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THE PATH AHEAD
Can We Say “Cure”?
Joseph Pizzorno, ND, Editor in Chief
Most of the commonly prescribed conventional drugs
treat only symptoms, not the underlying causes of a
patient’s disease. This logically leads to a perception that
much of modern medicine is about management of
chronic disease and prevention of more serious sequelae—
not actual cures. However, most health care professionals
n the late 1970s and early 1980s when I was creating
Bastyr University, I engaged in many conversations and
debates with MDs in academic, foundations, and policy
positions. After trying to make the case for the important
role of natural medicine in health care, I was many times
admonished to not assert that we could cure patients.
I remember vividly an argument with a professor at
the local medical school who asked me to define
hypertension after relating to him several successful patient
outcomes. I then spent probably too long giving him a
scientific overview of cardiac output, arterial elasticity,
kidney function, etc. He looked at me and stated, “Oh, I
thought you were misusing the term as a description for
patients under a lot of stress.” Sure brought home how
much work was needed to change conventional medicine’s
perspectives of “alternative medicine.”
Nonetheless, after being told yet again to stop saying
we were curing patients, I realized there was some truth to
their advice. As I was working hard to establish a scientific
foundation for naturopathic medicine, I could see the
validity of their perspective—lack of double-blind,
placebo-controlled studies of naturopathic concepts and
interventions necessary to prove cure. Although I and my
colleagues appeared to be having a lot of clinical success
with our patients, realistically this was all anecdotal until
objectively researched and validated (or invalidated). So I
stopped using the term cure. But then in the early 1980s,
Michael Murray, ND, and I began the arduous process of
deeply digging through the peer-reviewed medical
research to write The Textbook of Natural Medicine
(TBNM). (I say arduous because when we started, the only
way to find and access articles was through old-fashioned,
Integrative Medicine • Vol. 15, No. 5 • October 2016
are attracted to medicine with the mission of curing
patients leading to the cognitive discord that eventually
leads them to integrative/functional medicine. Though
use of the term cure has been actively discouraged except
in limited types of cases, perhaps true health care reform
needs to reclaim this term and concept.
thick, paper index volumes and searching isles and isles of
journal racks—desperately hoping the article you wanted
was not out for binding.) We were very pleasantly surprised
to find a huge body of work documenting the efficacy of
natural medicines in a wide variety of diseases (the fourth
edition of the TBNM has more than 10 000 citations).
Although the research was not yet to the state of directly
validating naturopathic philosophy and practices, we
found many supportive studies. The strongest were those
showing that many diseases are due to a deficiency of
specific nutrients, whereas other studies showed that
supplementation resulted in apparent total reversal of the
disease. I started thinking that maybe we could now start
asserting cure was possible.
Then in the late 1980s, I was invited by the National
Institutes of Health to debate the recently retired dean of a
conventional medical school. He was quite aggressive and
asserted that, except for some acute illness such as
antibiotics for infections and insulin for type 1 diabetics,
cure was not possible. All doctors could do was alleviate
symptoms and try to prevent more serious sequelae. I
must admit to being quite surprised by his pessimistic
stance and even more surprised when I looked around the
room and saw a lot of nodding heads. Happily, although
we disagreed on almost everything, the debate was
amicable and we each made a number of important points.
On the flight home cross-country, I continued to think
about our conversation. I was stuck on wondering why a
well-respected medical leader would take such a strong
anticure position that I thought would be quite
discouraging to most anyone who entered medicine
wanting to help people.
Pizzorno—The Path Ahead
com Then I happened to see a list of the top 10 most commonly prescribed drugs of the time. To share or copy this article. Anything else. Is the patient cured if all that is accomplished is that their symptoms are alleviated? 2. cessation of wheat and dairy products. Period. Careful case history revealed that as a child she had suffered from recurrent urinary tract infections and was started on daily antibiotics at age 8 years. Patient Example. This also made much clearer the centuries-old philosophical conflict between “unconventional” medicine (by its various names) and conventional medicine. providing a patient suffering depression an antidepressant is rarely curative. Appropriate antibiotics resulted in complete resolution within a few days. chronic gut inflammation. Depression is not caused by a lack of Prozac. She had just seen her gastroenterologist who was recommending that she switch to another anti-inflammatory but had been delaying prescribing as patients experience so many side effects. 5 • October 2016 9 . In Table 1. She had been first diagnosed when 14 years old and was getting worse. and rust-colored sputum. For example. How Do We Differentiate Between Symptom Palliation and Disease Cure? I believe this is a foundational issue that must be fully addressed if the health care crisis is ever going to be cured. despite treatment. except in very limited cases. being low in vitamin D increases all-cause mortality. Table 1. She was a very compliant patient but experienced only modest improvement—approximately 30% reduction in symptoms Integrative Medicine • Vol. or by their life choices not working for them and they need to make changes in their life. if the child is having recurring ear infections. An 18-year-old young woman came to me for help with her ulcerative colitis. she was constantly having intestinal upset and eventually was diagnosed with inflammatory bowel disease. Physical examination. But for the small percentage of the population that has trouble metabolizing sulfur compounds. and reseed her gut with healthy bacteria using a multistrain product I have found quite effective. we should not be using interventions that damage our patients. Having a mouth full of mercury increases the rate of dementia. is simply addressing symptoms rather than the underlying true causes. An otherwise apparently healthy 35-year-old man came to see me acutely ill with high fever. this must always be considered. Nor is it caused by a lack of St John’s Wort. The bottom line is that we need to ensure our interventions are not causing damage.This article is protected by copyright. Use ISSN#1945-7081. visit imjournal. The patient could be depressed due to deficiency of vitamin D (very common cause). the intervention is clearly not curative. he said her case was so bad that she would likely need a colectomy within only a few years. 9 of the drugs only relieved symptoms while allowing the underlying disease to progress. such as the Affordable Care Act. Do the symptoms recur when the intervention is stopped? 4. Criterion 2 Adverse drug reactions and other side effects are a huge problem. and Gram stain of his sputum made the diagnosis of bacterial pneumonia easy. and eventually leaky gut. The cause was clear to me: disruption of her healthy gut bacteria with whatever would grow there after all the antibiotics causing recolonization with inappropriate bacteria. Does the patient report their general health as improving or getting worse over the course of care? Criterion 1 Sometimes the symptoms are indeed the full manifestation of the disease. etc. The problem with only treating the symptoms is that the underlying problem continues unabated and is very likely causing many more problems than only the symptoms. complete blood count. But worse. allergies. As this was a regular patient whom I saw periodically and did not have recurrent infections. I finally started to understand the problem—the interventions actually being used for the vast majority of patients were indeed only palliative. Patient Example. She came to me hoping for an alternative medicine miracle. As is now well established. I am NOT saying causing less damage than their benefits. I am saying that. Is the intervention causing any adverse effects? 3. please visit copyright. By age 11 years. fatigue.com. To subscribe. Pizzorno—The Path Ahead osteoporosis. According to my understanding of cure (discussed later). No. Although not as common with “natural” drugs. NAC can be toxic. unless only an analgesic is used. etc. No. immune dysfunction was not a problem and intervention was clearly a cure. Criteria for Determining Whether a Therapy Is Curative 1. 15. However. a toxin such as mercury leaking from a “silver” filling (which is typically 55% neurotoxic mercury). properly prescribed drugs are the fourth leading cause of death in the United States. In contrast. I started her on my usually successful protocol for this condition: improve diet food quality. For example. I list criteria that I suggest to students on how to evaluate the care they provide a patient to help determine whether their treatment is actually addressing the cause(s) or only transiently controlling symptoms—no matter how “natural” the intervention. a child with an acute ear infection is cured in proportion to the degree to which symptoms are cleared and the physical signs normalize. cough. cancer.1 I have many times recommended in my editorials N-acetylcysteine (NAC) as a very effective way to increase glutathione thus supporting detoxification and protecting mitochondria from oxidative stress. supplement with digestive aids.
Criterion 4 This is the most difficult to address objectively but is well recognized by most every health care professional and may be the most important criterion of all. optimizing their levels will often also improve function of all the other biochemistry affected by the deficiency. To subscribe. As this is now 5 years later. After 10 years. Criterion 3 If the symptoms recur when the intervention is stopped. A 50-year-old woman presented with osteopenia and a strong family history of every older woman in her family dying from complications of osteoporosis—typically hip fractures. 10 Integrative Medicine • Vol. Intervention required supplementation with 14 000 units of vitamin D for 2 years (of course. her bone density became normal but requiring a maintenance dose of 10 000 IU (many times the supposed recommended daily intake). As their biochemistry normalizes. So many times I have had a patient profusely thank me for alleviation of a health problem that I had not consciously addressed. she started researching her condition and learned about fecal transplants. Patient Example. If a patient suffers depression due to a lack of vitamin D. In each of these situations. and good supplementation. please visit copyright. She decided to do the transplant on her own using her father’s stools. polychlorinated biphenyl. yearly dual-energy x-ray absorptiometry (DEXA) scans showed relentless loss of bone. we now know that many people have polymorphisms in the vitamin-D receptors requiring much high–levels of vitamin-D supplementation unless they get a lot of regular sun exposure. her symptoms quickly started to improve and after repeating one more a month later all her symptoms were gone and her surprised gastroenterologist proclaimed her in remission (apparently unwilling to say she was cured). After only 1 treatment. carotenoids and flavonoids in diet Diabetes See editorial in 15. COPD Almost entirely due to diet and lifestyle Acid blocker Almost entirely due to diet and lifestyle Anti-inflammatory Almost entirely due to excessive arachidonic acid and inadequate antioxidant vitamin C. it is much more complex when considering biochemical individuality. ADHD. for example. regular energetic exercise. must also supplement with vitamins A and K2) before bone loss was stopped. then it is very unlikely to be curative.com and continued dependency on the prescribed drugs. COPD. nutritional support is needed to maintain normal physiology. This being the modern age of the Internet with so much health information available online. Some patients have very limited capability to detoxify the pesticides and herbicides that contaminate conventionally grown foods. Table 2. The genomics revolution has greatly enhanced our ability to understand each of our patient’s unique nutritional needs and susceptibility to toxins. chronic obstructive pulmonary disease. Use ISSN#1945-7081. PCBs poison thyroid enzymes Elevated cholesterol Almost entirely due to diet and lifestyle Asthma. The 10 Most Commonly Prescribed Drugs in the United States2 Drug Purpose Synthroid (levothyroxine) Hypothyroid Crestor (rosuvastatin) Ventolin HFA (albuterol) Nexium (esomeprazole) Advair Diskus (fluticasone) Lantus Solostar (insulin glargine) Vyvanse (lisdexamfetamine) Lyrica (pregabalin) Spiriva Handihaler (tiotropium) Januvia (sitagliptin) Why Not Curative Iodine deficiency common. No.4 showing environmental toxins a primary cause of diabetes3 Abbreviations: PCB. a quick call revealed robust health and a clear cure. 15. 5 • October 2016 Pizzorno—The Path Ahead . Others have trouble converting dietary folates to their activated forms. selenium deficiency common. To share or copy this article.com. but needed to be continued due to a unique biochemical need. estrogen replacement. For example. This is a good example where the intervention was curative. they become healthier and more energetic.4 showing environmental toxins a primary cause of diabetes3 ADHD Children in top quintile of organophosphate exposure have doubled incidence of ADHD Epilepsy Diverse causes COPD Almost entirely due to diet and lifestyle. Despite a very good diet. Although in many ways this is pretty obvious. especially smoking Diabetes See editorial in 15. attentiondeficit/hyperactivity disorder. A genomic test revealed 5 (of 6) single nucleotide polymorphisms impairing vitamin-D receptor site function. visit imjournal.This article is protected by copyright.
Gossard. Brings to mind teacher Bob Carroll. please visit copyright. who. MD. Williamson. To share or copy this article. I am asserting that the best medicine first addresses the causes. director of the Department of Veterans Affairs’ Office of Patient Centered Care and Cultural Transformation. sleep disturbance. CNS. After all. I consider this a good indication that something curative has happened. but her tremor fully abated and she remarked feeling better than she had in years. interviewed Tracy Gaudet. MS. We have an interesting case report in this issue. Associate Editor Bill Benda. I have ordered some to try myself. CEDRD. IFMCP: Keren E. Gasta. by Managing Editor Craig Gustafson. Lipski. Also interviewed this month by Craig is neurologist David Haase. A large and growing body of research helps us determine which strains to use according to clinical needs. Putting her on my standard metal detoxification program not only resulted in reversal of depression. Crystal M. Scaffidi. who bring to our attention a novel natural health product. ND. Quite fascinating when another obscure gut organism is shown to have a surprisingly significant effect on health. This requires restructuring medical education and the reimbursement system so that we have the skills and time needed to find and correct the causes. I can confidentially state that virtually everyone reading this journal cares deeply about their patients and became a health care professional with the expectation of being in medicine to cure their patients. almost all of them only address symptoms. aren’t we all in medicine because we want to cure our patients? In This Issue I am very excited to start with this issue a multipart series on probiotics written by master of science nutrition graduates of Elizabeth A. I am delighted. in 1973. and dietary supplements. For more than a decade. MS. Margaret G. Notice the use of a new template created by Associate Editor David Riley to more clearly collect and track patient data. CNS. MD’s integrative medicine program. Parker. the very first government agency to approve then-named John Bastyr College of Naturopathic Medicine was the VA in 1979. by our presenter interview of Kabran Chapek. MS. MS. MD. Integrative Medicine • Vol. As I am in the process of working to regenerate my knees from basketball.com. Associate Editor Jeffery Bland. As we all know. Challenge testing showed high levels of mercury and lead. Rather. I was very impressed by David’s deep understanding of functional neurology and ways to facilitate regeneration. Australia. and Christy B. Liz! You are setting the standard for online graduate nutrition education. MD. They were colleagues in the early days of Andy Weil. lifestyle modification. DC. Cathleen M. Dolan.This article is protected by copyright. in the treatment dementia. Jessica M. CCN. Original research is by Katherine Spinks. PhD. To subscribe. discusses in his commentary our evolving understanding of the gastrointestinal microbiome. 15. Burns. Heather J. gut bacteria have a huge effect on health and expert probiotic supplementation is a very important skill for integrative medicine clinicians. presents reversal of irritable bowel syndrome. but also able to listen to each other. BCHN. comprehensive approach to neurological health is so much more effective than isolated drugs. Full neurological exam revealed no apparent abnormalities. 2-Beta Coxatene. However. I noticed a fairly strong “essential” tremor. Yes. I did notice a mouth full of amalgam fillings. 5 • October 2016 11 . not the actual causes of disease. Use ISSN#1945-7081. PhD. MS.com Patient Example. DNM(c). DC. RD. to facilitate joint regeneration. Pizano. She had dismissed it as a sign of growing old and had not even noted it on her intake form. RD. to provide a comprehensive series of lectures and workshops in Sydney. While examining her. once again modern research now confirms the remarkable clinical insights of these courageous pioneers. this is anecdotal—but when a patient responds with not only relief of the presenting complaint but improvement in other areas. I have been following the breakthrough work of Dale Bredesen. MD. Finley. LD. ND) were recruited by Mark Houston. and fatigue with an elimination diet. The only cure for the health care system is to address causes. RD. ND. MS. so we were able to not only fully present our content. Symptom control is much easier and almost the only approach in a health care reimbursement system that limits doctors to only 10 minutes with a patient. MS. MD. RD. An historic note. A 55-year-old woman came to me with a chief complaint of depression. Conclusion Please be clear that I am not recommending against use of these drugs. As you can see from my comments. CNS. BSc. Applying This Logic to the Most Commonly Prescribed Drugs Table 2 lists the most common drugs prescribed in the United States by number of prescriptions filled per month. Emily C. CNS. and James J. not only symptoms. visit imjournal. The first Pizzorno—The Path Ahead part starts with a review of probiotics for various neurological conditions. RDN. Stephanie Davis. No. therefor. What was special about this conference is that there were only the 4 of us for the 4-day conference. CCN. I find very encouraging that the Veterans Administration (VA) is engaging our medicine to help our military who suffer so much to keep us safe. “Disease begins in the gut!” Although at the time I was doubtful. Drugs are should only be used if addressing the causes does not produce the desired clinical results or patient safety requires transient use. Fantastic work. MS. asserted to my third-year class. I first met David when we (and Michael Ash. He very clearly presents why a multifactorial understanding of causes and an integrated.
Our medicine is fortunate to have friends such as Michael paying attention to these important issues. Editor in Chief email@example.com(4):8-17. Perhaps it is neurotoxicity from all the mercury in Florida air from coal burning for electricity. 15. No wait— he now lives in Florida. a different company would benefit. I vividly remember the candor of an MD medical director of a major insurance company to whom I was presenting a wellness program. 2016. Web MD Web site. sounds like he needs some mood-elevating vitamin D. ND. Or perhaps it is a healthy response to the polarizing political environment. Joseph Pizzorno.com. Associate Editor Bill Benda. Brown T. 12 Integrative Medicine • Vol. 2. Levin where he covers the key problems with the FDA’s proposed regulations. http://www.279(15):1200-1205. 5 • October 2016 Pizzorno—The Path Ahead . so there was no reason for them to spend the resources. 2016. The 10 most-prescribed and top-selling medications. Pizzorno J.com/news/20150508/most-prescribed-topselling-drugs. visit imjournal. To subscribe. In BackTalk. Incidence of drug reactions in hospitalized patients: A meta-analysis of prospective studies. 3. No. He also stated that clients change insurance companies so often that even if they worked to improve health.com/drpizzorno References 1.This article is protected by copyright. Is the diabetes epidemic primarily due to toxins? Integrat Med Clin J. But applying excessively onerous drug-like standards is inappropriate and will impair our ability to take care of our patients. please visit copyright. Corey PN. Lazarou J. JAMA. Pomeranz BH.com http://twitter. I strongly encourage all readers to contact their professional organizations and urge them to collaborate for a strong response to the FDA. Use ISSN#1945-7081.webmd. To share or copy this article. Accessed September 4. so sunshine should be readily available. 1998. It was quite frustrating. MD. We clearly want to be sure our medicines are safe and effective. Another important issue raised by John is the potentially huge problem that the new Food and Drug Administration (FDA) Good Manufacturing Practice guidelines will likely eliminate many of our natural medicines. He basically told me that insurance companies have no incentive for improving client health as the only way their bottom line improves is for health care costs to increase with time. 2015. Please carefully read the commentary by Michael D. Published May 8.com John Weeks addresses the challenging and politically sensitive issues that impair insurance companies’ engagement in health promotion and integrative medicine.