The 2013 Dr. Rogers Prize for Excellence in Complementary and Alternative Medicine was awarded to Dr. Sunita Vohra of theUniversity of Alberta at a gala award dinner in Vancouver, BC. Dr. Vohra is the founding Director of Canada’s first academic pediatric integrative medicine program, CARE (Complementary and Alternative Research and Education), at theUniversity of Alberta. She is currently evaluating the effectiveness and cost effectiveness of pediatric integrative medicine as an adjunct to usual care at the Stollery Children’s Hospital in Edmonton. She has led many high quality studies of the effectiveness of CAM including ginseng for pediatric upper respiratory tract infection and Mind Body Stress Reduction for at risk youth. With her background in pediatrics, clinical epidemiology and clinical pharmacology, Dr. Vohra is a respected leader in both CAM and conventional medicine, often working to help these two communities connect. She founded Canada’s national pediatric CAM network as well as helped found and now chairs the American Academy of Pediatrics’ Section on Integrative Medicine. Dr. Vohra initiated the use of N-of-1 studies (a multiple cross over trial performed in a single person) as an innovative and patient-centered solution to the limitations of randomized controlled trials for individualized therapies. At the beginning of her career, at the Hospital for Sick Children in Toronto, she recognized the importance of complementary and alternative medicine to her patients and their families and the lack of substantive information on the therapies and potential interactions with conventional care. She was recruited to the University of Alberta to implement her vision of the CARE program in 2003, a program which now trains the next generation of researchers, educators, and clinicians about pediatric integrative medicine. Founded in 2007, the $250,000 Dr. Rogers Prize for Excellence in Complementary and Alternative Medicine highlights the important contributions of complementary and alternative medicine to health care. Funded by Vancouver’s Lotte and John Hecht Memorial Foundation, the Prize is awarded every two years and is the largest of its kind in North America.
A world first: Douglas Institute researchers identify neural circuits of REM sleep
A team of scientists led by Dr. Antoine Adamantidis, a researcher at the Douglas Mental Health University Institute and an assistant professor at McGill University, has released the findings from their latest study, which will appear in the October issue of the prestigious scientific journal Nature Neuroscience. Previous studies had established an association between
the activity of certain types of neurons and the phase of sleep known as REM (rapid eye movement). Researchers on the team of Dr. Antoine Adamantidis identified, for the first time, a precise causal link between neuronal activity in the lateral hypothalamus (LH) and the state of REM sleep. Using optogenetics, they were able to induce REM sleep in mice and modulate the duration of this sleep phase by activating the neuronal network in this area of the brain. This achievement is an important contribution to the understanding of sleep mechanisms in the brains of mammals, as well as the underlying neuronal network, which is still not well understood despite recent breakthroughs in neuroscience. “These research findings could help us better grasp how the brain controls sleep and better understand the role of sleep in humans.These results could also lead to new therapeutic strategies to treat sleep disorders along with associated neuropsychiatric problems,” stated Dr. Antoine Adamantidis, who is also the Canada Research Chair in Neural Circuits and Optogenetics.
Valeant Pharmaceuticals announces approval of Jublia® for Onychomycosis
Valeant Pharmaceuticals International, Inc. announced today that its wholly owned subsidiary, Valeant Canada LP, has received notice that the New Drug Submission for Jublia® has been approved from the Canadian regulatory authority, Health Canada. Jublia® (efinaconazole 10% topical solution) is indicated for the treatment of mild to moderate onychomycosis,
a common and destructive nail infection caused predominantly by dermatophyte fungi. The only currently approved topical treatments are lacquers with limited efficacy. Oral treatments are limited by drug interactions and numerous safety concerns including the potential for acute liver injury. Laser treatments only improve the appearance of the nail. “Jublia® represents the first new topical onychomycosis treatment approved in more than a decade, and we are very excited to bring this new treatment option to patients in Canada,” said J. Michael Pearson, chairman and chief executive officer. “An effective
topical therapy like Jublia® is a logical treatment option to avoid drug interactions and systemic side effects, and we believe Jublia® will position us well to address a growing unmet need.” “There is a pressing need for an effective topical therapy for mild to moderate onychomycosis, especially in individuals who cannot tolerate or are not candidates for an oral antifungal,” stated Dr. Aditya K. Gupta, M.D., Ph.D., F.A.A.D., F.R.C.P(C), Professor, Department of Medicine, University of Toronto, Canada. “The Phase III clinical trial data for Jublia® show that it is an effective and safe topical antifungal therapy for mild to moderate onychomycosis. Jublia® is likely to become widely prescribed by dermatologists, family physicians and other healthcare providers for the treatment of onychomycosis”
Gamma-Dynacare Medical Laboratories announces acquisition in genetics
Gamma-Dynacare Medical Laboratories (Gamma-Dynacare) announced that it has completed the acquisition of a controlling interest in Impact Genetics Inc. (Impact Genetics), a Toronto-based laboratory specializing in high-complexity, disease-specific genetic testing. “We welcome this opportunity to strengthen Gamma-Dynacare’s position as a leading Canadian reference laboratory,” said Naseem Somani, President and Chief Executive Officer, Gamma-Dynacare
Medical Laboratories. “Experts around the world seek out the specialized genetic testing expertise of Impact Genetics. This investment brings to Gamma-Dynacare expanded capabilities in molecular medicine, oncology and genetic testing for rare diseases that will enhance our continued growth in the field of personalized medicine.” Impact Genetics is recognized by oncologists and geneticists around the world as a leader in genetic testing for rare diseases. With a test menu
including Retinoblastoma RB,Hereditary Hemorrhagic Telangiectasia (HHT), Von Hippel-Lindau Syndrome
VHL and Gene Copy Number Analysis, Impact Genetics serves clients throughout North America, Asiaand Europe.
New tests for Uveal Melanoma and Inherited Leukemia will soon be launched. “This exciting partnership will provide Canadians with better genetics services and build on local expertise and talent in this rapidly expanding market,” said Franny Jewett, CEO, Impact Genetics. Over the coming months, Impact Genetics’ operations will move to Gamma-Dynacare’s centre of excellence for pathology, immunopathology, genetics and pharmacogenomics testing in Bowmanville Ontario, near Toronto. Ms. Jewett, Medical Director Dr. Brenda Gallie and the entire Impact Genetics team will remain in their respective roles with the company.
Vita Health Products issues voluntary recall of products
Vita Health Products Inc. announced the voluntary recall of three lots of Pharmasave Extra Strength Ibuprofen Liquid Capsules, 12 count and Remedy’s Rx Cold + Sinus, 20 count. The product is being recalled due to a labeling design error. The finished good is a labeled bottle in a box. The inner label correctly states in French and English that the product is not child resistant. The outer box correctly states the product is not child resistant in English but incorrectly states “Bouchon à l’épreuve des enfants” in French which translates to “Child Resistant Cap”. The outer box and inner label state
‘CAUTION: KEEP OUT OF THE REACH OF CHILDREN. There is enough drug in this package to seriously harm a child’ in French and English in prominent red text. Once Vita Health became aware of the issue, the company immediately notified Health Canada and began the recall process. To date there have been no adverse events reported concerning the product. Consumers who have any of this product in their possession should return the product to the place of purchase or call 1-(800)-665-8820, Monday-Friday 9 am-5:30 pm EST for further instruction.
Highland Therapeutics announces positive interim results of HLD-200 in ADHD patients
Highland Therapeutics Inc., a specialty pharmaceutical company leveraging its proprietary technologies to optimize the delivery of previously approved drug products, announced that its wholly owned subsidiary has generated positive interim Phase I/II results from an ongoing study of HLD-200 – a novel formulation of methylphenidate being developed to treat the symptoms associated with Attention-Deficit/Hyperactivity Disorder (ADHD). The study, “A Phase I/II, Single Center, Single-Treatment, Open-Label, Adaptive Clinical Trial Design Examining the Pharmacokinetic Effects of up to Two Separate HLD-200 Modified Release Formulations of Methylphenidate in Adolescent and Pediatric Subjects with Attention-Deficit Hyperactivity Disorder”, is expected to be completed in the fourth quarter of 2013. Based on an interim analysis of data from adolescent patients, the study demonstrated that the active pharmaceutical ingredient (API), methylphenidate, was consistently delivered in a manner that allows for dosing of HLD-200 prior to bedtime, with the objective of controlling the symptoms of ADHD immediately upon wakening. Further, a comparative analysis of the pharmacokinetic (PK) profiles suggests that HLD-200 could have an extended duration of effect when compared to other once-daily methylphenidate medications. Notably, patients enrolled in the study did not report any significant adverse events, which suggests that HLD-200 could potentially have a better safety profile than other available medications to treat ADHD.
Lithium in the brain: Neutrons show accumulation of antidepressant in brain
Experiments with neutrons at the Technische Universität München (TUM) show that the antidepressant lithium accumulates
more strongly in white matter of the brain than in grey matter. This leads to the conclusion that it works differently from synthetic psychotropic drugs. The tissue samples were examined at the Research Neutron Source Heinz Maier-Leibnitz (FRM II) with the aim of developing a better understanding of the effects this substance has on the human psyche. At present lithium is most popular for its use in rechargeable batteries. But for decades now, lithium has also been used to treat various psychological diseases such as depressions, manias and bipolar disorders. But, the exact biological mode of action in certain brain regions has hardly been understood. It is well known that lithium lightens moods and reduces aggression potential. Because it is so hard to dose, doctors have been reluctant to prescribe this “universal drug”. Nonetheless, a number of international studies have shown that a higher natural lithium content in drinking water leads to a lower suicide rate in the general population. Lithium accumulates in the brains of untreated people, too. This means that lithium, which has so far been regarded as unimportant, could be an essential trace element for humans. This is what Josef Lichtinger is studying in his doctoral thesis at the Chair for Hadron and Nuclear Physics (E12) at the Technische Universität München. From the Institute for Forensic Medicine at the Ludwig-Maximilians-Universität Munich (LMU) he received tissue samples taken from patients treated with lithium, untreated patients and healthy test persons. The physicist exposed these to a focused cold neutron beam of greatest intensity at the measuring station for prompt gamma activation analysis at FRM II. Lithium reacts with neutrons in a very specific manner and decays to a helium and a tritium atom. Using a special detector developed by Josef Lichtinger, traces as low as 0.45 nanograms of lithium per gram of tissue can be measured. “It is impossible to make measurements as precise as those using the neutrons with any other method,” says Jutta Schöpfer, forensic scientist at the LMU in charge of several research projects on lithium distribution in the human body.
The Community Clinic Roncesvalles
From the beginning of his practice in 2008, Dr. Chris Pickrell, ND, RH decided that he wanted to offer health services at rates that were affordable and accessible. He set out to build his practice in accordance with that plan and decided this by literally writing out the answer to the question: “What does integrity mean to me?” The answer to this question dictated how he would practice, and he made a personal commitment never to operate his business from a place of fear, but rather to only operate from a place where he felt comfortable and displayed integrity. At this point, Dr. Pickrell started his private practice and teamed up with an acupuncturist to create the community acupuncture clinic. He decided on the clinic location because he lived in the neighbourhood and the location matched his philosophy on healthcare. He knew other NDs had worked in that location and had moved on, but he was determined and became successful. The clinic consists of one large room from which the clinic offers all its services. He currently sees over 50 patients per week.
In 2012, Dr. Pickrell teamed up with two other clinics to continue his journey of providing affordable and accessible care. The result was the creation of a team of three NDs as a board of directors for The Community Clinic. Together, they share branding, philosophy of practice, resources, and even practitioners. The mandate of The Community Clinic remains to provide a better model of naturopathic care in Ontario, one that is more accessible to patients and also financially successful for the practitioners.
Dr. Pickrell offers naturopathic services, acupuncture, yoga, and educational talks. All of these fall under the umbrella of The Community Clinic Roncesvalles. To help further the clinic’s goals, the business model moves towards the idea of “filling more spaces more often”. In other words, the patient experience is similar to that of other conventional practitioners: combining scheduled visits with the flexibility of walk-in access. From a business perspective, filling space with a patient, even if it’s a smaller source of revenue, is better than allowing the space to be fallow, obtaining no revenue at all.
Dr. Pickrell has found that less than 20% of Ontarians have the coverage or the income available for most The Community Clinic naturopathic care, so a large amount of the population cannot access services. From a business perspective, this means Roncesvalles the majority of the market is untapped. Regardless of the service they wish to access, Dr. Pickrell’s patients always have the option of choosing to pay what matches them best. Every service has the option to “pay what you can” or “pay as you like”. When asked if everyone simply chooses to pay the lower rate, Dr. Pickrell responds: “Not at all. Time and again the people who can afford it or have coverage pay on the higher end. Others have started on the lower rate and have chosen to move up to the higher rates as their situations changed.” Approximately half of his patients access the half-rates and only a handful of people have elected not to pay at all, though everyone receives the option. A few people actually barter. When asked further about this, Dr. Pickrell recounts an experience where one of his patients asked if she could pay with chicken because her parents owned a chicken farm. He replied humorously: “I’ve been waiting my whole life for someone to pay me with a chicken.”
Dr. Pickrell’s educational talks include a group elimination diet exercise, as well as talks to understand digestion and absorption, with planned talks on fertility. All talks are free of charge. At any given time, 20% of the community acupuncture patients (which sees the higher volume of people) are also seeing him as an ND. Most yoga students also overlap with the other health services. Dr. Pickrell has everything set-up such that it is easy to flow between services, with no additional forms or fees to move between them and there are no late fees, cancellation fees, or additional first visit fees. Many of the patients he sees tend to use The Community Clinic services as their primary care access, opting to use the acupuncture clinic or walk-in clinic components for acute concerns.
When asked about the brands and supplements he carries, Dr. Pickrell explains that he doesn’t carry many supplements. Many of his patients see him for counselling. When further prescriptions are required, Dr. Pickrell relies on herbs and herbal tinctures.
Over time, he found that herbal tinctures were difficult for patients to purchase because they were so expensive. Going back to his plan to provide accessible and affordable services and using his expertise as a Registered Herbalist, Dr. Pickrell started a herbal tincture company called ‘Perfect Herbs’. His herbal company not only supplies his patients, but he also sells these tinctures to other clinics, so that they too may benefit from the decreased cost. Perfect Herbs now carries over 120 individual tinctures and a dozen signature blends.
Dr. Pickrell has had surprisingly few obstacles in his career. His practice has built up smoothly, despite minimal marketing. He believes the quality of care is what has driven his current patient base, since the majority of his patients come from word-of-mouth referrals from existing patients. He is well-known in his community, and comes up as one of the first few hits on Google for the search “affordable ND”. His average patient demographic is adults in the 24 to 44 age range, but also many over the age of 70. In general, they are people who want to see an ND and with a genuine desire to improve their health and live better. Commonly, Dr. Pickrell’s patients tell him “thank you for offering this model of care, otherwise I wouldn’t be able to afford it.”
To date, The Community Clinic is needle-stick free, which is impressive considering more than 10,000 acupuncture needles have been inserted. Recently, Dr. Pickrell has teamed up with Dr. Jon Sheridan, ND, who now also offers his services at the clinic within the same framework. Together, they would like to thank the community for supporting the philosophy of accessibility. Their future directions include expanding the number of
practitioners who are using this model, and at some point perhaps opening the first walk-in naturopathic clinic. We at IHP wish these awe-inspiring practitioners continued success.
Operating From The Herbal Clinic & Dispensary
409 Roncesvalles Ave. Toronto, ON
Phone: 416-436-3715
Email: roncesvalles@thecommunityclinic.ca
Website: http://www.thecommunityclinic.ca
The Vivian Medical Spa
The Vivian Medical Spa is a stunning integrative medical facility and European-inspired spa situated 30 minutes northeast of Toronto, in a beautiful home overlooking a 25-acre property. The center offers preventative therapy, anti-aging medical treatments and non-surgical cosmetic aesthetics designed to rejuvenate and optimize health. The medical facility was founded in 2005 by Dr. Andrew Wojcicki MD, whose medical background prior to establishing this center was in orthopedic surgery, internal medicine, gerontology and anti-aging medicine. Dr. Andrew’s wife, Dr. Anna Wojcicka MD, and a team of healthcare professionals work together to customize individual care for their patients and support them in healthy lifestyle change in order to prevent illness and enhance quality of life.
Dr. Andrew Wojcicki, MD
Therapies offered at the facility include bioidentical hormone replacement, detoxification programs, intravenous therapies, non-surgical joint rejuvenation using hyaluronic acid injection therapy and platelet rich plasma (PRP), back decompression therapy, and cold laser. In addition, the center offers a range of physical activities including hiking on its stunning grounds and the use of exercise equipment. Aesthetic therapies offered include botox, fillers, Juvederm, and Lipolaser. Cold laser is a key feature of chronic pain management, while Lipolaser is a cosmetic laser that enhances fat loss and reduction of cellulite.
Detoxification techniques used include Moor mud bath therapy, salt water pools, and infrared sauna. Balnotherapy refers to “bath therapy”, considered to be distinct from hydrotherapy, using a variety of organic solutions or “mud” that contains humic acid, minerals, phytohormones, and other organic substances. More specifically, a recent systematic review defines balnotherapy as “the use of baths containing thermal mineral waters from natural springs at a temperature of at least 20 °C and with a mineral content of at least 1 g/L” (Falagas 2009). At the centre, a typical bath consists of half an hour at 42 °C, based on the physics of the solute. Austrian mud is used for the treatment of pelvic inflammatory disease (PID) as well as prostate disease, for instance.
Intravenous therapies include intravenous vitamin C for a range of conditions including adjuvant cancer therapy. For cancer, Dr Wojcicki also utilizes intravenous bicarbonate (HCO3) alongside IVC in in his practice. Dr Wojcicki emphasizes that the facility employs a truly holistic approach in treating patients with cancer. In addition to intravenous therapies, his patients receive counseling regarding diet, with a reduction in refined carbohydrates and an increase in fruits and vegetables recommended as part of an alkalinizing diet. In addition to cancer, Dr Wojcicki uses IVC therapy for patients suffering from fibromyalgia and arthritis, for patients with neurodegenerative disease such as dementia and Parkinsons, as well as in the prevention and treatment of bacterial and viral infections.
For patients with atherosclerosis, intravenous EDTA is used alongside IV phosphatidylcholine (PC). Plaque therapy is the use of essential phospholipids (EPL) extracted from soy. This may be recommended for patients who have suffered a stroke, poor cardiac function, or who have diabetes. Anticipated outcomes from an 10-week program include a reduction in atherosclerotic plaques between 10-60%, reduction in angina pain and frequency, reduction in LDL cholesterol, increase in HDL cholesterol, improvement in cognitive function, improvements in sexual function, and improved exercise tolerance as measured by walking distance. Not unlike a growing number of his colleagues, Dr Wojcicki questions the real usefulness of statins in their role as the universally applied therapy in most conventional medical practices, especially apart from a proper emphasis on the role of diet and lifestyle. IV therapies for liver support include N-acetylcysteine (NAC), glutathione, and phosphatidylcholine (PC).
Dr Wojcicki’s story is an intriguing one: originally an MD in Poland, licensed in 1988, Dr Wojcicki practiced as an orthopedic surgeon for several years prior to immigrating to Canada. At that time, he completed re-training through the University of Toronto and completed a five-year residency in internal medicine and gerontology. He established a private practice in 1996, and became increasingly more interested in a more holistic approach. In particular, he felt dissatisfied with the constraints of medical guidelines, convinced that he should be free to “use my own brain.” Dr Wojcicki believes that the therapeutic application of medicines is all about their mechanism of action and “knowing the molecule”; if you have the biochemical basis for its behaviour, you can apply it intelligently in human systems.
Dr Wojcicki expresses reservations about the pharmaceutical bent present within medicine as it is commonly practiced. He dislikes the mentality that focuses on pharmaceutical drugs first and relegates diet and lifestyle to a secondary role. Treatment and prevention of disease begins with lifestyle, he says, and this is systematically neglected in primary medical care. This is especially problematic in the management of conditions such as obesity and diabetes. Dr Wojcicki relates that he often recommends a gluten and/ or dairy free diet and the avoidance of genetically modified organisms (GMOs), in patients with asthma, allergy, or gastrointestinal problems.
An initial visit with Dr Wojcicki lasts two hours and includes a one hour discussion of lifestyle and diet, as well as a physical exam and thoracic ultrasound. Additional testing that maybe run includes hair heavy metal testing, salivary and blood hormone testing, cancer markers, cardiovascular biomarkers such as ApoB and E, hs-CRP, homocysteine, fibrinogen, and a calculation of the Framingham risk score. The patient receives a medical report regarding current health status and recommendations based on diet, lifestyle, supplements, and hormones. A referral to a specialist is given where indicated.
Dr Wojcicki retains one foot in the conventional model, so to speak. His wife remains as a full time hospitalist at Southlake Hospital (Newmarket, Ontario), and enjoys ongoing involvement there given her own surgical background.
The facility is open to both membership service and walk-in patients. The membership delivers walk-in service for almost free. Walk-in service is based on fee-for-service, with some testing covered by OHIP. Dr Wojcicki estimates that about 20% of his practice is management of chronic disease, while 80% focuses on disease prevention and wellness.
IHP is grateful to Dr Wojciki and the Vivian Medical Spa team for taking the time to introduce us to their impressive facility. Dr Wojciki embodies the true tenants of integrative, holistic, individualized medicine. He serves as a powerful force in the advancement of integrative therapeutics, and his choice of facility marries perfectly with his vision of world-class healthcare.
References
Falagas ME, Zarkadoulia E, Rafailidis PI. The therapeutic effect of balneotherapy: evaluation of the evidence from randomised controlled trials. Int J Clin Pract. 2009 Jul;63(7):1068-84.
Andrew Wojciki, MD :Chief Medical Officer Brandy Kinner: Director Sheila Sanchez Silverio, MSc: Clinic Manager Krystyna Mlodzianowska: Medical Assistant Carly Andrews: Reception Tetyana Nakonechna: AestheticianGymnemic acid inhibits hyphal growth and virulence in Candida albicans
Candida albicans is an opportunistic and polymorphic fungus that causes mucosal, disseminated, and invasive infections in humans. Transition from the yeast form to the hyphal form is one of the key virulence factors in C. albicans contributing to macrophage evasion, tissue invasion and biofilm formation. Nontoxic small molecules that inhibit C. albicans yeast-to- hypha conversion and hyphal growth could represent a valuable source for understanding pathogenic fungal morphogenesis, identifying drug targets and serving as templates for the development of novel antifungal agents. In this study, the authors identified the triperpenoid saponin family of gymnemic acids (GAs) as inhibitor of C. albicans morphogenesis. GAs were isolated and purified from Gymnema sylvestre leaves. The results showed that purified GAs had no effect on the growth and viability of C. albicans yeast cells, but inhibited its yeast-to-hypha conversion under several hypha-inducing conditions, including the presence of serum. In addition, GAs promoted the conversion of C. albicans hyphae into yeast cells under hypha inducing conditions. They also inhibited conidial germination and hyphal growth of Aspergillus sp. Finally, GAs inhibited the formation of invasive hyphae from C. albicans infected Caenorhabditis elegans worms and rescued them from killing by C. albicans. PLoS ONE. 2013. PMID: N/A
