The most recent information collected by the US National Poison Data System which is the annual report of the American Association of Poison Control Centers, showed there were 0 deaths caused by any dietary supplements in the United States in 2008 (the latest year with complete information available).  Various data suggests that half of Americans take dietary supplements, which amounts to somewhere around 56 billion doses of supplements in a year.  Of those 56 billion doses, there were NO (zip, zero, zilch, nada) deaths from the best available data we have.

Compare that to deaths from pharmaceutical drugs, which are well regulated and much safer than supplements, and then tell me how dangerous supplements are again.

You can download the Annual Report of the American Association of Poison Control Centers for free here.

What are your thoughts?  Share them with us in the comments below.

Unfortunately as an alternative provider, the medical evidence used to ration care still almost exclusively excludes the kind of care I do, meaning many patients are unable to benefit from it.

The article is a little long, but worth reading.  Find it here.

What are your thoughts?  Is rationing an unfortunate necessity?  Share them with us in the comments section below.

Enter Business as Unusual by Anita Roddick, one of the founders of the Body Shop.

In this book she talks candidly about her experience from founding the Body Shop to making it a worldwide company.  How she never compromised her principles despite intense pressure within and without the company to stop “her silliness and get with the program”, that is, running a business with the bottom line as the only goal.  She talks about being a leader in cruelty-free cosmetics (no animal testing), recycling, encouraging others both within and outside the company to be politically active about causes they care about, and going straight to poor and underserved populations to improve their quality of life.

If you’ve resigned yourself to business as usual as exemplified by the Great Recession we’re going through, caused primarily by the myopic focus on the short-term bottom line and greed, this book is a refreshing breath of fresh air.  You can be successful, found and run a multi-million dollar international company with both principles and profits.  You do NOT have to compromise your principles in order to be successful.

If this topic is of interest to you, I highly recommend picking up Business as Unusual and giving it a read.

Have you read the book?  Have you struggled between principles and profits in your life?  Share your thoughts in the comments section below.

Part II here

In part I of this series we answered the basic question, what is evidence based medicine (EBM) with the definition:  EBM is the equal use of clinical experience and external evidence to make the best decisions about the care of patients.

In part II we saw how this definition is often discarded for the much more stringent and less useful definition of EBM as the selection of therapies according to the evidence presented in the scientific literature.  This evidence is ranked with double blind, placebo controlled studies at the top (considered most authoritative) and clinical experience at the bottom (considered least reliable).

In part III, my intention is to outline how I use EBM in my practice.  Alternative or natural practitioners are often dismissed by conventional practitioners with the refrain “not enough evidence” or “hasn’t been proven to work”.  This is true only under the strict definition of EBM we talked about in part II but as I will show I base my practice on a great deal of evidence, much of which is not given significant value by the conventional community.

In my practice of medicine, I break evidence down into four quadrants.

Quadrant I – Tradition

The use of food and plants as medicines dates back to the beginnings of humanity and is found in every culture around the globe.  The most widely known traditional medical systems are Chinese medicine and Indian (Ayurvedic) medicine which have experience spanning several thousand years, and many generations of healers.

There is a tendency in modern culture to view our predecessors as ignorant or at the very least to think, “they were doing the best they could, but we’re clearly so much smarter and better than they are, after all we have iPods and electricity…” and to discount their knowledge and wisdom.  I think this is an arrogant and prideful view.  Our ancestors faced many of the same health problems we face today and generations of experience helped them to accumulate a wealth of wisdom about what heals and what doesn’t.

This is not to say that tradition has all of the answers, it doesn’t.  Superstition pervades this quadrant, some of the therapies our ancestors used were ineffective and some were downright harmful, and the conditions of our modern lives are uniquely different from those of our ancestors.  But to throw out this quadrant of evidence because of these flaws is to “throw the baby out with the bathwater.”  We have much to learn from our ancestors, and in my opinion, evidence based medicine starts here.  I look at how my Naturopathic predecessors treated disease and restored health, and how traditional cultures around the world used food, plants and other medicines.  To this base I add…

Quadrant II – Scientific literature

Because I am a Naturopathic doctor (ND) and not a medical doctor (MD) I have been called anti-science.  Let me be clear, I am NOT anti-science.  I value and use science, but I also do not revere science.  For me it is one of four quadrants of evidence, not the only quadrant.

Science is incredibly valuable.  At its best it helps us to uncover mechanisms of action so we can more deeply understand how diseases and medicines work, and how to better use our medicines.  It also helps us strip superstition and bias out of tradition and our own personal experiences.  But science is also a human endeavor and not something passed on down from ‘on high’.  Recent exposés have shown the bad side of science, manipulated for monetary gain: some scientific studies are ghost written by marketing people looking to influence the prescribing habits of doctors, some pharmaceutical companies hold back scientific data that would make their drug look worse, and that studies are manipulated from the very beginning to give the results that are being looked for.

Scientific studies are not gospel, and in my opinion, need to be taken in the context of other quadrants of information.  So to them we add…

Quadrant III – Personal clinical experience

Nothing can replace a doctor’s experience with their patients and their medicine, which is why we all value a doctor with years of experience.  A doctor’s experience working with their therapies, seeing what works and what doesn’t on real people in front of them, gives personal knowledge of that therapy that cannot be learned from tradition or the scientific literature.

This is not to say we should rely only on clinical experience because we are all subject to our biases and the biases of our patients and the population that we serve.  But by placing it in the context of the other quadrants we gain irreplaceable knowledge.  The last quadrant is…

Quadrant IV – Non-rational or intuitive

This is the hardest category to explain, and as such is often just ignored and swept under the rug.  Medicine is not just a science, it is also an art.  Hunches, gut feelings and intuitive leaps of thought play a vital part in the practice of medicine, even for the staunchest scientific practitioners.  Sometimes we choose therapies because it simply feels right.

Each of the four quadrants provides valuable evidence that I feel is, in and of itself, insufficient for the practice of EBM.   Conventional medicine, I believe, makes the mistake of discarding quadrant I (tradition) and IV (intuition), minimizing quadrant III (clinical experience), and attempting to rely almost exclusively on quadrant II (scientific literature).  Alternative medicine, I believe, also makes the same mistakes by rejecting quadrant II (scientific literature)  attempting to rely almost exclusively on quadrant I (tradition) and III (clinical experience), while some alternative practitioners think quadrant IV (intuition) by itself is enough.

I value each quadrant equally, and do not rely on any one to provide all the evidence for my treatments.  The strongest evidence is where each quadrant converges with the others; where a traditional use is verified by modern scientific studies, the clinical experience of the doctor and their peers, and by the practitioners and patients non-logical intuition.   This I believe is truly comprehensive, holistic EBM and best serves patients.

What are your thoughts?  We’d love to hear them, please post your comments below.

Watch the video here.

What are your thoughts?  We’d love to hear them.  Share them with us below.

Part III of this series

In part I of this series, I explained what I believe evidence based medicine (EBM) should be:  the equal use of clinical experience and external evidence to make the best decisions about the care of patients.  In this interpretation of EBM both clinical experience and external evidence are important and necessary.

Clinical Experience <—-> External Evidence

Unfortunately this interpretation is rarely used in current discussions of EBM.  Instead we find this version of EBM widely promoted.

1.  Randomized, controlled studies

2.  Other studies

3.  Clinical experience & “consensus” opinion

Under this interpretation, the value of evidence is now ranked.   Double blind, placebo controlled studies are given the highest value, followed by a variety of other studies, and lastly clinical experience and consensus views from committees, associations, and experts.  Instead of external evidence and clinical experience being given equal weight we now find that clinical experience is considered the least valid (and valued) form of evidence.

This form of EBM is often used to disparage and discredit alternative or non-mainstream therapies with the refrain, “there’s no / not enough evidence” because the only evidence considered worthwhile is that produced from studies, and especially from double blind, placebo controlled studies.  The reports of hundreds or thousands of doctors and hundreds of thousands or millions of patients are brushed aside with the comment “anecdotal” as if that means they have no value.

To run a well conducted scientific studies, especially double blind placebo controlled studies, requires  scientists to be hired, the study designed, subjects recruited, screened, and selected, the trial run for weeks, months, or years (in some cases), the data collected, analyzed and then published.  All of this isn’t free and in fact costs a tremendous amount of money.

The government does sponsor some studies, but the current budget allocated for studying alternative therapies is pathetically small.  The majority of studies are funded by private companies, and in a capitalistic society the goal of business is to make money.  Studies funded by private companies are not done to prove whether a therapy is effective or not, but ultimately to prove that their therapy (being studied) is effective so that the results can be used to promote that therapy, and make money.

For example, a pharmaceutical company comes up with a drug they believe might have potential, they patent it which gives them exclusive rights to sell it for a period of time.  This ensures that if the drug is shown to be useful they will be the only ones who can sell it and therefore they will be able to make a lot of money with it.  The company will then fund scientific trials to prove that it is effective and bring it to market.

In contrast, something like vitamin C is cheap and widely available.  It is a natural substance and so cannot be patented.  If a company paid for a study on vitamin C and found it beneficial, anyone selling vitamin C could use the study to promote their brand of vitamin C.  The company that spent the money to have the study done would not have any advantage because they cannot patent and hold exclusive rights to vitamin C.  In fact the sponsoring company would be at a disadvantage because they spent the money to have the study done, while competitors could use the results of the study for free.

Pharmaceutical companies run the majority of trials on medical therapies, and because they cannot own natural therapies most natural therapies are not studied.  Further, as many natural substances may be replacements or alternatives for drugs, pharmaceutical companies have a further disincentive to conduct trials on natural substances.  The only studies they would have interest in running are those that prove that natural substances don’t work or are inferior to their products.

Therefore as alternative practitioners we find that the majority of our therapies are not studied in scientific trials, because there is no profit in doing so.  Most supplement companies, alternative medical societies, associations, and schools are small and don’t have the millions of dollars needed to run the studies to “prove” that the therapies work.  Evidence from practitioners and patients is discounted as anecdotal and therefore “worthless”.

Under this version of EBM, the conventional community claims there is no evidence to support the use of alternative therapies.  However, if we turn this same standard upon the conventional community, we find they have little evidence to support many of the practices and therapies they use.  By some estimates, up to 80% of conventional practice do not have sufficient studies behind them to justify their use under this version of EBM.  Most MDs rely on evidence presented in scientific journals, what they are told by pharmaceutical representatives about medications, their own clinical experience and the consensus opinion of their colleagues and medical associations to provide evidence for the use of their practices and therapies.  The majority of this evidence is considered lowest tier evidence under this version of EBM.

It is my belief that this version of EBM sets unrealistic and non-usefully high standards for what can qualify as evidence to justify therapies and practice, and by doing so denies patients effective care.  In part III of this series I will lay out the form of EBM that I use in my practice and how I feel it best serves my patients.

What are your thoughts and opinions on EBM?  We’d love to hear them.  Feel free to share them below.

Part III here

Evidence based medicine (EBM) has emerged as one of the key concepts being debated in leading medical journals, doctors offices and conventions, insurance boardrooms, and government agencies  as a major piece of  the effort to reduce costs and improve outcomes in medicine.  In this series I’ll be explaining what evidence based medicine should be (part I), is (part II), and how I use it in my practice (part III).

The definition of evidence based medicine I believe makes the most sense comes from this paper.  BMJ 1996;312:71-72 (13 January) Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS (1996). “Evidence based medicine: what it is and what it isn’t”. Excerpts from the paper will be in italics.

“Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”

The intention behind evidence based medicine is a good one.  As doctors we want to carefully and consciously use the best evidence to select therapies that are helpful to patients, and avoid those which are harmful or useless.  As the article says:

“[The purpose of evidence based medicine is to] invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious [effective], and safer.”

Whatever gives us the best results is what we want to use for the good of our patients.  But, how do we decide what is the best evidence?

“The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”

We combine our clinical experience as doctors (personal, subjective evidence) with the best evidence from external sources (impersonal, objective experience).   In contrast to what we will see in part II of this series, we see that evidence based medicine combines the clinical experience of the doctor with external sources, such as the scientific literature.

The article continues: “Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients.”

In this view of evidence based medicine, which I subscribe to, both clinical experience and the scientific literature are equally important.  One without the other is insufficient and leads to poor practice and outcomes.  Clinical experience without external evidence is narrowly focused and becomes quickly out of date, and the external evidence without clinical experience attempts to fit a “one size fits all” solution to individuals, which typically works very poorly.

In part II, we’ll move away from what EBM should be, to what it most often is.

What are your thoughts and opinions on EBM?  We’d love to hear them.  Feel free to share them below.

Bottom Line:  A combination of ignorance, arrogance, and greed often combine to keep effective therapies out of public awareness.

Sound too ridiculous to be true?  This interview with Dr. Burt Berskon, MD, PhD sadly illustrates this point all too well.

As a medical resident in a teaching hospital, Dr. Berkson was told to watch two patients die, take notes, and present on it.  Both had eaten poisonous mushrooms and were diagnosed with uncurable and fatal liver damage.  Despite being told there was nothing that could be done, and his orders to simply watch, Dr. Berkson felt compelled to try and help these two patients.  He had a PhD and had been a research scientist for 6 years before deciding to become a doctor, and he called his contacts at the NIH (National Institutes of Health) to find out if they had any ideas that might save these people.  They suggested alpha lipoic acid might work and rushed some to him.  Dr. Berkson gave it to both patients (by IV) and over two weeks both patients regenerated their livers and fully recovered.  He was thrilled, the patients were thrilled, and his bosses were angry.  He had disobeyed orders (they told him to watch, not treat) and he has used a non-approved drug.  Were they interested in what he did or further exploring the therapy?  No.

When more patients came in with fatal mushroom poisoning he was told not to use the alpha lipoic acid treatment that had saved the other two patients.  He did so anyway and these patients also recovered.  He was disciplined again and the only reason he kept his job was because of his contacts at the NIH.  He conducted a small trial with alpha lipoic acid showing 75 of 79 people with terminal (fatal) liver disease recovered.  Despite these stunningly spectacular results no one in the US was interested.  Journals had no interest in publishing his papers, companies had no interest in sponsoring further trials, and doctors had no interest in utilizing the therapy.  He traveled to Europe and was finally able to publish his research in Germany (where MDs DO use herbs, nutrients and other non-conventional therapies)

Later in the article Dr. Berkson talks about another non-standard remedy, low dose naltrexone (LDN).  A woman came to his clinic suffering from fatal pancreatic cancer that had spread to her liver.  She had been told that there was nothing more that could be done but had sought out Dr. Berkson for a second opinion .  He started her on a regimen of intravenous alpha lipoic acid and low dose naltrexone and five months later there was no sign of the cancer.  The woman wanted to return to her home state and when she returned home she found that there weren’t any doctors who would even consider continuing her treatment with alpha lipoic acid and LDN.  Dr. Berkson spoke with the woman’s primary doctor about the results they had seen and asked if she would continue the treatment.  Her response:

“You know, I really would not want to do anything different because the medical boards might look down on me. I’m not an oncologist, and if I treat the cancer, the oncology people might get angry about it. So I can’t do it.”

These two incidents are only a piece of the article, which is found here.  It is well worth reading and will sadly open your eyes to the fact that there’s far too much too much ignorance, arrogance, and greed in medicine.  I’m grateful to practice Naturopathic medicine where I have the freedom to explore non-conventional therapies.  Where the priority is still caring for the patient, and big money and big politics haven’t corrupted that.  Most MDs and other conventional practitioners (nurses, etc) are truly caring, dedicated people (I know quite a few), but unfortunately the system has become more about making money than healing.  I’ll be exploring both alpha lipoic acid and LDN as potential options for my patients and I hope by spreading the word it’ll encourage other doctors to take a look at these non-conventional but effective therapies.  A world of healing DOES exist outside of the conventional system, and if we set aside our ignorance, arrogance and greed we can be free to use whatever therapies help patients heal.

What are your thoughts?  We’d love to hear from you.  Please feel free to post below.

1. I recently posted about a report from the Food Standards Agency of England which reported that there were no differences in nutritional content between conventionally grown and organic food. This article from the Life Extension Foundation argues that that claim is wrong and that: ‘”The science has consistently shown that organic food provides higher levels of Vitamin C and total antioxidants, two nutrients that the American public needs more of,” said Richard Wiles, Senior Vice President for Policy and Communications with the Environmental Working Group. “The London study is not supported by the majority of the science. We should not attach too much significance to its findings until it can be replicated,” Wiles added.’

2. Are proponents of organic food naïve? I found the following article by a conventional farmer fascinating and thought-provoking. While I believe that a number of his logical arguments are flawed, he raises some points I think we need to consider.  As a fan of organic food, this article made me wonder, are all the chemicals a “necessary evil”?  Would the “best” farming system include the many insights of organic and permaculture farming and combine it with the targeted and minimal use of chemicals (herbicides, insecticides, etc.)?

3. In another post I spoke about some of the less-than-ethical tactics that the pharmaceutical companies use to increase their sales and bottom line. Ghost writing, where a scientific article is written by a media agency and signed off by a prominent doctor that had little or nothing to do with it, is one of those things. The following article talks about some examples of this practice.

4. This three part blog post (Part 1. Part 2. Part 3) is one woman’s birth story. Originally a die-hard fan of medicalized childbirth, to her own surprise she finds herself deciding to opt for a natural birth. Compelling, raw, and very, very honest.  WARNING: Not kid friendly. These posts contain quite a bit of profanity.

What are your thoughts?  We’d love to hear them, please share them in the comments below.

No evidence of a difference in content of nutrients and other substances between organically and conventionally produced crops and livestock products was detected for the majority of nutrients assessed in this review suggesting that organically and conventionally produced crops and livestock products are broadly comparable in their nutrient content. The differences detected in content of nutrients and other substances between organically and conventionally produced crops and livestock products are biologically plausible and most likely relate to differences in crop or animal management, and soil quality. It should be noted that these conclusions relate to the evidence base currently available, which contains limitations in the design and in the comparability of studies.

And it seems reasonable.  There is nothing magical about organic food that somehow makes it more nutritious or healthful than conventionally raised food, except the way it may be cultivated. Simply not spraying plants with chemicals does not increase their nutrient content. But cultivating good, healthy soil rich in minerals and nutrients, and selecting more nutritious varieties of plants can increase their nutrient content, not to mention their taste. Unfortunately with the entrance of big business (such as Wal-Mart and others) into the organic market, we are seeing these quality features (like cultivation of the soil and selection of premium varieties) being sacrificed to the almighty bottom line of profit.

But is it true that organic foods have no health benefits over conventionally grown foods? In my opinion, no, that is not true. Well raised organic foods have health benefits and other benefits that go far beyond simple nutrient content.

Personal

1. No pesticides, herbicides, fungicides, insecticides, rodenticides and others. Many scientists, doctors, and people in positions of power continue to misguidedly claim there are no health issues related to the use of these chemicals, but that simply isn’t true. If you wish to investigate this further I highly recommend you visit the EWG website or read the book Living Downstream by Sandra Steingraber.

2. Taste. This is not directly health related, but organic food often tastes significantly better than conventional food. This is often a result of choosing tasty varieties. For example, conventional tomato plants have been selected to be fast growing, bountiful (many tomatoes on one plant), large (big tomatoes), disease resistant, and sturdy (meaning tomatoes survive the trip to the market intact). Nowhere in that list of qualities is tasty or nutritious included. Smaller organic farmers often chose tastier, more nutritious varieties and nurture the health of their plants, leading to tastier produce. We could argue that if veggies tasted better people might eat more of them, leading to health benefits.

Social, Environmental, Community, Humanity

3. Healthy soil. In conventional farming, soil is often seen as simply the stand that you put the plant in. If the plant needs minerals, you use fertilizer. Organic farmers recognize that the health of the plant is directly related to the health of the soil. Maintaining healthy soil:

a. Reduces environmental impact – healthy soil protects waterways by preventing top soil run off (which also destroys farmland and creates deserts). Also by cultivating healthy soil and avoiding chemicals, run-off is prevented. Run-off is when chemicals drain away from fields into rivers, lakes, and streams, poisoning fish and other wildlife.

b. Protects wildlife – Not only are wildlife protected by preventing run-off, but smaller organic farms tend to be much more diverse and utilize natural protection for crops like hedgerows that provide habitat for wildlife. Birds, bugs, and small animals can thrive around these kinds of farms, allowing us to recover and protect some of our wildlife.

4. Humane treatment of animals – Many people choose not to eat meat because of the horrible way we tend to treat our food animals. If you need more proof, feel free to look up PETA & animal abuse on the internet and they’ll be happy to point you to some truly horrific videos of food animal abuse. But, despite what they say, it doesn’t have to be like this. Food animals can be treated humanely and well, can live good lives, and be killed respectfully. Cows can roam on pasture, and chickens can be free to move about.

5. Fair wages, support of small, family farms – Each year more and more small family farmers (the old backbone of American society) are forced off of their farms due to debt. For a look at this, I recommend the documentary King Corn, which shows that without government subsidies it is impossible for a farmer to make a profit on corn because the price that the market pays is less than what it costs to grow the corn. Selling organic is often a way for these small farmers to make a living. Buying organic, especially from family farmers can provide a fair living wage to real people, and help put the humanity back into farming.

6. Counteract the high cost of cheap – Ellen Shell in her recent book the Cheap: The High Cost of Discount Culture documents the true cost of always striving for the lowest cost. When we go into Wal-Mart of CostCo or any of the variety of discount retailers we often marvel at the low cost of things, but what we fail to see are all of the invisible costs. That cheap shirt may have been made by a child working in poor conditions for a miniscule wage. That factory may be dumping loads of toxic waste into the environment. Shipping that shirt half-way around the world consumes a lot of resources. And that mega-store may have put hundreds of local people out of work: the local store owners and their employees, and the factory workers who used to produce the shirts here in the US. Food is the same – when we buy a quality product and pay a fair wage for it, we improve people’s lives.

When we choose factory farmed conventional food, the price is right, but the hidden costs are the exploitation of poor farm workers, the poisoning of the environment, the inhumane treatment of animals, and the loss of family farmers. When we buy organic food, preferably well made from a small family farmer, we improve the health of our world, as well as our own.

Bottom Line: The nutrient content of conventional food and organic food might be similar but to say then that organic food has no health benefits ignores the many other benefits of organic food.

What are your thoughts?  Do you buy organic food?  We’d love to have your input.  Please feel welcome to post below.