October 2015 John Weeks Integrator Round-Up

• Policy
• Clinical Care
• Academics
• Organizations
• Awards
• Miscellaneous
• People

 

Policy  

Whole System Approach Slapped Down: Federal Panel Rejects Sustainability in Dietary Guidelines

A federal panel has dropped two controversial draft recommendations for the nation’s dietary guidelines, according to this account at Yahoo News: “The most controversial portions of the original draft - a sustainability measure that suggested Americans consider the environment when deciding what foods to eat and a soda tax to help cut sugar consumption - were both dropped this week in response, some say, to food industry pressure.” Tom Vilsack, Secretary of Agriculture, and Sylvia Burwell, Secretary of Health and Human Services, each argued that sustainability considerations were outside the scope of the panel’s authority.

The sustainability connection was lobbied by the National Resources Defense Council, and others. A legal opinion supporting the position is available here. Basic information to back the connection of diet and sustainability is in this January 2014 presentation by Kate Clancy to the Dietary Guidelines Advisory Committee. The draft section of the guidelines (Part D, Chapter 5) that includes the abandoned recommendations is here. This year the public process for the guidelines, amended every 5 years, drew 29,000 public comments.

Comment: This linkage is a great fit for the integrative health and medicine community to embrace and advocate. What whole system-minded person or organization would not draw the connection? Perhaps this concept would have been better vetted through the National Prevention, Health Promotion and Public Health Council set up under the Affordable Care Act. That agency was created to instill more systemic thinking into the silos of decision processes in separate federal departments. Credit to the professionals who brought sustainability issues into this debate. Where are you and your organization on this?

RAND Report Engages Critical Issue: Complementary and Alternative Medicine - Modalities or Professions?

The subtitle from the RAND Corporation authors suggests the importance of the themes engaged in the new report Complementary and Alternative Medicine: Professions or Modalities? The veteran co-author team of Patricia Herman, ND, PhD and Ian Coulter, PhD tacked this on: “Policy Implications for Coverage, Licensure, Scope of Practice, Institutional Privileges, and Research.” The report’s purpose was to address “a problem that confronts the complementary and alternative medicine (CAM) professions whereby a profession is defined politically not by its full professional scope but by its treatment modalities.”  The report was developed with the advice of two expert panels: one of licensed professionals, and the other of insurers and other stakeholders.

The report includes multiple useful recommendation. The authors argue that: “employers are important”; “education and health literacy are essential”; and “CAM professions need to work together.” In addition, they state that “Federal and State Laws and Regulations Limit the Inclusion of CAM in Health Systems.” They provide a useful grouping of seven specific examples. The report was funded through a grant from the NCMIC Foundation.

Comment: This report is particularly timely for chiropractors, for which the Foundation’s parent, NCMIC Group, is the main malpractice provider. Medicare is evaluating this precise question: should chiropractors be respected and paid as professionals who evaluate and manage patients with skills and a legal scope of practice well-beyond spinal manipulation for low back pain? Or is it in the best interest of human health to continue to treat DCs only as rack-‘em-and-crack-‘em machines? What do you think is the best for health care?

Given the chiropractic-related input, I was intrigued to see the recommendation that “CAM Professions Need to Work Together.” This will be tough to swallow for many of chiropractic’s professional leader who like to keep other “CAM” professions at arms-length.  For example, the American Chiropractic Association (ACA) is the only national professional “CAM” organization that is not a member of the Integrative Health Policy Consortium that the report describes in an appendix.  Listen to RAND and join ACA, eh? Great project. I will be returning to this content.

From Pills to Pins: Oregon Said to Be Changing Its Approach to Back Pain

Oregon Public Broadcasting recently presented a report that suggested that Oregon is moving toward natural therapeutics first in its approach to back pain. Entitled ”From Pills to Pins: Oregon Is Changing How It Deals With Back Pain”, the article quotes Denise Taray, the coordinator of the Oregon Pain Management Commission.  Speaking to the limits in Medicaid’s historic way of covering back pain, Taray states: “The only thing that might have been covered in the past was narcotics. Treatments such as acupuncture, chiropractor, massage therapy, physical therapy and rehab would never have been covered.” This is about to change. Starting in January 2016, according to the report, “the state will fund many of these back-pain treatments for patients who get their health care via Oregon’s version of Medicaid —the Oregon Health Plan.”

The writer continues: “While the treatments may cost more than a course of pain pills, the hope is that money will be saved by reducing the number of people who become addicted to opioids or abuse them. And pills aren’t always as effective as some people assume.” Taray adds: “Research is out there that suggests that with back conditions we’re spending a lot of money on health care treatments and services that aren’t improving outcomes.” Then the close: “Oregon has not found overwhelming evidence that acupuncture, yoga or spinal manipulation work better than other options. But, as Taray points out, these alternatives don’t involve drugs.”

Comment: The Oregon experiment will be fascinating for the entire nation. Notably the report profiles on the Quest Center for Integrative Health, a pain management clinic run by David Eisen, LAc. Eisen is a national leader in community acupuncture for the underserved. Practitioners of all stripes in Oregon will be wise to educate each other on the most clinically efficient and cost-smart means of responding to this opportunity to prove what most have believed for years. Special seminars are in order. Notably, Oregon’s direction appears to be fully aligned with that promoted by the Joint Commission a year ago with the Clarification of the Pain Management Standard. Integrative pain treatment is the engine of integration.

Meantime, Oregon has its work cut out to alter the course of pain care. A Kaiser Northwest Permanente research team that found the organization’s primary care providers are likely unaware of existing patient use of acupuncturists and chiropractors according to this piece here at Pain Medicine News.

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Clinical Care

 

Cory Jecmen, MAc, LAc: An Acupuncturist/Tech Player in Casey Health Institute's Integrative PCMH

This interview with Cory Jecmen, MAc, LAc began with curiosity about his role as a licensed acupuncturist in a Patient Centered Medical Home (PCMH). It's still rare enough to find licensed acupuncturists in PCMHs. Jecmen turned out to me one of a kind. The former acupuncturist with the Veteran's Health Administration, wears has two hats at Maryland’s Casey Health Institute: clinical acupuncturist and electronic medical record (EMR) techie. Jecmen speaks to the difference in working with a population that is 90 percent via referral, and mostly individuals who knew little about acupuncture before their first visit. On the tech side, Jecmen describes strategies he is developing to better capture the quirks in integrative interventions that are not typically in electronic medical records.  The article is produced as part of a partnership between the ACCAHC Project for Integrative Health and the Triple Aim (PIHTA) and CHI. The Integrator is providing media support.

Comment: Of particular value to the advance of the licensed acupuncture field in what Jecmen describes are the outcomes of this care on “acupuncture naïve” patients. Looking forward to those data!

Chinese Herb Strategy at the Cleveland Clinic: Insights from Jamie Starkey, LAc, Program Director

The pioneering decision of the Cleveland Clinic to include a Chinese Medicine Clinic has been widely reported on the major media. (A more recent account at U.S. News & World Reports is here.) The driving force behind the development of the program is Jamie Starkey, LAc. Starkey is a biology-trained practitioner who has been at the Clinic in multiple roles, including running quality insurance on research projects, since 1997. This interview describes the sensitivity to the organization’s culture at various decision points. This led to a model through which patients receive a prescription that is individually created as a “custom blended formula” and shipped to the patient via the bicoastal Crane Herb Company.  Starkey will be speaking on this topic as part of a panel on the Cleveland Clinic’s functional, integrative and Chinese medicine initiatives, moderated by this writer, February 27, 2016 at the Integrative Healthcare Symposium annual conference.

Comment: Starkey’s is a fascinating story of passion for an organization plus commitment to a profession. These are woven together through her own bilingual grasp of the two medicines. It may also be meaningful that she is herself, half Korean, a product of a bicultural union. Great tale, and hopefully useful to other medical organizations and practitioners that might be interested.

Detroit Free Press Profiles the Yoga Therapy Program Led by Veronica Zador at Beaumont Healthcare

Perhaps the first medical delivery organization to specifically hire a staff yoga therapist, Detroit’s Beaumont Hospital, is profiled in this Detroit Free Press article unabashedly called “Yoga is Good Medicine for Strength and Flexibility.” The article notes area football, soccer, cross-country and pom-pom teams that include yoga as routine parts of training, then returns repeatedly to the Beaumont program run by Veronica Zador, a past president of the International Association of Yoga Therapists. Notably, Zador has also chosen to open the Beaumont School of Yoga Therapy, also most certainly a first.

Quick Links to Integrative Medicine News in Medical Systems and Communities: September 2015

This Integrator feature is a quick capture of highlights from stories on the web relative to integrative medicine in the prior month. Here are 28 involving medical delivery systems and 10 more in communities. The global nature of the movement is evident in a couple of pieces: Woodson Merrell, MD, co-founder of the Continuum Center in New York, is interviewed on his book for Arab News, and Katherine Gergen-Barnett, MD, the integrative group visits maven, was speaking in Australia. Good to see the news on Beaumont Hospital's inpatient-outpatient Yoga therapy program. Sad to see Newsweek on the bandwagon with Reason.TV in blasting NIH NCCIH. And the rare MD, LAc - Iman Majd (see People, below) – was honored as a top integrative doctor in Seattle.

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Academics

 

Yo San University Receives $1-Million from the Thomas Blount Trust

Los Angeles-based Yo San University, a not-for-profit institution educating acupuncture and Oriental medicine professionals, has announced a $1-million grant from the Thomas Blount Trust. The grant was Yo San’s largest charitable gift. Blount was reportedly “a retired naval officer, aerospace consultant, and philanthropist, who dedicated his life to being a friend and mentor to many including Yo San University.” A colleague in the AOM field shared the following on learning this news:  “Great news. Do you know the Ni brothers? Mao and Dao? They started the college and have been there forever and papa Ni was as well and is a renowned Qi Gong master. They treat all kinds of movie stars all over LA.”

Comment: Always good, and rare, to see a so-called “CAM” institution break the color-barrier (green) of philanthropic money at over $100,000. Rarer yet at seven digits. No matter the profound contributions to individual health from these so-called “CAM” schools via educating thousands of AOM professionals or chiropractors or naturopathic doctors who give patients new options, few philanthropists are drawn to support them. A barrier in the AOM world is that a significant percentage of the schools are for-profit.  Another is the limited investment of these institutions in finding and nurturing philanthropic partners. Another factor may be the misfit of legacy (a major gift) and the relative uncertainty of one of these schools versus a major research institution. Congratulations Yo San for breaking the color barrier!

Former Watergate Lawyer Sherman Cohn in 15th Year Offering “CAM” Seminar at Georgetown University Law

One of the quiet forces in the advance of the integrative health and medicine movement is former Watergate lawyer Sherman Cohn, JD of the Georgetown Law. In the early years of integration, Cohn added a Seminar on Legal Issues of Alternative, Complementary, and Integrative Medicine at Georgetown. He recently estimated for the Integrator that “the seminar, which has gone 15 years, has about 15 students a year, so, somewhere around 225 in that seminar.”

Comment: Imagine the webs of knowing and doing that Cohn has influenced in this body of brainiac young lawyers, through the teaching of the seminar. Never mind for this moment Cohn’s work on the board of Maryland University of Integrative Health, on the board of the Integrative Health Policy Consortium, and as chair of the Accreditation Commission for Acupuncture and Oriental Medicine. Quite a legacy. By the way, Cohn has taught for a total of 51 years at Georgetown. He estimates, thinking of all of his students, that, since there “were years where I had 300-400 students, I expect that the accurate number (if one could ever find it) would be closer to 12,000” total new lawyers influenced.

Canadian Naturopathic College Partners with Rwanda Researchers: Benefit Found for Selenium in People with HIV

AIDs, the official journal of the International AIDS Society, has published a recent article that found that “daily supplementation of selenium significantly reduces the rate of CD4 cell count decline.” According to a release from Canadian College of Naturopathic Medicine (CCNM), the 2-year randomized controlled trial involved 300 HIV+ patients with results showing a 43.8% decrease in the rate of CD4 decline. The research effort was a collaboration of CCNM and Rwandan researchers. Information on the trial and parameters is here. The project was initiated by naturopathic doctor Don Warren, ND, a co–principal investigator. In the Rwandan capital of Kigali, Julius Kamwesiga, MD, MS, with the National University of Rwanda, led the local team. The opportunity developed out of a small 2007 positive pilot in Kenya that was led by James Farquarson, ND.

Comment: This may be a first such collaboration between a North American institution established to educate one or more types of integrative health practitioners, and researchers on the ground in an African nation. The individual who motored it along through recent years was Warren, whose CV includes a period as CCNM president and one as president of the naturopathic profession’s accrediting agency. While anyone who knows Warren will know that he is the last person to call attention to himself rather than the good that may come of this research, he has doggedly knitted together here another powerful piece to an already rich mosaic of contribution.

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Organizations

 

Who Is a Doctor, a Physician, a Modality, or a Profession? For AIHM, Language Matters

The Academy of Integrative Health and Medicine (AIHM) is committed to going where no organization in the integrative space has gone before: full-on, respectful, shared power in interprofessionalism. As a board member and participant in seeking to realize AIHM’s vision, I was part of a team that explored strategies for reconciling some of the historic challenges and inequities between the professions. One factor is the role of language. The AIHM Board recently affirmed a plan under which all presenters at the AIHM’s conference, People, Planet, Purpose, October 25-30 in San Diego, will be asked to be mindful of the language they choose. Is “physician” appropriate to refer to only medical doctors since osteopaths, dentists, naturopaths and chiropractors are also “physicians?” Is an acupuncture and Oriental medicine practitioner a “modality”?  As part of the consciousness raising, AIHM published this blog piece that includes the meat of what will be sent to speakers:  Language Matters: Building Trust, Inclusion and Interprofessional Teams.

Comment: I enjoyed the coincident publication of the RAND report noted in the policy section of this Round-up: Complementary and Alternative Medicine: Professions or Modalities? This issue is, for me, what my wife would call a “pet peeve.” I have wondered when whole professionals who are referred to as a limited “it” (a.k.a. “modality”) would begin to generate the kind of opposition women did to their treatment as objects in the early days of the women’s movement the late 1960s.

AANP Gains Congressional Endorsements for Inclusion of Naturopathic Medicine in Veteran’s Health

Mike Jawer sends a note that endorsements are now at 17 members of Congress, 8 of whom are noted here, for the naturopathic medical profession’s push to gain inclusion as practitioners with the Veteran’s Health Administration.  Jawer is director of governmental and public affairs for the American Association of Naturopathic Physicians (AANP). Leading the charge in Congress is Wisconsin representative Mark Pocan (D-WI). AANP has started a grassroots consumer letter-writing effort. The target of the campaign is Robert McDonald, secretary of the VHA. Jawer notes that work on the Senate side is Senator Barbara Mikulski, “a true champion of naturopathic medicine,” who sent her own letter.

Comment: Fascinating that the campaign is led by a member of Congress in a state in which the field is not licensed. Curious to see if this VA-targeted campaign will work.

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Awards

Nobel Prize Based on a Traditional Chinese Medicine Herb & Text: Turning Point for TCM?

Global traditional medicine news is over-flowing with multiple reflections on the meaning of the award of the Nobel Prize in Medicine to Chinese researcher Tu Youyou. The award followed the discovery by Tu and her team on the utility of a derivative of sweet wormwood (Artemesia annua) to combat malaria. This Integrator Special takes a look at the news that shocked most Nobel observers. The “firsts” tumble out: Nobel to a Chinese woman, Nobel in medicine to a Chinese national, award to a researcher with no doctoral level education, and of course the traditional medicine focus. Not to mention a connection to the Vietnam War and a secretive Maoist initiative.  Here are some of the intriguing themes in these media accounts, with some commentary. The announcement of Tu’s award is here. (This article was first prepared for the Global Integrator Blog for Global Advances in Health and Medicine.)

Comment: The award is remarkably timely for China, given that country’s medico-cultural-economic push to inlay TCM across the globe. Yu’s award is a fascinating story that begins in the jungles of Vietnam in the late 1960s and has now placed a diamond on these dissemination efforts. It certainly won’t harm general public perception of the potential in botanicals. How many people still know how many drugs are herb based? Natural medicine and environmental leaders, who hold up rainforests as the wombs for future medicines, each got a push from this surprising award.

$250,000 Dr. Rogers Prize to University of Toronto Integrative Leader Heather Boon, PhD

The $250,000 Dr. Rogers Prize was awarded to long-time integrative medicine researcher and organizer Heather Boon, BSc, Phm, PhD. A Vancouver Sun article notes that Boon is a co-founder and has been the co-chair of the Canadian IN-CAM network. She also was one of the visionaries who saw the value in an international organization for researchers in the field and helped form the International Society for Complementary Medicine Research (ISCMR). Boon is ISCMR’s immediate past chair. She is an international leader in the push for more whole systems research. Her academic work includes a textbook on natural health products and some 150 academic articles that focus on safety and effectively. She is now dean of University of Toronto’s Leslie Dan Faculty of Pharmacy. Boon has also been a leader in the university’s effort to create a Centre for Integrative Medicine.

Comment: This is a great decision by the Dr. Rogers Prize team. The Sun article gives a taste of Boon’s straightforward courage in a story about some current research. She was recently lambasted by 90 of her academic colleagues for undertaking research on homeopathy. Boon responded: “I don’t think the criticism was warranted. I think that we have a phenomena, people claiming they’re getting better, and so like any scientist I’m curious about what’s going on.” Yes!

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Miscellaneous

 

Media Bias: Would This Headline Have Said “Chiropractor” or “Naturopath” If One of These Were the Perpetrator?

This Pennsylvania newspaper article ran under the title: Northampton County man accused of sexually assaulting 2 children. Nowhere does the article mention the man’s occupation. The article is a re-post of a similar piece from the Lehigh Valley News. The original Lehigh Valley article mentions, in the second paragraph, that the accused is a “doctor.”

The Integrator received the article as an attached PDF in an email entitled “Note the Deference to the MD in the headline.” The note was from Lou Sportelli, DC, a chiropractor who is an acute observer of the Nation’s rough and tumble move toward healthcare integration. He sent the article to a list with this note: “This is a classic example of continual bias in the press in 2015.  Please look at the headline of the attached newspaper article which appeared today. Can you imagine if a DC were involved, what the news headlines would say?”

Comment: Sportelli drops a plumb line to check-in on the status of bias in integration. What are the chances the headline would have run:  “Chiropractor accused of sexually assaulting 2 children.” What do you think? Sportelli’s note concluded: “We have come a long way, but we have a long way to go.”

Montana’s Margaret Beeson, ND Moderates Panel on Marijuana Legalization

Long-time Billings, Montana, naturopathic physician Margaret Beeson, ND was invited into an intriguing role in late September. The article in the Billings Gazette on the event begins: “Few topics can spark debate like marijuana legalization, whether for medicinal or recreational uses.” The state has allowed medical use since 2009. Beeson, who founded the robust, interprofessional though ND-dominant Yellowstone Naturopathic Clinic, was inserted into the middle of the state’s debate by the organizers of the event, Humanities Montana. Her role was to moderate a panel that included, in the reportedly rousing discussion, the superintendent of a local school district, an oncologist at Bozeman Deaconess Hospital, the president of the Montana Cannabis Information Association, the Billings Chief of Police, and a retired federal magistrate judge.

Comment: The article is noteworthy for a couple of reasons. First, the basic trust implicit in selecting Beeson as a moderator in this rich mix of perspectives. Second, the community respect earned by this naturopathic physician who has chosen to dedicate herself to service to her own community. And third, well, Billings is not exactly Marin County. Beeson is a relatively unsung leaders of her profession. This small story of a cultural opening forged via long labor.

People

Lou Sportelli, DC Exits NCMIC Group Presidency and Now Leads the NCMIC Foundation

One of the most influential chiropractors in the modern era, Louis Sportelli, DC, has stepped down from his position as president of NCMIC Group and become president of the organization he has diligently powered up in recent years, the NCMIC Foundation. NCMIC Group is the chief provider of malpractice insurance for chiropractors and for naturopathic doctors. As the long-time president of NCMIC Group, Sportelli guided significant strategic corporate gifts. Many advanced the evidence base for the chiropractic profession. Others kick-started the budding integrative health and medicine movement. Included were a series of formative reports on the future of chiropractic, and of complementary and alternative medicine, developed through the Institute for Alternative Futures.

The most significant NCMIC Group investment was to create an endowed foundation so that NCMIC could keep on giving, year after year. At NCMIC Foundation, Sportelli joins his long-time close colleague, Reed Phillips, DC, PhD who serves as executive director. The RAND initiative Complementary and Alternative Medicine: Professions or Modalities? Covered in this Round-up, is an example. The job transition for Sportelli took place June 30, 2015. The new president is Wayne Wolfson, DC.

Comment: Many, though the years, have jokingly referred to Sportelli as “Godfather.” Truth is, he and his teams have been skillfully moved certain chess pieces in the advance of chiropractic, naturopathic medicine, and integrative health and medicine. Projects and ideas could take life or die based on his team’s decisions.

He’s made many terrific ones. Through Sportelli, for instance, NCMIC was an earlier backer of David Eisenberg, MD’s early conferences at Harvard and with Stanford. My own work has been a very significant beneficiary of NCMIC’s backing. NCMIC helped sponsor the first multi-stakeholder Integrative Medicine Industry Leadership Summits (2000-2002).  NCMIC backed the National Policy Dialogue that led to the creation of the Integrative Health Policy Consortium. NCMIC’s founding commitment to the Integrator in 2006 allowed me to get this work to connect the fields and stakeholders off the ground.  Lou has mentored me on many occasions. NCMIC Foundation has committed over$100,000 since2008to the Academic Consortium for Complementary and Alternative Health Care. That NCMIC, and now the Foundation, have been led by a professional with a profound personal commitment to, and experience as a practitioner of, integrative care, has been a remarkable stroke of luck for all of our fields. Great contributions already, and terrific for all of us that you are staying in the game, Lou!

In Memoriam: Pioneering Integrative Medical Doctor Mitchell Gaynor, MD

The thorough obituary in the New York Times honored author and integrative oncologist Mitchell L. Gaynor, MD as a “popular author who taught cancer patients to supplement conventional medicine with soothing music, diet and meditation — and practiced what he prescribed.” He was founder and president of Gaynor Integrative Oncology in Manhattan. Previously, Gaynor was a clinical assistant professor at Weill Cornell Medical College and director of medical oncology at the school’s Center for Integrative Medicine. Gaynor reportedly died of suicide. He was 59. Gaynor’s last interview, two weeks prior to his death, is here.

Iman Majd, MD, LAc Honored as a Seattle Top Doctor in Integrative Medicine

Rare is the medical doctor who has also completed a full acupuncture program and has chosen to become certified as a Diplomate with the National Certification Commission for Acupuncture and Oriental Medicine (NCCAM). Rarer yet is such a medical doctor who is simultaneously pioneering a new role for acupuncture in his/her delivery organization while also choosing to volunteer in a leadership role for the licensed acupuncture field. These characteristics are part of the make-up of Iman Majd, MD, LAc, Dipl.Ac., honored as a Top Doctor in Integrative Medicine by Seattle Metropolitan magazine. An interview notes that while he was “recognize(ed for) his work at the University of Washington, Majd also takes an integrative approach to treatment at Bastyr Center for Natural Health, where he is a faculty member supervising Immune Wellness appointments.” Majd also serves on the board of NCCAOM for which he heads a project on credentialing and privileging licensed acupuncturists.

Comment: I’ve had the pleasure of working with Majd on the NCCAOM project. As a Seattleite, I was pleased not only to discover that he was delivering acupuncture in the otherwise CAM-limited University of Washington primary care delivery, but also choosing to continue to straddle his professional universe with commitments to teaching at Bastyr University. Good to see this work acknowledged by his colleagues at the level of care delivery.

Cleveland Indians’ Jamie Starkey, LAc: First Acupuncturists Employed by Major League Baseball Team

The interview with Jamie Starkey, LAc on the Chinese herbal medicine program at Cleveland Clinic, reported above, revealed another piece of news: the Cleveland Indians baseball team appears to be the first to have a staff acupuncturist. An article by Sanjay Gupta and related video clip shares the team’s evolution from first use by Jason Giambi, who was in 2014 the oldest player in the major leagues. Younger players grew interested on observing its value to Giambi.

Starkey has the role via her work with the Cleveland Clinic, with which the team contracts for diverse medical services.  Starkey says she is on call when the team in in town and at least twice a week takes trips to the stadium to deliver services in those intervals. While individual licensed acupuncturists are known to provide services for individual pro-baseball players, the Cleveland Indian’s spokesperson on the video believes Starkey is the first to be employed by the team.

Comment:  I sometimes watch sports with my ND, MPH spouse, who, while not an acupuncturist, has significant experience in referring patients for such services. Thus far no teams have heard her, from our couch, offering prescription of acupuncture for one or another team member who she believes could benefit. Good on the Cleveland Indians for being the first to break the barrier, hire Starkey, and make these services available.  Giambi’s video story of the younger ball-players first scoffing then trying it out is compelling.

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