Marc Micozzi, M.D., Ph.D on March 27, 2001

This section is compiled by Frank M. Painter, D.C.
Send all comments or additions to:    Frankp@chiro.org

Good morning. As most of you know, I have been quite involved in medical education in complementary medicine over the years. In fact, many of the distinguished members of this panel have been helpful to me in those efforts, and I want to thank you all for that at this time, as well as all of you for your service in this important commission.

But in keeping with today's theme, I am going to direct my comments to the work of the College of Physicians, particularly through our Division of Public Services and our C. Everett Koop Community Health Information Center, which we call the Koop CHIC. Andrea Kenyon, who directs the Division, is with me today.

As you know, it is customary for people about to give testimony in Washington to provide details, charts, graphs, or other visual aides. In 1993, at the request of Senator Harkin, I appeared before a senate subcommittee with an entire iron lung. This was to help make the point that federal support for biomedical research had eliminated the need for it, but today, the only visual aide I brought with me is small enough to fit in my pocket. I am holding up a library card for a C. Everett Koop Community Health Information Center. This is a free resource that provides authoritative and timely information on a host of diseases, conditions, and health concerns.

In communities across the nation, accessing reliable information on complementary and alternative medicine and other health-related topics should be as simple as owning a library card. The foundation for such a development is being established in a unique alliance between the College and the Free Library of Philadelphia. The College has a strong history in advocating improved public health since its founding.

The Free Library of Philadelphia was founded by a physician and member of the College, Dr. William Pepper, in 1891. Fueled by support from Andrew Carnegie, library branches also soon sprouted in neighborhoods throughout the nation. Today, with 50 branch libraries and 2 million card holders, the Free Library system in Philadelphia constitutes one of the most important networks for diffusion of knowledge and information in the eastern U.S. With this large client base and convenient access to cities, the fifth largest city, the Free Library is the right partner to distribute accurate public health information.

The generation born between 1946 and 1957 has transformed America, with the freedom to make real substantive choices in various fields, this group applies the concept of choice in health care as well. They sought alternatives to medical procedures which they perceived as expensive, invasive, and increasingly technological.

Coupled with the determination of the active partners in protecting their health, and through the power of the marketplace, the cohort is changing the nation's health care system as well. Complementary medicine has become one of the most significant consumer movements in modern times. Millions care enough about these approaches to pay for it out of their own pockets, and more visits are logged to alternative practitioners than to primary physicians.

Different parts of the federal government have begun to conduct clinical trials to test the effectiveness of promising complementary approaches. Medical schools have begun to educate their students about the history and clinical significance of alternative treatments. Health insurance plans, which once avoided complementary approaches as experimental, now sometimes cover them and aggressively market their availability. It seems that these approaches have gone from being taboo to a marketing tool of choice in little more than 10 years.

Several years have passed since the FDA reclassified the acupuncture needle from an experimental to a therapeutic device, based upon evidence. Yet, many Americans who suffer from chronic pain remain unaware that acupuncture may be an effective, non-addictive form of pain relief.

Time has marched on since the AHCPR concluded that spinal manual therapy provides more effective relief for acute lower back pain than do drugs or surgery. Yet, the nation's workers and employers confronted daily with this most common of all injuries are often not aware that manual therapies can save them money while providing relief.

We have all read about recent efforts by state legislatures around the country to legislate safety in the schoolyard. We have known for years that meditation relaxation techniques associated with different traditions, such as Ayurveda, for example, can be effective in reducing tension and stress, and also aiding academic performance in schools. You may have seen the January 15th article in the Washington Post which discussed the growing popularity of acupuncture as well as a means of reducing stress among students.

We could cite many more examples about the disconnect between the results of clinical research conducted or supported by the federal government in current public practice in many spheres of life in the U.S. So what is to be done?

In my experience, those physicians being trained today are often aware of these facts and may offer appropriate advice to individual patients and institutional clients alike. One problem is that older physicians differ greatly in their awareness of these facts and their willingness to accept them. Perhaps the surgeon-general might send a letter to the nation's doctors reporting briefly on those complementary approaches which have been validated by clinical research within the last five years.

Also, many local school districts throughout the U.S. require some form of health education as part of their regular curriculum. Let's take a hard look at what is actually being taught in these classes. In communities where local school boards are open to it, let's begin to teach students and their teachers about meditation and relaxation techniques. We might also consider including more and better information about the ancient civilizations and diverse cultures which gave rise to many of these health traditions in the first place.

While focused on children, it is important to point out that pediatricians have a growing interest in complementary medicine. The wellness and health promotion orientation of most complementary medical systems and modalities provides a natural affinity for much of pediatric practice, taking care of the well child.

Our social view of complementary medicine for children is somewhat paradoxical, however. On the one hand, complementary therapies are seen as gentler, less invasive, and "more natural." They appeal to many parents as approaches to some childhood illnesses for these reasons. We often seem less willing to accept the often harsh side effects of conventional treatment in children than we do in adults. On the other hand, because much of complementary medicine remains untested by the standards of contemporary research, there is a natural reluctance to feel as if one is experimenting on children with unproven remedies.

So again, this can be answered by research, and the NIH has begun to create programs specifically focused on children in more recent years. Also, practitioners in certain fields, such homeopathy, nutrition, and manual therapies, have been conducting pediatrical research on their own for many years.

President Bush is a firm believer in the idea that the private sector and the states are the true engines of innovation and experimentation in the U.S. States might be willing to offer incentives to employers to start new workplace health and wellness programs, incorporating, appropriately, complementary and alternative medical modalities. If states save as much in Workmen's Comp payments as might be anticipated, others will choose to participate as time goes on.

At the College of Physicians, our own Koop Center was established for two reasons: patients want and need to be more involved in caring for their own health. Doctors responding to the realities of managed care are now expected to see more patients, spending less time with each. Our goal in the Koop Center is to help empower patients by providing them with credible knowledge and accurate information to help make the most of the time they do have with their physicians, and to interact more effectively with the health care system as it is.

Our members, and physicians generally, are very concerned about the inaccurate and misleading health information which is currently available on the Internet and through commercial sources. This information constitutes a public health problem of its own. This is one reason a growing number of physicians are taking advantage of, we call it, Prescription for Knowledge Program. Under this program, doctors send patients to our Community Health Information Center at the time of diagnosis to access additional information.

One cornerstone of this system is that a trained medical reference librarian is always present. Although labor intensive, it makes it much easier for patrons to take advantage of the resources that the CHIC offers.

The U.S. Centers for Disease Control did a survey to learn more about the information needs of our patrons and our ability to serve them. We found that 49 percent of our respondents want information on a specific disease or condition -- that is the time of diagnosis, often -- 20 percent wanted wellness information, 13 percent want physician information, 11 percent had questions about complementary medicine, and 8 percent sought information on specific medications.

The CDC evaluation found the CHIC to be the most credible, thorough, and accurate source of health information in greater Philadelphia. I believe that the developing alliance between our medical library and the public health library system in Philadelphia, as a model for elsewhere in the nation, will be able to serve a multitude of different audiences with different health information needs. If replicated across the U.S., it should constitute a major advance in making credible and timely information about complementary medicine, as well as health promotion and disease prevention, available to a broad audience.

Thank you.

Return to the WHCCAMP Testimony Page