California Mandates Disclosure of Physician Sexual Misconduct

By Erik Goldman, Editor

As Dr. Christine Blasey Ford and Judge Brett Kavanaugh faced off in the Senate, the state of California quietly passed a major piece of legislation on sexual misconduct, one that could provide patients with far greater protection against predatory physicians. The Patient's Right to Know Act will require any California physician placed on probation for sexual wrongdoings to disclose this fact to any and all patients before an appointment.

Gawande to Head Amazon Healthcare Initiative

By Erik Goldman

Amazon, together with Berkshire Hathaway and JPMorgan Chase, has named Atul Gawande as the CEO of its new joint venture in employee healthcare.

Since December, when the three companies announced a plan to do “something” in healthcare, the medical world has been abuzz with speculation, adulation, and nay-saying about what this trinity of Fortune 500 companies might do.

While the companies have still not revealed much about the specifics of their initiative, the selection of Gawande to lead the effort suggests that it will be strongly focused on reducing healthcare cost disparities from region to region, minimizing unnecessary care, improving efficiency, and emphasizing prevention.

Atul GawandeAtul Gawande, MDGawande, an endocrinological surgeon based at Brigham & Womens’ Hospital in Boston, is best known to many Americans as the author of Being Mortal: Medicine and What Matters in the End---a deeply thoughtful meditation on death-and life—in an era of high-tech “solutions”.

Parallel with his surgical career, Gawande has always had a strong interest in public health and big-picture issues. In 1992, he interrupted his medical school training to work on healthcare issues during Bill Clinton’s campaign, and later became a senior advisor to the Department of Health & Human Services under the Clinton administration.

A gifted writer, Gawande sent shockwaves through the healthcare world with a 2009 article in the New Yorker, documenting the extreme cost disparities for the same healthcare services between two communities in Texas.

His message was that a medical culture dominated by corporate profit-making fosters a lot of unnecessary, ineffective and expensive “care,” and that costs could be reduced, and care vastly improved if more healthcare systems adopted the efficiency models championed by systems like the Mayo clinic.

Gawande’s work greatly influenced the Obama administration’s vision for reform. It also attracted the attention of Charlie Munger—Warren Buffett’s business partner—who sent Gawande a thank-you gift of $20,000, which the surgeon donated to the Brigham & Women’s Center for Surgery and Public Health.

In an official statement released by Amazon, Berkshire, and JPMorgan on June 20, Gawande says: “I have devoted my public health career to building scalable solutions for better healthcare delivery that are saving lives, reducing suffering, and eliminating wasteful spending both in the US and across the world. Now I have the backing of these remarkable organizations to pursue this mission with even greater impact for more than a million people, and in doing so incubate better models of care for all. This work will take time but must be done. The system is broken, and better is possible.”

Combined, the three companies have nearly 1 million employees---a very sizable health insurance pool all its own. The companies’ leaders believe they can find ways to improve employee healthcare that existing insurance plans have been unwilling or unable to do.

But in a statement on May 24, Berkshire Hathaway chairman Warren Buffett stressed that the trio of companies have no intention of building their own insurance company.

“The motivations are not primarily profit-making. We want our employees to get better medical service at a lower cost…..we do think that there may be ways to make real significant changes that could have an effect.”

Buffett’s statements seem to suggest that whatever the triad does together in healthcare, they will keep it “in house.”

But given Amazon’s history of disrupting industries, there’s no reason to believe the impact of an Amazon-Berkshire-JPMorgan healthcare play will be limited to its own employee base.

Amazon CEO, Jeff Bezos, recently said, “I think healthcare is going to be one of those industries that is elevated and made better by machine learning and artificial intelligence. And I actually think Echo and Alexa do have a role to play in that.”

Advanced technology will no doubt play a role in whatever healthcare system does emerge from this large-scale collaboration. But the selection of Dr. Gawande—a clinician with a deeply compassionate perspective—is a promising sign that the three companies are trying to balance the technological thrust with a strong humanistic hand.


doTERRA, the Essential Oil Titan, Launches Healthcare System

By Erik Goldman, Editor

doTERRA, one of the world's leading marketers of botanical essential oils for healthcare uses, is launching a healthcare system.DoTerra Healthcare

Guided by a bold vision of transforming American healthcare, the company is planning a nationwide network of integrative medical clinics wholly owned and overseen by doTERRA, that would operate on a membership or concierge-style model, in which "patients pay a monthly membership fee that covers the cost fo their clinical care." These clinics will be completely insurance-free, according to the company's website.

Though the plan is still in an early stage, doTERRA says the company is looking for teams "of dedicated doctors (MDs and DOs), nutritionists, essential oil experts, and wellness coaches" who will "ensure that patients receive the highest levels of care." Those patient will have 24/7 access to their practitioners via a telemedicine practice, and "more face time when they meet with their doctors in person."

The proposed medical services include: complete primary care, urgent care, wellness coaching, nutrition counseling, essential oil therapies, and genome testing.

The Utah-based company is appealing to the public's clear and persistent frustration with mainstream care delivery, by promising comprehensive services that integrate conventional allopathic care with holistic alternatives, including of course use of essential oils as adjunctive therapies. They're simultaneously tapping practitioner desire for a more humane, less-abusive, and more fiscally healthy mode of practice.

A Ready-Made Market

doTERRA has over 400 full-time employees, and claims upward of 3 million distributors (which the company refers to as "wellness advocates") its multi-level marketing system. That's a sizeable ready-made market of individuals who've self-selected for interest in botanical medicine, and other non-pharm alternatives.

Doterra oilsA survey conducted by the company suggests that 85% of Americans want integrative solutions, including essential oils, from their medical practitioners, and 85% would be willing to join a membership-style practice that offers these alternatives. Yet currently, only 15% of respondents have doctors who are providing the sort of care they seek.

According to the company's site, nearly 50,000 people have already pre-registered to join doTERRA Healthcare.

The company has not released any specifics about the membership costs, the fiscal relationships between clinics and the company's administrators, or how exactly the doTERRA clinics will deliver high-quality primary care imore effectively than mainstream clinics. doTERRA declined Holistic Primary Care's request for an interview at this point. A company spokeswoman stated that it is too soon to reveal details, but that the full plan will be revealed later this summer.

The flagship clinic will be located in Pleasant Grove, UT, to serve doTERRA's on-site employees, followed by a roll-out of clinics across the US later this year.

The effort is being led by Brannick Riggs, MD, a family physician who trained in integrative medicine at the University of Arizona, and David Hill, DC, a chiropractor with broad interests in holistic modalities. Both have extensive experience with essential oils, and with doTERRA as a company.

If doTERRA is able to develop an effective and replicable practice model, it is likely to appeal to many holistic and functional medicine physicians who currently struggle with fiscal and practice development issues.

In it's new initiative, doTERRA is certainly making bold promises. But that should not be surprising. The company--founded in 2008 by former employees of Young Living, another essential oil MLM--has been known for its envelope-pushing claims. On occasion, that's drawn ire from regulators.  In 2014, doTERRA received warning letters from the FDA ordering the company to cease promoting essential oils as treatments for cancer, autism, Ebola, and other diseases.

It remains to be seen how doTERRA will meet the very complex challenges of primary care delivery, and whether they will ultimately come up smelling sweet. But the company clearly has considerable resources,  management know-how, and a committed ecosystem of bright, independent-minded people who are seeking healthcare alternatives.These factors bode well for the success of doTERRA Healthcare.





Feeding the "Multivore" Family

By Ellen Kanner, Contributing Writer

The New Year brings a post-holiday parade of patients streaming into your office resolving to eat healthier (maybe after a little urging from Multivore Tableyou). It’s among everyone’s top New Year’s resolutions.

But by the early Spring, many grow discouraged as they find that they are unable to uphold their resolutions.

The reality is that major dietary changes are among the hardest resolutions to keep, with so many barriers to success. For many people, the biggest barriers may be the people they live with and love. Their spouses, parents and children.  

“The choice of individual family members to walk a distinctly different path from the rest of the clan can pose challenging problems in family dynamics,” says Seattle-based naturopathic physician, Dr. Herb Joiner-Bey.

Feeding a “multivore” family—where each member has distinct and divergent dietary restrictions and preferences--is challenging, says Joiner-Bey. But it is doable: all you need is some “good common sense.” A little guidance and encouragement from a clinician who understands the quandaries also helps!

Some might call it multivore madness. I call it life. I’m a vegan married to an omnivore, and the daughter of a man who thinks meat and sugar are the two basic food groups. We love each other and love to eat together. It beats walking a lonely path or eating alone.

How do we make it work?

It starts with a conversation. We need to talk about what’s at stake here. Maybe it’s a medical necessity— losing weight to avoid surgery, changing diet to manage out-of-control diabetes, avoiding gluten and the bloat, inflammation, and leaky gut associated with it.

Perhaps it’s an ethical lifestyle choice—the desire to go vegetarian or vegan to eliminate animal cruelty and lighten one’s environmental impact. In other cases, the intention to change one’s diet comes from wanting to look terrific at an upcoming high school reunion.

When making dietary recommendations to your patient, it’s important to gather information about his or her family life—and how the proposed changes will likely affect family members and other loved ones. Does the patient live with people who will support or undermine their efforts to change their eating habits? Though it might not seem like a “clinical” issue, the answer to this question will have profound impact on the likely outcome.

Even in the most supportive families, change can be challenging. It’s important for you—and your patients—to anticipate this and to deal with the realities each individual will face.

Challenges may be even greater within certain cultures. My hometown of Miami has a distinctly Latin flavor. Cafecito breaks are a beloved afternoon tradition — and meat is on the menu at every meal. It’s not a coincidence the leading causes of death among Latinos are cancer and heart disease, but try telling that to a doting abuela. Many other cultural and regional eating habits can also be very challenging: going gluten-free in a pasta-loving Italian family, or becoming a vegetarian in a steak n’ potatoes household is no easy feat.

So how can you help your patients succeed, especially when they’re meeting resistance at home?

Begin by asking them how they plan to meet their goals and what eating healthier — or eating cleaner — the term of the moment — means for them. No gluten? Less processed food? Less sugar? And how much less? For my father, healthier eating means only one dessert a day. Nice try, Dad. But that may not be enough to move the needle.

When making dietary recommendations to your patient, it’s important to gather information about his or her family life—and how the proposed changes will likely affect family members and other loved ones. Does the patient live with people who will support or undermine their efforts to change their eating habits? Though it might not seem like a “clinical” issue, the answer to this question will have profound impact on the likely outcome.

That’s where the why--the motivation-- comes in. Clarifying the incentive ups the odds of achieving wellness results your patient — and you — want.

Help your patients focus on the positive, on getting the outcomes they want and maybe discovering some happy surprises along the way. Changes to diet offer an opportunity to explore new cuisines, new flavors.

“Culinary herbs and spices make food exciting,” says Joiner-Bey. They add no sodium, no sugar, no calories. Just pleasure.

The most important conversations, of course, happen not in your office or any other clinical setting, but around the dinner table. Mealtime is a great opportunity for your patients to talk with their families about why they’re making different food choices.

Though you won’t be there at those discussions, you can be a valuable ally. Collaborate with your patients so instead of initiating “food fights,” they go in with clear strategies and explanations.

Victoria Moran, vegan author and lifestyle coach, and founder of the Main Street Vegan Academy keeps peace at the multivore table with a technique she calls DINE:

  • Dedicate — at least one night a week to a family meal.
  • Involve — everyone. The whole family stands to gain by your patients’ success and they can all have a part of the process, be it planning or preparing meals or researching recipes or wellness benefits on the web.
  • Negotiate — find points where everyone can agree. My suggestions: no special meals and no sniping. “Nobody is more zealous about a belief system than a recent convert,” warns Dr. Joiner-Bey. The food police are not welcome at the dinner table. Neither are cell phones, but that’s another article.
  • Entertain — This may sound like extra work, but trust me on this, inviting friends for a meal coaxes — or forces — family members into better behavior.

Anna Thomas, the Los Angeles-based James Beard Award-winning cookbook author (Love Soup, Vegan, Vegetarian, Omnivore) believes, as I do, that the solution to multivore madness starts in the kitchen.

It’s not about making a regular meal (whatever that is), and a gluten-free meal and a vegan meal. “Start with the food everyone eats,” Thomas says. “I love to start with a great grain – a risotto or tabbouleh or a formidable, hearty pilaf of farro and black rice – and build a meal around that.”  

Cook up a mountain of whole grains, a bushel of beans or a big pot of soup, thick, rich and oomphy with spices and seasonal vegetables. Yes, vegetables — they’re the #1 dining trend, and you can make them the stars of the meal.

Everything else — gluten, dairy, animal products — can have optional supporting roles.

It’s an unfortunate fact that all-too-often, diets divide us, as Dr. David Katz, of Yale University’s Prevention Research Center, so aptly points out.

But that’s only if we let them. There are so many wonderful foods and flavors that everyone can enjoy. It’s a matter of finding the ones that work for your patients and their family. You can help your patients see their food choices as a means to achieving their wellness goals and as an opportunity to bring their families together. Everybody wins!

Wild Rice with Winter Greens,
Lemon, Pine Nuts & Raisins
Wild rice is actually a grass, and is naturally gluten-free. An old Sicilian trick, balancing the bitterness of winter greens with rich pine nuts and sweet raisins, yields a whole grain dish that’s fortifying, fabulous and brings the multivores together.
1 cup wild rice
4 cups vegetable broth or water
2 lemons, zest and juice
1 tablespoon olive oil
1 onion, chopped
1 bunch winter greens — collards, cabbage or kale, tough center ribs removed, leaves sliced into skinny ribbons
1/4 cup pine nuts, lightly toasted
1/4 cup raisins
1 good pinch red pepper flakes
sea salt to taste
In a large pot, bring water or broth to boil over high heat. Add wild rice. Cover and reduce heat to low and simmer for half an hour. Turn off heat; leave the pot on the burner for another half hour or so, until all the liquid is absorbed. (May be done the day ahead. Cover and refrigerate. Bring back to room temperature before proceeding.)
In a large skillet, heat oil over medium-high heat. Add chopped onion and sauté stirring until it softens, about 5 minutes. Add chopped winter greens, which will shrink in the heat to a fraction of their volume. Continue cooking until greens are just wilted — another 3 to 5 minutes.
Tip in cooked rice and stir mixture gently to combine. Grate in the zest of both lemons, squeeze in lemon juice, stir in sea salt and pepper flakes. Add pine nuts and raisins just before serving.
Serves 4 to 6.

ENDEllen Kanner 2017 11 30 04761 RETOUCH web version

Ellen Kanner is the author of the award-winning book, Feeding the Hungry Ghost: Life, Faith and What to Eat for Dinner (VegNews’ 2013 Book of the Year and PETA’s Book of the Month Club debut pick). She is also Huffington Post's Meatless Monday blogger, the Miami Herald syndicated columnist Edgy Veggie, and contributor to print and online publications including: Bon Appetit, Eating Well, VegNews, Salon, Every Day with Rachael Ray and PETA Prime.