Health Care

Off the Shelf: On Cranks, Real or Just Apparent

What can we make of doctors who challenge conventional wisdom in their fields?

Editor’s Note: Every week, Michael Brendan Dougherty writes an “Off the Shelf” column sharing casual observations on the books he’s reading and the passing scene.

When I was young and really hard up for a job, I spent a summer working for a chiropractor. She was far out on the crankish end of things, and my job was sprawling. Sometimes I did paperwork. Sometimes I developed x-rays. At other times, I worked on cleaning up the data for her immense direct-mail-marketing operation. A few times I performed quacky treatments on patients themselves. The one that made me most embarrassed was a footbath she gave customers who had the most credulous or generous insurance plan. I would insert a device into warm water, where the patient’s feet would sit as the device sort of vibrated and did whatever it did. The water would slowly turn different colors depending on what toxins it was supposedly removing from the patient’s system. I think I figured out that the insurance companies were getting charged $75 every time we did this to someone. My duties also included driving to the Bronx with my mother’s SUV, because it could fit the enormous and expensive new kitchen appliances my boss needed for her home remodeling.

It all would be enough to put most people off alternative medicine forever. Except that, over time, mainstream medicine and health treatments inflict their own greed-addled, idiotic, grasping, lawyer-fearing systems on us.

This week, a family member had to go to the hospital. He’d received great treatment there before, but now we’re witnessing the way incompetence is engineered into the system. He was admitted during the current awful heat wave, and even after being moved from the emergency room to a room of his own, he was denied water — the simplest, most obvious thing to give a person in need — because a nutritional profile hadn’t been uploaded into what they call “the system.” You see how the avoidance of lawsuits worsens even the most basic care.

Hospitals are bewildering institutions. One family member visits and gets great, tender, well-organized care. Another visits and gets something less than that. I’ve seen family members go into hospitals and get scanned for everyday things, because the hospital has figured out that the insurance company will pay for anything and everything. Dr. Quackbath got $75 a pop for her ministrations. But a hospital can and will mint $3,000 a day out of patients with needless scans if their insurance coverage is expansive enough.

It all would be enough to put most people off alternative medicine forever. Except that, over time, mainstream medicine and health treatments inflict their own greed-addled, idiotic, grasping, lawyer-fearing systems on us.

When I was 14, I got braces. My teeth didn’t look so bad, but my mother wanted me to avoid problems she had experienced and took the recommendation from our dentist. The only thing memorable about it was that the orthodontists’ assistant was subtly inappropriate with me. Not in any way that was actionable; she just had a weird vibe. (Then again, 14-year-old boys hope, above all else, to catch the interest of a woman, any woman.) When the braces were taken off, I wore a retainer, occasionally. I rarely thought about it again.

But I recently fell down an Internet rabbit hole, as you sometimes do when you the YouTube app’s algorithms collide with the thought patterns you reveal by clicking around or lingering over other videos. Somehow, I came upon a channel created by a British doctor who is the Internet’s most prominent advocate for an entirely different approach to our teeth.

From what I gathered, Dr. Mike Mew is a third-generation tooth man. And the multi-generational perspective on trends in patient problems and treatments that this experience affords him has led him and his father to reject the conventional wisdom of their field. The conventional wisdom is that the misalignment of teeth in humans is probably genetic in nature. Mew believes it is environmental. Namely, he thinks that modern humans are eating softer food and carrying themselves with worse posture. They’re breathing with their mouths and their tongues are flopping around in the bottoms of their mouths. They fail to develop a fully adult swallowing motion and have the remnants of an infantile “suckle” to their swallows, the force of which slowly sucks their teeth backward over time. All these factors contribute to faces that grow downward and fall back rather than forward and outward over time. The resulting craniofacial distrophy, the misshaping of the face, then causes teeth to be misaligned.

Mew is the first dental-health professional I think I’ve encountered who recommends people chew gum every day, because it strengthens the muscles. From what I can gather, instead of intervening at 14 to correct misaligned teeth, he prefers to intervene at age six or seven to encourage proper facial growth, prevent misaligned teeth, and ingrain good habits in patients.

Mew has a small and devoted online following of young people who have been searching YouTube for ways to improve their physical beauty. They are adopting his recommendations on good physical and oral posture at the dinner table. They are making their own videos on how to do the “Mona Lisa” swallow and achieve the correct resting posture (lips together, teeth together, tongue on the roof of your mouth). In the comments they have named these techniques “Mewing,” and come up with a slogan, “If you’re not Mewing, what are you doing?”

I actually find this all rather convincing. But it gets sad in the occasional video where Mew voices his frustrations with challenging the consensus among orthodontists and dental-care professionals. He wants to start a debate, he wants other doctors to look and report if they are seeing in their patients what he is seeing. Instead, he’s met with indifference.

For me it became poignant when Mew laid out the implications of his work for those suffering with sleep apnea, a phenomenon which seems to just now be achieving wide recognition and public consciousness. The craniofacial dystrophy he talks about is a weakening of the muscles in the face, and a shortening of the face’s outward projection, which itself can lead to a restricted airway. It’s a self-reinforcing cycle. If his theories are correct, the main treatment for sleep apnea — the CPAP machine — is likely disastrously counter-productive. It may help people sleep overnight, by blowing enough air to keep their airway open. But the straps people use to secure it over their face, will, over the long run, subtly push their mandibles further back, and constrict their airways even more.

My mother died a few years after starting on CPAP. Her heart gave out not long after her breathing became incredibly labored and uncertain.

Most doctors do not have the mix of caution and adventure needed to be successful pioneers in their field. They’re better applying the best and most current conventional wisdom conscientiously. Telling doctors to think of themselves as explorers would probably cause more harm than good. But you can see how, if Mew’s theory is correct, the rot in orthodontics runs pretty deep. The data that informs the field is taken from the middle of the 20th century — a time when, if Mew’s theories are correct, the diet had already so softened that misalignment was already far more common than it should be.

Mew’s venture reminds me of another unorthodox doctor I’ve come to appreciate: Dr. Jason Fung, author of The Obesity Code. Fung is a Canadian nephrologist, a specialist in kidney functions who has treated many patients suffering from diabetes. He also came to reject the conventional wisdom in his field. Instead of a thermodynamic model of weight gain — calories in, calories out — he focuses on a hormonal model. It’s still “calories in, calories out” — but the hormone insulin determines if the calories you’re putting in are going to be stored as fat.

And so, Dr. Fung’s recommendation for treatment isn’t to go on a special diet; it’s to fast. At first, shorten the window of eating during the day, what’s called intermittent fasting. Don’t snack, because eating itself stimulates the production of insulin, which will store fat. Eventually, graduate to extended fasting, where your body finishes consuming the energy from your recent meals, then digs into the glycogen, and finally into your stores of fat.

Unlike calorie-restrictive dieting, fasting doesn’t result in an enormous crash in energy. It is almost an extension of the paleo and primal diet trends, which seek to reduce insulin production by severely limiting carbohydrates. The idea is the same: Burn the excess fat for the energy you need.

My old colleague Joe Weisenthal also likes Dr. Fung. Weisenthal has gotten skinnier since moving to television, and he has done so by combining these anti-carb diets with a little bit of fasting. He eats steak and bacon. My own early results experimenting with this approach have been really encouraging. I’ll probably write about it more when I have more personal experience and data.

My experience in a fast is that there is an initial headache, the so-called “carb flu.” For me it lasts about 12–15 hours. I can’t treat it with water, or Tylenol, or anything. Once it starts, I’ve found it can’t even be treated by eating carbs. It just runs its course. But it gets easier each time, as if the body is learning how to make the switch. By the third day you feel great.

With the holiday and hospital visits, I didn’t read much this week. The best article I read was by another former colleague, Glynnis MacNicol, about the happiness found in living a life without a husband or children in her 40s. My book isn’t quite done, yet, and I’ve been flipping through books of poetry and a history book — Patrick Pearse and the Lost Republican Ideal, by Brian P. Murphy — before I attempt the finishing touches.

I have a door-stopping history book, The Thirty Years War: Europe’s Tragedy, by Peter Wilson, waiting for me soon, though I might save it for beach reading in August. As you can guess, I’ve been reading this with my tongue planted firmly against the roof of my mouth. My stomach is growling a bit, but the big headache will come soon. Even if most doctors shouldn’t experiment freely with their patients’ health, more patients should experiment for themselves. I’ll keep you updated as the results come in. No goofy foot baths for me, though.

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