONCOLOGY RESEARCH INSTITUTE
1250 E. Baseline Rd., Suite 205
Tempe, AZ 85283
JOINT MEETING OF THE
AMERICAN NATUROPATHIC RESEARCH INSTITUTE (ANRI)
NATUROPATHIC ONCOLOGY RESEARCH INSTITUTE (NORI)
INVESTIGATIONAL REVIEW BOARD (IRB)
November 2, 2012
MINUTES AND MEETING NOTES
In accordance with the requirements of the United States Code of Federal Regulations, Title 45, Part 46, the twelfth regular quarterly meeting, of the American Naturopathic Research Institute (ANRI) and the Naturopathic Oncology Research Institute (NORI) and the Institutional Review Board(IRB) was called to order at 12:35 p.m., November 2, 2012 at 1250 E. Baseline Rd., Suite 205, meeting in Suite 203, Tempe, AZ 85283.
The following members and visitors were in attendance (alphabetically by last name):
Colleen Huber, NMD
Thomas Jemison, NMD
Cheryl Kollin, naturopathic medical student
Kenneth Lashutka, NMD
Eric López, NMD
María Martínez, medical assistant
Paul Stallone, NMD
Nanao Takaki, NMD
Phranq Tamburri, NMD
Others who have attended previous meetings or wish to attend future ones are cordially invited to join us for future meetings.
PRE-MEETING INSURANCE MATTERS
It has generally been the policy of ANRI / NORI to stay uninvolved in insurance matters. However, there was a brief discussion about the state of insurance reimbursement for naturopathic treatments as well as some strategies to enhance likelihood of reimbursement. María Martínez, Medical Assistant, gave us some information from her experience regarding billing. Dr. Stallone has been in practice about a decade and has submitted to insurance for most of that time, so he shared some knowledge that he has acquired over the years regarding insurance.
MEETING CALLED TO ORDER
Dr. Huber, Secretary of ANRI / NORI, in the absence of the President, called the meeting to order. She summarized the now almost 3-year history of ANRI / NORI, beginning with the discussion and establishment of goals and mission statement at the beginning, and a lot of general administrative decisions that were made back then, mentioning also that all such previous decisions were subject to review and updating any time that the membership chooses to do so.
Dr. Huber said that now that a lot of that previous business was settled, at least for now, our meetings are focusing far more on the Grand Rounds that members have generally been asking for and looking forward to having. So we then began those discussions.
In the previous ANRI / NORI meeting in May 2012, we discussed qualification for the awarding of an ANRI fellowship or a NORI fellowship to ANRI / NORI members. We had agreed back then that each doctor should present 5 case studies in order to qualify for this designation, and the membership agreed. We look at those 5 cases, and we ask questions, such as what is happening with the patient now, and questions based on seeking further clarification of what happened during treatment. We also give treatment suggestions for unresolved cases. We had decided that during each meeting a certain number of cases could be presented, perhaps one from each doctor each time, until each doctor arrives at 5 cases presented.
It was generally agreed that case studies would be the requirement of a Fellowship for ANRI or NORI, depending on the nature of the cases presented, ANRI for general cases, NORI for cancer cases, as each physician prefers for himself or herself.
We had agreed back in May that next time we would begin to all bring case studies and begin with these, and that as time goes on more and more of our meetings would be about this. So that is how we spent almost all of today’s meeting.
Dr. Jemison presented his first case of a 60 y.o. man with non-small cell lung cancer. It started as a URI, but became more involved. At the time of diagnosis the patient rejected chemotherapy or radiation. He has been doing well with only natural treatments, doing a 50-hour/week physical job. However, having reached a plateau, we discussed some considerations regarding future treatment.
Dr. Stallone presented his first case to the Board, that of an 87 y.o. man also with non-small cell lung cancer, with CHF and pleural effusion. Dr. Stallone used a variety of natural treatments. First the bloodword improved. Then the patient went into remission. His improvement was considered by Dr. Stallone to be dramatic. A large mass shrunk to a small fraction of its previous volume. All of the patient’s lymph nodes resolved.
Dr. Stallone discussed ozone therapy. He reminded us that the first pass is to the lungs of intravenous ozone therapy.
Dr. Stallone then presented his second case to the Board, that of a 51 y.o. female with non-small cell lung cancer. The tumor was extensive to the left main bronchus. Surgery was attempted, but not completed, due to finding her cancer inoperable once under surgery. The patient rejected chemotherapy. Natural treatments resolved the cancer to such an extent that the previously planned pneumonectomy then became possible was done successfully. The patient was then cancer-free, including in the lymph. This patient was Stage IIIB, then went into total remission.
Dr. Nanao then presented her first case to the Board, that of an 87 y.o. female patient with weakness and acid reflux, who had unpredictable and inconsistent results with various therapies. The patient self-medicated extensively with retail supplements of her own choosing. Pt also did not recognize as much improvement as others observed. The Board discussed various treatment options.
Dr. Tamburri presented his second case to the Board, of a prostate cancer patient, a Vietnam veteran with Agent Orange exposure and a history of exposure to agricultural toxins. His PSA was over 50. Dr. Tamburri discussed the almost certain likelihood of such a high PSA being cancerous. However, on DRE the texture of the prostate was completely boggy. Biopsy was negative, and there was no abnormal blood flow.
So Dr. Tamburri raised the question: “So what is a cancer, exactly?” Are there cancers that are always with us? We only think of the malignant kind.
Dr. Tamburri then presented his third case to the Board, in which he saw a patient in whom all 12 biopsy sites had Gleason scores over 10, which is definitive as being cancerous, but the PSA never went over 2. Dr. Tamburri reminded us that PSA is prostate specific antigen, not “prostate cancer specific antigen.”
Dr. Tamburri reminded us of recent wide acknowledgment of the usefulness and limitations of PSA. He talked about how a man’s PSA number is not nearly so useful or helpful as PSA velocity, or the trajectory of where PSA goes over time, such as how fast it rises, as well as other valuable tests, such as PCA3, etc.
Dr. Tamburri discussed the history of the use of PSA, pointing out that prior to 1980 the number of men who were diagnosed with prostate cancer was only slightly higher than the number of men who died of prostate cancer, because there were no good diagnostic markers, and we did not know a man had prostate cancer until it had advanced to a late stage, and until he had unrelenting back pain or anuria or hematuria, etc. By then the cancer was usually Stage IV and very hard to treat. Then, in 1980, with the advent of the PSA test, there was an enormous difference in the number of men diagnosed with prostate cancer and the number of men who die from prostate cancer, because it is now diagnosed much earlier, even to the point of overdiagnosis, highly sensitive testing, not highly specific.
Dr. Tamburri also noted that outlying patients such as these often do better than more typical cases, and outliers, such as the two patients above, almost all seem to survive long-term, and almost never metastasized. They mostly seem to have their cancers well-encapsulated. These outliers very often seem to be related to exposure to such toxins as Agent Orange.
Then Dr. López revisited the question of “What is cancer?” Dr. Tamburri said, “Well, let’s revise the definition of cancer. We’re finding, due to increased imaging, with more precise resolution than ever, that we humans have a lot of strange densities and lumpiness inside of us. The real question is, “Does it have legs?” Rather, is it capable of creating a malignant condition or metastasizing?
Dr. Tamburri also mentioned that he runs the PAP (prostatic acid phosphatase) test when the PSA > 10. He always tests %-free PSA when the PSA is under 10. He finds that PSA velocity and density is all over the place with the outliers.
Dr. Tamburri counseled to always run a PCA3 lab. Bostwick Labs does this, and now there are a number of other labs who do it as well. Dr. Bostwick is a well-known urologist.
PCA is Prostate Cancer Antigen, which unlike PSA, is more specific to prostate cancer. This PCA3 is not FDA approved. Last year, the FDA finally approved a form of the PCA test. If a man refuses a biopsy à this PCA is a good test. This lab used to be about $1400, now about $200.
Dr. Tamburri also discussed patients who insist on maximum unorthodox treatments. He explains to patients that he cannot legally diagnose a person with cancer without a biopsy. Also, if you have ever been diagnosed with cancer, Dr. Tamburri cannot call you “Cancer free”.
Here are four questions that Dr. Tamburri asks regarding prostate cancer patients:
1) What is the chance that I think the patient has a significant cancer? Is there something reproducible in testing, imaging, etc.
2) If there is a cancer there, how aggressive, or how bad is it? (15 – 20% of prostate cancer is badly aggressive.
3) If it is not cancer, what other prostate pathology is going on: prostatitis, BPH, etc., or an outlying problem, such as a severe allergy
4) How do I track the patient, especially with the unreliability of typical markers and imaging?
Dr. Stallone asked: Can you give testosterone to a prostate cancer patient? Dr. Tamburri responded that he prefers to given DHEA, so that the upstream addition of a hormone will find its path to an appropriate amount of testosterone under the body’s natural influences.
Dr. Huber asked about a strategy of generally depleting estrogen in prostate cancer. Dr. Tamburri responded that he does that, but is more concerned with disproportion between estrogen and testosterone.
Dr. Stallone mentioned that DHT is also something to be concerned about.
Dr. Tamburri pointed out that Progesterone is also a 5-alpha reductase inhibitor. Vitex is an herb that decreases prolactin and increases progesterone. Dr. Tamburri advocates exercise in order to modulate hormones.
Dr. Stallone discussed how Dr. Kail had talked about how if you can show why you’re doing something, you will be much less likely to have a legal problem. If you have done your homework and crossed your t’s, you should be okay most of the time.
Dr. López then presented his second case to the Board, that of a 76 y.o. woman with anxiety and fatigue since Prednisone. Labs showed low thyroid function. This patient reacts to everything, but started to do better and better on T3. Dr. Stallone thought that there might be an autoimmune component to the thyroid, such as Hashimoto’s. Or look at possible iodine deficiency.
Dr. Huber then presented her third case to the Board, that of an 84 y.o. female patient who has been in remission for over a year from uterine cancer, following only hysterectomy and natural treatments with Dr. Huber. At this time, the patient’s energy and wellbeing are excellent. The patient is described by her husband as an “energizer bunny,” in constant motion, gardening, doing housework, etc. The problem is that her cholesterol is 419 despite many different hypolipidemic natural agents. Dr. Huber expressed much reluctance to begin a statin drug which would attack the patient’s mitochondria, and would likely lead to less energy. Dr. López, Dr. Nanao and Dr. Stallone suggested further natural treatments that had not been considered, and Dr. Stallone advised updating such inflammation markers as homocysteine, CRP etc., along with a more specific lipid panel to see proportions among apolipoproteins.
Dr. Stallone presented his third case to the Board, that of a 60 y.o. patient with 3 primary cancers: Non-Hodgkins Lymphoma, prostate cancer and bladder cancer. His Gleason score was 7. He had a radical prostatectomy and went to see Dr. Stallone for ozone treatments, after which he went into remission from everything, one at a time. First the bladder cancer went into remission. Then in one year, all the lymphoma was gone. This patient is still in complete remission since 2004.
NEXT BOARD MEETING: Friday, February 8, 2013 at noon, at the usual place, the clinic of Drs. Huber, Lashutka and Jemison, in Tempe. Food from Herbs and Flavors will be served, unless objections surface before then.
Please mark your calendars now, to keep this afternoon open for ANRI / NORI.
Please remember to bring your case studies in to present, at least one. We may have time for two each, for those of you feeling ambitious.
Dr. Huber continues to offer for her clinic to provide lunch for the meetings at no cost to the membership, in order to save up the usual $10 dues per quarter per person to pay the $400 fee for the eventual incorporation of the non-profit.
POSSIBLE AGENDA ITEMS FOR FEBRUARY 8, 2012 BOARD MEETING
These meetings are the opportunity to present anything that you think important or interesting. Of course, agenda items may even be added at the last minute.
Colleen Huber, NMD
Secretary, ANRI / NORI
November 2, 2012