Treating the Person vs. Treating the Labs - Dr. Michael Ruscio, DNM, DC

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Treating the Person vs. Treating the Labs

A Side-By-Side Comparison, and The Pitfalls of Relying on Lab Work to Guide Treatment

One of the core principles guiding our work at the clinic is the idea that treating the patient – rather than just lab numbers – leads to better outcomes and at less cost. 

In the second video of my 3-part patient education series, I explain how relying on lab work – from allergy testing, SIBO tests, and adrenal cortisol tests – rather than treating the symptoms, is less likely to result in benefits to the patient – and may even cause harm.

In This Episode

Episode Intro … 00:00:45
Treating the Numbers vs. Treating the Person … 00:06:47
The Scorecard Comparison … 00:07:36
Episode Wrap-Up … 00:15:42

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➕ Full Podcast Transcript

Episode Intro:

Welcome to Dr. Ruscio Radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates, visit DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now, let’s head to the show.

Dr. Michael Ruscio:

Hey everyone. This is Dr. Ruscio. Welcome back to Dr. Ruscio Radio. Today I have a special treat – although it feels weird to say that about something you made). I took quite a bit of time over the past few months to think about how we can best describe what we’re doing at the clinic in such a way that it arms people with tools to be able to evaluate other healthcare providers; to really ensure they’re not getting pulled into some of the shenanigans in the field and to have a short list of principles. Follow these and that will hopefully help keep you on the best path in functional medicine. And so I created a three-part video series. This is going to form an educational mainstay for new patients at the clinic, but it has very broad applicability for anyone who is following the work of gurus, health coaches, doctors, online programs, working with doctors directly, etc.

DrMR:

There is a lot of carryover into how you use these principles to evaluate information; to have a checklist as to whether a provider is giving you advice that is keeping with the paradigm we use at the clinic. So a three part series – I just want to give you a quick foreshadow/overview here and then we’ll go right to the audio from the videos. We’ll release the audio, obviously, in succession here in the podcast, but you’ll also be able to locate the video in the description for each of the podcast episodes. We’ll release these on Monday, Wednesday, and Friday. I would definitely go to the YouTube versions of the videos because there are a lot of visual aids there that really help tie this together.

DrMR:

In video #2, we cover the principle and expand upon the principle that treating the person leads to far better results. And we actually comprised an evidence-based scorecard – borrowing from clinical trials and/or meta- analyses – looking at response rates when using a testing guided model, as compared to using an individual or person-guided model.

DrMR:

We actually did the best we could to assign a quantifiable numeric value to each model, and then we went through a 1-2-3 step evolution of a patient journey so you could get a sense for how there is around a 30% to 50% better outcome when using this model that we advocate for; to try to make that very clear to see because sometimes you hear a philosophy/a method, but if you can have a quantification of “the delta for one method compared to the other nets out to 60%” that’s fairly significant. And then in video #3, we develop three final operating principles that an order of operations guides decision making — not emotion… not the Google algorithm… not advertising… not industry influenced thinking — that lab results are 1/4 of the data needed to make a healthcare decision, and that weeding out unnecessary tests reduces costs and improves results.

DrMR:

There are also great visual representations here of what a patient path looks like as they navigate through this inverted tree analogy that I’ve been using lately. In this inverted tree, the trunk is the core of our model and is the diet, lifestyle, and gut health foundations model. But as you progress down through the trunk, certain symptoms remain while others have responded. And it’s those remaining symptoms combined with your personal information that helps us dictate what branch items – that we don’t do for everyone – we may want to pursue. So HCL – yes or no? Enzymes – yes or no? Antimicrobial therapy – yes or no? Mold treatment – yes or no? Specialty niche diets like low histamine, abdominal massage, pelvic floor, female hormones, thyroid, limbic, apnea studies — these are all things that are second or third level.

DrMR:

I really go through a number of examples of how important it is to look at the evolution of a patient’s symptoms in juxtaposition to their history and their other personal information to then dictate what care someone gets going forward. And I think this is probably one of the most valuable images that we’ve made in a long time. We also tie this all together when looking at a cost comparison between models. You can see what this nets out to in terms of cost. So anyway, I think this hopefully should be one of the more informative video series that we’ve done in a while. I hope you will go through every one, and also share these with someone who is thinking about pursuing functional medicine so they have a better idea of (well, in my opinion and our opinion at the clinic) what functional medicine should look like. I hope you find this series helpful. And please, if you have any feedback, I would love to hear it. All right. Thanks guys. Bye-bye.

Treating the Numbers vs. Treating the Person

DrMR:

Hey, this is Dr. Ruscio. Let’s go into a direct comparison of the “treating the numbers” paradigm of functional medicine versus the “treating the person” paradigm of functional medicine. Functional and integrative medicine providers are an important complement and alternative to standard and conventional medical care. This is something that was incredibly helpful in my own healthcare journey. However, as we detailed in the last video, much of the functional and integrative medicine paradigm has been based upon this industry-influenced testing and overuse of supplement paradigm – “treating the numbers” and not “treating the person.” This does not help people and oftentimes can harm them. So, let’s now lead to this comparison and what I put together as a scorecard.

The Scorecard Comparison

DrMR:

You can see side-by-side what the percent outcomes tend to be. Do you have a 10% or a 40% likelihood of benefit from these paradigms? Again, our operating principle here will be “treat the person.” And by treating the person, this leads to far better results building upon our past two principles that 1. the science tells us how to treat people, not tests and 2. many of those tests are inaccurate.

DrMR:

So, here is the “treating the patient vs. treating the numbers” scorecard. This is a side-by-side comparison, and we will briefly outline and develop them. Food allergy testing sums out to about a 10% to 48% response rate or benefit rate, whereas the low FODMAP diet (as just one example) based upon the individual symptoms leads to a 50% to 80% response rate. The data I’m providing here are mainly from meta-analyses, which are summaries of the available clinical trial.

DrMR:

As you can already see right out of the gate, if we use the right paradigm for diet, we can have a 5x higher benefit (or double the benefit.) This next point here is avoiding probiotics if someone has SIBO and just using antibiotics. Our recent meta-analysis found a 51% response rate to rifaximin, which is great. However, if we go over to the “treating the person” paradigm, and we look at the SIBO response rate to probiotics, it’s about the same @ 53%. However, if you add probiotics to antibiotics, you get an 85% response rate. Again, we’re seeing 30% better results when we’re treating the person rather than treating the labs. And a little bit harder to quantify specifically — adrenal support based upon testing as compared to symptoms. We’ll outline this in a moment. I think it’s pretty clear and obvious that we don’t want to use the testing mainly because a meta-analysis found that over half the time the tests and the individual do not match. When you really lay this out, the scorecard shows there’s a much higher likelihood of benefit when you treat the person and there’s a much lower likelihood of benefit (and even a chance of harm) when you treat the labs. Let’s outline this just a touch further.

DrMR:

There have been a few studies looking at the response rates to food allergy testing guided dieting. However, I should speak to the fact that with this 10% to 48% response (when you actually look at these studies individually), you see that people oftentimes end up doing one of two things. One – they’re more diligent with their diet. There’s this cleaning up of the diet and getting rid of processed foods, which has an impact in and of itself. Also, perhaps more importantly, the foods that are normally advised to be avoided are ones that we already have encapsulated into various diet templates.

DrMR:

Someone could give you a handout for a paleo diet and you could follow that minus the $300 to $1,000 of cost having to go to a lab and waiting weeks to get your results back. By the time someone got their lab results back, they could already be weeks into their improvement at far less of a cost. This is just by using what the research has informed are diet handouts that are clusters of foods that are known to be problematic for people. Now, with a low FODMAP diet, there’s that higher response rate of 50% to 80%. When you put these side-by-side, you see that the testing produces lower results, takes more time, and costs more money. This is just step one, but already we’re seeing that the ‘treatment of the person’ paradigm is putting us at an advantage.

Dr. Ruscio Resources:

Hi, this is Erin Ryan from the Dr. Ruscio team. We get lots of questions about Elemental Heal – our gut supporting meal replacement shake. So, I thought it would be helpful to answer a couple of those questions now. Let’s talk about the investment. Some people wonder – is it worth the cost? What if it doesn’t agree with me? What then? Well, there are a lot of different ways to think about it in terms of offsetting costs. You’re using this shake as a meal replacement so you’re not paying for food while you’re using it as a meal replacement. That helps with the cost. It could also offset future costs for ongoing therapies. If Elemental Heal is really helping you and you only need to use it in combination with one or two other therapies, you’re offsetting costs of more doctor’s appointments, more testing, and so on. In terms of the sourcing, every ingredient is impeccably sourced by Dr. Ruscio himself. There is nothing in this product that he wouldn’t put in his own body. In terms of the taste, it tastes great! I love the chocolate, but there’s also peach and vanilla. We also have a money back guarantee in case you order too much, or if it doesn’t agree with you. Just let us know and we’ll help you out. There’s a lot more info on the website: DrRuscio.com. There are customer reviews, research, and scientific evidence all about Elemental Heal.

DrMR:

When we go over to treating the person as it pertains to SIBO, treating the numbers would advocate for ‘don’t use probiotics — use antibiotics.’ And like we discussed earlier, there’s about a 51% response rate to antibiotics from a recent meta-analysis, which is great. That is a big step in the right direction. However, a 2017 meta-analysis in the Journal of Clinical Gastroenterology found that probiotics have a similar response rate of 53%, but when you add antibiotics to probiotics, you go from a 53% to an 85% response rate. As you start building these on top of each other, we can have better success with the diet, less time + less cost. And then we can have better response for SIBO if we use the data to treat the person and not treat the numbers.

DrMR:

And then when we come over to adrenal health (as I mentioned earlier), our recent meta-analysis found that over 50% of the time, the lab results and the individual symptoms did not match. What can really be sad about this (and we published a case study on this recently), you can have an individual who doesn’t really exhibit adrenal fatigue symptoms, yet their test says they have adrenal fatigue. So, this person who doesn’t seem to be exhibiting any of the symptoms is told to avoid coffee… reduce exercise… take a bunch of supplements… and guess what happens? These people don’t feel better. In fact, they may even feel worse because you’re having them contort their lifestyle in an unnecessary fashion. Again, as one of our recent case studies exemplified.

DrMR:

Now, if you’re treating the person, you don’t use the tests because of the questionable accuracy and you ask questions about the individual: How is your energy? How is your sleep? Are these symptoms getting better as we progress through gut care, dietary, and lifestyle changes? If yes, great – we’ll keep going. It’s working. If you’re still having issues with fatigue or exercise intolerance or your symptoms dictate that there could be some sort of stress maladaptation, then we can use various adrenal supports to support you as a person and your symptoms and not get wrapped up in treating the labs. Again, when you tally this all up, you really see how the paradigm of “treating the person” is far more effective than “treating the labs.” Even though the labs can pull at your emotional strings, remember that most of the labs are inaccurate and they don’t actually tell us how to better treat you. Treating the person really leads to better outcomes with less time and with less money.

Episode Wrap-Up:

I hope this is somewhat apparent that we should treat people and not numbers. And again, we get much better results when we do so. And in the next video, I’ll expand further on the approach that we use at the clinic, which is treating the person so you can better understand what it looks like when you really treat a person. And you get out of this array of lab tests and treatment of the test, and you move over to this paradigm of listening to the person and really personalizing care to them.

Outro:

Thank you for listening to Dr. Ruscio Radio today. Check us out on iTunes and leave a review. Visit DrRuscio.com to ask a question for an upcoming podcast, post comments for today’s show, and sign up to receive weekly updates.

 

➕ Links & Resources

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Discussion

I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!

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