How Poppy Got Her Name and the Limitations of Evidence-Based Medicine

By Jacob Schor, ND, FABNO

Hamantaschen. Photo by stu_spivack via Flickr, used under the Creative Commons License.

Our dog Poppy was named on the 14^th day of the Hebrew month of Adar in the year 5765. It was Purim, the Jewish holiday that commemorates the deliverance of the Jewish people in the ancient Persian Empire from destruction by an evil advisor to the king, a story recorded in the Book of Esther. Our puppy was about 12 weeks old at the time and still unnamed. We had simply been calling her ‘puppy.’

Part of the celebration of Purim involves the making and sharing of pastries called hamantashen. These triangular shaped pastries traditionally contain fillings made of either poppy seed or prune. How far back the tradition of making them goes is unclear. The holiday of Purim itself has been celebrated for nearly two millennia. As both opium and prunes both originated in the general vicinity in which the Purim story occurred, one might assume the custom of eating hamantashen goes back equally far in time.

In our home, we take making hamantashen seriously. We actually own a special hand crank grinder designed just for crushing the poppy seeds to prepare the filling. And I must admit that my dear wife Rena Bloom makes the best hamantashen I’ve ever tasted.

One cannot, or at least should not, eat poppy seed hamantaschen alone. All poppy plant derivatives have, to a varying degree, the same effect on the intestines. They slow things down. Whether we are talking about opium, heroine, or just poppy seed filling, they all cause constipation.

Alternating the consumption of poppy seed hamantashen with prune filled hamantashen completely solves the problem. Prunes, as we are all well aware, have a laxative action. With ease, one can achieve a balance between the poppy and the prunes’ therapeutic actions.

Let me come back to the story of our dog’s name. Six years ago, during the feast of Purim, as we sat around the dinner table consuming the last plate of homemade hamantashen, my dear wife lifted her last fragment of poppy seed filled hamantashen into the air and declared, “I love poppy.” Our young dog, up to then who had only been referred to as ‘puppy’, assumed Rena was talking about her and came bounding over to us.

This memory came back to me as I was reading a soon-to-be-published study about prunes.

We may all know what eating too many prunes will do but, in truth, this is only anecdotal evidence and until recently an unproven fact. We live in the age of Evidence-Based Medicine (EBM) and according to the rules, we had no way to know whether the laxative effect attributed to prunes was real or merely a placebo effect. That worry is over.

A paper written by researchers from the University of Iowa College of Medicine will be published next month, April 2011, which will tell us that prunes really do help constipation.ⁱ

The researchers fed 40 constipated test subjects either prunes or psyllium powder daily for three weeks in amounts that supplied six grams per day of fiber. After three weeks, the subjects took a week off and then switched therapies. During the course of the experiment, the subjects kept careful diaries, tracking all sorts of details about bowel habits that we don’t really need to discuss here. Suffice to say that when the data were collated and analyzed, it was abundantly clear that prunes had a significant effect in doing what we all know they do.

This was not a perfect study by any means. It was only a single-blinded placebo controlled trial, not the hallmark double-blinded trial that modern medicine considers the gold standard. There were only 40 subjects, 37 of whom were female. One might easily argue that this study is insufficient evidence to base clinical decisions upon.

Still, it may be the first study that clearly demonstrates that prunes do what everyone has known they do since the Book of Esther was written in the third or fourth century BCE.

This points out the weakness of our current reliance on Evidence-Based Medicine (EBM). If we adhere faithfully to the tenets of EBM, we would be obligated to suggest sodium docusate to relieve constipation, a substance that the drug manufacturers have proven works. Or if we insist on a more natural approach, we might consider psyllium, a fiber that research suggests may work better than sodium docusate.ⁱⁱ Up until now, prunes were not evidence-based medicine; they were just food. Now we can say they work better than either of the other two therapies, at least in women.

When we are dealing with serious pharmaceutical agents, it is nice to have evidence that they are beneficial. That’s because they often come with unwanted side effects. It’s nice to know that they will do what they promise. Perhaps we don’t need to require the same degree of caution with simple food therapies such as prunes. And especially with things that have so obvious and well-acknowledged action, we may not need double-blinded, placebo-controlled randomized trials.

Some times we need to preserve a bit of common sense in the practice of medicine.

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ⁱ Attaluri A, Donahoe R, Valestin J, Brown K, Rao SS. Randomised clinical trial: dried plums (prunes) vs. psyllium for constipation. Aliment Pharmacol Ther. 2011 Apr;33(7):822-8.


ⁱⁱ McRorie JW, Daggy BP, Morel JG, Diersing PS, Miner PB, Robinson M. Psyllium is superior to docusate sodium for treatment of chronic constipation. Aliment Pharmacol Ther. 1998 May;12(5):491-7.

Remembering Daniel Leek

By Christine Girard, ND
AANP 2010 Physician of the Year

Daniel Leek, SCNM second year medical student. Photo courtesy of SCNM.

The Southwest College of Naturopathic Medicine mourns the loss of Daniel Leek, a second year medical student, in a tragic car crash that occurred Thanksgiving morning.

Dan grew up in Rockford, IL, and attended Southern Illinois University – Carbondale where he received three Bachelor’s of Arts Degrees: in psychology, physiology and biochemistry. He started his professional life as a senior research associate at the University of Chicago, conducting research in muscle physiology and molecular biology.

Dan started SCNM in the fall 2008 and made an immediate impression with his exuberance for experiential learning and his passion for research. Dan worked closely with Drs. Langland and Waters on research projects both at SCNM and at the ASU Biodesign Institute. He is an author on a recently submitted article, “Quantitative evaluation of the broad-spectrum anti-microbial activity of colloidal silver.”

In August 2010, Dan had the opportunity to speak before researchers and clinicians at the American Association of Naturopathic Physicians conference. He presented “The Regulation of Inflammatory Gene Expression by Immunostimulatory Botanicals” – and won the student research award which was presented at the formal awards ceremony that concludes the conference. He also presented research findings at the September 2010 SCNM Board of Trustees meeting – and wowed the Board members. Dr. Schwalm, the president of the Board, when informed of Dan’s passing extended his and the Board’s deepest sympathies for the loss our community has sustained.

Dan’s ultimate goal was to pursue a career in research, through an NIH post-doctoral fellowship, to expand knowledge in the area of naturopathic medicine.

Those who knew Dan, knew that he was a spiritual guy – and a guy with a big brain for big teachings whether the Bible, the Upanishads, Ram Dass, or quantum mechanics. Many of the stories about Dan involve hours-long conversations. He loved to talk about where we might go with a topic, be it spiritual or scientific.

Dan paraphrased Ram Dass by saying, “Moments of suffering in life are the fuel for bliss if interpreted spiritually.” Dan would want everyone to remember that.

Dan is well respected and well loved. He remains with us as an integral part of the fabric of the SCNM community. Memory Eternal!

The End of the Innocence

By Bill Benda, MD, FACEP, FAAEM

Photo by tibchris via Flickr, used under the Creative Commons License.

Yes, the time has come. After four captivating (and at times interminable) years, the “let’s let an MD on the Board” experiment has come to its predetermined end and the data has been analyzed. The following is my technical report:

It was very interesting.

It was interesting to learn that our commonality was actually based more upon similarities in personality and style then clinical expertise or professional ideology. Idealistic, aggressive, principled, paranoid, outspoken, insecure, clear on others’ shortcomings but in denial of our own, tilting at windmills to save the world – naturopathic medicine has been more a mirror of my own life than anything allopathic medicine has had to offer in 35 years of practice.

It was interesting to discover that our future lies in fact upon the shoulders of our students, and not in the posturing and proclamations of those who claim to really, really know what is best for us.

It was interesting to feel the buffeting between the forces of science and intuition, observing the quick footwork as “evidence-based medicine” shuffles to keep up with the fact that evidence constantly changes with the analytical tides, while intuition remains an immovable constant that no academic text or research submission can ever hope to emulate.

It was interesting to experience the unceasing anger and derision directed at my own professional heritage, allopathic medicine, partly deserved in your struggle for equity, and partly an old story somehow needing to be retold within every conference hall or blog conversation.

It was interesting to feel like a father at a birth, not really allowed to get my hands into the actual delivery, but still knowing I had something to do with the blessed event, even now as I cut the cord.

It was actually far more than simply interesting – it was exhilarating, and painful, and fulfilling, and empty, and all the things we feel when we really do commit to a relationship knowing full well that it will someday come to an end. But of course I cannot hope to write of these things and expect they will be allowed in print, so I will leave this at goodbye.

So goodbye, dear naturopaths – I leave you in mostly good hands, grateful for the time that I have had with you, and how my life is the better for it. Goodbye to my fellow board members past and present – hopefully you have grown as I have, but with a fraction of the irascibility and frustration. Goodbye to Karen and David and Jan and all who have dedicated your emotional lives to this profession – you can still call on me to be your hit man from time to time if you find you just can’t pull the trigger yourselves.

Goodbye. Another adventure awaits . . .

President's Message: Science and Naturopathic Medicine

By Carl Hangee-Bauer, ND, LAc
AANP President

Photo by CIAT - International Center for Tropical Agriculture via Flickr, used under the Creative Commons License.

When I was a teenager, my first career choice was marine biology. Growing up along the coast in Florida, I spent much of my spare time in nature and in the water, enjoying the marvels of life and the natural world around me, and I still spend most of my vacations in natural settings and in the water. In school, I was a science geek and took every course in biology, chemistry, physics, etc., I could. When I went to college at Florida State University, my major was Biology, with dual minors in Chemistry and Physics. It was during my four-year stint in the United States Army that my attention was redirected to the medical field (I was a Medical Service Corps Officer), which eventually led me to naturopathic medicine and my true life career.

I tell you this to let you know that I am no stranger to science. I still find it fascinating and appreciate the many ways it helps us understand the workings of nature and the world, helping us separate what appears to be the truth of things from reality. Studying naturopathic medicine, and especially acupuncture, presented me with many challenges, and I learned along the way that our medicine, as well as all other systems of medicine, are really a combination of science and art. When we work with our patients, we draw from both in order to stimulate the vis and provide well-rounded care to our patients.

Thus it has become an increasing concern to me when I read articles and blogs on the Internet blasting naturopathic medicine for being “unscientific.” These frequently polemic articles, while professing to come from scientific logic, to my eye are biased misrepresentations of the truth. They often lambast our profession and philosophy as unscientific, yet I have yet to see any one of them provide a critical analysis of research done by naturopathic physicians and researchers. It is sad that science can be used in these political ways.

This is important. As a student at Bastyr University, I remember Dr. Joe Pizzorno saying that if our profession is to be taken seriously by the larger world of medicine, we must speak in a language that everyone can understand and appreciate. That language is the language of science, and few have done more over the past 25 years than Dr. Pizzorno to increase the credibility of the naturopathic profession using this approach. While I think we all can agree that we draw both from science as well as traditional practices and experiences when evaluating the efficacy of our therapies and approaches to practicing medicine, advancing the research and science agenda remains an important step for our profession to move forward, especially with the continued interest in evidence-based approaches to health care.

Fortunately there is now a great effort within the profession to advance our understanding of how science informs naturopathic practice, especially in the realm of whole practice approaches to health issues. Dr. Michael Cronin, the AANP’s President-Elect, has been a strong advocate on the AANP Board for promoting scientific affairs. The Naturopathic Physicians Research Institute (NPRI), headed by Dr. Carlo Calabrese, is a group of academic and community clinicians, clinical researchers and other health scientists whose aim is to increase the amount of original data and analysis on the practice of naturopathic medicine for the purposes of its documentation and improvement, the discovery of potentially generalizable health applications, and to inform policy. And, of course, there is active research going on presently at all of our naturopathic colleges by well-trained and experienced researchers who are testing the theories and practices of naturopathic medicine. Much of the discussion I’ve heard lately focuses on studies of whole practice approaches to health care versus single agent actions.

On August 16, 2011, the Tuesday before the start of the 2011 AANP Convention, the AANP will be sponsoring a scientific summit. While only in the early stages of planning, it promises to be a gathering for the different players in the naturopathic profession to connect and define how the AANP mission, naturopathic research, and evidence-informed health policy can join and result in healthier patients, a more effective health-care system, and a flourishing naturopathic profession. Core discussion points will include articulating policy and practice issues driving our research agenda, where the profession is now and what future possibilities exist, and defining the core research questions relating to safety, effectiveness, and costs.

The AANP Board and many in our profession agree that where possible providing a scientific basis for our therapies and for the naturopathic approach is an important step in growing our professions credibility and inclusion in the greater health care system. How we prioritize this and communicate to the public is of vital importance.

I hope to see many of you there.