Sometimes, a successful treatment depends on matching the right drug or therapeutic approach with the symptom patterns at hand. But in other cases, it takes a little outside-the-box thinking to get results.
With a disorder like asthma, the problem may be as much environmental as individual, and unless you deal with the environmental triggers, the patient may never really get better. And sometimes, getting to the bottom of one patient's problems can benefit an entire community.
Jason Allen, N.D., a naturopathic physician at the Bastyr Center for Natural Health, Seattle, believes that all health care professionals—regardless of their clinical training or subspecialty discipline—need to pay more attention to the environmental drivers of common diseases.
A case in point is the young girl with asthma who came to see him at the Bastyr clinic a few years ago. Her symptoms were obvious enough, and it would have been easy to jump right into a treatment protocol aimed at controlling her attacks and reducing airway inflammation.
But Dr. Allen's naturopathic training and his personal interest in environmental science led him to think about the problem in a broader context. One of his first principles is to find ways to help patients by improving the environments in which they live. “I asked questions and found out that other kids in her family also had asthma,” he said in an interview. “They all went to the same school, and had at one time had the same homeroom.” He visited the school, and discovered the classroom was next to a parking lot where school buses sat idling their engines during the day.
Children in that classroom were exposed to unusually high amounts of vehicle exhaust. It might not have been a problem for most of the children, but the sensitive or asthmatic ones, like Dr. Allen's patient, were having a hard time.
He teamed up with an environmental hygienist who came to the school and made assessments, which eventually led to a districtwide policy change that stopped bus drivers from needlessly idling their engines.
By thinking outside of the conventional disease-treatment box and shifting into a public health mind-set, Dr. Allen not only helped his young patient, but may have prevented or ameliorated asthma and other respiratory problems for many other children as well. And he saved the school district thousands of dollars in wasted fuel.
All it took was a willingness to look beyond the narrow frame of individual diagnosis and treatment.
“Physicians can treat literally millions of people during our careers through environmental health policy,” said Dr. Allen. He and many other environmentally concerned health professionals believe that more doctors need to speak out about environmental issues. Air and water pollution is extremely detrimental to public health, and makes it more difficult for doctors to help people get well or stay healthy.
According to the Clean Air Task Force, air pollution can be linked to an estimated 50,000 early deaths each year, including 3,000 from lung cancer. It is a primary driver of asthma, accounting for 410,000 asthma attacks, Dr. Allen said. It is responsible for 2.4 million lost work days and 14 million restricted activity days, a very heavy burden of morbidity.
Despite significant amounts of data correlating pollution with a host of common, sometimes life-threatening, disorders, the medical community as a whole has been quiet about environmental issues.
In part, this is because modern medicine focuses largely on treatment of the individual, with public health having little bearing on the lives and practices of most doctors unless they are public health or infectious disease specialists. This focus on the individual is as common in holistic and naturopathic practice, he said.
“Mainstream MDs look at a patient and say, 'What pharmaceutical can I use to treat this condition?' Most NDs or holistic doctors will say, 'What herbs or nutrients can I use?' Public health asks: 'Why do all these people have these conditions?' It's about finding underlying causes and treating” people and their environments, he said.
Positive environmental policy change can emerge naturally out of patient care. More than anything else, it takes a shift in thinking, from the narrow focus of individual therapy to the bigger picture of community health, as Dr. Allen's case shows.