Sunday, 9NOV2014 – Renegade

“Do you fools listen to music or do you just skim through it…”

 

The following piece is by a gentlemen who is one of the smartest in his field of functional medicine, his name is Doc Parsley. I am copy and pasting this latest blog on Western Medicine and how it can help but also can hurt. I am posting this because he pinpoints so eloquently the positives and negatives to the differences between Western Med and Easter Med. Neither is 100% right nor are they 100% wrong. Most things that he writes below, relate to myself and how I program/train athletes. 

I have been saying for a long time that one size does not fit all for training programs or nutritional programs. Not one program is necessarily wrong nor is it right. The entire history of clients needs to be taken into account. For my football players, each player is different. So much goes into their training. What position do they play? What do they lack in their position? What do they lack as an overall athlete? How old are they and how long have I been training them? How do they adapt to certain types of training? Is one consumed with AP classes or not? How does this player eat versus this one? The list is endless and having an ability to read your athlete and adjust YOUR program for them is what separates an average coach from a great one. Can you adapt your ideology to what is best for the athlete. Knowing that takes an incredible level of skill, it is one I am still learning on a day to day basis. I was telling a friend the other day that it all works, but it ALL can make the athlete worse. What do they need? What is the underlying issue and how do you fix it. 

IF YOU HAVE A COACH THAT SAYS HIS/HER PROGRAM IS THE BEST OUT THERE you are not getting the best service, because it’s false. A good coach reads and dissects their athlete, THEN they give the athlete a program. It is a constant update of the program that makes the athlete continually grow, not the gold medal 12 month program that is followed to the “T”. 

WAKE UP, figure out what is wrong and fix it. 

 

 

Do I Believe In “Western Medicine”?

Western vs. Eastern vs. Integrative vs. Evolutionary vs. Anscestrial vs. Natural Medicine . . .
The most confusing part of any conversation that I have with people–regardless of the venue–is when they ask me: What type of medicine do you practice. Yes, I’ve read all the books and heard all of the advice on creating my “elevator pitch” etc.

The problem is that language is only an approximation of ideas, and I do not think that the english world has yet to develop the appropriate language for what I (and many others) do to help people. Yes, I am a western trained M.D. I am somewhat sceptical about where western medicine is heading. However, I do not think it is a calculated mis-information campaign like many suggest. In my opinion a program that started with the best of intentions got lost, little by little.

I think the state of western medicine can be fairly compared to the banking crisis of 2007-2008. The financial industry was busy doing exactly what the American public wanted them to do: figuring out more and more “creative” ways to leverage money, to allow the average American to buy more and more things on time (credit). However, to stay competitive in their lending–which by-the-way is where the vast majority of their profits come from–they had to let the criteria for borrowing get less and less realistic. Eventually, this was non-sustainable. The borrowers got in over their heads, and the banks had a lot of unrealistic debt to collect, and no real means for recouping that debt–as seen by all of the offers to short-sell your house, “negotiate” your credit card debt down by 50% etc. We couldn’t make our payments, and the banks couldn’t make theirs. So, we re-booted the system, and I believe there are a lot of reprecutions yet to be seen. I learned this analysis from Bill Harris of Centerpointe research center, and I use a lot of his products to help my clients.

Now compare that to western medicine. The doctors spent their most valuable years of health and social development getting straight A’s in college, while playing sports, volunteering at homeless shelters, doing research, sucking up to professors and doctors in the nearly impossible quest of getting into medical school. They then played this same game (at a higher level) to get through medical school, and land the residency of their choice, and often played this game again to get the sub-specialty or fellowship that they wanted, and then one more time to get the staff job they really wanted.

The successful ones don’t have it so bad. They have now specialized to the point where they only do surgeries or procedures on the left eye, of brown-eyed males, between the ages of 23-36. So, they are in a niche that allows them to stay abreast of new researching. This is, of course, an exaggeration, but you get the idea.

Compare that to the primary care doctor–this is any doctor that you can go directly to, for any purpose. They go by different names (generalist, primary-care, internist, family practice, etc.), but we’ll just call them PCP’s (primary care practitioners–which includes certain nurses, PA’s, and non-western trained doctors). Depending on where you try to get the data a PCP gets about $25-$75 for an office visit. After he/she pays fixed and variable cost, the doctor may put 10% of that in his/her pocket. So, do your own math, and you can see how many patients a doctor would need to see to make a decent living. Now add in the time he/she needs to actually run their business, train staff, follow-up on incidentals, etc. and spend time on his/her own life (wife, kids, hobbies, rest, sleep, professional/personal development . . .)

Now, just like the financial industry, doctors have been trying to come up with more and more instant fixes for what their patients are complaining about. That is what Americans have been counting on for decades. How many times have you heard a comment that there will be a cure for “X” by the time I need it? The 20-30 somethings today are a diffent population, and we’ll get to them in a minute.

However, follow this logic; you’re a PCP, you work 80hrs/week, and you often have to answer text, phone calls etc. when you are not “working”. There are about 300,000 peer-reviewed “research” or “clinical” articles produced EVERY YEAR. If your doctor wanted to stay on top of that he/she would have to spend about 25,000 hours per year just reading, never mind analyzing, or researching what he or she read. Now, since there are only 8,760 hours in a year, this isn’t possible. But, if only 10% of those publications applied to your doctor’s practice, he/she would still need to read 2,500 hours per year (which is more than 40hr/week). So, again: not realistic.

So, they do what the financial industry did. They seek out the latest innovations in their field to allow them to provide the “best” care. These inovations are almost always pharmaceuticals, and the way the game is set up, pharmaceutical companies can deduct “educational” cost from their expense coloumn for P&L (and tax) purposes. Who do you imagine they are “educating”. PCP’s of course. This seems like a win-win. The pharmaceutical companies have to stay up with the research to be able to produce new drugs. They then distal this research down to an actionable plan, create a new product, and “teach” the PCP’s what the “research” shows and how their product will solve “X”, and we know that the FDA has read through all of this data, dispassionately, and objectively, and agree with the pharmaceutical companies. Right?;-) (That is a totally different topic–to be posted later).

The generations older than me (50’s+) have counted on this method working their entire lives. They have been taught that the doctors have the answers. They have been trained well, and these interventions will treat their problems, and keep them “healthy”. Of course, we now know this plan didn’t work out as planned. I only go into detail on this to explain why I think medicine is where it is now.

Now, I didn’t discuss medical insurance in this plan, but I will later. For now, let’s just say that PCP’s are becoming more and more unable to think “outside of the box”, and I’d expect this to get MUCH worse. Possibly another blog.

The point of this ridiculously long analogy, is that I don’t think western doctors are lazy, stupid, disinterested, or evil. They are simply pawns in a game way too big to combat (again–expect this to get worse). So, when people ask me if I practice “western” medicine (based on what I’ve outlined above) I say; “No”. But, to be clear, I’m not saying that “western” medicine doesn’t work. If I get hit by a bus, I want to be rushed to a trauma center–not an accupuncturist. If one of my kids breaks a leg, I’m taking him/her to the ER. If my wife has a headache, she takes motrin/asprin/acetomenophen etc.

Now, to the point of this blog: I have a small enough patient population that I can research each and every one of their needs. I do not have to rely on insurance guidance, or algorythms memorized in medical school. A pharmaceutical is sometimes a good option–as long as it is short term, and there is no obvious underlying issue leading to the complaint.

But, often times my patients complain of chronic problems. Things that have been bothering them for months or years. They lack obvious signs of disease. In these cases, western approach is usually sub-optimal. They often haven’t optimized the foundation of health: Sleep, Exercise, Nutrition, Rest/Mindfulness.

So, I start there. If you aren’t willing to get more sleep, exercise a bit, eat food that nurishes your body, and reduce stress–I can’t help you. These are the basic prerequisites for working with me. About 80% of the time, optimizing these pillars of health, will “cure” what is bothering you–and often have far reaching benefits that you may have not even realized were bothering you.
With that said, I use “all” of the approaches available to me. I consult with experts in Naturopathy, Eastern Medicine, Mindfullness, Integrative Medicine, Nutritionist, Strength and Conditioning experts, etc. I am no different than any other doctor, in that I cannot possibly keep up with all of the “literature”. I keep an open mind, I consider the evidence and my clinical experience. I consider what my patients need, what they want, and what they are opposed to, and we come up with a plan. We try it, we adjust, we try again, we adjust, . . . until they are happy with their progress and goals.

Of course, I do have a compass to keep me on track. The foundation of my approach is that humans have evolved on a planet that we no longer live on. We have made an artificial micro-planet that we humans live in. We make it cold when we’re hot, we make it hot when we’re cold. If we want it dry, we make it that way. If we want it wet, we make it that way. If we want to be on the otherside of the world–in a climate and culture we know nothing about, we are only a plane ticket away.

So, my basic question is; would this “health problem” have existed 5,000 years ago? If so, how would it be fixed? If not, how can we use what we know about human evolution to optimize this person’s health?

Many forms of medical education “disintegrate” the body into “systems” for the sake of education. “Integrative Medicine” tries to re-integrate this arbitrary break-up of the human. I learned this lesson from Dr. Russ Jaffe (grandfather of “alternative medicine”)–former program director of NIH’s “alternative medicine program”.

So, to make a long story longer; I do not follow any one path. I believe that all fields of medicine have something to offer. Evolution/Ancestrial medicine is a great blue-print and guide, but it doesn’t necessarily provide a solution for everyone. For example, if you are a police officer and you have to work from mid-night until 8AM every day, we obviously cannot optimize your sleep. So, we may need to compensate with other forms of medicine to be able to get you where you need to be.

You will hear this phrase from me a million times: “Everything Matters”. We cannot treat a single symptom. We cannot treat a single “system”. We cannot just optimize your nutrition and gut biome. We MUST at least do that, but those things impact everything else. So, we must consider “Everything”, and every possible intervention. No two people will ever be treated the same by me, because no two people have the exact same varibles leading to their “problem/s”.

 

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