risk
Hurray, I can hear the Champagne corks popping: this month is ‘National Chiropractic Months’ in the USA – a whole month! This has depleted my stock of the delicious fizz already in the first three days.
Now that my bottles are empty (is there a chiropractic cure for a hang-over?), I must find other ways to celebrate. How about a more sober look at what has been published in the medical literature on chiropractic during the last few days?
A quick look into Medline identifies several articles of interest. The very first one is a case-report:
Spinal epidural hematoma (SEH) occurring after chiropractic spinal manipulation therapy (CSMT) is a rare clinical phenomenon. Our case is unique because the patient had an undiagnosed cervical spinal arteriovenous malformation (AVM) discovered on pathological analysis of the evacuated hematoma. Although the spinal manipulation likely contributed to the rupture of the AVM, there was no radiographic evidence of the use of excessive force, which was seen in another reported case. As such, patients with a known AVM who have not undergone surgical intervention should be cautioned against symptomatic treatment with CSMT, even if performed properly. Regardless of etiology, SEH is a surgical emergency and its favorable neurological recovery correlates inversely with time to surgical evacuation.
This is important, I think, in more than one way. Many chiropractors simply deny that their manipulations cause serious complications of this nature. Yet such cases are being reported with depressing regularity. Other chiropractors claim that excessive force is necessary to cause the damage. This paper seems to refute this notion quite well, I think.
But let’s not be inelegant and dwell on this unpleasant subject; it might upset chiros during their month of celebration.
The next article fresh from the press is a survey – chiropractors are very fond of this research tool, it seems. It produced a lot of intensely boring data – except for one item that caught my eye: the authors found that ‘virtually all Danish chiropractors working in the primary sector made use of manipulation as one of their treatment modalities.’
Why is that interesting? Whenever I point out that there is no good evidence that chiropractic manipulations generate more good than harm, chiropractors tend to point out that they do so much more than that. Manipulations are not administered to all their patients, they say. This survey is a reminder (there is plenty more evidence on this issue) of the fact that the argument is not very convincing.
Another survey which has just been published in time for the ‘celebratory month’ is worth mentioning. It reports the responses of patients to questions about chiropractic by providing the ‘positive angle’, e.g.: ‘Most (61.4%) respondents believed that chiropractic care was effective at treating neck and back pain…’ Just for the fun of it, I thought it might be worth doing the opposite: 39% did not believe that chiropractic care was effective at treating neck and back pain… If we use this approach, the new survey also indicates that about half of the respondents did not think chiropractors were trustworthy, and 86% have not consulted a chiropractor within the last year.
Oh, so sorry – I did not mean to spoil the celebrations! Better move on then!
A third survey assessed the attitudes of Canadian obstetricians towards chiropractic. Overall, 70% of respondents did not hold a positive views toward chiropractic, 74% did not agree that chiropractic had a role in treatment of non-musculoskeletal conditions, 60% did not refer at least some patients for chiropractic care each year, and comments of the obstetricians revealed concerns regarding safety of spinal manipulation and variability among chiropractors.
And now I better let you get on with your well-deserved celebrations and look for another bottle!
Proponents of alternative medicine regularly stress the notion that their treatments are either risk-free or much safer than conventional medicine. This assumption may be excellent for marketing bogus treatments, however, it neglects that even a relatively harmless therapy can become dangerous, if it is ineffective. Here is yet again a tragic reminder of this undeniable fact.
Japanese doctors reported the case of 2-year-old girl who died of precursor B-cell acute lymphoblastic leukaemia (ALL), the most common cancer in children.
She had no remarkable medical history. She was transferred to a hospital because of respiratory distress and died 4 hours after arrival. Two weeks before her death, she had developed a fever of 39 degrees C, which subsided after the administration of a naturopathic herbal remedy. One week before death, she developed jaundice, and her condition worsened on the day of death.
Laboratory test results on admission to hospital showed a markedly elevated white blood cell count. Accordingly, the cause of death was suspected to be acute leukaemia. Forensic autopsy revealed the cause of death to be precursor B-cell ALL.
With the current advancements in medical technology, the 5-year survival rate of children with ALL is nearly 90%. However, in this case, the child’s parents had opted for naturopathy instead of evidence-based medicine. They had not taken her to a hospital for a medical check-up or immunisation since she was an infant. If the child had received routine medical care, she would have a more than 60% chance of being alive 5 years after diagnosis of ALL.
The authors of this case-report concluded that the parents should be accused of medical neglect regardless of their motives.
Such cases are tragic and infuriating in equal measure. There is no way of knowing how often this sort of thing happens; we rely entirely on anecdotes because systematic research is hardly feasible.
While anecdotes of this nature have their obvious limitations, they are nevertheless important. They can serve as poignant reminders that alternative remedies might be relatively harmless, but this does not necessarily apply to all alternative practitioners. Moreover, they should make us redouble our efforts to inform the public responsibly about the all too often trivialized risks of alternative medicine.
‘Doctor’ Don Harte is former medical student who prematurely left medical school and currently works as a chiropractor in California. He, has served on the Boards of the World Chiropractic Association and the Council on Chiropractic Practice. He has published extensively; on his website, he offers a list of his articles:
- July 16, 2015: “CA SB277: Marin Chiropractor Says Power Structure Bigoted Against Boy in Wheelchair, vs. Leukemia Boy”
- July 1, 2015: “SB277: Marin Chiropractor Charges California with Chemical Child Molestation”
- June 15, 2015: Press release: “Dr. Don Harte warns about the Failure of Big Pharma and Growing Opioid Addiction Crises”
- May, 2015: “The Biological, Economic and Political Case Against Vaccination” in North Bay Biz magazine
- May 15, 2015: “Dr. Don Harte Calls Draconian SB277 Vaccination Initiative Sacramento’s Syringe of Shame”
- April 21, 2015: “End of a Made-up Measles Crisis”
- February 12, 2015: “It’s a childhood disease, not a tragedy” Letter to the Editor in the Pacific Sun, about the measles hysteria.
- January 27, 2015: “California Straight Chiropractor Fights Disney Measles Mania”
- March 5, 2015: “You cannot have vaccination that works, yet doesn’t work” Letter to the Editor in the Pacific Sun. “The grotesque level of bigotry, backed up by the lack of any comprehension of immunology, toxicology and the vitalistic paradigm of Chiropractic, is astounding.”
- April, 2009: “Seize the Time” in The Chiropractic Journal. The future of Chiropractic, as Medicine is breaking down, and bankrupting the country.
- April, 2009: “Refusal to Vaccinate Puts Kids At Risk”Dr. Harte quoted, “Vaccination is based on the medical fallacy that our bodies are stupid.”
- Spring, 2008: “The Future of Chiropractic” Journal of the California Chiropractic Association. For chiropractors, my view on the future of Chiropractic.
- November, 2007: “Is There a Vaccine That Protects Against ‘Non-Science?’”Marin Independent Journal. Discussion of Guardisil, the HPV vaccine, the flu vaccine, and the general foolishness of vaccination, the lack of science and efficacy, etc.
- May, 2005: ”Generations of Unbridled Power” The Chiropractic Journal. In a publication for chiropractors, I am standing up against the harassment and debasement of the chiropractic profession, specifically by the California Board of Chiropractic Examiners.
- October, 2004: “Time for regime Change in Attitude about Medicine” San Francisco Chronicle. The very popular anti-inflammatory medication, Vioxx, was just pulled off the market, at the same time as a massive contamination of flu vaccine.
- January, 2004: “Alternative to the Sting of a Failed Flu Vaccine” San Francisco Chronicle. Discusses the absurdity and the dangers of the annual flu vaccine ritual. The heroic role of Chiropractic in the Great Flu Pandemic of 1918.
- May, 2003: “Where is the Danger in Chiropractic?” San Francisco Chronicle. Responding to another baseless attack upon Chiropractic by medical bigots, noting the extreme risks of Medicine, and the extreme safety of Chiropractic.
- January, 2002: “To X-Ray or Not to X-Ray” The Chiropractic Journal. An article to chiropractors about how essential X-ray is to the practice of Chiropractic. Sadly, very few chiropractors X-ray these days.
- May, 2000: “By Giving Our Kids Certain Drugs, We’re Playing Russian Roulette With Their Lives” Marin Independent Journal. Ritalin and anti-depressants for children, the Columbine massacre, the role of Chiropractic in children’s health.
- December, 1999: “It’s a Myth that Children Need Vaccines” Marin Independent Journal.
- July, 1999: “Too Little Drugs, Too Many Organs” Marin Independent Journal. Does the medical paradigm really make sense? Is it logical?.
- November, 1979: “Interferon and Beyond” OMNI Magazine “Forum,” (Response to a cover story, “Cancer Cure at a Billion Dollars a Pound.”
His website also reveals that Harte views chiropractic as a ‘cure all’ and believes that the “Vertebral Subluxation Complex (VSC) is THE most serious threat to your health and well-being.”
Harte is not impressed with conventional medicine: “Virtually everyone has lost loved ones to medical mistakes and indifference. I, myself, count my father, my favorite uncle and two cousins amongst this unnecessary medical death toll. Though people concoct all kinds of charges against Chiropractic, nobody knows of any deaths from Chiropractic, because there just aren’t any. You might want to read the article that I wrote on this subject in the San Francisco Chronicle, “Where is the Danger in Chiropractic.”
In particular, Harte is no friend of immunisation. Here are some of the things he has been quoted as saying recently about the subject:
- He charged the media with “an evil bigotry” in relation to vaccination.
- He said that “The mass media refuses to acknowledge the existence of vaccine-injured children. This is quite a trick, since we are talking millions of children.”
- He explained that “their whole con game relies on fear, trying to convince you that you and your children have nothing inside to protect them from all those evil germs. That you need their HOLY WATER, the vaccines, or you will die.” Once again, Harte charged the California Governor and the legislature “as Destroyers of the family, as Enemies of liberty, as CHEMICAL CHILD MOLESTERS.”
- He claimed that “His (Mr J Coleman’s) son, Otto, who was paralyzed by a vaccine reaction, was there, in his wheelchair; as were other vaccine-damaged children. Some participants held up photos of their children who had died from vaccines.” And he said, “There were no photos of these children, nor any mention of them in news accounts. Establishment media refuses to put a human face on the suffering caused by vaccinations. I don’t know whether to call them ‘chicken’ or ‘evil.’”
- Harte also stated that “The claim that non-vaccinated children are a threat to Rhett has ZERO scientific basis. First of all, less-vaccinated and non-vaccinated kids tend to be healthier. And more specifically, children recently vaccinated with live virus vaccines will shed viruses, and thus, be contagious, for up to 28 days.”
- “Here we have a case,” explained Harte, “of one boy held up as a potential victim of unvaccinated or less-vaccinated children, who has had, in reality, no harm done by those children. The millions of children who have endured great harm, up to and including paralysis and death, are ignored. This is not science, nor is it reputable news reporting nor reputable public policy. It is naked propaganda, paid for by Big Pharma.”
It seems that Harte is an altogether dangerous person.
Of course, chiropractors will (yet again) claim that Harte does in no way stand for chiropractic as a whole and that chiropractors are just as appalled by such dangerous anti-vaccination propaganda as we are. They will say he is just ‘a rotten apple’ within a mostly laudable profession.
But is that true? What have the professional bodies of chiropractic done against him and his hazardous views? Have they excluded or reprimanded him, or requested that he seeks treatment for what seems to be rampant paranoia?
The answer, I am afraid, is NO! What they did do instead was to name him, in 2006, as “Chiropractor of the Year” – an honour bestowed on him by the World Chiropractic Alliance.
I will state my position up front: THERE IS NO CHILDHOOD CONDITION FOR WHICH CHIROPRACTIC SPINAL MANIPULATION GENERATES MORE GOOD THAN HARM. What is more, I have published evidence (published here, here, here, and here, for instance) to support this statement. If you disagree with it, this is the place and time to do so – and please don’t forget to cite the evidence that supports your statements.
Given that there is very little reliable evidence in this area, I find it surprising that so many chiropractors continue to treat kids. Not true! I hear some chiropractors shout, we do not often treat children. Who is correct? Clearly, we need data to answer this question.
The objective of a new paper was to investigate characteristics of clinical chiropractic practice, including the age of pediatric patients, the number of reports of negative side effects (NSEs), the opinions of doctors of chiropractic on treatment options by patient age groups, the conditions seen and the number of treatment sessions delivered by conditions and by patient age.
An Internet cross-sectional survey was conducted in 20 European countries with 4109 chiropractors invited to reply. The 19 national associations belonging to the European Chiropractic Union and the Danish Chiropractic Association were asked to participate. Respondents were asked to self-report characteristics of their practices.
Of the 956 (23.3%) participating chiropractors, 921 reported 19821 pediatric patients per month. Children represented 8.1% of chiropractors’ total patient load over the last year. A total of 557 (534 mild, 23 moderate, and 0 severe) negative (adverse) side effects were reported for an estimated incidence of 0.23%. On the given treatment statements, chiropractors reported varying agreement and disagreement rates based on patient age. The 8309 answers on conditions were grouped into skeletal (57.0%), neurologic (23.7%), gastrointestinal (12.4%), infection (3.5%), genitourinary (1.5%), immune (1.4%), and miscellaneous conditions (0.5%). The number of treatment sessions delivered varied according to the condition and the patient age.
The authors of this survey concluded that this study showed that European chiropractors are active in the care of pediatric patients. Reported conditions were mainly skeletal and neurologic complaints. In this survey, no severe NSEs were reported, and mild NSEs were infrequent.
In my view, a more appropriate conclusion might be that MANY EUROPEAN CHIROPRACTORS ARE ACTIVE IN QUACKERY.
I thought I had seen everything that is lamentable about homeopathy. When I came across this article, I had to change my opinion. It is a more despicable, unethical and dangerous promotion of falsehoods than I could have imagined.
Strong words? Read for yourself:
There are treatments that can heal vaccine damage, but few physicians in the conventional medical care system know about them, since vaccine injuries are usually denied as the cause of any illness. Some parents with autistic children report that homeopathy has completely reversed their children’s autism and healed other serious health conditions caused by vaccines. This article explains how homeopathic remedies can bring about healing for many types of vaccine injuries.
Homeopathy is not the only treatment that has helped children and adults recover from vaccine damage, but it is the one that is the focus of this article. I will describe how homeopathy can bring about a true cure for the harm that vaccines have caused to children and adults…
It is a tragedy when a normal young child suddenly starts losing the ability to speak sentences or even to speak words after receiving vaccines. The ability to have positive social interactions with other children or adults can disappear in a matter of days after vaccines have been given to children. Intellectual development can be lost and even successful potty training skills can disappear. The ability to sit quietly, listen to a story being read, and the ability to learn can suddenly be replaced with hand flapping, body spinning, head banging, food allergies, asthma, agitation, hyperactivity, learning disabilities, chronic colds and fevers, constant stomach pain, constipation, and a general failure to grow and thrive. There are also serious consequences for adults who use vaccines. Formerly productive adults can lose their independence and become paralyzed, infertile, chronically ill, and even die, because of vaccine damage. It happens every day, yet few people make the connection between their illnesses and vaccine use…
By the time parents fully awaken to the harm that has occurred to their children, many have already resigned themselves to a lifetime of caretaking their disabled children. Some parents will even receive counsel from their physicians to give up their children to the care of the state, because they have no treatments to offer and can offer no hope of recovery. Some physicians will try to convince parents that this is a genetic problem that might be cured someday, but not in the near future. The conventional medical care system leaves parents feeling like helpless victims without any good options. The truth is there are good options for restoring health after vaccine damage, and homeopathy is one of them!…
Homeopathy does not wage war on disease and seek to destroy the symptoms of disease through brute force. It does not bring substances into the body as is done with allopathic drugs, for the purpose of doing hand to hand combat against disease. Instead, homeopathy and its remedies are intended to gently stimulate and strengthen the body so that it can overcome illness through its own vital force and strength. Homeopathic remedies restore the natural ability of the body to defend itself against illness and to heal itself. When this happens, a person is truly cured of what ails him…
Allopathic drugs and treatments do not have a positive effect upon the vital force in the body. They do not improve the strength of a person, and they do not provide for physical, emotional, or mental renewal. Rather, they just suppress symptoms, and add side effects…
You may also wish to ask for a referral from your chiropractor, osteopath, or acupuncturist. Such practitioners are often aware of good homeopaths in the area. Sometimes the person who is responsible for managing supplements and remedies sold at health food stores will be aware of experienced homeopaths as well…
I know, apologists will claim that such extreme idiocy is always the work of a few ‘rotten apples’, even most homeopaths would object to such dangerous and amoral lunacy. But the fact is, they don’t! If you disagree, please show me the protests from homeopaths or other alternative practitioners.
When Wakefield was shown to be a fraud endangering public health with his bogus claims about vaccine damage, there were protests in abundance, and he was ousted by the medical and scientific communities. Where are the protests by the alternative medicine fraternity against this article and the many, many others like it?
NOBODY SHOULD BE ALLOWED TO ENDANGER PUBLIC HEALTH IN THIS WAY.
PS
In case you wonder who wrote the above article, it is John P. Thomas. He is a health writer for Health Impact News. He holds a B.A. in Psychology from the University of Michigan, and a Master of Science in Public Health (M.S.P.H.) from the School of Public Health, Department of Health Administration, at the University of North Carolina at Chapel Hill. John specializes in environmental health, but writes on a variety of issues.
If you ask a chiropractor, you will probably be told that chiropractic spinal manipulation is a safe treatment. Unfortunately this is not quite true, as regular readers of this blog will appreciate. About half of all patients suffer mild to moderate adverse effects after chiropractic treatments and, in addition, many instances of much more serious complications have been documented, including rare cases of Horner syndrome. It results from an interruption of the sympathetic nerve supply to the eye and is characterized by the classic triad of miosis (ie, constricted pupil), partial ptosis, and loss of hemifacial sweating (ie, anhidrosis).
Danish neurologists recently reported the case of a 60-year-old man with no relevant medical history who was admitted to the Department of Neurology with drooping of his right upper eyelid and an ipsilateral contracted pupil, combined with pain, weakness, and numbness in his upper right limb.
The patient had experienced thoracic back pain of moderate intensity with radiating right-sided belt-like chest pain for 7 days. When the discomfort suddenly intensified, he sought chiropractic treatment. Following manipulations of the thoracic and cervical spine, the pain intensity initially lessened. Approximately one hour after chiropractic treatment, the patient experienced the eye and upper limb symptoms described above, for which he sought medical assistance three days later.
A detailed neurologic examination revealed moderate right-sided ptosis and miosis, no facial anhidrosis, decreased strength of the intrinsic and opponens muscles of the right hand, and reduced cutaneous sensation corresponding to the T1 dermatome, with inability to discriminate pain and light touch. The remaining clinical examination, routine blood tests, and vital parameters were unremarkable.
Brain CT scan and CT angiography including the aortic arch and neck vessels were performed and ruled out cerebral stroke and carotid artery dissection, respectively. As clinical signs of Horner syndrome and a concomitant radiating pain to the medial arm were considered suggestive of either a lower brachial plexopathy, i.e., due to a Pancoast tumor, or a radiculopathy, chest X-ray and electroneurography (ENG) were performed. No apical pulmonary pathology was detected. ENG of the right medial cutaneous antebrachial nerve demonstrated a normal sensory action potential (SAP), consistent with the lesion being located proximally to the dorsal spinal root ganglion, thus suggestive of a spinal nerve root lesion. A subsequent MRI of the thoracic spine showed a para-median herniation of the T1-T2 intervertebral disc compressing the right T1 spinal nerve root.
The patient received no surgery, and follow-up examination 6 months later revealed near-complete recovery, with only mild paraesthesia in the T1 segment of his right arm and a subtle ptosis remaining.
Horner syndrome due to a herniated thoracic disc has only been reported 6 times in the English language literature, though never preceded by chiropractic manipulation.
One of the most frequent causes of Horner syndrome is carotid artery dissection, which may occur spontaneously or due to local trauma to the neck region. Chiropractic manipulation as an independent risk factor for neck artery dissection and a consequent stroke is a controversial topic, though multiple cases of Horner syndrome due to ICA dissections subsequent to chiropractic manipulation have been reported. In the patient described here, an ICA dissection was considered unlikely due to the concomitant prominent radiating medial brachialgia and was furthermore ruled out by a CT angiogram of the neck vessels.
This patient experienced the onset of a Horner syndrome and ipsilateral upper limb symptoms shortly after chiropractic treatment, suggesting the cervico-thoracic manipulation as the cause of or at least worsening factor in the T1-T2 disc herniation. Several cases of disc herniations following chiropractic treatment have been reported.
While the definite pathophysiologic mechanism to explain this patient’s Horner syndrome remains unclear, it seems, according to the authors of this case-report, evident that manipulations as a minimum altered the configuration of an already existing disc protrusion.
I have repeatedly stressed that herbal remedies can cause harm in a range of ways. Indian rheumatologists recently enforced this point by publishing a case-report of adrenal suppression caused by herbal remedies.
A 49-year-old male presented with polyarthritis from which he had suffered for more than 10 years. His serum cortisol levels were extremely low, he had vitamin D deficiency, and his rheumatoid factor was negative. He revealed symptoms of adrenal suppression, mainly muscle weakness and suicidal tendency, and few other psychiatric disturbances.
The patient eventually discontinued his herbal medicine. Then, he was put on deflazacort for 12 weeks at 12 mg twice daily and later the dose was tapered to 6 mg/day. Deflazocort, an intermediate-acting corticosteroid, was prescribed to minimize the probable withdrawal symptoms due to the probable presence of dexamethasone or betamethasone (long-acting steroids) presumably from the herbal medication.
The herbal samples of used by the patient was analysed by mass spectrometry. It showed the presence of steroidal compounds by the mass 393.81, which may be dexamethasone or betamethasone.
The authors of this paper believe that the symptoms of adrenal suppression could have precipitated or exacerbated the neuropsychiatric disturbances due to Hypothalamus-Pituitary-Adrenal (HPA) suppression. In their view, adrenal suppression following ingestion of herbal remedies is of major concern. Abrupt withdrawal of such products could precipitate adrenal failure which can be fatal.
It should be added, I think, that such illegal adulterations of herbal remedies have been reported with some regularity, particularly in Indian (and Chinese) preparations. Our systematic review showed that this problem has caused serious harm. The most severe documented adverse effects include agranulocytosis, meningitis, multi-organ failure, perinatal stroke, arsenic, lead or mercury poisoning, malignancies or carcinomas, hepatic encephalopathy, hepatorenal syndrome, nephrotoxicity, rhabdomyolysis, metabolic acidosis, renal or liver failure, cerebral edema, coma, intracerebral haemorrhage, and death.
As under-reporting can be suspected to be huge, we do currently not know how frequent these events are.
In the world of homeopathy, the truth is often much weirder than fiction. Take this recent article, for instance; it was published by the famous lay homeopath Alan Schmukler in the current issue of ‘HOMEOPATHY 4 EVERYONE’.
Before you read the text in question, it might be relevant to explain who Schmukler is: he attended Temple University, where he added humanistic psychology to his passions. After graduating Summa Cum Laude, Phi Beta Kappa and President’s Scholar, he spent several years doing workshops in human relations. Alan also studied respiratory therapy and worked for three years at Einstein Hospital in Philadelphia. Those thousands of hours in the intensive care and emergency rooms taught him both the strengths and limitations of conventional medicine. Schmukler learned about homeopathy in 1991 when he felt he had been cured of an infection with Hepar sulph. He later founded the Homeopathic Study Group of Metropolitan Philadelphia, giving free lectures and hosting the areas best homeopaths to teach. He also helped found and edit Homeopathy News and Views, a popular culture newsletter on homeopathy. He taught homeopathy for Temple University’s Adult Programs, and has been either studying, writing, lecturing or consulting on homeopathy since 1991. He wrote Homeopathy An A to Z home Handbook, which is now available in five languages. Alan Schmukler has been practicing homeopathy for more than two decades and is Chief Editor of Hpathy.com and of Homeopathy4Everyone. He says that his work as Editor is one of his most rewarding experiences.
Now, brace yourself, here is the promised text/satire (in bold); I promise, I did not change a single word:
EIGHT REASONS TO VACCINATE YOUR CHILD
- Your child is deficient in Mercury, Aluminum, Formaldehyde, viruses, foreign DNA or other ingredients proven to cause neurological damage.
- Your child has an excess of healthy, functioning brain cells.
- You need more cash. The National Vaccine Injury Compensation program has paid out 2.8 billion dollars to parents of children injured or killed by vaccines.
- You and your husband are feeling alienated and you need a crisis to bring you together.
- You believe that pharmaceutical conglomerates which earn billions from vaccines are more credible than consumer groups.
- You think thousands of parents who report that their children became autistic two weeks after vaccination are lying.
- You don’t see a problem in logic when the government tells you that vaccines work, but that vaccinated children can catch diseases from unvaccinated children.
- You think the government should dictate which healing methods you and your children are allowed to use.
Funny? No!
Bad taste? Very much so!
Barmy? I think so!
Dangerous? Yes!
Irresponsible? Most certainly!
Unethical? Yes!
Characteristic for lay homeopathy? Possibly!
There are things that cannot be said too often. In medicine, these are often related to issues that can save lives. In alternative medicine, it is worth remembering that there is nothing that can save more lives than the following rule: EVEN AN APPARENTLY HARMLESS REMEDY WILL BECOME LIFE-THREATENING, IF IT IS USED AS AN ALTERNATIVE TO AN EFFECTIVE THERAPY FOR A SERIOUS CONDITION.
Here is a publication that serves as a very sad reminder of this important axiom.
Japanese physicians recently published a case-report of 2-year-old girl who died of precursor B-cell acute lymphoblastic leukaemia (ALL), the most common cancer in children. She had no remarkable medical history. She was transferred to a hospital because of respiratory distress and died 4 hours after arrival.
Two weeks before her death, she had developed a fever of 39°C, which subsided after the administration of a naturopathic herbal remedy. Subsequently, she developed jaundice one week before death, and her condition worsened on the day of death.
Laboratory test results on admission showed a markedly elevated white blood cell count. Accordingly, the cause of death was suspected to be acute leukaemia. Forensic autopsy revealed the cause of death to be precursor B-cell ALL.
With advancements in medical technology, the 5-year survival rate of children with ALL is nearly 90%. However, in this case, the deceased’s parents preferred alternative medicine to evidence-based medicine and had not taken her to a hospital for a medical check-up or immunisation since she was an infant. The authors state that, if she had received routine medical care, she would have a more than 60% chance of being alive 5 years after diagnosis. Therefore, we conclude that the parents should be accused of medical neglect regardless of their motives.
Alternative practitioners who treat their patients in this way, are in my experience often full of good intentions. They remind me of something Bert Brecht one wrote: THE OPPOSITE OF GOOD IS NOT EVIL, IT IS GOOD INTENTIONS.
Ayurvedic medicine has become highly popular in Western countries; it originates, of course, from India, and is considered to be one of the world’s oldest health care systems. Its adherents claim to create harmony between the body, mind, and spirit, maintaining that this balance prevents illness, treats acute conditions, and contributes to a long and healthy life. In India Ayurveda is mainstream and more than 90% of the population are said to use it. Outside India, Ayurveda is usually classified as an alternative therapy.
Ayurvedic treatments can consist of a range of modalities, including herbal remedies taken by mouth. These preparations have often been reported to be contaminated with toxic metals. Despite several case reports of poisoning from such contamination, the epidemiological evidence is still limited. A new paper on this important topic is therefore welcome. It reports on a cluster of lead and mercury toxicity cases which occurred 2011 among a community of users of Ayurvedic remedies in the US.
Following the identification of the index case, adherents of Ayurveda were offered heavy metals screening. The results showed that 46 of 115 participants (40%) had elevated blood lead levels (BLLs) of 10 μg/dl or above, with 9.6% of BLLs at or above 50 μg/dl.
The authors issued the following warning: this is the largest cluster of lead and mercury toxicity following use of Ayurvedic supplements described in the literature in the US. Contamination of herbal products is a public health issue of global significance. There are few regulations addressing contamination of “natural” products or supplements.
Rasa shastra, the practice of adding metals, minerals or gems to herbal preparations, is a well-documented part of Ayurveda. Adverse reactions to herbs are described in traditional Ayurvedic texts, but practitioners tend to be reluctant to admit that their remedies could be toxic and that reliable information on their risks is not readily available.
Already in 1990, a study on Ayurvedic medicines in India found that 41% of the products tested contained arsenic, and that 64% contained lead and mercury. A 2004 study found toxic levels of heavy metals in 20% of Ayurvedic preparations sold in the Boston area. A 2008 study of more than 230 products found that approximately 20% of remedies (and 40% of rasa shastra medicines) purchased over the Internet from U.S. and Indian suppliers contained lead, mercury or arsenic.
My 2002 systematic review summarised all the available evidence and concluded that heavy metals, particularly lead, have been a regular constituent of traditional Indian remedies. This has repeatedly caused serious harm to patients taking such remedies. The incidence of heavy metal contamination is not known, but one study shows that 64% of samples collected in India contained significant amounts of lead (64% mercury, 41% arsenic and 9% cadmium). These findings should alert us to the possibility of heavy metal content in traditional Indian remedies and motivate us to consider means of protecting consumers from such risks.
Despite these concerns, Ayurveda-fans continue to believe that the toxicity of these remedies is reduced through the purification processes of Ayurvedic remedy preparation. Bizarrely, they may involve prayers as well as physical pharmacy techniques.
The Indian government ruled that Ayurvedic products must be labelled with their metallic content. However, one Indian expert, has been quoted claiming that “the absence of post-market surveillance and the paucity of test laboratory facilities [in India] make the quality control of Ayurvedic medicines exceedingly difficult at this time”. In the US, most Ayurvedic products are marketed without having been approved by the FDA. Since 2007, the FDA has placed an import alert on some Ayurvedic products in order to prevent them from entering the US.
Protecting consumers from heavy metal poisoning by Ayurvedic remedies is certainly not easy – but, in the interest of public health, it is a task that we must tackle with some ungency.
