The Obama Presidency
That Tuesday evening in November when Barack Obama was elected president was one of the few moments of unbridled euphoria in 2008. The electrifying announcement by the networks and news services of Obama's win, coming much earlier than most similar election night announcements, metamorphosed us into wild dervishes, dancing in the streets, roaring in delight, jumping up and down in celebration. By us, I mean not just Americans, but also people around the world – including crowds in Paris, Jakarta, Nairobi, and Rio. For some, the US election had been viewed as the one hope for leadership in the global economic debacle. In that regard, Obama's promise for "change" resonated exactly right with the US populace as well as with friends and "enemies" abroad. The outrageous and wholesale implosion of Wall Street and the banking institutions, the looming bankruptcy of GM and the auto industry, and the unprecedented trillion-dollar loan by the Treasury and Federal Reserve overshadowed the unending, abysmal foreign occupations and war-mongering, as well as the federal government's feeble response to natural disasters like Hurricane Ike. Although Obama's election was engineered by the street-smarts of a Chicago politician and with the unprecedented power of Internet fundraising, Obama looked and sounded above the political fray, and voters believe he will be able to "get us there" – "there" being a place where the US will regain respect without hegemony and citizens will regain their dignity without revolution.

Despite the naysayers, the world does seem brighter and lighter; Obama's election has transformed everyone's affairs with the expectation that things may work out better than expected in the future. One can certainly hope that the terrible morass of US health care and the untenable inflation of health insurance will finally be addressed. As for natural medicine, let us also hope that Obama is not persuaded by the regulatory efforts of Congressmen Waxman and Dingell and Senators Kennedy and Durbin to straitjacket doctors who practice alternative medicine.

Device Diagnostics
In this month's issue of the Townsend Letter, "Shorts" columnist Jule Klotter takes a gander at the medical diagnosis world through the use of medical devices. I remember when I was attending medical school, back in the days when there was no such thing as a Cat Scan, Pet Scan, or Dog Scan, when we were obliged to do a careful history and physical to work-up a patient. Old-time internist Sir William Osler commended the careful bedside exam as the best means to making a diagnosis. So why do so many medical doctors use CT Scans and MRIs to evaluate patients? Doing so may not seem to be such a bad thing -- except that of the nearly 115 million scans doctors order annually, more than half offer not a scintilla of useful information for a more informed diagnosis. Our own Dr. Alan Gaby has opined that he would not order a lab test unless it was crucial to determining the cause of the problem. Well, at least we now know how our Medicare dollars are wasted. Klotter also gives a look-see at the unjustified criticism made of bio-energetic medical devices and their role in functional medicine.

Ascorbic Acid Administration for Cancer
My patients often tell me that they are reading about the great strides medicine is making in integrating complementary and naturopathic medicine into conventional medical settings. I usually receive such comments with a measure of disbelief, knowing that my own discussion of chelation and nutraceuticals is usually greeted with cross-eyed derision at local medical meetings. But there probably is reason for me to shed some of my apprehensions. In the photo at the ACAM meeting (on page 8), Dr. Jeanne Drisco is shown next to yours truly. Dr. Drisco is in charge of a section at the University of Kansas Medical School Hospital involved in administering vitamin C intravenously to cancer patients. Her treatment is integrated into cancer care; in other words, patients receive chemotherapy as well as intravenous ascorbic acid, albeit not at the same setting. Dr. Drisco's work has demonstrated positive effects for vitamin C, but only when it was administered intravenously, not orally. Drisco, who is president of ACAM, lectured about the role of ascorbic acid in cancer treatment at the November 2008 ACAM meeting in Las Vegas.

Kaiser Permanente Offers Herbs
Further evidence that the orthodox camp is beginning to open the door to natural treatment methods may be seen by looking at the operations of Kaiser Permanente HMO. As discussed by Elaine Zablocki in her "Pathways to Healing" column, Kaiser offers complementary therapies to their nine million subscribers.

One of the "treatments" offered is guided imagery. Dr. O. Carl Simonton popularized this method of meditative imagining in the 1980s as a means to improve patient control during the cancer treatment process. Kaiser offers guided imagery for other conditions as well, including as a tool for controlling hypertension. What is more surprising is that Kaiser dispensaries also offer a variety of herbs and nutraceuticals to patients. One wonders if Kaiser's move will tempt reluctant cardiologists to offer a little guided imagery and some garlic and ginkgo biloba to see if additional blood pressure control might result.

Growth Hormone Secretagogues
On a more serious note, Dr. Stephen Holt walks us through the somewhat arcane world of growth hormone treatment. The exploding use of growth hormone (GH) injections and the burgeoning Internet sales of GH supplements have caused increasing concern among medical authorities and the FDA. Theoretically, anti-aging clinics are offering GH treatment as supportive treatment for putative growth hormone decline and aging dysfunction of the endocrine system. However, legal concerns arise because GH administration is limited to conditions diagnosed as having primary GH deficiency, such as dwarfism. Further, Holt examines the mechanisms offered as the basis for GH therapies, so-called secretagogues that may or may not accomplish the work of GH injections. This article deserves careful review to understand the current rationale for GH treatment.

Functional Lab Testing
Functional lab testing and functional medicine have become important areas of the alternative medicine arena. Functional medicine examines the functioning of the liver, for example, not merely possible enzyme abnormalities in the liver, characteristic of infection, inflammation, or cancer. We all know that some of us can seem to imbibe many alcoholic drinks without effect, while others can only consume a few drinks before becoming inebriated. This would be the Happy Hour version of functional liver testing. A more serious example of liver function testing would be an examination of the liver's ability to metabolize caffeine. Strange as it may seem, caffeine metabolism is not uniform for everybody: some of us metabolize caffeine at a much greater rate than others. Although the detoxification capability of the liver is not generally studied in the conventional medicine setting, such evaluation offers important insights into how the liver is functioning before disease develops. Dr. Russell Jaffe examines functional lab testing and offers nutritional therapeutics appropriate for managing "functional" impairments. His article is printed in this issue and also appears on our website, together with the first two articles in his series on functional lab testing.

Vitamin D Supplement as a Cause of Immunosuppression
Lastly I would like to direct readers to reading Dr. Joyce Waterhouse's article on vitamin D immunosuppression, published here in abbreviated form as a Letter to the Editor. Waterhouse has appeared on these pages before (and on our website), discussing the role of vitamin D in the treatment of Lyme disease. Somewhat counter-intuitively, she argues that vitamin D deficiency is not the problem; rather, increasing vitamin D levels play a role in worsening the inflammatory process of infection. Waterhouse's writing is based on the model developed by Trevor Marshall, PhD. His theory indicates that the vitamin D receptor site is the troublemaker in inflammatory conditions and that treatment needs to be predicated on interfering with the vitamin D receptor site. Accordingly, increasing vitamin D levels aggravates rather than improves inflammation.

Admittedly, this theory flies in the face of the current medical model espoused by Dr. John Cannell and others in this publication and elsewhere. We offer this work by Dr. Waterhouse to open further dialogue on vitamin D therapy. To read Dr. Waterhouse's article in full, along with her earlier articles on Lyme disease, please visit www.townsendletter.com.

We hope you enjoy this issue and look forward to your participation in the Townsend Letter in 2009!

Jonathan Collin, MD