Principles That
Identify Orthormolecular Medicine: A Unique Medical Specialty
Richard A. Kunin,
M.D.
In 1969 Linus
Pauling coined the word "Orthomolecular" to denote the use of
naturally occurring substances, particularly nutrients, in maintaining health
and treating disease. At that time megadose niacin therapy for schizophrenia
and dietary treatment of "hypoglycemia7 were the major focus of the
movement. Since then Orthomolecular psychiatry and medicine have emerged as a
distinct and important specialty area in medical practice.
In the meantime,
other medical movements have sprung up out of the public demand for Hope in the
face of a worsening epidemic of cancer, heart attacks and mental illness and in
response to the outcry against adverse effects of modern medical treatments and
invasive diagnostic and intensive care procedures. Alternative therapies have
come forward to fill the vacuum left by modern Medicine, which failed to
provide effective treatments for the major epidemic diseases and in protest
against Medicine's over-reliance on pharmacology, for the drug treatments seem
to have fostered the epidemic of drug-dependence which is the major epidemic of
our time. The public majority were ready for a new medicine based on nontoxic,
non-invasive, "natural" medicines to go with the re-discovered
"natural foods".
Holistic medicine
became a rallying point for the New Medicine by putting nutrition, exercise and
meditation ahead of surgery, radiation and drugs. It was an answer to the
adverse effects of MegaMedicine, the cut burn and poison approach to
"health". And, since holistic medicine did not focus on basic science
data, it did not force a paradigm shift in the medical establishment.
Orthomolecular,
on the other hand, because it is identified with Linus Pauling, our greatest
living scientist, and because it rests on vast body of research in the basic
and clinical sciences, does force a major revision in medical thinking.
Nutrition, which has been the stepchild of medicine and generally considered a
dead issue in medicine, suddenly is at the crux of this new medical movement.
No wonder then, that Orthomolecular became a buzzword to the medical
establishment, who saw it only as megavitamins and judged it as quackery. By
contrast, the word, Holistic became the subject of numerous symposia, journal articles,
welcomed by editors eager to promote the image of modern medicine as a
progressive and responsive institution. But as it gained supporters, Holistic
Medicine also gained additional theories and practices, some of dubious value,
some downright unscientific, Even the most broad-minded and liberal-minded
editor had to recoil from permitting such things as psychic healing and
kinesiology within the pages of a refereed journal.
Soon the word
"Alternative, came to replace Holistic in the medical journals. Now the
establishment could pick and choose individually between the various therapies
that had gathered under the holistic umbrella; nutrition, biofeedback,
chiropractic, acupuncture, herbalism, homeopathy, massage, hypnosis, iridology,
kinesiology, astrology, psychic healing and other intuitive therapies, to name
a few.
The
orthomolecular movement was faltered with identity confusion and, in fact, many
of our own members seem to have chosen Holistic as their preferred badge-word.
This is good for the short run, I agree: it is attractive to patients and
profitable while being non-controversial and safer professionally as well. In
the long run, however, I think Holistic Medicine has no future. It has already
lost its identity, except as a clearing house for medical novelty. Most
important, because it does not identify strongly with science it has lost
reliability. Meantime, Orthomolecular Medicine retains scientific reason for
being: its basic science foundations of nutrition, biochemistry and clinical nutrition
have grown at a prodigious rate. Megavitamin niacin therapy, which was am
considered dangerous and controversial in treating schizophrenia, is now the
standard of care in the hyperlipidemias. What began as megavitamin therapy now
employs a broad data base and a variety of therapies applicable to numerous
medical and psychiatric conditions. It is ironic that this positive growth of
orthomolecular science and therapy has actually clouded the identity of the
Orthomolecular movement. On the one hand we are confused with Holistic
Medicine; on the other we are seen only as the avant garde of orthodox medicine
In hopes of defining our true identity let me update the concept of
Orthomolecular Medicine as anew medical specialty.
First of all, the
orthomolecular data base rests strongly on the following areas of scientific
knowledge: 1. nutrition, 2. biochemistry, 3. Cell biology, 4. physiology, 5,
general medicine, immunology, 7. allergy, 8. endocrinology, 9. pharmacology,
10. toxicology, 11. gastroenterology, 12, parasitology, 13. nephrology, 14.
physical medicine and manipulation therapies, 15. dentistry, 16. veterinary
science, 17. food science, 18, agriculture, 19. climatology, 20. medical
politics.
The following
therapeutic modalities fit the definition of orthomolecular: 1. vitamins, 2.
minerals 3. amino acids, 4. essential fatty acids 5, fiber, 6. enzymes, 7.
antibodies, 8. antigens, 9. cell therapy, 10. chelation therapy, 11. dialysis,
12. plasmapharesis, 13. hydrotherapy, 14. thermal therapy, 15. phototherapy,
electrotherapy (including electroconvulsive therapy), 17. air ion therapy, 18.
light therapy, 19. solar therapy, 20. acupuncture, 21. massage, 22. exercise,
23. biofeedback 24. hypnotherapy and other psychotherapies.
All of the
orthomolecular practice rests on a foundation of basic science advances in
biochemistry, biophysics, physiology, psychophysiology and ecology. We do not
eschew drug therapy or pharmacology; but we do recognize their limitations and
their potential for toxicity. Orthomolecular knowledge gives greater choice of
benefits for our patients id with less risk of adverse affects.
Aside from these
areas of interest, there are by now some well defined beliefs and principles
that also distinguish the orthomolecular practitioner from orthodox health
practitioners. These principles actually are an important part of our
professional identity. Just as knowledge of science and therapeutics might be
thought of as our Ego, these principles makeup our professional conscience or
Superego, The desire to be in the avant garde of medical progress, to share the
excitement of discovery, no doubt, is a major source of our motivational energy
or libido, our medical Id, as it were. No, the love of our grateful patients,
those we are privileged to heal and comfort, this must be the ultimate motive.
At any rate, I think you will agree that the orthomolecular professional is a
different personality, with different beliefs and values than most present-day
practitioners of medical orthodoxy. Of course all physicians do cherish our
Hippocratic oath, but the orthomolecular identity confers upon us additional
values and beliefs. Hippocrates first rule was: "Primum non nocere,"
i.e. "first, do no harm". We in orthomolecular practice have less
need for the primacy of that rule, for it is already implicit in the essence of
Orthomolecular practice, which is: "put nutrition first".
Here is a list of
15 principles that identify the spirit" of Orthormolecular Medicine:
1. Orthomolecules
come first in medical diagnosis and treatment. Knowledge of the safe and
effective use of nutrients, enzymes, hormones, antigens, antibodies and other
naturally occurring molecules is essential to assure a reasonable standard of
care in medical practice.
2. Orthomolecules
have a low risk of toxicity. Pharmacological drugs always carry a higher risk
and are therefore second choice if there is an orthomolecular alternative
treatment.
3. Laboratory
tests are not always accurate and blood tests do not necessarily reflect
nutrient levels within specific organs or tissues, particularly not within the
nervous system. Therapeutic trial and dose titration is often the most
practical test.
4. Biochemical
individuality is a central precept of Orthomolecular Medicine. Hence, the
search for optimal nutrient doses is a practical issue. Megadoses, larger than
normal doses of nutrients, are often effective but this can only be determined
by therapeutic trial. Dose titration is indicated in otherwise unresponsive
cases.
5. The
Recommended Daily Allowance (RDA) of the United States Food and Nutrition Board
are intended for normal, healthy people. By definition, sick patients are not
normal or healthy and not likely to be adequately served by the RDA.
6. Environmental
pollution of air, water and food is common. Diagnostic search for toxic
pollutants is justified and a high "index of suspicion" is mandatory
in every case.
7. Optimal health
is a lifetime challenge. Biochemical needs change and our Orthomolecular
prescriptions need to change based upon follow-up, repeated testing and
therapeutic trials to permit fine-tuning of each prescription and to provide a
degree of health never before possible.
8. Nutrient
related disorders are always treatable and deficiencies are usually curable. To
ignore their existence is tantamount to malpractice.
9. Don't let
medical defeatism prevent a therapeutic trial. Hereditary and so-called
'locatable disorders are often responsive to Orthomolecular treatment.
10. When a
treatment is known to be safe and possibly effective, as is the case in much 0
Orthomolecular therapy, a therapeutic trial is mandated.
11. Patient
reports are usually reliable, The patient must listen to his body, The
physician must listen to his patient.
12. To deny the
patient information and access to Orthomolecular treatment is to deny the
patient informed consent for any other treatment.
13. Inform the
patient about his condition; provide access to all technical information and
reports; respect the right of freedom of choice in medicine.
14. Inspire the
patient to realize that Health is not merely the absence of disease but the
positive attainment of optimal function and well-being.
15. Hope is
therapeutic and orthomolecular therapies always are valuable as a source of
Hope. This is ethical so long as there is no misrepresentation or deception.
The following
tabulation further clarifies the role of Orthomolecular Medicine in relation to
medical orthodoxy.
The essentials
boil down to 7 cardinal rules:
1. Nutrition
comes first in medical diagnosis and treatment.
2. Drug treatment
is used only for specific indications and always with an eye to the potential
dangers and adverse effects.
3. Environmental
pollution and food adulteration are an inescapable fact of modern life and are
a medical priority.
4. Biochemical
individuality is the norm in medical practice; therefore stereotyped RDA values
are unreliable nutrient guides.
5. Blood tests do
not necessarily reflect tissue levels of nutrients,
6. Nutrient
diagnosis is always defensible because nutrient related disorders are usually
treatment responsive or curable,
7. Hope is an
indispensable ally of the physician and an absolute right of the patient.
Finally, let me
repeat, that our rallying point and badge-word must be "Orthomolecular",
a landmark concept that conveys the genius of Dr. Pauling, who saw the need to
resurrect nutrition and put it first, not last, in our science of health and
disease.
