In February, I attended The Society for Orthomolecular Health-Medicine's 13th Annual Scientific Meeting in San Francisco. This small group, headed by Dr. Richard Kunin, MD, consistently puts on a terrific, information-packed meeting in a quaint San Francisco hotel at a very modest price. Don't let the title "orthomolecular" scare you off: Dr. Linus Pauling referred to strategies of optimizing nutrition through diet and supplemental vitamins as "orthomolecular." The meeting is scheduled each year in February in San Francisco, a great time to meet colleagues and escape the winter blues.

I graduated many moons ago from the Albany Medical College, and I am reminded in monthly mailings for dues and school donations that I was not trained in orthomolecular medicine at this institution. In fact, the classmates who I read about or occasionally meet are actively practicing surgery and medicine and are not inclined to study natural medicine except through the infrequent editorial that appears in a medical journal. So, it was a particular pleasure to discover that one Albany Medical graduate not only shared many philosophies of the orthomolecular society, but also was speaking at the February meeting, relating his experiences practicing "orthomolecular" and "conventional" medicine.

Dr. Richard Gracer served as my third-year student mentor when I entered medical school as a freshman. Dr. Gracer did a residency in family practice at Baylor University and then was certified in occupational medicine. Having been exposed to many patients with chronic pain, Dr. Gracer was interested in considering alternatives to narcotic prescriptions. In the late 1980s, he was introduced to orthopedic medicine (as compared to surgery) and learned about prolotherapy. Prolotherapy is a skilled, anatomically based injection therapy developed to progressively treat weakened ligaments in chronic back and neck pain. Gracer's proficiency in prolotherapy led to a large referral-based clinic in the San Francisco Bay area. During the time period that Dr. Gracer practiced prolotherapy, he was introduced to the value of nutritional medicine and natural therapies. He integrated many orthomolecular protocols into the treatment administered to chronic pain patients. Despite the success that prolotherapy and natural medicine offered patients, many remained addicted to opiods. Gracer was frustrated with the need to fill prescriptions for hydrocodone and oxycodone for those who seemed to resist improvement with prolotherapy and other rehabilitative modalities.

What Gracer observed was that among the population of patients who required opiod medications for a period of time greater than two months, pain medication needs tended to increase and any attempt to reduce medication resulted in pain aggravation. Rather than reporting gradual improvement in pain, these patients reported greater pain one year later, and the narcotic prescription was usually 50% higher with poorer pain control. Patient visits were often arbitration sessions, with patients arguing for more narcotics and the doctor arguing for less. The physician would seek alternative means to control pain, including use of anti-depressant medication, physical therapy, and rehabilitation evaluation, while the patient would refuse, preferring more narcotic prescriptions. Both patient and physician were usually frustrated: the physician wouldn't prescribe more narcotic; the patient would complain that the pain only intensified more.

At the Orthomolecular meeting, Gracer discussed the problem occurring neurochemically in the pain-addicted patient. Reduction in narcotic medication led to immediate withdrawal symptoms: anxiety, insomnia, muscle tension, pain intensification, and emotional instability. Long-term use of narcotics altered the neuron pain receptor, the so-called "mu" receptor, in a process referred to in pain medicine as neuroplasticity. Whereas the mu receptor requires minimal "neuro-chemicals" to "fill up" in a non-addict, an addicted patient's mu receptor requires an exceptionally large supply of opiod narcotics to fill up. Incomplete filling of the receptor, characteristic of withdrawal from the drug, is ineffective in pain analgesia. The challenge in addiction medicine has been to allow the patient to withdraw from the narcotic agent, while satisfying the needs of the mu receptor. Most pain addiction programs have been unsuccessful in answering this dilemma. While counseling programs are useful for learning how to cope with narcotic withdrawal, they fail to ameliorate the disrupted mu receptor.

In the last ten years, a new drug agent, Buprenorphine, has been developed, which may satisfy the mu receptor deficiency in narcotic withdrawal. While narcotic drugs act as full "agonists," or mu receptor fillers, Buprenorphine is a partial agonist for the mu receptor. Whereas the opiate effect for a narcotic is linear in analgesically shutting down pain sensation and systemic consciousness, Buprenorphine is limited in analgesically quieting the system. From a practical viewpoint, Buprenorphine satisfies pain needs analgesically but eliminates the withdrawal effects encountered in narcotics discontinuation. A patient who is addicted to 60 Norco or Vicodin tablets daily (there are many out there) can literally be cut off the entire dose in days with Buprenorphine – with no withdrawal, no cravings, and no pain intensification.

Unfortunately (or fortunately) Buprenorphine may NOT be prescribed by any practitioner who is not trained in its use. The special training is not arduous, but uncertified practitioners are prohibited from Buprenorphine prescription. Furthermore, the number of patients a practitioner may detoxify with Buprenorphine is limited initially. Nonetheless, many patients can be referred to Dr. Gracer or other pain medicine specialists for narcotic detoxification now. Dr. Gracer's book describing Buprenorphine and integrative medicine strategies for addiction control, A New Prescription for Addiction: Subutex, Prometa, Vivitrol and Campral – the Revolutionary New Treatments for Alcohol, Cocaine, Methamphetamine and Prescription Drug Addiction, is available at Amazon.com. For information about Gracer Behavior Health Services in San Ramon, California, please visit www.gracermd.com. To contact the author, email info@gracermedicalgroup.com. To join the Orthomolecular Health-Medicine Society and/or get information about future meetings, visit www.ohmsociety.com or call 415-922-6462. To order CDs of the February meeting, contact PAR by emailing PAR4AUDIO@aol.com or call 909-593-1862.

Oral Chelation and Mercury Toxicity
In this issue of the Townsend Letter, we examine the role mercury and other toxic elements have played in causing chronic degenerative disease. In dentistry and medicine, mercury is officially labeled as a toxin but is not considered a significant factor in disease except in pregnancy. (However, as far as I know, dentists are still placing amalgam fillings in the mouths of pregnant women.) Dr. Tom McGuire's many years in the dental field has provided him a breadth of experience in examining dental mercury's role in causing chronic mercury poisoning. He reviews the strategies needed to successfully detoxify mercury. Dr. Hal Huggins is internationally recognized for his stance on mercury dental toxicity. Dr. Huggins has established protocols for removal of amalgams and testing of varying dental materials for successful dental restorations. Huggins has also documented the toxicity of root canals as well as dental micro-abscesses in the jawbone underlying infected teeth as a major oversight in dentistry. His important work is updated in this month's issue. Dr. Garry Gordon, MD has been recognized internationally for his long-standing work in intravenous and oral chelation. Dr. Gordon's two-part article on chelation is a must read for anyone interested in the detoxification of mercury, lead, and other toxic elements.

We are also pleased to publish reports on the efficacy of oral and suppository chelation by Partain et al., Payne-Salomon, and Braid. David Quig, PhD, of Doctor's Data, considers the challenges and difficulties posed in detoxification of metals by intravenous and oral chelation. While the academic medical institutions generally define metal toxicity based on measurements of serum levels, Quig notes the preferred method of defining tissue toxicity is based on measuring levels in the urine post-chelation treatment challenge.

Kinesiology Evaluation in the Treatment of Neurologic Disorders
Jonathan Walker, MD, a neurologist, submits a case review of migraine patients who were treated through neural kinesiology. Dr. Walker's work offers an alternative to migraine drug therapy. Coming in our July issue, chiropractor Scott Cuthbert submits a case-review of Down syndrome pediatric patients treated by chiropractic through kinesiology evaluation. His report suggests that Down syndrome patients may have long-term improvement by early chiropractic/kinesiologic intervention.

Cancer Papers Request
We invite practitioners, researchers, and writers to submit papers, reviews, and letters for our upcoming August/September issue, which will focus on alternative treatments for cancer. Papers are due by June 6, 2007.

Jonathan Collin, MD