Book review: Neil Nathan's Healing is Possible.
When I started my solo Family Practice (FP) in the sparsely populated Eastern Shore of Maryland in 1980, I wanted to make a difference. I had good training (Duke), an excellent rural FP residency (Williamsport, Pa) and a burning desire to improve the lot of Man. I wanted to bring my modern medicine to my new patients. That approach rubbed off quickly: my patients were teaching me. I had to learn to listen.
My world changed when a new illness appeared in the nearby Pocomoke River in 1996. It wasn't long before Pfiesteria piscicida, the "Cell from Hell," was killing fish and making people sick in 22 tributaries of the Chesapeake Bay. No one knew anything about the human health effects caused by exposure to the biotoxin made by this dinoflagellate. Luckily, I stumbled onto the use of cholestyramine (CSM) as an effective treatment for the biotoxin illness. It wasn't long after that I learned about other biotoxin-forming organisms, like more dinoflagellates, molds, blue green algae, spirochetes, apicomplexans, lion fish, recluse spiders, actinomycetes and bacteria too, among others.
Talk about a life-changing event. I have dedicated my career since 1997 to unraveling the complex inflammatory immunology seen in biotoxin-associated illnesses. The application of that learning to the chronic illnesses of the 21st century is uncanny.
But what I started learning too was the nasty little world of government involvement in environmentally-derived illnesses. Keep the lid on, don't share the truth, look the other way. Responsible patient care? Nope, that wasn't the theme from the CDC or EPA.
I saw a lot of sloppy medicine along the way. I heard of made-up illness names like Chronic Fatigue Syndrome and fibromyalgia too, as if an illness didn't fall into a textbook of medicine, let's invent an explanation to get the patient on his way. Improvement? Nope, the illness is just an arbitrary collection of symptoms with nothing objective or diagnostic about the conditions. Many people might actually believe there are such illnesses even to this day. I don't. Define the physiology!
As I got involved with legal cases (I fought for the plaintiff), I saw a vicious side of medicine. Meet the mean-spirited medical consultants for the defense. Believe me; if the money is right those guys lie with a straight face hoping a judge will believe them. Revolting. Well, kicking those guys was a necessary part of the game, right?
What I kept learning though was coming from the open window of what inflammation told us about ourselves, our illnesses and our disease-modulating exposures. The new inflammation was called innate and it was no longer controlled by our protective immune functions. Without control of that new kind of injury-that coming from our own host defenses- we became our own scourge and still are.
The learning hasn't stopped. Now our small group is opening what (today isn't tomorrow) feels like the final frontier. We see the influences of environmental exposures, unusual commensal organisms and inflammation itself on gene activation/suppression. We can change gene expression to stop illness. Really. Regulating gene expression sounds kind of sci-fi; I guess it is. But NOT regulating such gene expression seems pretty backward! Some might not agree. No wonder it took three months to get approval from the Institutional (Ethical) Human Research Board!
To be frank, my drive to learn more about illnesses not even in textbooks started taking more time than patient care. And it started taking more time from interaction from docs who might not share the same burning passion to ask new questions in search of new answers. It made little difference to me if I spent time with docs or not. The answers to basic questions were at hand!
And then Neil Nathan, MD showed up in Pocomoke. He didn't share my data-driven model, and he still does some things that I don't like, but Neil was focused on learning how to help his patients better. What could I show him? As it turned out, Neil showed me some of what he does and in the end, I think learned more about Neil's medicine than Neil did of mine in our few hours of interaction.
As you have seen, Neil is a healer. Hands on, ears on, puns on (no wonder I enjoy talking with him so much) and more, Neil has the rare skill to get into somebody's being, helping and healing all the while.
It is a remarkable skill that Neil has. You can read about it in his newest (and best in my mind) book, but even better, when you talk with Neil, you can feel it. A sense of fullness of being comes along with his smile and saying hello.
I was pleased that he included some discussion about molds and biotoxin illness treatment protocols in his book, though I would have liked more discussion of ongoing exposures to moldy homes (Calvin's story on page 280 makes my point) and use of VIP.
Still, when I was in a hurry to nitpick over some physiology or some point (hey Neil, the mold is Wallemia, not Walleria); the underlying tone of Neil came through, not hidden in the pages but part of them. When I got to his last vignette (page 294, The Most Valuable Thing I've ever Done), I realized that for the last couple of hours as I was reading, Neil was sharing his being without my knowing it. He had been holding my hand too.
I felt the goose bumps of knowing that despite our different approaches, I was a better person for having read Neil's book. The insight he provides is a remedy others might try to bottle and sell, but Neil simply holds it out for others to take with them at no charge.
VIP might fix the inflammation (it does), but I think Neil heals the soul of medicine.
Ritch Shoemaker MD