Alternative and Complementary Health Practices
Editor: Beth Sommers
Co-editor: Paul Kadetz
Letter from the Co-Chairs
Dear ACHP Members and Friends,
On behalf of Alan and myself, I want to welcome you to the Fall/Winter issue
of our newsletter.
Preparations for the Annual Meeting have been continuing throughout the spring and summer. Thanks to everyone who contributed abstracts, reviewed abstracts, and dedicated time and energy to programming conference events. Rick Harvey and Anne Doherty-Gilman deserve special recognition for organizing and designing the tapestry of presentations that will be featured in November. The lineup of presentations continues to reflect the diversity of experience and vision that our members have – truly inspiring for improving our work and promoting access to wellness!
Your participation in ACHP activities continues to be important. We hope to see you in Washington, D.C., Nov. 3-7 for the Annual Meeting. When you renew your APHA membership, select ACHP as your primary affiliation; membership numbers are key in influencing APHA. Encourage your friends and colleagues to join our SPIG (as primary or secondary affiliates) as well.
Because we want to nurture and grow our work, expansion is important. Both Alan and I would like to see our group become an APHA section; doing this requires more members. Whether you’re a researcher, public health advocate, supporter of health care choice, or a consumer who wants the benefits of integrated care, please consider becoming more involved with this work.
Complementary and alternative health care practices include a wide variety of approaches, as you’ll read in this issue. This newsletter features articles on:
The recovery effort in New Orleans;
Providing affordable CAM care in Seattle;
Creative care for U.S. veterans of Iraq and Afghanistan by Acupuncturists Without Borders;
Working with the FDA.
Your input and feedback are important to us. Please feel free to contact me at email@example.com.
Best wishes to all our readers! We hope to see or hear from you soon.
Beth Sommers, MPH, LAc
Health care that includes wellness is a right, not a privilege.
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Update on the 2007 Annual Meeting – Report from ACHP Program Co-Chairs
We would like to thank all the members who submitted abstracts for the 135th APHA Annual Meeting. The meeting will be held Nov. 3 - 7, 2007 in Washington, D.C. We received a high volume of abstracts this year with a wide variety of topics represented. There are a number of papers addressing Alternative and Complementary Health Practices in relation to this year's Annual Meeting theme, "Politics, Policy, and Public Health," that should be of great interest to members of our SPIG.
A few changes were made to the usual Annual Meeting format this year by the APHA Planning Committee. One change is the addition of poster sessions on Sunday evening following the Opening General Session. We were happy to secure two of these new poster sessions. We've also added a special joint business meeting with the Health Promotion Section on Sunday. This year's ACHP scientific program is now being finalized, and in addition to more poster sessions, we’ve incorporated a roundtable format on Monday morning so that attendees can interact more directly with the presenters. Monday will be a very full day and topics will include:
Herbal and Dietary Health Practices.
Education and Integrative Health Practices.
Traditional Healing and Cultural Competence
Women and Minority Aspects Chronic Diseases and Cancer.
We'll also have our business meeting on Monday night at 6:30 p.m., and we hope all of you can attend.
On Tuesday, there will be two interesting panels on Research Approaches and Evidence in ACHP and on Health Promotion. We'll finish on Wednesday with a final poster session covering a wide variety of ACHP topics. It's sure to be an informative few days!
We look forward to seeing you in Washington, D.C.!
Rick Harvey, PhD, and Anne Doherty-Gilman, MPH
Alternative and Complementary Health Practices Program Chairs
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Letter from ACHP Student Liaison
Dear Fellow Alternative and Complementary Health Practices SPIG Members,
I am excited to serve as the 2007 section liaison of the ACHP SPIG. As the section liaison, I hope to garner increasing student involvement, facilitate communication, and promote the missions of the APHA Student Assembly and the ACHP SPIG.
I am a graduate student in nutrition science at Indiana University. Having just completed my first year in graduate school, I am anticipatory about my future in the field of nutrition and dietetics. Although my background is in media, I believe my passion has always been in the field of holistic health. I believe in a holistic approach to health care, treating the entire person. I believe in preventive care, incorporating a healthful lifestyle, good nutrition and physical activity. I was excited to find a special primary interest group devoted to alternative and complementary practices within APHA.
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APHA Student Assembly Alumni Database
This year, the APHA Student Assembly Opportunities Committee provided more resources to students regarding scholarships, conferences, job postings, potential employers and fellowships/internships. In addition to these endeavors, the committee revamped the Student Assembly Alumni Database. The Alumni Database is meant to not only allow the Student Assembly to keep track of their past members, but it also provides current and potential students access to learn about possible careers in the public health field.
To access the Alumni Database, students can visit www.aphastudents.org and click on the Opportunities Committee Web page. Here students can look at job positions currently held by public health professionals in the field. Prospective public health students could access this database and view jobs that people with public health degrees have to gain a better understanding of the wide variety of career paths available to them. Alumni range from recent graduates working in fellowships or entry-level positions to seasoned health professionals with well-established research agendas.
The Student Assembly Opportunities Committee Co-Chairs are working to increase participation of alumni in the Alumni Database. Anyone who at one time was a member of the Student Assembly (previously entitled Public Health Student Caucus) can visit the website, complete the form available on the www.aphastudents.org/phso_alumni_db.php and return it to firstname.lastname@example.org. This endeavor depends on the cooperation of the Student Assembly alumni. With alumni support, the Database can become a wonderful resource for the next generation of public health students. We hope you will consider taking a few moments to add yourself to the Alumni Database.
If you have any questions or want more information, please feel free to contact Jennifer Cremeens or Anna Pollack, the Opportunities Committee co-chairs, at email@example.com.
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Former ACHP Chair Elected to Montgomery County Council
On Nov. 6, 2006, Duchy Trachtenberg, MSW, former chair of the ACHP SPIG, was elected to the nine-member County Council of Montgomery County, Md. In Montgomery County, the County Council also functions as the County Board of Health. In her brief tenure so far, Duchy has gained the first county funding for acupuncture: a $20,000 appropriation to add acupuncture to the county's growing drug court program. The county's acupuncture will follow the five-point bilateral auricular acupuncture protocol promulgated by the National Acupuncture Detoxification Association.
Duchy also introduced a Health Board regulation to ban artificial trans fats from county-licensed eating and drinking establishments. Montgomery County is now the first county to pass such a ban, and the council approved the bill unanimously.
In the fall, Trachtenberg plans to introduce a bill to guarantee equal rights for transgendered individuals and protect them against discrimination. She will also introduce legislation for the funding of a Family Justice Center, a clearinghouse for the comprehensive services needed by victims of domestic violence and their children.
During her council campaign, Duchy enjoyed support from the public health community and alternative health practitioners in the county and from around the country. As Maryland State President and National board member of the National Organization for Women, she also enjoyed considerable support from the feminist and women's health communities.
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Rebuilding a New Orleans Community
Tulane University is involved in a number of community projects. The aftermath of Hurricane Katrina and the subsequent flooding of New Orleans has kept Tulane volunteers busy. One new project, The Tremé Table Project, is noteworthy in its creative approach to invigorate a neglected New Orleans neighborhood and promote health.
The New Orleans neighborhood of Tremé is one of unusually rich cultural heritage. Originally a French-speaking, “people of color” community and known as America’s oldest black neighborhood, it evolved into one of the first multiracial districts in the early 19th century. For freed slaves to acquire, purchase or own property was remarkable for an era in which America was still immersed in slavery. Among other noteworthy firsts, Tremé is known as the home of: the first African-American newspaper, the first African-American Roman Catholic Parish, the first literary salons (at a time in this country when teaching blacks to read was illegal), and the first anthology of African-American poetry, as well as the home of a cornucopia of famous jazz musicians. However, in spite of this rich history, Tremé is also characterized by the poverty that has prevailed since the 1960s. This neighborhood suffered more than many in post-Katrina New Orleans, by virtue of its pre-storm vulnerabilities.
Several schools and departments of Tulane University, including the School of Architecture, the Department of Sociology and the School of Public Health & Tropical Medicine have committed to addressing the needs of this neighborhood. Nancy Mock, DrPH, a professor in the Department of International Health & Development at the Tulane School of Public Health & Tropical Medicine, was a founder of Tulane’s International Health & Development Department and has extensive professional experience in disasters and recovery. She has been involved in community action research post-Katrina, specifically in Tremé, including surveillance of community needs and a community food pantry that aided more than 3,000 families in need. Initial assessments have pointed to the need for interventions that engender sustainable solutions. To this end, Mock has developed the Tremé Table Project. The objective of the project is to improve the health and nutrition of Tremé families and strengthen the cultural heritage of its members, thereby empowering the community and mobilizing community involvement.
The project is proposed in several phases. Phase 1 is the compilation of a “cookbook” of Tremé residents’ healthy recipes and oral histories. In Phase 2, proceeds from the book will be applied to a Community Café project at St. Augustine’s Church in Tremé. Musical events and cooking classes will also be held at St. Augustine’s. Phase 3 will include workshops on preventative health care and nutrition at the Community Café, thereby promoting future health.
Dr. Mock, could you tell me the impetus for this project?
Well, it was actually rather serendipitous. When Katrina struck, I queried my students, and several of them wanted to work with me in post-Katrina New Orleans doing recovery work. As soon as we were able to get back into the city we organized internally, working out of my house. Initially upon returning, we assessed neighborhoods for needs. I targeted Tremé for my efforts because of its historical significance and what I perceived to be an opportunity for a major turnaround. We began to work with Father Ledoux, a community leader at St. Augustine’s Church. Also at this juncture a Tulane student from Second Harvest Food Pantry called me asking if I knew of locations that were in need of a food pantry. I immediately thought of St. Augustine’s. My students were very instrumental in opening and running the food pantry. The work was greatly facilitated by contacts provided to me by Bethany Bultman, co-founder of the New Orleans Musicians Clinic [which provides access to health and social welfare services to the local music community] who suggested a joint cultural and public health project. From there the social network evolution of this project was very organic. The French Consulate provided initial seed money.
How do you envision a project like this will be valuable to post-Katrina New Orleans?
We are seeking to revitalize this community by reestablishing the central importance of the table in family life. Experience has taught me that for an intervention to be sound and efficacious, the population must be addressed holistically. A community should be understood as a complex ecosystem in which interventions are built on the strengths of its members. People are more than the sum of their indicators, and there is more to helping a community than where you place the sidewalk.
Why specifically a cookbook?
Well, it is actually much more than a cookbook. Yes, there will be local recipes that focus on good nutrition, but it will also be an oral history of this community. We want to celebrate this community and create an historical record of an important and significant culture. We are trying to capture perishable history. Furthermore, we would like to provide a written project for schools to include in their curriculum. Finally we need a commercial dimension for raising funds for later phases of the project. We are planning for all proceeds from sales of the book to be reinvested into the project. In this manner we are planning for the project to remain sustainable.
How is this project different from your other projects and research?
This is a project to improve health and development through cultural revitalization of family-centered food and music. This requires an understanding of social and behavioral changes as part of a community ecosystem. Recovery allows you to restore a community to a time when things were working well. You are mining for strengths in cultural traditions in order to perpetuate strength and engender empowerment. People are seeking an anchor. This offers an opportunity to bring back a community in a better way.
The project has received initial funding from the French Consulate and in-kind support from Tulane University. Other partners include the New Orleans Musicians Clinic, and the Food and Beverage Museum of New Orleans.
Paul Kadetz authored this article and is currently completing his MPH in International Health & Development at Tulane University School of Public Health & Tropical Medicine. He is an adult nurse practitioner and a licensed acupuncturist.
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Providing Affordable Complementary and Alternative Medicine
One of the most apparent gaps in the field of complementary and alternative medicine (CAM) services is widespread access for individuals with limited incomes. On a federal level, this is clearly evident due to the lack of federal recognition and availability of services with highly used CAM therapies such as acupuncture. Although many private insurance companies provide reimbursement to individuals who utilize particular CAM therapies, such coverage is reserved for individuals who are most likely able to afford CAM services. Contrarily, individuals on public assistance programs such as Medicare and/or Medicaid are more likely to pay out-of-pocket costs for CAM services, thus reducing their available resources.
The current status of federal activity and funding with CAM lies primarily in the research arena. Resources placed into epidemiological studies have identified the major CAM therapies used, why they are utilized and the populations who use them. As a result of these studies, large-scale clinical trials for the most promising therapies have been implemented but are still too far and few (and time consuming) to further the recognition of CAM’s benefits. Likewise, previous efforts to fund public CAM services have been denied due to the lack of widespread documentation with their clinical benefits. Although it is completely understandable to not fund services without definitive and massive results of treatment success, the existing gap between populations who have insurance coverage for them and for individuals with limited incomes who want CAM therapies but cannot afford them is dispiriting.
The Kang Wen Clinic, founded in 1987, is one of the first nonprofit public health CAM organizations that provides low-cost CAM care to individuals who could not afford it otherwise. For nearly 20 years, Kang Wen has continued to be committed to provide CAM health care to individuals on limited incomes and with little resources to pay for CAM services. The clinic’s primary mission has been to close the gap for limited income individuals who do not have coverage or reimbursement programs for CAM therapies. Kang Wen’s patients are virtually all living with incomes at or below 150 percent of the Federal Poverty Level (currently at $1,277/month), and nearly 80 percent are on public assistance health service programs.
The challenge for Kang Wen to further our mission is comprised of two major areas: funding and work force retention. Funding the organization has continually remained a challenge in consideration that Kang Wen currently charges about 10 percent of an average private practice treatment fee and serves a population of entirely low-income patients. Relying on soft monies such as grant funding, individual and in-kind donations are often unpredictable and volatile and also require a considerable amount of personnel resources. While other conventional community clinics benefit from significant federal, state and local public assistance funding, Kang Wen creatively identifies ways to procure a fiscal structure that will promote growth and increase availability of services. However, the lack of public funding for CAM services continues to challenge the clinic’s growth and requires a significant amount of time and personnel resources, which are mostly provided pro-bono.
Likewise, in terms of work force retention, practitioner availability and leadership is also a barrier to the clinic’s future. In the Seattle area we are fortunate to have two major acupuncture training institutions; the downside with such a presence is the aftermath for the graduates. The current paradigm of an acupuncturist after graduation is to build private practices. There are no financial incentives for graduates to commit to CAM public service in consideration of mounting school loan debt, a fiercely competitive private practice market and the lack of available postgraduate “residencies” for further clinical training. Although recruiting practitioners has never been a barrier from Kang Wen, sustaining and grooming them as leaders in their community has been a critical issue. For our practitioners, committing to pro-bono work in exchange for clinical experience has not proven to be a sustainable model. Our practitioners often struggle to balance their private practice as their income source and also fully commit to Kang Wen. This formula leaves our practitioners susceptible to burnout.
The struggle to contend with these major issues challenges the future of Kang Wen and related programs. Recent strategic planning has identified that providing a nurturing environment for our practitioners and diversifying our patient population with a variety of income levels to increase revenue sources may be critical to the clinic’s future success. However, competing for patients with other local private practices will not promote community health, nor does this address the larger issue of providing nationwide widespread access to CAM healthcare for individuals with limited incomes. Until CAM therapies widely used by the public are recognized and reimbursed to limited income individuals, significant barriers will continue to exist in making CAM available to all populations.
Jung G. Kim; Susan Darling, MSAOM, LAc; David McGraw, MAcOM, LAc
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Iraq/Afghanistan Veterans Project
Acupuncturists Without Borders (AWB) provided hurricane relief services to approximately 8,000 people in the New Orleans area starting in October 2005. The free community acupuncture brought hope, promise and peace of mind to the people of New Orleans. With the experience and expertise of bringing community style acupuncture to the people of Louisiana, AWB is taking its service to a different population, U.S. veterans. The Iraq/Afghanistan Veterans Project will provide free acupuncture treatments for veterans returning from Iraq or Afghanistan, but also welcomes veterans from all other past conflicts or wars as well as the veterans’ family members.
Currently, the Veterans Project is under way in Albuquerque, N.M. As in Louisiana, treatments are based on the National Acupuncture Detoxification Association ear protocol which has proven to be extremely powerful in alleviating symptoms of acute stress and trauma. During treatment, people sit fully clothed in a circle of chairs, and the licensed acupuncturist places five tiny needles on each ear. The recipients are invited to close their eyes and rest for 30-45 minutes, as the acupuncture does its work. Group treatment creates a sense of community and commonality, and the energy of the group enhances the treatment for everyone.
Albuquerque veterans are experiencing benefits such as a full night’s sleep for the first time in years and fewer bad dreams. They are reporting improved mental clarity, less anxiety and a reduction in stress. AWB is now working with acupuncturists around the country who plan to open local clinics in their communities. We expect to have at least 15 clinics up and running in 2007, and many more in 2008.
The potential of this program is enormous. History has shown that the long-term impact of war takes a tremendous toll for decades. In many cities, the greater percentage of the homeless population consists of Vietnam vets. By providing free acupuncture treatments to veterans currently returning from war, we can play a part in preventing history from repeating itself, and by providing treatments to veterans from past wars and conflicts, we can be a part in helping mend the psychological wounds of the past.
The beauty of acupuncture is that it is a simple, low-cost modality offering immediate, effective and easily accessible treatment for large numbers of people. Acupuncture is a tool that can work harmoniously with other more conventional treatment modalities such as counseling and medication.
“I served two tours of combat in Vietnam. I’m 100 percent disabled because of PTSD. When I first started coming to the AWB clinic in Albuquerque, I had spent years suffering from high anxiety. I believe that because of the acupuncture I have become calmer and my anxiety has drastically come down. I don’t want the new vets to suffer for years like I did. Acupuncture is helping me get my life back.” ~ Raul Rojas
E-mail firstname.lastname@example.org or contact AWB at (505) 286 0111
Contributed by Diana Fried (Acupuncturists Without Borders)
Permission granted by Acupuncturists Without Borders to the Alternative and Complementary Health Practices newsletter to reproduce this article.
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Can We Heal the FDA?
The Food and Drug Administration is in the process of classifying alternative health practice and drafting Guidance for Industry on Complementary and Alternative Medicine Products and Their Regulation by the Food and Drug Administration. CAM practitioners and our allies should be encouraged to show more awareness and vision in how we approach the FDA.
CAM practitioners must first acknowledge the ways in which the FDA benefits public health, and the ways in which certain practitioners have not.
When we go the corner drugstore to buy a medication, we go with general confidence that: 1) the amount of active ingredients per capsule are what the label indicates, so we don’t unintentionally overdose; and 2) that the drug does not contain mercury, lead or other unlisted additives that might poison us. We have this confidence thanks to the FDA. A century ago, in the days when alleged caregivers could advertise cures for blindness and diabetes to the desperate with impunity, and when the public was far more at risk from toxic additives, this confidence was justified.
CAM practitioners need to join forces with public health activists who are working to dis-entangle the FDA from the pharmaceutical industry.
The section of the FDA that reviews new drugs receives over half of its budget in “user fees” from the very pharmaceutical manufacturers it is supposed to regulate. This industry influence has lead to fast-tracking approval of expensive brand-name drugs, sometimes without adequate testing. Casualties of the FDA’s rush to market include those harmed from Vioxx and other medications whose dangers became apparent years (and billions of dollars in profits) later.
Undue influence by industry—whether it’s the pharmaceutical industry or the dietary supplement industry—is harmful to the FDA and to public’s health. CAM practitioners should link arms with progressive doctors and healthcare advocates and demand that the user fee system be scrapped, and that the FDA’s 18 advisory committees prohibit their members from working as consultants for drug or dietary supplement companies.
CAM practitioners need to re-envision an FDA that embraces diverse healing traditions while protecting the public from fraud and physical harm — and then vigorously work toward that vision.
Let us imagine an FDA that is free of corporate influence and has rededicated itself to the public’s health and well-being. Advisors should include all health care stakeholders. The FDA needs to acknowledge that its research methodologies have a pharmaceutical bias and should assure the safety of herbal products using new methodological approaches that require close collaboration with expert holistic practitioners. A consortium of these practitioners and the FDA could be dedicated to routing out fraudulent or harmful health care products wherever they find them, with special citizen panels ultimately deciding whether these products should be restricted or even banned.
This is an FDA that the public could trust again.
Karlo Berger, ABT, LMT, is founder and board member emeritus of the Integrative Medicine Alliance (www.IntegrativeMedAlliance.org). You can reach Karlo at Karlo@KarloBerger.com , (401) 383-0661, or at www.KarloBerger.com .*For a highly informative article on this debate, see John Weeks’ Integrator Blog (http://theintegratorblog.com/site/index.php?option=com_content&task=view&id=274&Itemid=189).** For more on how the FDA was formed, see http://www.fda.gov/oc/history/historyoffda/section1.html
Authored by Karlo Berger, ABT, LMT
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Traditional, Complementary and Alternative Medicine: Policy and Public Health Perspectives
. Bodeker G and Burford G. Editors. Imperial College Press 2007.
A must-read for every public health advocate who envisions international CAM access! Chapters include perspectives on policy, safety, efficacy and quality, access, training health workers, rational use, ethics, financing and sustainability. Dr. Fredi Kronenberg, a dear friend of ACHP, is also a contributor to the book.
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Congratulations are in order for the following individuals and groups:
1) Members and supporters of the PanAfrican Acupuncture Project, who have successfully trained over 120 Ugandan health workers to provide acupuncture care to patients. For more info:
2) Duchy Trachtenberg for her innovative work and long-term stamina and dedication to public health,
3) Co-Chair Beth Sommers, who has been invited by the British Acupuncture Council to give the keynote research address at its annual conference. She’ll be speaking on health economics and the role of acupuncture in promoting adherence to HIV-medications.
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