Environmental Medicine Doctor Chastised
Longtime environmental medicine expert Dr. William James Rea of Dallas, Texas, was disciplined by the Texas Medical Board at the end of August 2010.1 Rea has been a pioneer in developing techniques to diagnose and treat chemically and biologically sensitive patients. His clinic has focused on patients who are extremely sensitive to allergens, but not the allergens generally scrutinized by allergy specialists. Instead, Rea diagnoses sensitivity to petroleum and industrial chemicals, pesticides, and plasticizers, addressing the problem with strict protocols for avoidance of chemical exposure. Treatments do not rely on pharmaceuticals; instead, Rea administers desensitization therapies, usually in homeopathic dosing for the offending chemicals. In rare cases, patients are so sensitive that they need to be entirely removed from exposure to any chemicals. Rea, like other environmental medicine physicians, has advised some patients to confine themselves to special living units designed of plain metal and porcelain with fully filtered air and water.
One patient of Rea's who has been living in a 150-square-foot module in a suburb of Dallas has been the target of the local city planning department for failing to get a permit before building. Rea's design of the "home" and his treatment of the patient led to a medical board investigation initiated in 2007.
The medical board and Rea reached a settlement on the board's complaint that Rea did "unscientific tests which mislead patients into believing that they have either an autoimmune or immunologic basis for their complaints, when in fact, they do not." Rea had written a letter to his patients in which he stated that "the unit which has filtered air and water is the only way to protect the patient from an exacerbation of her symptoms and a worsening of her already unstable condition."
The medical board's complaint found that Rea "injects patients with neurotransmitters, mycotoxins, jet fuel, natural gas and other chemicals." The board thought that the "treatments are inappropriate, not based on evidence, not based on any physiologic correlate, are nonsensical and can be harmful." Rea responded that the "injections contain electromagnetic imprints of chemicals such as propane gas, formaldehyde and gasoline, not the chemicals themselves." The board did note that no patients claimed to be harmed from Rea's treatments.
The Texas Medical Board ordered Rea to have each patient read and sign a special consent form indicating that his treatments are not approved by the FDA and that "their therapeutic value is disputed." Also, the board stipulated that Rea's injections "must be electromagnetic imprints and not the harmful chemicals." The patient has been fined by the city for failing to obtain local permits, with penalties now reaching $42,000. The patient's family sued the city in federal court, but the lawsuit was dismissed.
Once again an alternative medicine physician is disciplined without a patient's being harmed. Of course, designing a building for a patient is usually not considered within the scope of medical practice. The failure of the patient to get proper permitting undoubtedly exacerbated the complaint against the doctor.
The Ultimate Human Bioidentical Hormones
One of the boldest changes in public health policy is proposed in a book, Stay Young & Sexy with Bio-identical Hormone Replacement: The Science Explained, by Jonathan Wright, MD, and Lane Lenard, PhD. The authors discuss in great detail how estrogen hormone replacement in the form of Premarin poses considerable risk to women, particularly because the estrogen is derived from pregnant mares. Wright and Lenard argue that the chemical structure of estrogen in Premarin is distinctly different from the estrogen in humans. They question whether a horse estrogen can function in a human female as well as a "bioidentical" estrogen. However, Wright and Lenard were impressed with the method of preparing Premarin through collecting urine from pregnant mares, and propose a novel means of making "über" bioidentical hormones. Why not set up "collection stations" in high schools across the US to collect urine from young men and women? The urinary hormones in 15- to 19-year-olds would be at their maximal levels and the hormones would assuredly be bioidentical. And public schools would benefit economically by charging a fee for supplying the raw material to the pharmaceutical company manufacturing the hormones. Wright comments that we probably wouldn't see such a policy change, even though it would be a win-win for schools and patients.
Should Every Male Over Age 50 Be a Candidate for Testosterone Replacement?
Bioidentical hormone therapy for male "menopause," or andropause, has been well recognized. Many men in their 50s and 60s (or earlier) seek medical attention when they begin to experience symptoms of erectile dysfunction. Their doctors order serum testosterone levels, and if the levels are low, a testosterone prescription is usually made. Of course, there are many men who avoid seeing their physicians about erectile problems, and without testing there is no testosterone treatment. And erectile dysfunction is only one component of testosterone deficiency. According to Eugene Shippen, MD, and William Fryer, authors of Testosterone Syndrome: The Critical Factor for Energy, Health & Sexuality—Reversing the Male Menopause, low testosterone is the primary factor in accelerating the aging process. Shippen notes that men with low testosterone levels experience mental fatigue, tiredness, change in creativity, decrease in competitiveness, depression, and change in memory. From a physical standpoint, a low testosterone level leads to soreness, decrease in flexibility, decrease in muscle size, back pain, osteopenia, development of chest pain, lightheadedness, poor circulation, and change in visual acuity. On a laboratory basis, low testosterone increases cholesterol and triglyceride, raises blood sugar, and leads to unexplained weight gain. If treating testosterone deficiency offers the prospect of correcting most of these problems, why shouldn't most men be routinely screened for testosterone as they age?
The main objection to instituting testosterone therapy is concern about increasing the risk of developing prostate cancer. Because prostate cancer includes antitestosterone therapies, the general medical consensus has been that testosterone replacement poses an increased risk for either developing or exacerbating prostate cancer. Shippen and Fryer examine the evidence and disagree. Their review of the literature has not supported the thesis that testosterone therapy increases the risk for prostate cancer. Nevertheless, Shippen always measures the PSA and does not offer testosterone to men with elevated PSAs. Further, he prefers that alternative means to increase testosterone be attempted prior to initiating testosterone replacement. For many men who suffer from metabolic syndrome, restricting calories, weight loss, exercise, prudent use of supplementation, and avoidance of medications that diminish testosterone may be all that is needed to increase testosterone level. Shippen is greatly concerned with men who "aromatize," meaning that they convert testosterone into estrogen, leading to an excess estrogen state. The estrogen will compete with testosterone, interfering with testosterone's normal activities. Shippen contends that if steps are taken to prevent the aromatizing of testosterone, leading to lower estrogen levels, testosterone is effectively increased to normal levels. He likes supplementation of zinc and eating soy as two easy means to stop aromatization.
From Shippen's vantage point, everyone with a low testosterone level needs supportive steps to increase testosterone and avoid symptoms of testosterone deficiency. If there is concern about prostate cancer because of an elevated PSA, then alternative steps to support testosterone should be taken without taking the hormone. Still, Shippen's examination of the literature has not shown that testosterone increases the risk for prostate cancer.
Integrative Protocols for Prostate Cancer
Prostate cancer is a leading cause of cancer death in males. Yet most men who develop prostate cancer will die from noncancer causes. The fact that prostate cancer does not necessarily metastasize presents difficult therapeutic dilemmas for the practitioner and the patient. It may be the only cancer for which "watchful waiting" is the appropriate course of action.
In years past, prostate cancer was treated aggressively with surgical prostatectomy, radiation treatment, hormone therapies, and in rare cases surgical castration. Many men survived their prostate cancer but suffered with impotence and urinary incontinence. While such interventions may have been appropriate for preventing cancer spread, researchers questioned the need for aggressive intervention. After all, if the prostate cancer is slow-spreading and many men do not develop metastasis, why would radical intervention be necessary? In fact, treatment of prostate cancer has changed in the last several years, with many urologists agreeable to engage in watchful waiting for early prostate cancer. Additional difficulties using PSA laboratory testing have made diagnosis and treatment of prostate cancer uncertain. Many patients also express concern about prostate biopsy, worrying that the biopsy itself may seed the tumor in the bloodstream to other tissues. A diagnosis of prostate cancer now leads to conflicting second opinions about its management.
We are pleased to present two articles in this issue of the Townsend Letter to approach the management of prostate cancer. The first discusses a clinic's protocol of integrating Eastern and Western medicine. Elaine Weil, Cheri Quincy, and Nancy Faass discuss the treatment philosophy at the Amitabha Medical Clinic in Sebastopol, California. The clinic was founded by Isaac Eliaz, MD, MS, LAc. Weill, Quincy, and Faass emphasize the need to individualize the protocol for each prostate cancer patient. "Two men, both diagnosed with prostate cancer and with the same Gleason score, might actually have very different conditions, and we would develop two very different programs to meet those needs." The authors describe a treatment matrix of "detoxification, antiangiogenesis, promoting apoptosis, lowering viscosity, modifying genetic signaling, modulating hormone levels, and constitutional balancing." The clinic employs acupuncture and infusion therapies of intravenous vitamin C. Laboratory diagnostics are very important. The integrative approach complements conventional medicine as needed to support the cancer patient.
A second article by Robert Gorter, MD, PhD, and Erik Peper, PhD, discusses the approach used at the Medical Center Cologne in Cologne, Germany. The strategies used in the "Gorter Model" will be detailed in a book to be released in May 2011 titled Fighting Cancer (North Atlantic Press/Random House). The Gorter approach includes "therapeutic fever (total body, fever range hyperthermia), localized hyperthermia administered to the tumor tissue, immune inoculation using dendritic cells to improve immune activity, and immune-enhancing approaches such as nutrient infusions and oral supplements, as used in orthomolecular medicine." The Gorter approach has had significant success in treating advanced metastasized prostate cancer. Gorter and Peper's report suggests that the clinic has had a 60% success rate in prolonging survival time in patients with very advanced cancers.
We are indebted to Nancy Faass for contributing to the authorship of one article and facilitating the writing of the Gorter/Peper article.
Jonathan Collin, MD
1. Amerman K. 'Bubble' home doctor settles 'pseudoscience' complaint. Morning Call. Sept. 6, 2010. Available at: www.mcall.com/news/local/mc-south-whitehall-bubble-doctor-20100906,0,7133208.story.