"Why am I tired all the time?"
"Why do I have heart disease?"
"Why does my father have Alzheimer's?"
"Why did my sister get cancer?"
"Why are my mother and brother healthy?"

The answer to these questions is at the heart of how I practice medicine. Over the last 30 years, many terms have been applied to this approach of looking closely at the individual whose health is no longer optimal. Linus Pauling coined the term orthomolecular medicine, suggesting that if we found the right molecule (the substance that the individual was lacking and replaced it), health would be restored. Since then we have used many terms, including holistic medicine, alternative medicine, complementary medicine, functional medicine, and lately integrative medicine. All of these are attempts to balance and fill out the limitations of our current generally accepted medical model.

This generally accepted medical model, or "conventional medicine" as I refer to it, has given us many of the miracles of the last 60 years. Pneumonia is no longer the death sentence it once was. Major trauma heart attacks are now treatable events with often excellent outcomes. There is no doubt that conventional medical therapies reduce a great deal of pain and suffering in 2002. Most of these modern miracles are there to rescue us from illness, but ill suited to keep us well.

This conventional medical model works best when our biochemical, emotional and spiritual individuality can be overlooked. When we are near death, our physiologies are remarkably similar, but in life we are incredibly different. Some of us are able to eat 5,000 calories a day and sit around and not gain weight; others eat 1,200 calories a day, exercise, and inexorably put on the pounds. Some of us need 6 hours of sleep; others need 9 hours. Some can take sulfa drugs; others get an allergic reaction. Some can be exposed to chemical smells and not be bothered; others get very sick. Some people can have a mouth full of amalgam fillings and do fine; others develop chronic illnesses.

Researchers are studying these individual differences, but most MD's won't do much with them until they are blessed by some academic authority or go through the rigors of double-blind controlled studies. This new world of what has been termed evidence-based medicine makes excellent sense. We would all like to know that what the doctor suggests for us to do is based on solid evidence. The problem is the price tag for most of these studies is so high that only drug companies and HMOs can afford to do them. Drug companies are not bad, but they are in business to make drugs that can be patented and then recover their expenses and make a profit. All that is well and good, but the unintended consequence of this evidence-based medicine is that we have evidence only for expensive medicine

My approach to heart disease demonstrates the difference between individualized medicine and conventional medicine. This example will just deal with the biochemical aspect of my approach. The conventional approach is to screen people for HDL cholesterol, LDL cholesterol, trigycerides, and then treat with expensive and occasionally toxic statin type drugs. This is cost effective evidence-based medicine. However, there are many people who have normal numbers and still develop heart disease. If you have a family history of heart disease, how about checking other risk factors that apply to various sub-groups? These risk factors include C-reactive Protein, homocysteine, ferritin, Lipoprotein (a), fibrinogen, Apolipoprotein A and Apolipoprotein B, etc. These are all reported in the conventional medical literature to be significant risk factors for heart disease.. Statistically they are not significant predictors of heart disease risk when looking at large numbers of people. However they are very significant for some people. The risk of anything is 100% when it happens to you. Most of these risk factors can be changed for the better with safe and inexpensive nutrient and diet changes tailored to your unique physiology.

We all want to practice evidence-based medicine when we can, but let us not allow people to die while we collect the evidence. Let us apply what we know based on individual risk and benefit determinations.

We should not lose perspective in the glare of evidence-based medicine; it is a great concept, but in 2002 America it is mostly a pharmaceutical and HMO-controlled tool. Both of these entities are interested in promoting health, but they are also driven by the need to make a profit. Which interest do you think wins at the end of the day?

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