White Coat Underground

By now, we all know that the Huffington Post represents the zombification of medical news—interesting ideas are taken, eviscerated of any real meaning, their innards replaced with pablum, and the reanimated creature set loose on the world.

Reanimation of the undead is, it would seem, a rather addictive behavior, because HuffPo just keeps at it. Another one of their fake experts is “Dr” John Neustadt. The scare quotes indicate that John is not a doctor in any recognized sense: he’s a “naturopathic doctor”, representing a fringe, vitalistic health cult. But that fact isn’t made clear. He’s presented as “Dr” so that we might assume that he is the real deal.

Anyway, Mr. Neustadt is apparently a proponent of “functional medicine”, another medical cult whose purpose is vague, but probably involves taking your money. Wally Sampson has begun an analysis of this curious set of beliefs but let’s look at some of Neustadt’s specific claims.

Neustadt claims that we have a problem with medical education in this country, an assertion I can get behind. The high cost of medical education, combined with the system we use to reimburse doctors actively discourages bright, young students from pursuing primary care. But that’s not the same problem he sees.

The current system teaches disease management and symptom suppression, which is insufficient to meet our healthcare needs. A reformed system needs a new paradigm that stresses health promotion and treatments that attempt to correct the underlying causes of disease.

Anytime someone uses the “P” word, my bullshit detector perks up. What would this new paradigm be? Does he even know what a paradigm is? Usually, paradigm is not defined as, “a new idea that I just pulled out of my ass.” Is he really so uneducated that he thinks that primary care physicians (PCPs) don’t stress “health promotion”, or that we don’t try to correct “underlying causes of disease”? What does that even mean? Some diseases are more or less amenable to this type of thinking. Genetic diseases such as cystic fibrosis and sickle cell disease cannot have their “underlying cause” corrected, or at least not in any way that Mr. Neustadt would accept. The underlying cause of sickle cell disease can be “corrected” with a bone marrow transplant, but this difficult and dangerous procedure is not usually used. Many diseases, such as type II diabetes, are a product of genetics and environment, and while some of these factors can be modified, others cannot.

While no one can dispute that these professionals [PCPs] work exceedingly hard, they are hampered by two major failings of conventional medical education philosophy: 1) it focuses on suppressing symptoms with drugs, which are considered the primary and only legitimate treatment modality; and 2) it doesn’t teach how to treat the underlying causes of disease

Huh? That Mr. Neustadt believes this is a marker of his own ignorance rather than a failing of our medical education system. “Suppressing symptoms with drugs” is not necessarily a bad thing. Let’s take a few examples. Kidney stones hurt—a lot. Should we treat this pain? Does he believe that after we have identified a patient as being prone to kidney stones we don’t go after the cause? Low back pain hurts. We treat the pain with drugs, when necessary, but we also teach proper back care. This is pretty basic stuff. What about coronary heart disease? Our knowledge of its underlying causes has revolutionized primary, secondary, and tertiary prevention of heart attacks. Failing to understand these basic ideas disqualifies Neustadt from having an opinion that won’t get him laughed out of the room.

Once again, HuffPo and it’s merry band of fake experts is using their own ignorance to spread false ideas about health and disease. They should be ashamed.

But of course, they have no shame.

Comments

#1 D. C. Sessions
July 13, 2009

I’m curious about his identification of the “primary cause” of this and what objections he has to “conventional” treatment for it. Perhaps he expects that patients with this condition are just given pain meds and left to take their chances?
#2 PalMD
July 13, 2009

Obviously, DC, we need to forbid snow skiing.
#3 daijiyobu
July 13, 2009

The ND in question (Bastyr 2005) states in “Frequently Asked Questions” (see http://www.montanaim.com/faq.html#education ):

“naturopathic doctors must pass two sets of national board exams. The first exam tests basic sciences knowledge ['a basis of science' claim] and is administered after the second year of the program, while the second exam tests clinical knowledge and is administered after the fourth year of the program [a 'from that science basis we treat' claim]. The naturopathic medical board exams are administered by the North American Board of Naturopathic Examiners (NABNE).”

So, NDs claim a professions-level science-expertise basis.

NABNE’s exam is the NPLEX, which labels naturopathy’s requisite homeopathy “clinical science”.

That’s as sensible as labeling the supernatural scientific — in other words ABSURD.

For such naturopaTHICK ABSURDITY, see Bastyr’s

http://www.naturalhealers.com/schools/bastyr :

“[our] science-based approach to teaching with an emphasis on understanding the mind, body, spirit and nature.”

Bastyr is the trunk of such epistemic absurdity: placing within science the supernatural, the vitalistic, the unevidenced, the scientifically-refuted.

Naturopathy is definitely a vitalistic cult.

Definitely ‘of the supernatural and vitalistic falsely posed as scientific’.

Definitely scientifically illiterate.

Beware. They are the education robbers.

Bravo.

-r.c.
#4 Rev Matt
July 13, 2009

Forbidding snow skiing is, as any naturopath would tell you, woefully insufficient and only treats the symptom not the underyling problem. My aged mother recently broke her ankle and wrist while walking along a sidewalk. Clearly the only reasonable solution to treat the underlying problem of bones breaking is to forbid mobility in all forms.
#5 D. C. Sessions
July 13, 2009

Obviously, DC, we need to forbid snow skiing.

Wouldn’t help, since (as with RM’s mother) that particular condition wasn’t the result of skiing. Nor snowboarding, for that matter.

And I do truly wonder what drugs you evil nasty slaves of Big Pharma use to treat conditions like that one.
#6 Tye
July 13, 2009

I agree with Neustadt, not enough is being done to homogenize and roboticize the human body. Until we can replace biology with engineering we’ll never get at the root cause of disease…/sarcasm
#7 D. C. Sessions
July 13, 2009

OT: WRT snow sports, snowboarders bring us some utterly beautiful Colles’ fractures [1]. Full-up silver fork presentation. A bitch to splint, but the hard part is not biting our tongues. “Broken” is a word we dare not utter, since that’s a diagnosis.

Instead, we get to ask people whether their clavicles (or arms, or …) used to match …

[1] Wear the PhysioProfing wrist braces!
#8 Snoof
July 13, 2009

My aged mother recently broke her ankle and wrist while walking along a sidewalk. Clearly the only reasonable solution to treat the underlying problem of bones breaking is to forbid mobility in all forms.

Hardly. I know someone who broke a bone when something fell on them when they were sitting still. The _reasonable_ thing to do is remove everyone’s bones. No bones, no breakages!
#9 Jeff
July 13, 2009

I think Neustadt does give a clear definition of Functional Medicine:

“In many cases, the underlying causes of disease are biochemical in nature. Biochemistry is how the body uses vitamins, minerals, fats and proteins to do its job, and how things like infections, allergies and environmental toxins interfere with proper biochemistry to cause symptoms and disease. In other words, if you weren’t sick last year or last month, and you are now, something has changed in your biochemistry. Determining where a person’s biochemistry has gone haywire and then correcting it through targeted nutritional therapies is called medical biochemistry or functional medicine.”

One example from my own life: For many years I suffered from severe hayfever. I read this is often caused by adrenal insufficiency:
“Under normal circumstances the body will begin producing antihistamines (surprise – you don’t have to buy them!) neutralize the histamine and you have very little reaction. But all too often, the prime producer of antihistamines (the adrenals) are fatigued and incapable of responding. When that happens, we have the ever-increasing problem of allergies which so many face today.”

The most important nutrient for properly functioning adrenal glands is vitamin B5 (pantothenic acid). I started taking pantothenic acid, gradually increasing the dose until my symptoms disappeared. Recently I switched to pantethine (a different form of B5) which seems to work even better. The result: no hayfever for 20 years.

Wouldn’t this be a successful application of Functional Medicine? It wouldn’t work for sickle cell disease but it might for many other conditions.
#10 D. C. Sessions
July 13, 2009

One example from my own life: For many years I suffered from severe hayfever. I read this is often caused by adrenal insufficiency:
“Under normal circumstances the body will begin producing antihistamines (surprise – you don’t have to buy them!) neutralize the histamine and you have very little reaction. But all too often, the prime producer of antihistamines (the adrenals) are fatigued and incapable of responding. When that happens, we have the ever-increasing problem of allergies which so many face today.”

The most important nutrient for properly functioning adrenal glands is vitamin B5 (pantothenic acid). I started taking pantothenic acid, gradually increasing the dose until my symptoms disappeared. Recently I switched to pantethine (a different form of B5) which seems to work even better. The result: no hayfever for 20 years.

So B5 is an immunosuppressant. Sounds like something to avoid.
#11 Dr. Steve
July 14, 2009

One example from my own life: For many years I suffered from severe hayfever. I read this is often caused by adrenal insufficiency:
“Under normal circumstances the body will begin producing antihistamines (surprise – you don’t have to buy them!) neutralize the histamine and you have very little reaction. But all too often, the prime producer of antihistamines (the adrenals) are fatigued and incapable of responding. When that happens, we have the ever-increasing problem of allergies which so many face today.”

The most important nutrient for properly functioning adrenal glands is vitamin B5 (pantothenic acid). I started taking pantothenic acid, gradually increasing the dose until my symptoms disappeared. Recently I switched to pantethine (a different form of B5) which seems to work even better. The result: no hayfever for 20 years.

Wouldn’t this be a successful application of Functional Medicine? It wouldn’t work for sickle cell disease but it might for many other conditions.
=============
Even if this were actual evidence instead of an anecdote it would not prove the concept of functional medicine. You can’t prove a hypothetical mechanism through successful application.
For instance – my hypothesis is that when I hit the B key on my keyboard, microscopic light-speed aliens armed with cans of spray paint rush into the Internet and paint capital B’s all over the place.
You doubt my proposed mechanism?
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB

More on point. If pantothenic acid worked for you, great. Of course, it may have worked through a different mechanism than the one you proposed – it also may have done nothing – you may have gotten over your allergies on your own – it happens.
#12 daedalus2u
July 14, 2009

The replies about B5 illustrate that what is being called “functional medicine” by Neustadt isn’t. It is simply a just so story.

The physiological pathways are not sufficiently understood, and the practitioners of FM do no tests of sufficient accuracy to elucidate with sufficient fidelity what is going on in those pathways to be able to influence those pathways sufficiently so as to resolve the problem.

Everything that is important in physiology is under physiologic control (that would be everything).
#13 jen
July 14, 2009

In other words, if you weren’t sick last year or last month, and you are now, something has changed in your biochemistry. Determining where a person’s biochemistry has gone haywire and then correcting it through targeted nutritional therapies is called medical biochemistry or functional medicine.”

So, that bout of food poisoning last week was a result of my biochemistry going haywire? And here I’d thought it was a result of my eating something I shouldn’t have ….
#14 Mu
July 14, 2009

Makes me wonder what his position on antibiotics is. Clearly, they do treat the underlying cause of the disease, infection. On the other hand, they clearly don’t work by empowering the body’s own systems, and are derived from big pharma at its best. So maybe treating an infection is also only treating a symptom of an underlying cause, your weak immune system.
#15 The Blind Watchmaker
July 14, 2009

I think that he is confusing PCP’s with homeopaths. Wasn’t Hahnemann’s goal ‘cure’ symptoms by giving tiny bits of the cause of the symptoms?

If all I am interested in is curing symptoms, then I would just spend most of the day dishing out narcotics and tranquilizers. Never mind the diagnostic studies and films. Let’s just treat the symptoms! At least the patients will die of their heart disease and spinal tumors symptom free!
#16 Dunc
July 14, 2009

he really so uneducated that he thinks that primary care physicians (PCPs) don’t stress “health promotion”, or that we don’t try to correct “underlying causes of disease”?

I guess that would be why my doctor has never told me to quit smoking.

Oh, wait…
#17 jay
July 14, 2009

Vitamins do indeed cure vitamin deficiency. Alas, most diseases are not vitamin deficiencies.

And even antibiotics DO work with the body’s natural defenses. They simply knock down the bacteria level to a point where the body can manage the problem. But somehow these guys seem to be in a vitamints=good, drugs=bad mindset.
#18 Jeff Engle
July 14, 2009

Dr. Steve: More on point. If pantothenic acid worked for you, great. Of course, it may have worked through a different mechanism than the one you proposed – it also may have done nothing – you may have gotten over your allergies on your own – it happens.

I wasn’t able to find any clinical studies using B5 for allergies, only a few entries like this:

“Pantothenic acid supplementation may reduce allergic reactions, especially allergic rhinitis. Clinical observation: The majority of over 100 patients with allergic rhinitis who took 250mg of pantothenic acid twice daily had almost instant relief. [Martin W. On treating allergic disorders. Townsend Letter for Doctors Aug/Sept 1991: pp.670-1]”

jay: “Vitamins do indeed cure vitamin deficiency. Alas, most diseases are not vitamin deficiencies.”

If nutrient deficiencies are widespread it seems plausible this might be responsible for some diseases:

Inadequate Micronutrient Status Is More Common Than Expected:
http://www.medicalnewstoday.com/articles/145717.php
#19 Doug Alder
July 14, 2009

Mr. Neustadt is apparently a proponent of “functional medicine”, another medical cult whose purpose is vague, but probably involves taking your money.

ba da bing!You have a career waiting for you as a stand up comediam – that’s a great line
#20 JennS
September 2, 2009

My sister is seeing a FM doc for her Fibromyalgia. This is a condition that many traditional doctors wont’ even recognize. That doesn’t change the fact that she lives with pain each and every day. When she was diagnosed with this almost 20 yrs ago, they tested her for everything under the sun (lupus, ms, md, etc. etc.) they said you don’t have all that so you have Fibromyalgia.

Her regular OB/Gyn is now offering the FM services. So he tested her hormone levels and vitamin D levels. Her D was a 6. I think she said normal was a 60. Instead of sending her home with a prescription for supplements as a regular MD would have. Her FM doctor stepped back for a moment and asked the question “Why is the vitamin D so low” My sister has a pretty good tan so it’s not an issue with not getting enough sunshine. He researched further and had her tested for heavy metals. She tested positive and in the danger range for mercury, aluminum, nickel and lead. My sister is reviewing the options for removing the metals from her system.

I have a friend at work that recently was tested for vitamin D at her MD’s office. Her level was a 10, only 4 higher than my sister. She was told to take supplements.

Take it for what it’s worth.
#21 PalMD
September 2, 2009

Oh, I will.
#22 brian
March 15, 2010

wow…I see no joy in you as you claim to have and as you claim to share with others. I’m glad all you old closed minded docs are retiring by the dozens right now so that a new medical “paradigm” can take hold . It’s not that you PCP’s don’t promote prevention. It’s that when you are with a patient you have one hand on the door knob and the other hand on your prescription pads. Good job – that’s “real” medicine there.