Posted tagged ‘alternative medicine’

Beware melatonin supplements – their labels lie

February 27, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

About 36 billion dollars will be spent on vitamins and nutritional supplements in the US this year. It is a huge industry, with big advertising and PR budgets. Maybe it’s time for the manufacturers to spend a little money figuring out how to deliver honest and accurate products.

Tests on a variety of supplements have already shown that most of them are contaminated – many with toxic metals, like lead and arsenic. And a new study of one of the most popular supplements, melatonin, shows that most of the brands available have doses far different from what’s on the label.

Researchers in Canada purchased 31 melatonin products from stores in Guelph, Ontario (IKR! I didn’t know there was a Guelph in Ontario!) They analyzed the content of tablets, liquids, and chewables, and found that few of the products contained their labeled dose. 71% of the products were off by more than 10%, with the actual content of melatonin ranging from 17% to 478% of the labeled dose. There was a huge variability even among the same brand, with different bottles varying by 465% in content. Their research was published in the February, 2017 edition of The Journal of Clinical Sleep Medicine.

Potentially worse: 26% of the samples contained serotonin, a contaminant that can cause serious side effects, especially when combined with a variety of medications.

Though these samples were purchased in Canada, there’s no reason to think melatonin products sold in the US would be any more consistent. Neither country has any laws or standards established to regulate, test, or ensure the quality of “dietary supplements” including melatonin, vitamins, or any so-called “natural” or “herbal” products. In other words, there’s no reason to think that you’re getting what you think you’re getting.

There are some voluntary industry standards, and at least that’s a start. The press release about the melatonin study suggested that consumers from the USA look for a “USP Verified” logo certification from the “United States Pharmacopeial Convention.” I could only find one brand on the USP website of melatonin that’s been certified – “NatureMade” (scroll down the bottom, here. Oddly, the Amazon entries for these products don’t indicate that they’re USP certified.)

Many people purchase herbs and supplements for a variety of reasons – and there are some good clinical studies showing that some of them may help (many others, not so much.) But it doesn’t matter what the studies show if what you’re taking isn’t what’s labeled on the bottle. If the supplement manufacturers want to genuinely help people stay healthy, they need deliver a consistent and reliable product. Otherwise, it’s just smoke, mirrors, and empty promises that might make you sick.

Welcome to Guelph

Do natural remedies work?

January 23, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

Last post, I gave Rachel’s questions about “natural remedies” a hard time. They’re not, usually, natural at all. And whether they’re natural or not doesn’t imply that they’re good for you or bad for you. The label “natural” is an irrelevant marketing gimmick slapped on products to get you to buy them.

Still: Rachel had a fair question, and I really haven’t answered it yet:

My daughter and I were talking the other day and saying we would like to ask a doctor what his thoughts are about all these ‘natural’ remedies that are available. Recently a friend made the remark, ‘I do everything I can to avoid a doctor.’ I lean more toward the medical system and the knowledge they have acquired over the years rather than relying on these home remedies.

OK, for the sake of answering the question, let’s just accept that “natural” means “seems natural” or “marketed as natural” or whatever you want it to mean. I think we know what Rachel’s talking about here – home remedies, or alternative medicine things, or things you can do yourself without relying on a physician. Do these kinds of things “work”?

Yes. They do. Most of the time, for most people with most problems that come to the doctor, “natural remedies” will indeed work. Usually, you will feel better, and indeed you will get better, after taking them.

(I’m not talking about a placebo effect here—though that’s an interesting subject we can talk about another time. And I’m not saying that these natural remedies “trick” you into feeling better, or that you only feel better because you spent money on something and you expect to feel better. I’m talking 100%, honest-to-goodness, my rash went away and I am better-better!)

Here’s the scoop, the insider secret you all have been waiting for: most concerns that most people bring to the doctor, most of the time, are things that will get better on their own. Your cough will get better, your fever will get better, your sprained ankle will get better. Your rash will improve, you’ll have fewer belly aches, and that weird foot odor will probably improve, too. The fact is, and doctors and alternative-health practitioners know this, that your body will heal, and your symptoms will improve, and — if what you want to do is play the odds – whatever is on your mind the day you go to a medical practitioner is probably going to get better on its own.

There’s two reasons for this, depending on the nature of the problem. For acute things (like a common cold, or the flu, or a twisted ankle), your body will probably do a pretty good job healing itself if you get out of the way and let it get better. For longstanding sorts of things, like headaches or back pain, you’ll get better, too—if only because you usually go see your healer when these symptoms are at their peak. Think about it – you’ve got backaches, or stomach pains, or whatever. From day to day or week to week the symptoms go up and down. Your symptoms are sometimes worse, or sometimes better. You don’t go to your doctor (or naturopath) when the symptoms are minimal or improved. You go when you feel bad. And—guess what?—the symptoms continue to go up and down. Only now, you think it’s going down because of the medicine, or because of the herb or the magic potion. But: in truth, the “treatment” probably doesn’t matter. All that matters is that most problems get better.

Of course, “most problems” isn’t all problems. Your child’s asthma, leukemia, or iron deficiency anemia isn’t likely to go away on its own, and if you’ve had a heart attack you’d better get thee to a hospital, pronto. Some things will get better faster with appropriate treatment. I am not suggesting that no one needs a medical evaluation. But the main point of almost any doctor visit is to get advice from someone with both the expertise and experience to tell the very-many-who-will-get-better from the few-who-really-need-therapy.

And the few who truly need therapy probably don’t need what naturopaths have to offer.


Ric Flair

Most natural remedies aren’t

January 17, 2017

The Pediatric Insider

© 2017 Roy Benaroch, MD

Rachel wrote:

My daughter and I were talking the other day and saying we would like to ask a doctor what his thoughts are about all these ‘natural’ remedies that are available. Recently a friend made the remark, ‘I do everything I can to avoid a doctor.’ I lean more toward the medical system and the knowledge they have acquired over the years rather than relying on these home remedies. What are your thoughts?

A great question, Rachel. It turns out that many of these “natural” remedies aren’t very natural at all. Something should be considered “natural” if it exists in the world around us – if it’s a part of the observable, real world we live in – and a part of our world that we didn’t create or imagine. Trees and rocks and wind are natural. Ghosts and voodoo curses are not (they only exist in our imagination). Bridges, ovens, clothing, and books are not (we made those things.)

When you think about it, a lot of what passes for “natural” remedies are not natural. Homeopathic remedies rely on an entirely imagined mechanism of chemistry invented by Samuel Hahnemann around 1796. He thought that by diluting and shaking substances, a vital essence of their properties could be captured, which upon further dilution could alleviate the symptoms that were caused by ingesting that same substance. Acupuncture relies on changing the flow of a life-energy, Qi, through channels in the body that do not, objectively, exist. Chiropractic (invented by DD Palmer in 1895) relies on identifying and treating “subluxations” that do not exist on x-rays or any other objective test. Modern chiropractors have acknowledged that their subluxations are more of an idea than a real thing, but most of them insist that treating these nonexisting things is helpful. (Not all chiropractors subscribe to this belief – a small group is trying to distance themselves from the dogmatic belief in Palmer’s subluxations. I wish them well.)

Many other kinds of healing supported by “naturopathic doctors” are not at all natural. Reiki, Ayurveda, “detoxification”, iridology, reflexology, kinesiology, and many other ideas are like homeopathy, chiropractic, and acupuncture. They all  “supernatural”, like ghosts and voodoo and magic.

What about herbal medicine? Herbs, themselves, are natural (and, often, tasty!) But what’s sold at drug and what used to be called “health food” stores is not. Many herbal supplements do not in fact contain the labeled herbs. The herbs are imaginary and un-natural. Even if the herbs are indeed contained in the supplement, by the time they’ve been processed and turned into capsules, are they any more natural than the “medications” on the shelf nearby?

I think the wisest way to think about Rachel’s question is to reject the false dichotomy between what’s “natural” and what’s not. There’s nothing inherently safer or better about natural things. Smallpox is natural, earthquakes are natural, heart attacks and strokes and cerebral palsy are all natural. Poisons from pufferfish and venoms from rattlesnakes are natural. On the other plenty of good and necessary things are “unnatural.” The food we eat has been grown with fertilizers and pesticides (including organic foods, which use all kinds of substances you wouldn’t consider “natural” at all), brought to stores by trucks on roads driven by people wearing wristwatches and clothes. None of these things are natural. And that’s OK.


Coming up next post: OK, fine, natural remedies aren’t natural. But do they work?

Who you gonna call?

Homeopathic teething pills: Still poisonous

October 4, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

In 2010, I wrote about the FDA’s recall of Hyland’s Teething Tablets. It turned out that the tiny little pills, sold to allegedly help babies with teething symptoms, had measurable and potentially toxic amounts of a poisonous plant extract, belladonna. See, they were supposed to not actually have any of that, because homeopathic products aren’t supposed to have any of anything.

One principle of homeopathy works like this: by ultra-super diluting a poison, you get a cure for the poison, or at least relief of the symptoms that the poison would have caused if you ingested it. Which, of course, you shouldn’t do (ingesting the actual poison is discouraged, until it’s ultra-super diluted and isn’t there anymore. That’s what you’re paying for.) Those Hyland’s Tablets turned out to contain the poison that wasn’t supposed to be in there. Oops.

By the way, it’s called “belladonna” from the Italian roots for “beautiful woman”. Belladonna comes from the nightshade plant, and this “natural” chemical will make your pupils dilate (that’s the beautiful part.) It can also cause excessive sleepiness, muscle weakness, difficulty breathing, agitation, and seizures. Those parts are less beautiful.

Last week, on September 30, the FDA updated their 2010 release, warning consumers against using any homeopathic teething tablets or gels. This includes not just Hyland’s products, but those sold at CVS and other retail and online stores.

The bottom line: if they’re manufactured correctly, homeopathic products don’t contain any active ingredients at all. There is nothing in there that could possibly help with teething or any other condition. Oh, sure, there may be other things added to homeopathic products to make you drunk, but that’s not the point. Homeopathic products should be as safe as drinking a little water or swallowing a tiny little sugar pill—because that’s exactly what they’re supposed to be, a little vial of water or a tiny little placebo pill.

That’s if they’re made the way they’re supposed to be made. But homeopathic products, like all of the other alt-med goodies sold next to the real medications, aren’t regulated. There’s no guarantee of purity, and no guarantee that what’s on the label is on the bottle. You’re paying for what you hope is a bottle of literally nothing, but you might accidentally get something that can hurt you.

Funny world, isn’t it? Can you imagine someone complaining to the manufacturer that their placebo was contaminated with a biologically active substance that might actually have an effect on their body? Hey, I paid good money for absolutely nothing, and that’s exactly what I wanted!

Anyway: if your baby seems to be having teething symptoms, try hugs and love or a dose or two of acetaminophen. If that doesn’t help, go see your doctor (it may not be teething at all—those little babies can’t talk yet, and it’s hard to know exactly what’s on their minds. Maybe they got a glimpse of that presidential debate, and they’re understandably worried about the future.) “Homeopathic Teething Tablets” certainly aren’t going to help, and might just make your baby sick.


Chiropractic’s choice: Quackery or medicine

August 1, 2016

The Pediatric Insider

© 2016 Roy Benaroch, MD

Can the chiropractic profession evolve and renew itself as a legitimate part of the health care system? Prominent Australian chiropractor Bruce Walker, who is also the editor-in-chief of the Journal Chiropractic and Manual Therapies, has proposed a 10 point plan to ensure that chiropractors create a profession based on science, knowledge, and genuine healing. He makes a strong case that chiropractors need to embrace research, shun “nonsensical elements”, and follow evidence-based practice models. Can this be the spark that leads to genuine reform?

Walker lists several practices that he characterizes as “aberrant” and damaging to the reputation of chiropractic, including over-servicing their patients, pushing “life time” chiropractic care, misleading and deceptive advertising, and an “unhealthy disregard of clinical research.” He singles out two items of special interest to pediatricians, calling for chiropractors to stop their unnecessary treatment of babies and their penchant for anti-vaccination propaganda. (Anti-vax fraud doc Andrew Wakefield is a speaker at this year’s International Chiropractors Association Pediatrics Council.)

“The New Chiropractic,” as Walker calls his plan, relies on a very different model of professional conduct. He calls for improved education and accreditation of chiropractic learning centers, an emphasis on improving public health, and ongoing efforts to improve clinical practice with research and outcomes-based study. Specifically, he says that chiropractors ought to focus on the musculoskeletal system, with a special emphasis on spinal pain – becoming the spinal pain experts.

There’s certainly room for a profession of healers dedicated to the non-pharmacologic treatment of skeletal and back pain. These are common problems, and there’s a growing body of research both in support of alternative treatment modalities for pain and for the potential harms done with the chronic use of pain-killing drugs. But many chiropractors believe their expertise extends far beyond the back, and far beyond pain. There’s no evidence for that, as Walker and his journal have made clear.

For those of you interested in chiropractic care, or in making a career in chiropractic, it’s worth reading Walker’s commentary in full. There’s a lot going on in the chiropractic profession, including disillusionment with the educational expenses, high loan default rates, and a challenging job market for new graduates. Meanwhile, efforts at reining in health care costs are squeezing chiropractors at the payment end. By embracing these changes and demonstrating that chiropractors can be a cost-effective, helpful part of the health care system, chiropractors may yet be able to save themselves a place at the table. We’ll see what they decide.

More info:

A history of chiropractic

What do chiropractors claim to treat?

Does chiropractic work?

A chiropractor

Chiropractic abuse: An insider’s lament (Book review)

November 25, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

This blog, The Pediatric Insider, is here to tell you the real deal. What the science of pediatrics really says– which, I know, isn’t always what’s told to parents at pediatric offices. I’ve been critical of medical doctors who put profits ahead of patients, or who are just going through the motions, following old habits that aren’t really helping anyone. I’ve been critical of pseudo-science and silly beliefs, whether they’re from medical doctors, anti-vaccine zealots, or alternative medicine practitioners. You want the truth? I think you can handle the truth.

Now you’ve got a chance to hear what an insider from another field has to say about their profession. You want the truth about chiropractic? Chiropractor Preston Long’s book, Chiropractic abuse: An insider’s lament, exposes his field for what it really is. This isn’t just some guy who’s read about chiropractic, or a sour-grapes chiropractic competitor looking to smear a profession. Long is a licensed chiropractor who has worked in his profession for many years, it’s clear that he really wants to help his patients. He puts that above any sort of blind loyalty to what he’s been taught, or his own self-interest in making a buck. And what he’s decided is that the practice of chiropractic is rife with fraud and quackery, and that chiropractors are far more trained in extracting dollars than in the diagnosis and management of any health condition.

Long’s book recounts his own decision to attend chiropractic school, and the odd, cultish setting that he soon encountered. He became disillusioned when he realized just how minimal the actual training was, even moreso when he found that most of what chiropractors rely on as “education” is centered on building a practice and retaining paying customers, rather than learning about the human body and how to prevent and treat illness. Their education, Long explains, is vastly different from that of medical doctors. In medical school and residency, a learning doctor will see thousands of patients across many settings, proctored and guided by experienced teacher-physicians, texts, and articles. In contrast, during chiropractic training Long was required to interact with only a few dozen patients, all in one place, most of whom were allowed to be his own friends and relatives. Has that changed since his training in the 1980s? Not really– in 2011, the chiropractic accreditation agency decided to set the requirement at 35 patient interactions to graduate. And only 10 of those had to be genuine, live patients rather than simulations or paper-based discussions. It is simply not possible for anyone to learn about the breath of variety in health and disease from so few patients.

The most striking chapter in the book is titled “Twenty Things Most Chiropractors Won’t Tell You.” Some of Long’s points include:

  • Chiropractic theory and knowledge aren’t based on anything close to what’s known by the scientific community. Their notions stem from a made-up theory from the 1800s which has no bearing on reality or how bodies actually work.
  • The legitimate scope of chiropractic practice is very narrow, limited to certain musculoskeletal conditions. Yet chiropractors often promise to be able to treat just about anything.
  • Chiropractors offer all sorts of unnecessary services, take too many x-rays, and sometimes do really strange things.
  • Chiropractic licensing boards won’t help protect patients from fraud or even sexual assault.
  • Chiropractors have no business treating children. (As I’ve said before, there is essentially zero evidence that anything chiropractors do can help kids.)

Long’s book does not set a hopeful tone. He’s spent his career trying to change the chiropractic profession by trying to bring it into the fold of legitimate, scientific medicine– and has been thwarted at every turn. Most chiropractic schools and practicing chiropractors, Long says, have no interest in improving care, advancing knowledge, or working with the medical community. There are good chiropractors out there, who genuinely try to help people, but they are hard to find, and are shunned and vilified by mainstream chiropractors. His chapter on “How to Protect Yourself” offers practical tips to help people find a good chiropractor, and protect themselves and their wallets from the bad one.

Dr. Long isn’t going to make many friends with this book—that’s not his point. But people who read this will understand what the field of chiropractic is, and what it is not. If you’re thinking of visiting a chiropractor, read this book first.

New therapies aren’t necessarily better

August 9, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

The thing about science: it’s not a body of knowledge, or a list of facts. It’s a method. It’s looking at natural things, explaining them, and testing ideas to see if they’re right. More experiments (and better experiments) on more ideas leads to improved understanding and better ways to predict and influence what happens.

But science doesn’t go in a straight line. Not every study is valid, and not every idea is right. Sometimes it takes years (or centuries!) to figure things out. The path is winding and it is difficult to see what’s around the next corner. Still, for matters related to medicine, I think science is the best way to lead us to better health.

Case in point: good science shows us that the way we’re doing things isn’t always the best way. A recent review from the Mayo Clinic looked at ten years of scientific articles, and found that current practices were about as likely to be wrong as correct. Of 363 studies of interventions that were considered “standard of care,” about 40% affirmed that the care good, and about 40% showed that current practice should be changed (the remaining 20% didn’t reach a firm conclusion either way.)

Some examples of studies that contradicted current advice: controlling exposures to mites with impermeable bed covers was found to be of no benefit to asthma sufferers; and pre-implantation genetic studies during in-vitro fertilization actually reduced the rates of pregnancy and live births.

So how should doctors and patients look critically at medical decisions? We can’t just cower in the corner and not make up our minds, waiting for the best possible studies.

Look at the totality of the evidence. The best medical practices are backed up my multiple studies done from multiple points of view. For instance, current vaccine schedules are backed up by hundreds of studies of basic science, immunology, clinical outcomes, and studies of adverse events; these studies have been done in dozens of countries around the globe by thousands of researchers, backed by government, industry, and academic support. The evidence here is a huge mountain that is unlikely to be wrong. Does that mean there isn’t more to learn? Of course not. But vaccine schedules aren’t just a current fad or bandwagon to jump on—there is solid, ever-increasing evidence here that should make people confident.

Be wary of new things. New treatments are hip and cool and heavily marketed, and have that “new car smell” cache. But they’re also more likely to lack multiple studies and solid foundation of experience.

Be humble. Doctors and patients like to be right. Once we’ve decided on a course of action, it is difficult for us to admit we’re wrong and change course. Doing something because we’ve always done it is not good science. Keeping one’s mind open is.

But remember: too much of an open mind means that your brain may fall out. An open mind is good; but there can be too much of a good thing. Look at the world of alternative medicine—have you ever seen any alt-med proponent criticize anything, or proclaim any skepticism of any treatment? To make good decisions we have to be rational, and, yes, judgmental. Things that have no basis in any rational understanding of science, and lack any clinical evidence of any benefit whatsoever (homeopathy), need to be discarded. While other things that do have some rationale and evidence for effectiveness ought to be further investigated and brought into the realm of every-day, real medicine. Doctors and alt-med proponents need to be willing to say, yes, science shows that what we’re doing is wrong.

Do doctors and scientists have all the answers? Of course not. But it’s exhilarating to keep looking.