Dr. John Monagle owns and operates the Marin Center for Natural Medicine, which is a state of the art medical clinic and natural pharmacy located 15 miles north of San Francisco in Larkspur (part of Marin County). John (who also goes by JK) has dedicated himself to helping others live their lives better, longer, and stronger through natural medicine. He is an expert in a variety of progressive sport therapies including Platelet-Rich Plasma (PRP), a treatment for regenerating and repairing connective tissue in the joints and Prolozone Therapy which is beneficial in repairing painful arthritic joints using the regenerative power of ozone. John treats a variety of clientele ranging from NFL superstars to the weekend warrior athlete, the old to the young, and everyone else in between.
Here are my 5 questions with John and his answers:
1. What do you see as the primary differences between Naturopathic Medicine’s approach to sports medicine versus a conventional Allopathic medical approach?
The primary differences are in the treatment of sports injuries, and whether the ailment is acute or chronic. Allopathic medicine has two major approaches; drugs and surgery. In my opinion, drugs do not heal, they relieve symptoms. Pharmaceuticals may help temporarily, but are also dangerous in that they can mask a problem that needs to be addressed and therefore risk causing further damage to the area, not to mention the addictive properties of pain killers. The other option in conventional medicine is surgery, which in my opinion, should only be considered as a last resort when every other alternative has been explored and there is absolutely no other choice. Period.
Two of the major tenet’s of Naturopathic Medicine are: Treat the underlying cause of illness; And treat the whole person. Following these principles, I address not just the injured area itself, but the whole body. I put my patients on a regimen of nutraceutical supplements to help build their energy, increase their healing strength, and decrease their pain. Then, with regard to the injury, whatever it may be, I use therapies to heal the area, and not just remove the pain. I treat a lot of chronic joint pain from normal wear and tear, or from repetitive use in sports or exercise like running, swimming, biking, lifting weights, etc.
One of the main tools that conventional Medical Doctors use for pain is a steroid injection, primarily Cortisone. These doctors mean well, because it does help with the pain. The problem is, it is like cutting the wire to the “check engine” light in your car. The pain may be gone, but the tissue is not fixed. In fact, multiple cortisone shots only serve to weaken the connective tissue further, because they block any possibility of healing in the affected area. The other non-surgical treatments of conventional medicine are pharmaceuticals like anti-inflammatory medicines, pain killers, and steroids, all with a host of negative side effects and no true healing effects.
2. In Western medicine (after far too long in my opinion) we are finally seeing clinicians and practitioners focus on prevention. For instance, doctors are making more of a concerted effort to prescribe exercise for mild hypertension rather than wait for it to progress and treat the problem with pharmaceutical drugs. Is this paradigm shift in ideology affecting Natural Medicine as well?
I think Natural Medicine is the paradigm shift. It is the way Naturopathic Doctors are trained to think about health in the first place. It is an ideology of true health and one that is far older than pharmaceutical medicine. It is affecting more and more doctors every year, and the beauty is, it is coming from their patients not wanting to take a drug or have surgery. More and more people are recognizing the downside of being a slave to prescription drugs. Thanks to the Internet, they are more informed about health in general and they want healthier alternatives; and they want their doctor to know about these alternatives.
3. Personally, I’ve had mixed results with both Non- Western medicine and Western medicine. Acupuncture cured some chronic arthritic pain I had in my thumb – where traditional pain relievers could do little to ease the ailment. Conversely, I tried to treat my insomnia with acupuncture – the approach was met with limited success – so I began using Lunesta which has worked wonders. Do you support the theory that the multiple disciplines augment each other? Is the best path for a patient trial and error to figure out what works best?
I do think that multiple disciplines augment and complement each other. Usually, you can’t get everything you need for your health from just one practitioner or modality. I think the best path is one that works for the individual. Contrary to what some might have you believe, it is important to be participant in nurturing your well-being. The more informed you are with the choices you have, the better you can tailor your own health care approach.
4. If you could clear up one misconception about Naturopathic Medicine what would it be?
That we are not “real” doctors or that we didn’t go to a “real” medical school. Anyone who does a little bit of research (www.naturopathic.org)
can learn that a Medical Degree from a Naturopathic Medical School is equivalent to any MD degree from an Allopathic Medical school. The first two years in either program are nearly identical. We take the same classes, use the same textbooks, and learn the same basic facts about how the body works, pathology, diagnosis, and yes, even pharmacology. I have a DEA license to prescribe pharmaceuticals, but I hardly ever need to use it, because I prefer to use natural and less toxic medicines. I’ll take it one step further and say that the didactic part of an MD’s education ends after their second year, when they begin rotations and learn more about disease management through the use of pharmaceuticals or surgery.
Conversely, in Naturopathic Medical after our second year, we begin rotations and seeing patients in a clinical setting, but we continue to take classes in our 3rd and 4th year to learn about Homeopathy, Botanical Medicine, Intravenous Therapy, Physical Medicine (Chiropractic, Physiotherapy, Physical Therapy), Chinese Medicine, and most importantly, Nutrition (where the average MD school might teach two weeks). Our board exams after year two and four are in the exact same subjects and are modeled in the same manner as an MD.
We are licensed Primary Care Physicians, and are exceptional at treating chronic illnesses by getting to the root cause of the problem.
We can order lab tests, radiographic imaging, and perform minor surgery if we choose to do so in our practice. When it comes to Primary Care and Family Practice Medicine, we resemble the “old fashioned doctor” who knows the family and makes an occasional house call as opposed to a focus on cranking out cases. We treat patients with the best of what modern Natural Medicine has to offer (based on the latest scientific and clinical research).
5. Thinking back through your years of practice, what is your favorite sport/fitness related success story (rehab, prevention, or otherwise) regarding Naturopathic Medicine?
I treated one of the Oakland Raiders who was told he couldn’t play in the game that upcoming weekend because of a pulled muscle. I saw him for two days in a row, and did several trigger point injection therapies and a prolotherapy treatment. In three days he was back on the field, playing full speed and ready to go on Sunday. His coaches were so surprised, they gave him a random drug screening to see if he took something illegal. He laughed, took the tests, which all came back negative, and played a great game.
Interview with Gear Fisher About Performance Metrics
Gear Fisher is the Chief Operating Officer of Peaksware, a company that has been evolving since the late 1990s to provide coaches and athletes innovative tools to monitor, plan and analyze athletic performance. Gear is responsible for managing all business processes and product development at Peaksware. He is also an recreational cyclist, who in is prime landed top ten honors in various cycling events while competing at the category II level.
Here are my 5 questions with Gear and his answers:
1) You have been building exercise technology for more than a decade now. In that time what do you think the biggest game changer has been regarding technology and fitness – an innovation that when observed for the first time made you realize the environment has now permanently changed?
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The acceptance and understanding of downloadable training devices like heart-rate monitors, GPS, and power meters has changed how people train and their expectation of what to expect when buying these sorts of devices. From a high level, we’re seeing the formation of a “consumer health data warehouse” that previously only doctors, hospitals and maybe professional athletes might have had access to. We are seeing the landscape for an interconnected health management system affordable by the masses beginning to take shape. This will truly be the major game changer in the next 10 years as the world struggles with the changing health care system.
I first wrote a web-based .csv file reader for the PowerTap in 2001. At the time, it was pretty cutting edge, maybe too cutting edge. At one point, I was on the phone with Saris showing them what I had done and how you could view the data files on the web, they basically said, “nice, but nobody downloads, so, we’re not sure why you spent time doing it.” At the time, they had just been acquired and were rebuilding their newly acquired PowerTap technology from its original creator, so I think they might have underestimated the importance of post exercise data analysis and athletic performance metrics.
There were a few other companies with downloadable devices at the time (Polar, CompuTrainer, SRM, to name a few) but there are now so many excellent companies bringing downloadable training devices to market, consumers have come to expect the feature on any new device over $200. We’ve moved beyond a “geeky” feature into an expected and sought-after feature. Thanks to Garmin, Timex, Suunto, Saris, Polar, and SRM many others are preparing more downloadable devices. To bring this topic fully up to date, I have to mention the work that Dynastream has done to standardize the ANT+ protocol for enabling wireless sensors and devices in the “personal area network” space too. This has made the sensors easy to install and manage, as well as allowed consumers to easily get the data from their device to the cloud or to their personal computer.
2) A big movement in health and fitness innovation has been the ability to amass and store user metrics quickly and easily. For example, regarding health, the consumer start-up company ZEO was able to accumulate the largest known sleep study database in less than a year. This has given ZEO the ability to identify key factors that affect people’s sleep, which up until this point had been unavailable (even to the academic community). In theory, the ability to amass and identify trends from performance metrics should be beneficial in fitness applications in a similar way. Do you see this evolution in the ease and ability to store performance data enabling fitness professions to expand the breadth of their ability to foster athletic improvement? And, if yes, then how?
Without a doubt, yes. As I mentioned above, we’re seeing a changing health care system, one that is moving from a 3rd party managed system, to a self-managed, self-informed system. We look at what we’re doing at Peaksware as the top of the health care pyramid. Our customers have taken control of their health, are self motivated and looking for fitness and performance. This will trickle down to the masses as health insurance, doctors and hospitals begin to adopt a more wide-ranging care system beyond the walls of the doctor’s office and hospital. Let the people manage the data collection, provide easy access to it by professionals, then make decisions based on data and consultation with experts. Right now, we are performing this feedback loop in the performance realm, but it makes sense to translate this to general health as well. We often refer to it as the “monitor, analyze, and plan” cycle.
The data we’re collecting is going to inform the decisions and algorithms of tomorrow’s innovation. Power meters are a great example. Before power meters, the training “dose” was pretty much limited to duration and distance. Now, we have new metrics like the Training Stress Score that provide concise feedback and performance prediction, born out of data collected by people using power meters. Of course, we believe in giving the tools and technology to the people, and our software lets you “visualize your fitness and performance” and enables our customers to monitor their own data. This gives every individual the user interface for their own physiology so they can investigate and discover their own correlations and metrics by analyzing their data through TrainingPeaks.
Who knows, someday we may find a correlation to threshold power/heart rate and heart disease. I’m certain there are amazing discoveries just waiting to be found in the data.
3) Biofeedback capturing is a key element in the ability to provide practical output to users regarding exercise. Are there any innovations you see on the horizon that will accelerate this ability, or alternatively, you have a desire to see? For example, GPS units are getting smaller, heart rate monitors better, bike computers more savvy, and we can tell body fat through electrical impedance… what’s next?
I think there is a long way yet to go with data collection. The easier and faster we can get data to the cloud, the better, faster, more intelligent we can become with regard to making decisions on our training or on our general health. Lots of people recognize this and we’re seeing some great innovation in this area. I would love to see more integration with Wi-Fi and cell networks to enable easier data transfer from device to the cloud. The Withings Wifi Body Scale
is the first Wi-Fi device I’ve seen that really works. You stand on the scale, it sends your weight and body composition data directly to the cloud instantly. Nothing to write down, no “work” to save and store, it just gets saved right in your TrainingPeaks account. I want to finish a bike ride, roll into my garage, have the bike computer recognize my wi-fi network and beam the ride’s data to my TrainingPeaks account. Garmin and Dynastream have done some great work in this area too.
There are several iPhone and Android phone apps that do this sort of data collection, even in real-time, but it has got a ways to go for enabling more data sensors like heart-rate and power. I’ve seen several ANT+ dongles like Digifit that plug into an iPhone and enable ANT+ sensors to beam their data to your phone during a workout. You then can send the data to your personal TrainingPeaks account, but it’s just now coming to market. The phone essentially brings a super-computer along with you on your ride, run, hike or walk. It’s a great point for doing data capture and transmission. There are some problems and challenges with it, but we will see incredible innovation in this space soon.
I’m particularly excited to see these technologies move indoors as well. As odd as it sounds, we’ve captured more data out on the trails and roads than we have in health clubs and spinning rooms. There is so much potential for data collection within the walls of the health club, and the opportunity to further push the technology that has already been invented and adopted by athletes down to general consumers just trying to lose weight and maintain some healthy habits while in the gym.
I’ve also seen new athletic performance metrics being collected. Respiratory rate, body position, skin temperature, real-time VO2, water consumption… So many new sensors and things we can manage. My partner, and CEO, Donavon Guyot half-seriously joked 7 years ago about under-skin sensors that collect data. This year, Allan Lim had Lance Armstrong swallowing “pills” that measure core temperature during exercise. We simply don’t know how some of these data points affect performance, because we haven’t been able to collect the data in real-time during exercise outside of a lab. We’re getting there now. And that’s a critical component, outside the lab, under pressure of a race, in the heat and cold, while raining and at altitude. So many environmental factors go into performance, training and fitness.
4) How do you foresee fitness software progressing? Will it become more dynamic and adaptive? Currently, most online products sell static programs that promote authorship (and commerce) from fitness experts (i.e. training zones are established but then set for the duration of the program). However, this approach somewhat limits the potential of software to tailor itself to an individual’s specific adaptations over time. Do you think endurance software will advance to the point that programs literally optimize daily workouts based on biofeedback from the prior day/week?
Without a doubt, software will be able to do this, it’s already started. Remember that weather forecasting model I mentioned earlier? We need a physiology model to make optimized workouts and changes based on biofeedback. Several companies have, or have tried to build these tools, but I have yet to see a comprehensive system. It’s an enormous task to make it affordable and most of all, to make it actually work. As soon as a computer-generated system gets it wrong, you lose trust in it. It comes back to the data collection and analysis. We need a LOT more data to make this sort of model truly work. But, we’re getting there. The VirtualCoach within TrainingPeaks.com is based on Joe Friel’s “TrainingBible” methodology and was an early version of this sort of system. It’s a tool that embodies much of Joe’s periodization ideas into a down-to-earth, go workout today and do “xyz” system. However, even today, after many updates and tweaks, it continues to only serve a certain population, and it’s not comprehensive, but it’s very effective for that narrow band of user.
5) Lastly, where do you think the balance between a platform’s utility and ability to be user friendly lie? Dealing with the unfortunate reality that in the world of fitness that positive outcomes are for the most part reliant on user compliance, is it sometimes necessary to compromise sophistication for usability?
This is a fascinating topic for me. I live this balance every day and make decisions constantly that go one way or the other. Ultimately, and I’ve said this for years, it comes down to ‘reason for use’. It’s a term I’ve thrown around for a decade, and I believe it’s the ultimate driver of a user’s decision to buy or use a product. If the product provides enough reason for use, whether it be because a friend suggested it, a doctor told them to do it, or it provides a key feature or has a function that is not found elsewhere, it’s the ultimate decision maker. On top of reason for use though, comes ease of use. On top of ease of use, comes the age old cliche “form follows function”. So, if it does something cool, is intuitive and looks good, you’ve got the magic three ingredients… except there’s one more issue: everyone has a different opinion on what’s easy, pretty and useful. That’s both the frustration and the fun. We build stuff that we use, based on feedback from others and incorporate some very forward thinking into the recipe. The end result is our vision of an app. To be clear, I will say that again: we don’t think of ourselves as having a weblisite, we have an appcation.
Every software system that’s developed follows the same path: build it, start adding to it, eventually re-build it, add more stuff to it and repeat. We just went through this cycle ourselves. We chose to scrap 7 years of code and rebuilt our entire web application from the ground up much to the disdain of many users that were infuriated we’d do such a thing. Many people exclaimed that we’d “wake up” when our horrible decision hit us in the pocketbook. The end result: sales have doubled and we’re reaching new markets that would have never considered us before, largely because of the elegance and simplicity of the new interface. Some old customers wanted to strangle us, but over time, they’ve come to understand the new systems and how to get things done, and it’s been a big hit. New users have no “baggage” and we’re seeing that they get up to speed much faster with the revised tools.
As far as usability, if you can get the most critical things communicated to your user quickly, you’ve done a good job. From there, they can dig in to the deeper, more complicated features. The people that dig in are ultimately your best customers, and they quickly move past ease of use and just want features. Speed is the #1 feature, from there, it depends on what you identify as important for your audience. Carefully managed and supported features are the foundation to our approach.
Ultimately, deciding form over function depends largely on what you’re trying to accomplish, it depends more on your business model, target audience, corporate goals and direction. For instance, Nike+ is a huge hit, but they focus on a single sport: running. It’s a drastic simplification that they can afford to do. They also pour millions of dollars into it in order to engage customers with their brand, instead of charging a fee to buy it. That’s a fine business model if you like making people pay for shoes but not software. Selling software is tough, and constantly evolving, it’s hard to get people to pull out their wallets and actually make them pay for what you’ve produced. A couple years ago, we were told by many that we couldn’t charge for software and that we’d need to pay for it through advertising. No thanks, not the business we’re interested in. Same thing in 2000 when we started, it was only about eyeballs. Instead, we charged for our product from day 1. We focus on providing value to our customers, and we’re not afraid to make people pay for it. If we do a good job, we believe we’ll be rewarded by paying customers, and so far, that’s worked out very well for us.