Transformative Health Strategies: Integrative Medicine and the COVID-19 Pandemic

By Lee Xenakis Blonder PhD

The book "Transformative Health Strategies: Integrative Medicine and the COVID-19 Pandemic" is an essential resource for staying up to date on current topics in integrative and alternative medicine. Its comprehensive coverage provides invaluable insight into the history and organization of fields like 'functional,' 'integrative,' and 'complementary and alternative' medicine. The first part of the book delves into crucial topics and practices related to health maintenance and personalized medicine. These include:
• direct-to-consumer genetic testing
• nutrigenomics
• evidence-based medicine biases and pitfalls
• vitamin, mineral, and botanical supplementation
• longevity
• nutrition and diet
• brain health
In Part Two, the author critically examines the following:
• the COVID-19 pandemic
• the Sars-COv-2 virus
• COVID-19 vaccine safety and efficacy
• authorized treatments and off-label and nutraceutical approaches used by community practitioners
• integrative strategies for boosting immunity
• excess mortality
• informed consent
• censorship of opposing views
• medical freedom and the importance of individual research
This book seeks to engage readers in solutions rooted in understanding the history and significance of unconventional approaches to health.

• Language: English
• Publisher: BookBaby
• Release date: Oct 12, 2023
• ISBN: 9798350918908

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Copyright © 2023 Lee Xenakis Blonder, PhD

All rights reserved.

Paperback ISBN: 979-8-35091-889-2

eBook ISBN: 979-8-35091-890-8

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While all attempts have been made to verify the information provided in this book, the author does not assume any responsibility for errors, omissions, or contrary interpretations of the subject matter herein. The internet addresses provided in this book may change following publication and may no longer be valid.

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The author is not a healthcare professional, and this book is solely for educational purposes and does not constitute health or medical advice. The information presented is the author’s opinion, and the views expressed are solely those of the author. This book is not intended to diagnose, treat, cure, or prevent any condition or disease. This work is sold with the understanding that the author is not held liable for the results accrued from information found in this book. This book is not intended to be a substitute for the medical advice of a licensed healthcare practitioner. The reader should consult with their doctor in any matters relating to their health.

Any product names, brands, or trademarks referred to in this book are for identification only and are the property of their owners. No claim is implied by their use. The author is not affiliated with any companies or trademark holders, and they do not endorse or sponsor the contents or materials discussed in this book.

Small portions of this book have been reproduced from the following chapter with permission of the publisher Springer Nature (SNCSC): Blonder, L.X. (2021). Inclusivity in Medical Education: Teaching Integrative and Alternative Medicine in Kentucky. In: Martinez, I., Wiedman, D.W. (eds) Anthropology in Medical Education. Springer, Cham. 2021:269-293; https://doi.org/10.1007/978-3-030-62277-0_12.

Cover Design and Book Layout by BookBaby

Edited by Christine Bucher

Table of Contents

Acknowledgments

Introduction

Part 1: Transformational Approaches To Health

1. Integrative and Alternative Medical Modalities

2. Efficacy and Evidence in Integrative and Alternative Medicine

3. Genomic Medicine and the Direct-to-Consumer Movement

4. Longevity and Centenarian Research

5. Diet and Nutrition

6. Mental Health

Part 2: The COVID-19 Pandemic

7. SARS-CoV-2

8. Viral Characteristics and Mechanisms

9. Authorized Pharmaceutical Treatments

10. Practitioners’ COVID-19 Response

11. Nutraceutical Support during the Pandemic

12. Behavioral Factors in Immunity

13. Concluding Thoughts

Bibliography

Index

Acknowledgments

I want to express my deepest gratitude to my husband Endre Nyerges and my children, Eva and Lucas Nyerges. Their love and support have meant everything to me. I also want to thank my sister Erica Cook who has offered sound advice and encouragement throughout the writing of this book.

I am extremely indebted to Jim Roach, MD, whose brilliance inspired me to learn, teach, and write about integrative, functional, and naturopathic medicine and to adopt a new perspective on health and disease. He has been a true mentor. I also want to recognize eminent behavioral neurologist Kenneth Heilman, MD, whose friendship, phenomenal talent, and generosity as a postdoctoral mentor I will forever cherish.

I wish to thank my university colleagues, whose support, flexibility, and friendship helped make the last years of my employment during the pandemic workable and gratifying.

Lastly, I am grateful to my older dog Zoltan and my pandemic puppy Zeke, who are constant sources of amusement and affection.

Introduction

This book grew out of my desire to impart my knowledge, acquired through personal and professional experience, to help people navigate integrative and alternative approaches to health and longevity. One fundamental premise of this book is that conventional medicine, the kind of medicine practiced by doctors and hospitals across the US and around the world, is insufficient. A second premise is that to appreciate this statement and its implications for personal healthcare decision-making, one must understand history. Biomedical science and mainstream public health guidance haven’t appeared de novo as the truth, but instead evolved over time via human trial and error discovery, shaped by historical, political, and sociocultural figures and forces. Once these are understood, we are better equipped to evaluate alternative approaches and make the best decisions to guide our personal health journey. This book focuses on integrative, functional, and alternative medicine and patient empowerment using tools readily available to most US consumers and others worldwide. To extend this approach, I also dive into the COVID-19 pandemic, which has disrupted progress and altered our lives in ways we could have never imagined.

Before I describe the structure of this book, let me provide a bit about my personal and professional history. Since childhood, I’ve suffered from health anxiety. This used to be called hypochondriasis, but the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; [1]) retired this diagnosis and replaced it with Illness Anxiety Disorder and Somatic Symptom Disorder. Unfortunately, as it plays out in our culture, health anxiety is a risk factor for submission to medical procedures that may lead to adverse events or long-term side effects. Checking and reassurance-seeking that accompany health anxiety often lead to excessive interaction with a medical system that routinely recommends pharmaceuticals, diagnostic tests, and procedures that may be unnecessary or harmful. While many healthcare providers now refrain from overprescribing or ordering potentially risky screenings, not all do. Some have conflicts of interest and receive direct or indirect income through procedures and repeat visits. Others worry about lawsuits should a potentially serious condition go undetected. Clinical practice guidelines may also put patients at risk.

To some extent, health anxiety is encouraged by the medical profession and the media through the relentless insistence on screenings, drugs, and vaccines. Loss of confidence in one’s health and power to sustain it results in dependency that benefits the healthcare industry. Diagnostic and treatment-seeking behavior may lead to endless courses of medications like antibiotics to treat scary symptoms: fever, sore throat, respiratory infections, sinusitis, etc. A small fraction of these infections are bacterial and thus appropriate treatment targets for antibiotics. Providers do not commonly perform cultures to identify the pathogen; instead, patients are often prescribed broad-spectrum antibiotics. The consequences of overprescribing are well-known: fungal infections, bacterial infections including Clostridioides difficile (C. diff), and antibiotic-resistant infections. Some of these can be deadly. Other go-to treatments in the conventional management of fever and aches and pains are acetaminophen and nonsteroidal anti-inflammatories. Excessive use of the former is a well-known cause of liver damage, and the latter promotes intestinal permeability, gastrointestinal bleeds, and kidney dysfunction. Yet patients might be told to take 200 mg of ibuprofen four times daily for acute injury or pain. Or 500 mg of acetaminophen. Or both, alternating them throughout the day.

What about inappropriate diagnostic procedures? How often are patients given X-rays and CT scans unnecessarily? The overuse of radiation may fuel an increase in thyroid and other cancers. Many conventional doctors and dentists minimize such concerns: It’s no more radiation than a transcontinental flight. Some dentists and X-ray technicians offer patients lead aprons and thyroid shields, but given advanced technology, others feel these are unnecessary. And what about magnetic resonance imaging? MRI is an excellent and safe technology that can detect many abnormalities, but overuse of gadolinium, a contrast agent that is associated with serious side effects, may harm some patients. It shouldn’t be up to the patient or a relative to undertake a risk-benefit analysis or question the necessity of such procedures, but it often is.

The consequences of overprescribing and overuse of potentially harmful diagnostic procedures are borne by the individual, possibly years after developing unexplained head or neck cancer, a gastrointestinal bleed, or liver or kidney damage. It may not even be possible to trace developing conditions to a procedure or pharmaceutical. Some patients are taking matters into their own hands through the Internet. Others are targeted by personal injury attorneys who initiate class-action lawsuits against pharmaceutical companies on behalf of injured parties. In my case, had I been better informed and better equipped to question and refuse unsupported treatments and diagnostic procedures, I may have reduced my risk of long-term complications.

In his book The Blue Zones, author Dan Buettner identifies several cultures, living in several areas worldwide, with a higher-than-expected number of centenarians [2]. Many of these areas are remote, with limited access to doctors and hospitals. One must wonder if, in addition to a healthy diet, exercise, social connections, and favorable genes, these individuals survived so long because they didn’t expose themselves to repeated screenings, procedures, or prescription medications. In one account, a Greek man in his 60s with advanced lung cancer who lived in Florida declined chemotherapy and returned to his village of origin in Ikaria, Greece, one of the Blue Zones. Several months after adopting the local diet and lifestyle, he began to recover—and lived well into his 90s. I write this to help those who have not yet made such mistakes or might benefit from a course correction. I now intentionally work to undo or prevent further harm, as I shall describe later.

My approach to health and healthcare changed dramatically in 2012 when I made the decision to visit a local integrative practitioner. I became familiar with this practitioner after reading an article in my local newspaper. I made an appointment and went in for my first visit. After reviewing past laboratory tests and taking a medical history, this physician ordered standard labs plus testing that is not routine in conventional medicine. Examples included food sensitivity testing, micronutrient testing, and assessment of genetic markers related to homocysteine, a metabolite that, if elevated, places one at risk for cardiovascular and neurodegenerative disease. I learned that 40% of the population has a specific genetic polymorphism that leads to elevated homocysteine. Some of these tests had substantial co-pays, and my out-of-pocket expenses were considerable. However, the results caused me to alter my diet and take various supplements that modify gene expression and address any deficiencies identified to promote health and longevity. These changes improved my lab results the following year and in subsequent years. In short, that visit changed my life and spawned an intense study of integrative, functional and alternative medicine that I later translated into a teaching program, explained below.

I am a biomedical anthropologist and a professor emerita in the Department of Behavioral Science at the University of Kentucky (UK) College of Medicine. Before my retirement in 2022, I held joint appointments in the Departments of Neurology and Anthropology and was a faculty associate in the Sanders-Brown Center on Aging. During my three decades in the College of Medicine at UK, I served as a preceptor in first-year medical student courses such as Communication and Interviewing, Physicians, Patients, and Society, and Introduction to Clinical Medicine.

During the last several years, I sought to apply my background and interests as a medical anthropologist and faculty member in a medical school to curriculum development. I embarked on a mission to teach integrative and alternative medicine, a subject that, although recognized, currently falls outside mainstream medical education. It is almost incongruous that this is so, given that approximately 50% of consumers in the US use dietary supplements or some form of complementary or alternative therapy [3-5]. To the extent that integrative and alternative medicine includes non-Western, non-European traditions that may be at odds with biomedicine, its lack of incorporation into the mainstream allopathic medical education curriculum reflects the ethnocentrism that underlies scientific medicine, mainly as practiced in the US.

The courses that I developed addressed these issues while at the same time exposing students to the content and philosophies of integrative and alternative medicine. These courses were not simply a smorgasbord of possible alternative treatments that might be used in stress management or lifestyle medicine. Instead, I developed courses that exposed the historical and philosophical influences that have generated the constructs of complementary, alternative, functional, and integrative medicine in the US today. I have taught elective courses on these topics to undergraduates, graduate students, Doctor of Pharmacy students, and medical students.

As an anthropologist and preceptor in the UK College of Medicine, I became increasingly cognizant of the narrow training—philosophically, historically, and practically—that students receive, and of the unacknowledged bias that underlies some of the teachings. To further my goal of promoting integrative and alternative medicine in medical education, I teamed up with a UK family physician, fellowship-trained and board-certified in integrative medicine. We received funding from the Weil Foundation to expand integrative medicine offerings to fourth-year medical students, residents, and faculty members. I describe these teaching efforts in detail in my chapter entitled Inclusivity in Medical Education: Teaching Integrative and Alternative Medicine in Kentucky in Sustained Anthropological Engagement in Medical Education [6].

My experiences as a patient, an anthropologist in a medical school, and a teacher of integrative and alternative medicine to undergraduate, graduate, and professional students inspired this book. I was hopeful that these various forms of medicine would eventually merge, be taught and practiced widely, and be incorporated into mainstream medicine. But the COVID-19 pandemic has dampened my optimism, given the singular focus on authorized vaccines and pharmaceutical treatments, mandates, and passports. Moreover, our institutions are very slow to change, as is the socioeconomic and political context within which they operate. Conventional healthcare, for all its revolutionary discoveries and treatments, is not always the best or the only solution to the treatment of medical problems, particularly chronic conditions and those that develop from lifestyle choices. Too little attention is paid to prevention and non-pharmacologic, non-surgical treatments. To achieve a paradigm shift in healthcare that incorporates the full spectrum of modalities—including those used in alternative medicine, as well as a state-of-the-art personalized approach—may require the healthcare enterprise to reinvent itself.

As I write this, COVID-19 has taken millions of lives and is causing long-term health consequences for many. The pandemic has disrupted our world in myriad ways, and the countermeasures authorized to control the virus have themselves contributed to suffering. There is still much to learn. Factors that place individuals at particular risk for serious disease and death include advanced age and specific underlying health conditions (e.g., diabetes, hypertension, high body mass index, metabolic syndrome, compromised immune system). Some of these conditions are preventable with diet and lifestyle changes. In a survey conducted from 2009 to 2016, Araújo et al. [7] found that about 88% of Americans are metabolically unhealthy, defined by measures of waist circumference, fasting glucose, hemoglobin A1c, blood pressure, and blood lipid values. Poverty and health inequities promote negative outcomes by reducing access to healthcare, nutritious food, and satisfactory housing. Obesity is a contributor, and some 40% of the US population falls into this category. Many people have vitamin D and other micronutrient deficiencies that impact health and the ability to fight infection. Taken together, these factors may explain why the US has one of the highest rates of COVID-19 confirmed deaths per million people, according to the Johns Hopkins University Coronavirus Resource Center. An integrative approach that emphasizes personalized diet, nutrition, and lifestyle choices to maintain health is ever more vital as we encounter this virus and future pandemics. COVID-19 has revealed that the pill for an ill mentality is inadequate as a health maintenance strategy.

This book is divided into two parts. In part 1, I present Transformational Approaches to Health. First and foremost, I discuss the historical context within which unconventional medicine became just that, the fields that comprise it, and the foundational principles that undergird various strategies to maximize health and longevity. It is essential to understand the human imprint on each modality and the pivotal figures, industries, cultural factors, and organizations that shaped the unfolding of conventional, integrative, and alternative medicine—past and present. These forces have influenced beliefs and promoted biases in science-based medicine and human healthcare decision-making that extend into the pandemic. The chapters in part 1 delve into innovations and issues related to health, including the direct-to-consumer movement, genetic testing and personalized healthcare, nutrition and diet, how we evaluate evidence in medicine, and mental health.

The second part of this book is devoted to the COVID-19 pandemic. I delve into viral mechanisms, authorized countermeasures, and lifestyle, diet, and nutraceutical approaches to mitigate disease risk. Many people have suffered during the pandemic and continue to do so. Some have lost loved ones, friends, coworkers, and jobs. Others have had their beliefs in democracy shattered or their sense of personal autonomy disrupted. Most of us have faced multiple challenges and have had to find ways to adapt and survive. Some have endured long COVID, vaccine injury, social and workplace oppression, or disconnection. Others have profited, and some have thrived. Together, parts 1 and 2 provide insights into the historical background and socio-political context driving the current state of medicine, as well as valuable and practical information regarding ways to achieve optimal health using integrative and alternative approaches.

PART 1:

TRANSFORMATIONAL

APPROACHES TO HEALTH

Chapter 1

Integrative and Alternative Medical Modalities

There are various terms in use that refer to the dominant medical system practiced today in the US and around the world. These include conventional medicine, biomedicine, allopathic medicine, and Western Medicine. I consider all these terms synonymous. Note that the term Western Medicine is somewhat ethnocentric. Although this approach originated in Europe and the US, biomedical scientists and physicians worldwide have contributed to knowledge and therapeutics over the last one hundred years, making it a collaborative effort. Having said this, there is considerable worldwide variation in the extent to which competing or complementary, traditional, and indigenous medicine are practiced, sanctioned, and incorporated into a country’s healthcare system. The World Health Organization Traditional Medicine Strategy: 2014-2023 provides a wealth of information regarding the status of traditional medicine in each member state.

In the US, providers with a Doctor of Medicine (MD) degree are often referred to as allopathic physicians to distinguish them from Doctors of Osteopathy (DO). This distinction is rooted in history. Osteopathic medicine was developed by frontier physician Andrew Taylor Still in 1895 to protest the medicine of his day. Initially, it began as a holistic approach involving the manipulation of joints and bones to treat disease and maintain health [8]. Nineteenth-century osteopathy was considered alternative medicine, but now DOs receive virtually the same training in osteopathic medical colleges as MDs receive in allopathic medical schools. Both MDs and DOs attend the same residency programs and are licensed physicians.

Throughout this book, I will use the term conventional medicine to refer to the mainstream Western Medicine or biomedicine that we encounter in most clinics and hospitals. In contrast, the following modalities are often considered alternative medicine, although some, such as chiropractic, have gained mainstream recognition and are covered by health insurance in the US:

Chiropractic

Homeopathy

Naturopathy

Mind-body practices like yoga and meditation

Ayurveda (ancient medical system of India)

Traditional Chinese Medicine, including acupuncture

Indigenous medicine of native peoples 

Herbal medicine

The phrase Complementary and Alternative Medicine (CAM) is often applied to non-Western or non-allopathic medical practices that may be used in conjunction with conventional medicine. The phrase is considered by many to be outdated, and some have criticized it as ethnocentric because it reinforces a hierarchy designating traditional/Western/scientific medicine as superior and other medical systems and approaches as subordinate to it. In contrast, integrative and functional medicine combine conventional and alternative medical diagnostics and treatments and differ philosophically from conventional medicine. In this chapter, I discuss the history of medicine as it applies to practices today and review select approaches that are considered alternative or integrative.

Historical Background

During the 20th century, biomedicine became the predominant medical system in the United States and worldwide. Before this, medicine in the United States was pluralistic and, in some other countries, consisted of traditional healing practices developed over centuries. Some regions had evolved complete medical systems dating back to antiquity. Prime examples are Traditional Chinese Medicine (TCM) and Ayurveda, the medical system of India. Both modalities are rooted in religious beliefs and maintain a holistic view of body and mind. Both use herbal medicine as well as mind-body practices. TCM is noted for the development of acupuncture, and Ayurveda is recognized for surgery. In contrast, biomedicine is not rooted in religious philosophy and has been characterized as both mechanistic and dualistic, reflecting Descartes’ separation of mind and body [9, 10].

Medical modalities practiced in 19th-century America included Thomsonianism, homeopathy, chiropractic, osteopathy, naturopathy, and eclectic medicine. Eighteenth and 19th century heroic medicine practiced by Euro Americans and Europeans derived from humoral theory originating centuries ago in Ancient Greece and Rome. Heroic medicine used treatments such as bloodletting, leeches, the dispensing of heavy metals, opium, and other harmful regimens. A famous case is that of George Washington, who probably died from blood loss due to the heroic treatments he received, rather than pharyngitis, his presenting illness. The shift toward scientific medicine began in the late 19th and early 20th centuries with the development of Louis Pasteur’s germ theory and advances in diagnostic technologies (e.g., the stethoscope and microscope), public sanitation, vaccination, and surgery, as well as discoveries like penicillin and insulin [11]. This transition accelerated in the United States following the Flexner Report of 1910 [6, 12].

The Flexner Report

The pluralistic landscape of the 19th century changed dramatically during the first two decades of the 20th century. A major catalyst was the Flexner Report of 1910, which transformed medical education in the United States and aligned it with biomedical science. The impetus for the Flexner Report came in 1904 when the American Medical Association (AMA) created the Council on Medical Education (CME). The CME sought to promote the restructuring of medicine in the US per the AMA’s goals. The CME requested that the Carnegie Foundation for the Advancement of Teaching survey medical schools in the US and Canada. Henry Pritchett, President of the Carnegie Foundation, chose Abraham Flexner, an educator from Louisville, Kentucky, to do so. Flexner visited 155 medical schools over one year and wrote a detailed report in 1910. Flexner’s model was that of Johns Hopkins School of Medicine, which emulated German academic medicine. His recommendations included reducing the number of medical schools and poorly trained physicians, increasing the prerequisites, aligning medical schools with universities, training physicians to practice scientifically, and engaging the faculty in research [6].

The Flexner Report contributed to the standardization of medical education in the US. Following the report’s publication, 70 of 155 medical schools closed, including five out of seven black medical schools, six out of seven women’s medical colleges, and 13 out of 15 homeopathic medical schools. Many of these schools closed because they could not secure the funds needed to meet the standards Flexner recommended or because they failed to satisfy increasingly stringent state licensing and accreditation rules championed by the AMA and the Federation of State Licensing Boards, founded in 1912. In some states, alternative medicine practitioners such as chiropractors and naturopaths were prosecuted for practicing medicine without a license. State licensing boards succeeded in restricting alternative practices and enforcing the adoption of biomedical curricular standards [6, 13].

Flexner’s recommendations have continued to influence medicine over a century later via support from philanthropists such as John Rockefeller and Andrew Carnegie, medical educators, the AMA, and licensing and accrediting bodies. The American medical school curriculum has been somewhat modified, but the four-year program and most of the pre-medical requirements that Flexner championed remain today. In addition, the alliance of allopathic medical schools with universities and the archetype of the academic physician engaged in biomedical research endures. However, tenure-eligible positions for physician-scientists are vanishing, and the new generation of physicians who work in university systems tend to be clinical faculty on renewable contracts. The achievement of academic tenure in US medical schools often requires that faculty secure highly competitive National Institute of Health grants to fund science-based medical research on topics of programmatic interest to the funding agency. Physician-scientists also conduct randomized clinical trials, often sponsored by pharmaceutical or medical device companies.

Positive outcomes attributed to the Flexner Report include the following: medical students received uniform training in the basic and clinical sciences; medical education became standardized and regulated; the alignment with science eliminated any vestiges of heroic medicine as practiced in the 18th and 19th centuries, and the affiliation with universities upgraded teaching and fostered research as well as the translation of findings into clinical practice. Nevertheless, the report, which bolstered the power and authority of the AMA, also fostered an elitism that endures to this day. Women, minorities, residents of rural and poor areas, and alternative medical approaches have suffered from a lack of support or marginalization, and