CAMLAW: Complementary and Alternative Medicine Law Blog

The Bulldog at Yale Gets No Tail

Mon, 01 Feb 2010 12:25:57 -0500

The Bulldog at Yale Gets No Tail (we used to sing that at Columbia), But he can get integrative medicine CME.

Yale is offering integrative medicine CME:

Yale School of Medicine, Integrative Medicine at Yale

Integrative medicine combines treatments from conventional medicine and complementary and alternative medicine (CAM) for which there is evidence of safety and effectiveness. Integrative Medicine at Yale was established in 2007 to create a forum for interdisciplinary research and education in complementary, alternative and integrative medicine. This symposium will showcase recent findings in CAM research and will provide attendees with evidence-based information about integrative therapies.

The mission of this conference is to: (1) showcase the breadth and depth of complementary, alternative, and integrative medicine (CAM/IM) research and clinical care already in progress by Yale researchers and clinicians; (2) educate and increase awareness among the community about integrative medicine topics and modalities, and (3) support interdisciplinary discussion and future collaboration.

In April 2008, Integrative Medicine at Yale and Yale CME sponsored the 1st Annual Yale Integrative Medicine Scientific Symposium. This conference featured presentations from experts in CAM/IM from Yale and other leading medical institutions and drew national and international attention. The symposium was attended by 170 participants. Since few opportunities exist for Yale-affiliated clinicians, researchers, and students to learn about CAM/IM therapies, demand is high for a second conference with a larger capacity.

Learning Objectives

Participants who attend will be able to:

-Describe the latest trends in the use of complementary and integrative therapies in the United States

-Identify methodological challenges in complementary and integrative medical research

-Distinguish the role of evidence in translating complementary and integrative medical research into clinical practice

-Describe recent advances in core complementary and integrative medical research areas

-Assist patients in making informed, evidence-based choices about commonly used complementary and integrative therapies

-Identify complementary and integrative therapies used by cancer patients and explore their evidence base

Thursday, March 4, 2010

5 AMA PRA Category 1 CreditsTM
Harkness Auditorium - Yale School of Medicine

333 Cedar Street

New Haven, CT

Registration Fees

Registration fee includes all conference materials and refreshment breaks

$150                             Physicians

$100                             Nurses/PAs

$100                             Allied Health Professionals

$100                             Others

$ 25                              Non-Yale Residents/Fellows/Students

Complimentary              Yale Residents/Fellows/Students

*A letter of verification from department head must accompany registration. If registering online, letter should be sent separately to Yale CME address below.

All cancellations must be received in writing (or via email) at least one week prior to the start of the conference to receive a refund. Any requests for refunds received after this date, or by telephone, will not be honored.

Center for Continuing Medical Education
333 Cedar Street
PO Box 208052
New Haven, CT
06520-8052

Accreditation Statement

The Yale School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The American Medical Association has determined that physicians not licensed in the US who participate in this CME activity are eligible for AMA PRA Category 1 Credit.

Designation Statement

The Yale School of Medicine designates this educational activity for a maximum of 5 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Disclosure Policy

It is the policy of Yale School of Medicine, Continuing Medical Education, to ensure balance, independence, objectivity and scientific rigor in all its educational programs. All faculty participating as speakers in these programs are required to disclose any relevant financial relationship(s) they (or spouse or partner) have with a commercial interest that benefits the individual in any financial amount that has occurred within the past 12 months; and the opportunity to affect the content of CME about the products or services of the commercial interests. The Center for Continuing Medical Education will ensure that any conflicts of interest are resolved before the educational activity occurs.

Nursing Credits

Yale-New Haven Hospital is an approved provider of continuing nursing education by the Connecticut Nurses' Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. This activity is designated for a maximum of 4.5 CEU Credits.

Medical students want CAM:

Are up-and-coming young doctors going to practice the same kind of mainstream medicine as their predecessors? Will the next generation of docs turn up their noses at alternative therapies such as acupuncture, yoga, herbs and vitamins -- just like the majority of the current crop of docs? In what may come as a surprise to many mainstream physicians, the answer to those questions may be a resounding "no".

According to research published in the online edition of the peer-reviewed journal Evidence-based Complementary and Alternative Medicine (eCAM), 75 percent of medical students surveyed think it would be beneficial for conventional Western medicine to integrate with complementary and alternative medicine (CAM). CAM places emphasis on natural therapies and using the body's own healing powers instead of relying on drugs, vaccines and other standard Western treatments.

A University of California at Los Angeles (UCLA) and University of California, San Diego, research team comprised of experts in the fields of CAM, integrative medicine, Western medicine, medical education and survey development created a first of its kind 30 question survey that was distributed to 126 U.S. medical schools. Some 1,770 medical students completed the survey -- roughly, about three percent of the 68,000 medical students nationwide. Although the response rate to the survey was fairly low, the researchers say it provided valuable insights into current medical students' perceptions of CAM.

For example, the findings revealed that 77 percent of the medical student participants agreed patients whose doctors are knowledgeable about complementary and alternative medicine in addition to conventional medicine benefit more than those whose doctors are only familiar with Western medicine. In fact, 74 percent agreed that a medical system which integrated conventional medicine with CAM could be more effective that either type of medicine used independently.

A whopping 84 percent of the participants surveyed said CAM contains beliefs, ideas and therapies that could benefit conventional medicine. Some of this attitudinal shift in medical students could be the result of personal experiences -- almost half of the participants said they had used complementary and alternative treatments themselves.

The Washington Post keeps us out of a nutritional haze:

Many people take just one supplement, a multivitamin. Here are some tips for choosing the best multivitamin, from Andrew Weil, founder of the Arizona Center for Integrative Medicine at the University of Arizona, which focuses on combining alternative treatments with conventional medical practices...

Others see dietary supplements as a type of insurance: "There is a big discrepancy between what people think they eat and what they actually are eating," said Kelly Dorfman, a nutritionist in North Potomac. "Taking nutrients just makes good sense."

And for certain medical conditions, such as diabetes, supplements are highly recommended. Benjamin Caballero, a professor at the John Hopkins Bloomberg School of Public Health, said he does not think any "healthy person with a healthy diet" should take dietary supplements, with a few exceptions: "pregnant woman; children under the age of 6 months who are being breast-fed, as breast milk is not rich in vitamins A, C, and D; and people with gastrointestinal problems." And, in those cases, he believes a doctor would have already been consulted.

A quick blood test at the doctor's office can determine a person's vitamin levels. District nutritionist Mindy Block Feirman recommends asking for the test during your next physical. "Many individuals are coming back with their blood work low on Vitamin D," Feirman said. "We don't want to sit in the sun because we don't want to get skin cancer, so we don't get enough Vitamin D." She takes Vitamin D and calcium supplements every day.

Consumers should research brands before they buy. Siobhan DeLancey, a spokeswoman for the Food and Drug Administration, said that the FDA can take action against a manufacturer only after a supplement is on the market and complaints have been filed. Because of this lack of oversight, many labels are misleading.

"Vague claims, which make no mention of a disease but offer generalizations such as 'improves heart health' or 'builds strong bones,' have no FDA stamp of approval," Dorfman said.

Sleep well with Chinese medicine:

An approach that can also aid in the quest for a good night's sleep is that of Chinese Medicine. This ancient healing system has offered relief to the sleep challenged for thousands of years. While new to many, Chinese Medicine is mainstream in China, and it is used today for a wide range of conditions by an estimated one-fourth of the world's population.

The Roots of Traditional Chinese Medicine

Chinese Medicine is considered the oldest, most continuously practiced, professional, literate medicine in the world. Written records date back over 2000 years, although the medicine is believed to go back even further. Some experts believe Chinese Medicine is at least 5000 years old.

Chinese Medicine employs acupuncture, herbal medicine, nutritional therapy, tuina (pronounced "twee nah") massage, acupressure, and qigong.

The Huangdi Neijing (The Yellow Emperor's Inner Canon) is considered the Bible of Chinese Medicine, emphasizing medical theory and acupuncture. Some scholars estimate that it dates back to the first century B.C. In addition, The Shen Nong Ben Cao Jing (The Divine Farmer's Materia Medica Classic) details the medicinal uses of 365 herbs and is believed to have been compiled around 200 A.D. Many of the protocols mentioned in these ancient texts are still used today....

Chinese Medicine and the West

The development of East-West relations has promoted the use and interest of Chinese Medicine in the United States. During the past 30 years, the practice of Chinese Medicine has dramatically increased here. The National Institutes of Health (N.I.H.) has reported that visits to Chinese Medicine practitioners in the U.S. tripled from 1997 to 2007.

At the same time, the United States is seeing an increase in the practice of integrative medicine. University centers and hospitals are offering Chinese Medicine. Integration has been common in China, where Chinese Medicine is often practiced side-by-side with Western Medicine.

The Chinese Medicine Approach to Sleep

Insomnia comes in various forms, such as trouble falling sleep, difficulty staying asleep, and having dream-disturbed sleep. When a Chinese Medicine practitioner is gathering information to put together a treatment plan, the pattern of the sleep disturbance as well as health and lifestyle issues will be taken into consideration.

A Chinese Medicine practitioner might use the term "calm the shen" when describing a treatment principle. "Shen" is best translated as the spirit of the person in a nonreligious sense. When evaluating Shen, the Chinese Medicine practitioner is looking for the emotional state and presence (or lack) of radiance, calm, and balance. Often with sleep disturbances, the patient will be experiencing patterns of stress, anxiety, or agitation. Chinese Medicine would call this "disturbed shen."

A new book compares and contrasts shamanism and psychiatry:

Review - Psychiatrists and Traditional Healers
Unwitting Partners in Global Mental Health
by Mario Incayawar, Ronald Wintrob, Lise Bouchard (Editors)

This may well be because positive aspects of health (to undertake effectively clinical care, prevention and health promotion) have recently incorporated the emerging concepts of complementary and integrative medicine as attempts to harmonize conventional or scientific medicine and traditional medicine. (Juan E. Mezzich, President of the World Psychiatric Association, 2005-2008, p. xv) But what has led to this idea of complement and integrating traditional healing in western medicine? According to a general observation, expressed concisely by Raymond H. Prince, Emeritus Professor of Psychiatry, that their treatments, whatever they were, were as efficacious as his own. (Foreword, p. xi)

To start with, it is relevant to realize upfront that "the majority of the 450 million patients with mental disorders around the world are not receiving even the most basic mental health care. In developing countries, 76.3%-85.4% of serious cases receive no treatment". (ch 20, p. 251) And the number of people with psychiatric disorders is likely to rise in the coming decade becoming a pressing global issue.

1. DIAGNOSIS

Diagnosis similarity is a one of the topics addressed in the book. It is assumed that diagnosis and treatment are 'evidence-based' and that evidence is 'scientific'. So why are there so many people that turn to traditional alternative medicine? (ch 1) Don't people want science? There is a need to prove traditional healer's skills relying on their ability to provide a similar diagnosis (ch 5) and that is important in the sense that for centuries, Quichua people/ Inca Confederation (Bolivia, Ecuador, Peru and parts of Argentina, Chile and Columbia) lived under a regime of domination and exploitation which still persists today. Oppression, persecution and imprisonment. (ch 5, p. 54, 55; the same also happened in South Africa, ch 16) The diagnosis situation is a polemic one, even among psychiatrists, since there are several classification systems around the world ("DSM-IV", produced by the American Psychiatric Association; "International Classification of Diseases" (ICD) an international standard diagnostic classification for a wide variety of health conditions, including mental and behavioral disorders; Chinese Society of Psychiatry's Chinese Classification of Mental Disorders (currently CCMD-3), Latin American Guide for Psychiatric Diagnosis (GLDP). The Maori (New Zealand) have openly questioned the use of a diagnostic manual such as DSM IV because it seems to conflict with cultural understanding. (ch 19, p. 247) Treatment is in some cases not as effective as in Western Medicine (ch 14) but the fact that symptoms and diagnosis are correctly assessed, or it is assed as accurately as in Western Medicine, is important in the sense that it attests 1) seriousness in the observation of the patient by traditional healers; 2) affirming traditional healing knowledge itself as a different alternative/ possible method of classification.

2. INTEGRATION VS COLLABORATION

The WHO Strategy for Traditional Medicine 2002-2005 (World Health Organization, 2002) has encouraged countries to integrate traditional medicine within national health care systems, safely, and at affordable prices for the general population. But a main question remains: what aspects to keep from biomedicine and which one to eliminate? By whose standards? How can one consider legitimacy on this topic and why to address it, it is better to say collaboration instead of integration? (ch 2, p. 17, 18, 22)

Collaboration can be, for example, an experience of culture immersion where anthropology and cultural psychiatry meet (ch 6, p. 76), promoting a closer relation with the environment (ch 19), or engaging in the doctor as someone multi-dimensional, inserted in a community and not so much office based (ch 3, ch 8). The main idea is that a medical pluralism model that represents a health care environment should be a goal (ch 8, p. 105). Disregarding culture and cultural heritage when it comes to health may have serious consequences in disrupting individuals and social order. (ch 9)

The interaction between health, psychiatry and religion is also explored in the book. In Italy, religion plays a very important role in healing (ch 18); Islam, promotes self-help through religion but also encourages family, community, doctors and psychiatrists as additional resources (ch 15); Japan's view psychiatry is a complex one, precisely because it triggers a cultural ambiguity: should one aim at healing or salvation, should illness be battled or accepted? (ch 13)

Read the review (excerpted above).

Integrative medicine award awarded (now I know that's redundant!):

GAINESVILLE, VA -- In recognition of her commitment to integrative therapy, the economic power of Integrative Medicine, the American Association of Integrative Medicine, recently awarded Taras NK Raggio, MPA, HHP the prestigious Board Certified in Integrative Medicine, BCIM™, credential by the American Association of Integrative Medicine (AAIM)™. The BCIM designation is reserved for those individuals who are able to meet the stringent requirements of AAIM in the areas of knowledge, skill, education, training, and experience in their health care specialty.

About Taras NK Raggio, MPA, HHP, BCIM
For the past 10 years Taras has address whole person management; mind, body, spirit, to include negative emotions associated with stress. Her service differential is to educate, inspire, and integrate life coaching and wellness programs as an alternative to traditional diagnosis and treatment. Her specialties include: Stress Depression/Anxiety Emotional Wellbeing Aromatherapy and Breath work. Taras' honors include: Masters of Public Administration (Public Health); Credentialed Holistic Health Practitioner, Certified Holistic Stress Management Specialist, Life Coach, Lifestyle and Weight Management Specialist, and Clinical Aroma therapist.

Her Company, TARAS TECHNIQUES, LLC- Holistic Health Services provides Health Promotion Programs for employers, large and small. Established in 2001, the firm is a National Minority Certified Woman; Veteran owned and operated small business comprised of subject matter experts with extensive military and commercial experience. The goals of the firm are to deliver behavioral health and lifestyle management solutions to corporations and public safety organizations that enhance the overall health and wellness of a workforce.

About AAIM
AAIM is an international membership association that brings together health care professionals from a variety of specialties. Membership is comprised of integrative, alternative, holistic, complementary, and traditional health care professionals. This forum allows members to share information in an effort to increase both public and professional knowledge and acceptance of integrative medicine, thereby benefiting the patient as well as the practitioner.

F or membership information, please visit the AAIM website at www.aaimedicine.com or contact AAIM Headquarters toll-free at (877) 718-3053. American Association of Integrative Medicine 2750 E. Sunshine • Springfield, MO 65804

Media Contacts
Phone: 703.636.4123
Email: info@tarastechniques.com

Website Link: http://www.tarastechniques.com/tarasraggio

For additional information, please contact:
Contact: Taras NK Raggio, MPA, HHP, BCIM
Telephone: (703) 636-4123
Fax: (703) 636-4123
E-mail: info@tarastechniques.com

- Dr. Mark Beitel, a licensed clinical psychologist and psychotherapist, has joined the Greenwich Hospital's Center for Integrative Medicine at 35 River Road in the town's Cos Cob section, as a clinical psychologist.

The Minnesota complex of hospitals providing integrative medicine services gets profiled:

AN OVERVIEW
An overview of how complementary medicine expanded in this region of the country begins with the Hennepin County Medical Center. It began clinical trials with acupuncture in 1986 and in 1993, and it was the first conventional medical facility in the United States to open an alternative medical clinic.

Two years later, the University of Minnesota created the Center for Spirituality and Healing. This center was designed to conduct research, educate health professionals and empower consumers. Once a public clinic, the Center for Spirituality and Healing closed that operation in 2002.

Then in 1998, the second oldest hospital in Minnesota, Lakeview Hospital, began offering a holistic approach to care by incorporating non-traditional therapies with standard conventional patient care. Administrators there believed the addition of complementary therapies benefited patients by providing pain relief, stress reduction and recovery enhancement.

In 1999, Children’s Hospitals and Clinics of Minnesota launched an integrative medicine program in its oncology department following suggestions by parents who felt their children needed more help managing symptoms. The program used therapies in the treatment of cancer with simple approaches like mind/body skills, aromatherapy, and massage. To date, the integrative medicine program at Children’s, one of sixteen in the nation, is the largest and longest running.

In 2000, the Woodwinds Health Campus opened in Woodbury. It is an 86-bed hospital built around a holistic care model that recognizes the role of the individual and the family in the health care experience.

In 2002, the concept for the Penny George Institute for Health and Healing was developed around the idea of creating an optimal healing environment. By 2003, the inpatient program was in operation, managed by teams of nurses. A year later, its outpatient clinic was opened, featuring an acupuncturist, massage therapist, nurse/healing coach, and nutritionist, and the healing institute has continued to expand its services to date. In addition to inpatient and outpatient care, in 2007 the Penny George Institute opened a center to research both clinical trials, as well as the economics of integrative medicine.

In 2006, Regions Hospital opened its Complementary Care Therapies Department as a result of an internal grant opportunity. Regions had been trying to expand its nursing services, and there was interest from nursing and other professionals, but a lack of time. With the grant in place, two nurse managers were able to create the complementary therapies program.

PHILOSOPHY, THERAPIES AND GOALS
The following is a brief look at the health care clinics, centers and health systems that will be explored in more depth in coming months.

Integrative medicine at the new Disney center:

The new Roy and Patricia Disney Family Cancer Center at Providence Saint Joseph Medical Center is not only equipped with the latest technology but it has a complete floor reserved for Eastern-style therapies such as herbal medications, yoga and meditation.

With the goal of treating body, mind and spirit, the Sheri and Roy P. Disney Center for Integrative Medicine will offer complementary therapies that have proven safe and effective when used with conventional approaches including radiation and chemotherapy. These therapies include acupuncture, tai chi, Qigong and guided imagery.

“Integrative medicine considers all aspects of a person’s lifestyle and combines complementary and conventional medical therapies into an individualized, evidence-based treatment program,” said oncologist Lisa Schwartz, M.D., Director of the Center for Integrative Medicine.

“By giving patients access to a broad range of proven therapies, we ultimately give them more control over their own destinies. We also hope to contribute to the increasing body of research that demonstrates patients using integrated therapies experience improved quality of life and better outcomes compared to patients receiving conventional therapies alone.”

Sheri and Roy P. Disney contributed $1 million to the integrative medicine program. Roy P. Disney’s parents, the late Roy E. Disney and Patricia Disney, donated $10 million on behalf of their family to the new Providence Saint Joseph Medical Center free-standing cancer center.

“We do not live in isolation but as an integrative whole,” Roy P. Disney said. “Sheri and I feel strongly that this cancer center is an extension of that philosophy.”

AAIM has a new credential:

AAIM Releases First Integrative Medicine Certifications

New AAIM Board Certifications lend additional credibility to complementary and alternative medicine (CAM) practitioners worldwide.

01.20.2010 – Springfield, MO – The American Association of Integrative Medicine (http://www.aaimedicine.com), the medical society for the 21st century, today announced the release of certifications designed to enable holistic, natural and complementary and alternative health professionals to lend additional credibility to their practice of integrative healthcare. Board certification also enables consumers to make an informed decision when selecting a provider.

“Today there are millions of medical practitioners that are embracing both traditional and alternative medicine in response to increasing consumer demand,” said Dr. Zhaoming Chen, Chief Spokesman & Board Chairman for the American Association of Integrative Medicine (AAIM). “However, it has become more difficult for individuals to choose, and for practitioners to stand out from other providers. These certifications ensure quality in the industry by providing a high standard.”

For licensed integrative medicine professionals, including physicians, nurses, therapists, veterinarians and dentists, AAIM Board Certification in Integrative Medicine (BCIM) is available to those with a Bachelor’s Degree or higher from an accredited college or university, a current license from at least one state and a minimum of three years of experience in a role related to integrative medicine. In addition, professionals must pass the rigorous AAIM Board Certification exam.

For health practitioners, such as naturopaths, homeopaths, nutritionists, massage therapists, reflexologists, Reiki practitioners, herbalists and practitioners of other CAM modalities, AAIM Board Certification in Integrative Health (BCIH) is available to those with a Bachelor’s Degree or higher from an accredited college or university and a minimum of three years of experience in a role related to integrative medicine. Like the BCIM certification, individuals must also pass the rigorous AAIM Board Certification exam.

For more information about becoming certified visit www.aaimedicine.com or call toll free (877) 718-3053.

# # #

About the American Association for Integrative Medicine
Founded in 2000 and headquartered in Springfield, Missouri, the American Association for Integrative Medicine (AAIM) educates and certifies practitioners in the integration of Eastern and Western medicine with the goal of improving clinical outcomes for patients. For consumers, they provide information and education about the benefits of integrative health care, as well as a careful selection of trusted providers. For healthcare providers, AAIM promotes their high standards of professional competence to consumers and provides a gathering place for like-minded individuals who are committed to preserving global indigenous therapies and evaluating new approaches. They have thousands of members worldwide representing over 22 medical specialties. For more information, visit www.aaimedicine.com.

Press Contact: Carol Arnold, Arnold Communications, (877) 718-4604 x2, carol@arnoldcomm.com.

Duke offers mindfulness training:

In-depth professional training and development are cornerstones of the program at Duke Integrative Medicine. Participants from across the medical and allied health fields—medicine, nursing, physical therapy, health education, teaching, exercise physiology, psychotherapy, nutrition, acupuncture, massage therapy, acupuncture, etc—are encouraged to register for our programs.

Mindfulness Training for Professionals

An 8-day training in two parts:

February 4-7, 2010 and March 18-21, 2010.

Mindfulness Training For Professionals offers an extensive training in this core concept, designed to help optimize the health and well-being of clients and patients. Mindfulness is recognized as an increasingly important element in healing, and in the helping relationship between professionals and their clients and patients.

Our attorneys regularly consult and advise on telemedicine and other health care law and business legal matters involving online enterprises. For legal advice concerning telemedicine and other health care practices, whether involving physicians, nurses, psychologists, or CAM providers such as acupuncturists, or even life coaches, fitness consultants, nutritional advisors, and others, contact our health care lawyers today.

Our law firm has many successes with health care and business law clients, whose practices are transforming the business and health care landscape as we know it.

Michael H. Cohen is an attorney providing business legal advice to green entrepreneurs and companies, and health care law advice to businesses and physicians, acupuncturists, naturopaths, homeopaths and others in the holistic health, wellness, and green industries. As a founding attorney of the Global Vision Law Group, he represents businesses poised for vertical lift, whose leaders are conscious, intuitive, and committed to shaping a better world. Michael also advises medical spas and integrative medicine clinics, physicians, chiropractors, naturopathic physicians, massage therapists, energy healers, nutritionists and herbalists, dietary supplement and cosmetics companies, and businesses with bio-energy and other technologies and medical devices. Michael offers the Entrepreneur’s Legal Toolkit as a series of legal guides to businesses. The first legal e-book deals with Contract Essentials, giving legal tips every business needs to negotiate its legal agreements; the second addresses legal issues faced by multi-level marketing companies and individuals involved in multilevel marketing and direct sales; and the third one so far is a HIPAA Regulations and Privacy Manual at far less the cost than it would take for an attorney to prepare.

Michael also sponsors Being Central, a Portal for Potential, which gives access to other, pre-paid legal services.

Read reviews of Michael’s work on the Complementary and Alternative Medicine Law Blog. And visit the Flat Rate Legal Services page for information on legal services offered at a flat rate or project fee (such as incorporation for entrepreneurs, review and drafting of business contracts, trademark, and health law services for CAM providers and others).

Michael’s clientele through the Global Vision Law Group includes businesses not only in California, New York, Maryland, Massachusetts, Washington, D.C., and other U.S. states, but also abroad. To speak with a lawyer about health care law issues pertaining to complementary and alternative medicine, or to consult a business lawyer about laws and legal issues for entrepreneurs and new enterprises that are seeking legal advice, contact the Global Vision Law Group today.

Birthday blessings from Spirit

Fri, 29 Jan 2010 02:39:50 -0500

I am always amazed at how we live in multiple worlds, the human and the cosmic/divine, the material and spiritual, the world of the mundane and then the numinous sacred.

In the world of psychological reality I was processing some thoughts today about tomorrow's birthday.

Then I was also sitting in a networking meeting - second of the day - listening to information upon information about networks of networks. My eyes drifted, and suddenly I was in meditation.

The God Force erupted - I'll just call it that, maybe it's quantum reality or the nanosphere or shifting templates or inter-dimensional spaces or just a wall of White, which is what the energy looked like as it spread through my being and all the space in the room, and then all the space in between space, and then into all of space and the non-space space.

Anything that had previously been occupying a space of blockage instantly blew out and cleared, and I was left in a peace that surpassed even the room or the planet on which the room in an investment banking firm sits.

Yes, I had a moment or something that is not even recognizable as a moment, of cosmic consciousness.

It was like the Haftorah portion I read on my Bar Mitzvah: in the year that King Uzaiah died (ok, that Obama was elected), I saw the Lord sitting on a throne (ok, it was a wall of white energy permeating the entire cosmos, and I didn't really "see" it, my third eye opened and became the whole universe) and around were seraphim (well I did see white shadows, outlines of energy beings, behind the speaker) and His entire Glory filled the hall (that's a fairly good description).

Funny, because the name Isaiah kept coming to me all day.

It was an e-card (energy card) from On High. What a great experience, what a wonderful. Just then I landed back in my body and felt a happy radiance. It was not merely a happy birthday present, it was an ecstatic one.

I realized some hours later my purpose is to channel this energy. So put another way it's simply to be. That is the literal translation of the divine name in Hebrew--literally, BEING. Some folks write it as "I am that I am." I understand the Hebrew root as a verb. Being itself. Am-ness. Presence. To be one with the Presence and let it, Being, flood the being of the tiny self.

And whatever comes from that space comes from a much larger space than the small limited self.

The still small voice becomes a mighty roar.

Religious language points beyond itself to a numinous reality that cannot be confined by words nor limited by any human conception, for how can the infinite be described via the finite? But then that is the journey, as one Baba put it, from the finite to the infinite.

And rather than coming when sought on the official birthday it took me by surprise the day before and during a networking meeting (second of the day) when I was not looking.

Maybe that's how Isaiah got it too. One ordinary day in an extraordinary moment, a portal opened, and revelation unfolded.

Then, thrust back into ordinal time, his job to put words to experience, and to let his being become a continuous aperture for translation of divine energies into the human realm.

And to have the humility to recognize his human side, too, and the limitations of pouring the infinite into finite, of bringing the formless into form.

Must you be a physician to perform laser techniques?

Mon, 25 Jan 2010 12:20:25 -0500

Medical spa owners frequently call for legal advice on the question of whether they need a physician to perform cosmetic laser techniques?

The answer is that every state has different laws regulating the practice of medicine. State laws also regulate estheticians, cosmetologists, and other beauty industry professionals.

It's sometimes difficult to know which board regulates laser cosmetic techniques, although the term "laser surgery" gives a good clue.

Our attorneys specialize in guiding medical spas, cosmetics facilities, beauty establishments, and wellness and fitness industry professionals and corporations regarding the legal rules regulating aesthetic medicine and cosmetics procedures such as laser, intense pulsed light (IPL), Botox, Restalyne, and other therapies.

Below is some regulation in Georgia, as an example of how the regulations can pinpoint the legal requirements for companies venturing into this complex legal arena:

§ 43-34-244. (For effective date, see note.) Two levels of license; application
(a) There shall be two levels of a license for a cosmetic laser practitioner: assistant
laser practitioner and senior laser practitioner.
(b) Any person desiring to obtain a license as a cosmetic laser practitioner under the
terms of this article shall make application to the board as follows:
(1) An applicant for an "assistant laser practitioner" license shall present proof that
he or she:
(A) Holds a current valid license or certificate of registration as a physician
assistant, licensed practical nurse, nurse, esthetician, or master cosmetologist, or
has previously held a license or certificate of registration as a medical practitioner;
and
(B) Has received at least three laser certificates from attending laser/intense
pulsed light (IPL) courses as approved by the board, directly taught by a licensed
physician or certified continuing medical education or continuing education educator.
If, after review of the application, it is determined that the applicant is at least 21
years of age; has met the minimum educational requirements; is of good moral
character; and is possessed of the requisite skill to perform properly cosmetic laser
services, a license shall be issued to the applicant entitling the applicant to practice
the occupation of cosmetic laser practitioner at the assistant laser practitioner level
under the on-site supervision of a senior laser practitioner.
(2) An applicant for a "senior laser practitioner" license shall present proof that he
or she:
(A) Holds a current valid license or certificate of registration as a physician
assistant or nurse or has previously held a license or certificate of registration as a
medical practitioner;
(B) Has at least three years of clinical or technological medical experience, or
both;
(C) Has been or was licensed or nationally board certified as a medical
practitioner for at least three years; and
(D) Has received at least two laser certificates from attending laser/intense
pulsed light (IPL) continuing medical education courses as approved by the board,
directly taught by a licensed physician or certified continuing medical education or
continuing education educator. If, after review of the application, it is determined
91
that the applicant is at least 21 years of age; has met the minimum educational and
clinical training requirements to perform cosmetic laser services with indirect
supervision; is of good moral character; and is possessed of the requisite skill to
perform properly these services, a license shall be issued to the applicant entitling
the applicant to practice the occupation of cosmetic laser practitioner at the senior
laser practitioner level pursuant to the protocols of a consulting physician.
(c) Any person desiring to obtain a license as an "assistant laser practitioner" who
does not meet the requirements of paragraph (1) of subsection (b) of this Code
section shall also be eligible for a license as an "assistant laser practitioner" if he or
she makes application to the board within nine months of the effective date of this
article and presents proof that he or she:
(1) Prior to the effective date of this article, obtained a minimum of at least 2,000
hours of experience in administering cosmetic laser service; and
(2) Has received at least two laser certificates from attending laser/intense pulsed
light (IPL) courses, directly taught by a licensed physician or certified continuing
medical education or continuing education educator.
(d) Should an applicant have a current cosmetic laser practitioner license or
certificate of registration in force from another state, country, territory of the United
States, or the District of Columbia, where similar reciprocity is extended to this state
and licensure requirements are substantially equal to those in this state, and have
paid a fee and have submitted an application, the applicant may be issued a license
at the appropriate level entitling him or her to practice the occupation of a cosmetic
laser practitioner at that level, unless the board, in its discretion, sees fit to require a
written or a practical examination subject to the terms and provisions of this article.
HISTORY: Code 1981, § 43-34-244, enacted by Ga. L. 2007, p. 626, § 1/HB 528;
Ga. L. 2009, p. 859, § 1/HB 509; Ga. L. 2009, p. 989, § 2/SB 104.
§ 43-34-245. (For effective date, see note.) Expiration of licenses; license renewal
(a) All licenses shall expire biennially unless renewed. All applications for renewal
of a license shall be filed with the board prior to the expiration date, accompanied by
the biennial renewal fee prescribed by the board. A license which has expired for
failure of the holder to renew may only be restored after application and payment of
the prescribed restoration fee within the time period established by the board and
provided the applicant meets such requirements as the board may establish by rule.
Any license which has not been restored within such period following its expiration
may not be renewed, restored, or reissued thereafter. The holder of such a canceled
license may apply for and obtain a valid license only upon compliance with all
relevant requirements for issuance of a new license.
(b) As a condition of license renewal, the board shall require licensees to provide
proof, in a form approved by the board, of a minimum of five hours of continuing
education courses as approved by the board in the area of cosmetic laser services,
equipment safety and operation, procedures, and relative skin modalities, directly
taught by a licensed physician or certified continuing medical education or continuing
education educator.
92
HISTORY: Code 1981, § 43-34-245, enacted by Ga. L. 2007, p. 626, § 1/HB 528;
Ga. L. 2009, p. 859, § 1/HB 509.
§ 43-34-246. (For effective date, see note.) Sanctions
The board may impose on a cosmetic laser practitioner or applicant any sanction
authorized under subsection (b) of Code Section 43-34-8 upon a finding of any
conduct specified in subsection (a) of Code Section 43-34-8.
HISTORY: Code 1981, § 43-34-246, enacted by Ga. L. 2007, p. 626, § 1/HB 528;
Ga. L. 2009, p. 859, § 1/HB 509.
§ 43-34-247. (For effective date, see note.) Petition to restrain or enjoin unlicensed
cosmetic laser practitioner
The practice of providing cosmetic laser services is declared to be an activity
affecting the public interest and involving the health, safety, and welfare of the
public. Such practice when engaged in by a person who is not licensed as a cosmetic
laser practitioner or otherwise licensed to practice a profession which is permitted
under law to perform cosmetic laser services is declared to be harmful to the public
health, safety, and welfare. The board or the district attorney of the circuit where
such unlicensed practice exists, or any person or organization having an interest
therein, may bring a petition to restrain and enjoin such unlicensed practice in the
superior court of the county where such unlicensed person resides. It shall not be
necessary in order to obtain an injunction under this Code section to allege or prove
that there is no adequate remedy at law, or to allege or prove any special injury.
HISTORY: Code 1981, § 43-34-247, enacted by Ga. L. 2007, p. 626, § 1/HB 528;
Ga. L. 2009, p. 859, § 1/HB 509.
§ 43-34-248. (For effective date, see note.) Agreement with consulting physician
(a) Any facility providing cosmetic laser services other than hair removal using
lasers or pulsed light devices shall have an agreement with a consulting physician
who shall:
(1) Be trained in laser modalities;
(2) Establish proper protocols for the cosmetic laser services provided at the
facility and file such protocols with the board;
(3) Examine each patient prior to any cosmetic laser service other than hair
removal using lasers or pulsed light devices being performed; provided, however,
that a consulting physician may delegate the authority to perform such examination
to a physician's assistant who is a licensed cosmetic laser practitioner, in accordance
with a job description approved by the board, or to a registered professional nurse
who is also an advanced practice registered nurse as defined in paragraph (1.1) of
Code Section 43-26-3 and who is a licensed cosmetic laser practitioner, pursuant to
a protocol approved by the board; and provided, further, that in facilities subject to
the provisions of Code Section 43-34-249.1 such delegation may be to: (A) a
physician's assistant who is not required to be a licensed cosmetic laser practitioner,
in accordance with a job description approved by the board; or (B) a registered
professional nurse who is also an advanced practice registered nurse who is not
93
required to be a licensed cosmetic laser practitioner, in accordance with a protocol
approved by the board; and
(4) Be available for emergency consultation with the cosmetic laser practitioner or
anyone employed by the facility.
(b) Any facility providing cosmetic laser services other than hair removal using lasers
or pulsed light devices shall have a supervisor present at the facility or immediately
available for consultation and supervision either personally or via
telecommunications. The supervisor shall supervise the performance of all cosmetic
laser services performed by a person other than the consulting physician. The
supervisor shall be a physician licensed under this chapter who is trained in laser
modalities or a senior laser practitioner.
(c) (1) Any facility providing cosmetic laser services other than hair removal using
lasers or pulsed light devices shall post a sign listing the consulting physician's name,
emergency contact number, his or her board certification and specialty, and the
address of his or her principal place of practice, and indicating whether he or she is
presently on site at the facility.
(2) If the consulting physician is not on site for any period of time during which the
facility is open, the facility shall post a sign indicating who is presently acting as the
supervisor for the facility and that person's name, emergency contact number, his or
her degrees and qualifications, and the type of cosmetic laser practitioner license
held.
HISTORY: Code 1981, § 43-34-248, enacted by Ga. L. 2007, p. 626, § 1/HB 528;
Ga. L. 2009, p. 859, § 1/HB 509; Ga. L. 2009, p. 989, § 3/SB 104.
§ 43-34-249. (For effective date, see note.) Informed consent
(a) Prior to receiving cosmetic laser services from a cosmetic laser practitioner, a
person must consent in writing to such services and shall be informed in writing of
the general terms of the following:
(1) The nature and purpose of such proposed procedure;
(2) Any material risks generally recognized and associated with the cosmetic laser
service to be performed which, if disclosed to a reasonably prudent person in the
customer's position, could reasonably be expected to cause such prudent person to
decline such proposed cosmetic laser services on the basis of the material risk of
injury that could result from such proposed services;
(3) The name of, degrees and qualifications held by, and type of licenses obtained
by the individual who will be performing the cosmetic laser service, and with respect
to cosmetic laser services other than hair removal, the supervisor and the consulting
physician;
(4) The steps to be followed after the cosmetic laser service is performed in the
event of any complications; and
(5) With respect to cosmetic laser services other than hair removal, the emergency
contact information for the consulting physician and the address of his or her
94
principal place of practice.
(a.1) After receiving each cosmetic laser service other than hair removal, a person
shall be informed in writing of the information required by paragraphs (4) and (5) of
subsection (a) of this Code section.
(b) It shall be the responsibility of the cosmetic laser practitioner to ensure that the
information required by subsections (a) and (a.1) of this Code section is disclosed
and that the consent provided for in this Code section is obtained.
(c) Where the consumer is under 18 years of age, the consent of the consumer's
parent or legal guardian shall be required.
(d) The board shall be required to adopt and have the authority to promulgate rules
and regulations governing and establishing the standards necessary to implement
this Code section specifically including but not limited to the disciplining of a
cosmetic laser practitioner who fails to comply with this Code section.
(e) Nothing in this Code section shall prohibit the information provided for in this
Code section from being disclosed through the use of video tapes, audio tapes,
pamphlets, booklets, or other means of communication or through conversations
with the cosmetic laser practitioner; provided, however, that such information is also
provided in writing and attached to the consent form which the consumer signs.
HISTORY: Code 1981, § 43-34-249, enacted by Ga. L. 2007, p. 626, § 1/HB 528;
Ga. L. 2009, p. 859, § 1/HB 509; Ga. L. 2009, p. 989, § 4/SB 104.
§ 43-34-249.1. (For effective date, see note.) Waiver
The board shall have the authority to waive the requirements of subsection (c) of
Code Section 43-34-248 and paragraph (5) of subsection (a) of Code Section 43-34-
249 for facilities offering cosmetic laser services which serve as a principal place of
practice at which a physician regularly sees patients if medical services are regularly
performed at such facilities. For purposes of this Code section, "medical services"
shall mean the general and usual services and care rendered and administered by a
physician.
HISTORY: Code 1981, § 43-34-249.1, enacted by Ga. L. 2009, p. 989, § 5/SB 104.
§ 43-34-250. (For effective date, see note.) Advisory committee
The board shall appoint an advisory committee. The advisory committee shall
include licensed cosmetic laser practitioners licensed under this article and such
members as the board in its discretion may determine. The advisory committee shall
include at least one person licensed to practice medicine under this chapter and
specialized in a field with expertise in the biologic behavior of the skin. Members
shall receive no compensation for service on the committee. The committee shall
have such advisory duties and responsibilities as the board may determine, including
but not limited to consulting with the board on the issuance, denial, suspension, and
revocation of licenses and the promulgation of rules and regulations under this
article. The initial members of the advisory committee may include persons eligible
for licensing under this article. Subsequent advisory committee members must be
licensed pursuant to this article.

Our attorneys regularly consult and advice on telemedicine and other health care law and business legal matters involving online enterprises. For legal advice concerning telemedicine and other health care practices, whether involving physicians, nurses, psychologists, or CAM providers such as acupuncturists, or even life coaches, fitness consultants, nutritional advisors, and others, contact our health care lawyers today.

Our law firm has many successes with health care and business law clients, whose practices are transforming the business and health care landscape as we know it.

Michael also sponsors Being Central, a Portal for Potential, which gives access to other, pre-paid legal services.

FDA can seize unapproved medical devices used for "energy diagnosis"

Sun, 24 Jan 2010 12:40:39 -0500

If you are performing an "energetic diagnosis" for your healing or health care practice, beware of FDA medical device rules.

According to the federal Food, Drug & Cosmetic Act (FDCA), medical devices must be approved by the FDA prior to introduction in state commerce.

Merely stating that a machine or instrument is not a medical device or that it simply scans the body energetically is not enough.

Our law office represents manufacturers, distributors, and physicians and other health care providers involved in alternative energy devices that are supposed to read the patient's bio-energy (bioenergy) or energy field (aura). These present significant legal issues, including FDA medical device law, licensing law, professional discipline provisions of state medical boards and other professional regulators, malpractice liability (negligence), informed consent, insurance reimbursement, and other health care law issues. If you need legal advice concerning an FDA medical device used in a complementary and alternative medicine (CAM) or integrative health care practice, call one of our attorneys today. Our lawyers are experienced in FDA medical device, dietary supplement, and related law.

Below is just one warning letter suggesting the length and breadth of FDA enforcement action. This was retrieved when searching the FDA warning letters for light therapy, energy diagnosis, or biofeedback.

June 18, 2003

WARNING LETTER

VIA CERTIFIED MAIL
RETURN RECEIPT REQUESTED

Ms. Nadine M. Donahue,
CEO and President
Bioscan, Inc.
45 Dusty Trail Drive
Placitas, New Mexico 87043

Ref. #: DEN-03-18

Dear Ms. Donahue:

We are writing to you because of the regulatory problems involving the BioFind III (or Biofind), BioPack II (or BioPack), Light Patch, Spinal Pad, and Knee Saver products, which are manufactured or distributed by your firm. These products are medical devices under section 201 (h) of the Federal Food, Drug, and Cosmetic Act (the Act). Your firm fails to comply with applicable premarket notification requirements and the agency’s Quality System/Good Manufacturing Practice Regulation.

A. Violation of premarket notification requirements

Information on your firm’s website at http://www.bioscanlight.com indicates violation of premarket notification requirements. The law requires that manufacturers of medical devices obtain marketing clearance for their products from the FDA before they may offer them for sale. However, your firm has not submitted a premarket notification (510(k)) submission and obtained marketing clearance before it began marketing the Knee Saver by offering it for sale on your website. In addition, your firm may be marketing a new product called the Podiatric LED Device: Neuropathy Boot. This product appears on your firm's website. We have not received a premarket notification submission for this product and we request that you provide information on the marketing status-of this device. We also urge you to review all of the products that your firm distributes to assure that required premarket clearances have been obtained.

Also, our records show that, while your firm submitted premarket notification (510(k)) submissions for the BioFind III (or Biofind), BioPack II (or BioPack), Light Patch, and Spinal Pad devices, you are marketing these devices for many new indications for use for which you have not obtained marketing clearance. Examples of these new indications for use, taken from your firm’s website, through which customers can buy the products, include the following: treatment of corneal ulcers, stimulates the release of adenosine triphosphate (ATP), increases RNA and DNA synthesis, increases phagocytosis, and stimulates acetylcholine release. These are major changes or modifications in the intended use of these devices and require new premarket notification submissions (21 CFR 807.81 (a)(3)(ii)).

In general, your BioPack II (or BioPack), Light Patch, and Spinal Pad devices containing infrared diodes were cleared as infrared lamps that provide topical heating in a therapeutic range, not for photonic or light therapy; and the visible red diodes that do not provide topical heating were not to be discussed in your device labeling, etc. Specifically, the only indications for use that these devices were cleared for are: Use whenever hot applications are desirable for personal comfort and whenever recommended by a licensed medical professional, providing temporary relief of minor aches and pains in muscles and joints, aiding in relaxation of muscles, helping to provide for a temporary improved range and freedom of motion due to muscle relaxation and temporary minor pain relief, and providing a temporary increase in local blood
circulation.

With respect to the BioFind III (or Biofind) device, the only cleared indication for use is for galvanic skin measurement for biofeedback information. Also, your firm was informed by FDA during the 510(k) review process in 2001 that scanning the whole body and not just two points in the body is a new intended use for which the predicate device was not cleared, and your firm subsequently agreed to delete references to the scanning as well as to limit other specified claims.

The kind of information your firm needs to submit in order to obtain premarket clearance for the Knee Saver and for the new intended uses for your other products is described on the agency’s Internet website at http://www.fda.gov/cdrh/devadvice/3122.html. Please be advised that your Premarket Notification submissions should include valid scientific data to support any claims outside of the above listed cleared claims/indications for infrared lamp devices and for the BioFind III. The FDA will evaluate this information and decide whether your products may be legally marketed.

Your promotion and introduction into interstate commerce of the BioFind III (or Biofind), BioPack II (or BioPack), Light Patch, Spinal Pad, and the Knee Saver for these uncleared indications render them adulterated under section 501 (f)(1)(B) of the Act, for failure to obtain FDA premarket approval, and misbranded under section 502(o) of the Act, for failure to notify the agency of your intent to introduce the device into commercial distribution, as required by section 510(k) of the Act. For a product requiring premarket approval before marketing, the notification required by section 510(k) of the act is deemed to be satisfied when a premarket approval application (PMA) is pending before the agency (21 CFR 807.81 (b)).

You should know that these serious violations of the law may result in the FDA taking regulatory action without further notice to you. These actions include, but are not limited to, seizing your product inventory, obtaining a court injunction against further marketing of the product, or assessing civil money penalties. In addition, United States federal agencies are advised of the issuance of all Warning Letters about medical devices so that they may take this information into account when considering the award of contracts. Also, no requests for Certificates For Products For Export will be approved until the violations related to the subject devices have been corrected. It is necessary for you to take action on this matter now.

B. Violation of quality system regulation requirements

Additionally, for your information, on September 17, 25, and 26, 2002, an investigator from the FDA Albuquerque, New Mexico office conducted an inspection of your establishment located at 45 Dusty Trail Drive, Placitas, New Mexico 87043. The inspection revealed that the methods used in, or the facilities or controls used for, the manufacture, packing, storage, or installation of these devices are not in conformance with the Quality System (QS) Regulation, as specified in 21 CFR, Part 820. These deviations from the QS Regulation cause your products to be adulterated within the meaning of section 501 (h) of the Act. Significant deviations include, but are not limited to, the following:

1. Failure to establish and maintain device master records (DMR) for the BioFind, BioPack, Light Patch, Spinal Pad, and Knee Saver devices, which include:
a. device specifications;
b. production process specifications;
c. quality assurance procedures and specifications;
d. packaging and labeling specifications and;
e. installation, maintenance and servicing procedures and methods; as required by 21 CFR 820.181.

2. Failure to establish and maintain device history records (DHR), for each batch, lot, or unit, to demonstrate that the device is manufactured in accordance with the DMR and the requirements of 21 CFR Part 820, as required by 21 CFR 820.184.

3. Failure to establish and maintain a quality system that is appropriate for the specific medical devices designed and manufactured by your firm, which includes:
a. quality policy;
b. organizational structure;
c. management review of the quality system;
d. a quality plan which defines the quality practices, resources and activities;
e. a quality system procedure; as required by 21 CFR 820.5 and 820.20.

4. Failure to establish procedures for quality audits, and to conduct audits to determine the effectiveness of the quality system and assure that it meets established requirements, as required by 21 CFR 820.22.

5. Failure to establish and maintain procedures for receiving, reviewing, and evaluating complaints by a formally designated unit, and for ensuring that complaints are evaluated to determine whether the complaint represents an event which is required to be reported to FDA under 21 CFR 803, Medical Device Reporting (MDR), as required by 21 CFR 820.198.

6. Failure to establish and maintain procedures for implementing corrective and preventive action, as required by 21 CFR 820.100.

7. Failure to establish and maintain procedures to control the design of the device in order to ensure that specified design requirements are met, as required by 21 CFR 820.30.

8. Failure to establish and maintain procedures for control and distribution of finished devices to ensure that only those devices approved for release are distributed, as required by 21 CFR 820.160.

9. Failure to establish and maintain procedures to control product that does not conform to specified requirements, as required by 21 CFR 820.90.

10. Failure to establish and maintain procedures for identifying product during all stages of receipt, production, distribution and installation to prevent mix-ups, as required by 21 CFR 820.60.

11. Failure to establish and maintain procedures to control all documents specified by the Quality System regulation, as required by 21 CFR 820.40.

12. Failure to establish and maintain procedures to ensure that all purchased or otherwise received product and services conform to specified requirements, as required by 21 CFR 820.50.

This letter is not intended to be an all-inclusive list of deficiencies at your facility. It is your responsibility to ensure adherence to each requirement of the Act and regulations. The specific violations noted in this letter and in the Form FDA 483 provided to your firm at the closeout of the inspection may be symptomatic of serious underlying problems in your firm’s manufacturing and quality assurance systems. You are responsible for investigating and determining the causes of the violations identified by the FDA. If the causes are determined to be systems problems, you must promptly initiate permanent corrective actions. We have received a letter from you dated October 1, 2002, and letter from Mr. Peter J. Chase, dated March 3, 2003. The responses in these two letters are not adequate; they did not fully address or describe how you have corrected or will correct the noncompliances noted above.

Please let this office know in writing within 15 working days from the date you receive this letter, the steps you are taking to correct the problems. We also ask that you explain how you plan to prevent these deficiencies from occurring again. If you need more time, let us know why and when you expect to complete your corrections. Please address your response and any questions you may have regarding this letter to William H. Sherer, Compliance Officer, Food and Drug Administration, Denver District, P.O. Box 25087, Denver, CO 80225-0087, (303) 236-3051.

Sincerely,

/s/

B. Belinda Collins

District Director

Our law firm has many successes with health care and business law clients, whose practices are transforming the business and health care landscape as we know it.

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Which corporate entity is best for your business?

Sat, 23 Jan 2010 17:50:30 -0500

Should you form a corporation (S or C), LLC, general partnership, limited partnership, or some other entity ... or do you need a professional corporation?

Our attorneys have experience advising on corporate entity formation and can give you guidance in making critical business decisions, whether you need help with general business legal issues or in health care relating to complementary and alternative medical therapies or otherwise.

There are also many online resources about incorporation and the pros and cons of different structures.

Here is just one we came across researching other aspects of law. This one is from Georgia's Department of Corporations.

Thanks Georgia, you're always on my mind.

Ready to scroll? Here goes:

WHICH LEGAL ENTITY
IS RIGHT FOR
YOUR BUSINESS:
YOUNGER LAWYERS SECTION
CORPORATE, BANKING AND IN-HOUSE
COUNSEL COMMITTEE
STATE BAR OF GEORGIA
This brochure has been prepared by the Corporate, Banking and In-House Counsel
Committee of the Younger Lawyers Section of the State Bar of Georgia. Its purpose is to
inform the public and not to advise regarding specific legal issues. Consult your attorney
for legal advice pertinent to your particular situation. 2/00
SPONSORED BY
© 2000 State Bar of Georgia
SOLE PROPRIETORSHIP,
GENERAL PARTNERSHIP,
LIMITED PARTNERSHIP,
CORPORATION OR
LIMITED LIABILITY COMPANY?
of Atlanta
A limited partnership is composed of general partners and limited partners. The defining
characteristic of a limited partnership is that limited partners can invest capital
in a business of the limited partnership and take a share in the profits without
becoming personally liable for partnership debts and obligations.
Control
Unlike limited partnerships in many other states, in Georgia limited partners may participate
in controlling the business without becoming personally liable for the limited
partnership's obligations. Thus, Georgia is a particularly attractive state for the
formation of limited partnerships in which limited partners wish to have an active
role in the management and control of limited partnership affairs.
The limited partnership agreement may govern which partners or classes of partners
control the entity. As with general partnerships, Georgia law will govern the handling
of matters not addressed in the partnership agreement. General partners have equal
rights to participate in the management of the limited partnership and have the
power to bind the limited partnership in transactions with third parties. A limited
partner can assign his or her interest in the profits of the limited partnership and
the assignee may become a limited partner if the limited partnership agreement so
provides or if all other partners consent.
Liability
As mentioned above, limited partners are not personally obligated for the liabilities
of the limited partnership by reason of being a limited partner and do not become
so by participating in the management or control of the business. A general partner
has unlimited liability, similar to a general partner in a general partnership (except
as otherwise provided in the Georgia Revised Uniform Limited Partnership Act). To
avoid such unlimited liability, many limited partnerships have a corporation as their
general partner. Alternatively, the entity may limit the liability of the general partner
by electing LLLP status through a filing with the Secretary of State. Each general
partner owes the utmost duty to the limited partnership and to each of the other
general and limited partners.
Taxation
The limited partnership pays no entity-level income tax or net worth tax, and each
partner is taxed directly upon his or her respective distributive share of the limited
partnership's profits (which may or may not be the same as their ownership percentage),
unless the limited partnership elects to be taxable as a corporation.
Administration
Limited partnerships in Georgia are required to register with the Secretary of State,
but are governed by a Limited Partnership Agreement among the parties, and generally
do not have to contend with burdensome requirements for filings, publications,
or record maintenance.
LIMITED PARTNERSHIP
The Limited Liability Company (LLC) is a business entity organized under state law
that offers limited liability like a corporation along with the possibility of "passthrough"
taxation, unless it elects corporate treatment for federal tax purposes.
Therefore, an LLC is a cross between a partnership and a corporation.
An LLC is owned by one or more interest holders called "members" and any member
can exercise management rights. However, an LLC also allows the members to
manage the entity or to designate specific managers who may or may not be members,
to manage the entity as is done in many corporations. Like a corporation, an
LLC has the advantage of "perpetual" existence — its business operations can continue
despite the death of someone who owns a business interest. Ownership interests
are transferred easily from one member to another.
Liability
As its name implies, the LLC provides limited liability for its owners similar to shareholders
in a corporation. The LLC owner risks only their investment in the business.
Other personal assets are not a risk, unless the owner has personally guaranteed the
debt.
Taxes
Under new IRS regulations, the LLC with more than one member will be taxed as a
partnership unless it elects to be taxed as a corporation and the LLC with only one
member will be disregarded for tax purposes. If it is treated as a
partnership, the LLC's earnings will be apportioned to its owners and taxed at their
personal tax rates, similar to the tax treatment of a limited partnership. However, it
is possible to elect corporate tax treatment, whereby it will be taxed as a corporation.
Administration
The process of creating an LLC closely resembles the process of creating a corporation.
Georgia law requires that "Articles of Organization" be filed with the Secretary
of State. An LLC has an "operating agreement" which, like the agreement of
partnership or LP, determines the conduct of the business, including the rights and
powers of its members, managers, and employees and which generally allows the
members to structure the company's affairs as they see fit, rather than as a statute
requires.
LIMITED LIABILITY COMPANY
A corporation is a legal entity that is separate from its owners, the shareholders. It
is formed by filing certain documents with the Secretary of State and taking other
actions required by the Code. A corporation may have perpetual existence, meaning
that it continues to exist regardless of the status of the individual shareholders.
Control
A corporation is composed of three different "players": the shareholders, directors and
officers. It is critical to understand that these players have different responsibilities,
obligations and authorities. The shareholders own the corporation and elect the directors.
The directors govern the general affairs of the corporation and appoint officers
who conduct the day to day business of the corporation. It is typical in smaller corporations
for an individual to hold two or three "player" positions. In fact, one person
can be the sole shareholder, director and officer.
Liability
Limited liability is the most important reason to incorporate. The debts incurred by
the corporation cannot generally be collected from the officers, directors or shareholders
of the corporation. This allows one to protect his or her personal assets from
the debts and obligations of the corporation. However, oftentimes shareholders are
called upon to guaranty payment of the debts of the corporation. It is important to
keep personal and business dealings separate from the corporation's business in order
to ensure that one cannot be personally liable for obligations of the corporation.
Taxation
"For profit" corporations (other than S corporations, which are discussed below) are
subject to what is know as "double taxation." This means that the corporation pays
tax on the income earned by the corporation and its shareholders pay tax on dividends
received from the corporation. An S corporation is not subject to double taxation.
Rather, for tax purposes, it is known as a "pass-through" entity (as is a partnership).
The term "pass-through" means that there is no tax on the corporation, but
that the income and losses of the S corporation are passed through to the shareholders
in proportion to their ownership interests whether or not they record a distribution.
A corporation can be an S corporation merely by meeting certain eligibility requirements
and making a special election with the IRS. These eligibility requirements
include having no more than 75 shareholders who must be individuals or certain
trusts or estates. Further, the shareholders may not be non-resident aliens and the S
corporation can only have one class of stock. From a legal standpoint, an S corporation
is no different than any other corporation. It is organized and operated like other
corporations and has all of the characteristics of a corporation described above. From
a tax perspective, however, they are very different. A tax professional should be consulted
to determine whether the shareholders will benefit from causing a corporation
to make an S election.
CORPORATION Administrative
The corporate form of doing business does have some disadvantages. Sine the corporation
is a separate entity, it must file tax returns and pay taxes on its income. A
corporation must maintain certain records in order to ensure that its corporate status
is maintained. This means additional accounting and legal costs associated with
using the corporate form of doing business.

The sole proprietorship is the simplest, least regulated and most common form of
business organization. Legally and for tax purposes the individual owner is the business.
The liabilities and profits are personal to the owner.
Control
The sole proprietor has total control of the business. The problem with total control
is that if the owner dies, the business ceases to exist. The assets and liabilities of the
sole proprietor will pass to his or her estate, but often the expertise and knowledge
of the business usually die with the sole proprietor. A competent estate planning
lawyer can assist the sole proprietor in arranging for the business to be transferred
to a family member or some other person upon the death of the sole proprietor.
Liability
In a sole proprietorship, all of the personal and business assets of the sole proprietor
are at risk. One obtaining a legal judgment for damages against a sole proprietor
can secure a lien against his or her personal assets and can foreclose on the
lien. This unlimited liability is the greatest disadvantage of this type of business form.
Different types of insurance coverage are available to lessen the perils of having one’s
personal assets at risk.
Taxes
Taxes are reported on the sole proprietor's personal income tax forms. The sole proprietorship
is the simplest form of business for tax purposes. As the business grows,
the sole proprietor may wish to change to another business organization if it would
result in significantly lower taxes. Sole proprietors should also contact their local, state
and federal tax authorities regarding the collection of sales and other taxes.
Administrative Obligations
The sole proprietor should maintain adequate records to successfully run the business
and for tax purposes. However, there are no administrative requirements, such as maintaining
minutes of meetings or passing resolutions, with which he or she must comply.
Usually, the only requirement is to obtain and pay the fee for a local business
license. Georgia also requires that a sole proprietor operating under a trade name
register in the county where it will transact a majority of its business. This allows
creditors and others the opportunity to learn the identity of the actual owner, since
it will be the owner who is personally liable for the debts and obligations of the
business.
SOLE PROPRIETORSHIP
The legal form of doing business as a general partnership comes into existence when
there is an association of two or more persons, the general partners, who carry on
a business for profit as co-owners. The existence of a profit motive is essential. No
filing or other registration with the Secretary of State is required.
Control
Each general partner has a right to participate in partnership management, as well
as a right to share in the profits of the partnership. The issue of control can be
addressed with a partnership agreement. This written agreement is not legally
required, but it encourages specificity. An interest in a general partnership cannot be
transferred without the consent of the other general partners (unless the transferred
interest is only a right to profits). Death or withdrawal of any general partner dissolves
the general partnership.
Liability
Each general partner has joint and several unlimited personal liability for obligations
of the general partnership. This means that each general partner has the potential
of being personally indebted for each obligation of the general partnership. One general
partner's actions can make another general partner personally liable on a contract.
Similarly, the actions or torts of one general partner arising in the ordinary
course of the general partnership's business can result in another general partner
being personally liable on a contract or in a lawsuit. Further, a general partner owes
the utmost duty to the general partnership and to each of the other general partners.
In order to limit the liability of a general partner, such entities often elect to
be treated as a LLP by filing a certificate with the Secretary of State.
Taxation
Partnerships are "pass-through" entities for tax purposes; the general partnership itself
does not pay taxes. Each general partner takes into account his or her share of general
partnership income, losses, deductions and credits in determining his or her personal
tax liability. A partnership agreement may provide for the allocation of these
tax benefits and burdens.
Administration
General partnerships do not require any formal organizational meeting or state filing
requirement to come into existence. The only obligations required are those germane
to all business entities such as a business license, tradename registration, proper permits
and the like, unless a decision is made to elect LLP status.
GENERAL PARTNERSHIP
SOLE
PROPRIETORSHIP
CONTROL LIABILITY TAXES ADMINISTRATION
GENERAL
PARTNERSHIP
LIMITED
PARTNERSHIP
CORPORATION
LIMITED
LIABILITY
COMPANY
Sole Proprietor has total
control of business
operations and complete
share of profits
All of Sole Proprietor's
personal and business
assets are at risk
Taxes reported on Sole
Proprietor's tax forms
No administrative
requirements other than
obtaining business license
and registering trade name
Management and profits
shared between partners
per the terms of the
Partnership Agreement
General Partners are
generally liable for
obligations of General
Partnership and tort
damages incurred by other
General Partners
"Pass-Through" Entity.
Each general partner is
taxed directly upon his/her
share of profits
No formal administrative
requirements other than
obtaining proper licenses
and permits.
General and Limited
partners share in the
control and profits of the
partnership per the terms of
the Partnership Agreement
Limited partners: not
personally obligated for
liabilities of partnership
General partners: same as
partners in a General
Partnership
Pass-Through Entity.
Each partner is taxed
directly upon his/her share
of profits
Registration requirements
similar to Corporations,
but no burdensome
record-keeping or tax
filing requirements
Shareholders: ownership
rights & elect directors
Directors: govern general
affairs & appoint officers
Officers: manage business
operations
Neither Officers, Directors
or Shareholders are liable
for debts incurred by the
Corporation or torts
committed in conducting
the Corporation's business
"Double-Taxation" unless
"S" Corporation, which is a
"Pass-Through" Entity akin
to a General Partnership
Formal incorporation
process and annual
registration with Secretary
of State. Comprehensive
record-keeping and tax
filing requirements
Members share profits per
Operating Agreement
which specifies management
procedures
Generally, Members risk
only their investment in
the LLC
May be taxed as
Partnership or Corporation,
depending upon the
election filed with the IRS
Similar to Corporation's
requirements with regard
to formation and operation
Selecting the appropriate legal entity for conducting one's business requires consideration of many factors. This brochure sets forth some of the basic characteristics of five
different types of legal entities. It is unlikely that you will be able to select the entity most appropriate for your business by only reading this brochure. Consult private counsel to
select the legal entity most appropriate for your business.

Telemedicine prohibitions and legal rules governing online patient consults

Fri, 22 Jan 2010 12:48:17 -0500

With advent of Google health and online personalized, health care recommendations, telemedicine legal issues frequently arise.

Telemedicine laws vary by state, and frequently take some digging to discover.

For example, this little legal rule is buried inside a disciplinary provision of one of the Administrative Rules of the Georgia Composite Medical Board:

(6) Providing treatment via electronic or other means unless a history and physical examination of the patient has been performed by a Georgia licensee. This shall not prohibit a licensee who is on call or covering for another licensee from treating and/or consulting a patient of such other licensee. Also, this paragraph shall not prohibit a patient’s attending physician from obtaining consultations or recommendations from other licensed health care providers.

The do's and don't are fairly clear here, but the point is that it takes some legal research to ascertain what rules apply, and that one must look to the state where the patient is situated as well as the state of the health care practitioner.

Our law firm has many successes with health care and business law clients, whose practices are transforming the business and health care landscape as we know it.

Michael also sponsors Being Central, a Portal for Potential, which gives access to other, pre-paid legal services.

Laws regulating who can perform cosmetic laser procedures

Fri, 22 Jan 2010 12:26:47 -0500

Who can legally perform cosmetic procedures including laser surgery?

The answer varies by state law. Sometimes only a physician may perform cosmetic procedures involving lasers as these are considered the practice of medicine.

Below is the law in Georgia. For more information regarding your intregrative or holistic health center or medical spa about the legality of cosmetic procedures including laser, Botox, Restalyne, and other aesthetic medical treatments, contact one of our medical spa and health care law attorneys today.

Code 1981, § 43-34-240, enacted by Ga. L. 2007, p. 626, § 1/HB 528; Code 1981, § 43-34-241, enacted by Ga. L. 2007, p. 626, § 1/HB 528;

ARTICLE 9. COSMETIC LASER SERVICES

§ 43-34-240. (For effective date, see note.) Short title

This article shall be known and may be cited as the "Georgia Cosmetic Laser

Services Act."

HISTORY:

Ga. L. 2009, p. 859, § 1/HB 509.

§ 43-34-241. (For effective date, see note.) Legislative findings; purpose

This article is enacted for the purpose of safeguarding the public health, safety,

and welfare by providing for state administrative control, supervision, and regulation

of the practice of providing cosmetic laser services. It is the intention of the General

Assembly that cosmetic laser services be made available and affordable to the people

of this state in a safe, reliable manner. Unregulated cosmetic laser services do not

adequately meet the needs or serve the interests of the public. Licensure of those

performing cosmetic laser services and required education and training of such

practitioners will help ensure the health and safety of consumers. The practice of

providing cosmetic laser services is declared to be affected with the public interest;

and this article shall be liberally construed so as to accomplish the purpose stated in

this Code section.

HISTORY:

Ga. L. 2009, p. 859, § 1/HB 509.

§ 43-34-242. (For effective date, see note.) Definitions

As used in this article, the term:

(1) "Board" means the Georgia Composite Medical Board created by Code Section

43-34-2.

(2) "Consulting physician" means a person licensed to practice medicine under

Article 2 of this chapter and:

(A) Whose principal place of practice is within this state; or

(B) Whose principal place of practice is outside this state but is within 50 miles

from the facility with whom he or she has an agreement to provide services in

accordance with Code Section 43-34-248.

(3) "Consumer" means a person on whom cosmetic laser services are or are to be

performed.

(4) "Cosmetic laser practitioner" means a person licensed under this article to

provide cosmetic laser services as defined in this article and whose license is in good

standing.

(5) "Cosmetic laser services" means nonablative elective cosmetic light based skin

care, photo rejuvenation, or hair removal using lasers or pulsed light devices

approved by the United States Food and Drug Administration for noninvasive

procedures. Such services and the provision thereof shall not be considered to be the

practice of medicine.

(6) "Facility" means any location, place, area, structure, office, institution, or

business or a part thereof in which is performed or provided cosmetic laser services

regardless of whether a fee is charged for such services.

(7) "License" means a valid and current certificate of registration issued by the

board which shall give the person to whom it is issued authority to engage in the

practice prescribed thereon.

(8) "Licensee" means any person holding a license under this article.

(9) "Medical practitioner" means a registered professional nurse, nurse

practitioner, physician assistant, or physician.

(10) "Nurse" means a registered professional nurse or nurse practitioner.

(11) "Person" means a natural person.

Code 1981, § 43-34-242, enacted by Ga. L. 2007, p. 626, § 1/HB 528;

HISTORY:

Ga. L. 2009, p. 859, § 1/HB 509; Ga. L. 2009, p. 989, § 1/SB 104.

§ 43-34-243. (For effective date, see note.) Permitted activities

This article shall not be construed to prohibit:

(1) A licensed physician from engaging in the practice for which he or she is

licensed;

(2) A licensed physician assistant from engaging in the practice for which he or she

is licensed;

(3) A person licensed by this state as a registered professional nurse, licensed

practical nurse, or nurse practitioner from engaging in his or her profession;

(4) A licensed esthetician from engaging in his or her profession;

(5) A master cosmetologist from engaging in his or her profession;

(6) Any person licensed under any other article of this chapter from engaging in

the practice for which he or she is licensed;

(7) A person licensed in this state under any other law from engaging in the

practice for which he or she is licensed;

(8) The practice of providing cosmetic laser services by a person who is employed

by the federal government or any bureau, division, or agency of the federal

government while in the discharge of the employee's official duties;

(9) The practice of providing cosmetic laser services by a student enrolled in an

accredited school of nursing or medical school as part of his or her training; or

(10) Employees or authorized representatives of a manufacturer of a laser used for

cosmetic laser services from engaging in one or more of the following: evaluating,

adjusting, measuring, designing, fabricating, assembling, fitting, servicing, training,

repairing, replacing, or delivering a laser used to provide cosmetic laser services

under the order, direction, or prescription of a physician or health provider operating

within his or her licensed scope of practice.

Code 1981, § 43-34-243, enacted by Ga. L. 2007, p. 626, § 1/HB 528;

HISTORY:

Ga. L. 2009, p. 859, § 1/HB 509.

§ 43-34-244. (For effective date, see note.) Two levels of license; application

(a) There shall be two levels of a license for a cosmetic laser practitioner: assistant

laser practitioner and senior laser practitioner.

(b) Any person desiring to obtain a license as a cosmetic laser practitioner under the

terms of this article shall make application to the board as follows:

(1) An applicant for an "assistant laser practitioner" license shall present proof that

he or she:

(A) Holds a current valid license or certificate of registration as a physician

assistant, licensed practical nurse, nurse, esthetician, or master cosmetologist, or

has previously held a license or certificate of registration as a medical practitioner;

and

(B) Has received at least three laser certificates from attending laser/intense

pulsed light (IPL) courses as approved by the board, directly taught by a licensed

physician or certified continuing medical education or continuing education educator.

If, after review of the application, it is determined that the applicant is at least 21

years of age; has met the minimum educational requirements; is of good moral

character; and is possessed of the requisite skill to perform properly cosmetic laser

services, a license shall be issued to the applicant entitling the applicant to practice

the occupation of cosmetic laser practitioner at the assistant laser practitioner level

under the on-site supervision of a senior laser practitioner.

(2) An applicant for a "senior laser practitioner" license shall present proof that he

or she:

(A) Holds a current valid license or certificate of registration as a physician

assistant or nurse or has previously held a license or certificate of registration as a

medical practitioner;

(B) Has at least three years of clinical or technological medical experience, or

both;

practitioner for at least three years; and

(D) Has received at least two laser certificates from attending laser/intense

pulsed light (IPL) continuing medical education courses as approved by the board,

directly taught by a licensed physician or certified continuing medical education or

continuing education educator. If, after review of the application, it is determined

that the applicant is at least 21 years of age; has met the minimum educational and

clinical training requirements to perform cosmetic laser services with indirect

supervision; is of good moral character; and is possessed of the requisite skill to

perform properly these services, a license shall be issued to the applicant entitling

the applicant to practice the occupation of cosmetic laser practitioner at the senior

laser practitioner level pursuant to the protocols of a consulting physician.

does not meet the requirements of paragraph (1) of subsection (b) of this Code

section shall also be eligible for a license as an "assistant laser practitioner" if he or

she makes application to the board within nine months of the effective date of this

article and presents proof that he or she:

(1) Prior to the effective date of this article, obtained a minimum of at least 2,000

hours of experience in administering cosmetic laser service; and

(2) Has received at least two laser certificates from attending laser/intense pulsed

light (IPL) courses, directly taught by a licensed physician or certified continuing

medical education or continuing education educator.

(d) Should an applicant have a current cosmetic laser practitioner license or

certificate of registration in force from another state, country, territory of the United

States, or the District of Columbia, where similar reciprocity is extended to this state

and licensure requirements are substantially equal to those in this state, and have

paid a fee and have submitted an application, the applicant may be issued a license

at the appropriate level entitling him or her to practice the occupation of a cosmetic

laser practitioner at that level, unless the board, in its discretion, sees fit to require a

written or a practical examination subject to the terms and provisions of this article.

Code 1981, § 43-34-244, enacted by Ga. L. 2007, p. 626, § 1/HB 528;

HISTORY:

Ga. L. 2009, p. 859, § 1/HB 509; Ga. L. 2009, p. 989, § 2/SB 104.

§ 43-34-245. (For effective date, see note.) Expiration of licenses; license renewal

(a) All licenses shall expire biennially unless renewed. All applications for renewal

of a license shall be filed with the board prior to the expiration date, accompanied by

the biennial renewal fee prescribed by the board. A license which has expired for

failure of the holder to renew may only be restored after application and payment of

the prescribed restoration fee within the time period established by the board and

provided the applicant meets such requirements as the board may establish by rule.

Any license which has not been restored within such period following its expiration

may not be renewed, restored, or reissued thereafter. The holder of such a canceled

license may apply for and obtain a valid license only upon compliance with all

relevant requirements for issuance of a new license.

(b) As a condition of license renewal, the board shall require licensees to provide

proof, in a form approved by the board, of a minimum of five hours of continuing

education courses as approved by the board in the area of cosmetic laser services,

equipment safety and operation, procedures, and relative skin modalities, directly

taught by a licensed physician or certified continuing medical education or continuing

education educator.

HISTORY:

Code 1981, § 43-34-245, enacted by Ga. L. 2007, p. 626, § 1/HB 528; Code 1981, § 43-34-246, enacted by Ga. L. 2007, p. 626, § 1/HB 528; Code 1981, § 43-34-247, enacted by Ga. L. 2007, p. 626, § 1/HB 528;

Ga. L. 2009, p. 859, § 1/HB 509.

§ 43-34-246. (For effective date, see note.) Sanctions

The board may impose on a cosmetic laser practitioner or applicant any sanction

authorized under subsection (b) of Code Section 43-34-8 upon a finding of any

conduct specified in subsection (a) of Code Section 43-34-8.

HISTORY:

Ga. L. 2009, p. 859, § 1/HB 509.

§ 43-34-247. (For effective date, see note.) Petition to restrain or enjoin unlicensed

cosmetic laser practitioner

The practice of providing cosmetic laser services is declared to be an activity

affecting the public interest and involving the health, safety, and welfare of the

public. Such practice when engaged in by a person who is not licensed as a cosmetic

laser practitioner or otherwise licensed to practice a profession which is permitted

under law to perform cosmetic laser services is declared to be harmful to the public

health, safety, and welfare. The board or the district attorney of the circuit where

such unlicensed practice exists, or any person or organization having an interest

therein, may bring a petition to restrain and enjoin such unlicensed practice in the

superior court of the county where such unlicensed person resides. It shall not be

necessary in order to obtain an injunction under this Code section to allege or prove

that there is no adequate remedy at law, or to allege or prove any special injury.

HISTORY:

Ga. L. 2009, p. 859, § 1/HB 509.

§ 43-34-248. (For effective date, see note.) Agreement with consulting physician

(a) Any facility providing cosmetic laser services other than hair removal using

lasers or pulsed light devices shall have an agreement with a consulting physician

who shall:

(1) Be trained in laser modalities;

(2) Establish proper protocols for the cosmetic laser services provided at the

facility and file such protocols with the board;

(3) Examine each patient prior to any cosmetic laser service other than hair

removal using lasers or pulsed light devices being performed; provided, however,

that a consulting physician may delegate the authority to perform such examination

to a physician's assistant who is a licensed cosmetic laser practitioner, in accordance

with a job description approved by the board, or to a registered professional nurse

who is also an advanced practice registered nurse as defined in paragraph (1.1) of

Code Section 43-26-3 and who is a licensed cosmetic laser practitioner, pursuant to

a protocol approved by the board; and provided, further, that in facilities subject to

the provisions of Code Section 43-34-249.1 such delegation may be to: (A) a

physician's assistant who is not required to be a licensed cosmetic laser practitioner,

in accordance with a job description approved by the board; or (B) a registered

professional nurse who is also an advanced practice registered nurse who is not

required to be a licensed cosmetic laser practitioner, in accordance with a protocol

approved by the board; and

(4) Be available for emergency consultation with the cosmetic laser practitioner or

anyone employed by the facility.

(b) Any facility providing cosmetic laser services other than hair removal using lasers

or pulsed light devices shall have a supervisor present at the facility or immediately

available for consultation and supervision either personally or via

telecommunications. The supervisor shall supervise the performance of all cosmetic

laser services performed by a person other than the consulting physician. The

supervisor shall be a physician licensed under this chapter who is trained in laser

modalities or a senior laser practitioner.

lasers or pulsed light devices shall post a sign listing the consulting physician's name,

emergency contact number, his or her board certification and specialty, and the

address of his or her principal place of practice, and indicating whether he or she is

presently on site at the facility.

(2) If the consulting physician is not on site for any period of time during which the

facility is open, the facility shall post a sign indicating who is presently acting as the

supervisor for the facility and that person's name, emergency contact number, his or

her degrees and qualifications, and the type of cosmetic laser practitioner license

held.

Code 1981, § 43-34-248, enacted by Ga. L. 2007, p. 626, § 1/HB 528;

HISTORY:

Ga. L. 2009, p. 859, § 1/HB 509; Ga. L. 2009, p. 989, § 3/SB 104.

§ 43-34-249. (For effective date, see note.) Informed consent

(a) Prior to receiving cosmetic laser services from a cosmetic laser practitioner, a

person must consent in writing to such services and shall be informed in writing of

the general terms of the following:

(1) The nature and purpose of such proposed procedure;

(2) Any material risks generally recognized and associated with the cosmetic laser

service to be performed which, if disclosed to a reasonably prudent person in the

customer's position, could reasonably be expected to cause such prudent person to

decline such proposed cosmetic laser services on the basis of the material risk of

injury that could result from such proposed services;

(3) The name of, degrees and qualifications held by, and type of licenses obtained

by the individual who will be performing the cosmetic laser service, and with respect

to cosmetic laser services other than hair removal, the supervisor and the consulting

physician;

(4) The steps to be followed after the cosmetic laser service is performed in the

event of any complications; and

(5) With respect to cosmetic laser services other than hair removal, the emergency

contact information for the consulting physician and the address of his or her

principal place of practice.

(a.1) After receiving each cosmetic laser service other than hair removal, a person

shall be informed in writing of the information required by paragraphs (4) and (5) of

subsection (a) of this Code section.

(b) It shall be the responsibility of the cosmetic laser practitioner to ensure that the

information required by subsections (a) and (a.1) of this Code section is disclosed

and that the consent provided for in this Code section is obtained.

parent or legal guardian shall be required.

(d) The board shall be required to adopt and have the authority to promulgate rules

and regulations governing and establishing the standards necessary to implement

this Code section specifically including but not limited to the disciplining of a

cosmetic laser practitioner who fails to comply with this Code section.

(e) Nothing in this Code section shall prohibit the information provided for in this

Code section from being disclosed through the use of video tapes, audio tapes,

pamphlets, booklets, or other means of communication or through conversations

with the cosmetic laser practitioner; provided, however, that such information is also

provided in writing and attached to the consent form which the consumer signs.

Code 1981, § 43-34-249, enacted by Ga. L. 2007, p. 626, § 1/HB 528; Code 1981, § 43-34-249.1, enacted by Ga. L. 2009, p. 989, § 5/SB 104.

HISTORY:

Ga. L. 2009, p. 859, § 1/HB 509; Ga. L. 2009, p. 989, § 4/SB 104.

§ 43-34-249.1. (For effective date, see note.) Waiver

The board shall have the authority to waive the requirements of subsection (c) of

Code Section 43-34-248 and paragraph (5) of subsection (a) of Code Section 43-34-

249 for facilities offering cosmetic laser services which serve as a principal place of

practice at which a physician regularly sees patients if medical services are regularly

performed at such facilities. For purposes of this Code section, "medical services"

shall mean the general and usual services and care rendered and administered by a

physician.

HISTORY:

§ 43-34-250. (For effective date, see note.) Advisory committee

The board shall appoint an advisory committee. The advisory committee shall

include licensed cosmetic laser practitioners licensed under this article and such

members as the board in its discretion may determine. The advisory committee shall

include at least one person licensed to practice medicine under this chapter and

specialized in a field with expertise in the biologic behavior of the skin. Members

shall receive no compensation for service on the committee. The committee shall

have such advisory duties and responsibilities as the board may determine, including

but not limited to consulting with the board on the issuance, denial, suspension, and

revocation of licenses and the promulgation of rules and regulations under this

article. The initial members of the advisory committee may include persons eligible

for licensing under this article. Subsequent advisory committee members must be

licensed pursuant to this article.

HISTORY:

Code 1981, § 43-34-250, enacted by Ga. L. 2007, p. 626, § 1/HB 528; Code 1981, § 43-34-251, enacted by Ga. L. 2007, p. 626, § 1/HB 528; Code 1981, § 43-34-252, enacted by Ga. L. 2007, p. 626, § 1/HB 528; Code 1981, § 43-34-253, enacted by Ga. L. 2007, p. 626, § 1/HB 528;

Home > General Business > You can be liable for a blogger's enthusiasm

You can be liable for a blogger's enthusiasm

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FTC rules regarding testimonials and endorsements can make you liable as an advertiser for false and misleading claims made by someone who describes your product on a blog.

These FTC rules show why it's important to have a qualified attorney review your legal situation, including your website and any disclaimers that may be necessary.

The FTC notes:

A skin care products advertiser participates in a blog advertising service. The
service matches up advertisers with bloggers who will promote the advertiser’s products on
their personal blogs. The advertiser requests that a blogger try a new body lotion and write
a review of the product on her blog. Although the advertiser does not make any specific
claims about the lotion’s ability to cure skin conditions and the blogger does not ask the
advertiser whether there is substantiation for the claim, in her review the blogger writes
that the lotion cures eczema and recommends the product to her blog readers who suffer
from this condition. The advertiser is subject to liability for misleading or unsubstantiated
The Commission tested the communication o 1 f advertisements containing testimonials
that clearly and prominently disclosed either “Results not typical” or the stronger “These
testimonials are based on the experiences of a few people and you are not likely to have similar results.” Neither disclosure adequately reduced the communication that the experiences depicted are generally representative. Based upon this research, the Commission believes that similar disclaimers regarding the limited applicability of an endorser’s experience to what consumers may generally expect to achieve are unlikely to be effective.

Nonetheless, the Commission cannot rule out the possibility that a strong disclaimer of
typicality could be effective in the context of a particular advertisement. Although the
Commission would have the burden of proof in a law enforcement action, the Commission notes that an advertiser possessing reliable empirical testing demonstrating that the net impression of its advertisement with such a disclaimer is non-deceptive will avoid the risk of the initiation of such an action in the first instance. representations made through the blogger’s endorsement. The blogger also is subject to liability for misleading or unsubstantiated representations made in the course of her endorsement. The blogger is also liable if she fails to disclose clearly and conspicuously that she is being paid for her services.

That's the strange truth about Federal Trade Commission rules regarding false, misleading and deceptive advertising.

The FTC publishes its Guides Concerning the Use of Endorsements and Testimonials in Advertising online. Our lawyers frequently do website review for FTC compliance and give legal advice to many new businesses seeking website user agreements, disclaimers, privacy policies, and legal advice.

It's better to steer clear of trouble ahead of time than incur a potentially large fine down the road.

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Our law firm has many successes with health care and business law clients, whose practices are transforming the business and health care landscape as we know it.

Michael H. Cohen is an attorney providing business legal advice to green entrepreneurs and companies, and health care law advice to businesses and physicians, acupuncturists, naturopaths, homeopaths and others in the holistic health, wellness, and green industries. As a founding attorney of the Global Vision Law Group, he represents businesses poised for vertical lift, whose leaders are conscious, intuitive, and committed to shaping a better world. Michael also advises medical spas and integrative medicine clinics, physicians, chiropractors, naturopathic physicians, massage therapists, energy healers, nutritionists and herbalists, dietary supplement and cosmetics companies, and businesses with bio-energy and other technologies and medical devices. Michael offers the Entrepreneur’s Legal Toolkit as a series of legal guides to businesses. The first legal e-book deals with Contract Essentials, giving legal tips every business needs to negotiate its legal agreements; the second addresses legal issues faced by multi-level marketing companies and individuals involved in multilevel marketing and direct sales; and the third one so far is a HIPAA Regulations and Privacy Manual at far less the cost than it would take for an attorney to prepare.

Michael also sponsors Being Central, a Portal for Potential, which gives access to other, pre-paid legal services.

Read reviews of Michael’s work on the Complementary and Alternative Medicine Law Blog. And visit the Flat Rate Legal Services page for information on legal services offered at a flat rate or project fee (such as incorporation for entrepreneurs, review and drafting of business contracts, trademark, and health law services for CAM providers and others).

Michael’s clientele through the Global Vision Law Group includes businesses not only in California, New York, Maryland, Massachusetts, Washington, D.C., and other U.S. states, but also abroad. To speak with a lawyer about health care law issues pertaining to complementary and alternative medicine, or to consult a business lawyer about laws and legal issues for entrepreneurs and new enterprises that are seeking legal advice, contact the Global Vision Law Group today.

Ga. L. 2009, p. 859, § 1/HB 509; Ga. L. 2009, p. 989, § 6/SB 104.

§ 43-34-251. (For effective date, see note.) Prohibited activities

(a) It shall be unlawful for any person licensed as a cosmetic laser practitioner to

perform cosmetic laser services within any area within one inch of the nearest part of

the eye socket of any consumer.

(b) It shall be unlawful for any person licensed as a cosmetic laser practitioner to

administer any pharmaceutical agent or other substance by injection.

HISTORY:

Ga. L. 2009, p. 859, § 1/HB 509.

§ 43-34-252. (For effective date, see note.) Noncompliance of facility owner;

penalty

Any person who owns a facility in which cosmetic laser services are offered or

performed in noncompliance with the requirements of this article shall be guilty of a

misdemeanor.

HISTORY:

Ga. L. 2009, p. 859, § 1/HB 509.

§ 43-34-253. (For effective date, see note.) Violation; penalty

Any person convicted of violating any provision of this article shall be guilty of a

misdemeanor.

HISTORY:

Ga. L. 2009, p. 859, § 1/HB 509.

Acccess to Medical Treatment Act Softens Physician Discipline for CAM

Fri, 22 Jan 2010 12:11:57 -0500

A state version of the federally proposed "Access to Medical Treatment Act" expands consumer health care choices by softening physician discipline for alternative therapies.

The law in Georgia reads:

(b) Notwithstanding any other provision of law, and except as provided in subsection (c) of this Code section, an individual shall have the right to be treated for any illness or disease which is potentially life threatening or chronically disabling by a person licensed to practice medicine under this article with any experimental or nonconventional medical treatment that such individual desires or the legal representative of such individual authorizes if such person licensed to practice medicine under this article has personally examined such individual and agrees to treat such individual.

treatment to an individual described in subsection (b) of this Code section if:

(1) There is no reasonable basis to conclude that the medical treatment itself, when administered as directed, poses an unreasonable and significant risk of danger to such individual; and

(2) The person licensed to practice medicine under this article has provided the patient with a written statement and an oral explanation, which the patient has acknowledged by the patient's signature or the signature of the patient's legal representative, that discloses the facts regarding the nature of the treatment, specifically including that the treatment offered is experimental or nonconventional, that the drug or medical device has not been approved by the Food and Drug Administration for any indication, as well as the material risks generally recognized by reasonably prudent physicians of such treatment's side effects.

(d) The treatment of patients in compliance with this Code section by a person licensed to practice medicine under this article shall not by itself constitute unprofessional practice or conduct.

For further information about physician discipline, malpractice and other liability issues when giving patients complementary and alternative medical treatments, contact our attorneys today at the Global Vision Law Group, PLC.

You can be liable for a blogger's enthusiasm

Fri, 15 Jan 2010 16:07:24 -0500

FTC rules regarding testimonials and endorsements can make you liable as an advertiser for false and misleading claims made by someone who describes your product on a blog.

These FTC rules show why it's important to have a qualified attorney review your legal situation, including your website and any disclaimers that may be necessary.

The FTC notes:

A skin care products advertiser participates in a blog advertising service. The
service matches up advertisers with bloggers who will promote the advertiser’s products on
their personal blogs. The advertiser requests that a blogger try a new body lotion and write
a review of the product on her blog. Although the advertiser does not make any specific
claims about the lotion’s ability to cure skin conditions and the blogger does not ask the
advertiser whether there is substantiation for the claim, in her review the blogger writes
that the lotion cures eczema and recommends the product to her blog readers who suffer
from this condition. The advertiser is subject to liability for misleading or unsubstantiated
The Commission tested the communication o 1 f advertisements containing testimonials
that clearly and prominently disclosed either “Results not typical” or the stronger “These
testimonials are based on the experiences of a few people and you are not likely to have similar results.” Neither disclosure adequately reduced the communication that the experiences depicted are generally representative. Based upon this research, the Commission believes that similar disclaimers regarding the limited applicability of an endorser’s experience to what consumers may generally expect to achieve are unlikely to be effective.

Nonetheless, the Commission cannot rule out the possibility that a strong disclaimer of
typicality could be effective in the context of a particular advertisement. Although the
Commission would have the burden of proof in a law enforcement action, the Commission notes that an advertiser possessing reliable empirical testing demonstrating that the net impression of its advertisement with such a disclaimer is non-deceptive will avoid the risk of the initiation of such an action in the first instance. representations made through the blogger’s endorsement. The blogger also is subject to liability for misleading or unsubstantiated representations made in the course of her endorsement. The blogger is also liable if she fails to disclose clearly and conspicuously that she is being paid for her services.

That's the strange truth about Federal Trade Commission rules regarding false, misleading and deceptive advertising.

The FTC publishes its Guides Concerning the Use of Endorsements and Testimonials in Advertising online. Our lawyers frequently do website review for FTC compliance and give legal advice to many new businesses seeking website user agreements, disclaimers, privacy policies, and legal advice.

It's better to steer clear of trouble ahead of time than incur a potentially large fine down the road.

Our law firm has many successes with health care and business law clients, whose practices are transforming the business and health care landscape as we know it.

Michael also sponsors Being Central, a Portal for Potential, which gives access to other, pre-paid legal services.

You can be liable for a blogger's enthusiasm

Fri, 15 Jan 2010 16:07:24 -0500

FTC Cracks Down on Weight Loss Products

Fri, 15 Jan 2010 14:08:27 -0500

Dietary supplement labeling issues come to the fore again, which is why manufacturers and distributors of dietary supplements and cosmetics need good legal advice on their labeling.

Marketers of Unproven Weight-Loss Products Ordered to Pay Nearly $2 Million

Court Rules in Favor of FTC in Case of Diet Tea and Bio-Slim Patch

A federal district court has ordered the marketers of an herbal tea and a diet patch to pay nearly $2 million to the Federal Trade Commission for making deceptive claims that both products would allow users to lose weight quickly without diet or exercise.

For nearly two years before the FTC complaint was filed, Bronson Partners, LLC and its officer, Martin Howard, marketed Chinese Diet Tea, telling consumers they could lose as much as six pounds a week by drinking one cup of the green tea after each meal to “neutralize the absorption of fattening foods.” Advertising in national magazines such as USA Weekend and Clipper Magazine, the marketers charged $24.95 plus shipping and handling for a month’s supply.

Also during this time, the marketers sold the Bio-Slim Patch, a diet patch that contained extracts from the fucus, garcinia, and guarana plants. Instructing consumers to wear the patches 24 hours a day for at least three months, the marketers claimed that “repulsive, excess ugly fatty tissue will disappear at a spectacular rate due to the combination and synergy of these three natural ingredients.” The marketers advertised the patch in national magazines and in a company catalog, and consumers paid $24.95 plus shipping and handling for a month’s supply.

In addition to ordering the nearly $2 million payment, citing “obvious and widespread” violations of the FTC Act, Judge Stefan R. Underhill of the U.S. District Court for the District of Connecticut granted the FTC’s request to prohibit the defendants from deceptively selling or advertising any weight-loss products. “Future violations of a similar nature would surely result in financial harm to consumers, and possible physical harm if consumers engage in risky weight-loss techniques in reliance on (the) defendants’ misleading representations,” the judge wrote in his December 2009 ruling and order. He also ordered the defendants to help the FTC identify consumer victims who lost money on the products, so that restitution can be made.

The FTC filed its complaint against Bronson Partners, LLC and Martin Howard as part of the “Big Fat Lie” law enforcement sweep in November 2004. The sweep targeted marketers of bogus weight-loss products, such as pills, powders, gels, green teas, and diet patches. In July 2008, the U.S. District Court for the District of Connecticut granted the FTC’s request for summary judgment against Howard and Bronson Partners, LLC – also doing business as New England Diet Center and Bronson Day Spa.

Copies

of the November 2004 complaint and the December 2009 ruling and order are available on the FTC’s Web site at

http://www.ftc.gov

and from the FTC’s Consumer Response Center, Room 130, 600 Pennsylvania Avenue, N.W., Washington, D.C. 20580. The FTC works for the consumer to prevent fraudulent, deceptive, and unfair business practices in the marketplace and to provide information to help consumers spot, stop, and avoid them. To file a complaint in English or Spanish, visit the FTC’s online

Complaint Assistant

or call 1-877-FTC-HELP (1-877-382-4357). The FTC enters complaints into Consumer Sentinel, a secure, online database available to more than 1,700 civil and criminal law enforcement agencies in the U.S. and abroad. The FTC’s Web site provides free information on a variety of

consumer topics

Our law firm has many successes with health care and business law clients, whose practices are transforming the business and health care landscape as we know it.

Michael also sponsors Being Central, a Portal for Potential, which gives access to other, pre-paid legal services.

Self-referral, Kickback, and Fee-Splitting Legal Issues in Health Care

Thu, 14 Jan 2010 12:40:35 -0500

New York, like California and other states, has provisions prohibiting Self-referral, Kickback, and Fee-Splitting when physicians and other healthcare providers have an ownership or compensation interest in entities to which they refer.

These provisions apply both to conventional care and to complementary, alternative medicine and integrative care.

In New York, within Title VIII, the general provisions of Article 130 are applicable to all the health care professions.

Subarticle 1 deals with licensing; subarticle 2 with regulatory responsibilities of the Board of Regents, the Education Department, and state boards for the professions; subarticle 3 with Professional Misconduct; and subarticle 4 with unauthorized practice (including aiding and abetting) and penalties. Under subarticle 4, professional misconduct includes:

Aiding and abetting unlicensed activities
Committing unprofessional conduct, as defined by the board of regents in its rules

Subarticle 4 (also known as “6509-a” after the section of NYS Education Law) also contains the following additional definition of professional misconduct:

That any person subject to the above enumerated articles, has directly or indirectly requested, received or participated in the division, transference, assignment, rebate, splitting or refunding of a fee for, or has directly requested, received or profited by means of a credit or other valuable consideration as a commission, discount or gratuity in connection with the furnishing of professional care, or service, including x-ray examination and treatment, or for or in connection with the sale, rental, supplying or furnishing of clinical laboratory services or supplies, x-ray laboratory services or supplies, inhalation therapy service or equipment, ambulance service, hospital or medical supplies, physiotherapy or other therapeutic service or equipment, artificial limbs, teeth or eyes, orthopedic or surgical appliances or supplies, optical appliances, supplies or equipment, devices for aid of hearing, drugs, medication or medical supplies or any other goods, services or supplies prescribed for medical diagnosis, care or treatment under this chapter, except payment, not to exceed thirty-three and one-third per centum of any fee received for x-ray examination, diagnosis or treatment, to any hospital furnishing facilities for such examination, diagnosis or treatment.

IVC1a. “Groups” Exception

The definition in Section 6509-a, continues with an exception:

Nothing contained in this section shall prohibit such persons from practicing as partners, in groups or as a professional corporation or as a university faculty practice corporation nor from pooling fees and moneys received, either by the partnerships, professional corporations, university faculty practice corporations or groups by the individual members thereof, for professional services furnished by any individual professional member, or employee of such partnership, corporation or group, nor shall the professionals constituting the partnerships, corporations or groups be prohibited from sharing, dividing or apportioning the fees and moneys received by them or by the partnership, corporation or group in accordance with a partnership or other agreement; provided that no such practice as partners, corporations or in groups or pooling of fees or moneys received or shared, division or apportionment of fees shall be permitted with respect to care and treatment under the workers' compensation law except as expressly authorized by the workers' compensation law. Nothing contained in this chapter shall prohibit a medical or dental expense indemnity corporation pursuant to its contract with the subscriber from prorationing a medical or dental expense indemnity allowance among two or more professionals in proportion to the services rendered by each such professional at the request of the subscriber, provided that prior to payment thereof such professionals shall submit both to the medical or dental expense indemnity corporation and to the subscriber statements itemizing the services rendered by each such professional and the charges therefor.

This additional definition of professional misconduct applies to persons licensed under articles 132 (chiropractic), 133 (dentistry, dental hygiene, and certified dental assisting), 136 (physical therapy and physical therapy assistants), 137 (pharmacy), 139 (nursing), 140 (professional midwifery), 143 (optometry), 144 (ophthalmic dispensing), 156 (occupational therapy), 159 (speech-language pathologists and audiologists), and 164 (respiratory therapists). Subsequent sections set forth the rules governing proceedings and penalties in cases of professional misconduct.

Certain professions are not on this list (for example, medicine and acupuncture), but there still could be fee-splitting provisions in the licensing laws governing these professions. Further, the Rules of the Board of Regents (below) would likely govern these prohibitions.

Our law firm has many successes with health care and business law clients, whose practices are transforming the business and health care landscape as we know it.

Michael also sponsors Being Central, a Portal for Potential, which gives access to other, pre-paid legal services.

Telemedicine and Anti-Kickback Law

Wed, 06 Jan 2010 14:56:36 -0500

Telemedicine and raise anti-kickback legal issues.

Which safe harbors in the Anti-Kickback Law apply to telemedicine?

Safe harbors which may apply to telemedicine arrangements typically involve the following:

Space Rental Safe Harbor
Equipment Rental Safe Harbor
Personal Services and Management Contracts Safe Harbor
Bona Fide Employees' Safe Harbor

Our attorneys are working regularly with clients involved in telemedicine as well as regular medical practices (both conventional medical care, and complementary, alternative and integrative therapies) who have Stark and anti-kickback concerns.

If you are concerned about fee-splitting issues involving federal law or state law (such as fee-splitting laws in New York, California, Vermont, and other states), contact one of our experienced health care lawyers today.

Our law firm has many successes with health care and business law clients, whose practices are transforming the business and health care landscape as we know it.

Michael also sponsors Being Central, a Portal for Potential, which gives access to other, pre-paid legal services.

Horton Hears a Zhu

Mon, 28 Dec 2009 23:49:35 -0500

Specifically Horton heard a doctor Zhu getting a prize for integrative medicine.

Dr Zhu gets anintegrative medicine prize:

A former Alexandra woman who arrived in New Zealand aged 6 unable to speak a word of English, has just graduated from the prestigious University of Melbourne School of Medicine.

Jia Ni Zhu, known as Jarnie, was educated at Alexandra Primary School and Columba College.

Dr Zhu (24), was one of thousands who applied to gain entry to the medical school in 2004 and one of the three New Zealanders accepted.

She started learning English when she arrived in this country and was a familiar sight behind the counter at her parents' Chinese restaurant and takeaways shop in Alexandra, working there from "when I could just see over the counter" through until the end of her secondary schooling.

Dr Zhu now volunteers as an English teacher for elderly migrants.

She was awarded the proxime accessit prize in her final year at Columba College and paid tribute to her teachers over the years - "especially those at Columba College, whose excellent teaching made it possible for me to gain entry into the school of medicine at the University of Melbourne in the first place".

While completing an Advanced Medical Science year to gain an additional degree - a Bachelor of Medical Science - Dr Zhu won the prize for best student research presentation and also won the annual Australasian Integrative Medicine Association Medical Student Essay competition.

Her essay was titled "My vision of integrative health care in Australia" and the competition was contested by medical students throughout Australia and New Zealand.

Athletes use functional medicine:

VAIL, Colorado — As the margins of competition become ever tighter, athletes in the Vail Valley and beyond are looking for more innovative and natural (and legal) ways of gaining an edge. Along with traditional training, there are other key challenges to be mastered; eating well, strengthening the immune system, improving mental clarity, and getting restful sleep while traveling through different time zones. All of these factors are as important to the professional athlete as fine-tuning of technique through practice.

Physical training is imperative, but I believe that maximum results can only be achieved by improving “cellular performance” as well. Body chemistry, along with nutritional demands and deficiencies, influence how an athlete feels, performs and recovers. As we've seen many times, even the best athlete can lose the day because of a simple cold.

More top athletes are starting to recognize the importance of integrating a functional medicine approach into their training strategies. Functional medicine focuses on treating the underlying causes of disease rather than the symptoms. It involves several key principles that also seem to mirror competitive athletic principles; a view that every system in the body is connected rather than operating on its own, that each person possesses a unique set of physical variations that must be evaluated and considered, and that there is a constant yet dynamic balance of internal and external factors at work. Similarly, any imbalance in the interconnected system will hinder optimum performance. The heart of functional medicine treatment lies in nutrition, using targeted nutrients to overcome deficiencies and fight disease.

Top athletes know that a detailed, comprehensive and health-oriented training regimen leads to improved performance and longevity of career. Perhaps the best example is Lance Armstrong, who has worked closely with functional medicine doctors and nutritionists not just in his fight against cancer, but also to improve performance through diet and prevention. Clearly, he's been so successful with this approach that even his mitochondria are wearing yellow jerseys! Mr. Armstrong's understanding and use of “alternative” strategies have helped him reach amazing success even after cancer, and has changed the way many professional athletes now go about their business.

Athletes are indeed fit, but not always healthy. They demand a lot from their physical machinery, so its imperative that they obtain knowledge not just from their coaches and trainers, but also from their doctors. When working with athletes I start by getting important information on both their competitive career and their ‘civilian' life. I treat them as comprehensively as any other client, but with close attention paid to the extraordinary physical stress they experience. I collect laboratory evidence that reveals accurate data on how the body is functioning and repairing itself. Detailed results from specific blood tests administered for each individual reveal the first signs of hidden breakdown in the body, and provide a road map for treatment, enhancement of overall health and ultimately, to the podium.

Despite the façade, athletes can develop problems quite easily, and may do damage to their bodies that will manifest later in life. But through individual biochemical analysis, we can identify and address functional and nutritional deficiencies in order to help prevent illness, improve cellular function and repair, boost energy levels and enhance mental acuity all at once. Everyone, athletes especially, should not just be concerned about getting the right mix of proteins and carbohydrates, but also taking in the right amounts of high-quality micronutrients, vitamins and minerals. (A list of my top 10 nutrients can be found on my Web site).

With a solid foundation of health, athletes can enjoy the challenges and successes of their disciplines without the distraction of getting ill or run down. More importantly, they can enjoy a good level of fitness and health way beyond their competitive years. To be active and able into older age is the true reward. Researchers are discovering how many ways we depend on specific nutrients to promote optimal physical performance, and many findings are coming from the front lines of elite athletic training. Working with people who are as much interested in their health as you are in their health creates a true, partnership model of healthcare in which the patient and doctor combine their knowledge not just for the sake of a “winning mentality,” but also for a “winning vitality.”

Dr. Elina Chernyak is an Osteopathic Doctor specializing in Integrative Medicine in Edwards. For more information, call 970-306-2737 or visit www.WholisticIntegraCare.com. If you have a question you'd like to ask Dr. Elina, please e-mail DrElina@WholisticIntegraCare.com.

Holistic health joint venture here:

Holistic Globe Networks broadcasting and publishing company announced this week that it has now merged with Quantum Life, the holistic directory publisher. Quantum Life directories are published in multiple metropolitan areas in the USA, while Holistic Globe Radio is broadcast via the Internet, reaching listeners in dozens of countries. Quantum Life is distributed at many Publix stores in Miami-Dade, Broward, and Palm Beach counties, as well as health food stores, holistic clinics, yoga centers, and other locations. Holistic Globe Radio is poised to broadcast a wide range of audio content in three languages, beginning in 2010. Holistic product and service providers often use these focused media resources to inform health conscious segments of the public about health and wellness topics while marketing their businesses.

This announcement comes from Maria Baez, programming director and publisher at Holistic Globe Radio, and Bryan Weissman, D.C., publishing consultant and director of Quantum Life in South Florida since acquiring the publication from Steven Wentworth. Holistic practitioners themselves, Baez and Weissman seek to increase the impact of promotion for holistic wellness products and services by creating this merger. Public interest in holistic health and wellness continues to grow, as the limitations and corruption seen in conventional medical care lead many to use alternatives that they see as safer and more likely to truly resolve their health challenges. Holistic wellness approaches are numerous, and include modalities such as homeopathy, naturopathic medicine, ayurveda, oriental medicine, integrative medicine, alternative medicine, complementary medicine, energy medicine, spiritual healing, mind-body medicine, herbalism, nutrition, diet and cleansing, hypnosis, massage and bodywork, chiropractic, biofeedback, aromatherapy, energy psychology, and more.

British Columbiapioneers an information system alerting patients to CAM options:

Through a collaboration between the cancer agency and the University of B.C. School of Nursing, information-seeking patients will get the latest, unbiased, credible evidence about complementary medicines from a handful of nurses and other experts. They will not endorse anything nor will they make recommendations. Instead, patients will get the straight goods on the evidence available for each type of therapy.

CAM is generally defined as diverse health care practices and products that are offered by allied health professionals. It includes such things as physical therapy, mind-body therapies like meditation, naturopathic medicine, energy medicine such as reiki and therapeutic touch, acupuncture, chiropractic medicine, homeopathy traditional Chinese medicine, Ayurvedic medicine and first nations traditional healing.

Complementary medicine is used with conventional medicine while alternative medicine may be used in place of conventional medicine. The CAMEO program intends to emphasize complementary, rather than alternative medicine.

Lynda Balneaves, an associate professor of nursing at UBC, is the principal investigator in the CAMEO program, which has received a major financial boost with a $1-million grant over four years from the Lotte and John Hecht Memorial Foundation, along with additional support from the Canadian Breast Cancer Research Alliance and the Canadian Institutes of Health Research.

Balneaves said in an interview Tuesday that the mandate of the program is to educate patients about evidence, benefits and potential risks of complementary therapies.

"With cancer patients, the general rule around CAM is that if you are going to consume or ingest anything you should have a discussion with your health providers about that," she said, adding there are pharmacists at the cancer agency who are well informed about potential interactions. Herbs like St. John's Wort, for example, taken for depression, might have a negative effect on the intended action of chemotherapy drugs.

CAMEO will also conduct research. In one project, active ingredients in pomegranate juice will be studied to determine if they have a beneficial effect on men undergoing prostate gland removal. Balneaves said researchers want to know if the compounds in the fruit help limit cancer cell growth.

Our law firm has many successes with health care and business law clients, whose practices are transforming the business and health care landscape as we know it.

Michael also sponsors Being Central, a Portal for Potential, which gives access to other, pre-paid legal services.

The Dog that Ate the World

Mon, 28 Dec 2009 23:34:40 -0500

These and other fascinating stories enliven this week's discussion of law and alternative medicine / holistic health care.

Wow, the Massachusetts Medical Society has a podcast on integrative medicine:

Physician Focus, September 2009: Integrative Medicine

Posted on August 28th, 2009 by ffortin

Integrative medicine is a new approach to care, combining conventional or evidence-based medical therapies with complementary or alternative treatments such as acupuncture, biofeedback, stress reduction, or herbal medicines. Such an approach is growing in a variety of health care settings.

How much do we know about such methods? Are they effective? What is the current thinking of medical doctors about integrative, complimentary and alternative medicine? And how and when should a patient decide on such treatments?

Host: Bruce Karlin, M.D.

Guest: Harvey Zarren, M.D., President, Integrative Medicine Alliance

Co-produced with Hopkinton Community Access Television, HCAM-TV, Hopkinton Mass.

Listen to the po

More integrative medicine in hospitals -

Integrative Medicine at Kellogg Cancer Care Center

NorthShore University HealthSystem is pleased to announce that The Evanston and Highland Park Hospital Kellogg Cancer Centers and The Integrative Medicine Program have collaborated to offer the following Integrative Medicine services to patients during their visit at Evanston and Highland Park Hospitals.

NEW at Highland Park Kellogg Cancer Center:
Laughter Yoga
Guided Imagery

Oriental Medicine & Acupuncture
Evanston - Wednesdays – 12:30 p.m.–4:30 p.m.
Highland Park - Fridays – 11:00 a.m.–3:00 p.m.
45-50 minute consultation and treatment         $125
Follow up treatment                                         $75

Integrative Bodywork, including various forms of massage and stress reduction technique

Evanston - Fridays – 10:30 a.m.–2:30 p.m.
Highland Park - Tuesdays – 10:30 a.m.–2:30 p.m.

25 minute consultation and treatment $ 55
55 minute consultation and treatment $ 85

Who will benefit?
Acupuncture and integrative bodywork fit safely and effectively with conventional cancer care in primarily reducing fatique, nausea, pain, weight loss and neuropathy. These therapies may also help reduce stress and anxiety. Interested patients should check with their oncologist or nurse to discuss whether this is an appropriate treatment option while at Kellogg.

Where are the treatments performed?
Treatments are performed in a tranquil, private room at Kellogg on a massage table or in a chair, depending on what is most appropriate for the patient

For more information or to schedule an appointment, please call the Integrative Medicine Patient Clinic at 847.657.3540.

"The acupuncture and bodywork therapies that I received through the NorthShore Integrative Medicine program provided my mind and body with some reprieve from the assault of chemotherapy. It was a brief time to feel normal. I encourage you to give it a try!”
~ Vickie Burke – Former Kellogg Cancer Patient

You may also schedule appointments at our Park Center Patient Desk for the following services by calling 847.657.3540.

• Integrative Medicine physician consultations
• Oriental Medicine and acupuncture
• Integrative counseling and stress relief strategies, including biofeedback
• Integrative Bodywork, including various forms of massage
• Nutrition counseling
• Herbal medicine counseling
• Therapeutic yoga and meditation

IM does not stand for instant message - it's integrative medicine!

Adjunct UH Manoa professor, Inouye aide elected to Institute of Medicine

Posted on December 22, 2009. Tags: institute of medicine, john a burns school of medicine, patrick h deleon, uh-manoa

MEDIA RELEASE

The Institute of Medicine (IOM) has announced the selection of Patrick H. DeLeon, PhD, JD, MPH, to its active membership.

DeLeon, Chief of Staff in Washington, DC for U.S. Sen. Daniel K. Inouye, is a Clinical Adjunct Professor of Psychiatry and Complementary and Alternative Medicine at the University of Hawaii at Manoa’s John A. Burns School of Medicine (JABSOM) and an affiliate faculty at the UH-Hilo School of Nursing. He also holds an adjunct professorship at UH Manoa’s School of Nursing and Dental Hygiene, and is a national past president of the American Psychological Association.

The IOM, part of the National Academy of Sciences, is an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision-makers and the public. Election to the IOM is considered one of the highest honors in medicine. Worldwide, there are fewer than 2,000 members.

“The IOM is really an outside federal think tank, advising on important matters involving medicine from numerous perspectives”, said DeLeon, noting that members of the IOM include professionals from multiple disciplines, including law, education, and clinical practice.

“Dr. DeLeon has received more than 60 national awards for his own contributions to multiple disciplines, including the fields of psychology, nursing, medicine, social work and public health,” said Dr. Jerris Hedges, JABSOM Dean and a fellow member of the IOM. “He has been a tireless advocate for improving health care throughout the nation as well as in Hawaii.”

DeLeon has served Inouye for 36 years. He holds a master’s in public health degree from UH Manoa, and in 1978 was recognized as a distinguished alumnus of the school.

Big Pharma gets big criticism:

Pharmaceutical companies are the most profitable industry in the world. Marcia Angell, M.D., first woman editor-in-chief of the New England Journal of Medicine, reports that in 2002 the $35.9 billion the top drug companies earned were greater than the profits of the other 490 Fortune 500 companies combined.

In the last few years as I drive around Modesto, I see new pharmacies everywhere. The Internet Yellow Pages show there are 31 Walgreens, CVS and Rite-Aid pharmacies in the Modesto, Oakdale, Turlock area. This doesn't count all the pharmacies within grocery stores or the few remaining locally-owned drug stores.

In 1997 the Food and Drug Administration reversed its policy on direct-to-consumer advertising. At that time, $220 million a year was spent by pharmaceutical companies on advertising. In 2002, the amount was

$2.8 billion. Big pharma spends twice as much on advertising as on research and development and it's working.

Perhaps we're buying so many more prescription drugs because we're being brainwashed to believe we need what they're selling. "TV advertising works by mobilizing the appeal of group morale. By showing you pictures of beautiful, happy people, they persuade you that everyone else in the world is having a terrific time, only you are left out. Want to stop being a lonely loser? Join them -- just tune into this, or buy that," says Bill Manville, former advertising copywriter for Grey Advertising and now a New York Daily News columnist.

Pharmaceutical ads subtly increase fear and worry about medical conditions. For example, statins were first prescribed only to those with heart problems. Now, they're routinely prescribed for anyone with high cholesterol. In the book "Spontaneous Evolution," the authors report that statins are a $20 billion-a-year market worldwide. But how effective are they? In The Lancet medical journal, a study shows "... 67 individuals would need to be treated for five years for one medical event to be prevented...(and) that there was no apparent benefit seen in woman of any age."

Read more: http://www.modbee.com/opinion/community/story/982217.html#ixzz0b37husQY

Dude, stressed out by holidays? Get some yoga therapy:

An 85 year-old yoga teacher and Vedanta scholar with a Doctorate in Complementary Medicine, Dr. Bali teaches and advocates yoga as a complementary form of therapy in treating psychosomatic disorders - physical illnesses caused or influenced by emotional factors.

"During the flight or flight (i.e. stress) response, our immune system goes down and doesn't protect the body," said Dr. Bali. "It is in deep sleep that we heal most, when the body shifts to an optimal level of efficiency without the everyday, rational mind interfering."

Through yoga, one can suspend the mental chatter and reprogram the immune system to restore that optimal threshold of healing capacity.

"The brain is like a computer system being short circuited by stress and the fact that it is overloaded by today's hectic life-style," said Dr. Bali.

"Through the yoga postures - we improve the system of communication and restore the brain-body connection for optimal healing."

The body is capable of producing its own endorphins, tranquilizers and anti-depressants that are more powerful and have no side effects. With this complete pharmacy within, we need only trust our bodies to deal with any demand, even the stress of in-laws visiting for an entire week!

The wear and tear of stress has detrimental effects in the short term of the holidays but also in the long run. Dr. Bali is 85 but "biologically feels like 56" and has not missed a yoga session in 40 years because of illness.

"The key is to teach your body to trigger the relaxation response," said Dr. Bali. "The body's natural inclination after a fight or flight reaction is to slow the heart rate and lower blood pressure and stress hormone levels."

Dr Bali teaches people how to manage stress consciously and set this relaxation response in motion so the body can heal itself.

Dr. Bali runs a yoga program for breast cancer patients through Sérénité, organized by the Quebec Breast Cancer Foundation (www.rubanrose.org). Yoga helps the women regain control of their bodies and better manage the stress generated from the disease and its treatments.

"I like how I feel after the workout - refreshed and strengthened physically and calmer in my spirit," said one participant. "I appreciate the fact that I can do the exercises at my own level, and that we have guidance for adaptations" to limitations of movement, especially after surgery.

Yoga Bliss Studio offers drop in courses Mondays at 7pm and Fridays at 9:30am and 7pm and free information sessions upon request. The Studio is located at 3545 Chemin de la Côte-des-Neiges suite #090 in the Regency Medical Building in Montréal.

For further information: Dr. Madan Bali, PhD, Yoga researcher and instructor, (514) 932-7971 (main), (514) 808-YOGA (media requests), info@yogabliss.ca; www.yogabliss.ca

Gridlock discusses anintegrative approach to back pain:

home

26 December 2009

Back Pain: An Integrative Approach

Back ache is one of the most garden reasons people seek medical treatment â€“ past either reactionary or naturopathic medicine techniques. Each grieve administration advance offers divergent benefits, which is why Southwest Integrative Medicine offers elements of both. In fact, this team of Phoenix doctors addresses a wide range of physical ailments with treatments ranging from acupuncture to I.V. nutrient therapy. If you suffer from subvene pain, then you contain something in well-known with more than 80 percent of the population. That’s how many people will experience it at some as regards in their lives â€“ on the whole lower back pain brought on by worry and strain. Moreover proper for something so common, remarkable remedies for back pain within conventional medicine alone are few and far between. One of the most common “solutions” is medication painkillers. Though efficacious when used in conjunction with other treatments, painkillers do little good on their own. After all, what’s the detail of treating the symptom if you not in a million years note down to the call? Physiotherapy is another garden-variety treatment for back pain â€“ essentially prescribing personal to exercises intended to improve your mobility. However, studies now show that physiotherapy matchless is no more effective at alleviating back trial than regular vex. One proven way of getting to the well-spring of back grieve is from top to bottom acupuncture, an option nostrum technique involving the insertion of hair-underfed stainless bite the bullet needles into the outer layer. Originating in China thousands of years ago, acupuncture’s aim is to weigh the issue of zing, or “Qi,” in the body. This is done by strategically placing these needles at various points along the body’s particular strength channels, or meridians, where the Qi blockage is believed to be. Local acupuncture treatment involves the insertion of the needles at the put of pain. However, the sensation of pain in the back may actually control from somewhere else in the body, requiring distal acupuncture treatment â€“ the insertion of needles on an area other than the point of spasm. So whether yours is back pain associated with a sprain or spirit, herniated disc, sciatica or any other condition, acupuncture may be able to help â€“ on its own or when combined with conventional approaches in the same way as physiotherapy and prescription medications. Of course, impartial as with any other medical procedure, acupuncture should be preceded by a to the greatest medical history and true exam, including tongue, pulse and diagnostic techniques unique to this special holistic come near. Southwest Integrative Medicine typically performs these tests during the primary consultation. Guilelessly submit their online with get develop to schedule your before all visit today.

That bites! Check out the Wellness Blog's definitions of alternative medicine, CAM, and integrative medicine, holistic health, and the dog that ate the world:

Alternative Medicine, Complementary, Integrative, Wellness, Holistic – What Do They All Mean?

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Alternative medicine has grown in so many ways in North America. More people are visiting alternative medical practitioners than Western medical doctors. People spend more money on alternative medicine than they do out-of-pocket on Western medicine.

Another way that alternative medicine has grown is in the different labels. We have so many!

What do they all mean?

All these terms refer to a wide variety of healthcare practices originating from various countries and cultures. They include acupuncture, yoga, herbs, vitamin therapy, nutrition, exercise, reiki, reflexology, polarity and many, many other therapies.

However, each label also has its own unique twist when referring to this set of practices.

Let me take the labels one-by-one and give you a short description. Please note that these are my descriptions for each term, and other people may not agree. But I think I’m using the most widely-used definitions here.

Alternative Medicine

The term alternative medicine is probably the oldest and most widely used term. Unfortunately, it is also the most misleading.

Alternative medicine means that these healthcare practices (acupuncture, yoga, etc.) are used instead of Western medicine. A patient swears off any type of pharmaceutical drug or surgical technique and uses only Chinese medicine or homeopathy or whatever.

This hardly ever happens. Few patients are so myopic to close themselves off from all Western medical treatments. It really isn’t advisable. I know many, many holistic practitioners and I’ve never heard any of them advise a patient to close themselves off from Western medicine. How silly! Western medicine has its own benefits to offer too, why ignore them.

But, that is the real definition of alternative medicine. You can see why it is being phased out slowly.

Complementary Medicine

A newer term is complementary medicine. This means that the practices I list above may be used as a complement to Western medicine. You go to your doctor, and he prescribes some drugs and/or surgery, then if that doesn’t work, he asks you to try some other complementary approaches. Or, it may also mean when the above practices are used side-by-side with Western medicine. An example of this is when acupuncture is used for chemotherapy cancer patients to relieve the nausea and pain. This would be considered complementary medicine.

Be careful of the spelling here too. Complementary means a side-by-side approach to medicine. Complimentary means that it is free, no charge.

Integrative Medicine

A term pioneered by Dr. Andrew Weil from the University of Arizona is integrative medicine.

This means that physicians (Western and otherwise) have an integrated system of medicine that involves certain pieces of Western medicine and certain parts from the Chinese, Indian, etc. therapies that I listed above. All the therapies intermix and you have the best possible “super therapy” as a result.

As much as I like and respect Dr. Weil, I have to say that my experience says that truly integrative medicine does not yet exist anywhere yet. I’ve never seen a physician or any kind of practitioner who has an integrated plan for his patients that includes little bits of Western medicine and bits from multiple holistic practices.

This is probably the “Holy Grail” of medicine, but I think it will be a long time coming. The clinics that proclaim themselves to be “integrative medicine” centers are usually just a collection of different practitioners who share the rent together in one building. True integration would be great, I just haven’t seen it happen.

Wellness

If the previous terms have been misleading or overly optimistic, this term is really succinct and accurate. The term wellness applies to everything a person does to stay well. It is all about prevention and achieving the greatest health a person can achieve.

This is extremely accurate in describing the Chinese or Indian systems of medicine. And it is the best possible advice for patients, to get them on the track of staying well, rather than fixing illnesses.

But, as you might guess, this term has a problem too. (Don’t they all?) Wellness has been hijacked as a label for “early detection of disease.” Many hospitals have a “Wellness Center” where they conduct cancer screenings and do unnecessary MRI scans to look for problems or potential problems. These are great profit centers for the hospitals, but unfortunately they have ZERO to do with wellness.

Wellness is about eating right, getting enough sleep, exercising, taking the right herbs and having great relationships. It is NOT about early detection of disease. That doesn’t help you stay well, it just allows you to jump on an illness before it has the chance to become life-threatening. Valuable, sure, but it is not wellness.

Holistic Health

Finally, we come to the term holistic health. You could also call it holistic medicine or holistic practices. It is also sometimes spelled “wholistic.”

Holistic comes from “the whole.” It means to take a person as a whole being. The Chinese and Indian healing systems see a person, not just as a physical body, but as a body-mind-spirit. Their healing practices allow for all parts of the person and treat all parts equally. They have methodologies for solving problems in all three areas, and especially for finding problems that crisscross between body, mind and spirit (which most health problems do).

Holistic health is my favorite term. It too has problems, though. Sometimes, holistic health is perceived as a “New Age” term, evoking angels and witches and crystal balls. These off-beat practices can certainly be included as part of holistic health, but they are not at its center. Practices like naturopathy, homeopathy, Chinese medicine, Indian ayurveda are truly about holistic health.

But it will be hard to shake the New Age association for people who use the term holistic health.

There’s your whirlwind tour of definitions for alternative medicine. I hope this has been helpful. Use the definition that makes most sense to you. And be well!

Another hospital comes to the fore with integrative medicine:

Schmidt, 61, a former small-town head nurse, has made Woodwinds into one of the nation’s first hospitals to incorporate alternative or “integrative” medicine into every clinical department - not as primary methods of treatment but as techniques that complement primary treatments.

Each patient who enters through the doors of Woodwinds - a placid, wood-paneled, 86-bed facility that feels more like a corporate retreat than a care center - has access to healing touch, essential oils, acupuncture, calming music and other Far Eastern wellness techniques.

“Some of the different approaches to healing have not been available in the Western medicine array,” Schmidt says. “So what we did at Woodwinds was to make that platter, that tray of healing options, much larger.”

The therapies are not just reserved for patients. Staffers also have ready access to the full range of therapies in the hospital’s “natural care center.” After all, Schmidt points out, if a nurse is having a bad day, he or she is probably not going to be taking the best care of patients.

Here is how Woodwinds works: Say you are a patient scheduled for orthopedic surgery. Your admission is dealt with before you come in. When you arrive, you get wheeled directly to your room, past lines of fuzzy potted pine trees. You won’t be disturbed by noisy overhead pages - except for dire emergencies, they are not used. “It’s very peaceful most of the time,” Schmidt says.

Your information will be taken by a nurse with a laptop when you are comfortable in bed. Then, once you are prepped for surgery and just before you head to the operating room, you are administered “essential oils” - perhaps aromatic lavender - to calm you. Gentle music will play as the general anesthetic is applied and you quietly go under.

After surgery you will receive more essential oils and “healing touch” treatments from a nurse back in your room. You’re not even likely to get lonely, since there is no limit on visiting hours.

Woodwinds’ basket of “healing arts therapies” also includes acupressure and acupuncture, guided imagery, and energy-based therapies such as Reiki, a Japanese stress-reduction technique.

If it all sounds a bit New Age, it is.

Our law firm has many successes with health care and business law clients, whose practices are transforming the business and health care landscape as we know it.

Michael also sponsors Being Central, a Portal for Potential, which gives access to other, pre-paid legal services.

Blue Moon, you heard me saying a prayer for

Fri, 25 Dec 2009 13:03:48 -0500

Someone I really could care for....

Sometimes guidance comes in the form of a song. I was meditating on ... well it's not hard to guess ... and suddenly, deep in meditation, these words came:

Blue Moon.

The lyrics of the song ran through my mind, and I got the message. The message was: your prayer is answered.

However, guidance sometimes occurs on multiple levels, and it often has a sense of humor. We all know about particle entanglement, which Einstein called "spooky action at a distance."

Actions and reactions occurs on different levels of the unified field.

The night after the meditation, I went to a crazy party. I was hanging out with this family medicine doc from Hollywood Hills, and as he turned, I suddenly did something I haven't done since I was a Dark Heineken aficionado in college (yes, that's my only dark secret): I noticed the label on his beer bottle.

It sparkled with an unusual radiance, because I had not seen the label ever before.

It read: "Blue Moon."

Blue Moon

Blue Moon, a Belgian-Style white beer brewed by the Molson Coors Brewing Company, was launched in 1995. Originally called Bellyslide Belgian White, it was created by Keith Villa, a brewmaster at Coors Field's Sandlot Brewery (the onsite brewery owned by the Molson Coors Brewing Company). The beer is orange-amber in color with a cloudy appearance because it is unfiltered. It is also spiced with coriander and orange peel in addition to the hops found in most beers.

Who knew?

The Shadow knows.....

***

Strange dream last evening. I met the beautiful Crystal at a library inside a party. But suddenly saw a small flaming hole in the adjacent building, one of the Twin Towers. Because I had come from the future (8 years future) I knew the building would collapse. I called her name and whisked us down the stairwell. People were already rushing into the stairwell, but we ended up alone beneath the building at the subway. A train pulled up and stopped before us, doors closed. As I woke up, I wondered whether to take the train north or south, but I knew we were safe.

Why a dream about 9/11, now? Who was Crystal? Was the name symbolic? (Someone told me I had been the guardian of the crystals in Atlantis.) What was I doing moving the crystals from the flames?

I had been hanging out at the House of Blues in LA, in the Ganesha room--walls and ceiling filled with powerful energies (the ceiling was made of two temple doors from India). Even with the 80's music pumping through the speakers, there was a serenity, joy and power about the room.

Somehow my inner troubadour was triggered. There was conversation about yoga, and Judaism, and Civil War past lives.

Why the Moon energy, the rare and crystalline Blue Moon, juxtaposed with the fiery towers? Why the silver subway in a Matrix-like image of stalling between worlds? The lovers about to embark on a journey, moving away from the public and past?

Maybe it was the crystalline light of my own heart, protecting it from the fire of destruction represented by aimless drinking and carousing.

Or perhaps there is another meaning altogether.

_______________________

Our law firm has many successes with health care and business law clients, whose practices are transforming the business and health care landscape as we know it.

Michael also sponsors Being Central, a Portal for Potential, which gives access to other, pre-paid legal services.

Managing Fee Splitting Issues in the Integrative Care Center or Medical Spa

Thu, 24 Dec 2009 18:27:11 -0500

This article updates our discussion of how our attorneys structure multidisciplinary clinical practices involving complementary medicine, holistic health, and medical spa therapies.

In Legal Issues in a Medical Spa or Integrative Care Center: Anti-kickback and Fee-Splitting Concerns - The Laws we looked at some of the governing laws - the federal "Stark" and Anti-Kickback statutes, and mirror state prohibitions such as those on fee-splitting.

In Legal Issues in a Medical Spa or Integrative Care Center: Anti-kickback and Fee-Splitting Concerns - Structuring the Practice we wrote about the way we help our clients structure their centers or spas so as to address these legal concerns.

We noted that legal issues involving self-referral, kickbacks and fee-splitting need to be addressed in structuring a medical spa or integrative medicine care center - or even a multidisciplinary clinical health care center or group practice that involves multidisciplinary teams of allied health providers, such as psychologists and nurses. Within the medical spa, we are dealing with therapies such as Botox, collagen injections, laser skin resurfacing and laser therapy, and other cosmetic, aesthetic, and retail medical procedures.

Below we update the earlier information to make it more comprehensive:

Fee-Splitting and Kickbacks in Integrative Clinical Care or Holistic Wellness Centers and Medical Spas

The problem with splitting the check: Many clients call our attorneys and present a typical arrangement in which the center or spa accepts a fee for service from the patient and then splits it with the practitioner. For example, the center takes in $100 and gives the chiropractor, acupuncturist or massage therapist a percentage (say 60% or $60).

Whether you call this a fee-split or kickback, the problem is still the same. Federal law tends to call it a "kickback." Both the Health and Human Services (HHS) and Office of the Inspector General (OIG) opinions consider kickbacks a form of health care fraud and abuse. The kickback involves being paid in exchange for referring patients to an entity as opposed to getting paid market value for health care services. State laws may use kickback language or may simply prohibit fee-splitting. In any case, the basic concept is this:

The health care provider) cannot be paid a 'volume-based discount.' By health care provider we typically, but not always, mean the physician (MD or DO), because there is normally a state law that prohibits medical doctors from doing so. Some states will include other practitioners such as chiropractors (this is the case, for example, in NY).

This prohibition is particularly relevant to the integrative care center (which integrates conventional medicine with complementary and alternative medicine (CAM) therapies, and physicians and allied health care providers with CAM professionals such as chiropractors, acupuncturists, massage therapists, and nutritionists or energy healers) or medical spa. We use the two interchangeably for this discussion because the fee-splitting concerns are the same.

Translating the prohibition down to its most understandable level, the Professional Medical Corporation (or Physician, or other health care practitioner in states that apply the prohibition more broadly than to MDs and DOs) cannot be paid on a per-patient, production basis, The Physician may be operating through a Professional Medical Corporation so we use the two interchangeably here.

The prohibition on payment on a per-patient basis means that the patient payment for the health care or medical service cannot be split between Professional Medical Corporation (or Physician) and the Medical Spa or Integrative Care Center. That would quite literally be splitting the doctor's fee between the doctor and the corporate entity (center or spa).

In terms of payment flow, the patient cannot pay (write the check out to) Professional Medical Corporation (or Physician) for medical services at the Medical Spa or Integrative Care Center, and have Professional Medical Corporation (or Physician) then rebate a percentage to the Medical Spa or Integrative Care Center, as this would be considered a kickback from the patient's fee. Example: Patient pays Doctor $100 and Doctor rebates $25 to Integrative Care Center of Medical Spa.

Nor can the patient pay the Medical Spa or Integrative Care Center for Professional Medical Corporation (or Physician)'s services, and then have the Medical Spa or Integrative Care Center then rebate a percentage to Professional Medical Corporation (or Physician). Example: Patient pays Integrative Care Center or Medical Spa $100, and Center or Spa pays Doctor $75.

The reason it is important to track the flow of payments (who gets the check from the patient, and who then pays whom) is because, as illustrated above, this sets up the fee-splitting (kickback) prohibition. But our lawyers have developed a work-around, based on existing law and other models.

If the practitioner receives payment from the patient and then pays the Center or Spa for administrative services (such as receptionist/scheduling or front desk support, and other services on a menu, such as billing, accounting, and marketing), then the practitioner is not being paid in exchange for referring patients to the Center.

If the Center or Spa has hired the practitioner to perform the service, and the Center or Spa receives the check from the patient and then pays the practitioner, then the practitioner is simply an expense of the Center.

Of course there is never any guarantee that a proposed arrangement will not be investigated or subject to enforcement action. However, one can design structures that take account of legal roadblocks and attempt to create a flow of payments that respect existing legal rules.

Structuring the Arrangement to Manage Legal Risk of Illegal Fee-Splitting or Kickback

Our law office uses two basic, different structures, the "Medical Mall" and the "Center" model, in order to address these concerns. These two structures basically follow the flow of payments laid out above.

Once again, whereas federal law applies anti-kickback rules only to physicians (not including naturopathic physicians), some states, such as New York, apply the fee-splitting prohibition to a variety of practitioners including, for example, nurses and chiropractors. But the approach our lawyers take is intended to cover both sets of legal rules.

In the examples below, read "psychologist," "nurse," "practitioner," or simply "other practitioner" for physician if dealing with a non-medical, health care provider. As noted in our previous article on fee-splitting, some states apply these prohibitions broadly against designated non-medical practitioners as well as against physicians.

"Medical Mall" Model

The reason we call this the "medical mall" model is because the set-up for the Center, Clinic or Spa is essentially like a mall that has various "storefronts," one for a medical practice and the other for other health care practitioners. Simply put, in the medical mall model, the medical doctor rents space; patients pay the medical doctor for services; and the medical doctor pays the Center, Clinic or Spa for administrative services.

So in this arrangement, the Center or Spa will also lease space to the medical doctor and other health care practitioners. The lease will be a separate written contract. Lease payments will have to be for the market value of the lease, and not be tied to the volume of patients the practitioner sees or refers to the Center or Spa. However, in order to accommodate ramp-up time in the practice, the lease can establish a rising amortization payment over time.

Note that there could also be a separate equipment lease. For example, the medical Spa may buy an expensive laser and lease its use to the medical doctor.

Our attorneys will also draft an agreement to govern the understanding between the Center or Spa and the practitioners, beyond the lease itself.

Whose Patient: The agreement specifies that the Professional Medical Corporation (or Physician) is retained as an independent contractor, with independent medical judgment, to see its own patients at the Medical Spa or Integrative Care Center. Therefore, the medical records are owned and maintained by Professional Medical Corporation (or Physician) and not by the Medical Spa or Integrative Care Center. However, the Medical Spa or Integrative Care Center can be given the right to a copy of those records when the contract terminates. (There is an option for Medspa to administer the records but this would be atypical, and Professional Medical Corporation (or Physician) should in any event be considered 'owner' of the medical records).

Fee structure: Professional Medical Corporation (or Physician) will pay the Medical Spa or Integrative Care Center fair market value for space under a separate lease agreement.

In addition, Professional Medical Corporation (or Physician) will pay the Medical Spa or Integrative Care Center a monthly management or administrative fee.

Flow of payments: In the Medical Mall model, patients must write checks for medical services provided by Professional Medical Corporation (or Physician) directly out to Professional Medical Corporation (or Physician). The Medical Spa or Integrative Care Center can serve as the billing and collecting agent for Professional Medical Corporation (or Physician), and be authorized to deposit those checks directly into the Professional Medical Corporation (or Physician) account. The Medical Spa or Integrative Care Center can be authorized to withdraw its administrative fee from the account it maintains for Professional Medical Corporation (or Physician).

Possible business advantages: This model arguably presents less of a corporate practice of medicine problem for the Medical Spa or Integrative Care Center, because it puts the Medical Spa or Integrative Care Center at one further remove from the medical practice of Professional Medical Corporation (or Physician) than the "Medical Spa or Integrative Care Center" model. This removal also could, theoretically, potentially distance the Medical Spa or Integrative Care Center from liability for actions of Professional Medical Corporation (or Physician). It may also be easier to use existing coding and bill insurance companies for various therapies under this model, since patients will 'belong' to Professional Medical Corporation (or Physician), making it easier to justify visits as medically necessary.

Financial Implications:

Medical Spa or Integrative Care Center profit =

Lease payment received from Professional Medical Corporation or Physician.

Plus: Administrative fee received from Professional Medical Corporation or Physician.

Less: Overhead.

Professional Medical Corporation (or Physician) profit =

Income collected from patients seen at the Medical Spa or Integrative Care Center.

Less: Lease payment paid to Medical Spa or Integrative Care Center.

Plus: Administrative fee paid to Professional Medical Corporation (or Physician).

Financial Advantage: Theoretically, Professional Medical Corporation (or Physician) does better under this model, assuming it generates large cash flow in its practice at the Medical Spa or Integrative Care Center, and that the lease and administrative payments are not too high.

"Medical Spa or Integrative Care Center" Model

In the "Center" model, the Center is essentially the entity dealing with the patient, and it hires the Professional Medical Corporation to perform designated services. Simply put, the Center model is one in which the Center contracts with the physician's corporate entity for medical services, and in return, the physician's corporate entity contracts for administrative services.

Whose Patient: In the agreement our attorneys will draft for you, the Professional Medical Corporation is retained as an independent contractor, with independent medical judgment, to see the Medical Spa or Integrative Care Center's patients.

If the state has a strong corporate practice of medicine doctrine, the medical records should still be owned and maintained by Professional Medical Corporation, with the Medical Spa or Integrative Care Center having the right to contemporaneous copies of these records; otherwise, records can be shared among practitioners or a central (i.e., electronic) record can be created, with each of the Medical Spa or Integrative Care Center and Professional Medical Corporation having the right to contemporaneous access and copies upon termination. Patients should be required to execute a consent authorizing access by multiple caregivers within the Medical Spa or Integrative Care Center.

Fee structure: The Medical Spa or Integrative Care Center pays Professional Medical Corporation a pre-set amount for services rendered or to be rendered. Examples include:

$X per Botox injection
$Y per hour of medical services
$Z per month.

To avoid the appearance of a kickback, this has to be a flat fee and not a percentage. Professional Medical Corporation pays the Medical Spa or Integrative Care Center a monthly management or administrative fee.

Performance bonuses can be included, so long as they are not based on the volume of patients seen; otherwise it looks like a kickback for patient referrals.

Typically, there is no additional rental (or lease) payment for space from Professional Medical Corporation to the Medical Spa or Integrative Care Center. The Professional Medical Corporation is just contracting with the Center or Spa to provide medical services and to receive administrative services; as contrasted with the Medical Mall in which the concept is essentially an independent medical practice sitting inside a multidisciplinary space.

Flow of payments: In the Center Model, the patient pays for medical services rendered by Professional Medical Corporation by writing the check out to the Medical Spa or Integrative Care Center.

The Medical Spa or Integrative Care Center again can collect the money either itself or through a third-party MSO or billing and collections service.

The Medical Spa or Integrative Care Center can pay Professional Medical Corporation (or Physician) out of this account.

Possible business advantages: The patient experience arguably will be enhanced in a more integrated environment, and this may also be conducive to more cross-referrals within the space, generating additional revenues as well as enhancing collegiality across disciplines.

Financial Implications:

Medical Spa or Integrative Care Center profit =

Income collected from patients Professional Medical Corporation has seen at the Medical Spa or Integrative Care Center.
Plus: administrative fee paid by Professional Medical Corporation.
Minus: Service fee paid to Professional Medical Corporation.
Minus: Overhead.

Professional Medical Corporation profit =

Service fee received from Medical Spa or Integrative Care Center.
Less: Administrative fee paid by Professional Medical Corporation (or Physician) to Medical Spa or Integrative Care Center

Financial Advantage: Theoretically, the Medical Spa or Integrative Care Center does better under this model, assuming that Professional Medical Corporation generates large cash flow in its practice at the Medical Spa or Integrative Care Center, and that the service fee paid to Professional Medical Corporation is not proportionately high.

Note that the shorter the contract term, the more regularly the service fee can be adjusted for a growing or declining practice, respectively. The "Center" model also should be easier to implement administratively, since patients are all writing the check out to the same entity.

However, centers or spas can choose the "Medical Mall" option for some of their practitioners (for example, for the MDs) and the "Center" option for the rest. One consideration is that it may be administratively (and psychologically) challenging to migrate from an all-Mall option, say, to an all-Center option, so it is important to structure the practice carefully from the beginning.

Contractor Model

There is actually a third model, one in which the medical doctor is simply a contractor personally with the Center or Spa. The medical doctor does not have a professional medical corporation, but instead is effectively "inside the spa."

In this scenario, the doctor can be paid by the Center or Spa a set amount per procedure as in the Center model, and also, can be paid a percentage of revenues he or she brings to the practice. The argument is that is not a volume-based kickback, because the provider is inside the entity and is getting paid the exact same amount per procedure. In other words, the provider is not being paid for the volume of patients referred to the Center or Spa. If the doc refers patients to other providers within the entity, the doc is not thereby profiting.

Of course, were the arrangement to offer the physician compensation in exchange for referring patients, say, to the massage therapists within the Center or Spa, that would be illegal. (Note that the doc could refer to other doctors downstream within a "group practice," meaning other docs who spend 75% or more of their time within the practice and have a partnership agreement to that end. This is a so-called "safe harbor" under the federal statute known as the in-office ancillary exception).

Although the Contractor model has benefits, it does not provide the same kind of liability protection as a professional medical corporation, and in addition, the corporation may offer tax benefits.

Corporate Practice of Medicine Concerns

In addition, there are usually two intersecting legal problems--the anti-kickback, fee-splitting rule, and the prohibition against corporate practice of medicine. The agreement our attorneys draft between the medical doctor and the Center or Spa specifies that the MD has independent medical judgment. This is to overcome the corporate practice of medicine problem. For example, the Spa cannot, simply because it needs the money, pressure the doctor to treat a patient who is not a good candidate for Botox.

Every state has a different spin on the corporate practice of medicine doctrine, however, so state law has to be carefully researched.

Liability for Negligence

Another related issue that needs to be examined is who bears liability for negligence. This is complex, because there are so many different practitioners, and the question involves direct liability, as well as vicarious liability (liability for the negligence of another). Briefly, the Spa generally will not be liable for medical malpractice because the malpractice would be that of the physician. However, the Spa (or Center) could conceivably be liable for negligent retention of the medical doctor (or other health care practitioner), or for negligent supervision. It is a good idea to think through possible liability scenarios, and also to have appropriate E&O (errors and omissions) or other insurance.

Self-Referral Issue

Above we have dealt largely with kickbacks and fee-splitting. There is a separate legal issue known as self-referral. Essentially, federal (and often state) law prohibit a licensed physician from owning a financial interest in an entity to which he or she refers patients. So if the medical doctor owns a percentage of the Center or Spa, there is a self-referral problem.

Under federal law, this is known as "Stark." However, Stark only applies to 10 services identified in the federal statute.

Some states (such as California) fill in the gap by having statutes address both self-referrals and kickbacks. State law should be researched carefully. Federal anti-kickback law only applies if federal money is involved regarding the health care service, but again, state anti-kickback law may "kick" in and should be carefully analyzed.

One way to go about the analysis is to ask questions in this order:

1. Does the doc have an equity position in the Spa or Center? If so, look for a self-referral problem.

2. Does the Spa or Center offer one of the 11 designated services under Stark (note: these do not include cosmetic procedures or aesthetic medicine)? If not, check state law for self-referral issues.

3. Does the flow of payments raise an anti-kickback concern? If so, are federal funds involved (as in Medicare/Medicaid, CHAMPUS, or a federally funded employee insurance program).

4. Do the arrangements trigger a state law, fee-splitting or kickback concern? Is there a federal safe harbor (such as fair market value) that the state would likely follow?

5. Can the arrangement be structured as a "Medical Mall," "Center," or "Contractor" model so as to manage legal risks?

Conclusion

This article represents an introduction to one area that we address in helping our clients structure their medical spas, integrative care centers, or related health practices and business in a manner that is as legally safe yet financially viable as possible. Please contact us for further information.

Our law firm has many successes with health care and business law clients, whose practices are transforming the business and health care landscape as we know it.

Michael also sponsors Being Central, a Portal for Potential, which gives access to other, pre-paid legal services.

Structuring the Holistic Health Care Clinic, Wellness Center, Medical Spa, or Integrative Care Center: Legal Issues

Thu, 24 Dec 2009 18:05:23 -0500

Attorneys at Global Vision Law Group routinely advise clients setting up holistic health care centers, wellness clinics, integrative medicine centers, and medical spas regarding the legal issues involved in structuring a group health practice or wellness initiative.

The checklist of legal issues that our lawyers address includes areas such as:

medical malpractice
chiropractic malpractice, acupuncture malpractice, and negligence by other healers such as homeopaths, naturopathic physicians, homeopathic physicians, massage therapists, energy healers, psychologists, and other mind-body providers and therapists
scope of practice (the practice boundaries for health care practitioners other than MDs and DOs)
medical board and other regulatory board discipline for unprofessional conduct (also known as professional misconduct
insurance billing and coding
Medicare opt-out and dealing with Medicare patients as a par or non-par physician
health care fraud and abuse issues
contracts between the center and associated practitioners
other legal issues

Because this is such a huge and growing part of our niche practice in holistic health care, complementary and alternative medicine, integrative medicine, and the medical spa and wellness industries, we have dedicated considerable blog time to posts discussing the legal issues.

Most commonly our attorneys refer clients to posts such as:

Legal Issues in a Medical Spa or Integrative Care Center: Anti-kickback and Fee-Splitting Concerns - The Laws

Legal Issues in a Medical Spa or Integrative Care Center: Anti-kickback and Fee-Splitting Concerns - Structuring the Practice

In the next post we will update our discussion of medical spa legal issues with a focus on contracts between the wellness or holistic health care (CAM or integrative medicine) center or medical spa on one hand, and the practitioners on the other.

Our law firm has many successes with health care and business law clients, whose practices are transforming the business and health care landscape as we know it.

Michael also sponsors Being Central, a Portal for Potential, which gives access to other, pre-paid legal services.

What time you wake up has meaning

Wed, 16 Dec 2009 14:58:21 -0500

If you wake up in the middle of the night at a certain time, it could have a specific meaning.

I got this from Marie Jones who wrote "2013," a book about what happens after 2012.

Last night I woke up and thought, "sure, 1:01, 2:02, 3:03, big deal....." I checked the clock. The time was 2:42.

What does that mean?

I have a client who compared an interpretation of law that opposing counsel had, to UN Resolution 242 which pertains to the territorial integrity of Israel.

When I thought of it, I got "chills." Why did I wake up at exactly 242?

The Universe is watching. (Or as the optimist put it, the cosmos is conspiring in my favor).

And territorial integrity is important for all of us who wish to live within secure and defensible borders (even as we expand ourselves out past the Milky Way in our sleep ... so long as we return at exactly 2:42).

Our law firm has many successes with health care and business law clients, whose practices are transforming the business and health care landscape as we know it.

Michael also sponsors Being Central, a Portal for Potential, which gives access to other, pre-paid legal services.

New Icons In My Signature

Tue, 15 Dec 2009 21:32:20 -0500

My signature now has stunning new icons, based on the popular Webtoolkit Icon Set Vol 1, expanded by my web designer with some custom images to represent my websites. Simply click an icon to visit.

Michael H. Cohen is an attorney providing business legal advice to green entrepreneurs and companies, and health care law advice to businesses and physicians, acupuncturists, naturopaths, homeopaths and others in the holistic health, wellness, and green industries. As a founding attorney of the Global Vision Law Group, he represents businesses poised for vertical lift, whose leaders are conscious, intuitive, and committed to shaping a better world. Michael also advises medical spas and integrative medicine clinics, physicians, chiropractors, naturopathic physicians, massage therapists, energy healers, nutritionists and herbalists, dietary supplement and cosmetics companies, and businesses with bio-energy and other technologies and medical devices. The law firm has many successes with health care and business law clients, whose practices are transforming the business and health care landscape as we know it.

Michael offers Entrepreneur’s Legal Toolkits, a series of legal guides for businesses, designed to deepen your understanding of legal essentials. The first kit deals with Contract Essentials, giving legal tips every business needs to negotiate its legal agreements; the second addresses legal issues faced by companies and individuals involved in Multi-level Marketing and Direct Sales; and the latest is a HIPAA Regulations and Privacy Manual available at far less cost than it would take for an attorney to prepare.

Visit Flat Rate Legal Services for information on legal services offered at a flat rate or project fee (such as incorporation for entrepreneurs, review and drafting of business contracts, trademark, and health law services for CAM providers and others). Michael also sponsors Being Central: A Portal for Potential, which gives access to other pre-paid legal services.

Michael’s clientele through the Global Vision Law Group includes businesses in California, New York, Maryland, Massachusetts, Washington, D.C., other U.S. states, and also abroad. To speak with a lawyer about health care law issues pertaining to complementary and alternative medicine, or to consult a business lawyer about laws and legal issues for entrepreneurs and new enterprises that are seeking legal advice, contact the Global Vision Law Group today.

Michael also invites you to visit his Complementary and Alternative Medicine Law Blog, a leading resource for news on legal and ethical matters of interest to CAM providers.