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)
INTERNATIONAL NATUROPATHIC CLINICAL RESEARCH INSTITUTE
INSTITUTIONAL REVIEW BOARD (IRB)
August 9, 2013
MINUTES AND MEETING NOTES
In accordance with the requirements of the United States Code of Federal Regulations, Title 21, Chapter 1, Subchapter A, Part 56, the fifteenth regular quarterly meeting, of the American Naturopathic Research Institute (ANRI) and the Naturopathic Oncology Research Institute (NORI) and the International Naturopathic Clinical Research Institute (INCRI) and the Institutional Review Board(IRB) was called to order at 12:40 p.m., August 9, 2013 at 1250 E. Baseline Rd., Suite 205, meeting in Suite 203, Tempe, AZ 85283.
The following members were in attendance (alphabetically by last name):
Keith Chambers, NMD
Margarita Hernández-Guzmán, NMD
Colleen Huber, NMD, Secretary
Cheryl Kollin, NMD
Kenneth Lashutka, NMD, Treasurer
Glenn Ozalan, NMD
Kenneth Proefrock, NMD, President
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.
MEETING CALLED TO ORDER
Dr. Huber, Secretary of ANRI / NORI, called the meeting to order.
REPORT FROM THE AANP CONFERENCE
Dr. Proefrock discussed the purpose of going to the annual AANP conference in Colorado last month. Our organization, through Dr. Tamburri, had proposed a recognition of pluralism of specialty organizations. Unfortunately, there was a group that felt as if we were opposing them, although our proposal was very specific about welcoming all specialty organizations. The debate took the form of questioning the naturopathic physicians’ role in Obamacare, specifically how we are primary care physicians. However, we tried to get back to the topic at hand: that is, should specialty organizations dictate to other naturopaths how to proceed? The trouble is that there are a lot of people in administrative positions who are not terribly successful in practice – leaving them time to manage others – so this is rife with problems, because then the worst policies, produced out of ignorance, can be imposed, and often are.
Much of the discussion at the AANP conference centered around speculation about Obamacare. There is the idea that there are 35,000 to 40,000 jobs available for naturopaths. So the question is will we have to sacrifice being a full-spectrum type of physician in order to narrow ourselves down to what insurance will be willing to reimburse? At the same time, the role of a specialty group is to be a particular part of a thought process. So our proposal is that a specialty organization is an educational group, which can inform others. The problem is when they try to dictate to others. So while many NDs are now worried about whether they will live up to expectations of Obamacare, they can especially be dictated to, and can be expected to conform to unreasonable demands, and to sacrifice their scope of practice and their liberties.
Dr. Proefrock reported that his contacts with others at AANP were mostly positive – that we can be a clearinghouse of ideas and can we set up a format for people to meet. We could possibly be a liberating force in the profession. The goal would be progressive understanding, in which more experienced naturopaths can advise and guide other less experienced naturopaths, rather than dictating to them.
So, for example, there are outside-the-box natural cancer treatments, i.e. cesium, laetrile. The ignorant lawmaker will take the easy route and judge a substance or procedure with which he/she is unfamiliar to be unsafe. Thus too often things will get exorcised out of our toolbox, before future patients have the chance to benefit from them. So we need to keep it a goal of these meetings to make sure that people learn things and make it worth their while to actually show up, because this organization right now is the strongest bastion in favor of a broad scope of naturopathic practice. OncANP had suggested that cesium be taken out of our formulary because they didn’t know anything about it. This is an example of the problem of allowing our treatments to be amputated. Here is a major goal: We need to break down the walls that exist between the ways people communicate. The biggest wall is people’s own pre-conceived notions.
The practice I have is very successful, he said, but it’s not like it’s not reproducible. I am willing to share knowledge with people. When you look at ANRI / NORI, there is a lot of clinical experience that is at people’s disposal. What is often out there in naturopathic education in the medical schools, there is the usual boilerplate. What students need to learn is how we think about patients and how we think about how to go about helping them.
Dr. Ozalan responded, as you’re portraying the dilemma, that’s what the problem is. The profession has individuals that respect process, but they are lacking the ability for complex assessment. Dr. Ozalan talked about emotional intelligence, and how we have to be able to have that orientation, not only the linear logical intelligence that is promoted in the naturopathic educational institutions. Too often only embryonic understanding of human relationships and of naturopathic medicine is maintained.
Naturopathic education, said Dr. Proefrock, is sometimes best in one-on-one or one-on-two, etc. settings, where more can be learned than in a classroom full of people. Too many NDs want a cash cow, just wanting to fit into a niche to only do one thing, in order, as they see it, to satisfy insurance requirements. Yet this is a very boring way to practice. Who would want to narrow down such a vast education as naturopaths have, in order to simply do one procedure over and over?
Dr. Lashutka asked, “How do you fix this?” People are too stuck in trying to do whatever they can to make a living, that they lose sight of the goal of becoming a better doctor in order to better help the patient.
Dr. Proefrock responded: So that’s where something like ANRI / NORI can help, in that we can provide the means for people to understand that it’s not what we use that makes a naturopathic physician. It’s why you use what you use. So Dr. Proefrock asked people in his breakout group at AANP: What is this effort to conform going to do to our profession? For example, how many of you think that doing colonics is a good idea sometimes for some patients? The response was generally, yes that’s valuable. So, said Dr. Proefrock to them, how do you think you’re going to get reimbursed for colonics? The point is insurance demands could tear down our medicine.
Dr. Ozalan said that naturopaths keep wondering – how am I going to make a living? A ND gets successful when they get a reputation for learning how to think, not for being known for doing a particular procedure. First we have to talk about what it means to be a human being, how to connect with others in that way, rather than being a predictable stuntmaker in their patients’ lives. How have we connected with them in a way that brought them to a new higher plane of self-actualization?
Dr. Proefrock said the key question for a naturopath is: How do I become more effective at transforming people or helping them transform their lives? They really need to approach this in naturopathic medical school, yet that is not addressed.
Dr. Tamburri said that the specialty board issue is closely connected with the Obamacare issue. When I got into naturopathic medicine, I wanted to be able to make money, but more so, that there were ethics, and that I was free to practice without a lot of restrictions. As naturopaths we were off the grid. People don’t realize that government money equals restrictions. So I liked this field for the very reason that it was off the grid and that we weren’t tied into the system. MDs are government workers, in that they are over-regulated. People may think that the way I practice medicine is that I do procedures, ultrasounds, etc. But what my practice is really all about is giving people options. I would tell new naturopaths: don’t dwell on getting hung up on procedures, technical details, doses, seeking the Cliff notes, the protocol, the certification, and I’ll finally be able to make money. They keep thinking one more degree, one more set of initials after my name, and I’ll be ready to make more money. But that’s not what’s important. What’s important is our independence. When you get rid of freedoms, it’s hard to get them back.
Sanjay Gupta, MD has finally admitted that he was really wrong about marijuana. He spent many years declaring that medical uses of marijuana were invalid, and that marijuana was worthless. He has done a 180, and now is saying that he was completely wrong. The public looks at the made-for-TV medical doctor, even as they’re rubber-necking his pendulum swings, and they say that he must know what he’s talking about. However, those who have been paying attention know that it’s the naturopaths who have been the ones to consult. Our role is always planting seeds, and starting to grow them among the public, our patients.
Talking to people one-on-one is where we have to start. It’s the grassroots that’s going to influence the upper levels. Dr. Tamburri also says that we have to be the bastion of freedom, the clearinghouse, a place where people can go to see a holistic physician.
AANP used to have everybody have an equal vote. But now, “for efficiency sake” only the executive board makes decisions. The rest of us have been demoted by default, and don’t have nearly as much say as before. Government produces restrictions and mandatory protocols. Thus it is decreed: this is how to do it safely. Then it becomes “this is the ONLY way to do it.” Ex. PSA guidelines have finally caught up to what naturopaths are saying. But the knee-jerk government reaction is: okay now Medicare will not pay for it, except for once a year. Again bureaucrats are making decisions that they should not make.
Dr. Chambers said, a lot of naturopaths want to hitch their cart to this horse. Ultimately, you’re going to make less money with insurance. So why is everybody all over this, and wanting into this system?
Dr. Huber said she’d play devil’s advocate, taking the side of the patient who says, “I pay massive insurance premiums. Why don’t you take my insurance?” This puts pressure on the naturopath to play along with the insurance system.
Dr. Chambers responded that what is insured is not at all quality medicine. It’s still a matter of you get what you pay for. Naturopaths heal and then obviate the need for ongoing expensive care. This is worth paying for. Dr. Huber acknowledged that this is true.
Dr. Tamburri said, The AANP feels finally able to catch up to the big brother and get what the big brother (MD) has had all these years – insurance reimbursement. However, they’re rushing into the building to go to the party that is being vacated by the MDs because not only has the party fizzled badly, but the building is on fire. Meanwhile the naturopaths are rushing into the burning building. These are lambs eager to be the first to slaughter.
So Dr. Tamburri had said at the AANP conference: Many Americans are opposing or at least questioning Obamacare. Another 30% say it is do-able, but not in the form that it is now. Most MDs are also questioning Obamacare. Responses to Dr. Tamburri were a lot of people who came up to him saying, I really agreed with you. A lot of other naturopaths came up and said, you know you made me think about this a lot, and I had not thought about it before. Even Dr. Milliman approached Dr. Tamburri and said that this is something he doesn’t understand well enough.
70% of MDs feel that the AMA doesn’t represent them.
So it seems that there are a lot of naturopaths who are feeling the same about AANP. When did the AANP ask its membership – hey what do you all think about Obamacare? Should we try to get on board with that? There is the population that these desperate, insurance-seeking naturopaths are trying to pursue. Then of course, there is a whole other market – homeschooling, Whole Foods going, independent thinking people, who don’t fit into that model.
We naturopaths here in Arizona have an advantage that the MDs don’t have. We say: let’s let the dust settle with controversies such as medical marijuana. Watch the MDs go through all this chaos with medical marijuana. We NDs can stay above the fray until we see how things are going to shake out.
NDs and NMDs could actually spin off into separate licenses. If restrictions get too severe with say the ND license, then NMDs could create a separate qualification for a separate degree, a distinct board and say this is our profession, which is different. This is what the MD(H)s did in order to separate from the MDs. Now a lot of MDs want into the MD(H) designation in order to avoid anticipated aggravation of Obamacare, and to just have a cash practice.
Dr. Tamburri also said that chiropractors are close to having a bill passed where they can do IV medicine. Now there’s opposition. There are naturopaths saying that the chiropractors should not be allowed to do it. There’s the familiar situation of: I’ve got mine, and now I don’t want you to have a path to get yours.
Dr. Proefrock said, well in that case, we can be the ones who teach the chiropractors how to do intravenous treatments.
THE INTERNATIONAL CONGRESS OF NATUROPATHIC MEDICINE, JULY 2013
Dr. Huber discussed her visit to the International Congress of Naturopathic Medicine in Paris a month ago, the same time as the AANP conference. It brought together people interested in naturopathic medicine from a number of continents, primarily Europe and North America.
As in the Colorado conference, Dr. Huber wanted to familiarize the conference participants with our organization’s mission of promoting medical freedom and patient choice. Rather than trying to communicate such an abstract concept in a short soundbite to many, Dr. Huber chose to go “deep rather than broad,” and spent each breaktime and lunch break with a different individual, and talked to each at length about ANRI / NORI goals. Without exception, everyone seemed very interested in our work, and wanted to be kept informed. That was 14 people. Dr. Huber has emailed each about today’s quarterly meeting.
Conference participants were not all currently qualified to be naturopathic physicians, by North American standards for the profession. However, we went in the same spirit as three of the naturopathic medical schools. Like Bastyr, NCNM and SCNM, ANRI / NORI was a sponsor of the Congress. All of these institutions were able to appreciate this about the conference participants: the attendees aspire to be like us in the sense of wanting a four-year post-baccalaureate medical program encompassing our curriculum, followed by a licensing process that would enable them to be practicing physicians. Dr. Huber’s hope is that ANRI / NORI would be there from the beginning, to try to guide and mentor them through the many huge hurdles they will have to cross, maintaining priorities of patient choice and medical freedom to the greatest extent possible while they struggle to find their way to become a profession of physicians in each country. Now that ANRI / NORI has created a visible presence in the international arena of naturopathic medicine, we should try to maintain our influence there and not let our new contacts drift too far away.
Dr. Tamburri said he doesn’t have any problem with associating with people internationally, who don’t yet meet the criteria for naturopathic physicians that has been defined in this country. We are then in a position to mentor them through their soon to be written history.
Dr. Proefrock said that there is also a problem brewing in the international community regarding naturopathic medicine, that is, reciprocity of licensing between France and Canada. A case came up of a MD in France who did some training also in aromatherapy. So he wanted to be grandfathered in as a naturopathic physician in Alberta. He wanted to sit for the clinical board exams without studying in a North American naturopathic school. Dr. Proefrock explained that you have to go all the way through the naturopathic education in order to be able to sit for our exams, because it is not a question of memorizing some facts and sitting for an exam. The philosophical foundation of naturopathic medicine runs through our entire curriculum. You really have to be able to think like a naturopath, and that requires the four years of our education.
ADDRESSING THE AZ NATUROPATHIC PHYSICIANS BOARD
Dr. Ozalan talked about how he and other physicians started NPBAM a number of years ago. The problem was there was a board totally unfamiliar with aesthetic medicine. This same question came up. You had a board unqualified to adjudicate aesthetic medicine. Yet they were the ultimate arbiters of what was permissible. The more controversial it became – it became a territory within naturopathic medicine – the board members were mostly anti-aesthetic medicine. We need to reach out to other naturopaths, knowing that we can unite with them without creating that mindset of territory within the profession. We need a strong confident presentation. The conventional group slides into a vacuum, and whoever steps in to take it is going to get what they want. Whereas board members are torn between punishing evildoers and protecting the public, they really don’t know what they’re doing. We have to establish a presence with them to let them know that when they’re confused on these matters, they can turn to us, because we have the knowledge and the ability to guide them in matters with which they are unfamiliar. They are less likely to make a call without us, knowing that we are going to be the ones to provide reliable answers.
Once that is accomplished, our job is to create a lot of fuss and chaos. Raise hell, grab attention, and be in the vanguard of defining what it is to be a naturopathic physician.
Dr. Huber presented a proposed letter to the AZ Naturopathic Physicians board to let them know that NORI exists and that we are available for consultation in matters that involve our fields of expertise, particularly related to naturopathic oncology. There was unanimous agreement to send the letter to the AZ Board as it was drafted.
Dr. Proefrock responded that oncology is the turf in which we have to establish ourselves, and oncology is the crucible for the very issues we’ve been discussing: medical freedom, patient choice, the role of specialty organizations.
THE PURPOSE OF OUR CLINICAL WORK
Dr. Proefrock talked about the purpose of our work: Regarding patients, he said that he would like to meet them where they are, and to foster as much of a transformative experience as we can have. And this is a game-changer for people. This is why we get up and come to work. The progressive edge of interaction with patients is not being done well by MDs. And if I think something is going to be workable for somebody, I really want to try it, and see how it goes.
The reason that Americans pay more for healthcare than anywhere else in the world is that we as a country are not getting people well. We’re still 27th in the world in infant mortality. Obamacare or no, we have a medical bureaucracy that proclaims that they are state of the art, and frankly they are not doing a very good job.
In contrast, naturopaths often have very good results. Dr. Proefrock has been told by an independent observer, “You have to get your nebulizer on the market; it’s huge; it’s the best.” But says Dr. Proefrock, “it’s not the nebulizer; it’s the approach.
A ROLE FOR OUR ORGANIZATION INTERNATIONALLY
Dr. Ozalan said, let’s consider again the international group – what is it that we have in common with these individuals apart from experience? The whole purpose of what we do is to be consistent with human nature – to be a driving biological force. So you train your fundamental nature, in order to enable healing. So it’s not about an identity and a credibility to come from identity. These are human beings, and we should unite with them and be their allies.
Dr. Huber said they may not yet be qualified as naturopathic physicians, but snobbery is not a characteristic of our organization. So let’s maintain this relationship, especially if our mentoring them can help them move forward to achieve the standards for naturopathic medicine that we hold in North America.
Dr. Proefrock said we should go abroad and offer them training.
Dr. Ozalan said, “They’re going to be looking at the process. All we have to be is human beings and look at others as human beings. That’s where we will enable successful healing. We relate to these people as human beings. Our common humanity is what’s important – so it’s not so important that they may be as yet unlicensed in our sense. We will mentor them, and they will achieve eventually the full training and licensure that we have.
However, Dr. Proefrock said, the more international naturopathic researchers need credibility, the more we are seen suspiciously by associating with them. On the other hand, when you look at Brno University in the Czech Republic, this is a very highly respected group of pediatric oncologists, with an excellent international reputation. Yet right now they are pointing to ANRI / NORI as the source of their Informed Consent, that we are a feather in their cap, from the work that we did here six months ago on that Informed Consent.
CRITERIA FOR FELLOWSHIP IN ANRI AND/OR NORI
Dr. Huber then presented an idea for a way to have broadly acceptable criteria for fellowship in ANRI / NORI and the designation of “naturopathic oncologist.” She proposed an exam in essay format, where doctors are given general information for a number of hypothetical patients. As the examinee, you would write questions for the S and O of the chart notes. Then you are given answers, that is, more information about the patient, that may or may not correspond to all of your questions. Now you write the A and P of the chart notes. Exams are graded by other ANRI / NORI members with a view to assessing the examinee’s reasoning process, not so much looking for right or wrong answers.
Dr. Proefrock emphasized that there really aren’t any wrong answers. It’s a question of your process. But start with a more fleshed out case for part 1. What I really want to know is what about the person taking this interest in taking the exam? Is there any way that I can verify or deny that this is a right answer? This exam should not be something that statistically separates the wheat from the chaff. This is in contrast to the OncANP, who has an exam that is mostly epidemiology, multiple choice, right and wrong answers. But that doesn’t seem very interesting. If we make the exam into a means for a naturopathic physician to express his or her way of thinking in approaching cases, then we have a process that may very well enlighten us all.
He said that very vague cases were given for the panel discussion at the Healthy Medicine Academy. You could really see the difference between the clinicians and the researchers among the panel members. The researchers had a hard time figuring out how to proceed, whereas the clinicians were able to start tackling the case.
Dr. Ozalan said that then we can look at the experience of the physician, and distill from your experience and processes what drives the way you think.
Dr. Lashutka said that an exam may not be the best way of earning fellowship in ANRI / NORI. Isn’t there a better way? We had plenty of exams in naturopathic school, yet I have learned far more here in a clinical setting than I ever learned in naturopathic school.
Dr. Huber agreed that her year in Dr. Proefrock’s clinic also was far more valuable in forming her as a physician than four years of medical school. And that never involved exams.
Dr. Proefrock agreed that the apprenticeship thing works; one learns more from the one-on-one in the clinic than in the classroom. The specialty organization that devised their exam at first wanted to show how treatment could progress for patients, and the exam was designed to cover that. But as time went on, it became a gatekeeping mechanism to limit entry to being able to treat a certain segment of the population.
Dr. Lashutka said that the formality of having a test or an exam was not appropriate. But the whole process of being here and sharing cases and discussing items of import to our organization’s mission and goals, that is what is important, and should matter more to the awarding of fellowships here. Dr. Lashutka said if we do this essay test, we should make it a creative process.
Dr. Proefrock said, well then why don’t we dispense with an exam, and instead have the candidate write a research paper of a quality that could be presented at a medical conference?
Dr. Huber said that it is not a good enough reason to dispense with the idea of an exam due to embarrassment over having to proctor and to grade the exam of a trusted colleague. That is, if an exam is the best way to go with this, then we can’t dispense with it simply because it’s awkward to proctor an exam.
Dr. Proefrock responded that the merits of the research process and independent presentation of a paper would be more valuable and educational to the whole organization, and could be placed in the ANRI / NORI library. He said that instead of an exam, this could be the final qualifier for fellowship in ANRI / NORI.
It was unanimously agreed to adopt Dr. Proefrock’s proposal to have a research paper instead of an exam for “naturopathic oncologist” or other ANRI / NORI fellowship, after which the meeting was adjourned.
NEXT BOARD MEETING: Friday, November 8, 2013 at noon, at the usual place, the Nature Works Best Medical Clinic in Tempe. Food from Chipotle’s will be served, unless objections surface before then. We will ask you a few days in advance to choose something from that menu.
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. And we should allow extra time for those who have not presented many cases yet.
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 NOVEMBER 8, 2013 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. But please remember that we should probably curtail political discussions after a certain point in order to have time to get to the case presentations.
Also, should we take a maximum of say 45 minutes for miscellaneous issues and politics, so that we can then hear a lot of cases before people have to leave? Or shall we start with case presentations?
Colleen Huber, NMD
Secretary, ANRI / NORI
August 9, 2013