A. Hoffer MD PhD FRCP

Congratulations to Editor Dr. Prousky and the International Board and welcome to the new International Journal of Naturopathic Medicine. I hope that for the sake of their patients many of whom they share, this will improve the relationships between physicians in Natural Medicine and in Allopathic Medicine. Since I have come to know more accurately what naturopathic physicians do and how their patients respond it is my wish that this journal might lead one day to a universal physicians degree which would have its sub divisions, its specialties. All physicians would go to the same medical schools, would receive the same basic training in the art and science of medicine and would have the option of specializing in various aspects of therapeutics such as allopathic medicine, and being more expert in the proper use of drugs, or naturopathic medicine, being more expert in the use of nutrition, nutrients, herbs, being more expert in physical manipulation such as chiropractic, massage, physical fitness, more expert in the use of surgery and more expert in the use of energy therapeutics such as acupuncture. For we are all allowed to practice our professions because we all have the same end in mind, the beneficial treatment of our yet know what they are.

Allopathic medicine adopted the idea that it was the only scientific medicine and uses this as sword to attack the other forms of therapeutics and as a shield to protect itself against the ideas of the other therapies. And in this it has been helped by the connection to the Universities and scientific institutes over the past century and by the phenomenal growth of the drug companies in the past fifty years who now with their immense resources play an exceedingly major role in medicine both in the field and in the medical schools and universities. But I do not think that outcome of treatment depends upon how scientific medicine is. In my opinion the most important question in medicine is not why does something work, but does it work. Physicians tend to think that scientific means knowing why something works. This has become so engrained in medicine that doctors will not accept that a compound might have any value if they do not understand why it might work. I have faced this problem since 1957 when we first published our findings that niacin in large doses was very helpful in the treatment of the schizo-patients, the restoration of health and the protection of the public. It is very unlikely that this will ever come about. A reasonable approach will be for the various health professions on their own to learn as much as they can about each other and to establish collegial relationships. They will do so by making their art as scientific as the allopathic profession claims theirs is. This can be an important role for this journal.

The allopathic medical profession has fought long and hard to carve out its own areas of expertise and to prevent invasion by other forms of the healing arts. Even within the field of allopathic medicine there may be intense jealousy and fear of one specialty invading the turf of another. Over 40 years ago the Dean of Medicine at the University of Saskatchewan was attacked in Toronto by a group of rheumatologists because I, a psychiatrist, had favorably reviewed two books on the treatment of arthritis by niacin, a marvelous book by Dr William Kaufman. A recent book by A Patrick Over MD “Mark Twain and Medicine” covers what has happened in the struggle for survival of the various therapeutic arts by describing Mark Twains involvement with medicine as it was practiced over 100 years ago. Naturopathic Medicine is not mentioned suggesting it played a minor role. Mark Twain tried every form of therapeutics then in use to help his wife. It is very interesting but in my opinion the author over values the placebo effect and equates the other healing arts such as homeopathy as practicing the art of the placebo. Under my direction in Saskatchewan we did the first psychiatric double blind controlled therapeutic trials and I have been a student of the placebo ever since. It is one of the most important factors in therapeutics but it does not explain everything. In addition to the effect of faith, hope and belief there has to be an element of therapeutics, which is a result of the physical, nutritional and other changes in the body even if we do not phrenia. To the average psychiatrist then and even now this made no sense because it did not fit in with their concept of what schizophrenia is. If they were not bound so tightly to their concept of scientific medicine they would have been much more apt to realize that the best test of any therapy is not why it works but whether it does in fact work. Medicine ought to be pragmatic and accept whatever works and does not harm patients. I think naturopaths are much more apt to practice based on this belief. This does not mean they are less scientific It means that they value more the art of medicine and its pragmatic approach. I am not opposed to the scientification of medicine because it is very nice to have a theory, which will explain why, for example, the antibiotic works or why atypical antipsychotic works, even though we do not yet have answers to these questions. Historical observa- tions are facts, which are invariant. The first observation that the bark of the willow tree was analgesic remains as true today as it did many years ago but the explanation of why it works is not. Explanations are evanescent and change with the development of more information. I would like to see all doctors practice the art of medicine and depend more on the observations of their colleagues made in good faith and not tied to any drug companies; and to practice the best pragmatic medicine they can while encouraging research to examine the reasons why certain things help and others do not. I think that a grand overall physician’s degree subdivided into these specialties like naturopathy would help solve many of the problems facing society today.

Naturopathic medicine must retain the best of modern naturopathy but must be open to new ideas, which will expand its usefulness much more. Too few naturopaths are familiar with orthomolecular medicine, with the use of optimum and often this means large doses, of the nutrients. This is a rapidly advancing field and has received powerful scientific support by the recent paper by Dr Bruce Ames in the American Journal of Clinical Nutrition (2002,75; 616-658). Linus Pauling showed how in nature certain enzymes could drop out to the benefit of the individual provided the nutrients made by these enzymes are present in ample amounts by the diet. His work shows that only the use of natural compounds normally present and needed by the body can be of any general help in the body. The xenobiotics, the drugs that are foreign to the body, act primarily as inhibitors of reactions. You can’t restore to normal a very complex system that is not working well simply by throwing in a foreign substance that plays no role in metabolism. It is like kicking the computer in order to get it working again. It is like trying to stop a rapidly moving bicycle by putting an iron bar in the spokes. It will stop but the results can be awful. Only chemicals with which the body is familiar with and understands have any chance of being really therapeutic. That is why the really good therapeutic compounds are the natural compounds like the true hormones (not the synthetics that every woman thinks is a hormone). Dr Ames referred to “50 human genetic diseases due to defective enzymes which can be remedied or ameliorated by the administration of high doses of the vitamin components of the corresponding coenzymes, which at least partially restores enzymatic activity.” No other chemical will restore the activity of these defective enzymes.

Naturopaths can enlarge their practice by undertaking the use of the vitamins like niacin that can normalize blood lipids. The modern statins, a many billion-dollar industry, are xenobiotics, have undesirable and dangerous side effects compared to niacin. Niacin lowers triglycerides, lowers total cholesterol, lowers lipoprotein A, and elevates HDL. It does not increase the suicide rate. The elevation of HDL is the most important feature and will help cleanse the arteries of plaque. Niacin is over-the-counter (OTC), and therefore, much cheaper and within the reach of everyone compared to the expensive drugs. Naturopaths can help their schizophrenic patients by using orthomolecular treatment and several are already doing so with great success, as are many chiropractors in the United States. Vitamins except for folic acid are OTC and can be used by naturopaths. But they must lose their fear of vitamins used in large doses- a fear which is still pervasive in the allopathic medical profession.

There should be one major healing profession with its subspe- cialties such as allopathic and naturopathic medicine. But as this ideal is not attainable each of these subspecialties should try to work together for the benefit of their patients. We should all strive to be more scientific but not allow this to inhibit the use of treatments that work but which have no acceptable scientific explanation. Finally, naturopaths can close the gap between their practice and allopathic medicine by embracing orthomolecular medicine.