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Thirty years ago, in 1983, Sally K. Ride became the first US woman astronaut to enter space; Motorola began testing cellular phone service in Chicago; and Jonathan Collin, MD, published the premier issue of Townsend Letter for Doctors. What began as an "informal newsletter for doctors communicating to doctors" has matured into a 120-page magazine with an international reputation for presenting the clinical experiences of alternative/integrative doctors and practitioners. Collin, who has had a lifelong interest in publishing, wanted to provide an outlet for doctors who thought and worked outside the medical status quo. He envisioned the publication as "a bulletin board for doctors to share their pet therapies and mad-scientist ideas." Unlike professional journals that specialize in one branch of medicine, Townsend Letter is a kaleidoscope, a truly holistic publication that has not shied from discussing any subject that affects alternative/integrative practitioners and the patients whom they serve.
The Early Years
The Townsend Letter office consists of the dining room and a bedroom in a small, two-story house, which also holds Dr. Collin's Olympic Peninsula medical practice, in uptown Port Townsend, Washington. It was there that Collin and editor Jan Kelley prepared the very first eight-page issue. That issue contained three articles and six advertisements. One article was a press release about a proposed study that would use bone densitometry to monitor changes in patients undergoing EDTA chelation therapy. "Controversies in Nutrition," written by Collin and Kelley, discussed the digestion and absorption of fat-soluble vitamins A and E.
The third article concerned the use of chiropractic and thyroid gland support to help athletes with chronic pain. Dr. Collin and colleague Harold McCoy, DC, had observed a correlation between severe muscular stress in the neck and hypothyroid area and hypoglycemic-type complaints and thyroid symptoms. Dr. McCoy had become a staff consultant for the University of Washington intercollegiate athletic department in 1980, the first chiropractic physician, ever, to consult for a university. "A delicate balance exists between the thyroid gland and the musculature of the head and neck," Dr. Collin wrote in this article. "A wide number of individuals demonstrating muscular stress in the neck also demonstrate symptoms typical of thyroid underactivity." Both chiropractic adjustment and iodide-containing biologics/treatments, such as kelp or thyroid hormone (USP), reduced symptoms and muscle stress.
Those first articles modeled the inquiry, debate, and clinical observations that Collin and Kelley hoped to receive from the newsletter's readers. They made it very clear in that first issue that Townsend Letter for Doctors was intended to be different from other medical publications: "…By expressing a minority opinion, asking for helpful information on a patient case, disputing a previously published report, offering a suggestion for another physician's inquiry, we can establish a network for physician communication."
By November 1985 (#32), Townsend Letter for Doctors was a 28-page publication – too lengthy to be a newsletter but not yet a bound magazine. Chelle Roberts had been hired to handle subscriptions and circulation, and Alan Gaby, MD, signed on as medical editor. Gaby had written for the Northwest Academy of Preventive Medicine newsletter when Collin was editor. "I was impressed with his open-mindedness and his interest in nutritional medicine," Dr. Gaby told me by e-mail. "When he founded the Townsend Letter and asked me to be a writer, I was happy to be a part of his new endeavor."
That issue contained many of the same features found in the magazine today. The front page, however, consisted of text – in this case, the text of Stephen Barrett's August 23/30, 1985, JAMA article that condemned commercial hair analysis. In "Letters to the Editor," E. Blaurock-Busch, PhD, and colleagues at Trace Minerals International rebutted Barrett's article; and George Hickok, chairman/CEO at Doctor's Data, described steps that his company had taken to defend hair analysis from assault, including PR countermeasures and hiring a lawyer to combat New York Department of Health's intention to outlaw it. Other TLfD features in issue 32 included reviews in "Book Corners," editorials by Collin and Gaby, "Townsend Calendar," and Gaby's "Literature Review. True to Collin's original vision, multiple letters debated patients' allergic reactions to the starting material for ascorbic acid manufacture (corn, sago palm, tapioca, potato starch).
The next year, 1986, brought major changes to TLfD's small core staff. Both Jan Kelley and Chelle Roberts left. Reba Be (later Rebecca Brown) took charge as managing editor. She kept track of subscriptions and advertisers, did paste-up layouts for each issue, and oversaw the mailing. Ten times each year, the mail crew – a group of adults and teens – took over the living-dining room of Dr. Collin's clinic to address, add inserts, and organize according to zipcode and post office regulations the boxes of finished issues, trucked from Printery Communications down the street. Irene Alleger, a writer who also managed Dr. Collin's Port Townsend medical practice, became TLfD's editor. Alleger was known for her "eagle-eye" attention to detail and thought-provoking editorials and book reviews. Barbara Smith performed TLfD's typesetting, layout, and film at the the Printery, tasks that she continued as a private contractor (the TypeSmith [a.k.a. Sign Me Up!]) in 1987.
By June 1986, those 28 pages had grown to 36 pages and five advertiser inserts, held together with a single, heavy-duty staple centered on the right-hand side of the magazine. In headline articles on the front page, Bruce Halstead related his dealings with the California State Board of Medical Quality, resulting in a truly "draconian sentence" of four years in state prison, $10,000 fine, delicensure, and court orders to "desist from all professional activity in the health care field." He was also ordered to "desist from … professional or scientific activity within the World Life Research Institute," an organization that researched marine biotoxicology. Halstead was the institute's cofounder and president. What terrible actions had led to this sentence? Halstead had recommended a homeopathic herbal preparation to patients in the hope of enhancing their immune function. He neither manufactured the product nor profited from its sale. Dr. Halstead was just one of numerous physicians being prosecuted in the US for advocating alternative therapies.
No Longer a Newsletter
With the August/September 1988 issue (#61/62), Townsend Letter for Doctors graduated to magazine; two staples on the publication's spine secured its 64 pages. Two editorials headlined on its front page. In the first, Jonathan Collin marveled at New England Journal of Medicine's acceptance of research linking cobalamin (vitamin B12) deficiency to neurologic and neuropsychiatric disorders and the therapeutic value of B12 injections; conventional medical journals usually ignored or disparaged vitamin therapy studies, especially ones with positive outcomes. In the second editorial, homeopath Dana Ullman, MPH, reviewed the response to Nature's publication of Jacques Beneviste's research in which potentized, highly dilute preparations of IgE produced basophil degranulation. Although that famous (or infamous) experiment has been reproduced at other laboratories, it is still widely denounced because it seems to validate homeopathy.
Inside that 1988 issue, a robust "Letters to the Editor" section debated the possible toxicity of Streptococcus faecium used in some probiotic products. In other letters, Warren M. Levin, MD, suggested applying nitroglycerine patch to acupuncture point Pericardium 6. Bernard Rimland, PhD, asked for scientific references that support kinesiology. Serafina Corsello, MD, responded to an earlier writer's criticism of the "interventive naturopathic approach." Sherry A. Rogers, MD, notified doctors of a recent paper that explained how to test for environmental chemical reactions, at a time when sick building syndrome and multiple chemical sensitivities were just beginning to be acknowledged. TLfD had become the "bulletin board," the forum for questioning and discussion as physicians and patients sought answers to recognized illness and to new syndromes that failed to respond to conventional therapies.
While mainstream press assured readers that the new disease AIDS was "incurable and almost always fatal," TLfD reprinted an article by Robert F. Cathcart III, MD, describing his clinical use of large doses of ascorbic acid (vitamin C) and other nutrients along with a clean diet to lessen symptoms. While conventional medicine and the chemical lobby maintained that people with a bewildering array of symptoms were delusional, TLfD gave people with chemical sensitivity and environmental illness a place to voice their experiences and gave practitioners a venue for sharing their clinical insights. AIDS, attention deficit/hyperactivity disorder, chronic fatigue syndrome, fibromyalgia, multiple chemical sensitivities, chronic Lyme, autism – a profusion of new diseases and syndromes erupted in the 1980s, conditions that affected mind and body and could not be cured with a simple procedure or magic pill.
The surging interest in alternative therapies caused the US Congress to give National Institutes of Health $2 million to establish the Office of Alternative Medicine (OAM). OAM and an advisory panel were charged with recommending a research program that would investigate promising unconventional medical practices. Jonathan Collin, Townsend Letter for Doctors's publisher and editor, served on that panel. OAM became the National Center for Complementary and Alternative Medicine (NCCAM) in October 1998.
The First Milestone
With its 100th issue in November 1991, Townsend Letter for Doctors added color to its cover and some of its 120 pages. Staff had grown to include JoAnn Reuther, manager of the Subscription Department; Jill Tomasi, who assisted Reba Be and managed Dr. Collin's Port Townsend clinical practice; and Jule Klotter, who developed an index for the magazine. Later, Collin asked Klotter to write book reviews that provided information for busy doctors and the "Shorts."
"Letters to the Editor" still held the TLfD's core, but new columns joined Gaby's "Literature Review and Commentary" as regular features. Morton Walker, DPM, presented information about products, therapies, and clinics outside the mainstream in his "Medical Journalist Report." In addition, naturopathic physicians Judyth Reichenberg-Ullman and Robert Ullman began their "Healing with Homeopathy" column in 1990, soon after they read TLfD for the first time. Dr. Judyth remembers thinking, "Holistic medicine is well represented, but why isn't anyone writing about homeopathy in the Townsend Letter?" She says, "All it took was a call to Jonathan and we have been columnists ever since!"
The November 1991 issue also reflected the turmoil surrounding the FDA's attempts to regulate dietary supplements as if they were drugs. TLfD contained testimonies, written by Jeffrey S. Bland, PhD, and Kirkpatrick W. Dilling, that were submitted to the FDA Dietary Supplement Task Force. FDA agents had shut down several clinics and supplement manufacturers and suppliers over the years, restricting access and consumer choice.
The FDA's actions gained widespread notoriety in May 1992, when armed police and FDA agents raided Dr. Jonathan V. Wright's Tahoma Clinic in Kent, Washington. What "illegal" substance instigated the raid? B vitamins. The police thought that they would find narcotics. Dr. Wright fought a hard legal battle for almost four years until the FDA finally dropped the charges in 1995. The highly publicized raid generated more urgency to pass the federal Dietary Supplement Health and Education Act (DSHEA). The legislation, which was an ongoing topic in TLfD for several years, asserted consumers' right to have access to safe dietary supplements. It was finally signed into law in 1994.
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