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.

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.

In this polarized time, people are falling into groups as if it were their only safety.  In politics if you aren't a Republican, you're a Democrat.  In medicine you're either pro-vaccine, or an anti-vaxxer.  In religion you're either devout, or an atheist.  I'm here to tell you that none of those are true.

I'm an Independent, politically.  I'm a vaccine moderate, meaning I think some vaccines are good and some not so good, and some people should get vaccines that other people should not.  I'm "spiritual but not religious" meaning that I don't go to any church but I have my own practice which brings me into contact with the sacred and sublime, and I believe that some such practice is essential for becoming a moral human.  In other words, I live in the grey.

If you are like me and don't fit into the pre-made groups, welcome.  Fellow seekers, people who do not accept anyone else's narrative and prefer to learn and discover and make our own story, we are this nation's hope for the future, this world's hope for the future.  Collective intelligence relies on both diversity and disagreement; we have to be able to talk about tough issues without shutting each other down.  Without disrespecting each other.

When you already know all the answers, in spite of not having done the study for yourself, you are taking a shortcut to a dead end.  People who are sure that one political party or the other is 100% on the right track are mistaken.  People who think that every single human should be given the Covid-19 vaccine are just as mistaken as those who think it's a government effort to inject micro-chips and track us all.  People who think that every single soul who does not agree with their religion is going to hell, they're already in a philosophical dead end.  It can be hard to turn around in a dead end.

It is important to understand the best arguments of your adversaries.  It is valuable to develop real arguments for your positions rather than simply saying that the other side is wrong, or so-and-so told you so.  Humans being social creatures are susceptible to accepting whatever version of reality is used by those around us--but we are also intelligent enough to question it.

It's time to develop our moderateness, our humility and kindness.  Nobody can know everything.  Admitting that we don't know is an opportunity to learn.  Admitting that we've been listening to an authority figure who doesn't actually know gives us an opportunity to investigate new sources, to check out different experts, and to develop a more nuanced and complete view of our world.  The truth pretty much always lies somewhere in the grey.

Hi friends.  This blog has been neglected for a while but I'm getting back to it.  I had to look up my log-in information!  I've been working on a couple of books.  One I've been calling "homeopathy lessons" but really it's about the need to look more deeply at every question in medicine.  It does not serve us to dismiss anything out of hand.  We should learn what we can from the very slow evolution of medicine.

Speaking of which, back in January the American Diabetes Association FINALLY decided to add the low carb diet to their list of acceptable diets for diabetics!  They're STILL not telling diabetics to stop eating so much sugar and carbs, they're just saying if you do, you'll have to take more insulin.  There is no sense in that, insulin is not something you want any extra of in your system.  Better to eat less carbs and then have to take less insulin.  So simple.  Curative, in fact.

Anyway, if you have any requests for blog subjects, let me know.  I have such a long list of possible topics that it helps to focus my energies when someone asks a question.

​Hope your summer is going well!!  Here, our tomatoes are just starting to come in.

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.

Many people have this idea that naturopathic medicine is off in lala land somewhere, and that nothing about it is based on reality.  While this could be true for some practitioners, MY practice is based on what we can deduce from what we know and what we are learning.  I base my decisions on scientific findings, and not just one study, but composites of information that add to the big picture.  I advise against using unsubstantiated treatments, and against using any new pharmaceutical drug until it has been on the market at least 10 years.

Ironically, the treatments given by many conventional doctors are not based in science or even in common sense.  Sometimes a treatment idea gets broadly adopted before it has been really studied.  Once everyone thinks that is what works, they just keep doing it.  Patients demand treatments that have no evidence behind them at all.  It takes a lot of information to turn around public opinion after the people have been brainwashed by doctors.

Take chemotherapy for example.  Chemo is poison intended to kill the cancer.  In many cases chemo causes the death of a cancer-ridden patient.  Sure, there are specific cancers which respond very well to chemo, but there are many more that do not.  Doctors will sometimes give in to a patient's desire to "do anything possible" to help, even when they know that it will not help.  It is in fact easier to give people the poison they demand, than to explain to them why they won't benefit from it.

For another example, take a look at the ACIP schedule for vaccinating babies.  While I agree that vaccination is effective for preventing epidemics, there is little evidence behind the schedule.  Vaccinating a newborn for Hepatitis C is destructive, not helpful.  The schedule for vaccination is based on convenience.  Doctors stick the babies with multiple vaccines at every wellchild visit, and don't worry about possible negative effects (and lack of benefit) from that practice.  The vaccination schedule bears some research to make sure that we are building appropriate herd immunity while also not hurting anyone's baby.

I ran across this post about statins today.  Many people take statins. Statins are drugs that stop your body from making its own cholesterol.  There is no evidence to support the use of statins for preventing heart attacks, and they may actually increase the risk of heart attacks in women.  They're also linked to the formation of cataracts, crippling muscle pain, dementia, fatigue, diabetes and erectile dysfunction.  Doctors give statins when they want to lower someone's cholesterol and don't think they can get that person to change their diet and lifestyle.  The evidence says that diet and lifestyle are FAR more effective for adjusting blood lipids than statins are.

Oh and last but not least in my list of conventional medical madness is the idea that eating cholesterol makes the body's cholesterol go up.  For 20+ years the medical establishment has been teaching that if you eat too much eggs and bacon, you will have high cholesterol.  The truth is that your body MAKES cholesterol from pasta and bread.  Your body makes cholesterol because it NEEDS cholesterol.  Cholesterol is not evil.  If your cholesterol is too low, you are sick.  People get high cholesterol from being sedentary and eating too many carbs, not from having an egg breakfast and a full and active day.

Just because something is widely accepted as the state of medicine does not mean that it is the best we can do.  We can do better.  The status quo is for dead people.  Living people have the capacity to keep learning and trying new things.  I urge you to question everything that you think you know about healthcare and health. Many things that have been accepted for a long time are about to be turned on their heads.

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.

I'm studying for boards these days.  We have a long list of herbal medicines we are supposed to know (in addition to a 3x longer list of Rx meds).  I consider this to be my opportunity to sort out which plants I want to use in my practice.  I am studying up on each one, and deciding if I think the evidence is sufficient for me to recommend it.  

On the internet I find two dominant claims about phytomedicine. 1) Herbs don't do anything useful, are inert or inactive, and 2) Herbs might cause you grave harm and could interact with your medications and kill you.

The conflict between these two claims is amusing to me.  If plant medicine is so worthless, then why isn't it harmless?  If herbs don't do anything, then why are we so worried about them?  And on the flipside, if a plant can cause drastic changes to your physiology and interact dangerously with your medications, how can it be inert and wimpy?

Plant medicine is more useful than conventional practitioners want to admit.  Many would like to convince their patients to avoid plant medicine entirely, because it is unpredictable and unknown to them, and so seen as dangerous instead of helpful.  It is my observation that conventional practitioners are extremely concerned about interactions between herbs and medications, while they very rarely check for interactions among the medications that they prescribe.  I have studied cases in which my patients or family were prescribed many meds that are processed by the same pathways in the liver.  Their physiology must have been significantly altered in ways that have certainly not been studied.  Show me a drug study that gives four or more medications and measures their combined effects!!  Yet it is no problem finding a baby boomer on that many meds.  When people complain that herbal medicine hasn't been studied enough, remember that pharmaceutical medicine is mainly studied by the people who wish to profit from it, and that negative results are routinely swept under the carpet.

One criticism of plant medicine rings very true, and that is the inconsistency of the contents of the supplement.  Plants grow differently in different places, are harvested with varying levels of care, different parts of the plants are used, different methods are used in processing them, and different kinds and amounts of fillers are added.  There is tremendous variability in the amount and quality of the plant matter in any given capsule.  Some contain little, if any, of what they claim to contain.  There are higher quality supplements available to licensed Naturopaths, and we trust them more, but I for one intuitively trust plants more than pills.

If you can't be sure of the contents of a capsule you bought on the internet, what can you be sure of?  I am sure that plants contain more constituents than we have researched, more than we know about.  I am sure that the whole plant often has actions that one of its components does not.  All the constituents in a given plant (or combination of plants) may have a synergistic effect that we never completely understand, because of the complexity of plant matter and life itself.

So I operate on a few assumptions, based on experience and centuries-long traditions.  In most cases fresh herbs are more potent that dried and processed ones. There are exceptions when processing removes a constituent that is harmful, or when a concentrate or extract really is better.  But not always.

I am pretty sure, from a commonsense gardener's point of view, that I trust my dirt more than dirt in China.  I happen to live where the soil is good and many plants grow.  If I lived in the desert, I'd want to know that my plant medicine came from a clean place.  If I'm going to buy herbs, I'd like to know what kind of care was put into its selection and care, where it grew, how it was harvested and processed, stored and delivered.  I want a minimum of fillers, and I want to know what fillers they are.  I want to know it all.

Most of the herbs on our study list have a very long list of traditional indications, and just a tiny little bit of actual science on a few of their constituents.  A few of them have plenty of science, usually the poisonous ones.  Dr Google sends warnings about avoiding this plant, because it can kill you.  Tell me this: what pharmaceutical medication is not dangerous if overdosed?  They all are!  Toxic herbs are the most potent medicine available to an herbalist.  The trick is in knowing how to dose them appropriately.  The use of toxic herbs is not appropriate for lay people to attempt without guidance, and so the warnings are welcome.

Plant medicine is both more powerful than we realize, and more benign than pharmaceutical medications.  Its reputation should not be marred by the offenses of a few profit-seeking supplement companies.  We are designed to eat plants, touch plants, live in harmony with plants.  When you sip your coffee, or put ketchup on your burger, you are partaking of plant medicine.  Look out!!  It might make you feel better.

http://www.chitari.org/    <----Here's the link to the org that is creating the Naturopathic Hospital in Oregon.  This is going to be awesome.  =-]   (Chitari means meeting place in Nepalese.)