Spring cleaning and counting pebbles

May 28, 2012

Jacob Schor ND, FABNO

www.DenverNaturopathic.com

 

There’s a Hebrew expression that in English sounds like ‘juke bah rosche’ that translates to ‘cockroach in the head.’  It refers to an idea that gets stuck in your mind that you just cannot shake.

 

About two weeks back, Dr. Bloom and I both acquired similar juke’s in our heads; we wanted to paint our office.  And of course while we were at it, we had the carpets replaced. So that’s what happened over the holiday weekend.

 

Most things are back in their places except for my two filing cabinets.  As we were emptying the office prior to painting, I made a decision and emptied their contents into our recycling dumpster.  This is a measure of how much the way I practice has changed over the decades.  [in fact if anyone is interested in owning two used matching four drawer Hon cabinets in an off-white color, let me know]

 

I started collecting files when I was a student at National College of Naturopathic Medicine.  At the end of each semester I sorted my notes by ‘condition/disease’ and put them into file folders.  By the time we graduated I had almost a full file drawer.  Over the years since then, I added to those file folders. One drawer grew to ten drawers.

 

When a patient would present with a particular condition I would open the appropriate file and go about my business.  Then something happened. The worldwide web and PubMed.gov made my filing system obsolete.  These days it is no longer appropriate to consult information that may be a decade old or even five years old or sometimes even 5 months old.  Information on the use of natural therapies is being published so frequently in the scientific journals that it is more appropriate to start from scratch each morning rather than look at ‘ancient history.’

 

Nowhere is this truer than in the practice of naturopathic oncology where we can find ourselves making decisions based on data that were published within months or weeks. 

 

Making repeated trips to the recycled paper dumpster with our hand-truck loaded lugging all these old files gave me the chance to think about my current decision making process when it comes to creating a treatment plan for patients.  There is a sort of calculus to making choices as to what might be useful and what therapies I no longer encourage.

 

I confess to lingering over and reading many of these files as I dumped them, reading through what are now outmoded ideas.   Remember when John Lee MD announced that progesterone would cure osteoporosis back in 1990? There is no point in saving Lee’s original paper in Medical Hypothesis now that we are pretty certain that he was wrong. (How about ‘Relaxin’ to treat fibromyalgia, or that stuff called Remedium?) It was a slow process.

Back to this idea of a calculus to determine what therapies to use for a moment.

 

Calculus is an interesting word. According to Encyclopedia Britannia, "About 15 BC, the Roman architect and engineer Vitruvius mounted a large wheel of known circumference in a small frame, in much the same fashion as the wheel is mounted on a wheelbarrow; when it was pushed along the ground by hand it automatically dropped a pebble into a container at each revolution, giving a measure of the distance traveled. It was, in effect, the first odometer." This odometer was used to calculate fares for what passed as taxis back then.

 

These days I collect pebbles of information in a number of ways.  For the sake of an example let me talk about the alkaloid berberine and try to illustrate the process.

 

Berberine is found in a number of medicinal herbs, in particular Goldenseal (Hydrastis canadensis), dyer’s woad (Isatis tinctoria), and Oregon grape (Berberis aquifolium).  These plants have all been used as medicinal herbs going back into antiquity.  Archaeological evidence suggests that people were growing and collecting Isatis as far back as the Neolithic period. Benjamin Barton in his 1798 attempt at writing a Materia Medica of the United States stated that the Cherokee used goldenseal as a cancer treatment. The Eclectic doctors of the early 1800s who were supremely competent herbalists used goldenseal as a cancer treatment. 

 

Without question plant extracts that contain berberine have a long history of use in treating cancer.  That’s worth about 4 pebbles.  Two decades ago, this knowledge alone would have been adequate to prescribe one of these herbs for a cancer patient.  Not anymore.

 

From the old books, we turn on the computer and go to the library.  For the purpose of this discussion, I will use the National Library of Medicine in Washington, DC.  The search engine at this library is well known: www.PubMed.gov.

 

A quick search using PubMed yields 332 citations of papers published in scientific journals about berberine and cancer.  If we say that each one hundred published papers is worth about a pebble, we can add 3 more pebbles to the pile.

 

Most of these papers are in vitro research, that is the results of experiments in test tubes, or cell cultures.  This kind of research is always interesting to me, but the truth is that extrapolating from these data to actual effect in human patients is difficult.  What we really want is human research using berberine.

 

Limiting the PubMed search to human clinical trials on berberine and cancer yields 23 studies.  Let’s award a pebble for each 5 studies, so we drop another 4 pebbles into our virtual calculator.

 

Typically we will fine tune this further and look for information relevant to the particular patient, especially the kind of cancer they have or the type of therapy their medical oncologist is treating them with.  For example if they are about to undergo radiation, we can quickly find several clinical trials supporting the use of berberine in conjunction with radiation therapy, for example:

 

Li GH, Wang DL, Hu YD, Pu P, Li DZ, Wang WD, et al. Berberine inhibits acute radiation intestinal syndrome in human with abdomen radiotherapy. Med Oncol. 2010 Sep;27(3):919-25.

PMID: 19757213

 

Each study that seems to be ‘spot on’ the way this one would be is worth another pebble.

Or maybe two as that study certainly is encouraging.

 

At about this point I often switch websites and go to www.Clinicaltrials.gov.

 

This website provides information on all the clinical trials going on in the world.  First we ask the question, “are there clinical trials in progress using berberine?”   [This isn’t an iPhone and we don’t just ask like that, we type in an appropriate term in the box to search the trials….]

 

The website tells us that there are now ten clinical trials listed using berberine for treating a range of conditions.  Two of these are related to ovarian cancer risk.  One is recruiting and one is in progress.  Each clinical trial in progress is worth a pebble.

 

So what’s that add up to?

 

Long history of use:  4 pebbles

332 studies on berberine and cancer: 3 pebbles

23 Human Clinical Trials on berberine and cancer: 4 pebbles

No points for spot on studies as we don’t have a real patient here: 0 pebbles

2 clinical trials in progress on berberine and cancer:  2 pebbles

 

 

Well that is what I have been thinking about this last week, how to count pebbles.  

Rena and I have managed to cure our impulse to paint and carpet.   We are back to doing what we do best now, seeing patients.

 

The office looks great by the way….

 

 

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