Posted tagged ‘integrative medicine’

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?

Chiropractors know almost nothing about child health

February 6, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

There are plenty of things we don’t know about health and illness. Sure, we know a lot more than we did fifty or a hundred years ago—but every day, still, I have questions that aren’t yet answered. I read a dozen or so journals each month. (I know. Nerd.) Each one has at least ten or so good quality studies—good, solid experiments to determine the best way to treat something, or basic science investigations to really understand what’s going on in the body. Heady stuff. And there are always more questions!

A question was posed to me this week: can chiropractic treatments help with scoliosis? My first thought was: probably not. I mean, I’ve never run across a study of chiropractic in my journals that shows effectiveness for scoliosis. Still, I wondered—what about the chiropractic journals? They have their own literature. Why not take a look?

I looked. And I am appalled. There is nothing—nothing, not a shred of evidence—that chiropractic can help scoliosis. One trial has been published involving all of six pediatric patients. That’s it? These are people who routinely treat children, who routinely treat back problems, and who are giving people the impression that they can help with scoliosis. And they’ve barely even studied it!

OK, maybe that was an isolated thing. So I dug more. I ran across a series of three published reports, all in established chiropractic journals, that together have reviewed the entire chiropractic published literature on pediatric care. Keep in mind, this is chiropractors themselves, reviewing their own knowledge base.

The first review, published in 2005, is titled Assessing the evidence for the use of chiropractic manipulation in paediatric health conditions: A systematic review. Chiropractors Gotlib and Rupert of the Canadian Chiropractic Association searched the entire biomedical literature, looking at everything that had been published using every database imaginable, to find all articles relevant to children.  Their “inclusion criteria” were quite broad—they looked for any study involving children in a therapeutic setting that was published in a peer reviewed journal or reported at a conference, or any relevant systematic review. They found 166 published reports, almost all of which were “descriptive studies”—the lowest kind of evidence, where an author describes what was seen or done, without any corroboration or experimentation that what was done was effective. As for high-quality evidence, through 2003 only NINE randomized trials in children of chiropractic care for any pediatric health condition had been published. One was only a feasibility study that didn’t report results; one was on nursemaid’s elbow, which isn’t treated with chiropractic spine manipulation. Of the remaining seven studies: four showed no effect on asthma, bedwetting, colic, and jet lag; and three showed benefits in asthma, bedwetting, and colic. The total number enrolled in all 9 clinical studies was 590 children. The authors concluded:

“Health claims made by practitioners regarding the application of chiropractic manipulation as a health care intervention for paediatric health conditions are, for the most part, supported by low levels of scientific evidence.”

The same authors compiled a second review in 2008, to catch any studies published from January 2004 thru June 2007. They used the same exhaustive search, and the same broad criteria. They found ONE additional randomized trial—which was, actually, only a feasibility study involving six children with scoliosis. Their conclusion:

“There has been no substantive shift in this body of knowledge during the past 3 1/2 years. The health claims made by chiropractors with respect to the application of manipulation as a health care intervention for pediatric health conditions continue to be supported by only low levels of scientific evidence.”

OK, this is looking bad. Real bad. Is anyone actually even trying to study children to figure out if chiropractic works, and when to use it?

A second group of authors picked up the baton, publishing their own thorough review in June 2012, specifically to see what new trials concerning children had appeared. There was quite an uptick in publications—from the four year span since the last review, from 2007 through 2011, sixteen studies were published about children, looking at a total of 1980 kids. About 500 kids a year were actually enrolled in clinical studies. It is a step in the right direction. However, many of the studies were poorly designed and difficult to interpret, according to the chiropractors who wrote the review. And ironically, there have been ZERO published studies, ever, looking critically for genuine evidence that Spinal Manipulative Therapy helps children with back pain. These authors concluded:

“Further research is clearly required in this area of chiropractic health care, especially with respect to the clinical effectiveness of SMT on pediatric back pain.”

I am glad that the chiropractors who compiled these three reviews have expressed their need for better pediatric studies. They’ve illustrated that their own profession has neglected children. They have essentially no evidence that any of their treatments work for any pediatric condition. However, at the rate they’re going, the tiny dribble of studies being published isn’t going to come close to a decent, reliable body of literature any time soon. A single issue of Pediatrics contains far more studies looking at far more children than the entire accumulated published experience of the entire chiropractic profession.

A caveat: these reviews of the chiropractic literature included all publications through the end of 2011. It is possible that 2012 saw an explosion of pediatric studies. I’d love to hear that, if it’s true. I don’t have subscriptions to these chiropractic journals, and don’t have the ability to completely review their 2012 literature myself.

Chiropractic professionals need to decide: Is treating children part of our practice? If so, they should insist on quality information to guide their practice to effectively help pediatric patients. Until they have that knowledge, they ought to tell parents that, honestly, they have no idea what they’re doing.