Fwd: [SSRI-Research] Principles That Identify Orthormolecular Medicine: A Unique Medical Specialty

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[sSRI-Research] Principles That Identify Orthormolecular Medicine: A

Unique Medical Specialty

 

Principles That Identify Orthormolecular Medicine: A Unique Medical Specialty

 

Richard A. Kunin, M.D.

In 1969 Linus Pauling coined the word " Orthomolecular " to denote the use of

naturally occurring substances, particularly nutrients, in maintaining health

and treating disease. At that time megadose niacin therapy for schizophrenia and

dietary treatment of " hypoglycemia7 were the major focus of the movement. Since

then Orthomolecular psychiatry and medicine have emerged as a distinct and

important specialty area in medical practice.

 

In the meantime, other medical movements have sprung up out of the public demand

for Hope in the face of a worsening epidemic of cancer, heart attacks and mental

illness and in response to the outcry against adverse effects of modern medical

treatments and invasive diagnostic and intensive care procedures. Alternative

therapies have come forward to fill the vacuum left by modern Medicine, which

failed to provide effective treatments for the major epidemic diseases and in

protest against Medicine's over-reliance on pharmacology, for the drug

treatments seem to have fostered the epidemic of drug-dependence which is the

major epidemic of our time. The public majority were ready for a new medicine

based on nontoxic, non-invasive, " natural " medicines to go with the

re-discovered " natural foods " .

 

Holistic medicine became a rallying point for the New Medicine by putting

nutrition, exercise and meditation ahead of surgery, radiation and drugs. It was

an answer to the adverse effects of MegaMedicine, the cut burn and poison

approach to " health " . And, since holistic medicine did not focus on basic

science data, it did not force a paradigm shift in the medical establishment.

 

Orthomolecular, on the other hand, because it is identified with Linus Pauling,

our greatest living scientist, and because it rests on vast body of research in

the basic and clinical sciences, does force a major revision in medical

thinking. Nutrition, which has been the stepchild of medicine and generally

considered a dead issue in medicine, suddenly is at the crux of this new medical

movement. No wonder then, that Orthomolecular became a buzzword to the medical

establishment, who saw it only as megavitamins and judged it as quackery. By

contrast, the word, Holistic became the subject of numerous symposia, journal

articles, welcomed by editors eager to promote the image of modern medicine as a

progressive and responsive institution. But as it gained supporters, Holistic

Medicine also gained additional theories and practices, some of dubious value,

some downright unscientific, Even the most broad-minded and liberal-minded

editor had to recoil from permitting such things as psychic

healing and kinesiology within the pages of a refereed journal.

Soon the word " Alternative, came to replace Holistic in the medical journals.

Now the establishment could pick and choose individually between the various

therapies that had gathered under the holistic umbrella; nutrition, biofeedback,

chiropractic, acupuncture, herbalism, homeopathy, massage, hypnosis, iridology,

kinesiology, astrology, psychic healing and other intuitive therapies, to name a

few.

The orthomolecular movement was faltered with identity confusion and, in fact,

many of our own members seem to have chosen Holistic as their preferred

badge-word. This is good for the short run, I agree: it is attractive to

patients and profitable while being non-controversial and safer professionally

as well. In the long run, however, I think Holistic Medicine has no future. It

has already lost its identity, except as a clearing house for medical novelty.

Most important, because it does not identify strongly with science it has lost

reliability. Meantime, Orthomolecular Medicine retains scientific reason for

being: its basic science foundations of nutrition, biochemistry and clinical

nutrition have grown at a prodigious rate. Megavitamin niacin therapy, which was

am considered dangerous and controversial in treating schizophrenia, is now the

standard of care in the hyperlipidemias. What began as megavitamin therapy now

employs a broad data base and a variety of therapies applicable

to numerous medical and psychiatric conditions. It is ironic that this positive

growth of orthomolecular science and therapy has actually clouded the identity

of the Orthomolecular movement. On the one hand we are confused with Holistic

Medicine; on the other we are seen only as the avant garde of orthodox medicine

In hopes of defining our true identity let me update the concept of

Orthomolecular Medicine as anew medical specialty.

 

First of all, the orthomolecular data base rests strongly on the following areas

of scientific knowledge: 1. nutrition, 2. biochemistry, 3. Cell biology, 4.

physiology, 5, general medicine, immunology, 7. allergy, 8. endocrinology, 9.

pharmacology, 10. toxicology, 11. gastroenterology, 12, parasitology, 13.

nephrology, 14. physical medicine and manipulation therapies, 15. dentistry, 16.

veterinary science, 17. food science, 18, agriculture, 19. climatology, 20.

medical politics.

 

The following therapeutic modalities fit the definition of orthomolecular: 1.

vitamins, 2. minerals 3. amino acids, 4. essential fatty acids 5, fiber, 6.

enzymes, 7. antibodies, 8. antigens, 9. cell therapy, 10. chelation therapy, 11.

dialysis, 12. plasmapharesis, 13. hydrotherapy, 14. thermal therapy, 15.

phototherapy, electrotherapy (including electroconvulsive therapy), 17. air ion

therapy, 18. light therapy, 19. solar therapy, 20. acupuncture, 21. massage, 22.

exercise, 23. biofeedback 24. hypnotherapy and other psychotherapies.

 

All of the orthomolecular practice rests on a foundation of basic science

advances in biochemistry, biophysics, physiology, psychophysiology and ecology.

We do not eschew drug therapy or pharmacology; but we do recognize their

limitations and their potential for toxicity. Orthomolecular knowledge gives

greater choice of benefits for our patients id with less risk of adverse

affects.

 

Aside from these areas of interest, there are by now some well defined beliefs

and principles that also distinguish the orthomolecular practitioner from

orthodox health practitioners. These principles actually are an important part

of our professional identity. Just as knowledge of science and therapeutics

might be thought of as our Ego, these principles makeup our professional

conscience or Superego, The desire to be in the avant garde of medical progress,

to share the excitement of discovery, no doubt, is a major source of our

motivational energy or libido, our medical Id, as it were. No, the love of our

grateful patients, those we are privileged to heal and comfort, this must be the

ultimate motive. At any rate, I think you will agree that the orthomolecular

professional is a different personality, with different beliefs and values than

most present-day practitioners of medical orthodoxy. Of course all physicians do

cherish our Hippocratic oath, but the orthomolecular identity

confers upon us additional values and beliefs. Hippocrates first rule was:

" Primum non nocere, " i.e. " first, do no harm " . We in orthomolecular practice

have less need for the primacy of that rule, for it is already implicit in the

essence of Orthomolecular practice, which is: " put nutrition first " .

 

Here is a list of 15 principles that identify the spirit " of Orthormolecular

Medicine:

 

1. Orthomolecules come first in medical diagnosis and treatment. Knowledge of

the safe and effective use of nutrients, enzymes, hormones, antigens, antibodies

and other naturally occurring molecules is essential to assure a reasonable

standard of care in medical practice.

 

2. Orthomolecules have a low risk of toxicity. Pharmacological drugs always

carry a higher risk and are therefore second choice if there is an

orthomolecular alternative treatment.

 

3. Laboratory tests are not always accurate and blood tests do not necessarily

reflect nutrient levels within specific organs or tissues, particularly not

within the nervous system. Therapeutic trial and dose titration is often the

most practical test.

 

4. Biochemical individuality is a central precept of Orthomolecular Medicine.

Hence, the search for optimal nutrient doses is a practical issue. Megadoses,

larger than normal doses of nutrients, are often effective but this can only be

determined by therapeutic trial. Dose titration is indicated in otherwise

unresponsive cases.

 

5. The Recommended Daily Allowance (RDA) of the United States Food and Nutrition

Board are intended for normal, healthy people. By definition, sick patients are

not normal or healthy and not likely to be adequately served by the RDA.

 

6. Environmental pollution of air, water and food is common. Diagnostic search

for toxic pollutants is justified and a high " index of suspicion " is mandatory

in every case.

 

7. Optimal health is a lifetime challenge. Biochemical needs change and our

Orthomolecular prescriptions need to change based upon follow-up, repeated

testing and therapeutic trials to permit fine-tuning of each prescription and to

provide a degree of health never before possible.

 

8. Nutrient related disorders are always treatable and deficiencies are usually

curable. To ignore their existence is tantamount to malpractice.

 

9. Don't let medical defeatism prevent a therapeutic trial. Hereditary and

so-called 'locatable disorders are often responsive to Orthomolecular treatment.

 

10. When a treatment is known to be safe and possibly effective, as is the case

in much 0 Orthomolecular therapy, a therapeutic trial is mandated.

 

11. Patient reports are usually reliable, The patient must listen to his body,

The physician must listen to his patient.

 

12. To deny the patient information and access to Orthomolecular treatment is to

deny the patient informed consent for any other treatment.

 

13. Inform the patient about his condition; provide access to all technical

information and reports; respect the right of freedom of choice in medicine.

 

14. Inspire the patient to realize that Health is not merely the absence of

disease but the positive attainment of optimal function and well-being.

 

15. Hope is therapeutic and orthomolecular therapies always are valuable as a

source of Hope. This is ethical so long as there is no misrepresentation or

deception.

 

The following tabulation further clarifies the role of Orthomolecular Medicine

in relation to medical orthodoxy.

 

FACTOR

 

GOAL

 

DIAGNOSIS

 

TREATMENT

 

 

ECOLOGIC VIEW

 

ETHIC

 

UNPROVEN REMEDY

 

DOUBLE-BLIND STUDIES

 

PATIENT REPORTS

 

RESPONSIBILITY

 

PLACEBO EFFECT

 

MEGAVITAMINS

 

INCURABLES

ORTHOMOLECULAR

 

cure of cause

 

nutrient levels

history, physical history

 

wellness model

ecologic view

 

orthomolecular

exercise

meditation

nutrient ecology and toxic factors

 

safety first

 

often useful on individual basis

 

false negatives occur

good treatment is lost

 

usually correct

 

patient is educated and responsible

 

useful adjunct

 

safe, effective

medical therapy

 

treat; offer hope

ORTHODOXY

 

palliation of symptom

 

chemistry levels

physical

 

disease model

germ theory

 

surgery

radiation

pharmacology

hazy on diet and toxic factors

 

efficacy first

 

always quackery; do not use - too risky

 

infallible standard of proof

accept no therapy without it

 

unreliable data

 

patient is ignorant and incompetent

 

suspect, dishonorable

 

unsafe, unproved

worthless therapy

 

don't treat; offer no " false' hope

 

 

 

The essentials boil down to 7 cardinal rules:

 

1. Nutrition comes first in medical diagnosis and treatment.

 

2. Drug treatment is used only for specific indications and always with an eye

to the potential dangers and adverse effects.

 

3. Environmental pollution and food adulteration are an inescapable fact of

modern life and are a medical priority.

 

4. Biochemical individuality is the norm in medical practice; therefore

stereotyped RDA values are unreliable nutrient guides.

 

5. Blood tests do not necessarily reflect tissue levels of nutrients,

 

6. Nutrient diagnosis is always defensible because nutrient related disorders

are usually treatment responsive or curable,

 

7. Hope is an indispensable ally of the physician and an absolute right of the

patient.

 

Finally, let me repeat, that our rallying point and badge-word must be

" Orthomolecular " , a landmark concept that conveys the genius of Dr. Pauling, who

saw the need to resurrect nutrition and put it first, not last, in our science

of health and disease.