by Jacob Teitelbaum, M.D.
WHY most physicians do not focus on natural medicine for pain
If pain management is to be adequate, it will be necessary for medical schools to do a better job training physicians and/or recognize that it may be necessary for non-M.D.s to be given the legal right to prescribe, so that they may appropriately take over this role. With pain being such a common problem, one would wonder why more physicians don’t specialize in its treatment. As is often the case in medicine, it boils down to dollars and cents.
Insurance companies pay poorly for a doctor’s time, unless
they are doing a procedure. If one is doing surgery or a heart
catheterization, for example, or even setting a broken bone,
s/he will be paid handsomely. If, on the other hand, the doctor
is predominantly spending time listening, data-gathering or
doing an examination so that s/he can make a proper diagnosis,
the insurance company will often pay less than the physician’s
overhead. Basically, the insurance companies pay for the average eight-minute doctor visit. If the doctor spends more
than this on your case, without doing other procedures or
testing that s/he gets reimbursed for, the doctor is likely going
to lose money.
The evaluation of pain is a complex and time-consuming
process. For reasons that escape me, insurance companies by
and large will also not pay for time spent doing simple yet
highly effective pain management procedures such as trigger
point injections or stretch and spray. By not paying adequately
for safe and effective procedures, more and more patients are
forced into surgery, medications or nerve blocks which are
often far more expensive, riskier and less effective. If you have
a physician who spends the time needed to take a proper history
and do a proper examination and who has taken the time
to learn trigger point injections and/or stretch and spray and
uses these techniques, it is unlikely that s/he will be able to
stay in business if s/he accepts what your insurance company
pays as payment in full.
In addition to being poorly reimbursed by insurance companies,
pain specialists are often faced with patients who require
narcotics for severe and chronic pain. Because of the current
political climate, pain specialists sometimes are threatened
with the loss of their license and are sometimes even arrested
for the appropriate prescribing of these medications. This is the
risk faced by pain specialists every time they prescribe a narcotic
medication—no matter how appropriately it is given. This
causes major problems for pain doctors, pharmacists and suffering
patients. In a front-page article in the Washington Post,
Attorney General John Ashcroft was quoted as saying that
arrests of pain specialists who prescribe Oxycontin show “our
commitment to bring to justice all those who traffic in this very
dangerous drug.” The doctor is presumed guilty until proven
innocent and is often judged by people who are incredibly hostile
to the use of narcotics in chronic pain patients.
In the same article, Russell Portenoy, a pain specialist at
Beth Israel Medical Center in New York, who is considered one
of the fathers of modern pain management, notes “15 years of
progress in treating patients in chronic pain could really be
wiped away if these prosecutions continue . . . treating people
in pain isn’t easy and there aren’t black-and-white answers . . .
but what’s happening now is that the medical ambiguity is
being turned into allegations of criminal behavior. We have to
draw a line in the sand here, or else the treatment will be lost,
and millions of patients will suffer.” In the same article,
Rebecca Patchin, a pain specialist who is a board member of
the AMA, notes that an estimated 50 million Americans live
with chronic pain. She says that almost half of all Americans
will seek care for persistent pain sometime during their lives, but that many will not receive the treatment they need. She
notes that “Doctors hear what’s happening to other physicians
. . . and that makes them very reluctant to prescribe opiates
that patients might well need. Unfortunately, it will not be
doctors who get these misguided laws changed. The doctors
attempting to get the laws changed can make themselves targets
for those who would take away their medical licenses. It
will come only when patients make it clear to their senators and representatives (and the
president) that they demand the right to proper
care without being treated like drug addicts.
Otherwise, many government officials seem to
live by the saying that “all pain is tolerable—as
long as it is somebody else’s.” We live in a
democracy—be heard, be clear, and make your
vote count. The article in the Washington Post
mentions a group called the “Pain Relief
Network”(see www.PainReliefNetwork.org)
that is fighting for your right to be pain free.
The good news is that the large majority of patients with pain can become pain free without narcotics by using
the principles in my book.* Although I recommend that you make
your voice heard, I would direct most of your energy into getting
your life back. You can do this now, without waiting for the government
to act.
Things are already starting to change. Doctors are interested
in learning more about pain management. For example,
a survey of 247 physicians from various specialties showed
that 96 percent were dissatisfied with the training they received
in medical school about opiates and 84 percent were dissatisfied with such training during residencies and fellowships. For
patients with persistent pain, 82 percent of providers were
uncomfortable prescribing opiates for more than three months;
42 percent said they were not prescribing opiates properly and
34 percent were not sure whether they were properly prescribing
them. Nearly all (94 percent) said that further courses
in opioid management would help them in their practices.
The relationship between prescription and natural medicine
Standard allopathic medicine, which focuses predominantly
on prescriptions and surgery, offers powerful new techniques
that fall outside of what is found in nature. Because they are
tailored to specifically suppress certain reactions in the body,
they can at times be more powerful than natural medicines.
Experience shows, however, that they are also far more likely to
be toxic. As the pharmaceutical industry is driven largely by
financial motivations (this is not necessarily a bad thing—simply how our capitalist system is structured), the ability of a
prescription to make money is usually the predominant driving
force. Although physicians are well meaning, they sometimes
attempt to make sure that anyone who is a different religion
than “scientism” is legally prevented from practicing. They
also simply ignore any scientific data that does not fit their
belief system.
But can’t we rely on the results of scientific studies?
I wish this were always so. Unfortunately, both clinical experience
and research has shown that “troubling financial links
between pharmaceutical firms and academic scientists are pervasive and may impact the research process.” In a recent
study published in the Journal of the American Medical
Association, researchers led by Yale’s Cary Gross found that
industry funding makes it 3.6 times more likely that a study
result will be favorable to the sponsor. What makes this interesting
is that many doctors and academics would not dream
of publishing or relying on a study that is not placebo placebo controlled,
because this increases the chance of positive
outcome by 30 percent. On the other hand, that the drug
companies’ paying for a study increases the chance of a positive
outcome by 360 percent does not seem to affect
whether they will rely on or publish that study. The Yale study
also showed that one quarter of medical researchers have
financial ties to companies whose products they are
studying, while approximately two thirds of the schools have
financial ties.
That the study is paid for by the drug company can affect
results in a number of ways. For example, as a physician, I have
often seen study designs that markedly favor the sponsor’s
drug. They would use the proper dose of the sponsor’s drug,
but too low a dose of the competitor’s drugs. In addition, if the
study does not give a favorable outcome, the company will not
allow the data to be published and journals are less likely to
publish studies showing a negative outcome because this is
considered boring or less important. The exception to this is
that they are happy to publish studies that reflect negatively on
natural remedies, no matter how poorly the study was done,
yet are often unwilling to publish studies that show a positive
effect from natural therapies.
The Center for Science in the Public Interest says, “There
is a lot of idealism about how science is isolated and objective.
Unfortunately, that’s not the case. Money can
absolutely influence scientists.” In addition, despite the
heavy biases of studies that are paid for by the drug companies,
the FDA still uses that data in assessing whether a
drug will be approved, as drug companies funded nearly 60
percent of medical research in the United States (spending
over $30 billion last year). In addition to spending an enormous
amount on television and other advertising, they have
enormous clout with both the medical and media establishments.
Basically, upsetting them by saying anything bad
about them can be a very expensive mistake. As a medical
journal editor, one tries very hard to maintain objectivity.
This is one reason for my policy of not taking money from
any company whose products I recommend (or for that
matter, from any company).
So why does it seem like there’s a conflict between the two
systems?
Medicine is evolving. When I was in medical school in the early
‘70s, the focus of treatment was on how to poison one body
system to bring about balance in another. For example, Prozac
poisons the system that brings serotonin back into the cell to
be stored, thus raising serotonin levels outside of the cell. But
Prozac also causes sexual dysfunction and other side effects in
upwards of one-third of the people who use it. Nonetheless, in
a society based on economics and quick fixes, the use of
prescription medications and surgery moved forward fairly
quickly and increasingly squeezed out other branches of the
healing arts.
It is worth looking at how things came to be the way they
are. This gives us both understanding and the ability to choose
where we want to go. In the 1800s there was little research and
regulation in the healing arts. The healers and wise women in
the tribe would learn what worked from experience and pass
on the information to their apprentices in a chain that often
spanned thousands of years. As world wars and the expansion
of Western civilization began to destroy long-standing social
structures around the planet, much of this information and
experience was lost. Natural medicine began to enter a period
of decline. In some areas that did not have enough well-trained
healers/herbalists, accountability was also lost, and we began
to see the rise of the “snake oil salesman.”
It was in this context that science began to come to the forefront.
People longed for something more proven, from groups
in which there was accountability. Scientists provided this,
using techniques that allowed ideas to be tested, reproduced
and validated. Because of the natural competition between
them, these ideas initially had to make it through the gauntlet
of others’ skepticism before being accepted. Testing and validation
began to take hold in the healing arts.
As in any system that generates a large amount of money
and power, however, financial influences began to have their
say. In the early 1900s, research focused on both biophysics
(i.e., treatments that affected the body’s energy systems) and
biochemistry. Politics being what it is, the biochemists were
able to get the upper hand and research and treatment using
biophysics was marginalized and suppressed. Seeing which
way the winds of change were blowing, many of the greatest
names in modern medicine switched from exploring biophysics
to biochemistry. Medical schools were begun (which
often initially focused on using natural therapies), standardized
curriculums and tests were developed and it became possible
to develop reliable conditions for being licensed. To
counteract “snake oil salesman” who were preying on the
public, state governments developed licensing requirements
for the practice of the healing arts, bringing more credibility,
power and respect to the field. Medicine was therefore able to
attract those people who were compassionate and healers. The
fields of allopathic medicine (i.e., “M.D.” medicine) and chemistry
blossomed.
As our understanding of chemistry evolved, it began to
change the face of our country. We went from almost no foreign
chemicals in our environment to tens of thousands of
new ones that our bodies had to learn to detoxify. These are
added to our food, water supply, building materials, clothing,
and not surprisingly to our medications. In addition, where a
natural substance cannot be patented, new chemicals can be.
As a patent prevents competition, much more money can be
made (e.g., for indigestion, patentable acid blockers can cost
over $2 a pill where nonpatentable calcium carbonate may cost
a nickel). People realized that there was a lot of money to be
made in medicine and in patentable medications. This money
was used to influence legislation and people’s perceptions in
an attempt to eliminate competition.
Language was added to legislation to consolidate allopathic
medicine’s power. As the FDA was appropriately developed to
protect public safety in the face of thousands of new chemical
medications, language was also added saying that a manufacturer
could not claim that something was effective for treating
an illness unless it went through the FDA approval process. As
this process costs $400–$800 million per treatment, only
things that are patentable (i.e., not natural) can recoup these
enormous costs. Vitamin B6 used for carpal tunnel syndrome
is an excellent example. Treating carpal tunnel syndrome with
250 milligrams of B6 daily for six weeks costs about $9 per
patient. Vitamin B6 manufacturers would therefore find it
impossible to recoup the cost of getting FDA approval for this
treatment and cannot advertise B6 for the treatment of carpal
tunnel syndrome. Because of this, most patients instead
spend between $2,000 and $4,000 to have surgery. This situation
is the same for hundreds of other nonpatentable, effective,
inexpensive and relatively safe treatments. The FDA has
even been fighting to make it illegal for stores that sell supplements
to hand out copies of well done scientific studies
showing the effects of the supplements.
In one legislative stroke it became illegal for the manufacturer
of natural medicines/products to advertise or even give
you information about how they can help you get well—regardless of how good the scientific data was supporting the
claim. Legislation was also pushed through saying that anyone
who was not an M.D. or osteopathic physician could not diagnose
or treat you. In addition, it was illegal for companies
making natural products to give the patient the research
studies and information needed to make an informed decision.
At the same time, we were (mistakenly) taught in medical
school that nutritional and natural therapies had no scientific
basis and were only used by quacks. We were told that only
“old-fashioned” doctors would use these treatments. Thus,
despite large amounts of scientific data supporting natural
medicine, you’ll find that your doctor will usually not have been
told about this data, may be hostile to it and will sometimes
even refuse to look at the studies. Modern medicine went from
using the wonderful tool of science to becoming the “religion
of Scientism.”
Fortunately, as always, life moves forward seeking balance
and growth. Although it had its strengths, people also began to
recognize allopathic medicine’s weaknesses. Research continued
on natural and energy (e.g., acupuncture) therapies
despite lack of funding and acceptance by mainstream journals,
and many practitioners, seeing how effective they were,
explored this expanding body of research. As medicine was
hostile to and turned a blind eye to this research, those who
were M.D.s (like me) were often introduced to this information
by our patients.
As a physician, I therefore came out of
medical school with the impression that
if an important treatment existed for an
illness, I had been taught about it. If
someone claimed he or she could effectively
treat a nontreatable disease, that
person was a quack. If such a treatment
existed, I would surely have been told
about it.
I was wrong.
When I first started my practice,
patients would ask me if I knew about
certain herbal or nutritional treatments
for illnesses. For example, one patient
asked me if I had ever heard about using
coenzyme Q10 for congestive heart
failure. “That’s nonsense,” I answered.
“If coenzyme Q10 helped congestive
heart failure, don’t you think I would
have been taught to use that instead of
doing heart transplants?” I said that I
would look into it, however.
Joyce Miller, the Anne Arundel
Medical Center librarian, has always
been happy to obtain studies for me (and
she has found many thousands over the
years). When she did a literature search
on coenzyme Q10, she found a number
of studies showing it could be beneficial
in treating congestive heart failure. I
thought that was curious. Over the next
few months, this scene was played out
again and again. I decided to keep notes
on these rare “pearls” in a 30-page spiral
notebook. My notes are now over a thousand
pages long.
The area of natural medicine has been
growing tremendously in the last few
decades and is now able to help give you
your life back. As an example, combining
natural and prescription therapies has
allowed us to research and develop
highly effective treatments for people
with chronic fatigue syndrome and
fibromyalgia. These syndromes are characterized
by exhaustion, widespread pain,
“brain fog,” and insomnia—crippling
over 6 million Americans. Most doctors
tell the patient that nothing can be done
and they simply have to live with the illness.
Natural practitioners, however,
know that this is not the case. “Gold
standard” placebo-controlled research
demonstrates that over 91 percent of
patients can now get marked improvement
using an integrative medicine
approach (the full text of the studies can
be seen at www.Vitality101.com). In fact,
natural medicine is now able to markedly
improve the treatment of most illnesses.
Recognize that as most physicians
were trained in university hospitals, over
95 percent of the clinical training that
your M.D. received was in treating
severe, life-threatening illnesses. I was
taught more about how to tell whether
fluid coming from the patient’s nose was
from a skull fracture than I was taught
about how to treat a common cold. It
was somehow presumed that if we could
save your life in acute life-threatening
emergencies, we would also magically
know how to treat common non-emergency
problems. As most of you with
pain, fatigue, hormonal or other day-today
problems have learned, this is sadly
not the case.
The good news is that as more and
more doctors familiarize themselves
with the scientific literature, many are
becoming more open minded to therapies
that can help you. They are trying to
do the best they can and progress is
occurring. Comprehensive medicine,
which combines the best of natural and
prescription therapies, is well on its way
to becoming the medicine of the future.
Meanwhile, effective treatment for illnesses
most doctors treat poorly is
already available and will be discussed in
the next two issues.
*This article is part one in a three-part
series from Pain Free 1-2-3! A Proven
Program to Get YOU Pain Free! by Jacob
Teitelbaum, M.D. available Oct. 15, 2004
from www.Vitality101.com
Next issue we will teach you effective
treatment of chronic fatigue syndrome,
fatigue, insomnia and fibromyalgia. The
following issue we will discuss how to
treat pain effectively. If you can’t wait, go
to www.Vitality101.com
Jacob Teitelbaum, M.D. is medical
director of the Annapolis Center for
Effective CFS/Fibromyalgia Therapies,
senior author of the landmark study
“Effective Treatment of Chronic
Fatigue Syndrome and Fibromyalgia—a Placebo-controlled Study,” and
author of the best-selling book From
Fatigued to Fantastic!, the recently
released Three Steps to Happiness!,
Healing through Joy and Pain Free 1-2-3!
A Proven Program to Get YOU Pain
Free! (Release date October 2004).
His Web site: www.Vitality101.com.
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