Mercy Hospital's Definition of Naturopathy: MD Diagnosis, alternative treatment.

I was very pleasantly surprised by Mercy Hospital's lovely discussion of CAM.  I like their definition of Naturopathy, which is succinct if a little inaccurate.  Generally we spend an great deal more time diagnosing than what is allowed by a fifteen minute office visit.  We also tend to try and link different body symptoms together:  chronic tension and upset stomach, insomnia and foot pain, etc. 

I've compiled a definition of Naturopathy under What in the World is a Naturopath?  It gives the scope of Naturopathy in comparison to MDs and DOs. 

Thirteen Virtues: Does Anyone Do Ben's List Today?

When he was twenty years old, Benjamin Franklin wrote a list of virtues for himself and evidently tried to practice them for the rest of his life. 

So there's a free website set up called Thirteen Virtue.com, but it appears to be defunct.  So is anyone still trying to follow Franklin's advice? 

I admit to trying, but I never really got into it.  Maybe a week is too long a period for modern life. 

Here are the virtues (listed on Wikipedia.)

1.Temperance. Eat not to dullness; drink not to elevation.


2.Silence. Speak not but what may benefit others or yourself; avoid trifling conversation.

3.Order. Let all your things have their places; let each part of your business have its time.

4.Resolution. Resolve to perform what you ought; perform without fail what you resolve.

5.Frugality. Make no expense but to do good to others or yourself; i.e., waste nothing.

6.Industry. Lose no time; be always employ'd in something useful; cut off all unnecessary actions.

7.Sincerity. Use no hurtful deceit; think innocently and justly, and, if you speak, speak accordingly.

8.Justice. Wrong none by doing injuries, or omitting the benefits that are your duty.

9.Moderation. Avoid extremes; forbear resenting injuries so much as you think they deserve.

10.Cleanliness. Tolerate no uncleanliness in body, cloaths, or habitation.

11.Tranquillity. Be not disturbed at trifles, or at accidents common or unavoidable.

12.Chastity. Rarely use venery but for health or offspring, never to dullness, weakness, or the injury of your own or another's peace or reputation.

13.Humility. Imitate Jesus and Socrates.

Heartburn: Now It's a Problem for Kids?

It's very troubling to have the expansion of heartburn medication to children and even infants.  Especially when we have no evidence that they are effective and we do have evidence that long term use of acid blockers affects bone health.  But without evidence, we're still seeing prescriptions for the medication.  Here's the expert meta-analysis from the Cochrane database.  I've highlighted the relevant sentence. 

Pediatrics. 2011 Apr 4. [Epub ahead of print]


Efficacy of Proton-Pump Inhibitors in Children With Gastroesophageal Reflux Disease: A Systematic Review.

van der Pol RJ, Smits MJ, van Wijk MP, Omari TI, Tabbers MM, Benninga MA.

SourceDepartment of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital AMC, Amsterdam, Netherlands;

Abstract

Introduction: Use of proton-pump inhibitors (PPIs) for the treatment of gastroesophageal reflux disease (GERD) in children has increased enormously. However, effectiveness and safety of PPIs for pediatric GERD are under debate. Objectives: We performed a systematic review to determine effectiveness and safety of PPIs in children with GERD. Methods: We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews for randomized controlled trials and crossover studies investigating efficacy and safety of PPIs in children aged 0 to 18 years with GERD for reduction in GERD symptoms, gastric pH, histologic aberrations, and reported adverse events. Results: Twelve studies were included with data from children aged 0-17 years. For infants, PPIs were more effective in 1 study (compared with hydrolyzed formula), not effective in 2 studies, and equally effective in 2 studies (compared with placebo) for the reduction of GERD symptoms. For children and adolescents, PPIs were equally effective (compared with alginates, ranitidine, or a different PPI dosage). For gastric acidity, in infants and children PPIs were more effective (compared with placebo, alginates, or ranitidine) in 4 studies. For reducing histologic aberrations, PPIs showed no difference (compared with ranitidine or alginates) in 3 studies. Six studies reported no differences in treatment-related adverse events (compared with placebo or a different PPI dosage). Conclusions: PPIs are not effective in reducing GERD symptoms in infants. Placebo-controlled trials in older children are lacking. Although PPIs seem to be well tolerated during short-term use, evidence supporting the safety of PPIs is lacking.

PMID:21464183

So let's all step away from treating colic, which is likely to be associated with overgrowth of bacteria, with acid blockers. 

I have extensive information on options for adults on my website:  http://www.maloneymedical.com/ under What Do I Treat? and GERD. 

How Many of Us Are Dying Because We Go To Our Doctors? (As Opposed To Dying Because We Can't Afford To Go.)

I'm often curious about the denial of the pretty clear reality that our medical system needs serious help.  One of the denial sticking points is the number of deaths directly attributable to medical care.  Let's be clear.  Almost everyone dies under medical care at some point.  But a fair percent of patients are helped on their way unnecessarily and prematurely by the very people who want to preserve their lives. 

We rank poorly (twelfth out of fifteen) in comparison to other industrialized nations' healthcare.  Before you blame the fat Americans, we rank 3rd lowest in smokers and fifth lowest in drinkers.  U.S. men 50-70 have the lowest cholesterol of the group.  So it isn't just that we're less healthy. 

"According to several research studies in the last decade, a total of 225,000 Americans per year have died as a result of their medical treatments:


• 12,000 deaths per year due to unnecessary surgery

• 7000 deaths per year due to medication errors in hospitals
• 20,000 deaths per year due to other errors in hospitals
• 80,000 deaths per year due to infections in hospitals
• 106,000 deaths per year due to negative effects of drugs
Thus, America's healthcare-system-induced deaths are the third leading cause of the death in the U.S., after heart disease and cancer.

Where am I getting all these disturbing statistics?  From the Journal of the American Medical Association, that den of alternative radicalism (seriously, one of the most conservative medical journals on the planet).  Here's the data written out at a radical blog and here's -WAIT-where is that pesky journal article?  Oh, right here on the JAMA website.  Oh, and if you had some concerns about Starfield's credentials, she works at John Hopkins.  So that's where we get our statistics. 

If you'd like a whole book on our chilling reality, check out Money Driven Medicine.

Differentiating between Naturopaths and Naturopathic Physicians.

For anyone not involved in the field, it can be incredibly difficult to differentiate the relative training and authenticity of degrees within alternative medicine.  Let me say that within all of medicine, it matters far more how ethical the person is than what degree they have. We all know stories of top ranked surgeons who have failed to practice ethically, and relative laypeople provide the backbone of much of our hospice and homecare structures.  So the degree doesn't matter in one sense.  But in another sense it really does matter, especially when it becomes the focus. 

Here's the information on Robert Theil.  "He is not a medical doctor, but is registered as a naturopath by the Federal District of Columbia, licensed as a Naturopath by the State of North Carolina, licensed as a Naturopathic Scientist by the State of Alabama and is licensed as a Naturopathic Physician by Bingham County, Idaho." 

Wow!  So if I were anyone other than who I am, I would think this guy is a naturopathic doctor, same as doc maloney.  Well, no.  Every place that he lists happens to not require a four year degree, boards, etc.  So he didn't go to Naturopathic medical school.  It doesn't mean he's a bad person, just that he's not licensed. 

In fact, the organization that Robert Thiel is a major member of, the American Naturopathic Medical Association, is the one fighting licensing and the medicalization of Naturopathy.  That's right, the ANMA is against the licensure of N.D.s  They run a program where you get a correspondence degree when you are board certified by the American Naturopathic Medical Certification and Accreditation Board.  Yep, they are board certified, not licensed.  It's kind of the cart without the horse, and if it seems confusing, it's meant to be.  It is this confusion, and the layering on of degrees without depth, that truly bothers me.  I have one degree, from one state, and it is more comprehensive than I can hope to master in my lifetime.  I can't imagine trying to fully master a variety of degrees from a variety of states. 

So a traditional Naturopath like Robert Thiel is not to be confused with the American Association of Naturopathic Physicians (http://www.naturopathic.org/) which is the professional group advocating for the licensure of N.D.s.  We all get licensed, and practice medicine, which includes diagnosing and treating disease.  In Maine, I do not use the term physician, but the term Naturopathic Doctor.  See http://maloneynd.tripod.com/naturopathicmaine/  But I was trained in Oregon, where we are Naturopathic Physicians. 

Now, I also saw a nice looking book from an English Naturopath, and I have no idea of her relative level of qualification.  It just shows the level of knowledge necessary to differentiate.  But it also matters what people do it their practices.  So, to show that differentiating does not mean discarding, have a look at both their books. 

Why We Get Fat: It's the Carbs or our Genotype?

Gary Taubes has a new book that explains why we get fat.  Guess what?  It has nothing to do with calories.  Well, it does to some extent, but what should be obvious from the title of his previous work is that all calories are not equal.
So Taubes sets out to convince that calories alone do not explain our weight gain.  Then he progresses on to basically say:  meat is good.  Carbs are bad.  The first part is great the second part has yet to be proven (NY Times reviewer agrees.)

Ok, I'm already convinced that calories don't work.  But I'll also say that low carb is effective for only some people.  Yes, it is an answer for a very select subsection of the population.  But the rest of us do not need a blanket prescription for low carb.  We need to look at individual variation in food choices. 

The D'Adamos had at least a little variety, although they based it all on blood type, which is only one factor in individual makeup.  Now Peter D'Adamo has moved on to genotyping the diet, which is really cool and hopefully leads to more options.  But it isn't the genes, it's the histones.  They determine the activation of the genes.  So maybe I'll get a jump on everyone and start promoting the Histone Diet (patent pending).  Watch for it!  

By the way, Taubes Good Calories book does a number on a lot of diet myths.  It just concludes the way he wants it to conclude, because we don't have the perfect diet data yet. 

More information on radiation than you should want to read.

Wow, it just keeps getting more scary in Japan.  So here's a whole range of resources for those of you who are busy watching it real time and hearing about it on the news. 

First, take a minute to check the EPA's up-to-date radiation readings for your area.  (When are they going to start adding this to the weather report?)

Then, take a few moments to read what the National Institutes of Health has to say about radiation exposure. 

If you're more of a visual person, here is a fun (in a gallows humor sort of way) way to visualize your relative exposures to radiation. 

As I've pointed out at alternative health answers and at my website, the ionizing radiation you receive from medical testing is likely to far outweigh your exposure from Japan. 

If we take that idea to the next level, there is a whole group that irradiates people for a living.  Radiation oncologists specialize in treating you with radiation.  They just celebrated a century of using radiation as a treatment for cancer.  If you look at the second abstract, in many cases radiation therapy is the only available treatment.  The doses being used to palliate suffering are astronomically higher than anything we see anywhere else. 

If you look at the third abstract, in cases of advanced head and neck cancer the application of radiation in huge doses directly to the area is often not sufficient to cause hypothyroidism.  We're talking about extraordinary exposure, and still the body keeps on ticking.  It's a wonderful thing. 


If you are still panting for more information on radiation,  I've attached links to three books on the subject.  Bring your medical dictionaries and dig in.  Or maybe take a walk outside and breathe easy. 

Nat Rev Cancer. 2004 Sep;4(9):737-47.



Radiation oncology: a century of achievements.

Bernier J, Hall EJ, Giaccia A.

Department of Radio-Oncology, Oncology Institute of Southern Switzerland, CH-6504 Bellinzona, Switzerland. jacques.bernier@hcuge.ch



Abstract

Over the twentieth century the discipline of radiation oncology has developed from an experimental application of X-rays to a highly sophisticated treatment of cancer. Experts from many disciplines - chiefly clinicians, physicists and biologists - have contributed to these advances. Whereas the emphasis in the past was on refining techniques to ensure the accurate delivery of radiation, the future of radiation oncology lies in exploiting the genetics or the microenvironment of the tumour to turn cancer from an acute disease to a chronic disease that can be treated effectively with radiation.

PMID: 15343280


Radiother Oncol. 2011 Mar;98(3):287-91.

Palliative radiotherapy for cervical carcinoma, a systematic review.

van Lonkhuijzen L, Thomas G.

Odette Cancer Centre, ON, Canada.

Abstract

Purpose: Worldwide, particularly in developing countries, many women present with advanced stage cervical cancer for which palliative radiotherapy is the treatment of choice or may be the only available treatment. The purpose of this study was to determine from the literature the optimal palliative radiation scheme for the treatment of advanced cervical cancer. Design: A systematic literature review up to January 2010 was performed in Medline, Embase, the Cochrane database, CinHL and Google Scholar using a combination of synonyms for: cervical cancer, palliative treatment and radiation therapy. No limitations were applied for language or study types. For included papers data were extracted and described. Results: Only eight papers were identified and none compared the results of different fractionation schemes. Most used observational retrospective study design with considerable sources of bias. No studies used validated endpoints for symptom relief nor did they include measures of the quality of life. Several papers described the experience with single or multiple monthly 10Gy doses or with a higher total dose delivered in 2-4 fractions within 48h to 1week. Studies report varying amounts of relief from bleeding. The effect on other symptoms such as pain and discharge is not evaluable. Acute and late toxicity is poorly documented. Conclusion: There is a dearth of information in the current literature to guide selection of an optimal palliative radiation schedule for treatment of patients with advanced cervical cancer. Based on this review and information from other solid tumors, there is no evidence to support the common belief that better and longer palliation is achieved with a high dose delivered in multiple smaller fractions. There is a clear need for comparative studies of different radiation fractionation schedules in order to identify an optimal palliative radiation scheme. These studies require the use of validated endpoints to measure specific symptom relief as well as accompanying quality of life.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

PMID: 21316785

Radiother Oncol. 2011 Apr 1. [Epub ahead of print]

Radiation-induced hypothyroidism in head and neck cancer patients: A systematic review.

Boomsma MJ, Bijl HP, Langendijk JA.

Department of Radiation Oncology, University Medical Center Groningen, The Netherlands.

Abstract

PURPOSE: To review literature on the relationship between the dose distribution in the thyroid gland and the incidence of radiation-induced hypothyroidism in adults.

MATERIAL AND METHODS: Articles were identified through a search in MEDLINE, EMBASE and the Cochrane Library. Approximately 2449 articles were screened and selected by inclusion- and exclusion criteria. Eventually, there were five papers that fulfilled the eligibility criteria to be included in this review.

RESULTS: The sample sizes of the reviewed studies vary from 57 to 390 patients. The incidence of hypothyroidism was much higher (23-53%) than would be expected in a non-irradiated cohort. There was a large heterogeneity between the studies regarding study design, estimation of the dose to the thyroid gland and definition of endpoints. In general, the relationship between thyroid gland volume absorbing 10-70Gy (V10-V70), mean dose (Dmean), minimal dose (Dmin), maximum dose (Dmax) and point doses with hypothyroidism were analysed. An association between dose-volume parameters and hypothyroidism was found in two studies.

CONCLUSIONS: Hypothyroidism is frequently observed after radiation. Although the results suggest that higher radiation doses to the thyroid gland are associated with hypothyroidism, it was not possible to define a clear threshold radiation dose for the thyroid gland.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

PMID: 21459468