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Functional Medicine III

Let’s look at one example.

A unknown number of Functional Medicine adherents broadcast call-in programs on radio stations. One FM physician, a Dr. “D” in Northern California graduated from UC Davis School of Medicine (Central California’s Sacramento Valley.) I find her program fascinating, requiring some attentive listening.

Dr. D’s recommendations for people’s complaints and conditions are often complex, a chimera of standard explanations and therapies, but painted with a variety of views that are anything but standard. The problem I found was that some of each answer was rational – especially the logic of her differential diagnosis – but suddenly spun out into space with unfamiliar methods or some recognizable as one component or another of sectarianism. Some answers had no relationship to the problem at hand, but seemed to be plucked out of a firmament of independent ideas, theories, ideologies, and personal anecdotes – a medical Separate Reality.

One can be carried along by an answer that sounds on surface reasonable because of the confidence and the delivery’s vocal tone. Her voice is medium-low, sort of a mezzo or contralto. It’s a voice ideal for advice; confidence oozes. Some of her separate reality recommendations she precedes with a biochemical or physiological explanation, so the shifting from standard to “separate reality” grids goes so smoothly, the usual recognizable red flags may not spring up.

Lacking those usual audio-cues, I found myself sometimes several sentences into an advice scheme before asking if this is material substantiated or speculative. This doc is well-educated in biology and human physiology. She introduces analogies imaginatively. Yet some principles and relationships were unfamiliar. In order to conclude as to their veracity or applicability I would have to spend time referring to texts and journals.

Here is a condensed record of the program from earlier this year.

Q: My (friend, relative) a 70 year old man has anemia, doesn’t improve on iron, what to do? Is there a Chinese remedy? A: (First gives a short differential diagnosis of anemia and iron absorption.) TCM teaches that the kidney is in charge of the blood – how they came to that conclusion “I don’t know.” Perhaps it’s defective absorption. Take the iron with vinegar or juice. Consult a nutritionist or a naturopathic doctor. Medical school training is defective in nutrition.
Um: The short differential was OK, stressing possibility of blood loss. Defective iron absorption however is not likely. Why not recommend a good internist?
Q: Patient with primary thrombocythemia on agrylin, with not much response, but on black cohosh the platelets decreased, and on ceasing it they increased again…what to do? A: Cohosh could be interact with agrylin through cytochrome P450
Um…perhaps, but most P450 interactions act by activating P450, thus more rapid degrading of the drug. But she could be right. Drug interaction was the key. Good.
Q: What to do for foot fungus? (presumed toenail)
A: Tea tree oil or Non-X.
Um: Perhaps. Medline search for tea tree oil and foot fungus turned up two papers. One using a mix with butenafine (a hexosamine) and another with another combination – 1994 and 1999, both showing effect. One paper on a hypersensitivity reaction to TTO. Most refs are on antibacterial properties and other fungi. Not a good record.
Non-X …OK.
Q: What do you know about the CSA test? The claim is to diagnose cervical Ca and to monitor for advancing disease
A: CSA is elevated in”pre-cancer” of the cervix. Dr. “D” rec’d the Onconix (manufacturer) web site.
Umm: I went there – CSA is a cancer antigen marker, insulin-like growth factor II. A page dated 2006 seemed to be invitation to invest in the company and pay $85 for a 1882 word paper. I do not know much about current standards for its use. I imagine, like most, there are false positives and so forth. I dunno. Lots of papers on Medline.
Q: A young man, returning soldier, gets episodes of hostility to people associated with chest pains. Question also about “burn testing”(?)
A: Mood swings could be due to heavy metal toxicity to higher neural centers. Advise getting lead and mercury blood tests.
Q2: Could metal poisoning be cause hallucinations and nightmares?
A2: Yes.
And then as an afterthought, “It could be psychological. Try beta-blockers.”

Ummm: (During the first and second Gulf Wars there were claims of MS and ALS being increased in veterans, claimed due to spent uranium dust and fragments – uranium having been used as artillery shell tips for metal penetration (it’s hard.) Plus other unspecified metals and toxins. The fears were akin to those of Hg poisoning from MMR and other vaccines.)
This series of answers locked in “Dr D” to the annals of hysteria and pseudoscience. Here is a combat vet with episodes of expressive anger and somaticism (chest pains) and the doc recommends heavy metal poisoning? I tried to lobby my congresswoman once about quack methods and the NCCAM, and was told by a staffer that she would only consider problems in which there is harm to the patient. How about this one and the harm to the people around him who might be victims of his aggression?
And then the back-up treatment of choice for servicemen with post-combat disorders and anxiety is beta-blockers?
Q: Another question on foot fungus, leading to chiropractic: Caller used tumeric for foot fungus which he/she claimed worked.
A: Balinese medicine uses Golligo (?) for lots of things
Umm: Lots of anecdotal stuff bubbling here – no comment.
Q2: Had back problems secondary to foot problems with back out of place. Asked personal physician to write a TAR (a Medicaid authorization) for a chiropractor referral, but the doc refused.
A2: Doctors are burdened with excess paperwork, – Dr “D” figures paper work costs her about $75K/year. But doctors are inappropriately dismissive of chiropractors. If someone seems to need repeated chiro treatments, then it’s a muscle problem, and that needs physical therapy (implying not chiropractic.)
Ummm: I’ve never heard of that one before. It’s an interesting rhetorical move to deny unnecessary return visits, refer out of chiropractic without calling DCs quacks and abusers, but it’s probably not true.
Q3: Will there be a provision for physician education in nutrition in the health plan bill?
A3: Brief discussion about P. Obama’s plan (who really knows – even he?) concluding it’s premature to speculate. Then the odd comment” If it’s a contest between nutrition and surgery, nutrition will win. Nutrition for back pain? I suppose it’s better than unwarranted surgery, being equally ineffective. But against established effective disc, stenosis, and other surgeries? What kind of statement was that?
Q: The program devolved into less controversial aspects such as “lamosil” for foot fungus, and newly recommended 5% benzyl alcohol for head lice. “Dr D” quit while ahead on that one.

I think one can see at least part of the problem here. A capable, intelligent physician, with a more than usual base in biological and medical research gets principles of differential diagnosis right, but comes up with a mix of standard, sometimes insightful answers, and a set of answers with no factual or knowledge base other than hearsay and hunches. Moreover, she makes recommendations such as for heavy metal testing and for chiropractic in the face of established evidence to the contrary.

This is what I find hard to understand about the crank and quack mind. A mind that functions well in most areas of living but that is diverted into near fantasies, at least into a different or “separate reality.”

We found with Laetrile as with Carlos Castaneda and other literary fraudsters, that frank fraud involves creation of an entire thought system that might even be internally consistent. Their motivations may be different but their phenotypes are similar – even overlays of one another.
But practitioners who make up the bulk of sectarian practitioners thrive on having one foot in reality and the other in theater of the absurd, and seem unable to raise significant meaning or warning signs from claims of the absurd. They are another problem. The former are sociopaths. The latter I have no term for.

Posted in: Science and Medicine

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6 thoughts on “Functional Medicine III

  1. jmm says:

    Maybe some of my experiences can give you some insight as to what could make someone like this tick. Suspend disbelief if necessary for a moment and assume that amongst the 99% dross of CAM, there is 1% that works extremely well. Contact with that 1% can have a profound effect on a person, unfortunately making them question the other 99% too, without totally losing rationality, and hence turn them into someone like Dr D.

    In my case, although this sort of contact happened, I still believe that the evidence shows that 99% is dross. I am a professional scientist and a skeptic and too well trained that way to believe otherwise. Still, for many aspects of CAM, there have been no good studies to date, so it is entirely possible that there is a really important subset that we have missed.

    To substantiate my own case, I have (or had) general dysautonomia, including chronic fatigue syndrome and inappropriate sinus tachycardia, and I had been dependent on beta-blockers for many years to manage the latter. Then I started learning serious pranayama (yogic breathing exercises) and practicing them daily. Within only weeks I could reduce my drug dose , within 6 months I was on what doctors consider a subtherapeutic dose, and after a couple of years I no longer needed any, and have now been drug-free for some years more. This was hardly the first time I had attempted to go off drugs. In fact, I am now almost symptom free, despite reverting to an incredibly high stress tenure track lifestyle: this is an incredibly rare outcome for chronic fatigue syndrome. Symptoms sometimes reoccur, however, if I skip pranayama for too long.

    There is no clinical trial, but the data even for me as one patient is impressive, since I could monitor my heart rate under controlled conditions with a heart rate monitor. During pranayama itself the effects on heart rate are very dramatic, and there was a systematic trend in measurements even at other times.

    There is also a plausible mechanistic explanation, in that breath, while being under conscious control, does have profound effects on the autonomic system.

    My experiences clearly fall in the category of CAM, but were immensely effective. They haven’t made me accept CAM wholesale or in part like Dr D, but they have made me upset that so few high-quality studies exist to either prove or definitely disprove certain techniques.

    Which is why I think the NCCAM is a good thing, and a string of negative results is not evidence to the contrary. Drug companies will never do these trials, but it only takes one cheap intervention to work for a common disease, and the public investment would be well rewarded.

  2. wasabi says:

    “Golligo” is probably galangal, which is a rhizome similar to ginger. Su-Mei Yu writes in Cracking the Coconut: Classic Thai Home Cooking: “It tastes like ginger with a gentle afterglow. Galangal is believed to be good for the lungs, menstrual problems, and stomach complaints.” Turmeric is another rhizome, which many know for the yellow color it lends to “hot dog” mustard. Yu states, “Turmeric is believed to cure ulcers, to be good for the digestive system, and to cure skin problems.”

    Yu’s book makes for great cookery, if you can get past the quackery.

    These functional medicine folks sound like the loons who bought the 6-7 am weekend slots on KHOW-AM in Denver during the 90s for the purpose of advertising supplements under the guise of promoting health. Dr D sounds eerily similar to one of the prime perpetrators of poo and puffery on the Denver program (a nutritionist). The “doctors” on the show (one of which was an MD) also served up the mix of answers you describe above.

    I used to have the radio on KHOW for background noise, but found something different after hearing one too many cancer patients bombarded with woeful, worthless woo.

    Lesson of this post seems to be: If one tells lies often enough, one soon believes they are true.

  3. friday says:

    Since I believe tea tree oil should be immune from criticism. I searched and I found a hit for Tea Tree Oil on PubMed. (Treatment of dandruff with 5% tea tree oil shampoo. Satchell AC, Saurajen A, Bell C, Barnetson RS.)

    It is AWESOME for my scalp dermatitis. I had tried every prescription under the sun. It was the only relief I had beforeclobetasol propionate cream was introduced to me.

    It is the only woo, that I “woooo” for! :D

    Now, I am too le tired to look for any more references. My beliefs haz been confirmedz.
    Goodbai.
    Friday

  4. daijiyobu says:

    Dr. S. wrote: “the latter I have no term for.”

    So, if a sociopath is “without concern for the effects of their behavior on others” [one dictionary usage],

    may I venture that ‘the latter’ are

    epistimopaths,

    ‘without concern for knowledge typification / delineation.’

    Such do not distinguish between, say, a scientifically derived explanation [e.g. an a posteriori biological explanation] and an article of faith explanation [e.g. an a priori vitalism-teleology-supernaturalism explanation].

    And, in that sense, epistemopaths harm the very basis of rational thinking.

    I think you may guess at the THICKNESS I’m alluding to…

    the naturopaTHICK.

    Where an article of faith and a scientific fact are equated.

    -r.c.

  5. george_seifert says:

    Thanks for your appraisal of Dr. D. I also thought that some of diagnosis were sound, but other times she sounded like she left all her science based thought behind. I used to listen to Dr. D weekly until her references to acupuncture and homeopathy became too prevalent. She says she has no idea how homeopathy can work – it goes against her science training, but she has seen it work. She says that the studies that have shown it to be no better than a placebo have been designed to make the test fail. It’d be really interesting to hear her debate the topic with one of the Science-Based Medicine crew.

  6. Ed Uthman says:

    There is currently an FM article in the HuffPo Health section written by Mark Hyman, MD of the “UltraWellness Center.” In it, he advocates use of an enormous battery of lab tests, some quite esoteric, to assess risk for diabetes. He also says that insurance and Medicare will pay for most of them. I looked up his Website and sent this comment to HuffPo:

    “I’m not sure how Dr. Hyman can know that insurance will pay for that ridiculous panel of lab tests, seeing as his ‘UltraWellness Center’ doesn’t file for or accept Medicare or insurance reimbursement. In fact, to see him, the initial visit will cost you $1100, plus $150 to see the nutritionist. (This is all from his Website.)

    “That many tests will generate one or more abnormal results on just about any adult, which of course means more doctor visits. Presumably the nutritionist will feed at the trough as well.

    “But wait–that’s not all! Again from the Website:

    “‘The individual tests done at UltraWellness Center range between $130 dollars and $1200 dollars. On average, testing costs approximately $2000 – $5000 dollars; but if this is a concern, discuss it with your doctor.’

    “As a practicing pathologist, I make my living from medical laboratories. If all my client physicians ordered that much lab work on healthy patients, I could have retired years ago. Dr. Hyman, where have you been all my life?!”

    As was the case with a previous comment I had sent in critical of Dr. Hyman’s writing, this one disappeared into moderator oblivion. Only about half my comments to the Health section ever get posted (cf., about 90% of my comments to the Politics section), so ultimately I have decided to say hasta la vista to the Huffington Post and start spending more time here.

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