A Graphic on the Cost of Fast Food

I've blogged extensively in the past about the health-destroying effects of fast food, but this week, I'm posting a graphic on the wallet-destroying effects of fast food. One of the main arguments made about fast food is that it's simply less expensive, and that's why it's causing such health problems amongst people of lower socioeconomic status. As this graphic, created by the New York Times, illustrates, that's simply not the case.

The accompanying article goes into a detailed analysis of why people continue to purchase more expensive food, even when they are strapped for cash. Access is a big issue, as is time - many folks simply do not have the time to cook for themselves, nor do they have the know-how to make meals they want to eat. There's a lot of inertia holding these behaviors in place, but as I've said before, we're a people who have solved some pretty astronomical problems - it's time we dealt with this one.

A Physician’s Take on the Shooting in Aurora, Colorado

Let me begin by saying that the news of this event was truly shocking to me. In those hazy early hours of the news reports, I wasn’t clear as to where the shooting had taken place, and my thoughts automatically went to my friends in Colorado, as well as my many friends who have family in Colorado. Fortunately, no one I know was injured or killed in the shooting, but even so, the event weighs heavily on me. I am probably only one of many who are most dismayed by the fact that this shooting, though undoubtedly horrific, is not unfamiliar to us Americans – the recent shootings at Café Racer in Seattle, Arizona representative Gabby Giffords’ shooting, and many, many similar events seem increasingly common. These events may not actually be becoming more frequent, but they bring into sharp focus a general problem with gun violence in America. As horrible as it is to hear of even one death, let alone fourteen, it should be pointed out that, if July 19^th was a day like any other in America, the fourteen killed in Aurora were matched by another 70 Americans who were shot to death elsewhere.

I make an effort to avoid political topics in this blog, so I don’t want to address this as a political topic. I’m not going to be discussing the constitutionality of gun ownership, I’m not going to be discussing the NRA, and I’m not going to be discussing responsible ownership. I have a number of friends and colleagues whom I respect enormously who are gun owners, and I don’t have any interest in causing offense. I want to discuss this as a public health issue.

Let’s first do some basic math. Several sources (1, 2) I’ve read have stated that 84 Americans are shot to death each day, and that about twice that number are injured by gunfire. A quick expansion would suggest that 30,660 Americans are killed by guns per year, and 61,320 are injured. Because I’m using rough figures, I’ll round them down to 30,000 and 60,000.

To put these numbers in perspective, here are 2009's death rates for some other leading causes of death (2009 is the most recent year published by the CDC). Heart disease continues to top the list, claiming nearly 600,000 Americans in 2009, the most recent year I was able to find. Malignant neoplasms (cancer) come in next at approximately 568,000. The numbers fall sharply after this, with chronic lower respiratory diseases coming in third place at 137,000. The numbers keep going down, through cerebrovascular disease, Alzheimers, diabetes, kidney disease and others.

Included on the list are accidents/unintentional injuries, intentional self-harm/suicide, and homicide – gunfire is not listed separately by the CDC, but we might assume that guns cause a portion of the deaths in these categories. If gun-related deaths were counted separately, and the figures listed above are accurate, gunfire would have been the 13^th most common cause of death in 2009, placing right between chronic liver disease/cirrhosis and essential hypertension/hypertensive renal disease.

So how do we interpret these facts? Let’s look at how physicians have responded to the other major causes of death.

Clearly heart disease and cancer are the two biggest killers in America, by a significant margin. In an effort to stem the tide, the American Heart Association and the American Cancer Society have launched massive awareness campaigns, and physicians are actively engaged in efforts to prevent these diseases. We encourage healthy eating and exercise, we encourage patients to quit smoking, we order imaging studies, we order labs, and we use medications to reduce the likelihood that our patients will die from these causes. In the political arena, we’ve banned smoking in many public places, a step that is aimed at these two causes of death, as well as the third cause of death, chronic lung disease. In short, we're hard at work combatting these diseases.

Even with some of the less common causes of death, we have taken measures to prevent them. At an annual physical, a doctor screens not only for heart disease, hypertension, cancer, and lung disease, but also kidney disease, liver disease, depression, and a whole host of other causes of death. When I was still in training, our clinic’s intake sheet even had questions about seatbelt and helmet use. Many of these are so routine that they involve little more than checking a box. As patients, many of us have our liver and kidney function checked without even knowing it or with much discussion. Why then, as doctors, are we not asking our patients about gun use or safety? As a cause of death, it’s at least as important as these two other diseases, and yet we as doctors are doing very little, either in our offices or politically to reduce deaths due to gunfire.

Some of the other causes of death are more complicated. Heart disease and cancer are a complex mix of environmental and genetic factors, and while they are largely preventable, it’s unlikely that we will ever get a full grip on these diseases. Deaths due to gunfire, however, are far more preventable – there will be occasional accidents, but I think we can all agree that deaths due to gunfire are nearly entirely preventable. We as physicians work hard to prevent these other causes, and it’s high time that we made an effort to prevent gun deaths as well. As I stated at the beginning of the article, I’m not going to make this political, but as physicians who have taken oaths to do no harm and to alleviate suffering, I believe we have an obligation to do what we can to combat death and injury due to gunfire.

(For those interested, here's a petition to Pres. Obama and Mr. Romney on behalf of the Brady Campaign.)

A Better Article Than I Could Have Written

I've had an article on the cost of fast food waiting in the wings for several weeks, which keeps getting delayed in its publication because other topics keep coming up that take precedence - this week, again, that article will be delayed.

The topic taking precedence this week is an article published in the New York Review of Books that was written by Dr. Marcia Angell, the former editor-in-chief of the New England Journal of Medicine. Dr. Angell has been a critic of the pharmaceutical industry throughout much of her career, and her article is partly a review of three books on the pharmaceutical industry, partly a editorial from a physician who's gotten fed up with how the pharmaceutical industry's drive to increase profits has invented false diseases, pushed ineffective drugs, and debased the way medicine is practiced in the United States. The article is a few years old at this point, but recent events, like this one or this one, make it as timely as ever.

Even in these short Monday articles, I often write extensively, but Dr. Angell's article is better-sourced, better-written, and more comprehensive than anything I could hope to write. I suppose I ought to put in my obligatory statement that, even though I'm a naturopathic physician, I'm not against pharmaceutical drugs, I'm against their misuse, but I would hope that regular readers of this blog should know that by now.

Read on and enjoy - there are no easy solution to the problems raised by Dr. Angell, but the conversation is a crucial one.

Oleocanthal: The Next Big Thing?

Chances are, you’ve never heard of this. That is, unless you read Thomas Mueller’s 2011 exposé on olive oil, Extra Virginity. For those who haven’t, here’s a brief précis that will get you up to date: Most Americans don’t know that high quality olive oil should have a peppery, biting taste to it, a state of ignorance due to the fact that we consume low quality, heavily processed, often adulterated oil masquerading as extra virgin olive oil. A few years ago, a biopsychologist on vacation in Italy attended a class on molecular gastronomy, and was surprised to discover a biting sensation in the back of his throat on consuming olive oil. More surprising, however, was that he recognized that biting flavor immediately – it was uniquely similar to the taste of ibuprofen, a compound whose flavor he’d been investigating very recently. Interested by this similarity, he embarked on a series of experiments to isolate the compound that was causing this taste effect, and eventually found a wholly novel and unique compound he termed ‘oleocanthal.’

This compound, though dissimilar from ibuprofen in chemical structure, has displayed a similar anti-inflammatory effect in laboratory testing, and I’m writing about it today because I believe that it’s a compound we will be hearing more about in the near future. I would anticipate that it will become commercially available fairly soon, and that it is also likely to be picked up by pharmaceutical companies, who will probably be researching the effects of synthetic analogs of oleocanthal for use as a drug.

That said, there’s not much information about this product at the moment. Some basic lab testing has shown that it does have an anti-inflammatory effect, as it inhibits the same cyclooxygenase (COX) enzymes that the conventional NSAIDs inhibit. Some additional lab testing has shown that oleocanthal inhibits some of the processes associated with inflammatory joint conditions. This certainly gives us some indication that oleocanthal may have a role to play in the standard aches and pains that plague many of us, so it’s possible that it may be marketed for this effect.

More interestingly, however, there has been some research into oleocanthal’s effects in cancer and Alzheimer’s disease. The cancer research has indicated that oleocanthal may have a role to play in slowing the progression of certain types of cancers. A study of oleocanthal on isolated breast and prostate cancer cells indicated that the compound inhibits the profileration, migration and invasion of the cells – in plain English, this means that the cells are less likely to grow in the first place, and are less likely to metastasize when tumors have developed. Other polyphenols found in olive oil has demonstrated a similar inhibition of carcinogenesis (1, 2), though this compound hasn’t received the same press as oleocanthal.

The studies done on Alzheimer’s are similarly in the lab testing phase, but do show promising results. Oleocanthal has been shown to inhibit tau fibrillation (1, 2). Of course this doesn’t mean a lot to lay readers of this blog, but the significance of this discovery is that it means that oleocanthal may prevent the development and progression of Alzheimer’s disease by preventing the molecular changes that cause Alzheimer’s disease. Alzheimer’s is not fully understood, however, and it’s possible that other biochemical causes lie at the root of this debilitating disease – oleocanthal has been observed to inhibit those changes as well.

If the past 15 years have taught us anything in medicine, it’s that inflammatory processes underlie just about every major chronic disease, from heart disease to rheumatoid arthritis to cancer to Alzheimer’s. Interest in anti-inflammatory foods, diets, herbs and drugs has increased as we have learned more about this process, and it’s no surprise that we are discovering more and more anti-inflammatory compounds in nature. Curcumin, found in turmeric, was discovered some years ago, and has now been the subject of thousands of research articles. Oleocanthal, a more recent discovery, is still poorly understood, but I believe that we are likely to see it grow exponentially in importance in the next few years.

In the meantime, if you haven’t read Extra Virginity, pick up a copy – it’s one of the better reads I’ve come across in recent months.

The Global Fat Scale

Recently, a team of researchers at the London School of Hygiene and Tropical Medicine calculated the mean BMI of each country around the world, and produced a table which the BBC has uncharitably dubbed, 'The Global Fat Scale.' The BBC has used the data to create an interactive tool that allows you to compare your BMI to your country's mean BMI and the global mean BMI, along with some other neat facts.

The information is interesting for a number of reasons. First, it's always worth knowing your BMI, even though researchers will sometimes bemoan the limitations of measuring BMI as an indication of fitness. Secondly, it's worth knowing how you measure up to your compatriots and fellow humans, especially in the United States - it's well known that Americans tend to be larger than our cousins in Europe or Asia, but when assessing our fitness as individuals, we judge ourselves against each other, not the people we saw while on vacation in Paris or Rome.

Thirdly, and, I think most importantly, the list of mean BMIs tells us a lot about social forces at play in the world today. For example, among the heavier nations, we see ones we might expect, like the United States and the United Kingdom. We also see Tonga, Micronesia, and Samoa, Pacific island nations whose inhabitants may have genetic predispositions to a high BMI. However, we also see Kuwait, Qatar, Bahrain, and other Middle Eastern nations currently shifting rapidly towards Western-type consumer economies, a shift that's bringing in fast food and sedentary lifestyles.

As we scan down the list, we start to see declining BMIs as well as declining GDPs. It's not a straight line, of course, but it's certainly striking that the countries with the lowest BMIs are countries wracked by poverty and conflict, such as Eritrea, DR Congo, Central African Republic, and Somalia. In the US, obesity and it's associated diseases are often considered diseases of poverty, but worldwide, poverty still means starvation.

So check it out, find out where you size up, and you just might learn something in the process. Here's that link again, so you can read about it.

Prayer and Medicine: Do They Mix?

Over the past several years, there’s been a public argument happening between science and religion on a variety of points. As a physician, I take a non-partisan stance in this debate, and simply want to know what works so that I can best help my patients - as a favorite teacher of mine used to say, ‘There’s no room for dogma in medicine.’ With that in mind, let’s see what happens when religion and science mix directly, in the form of intercessory prayer to achieve health outcomes.

Let’s take a look first at some studies that show positive benefit. One study I came across was done to measure the effect of intercessory prayer on aiding South Korean women undergoing IVF in an effort to become pregnant. 219 women were randomized to either a prayer group or a control group. Interestingly, the women were not informed that they were taking part in a study, nor were their healthcare providers. The prayer groups were located in Canada, Australia and the United States (some distance from South Korea). The study found that the group receiving the prayer intervention achieved implantation and became pregnant at nearly double the rate that their non-prayed-for counterparts did. One of the points this study illustrates is that prayer apparently doesn’t have to happen locally to demonstrate benefit.

A quite large study, done in Israel, was published in the British Medical Journal that looked at 3393 adult patients with bloodstream infections (sepsis). An interesting aspect of this study is that the prayer was done retroactively – 4-10 years after the episodes occurred. This intervention was done on the argument that God was not limited by linear time the way we are, and that we could not assume that time was linear in any event. The study found a minor trend towards decreased mortality among the group receiving prayer, but this was not statistically significant. However, the length of stay in the hospital and duration of fever among the group receiving prayer were both shorter. The duration of fever was mildly shorter among the intervention group, but the length of hospital stay in the intervention group was remarkably shorter, especially as one reached the more severe levels of disease.

One of my favorite studies on this topic was done on bush babies who displayed a condition called chronic self-injurious behavior – a condition characterized by excessive self-grooming that results in the formation of skin lesions, being something like a non-human obsessive-compulsive disorder. Twenty-two bush babies were assigned to receive either l-tryptophan alone, or l-tryptophan and intercessory prayer for four weeks. After the four weeks, researchers found that the bush babies receiving prayer in addition to conventional treatment had a reduction in wound size compared to their counterparts, engaged in less wound-grooming, and less grooming behaviors overall. The authors noted that because the study was done on non-human animals, the results were not susceptible to the effects of placebo, as they might have been in a human trial.

Here's a pic of Otolemur garnetii, the type of bush baby studied

Obviously, however, not all studies have shown benefit. A study done among kidney dialysis patients showed that intercessory prayer could not be distinguished from the effect of expectancy (sometimes called ‘placebo’) in improving medical or psychological measures of patient’s well-being, and a study of HIV patients that included intervention by professional healers, untrained nurses, or no intervention found that there was no benefit to prayer among study participants, and no clinical outcome could be attributed to the prayer. We shouldn’t be surprised that some studies have shown no benefit, as almost all treatments have tested poorly at one point or another.

One interesting focus of study has been on cardiac patients in the hospital. A study was published in 1999 in the Archives of Internal Medicine which suggested that intercessory prayer might improve a patient’s experience in the coronary care unit. In the study, 990 patients were randomized into intervention or placebo groups without their knowledge, and either did or did not receive intercessory prayer while they were in the hospital. While the length of CCU and hospital stay did not vary between groups, the patients in the prayer group had lower CCU course scores, which basically means that they had fewer adverse events in the course of their stay. However, a year later, the Mayo Clinic published a similar study which found no significant benefit from intercessory prayer among 799 CCU patients.

These findings caught the eye of researchers at Harvard’s Medical School, and so they set up a similar study with one twist – that along with the patients who were blinded as to whether or not they would receive prayer, a third arm of patients would be told they would be receiving prayer, and did receive prayer. This study was the largest of all, with a total of 1802 patients being involved. However, not only did this study find that prayer did not reduce complications in patients receiving CABG (commonly known as bypass surgery), nor did it change mortality after surgery, but in fact, being certain that one was receiving prayer was associated with a higher incidence of complications. The study authors brushed off this as a fluke, but needless to say, this was not good news. In reaction to the published results, commentators noted that participants’ concealing from their providers the fact that they were being prayed for may have caused this increase in complications. This study is confusing at best, troubling at worst, and needs further examination, as the commentators called for.

What happens when we put this all together? A Cochrane Systematic Review looked at 10 studies on intercessory prayer for patients already receiving routine care for a variety of conditions. Not unexpectedly, the review noted that the results were mixed, and that although some studies showed positive results, others showed no result. The review declared that there was not enough data to recommend either in favor or against of the use of prayer to improve health. The authors went on to say that resources available for the study of prayer should be better devoted to other questions in health care. The Cochrane Review is a very high quality, but largely scientifically conservative organization, and their commentary is unsurprising.

So what’s my opinion after reading all of this literature? I think you ought to pray if the spirit moves you. A few studies have noted beneficial effects. A few have noted no measurable effect. I think that the one outlier study, which showed a negative effect needs a critical reexamination – the authors brushed off the negative effect, but I think it’s worth taking a good hard look and trying to determine what factors may have caused the negative effect (I’m inclined to believe that the stress of concealing information from one’s providers while undergoing major surgery may have been part of the cause). In the future, research into this topic should be improved – a few studies have noted a measurable beneficial effect, and I think we need to nail down factors that influenced that positive effect, a process that will require further quantifying and describing the prayer process. I have no illusions that this will remain on the back burner for researchers, and some might argue that quantifying prayer defeats the whole point, but I think that there’s enough evidence that something is going on that we should work to figure it out.

A Graphic on Tea

While normally I post on Mondays and Thursdays, I'm making an exception today to share with you a fantastic graphic on tea, my favorite beverage. Not science-y or intellectual, like many of the graphics I share, this is simply intended to make you one of the more sophisticated people you know. Enjoy this little gem.

A Monday Morning Graphic on Medications

It's Monday, so it's time for another infographic. You may remember this one and this one from a few months ago, and so I'm posting yet another from the folks who put them together. To be sure, I'm not posting this to voice my opposition to the use of medication. There's a time and place for the use of all medications, but frequently they are treated as the only option, which they're not. As we progress through the 21st century, we're seeing more and more shortcomings of the 1950's dream of 'better living through chemistry,' and as the pendulum swings back, I'm hoping we can find a happy medium.

I also want to point out that medications are only a symptom of a larger problem. Physicians simply need more time with patients. Prescription-based medicine is a product of this time crunch, as it's relatively easy to choose one in a short period of time, and patients walk away feeling that at least the doctor 'did something.' Moving away from over-medication will take changes in the way insurance works, in the way we live, and in the way we eat, to name but a few. It's not going to be simple, but as a species, we've repeatedly shown that we can solve some pretty big problems when we set our minds to them. Let's see if we can sort this one out.

 

Created by: MBACC.net

Putting Homeopathy in a Historical Context Part 4

Welcome to the conclusion of a long series on homeopathy. We’ve talked about the practice of medicine in the 17^th century, homeopathy’s empirically-based beginnings, some of the field’s more difficult concepts, and why it held so much appeal in the 18^th century. What a wild ride it’s been.

The Early 20^th Century

In 1900, homeopathy was still riding high, and in fact, a monument was built just a few blocks from the White House in Washington, DC, to honor the contribution that Samuel Hahnemann had made to the practice of medicine. President William McKinley was the guest of honor at the monument’s dedication.

Ten years later, Abraham Flexner issued a report on medical education in the United States with endorsement from the Carnegie Foundation. The report urged medical schools to adopt stricter admissions standards, place stronger emphasis on scientific education, and lengthen training. These recommended changes are now standard in all doctoral-level clinical degree programs (MD, DO, ND), and have lead to an increase in quality of education. However, though the long-term benefits have been great, the short-term results were devastating. Many, many medical schools were forced to shut their doors – naturopathic medical schools, osteopathic medical schools, chiropractic schools, and homeopathic medical schools were especially hard hit, but the number of institutions granting MDs was cut in half in the two decades following the Flexner Report, and the number of MDs graduating each year decreased nearly by half. Additionally, in the wake of the report there was a decrease in women, racial and ethnic minorities, and people of lower socioeconomic status entering the medical profession, reversing a trend that had been underway throughout the 19^th century. The quality of medical education went up, but so did the price of education, and so the number of providers went down.

So homeopathy, like many other medical fields, was crushed. The osteopaths and chiropractors were slowly able to regain their strength throughout the 20^th century, and the naturopathic profession was eventually able to regain a foothold and come roaring back in the late 20^th century, but the homeopaths really suffered, and have never been able to regain the strength they once held.

As it was a movement driven by physicians seeking a pragmatic approach, pragmatism was also the downfall of homeopathy. It was harder to learn homeopathy, and so it lost some adherents, and certainly new practitioners. Additionally, in the age of rampant infectious disease, the allure of homeopathy was undercut by the invention of antibiotics in the early 20^th century. Obviously, chronic diseases did exist in the early 20^th century, but the biggest health problem was infectious disease, and the invention of antibiotics offered a solution that was beyond belief. If the identification of infectious organisms was revolutionary in the world of medicine, the development of antibiotics was earth-shattering. Additionally, the development of novel vaccinations was similarly staggering. In a world in which even the President wasn’t immune to polio or other infectious diseases, these advances were awe-inspiring. If homeopathy offered order and methodical practice in the Enlightenment, pharmacology was the medicine that gained ascendancy in the technologically-minded 20^th century. It offered the promise of a brave new world that homeopathy simply couldn’t compete against.

A Revival in the 1970’s

There were few homeopaths still in practice in the early 1970s. I’ve heard those stragglers compared to The Mystics from the movie The Dark Crystal – wizards of nature who engaged in the dusty, arcane rituals of a forgotten age. Had things continued on the same course, homeopathy would likely have been a footnote in the history of medicine, forgotten and ignored. Instead, it’s a bit of a hot button issue, especially in certain circles. This status comes largely from homeopathy’s revival in the mid-1970s. Let’s look at the historical how and why.

As I said, in the 1970s, homeopathy was largely consigned to libraries and not active practice. However, the 1970s were also a time of rediscovery and exploration in America, and especially in California. The Bay Area was a hotbed of experimentation, and just about everything was an alternative to how things were done elsewhere. Radical politics, communal living arrangements, and new age spirituality were the milieu in which homeopathy re-emerged.

Homeopathy had a strong mind in the form of George Vithoulkas, a Greek homeopath who had gained quite a reputation for his clinical skill. Much in the same way that their colleagues were travelling to India to learn from gurus, a number of Californians would travel to Greece to learn from Vithoulkas and bring his teaching back to the Bay Area. However, the context they came from and brought their lessons back to redefined homeopathy significantly – it was now truly ‘alternative’ medicine. Homeopathy as it came to be practiced was now consciously and deliberately separate from the general practice of medicine, and indeed opposed to it at many points.

The conflict between homeopathy and general medical practice is as much a cultural dispute as scientific. Homeopathy became its modern self in a specific context, and though homeopathy has grown and changed in the last 40 years, it has ever since born the stamp of being ‘alternative’, as well as retained some unique ‘Californian’ attributes. Modern homeopathy, in the broadest sense, is heavily informed by new age views of the mind and the universe, by a suspicion of scientific practice, and by counter-cultural attitudes. Gone is the emphasis that Hahnemann (and 19^th century physicians) placed on experimentation and empirical evidence, it having been replaced by intuition and (if I can say so myself) somewhat sloppy thinking. In fact, some of the practices that Hahnemann specifically railed against have re-emerged in homeopathy. It’s worth noting that George Vithoulkas (an engineer by training) has disowned much of what has happened in the homeopathic revival that he is in part responsible for.

So contemporary homeopathy was created in the context of ‘alternative’ medicine and counter-culture – a very different context than the one that Hahnemann was working in. The disputes between conventional medicine and homeopathy have to be understood through the lens of the history that it takes place in; given that contemporary homeopathy is based on a rejection of conventional medical thought, are we surprised that there’s conflict?

Conclusion

Though this series has been long, I’ll try to keep the conclusion short. I’ve endeavored to show that homeopathy has deep roots, and bears more resemblance to modern medicine than many docs would care to admit. In most ways, homeopathy prefigured modern scientific medicine. That said, it’s gotten significantly off-track, as its reinvention has taken it far from its prior forms.

The final question I’ll ask is this: Is there a place for homeopathy in our modern world?

I think the answer is yes. In Hahnemann’s time, infectious disease and acute illnesses were the most important problems physicians had to tackle. Homeopathy evolved to treat these illnesses, but was eclipsed when we discovered bacteria, and more specifically, how to kill them. Now, though, we are facing different challenges – we’re facing chronic diseases, mental health problems, and other issues that are multi-factorial in origin. When you’re dealing with a disease that has a single discrete cause, it’s easier to devise a cure – this is the medicine of bacteria and antibiotics. However, when you’re dealing with something that has no clear cause, things get much more complicated. Many contemporary drugs alleviate symptoms, but don’t cure (at least not in the finite way that antibiotics cure infections). In a previous post, I discussed the appropriate and inappropriate use of homeopathy, but I’ll go on record as saying that homeopathy has an important role to play in the management of chronic disease. Given that most drugs are designed to reduce symptoms, not cure the disease, I think it’s important to consider treatment through non-pharmacologic means when the circumstances permit – this is in line with my interpretation of primum non nocere.

That said, the practice of homeopathic medicine must regain its strong tradition of documented experimentation. Scientific endeavor was one of the founding principles of homeopathy, but it’s been lost as the recent generation has picked up homeopathy as a new-age, non-scientific practice. Old medicines need to be re-evaluated, new medicines need to be examined, and the testing process needs to be given a modern make-over.

To look at it, homeopathy is a pretty darn ugly duckling. It’s got a long neck, weirdly-colored down, and it’s a bit ungainly on land. Even so, I think it could become quite a magnificent creature – it just needs some help growing up.

(As in the first of this series, I’d like to thank my teachers Dr Paul Herscu and Amy Rothenberg of the New England School of Homeopathy.)

A Side Note about the Affordable Care Act

It should be news to no one that the constitutionality of the Affordable Care Act, and specifically the mandate that all Americans should carry health insurance, was upheld last week by the Supreme Court. As a naturopathic physician, I recognize the importance of this piece of legislation, both in terms of the consumer protection measures taken, and in it's political importance in terms of allowing debate on health care reform to remain open. Even so, it's far from perfect, and health care will need further reform in the future (starting now).

One small victory that you may not know was gained in the ACA was Senator Harkin's amendment (Section 2706 (a) of the PPACA), an amendment that bars health plans and insurers from discriminating in plan coverage and participation based on provider type. That may sound fairly verbose, but what it means is that all types of healthcare providers licensed in a given state will be able to bill insurance for services rendered. While this will mean that so-called 'alternative' professionals such as chiropractors, acupuncturists, and yes, naturopathic physicians, will be able to bill insurance directly, it also means that many other small professions will now be covered by health insurance - these include physical therapists, optometrists, nurse practitioners, and other more 'mainstream' healthcare providers who may not be able to bill health insurance plans in all 50 states.

Many of you are already using these types of providers, and it's only right that you be able to use your insurance to pay for their services. This amendment will go into effect in January of 2014, and while that's still some time off in the future, the victory is an important one.