-Caveat Lector- Dave Hartley http://www.Asheville-Computer.com http://www.ioa.com/~davehart ---------------------------------------------------------------------------- ---- http://www.healthy.net/library/articles/naturopathic/art.natru2.pc.htm Naturopathic Medicine and the New Political Realities Where Do We Go From Here? � Peter Chowka 1995 American Association of Naturopathic Physicians ---------------------------------------------------------------------------- ---- 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 ([EMAIL PROTECTED]) 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. ---------------------------------------------------------------------------- ---- NATIONAL HEALTH CARE REFORM The Hidden History The Hidden Costs A talk by Peter Barry Chowka presented at the Ninth Annual Convention of the American Association of Naturopathic Physicians (AANP), San Diego, CA, September 10, 1994 It was almost exactly one year ago that President Bill Clinton went up to Capitol Hill in prime television viewing time and addressed a joint session of Congress and the nation about his proposals for national health care reform. This process had begun in 1992, when Clinton used the health care issue to help get himself elected. It was actually Clinton's political handlers who came up with this strategy. In 1991, these consultants handled the Pennsylvania Senate campaign of Democrat Harris Wofford. In that race, Wofford surprised almost everyone by beating George Bush's Attorney General Dick Thornburgh. The issue that supposedly tipped the balance was health care reform, and Wofford's advocacy of guaranteed national health care for all. In 1992 Clinton turned to James Carville, the savvy political operative who had run Wofford's campaign. And virtually overnight, the whole issue of a "health care crisis" and the supposed need for major reform (as defined by the politicians and their hired guns) was up and running. This little bit of recent history suggests what is really at stake here, and also what my theme is in this presentation: That from the start, national health care reform was very little about true health care reform but very much about political strategy...about the need to amass short-term power, maintain that power, and get re-elected in 1996. It's also possible to see the push for mandatory federalized health care as a grab for longer-term power and control; but more on that a little later. Paul Weaver has written a fascinating new book, The Culture of Lying: How the News Media Really Works. Weaver's thesis is that virtually all of our public discourse is misrepresented or fabricated -- it is little more than outright lies that serve the interests of both the politicians and the top national media. An example of this synergy is that, for virtually anything in the realm of public affairs to be reported on or taken seriously, it has to achieve the level of a perceived crisis. This is particularly obvious in foreign affairs, where we pay little attention to the rest of the world until there are crises in places like Somalia, Haiti, Cuba, Bosnia, and so on. Domestically, things work much the same way. Therefore, real problems with the health care delivery system in this country -- which as an investigative journalist I have been reporting on for two decades, and which form the basis, or the raison d'etre, for the success of nontoxic healing and naturopathic medicine -- these problems went largely unreported by the big media until an obscure Southern politician and his wife -- Bill & Hillary Clinton -- came along and cried "crisis." But the limited mainstream analysis that arises, on this and most other issues, has little to do with reality, and more to do with spin doctoring and smoke and mirrors. I recently came across a white paper dated September 4, 1992. It's written by Paul Bergner [at the time the publisher of the Naturopathic Physician] and Dr. Konrad Kail, [past president of the AANP and a current member of the AANP board of directors]. It's titled The U.S. Health Care Costs Crisis: A Crisis of Chronic Disease. In its 11 pages I found more clarity, insight, understanding -- and more potential for real reform -- than in the 1,340- odd page Clinton health reform legislation or in most of the other rhetoric that has been flying during the past year. The Bergner-Kail paper says -- and I've been saying much the same thing myself for many years -- that America's health care crisis is more than an economic crisis: it is a crisis of chronic disease, and of the failure of our medical establishment to prevent and treat chronic disease successfully. It is a crisis in the kind of medicine we have or are allowed to have -- not just who's paying for it. The promise for true reform, then, is to be found in reality-based solutions to problems caused by the lack of prevention and the lack of successful treatments. This opens the door wide to approaches like naturopathic medicine, which is all about true prevention and getting t o the root causes of chronic, disabling, expensive disease. To repeat: The national health care reform plans that have been pushed this year, especially the Clintons' plan, do not address the core and substance of the problem -- which is, the failure of conventional medicine to successfully prevent and treat most illnesses. Orthodox medicine is useful in dealing with things like emergencies and trauma, and in performing high tech surgeries. But in terms of the increasing incidence and death rates from cancer, AIDS, diabetes, and Alzheimers and the persistence of heart disease, stroke, and hypertension as the leading causes of death and disability...conventional medicine is not doing well at all. As John Knowles, MD wrote almost two decades ago, American Medicine is about "doing better and feeling worse!" Our society's organized efforts against and standard ways of treating most chronic diseases have become Medical Vietnams -- a series of no-win strategies and wars based on a flawed premise and a kind of permanent war economy. The premise, like in Vietnam, is that you can search out and destroy disease, using toxic, even deadly, weapons. This philosophy denies how the body actually works and how it truly can be healed, or how it can be encouraged to heal itself. Think back to Vietnam and the unsuccessful, even insane, policy: "Let's destroy this village in order to try to save it." Similarly, the conventional medical model often says "Let's destroy this body in order to try to save it." The medical-industrial complex that has grown up around this mindset is consistently profitable to the medical war-makers -- in this case, the drug companies, for-profit hospitals and chains, HMOs, government agencies, university academic research centers, disease "charities", highly paid doctors and specialists, and so on. As we know, this medical-industrial complex is now costing us $1 trillion a year. It's become the biggest business in North America. In fact, the U.S. medical system represents the greatest concentration of wealth and power in the history of the world. But like all establishments, its first need is to perpetuate itself, and not necessarily to find solutions. New ideas and solutions tend to be overlooked and suppressed. The statistics unfortunately prove that the $1 trillion a year we're spending on conventional medical care is not linked with improved health. Much of the money, if not most of it, is probably wasted. Recently, in fact, orthodox medicine has given us a whole new category of illness -- iatrogenesis -- doctor-caused injury or death. It is an underdiagnosed epidemic. Examples include silicone breast implants, halcion, cancer chemotherapy drugs (which studies show help no more than 5 percent of patients who receive them, although that hasn't stopped chemotherapy from becoming a multi-billion-dollar industry in itself). Continuing the litany we have AZT (which the latest studies show to be largely useless); 70,000 hospitalizations and 7,000 deaths every year from non-steroidal anti-inflammatory drugs for arthritis; 60,000 deaths from unnecessary surgeries...and on and on and on. This little bit of history, which i know many of you have considered or confronted in your own educational or clinical careers, is important here -- because it is the designers of this system -- this medical-industrial complex -- who played key roles in designing the Clinton plan and most of the other so-called health care reform plans. We're talking here about the pharmaceutical industry, the hospital association, leading HMOs and managed care organizations, and the top insurance companies. These forces represent the ideological and financial wellsprings of national health care "reform." All of these players have historically been opponents of natural healing, innovative nontoxic medicine, pluralism, freedom, and alternatives. I've been reporting, analyzing, writing, and speaking about the push for national health care reform for the past two years. A recent article I wrote on the topic, National Health Care Reform and Alternative Medicine: Never the Twain Shall Meet!, goes into considerable detail. A few quotes and citations will suffice here. A highly-credentialed New York City MD -- a respected leader in the field of innovative cancer therapies -- told me recently that national health care reform "could be the end of alternative medicine." Interestingly, this same MD recalled during our interview that he knew Ira Magaziner, a key strategist of the Clinton plan, when both of them were undergraduates at Brown University in the 1960s. Magaziner "knows nothing about health care -- his degree was in political science," my source reported. Recently, i saw a quote from another aquaintance of Magaziner's, at the other end of the ideological spectrum -- Rep. Jim McDermott, the Washington state Democrat who supports a single payer national plan. McDermott also said that Magaziner knows nothing about health care; and that his arrogance and insensitivity helped to doom the Clinton plan. I question the premise that we can ever turn to the federal government for relief in this area. The federal government's increasing role in health care throughout this century has contributed to the current crisis situation. The government has unfairly supported conventional allopathic medicine and has helped to reshape the whole context and practice of healing, away from centuries-old traditions to reductionist, mechanistic, pharmaceutically-driven, high-tech allopathy. Out went attention to the whole person -- his or her lifestyle, mindset, use of nutrition, herbs, homeopathy. In came drugs, surgery, radiation, bone marrow transplants and the like. The federal government helped to encourage all of this by making loans to hospitals and academic institutions, by its myopic research policy, by encouraging and paying for toxic drug development, by declaring "wars" on diseases, and by collusion or conspiracies with other conventional forces. Recently, added to the mix have been a series of repugnant developments at the hands of federal agencies including, in the words of Seattle's largest newspaper [The Seattle Post-Intelligencer], the FDA's 1992 "gestapo-style" raid on the office of Washington state holistic clinician Jonathan Wright, MD. In national health care "reform" we have an attempt to bail out orthodox medicine and raise it to a new level: one endorsed, mandated, paid for, and largely controlled by the federal government. Left to its own devices, orthodox medicine has largely bankrupted itself. But now, we're being told that we all have to chip in -- whether we want to or not -- to prop up this crumbling edifice. So-called reform is really about redistributing costs, or cost-shifting. Consider it in this way...It's simple arithmetic: Orthodox medicine costs $1 trillion/year. There are 250 million Americans, which works out to roughly $4,000 per capita. If each of us is taxed at $4,000 annually, consider how that will cut into what we can afford out-of-pocket for prevention, nutritional supplements, natural primary care, and other things that a national plan will be unlikely to cover. Consider, as well, how much high quality natural, primary care and prevention you, as a naturopathic clinician, could offer a person for $4,000 a year! To this point, it hasn't exactly been a level playing field of free market competition between conventional and nontoxic medicine. Still, millions of Americans -- about 85 million if David Eisenberg, MD and his colleagues at Harvard University are correct -- 85 million Americans choose natural alternatives. Nobody is putting a gun to our heads, or mandating such expenditures. We choose these options because they work and because they are cost effective. True reform, then, would involve more so-called "alternative" medicine. True reform would entail true prevention -- not simply mammograms or pap smears or compulsory immunizations, which is how the Clinton plan defines "prevention." True prevention means lifestyle modification -- diet, exercise, nutritional supplements, herbs -- taking responsibiity for oneself...and cleaning up the environment, which is a point that the theme of this convention suggests. I have to believe that if Americans are given information and options, they will usually make appropriate and sound decisions. Meanwhile, if the government is doing the deciding...well, just look at the track record! Look at the disappointing performance of the NIH'S Office of Alternative Medicine, which has been underwhelming. Remember something called "special interests?" In case you haven't noticed, they run Washington. Numerous studies have shown that third party reimbursement (which would be the case in a government health care plan) can never be cost-effective. There is simply no incentive to control costs or for people to take personal responsibility. Everyone would pay basically the same amount for health care, whether they take personal responsibility or not. Such policies in the past, as with Medicare, have led to wasteful and ineffective high-tech health care environments and over-specialization with virtually no overall improvement in the nation's health. Under the current, limited free-market system, though, things are changing, in many ways for the better. True clinical alternatives are continuing to flourish. Even some insurance companies are seeing the benefits of clinical alternatives and are funding them. The Wellness Plan offered by American Western Life, for example, covers things like naturopathic medicine, and has found this strategy to be extremely cost-effective. Indeed, the answers lie in true competition and in helping to ensure a more level playing field: removing unfair barriers, stopping the suppression of clinical alternatives, and ending restraints of trade. For people who want medical insurance, portability could be guaranteed, as well as ending discrimination by insurance companies on account of pre-existing conditions. Basic catastropic coverage could be provided for an affordable price, and cost-effective nontoxic alternatives could be made available. In order to find and confirm the effectiveness of new therapies, demonstration pilot projects could be funded -- in previously neglected areas like wellness, prevention, and cost-effective nontoxic treatments -- using clinical centers and practitioners who are already doing the work (such as the clinics at the three naturopathic medical schools). The federal government could resume its proper role of making information available to the American public at low or no cost, so that we -- as individuals -- can make informed, better choices. Something like this was explored in the 1970s when the McGovern-Dole Subcommittee on Nutrition and Human Needs in the U.S. Senate published several reports (including Dietary Goals) that informed citizens about the dangers of the typical American diet and how we might change our eating patterns in order to avoid avoid degenerative diseases and live longer. I'd like to close the prepared part of my remarks with these observations: Our choices in health care reform come down to two very different philosophical and practical models of how we can progress and move forward in this critical area, as individuals and as a society... The first way is the requirement that we be part of a centralized, bureacratic, compulsory/mandatory system of industrial medicine. The second way involves a commitment to reform that respects freedom, pluralism, choice, traditions, innovation, consensus, and building on the better elements of the system we have. Michael Ventura has written an interesting essay, The 21st Century is Now in the Los Angeles Times Magazine, May 8th, 1994. It reminds me of some of the seminal writings of E.F. Schumacher, the British economist and author of Small is Beautiful, or the poet/essayist Wendell Berry, particularly his book, The Unsettling of America. Ventura first observes -- with caution -- that "When you change form, you often dump the old content" -- unwittingly and too often unfortunately. He goes on: "The distinguishing feature of our 21st century [by which he means the present] is that we are on our own...the helplessness of those in authority has left us exposed to...ourselves. I am forced back upon my own resources, on my own spirit. How that fact is met will determine the history of tomorrow." Michael Ventura's vision reminds me of naturopathic medicine -- in which we rely more on our own inner resources, on our own spirit...to bring us into closer contact with the best and truest traditions of the long history of healing -- which are natural, organic, experiential, grounded...and involve first do(ing) no harm. In my view, it's in this kind of holistic philosophy and practice that we will find our best opportunities for real national health care reform. 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 in the award- winning production Hoxsey: 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 researching and writing about a variety of topics for several national publications and expanding his sites on the Internet's World Wide Web. He is the public and national affairs consultant to the American Association of Naturopathic Physicians. � 1994 by peter barry chowka All rights reserved. email to: [EMAIL PROTECTED] go to: Peter Barry Chowka Home Page DECLARATION & DISCLAIMER ========== CTRL is a discussion and informational exchange list. Proselyzting propagandic screeds are not allowed. Substance�not soapboxing! 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