Dr. Ronald Hoffman is one of this country’s foremost integrative physicians. By this I mean that he uses the best treatments from both conventional and alternative medicine to provide truly integrative (or “intelligent”) care. He is Medical Director of the Hoffman Center in New York, and is also the author of several books, including: “Intelligent Medicine” (1997); “The Natural Approach to ADD” (1999); and his 2006 book, which he wrote with my friend Sidney Stevens, entitled “How to Talk With Your Doctor: The Guide for Patients And Their Physicians Who Want to Reconcile And Use the Best of Conventional And Alternative Medicine.” His most recent book, written with Barry Fox for Rodale Press, is “Alternative Cures that Really Work.”
Dr. Hoffman speaks with Honest Medicine on several topics including how so-called scientific “studies” present holistic therapies in the worst possible light –- and how this is sometimes done on purpose.
00:00 to 2:36 -– Introduction. Dr. Hoffman’s background. As a medical student in the 1970s, he was the “perfect stealth medical student, studious by day, while quietly pursuing my holistic interests after hours.” Today, in addition to being Medical Director of the Hoffman Center, and the author of several books, Dr. Hoffman is Past President of ACAM (American College for Advancement in Medicine), and the host of “Health Talk,” the longest-running MD-hosted health show on syndicated radio. Read more about Dr. Hoffman’s biography here.
2:36 to 4:00 –- Defining terms: Alternative Medicine, Complementary Medicine, Integrative Medicine, “Intelligent Medicine”
4:00 to 5:00 -- A discussion of how alternative medicine is too often misused as “the last resort of the desperate” -- or put another way, as an “almost magical, eleventh hour treatment when conventional options have failed.” Used this way, it is bound to fail. A much better way to use alternative medicine is in conjunction with conventional medicine –- either under the care of a doctor who understands how to combine the two; or of two doctors who communicate closely with each other.
5:00 to 8:36 –- A discussion of the Mayo Clinic’s Dr. Charles Moertel’s study of Vitamin C, the results of which were published in 1979. In this trial, extremely sick colon cancer patients, who had already failed to respond to chemotherapy, radiation and surgery, were given very small doses of oral Vitamin C. Read more about this flawed "study" in the book, "Vitamin C and Cancer: Medicine or Politics." Now, 20-30 years later, we’re looking again at the use of Vitamin C to treat cancer. But now, it is intravenous Vitamin C –- which is what Linus Pauling (pioneer in the use of Vitamin C for the treatment of cancer) always said should be used.
Dr. Hoffman discusses how other studies are designed in such a way as to fail, by putting the (natural) agent being studied at a disadvantage, so it will more than likely fail the test. For instance, one study of St. John’s Wort was conducted on people with moderate to severe depression. This was not a fair test for an herb that has a mild to moderate effect! In addition, this study was partly funded by the pharmaceutical company that manufactures Zoloft. But it was not publicized that the study also showed no statistical advantage to using Zoloft with depression of that severity! Of course, the headlines read: “St. John’s Wort worthless in the treatment of depression.” They might also have read, “Zoloft worthless in the treatment of depression.” The message in the press was therefore skewed, thus depriving people of a possible treatment for mild to moderate mood disorders.
8:36 to 11:00 –- So how can we know how to interpret these studies? This is difficult, because -- in addition to the fact that many of these studies are skewed -- we’re now getting what Dr. Hoffman calls “reporting by press release.” Often, science and health reporters are simply “quick studies,” without the background and understanding necessary to get the story right. In order to pick apart and analyze a study correctly, you must know if the study meets the proper criteria “in terms of objectivity and statistical strength.” Understanding how to analyze these studies is even difficult for doctors who read the medical journals all the time, and are bombarded with conflicting studies about various drugs. For instance, doctors will read studies hailing a drug as a “miracle drug,” and they’ll prescribe it widely. Then a few years later, it may turn out that the drug has DIRE side effects. On his radio show, Dr. Hoffman tries to do “spin control” on the headlines from the popular press to help people interpret the news and be better arbiters.
11:00 to 13:00 –- Why TV, which is where most people get their news, is not as good for in-depth reporting about supplements (and other complex topics) as is radio. Also, so many TV shows are bracketed by pharmaceutical ads and, even if there is not direct pressure, the station is probably subtly pressured NOT to lash out violently at the pharmaceutical companies that pay the bills. A discussion of video news releases (VNRs – or “fake news”), which look like news, and stations play them as if they were actual news. But they are really written and paid for by pharmaceutical companies, and produced by big PR firms. According to Dr. Hoffman, this kind of thing is also happening with natural products.
Dr. Hoffman knows that he is riding the crest of a wave of acceptance of natural products, but many players in this arena are also unscrupulous and they take advantage of the credibility that has been created for natural supplements.
13:00 to 15:21 -– Lot of the really reputable, excellent supplement companies are small companies that don’t have the big advertising budgets, so they are not known by the general public. They are mainly known by some holistic doctors and savvy patients.
Dr. Hoffman’s belief that there is a “populist revolution” going on, with some good websites, publications and radio shows disseminating information that would otherwise not reach the public. There is also a proliferation of outlandish junk. But people need to know how to access and understand the reputable information, and how to separate the bad information from the good. He sees his role as that of an “air traffic controller” for all claims (including natural claims) that need a “reality check.” People who are interested in this topic will read publications and listen to radio shows. But what is on TV is what most of the public is looking at. And what is in the medical journals is what most doctors are reading. Both versions are too often skewed. So this “populist revolution” is going on within a small part of the population.
15:21 to 16:43 -– Dr. Hoffman talks about the “bifurcation” in health styles of Americans, with the aggregate health of Americans deteriorating, since the average is dragged down by fatter, more sedentary, junk-food-fed people. But there is a smaller minority who are healthier than ever -– eating organic food and exercising. He remembers that the supermarkets of the 1950s had terrible food -– vegetables in cellophane -– horrible produce. Now, there are more options for folks who want to eat well. So we have a split between the least and the most healthy.
16:43 to 20:00 –- Dr. Hoffman (and co-author Sidney Stevens’) book, “How to Talk With Your Doctor.” A true story in the book: One of Dr. Hoffman’s patients who had cancer was taking supplements under his direction, while undergoing chemotherapy –- until her oncologist ordered her to stop. She stopped, and started to feel and look sicker. Although Dr. Hoffman doesn't agree with this oncologist –- when patients are taking the supplements under the care of a qualified holistic doctor –- he doesn't want patients to feel conflicted, so he doesn't argue. However, he feels that it is a shame that these patients are being denied these supplements that can protect them from the harmful effects of chemo and radiation, and can also keep their immune systems functioning better.
However, Dr. Hoffman often encourages his patients to take conventional therapies, if he thinks they need them. One example: A patient with AIDS, who wanted to avoid all pharmaceutical treatments. Dr. Hoffman convinced him that he would die without drug treatments. Today, 15 years later, thanks to following a truly integrative approach, the man is doing well, and is taking his meds, as well as weekly intravenous Vitamin C treatments. It is the combination approach that is working for him.
20:30 to 22:35 –- There is not enough dialogue between conventional and holistic doctors. His book is a call for this dialogue. Without this cooperation between doctors, patients are put in a bind. More oncologists are starting to work with him –- and with doctors like him.
22:35 to 24:30 –- How conventional doctors can learn more about alternative treatments through organizations like ACAM (American College for Advancement in Medicine). Dr. Hoffman encourages young doctors and medical students to attend ACAM conferences (for which they can get CME credits), to hear presentations on complementary medicine done in a highly rigorous manner. At these conferences, doctors learn about the serious research being done on supplements. He also invites conventional doctors to whom he refers patients to come to his office for rounds, where they learn that he’s just adding natural medicine to sound medical practice.
24:30 to 26:13 –- Dr. Hoffman wants to teach medical students about integrative medicine. So, over the last 10-15 years, he has had approximately 25 medical students do a 1-month rotation at the Hoffman Center. These young doctors become very excited because what they get in medical school is often not patient-oriented. ACAM encourages doctors around the country to do this.
26:13 to 29:00 -– There are not enough medical school courses in complementary medicine. And those that are taught are often not taught by doctors really knowledgeable in CAM (“Complementary and Alternative Medicine”). Some hospitals in wealthier suburbs offer what they call “CAM,” but it’s really window dressing for conventional medicine. In such hospitals, patients will get chemo and radiation, along with foot massages and music therapy. And these hospitals and doctors think that this is true CAM. They should really be looking at a more intensive use of diet and supplements, for a more cutting-edge, potent version of complementary medicine. But this “CAM-lite” approach lulls people into thinking they're getting complementary medicine, when they're not.
29:00 to 32:00 -– How the yearly physical might be improved upon. The way physicals are currently done in many conventional medical offices doesn't make much sense. For instance, to do yearly EKGs and Chest X-rays for everyone is NOT cost effective, nor does it make sense. AND, it is NOT evidence-based. Dr. Hoffman feels that we should eschew some of the things that have been done routinely, but that we should add other things that really make sense. For instance, the New York City health commissioner recently announced that one-fourth of all New Yorkers have high levels of mercury. Why not do tests for this at the time of the physical? Also, there is an epidemic of pre-diabetes in America. Why not do a 5-hour glucose tolerance test on those people the doctor feels are probably pre-diabetic. Vitamin D levels have been found to be inadequate in 60% of the population in the Northeast. Why not test for this? But conventional doctors aren’t aware of things like mercury and vitamin D levels.
32:00 to 37:00 –- Dr. Hoffman thinks things are changing. For instance, the “New England Journal of Medicine” recently published a review article by Dr. Michael Holick, about the huge role Vitamin D can play in the prevention of many diseases. Not long ago, this researcher was widely criticized for his views on vitamin D. However, it will take a long time before doctors will be actually checking patients’ Vitamin D levels, and prescribing Vitamin D supplements if levels are low. We can be quite sure that drug detail people won’t be giving doctors samples of Vitamin D, and that there won't be TV ads for Vitamin D. However, some good news: fish oil is now prescribed by cardiologists, because one brand of fish oil achieved drug status with the FDA. It is now in the PDR (Physicians’ Desk Reference).
These are moments of vindication.
37:00 to 40:00 –- The difficulty for doctors who practice in both the conventional and alternative medical worlds.
40:00 to 43:00 –- the unreliability of the Meta-Analysis, which combines the results of lots of studies. Unfortunately, studies are included or excluded in these meta-analyses, according to the biases of those who are putting them together. For example, in 2005, one meta-analysis of Echinacea for use with the common cold led to the headline that this herb showed no benefit. Then, in 2007, the highly respected Lancet published the results of another meta-analysis, that said that Echinacea reduces colds by 60%. How do you reconcile these results?
We know that in studies conducted by pharmaceutical companies, in which their drug is compared with a drug from another company, 85% of the time it is “shown” that their drug is better. Recently, a drug company tried to bury the results of a study that showed that their drug was not superior to another. They had to pay damages because of this scientific dishonesty. The researcher said she was intimidated by the pharmaceutical company.
43:00 to 44:00 –- This is a scary time, because our “news” is influenced and paid for and promoted by pharmaceutical companies and their publicists. The natural products industry is not exempt from this kind of behavior either.
44:00 to 45:45 -– It is disingenuous for conventional medicine to be writing articles on the perils of natural therapies. The damage ratio is probably 10,000 to 1 -– of damage caused by drugs versus damage caused by natural products. The "New York Times" published an article on the dangers of natural products. They got so many letters objecting to this article that, weeks later, they wrote a retraction –- which was buried in Section D, page 28, in tiny print. So the message that gets out is about the so-called dangers of natural products!
45:45 to 47:00 –- When he was a medical resident, Dr. Hoffman often reported the causes of death in the hospital where he worked. Harried interns and residents filled out the cause of death forms. Many times the cause of death was cardiac arrest -- often the result of drug toxicity. However, the cause of death was most often listed as “cardiac arrest,” rather than drug toxicity.
47:00 to 48:15 –- Dr. Hoffman’s website, www.DrHoffman.com, has lots of great articles, also information about his radio show and his salmon and salad diet.