CAMLAW : Complementary And Alternative Medicine Law Blog

Is homeopathy a scam?

Homeopathy is bunk, skeptics continue to claim.

]]> This is from an article entitled Homeopathy Awareness Week:

ccording to the British Homeopathic Association (does that mean the fewer members they have the more powerful the group?) June 14-21 is Homeopathy Awareness Week. I would like to do my part to increase awareness of homeopathy.

I would like people to be aware of the fact that homeopathy is a pre-scientific philosophy, that it is based entirely on magical thinking and is out of step with the last 200 years of science. People should know that typical homeopathic remedies are diluted to the point that no active ingredient remains, and that homeopaths invoke mysterious vibrations or implausible and highly fanciful water chemistry. I would further like people to know that clinical research with homeopathic remedies, when taken as a whole, show no effect for any such remedy.

In short, homeopathy is bunk. But here is a somewhat longer description of its history.Homeopathy was founded by Samuel Christian Hahnemann (1755-1843), a German physician who had become dissatisfied with the medicine of his day. Hahnemann lived in a time before the rudiments of modern medicine had been developed, before the germ theory of infectious disease, before the first antibiotic, before systematic testing of drugs for safety and efficacy, before surgical procedures were performed with anesthesia or sterile technique. In his century, it is fairly safe to say, conventional medicine was more likely to do harm than good, and hospitals were a place people went to die, rather than get well. It is no surprise, therefore, that Hahnemann sought for an alternative to the classical approach of his day.

For many years Hahnemann’s search was unsuccessful, until he stumbled upon what he thought was an amazing observation. He took a small amount of cinchona bark, which contains quinine, the drug used to treat malaria, and developed the symptoms of malaria. From this observation he developed homeopathy’s first law, similia similibus curentur, or let likes be cured by likes. In other words, drugs which cause specific symptoms can be used to cure diseases which cause the same symptoms.

As homeopathy evolved, other laws were also discovered. The law of infinitesimal doses was actually a late development by Hahnemann, but today is often thought of as the primary characteristic of homeopathy. This law states that when drugs are diluted in either water or alcohol, they actually increase in potency. Today, serial dilutions of 1:100 repeated 6 or 30 times are commonly used. Between each dilution the substance is violently shaken, which is thought to be necessary to activate the properties of the drug.

Hahnemann also developed, as the underpinning of homeopathy, his own theory of disease, called the miasm theory. According to this theory there are three miasms which are responsible for all human disease, and homeopathic remedies are directed towards treating these offending miasms.

Homeopathy enjoyed a great deal of success in Europe and later in the U.S. in the 19th century. In the year 1900, there were 22 homeopathic colleges and 56 purely homeopathic hospitals in the U.S. During this century, however, as modern medicine came into its own, as life expectancy rose from about 40 years to 80 years, and as the modern approach to disease continuously improved the quality of life, producing a stunning revolution that homeopathy had failed to provide in the previous century, homeopathy declined steadily until it was all but gone.

It is an amazing fact of history, however, that pseudosciences rarely, if ever, die completely. Belief systems such as astrology, phrenology, and homeopathy itself survive long after their usefulness or the primitive scientific environment in which they were developed. Today, homeopathy is experiencing a resurgence, initially in Europe, but it is quickly spreading to the U.S. Homeopathic hospitals have been incorporated into the National Health Service in Britain, and early on in its history the FDA granted approval to the entire homeopathic pharmacopoeia because the remedies had already been in use for so many years.

Today, although there are several different traditions of homeopathy, the basic principles as outlined above remain unchanged. Homeopaths offer as a point of superiority of their method of treatment, that they treat the whole person, taking a “holistic” approach. They denigrate conventional physicians for “focusing narrowly on the disease.” But what does their holistic approach actually entail?

Practitioners with legal questions concerning the practice of homeopathic medicine should consult an attorney familiar with laws and regulations surrounding homeopathy.

CAM used widely outside the U.S.

The term "traditional medicine" is used differently in the U.S. and abroad.

]]> In the U.S. we often refer to allopathic or orthodox (aka conventional) medicine as traditional, but WHO uses traditional medicine as a term of art.

In fact, this is from an article entitled TCM:

Merican I., (2002) Traditional/Complementary Medicine: The Way Ahead. Medical Journal of Malaysia, 57 (3). pp. 261-265. ISSN 0300-5283
Full text not available from this repository.
Affiliations

Institute of Medical Research Malaysia
Abstract

The use of Traditional/Complementary Medicine (T/CM) is widespread in developing countries and is steadily increasing across the developed world. The World Health Organisation (WHO) estimated that “In many countries, 80% or more of the population living in rural areas are cared for by traditional practitioners. About half the populations of developed countries regularly use T/CM. The United States of America's expenditure on T/CM increased from $13 billion to $38 billion per year in 1990-7. The same trend is seen in Australia and in the United Kingdom. By 1993, it was estimated that Australians were spending almost twice as much on complementary medicines (CM) ($AU621 million yearly) than their contributions to pharmaceuticals. Recent government estimates revealed that each year 57% of Australians use some form of CM. A survey in Southampton (with a population of (200,000) revealed that about 4 million pounds were spent a year on T/CM outside the National Health Service. At least 40% of general practices in the UK provide some complementary services. In China, T/CM accounts for 30-50% of the total medicine consumption while in Hong Kong, 60% of the population has consulted TM practitioners at one time or another.

So you say traditional, I say non-traditional: it's all a matter of perspective.

Australia accelerates CAM accreditation

Australia accelerates CAM accreditation in a lead story about naturopathy.

]]> The accreditation boost emerged from a story alleging dangerous care:

NATUROPATHS and other alternative therapists hope a new national register will separate the qualified practitioners from the shonks.
The industry's reputation was dealt a blow this month after the NSW Supreme Court convicted a homeopath of the manslaughter of his nine-month-old daughter, who died of septicemia caused by chronic eczema.

The court found the refusal of Gloria Thomas's father, Thomas Sam, and his wife, Manju, to seek emergency assistance for their daughter constituted gross negligence.

University of Queensland researcher Jon Wardle, who heads a steering committee that is seeking to establish a national independent register for naturopaths and herbalists by mid-2010, said it would help remove potential conflicts of interest from industry associations that must promote the profession and also protect the public interest....

Mr Wardle said the lack of formal accreditation meant people with as little as one week's training could call themselves naturopaths.

He said most homeopathic remedies were dispensed by naturopaths, but there was evidence that the discipline was gaining recognition among conventional medical groups. British podiatrist and homeopath Tariq Khan, who visited Australia last month, recommends homeopathy be used in conjunction with conventional treatment.

Homeopathy, which was developed by German physician Samuel Hahnemann more than 200 years ago, operates on the idea that substances which can produce symptoms in a healthy person can be used to treat symptoms in the sick.

During his visit, Dr Khan met the head of dermatology at St George Hospital, Dedee Murrell, to discuss using homeopathic remedies to treat the rare genetic condition epidermolysis bullosa. Those with the condition, also known as cotton wool kids, suffer severe skin blistering after minor bumps. There is no cure, but patients are treated with protective bandages. Stevie Hislop, who has recessive dystrophic epidermolysis bullosa, is the size of a 10-year-old even though she is 19.

Professor Murrell said Ms Hislop, of Moree, may benefit from additional homeopathic treatment.

The Royal Australian College of General Practitioners and the Australasian Integrative Medicine Association have given qualified support to the use of complementary medicine where there is research about its outcomes.

However, a Sydney Children's Hospital spokeswoman said the use of homeopathy for children was still being debated.

The story has been repeated all over the region:

A steering committee, representing key complementary medicine stakeholder groups, has been established to set up the Australian Register of Naturopaths and Herbalists, which will independently register practitioners and set uniform standards for the naturopathic and herbal medicine workforce.
Nearly one in six Australians utilise complementary therapists as their primary care practitioners.

Other complementary therapists such as chiropractors, osteopaths and Chinese Medicine practitioners are currently regulated or undergoing the process of being regulated by the government. However, naturopaths – by far Australia’s largest complementary therapy profession – have no such regulation. There are no national uniform standards for training or ethical practice, placing the public at risk from incompetent or unethical practitioners.

University of Queensland researcher and member of the steering committee, Jon Wardle, said lack of registration was a major public health issue and that this initiative was long overdue.

“Until we get an independent and completely transparent registration process for naturopaths the potential benefits from this sector will remain unrealised and the potential risk of harm to the public maximised,” Mr Wardle, of UQ’s School of Population Health, said.

Professor Stephen Myers of NatMed Research at Southern Cross University, also on the committee, said registration would enable consumers to check the credentials of practitioners.
"Many graduates in naturopathy and Western herbal medicine complete 3 to 4 years of full time study. By and large the field is made up of well educated professionals. But, unfortunately there is no protection from people with little or no qualifications attempting to practice as a naturopath or herbalist. Setting minimum standards is an idea whose time has come."

John Baxter, President of the National Herbalists Association said “Ensuring minimum standards of naturopaths and herbalists is something we’ve been pursuing for a long time. Registration will provide greater protection from bogus or unethical practitioners, improve communication between the mainstream and complementary health sectors, and lead to better health outcomes for Australians”.

***

CAM approaches to pain management are addressed by the American Association of Integrative Medicine:

Pain is the No. 1 reason people seek medical help. Acute-onset pain suggests a medical emergency and immediate medical assistance is necessary. Chronic pain has a significant impact on human life. According to Dr. Zhaoming Chen, the best way to control chronic pain is a multidisciplinary approach that includes complementary and alternative medicine.
Chen, chairman of the American Association of Integrative Medicine and a physician at St. Agnes Hospital, offers several easy ways to help people deal with pain.

•Regular exercise, 20 to 30 minutes daily, can relieve muscle cramping and stiffness, as stretching muscles can accelerate local blood circulation and remove metabolic products. Tai Chi is one of the appropriate exercises that will relieve muscle cramping.

•Eating healthy food can reduce the frequency of migraine headache attacks. The list of foods that trigger migraines is long. The simple way to find out whether or not a specific food triggers an attack is to check the food you ate before each pain attack. You may be able to identify the troublemaker.

•The brains of patients with chronic pain may misinterpret or amplify the pain signal from distant parts of the body. Qigong (a system of breathing and movement) and meditation can help people stay relaxed. Additionally, small doses of vitamin B complex are helpful to decrease stress associated with pain and discomfort.

•If you have to take pain medication, try to minimize the dose, minimizing side effects or drug interactions. Sticking to the schedule of pain medications may reduce rebounding pain.

•It is believed that people with chronic pain may have lower endorphin levels and cerebral spinal fluid, which can be elevated after acupuncture treatment - electrically or manually. Stimulation on special points throughout the body with fingertips is also effective to control headaches, neck pain, shoulder pain, lower back pain, abdominal pain, etc.

•High-quality sleep will reduce morning headaches. Go to bed at the same time every night. Watch your body weight closely. Acupuncture and qigong are very effective in helping people sleep.

More information about complementary and alternative medicine is available at the American Association of Integrative Medicine Web site: aaimedicine.com.

A newspaper is seeking holistic health stories:

Reiki, acupuncture, massage, rolfing, reflexology, kinesiology, and many other treatments are now routinely used by people to supplement their health and wellbeing.
What kinds of complementary treatments have you tried? How do you balance your health? What helps to maintain your well-being?

Let us know. Hit the comment button and tell us your holistic story.

***
From another version of the story about Australian regulation:

ONE in six Australians visit a complementary therapist as their primary health carer, but experts fear many do so without being aware of the possible risks.
University of Queensland researcher Jon Wardle is calling for the registration of complementary medicine therapists to make it safer for people to consult a naturopath.

Mr Wardle, a research scholar in the area of complementary therapy and a qualified naturopath with UQ's School of Population Health, says registration is long overdue.

"One in six people use complementary therapists as their primary healthcare practitioner and yet currently anyone can hang up a shingle and begin practising without any qualifications at all,'' Mr Wardle said.

"This is a major public health issue.''

He said a quack in the NSW city of Newcastle offered cures for untreatable cancers with backyard concoctions.

"This particular man shouldn't have been practising in the first place because he had convictions for fraud and armed robbery, on top of falsifying his qualifications,'' Mr Wardle said.

"This is something that any other health profession would have stripped him from practice straight away, but there's no legal restriction on calling yourself a naturopath.''

Others had tried to treat serious medical problems which needed referral to other health professionals.

A naturopathy student can spend four years obtaining a university degree to practise responsibly or a charlatan can start a practice with little more than a glib tongue.

Complementary medicine groups plan to establish a national register of naturopaths and herbalists by 2010.

Registration already exists for Chinese medicine practitioners, chiropractors and osteopaths.

Homeopathy touted, yoga studied, and other news

Tennis player-turned-TV presenter Annabel Croft describes how her life has been transformed by homeopathy.

]]> The UK Telegraph reports on a tennis pro's use of homeopathic medicine:

In the commentary box, former England women's number one Annabel Croft, now a TV presenter and mother of three, will be reaching for a cocktail of remedies to see her through the tournament.... Annabel, who is reporting from Wimbledon for BBC Radio 5 Live and GMTV, has been taking homeopathic medicine in advance of the competition to prepare for whatever comes her way this week.
But her first encounter with homeopathy – a form of complementary treatment based on the premise that tiny quantities of certain substances can stimulate the body's natural forces of recovery – came in rather more dramatic circumstances.

In 2003, Annabel, now 42, began suffering throbbing pains on her lower left-hand side. The pain was sometimes so intense that, on several occasions, it caused her to faint. At one point, her daughter Amber, now 15, was so frightened she was on the verge of calling an ambulance.

After referral from a GP, an ultrasound scan from a private doctor showed that Annabel had developed a cyst on her left ovary. While ovarian cysts – fluid-filled sacs – are common and usually painless, if they swell, they can cause acute pain and may need to be removed. Annabel's pain was "unbearable", she says, and her GP thought she would need an operation.

When cysts become a serious problem, they fall into three types. According to the NHS Choices, an online compendium from the health service, if a cyst is growing on a stem from an ovary, the stem can become twisted. This stops the blood supply, causing severe discomfort in the lower abdomen. Alternatively, it may burst, with very painful results. The effects you feel depend on what the cyst contained, whether it is infected and if there is any bleeding. Lastly, occasionally, a cyst is an early form of ovarian cancer. However, about 95 per cent are non-cancerous.

When Annabel mentioned her cyst to a friend, she was advised to see local homeopath Hilery Dorrian, but was sceptical. "I'd grown up believing diseases were out there waiting to get us. When I saw Hilery, I was astonished to see my ideas of health turned on their head. She explained to me that homeopathy treats the real causes of illness in the body, not just the symptoms – as conventional medicine does. The whole concept made so much sense to me. It was a huge turning point.

"Hilery didn't perform a physical examination. Instead, she asked me about my background, my personality, my emotions, what made me stressed – even my parents' health. She constructed a picture of me and gave me a remedy made up exactly to treat my left ovary."

Homeopathic remedies can be taken in several ways, the most traditional being to place small white pillules – pin-head-sized sucrose pills containing an active ingredient diluted down to microscopic quantities – under the tongue, several times a day. They can be dissolved in warm water if preferred, and creams and tinctures containing the key ingredients are also available.

Annabel left Dorrain's homeopathy centre with an open mind, but not expecting a miracle. However, after taking the prescribed pillules, her cyst gradually became less painful; the throbbing stopped; and she never went back to her GP. She is convinced that the homeopathic remedies she took enhanced and perhaps speeded up the healing process.

NCCAM has a big study plan for yoga:

NCCAM and NIH is currently researching the effects of yoga for:
* Blood pressure
* Chronic low-back pain
* Chronic obstructive pulmonary disease
* Depression
* Diabetes risk
* HIV
* Immune function
* Inflammatory arthritis and knee osteoarthritis
* Insomnia
* Multiple sclerosis
* Smoking cessation.

Does CAM work? Alan Gaby comments:

Recent media reports have focused on multiple government-funded studies conducted by the National Center for Complementary and Alternative Medicine (NCCAM) in recent years, which found that certain herbal remedies and nutritional supplements were not more effective than a placebo for specific health conditions. Based on these results, many reports have made a case against natural medicine as a whole, while at the same time expressing concerns about product regulation, bias, and so on. But while some may find it reasonable to draw such conclusions from this group of studies, taking such a narrow a view ignores important points to the contrary and does a disservice to millions of people seeking safe and effective complements or alternatives to drugs and surgery.

A researcher offers a new perspective on CAM studies:

The potential contribution of complementary and alternative medicine (CAM) modalities to promote and support critical health literacy has not received substantial attention within either the health promotion or the CAM literature. This paper explores the potential of one CAM modality, shiatsu, in promoting well-being and critical health literacy.
Methods: Data are drawn from a longitudinal, 6 months observational, pragmatic study of the effects and experience of shiatsu within three European countries (Austria, Spain and the UK).

Client postal questionnaires included: advice received, changes made 6 months later, clients 'hopes'from having shiatsu and features of the client-practitioner relationship.Result: At baseline, three-quarters of clients (n=633) received advice, on exercise, diet, posture, points to work on at home or other ways of self-care. At 6 months follow-up, about four-fifths reported making changes to their lifestyle 'as a result of having shiatsu treatment', including taking more rest and relaxation or exercise, changing their diet, reducing time at work and other changes such as increased body/mind awareness and levels of confidence and resolve.

Building on the findings, an explanatory model of possible ways that a CAM therapy could contribute to health promotion is presented to guide future research, both within and beyond CAM.

Conclusion: Supporting individuals to take control of their self-care requires advice-giving within a supportive treatment context and practitioner relationship, with clients who are open to change and committed to maintaining their health. CAM modalities may have an important role to play in this endeavour.

Author: Andrew Long
Credits/Source: BMC Complementary and Alternative Medicine 2009, 9:19

Law and IT among the top careers for 2009

An article on education reported that legal and IT careers were tops for 09.

]]> Here's what the article says, though I suspect it's a plug for legal and IT career schools. Still, it's good news for those of us in law and IT:

With all the recent worry over the economy, which jobs are still safe? Check out this set of careers slated to remain a great pick for anyone considering an education--even in this current difficult period for profits and growth.
According to the 2009 Robert Half International Salary Guide, careers in business, IT, and law are among the fields expected to yield top careers in the coming year. Learn more about which careers are expected to see the most growth, the highest starting salaries, and the best opportunities.
Technology Careers on the Rise

CIOs were asked which technical skill sets are in the greatest demand in their IT departments. Their response? Administration, support, and management skills are golden. The top responses, according to Robert Half International:

1. Network administration (LAN, WAN)
2. Windows administration
3. Desktop support
4. Database management

What do all these skills have in common? They can each be learned in an associate's or bachelor's degree program online. Bachelor's degrees in computer science, information science, or management information systems (MIS) are generally considered ample training for administrators. Desktop support professionals in smaller companies may only hold a two-year associate's degree in the field.
Creative Careers, Competitive Salaries

Looking for a job that challenges your creative side? Career training in artistic and creative careers can land you high starting salaries. Check out starting salary ranges for some of the top creative jobs for 2009, according to The Creative Group:

* Graphic designer: $36,000-$49,250
* Desktop publisher: $35,500-$45,000
* Motion graphics specialist: $56,000-$87,500

Remember, those are just starting salaries. While no career training program can guarantee a particular salary, the portfolio-building training you receive while working towards a degree in graphic design, desktop publishing, or animation can help prepare you to enter the field with confidence.

Freelancing is another option to keep your creative career in demand. When advertising and marketing executives were asked about the greatest benefits of using creative freelancers, 36 percent said that freelancers provided access to skills that didn't exist internally, and 21 percent noted that freelancers help avoid overstaffing followed by layoffs. In this volatile economy, you may earn more by diversifying your skills into a range of different jobs.

Career Training for Office Jobs

What do hospitals, retail centers, executive offices, and manufacturing plants have in common? They all need someone to sit at the front desk. A nationwide demand for administrative assistants, customer service representatives, and receptionists means that you can put your office management training to work. Here are a few special skills in demand in 2009, according to a survey by Office Team:

* Technical aptitude: Including Microsoft Office as well as accounting, payroll, and human resources applications
* Multilingual ability: Communicating with culturally diverse consumer groups is the biggest drive behind bilingual and multilingual hiring
* Continuing education: Hiring managers like to see employees continue their education by securing Certified Professional Secretary (CPS), Microsoft Business Certification, and other training.

Education plays a real role in the workforce. During times of high unemployment and higher job competition, boosting your resume with a career training program can make a big difference.
Training for Legal Careers

Salaries are expected to increase across the board for legal workers in 2009, according to Robert Half Legal. With specialized training in the form of an associate's degree, you may land a job as a paralegal, legal secretary, legal receptionist, or office clerk. Check out some of the salaries that may be available to graduates with the two-year degree:

* Case Clerk (zero to two years' experience): $32,000-$41,000
* Junior Paralegal (two to three years' experience): $40,500-$49,200
* Legal Receptionist: $26,750-$38,000
* Office Clerk: $27,000-$37,250

Use a degree or certificate to obtain the specialized education you need to enter the legal field. According to Robert Half Legal, most law firms and legal departments expect paralegals to hold at least a two-year college degree.

In this changing economy, popular jobs may see more competition. Hiring managers may expect applicants to be able to start on the first day with a strong set of skills. Rise to the challenge with the help of an online degree or certificate.

Hmmmn, shouldn't this have been a press release for that legal placement firm? At any rate, it's reassuring.

By the way, is anyone taking classes on social networking? As if it's news.

Michael H. Cohen is a California, New York, Massachusetts, and Washington, D.C. lawyer and providing business legal advice to entrepreneurs, and health care law advice to businesses and clinicians in the wellness industry. He represents individual entrepreneurs whose businesses are taking off vertically. He also advises medical spas and integrative medicine clinics, physicians, chiropractors, naturopathic physicians, massage therapists, energy healers, nutritionists and herbalists and others, as well as companies with new technologies including quantum, resonance, and other bio-energy devices. He is also known as a spiritual lawyer, because of his interest in numerous alternative medicine modalities, and in advising entrepreneurs and businesses with legal advice that is grounded yet intuitive. Read the Entrepreneur’s Legal Toolkit for legal issues affecting small, medium, and emerging businesses. Michael also sponsors Being Central, a Portal for Potential. To speak with a lawyer about health care law issues pertaining to complementary and alternative medicine, or to consult a business lawyer about legal issues for entrepreneurs and new enterprises that are organizing or seeking investors, contact the Law Offices of Michael H. Cohen today.

Complementary medicine boost in Europe

Biometric passports get the nod along with alternative, complementary, and integrative medicine in European legal initiative.

]]> In Switzerland, Swiss cheese is not the only hot item:

Swiss voters have approved the introduction of biometric passports - by the narrowest of margins.
Official final results show 50.14 per cent voted in favour. A separate initiative promoting alternative medicine won 67 per cent approval.

The result of the biometric passport vote was for several hours too close to call. And although it was passed, a majority of cantons - including Bern, Geneva, Basel City and Ticino - said no.

In the end just over 5,500 votes separated the two sides.

Turnout was low at 38 per cent.

The controversial new travel document will include the holder's electronic photograph and two fingerprints.

Members of the European single border area, including Switzerland, are required to introduce new biometric passports by next March. The new document should also allow visa-free entry into the United States.

The referendum came about after a broad political coalition challenged parliament's decision to adopt the new passport - in line with the European Union - and set up a fingerprint register.

....

Complementary medicine
Alternative medicine was given a boost on Sunday when the electorate gave wholehearted backing to an initiative requiring complementary forms of medicine to be covered by obligatory health insurance.

Alternative forms of medicine - including homeopathy and traditional Chinese medicine - are very popular in Switzerland, and approval had been expected.

Final results showed a 67 per cent approval rate and the backing of all cantons.

Opponents had unsuccessfully argued that including these forms of treatment would put more financial strain on the health system.

The rightwing Swiss People's Party was the only major party to reject the proposal.

Look for more news to come on legal developments in complementary medicine in Europe.

Michael H. Cohen is a California lawyer, New York attorney, Massachusetts lawyer, and Washington, D.C. lawyer and providing business legal advice to entrepreneurs, and health care law advice to businesses and clinicians in the wellness industry. He represents individual entrepreneurs whose businesses are taking off vertically. He also advises medical spas and integrative medicine clinics, physicians, chiropractors, naturopathic physicians, massage therapists, energy healers, nutritionists and herbalists and others, as well as companies with new technologies including quantum, resonance, and other bio-energy devices. He is also known as a spiritual lawyer, because of his interest in numerous alternative medicine modalities, and in advising entrepreneurs and businesses with legal advice that is grounded yet intuitive. Read the Entrepreneur’s Legal Toolkit for legal issues affecting small, medium, and emerging businesses. To speak with a lawyer about health care law issues pertaining to complementary and alternative medicine, or to consult a business lawyer about legal issues for entrepreneurs and new enterprises that are organizing or seeking investors, contact the Law Offices of Michael H. Cohen today.

Telemedicine issues addressed by regulation

Telemedicine law increasingly affects our clients, whether they are physicians or non-medical, holistic health practitioners.

]]> Below is information from the California state medical board regarding telemedicine. Telemedicine issues affect many of our clients who wish to store patient health information online and, increasingly, use electronic services to transmit diagnostic and therapeutic communication between physicians and patients.

Practicing Medicine Through Telemedicine TechnologyIn California:
There are no legal prohibitions to using technology in the practice of medicine, as long as the practice is done by a California licensed physician. Telemedicine is not a telephone conversation or fax; it typically involves the application of videoconferencing or store and forward technology to provide or support health care delivery.

The standard of care is the same whether the patient is seen in-person, through telemedicine or other methods of electronically enabled health care. Physicians need not reside in California, as long as they have a valid, current license.

There are prohibitions relating to prescribing over the Internet, which can result in license discipline, and carries hefty fines for prescribing without an appropriate prior examination. This examination, however, need not be in-person, if the technology is sufficient to provide the same information to the physician if the exam had been performed face-to-face. A simple questionnaire, however, without an appropriate examination would be a violation of law, and would be a disciplinable offense.

In summary, the law governs the practice of medicine, and no matter how communication is performed, the standards are no more or less. Physicians practicing via telemedicine are held to the same standard of care, and retain the same responsibilities of providing informed consent, ensuring the privacy of medical information, and any other duties associated with practicing medicine. Telemedicine is seen as a tool in medical practice, not a separate form of medicine.

California Licensed Physicians Practicing Medicine in Other States:
Physicians intending to practice medicine via telemedicine technology to treat or diagnose patients outside of California should check with other state licensing boards. Most states require physicians to be licensed, and some have enacted limitations to telemedicine practice or require or offer a special registration. A directory of all U.S. medical boards may be accessed at the Federation of State Medical Boards Web site: http://www.fsmb.org/directory_smb.html.

Exemption for Consultants and Guests:
Business & Professions Code Section 2060 provides for an exemption for consultants and guest physicians, it states:

Nothing in this chapter applies to any practitioner located outside this state, when in actual consultation, whether within this state or across state lines, with a licensed practitioner of this state, or when an invited guest of the California Medical Association or the California Podiatric Medical Association, or one of their component county societies, or of an approved medical or podiatric medical school or college for the sole purpose of engaging in professional education through lectures, clinics, or demonstrations, if he or she is, at the time of the consultation, lecture, or demonstration a licensed physician and surgeon or a licensed doctor of podiatric medicine in the state or country in which he or she resides. This practitioner shall not open an office, appoint a place to meet patients, receive calls from patients within the limits of this state, give orders, or have ultimate authority over the care or primary diagnosis of a patient who is located within this state.

Some have sought to use this code section to exempt themselves from licensure by calling themselves "consultants." This is a misreading of the code. As you can see, this section is to be used for purposes of the advancement of science, education, and scholarship, and to allow California licensed physicians to consult with experts in other states. It does not, however, authorize persons to practice medicine in California for any and all purposes by virtue of not having an office or taking calls from patients. Physicians contracting for providing diagnostic services to facilities in our state would be required to have a full and unrestricted California license and would not fall under this exemption.

There is No California Telemedicine Registration Program:
California has no telemedicine registration program. In 1996, the Board sought legislation to obtain the regulatory authority to develop a program for physicians in other states to become registered in California, without requiring full licensure. The legislation was unsuccessful in obtaining regulatory authority, and, instead, added Section 2052.5 of the Business & Professions Code. This code has been the source of some confusion, as it outlines the original proposal for the registration program, but requires the Board to seek legislation to place a future program in statute. Those unfamiliar with the law's history assume that the Board has a program or the authority to implement one — the Board has neither.

Following the Board's original efforts, the members worked with those who opposed the establishment of a registration program. In summary, due to substantial opposition and little support, there was no consensus to move forward with legislation

Helpful Information Outside of the Medical Board's Jurisdiction:
While the Medical Board has no jurisdiction or authority over matters of reimbursement, funding, billing or fees, physicians interested in obtaining more information on telemedicine practice may find the following helpful:

California Telemedicine & eHeath Center (CTEC) offers a number of helpful publications, including:

Telemedicine Reimbursement Handbook
eMental Health and Telepsychiatry Practice Guide
Teledermatology Practice Guide
A Glossary of Telemedicine and eHealth
Telecommunications Discount Guide

These publications can be found at the CTEC Web site: http://www.cteconline.org/publications.html

University of California, Davis, Telemedicine Learning Center: http://www.ucdmc.ucdavis.edu/cht/programs/tlc/"

Center for Telehealth and e-Health Law: www.telehealthlawcenter.org

U.S. Department of Agriculture Rural Utilities Services: The Distance Learning and Telemedicine Grant and Loan Program: http://www.usda.gov/rus/dlt/overview.htm"

Telemedicine Information Exchange (Including grant funding opportunities): http://tie.telemed.org

AB 354 (Cogdill; Chap. 449, Stats. of 2005) added section 14132.725 to the Welfare and Institutions Code, which authorizes Medi-Cal reimbursement for teleophthalmology and teledermatology. To view the entire bill: http://www.leginfo.ca.gov/pub/05-06/bill/asm/ab_0351-0400/ab_354_bill_20050930_chaptered.html"

AB 1224 (Hernandez; Chap 507, Stats of 2007) amended 2290.5 and 3041 of the Business & Professions Code, extending the same telemedicine provisions to optometrists in telemedicine practice as physicians and surgeons. To view the entire bill: http://www.leginfo.ca.gov/pub/07-08/bill/ams/ab_1201-1250/ab_1224_bill_20071011_chaptered.html

Managed Care Programs contracted to provide services to Medi-Cal patients may not require person-to-person contact with the provider for reimbursement. (H&S Code Section 1374.13): http://www.leginfo.ca.gov/cgi-bin/displaycode?section=hsc&group=01001-02000&file=1367-1374.17

Health Insurers must reimburse for services provided through telemedicine. (Ins. Code Section 10123.147): http://www.leginfo.ca.gov/cgi-bin/displaycode?section=ins&group=10001-11000&file=10110-10127.18

Note that each state regulates telemedicine differently, since telemedicine like the practice of medicine is a creature of state law.

As medicine and health care increasingly move across state boundaries into virtual reality, it will become more and more important to seek legal consultation regarding the impact of telemedicine rules.

Also relevant are Federal Trade Commmisssion (FTC) rules regarding advertising and marketing health care services, as well as state law rules governing advertising for medicine and other health care professions. These are all areas in which our law office has expertise and in which we regularly advise our health care clients.

*************

And on an unrelated note about day trading, Velez Capital Management has supplied this incredible definition - really, it's a yoga sutra about handling the market:

“Using technical analysis to find a moment in time when the odds are in your favor. Then it becomes a matter of entry and management. In other words, it is having the KNOWLEDGE to know when the odds are in your favor, having the PATIENCE to wait for that moment, then having the DISCIPLINE to handle the trade properly when it goes in your favor and properly when it goes against you.”

Spiritual attorney Newport Beach

Googled recently did I (that's "Yoga grammar") under spiritual attorney Newport Beach and found Michael H. Cohen pop up.

]]> Privacy has truly been eroded down to nothing. I was in a bookstore reading 'How to Disappear,' only it wasn't written by Harry Potter, it was from a wealth management consultant advising the ultra-rich how to get off the radar.

But if you want get noticed, and have 15 nanoseconds plus of fame, you do need to be googable. Usually I am on the map as holistic health attorney, alternative medicine lawyer, complementary medicine and health care law or legal, or some other such combination.

(People have even searched for decaffinated coffee).

I've also drawn people who are looking for a lawyer who is "green." That I am, as long as clients don't mind the antennas.

Insert smiley emoticon here.

Now what would the ancestors have thought about emoticons? Millions of years to develop spiritual psychology and the human brain, and we're reduced to texting emoticons.

Know what I mean? :)

Anyway, keep smiling, and keep amping up the efforts to individualize, distinguish, and cull a separate identity from among the billions of us sharing the same protons and electrons and gluons and who knows what else. We're all one, after all, and google binds us in the light of being able to discover common kinship.

Meawhile, the Newport Beach Orange County Los Angeles San Diego Riverside Costa Mesa Huntington etc. spiritual yoga holistic entrepeneurial business health law Harvard decaffinated coffee green holistic health integrative medicine and other important keywords lawyer continues to blog.

The joy of being a lawyer representing holistic health and business professionals

A lawyer is a wordsmith who answers complicated questions with diligence and ease.

]]> That is a sutra that just came to me.

I have made a one-hour, exploratory consult available (click on initial consult). The hour helps me explore whether I want to represent the client, and helps the client get to know me as well. We canvass the situation and assess whether a full-blown legal consultation will be helpful.

Sometimes people ask about an hourly rate, but many times these one-hour consults come after someone has paid tens of thousands of dollars for some educational holistic health training, certification, or presumed credential. And in the one hour, after they have spent years and drained their bank accounts, our assessment may result in a complete change of mind on their part about the proposed business model or even the business itself. To simplify, think of getting a green, yellow, or red light. Amplify this with all the legal caveats, disclaimers, cautions, and assessed risks.

Today somebody asked, "do I need the full hour if I have but two questions?" A good lawyer would answer that it depends on the questions. But I had a little fun with this. Because if the question is, "what is the good," that entangled philosophers for centuries. It took Plato a few hundred pages to answer the question, "what is the just society?" And that's only five words. Or, "what is love?"

It's all about complexity really. What a good professional does--an attorney, an architect, an engineer, a plumber--is help the layperson assess the level of complexity, and then tackle the problem in the most effective, efficient, and cost-effective fashion. That's what you're looking for when evaluating an attorney or any professional. And an initial consult is a good way to do it (understand the term "good" without reference to philosophical analysis). What may seem like two little questions may open up a lot more; on the other hand, a seasoned professional knows when a question is just a toss-away that can easily be framed and addressed.

Eric Lofholm and Arvee Robinson Continue to Rock

Eric Lofholm and Arvee Robinson continue to provide value in day 2 of seminar.

]]> Eric Lofholm demonstrates the value of scripting presentations, whether this involves selling coaching, marketing, or (even legal) services.

Some people think scripting is manipulative, but this is just a resistance to sales itself, Eric explains, which can be overcome by understanding the proper uses of influence and persuasion.

The day started with a group exercise in which participants presented a script they had memorized for a free coaching consultation. The exercise showed how simply memorizing a sales script can then create the freedom for authentic self-expression by connecting with the audience. Something static and scripted, in other words, can lead to real expression.

Arvee Robinson drilled down into the details of creating your own speaking platform.

Be sure to check out Eric Lofholm and Arvee Robinson for your sales and public speaking training.

Eric Lofholm and Arvee Robinson Rock

Eric Lofholm and Arvee Robinson do a great job teaching people about sales and public speaking.

]]> Even in the holistic health field, entrepreneurs and business owners can learn how to develop sales scripts, develop public speaking skills, and expand their influence.

Eric Lofholm helps people increase sales by teaching a variety of techniques. I am learning a tremendous amount through information he is lucidly and vidily presenting about sales scripting, closing, and developing master presentations.

Arvee Robinson has mastered the art of public speaking. She shows the way to much more than developing charisma at the lectern. Every marketing angle is covered. She also takes students through the basics such as when to use a powerpoint, how to best use notes, developing rapport with the audience, and slotting different types of talks for different purposes.

Both excel at teaching skills that are fundamentally necessary to develop business and increase wealth.

Even lawyers can benefit from learning sales basics such as overcoming objections, developing a call to action, and converting leads into the kind of satisfied clients that 'rave about you to everyone they know for the rest of their lives,' as Eric puts it.

Arvee says less than 10% of the planet is involved in lifelong learning, so take the opportunity to maximize opportunity.

Eric's bio says:

Eric is a Master Sales Trainer who has trained tens of thousands of sales professionals nationwide. He is President and CEO of Eric Lofholm International, Inc., an organization he founded to serve the needs of sales professionals worldwide. Eric began his career as a top-producing sales representative for 3 different sales organizations. His consistent track record of regularly outperforming his fellow sales reps earned a reputation of success that follows him to this day. Eric has been trained by the top trainers of his time including: Anthony Robbins and Dr. Donald Moine Ph. D. as well as countless others. He has an insatiable quest for knowledge that he feeds by reading, listening to audio tapes, and attending seminars regularly. Many of America's top companies hire Eric regularly to train, motivate, and inspire their sales teams. His clients have added millions of dollars in sales to their record after attending Eric's energetic and groundbreaking seminars. Eric has delivered over 1,500 public and private presentations in companies.

Arvee says:

In addition to being a Persuasive Speech Coach, I am a professional storyteller, author, and Distinguished Toastmaster (the highest credentials Toastmasters International offers). Above all, I am passionate about showing others how they can attract more clients by learning the secrets of persuasive speaking and turn their words into wealth!

Be sure to check out Eric Lofholm and Arvee Robinson for your sales and public speaking training.

Fun Shopping

Road to Riches

Fun Easy Shop

If a potential customer doesn't buy your service, you might still capture a lead through a Fun Easy Shop system.

]]> Fun Easy Shop is a global shopping portal where prices go down as you bid.

There are 3 types of auction, including Xpress and Zero. In zero auctions, items can actually be sold for nothing. All the details are online at Fun Easy Shop.

This is a particularly interesting business opportunity for health care professionals, such as medical doctors, nurses, psychologists, and even chiropractors and massage therapists, who are looking for passive streams of income. Many get involved with multi-level (multilevel / MLM) and direct selling schemes promoting dietary and nutritional supplements. But these MLM schemes can be legally perilous (see MULTILEVEL MARKETING AND DIRECT SALES: Dietary Supplements and Nutritional Products — Legal Pitfalls And Guidance For Your Business).

State conflict of interest rules (not to mention Stark and anti-kickback rules for medical doctors (MDs and DOs)) can create significant legal obstacles, and physicians who ignore these rules in order to sell nutritional products and dietary supplements to their patients do so at their peril.

Even nonphysicians who promote this stuff can run into legal danger. So many pitch the "science" behind the latest formula but there really is no science, certainly not the kind of science accepted in mainstream journals, and at any rate, one does not get any training in science simply by being on conference calls where enthusiastic uplines pitch the latest conjecture about this antioxidant or that supposed discovery about the human body.

On the other hand, a purely virtual opportunity may be just right for the temperament of this age.

Each person has to do their own due diligence in order to ascertain whether a particular opportunity is right for them. There are no short cuts to reading the fine print of affiliate program policies and procedures, in order to understand the pros and cons, limitations and potential risks. It is also useful to consult independent legal counsel regarding any potential opportunity, and to suss out legal perils and pitfalls before committing any funds to a business venture.

That is why the disclaimer at Being Central speaks to the inability to forecast results. Promoters often get themselves in trouble by exaggerating sales and making income claims.

To paraphrase an old favorite quote, in our search for financial freedom we must be as discerning as we are enthusiastic.

Dietary Supplements: structure-function and implied disease claims

Dietary supplements that make claims to "treat disease" suddenly become classified as drugs.

]]> The FDA has issued a regulation entitled Certain Types of Statements for Dietary Supplements, which describes the types of claims that can and can not be made for dietary supplements. This regulation attempts to separate prohibited, “disease claims” (those which claim that the product will diagnose, mitigate, treat, cure, or prevent disease) from permissible “structure-function” claims.

To summarize relevant parts of this long and complication regulation:

• “disease” “refers to damage to an organ part, structure, or system of the body such that it does not function preoperly (e.g., cardiovascular disease), or a state of health leading to such dysfunctioning;”

• Disease claims can be not only express (e.g., made as statements or claims on the label), but also implied by the name of a product (for example, “herbal Prozac” and “antiobiotic”).

Further, in determining whether an express or implied disease claim has been made, the FDA will look at whether statement claims that the product:

(1) Has an effect on a specific disease or class of diseases; (2) has an effect, using scientific or lay terminology, on one or more signs or symptoms that are recognizable to health care professionals or consumers as being characteristic of a specific disease or of a number of different specific diseases; (3) has an effect on a consequence of a natural state that presents a characteristic set of signs or symptoms recognizable to health care professionals or consumers as constituting an abnormality of the body; (4) has an effect on disease through one or more of the following factors: (a) The name of the product; (b) a statement about the formulation of the product, including a claim that the product contains an ingredient that has been regulated by FDA as a drug and is well known to consumers for its use in preventing or treating a disease; (c) citation of a publication or reference, if the citation refers to a disease use; (d) use of the term ``disease'' or ``diseased;'' or (e) use of pictures, vignettes, symbols, or other means; (5) belongs to a class of products that is intended to diagnose, mitigate, treat, cure, or prevent a disease; (6) is a substitute for a product that is a therapy for a disease; (7) augments a particular therapy or drug action; (8) has a role in the body's response to a disease or to a vector of disease; (9) treats, prevents, or mitigates adverse events associated with a therapy for a disease and manifested by a characteristic set of signs or symptoms; or (10) otherwise suggests an effect on a disease or diseases.

Our law office represents companies who need legal assistance with their dietary supplement or cosmetic labels and labeling. We also handle medical device and other FDA issues. The regulatory distinctions are sometimes very subtle and one has to know where to look for answers.

Conscious evolution includes holistic medicine

The Obama Administration has asked the "Evolutionary Leaders" to communicate about how we can change the course of the unprecedented events that are challenging this planet.

]]> Here is a call to action from "the Evolutionary Leaders:"

The human family is in the midst of the most significant transformation of consciousness since its emergence in Africa over one hundred thousand years ago. Consciousness has been evolving for billions of years from the first cell to us. We are becoming aware that through our own consciousness the universe can know itself. This awareness reveals incredible new potential for our individual and collective humanity.
Simultaneously, we are the first species on this Earth aware that we can destroy ourselves by our own action. This may be the greatest wake-up call to the evolution of consciousness since the origin of Homo sapiens.

We now realize that we are affecting our own evolution by everything we do. This knowledge awakens in us the aspiration to become more conscious through subjective practices including meditation, reflection, prayer, intuition, creativity, and conscious choice making that accelerate our evolution in the direction of unity consciousness and inspire us to deeply align our collective vision.

THE CHALLENGE
At this juncture in human history, urgent global crises challenge us to learn to live sustainably, in harmony and gratitude with one another and with the living universe. The changes required of humanity are broad, deep, and far reaching. Only by acting swiftly and creatively can we birth a planetary culture that will bring well-being to every form of life in the Earth community.

The good news is that a compelling new story of our potential as a whole human species is emerging–a story of collaboration, citizen action, dialogue and new understandings propelled by unprecedented levels of democratic freedom, multicultural exchange, and access to communication technologies. It is nothing less than the story of our collective evolution.

OPPORTUNITIES FOR ACTION
We recognize that the inner and outer aspects of life evolve together. A dramatic awakening in consciousness will involve an equally dramatic shift in outward aspects of our lives. In particular, we see the following as vital opportunities for our conscious evolution, both personally and collectively:

Cultivating a Paradigm of Aliveness: We regard the universe as deeply alive and conscious by nature. In a living universe, our sense of subtle connection and participation with life around us is the basis for a compassionate and cooperative approach to living.

Educating for an Evolving Consciousness: Awakening consciousness is the foundation for all the change we seek to see in the world. We can work to elevate our capacity for conscious reflection and creative action in our personal lives as well as our collective lives as communities. We must support research and educational strategies that optimize human capacities and explore the nature of consciousness.

Restoring Ecological Balance: The balance of planetary ecosystems is fundamental to our survival. We must reverse the pollution of our global commons–the water, air and soil that nourish all life. We must encourage the proliferation of clean, renewable energy sources and expend all necessary resources toward mitigating the effects of climate change.

Encouraging Conscious Media: We must find innovative ways to use the new electronic media as the mirror of our positive evolutionary story, investing in their capacity to reach across differences of generation, culture, religion, wealth, and gender to build a working consensus about our collective future.

Engaging in Social and Political Transformation: More sustainable ways of living will require the support of a more conscious democracy and vibrant civil society from which more enlightened leaders will emerge. All individuals should be encouraged to use their gifts to create participatory, responsible and compassionate models of governance.

Working for Integrity in Commerce: Conscious businesses that are aware of the scope, depth, and long-range impacts of their actions are key to achieving sustainability. Business must become an ethical steward of the Earth’s ecology and consciously establish an economic basis for a future of equitably shared abundance.

Promoting Health and Healing: The science of mind-body-spirit health has demonstrated the profound connection between the health of a whole person and the health of the system in which he or she lives. Whole systems healing, respecting both traditional knowledge and modern sciences, must be supported in physical, social, and spiritual domains.

Building Global Community: The new story is about all of us who share this planet. Together, we can create a culture of peace that eliminates the need for armed conflict, respecting and appreciating the glorious diversity of our human family.

YOUR PARTICIPATION IS VITAL
Our group has done its best to articulate possibilities for the evolution of consciousness at this crucial moment in time. Please reflect on this document, feel what resonates in your being and calls forth a response on your part. We invite you to discuss it with others, continuing this global conversation by adding to it the wisdom that is uniquely your own.

Together, let us co-create a new narrative of conscious evolution that is a call to individual and collective action, birthing the most significant transformation of consciousness in history. Join in the Call to Conscious Evolution by signing the pledge now.

FOUNDING SIGNATORIES
Chopra Center, Carlsbad, California, July 26, 2008
Michael Beckwith, Joan Borysenko, Gregg Braden, Rinaldo Brutoco, Thomas Callanan, Deepak Chopra, Mallika Chopra, Dale Colton, Gordon Dveirin, Duane Elgin, Leslie Elkus, Barbara Fields, Debbie Ford, Ashok Gangadean, Kathleen Gardarian, Tom Gegax, Charles Gibbs, Kathy Hearn, Jean Houston, Barbara Marx Hubbard, Bruce Lipton, Judy Martin, Rod McGrew, Steve McIntosh, Lynne McTaggart, Deborah Moldow, James O’Dea, Carter Phipps, Wendy Craig-Purcell,Carolyn Rangel, Rustum Roy, Peter Russell, Gerard Senehi, Emily Squires, Brian Swimme, Diane Williams, Marianne Williamson, Tom Zender.

http://www.thepetitionsite.com/takeaction/248704259