Dr. Robert A. Kornfeld

October 18, 2011, "The more things change, the more they stay the same." This couldn't be truer of our health care delivery system. As a practicing physician for more than 30 years, I have experienced firsthand the explosion of medical technology, much of which has dramatically changed the way we diagnose pathology and the way we surgically and medically treat pathology. I will admit that this has served patients and doctors well, yet recent history has seen an explosion of illness and morbidity in our society.

What I feel compelled to take issue with, and the reason I am writing this treatise, is that the actual paradigm of medical care has not changed much in spite of all of our technological advances. Physicians have been extensively trained and have held steadfast in the belief that presenting symptoms are entities unto themselves. These symptom complexes have been treated as if they have a life of their own, separate and apart from the innocent bystander host, the person with the medical problem. We have divided the human body into a jigsaw puzzle of component parts. We've taken the jigsaw puzzle apart and assigned a specialist to address each one of these pieces of the whole, losing sight of the fact that everything is part of the whole, and everything we do as physicians to each little part affects the whole person. This has fostered the current allopathic paradigm of "symptom care" in lieu of the more important issue of "health care."

In order to establish a system that is truly focused on health care, we need to expose some "myths" that will allow us to unlock the door to creating a more efficient and successful healthcare delivery system.

Myth #1- Technology has improved healthcare

Ask any physician if he believes that technology has improved health care and you will get a resounding "Yes!" Advances in medical technology now enable us to look inside the human body with relative ease and with great detail. Our surgical tools allow us to operate on all parts of the body with a minimum of trauma and blood loss. Technology has helped us improve the quality of life for millions of patients every year. It has enabled us to save countless lives as well. Therefore, it is certainly a foregone conclusion that technology has, in fact, improved our health. Or has it?

Statistically, since the age of technology, there has been an onslaught of increasing pathology. The amount of illness and morbidity in our society is dramatically rising. There are now more cases of cancer, heart disease, arthritis, auto-immune illnesses, endocrine disorders, developmental disorders, allergies, respiratory problems, infectious diseases, neurological problems, musculo-skeletal pathology, gastro-intestinal disorders, psychological illness, etc., than ever before.

While it is true that our technology has enabled us to better handle the enormity of disorders now facing mankind, it has done literally nothing for "health care." If it had, we would have seen a decrease in the amount of illness and pathology in society. We would have experienced a drop in the amount of people requiring intervention from the medical community. Pharmaceutical companies would not be as rich and powerful as they are if people would be less dependent on medication to "feel well". If anything, advances in technology have fostered a narrow field of vision, focused more on early detection and intervention than on prevention. If, by definition, health care means "the maintenance of good health," then technology has failed miserably to produce any measurable improvement in the overall state of health of mankind.

Myth #2 - Inflammation is bad

Ask any doctor what to do about inflammation and the answer will be a uniform, "Take an anti-inflammatory." While it is true that taking medication to suppress inflammation can certainly lead to increased comfort, should we be doing that in the first place? Is inflammation bad? Is it something that occurs by freak accident, some physiologic aberration, that occurs and causes great distress and suffering amongst mankind? We have been conditioned to think of inflammation as something bad because it causes pain and makes us miserable, therefore it should be medicated and suppressed. Right? Wrong.

Inflammation is a directed response by the immune system designed to detoxify, repair and protect tissues under any form of functional or metabolic stress. It is important to understand the purpose of inflammation in order to see why we should not work to suppress it, but rather to support it.

Whenever there are tissues in our body under any form of functional or metabolic stress, the problem will be immediately identified by the immune system. It first recruits a pathway called primary inflammation. This pathway is employed by the body in order to detoxify the tissues under stress (as tissues under stress increase their metabolic rate and produce more toxic by-products) as well as facilitate the repair of any injured cells. A primary inflammatory response will produce no symptoms in low-level stress situations, as long as it is efficient in managing the problem. You would not even know that this process is going on because there are no identifiable symptoms such as pain, swelling, redness and heat. Cardinal signs of inflammation will occur only when there is rapid, high level stress in an area such as in acute trauma, repetitive stress episodes, allergic/toxic reactions and metabolic disease.

In situations where the stress on the tissues is beyond the capability of the primary pathway, or in situations where there is an inefficient inflammatory response (we will discuss this later in the treatise), the immune system will then incorporate the secondary, or chronic, inflammatory pathway. This pathway is a protective pathway. It prevents rapid tissue destruction by allowing for cellular adaptation to the stress as well as the release of pain-causing chemicals to prevent continued "overuse and abuse" of the involved part. Therefore, the patient becomes aware that there is a problem because they are in pain.

Now that you understand this simplified explanation of inflammation, you can see that inflammation is actually a good thing. It is the body's way of trying to help itself deal with these kinds of issues. It should be obvious then, that anti-inflammatory medications actually impair the body's ability to detoxify, repair and protect itself. Additionally, these medications add toxic load to the body and are responsible for many varied side effects.

What makes more sense, empirically, is to treat these problems mechanistically and supportively. In other words, we want to work to help make the pathway of primary inflammation more efficient, with supportive, rather than suppressive, protocols. There are many natural medicines that can help accomplish the task of supporting our bodies, be they homeopathic, nutritional or herbal. Additionally, we want to be able to identify the reason(s) that this pathway is not functioning efficiently.

It is imperative that we look more comprehensively into our patient's physiology in order to detect reasons why the immune system is not up to the task it is being called upon to perform. To do this, we need to understand our patient's lifestyle, diet, adrenal health, the presence of food sensitivities, free-radical levels (free-radicals being compounds that essentially are responsible for cellular damage and degeneration over time), metabolic function analysis and perhaps other tests. In other words, we must work to comprehensively understand our patient's total health picture and not just concentrate on the body part involved in the pathology.

Myth #3 - Genetically coded diseases are unavoidable

How many times have you heard someone say, "My mother had arthritis, that's why I have it"? We now believe, through scientific technology, that many diseases are inherited. Genes for specific diseases have been recognized via gene mapping. Many of you may know or have heard of women who have had total bilateral mastectomies, completely prophylactically, because their mothers died of breast cancer, firmly believing that they could not avoid the same fate.

Let's take a closer look at this issue. If having a gene for any illness condemns you to having that disease, then why are you not born with the disease you are coded to have? Why isn't every person who carries a gene for disease suffering at all times from that disease? The answer is that all genes do not express themselves at all times and many never do. There must be a reason why the body would call upon a gene to express itself. Otherwise, none of us would be able to survive the onslaught of genetic expression. So what is it that causes a gene to express itself? If you consider for a moment that diseases are just a complex of symptoms being incorporated by the body in an attempt to protect itself from tissue destruction and/or imminent death, you may begin to get a clearer understanding of what I am trying to say. Once we begin to pay attention to the reasons that a gene might express itself, we may be able to prevent that gene from releasing its code for illness.

To do this, one must look again at the lifestyle of the patient. As stated earlier, degenerative illness is a function of free radical damage to our cells over time. If someone carries the gene for arthritis, for example, one would expect genetic coding to foster storage of free radicals in their joint tissues. The prolonged exposure to these free radicals over time will cause progressive vicariations, which lead to cellular damage and eventual joint destruction.

But what if we intervene on behalf of gene expression by controlling the formation and liberation of free radicals in the body? Would there then be a need for the gene to express itself? I contend that there would be no need for this gene to express because, as I stated earlier, disease is the body's way of protecting itself from rapid destruction of tissues and/or imminent death. If it doesn't have to go to extraordinary lengths to protect itself, the gene remains dormant and no disease ensues.

So, again, we must look at the lifestyle and diet of the patient to discover why their body is failing to control the formation, liberation and damage caused by free radicals. You have all heard the term "antioxidants" and for good reason. Antioxidants are the nutrients we require in order to neutralize free radicals so they can then be eliminated from the body in a harmless form. Many people in our society live on nutrient deficient diets from highly processed and refined foods that do not supply essential nutrient protection.

You should be beginning to see the pattern here. Are we treating cancer by cutting it out? Are we treating arthritis by suppressing the protective inflammation brought about by years of free radical damage? Does coronary artery bypass grafting cure cardiovascular disease? Of course not. Our goal should be in maximizing understanding of cause and effect and employing life affirming, nutrient-rich diets with a healthy, wholesome, natural lifestyle. This is the way to "prevent" genetically coded diseases.

Myth #4 - Medications improve health

We are, in this country, the most heavily medicated society on the planet. People are taking medications to control the symptoms of countless diseases. These medications are either prescribed by their physicians or purchased over the counter by the patient. I have seen, in my practice, thousands of elderly patients taking upward of 10 prescription medications as well as a few over-the-counter ones. If you ask the average senior how they are feeling, most will say that they feel awful in spite of their medications. How could this be? If the medications are supposedly "keeping them healthy," how come they feel so bad? There are a number of reasons for this.

First of all, every medication swallowed is perceived by the immune system as a "poison," because there is nothing in nature that would ever present to the G.I. tract in that form of chemicals. This added "toxic load" places additional stress on the body. These chemicals must be detoxified and eliminated by the body. This need to detoxify causes stress in the liver and kidneys and can damage these vital organs.

Additionally, all medications, because they are designed to interfere with natural body physiology, will produce inevitable side effects. Why? In every situation where a drug is used to block symptoms (the roadblock), the body will undergo physiologic compensations in an effort to get around the roadblock. So, the body will recruit different physiologic pathways in an attempt to bypass the roadblock. Hence, the patient will experience new symptoms as these other pathways elicit undesired effects. Some of the side effects can be potentially more disabling than the symptoms they are being used to treat.

Many side effects are treated with additional drugs, further increasing the toxic load. The other issue most important to understand is that the symptoms are a directed response by the body to solve whatever issue needs to be dealt with. If you inhibit these symptoms with medications, symptoms will return when the drug is withdrawn if the body has not successfully solved the problem.

So, what am I saying here? Quite simply, if a patient has high blood pressure and is taking medication to control it, and then they cease taking it, they will see their blood pressure rise again. If they are suffering with an inflammatory problem and are taking anti-inflammatories to control their discomfort, and cease taking their meds, they will again be in pain. If they are suffering with sinus congestion and take a decongestant, they will feel congested again if the drug is withdrawn. Empirically then, we see that the medication has not at all improved their health, just their symptoms.


Myth #5 - Childhood immunizations protect us from serious disease

It's a foregone conclusion that upon the birth of your new baby, immunizations will start as soon as possible to protect your child from many serious childhood illnesses that can devastate his/her health. Pediatricians set up important immunization schedules to be adhered to so that the baby is not left unprotected. In years gone by, many children were afflicted with polio, measles, mumps, Rubella, influenza, small pox, diphtheria, whooping cough and others. Of course, the majority of these children recovered without incident (other than polio, which caused permanent nerve damage most of the time), but there were some children who had serious sequelae and even some who died from these diseases. Modern science discovered a way to confer immunity on these children so that they would never become afflicted with these diseases, and for the most part, it has been successful. The question is, at what price?

If we think for a moment that we are taking infants with immature thymus glands (the main gland responsible for proper immune system function does not mature until around five years of age) and exposing them to numerous live and attenuated viruses, much more frequently than the child could possibly be exposed to any of these diseases, we may begin to understand some of the very discomfiting statistics that have evolved since the age of immunization. Rather than decreasing childhood morbidity and improving the health of all subsequent generations being immunized against these diseases that have affected mankind for thousands of years, we have instead seen a dramatic rise in childhood illness in the form of ADD, ADHD, autism, allergies, learning disabilities, infectious diseases, auto-immune illnesses and, most importantly, cancer. Cancer has been on a frighteningly dramatic rise in small children over the past decades and shows no signs of letting up. Mortality rates for childhood cancers are unacceptably high although technology has slowed the course of death.

Is there anyone out there, like myself, who is not convinced these childhood morbidity statistics have nothing to do with immunizations? Have we traded off less serious illness for more devastating disease? How did mankind survive and thrive through thousands and thousands of years without being immunized? Are we interfering in a way that has created a weakening, rather than a strengthening, of the human immune system? Is it possible that we are interfering with the natural course of genetic mutation that would have rendered authentic immunity to these diseases? There are too many unanswered questions here for my comfort level.

It is my opinion that it is incumbent upon epidemiologists to delve deeply into this possibility and definitively rule out a link between immunization and childhood morbidity from the aforementioned conditions.


Myth # 6 - The double blind - placebo controlled study guarantees safety and efficacy in drug therapy

At this point in the history of mankind, we have been conditioned to abhor symptoms of any kind. Headaches, sneezing, coughing, colds, allergies, pain, infections, hypertension, etc., are no longer tolerated as a part of the process of living. Rather than look into the mechanisms that may be causing these symptoms, we are reaching for the medicine that will suppress them. In so doing, we may feel better, but we now have no motive to look at causes and correct for the issues that may be impairing our health, thus increasing our "need" for more medications over time.

Well, what about these drugs? How do they make it to the market for public consumption? The answer is the "gold standard" double blind, placebo controlled study. Without this approach, there can be no FDA approval and hence, no way to market a drug. So let's look at this approval process more closely.

It is imperative that a drug be tested for two main issues in clinical trials, the first being safety and the second, efficacy. Of course we want to know that if a drug proves to control the symptoms it is being designed to control, it can it do it safely, (e.g., with a minimum of "tolerable" side effects).

We then want to be able to establish that it is the drug that is working and not the "mind over matter" phenomenon. To ensure this, the drug is given to half of the test subjects and a placebo is given to the other half, who believe that they are actually being given the medication. Both groups are also instructed to refrain from taking other medications so that a "synergy" effect does not confuse the results. It would be harder to know if side effects and/or efficacy are being affected by these other meds so they are eliminated from the trials. The expectation is that there should be a great discrepancy between the medicated group and the control group (placebo) in the relief of symptoms being reported. This establishes the drug's efficacy.

All through the clinical trials, all side effects are being reported and catalogued. The side effects are rated as to severity and frequency. The FDA will then look at this "safety" profile and decide whether or not the drug is safe enough to be approved for marketing.

So let's assume that a drug has passed the stringent testing requirements and is now FDA approved. Soon, the drug will begin to be prescribed by an ever-increasing number of doctors who believe that new is better. Now, this is where the bigger, broader issues become revealed. Firstly, we mentioned that the medicated group in the study takes the test drug in isolation of other drugs. That is not what happens in real life. As soon as the drug hits the market, it is going to be mixed with lots of other prescription and over the counter medicines, as well as herbal and homeopathic medicines. We now begin to see drug interactions that will cause previously unreported side effects, some of them severe and some of them causing deaths. It is actually after the marketing of the drug that the public becomes the "test subjects" for drug interactions. The Department of Health will quickly respond by informing doctors of these "new" side effects, but it is too late for some people.

In addition, as the public use of the drug increases, there is now a much larger population of people using the drug and the statistics begin to change. What may have been reported to occur in 2 percent of the original test group may now be seen to be occurring in 6 percent of a broader population. Additionally, new side effects, not previously reported in clinical trials, become apparent. This is because there are so many variables in human physiology that results are often skewed by small populations of people who live in and around the same geographic location.

Lastly, clinical trials do not reveal the effects of long-term use. This, again, is something that turns the public into human guinea pigs. The recent Vioxx debacle bears this out.

So, in fact, this double blind placebo controlled study does not guarantee safety or efficacy because the test leaves far too many questions unanswered.

Where Do We Go From Here?

The focus on optimization of health not only depends on a working knowledge of genetics, but a deeper understanding of cause and effect through a working knowledge of epigenetics. Integrative medicine (the practice of conventional and holistic medicine) seeks to relate cause and effect in the treatment and prevention of illness by addressing the causative factors in the patient's diet, lifestyle and environment. When the medical profession embraces the duality of symptom care and the optimization of health by addressing epigenetic influences on gene expression, we will begin to see a decrease in morbidity and an overall improvement in quality of life.

Our goal is to educate the public on how to stay as healthy as possible. Correcting mechanisms of pathology requires a receptive public, one that is willing to alter diet and lifestyle for their own benefit. One can easily extrapolate that in order to have a clean, natural, chemical free diet, issues of environmental toxicity can no longer be tolerated. We would now have a society of proactive people whose goal is to protect their health, the health of their children and grandchildren as well as preserve nature so we can be a part of it rather than a detriment to it.

The future of our health depends on knowledge and action. The future of our survival depends on knowledge and action. We can no longer afford to be innocent bystanders of our own health. The system is bursting at the seams. It is costing us far too much money to administer medical/surgical care. True, we have technology that can facilitate early detection, but this technology by no means confers prevention of disease on any of us. As such, we have become masters of symptom control and disease management but unfortunately, we are losing the battle to increasing morbidity and suffering.

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