MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

children

This is the conclusion Britt Hermes draws in her new blog post about US naturopaths claiming to be competent to treat children.

Britt is a most remarkable and courageous woman. She clearly knows what she is talking about: “My experience puts me in a unique position to show what naturopathic training looks like from the inside and why, especially for children, naturopathic care is dangerous. I support this point with a critical review of pediatrics syllabi from Bastyr University (Seattle, WA) and Southwest College of Naturopathic Medicine (Phoenix, AZ) and correspondences with a number of pediatricians in the U.S. and Canada.

At Bastyr, I took pediatrics 1 and 2 (NM 7314 and 7315) and an additional elective course in “advanced pediatrics” (NM 9316) from 2010-2011. I also opted to take the elective pediatrics clinical shift at Bastyr’s outpatient teaching clinic. Only pediatrics 1 and 2 were required for graduation. Each class met for 2 hours per week for 10 weeks, not including the 11th week for a final exam. By taking the advanced course, I received a total of 60 hours, but remember, only 40 hours was required. (In the year after I graduated from Bastyr, the curriculum changed to a systems-based program, which folded pediatric instruction into courses linked by medical theme.)…

Here’s the bottom line: a pediatrician gets a combined 20,000 hours of training in medical school and residency; a licensed naturopath has the option of doing a naturopathic residency for 1,300 hours after having done 30 to 40 hours of lecture hours in paediatrics…”

If you think that is bad… it gets worse:

A serious concern with this course syllabus is the book list. Current and Nelson’s Pediatrics are considered standard texts, but these were not even required to read in order to do well in the course. I didn’t buy either book and didn’t complete any of the assigned readings but passed with flying colors.

It should be appalling for anyone to see Dana Ullman’s Homeopathy for Children and Infants and Dr. Bob Sears’s The Vaccine Book, not once, but twice in the list! All of my syllabi for the Bastyr pediatrics courses include these texts. The syllabus for pediatrics at SCNM does not, but its instructor is a known promoter of vaccine myths

Naturopathic students are essentially trained in alternative vaccines schedules, perhaps leading them not to vaccinate. If this isn’t smoking gun proof that naturopaths are anti-vaccine to the core, then what is?”

Britt’s final conclusion is that “Naturopathic programs do not provide their students with medical training that should instil public confidence. Yet, naturopaths argue that they deserve licensure based on the quality of their training and practice.”

I agree completely with Britt’s view and encourage everyone to read her article in full.

The website of the Brighton and Hove News informs us that the Brighton charity Rockinghorse is paying for a Reiki healer to treat young patients at the Royal Alexandra Children’s Hospital in Kemp Town. They claim that studies suggest that Reiki can relieve symptoms of chronic and acute illness, manage stress levels and aid relaxation and sleep. Rockinghorse has provided funding for an initial three years to therapists from Active LightWorks who have already been treating patients at the Alex as volunteers since 2012. The funding will allow the therapists to double the amount of time that they are able to offer treatments from five hours a week to ten.

One of the HDU patients to receive Reiki therapy is eight-month-old Blake Mlotshwa. He suffered a serious infection when he was 18 days old which led to him having two thirds of his bowel removed. Blake is unable to absorb the food and nutrients that he needed to grow and his condition remains critical. The reiki therapists are working with his doctors and nurses to help keep him as comfortable as possible.

Ali Walters, a Reiki therapist, said: “It is wonderful to be able to give both the children and parents an opportunity to relax and unwind. So often parents tell me they are delighted that during treatment their child drops off to sleep or they see their child become more calm and comfortable. I am delighted that Rockinghorse is now funding our work so we can provide more therapists and treatments to support the critical care that is provided in HDU.”

Kamal Patel, paediatric consultant at the Alex, said: “The reiki treatment has improved sleep, fear, anxiety, distress and pain for children on our Paediatric Critical Care Unit over and above what we can achieve through modern medicine. To have such a fantastic team of people offering reiki really helps our patients get better quicker.”

Yes, we have discussed Reiki several times already on this blog. For instance, I quoted the Cochrane review aimed at evaluating the effectiveness of Reiki for treating anxiety and depression in people aged 16 and over.

Literature searches were conducted in the Cochrane Register of Controlled Trials (CENTRAL – all years), the Cochrane Depression, Anxiety and Neurosis Review Group’s Specialised Register (CCDANCTR – all years), EMBASE, (1974 to November 2014), MEDLINE (1950 to November 2014), PsycINFO (1967 to November 2014) and AMED (1985 to November 2014). Additional searches were carried out on the World Health Organization Trials Portal (ICTRP) together with ClinicalTrials.gov to identify any ongoing or unpublished studies. All searches were up to date as of 4 November 2014.

Randomised trials were considered in adults with anxiety or depression or both, with at least one arm treated with Reiki delivered by a trained Reiki practitioner. The two authors independently decided on inclusion/exclusion of studies and extracted data. A prior analysis plan had been specified.

The researchers found three studies for inclusion in the review. One recruited males with a biopsy-proven diagnosis of non-metastatic prostate cancer who were not receiving chemotherapy and had elected to receive external-beam radiation therapy; the second study recruited community-living participants who were aged 55 years and older; the third study recruited university students. These studies included subgroups with anxiety and depression as defined by symptom scores and provided data separately for those subgroups. As this included only 25 people with anxiety and 17 with depression and 20 more with either anxiety or depression, but which was not specified, the results could only be reported narratively.

The findings did not show any evidence that Reiki is either beneficial or harmful in this population. The risk of bias for the included studies was generally rated as unclear or high for most domains, which reduced the certainty of the evidence.

The authors of this Cochrane review concluded that there is insufficient evidence to say whether or not Reiki is useful for people over 16 years of age with anxiety or depression or both.

On a different blog post, I concluded that “we do not need a trained Reiki master, nor the illusion of some mysterious ‘healing energy’. Simple companionship without woo or make-believe has exactly the same effect without undermining rationality. Or, to put it much more bluntly: REIKI IS NONSENSE ON STILTS.”

Perhaps someone should tell the guys at Rockinghorse that they are funding nonsense?

Perhaps the charity should have been responsible enough to do a quick search on the evidence BEFORE they committed their funds?

Perhaps the consultant pediatrician should be sent to a refresher course in evidence-based medicine?

So many ‘perhapses’ – and only one certainty: THIS CHARITY IS WASTING ITS FUNDS ON OFFENSIVE NONSENSE.

Yes, this is exactly the claim I found on this website entitled ‘ALL NATURAL IDEAS. WAYS TO LIVE A HEALTHY LIFE NATURALLY. Here we learn that “All Natural Ideas is a site is designed to provide simple ideas on how you can live a more natural and healthy life. Lisa is the mastermind behind All Natural Ideas. She is a full-time engineer who has become passionate about sharing information on how to live a healthier life by following a natural based diet low in carbohydrates.”

But Lisa does not just do ‘low carb’, she recently also ventured into the realm of immunisation – but, as conventional immunisations are not ‘natural’, it had to be ‘homeopathic immunisations. This is what she writes:

Homeopathic immunizations… is increasing in popularity. Parents like the idea of protecting their child from disease without potentially toxic vaccine ingredients…

Critics contend that no conclusive double-blind, randomized controlled trials have proven, in general, homeopathy’s efficacy, as well as homeopathic immunizations. But proponents of homeoprophylaxis contend that conventional vaccines are also lacking in critical scientific studies that prove the long-term safety of pharmaceutical-grade vaccines.

Dr. Isaac Golden is a homeopath and earned the first ever PhD in homeopathic research from a mainstream Australian University. Golden has been a pioneer in the field of homeopathic prophylaxis since 1984. His research website, offers historical evidence, epidemic studies, and his own 20-year study of over 2,000 children whose parents used his prophylaxis program, the latter of which, Golden concluded, proved over 92% effective at preventing disease…

Homeopathy is a holistic form of medicine. Rather than a conventional doctor spending little time with a patient analyzing symptoms, homeopathy is considered effective when administered by a classically-trained homeopath, who will meet with the patient for well over an hour, getting the whole picture of the patient (hence ‘holistic’) , i.e. diet, stress levels, and many other factors.

About 200 years ago, Hahnemann developed an immunization based on his ‘like treats like’ principle, for scarlet fever. Homeoprophylaxis, the homeopathic vaccine alternative, prevents disease through nosodes.

END OF QUOTE

Yes, homeopaths tend to promote a whole lot of untruths to advise their patients against immunisations and instead recommend homeopathic immunisations or ‘homeo-prophylaxis’. This normally entails the oral administration of homeopathic remedies, called nosodes. Nosodes were added to the homeopathic Materia Medica only in the 1830s and are not in agreement with Hahnemann’s like cures like theory. Nosodes are potentised remedies based on pathogenic material like bodily fluids or pus. In 2015, the Canadian Paediatric Society issued the following caution: ‘There is scant evidence in the medical literature for either the efficacy or safety of nosodes, which have not been well studied for the prevention of any infectious disease in humans.’

There is no good evidence that any form of homeoprophylaxis is effective. After conventional immunisations, patients develop immunity against the infection in question which can be monitored by measuring the immune response to the intervention. No such evidence exists for homeopathic immunisations. More importantly, there is also no clinical data to show that homeoprophylaxis might work.

Despite this lack of evidence, some homeopaths – particularly those without medical training – continue to recommend this form of quackery. The promotion of this approach constitutes a serious risk for public health: once rates for conventional immunisations fall below a certain threshold, the population would lose its herd immunity, subsequently even those individuals who were immunised are at risk of acquiring the infection.

I am afraid, there can be only one conclusion: Homeoprophylaxis is dangerous charlatanry.

I must have stated this a thousand times – but I will do it again: A HOMEOPATHIC REMEDY MIGHT BE HARMLESS, BUT MANY HOMEOPATHS AREN’T!

As to prove my point, US homeopaths are about to host a conference where it is made quite obvious. The National Center for Homeopathy (NHC) is a non-profit organization in the US dedicated to “promoting health through homeopathy by advancing the use and practice of homeopathy.” The NCH is also the host organization for the Joint American Homeopathic Conference (JAHC). This event offers an afternoon of homeopathic learning for those interested in understanding more about the use of homeopathy on 9 April this year.

“We host a conference every year for practitioners and serious students but we also know there are a lot of people who’d like to learn more about homeopathy. So we created this special afternoon for interested beginners called Homeopathy Academy for Moms Live! Though we find moms and dads increasingly interested in using homeopathic remedies for their families, we created this event for all novice users,” explains NCH Executive Director Alison Teitelbaum. “People are interested in homeopathy because it’s safe, has no side effects, is inexpensive and, best of all, natural.”

Interested attendees to the introductory workshop receive:

1. Two 2-hour workshops taught by renowned homeopathic instructors that are guaranteed to increase your understanding, skill level, and confidence in using homeopathy at home for yourself and your family
2. Access to our one-of-a-kind holistic Marketplace – where close to 40 exhibitors and vendors will be showcasing and selling their natural, holistic, and homeopathic products and services.

Pre-registration rate of $35 is available until March 23 and then $50 thereafter.

A few clicks away, I found a NHC website which might disclose more clearly what the moms are about to be taught. Here are a few highlights:

Based on a thorough review of the literature, I believe strongly that the decreased incidence of these serious diseases is linked to improved sanitation and hygiene as well as to the introduction of vaccinations.  However, I am deeply concerned about the catastrophic rise of chronic diseases like asthma, autism, and behavioral disorders. Much more research into the possible relationship between vaccinations and these epidemic problems needs to be done.

At present, there is little data to support or reject any such association.

If your state permits exemption to vaccination, you may decide to withhold vaccinations from your child based on the simple philosophical decision that you do not wish to inject foreign bacterial/viral matter into your healthy child. Given that the infectious diseases for which people get vaccinated are exceedingly rare in the U.S., it is unlikely that your child would suffer the consequences of one of them. Be aware, however, that in some cities it is becoming routine to remove unvaccinated children from schools whenever there is a child with an infectious disease for which the majority are vaccinated. In the case of chickenpox, this could result in a child being removed from school two or four weeks a year, without recourse….

Do not accept the bland reassurances of health professionals or public health authorities that your child will be safe if vaccinated. There is no question that vaccines have the potential to undermine immune function in some children who receive them. Many vaccine investigators agree that the increase in asthma, diabetes, autism, and some autoimmune diseases is directly attributed to vaccine use in children. Educate yourself about disease incidence, vaccine effectiveness, and vaccine adverse effects before you agree to any vaccinations…

Don’t be bullied by the medical profession. Do make a decision and try not to let it plague you–move on and enjoy your baby! Also, don’t forget that if you are breastfeeding, your baby will get a lot of immunity from you and it would be unnecessary to vaccinate quite so early in their life…

All vaccines are artificial disease products, accompanied with preservatives of varying potential toxicity. Their introduction into the body is a serious proposition…

NOW, WHO FEELS LIKE PERPETUATING THE MYTH OF HOMEOPATHY BEING HARMLESS?

It’s acupuncture awareness week in the UK, and therefore, I will focus on this treatment for a few days.

Yesterday, the ‘HALE CLINIC’, London happened to be in the papers for making unsubstantiated claims. It seems to be THE place where the super-rich take their money when they feel a little off colour.

This institution has for many years been a great promoter of acupuncture. On their website, which seems to have changed significantly since the press report about bogus claims made there, they even advertise acupuncture for children and little babies:

Acupuncture has been a normal part of the healthcare system in China for thousands of years, ever since ancient times, being used on babies and children as well as adults. Paediatric acupuncture is a specialist branch of traditional acupuncture, fundamentally the traditional theory is no different, the difference comes with how we assess the children and the way we use the needles. A child’s vital energy or Qi is abundant and much easier to access as it is young. This often means results can be very dramatic and sustained in a positive way, enabling the child to grow into adulthood without conditions that may have stayed throughout their lives.

Acupuncture involves using very short, fine sterile needles which are inserted using a very gentle needle technique specifically for babies. The needles do not stay in so the consultation is relatively quick and the child feels very little. Moxa is often used which is a herb called mugwart that has been rolled into a cigar shape. This is lit and then it smoulders producing a gentle heat which is held over the skin of the child creating a delightful warming sensation. This therapy is very popular with the children as it is very relaxing.

Acupuncture is an extremely effective therapy for babies and children and they are very receptive to it. Once their initial natural anxieties have been overcome, children often find the whole experience enjoyable and look forward to coming for their appointments.

In the interest of promoting awareness of the truth about acupuncture, I think, one ought to point out a few things here:

  1. The history of acupuncture was not at all as simple as implied above. Acupuncture was even banned in China. Mao re-introduced it, not because he thought it was effective but because he needed to offer some sort of healthcare to the masses.
  2. The concept of vital energy is a pre-scientific myth which has no basis in reality.
  3. To claim that children can grow into adulthood without conditions that may have stayed throughout their lives, implies that acupuncture effectively prevents certain diseases. I am not aware of any good evidence for this claim and would therefore classify it as bogus.
  4. The claim that acupuncture is an extremely effective therapy for babies and children is not supported by good evidence.
So, it took me all of 10 minutes to find therapeutic claims made by one of the UK’s most prominent alt med clinic which are, in my view, not supported by sound evidence or good science. I would not be surprised to find many more, if I spent more time on the task.

What does that tell us about the honesty of the claims made for acupuncture?

You are not surprised?

Considering that the HALE CLINIC now had many hours to ‘clean up’ their website after the allegations in the press, I have to admit that I am a little shocked. They seem to make unsubstantiated claims in order to take parents’ money for sticking useless and potentially harmful needles into their tiny infants.

I am shocked that such misleading information seems to be deemed to be inoffensive.

I am shocked to think that some parents might be sufficiently gullible to do this sort of thing to their infants.

And I am shocked that some people seem to earn their living doing such things.

A 2016 article set out to define the minimum core competencies expected from a certified paediatric doctor of chiropractic using a Delphi consensus process. The initial set of seed statements and sub-statements was modelled on competency documents used by organizations that oversee chiropractic and medical education. The statements were then distributed to the Delphi panel, reaching consensus when 80% of the panelists approved each segment. The panel consisted of 23 specialists in chiropractic paediatrics from across the spectrum of the chiropractic profession. Sixty-one percent of panellists had postgraduate paediatric certifications or degrees, 39% had additional graduate degrees, and 74% were faculty at a chiropractic institution and/or in a postgraduate paediatrics program. The panel was initially given 10 statements with related sub-statements formulated by the study’s steering committee. On all 3 rounds of the Delphi process the panelists reached consensus; however, multiple rounds occurred to incorporate the valuable qualitative feedback received.

The results of this process reveal that the Certified Paediatric Doctor of Chiropractic requires 8 sets of skills. (S)he will …

1) Possess a working knowledge and understanding of the anatomy, physiology, neurology, psychology, and developmental stages of a child. a) Recognize known effects of the prenatal environment, length of the pregnancy, and birth process on the child’s health. b) Identify and evaluate the stages of growth and evolution of systems from birth to adulthood. c) Appraise the clinical implications of developmental stages in health and disease, including gross and fine motor, language/communication, and cognitive, social, and emotional skills. d) Recognize normal from abnormal in these areas. e) Possess an understanding of the nutritional needs of various stages of childhood.

2) Recognize common and unusual health conditions of childhood. a) Identify and differentiate clinical features of common physical and mental paediatric conditions. b) Identify and differentiate evidence-based health care options for these conditions. c) Identify and differentiate clinical features and evidence-based health care options for the paediatric special needs population.

3) Be able to perform an age-appropriate evaluation of the paediatric patient. a) Take a comprehensive history, using appropriate communication skills to address both child and parent/ guardian. b) Perform age-appropriate and case-specific physical, orthopaedic, neurological, and developmental examination protocols. c) When indicated, utilize age-appropriate laboratory, imaging, and other diagnostic studies and consultations, according to best practice guidelines. d) Appropriately apply and adapt these skills to the paediatric special needs population. e) Be able to obtain and comprehend all relevant external health records.

4) Formulate differential diagnoses based on the history, examination, and diagnostic studies.

5) Establish a plan of management for each child, including treatment, referral to, and/or co-management with other health care professionals. a) Use the scientific literature to inform the management plan. b) Adequately document the patient encounter and management plan. c) Communicate management plan clearly (written, oral, and nonverbal cues) with both the child and the child’s parent/guardian. d) Communicate appropriately and clearly with other professionals in the referral and co-management of patients.

6) Deliver skilful, competent, and safe chiropractic care, modified for the paediatric population, including but not limited to: a) Manual therapy and instrument-assisted techniques including manipulation/adjustment, mobilization, and soft tissue therapies to address articulations and/or soft tissues. b) Physical therapy modalities. c) Postural and rehabilitative exercises. d) Nutrition advice and supplementation. e) Lifestyle and public health advice. f) Adapt the delivery of chiropractic care for the paediatric special needs population.

7) Integrate and collaborate with other health care providers in the care of the paediatric patient. a) Recognize the role of various health care providers in paediatric care. b) Utilize professional inter-referral protocols. c) Interact clearly and professionally as needed with health care professionals and others involved in the care of each patient. d) Clearly explain the role of chiropractic care to professionals, parents, and children.

8) Function as a primary contact, portal of entry practitioner who will. a) Be proficient in paediatric first aid and basic emergency procedures. b) Identify and report suspected child abuse.

9) Demonstrate and utilize high professional and ethical standards in all aspects of the care of paediatric patients and professional practice. a) Monitor and properly reports of effects/adverse events. b) Recognize cultural individuality and respect the child’s and family’s wishes regarding health care decisions. c) Engage in lifelong learning to maintain and improve professional knowledge and skills. d) Contribute when possible to the knowledge base of the profession by participating in research. e) Represent and support the specialty of paediatrics within the profession and to the broader healthcare and lay communities.

I find this remarkable in many ways. Let us just consider a few items from the above list of competencies:

Identify and differentiate evidence-based health care options… such options would clearly not include chiropractic manipulations.

Identify and differentiate clinical features and evidence-based health care options for the paediatric special needs population… as above. Why is there no mention of immunisations anywhere?

Perform age-appropriate and case-specific physical, orthopaedic, neurological, and developmental examination protocols. If that is a competency requirement, patients should really see the appropriate medical specialists rather than a chiropractor.

Establish a plan of management for each child, including treatment, referral to, and/or co-management with other health care professionals. The treatment plan is either evidence-based or it includes chiropractic manipulations.

Deliver skilful, competent, and safe chiropractic care… Aren’t there contradictions in terms here?

Manual therapy and instrument-assisted techniques including manipulation/adjustment, mobilization, and soft tissue therapies to address articulations and/or soft tissues. Where is the evidence that these treatments are effective for paediatric conditions, and which conditions would these be?

Clearly explain the role of chiropractic care to professionals, parents, and children. As chiropractic is not evidence-based in paediatrics, the role is extremely limited or nil.

Function as a primary contact, portal of entry practitioner… This seems to me as a recipe for disaster.

Demonstrate and utilize high professional and ethical standards in all aspects of the care of paediatric patients… This would include obtaining informed consent which, in turn, needs to include telling the parents that chiropractic is neither safe nor effective and that better therapeutic options are available. Moreover, would it not be ethical to make clear that a paediatric ‘doctor’ of chiropractic is a very far cry from a real paediatrician?

So, what should the competencies of a chiropractor really be when it comes to treating paediatric conditions? In my view, they are much simpler than outlined by the authors of this new article: I SEE NO REASON WHATSOEVER WHY CHIROPRACTORS SHOULD TREAT CHILDREN!

If you start reading the literature on chiropractic, you are bound to have surprises. The paucity of rigorous and meaningful research is one of them. I am constantly on the look-out for such papers but am regularly frustrated. Over the years, I got the impression that chiropractors tend to view research as an exercise in promotion – that is promotion of their very own trade.

Take this article, for instance. It seems to be a systematic review of chiropractic for breastfeeding. This is an interesting indication; remember: in 1998, Simon Singh wrote in the Guardian this comment “The British Chiropractic Association claims that their members can help treat children with colic, sleeping and feeding problems, frequent ear infections, asthma and prolonged crying, even though there is not a jot of evidence. This organisation is the respectable face of the chiropractic profession and yet it happily promotes bogus treatments.” As a consequence, he got sued for libel; he won, of course, but ever since, chiropractors across the world are trying to pretend that there is some evidence for their treatments after all.

The authors of the new review searched Pubmed [1966-2013], Manual, Alternative and Natural Therapy Index System (MANTIS) [1964-2013] and Index to Chiropractic Literature [1984-2013] for the relevant literature. The search terms utilized “breastfeeding”, “breast feeding”, “breastfeeding difficulties”, “breastfeeding difficulty”, “TMJ dysfunction”, “temporomandibular joint”, “birth trauma” and “infants”, in the appropriate Boolean combinations. They also examined non-peer-reviewed articles as revealed by Index to Chiropractic Literature and conducted a secondary analysis of references. Inclusion criteria for their review included all papers on breastfeeding difficulties regardless of peer-review. Articles were excluded if they were not written in the English language.

The following articles met the inclusion criteria: 8 case reports, 2 case series, 3 cohort studies and 6 manuscripts (5 case reports and a case series) that involved breastfeeding difficulties as a secondary complaint. The findings revealed a “theoretical and clinical framework based on the detection of spinal and extraspinal subluxations involving the cervico-cranio-mandibular complex and assessment of the infant while breastfeeding.”

Based on these results, the authors concluded that chiropractors care of infants with breastfeeding difficulties by addressing spinal and extraspinal subluxations involving the cervico-cranio-mandibular complex.

Have I promised too much?

I had thought that chiropractors had abandoned the subluxation nonsense! Not really, it seems.

I had thought that systematic reviews are about evidence of therapeutic effectiveness! Not in the weird world of chiropractic.

I would have thought that we all knew that ‘chiropractors care of infants with breastfeeding difficulties’ and do not need a review to confirm it! Yes, but what is good for business deserves another meaningless paper.

I would have thought that the conclusions of scientific articles need to be appropriate and based on the data provided! It seems that, in the realm of chiropractic, these rules do not apply.

An appropriate conclusion should have stated something like THERE IS NO GOOD EVIDENCE THAT CHIROPRACTIC CARE AIDS BREASTFEEDING. But that would have been entirely inappropriate from the chiropractic point of view because it is not a conclusion that promotes the sort of quackery most chiropractors rely upon for a living. And the concern over income is surely more important than telling the truth!

When it comes to alternative medicine, the public relies heavily on the writings of health journalists. We therefore have to count ourselves lucky to have some that are outstanding in their ability to inform the public honestly, objectively and responsibly. Here is an excerpt of what one particularly gifted and ethical heath journalist (and consultant!!!) just published regarding the treatment of babies and kids on a highly visible, popular website:

Homeopathy, or homeopathic medicine, is based on the principle that “like cures like.” Instead of treating an individual’s illness, homeopathy treats individual symptoms with substances from plants and minerals that are highly diluted and “succussed,” or shaken to release energy, said Sara Chana Silverstein, a homeopath, master herbalist and an international board-certified lactation consultant…Although homeopathy isn’t meant to replace Western medicine, it can be a complementary or alternative approach for ailments like colds, the stomach flu and teething. For example, if your pediatrician has diagnosed your baby with an upper respiratory infection, there’s not much you can do other than offer lots of fluids, rest and possibly acetaminophen or ibuprofen. In this case, a homeopathic remedy might help. Plus, since antibiotic overuse and antimicrobial resistance remain a major concern in the U.S., and antibiotics often have side effects, homeopathy could help heal without the need for a prescription. In fact, a study in the journal Homeopathy found that homeopathy for ear infections was just as effective as conventional treatment but patients in the homeopathic group had a faster improvement in symptoms. Although some studies show promising results, more research is needed to determine who homeopathic remedies work best for and in what situations, said Dr. Hilary McClafferty, chair of the American Academy of Pediatrics’ Section on Complementary and Integrative Medicine…

“In the United, States, the homeopathic products that carry the label, HPUS

Homeopathic Pharmacopeia of the United States— are prepared with a very standardized, procedural monograph. So there is a map and regulations that ensure what’s on the label is what’s in the bottle,” McClafferty said…The only adverse effect of homeopathy, according to Silverstein, is that if a baby consumed a remedy too frequently, such as every hour for 10 hours, they would “prove” the remedy, or create the symptoms the remedy was trying to heal. “But if you gave it to a child 3 times a day at a low dose, personally I do not believe it could injure a child in anyway whatsoever,” she said…Your best bet is to see a trained homeopath who will target individual symptoms and give you pellets in the size that’s appropriate for your child’s age, Silverstein said. The bottom line when it comes to deciding between homeopathy, a medication or another remedy? “You want to be well educated, conservative and in touch with your pediatrician,” McClafferty said.

Julie Revelant is a health journalist and a consultant who provides content marketing and copywriting services for the healthcare industry. She’s also a mom of two. Learn more about Julie at revelantwriting.com.

As I said: outstanding!

With so much sound information about homeopathy and its merits in the treatment of childhood conditions, we are inclined to forgive the few tiny errors and marginally misleading statements that might require corrections such as:

  • homeopathy is very much meant as a replacement of conventional medicine by its inventor Hahnemann who was adamant that it must not be combined with other treatments because it is the only true healing art;
  • there is no good evidence that homeopathy is anything else than a placebo for children or, indeed, for anyone else;
  • the study in the journal ‘Homeopathy’ was lousy and does not allow any conclusions whatsoever about the effectiveness of homeopathy;
  • to state “some studies show promising results” is very misleading; the totality of the reliable evidence is negative;
  • more research is not needed to determine who benefits from homeopathy; there is no longer a debate about homeopathy within science;
  • the label of a typical homeopathic preparation does not tell you what’s in the bottle, at best it tells you what used to be there;
  • the main risk of homeopathy is that diseases are not treated effectively; in this way, homeopathy can kill.

Yes, these are but very minor flaws, I know. They should not distract from this journalist’s great achievement of getting her brilliantly informative article read by the widest possible audience. If Prince Charles offered an award for the best science writer of the year (why has he not yet thought of this publicity stunt?), she would certainly be a candidate.

Anthroposophic medicine is based on Rudolf Steiner’s mystical ideas. It is popular in Germany and is slowly also spreading to other countries.  Anthroposophic drugs are prepared according to ancient notions of alchemy and are fly in the face of modern pharmacology. Anthroposophic doctors treat all sorts of diseases, and their treatments  include anthroposophic medications, and a range of other modalities.

A recent paper reported a secondary analysis from an observational study of 529 children with respiratory or ear infections (RTI/OM) <18 years from Europe and the USA. Their caregivers had chosen to consult physicians offering either anthroposophic (A-) or conventional (C-) treatment for RTI/OM.

During the 28-day follow-up antibiotics were prescribed to 5.5% of A-patients and 25.6% of C-patients (P < 0.001); the unadjusted odds ratio for non-prescription in A- versus C-patients was 6.58 (95%-CI 3.45-12.56); after adjustment for demographics and morbidity it was 6.33 (3.17-12.64). Antibiotic prescription rates in recent observational studies with similar patients in similar settings, ranged from 31.0% to 84.1%. Compared to C-patients, A-patients also had much lower use of analgesics, somewhat quicker symptom resolution, and higher caregiver satisfaction. Adverse drug reactions were infrequent (2.3% in both groups) and not serious.

What can we conclude from these data?

Not a lot, I fear!

The authors of the study are a little more optimistic than I; they conclude that this analysis from a prospective observational study under routine primary care conditions showed a very low use of antibiotics and analgesics/antipyretics in children treated for RTI/OM by physicians offering AM therapy, compared to current practice in conventional therapy settings (antibiotics prescribed to 5% versus 26% of A- and C-patients, respectively, during days 0–28; antipyretics prescribed to 3% versus 26%). The AM treatment entailed no safety problem and was not associated with delayed short-term recovery. These differences could not explained by differences in demographics or baseline morbidity. The low antibiotic use is consistent with findings from other studies of paediatric RTI/OM in AM settings.

They are clearly careful to avoid causal inferences; but are they implying them? I would like to know what you think.

 

Conventional cough syrups do not have the best of reputations – but the repute of homeopathic cough syrups is certainly not encouraging. So what should one do with such a preparation? Forget about it? No, one conducts a clinical trial, of course! Not just any old trial but one where science, ethics and common sense are absent. Here are the essentials of a truly innovative study that, I think, has all of these remarkable qualities:

The present prospective observational study investigated children affected by wet acute cough caused by non-complicated URTIs, comparing those who received the homeopathic syrup versus those treated with the homeopathic syrup plus antibiotic. The aims were: 1) to assess whether the addition of antibiotics to a symptomatic treatment had a role in reducing the severity and duration of acute cough in a pediatric population, as well as in improving cough resolution; 2) to verify the safety of the two treatments. Eighty-five children were enrolled in an open study: 46 children received homeopathic syrup alone for 10 days and 39 children received homeopathic syrup for 10 days plus oral antibiotic treatment (amoxicillin/clavulanate, clarithromycin, and erythromycin) for 7 days. To assess cough severity we used a subjective verbal category-descriptive (VCD) scale. Cough VCD score was significantly (P < 0.001) reduced in both groups starting from the second day of treatment (−0.52 ± 0.66 in the homeopathic syrup group and −0.56 ± 0.55 in children receiving homeopathic syrup plus oral antibiotic treatment). No significant differences in cough severity or resolution were found between the two groups of children in any of the 28 days of the study. After the first week (day 8) cough was completely resolved in more than one-half of patients in both groups. Two children (4.3 %) reported adverse effects in the group treated with the homeopathic syrup alone, versus 9 children (23.1 %) in the group treated with the homeopathic syrup plus antibiotics (P = 0.020).

Conclusions

Our data confirm that the homeopathic treatment in question has potential benefits for cough in children as well, and highlight the strong safety profile of this treatment. Additional antibiotic prescription was not associated with a greater cough reduction, and presented more adverse events than the homeopathic syrup alone.

Let us be clear about what has happened here. I think, the events can be summarised as follows:

  • the researchers come across a homeopathic syrup (anyone who understands respiratory problems and/or therapeutics would be more than a little suspicious of this product, but this team is exceptional),
  • they decide to do a trial with it (a decision which would make some ethicists already quite nervous, but the ethics committee is exceptional too),
  • the question raises, what should the researchers give to the control group?
  • someone has the idea, why not compare our dodgy syrup against something that is equally dodgy, perhaps even a bit unsafe?
  • the researchers are impressed and ask: but what precisely could we use?
  • let’s take antibiotics; they are often used for acute coughs, but the best evidence fails to show that they are helpful and they have, of course, risks,
  • another member of the team adds: let’s use children, they and their mothers are unlikely to understand what we are up to,
  • the team is in agreement,
  • Boiron, the world’s largest producer of homeopathic products, accepts to finance the study,
  • a protocol is written,
  • ethics approval is obtained,
  • the trial is conducted and even published by a journal with the help of peer-reviewers who are less than critical.

And the results of the trial? Contrary to the authors’ conclusion copied above, they show that two bogus treatments are worse that one.

BOB’S YOUR UNCLE!

EVERYONE SEEMS HAPPY: THE RESEARCHERS CAN ADD AN ARTICLE TO THEIR PUBLICATION LIST, BOIRON HAS MORE ‘EVIDENCE’ IN FAVOUR OF HOMEOPATHY, AND THE ETHICS COMMITTEE SLEEP JUST AS SOUNDLY AS THE PEER-REVIEWERS.

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