The Power of the Sun

As the sun shown down on me this morning during my drive to the Osage Beach office, I reflected on the power of the sun.  It was 37 degrees outside – the very same temperature as it was yesterday morning while the rain that had fallen for a couple days had turned to snow. But this 37 degree morning just felt different, without the rain or the snow or the fog because the sun was shining.

The sun is powerful, and we are just beginning to understand this essential center of our solar system. It is the best and finest source of vitamin D, which is responsible for many processes in our bodies. It also gives off ultraviolet (UV) light.  Interestingly, both vitamin D and UV light have been the source of multiple scientific studies, and of derision, during this last year. Let me explain.

Several years ago, I attended an excellent lecture on the benefits of vitamin D3 supplementation, not only to prevent infantile rickets and to build stronger bones but also for immune health. I began my daily supplementation of vitamin D3 afterwards, and at levels much higher than “recommended.”  Rest assured, I checked my levels on occasion, and have suffered no ill consequences of “overdose” despite the doses of 5-10,000 IU daily. The benefit for me has been this – no illnesses. No “colds,” no influenza, no “GI bugs.” Even my propensity for catching infectious conjunctivitis (“pink eye”) were dramatically reduced. For 3-4 years now I have been taking the nutraceutical D3 with K2, with absorption second only to intravenous. I have missed NO days of work for illness since instituting this into my routine.  And I am around sick people nearly every day.

Now I see there are studies that have linked low vitamin D levels, into the deficiency range, to increased risk and severity of respiratory tract infections, including the acute respiratory distress of infection with SARS-COV-2. Cautiously, researchers say vitamin D “might” aid in prevention of infection with the virus with which our world is currently obsessed, that it “may” act as a strong immunosuppressant inhibiting the release of the cytokines in COVID-19 infections that can cause the severe illness, and that it “might” prevent loss of neural sensation. To attempt to debunk the obvious value of D3 supplementation, a recent article was published of patients already hospitalized with the COVID-19 infection, but I see this strategy as closing the barn door after the horses are already out.  Vitamin D supplementation should be a part of our every-day regimen, and we should not expect the institution of same to come to the rescue when it is far too late to do any help.  Why not study firefighters urinating on that California forest fire and see if that puts the fire out?

Now, the UV light stuff.  I happened to read an article evaluating the use of UVC light, which has been known to kill airborne influenza virus as well as “inactivating” 99.9% of a couple other human coronaviruses (the SARS-COV-2 itself was not studied).  It is well-known that UVC radiation reduces person-to-person viral transmission.  Even per the FDA, “UVC radiation has been shown to destroy the outer protein coating of SARS coronavirus.”  The only problem with this form of UV light is it is dangerous when directly exposed to eyes and skin. The FDA states the UVC “used inside air ducts to disinfect the air . . . is the safest way to employ UVC radiation.”

After reading these articles (and doing a bit more research) I contacted our AirServe Heating and Air Conditioning fella and met with him to discuss this. I am proud to say that our suites in Osage Beach are now complete with UVC treatment to our air ducts, thereby assuring the death of not only respiratory-illness-causing viruses, but also bacteria, mold, and other nasty players.

No, I don’t mask. Yes, I hug my patients.  But I not only take vitamin D3 supplements, I encourage my patients to do the same. And I am treating the very air that circulates throughout our suites. That goes a LOT farther to genuinely accomplish what the masks and distancing and sheltering in place cannot.

It’s not the sun, but it’s second best. You’re welcome.

Paint Me Green and Call Me Gumby

“Paint me green and call me Gumby” –  this is one of my favorite lines from a television show. I can’t even remember the name of the show, but a young man has a cousin (from a foreign country) come and live with him, and the show was mostly about the culture differences between the two. But this was the foreign cousin’s response to a question regarding a change in plans. It was a colorful way of saying he was flexible.

Former US President John F. Kennedy said, “Change is the law of life.  And those who look only to the past or the present are certain to miss the future.”  But, indeed, history repeats itself, because human beings are human beings, now and forever.  Human behavior, in general, does not change overmuch.  Individuals can and do change, but as a collective, humans are designed to operate a certain way and no amount of genetic engineering can alter that.

But as a species, the one thing we excel at is adapting to change. How have we managed to populate even the harshest environments on planet Earth? So, as the landscape may change and we adapt or perish, we need to look to those things that will NEVER change.

I took an oath in 1999, and in that oath I confirmed that there were some things I would never do and some things I would forever do. I am determined to continue to serve my individual patient as long as I have breath. The business model I have adopted is molded about that oath and that determination. If I had set up a clinic dependent on third party payers, I might face a future where I could no longer support my oath. Our current membership-based method of serving you, our members, was felt to be the most fair and balanced method of billing for access to our services. I do not anticipate that changing. But we are prepared to face whatever challenges the free market may experience in the future.

I continue to encourage you to be prepared for events beyond your control, to the best of your ability. The most important way to prepare is to create community with like-minded folks and prepare together for what ever may ensue. You should have supplies of necessities, in case there may be transportation interruptions, and remember – it is not just food and water, but other things that you rely upon for daily living that could easily become scarce and difficult to access. (I am not necessarily referring to toilet paper, folks!) Find ways of communicating with loved ones that does not rely fully on “the grid.” If you do not have a plan, it may be time to create one.

When it comes to things that NEVER change, I know of only One. Everything else does change, but God’s love and grace is unchanging. That is the other, and most important, element of our clinics. We attempt daily to serve His people in a manner worthy of Him, which can be challenging. We hope this brings you comfort and assurance.

If any of you ever had a Gumby, there is something you know about it. While it is very flexible and can bend to a certain degree, there is a point where, if bent too far, with too much pressure, Gumby will break. Being flexible – able to adapt to small changes where needed – is NOT the same as fully changing. There are some things this liberty-loving physician cannot and will not do. If you want to know what those are, look to the oath I took and to the Word I revere.

~JPowell MD

Body, Heal Thyself

While humans have known for centuries that the body can and will, indeed, heal itself, our present generations have been programmed to rely on human interventions, medications, and other unnatural means. My favorite quote about this comes from Steve Gundry:

Thousands of years ago, Hippocrates, the father of modern medicine, had described the body’s ability to heal itself, which he called ‘veriditas’ (green life force). He believed that the physician’s job was to identify which forces were keeping the patient from healing himself and then remove them. Veriditas would take it from there.”

What does this mean for all of us today, faced with a pandemic and a host of misinformation, political mazes of intrigue, and boondoggling? I suggest we look at what we CAN and DO know.

The human body – as with most living things – is a biome all its own. We are carriers for microbes and microsystems, and the balance of all these can and should together for the benefit of the individual. Then there is the understanding that, of course, “no man is an island, entire of itself.” [John Donne] Human beings are pack/herd animals and we require interpersonal relationships for our best health. Is this not why solitary confinement is such an austere punishment?

Once we understand this concept, once we realize that the body does not consist of discrete systems and parts, but rather synergistically complex relationships, we can then begin to conceive of illness and disease as a matter of imbalance, an “undoing” of the delicate harmony maintained by a healthy body. As Hippocrates and his students, the giants on whose shoulders we stand, understood, our job as physicians is to “identify which forces” prevent our patient’s body from healing itself and “remove them.” This may be removing harmful forces (smoking, exposure to human-manipulated chemicals, etc) or adding in helpful forces (utilizing food as medicine, assuring the body has essential vitamins and minerals available to it, etc), or – most likely – a combination of both.

Everyone knows at this point that cigarette smoking is harmful to the human body; they do not need physicians to tell them this. But then – after years of smoking – people are still amazed when they experience cancers, emphysema and/or heart disease, almost as if they chose to ignore the facts. Perhaps it is the belief that it can’t happen to them. Perhaps they prefer to blame other things in their environment (and it is much more likely that it is from a combination of multiple factors). The bottom line is our bodies are made to fight cancer.  We all have cancer cells processing through our bodies at all times.  But the immune system, whose job it is to clear these cancers through various methods, is overwhelmed and cannot suddenly decide to work after years of being abused and fed improper nutrition and faced with multiple abuses. Heart disease, emphysema, cancer – they do not materialize overnight.

So – along comes a novel contagion that our bodies have not seen before. How does the body naturally handle such a thing? An intact, well-fed, and well-maintained immune system takes the newcomer hostage.  It analyzes it, identifies its clothing and its internal components, and then constructs a lethal elimination process. If it cannot destroy it by any other method, it isolates it. Then the body is well prepared; if it ever sees that enemy attempt to pass its gates, there is an army of defense ready to attack and destroy.  This is how the body can defend and maintain itself.

Is it any wonder, then, that it is the unhealthy, those with poorly operating immune systems, that are most vulnerable? Not at all. At least, not to those who understand the concept of how the body works.

How about “social distancing,” then? Stay-at-home recommendations? Isolation of the healthy and the young? Surely that helps to protect our elderly and vulnerable, correct?

Actually, no. All it really does is prolong the inevitable. If the healthy body does not see the virus, it cannot produce its own antibodies to it.  If it does not product its own antibodies, it will be more likely to shed the virus and unknowingly expose the elderly and vulnerable to the virus. This idea is commonly referred to as “herd immunity,” but I prefer to think of it as the best way to stop the enemy. Those of us who actively attempt to provide the body with what it needs in order to maintain its delicate balance MUST be exposed to the contagion, and for the ultimate greatest benefit to “society,” MUST produce our own antibodies.  Natural immunity is far superior to engineered immunity.

Let us also consider vaccination. Vaccines are best reserved for diseases that have a high mortality rate. Tetanus, for instance, has a high mortality rate. Most cases occur in unvaccinated people, and the elderly, newborns and injection drug users are at higher risk. It has a short incubation period. Another problem disease – at least for newborns – is pertussis.  While it causes “whooping cough” in older children and “the cough of 100 days” in adults, it can cause death in newborns and infants. Vaccination is therefore important for all who will be in contact with those most vulnerable.

Vaccination is practically useless, however, in diseases with very low mortality rates. It is far preferred to boost the immune system and avoid those forces that interfere with the body healing itself (i.e., its immune defenses). The reliance on engineered immunity versus natural immunity only creates more problems than it solves. We know from experience that multiple vaccinations at one time overwhelm the immune system and create auto-immune situations, where the immune system is “turned on” and begins attacking the body as if it were something foreign. This creates as big a problem as processes which attack the immune defenses and create immune deficiencies. Again, the problem is with BALANCE.

My suggestion to you is, learn about your body. Learn how to balance the body’s needs and what to avoid. Learn what foods are inflammatory in nature and anti-inflammatory in nature. Learn what exposures you CAN control and eliminate them. To quote Michael Pollan: “Eat food, not too much, mostly plants.”

What is “Healthcare Freedom?”

We know the definition of Healthcare (or we think we do). But the definition of Freedom? Not so much.

You might think that the ability to choose your doctor would be healthcare freedom. “Free to choose,” sounds about right, doesn’t it? Or being able to choose what “healthcare system” one utilizes might be closer. Okay, you think, I can’t choose my doctor, per se, but I can choose which hospital system I use. How about insurance? I can still choose which insurance company to use, and choose among policy options – right?

None of the above represents true Healthcare Freedom. The field of medicine is one of the most heavily regulated in our nation, and regulation is the mirror opposite of Freedom. It is slavery – slavery to rules and regulations, slavery to a system designed to kill innovation and creativity. The online journal  http://LiveScience.com defines Freedom as “the power or right to act, speak, or think as one wants without hindrance or restraint.”

And in today’s healthcare landscape, it appears that Cancer patients are not free to act, speak, or think as they want without restraint.  I recently received a forceful request for records on a patient who refused to undergo any chemotherapy or radiation treatment. We politely sent the request back, stating we needed the patient’s signed consent to share records. “No, you do NOT,” the requestor said, because apparently “when a person has cancer they ‘belong’ to the collective, to the community, to the cancer board.” It has been deemed in the best interest of the population as a whole to have all information on every cancer patient available to everyone.

How does THAT make you feel?

The body requesting the information stated they had attempted to get the information from the patient, but received no response. Clearly, the patient didn’t want to share his/her information with them. After a brief tussle regarding the patient’s right to privacy, I politely told them that I could not help because we also had no further records available. This patient must have realized that their information would be sought from all possible sources, and strategically insulated themselves against just such a vigorous invasion of privacy.

Healthcare Freedom is something we lost years ago, when we collectively bought into the lie that we need health insurance. It became inextricably tied to our employment status, and that was when the chains of slavery were forged for us. And when the unholy alliance of insurance and hospital systems was formed, the iron shackles were placed around our feet. When governmental entities started regulating insurance companies, hospitals, and independent physicians, we were placed in our cells. And when we gave up our right to privacy from those same regulating bodies, we lost our last shred of hope for Healthcare Freedom.

“These are the times that try men’s souls,” wrote Founding Father Thomas Paine during a very bleak period in our country’s history. In “The Crisis”, penned on December 23, 1776, he wrote “Tyranny, like hell, is not easily conquered. Yet we have this consolation with us, that the harder the conflict, the more glorious the triumph.”

Today – as an independent patient-driven healthcare professional, I will continue to fight for healthcare freedom, though it is a true David vs. Goliath match-up.  I will continue to find holes in the walls that have been built up and throw rocks at the heads of the giants.  I will work hard to get my patients the tools they need, even if it means being a blockade runner.  And I will fiercely guard their personal information, even if I must spin a web of my own to protect it.

Because even if you don’t value your privacy or freedom, I do.

 

Why More Assistant Physicians Should Be Utilized in Primary Care

Last month, I wrote about “What is an Assistant Physician?,” and also introduced you to Amber Milward, MD AP. It’s been three weeks since she started with us here at Direct Primary Care Clinics, LLC in Osage Beach, Missouri. So, what do I think?  I think I need to explain why Assistant Physicians should be utilized in Primary Care.

Dr. Milward’s knowledge is far superior to that of any nurse practitioner student that has previously rotated through my office. This is no surprise, since Dr. Milward matriculated from an accredited medical school. The healthcare industry is beginning to take notice of Assistant Physicians’ strength of education. According to the Primary Care Coalition Issue Brief: Collaboration Between Physicians and Nurses Work, the number of clinical hours (hands-on training seeing actual patients) for MDs is four times that of those getting a Doctorate of Nursing Practice (DNP).

So when it comes down to it, who would you prefer to be treated by if you’re sick – Someone with 500-1500 combined clinical hours, or someone with 6,000? Of course, there is another big difference in that certified physicians (like myself) have also completed at least three years of residency in primary care – including another 9,000-plus hours of intense, grueling training.

Of course, specialty residency training delivers a superior level of overall knowledge and expertise. I am not saying there is anything wrong with Nurse Practitioners, merely pointing out the vast difference in training and education. I have yet to work with or meet a Nurse Practitioner or PA (Physician Assistant) who does not acknowledge the extent of my education and training, as well as appreciating what they can learn from me. I believe they would each likewise feel there is something to learn from those MDs who have completed medical school, but have not completed residency training.

Imagine a practice consisting of a Family/Internal Medicine/Pediatrics physician, supported by an Assistant Physician (MD), a Nurse Practitioner (APRN or FNP) and a Physician Assistant (PA). Patients would have confidence that the care they receive from such a collaborating practice would be complete and thorough, as the definition of a collaborating practice is under the umbrella of supervision of the residency-completed overseeing physician.

To my fellow residency-completed primary care physicians: I suggest that you consider hiring an Assistant Physician as a mid-level provider in your practice. It would be a bit more like the “good ol’ days,” when physicians were trained as apprentices. The extent of their knowledge base is fantastic, and they are closer to medical school than you; they’ve more recently dissected the human cadaver. They have more recently practiced over and over the one-handed tie. And they are eager to work and to learn everything you can teach them about what you know best: how to deliver excellent individualized primary medical care. Feel free to contact me if you have any questions!

What is an Assistant Physician?

In 2014, then-Missouri Governor Jay Nixon signed the bill that created a new “mid-level” medical provider position, making Missouri the first state to license Assistant Physicians. But what is an Assistant Physician?

An Assistant Physician (NOT to be confused with a Physician Assistant!) is a graduate of a medical school, who therefore has a Doctorate in Medicine (MD), but has yet to complete a residency program. This medical school experience contains intense learning and skill development, covering ALL areas of medicine. For physicians, the residency that follows hones those skills into a particular specialty, such as Internal Medicine or General Surgery.

So why didn’t these medical school graduates get into residency? Is it really that difficult to get into a residency program?

Most folks don’t care if their physicians have an MD or a DO behind their name, which is good.  They are still “doctors.” There are differences in the methodology of the two schools, but overall competency is pretty much equivalent between the graduates who matriculate from medical schools or osteopathic schools.  Take a look at the chart below and note the 2016 percentages of MD and DO graduates in the U.S., as well as International Medical Graduates, who are degreed from non-U.S. medical schools.

Figure 1

Figure 1:Society of Teachers of Family Medicine

This gives you some idea of what the competition looks like, but not as clearly as this second graph I found:

FMpositionsfilled

When I graduated from my US medical school in 1999, it was so easy to get my first choice– notice the difference between number of available slots in Family Medicine residencies (blue line) and the number filled (red line). Nearly 600 residencies went unfilled in 1999, versus just over 100 empty spots this year. No wonder my second choice wanted to convince me to be their first choice – I was a U.S. medical school grad! Easy-peasy!!!

But take another look at that same graph – what happened around 2013? The number of residency positions in Family Medicine had decreased over the years, because they weren’t filling. Then in 2013 they started filling again. The number of available positions gradually increased, but the rate of filling those positions remains the same. In short, it has become a fierce competition to get into residency.

I know, I know – I’m throwing a lot of boring statistics at you. But the bottom line is this: getting into residency has become extremely competitive. Unfortunately, this leaves many competent doctors left behind in a cartoonish dust cloud. So they re-apply the next year. And the next. After a couple years out of medical school – with the medical school debt they can’t possibly pay back on a non-physician salary – it becomes harder and harder to get into residency.

Okay, this is all very well and good, but I have been speaking in a vague and abstract manner.  Let me put a face and a soul to this problem:

Meet Amber Milward M.D., AP. She received her Bachelors in Science from the American University of Antigua, St. Johns, then went on to earn an M.D. from their accredited medical school in 2013. While attending medical school, she also earned her online Masters in Healthcare Administration from Walden University in Minnesota, with the goal of gaining a competitive edge when applying to residency programs. Upon graduating in 2013, she applied for residency positions in multiple primary care specialties. And then again in 2014. And again in 2015. She was told by every residency program director that they “ranked” her as a potential candidate, but she had not matched – meaning, she had yet to get a foot in the door of a residency program.

Since then, she has done volunteer work to keep her skills up, and studies to stay up-to-date. But stuck in the limbo-land of Medical School/Residency purgatory, she could not get a paid position that allowed her to use the knowledge and skills she has obtained. Until Missouri’s Assistant physician program became reality. This program gives her –and the many other qualified medical professionals just like her– an opportunity to use their earned medical degrees to benefit patients in need of care.

Dr. Milward, Assistant Physician, will begin a collaborative practice agreement with me in April. Dr. Milward is originally from Arkansas and is no stranger to the Ozarks. She can learn a lot from our members and this experience will give her a lot of additional training.  I hope you will all welcome her and help her learn even more about Family Medicine. As I will attest, the ONLY excellent way to learn the practical side of family medicine is from listening to you – our patients.