Dr Neil McKinney on Clinical Pearls
Dr. Janine Fraser: As a teacher, practitioner, and volunteer over the last few decades, I want to thank you on behalf of the profession for all your contributions to advancing naturopathic medicine. And, of course, thank you for making time in your clinic day for an interview. I was hoping we could simply have a conversation about some of the pearls that have helped you help patients, and any other business or clinical tips that you might think useful to your colleagues.
Dr. Neil McKinney: Okay, well I’ve got a couple of gems to share for sure. Something I find really useful is a product called Venoplant, which was a prescription drug in Canada for many years, then was made in Quebec as a herbal tablet. When they stopped making it, I looked at the formula and just started recreating it with tinctures, 17 parts horse chestnut, 12 parts milk thistle and three parts witch hazel. For most patients the dose is orally a drop or two three times a day, but it could be as much as half a teaspoon twice a day in some water. I usually add a homeopathic remedy to this as well, such as nitricum acidum 6 cc. Venoplant is particularly good for varicose veins, takes the pain out—of course it doesn’t fix the valves but it takes the pain out. I’ve found it’s really amazing for hemorrhoids and fissures. I’ve kept a number of patients out of surgery for hemorrhoids with this tincture. It decompresses the portal vein and thus the haemorrhoidal veins and therefore the base of the leg. Very simple formula, works consistently, I’ve really never seen it not help.
JF: That’s a good tip for a very hard problem to treat. I typically use the newer remedies, for example Xymogen has a small fractionated substance called DioVasc which I find helps, but knowing of a classic botanical preparation, that’s a great tip. Have you found any patients with breathing issues arising from the use of horse chestnut? I’ve had a couple of patients who seem to come down with some onset asthma.
NM: Not in my experience. Although it does have a side effect that can cause patients to experience shortness of breath, so that does make sense. Something else that I have found really good came about when I gave my advanced oncology class. Cynthia Bye, who’s an ND focussed on adjunctive oncology, she told me for skin cancers, pre-cancerous skin lesions, she told me to put vitamin A emulsion, e.g., from Seroyal, mixed with castor oil, pretty much equal parts, directly on the skin; it’s quite sticky, and of course when you put it on its kind of messy. To mediate that texture, what I do is I put three drops of vitamin A and castor oil in my palm and one pump or squirt from the grape seed extract cream I keep in stock. I use the Nasobih. Then I mix it together and it makes a nice little cream. Patients can dab it on, possibly at bedtime, as it’s not something most people would want thave on all day. You can also take the same base and add neem oil to it for psoriasis which works exceptionally.
JF: So you’re really mixing quite a few things yourself, that’s really wonderful.
NM: Another variation is when I mix it with sea buck thorn oil for rosacea. The great thing about taking grape seed, is if you take it internally as well as using it as a topical it gets rid of the redness of rosacea really well.
JF: Where do you get your sea buck thorn oil and plain neem oil from?
NM: SBT in BC sells sea buck thorn oil. Neem oil and related products can be purchased from Ferlow Botanicals. Another real treasure in respect to acne is the success I’ve had
combining di-indolymethane, about 600 mg per day, with burdock root. Either works, but together they are exceptional.
JF: I can see that working. You’re focusing on the liver function there. Add to that a patient conversation and testing to show what’s really going on with the hormones, especially with females, and it makes sense that these things are really going to work, particularly for the people that are making some of the more highly stimulatory estrogens in their body.
NM: Another tip comes from when I started using indole-3- carbonal for prostate cancer. I had read that it not only clears estrogen through the liver, but it interferes with the androgen receptor, which is when it occurred to me to try using it for acne and it really worked. Now burdock, the Japanese use it but call it gobo root, has a long history of cosmetic use. It was, apparently, an ingredient used by many Geishas for skin care.
JF: Have you seen any research on that being an androgen suppresser?
NM: Yes, the theory came before the practice. I can source information on that if doctors are looking for it.
JF: I was wondering why you decided to take such an interest in oncology.
NM: I worked in cancer research, in radiation research, for many years before becoming an ND. Particle physics research at UBC’s TRIUMF and SFU. I also worked on radiosensitizing drugs, cell model systems, and so forth. I remember meeting Terry Fox, he sometimes came down to my lab at SFU; he was a really great soul, such a cool kid. After the amputation, when he was learning to run with the artificial limb, he spent a lot of time at children’s hospitals encouraging other kids to be active despite their predicament. Well one day he came down to my office and said “What are you guys doing, children are still getting their legs cut off, and it hurts me. I’m trying to give these kids some encouragement here, but, if you guys don’t hold up your end, what’s it all for?” At one point he looked me in the eye and he said to me, “I’m going to raise a whole bunch of money so that smart guys like you can find a cure for cancer.”
JF: So there’s a true passion for what you’re doing here, which I see lacking in some of the younger doctors these days.
NM: You know when I was in cancer research, we would get calls, desperate calls from people all over the world. I remember this one man from England got a hold of me. I’m not sure how, probably no one else would take the time to listen. He said to me “if you can get this one thing for me I’ll give you anything you want man, house, Rolls Royce, whatever, just save my life.” This was typical. Calls from desperate patients who had run out of medical options but felt there must be something in a research lab that could help them. So certainly, on becoming a doctor, a prime motivator is simply wanting to help people. I was in Vernon for several years where my practice was mainly primary care, I took over from a retired ND. It was a small community with very few doctors and it was easy to be the go-to ND. But when I moved to Victoria I was just another face in the crowd. I needed to re-establish myself and my practice.
JF: I have a deep reason why I do what I do as well, I have a lot of family members who have died because they didn’t get the services we offer.
NM: So I reconsidered my purpose. Victoria has a slightly olde population, there is a relatively high incidence of cancer, and at that time no one had stepped up to focus on the cancer issue. Although I was a well-established and confident clinician, it was important to refocus. I studied down at the Cancer Treatment Centers of America, courses at Bastyr and other places. I pored over the cancer literature. Also, being closer to BINM, I was able to develop their oncology course which coincided with me publishing my first book.
JF: So really you just took the opportunity to do something that nobody else was doing in the area that you were in.
NM: Exactly, yeah. And it involved a lot of study, I read every book and paper I could get my hands on for years.
JF: Tell me what inspired you to write your first book?
NM: Starting the course at BINM was a major impetus, but not the only one. There was this great book written by John Boik, Cancer and Natural Medicine, in which he described the basic science on, e.g., green tea, bromelain, etc. He said that it’s quite clear that none of these things have the same power as chemo drugs, but there might be some synergies that work that could benefit from further research.
JF: So by reading that it inspired you to look at how you treat people and the combinations you create to make the chemo work better?
NM: Well it certainly confirmed that I was on track with many of my ideas, what I was clinically interested in. And, fortunately, other people focused in this area gave me the affirmation that I wasn’t crazy and that there might actually be something natural that could, if not cure, then mediate cancer. A good metaphor goes back to my research years. I remember a quote from Neils Bohr that went something like “Anyone who is not shocked by quantum mechanics has not understood it.” And Nobelist Richard Feynman, who wrote a lot about chaos theory, noted that in nature order can come out of chaos, things that are random can often become orderly. Feynman described in detail what’s called the three body problem. In simplest terms, the outcome is regularly random, irregularly random, or orderly. I would say, on the theoretical level, I was not looking for one or two things, but a triad. I had this idea that a combination of three could be more effective than one or two.
JF: Just like your green tea, curcumin and grape seed extract as an example.
NM: Exactly. So I figured that out. Interestingly, a couple of months ago I received a study from the Wake Forest Research Centre on mice and sarcoma. Use of green tea, no impact, they die. Give them grape seed extract, some live a little longer, but not statistically significant. Curcumin alone, some positive impact. Mix the curcumin with green tea and there is a synergistic response. The additive effect is considerably better than the individual response. While this research is recent, I was actually in contact with them because they had seen my writing on this synergistic response and wanted to know how I arrived at my conclusions. They even asked, “well what other bright ideas do you have?”
So just to sum up, this professional change in focus came about by a number of factors: The move from Vernon to Victoria, the focus on oncology to suit my new practice environment, writing a book, getting involved with BINM, and the curcumin, grape seed, green tea work.
JF: I just had a couple more questions about the book. I work with a colleague who is writing a book and wanted to know about how a doctor knows when the first draft is complete.
NM: Well my first book was self-published, and although it was pretty crude I was surprised at how little general interest there was. I think you have to realize that everything is a work in progress and there comes a point where you have enough useful information and its better than anything else out there and you’ve got to just give it to the publisher and let them publish. With that first book we had a lot of programming problems, file issues. In the end we found a simple fix, which was as basic as a font change, but it was about six months before we were ready for publication. Basically I worked on getting the first issue published, on getting through these technical stumbling blocks, and I knew it was good enough, the next one will be better; and it was. I’ve written four books now, this one I changed the title to The Second Edition of Naturopath Oncology and there will be a new one next year. People who attend my courses get the electronic versions which are much more cleaned up (I’ve created a better index, with sub-topics and so forth).
JF: So many people are self-publishing now, and the reason I’m talking about this is because people are getting upset that there’s not a lot of course work where it’s NDs teaching NDs, it’s all about the MD who has written a book and now they are the expert on wheat belly or allergies and why aren’t we doing this? I think we need to see all of our colleagues doing this.
NM: I agree. Dr. Kate Rheaume-Bleu wrote an excellent book on vitamin K2 and the calcium paradox. We do need more NDs to publish. Something frustrating to me is that none of the naturopathic schools use my book as a textbook. One instructor claimed it was too expensive for students [at $60].
JF: Really. As we pay $200 for calculus book. And yours has over 35-40 years of knowledge in there!
NM: Exactly. But you know even getting colleagues to look at it was difficult initially. One colleague wouldn’t review a copy as he said he was writing his own book and didn’t want my ideas to “pollute” his mind.
JF: I can understand the stumbling blocks to getting into a college curricula but I’ve never considered that colleagues might not even want to expose themselves to the information. This is similar to my experience with business success: The information is out there, but people are just not making any effort to discover what works for them, or could work for them.
NM: I was at CCNM and discovered they didn’t have a copy of my book in their library. That’s baffling. What have I done wrong?
JF: I’ve seen grads come from other schools and they say “I don’t want to treat cancer” and I’m thinking, why the heck not? People need your help, right? I mean at least do the basics, refer them, learn some more but they didn’t have a course.
NM: You know even Bastyr has dropped their course in oncology, Southwest has also dropped their course in oncology, National has never had a course that’s amounted to anything. In fact the basis for their entire course states that it’s unethical to do anything for cancer other than radiation, chemo and surgery, so they teach their students to refer for those patients and back out. No natural methods are proven so therefore its unethical to use them.
JF: That seems to me a case of ruining our practitioner’s opportunity for success before they even start practice. Not even giving them a scope of practice to operate in.
NM: And it’s not an NPLEX topic. My pitch at BINM has been if you have a course in cardiology, take a step back and ask what are, statistically, the two big killers of Canadians? Cancer and heart disease. What better way than to integrate your basic science knowledge and think clinically and solve clinical problems and synthesize the information out there. Then your grads are going to be better prepared for something like this that is challenging in practice, illnesses with major drug interactions or a serious life threatening illness. You have to be able to deal with these issues and step up and sometimes make some big decisions and I feel it’s the ideal clinical course to help
students with their confidence levels. So I think it certainly has a place in the curriculum and BINM seems to agree but unfortunately this isn’t the case at other schools. I believe the only course left is one in Chicago, although it’s not long. Also, Dan Lander incorporates adjunctive oncology into his clinical nutrition lectures. This is one of the reasons I put together my course, to meet an educational need. I realize a lot of my colleagues are gravitating towards FABNO. And that’s useful. But what I find with the American focus is that it’s much more tentative, they’re more worried about litigation and somebody getting hurt, where I name more products and dosages and I’m explicit in what I do, I’m very transparent with my methods. Right or wrong I put down what I think and what I do, so it’s not filtered by any lawyers or a committee or anybody else. And I think that’s why people find it valuable because its clinically relevant, its real.
JF: How did you find that balance between what’s clinically relevant and what’s available for the layperson? That’s one thing I was thinking about because I would like someday to write my own book, which I’m beginning to draft now. I’m just wondering about the focus of the book. Am I writing for the public or the layperson?
NM: It’s really tough that balance. I’m going to simplify the next version, I’m thinking of writing almost more of a booklet for
the public and then a more clinical book. You know people don’t make money off of books; it’s very difficult to market them, especially books for the public—they can really die on the vine.
JF: I think it’s more of a promotional tool, allowing us to stand up and claim that we know this stuff.
NM: I’m very glad I wrote it. It has helped a lot of people, I’ve gotten a lot of good feedback and it’s helped me organize my thoughts. And I still refer to it.
JF: I thought your technique of highlighting it and putting in sticky notes when you’re in with patients, how genius is that. Here it is, everything is there for the patient, who is typically so glassy eyed and not able to hear a doctor’s full message. This way, they can take it home for review. Plus it helps speed up just your day to day, I mean here I am writing out whole treatment plans every time, why am I not just checking things off lists?
NM: One of the things I promised at OncANP is I would create a repertoire for the different cancers, and that’s part of the course I offer NDs. A summary of the key things we do, resources for people, etc. One of the good things about the OncANP course was we had five FABNO doctors there—it’s not just me giving the course; it was more of a discussion about how different doctors approach different aliments, so the next synthesis is these various accounts from all of these experienced practitioners.
JF: I wonder if you could speak to what you gained by being a teacher at Boucher. I certainly know why you got involved in the establishment of an accredited west coast college, but is there anything that you’ve really gained from the experience?
NM: It’s in my nature to be a bit of a story teller and confabulator. I’m not as detailed of a person as you might think, from my book and all that—which is why I have the book because I often think in much broader concepts. So it certainly made me focus on providing clinical detail and made me realize yeah, I have been an innovator in practice and discovered a few remedies through trial and error. Different people I’ve run into throughout my career have taught me patience, so I’ve seen and come across things that not everyone has come across. Putting together a course for Naturopathic Clinical Arts and Sciences, in particular, made me realize I’ve had very good success with allergies, colitis, pain issues and cancer. And in coming to this conclusion, it forced me to think about what do I know that maybe somebody else wouldn’t know? It helped me refine what I’m good at and then build on that so my expertise could be shared. Clinically, I’m now more clear on what demographic I want to market to, who I am best able to treat and, this is uncommon amongst some of my colleagues, who is best off with a referral to another ND. Here’s another pearl, something really wonderful. I was doing a herb walk, I had just started practice—this would have been some 28 years ago or so. Of course I had a lot of knowledge of botanical medicine and pharmacognosy and preparing tinctures and that sort of thing. Well I met a herbalist (from the Armstrong area) and we used to do herb walks in the area and we would walk around and identify different herbs (she knew some things from Native traditions, I knew some from European traditions). One day we were walking and we came across this pasture and there was pipsissewa growing with barberry (burberis vulgaris). She said “the creator put these together, they grow together and they need to be used together.” As it happened, the very next day somebody needed that. So I had these two herbs in my clinic and someone came in with a urinary tract infection and what do you know it worked like a charm. I continue to have so much success with that formula for kidney infections, people on antibiotics in the hospital not getting better, I mean it’s just remarkable. I’ve only had one or two cases that didn’t respond to it.
JF: What dosage do you recommend?
NM: Usually a 50-50 mix, but it depends on the case. With prostatitis I switch it to 60 per cent barberry. In my style of practice, I like to add a homeopathic. Again, with prostatitis I might add belladonna or with a UTI cantharas or another bladder remedy.
NM: Low dose naltrexone I’m prescribing a lot. That’s about it. I was seeing patients with Lyme disease, but less so now.
JF: Dichloroacetic acid, do you use that at all?
NM: Absolutely. Not as much as I used to. Aretmisinin, DCA and I suppose my number two prescription item would be d-alpha lipoic acid by IV (i.e., DALA).
JF: And you would use that for what types of cases?
NM: Almost all kinds of cancers, but especially the aerobic cancers, brain, lung, we are seeing really good results with prostate cancer, since we’ve got the D form from York Downs instead of the DL, remarkable difference, better tolerance, more consistent overall results. In my experience it far out-performs IV vitamin C for cancer patients. I use 150 mgs DALA. Doctors can contact me if they’d like the complete protocol.
JF: In closing, I wanted to ask you about patient compliance or dealing with a difficult patient. Do you have a style for dealing with that sort of situation?
NM: In the last few years in Vernon as well as the last few years in Victoria, I’ve been in practice in one place long enough that there’s a sort of critical mass you get to where your reputation precedes you. Patients are seeking you out; they are serious about getting better. They know who you are and are inclined to follow the personalized protocol you develop for them. So I find compliance has gone up as my practice reputation has grown. For example, a patient might book in because a nurse or oncologist has recommended me. Doctor’s developing a reputation where they practice, which in turn becomes a referral network, that’s worth a million dollars. I would add though that it’s not about being friends with your patients, it’s about who you can work with and who you can’t, who you can really help. Respect is a much more important doctor patient value. You can’t control compliance, but you can control input. Focus on what you can do, and do it to the best of your ability. It’s true though, when there’s a certain amount of resistance from a patient in respect to following a protocol, ongoing treatment success becomes impossible. I had a patient come in recently for a cannabis referral. I didn’t sign their form but I did speak with them about alternatives and laid out a number of options for them to consider. Halfway through the consult they realized they were getting medical advice and not a signature. And they had no inclination to take steps toward better overall health care. In a case like that there is no opportunity to develop a therapeutic relationship. Setting boundaries is very important. And this in most cases can be ascertained on the first visit, usually in the first 15 minutes.
JF: Neil, I thank you for your time and for sharing your experience and pearls.