Ok, Ok. I've heard enough. My mailbox is besieged by near-hysterical, badly edited e-mails from one group, yet most of the groups I trust have been largely silent on the FDA ruling/Codex issue. I know many of you are concerned, mostly due to the aforesaid hysteria traveling quickly by way of Internet.
If you would like to read a well-reasoned, very fair assessment of the situation--including interviews with the FDA scientists, and a multitude of links to other opinions, visit John Weeks at the Integrator Blog.
If you want my take, well, take it with a grain of salt, and make up your own mind. (And this you should do for anyone's opinions, no matter how well-educated and how much you like--or dislike--them.) As far as I can tell, the ruling only states to clarify claims made about supplements & herbs on the same level as claims made for drugs. Put very simply (because this is the level on which it made sense to me): if I claim that the latest Tea-of-the-Week*** here at Stellaria cures cancer, then that tea falls into the category of a drug, and should only be dispensed/prescribed by those with the authority to do that. If I don't make that claim, then anyone can pour, enjoy, recommend the tea. Make sense?
The tea hasn't changed. The idea of who can "prescribe a drug" hasn't changed--and indeed, this is something that is regulated by the individual states, not by the FDA. For instance: I am licensed as a Naturopathic Physician by the State of Oregon. If I were practicing in Oregon, I could prescribe many things, including most common antibiotics. The State of Illinois, where I currently practice, does not license Naturopathic Physicians. Therefore, I may not "prescribe" anything; I make recommendations regarding commonly available food, herbs, and supplements. In this state I have no more access to regulated drugs than the average citizen. The drugs haven't changed, my training hasn't changed; but I work in a State with different laws. By the same token, though Washington and Arizona both license Naturopathic Physicians, there are drugs that Arizona NDs are allowed to prescribe that Washington NDs may not. (By the way, the drugs that a practitioner can work with are collectively known as the "formulary", and the formulary for each state is set by the governing board of the profession in that state. In Oregon, that's the Oregon Board of Naturopathic Examiners--you can read more about them here.)
So, back to the FDA ruling: if I claim that my Tea cures cancer, than under the terms of the ruling, I have claimed that this tea is a drug--and therefore access to it should be limited to trained and licensed practitioners. It is my hope that this ruling will stop certain people from making spurious and overblown claims for their products. It is important to remember that this ruling will not change your ability to enjoy good effects from any tea or herb on the market--it will prevent unscrupulous types from offering you medical miracles. (and if it does happen to cure your cancer, well, that would be a wonderful turn of events)
As John Weeks put it, "if the power of the FDA as described in this Guidance document makes you nervous, you had reason to be nervous already."
***By the way, the Tea of the Week is May Flowers, an aromatic and uplifting blend of Red Clover, Red Raspberry leaf, Nettles, Gingko, Gotu kola, Calendula, Chamomile, and Lavender. Come on by and have a cup! (It will not cure cancer, obesity, diabetes, or any prevailing social or physical ill. But it is lovely.)
Monday, April 30, 2007
Friday, April 13, 2007
Book Review: Arthritis Rx, Vijay Vad, MD
Books on natural and noninvasive medicine abound. Since I like to read, and since I have not yet written a book of my own, I thought I'd review some of the books that come across my desk--usually by way of my local library. We'll start off with:
Arthritis Rx: A Cutting-Edge Program for a Pain-Free Life, by Vijay Vad, M.D. Gotham Books: NY, 2006.
The author is a specialist in "minimally invasive arthritis therapies" at Manhattan's Hospital for Special Surgery. He also works as a physician for the PGA golf tour and the ATP tennis tour. Impressive credentials.
Grain of salt: I am wary of the term "minimally invasive", as it can have a range of meanings. Dr. Vad's specialty is the use of hyalan injections to lubricate arthritic joints. Hyalan is a synthetic version of the body's own hyaluronic acid, a component of joint lubrication. On the scale of invasiveness, not too high, especially compared with joint replacements.
Second grain of salt: I don't believe that doctors who practice at surgical hospitals are the best references on noninvasive therapies. Doctors with surgery at their disposal are inclined to use it. That has been my experience, anyway.
Third grain of salt: each time I pick up a book purporting to discuss integrative therapies, I check the index for references to Naturopathic Medicine. This book had none. The author does discuss osteopathy, chiropractic, massage therapy, and acupuncture, and in quite reasoned tones, which did make me feel better about his view of "alternative" medicine.
The book begins with an anecdote about Dr. Vad's grandfather, who dealt with 2 decades of arthritis through daily use of ginger, a daily yoga practice, and daily walks. This is the inspiration for the book. Grandfather Vad was a native of India; I don't know where Dr. Vad grew up, but I am impressed by doctors who go through conventional medical training without losing respect for traditional medicine.
The meat of the book consists of dietary guidelines, supplement recommendations, and exercises for maintaining mobility and flexibility and diminishing pain from osteoarthritis. Reference is made to the inflammatory arthritides (Rheumatoid arthritis, lupus, and so on), but the book really deals with the more common osteoarthritis, once considered an unavoidable part of aging.
Nutritional guidance consists of encouraging an anti-inflammatory diet--in this case, fruits, vegetables, whole grains, & fish--and cautioning against pro-inflammatory foods, defined as red meat, most dairy, and processed foods. Mention is made of food allergies/intolerances and their effect on inflammation. An emphasis on *real*, whole foods (as opposed to food substitutes like green food powders and the like), and the importance of the essential fatty acids. A good introduction to eating for health and healing.
The author next deals with supplements. He focuses on ginger (510 mg per day reduces pain, according to the study he quotes), glucosamine, and chondroitin. Use of the latter two is backed up by reference to the GAIT study** results, refreshingly summarized as "...(this combination) was at least as effective as the anti-inflammatory Celebrex in treating knee arthritis."
**The GAIT study was commonly misrepresented in the media as proving that glucosamine and chondroitin were ineffective, as they showed no significant effect on "mild" knee pain. Of course, these supplements shouldn't be given for mild pain that would resolve, with supportive care, on its own. They are used in cases of chronic inflammation, not as temporary painkillers... But back to the review.
Dr. Vad then surprised me by plugging his own supplement, Zingerflex, a combination of glucosamine, chondroitin, and ginger. He claims it is the only supplement available with this combination. I checked Emerson Ecologics, distributor of professional-grade supplements to many doctor's offices (including mine), and it's true, there was no exactly comparable formula. However, the amounts of ginger recommended (about 1/2 gram) are easy to incorporate into the diet, so is a supplemental ginger really necessary? Quality glucosamine/chondroitin supplements abound.
Still, I can hardly blame Dr. Vad for formulating his own product, as plenty of Naturopathic Docs work with supplement companies. Interestingly, the Zingerflex website makes no mention of the doctor's name, referring simply to a "leading physician researcher", but this may be standard practice for MDs. The product is reasonably priced, approximately $29.99 for a one month supply.
The next part of the book are the exercises, given in 3 series, from mild to strenuous. The author claims that many of his patients have done just fine sticking to the first series, with no need to progress to the others. Looking at the exercises (and I must admit, I did not try the sequences myself), they seem to be well-thought out combinations of Yoga with Pilates variations. Kudos to Dr. Vad for his emphasis on proper breathing during the exercises. I agree with him that controlled breathing is just as important to health as strengthening the muscles, if not more so.
The last part of the book deals with other approaches to healing arthritis, including a well-thought-out synopsis of several integrative therapies. The author balances the conclusions of Evidence-Based Medicine** with his own clinical observations. For instance, though EBM tells us that chiropractic has not yet been shown to be effective for arthritis, Dr. Vad adds that it has been quite effective for the low back pain of several of his patients. Good for you, Dr. Vad!
**Evidence-based medicine can be roughly summarized as the theory that only those interventions which have been tested in approved, double-blind studies and shown to be effective should be recommended to patients. While there is a great deal of logic to this, it ignores the importance of the observations of a learned physician.
The book concludes with a description of future treatments for arthritis, with an emphasis on gene therapy, in which stem cells (from the patient's own body; no need to be alarmed, GWB!) are used to grow new bone or cartilage. Ooooooh, cooool, I thought; and then I remembered something... In my country, the U.S. of A, we are so very good at creating extremely expensive interventions for medical problems. We are not so good at taking care of our citizen's basic medical needs. What would one stem cell procedure to ease one person's knee pain cost? And how many uninsured women could get good prenatal care for that money? Or how many cooking classes for diabetics could we fund?
But that is not Dr. Vad's fault. And he seems to be doing his best to promote the "interventions" of good food, good exercise, and good care to prevent the "need" for such expensive procedures.
Would I recommend this book? With reservations; I believe that the personal guidance of a provider with experience in nutrition, exercise, and herbal medicine is key to success with natural medicine. This book could then provide an adjunct, as it is a nice summary of valuable methods. The exercise and recipe sections alone could prove quite useful.
Until a book on arthritis from the standpoint of Naturopathic Medicine is widely available, Dr. Vad's book will do fine.
Arthritis Rx: A Cutting-Edge Program for a Pain-Free Life, by Vijay Vad, M.D. Gotham Books: NY, 2006.
The author is a specialist in "minimally invasive arthritis therapies" at Manhattan's Hospital for Special Surgery. He also works as a physician for the PGA golf tour and the ATP tennis tour. Impressive credentials.
Grain of salt: I am wary of the term "minimally invasive", as it can have a range of meanings. Dr. Vad's specialty is the use of hyalan injections to lubricate arthritic joints. Hyalan is a synthetic version of the body's own hyaluronic acid, a component of joint lubrication. On the scale of invasiveness, not too high, especially compared with joint replacements.
Second grain of salt: I don't believe that doctors who practice at surgical hospitals are the best references on noninvasive therapies. Doctors with surgery at their disposal are inclined to use it. That has been my experience, anyway.
Third grain of salt: each time I pick up a book purporting to discuss integrative therapies, I check the index for references to Naturopathic Medicine. This book had none. The author does discuss osteopathy, chiropractic, massage therapy, and acupuncture, and in quite reasoned tones, which did make me feel better about his view of "alternative" medicine.
The book begins with an anecdote about Dr. Vad's grandfather, who dealt with 2 decades of arthritis through daily use of ginger, a daily yoga practice, and daily walks. This is the inspiration for the book. Grandfather Vad was a native of India; I don't know where Dr. Vad grew up, but I am impressed by doctors who go through conventional medical training without losing respect for traditional medicine.
The meat of the book consists of dietary guidelines, supplement recommendations, and exercises for maintaining mobility and flexibility and diminishing pain from osteoarthritis. Reference is made to the inflammatory arthritides (Rheumatoid arthritis, lupus, and so on), but the book really deals with the more common osteoarthritis, once considered an unavoidable part of aging.
Nutritional guidance consists of encouraging an anti-inflammatory diet--in this case, fruits, vegetables, whole grains, & fish--and cautioning against pro-inflammatory foods, defined as red meat, most dairy, and processed foods. Mention is made of food allergies/intolerances and their effect on inflammation. An emphasis on *real*, whole foods (as opposed to food substitutes like green food powders and the like), and the importance of the essential fatty acids. A good introduction to eating for health and healing.
The author next deals with supplements. He focuses on ginger (510 mg per day reduces pain, according to the study he quotes), glucosamine, and chondroitin. Use of the latter two is backed up by reference to the GAIT study** results, refreshingly summarized as "...(this combination) was at least as effective as the anti-inflammatory Celebrex in treating knee arthritis."
**The GAIT study was commonly misrepresented in the media as proving that glucosamine and chondroitin were ineffective, as they showed no significant effect on "mild" knee pain. Of course, these supplements shouldn't be given for mild pain that would resolve, with supportive care, on its own. They are used in cases of chronic inflammation, not as temporary painkillers... But back to the review.
Dr. Vad then surprised me by plugging his own supplement, Zingerflex, a combination of glucosamine, chondroitin, and ginger. He claims it is the only supplement available with this combination. I checked Emerson Ecologics, distributor of professional-grade supplements to many doctor's offices (including mine), and it's true, there was no exactly comparable formula. However, the amounts of ginger recommended (about 1/2 gram) are easy to incorporate into the diet, so is a supplemental ginger really necessary? Quality glucosamine/chondroitin supplements abound.
Still, I can hardly blame Dr. Vad for formulating his own product, as plenty of Naturopathic Docs work with supplement companies. Interestingly, the Zingerflex website makes no mention of the doctor's name, referring simply to a "leading physician researcher", but this may be standard practice for MDs. The product is reasonably priced, approximately $29.99 for a one month supply.
The next part of the book are the exercises, given in 3 series, from mild to strenuous. The author claims that many of his patients have done just fine sticking to the first series, with no need to progress to the others. Looking at the exercises (and I must admit, I did not try the sequences myself), they seem to be well-thought out combinations of Yoga with Pilates variations. Kudos to Dr. Vad for his emphasis on proper breathing during the exercises. I agree with him that controlled breathing is just as important to health as strengthening the muscles, if not more so.
The last part of the book deals with other approaches to healing arthritis, including a well-thought-out synopsis of several integrative therapies. The author balances the conclusions of Evidence-Based Medicine** with his own clinical observations. For instance, though EBM tells us that chiropractic has not yet been shown to be effective for arthritis, Dr. Vad adds that it has been quite effective for the low back pain of several of his patients. Good for you, Dr. Vad!
**Evidence-based medicine can be roughly summarized as the theory that only those interventions which have been tested in approved, double-blind studies and shown to be effective should be recommended to patients. While there is a great deal of logic to this, it ignores the importance of the observations of a learned physician.
The book concludes with a description of future treatments for arthritis, with an emphasis on gene therapy, in which stem cells (from the patient's own body; no need to be alarmed, GWB!) are used to grow new bone or cartilage. Ooooooh, cooool, I thought; and then I remembered something... In my country, the U.S. of A, we are so very good at creating extremely expensive interventions for medical problems. We are not so good at taking care of our citizen's basic medical needs. What would one stem cell procedure to ease one person's knee pain cost? And how many uninsured women could get good prenatal care for that money? Or how many cooking classes for diabetics could we fund?
But that is not Dr. Vad's fault. And he seems to be doing his best to promote the "interventions" of good food, good exercise, and good care to prevent the "need" for such expensive procedures.
Would I recommend this book? With reservations; I believe that the personal guidance of a provider with experience in nutrition, exercise, and herbal medicine is key to success with natural medicine. This book could then provide an adjunct, as it is a nice summary of valuable methods. The exercise and recipe sections alone could prove quite useful.
Until a book on arthritis from the standpoint of Naturopathic Medicine is widely available, Dr. Vad's book will do fine.
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