One aspect of healthcare reform that hasn't received nearly enough media attention is the need to reform the primary care medical education system. The current system teaches disease management and symptom suppression, which is insufficient to meet our healthcare needs. A reformed system needs a new paradigm that stresses health promotion and treatments that attempt to correct the underlying causes of disease.
Primary care physicians are on the front lines of healthcare. They are the first doctors people see, and the ones they return to for long-term care. One trait that tends to draw people into primary care medicine is the desire to develop lasting relationships with their patients. This frequently means that these doctors end up treating entire families, and in the process learning intimate details of a person's family dynamics and medical conditions. These relationships provide opportunities to help and affect individuals and families in profound ways.
I have the privilege of working with primary care docs all over the country. Many report to me with frustration that their education doesn't give them the tools they need to provide the highest possible care. While no one can dispute that these professionals work exceedingly hard, they are hampered by two major failings of conventional medical education philosophy: 1) it focuses on suppressing symptoms with drugs, which are considered the primary and only legitimate treatment modality; and 2) it doesn't teach how to treat the underlying causes of disease.
I believe that the symptom-suppression model of healthcare provides great insight into why our healthcare system is failing. If people are depressed, prescribe antidepressants such as Prozac or Welbutrin. If they have anxiety, prescribe benzodiazepines such as Klonipin. If they can't sleep, prescribe sleeps aid such as Ambien. While these medications can be extremely effective and necessary in some cases, they are frequently unnecessary and carry their own risks of side effects. Training doctors to uncover and treat the underlying causes of disease could eliminate much of the unnecessary reliance on pharmaceuticals and reduce their devastating, and sometimes deadly, side effects.
In many cases, the underlying causes of disease are biochemical in nature. Biochemistry is how the body uses vitamins, minerals, fats and proteins to do its job, and how things like infections, allergies and environmental toxins interfere with proper biochemistry to cause symptoms and disease. In other words, if you weren't sick last year or last month, and you are now, something has changed in your biochemistry. Determining where a person's biochemistry has gone haywire and then correcting it through targeted nutritional therapies is called medical biochemistry or functional medicine.
While bringing these concepts together into a coherent medical philosophy is relatively new, the underlying clinical observations, basic research and clinical trials are more than 100 years old. This approach has even shown in rigorous clinical trials that genetic diseases that were once considered untreatable -- such as phenylketonuria (a metabolic disease that can cause mental retardation and seizures) -- can be treated successfully with targeted nutrient therapies.
Let's go back to depression. As far back as 1951, researchers discovered that a deficiency in any one of 10 different amino acids (the building blocks for proteins) can cause symptoms of lack of appetite, extreme fatigue and irritability -- all symptoms of depression and anxiety. Those schooled in functional medicine also know that deficiencies of other nutrients that can cause, or are associated with, depression include vitamin B12, folic acid, magnesium, vitamin B6, omega-3 fatty acids and iron. No one ever has a deficiency of Prozac or Welbutrin. So why should that be the first line of therapy? Instead, primary care doctors should know how to diagnose nutrient deficiencies through sophisticated and comprehensive biochemical tests, and how to correct them for optimal body function.
Clinical trials show unambiguously that targeted nutrient therapy can be safe and effective, and in the hands of skilled clinicians, this approach often times can be more successful, more cost-effective and safer than the pharmacologic approach. Take vitamin K2 and osteoporosis, for example. Since 1995 in Japan, MK4 (a form of vitamin K2) has been approved for the treatment of osteoporosis. Clinical trials show that taking 45 mg MK4 daily with calcium and vitamin D3 can decrease fracture risk by more than 80%, compared with about 45-50% for Fosamax, Actonel and Boniva. But MK4 can't be patented, so there is no financial incentive for the pharmaceutical industry to bring this to market. Luckily, it's available in osteoporosis supplements in the US.
But in discussing the benefits of MK4 with doctors, many of them become concerned that it will cause blood clots. This is because the only role for vitamin K that most doctors have heard of is to promote blood clotting. Since they aren't educated in nutritional medicine, they don't know that vitamin K is used for many processes in the body, including bone building. Once the body has enough vitamin K for proper blood clotting, the biochemical pathways responsible for creating blood clots are saturated and the left-over vitamin K is used for other processes, such promoting bone health. The safety of MK4 is proven in studies using more than one hundred milligrams daily that didn't show any tendency towards increased blood clotting, and in fact, the US Institute of Medicine (IOM) has deemed that vitamin K is safe at all doses.
There are so many more examples. Six hundred milligrams daily of the nutrient alpha lipoic acid can decrease pain experienced by people with diabetes when they walk, called diabetic peripheral neuropathy. Clinical trials using zinc have been shown to promote improved self-image and weight gain in girls and women with anorexia nervosa. Supplementation with magnesium and vitamin B6 significantly reduced PMS symptoms in women in another clinical trial. There is a multitude of other studies and data, literally hundreds of thousands of citations indexed by the National Library of Medicine on the healthful effects of nutrients. Unfortunately this research is ignored by the general medical community.
In addition to the studies supporting this approach, this paradigm provides a rational philosophy that is sorely lacking in medicine. The next time you see your healthcare provider, ask him or her which philosophy of medicine they were taught. Likely he or she will tell you, "First do no harm." But what does that mean? Deaths from correctly prescribed and taken medications in this country are now the fourth leading cause of death. Therefore, the "first do no harm" philosophy is not working. And that's because conventionally trained doctors aren't taught any way of conceptualizing, evaluating or treating disease except through the very narrow perspective of drugs and surgery. There is another way and another, more expansive and physiologically appropriate philosophy based on the way the body's biochemistry works, and how we can restore health.
While we reform our health care system, let's make sure a part of that is the education in our medical schools. Currently, conventional medical schools in the US don't require courses in nutritional medicine. Yet the more our primary care doctors know about medical biochemistry -- nutritional deficiencies and how to correct them -- the more efficient, efficacious and cost-effective our medical system will be. The conventional medical establishment needs to take a page out of naturopathic medical training and shift their philosophy to healthcare that "treats the cause." Doing no harm is no longer good enough.
John Neustadt, ND is medical director of Montana Integrative Medicine and the co-founder, with Steve Pieczenik, MD, PhD, of Nutritional Biochemistry, Incorporated (NBI) and NBI Testing and Consulting Corp (NBITC). The doctors created Osteo-K, a dietary osteoporosis supplement formulated by physicians from Harvard, Cornell, MIT and Bastyr. For more information on osteoporosis supplements and decreasing your risk for osteoporosis and fractures, visit www.bonehealthproduct.com.Their latest book, Foundations and Applications of Medical Biochemistry in Clinical Practice, is available on Amazon.
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