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Role of the Natural Medicine

Physician Within the NewHealth Care Paradigm

Joseph Pizzorno, ND

President Emeritus, Bastyr University

Editor,

President, SaluGenecists, [email protected]

Copyright 2011

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Dr. Joseph E . Pizzorno, N .D . Academic

o Founding president of Bastyr University, first accredited, natural medicine university

o Editor:

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, 2003-2005o 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 - 2009

o Institute for Functional MedicineLinus 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. 2001o Alternative Healthcare Management: 1 of the 4 most influential CAM leaders, 2000


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Overview1. Why do patients come to see us?

2. Do we believe in wellness?

3. How does a wellness orientation in primary care contrast withthe conventional medicine approach to patients?

4. How can this fundamental change in patient care impactthe healthcare crisis?

5. Is there any research to support a wellness rather thandisease-centric approach?

6. What are the political and insurance reimbursement hurdles

that need to be overcome to provide an environment to notonly allow, but nurture this better approach to healthcare.

7. Finally, what does an optimal healthcare system look like andhow does the natural medicine physician fit in?

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Conventional Medicine:

Many Successes

Huge success in acute illness, trauma and life-threatening disease

This was accomplished through:

o Disease-treatment focuso Standardization of disease, diagnosis, therapy and,

unfortunately, people

o

o Active suppression of other ideas and practices

However

o Many problems and limitations have surfaced (aspredicted by natural medicine doctors a century ago)


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Why Do Patients Come To Us?

Heavy DISEASE BURDEN

o

High incidence of SIDE EFFECTS Out-of-control COSTS

The MYTH of increased longevity


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Heavy Disease Burden Only adults: 18-64 yo

Only 6 most common dzs

-

o Adds 15-20%

Those with the pooresthealth habits develop

chronic disease 5 yearsearlier and their disease istwice as severe.

Wilper AP, et al. A National study of chronic disease prevalence and access to care in uninsured

U.S. adults. Ann Intern Med. 2008;149:170-176

Vita A , et al. A in , health risks, and cumulative disabilit . NEJM 1998;338:1035-41

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3+

0%

10%

20%

30%

40%

50%

Incidence of Chronic

Disease


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Despite Increasing Use OfDrugs And Surgery

http://www.cdc.gov/nchs/data/databriefs/db42.htm

Coronary artery stent proceduresPrescription drug use, past month

1 in 7 restenose within just 1 year!


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Surprising Incidence ofAdverse Drug Reactions

Not anti-medicine, but real, undisclosedproblems

Doctor: adverse event in 4-18% outpatient

visits Patient: 25% of 661 outpatients, 13% serious Result:

o 116 million extra physician visitso 77 million extra prescriptionso 18 million ER visitso 8 million hospital visitso 199,000 additional deathso $77 billion extra costs (equivalent to diabetes)

Wiengart SN, et al. Epidemiology and medical error. BMJ 2000;320:774-7Gandhi TK, et al. Adverse drug events in ambulatory care. 2003;348:1556-64


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Increased Longevity?


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Out of Control Costs

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Marshall E. Science and the stimulus. Medicine under the

microscope. Science. 2009 Nov 27;326(5957):1183-5. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5813a5.htm


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Walter Bortz, II, MD inNext Medicine

o Excessive cost

Ex: Health insurance costs rising 4x faster than workers earnings

o Injustice/Inequity

o Harmfulness

Annually, iatrogenesis

o Corruption

Ex: Vioxx & Merck, unnecessary surgeries, etc.

o Inefficiency

o Irrelevance

This symptom he considers to signify a complete disconnect betweenour health and health care system


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Walter Bortz, II, MD

and scientific conceptual framework that would

obesity]

bag are the fundamental tools of the medical

72% of physician visits are now due to chronic

conditions 12


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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 andPanacea (health preservation and repair,respectively)

In legend, Hygeia is the daughter of the god of

medicine, and is closely correlated with the origin ofthe vis medicatrix naturae.

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Do We Believe in WELLNESS?

Is NATURAL MEDICINE about therapies? Or aboutconcepts & intent?

Despitappropriate herb, nutrient, manipulation,acupuncture technique, etc. No matter how

natural, many still have a focus on disease.

does this not trump disease? Do we believe in

wellness? 14


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What Really is Nature Cure? NATURE CURE is simply restoration of

wellnessby whatever means mostappropriate for each unique personas thisis how the body removes disease

inherent striving for wellness inherent in lifethat differentiates us?

often

unknowinglyseeking?15


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Treating Symptoms With Natural

Therapies is Still Allopathy

When a person is depressed, it is not due to a lackof Prozac.

wort.

It could be due to a lack of sunshine, and vitamin D

Are they toxic, are they eating the wrong foods ornot enough of the right ones, or is their life without

meaning.

core of NATURE CURE?

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Is a Belief in Wellness aRecognition of the Vis?

The VIS embraces VITALISM.

Natural medicine is fundamentally a vitalistic

practice (vis medicatrix naturae)

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 ifyour patient is actually improving rather than justsuppressing symptoms?

o Is the patient HEALTHIER after your treatment?

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Pizzorno (2007)

I have been involved in naturopathic medicine for

can see the Vis in othersit is something we allsense. As a clinician, you watch the level of a

are on the path to cure, but if it decreases then youare only palliating symptoms and suppressing the

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Bill Mitchell, ND 1948-2007

Co-Founder Bastyr University

Inspiration teacher for 20 years

My friend

with permission from Leanna Standish, PhD,ND, LAc

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ConceptsVMN = the healing power of nature

VNM = the self-organizing property

tendency to organize that system so as to maintain

The Vis is universal.

systems contains an internal intelligence for self-maintenance as well, meaning that the Vis exists

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But Bill Goes on to Say

The Vis is not weakened or strengthened bythe weakness or strength of the individual.The VMN exists internally and universally.

This is best thought of as an equation that

And change the value of X, Y, or Z, the equationitself exists as a structure in which these

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Wisdom from Dr. Standish

Naturopathic medicine distinguishes itselfphilosophically from mainstream medicine by itscore principle Vis medicatrix naturae, the healing

power of nature.

served to isolate, and perhaps sideline,naturopathic medicine from mainstreamconventional and pharmaceutical medicine of thesecond half of the 20th century, which has beenhistorically based exclusively on scientificmaterialism.

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Dr. Standish Concludes

However, the experimental findings from quantummechanics in physics, neuroscience, and thedistant healing literature suggest that scientific

materialism is an incomplete description of realityand thus cannot be the sole philosophy of modernmedicine.

concept of biological field effects, macro-entanglement, non-local interaction, andemerging in the 21st century.

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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 .

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Jeffrey Bland, PhD Conversation with Dr. Szyf @ McGill University:

o -wired into ourgenes ..our responses that give rise to disease are adaptiveresponses to an altered environment, in which the

outcome over time, through the epigenetic modulation,becomes a disease. In other words, we don't have diseaseswired into our genes, we have physiologic responses toenvironmental modulation wired into our genes that thencreates an outcome that's later called our phenotype of

25FMU. November 2010


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Wellness vs. Conventional

Orientation in Primary Care Former head of CDC andwell over 90 percent of our

national health budgettreating diseases andcomplicationsmany of whichcould have been prevented in

hope that the day will comewhen all health care providerswill write prescriptions for

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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 Americanpeople. N Engl J Med. 2007 Sep 20;357(12):1221-8.


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How Does Fundamental Change in

Patient 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 behaviorso Although genetic predisposition influenced physiological

function and risk of disease, it was largely modifiable byhow people lived

o Preventable illness is thought to make up at least 70

percent of the burden of illness and the associated costs

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O'Keefe 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).

1998 Mar-Apr;17(2):70-84.

Ch C t H lth C
http://www.ncbi.nlm.nih.gov.offcampus.lib.washington.edu/entrez/utils/fref.fcgi?PrId=3051&itool=AbstractPlus-def&uid=19648392&nlmid=0405543&db=pubmed&url=http://www.mayoclinicproceedings.com/cgi/pmidlookup?view=long&pmid=19648392http://www.ncbi.nlm.nih.gov.offcampus.lib.washington.edu/entrez/utils/fref.fcgi?PrId=3051&itool=AbstractPlus-def&uid=19648392&nlmid=0405543&db=pubmed&url=http://www.mayoclinicproceedings.com/cgi/pmidlookup?view=long&pmid=19648392http://www.ncbi.nlm.nih.gov.offcampus.lib.washington.edu/entrez/utils/fref.fcgi?PrId=3051&itool=AbstractPlus-def&uid=19648392&nlmid=0405543&db=pubmed&url=http://www.mayoclinicproceedings.com/cgi/pmidlookup?view=long&pmid=19648392


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Change Cuts Health CareCosts Too

Reduced healthcare costs

o Even a modest focus on prevention, early intervention, andbehavioral change could save annually in treatment and

productivity loss costs an estimated $217 billion and $1.6trillion, respectively

o Greater emphasis on primary care and health promotion,less specialty care

Greater function, longer healthspan

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A wellness initiative for the nation, 2008. http://ihpc.info/resources/resources.shtml


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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 atleast 5 servings of fruits and vegetables a day have a 4-fold lowerrisk 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 ofdiabetes by 11 years, metformin only 3 years

o Lifestyle intervention was found to be $1,100 per quality adjustedlife year (QALY), while metformin was $31,300

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Khaw KT, et al. Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective

population 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 years'

follow-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 with

impaired glucose tolerance. Ann Intern Med. 2005 Mar 1;142(5):323-32.

H Ab t O O


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How About Our OwnResearch?

Duke reports annualized $2,200/employee/yearsavings 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


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Hurdles to Overcome Pharmaceutical & device manufacturers have

powerful lobbies to prevent change.

o Penetration into all realms of medical care, includingmedical education, is extensive

o Recent survey of health professionals: 88% thoughtcommercial sponsorship of CME was biased, yet only 12%wanted to eliminate it, and less than would pay higherfees

o Also penetration into public perception about causes ofhealth and disease

31Tabas, J. Clinician Attitudes About Commercial Support of Continuing Medical Education. Archives of InternalMedicine, Vol. 171 No. 9, May 9, 2011


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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 almostentirely on specialist care

Efficacy research mostly based on single modalityvs. outcomes

o Wellness is about systems of healing, not isolated therapies)

Cherry picking of natural therapies withoutunderstanding of underlying concepts of health

Even minimal focus on prevention does not equal

wellness, i.e. prevention versus early detection 32


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Optimal Healthcare System Fully embraces:

o understanding human physiology and pathology

o

times miraculous, ability to cure many types of disease

o promoting therapies

o improving the environment and decreasing disease risk ofpopulations.

o Healing as our fundamental motivation

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O ti l S t R l f


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Optimal System Role ofNatural Doctor?

Integrated acute care, disease prevention, wellnesspromotion, personalized care, core of which is

primary care doctor

Allows for primary care providers to facilitate careby other providers, with wellness as central goal

Who better suited to be this bridge than the naturalmedicine physician?

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N t l M di i


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Natural MedicinePhysician 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 individualityo Diagnostic tools

o Health informatics

Primary care family doctors

Experts in integration 35

D ti Ch i


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Dramatic Change inLegislative Acceptance

Both the senate and house of the Washington State legislatureunanimously passed a resolution honoring Bastyr University andnatural medicine.

This is the same legislature where for decades we walked the

halls as beggars knocking at the door pleading to not bemade outlaws.

As I watched legislator after legislator stand and proclaim totheir colleagues how naturopathic medicine had saved theirlife, helped them get pregnant or cured a treasured child the

conventional medical system had failed,

matter the obstacles they place, the truth of our medicine will

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Wh t i th F t f Th


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What is the Future of TheNatural Medicine Physician?

The future IS NATURAL MEDICINE

It is not:

o Green drug allopathyo Holistic medicine

o Integrative medicine

o Functional medicine

o Anti-aging medicine

It is FULLY embracing the VIS

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The Future of Natural Medicine Changing healthcare by practicing true natural

medicine is the future of natural medicine. And ithas started.

The truth of our medicine will continue to inspire andtransform healthcare.

Paraphrasing Margaret Mead,

In fact, the truth of our medicine is the only thing

that can change healthcare.

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