About Us

Ann McKay, R.N.C., John McGonigle, M.D. and Mark Brody, M.D. have devoted themselves to homeopathy and related alternative medical treatments. In keeping with the spirit of homeopathy's founder Samuel Hahnemann M.D., we utilize treatments that emphasize safety and the restoration of the sick to health.

Sunday, December 28, 2008

Sustainable Medicine

If you read the newspapers, or, as in my case, the e-paper, you may have noticed that the buzzword of the times seems to be "sustainable." References are commonly made in the press to sustainable energy resources, sustainable agriculture, sustainable economic policy, and sustainable environmental policy. So much has this term appeared in the press lately that one might consider it symbolic of a new zeitgeist -- one of preservation, of a growing awareness of our limitations as a country and even as a species.

For those of you familiar with the current homeopathic theories about the periodic table, you might recognize in this transformation the characteristics of the twelfth or even the thirteenth row of the periodic table, as described by Scholten, Sankaran and others. The twelfth stage is one where the structure (analogize freely to person, group, or nation) has gone beyond its apex, and is now clearly in decline, and desperate efforts to shore up its weaknesses are being made. There is a feeling of crisis (Jayesh Shah observed this) -- that unless some drastic measures are rapidly implemented against the growing threats that are mounting, the system will go into decline. By the thirteenth row, there is already the beginning of a feeling that the structure's best days are behind it, and the most that can be done is to try to prevent further damage to its integrity. The situation remains desperate, but now there has been measurable damage done, and the structure is weakened.

There is a crisis of global warming, a crisis of pollution more generally -- there are toxins in our food, in our commodities, and in every life-sustaining natural resource, and a crisis in our economy -- we've mortgaged our future and can't keep up the payments. The first decade of the twenty first century may be remembered as a time where the United States moved from maturity into middle age. The question is being asked nowadays what kind of old age lies ahead of us -- one of continued decline into progressively greater states of debility, or one of stable sustenance of a lower level of productivity, but with the gracefulness and wisdom that can be attendant to the latter years of life. Graceful decline sows the seeds for healthy renewal. The karma that we accumulate in these years of our lives benefits the next generation.

In medicine, the awareness of its non-sustainability has grown more slowly. Government, businesses, doctors, health care administrators, health insurance companies, and the public has been aware for at least two if not three decades that there were serious problems in the economic viability of our health care system. Since the Hillary debacle of the early 1990's, the government has sat in nearly paralyzed silence as the crisis has mounted. In the past two years there has been a growth in community health centers, thanks to legislation passed in 2006 to make funds available to promote their development. But the number of uninsured has remained relatively stable at about 16% of the population, and the costs of health care have grown yearly at triple or quadruple the rate of inflation over this time. The Medicare Part D plan has led to many Medicare recipients simply not taking their medications since they can't pass through the dough-nut hole. Businesses continue to shed health care costs at increasing rates because they are unaffordable. Yet in all of this spiralling of health care costs, we rarely hear that our health care system is unsustainable.

The elephant in the room won't go away, although noone likes to admit its presence. Cadillac care for all simply can't be bought, unless it is with Madoff money -- that is with money that isn't there. But who is talking about down-sizing the health care system? Instead, the main focus nowadays seems to be on increasing coverage for the uninsured and the underinsured. We are trying to prop up a system that is collapsing under its own weight. The tree simply won't support Horton the Elephant any more and (with apologies to Dr. Suess) the egg is cracking under his massive weight.

Bloomingdale's style health care has to go, and no one is willing to say it. In part the reluctance to acknowledge that we have to cut health care expenditures is based on the misconception that no safe alternatives to Bloomingdale care exists. It is also based on the fact that cost-saving measures, while good for the public and the government, are bad for the health care industry, which thrives on copious health care spending. The more health care is consumed, the more money for doctors, hospitals, the pharmaceutical and medical device industry, and for health care corporations. Insurance companies do not benefit directly from greater health care consumption, as their costs rise, but the need for health insurance just increases as expenses sky-rocket, so their product is in greater demand.

If an inexpensive wonder-drug came along that would cure 90% of people of 90% of their problems, it would spell disaster for the health care industry. A healthy population would consume less health care. Doctors, hospitals, nurses and countless bureaucrats and administrators would have to close their businesses. The health care industry would be a victim of its own success, and would probably get in line for the next big government bailout. So who in the health care industry wants a healthy population, when it means economic ruination? Homeopathy has been "dissed" for centuries for many reasons, but this one may be the best one yet. Homeopathy purports to cure at least 90% of health problems, although probably not at a 90% rate. Still, with skillful care, at least 50% can be substantially benefited or cured, and in the hands of experts 75% - 80% cure rates have been reported. Homeopathy is accustomed to being treated as a cipher, notwithstanding the growing body of evidence that has accumulated to support it. But it is the lack of economic utility towards sustaining the medical industrial complex that will help to keep it from becoming a more popular form of treatment. Medical care is still in the 11th stage of the periodic table. There is a perception of threat, but the feeling exists (in spite of the obvious evidence that contradicts it) that the structure is sustainable. Like all that grows, the health care system too will age, and when it reaches stage 12 or 13, homeopathy will be ready to be called into service. Because homeopathy is that wonder-medicine. Understandably, those unfamiliar with it will smile at this proclamation with self-assured skepticism, but those familiar with homeopathy know it to be true, since they have experienced it themselves, are acquainted with the scientific evidence, and see it daily, if they are practitioners, in their practices. Cheap, effective, safe treatment. What could be better? What could be more sustainable? Our time will come.

Friday, December 19, 2008

"Not" Research

When my 2 year old daughter Aviva becomes unspeakably tired, she sometimes moans, "I don't want to go to bed!" When she isn't sure what she wants to eat, she often stubbornly insists on being given the "whole thing" and then leaves the "whole thing" on the table, with perhaps a nibble removed. This perverse tendency towards opposites is not just a phenomenon of two year olds. It appears as a kind of systemetized madness in our world in general and in particular in the world of modern medicine. The "No Child Left Behind" act of our waning administration turns out to be an unfunded mandate, leaving behind every child it purports to help. The law governing the timber industry pushed through by the Bush administration which was sold as a way of protecting the environment earned the moniker "The No Tree Left Behind" act by the environmentalists who exposed its hidden agenda, which was to allow an increase in logging on previously protected lands. "Investment" in today's marketplace, as Paul Krugman points out in a recent editorial in The New York Times, often turns out to be joining a kind of "Ponzi economy" where you let the rich steal your money and you end up in bankruptcy court. I sometimes wonder whether we are we the "not" generation?

Modern medicine has been riding under the banner of "evidence-based medicine" for many years now. This is in many ways yet another ironic hoax, however well meaning, that doctors, researchers, and the public have allowed themselves to be taken in by. As usual, it has been exploited fully by those who tend to profit from it, such as drug companies and the research industry itself. Evidence-based medicine all too often turns out to be (you guessed it) stealth advertising. Naturally, evidence-based medicine is being promoted as an antidote to the kind of irrational and misleading information that advertising is famous for. Not! The campaign to promote evidence based medicine has become an example of science becoming not-science, of salesmanship masquerading as evidence -- it is a wolf in sheep's clothing. While this may not be true for all medical research, I find it hard nowadays to pick up a journal and find an article that is free from the "not" wisdom that poisons our times. It is ironic (but perhaps not surprising) in this "information" age, where through the internet, cell phones, i-phones, and blackberries we can rapidly access more information than was ever before imaginable that so much of it seems to be "not" information.

Let's take a guided tour of a recent example of "medical science" that illustrates this point. This "research" article is contaminated by lies, misrepresentation, and distortion -- enough to make the most aggressive salesman blush. Yesterday, a sales rep left me (red flag) a copy of an article recently published in the Journal of Affective Diseases (109 (2008)252-263). The article is entitled "Efficacy and Safety of Quetiapine in Combination with Lithium or Divalproex for Maintenance of Patients with Bipolar I Disorder." The abstract concludes resoundingly with this bold summation: "Quetiapine with lithium/divalproex can provide an effective long-term treatment option for bipolar I disorder to prevent recurrences not only of mania but also depression." Taken at face value, it would appear that this claim should be considered as a tremendous step forward in the treatment of bipolar disorder. Since many of us doctors are too busy to read scientific articles in depth, to say nothing of critically, this take home message may be what we are left with (this, I believe is what the authors hope). Examining the claim carefully, one might reasonably infer that quetiapine, in combination with lithium or valproex is effective in preventing recurrence of both mania and depression in bipolar disorder.

Eureka! If true, this is the answer that researchers have been searching for for decades -- an effective way of preventing the recurrence of manic or depressive episodes in bipolar patients. Shouldn't this make the national news, if it is indeed the case? Not only that, the article implies that this treatment is just one of many "treatment options" that are available that "prevent" the recurrence of mania and depression in bipolar disorder (although these options are not mentioned in the article). Put to rest your worries, patients and families of patients with bipolar disorder, one need not worry about future recurrences of this illness, if only you or your family member take quetiapine with either valproex or lithium. What a relief!

But not so fast! Elsewhere in the article, the authors write that the addition of quetiapine to valproex or lithium actually only "increased the time to recurrence of any 'mood event' compared with placebo plus lithium or divalproex. In other words, you still get recurrences, but it takes on average longer to get them. Well, that's a different kettle of fish! What happened to "prevent"? A close reading of the article reveals that there are also methodologic limitations, which resulted in the exclusion of many patients who could not be excluded if that patient happened to belong to you, the treating doctor, because they didn't fit the research protocol neatly enough.

The authors also highlight in their introduction that the current treatments available for bipolar disease have "significant safety and tolerability issues." Yet in this particular study, they conclude that the "long term treatment with quetiapine plus lithium or divalproex was generally well tolerated." How can this be, since all of these medications (quetiapine, lithium, and divalproex) are examples of the very treatments which the authors refer to in their earlier criticism of the safety and tolerability of bipolar medications? Finally, in a last ditch effort to dust off the safety record of the drug quetiapine, whose reputation they clearly are attempting to elevate, they say that although there were "increases in weight, lipids and glucose with the addition of quetiapine...", "further long term research studies are required to fully assess the consequence of change in [these] metabolic parameters..." In other words, they imply that bad effects should not necessarily be accepted as valid until further research produces evidence that they are as bad as they sound, but the good effects should be accepted without the need for further research to see if they are indeed as valid as they sound. Ahem!

They conclude that the "results from this study suggest that those two combinations [quetiapine plus lithium or valproex] may carry a positive benefit-risk ratio for the long term treatment of bipolar disorder..." Well, why may carry? Why not does carry? The reasons are clear. This treatment option is not clearly safe. In saying that the treatment may carry a positive benefit-risk ration, the authors implicitly acknowledge that the drugs tested actually may not carry a positive benefit-risk ratio. The word may is one of the most common words I see in medical research articles in the conclusions section. Nobody wants to commit, because, after all, most results are just suggestive, and almost never conclusive. I have found that the only thing one can safely count on in a medical reseach article is that in the body of the text the need for further research will be unquestionably endorsed. And so the research goes on, and on, and on.

I've become so used to these deflating qualifications to research, which are invariably paired with overstated conclusions, that I sometimes feel like I would imagine an experienced chess player feels, who easily finds the weaknesses in his beginning opponent's position. You know they are there, it's just a matter of spending the time, and you will almost surely find them. It's a shame that the authors misstate their conclusions. One can see they desperately want to offer something helpful, and as a result are drawn towards making inaccurate, false or misleading statements. The fact is, in this article, quetiapine did actually decrease the relapse time to the next "mood event." This is a limited but significant finding. If only the authors would acknowledge the full limitations of their work, instead of overstating it, they would not undermine their credibility so much.

Aviva doesn't cause too much trouble juxtaposing her opposites. She may complain about not wanting to go to bed, but she still gets put to bed. Sometimes I wish I could put this misleading research to bed too, but the researchers never seem to sleep.

Friday, December 12, 2008

Immunizations: controversy or non-controversy?

Recently NPR ran a piece about a woman who asked questions about the safety of vaccinations for her child. She was somehow connected with a leading vaccine "expert" who "educated" her about vaccinations. This physician was well supplied with research data which lent support to the idea that vaccines are both safe and effective. The women told how she went from being skeptical of vaccinations to being militantly against the non-vaccinators in this world, who she felt just freeloaded the benefits of vaccination without going through the trouble of vaccinating themselves or others. My colleague in homeopathic practice, Dr. Jon McGonigle, recently gave a talk at a local hospital in which he presented the case for thoughtful consideration of the safety and efficacy of vaccinations. His opponent, who argued the case for vaccination, attempted to shut down such thoughtfulness by presenting volumes of research data supporting vaccination.

To supporters of vaccination, those who question it must seem like spoil-sports or stubborn contrarians who obnoxiously refuse to accept what is clear and obvious. With such voluminous data supporting the safety and efficacy of vaccinations, who but the most mule-headed could continue to question the wisdom of vaccination? Is there any reasonable basis to doubt the evidence that would seem to make the widespread use of vaccinations a virtual no-brainer?

I do not claim to be an expert in vaccinations, but I have read about the topic and am familiar with the arguments on both sides. As a physician, I find the research evidence compelling, but I also find it impossible to ignore the arguments that have been raised against vaccination. I am not an anti-vaccinationist. Still, reason dictates (to me, at least) that a wiser course of action is to neither blindly accept the vaccinationists or the anti-vaccinationists positions, and to maintain an open-minded attitude about vaccinations. Indeed, you should not allow your minds to be shut to the thoughtful process of evaluation of anything your doctor recommends, and I include myself here, whether it be vaccination or any other medical intervention. Your brain has a purpose: use it!

The research evidence for vaccinations speaks for itself. It uses the instrument of statistics to demonstrate that vaccinations are both safe and effective. The statistics are there and their validity is in general quite impressive. In areas of the world where infectious disease is endemic, research has shown that incidence of these infectious diseases, along with subsequent mortality and morbidity has dropped dramatically and in some cases (polio and smallpox) disappeared entirely (see the National Network for Vaccinations website) with the introduction of vaccination programs. As usual, the problem with statistical methods is not usually in the statistics themselves, but with their interpretation. This is what led Mark Twain to observe that "there are lies, there are damn lies, and there are statistics." Caution in the interpretation of statistics is rarely in evidence in medical journal articles. Indeed it is not uncommon to find unjustified claims of safety and efficacy in the title, abstract or conclusions of a scientific medical research article. These mistakes have led to tragic errors of medical judgment such as with Thalidomide, Diethystilbestrol and Vioxx, to name but a few. Let us therefore survey briefly some of the problems with vaccinations that have been raised for the most part by those who come from the "safety first" camp. Consider the following facts that have been reported in various sources as you evaluate the merit of vaccinations:

  1. The incidence of infectious disease began to drop markedly in the early and mid-twentieth century well before the introduction of massive vaccination in the 1950's and 1960's. This has been widely attributed to improvements in public health and greater awareness of hygienic practice. This trend continued after the introduction of vaccinations. Whether the continuation of the trend represents a continued effect of improved public health practices or the effects of the vaccination program, or both has not been proven.

  2. There is a well established record of vaccine injuries. Indeed the government established a national vaccine injury compensation program for such people, so even our government acknowledges that vaccines can be harmful. Congress enacted a law in 1986 ("The National Vaccine Injury Compensation Program" (NVICP) in response to information about multitudes of children who had become sick or even died after vaccinations. Some reports have linked vaccinations in infancy to SIDS (Sudden Infant Death Syndrome). These include findings by Australia's Viera Scheibner, PhD, which revealed an increased incidence in SIDS among infants after vaccination. There have been 100's of children whose parents have developed autism within weeks or months after vaccination. Their efforts to obtain compensation through NVICP have, with a few notable exceptions, been rejected because statistics do not support their claim of a cause and effect relationship between vaccination and their children's illness.
  3. Many people who have been vaccinated fail to acheive immunity (as measured by antibody titers found in their blood) or, for whatever reason, become infected in spite of being vaccinated. Infants in particular, whose immune systems are underdeveloped are prone to this, which is a reason for frequent revaccination during the first year of life. This has also led to the addition of "adjuvants" or immune enhancers to trick the immune system into responding more robustly than it naturally would. By asking the immune system to respond in an abnormal way, it is assumed there is no payback or fallout, but in fact the economy of nature would suggest otherwise (there are no free lunches).

  4. For some illnesses, such as influenza, those who would benefit most from the vaccination, such as infants and the elderly, because of their vulnerability to develop more serious and potentially dangerous forms of the illness are also least likely to develop a protective antibody response to the vaccination because of weaker immune function. This is the case with influenza, and possibly some other vaccinations, such as pneumovax. In addition, vaccination for influenza is from last year's strain of influenza (from which the vaccine has been cultured) and may or may not be relevant for the current year's influenza strain, which can not be determined until mass outbreaks occur.

  5. There are many case reports in the scientific literature and reported in other journals of children who received vaccinations who developed autism or developmental regression soon after receiving vaccines. While the research has thus far not established a statistically verifiable connection between autism and MMR (the vaccine most often implicated in the development of autism), the parents of these autistic children have repeatedly testified that their children showed dramatic negative changes in their health soon after vaccination and would likely be unpersuaded by (and probably furious with) anyone who tried to tell them that vaccines are safe. Indeed, there are a few reported cases where the government has offered compensation to the parents of children who have become autistic after vaccination, in spite of NVICP's general policy of denial of such suits.

  6. It is known that infant's immune systems are immature, yet it is considered without substantial risk to embark upon a course of extensive vaccination for them. Children may be vaccinated within hours of emerging from the womb. Hepatitis B vaccination is usually begun within hours of birth, and while it appears to have led to a reduction in the incidence of Hepatitis B, there have been reports of immune and immunologic damage following Hepatitis B vaccination. This may be because the infant's immune system is not prepared to handle foreign proteins injected internally.

  7. The incidence of autism, asthma, ADHD, allergies and other chronic illness is rising with no credible reason offered by the medical profession. The development of chronic illness when acute illness is suppressed is consistent with the homeopathic concept that suppression of illness tends to lead to the development of more serious and more chronic illness. Indeed, the costs of health care in the United States are growing by leaps and bounds, so while we may celebrate the decreased incidence of infectious disease, we can not necessarily conclude that we as a society are healthier as a result of vaccination. Many have argued that there is a price to good health, but the reverse logic is equally credible -- namely, that the healthier we are, the less health care we should need.

  8. There seems to be no limit to the number of vaccinations our children can be given without raising questions about their benefits. While each individual vaccination comes with its body of research evidence, no concerns ever seem to be raised about the number of vaccines we subject ourselves and our children to. The more, the better seems to be the underlying assumption. This raises the question whether the actual risk may be greater than the sum of each individual risk -- a synergism of multiple vaccinations. It is well known to be the case with medications, where polypharmacy is regarded in most medical circles as a dangerous practice, or at least one best avoided if possible. During the first year of life, the CDC recommends a total of 7 different types of vaccines, given a total of 18 times. Over the first 15 months of life, there are 12 different recommended vaccines, given a total of 27 times. Gardasil is now being considered as another mandatory vaccination. (Since I first posted this blog one month ago, 2 rotavirus vaccines in the first 8 months of life have been added to the list of recommended vaccinations by the American Academy of Pediatrics.) Where do we stop? Nowhere, or only when it is clear we have gone too far, when the damage is widespread and irreversible?

  9. We have been given reassurances many times about the safety of medical treatments that seem to challenge common sense, only to find later that the data had been misinterpreted, or methodologically flawed. In addition to misinterpretation, research data may be fudged, suppressed, used in restricted population groups which don't relate to the public in general. The dangers of long term effects may not be apparant in short term or even extended trials, only to raise their ugly heads later, after many have died or been permanently maimed. Medical research has emphasised efficacy over safety for centuries. Hahnemann warned of this back in the early nineteenth century, when he referred to primary and secondary effects of medicines: the good effects came first, and the heavy price often came second. In short, research data can no longer be trusted the way it once was. People have been killed or maimed too often by treatments which the government, medical researchers, and physicians themselves have calmly and self-confidently proclaimed to be entirely safe.

  10. There is increased evidence that we must try to live in harmony with nature, not try to master it. The triumph of vaccination has helped to eliminate illnesses that were once the scourge of humanity: polio and smallpox for example. But now new infectious agents arise that are proving even more challenging, such as AIDS, MRSA, and possibly new strains of influenza (bird flu). Humans have tried to master nature for their safety, pleasure and comfort. We have found however, that our use of fossil fuels, commercial agriculture, and technology has proven imprudent. We did not forsee the problems of pollution, such as global warming, toxins in our food, in the toys of our children, in the water we drink, and in the air we breath. We did not forsee the effects of commercial agriculture on the quality of our food, which has now affected the quality of our health. Thinking that we can ride roughshod over mother nature has proven to be misguided. The use of antibiotics has led to the appearance of MRSA, clostridium difficile, pseudomonas, and resistant strains of tuberculosis. Antibiotic use can also lead to fungal infections, and to the selection of multiple antibiotic resistant bacterial strains. As we continue to make "progress" technologically, we wipe out species of plants and animals. When do we stop to consider the possibility of living harmoniously with nature, rather than destroying, in General Sherman-like manner, every part of it that lies in our path?

  11. Some may say that one can't live harmoniously with small pox, plague, polio or leprosy. Homeopathy is able to prophylax against most infectious disease with some success (albeit possibly with less overall efficacy than vaccination). It can also treat most acute infectious illness including viral illness, again with considerable, but not total success. Homeopathic treatment virtually never results in any serious morbidity or mortality. It also provides a means of living harmoniously with nature. It does not have dangerous or lethal side effects. The worst that can be said about it is that it is not perfect. It does not wipe out infectious organisms or the diseases they cause. But it also does not cause holes in the ecosystem which later may be filled by even more pathogenic organisms. It does not pollute or destroy the environment. It does not suppress acute illness and in the process create chronic illness. It is a reasonable alternative to vaccination for many or most infectious illnesses, but it may not alway confer the degree of protection we would like to have.

In sum, vaccination has been shown by numerous studies to be effective in reducing the incidence of certain infectious diseases, but it has not proven to be equally effective for all, and it has a compromised safety record. It is touted as being a wise choice without sufficient regard for the long-term and short-term risks, both to ourselves and to the ecosystem. It is difficult not to succumb to the temptation to protect ourselves and our children from frightening diseases. But we must remember that while we protect with one stroke, we may be opening ourselves up to other dangers with another. We simply do not know the long term consequences of vaccination. Vaccination should be considered a useful option, probably some vaccines more than others (Diphtheria and Tetanus appear to be among the safest), and particularly in situations where epidemics are present or threatening, but it may or may not be a wise choice as routine treatment for ourselves or our children. It is not the no-brainer choice that it has been held up to be. It warrants careful thought, and much further research. This research will not occur as long as there is blind acceptance of the safety and efficacy of vaccines and as long as an attitude that discourages thoughtful reflection upon the research data persists in the medical community.