Established in 2007, Cann Worldwide was active in the health-related hashish place and also operated a well being food items division as nicely. Its move into energetic pores and skin treatment with the Fuss Pot brand aimed to consider the electric power of hashish, via CBD [cannabidiol] and hemp actives, into magnificence.
Fuss Pot had developed two distinct pores and skin treatment ranges: a hemp-primarily based line concentrating on ageing and a CBD-primarily based line for fix. Both equally traces featured cleansers, serums, creams and entire body oils.
Offered on the internet via its web site, the manufacturer had kickstarted with the launch of its ‘ageless’ hemp pores and skin treatment line and would enter France this thirty day period and Australia in August with the range. The start of its CBD variety was on the horizon.
Setting up ‘support’ and ‘community’ all around the model
“We’re brand name-new globally. We did a compact generation run late very last year, just to get us into the area, but we will be formally kicking off in Europe,” stated Toni Cohen, marketing manager at Cann World-wide.
The brand name was starting up in France wherever it had a strong community, such as a formulation companion, and would then look to grow even more into Europe after it had constructed up “the aid and the group all over the product”, Cohen explained.
Speaking to CosmeticsDesign-Europe at Cosmoprof All over the world Bologna again in April, she said there experienced already been strong curiosity from the Uk, the Nordics, Canada and the US, but enlargement would come about slowly and gradually. “We really do not want to rush we want to do it nicely.”
Tackling the patchwork of CBD and hemp regulations
As the manufacturer expanded, Cohen explained it would have to navigate the patchwork of differing laws throughout the world, especially in Europe, but with two diverse traces, which includes a hemp-based assortment that faced much less legislative hurdles, Fuss Pot was self-confident it could extend reach very well. Cann World-wide also had widespread knowledge in doing the job in these fields, she explained, which would help transferring forward.
“Cann International, the dad or mum organization, has been in the cannabis and hemp place for many years (…) so, this is our heritage.
“…We actually fully grasp that hemp seed oil, which is our anti-ageing vary, is just as efficient in what it’s striving to do as the CBD fixing selection. So, we’re not heading to lose out. We think equally ranges are incredible, and if your marketplace accepts it, then – superb. We have set the science into the two,” she reported.
D2C engagement with retail ‘visual appeal’
Even though the model would continue to promote immediate-to-consumer (D2C), Cohen said Fuss Pot obviously experienced “visual appeal” for merchandising in much more standard bricks and mortar settings. Its ranges ended up packed in matte black UV protecting glass and utilized sustainable cardboard with vibrant styles as secondary packaging. These investments also intended the brand name would under no circumstances be mass sector, sitting down additional in the mid-to-high quality end of skin care.
“So that people can study and buy at their very own advantage, D2C is massive for us. But we are also performing with suppliers who are aligned with what we’re making an attempt to do and the consumer we’re trying to goal.”
And that client, she explained, ended up men and women searching for “natural skin treatment merged with helpful outcomes”.
“It’s not just about being all-natural and organic, which is obviously quite vital for the modern day customer, but it’s also about generating absolutely sure that it operates. So, we have the investigate and facts guiding both equally hashish and hemp from our guardian organization, but then are also functioning with our French formulator to make certain all the components we use have some sort of scientific or scientific qualifications for success,” she reported.
Further than CBD and hemp?
Requested if Cann World was seeking into other cannabinoids for Fuss Pot, Cohen reported: “To a certain diploma, for the reason that of the regulatory atmosphere, a ton of exploration has been lacking on some of all those other types. As I reported, it is actually important for us that the science and facts is there. So, as it gets to be out there – and we’re investing in this space ourselves, in terms of the terpenes side of issues and other cannabinoids – we surely will go on to investigate, innovate and look into as the knowledge becomes available.”
CBD of Denver (OTCMKTS: CBDD) has been under accumulation in recent weeks and recently broke north of its trading range. The stock had fallen to lows of $0.0016 from highs near $0.04 in early 2021, and the cannabis market looks ripe for a rally as there are 8 states with Marijuana legalization measures on the ballet including Texas, Oklahoma, South Dekota, Ohio, North Dekota, Nebraska, Missouri, Maryland, Iowa, and Arkansas.
CBDD hit the OTC in November 2018 and Microcapdaily reported on it at the time, stating in our article from November 16 “CBDD is a publicly traded company listed on OTC Markets and traded under the stock symbol CBDD. The Company is currently developing innovative CBD products and related social networking. CBDD is the new ticker for VGMI. The Company is led by new CEO Nicholas Sprung, a serial entrepreneur who used to be CEO of a Ski Company with an ambitious vision to make CBD of Denver a leader in the booming CBD space. The Company has established its principal corporate office located at 4610 South Ulster Street, Suite 150, Denver, CO 80237, where it has rented office space.
CBD of Denver (OTCMKTS: CBDD) is a Distributor of CBD and Cannabis flower and a producer of a full line of CBD oil and unique products sold in Switzerland and throughout Europe. CBD of Denver, Inc. is focused on using equity to acquire profitable Swiss assets at attractive valuations to create value for all our shareholders and is driven by a passion to improve lives and strengthen communities by unleashing the full potential of cannabis. Through our Rockflowr brands we have built a very strong European customer base by focusing on top quality products and meaningful customer relationships.
Earlier this year CBDD reported it filed audited financial statements for fiscal year 2021 on April 15, 2022 reporting a record $23.5 million in revenue and net income of $0.33 million. Management credits a fast growing market for its success and first profitable year. According to CBD of Denver CEO Paul Gurney: “While our internal momentum continues to grow, the market itself is providing increasing tailwinds. Just this week, Swiss authorities greenlighted a recreational usage pilot in the city of Basel to begin over the summer. As this trend potentially spreads across Switzerland, and ultimately across Europe, CBD of Denver is ideally positioned to capitalize on the rapidly evolving opportunities,” added Gurney. “I want to thank our shareholders for their continued support. I firmly believe we are on a great trajectory and look forward to reporting on our ongoing successes.”
While fiscal year 2021 financial results were exceptional the Company was negatively impacted in Q1, 2022, due to the reintroduction of COVID controls across Europe and pricing pressure on CBD flower. These trends have already reversed, and the Company’s April revenue nearly surpassed the entire first quarter’s revenue as prices began to stabilize. CBD of Denver generated $908,086 revenue in the first three months of 2022, with a net loss of $314,248 mainly on an inventory write down of $102,856. CEO Paul Gurney said “On the surface, the numbers don’t tell the full story and should be viewed in context. While revenues at 3.5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} margins don’t usually result in overall profitability, my mandate is to transform this business from a commodity trader into a higher-margin, multi-pronged, health and wellness powerhouse in Europe and Asia.”
To Find out the inside Scoop on CBDD Subscribe to Microcapdaily.com Right Now by entering your Email in the box below
The Company recently acquired 100{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of Mellow, a CBD ecommerce distribution platform and technology company, with capabilities in the UK, Europe, and Asia, for an undisclosed sum. The acquisition is expected to close in the second quarter of 2022. With operations in Asia, Mellow gives CBDD an entrance into the rapidly evolving CBD markets in the fast-growing Asia Pacific region. The Mellow technology stack will accelerate the Company’s plans to become the go-to name for cannabis across all parts of the value chain in international markets. his acquisition will combine technology and retail e-commerce distribution alongside manufacturing and supply chain infrastructure to create a turnkey solution for the CBD industry across Europe. According to CBDD management “Mellow is also the leading multi-channel distribution partner of choice for globally minded CBD and Hemp brands in Asia too, with our own physical store network and ecommerce channels. This is a global play.”
The Company recently expanded into the German medical cannabis market with the hiring of Bijan Hezarkhani to lead CBD of Denver’s growth in this fast growing European market. Bijan has extensive experience in the cannabis industry, including building out a medical cannabis franchise in Germany. He was the business development manager for Khiron Life Sciences for the last three years, visiting doctors and pharmacies in Germany to build Khiron’s medical cannabis business. Previously, he spent time at Canopy Growth as a business analyst covering Europe. Bijan will be the head of the Company’s medical cannabis sales in Germany and will be based in Frankfurt.
Germany officially approved medical cannabis in 2017. Germany is the largest medical cannabis market in Europe at 15 tonnes annually and generated approximately US$300 million of revenue in 2021. According to Forbes Magazine, over a million patients in Germany will have access to medical cannabis by 2024, with the German medical market worth €7.7 billion by 2028. The German market appears to be moving closer to adult-use legalization, a market estimated at 400 tonnes annually, making it critical to have the infrastructure in place in country. With 83 million people, Germany is the most attractive market in Europe for cannabis.
On May 26 CBDD announced mellow has signed an agreement with UK luxury CBD consumer brand OTO to act as their distribution partner in Asia. OTO, headquartered in London, is a premium positioned consumer CBD wellness brand, specializing in offering sophisticated products at the luxury end of the industry price spectrum. Mellow aims to provide the OTO brand experience through its mellow Asia division, which is operated out of the Hong Kong market, and which already operates a network of physical retail stores under the mellow banner as well as an eCommerce site
CBDD CEO said Paul Gurney said: “We are extremely excited to welcome the OTO brand to the mellow portfolio of brands in Hong Kong. This agreement will combine retail and technology/e-commerce distribution to enable mellow to continue the great work that the OTO team have achieved in other markets, and in doing so, will position OTO as the leading luxury CBD and wellness brand in the Asian markets. There is no other company present in the industry in Hong Kong with offering close to that of OTO. We are very pleased to be able to make this announcement, and we have much more in store ahead.”
Microcapdaily reported on CBDD in November 2020 in the $0.002 level right before the stock skyrocketed to over $0.03 per share in December. We stated in our article “CBD of Denver Inc. (OTCPINK: CBDD) is making an explosive move up the charts after the Company announced record revenues of $5,963,820.00 with gross profits of $484,666.00 for the 3rd quarter ended September 30, 2020. CBDD is an emerging player in the booming global CBD oil and CBD consumer health market which is expected to reach USD $123.2 billion by 2027, expanding at a CAGR of 25.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} over the forecast period. It’s easy to see why penny stock speculators are so bullish on CBDD; the Company’s subsidiary Rockflowr GmbH is quickly emerging as one of the leading wholesale companies for CBD in Switzerland. Rockflowr sources its hemp flower from the United States in large quantities and its distribution has grown to more than 7 countries in Europe. Rockflowr GmbH generated the bulk of CBDD revenues.”
Currently trading at a $31 million market valuation CBD of Denver has come a long way since we first reported on it in 2018, when the Company as nothing more than an ambitious vision. CBDD had a stellar year in 2021 reporting a record $23.5 million in revenue and net income of $0.33 million. While fiscal year 2021 financial results were exceptional the Company was negatively impacted in Q1, 2022, due to the reintroduction of COVID controls across Europe and pricing pressure on CBD flower. These trends have already reversed, and the Company’s April revenue nearly surpassed the entire first quarter’s revenue as prices began to stabilize. CBDD has been under accumulation in recent weeks and recently broke north of its trading range. The stock had fallen to lows of $0.0016 from highs near $0.04 in early 2021, and the cannabis market looks ripe for a rally as there are 8 states with Marijuana legalization measures on the ballet including Texas, Oklahoma, South Dekota, Ohio, North Dekota, Nebraska, Missouri, Maryland, Iowa, and Arkansas. Microcapdaily gave the heads up on CBDD in November 2020 when the stock was $0.002 right before it ran to over $0.03 in December 2020.We will be updating on CBDD when more details emerge so make sure you are subscribed to Microcapdaily so you know what’s going on with CBDD.
Disclosure: we hold no position in CBDD either long or short and we have not been compensated for this article.
In a move that many health care advocates have been pushing for years, the state Senate introduced a bill on Wednesday that would expand the state’s Medicaid program to some half million-plus low-income North Carolinians.
Until this point, Medicaid has been reserved mostly for children from low-income families along with a small number of parents in those families, poor seniors and people with disabilities. Since 2012, the possibility to sweep in many low-income workers has been on the table as a result of the Affordable Care Act, but Republican leaders in the state senate have been staunch opponents.
Now, after years of saying no, powerful Republicans in the state Senate are saying yes.
“Why now? Why this? First, we need coverage in North Carolina for the working poor,” said state Senate leader Phil Berger (R-Eden), who admitted during a press conference Wednesday that he has likely been the most outspoken person in the state about his opposition to Medicaid expansion.
“Second, there is no fiscal risk to the state budget moving forward with this proposal,” Berger added, noting that the bill includes pay-fors that would have hospitals largely on the hook to pay the 10 percent of the costs for the expansion population not covered by an enhanced federal payment. There’s also a federal incentive that would total some $1.5 billion in extra funds that would flow to North Carolina over a two-year period.
Finally, he argued that since the state has moved Medicaid from being a state-run fee-for-service program to one managed by commercial insurance companies, the program has been “reformed and transformed.”
“Medicaid expansion has now evolved to a point that it is good state fiscal policy,” Berger continued. “But again, I cannot emphasize this enough: Expanding Medicaid needs to happen with additional reforms.”
Those reforms could make the bill to be titled Expanding Access to Healthcare in North Carolina a hard pill for many to swallow. One aspect of the bill would set up a work requirement for the new beneficiaries, something that’s been repeatedly struck down in other states by federal judges.
What really might jeopardize passage of the bill is that it contains provisions that already are raising hackles in some powerful health care lobbies, including those that advocate for the state’s physicians and hospitals.
Resistance from doctors
One reform proposed in the 33-page bill would make it possible for advanced practice nurses such as nurse practitioners, nurse midwives and certified registered nurse anesthetists (CRNAs) to practice without having a contract with a physician for their supervision.
Physician and nursing groups have been divided over the so-called SAVE Act for years, with medical providers — led by the North Carolina Medical Society — usually being able to stop the nurses from having more leeway in their practices. At a Senate Health Care Committee hearing held after the press conference, several Democratic lawmakers also expressed reservations over this part of the bill.
Chip Baggett, head of the North Carolina Medical Society, also spoke out about the nursing practice language in the bill at the committee. He had a number of problems with the changes.
“The first is the foundational education that is received by APRNs, many of which are receiving online education right now, and we do not think that provides the foundation necessary for independent decision making,” Baggett added after the meeting.
Joyce Krawiec, a Republican state senator from Kernersville, noted that 137 health care facilities across North Carolina only have CRNAs to deliver anesthesia services and that 34 other states have already loosened the rules around nursing practice.
“My husband had a colonoscopy recently, and they can do it with the supervision of a physician,” Krawiec said. She recounted how she asked the physician leading the procedure if he was overseeing the anesthesia. He responded, “Heavens, no, I don’t supervise her. He said I haven’t looked at anesthesiology since I was in medical school. I wouldn’t know what to do. She does it all on her own.”
Sen. Ralph Hise (R-Spruce Pine) argued that making it easier for nurses to practice, particularly in rural burgs, needed to be included in any bill that would make it easier for more people to see those providers.
“Finding nurses in this state is becoming more and more impossible,” Hise said. “And so this bill, allowing the nursing profession to expand its scope, to have more upward mobility in the nursing program is what ultimately I think will allow us to provide a lot of health care that we currently just don’t do.”
Rep. Gale Adcock (D-Cary), who is also a nurse practitioner, said that increasing access to health insurance would require adding providers.
“The majority of folks clearly understand these things all need to happen at the same time, and I’m excited to see that it might happen soon,” she said.
Hospitals, House objecting?
One of the big obstacles to Medicaid expansion that Republican lawmakers have raised for years has been where the 10 percent of the expansion cost not covered by the federal government would come from. For years, lawmakers have argued that hospitals would be the main beneficiaries of more federal dollars for Medicaid flowing to the state, so hospitals could foot much of the bill in the form of an additional assessment.
Hospitals have said they lose so much on uninsured patients that they were willing to pay for some of the cost, but not the whole tab. In Medicaid expansion bills in other years, this cost was also borne by a new tax on commercial managed care companies providing coverage under the “transformed” Medicaid program.
Rep. Tim Moore (R-Kings Mountain), speaker of the North Carolina House of Representatives, told reporters on Wednesday afternoon that he didn’t think members of his caucus had an appetite for Medicaid expansion this year. Photo credit: Rachel Crumpler
Hise contended the proposal will definitely help hospitals’ bottom lines, with more federal money flowing into the health care systems than they’ll have to put out to cover the rest of the Medicaid expansion population.
A spokesman from the NC Healthcare Association, which represents the state’s hospitals, told NC Health News that his organization was reviewing the new bill and would wait to offer comment on its potential impact.
The other big obstacle to passage of the bill may come from the other side of the General Assembly building in Raleigh, in the House of Representatives. Leaders there have expressed hesitation about making such a big policy change during this year’s short legislative session.
“The position of the House is we have no plans to take up expansion in the short session,” Rep. Donny Lambeth (R-Winston-Salem) said in a text to NC Health News.
Lambeth has been leading a committee with members from the House and Senate since January that has been examining what it would mean for the state to expand Medicaid.
“The work of the committee has not been finished and the committee has made no recommendations,” Lambeth continued.
The line from Lambeth and others on the House side has been that they’d rather come back for a special session on health care access in the fall. That, however, has drawn misgivings from state health leaders.
“I mean, September sounds nice,” Health and Human Services Sec. Kody Kinsley said last week. “But here’s why I’m worried. First and foremost, this $1.5 billion dollar signing bonus that’s on the table right now. Right now, the money that is earmarked for North Carolina is nothing more than, you know, some print on a piece of paper. And it would not be hard for Congress to take that off the table, so they can invest it in other things they need to invest in. We cannot wait.”
On Wednesday afternoon, Rep. Tim Moore (R-Kings Mountain), the speaker of the House of Representatives, said he believed that money would be available next year.
“All indications are it would,” he said. “If that is going to go away, then that’s a problem with the premise of even doing this.”
Medicaid already expanded
Since the beginning of the pandemic, Medicaid rolls have ballooned to close to 2.7 million beneficiaries, up from 2.1 million enrollees since March 2020. That’s because in one of their early COVID-19 relief bills, the U.S. Congress ordered all the new enrollees who qualified for the program to stay on the program for the duration of the federal state of emergency created by the pandemic.
Advocates have pointed out that many of those folks were people who would have qualified had North Carolina already expanded the program.
North Carolina likely paid billions more to cover those additional 600,000 people than the state would have if they had already expanded Medicaid, as the Affordable Care Act allowed. Instead of getting the 90 percent match that the federal government would have provided, the state had to make up the difference, paying 27 percent of the cost.
“We’re actually looking at a situation where a lot of the expansion population are already enrolled on Medicaid,” Hise admitted.
Hise also talked about the anxiety that county social service leaders have around the requirement to “recertify” all of these new Medicaid enrollees once the federal emergency ends. If the state doesn’t expand, at least half of those new enrollees would be purged from the rolls in a time-intensive process that would take up to a year.
The process of recertifying these peoples’ eligibility would be much less cumbersome if they end up rolled onto the program via Medicaid expansion, Hise noted.
Political process
After years of waiting for such a bill to come out of the Senate, there was a palpable upbeat energy in the Senate committee room.
“Sen. Krawiec, I hate to say I told you so,” quipped Sen. Gladys Robinson (D-Greensboro), an advocate of expanding Medicaid for years. Laughter erupted.
That giddy feeling might not last long. Getting the bill across the finish line seems like a stretch, given the resistance from the House and from powerful groups.
Catawba College political science professor Michael Bitzer said that many details could be hashed out once the House rejects the bill and it goes to a conference committee with people from both chambers.
“You know, conference committees are typically called the third chamber of the legislature because that is where the true dealmaking has to occur within the legislative dynamic,” Bitzer said. “With the way the two chambers are, that could become the real power base of any type of legislation that’s gonna get moved from either chamber.”
That bargaining will come down to who is willing to give up what from their wish lists during negotiation, Bitzer added.
“I think oftentimes with this type of significant legislation, people are probably more willing to say, ‘I can live without this,’ rather than, you know, ‘this is what my final demands are going to be,’” Bitzer said.
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by Rose Hoban and Rachel Crumpler, North Carolina Health News May 26, 2022
The state Legislative Building designed by architect Edward Durell Stone almost 60 years ago has a maze of hallways where lawmakers often buttonhole each other for private discussions about contentious public issues.
Rep. Donny Lambeth (R-Winston-Salem) is one of those lawmakers who has been taken aside recently to discuss the pros and cons of expanding Medicaid in North Carolina.
“One of the hallway conversations always comes around to, ‘Well so and so state has had all kinds of financial problems because they expanded Medicaid’ … so I really want to understand what has been the experience in other states as far as balancing their budgets, the impact on their operating funds and pressure it puts on their operating funds because they expanded,” Lambeth said Friday at the first meeting of the Joint Legislative Committee on Access to Healthcare and Medicaid Expansion.
While lawmakers from both parties have talked about ways to expand health care access for a while, there seems to be more momentum behind the joint House and Senate committee whose charge grew from budget negotiations last year with Democratic Gov. Roy Cooper, an expansion advocate.
Rep. Donny Lambeth (R-Winston-Salem) discussed some of the structural issues with Medicaid that the legislature has addressed over the past few years during a press conference at the NC General Assembly in 2019. Photo credit: Emily Davis
The new panel of lawmakers met for the first time on Friday to probe how to provide health care coverage to some 500,000 low-income adults who could have access to Medicaid if North Carolina joined 38 other states and expanded the program as the Affordable Care Act has allowed since 2013.
Through much of the past decade, Medicaid expansion has been a thorny topic that has divided Democrats, who support it, and Republicans who have resisted adding more North Carolinians to the subsidized government health insurance program. More recently, some Republicans including Senate Leader Phil Berger (R-Eden) have warmed up to the idea, recognizing a need to close the insurance gap in the state.
Dispelling misinformation
The federal government subsidizes 90 percent of the cost for adults enrolled through the ACA expansion. The American Rescue Plan Act of 2021 provides additional financial incentive for the 12 states that have yet to approve expansion, allowing them to temporarily draw down additional federal funds.
The National Conference of State Legislatures estimates North Carolina could get an additional $1.5 billion to $2 billion in additional federal funding. Kate Blackman, NCSL health director, and Emily Blanford, NCSL program principal, presented a report to the legislators on Friday with specifics on North Carolina and an overview of what other states have done.
Lambeth told Blanford about another hallway conversation he’s had, one that many Republicans have echoed as they explained their financial worries about expanding Medicaid. They worry the federal government will shift the fiscal burden to the state by decreasing its percentage of funding either abruptly or over time.
“The second part of that financial piece — you know, hallway conversations — is ‘Well, you know they started at 100 percent, that rate dropped to 90. What prevents them from going down to 70 or 60 or 50, and pull the rug out from under us and put more pressure on our state budget because all of a sudden now we’ve done it. It’s hard to take away a benefit, and we’re just going to have to pay more because you know, they kind of pulled that rug out from under us on that 90 percent,’ ” Lambeth said. “What does the law say about the 90 percent and how would that percent be changed?”
The federal government’s commitment to providing states with 90 percent of the expansion cost is written into the Social Security Act, Blanford responded, so it would take an act of Congress to change the law.
Lambeth explained after the meeting that he was trying to get answers throughout the two-and-a-half-hour discussion to dispel misinformation he’d heard from legislators who often stopped him in the corridors because they knew he was co-chair of the new committee.
Chilly caucus
Though some longtime critics of expansion have warmed to the idea during the coronavirus pandemic, such as the powerful leader of the Senate, there still are staunch opponents, especially in the state House.
“We’re not lukewarm in the House,” Lambeth told reporters after the meeting. “It is still rather chilly. It is a heavy lift to convince our House caucus that this is the right direction to go. Now is it impossible? No. I wouldn’t be here if I thought it was impossible.”
The committee touched on a wide range of health care topics Friday. The lawmakers discussed how to rein in the surprise medical bills that insured people get after inadvertently receiving care from an out-of-network provider they did not choose. They also discussed the shortage of nurses and other health care providers already hampering the state and how to help struggling rural hospitals and expand care access in those areas.
The next meeting of the Medicaid expansion committee is set for March 1.
‘The health care session’
The coronavirus pandemic has exposed under-funded health care systems and a lack of convenient access to quality care for numerous North Carolinians, many who live in some of the more rural districts represented by Republicans.
Lambeth said he expected the committee to spend months fact-finding and creating recommendations for what he called a “North Carolina plan” that could be ready in August or September and perhaps put to a full General Assembly vote by October. That could be a politically charged vote before the November elections.
That plan might expand Medicaid or subsidized coverage to hundreds of thousands of North Carolinians without specifically calling it “Medicaid expansion.”
“I can sort of view this as the health care session,” Lambeth said.
Sen. Kevin Corbin (R-Franklin), a committee member, is interested in exploring an array of programs that he has heard other states have used. “The view from 130,000 feet is we have a large number of uninsured people,” he told reporters after the meeting. “We need to get those people insured. How to do that is the question.”
“Medicaid expansion” used to be a bad word in some corridors of the Legislative Building, he said. “I think it has been, but I think it’s not so much anymore,” Corbin said.
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You can copy and paste this html tracking code into articles of ours that you use, this little snippet of code allows us to track how many people read our story.
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by Anne Blythe, North Carolina Health News February 21, 2022
For years, the conversations surrounding care for patients with multiple sclerosis (MS) mainly centered around drug development and the optimization of disease-modifying therapies (DMTs). There are now more than a dozen DMTs approved for MS, administered in various forms such as tablets, injections, or infusions. Although, as clinicians have learned, the management of these patients extends past treating solely the relapses.
Integrative wellness is a practice based around the belief that treating patients involves much more than only disease and symptom management and has become an approach adopted by more clinicians in recent years. This all-purpose type of method encompasses aspects of diet and nutrition, exercise, sleep, and ongoing preventive care, among others.1,2 Although there are no set guidelines on how to conduct this care, there are several overlapping themes and ideas.
The conceptual idea of integrative wellness often also carries a stigma, with many assuming these practices are not backed by scientific evidence. Contrary to this belief, ongoing research and the COVID-19 pandemic have confirmed the need for alternative approaches, particularly for patients with MS, who may benefit from interventions tailored to their individual needs.1-5
Variety in Wellness Approaches
Kathy Zackowski, PhD, OTR, senior director of patient management, care, and rehabilitation research, National Multiple Sclerosis Society (NMSS), has been at the forefront of researching and advocating for this new style of care. Her organization funds work that ranges from better understanding the use of acupuncture and yoga, to the resilience of psychosocial approaches, to the relationship of dieting and changes in the gut microbiome.
“The whole idea with wellness is that this is something that everyone can do right now,” Zackowski told NeurologyLive®. “You don’t need a lot of equipment, but you need to understand the important elements of a wellness strategy for you. For someone in pain, we might recommend some of these psychosocial strategies looking at resilience and pain management, but for someone who’s weak, they may need just exercise. Exercise is its own intervention. It’s not simple to go out and say, ‘go exercise.’ We need to understand what elements of that intervention are important for that person.”
The variety and usage of these integrative wellness approaches differs from clinic to clinic, which has added to its natural phenomenon. At Cleveland Clinic,6 physicians recommend maintaining a low-salt Mediterranean diet, getting at least 150 minutes of moderate movement per week, maintaining vitamin D levels between 40-70 ng/mL, not smoking or using tobacco products, and undergoing routine mental health screening.2,7,8
Nutrition’s Role in Wellness
Although there is a migration towards a better understanding of the need for collaboration and comprehensive care, some specialties are not consistently included in the model. Registered dietitians, for example, have historically been excluded from the multidisciplinary care team, with information on nutrition coming instead from integrative or alternative practitioners.
Mona Bostick, RDN, LDN, a nutritionist living with MS with a dedicated passion for optimizing nutrition, commented on this exclusion, adding that while nutrition is often miscast as an “integrative” approach, diet and how patients eat is not an alternative treatment for MS, but it is rather a pivotal aspect of overall health. Bostick is the founder of her private practice, Food Matters 365, now called MSBites, a source for evidence-based nutrition and wellness advice to help patients with MS.
“I believe the shift toward the integrative exists precisely because dietitians have not been included in the care team. With MS being such a disease [that] steals control over the things you thought you had control over, when alternative practitioners are promising to heal, beat, reverse, or give you that control back, the vulnerability that MS presents is going to make someone take a risk on that,” she told NeurologyLive®. “It’s important to know that nutrition and what you eat plays an important role in your overall health, but it doesn’t offset demyelination—nuance and context around what food can do is missing a lot of times in these integrative and alternative messages of this practitioners. I find that to be disconcerting because there is a vulnerability to the MS population, for sure.”
Zackowski echoed similar thoughts to Bostick, adding that even the general public should be exposed to nutritional dietitians. “With MS, it’s complicated. We don’t have the cure yet, and one of the ways the [National MS] Society talks about this is the pathway to cures. The idea that there’s not just one cure, there are multiple cures, and people define cure in a different way. One way of defining cure is taking away symptoms. If diet can provide some improvements in the symptoms people [with MS] have that’s one form of an MS cure,” she explained.
Sharing Best Practices for a Sense of Community
Amidst the ongoing COVID-19 pandemic, the shift to telemedicine challenged clinicians to provide care remotely, whether that be for symptom management or for integrative approaches. Interestingly, some clinicians say the use of telemedicine had a positive effect in increasing collaboration and information sharing within the MS field, as the unknowns associated with COVID-19 generated a need for experts to share timely data relating to the virus and overall best practices with one another.
Mitzi Joi Williams, MD, CEO, Joi Wellness Group Multiple Sclerosis Center, spoke on this increased sense of community within the MS field since the onset of the pandemic and over the course of 2021. Williams noted that her colleagues were not afraid to share findings and information from registries, whereas in the past, the scientific community had cultivated a sense of protectiveness in terms of clinical data that had yet to be published.
“The information sharing that has emerged from the COVID-19 pandemic has really been amazing, and to see the collaboration from people from different academic centers, from the academic centers in the community, to across the pond, across the world, across the globe, has really been astounding,” Williams told NeurologyLive®.
Social media has been crucial in establishing this sharing of information and collaborative attitude, allowing experts in the MS field to share information quickly and freely via online platforms like Twitter, Williams said. Monthly webinars and conferences also aided in the dissemination of updated data, with experts then able to implement practices in real time.
“I hope this collaborative approach amongst MS specialists, general neurologists, and my colleagues around the globe stays,” Williams said. “There has been this amazing unity amongst everyone to try to find the scientific answers we need to be able to adequately care for our patients. We’ve seen a lot of synergy with people creating registries fairly quickly—a lot of things that we thought couldn’t get done are absolutely getting done, [and] a lot of things we thought couldn’t be done remotely are absolutely being done remotely.”
Zackowski spoke on ongoing work of the NMSS to improve this collaboration and sharing of information as it pertains to wellness, which includes the development of the Wellness Research Group and 3 different subgroups: physical wellness, nutritional wellness, and psychosocial wellness.9-11 Information published online is tailored specifically to patients or clinicians, making it easier to access veritable, valuable sources, Zackowski said, noting that patients “do not need to be scientists” in order to understand findings from ongoing studies. This is not, however, a foolproof method for getting the word out about wellness, particularly due to the need for practices and information to be adjusted for individual patients.
“The idea of integrating just those 3 areas is challenging—and that’s not really addressing everything—there’s so many symptoms that people have with MS that I think can be addressed by different wellness approaches,” Zackowski said. “I think it’s really hard to get the message out to people about what to do because there’s no regulatory body on how to make sure the standards are the same everywhere, and that’s something we as a society are trying to grapple with a little bit more.”
Need for Increased Research
Although there is good reason to be excited about these integrative approaches, clinicians themselves also agree that there is a need for extended research that aims at understanding and optimizing these methods. As of now, clinicians use their better judgement, paired with what’s been observed in the literature and through the help of their multidisciplinary teams. There is no current law-abiding guideline that the community has developed or strictly follows.
“When you talk about exercise, diet, or even cognitive rehabilitation, no one knows exactly the right dose, Zackowski stressed. “How much do you need as a person with MS to address your particular issue? We do this automatically with medications because the FDA dictates that you have to put a particular dose and explain what that dose is. In the wellness area, we need to address those things, we need to understand the dose, the intensity, the setting that this is done in, and how that approach will be effective in people who have more than one symptom.”
Despite advances in research in recent years, the space is stilling being held back. Without backing from pharmaceutical companies or industry leaders, it has been difficult to conduct large scale trials that further help validate these methods. These groups have yet to formally recognize integrative wellness as something that has significant therapeutic benefit, especially since the data thus far has been hard to quantify.
That, ultimately, leaves supporters of integrative wellness practices like Bostick and Zackowski to fend for themselves in terms of powering research, or forces them to turn to organizations such as the NMSS in hopes of acquiring funding and materials.
“I’m thinking of getting pharmaceutical companies interested in this combined approach that uses a medication and a wellness strategy,” Zackowski said. “This might be another way to encourage greater funding for this, but it will take time and money to get this understood better. We are right on the forefront though—we’re at a place where this can be studied now, and I’m encouraged by that.”
A Look Ahead
In addition to the need for increased research, there remain complexities in the integration of dietitians into standard of care, according to Bostick. “Out in the community, there are dietitians everywhere. At this point, the obstacle is that continuing education hours are expensive and difficult to obtain. There’s not been a reason for a dietician to justify becoming educated and informed on this topic, because they’ve not yet been welcomed into the comprehensive care team,” she said.
Bostick added that once the talents of these specialists are more appreciated, they may go back to their communities and advocate for these roles as well as provide information for newcomers to feel more comfortable. While a dietitian may have a broad knowledge of nutrition, they may not be as equipped at that moment to treat the MS-specific component. “Broadly speaking, multiple sclerosis is not discussed in our education and training. That’s the obstacle,” she said.
Much like how the efficacy of drugs continues to be optimized in post hoc analyses, it will only be a matter of time before similar studies to further validate these wellness approaches. Overall, the commitment to these nontraditional, forward-thinking ideas represents the general trend within the medical system in recent years to treat the patient from a complete holistic perspective that addresses all downstream aspects of the disease, and not just the root cause.
This contribution to HCPLive’s 2021 This Year in Medicine series comes from sister publication NeurologyLive®.
REFERENCES 1. Latimer-Cheung AE, Pilutti LA, Hicks AL, et al. Effects of exercise training on fitness, mobility, fatigue, and health-related quality of life among adults with multiple sclerosis: a systematic review to inform guideline development. Arch Phys Med Rehabil. 2013;94:1800-1828. doi:10.1016/j.apmr.2013.04.020 2. Fitzgerald KC, Tyry T, Salter A, et al. Diet quality is associated with disability and symptom severity in multiple sclerosis. Neurology. 2018;90:e1-e11.doi:10.1212/WNL.0000000000004768. 3. Farinotti M, Vacchi L, Simi S, Di Pietrantonj C, Brait L, Fillipini G. Dietary interventions and multiple sclerosis. Cochrane Database Syst Rev. 2012;12:CD004192. doi:10.1002/14651858.CD004192.pub3 4. Skovgaard L, Bjerre L, Haahr N, et al. An investigation of multidisciplinary complex health care interventions–steps towards an integrative treatment model in the rehabilitation of people with multiple sclerosis. BMC Complement Altern Med. 2012;12:50. doi:10.1186/1472-6882-12-50 5. Alphonsus KB, Su Y, D’Arcy C. The effect of exercise, yoga and physiotherapy on the quality of life of people with multiple sclerosis: Systematic review and meta-analysis. Complement Ther Med. 2019;43:188-195. doi:10.1016/j.ctim.2019.02.010 6. Rensel MR. Wellness Practices That Can Improve Multiple Sclerosis Outcomes. August 14, 2017. Accessed December 10, 2021. https://consultqd.clevelandclinic.org/wellness-practices-that-can-improve-multiple-sclerosis-outcomes/ 7. Petajan JH, Gappmaier E, White AT, Spencer MJ, Mino L, Hicks RW. Impact of aerobic training on fitness and quality of life in multiple sclerosis. Ann Neurol. 1996;39(4):432-41. doi:10.1002/ana.410390405 8. Mokry LE, Ross S, Ahmad OS, et al. Vitamin D and Risk of Multiple Sclerosis: A Mendelian Randomization Study. PLoS Med. 2015;12(8):e1001866. doi:10.1371/journal.pmed.1001866 9.Wellness and Lifestyle Research. NMSS website. Updated 2021. Accessed December 10, 2021. https://www.nationalmssociety.org/Research/Research-News-Progress/Wellness-and-Lifestyle 10. Society-Supported Wellness Research Group Publishes Strategies for Improving Diet Studies in People with MS. NMSS Website. April 27, 2020. Accessed December 10, 2021. https://www.nationalmssociety.org/About-the-Society/News/Society-Supported-Wellness-Research-Group-Publishe 11. Fitzgerald KC, Sand IK, Senders A, et al. Conducting dietary intervention trials in people with multiple sclerosis: Lessons learned and a path forward. Mult Scler Relat Disord. 2020;37:101478. doi:10.1016/j.msard.2019.101478
When 51-yr-aged Bishwa Nath Oli visited Swayambhu’s department of Phende Clinic in February this yr, he wasn’t completely confident of what to hope. At the time, Oli experienced from unpleasant gout triggered by high uric acid levels, a healthcare situation that he experienced for just about ten many years. Just after seeking different treatment method strategies to stabilise his uric acid levels and failing to do so, Oli’s buddy proposed checking out Phende Clinic and consulting with Dr Tenjing Dharke Gurung, Alternative Medicine.
“After various consultations with Dr Tenjing and having his medicines for pretty much 6 months, my uric acid stabilised, and my pain was totally absent,” mentioned Oli in the course of a single of his regular visits to the clinic a couple of months in the past. “Since the treatment method wholly worked on me, I have been suggesting close friends and family members who put up with from identical wellbeing ailments to stop by Phende Clinic and give Sowa Rigpa a check out.”
Sowa Rigpa is a traditional clinical method that dates again more than 2,000 several years and is seriously affected by Buddhist philosophy. Sowa Rigpa healers are customarily known as amchis, but several of them these times use the title medical professional prior to their names. In certain mountainous districts of Nepal and India, the clinical technique is superior recognized as the ‘Amchi process of medicine’. Even though in several areas of the entire world, it is better recognized as traditional Tibetan medication. Aside from Nepal’s mountainous districts, Sowa Rigpa, normally translated into English as ‘the science of healing’, is broadly practised in India, Bhutan, China, and Mongolia.
For hundreds of years, for the people residing in Nepal’s mountainous districts, this professional medical process was the only accessible health care technique. But in the very last few many years, as additional persons from the region commenced migrating to towns like Kathmandu and Pokhara in the hopes of far better employment and training opportunities, a handful of Sowa Rigpa clinics started off operating in these cities to cater to the diaspora. In the previous couple of a long time, however, the amount of Sowa Rigpa clinics in these towns has improved, but a substantial number of clients that these clinics cater to are from communities that did not traditionally rely on the professional medical technique.
The very first registered Sowa Rigpa clinic in the region was Kunphen Ausadhalaya, established in 1973 and positioned in Chhetrapati, Kathmandu.
“The royal palace invited renowned Amchi Kunsang Phentok to Kathmandu to treat the then King Tribhuwan who was suffering from chronic liver ailment. Amchi Kunsang productively treated the late king, and which is how the initial registered Sowa Rigpa clinic in the country came into becoming,” explained Dr Nyima Tsering Nepali, who is just one of the two Sowa Rigpa doctors at present working at Kunphen Ausadhalaya. “In these days, the the greater part of individuals who came to our clinic ended up Kathmandu’s elites and individuals linked with the royal palace and people today from Nepal’s mountainous districts who had migrated to Kathmandu. But a large amount has transformed in the very last couple a long time. These days, folks from throughout the country and foreigners residing in Nepal visit our clinic.”
Sowa Rigpa physicians like Dr Gurung and Dr Nepali are educated to diagnose individuals employing a variety of diagnostic methods. “Some of the most widespread procedures Sowa Rigpa doctors use to analyse patients are by analyzing their pulse, tongue, and urine,” claimed Dr Gurung. “The medicines are all made employing goods that are found in character and subsequent the system’s generations-old custom.”
It was 2012 when Dr Gurung founded Phende Clinic in Swoyambhu. For the 1st two years, most of his sufferers have been persons from the indigenous communities of Nepal’s mountainous districts. Every single the moment in a whilst, says Dr Gurung, folks from other communities would appear to the clinic searching for health care.
“But a great deal has modified in the last handful of years. At my clinic in Swoyambhu, I see an regular of 80 clients, and all-around 70 percent of them are from communities in the hills and Tarai location of the state, each of which did not historically rely on Sowa Rigpa,” claimed Dr Gurung.
This rising acceptance of Sowa Rigpa as a medical procedure amid individuals from across the place inspired Dr Gurung to open branches of Phende in Dharan, Jhapa, Syangja, and Pokhara.
Section of the rationale the clinical process has been steadily getting popularity seems to be its efficacy and affordability. Saraswati Rashmi Shakya, a college student of Buddhist Studies, particulars her practical experience with Sowa Rigpa above 4 several years with The Article as “I had a harrowing issue of thyroid for which I sought treatment from a number of hospitals all over Kathmandu. The medications that I had been approved simply just exacerbated my psychological condition, as I would often experience down and dejected just after having it. Until, of course, I identified Sowa Rigpa, and it substantially enhanced my situation. While I had to be individual with the general course of action, it was unquestionably well worth it in the finish.” Shakya statements to have been introduced to this practice by 1 of her buddies finding out to grow to be an amchi in India. Her remedy, nonetheless, began at Chhetrapati’s Gentlemen-Tsee-Khang, which operates various branches of Sowa Rigpa clinics in Nepal. The main Sowa Rigpa medical doctor of Males-Tsee-Khang’s Chhetrapati branch is Dr Dhindup Tsering Tamang Lama (Daniel).
Dr Daniel started out his exercise in 2018 right after graduating from Gentlemen-Tsee-Khang (Sowa-Rigpa) Tibetan Medical and Astro School in Himachal Pradesh, India. All a few doctors the Article talked to for the tale analyzed Sowa Rigpa in India.
Until eventually 2016, Nepal did not have a focused university-affiliated Sowa Rigpa university and that’s the purpose why, say Sowa Rigpa medical professionals the Post talked to, several went to examine at Sowa Rigpa institutes in India.
“We knew that if we had been to protect and advertise Sowa Rigpa in Nepal, it is essential to have a focused federal government-recognised instructional institute in the country so Nepal can generate experienced and very well-experienced Sowa Rigpa health professionals proper here in the region. Right after yrs of really hard work, Sowa Rigpa Worldwide College, an affiliate of Lumbini Buddhist University, opened in February 2016. It is the only institute in Nepal to supply a Bachelor’s degree in Sowa Rigpa Medication [BSM],” claimed Dr Gurung, who also serves as the college’s director.
In accordance to Dr Nepali, who serves as the higher education principal, the institute has been ready to bring in worldwide pupils from Bhutan, Finland, India, Spain, and England. “In the past, only persons from Himalayan communities would research to turn into Sowa Rigpa health professionals, but this is no for a longer time the case. We not only have worldwide students but also nearby college students from non-Himalayan neighborhood backgrounds. This is an encouraging sign,” explained Dr Nepali. “The university is a not-for-earnings organisation and the most important purpose is to present excellent instruction to our college students. We also deliver attractive scholarships to deserving pupils. For the first 4 and a 50 percent several years, our learners go through arduous academic coaching, and in the remaining calendar year, they intern at recognised Sowa Rigpa clinics.”
Even so, the term-of-mouth publicity that served proliferate Sowa Rigpa, as properly as its usefulness, has actually bolstered its believability and overall reputation.
Even though Sowa Rigpa has permeated further than the Himalayan communities of Nepal only in the very last couple many years, it is nicely worthy of noting that this custom had taken root in the Western environment a long time before. This procedure of medication has also pervaded many sections of India above the past two decades. With the Indian federal government bolstering the infrastructures by incorporating Sowa Rigpa in just educational establishments and hospitals, this practice has steadily been making its way into the mainstream.
Stewart Mushet, a Scottish based mostly in Malaysia, who sought Sowa Rigpa procedure through a friend’s referral, urges absolutely everyone to strategy it with an open up head. “People normally tend to understand organic treatment as becoming like an antithesis to Western medicines. I would strongly recommend anybody in search of Sowa Rigpa to break out of that binary contemplating. You can follow your clinically recommended medicines when at the same time getting Sowa Rigpa medicines as properly,” explained Mushet. “Sowa Rigpa is not a competitiveness towards Western medications, but rather a complementary treatment method.”
At his clinic in Chhetrapati, Dr Nepali sees dozens of people daily. “The greater part of the people who appear to our clinic are all those with persistent non-communicable disorders this sort of as diabetes, hypertension, thyroid, arthritis, etcetera. Supplied that Sowa Rigpa clinics have never promoted their services, it surprises me to see people from these varied components of the state come and seek professional medical treatment method at our clinic. Those from economically marginalised backgrounds can also get free-of-value medical care at our clinic if they furnish a letter from the area authorities stating their circumstance,” mentioned Dr Nepali. “As Sowa Rigpa medical professionals, we are experienced to look at our occupation as an altruistic endeavour exactly where the most important objective is to relieve people’s sufferings, which is the main of Buddha’s teachings. As the folks of the land the place Buddha was born, we ought to shield and market this one of a kind professional medical technique.”
