Is Your Doctor Treating You or Your Lab Results? - Dr. Michael Ruscio, DNM, DC

Is Your Doctor Treating You or Your Lab Results?

An Educational Video Series for Patients: Part 1

Scientific research tells us that treatment approaches in functional medicine are best decided by looking at patients and their symptoms rather than allowing lab results to dictate those decisions. 

In this video series, I provide a short checklist to help educate patients and clinicians about best practices.

Video 1 discusses why weeding out unnecessary tests reduces costs and improves health outcomes.

In This Episode

Episode Intro … 00:00:45
The “Treating the Numbers” Model … 00:07:40
The Importance of Treating the Person Over the Numbers … 00:09:38
The Inaccuracies of Lab Testing … 00:15:23
Episode Wrap-Up … 00:16:45

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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 the first video, we cover two operating principles. #1 – that the scientific literature overwhelmingly informs how to treat people and not how to treat tests. We actually made a side-by-side table for certain conditions, and you can clearly see there is absolutely vastly more information that tells us how to treat people rather than how to use lab results to treat people. And I think looking at the comparison table is kind of sobering. I then tie in a few elements of what you may have heard in the past. #2 – how certain companies have been found fraudulent and how some labs have falsified their lab ranges. That’s what we cover in video #1 and again, it is heavily leveraged with visual references. And then 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.

The “Treating the Numbers” Model

DrMR:

Hi. This is Dr. Ruscio. Let’s discuss the question: “Are most functional medicine tests snake oil?” If you’ve been struggling with a health problem and are perhaps frustrated by the limitations of conventional medicine, it can be alluring when along comes functional medicine, which promises to treat the root cause. And perhaps it’s even more alluring when a test is offered up as something that can find that root cause. Why am I having chronic brain fog? Why am I having chronic fatigue… or insomnia… or loose bowels… or abdominal pain and bloating…? But what this actually seems to translate to is excessive testing, expense, and really this paradigm of treating the numbers rather than treating the patient. Now, it’s also our belief that functional medicine, doctors, and clinicians have the best intentions, but they seem to have been misled into thinking that testing offers more utility than it does.

DrMR:

And what’s unfortunate here is all of the incentives seem to be pointed in the wrong direction. Labs are incentivized, of course, to educate and market about their tests. Doctors often will proclaim their progressive model of testing can really help patients uncover the root cause of their disease. And if patients are watching or listening to videos or podcasts or reading blogs, they can get sucked into this. So, the labs and the doctors, and even the patients, all seem to have this incentivization toward more testing. Unfortunately, this has led to the current state of affairs, which we term the “treating the numbers” model. I want to try to outline for you how fallacious this is so we can really start turning the tide toward the paradigm we use and advocate for, which is that of treating the person.

The Importance of Treating the Person Over the Numbers

DrMR:

Let’s detail what you as a patient or a doctor need to be aware of and why treating the numbers doesn’t work and why we must treat the person instead. There are two operating principles I want to develop in order to convey this. One – the scientific literature overwhelmingly informs how to treat people and not how to treat tests — treat people not numbers. Two – many labs are inaccurate (even fraudulent) and should not be used.

DrMR:

Let’s develop point #1 here. We put together this table to help showcase the overwhelming majority that scientific research guides clinicians on how to apply therapies to patients and their symptoms (or their clustering of symptoms sometimes known as various syndromes.) There has been very little scientific research regarding how we can use a given lab value to personalize and to guide treatment.

DrMR:

Let’s look at probiotics for IBS. Many patients (and even doctors) have the mistaken belief that a stool test will inform how we apply probiotics. Yet, when you look at the scientific body of evidence, only one study in existence has done a stool test and used that stool test to then give a probiotic, whereas there are 2,649 studies in existence that help guide a clinician in terms of how they apply probiotics to individuals with this cluster of symptoms known as IBS – bloating, distension, abdominal pain, and altered bowel function – whether that be constipation, diarrhea, or an oscillation between the two.

DrMR:

How about mood? There are zero studies in existence that inform how to use testing – let’s say a stool test – to then treat someone’s depression or anxiety. However, there have been 19 clinical trials that inform how clinicians can use probiotics to support depression or anxiety.

DrMR:

How about adrenal support? This might be the most surprising because it’s common practice in the field to do a baseline adrenal test and then give various adrenal supports based upon the tests. There are two studies in existence – one from my friend and colleague Dan Kalish and one case study, whereas there are 75 to 85 (depending on what parameters you use) that inform how we should use various adrenal supports to help people with fatigue, with insomnia, with caffeine dependence? Again, the trendline here is overwhelmingly toward looking at a person and their symptoms – understanding them and applying the therapies to them and not to a lab value.

DrMR:

And what about food allergy avoidance? There are eight studies that have guided someone’s diet based upon food allergy testing, whereas there are 80 for guiding the diet via IBS symptoms and 742 for digestive maladies altogether. Again, the overwhelming majority of the scientific research that a clinician can go to to learn how to be a better clinician informs how to treat people and the symptoms that they’re suffering with rather than a lab value.

Dr. Ruscio Resources:

Hi everyone. If you are in need of help, we have a number of resources for you. Healthy Gut, Healthy You – my book and your complete self-help guide to healing your gut. If you’re not a do-it-yourselfer, there is the clinic – The Ruscio Institute for Functional Medicine – and our growing clinical and supporting research team will be happy to help you. We do offer monthly support calls for our patients where I answer questions and help them along their path. Health coaching support calls every other week. We also offer health coaching independent of the clinic, for those perhaps reading the book and/or looking for guidance with diet, supplementation, et cetera. There’s also the store that has our elemental diet line, our probiotics, and other gut health and health supportive supplements. And for clinicians, there is our FFMR – The Future of Functional Medicine Review database – which contains case studies from our clinic, research reviews, and practice guidelines. Visit drruscio.com/resources to learn more.

DrMR:

Even with something like rifaximin (which is an antibiotic for small intestinal bacterial overgrowth amongst other conditions), there is still more evidence guiding how to treat the person rather than how to treat the lab value. So, even a prescription antibiotic has more evidence for how to treat the person and their symptoms than it does the lab values, although this would be one case where the evidence seems to be fairly evenly mixed. Hopefully this table helps you to see that your clinician has much more to pull from in terms of groups of patients with symptoms similar to yours, and they are given either placebo or a treatment. There is much more information on looking at the person and their symptoms and their history than there is a lab value. So again, this is one reason why I say the scientific literature overwhelmingly informs how to treat people and not how to treat tests.

The Inaccuracies of Lab Testing

DrMR:

Now, with my second point, some labs have been discredited or even had litigation brought against them. So, our principle #2 – many labs are inaccurate, even fraudulent, and should not be used. I’ve discussed this before, but it’s worth repeating. uBiome – a very popular stool test – literally used dog feces to help establish what the normative ranges were for humans. And this is likely in part why they were subject to an FBI investigation and later went bankrupt. As more of this investigation rolled on, insiders from the company said the science was flawed from the start. And again, this was a test I had warned against for years, but sadly patients would routinely come in with uBiome results in hand asking, “What do we do with this?” And my response was always — “This test has not been validated and it’s not something we should be using.” And this is not the only example. As I’ve also discussed before, a neurotransmitter testing company pled guilty to falsifying lab ranges in order to sell more supplements through their sister company. Inaccurate and unnecessary labs are distracting from the root cause rather than clarifying, and they really limit your care to treating the numbers instead of treating you as an entire person.

Episode Wrap-Up

DrMR:

In summary, those two principles – 1. the scientific literature overwhelmingly informs how to treat people and not how to treats tests and 2. many labs are inaccurate, even fraudulent, and should not be used.

DrMR:

In the next video, I’ll explain our model in direct comparison to the standard model so you can easily compare and contrast and decide for yourself what model you think is best for you. I hope that this video has been insightful because if we can save patients from squandering hundreds, or even thousands, of dollars on lab work, then that is a huge win. And if we can help prevent patients from wanting to ask their clinician – “What about this test? What about the other test?” – and stop wasting that time on having your provider use your valuable time together to explain some of the fraudulence of these labs, then that’s a huge win because now you and your provider can go to work on better understanding you, your symptoms, your history, and then personalizing care to you (as we’ve just outlined is what the majority of the science helps us to do.) This is Dr. Ruscio. I hope that helps. And again, in the next video we’ll do a direct side-by-side comparison of our model to more of the standard model.

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.

 

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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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