Posted tagged ‘quackery’

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.

belladonna

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Homeopathy as good as antibiotics? No.

November 9, 2015

The Pediatric Insider

© 2015 Roy Benaroch, MD

An August, 2015 study in Multidisciplinary Respiratory Medicine is being touted as evidence that homeopathy is as affective as antibiotics for respiratory infections in children. It doesn’t show that at all—in fact, it doesn’t show anything, except that crappy studies in crappy journals can nonetheless be used to manipulate opinion. Beware.

First, the study itself. Researchers in Italy looked at about 90 children with ordinary colds. All of them were given a homeopathic product that the authors claimed had already been shown to be effective for cough (that’s not actually true, but let’s let it slide for now.) All of the children did improve, as expected—colds go away, as we all know.

The “study” part was randomizing the children into two groups. One half of the study subjects only got the homeopathic product, the other half got both the homeopathic syrup PLUS amoxicillin-clavulanate, an antibiotic. You Insiders are already thinking—what, wait, what? You know that antibiotics have no role at all in the treatment of the common cold. Colds are caused by viruses, and antibiotics won’t make any difference. In fact, they’re very likely to cause harm, causing allergic reactions and gut problems and maybe triggering c diff colitis. It was entirely unethical for them to even give these antibiotics to the children, with not even an inkling of a reason to think they were a valid medical therapy. But they did it anyway.

The results are exactly what you’d expect. Both groups of children (the ones on homeopathy, and the ones on homeopathy plus antibiotics) did the same—their symptoms all improved over the weeks of the study. No surprise at all.

But the authors claimed “Our data confirm that the homeopathic treatment in question has potential benefits for cough in children…” The study didn’t show that all. They didn’t even look for that kind of effect—if they wanted to, they could have, by randomizing one group to receive homeopathy, and the other group to not receive homeopathy. But that kind of study wouldn’t show what they wanted it to show, so they didn’t do it.

You’re wondering, maybe, why did Multidisciplinary Respiratory Medicine even print this unethical, worthless study? The answer is here:

How much does it cost to publish?

 

Multidisciplinary Respiratory Medicine is what’s called a “predatory journal”, which charges high fees — $1,940 — to publish articles. These types of journals exist only to make money—there is minimal or no editorial oversight, and the whole point is to publish whatever someone will pay them to publish. The authors get their publication, and journalists and the public are fooled into thinking real science has occurred.

Another highlight – I’m not an investigative journalist, but looking at the full text of the article, I see under footnotes “The authors declare they have no competing interests.” Yet under acknowledgements, it also says “We thank Boiron SA, Messimy, France for a non-binding financial contribution.” Boiron is a huge producer and marketer of homeopathic products. And: when I Googled the lead author’s name + the word “Boiron,” I found this page, which features a video of him on Boiron’s site. No competing interests?

So, an unethical study comparing the wrong things claiming to show something it didn’t, published in a pay-to-play journal, paid for by a homeopathy company, written by a guy who is featured on said homeopathy company’s website. You still shouldn’t use antibiotics to treat a cold. And this study, like so many other homeopathy studies, shows only that homeopathy is a scam.

Essential oils: When shady marketing and quackery meet

January 23, 2014

The Pediatric Insider

© 2014 Roy Benaroch, MD

Kayla wrote in: “Hello!  I am curious what you think about essential oils.  They have recently become incredibly popular in my community, but I am pretty skeptical because so much of the enthusiasm is coming from those who have signed up as ‘distributors’ with doTerra or Young Living (2 essential oil multi-level marketing companies.). The biggest concern I have is that these companies (and all these new distributors) recommend taking many of these oils internally, and giving them orally to children.  I know there is little research to validate the super exaggerated claims that these oils cure EVERYthing, and I am wondering if there is evidence of them actually being harmful-especially taken internally?  I try to provide good information to the moms in my community groups (I am a BSN/public health nurse), and I wonder if taking these oils internally, and especially giving them to children internally, is something that should be discouraged.”

One of the reasons I enjoy writing this blog is questions like these—I had no idea that essential oils were being aggressively marketed for their alleged health benefits to children. I just thought they smelled good. Silly me. When there is money to be made, you can bet someone is out there hustling.

Essential oils are concentrated liquids containing volatile compounds from plants. The name itself, essential, refers to the “essence” of a plant, or the key compounds that form a plant’s unique aroma. It does not mean “essential” as in, “essential for health” the way that the word “essential” is sometimes used to refer to vitamins or other compounds. Because they deliver a concentrated aroma, essential oils are commonly used in soaps, fragrances, incense, and as flavorings in foods.

Of course, not all essential oils are the same. What they are and what they do depends on what plant they’ve come from (and sometimes what part of the plant.) Some essential oils have clear medical uses:

  • Oil of wintergreen (chemical name methyl salicylate) is a constituent of many heating rubs, like Ben Gay. If swallowed, even a small dose of concentrated oil of wintergreen can be fatal. In lower concentrations the same compound is used to flavor chewing gum.
  • Oil of cloves has both antiseptic and analgesic properties, and is used topically in dentistry to numb toothaches (remember that scene in Marathon Man? By the way, the book was better.) High doses of oil of cloves can cause abdominal upset, intestinal bleeding, and liver or kidney failure.
  • Oil of lemon eucalyptus is an effective mosquito repellant when applied topically. But, as with many other essential oils, it’s dangerous when swallowed.

Some essential oils can have harmful effects even when used topically. Lavender and tea tree oils, used only on the skin, can be absorbed well enough into the blood to cause systemic, estrogen-like effects, causing breast growth in boys. Whether taken internally or used topically, essential oils should be used with caution.

Is there any reason to think there are broad health benefits from essential oils, as a group? Many of them smell good, and I imagine that used in a sort of aroma therapy they might be relaxing to people who like the smell of lemon, cedarwood, patchouli, or hyssop. But statements referring to essential oils collectively as having near-magical health benefits are just plain silly. If you wouldn’t say “chemicals are healthy,” then you shouldn’t say “essential oils are healthy”—because essential oils are just one group of chemicals, a group that contains many different things that could all have different effects when put on or in a human body.

Essential oils have been around a long time, but what about these firms that have sprung up to market them? Kayla mentioned two companies that she says are aggressively setting up “distributors” in neighborhoods via multilevel marketing schemes. Parents need to be very wary about purchasing anything through these kinds of shady arrangements, or (worse) of getting themselves involved in these schemes as distributors themselves. Multilevel marketing arrangements rely on distributors recruiting their own distributors, where each level above gets a slice of the commissions from each level below. If you recruit your own distributors, and they then recruit their own distributors, then you will get a slice from everyone below you. Of course, the early adopters above you are getting their slices too—and unless a whole ton of product is actually sold, you can bet that most of the people who actually sell product don’t themselves have much commission left over for themselves. The math just can’t work unless each level manages to recruit an ever-growing number of further distributors… and eventually, the pyramid collapses. With distributors at the bottom of the pyramid left with unsellable inventory and no possible way to recoup their investment.

When these kinds of sales arrangements evolve, with everyone depending on commissions and the recruitment of further distributors, exaggerated claims for a product’s benefits are very likely to follow.

So, Kayla is right to be suspicious of this latest health fad. Some essential oils probably do offer health benefits, but many can be harmful if used incorrectly; and since selling these is intertwined with questionable business practices, it’s unlikely that Kayla is going to get reliable or balanced health information from local distributors. Don’t waste your money or endanger your health—stay away from the multilevel marketing of essential oils.

Vitamin B12 quackery

December 6, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

Here at The Pediatric Insider, we’re about science. Medicines and other treatments need to be tested. We want reliable proof that something works and is safe before we recommend it. We don’t like the false dichotomy of “alternative medicine”. If there is good evidence that it works, it’s medicine. If it doesn’t work, it’s quackery.

It doesn’t matter who’s doing the quacking. A quack is a quack, even if there’s a medical diploma on the wall.

The story: a woman brings in her teenage daughter, complaining that the girl is tired a lot. It turns out that mom herself has had some blood tests that showed a low vitamin B12 level, so her doctor is giving her regular B12 injections. Can her daughter get some, too?

I realize that B12 injections are common. Many docs administer these, and many adults get these—probably some of you reading this. So what’s the science behind this practice?

Vitamin B12 deficiency is a real thing. It can occur because of a poor diet, or because some medications (like acid blockers) interfere with absorption. Or it can occur because of a specific autoimmune disorder called “Pernicious Anemia.” Whatever the cause, the health consequences of vitamin B12 deficiency can include anemia, neuropathy, irritability, and depression.

There is a simple blood test to measure vitamin B12 levels, though the levels in the blood don’t always correlate with whether there is enough B12 levels in the cells themselves. We can test for this, too, indirectly, through other blood tests including methylmalonic acid and homocysteine levels. So we can, in fact, know if a person is truly deficient. These confirmatory tests are rarely done.

Instead, many adults are told that their vague symptoms of tiredness or fatigue are caused by B12 deficiency, instead of actually trying to address genuine issues like insufficient sleep, sleep apnea, overreliance on caffeine, and depression (to name a few of the many genuine causes of fatigue.)

It gets worse. The treatment of B12 deficiency, as has been established from studies done in the 1960s, is ORAL B12. That’s right. Pills. Injections of B12 are not necessary—oral supplements work well, even in pernicious anemia. They’re cheap and they work. I suppose a very rare patient, say one who has surgically lost most of their gut, could require injections. But the vast majority of people with genuine B12 deficiency can get all of the B12 they need through eating foods or swallowing supplements. No needles needed.

So why this fetish with injections? From the patient’s point of view, shots feel more like something important is going on. Placebos need rituals—with acupuncture, for instance, the elaborate ritual creates an illusion of effectiveness. And from the doctor’s point of view, injections reinforce dependence on the physician, creating visits and cash flow.

So: people seem to think they feel better with injections, and the doctor makes a little cash, and everyone’s happy. So what’s the harm in that?

I think it’s wrong to knowingly dispense placebos, even harmless ones. We doctors like to criticize the chiropractors and homeopaths. We point fingers. They’re the quacks. We’d better take a close look at what we’re doing, first. Our placebos are sometimes far more dangerous than theirs.

More importantly, people should be able to expect more from physicians. Patients come to us for genuine answers—if they wanted a witch doctor, they would have found one. I think we need to hold ourselves to a higher standard than a huckster at the carnival. We’re not here to promise that we’ve got all the answers. We are here to be honest, and to use the best knowledge that science has to offer, using  genuine compassion and thought. Let’s leave the quacking to the quacks. We’ll stick with real medicine.

Gas drops, teething tablets, and pinkie straighteners

February 6, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

A carnival. A white-toothed, perfectly-haired Huckster stands on a platform in front of a crowd of parents.

The Huckster: “Step right up! I’ve got what every parent needs! A fix to one of The Most Serious problems your child has—right now!”

Boscoe’s mom: “There’s nothing wrong with my Boscoe! He’s the very picture of health!”

The Huckster: (looking down with concern at Boscoe, aged 2) “Hmmmm… yes, yes, I can see why you’d say that, Ma’am. But I can tell he’s headed for trouble! Just look at that pinkie!”

The Huckster reaches down, and picks up Boscoe, who continues to eat his cotton candy. His mouth is blue and sticky (the child, I mean.) The Huckster holds up Boscoe’s pinky finger to the crowd.

The Huckster: “Look!”

The crowd gasps, and inches forward.

 Boscoe’s mom looks apprehensive, but confused. She turns her head sideways.

Boscoe’s mom: “That’s his pinky. I don’t see anything wrong with it.”

The Huckster: “It looks ok now, sure, but if you look at it from the side— Behold! It isn’t straight!”

Pandemonium ensues. The crowd erupts in fearful chatter. A woman faints. Sirens can be heard in the distance, and strobe lights from the nearby Tilt-a-whirl along with inexplicable gusts of smoke add to the mayhem. The Huckster seems to have grown taller, looming over the crowd.

 Boscoe continues to eat his cotton candy.

Boscoe’s mom, joined by several other onlookers, wails: “What can we do?”

The Huckster: “I have just the thing you need!”

From the depths of his topcoat The Huckster draws out a handful of devices, each of which looks like two pencils held together by rubber bands. The crowd pushes fistfuls of money at him, buying each for $19.95.

There is a sneaky and pervasive influence on health expectations, and I’ll bet most of us have fallen for it. Companies—The Hucksters—are trying to sell you things. And often, to sell them, they’ll first convince you that your child has a problem. Then, surprise, they’ll turn out to have the perfect thing to fix it.

Take “gas drops.” Usually made of simethecone (sold in common brands like Mylicon, and many others), these products “cure” your child of “gas.” But it’s just The Huckster at work. The truth is, farts do not hurt. Sure, newborns might be surprised and alarmed at the weird, unexpected feelings of stuff moving around in their little tummies, but that’s not pain, and it’s not anything that needs medicine. What it needs is love and support and reassurance, so babies learn that they don’t have to worry about these normal sensations. Gas and farts are a normal part of life. They are not a medical condition that needs a cure.

No medical study has ever shown that any gas remedy (including simethecone, but also gripe water and anything else you can find) actually helps alleviate any symptoms. It helps The Hucksters, but they certainly won’t help you or your child. If you’re using them, and they seem to work, it’s because symptoms we call “gas” always come and go. You give the gas drops when there are symptoms, and the symptoms improve—because they always improve. Go ahead and give the gas drops when there aren’t symptoms, and you’ll likely see that soon enough symptoms will start up again. Because they come and go, no matter what “medicine” you’re giving.

Another example: teething tablets. Study after study has shown that teething children have no consistent symptoms. The only thing teething causes is teeth. Sure, infants often have fussy times, or loose stools, or feel warmish—but they do that whether they’re getting teeth or not. It’s not the teeth, it’s the child. Teething is not a medical problem, but there sure are a lot of Hucksters who will tell you otherwise. And they’ll sell you something, too!

The vast majority of these nonsense cures are perfectly safe, and they’re actually not very expensive. So what’s the harm? The biggest problem I see is that parents get convinced that their children have many problems, and that every problem needs a cure. Most kids are very healthy, and few kids actually need any kind of medicine at all. That may sound weird, coming from a doctor, but honestly I will tell you that 90% of the “cures” given to our children (whether prescription, non-prescription, alternative medicine, voodoo magic beans, or stuff purchased at a carnival) are completely unnecessary and do nothing to help your child.

Don’t fall for The Huckster. Save your money, hug your child, and stay away from the drug store. If you do go to the carnival, take the rides, but don’t be taken for a ride. Tell The Huckster your child’s pinky is straight enough, and go get yourself a hot dog instead.