Monday, July 25, 2011

Where Do We Live?

By Jacob Schor, ND, FABNO

Photo by Liralen Li via Flickr, used under the Creative Commons License.
There’s a Hebrew expression that roughly translates as "Where do you live?" It’s not meant to ask the location of a person’s residence. Instead it expresses shock, dismay, or disbelief in the ideas held by the person being addressed. By implication, "Do you live on Mars?"

During the winter, I go skiing with my friend Jim every Wednesday. We have done this for almost two decades, from opening day in November to closing day in May. Given the many shared months of our lives spent shivering together, I guess it was fitting that when Jim came back from a business trip to Dublin last winter, he brought me a gift: a handmade wool sweater.

This beautiful sweater came with a brochure affixed to it with one of those plastic fasteners, which needs to be snipped off lest you leave a hole in the garment. The brochure informed me that because the sweater was made of Merino wool, it would be comfortable year round, winter, spring, summer and fall. It is a beautiful sweater and nice to wear outdoors with my vest when the temperature is in the twenties. It’s even wearable indoors when I’m writing, the heat is off and the temperature is below sixty. I’ve tried unsuccessfully to wear it a few times this spring. I joke about wearing it in the summer. We live in Colorado. It’s too hot here to even touch wool during the spring and summer. Though it makes for a good joke, "Oh, the temperature has dropped to 85. Shall I wear my sweater?"

I mention this sweater because I use it as an analogy. That information on that sweater tag teaches us two things. The first is obvious: you can’t believe everything you read. That certainly applies to a good many ‘miracle cancer cures’ my patients read about on the Internet and then expect me to believe in. I tell them about the sweater.

The second sweater lesson is less obvious. The statement that the sweater is wearable year round isn’t false. It’s probably true if you live in Ireland. The truth is relative. In the case of my sweater, to where you live.

My ruminations on the relativity of truth are triggered by Nathan Seppa’s article in last week’s Science News titled "The Sunshine Vitamin."i

Nathan Seppa and before him Janet Raloff have in their earlier Science News articles closely followed and reported on the growing vitamin D research over the last ten years. This article on the surface purports to cover both sides of the debate triggered by last year’s Institute of Medicine’s report on vitamin D.

Last November, an Institute of Medicine (IoM) panel of scientists announced new vitamin D recommendations. They recommended daily intakes of 200 to 600 IUs per day. For most of us who follow the growing data on vitamin D, and routinely prescribe doses ten times this high, these suggestions seemed absurd.

Seppa points out the argument on which most vitamin D proponents fall back: that "… these amounts still fall short of prehistoric people’s intakes by a Stone Age mile." Living outdoors with little clothing, these people manufactured thousands of international units, or IU, every day, perhaps getting three to five times as much as most people get now.

Seppa then goes on and writes a comprehensive review of the benefits associated with vitamin D. He reviews the many research studies that form the basis of our thinking that vitamin D can produce anti-viral, anti-cancer, anti-allergy (including asthma, allergies etc), anti-autoimmune (including DM, and especially MS), anti-neurodegnerative (Parkinson’s disease, Alzheimer’s disease), anti-hypertensive and anti-cardiovascular disease effects.

Seppa contrasts the IoM’s recommendations with those published this month by the Endocrine Society in the Journal of Clinical Endocrinology & Metabolism.ii "The society, the world’s oldest and largest group devoted to hormone research, called for vitamin D intake levels two to three times higher than the IOM’s recommendations."

The question in my mind isn’t which of these opinions to follow. For naturopathic physicians, this is a no brainer. The majority of us will follow the guidelines and thinking of the Endocrine Society over those of the IoM. The question is why varying groups of intelligent and well-meaning scholars see the world so differently.

I think our views are tainted by the day-to-day needs of clinical practice and the demands it places on us to make pragmatic decisions based on often incomplete data, while those of the IoM panel are made in the academic luxury of being able to stall until more data is available.

Seppa quotes Patsy Brannon, a molecular nutritionist at Cornell University and a member of the IoM panel, who expressed the need for more randomized to settle the question:
"We looked extensively at those areas," Brannon says. In non-bone research, she says, "We found very limited randomized controlled trials, and evidence for cause and effect was not present."
At this point, there is slim if any indication that vitamin D supplementation will be hurtful and ample suggestion that it will provide vast benefits. But that’s our point of view.

This brings to mind another recent article, this one in last Sunday’s New York Times by Siddartha Mukherjee, the author of 2010 book The Emperor of All Maladies: A Biography of Cancer, which won the Pulitzer Prize for General Nonfiction. In his Times article, he reviews the evidence behind the current fear that cell phones will cause brain cancer and compares it with the evidence that links formaldehyde exposure to leukemia and smoking with lung cancer.

Mukherjee points out that the link between formaldehyde and cancer was known in the 1970s. It wasn’t until recently that the National Toxicology Program actually announced the connection. He blames industry lobbyists, particularly plywood manufacturers, for delaying this official stance.

Mukherjee reminds us that "The human trials that established that tobacco smoke is a carcinogen were initially performed in the mid-1950s (some even earlier). The tobacco industry mounted an aggressive campaign to discredit the data, and continued marketing tobacco to the public. The landmark Surgeon General’s Report on smoking and cancer was released in 1964. And it took yet another decade of innovative strategies, including powerful anti-tobacco advertisements and tort cases against tobacco companies, to alter the trajectory of smoking behavior in America."iii

It can take a long time for knowledge to move from research publications to changes in public awareness and behavior. Let’s not even attempt to explain the recent trend toward increased smoking in young people in certain parts of the country.

Seppa sums up the arguments against the IoM’s desire for better evidence of vitamin D effect, and their desire for more randomized controlled trials by quoting Cedric Garland of the University of California, San Diego:
Besides, randomized controlled trials have never been the sole arbiter of medical thinking or policy, Garland says: "If they were, we would all still be smoking cigarettes and no one would be wearing seat belts."
We may never have randomized controlled trials on smoking because at this point it would be unethical to assign people to a ‘smoking arm’ of a trial. The weight of the evidence in support of vitamin D may soon bring us to a similar situation. How can we ethically tell people in a control group to not take vitamin D?

When it comes to wearing Merino wool sweaters in the summer, I don’t live in Ireland. What’s true in Ireland is not true in Denver.

We have to accept that the members of the IoM committee do not live in the same world we do. When it comes to encouraging higher intake of vitamin D, I want to think that we live in the real world, where our desire to improve patient health comes first in our list of priorities.


iNathan Seppa. The power of D: Sunshine vitamin’s potential health benefits stir up, split scientists. Science News / July 16th, 2011; Vol.180 #2

iiHolick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM. Evaluation, treatment, and prevention of vitamin d deficiency: an endocrine society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30. PMID: 21646368

iiiMukherjee S. Times Patrolling Cancer’s Borderlines. New York Times. July 12, 2011.

Wednesday, July 20, 2011

President's Message: Remembering Dr. Konrad Kail and "The Run" Takes Off

By Carl Hangee-Bauer, ND, LAc
AANP President

Dr. Konrad Kail
In just the past several days, two events have occurred that have a profound impact on the naturopathic community.

I’m sad to report that the first is the passing of Dr. Konrad Kail on the morning of July 18th. Dr. Kail was diagnosed with malignant brain cancer several years ago and, with the dedicated support of his wife Petie, used both conventional and naturopathic treatments to fight this terrible disease. Unfortunately he finally succumbed and died peacefully in Petie’s arms in their home in the Phoenix area.

Dr. Kail was a force in our profession and a true leader who has left a mark that will endure for many years. He was a founder of SCNM and later chaired SCNM's Board of Trustees. He also chaired the Arizona State Board of Examiners and was the first naturopathic physician to sit on an NIH Advisory Council. Dr. Kail served a term as President of the AANP, which I remember well with his “One Person, One Project” campaign. Whenever there was a call for help to move some project forward, Dr. Kail was in the front of the line.

Konrad was a personal mentor for me, and he and Petie gave their time and wisdom generously. After California passed the Naturopathic Practice Act and I was making plans with my colleagues to expand our practice and transform it into a larger naturopathic medical clinic, they spent time with us sharing their experiences running a naturopathic practice, giving encouragement and advice on what worked for them, and helping us see the pitfalls and challenges that would lie ahead. They wanted to see this profession expand and see other doctors meet with success, and actively worked toward making that happen. I am sure we were not the only ones to benefit from Konrad and Petie's wisdom and experience.

Konrad was also an avid golfer, and I had the good fortune to play golf with him on multiple occasions when I visited Phoenix. On the golf course he was much the same as in his life as a naturopathic physician: bigger than life, bold, and a teacher. I will miss those outings.

Dr. Kail touched many of us in our journey in naturopathic medicine as a teacher, mentor, leader, scientist, researcher and entrepreneur. He will live on in our hearts and our history, and his wife Petie will always be a member of our naturopathic family. We will sorely miss his presence.

There’s one final note on Konrad that many of you may not know. In 1983, shortly after completing his studies at NCNM, he and a small group of NDs took a bicycle trip across the United States on their “Wheeling and Healing Tour” to introduce the public to naturopathic medicine. Through his radio and in-person interviews and connections with people along the way, many Americans got their first exposure to naturopathic medicine.

Similarly, on Sunday morning, July 17th, Dr. Dennis Godby, his sons Isaiah and Jeremiah, and his nephew Jonas Ely began their cross-country run from San Francisco, California, to raise awareness of naturopathic medicine and the true choices people have to empower themselves, improve their health, and prevent chronic disease such as diabetes and obesity. I had the pleasure and privilege to sponsor and plan the opening event as we sent Dennis and his entourage on its way, and along with David Schleich from NCNM, headed to Marin County to meet them at the end of the first day of their run.

As most of you know, they will pass through many small towns and big cities, from the streets of San Francisco to Main Street USA, carrying this message to thousands, perhaps millions of people along the way before ending in Bridgeport, Connecticut, in mid-November.

This is a win-win situation for our profession. Not only will their run raise awareness about naturopathic medicine and the choices it offers, it is also an opportunity for naturopathic physicians both along the route and in general to raise public awareness about their individual practices.

I urge you all to get involved and support The Run. If you are along the route, plan and sponsor a local event celebrating the runners as they pass through your town. Donate to their effort; Dr. Godby is sacrificing for this in many ways and needs our support. I donated a penny a mile for each of the 4 runners, a mere $130. If we all did this it would go a long way to meeting the goals for this historic run.

We had a lot of fun on Sunday and look forward to following Dr. Godby on his journey, and wish him all the best.

Tuesday, July 12, 2011

It’s the Little Things…

By Christine Girard, ND
2010 AANP Physician of the Year

A typical Airstream. Photo by Jacob Davies via Flickr, used under the Creative Commons License.
It’s the little things…

William had a rough day yesterday. No, a seriously rough day. As he put it in one of his texts, “Bad karma morning. Way overheated. Had to walk away from it.”

As I understand it, it all started after he dropped me off at work. There was a huge crash on the 202 that left traffic at a standstill, so bad that the cops re-routed traffic through downtown Tempe. Getting home took three times longer than usual. Now William is a not-so-patient guy with a plan. He had things to do at home. Let me re-phrase that, he had a list of things to do at home. So, this put him “behind.”

As he arrived home, he noticed that Lotus (now nicknamed Killer Kitty for her hunting prowess) did not greet him outside as she usually does. This made William suspicious. As he entered the house he found a trail of feathers leading from the kitty door through the living room and down the hall into the guest bedroom. In the guest bedroom he found said Killer Kitty playing with one partially denuded pigeon, which happened to be alive as William discovered upon wresting it from Lotus’s mouth. The pigeon, much relieved and a bit disoriented flew across the hall into the shutters above Sage’s favorite sunspot where Sage was napping. Awakened by the flapping of wings, Sage leapt up and promptly began chasing the pigeon as it flew down the hall into the living room. By this time, Lotus had caught up and William was in hot pursuit. The pigeon perched and pooped on top of the entertainment center as the cats sat staring, plotting their plan of kill. William stood plotting his plan to get the pigeon outside where, in his humble opinion, the bird belonged. The bird, having its own opinion, flew into the laundry room and hid behind the dryer. I’m not sure which it was, feline or human, but someone flushed it from hiding and it flew onto the bookshelves where William finally was able to cover it with a towel and take it outside – after he locked the kitty door. His next text: “Kittys on house arrest.”

William, not to be taken off plan, began to get things set up so he could move the 31’ Airstream travel trailer from its current parking spot to another that would offer him more opportunity for shade as he worked on it and offer more space to park the truck. As he later explained, it took him “hours” to hitch the Airstream in the 112° heat of Phoenix in a truck that has no (zero, zilch, nada) air conditioning (yeah, really). Once hitched, William needed to pull the Airstream forward and back it up, negotiating around the orange tree into the new, highly sought-after parking spot. His next text, “Tried moving the A/S and creased the passenger front quarter. I am so pissed.” I phoned William to check in. He was not in a good place. There were many words I cannot put in print. He expressed his desire to use C4 (explosives for those of you unfamiliar) to blow up the Airstream.

Later William picked me up from work and during the tense ride to do a couple of errands (he was still not in a good place), I learned that not only did he dent the Airstream; he backed the truck into the accursed orange tree and shattered his passenger side taillight. Errands complete and driving home, William stated that he needed my help to get the Airstream parked because after his drama of the afternoon, he left the @&!^%#$ Airstream on the lawn. He needed to get this done that evening so he could let it go. I asked if he needed to do this before or after dinner. He said, “Before.” As I said, he’s a guy on a mission.

Home, in the now 108° heat, I found myself in the precarious position of offering a severely pissed off and hypoglycemic man directions not only on how to drive, but also on how to back up a 31’ trailer. Do you see my precarious position?

The first order of business was to extract the truck and Airstream from the accursed orange tree. Seriously, it only happened because God is good and the tree, fearful for its life, sucked its branches in a couple of inches to let the Airstream pass unscathed. Then onto the business of backing the Airstream into the glorified parking spot, which would allow for the very high priced commodity of shade in Phoenix. Around the orange tree (no longer accursed as it had cooperated with the extraction process) and next to the carport (which has a very pointy front corner of the roof that seemed to leap out in an effort to strike the Airstream – maybe it was a mirage from the desert heat), across the driveway, over the lawn, into the flower bed. Back and forth. Back and forth. Back and forth… Yeah, it took awhile. "A while" here is measured by the number of trips the Teach for America guys took to the dump as a result of moving in across the street: seven.

I went inside and began dinner while William cleaned up outside. By the time he came in and showered, dinner and a gigantic vodka tonic were waiting for him. We ate and he began to come around to himself. He apologized for being tense and harrumph-aly. He talked about how nothing seemed to go right during the day and how pissed he was about denting the Airstream. And how he was going to miss me because I was to fly out the next morning to attend a conference. We talked about my day and just hung out. A little later, while he watched a movie, I went into the kitchen and began to make brownies, his favorite. Done, so crispy on the outside and fudgey-gooey on the inside, I brought him a plate of brownies and gave him a hug. “Wow! “ He said, “Thanks. Chocolate is good!”

“Yup, you’re welcome Sweetie. It’s all about the little things. I love you.” He smiled and hugged me, “Love you too, Sweetheart. Thank you.”

Monday, July 4, 2011

Upcoming Convention – There is Hope!

By Sara Thyr, ND

I have the very time-consuming and honorable task of co-chairing the Convention committee and reviewing the talks before the conference to be sure that they are free of commercial bias. It can be a daunting task. We receive many really enticing abstracts, and have to work together to find the ones that will be the most interesting and educational to the most brilliant naturopathic doctors in the country.

As I look over the schedule and presentations for this upcoming Convention, I am filled with incredible pride, and–more mushy–a great sense of hope! There is a deep need for our medicine in the world and now is the right time.

I know first hand the incredible effort and time it takes to prepare a lecture for the AANP Convention. It is a daunting task to present to your peers. And what we will be able to listen to this year comes from some amazing and inspiring leaders in the field, and some doctors who have put together very well-researched and inspiring lectures.

What makes me so hopeful is knowing that we will come away with information about how a simple plant may help us deal with infections that are resistant to antibiotics. We will learn how epigenetics and preconception health affects health throughout our lives…the true heart of preventative medicine. We will have a chance to learn from some of the most practiced homeopaths in our profession – how to make homeopathic prescriptions as a naturopathic doctor that will increase our effectiveness with patients. We have a chance to hear about the importance of creativity in healing and actually learn how to help our patients implement this for the benefit of their lives. We can learn from someone who does more nutrition research in a week than most of us do all year about all of the myths and important research in the literature that most of us don’t find the time to look at. We can learn how genetically modified foods are dangerous and the interesting mechanism used to grow these foods that makes them so harmful (along with the shocking information about how our government, influenced by industry, continues to ignore the health risks involved).

Do you know how medicinal botanicals can help with neurodegenerative diseases? You will if you make it for the concurrent sessions on Wednesday. And if you are torn, as I am, about listening to that talk or learning about how to treat cancer patients if you are not a cancer specialist, have no fear. The AANP is making sure that you have the opportunity to hear every talk – even the ones that you can’t attend. I love this. I have always been torn in making a schedule where I’d get to see everything I am interested in. This year we can. We get to hear every lecture.

We have more keynote speakers this year, and more keynotes from naturopathic physicians, that will not only be educational, but also inspirational. The Convention theme is “Composing Effective Patient Care” and fitting this theme we will learn how tones and music affect our health.

I am so incredibly grateful to everyone who has put so much time, thought, and effort into making this Convention so incredible. I am more excited than ever to be attending. (Well, maybe I’ll be more excited next year when I won’t have any Board or Convention responsibilities. We’ll see.)

We are so lucky to get to meet again at the jewel of the desert, the Arizona Biltmore. All who have been there know that it is the perfect location for us to connect with friends and make new ones; to sit in on some great continuing education talks, and celebrate our profession.

I hope you will be there this year. It is not to be missed as a source of rejuvenation for your practice and your soul.