As a licensed physician assistant I have written thousands and thousands of prescriptions for hundreds of different drugs. I used to pride myself on the ability to know, off the top of my head, the detailed pharmacokinetics of hundreds of drugs. And if I didn't know it I could pull detailed information out of my Palm Pilot (later smartphone) in seconds. That skill alone allowed me to be a very effective provider, since the most important subject at the University of Utah's School of Medicine's Physician Assistant program is drugs (therapeutics), and for a very good reason: They are dangerous.
Let’s be honest. How often have you gone to one of us "insurance approved medical providers (NP, PA, MD, DO)" and we offered you a prescription? Each time involves a balance between benefit and danger. If we write the wrong dose or the wrong drug or for the wrong patient then we can kill someone. And worse, we can even write for the right drug at the right dose with the right indication and still kill someone. Yes, it is true we have the support of an amazing pharmaceutical industry that includes smart pharmacists to hold our hand sometimes, but the fact that drugs are dangerous does not change. The flip side is if we select the right drug we can save someone's life and that fact is important because it will hopefully give you insight into why it took me (and many others) so long to discover the power of plants.
From my early days in PA school, I remember hearing an instructor(for whom I have a high level of respect and admiration) say that "naturopathy" is a hoax and all the claims we hear of this herb or that supplement curing someone's loved one is nothing more than a mere coincidence (association vs. causation). At the time I had just spent five years of college earning a summa cum laude degree in psychology (reinforcing "evidence based medicine") and competing with hundreds of qualified candidates for one of thirty-four seats in PA graduate school. So I took every word told from perceived authority as gold. After going into solid organ transplantation early in my career as a PA, I witnessed the most amazing power of immunosuppressive drugs that would prevent a patient from rejecting the new organ we had so painstakingly worked to give them. This only reinforced the idea that a "drug" is the only way, especially when even the slightest supplement or herb could throw off the narrow therapeutic range of one of the many different immune suppressing drugs I was prescribing. If one ever has any doubt of the amazing benefits of immunosuppression and transplant surgery, then look at the work of the team lead by Dr. Diane Alonso, a board certified transplant surgeon, whom I had the privilege of operating with at Intermountain Medical Center.
"Questions” or “Epiphany”
I did not start to question things until I began yoga several years ago. I remember the yoga instructor talking about yoga as a therapeutic modality and also as a medicine. At first I dismissed the claims of one instructor healing himself back from a severe cancer with only the help of yoga. "Yoga saved my life" is what I remember him saying. One thing, though, that kept me going to yoga classes and learning was that after just a few short weeks I began to feel myself heal. This was an epiphany for me because I did not even know I needed healing. Heck, I worked out 5-6 times a week lifting weights, riding a bike and/or running. Plus I had all of the best of what modern day medicine has to offer at my disposal. Where I first noticed the changes was in my abdomen. No matter what I had ever tried I could never lose that mass we call our "belly," the place we all seem to hold stress, suffering and insecurity. Yes, I did also quit refined sugars, and that absolutely played a large role. But for all my "evidence based medicine" colleagues please don't get lost on that point.[?] If you look at things from 20,000 feet you see only associations, but what was really was happening is I was learning to listen to my body...and yoga was my teacher; it was my facilitator allowing me to heal myself.
I realized the only person who can truly "cure" me is myself. That gem of knowledge was amazing, to say the least, and very empowering. As you can imagine, this new holistic, self-healing world disrupted my core beliefs of how to truly heal someone. At the time I was working with one of the best surgeons I have ever seen, Dr. Robert Ferguson, who is a board certified plastic and reconstruction surgeon and now chief of surgery at Utah's Intermountain Medical Center. The things this healer can do with his hands, but also with his heart, can leave even the most skeptical patient (me being one) in tears of joy. I would see miracles on a weekly basis while being privileged to learn from him as a mentor and a friend. We specialized in microsurgical cancer/trauma reconstruction. In spite of the amazing surgeries we were doing together, I was never satisfied with the proposition that, while a lot of women get breast cancer and some heal well and others do not, in either case $30,000 for one cancer drug treatment is the solution.
Armed with this newly gained knowledge of natural holistic approach to healing, I began the quest to rid my patients of refined sugars (although, ironically, I was putting it into their IV fluids?), increasing protein intake while healing and, of course, starting yoga. The amazing thing is the patients who listened really did get better faster and had less complications. I had one persistent nuisance though: the horrific side effect of surgery is opiates. Compared to other services performing similar procedures, our surgical practice had some of the lowest rates of opiate use after surgery (as well as low rates of complications related to opiates) with extensive education of NSAID's (ibuprofen/naproxen) and Tylenol. Scheduled Tylenol (acetaminophen) and Advil (ibuprofen) at the right dose will do wonders for pain after surgery; unless you do not take enough or take too much (CDC says ~320 a year die from Tylenol) or have dehydration or renal problems or liver problems or bleeding disorder or history of stomach ulcers or on immune suppressing drugs. . . .You get the picture. There are benefits and there are dangers.
Post-operative pain became a much bigger problem when I moved to orthopedic surgery with Dr. Charles Lind, a board certified orthopedic surgeon who is now chief of surgery at Utah's Park City Medical Center. Our patients did not have more pain because he is any lesser of a surgeon, but because having your knee totally replaced with a metal or ceramic joint really hurts. Having a total soft tissue reconstruction of my own shoulder (Latarjet by Dr. Metcalf) gives me some insight into how much something can hurt. Once again, though, approaching the problem of severe post-operative pain and inflammation with ibuprofen/Tylenol and holistic approach worked really well, but at least while still in the hospital patients needed a lot of opiates. Here is my big issue with opiates (Oxycodone, Hydrocodone, Morphine, Fentanyl, Dilaudid, Heroin): they kill people. They kill a ridiculous number of people. Actually, they are the leading cause of accidental death for all Americans, and are double the #2 and #3 causes of accidental death (motor vehicle accidents and falls, respectively).
The rub for me, and what really gives me the strength to be an early adopter of complementary whole-plant medicinals, is that on the one hand the FDA/CDC/DEA/FBI/HLS/CMS tells us "prescribers should only use opiates as a last resort," but in the same breath they say that if I were to give a patient in Utah a plant with THC (zero related deaths) over 0.3% then I deserve to be in a metal cage for the rest of my life. As a healer that lives next to Colorado and started paying attention when it legalized the use of cannabis for recreational use, things got really confusing fast--and not because I was spending all my time learning about cannabis in Denver. I remember having a conversation with an anesthesiologist, whom I respect dearly and know without doubt is a caring and intelligent doctor, about whether cannabis could be the missing medicine we could compliment our implemented IV Tylenol and IV Toradol (NSAID) protocols for immediate post-operative patients. The response was not surprising, but it went along the line that it will never happen and all the "evidence" of cannabis being a pain reliever for severe pain is a hoax, said while pushing more opiates into a patient's IV. Well, I can comfortably say after reading the "evidence" and experimenting with it myself in Colorado; cannabis as a whole is the safest and most effective pain reliever I have ever come across.
Author: Travis Remington MPAS, PA-C has been in healthcare for over 20 years. He has practiced in Complementary/Integrative Medicine, Urgent Care, Primary Care, Occupational Medicine, Transplant Surgery, Hepatology, Nephrology, Acute ICU care, Plastic & Trauma/Cancer Reconstruction, and Orthopedic Surgery. He now is spending most of his time researching the integration of whole plant medicinal therapies to improve the quality of life for his fellow humans.
Confessions Of A Pharmaceutical Disillusionist - Open Letter to the Medical Community
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