The Search for Natural

I think I might be described by many as a nature-lover. I have hundreds of plants in my home, I would rather walk in the woods than go to Disney Land and I think the smell of dirt is grand. But although Nature has brought us dogwoods, mountain vistas and rainbows, we should not forget about nature’s less beautiful gifts: rats, hurricanes, leprosy—just to name a few of the more-beloved gifts of Nature’s bounty. Nature demands respect. Four hours of heavy rain at the right time on a Friday, especially in the summer, can totally grid-lock New York City. Of course the beauty of Nature is she is out of our control, but it is also what makes Nature a fickle and untrustworthy mistress.

Despite the inability to control or predict nature, or maybe because of it, people often

think anything natural is superior to anything manmade. This is particularly striking as a physician when you are listening to your patients. Here are two twisted examples of what I have heard recently in reference to the mysterious word natural. A patient told me she no longer uses the birth control pill, because after her surgery she decided to go all natural. I enquired about the type of surgery she was referring to as there was no note on the chart. “Oh, “ she said, “after the tummy-tuck I had last summer.” And during the same week a patient with vitamin D deficiency who has had two skin cancers removed from her face told me she had stopped using sunblock because she preferred getting vitamin D from a natural source such as the sun rather than from a commercially available supplement. She was opting for the strong possibility of getting another skin cancer because she was afraid of vitamin D toxicity—a side effect which, if it exists at all, is exceedingly rare.

Of course, there are many doctors who employ the opposite logic: anything I give you is going to work better that anything you do for yourself. Rather than changing your diet or exercise, take my pill. This attitude is engendered in doctors because we see the unpleasant side of nature in graphic detail: fever, vomiting, pain, diarrhea, dementia and, of course, death. After a few encounters with some of these natural phenomena, you think modern medicine can’t do any worse and can only improve one’s lot in life. Seeing the sad lot of humanhood in medical school and as a resident makes the word “natural” lose some of its previous glamour.

We humans have problems with gray areas, but most of life seems to fall in that unfathomable space between white and black. I was asked at a party, “Do you believe in estrogen?” I had to point out it is neither a religion nor a political party. Like many drugs it has improved some women’s lives immeasurably and given other women an increased chance of getting a stroke. Most things we do in life have a risk/benefit ratio. We need to examine that ratio with all medications. What will I stand to gain and what am I at risk for? Unfortunately even drugs with a lot of gain can hurt you if you are the one-in-a-million to get a bad side effect. But not treating some maladies also has a risk/benefit ratio and that should also be examined before a decision on medication is made.

Nowadays, we have a third choice—“natural” products. Some may be superior to conventional Western treatments and some may be deleterious. Tobacco is a natural product but not one most people would use to promote their future health. Many, perhaps most, products sold as “natural” have had little testing and this is why most physicians are reticent to recommend them. Products that have been tested and found to have benefits and few risks such as red-rice algae or fish oil for elevated cholesterol should become part of a doctors’ armamentarium, perhaps before, or in addition to statin medications, but products like bio-identical hormones that are not made by recognized pharmaceutical companies and have no long-term prospective investigations should be looked at with skepticism until further studies are forthcoming. For example, we do not know that bio-identical progesterone creams are any less stimulatory to the breast than oral progestogens. They may turn out to have less risks or the opposite may be true.

Many people argue with some justification that FDA approval of a drug is no longer meaningful, either, especially in light of revelations about drugs like Vioxx or Avandia whose risks were obscured by the companies selling them. As a physician, I share those concerns. “At least do no harm” is probably the only part of the Hippocratic oath that most physicians can quote or even remember. I always prefer to wait a year or so after a drug comes out before prescribing it, just to see if any previously unreported side effects come to light.

Doctors and patients alike must have a healthy respect for medications. I totally understand when patients want to wait to explore all treatment options before deciding on a course of action. We as physicians should supply patients with as much information as we can and encourage them to research solutions on their own. We should all own our own health. But we should also abandon the idea that if it’s “natural” it must be better. 

In medicine we learn to individualize. The medication that sent you into the hospital with a frightening and potentially fatal side effect may have saved your neighbor’s life. When we prescribe a drug, no matter how much we know about you and the drug, an element of chance still enters. You could be the person with a serious allergic episode or this could be a drug which adds five years to your life expectancy or improves the quality of your life tremendously. Like Nature, medication can be fickle. In January, I had a life-threatening reaction to an anti-inflammatory medication. It would be easy to vilify these drugs as “bad”, but this class of drug has made my life livable. Although I have had a serious joint disease since I am twenty-nine, I am still walking, exercising and swimming and I don’t have any artificial joints. I have these drugs to thank. Back to that grey zone.

Medications or natural products should not be part of a philosophical or political agenda. I don’t want a pharmaceutical rep or a radical feminist deciding what is right for me. I want to have a physician I can discuss my health issues with, who can outline my particular risks and can help me decide how to live my life with quality and dignity, while incurring the least risk. When deciding on medications, whether traditional or not, I would recommend the same for you. And if you can’t discuss these issues with your current physician, may I suggest an MD trade-in. I hope nature treats you well this weekend. The current weather report has us in for 97 degrees tomorrow.

Comments

[Caroline Hagood]

Oh that pesky gray area gets me every time. It's kind of sad that it's hard to inhabit since, as you point out, most of life takes place there. Another thought-provoking piece from the great Judi.

[Adriel Gerard]

Wonderful post with great insights...keep up the great work!

[Joan Erskine]

Oh dear, that's hilarious. After a tummy tuck, she espouses going all natural? Has she stopped driving her car? Has she foregone air conditioning this summer? Is she wearing make up?

[Khebert.blogspot.com]

Well said!