CoChairs:

1
Co-Chairs Representative Sharon Cissna Senator
Donny Olson
2
Our next Health Caucus will be
Check out our website at www.akhealthcaucus.org
Filling the Need Complimentary Medicine Workforce
Wednesday, March 21st 2007 Noon to 100
PM Butrovich Room, State Capitol A light lunch
will be served
3
Naturopathic Medicinein the Aleutian/Pribilofs
Gary Ferguson, ND
4

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(No Transcript)
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A history rich in culture, traditionsThe
Unangan/Aleut People
7
Age-adjusted prevalence of diagnosed diabetes
among American Indians/Alaska Natives aged 20
years or older, by area, Indian Health Service
2002
Age-adjusted based on the 2000 U.S.
population Source FY9702 IHS APC files.
Excludes data from 38 service units (5 of the
IHS user population).
8
Increase in age-adjusted prevalence of diagnosed
diabetes among American Indians/Alaska Natives
aged 20 years or older, by IHS area, 1997 and 2002
Age-adjusted based on the 2000 U.S.
population Source FY9702 IHS APC files.
Excludes data from 38 service units (5 of the
IHS user population).
9
Diabetes Prevalence Age-Adjusted Rates Per 1,000
(use population)
Aleut Area
106
89
68
33
Change
1990
2003
10
The Metabolic Syndrome
Abdominal Obesity High Blood Pressure Low Levels
of HDL High Levels of Triglycerides High Glucose
Resistance to Insulin
Heart Disease
11
The Effect of Seal Oil/Salmon on Glucose
Intolerance
with IGT or DM
Glucose intolerance is more common among those
who eat seal oil and/or salmon less than daily
Daily Consumption of Seal Oil or Salmon
Associated with Lower Risk of Non-Insulin
Dependent Diabetes Mellitus and Impaired Glucose
Tolerance in Yupik Eskimos and Athabascan
Indians in Alaska. Circumpolar Health
1993270-273.
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Let foods be your medicine-Hippocrates
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Naturopathic Medicine

• Docere
• Doctor as Teacher
• Vis Medicatrix Naturae
• The Healing Power of Nature
• Support the bodys inherent healing ability
• Tolle Causum
• Treat the Cause

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Vis Medicatrix Naturae
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Concept of Morbidity Line

• Wellness vs. absence of disease

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Providing Optimal Nutrition Status

• First and foremost
• Traditional Foods are your best medicine

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Kelp - a rich source of minerals
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Effect of a short-term diet and exercise
intervention on metabolic syndrome in overweight
children.

• High Fiber, Low Fat nutrition plan plus daily
  aerobic exercise for 2 weeks reversed Metabolic
  Syndrome.
• Decreased Fasting Insulin, insulin resistance,
  LDL cholesterol, and BP

Metabolism. 2006 Jul55(7)871-8
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Health Aide
An Integrative Team
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Alaska Native Physical Activity Leader
Certificate Program Eastern Aleutian Tribes
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Elders

• Community Care Technicians
• Outreach
• Home-based care
• Greenhouse Model Assisted Living, Anchorage

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Living Well Alaska

• Chronic Disease Self Management
• Evidence-based
• Partners
• Stanford University
• State of Alaska

23
Leading Causes of Death in Alaska Natives
1989-1998
Lanier, Ersham, Sandidge 2002
24
Cigarette Smoking Trends Adults, 1983-2002
American Indian/Alaska Native
African American
White
Hispanic/Latino
Asian/Pacific Islander
HP 2010 Goal(12)
Smoking on 1 or more of the previous 30
days. Source National Health Interview Surveys,
1983-2002, selected years, aggregate data
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Akutan School is Tobacco Free!
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Choosing the right tool

• Pipe Wrench vs. Torque Wrench

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The doctor of the future will give no
medicine, But will interest his patient in the
care of the human frame, In diet, and in the
cause And prevention Of disease. THOMAS EDISON
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Resources

• www.naturopathic.org
• www.healthyalaska.net
• www.easternaleutiantribes.com
• www.southcentralfoundation.com
• www.avantemedicalcenter.com
• CONTACT garyf_at_EATribes.net
• 907-632-3624

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Comparison of Licensed Medical Professions in the
State of Alaska

• Scott Luper, N.D.
• President of Alaska Association of Naturopathic
  Physicians

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Licensed Practical Nurse (LNP)

• High School diploma.
• Completion of Practical Nursing Program
• 9 months to 2 years.
• Must pass National Council License Examination
  (NCLEX-PN).
• UAA has a 12 month program.
• Alaska Vocational Technical Center has an 11
  month program.

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Registered Nurse (RN)

• Graduation from high school.
• Completion of an approved nursing program.
• 2-3 year associate degree in nursing or
• 4 year bachelors degree nursing.
• Must pass National Council License Examination
  (NCLEX-RN).

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Advanced Nurse Practitioner (ANP)

• Hold license as RN.
• Complete ANP program.
• 9 months to 2 years.
• 2 years for masters degree in specialty such as
  family nurse practitioner, pediatrics, women's
  health, and geriatrics.
• National certification or proof of specialty
  education.
• Consultation and referral plan.

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Physicians Assistant (PA)

• Graduation from high school.
• Completion of at least two years of college
  coursework in the sciences. Some programs require
  a Bachelor's degree prior to admission.
• Completion of a 24-month PA program.
• Must pass national certification exam (NCCPA).
• Must work under physician supervision.

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Naturopathic Doctor (ND)

• Graduation from high school.
• 4 year Bachelors degree (some rare exceptions).
• Graduation from a 4 year medical school awarding
  an ND degree.
• Completion of 1-2 years of residency as
  available.
• Must pass the North American Board of
  Naturopathic Examiners national examination
  (NABNE).

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Medical Doctor

• Graduation from high school.
• 4 year Bachelors degree (some rare exceptions).
• Graduation from a 4 year medical school awarding
  either a Doctor of Osteopathy (DO) or a Doctor of
  Medicine (MD) degree.
• Completion of 2 to 6 years of residency.
• Must pass United States Medical Licensure
  Examination (USMLE).

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Acupuncture in Alaska

• Valerie DeLaune

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QUICK FACTS ABOUT ACUPUNCTURE AND ORIENTAL
MEDICINE IN THE US

• Acupuncture and Oriental medicine is one of the
  fastest growing forms of health care in the
  United States. This explosion is due to the
  recognition by consumers and regulators of the
  safety, effectiveness, and low cost of this form
  of health care.
• The FDA estimated in May 1993 that there were 9
  to 12 million patient visits each year for
  acupuncture.
• Acupuncture has been cited by the World Health
  Organization to treat over forty-three conditions
  including allergies, asthma, back pain, carpal
  tunnel, colds and flu, constipation, depression,
  gynecological disorders, headache, heart
  problems, infertility, insomnia, pre-menstrual
  syndrome, sciatica, sports injuries, tendonitis
  and stress.

38
QUICK FACTS ABOUT ACUPUNCTURE AND ORIENTAL
MEDICINE IN THE US

• The Accreditation Commission for Acupuncture and
  Oriental Medicine (ACAOM) is recognized by the
  United States Department of Education.
  Acupuncture is a three-year masters level
  program. Oriental medicine is a four-year masters
  level program. Over forty colleges are accredited
  or in candidacy status.
• Acupuncture is used in more than 20 states in
  over 800 drug dependency programs. Patients who
  go through these programs have lower re-arrest
  rates on drug-related charges than those not
  treated with acupuncture.
• ? The 1997 National Institutes of Health
  Consensus Conference on Acupuncture stated, "The
  data in support of acupuncture are as strong as
  those for many accepted Western medical
  therapies.

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Acupuncture Superior to Drug Therapy for
Migraines

• According to the National Headache Foundation, as
  many as 28 million Americans suffer from migraine
  headaches each year.
• Migraine headaches are also one of the leading
  causes of time missed from work. It is estimated
  that migraine sufferers lose more than 157
  million workdays each year, leading to a loss of
  approximately 50 billion dollars per year due to
  absenteeism and medical expenses caused by
  headache. An additional four billion dollars a
  year is spent on pain relievers for migraines and
  other headaches, but many of these remedies
  either do not work as needed, or simply mask an
  underlying condition.

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Acupuncture Superior to Drug Therapy for Migraines

• Statistical analysis of the groups found that
  acupuncture improved the symptoms of migraine
  without aura "more significantly" than any type
  of pharmacological therapy. Total symptom scores
  in the acupuncture group dropped more than 7,800
  points from the start of study to six months
  after the first treatment in comparison, scores
  in the drug therapy group dropped less than
  4,500. Twelve months after the start of the
  study, total symptoms scores for patients using
  drug therapy were still nearly twice those
  compared to subjects treated with acupuncture

41
Acupuncture Superior to Drug Therapy for Migraines

• Statistical analysis of the groups found that
  acupuncture improved the symptoms of migraine
  without aura "more significantly" than any type
  of pharmacological therapy.

42
Side Effects of Acupuncture in Headache Study
(Lack of)

• One of the most significant aspects of the study
  was that even though patients were asked to
  document any side-effects from treatment, none
  were reported by participants in the acupuncture
  group.
• Of the 60 patients given pharmaceuticals, over
  three-quarters - 47 - reported side-effects
  ranging from nausea and diarrhea to flatulence
  and burning sensations.

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Cost Savings of Acupuncture

• The researchers then extrapolated the information
  gleaned from the two groups and applied that data
  to the total number of patients in Italy affected
  by migraines without aura (approximately 800,000)
  to determine the costs if every migraine patient
  were treated with just acupuncture or just
  pharmaceuticals. The results were overwhelmingly
  positive for acupuncture, with an estimated cost
  savings of more than a trillion lira
  (approximately 653 million in U.S. currency at
  the time of the study) compared to drug therapy.
• Other Cost-Savings Studies
• ? A study in six clinics in five states showed
  efficacy and cost savings of acupuncture. Of the
  patients treated with acupuncture, 91.5 reported
  disappearance or improvement of symptoms 84
  said they see their MDs less 79 said they use
  fewer prescription drugs and 70 of those to whom
  surgery had been recommended said they avoided
  it.
• Controlled clinical trials in the United States
  have evaluated the use of acupuncture combined
  with standard stroke protocol for the treatment
  of paralysis due to stroke. Effective or markedly
  effective results were found for over 80 percent
  of the patients receiving acupuncture with a cost
  savings of 26,000 per patient.

44
Earning a Living as an Acupuncturist

• The average cost of an acupuncture visit is about
  60, for one hour of treatment
• Most acupuncturists will make about 40,000 -
  60,000 / year
• About half of that will go to expenses and taxes
• It requires a three four year Masters Degree,
  with accompanying student loans
• A Range 16 position with the State of Alaska
  starts at 41,052 plus benefits, including paid
  time off, and typically only requires a
  Bachelors Degree
• Over ½ the people I went to school with could not
  afford to stay in practice

45
Earning a Living as an Acupuncturist

• People who have insurance are less likely to pay
  for non-covered services than people who dont
  have any insurance, and given the number of
  Alaskans who do have good health care coverage,
  it is more difficult for an acupuncturist to
  establish enough of a clientele to succeed in
  business
• People who dont have insurance are more likely
  to choose acupuncture as an alternative care
  since it is cheaper than Allopathic medicine and
  for many conditions has better results
• Some insurance plans are voluntarily covering
  acupuncture because of both consumer demand, and
  because of the recognized cost-savings, such as
  NEA Alaska, Workers Compensation, and Blue Cross
  of Alaska Heritage Plus
• The State of Alaska does not cover acupuncture,
  and could save money by voluntarily covering
  acupuncture services

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Valerie DeLaune, LAc

• Licensed Acupuncturist, State of Alaska
• Neuromuscular Therapist
• Author of Pain Relief with Trigger Point
  Self-Help Book-on-CD ROM
• Author of Treating Headaches and Migraines with
  Trigger Point Self-Help Techniques coming out
  Spring 2008
• Natural Resource Specialist II with DNR
• triggerpointrelief.com
• valerie_at_triggerpointrelief.com
• [phone]

47
Massage Therapy as CAM Massage therapy is a
practice that dates back thousands of years.
There are many types of massage therapy all
involve manipulating the muscles and other soft
tissues of the body. In the United States,
massage therapy is sometimes part of conventional
medicine. In other instances, it is part of
complementary and alternative medicine (CAM).
This Backgrounder provides a
general overview of massage therapy used as CAM
and suggests some resources you can use to learn
more.
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Key Points People use massage therapy as CAM
for a variety of health-related purposes, from
treating specific diseases and conditions to
general wellness. Scientists do not fully know
what changes occur in the body during massage,
whether they influence health, and, if so, how.
The National Center for Complementary and
Alternative Medicine (NCCAM) is
sponsoring studies to answer these questions and
identify the purposes for which massage may be
most helpful. There appear to be few risks to
massage therapy if it is used appropriately and
provided by a trained massage professional.
Tell your health care providers about any CAM
therapy you are considering or using, including
massage therapy. This helps to ensure safe
and coordinated care. Conventional medicine is
medicine as practiced by holders of M.D. (medical
doctor) and D.O. (doctor of osteopathy) degrees
and by their allied health professionals, such as
physical therapists, psychologists,
and registered nurses. An example of massage
therapy as conventional medicine is using it to
reduce a type of swelling called lymphedema.
CAM is a group of diverse medical and health care
systems, practices, and products that are not
presently considered to be part of conventional
medicine. While some scientific evidence exists
regarding some CAM therapies, for most there are
key questions that are yet to be answered through
well-designed scientific studies. An example of
massage therapy as CAM is using it with the
intent to enhance immune system functioning.
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What Massage Therapy Is The term massage
therapy (also called massage, for short massage
also refers to an individual treatment session)
covers a group of practices and techniques. There
are over 80 types of massage therapy. In all of
them, therapists press, rub, and otherwise
manipulate the muscles and other soft tissues of
the body, often varying pressure and movement.
They most often use their hands and fingers, but
may use their forearms, elbows, or feet.
Typically, the intent is to relax the soft
tissues, increase delivery of blood and oxygen to
the massaged areas, warm them, and decrease pain.
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A few popular examples of this therapy are as
follows In Swedish massage, the therapist
uses long strokes, kneading, and friction on the
muscles and moves the joints to aid
flexibility. A therapist giving a deep tissue
massage uses patterns of strokes and deep finger
pressure on parts of the body where muscles are
tight or knotted, focusing on layers of muscle
deep under the skin. In trigger point massage
(also called pressure point massage), the
therapist uses a variety of strokes but applies
deeper, more focused pressure on myofascial
trigger pointsknots that can form in the
muscles, are painful when pressed, and cause
symptoms elsewhere in the body as well. In
shiatsu massage, the therapist applies varying,
rhythmic pressure from the fingers on parts of
the body that are believed to be important for
the flow of a vital energy called qi.
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• Massage therapy (and, in general, the laying on
  of hands for health purposes) dates back
  thousands of years. References to massage have
  been found in ancient writings from many
  cultures, including those of Ancient Greece,
  Ancient Rome, Japan, China, Egypt, and the Indian
  subcontinent.
• In the United States, massage therapy first
  became popular and was promoted for a variety of
  health purposes starting in the mid-1800s. In the
  1930s and 1940s, however, massage fell out of
  favor, mostly because of scientific and
  technological advances in medical treatments.
  Interest in massage revived in the 1970s,
  especially among athletes.
• More recently, a 2002 national survey on
  Americans use of CAM (published in 2004) found
  that 5 percent of the 31,000 participants had
  used massage therapy in the preceding 12 months,
  and 9.3 percent had ever used it. According to
  recent reviews, people use massage for a wide
  variety of health-related intents for example,
  to relieve pain (often from musculoskeletal
  conditions, but from other conditions as well)
  rehabilitate sports injuries reduce stress
  increase relaxation address feelings of anxiety
  and depression and aid general wellness.

52

• Who Provides Massage Therapy
• A person who professionally provides massage
  therapy is most often called a massage therapist,
  although there are some other health care
  providers (such as chiropractors) who also have
  massage training.
• This Backgrounder mainly uses the term massage
  therapist. Most massage therapists learn and
  practice more than one type of massage. To learn
  massage, most therapists attend a school or
  training program, with a much smaller number
  training instead with an experienced
  practitioner. Many students are already licensed
  as another type of health care provider, such as
  a nurse.
• There are about 1,300 massage therapy schools,
  college programs, and training programs in the
  United States. The course of study typically
  covers subjects such as anatomy and physiology
  (structure and function of the body) kinesiology
  (motion and body mechanics) therapeutic
  evaluation massage techniques first aid
  business, ethical, and legal issues and hands-on
  practice of techniques.

53

• These educational programs vary in many
  respects, such as length, quality, and whether
  they are accredited. Many require 500 hours of
  training, which is the same number of hours that
  many states require for certification. Some
  therapists also pursue specialty or advanced
  training.
• At the end of 2004, 33 states and the District
  of Columbia had passed laws regulating massage
  therapyfor example, requiring that massage
  therapists graduate from an approved school or
  training program and pass the national
  certification exam in their field in order to
  practice. Cities and counties may have laws that
  apply as well. Professional organizations of
  massage therapists have not agreed upon the
  standards for recognizing that a massage
  therapist is properly and adequately trained.

54
Licenses and Certifications Some common licenses
or certifications for massage therapists
include LMT Licensed Massage Therapist LMP
Licensed Massage Practitioner CMT Certified
Massage Therapist NCTMB Has met the
credentialing requirements (including passing an
exam) of the National Certification Board for
Therapeutic Massage and Bodywork, for practicing
therapeutic massage and bodywork NCTM Has met
the credentialing requirements (including passing
an exam) of the National Certification Board for
Therapeutic Massage and Bodywork, for practicing
therapeutic massage
55

• What Massage Therapists Do in Treating Patients
• Massage therapists work in a variety of
  settings, including private offices, hospitals,
  other clinical settings, nursing homes, studios,
  and sport and fitness facilities. Some also
  travel to patients homes or workplaces to
  provide a massage.
• Massage therapy treatments usually last for 30
  to 60 minutes less often, they are as short as
  15 minutes or as long as 1.5 to 2 hours. For some
  conditions (especially chronic ones), therapists
  often advise a series of appointments. Therapists
  usually try to provide an environment that is as
  calm and soothing as possible (for example, by
  using dim lighting, soft music, and fragrances).
• At the first appointment, a massage therapist
  will discuss your symptoms, medical history, the
  results you (and your health care provider, if
  applicable) desire, and possibly other factors
  such as your work and levels of stress. She will
  likely perform some evaluations through touch. If
  she finds nothing that would make a massage
  inadvisable, she will proceed with the massage.
  At any time, you can bring up questions or
  concerns.

56

• During treatment, you will lie on a special
  padded table or sit on a stool or chair. You
  might be fully clothed (for example, for a chair
  massage) or partially or fully undressed (in
  which case you will be covered by a sheet or
  towel only the parts of your body that the
  therapist is currently massaging are exposed).
  Oil or powder helps reduce friction on the skin.
  The therapist may use other aids, such as ice,
  heat, fragrances, or machines. He may also
  provide recommendations for self-care, such as
  drinking fluids, learning better movement, and
  developing an awareness of your body.
• Why People Use Massage Therapy
• In the 2002 national survey on Americans use of
  CAM, respondents who used a CAM therapy could
  choose from five reasons for using the therapy.
  The results for massage were as follows
• They believed that massage combined with
  conventional medicine would
• help 60 percent
• They thought massage would be interesting to
  try 44 percent
• They believed that conventional medical
  treatments would not help 34 percent
• Massage was suggested by a conventional medical
  professional 33 percent
• They thought that conventional medicine was too
  expensive 13 percent

57

• Side Effects and Risks
• Massage therapy appears to have few serious risks
  if appropriate cautions are followed. A very
  small number of serious injuries have been
  reported, and they appear to have occurred mostly
  because cautions were not followed or a massage
  was given by a person who was not properly
  trained.
• Health care providers recommend that patients not
  have massage therapy if they have one or more of
  the following conditions
• Deep vein thrombosis (a blood clot in a deep
  vein, usually in the legs)
• A bleeding disorder or taking blood-thinning
  drugs such as warfarin
• Damaged blood vessels
• Weakened bones from osteoporosis, a recent
  fracture, or cancer
• A fever
• Any of the following in an area that would be
  massaged
• An open or healing wound
• A tumor
• Damaged nerves
• An infection or acute inflammation
• Inflammation from radiation treatment.

58
If you have one or more of the following
conditions, be sure to consult your health care
provider before having massage Pregnancy
Cancer Fragile skin, as from diabetes or a
healing scar Heart problems Dermatomyositis,
a disease of the connective tissue A history of
physical abuse. Side effects of massage therapy
may include Temporary pain or discomfort
Bruising Swelling A sensitivity or allergy to
massage oils.
59
Some Other Points To Consider About Massage
Therapy as CAM Massage therapy should not be
used to replace your regular medical care or to
delay seeing a doctor about a medical problem.
Before you decide about having massage therapy,
ask the therapist about Her training,
experience, and any licenses or credentials Any
medical conditions you have and whether she has
had any specialized training or experience with
them The number of treatments that might be
needed Cost Insurance coverage, if any. If a
massage therapist suggests using other CAM
practices (herbs or other supplements, a special
diet, etc.), discuss it first with your regular
health care provider. For findings from
research studies on massage therapy for various
health conditions, see For More Information.
However, the available literature is limited, and
more research is needed to make firm conclusions.
60
How Massage Therapy Might Work Scientists are
studying massage to understand what effects
massage therapy has on patients, how it has those
effects, and why. Some aspects of this are better
understood than others. For example, it is known
that When certain forces are applied to the
muscles, changes occur in the muscles (although
those changes are not clearly understood or
agreed upon). Massage therapy typically
enhances relaxation and reduces stress. Stress
makes some diseases and conditions worse. There
are many more aspects that are not yet known or
well understood scientifically, however. Some of
the proposed theories are that massage Might
provide stimulation that may help block pain
signals sent to the brain (the gate control
theory of pain reduction).
61
Might shift the patients nervous system away
from the sympathetic and toward
the parasympathetic. The sympathetic nervous
system helps mobilize the body for action. When a
person is under stress, it produces the
fight-or-flight response (the heart rate and
breathing rate go up, for example the blood
vessels narrow and muscles tighten). The
parasympathetic nervous system creates what some
call the rest and digest response (the heart
rate and breathing rate slow down, for example
the blood vessels dilate and activity increases
in many parts of the digestive tract). Might
stimulate the release of certain chemicals in the
body, such as serotonin or endorphins.
62
Might cause beneficial mechanical changes in
the bodyfor example, by preventing fibrosis (the
formation of scar-like tissue) or increasing the
flow of lymph (a fluid that travels through the
bodys lymphatic system and carries cells that
help fight disease). Might improve sleep,
which has a role in pain and healing. Might
provide some health benefit from the interaction
between therapist and patient. More
well-designed studies are needed to understand
and confirm these theories and other scientific
aspects of massage.
63
NCCAM-Sponsored Research on Massage Some recent
examples of NCCAM-sponsored research on massage
include How massage affects healthy people,
and whether these effects are different depending
on how many massages are given and how often
The effects of massage on chronic neck pain, and
comparing the benefits of conventional
therapeutic massage with usual medical
treatment Massage for cancer patients at the
end of life, to see if massage helps relieve
depression, improves emotional well-being and
quality of life, and eases the process of
dying Whether massage given at home by a
trained family member helps reduce pain from
sickle cell anemia.
64
Co-Chairs, Sen. Donny Olson and Rep. Sharon
Cissna thank you for participating in the
Legislative Health Caucus. A copy of this
powerpoint, as well as other up-to-date
information, can be found on our website
www.akhealthcaucus.org The audio file of todays
program can be found at http//www.ktoo.org/gave
l/audio.cfm (type in the date of this
Caucus). For more information, please call
1-800-922-3785