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Nearly three decades ago, I shared a physically intimate moment with Dr. Tori Hudson. After inducing me to strip off most of my clothing, she was all over me with her hands, touching me in places that made me gasp. More accurately her hand that held a washcloth wrapped around a chunk of ice was all over me, finding those sensitive spots that preferred to stay warm. A classroom of students, who would go on to eventually become NCNM's class of 1991, watched Dr. Hudson and me; as I hooted and hollered, my classmates laughed with pleasure at my discomfort. In hindsight, I may not have been the easiest student to have in your class. That was the last time I volunteered my body for any classroom demonstration. Dr. Hudson will no longer admit she remembers our little interlude of iced-mitten-friction, but I like to think that we once had our own special moment. This is the same Tori Hudson who has contributed monthly articles to the Townsend Letter for the past 25 years. (I recently realized that Tori and I share another passion—not for each other but rather for sea kayaks; we both spend our off-time studying catalogs and longing for these sleek, elegant, long-bodied sea craft.)
We are fast approaching an important anniversary for Dr. Hudson. It is nearly 20 years since Dr. Hudson founded the Institute of Women's Health and Integrative Medicine. Since then, this institute has held 78 seminars on topics related to women's health. Assuming that 50-100 attendees have come to Portland for each of these three-day weekends, Dr. Hudson has deeply impacted the practices of nearly 5,000 doctors who have participated in programs put on by the Institute over those 20 years.
I think back to the single Tori Hudson conference I attended years ago. I suppose you could say that I once spent a romantic weekend with Tori—well, Tori and about 80 other colleagues who attended a seminar titled, "Excellence in Breast Cancer Care." Currently the Institute holds four conferences per year. This coming year there are three-day programs covering pediatrics, menopause, women's primary care, and fertility, and contraception: http://instituteofwomenshealth.com/future-conferences/.
I was one of a handful of men at the breast cancer program I attended. I could joke about the conference having been a great way to meet women, but I suspect such misogyny, even written in good humor, might not be appreciated. Even though this conference was years ago, I remember certain aspects quite clearly as the program reaffirmed some deeply held suspicions.
The first is that Oregon's long history of licensing naturopathic doctors allows a level of collaboration between NDs and MDs that is unimaginable in unlicensed states. Both an oncologist and a breast surgeon that Dr. Hudson works with presented lectures. That was novel for me. In Colorado, where the practice of naturopathic medicine was still illegal, such collaboration would never have occurred. Now that Colorado naturopathic doctors have been legal for a few years, I can just begin to imagine this happening. In fact, I have now been invited to speak at a local cancer center several times. I thought the big reason to get licensed was to stay out of jail; the reality is that regulation fosters collaboration between professions and improves patient care. Who knew?
Second, while medical doctors are smart, naturopathic doctors may be smarter. While the two medical doctors provided much of the continuing education, I recall being disappointed in their information. Medical doctors have a tendency to talk about things, talk about studies; but all too rarely do they transform data so it truly informs my practice; they did not change what I do. The naturopathic speakers, on the other hand, provided intellectual information along with practical details that change what I do with patients. Cancer Treatment Centers of America cosponsored the seminar and sent some of their best NDs to speak. Paul Reilly, who at the time was still working for CTCA in Seattle, spoke about using the immune system to treat cancer. Michelle Ququandah, who was at the Philadelphia CTCA, spoke on preventing and treating the side effects of chemo and radiation. Michelle has since left CTCA, gotten married, and is living happily ever after in Southern France teaching Mediterranean cooking. (I said these were smart people) Tina Kaczor and Lise Alschuler were already a lecture tag team back then and presented one of those intellectually weighty lectures they pioneered years ago at AANP conventions. This was back before there were a gazillion references on supplements listed on PubMed. They identified and described the biochemical mechanisms and signaling pathways that hinder breast cancer and then identified which supplements could impact those pathways. Those two brilliant ladies earned a place in my heart with their practical intelligence. Their method of breaking down therapeutic challenges to target mechanism continues to fascinate me to the point that I have started calling their process'naturopathic translational medicine.'
Way back in 1995, Everett Rogers in his book Diffusion of Innovation explained how technology spreads; he explained in a way, who would be the first and who the last person to buy a new iPhone. The same principles might be applied to the spread of new knowledge. The way Alschuler and Kaczor brought up some new information made me conclude our profession adopts new in an innovative manner. Let me explain.
I remember this conference distinctly because it was held shortly after the Women's Healthy Eating and Living (WHEL) data were first published. Their publication triggered a huge shift in what we tell patients about diet and breast cancer.The WHEL trial had followed 3,088 women diagnosed with breast cancer. About half the women, (n=1,537) were encouraged to eat more vegetables, fruits and fiber and far less fat (5 vegetables, 3 fruits plus 16 ounces of vegetable juice per day). The control group was encouraged to simply follow the ‘Five a Day' guideline the government promotes.
When the WHEL trial was begun in the late 1990s, these recommendations were the ‘best diet' for breast cancer patients so we actively encouraged our patients to follow this eating pattern, believing it would help. It didn't. After 7.3 years follow up, the rates of cancer recurrence or death from breast cancer varied by only decimals of a percentage point between the groups of women; there was no statistical difference nor even a hint of a trend suggesting benefit. (Comparing diet group vs. control group; for recurrence 16.7% vs. 16.9%, for death 10.1% vs. 10.3%)
Our years of encouraging women to eat all those fruits and vegetables and juice had done little good.
Listening to both Alschuler and Kaczor speak about how they were altering their views in response to these WHEL results made me think of the Roger's book. Our profession appears to have more than the expected number of what Rogers called, early adopters. An early adopter is the person who embraces new technology or, in my interpretation, new ideas, before most other people do. In terms of medicine, early adopters would be those who change their treatments quickly based on new and innovative research. According to Rogers' theory, early adopters make up 13.5 percent of the population.
Remember the early days of Helicobacter pylori? Recall that although Marshall and Warren discovered this bacteria in 1982 and solidly linked it to stomach ulcers, it took years for general practitioners to abandon the idea that stress caused ulcers and to start testing for and treating H. pylori. Six years after Marshall and Warren's landmark paper, only 44% of doctors had "… noted this relation." It wasn't until 2003 that the majority of physicians in the world accepted the H. pylori theory and begin treating ulcers appropriately. Marshall and Warren, by the way, were awarded the Nobel Prize in 2005 for their discovery.
Back in the mid-1980s at National College of Naturopathic Medicine (NCNM), I recall that our instructors were already teaching H. pylori treatments and debating the best approach. The speed with which we had incorporated this new knowledge into practice suggests that as a profession, we are all early adopters.
Early adopters, while eager to explore and accept new options, are not the most daring of people and are not especially prone to taking risks. According to Rogers, a much smaller segment of the population serves that role. He estimated that one person in 40 is an "innovator." Rogers also labeled individuals at the opposite end of the spectrum, calling them "laggards" and "Luddites." Laggards are slow or reluctant to embrace new technology because of disinterest or financial constraints. Luddites actively fear or loathe new technology, especially those forms they believe threaten their jobs.
The WHEL trial told us that eating lots of fruits and vegetables and cutting out fat does little to help breast cancer patients. I went to the Hudson Breast Cancer Conference pondering what our profession would do with the WHEL information. Now, a decade later, I can actually look at the shifts in our dietary prescriptions and trace them back to that conference, in particular to the Alschuler and Kaczor presentations.
As we could have guessed, the laggards among us simply ignored the data and went on promoting vegetable juicing and high vegetable and fruit consumption as the cure for breast cancer. The Luddites continue to talk of BigPharma conspiracies and how they must have manipulated the data to keep cancer rates high. They continue their long-honored tradition of not letting the facts get in the way of their beliefs. On the other hand, the innovators among us looked at the data and used them to catalyze a shift in our paradigm. This whole digression about slackers and Luddites is to explain what Alschuler and Kaczor did in their lecture all those years ago.
They did two things. First, they responded to the research and the current state of knowledge and shifted their priorities. While the benefits of diet for treating breast cancer had tanked, at the same time, there were still some gems hidden in the data that they picked out and held up for us; in particular that eating broccoli, losing weight, and exercising all impacted breast cancer survival. All were associated with better outcome in the WHEL women. They found the gems hidden in the data, highlighted them, and used them as leverage to move us toward a new paradigm, which at the time was in its infancy. In hindsight, it seems easy to look back and see the key studies that shifted our practices. But back then, a decade ago, these ideas were hard to see. Now we speak easily of the interconnection between weight, obesity, insulin, IGF-1, glycemic control, and AMPK activation. Back then, we were counting vegetables and juicing carrots.
That lecture effectively moved our understanding forward via a study that many practitioners had been seeing as a failure.
It is not often that lectures stick with me the way that one did. This is the sort of information that Dr. Hudson has been able to elicit regularly from her speakers for years; it is little wonder that her Institute has been so successful. Is there a secret to her success? Yes, it's got something to do with intelligence, discrimination, and wisdom; but I should refrain from writing anything too complimentary least anyone think I have ulterior motives. That hydrotherapy class was long ago.
It doesn't hurt that these conferences are not geared to make money. "These conferences are," in Dr. Hudson's words, "… lean conferences with small profits…. Any profits that do accrue go toward supporting residency salaries." Dr. Hudson, we should note, has for many years employed naturopathic residents in her office. In fact, back in 2005, Dr. Hudson partnered with Margaret Beeson, ND, of Billings, Montana to form an organization, the Naturopathic Education and Research Consortium (NERC), that is dedicated to increasing postgraduate residency and training opportunities across the country.
According to Dr. Beeson, "Residencies are crucial to the advancement of our profession…. graduates need paid opportunities to hone their skills in a supervised setting with seasoned naturopaths who can support and educate beyond medical school." Residencies "… are the foundation for passing on the wisdom of medicine as both art and science."
It's rare, actually hard, to imagine a conference that has me still pondering the contents of its lectures 10 years late. Dr. Hudson has done something really special with her Institute. We all should be taking greater advantage of what they offer.
Orr G. A Review of Diffusion of Innovations by Everett Rogers (1995). March 18, 2003. Available at http://web.stanford.edu/class/symbsys205/Diffusion%20of%20Innovations.htm.
Pierce JP, et al. Influence of a diet very high in vegetables, fruits, and fiber and low in fat on prognosis following treatment for breast cancer; the Women's Healthy Eating and Living (WHEL) randomized trial. JAMA. 2007 July 18; 298(3): 289-98.
Thomsen AS, et al. [Knowledge about about Helicobacter pylori and antibiotic treatment of peptic ulcer. A model study of information dissemination and implementation of the new knowledge in clinical practice] [Article in Danish]. Ugeskr Laeger. 1999 Nov 29;161(48):6630-4.
Huang J, et al. Has education about Helicobacter pylori infection been effective? Worldwide survey of primary physicians. J Gastroenterol Hepatol. May 2003; 18(5): 512-520.
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Jacob Schor, ND, FABNO