What Is The Purpose Of Doctoring?
The purpose of doctoring is to keep people well. Its secondary function is to improve the situation if the first function fails. On the face of it, these statements seem self-evident. Note, however, what I have not said. I have not said that the purpose of doctoring is to cure disease. The appearance of disease represents failure of doctoring. From this simple little catechism, you can quite quickly develop a serious criticism of the health care industry. This newsletter will concentrate on methods of keeping yourself well. It will also look at individualized techniques. Prevention is better than cure.
Bernard Shaw, the great Irish/English novelist of the first half of the twentieth century and a prescient socialist, used his dramatic plays to bring out some concepts which have been important in the sociology of the twentieth century. In The Doctors' Dilemma, he points out that when professionals come together they do so in order to find means by which to defraud the public. Diseases are often merely labels with which to frighten people. In the business of doctoring, the maintenance of disease guarantees continued custom. Accordingly, curing patients is exactly what the doctor should avoid to maximize his income. Mind you, fatal diseases can interfere with the continuous availability of customers; they do warrant a cure. Chronic disease, however, well, that is another matter. It is stated by the authorities of the bureaucracies in various governments that it is the business of public health to protect us from disease. Perhaps they have been useful in helping with epidemics by quarantine and, just possibly, by certain categories of vaccination, at least against illnesses such as yellow fever.
The Industry of Medicine
If we were to conduct a brief survey of chronic illnesses from our everyday experience in contemporary America, we would observe that the heart disease industry is thriving. The "war on cholesterol" was a misdirected misadventure. The incidence of coronary angiography, stent placement, and, particularly, bypass surgery, increases year by year. The back pain industry feeds the dividends of the companies who make anti-inflammatory NSAIDs (nonsteroidal anti-inflammatory drugs). It feeds the assessment and rehabilitation industries, and because it is ineffectual, it also feeds the argument industry: the independent medical evaluations, the workers' compensation bureaucrats, and, of course, the lawyers who have specialized in these arguments. Most hospitals' operating room schedules are replete with operations on people’s backs, knees and shoulders, which common experience tells us have only a small overall beneficial effect (it is this newsletter's opinion that these operations are wonderful technologically, but frequently misapplied).
Doctoring, as such, does not occur much anymore. The socialists' takeover of the medical profession has harmed it in a way that socialist takeovers harm all human endeavors and industries. The young bureaucracy, tasked with regulating its target, in this case doctoring and the medical profession in particular, starts out by studying "what is." This creates the basis for keeping everything in line. Is this approach likely to bring innovation? Of course not. Now, the good reputation innovation has had allows further advances on existing lines, but, of course, true innovations, by their nature, do not follow existing patterns or research fronts. These innovations are precluded. They are not within the standard of care. The closed loop of research funding, existing academic perspectives, the herd mentality of excluding the new, and, unfortunately, corruption in the medical journal publication industry, all militate against useful advances. They do, of course, maintain the status quo, which is that of treatment of disease. The profession of pathology, started in the eighteenth century, has yielded a wonderful harvest in recognizing static end-stage disease. This article started with the concept of prevention. For prevention, static disease diagnosis is useless. The paradigm based on care for static or end-stage disease has the same limitation.
The insurance business, which is part of the feedback loop in medicine, has contributed in an important way to the restriction in innovation. A person going to a doctors' meeting hears only discussion about what is "reimbursable" and what is not. Prevention is not reimbursable.
The Insurance Dragon
From my point of view, I like this state of affairs. Anything the socialist system touches, it damages. Although it is customary to speak of health insurance, in fact, the issue is sickness insurance. The insurance company will reimburse you for corrective measures for disease, not for health maintenance. If you want an analogy, the homeowners' insurance policy reimburses you if there is a disaster and your house burns down. It does not reimburse you for paying your taxes which contribute to the fire department, for keeping fire extinguishers handy, and ensuring that fire in the house is used safely. Why does the public demand reimbursement for health maintenance expenses? This irrational urge has been foisted on the American public through false advertising by facilitators (provocateurs) and agents of influence. When (probably not if) a critical mass of public opinion shifts to demanding the governments take care of preventive health, Americans will have surrendered the last iota of personal medical independence. I conclude, therefore, that individuals who take responsibility for themselves, who have ambitions for the good life, and who recognize the inevitable conspiracy professionals have to increase the public's utilization of their services for a fee, will find the information in the balance of this newsletter to their liking.
The Rational Mind
When dealing with mechanical systems it is usual to find that there is an interactive relationship between the components. The automobile requires its fuel injection mechanism, as well as its tires. Locomotion lags when either is faulty. The human (or the animal) can be surveyed the same way, except that the considerations are not only mechanical (orthopedic medicine), but also biochemical. Another dimension which the Paracelsus Clinic is pursuing vigorously is the physical, electronic and biomagnetic properties of living people. The spiritual well being of people may be better handled by the priest. However, the unique property of a human is his rational mind, and rationality is definitely improved with a biochemical approach. The best investment a man can make is an investment in his own intellectual capability. It is, after all, the intellect, the rational mind, which creates added value to material things. (Karl Marx claimed that it was only labor which added value. He was wrong.) A healthy mind lives in a healthy body. This newsletter, accordingly, will recapitulate some of the points made in earlier newsletters about maintaining a healthy body and focus primarily on containing a healthy mind. The tests which are discussed below represent a new paradigm in medicine, a paradigm which represents such a great shift, such a completely new way of doctoring, that for very little expense you as an individual can plan your preventative health maintenance in a manner which is more sophisticated than was imagined even a few years ago, and of immense value to each of us. The personalized quality of this planning severely contradicts the present paradigm of medicine. The present prevalent paradigm makes generalizations. It looks at human beings as homogenous biochemical populations. This fixation on homogeneity contradicts the politically correct language on diversity, but, as is usually the case, politically correct language always means exactly the opposite of what it says.
In spite of the mass hypnosis which is called education and the media, here in America individuality is still highly valued. Individuality, however, is, in a biochemical sense, not a matter of choice. In previous and recent newsletters you will have read about a series of laboratory tests which evaluate a person for his biochemical peculiarities. Are you a fast oxidizer or a slow oxidizer? Are your cells replete with glutathione or depleted? How about your phase I detoxification? For instance, your ability to detoxify caffeine? Are your sex hormone levels adequate for your needs at your particular phase of life? How heavy a load of toxins have accumulated in your body? Organic compounds? Heavy metals? And, how are your digestive processes? Does your stomach manufacture enough acid for your requirements? The subculture of naturopathy and alternative medicine has been aware empirically of its ability to sometimes classify people by external manifestations of some of these issues. Standard medicine has rejected these forms of classification because they could not be verified when randomly selected medium-sized groups of people were tested by these measures. A dichotomy between evidence-based medicine on the one hand and quackery on the other was created. We now know that this is a false dichotomy. The problem with these alternative methods of evaluation is that they have been based on external manifestations of these metabolic and chemical subtypes, (phenotypes) and, as there is an extraordinarily large variation in the population, both in these subtypes and in the manifestations of these subtypes, these intuitively arrived at methods of classification have never been borne out by the quantitative control studies on randomly selected individuals. The standard of care fixation, which has taken grip of the medical academic and research business complex, is going to face a titanic battle. There have arrived objective ways of measuring peoples' biochemical individuality by the criteria outlined, modifying the weaknesses, usually with nutritional means, and, finally observing clinical improvement in the chronic illnesses which have gone badly treated so long and so profitably.
Genetics
The term genetics has been used to explain individual variations between people. Mendelian inheritance has helped us understand the transfer of genetic characteristics. It is, however, only with the completion of the Genome Study in the last year that an increasing sense of clarity and order has arrived with practical clinical usefulness. It has become possible through a technology called third-wave invader assay to test a sample of DNA accurately (with an accuracy that is much greater than the previously frequently used polymerase chain reaction [PCR] technology), to identify individual genetic units and their variants. Variants are common. These variants have been called polymorphic isoforms, and also SNPs (pronounced snips). This stands for single nucleotide polymorphisms. The biochemical pathways dependent on proteins called enzymes are regulated by this genetic material. It is estimated that there are approximately three billion nucleotides in the human genome (nucleotides are the smallest components of the coding language in the DNA). It is estimated that from these there are approximately 40,000 genes in the human genome. The amount of information arriving from basic research in databases on these genetic polymorphisms is very large, indeed. Luckily for us, some researchers in select laboratories scan this research information regularly. They have noted that approximately 1.6 million SNPs have been identified (though it is likely that a very many more will be identified as this research continues). The term polymorphism is used to refer to a mutation that is found in a significant proportion of the population (that is, over 1%). When your blood is sent to the laboratory for DNA analysis, these polymorphisms can be identified by the third-wave invader assay technology. The laboratory has determined four criteria by which to judge which of the 1.6 million SNPs recognized to study. They are:
- Relevant. In other words, they affect a person's biochemistry, physiology and health.
- They need to be present frequently enough for the effort in the study to be rewarding, i.e., prevalent. Now, it is no use merely to collect bad news. We cannot change our genetics. However, because the genetic makeup of any individual may merely predispose him to certain risks under certain circumstances, the term "environmental factors" is used, although, truly, the internal body environment, as well as the external environment, is relevant here.
- Accordingly, the lab looks for SNPs which are modifiable. The means of modification are diet, nutrition, lifestyle, supplements and pharmaceuticals.
- The fourth criterion is that the benefit from recognizing the SNPs can be measured. By this the laboratory means that there are some other laboratory tests which can monitor whether a person has improved his prospects by the above mentioned modifications (I am personally not convinced that this is a definitive criterion. It might be worth taking some measures to improve one's health even if the laboratory has not developed a test to measure their biochemical outcome. That issue will, however, need to be addressed by a future generation, as it is likely that our generation will be completely occupied in preventive medicine, maximizing the benefit from this threshold new paradigm.
From the Allopathic Perspective
- From the point of view of regular physicians who prescribe medication there has just arrived a new option. A high-tech company has just been launched in the last days of October 2002. SERYX, or Signature Genetics offers a health-club-like option for continual monitoring of your genetic risks for a membership fee. Both you and your physician will need to be members. They have not even forgotten a discount for additional family members. (They haven't quite thought out the anonymity aspect of this). The company offers to bank your DNA in a secure vault in Switzerland anonymously after analyzing the SNPs in New Jersey &/or Montreal. They offer repeat analyses of the original sample as more genetic information becomes available and relevant. SERYX will offer ongoing comments on your medication as seen from the point of view of your ability to detoxify. You might, in fact, be able to arm yourself with a long list of drugs that are "permissible" and share the list with you physician and check before any new prescription is filled. This might be an instance of being and appearing-to-be a consumer who is most-fully-informed. Your doctor won't soon forget your case! As this company is new and looking for new physicians to participate in their venture you might just get the equivalent of a finders' fee when your doctor books his first genetic analysis with them. The practicalities are as simple as a blood draw. The fee they are quoting is in the order of $2000+ to start with. This seems, to your newsletter editor, modest indeed when you spread the benefit, in an actuarial sense, over a lifetime. The phone number is: 877-243-3684. Their web page (not operational at the time this went to press) is www. signaturegenetics.com.
The Solution Of The Great Mystery
The standard medical, and, particularly pharmacological literature, is replete with warnings about the side effects of drugs and drug interactions. Indeed, we read in the lay press that in America alone there are 100,000 major complications and deaths from medical misadventures. Most of them are drug related (in this context it is salutary to observe the paucity of complications in a natural medicine practice). Pharmacists are constantly on guard, warning physicians and their patients about possible drug interactions. The phenomenon of doctors prescribing for patients not knowing the whole inventory of the patient's medicine cabinet (often more than one specialist is prescribing) leads to this nightmare of complications from pharmaceuticals, particularly drug interactions. How interesting it is that, in spite of this epidemic, pharmacy houses continue to pump out more and more drugs. The demand for them is ever increasing, mostly because of the complications from the existing armamentarium. A good example of that is the need for specific antibiotics, because of the wholesale use and contamination of the environment by antibiotics (the farming business has a lot to do with this). The promiscuous sexual transfer of genetic material between separate species of bacteria causes the scene. How much better it would be if the medical profession at large concentrated on boosting peoples' immunity and used a general health measure, reserving antibiotics only for extreme cases. In this context, the use of oxidative therapy in natural medicine is salutary.
Genovations
The analysis of your individual genetic SNPs is now possible. One alternative medicine laboratory has pioneered this work. (Great Smokies Laboratory, Phone: 800-522-4762.) The extreme beauty of the reports from these analyses is that, based on the individual person's genetic polymorphisms, it is possible to predict with a high degree of confidence to which drugs the person will react unfavorably, and which drug combinations are apt to be particularly harmful. Most of this is based on an understanding of the modes, or method, of detoxification. Most of the substances which need to be degraded and excreted by the body are substances which play important roles in our biochemical machinery. These may be items present in food, which serve useful purposes. The need for detoxification is, of course, true for all drugs, but in the environment there are many other substances which are absorbed into our bodies willy-nilly in small quantities, such as diesel fumes, aromatic polycarbons, and a host of other organic molecules. In fact, in modern times, the prevalence of these in the environment is increasing due to industrial productions. Most of these substances are fat soluble. Most of them require excretion through metabolic pathways which are present predominantly in the small intestine and liver. These are called phase I and phase II detoxification pathways. These are, of course, regulated biochemically by the relevant enzymes present mostly in the microsome part of the cytosol of liver and small intestinal cells. Here, in the cytosol mitochondria are also present and the energy for the cell is produced in them. Detoxification occurs through a system which has the somewhat un-euphonic name of P450 cytochrome system. There is a multitude of specific enzymes within this system. Any one of these enzymes can be present in varying amounts and with varying degrees of effectiveness based on the amino acid makeup in them. This make-up is predicated on the SNPs. A small matrix of variations is present in the population based on inheritance through the chromosomes, one from each parent. Each locus of relevance on the genetically active potion of the DNA (exon) may have more than one allele. An allele is a genetic unit. It may have more than one form and be responsible for differences in the specific amino acids making up the enzymes, and hence their potency and specificity. There may be several, say up to ten, alleles for each SNP. The variation amongst people is enhanced, however, because of the multitudes of genes concerned. Taking into account only the 50 or so SNPs which are analyzed by this new laboratory technique of genomics, you can see that the total number of variations in the population is quite large. Almost certainly, this number will grow as additional tests are brought on line. The beauty of this technique is its predictive value in helping you with your health. Suppose you knew that drug A is likely to be toxic if you were to take it, but that drug B has a similar beneficial pharmaceutical effect. Do you see the point? The possible range of drugs your doctor might prescribe for you in the future at any time is unknown, but large. Would you not be wise to be armed with information about what might be helpful and what might be harmful, just in case? Considering the epidemic of 100,000 deaths a year, or thereabouts, in America alone, from medical maladventure, I think you have worked out what the answer is. The available information is immensely useful; more is likely to come on-stream. You will, however, never need to duplicate evaluation of any individual SNP again, because a person's genetics do not change in one lifetime. If ever there was advantage in assessing risks, in prevention rather than cure, this is it. One might even say that since the detoxification genomics studies are now available a person is playing Russian roulette with his life if he does not check his medication against the his genetic make up.
Use For The Physician
The Genovations studies, particularly the detoxification studies, are of great use to the clinician who is pondering a complex case, particularly of a chronic malady which is not responding to standard measures. This is in treating a chronically ill person who does not have a disease by the criteria we discussed earlier. Of course, most of these poor people are shunted from one specialist to another, and finally told to go see a psychiatrist. The second use is to evaluate possible risks. Suppose your family has a strong history of breast cancer. Clearly your risk is increased, but what degree of risk do you carry, indeed? And, if there is a high risk, are there any measures you can adopt to protect yourself from developing breast cancer? The detoxy-Genovations studies will help in this analysis.
Predictive Use in Career Choice
Suppose you are an individual who is unable to detoxify organic phosphorylated compounds such as Malathion. Would you choose a job in American agribusiness? The answer is clearly no. Would it not behoove a young man planning such a career to evaluate his own detoxification genomics? Of course it would. How about the risk of premature Alzheimer's disease for a prospective professor? You get the picture. I conclude, therefore, that for the purpose of personal planning and prognostication the genomic analyses have an immense potential.
Are There Any Risks Involved?
Is it an irony of fate that the arrival of this wonderful method in preventative medicine has coincided with the loss of medical privacy in America? Does not the arrival of these two phenomena within the same year represent an apocryphal warning of the titanic battle between good and evil that is developing through this modern world of ours? I have dealt with the issues of privacy, i.e., the issue of the importance of the responsibility of physician to his patient/customer and not to the State.Since October 15, 2002, the United States government has arrogated to itself the right to read every private jot and tittle in your medical record through the artifice of insuring privacy. (Yes, that is what they actually claim. Is it not striking how the politically correct words say exactly the opposite of what they mean?) The second excuse given for reading your private affairs is to facilitate a uniform method of transmitting electronic information to the insurance companies in order to facilitate that famous reimbursement we discussed earlier. Through gradualism, both the Clinton and Bush administrations have decreased any semblance of privacy to your record. Any bureaucrat can have access to them, although the draconian measures imposed on the poor doctor’s office, supposedly to preserve your privacy, will be not only a bureaucratic nightmare, but also another tool to criminalize any doctor who is targeted by the bureaucracy because the regulations cannot be followed. They are complex, arcane and vague. The fascism in these regulations is clear. [Readers may wish to refer to these web pages: http://www.aapsonline.org and http://www.cchconline.org.
You might ask, however, what do I care if they know what is in the record? You might have complained of prostate disease and received a remedy. Perhaps you have had appendicitis and an operation for it. Who cares? No one cares. So why, might you ask, are they wanting all this information? Here I have to share with you sotto voce that I have a very great worry. I am sure many of you will regard it as an irrational fear, i.e., paranoia. I do hope you are right. The last time western civilization was subject to a period of fascism, an important accompaniment of the Hitlerite regime was an attempt to create a super race. We are told that blond German women were encouraged to bear children, legitimate or bastards, to the SS officers to boost the favorable gene pool in the German nation. Not a very tasteful idea in modern America, is it? But suppose, just horror of horrors suppose, that this eugenic plan were to come back. After all, we are introducing in America this very decade a host of further fascist policies. Do you think there is a very tiny risk that people with favorable alleles will be preserved? We have been told (Henry Kissinger's announcement in 1971) that it is a prime strategy of United States policy to reduce the world population to half a billion (remember there are about six billion of us humans on the planet at the moment). Take note of the propaganda about limited resources and the excessive number of mouths to feed (I feed myself. Are you fed by the government?) I do not want to join the dots…. I do not want to think about it. But, for myself, I propose to keep my genetic information private.
What Of The Future?
The continual survey of the SNPs which are discovered through genetic research, matching them against the possibility of modifying them by lifestyle and similar measures, will continue, thanks to the vigilance of the researchers at the Great Smokey's Laboratory (and hopefully others soon enough). I, for one, have a shopping list of priorities in this area. We in natural medicine have been struggling with the problem of heavy metal toxicity. The existence of this entity is quite certain. The presence of high loads, in fact increasing loads of heavy metals, and particularly mercury, are recognized as a public health hazard. Strikingly, some individuals carry high loads and are not affected, as far as we can reasonably judge, in their health. Contrariwise, relatively small loads seem to be highly toxic to others. Those living in a similar environment would, one would presume, have similar total body loads. The body load will depend, of course, on the rate of accretion of the metal from the environment on the one hand, and the rate of excretion, i.e., through detoxification, on the other. We are beginning to understand something about the detoxification pathways for heavy metals. In this context, the last issue of the sorely missed publication Smart Life News, from June 2001, then published by William Fowkes and Ward Dean, MD, conducted an interesting secondary study relating major depression and the onset of Alzheimer's disease to mercury levels. The most important detoxification marker, the cytochrome P4504A3 is involved, and distinct polymorphisms are responsible for the relationship between this polymorphism and Alzheimer's disease has been recognized for about half a decade. The ApoE4 isoform is associated with a greater risk of Alzheimer's disease (as well as cardiovascular disease) (about 2% of the population are homozygous for this allele). This apolipoprotein, as all proteins, contains a sequence of amino acids. In positions 112 and 158, variations occur. These variations correspond to the isoforms discussed here. The unfavorable (ApoE4) has arginine in these positions, while the favorable isoform has cystine. Cystine, of course, binds through the sulfa bond to the mercury atom. It is not unlikely that the reason for the risk of Alzheimer's disease being higher is due to the failure of sulfate bonding in this position, at least in part. You will have drawn your own conclusion that if you are an individual with this unfavorable CYP3A4, you will be particularly careful to avoid mercury containing fillings and other forms of mercury contamination (this is an example of some of the precautions you will take; there are others). So my wish list is to see a study based on the algorithm that this genetic makeup of people should have detoxification for heavy metals before they become ill. It goes without saying that a further analysis of genetic risk factors for mercury and other heavy metal toxicity would be valuable, indeed.
In Summary
In conclusion, we are living in interesting times. The locomotive force of socialist and central governmental control of medicine, with the silly phrase evidence based medicine has its throttle open with its homogenizing agenda for the universe. On the other hand, the microeconomics of individualism is changing the paradigm. With any luck it will help us with the epidemic of medical misadventures. More importantly, it gives each of us a chance of recognizing our biochemical individuality and taking appropriate action, assuming that the logic of this analysis is true, and assuming that the science behind it is solid. It is very likely that we will see a successful outcome to this approach. If these three assumptions are correct, no one with a rational mind will omit genomic testing for himself, particularly for detoxification.
