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Editor,
The Journal of Integrative Medicine
Formerly, Associate Professor of Pathology (adj.), College
of Physicians
and Surgeons of Columbia University, NY
Formerly, President of Staff and Chief Pathologist,
Holy Name Hospital, Teaneck, NJ
Fellow, Royal
College of Surgeons of England -
Diplomate,
American Board of Anatomic and Clinical Pathology
Diplomate, American Boards of Environmental Medicine
Past President Capital University of Integrative
Medicine |
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Why I Became An Integrative
Physician
In 1963, I graduated from King Edward Medical College, Lahore, Pakistan and
traveled to England where I obtained a diploma of the fellow of the Royal
College of Surgeons of England in 1966. In 1972, I received certification from
the American Boards of Anatomic and Clinical pathology. From 1974 to 1996, I
served as chairman of the Department of Pathology and Laboratories, Holy Name
Hospital, Teaneck, New Jersey. From 1972 to 1998, I also served on the faculty
of the College of Physicians and Surgeons of Columbia University, New York.
My personal perspective of integrative medicine evolved over a period of many
years. It began began when I learned to think ecologically. As I recall it one
day in 1969, as a pathology resident, I received a large basin brimming with a
messy inflamed and distended colon with copious bloody fecal matter spilling out
of some tears in its wall. It was not much fun to clean that bowel and take
tissue samples for preparing microscopic slides. The next day I examined the
slides and observed the expected microscopic features of ulcerative colitis:
acute and chronic inflammation, dead and dying immune and other types of cells,
ulceration of the lining mucosa, disruption of the general architecture of the
colon wall, and pockets of pus. After finishing my study, I took the case to one
of my professors. He examined the slides and agreed that it was a case of
ulcerative colitis.
The next day, something unexpected happened. Without purpose, I picked another
slide of that colon, looked at it, and chanced upon a cluster of large, pale
cells forming a discrete round structure. Such a formation is called a granuloma
and is considered diagnostic of Crohn's colitis. "Look at that!" I said to
myself in surprise. "Now, that granuloma makes it Crohn's colitis, doesn't it?
Yesterday it was ulcerative colitis. Today it seems to be Crohn's colitis.
Interesting!" I marked the microscopic field with ink and took the slides to a
second professor, since the first one was out of the department. He looked at
the case and readily diagnosed Crohn's colitis.
The next day as I prepared to carry the slides to one of the secretaries for
filing, I picked another slide from the same case and started gazing at an area
that showed discrete layers of tissue debris covering small patches of the inner
surface of the bowel wall. Those are the features of another common type of
colitis called pseudomembranous colitis. "Aha! Another diagnosis!" I exclaimed.
"Let's see if I can get someone also to agree with me." That time I purposefully
looked for a third professor and decided not to tell him about the diagnoses
made by the other two. I pointed out to him the membrane-like structures and he
agreed that we had a case of pseudomembranous colitis. I returned to my desk
triumphantly. I knew I had a story to tell. Sometime after that Choua said, "Can
you make more slides from that colon and see if you can get another professor to
diagnose yet another type of colitis from the same colon?" he challenged. I
smiled. Worth a try, I murmured to myself.
I went back to that colon and took many more sections of tissues. A technician
looked at me, a little annoyed because she had to prepare the slides from all
those sections. The next day she brought me several trays of slides and I went
to work. In one of the slides, I found areas that showed well-preserved bowel
architecture, congested blood vessels, pooled and disintegrating red blood cells
in the tissue, and small surface erosions. Bingo! I knew those were the features
of another type of colitis called ischemic colitis. I continued my search. I was
not disappointed. I found some microscopic fields that showed diagnostic
features of a type of colitis called collagenous colitis. "Ah! Another
diagnosis!" I congratulated myself and continued study of the case with yet
other slides. There were many fields which could only be diagnosed as
nonspecific colitis. With some more persistence I found other areas qualifying
for other forms of colitis. Getting my teachers to agree to those various
diagnoses with different slides of the same colon did not prove to be difficult
either. I spoke to Talat, my wife, about my accomplishment, but decided not to
tell my professors about it. I did not know how some of them might take it.
Next I turned my attention to my pathology textbooks for a critical study of the
causes of those various types of colitis. That turned out to be a yet more
fruitful search. I made the second and equally important discovery: The cause of
none of those types of colitis was known. It was not that dozens of pages of
those texts were not filled with discussion of the etiology (cause) of all those
types of colitis. For every type of colitis, some immune disorder, infectious
agent, or vascular event was suspected or proposed, but in every case the final
conclusion was always the same: The cause is not fully understood.
That search led me to a third important discovery: There is such a large overlap
in the clinical symptomatology, microscopic appearances, and suspected causes
that there was hardly any point in slavishly adhering to the system of
classification of colitis which I was being taught as "science."
The young pathologist in me was jolted by his three discoveries. An image of
several blind men surrounding an elephant arose in my mind's eye. During the
weeks and months that followed, some vague, ill-defined notion of altered states
of bowel ecology began to evolve. It took me several years before I could muster
courage to begin writing about what I thought were my awkward notions of bowel
pathology, which I thought would be heartily laughed at.
In the late 1970's I introduced the terms "bowel ecosystem," "blood ecosystem,"
and "liver ecosystem," to express my view that we clinicians need to think
ecologically and focus on the relationships among those ecosystems rather than
be bound by the prevailing one-cause/one-disease/one-drug model. In a series of
essays published in the curriculum of The American Academy of Environmental
Medicine, I focused on the impact of environmental factors and the body's redox
homeostasis.
In 1983, based on a chance reflection on why stale buffers lose some of their
buffering capacity with time, I wondered why butter turns rancid spontaneously,
but, but does not turn unrancid spontaneously. Fruit on the kitchen table spoils
spontaneously but spoiled fruit does not spoil unspontaneously. Unmindful of the
evident relevance of the second law of thermodynamics to those questions, I put
forth a hypothesis that spontaneity of oxidation in nature is the primary
driving force in molecular and cellular injury, and hence of aging and all
disease processes. That simple idea has preoccupied me ever since.
In 1987, in a monograph entitled, "Leaky Cell Membrane Dysfunction," I presented
the biochemical and clinical consequences of an increased cell membrane
permeability state. Specifically, I drew comparison between the ever- increasing
indication of calcium channel blockers in pharmacologic medicine and
ever-sharpening focus of nutritionist- physicians on magnesium supplementation.
With a leaky cell membrane, what is inside the cell hemorrhages out and what is
on the outside of the cell floods the cells innards, hence the clinical benefits
of calcium channel blockers and magnesium.
In 1990, with The Cortical Monkey and Healing, I began a series of volumes for
the general readership that presented the integrated spiritual and
energetic-molecular model of the health/dis-ease/disease continuum. I wrote
about a physician's need to think and act like a gardener—for ever seeking to
nourish, nurture, and detoxify his patient's body. And, of course, he has to be
prepared to serve as a spiritual guide in matters of illness for the sick as
well.
In 1996, I accepted the presidency of Capital University of Integrative
Medicine, in Washington, D.C., and proposed that integrative medicine be defined
as a philosophy of medicine that requires physicians to offer their patients all
that is safe and effective without subservience to one or more schools of
medical thought.
In 1998, I introduced the term
dysoxygenosis for a state of partial or complete
failure of oxygen utilization in cells. I put forth the hypothesis that
dysoxygenosis is caused by impaired function of enzymes involved in oxygen
homeostasis ("oxyenzymes") and leads to altered expressions of genes induced by
hypoxic environment ("oxygenes"). The webs of oxyenzymes are vast, with each
entity linked to every other through multiple pathways. The webs of oxygenes are
seemingly more complex. All such webs are exquisitely aware of changes in oxygen
availability in their microenvironment and vigorously responds to them. When one
thing changes in those webs in one way, everything changes in some way.
Dysoxygenosis, then, is discerned as a state caused by rich diversity of
elements but one that creates the same cellular oxygen dysfunction. I 1998, I
also introduced the terms dysfunctional oxygen metabolism and oxygen disorder
for readers without medical or biomedical background.
In The Principles and Practice e of Integrative Medicine, I make a case for
shifting focus from individual genes, proteins, and other d tissue-organ
ecosystems. The basic research in those areas, of course, will take decades if
not longer, and enormous funds. However, clinicians need not waiting that long.
Integration in medicine is a matter of integration of the spiritual dynamics of
the injury/healing/injury cycles with energetic-ecologic concepts of health and
disease. And those concepts must be solidly grounded on sound biomechanical,
morphologic and empirical observations.
Human biology is a wonderous web of wenergetic-molecular happenings—a
kaleidoscope brought to life by bursts of innate energy, colored by cellular
mosaics, moved by paradoxes of complementarity and contrarity.
A Discipline of Wholeness
Human biology is a wondrous web of energetic-molecular happenings—a kaleidoscope
brought to life by bursts of innate energy, colored by cellular mosaics, moved
by paradoxes of complementarity and contrariety. When one thing moves in a web
one way, everything in it moves in some way. Within the injury-healing-injury
cycles in that web, life begets death and death begets life.
We physicians have not been ecologic thinkers. We need to be,. To paraphrase
Leonardo daVinci, every part is destined to unite with the whole so that it may
escape its own incompleteness. In recent years, there have been astounding
advances in the dissection of the molecular pathways of healing and dying. The
clinician can now see the whole with increasing clarity. Health must be seen as
harmony among the molecular and cellular ecosystems of the body —forms of
sickness need to be recognized as ecologic disruptions caused by spiritual,
nutritional, and ecologic elements. "I will peak of the functions of each part
in every direction, putting before your eyes a description of the whole form and
substance of man," da Vinci wrote. Today, that every direction must include not
only the essential aspects of spiritual equilibrium—which da Vinci was acutely
conscious of—but also the other fundamentally issues of oxidosis and
disoxygenosis. It is not enough to speak of lymphocytic thyroids or renal lupus
as 'diseases' nor is it sufficient to merely substitute echenacea for
erthyomycin for recurrent infections or to replace hydrodiuril with hydrogen
peroxide foots soaks for leg edema. Wee need a discipline of wholeness—a model
of medical holism which would have brought smiles to Socrates, da Vinci, and
Darwin.
Notwithstanding the possible virtues of controlled and blinded studies for
evaluating g the short-term efficacy of drugs, the prevailing pharmacologic
blockade medicine for chronic disease is essentially flawed. Nutritional,
ecologic, autoimmune, and degenerative disorders cannot be reversed by synthetic
chemicals. It saddens me how often "control- crazed" clinicians deny the sick
wonderful opportunities for healing with natural measures only because they
think that it is not scientific. Those words may irk some readers, but if I
succeed in raising a few discomforting questions in these volumes, my purpose
would have been served.
A Scientist Has No Paradigm.
A scientist has but one allegiance—to the truth in his observations. He grows
when he continues to observe. A theory may be proposed to explain observation.
But first he must continue to observe. A valid observation once made stands on
its own. The interpretations of that observation and conclusions drawn from it
can—and should—be open to question. But no valid observation, once made, must be
discarded because it does not fit into any pre-existing model or concept. This
principle is as relevant to clinical medicine as it is to experimental sciences.
In this series of books, I have strived to see the suffering of my patients
through their eyes and through the prism of oxygen homeostasis. Taking lead from
Socrates, I have pursued questions raised by my patients, subordinating my own
prejudices to their sense of things. In Darwin’s footsteps, I have attempted to
understand parts only through their relationship with the factors to
relationships among molecular, cellular, an whole. |
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