The Legislative Effort Continues

This week, naturopathic doctors from around Maryland came to Annapolis to talk with legislators about the importance of licensing and regulating the practice of naturopathic medicine. This is the fourth year that the MDANP has been at work in its legislative effort, and in honor of the effort, I'm posting a map showing the US states and territories that currently license naturopathic doctors (in green) and those that will be debating the issue in 2014 (in yellow). Currently, a third of states license naturopathic doctors, and many more will consider doing so in 2014. While I work in a profession characterized as fringe, I hope this map makes clear the fact that naturopathic medicine has moved into the mainstream. And really, why wouldn't it? With a clear focus on prevention, treatments that offer cost savings, and an extremely low incidence of malpractice or harm, naturopathic doctors offer the nation something important at a time when it's needed more than ever before. If you haven't before, take a minute this week to find out what the naturopathic professional organization in your state is up to; you might even pitch in!

Simple Pleasures

Simple recipes are often the most difficult. While large ingredient lists are imposing and can offer the logistical challenge of managing a massive number of ingredients and preparation, a long list of spices often brings with it a strong-enough flavor that it can cover up sub-par technique and preparation. It's ironic, but true. It's easier to get results with complicated recipes. In contrast to that, I'm offering a simple but sublime recipe adapted from Claudia Roden's The Food of Spain. Rather than a curry with a list of 15 spices alone, this is a simple dish prepared from a few ingredients and spiced only with garlic and paprika, and yet the results are fantastic.

1 cup dried chickpeas soaked overnight or 1 15 oz can chickpeas
Salt
1/4 cup olive oil
A whole head of garlic
1 cup dried raisins, soaked in water for 20 min
1 teaspoon sweet paprika
5 cups chicken stock
2 1/2 cups arborio rice

Drain the chickpeas, and bring to a boil in fresh water. Reduce heat to low and simmer for 1 hour, adding 1 tsp salt.
Preheat your oven to 400 degrees.
Peel and chop the garlic cloves, and drain the raisins.
Heat the oil in a medium size pot or casserole that can go in the oven. Stir fry garlic and raisins in the oil for 2-3 minutes, until the aroma arises from the garlic. Add paprika and stir well, then add chickpeas, stock and another teaspoon of salt. Bring the mixture to a boil and add the rice. Stir well to achieve a consistent mixture.
Bake in the oven for 30 minutes, until the rice is al dente.

Simple, yes. Wholesome, yes. Sublime, yes as well. This is a great, filling Spanish delight that will surprise you with its fantastic taste and elegance. It's as well suited to a dinner party as it is a simple family meal. Enjoy.

The 50th Anniversary of an Important Moment

Fifty years ago this week, the Surgeon General of the United States, Luther L. Terry, released Smoking and Health: Report of the Advisory Committee to the Surgeon General, an important milestone in the effort to control tobacco as a public health hazard. While studies from the early 1950s had already indicated that smoking caused lung cancer, and prior studies had shown correlations between smoking an risk of premature death, the report of the Surgeon General made it the opinion of the United States government that smoking was a significant health hazard, and should be controlled by legal means. In that time, we've seen efforts to restrict the purchase of tobacco, the act of smoking, and many, many taxes levied on tobacco, all in an effort to reduce smoking and tobacco consumption.

I won't belabor the point here, so I'll simply point out that the Journal of the American Medical Association has devoted its entire issue to the anniversary of this important event, and also note two studies published in JAMA this month.

The first study found that since the publishing of the Surgeon General's report in 1964, an estimated 8 million smoking-related premature deaths have been prevented in the United States. While lifespan has increased overall since 1964, smoking restriction has added 2.3 years to life expectancy for men, and 1.6 years to life expectancy for women. My own conclusion is that it's been no small potatoes.

The second study found that global smoking rates have decreased for men from 41% in 1980 to 31% in 2012, and for women from 11% in 1980 to 6% in 2012. While this is excellent news - it means that global smoking rates have decreased by over a third - the total number of smokers has actually increased as the global population has increased, so we still have lots of work to do.

As we move forward into the second 50 years of tobacco restriction, and especially as we now see the rise of legalized marijuana consumption, let's not ignore the important work that still must be done, while we celebrate that this global effort has had excellent success.

Vitamin E Surprises Me

Most of the articles written here are meant to be free-standing, so that anyone who happens across them will be able to benefit, but regular readers of my blog will benefit from their experience in reading my blog post today.

To set the scene: Three weeks ago, I made an off-hand comment about the rise and fall of vitamins, mentioning specifically vitamin E. Vitamin E was the focus of a lot of attention many years ago, when it was believed that use of high doses of the antioxidant vitamin might prevent cardiovascular disease. Since then, however, it has fallen out of favor, and is now believed by many to have been over-hyped. Further studies of vitamin E have failed to verify the benefit, and so I tend not to recommend it much, or at least not to patients with cardiovascular disease. In my most cynical moments, I dismiss vitamin E as a fad of a prior time.

Then, two weeks ago, an editorial in the Annals of Internal Medicine came out slamming vitamins in general and vitamin E in particular. I deconstructed that article and argued that it was riddled with problems, but as it relates to today's posting, the editorial suggested that vitamin E was ineffective for, just about anything, and was also probably unsafe.

It turns out that I was wrong to dismiss vitamin E, and so was the Annals of Internal Medicine. Just two days ago, an article was published in the Journal of the American Medical Association that found that vitamin E may provide benefit as an adjunct treatment in Alzheimer's disease. Further confirmation is necessary, but the findings were significant and worthy of attention because of their clinical utility - researchers posited that vitamin E delayed progression of symptoms by about 19% per year in Alzheimer's patients. Additionally, no ill effects were noted over a mean follow-up time of about two years.

I'm not going to discuss the results of the study here, however. Rather, I'm going to make an important point about research. The editorial published in the Annals of Internal Medicine was rash in its suggestion that physicians stop recommending supplements, consumers stop buying supplements, and researchers stop investigating supplements. I argued that broad, blanket statements like this one rarely, if ever, hold up to scientific scrutiny, and less than two weeks after publication, we've already started chipping away at the editorial by way of a peer-reviewed study published in a major medical journal. Broad statements that do not take into account nuances, or indeed evidence, are bound to fail, though they may be partnered with major media campaigns.

The second point is this - clearly I was wrong too. Medicine, despite its attempts to pursue neutrality and evidence, is subject to fads - treatments of all kinds come in and out of favor, and it's not uncommon for clinicians to discount older therapies in favor of newer ones. And lo, I was guilty as charged. Though the evidence for vitamin E in cardiovascular disease remains weak, I was wrong to dismiss the supplement altogether as a fad that lost favor. Vitamin E may indeed hold promise as an effective treatment for other conditions, and I'll now continue to keep an eye out for research.

The point is this: It does no one any favors to close doors in medicine. When we do so, we're inevitably proven wrong. While evidence may lead us away from going to a certain treatment for a certain condition, we should never discount that treatment entirely. I hope we've all learned our lesson today.