Natural Selection
Alternative medicine and the genome pave the way to über-personalized health care.
by Jessica Voelker with Kelly Huffman
INSIDE THE SOUTH LAKE UNION office of Dr. Astrid Pujari, patients begin their visits with an offer of herbal tea and a leisurely chat about how their lives are going, how they’re feeling physically, and what’s been on their minds. Next, Pujari—who worked as a primary care physician at Virginia Mason before setting up her private practice—might guide them through a meditation or refer them to an expert masseuse. If this is the future of medicine, sign us up.
“Behavioral change is what 99 percent of medicine is about,” says Pujari. “It comes from inspiring people and helping them get reinspired about their lives. In order to really change things, you have to have somebody who is looking at a patient like more than just a physical machine.” A slim woman with large, expressive eyes and a few wiry, white hairs topping her -tangle of black curls, Pujari is at once a plain-talking scientist (“Are you familiar with E = mc2?” she asks seriously, ready to lay it out for you if necessary) and a free-spirited, tie-dyed-in-the-wool hippie (“I love plants; when I go camping it’s like I’m visiting my friends”). She’s the daughter of a French woman and an Indian man, with an MD from Tufts University and expertise in medical herbology earned at the College of Phytotherapy in London. If integrative medicine needs a poster child, Astrid Pujari will do.
Complimentary and alternative medicine (CAM) often conjures images of herbal potions and needle-wielding old women administering acupuncture. That’s not inaccurate: The umbrella term encompasses everything from chiropractic therapy to Chinese herbal medicines to yoga. But what unites most CAM practitioners—and what has made them so popular (one in three American adults now uses them)—are two things: They avoid recommending symptom-suppressing meds whenever possible, opting to root out the cause of illness instead, and they consider their patients holistically, rather than focusing only on the physical body. While most of us would be happy to take antibiotics for our more serious bacterial infections, we also want help avoid illness in the first place. And when are sick, we want a provider who will guide us through it, help us not only survive illness but learn from it, and live better afterward. More and more, Americans are demanding a personalized health plan, one that allows them to cherry pick treatments, seeing a conventional doc for an irregular heartbeat, say, but asking a naturopath to help them find drug-free ways to conquer insomnia. With states, including ours, now forcing insurance companies to cover alternative therapies, and with med schools—University of Washington among them—adding CAM to the curriculum, the mainstream medical world has started to catch on.
More and more, Americans are demanding a personalized health plan that allows them to cherry pick treatments, seeing a conventional doc for an irregular heartbeat, say, but asking a naturopath for drug-free ways to conquer insomnia.
“Personalized health care” became a buzz phrase back in 2003, when researchers finished mapping the human genome. Armed with their patients’ DNA, experts figured, future docs would be able to customize every treatment plan. So if a woman’s genetic code indicated she was prone to breast cancer, for instance, her doc could prescribe a mammogram at age 20 instead of 40. No longer would patients be lab rats, testing out prescriptions to see what works. Our docs could now precisely prescribe our drugs based on how they’d interact with our DNA. The implications for insurance plans were enormous, and enormously terrifying—who would cover a patient whose genetic makeup made them 99 percent likely to come down with some deadly disease? Genetics have not had quite this effect yet: DNA analyzers are on the market, but they’re too expensive to be a doctor’s office mainstay. Still, it’s not far-fetched to believe they’ll be affordable within the next few years, and when that happens things are going to get very personal.
In a way, then, the genome map has paved the way for integrative practitioners like Pujari, who specialize in helping people avoid illnesses. A genetic predisposition usually only means a person could get a disease, after all. Lifestyle choices—nutrition, stress reduction, exercise—go a long way in warding off illness, and CAM providers are all about inspiring patients to make healthy choices, whereas allopathic doctors aren’t often trained to teach deep breathing or counsel patients on their diet. But before MDs start referring patients to herbalists and Ayurvedic physicians, they want proof that their approaches actually work. And although the National Institutes of Health has funded millions of dollars’ worth of CAM research, there’s almost nothing conclusive on the books.
Seattle naturopath Joe Pizzorno wants to change that. The founding president of Bastyr University and a former appointee under Presidents Bill Clinton and George W. Bush, Pizzorno’s passion is bringing rigorous evidence-based study to the holistic world. He says the problem is that the lion’s share of CAM studies measure one single factor rather than the entire approach. So a study may offer subjects St. John’s wort to see if it helps their depression, he says, rather than assessing whether a complete naturopathic treatment—including nutrition plans and health-related lifestyle changes—makes patients happier.
In his own research Pizzorno focuses on supplementary therapies, a hallmark of naturopathic medicine. Right now he’s measuring vitamin D deficiencies in denizens of sun-deprived climates (Attention Seattleites: Pizzorno says he’s never seen a local who had normal levels of D). He believes that once people learn the most effective way to get vitamin D—seek more sun exposure (but not enough to burn), take a carefully prescribed supplement—we’ll see a dramatic reduction in a host of illnesses, from breast cancer to autoimmune disease. Pizzorno is also building an artificial intelligence system called SaluGenecists, which docs and patients will use to investigate holistic treatments. “I believe we’ll develop a health-care system which is collaborative between conventional medicine and natural medicine,” he says, “where we use the strengths of each medicine where they are most effective and work collaboratively towards the patient’s best interest.” If that means more sunbathing and massages, our health-care future could be very bright indeed.
Published: August 2008
