The big news right now is the nearly 75,000 healthcare workers who are striking in the Kaiser Permanente system. What is Kaiser Permanente? It's an American integrated managed care consortium. What is managed care? It's the system by which mega-businesses corner people into using only particular healthcare services based on their insurance. In other words, you buy X insurance, you can only see X care providers and on X schedule. And the staff at KP say it's not working for them anymore, they're being squeezed and the mega-biz profits. They also say it's not working for patients.

The vast majority of Americans get their healthcare through managed care. What this giant system in effect does is leave out providers like me, who can't get a job there. They need care providers, but they won't hire naturopaths UNLESS we have another degree in something more conventional. What's especially insulting is that virtually everyone thinks that they know more about holistic healthcare than a naturopath. As if the years I've invested were for naught. In retrospect, it was clearly a mistake.

I went into naturopathic medicine because the conventional healthcare system failed me. An N.D. was the first person to actually help me, and another N.D. was the first one to actually understand and diagnose my problem. I didn't know that this credential would get me exactly nowhere in the "modern" medical system in the U.S.. I didn't know that chiropractors and acupuncturists have better luck getting paid by insurances.

There has been a lot of writing about the Art of Medicine. And there's also a lot of noise about the Science that underlies Evidence Based Medicine. Which evidence will you accept? All this noise tends to bypass the question of truth in all its complexity. In today's post-modern culture, truth is a fuzzy thing, unclear, unknowable, subjective and slippery. In today's culture, the only evidence that counts is either double-blinded placebo-controlled studies done by pharmaceutical companies, OR your personal experience.  It's nonsense.

What is true? It is true that we are each individuals, with different genetics, environments, and behaviors. We humans all share some basic physiology, and our anatomy maps to our species. It is also true that to be truly healthy we need more than what our commercialized medical system can offer.

A true student of medicine knows the magnitude of the challenge. There is more to know about human health and illness than any one person can know. Humans are inherently biased and susceptible to a wide range of delusions and denial. Businesses are not human and do not care about health. Profits are their motivation. Whether you think of medicine as an art or a science, you probably know that our modern money-grubbing mega-businesses are failing us. What you may not realize is that by paying for a particular insurance, you trap yourself in that dysfunctional system. If you have no money for other kinds of self-care, you get what managed care offers, regardless of how inhuman it might be.

Insurance is not healthcare. Insurance is a gamble, a bet. Insurance is paying in advance for what you hope you don't need. Seeking the care of a human that will listen to you and actually cares about your wellbeing, well, hardly anybody does that. It is beyond me why people place their trust in mega-businesses instead of each other.

This morning I talked to a friend of mine who is a pediatric ER doc, and she has covid.  She got it from a kid who came to the emergency room with a rash--it's a hazard of the job.  She at least tested herself for covid when she got symptoms, whereas a nurse that she works with is sick and didn't test.  My doc friend's husband also didn't test, and these folks are out in the world sharing the virus with you.  It will be with us forever now.

The FDA would like to increase the availability of a range of home-testing options, not just for covid. Now that the emergency use authorization for previous covid tests has ended, there's been a shift in who can do what, and in how the money flows.  The Cue brand home test is FDA authorized to be marketed to you using a "traditional premarket review pathway".  It's a NAAT test which is short for a molecular nucleic acid amplification test (NAAT)--it tests for DNA of the virus in your nose.

The kit will contain a "reader" that is battery powered, and cartridges which are disposable.  There is also an associated app.  It will give results in about 20 minutes.

The accuracy of the system is similar to prior testing options.  "In a study reviewed by the FDA, this test correctly identified 98.7% of negative and 92.9% of positive samples in individuals with signs and symptoms of upper respiratory infection."

https://www.fda.gov/news-events/press-announcements/fda-permits-marketing-first-covid-19-home-test-using-traditional-premarket-review-process

Anti-vaccination sentiment is still spreading in our communities. People have lost faith in the authorities and in the medical field, and they are finding their own way. Unfortunately for them, the decision not to vaccinate their children will backfire.

Just this morning I read that there is a Measles outbreak ongoing in Ohio. For months now I've been reading about a resurgence of polio in New York. And of course Military personnel will no longer be required to take the Covid vaccine. The backlash against vaccination (what people perceive as an assault on bodily autonomy) will result in an increased death rate from vaccinatable diseases.

It's not an easy question, when and how to vaccinate. I don't exactly trust the official recommendations either, because I know that the guidelines are created by a council packed with representatives of Big Pharma. I am sympathetic with those who are skeptical. And I see the writing on the wall. If you don't vaccinate smartly, you are destined to be diseased.

There are a lot of anti-vax media personalities and websites that are spreading a bunch of BS. You can't believe everything you read on the internet. Of course you know that. But you also can't believe everything you read that you already agree with. If you seek "information" that supports your current position about ANYTHING, you could be allowing Confirmation Bias to steer you into a trap.

Rather than seeking supportive information, seek out the information that tries to prove your belief wrong. Test your belief. Check your understanding against what the experts say. Check your medical knowledge against the CDC, or come bounce it on me. I am not parroting anyone's sound bytes, I am a true student of medicine. I am interested in scientific studies or background information that sheds light on the hard questions.

The problem with the anti-vax craze is that a lot of the so-called "information" is coming from people who have zero science background and very little understanding of the actual risks and benefits of vaccination. Unfortunately for the anti-vaxxers, their sources are misguided and downright wrong about a lot of things. And they and their kids will suffer and die as a result.

I am always one to look for silver linings, and this particular situation has just one, which is that a reduction in the human population would be a quick way to reduce our impact on the planet. We are destroying habitat and polluting air and water at such a rate as to cause massive suffering and death in the not-so-distant future. Anti-vaxxers are offering to remove themselves and their children from the human population which will be a boon to future generations who survive diseases because their ancestors were vaccinated.

It is unfortunate that simply saying the above headline to a person of color is now considered RACIST. Unfortunate because in the pursuit of health, it is helpful to understand a person's genetic makeup. You learn a person's genetic makeup by exploring their deep history. "Where did your people come from?" is a question I have used for years to begin to understand this. I get very interesting answers and stories.

It would be so much easier if everyone would do genetic testing like to assess their origins. If someone were to ask me "Where are you REALLY from" I would answer "I am a Euro-mutt."  If they pressed me further, I'd say I'm from "Northern and Western Europe, plus a trace of Polynesian islander". In spite of family lore and my blood type, I know that I am not descended from the native tribes of North America--unless 23 and Me (the gene testing I used) has mistaken Native American genes for Polynesian. I have no way to assess that.

Discussing people's origins and genetics is important in medicine. To really understand a person's evolutionary predispositions and needs, we need to know where (or better, WHO) they are "from".

I understand that people of color have long been harassed by repeated questions along these lines. I know that recently a British royal employee apologized and resigned after questioning an Australian official this way. The social ramifications are playing out as they must in this time of high sensitivity. As medical professional, I maintain that we need to be allowed to talk about our evolution and genetics, because if we cannot, we are deprived of a huge and growing resource.

Genetics and epigenetics will be part of the Future of Medicine. There is no avoiding it. Learning about a person's evolutionary origins is not racist in this setting, it is humanist. It is an attempt to understand, and to help.

Please be kind to each other. Regardless of variations in genetics and in appearance, we are all human. It is my opinion that all humans deserve a certain base level of respect and dignity. Give it. Without question. Work to recognize and deprogram your biases. Accept that not all words that hit your buttons are "racist" or sexist. Your buttons are YOUR biases, your programming, and only you have the ability to do something about them.

Image below: Skin with low melanin, and its layers.

The NIH (National Institutes of Health) has a website up where they are tracking people's home tests.  It's here: https://makemytestcount.org/ .  Many people, myself included, have taken a home test from time to time and reported it to NOBODY except my friends and family.  That does not help the public health people track the virus and provide for areas that are getting hit hard.  So I will be reporting self tests from now on, and suggest that you do the same.  By working together on this we help all of us!

A healthy friend of mine had Covid over the last couple of weeks.  She described it as the worst sore throat she'd ever had. When she described the testing that she had done it became apparent that she didn't know that DAY 5 is the day that you are likely to test positive--at least with the last few variants.  She tested herself during the first 4 days when she felt sick, and thought she didn't have Covid. She even went in for PCR testing.  All came back negative until day 5.

Experts say that the best way to home test is to test twice (or more) once you have symptoms, 48 hours apart. That's two DAYS apart, right?  Lots of people test just once when they get symptoms, and consider that test definitive.  It isn't. If that one test negative they think they have something other than Covid, but that could be a terrible mistake.

The message here is Don't Trust negative Covid tests before day 5 of feeling symptomatic. If you test negative after feeling sick for 3 days, and spend time with someone who then spends time with an elderly relative, you could conceivably cause the elderly person to die. 

This is why the new normal is to stay home if you feel sick.  Don't go to work.  Don't go be social.  Take the opportunity to rest and relax.  You know you need it anyway.  Take the time and slow the spread.

Oh and by the way I got my bivalent booster 2 days ago and I did not have nearly the massive response that I had to previous vaccines.  To me this means that I have not yet had the new variants that they are vaccinating us against.  This vaccine is FREE and it's available NOW and I recommend that as many people get it as possible, because it is still our best tool for limiting severe disease and death during the spikes that are going to come this winter. 

Go get your bivalent Covid vaccine, says this naturopath.  Why does this naturopath say get a vaccine?  I don't say you should get all vaccines, I say you should pick and choose.  Get this one because it will save a lot of lives. Because the benefits of the previous Covid vaccines far outweigh the risks, according to the science.  And believe me, I do look at the science.  I am even trained to recognize bogus "science" which is definitely out there.

Should you listen to the CDC?  I say yes.  They are on the comeback from a period of political distortion and I trust them more now than I did last year.

​They say Get Your Vaccines, and do it right now. The media and public health authorities these days are encouraging us to go in for both our flu vaccine and our bivalent covid booster at the same time. Last night's news reported that you CAN get both vaccines at the same time with little increase in minor side effects, and no increase in major adverse effects. This is true. You CAN.

What they did not address is SHOULD you. Public health authorities want you to get both vaccines at once because they fear that if you only get one, you won't be back for the second one. Their motivation is about convenience (for them and for you), and enhancing (numbers) coverage in the population. But for the individual there are more concerns.

You are not a number. You probably want to know how well YOU will be protected by a vaccine. You will not see news or magazines reporting about the relative efficacy of vaccines with different dosing schemes. Odds are there hasn't been a double blind placebo control study asking exactly that question.

There are things we do know. For example, we know that getting sick with two diseases at the same time makes you less able to fight either one. Getting vaccinated with two vaccines at the same time does the same thing. It’s a two-front war. We know that the standard advice about getting a vaccine is to delay it until you are not sick. When your immune system has to fight two adversaries at once it does not fight as well. You will muster a stronger and longer immune response if you only get one vaccine at a time.

Public health authorities think that the public is not able to understand and act on information this complex. I think otherwise. I think you are smart enough to do it. Here's the plan. (This applies unless you have a contraindication, which you should discuss with your doctor.)  Get one of the two vaccines ASAP. On the day you get that vaccine, put a reminder on your calendar to get the other one in one month’s time. What that reminder comes up, go get the other one ASAP. That is how you do it. Prove them wrong.

(Image text below is a screenshot from the CDC.)

Organizing your medical knowledge is a big project. If you are unsure why you'd want to make a Black Book for yourself, please read the previous post. I think most students don't start because they don't know how--and because the schooling process leaves you with so little time for synthesis. Organizing it all is intimidating and seems impossible. Besides, everything is searchable now. You can look it up on the internet. You can search for terms in digital documents. 

What you cannot locate or organize using technology is your mind. The only way to synthesize the things you learn is by using your brain. You decide which information is most valuable by processing every bit of it through that giant calculator in your skull. I process data by writing it in my own words, and organizing it into my own categories. Making Black Book pages is a good way to do that.

Before you start making a black book page for any one condition, create your Template. Use a familiar word processing program. Choose a format that suits you--font, size and overall style. Make your own original header and footer and decide on the headings you will use. Date it. Then improve it as you go along.  Put your logo or byline in there.

Save your Template somewhere accessible. You will duplicate it whenever you want to make a new Black Book Page. At the beginning you will create a lot of documents filled with mostly empty space. Don't worry about that. Start one any time you learn something useful about a condition that you don't have notes on yet. It will grow.

Here are the parts of a template:

• Name the template document. I name mine AA_Template so that it's always at the stop of the alphabetical stack of documents.
• Title. In the template I have the word TEMPLATE as my title, and I center the title in the header.
• Your name, business name and byline. This also goes in the header.
• Date updated. I like to put in a date that I can just click to make it today.
• HEADINGS. I capitalize my headings so they stand out from all the other stuff, because sometimes the sections get long.
• Page numbers in the footer if you care.

Picking the headings is important.  These notes will become your protocols. For each condition or diagnosis you collect information and your headings will influence what information you seek. That information guides prevention efforts, assessment and treatment. As long as you practice medicine, there are opportunities to expand.

Below are the headings I use most. The PDR (Physician's Desk Reference) or Merck Manual will show you the categories and organization that are used conventionally. Start with a lot of headings in your template and delete any you don't use. After a while you'll change your template to match your way of thinking. Reorganize however it suits you.

Category headings are in ALL CAPS in my BB, and they differ depending on the condition.  Many of these are in there:

DEFINITIONS
ETIOLOGY
RISK FACTORS
PREVENTION
EPIDEMIOLOGY
HISTORY
INCIDENCE
TRANSMISSION
NORMAL PHYSIOLOGY
PATHOPHYSIOLOGY
PRESENTATION
DIFFERENTIAL DIAGNOSIS
RELATED
EVALUATION (HISTORY, PHYSICAL EXAM, LABS, IMAGING)
COURSE & PROGNOSIS (PARQ)
TREATMENT (ends up being a big category, I use an outline)
SOURCES
RESOURCES

I will explain more about what goes under each heading in a future post. ​If you are new enough to medicine that you don't fully understand the meanings of these headings, a smart first project is to learn the words. I didn't know them all when I started, and it would have helped.

There are students working in the medicinary again. Due to covid we had no workstudy students for a couple of years. It's good to have them back, to be teaching again. And it's a heads up about all the things they just haven't been taught, don't know, don't have any way of knowing. I have a few pieces of advice that I have given to lots of ND students in the past, and I decided it's time to write them down because their shifts are shorter than ever, and we are so understaffed that we rarely have much time to talk.

There's one piece of advice that I wish someone had given me before I even started Naturopathic Medical school. This tidbit could be useful for anyone studying medicine, or really, for anyone studying something complex that they hope to be really good at. This is it: find a way to organize your knowledge, and do it persistently for your whole life.

In medicine, like in any large field of knowledge, there is more to know than any one person can. There is more than you could possibly remember. This is why there are specialists, and reference books. But an ND degree is preparation to be a primary care doctor, and in primary care, anything or anyone could walk through that door. You have to be ready. You want to do right by your patients.

To develop deep knowledge you need to approach your subject from lots of different perspectives. To practice naturopathic medicine, you need to understand the conventional approach and something about all the alternatives. You must do the work of sorting through what works, what doesn't work, and what we don't know yet. Sometimes the conventional approach is the best, and sometimes it fails. You need to know that.

But back to that tidbit of advice I wish I'd had. Start your Black Book. The Black Book is a term for whatever system you use to organize your notes about conditions and treatments. I don't know where the term black book comes from, but I do know that Wiccans write out their spells in actual black books. Farmers keep notes on their plantings and when things bloom or fruit, which is how we know that the grape harvest in Napa Valley is a whole month earlier than it was a decade ago. These days my notes are in documents stored on dropbox, accessible anywhere I can get online.

​I suggest that every student of Naturopathic medicine begin while you are in school. Ideally you'd start before you are in school, or in your first year, but most students don't because they don't know what information is important, yet. They don't know how to organize it. If this describes your situation, the next post is the How To of the Black Book. You are expected to know not only how the body/mind/spirit works, but also the conventional standard of care, and enough about a myriad of alternatives to pick the best ones for patients who don't want to do what convention dictates.

If you start while you are in school, you can use your black book as a study tool. Make black book pages relevant to whatever therapeutic targets are mentioned. Don't worry if you don't have information for every heading, just put in what you have learned. When you are preparing for yet another test, get the useful bits into your Black Book. Use the clinical board exams as another occasion to build your understanding. Study up on any conditions that you or your dear ones have, because that could well end up being your specialty. Later you will study the same way for your patients, each time one comes in the door with a new concern. Continuing Education requirements are an attempt to force even complacent doctors to update their knowledge. The practice of medicine is best done by life long learners.

The WHO chief says AVOID "endgame" talk about Covid
https://apnews.com/article/coronavirus-pandemic-health-pandemics-united-nations-world-health-organization-d500f7942d0c920912261b30ab8bfd66

New Phase Initiated by Omicron
nytimes.com/live/2022/01/24/world/omicron-covid-vaccine-tests


Recently I became acquainted with a virologist here in PDX who, working at OHSU, helped develop an antibody test for covid. The test he developed has not gained wide usage. 

The virus makes 20+ proteins for which our bodies make antibodies, but the vaccines contain only the spike protein. What this means is that we can tell if people have had the virus, or if they have just had the vaccine. IMO this would be useful information at the population level.

It is still possible for us to know how many people have had the virus. Many people have probably had it but didn't know because they were asymptomatic. Many others have probably had it but don't know because testing wasn't available--especially early in the pandemic. Of course there are pockets of population who still haven't been exposed--but Omicron is reaching many of them. We will not have a good sense of the immunity level of humans on earth until we know the proportion who've had the disease.

Tracking the proportion who've had the vaccine is easier. I have a vaccination card that shows that I've had 3 jabs so far. For me it was mandatory because I work in healthcare. It was also a no-brainer because I'm old and fat enough that covid posed a significant risk, whereas the vaccine poses a miniscule risk.  Sure, it's uncomfortable and unpleasant to deal with the symptoms after vaccination.  I have some tricks for minimizing that.  But basically I agree with the vaccine pushers that getting the vast majority of us stuck makes good sense.

Infection does confer a higher level of immunity than the vaccine. This is because the virus makes those 20+ proteins and our immune systems recognize all of them. The vaccine only contains one protein, the spike. When you've had the virus, your body knows 19 more ways to recognize the virus than if you've just had the vaccine.

Our bodies have T-cells that remember viral proteins that they have met, and go on attack whenever the virus is in us. T-cell immunity is different from antibodies. T-cells last 10-20 years after an infection. B-cells make antibodies and some of them stick around a long time too. "Memory" B-cells live for years and make antibodies for an infection for about 6 months, then they go on break. They are still there to make more antibodies if needed.

Years after vaccination you still have memory B-cells that can resume antibody production, and T-cells that can go on the attack. Unless. Unless you are immune compromised somehow. Unless you get measles, which actually KILLS memory B-cells. This is why I recommend that most people get the MMR vaccine too. It protects you from the damages done by measles, which are more than most people realize.

The nugget here is that the immune system is complicated and managing a pandemic is even more complicated. The public messaging is simplistic. Public health officials are trying to get everyone to take the jab. This is for the benefit of the population; we do it for each other. What I wish that public health as an institution would do for us is invest in antibody testing AND some ways of evaluating immune function so that we can move forward and leave this pandemic era behind.

The world will never be the same again. Those of us who've lived through this pandemic are changed. So many people are dead. Some near to me. Some far away. Wearing a mask is hard. Being isolated from people is hard. But in spite of this we are resilient and we who have survived so far have a good chance of continuing to survive. Let us unite in caring for each other, in being decent to each other.

Let us plan ahead for the possibility of another pandemic in our lifetimes. The increasing density of humans on the planet increases the odds of pandemics. The crowding of our food animals also increases the odds. Rather than pretending that the conditions for pandemic-making are the same as they were in the past, we need to collectively recognize the reality of our situation and do our best to be prepared. It is never over.