“The only paradigm to have is no paradigm”


Natura’s Clinical Psychoneuroimmunology (cPNI) is a post-graduate course. Do you remember when you did your first significant studies in a health-related subject (which brought you to cPNI), and probably studied some biochemistry and laboratory-testing? You sat through those lectures thinking “I get this, but I’m going to need to re-visit this at some stage because it is a big topic and I don’t have time to immerse myself in it now. Yes, I appreciate its fundamental value in health science but I cannot take it all in right now”. But then your course continues and you miss your chance to really get your teeth into understanding the biochemistry/lab work. Did you go back to it later? Do you now really understand what are the biochemical norms and changes that can take place within the individual, and thus are able to focus your intervention in your patient from a place of knowledge?  Did you immerse yourself in it? I’m guessing that you probably did not. There were other things that were more important at the time and then life went on and you became distracted by things you felt were more important to your work as a health professional. Yet there remains that niggling thought in the back of your mind “Actually, if I’m honest with myself, I still have a gap in my knowledge”.

Golden opportunity

When I saw this subject coming up in the timetable I knew that this was to be my golden opportunity to fill in the gaps in my knowledge I had neglected before. It is an area that is important to all health professionals who value a science-based approach in assessing their patient’s biochemical and physiological status. The wider aspects of laboratory testing fascinates me and I know it is important, but although there are various seminars available run by the labs themselves, their seminars are clearly designed to get you to use their tests and thus the element of bias creeps in. This was not the case with Prof Frits Muskiet.

Top-class education, with a sense of humour

Prof Muskiet is a Biochemist by training. He later became a Clinical Chemist and admitted to us that he has a problem in that he cannot stick to just one subject as there are too many allied areas which interest him. This was more than fine with me. The Professor was clearly a very knowledgeable man and could draw upon his experience from a multitude of fields to deliver a top-class education, and with a sense of humour. Frits taught us that the standard meter was in Paris (in the 1790s the French originated the meter as one/ten-millionth of the distance from the North Pole to the Equator along a meridian through Paris) and joked that the standard cholesterol is in Washington! Ah, health-science jokes! But then he brought us down to earth by following that with saying that if a patient has high cholesterol then we should check their thyroid.

 

Frits’ current roles are in research and teaching – a perfect combination! It’s such a shame we are only in the presence of these great teachers for a couple of days. But by the end of those too few days the inspiration has been born and you can run with that into your own study.

 

The four main subjects that we covered for these two days were interpreting laboratory data, enzymes as testing markers, PUFAs in health and disease, and of course the sessions would not be complete without a healthy discussion on the vitamin du jour: vitamin D (myth or miracle?)! It was interesting to hear his experience researching his team’s paper about traditionally living East Africans and their serum vitamin D levels, published this year in the British Journal of Nutrition: http://www.ncbi.nlm.nih.gov/pubmed/22264449. There are many good papers by Frits on PubMed.

No ordinary lab-science

cPNI is grounded in evolutionary biology, so it was perhaps inevitable that we would eventually get around to discussing race and genetics. This may not seem particularly relevant to typical laboratory science, but (thank God) Prof Muskiet is no ordinary laboratory scientist. This again was a departure from the slides but, who cares?! It is fascinating stuff and all expands your understanding beyond the usual paradigms in which we deliver the treatment intervention in which we have been trained. So what of race? Well, we have 7 races: American; Australoid; Capoid; Caucasian; Ethiopian; Malayan; and Mongolian. Let’s have a look at skin colour. It is now thought that black skin may be a protection against folic acid (FA) loss. Melanin protects FA which is constantly circulating and not stored. We know that UV radiation destroys FA so the genetic mutation of paler skin (compared to our original dark skinned ancestors) may allow in more UVB radiation for vitamin D synthesis but it’s not only easier burning that is its downside, and FYI the white skin of Caucasians compared with East Asians is a different mutation. Interestingly most genetic differences were present before our evolution into Homo sapiens sapiens. But not all black skins are the same. For example, black aboriginals in Australia are genetically more like European whites than black Africans due to the out-of-Africa hypothesis (which Frits and others believe is not a hypothesis but a fact).

Important ABCs

There were some important ABCs Frits covered which I did not remember from University. For example, we know that good science is all about asking questions so he told us that the four most important questions to address to the lab are:

  1. Is the outcome (ab)normal?

  2. Is the outcome consistent with the laboratory diagnosis of a particular disease?

  3. Is the outcome above/below a consensus cut-off value for a diagnosis or a treatment goal?

  4. Is the outcome different from the previous one?

These all contribute to the differential diagnosis which leads us onto the functional assessment. Of course, differential diagnosis is about looking at chances – everything is a chance in life. It’s looking at the symptoms and deciding which of the list of possible pathologies it’s most likely to be. But which lab test will you select? Did you know that saliva is a good reflection of what is happening in the blood, so it’s becoming more important now as a sample for markers? Not everyone enjoys having a needle stuck in their arm! Did you know that the only difference between plasma and serum is the use of anticoagulant? Did you know that as soon as you start running you get an immediate inflammatory reaction? Did you know that iron is a growth factor for bacteria? How do you understand the half-life of a marker? If 100 erythrocytes are synthesised from red bone marrow then the last erythrocyte will be removed in the spleen after about 120 days. 50% of them will be gone in 35 days. This is what’s known as the half life.

Fast-track to enhanced understanding

I had a great discussion with Frits in a break about the limitations of randomised controlled trials and indeed he reminded us all why it is so very important to understanding what is happening today in science and how it is evolving (or not). Our understanding is now changing so rapidly in contrast to previous decades and centuries of science so it is essential to keep up with the changes in order that we can be of real use to our patients. But just as importantly we must realise that we will interact with other health professionals who will not have the same understanding of the science. What cPNI offers are the answers to the all-important questions that ask ‘why?’ and it is once we have that understanding ourselves that we will be equipped to enter into a mature dialogue with other health professionals with whom our patient is also consulting. I do believe cPNI is a fast-track to our enhanced understanding. It is not an easy subject to study. There are many considerations to take on board. But then does deeper satisfaction and learning come from an easy life? As Frits said, you can chose to be interested in a subject or you can chose to be bored by it.

Clinical PNI – Next course beginning 2012

The next PNI-course will start in October 2012, if you are interested in knowing more please contact Justin Sheehan on 0845 862 8862 or j.sheehan@bonusan.co.uk. If you would like to contact Adam about being a post-graduate student of Clinical PNI then please e-mail him at info@adamnt.com.