The complexity of medicine these days leads me to wonder: Has medicine gone hopelessly awry? There are so many different types of medication, surgical options and now new hi-tech bio-engineered designer drugs! This situation has led a good colleague and friend of mine, Dr. Allen Gaby, to speculate on the same topic in a recent column titled, "Is Medicine Too Complicated?"
As a case in point, a recent study published in the Journal of the American Medical Association shows that one in four elderly patients receive the wrong drugs. The author of the study, Dr. Steffi Woolhandler of Harvard Medical School says, "A lot of the problem is that doctors frequently ascribe side effects of drugs to old age. If a patient loses memory or loses balance, they says it’s old age."
Indeed, the potential for mayhem is great, given all the permutations of modern medical interventions, their firepower, and their unforeseen interactions. Many readers may recall the character of Dr. Malcolm, a mathematician in the movie "Jurassic Park." Entranced by chaos theory, Malcolm explains that when three or more variables are present in a natural system, outcomes can no longer be predicted with certainty.
"Jurassic Park’s" terrifying events are the ultimate embodiment of the unpredictability of natural systems. They result directly from the sheer hubris of people who try to impose simple human order on complicated natural systems. In some way, our current medical paradigm is like Jurassic Park. We attempt to derive laws about how the body works. Then we harness our molecular model to a technology that seeks to alter the very chemical reactions which comprise the body. These reactions are so complex, however, that drugs may operate on a multiplicity of systems, creating unpredictable side effects. While it may seem at first that chaos is reigned in, surprising new manifestations of disease may arise.
For example, a new medical diagnosis is "polypharmacy." The diagnosis sometimes appears on medical charts of patients suffering reactions to the numerous drugs they have been placed on. Polypharmacy has become an increasing problem. It ranks with many common diseases as a cause of hospital admissions and it is a contributing factor to spiraling medical costs. I commonly treat polypharmacy in patients who come to me for a second opinion after conventional treatments have failed or have created problems of their own.
I recently saw a 74-year-old woman who was reluctant to visit my office. I received a plaintive phone call from her son saying that his mother had suddenly taken a turn for the worse; that she was depressed, had stopped eating, and had lost the will to live. I reminded the son that sometimes people reach the limits of their natural life span in this fashion, and I suggested to him that prognosis was poor if his mother was uninterested in placing the phone call herself and perhaps was not motivated to get better. But the son was insistent that his mother had only recently taken this dramatic turn for the worse, and that six months ago she had been healthy, robust, and jovial. Obviously something had happened, so I agreed to see her.
When I saw this lady I was struck by her tired-looking face and emotional flatness. She indeed seemed ready to die. But nothing seemed medically wrong with her. Prior blood tests, which her son showed me, seemed to be normal. A physical exam could reveal no evidence of underlying serious disease. When I inquired about her medical history, the son told me that she had recently been diagnosed as having high blood pressure. The high blood pressure had not responded to the initial drug she was given, so she was given a second.
It struck me that this was the same time when she began to report loss of appetite, depression and fatigue. But her personal doctor had not noted this, suggesting instead that she see a psychiatrist. Indeed, depression is common among the elderly. She was then placed on an antidepressant medication along with a remedy for anxiety that would help her sleep. When she came to see me, she was taking all four of these medications. One interesting feature of the lady’s complaints was that she experienced dry-mouth and change of taste, so that food tasted "ashen" to her. Quickly checking the physician’s desk reference for each of the four medications she was taking, I noted that each and every one of them was known to have the potential to cause taste disturbance and loss of appetite. One might well imagine the combined effects of all four medications!
I ran additional tests to assess the lady’s nutritional status and then shared my hunch with mother and son. I told them that, in my opinion, she was suffering from polypharmacy. I suggested that Mom try a diet to moderate her blood pressure while I gradually tapered her medications. I told her to do so carefully; I did not ask her to go off all medications at once. I then sent her home with supplements and asked her to come in twice a week for intravenous infusions of vitamins and minerals.
Three weeks later we reconvened. The woman looked absolutely transformed. Her expressionless face was animated and there was rosy color in her cheeks. She was gregarious and smiling, in dramatic contrast to the first visit. At that time, she had barely uttered a word and had let her son speak on her behalf. I asked her how she had done in tapering the two of the four medications that I had wanted her to target first. But to my surprise and somewhat to my dismay, she told me she had gone off all medications after the second week. She said that she had felt so good after getting off one or two of her drugs that she was tempted to try to get off all of them.
I had checked her blood pressure prior to this return visit, and I was satisfied that it was now normal. And I could see what the son had meant when he said that his mother had been a vibrant person until just a few months ago. I could also see why he was so determined to get her out of her rut rather than let her sink slowly into what ultimately would most certainly have culminated in her death.
Of course, this case illustrates that nutritional intervention should be tried first in the treatment of medical problems like high blood pressure. Doctors should be aware that patients’ complaints may be attributable to the very medications they use to treat their conditions. It’s easy to add drugs as new symptoms arise, but few physicians have the inclination, or frankly the guts, to taper patients off medications and see what really is the underlying cause of their problems.
So let’s survey the "Jurassic Park" of medicine and see where some common medical blunders are being made.
High Blood Pressure
High blood pressure is a condition which is multifaceted, having to do with overweight in some cases, excess sodium in others, deficient minerals, imbalances, essential fatty acids, sedentary life style, and stress, in various combinations. Sometimes, too, lead and cadmium toxicity have been implicated in high blood pressure. The current approach to high blood pressure is to control it aggressively with drugs. Some studies, however, suggest that there is a "J-shaped curve" in relation to blood pressure control.
In other words, by controlling blood pressure moderately we achieve benefit, but if we control it too aggressively and lower it too far we can actually decrease blood flow to essential organs like the heart and brain, thereby increasing the risk of stroke or heart attack. This is not to mention the deleterious effects of the drugs themselves. Some studies show that fully 40 percent of patients on high blood pressure medication have normal blood pressure when they’re given a "drug holiday" and taken off their medications, even if no life-style interventions are undertaken with diet modification exercise, stress reduction, or nutritional supplementation. That 40 percent increases to 80 or 90 percent when natural interventions are provided in lieu of drugs.
Heart Disease
Modern medicine now prides itself on the fact that it has entered the era of prevention with its new armamentarium of cholesterol-lowering drugs designed to prevent heart disease. But are these drugs the best way to go about lowering heart-disease risk? The use of cholesterol-lowering drugs stems from the belief of many physicians that dietary modification can only reverse high cholesterol in a minority of patients.
Many physicians don’t even bother to change their patients’ diets. Even when they do, they introduce the popular low-fat diet endorsed by the American Heart Association. While helpful for some, the diet leaves others in the lurch with dangerously high cholesterol. Doctors then suggest cholesterol-lowering drugs. These drugs are now a source of billions of dollars of revenue for the pharmaceutical industry. While some studies suggest that they do lower the rate of heart disease, no study has ever demonstrated that they extend longevity. At a cost of up to $100,000 per person per lifetime, their benefits are equivocal at best. They also may produce insidious side-effects.
When it is too late to prevent heart disease with cholesterol-lowering drugs, angioplasty and coronary artery bypass grafting are encouraged. These procedures buy time for some severely debilitated patients but many studies show that most patients who refuse bypass do as well or better than those who undertake the procedures, even when only heart medication alone is used. Nutritional supplementation, diet modification, exercise and stress reduction along with chelation therapy with EDTA can help to dramatically reverse atherosclerosis.
It is even suggested by some that bypassing diseased segments of coronary circulation may remove the impetus for building new blood vessels. This process of remodeling of diseased blood vessels is called "collateralization." Collateralization explains why some patients with even very severe blockage can be enjoying high levels of health and relative freedom from cardiovascular risk within a few years after undertaking a concerted program of natural intervention.
Arthritis
Arthritis is almost a universal problem in this country. Even those of us who are fortunate enough to avoid the ravages of rheumatoid arthritis (which usually develops in earlier middle age and affects more women than men) are prone to osteoarthritis, which occurs in virtually everyone at an older age. Osteoarthritis is responsible for the vast epidemic of hip replacements and knee surgeries and for a great deal of debility among the older population. The mainstay of treatment for osteoarthritis are the NSAIDS (Non-Steroidal Anti-inflammatory Drugs). NSAIDS are effective pain relievers in some cases but they cause a host of side-effects. Most importantly, they cause a high incidence of gastrointestinal bleeding. NSAIDS are now being offered over-the-counter in the form of ibuprofen under various brand names (Advil, Motrin) and Naprosyn (recently introduced Aleve.)
These drugs tend to exacerbate high blood pressure. This was recently demonstrated in an Australian study reported in the Annals of Internal Medicine which showed that regular NSAID use caused an average of 5 point elevation in blood pressure. Other studies have shown a tendency of NSAIDS to prompt attacks of colitis in patients prone to this inflammatory bowel condition.
Far preferable are dietary interventions designed to detoxify the body and the use of antioxidants and essential fatty acids. Traditional Chinese medicine also offers an herbal armamentarium to complement the use of acupuncture in dealing with these same problems.
Asthma
Asthma is often successfully "managed" with medications which ultimately cause it to progress inexorably. Asthma is usually due to a combination of allergies and inflammatory susceptibilities in the body, which can be alleviated with diet modifications, environmental controls, immunotherapy, and nutritional supplementation as well as special breathing techniques, relaxation and acupuncture.
Certain of the medications used to treat asthma put patients on a metabolic roller coaster and exacerbate the stress that underlies this disorder. Use of prednisone and immune suppressant drugs like methotrexate is a particularly unfortunate trend in asthma management. It is not uncommon for asthmatics to take as many four or five different medications simultaneously (think of chaos theory!).
Colitis, Crohn’s Disease
These two inflammatory bowel diseases, while not identical, form a clinical spectrum. Sometimes it is difficult to precisely differentiate one from the other. The medical world persists in ignoring the fact that the food that passes through your gastrointestinal tract can have an impact on the lining of this organ. This may seem like a commonsense notion but it is entirely ignored in the practice of gastroenterology.
Many research studies support the notion that elimination diets and food allergy detection can alleviate inflammatory bowel disease, but instead a drug approach is favored, sometimes invoking surgery. As in asthma, powerful immunosuppressive drugs like prednisone therapy agents are utilized. The benefits of supplementary nutrients, acupuncture, and herbal remedies remain unrecognized. New techniques of immunotherapy developed in Great Britain promise alleviation of inflammatory bowel disease where simple diet modification does not suffice.
Diabetes
Here, too, medicine is making serious blunders. First of all, physicians and dietitians can’t get straight the proper diet to treat diabetes. They adhere slavishly to the diabetic "exchange diet" developed decades ago, which emphasizes bounteous carbohydrate portions that create wide swings in blood sugar. A recent study in Journal of the American Medical Association compared the standard American Diabetic Association diet to a Mediterranean Diet lower in carbohydrates and higher in beneficial monounsaturated fat. It concluded that the Mediterranean diet, higher in monounsaturated fats and lower in carbohydrates, provided greater advantages.
In addition, the oral hypoglycemic agents used before insulin is employed, certainly help to normalize blood sugar but nowhere have been demonstrated to extend longevity. So just as with cholesterol and blood pressure, we are affecting a single parameter, in this case sugar levels, without really having significant impact on quality or duration of life.
Osteoporosis
America’s number one drug is now Premarin, a synthetic form of estrogen used for hormone replacement therapy in menopausal women. Its use is so vociferously promoted by the gynecological establishment that some have suggested that the omission of prescribing estrogen at the time of menopause will ultimately be considered a form of malpractice. While some women clearly benefit from estrogen, they are by far the minority. Estrogen demonstrably increases the risk for breast cancer, now epidemic in this country, and sometimes adversely affects the quality of life for women who suffer from ongoing monthly bleeding, repeated biopsies, breast tenderness, and the need for frequent mammograms and breast aspirations.
Estrogen use is best confined to those women who have early menopause either naturally or due to early hysterectomy (which, by the way, is far too prevalent). It may also be employed in those few cases where natural interventions to treat the symptoms of menopause fail to alleviate hot flashes, depression, and natural dryness and other consequences of change of life. The notion that we can bioengineer women’s lives with hormone replacement therapy is truly "Jurassic Park" medicine.
Natural interventions like traditional Chinese medicines, diet modification, topical progesterone cream applications, and nutritional supplementation can make menopause manageable, and when combined with an ongoing program of exercise, can help alleviate osteoporosis. With appropriate input from her physician, every woman should have the option to decide whether or not hormone replacement therapy with estrogen is worth undertaking. It should not be "pro forma" or "de rigueur."
Allergies
Allergies are poorly handled in medicine. For the most part, allergists have abdicated their role as detectives in favor of the pharmacological quick fix. Many patients are surprised to find that when they visit an allergist for symptoms of itchy eyes, runny nose, or hives, they are prescribed medications instead of being evaluated for the cause of their allergies.
New and better antihistamines are now available that do not cause drowsiness, but for some patients the new antihistamines are ineffective. Worse still, unsettling reports are trickling in suggesting that some of the common non-sedating antihistamines may encourage the growth of preexisting cancers in experimental rodents. This should give pause to patients who continually rely on these medications to suppress symptoms.
While allergies can be suppressed with drugs, the result of this suppression is often to drive illness to a deeper level where it may later emerge as immune disregulation of a more profound sort. Far better is to trace the origin of allergies to foods or environmental sources and to institute diet modification or environmental controls or use immunotherapy to reduce sensitivity to the offending substances. Newer allergy therapies can modify an individual’s sensitivities and tweak the immune system toward better tolerance of the environment. Use of nutritional supplements and herbs may be a far safer alternative to currently-used drugs for treating allergies. In my experience, they are extremely successful.
Many other medical blunders are perpetrated because the orientation of modern medicine is to suppress symptoms with multiple drugs. Perhaps medicine of the future will recognize the need to reestablish homeostasis in the body rather than to introduce numerous new variables into the chaos equation that is our bodies. Meanwhile, don’t let your body become Jurassic Park. Minimize the unnecessary interventions that can unleash the rampaging forces of chaos.
Dr. Ronald Hoffman is Medical Director of the Hoffman Center in New York City and host of Health Talk, a syndicated radio program heard weeknights in New York on WOR (710 AM) from 9:00 to 10:00 pm, Saturdays noon to 2:00 pm. He is author of several books, including Intelligent Medicine (Fireside, 1997). Dr. Hoffman’s website contains useful health information.