AMERICAN NATUROPATHIC RESEARCH INSTITUTE
NATUROPATHIC ONCOLOGY RESEARCH INSTITUTE
1250 E. Baseline Rd., Suite 205
Tempe, AZ 85283
JOINT MEETING OF THE
AMERICAN NATUROPATHIC RESEARCH INSTITUTE (ANRI)
NATUROPATHIC ONCOLOGY RESEARCH INSTITUTE (NORI)
INVESTIGATIONAL REVIEW BOARD (IRB)
February 10, 2012
MINUTES AND MEETING NOTES
In accordance with the requirements of the United States Code of Federal Regulations, Title 45, Part 46, the ninth regular quarterly meeting, of the American Naturopathic Research Institute (ANRI) and the Naturopathic Oncology Research Institute (NORI) and the Institutional Review Board(IRB) was called to order at 12:35 p.m., February 10, 2012 at 1250 E. Baseline Rd., Suite 205, meeting in Suite 203, Tempe, AZ 85283.
The following members were in attendance (alphabetically by last name):
Margarita Hernández-Guzmán, NMD
Marilyn Brewer, LAc
Colleen Huber, NMD
Thomas Jemison, NMD
Kenneth Lashutka, NMD
Kenneth Proefrock, NMD
Paul Stallone, NMD
Phranq Tamburri, NMD
Others who have attended previous meetings or wish to attend future ones are cordially invited to join us for future meetings.
PRE-MEETING PHILOSOPHICAL DISCUSSION
Dr. Tamburri brought in a very old book on health and diet found in his grandparents’ house and discussed the history of human attempts to control nature and economies (markets). He reminded us that although humanity has attempted to control nature and other people since we started exercising our opposable thumb and our voices, the 19th century was a time when in many fields of human endeavor, including in medicine, the transition had gone to an extreme from nature controlling man to man controlling nature. So humans also tried to control economies, which Dr. Tamburri argued, has not been as successful throughout history as laissez-faire capitalism.
Dr. Proefrock pointed out that as time went on those who did well and made out well (under a laissez faire system, it must be said) ended up in control, which made it ever easier for them to expand and consolidate their power. Banks ultimately became “too big to fail,” and therefore, also too big to jail when breaking laws, abusing their power, and generally engaging in rip-off behavior. Turning our attention to medicine, Dr. Proefrock pointed out that hospitals became such an cherished part of communities that they are also too big to fail, and now we have a medical system so sclerotic and brittle, so dependent on the established way of doing things, that it cannot bring itself to operate differently or to even examine itself honestly and critically.
So centralization of power has only increased (although the trend was present as early as colonial times in the U.S., and of course earlier elsewhere in the world.) Dr. Tamburri mentioned the internet as being probably the most important development of our lifetimes, that our generation is living through a historically unique era, as having remembered a time before the internet as well as afterward, as if there were horses and buggies, and suddenly a Model T comes roaring down the road.
Dr. Hernández agreed that computers made the world closer and smaller, but also inter-national markets brought the world closer together.
Then we moved on to business.
VACCINE RESEARCH PROGRAM?
Dr. Huber asked: Should we offer a vaccine research program for those who feel they need a legitimate haven in which to make vaccine decisions, that is not to be coerced.
Dr. Stallone and Dr. Proefrock felt that was not necessary, because the Arizona exemption forms had always been adequate for their patients. Dr. Stallone pointed out that a letter from us would even more likely be rejected by a school than the Arizona exemption form. Dr. Stallone has encouraged patients to mark the exemption due to personal belief, rather than the medical exemption, and has never had a patient have a problem with that. He said it may be a stronger defense against getting a vaccine than a medical exemption, because it is easier for bureaucrats to challenge medical reasons for not getting vaccines.
Dr. Proefrock pointed out that the situation is more difficult for medical students. He said that you can offer an antibody titer. The school can then reject that. So you could offer a diluted Hepatitis B shot, in which you use EDTA to precipitate out the mercury and the aluminum.
In summary, it was agreed that the rights of Arizona citizens and their children not to be vaccinated were adequately protected by filling out the AZ exemption forms, particularly for reasons of personal or religious belief.
THE PURPOSE OF OUR ORGANIZATIONS AND WHY WE MEET
Dr. Proefrock, President of ANRI / NORI, reminded us of why we came together two years ago this month to form our organizations: any experimental treatment should have an IRB, according to FDA regulations. Now in our case, this has morphed from an Institutional Review Board to an Investigational Review Board. And we hammered out a disclaimer with an informed consent. But we have not yet fully considered what we have to be accountable for. If one of us were called to task for a treatment, one advantage of these organizations is that others among us would step forward and be able to say to the Board, “Yes, I do that experimental treatment as well.”
Dr. Tamburri mentioned that the presence of only three doctors in the community who practice an experimental treatment are enough to justify that treatment to continue to be used.
Another important purpose of ANRI / NORI, according to Dr. Stallone, is that we should have a tumor board, grand rounds format, to be able to learn from each other, to be able to see what we can learn from each other, and to say, well if that worked, I’ll try that.
OUTREACH TO OTHER NATUROPATHS
Dr. Hernández mentioned that if Facebook were used for ANRI / NORI, then we would much more easily reach a wider audience of naturopaths, to let them know we exist. She said that each one of us should upload a file, that is a page that we make for ourselves to place in the ANRI / NORI group on Facebook.
Dr. Hernández says it could be linked to SCNM alumni, for which she already has created a Facebook page.
Dr. Jemison agreed with the advantages, that Facebook is easier to use than other forums. Also, the general public can easily access it.
Dr. Hernández says it can be made user-friendly. She also mentioned that she is planning to go around to different naturopaths in their clinics and video them at work and feature the differences in styles of care, modalities, “flavors” of each clinic. This will enable us to know how to make good referrals to other naturopaths, and will allow the public to learn about a naturopath before going to see them.
Dr. Tamburri reminded us that a lot of new privacy guidelines have come out for Facebook, just going into effect in the last week.
Dr. Lashutka mentioned the advantage of the free advertising – but not overtly so.
It was then unanimously agreed that it was a good idea to go ahead with Facebook. Dr. Huber asked for a volunteer to make this happen. Dr. Hernández said, “I can do that,” and we thanked her for going ahead with this. She said that she will set up a group, but will need an individual page from each of us.
NOTE TO MEMBERSHIP: If you do not already have a Facebook page, please create one for yourself and then write to Dr. Hernández at email@example.com, to let her know.
Dr. Tamburri said that we should not forget about other ways of letting others know about ANRI / NORI. We should give talks, especially the newer naturopaths among us. Dr. Tamburri will go to Berkeley soon for the CNDA conference, and will let people know in his talk there about ANRI / NORI.
Dr. Hernández said that one could have long-distance participation in meetings such as this, and that Skype would be very helpful for that.
LONG DISTANCE PATIENT CARE
Dr. Tamburri raised the topic of what would be involved in seeing patients by Skype, and that the NPBOMEX has not yet approved this type of patient care.
Dr. Huber expressed dread of long-distance medicine by video conferencing, because ours is one of the few professions that have been, at least until now, immune to outsourcing, an extremely devastating condition of many American workers over the last couple of decades. And suppose an international doctor charges a tiny fraction (having tiny overhead costs) of an American doctor?
Dr. Tamburri said that as long as a patient has been touched by a doctor during the last year, the care can be transferred to any other doctor, including a “Doc-in-the-box” who only sees patient by Skype.
Dr. Proefrock added that it need only be a Medical Assistant.
Dr. Stallone says that regarding outsourcing, Arizona patients need only go to Mexico if they are determined to get medical care at a lower cost, which already happens, for those who hold thrift as a priority.
Dr. Hernández says that there are limits to the extent of outsourcing, because healing is energetic. The healing touch, the compassion cannot come across long-distance.
Dr. Proefrock agreed, noting that he could be sympathetic about your back pain from far away, but he cannot do too much about it at a distance.
Dr. Tamburri said that there are a lot of exciting developments in long-distance medicine. For example, the Da Vinci prostatectomy robot is being used by the military. A surgeon at the Pentagon can remove a prostate on someone out in the field with very fine hand movements directing the robot’s movements.
Dr. Huber said that when first setting up this organization two years ago, we were very careful to get a lot of important principles, goals and documents in place. But one glaring omission was regarding elections, and how frequently to have them. She reminded everyone that there were four officers: President, Vice President, Secretary and Treasurer. The office of Vice President has never been filled.
Dr. Proefrock noted that he had had a turn being President, and he was okay with not being President anymore, and that because it had been two years that maybe two years was a good term length.
Dr. Huber agreed that two years would be appropriate. Dr. Huber asked for nominations and self-nominations to come in by e-mail before April 30, so that they can be forwarded to the membership in early May before the next meeting. All nominees should e-mail a paragraph describing their qualifications, and their goals for ANRI / NORI to Dr. Huber at firstname.lastname@example.org.
The nominations will be forwarded to the entire membership. Then, as Dr. Proefrock stipulated several meetings ago, only those members actually in attendance should be able to vote. So at the May 18, 2012 meeting, there will be a secret ballot for President, Vice President, Secretary and Treasurer.
Please show up and vote.
NORI CERTIFICATION OR FELLOWSHIP
Dr. Proefrock said that more “legitimate” appearing doctors are attractive to ND students and new NDs for mentoring and rotations and emulation. There is a phenomenon of the little brother seeing what the big brother is doing, as it were, and wanting the same for himself. When one type of naturopath seems to be more employable, more tied in to the massive money of the conventional medical system, there is a desire to get on board with that, and to share in the perceived bonanza.
Dr. Tamburri clarified that students who only see FABNO-type doctors are going to believe that they have to buy their way into a club in order to treat cancer.
Yet, said Dr. Proefrock, FABNO is actually on shaky legal ground, because they don’t believe that IRBs are necessary.
Dr. Tamburri asked the question: Do we need a NORI fellowship?
Dr. Huber enthusiastically responded yes, because although legitimacy is just a veneer that does not reflect any authenticity or lack thereof to the doctor underneath the title, it does have the impact on the public and the profession of a statement of competence and dedication to the field in which certified. There are many initials after the name of a FABNO doctor. However, because of OncANP’s history of extreme capitulation to the priorities and wishes of the oncology profession, FABNO doctors tend to only know enough to be dangerous regarding cancer, and especially about how to get well from cancer, and what a patient goes through when healing from cancer or from chemotherapy. This is especially a problem because FABNO doctors have laid claim to the title “naturopathic oncologist,” which implies that other naturopaths who work primarily or exclusively with cancer patients are excluded and unqualified to have that title. Therefore, it is necessary to have ANRI / NORI doctors be acknowledged to be approved by our organizations to do what we do. Perhaps “NORI Fellow” would be such a designation.
Dr. Jemison raised the issue of the difficulty of certifying anyone without some standardization of training, testing, etc. He asked, “How can you certify someone without having them learn a particular protocol?”
Dr. Proefrock pointed out that ABNO offers a standardized training program. What a FABNO doctor does is dictated by the organization. This is almost as bad as a health insurance company dictating your treatments. If you get in an insurance network, pretty soon you have a MBA with an eye on the bottom line dictating your treatment plans.
Dr. Tamburri said, “Let’s be the opposite of FABNO.” FABNO certification is top-down. Protocols are dictated, and obedient doctors are asked to turn off their critical thinking skills, their flexibility to best troubleshoot the health concerns of the patient in front of them, and contradictory aspects of their medical education and knowledge, in order to most obediently observe the top-down decrees. Whereas we (being somewhat anarchistic) are bottom-up. So let it be a little more like the Good Housekeeping Seal of Approval, in the sense of a broad-minded acceptance, which is broadly approving of all reasonable, well thought out, medically informed treatments, modalities and treatment strategies that are approved on being presented to this Board and approved by a quorum of the membership. That is, what we say with this Certification or conferring of Fellowship is that you are within the standards of what the other doctors are doing. We are not “my way or the highway.”
Dr. Huber agreed with this, pointing out that by the nature of our principles as an organization, we respect the needs of the individual patient, and rather than trying to jam that person into a one-size-fits-all sort of situation, we bring all appropriate and necessary and mutually compatible and tolerable and generally safe treatments to bear on the person in front of us. Because that varies from person to person, this precludes any strict definitions regarding certification of mastery of a particular protocol.
Dr. Hernández said that an essential part of what we do is we create a unique plan for the patient.
Marilyn, our acupuncturist, made it clear to us that there is all the difference in the world between a doctor who is mindlessly following the protocols dictated by an institution external to the doctor-patient pair on the one hand, and a doctor who forgets everything except the needs of the patient and his/her knowledge of medicine, in order to best serve the patient’s best interests, on the other hand. Marilyn’s experience as a patient with the two types of doctors made her discussion of this contrast all the more compelling.
Dr. Tamburri suggested that each one of us should present to ANRI / NORI what we are doing and if we get approval, then we can be a “Fellow of ANRI / NORI.”
Dr. Huber agreed that that should be the only stipulation. Anything more narrowly defined would restrict practice undesirably and unnecessarily. Therefore, a “fellowship” would be more appropriate than a “certification,” for what we want with this.
NOTE TO MEMBERS: Come prepared next time to discuss briefly what you generally do in your practice, or what you have been working on recently. At that time we can vote on granting Fellowship in ANRI / NORI.
TOP-DOWN OR BOTTOM-UP GOVERNANCE
Dr. Stallone gave an example of top-down decrees. For example, naturopaths have been recently warned by self-styled experts not to use glutathione with Vitamin C intravenously. The argument is that because Vitamin C has been shown to have oxidative effect at high dose (producing H2O2 in the extracellular fluid) that reduced glutathione, GSH, has a strong anti-oxidant effect, and would therefore not work well with, or be useless or counter-productive, with the Vitamin C.
However, Dr. Stallone noted that he has had some of his best successes with patients when he went back to using high-dose glutathione, and that in general his results with cancer patients particularly improved with the use of high-dose glutathione, along with moderate or high doses of Vitamin C intravenously.
Dr. Huber re-emphasized the top-down politics of this: “It has been decreed . . that you shall not use glutathione” rather than allowing the rational and naturopathically educated doctor to decide what to use among known, generally safe treatments for the particular patient.
RALPH MOSS, PhD COMES TO ARIZONA
Ralph Moss is one of the foremost natural cancer researchers in the world. Dr. Huber’s clinic welcomes him to the clinic on Thursday, February 23 from 10:30 to 12:30 a.m. He will be meeting a lot of well cancer patients (and some not so well ones) who chose natural methods. Dr. Huber will be talking to him about ANRI / NORI as well. You are all welcome to visit us on that day.
POST-MEETING GRAND ROUNDS
Almost everybody had to leave before Case #1 was presented. So Dr. Huber asked Dr. Proefrock for advice regarding this case, described below.
A 55 y.o. woman with stage 4 breast cancer, with a history of lumpectomy, and on and off chemotherapy since 2000 presented to our clinic one month ago. The secondary metastases were to the liver, which had been almost completely replaced by cancer at the start of our treatments. Chemotherapy became less and less tolerable, mostly due to intolerable mouth sores. Fewer, smaller, shorter doses of chemo were given by her oncologist, until there was nothing that she could tolerate anymore. She gave up on chemo and moved to Arizona for our treatments. This woman’s wellbeing improved somewhat during the first two weeks at our clinic. The mouth sores cleared after about a week. She did yoga and power-walking. Then there was a week away out of state, with I believe no medical treatments of any kind, nor major changes in diet. Then on return, the health drastically took a turn for this worse, and the patient died this past Monday. This patient was an engineer who was meticulous about tracking her blood results following chemotherapy and wanted CBC/CMP blood labs once per week, which we did. Blood labs started coming toward normal for all analytes except liver enzymes, which steadily worsened, both back during chemotherapy before arriving to our clinic, and continuing after chemotherapy, until AST and ALT were close to 300 at the last blood lab.
The worst affected lobe of the liver, unfortunately for this patient, was the caudate lobe, which you’ll remember is where you find the hepatic portal vein, hepatic ducts close to juncture with the common bile duct and the hepatic artery. The adjacent quadrate lobe was also in bad shape, and again most of the liver had been replaced by cancer over the course of the previous 12 years.
All through treatment, and for the prior year, the patient had copious oral eructations, with a painful feeling of trapped gas in the abdomen. One carminative after another was tried, natural and conventional, with no effect. A colonic had once made this worse, and the patient was not eager to try colonics or coffee enemas. During her last week and a half, jaundice and ascites became apparent. We feared compromise of the above vessels and ordered a MRI. This is where things became confusing. The portal vein was clear and uncompromised. The bile ducts were not dilated or kinked, that we could see. The caudate lobe was atrophied, and although the liver had been almost entirely replaced by cancer, the radiologist found no uptake of contrast aside from that expected in a normal liver. No mass took up the contrast. The cancer appeared to be inactive. We were of course expecting mass effect on the large vessels into and out of the liver, but neither the patient and I nor the radiologist saw any evidence for that on the MRI images.
Within a couple of days, I recommended going to the emergency room after the jaundice, ascites and green-black stools (after high greens intake) presented all together. The patient wanted to hold out and wait till last Monday to see a GI specialist, despite my recommendations, because she feared too much of a revolving door of doctors in the hospital.
But Monday didn’t come soon enough. On Sunday evening, the patient began to vomit blood, collapsed and was taken to a hospital that has previously shown hostility to patients who have chosen natural treatments, not going to either of the hospitals that I had suggested earlier in the week.
When I got to the hospital on Monday afternoon, the patient was restless, drowsy, with dyspnea, with an O2 sat of 99%, BP = 73/33. A nasogastric tube was removing medium to dark red blood. The nurse told me the patient was losing blood as fast as they were putting it in her, and her hemoglobin had gotten down to 5, which explained the air hunger, but little else to me at that time.
I got on the phone with the GI doctor who had just seen her. He said her platelets were very low, and it was strange but she almost had a DIC-like condition. He could not scope her because there was too much blood to be able to see anything. The patient had told me when I arrived to the hospital that the ascites fluid removed in the paracentesis appeared to be clear, although there was non-stop blood being drained from her stomach by the NG tube.
The GI doctor’s differential included a bleeding ulcer and/or the cancer breaking through to the stomach and an artery. He was surprised when I told him about the lack of contrast uptake on the MRI of a few days prior. Yet, still thinking macroscopically, and still suspecting obstruction in the caudate lobe, I asked him if stents could be placed. He declined as explained below.
Dr. Proefrock and I later suspected that what may have happened was that the liver was so compromised that a person who previously tested normal for G6PD may have lost her ability to make G6PD. This is turn would explain the jaundice and the DIC condition, coming from hemolytic anemia.
G6PD you’ll remember is necessary to test for prior to IV Vitamin C, because it is necessary to dehydrogenate glucose 6-phosphate. This adds a H+ to NADP to produce NADPH. NADPH in turn converts oxidized glutathione (GSSG) to reduced glutathione (GSH). Reduced glutathione in turn can neutralize oxidants such as H2O2, which are hell on cell membranes, particularly the vulnerable RBC (except when protected by catalase, which normal non-neoplastic cells are, because catalase breaks down H2O2 to H2O and O2. Cancer cells are different in part for not having catalase, making them more vulnerable to the H2O2 from Vitamin C. Remember H2O2 is produced in the extracellular fluid from high dose intravenous Vitamin C.) Without G6PD to give all this protection, the RBCs lyse, spilling bilirubin into the bloodstream, showing up as jaundice and producing the fatigue of hemolytic anemia.
The hospital doctor told me that he was not going to do anything for this patient except palliative care. When I tried to persuade him (and even tried to guilt-trip him) to do more, he said that life has to end at some time for everybody, and at most she would have three months, and that my concern made it seem that I was more of a friend to the patient than a doctor. I wish I had said, well, we’ll take the 3 months, because as it turned out, the patient died only a few hours later. The family didn’t even have time to fly in and say goodbye. The blood loss was so severe that the blood pressure fell from 73/33 when I arrived to the hospital, to 29/15, and consciousness was not regained. To be fair to that doctor, not a lot can be hoped for with an uncontrollable bleed and/or DIC. And no amount of stents would have made a difference.
The moral of the story is, and this is what I wish I had figured out in time, and will always regret that I hadn’t:
|When a patient with a very diseased liver gets jaundice, and your therapy includes high-dose Vitamin C, there may or may not be any bile duct compromise. Go ahead and run a new G6PD lab, because it is hypothetically possible (although not yet documented in the medical literature that I can find) to have a normal to deficient seroconversion of your patient’s G6PD, and you may have to discontinue the vitamin C in a hurry.|
On the other hand, what looks like a bleeding ulcer may simply be a bleeding ulcer. And what presents as portal vein obstruction and bile duct obstruction in a person with a very diseased liver may not show up in imaging, and may be what it looks like from signs and symptoms. For the above patient we will never know.
NEXT BOARD MEETING: Friday, May 18, 2012 at noon, at the usual place, the clinic of Drs. Huber, Lashutka and Jemison, in Tempe. Chipotle’s will be served, unless objections surface before then.
Dr. Huber continues to offer for her clinic to provide lunch for the meetings at no cost to the membership, in order to save up the usual $10 dues per quarter per person to pay the $400 fee for the eventual incorporation of the non-profit.
POSSIBLE AGENDA ITEMS FOR MAY 18, 2012 BOARD MEETING
Before leaving, Dr. Stallone again urged that we use these meetings for Grand Rounds type presentations.
Elections by secret ballot.
Presentation of summary of your selected treatment protocols to the Board for an up or down vote on approval for Fellowship.
May I please order ANRI / NORI letterhead, to formally write a letter to the Fellows announcing the awarding of the Fellowship?
And then, without further ado, let’s jump right into the Grand Rounds that we all want, so that we actually get around to it this time. Feel free to bring in a case to discuss, but don’t feel you have to in order to attend.
Anything else? It’s always okay to add to the agenda, even at the last minute, but preferably earlier.
Colleen Huber, NMD
Secretary, ANRI / NORI