Q&A: Environmental medicine leader aims to root out hidden illness triggers

The president of the American Academy of Environmental Medicine (AAEM), Amy L. Dean, DO, first became aware of the environment’s impact on health as a child. She observed her mother suffer precipitous cognitive decline that was eventually attributed to exposure to cleaning solvents.

After majoring in biology at the University of Michigan in Ann Arbor, Dr. Dean went to work for an environmental medicine physician for a year, assisting with research. At an AAEM conference, she became acquainted with DOs who convinced her that the whole-patient approach of osteopathic medicine would mesh well with her already strong views on holistic health care and the need to find the underlying causes of symptoms and conditions.

She earned her DO degree from the A.T. Still University-Kirksville (Mo.) College of Osteopathic Medicine in 2000. With her sister, a nutritionist, Dr. Dean opened Ecological Internal Medicine in 2004. The mostly referral-based Ann Arbor practice has succeeded financially by keeping overhead low and not accepting insurance.

Dr. Dean integrates osteopathic manipulative treatment, including cranial techniques, into her practice.

Following is an edited interview with Dr. Dean.

When did you become interested in environmental medicine?

I learned about the field when I was in grade school. My mom, a teacher, was exposed to some cleaning solvents that weren’t used properly in her school. A lot of the teachers got sick, with some developing cancer, toxic encephalopathy and immune system dysfunction. My mom had just gotten a PhD, and she actually went down to a third-grade reading level and had to relearn how to tie her shoes. It was quite a change in my life.

The school physician, an internist, had a special interest in environmental medicine. He saw a pattern in what was going on and assessed the situation from a different angle.

Why did you become a DO?

Honestly, I didn’t know about osteopathic medicine when I was a premed student at the University of Michigan. I applied to MD schools but wasn’t getting in, and the guidance counselors couldn’t figure out why.

So I took a year off from the med school application process and went to work for an environmental medicine physician. One of my roles was to assist with research. In that capacity, I attended a conference of the American Academy of Environmental Medicine, where I met a number of DOs. I noticed that they were accepted by the MDs in the group. The DOs had good ideas and were holistic in their approach. This opened my eyes to osteopathic medicine.

Like environmental medicine physicians, DOs look for underlying causes; they don’t just treat symptoms. That describes the physician I wanted to become.

You recently became certified by the American Board of Environmental Medicine six years after obtaining a certification from the American Board of Integrative Holistic Medicine and eight years after obtaining your primary AOA board certification from the American Board of Internal Medicine. What led to your earning secondary certifications?

I have a passion for learning. During my rigorous osteopathic residency in internal medicine, I was not focusing on environmental medicine. So I wanted to update my knowledge when I started my practice. Initially, I had more of a primary care practice, but it evolved into mainly an environmental medicine specialty practice, as I gained more expertise in this area and received more and more referrals.

The holistic medicine certification paved my way to pursue the more strenuous board certification in environmental medicine, which requires both an oral and a written examination. The AAEM is accredited by the Accreditation Council for Continuing Medical Education.

Is environmental medicine considered alternative medicine?

I receive referrals from the University of Michigan Health System and other respected hospitals and many highly regarded MDs and DOs. What I do is evidence-based, but it is not part of the standard training of physicians. So most physicians lack any knowledge of environmental medicine, and some are not aware of the field.

Environmental physicians focus on recognizing, treating and preventing illnesses caused by exposure to biological and chemical triggers in air, food and water. Systemic illness caused by mold exposure, the toxins present in cleaning and other everyday products, food sensitivities and allergies, and the potential hazards of consuming genetically modified food are among the concerns and interests of environmental physicians.

Physicians who are ABEM-certified in environmental medicine have primary board certifications in other specialties, such as general surgery, pediatrics and family medicine. The American Board of Environmental Medicine developed outside of the mainstream of the American Board of Medical Specialties (ABMS). Years ago, the American Board of Occupational and Environmental Medicine added environmental medicine to its title, which resulted in the exclusion of a separate certifying board strictly for environmental medicine.

But environmental medicine is an interdisciplinary field that crosses all medical specialties. Primary care physicians and others whose interests lie outside of occupational medicine needed a way to acquire environmental health expertise and credentials.

As environmental physicians, we start with the traditional model of medicine for our foundation. But with our additional training, we take traditional medicine a step further by asking, “What caused this condition?”

If I have a patient with rheumatoid arthritis, for example, I’ll try to find out if there is a trigger or something he or she has been exposed to that may be fundamentally affecting that disease process. To do this, I’ll run a series of tests. Depending on the patient’s environmental history, I may do a solvent or pesticide panel or another toxicology test.

As an osteopathic physician, as well as an environmental physician, I look for the root cause of a problem and address that in trying to reverse the disease or to at least prevent it from progressing.

Besides rheumatoid arthritis, what types of ailments do you frequently address at Ecological Internal Medicine?

It’s across the board. For example, I had one patient with new-onset seizures who didn’t want to start seizure medications. We did a workup and found that the patient had very high levels of solvents in her blood. So we did genetic blood testing to see how well the patient is able to detoxify poisons. We found that she has alterations in her genes that were making it hard for her to keep her solvent levels down. Using various environmental interventions, osteopathic manipulation and dietary changes, we were able to restore her system. She has been seizure-free for about a year now.

Your genes plus your environment equal your disease. In other words, a person’s genetic predisposition to a disease plus what he or she has been exposed to adds up to how a disease manifests itself.

Some patients have food-related issues. My sister, who has an MS degree in nutrition, works with patients to optimize their diets. To identify food sensitivities, it is effective to eliminate certain foods one at a time from a patient’s diet and monitor the results.

How do you use OMT in your practice?

When I was at Kirksville, I became very interested in manipulation. Fortunately, I was able to do some osteopathic manipulative medicine rotations during my internal medicine residency as well. And I still take classes in manipulation, including cranial techniques, through the American Academy of Osteopathy and The Cranial Academy. The more I learn, the more I realize what I still don’t know.

I use manipulation on a lot of patients who have neurological issues, such as Parkinson’s disease, and many patients with autoimmune diseases. Often working on their cranial pattern or finding structural lesions in the body and releasing them lowers their structural burden enough that they start feeling better.

You took a bold step in starting a solo medical practice at a time when many young physicians begin their careers as employees. How have you survived financially?

The business community has been very supportive from the beginning, as have my environmental medicine mentors. Nevertheless, when I first opened my practice out of residency, I didn’t have a way to budget for a biller. So I decided to be out of network and have patients submit their own paperwork to their health insurance plans.

Running a cash-based practice has worked out well for me. And my patients have found that a lot of the diagnostics and lab work I do are covered. Though it depends on the plan, there usually is some degree of coverage for office visits too, as long as a patient isn’t in an HMO. However, recently I’ve found that patients have incredibly high deductibles that they probably won’t meet anyway, so it doesn’t matter as much to them whether they see someone in network or not.

I think our growth has been slower because we don’t take insurance. But many very sick patients who haven’t found answers elect to see us because they think we can help. Despite the nation’s economic slump, last year was our best so far.

What are you trying to accomplish as the president of the American Academy of Environmental Medicine?

I’m trying to increase interest in environmental medicine among physicians and the public. The AAEM strives to educate people about the connection between the environment and health. Often this connection is overlooked, especially in the current model of health care, in which physicians have limited time to spend with patients.

I wish that more physicians would have the time to take a thorough environmental history, going back through a patient’s life to see what kind of exposure he or she may have had.

Studies have shown an approximately 60% improvement in the symptoms of patients who make changes to their environment. So the data is there. It’s just a matter of getting the information out to people so they make better choices.

The United States lags behind Europe when it comes to championing environmental health. Europe operates on the precautionary principle—the burden is on industry to prove a product is safe before consumers are exposed to it. In the U.S., the burden tends to fall on the consumer. We’re advocating for this to change.