Why Should There Be One?
Four freshmen students come down with the flu at their college dorm. One of them is sick with a sore throat for a few days but doesn't miss any classes.
The second student also suffers from a sore throat, runs a fever for some days, stays in the dorm and misses some classes. The third student develops fever, rash and enlarged lymph glands in his neck. He is very fatigued and consults his physician. The tests for "mono" - infectious mononucleosis, the kissing disease - come back positive. He is given a steroid shot and advised to go home and rest for a few weeks. At home, he feels unduly tired as weeks pass by. He returns to school, still tired. He gradually regains his usual level of energy over the course of several months.
The fourth student also tests positive for mono and is given a steroid injection. He becomes progressively tired, loses several pounds, develops a hacking cough and runs a low-grade fever. His family physician prescribes more broad-spectrum antibiotics.
Weeks go by, but the fourth student doesn't recover. His low-grade fever doesn't let up, and his cough persists.
He consults his physician again and is prescribed a course of broad spectrum antibiotics. His fatigue persists, and he suffers from malaise, headache and muscle aches. His parents are worried now and take him to a rheumatologist. He orders many tests and prescribes yet more antibiotics and some non-steroidal antiinflammatory agents.
The cough persists and he develops wheezing. His physician orders some more tests and prescribes steroid therapy. He begins to suffer from mood and memory difficulties and becomes depressed.
More Nystatin prescriptions are followed by more antidepressant prescriptions...
A return visit to his physician earns him a prescription for Elavil. He continues to lose weight and develops joint pain.
His parents become very worried and take him to another rheumatologist who orders yet more tests and then prescribes a non-steroidal antiinflammatory pain killer. The drug adds stomach discomfort to the long list of his symptoms.
The young man's condition continues to deteriorate. His parents panic and take him to a famous chronic fatigue expert, one who authoritatively orders four thousand dollars worth of immunologic tests and states that the young man suffers from chronic fatigue syndrome. The young man and his parents have their worst fears confirmed.
The fatigue expert then writes out a prescription for Acyclovir (an antiviral drug) and changes the antidepressant medication to Prozac.
The fourth student loses more weight, develops "new" allergies, becomes sensitive to perfumes and formaldehyde, and suffers from unrelenting abdominal bloating and digestive problems. He becomes anxious, confused and frightened.
A friend gives him a copy of The Yeast Connection. The young man begins to read the book and suddenly it dawns on him that the yeast syndrome described in the book fully describes his condition. He is both elated and relieved. At long last, the young man knows the cause of his suffering.
He now sees a naturopathic yeast specialist who gives him a load of vitamins and prescribes high colonics.
The therapies really work and his energy level improves for the first time since he fell ill. His mental functions improve significantly.
Weeks go by and his fatigue returns - and with it his worst fears. Deeply disappointed that the relief was just temporary, he now consults another yeast specialist who undertakes another work-up and prescribes Nystatin.
Once again, his initial response is very positive. Within a week, there is a recurrence of fatigue and related symptoms. More Nystatin prescriptions are followed by more antidepressant prescriptions.
The energy roller coasters persist, each low becoming deeper than the preceding. The young man continues to waste away.
Deeply anguished and frightened, the parents take the frail body of what was once a healthy human being to another fatigue center - one out of state.
This time, a comprehensive workup includes a muscle biopsy that shows injured and split muscle fibers, overgrowth of mitochondria and some dead muscle fibers.
A SPECT scan (single Photon Emission Computed Tomography) shows diminished blood supply to the frontal and temporal lobes of the brain, and a PET scan (Positron Emission Tomography) reveals evidence for impaired glucose metabolism. Cortical evoked potential studies show abnormalities of P3 waveform and reduced amplitudes of some potentials.
Many other tests for biologic immune response modifiers show evidence of damage to several different components of the immune system.
Six months later, the young man is convinced that this "think" is for life. The parents sadly begin to wonder if this is the end of the dreams they cherished for their son.
An unusual case history? A sensationalistic attempt at melodrama? Not for those who have suffered the unremitting agony of such devastating journeys. Not for those who will surely see part of their own heart rending stories in it.
All of us who care for sufferers of chronic fatigue have thick clinical charts in our offices that tell and retell such sad and unnecessary stories.
PROMOTING POOR PROTOPLASM
A senior surgeon colleague recently told me that he thought the number of children he saw with poor protoplasm had increased markedly during the brief period of his own surgical career.
Protoplasm is the soup of life that makes up each living being. I was introduced to the term "poor protoplasm" in my first year in medical school. This term was used by our teachers for people who were always getting sick - and, in doing so, frustrating their treating physicians. The idea behind this term, of course was simple: Such individuals were constitutionally weak - genetically destined to be sickly. I didn't see it then, but this model of poor protoplasm comes in handy to s physicians in more than one way. It absolves us of any wrongdoing.
Our drugs do what they were designed to do. Now if someone still chooses to be sick, it's really his problem isn't it?
Our medical science is sound. We do our part right. Our drugs do what they were designed to do. Now if someone still chooses to be sick, it's really his problem, isn't it?
We medical students learned his lesson well. Unlearning is much harder than learning, and nowhere - it seems to me - is it more so than in medicine. Unlearning is not written into the scripts we physicians follow when we leave medical schools for the "trenches" of clinical medicine. A surgeon friend has been out of medical school for over 30 years. Still, he cherishes the concept of poor protoplasm.
I asked the surgeon why he thought children have poor protoplasm now more than in the past. He shrugged his shoulders.
"Who knows? Maybe you do. I mean you're the one who writes about oxidized fats and denatured proteins and pollutants and increased oxidizing capacity of the planet Earth and the oxidant stress molecules." He chuckled.
My surgeon colleague left out something important in his brief list of things: the part we physicians play in promoting poor protoplasm.
ANTIBIOTICS CREATING CHRONIC FATIGUE
The prevailing mode of drug medicine creates fatigue in two effective ways:
First, at the slightest prompting, it feeds little babies broad-spectrum antibiotics (translation: designer killer molecules that have broad powers to kill everything in sight and ruin the delicate bowel ecosystems) and older folks receive multiple drugs that slowly but most assuredly impair their life span enzymes.
Second, it actively withholds from the sick effective, non-drug nutritional and environmental therapies. Chronic fatigue is created by chronic neglect of essential health issues and by shortsighted drug therapies for health problems that can be effectively managed without drugs.
It is not only environmental pollutants, poor nutrition and stress that are turning many people into canaries. The tools of drug medicine are contributing their fair share. This sad story does not end here.
The champions of drug medicine ferociously harass a handful of holistic physicians who seek to promote health with natural therapies. It may seem a harsh criticism of my profession. But it is well deserved.
A CLICHE TELLS THE STORY
"If you treat a cold, it takes three weeks, if you don't it takes 21 days."
Recently, a visiting professor at a hospital conference spoke the above words and grinned broadly to communicate to us how good he felt about his discovery.
His comments turned my thoughts to how rapidly human biology is undergoing profound changes as we relentlessly prescribe drugs in pursuit of the glorious dreams of Star Wars medicine.
Of course, we all remember the old cliche: If you treat a cold it takes a week, if you don't it takes seven days. Why did the cliche change from seven days to 21?
Those of us who seek to care for our patients with non-drug therapies know things have changed. Common colds that leave in their wake malaise, muscle aches and a hacking cough for weeks are not uncommon. Such colds not uncommonly turn into pneumonias.
Often I see another facet of this problem of prolonged recovery from common colds:
Many chronic fatigue sufferers make painstakingly slow progress with non-drug nutritional, environmental and self-regulatory approach therapies.
And then they come down with a cold that is treated with long courses of antibiotics. They nose dive and months of restorative work go down the drain.
A MOMENTOUS DISCOVERY
Recently, someone made an astounding discovery. He realized people could be safer at home than in a hospital. Fascinating stuff? We understood this as medical students in Pakistan in the early 1960s
"The result is a war in which humans using refrigerators, sanitation, boiled water, and antibiotics try to kill, starve, and subdue microbes. The microbes fight back by developing new pathways, new proteins, and new strategies for survival that are as ingenious as those devised by humans out to destroy them. It is a war involving millions of lives, causing pain and tragedy. One doctor, interviewed by this editor said, "When these new drug-resistant strains become endemic in hospitals, you will be safer staying home than going to a hospital, unless you have a truly dread disease."
Science 257:1021; 1992
Safer at home than in hospitals! Such comments amuse me. Everyone recognizes the chemical risks we all face. And yet when fatigue experts of drug medicine lecture on how to treat chronic fatiguers, all they talk about is drugs. They never talk about environmental sensitivities or adverse food responses or allergies.
I never hear one word about sugar-insulin-adrenaline roller coasters or about nutrition. Not one word about meditation. Not one word about slow, sustained exercise. Not one word about some spiritual dimensions. All these fatigue experts love to talk about is the Epstein-Barr virus and then they move on to extolling the virtues of their favored antidepressants.
This is the central issue facing those who suffer from chronic fatigue and their caretakers. The battle lines are clearly drawn. On one side are physicians like me who are convinced that the true answer to this problem is in restoring normal energy enzyme pathways with non-drug therapies.
On the opposite side are champions of drug medicine who are equally convinced it is simply a matter of time before some drug will arrive at the scene and cure chronic fatigue syndrome once and for all. We have our clinical outcome studies to buttress our case. The drug medicine folks are pregnant with the glorious promise of miracle drugs in the wings.
There is an irony in the battle between holistic medicine and mainstream drug medicine. Hippocrates, the father of medicine, believed in the innate healing nature of the human body, and taught his pupils to look for answers to the problems of sickness in that inner healing capacity of injured tissues.
If the injured tissues are allowed to heal, he taught his students, they will do so. Democratus, a contemporary of Hippocrates about 2,500 years ago, thought Hippocrates was nuts. The human body, he pronounced, was made up of tiny particles, which he called atoms. In his theory of atomism, sick organs were incapable of healing by themselves. He scorned Hippocrates for his theory of vitalism. The battle between atomism and vitalism has raged on in one form or another ever since.
The gods of American medicine who populate our medical schools and sit on state medical schools and sit on state medical licensing boards think that real diseases can be treated only with drugs and surgical scalpels. Hence, their wrath against those who seek answers to chronic fatigue in Hippocrates' vitalism - in nutritional medicine, in environmental medicine and in medicine of self-regulation. Their venom against holistic physicians today isn't any less lethal than that of French doctors against Pasteur.
The sad truth is that our American gods of drug medicine know little, if any, about issues of functional nutritional deficiencies, adverse bowel responses to foods, battered bowel eco-systems, chemical sensitivities, delayed consequences of toxic metal overload, and the "Fourth of July" chemistry under the skin of chronic fatigues. Those are the real issues in restoring normal energy pathways in chronic fatigues.
None of those issues are of any concern to the practitioners of drug medicine because none of them can be truly addressed with the miracles of our synthetic chemistry.
Many champions of drug medicine will snicker at my notions of holistic molecular relatedness in human biology. They would want me to compartmentalize my fatigue patients in some cage, so that I could follow their prescriptions of double-blinded, crossed-over research models.
They would want me to feed one group of my patients some kind of drug and the other sugar pills. They would insist on that kind of proof.
They do not understand that such a frivolous notion of proof is utterly irrelevant to holistic methods of caring, where the only thing that really matters is whether or not chronically tired people regain their normal energy patterns. From extensive clinical experience I know they do. And I know that from the experience of my colleagues in environmental and nutritional medicine.
Pasteur concentrated on one factor - the Anthrax bacillus - because his sheep were made sick by just that one single agent. I have to think differently for my patients because my patients are not made sick by just one thing. They are vulnerable in many ways. They are different from Pasteur's sheep. This the champions of N2D2 medicine do not comprehend.
I AM OPTIMISTIC
This is my chance to answer my colleagues who do not understand how anyone in holistic medicine can be optimistic today.
"Something wonderful happened...and a quiet grass-roots revolution in health care was officially recognized...last week on the sixth floor of government Building C in Bethesda..
The something wonderful was the atmosphere of respect and affection accorded to about 90 spokesmen for "unconventional therapies" invited to present their treatments to an unusually eclectic ad hoc panel convened by the National Institutes of Health... There is a generosity of spirit manifested here... In the midst of the optimism and good will, however, was an undercurrent of anger and distrust. There were frequent mentions of unnamed individuals practicing controversial and allegedly successful therapies who didn't dare appear for fear of losing their licenses.
Washington Post, June 26, 1992
I am a realist as well as a dreamer. Within months of this conference, the office of one well-known nutritionist was raided by authorities with drawn guns. They confiscated his supply of vitamins. Some months later, the license of another colleague was summarily suspended because one of his very sick patients developed a complication following an intravenous treatment.
How many surgeons do I know whose licenses were suspended because one of their patients developed complications after surgery and died? Indeed, how many surgeons would have still retained their licenses if their licenses were revoked every time a surgical complication developed? Not one! I am sure of that.
How many oncologists do I know whose licenses were revoked because the patient died as a result of their chemotherapy and not of his disease? It is not at all uncommon for patients to die of sepsis after their immune defenses have been totally destroyed with chemotherapy.
How many internists would still have their licenses if their licenses were to be rescinded every time there was a complication caused by a drug prescribed by one of them?
Then there are times when practitioners of drug medicine turn on holistic doctors, and report them to state licensing boards. I know of physicians whose licenses were revoked because they treated their patients with nondrug therapies. The area's practitioners of drug medicine banded together to put them out of business - and did exactly that.
Many medical boards take the position that all nondrug nonsurgical methods of treatment are unconventional, and hence punishable. The holistic physicians who use nondrug therapies have no defense against such tyranny.
Such are the burdens we holistic physicians carry! Such are the risks we take! If you think this is cheap melodrama please go and listen to the wives of physicians who lost their licenses simply because they tried to care for their patients with nondrug therapies. I know, because I have listened to them. I know many families of holistic physicians that were destroyed by maestros of N2D2 medicine.
I am not optimistic because I have not witnessed the tyranny of drug medicine or the venom of its high priests. Or because I do not know their capacity for inflicting hurt upon those who choose to think differently. Or because I am not aware of how fiercely the state licensing boards protect the interests of N2D2 medicine. Or because I do not see the unfaltering devotion of the editorial boards of our medical journals to the double-blind, cross-over. Or because I have not experienced the disdain of disease doctors for those who do preventive medicine.
I am optimistic for different reasons.
"We are incarcerated in the double-blind, cross-over model," said Majid Ali, a New Jersey pathologist whose clinical practice stresses nutrition, fitness and environmental therapy. "It is not appropriate for holistic therapy, in which there are many variables and neither the practitioner nor the patient can be blinded to treatment."
Washington Post, June 23, 1992
I am an optimist because once we know something, we cannot unknow it. I am optimistic because the truth cannot be suppressed forever. And the truth is that the gods of the double-blind, cross-over medicine are false gods. And their disciples who sit on the editorial boards of medical journals and consider all nondrug and nonsurgical therapies quackery are misguided. Their double-blind, cross-over research model is totally and utterly irrelevant to our work with chronic fatiguers.
No matter how dictatorial and ruthless the state licensing boards become, holistic physicians are not going to abandon safe and effective nondrug therapies. And the truth is that chronic fatiguers are beginning to see it.
They are beginning to see through the folly of hiding behind frivolous diagnostic labels. They are beginning to see through the yarn that practitioners of drug medicine weave for their benefit. They are beginning to see through the false promise of wonderful drugs that are touted to cure chronic fatigue - and only leave them sicker.
The truth is that chronic fatiguers are beginning to stay away from drug trials. They are shunning antiviral therapies that make them more toxic. They are rejecting those megabuck work-ups that only lead to prescriptions for antidepressants.
The truth is that an ever-growing number of chronic fatiguers are not waiting for Godot. By and large, they are looking for answers in their nutrition, environment, self-regulation and in some spiritual dimensions. And by and large, they are succeeding.
These are the reasons I am optimistic. There are yet others.
Extrapolation to the U.S. population suggests that in 1990 Americans made an estimated 425 million visits to providers of unconventional therapy.
This number exceeds the number of visits to all U.S. primary care physicians (388 million). Expenditures associated with the use of unconventional therapy in 1990 amounted to approximately $13.7 billion, three quarters of which ($10.3 billion) was paid out of pocket.
New England Journal of Medicine, 328:246, 1993
This is an eye-opening conclusion from a very large study. It should remove any doubts in anybodies mind as to the preference of American people in health care. Indeed, they preferred nondrug therapies to drugs even when they had to pay for it twice, once as a premium for health insurance and the second time as a fee for service.
The United States is a democratic society. In such a society, the majority opinion determines what the standards are - and what they should be. If we hold as valid the principle of majority opinion, then it is quite evident from the above study what the majority of Americans want: nondrug therapies.
Drug therapies must be considered as unconventional - not a bad idea at all, because there is nothing wrong with using unconventional therapies in unconventional (acute, life threatening) diseases. The conventional health disorders - those caused by problems of nutrition, environment, stress and fitness - should be managed with conventional nondrug therapies.
"Forget health care reform or reinventing government. The biggest volume of mail being logged in many Congressional offices these days calls on the lawmakers to block action by the Food and Drug Administration to ban the sale of vitamins and other dietary supplements. ... The Hatch-Richardson legislation would lower the new labeling standard to allow health claims for supplements supported only by unconfirmed preliminary studies not subjected to any meaningful scientific per review ... The fight, in other words, really isn't about keeping supplements on the shelves. It's about the right of unscrupulous companies and individuals to maximize profits by making fraudulent claims."
The New York Times, October 6, 1993
This editorial by the Times surprises me. The Times usually speaks for citizen rights. Why does it choose to act differently in the matter of nutrients?
First, it recognizes that Americans are much more interested in protecting their free access to nutrients than they are in President Clinton's grandiose plans for revamping the entire health care system - in which he cannot succeed unless he makes preventive medicine the centerpiece of his strategy.
Next, it moves to defend the regulatory restrictions on nutrients. The Times' words against free access to nutrients for Americans do not matter much to me.
What is heartening for me is its recognition that Americans consider free access to nutrients more important than Clinton's plans. I continue to be optimistic.
NIH REFERS A PATIENT TO A HOLISTIC DOC!
Blasphemous! Delusive plausibility of an ideologue! Not really.
Trudy L, a 41-year old teacher, consulted me for a long list of complaints that included incapacitating chronic fatigue, weight loss, sinusitis, malaise, low-grade fever, skin rashes, daily headaches, arthralgia (joint pains), myalgia (muscle pain), neuritis (persistent pins and needles in limbs), "increased sexuality," mood and memory difficulties and depression.
"I was a teacher, I have a double masters. I had the energy of a butterfly," she spoke fervently. "That was five years ago when I went to Central America. I returned with some kind of parasite. I have had 13 workups, with every blood test you can name, and X-rays including CAT scans, MRI scans.
The MRI scan showed some bright spots in my brains. I went to Johns Hopkins and Hahnemann. The guy at Hopkins told me it was all depression and gave me a prescription for an antidepressant. The fellow from Hahnemann was honest. He said he really didn't know what my problem was."
I listened to the story. Nothing really new there for me. I thumbed through the heavy chart. In the end, I asked,
"How did you come here?"
"I was referred to you."
"NIH?" The words simply escaped my lips before I regained my composure.
"Yes! by NIH." She seemed to sense my surprise.
"That's interesting. Did you ever develop fatigue when you were a teenager?" I tried to change the subject.
"It wasn't easy finding you, Dr. Ali," she returned to the subject of referral.
"Well! You're here now. Tell me if you suffered fatigue when you were a teenager.""I wasn't ready to give up," she was intent on telling me more about her journey. "After Hopkins and Hahnemann, I was determined to find someone who could solve this puzzle. I want my life back. so I called NIH, and I called them and I called them. Finally someone there gave me your number."
When the NIH begins to refer patients to holistic physicians, there is hope. I am optimistic.
DRUGS ARE POISONS THAT SOMETIMES HELP
A psychiatrist colleague one day limped into my office at the hospital, leaning on a walking stick. He had lost considerable weight since I had seen him last and looked exhausted.
"What happened? I asked with concern.
"The virus did it," he forced a smile.
"You have lost some weight, haven't you? I asked sympathetically.
"Yes about 15 pounds."
"And you look tired," I added.
"Tired! You can say that," he strained as he shifted his weight on the stick. "I was very tired to begin with. They put me on heavy doses of antidepressants that make fatigue worse."
"Why? I asked, surprised.
"I suppose they thought an antidepressant would help. Or maybe they thought the whole thing was in my head and I was simply depressed."
"Did antidepressants help?"You really don't know what these psychiatric drugs do to you unless you happen to be the patient." The psychiatrist forced another smile. "The cholinergic side effects were terrible. So I stopped all drugs."
"Hopefully you'll get over it soon. "I wished him well.
I'll tell you something for your next book," he continued. "Drugs are poisons that sometimes help. I don't know who said that, but whoever it was knew something about drugs," he grinned, shifted on his stick and limped out.
He has made the first discovery that drugs do not work for chronic fatigue, I thought. Hopefully, he will also make the second: that nondrug, natural therapies do work.
Drug therapies for chronic fatigue are becoming more common among practitioners of drug medicine.
Drugs, in my judgment, have no valid place in the care of people suffering from chronic fatigue. Drugs work by blocking, impairing or inactivating enzymes. Almost all drugs increase oxidant stress on tissues. This is the reason why there are no drugs in the PDR that do not have any side effects.
The judicious short-term use of drugs, of course, may be necessary to manage those health problems that are most often associated with chronic fatigue.
A NEW KIND OF MALAY A NEW KIND OF PHYSICIAN
Chronic fatigue will be the dominant chronic health disorder of the 21st century. Prophecy is an uncertain business. And perhaps more so in medicine than in any other field of endeavor. Yet, who among us has the wisdom to resist it? I am certain that the epidemic of chronic fatigue states that we witness now will continue to spread among our children, among our adults and among our elderly.
The pandemic of chronic fatigue will also, I am confident expose he principle weakness of the prevailing mode of drug medicine.
Ill-health caused by problems of nutrition, environment and stress cannot be managed with miracles of synthetic chemistry. I do not believe this realization will come from the academia. It will come from the people who suffer from chronic fatigue and who are drugged for short-term benefits and long-term ill health.
As the pandemic of chronic fatigue continues to claim new victims in ever-increasing numbers, and as the false promise of drug therapies for fatigue is widely recognized, chronic fatiguers will learn about the real molecular dynamics of such energy, both in health and in states of chronic fatigue.
People who suffer unrelenting chronic fatigue quickly discover that drugs do not work. These people are now forcing their physicians to look beyond the false promise of drugs for a cure. They are learning - and more and more chronic fatiguers will as time passes - the true nature of chronic fatigue.
They are looking beyond simplistic notions of Epstein-Barr infection, Lyme disease, yeast connection, intestinal dysbiosis, immune-depression syndrome and a host of other diagnostic labels favored by most physicians.
Chronic fatiguers are demanding that their physicians look for the answer to their problems in their own host defenses - their energetic-molecular defenses that normally preserve their energy enzyme pathways.
Chronic fatiguers in the future will seek out a different kind of physician - a new kind of physician who understands human biology and the impact of environmental agents on man's genetic makeup.
He will be a physician with moral courage to defy the petty platitudes of drug doctors who sit on the state licensing boards and threaten to revoke his license.
He will be a holistic physician, someone who understands the metabolism of nutrients, the chemistry of environment, the pathology of immune disorders, the physiology of exercise and the energy dynamics of self-regulation.
He will be a new physician for new patterns of suffering. Two things will be important to him: first, the words the patient uses to describe his suffering; and second, the energetic molecular events that cause that suffering and the natural means of reversing those events.
He will have no use for the scientific vigor of drug researchers and their obsession with miracles of synthetic chemistry.
Drugs - as necessary as they may be for symptom-suppression in acute distress - cannot be considered legitimate therapies to manage chronic fatigue states.
There is a complete agreement among physicians about the clinical efficacy of intravenous nutrient protocols. Those who use these protocols are completely convinced of their enormous clinical value. Those who do not use them are equally convinced of their futility.
Intravenous Nutrient Protocols allow us to dramatically reduce the use of antibiotics and other drug therapies. They are extremely effective for resolving hard to define, but unrelenting clinical symptoms including, fatigue, stress, panic attacks, palpitations, mood and memory disorders, abdominal bloating, symptoms of allergy and chemical sensitivity.
Further, these protocols frequently allow us to successfully manage patients with chronic indolent degenerative and immune disorders who obtain little long-term clinical relief from the prevailing pharmacologic regimens.
In classical medicine, we follow what I call the dogma of three D's (one disease, one diagnosis, one drug). This is the legacy of Oslerian philosophy of using all available clinical data to arrive at the diagnosis of a single disease to be treated with a single therapeutic.
Drugs, we know, work by inactivating, impairing or inhibiting one or more molecular pathways. Drugs are designed for this purpose.