An increasing number of people are developing autoimmune disease. And an increasing number of people are googling their symptoms. Invariably, they’ll come across what’s known as the “Th1/Th2” system. This system itself asks a question: which one are you–Th1 or Th2?
It’s a simplistic way of looking at it, because few people are strictly Th1 or Th2. Yet, it remains among the public (and uninformed doctors) a multiple-choice question without an option “C” in the answer bank. You’re treated as having one or the other.
Members of the general public (and those same doctors I just mentioned) have a tendency to get stuck on keywords and buzzphrases, latching onto a trendy concept and beating it to death. (MTHFR, anyone?) Among autoimmune communities, the Th1/Th2 topic is what the MTHFR obsession is to the detoxification crowd.
Several supplement companies arose to the demand, developing a Th1-stimulating formula, and a Th2-stimulating formula. They packaged samples of each in little bags, complete with instructions for a “6-day clinical challenge”. Patients would take the first formula for the first 3 days, and the second formula for Days 4-6. They were advised to report back to their doctor any symptoms they felt, and in response to which formula.
Most people think the Th1/Th2 question is a new thing. It’s not. It had been the accepted model since the 1980s, when we only knew about those two players.
Things have changed, kids. Enter Th17, the “new” kid on the block, although investigative research didn’t really take hold in earnest until about 2006. Yes, that’s right – that far back. (Most people didn’t know about it until around 2012, and even now, in 2017, it gets glossed over.) The “new” Th17 player did answer a few conundrums that kept popping up like a carnival whack-a-mole game: why people undergoing the Th1/Th2 “clinical challenge” were reacting badly to both the Th1- and the Th2-stimulating supplement formulas.
It’s bad enough to feel symptoms in response to one formula, but both??
Let’s not ignore the elephant in the room: symptoms are the body’s way of saying “this sucks! I’m getting damaged here!”
The “clinical challenges” were flaring people’s autoimmune symptoms up, for days, weeks, or even months.
“First do no harm” indeed.
Enter a lab to the rescue!
Word on the clinical hill began to spread about a lab test panel that would test blood samples for immune reactivity instead. It was only as invasive as a blood draw, and once at the lab, the lab techs could hit the sample with all several types of immune stimulants and measure the response of different immunological biomarkers.
Better yet, that panel was connected up with saliva and urine samples to get an idea of what was also going on in the nervous and endocrine systems, since they have a significant impact on immune function. So do lectins and bacterial endotoxins, which were also included in this panel!
Lab testing FTW! Pharmasan Labs became my new hero, the Stimulated Cytokine Test my holy grail.
Only when this lab “super-panel” was recommended to me by an experienced an unbiased colleague I have come to deeply respect did I actually start recommending it to my patients.
One drawback: it was god-awful expensive. But, this lab was the only one doing this type of test, and we (the doctors in the trenches) needed this crucial information.
All was calm and all was bright until one day, probably about 2 years ago: we received a notice, either by email or snail mail, that the lab would be discontinuing certain test codes and changing the available analytes on the existing tests.
My beloved lectin sensitivity results (the PHA biomarkers) were going away, in favor of the more-generic “candida” stimulant. In addition, the report format would be changing, and not in a good way. The previous way was relatively readable:
(The blurriness notwithstanding. Thanks, Russian web pirates.)
As opposed to the new format:
(Don’t worry, I’ll take an anonymized picture and insert it here. I couldn’t find a sample report online, not even on the lab’s website. Not exactly shocking.)
We contacted Pharmasan Labs and flat-out told them that these new changes were unwise and unnecessary. We had no idea what to make of the new report format, as there didn’t seem to be any consistency between where the actual numbers fell compared to the given reference range, and what was graphically depicted as “high” or “low”.
Come to think of it, that had been a bit of a problem before. And I also noticed the same problem with their urinary transmitter testing.
But to give the PHA/lectin marker the axe, that was a dealbreaker. Continuing with my flat-out-ness, I stated that the lectin sensitivity section was one of the primary reasons for my running this lab panel, and the lab would not do well to remove one of its biggest draws, one of the chief selling points that separated them from every other lab out there.
Because if need be, I could take every other component of that “super-panel” and piece it together from other labs. The adrenal component could be obtained (easily and cheaply) from another lab, as could all hormones, and even some urinary neurotransmitters, if I felt like it.
Beyond the stimulation of the immune system, Pharmasan didn’t really have anything I was interested in that I couldn’t get somewhere else.
And they wanted to kill it.
I must not have been the only doctor who raised a stink, because for a while, they listened. But like so many other corporate and government initiatives in contemporary society, they said, “Okay, okay, we’ll behave ourselves, give you what you want, and bring back what we were doing before. We won’t change, it’s okay!”, but then later, quietly, when no one’s looking, they’ll hit the Retry button on their initiative and hope nobody notices–or that at least it’s accepted this time.
I guess not a whole lot of doctors expressed their discontent this time around, because the changes went through, and they stuck.
Maybe the changes stuck because the lab itself wasn’t as forthcoming this time, or perhaps they were, but not as far in advance.
Proof that they offered this test before (from their (outdated) CPT codes page):
Proof that they don’t now (from their test menu):
Yeah, it’s gone. You can’t order it.
They were on their way out of my office before, but then came the kicker: they were sanctioned in court, something relating to fraudulent Medicare billing, occurring over the course of years, complete with an $8.5 million dollar tag.
Once I started digging, I found that there have also been some CLIA issues (PDF). Although I believe they’ve regained their CLIA certification since then, I had heard through the grapevine that it was in danger of being revoked again, this time for issues with consistency, after a doctor mailed in 2 test kits containing material taken from the same sample and received wildly different results, but I can’t find any instance of that having made the public record, so I can’t verify that. The juicy tidbit came from a very trusted source, though, who has no vendetta or other reason to falsify something like that.
Obviously, I’m looking into other options. Pharmasan Labs is no longer in my office.