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.
Follow Dr. John Neustadt on Twitter: www.twitter.com/drneustadt
http://www.oilofpisces.com
Dr. Joseph Hibbeln at the NIH, one of the world's foremost experts on fish oil, has shown that the more a nation consumes omega-3 fatty acids, the healthier its people are. There is a direct correlation with death rate.
Nutritional medicine is the only hope for containing spiraling health care costs.
Without health care reform, medicine will be done for, as people find out that they are better off turning away from, burn, cut and poison.
That is both ridiculous and meaningless. That's like saying the underlying cause of a tidal wave is molecules of water. The body operates by biochemical processes and a tidal wave is made up of molecules, but neither is the proximate cause.
Advocates of alternative health like to pretend that disease is caused by patient behavior and is easily remedied by "education." Certainly, there is a great deal of disease caused by smoking and drinking to excess, but the sad reality is that most diseases are caused by factors far beyond our control, and it is wishful thinking to pretend otherwise. The single most common cause of illness is old age, a purely natural event. Other common causes include genetic defects, bacteria, and viruses, none of which are amenable to "education."
More importantly, so called "nutrient" therapy is a complete and utter hoax. It cures no one of anything and merely separates consumers from their hard earned money which then goes to line the pockets of purveyors of alternative health.
Frankly, it is unethical to promote any "therapy" for which there is no scientific evidence, no evidence of efficacy and no data on safety. If it works, you should be able to show it scientifically before you profit from it, and without scientific proof, no one should promote it or profit from it.
This is why so many of your patients will seek alternative treatments, that narrow focus you apply often doesn't work.
That MRSA patient that you can't handle? Yes, both the MRSA and the Alpha Toxin load that you can't handle gets handled quickly and easily by nutritional therapy. The Hep C patient whose titers continually are going down incorporating a nutritional therapy...wonder why?
The question is...why arn't you doing it?
Until then, as one example, I believe that entrusting a doctor (or dentist) with conventional training to safely implement a heavy metal detoxification protocol using classical chelating agents and/or dental restoration techniques might result in serious harm to the patient.
Out of frustration, and based on the likelihood that all of us are toxic, I have experimented with detoxification protocols based on nature, in an effort to provide the average consumer with a prophylactic approach that relies on soil-based compounds that have been safely consumed for millennia by humans and other mammals.
While I do believe the medical community provides superb treatment for accidents and injuries, my intention for illness prevention is to substitute natural protocols, where feasible, in place of medical intervention.
I wish you all the best with your healthcare reform efforts.
SOT
Finally, if you’ll consult Spine, the preeminent medical spinal journal, you will find vetted studies of chiropractic vs. pain killers vs. back surgery for relief from back and neck pain, and in every case, people who chose chiropractic got better results with NO drug side effects or intrusive procedures. So much for your false uniformed claim of no valid scientific documentation.
SOT
When I went took nursing and anatomy classes, the doctors who taught them hammered into our heads that the number one way to prevent disease is healthy eating and exercize and that this is what we need to tell patients. When I started out and was an assistant in a cardiothoracic surgery unit, the doctors I worked with were very big on wanting patients to try and fix their health THEMSELVES instead of resorting to meds and surgery, unless it was absolutely necessary. Most patients flat out refused. They completely balked at the idea of taking control of their own health, and often would threaten to sue the doctors unless a pharmaceutical or surgical alternative was offered to them.
Americans are lazy, and most of them would RATHER take a fistful of drugs instead of eating less junk, more vegetables, and getting even a minimal amount of exercize.
Doctors are too quick to give out prescriptions, and many of them do have financial incentives from pharmaceutical companies to do so. I would never argue against that or that this is something that needs to change.
From my experience, when it comes to America's #1 health problem, poor diet and exercize, most doctors DO tell patients EXACTLY what they need to do to prevent most diseases without drugs...the patients just don't listen.
The suggestion that conventional medical schools in the US require courses in "nutritional medicine" concerns me because it implies a correlation between nutrition and medicine. I would suggest simply a course in nutrition, using nature as a template. Years of research in this area have produced eating plans that bear little resemblance with current nutritional wisdom (see "The Original Diet" as one example). Another reason to drop the term "medicine" when dealing with natural protocols is the use of the term "preventive medicine", which I regard as an oxymoron. Why would anyone need a lifetime of drugs to stay healthy? Ask BigPharma.
I would also be cautious with the use of high dose alpha lipoic acid in those with mercury amalgam fillings in place or for those who eat significant amounts of large ocean fish. I have posted on this issue elsewhere in HuffPo, or for details and references, see "The Wellness Project".
Roy Mankovitz, Director
http://www.MontecitoWellness.com