The September 2004 issue of Seattle magazine trumpeted its main feature, "Top Doctors," and highlighted the fact that it had selected Seattle's "Top Alternative Practitioners." I tore to the section of the local publication listing Seattle's top alternative docs—I was not surprised to find that alternative medicine had been compartmentalized into naturopathy, chiropractic, acupuncture, osteopathy. What was particularly galling was the fact that the great leaders and minds of alternative medicine, many of whom are M.D.'s who decided not to practice conventional medicine, would not be welcomed by this classification of alternative practitioners. Licensing prohibits an M.D. from being referred to as a naturopath; hence, from the viewpoint of the magazine, M.D.'s practicing alternative medicine do not officially practice alternative medicine, unless they become licensed in naturopathy, chiropractic, acupuncture or osteopathy.

In the Seattle area, it would be obvious to honor Jonathan Wright, M.D. as a top alternative practitioner, but as an M.D., Wright has no cachet in the magazine's honor system. Nationwide I can think of many outstanding M.D. alternative doctors who would have never received honors: Alan Gaby, Robert Atkins, Abram Ber, Emmanuel Cheraskin, Deepak Chopra, Elmer Cranton, Charles Farr, Garry Gordon, Abram Hoffer, Evarts Loomis, Theron Randolph, Norman Shealy, Bernie Siegel, Lendon Smith, Melvyn Werbach, Julian Whitaker, James Carter, James Gordon, John Lee, Christiane Northrup, William Philpott, Doris Rapp, Bernard Rimland, Hugh Riordan, Andrew Weil and many others.

The concept that M.D.'s are not alternative practitioners is not limited to this local magazine. Official study of alternative medicine generally focuses on traditional, established forms of alternative medical practice such as naturopathy and acupuncture. The practice by alternative M.D.'s of orthomolecular medicine, intravenous vitamin and mineral therapy, chelation, bio-oxidative therapies, ozone treatment, colonic therapy, glandular therapy, bio-identical hormone treatment, cell therapy, hyperbaric oxygen, unconventional cancer therapies, hyperthermia, homeopathy, herbal treatments, nosode therapy, neural therapy, and detoxification are generally not considered acceptable alternative practices and, therefore, are not recognized by authorities or society. The fact of the matter is that a large part of alternative medicine practice which goes unrecognized officially is conducted by alternative M.D.'s who use one or more of the aforementioned therapies. As society and university studies examine alternative medicine in the future, it will be obligatory to recognize the role M.D.'s have had in developing alternative medicine.

In this issue of the Townsend Letter for Doctors and Patients we consider the role alternative medicine has in treating anxiety disorders. Werbach spells out in the simplest of terms the effectiveness of B vitamins in arresting symptoms of agoraphobia (fear of open spaces). Inositol, Niacinamide, Thiamine, B6 and B12 are all considered key to reversing anxiety symptoms. For most patient treatments, the B Vitamins must be used in a "mega-dose" fashion to establish an anti-anxiety effect. It is a curious phenomenon that for a minority of patients, B vitamins in mega-doses tend to exacerbate the anxiety symptoms. When a patient indicates that high dose B-vitamins has had an ill effect on anxiety and depression symptoms, the practitioner would be well advised to be very cautious prescribing again mega-dose B-Vitamins. It is unlikely that the adverse effect of B-vitamins was coincidence—instead, the patient probably has some hypersensitivity which the B-vitamins is triggering. The most concerning patient is the anxious patient with insomnia; B vitamins may worsen the insomnia, assuredly aggravating the anxiety state. Gaby emphasizes the role that stimulants in the diet play in creating an anxiety state. His primary target is coffee drinking and excess caffeine consumption. Gaby reminds us that for a few individuals even tiny amounts of caffeine will set off the anxious patient; for these few individuals, a complete elimination of coffee and caffeine in the diet is mandatory for anxiety relief. Interestingly, classical homeopathy, as discussed by the Ullmans mandates that patients omit coffee drinking before being administered the correct remedy. Homeopathy prohibits the consumption of coffee, as coffee is considered to be a neutralizer of effective homeopathic treatment. Is it possible that coffee is hypersensitizing to anxious patients not only because of the caffeine but also because of the coffee itself?

For those interested in a more scientific discourse on why nutrients impact anxiety disorders, please read Nick's evaluation of inositol as a treatment for obsessive compulsive and panic disorder. Wolfe reminds us that Chinese medicine, particular acupuncture, is a very effective tool for controlling anxiety and abating more severe psychiatric disorders. Flaws discusses the rationale of Chinese medicine for anxiety requires a balancing of qi energy especially in the liver, heart, kidney and spleen meridians. The role of Chinese medicine in treating anxiety is documented by Flaws with Hamilton Anxiety Scale tests before and during treatment with Chinese herbals.

Anecdotally, I should mention my patient's treatment of panic disorder and anxiety syndrome using a form of neural therapy. This patient, a woman in her early 40's, suffered for years from panic disorder, agoraphobia, fatigue syndrome, depression, and cognitive dysfunctioning. My first treatment recommendations included reduction in caffeine, food allergy elimination diet, selective use of vitamin, mineral, amino acid, and essential fatty acid supplements, and homeopathy (anti-anxiety formulas). Further evaluation indicated a low grade form of hypothyroidism and treatment with thyroid USP 1/2 grain. To increase the effectiveness of B Vitamins, I had her self-inject B12 several times weekly according to the recommendation of orthomolecular psychiatrist, Newbold. Herbals kava kava and valerian were employed despite the warnings that this may cause liver toxicity (liver function tests have remained normal). Despite the variety of treatment supports and continuation of therapy, she continued to experience panic disorder and anxiety.

A review of her medical history disclosed that she did not experience anxiety disorder until sustaining a brain concussion, the result of injury from a domestic violence incident. She had been punched in the forehead by her husband, knocking her unconscious. The resulting injury took some time to heal and left an area of sensitivity to touch in her forehead. Neural therapy, a topic too complicated to discuss here, claims that painful scarred areas in the body can be the focus of energetic disturbance leading to medical conditions and disease. Neural therapy recommends the injection of procaine and/or similar agents in the scarred area to dissipate the abnormal energetic field. With some trepidation, I began a form of neural therapy which probably was not acceptable to neural therapy instructors. I like mixing procaine with B12 and occasionally using minimal doses of DMSO. I injected the patient through the scarred area of her forehead with the procaine mixture, injecting approximately 10cc, in a grid-like pattern across her forehead. She stated after the treatment that as a child she had been called a "numb-skull," but this treatment definitely made her one. With the very first treatment, and with each treatment thereafter, she has had a complete cessation of anxiety and agoraphobia symptoms for the first time since the domestic violence assault. She has regained her ability to work and be out in the community. The treatment seemed to have a half-life; she needed to be reinjected about a month later to sustain the anti-anxiety effect. Why this procaine injection treatment of her forehead would control her anxiety symptoms gives some validity to the idea that scar formation from past trauma plays an important role in perpetuating anxiety and depression.

The next two issues of the Townsend Letter examine Women's Health and Men's Health.

Jonathan Collin, M.D.