The Goldberg Clinic


Paul A. Goldberg, MPH, DC, DACBN
Clinical Nutritionist, Clinical Epidemiologist, Diplomate of The American Clinical Board of Nutrition, Certified Natural Hygiene Practitioner

"Causes Identified... Causes Addressed... Health Restored"

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Patient Information
Before After
Diagnosed With
Rheumatoid Disease & Ulcerative Colitis

Physicians told Dr. Goldberg as a young man that he would be permanently crippled by severe rheumatoid disease, accompanied by advanced ulcerative colitis, environmental allergies, chronic fatigue and psoriasis (see picture on left). Through the study and disciplined application of nutritional biochemistry, clinical epidemiology and natural hygiene, he recovered his health (current picture on right).
Since that time, for over thirty years, Dr. Goldberg has successfully helped chronically ill patients from across the U.S. recover from a wide variety of difficult, chronic, conditions by carefully seeking out and addressing the individual causes of ill health.
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Patient Information


Patient Testimonials





For the article as pdf-file (abbreviated) - click here:
Infinite Variety




PAUL A. GOLDBERG, M.P.H., D.C., D.A.C.B.N.

Infinite Variety: An Introduction To Biochemical Individuality
(Part II)



  • INTERNAL AND EXTERNAL SYSTEMS
  • THE IMPORTANCE OF PATIENT HISTORY
  • ENVIRONMENT/HYGIENIC FACTORS
  • EACH PATIENT PRESENTS UNIQUE CASE
  • THE PITFALLS OF DIAGNOSTIC TITLES
  • WHAT SHOULD ONE DO FOR CONDITION "X"?

  • An allopathic physician, Sir William Osler (1849-1919), said,
      "It is much more important to know what sort of patient has a disease than what sort of disease a patient has."

    In the introductory article to this series, I discussed the enormous variations that exist between people and how each person is biochemically unique. We discovered how the traits that make us unique fall into two categories: genetic factors (our genotype); and environmental factors.

    "It is much more important to know what sort of patient has a disease - than what sort of disease a patient has."

    It is the interplay between these two that determines what health and disease traits we express (our phenotype). Now, we will examine applications of these concepts and the errors made when relying on diagnostic categories alone to determine the course of patient care rather than the individual traits of the person with the disease.

    Health care has long been one-dimensional, viewing a variety of diseases but not the individual patient who has the disease. The idea of a holistic approach (mind, body and spirit) has been increasingly promoted in recent years. What should be added to this is the need to also take an individualistic approach unique to the situation of each patient.

    Part one discussed the 64 trillion genetic (and therefore biochemical) variations possible from one person to the next and how they play a major role in determining biochemical individuality. Imposed upon this are variations that occur due to living in different environmental conditions across planet Earth. Thus, there are external and internal factors that influence the individuality of each person.

    Claude Bernard supplemented the contributions of Darwin's concepts of survival of the fittest and evolutionary adaptation by proposing that health depends upon a constant interplay between the internal and external environment of the individual.

    He emphasized that
      "at all levels of biological organization, in plants as well as in animals, survival and fitness are conditioned by the ability of the organism to resist the impact of the outside world and maintain constant, within narrow limits, the physiochemical characteristics of its internal environment."(1)

    The idea of a holistic approach (mind, body and spirit) has been increasingly promoted. What should be added is the need to take an individualistic approach unique to the situation of each patient.


    INTERNAL AND EXTERNAL SYSTEMS
    The act of living involves the interplay between the internal and external systems:
      • The internal environment — operating within a certain set range in each species. The differences within that set range, however, create significant differences between one animal and the next animal of that species.
      • The external environment — in which the animal interacts with the elements of nature with which it is in constant contact. There is a state of constant flux between the animal and its environment with short-term changes from day to day, moderate changes season to season and dramatic changes from eon to eon.
    These two systems (the internal and external environments) change on an ongoing basis in and of themselves and in relationship to each other. Therefore, the one constant for us, biologically and health-wise, is change. To survive and thrive, an animal must make constant modifications to these changing relationships, which in turn affect both its own biochemical individuality and, to a lesser role (in the short term), that of its descendants.

    A patient's internal environment (metabolism/biochemistry) and external environment (climate, occupation, social and cultural factors, etc.), likewise need to be considered individually, as well as the interplay between the two, in order to ascertain what is required for that patient's best interests.

    René Dubos, in his classic The Mirage of Health, commented on these relationships:
      "Ancient physicians knew that the severity and prevalence of various diseases differed greatly according to the geographic area, the time, the social customs, the economic status and the occupation. In the past, this dependence was emphasized chiefly with reference to the "fevers," simply because infections like malaria were so common. It is becoming clear that the environment plays a large part also in determining the prevalence of the diseases most talked about in our times — defects of the cardiovascular system, cancers of various types, peptic ulcers, mental disorders, etc. This is evident from the fact that, as was the case for the fevers in the past, the frequency of the modern diseases differs from one place to another and varies with economic status and professional activities."(2)

    Environmental influences, such as heat, cold, noise, toxins in food and water, air pollutants, etc., may bring about immediate or delayed, acute or chronic problems in the individual state of health. Environmental influences are not only significant in the short term to the individual, but also to the species' long-term characteristics. Radiation is an example.

    Dubos points out:
      "Throughout his life and evolution, man has been exposed to a background of radiation from natural sources. This normal background, which seems to have remained fairly constant, at least in geologically recent times, must therefore be a tolerable factor of human environment. But any increase in dose rate of radiation is likely to increase the rate of mutations — with unforeseeable consequences. It is unlikely that adaptive processes can occur fast enough to cope with the potential long-range dangers if man-made radiation continues to increase at its present rate."(3)

    Professionals who utilize radiographic studies should be cognizant of this, as they not only can adversely affect the patient receiving the radiation but also create hazards for future generations. This may in turn create new and likely negative kinds of "biochemical individuality" with adverse effects that might have been avoided.(4)

    A patient's internal environment (metabolism/biochemistry) and external environment (climate, occupation, social and cultural factors, etc.), likewise need to be considered individually, as well as the interplay between the two.
    THE IMPORTANCE OF PATIENT HISTORY
    The nature of biochemical individuality and the influence of internal and external factors on the individual underline the importance of conducting a thorough patient history, taking time to understand the role environment has played in the development of disease and how it influenced the biochemical state.
    This includes past and present home, occupational and social environments and their interactions with the patient.
    The tools for accomplishing this are:
    1. Taking the time to thoroughly discuss the patient's background.
      There is no special X-ray, laboratory test, adjusting technique or any device that can take the place of allowing the time to dig into the patient's background thoroughly. I generally allow the first half-hour of the patient's one-hour initial visit for this interview process, in addition to having the patient fill out a comprehensive patient history form before the interviewing process begins.
      Skill is required to ask the right questions of the patient, listening carefully to the answers, and putting the pieces of the puzzle together as a good health and disease detective. Application of the principles of natural hygiene, epidemiology, toxicology, social sciences and good interviewing skills are all useful in uncovering the circumstances that have contributed to each patient's illness. We must think and feel our way through with each patient, bringing to bear both objective and subjective reasoning powers.

    2. Developing an awareness of the role a wide range of environmental factors play in disease production.
      The vital roles of air, water, food, sunlight, noise and other environmental factors must be appreciated, not simply passed off with a few simple questions as to if the patient "drinks enough water, gets enough rest and eats a good diet." Exploration of these and other environmental/hygienic factors need to be performed in detail, for it is here where many disease problems have their roots.
      It is to be expected that by thoroughly interviewing the patient and recording their history and influential environmental factors, we will have a good idea of what is wrong with the person (i.e., etiological factors) before we proceed with the physical examination, and appropriate laboratory and/or radiological studies.
    We must think and feel our way through with each patient, bringing to bear both objective and subjective reasoning powers.


    ENVIRONMENT/HYGIENIC FACTORS
    Few doctors emphasize the major role that environmental-hygienic factors play in their patients' diseases, and only a few are experienced with the application of environmental-hygienic principles in the recovery process of their clients.

    A small, but active group of practitioners focus their attention on the hygienic care of their patients. For such practitioners, the role of environmental and hygienic factors in health and disease causation is paramount.
    They are, in practice, the descendants of the ancient physicians of the school of Hygeia, who was a goddess of reason and the guardian of health. She symbolized the belief that men would live in good health if they lived according to reason (i.e., natural laws). For many years, Hygeia symbolized the virtues of a sane life in a healthy environment (mens sana in corpore sano).

    For these doctors, the study of environmental factors as etiological factors in the health and disease states of their clients is an art and a science. Hygienic practitioners understand that environmental factors frequently play the major role in disease causation.
    For doctors who have not witnessed the role environmental factors play in health and disease, a visit to a Natural Hygiene Institute is most enlightening. Here, environmental-hygienic factors, such as rest, sleep, appropriate diet, fasting, sunshine, clean water, freedom from emotional stressors and tranquil surroundings, are given primary emphasis.

    Here, patients without any "treatments" get well from a wide variety of disorders as they are placed in an environment that supplies what the body requires (as per individual needs) and avoids those things that are harmful. In such environmental conditions, the body optimizes its healing potential, as each patient is provided what is needed in their own case. A further discussion of this will be presented in part three of this series.

    For doctors who have not witnessed the role environmental factors play in health and disease, a visit to a Natural Hygiene Institute is most enlightening.

    EACH PATIENT PRESENTS UNIQUE CASE
    It has proven easier, but not effective, for health-care practitioners to treat patients as diagnostic groupings rather than as complex individuals. This includes both the allopathic physician, who sees the patient as his "diabetic, heart disease or rheumatoid arthritis case," or the chiropractor who sees the patient as his "C3 subluxation case, his auto accident case, his low back pain case or his workmen's compensation case."

    There are six billion people on the planet, but only a few hundred relatively commonly used disease classifications.
    Allopathic classifications can be accessed in the Merck's Manual to have a ready-made "care program" for each disease state.

    Sidney Baker, M.D., comments on the need to treat the individual — not a diagnostic category — in his book Detoxification and Healing, and why the health professions have been slow to do so:
      "We human beings are quite consciously aware that each of us is different from everyone else. I don't think that the notion of our individual uniqueness is a conceit. It is firmly based on biology and probably is enhanced by the fact that our habitat has changed as much as that of any creature during the last few thousand years of migration, the establishment of agriculture and the addition of thousands of new chemicals to the human environment."

    "However, it is easier to group people to avoid the complexity of thinking about and treating each person as an individual. Supposing I were to fill out an insurance form for Seth Hammer and report that he has Seth Hammer's disease and that I am giving him the Seth Hammer treatment … this does not help with insurance forms.
    It has been 40 years since Roger Williams' research and writing introduced a new paradigm for medicine backed by solid scientific research. It is not a lack of science that has retarded the blossoming of a medical practice focused more on individuality. It has more to do with the inertia of a medical hierarchy that yields slowly to change and the strong investment of various levels of the hierarchy in treating diseases, not individuals."(5)

    [Note: This same unfortunate phenomena is sometimes seen with the chiropractic profession. There are some chiropractors who depend on third-party payers, playing the requisite medical diagnostic categorization games and toeing the line to the HMOs and PPOs in how they will care for patients and what they will "treat." The result of this dependence on insurance carriers is one "treats" diagnostic categories and no longer cares for the individual nature of patients. The doctor becomes a slave to the insurance companies and creates a new kind of patient, one who seeks out their doctor not based on his/her skills, but rather as to who will take "insurance assignment."]

    There are many "natural therapy books" for the drugless practitioner.
    From arthritis to zoster, each "disease" is listed and a standard protocol is given for one with that diagnosis. Such books differ little from the Merck's Manual, except that the "therapies" are composed of herbs, diets and other "natural" nostrums, as opposed to pharmaceutical or surgical remedies.

    In both cases, symptoms are addressed, i.e., the names of the disease entities. The needs of the individual patient and his/her unique traits that led to the development of the disease are left untouched.
    It would be wise for doctors to minimize use of such recipe books. Such books are the tools of the novice practitioner who fails to recognize the need to address each patient individually and mistakes the name of the disease for what is wrong with his patient.
    If practitioners use such books (whether the remedies are drugs, herbs, diet or other therapies) to formulate patient care, they should be candid about it. Give the patient the book, and send them home to follow its directions!

    It would be wise for doctors to minimize use of such recipe books. Such books are the tools of the novice practitioner who mistakes the name of the disease for what is wrong with his patient


    THE PITFALLS OF DIAGNOSTIC TITLES
    I became painfully aware of the pitfalls of such diagnostic schemes and how they ignored biochemical individuality in 1976 when suffering from auto-immune rheumatic disease problems (metabolic arthritis).
    The diagnoses given were based on my symptoms (fatigue, joint pains and tremendous stiffness).
    One physician labeled my condition lupus; another diagnosed ankylosing spondylitis; the third labeled it mixed connective tissue disease, and the fourth noted psoriatic arthritis, each one attempting to closely match the symptoms with a name.

    In each case, the symptom-based treatments were virtually identical for all four "conditions" (some natural practitioners follow a similar pathway, addressing disease names rather than the individual characteristics of the person). Partially due to this type of confusion with my own health dilemma, I would endure progressive illness for well over a decade before beginning to understand what was involved in my situation and addressing its roots.

    In later years, a chiropractic college professor, learning I had been diagnosed with ankylosing spondylitis, remarked that I must have been misdiagnosed, since anyone with such a problem could not possibly still be walking, standing straight, and able to turn their head freely 14 years later. He had bought into the medical model of disease naming and self-fulfilling prophecies.

    Partially due to this type of confusion with my own health dilemma, I would endure progressive illness for well over a decade before beginning to understand what was involved

    WHAT SHOULD ONE DO FOR CONDITION "X"?
    It has been commonplace for patients, students and chiropractors to inquire of me:
      "Dr. Goldberg, what would you do for a patient with (rheumatoid arthritis, ulcerative colitis, multiple sclerosis, Crohn's disease, infertility, fibromyalgia, chronic fatigue, diabetes or other titles for disease classifications)."
    My reply is simple:
    "I would perform on the patient: a thorough case history, a thorough physical examination, appropriate laboratory and/or radiological studies, based on the case history and physical examination."

    "What if it was heart disease?" they ask.
    Again, I reply,
    "A thorough case history, a thorough physical examination, appropriate laboratory and/or radiological studies, based on the case history and physical examination.

    "But Dr. Goldberg," they ask, now frustrated, "what if it was cancer?"
    Again, I reply:
    "A thorough case history, a thorough physical examination, appropriate laboratory and/or radiological studies, based on the case history and physical examination."

    It is only by taking the time to thoroughly complete these three steps that we learn the patient's individual traits, the hereditary and internal factors at play, the environmental factors and how all these factors interact.

    A similar question received is: "What laboratory studies should be conducted on a patient with diabetes, lupus, multiple sclerosis, etc.?"
    This decision should be based on the patient's case history, physical examination and the individual traits that these investigations expose in that person.

    Based on the information gathered, along with consideration of the patient's desires, appropriate measures can be taken.
    The course of action should always be based on these findings, not on the disease category which the patient had upon entering the office.

    The allopathic diagnostic model has some limited utility. When we read about a medically categorized disease and what its outcome tends to be, we are informed what the natural history of the syndrome is under medical care, with the average patient.

    I was first introduced to the term "natural history of disease" while I was enrolled in a graduate school course in the mid-1970s at the University of Texas. The course reviewed a number of disease conditions, how they presented and how they evolved in the average person. The medical treatment of the problems was a minor aspect of discussion, while emphasis on the history, distribution, signs, symptoms and evolution of the diseases was emphasized. My natural hygiene perspective on health and disease differed from the medical doctor teaching the course, but I respected his experience and found the course informative and insightful.

    The natural history is based on the clinical observations of numerous people who presented over the years with similar signs and symptoms and received similar treatments (or in the purist sense of "natural history of a disease," no treatments at all).

    An understanding can be gained by viewing this as to how patients with these signs and symptoms generally respond to allopathic care and standard living habits. We are thereby informed of the patient's outcome, under a standard regimen of what is commonly composed of drugs and standard living habits of processed foods, chlorinated water, polluted air and stressful lifestyle.

    The many allopathic disease entities with dismal prognoses are evidence of the failures of allopathic medicine with most conditions (particularly the chronic degenerative diseases).

    Reason warrants, however, not to accept these often dismal natural histories as being the only possible outcomes, but rather the likely outcomes under allopathic care and conventional living habits.
    The many allopathic disease entities with dismal prognoses for the patient are evidence of the failures of allopathic medicine with much of the population with most conditions (particularly the chronic degenerative diseases).
    It is also an indictment of the manner in which most live in this culture.
    There is value, nonetheless, in studying the natural history of disease, because it shows both patient and clinician what the likely outcome is under conventional care and an unhygienic manner for most of the disease conditions in our culture. ("Unhygienic" pertains to our lifestyle habits, such as diet, air, lack of rest and sleep, too little or too much activity, lack of sunshine, lack of mental and spiritual pose, inharmonious work and home environments, etc.)

    In our case study records at the Goldberg Clinic, we keep patient testimonial letters, along with independent laboratory studies (sedimentation rates, blood chemistries, etc.) to document the improvements in clients.
    It is important to produce objective evidence of clinical successes (or failures) experienced with clients to validate the outcomes with our clients to others, including health professionals, perspective patients, and the public at large.

    The studies conducted are through independent laboratories. Testimonial letters written by patients include their full names or are not used. These laboratory records and patient letters attest to the common sense approach of implementing a natural hygienic approach specific to the background and individual needs of each patient.

    Two sets of case studies, one regarding two patients diagnosed with "psoriatic arthritis" and the other showing two patients medically diagnosed with "rheumatoid arthritis," will exemplify the concepts discussed above in regard to diagnostic categorizations and biochemical individuality.

    It is important to produce objective evidence of clinical successes (or failures) to validate the outcomes with our clients to others, including health professionals and the public at large.


    Continued here with case studies.


    For Infinite Variety: An Introduction To Biochemical Individuality - PART II - CASE STUDIES continue here



    Patient Testimonials               Case Studies
    patient testimonials

    Video Testimonial
    Rheumatoid Arthritis (since childhood), Extreme Pain, Joint Pain, Inflammation, Insomnia, Low Energy






    Video Testimonial
    Swelling, Numbness, Undiagnosed Neurological Condition, Pain Allover, Pain in Stomach - Legs - Head, Bad Hearing, Tired, No Energy, Bed-bound, Down-and-out






    Video Testimonial
    Multiple Sclerosis, Drooping Face, Extreme Weakness & Paralysis in Right Side of Face, Very Tired, Extreme Pain in Joints & Feet & Wrists & Elbows & Eye, Dizziness, Balance Problems, Chronic Fatigue






    Video Testimonial
    IBD, Colitis, Severe Exhaustion & Fatigue, Raynaud's Disease, Cold Fingers, Cold Feet, High Blood Pressure, Rheumatic Symptoms, Mental Problems






    Video Testimonial
    Juvenile Rheumatoid Arthritis, Pain, Head Aches, Stomach Aches, Pain in Knees & Hips, Weight Gain & Side Effects from drugs






    Video Testimonial
    Severe Allergies, Digestive Problems, Seasonal Allergies, Low Energy






    Video Testimonial
    Overweight, General Health Problems






    Case Story
    Skin Disease, "Pityriasis Ruba Pilaris", Severe Dermatological Problems, Itching, Seboric Dermatitis, Melanoma






    Case Story
    Skin Disease, Systemic Lupus Erythamatosus




    LECTURE: CONNECT TO THE EARTH
    at the 2011 NHA conference





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