86 | Moving away from "cookie cutter" clinical practice with Dr. Kevin Spelman

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Hi there. Welcome to In the Clinic with Camille. My name is Camille Freeman.

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I'm an herbalist and nutritionist, and in this podcast, I share little tips

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and tidbits that might be helpful for other practitioners.

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Today, I want to share with you a conversation that I had recently with Dr.

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Kevin Spelman, who is one of my very earliest herb teachers.

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I started studying with Kevin back in 2002, so it's been quite some time.

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I'll tell you more about Kevin in a minute here, but I actually asked Kevin

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to come and present a class on medicinal mushrooms in my 2025 immune deep dive.

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And as we were preparing for that class and I was sharing suggestions and thoughts

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about how to best present in that context, we struck up a conversation about clinical education.

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And this conversation emerged from that back and forth.

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And so I really wanted to capture it and share it so that others could hear

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some of our thoughts, and especially some of what Kevin has to say on how we teach herbalism,

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how we teach clinical practice in ways that are less cookie cutter and following

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a recipe, and more about teaching clinical thought.

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So I hope you really enjoy this conversation. It's a little bit longer than

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our normal podcast, and I hope you get a lot out of it.

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So before I share our conversation, let me just let you know a little bit more

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about Kevin's background.

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So Dr. Kevin Spelman is an Ayurvedic practitioner, phytotherapist,

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molecular biologist, and nutrition consultant.

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As a researcher, he has performed clinical trials and immunological investigations.

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He studied plants for brain and ovarian cancer, as well as doing chemical analysis.

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As a clinician, he's practiced Ayurveda, supported by the understanding of molecular

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interface between phytonutrients and human cellular networks for over three

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decades and has delivered over 100 CMEs to healthcare providers.

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So Dr. Spellman is an adjunct professor at the Massachusetts College of Pharmacy.

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He works at National University of Natural Medicine at Bastyr.

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He was a core faculty member at MUIH when I was there and continues to teach

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there as an adjunct capacity, as well as directing health education and research

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consulting service for natural products industry.

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So without any further rambling, let me share this interview that I had with Dr. Spelman.

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All right. So I'm very excited to have this conversation with Kevin Spelman.

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This topic came up actually when we were preparing for Kevin's deep dive lecture

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on medicinal mushrooms.

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And we were talking about teaching philosophies and teaching strategies and

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what it means to give a presentation for clinicians.

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And, you know, how do we provide information for clinicians that's valuable,

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that informs clinical practice, and, you know, some of the philosophy and ethics. that go into that.

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So Kevin brought up some really interesting points in that discussion.

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And Kevin, I'm wondering if you could share some of what you told me and some

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of the things that you've been mulling over and pondering when it comes to clinical education.

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Sure. Well, first, let me tell you a quick story. All this kind of coalesced for me back in the 90s.

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And I was a site for interns from an osteopathic college to do rotations, clinical rotations.

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And so, well, I learned a couple things there.

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Number one, the physics principle of an observer changing things,

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I definitely learned that.

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But what I really learned was the desperation and need for students who are

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about to become clinicians.

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Grabbing onto something to get some solid ground.

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And I'll tell you what I mean. So I had just seen a patient or a client,

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whatever word you want to use for, she had a urinary tract infection,

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but I've been dealing with her on other issues as well.

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And so, you know, I wrote up a formula for her, for the particular urinary tract

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infection, which was constitutionally based.

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I mean, coming from an Ayurvedic background, I definitely strongly practice

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from a constitutional perspective.

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And by constitutional, for those of you who are wondering, we're not talking

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about the U.S. Constitution.

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We're talking about archetypes, Vatipipa Kappa specifically to Ayurvedic medicine.

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And if you want to translate that into more of a Western model,

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it would really be ectomorphic, mesomorphic, endomorphic.

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But nonetheless, so I put up the formula, and I see three naturopathic students

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popping the formula down, and one of them I see right on top, urinary tractors.

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And so I pulled them into the office and I said, hey, guys, yes,

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that is a urinary tract infection formula, but very specifically for this particular

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patient due to her constitution, her weaknesses, her strengths.

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And that seemed to go unheard.

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It seemed to be ignored. It looked to me like they were just excited to have

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something that they could treat urinary tract infections with.

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And so that right there really showed me that clinical education needs to have more depth to it.

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And I see this trend happening where,

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and indeed I've been criticized for this as well, but I see a lot of reviews

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in integrative practitioners after a conference.

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You see them really saying, hey, we just want clinical pearls.

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And that's following in the footsteps of allopathy, first of all.

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But second of all, it doesn't provide the depth and the critical thinking that

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we need to really understand the individuality of patients.

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We're in an age now where we're talking about personalized medicine or even

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precision medicine, and that attitude has nothing to do with precision or personalized medicine.

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You know, remember that there are somewhere between 8 and 10 million SNPs,

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single nucleotide polymorphisms, in the human genome DNA, which means that you

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and I probably have more than one SNP, and everybody out there probably has

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more than one different SNP than we have.

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Meaning that your proteins operate in

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a different way at different kinetics different

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speed and therefore you may have a strength or a weakness based on that and

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so that that's really what i'd like to kind of have this conversation about

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is we need more critical thinking in our clinical education.

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And having been a guy that out of curiosity has gone to a few pharmaceutical

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presentations where a doctor gets paid to and flown all over the world and treated

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like royalty to presentations on a particular new drug that's coming out.

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And what I saw, what I've seen in those presentations, and I was just one of

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them for asking if she could reference the material she just gave.

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What I thought was this real cursory, this drug does that.

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Not who it's for, not how SNPs might be involved, not how epigenetics might

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change that, not how their current condition and other associative factors might change it.

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And the only thing they really would touch on might be herb-drug interactions,

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which of course is a huge buzzword.

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And don't even get me started on that because another load of controversial

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and really poor science at this point. So I'll stop.

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Yeah. And I completely agree. I think that it's a disservice to have people

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walk away from their education having the formula or even a handful of formulas

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that are sort of like the urinary tract infection strategy.

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Because it just, I mean, at that point, why not just have AI be an herbalist?

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I mean, like, why? Why? If it's just a, if this, then that formula,

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we don't need people to do that.

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So I'm curious as to how do you think about providing a type of education where

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people aren't coming out and just wanting to know the formula?

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What do I do if X, Y, Z? How do we share that with people or how do we train people in that way?

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Well, you know, I'll tell you another story. I was in a resident program at

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a particular naturopathic school doing research in their lab on echinacea.

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And I got asked to do a couple lectures in their philosophy course in kind of

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a 101 for the naturopathic physician, the soon-to-be naturopathic physician,

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which I've always enjoyed.

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I'm a really huge proponent of philosophy. and it.

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I gave this presentation, and I looked at my reviews a couple days later,

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and about 65% of them were positive, and then about another 30% were really

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negative. They were like, this is philosophy.

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I'm going to say, this is philosophy. What does this have to do with preparing us in medicine?

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And I guess what I'd like to say is one of the really strong things about philosophy

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is it provides critical thinking skills.

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And that is exactly what you and I are pointing at. We really need critical thinking skills.

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The other thing it does, frankly, is it exercises your mind to move out of a

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certain channel when you're looking at big questions.

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And if we're not looking at big questions in clinical medicine, for example.

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What are the goals of the patient right that's

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huge and that gets ignored all the time in

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evidence-based medicine which is a whole other thing i

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could go off on but not that

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evidence-based medicine is necessarily bad but it has some very significant

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weaknesses so the way i've tried to approach it and indeed i have sometimes

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have people that are unhappy is i always try to include at least a few slides that talk about why.

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Why are we doing this? Or why might this herb be good for that?

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Or why might a dietary supplement be useful?

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And in what application, what specific application?

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I think that's really, really key because we certainly don't want...

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Well, it leads to the idea of cookbook medicine, and there's so many weaknesses

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with cookbook medicine.

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Really, I'd have to say that this idea of a protocol that you strictly adhere

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to to treat a particular condition is not about treating the patient.

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It's about treating a condition. And I like what Roger Williams said,

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he was, I believe, a PhD back in the first half of the 20th century.

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And it feels so funny to say that because that was my century.

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Sorry, yes, I'm showing my age. You know, he said something to the effect of, how did he say it?

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He said, medicine is for real people.

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Statistical humans are of little interest. And so really what cookbook medicine

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and indeed evidence-based medicine, which cookbook medicine grew out of,

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is about treating the average response.

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And as I've mentioned, we've already got ample evidence that people are going

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to react differently based on who they are, what's going on in their lives,

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how much they're sleeping, what their diets are.

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I mean, diet can change pharmacokinetics, for example, of any drug or any herb

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even, and what their psychology is.

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All these things have to be put into play when we start thinking about the average

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patient, because really there is no average patient.

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So that's where I'd leave it, there.

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I love that. And I think that part of the hard thing about that is it takes time.

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You know, like if you want to teach someone how to think, you can't do that

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in a three-hour workshop.

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That's really true, and it takes me to the idea of dosing, right?

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Because I'm really big on, like I rarely follow a standard dose on anything.

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And the reason behind that is, again, because people are so unique and respond

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so differently to different doses.

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And this fate said, if you look at the hormesis model, I mean,

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most doses are biphasic anyway. So, you know, too much or too little may get

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you in the weeds where you get effects you don't want, but there's an optimal dose.

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And that optimal dose varies from person to person.

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So one of the things that I really like to do clinically is I will always say

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to a patient, we're going to have to find the dose on whatever herb we're talking

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about, right? So I will start low.

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And this comes from the cannabis industry. How does it go?

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Start slow and low. and don't be afraid to go all the way. Dustin Sulak added that last part.

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Don't be afraid to go all the way.

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Start low and slow. Build up your dose. Find where that piece is,

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where that optimal dose is.

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Now, your point is very well taken.

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Many consumers, many clients, many patients are existing in a state of stress,

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whether it be economic stress or familial stress or societal stress.

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And they may not have the luxury of paying attention, which sounds a little

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funny, but it's really true.

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I mean, in many ways, paying attention to your body is often for those people

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that are economically stable.

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And I mean, there are groups out there that treat the economically depressed

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and suppressed folks out there.

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But I think for a lot of us, I know for me, I'd have to say that most people

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that come to me are generally not economically stressed. So-

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Oftentimes, you don't have to deal with that, depending on who your group of patients is.

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But nonetheless, it takes time to find that dose. It's not going to happen in a week.

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This might take a month or two months to find the perfect right dose for somebody.

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And there's advantages to this. Number one, they may save money if it's a lower

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dose that they need, rather than following cookbook medicine, average doses.

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Or number two they might need more and

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you you you were thinking the herb wasn't working but

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if you go all the way low and

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slow go all the way slow and low and go all the way then potentially

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you may find that this herb might work really well or

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this dietary supplement might work really well for whatever whatever they're

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dealing with so yeah i i think that's

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really true yeah well and

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i think that I think that it's easy as

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a student it's easy to learn from a book or from a formula where somebody says

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oh here's urinary tract infections here's the bacteria involved here's an herb

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that has effects on that bacteria here's whatever it's hard to show up in clinic and observe.

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And learn that way.

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And so I think when we're talking about education, you know,

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the easiest path of least resistance is to just ask people, what do you do for

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urinary tract infections?

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And then try that on your clients versus, you know, having the time,

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which also takes money and patience. And like you said, there's a lot of privilege

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in having years to spend training as an herbalist.

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But I also think if you want to not practice cookie-cutter herbalism,

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I don't know if there is a way around the time piece of it.

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Yeah, I don't know either. Honestly, I think that...

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There's a saying that goes something, and I'm going to butcher it,

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excuse me, but there's a saying that goes something like anything worth something is going to take time.

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And I think that's true about developing expertise. You know, it takes time.

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I've been in this now for, what, I think 40 years.

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And quite honestly, there's days when I still feel like a beginner.

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So we have a lot to learn. And that's one of the beauties, and that's why things

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like critical thinking are so key, because if you don't have that critical thinking

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piece, if you haven't trained yourself through, for example, philosophy,

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understanding, or by understanding psychology and physiology and emotional regulation,

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then it becomes really difficult to think outside of the box.

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And I think that's my main call here is really, how do we train clinicians to

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think outside of the box?

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You know, one of the reasons that if you go into an ER with some weird condition,

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one of the reasons that new interns in the ER do better than old docs is because

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they're still looking for zebras.

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The expression they use, they're still looking for zebras rather than horses.

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In other words, they're looking for, their mind is fresh with all these different

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diseases that this cluster of symptoms might be.

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And the old docs are like, yeah, it looks like this, you know.

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But the newer docs are like, wait, this could be that.

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And so they investigate it, right? And there's a place where there's burnout,

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right, for people, and they stop doing that.

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This is another reason that continuing education is so key.

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But yeah, I definitely think that our model has lent itself towards evidence-based medicine.

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There are some strengths to evidence-based medicine, but there are some real

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weaknesses around evidence-based medicine.

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And evidence-based medicine leads to cookbook medicine, and it leads to treating the average.

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It also often leads to treating conditions with drugs or even herbs that a company

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had the money to commote and had influence on therefore getting clinical trials

00:19:38.889 --> 00:19:43.409
done rather than an older that nobody's ever thought about.

00:19:43.569 --> 00:19:47.429
For example, like taraxicum and diureses.

00:19:48.169 --> 00:19:55.349
Your good friend, Bevan Clare, and I did what I could see as I was shocked of

00:19:55.349 --> 00:19:56.469
the first clinical trial.

00:19:56.669 --> 00:19:59.109
And it was small. It was really a pilot trial. But nonetheless,

00:19:59.709 --> 00:20:05.049
first clinical trial in humans showing that dandelion was actually a good diuretic, right?

00:20:05.229 --> 00:20:10.329
So, but what are we doing? We're ignoring that and going towards other herbs

00:20:10.329 --> 00:20:15.549
that have more clinical research on them or drugs that have more clinical research.

00:20:15.809 --> 00:20:20.449
And one of the really cool things about dandelion in terms of diureses is the

00:20:20.449 --> 00:20:22.569
pharmaceutical diureses are part of the kidneys.

00:20:22.589 --> 00:20:28.169
And you can only take them for so long before you really start getting kidney degradation.

00:20:28.869 --> 00:20:33.369
One of the great things about dandelion is the sicoaric acid in there,

00:20:33.709 --> 00:20:37.489
a caffeic acid derivative, is renal protected.

00:20:37.729 --> 00:20:40.229
So not only are you getting a push to,

00:20:41.784 --> 00:20:44.844
to move fluids out of the body, you're also getting renal protection.

00:20:45.304 --> 00:20:50.964
So might it make sense to not only, if you're on a pharmaceutical diuretic,

00:20:51.084 --> 00:20:52.764
might it make sense to lower that dose,

00:20:53.004 --> 00:21:00.844
add dandelion to synergize and get more urine output and get renal protection?

00:21:01.364 --> 00:21:03.384
I don't know, but that would be heresy.

00:21:06.784 --> 00:21:09.924
Well and i think i think too

00:21:09.924 --> 00:21:12.944
like understanding yeah is a reason to

00:21:12.944 --> 00:21:17.424
think this is there a reason to try it but then you also have to balance that

00:21:17.424 --> 00:21:22.864
like oh okay and then this person comes in and they have a gallstone and they

00:21:22.864 --> 00:21:25.824
can't take something that's bitter like dandelion leaf like this is where we

00:21:25.824 --> 00:21:32.124
come into the personalized bit of things because it's like well it's it's helpful in this category.

00:21:32.444 --> 00:21:35.104
And then maybe energetically, it's not a fit. Or maybe there's some other reason

00:21:35.104 --> 00:21:37.444
that maybe that's not the greatest option for them.

00:21:37.564 --> 00:21:42.224
And I think that that's where the experience starts to come in.

00:21:42.564 --> 00:21:48.004
So anyway, I want to be respectful of your time and wrap this up because I think

00:21:48.004 --> 00:21:49.664
we've given people a lot to think about.

00:21:49.904 --> 00:21:55.524
But I think maybe just for some final thoughts on the way I see what we've talked

00:21:55.524 --> 00:22:02.464
about is a call to educators and also a call to people who are ongoing students,

00:22:02.524 --> 00:22:05.664
which I think both of us consider ourselves in that category,

00:22:05.664 --> 00:22:08.944
but a call to all of us who are in the herbal field or in the,

00:22:09.104 --> 00:22:10.644
you know, related to education.

00:22:11.084 --> 00:22:16.004
How do we develop our critical thinking skills? Any, any like final words of

00:22:16.004 --> 00:22:22.444
wisdom or pearls or advice that you might recommend to, to people who are thinking deeply about this?

00:22:23.483 --> 00:22:30.643
Yeah, I think, so really the key, as you pointed out, really the key is education, right?

00:22:30.923 --> 00:22:37.103
And I think what I would say to people is, number one, read philosophy.

00:22:37.663 --> 00:22:40.983
Some great, and if you want to do medical philosophy too, that's fine.

00:22:41.143 --> 00:22:45.863
But there's some great, great books out there that really get people to think.

00:22:46.023 --> 00:22:47.743
And I think that's critical.

00:22:48.203 --> 00:22:55.163
Number two, read medical history. I have learned so much about medicine in general

00:22:55.163 --> 00:23:01.943
by reading medical history and listening to these people that were either unheard

00:23:01.943 --> 00:23:04.143
or heard and then forgotten.

00:23:05.863 --> 00:23:11.303
It's really helped me in my clinical practice. The third thing I would say is

00:23:11.303 --> 00:23:16.503
really embrace an energetic model of medicine.

00:23:17.103 --> 00:23:20.843
That doesn't have to be TTM. It doesn't have to be Ayurvedic medicine.

00:23:21.323 --> 00:23:23.963
It could be Unani-Tib. It could be Native American.

00:23:24.483 --> 00:23:32.603
But embrace a model there because that, you know, that leads us to pattern recognition.

00:23:33.443 --> 00:23:38.343
And while medicine, the allopathic medicine system will say that pattern recognition

00:23:38.343 --> 00:23:41.343
is important, they use it in a different way than I use it.

00:23:41.343 --> 00:23:48.183
Pattern recognition for them is recognizing particular symptoms and clustering

00:23:48.183 --> 00:23:52.863
those into diagnosis of providative disease. That's useful. Don't get me wrong.

00:23:53.103 --> 00:23:58.043
But what energetic models of medicine do is they look at pattern recognition

00:23:58.043 --> 00:24:01.943
intriguingly through a fractal line piece of the body,

00:24:01.983 --> 00:24:10.943
such as the tongue and a pulse or an iris, and put together patterns that help

00:24:10.943 --> 00:24:12.923
you understand the whole person.

00:24:14.472 --> 00:24:19.472
Psychologically, emotionally, physically, pathophysiologically.

00:24:20.012 --> 00:24:26.412
And that gives you real insight into what herbs to use, what herbs not to use.

00:24:26.912 --> 00:24:32.112
So that's, I think, what I would say is think of it that way.

00:24:32.312 --> 00:24:36.672
And hopefully that'll boost your education.

00:24:37.192 --> 00:24:41.672
I love it. And do you have any recommendations or other reading recommendations

00:24:41.672 --> 00:24:43.652
for where people could start if they haven't?

00:24:44.172 --> 00:24:47.352
Before read any philosophy or a medical history? Is there anything you feel

00:24:47.352 --> 00:24:50.592
like is pretty accessible for a newbie in that area?

00:24:50.732 --> 00:24:53.032
Oh my God, I've got so many medical history books.

00:24:54.612 --> 00:24:57.852
Didn't anticipate this question. Can I get back with you on that?

00:24:58.412 --> 00:25:01.892
Yes, I'll put it in the show notes. Good. I'll put it in the show notes.

00:25:01.892 --> 00:25:02.952
I'll put a list together. Great.

00:25:03.592 --> 00:25:06.452
Yeah, amazing. Thanks for having me today. I really appreciate it.

00:25:06.672 --> 00:25:09.112
Well, thank you so much for coming. This is a great discussion.

00:25:09.312 --> 00:25:12.732
I hope we can kind of continue thinking about it and hopefully it'll be helpful

00:25:12.732 --> 00:25:15.892
for people who are listening to think about this on their own.

00:25:16.372 --> 00:25:21.952
And I just have to add that, you know, you were a student of mine.

00:25:22.232 --> 00:25:27.552
And now that I feel like you have far surpassed me, and that's really rewarding

00:25:27.552 --> 00:25:32.572
on my end to see that, to see what you're doing and that you're in herbal medicine

00:25:32.572 --> 00:25:36.812
and that you're really shaking things up. So I really appreciate that about you.

00:25:37.612 --> 00:25:42.272
Well, thank you, Kevin. And as they say, I stand on the shoulders of giants.

00:25:42.732 --> 00:25:49.192
Such as yourself i'm only five seven and a half these days i've lost an inch due to aging so.

00:25:51.752 --> 00:25:57.172
I think that that's that's a metaphorical metaphorically giant in the field

00:25:57.172 --> 00:26:02.272
well thank you so much is is there any way that people can kind of stay in touch with you follow you,

00:26:02.912 --> 00:26:06.512
be connected with you is there anything to share with you yeah sure sure i'll

00:26:06.512 --> 00:26:07.952
add that to the notes, but Dr.

00:26:08.072 --> 00:26:15.552
Spellman, D-R-S-P-E-L, 1-L-M-A-N, at phytochemks.com.

00:26:16.252 --> 00:26:23.132
Phytochem is P-H-Y-T-O, phytochemks.com. Chem is chemistry, phytochemks.com.

00:26:23.852 --> 00:26:25.612
That's a lot of explanation, Kevin.

00:26:26.952 --> 00:26:31.392
We'll put it in the show notes. I didn't pick an easy email address.

00:26:32.252 --> 00:26:35.072
That's amazing. Awesome. Well, thank you so much for being here.

00:26:35.212 --> 00:26:39.532
And I so appreciate you spending this time. Likewise. Thank you, Camille.