Role of the Natural Medicine Physician Within the New Health Care Paradigm by Joe Pizzorno, ND.

1. Role of the Natural Medicine
Physician Within the New
Health Care Paradigm
Joseph Pizzorno, ND
President Emeritus, Bastyr University
Editor, Integrative Medicine: A Clinician’s Journal
President, SaluGenecists, Inc.
Mail2@DrPizzorno.com
Copyright © 2011
1

2. Dr. Joseph E. Pizzorno, N.D.
• Academic
o Founding president of Bastyr University, first accredited, natural medicine university
o Editor: Integrative Medicine: A Clinician’s Journal
o Speaks worldwide to academic institutions, healthcare professionals, public and legislators
o Textbook of Natural Medicine, 3nd ed. 2009; 4th edition now in process
o Adjunct Professor, South Pacific College of Natural Therapies
• Policy
o Member Medicare Coverage Advisory Committee, 2003-2005
o Member White House Commission on CAM Policy, 2000-2002
• Public
o Chair, Board of Directors, Institute for Functional Medicine, 2006-
o Encyclopedia of Natural Medicine, 1998 (1,000,000 copies in six languages)
o Encyclopedia of Healing Foods, 2005
• Example Awards and Recognitions
o Juror for Roger‘s Prize - 2009
o Institute for Functional Medicine – Linus Pauling Award, 2004
o American Holistic Medical Association: Pioneer in Holistic Medicine, 2003
o American Association of Naturopathic Physicians: Physician of the Year, 2002
o Natural Health Magazine: Leading health educator in the past 30 years. 2001
o Alternative Healthcare Management: 1 of the 4 most influential CAM leaders, 2000

3. Overview
1. Why do patients come to see us?
2. Do we believe in wellness?
3. How does a wellness orientation in primary care contrast with
the conventional medicine approach to patients?
4. How can this fundamental change in patient care impact
the healthcare crisis?
5. Is there any research to support a wellness rather than
disease-centric approach?
6. What are the political and insurance reimbursement hurdles
that need to be overcome to provide an environment to not
only allow, but nurture this better approach to healthcare.
7. Finally, what does an optimal healthcare system look like and
how does the natural medicine physician fit in?
3

4. Conventional Medicine:
Many Successes
• Huge success in acute illness, trauma and life-
threatening disease
• This was accomplished through:
o Disease-treatment focus
o Standardization of disease, diagnosis, therapy and,
unfortunately, people
o A huge investment of our country‘s resources
o Active suppression of other ideas and practices
• However
o Many problems and limitations have surfaced (as
predicted by natural medicine doctors a century ago)

5. Why Do Patients Come To Us?
• Heavy DISEASE BURDEN
o And it is getting worse…
• High incidence of SIDE EFFECTS
• Out-of-control COSTS
• The MYTH of increased longevity

6. Heavy Disease Burden
• Only adults: 18-64 yo
Incidence of Chronic
• Only 6 most common dzs Disease
• Does not include ―ill- 50%
health‖ 40% 3+
o Adds 15-20%
30%
2
• Those with the poorest 20%
health habits develop
1
chronic disease 5 years 10%
earlier and their disease is 0%
twice as severe.
Wilper AP, et al. A National study of chronic disease prevalence and access to care in uninsured
U.S. adults. Ann Intern Med. 2008;149:170-176
Vita Aj, et al. Aging, health risks, and cumulative disability. NEJM 1998;338:1035-41

7. Despite Increasing Use Of
Drugs And Surgery
Prescription drug use, past month Coronary artery stent procedures
1 in 7 restenose within just 1 year!
http://www.cdc.gov/nchs/data/databriefs/db42.htm

8. Surprising Incidence of
Adverse Drug Reactions
• Not anti-medicine, but real, undisclosed
problems
• Doctor: adverse event in 4-18% outpatient
visits
• Patient: 25% of 661 outpatients, 13% serious
• Result:
o 116 million extra physician visits
o 77 million extra prescriptions
o 18 million ER visits
o 8 million hospital visits
o 199,000 additional deaths
o $77 billion extra costs (equivalent to diabetes)
Wiengart SN, et al. Epidemiology and medical error. BMJ 2000;320:774-7
Gandhi TK, et al. Adverse drug events in ambulatory care. 2003;348:1556-64

9. Increased Longevity?

10. Out of Control Costs
Marshall E. Science and the stimulus. Medicine under the http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5
microscope. Science. 2009 Nov 27;326(5957):1183-5. 813a5.htm 10

11. Walter Bortz, II, MD in
Next Medicine
• Symptoms of ―Current Medicine‖
o Excessive cost
• Ex: Health insurance costs rising 4x faster than workers earnings
o Injustice/Inequity
• Although he advocates for universal health care, he is ―convinced that
adopting a universal health insurance policy…..will by itself contribute
only marginally to Americans‘ health‖
o Harmfulness
• Annually, iatrogenesis causes equivalent of 3 747‘s crashing every day.
o Corruption
• Ex: Vioxx & Merck, unnecessary surgeries, etc.
o Inefficiency
o Irrelevance
• This symptom he considers to signify a complete disconnect between
our health and health care system

12. Walter Bortz, II, MD –
Irrelevance of “Current Medicine”
• ―Current medicine lacks the philosophical, moral,
and scientific conceptual framework that would
make it capable of helping‖ [diabetes, aging, and
obesity]
• ―It reaches into its black bag for a remedy. In the
bag are the fundamental tools of the medical
industrial complex: surgery and pills.‖
• ―These two treatments represent nearly all of
Current Medicine‘s $2.5 trillion annual budget, but
they are powerless against aging and diabetes.‖
• 72% of physician visits are now due to chronic
conditions 12

13. Walter Bortz, II, MD
• Mission of medicine is to assure and assert human
potential
• Calls for a new paradigm in medicine, which
restores the balance between Hygeia and
Panacea (health preservation and repair,
respectively)
• In legend, Hygeia is the daughter of the god of
medicine, and is closely correlated with the origin of
the vis medicatrix naturae.
13

14. Do We Believe in WELLNESS?
• Is NATURAL MEDICINE about therapies? Or about
concepts & intent?
• Despite assertions of ―treating the person not
disease‖, most therapies focus on selecting the
appropriate herb, nutrient, manipulation,
acupuncture technique, etc. No matter how
natural, many still have a focus on disease.
• Do we truly believe in the body‘s ability to heal, and
does this not trump disease? Do we believe in
wellness?
14

15. What Really is Nature Cure?
• NATURE CURE is simply restoration of
wellness—by whatever means most
appropriate for each unique person—as this
is how the body removes disease
• Isn’t it our profound ability to recognize the
inherent striving for wellness inherent in life
that differentiates us?
• And isn’t this what our patients are—often
unknowingly—seeking?
15

16. Treating Symptoms With Natural
Therapies is Still Allopathy
• When a person is depressed, it is not due to a lack
of Prozac.
• Nor is it due to a deficiency of St. John‘s wort.
• It could be due to a lack of sunshine, and vitamin D
• Are they toxic, are they eating the wrong foods or
not enough of the right ones, or is their life without
meaning.
• Isn‘t seeking and acting on this understanding the
core of NATURE CURE?
16

17. Is a Belief in Wellness a
Recognition of the Vis?
• The VIS embraces VITALISM.
• Natural medicine is fundamentally a vitalistic
practice (vis medicatrix naturae)
• The best doctors facilitate their patient‘s belief in
their health and ability to get healthy
o Placebo is still more effective than virtually every drug
• Without understanding the vis, how do you know if
your patient is actually improving rather than just
suppressing symptoms?
o Is the patient HEALTHIER after your treatment?
17

18. Pizzorno (2007)
I have been involved in naturopathic medicine for
35 years, and I still can’t define it. Nonetheless, we
can see the Vis in others—it is something we all
sense. As a clinician, you watch the level of a
patient’s vitality; when it increases you know you
are on the path to cure, but if it decreases then you
are only palliating symptoms and suppressing the
individual’s expression of the Vis.
18

19. Bill Mitchell, ND
• 1948-2007
• Co-Founder Bastyr University
• Inspiration teacher for 20 years
• My friend
The following slides on Bill‘s philosophy used
with permission from Leanna Standish, PhD,
ND, LAc
19

20. Bill’s Concepts
VMN = the healing power of nature
VNM = the self-organizing property
‗The VNM functions in any given living system as the
tendency to organize that system so as to maintain
existence‘.
The Vis is universal.
‗A fascinating assumption… is that life on other
systems contains an internal intelligence for self-
maintenance as well, meaning that the Vis exists
universally and is a cosmological reality.‘
20

21. But Bill Goes on to Say…
The Vis is not weakened or strengthened by
the weakness or strength of the individual.
The VMN exists internally and universally.
This is best thought of as an equation that
exists during the life of the system….
And while the inputs into an equation…can
change the value of X, Y, or Z, the equation
itself exists as a structure in which these
values interact with each other.‘
21

22. Wisdom from Dr. Standish
• Naturopathic medicine distinguishes itself
philosophically from mainstream medicine by its
core principle Vis medicatrix naturae, the healing
power of nature.
• Its insistence on referring to the ‗vital force‘ has
served to isolate, and perhaps sideline,
naturopathic medicine from mainstream
conventional and pharmaceutical medicine of the
second half of the 20th century, which has been
historically based exclusively on scientific
materialism.
22

23. Dr. Standish Concludes
• However, the experimental findings from quantum
mechanics in physics, neuroscience, and the
distant healing literature suggest that scientific
materialism is an incomplete description of reality
and thus cannot be the sole philosophy of modern
medicine.
• The findings of the ‗new science‘ support the
concept of biological field effects, macro-
entanglement, non-local interaction, and
downward causation. A ‗new medicine‘ is
emerging in the 21st century.
23

24. My Current Thinking
Vis is the manifestation of the universal
Consciousness in biological form. Our environment,
beliefs, interactions with others, actions, lifestyle,
diet, etc. modulate the manifestation of Vis as our
vitality, but Vis itself is immutable. As we harmonize
with the Vis, our consciousness expands .
24

25. Jeffrey Bland, PhD
• Conversation with Dr. Szyf @ McGill University:
o ―Rather than these diseases being hard-wired into our
genes ..our responses that give rise to disease are adaptive
responses to an altered environment, in which the
outcome over time, through the epigenetic modulation,
becomes a disease. In other words, we don't have diseases
wired into our genes, we have physiologic responses to
environmental modulation wired into our genes that then
creates an outcome that's later called our phenotype of
health or disease..‖
FMU. November 2010 25

26. Wellness vs. Conventional
Orientation in Primary Care
• Former head of CDC and
Surgeon General: ―We spend
well over 90 percent of our
national health budget
treating diseases and
complications—many of which
could have been prevented in
the first place…. ―
• ―I hope that the day will come
when all health care providers
will write prescriptions for
prevention for patients‖
Satcher D. The prevention challenge and opportunity. Health Aff (Millwood).2006;25(4):1009-11
Schroeder SA. Shattuck Lecture. We can do better--improving the health of the American 26
people. N Engl J Med. 2007 Sep 20;357(12):1221-8.

27. How Does Fundamental Change in
Patient Care Impact Healthcare Crisis?
• Reduced Disease Burden
o Ex: Myocardial infarction & INTERHEART STUDY
o Risk of myocardial infarction almost entirely attributable to
modifiable risk factors, specifically lifestyle behaviors
o Although genetic predisposition influenced physiological
function and risk of disease, it was largely modifiable by
how people lived
o Preventable illness is thought to make up at least 70
percent of the burden of illness and the associated costs
O'Keefe JH, et al. Primary and secondary prevention of cardiovascular diseases: a practical evidence-based
approach. Mayo Clin Proc. 2009 Aug;84(8):741-57.
Fries JF, et al. Beyond health promotion: reducing need and demand for medical care. Health Aff (Millwood). 27
1998 Mar-Apr;17(2):70-84.

28. Change Cuts Health Care
Costs Too
• Reduced healthcare costs
o Even a modest focus on prevention, early intervention, and
behavioral change could save annually in treatment and
productivity loss costs an estimated $217 billion and $1.6
trillion, respectively
o Greater emphasis on primary care and health promotion,
less specialty care
• Greater function, longer healthspan
A wellness initiative for the nation, 2008. http://ihpc.info/resources/resources.shtml
28

29. Research Supporting Wellness
• Prospective study of over 20,000 men and women
o Individuals that did not currently smoke, were physically active,
moderate alcohol intake and plasma vitamin C indicative of at
least 5 servings of fruits and vegetables a day have a 4-fold lower
risk of mortality than the those with the least healthy behaviors.
o Greater than a 2-fold difference in stroke risk
o Equivalent to 14 years in chronological age
• Diabetes Prevention Program Trial
o High risk for diabetes, adopted minimal lifestyle change
o Compared to placebo, lifestyle changes delayed the onset of
diabetes by 11 years, metformin only 3 years
o Lifestyle intervention was found to be $1,100 per quality adjusted
life year (QALY), while metformin was $31,300
Khaw KT, et al. Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective
population study. PLoS Med. 2008 Jan 8;5(1):e12.
Myint PK, et al. Combined effect of health behaviours and risk of first ever stroke in 20,040 men and women over 11 years'
follow-up in Norfolk cohort of European Prospective Investigation of Cancer (EPIC Norfolk): prospective population study.
BMJ. 2009 Feb 19;338:b349. doi: 10.1136/bmj.b349.
Herman WH, et al. The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with29
impaired glucose tolerance. Ann Intern Med. 2005 Mar 1;142(5):323-32.

30. How About Our Own
Research?
• Duke reports annualized $2,200/employee/year
savings from integrative wellness program
• t Ford plant indicates acupuncture, mind/body,
chiropractic reduces back pain medication & costs
• WA state finds CAM-using insureds with heavy
disease burden cost $1,420/year less
• Naturopathic medicine effective and saves
$1,025/person for Canada Post employees
• Australian government finds acupuncture and
natural products lower healthcare costs
• Tennessee Blue Cross Blue Shield finds 20-40% lower
costs for LBP patients who see chiropractors first 30

31. Hurdles to Overcome
• Pharmaceutical & device manufacturers have
powerful lobbies to prevent change.
o Penetration into all realms of medical care, including
medical education, is extensive
o Recent survey of health professionals: 88% thought
commercial sponsorship of CME was biased, yet only 12%
wanted to eliminate it, and less than ½ would pay higher
fees
o Also penetration into public perception about causes of
health and disease
Tabas, J. Clinician Attitudes About Commercial Support of Continuing Medical Education. Archives of Internal 31
Medicine, Vol. 171 No. 9, May 9, 2011

32. More Hurdles
• Insurance reimbursement pays for drugs and
surgery, not wellness medicine
• Frequent changing of jobs/insurance company –
not as much incentive to cover prevention/wellness
• Loss of interest in primary care vs. specialized care
• Dominance of teaching hospitals with focus almost
entirely on specialist care
• Efficacy research mostly based on single modality
vs. outcomes
o Wellness is about systems of healing, not isolated therapies)
• Cherry picking of natural therapies without
understanding of underlying concepts of health
• Even minimal focus on prevention does not equal
wellness, i.e. prevention versus early detection 32

33. Optimal Healthcare System
• Fully embraces:
o Basic sciences‘ remarkable advancements in
understanding human physiology and pathology
o Conventional medicine‘s incredible diagnostics and, at
times miraculous, ability to cure many types of disease
o Natural medicine‘s vitalizing healing wisdom and health
promoting therapies
o Public health‘s considerable effectiveness in fundamentally
improving the environment and decreasing disease risk of
populations.
o Healing as our fundamental motivation
33

34. Optimal System – Role of
Natural Doctor?
• Currently broad support in the US for ―personalized
medical home‖
• Integrated acute care, disease prevention, wellness
promotion, personalized care, core of which is
primary care doctor
• Allows for primary care providers to facilitate care
by other providers, with wellness as central goal
• Who better suited to be this bridge than the natural
medicine physician?
34

35. Natural Medicine
Physician of the Future
• Fully understands and embraces the vis
• Nature cure foundation
o Whole foods (more than supplements)
o Lifestyle, etc.
• Excellent patient communication and behavioral
change skills
• Advanced personalization of care
o Biochemical individuality
o Diagnostic tools
o Health informatics
• Primary care family doctors
• Experts in integration 35

36. Dramatic Change in
Legislative Acceptance
• Both the senate and house of the Washington State legislature
unanimously passed a resolution honoring Bastyr University and
natural medicine.
• This is the same legislature where for decades we walked the
halls as beggars knocking at the door pleading to not be
made outlaws.
• As I watched legislator after legislator stand and proclaim to
their colleagues how naturopathic medicine had saved their
life, helped them get pregnant or cured a treasured child the
conventional medical system had failed,
• The prophetic words of Dr. Bastyr came back to me: ―No
matter the obstacles they place, the truth of our medicine will
out.‖
36

37. What is the Future of The
Natural Medicine Physician?
The future IS NATURAL MEDICINE
It is not:
o Green drug allopathy
o Holistic medicine
o Integrative medicine
o Functional medicine
o Anti-aging medicine
• It is FULLY embracing the VIS
37

38. The Future of Natural Medicine
• Changing healthcare by practicing true natural
medicine is the future of natural medicine. And it
has started.
• The truth of our medicine will continue to inspire and
transform healthcare.
• Paraphrasing Margaret Mead,
In fact, the truth of our medicine is the only thing
that can change healthcare.
38