The most recent information collected by the US National Poison Data System which is the annual report of the American Association of Poison Control Centers, showed there were 0 deaths caused by any dietary supplements in the United States in 2008 (the latest year with complete information available).  Various data suggests that half of Americans take dietary supplements, which amounts to somewhere around 56 billion doses of supplements in a year.  Of those 56 billion doses, there were NO (zip, zero, zilch, nada) deaths from the best available data we have.

Compare that to deaths from pharmaceutical drugs, which are well regulated and much safer than supplements, and then tell me how dangerous supplements are again.

You can download the Annual Report of the American Association of Poison Control Centers for free here.

What are your thoughts?  Share them with us in the comments below.

Ask anyone about saturated fat and they will tell you that it will clog your arteries and give you a heart attack or a stroke, or that it will make you diabetic.  In fact, it does none of these things.

Two articles have recently been published that lend proof to these (perhaps) shocking words.

The first:

Am J Clin Nutr. 2010 Mar;91(3):535-46. Epub 2010 Jan 13. Meta-analysis of prospective cohort studies evaluating the association of saturated fat with cardiovascular disease.  Siri-Tarino PW, Sun Q, Hu FB, Krauss RM.

And the study concluded:  “A meta-analysis of prospective epidemiologic studies showed that there is no significant evidence for concluding that dietary saturated fat is associated with an increased risk of CHD [heart attack] or CVD [stroke].”

The second:

Am J Clin Nutr. 2010 Mar;91(3):502-9. Epub 2010 Jan 20.  Saturated fat, carbohydrate, and cardiovascular disease.  Siri-Tarino PW, Sun Q, Hu FB, Krauss RM.

The study concluded: “In summary, although substitution of dietary polyunsaturated fat for saturated fat has been shown to lower CVD risk, there are few epidemiologic or clinical trial data to support a benefit of replacing saturated fat with carbohydrate. Furthermore, particularly given the differential effects of dietary saturated fats and carbohydrates on concentrations of larger and smaller LDL particles, respectively, dietary efforts to improve the increasing burden of CVD risk associated with atherogenic dyslipidemia should primarily emphasize the limitation of refined carbohydrate intakes and a reduction in excess adiposity.”

Which is a complicated way of saying that replacing saturated fat in the diet with more carbohydrate, which is what virtually all mainstream nutrition advice suggests you do, causes MORE build-up in the arteries (and a higher risk of heart attack and stroke).  Instead, the authors of the study suggest that refined carbohydrates (such as sugar and flour) should be limited.

New meta-analysis

But wait! You might say.  Didn’t I just hear about a new study just come out the other day saying that replacing saturated fat with seed oils (polyunsaturated fat) lowers the risk of heart disease?

This study:

Effects on Coronary Heart Disease of Increasing Polyunsaturated Fat in Place of Saturated Fat: A Systematic Review and Meta-Analysis of Randomized Controlled Trials  Dariush Mozaffarian, Renata Micha, Sarah Wallace.

Doesn’t this suggest we’d be healthier if we replaced the saturated fat in my diet with vegetable oils?  Stephan Guyenet, PhD at Wholehealthsource.blogspot.com has done a very nice analysis of this study (which I’ve posted below), suggesting it’s fundamentally flawed, and you’d be better off ignoring it.  If you have not ready Stephen’s Whole Health Source blog, and this sort of thing interests you, you owe it to yourself to get over there.  He has a wealth of posts on a variety of health and nutrition related issues

Rebuttal by Stephen Guyenet

March 23, 2010

New Review of Controlled Trials Replacing Saturated fat with Industrial Seed Oils

Readers Stanley and JBG just informed me of a new review paper by Dr. Dariush Mozaffarian and colleagues. Dr. Mozaffarian is one of the Harvard epidemiologists responsible for the Nurse’s Health study. The authors claim that overall, the controlled trials show that replacing saturated fat with polyunsaturated fat from industrial seed oils, but not carbohydrate or monounsaturated fat (as in olive oil), slightly reduces the risk of having a heart attack:

These findings provide evidence that consuming PUFA in place of SFA reduces CHD events in RCTs [how do you like the acronyms?]. This suggests that rather than trying to lower PUFA consumption, a shift toward greater population PUFA consumption in place of SFA would significantly reduce rates of CHD.

Looking at the studies they included in their analysis (and at those they excluded), it looks like they did a very nice job cherry picking. For example:

• They included the Finnish Mental Hospital trial, which is a terrible trial for a number of reasons. It wasn’t randomized, appropriately controlled or even semi-blinded*. Thus, it doesn’t fit the authors’ stated inclusion criteria, but they included it in their analysis anyway**. Besides, the magnitude of the result has never been replicated by better trials, not even close.
• They included two trials that changed more than just the proportion of SFA to PUFA. For example, the Oslo Diet-heart trial replaced animal fat with seed oils, but also increased fruit, nut, vegetable and fish intake, while reducing trans fat margarine intake! The STARS trial increased both omega-6 and omega-3, reduced processed food intake, and increased fruit and vegetable intake! These obviously aren’t controlled trials isolating the issue of dietary fat substitution. If you subtract the four inappropriate trials from their analysis, which is half the studies they analyzed, the result disappears. Those four just happened to show the largest reduction in heart attack mortality…
• They excluded the Rose et al. corn oil trial and the Sydney Diet-heart trial. Both found a large increase in total mortality from replacing animal fat with seed oils, and the Rose trial found a large increase in heart attack deaths (the Sydney trial didn’t report CHD deaths, but Dr. Mozaffarian et al. stated in their paper that they contacted authors to obtain unpublished results. Why didn’t they contact the authors of this study?).

The authors claim, based on their analysis, that replacing 5% of calories as saturated fat with polyunsaturated fat would reduce the risk of having a heart attack by 10%. Take a minute to think about the implications of that statement. For the average American, that means cutting saturated fat nearly in half to 6% of energy, which is a real challenge if you want to have a semblance of a normal diet. It also means nearly doubling PUFA intake, which will come mostly from seed oils if you follow the authors’ advice.

So basically, even if the authors’ conclusion were correct, you overhaul your whole diet and replace natural foods with bland unnatural foods, and…? You reduce your 10-year risk of having a heart attack from 10 percent to 9 percent. Without affecting your overall risk of dying! The paper states that the interventions didn’t affect overall mortality at all. That’s what they’re talking about here. Sign me up!

* Autopsies were not conducted in a blinded manner. Physicians knew which hospital the cadavers came from, because autopsies were done on-site. There is some confusion about this point because the second paper states that physicians interpreted the autopsy reports in a blinded manner. But that doesn’t make it blinded, since the autopsies weren’t blinded. The patients were also not blinded, so the study overall was highly susceptible to bias.

** They refer to it as “cluster randomized”. I don’t know if that term accurately applies to the Finnish trial or not. The investigators definitely didn’t randomize the individual patients: whichever hospital a person was being treated in, that’s the food he/she ate. There were only two hospitals, so “cluster randomization” in this case would just refer to deciding which hospital got the intervention first. Can this accurately be called randomized?

Bottom line:

If you want to care for your heart and health, forgot about saturated fat and concentrate on reducing refined carbohydrates (sugar and flour; the ‘crack’ of our food supply).

Other resources

Have a hard time swallowing that saturated fat could possibly be healthy?  Don’t take my word for it, check out the following resources.  If you read these resources and still feel unconvinced that saturated fat is the problem, I’ll eat a stick of margarine!

• Good Calories, Bad Calories – THE book.  It’s thick and quite a read, but if you want to understand the past 100 years of nutrition science and how the whole idea that saturated fat is bad for you got started, you owe it to yourself to read this book
• Great Cholesterol Con by Malcolm Kendrick – Cholesterol is also NOT bad for you.  This is a very readable, user friendly book written by a British medical doctor (MD).  Highly recommended

And a trio of great blogs

• Whole Health Source Blog – Stephen Guyenet, PhD’s blog.  Highly recommended
• High Fat Nutrition Blog – by Petro Dobromylskyj a British vet.  Quite technical, but Peter does a fantastic job of analyzing studies and revealing what they truly show.
• Michael Eades Blog – very readable blog by Michael Eades, MD a long time proponent of a carbohydate controlled eating style.  Some fantastic gems in the archives.

Unfortunately as an alternative provider, the medical evidence used to ration care still almost exclusively excludes the kind of care I do, meaning many patients are unable to benefit from it.

The article is a little long, but worth reading.  Find it here.

What are your thoughts?  Is rationing an unfortunate necessity?  Share them with us in the comments section below.

With reasonable precautions ear candling is generally safe.  Years ago I had it done to me and did it to a few others.  None of us had any problems.  That’s not to say it’s totally safe however.  The most obvious issue is you have fire inches above the side of your head.  Reported injuries with ear candling include:  hair catching on fire, burns to the side of the head, ear, and ear canal, blockage of the ear canal with wax and rupture of the ear drum.

So ear candling is not an exceptionally dangerous nor especially safe procedure.  If you’re determined to use an ear candle it’s important to take the proper precautions to protect yourself.  But the real question is, does it work?  To the best of my knowledge there are no published studies on ear candling.  An informal poll of my Naturopathic colleagues representing several hundred years of combined practice says no.  A number of doctors have looked in the ears with an otoscope (the device doctors use to look in your ears) before and after patients have done ear candles and reported no change in the amount of wax.  Others have burned the candles without putting them in an ear, cut them open and found the same wax in the stub.  All evidence points to the fact that the wax in the stub is from the candle itself, not from anyone’s ear.

The bottom line is: ear candling presents too much risk for not enough benefit.  It does not seem to clear the ears of wax and occasionally people get hurt.  As one of my colleagues said, having to dig candle wax out of someone’s ear is no fun.

If ear wax build-up is a problem for you, it’s best to let a physician clean it out professionally.  If your situation doesn’t allow you the opportunity to have a professional do it, I would much rather see someone do a proper ear rinse than an ear candle.  If you feel you must do it yourself (and I am not recommending you do) the safest way to rinse your ears out is to start by piercing a capsule of docusate sodium (stool softener available in any pharmacy that works exceptionally well on ear wax) and squeeze the liquid inside into the ear (throw the capsule away).  Keep your head tilted to keep the solution in your ear for 10-15 minutes, then using a large syringe or bulb GENTLY squeeze warm water into the ear with that ear facing toward the ground to flush out the docusate and wax.  You may need to repeat several times over the course of a few days to clear the wax out.

What are your thoughts?  We’d love to hear them, please share them in the comments below.

Part II here

In part I of this series we answered the basic question, what is evidence based medicine (EBM) with the definition:  EBM is the equal use of clinical experience and external evidence to make the best decisions about the care of patients.

In part II we saw how this definition is often discarded for the much more stringent and less useful definition of EBM as the selection of therapies according to the evidence presented in the scientific literature.  This evidence is ranked with double blind, placebo controlled studies at the top (considered most authoritative) and clinical experience at the bottom (considered least reliable).

In part III, my intention is to outline how I use EBM in my practice.  Alternative or natural practitioners are often dismissed by conventional practitioners with the refrain “not enough evidence” or “hasn’t been proven to work”.  This is true only under the strict definition of EBM we talked about in part II but as I will show I base my practice on a great deal of evidence, much of which is not given significant value by the conventional community.

In my practice of medicine, I break evidence down into four quadrants.

Quadrant I – Tradition

The use of food and plants as medicines dates back to the beginnings of humanity and is found in every culture around the globe.  The most widely known traditional medical systems are Chinese medicine and Indian (Ayurvedic) medicine which have experience spanning several thousand years, and many generations of healers.

There is a tendency in modern culture to view our predecessors as ignorant or at the very least to think, “they were doing the best they could, but we’re clearly so much smarter and better than they are, after all we have iPods and electricity…” and to discount their knowledge and wisdom.  I think this is an arrogant and prideful view.  Our ancestors faced many of the same health problems we face today and generations of experience helped them to accumulate a wealth of wisdom about what heals and what doesn’t.

This is not to say that tradition has all of the answers, it doesn’t.  Superstition pervades this quadrant, some of the therapies our ancestors used were ineffective and some were downright harmful, and the conditions of our modern lives are uniquely different from those of our ancestors.  But to throw out this quadrant of evidence because of these flaws is to “throw the baby out with the bathwater.”  We have much to learn from our ancestors, and in my opinion, evidence based medicine starts here.  I look at how my Naturopathic predecessors treated disease and restored health, and how traditional cultures around the world used food, plants and other medicines.  To this base I add…

Quadrant II – Scientific literature

Because I am a Naturopathic doctor (ND) and not a medical doctor (MD) I have been called anti-science.  Let me be clear, I am NOT anti-science.  I value and use science, but I also do not revere science.  For me it is one of four quadrants of evidence, not the only quadrant.

Science is incredibly valuable.  At its best it helps us to uncover mechanisms of action so we can more deeply understand how diseases and medicines work, and how to better use our medicines.  It also helps us strip superstition and bias out of tradition and our own personal experiences.  But science is also a human endeavor and not something passed on down from ‘on high’.  Recent exposés have shown the bad side of science, manipulated for monetary gain: some scientific studies are ghost written by marketing people looking to influence the prescribing habits of doctors, some pharmaceutical companies hold back scientific data that would make their drug look worse, and that studies are manipulated from the very beginning to give the results that are being looked for.

Scientific studies are not gospel, and in my opinion, need to be taken in the context of other quadrants of information.  So to them we add…

Quadrant III – Personal clinical experience

Nothing can replace a doctor’s experience with their patients and their medicine, which is why we all value a doctor with years of experience.  A doctor’s experience working with their therapies, seeing what works and what doesn’t on real people in front of them, gives personal knowledge of that therapy that cannot be learned from tradition or the scientific literature.

This is not to say we should rely only on clinical experience because we are all subject to our biases and the biases of our patients and the population that we serve.  But by placing it in the context of the other quadrants we gain irreplaceable knowledge.  The last quadrant is…

Quadrant IV – Non-rational or intuitive

This is the hardest category to explain, and as such is often just ignored and swept under the rug.  Medicine is not just a science, it is also an art.  Hunches, gut feelings and intuitive leaps of thought play a vital part in the practice of medicine, even for the staunchest scientific practitioners.  Sometimes we choose therapies because it simply feels right.

Each of the four quadrants provides valuable evidence that I feel is, in and of itself, insufficient for the practice of EBM.   Conventional medicine, I believe, makes the mistake of discarding quadrant I (tradition) and IV (intuition), minimizing quadrant III (clinical experience), and attempting to rely almost exclusively on quadrant II (scientific literature).  Alternative medicine, I believe, also makes the same mistakes by rejecting quadrant II (scientific literature)  attempting to rely almost exclusively on quadrant I (tradition) and III (clinical experience), while some alternative practitioners think quadrant IV (intuition) by itself is enough.

I value each quadrant equally, and do not rely on any one to provide all the evidence for my treatments.  The strongest evidence is where each quadrant converges with the others; where a traditional use is verified by modern scientific studies, the clinical experience of the doctor and their peers, and by the practitioners and patients non-logical intuition.   This I believe is truly comprehensive, holistic EBM and best serves patients.

What are your thoughts?  We’d love to hear them, please post your comments below.

More and more people prompted by the bad economy and growing dissatisfaction with the way many companies are treating people are striking out on their own to work for themselves and bring their vision into reality.  If you’re contemplating working for yourself as part of your goals to lead a high-quality life, know that it’s incredibly rewarding and a LOT of work.  Success is far from  guaranteed and the best thing you can do is to educate yourself.

Let me help.  Of the 20 or so business books I’ve read,  here, are the ones I found most useful.

1. E-Myth Revisited (Richard Gerber) – a classic for small business owners.  If you haven’t read it, I would classify this as a must read.  The key idea of working ON your business instead of IN your business is gold.  Just because you are good at your skill set (for me, being a doctor) does not mean you are good at running a business, eye opening.
2. Principled Profits (Shel Horowitz) – as a doctor who got into the field to help people, the idea of charging money for my services often feels unpleasant.  This book went a long way to helping me reconcile the idea that charging money and providing quality, caring service do not have to be mutually exclusive.
3. Toilet Paper Entrepreneur (Mike Michalowicz) – a great no-theory, boiled down to basics primer on starting a business.  Filled with good tips and information.  Unfortunately, for marketing purposes, the author uses the theme of bowel movements and the book is littered with references to toilet paper and poop.  You can choose to ignore it in favor of the good information, find it funny (I think most of us find a good bathroom joke funny, but for me it got old halfway through the book), or be turned off which I think is a shame as the book really is worthwhile.
4. Stupid, Ugly, Unlucky, and Rich (Richard St. John) – Richard St. John is a modern day Dale Carnegie.  As a successful businessman he was asked one day by a young girl, how to be successful.  Admitting he didn’t know, he set out on a multi-year project to talk to as many successful people as he could and find out.  After hundreds of hours of interviews he has distilled success into 8 principles: passion, hard work, focus, pushing oneself, new ideas, constant improvement, service to others, and persistence.  While nothing in this book is new, and there are no secrets revealed, this book is inspirational and helped me feel as a small business owner that success is not something magical or pre-destined for some, but a result of definite principles that anyone can master.  I will be passing this one on to my children.
5. Let’s Get Real or Let’s Not Play (Mahan Khalsa) – Mahan Khalsa, the author of this book on sales sums up sales this way, “ [sales is] the second oldest profession, often confused for the first.”  Almost everyone hates sales because our common conception of sales is bullying or tricking someone into buying something that they really don’t want.  Khalsa reframes selling into the process of helping a person get exactly what they want.  In this light, sales becomes more about service to another.  Again, as a doctor, the thought of being a salesman had turned my stomach, “I don’t sell to people, I help people”, but this book helped me reframe the idea of selling, to helping people get what they want and need.  The process that he lays out in this book is complicated and most useful for large sales with large businesses, but the basic ideas are useful for any size business.  Highly recommended for those who think of selling as distasteful.

What are your thoughts?  Have you read any of these books?  Do you have any others you think should be on the list?  Post your comments below.

Part III of this series

In part I of this series, I explained what I believe evidence based medicine (EBM) should be:  the equal use of clinical experience and external evidence to make the best decisions about the care of patients.  In this interpretation of EBM both clinical experience and external evidence are important and necessary.

Clinical Experience <—-> External Evidence

Unfortunately this interpretation is rarely used in current discussions of EBM.  Instead we find this version of EBM widely promoted.

1.  Randomized, controlled studies

2.  Other studies

3.  Clinical experience & “consensus” opinion

Under this interpretation, the value of evidence is now ranked.   Double blind, placebo controlled studies are given the highest value, followed by a variety of other studies, and lastly clinical experience and consensus views from committees, associations, and experts.  Instead of external evidence and clinical experience being given equal weight we now find that clinical experience is considered the least valid (and valued) form of evidence.

This form of EBM is often used to disparage and discredit alternative or non-mainstream therapies with the refrain, “there’s no / not enough evidence” because the only evidence considered worthwhile is that produced from studies, and especially from double blind, placebo controlled studies.  The reports of hundreds or thousands of doctors and hundreds of thousands or millions of patients are brushed aside with the comment “anecdotal” as if that means they have no value.

To run a well conducted scientific studies, especially double blind placebo controlled studies, requires  scientists to be hired, the study designed, subjects recruited, screened, and selected, the trial run for weeks, months, or years (in some cases), the data collected, analyzed and then published.  All of this isn’t free and in fact costs a tremendous amount of money.

The government does sponsor some studies, but the current budget allocated for studying alternative therapies is pathetically small.  The majority of studies are funded by private companies, and in a capitalistic society the goal of business is to make money.  Studies funded by private companies are not done to prove whether a therapy is effective or not, but ultimately to prove that their therapy (being studied) is effective so that the results can be used to promote that therapy, and make money.

For example, a pharmaceutical company comes up with a drug they believe might have potential, they patent it which gives them exclusive rights to sell it for a period of time.  This ensures that if the drug is shown to be useful they will be the only ones who can sell it and therefore they will be able to make a lot of money with it.  The company will then fund scientific trials to prove that it is effective and bring it to market.

In contrast, something like vitamin C is cheap and widely available.  It is a natural substance and so cannot be patented.  If a company paid for a study on vitamin C and found it beneficial, anyone selling vitamin C could use the study to promote their brand of vitamin C.  The company that spent the money to have the study done would not have any advantage because they cannot patent and hold exclusive rights to vitamin C.  In fact the sponsoring company would be at a disadvantage because they spent the money to have the study done, while competitors could use the results of the study for free.

Pharmaceutical companies run the majority of trials on medical therapies, and because they cannot own natural therapies most natural therapies are not studied.  Further, as many natural substances may be replacements or alternatives for drugs, pharmaceutical companies have a further disincentive to conduct trials on natural substances.  The only studies they would have interest in running are those that prove that natural substances don’t work or are inferior to their products.

Therefore as alternative practitioners we find that the majority of our therapies are not studied in scientific trials, because there is no profit in doing so.  Most supplement companies, alternative medical societies, associations, and schools are small and don’t have the millions of dollars needed to run the studies to “prove” that the therapies work.  Evidence from practitioners and patients is discounted as anecdotal and therefore “worthless”.

Under this version of EBM, the conventional community claims there is no evidence to support the use of alternative therapies.  However, if we turn this same standard upon the conventional community, we find they have little evidence to support many of the practices and therapies they use.  By some estimates, up to 80% of conventional practice do not have sufficient studies behind them to justify their use under this version of EBM.  Most MDs rely on evidence presented in scientific journals, what they are told by pharmaceutical representatives about medications, their own clinical experience and the consensus opinion of their colleagues and medical associations to provide evidence for the use of their practices and therapies.  The majority of this evidence is considered lowest tier evidence under this version of EBM.

It is my belief that this version of EBM sets unrealistic and non-usefully high standards for what can qualify as evidence to justify therapies and practice, and by doing so denies patients effective care.  In part III of this series I will lay out the form of EBM that I use in my practice and how I feel it best serves my patients.

What are your thoughts and opinions on EBM?  We’d love to hear them.  Feel free to share them below.

Part III here

Evidence based medicine (EBM) has emerged as one of the key concepts being debated in leading medical journals, doctors offices and conventions, insurance boardrooms, and government agencies  as a major piece of  the effort to reduce costs and improve outcomes in medicine.  In this series I’ll be explaining what evidence based medicine should be (part I), is (part II), and how I use it in my practice (part III).

The definition of evidence based medicine I believe makes the most sense comes from this paper.  BMJ 1996;312:71-72 (13 January) Sackett DL, Rosenberg WM, Gray JA, Haynes RB, Richardson WS (1996). “Evidence based medicine: what it is and what it isn’t”. Excerpts from the paper will be in italics.

“Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.”

The intention behind evidence based medicine is a good one.  As doctors we want to carefully and consciously use the best evidence to select therapies that are helpful to patients, and avoid those which are harmful or useless.  As the article says:

“[The purpose of evidence based medicine is to] invalidates previously accepted diagnostic tests and treatments and replaces them with new ones that are more powerful, more accurate, more efficacious [effective], and safer.”

Whatever gives us the best results is what we want to use for the good of our patients.  But, how do we decide what is the best evidence?

“The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.”

We combine our clinical experience as doctors (personal, subjective evidence) with the best evidence from external sources (impersonal, objective experience).   In contrast to what we will see in part II of this series, we see that evidence based medicine combines the clinical experience of the doctor with external sources, such as the scientific literature.

The article continues: “Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough. Without clinical expertise, practice risks becoming tyrannised by evidence, for even excellent external evidence may be inapplicable to or inappropriate for an individual patient. Without current best evidence, practice risks becoming rapidly out of date, to the detriment of patients.”

In this view of evidence based medicine, which I subscribe to, both clinical experience and the scientific literature are equally important.  One without the other is insufficient and leads to poor practice and outcomes.  Clinical experience without external evidence is narrowly focused and becomes quickly out of date, and the external evidence without clinical experience attempts to fit a “one size fits all” solution to individuals, which typically works very poorly.

In part II, we’ll move away from what EBM should be, to what it most often is.

What are your thoughts and opinions on EBM?  We’d love to hear them.  Feel free to share them below.

Bottom line:  “Remove the term H1N1 from the equation.” If your child had regular flu, would you take him to the hospital? If the answer is no, then don’t take him/her to the hospital now.

—–

People were scared [mainly due to the media’s hype and constant coverage of H1N1, along with declarations by governments and health organizations of pandemics and national emergencies].   Health care professionals were blaming the media — accusing them of being alarmist [most health care professionals working with patients, not those working in government or for the media, are not overly concerned about H1N1].  The doctor who met me [in a pediatric (kids) emergency room] started by saying he was giving the media a C+ in its overall coverage of H1N1, and blamed his busy ER, in part, on the media for stoking fears.

There is no question that pediatric emergency rooms are much busier than this time last year — about two to three times busier at the ER I visited, [but] many of the patients sitting in the waiting room were there with flu-like symptoms, worried about H1N1.  [In the media we hear that emergency rooms are slammed with patients and barely able to keep up, giving us the impression that most of these people are deathly ill, when in fact the vast majority are there with colds or flu-like symptoms that do not need medical attention.  Most are briefly examined and told to go home.]

[Dr. Gupta’s recommendations for parents:]

Point 1. As things stand now, the vast majority of children who develop flu-like symptoms this fall will have a few miserable days, and nothing more. And those days are best spent at home — not in the ER or a doctor’s office.

Point 2. If you are worried, you should call your pediatrician’s [or Naturopathic doctor’s] office first. Don’t take your child in without calling. Two reasons: Your child may not have H1N1, but could become exposed by being around sick children. And, after several hours of waiting, you are still likely to be told the basics — plenty of fluids, rest and dose-appropriate acetaminophen for a fever [I strongly disagree with the recommendation to bring down a mild-moderate fever with aspirin or acetaminophen as research has shown that doing so will INCREASE the length and severity of an illness.   A fever is part of the body's natural defenses against an illness.  In children if the temperature is less than 104 F and the child is tolerating it well there is no need to bring the fever down, simply make sure the child does not become dehydrated by supplying plenty of fluids.  If the fever needs to be brought down a short bath in tepid (luke warm) water is the best way to do so.]  After all, it is still the flu we are talking about.

Point 3. One doctor told me a way to think about things that was helpful. He said “remove the term H1N1 from the equation.” If your child had regular flu, would you take him to the hospital? If the answer is no, then don’t take him/her to the hospital now.

Point 4. Yes, hearing between 30,000 and 90,000 could die from H1N1 is scary, but keep in mind — around 40,000 people die from the regular or seasonal flu every year. The numbers may not be that much different, yet there is not panic about the regular flu. As things look now, H1N1 is causing only mild to moderate illness, not the widespread deaths people are worried about.

Point 5. There are some children who should be seen by their doctor. Call your doctor if:

• A baby younger than 12 weeks has a fever greater than 100.4 degrees Fahrenheit

• A child, older than 12 weeks has a fever for three days

• A child’s fever returns after a 12-24 hour time period

• A child is not passing urine or making tears for more than six hours

• A child does not smile or show interest in playing for several hours

Dial 911 if:

• A child cannot speak while trying to breathe

• Has a blue or dark purple color to the nail beds, lips or gums

• Is not responding to you because he is too tired or weak

One point that was reinforced to me over and over again by the pediatricians is the best place for a sick child is at home. And, with regard to school — after 24 fever-free hours without the aid of medications, he or she can go back.

This is the advice that my wife and I will be following this fall for our own children. Hope it is helpful to you, and the media can score an “A,” at least this time around.

[Full unedited, article here]

—–

Very reasonable advice.  If you or your child comes down with a flu-like illness, don’t panic.  As long as the sick person is handling the illness well, there is no need for further treatment or concern.  The most important therapies are to stay home, rest, and get plenty of fluids.  If things take a turn for the worse (high fevers, extreme lethargy or trouble responding, or any of the warning signs listed above) get a medical professional involved.  But remember, for the vast majority of people, H1N1 is a mild to moderate illness, not a life-threatening one.

What do you think?  Have you had swine flu this year?  How did you treat it?  We’d love to hear your thoughts.  Please post below.

Bottom Line:  A combination of ignorance, arrogance, and greed often combine to keep effective therapies out of public awareness.

Sound too ridiculous to be true?  This interview with Dr. Burt Berskon, MD, PhD sadly illustrates this point all too well.

As a medical resident in a teaching hospital, Dr. Berkson was told to watch two patients die, take notes, and present on it.  Both had eaten poisonous mushrooms and were diagnosed with uncurable and fatal liver damage.  Despite being told there was nothing that could be done, and his orders to simply watch, Dr. Berkson felt compelled to try and help these two patients.  He had a PhD and had been a research scientist for 6 years before deciding to become a doctor, and he called his contacts at the NIH (National Institutes of Health) to find out if they had any ideas that might save these people.  They suggested alpha lipoic acid might work and rushed some to him.  Dr. Berkson gave it to both patients (by IV) and over two weeks both patients regenerated their livers and fully recovered.  He was thrilled, the patients were thrilled, and his bosses were angry.  He had disobeyed orders (they told him to watch, not treat) and he has used a non-approved drug.  Were they interested in what he did or further exploring the therapy?  No.

When more patients came in with fatal mushroom poisoning he was told not to use the alpha lipoic acid treatment that had saved the other two patients.  He did so anyway and these patients also recovered.  He was disciplined again and the only reason he kept his job was because of his contacts at the NIH.  He conducted a small trial with alpha lipoic acid showing 75 of 79 people with terminal (fatal) liver disease recovered.  Despite these stunningly spectacular results no one in the US was interested.  Journals had no interest in publishing his papers, companies had no interest in sponsoring further trials, and doctors had no interest in utilizing the therapy.  He traveled to Europe and was finally able to publish his research in Germany (where MDs DO use herbs, nutrients and other non-conventional therapies)

Later in the article Dr. Berkson talks about another non-standard remedy, low dose naltrexone (LDN).  A woman came to his clinic suffering from fatal pancreatic cancer that had spread to her liver.  She had been told that there was nothing more that could be done but had sought out Dr. Berkson for a second opinion .  He started her on a regimen of intravenous alpha lipoic acid and low dose naltrexone and five months later there was no sign of the cancer.  The woman wanted to return to her home state and when she returned home she found that there weren’t any doctors who would even consider continuing her treatment with alpha lipoic acid and LDN.  Dr. Berkson spoke with the woman’s primary doctor about the results they had seen and asked if she would continue the treatment.  Her response:

“You know, I really would not want to do anything different because the medical boards might look down on me. I’m not an oncologist, and if I treat the cancer, the oncology people might get angry about it. So I can’t do it.”

These two incidents are only a piece of the article, which is found here.  It is well worth reading and will sadly open your eyes to the fact that there’s far too much too much ignorance, arrogance, and greed in medicine.  I’m grateful to practice Naturopathic medicine where I have the freedom to explore non-conventional therapies.  Where the priority is still caring for the patient, and big money and big politics haven’t corrupted that.  Most MDs and other conventional practitioners (nurses, etc) are truly caring, dedicated people (I know quite a few), but unfortunately the system has become more about making money than healing.  I’ll be exploring both alpha lipoic acid and LDN as potential options for my patients and I hope by spreading the word it’ll encourage other doctors to take a look at these non-conventional but effective therapies.  A world of healing DOES exist outside of the conventional system, and if we set aside our ignorance, arrogance and greed we can be free to use whatever therapies help patients heal.

What are your thoughts?  We’d love to hear from you.  Please feel free to post below.