September 1, 2008

Standardized Treatment Not Always Best for the Patient

By Patrick B. Massey, M.D.

Two weeks ago, I attended a meeting of the American Academy of Environmental Medicine. That might sound like people who are interested in the environment - and that's partially correct. It's a group of physicians, nurses and other health-care providers who are interested in the internal "environment" of each person and in providing the best care using what is truly known about how the body works.

When I was in medical school, we learned a lot about the biochemistry of the human body. However, by the end of my residency, biochemistry was replaced by algorithms. Algorithms are simply standardized treatment protocols used in medicine. Algorithms were meant simply to be guides and not dogma. However, we were taught to follow the algorithms, and uniformity was stressed so that all physicians have the same foundation of knowledge.

But every patient is unique, and individualized therapy works best. Even well-researched medications do not have the same effect in each person.

The American Academy of Environmental Medicine emphasizes evaluating the specific biochemical pathways to see how they relate to disease and illness. If deficiencies are found, then therapy can be specific and individualized.

In my experience, there are many chronic medical conditions not diagnosed by common laboratory tests. Chronic fatigue, adrenal stress, fibromyalgia and clinical hypothyroidism with normal thyroid tests are but a few. Some people just don't feel well even though all of their tests are normal; sometimes, they are simply put on an antidepressant.

Exploring the biochemical pathways, abnormalities are often found, and if treated correctly, result in patient improvement. At the American Academy of Environmental Medicine meeting, we spend an entire day just on the thyroid. The next two days were spent reviewing the adrenal gland and insulin resistance.

Although I have learned these biochemical pathways in medical school, I could see how the commonly used laboratory tests were incomplete for patients with complex illnesses. I am sure that many physicians are confounded by patients whose laboratory tests are normal but who clinically are not doing well. The lecturers presented a number of such cases studies, as well as how to look beyond the traditional tests to find answers and how these patients responded to their individualized therapy.

Often, the therapies included a combination of medications, supplements, stress reduction, exercise and changes in nutrition.

You might say, "Well, in traditional medicine we prescribe medications, some supplements, exercise, stress reduction and nutrition," and you would be right. The difference is that the approach emphasized by the American Academy of Environmental Medicine is that the medications, supplements and other therapies are individualized, and the results are more robust.

There are many paths to each specific clinical illness. Intuitively, individualizing therapy should have a better result. Ultimately, this is the direction that traditional medicine will take.

- Patrick B. Massey, M.D., Ph.D., is medical director for alternative and complementary medicine for Alexian Brothers Hospital Network.

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