86 | Individualized v. "Cookie Cutter" Clinical Practice with Dr. Kevin Spelman

0:00 Hi there. Welcome to In the Clinic with Camille. My name is Camille Freeman. I'm an herbalist and nutritionist, and in this podcast, I share little tips and tidbits that might be helpful for other practitioners. Today, I want to share with you a conversation that I had recently with Dr. Kevin Spelman, who is one of my very earliest herb teachers. I started studying with Kevin back in 2002, so it's been quite some time. I'll tell you more about Kevin in a minute here, but I actually asked Kevin to come and present a class on medicinal mushrooms in my 2025 immune deep dive. And as we were preparing for that class and I was sharing suggestions and thoughts about how to best present in that context, we struck up a conversation about clinical education.

0:43 And this conversation emerged from that back and forth. And so I really wanted to capture it and share it so that others could hear some of our thoughts, and especially some of what Kevin has to say on how we teach herbalism, how we teach clinical practice in ways that are less cookie cutter and following a recipe, and more about teaching clinical thought. So I hope you really enjoy this conversation. It's a little bit longer than our normal podcast, and I hope you get a lot out of it. So before I share our conversation, let me just let you know a little bit more about Kevin's background. So Dr. Kevin Spelman is an Ayurvedic practitioner, phytotherapist, molecular biologist, and nutrition consultant.

1:23 As a researcher, he has performed clinical trials and immunological investigations. He studied plants for brain and ovarian cancer, as well as doing chemical analysis. As a clinician, he's practiced Ayurveda, supported by the understanding of molecular interface between phytonutrients and human cellular networks for over three decades and has delivered over 100 CMEs to healthcare providers. So Dr. Spellman is an adjunct professor at the Massachusetts College of Pharmacy. He works at National University of Natural Medicine at Bastyr. He was a core faculty member at MUIH when I was there and continues to teach there as an adjunct capacity, as well as directing health education and research consulting service for natural products industry.

2:05 So without any further rambling, let me share this interview that I had with Dr. Spelman. All right. So I'm very excited to have this conversation with Kevin Spelman. This topic came up actually when we were preparing for Kevin's deep dive lecture on medicinal mushrooms. And we were talking about teaching philosophies and teaching strategies and what it means to give a presentation for clinicians. And, you know, how do we provide information for clinicians that's valuable, that informs clinical practice, and, you know, some of the philosophy and ethics. that go into that. So Kevin brought up some really interesting points in that discussion.

2:45 And Kevin, I'm wondering if you could share some of what you told me and some of the things that you've been mulling over and pondering when it comes to clinical education. Sure. Well, first, let me tell you a quick story. All this kind of coalesced for me back in the 90s. And I was a site for interns from an osteopathic college to do rotations, clinical rotations. And so, well, I learned a couple things there. Number one, the physics principle of an observer changing things, I definitely learned that. But what I really learned was the desperation and need for students who are about to become clinicians.

3:36 Grabbing onto something to get some solid ground. And I'll tell you what I mean. So I had just seen a patient or a client, whatever word you want to use for, she had a urinary tract infection, but I've been dealing with her on other issues as well. And so, you know, I wrote up a formula for her, for the particular urinary tract infection, which was constitutionally based. I mean, coming from an Ayurvedic background, I definitely strongly practice from a constitutional perspective. And by constitutional, for those of you who are wondering, we're not talking about the U.S. Constitution. We're talking about archetypes, Vatipipa Kappa specifically to Ayurvedic medicine.

4:20 And if you want to translate that into more of a Western model, it would really be ectomorphic, mesomorphic, endomorphic. But nonetheless, so I put up the formula, and I see three naturopathic students popping the formula down, and one of them I see right on top, urinary tractors. And so I pulled them into the office and I said, hey, guys, yes, that is a urinary tract infection formula, but very specifically for this particular patient due to her constitution, her weaknesses, her strengths. And that seemed to go unheard.

5:02 It seemed to be ignored. It looked to me like they were just excited to have something that they could treat urinary tract infections with. And so that right there really showed me that clinical education needs to have more depth to it. And I see this trend happening where, and indeed I've been criticized for this as well, but I see a lot of reviews in integrative practitioners after a conference. You see them really saying, hey, we just want clinical pearls. And that's following in the footsteps of allopathy, first of all.

5:46 But second of all, it doesn't provide the depth and the critical thinking that we need to really understand the individuality of patients. We're in an age now where we're talking about personalized medicine or even precision medicine, and that attitude has nothing to do with precision or personalized medicine. You know, remember that there are somewhere between 8 and 10 million SNPs, single nucleotide polymorphisms, in the human genome DNA, which means that you and I probably have more than one SNP, and everybody out there probably has more than one different SNP than we have.

6:32 Meaning that your proteins operate in a different way at different kinetics different speed and therefore you may have a strength or a weakness based on that and so that that's really what i'd like to kind of have this conversation about is we need more critical thinking in our clinical education. And having been a guy that out of curiosity has gone to a few pharmaceutical presentations where a doctor gets paid to and flown all over the world and treated like royalty to presentations on a particular new drug that's coming out.

7:14 And what I saw, what I've seen in those presentations, and I was just one of them for asking if she could reference the material she just gave. What I thought was this real cursory, this drug does that. Not who it's for, not how SNPs might be involved, not how epigenetics might change that, not how their current condition and other associative factors might change it. And the only thing they really would touch on might be herb-drug interactions, which of course is a huge buzzword. And don't even get me started on that because another load of controversial and really poor science at this point. So I'll stop.

8:04 Yeah. And I completely agree. I think that it's a disservice to have people walk away from their education having the formula or even a handful of formulas that are sort of like the urinary tract infection strategy. Because it just, I mean, at that point, why not just have AI be an herbalist? I mean, like, why? Why? If it's just a, if this, then that formula, we don't need people to do that. So I'm curious as to how do you think about providing a type of education where people aren't coming out and just wanting to know the formula?

8:45 What do I do if X, Y, Z? How do we share that with people or how do we train people in that way? Well, you know, I'll tell you another story. I was in a resident program at a particular naturopathic school doing research in their lab on echinacea. And I got asked to do a couple lectures in their philosophy course in kind of a 101 for the naturopathic physician, the soon-to-be naturopathic physician, which I've always enjoyed. I'm a really huge proponent of philosophy. and it.

9:25 I gave this presentation, and I looked at my reviews a couple days later, and about 65% of them were positive, and then about another 30% were really negative. They were like, this is philosophy. I'm going to say, this is philosophy. What does this have to do with preparing us in medicine? And I guess what I'd like to say is one of the really strong things about philosophy is it provides critical thinking skills. And that is exactly what you and I are pointing at. We really need critical thinking skills. The other thing it does, frankly, is it exercises your mind to move out of a certain channel when you're looking at big questions.

10:14 And if we're not looking at big questions in clinical medicine, for example. What are the goals of the patient right that's huge and that gets ignored all the time in evidence-based medicine which is a whole other thing i could go off on but not that evidence-based medicine is necessarily bad but it has some very significant weaknesses so the way i've tried to approach it and indeed i have sometimes have people that are unhappy is i always try to include at least a few slides that talk about why. Why are we doing this? Or why might this herb be good for that?

10:55 Or why might a dietary supplement be useful? And in what application, what specific application? I think that's really, really key because we certainly don't want... Well, it leads to the idea of cookbook medicine, and there's so many weaknesses with cookbook medicine. Really, I'd have to say that this idea of a protocol that you strictly adhere to to treat a particular condition is not about treating the patient. It's about treating a condition. And I like what Roger Williams said, he was, I believe, a PhD back in the first half of the 20th century.

11:45 And it feels so funny to say that because that was my century. Sorry, yes, I'm showing my age. You know, he said something to the effect of, how did he say it? He said, medicine is for real people. Statistical humans are of little interest. And so really what cookbook medicine and indeed evidence-based medicine, which cookbook medicine grew out of, is about treating the average response. And as I've mentioned, we've already got ample evidence that people are going to react differently based on who they are, what's going on in their lives, how much they're sleeping, what their diets are.

12:32 I mean, diet can change pharmacokinetics, for example, of any drug or any herb even, and what their psychology is. All these things have to be put into play when we start thinking about the average patient, because really there is no average patient. So that's where I'd leave it, there. I love that. And I think that part of the hard thing about that is it takes time. You know, like if you want to teach someone how to think, you can't do that in a three-hour workshop. That's really true, and it takes me to the idea of dosing, right?

13:13 Because I'm really big on, like I rarely follow a standard dose on anything. And the reason behind that is, again, because people are so unique and respond so differently to different doses. And this fate said, if you look at the hormesis model, I mean, most doses are biphasic anyway. So, you know, too much or too little may get you in the weeds where you get effects you don't want, but there's an optimal dose. And that optimal dose varies from person to person. So one of the things that I really like to do clinically is I will always say to a patient, we're going to have to find the dose on whatever herb we're talking about, right? So I will start low.

14:00 And this comes from the cannabis industry. How does it go? Start slow and low. and don't be afraid to go all the way. Dustin Sulak added that last part. Don't be afraid to go all the way. Start low and slow. Build up your dose. Find where that piece is, where that optimal dose is. Now, your point is very well taken. Many consumers, many clients, many patients are existing in a state of stress, whether it be economic stress or familial stress or societal stress. And they may not have the luxury of paying attention, which sounds a little funny, but it's really true.

14:44 I mean, in many ways, paying attention to your body is often for those people that are economically stable. And I mean, there are groups out there that treat the economically depressed and suppressed folks out there. But I think for a lot of us, I know for me, I'd have to say that most people that come to me are generally not economically stressed. So- Oftentimes, you don't have to deal with that, depending on who your group of patients is. But nonetheless, it takes time to find that dose. It's not going to happen in a week.

15:28 This might take a month or two months to find the perfect right dose for somebody. And there's advantages to this. Number one, they may save money if it's a lower dose that they need, rather than following cookbook medicine, average doses. Or number two they might need more and you you you were thinking the herb wasn't working but if you go all the way low and slow go all the way slow and low and go all the way then potentially you may find that this herb might work really well or this dietary supplement might work really well for whatever whatever they're dealing with so yeah i i think that's really true yeah well and i think that I think that it's easy as a student it's easy to learn from a book or from a formula where somebody says oh here's urinary tract infections here's the bacteria involved here's an herb that has effects on that bacteria here's whatever it's hard to show up in clinic and observe.

16:31 And learn that way. And so I think when we're talking about education, you know, the easiest path of least resistance is to just ask people, what do you do for urinary tract infections? And then try that on your clients versus, you know, having the time, which also takes money and patience. And like you said, there's a lot of privilege in having years to spend training as an herbalist. But I also think if you want to not practice cookie-cutter herbalism, I don't know if there is a way around the time piece of it. Yeah, I don't know either. Honestly, I think that...

17:15 There's a saying that goes something, and I'm going to butcher it, excuse me, but there's a saying that goes something like anything worth something is going to take time. And I think that's true about developing expertise. You know, it takes time. I've been in this now for, what, I think 40 years. And quite honestly, there's days when I still feel like a beginner. So we have a lot to learn. And that's one of the beauties, and that's why things like critical thinking are so key, because if you don't have that critical thinking piece, if you haven't trained yourself through, for example, philosophy, understanding, or by understanding psychology and physiology and emotional regulation, then it becomes really difficult to think outside of the box.

18:10 And I think that's my main call here is really, how do we train clinicians to think outside of the box? You know, one of the reasons that if you go into an ER with some weird condition, one of the reasons that new interns in the ER do better than old docs is because they're still looking for zebras. The expression they use, they're still looking for zebras rather than horses. In other words, they're looking for, their mind is fresh with all these different diseases that this cluster of symptoms might be. And the old docs are like, yeah, it looks like this, you know.

18:50 But the newer docs are like, wait, this could be that. And so they investigate it, right? And there's a place where there's burnout, right, for people, and they stop doing that. This is another reason that continuing education is so key. But yeah, I definitely think that our model has lent itself towards evidence-based medicine. There are some strengths to evidence-based medicine, but there are some real weaknesses around evidence-based medicine. And evidence-based medicine leads to cookbook medicine, and it leads to treating the average. It also often leads to treating conditions with drugs or even herbs that a company had the money to commote and had influence on therefore getting clinical trials done rather than an older that nobody's ever thought about.

19:43 For example, like taraxicum and diureses. Your good friend, Bevan Clare, and I did what I could see as I was shocked of the first clinical trial. And it was small. It was really a pilot trial. But nonetheless, first clinical trial in humans showing that dandelion was actually a good diuretic, right? So, but what are we doing? We're ignoring that and going towards other herbs that have more clinical research on them or drugs that have more clinical research. And one of the really cool things about dandelion in terms of diureses is the pharmaceutical diureses are part of the kidneys. And you can only take them for so long before you really start getting kidney degradation.

20:28 One of the great things about dandelion is the sicoaric acid in there, a caffeic acid derivative, is renal protected. So not only are you getting a push to, to move fluids out of the body, you're also getting renal protection. So might it make sense to not only, if you're on a pharmaceutical diuretic, might it make sense to lower that dose, add dandelion to synergize and get more urine output and get renal protection? I don't know, but that would be heresy. Well and i think i think too like understanding yeah is a reason to think this is there a reason to try it but then you also have to balance that like oh okay and then this person comes in and they have a gallstone and they can't take something that's bitter like dandelion leaf like this is where we come into the personalized bit of things because it's like well it's it's helpful in this category.

21:32 And then maybe energetically, it's not a fit. Or maybe there's some other reason that maybe that's not the greatest option for them. And I think that that's where the experience starts to come in. So anyway, I want to be respectful of your time and wrap this up because I think we've given people a lot to think about. But I think maybe just for some final thoughts on the way I see what we've talked about is a call to educators and also a call to people who are ongoing students, which I think both of us consider ourselves in that category, but a call to all of us who are in the herbal field or in the, you know, related to education. How do we develop our critical thinking skills? Any, any like final words of wisdom or pearls or advice that you might recommend to, to people who are thinking deeply about this?

22:23 Yeah, I think, so really the key, as you pointed out, really the key is education, right? And I think what I would say to people is, number one, read philosophy. Some great, and if you want to do medical philosophy too, that's fine. But there's some great, great books out there that really get people to think. And I think that's critical. Number two, read medical history. I have learned so much about medicine in general by reading medical history and listening to these people that were either unheard or heard and then forgotten.

23:05 It's really helped me in my clinical practice. The third thing I would say is really embrace an energetic model of medicine. That doesn't have to be TTM. It doesn't have to be Ayurvedic medicine. It could be Unani-Tib. It could be Native American. But embrace a model there because that, you know, that leads us to pattern recognition. And while medicine, the allopathic medicine system will say that pattern recognition is important, they use it in a different way than I use it. Pattern recognition for them is recognizing particular symptoms and clustering those into diagnosis of providative disease. That's useful. Don't get me wrong.

23:53 But what energetic models of medicine do is they look at pattern recognition intriguingly through a fractal line piece of the body, such as the tongue and a pulse or an iris, and put together patterns that help you understand the whole person. Psychologically, emotionally, physically, pathophysiologically. And that gives you real insight into what herbs to use, what herbs not to use. So that's, I think, what I would say is think of it that way. And hopefully that'll boost your education.

24:37 I love it. And do you have any recommendations or other reading recommendations for where people could start if they haven't? Before read any philosophy or a medical history? Is there anything you feel like is pretty accessible for a newbie in that area? Oh my God, I've got so many medical history books. Didn't anticipate this question. Can I get back with you on that? Yes, I'll put it in the show notes. Good. I'll put it in the show notes. I'll put a list together. Great. Yeah, amazing. Thanks for having me today. I really appreciate it. Well, thank you so much for coming. This is a great discussion. I hope we can kind of continue thinking about it and hopefully it'll be helpful for people who are listening to think about this on their own. And I just have to add that, you know, you were a student of mine.

25:22 And now that I feel like you have far surpassed me, and that's really rewarding on my end to see that, to see what you're doing and that you're in herbal medicine and that you're really shaking things up. So I really appreciate that about you. Well, thank you, Kevin. And as they say, I stand on the shoulders of giants. Such as yourself i'm only five seven and a half these days i've lost an inch due to aging so. I think that that's that's a metaphorical metaphorically giant in the field well thank you so much is is there any way that people can kind of stay in touch with you follow you, be connected with you is there anything to share with you yeah sure sure i'll add that to the notes, but Dr.

26:08 Spellman, D-R-S-P-E-L, 1-L-M-A-N, at phytochemks.com. Phytochem is P-H-Y-T-O, phytochemks.com. Chem is chemistry, phytochemks.com. That's a lot of explanation, Kevin. We'll put it in the show notes. I didn't pick an easy email address. That's amazing. Awesome. Well, thank you so much for being here. And I so appreciate you spending this time. Likewise. Thank you, Camille.