Getting out of the rabbit hole of naturopathic medicine

3355824586_207b78009b_b

I’ve received interest about my departure from naturopathic medicine and exactly how I left and started a new, science-based career. Last Fall, I decided to apply to the Medical Life Sciences program at the University of Kiel, which is a Master’s of Science program focusing on biomedical research. I saw this opportunity as a way for me to get training in the science of medicine so I could contribute to helping people get well.

I think it is unusual to post my application statement of purpose, but it succinctly captures my history and motivation for becoming a scientist in medicine. This essay has served as my manifesto, and from it, I have distilled my new elevator speech when answering the question, “what did you do in America?”

Germans seem especially interested in this answer, because it’s not easy to explain that I was a naturopathic doctor. I always sense anticipation while I stumble about trying to explain myself in English that makes sense to a German speaker. My story is humbling, hard to talk about, and humiliating. I am embarrassed to admit that I fell prey to false advertising and lots of pseudo-scientific theories. To Germans, I can provide some meaningful context because homeopathy is widely popular here. So, I was “that” kind of doctor.

For interest, posted below is my application statement which I gave to such German scientists (that is, the ones who don’t believe in homeopathy):

13 October 2014

To the committee:

I made a mistake. I entered naturopathic medical school at Bastyr University with idealistic and naïve notions that naturopathy could surpass modern medicine. The program at Bastyr University cleverly weaved together medical sciences with pseudoscience to create the allure of something special. I loved my biochemistry, cadaver anatomy, physiology, and pharmacology coursework, but I hesitated and struggled with understanding why courses such as homeopathy were required.

Upon graduation, I won one of the few accredited naturopathic pediatric residency position offered in North America. In addition to patient care, I helped administer randomized, double-blind, placebo controlled clinical trials testing the effectiveness of phytotherapy for insomnia. The results of these studies were negative, and despite my insistence, were unfortunately never published. I worked hard to collaborate with the wider medical community by precepting with medical doctors and speaking at medical grand rounds and resident journal clubs. I lectured on topics ranging from the diagnosis and management of croup to the use of therapeutic diets and exercise for metabolic disorders.

After completing my residency, I relocated to Tucson, Arizona, where I unwelcomely discovered an abundance of fringe medical practitioners. Compared to Seattle, alternative medicine in Tucson was extreme: blatantly false, unethical, and dangerous. I saw that I had wandered down the rabbit hole. Edzard Ernst and Simon Singh’s book Trick or Treatment reminded me of the necessity of applying the scientific process to all medical therapies, and I reignited my passion for rational inquiry and research methods. This personal and professional watershed manifested as a deep and thoughtful self-assessment of my ethics and aspirations.

My drive to pursue a degree and career in biomedical research is fueled by my love of medicine, demand of truth, and yearning for scientific understanding. In the time since denouncing naturopathic medicine, I taught immunology and dermatology which sparked an interest in further understanding the pathophysiology of a disease I struggle with, plaque-forming psoriasis. Through literature reviews I galvanized my biomedical research goals in the exciting new area of psoriasis research that seeks to understand the aryl hydrocarbon receptor as a physiologic modulator of immune responses.

Although well studied, some essential physiognomies of the ligand-dependent transcription factor aryl hydrocarbon receptor remain mysterious.1 The full three-dimensional structure of the receptor and its conformational changes upon ligand binding are still not fully known in humans, even though a murine model exists.2 Furthermore, the mechanism of action underlying this conformational change and the downstream AHR signaling pathways triggered by ligand binding are not well understood, although it appears that AHR functioning may be both tissue and species specific.3 Both of these ambiguities have captured my attention as research routes for my thesis.

I am especially fascinated by studies demonstrating that AHR has physiological roles beyond the clearance of xenobiotic compounds. AHR appears to be a main player in the development and regulation of the immune system.1 The immunomodulation effects of AHR seem to occur in a ligand-specific manner with effects depending on the type of ligand, the strength of binding, or the ligand’s in vivo half-life. For example, Quintana et al. showed that the toxic ligand 2,3,7,8- tetrachlorodibenzo-p-dioxin (TCDD) inhibited the differentiation of Th17 cells and provoked the differentiation of Treg cells from immature T cells, resulting in a reduction of symptoms in murine experimental autoimmune encephalomyelitis (EAE).4 In contrast, the same study also demonstrated that the binding of the endogenous ligand 6-formylindolo[3,2-b]carbazole (FICZ) interfered with Treg differentiation and boosted Th17 differentiation, resulting in an exacerbation of EAE.4 Both of these ligands are AHR agonists but they created very different responses. These findings are significant because murine EAE is used as a model for multiple sclerosis, for which limited treatment options exist.

I want to explore how AHR ligands, such as TCDD and FICZ, can result in two very different clinical outcomes, and intend to apply this research to the pharmaceutical development for psoriasis and inflammatory diseases. This research is prudent as our current knowledge of benign AHR ligands is limited to weakly-binding compounds, such as dietary flavonoids or FICZ, that generate negligible or even deleterious downstream effects. Furthermore, understanding how environmental exposures, like foods, may alter the pathogenesis of chronic inflammatory disorders via AHR opens research doors beyond disease mitigation or treatment and into disease prevention and other insights regarding the biological pathways of related ligands.5

Walking away from naturopathic medicine is the first step to correct my mistake. Personal critique of my education, career, and ethics has been challenging. I’ve grieved over wasted time, money, and effort, but I’ve found comfort in my resolve to move forward. I seek to excel at earning a Master of Science with a renewed capacity for self-assessment, autonomous thinking, and an unwavering ethical commitment to scientific research. I have replaced immature and naïve principles with an evolved understanding that valid contributions to medicine manifest from hard work, rigorous methods, and critical analysis. Now that I know better, I want to do better.

Despite my critical self evaluation, I know that I have received solid training in the basics of molecular biology and genetics that will enable me to fit hand in glove with the curriculum in Medical Life Sciences. I look forward to being trained at a higher level and in the rigorous scientific principals necessary to contribute to a more complete understanding of inflammatory diseases. I am eager to work collaboratively with other dedicated students like myself on complex problems in order to come up with novel research findings. Through earning an MSc at the University of Kiel, I ultimately aim to make my research relevant to patients who have suffered as I have my whole life. I aspire to eventually take my career to the doctoral level, where I can combine my interest in patient care with fundamental advancements of medical science. At least from this point forward, I am out of the rabbit hole. Thank you for the consideration of my application.

Sincerely,

Britt Marie Hermes

 

References

  1. McMillan, B. J. & Bradfield, C. A. The Aryl Hydrocarbon Receptor sans Xenobiotics: Endogenous Function in Genetic Model Systems. Mol. Pharmacol. 72, 487–498 (2007).
  2. Wu, D., Potluri, N., Kim, Y. & Rastinejad, F. Structure and Dimerization Properties of the Aryl Hydrocarbon Receptor PAS-A Domain. Mol. Cell. Biol. 33, 4346–4356 (2013).
  3. Esser, C., Rannug, A. & Stockinger, B. The aryl hydrocarbon receptor in immunity. Trends Immunol. 30, 447–454 (2009).
  4. Quintana, F. J. et al. Control of T(reg) and T(H)17 cell differentiation by the aryl hydrocarbon receptor. Nature 453, 65–71 (2008).
  5. Zhu, C., Xie, Q. & Zhao, B. The Role of AhR in Autoimmune Regulation and Its Potential as a Therapeutic Target against CD4 T Cell Mediated Inflammatory Disorder. Int. J. Mol. Sci. 15, 10116–10135 (2014).
Image credit: Flickr user Samantha Marx under a CC License