Pamela Wartian Smith, MD, MPHMay 2005
Thinking “outside the box” has always come easily for Pamela Wartian Smith, MD, MPH.
As an undergraduate at De-troit’s Wayne State University, she majored in English rather than pre-med because she “wanted to be a literate physician.” Such thinking helped Dr. Smith eventually transition from emergency room (ER) physician to anti-aging practitioner and a leading authority on bioidentical hormone replacement therapy, an evolution that began 10 years ago.
An Inadvertent Transformation
At that time, while in her early forties, Dr. Smith suddenly developed acute insomnia, despite never having had trouble sleeping before. Her determined quest for relief led to a personal and professional awakening.
“I went to 11 physicians for help, and none could help me,” says Dr. Smith. “At the same time, I became interested in anti-aging medicine, which then was a relatively new medical specialty. I went to an anti-aging conference, where a saliva test revealed that I had no progesterone. Although I had early perimenopause due to a partial hysterectomy, I didn’t realize hormones held the key to my problem.”
While the insomnia mystery was solved, Dr. Smith’s glimpse into anti-aging medicine inspired her to seek more information, and led to revelations about her own health and career.
“I always thought I was a very healthy person,” she says. “I grew up eating natural foods. I cooked with organic ingredients. But then I learned that I really couldn’t get all the nutrients from the soil itself. I realized I had to start taking supplements, and needed to exercise, too.”
In a career-changing decision, Dr. Smith sought board accreditation from the American Academy of Anti-Aging Medicine. She did well on the written exam, then faced the oral exam, which required her to submit patient charts. As an ER physician, however, she did not have any patients. Her next move solidified her professional change of direction.
“I opened a small anti-aging practice designed to get patient charts for my exam, not to grow a business. Then I began reading
Life Extension magazine and attending more conferences, and I was hooked. By 2000, I’d left the ER, and there was no turning back.”
Dr. Smith is now the owner and director of the successful Center for Healthy Living and Longevity in Traverse City, MI, an anti-aging medical practice with four affiliated offices within the state. All are Body Logic MD centers, part of a group of physicians who practice anti-aging and functional medicine focusing on natural hormone replacement therapy.
“We’re all board certified in anti-aging medicine, and the patients get the same high-quality, anti-aging practice when they go to any Body Logic MD center,” says Dr. Smith.
Bucking the System
A member of the American Academy of Anti-Aging Medicine and a board examiner since 1997, Dr. Smith is the author of two books: Vitamins: Hype or Hope and HRT: the Answers—a Concise Guide for Solving the Hormone Replacement Therapy Puzzle, both published by Healthy Living Books. She has become a much sought-after lecturer on bioidentical hormone replacement therapy.
“I knew I could never go back to the way I practiced medicine before,” says Dr. Smith. “I wasn’t dissatisfied with emergency medicine, but I finally realized I needed to help people be healthy instead of waiting until they were sick to intervene.”
Early in her career, Dr. Smith earned a Masters of Public Health degree because she wanted to understand health care policy. Over the years, she concluded that the health care system is broken and fails patients. In anti-aging medicine, she saw a chance to defy the system and make a difference, particularly with regard to bioidentical hormone replacement. The problem with today’s physicians, she says, is that working within the broken system prevents them from practicing functional medicine.
“Physicians are overbooked—the average physician spends eight minutes with a patient,” she explains. “You can’t practice functional medicine in eight minutes. Doctors are rewarded for getting more people through quicker, rather than for keeping patients healthy. We would have to restructure how health care is practiced in the US so physicians would spend at least 45 minutes in evaluation, with follow-up visits of at least 20 minutes.”
Physicians are also too busy to keep up with the latest information in the medical journals, says Dr. Smith, noting that although the journals now contain considerable information about bioidentical hormone replacement, nutrition, supplements, and functional medicine, many physicians who attend her lectures are hearing about these topics for the first time.
“In our practice, we pride ourselves on the fact that all our physicians read for two hours a day,” she says. “We know what was in the New England Journal of Medicine last week. We call what we do the ‘standard of care.’ It’s what’s in the medical literature right now.
“It’s a totally different idea to focus on keeping people well rather than focus on disease-based medicine. Orthodox physicians need to change how they think to do this, and that’s not always easy.”
Bioidentical Hormone Replacement
Thinking differently once again, Dr. Smith wrote HRT: The Answers for her patients, publishing the book in a soft cover edition so every woman could afford it. Information is presented in a simple, easy-to-read, bulleted format for patients eager to participate in their own health care.
“Patients are more informed than they used to be. They read the medical literature and read Life Extension magazine, which I think is exquisitely written and contains fantastic research. Patients are learning that quality of life is really what anti-aging medicine is all about.”
Dr. Smith’s typical patient is 40-60 years old, primarily female (70% female to 30% male), and most likely to be interested in wellness or hormone replacement therapy. After a general history and exam, Dr. Smith orders lab work, including saliva testing, to measure the three estrogens (estrone, estradiol, and estriol), progesterone, total and free testosterone, DHEA, cortisol, melatonin, pregnenolone, and insulin-like growth factor.
“If the patient’s primary care doctor hasn’t done basic kidney and liver function tests, we do those as well,” says Dr. Smith. “We also check thyroid levels, running the entire panel of tests, which most primary care physicians don’t do.”
From the test results and the patient’s symptoms, history, and exam, Dr. Smith develops a customized treatment program.
“Your hormone response is as unique as your fingerprints,” she explains. “One size does not fit all. Customized therapy is more effective.”
Dr. Smith makes general and customized supplement recommendations, emphasizing antioxidants as an antidote to today’s often unhealthy, stressful life-styles. She also encourages balance in life, believing that longevity comes from a combination of physical, emotional, and spiritual health. In her personal life, she tries to blend home, family, and work life, engaging in cooking, needlepoint, and church activities when not on the lecture circuit or engaged in her practice.
In her writing and practice, Dr. Smith’s goal is to calm fears about hormone replacement and to educate women about why natural therapy is the only way to go.
“Hormone replacement isn’t and shouldn’t be scary,” she says. “I explain that estrogen itself has 400 functions in the body, and if you live without it, you live without 400 crucial functions that affect quality of life. Studies show that women who use hormone replacement therapy live longer than those who don’t. Taking bioidentical hormones of the same chemical structure as the ones the body makes before menopause is the only way to replace hormones safely. Synthetic hormones will become a treatment of the past. No patient in our practice gets synthetic hormones. I wouldn’t write a prescription for something I wouldn’t take myself.”
Dr. Smith was recently named director of the first fellowship in Anti-Aging and Functional Medicine, affiliated with the American Academy of Anti-Aging Physicians. This position will allow her to make her mark on the education of physicians who choose to study anti-aging medicine and, perhaps, on a health care system badly in need of change.
It will be a challenge, even for one who thinks outside the box. But Dr. Pamela Wartian Smith would not have it any other way.