Ask the Scholar
Document scope · 1 page
Scholar
Ask about this object, its catalog metadata, its source description, or the page inventory.
For page-specific OCR and visual context, open one of the page chats.
Scholar Source Context
Document identity
localId
44170191
label
WHCCAM Meeting Transcript, Volume I, May 14, 2001 [4]
core
doc
dtoType
document
citationUrl
pageCount
1
Source metadata
id
44170191
sourceUrl
contentType
document
title
WHCCAM Meeting Transcript, Volume I, May 14, 2001 [4]
citationUrl
collections
White House Commission on Complementary and Alternative Medicine Policy
Meetings
largeImageUrl
imageCount
1
hasImages
yes
source
import
hasTranscription
no
Source extras
naId
44170191
levelOfDescription
fileUnit
otherTitles
42-t-40967348-20110568S-019-001-2016
recordType
description
ocrSource
nara-archive
Single page context
seq
1
pageIndex
0
type
document
mediaId
23b85432f9ac47a7
ocrText
300
1
lifetime limits on public assistance coverage for low-
2
income populations and people dependent on public
3
assistance; a marked decline in charity care by private
4
physicians and community hospitals, thanks not to
5
Medicaid managed care but the kind of managed care that
6
you and I have through our commercial coverage, and the
7
demand by those managed care providers for significantly
8
reduced payment rates, which has immediately eliminated
9
the cost shift that covered what we still like to call
10
uncompensated care -- it is really cost-shifted care --
11
and then, the loss of Medicaid revenues as well.
12
Now, with respect to health centers and
13
complementary and alternative medicine, as I indicated
14
earlier, health centers serve almost eight million people
15
of color, and they strive to provide linguistically and
16
culturally appropriate care.
17
Many health centers -- I ran a health center
18
down in south Texas 30 years ago -- actually provide
19
complementary and alternative medicine modalities,
20
particularly traditional folk healing. My health center
21
used to make referrals to Curanderos for cases of susto,
22
literally fright, mal de ojo, evil eye, which our
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
301
1
physicians were more than happy to refer to the
2
Curanderos for because, quite frankly, they didn't have a
3
modality or treatment that would work for that. We
4
recognized it. We paid the Curanderos for their
5
coverage. No other third party payer at that time, 30
6
years ago, and I think no other third party today,
7
recognizes Curanderos and provides payment for those
8
services.
9
Health centers continue to provide it. Native
10
Hawaiian and Native American health services among many
11
of the health centers, also, acupuncture and herbal
12
medicine. In fact, two surveys done just a couple of
13
years ago found that on average 25 to 50 percent of
14
health centers offer one or another forms of
15
complementary and alternative medicine. The most common,
16
acupuncture, massage, chiropractic, and folk healing.
17
There are obviously barriers to greater use of
18
CAM by health centers, including the refusal of Medicare,
19
in most states, Medicaid, and CHIP programs to cover it,
20
as well as private insurers, and quite frankly, a lack of
21
awareness and appreciation by health center physicians.
22
We have some recommendations for you, the most
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
302
1
important of which is the establishment by the federal
2
bureau that funds health centers in Integrative Medicine
3
and Alternative Health Practices, IMAP Initiative, to
4
track better the use of alternative therapies and
5
modalities by health centers, and to provide more
6
information, which we hope to gain in the near future.
7
Obviously, the biggest barrier is the lack of
8
adequate funding, something that this Commission might
9
have something to say about, about providers like health
10
centers. Thank you.
11
Panel Discussion
12
DR. GORDON: Great. Thank you. Thank you very
13
much.
14
While the Commissioners are getting their
15
questions ready, it looked to me that the Bureau of
16
Primary Health Care and the community health centers only
17
provide care to a relatively small fraction of those who
18
are uninsured.
19
Why is that? What are the limitations there?
20
MR. HAWKINS: The biggest limitation is
21
funding. The support for the care of the uninsured comes
22
from four principal sources. First, is the federal
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
303
1
grant, which, as I indicated, even at $1 billion now, the
2
federal funding for health centers is only about a
3
quarter of health center operating budgets. They, like
4
all providers of care to uninsured and underserved
5
populations, have cobbled together resources from a
6
variety of locations and payers to support the cost of
7
care for the uninsured.
8
State and local funding, although it represents
9
about 18 percent of health center budgets, is actually
10
growing faster than the federal support. And then, the
11
patient payments themselves, but the patients, with 86
12
percent of all health center patients being members of
13
families with incomes below 200 percent of poverty, have
14
a very limited ability.
15
Health centers often face the issue of, do we
16
raise our minimum fee or our sliding charge fees, knowing
17
full well that even a dollar increase is going to
18
establish a barrier to some number of people coming in
19
for care when most importantly they need it for good
20
preventive care, early primary care. People will, just
21
as the uninsured do today, react to the barrier by
22
delaying care until it is more costly and more
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
304
1
complicated, more complex conditions.
2
So funding is the single greatest barrier.
3
DR. GORDON: So if you were us and you were
4
going to recommend funding, and recommend funding that
5
would include CAM approaches, what kind of recommendation
6
would you make?
7
MR. HAWKINS: I would look at two ways of doing
8
it. During the Carter Administration, I worked with
9
Secretary Joe Callifano, and a guy named Hale Champion,
10
who was the undersecretary, as they called them in those
11
days, the deputy secretary at HHS.
12
Hale was a wonder at making sure that you put
13
things in many different cubicles and cubbyholes so that
14
it wouldn't all jump out at somebody as being too large.
15
Creative budgeting. I would use that approach here.
16
First of all, within HHS, on the discretionary
17
program side, you have any number of programs that serve
18
identified populations that could benefit from, and very
19
much need, complementary and alternative medicine
20
therapies and modalities. You have the Indian Health
21
Service; you have the Maternal and Child Health Program;
22
you have the Ryan White AIDS Program; you have health
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
305
1
centers; you have the National Health Service Corps,
2
which is an important program that provides support in
3
the form of scholarships or loan repayment to health
4
professionals in return for obligated service in
5
underserved communities. Many of those National Health
6
Service Corps assignees serve at health centers.
7
Today, NHSE assignees are pretty much limited
8
to physicians, nurse practitioners, physician assistants,
9
nurse midwives, dentists, hygienists, very little in the
10
way of CAM therapists. That might be something that you
11
could identify as well.
12
You have many centers for disease control, CDC
13
programs, and even NIH, which on its way doubling to the
14
tune of about $23 billion this year, provides some form
15
of care for clinical trials and other activities.
16
Each of these discretionary accounts could be a
17
target for increased funding, and within that increase
18
then, some identified priority. I hate earmarks, but
19
some priority or incentive to utilize some of that
20
increase to establish or enhance the use of complementary
21
and alternative medicine.
22
I know if you asked health centers tomorrow to
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
306
1
make greater use of complementary and alternative
2
medicine, the response would be, what, you want us to
3
throw uninsured people out in the street, to turn this
4
money over to provide more CAM therapies to a smaller
5
group? The battle always is, do you a lot for a few
6
people, or a little bit for many. Health centers
7
struggle with that. Every health center in this country,
8
all 4,000 communities served, every day.
9
But there is a second thing I would recommend,
10
and I think you have touched upon it earlier today, and
11
that is third party payment. As I indicated today,
12
Medicaid is the single largest source of revenues for
13
health centers, and yet there are at least 1.5 million
14
children, children, low-income, being served by health
15
centers today who are uninsured. Unconscionable, in my
16
book. It is an indictment of health centers as much as
17
of the system that supposedly is out there to enroll them
18
and cover them.
19
Every one of those kids is eligible for
20
Medicaid. We fought like heck with many state Medicaid
21
agencies to get out-station eligibility workers,
22
enrollment workers, at health center sites to eliminate
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
307
1
the barrier of having to travel. Most states still do
2
Medicaid eligibility through their welfare office, and
3
many people will not do that. They won't go there. They
4
are either afraid or they feel treated with no dignity
5
whatsoever.
6
We need to try to get more kids covered, but
7
then, those programs need to extend the coverage that
8
they provide to include complementary and alternative
9
medicine therapies.
10
Now, I understand you heard from a HCFA source
11
this morning, much more knowledgeable than I about what
12
states do or don't do under Medicaid, what they do or
13
don't do under the Child Health Insurance Program. This
14
Commission could strongly recommend that all states under
15
Medicaid and CHIP ought to provide coverage for
16
appropriate and recognized, and you can best determine
17
what that mechanism and methodology is for doing that.
18
These programs which are the major insurer of
19
record for low-income people in communities, for
20
communities of color, for immigrant populations in this
21
country -- I listened to the question about what
22
populations use complementary and alternative medicine to
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
308
1
the gentleman from Blue Cross Blue Shield of South
2
Carolina this afternoon with interest.
3
I am not surprised, because, as he indicated,
4
among low-income populations and people of color, the
5
major coverage source is going to be public. It is going
6
to be Medicaid, CHIP, and Medicare. Those programs are
7
subject to public policy edicts. That is where the
8
coverage extension ought to be pushed most forcefully.
9
DR. GORDON: Thank you.
10
Dr. Miller or Dr. Stinson, do you have any
11
additional thoughts about these issues of how we would
12
move this agenda ahead?
13
DR. MILLER: I agree with the comments that Mr.
14
Hawkins made regarding promoting coverage through public
15
policy, particularly through Medicare/Medicaid, and also
16
the SCHIP programs.
17
I must say that there needs to be a linkage
18
between performance measurement and evidence with the
19
expansion of coverage in the same way that through
20
Medicaid and HCFA and some of the peer review
21
organizations that there are standards of measurement for
22
treatment of diabetes and congestive heart failure, in
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
309
1
terms of best practices that will help to promote the
2
increased use of complementary and alternative medicine.
3
DR. STINSON: I would also like to agree with
4
the two previous comments, and also to add that one of
5
the things that our office is doing in the Department is
6
tying in the importance of cultural competency, as far as
7
the delivery of quality health care. We, over this next
8
year, are actually going to be starting some new policy
9
initiatives that are going to look at what changes in the
10
health care system are going to be necessary to really
11
implement a way of dealing with diverse populations in a
12
way that guarantees the quality outcome.
13
I think that in addition to, certainly, looking
14
for opportunities to build in that funding support, we
15
are going to help build up the scientific base to show
16
why it is important to pay for it, because it is
17
something that improves health as a whole.
18
DR. GORDON: Thank you.
19
Charlotte.
20
SISTER KERR: My statement isn't related to a
21
particular group, but specifically here, I am thinking
22
many of us feel that self-care is primary care. I am
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
310
1
wondering, with CAM practices, for example, therapeutic
2
touch, reflexology, mind-body work, group prayer, where
3
are we with doing that? What is your sense about
4
creating your practitioners locally? What has been done?
5
I want to know what you think about it.
6
DR. MILLER: I'll be brave. I can talk to you
7
about it from the perspective of not just my position at
8
the Foundation but someone who has spent more than 10
9
years in clinical practice at community health centers,
10
and I continue to practice a half day a week at a
11
federally qualified health center.
12
The urgency of problems that come up on a day-
13
to-day basis in the number of patients that need to be
14
seen presents significant barriers to the practice of CAM
15
for those physicians who are interested in the services.
16
When I was in practice at a federally qualified
17
health center in San Francisco, we set up not necessarily
18
an integrative practice but a parallel practice with the
19
American College of Traditional Chinese Medicine in order
20
to provide services and attention to the patients who
21
were interested in receiving those services. About 15
22
percent of my practice was HIV and AIDS at that point.
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
311
1
Our practitioners wish that they had had more
2
of an opportunity to have a true integrative practice
3
with the Chinese Medicine physicians, and unfortunately,
4
because of time constraints and pressures of the
5
practice, that was not possible.
6
There is interest, but I think that, given the
7
current practice structure that exists within medicine,
8
the barriers are significant. Many providers end up
9
taking CME courses or setting up parallel practices in a
10
way that they are able to satisfy the needs of their
11
patients in other settings, but as I said, the barriers
12
are certainly challenging.
13
SISTER KERR: I just want to clarify my
14
statement. It had more to do with the patients being the
15
practitioners. When I ran a diabetes clinic, I was
16
adjusting heroin and insulin, like many of us have had to
17
do. As I have moved into other areas of healing, I
18
realize that we could be bartering the practices, the
19
moms doing therapeutic touch on the babes, and the foot
20
reflexology.
21
I don't see any of us doing it at any
22
socioeconomic level yet, but I am curious since sometimes
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
312
1
the poor people know a lot more about healing than other
2
folk.
3
DR. MILLER: I would agree with you on that,
4
Commissioner. I think that, oftentimes, in order to have
5
that shared type of practice, it is a question of people
6
going and seeking the information. Also, if it happens
7
in conjunction in a medical practice, it is a question of
8
time.
9
Before we set up the Chinese medicine practice
10
within our health center, we surveyed our patients. As I
11
said, 70 percent were uninsured. The balance of our
12
funds were a disproportionate share of funds, Medicaid
13
and Medicare, very little private third party payment.
14
Almost half of our patients in this low-income,
15
inner city clinic were going out and seeking CAM services
16
on their own. Usually, acupuncture, massage therapy,
17
spiritual healers, and mind-body work.
18
DR. GORDON: Joe.
19
DR. PIZZORNO: A question for Mr. Hawkins.
20
I was surprised that in your testimony you did
21
not mention the King County Natural Medicine Clinic, and
22
I was wondering if you were aware of it.
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
313
1
MR. HAWKINS: Which clinic is this?
2
DR. PIZZORNO: The King County Natural Medicine
3
Clinic.
4
MR. HAWKINS: King County --
5
DR. PIZZORNO: Washington State.
6
MR. HAWKINS: Oh. I am going to be up there
7
fairly soon. As a matter of fact, there are several
8
locations. I didn't identify them. Waianae Coast Health
9
Center in Hawaii has a whole separate facility with
10
Native Hawaiian medicine.
11
I have heard of King County as part of the King
12
County Community Health Centers, Tom Trumpeter's outfit.
13
Yes, he has talked to me about that. That is one
14
important point. Data is fairly scarce. It has been to
15
date. The two studies that I mentioned, or surveys, that
16
were done, were good surveys, but they were done four
17
years ago, and they were spot surveys of individuals at a
18
couple of different conferences.
19
I am pleased to report, though, that as part of
20
the IMAP Initiative at the Bureau of Primary Health Care,
21
beginning this year, data will be collected on exactly
22
how many health centers and at how many of their
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
314
1
locations offer many of the various CAM modalities by
2
type. So we should be able to be back here a year from
3
now, and be able to tell you exactly by state and across
4
the country how many health centers offer each of the
5
different modalities.
6
DR. PIZZORNO: I think the key element
7
important, when you go to visit, to take a look at, is
8
that it is a fully integrated care clinic. They don't
9
have separation of CAM here and conventional medicine
10
here. They actually work much more collaboratively
11
together, and there has been tremendous patient
12
satisfaction. They are now replicating this throughout
13
the rest of the nine clinics in their system.
14
MR. HAWKINS: Wonderful.
15
DR. GORDON: Tom, and then George.
16
MR. CHAPPELL: Daniel Hawkins, I just would be
17
interested in knowing more how these clinics are funded,
18
originally, and then sustained. I see it is a
19
public/private partnership, but could you be more
20
explicit about, for instance, what funds are coming from
21
the government, if any.
22
MR. HAWKINS: Right now, health centers in
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
315
1
somewhat of a growth mode, having been targeted by the
2
President and by a majority in Congress to double in size
3
over the next five years in order to serve twice as many
4
people in order to meet more of the need, especially
5
among uninsured and underserved Americans.
6
Right now, this year, at least 100 new health
7
centers will be funded for the first time in communities
8
that today do not have a health center in their community
9
or within reach. The typical process is one in which a
10
community organization or a facility that is already
11
providing care, perhaps a health department or a
12
hospital-affiliated facility or a community clinic that
13
is already up and running but has limited resources,
14
relies on volunteers, et cetera, meets the requirements
15
and applies for funding to be a community health center.
16
That is a process in which one has to meet two
17
sets of factors. One is the need criteria. You have to
18
serve an area or a population that is designated or can
19
be designated on the numbers as medically underserved.
20
There is a whole process one goes through for that.
21
Then secondly, you have to submit an
22
application that provides sufficient detail, and also go
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
316
1
through a site visit, to satisfy folks that you, in terms
2
of general operation, financial management, clinical
3
management and quality of care, and community involvement
4
in the policy making, convinces federal officials that
5
this is a good investment.
6
Federal investment begins with an operating
7
grant of 5- or $600 million, unless it is a very small
8
community where services are to be developed. That grant
9
provides a foundation.
10
It is, oftentimes, what you don't see. What
11
you see is everything above ground. This is the below-
12
ground foundation, the basement, if you will. Once the
13
health center opens its doors, it has to have an open-
14
door policy. Within the limits of its capacity, it must
15
accept within the door whomever walks in, regardless of
16
whether they do or do not have coverage, whether they can
17
or cannot pay for services.
18
Typically, the word gets out very fast among
19
the low-income community, especially those who are
20
uninsured, that the new health center is open. And so, a
21
majority of those who do come in the door, particularly
22
once it is up and running, tend to be uninsured or
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
317
1
underinsured.
2
But then, the health center must, must,
3
identify and bill and attempt to collect for any third
4
party payer, for anyone who has third party coverage.
5
They can't just fall back on the grant to cover the cost
6
of care for those who do have coverage, and they cannot
7
turn away someone who does have coverage, to say, no, no,
8
no; we are only a clinic for the uninsured.
9
The whole point is, once their door is open,
10
they really have to be an open-door health center
11
program, not discriminating against people who wish to
12
get their care there.
13
MR. CHAPPELL: [Off mike.]
14
MR. HAWKINS: Absolutely. I would be happy to
15
get to the Commission a pie chart that shows where
16
revenues come from.
17
MR. CHAPPELL: I would like that.
18
MR. HAWKINS: Seven percent of a typical house
19
owner's budget is patient payments. As I mentioned, 18
20
percent is state and local support, from state and local
21
governments.
22
MR. CHAPPELL: But it is all initiated with a
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
318
1
federal grant.
2
MR. HAWKINS: That is what really starts the
3
ball rolling.
4
MR. CHAPPELL: Thank you.
5
DR. GORDON: I have a sense that we want to be
6
talking with you more afterwards in more detail about
7
some of these proposals.
8
We only have time for one more question now.
9
George.
10
DR. BERNIER: I actually have a question for
11
Dr. Stinson.
12
And that is, from what you said about the
13
Office of Minority Health, that a diminution in the
14
utilization of CAM-related activities is a bell weather
15
that says that that decrease in the number will reflect
16
the decrease in any kind of overall health care.
17
I don't know if I am making that clear, but it
18
seems to me that the utilization of CAM products is, in
19
some ways, proportional to the affluence of the
20
population that is using it.
21
Contrary-wise, as people are decreasing the
22
level of CAM activities, it is a reflection of decreased
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
319
1
access to other kinds of health care as well.
2
DR. STINSON: I'm not sure. Could you repeat
3
your question again, because I'm not clear.
4
DR. BERNIER: I think you said that nationally
5
there was, among minority groups who were underserved, a
6
relatively low amount of CAM activities in their health
7
care program.
8
Is that correct?
9
DR. STINSON: Well, I think what I said, or
10
what I intended to say -- let me put it to you that way
11
-- that if you look at several different studies, some
12
will show that, and some will show other things,
13
depending on what specific modality you may be looking
14
at.
15
DR. BERNIER: So that, the extrapolation that I
16
just made would not necessarily be a valid one.
17
DR. STINSON: I think that the statement is too
18
general, at least from my own perspective. We have
19
resisted in getting into discussions with interested
20
parties about, is it high here; or low here, or high in
21
this population, low in this population, because as you
22
go through and look through the literature, the
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
320
1
literature is as diverse in its conclusions as the
2
populations we deal with.
3
What we have tried to focus on instead is the
4
fact that the use of complementary and alternative
5
medicine modalities is something that plays a very
6
prominent role in health care delivery in this nation,
7
and it is important and incumbent upon the health care
8
system to recognize that and work with that, and
9
understand the role that it does play in making decisions
10
that lead to the ultimate improvement in health of
11
whatever population we are dealing with.
12
DR. BERNIER: Thank you.
13
DR. GORDON: I just want to add one thing,
14
George, that may help clarify it. I have worked, over
15
the last 10 years, with HIV-positive ex-addicts and
16
current addicts in New York City, with over 5,000 now.
17
Where CAM services are available, they will use
18
them. There are tremendous barriers. There are economic
19
barriers, there are the primary, but what we have
20
observed is, the people who have never heard of CAM at
21
all and may have had no previous interest, once they are
22
exposed and once they experience, and this speaks to some
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
321
1
of what Charlotte was talking about, once they have
2
experiences with self-care, whether through mind-body
3
techniques or through physical exercise or through
4
acupressure, they get it and they are very eager to use
5
those therapies.
6
I think that some of the disparity in the
7
research has to do with different kinds of populations,
8
but also, that in some areas, for example, rural areas,
9
there is very, very little access at all. I think it is
10
a sort of chicken or egg question in many instances.
11
I want to thank you all very much, and we look
12
forward to continuing the discussion individually with
13
you. We are going to breaking up into small groups now.
14
Again, thanks so much for your very helpful testimony.
15
DR. STINSON: You are welcome.
16
DR. MILLER: You are welcome.
17
[Applause. ]
18
DR. GORDON: If Commissioners could just sit
19
for a moment. Steve is going to tell us about the
20
procedure for this next period of time.
21
DR. GROFT: We are now going to enter into a
22
breakout session to discuss access and delivery of CAM
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
322
1
practices and products. So Group IA, if you have your
2
list, Julia Scott will be the chair, and Corinne Axelrod
3
will be the staff person who will work with the group
4
there. They will meet right here in this main conference
5
room.
6
Group IB will go upstairs to the Balcony
7
Conference Room E, and that will be chaired by Tom
8
Chappell and Gerry Pollen. Gerry is sitting over there.
9
She will be the staff person.
10
Again, members of the audience who would like
11
to attend either session, Group IA will be Access and
12
Barriers to CAM Practices and Products, and Group IB will
13
be Delivery of CAM Practices and Products. So you can
14
break yourself out however you would like.
15
Again, there will be no public participation in
16
either of these two breakout sessions. We have about an
17
hour to formulate recommendations on these issues, and
18
the information has already been provided to the
19
Commission members from the December meeting and a
20
synthesis of other recommendations that came in from the
21
various Town Hall meetings and other meetings that we
22
held as a commission.
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
323
1
So if you have written comments, or any
2
comments or suggestions, please present them just to the
3
staff members who are present, and then we will take
4
those back and provide them to the Commissioners at a
5
later date.
6
DR. GORDON: We will reassemble back here
7
promptly at 5:20, and each of the breakout groups will
8
present its recommendations.
9
So Julia and Tom, you and your staff person who
10
is working with you will be in charge of giving us some
11
recommendations.
12
We will see you then. Thank you, everybody.
13
[Breakout session. ]
14
DR. GORDON: Julia, do you want to go first?
15
Group IA: Access and Barriers to CAM
16
Practices and Products
17
MS. SCOTT: Well, we weren't as disciplined to
18
actually write down our remarks, but we had a lot of
19
discipline in the room in terms of keeping on the mark
20
and getting back here on time.
21
DR. GORDON: Yes. Noted.
22
MS. SCOTT: Clearly, 50 minutes is not enough
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
324
1
to do justice to this, but it is the first broad-brush
2
recommendations. So in that spirit, we will offer you
3
what Group IA came up with, and this was a group effort.
4
Recommendations related to access.
5
Recommendation Number one, we recommend that all health
6
professionals, not just medical doctors, but CAM
7
professionals as well, be trained in how to interrelate
8
to each other, and in collaboration skills.
9
Number two, we recommend that there be
10
established a public information campaign on CAM
11
therapies, modalities, and philosophy for practicing
12
physicians, academic research scientists, and the general
13
public.
14
Three, we recommend that a federal office be
15
established to oversee regulation and standardization for
16
natural products.
17
The remaining ones, we really like we didn't
18
have enough time to do justice to them, but we thought it
19
was important to just get them up on the piece of paper.
20
DR. GORDON: Absolutely.
21
MS. SCOTT: And we will go back and be more
22
detailed about that. One was in the area of the special
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
325
1
populations, because clearly, there are specific
2
recommendations for each of the populations.
3
I think, in our group, there was a general
4
feeling that we shouldn't have too different classes,
5
those that can afford and those that can't, but that is
6
the reality right now in terms of these services not
7
being provided, wholesale, by reimbursement. So we felt
8
that there needs to be a recommendation on special
9
populations and their access to CAM modalities and
10
therapies that are not disparate, but as I said, we
11
didn't have time to talk about each one of those
12
communities.
13
The next recommendation is related to that
14
thinking, as Dr. Stinson was reminding us how healthy
15
2010 --
16
DR. GORDON: Healthy People 2010, yes.
17
MS. SCOTT: -- Healthy People 2010, the push
18
has been not to have different recommendations for
19
different populations, but to have general
20
recommendations for the whole area, say, for diabetes.
21
So that, we want to encourage an integrative model of CAM
22
and allopathic therapies to address health disparities.
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
326
1
Then finally, one other recommendation. We
2
felt it very important that we have a recommendation
3
related to safety, related to consumer access and safety.
4
We didn't have enough time to work out the words, but we
5
are very interested in a recommendation that would look
6
at allowing use of medical treatment that has been in use
7
in other countries for which that country's regulatory,
8
or equivalent body, have found to be safe.
9
We understand there is a lot of disparity
10
there. We know that some of these therapies may have
11
been used for years, but may not be safe. So we have to
12
go back to this recommendation and be a little more
13
specific about the kinds of data we would look at from
14
other countries.
15
DR. GORDON: Terrific. Thank you, Julia.
16
Anybody else from that group want to add
17
anything?
18
[No response. ]
19
DR. GORDON: That basically sums it up, then?
20
[No response. ]
21
DR. GORDON: Good. This is great. This
22
doesn't have to be precise now. We are going to be
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
327
1
filling these in, working on them, and then presenting
2
them to everybody. Then we will all have those two full
3
days to go over and refine them. So this is great for
4
general outlines.
5
Tom.
6
Group IB: Delivery of CAM Practices and Products
7
MR. CHAPPELL: We seemed to have consensus on
8
almost everything. There was just one issue we didn't
9
resolve, but specifically asking, how can we improve CAM
10
services, and to the theme of, should we integrate or
11
keep separate, our recommendation is that we offer the
12
CAM professions a choice of whether they want to
13
integrate or to maintain a separate professional, free-
14
standing service, that the marketplace will work that
15
out.
16
Secondly, if the professional chooses to
17
integrate with other physicians and services, the CAM
18
professional will need to use the standards of practice
19
in credentialing and licensing, and to provide experience
20
data on safety and efficacy. Much of what we have heard,
21
throughout, is the state credentialing, licensing, the
22
professional standards of practice that each group has,
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
328
1
we are affirming the reports of that as a principle.
2
In addition, get is much experience data, as is
3
available, experience on safety and efficacy. We were
4
saying that in order to integrate CAM, the burden is to
5
demonstrate as much experience data as possible on
6
efficacy or safety.
7
Again, continuing this theme of integration, we
8
want to help facilitate more funding and support for
9
better and more research in CAM services, research on
10
both safety and efficacy.
11
In that spirit, we are recommending
12
collaboration wherever possible or desirable among
13
physicians and CAM practitioners. There has been a lot
14
said throughout the process, that collaboration helps
15
everybody get down to the details and understand and
16
respect and gain a greater appreciation for the mutual
17
services.
18
Last, on this integrate versus separate, we
19
encourage loan forgiveness programs that promote CAM
20
services, that they pursue those services in areas of
21
special need.
22
DR. GORDON: I just want to ask a quick
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
329
1
question.
2
MR. CHAPPELL: Sure.
3
DR. GORDON: Did you cover the issues of
4
whether or not your group felt we should try to establish
5
any national standards? Or, were you just focused on the
6
standards that the different professions were
7
establishing?
8
MR. CHAPPELL: We handled that under the
9
products section, and I think the group would probably
10
feel the same would apply to the services section, but I
11
can check it out with the group when we get there.
12
DR. GORDON: The only reason I raise it, is
13
because I know this is an issue that we need to be
14
thinking about in many different ways and many different
15
times. So I was just wondering if there was any
16
preliminary thinking about it.
17
MR. CHAPPELL: Well, just to segue to that
18
point while we are on it, one of the things we thought
19
about in improving CAM products would be to -- where is
20
that point? Oh, under modeling?
21
I don't think it is under products after all.
22
It is not under products. It is under education.
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
330
1
DR. GORDON: Okay. Come back to it later.
2
That's okay. I'm sorry.
3
MR. CHAPPELL: What was the question?
4
[Laughter. ]
5
DR. GORDON: What is the answer?
6
[Laughter. ]
7
DR. GORDON: It was about national standards.
8
MR. CHAPPELL: The models. We thought we
9
learned a lot from models on CAM services, and we are
10
recommending that state boards do more to protect solo
11
practitioners who may choose to focus on CAM practices
12
exclusively, or those that choose to add CAM practices to
13
their existing. So there is some protection from state
14
boards being sought here as they try to expand their
15
services, or focus their services, around CAM.
16
Again, on the models. To increase federal
17
funding for models like the King County Community Health
18
Clinic, as well as some of the community concepts we
19
heard this afternoon, but we focused on the King County
20
clinic because it had so much of the collaboration,
21
community partnership, community management, and
22
integration of Western and CAM modalities.
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
331
1
Again, on models. Wherever these community
2
models are involved, to provide tax incentives to
3
encourage their community development all the more.
4
The third model that we talked about was
5
partnering, to create a partnering concept where we bring
6
CAM services to the uninsured, and that the partnership
7
would consist of the university, the CAM providers, the
8
physicians, the health plan providers, like those that
9
were here today, and to wrap that, perhaps, in a
10
community health clinic or not.
11
But again, it is the idea of partnering for
12
learning. This is mentioned specifically for the
13
research in improving the health of the uninsured.
14
We want to encourage Congress to include CAM
15
benefits language in Medicare. Similarly, with states,
16
on Medicaid, and to bring, wherever possible, the
17
evidence of efficacy.
18
Now I get to education. We are recommending
19
that self-care wellness education be introduced into our
20
schools at the high school level, and be maintained in a
21
continuous curriculum throughout the educational program.
22
Secondly, to create or build upon NCCAM to
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
332
1
provide information about different wellness modalities,
2
their theories and practices, and to create an
3
educational body of material.
4
The only piece that we didn't have enough time
5
to resolve was the integration model, where you have a
6
private hospital, a university, and trying to integrate
7
CAM and physicians in those various models that we were
8
part of the hearings. We were unable to resolve whether
9
that was an idea worth continuing or not.
10
DR. GORDON: I'm sorry, resolve what, though?
11
MR. CHAPPELL: Whether we would help with
12
policy recommendations that would promote the
13
continuation or development of that particular model.
14
DR. GORDON: What were the discussions on
15
either side of the issue?
16
MR. CHAPPELL: On the positive, it was seen as
17
very healthy to include the university system in the
18
community. On the negative, the question was whether we
19
could break through the professional dogma into a true
20
working partnership.
21
DR. GORDON: So it was considered a good idea,
22
but whether or not it was feasible was the question. Is
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
333
1
that right?
2
MR. CHAPPELL: Yes. So it is left with the
3
need for more discussion as to whether we would recommend
4
that.
5
DR. GORDON: Great.
6
MR. CHAPPELL: Products, oh yes. CAM products
7
need to be accompanied by a responsible, truthful
8
information about safety and efficacy.
9
Secondly, to have the government fund research
10
on the top 20 most popular herbs, that is, for their
11
safety, and then more in-depth research for their
12
efficacy.
13
DR. GORDON: Can you say a little bit about
14
where that is coming from.
15
MR. CHAPPELL: As to why they are separated,
16
safety and efficacy?
17
DR. GORDON: No. Where that recommendation
18
came from.
19
MR. CHAPPELL: Let's see.
20
DR. GORDON: I mean, for several reasons.
21
Since we weren't talking about research, but also,
22
clearly, there is some --
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
334
1
DR. LOW DOG: We were talking about delivery of
2
them, and part of delivery is also safety, because that
3
is the issue that keeps coming up, is that people's
4
access to these things actually may be removed if DSHEA
5
is overturned. Part of the big reason for that is
6
because of a few products on the market that are causing
7
a lot of problems for the whole field.
8
So what we were talking about was that 80
9
percent of sales are made up of only 20 herbs. If those
10
could be studied, instead of more obscure herbs, those
11
could be studied for toxicology, genotoxicity,
12
mutagenicity, carcinogenicity, these types of things,
13
p450, drug interactions, if that could be funded while we
14
are doing efficacy, because people are already using
15
these, it might go a long way to protecting people's
16
rights and access to these products.
17
MR. CHAPPELL: And the concern is that because
18
these are being consumed by the public and they are not
19
patentable and don't encourage private research, then we
20
feel the government needs to do the research for public
21
safety, on both safety and efficacy.
22
DR. GORDON: Terrific. This is all very good.
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
335
1
One of the things that is so interesting, of course, in
2
looking at these, is seeing how interrelated everything
3
is to everything else. So we may be talking about access
4
or services, and we are also talking about education and
5
public information and research at the same time, because
6
they are all connected. Terrific.
7
Any other comments?
8
DR. CHOW: I have a question. Can we get the
9
list of 20 herbs?
10
DR. LOW DOG: Sure.
11
DR. CHOW: You say 80 percent of the people use
12
only 80 --
13
DR. LOW DOG: Eighty percent of sales.
14
DR. CHOW: I would really love to get that.
15
DR. LOW DOG: You got it.
16
DR. CHOW: Just what you were saying, Jim, is
17
that we found we kept coming back to finances, even
18
though we weren't talking about that today; access. We
19
kept coming back to reimbursement and finance. So it is
20
all interrelated.
21
DR. GORDON: These are great and these will
22
definitely focus our attention. One thing, also, that
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
336
1
jumped out at me about that last recommendation is it is
2
imaginative. It is taking a little piece, and using the
3
piece to open up the whole field.
4
So it just occurs to me that one of the things
5
we need to think about is that we can come at this in
6
many different ways. We can come at these issues in many
7
different ways, and I think that is an interesting way of
8
coming at something indirectly, but that may be very
9
powerful and may be relatively easy to do. So thank you
10
all.
11
Any final comments or questions?
12
[No response. ]
13
DR. GORDON: It is getting very late. This was
14
very helpful. What we are going to do with all the
15
recommendations we get, is, we are going to pull them all
16
together, we are going to synthesize them, we are going
17
to give them back to everybody.
18
Probably, as we synthesize them and pull them
19
together, we will give them back in a form that will be
20
based on this form but that will include several
21
recommendations that we will the discuss further, and
22
that will provide the basis for what we are going to be
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
337
1
talking about at the July 2nd and 3rd meeting.
2
Is that reasonably clear, that this is like yet
3
another round? Each time we do this, we are getting
4
closer to major areas of agreement.
5
Okay, thank you everybody for your long day of
6
work. We are starting tomorrow at 4:00 in the morning.
7
[Laughter. ]
8
DR. GORDON: We are starting at 8:00 tomorrow.
9
Thank you.
10
[Meeting recessed at 5:55 p.m., to reconvene
11
Tuesday, May 15, 2001, at 8:00 a.m.]
12
+++
13
14
15
16
17
18
19
20
21
22
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010
338
CERTIFICATION
This is to certify that the attached proceedings
BEFORE THE:
White House Commission on Complementary
and Alternative Medicine
HELD:
May 14-16, 2001
were convened as herein appears, and that this is the
official transcript thereof for the file of the
Department or Commission.
DEBORAH TALLMAN, Court Reporter
PERFORMANCE REPORTING
Phone: 301.871.0010 Toll Free: 877.871.0010