Nutri­tional med­i­cine could save hun­dreds of mil­lions of lives, writes IAN BRIGHTHOPE MD, but vested inter­ests actively pur­sue the opposite.

 

(OMNS June 25, 2012) Health prac­tice in Aus­tralia is still focused on treat­ment of dis­ease as opposed to its pre­ven­tion and the opti­miza­tion of health. Although the sci­en­tific lit­er­a­ture has recently shown an increas­ing aware­ness of the impor­tance of lifestyle fac­tors in pre­vent­ing dis­ease, main­stream med­ical pro­fes­sion­als con­tinue to be trained to react to dis­ease and pur­sue drug treat­ment. This ‘drug and dis­ease’ par­a­digm is costly, not only in mon­e­tary terms but also the human toll of pain and suf­fer­ing and its impact on pro­duc­tiv­ity and qual­ity of life, and wide­spread ill­ness and death caused by med­ical treatment.

Iain Chalmers, direc­tor of the UK Cochrane Cen­tre, has said that “Crit­ics of com­ple­men­tary med­i­cine often seem to oper­ate a dou­ble stan­dard, being far more assid­u­ous in their attempts to out­law uneval­u­ated com­ple­men­tary med­ical prac­tices than uneval­u­ated ortho­dox prac­tices … These dou­ble stan­dards might be accept­able if ortho­dox med­i­cine was based solely on prac­tices which had been shown to do more good than harm and if the mech­a­nisms through which their ben­e­fi­cial ele­ments acted were under­stood.” Unfor­tu­nately, nei­ther of these con­di­tions hold true. [1]

The Aus­tralian gov­ern­ment has made invest­ment in the pre­ven­tion of dis­ease a pri­or­ity in its $7.4 bil­lion com­pre­hen­sive reform pack­age to the nation’s health sys­tem. Yet pre­ven­tion has been a sec­ondary con­sid­er­a­tion in most med­ical schools and prac­tices. A huge amount of dis­ease and death could be pre­vented by address­ing the use of tobacco and alco­hol [2]. There remains an enor­mous void in the government’s health pol­icy because it does not encour­age and sup­port the med­ical pro­fes­sion to prac­tice nutri­tional medicine.

Chang­ing Attitudes

“Indi­vid­u­als are ceas­ing to be mind­less con­sumers of drugs and ser­vices, becom­ing more dis­crim­i­nat­ing and aware in their choices. They are also bring­ing their new options back home to their fam­ily physi­cians, and con­tribut­ing to an aware­ness among doc­tors of the exis­tence and poten­tial of nat­ural ther­a­pies.” [3]

Research in the field of nutri­tional med­i­cine is grow­ing at a phe­nom­e­nal rate, and now that the human genome has been sequenced, the sci­ence sup­port­ing nutri­tion in pre­vent­ing dis­ease is more impres­sive than ever. Many gen­eral prac­ti­tion­ers and aca­d­e­mics are open to the use of diet and nutri­tional sup­ple­ments as viable alter­na­tives to drugs. How­ever, there are still too few to make a sig­nif­i­cant impact on pub­lic health. There will always be resis­tance, even hos­til­ity from the nutri­tional “flat-Earthers” — those who believe that “if you eat a bal­anced diet then you can­not be defi­cient in essen­tial nutri­ents” (despite over­whelm­ing evi­dence to the con­trary) [4] — and the aca­d­e­mic med­ical power bro­kers. But I believe the sys­tem will even­tu­ally change in line with the accu­mu­lat­ing evidence.

Recently, lead­ing eco­nomic fore­cast­ers Access Eco­nom­ics announced that expand­ing the use of complementary/nutritional med­i­cines could main­tain excel­lent patient out­comes while sav­ing hun­dreds of mil­lions of dol­lars a year in health­care costs. They stud­ied the cost-effectiveness of com­mon nutri­tional treat­ments for com­mon chronic and seri­ous con­di­tions. They eval­u­ated acupunc­ture for chronic lower back pain, St John’s Wort for mild to mod­er­ate depres­sion, fish oils in the pre­ven­tion of heart dis­ease and for the treat­ment of rheuma­toid arthri­tis. The direc­tor of Access Eco­nom­ics, Lynne Pez­zullo, said that analysing each treat­ment on a case-by-case basis showed patients could save a con­sid­er­able amount of money by using nutri­tional med­i­cines. In the case of St John’s Wort, for the 340,000 Aus­tralians who are being treated for mild to mod­er­ate depres­sion with drugs that don’t work well, she esti­mated a sav­ing of $50 mil­lion per annum. The poten­tial sav­ings from the use of vit­a­mins C, D, and E and fish oils in heart dis­ease is in excess of $2 billion.

The exec­u­tive direc­tor of the National Insti­tute of Com­ple­men­tary Med­i­cine who ini­ti­ated the study, Pro­fes­sor Alan Ben­sous­san, com­mented “I think gov­ern­ments should … look more closely at what impli­ca­tions this might have in the con­text of national health reform.” [5] I agree whole­heart­edly, and have been push­ing for sim­i­lar reforms for many years. I hope this will mark the begin­ning of a new endeavor to change our over­bur­dened health care sys­tem. Politi­cians and reg­u­la­tors are very cau­tious about such change for fear of reac­tions from the med­ical and phar­ma­ceu­ti­cal estab­lish­ment, who may per­ceive com­pe­ti­tion for the health dol­lar as a threat. But there is enough work to do in the goal of opti­mal health to keep every doc­tor, hos­pi­tal, natur­opath, and nutri­tion­ist busy for decades. That is, unless a mir­a­cle occurs and mega­dose vit­a­min C and a few vit­a­mins and min­er­als become widely used. For these sup­ple­ments can pre­vent wide­spread defi­cien­cies that are respon­si­ble for many age-related diseases.

The ‘Well­ness Model’ of health attempts to pre­vent dis­ease and opti­mise health by encour­ag­ing peo­ple with the proper nutri­tion and lifestyle tools. This can achieve the max­i­mum level of health, phys­i­cal and men­tal, for each indi­vid­ual. It cre­ates an opti­mal envi­ron­ment for the expres­sion of that individual’s genetic poten­tial. The keys to achiev­ing opti­mal health include the judi­cious use of nutri­tion and nutri­tional sup­ple­ments, reg­u­lar phys­i­cal exer­cise, the avoid­ance of envi­ron­men­tal pol­lu­tants, and the prac­tice of pos­i­tive out­look through sim­ple tech­niques such as med­i­ta­tion. This con­cept of opti­mis­ing health for every­one is for­eign to most tra­di­tional doc­tors and is glar­ingly absent from med­ical school cur­ric­ula and training.

Lob­by­ing for Disease

In this debate there are insid­i­ous influ­ences. A pow­er­ful lobby group called the Friends of Sci­ence in Med­i­cine (FOSM) is actively dis­cour­ag­ing the fed­eral gov­ern­ment from sup­port­ing uni­ver­si­ties with fund­ing if they con­duct courses in what they per­son­ally regard as unsci­en­tific. Shame­fully, the FOSM don’t have mem­bers trained in NM and the nutri­tional sci­ences. FOSM is pre­dictably against nutri­tional sup­ple­ments, regard­ing them as expen­sive and waste­ful. Could the money spent on nutri­tional sup­ple­ments be bet­ter spent in more hos­pi­tals by treat­ing the sick with drugs? In effect FOSM insists that uni­ver­si­ties should only teach what it defines as “cor­rect” knowl­edge — empha­siz­ing the treat­ment of dis­ease, not the pro­mo­tion of health. FOSM and the med­ical estab­lish­ment would do well to become aware of the vast lit­er­a­ture on nutri­tional med­i­cine and the clin­i­cal expe­ri­ence of sci­en­tif­i­cally trained nutrition-aware doc­tors and nutritionists.

Nutri­tional Sup­ple­ments in Med­ical and Phar­macy Practice

Most drug pre­scrip­tions are unnec­es­sary, an esti­mated 80% in Aus­tralia. [6] The list is long and includes antibi­otics, statins, anti­de­pres­sants, and many more. Yet through the best edu­ca­tion, lifestyle, fit­ness, dietary change and the proper use of nutri­tional sup­ple­ments and herbal med­i­cines, patient health out­comes can be opti­mised and hos­pi­tal admis­sions and adverse drug events sig­nif­i­cantly reduced. In 2009, gov­ern­ment expen­di­ture on the phar­ma­ceu­ti­cal ben­e­fits scheme (PBS) amounted to $6.9 bil­lion [7] and it is esti­mated that in 2009-10 it grew a fur­ther 9.3%. [8] I believe that at least $3 bil­lion could be wiped off the total PBS expen­di­ture and that these sav­ings could be used to pro­mote bet­ter nutri­tion, phys­i­cal fit­ness and safe, effec­tive nat­ural ther­a­pies. For exam­ple, use of more cost-effective niacin or St. John’s Wort as anti­de­pres­sants could free up more money to psy­chi­a­trists for proper coun­sel­ing and to ortho­mol­e­c­u­lar nutri­tion­ists for feed­ing the mind. Over­all this would lead to greater knowl­edge, more sup­port for the most appro­pri­ate research, and an eco­nomic ben­e­fit to the world’s population.

“There is an angry, scorn­ful tone used in lead­ing text­books of med­i­cine regard­ing the dis­cus­sion of micronu­tri­ent sup­ple­men­ta­tion; an arro­gance and igno­rance con­cern­ing the evi­dence for the pos­si­ble ben­e­fit of sup­ple­men­ta­tion.” [9]

Doc­tors and phar­ma­cists play a major role in inform­ing con­sumers about the safety, effi­cacy and cor­rect use of nutri­tional sup­ple­ments. A recent Aus­tralian study eval­u­ated the use of both nutri­tional and pre­scrip­tion med­i­cines by phar­macy cus­tomers. 72% had used nutri­tional sup­ple­ments within the pre­vi­ous 12 months, 61% used pre­scrip­tion med­i­cines daily, and 43% had used both [10]. The most pop­u­lar nutri­tional sup­ple­ments were: mul­ti­vi­t­a­mins, fish oil sup­ple­ments, vit­a­min C, glu­cosamine, vit­a­min B com­plex, pro­bi­otics, Echi­nacea, coen­zyme Q10, Ginkgo biloba and St John’s Wort. The authors of the study explained that cus­tomers or patients want more infor­ma­tion, ask more ques­tions, and no longer blindly accept the author­ity of health care providers. This new class of cus­tomer dif­fers dras­ti­cally from the gullible con­sumer of nutri­tion sup­ple­ments often char­ac­ter­ized by the main­stream media. Accord­ing to this study, nutri­tional sup­ple­ments were selected by the major­ity of peo­ple them­selves, although phar­ma­cists and phar­macy assis­tants were help­ful in this choice. From only a few bot­tles of vit­a­mins in the 1980s to shelves of vit­a­mins and essen­tial nutri­ents lin­ing the phar­macy walls, there has been a mas­sive change in the retail phar­macy. The demands of an informed pub­lic plus the need for prof­its drove the phar­macy indus­try into sell­ing nutri­tional supplements.

The study also high­lighted that some cus­tomers cur­rently feel phar­ma­cists are ill-equipped to coun­sel them about nutri­tional sup­ple­ments. Many don’t even refer to phar­ma­cists as an infor­ma­tion source. Phar­ma­cists also felt ill-informed about sup­ple­ments, and expe­ri­enced frus­tra­tion when deal­ing with inquiries about nutri­tional med­i­cines and nat­ural health products.

“We must act on the facts and the most accu­rate inter­pre­ta­tion of them, using the best sci­en­tific infor­ma­tion. That does not mean that we must sit back until we have 100% evi­dence about every­thing. When the state of the health of the peo­ple is at stake, we should be pre­pared to take action to dimin­ish these risks even when the sci­en­tific knowl­edge is not con­clu­sive. [11]

Unfit to Practice

There is not a sin­gle med­ical school in Aus­tralia teach­ing ade­quate nutri­tional sci­ence to future doc­tors to ensure that they are fit to prac­tice in proper health care. This applies equally to gen­eral prac­ti­tion­ers and spe­cial­ists. Most of any doctor’s patients are going to die from a nutri­tion­ally based dis­ease, yet for years before they die they have for­mi­da­bly obvi­ous nutri­tional defi­cien­cies that go undi­ag­nosed. For­tu­nately in Aus­tralia, we have highly qual­i­fied nutrition-aware health sci­en­tists in the pro­fes­sion of Nat­ural Ther­a­pists who can help to cor­rect these deficiencies.

Med­i­cine stands on two feet — the sci­ence and the clin­i­cal art. Take away either one and it is going nowhere. Sci­ence on its own doesn’t work because peo­ple aren’t wid­gets; we all have dif­fer­ent needs and dif­fer­ent strengths, but med­ical research finds it eas­i­est to treat us all the same. Got arthri­tis? Take this painkiller. But painkillers may destroy the joints, and in the case of the most com­mon, parac­eta­mol, cause dam­age to mul­ti­ple inter­nal organs — while sim­ple things such as chang­ing the diet, move­ment, vit­a­mins, glu­cosamine and turmeric, among many oth­ers, have been shown to be very safe and effective.

Clin­i­cal skills also need to be advised by good sci­ence, the con­stant quest for under­stand­ing. In real­ity nutri­tional bio­chem­istry holds the answers to most of our health prob­lems, but move­ments such as FOSM actively seek to cen­sor our knowl­edge of this.

Ref­er­ences:

1. Bower H (1998) Dou­ble stan­dards exist in judg­ing tra­di­tional and alter­na­tive med­i­cine BMJ 316:1694.3 doi: 10.1136/bmj.316.7146.1694b

2. A National Health and Hos­pi­tals Net­work for Australia’s Future? Deliv­er­ing the Reforms. At: http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/DeliveringTheReforms. http://www.abc.net.au/am/content/2010/s3009673.htm.

3. Ful­der S (1989), The Hand­book of Com­ple­men­tary Med­i­cine. Coro­net Books; Vin­cent Di Ste­fano (2006): Holism and Com­ple­men­tary Med­i­cine. Ori­gins and Prin­ci­ples. Allen & Unwin, Sydney.

4. Davies, S (1990) Nutri­tional Flat-earthers, Jour­nal of Nutri­tional & Envi­ron­men­tal Medicine,1:3, 167 — 170

5. Eco­nomic report finds com­ple­men­tary med­i­cine could ease health bud­get. 2010, Sep 13. http://www.nicm.edu.au/content/view/161/245/ See also: Hall, A. (2010) Call for Nutri­tional med­i­cine rethink. At: http://www.abc.net.au/am/content/2010/s3009673.htm.

6. Per­sonal com­mu­ni­ca­tion. Avni Sali, MD, PhD, for­merly head of the Uni­ver­sity of Mel­bourne Depart­ment of Surgery at the Hei­del­berg Hos­pi­tal, now Direc­tor of the National Insti­tute of Inte­gra­tive Med­i­cine, Melbourne.

7. ABS. 1301.0, Year Book Aus­tralia, 2009-10, Health Care Deliv­ery And Financing.

8. The Sen­ate Proof, National Health Amend­ment (Phar­ma­ceu­ti­cal Ben­e­fits Scheme) Bill 2010.

9. Good­win JS, Tangum MR. (1998) Bat­tling quack­ery: atti­tudes about micronu­tri­ent sup­ple­ments in Amer­i­can aca­d­e­mic med­i­cine. Arch Intern Med. 158(20):2187–91.

10. Braun LA, Tira­longo E, Wilkin­son JM, Spitzer O, Bai­ley M, Poole S, Doo­ley M. (2010) Per­cep­tions, use and atti­tudes of phar­macy cus­tomers on com­ple­men­tary med­i­cines and phar­macy prac­tice. BMC Com­ple­ment Altern Med. 10(1):38.

11. Hor­ton R. (1998) The new pub­lic health of risk and rad­i­cal engage­ment. Lancet. 352(9124):251–2.

Nutri­tional Med­i­cine is Ortho­mol­e­c­u­lar Medicine

Ortho­mol­e­c­u­lar med­i­cine uses safe, effec­tive nutri­tional ther­apy to fight ill­ness. For more infor­ma­tion: http://www.orthomolecular.org

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Edi­to­r­ial Review Board:

Ian Brighthope, M.D. (Australia)

Ralph K. Camp­bell, M.D. (USA)

Car­olyn Dean, M.D., N.D. (USA)

Damien Down­ing, M.D. (United Kingdom)

Dean Elledge, D.D.S., M.S. (USA)

Michael Ellis, M.D. (Australia)

Mar­tin P. Gal­lagher, M.D., D.C. (USA)

Michael Gon­za­lez, D.Sc., Ph.D. (Puerto Rico)

William B. Grant, Ph.D. (USA)

Steve Hickey, Ph.D. (United Kingdom)

James A. Jack­son, Ph.D. (USA)

Michael Jan­son, M.D. (USA)

Robert E. Jenk­ins, D.C. (USA)

Bo H. Jon­s­son, M.D., Ph.D. (Sweden)

Thomas Levy, M.D., J.D. (USA)

Stu­art Lind­sey, Pharm.D. (USA)

Jorge R. Miranda-Massari, Pharm.D. (Puerto Rico)

Karin Munsterhjelm-Ahumada, M.D. (Finland)

Erik Pater­son, M.D. (Canada)

W. Todd Pen­berthy, Ph.D. (USA)

Gert E. Schuitemaker, Ph.D. (Netherlands)

Robert G. Smith, Ph.D. (USA)

Jagan Nathan Vamanan, M.D. (India)

Andrew W. Saul, Ph.D. (USA), Edi­tor and con­tact per­son. Email: omns@orthomolecular.org Read­ers may write in with their com­ments and ques­tions for con­sid­er­a­tion for pub­li­ca­tion and as topic sug­ges­tions. How­ever, OMNS is unable to respond to indi­vid­ual emails.

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