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CNN on alternative medicine for kids
Posted: 08 January 2009 09:04 AM   [ Ignore ]
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I just came across this article on CNN.

Here are the highlights:

• Not all alternative medicine suitable for kids, but some are safe, effective, doctors say
• At correct doses, chamomile, fish oil and probiotics can be good for kids, experts say
• Experts: If interested, it’s good to find pediatrician who knows about both approaches

Can you, Brennen, macgyver, or anybody else, comment on this? Thanks.

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Posted: 08 January 2009 10:50 AM   [ Ignore ]   [ # 1 ]
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Good catch.  I just saw this article myself and felt compelled to leave a skeptical comment after the story to offset various comments with anecdotal remarks of the form “Alternative Treatment A worked wonders for my (relative’s/friend’s) child’s Disease D.”  Some other skeptical folks had already beat me to the punch.

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Posted: 08 January 2009 11:30 AM   [ Ignore ]   [ # 2 ]
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As usual, the recommendations are far stronger than the data supports. The Chochrane Review on fish oil for athma examines the studies of this treatment, and it had no measurable effects in adults or childrne. I’m not aware of any data on chamomile, though I know it’s a popular folk remedy. Probiotics have some weak supporting clinical data, but the fact is the normal GI flora is extremely complex and varied, we have no idea what to put in and what will help or harm, and there have been cases of severe systemic infections from the live organisms given in probiotic preparations (see Cochran Review and listen to Quackcast Probiotics Review).

Most of these things are probably harmless, but that’s mostly because they aren’t doing anything. And if they feed the general belief that CAM is safer and better than scientific medicine, they become dangerous. Typical case of mainstream media not checking facts but just quoting anybody with letters after their name.

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Posted: 08 January 2009 11:34 AM   [ Ignore ]   [ # 3 ]
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mckenzievmd - 08 January 2009 11:30 AM

listen to Quackcast Probiotics Review.

Oh, I haven’t listened to that one yet. Great! I like this podcast, he makes me laugh. Thanks, Brennen.

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Posted: 08 January 2009 01:13 PM   [ Ignore ]   [ # 4 ]
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mckenzievmd - 08 January 2009 11:30 AM

As usual, the recommendations are far stronger than the data supports. The Chochrane Review on fish oil for athma examines the studies of this treatment, and it had no measurable effects in adults or childrne. I’m not aware of any data on chamomile, though I know it’s a popular folk remedy. Probiotics have some weak supporting clinical data, but the fact is the normal GI flora is extremely complex and varied, we have no idea what to put in and what will help or harm, and there have been cases of severe systemic infections from the live organisms given in probiotic preparations (see Cochran Review and listen to Quackcast Probiotics Review).

Most of these things are probably harmless, but that’s mostly because they aren’t doing anything. And if they feed the general belief that CAM is safer and better than scientific medicine, they become dangerous. Typical case of mainstream media not checking facts but just quoting anybody with letters after their name.

I’m quite interested in the hype about probiotics. I will be sure to check out the links you provided. Do you have any other additional resources? It’s something I’ve been meaning to read up on.

There’s this Dannon stuff, Dannon Yogurt Faces Lawsuit Over False Advertising.

“The proposed class action accuses the company of lying in advertisements about the “clinically proven” ability of Activia, Activia Lite and DanActive to “regulate digestion” or improve the body’s “immune system” with exclusive strains of what are known as probiotic bacteria. The products cost about 30 percent more than ordinary yogurt.”
(...)
“Probiotic bacteria have only been proven to help with very specific disorders,” she says. “Probiotics is an exciting field, but it is too early to make … general claims like ‘regulates your digestive system.’ That doesn’t mean anything in medical terms.”

I hear a lot of lay advice about eating yogurt when taking antibiotics. I eat yogurt regardless of the news or marketing claims, because it’s tasty and convenient for breakfast. Mmmmm, vanilla flavor… I guess that makes me a consumer of alternative medicine!

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Posted: 08 January 2009 01:43 PM   [ Ignore ]   [ # 5 ]
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Great podcast, Brennen. I know you’ve recommended it before, but this is the first one I listened to.

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Posted: 08 January 2009 02:06 PM   [ Ignore ]   [ # 6 ]
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Probiotics, unlike some CAM like homeopathy, is quite plausible in theory. The devil is, of course, in the details. We don’t have a solid catalogue of what lives in the gut, partly because many of the organisms involved are difficult to culture. Some recent work involving genetic sequencing has expanded dramatically our understanding of what’s in there (For Example). The function of these bugs and the appropriate genral population levels, the amount of individual, regional, etc variation, and lots of other things about this field are unknown. So while we can say basically that there are a lot of bugs, we know the names of some of them, if the right ones aren’t there in the right numbers things go wrong, and lots of diseases and medical therapies can affect this stuff, we can’t say much specifically about what we should or shouldn’t put in the system. That’s where the whole probiotics business becomes quackery.

Pubmed and Cochrane review searches will turn up huge numbers of research studies on the effects of a few common bugs (lactobacillus, sacromyces yeats, and a couple others) in people with diarrhea, primarily due to infection or antibiotic use. There’s some limited evidence that some of these things may have some benefit (notice how many qualifiers in that sentence?). But anybody who confidently tells you that eating X will prevent or fix your diarrhea is lying. As the podcast I referenced mentioned, there is probably minimal risk to these things, except for people without great immune systems (the usual list-young, old, pregnant, HIV, chemotherapy, cancer, etc). But anything you take is essentially an experiment with an N of 1 and no control group. I happen to like yoghurt as well, but I don’t treat it as medicine or as a reliable preventative for GI problems.

This tgopic is on my list in terms of the veterinary client handouts I’m working on (next in line after fish oils), so hopefully i’ll have more details and references in a few weeks. As far as human med goes, macgyver or one of the nurses/md’s here probably is better informed than I am.

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Posted: 08 January 2009 06:19 PM   [ Ignore ]   [ # 7 ]
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This article refers to children. I’m an internist and don’t treat children so I can’t comment directly. Although a lot of what works in adults applies to children there are some important differences.

Fish oil has been a hot topic in adult medicine because there is some evidence that it can reduce heart attack rates and has been effective in lowering Triglyceride levels in patients. For people who are high risk for cardiac disease or are unable to get triglycerides into acceptable ranges with traditional medications Fish Oil seems to be a reasonable add on therapy. Obviously this would have limited application in children. Many people are using Fish Oil for other things such as joint pains and arthritis. I am not aware of any conclusive evidence that it works for these conditions.

Chamomile?? Like Brennan said, this folk remedy has been around forever and has been used to treat any number of illnesses including the common cold. It may help people feel better, but I would bet that any warm steamy drink would probably do the same thing. I haven’t reviewed the literature, but neither have I come across anything in my usual readings that any studies have showed chamomile to be useful for any particular illness.

Brennan pretty well summed up the Probiotic issue. Its extremely complicated and anyone who says they understand the bacterial mixture in our gut and how to optimize it for better health is, pardon the pun, full of crap. The human gut is a very complicated ecosystem. To introduce species of bacteria into the body and hope to get a desired effect is like introducing a new insect or bird into the amazonian rainforest in hopes of causing a specific change. The problem is that there are thousand or millions of species. We are haven’t cataloged all of them and we don’t understand most of the ones we have cataloged. What makes things even more complicated is that we have only the most superficial understanding of the infinite number of interactions which can occur between species. The most common use ( misuse) of Probiotics in medicine has been the recommendation to patients that they use Yogurt or Lactobacilus (acidophilus) to prevent antibiotic related diarrhea. Lactobacilus is one of the species of bacteria that naturally lives in the gut, and the presumption was that if you flood the gut with this bacteria you could restore the normal flora that had been disturbed by the use of antibiotics. Controlled studies have been inconclusive on the benefits of probiotics in the treatment of antibiotic associated diarrhea. Its an interesting idea and worthy of research, but this is a typical case of the treatments getting ahead of the science.

My take is that this announcement is a misguided attempt by the medical community to appear more open minded about alternative medicine and win back some of the patients ( business) that are being lured away by the alternative medicine practitioners. The evidence isn’t there.

[ Edited: 08 January 2009 06:27 PM by macgyver ]
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Posted: 08 January 2009 07:41 PM   [ Ignore ]   [ # 8 ]
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My doctor (a pretty skeptical guy generally) recommended fish oil for cardiac issues, and suggested I consider taking a small amount daily if I wasn’t having fish regularly. My dim understanding of the research would lead me to believe that was a good idea, and at the very least it is not likely to be harmful.

Probiotics are fringy; they may have some reasonable use, but I expect it will be limited to people with particular ailments, not for the general population. (E.g., yogurt’s supposed beneficial impact on the immune system, which Quackcast effectively demolished).

But it’s one thing to recommend these things to consenting adults who are in certain risk groups, or with given ailments. It’s another thing to recommend them generally to kids.

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Posted: 09 January 2009 01:14 AM   [ Ignore ]   [ # 9 ]
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One should be careful with the word ‘alternative’. If alternative means ‘against all established scientific insights’, then of course it is OK. But if it means ‘not established by scientific research’, one should be careful. It would be the end of scientific research….

On the other side: if there are some hints on that something might help, it is not yet time to yell from the roofs how great this stuff is.

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Posted: 09 January 2009 08:57 AM   [ Ignore ]   [ # 10 ]
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Well, “alternative” is IMHO a marketing term invented by the CAM movement. It’s only meaning, as far as I can tell, is that something has a lot of believers but hasn’t yet met the standards of scientific evidence required of everything else to establish safety and efficacy or has clearly failed to meet them. It identifies soemthing accepted as beneficial by faith rather than by evidence. Lots of things that haven’t yet been established as effective by scientific evidence aren’t alternative because there isn’t a lobby arguing that they work anyway (e.g. newly invented drugs).

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Posted: 09 January 2009 12:09 PM   [ Ignore ]   [ # 11 ]
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I like yogurt and salmon, but I think alternative medicine is hooey.  Does this mean I have to stop eating them?  LOL

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Posted: 10 January 2009 05:18 PM   [ Ignore ]   [ # 12 ]
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There is a spectrum ranging from medicine that works very well with a long established history and supporting data, i.e. insulin and type 1 diabetes, to “treatments” without supportive data or plausible biologic mechanism, i.e. homeopathy. 
The only thing that I see as “alternative” about these other therapies is that they depend on magical thinking and avoidance of the process to demonstrate their efficacy.

I have no doubt that many new therapies are yet to be discovered.  And, I would welcome treatments that are efficacious and safe, regardless of their origin. 
But, there is medicine and not medicine.  In this case, I don’t see any need for an “alternative” to rational thought.

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Posted: 11 January 2009 07:29 AM   [ Ignore ]   [ # 13 ]
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Hawkfan - 10 January 2009 05:18 PM

There is a spectrum ranging from medicine that works very well with a long established history and supporting data, i.e. insulin and type 1 diabetes, to “treatments” without supportive data or plausible biologic mechanism, i.e. homeopathy. 
The only thing that I see as “alternative” about these other therapies is that they depend on magical thinking and avoidance of the process to demonstrate their efficacy.

I have no doubt that many new therapies are yet to be discovered.  And, I would welcome treatments that are efficacious and safe, regardless of their origin. 
But, there is medicine and not medicine.  In this case, I don’t see any need for an “alternative” to rational thought.

The term alternative medicine is used to describe treatments that have not been subject to the same rigors of standard scientific study that is required of traditional medicine. While there are some alternative therapies that have begun to be studied in more traditional ways the majority have not. Even among therapies that have been studied, practitioners of alternative medicine often ignore studies that have proven a lack of efficacy or overstate studies that have shown a possible benefit. So even when traditional medicine tries to apply basic scientific principals to the study of alternative therapies, the alternative practitioners often refuse to follow a rational approach to the implementation of this knowledge and the use of these therapies.

As far as a “plausible biologic mechanism” for homeopathy, nothing could be further from the truth. Most of homeopathy is based on the theory that illnesses are caused by various toxins and that the illness can be treated by giving the person very dilute solutions of the toxin. These homeopathic solutions are made by diluting the “toxin” to such extreme dilutions that the original toxin is no longer present in the solution but the water retains a “memory”  of the original toxin. Aside from the lack of any medical evidence to support the efficacy of these treatments, 200 years of empirical evidence in the areas of physics and chemistry proves there’s no basis for this theory.

There is certainly a spectrum of traditional medical treatments in terms of the amount of scientific evidence to support their efficacy. To a much lesser extent this statement can also be applied to alternative medicines, but to imply that all these treatments lay along the SAME spectrum is a misunderstanding of the controversy.

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Posted: 11 January 2009 02:03 PM   [ Ignore ]   [ # 14 ]
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I think we are in agreement Macgyver.
I was being facetious when using homeopathy as an example.  It is nonsense and has no business being considered as medicine of any sort.
My point is more directed to the idea of labeling these alleged therapies as “alternative”.
I maintain that they are an alternative to rational thought.

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Posted: 11 January 2009 04:07 PM   [ Ignore ]   [ # 15 ]
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Sorry Hawk. Its always a bit risky trying to interpret sarcasm in forums and emails. Thanks for the clarification.

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