Book Review 10

Confessions of an Rx Drug Pusher by Gwen Olsen.

As more provinces in Canada, and states in the U.S.A., grant naturopathic doctors prescription rights, and after seeing several patients after only 2 months in clinic with side effects from prescription medications, I decided to read another book on the topic of pharmaceutical drugs.

This book is an autobiographical account of how drugs, both pharmaceutical & recreational, have permeated society with nearly a complete disregard to their consequences. As a former pharmaceutical sales rep for 15 years, Gwen Olsen discloses enough inside knowledge about the pharmaceutical industry to put the broad spread dependence on prescription drugs, especially those for depression and other mental illness, into serious question. The book is very well referenced with an abundance of evidence including heart wrenching patient cases and scientific research.

As an autobiography, the author openly recounts the horrific events in her life, including messy family dysfunction and mental illnesses, that gave her a first hand experience on the receiving end of many of the medications she was trained to believe would help people. Her ultimate conversion to a traditional view of wholistic medicine, and occasional moments of over disclosure, may give some ardent Big Pharma believers an illegitimate excuse to discard the authors' perspective based on character weakness. However, the book still stands on its own as another beacon of light uncovering the damaged path left by years of unabated over prescribing and the lack of public safety with regards to medications.

Another book outlining some of the corruption in the pharmaceutical drug industry is, The Truth About Drug Companies by Marcia Angell, MD. This book, in contrast, is written from a MD's perspective in completely unemotional prose by the former editor in chief of the New England Journal of Medicine.

Schooled by an MD!

I recently watched a debate on the effectiveness, safety and merits of complementary medicine. The panel included a medical doctor and a scientific sceptic on the con side, and two naturopathic doctors for the pro side. It was apparent to me early into the debate that the conventional medical community has a serious lack of understanding of what ND's actually do. ND's know what MD's do, and for the most part are familiar with the conventional medical school of thought, but so much of the time MD's really misunderstand what naturopathic doctors do.

There are some explanations for this. Certainly, there are some naturopathic doctors who muddy the waters and represent the profession in a way not typical of the profession as a whole. But, what makes naturopathic medicine most complicated is that the scope of practice is so large that some ND's may have an entirely talk-therapy based practice and on the other end of the extreme, some ND's may do primarily a sports medicine based practice.

One interesting point made by one of the naturopathic doctors was that, currently (because of the relatively few ND's by comparison), the largest population of doctors that practice natural medicines and therapies are actually medical doctors. This hit home when Dr. Lawrence Palevsky, MD came up from New York and gave a guest lecture on Pediatrics at CCNM earlier this week. It was fascinating to hear his perspective on the antecedents to conventional medical thought and its methodology for the treatment of childhood diseases. It was almost shocking to hear a Medical Doctor use every naturopathic tactic possible to avoid prescriptions of antibiotics, acetaminophen (Tylenol) and even present an informed choice on vaccines. I was reminded of the necessity of childhood fevers and shown, in tremendous detail, the great harm in handing out fever suppressing drugs like candy - and I learned this from a medical doctor! There is hope for much more integration of conventional and naturopathic medicine in the near future.

“Eat food. Not too much. Mostly plants."
Michael Pollan - In Defense of Food

The [CCNM] Hour

As an ND intern, I have the privilege to spend an hour visit with my patients. Initially, I thought this would allow ample time to ask all the pertinent questions, perform a relevant physical exam and ensure the proper care was provided for the patient by the end of the visit. Although this may be true in some straight forward cases, I have found that patients often see us as a last resort and have an extensive story and medical history to share. Furthermore, I think patients find some therapeutic value in just being able to freely tell me their story, in full, without me limiting their responses or cutting them off to one or two concerns per visit.

As such, I have already listened to (while carefully charting) some extremely complicated cases and the hour flies by before unearthing all the potential contributing factors to the person's current state. And, I still need to remember to at least take the person's blood pressure! However, when I review the patients case, I recognize the tremendous value of the information I gathered to point me towards treatment options and areas where I need to research. Furthermore, I have realized that most patients with complicated cases (that have stumped other health professionals) do not expect me to have an exact solution by the end of one hour. Although that would be nice, my assurance that a health improvement - at the very least - in the near future is possible is more important.

Meet the New Naturopathic Interns

Come on down to the Canadian College of Naturopathic Medicine (click for directions) on Monday June 14th at noon to meet the new interns. After 4 years of university and 3 years of naturopathic medical education, we are now entering our 12 month internship and are accepting patients. CCNM has one of the largest naturopathic teaching clinics in North America which has over 26, 000 patients visits per year.

During the event there will be an opportunity for everyone to learn more about naturopathic medicine through several short presentations including:

1) Brief intro to naturopathic medicine
2) Overview of services offered at RSNC
3) Pediatrics overview
4) Sports medicine overview
5) Adjunctive Cancer Care

Also, there are information tables and interns will be available to answer your questions.

The first clinical impression

Keeping in mind that my first impressions of clinic are highly influenced by the kinds of health care issues the patients I have seen thus far have presented with, my first thoughts traveling home after my clinic shifts were much more melancholy than I was expecting. Some people are really in need of a significant amount of help. Another realization I have been continually reminded of is the critical state of our current health care system and the luxury naturopathic doctors have to spend sufficient time with their patients. We have the time to ask the detailed questions and actually listen to the answer (I truly believe that most family doctors do not prefer to spend so little time with their patients but are forced to do so in order to survive under the provincial health care billing system).

So far, my aspirations of the valiant hero who swoops in with the naturopathic coup de grace and instantly changes the person's health future have been shifted, I believe positively, to recognize that pacing myself will be critical. This is a learning process - it is called a "practice" for a reason! Even if I do have all the answers in a particular case, delivering those answers in a way in which patients will comply is an art in of itself. There are so many new realities now in clinic and it is a very steep learning curve. As such, the first couple of weeks have been somewhat overwhelming.

However, we do have a great amount of support at the teaching clinic. Each intern has at least 4 different supervisors, and is therefore exposed to 4 different styles of practice and patient case management. Additionally, we have a variety of health professionals available for consultation on site at the clinic including Laboratory Technicians, ND's, Chiropractors and a Psychologist. So, there is help when we need it.

This was just a first impression and is subject to change!

Quote of the Month

“If you are traveling down a path without obstacles, it probably doesn't lead anywhere."

~Unknown Author

NPLEX Nastalgia

As Dr. Anderson's Naturopathic Physicians Licensing Examinations (NPLEX) prep course wrapped up here at CCNM for the 2nd year students, I clearly remembered last summer and a small part of me wished I could do it all again. Even though some of the same material was tested in my undergraduate, after 2 months of extensively studying the basic medical sciences, last summer was the 1st time I really felt like I knew what I was taking about!

In fact, last summer's studying was the highlight of my naturopathic journey until I entered clinic this May. I was my own boss, I could build up my weaker areas and dig deep into the areas that interested me the most.

Some words for the wise. If you are writing NPLEX 1 this summer (I write NPLEX 2 after graduation in August 2011), remember that no matter which one of the accredited schools you are in, the curriculum only sets a foundation to learn from. The exams are much, much more detailed and require extensive self study. The areas of anatomy, microbiology, immunology, food metabolism and pathophysiology are foundational to naturopathic primary care doctors and are one of the things that separate the accredited schools from the unaccredited schools.

Since the NPLEX format changed in August of 2009, there has been a heavy weighting on pathophysiology. Therefore a good pathophys textbook is a necessity. As a visual learner, another one of my favorite books is, "Metabolism at a Glance" by J.G. Salway (third ed). I also took Dr. Anderson's (systems based and focused more on Nutritional Biochemistry) & Dr. Grossman's (focused more on Anatomy & Microbiology) courses and enjoyed both. However, they are intended to remind you of the breadth of information required to know and indicate areas where you need extra studying. Furthermore, keep in mind that these review courses can not teach at the depth of knowledge required to pass NPLEX 1.

Just 3 study tips:

1. If possible with your school's schedule, take at least 2 weeks off after your final exams before starting to study for NPLEX 1.
2. Slowly build up to 8 hours of studying per day and take Sundays off to rest your brain (try for a minimum of 6 weeks of studying).
3. Take the day before the exam off completely. The NPLEX is a mental marathon, and like any athlete who has peaked for a performance, you need to rest the day before.

All the best!

A New Leaf

Today we completed the first of two days of clinic orientation. While biking to school this morning, the routine was so familiar, and our final exam marathon still so fresh in my mind, that I did not feel ready to be back at school. However, after the morning introductions, I realized that although the setting was the same, everything was different now. We are not only students, we are now health care providers. In fact, we were informed that 44% of the patients that visit the clinic here at CCNM reported that their ND intern was their primary health care provider. What a phenomenal responsibility!

We are turing over a brand new leaf in our journey. I understand that we are forever students and our next step is a 12 month long internship with 1035 clinical hours, case management documents, competency checks, more assignments, and still a few required classes. Even so, our focus has now shifted from excelling in class and passing exams to getting people to feel better. And, they do! We were shown some encouraging data that CCNM is accumulating, which reinforces what we all have known to be true: naturopathic medicine helps many people.

Quote of the Month

“We are indeed much more than what we eat, but what we eat can nevertheless help us to be much more than what we are."

Adelle Davis