July 2015 John Weeks Integrator Round-Up
Turn toward Darkness: Regular Medicine Takes Hits on Evidence and Industry Influence
Two recent news items eat at the already unsteady foundation of medicine as usual. Writing in the Lancet on May 31, 2015, editor Richard Horton, MD, blasted current scientific research: “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue.”
Turn toward Darkness: Regular Medicine Takes Hits on Evidence and Industry Influence
Two recent news items eat at the already unsteady foundation of medicine as usual. Writing in the Lancet on May 31, 2015, editor Richard Horton, MD, blasted current scientific research: “The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue.” He clarifies: “Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.”
Roughly a month later the LA Times ran an article on a government report that “doctors and teaching hospitals received $6.5 billion last year from drug companies and medical device firms for research, consulting and other reasons, new federal data show.” About half of the $6.5 billion in payouts were classified for research purposes. More than $2.5 billion was labeled as “general payments,” and $703-million represented “ownership or investment.”
Comment: “General payments” is the most queasy-making category, though “for other reasons” produces its own brands of odor. That being said, in the light of Lancet editor Horton’s note on “flagrant conflicts of interest” riddling much of research, the half of the $6.5-million spent on research may also reasonably be approached with a nose-clip. Integrative care research is hardly off these hooks. One might reasonably guess that all science related to integrative care may be part of what Horton lumps as “fashionable trends of dubious importance.” The 19th century French poet Charles Baudelaire speaks in one poem in the translation I grew to love of being “on a monstrous sea without a bourne.” Other translators put it as “shore” rather than “bourne.” Either way I believe he’s nailed it. (Thanks to cunao Stephen Campbell for the Times piece.)
American Botanical Council Publishes Report on the NY Attorney General Schneiderman’s Campaign Re Supplements
The activities of New York Attorney General Eric Schneiderman relative to the dietary supplement industry since February 2015 are characterized in the opening of this review of his activities and industry responses as “an unprecedented legal and public relations campaign against the American herb industry.” This timely review was written by Tyler Smith for the American Botanical Council. Schneiderman’s actions were based on a controversial DNA barcoding testing method. Smith’s article includes sections on: initial and then later reactions of the herb industry; General Nutrition Centers’ agreement with Schneiderman; the group of other attorney generals from additional states who joined in asking Congress to investigate the supplement industry; and anticipated next steps. ABC’s founder and executive director Mark Blumenthal is quoted as stating that “in my experience over 41 years in the herbal community, this is the biggest issue that has been on the table.
Comment: The article is an exceptional service from ABC. For those who are not directly in the industry, the piece is particularly useful for background on what has been a gross public relations disaster.
Health Affairs Features Katherine Gergen Barnett, MD and BMC’s Integrative Group Visits
The title of the Health Affairs Blog post on “innovations in care delivery” claims a good deal: “The Call to a New Kind Of Care: Integrative Medicine Group Visits Offer Promise in the Treatment of Chronic Pain and Depression.” The work portrayed is led by the author, Katherine Gergen Barnett, MD, a clinician with the integrative medicine program at the Boston Medical Center. In the article, she positions the model as an antidote to the fractionating of patients via disease codes and 15 minute visits. The BMC model stands on 3 legs: group visits, integrative medicine, and the mind-body stress reduction programs (MBSR) developed by Jon Kabat-Zinn, PhD. Early outcomes found that “the majority had a statistically significant decrease in pain and depression, and clinically significant improvements in sleep quality and perceived stress.” In addition: “Across the board, those who suffered from high blood pressure had a decrease in both their systolic and diastolic blood pressure.” Gergen-Barnett notes that the work has more recently been funded by a nearly $1.9-million PCORI grant.
Comment: Terrific to see this component of integrative care getting this type or research, and visibility. Integrative group visits fit beautifully with the mission and values at the root of integrative services. It is a wonder that so few are engaging them. While Gergen Barnett’s program focuses on the underserved, group care can be valuable to those at any income level. The Boston Medical Center, which is about to host the 2015 Integrative Medicine for the Underserved, continues to do leading edge work. In December 2013 CMS administrator Don Berwick, MD said he wasn’t quite sure what the strategies would be that would allow us to move away from our disease focus toward “salutogenesis” or health creation. Integrative group visits are a part of the answer. We have not even begun to explore what is the ultimate reach of their optimal use. Congratulations for great work and the best sort of practical placement.
Quick Links to Integrative Medicine News in Medical Systems and Communities: June 2015
This typically monthly Integrator feature is, for June 2015, a quick capture of highlights from various stories relative to "integrative medicine." There are 23 links from health system activity and 10 more in communities. Among these: a feature in The Atlantic on “The Evolution of Alternative Medicine;” and a strategic investment from the George Family Foundation to allow Minnesota Native Americans to learn to provide mind-body services to their members via James Gordon's Center for Mind-body Medicine; . (Note that Global News Links are now posted at The Global Integrator Blog for Global Advances in Health and Medicine - see related notice here.)
Northwestern Health Sciences University Sells Woodwinds-Based Integrative Care Center
Colleague Stephen Bolles, DC sent news that Northwestern University of Health Sciences, one of the most significant universities of natural health sciences in the country has sold off its once pioneering, Woodwinds health system-based integrative care center. In this blog piece, “Requiem for an Integrative Dream,” Bolles, a former Northwestern VP who was key to development of the clinic, reflects on the change as well as the context in which the clinic was created as part of the Health East system. He reports that the clinic “will be reconfigured and moved a few blocks away, preserving the same clinical services it has offered for years.”
After his reflections, Bolles provides five “precepts that can serve as a functional guide” to the future for integrative health and medicine investment. Here are abstracts of Bolles’ comments:
- The basis (clinical paradigm) for integrative health care needs to focus on value, not volume.
- A derivative precept is that integrative providers are likely going to need to be very disciplined in what their focused, clinical contributions are.
- Management of the costs of care (and payment options) will be enormously important.
- With employers limiting benefit option choices less and less and online shopping comparison sites for health care poised to take off, how integrative services are packaged and presented to consumers in private health exchanges will be important for business success.
- And finally, the form care coordination takes will matter. Is a common EHR required? Is greater involvement and stewardship of individuals’ PHI required with consumers more actively involved? This is an area that is going to emerge as very, very important over the next several years.
Comment: Bolles is an astute, leading edge observer and commentator on the integration movement. His perspectives merit consideration particularly following his stint at United Healthcare in a consumer and market-focused position relative to complementary and integrative care. He’s ahead of most of the field in, for instance, this: “How integrative services are packaged and presented to consumers in private health exchanges will be important for business success.”
Meantime, the decision by Northwestern is of concern. The once leading edge university of natural health sciences has seen a series of troublesome changes since Christopher Cassirer, PhD came in from another field and took the helm. The Gert Bronfort, DC, PhD/Roni Evans, DC, PhD heart of Northwestern’s once top-flight research department moved to the University of Minnesota. The university dropped its membership in the interprofessional Academic Consortium for Complementary and Alternative Health Care for which its personnel have in the past served in multiple leadership roles. And now this. The retraction at Northwestern, perhaps due to necessary scrambling at the bottom line, is presently a loss to the movement. Here’s hoping the University will find its way back.
National College of Natural Medicine Announces $3-million of NIH Research Grants
The NIH National Center for Complementary and Integrative Health (NCCIH) has awarded $3,092,898 to the Helfgott Research Institute at the National College of Natural Medicine (NCNM) for two, five-year complementary and integrative health (CIH) research grants. According to this NCNM release, the new grants “will provide funding for studies involving mindfulness-based stress reduction for people with multiple sclerosis; and clinical research training for naturopathic doctors, Chinese medicine practitioners, as well as training in naturopathic and Chinese medicine modalities for conventional medicine researchers.” Heather Zwickey, PhD directs Helfgott. NCNM senior investigator Ryan Bradley, ND, MPH was instrumental in bringing in the training grant via a partnership he first established with the University of Washington.
Comment: Great to see these grants from the NCCIH, especially the investment in capacity building for the NDs and licensed Chinese medicine practitioners via the training grant. The success speaks to the impressive base that Zwickey is building, including bringing in Bradley, at NCNM. The training grant supports the bold note in the 2011-2015 NCCIH strategic plan led by director Josephine Briggs, MD that states that "CAM practitioners are the key holders of knowledge related to the potential applications of CAM interventions and disciplines."
Natural Medicine Journal Integrative Medicine Research Series: Dugald Seeley, ND on Whole System Research and the Ottawa Integrative Cancer Center
The ongoing series of the Natural Medicine Journal on integrative medicine last month featured an interview with Dugald Seely, ND, the director of research at the Canadian College of Naturopathic Medicine (CCNM) and head of CCNM’s Ottawa Integrative Cancer Center. Seely and his team had a significant whole practice controlled trial published last year in Canadian Medical Association Journalas part of a significant body of work related to grants from Canada Post. In the interview, Seely describes an eight-site study on use of melatonin. Then he speaks to a separate multi-site pragmatic research design looking at the whole system of naturopathic care for cancer care engaged in partnership with Bastyr University.
Seely notes that one of the challenges in the kind of research that most interests him is looking at multi-modality programs: “Typically individual therapies are not provided in isolation. They are in a package. Isolating them is very difficult and not really reflective of practice in the real world.” He speaks to the value of “pragmatic design.” These are “more patient centered and reflective of practice in the community.” These pragmatic approaches, says Seely “will help us bring proof of principal” that integrative medicine works. Then, he adds, more specific studies to parse out the most significant individual therapy contributors may be in order.
Comment: Seely and the CCNM research team have steadily produced a very important base of research in whole person, whole t and whole system care. This 15-minute interview is a good listen for anyone who views whole systems research as the direction we need.
Acupuncture Group’s Response to JAMA on 2014 Australian Article Questioning the Value of Acupuncture for Chronic Knee Pain
The monthly Acupuncture Today has published Chinese Doctors Poke Holes in Australian Study regarding response to a 2014 study by Rana Hinman et al that concluded that acupuncture had no value in knee pain. The team included Lixin Lao, PhD, LAc, former professor at University of Maryland where he was located for 21 years as an integrative acupuncturist and researcher. The group of Chinese researchers and clinicians question both “the quality of the trial and the integrity of the researchers.” The language is strong: “Hinman appears to have the intention to mislead the editors and readers.” In Lao’s letter to JAMA, published February 10, 2015, he questions the protocol: “More frequent and short-term reassessments during and after acupuncture treatment may have better captured the treatment and maintenance effects of acupuncture.”
The Traditional Chinese Medicine American Alumni Association, supported by nearly two dozen acupuncture organizations, sent a letter that was even stronger: “We believe that the report by Dr. Hinman and her colleagues regarding acupuncture for knee pain is highly biased and possibly manipulated.” The Acupuncture Today article is written by acupuncturist Bill Reddy, LAc, a leading policy player in the AOM field.
Comment: Nice reporting work from Reddy, and defensive organizing from the group whose work he reports. I found it notable that Dr. Lao was less vociferous in his personal letter than others. It is intriguing that this publication came out of the very polarized Australian “CAM” environment where the high public use of alternative medicine is combined with heightened antagonism by government agencies.
AIHM Starts Historic Interprofessional Fellowship with Tieraona Low Dog, MD as Director
On July 1, 2015, the Academy of Integrative Health and Medicine (AIHM) announced that it is getting into the fellowship business. This Integrator article suggests AIHM is doing so with a double splash. The interprofessional AIHM, founded in 2013 as a "big tent" for all in integrative health and medicine, plans to offer the fellowship to members of multiple professions. These will include, according to the release, "medical, osteopathic, naturopathic and chiropractic physicians, dentists, advance practice registered nurses, physician's assistants, licensed acupuncturists, registered dietitians, pharmacists, licensed clinical social workers and psychologists." In addition, AIHM has brought in as director Tieraona Low Dog, MD, the former head of the presently standard-setting fellowship at the University of Arizona Center for Integrative Medicine. Low Dog will be teaming with AIHM's director of education Tabatha Parker, ND. AIHM’s details about the program, including costs, are online here. The AIHM Fellowship is open for applicants.
Comment: Fascinating to think of a fellowship in IM that is fully interprofessional. As noted in my comments here, the challenges of such a pioneering task relate to both content and cost. Low Dog and Parker hold the promise of being an exceptional set of interprofessional team leaders. I am a particularly interested party as I am a member of the AIHM board who chose to get involved in part due to my view that deep interprofessionalism, such as AIHM aspires to manifest, is one of the best ways to disrupt the negative cascade of the medical industry.
American College of Lifestyle Medicine Offers Training in Lifestyle Medicine Competencies
On August 23-24, 2015 the American College of Lifestyle Medicine and the American Academy of Preventive Medicine is offering a conference to share the field’s core competencies. Three of the 13 learning objectives are to: “describe the fifteen LM competencies for providing quality lifestyle medicine services and explain how to integrate the competencies into clinical practice; apply practical solutions and tools for competency implementation; and perform lifestyle assessments and evidence-based lifestyle prescriptions.” The sponsors thank natural products company Metagenics for being “the generous sponsor of the 2015 symposium.”
Metabolic Medical Institute Offers Fellowship in Metabolic and Nutritional Medicine
Through collaborations with George Washington University and the University Of South Florida Morsani College Of Medicine, the Metabolic Medical Institute is fellowship program in Metabolic and Nutritional Medicine that can connect to masters-level degrees in integrative medicine. The seven modules are described here. This is the 5th fellowship that the young MMI is offering.
Comment: Notably, the Metabolic Medical Institute website does not appear to address whether this fellowship will be acceptable as a basis for being boarded in integrative medicine through the American Board of Physician Specialties.
AAMC Focuses on Mindfulness in Medical Schools: From a Disease to a Health Focus for Mindfulness?
The Association of American Medical Colleges has published a recent article entitled “Bringing the Lessons of Mindfulness to Medical Schools.” The author describes the experience at a 2015 meeting of the AAMC’s Council of Faculty and Academic Societies (CFAS). The meeting included a program entitled “Optimizing the Learning Environment: Faculty and Resident Resilience.” The need for the content is pegged to the fact that “emotional exhaustion, burnout, and job dissatisfaction are not uncommon in the halls of teaching hospitals and schools of medicine.” Mindfulness programs at Mayo and Georgetown are touted in the article.
Comment: It has intrigued me that mindfulness is most likely to gain traction in regular medicine when pegged to disaster: the negative, disease-oriented foci of burnout, stress, resident suicides and the like. How nice to consider medical schools choosing mindfulness (merely) for the potential positive desire to create health. It is notable that when former Center for Medicare and Medicaid Services administrator and Institute for Health Improvement founder Donald Berwick, MD shared his vision of a system based on “salutogenesis,” his short list of mentors was dominated by mindfulness experts (Kabat-Zinn, Ornish, Jonas, Benson among them). Good that mindfulness is finding its way in, through whichever gap in the industry’s disease-focused armor. Here’s looking forward to the day when such programs are engaged (merely) whole-heartedly for the purposes of health creation. I wager that such a move is a necessary antecedent to health system transformation.
Midwifery, Education, Regulation and Association (MERA) 2015 Report and Priorities
The US Midwifery Education, Regulation and Association (MERA) of nurse midwives and certified professional midwives (CPMs), begun in 2013, has published its 2015 report. The report includes priorities for the group moving forward. These include: development and implementation of a Midwifery Bridge Certificate that will create a bridge for CPMs who have not completed an accredited education program but wish to be licensed in states with that requirement; finalization and distribution of a Consensus Statement on Principles for Model Midwifery Legislation and Regulation; convening of the Direct Assessment Task Force to develop a model to increase access to and affordability of midwifery education; launch of a US MERA website; development of an Equity Task Force to develop guidance for addressing equity issues within the US MERA collaboration; and, development of a US MERA strategic plan for the next 5 years.
Comment: Terrific that the two, formerly frequently warring groups of midwives – Hatfields and nurse-Hatfields, in this case - are continuing their commitment to collaboration, and upping the ante. Good also to see the elevation of both access and equity for the field’s future in their strategic planning.
Chanda Plan Foundation Integrative Program Receives Continued Medicaid Funding in ColoradoThe Chanda Plan Foundation reports to those on its list that “Colorado Governor [John] Hickenlooper signed Senate Bill 15-011 into law on June 5th, which renews the Spinal Cord Injury waiver.” The foundation provides integrative treatments for people with physical disabilities. The treatments are mainly acupuncture, massage, and chiropractic care. The program is funded by Medicaid. The Chanda Plan Foundation has advocated for these approaches through its “Systemic Change Program.” Comment: This story is one of the more remarkable, among many, in which one individual’s personal passion, in this case of Chanda herself, is converting into public good for many. If you are not familiar with Chanda’s work, or that of the foundation, and the breakthroughs she has created in the legislature there, take a look. Remarkable.
New Jersey’s Riverview Medical Center Receives $10-Million for Integrative Center
In a June 17, 2015 medical release, Riverview Medical Center Foundation announced two $5-million gifts that they expect “will significantly impact the way health care is delivered in our community.” The first gift was from Joan and Robert Rechnitz, founders of the Two River Theater Company. It targets the support of the launch of an integrative medicine program. Subsequently, “inspired by the couple's gift, and with the program underway, an anonymous donor provided an additional $5-million donation toward the initiative.”
Comment: In this case, when the other shoe dropped, it powered up rather than neutralizing the impact of the first. Wonderful. I hope everyone within miles benefits from Riverside’s great good luck. The vision of “significantly impact(ing) the way health care is delivered in our community” is a good starting place!
Emerson Ecologics Announces $25,000 of Grants: Projects of Natural Doctors InternationaI, Michigan NDs and Maryland University of Integrative Health Benefit
- Michigan Association of Naturopathic Physicians: $10,000 to support licensing efforts.
- Natural Doctors International (NDI):$7,500 to expand recruiting efforts for additional integrative disciplines, “including acupuncture, massage therapy, nutrition, herbalism and conventional medicine.”
- Maryland University of Integrative Healthcare, Dispensary Department: $7,500 to aid in developing a training program for current Good Manufacturing Process (cGMP) requirements.
Comment: These are precious, precious dollars to recipients. Few in regular medicine can understand well big a deal $7500 can mean to organizations that have no significant governmental or foundation backing. Yet this is much-ado about not very much from the perspective of Emerson, a dominant distributor in the field. Their program does set an example for other companies. More should follow suit. At the same time, Emerson might show leadership and up the ante by doubling down to (at least) $50,000 next year.
John Weeks' GAHMJ Global Integrator Round-Up for June 2015
The Global Integrator Blog posts for June 2015 include: Two Global Days in June Celebrate Health: Wellness Day & the U.N.’s International Day of Yoga; Blackmores Stimulates Furor in $1.3-Million Grant for U Sydney Integrative Medicine Chair; Cuba Formally Recognizes 10 Alternative Practices; Quick Links to Global News (75 links); and Ebola, Ambassador Andrew Young, and the Potential Role of Native African Medicine.
Comment: Fascinating to see Ambassador Young, a hero since his days speaking truth about human rights, and racism – though it got him removed from office at the United Nations – in this role as a global health promoter of research on traditional medicines. Meantime, those of you who have followed or visited and observed the integrative care in Cuba may be surprised, as I was, to learn that many of the integrative practices there, despite their inclusion in system services, did not yet have official standing. They do now.
Wellness and Yoga between War and Work: AIHM’s Friedland Promotes the Annual June Wellness Event on Turkish TV
June is proving to be the month for health and wellness with Global Wellness Day featured on the second Saturday of the month and now the UN’s International Day of Yoga appended last fall to every June solstice. The former is the brainchild of Turkish spa owner and wellness advocate Belgin Askoy, the founder of Global Wellness Day. People in over 70 countries on 5 continents took part in the wellness celebration in 2015, according to Global Wellness Day speaker and promotor Danny Friedland, MD, the chair of the U.S.-based Academy for Integrative Health and Medicine. This news show on Turkish television features an interview with Friedland, and Askoy. Friedland’s 15 minute keynote from Istanbul is here.
Comment: As I noted in my Global Integrator Blog piece on these activities, in the U.S. where Memorial Day (honoring those who fought in war) and Labor Day (honoring work) bracket the summer months, it is a move toward balance to insert days to memorialize and lift up wellness and yoga between war and work. With the empathy associated with mindfulness and wellness, this a sort of “global warming” that appeals.
Philanthropist Susan Samueli Honored for Her Visionary Work by UC Irvine System
On June, 2015, Susan Samueli, founder of the Susan Samueli Center for Integrative Medicine, was granted an award at the UC Irvine Health Heroes Gala “for her visionary role in helping people discover and experience wellness.” Samueli funded the start-up of the Center at the medical school and has continued to nurture its development. Roger Steinert, MD, the UC Irvine dean, noted that “we are indebted to Susan Samueli for her sustained contributions to healing mind, body and spirit.”
Comment: The award focused on Samueli’s local work. Those involved nationally will know her better from her support, with her spouse Henry Samueli, of the Samueli Institute, in Alexandria, Virginia, led by Wayne Jonas, MD. Kudos to this philanthropic partner to the integrative health and medicine field are well-earned for her bi-coastal investments.
Adi Haramati Receives Honorary Doctorate from Maryland University of Integrative Health
One of the most significant door-openers for interprofessionalism in integrative medicine, Georgetown University’s Aviad (Adi) Haramati, PhD, was granted an honorary doctorate by Maryland University of Integrative Health following his commencement talk at that institution in June 2015. Haramati is a highly honored educator who has played significant roles in the development of multiple integrative health and medicine initiatives. These include the Academic Consortium for Integrative Medicine and Health, the CAM M.S. in Physiology program at Georgetown, and multiple strategic initiatives with the Academic Consortium for Complementary and Alternative Health Care. MUIH, with now over 1,000 onsite and online students from 18 countries and over 40 states, is emerging as a leading educational provider in integrative health and medicine.
Comment: Fun to think of Haramati with a doctorate from MUIH, this rapidly growing, increasingly interprofessional institution in the integrative health space. Haramati’s contributions to inclusion have been many, and significant, particular his multiple convening of interprofessional gatherings at Georgetown. The most recent grows also from his long-time work promoting mindfulness, the CENTILE conference. It will take place this October with MUIH side by side with 5 mainline academic health centers as an institutional co-sponsor. The conference is titled: “2015 International Conference to Promote Resilience, Empathy and Well-Being in the Health Professions: An Interprofessional Forum.” Alignment of interest note: Haramati is a long-time associate and I have consulted with MUIH.
Mimi Guarneri, MD Listed as Top Female Physician in Integrative Medicine in Newsmax 100
An outfit called Newsmax has printed a list of what it considers the Top 100 Physicians Who Embrace Integrative Medicine. Number 6 in the list is the first female noted: former Scripps integrative cardiologist and president of the Academy of Integrative Health and Medicine Mimi Guarneri, MD. A release on Guarneri’s listing as the top female is here. The top 5 are medical doctors Mehmet Oz, Mark Hyman, Deepak Chopra, Andrew Weil and Michael Roizen. The list includes no mention of the methodology through which people were selected.
Comment: How does one come up with such a list?! The next female after Guarneri is one Erika Schwartz, MD, an HCG diet doc, at #10 and the next is #31, Sue Decoittis, MD, also a diet doctor. Fascinating. Notably, the very influential Joseph Pizzorno, ND shows up at #19, as the first non-MD on the list. Joseph Mercola, DO, is the first D.O., at #22. Two other NDs make the list. One Doctor of Oriental Medicine is included: Tony Wilcox, Ac. No chiropractic physicians do. It’s hard to say whether the list is most strange for those who are on it, or those who aren’t. Feels a little, for those not well known, like the product of a solicitation to get into some Who’s Who in Integrative Medicine. Please pay ahead.
NCNM Grants Integrator’s John Weeks an Honorary D.Litt. The Portland, Oregon-based National College of Natural Medicine granted Integrator publisher-editor John Weeks an honorary Doctor of Letters (D.Litt.) following his delivery of the commencement speech at NCNM’s June28, 2015 graduation of 187 doctoral and masters’ level students. The NCNM release on the subject was entitled “NCNM Commencement to Pay Tribute to Medical Heroes Past and Present.” The family of the founder of naturopathic medicine in the U.S., Benedict Lust, MD, ND, was also honored. NCNM President, David J. Schleich stated: “John understands the historically, deeply entrenched complexities of interprofessional relationships, like those within the natural medicine and Western medicine fields. We’ve come to trust his insights.”
Comment: I have had a few life-times worth of honors this past year following the tribute last May - though my gluttonous pleasure in them continues! Witness this brief! This award was particularly nice as I spent my first 10 years in the integrative health field (1983-1993) working in the resuscitation and rebirth of the naturopathic medical profession. NCNM is the profession’s “mothership.” There was a time from 1957-1978 when no other recognized school existed. I was also very happy to finally have a full on spousal “duh” moment when I took in how deeply my spouse Jeana Kimball, RDH, ND, LM (midwifery), MPH and I have been partnered, professionally, these last 26 year. I balanced a wee bit of karma by dedicating the doctorate to her. She has been my consultant and confidant on every significant question regarding strategy and people. And she has heard me prattling on ad nauseum on roughly one-zillion topics and themes. Consider how useful all of her clinical and research training and experience has been for a person such as myself who has had no formal education in either. Thanks to Jeana, and to Dr. Schleich and the NCNM faculty.