Tolle Causem

One of the 6 prinicples of naturopathic medicine is Tolle Causem, or Treat the Cause. The ultimate goal of a naturopathic physician is to identify and treat the cause of the patient's disease or symptoms.

Conventional physicians will often claim to do the same thing. I recently saw an advertisement for a medication for GERD (also known as heartburn) that claims to treat the "cause" of heartburn by preventing the stomach from making stomach acid.

Do people with heartburn really have a deficiency of Tums or Prilosec? Wait a second...does stomach acid actually cause heartburn? Why do we even have stomach acid?

According to MDConsult.com (a great resource for you aspiring physicians), stomach acid is a requirement to break down proteins into smaller pieces for easier digestion. Stomach acids also help the body absorb certain minerals and vitamins (did you know that long-term suppression of stomach acids can lead to osteoporosis?). Having stomach acid is also a vital part of our immune system (not very many bacteria can survive in that acid!), and decreasing your stomach acid can leave you vulnerable to infections by nasty bacteria like E. coli and others.

In fact, stomach acids are not the cause of GERD. Heartburn is actually caused by a weakness or relaxation of the muscle that separates the stomach from the esophagus. When this muscle relaxes, stomach acids come up into the esophagus and cause heartburn.

The job of a naturopathic physician is to figure out why this is happening, and to treat the true cause (not just give a bunch of drugs).

Note: this information is not intended to diagnose or treat any condition. Always consult your physician (preferably an ND) before making any medication or lifestyle changes. Remember, this is a blog, not a virtual doctor.

Prevention versus screening

What is prevention? The standard of care for preventive medicine specialists in conventional medicine is determined by the USPSTF (The US preventive services task force), which is an independent panel of experts in primary care (like internists, pediatricians, gynecologists, etc). The USPSTF determines when screening exams are necessary, which medications to take for prevention, and how to counsel patients.

The USPSTF comes up with guidelines based on a review of the scientific evidence, and publishes them in the form of “recommendation statements”. For example, the USPSTF determines at what age mammograms, physical exams, DEXA scans, blood tests, etc., are necessary. These are called “screening” tests because they are done for virtually every person of the recommended age and gender. The hope is that by screening millions of people, we can catch a few people who might actually have a certain disease (and thereby save lives).

Is this prevention? Screening exams, by definition, find people who actually have disease. A mammogram, for example, shows when a woman actually has breast cancer, it does not show that a woman might develop breast cancer in a few years. And it certainly doesn’t tell people how to prevent a disease from occurring in the first place.

Why is this important? Naturopathic physicians are experts in prevention, not screening (though we do a lot of that too). We want to work with our patients years before they get cancer, to talk about how to prevent it to begin with, not how to treat it when they already have it! We want to work with our patients to figure out the cause of their high blood pressure or high cholesterol, not just give them a drug to lower it.

Naturopathic physicians are the true preventive services task force! (We should get some fancy uniforms or something)

Evidence-Based Naturopathic Medicine (a continuation of my last post)

It’s been a long time since I’ve posted and I apologize. Summer happened!

This post will be about evidence other than double-blind placebo-controlled trials. Naturopathic physicians often have to use alternate forms of evidence since funding for trials of natural remedies is often seriously lacking. 

First we have the most general form of evidence: historical use. Some people argue that historical use has no place in evidence, but I would like to counter that. The fact is, historical use of medicines (herbals in particular) followed their own form of “scientific” rigor. That is, midwives, herbalists and healers passed down their knowledge word-of-mouth, and remedies that continued to work through the generations were passed down, whereas ones that were harmful were not. There is, of course, the chance that all of these remedies were simply acting as placebo, which is entirely possible. Even if it is placebo, however, we cannot say that the remedy doesn’t work (just the mechanism is different).

Next we have case-studies and evidence from personal experience. Case studies (published or unpublished) are very interesting to illuminate the exact presentation of a patient before and after a specific treatment. We can use case studies to speculate on what the mechanism of action of a particular intervention is. Though it is difficult to take a case study and project this to a general population, nevertheless it is still useful when we encounter a patient with a similar presentation. Similarly, we have evidence from personal experience in practice. Much of scientific research is based on what practitioners have seen work consistently in practice (for example, Omega 3 oils were used in naturopathic practice many years before research confirmed their validity for use in inflammatory processes). This is the value in working with experienced practitioners who can truthfully say that a particular nutrient, drug, herb, or other treatment modality has worked for them for 20+ years.

In our naturopathic education we generally learn the historical use of a treatment first. I find this to be a good foundation to lay the rest of our knowledge upon. After this we take our knowledge of biochemistry and physiology to make an educated guess as to whether the historical use seems plausible. When combined with repeated case studies or a long history of personal experience, we can start to become more convinced that a particular intervention will work. Of course, when using these treatments in a clinical context, we must always take the individual patient into account, and tailor the treatment plan for that singular person.

What happens when scientific research contradicts personal experience or historical use? Well, we have two options: 1) reframe or alter our current model for the particular disease and treatment, or 2) evaluate the research for consistency between what/who we are treating and what the research states.

Whew, that was a lot, and I could write a whole lot more. Questions? Feel free to post them under the comments section.