Book Review 11

Hippocrates' Shadow. Secretes from the house of Medicine by David H. Newman, M.D.

Anyone who is currently, or plans to practice, as a health care provider should read this book.  With that said, I would not recommend this book to everyone (even though my caution may inadvertently assist in perpetuating some of the medical secrets and pseudo axioms the author illuminates) as the author boldly presents some issues of huge magnitude with the potential to shake an ardent believers trust in western medicine.

However, for those in the healthcare field, this book exposes the history behind "schools of thought" in medicine and the steps that lead to many common assumptions about the practice of medicine.  The author, who practiced as an emergency medicine doctor, runs a clinical research program and teaches at Columbia University, boldly asks if certain segments of medical education is spent teaching material that is incorrect.

The book has a great layout as most chapters begins with an ER room scenario that leads to a discussion.  A thought provoking read that is a must for health care providers.

Lasting Impressions

Over the last few months I have had several patients preemptively express a similar sentiment about the use of supplements.  In these particular cases, after the patients’ have told me their concerns and reasons for coming to the clinic, they finish with a caveat that goes something like, “Now I don’t want to be sent home with 10 different supplements to take.”

I can certainly understand the intrigue many practitioners have with supplementation and the excitement that goes along with knowing which vitamin, mineral or co-factor is required for a person’s biochemistry to function optimally - nutrition in the form of supplementation is a very powerful thing.  However, this alone is not a legitimate reason to send a patient home with 10 different supplements.  As a patient, if taking that many supplements was your desire, it is not necessarily wrong (and I have several patients who have self prescribed more than 10 supplements) but it is not indicated or reasonable for most people.

I wonder if this impression also comes from an early model of naturopathic medicine where naturopaths were associated with a health food store and correspondingly sold supplements. Being confronted with this made me realize that there is a lot of power in a mental association.  For example, when you think of agriculture, do you still think of the little red barn?  This positive association connects what we eat to a small, caring farm where healthy animals run on open fields and come into a warm little red barn at night.  Although this is unfortunately seldom true anymore, the association benefits particular brands that continue to advertise something of the sort. 

When you think of a naturopathic doctor, what do you think of?  It is interesting how the naturopathic profession still feels the obligation to prove its legitimacy to the conventional medical community as well as the general public despite helping hundreds of thousands of people every year.  Although most ND's do not over-prescribe supplements, sometimes naturopathic medicine is growing so fast that not all ND's have embraced the role of a primary care doctor and these particular practitioners choose to practice in a more exclusive and specialized way.  This diversity can be a strength and is not necessarily a bad thing.

To help you chose an ND, most naturopathic clinics have a website that explains the practitioner's philosophy and services (I wish MD's had a website to explain their philosophy) so you can see if you are a good fit.  Remember that NDs are trained as primary care doctors who follow a therapeutic order and utilize diet, nutrition, herbs, physical medicine, lifestyle counseling and acupuncture individualized to each patient's needs.

NYGH Health & Wellness Fair

Yesterday I volunteered for our school at the North York General Hospital (NYGH) annual Health and Wellness Fair.  With the two establishments being in such a close proximity (directly across the street from each other), it was very interesting to see the range of responses to our booth.  Those who came through the fair were mostly employees of the hospital, although an occasional patient stopped by to ask questions.

I was somewhat taken aback by some of the stern looks, harsh comments and being brushed off by a small group of first year Residents.  I could not help but wonder if they thought we were a bunch of x-hippies cleaned up to look like business people instead of effective primary care doctors!  Over the course of the day, I realized that the naturopathic profession needs to remember how strange and foreign our world of quinoa, medicinal plants, and acupuncture, etc., etc., is to the average person whose medical doctor fixes all their health problems.

It is important to remember that the sample populations we are accustomed to seeing are not necessarily representative of the general consensus of the community.  The people that come to the RSNC clinic, or from my experience preceptoring in private practices, have already overcome many obstacles and boundaries to being a patient of naturopathic medicine.  If you are reading this blog, you also have already overcome many more barriers - even in terms of awareness - to understanding naturopathic medicine than the general population.  As such, there is a great need for the naturopathic profession to be culturally relevant when explaining our perspective of health to the general population and an attempt must be made to try to put ourselves in their position (and try to see things from their perspective).

There were some encouraging moments too at the fair and it was great to initiate awareness of how naturopathic medicine can help many health concerns. I should also consider the fact that we were invited to attend the NYGH Health and Wellness Fair another indication that integrative medicine is not so far into the future.

Village on a Diet

I wonder if twenty years ago we would have predicted that in 2011 people would be so fascinated with a television show about one of life's most basic physiological processes - losing weight?!  Village on a Diet has fascinated me by its simplicity.  Yet, despite a basic premise, the solutions for the town of Taylor, British Columbia are a matter of life and death for many of its citizens.

Change is difficult, especially lifestyle changes, and we can see this resistance in many of the people on the show.  What makes matters worse is a bombardment of advertising giving people the impression that they need to "ask their doctor" for something they can take that will make their life better, instead of what they need to change. 

Although the experts sent into Taylor seem to make up an effective team (despite the "suck-it-up" military style work-outs which may be required to get their weight loss goal in one month), it is very unfortunate that a naturopathic doctor was not part of the group to ensure long term diet and lifestyle changes.  This is important because living a longer, healthier life is not quite as simple as "eat less and move more" - although this formula certainly does contribute to weight loss in the short term (and many people have a serious food excess combined with a movement deficiency).  What is most important though is addressing the multifaceted root causes of obesity (beyond calories in and calories out).

The show does have many positives, and I have to say, I do love the community approach; that's a first for a weight loss show.  Finally, I realize that having a psychologist on the team was a great addition and I hope that her added help is enough to compensate for the physical shock some of the participants undoubtedly endured.  I hope this show is an indication that the general population is becoming aware that quick fixes and fad diets are not a long term solution.

Quote of the Month

"To teach is to learn twice." 

Joseph Joubert