In Search of the Holy Grail

By Bill Benda, MD, FACEP, FAAEM

Photo by speckyfish2000 via Flickr, used under the Creative Commons License.

I sat on an NIH panel a couple of weeks ago in Washington, D.C. Our mandate: to determine which of a few dozen grant applications deserved, through purity of methodology and virtue of intent, to be awarded funding by a commercial enterprise whose name I cannot reveal.

In fact, I wish I could tell about you the subject of the grants, or the people who sat on the panel with me, or the amount of monies given away, or how we determined who got the cash. But the NIH is very, very adamant that nothing ever, ever leaks to the outside world on what transpired those two days. Non-disclosure forms are signed, warnings are given, and papers and discs are shredded after the proceedings are completed. I imagine there is a sophisticated surveillance system set up in Bethesda, MD, to watch our every step, and should I inadvertently write the wrong words in this blog, an alarm sounds on the east coast: NIH Central Alert! Reviewer violation! Activate liquidation team! And within the hour an ominous black Prius would pull up in front of my house and bespectacled men in trench coats would emerge.

But I digress from the topic of this article. My time on the panel did serve to reinforce one particular belief I have harbored over the past couple of decades as I have explored the world of scientific investigation – that research, for all of its academic and cultural value, is not health care’s Holy Grail. It is not representative of any irrefutable fact, it is not the courier of absolute truth, and it certainly is nothing close to purity of thought and action.

Now before those of you who spend most of your waking hours in academia start sharpening your ninja swords, let me state firmly that research itself is indeed the best tool we have at our disposal to differentiate reality from fiction in the clinical arena. But it is a fragile tool, and prone to breakage and misuse. And I do hold a touch of credibility on this particular topic - I have conducted and published two randomized control trials (one funded by NCCAM), and have been providing peer review to six medical journals over the past decade or so. So I can state with some authority one thing that I have never seen echoed in any journal, except perhaps on the editorial page or in a letter to the editor, and that is: All research is flawed, and likely quite badly flawed.

Lets take a look at the process of publishing a study, from the first inkling of an idea to the final inking on the journal page. Someone, somewhere, comes up with a hypothesis. After much thinking and mulling, the hypothesis transmogrifies into a research plan–usually in conjunction with other co-investigators–then into a methodology, complete with inclusion and exclusion criteria, plans for statistical analysis, recruitment, carrying out the study, collation of data, actual statistical analysis, final conclusions, writing of the paper, peer review by a journal, revisions as requested by said journal (and perhaps repetition of this step several times), publication of the article, reading and attempted understanding by the subscriber and, finally perhaps, incorporation into clinical use.

There are countless steps where bias and error can creep into the final findings, and this doesn’t take into account influence by industry if the piece happens to be on a pharmaceutical or other medical appliance. And speaking of pharmaceuticals (and supplements), the study usually recruits a narrow demographic of males between this age and that age with this clinical condition but not complicated by that clinical condition (exclusion criteria!) and then treats at a specified dose for a set period of time. And if the positive findings are somewhat higher than the placebo effect, that pharmaceutical (or supplement) is marketed to men and women from 18 to 88 with all sorts of confounding conditions and with each very diverse patient getting pretty much the same dosage. This is part of the reason why, say, hormone replacement therapy protected against heart disease last month, but increases heart attacks this month, while protecting against breast cancer last year, but thought to stimulate breast cancer next year, and on, and on.

OK, I’m going to back up once more and restate a very important point: Research is the best tool we have at our disposal to differentiate reality from fiction in the clinical arena! But it’s simply not as perfect as we, and our media, purport. As I tell my students, no research study, no matter how well done, is the truth; it is simply another finger pointing in the general direction of the truth.

So the next time that your organization wants to put research at the top of its priority list, consider… Wait a minute...

I need to go. A black Prius just pulled up in front of my house.

President's Message: Remembering Dr. Konrad Kail and "The Run" Takes Off

By Carl Hangee-Bauer, ND, LAc
AANP President

Dr. Konrad Kail

In just the past several days, two events have occurred that have a profound impact on the naturopathic community.

I’m sad to report that the first is the passing of Dr. Konrad Kail on the morning of July 18th. Dr. Kail was diagnosed with malignant brain cancer several years ago and, with the dedicated support of his wife Petie, used both conventional and naturopathic treatments to fight this terrible disease. Unfortunately he finally succumbed and died peacefully in Petie’s arms in their home in the Phoenix area.

Dr. Kail was a force in our profession and a true leader who has left a mark that will endure for many years. He was a founder of SCNM and later chaired SCNM's Board of Trustees. He also chaired the Arizona State Board of Examiners and was the first naturopathic physician to sit on an NIH Advisory Council. Dr. Kail served a term as President of the AANP, which I remember well with his “One Person, One Project” campaign. Whenever there was a call for help to move some project forward, Dr. Kail was in the front of the line.

Konrad was a personal mentor for me, and he and Petie gave their time and wisdom generously. After California passed the Naturopathic Practice Act and I was making plans with my colleagues to expand our practice and transform it into a larger naturopathic medical clinic, they spent time with us sharing their experiences running a naturopathic practice, giving encouragement and advice on what worked for them, and helping us see the pitfalls and challenges that would lie ahead. They wanted to see this profession expand and see other doctors meet with success, and actively worked toward making that happen. I am sure we were not the only ones to benefit from Konrad and Petie's wisdom and experience.

Konrad was also an avid golfer, and I had the good fortune to play golf with him on multiple occasions when I visited Phoenix. On the golf course he was much the same as in his life as a naturopathic physician: bigger than life, bold, and a teacher. I will miss those outings.

Dr. Kail touched many of us in our journey in naturopathic medicine as a teacher, mentor, leader, scientist, researcher and entrepreneur. He will live on in our hearts and our history, and his wife Petie will always be a member of our naturopathic family. We will sorely miss his presence.

There’s one final note on Konrad that many of you may not know. In 1983, shortly after completing his studies at NCNM, he and a small group of NDs took a bicycle trip across the United States on their “Wheeling and Healing Tour” to introduce the public to naturopathic medicine. Through his radio and in-person interviews and connections with people along the way, many Americans got their first exposure to naturopathic medicine.

Similarly, on Sunday morning, July 17th, Dr. Dennis Godby, his sons Isaiah and Jeremiah, and his nephew Jonas Ely began their cross-country run from San Francisco, California, to raise awareness of naturopathic medicine and the true choices people have to empower themselves, improve their health, and prevent chronic disease such as diabetes and obesity. I had the pleasure and privilege to sponsor and plan the opening event as we sent Dennis and his entourage on its way, and along with David Schleich from NCNM, headed to Marin County to meet them at the end of the first day of their run.

The Run: Moving Natural Medicine Forward

As most of you know, they will pass through many small towns and big cities, from the streets of San Francisco to Main Street USA, carrying this message to thousands, perhaps millions of people along the way before ending in Bridgeport, Connecticut, in mid-November.

This is a win-win situation for our profession. Not only will their run raise awareness about naturopathic medicine and the choices it offers, it is also an opportunity for naturopathic physicians both along the route and in general to raise public awareness about their individual practices.

I urge you all to get involved and support The Run. If you are along the route, plan and sponsor a local event celebrating the runners as they pass through your town. Donate to their effort; Dr. Godby is sacrificing for this in many ways and needs our support. I donated a penny a mile for each of the 4 runners, a mere $130. If we all did this it would go a long way to meeting the goals for this historic run.

We had a lot of fun on Sunday and look forward to following Dr. Godby on his journey, and wish him all the best.

Horsing Around at the NIH

By Bill Benda, MD, FACEP, FAAEM

Image by the NICHD via Wikipedia.org, used under the Fair Use Doctrine.

An interesting thing happened to me back in February – I received a request from the National Institutes of Health to serve on a panel that would determine how to dole out quite a few millions of dollars to fund research in what the NIH refers to as Human-Animal Interaction (HAI), usually referred to as animal-assisted therapy. Apparently the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Nursing Research, and the WALTHAM Center for Pet Nutrition (the pet food division of the Mars company) had entered into a public-private partnership to pursue research on this topic.

My invitation, I am sure, was the result of having published two prior research studies (one part of an NCCAM Center grant) investigating the effect of hippotherapy (physical therapy on horseback) on children with spastic cerebral palsy. It seems that all of the other “experts” in this relatively tiny field had in fact applied for the current grants, leaving yours truly as a rather singularly available authority. The rest of the 35-plus members on the March review panel consisted of sociologists, psychologists, and behavioral scientists, with one or two other MDs thrown in for good measure.

The rather impressive vows of confidentiality we were asked to give preclude me from mentioning who was at the table, the nature of the submissions, or any aspect of the ensuing discussions, but that is not relevant to the gist of this blog report. What was most surprising was that exploration of this rather unique arena did not come from NCCAM, or in fact from any realm associated with the practice of alternative, or complementary, or holistic, or integrative, or naturopathic, or whatever-shall-we-call-it medicine. It came from pediatrics, nursing, and a pet food company. Surprising, as it awoke me to the fact that we do not have dominion over unconventional therapies, as our marketing brochures and indeed last February’s Institute of Medicine Summit on Integrative Medicine or last May’s North American Research Conference on Complementary and Integrative Medicine would have us believe.

This is a very, very good thing, especially for naturopathic medicine, because it confirms that no medical field, conventional or other, is able to usurp any clinical or research field as some have feared – the realm of healthcare is simply too slippery to remain within the grasp of any one profession. It’s sort of like the power of the Internet in China, or even here in the U.S. No government, or industry, or social experiment will ever control any culture or country or endeavor as long as people can find a way to share information with each other. Like in a blog.

By the way, if you may be wondering why the NIH has a new-found interest in the human-animal bond as a healing modality, keep in mind that there are over 750 equine therapy centers and over 2000 canine therapy programs up and running in our hospitals, cancer centers, nursing home, prisons, et al. – each with certified therapists and each with a waiting list stretching around the proverbial block. In other words, it exists, people are using it and paying for it out of pocket, and so we might as well research it and give it our medical stamp of approval.

Sound familiar?

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!