Integrative Medicine for Congressional Briefing 09-26-2007

Introduction

My name is Dr. Robban Sica and it is my pleasure to be able to share my experience with you. I have been practicing Integrative Medicine for over 22 years, following my residency training in internal medicine and psychiatry. I have had the privilege of studying with many leading integrative and environmental physicians and organizations in this country. I have trained and certified in Longevity Medicine and Clinical Metal Toxicology. I have had the pleasure of serving on the boards of the International College of Integrative Medicine, the American College for the Advancement in Medicine, and the American Board of Clinical Metal Toxicology as well as the Health Freedom Foundation and the American Association for Health Freedom.

 What is Integrative medicine?

Integrative medicine is a synthesis of conventional allopathic medicine with the best of complementary, alternative, and holistic treatments. However, it is much more than that. Integrative medicine is a new paradigm for a sustainable health care system. An integrative physician does not JUST prescribe a vitamin, instead of a drug. Integrative medicine identifies and corrects the underlying and contributing imbalances that cause an illness. Human physiology and chronic disease processes are multi-factorial. They are rarely caused by a single factor and rarely corrected by a single intervention. Understanding the underlying biochemistry, physiology as well as the effects of infections, toxins, and other factors allows the integrative physician to rebalance the system in such a way as to allow the body to heal

Let me explain the threshold phenomenon that I use to identify the various factors affecting my patient and which interventions are needed to restore health. Simply stated, when the total load of stressors is greater than the available reserves, the patient gets sick.

Figure 1: Threshold Phenomenon: Why do we get sick?

Threshold Phenomenon: Why do we get sick?

Which illness develops depends on their genetic patterns, toxic exposures, and deficiencies. Factors that affect the available reserves include genetic variability, deficiencies of vitamins, minerals, and other micro- and macro-nutrients, hormones, and malabsorption. Stressors can be infectious, dietary, environmental toxicity, and psychosocial. All stressors eat up a portion of the energy reserves. By reducing some of the stressors and /or optimizing reserves by correcting deficiencies, the total load is reduced below the threshold and recovery can occur.

 

Dietary supplements are successful utilized in many aspects of achieving this goal, from optimizing reserves with proper nutrition to reducing stressors by utilizing nutritional or herbal supplements that address infections, aid in detoxification, balance the intestinal tract, and many other functions.

Our Current Medical System Simply Isn’t Working

It is no surprise to anyone to state that our current medical system is not producing the outcomes that we expect and deserve, especially given the high costs of our current system. Dr. Abramson, a clinical professor at Harvard Medical School reported these sad statistics in his great book, “Overdosed America”. The United States ranked as the most expensive by far of 30 industrialized nations, yet our outcomes in terms of healthy life expectancy ranked 29th, with only the Czech Republic with a worse ranking.

Figure 2:

Health Outcomes & Medical Expenditures

There are many reasons for this failure, such as those listed in this table and those we will explore in further depth.

Table 1: Failure of the Old Paradigm

  • Focus on palliation or control of symptoms
  • Focus only on severe, diagnosable illness
  • Addressing chief complaint only
  • ”Quick fix”, spend less time (managed care)
  • Reliance on high tech solutions & new drugs
  • Using statistics to misrepresent research results
  • Belief in Biochemical sameness
  • ”Cause and effect“ thinking

We need a sustainable health care system that restores health and therefore reduces cost. The integrative medicine approach does just that. It does not seek to replace drugs or surgery where they are indicated, but reduces the dependence on long term medication for chronic illnesses, by using lower cost alternatives that actually restore health and prevent further illness.

Table 2: Integrative Medicine: A New Paradigm

  • Focus on support of healing & causes of degeneration
  • Understanding the patient’s context
  • Spend more time
  • Use natural, less toxic, less invasive remedies
  • Biochemical individuality
  • Multi-factorial approach to wellness
  • Better outcomes for complex, chronic illnesses

In my years of practice, I have used a broad variety of supplements and other complementary interventions to significantly reduce the number of medications needed by my patients. However, integrative medical practitioners do not simplistically replace a drug with a nutrient, as if that nutrient is treating the symptoms like a drug. Nutrient supplementation restores healthy biochemistry and physiology by providing the necessary precursors for optimal cellular function. By understanding basic science, one can easily identify how to correct the imbalance. Therefore, requiring studies to “prove” that a nutrient works is superfluous. The nutrient is simply serving its intended purpose.

 

While our health care system may excel at treating acute illness and trauma, effective treatment of chronic disease continues to elude us. Innovation to develop an effective approach to chronic illnesses is often stifled from the same kind of lack of understanding and superstition that held back Galileo. We suffer from epidemics of autism, diabetes, arthritis, Alzheimer’s disease, chronic fatigue syndrome, fibromyalgia, and a host of other diseases or conditions that conventional medicine has difficulty explaining. Unfortunately, if a patient’s condition does not fit into the known box or is not amenable to a simple drug therapy, they are told to live with their condition or are referred for psychiatric evaluation. By using a broader integrative paradigm, however, the physician can tease out many factors leading to the illness and, therefore, improve the patient’s health.

Our Methods Of Research Simply Don’t Work For Dietary Supplements.

A large part of the problem we face is that our medical system is based on a number of premises that simply do not work

First, reliance on the double blind placebo controlled study as the only proven “evidence” severely limits our treatment of patients. Only a drug therapy is amenable to that format. Nutrients, because they function by restoring healthy biochemistry and physiology, cannot be accurately studied by this method. Therefore, conventional medical sources say they are “unproven”.

Frequently, a given enzyme may require more than one co-factor to function. If a researcher is only studying a single nutrient, for instance, without providing the various co-factors, the resulting study will create an inaccurate picture of the effectiveness of the nutrient.

Furthermore, the double blind placebo controlled study assumes that all study participants are physiologically the same. The more we study genetics and genomics, which is the clinical application of modifying gene expression, the more we know that this is just not so. Each individual is genetically unique and therefore biochemically and physiologically unique. Treatment therefore must be individualized, not “one size fits all”.

 

Secondly, medications are aimed at attacking or palliating symptoms of a disease, not restoring function. Just the names given to categories of medications makes this clear, including ANTI-biotics, ANTI-inflammatories, ANTI-hypertensives, etc. etc. The mechanism of action of most drugs is to poison, suppress, or block an enzyme or a receptor site. This directly interferes with normal cellular function, leading to a broad range of unintended adverse effects as the drug alters normal physiology in other than the targeted tissues.

Let’s take the example of proton pump inhibitors (or PPI’s) such as Nexium, Prilosec, Aciphex, and others. These drugs are prescribed to inhibit stomach acid that aggravates ulcers, gastritis, and esophageal reflux. Symptomatically, they work well. But they ignore the basic laws of physiology. Why does the stomach make acid in the first place? To digest proteins and assist absorption of nutrients, especially minerals. Recent studies have demonstrated that long term use of these drugs lead to osteoporosis, most likely due to the fact that you cannot absorb calcium in the absence of stomach acid. By understanding the drug’s mechanism of action, this long term dangerous side effect could easily have been predicted and prevented. These medications were never studied for long term safety nor intended for long term use

An integrative approach to this problem may include SHORT TERM use of PPI’s while studying and restoring normal function to the stomach and intestines. For instance, by treating the underlying causes such as correcting digestive enzyme deficiency, use of probiotics, anti-fungal medications, or herbs where indicated, treating H. pylori infections, and treating food allergies, at least 95% my patients no longer need PPI’s or other antacid therapy

PPI’s are not the only medications that cause nutrient depletion over time, resulting in yet another disease or symptom. One of our other speakers, James Lavalle, RPh, ND, has written an entire book on this subject of Nutrient Depletion by Drugs. He demonstrates how use of one drug with almost inevitably result in further symptomatology that, in the conventional medical model, leads to the use of another drug, which causes further nutrient depletion, and so on. No wonder so many Americans, especially older Americans, are the victim of poly-pharmacy

Third, overdependence on an infectious disease model limits the ability of physicians to recognize, diagnose, and treat disorders of deficiency or toxicity. For instance, when the CDC responds to an epidemic in the world, they always send out two teams. One of principles from CDC is that there is no such thing as a genetic epidemic. All epidemics are either caused by infectious agents or toxins. So the CDC sends out the infectious disease team AND the environmental medicine team. One looks for infectious agents and the other looks for toxins. Unfortunately, this method utilized by the CDC to solve problems is NOT the same process utilized by physicians trained in the infectious disease model with little or no training in environmental medicine. The two methods look at the same information from different perspectives

The infectious disease model says, “This is the diagnosis based on what symptoms are manifesting, and if we treat these symptoms, the disease will be resolved.” While this approach may work for an acute infection, treating just the symptoms does little to resolve the underlying problems predisposing to the disease. Treating symptoms is merely masking the problem, not correcting the root cause. There is a basic breakdown in the methodology

Amazingly, the infectious disease health care system thinks that their portion of the medical knowledge box is the entire box. That has caused a tension and even hostility and opposition to practitioners who are actually successfully treating these baffling diseases. Unfortunately, because of medical politics early in the last century, practitioners that today control most medical policy making apparatus simply lack training in this other view of medicine that prevents them from seeing the rest of the world before them.

In the case of patients with chronic or recurrent infections, our current system treats the acute infection but ignores factors affecting the person’s immune system that sets them up for infection after infection. In this instance, using an integrative or environmental medicine approach, I evaluate the “terrain” that the bacteria or virus is infecting. By eliminating toxins and optimizing physiology, we improve immune function and prevent further infections. The cost savings, in terms of lost work time, quality of life, cost of the antibiotics and the drug side effects that are avoided, is considerable

However, we must recognize that incentives as they exist in medicine today have, in part, brought us to where we are. If there is no patent, there is no money for research, and if there is no money for research, the scientific evidence demanded cannot be mustered. It costs $3 million to do even a simple human clinical trial. Since no one has a financial incentive, for instance, to study a non-patentable nutrient or to study detoxification, these therapies do not get funded, nor would they be amenable to a double blind placebo controlled study.

Yet, detoxification is critical to recovery from a number of chronic health conditions. I recently came across a case where a man was disabled due to loss of muscle mass and strength, fatigue, hypertension, hair loss and a host of other problems. None of his many doctors could figure out what was wrong with him. Ten years after retiring from his gas station, his health returned. His exposure to leaded gasoline was the culprit missed by his health professionals, yet his disability and suffering could have been shortened a great deal by proper diagnosis and detoxification.

Ignoring basic physiology also blinds us to the truth. Nutrients, antioxidants, and bioflavinoids play key roles in many actions in the body. Nutrient deficiencies are rampant in the United States, according to the National Academy of Sciences.

Table 3:

image003As early as 1936, US Govt. concerned about depleted soils.

Senate Document #264: “The alarming fact is that foods, fruits, vegetables and grains now being raised on millions of acres of land, no longer contain enough of certain needed minerals and are starving us no matter how much we eat!”

Figure 3:

image002

Some of the reasons for rampant nutritional deficiencies are listed below.

TABLE 4: Why the American Diet is Deficient In Nutrients

  • Nutrient Poor Soils: Plants are fertilized only with Potassium, Nitrogen, Phosphorus
  • Processing of Foods Depletes Essentials Oils, Fiber, and Nutrients
  • Most Americans eat highly processed, fast food and convenience foods.
  • Length of Time from Harvest to Table
  • Alteration During Cooking: Heat Damages Oils, and Vitamins, Minerals are Lost in Water
  • Adulteration with Pesticides, Herbicides
  • Malabsorption Due to Lack of Digestive Enzymes (eg. Drugs that Block Stomach Acid)

 

It is well documented science that magnesium, for example, is an essential co-factor in over 300 enzyme systems in the body! Therefore, when magnesium is low, a lot can go wrong. Magnesium deficiency, which affects 40-60% of Americans (according to the National Academy of Sciences) and this deficiency can result in high blood pressure, arrhythmias, migraine headaches, chronic fatigue, fibromyalgia, seizures, asthma, muscle spasms, dysmenorrhea, and toxemia of pregnancy, to name a few. Magnesium supplementation balances the excessive calcium flux into the cell, correcting the underlying problem (nature’s calcium channel blocker). Using this single treatment, I have patients who are now migraine free, no longer dependant on antihypertensive medications or steroids for asthma.

One particularly poignant story that illustrates many of the points I have discussed is that of a 28 year old woman whom I will never forget. She came to my office literally trembling with fear about seeing yet another doctor. She started having significant chest pain a few months previously so she saw her primary care physician who then referred her to a cardiologist. Her workup included an EKG, Holter monitor, echocardiogram, and ultimately, a left heart catheterization, when the doctor could not explain the chest pain. All tests were normal. By this time, she was having panic attacks due to her fears about this unexplained chest pain. She was then referred to a pulmonologist who did CT scans and extensive pulmonary function testing; all normal. His conclusion was that she suffered from pulmonary hypertension and referred her back to the cardiologist for a right heart catheterization, which was also normal. Perplexed, they referred her to a cardiologist at nearby Yale who specialized in right sided heart problems. He dismissed her after a few moments, saying “Lady, you’re a single and I only treat home runs.” No explanation of her chest pain and no treatment. Only a $550 bill. After months of agony and worry, thousands of dollars of doctors’ fees, testing, and two invasive, potentially lethal catheterizations, she was no closer to a solution for her problem. After hearing her story, I ordered a simple intracellular magnesium test available through any standard lab. The result came back extremely low. Following three intravenous magnesium treatments and maintenance magnesium supplements, her chest pain and panic attacks resolved and have never recurred.

The Consumer Has The Right To Choose And The Practitioner Has The Right To Practice

Our current healthcare crisis is only going to get worse…and more expensive, if we continue on the path we are currently on. We need to examine the paradigm which is leading us down the wrong path. We need a sustainable, less expensive health care system that actually restores health, instead of just palliating illness. We need to change the way we evaluate evidence to take into account ALL science. So called “evidence based medicine” only takes into account the medical literature that evaluates drugs by double-blind, placebo controlled studies. It ignores the much more extensive literature scientific literature that examines basic biochemistry and physiology, including the nutrient actions at the cellular level. The Medical Information and Treatment Access Act will help us to move our system in the right direction by creating more effective avenues to research and distribute information about a broader range of therapeutic options: medical, surgical, as well as integrative treatments.

The Health Freedom Foundation (www.healthfreedom.net), along with our sister organization, the American Association for Health Freedom, supports right of the consumer to choose and the practitioner to practice, ensuring greater access to less expensive In and more sustainable healthcare options for all American citizens.

In attendance at briefing:

 

 

 

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