James interviews Michelle Simon, PhD, ND, president and CEO of the Institute for Natural Medicine (INM). Dr. Simon sees an increasing awareness that our current healthcare system is not delivering the results we need. She advocates for alternate solutions through her work with INM.

Some have argued that iatrogenic disease is the third-largest cause of death in America. Applying the Therapeutic Order, which is a guiding principle for naturopathic medicine, can reverse that trend. Naturopathic medicine combined with the group visit model has the potential to address most of the population’s health issues. It is an excellent option to improve healthcare on a large scale.

Listen to the full conversation about:

  • The Therapeutic Order: what it is and why its important
  • The reasons we need to change how we view primary care
  • A new residency program for naturopathic doctors
  • Projects that the Institute for Natural Medicine is working on
  • How lifestyle and naturopathic medicine prevent iatrogenic disease
  • And so much more!

Resources mentioned in this episode:


Improving Healthcare with The Institute for Natural Medicine | Ep 277


James Maskell:
Welcome to the Evolution of Medicine podcast, the place health professionals come to hear from innovators and agitators leading the charge. We cover the latest clinical breakthroughs in health technology, as well as practical tools to help you transform your practice and the health of your community. This podcast is brought to you by the Lifestyle Matrix Resource Center, who provide a range of options to help you deliver successful, effective, functional, and integrative medicine. To find out more and to get started, go to goevomed.com/lmrc. That’s goevomed.com/lmrc.

Hello, and welcome to the podcast. This week, we feature Dr. Michelle Simon, who is the head of the Institute for Natural Medicine that is taking natural medicine forward in many ways in partnerships with the naturopathic groups and also many other groups, just helping to get the word out about natural medicine. We talked about a number of things on the podcast that I think are interesting if you care about this cause. We talked about the Therapeutic Order. We talked about changes since the pandemic in perception of natural medicine. Then we talked about some of their exciting projects that they’re working on to bring more eyeballs onto natural medicine and increase the interest and the momentum for this kind of care. It was a really interesting half an hour. Enjoy. So a warm welcome to the podcast Dr. Michelle Simon. Welcome doctor.

Michelle Simon:
Thank you, James. Happy to be here.

James Maskell:
So we’re here today to talk a little bit about the Institute for Natural Medicine and the work you guys are doing. And maybe just to start off, obviously, we’ve been through a whole pandemic and there’s a heightened awareness of all things health. From your perspective, sort of speaking out on behalf of natural medicine, I guess, to the end consumer, how do you view how that is affecting the way in which the average person is thinking about natural health?

Michelle Simon:
Yeah. Great question. And I think you’re absolutely right. There are some trends that are changing based on the experience we’ve all had recently in health and healthcare. I think what I’m seeing from my perspective is that people are more interested in their health. They’ve always been interested, but now there’s an increased awareness that you can take steps yourself to become healthy. I think there’s a growing concern that our current healthcare system is not delivering the outcomes that we want or expect or need. There’s growing distrust in the institutions of public health, I would say, and the guidance we’re receiving from public health.

Right or wrong, people are just questioning that. So they’re seeking answers elsewhere, and I think that’s what’s driving this real interest in personalized healthcare and whole person healthcare. I’m starting to see patients come in younger and younger to see me. They’re basically healthy. They’re in their twenties and they’re interested in what can I do to be healthy. I never saw that decades ago. I’ve been in practice about 20 years. I never used to see basically healthy people coming in, interested in preventive healthcare. So that is a huge change. Very exciting.

James Maskell:
I was speaking to a doctor the other day at a conference, and he said for the first time in his whole career, someone came in and said they wanted to improve their resilience and he was like, “Hang on a minute.”

Michelle Simon:
Exactly. Good thing you’re sitting down when you hear that from a patient.

James Maskell:
Yeah. That’s good. Well, look, let’s talk a little bit about naturopathic medicine. This is something that I’ve been very involved with now for almost 20 years and as big a support as I can be. I used to live in Connecticut where I was licensed. Then I lived in New York where I wasn’t, and now, I’ve been in California. I’ve seen progress in licensure. I think, just recently, Massachusetts had a big win. So, tell us a little bit about what is whole-person care, why you communicate it like that, how a naturopathic doctor delivers that whole-person care and sort of what access to that care is… how that is changing.

Michelle Simon:
Yeah, for sure that’s a lot, I’m happy to answer that question for you. So naturopathic medicine has been around for over a hundred years. We are licensed I think it’s 102 years in Washington state where I am located, but it’s yet still a very small profession. We are licensed in 26 states now just recently in Wisconsin, most recent state that got licensed. So, we’re small, but growing, I would say. Kind of the original in a way, whole-person healthcare profession, we were founded actually by integrative MDs who at that time, a hundred years ago, were dissatisfied with their own profession and branched off to create naturopathic medicine, which is really interesting. I think the thing that makes this profession different is that we take a Therapeutic Order approach to seeing patients. So, what that means is we look at their whole person, so diet, lifestyle, nutrition, but we start in our interventions from the lowest order, which is the least significant or least impactful intervention.

So, establishing their foundation for optimal health, and that’s addressing whatever underlying causes of illness that they may have, starting there when possible. Of course, if somebody comes in an acute state, you’re going to deal with that, of course. But then you want to work back down the Therapeutic Order and get to the foundations and make sure that’s solid for them. That’s that resilience you were referring to earlier, trying to make people resilient as possible because we know our health is more than the absence of disease. Our health is really making us vital and able to heal. We know we have this inborn ability to heal naturally. You cut yourself and it heals. You don’t have to do anything. So, we know that we have that ability. We want to remove the obstacles to our body from getting healthy and being in balance. Then we stimulate the self-healing mechanisms as much as possible.

That’s sort of that healing power of nature I talked about. Then we can kind of ascend that therapeutic order, focusing on damaged organ systems, if there are, addressing structural integrities. Maybe bringing in targeted nutritional or botanicals. Then of course, if some drugs or new things like that need to be used, then they are. That’s part of the whole continuum of care. It’s just different when you start at a lower intervention than starting with perhaps a drug instead.

So, the thing that makes naturopathic doctors able to do this is we spend a lot of time with our patients. Our first office call for me is an hour to an hour and a half long. And then return office calls are typically half an hour or so because you have to have that relationship in order to communicate and motivate the patient to do whatever it is that you think that they need to be doing. We don’t do anything. We provide education. The patient does all the work, but it takes time to really help them understand what their options are and figure out a way to achieve a path forward to health and healing or whatever their healthcare goals might be.

James Maskell:
Yeah. Well, I’m glad you mentioned the Therapeutic Order because out of all things naturopathic medicine that is by far my favorite tool. And it’s because, one, as I was trained in health economics, I recognized just from an economic point of view using the least costly, least invasive interventions first makes a lot of sense from a cost-saving point of view. But also, I think it makes sense on a human point of view because ultimately a lot of people are dying from using higher force interventions than are necessary. Some have argued that it’s the third-highest cause of death in America, iatrogenic disease. So, starting with the lowest level, and if you look at the way that people are thinking now, I mean that bottom layer of the therapeutic order to me is really the social determinants of health, which are getting a lot of play now because ultimately people realize that you can’t medicate your way out of a stressful housing situation. You need to like deal with that as the foundation, and so, I think it’s an idea whose time has come for sure.

Michelle Simon:
Yeah. I agree with you when you think about one of the most important predictors on a person’s health is their zip code. Then you really do understand that the social determinants of health are the biggest thing playing and driving our healthcare economics in this country. And to me, it’s just common-sense healthcare, honestly. I mean, you deal with those things, and instead of a medication for the rest of your life, if you can cure whatever that issue was and solve it, that’s much better. I mean, we have a healthcare system that prioritizes interventions and procedures versus outcome. I think if we flipped that and we prioritized outcomes for our healthcare system, we’d be in a very different place right now. We have the most expensive healthcare system but not the best outcomes.

James Maskell:
Well, yeah, that’s really interesting. And there’s a comment that I want to make on that because there’s a graph that I saw recently, which was showcasing the shift from fee for service medicine to value-based healthcare. And the way that it portrays that is, right now, we have the inverted pyramid. And essentially what the inverted pyramid showcases is that primary care in the current system is really only used as a loss leader to generate revenue in the more high-revenue parts of the system, like secondary and tertiary care. So that inverted pyramid is the system we have today where essentially all the tertiary care makes the money, and the primary care doesn’t really make money. But the primary care practices have been bought up in order to feed into the system. And it was really 10 years ago when I worked that out or listened to doctors telling me that. I was like, oh my God, we have a real problem here because primary care’s all messed up.

Now when you see the way that the population health model, it’s the pyramid the right way up. And the bottom chunk of it is primary care, then secondary and then tertiary. And I think that makes sense to almost anyone who’s thinking about healthcare; we need to invest in strong primary care. We know that countries that have the best health outcomes invest in strong primary care, but I couldn’t help to notice that it looks suspiciously like the Therapeutic Order. I mean, ultimately it seems to be very, very aligned with it.

Michelle Simon:
Yeah. I love that you observed that, and it’s so true. We have to rethink what primary care is and take it out of the box of the doctor’s office and bring it into the community. Something I know you’ve advocated for a long time. Let’s talk about how we get it into the schools, we get it into group visits. You know, there’s a lot of this information that really doesn’t need to be one-on-one doctor-to-patient information. But if we start to figure out ways and new strategies to do that, then we’ll address more people where they need to be addressed earlier on in the process.

James Maskell:
Well, yeah, just a final thought to that, and I don’t need to take any credit for it, but in The Community Cure, in the last book, what I showcased was that I feel that if group medicine is done correctly, it can actually satisfy the bottom three layers of the Therapeutic Order. So, one is the social determinants of health on the bottom, and we’ve seen that when patients work together, they can actually solve each other’s problems. The next layer is turning on the healing mechanisms of the body. And you can see that mindfulness-based stress reduction groups, or even helping everyone get better sleep or even things like group acupuncture, some of the modalities that can be used in a group could all turn on the healing potential of the body.

Then addressing the weakened systems that’s obviously nutrition. That’s a big part of the successful group model, and so, I kind of made my own version of the Therapeutic Order that showcased that, okay, if we could do the bottom three layers with groups, ultimately it frees up the naturopathic doctor’s time and other provider’s time to deal with the top four layers, which they’re sort of uniquely trained to do. Which is how do we determine when should we use surgery? When should we use drugs? When should we use natural therapeutics?

Then when should we use things to reorganize or to help with misalignment and structure? So that just makes a lot of sense to me again, as an economist, because the naturopathic doctor’s time is very valuable too. So, I’ve just seen that groups can be valuable, and I’m excited to just keep talking about this. And I’ve actually got some podcasts coming up in the value-based care space that I want to talk about the Therapeutic Order because I feel like more than anything, it’s a sort of way that I see that we can signal to the rest of healthcare that we’ve already been ahead of this conversation.

Michelle Simon:
Yeah. I think I agree. This is, like you said, a message whose time has come for sure. And there’s two things like when we talk about group visits, I was thinking about this, we see that there’s something like 20% increase in learning when it’s in a group setting. There’s something about that kind of group effect that happens, which is awesome. Then the other, there’s a research program that we’re just kicking off right now in rural North Carolina, and it’s about group visits. And it’s really… it’s with folks who already have chronic disease in a very underserved community, rural North Carolina. We’re taking the folks that actually already have the disease, and the tagline of this group visit program is “12 weeks”, is “become your own health CEO.” The reason for that is if you understand more about your body and your physiology, then you’re just a leg up on making different choices.

I think that sometimes we think patients aren’t curious about that, but they actually are. They’re really quite curious about what is diabetes? How does it work? Why do I care? Is it affecting my system? What is the blood system? What is blood sugar? And this is so many questions that you can answer in a group setting and give that education. And then the participants, like you’ve mentioned, will work with each other to solve their own problems in that local community because they’re all of the same community. So, we’re doing a documentary alongside that, should be coming out later this year. So, I’ll be interested to share that with you when we’re done.

James Maskell:
Yeah, that’s great. Well, look, I think one of the things that you had shared is the role of the Institute for Natural Medicine is communicating the science of this medicine. And I guess, I think early on in the pandemic, the science of natural medicine, like the science of vitamin D, as an example. If you get in the sun regularly, and you have a higher vitamin D level, and you’re synthesizing vitamin D from the sun, which humans are uniquely able to do, your chances of getting a horrible version of COVID is that much lower. So, for the first time, it was like, okay, this should be front-page news. And I guess maybe you could just share a little bit of what the Institute for Natural Medicine is doing to showcase the whole breadth of research that exists in natural medicine and how that research is being delivered and developed and then how it’s being shared.

Michelle Simon:
Yeah. Thank you. It is a really important thing. I think it was a big, missed opportunity and still is with regard to our public health guidance in this country, not to stress that there are some natural things you can do to boost your immune system. I don’t think we can vaccinate our way out of this pandemic. I think we need other strategies and recognizing that we’ve evolved to deal with viruses and have an immune system that is capable of getting stronger with certain interventions is important to know. So, I published a research study. It’s an accumulation, sort of a meta-analysis of preventable lifestyle, modifiable lifestyle factors for prevention of acute COVID. And that is with Joe Pizzorno and Joe Katzinger.

So, we wrote this study, and you can search it on PubMed and find it. So, it goes through all of the different natural agents and lifestyle therapeutic agents that help people become more resilient, and likely, if they do get COVID, they’ll have a lesser effect from it. So, that’s one thing we did. We published this study. We’re definitely doing stories on our website. There’s a long-haul COVID story. We’ve done some articles, just trying to promote the idea and become a resource for people to understand more about what their options are to become healthier because really this is a time to be empowered and not to be afraid. And that’s what we’re trying to help people understand.

James Maskell:
Great. Yeah. Let’s talk long COVID for a minute, because we sort of identified this year in our year of growth that here’s a great opportunity for the natural medicine communities to grow, for many reasons. One of the biggest ones being that no one else really knows what’s going on with this. And I’ve sat in a few conferences recently realizing our community is uniquely tooled to deal with this issue. And so yeah. Can you just share what you’ve got going on on that end and some of the ways that you see that we can take advantage of this big uptick in demand to be able to push natural medicine to the forefront?

Michelle Simon:
Yeah, for sure. One of the things about COVID is it just influences and affects so many symptoms, systems, and symptoms in your body. So that the list of what you can experience when you have COVID is very long. So similarly, long COVID has several different characteristics as well. You can have more of a respiratory version or a neurologic version or a cognitive version or you’re just feeling fatigued or you’re muscle achy. There’s different versions of it. I think we’ll know a lot more in 10 years really kind of what those different buckets are. But one of the nice things is that I think we are uniquely tooled to help patients deal with this. One of the patients I recently dealt with was a 26-year-old young man who was perfectly healthy right before he got COVID. Got COVID, went down very hard, and I saw him six months after he got it.

He was still not working, very fatigued, lots of symptoms. And for him personally, in that state, I identified that he had a deficiency in his glutathione enzyme, and we gave him some IV glutathione and a lot of other things. But I think that was the key intervention in his particular case. That’s not a common conventional treatment by any means, having IV glutathione administered. But he got over it, and he got it back to life for him. So, it took all of the training that I have and experience to understand, to even look for that as a potential problem for him. But once it was addressed, he really did snap out of it.

I’m not saying all patients will respond that way, but it’s just an example of out-of-the-box thinking and strategy to address this particular condition. We are doing a study up in a rural FQHC in Eastern Washington with naturopathic approaches in a community health center for long COVID. So, we should hope to be publishing that later this year. So, we’re trying to figure out what all works in a community health setting, which is a little bit different than a private practice setting where you may have more tools and options available. But I’ll get back to you when we know more.

James Maskell:
Yeah. That’s super powerful. I guess one thing that’s come up for me a few times during this is, obviously, there’s been a massive increase in demand for mental health services. I think, ultimately, just given all the research that’s come out on the bidirectionality of… The mind affects the body, and the body affects the mind. And ultimately, so many of these mental health issues are a result of suboptimal function in key areas that could be addressed by providers in our space. I just feel like it’s a bright time to try and think about how we could get to younger people to give them an opportunity to really learn how their body works and to avoid future mental health issues.

At the same time, I think we have to be in reality about the fact that if there’s 400% increase in demand for mental health services, it can’t really be solved by a situation where patients are taking an hour and a half at the initial appointment. And that’s something that I’m thinking about all the time because ultimately, there’s a demand and supply issue or sort of a resource constraint, I guess. So, I mean, how well positioned do you think naturopathic medicine is for dealing with younger people? And are there ways that we can try and get into those patients in the juvenile psychiatric realm that needs some help? And what can we do for them?

Michelle Simon:
Yeah, it’s a really important point, James. We’re seeing levels of anxiety in our younger people that are just through the roof compared to how they were even five years ago. It’s just been rising. It’s been rising honestly for decades. It has been, but it’s taken a spike upward recently. I think part of it is just the uncertainty of the universe that we’re in now, not only health but environment as well. A lot of these young people are very concerned about environmental issues and sustainability. And just everywhere you look, there’s some bad news in a way. So, I do agree with you.

There is not one provider for every patient now that can have this approach. So, we do have to think a little more creatively about the group visits. There’s a company called LifeSpeak out of Canada that provides some online resources. And I like what they’re doing quite a bit. We’re definitely interested in working in ways like that, where you’re providing online resources. You kind of have some questionnaires and screen them through to figure out what it is they need and then deliver them those tools or strategies. And again, it’s a multiplicity. You have to have more patients per provider than we currently have available.

James Maskell:
Yeah. Well look, I think there’s a lot to work on. I’ve actually recently hired a naturopathic doctor into HealCommunity because ultimately, I think what he saw was just that the… How do you make it easy to make the parts of natural medicine that are necessary for chronic disease reversal as palatable as possible to the rest of medicine? I think that’s something that I’ve been thinking about for a long time is: how do we build a bridge between these two areas? I think you guys are doing a great, great job at that. And I would say, what are some of the things that you are working on here in the future to bring value to your partners, whether that be the ANP or the physicians themselves?

Michelle Simon:
Yeah. Well, we’re very interested in building bridges very similar to your approach. We’ve been working with the Foundation for Chiropractic Progress. We’ve done one infographic together. We’re working on a white paper on integrative and non-pharma approaches to chronic low-back pain. I think that’s an important way to look at how different professions can work together to address patient needs. We also have an NDDO Advisory Board that we’re gathering to help us understand… What are the best avenues for us to get in front of academic institutions and get NDs hired on staff and to explain the value of what we do?

We’ve created a white paper on the profession, and you can find that on our website, and I think that help goes a long way to explain naturopathic doctors as specialists in whole-person health. So that is available through our NDDO Advisory Board and through INM and through AANP. We partnered with AANP (American Association of Nurse Practitioners) to create that. We have a task force that we’ve created with seven different organizational partners, and the goal of that is to get NDs hired and to increase the workforce staff at community health centers. We really, I think, are well tooled to be primary care providers in these community health settings. So, we’re getting folks aware of what we do, aware that we’re licensed appropriately and can practice this kind of medicine and have the scope to handle those patients. So, we’re doing that in Washington and in Oregon where there’s definitely good scope for that. So, those are a couple of our projects.

James Maskell:
Yeah, so one of the things that I was interested in is that you have a residency program. And so, can you just share a little bit about what that is and where it came from and why it’s important?

Michelle Simon:
Yeah, sure. Thanks for asking that. We do have a residency program at INM. One of the key challenges we have in the naturopathic profession is that our residencies are not paid for by federal funding as they are for medical doctors. Medicare actually covers the cost of residencies for medical doctors, but we have to self-fund our own residencies, so it’s a little bit of a challenge. So, we’ve come up with a unique funding model here at INM. It’s a three-part funding model. We partner with an academic institution, so Bastyr University, in our case, and an affiliate primary care naturopathic clinic. And then we have a fund of stakeholder corporations and philanthropic individuals that also contribute for the third part of the funding for this.

Our most recent addition is actually orthomolecular research. And we currently have 14 residency clinics in the program, and those are across three states, so most of them are in Washington. We have four in California and one in Vermont. We’ve got about 25 first- and second-year residents. And these clinics that we involve are really unique in that they’re multi-practitioner. We have probably over 100 doctors involved in all of the clinics, and they are specializing in naturopathic primary care.

James Maskell:
That’s interesting. So, when you say naturopathic primary care, what does that mean to you?

Michelle Simon:
So, what I look at is the first entry point into the healthcare system. So, whatever that patient’s coming in needing help with, I think primary care physicians are the ones that are best able to triage that and assess the best team involved to handle that issue. So, it might be an acute issue. And then we do get patients that come in with something that they’re injured by or they are concerned about some acute health thing that they’re experiencing that they don’t know enough about yet. Or it could be chronic health issues that they’re maintaining some treatment plan approach to. So, it could be a wide variety of things, but generally, it’s your trusted, first person that you rely on in the healthcare system. And then from that point, they either address the issue and like I said, in a Therapeutic Order approach, we’ve talked about that earlier, or they triage them on somewhere else if it’s an acute issue.

James Maskell:
That’s exciting. So, what do you think the last state that will ever be licensed is probably going to be New York, right? They just don’t recognize us.

Michelle Simon:
Maybe.

James Maskell:
Well, good. Well, thank you so much for your time, I’m excited. If there’s anyone listening who would love to participate feel free to get in touch with the Institute for Natural Medicine and all the great work they’re doing. Thank you for being part of it. This is our year of growth here at the Evolution of Medicine, and we’re looking for all different ways in which organizations are looking to bridge that gap into conventional medicine and some of the projects that you’re working on sound to be just valuable in that way. So, thank you for being part of the podcast.

Michelle Simon:
You bet. Thank you, James. Really enjoy talking with you as always.

James Maskell:
Great. Well, this has been the Evolution of Medicine podcast. This is our year of growth. We’ve been talking to Dr. Michelle Simon from the Institute for Natural Medicine. We’ll put all the details in the show notes, but in the meantime, thanks so much for tuning in, and we’ll see you next time.

Thanks for listening to the evolution of medicine podcast. Please share this with colleagues who need to hear it. Thanks so much to our sponsors, the Lifestyle Matrix Resource Center. This podcast is really possible because of them. Please visit goevomed.com/lmrc to find out more about their clinical tools like the group visit toolkit. That’s goevomed.com/lmrc. Thanks so much for listening and we’ll see you next time.

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