Dr James Schaller
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Common Sense and Integrative Medicine

In recent years it has become clear that tradition allopathic medicine is limited.

First, respected journals like JAMA and The New England Journal of Medicine, report that most of allopathic medicine is controlled by pharmaceutical company money. While this helps expose physicians to new medications, the down side is that it only exposes physicians to new medications.

Second, the former editor of JAMA, Dr. Lundberg, has said that Americans are not getting what they pay for in medical care. Americans spend an incredible amount of money per month and do not receive the full benefit of this money.

In keeping with this, my concern is that American medicine has mastered acute emergency care, but it is very limited in the area of prevention. By "prevention" I do not mean removing a cancerous breast or a cancerous prostate gland. By prevention, I mean preventing the cancer at the cell level before it ever develops. This would include enhancing natural killer cell function, and using interventions that prevent the problem in the first place. Breast exams, prostate exams and mammograms are death prevention. They are not the earliest places for prevention.

Third, health care providers, like physicians and nurses, are working incredible hours and are being attacked from many sides. It is silly to expect a physician receiving a trivial payment for emergency room care, and who is being sued regularly, to have time to learn broader treatment methods. If physicians and nurses do not have extra time, it is ridiculous to expect them to learn anything other than updates in their current skills and practices.

Fourth, doctors and nurses, like everyone, look to mentors and certain authorities. Some of these authorities include standard refereed journals. Since I have worked as a reviewer for some journals and some of my friends and acquaintances are reviewers, I have gained some sense of how they think.

Simply, it is very hard for them to learn new paradigms outside their routine medical care, because they are finite and very busy. An example of this publishing bias would be in the field of nutrition. If I submit two articles to the same Journal, in which one is about a medication and the other on nutrition, I will usually find that the medication article is accepted faster and more easily.

Fifth, if one looks at material that is not from double-blind randomized studies, the quality can be hard to evaluate for traditional medical providers. Of course, even double-blind studies can have flaws. But the real issue is should physicians and nurses only value materials that come from expensive double-blind studies, which will usually involve prescription drugs or surgery techniques?

Health care providers should be aware of the importance of double-blind studies that have been done in nutrition. We require certain amounts of "essential" or mandatory nutrients. Anything below optimal amounts is sub-optimal health. Significantly low nutrients, almost never tested in any form of medicine, causes vast numbers of Americans to die of cancer, heart attacks and stroke. It is that simple. The studies have been done. The results are clear to anyone who spends the time reading the extensive literature. Many essential nutrients have thousands of studies published in peer-reviewed journals.

Previously, I was ambivalent about nutrition, because the area seemed boring, unclear, unproven and eccentric. Then I met research physicians who literally sent me four massive binders with hundreds of medical journal articles on nutrition. I was just the right place at the right time. Thankfully.

And despite all this clear science data I was given years ago, it was only this year, that JAMA published on the need for individuals to have daily nutrients i.e. supplements. Of course the article reflected a profound limited understanding of current data. Specifically, the article had no sense that dosage mattered and that delivery forms are highly variable. Meaning, some one tablet per day supplements -- formed under tons of pressure to become stone tablets -- appear not to have any effect on death rates in some studies.

Sixth, some integrative physicians do a poor job explaining the benefits and the reasons for non-prescription and non-surgical treatments. This causes physicians and nurses to therefore consider any nontraditional, not allopathic treatments as unusual.

Seventh, massive numbers of Americans are fully aware that allopathic medicine offers many benefits but that it is also very limited. The amount of money spent on treatments outside traditional allopathic medicine is massive. While this fact has stunned traditional medical journal editors, all it shows is they are unaware of the limits of their own medicine, and out of touch with the frustration of their patients.

Eighth, physicians and nurses want to be liked and appreciated. In other words they are human, and like to be thanked rather then insulted and devalued. There is still an antiquated perspective that anyone offering anything other than medications and surgery is eccentric and quote "alternative." No one likes to be perceived by his or her colleagues as unusual. Personally, I find myself fairly surprised that I can publish large numbers of articles in traditional medical journals about traditional medications, and yet the main thing some notice is that I am also learning "alternative or complementary" medicine. With some clinicians, one could be covered in parrots, and they would notice you were reading a book on natural progesterone or CoQ10.

The Bottom Line in this Millennium

  1. Nutrition used to prevent disease is not complementary medicine -- it is medicine. One need only read the articles that currently exist. The FDA has lost almost every case in this area. Some nutrition companies are allowed to make benefit claims.
  2. Removing exposures to environmental toxins is not alternative medicine, but merely sanity and common sense. It is medicine.
  3. Replacing selective bio-identical hormones because people are living long and twice as long as 100 years ago, is not alternative medicine, it is medicine. Indeed my father started replacing natural progesterone in aging women almost 35 years ago, long before the famous 2003 study reporting that synthetic progestin is dangerous. But for some in allopathic medicine there is no difference between your mild bio-identical progesterone and a synthetic powerful progestin. Simply, the main thing that natural progesterone and synthetic progestins have in common is the letter "p." After that, they act almost entirely the opposite.

    Currently, I would estimate that tens of thousands of physicians, nurse practitioners and other health-care providers prescribe bio-identical natural progesterone. Some traditional physicians say there is "no data" on this practice. They prefer using medications like Sarafem (Prozac) and Zoloft for PMS & PDD. Most practitioners using natural bio-identical progesterone have a 95-99 percent success rate treating PMS & PDD, and no drug can beat that success.

    I wonder if the struggles my colleagues have on this issue is related to problems in gathering information.

    For example, the FDA approved Prometrium, which is natural progesterone, many years ago. It is not a synthetic progestin. The FDA does not approve medications without evidence of their utility. The FDA has approved bio-identical natural progesterone powders which are made into various unique forms to fit individual needs. Again, this is not alternative medicine. It is merely being aware of medical data that currently exists outside of basic data streams.

This particular illustration of hormones is very important. For years, I watched intelligent practitioners prescribe Premarin or a combination of Premarin and synthetic progestin called Prempro. If I asked clinicians about the contents of Premarin or Prempro I would be told, "Premarin contains some replacement estrogens or estrogen." They were unaware Premarin contains approximately 200 different substances including known carcinogens. This data can be found on Medline and is published in basic peer-reviewed journals. Is not alternative or complementary medicine, it is medicine.

In conclusion, medicine must get its data from many sources and must stay broad. Ideally, we should be aware of other medical fields since they offer contributions to our own. This is renaissance medicine. Drug companies offer helpful contributions to medicine, but they are not the authoritative popes of medical knowledge. They are businesses involved in making money in medicine. We should neither praise them nor insult them for being capitalistic companies. The fact that Premarin and Prempro were some of the leading drugs in the USA shows most practitioners were unaware of much data.

Appropriateness should not be defined by the opinions of a mob or an educated elite. Similarly, medicine should not be defined by what most doctors are doing or what drug companies recommend.

Finally, lets leave the words "alternative medicine" and "complementary medicine" behind in the 80s and 90s. The correct expression for a broad and multifaceted medicine is integrative medicine. I hope that physicians will stop having to work absurdly long hours to pay for their malpractice premiums, overhead staff, school loans and other expenses, and someday can return to engage in extensive learning, to bring suffering people safe and helpful treatments from any source that is reasonable.

James Schaller, MD, MAR
Naples, Florida

Bank Towers, Tamiami Trail, Naples, FL
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