AROMATHERAPY is one of the most popular alternative therapies. The experience is usually pleasant enough, but what are the risks? None!!! At least this is what the therapists would claim. But is this true? Perhaps not. According to a recent press-release, the risks might be considerable.
Officials with the Tennessee Poison Control Center (TPC) are warning that they are seeing an increasing number of toxic exposures, mostly involving children, to essential oils used in aromatherapy. The TPC says the number of essential oil exposures doubled between 2011 and 2015, and 80 percent of those cases involved children. The primary route of poisoning is by ingestion, but also occurs with excessive or inappropriate application to the skin. Children are at risk because their skin easily absorbs oils and because they may try to ingest essential oils from the container.
“Tea tree oil is commonly cited, and most of those cases are accidental ingestions by children.” said Justin Loden, PharmD, certified specialist in Poison Information (CSPI) at TPC. Most essential oils have a pleasant smell but bitter taste, so children easily choke on them and aspirate the oil to their lungs, Loden said.
Several essential oils such as camphor, clove, lavender, eucalyptus, thyme, tea tree, and wintergreen oils are highly toxic. All of the oils produce oral and throat irritation, nausea, and vomiting when ingested. Most essential oils either produce central nervous system (CNS) stimulation, which results in agitation, hallucinations, delirium, and seizures or CNS depression, which results in lethargy and coma. Other toxic effects include painless chemical burns, hypotension, acute respiratory distress syndrome, acute liver failure, severe metabolic acidosis, and cerebral edema depending on which essential oil is in question.
Tennessee Poison Center Tips for using essential oils
- Safely using and storing essential oils is extremely important
- Use essential oil products ONLY for their intended purpose.
- Use only the amount stated on the label/guide.
- Do not swallow an essential oil unless the label says to do so.
- Do not use a product on the skin unless the label says to do so.
- Do not leave the product out (i.e. as a pesticide) unless the label says to do so.
- If you have bottles of essential oils at home, keep them locked up, out of sight and reach of children and pet at all times. Children act fast, so do poisons.
Many will think that this is alarmist – but I don’t. In fact, in 2012, I published a systematic review aimed at critically evaluating the evidence regarding the adverse effects associated with aromatherapy. No, it was not funded by ‘BIG PHARMA’ but by THE ROYAL COLLEGE OF PHYSICIANS, LONDON.
Five electronic databases were searched to identify all relevant case reports and case series. Forty two primary reports met our inclusion criteria. In total, 71 patients experienced adverse effects of aromatherapy. Adverse effects ranged from mild to severe and included one fatality. The most common adverse effect was dermatitis. Lavender, peppermint, tea tree oil and ylang-ylang were the most common essential oils responsible for adverse effects.
At the time, we concluded that aromatherapy has the potential to cause adverse effects some of which are serious. Their frequency remains unknown. Lack of sufficiently convincing evidence regarding the effectiveness of aromatherapy combined with its potential to cause adverse effects questions the usefulness of this modality in any condition.
I might add – before the therapists start making comments – that, yes, aromatherapy is still dimensions safer than many conventional treatments. But remember: the value of a therapy is not determined by its safety but by the risk/benefit balance! And what are the proven benefits of aromatherapy, I ask you.
Many cancer patients use some form of alternative therapy. Most of them combine it with conventional oncological treatments which begs the important question whether the two can interact.
The aim of this new investigation was firstly to assess prevalence of interactions between alternative medicines (AMs) and drugs for comorbidities from a large survey on melanoma patients and secondly to classify herb-drug interactions with regard to their potential to harm. Consecutive melanoma outpatients of seven skin cancer centers in Germany were asked to complete a standardized questionnaire including questions about their AM-use and their taken medication for comorbidities and cancer. Each combination of conventional drugs and AMs was evaluated for their potential of interaction.
1089 questionnaires were eligible for evaluation. From these, 61.6 % of patients reported taking drugs regularly from which 34.4 % used biological-based AMs. Risk evaluation for interaction was possible for 180 AM users who listed the names or substances they took for comorbidities. From those patients, we found 37.2 % at risk of interaction of their co-consumption of conventional drugs and AMs. Almost all patients using Chinese herbs were at risk (88.6 %).
The authors concluded that with a high rate of AM usage at risk of interactions between AMs and drugs taken for comorbidities, implementation of a regular assessment of AM usage and drugs for comorbidities is mandatory in cancer care.
On this blog, I have mentioned this problem repeatedly. For instance, I reported about a survey of 1,500 members of the German non-medically trained practitioner (NMP) associations. Its results showed that the treatments employed by NMPs were heterogeneous. Homeopathy was used by 45% of the NMPs, and 10% believed it to be a treatment directly against cancer. Herbal therapy, vitamins, orthomolecular medicine, ordinal therapy, mistletoe preparations, acupuncture, and cancer diets were used by more than 10% of the NMPs. None of the treatments were discussed with the respective physician on a regular basis. The authors concluded from these findings that many therapies provided by NMPs are biologically based and therefore may interfere with conventional cancer therapy. Thus, patients are at risk of interactions, especially as most NMPs do not adjust their therapies to those of the oncologist. Moreover, risks may arise from these CAM methods as NMPs partly believe them to be useful anticancer treatments. This may lead to the delay or even omission of effective therapies.
One problem regarding herb-drug interactions is that we currently have to rely more on speculations than on facts. The only exception is the issue of interactions with St John’s Wort (SJW). Some time ago, I reported on this blog about a study assessing how often SJW is prescribed with medications that interact dangerously with it. The researchers conducted a retrospective analysis of nationally representative data from the National Ambulatory Medical Care Survey. Twenty-eight percent of SJW visits involved a drug that has a potentially dangerous interaction with SJW. These included selective serotonin reuptake inhibitors, benzodiazepines, warfarin, statins, verapamil, digoxin, and oral contraceptives. The authors concluded that SJW is frequently used in potentially dangerous combinations. Physicians should be aware of these common interactions and warn patients appropriately.
My conclusion at the time is as true and important today: physicians ought to know about the potential of herbal remedies to interact with drugs but, considering the frequency of self-prescription of such treatments, raising consumers’ awareness of the risks associated with herbal medicines is at least as important.
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?
I get comments of this nature all the time, sometimes by the dozen per day. As the argument is so very common, let me ONCE AGAIN explain what is wrong with it. Here are 10 very simple points for those who find it hard to understand the issue.
- My expertise is in alternative medicine and not in pharmacology. I know many pharmacologists who are competent to criticise aspects of pharmacotherapy and do so regularly. I do NOT consider myself competent to comment on pharmacotherapy.
- The fact that some things are not perfect in one area of health care (e. g. pharmacotherapy) does certainly not mean that one is not allowed to criticise shortcomings in other areas (e. g. homeopathy).
- As far as I can tell, it is not pharmaceuticals that ‘kill 100k a year’, but the issue is more complex: a sizable proportion of this tragic total is due to medical errors, for instance.
- The 100k figure seems to refer to the US where the vast majority of the population take pharmaceuticals but only about 2% of the population ever try homeopathy.
- Nobody seems to dispute that pharmaceuticals have beneficial effects beyond placebo; the general consensus regarding highly diluted homeopathics is that they have no effects beyond placebo.
- To judge the value of a therapy, it is naïve and dangerously misleading to consider just its risks. If we did that, aromatherapy would be preferable to surgery, reflexology would be better than chemotherapy and OF COURSE homeopathy would be better than pharmacotherapy. And if we then implemented this ‘wisdom’ into routine practice, we would hasten the deaths of millions.
- Any reasonable judgement of the value of any therapy must account for its documented risks in relation to its documented benefits. In other words, we must always try to weigh the two against each other and do a risk/benefit analysis.
- If a therapy is associated with finite risks and no benefits, its risk/benefit balance cannot possibly be positive. Where the benefit is non-existent or doubtful, even relatively small risks will inevitably tilt this balance in to the negative.
- This is precisely the situation that applies to homeopathy: its benefits beyond placebo are doubtful and its risks are fairly well documented.
- This means that homeopathy cannot be considered to be a therapy that is fit for purpose.
Cervical spine manipulation (CSM) is a popular manipulative therapy employed by chiropractors, osteopaths, physiotherapists and other healthcare professionals. It remains controversial because its benefits are in doubt and its safety is questionable. CSM carries the risk of serious neurovascular complications, primarily due to vertebral artery dissection (VAD) and subsequent vertebrobasilar stroke.
Chinese physicians recently reported a rare case of a ‘locked-in syndrome’ (LIS) due to bi-lateral VAD after CSM treated by arterial embolectomy. A 36-year-old right-handed man was admitted to our hospital with numbness and weakness of limbs after receiving treatment with CSM. Although the patient remained conscious, he could not speak but could communicate with the surrounding by blinking or moving his eyes, and turned to complete quadriplegia, complete facial and bulbar palsy, dyspnoea at 4 hours after admission. He was diagnosed with LIS. Cervical and brain computed tomography angiography revealed bi-lateral VADs. Aorto-cranial digital subtraction angiography showed a vertebro-basilar thrombosis which was blocking the left vertebral artery, and a stenosis of right vertebral artery. The patient underwent emergency arterial embolectomy; subsequently he was treated with antiplatelet therapy and supportive therapy in an intensive care unit and later in a general ward. After 27 days, the patient’s physical function gradually improved. At discharge, he still had a neurological deficit with muscle strength grade 3/5 and hyperreflexia of the limbs.
The authors concluded that CSM might have potential severe side-effect like LIS due to bilaterial VAD, and arterial embolectomy is an important treatment choice. The practitioner must be aware of this complication and should give the patients informed consent to CSM, although not all stroke cases temporally related to CSM have pre-existing craniocervical artery dissection.
Informed consent is an ethical imperative with any treatment. There is good evidence to suggest that few clinicians using CSM obtain informed consent from their patients before starting their treatment. This is undoubtedly a serious violation of medical ethics.
So, why do they not obtain informed consent?
To answer this question, we need to consider what informed consent would mean. It would mean, I think, conveying the following points to the patient in a way that he or she can understand them:
- the treatment I am suggesting can, in rare cases, cause very serious problems,
- there is little good evidence to suggest that it will ease your condition,
- there are other therapies that might be more effective.
Who would give his or her consent after receiving such information?
I suspect it would be very few patients indeed!
AND THAT’S THE REASON, I FEAR, WHY MANY CLINICIANS USING CSM PREFER TO BEHAVE UNETHICALLY AND FORGET ABOUT INFORMED CONSENT.
Non-validated diagnostic methods, like those in abundant use in alternative medicine, run an unacceptably high risk of producing false positive or false negative diagnoses. The former would be a diagnosis that the patient is, in fact, not suffering from; this enables the charlatan to get rich on treating something that is not even there. The latter would be missing an illness that might even kill the patient. Thus both scenarios are unquestionably harmful.
It is now 21 years ago that I published a review of alternative diagnostic techniques entitled ‘WHICH CRAFT IS WITCHCRAFT?’. Here is the abstract:
The prevalence of complementary medicine in most industrialised countries is impressive and increasing. Discussions of the topic often focus on therapeutic approaches and neglect diagnostic methods specific for complementary medicine. The paper summarises the data available on such “alternative” diagnostics. Scientific evaluations of these are scant, and most techniques have never been properly validated. The ones that have can be demonstrated to be not reproducible, sensitive, or specific. The ones that have not should be regarded as such until shown otherwise by rigorous testing. Therefore it seems that “alternative” diagnostic methods may seriously threaten the safety and health of patients submitted to them. Orthodox doctors should be aware of the problem and inform their patients accordingly.
Exactly 15 years after the publication of this paper, PRINCE CHARLES published his book ‘HARMONY‘ where is covers amongst many other topic also the subject of alternative diagnostics. This is what he tells us about them:
I have also learn from leading experts how we can understand a great deal about the causes of ill health through more traditional methods of diagnosis – for example, through examination of the iris, ears, tongue, feet and pulse, very much the basis of the Indian Ayurvedic system. This is not to say that modern diagnostic techniques do not have a role, but let us not forget what we can gain by using the knowledge and wisdom accumulated over thousands of years by pioneers who did not have access to today’s technology. In fact, an over-reliance can often mean that the subtle signs of imbalance revealed by the examination of the eyes, pulse and tongue are totally missed. Including the fruits of such knowledge, gleaned over 8 000 years of studying the relationship of the human body to the rest of Nature and to the Universe, can but only provide an extra, valuable resource to doctors as they seek to make a full diagnosis. Why persist in denying the immense value of such accumulated wisdom when it can tell us so much about the whole person – mind, body and spirit? Employing the best of the ancient and modern in a truly integrated way is another example of harmony and balance at work.
Charles is talking here about iridology, amongst other methods. Iridologists try to diagnose disease or susceptibility to disease by analysing the colour pattern of a patient’s iris. It happens to be a technique that has repeatedly been put to the test. In 1999, I published a systematic review of the evidence and concluded that the validity of iridology as a diagnostic tool is not supported by scientific evaluations. Patients and therapists should be discouraged from using this method.
Given that the evidence for alternative diagnostic techniques is either negative or absent, why does the heir to the throne advocate using them? Does he not know that he has considerable influence and endangers the health of those who believe him? Why does he call this nonsense valuable? The answer probably is that he does not know better.
There is nothing wrong with Charles’ ignorance, of course. He is not a medic (if he were, his quackery might get him struck off the register!) and does not need to know such things! But, if he is ignorant about certain technicalities, should he write about them? At the very least, when giving such concrete medical advice about diagnostic methods, should he not recruit the expertise of people who do know about such matters?
In Charles’ defence, I should mention that apparently he did ask several physicians for help with his book. Two of those who he acknowledged in HARMONY have been mentioned on this blog before: Mosaraf Ali and Michael Dixon.
I MIGHT BE MISTAKEN, BUT IT SEEMS TO ME THAT CHARLES IS NOT JUST IGNORANT ABOUT MEDICINE BUT ALSO ABOUT THE ART OF CHOOSING EXPERTS.
Case reports of adverse effects after chiropractic spinal manipulation usually come as publications in peer-reviewed medical journals. As such they tend to documents that are factual, detached and clinical. This is an intended effect and is meant to increase objectivity; at the same time it omits all of the directness and emotions that are associated with such incidences which can, of course, be important. Here is a case report that is dramatically different. It is a story told by a sibling of the victim (both had been having manipulations for migraines regularly) on this website. As I think it is poignant, I have not changed anything except for shortening it slightly.
My youngest brother has been receiving chiro for… long, however last week he received very, very aggressive neck adjustments 3 times in a row. The last one left him feeling off and he felt like it worsened his migraine. He called me asking if I had ever had an adjustment worsen a headache and I said yes, once or twice. He then told me it was creating a different vision issue than his regular migraine aura. I told him get to emergency ASAP. He had a full stroke 15 minutes later. At the age of 29 years. Thank God he went to ER, he told me he almost went to try to sleep it off after he hung up the phone.
An MRI and CT scan showed that the stroke was NOT a clot that was already formed and agitated/released by the neck adjustment. But that the adjustment had actually caused a large tear in his vertebral artery and that it had in turn caused bleeding into his brain and consequently the stroke.
The doctor told him that had he not come in right when he did, he would most certainly have died or in the best case scenario, been a vegetable.
I realize that perhaps the chiropractor did not realize how aggressive he was being or even consider the trauma he could cause. Or maybe, he made a poor judgement call, he is only human. I have since consulted my own chiropractor, who sadly, is of the opinion that it’s just not possible for a chiropractor to cause such trauma and that it simply was an issue waiting to happen and that the adjustment just ‘helped’ it along. He stated over and over that chiro CANNOT cause a stroke. I am scared enough to not go back. I find physio to help my neck more anyway.
The other part is, the ER doctor told my brother that he has seen what he considers to be an alarming increase in chiropractic related strokes and vertebral artery tears. I realize that nowhere NEAR even 90% of all patients adjusted have this issue, but it definetely exists and it IS scary.
I expect that several apologists will now accuse me again of being alarmist, but I do wonder how often such cases happen and remain unreported. I am certainly not aware that this case has been published in a peer-reviewed journal.
We all hope that serious complications after chiropractic care are rare. However, this does not mean they are unimportant. Multi-vessel cervical dissection with cortical sparing is an exceptional event in clinical practice. Such a case has just been described as a result of chiropractic upper spinal manipulation.
Neurologists from Qatar published a case report of a 55-year-old man who presented with acute-onset neck pain associated with sudden onset right-sided hemiparesis and dysphasia after chiropractic manipulation for chronic neck pain.
Magnetic resonance imaging revealed bilateral internal carotid artery dissection and left extracranial vertebral artery dissection with bilateral anterior cerebral artery territory infarctions and large cortical-sparing left middle cerebral artery infarction. This suggests the presence of functionally patent and interconnecting leptomeningeal anastomoses between cerebral arteries, which may provide sufficient blood flow to salvage penumbral regions when a supplying artery is occluded.
The authors concluded that chiropractic cervical manipulation can result in catastrophic vascular lesions preventable if these practices are limited to highly specialized personnel under very specific situations.
Chiropractors will claim that they are highly specialised and that such events must be true rarities. Others might even deny a causal relationship altogether. Others again would claim that, relative to conventional treatments, chiropractic manipulations are extremely safe. You only need to search my blog using the search-term ‘chiropractic’ to find that there are considerable doubts about these assumptions:
- Many chiropractors are not well trained and seem mostly in the business of making a tidy profit.
- Some seem to have forgotten most of the factual knowledge they may have learnt at chiro-college.
- There is no effective monitoring scheme to adequately record serious side-effects of chiropractic care.
- Therefore the incidence figures of such catastrophic events are currently still anyone’s guess.
- Publications by chiropractic interest groups seemingly denying this point are all fatally flawed.
- It is not far-fetched to fear that under-reporting of serious complications is huge.
- The reliable evidence fails to demonstrate that neck manipulations generate more good than harm.
- Until sound evidence is available, the precautionary principle leads most critical thinkers to conclude that neck manipulations have no place in routine health care.
On this blog, I have repeatedly tried to alert consumers and patients to the risks of herbal medicine. The risks include:
- toxicity of one or more ingredients of the plant,
- interactions with other medicines,
- contamination with toxic non-herbal substances such as heavy metals,
- adulteration with synthetic drugs such as steroids,
- ineffectiveness in treating the target disease
- reduction of adherence to prescribed medicines.
A new paper throws more light on the latter issue which has been not well-studies so far.
The objective of this study was to investigate the relationship between the use of medicinal plants and medication adherence in elderly people. The authors conducted an observational, cross-sectional study of elderly residents in Cuité-PB, Northeastern Brazil, through a household survey. A stratified proportional and systematic random sample of 240 elders was interviewed in their homes and the use of pharmaceutical medicines and of medicinal plants was assessed by direct examination. The association of medication adherence with socio-demographic, clinical, medication and use of medicinal plants was analysed with multiple logistic regression.
The results showed that medication non-adherence increases with use of herbal medicines (adjusted odds ratio 2.022, 95% CI 1.059–3.862, p = 0.03), as well as with the number of different medicinal plants used (adjusted odds ratio 1.937, 95% CI 1.265–2.965, p = 0.002).
The authors concluded that this study provides first-hand evidence that the use of herbal medicines is associated with poor medication adherence. Given the high frequency of the use of herbal medicines, further research into the mechanisms of this association is justified.
This conclusion is well-put, I think. If these findings are confirmed in other populations, we are confronted with a somewhat paradoxical situation: combining herbal and synthetic medicines can reduce adherence to the synthetic drugs and, in cases where adherence is not affected, it could increase the risk of herb/drug interactions.
While some chiropractors now do admit that upper neck manipulations can cause severe problems, many of them simply continue to ignore this fact. It is therefore important, I think, to keep alerting both consumers and chiropractors to the risks of spinal manipulations. In this context, a new article seems relevant.
Danish doctors reported a critical case of bilateral vertebral artery dissection (VAD) causing embolic occlusion of the basilar artery (BA) in a patient whose symptoms started after chiropractic Spinal manipulative therapy (cSMT). The patient, a 37-year-old woman, presented with acute onset of neurological symptoms immediately following cSMT in a chiropractic facility. Acute magnetic resonance imaging (MRI) showed ischemic lesions in the right cerebellar hemisphere and occlusion of the cranial part of the BA. Angiography demonstrated bilateral VADs. Symptoms remitted after endovascular therapy, which included dilatation of the left vertebral artery (VA) and extraction of thrombus from the BA. After 6 months, the patient still had minor sensory and cognitive deficits.
The authors concluded that, in severe cases, VAD may be complicated by BA thrombosis, and this case highlights the importance of a fast diagnostic approach and advanced intravascular procedure to obtain good long-term neurological outcome. Furthermore, this case underlines the need to suspect VAD in patients presenting with neurological symptoms following cSMT.
I can already hear the excuses of the chiropractic fraternity:
- this is just a case report,
- the risk is very rare,
- some investigations even deny any risk at all,
- the risk of many conventional treatments is far greater.
- as there are no functioning monitoring systems, nobody can tell with certainty how big the risk truly is,
- the precautionary principle in health care compels us to take even the slightest of suspicions of harm seriously,
- the risk/benefit principle compels us to ask whether the demonstrable benefits of neck manipulations outweigh its suspected risks.
The last point is perhaps the most important: AS FAR AS I CAN SEE, THERE IS NO INDICATION FOR NECK MANIPULATIONS FOR WHICH THE BENEFIT IS SUFFICIENTLY CERTAIN TO JUSTIFY ANY SUCH RISKS.