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THE PATH AHEAD
Conflicts of Interest
Joseph Pizzorno, ND, Editor in Chief
n its October 12 issue, the British Medical Journal (BMJ) pub-
I lished a relevant editorial on conflicts of interest as the term
applies to medical research publications. BMJ is to be con-
gratulated for proposing a very stringent policy, complete with a
form for authors to fully disclose potential commercial conflicts
of interest. (And I might add, IMCJ also asks authors for such a
form, albeit a less comprehensive one. You can find our Conflict
of Interest form on our website www.imjournal.com by clicking
on “Submissions.”)
Over the past decade, we repeatedly have seen disquieting
revelations on research authors having undisclosed financial
associations with companies whose products they are supposed
to be objectively testing. Even worse is the more recent revelation
involving the Journal of the American Medical Association (JAMA)
among others that some authors, for a fee, simply put their
names on research articles written by drug companies. One won-
ders how a researcher can truly claim credit for publishing 500
original research studies over a lifetime, much less over 10 years.
The disclosure form is now posted on the website of the
International Committee of Medical Journal Editors (www.icmje.
org/coi_disclosure.pdf ) and includes instructions and examples
to help authors provide the needed information.
The bottom line appears to be full disclosure as well as hon-
est revelation of who actually has done the research.
However, readers of IMCJ may recall my editorial “How Do
We Get Better?” (IMCJ. 2008;7.4:8-10) where I cited an article
from JAMA that showed a more subtle form of conflict of inter-
est: The more drug research advertising a journal accepts, the less
likely it is to publish a study on CAM, and, if it does, the study is
almost always a negative one.
This issue of potential conflict of interest is extremely chal-
lenging and should apply not only to the authors of journal arti-
cles but also to those editors and peer reviewers associated with
the journal as well.
My Own Conflict of Interest Disclosure
So, time for my own full disclosure: I have become a consul-
tant to the Factors Group to develop a line of natural health
products for healthcare professionals under the Bioclinic Naturals
brand. You may shortly see my name and image with that of my
long-time friend and coauthor, Michael Murray, ND, in advertise-
ments for the Bioclinic Naturals.
This relationship, of course, poses a potential conflict of
interest for me as the editor in chief of IMCJ. The obvious con-
cern is that the journal might give unfair advantage to Bioclinic
Naturals in editorials, peer review, or article selection. Or per-
haps, as editor in chief, I will become biased against competitors.
A more subtle concern is that, just as so many of us have cri-
tiqued conventional medicine journals for being apparently in
8 Integrative Medicine • Vol. 8, No. 6 • Dec 2009/Jan 2010
bed with the pharmaceutical com-
panies, we may now become uncon-
sciously less rigorous when evaluat-
ing CAM research—in particular
research from natural health manufacturers—that proves the
efficacy of their products.
The issue of unfair advantage for Bioclinics Naturals is easy
to handle as I can simply recuse myself by handing off to other
editors any studies submitted by the Factors Group and can be
sure to not mention them or their products in any future editori-
als. (Interestingly, in early 2009, the Factors Group submitted an
article that is currently going through peer-review. I will, of course,
recuse myself from the acceptance decision.) On a more subtle
note, when Bioclinic Naturals advertises in any Innovision Health
Media publications, my name and image will not be in the ads.
The issue of unfair treatment of competitors is going to be
much more difficult to handle. IMCJ has for many years had an
editorial priority of strongly encouraging natural health product
manufacturers to conduct direct research on their own products.
We are very concerned that many manufacturers use borrowed
research—ie, they assert that research done by other companies
applies equally to their products. The problem with this is that
there are so many variables in how, for example, an herbal medi-
cine is processed that there is real doubt about just how compa-
rable products manufactured by different companies really are.
Another problem is that many formulations are put together by
some very smart people who read the research and determine
what should work. But really, how do you know that this appar-
ently wonderful blood sugar–lowering formula really will do
what it says it does without actually trying it on real people? (One
excellent article we recently ran on borrowed research was
“Quality Assurance: The Difference Between Quality Control and
Quality Assurance Using an Example of Pomegranate Extract” by
Rick Liva [IMCJ. 2009;8.3:48-50].)
At IMCJ, we have spent a lot of time and editorial resources
helping to encourage, teach, and guide manufacturers to engage
in real research. I realize this has not often been visible to you, the
reader, but I think you will agree that this is desirable.
Unfortunately, in spite of all our efforts, most of the research
submitted to us needs further refinement before it can be consid-
ered as original research. Happily, fellow editor David Riley, MD,
editor in chief of Alternative Therapies in Health and Medicine, one
of our sister publications, has made the excellent suggestion that
we add the category of Research Letters to accommodate such
submissions as another tier of research articles. (These letters will
be reports on original research that are between 600 and 1500
words of original text not published elsewhere.)
My intent is to continue to encourage manufacturers to
engage in research, and since IMCJ will welcome such research
Pizzorno—The Path Ahead
letters—clearly identified as such—I will actually be accepting
more research from supposed competitors.
In regard to unfair favoritism to the industry, all I can say is
that IMCJ has published more than 50 editorials, articles, and
columns on quality control problems with natural health prod-
ucts. While I expect to continue to receive the occasional irate
call or letter from a manufacturer, I can say with considerable
determination that IMCJ will continue to be a force for improve-
ment in the quality, safety, and efficacy of the agents we pre-
scribe for our patients.
I also want to be clear that if my association with the
Factors Group is perceived to be a conflict of interest or in any
way taints the integrity and/or professionalism of the journal, I
will step down as the editor in chief. It is actually a great oppor-
tunity to bring this issue to the forefront, and I am proud that
IMCJ can once again be on the leading industry edge and open
up such a discussion. I am utterly committed to continuing to be
an unbiased advocate for both the journal and the advancement
of good medicine.
A last point of consideration: There is also a reality factor for
all editorial disclosures. The vast majority of medical profession-
als who are associated with journals—including authors,
researchers, and editors—generally do so on a part-time basis.
This leaves time and finances that need to be filled. Liaisons with
commercial interests can be a win:win for both parties, so it is a
joining we will likely see continued in this field.
So, what do YOU think? Letters to the editor, please.
Write IMCJ, 2995 Wilderness Place, Suite 205, Boulder, CO
80301; e-mail imcjsubmissions@innovisionhm.com; or send a
fax to 303.440.7446.
Please be assured that if there are letters expressing concern
over my involvement with the Bioclinic Naturals brand, these
responses will be blinded before coming to me so I won’t know
who sent them. We want to keep the conversation as open and
receptive as possible.
In This Issue
In this issue, we have a special report on women’s reproduc-
tive issues. Bethany Hays, MD, starts us off with another of her
incredibly insightful articles, this time on infertility. She focuses
on 4 mitigating factors in infertility: the external environment, the
internal environment, the intracellular environment, and the
psycho-social-spiritual environment. Ways to address these areas
include cleaning up the patient’s environment with a diet of pri-
marily organic vegetables and animal products; normalizing
insulin resistance, obesity, and inflammation with a balanced
antiinflammatory diet; and evaluating vitamin deficiency with the
goal to replenish missing vitamins and minerals with a balanced
multivitamin, activated B-vitamins, and omega-3 fatty acids.
Associate Editor Tori Hudson, ND, chimes in with another of
her clinically useful articles: “Botanicals for Managing Menopause-
Related Symptoms—State of the Science.” Approximately two-
thirds of women develop perimenopausal and menopausal
symptoms. Vasomotor symptoms are reported as the most com-
mon, followed by anxiety, mood changes (such as sadness or
depression), sleep disruption, body aches, fatigue, and more.
Pizzorno—The Path Ahead
Botanical alternatives to hormone replacement therapy are of
increasing interest to this group of women, and, in fact, peri-
menopausal and postmenopausal women are among the most
frequent users of botanical and dietary supplements. Useful
herbs include black cohosh (Cimicifuga racemosa), chasteberry,
vitex (Vitex agnus-castus), dong quai (Angelica sinensis), ginseng
(Panax ginseng), kava (Piper methysticum), kudzu (Pueraria mirifi-
ca), maca (Lepidium meyenii), red clover (Trifolium praetense),
rhubarb (Rheum rhaponticum), St John’s wort (Hypericum perfora-
tum), burdock root (Arctium lappa), licorice root (Glycyrrhiza
glabra), motherwort (Leonurus cardiaca), wild yam root (Dioscorea
villosa), and pycnogenol.
I am always intrigued by clinician/researchers who cre-
atively conceptualize models to help us more deeply understand
our patients. W. John Diamond, MD, writes on the sympathetic
and parasympathetic nervous systems in “Allostatic Medicine:
Bringing Stress, Coping, and Chronic Disease into Focus.” This
article is not light reading. I found his discussion of the central
nervous system as the preeminent regulatory influence on somat-
ic physiology useful. He suggests a newly coined anticipatory
regulatory concept called allostasis that permits bodily efficiency
by matching resources to perceived or anticipated need. If this
need is not met, stress results. In turn, if the stress reaction is
continuously activated, the allostatic system of stress-associated
reactions is also chronically activated, and this prolonged arousal
leads to a wear and tear on the body, resulting in an inefficient,
“bad” stress response.
Our interview is with Mary Hardy, MD, and Anne Coscarelli,
PhD, of the Simms/Mann Center for Integrative Oncology, which
is part of the Jonsson Comprehensive Cancer Center at the
University of California, Los Angeles. My friend Dr Hardy is the
medical director and Dr Coscarelli is the director of the center. The
center was created based on the understanding that patients with
cancer have diverse psychosocial needs, and many of those needs
were not being met in other places. At the clinic, a patient’s needs
are assessed in a variety of areas: psychological, social support,
nutrition and dietary supplementation, mind-body techniques for
stress management, and physical appearance assistance. Based on
this assessment, the clinic offers services such as psychological and
nutrition counseling, guided imagery and mindful meditation
techniques, and a detoxification program.
Sadly, Andrea McCloud, MFA, who has done such a good job
conducting these interviews for us the past several years, is leaving
to start a promising career in screenwriting. We will all miss her.
Joel Kreisberg, DC, continues his Green Medicine Tips, this
time considering indoor pollution. Tobacco smoke, mold, pesti-
cides, chemical cleaners, radon, carbon monoxide, asbestos,
formaldehyde, and lead are the “short” list of the most common
household contaminants. Reading his article, I was reminded of a
patient I saw 30 years ago who became sick every summer but by
late winter was again symptom free. It turns out he worked as a
painter until he got too sick and then would go back to college
until his funds ran out and he had to start painting again. I fol-
lowed his toxic metals levels (using hair analysis) for several years
and found a remarkably consistent biphasic toxicity pattern. He
became so intrigued by the health effects of toxic exposure that he
Integrative Medicine • Vol. 8, No. 6 • Dec 2009/Jan 2010 9
 later became a naturopathic doctor!
While John Weeks’s News and Analysis is always interesting,
I found this issue particularly compelling. Reading it gave me a
sense that the environment for our medicine is reaching a point of
transition where we move from constantly knocking on the door,
asking to be heard, to having a real place at the table. This was
particularly evident to me at the Hecht Foundation’s Dr Rogers
Award Ceremony that John mentions. As part of the awards cer-
emony, the foundation hosted an afternoon-long colloquium
where several of us (Jim Gordon, MD; medical acupuncturist Steve
Aung, MD; and CAM researcher Marja J. Verhoef, PhD; and I) who
have been working for so many decades to advance this medicine
discussed the future of CAM with a sold-out crowd of researchers,
clinicians, students, and healthcare administrators from across
Canada. For me, this was one of the most inspiring and encourag-
ing signs of the advancement of CAM I have experienced.
BackTalk by Bill Benda, MD. What can I say? Bill, as usual,
you are our Xantippe: You provoke us to think creatively. My
response, “Can’t we all just practice good medicine and get
beyond the tribalism?” A must read.

Joseph Pizzorno, ND, Editor in Chief

drpizzorno@innovisionhm.com

Errata

In the column by Joel Kreisberg, DC, “Preparing Patients for

Proper Sun Exposure,” published in the Aug/Sep issue (IMCJ.
2009;8.4:52-54), a paragraph on page 52 incorrectly used the
word melatonin vs melanin. It should read: “In addition, as a
person’s own melanin kicks in from repeated sun exposure,
there is less need for environmentally impactful sunblocks when
the person stays out for a longer time.”
Also on page 52, the second bullet point in column 2 misspelled
the word melanocyte in “increases in alpha melanocyte-stimulating
hormone, which limits DNA damage resulting from UV radiation.”
IMCJ apologizes for these errors and any confusion they may
have caused.

10 Integrative Medicine • Vol. 8, No. 6 • Dec 2009/Jan 2010 Pizzorno—The Path Ahead