The Best of Both Worlds

"Science has been falsely equated with its tools: with oscilloscopes, computers, graphs, P values and reference lists. In truth, science is observing and describing nature, predicting her outcomes, testing predictions, and studying results for proof or disproof of predictions.

The most essential ingredients of a true scientist are eyes that are open to all natural wonders and words that can clearly describe them."  New England Journal of Medicine (volume 296, page 762.)

An Every Day Medicine

My patients are a fair sample of middle America. They appreciate that conventional medicine can produce miracles with some regularity. However, they do not always trust conventional physicians to tell them the truth about when a treatment will be valuable and when it is being done for some other reason. And they realize that unconventional medicine hasn't all the answers either. They want

• A solution to their health problem; and they don't care what the academicians say about it. Whether the word 'conventional' or 'natural' applies is not the main issue.

• To be self-sufficient;  and let me note here that if you can come up with a home remedy that is as effective as a prescription, thereby freeing the patient from the trials and costs of obtaining a refill, you are going to have a happy patient.

• Honest answers from physicians.

• To be treated as individuals.

• To make up their own mind what should be done for them. They consider monetary cost, time cost, inconvenience cost, perceived benefit, severity of problem, their understanding of the problem and the solution, and the intangible personal and interpersonal factors that facilitate a good outcome. They realize that they have a better understanding of what is best for them than does any physician or bureaucrat.

Dysfunction of system

Local dysfunctions

Let me give a few examples from my own experience of the dysfunction of the health care system.

Laboratory service

Some years ago the federal government in its wisdom decreed that physicians could no longer own clinical laboratories to which they referred patients. In our little town there was but one such laboratory, and it priced laboratory work at a fraction of the cost of the hospital lab. The hospital bought it at the forced sale, and raised prices. The result was a chemistry panel with CBC that cost over $100. (1995 prices)

We were already sending our specimens to a major referral laboratory in Seattle at a cost to the patient of about 30% of the hospital laboratory. We began to offer our service to the other physicians in town as a cost-saving measure.

One problem we faced was that the major local insurance company reimbursed us for lab specimen and handling at about half what they paid the hospital, and we were required by contract to accept that rate. I spoke to their medical director, explained what we were doing to save their premium dollar, and asked that we be allowed to charge lab specimen and handling at the rate required to allow us to cover our expenses.

The medical director said "no." After some argument from my side, he acknowledged the rightness of our stance, but to my astonishment added "We don't want you competing with that hospital."

Heart attack (myocardial infarction)

Another example of the dysfunction of the United States health care system was brought to my attention when an article in the January 20, 1984 Journal of the American Medical Association caught my eye. The commentary was entitled "Is it good practice to treat with patients with uncomplicated myocardial infarction at home?" The commentary reviewed studies done comparing home and hospital care. The results were surprising.

I looked up the various articles quoted. One that was especially intriguing had appeared in the British Medical Journal on 17 April 1976. In this study, 450 men were randomized to home and to hospital treatment of acute myocardial infarction. The death rate at 330 days after infarct was 20% in the home group and 27% in the hospital group. The authors noted that "older patients and those without initial hypotension fared rather better under home care." (!)

Now, we are doing better in our hospitals now than the Brits were doing in 1976, but recall that this article appeared in 1984. The commentary in JAMA article concluded: "Given the published evidence, should we not also be examining innovative home based care of selected patients?  ...our current strategy of forcing all patients into the same kind of high technology, expensive care is hardly defensible, and deserves much more critical scrutiny."

At the time I still had a hospital practice and so I telephoned one of the authors of the commentary in JAMA, Dr. Sam Eggertsen, on faculty at the University of Washington near our clinic. I queried him on what changes in practice they were investigating given the information in his article. He reported that given the general medico-legal climate that they hadn't the remotest dream of changing their current procedures. In other words, his own study showed that home care was better for many patients, but he could see no way to do that.

Sometimes my more traditional colleagues say "If you nutritonally-oriented docs would do more studies and publish them, we'd treat you with more respect." My response is "Why don't you traditional docs read the studies that already exist? Why don't you put concern for the patient ahead of 'this is how we've always done it'. Then maybe we wouldn't need the terms 'alternative ', or 'holistic' or 'traditional' or 'natural'.  Because what really matters is not what you call the treatment, but whether it helps the patient or not"

Patient education

A third example: In 1997 we wrote one managed care company to ask that they cover the extended time and education we give to help people learn to take care of themselves and get off the antibiotic merry-go-round for sinusitis and bronchitis. We promised the company that this would save their money because people could avoid office visits in the future. Service to the patient would be improved because they lose less time from work when they start self-treatment at home. They don't need to take time off from work, or wait for an appointment. Months later we were told "your request is not in accord with the principles of managed care."

Nationwide dysfunctions

The current medical establishment overestimates the value of pharaceutical medicine

Medical journals are less likely to publish results of studies in which a pharmaceutical agent was not effective. Who pays for the study seems to have a relation to the results of the study. In this investigation published in the Journal of the AMA, workers looked at 44 studies of anti-cancer drugs. They compared the conclusions when studies were paid for by pharmaceutical companies and when they were sponsored by a non-profit organization. (JAMA 1999 Oct 20;282:1453)

Similarly, opinions regarding safety of calcium-channel-blocking drugs seem to hinge on financial relationships with the manufacturers of these drugs. (New Engl J Med 1998;338:101)

The current medical establishment is biased against natural medicine

News of toxicity of vitamins is accepted without question by most of mainstream medicine. High-dose vitamin C, for example, has never been shown to increase the risk of kidney stones. (If anything, it decreases the risk.) However, someone did once advance that hypothesis in a medical journal, without evidence, and that idea has been quoted, and the quotation quoted in medical books and journals ever since. Several studies have recently been completed, and there is absolutely no evidence that vitamin C causes kidney stones. Ask your doctor, however, and see what he or she says.

Evidence of efficacy of natural substances is routinely ignored. Vitamin E was shown to relieve pain in the legs caused by narrowed blood vessels in the 1940's and 1950's. This condition is called intermittent claudication. However, the major textbooks of medicine made no mention of it in any edition published between 1947 and 1992. (You can read about this in the Archives of Internal Medicine 1998;158:2187)

For years some physicians have noted that their older patients sometimes felt much better with vitamin B12 injections even though their vitamin B12 level appeared to be normal. Now we know that vitamin B12 levels in the blood can be misleading, and sometimes tell us that a patient does not need vitamin B12 when in fact they do. We also know that in comparison to placebo injections, vitamin B12 injections do make some older people feel more healthy.

I am one of those physicians whose patients routinely tell him that they prefer natural thyroid hormone replacement over the synthetic. The natural hormone contains T4 and T3. The synthetic contains only T4, which the body needs to convert into T3 for maximum benefit. Some people do not convert T4 into T3 very well. In my experience, about 90% of patients prefer the natural hormone, if only for cost reasons; 10% seem to do better with the synthetic. This year, the New England Journal of Medicine (1999 Feb 11) reported that many patients do, in fact, feel better when they are given a combination of T4 and T3. This verifies what non-mainstream doctors have been saying for years. As usual, the Journal authors caution against actually following up on the results of their observations until "further studies are done."

Along with mainstream psychiatrists, I am one of those who finds that some depressed people with normal thyroid function tests seem to require thyroid replacement for optimal health. This is, however, a minority opinion. Some physicians have lost their medical license because they prescribed thyroid hormone in situations that medical boards felt were not justified.

An amusing scene from the movie "Gone with the Wind" comes to mind. Slaves are working in the fields. One looks at the setting sun and announces "Quitting time!" Another slave rebukes him. "I'm the foreman here. It ain't quitting time until I say it is quitting time." He then turns to the rest of the crew and yells "Quitting time!" At this, we in the audience laugh at this foreman. As I read modern medical journals, I see much the same vanity. Aunt Mildred may have known for years that honey heals infected wounds, but until the medical "scientists" have run their studies and published them in the approved manner, it ain't so. And even then, until "further studies are done," don't try this at home, kiddies.

One renaissance scholar argues that Galileo was not prosecuted for saying that the Sun was the center of the solar system. He was prosecuted for the far more serious crime of publishing his revolutionary ideas in Italian, the language of the people, and not in Latin, the language of the academics. And he was a mathematician, and he presumed to speak about the structure of the universe. The study of astronomy belonged to a higher caste, the philosophers. Naturally, he had to be squelched. Could this not explain conventional medicine's disdain for nutritional and "alternative" medicine? Not only are the ideas coming from 'non-experts,' but they are promoted directly to the ordinary citizen. (This observation comes from physicians at the University of Texas Medical School, published in Arch Int Med 1998;158:2187.)

Father knows best--or does he?

Migraine headache

Everyone knows that migraine headaches are difficult to treat. Medical textbooks, medical specialists, and medical journal articles tell us so. Treatments used include sumatriptan (brand name is Imitrex, but be careful about cardiac side-effects) and many other pharmaceuticals. But are you aware that there are over half-a-dozen studies linking migraine headache to low magnesium? And reporting benefit from magnesium? Or that vitamin B2 (riboflavin) in the relatively large dose of 400 milligrams every morning prevents migraine headache in many people? Again published in the medical journals?

Now you do know that. And let me tell you that in three of four people we're able to greatly reduce migraine headaches using these methods. We often inject the magnesium to speed up the response; magnesium by mouth is much slower. (You can only take a small amount at a time as it becomes a laxative at higher doses.)

Otitis media

Middle-ear infections in children are pretty simple to treat, aren't they? Prescribe an antibiotic and the job is done. Or is it? Are you aware that in 1981 the British published a study showing that children with acute otitis media recovered at the same rate whether or not they were given antibiotics? Several other studies followed, and we started to withhold antibiotics from such children. Instead we used a herbal tincture to help open the Eustachian tube, and medication to reduce pain. We found that 80% of the time the children recovered with this non-antibiotic treatment. Furthermore, we noted that we had very few children who had repeat ear infections. Previously, when I had been using antibiotics, very frequently children would return with "fluid in the ears." This started happening a great deal less frequently.

These experiences and many others have led me to doubt the wisdom of the medical establishment. I do not think that "Father knows best" in every instance. I see the exceptions every day.(Note added in 2001: more and more medical journal articles are calling for non-antibiotic treatment of ear infections in children.)

Let's give credit where credit is due

I cannot claim credit for most of the methods that I use in practice. Despite the fact that most of these treatments come from medical journals, they are not mainstream treatments. I have learned these treatments from the medical literature, and from physician colleagues Alan Gaby, Leo Galland, Jonathan Wright, and others. These physicians and many naturopathic doctors dedicate their careers to paying attention to their patients, what works for those patients and what doesn't. Paying attention to the details--if a treatment isn't working, why isn't it? What can we do to break the logjam and bring health? I would here like to give credit and appreciation to those colleagues and to the many physicians and non-physicians who advance medical knowledge. (One example of the latter is George Eby, a city planner who first noted that certain forms of zinc in lozenge form helped the common cold.)

What I am urging here is a medically free world, where innovation and diversity are honored. When our ancestors came to this continent, they turned to the natives for help with illness. Today we still have a great deal to learn from other systems of medicine.

And we have a great deal to offer them as well. I have many wonderful colleagues who devote their lives to conventional medicine. Some are in family practice, some in patient-centered research. Although I have highlighted some negative aspects of conventional medicine here, I use it every day in my practice. We owe a great deal to the physicians who toil in the vineyard of scientific American medicine. We in scientific American medicine may have faults, but our positive accomplishments are great. I believe that the future holds even more integration of conventional and natural methods.

4/8/07 L

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