PAAM Medical Letter, Vol. 9(1), March 3, 2022
PAAM Medical Letter
Vol 9, Issue 1, Mar 3, 2022
Dear Colleagues!
Here is the latest edition of the PAAM Medical Letter. Thank you for being part of the Anthroposophic medical movement and for supporting PAAM and this letter.
Please note: This Letter is for your thoughtful consideration and personal research, and is not to be taken as something dogmatic to believe in nor promote as something official from PAAM or the international anthroposophic medical movement.
Meditation
Meditative Verses
Every idea that does not become your ideal slays, kills a force, a power in your soul; every idea that becomes your ideal engenders life-forces with you.
Rudolf Steiner, Knowledge of Higher Worlds and Its Attainment, Chap 1, Conditions, CW 10, 3rd Edition, 1947
Where lie the sources of life?
They lie in what kindles the moral ideals that inspire us.
And so we can start to see that when we allow ourselves to be warmed
through and through
and illumined by moral ideals in the present life, these will bear life, tone and light [ethers]
out with us into the cosmos and become world-creative powers.
We bear world-creative powers out into the cosmos, and morality [moral ideals and virtues]
is the source of these creative powers.Moral ideals [from lucid moral and spiritual enthusiasm] stimulate the warmth organism,
Generate [etheric] light sources in the air organism,
Generate [etheric] tone sources in the fluid organism,
Generate life embryos [seeds of life ether] in the solid organism.While theoretical ideas [also utilitarian and materially oriented ideas]
Cool the warmth organism,
Inhibit/paralyze light sources in the air organism,
Deaden tone in the fluid organism,
Extinguish life in the solid organism. [This leads to dead substance.]
Rudolf Steiner, From Universality Spirituality and Human Physicality. Bridging the Divide. CW 202.
Calendar of the Soul
Verse #46 The Ahrimanic Deception
The world, it threatens to benumb
The soul’s inborn strength;
Now you, memory, come forth
Out of spirit depths, shining outward
And strengthen my beholding [spirit vision],
Which only through will-forces
Can sustain itself.
Virtues of the Month
Aquarius (1/21 – 3/1): Discretion, reticence becomes meditative strength, meditative capacity
Pisces (2/21 – 4/1): Magnanimity becomes love
Medical and Relevant Literature
Attachment 1: This is a recently published article in the Der Merkurstab, the German journal for Anthroposophic medicine. The Brazilian and Argentinian authors report their experience with using an herbal tincture of Chelidonium majus, a well-known medicinal plant in AM. They give their rationale for choosing Chelidonium, e.g., the vitality of this hepatobiliary herb to combat the hyperactivity of the astral body in COVID-19, the liver being the seat of etheric vitality, the balancing of astral and etheric vital forces by the plant, and the compatibility of Chelidonium’s homeopathic picture with prominent symptoms in COVID-19. They report their experience of using fairly high doses of the tincture in 20 COVID-19 patients and they also have additional positive clinical success in another 110 cases. The authors also point out Steiner’s addressing the “weakness of hesitant souls” during a pandemic (specifically, the 1918-1920 influenza pandemic) by appealing to three qualities necessary in the human soul: the strengthening of the will, the working to overcome selfishness, and the development of compassion. In this mantric verse, titled Spirit Triumphant, he gave in September 1919 in an esoteric lesson, Steiner powerfully and radically calls out to modern souls, and certainly when in the midst of a pandemic, their need for inner transformation, for a new soul-spiritual orientation that would result in less predisposition to pandemics:
Victorious Spirit,
Flame through the weakness of hesitant souls,
Burn out the ego addiction[of self-seeking],
Enkindle compassion.
That altruism,
The life stream of mankind,
Flows as a source
Of spiritual rebirth.
Attachment 2: Here’s a helpful summary of recent research by Scripps Research Institute on rosemary submitted by PAAM member, Alicia Landman-Reiner. It turns out that rosemary has carnosic acid and this can block the interaction with COVID-19 SARS-CoV2 outer spike protein and the ACE2 protein receptor the virus uses to enter respiratory epithelial cells. Carnosic acid also has anti-inflammatory effects which should also be helpful in COVID-19 hyperimmunoinflammatory response in severely ill patients. All the research is preliminary at this point. The carnosic acid is a safe, unreactive form and is only converted into its active anti-inflammatory form by inflammation and oxidation. In AM rosemary preparations are used to treat type 2 diabetes mellitus, various inflammatory conditions, hair loss, fatigue, and also ,in many Bambusa preparations, to treat various spinal problems, including inflammatory ones. Other medicinal herbs (not including many supplements and vitamins) found to have some possible effect on COVID-19 include quercetin with bromelain and curcumin.
Attachment 3: This is the recent published VITAL RCT that looked at vitamin D 2000 IU/d and omega-3 fish oil supplementation 1 g/d (with EPA 460 mg and DHA 380 mg) for 5 years in the prevention of autoimmune disease in a general US older population. The results confirm that vitamin D alone, but better with added omega-3, does decrease the incidence of confirmed and probable incidence of autoimmune disease (Hazard Ratio = 0.69, (CI 0.49-0.96), for definite autoimmune disease and HR= 0.71, (CI 0.55-0.92) for probable autoimmune disease). Vitamin D by itself may be nearly as good. This was a well-designed and relevant RCT since there is no conventional treatment available to prevent autoimmune disease. The results were even better if the first two years of the trial data was excluded, presumably to give time for the known immunomodulatory and anti-inflammatory effects of both substances to work. The study also found that vitamin D only significantly worked (HR = 0.62, (CI 0.42 – 0.93)) in subjects with BMI < 25. This has also been found in another study. There are additional interesting details in the study.
Attachment 4: Here is a helpful 1-page commentary and reflection by the senior author, Karen Costenbadder. The authors plan necessary ongoing, post-observation of VITAL participants to answer important questions in terms of durability of the findings, the possible genetic and lifestyle risk factors, and the comorbidities, that may be interacting with the supplements. As we all likely suspect, diet and other lifestyle factors probably play a significant role in the development of autoimmune disease.
From a conventional point of view, the study dose of vitamin D (2000 IU/d, plus up to 800 IU/d that participants were allowed to take on their own) is safe. However, vitamin D has lead-like effects in terms of hardening (sclerosis) and should not be taken without adequate vitamin A (as found in cod liver oil) to counteract the sclerosing effects of vitamin D. Cod liver oil brands have varying amounts of the ratio of vitamin A to vitamin D in them, anywhere from a ~2:1 up to about 10:1. What the right ratio should be is unknown, but my opinion is that it should be from 5:1 to 10:1. One note of caution- If you use the 10:1 ratio of vitamin A to vitamin D, at 2000 IU/d of vitamin D the amount of vitamin A is 20,000 IU/d, which risks long-term toxicity from it. A good and safe amount of chronic vitamin A supplementation is no more than 10,000 IU/d. We don’t know what the optimal and safe dose of vitamin d is. If you use cod liver oil, most brands have around 400 IU of vitamin D in 1 tsp. You would then need to take 5 tsps daily to get the vitamin D dose used in the study and you will need to assess for a potentially toxic dose of vitamin A dose in the 5 tsps.
Attachment 5 and Attachment 6: These attachments go together. The first is a ~1-page commentary and summary of the results of the other study on investigating for a possible link between immune-mediated diseases and an increase in cancer risk. The overall multivariable Hazard ratio, HR, was overall very modest at 1.08, indicating a significant, but not a clinical, risk. However, looking at specific immune-mediated diseases and organ-specific cancers, there were higher HRs, ranging from HR = 1.25 and up to HR= 42.12. The specific immune-mediated disease (not just autoimmune disease) linked to organ-specific cancers are listed in Table 2 of the study article: the HR asthma and lower airway cancers (below the epiglottis) was 1.34, for ulcerative colitis and colorectal cancer was 1.73 and for extracolorectal cancer was 1.30, for inflammatory bowel disease (any type) and colorectal cancer the HR was 1.54 and for extracolorectal cancer it was 1.25, for celiac disease and small intestinal cancer it was 6.89, for idiopathic thrombocytopenic purpura and hematologic cancer the HR was 6.94, for primary biliary cholangitis and hepatobiliary cancer it was 42.12 and, lastly, for autoimmune hepatitis and hepatobiliary cancer the HR was 21.26. As the commentary points out, this is still a preliminary, hypothesis-generating study that needs confirmation.
5. Stewart, D. R. (2022). Insights Into Immune-Mediated Disease and Cancer Risk—Delivering on the Promise of UK Biobank Big Data. JAMA Oncology, 8(2), 219–220. https://doi.org/10.1001/jamaoncol.2021.5572
Attachment 7: This is an article that focuses on clinical practice and how to use rapid diagnostic testing for SARS-CoV-2. It gives helpful, clinically relevant information on how to diagnose COVID-19 and how the different tests operate as well as the pathophysiology linked with the timeline of viremia, antigenemia and immune response. See helpful Figure 1. It also gives helpful background information for the strategies recommended and the evidence for them, as well as areas of uncertainty. This seems to be a useful clinical review article that can be helpful in your practice.
Attachment 8: This scholarly review is on the diagnostic testing for COVID-19. It provides more background information than the more practical article above. It’s Figure 1 is also quite good and has overlapping information with the above article’s Figure 1, but also adds additional information on viral load that is helpful. I found a few statements that are incomplete or misleading: 1) They quote a 2020 Danish article on the protection of reinfection from natural immunity as 80.5%. However, there are other articles, both clinical, epidemiological and immunological that show a range of protection of reinfection from 80-100%. One study found that natural immunity protection from reinfection with serious COVID illness in non-elderly healthcare workers was 93% (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00675-9/fulltext). Of course, the elderly have higher infection rates and lower protection rates from reinfection after natural immunity; 2) It is not true when they state that “Until now, there is little evidence that SARS-CoV-2 antibodies confer durable immunity to reinfection.” There have been a host of studies that demonstrate the durability of naturally acquired antibodies to provide durable protection. Even the CDC has reversed itself and now admits that natural infection provides effective and durable immunity to SARS-CoV-2; 3) At one point the authors of the review state that the emergence of SARS-CoV-2 variants places in doubt commercially available immunity passports, but don’t state there that this would be true for vaccine passports as well. Only later do they mention that the waning of vaccine-induced immunity also puts the value of vaccine passports in doubt; 4) They assume and state that real-time PCR test are very specific and sensitive, but without providing any references. We do know that the positive predictive value (PPV) and negative predictive value (NPV) of PCR tests, depends on the prevalence in the population. The lower the prevalence the COVID-19 in the population the worse PPV and NPV. Also, the accuracy of PCR tests depends on the primers used; they may cross-react with other RNA viral particles, making the specificity less. Lastly, high cycle time numbers previously recommended by the CDC (up to 45 cts) means there was a lot of false positives and lower specificity. While laboratory-based studies show high sensitivity and specificity, in clinical practice this seems to be rarely achieved. See “Real-life clinical sensitivity of SARSCoV-2 RT-PCR test in symptomatic patients”
https://doi.org/10.1371/journal.pone.0251661.
Not all clinical studies of PCR testing, however, have such modest results.
Attachment 9: This last attachment, The Progressive Case Against Medical Mandates by Nate Doromal, offers a different perspective from what one finds in the media about how liberals are for vaccine mandates and conservatives are often against them. Nate argues that the twin pillars of progressivism are economic justice and civil liberties, and that medical mandates threaten both of them. He also argues that the three conditions/criteria necessary for medical mandates are not met, i.e., COVID is an overwhelming fatal danger to the population; COVID vaccines are necessary, effective, and the only or least oppressive solution to that danger; and that the vaccines themselves pose no serious risks, no possibility that they might cause other harms equal to or greater than the specific danger of COVID. He argues that all three premises are incorrect and unsupported by the data. Read for yourself and decide.
Thank you for taking time to read this medical letter!
On behalf of the PAAM Board, and to you, our valued colleagues,
Ricardo R. Bartelme, M.D.
Emeritus Assistant Professor
Department of Family Medicine
University of Michigan Medical School
Ann Arbor, Michigan, USA 48109