I just completed a training at NCNM and what I learned is that there ARE other people in the community who are impassioned about social justice. Sometimes, when I'm walking down the street, and the people around me are completely closed off from each other, I wonder. I feel good every time that I am the one to stop and ask if someone is OK, offer a hand with something, or otherwise step up to be part of the kinder gentler world that civilization is supposed to bring.

I feel our common humanity more deeply than I fear our external differences. I do not care what color you are, or what you think is sexy, or which religion you think is the right one.  What I care about is joy.

So presume only that I will take you as another human, doing the best you can. I hope you will see that I am no different.

The irony is rich. The term "snake oil" has come to mean everything that is fraudulent. The reference is to the infamous "snake oil salesman" who pitched and sold his wares out of the back of a wagon to the unsuspecting villagers of the American west.

Snake oil has real medicinal value. It was used as medicine before the North American continent was on the map. Centuries ago the Chinese used an oil made from a cold water snake called Enhydris chinensis to treat joint pain and bursitis. It was introduced to the US by Chinese laborers who worked on the Transcontinental Railroad in the mid 1800's. There's evidence that the ancient Egyptians used it too. In the early 1700's the English had a patent medicine made from snake oil. Snake oil was sold here as a panacea in the early 1900's, but the products sold were probably more filler and adulterant than they were actual snake oil.

So what's in it that's good for you? Snake oil, depending on the snakes used to derive it, can be a rich source of an fatty acid known as EPA, eicosapentanoic acid. EPA is used by the body to synthesize series 3 prostaglandins, which are anti-inflammatory and pain relieving. You can know EPA is important because it's in human breast milk.  EPA is effective for treating depression, improving cognitive function, autoimmune diseases including rheumatism, high cholesterol, hypertension, and more. 

EPA can be derived in the body from other fatty acids, but it's much easier to eat in your food. The richest sources are fish: herring, mackerel, salmon, trout, pilchards, menhaden and sardines. Fish do not make their own EPA. They get it from eating algae like spirulina, which we also can eat. Plant foods don't contain any EPA at all.

Part of the reason it's easier to eat EPA than to make it in your body has to do with human genetics. Some people have the gene to make the enzyme which lets them convert ALA (alpha linolenic acid) into EPA. Other people have mutations in their genes that limit their ability to do the conversion. Diabetes and some allergies also limit a person's ability to convert ALA to EPA. ALA is an essential fatty acid, meaning that no humans can make it; we have to get it from the diet.

If we don't make it very well, and we don't eat much fish, we need to get our EPA some other way to keep our cell membranes happy.  Many healthcare professionals recommend that we take fish oil.  Fish oil contains 12-18% EPA.  Salmon oil tops the list at ~18%.  Chinese water snake oil contains ~ 20% EPA, whereas rattlesnake oil is said to contain 8.5%. Cod liver oil has more DHA than EPA and is best reserved for specific uses, like building baby brains or healing brain injuries.

The reason why some snakes have more EPA than others has to do with the temperatures that they live in. Snakes and fish are both cold blooded, so they have to function with their bodies at the same temperature as their environments. Omega 3 fats like EPA don't harden in cold temperatures like omega 6s do. They help keep cell membranes flexible. Flexible membranes don't get injured as easily, and are able to function better. Cold water fish, or cold water snakes, will have more EPA than those that live in warm sunshine, like rattlesnakes.

The next time someone tells you that a treatment is "snake oil", remember this. Public attitudes and language reflect our history, not our future. Science continues to give us reason to revise belief systems, erase myths, and sometimes to welcome old treatments back into the fold.

In this day and age, it is necessary to second guess every information source.  So much "information" goes by that it becomes difficult to sort out what is advertising and what is not.  Even reporting about scientific research can completely skew the issue.  It doesn't pay to be gullible.

The problem is that we are wired to be gullible.  We humans would much rather trust in some comfortable authority figure and believe what they say, than to do all that research and work ourselves.  Figuring out the truth takes time...and sometimes the truth is elusive.  We just don't know everything yet.  We'd rather just believe.

Modern first-world culture is divisive and argumentative.  People agree to disagree more often than agreeing in substance.  As in other parts of our public arena, in the healthcare debate the shouting overwhelms reasonable conversation. Conventional treatments espoused by governments and establishment medical business may not be supported by the research. The policy came about when someone had to make a decision by a deadline using the best information available. We all do it.  We have to go on what we know, even if it is incomplete or incorrect. More information comes along, but established policy stays the same.  This is the downside of bureaucracy. Proponents of established methods will say that this must work because it is the rule, and don't worry about finding out the truth.

Alternative treatments are espoused by a wide range of practitioners and patients.  Often alternative treatments have little or no science backing them up.  Proponents say this works because they have seen it work, and maybe it did.  Just because there is no science doesn't mean it isn't true. Proponents also commonly claim that the science backs them up when it does not.

The Skeptic doesn't believe anything just because an authority said so.  The Skeptic asks questions, and studies the important questions, so as to be able to know if someone is speaking from a position of knowledge and perspective, or blowing a lot of hot air.  The Skeptic realizes that real information or falsehoods can come from any side, and runs every morsel through an internal fact-checker.  The truth is a moving target, and the skeptic is ever on the hunt.

Speaking of mixed feelings....  I learned today that the penalty for not participating will be $95.  That's only $15 more than a Portland Parking ticket.  Of course, there is the possibility that decent care might result from being covered within this system.  But not necessarily.  I have a deep distrust, and dislike, of health insurance and what it has done to healthcare in America.  Mandating health insurance is... un-American.  Letting health insurance control what care is given and to whom is no better than socialized medicine.  It simply puts the power in the hands of megacorporations that are already mixed up with our government.  And it requires that everyone's personal health information go into an electronic medical record, supposedly to improve care, but potentially useful for other projects.  If the government would decide what care to provide based on what has the best outcomes for the most people, I would be less opposed to that.  It's not a simple situation, that much is for certain.  The best answer is just as the bumpersticker says: don't get sick.

My patients often ask if I think medical marijuana might be helpful.  We’ve had some widely ranging conversations about the risks and benefits of this drug.  As a naturopathic physician I may not prescribe cannabis even though it is legal for medical use here in Oregon; it is not in the ND formulary.  The fact that I cannot prescribe it does not prevent me from discussing it.  The issue will not go away, regardless of the laws and the war on drugs.  Cannabis is ubiquitous, even though it is federally illegal with varying levels of state permissiveness.

Just last month Colorado and Washington were the first states in America to approve the legalization of marijuana for recreational use.  Those who fear it as a gateway drug, and those who advocate its medical use or broader legalization, are all making noise about it.  The politics often plays more loudly than the facts.  Marijuana is the #1 drug brought our way by Mexican drug cartels, and Mexican weed is likely to contain pesticides and other toxins.  Synthetic cannabinoids are being imported from Asia labelled as bath soaps and sold in convenience stores.  The war on drugs highlights our incarceration problem and the ugly politics of race.  Reasonable medical questions remain unanswered.

Our own government propagated a lot of disinformation back in the 1930’s when the Federal Bureau of Narcotics was created and cannabis was classified as a narcotic (against the advice of the American Medical Association).  The original Greek meaning of “narcotic” was any psychoactive substance that induces sleep, but in more recent times it has come to mean opiates and any drug derived from them.  Opiates are addictive and are carefully regulated by the DEA.  Cannabis is pharmacologically a world apart from opiates, and is no longer thought of as a narcotic, but it is still plagued by the negative reputation engendered by federal prohibition and propaganda, and the War on Drugs.  Cannabis was federally prohibited in 1933, the same year that the prohibition on alcohol was rescinded.

In 2009 the AMA did a review of the scientific literature on cannabis and found a few legitimate clinical trials with a grand total of less than 300 study participants.  The DEA has refused to grant permission to universities or pharmaceutical companies to research it.   The drug is approved by 18 states for medical use, but we have very little scientific information on which to base clinical applications.  Anecdotal information about the indications of various strains guide the choices of medical users.  The federal ban is still in effect, and current federal enforcement efforts are focused on importers and distributors and not on small scale possession (like they were under Reagan).  Employers are within their legal rights to require drug testing.  Law enforcement budgets rely on asset forfeitures (police can seize any cash or items likely to be related to drug trade without proof of guilt) which is incentive for police forces to continue to pursue small scale dealers.  Medical cannabis programs provide a front for a new domestic black market.  That the issue is contentious is an understatement; it is explosive.  And we still don’t know what it is good for.

A future email newsletter will focus on known and theoretical risks and benefits of cannabis use.  Sign up for the monthly missive here.