| | Naturopathic Medicine : Naturopathic Medicine and the
New Political Realities - Where Do We Go From Here? | |
Peter Chowka ©
A talk by Peter Barry Chowka presented at the Tenth Annual
Convention of the American Association of Naturopathic Physicians
(AANP), Snowmass Village, Colorado October 13, 1995
We're here to discuss Naturopathic Medicine and the New Political
Realities: Where Do We Go From Here?
I'd like to begin with a joke I heard recently -- or perhaps it's a truism...
It is said that in the U.S. Congress the jokes there become laws, while the laws the
members of Congress make are a joke.
I wear two hats at this convention: Public Affairs/Media consultant to the AANP and independent investigative
journalist. Today, I'll be wearing the second hat and speaking for myself.
Some of you may disagree with me, but I hope that by proposing a point of
view based on my research, I'll help to encourage a much-needed dialogue
about the role of natural healing in the future of medicine in this
country.
For many years, in articles, lectures, and media appearances, I have provided people -- many of them seriously ill -- with information about the context of modern medicine. After years of reporting from the front
lines of alternative medicine, it's my view that choosing an alternative
or nontoxic course of treatment cannot be done properly without first
understanding the context that has made finding clinical alternatives and
employing them so daunting in our times.
To illustrate how quickly events can move and change, six months ago -- when I drafted the abstract
of this presentation for the convention program -- I wrote: ...problems
in the medical care system appear to be simmering on the back burner. Yet,
the American public's interest in natural healing continues to grow.
I still stand very much by the second half of that statement.
But the first part of the statement -- the back burner part -- has
obviously changed. Six or eight months ago, in the wake of the Republican
electoral victory in November, 1994, other concerns had moved to the forefront,
ahead of health care. Many people in the country appeared to be breathing
a sigh of relief, after the period from late 1993 through 1994, when conventional
medicine and its role in our lives received probably the most intense, sustained,
and hyped focus in history. The Clinton Administration had pushed an unprecented
national health care reform plan which would have completely transformed
and federalized the practice of medicine in this country. As the media reported
in September., 1994, however, the Clintons' health care reform was finally pronounced
dead somewhat after arrival.
As we know now, by looking at the newspaper or by watching television, the problems with medicine --
specifically, with paying for it -- that were briefly dormant a half year ago have
moved to the front burner once again. Since just before the Labor Day
(1995) congressional recess, the issue of Medicare -- the federal system
of medical welfare and entitlement -- has become the primary domestic political
topic...AND a principal issue in the opening shots of the 1996 Presidential
campaigns.
It's about time that we look closely at Medicare -- and at the whole system of conventional medicine
that remains the biggest single economic aspect of our society -- costing $1 trillion this year.
The federal expenditure on medical care is exceeded only by the interest
on the national debt and national defense. If change doesn't come, according
to independent analysts, Medicare will run out of money very early in the
next decade.
Some of you may have seen coverage on TV newscasts last September 20 from the corridors of Congress where members shouted at each other about the Republicans' plans to reform Medicare, and the disagreement
seemed like it might actually come to blows. To me that's a graphic image
of the quickening breakdown of the orthodox medical edifice.
But there's an even starker image that's emerged recently -- something new and
disturbing that's a part of the evolution of this story, taking place in
Southern California. Los Angeles County California, which is the second or
first in the nation depending on what criteria you use, has been wrestling
with a financial situation that is increasingly in critical condition, to
reach for a medical metaphor. Largely contributing to that state is the
out-of-control costs of the county's public medical care, in clinics and
county hospitals. Thousands of people have been employed to deliver conventional
medicine to the poor and indigent, at a cost of many billions of dollars.
The house of cards is beginning to crumble and it's not a pretty sight.
On September. 15th, the Los Angeles Times reported on page 1...
Los Angeles County officials, bracing for the possibility of violence,
have heightened security as they get ready for perhaps their grimmest task
ever -- issuing nearly 5,200 layoff and demotion notices today as part of
an effort to slash the public health care system to help solve a fiscal
crisis.
The situation was turning potentially ugly, as
authorities prepared for possible violence by people whose medical access
might be taken away and/or by the health care workers themselves!
The violence did not materialize -- this time. But in the days after the
story the health care workers participated in several sick outs that
paralyzed emergency rooms in the region.
You might ask what these kinds of stories have to do with natural medicine -- so-called alternative
medicine -- naturopathic medicine. And also, what the system of Medicare
itself, and what last year's failed Health Care Reform package, have to do
with alternative medicine.
The answer, I think, is...Everything!
Because ultimately, natural medicine in this society is practiced within a context of an enormous, bloated, schlerotic -- and largely ineffective -- system of conventional medicine that we are
now seeing is in a very advanced -- and even frightening -- state of
crisis.
Of course, the powers-that-be, including our political representatives in Washington, D.C. and in many of the state capitals, have a very limited vision when they look at the crisis and possible ways to solve
it. They're basically seeing the crisis merely in financial terms -- and
asking Where can we get more money, how can we stop the growth of
inflation? They're prepared to tinker a bit here, adjust something else
there, and cook the books to make the crisis look like it's been solved --
at least for the short term until after the next election cycle.
But the crisis runs much deeper. And for its roots, we need to go
back about 100 years -- which is to 1896 and what is considered the start
of Naturopathic Medicine in North America -- the centennial of which will
be celebrated next year.
In the late 1800s and early in this century, the arts of healing and the practice of medicine were extremely
diverse. The options were eclectic, small scale, community-based, grassroots,
and included some quite effective, traditional modalities that had been in
use for over hundreds and thousands of years: homeopathy, hydrotherapy, herbal
medicine, nutrition, physical medicine, the powers of touch and of the mind,
and so on.
There was some quackery, too, of course -- not least from the growing school of allopathy -- but there was considerable freedom and a free marketplace of medical ideas.
As many of you know, this democratic -- with a small d -- system came to a screeching halt shortly
after the publication of the Flexner Report in 1910. Paid for
by the special interests, and very much in sync with the allopathic, mechanistic
medical paradigm and the emerging petrochemical power structure of the period,
the Flexner Report was supposedly meant to regulate and improve medical
education. In reality, it succeeded in driving most of the eclectic practitioners
and their schools totally out of business. An example was the Hahnemann
homeopathic hospital and school in Philadelphia which became an
allopathic medical institution! The broad range of learning,
expertise, and clinical practice represented by things like botanical medicine
and homeopathy was relegated to a curious freak-like footnote in the history
of medicine, or driven underground to simmer quietly until the climate might
become accepting again.
As the 20th Century advanced -- and I have that word advanced in quotes, by the way -- As the 20th Century advanced, the hegemony of allopathic medicine came to be near-complete. First
it was the petrochemical and pharmaceutical mega-interests, and emerging
professional class of medical experts, who redirected healing into a very
narrow, reductionist, and self-serving approach. An example here is the
way the tax-exempt Eli Lilly Foundation, flush with profits from the Eli
Lilly drug company, gave hundreds of millions of dollars to U.S. medical
schools over several decades to ensure that the basis of medicine would become,
and would remain, pharmacology.
By the end of World War Two, it was the government that started to become involved, again, predictably on
the side of allopathic medicine.
It was the era of centralized medical research -- with power moving out of physicians' offices and clinics
and into the growing bureaucracies in Washington, or to the allied academic
facilities and drug company headquarters -- all of them tied together by
growing federal funding and regulation.
This system gave us a huge research establishment, mass, compulsory immunizations, wars
against diseases that mimicked actual wars -- although Vietnam more
than World War II - - and, beginning in 1965, Medicare -- the Federal
Government's entry into paying for civilians' medical care.
Medicare is not just a footnote in the history of 20th Century U.S. medicine.
It was the turning point -- toward the abyss.
We hear a lot right now about how great Medicare is, how we cannot live without it --
especially from politicians and those within the system. But here's a bottom
line to consider: In 1964, before Medicare, the typical American aged
65 or older actually paid less out of pocket for medical care than does the
older American today, in adjusted dollars -- even with the availability of
Medicare now!
That's because the advent of Medicare in 1965 immediately began to drive up the cost of medicine overall. It fueled inflation, like it had never been done before. So much so that the estimates in 1965
of what Medicare would cost today -- in 1995 -- were off -- too low -- by
a factor of ten.
The cause of the inflation was really very simple: When you have a payer in Washington legislated to pay medical
bills for 40 million Americans, the incentives for cost-effectiveness --
not to mention clinical effectiveness -- tend to fall by the wayside.
There have been a number of exposes lately in the mainstream media. One of them, on the NBC Nightly News with Tom Brokaw September 20, was part of the program's Fleecing of America series. That night,
the segment was titled Inflated Medicare Costs. NBC, reporting
on a GAO study, said that hundreds of millions of dollars were wasted
on medical supplies because of vague billing and grossly inflated
prices. Medicare, the GAO study found, typically reimburses
a hospital ten times the true cost for common items. For example,
a gauze pad that costs 19 cents retail, Medicare was paying
$2.32 for. The same night ABC's World News Tonight with Peter
Jennings reported that Medicare, which accounted for 6 percent of
the Federal budget in 1965, is now eating up 34 percent -- with that
share predicted to increase a lot in the years ahead.
You might think that, with all of this money at stake, there would be an interest in
economy or in better clinical effectiveness. But the story behind the figures
here is that conventional medicine is terribly ineffective in preventing
and treating most diseases that actually kill people. But the system
goes on -- it's on auto pilot. It remains easier to perform quadruple
bypass operations or balloon angioplasties for clogged arteries rather than
to practice primary prevention or to treat these conditions with diet and
lifestyle modification -- a clinically proven, and much cheaper and safer,
alternative. The alternative treatments that are allowed
are usually limited to high tech, expensive, hyped (but
never-quite-as-good-as-promised) breakthroughs rather than truly
alternative, primary clinical options based on a fundamentally different
paradigm of disease, wellness, and healing.
In the case of cancer and AIDS, the conventional strategy is to keep on with basically disproven
methods of combining cytotoxic chemotherapies rather than investigating the
ever present and growing anecdotal reports of benefit by primary nutrition,
herbs, and other nontoxic approaches. The annual U.S. death toll from cancer
and AIDS, meanwhile, now exceeds by a factor of ten the number of
Americans killed in the entire two decades-long Vietnam War.
HMOs, Managed Care, Medicare, and Medicaid
Health Maintenance Organizations offer their members comprehensive health services, including
physician visits and hospitalization, in return for advanced payment of a
fixed annual fee. They turn fee-for-service on its head: instead of more
services mean more income, fewer services mean more income.
But rather than encouraging prevention as the key, studies have shown that
HMOs simply encourage providing as few services as possible, often to
the detriment of patients' health.
The first article proposing HMOs as a marketable concept was written in 1970 by Paul Ellwood, a physician
who, two decades later, became influential in the elite Jackson Hole Group's
design of the Clinton Health Care Reform plan.
HMOs appear to cost less but only initially: their cost reduction tends to be one-shot. After
the initial downscaling of services, their rate of increase tends to be the
same as other health care providers. And they add new layers of
bureaucracy.
HMOs by their very nature...seek to make money by denying care, by cutting the amount of care that is provided, and by looking over a physician's shoulder and having some bureaucrat at the end of an 800
number second guessing it. That's the view of Sara Nichols, of Public
Citizen, interviewed on the MacNeil-Lehrer NewsHour, June 15, 1994.
I was talking earlier with Robert Broadwell, ND. He commented on the
myopia of another godfather of HMOs or group health plans, industrialist
Henry Kaiser. Kaiser built ships for the government at huge facilities during
WW2 and before that, dams and other mass public works projects during the
1930s. He tried to apply industrial techniques to medical care for his thousands
of workers. His assembly line medicine and creation of a legion of specialists
-- the antithesis of a holistic paradigm -- didn't work too well, however.
But they gave birth to the Kaiser-Permanente prepaid group health plans now
popular in California and several other western states.
Managed care is basically a synonym for HMOs. In the wake of the Medicare cost
crisis, HMOs and managed care are being proposed by politicians as money
saving solutions. But in reality they are merely a band aid or an attempted
quick fix of a larger problem.
As Alan Gaby, MD, who is here with the American Holistic Medical Association, told me, Let us seek
to restore humanism to managed care, keeping in mind that care by its very
nature cannot be managed.
Among my sources for this research are two books from different ends of the political spectrum: Prognosis
Negative: Crisis in the Health Care System published by the left-of-
center Health PAC in 1976 and What Has Government Done to our Health
Care? by the libertarian-oriented Cato Institute, 1992. Both of them
are very critical of the role of the government in the health care system.
From Prognosis Negative [pp. xii-xiii]...During the 1950s and early '60s government funds were earmarked for research and went primarily to academic medical institutions. Following the enactment of Medicare
and Medicaid in 1966, vast sums of money...poured...into hospitals and other
health-care institutions...The next five years were a period akin to the
heyday of the robber barons during the late 1800s. Medical empires...swallowed
up public and smaller private hospitals through a variety of affiliation
agreements. Hospitals grew by leaps and bounds...Health care costs
sky rocketed....The 1970s [was] a period of government intervention to control
and rationalize the system.
It's important to remember that Medicare and Medicaid were shaped by the American Hospital Association
to relieve the hospitals' financial crisis in the mid-1950s. [Prognosis
Negative, p. 289.] By the early 1960s, the inflated cost of conventional
medicine had outstripped many Americans' ability to afford it. The Democratic
Party landslide of 1964 resulted in a Congress that was willing to pump billions
of dollars into creating Medicare and Medicaid -- socialized medicine for
elderly Americans.
Look what Medicare and Medicaid resulted in: Between 1966 (when Medicare and Medicaid went fully into effect) and 1970, hospital daily service charges rose by 71.3 percent while the Consumer
Price Index rose only 19.7 percent. [Prognosis Negative, p. 19.]
Today, the average Medicare recipient costs the government more than
$5,000 a year! Also, the typical recipient takes more than $5 worth
of medical services for every $1 he/she paid into the program. Federal
and state governments now cover 42 cents of every dollar spent on health
care.
Health care is not the aim of the health care system. The health care system exists to serve its own ends.[Prognosis Negative, p. 29.]
We can see that clearly in the statistics which cut through the mythology.
The average life span in 1949 was
69 years. It has increased only a few years since then. [Prognosis
Negative, p. 9.]
For those who reach age 65, the life expectancy has increased only 3 years since the turn of the century -- from 12 to 15 years. [Prognosis Negative, p. 9.]
The behemoth industrialized system of medicine we have today is not an accident -- nor is it a result
of rational planning or the best choices. Instead, it was a combination of
economic self- interest, cooptation of government policy and tax dollars,
and a century's worth of propaganda that doctor and hospital
know best.
Would you like to know what did away with the family doctor and house calls? Government policy -- which during the 1950s moved health care into the hospitals and academic centers, and
in the 1960s cemented this centralized change with Medicare. But hospitals
and heroic medicine, as we know, are particularly ill-suited for dealing
with 80 to 85 percent of the conditions that kill people: chronic, degenerative
disease. Moving health care out of the doctors' offices and into the hospitals
was a shift that continues to have profound implications for the health of
the country and its economy.
As Konrad Kail, N.D. and Paul Bergner noted several years back in their AANP white paper on the impending health
care crisis, an extrapolation of a 1981 study by Steele et all shows that
iatrogenesis [doctor-caused harm] is likely the number 3 disease or cause
of death!
Meanwhile, prevention is not integrated into the dominant health care system. A clinical diagnosis is usually the first time prevention is even addressed!
The central government planning model for public health may well have made sense around 1900 -- when sanitation, clean water, and community infrastructural improvements were critical issues. Today,
centralizing health care no longer makes sense, when personal responsibility
and individual lifestyle choices represent the primary keys to improved
health.
The Future of Alternative Medicine
The situation I've been describing is changing -- slowly -- and that brings us to a review
of the outlook for alternative medicine in the face of emerging political
realities. I use the term alternative, by the way, realizing it's
an imperfect, and maybe misleading, term -- but it's in popular usage, so
bear with me.
I want to draw on my experience here -- 22 years as a journalist reporting on science and medical issues and medical alternatives; interaction with national politics and Congressional committees; serving
on advisory panels of the Office of Alternative Medicine; and, for the past
2 1/2 years, serving as the consultant in media and public affairs to the
AANP.
It's become a cliche to say that society can't stop the power of an idea whose time has come. But I feel that is what we're witnessesing here -- a potential resurgence and Renaissance of credible,
nontoxic, natural medicine.
It's still not fast enough for most of us. But look at some of the recent developments!...Homeopathic medicines
sold in regular drugstores, even in 7-11 stores! The media filled with reports
on medical alternatives. The Government at least paying lip service to the
credibility of natural medicine. Actually, more than lip service, since
the NIH gave Bastyr University more than $900,000 to become the center for
research on alternative approaches to HIV and AIDS.
And there is momentum on the legislative front, too. In 1993, reactively, the Congress
responded to an unprecedented public outcry and restrained Commissioner David
Kessler and the FDA from their plan to restrict access to popular nutritional
supplements.
The FDA is still on the march though...On Wednesday, Oct. 11, 1995, the CBS Evening News with Dan Rather
featured a report inspired and informed by the FDA about the supposed dangers of ma huang
(aka ephedra) -- a stimulant sold in health food stores, convenience
stores, and record shops. More regulation is needed, the report suggested
-- strongly implying that herbs are dangerous and that all herbs need
strong new federal regulation.
A subcommittee of Congress, the House Oversight and Investigations Subcommittee of the Commerce
Committee, is scheduled to hold a second hearing on FDA abuses, possibly
as early as the end of this month.
On July 25, 1995 the subcommittee held its first oversight hearing on the FDA's abuse of power. They established
an email address (fdaabuse@hr.house.gov) so that allegations of FDA
abuse can be reported directly to the subcommittee. The subcommittee staff
hopes to calculate the extent of FDA employee misconduct, but they acknowledgethat the harm already done to millions of patients who have been denied access
to needed treatments because of the impact of FDA abuses of authority cannot
be measured.
These hearings are a prelude to the Congress drafting FDA Reform legislation. California Congressman Henry Waxman (as might be expected) opposes the whole effort, but is reportedly the only member of
the subcommittee who does. It is likely that President Clinton will veto
any FDA reform legislation that reaches his desk. Accordingly, it will be
necessary to make any legislation veto proof. FDA Commissioner Kessler's
attacks on tobacco are a direct effort to align himself with the White House
in an effort to shoot down FDA reform.
To get a transcript of the July 25th hearing testimony, call the House Commerce Committee at
202-225-2927.
The NIH's Office of Alternative Medicine (OAM) came into being in 1991-92 -- the result of a Congressional mandate encouraged by citizens' grassroots interest and action.
3 1/2 years now after its first meetings, the OAM appears to be fairly well institutionalized
and to this point has escaped the Republicans' budget cutting plans. The
OAM newsletter is available free. The Office maintains a toll free number
-- 1-800-531-1794 -- to provide better access to OAM information.
The OAM sponsors periodic conferences on research methodology and is associated
with other conferences on alternative medical topics. While the OAM may be
somewhat of a disappointment to many of us who were initially invited to
participate in its workshops and advisory panels, the fact that it is
institutionalized is probably a benefit. As with most political entities,
it will be able to do good work to the extent that there is ongoing, vigorous
input from interested parties.
Again this year, two members of Congress reintroduced the Access to Medical Treatments Act, which would provide some additional protection to approaches previously considered unconventional
and inappropriate....and would help to stop the FDA from harassing alternative
medical practitioners. The latest word, however, is that, because the bill's
cosponsors are Democrats, the legislation will not be considered in the
current Republican controlled Congress.
The media, the public, and policy makers are seeing the cost crisis looming in health care. That was
the message of the Newsweek feature story on June 26:
Going Mainstream: Insurance companies have never been big on herbs
or homeopathy, and most would rather pay for a course of medication than
a course in meditation. But economics could change all
that.
Economics -- the cost crisis in our inability to continue to pay for conventional medicine - - is the wedge or the opening, according to Newsweek, by which alternative natural medicine
can now get a closer, more objective look.
There's also the decades long legacy of clinical failure on the part of conventional medicine
to significantly improve the health of Americans and to deal with the epidemics
of degenerative disease.
We are at a moment -- we are poised -- to be heard and to have a major influence.
Conclusion
I'd like to conclude the prepared part of my remarks with this perspective
on the new political realities within which alternative medicine
is now operating. Last fall's election results were in many ways a repudiation
of big government, big brother, paternalistic programs that have tended to
exacerbate problems more than solve them. To the extent that this is a
libertarian impulse, I think it's not a bad thing. Many naturopathic physicians
who may have a different political background than the one currently in power
in D.C. might want to consider adopting a more pragmatic, realpolitik
approach and build bridges to the leaders of the new Congress. Certainly,
in my view, we couldn't do any worse than the policies and actions pursued
by Democrats Henry Waxman, Bill Clinton, and Clinton's man at the FDA, David
Kessler.
These times are witnessing potentially profound changes
in the way medicine is practiced. There will be those who advocate becoming
allied with managed care, HMOs, and even the Federal Government's Medicare
program. In my opinion one should look long and hard before rushing headlong
to embrace such options -- without seriously considering the short and long
term impacts personally and for the naturopathic profession as a
whole.
I'd like to close with a comment that the late Linus Pauling made to me in an interview in 1982. How does change come, I asked him? From the grassroots up, not from the top
down, he insisted. Food for thought....
Peter Barry Chowka is a nationally-prominent journalist, medical-political analyst,
editor and lecturer. For over two decades his work in print, broadcasting
and nonfiction films (including his role in the award- winning production
Hoxsey: Quacks Who Cure Cancer?, aka How Healing Becomes a
Crime has documented the promise of innovative, nontoxic approaches
to healing. A 1992 appointee to several advisory panels of the NIH's Office
of Alternative Medicine, Peter is currently writing a documentary on AIDS
for public television and expanding his site on the Internet's World Wide
Web. He is the public affairs and media consultant to the American Association
of Naturopathic Physicians.
Other URLs
American Assocation
of Naturopathic Physicians
email to:
mediumcool@gnn.com
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