How Do We Determine The Correct Dose of a Treatment?
Conventional and holistic approaches for addressing one of the most important questions in medicine
I hold an inherent bias against drugs and surgeries because of how frequently I observe them create significantly more harm for the patient than the benefits they create. At the same time however, I frequently see the standard model of medicine greatly benefit patients to the point it would be difficult for me to offer any approach from any other medical system that I feel would be preferable to the patient.
When I’ve looked at why drugs are often so harmful for patients, the injuries they cause typically boil down to one or more of the following:
•The drug in question should not be on the market (as it provides significant risk with minimal benefit) but a lot of money has been spent to keep it there because of how profitable it is.
Note: a list of what I currently consider to be the most harmful drugs on the market can be found in this recent article about the acid-reflux industry.
•The side effects of the drug are conveniently omitted from the literature doctors receive, so when those side effects occur (which suggest the drug should be stopped), doctors frequently don’t recognize them (as you often can’t see something unless you know to look for it) and more importantly they have difficulty believing the adverse reactions could be linked the drug. This is especially true for the more subtle and chronic side effects drugs create.
•The appropriate dose significantly varies from person to person and is often very different from the standard dose.
Every physician I know has specific maxims they follow in their medical practice, and throughout my career I’ve taken many to heart espoused by the most talented physicians I’ve worked with. One of those was:
I always dose everything.
In turn, I believe that much of the benefits and harms of each therapy (be it a conventional or holistic one) used are the result of the dose that is used. In turn, I frequently observe drugs I do not like (due to their inherent toxicity) greatly benefit patients when they are instead provided at a much lower dose to patients and observe “safe” natural or alternative medical therapies (which I like) harm patients because they were given at too high of a dose.
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Low Dose Naltrexone
One of the most common therapies utilized within holistic medicine (and presently a popular choice for mitigating many of the autoimmune complications of the COVID vaccines) is low dose naltrexone. Since this drug illustrates how differently a drug can work at different doses, I would like to briefly discuss it.
Your body produces endorphins, which are peptide hormones that activate the opioid receptors in the body and thus function as natural pain killers which create positive feelings for the recipient. Many of the activities we associate with “feeling good” (e.g., exercise or intercourse) are associated with an endorphin release, and it has been observed that many activities necessary for the survival of our species also are (e.g., breastfeeding causes endorphins to be released and travel into the feeding infant).
Opioid drugs hijack that system and stimulate it at a much higher dose than what the body naturally experiences. This can be both helpful (since that can address severe pain) but also very problematic as the positive experiences opiods create can rapidly become addictive. That addiction, in turn, is a product of the body recognizing its opioid receptors are being overstimulated by those powerful external opioids and it then creating a compensatory down-regulation of that system to avoid an overstimulation. Once this happens, the natural endorphin production is no longer sufficient to meet the body’s needs and significant withdrawals occur once opioids are no longer consumed and artificially stimulating that system.
There are two important implications of this process.
First it helps to explain why so many drugs (such as those which work on systems besides the opioid receptors) are to varying degrees addictive and why their benefits diminish over time as they are taken chronically. Conversely, this is why it often works much better to give a drug or supplement intermittently so its signal can clear from the body before a new one is given and in many cases, (such as when treating the cell danger response), pulsed dosing is essential for restoring the body’s homeostasis.
Secondly, it raises the question. What if you did the opposite?
Because of how addictive drugs can be and how much damage certain addictions create for society, a lot of work has gone into developing protocols for addressing drug addictions. One approach has been to develop medications (such as naltrexone) which block the body’s opioid receptors, so that when an exogenous opioid (e.g., heroin) is taken, it cannot trigger a pleasurable response, and hence overtime causes the addicted individual to gradually lose the desire to consume the opioid.
Note: naltrexone is often used for other addictions, for example it has been found to be remarkably helpful for alcoholism.
In the 1974, Bernard Bihari MD become New York City’s addiction commissioner (heroin addiction was a huge problem at this time) and ever since was involved in the work being done to combat drug addiction. In 1984, naltrexone was developed, and because of his position, Bihari had followed naltrexone’s development closely, through which he had made note of the fact it had been found to triple the endorphin levels of participants who received it.
A few years before naltrexone hit the market, AIDS had emerged in New York, and since Bihari was seeing many of his addicted patients begin to die from AIDS, in 1985 he switched his focus from addiction to AIDS. Since endorphins were known to regulate the immune response (e.g., injecting them significantly increased immune function in animals) this made him wonder if naltrexone could be used to save the immune-suppressed AIDS patients.
However since naltrexone was difficult for many of his addicted patients to tolerate (as they could not handle the opioid withdrawals it created), Bihari decided to see if a lower dose than 52mg could still achieve a meaningful increase in the body’s endorphins. Before long, he found that 3mg worked as well as 52mg but did not create those significant withdrawals. He then proceeded to test it in AIDS patients and found that (if administered at the correct time), it dramatically improved the course of the disease. Unfortunately, like many other promising therapies for AIDS, it was given a cold shoulder so Fauci could push the toxic drug AZT onto the market.
Before long, Bihari also discovered low dose naltrexone therapy (LDN) also worked quite well for certain cancers (many cancer treatments essentially work by up-regulating the immune system). Furthermore, he also observed that in both cancer and AIDS, the body’s endorphin levels were about 30% of normal—which may explain why LDN helps so much for those conditions.
Since that time, LDN has also been found to be quite helpful for other conditions, particularly chronic pain and autoimmune disorders. Since a therapy like this threatens numerous pharmaceutical markets, there has always been an institution resistance toward sanctioning the research or use of LDN—however patient advocates have been able to and as time moves forward, more and more evidence of the benefits of LDS have accumulated.
How is a Dose Chosen?
Typically, for a drug to “work,” enough of it has to be present in a patient to trigger the desired effect of the drug. Exactly how much does that varies significantly as:
•The same drug concentrations affect people differently (for example, an opioid user typically requires a higher opioid dose to get high than someone who has never used opioids before).
•Different people require different amounts of a drug in their system to achieve the target concentration of a drug (this is why for example we often give higher medication dosages to heavier people).
•The degree to which people absorb an oral drug varies significantly.
•The degree to which people eliminate a drug varies significantly, so in some the drug may clear immediately, while in others it persists for a long time (e.g., some of the drug may still remain when the next dose is taken).
•The content of a drug may vary (especially with off-patent drugs produced overseas).
Note: many believe this was a major reason why the responses to the COVID-19 vaccines varied so much as the mRNA concentration was found to vary widely in the vaccines tested (along with the presence of contaminants like bacterial plasmids).
Conversely, the toxicity of a drug can widely vary (e.g., for all of the same reasons listed above).
Note: The chronic and more subtle toxicities of a drug receive minimal consideration when dose dependent adverse events are being evaluated.
When drugs are designed, the drug companies thus have to decide what constitutes an appropriate dose for the product. Ideally they want to have minimal side effects while simultaneously having the majority of patients experience the intended effects of a drug. In some cases this is fairly easy, as the toxic dose is much, much higher than the effective dose, while in other cases it’s challenging as the two are very close.
This concept is expressed by the idea of a “therapeutic index,” which quantifies how far the effective dose of a drug is from the toxic dose. With drugs that have a wide therapeutic index, it is relatively unlikely someone taking them as prescribed will experience a known toxicity toxic event, while with drugs that have narrow therapeutic windows, this is much more likely. For this reason, drugs with narrow therapeutic windows (e.g., chemotherapy—which needs to kill most of the cancer cells without killing too much of the normal cells) are often given in a supervised setting where the exact concentration of the drug can be controlled and side effects can be monitored for.
Note: one of the major problems with the mRNA technology is that since the mRNA doses varied so much lot to lot (as a result of their rushed production), and the time the mRNA persisted in the body also greatly varied, it was not possible to use the existing laws of toxicology to determine what a toxic dose of the COVID vaccines was.
Because it is often impossible to have an effective dose which is low enough that it does not also create side effects in some of the recipients, drug companies typically err towards the higher dose and do their best to downplay the toxicities that occur in their trials. This for example is why in drug trials, the drugs are often only tested on the healthiest members of the population who are the least likely to experience adverse reactions to the medications.
Note: often when a drug is first launched (especially if it is a new type of medication) the company will use a lower dose of it both in the trials and once it enters the market (as that prevents an initial wave of injuries which may cause the drug to get pulled from the market). However, once the drug is approved and has become something doctors and patients feel should always be available to them, the dose of the drug and the number of eligible who are eligible to receive it is increased, as at that point, the resulting wave of injuries are unlikely to be recognized or motivate the FDA to upset the public by withdrawing the drug from the marketplace. This chronology for example is exactly what happened with Viagra when it was brought to the market.
Since the FDA prioritizes signs of efficacy over ensuring safety, as best as I can tell, focusing on “efficacy” has become the industry standard. For example, a key metric the FDA uses to determine if a vaccine should be approved is the antibody response it generates in recipients. Since different people respond differently to the same vaccination, and there is no penalty for an excessively high antibody response to a vaccine, vaccine manufacturers often create products that overstimulate the immune system.
Prior to the COVID-19 vaccines, one of the best examples of this was the HPV vaccine Gardasil. When it was being designed, Merck realized that it was difficult for the body to develop an immune response to the HPV antigen (which I suspect was due to the body being designed to resist developing autoimmunity and the vaccine’s antigen having similarities to human tissue). To solve this problem, Merck used a much stronger adjuvant.
This “worked” and ensured the vaccine reliably produced an immune response in its clinical trial subjects—but also caused the vaccine to have a very high rate of severe side effects in those who received it. However, since the FDA prioritized “efficacy” this trade off was accepted and ever since then the FDA and CDC have worked hand-in-hand to cover up the immense number of injuries that have been caused by the HPV vaccine.
Note: many recognized from the start that having a single highly toxic protein (in a rapidly mutating region of the SARS-CoV-2 virus) be mass-produced within the body would lead to a large number of injuries and the virus rapidly mutating to a strain not covered by the vaccine. As such, a longstanding debate has existed over exactly why Pfizer, Moderna (and the FDA which approved their vaccines) chose what was clearly a bad design for the vaccines which would be pushed upon the world.
The least evil explanation I have come up with is that all the vaccine companies knew that whoever was the first to produce a vaccine that appeared to create immunity would likely be given a massive market. Pfizer and Moderna in turn prioritized what they thought would be the fastest and most reliable way to do that (using the vaccine to mass produce the most immunogenic part of the virus) in the body, knowing full well that the FDA, in line with its past actions (e.g., towards Gardasil) would ignore the evidence of harm created by this strategy.
Similarly, a case can be made that the reason the experimental mRNA technology was chosen (despite its innumerable safety concerns) was simply that of the existing vaccine platforms, it had by far the shortest production turnaround time. For context, Fauci and others had worked for years to develop the mRNA platform so that it could be used to make flu shots closer to the flu season, as the existing method required production to start long before it was realistically possible to know what the circulating strains would be (and hence what to put in the vaccine—which is why flu vaccines often have the “wrong” strain each year).
Why Does Dose Toxicity Vary?
Since I first entered medicine, I observed that some patients were much more sensitive to medications than others were. Yet, each time I tried to raise this point with my supervising doctors, they would insist it had to be something else (e.g., pre-existing psychiatric issues of the patient) because the dose the patient was taking was “appropriate.”
Over time, I began to realize that most people don’t understand how drug doses are chosen and don’t realize that the dose they see is a weighted average that does not account for the more sensitive members of the population. To a large extent, I sympathize with why things are this way, as it would be very difficult to run a medical system which quickly sees a large volume of patients (e.g., it would take much more than 30 seconds to prescribe the correct dose of a drug), but at the same time, it also makes a large demographic exist for which standard medicine care simply does not work.
In a recent article, I shared some common examples of why individuals can be more sensitive to the effects of medications:
•Age—as you become older, your body becomes less able to tolerate toxic pharmaceuticals. For example, the kidneys and liver are responsible for clearing drugs from your body, and since their function declines with age, the elderly often cannot tolerate the same dose of a drug that a younger person can. Likewise, as you age, your arteries become less able to reflexively bring blood to your head when the blood pressure drops there, and as a result, if we medicate the elderly down to a blood pressure younger adults can easily tolerate, it far too frequently results in them becoming light headed and passing out (which is a huge problem because of the severe harm falls often cause to the elderly).
Conversely, premature infants are less able to tolerate vaccinations than normal weight infants, and as a result, neurological disorders and sudden infant death syndrome following vaccination are much more common in those children. Nonetheless, because vaccines are assumed to be a 100% safe and effective, ways to prevent toxic doses (e.g., by vaccinating later in life or spacing out vaccinations) are never considered within the conventional medical system.
•Gender and Race—significant differences exist in how different ages and genders respond to many medications. Unfortunately, in the same way that drugs frequently given to the elderly are rarely tested on older patients in clinical trials (since to make a drug look “safe” it has to be tested on those least likely to be injured by it—which is typically young healthy adults) it is rare drug trials will assess for gender specific responses to a drug and rarer still that racial differences will be evaluated. Furthermore, in the name of DEI, there has recently been a push in the medical field to remove many of the metabolic differences that had been observed between different races (and affected their appropriate medical management).
Note: one reason many suspected SARS-CoV-2 was a race-specific bioweapon is because a lot of research has been done on racial differences in the ACE2 receptor (since many common pharmaceutical drugs target it) and because it was observed that the spike protein’s ACE2 affinity significantly varied by race—something which in theory was possible to design ahead of time due to the preexisting ACE2 research.
•In addition to demographic factors (e.g., age, race, sex) affecting one’s response to a pharmaceutical, genetic variations can as well. For example, the P450 enzymes play a pivotal role in liver detoxification, and as a result, P450 function directly affects how long a drug will stay in the system and what the resulting appropriate dosage is for it. On one hand this is considered in medicine since certain drugs are known to increase or decrease P450 function (decreasing is more common), although typically, the main reason we hear about this is because grapefruit juice also does that (to a moderate degree), so patients are often told not to drink it in conjunction with a variety of medications.
Note: during my training while at a rotation in a hospital where I didn’t know anyone or have access to a kitchen, I decided to go on an all fruit diet for a month instead of eating from their cafeteria. Since I ate grapefruits I brought with me each day at lunchtime, I received a lot of concerned comments from physicians and medical residents about how doing that could be dangerous—something I never heard them say about any the pharmaceuticals so many people there were on.
More importantly, significant genetic variations exist in P450 function that are virtually never considered. One of the more tragic examples can be seen with SSRI antidepressants. A long standing problem with those drugs is that a certain portion of people who take them become violently psychotic and then either kill themselves or others (e.g., in a school shooting). Many of the stories are quite horrifying and subsequent lawsuits those killings initiated showed these side effects were observed throughout the clinical trials and then covered up.
Forensic investigations in turn have been conducted to determine what caused the individuals to turn psychotic. One common thread was the individual having a genetically reduced P450 function, which in turn caused the individual to develop dangerously high levels of the SSRI in their bloodstream. For example, in one study evaluating 10 patients suspected to have this issue (due to them becoming violent after starting an SSRI), all ten were found to have a genetically altered P450 function, and all ten become normal once their SSRI was terminated.
This is important because very few physicians who prescribe SSRIs are even aware of the P450 issue, so it is something never screened for when the SSRIs are prescribed. Likewise once an individual starts developing early psychotic symptoms, it is rare for the physician to attribute that to the drug (rather they often assume it arises from insufficient dosing and hence give the patient more of the SSRI).
In addition to these examples, many other ones also exist. For instance, evidence exists showing that some individuals cannot mount a sufficient immune response against the SARS-COV-2 spike protein (not enough antibodies are produced). As a result, if those individuals are vaccinated, they will have free spike protein floating in their blood which then can wreak havoc throughout the body and this was exactly what was found in a study of young athletes who developed myocarditis after the vaccine.
Note: this argues that the vaccine only “worked” for people who would have already been able to survive a COVID-19 infection, which curiously was the exact same thing observed with the early smallpox vaccines—something many (myself included) consider to be one of the deadliest vaccines in history.
Selecting the Correct Dose
All of this article hence begs the question—how does one determine what the correct dose is for a patient? I believe the single most important thing is simply the awareness the dose you assume you should use may or may not be correct.
In turn I typically use a few strategies:
•Do what I can to become aware of the therapeutic window of the medication I am using. Some medications are fairly safe and extremely unlikely to create issues at normal doses in most patients, others are much more likely to cause issues for some of the people you give them to. The primary problem with this strategy is that it requires you to be honest with yourself over the side effects the medications you prescribe cause and I frequently observe well-intentioned doctors being able to spot if drugs other doctors prescribe cause issues but almost never are able to see when theirs do the same thing.
Note: one area this has come up recently for me is with LDN. Even though I am a fan of the therapy (and it is often very helpful for things like COVID-19 vaccine injuries), I’ve also seen a quite a few people who do not respond well to it or test for it. Similarly, I’ve seen numerous patients who looked like a perfect fit for LDN, but once they started it got worse and eventually learned that if someone is too depleted, they cannot tolerate the small endorphin blockade LDN initially creates.
•Have labs you are familiar with that can determine if a patient is at a higher risk from a specific pharmaceutical and indicate if the desired effect of a medical regimen are occurring or if any unwanted effects are occurring. I am personally not a fan of this approach because it is often quite costly for the patient, and I feel the lab results (especially the newer non-standard ones) often have a very weak correlation with how the patient is doing (which many are now discovering for COVID vaccine injured patients). However, while I and most of my colleagues are not as lab focused in our practice, I also know holistic physicians who have taken the time to really understand a few of them and effectively use them to guide appropriate dosing for their patients.
•Be aware of what nutrients drugs commonly deplete in the body, and be able to recognize if your patient may have a pre-existing deficiency of that nutrient prior to when you start the pharmaceutical.
Note: Suzy Cohen, in her book Drug Muggers has made a good case that many of the side effects we attribute to medications are a result of them causing critical nutritional deficiences.
•Evaluate if I am dealing with a more sensitive patient. Often I can quickly tell if this is applicable as sensitive patients have a variety of unusual characteristics and a very distinctive presence (that constitutional archetype is discussed further here). However, in many cases, you need to review their history and see if they’ve had any past experiences which suggest they are more susceptible than the average individual to a bad reaction from a drug.
•Learn what can be expected to occur with lower doses of a pharmaceutical.
•Start with a lower than normal dose of a therapy, evaluate what happens, and if it seems justified (no harms have occurred and the benefits are not sufficient for the patient), gradually raise it. This approach is much less likely to create adverse events for a patient, but it also much more time consuming to do, so patients who have not already been injured by pharmaceuticals are often unwilling to tolerate continuing to experience their symptoms as they wait for you to gradually increase them to an appropriate dose. For this reason, it’s important to have patients who are willing to go slowly and can afford the extended number of visits doing this requires. In many cases this is simply not viable, and both I and many of my colleagues have had numerous cases where we escalated a dose for a desperate patient faster than we had originally planned to and then regretted doing so once they had a significant reaction to that (still relatively low) dose.
Note: evaluating the effects of the therapy requires frequently carefully observing the patient for subtle signs of a change—as subtle signs the body is not tolerating a medication typically emerge before more overt ones.
As a result, figuring out how to balance all of these constraints is a bit of an art. Fortunately there are a few unorthodox tricks people have found over the years that greatly help.
Note: appropriate dosing does not only apply to pharmaceuticals—it can apply to everything you suggest to patients. For example, I’ve found red-light therapy (like the ones discussed here) can be extremely helpful for vaccine injuries, but only if they are dose appropriately and I recently had a patient share that they had a profound improvement in their quality of life once they had learned how to correctly self-dose the red-light therapy I had prescribed to them.
Lastly, the ideas laid out here also should be considered by patients. If you experience an adverse change or something simply feels wrong, you should be open to the possibility it is due to the drug. Many patients who developed chronic injuries from a toxic pharmaceutical have told me that one of their greatest regrets was listening to their doctor instead of their intuition or their body when they decided to go forward with taking the pharmaceutical that then ruined their life.
Intuitive Approaches to Medicine
Note: One of the biggest things I struggle with when writing this newsletter is which specific topic to cover. This is because many of the subjects I want to bring up are less important to share now than other current topics, many of the topics I bring up are far outside the acceptable range of discourse (so I am always unsure how this audience will receive them), and many of the ideas I want to put forward are contingent upon not generally recognized premises. Because of this, I’ve essentially laid out a mental road map of what I want to cover and the order it needs to go in, and since then, as time allows, I’ve slowly chipped away at that list of topics and gradually felt safer going into more controversial waters.
Over the course of my career, I’ve had the good fortune to work with some of the most talented physicians in the country who frequently can solve difficult cases other doctors are stumped by. In turn, I’ve put a lot of thought into trying to recognize what all of these doctors have in common (which I attempted to detail here).
One of the most important characteristics they all shared was using some type of “medical intuition” to decide what approach was best for the patient when the correct choice was otherwise ambiguous. In many cases, I’ve felt without this ability to directly evaluate how someone reacts to a potential therapy, it’s either impossible (or incredibly time consuming) to determine the correct therapy for someone.
Unfortunately, while style of medicine can get remarkable results (and is often where many of the innovations and protocols which later get used throughout the holistic medical field ultimately originate from) it suffers from three major issues:
•The majority of people who practice “intuitive” approaches to medicine do not integrate them with a comprehensive body of medical knowledge. As a result, medical intuitives frequently give useless or harmful advice based off of what they observe—which understandably casts the approach in a very bad light.
•If you look across the country, there is often a surprising degree of variation in how illnesses are treated (termed regional variations in the standard of care). In most cases, those variations are ignored—but when they conflict with the vested interests of the medical system (e.g., using off-patent drugs to treat COVID-19), they are attacked and any inconsistencies within them are focused upon.
In the case of intuitive approaches to medicine, they have an inherently high degree of inconsistency, since those approaches are both based on the skill of the practitioner and the practitioner’s own subjective experience. My own experience has been that the people who have the reputation for being the best in the field tend to come to the same conclusions the people I trust do, but outside of that there is a massive amount of variation in what medical intuitives proclaim and I often find myself strongly disagreeing with many of them.
•This approach to medicine is understandably “taboo” since it goes against the materialistic foundations our society is based upon which argue that the mind is separate from the body and our tissues lack any degree of consciousness. As a result, numerous well-known figures in the holistic medicine field (who often get very good results) have confided in me that they actively utilize things like applied kinesiology to decide which protocols to use or endorse, but they have likewise refused to ever publicly admit that as this would destroy their credibility.
Note: I previously published my perspectives on what constitutes the “optimal diet” for human beings. Given that for decades opinions have repeatedly changed over just what that diet is and than I’ve lost count of how many people I’ve known who fanatically pursued a diet for health reasons which either did nothing for them or worsened their health, this suggests that there is no universally correct diet and that what is ideal for one person is likely not for another.
One of the fascinating (and disconcerting) things I discovered after I started learning how foods tested on patients was that not only did the optimal diet vary person to person (often in ways I would not have predicted) but it also often varied over time for the same person, meaning that what might be correct to eat today was not correct tomorrow. For this reason, I believe that while there are some dietary rules I feel relatively confident in and frequently see patients benefit from, I often find unless patients actively test which foods are correct for them, the benefits they are hoping for from their diets simply do not materialize.
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One of the most common approaches healers use to determine if something is “good” or “bad” for someone and how to appropriately dose what they do is applied kinesiology, colloquially known as “muscle-testing.” A lot of people use this approach, so many of you have likely run into someone who did it and likewise numerous resources exist can be found about it online.
Like many other intuitive approaches to medicine I have come across, it is frequently immensely helpful, but also highly controversial and prone to immensely variable results depending on who performs this assessment of the autonomic nervous system. For that reason, I’ve spent a lot of time trying to understand how it works and how it can best be utilized for both patients and practitioners. Additionally, as I’ve gained a broader understanding of the principles at work, I’ve also come to understand that quite a few of our leaders use some variant of this method to make many of their decisions (with a few public figures having openly admitted to doing so).
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