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Getting Over Cold Medications

Very young children come down with colds. Agreement with this statement is universal among parents, pediatricians, drug makers, and even the Food and Drug Administration (FDA). But there is less agreement over whether or not medicine is helpful to little ones suffering from a cold.

“It’s important to point out that these medicines are safe and effective when used as directed…” said Linda A. Suydam, president of the Consumer Healthcare Products Association, quoted in The Washington Post, October 12, 2007.

“Clearly, the products don’t work and are unsafe,” said Joshua M. Sharfstein, M.D., Baltimore Health Commissioner, also quoted in The Washington Post.

Could these two views be any further apart? Both of them can’t be right, so which one is making things up, the cold medicine industry spokesperson, or the doctor?

“Take a cold remedy and get over the cold in seven days, otherwise recovery will take a week,” according to traditional folk wisdom.

The American Academy of Pediatrics tends to agree with tradition on this particular point and recommends against medicating young children to treat cold symptoms. Drug makers, on the other hand, spent about 50 million bucks last year to convince parents to buy over-the-counter (OTC) drugs to treat cold symptoms. And the advertising must be working because sales reportedly jumped 20 percent last year and were expected to climb again this year—up until last week.

Fourteen infant cold medications were pulled from store shelves across the country, just seven days before an FDA committee was slated to begin investigating the drugs.

“An FDA review prepared for next week’s meeting describes dozens of cases of convulsions, heart problems, trouble breathing, neurological complications and other reactions, including at least 54 deaths involving decongestants and 69 deaths involving antihistamines,” reports The Washington Post.

Dr. Sharfstein long ago alerted the FDA to widespread problems with the drugs after a total of 900 Maryland children under 4 years of age suffered an overdose in a single year, 2004.

“Given that there are serious consequences, including death, associated with the use of these products without compelling reason to use them, why are they being marketed for children?” Sharfstein asked. “The contrast between the state of the evidence and the displays in drugstores could not be more stark.”

“There is no evidence that the products are effective for young children, and there is evidence they can be unsafe, even at the usual doses. This is not just about misuse,” he said, noting that the dosages typically used are untested estimates based on studies in adults. “That’s why we are asking FDA to clearly label these products against use by children under age 6,” according to The Washington Post.

It is an interesting paradox that doctors are in the position of pleading with the agency in charge of drug safety to try and halt medical treatment of non-medical symptoms. Their preferred recommendations sound familiar: bed rest, lots of fluids, and chicken soup. And let’s not forget vitamin C.

“Whatever grandma recommends that’s nutritious, get the kid to eat it…It’s better than all the over-the-counter stuff,” said Daniel Rauch, M.D., director of the pediatric program at NYU Medical Center, quoted in the New York Daily News, October 12, 2007.

“These medications were never designed to cure colds but only to treat cold symptoms,” said Katherine Tom-Revzon, pediatric pharmacist at the Children’s Hospital at Montefiore in the Bronx. “In children under 2, there was little evidence they were effective, anyway,” reports the Daily News.

A robust, innate immune response in both children and adults requires expression, not suppression. The symptoms of a cold are self-limiting and benign for the vast majority of well-fed people; they are part of a lifelong process of encountering microbes in the environment and mounting an innate, short-term inflammatory response that results in cellular memory and strengthened immunity.

“This is not a situation in which pediatric data are lacking and we are unable to say one way or the other,” wrote Jay Berkelhamer, M.D., in a letter to the FDA last month. Dr. Berkelhamer is the national president of the American Academy of Pediatrics. In multiple studies, they have “been found not to be effective in this population at all,” according to Berkelhamer in an Associated Press article October 12, 2007.

Article originally posted at ICPA.org.

Tenets of Holistic Health

by Jeanne Ohm, DC – ICPA.org:

Nourishing the Terrain

When we think of nourishment, we naturally reflect on nutrition…the food necessary to establish a healthy terrain. After decades of propaganda leading us to believe that commercially produced “foods” are OK, we are coming to a rude awakening that we have deviated far from the natural, whole foods that truly nourish our bodies. Because this critical awareness is not upheld by all supporting systems in our society (agricultural, educational, economical, political, medical), only proactive individuals are making this difficult transition. We must be vigilant in selecting the foods we eat, how they are grown, how they are prepared and their consequent ability to nourish our cells. We know the importance of organically grown vegetables and fruits. Finding the best sources and preparations for our families may not be as convenient as we would like, but is certainly worth the extra effort. Our Nutrition section in this issue offers a few important suggestions to incorporate nutrient-dense foods and eliminate those that overload us. Included are family-tested recipes that improve the terrain and enhance immune system function.

Coordinating the Function

The classic medical text Gray’s Anatomy tells us that the nervous system is the master control system of the body, determining the function of all systems, all functions and all organs. Newer to science is the profound interconnectivity between the nervous system and immune system. Once thought of as separate, these systems are now considered intertwined. It is now widely accepted that a healthy immune system supports nervous system function, and vice versa. This is very important for us to recognize if we want to create a healthy terrain.

The nervous and immune systems are interconnected in several known ways. Adrenal glands are one common link. Chemicals and hormones that are produced by cells of both systems are another connection. Additionally, research shows that the brain uses nerve cells to communicate directly with the immune system.

Chiropractic care was first linked to improved immunity during the deadly flu epidemic of 1917 and 1918, when chiropractic patients fared better than the general population. This observation spurred a study of the field. The data reported that flu victims under chiropractic care had an estimated .25 percent death rate, considerably less than the normal rate of 5 percent among flu victims who received no chiropractic care.

In 1936, pioneering endocrinologist Hans Selye began groundbreaking research on the effects of stress on our health. B.J. Palmer tells us:

Selye’s great contribution to science was this clear concept, that disease affects people according to their previously developed ability to adapt. The writer goes on to relate that the physician prefers to hear that you have had childhood diseases rather than avoided them. He knows that a bout of harmless chickenpox while you were a child, will probably immunize you for life, but that if you contract it first as an adult, it could run a very serious course. This is somewhat of a reversal to medical thinking in years past. This may seem strange, but the writer has this to say regarding antibiotics. “All too often, a patient will insist on a shot of glamorous penicillin or some newer antibiotic for a mild infection. The physician will explain that the drug is not necessary—that it is better for the body to use its own defenses—but the determined patient shops around until he finds someone who will administer it anyhow.” “The frequent result is that, although the individual’s own natural resistance would have conquered the infection, the antibiotic suddenly robs the body of the germs necessary to stimulate the antibody producing mechanism into action. And, a stubborn chronic disease takes hold, against which, antibiotics are now powerless.”

In chiropractic we understand that nerve system function can be interfered with by subluxations, which create interferences to the normal transmission of nerve impulses. When this occurs, any and all systems are affected. Certainly immune system function, dependent on proper functioning of the nervous system, can be impaired as well.

Since then, additional studies have supported chiropractic care to improve immunity. One study found that disease-fighting white blood cell counts were higher just 15 minutes after spinal adjustments. In a similar study, the immune system response in HIV-positive patients under regular care for six months showed a 48 percent increase in white blood cell counts. Conversely, the group that did not receive chiropractic adjustments experienced a 7.96 percent decrease in immunity cells. More research is certainly warranted.

Trusting the Process

You may eat a perfect diet of raw organic, biodynamically grown whole foods, drink purified water, jog five miles a day, and get adjusted weekly, but if you are overcome with negative emotions enhanced by adversarial thinking, you will not be healthy. Your immune system, via your nervous system, listens to your inner thoughts.

Holistic healing practices have always recognized the relationship between thoughts and health. In 1910, D.D. Palmer introduced the idea of the three Ts. He explained that thoughts, traumas and toxins could cause distress to the nervous system, impairing its ability to function.

The science of Psychoneuroimmunology (PNI) studies the interaction between thoughts, their effects on emotions, and the resulting immune system function via the nervous system. In 1985, research by neuropharmacologist Candace Pert showed that neuropeptide specific receptors are present on the walls of cells in both the brain and the immune system. This revealed an interdependency between emotions and immunity via the central nervous system. Her work gave scientific credence to the ancient healing practices that have accepted the mind-body relationship. In her book Molecules of Emotion, she writes, “We know that the immune system, like the central nervous system, has memory and the capacity to learn. Thus, it could be said that intelligence is located not only in the brain but in cells that are distributed throughout the body, and that the traditional separation of mental processes, including emotions, from the body is no longer valid.”

That said, being conscious of our emotions is imperative in understanding health. For example, take fear, an underlying emotion that has an immense impact on health. In previous editorials and numerous additional articles throughout Pathways, we have looked at the stifling effects of fear on our well-being and normal, natural function. Fear propels us into the fight-or-flight mode—an override of our sympathetic nervous system. In this defensive state, our bodies limit cellular reproduction and growth as the systems of protection are activated. To paraphrase Bruce Lipton, we cannot live in a state of imbalanced protection and growth at the same time. He maintains that the state of being that fosters growth is love, and that the protection mode is activated by fear. When we are in a state of unresolved fear, we cannot heal, regenerate or be well.

A wise person once said that “fear” could be an acronym for “False Evidence Appearing Real.” When we look at the germ theory and feel the underlying emotion it produces, we can clearly see it is fear-based. The terms used in the course of allopathic medicine reflect this fearful, warlike mentality. We have to kill the cancer, destroy the germ, fight the disease, be rescued in labor, struggle through breastfeeding—the list goes on, with a mental perspective whose constant is fear.

Ah…and here is the killer (pun intended): The solution to these “problems” cannot be accomplished by our own selves; we are dependent upon an outside entity (in this case, modern allopathic medicine) for salvation. For example: Germs are our enemy and our only solution to overcoming them is that hopefully, someday, somebody will find that magic potion that can “kill those germs.” Until then, it is hopeless. Responsibility for our own lives has been stripped, and this disempowered state of mind creates even more fearful emotions. Healing in this model becomes an emotionally charged, futile pursuit.

So, how do we break the cycle of fear? Other than reading inspiring words of wisdom and surrounding ourselves with like-minded practitioners and friends, Pert advises us to get in touch with our bodies: “Your body is your subconscious mind and you can’t heal it by talk alone.” Bodywork, movement therapy, simple exercise, spinal adjustments and massage can all release stuck emotions by clearing blockages to normal body function. Ancient healing arts and modern holistic practitioners all recognize and support the mind-body connection in healing. Pert concludes, “…almost every other culture but ours recognizes the role played by some kind of emotional catharsis or energy release in healing.”

Let’s be honest—the role of the mind in healing is not new, it has just been allopathically suppressed. Hippocrates (the Father of Medicine) made these statements centuries ago:

• Humans are created to be healthy as long as they are whole: body, mind and spirit.

• People are characterized by self-healing properties that come from within and an innate healing force.

• Health and harmony is the normal state for all life.

Now, the accepted definitions of health are returning to Hippocrates’ way of thinking. Dorland’s Medical Dictionary defines it as “a state of optimal physical mental and social well-being and not merely the absence of disease and infirmity.”

Pert agrees, “Last but definitely not least, health is much more than the absence of illness,” she writes. “Live in an unselfish way that promotes a state of spiritual bliss that truly helps to prevent illness. Wellness is trusting in the ability and desire of your body-mind to heal and improve itself, if given half a chance. Take responsibility for your own health—and illness.”

I am excited to see science catch up to the holistic paradigm, challenging fear-based theories and supporting the return of logical wisdom. The reason why most holistic practices did not accept the germ theory from its onset was because the major premise of their healing model recognizes there is an innate intelligence in living matter: There is order, synchronicity, and a respect for natural law. It is a shift in consciousness, toward understanding and adhering to these vitalistic principles, that will have the most profound effect on our individual selves, our families and the future of humanity.

Article originally posted at ICPA.org.

The Homebirth Advantage

by Ronnie Falcão, LM, MS– ICPA.org:

When it comes to what’s best for you and your baby, you can consider a midwife-assisted home birth as safe an option as birthing in a hospital or free-standing birth center. At a home birth, your privacy will be respected and you can enjoy birthing in an intimate, family atmosphere. By birthing at home, you’ll be treated like a woman going through a natural process. Too often in hospitals, birthing women are made to feel more like patients with a dangerous condition.

Homebirth midwives carry the same equipment and medications found in a birth center. These includes hand held Dopplers and state-of-the-art machines for continuous monitoring of the baby’s heart rate, if necessary. Midwives also bring suctioning equipment and an oxygen tank to every birth, in the rare event they are needed. Anti-hemorrhagic medications will be on hand to prevent postpartum hemorrhaging, as will suturing equipment in case you tear.

In fact, midwives practicing in homes or independent birth centers can do everything that a midwife in a hospital could do. A 2009 Canadian study compared safety rates for planned home births and planned hospital births attended by the same cohort of midwives. They also evaluated the safety of planned physician-attended hospital births for a matched population of low-risk women who could have opted for home birth or hospital-birth midwives. Of the three groups, the home birth group had the highest safety statistics, including the lowest rate of interventions, serious perineal tearing and hemorrhaging. Babies born at home required resuscitation less often than those born in the hospital, and were less likely to experience meconium aspiration. Thus, the study indicated that home births were not only safer for low-risk mothers than any other birthing environment, but that they also called for less medical intervention.

One key difference is that professional midwives, in whichever setting they practice, work to recognize problems that could potentially interfere with a safe birth, and seek to correct them before they become major problems. They are also trained to handle life-threatening emergencies that can occur suddenly during a birthing, such as shoulder dystocia, postpartum hemorrhage or placental problems. Interestingly, each one of these emergencies occurs beyond the point when a cesarean section is still an option.

During the hours leading up to a birth, if a cesarean becomes necessary, there is a safety margin of 30 to 75 minutes in which to assemble a surgical team. For this reason, many midwives recommend that women labor within 30 minutes of a hospital as their emergency backup plan. This provides the same safety margin as women birthing in hospitals.

A landmark study on home birth safety was published in the British Medical Journal in June 2005. Like the 2009 study, this study showed that home births and hospital births had similar overall safety rates, but that there were fewer interventions and fewer complications for the home births. This prospective study with a rigorous research design is was most comprehensive North American study regarding birthing location options. A suite of home birth safety studies from the United Kingdom in 1996 also showed home to be as safe as or safer than a hospital for low- and moderate-risk women. In a 1999 review of all the literature on the relative safety of different birthing locations, childbirth researchers Luke Zander and Geoffrey Chamberlain concluded, “No evidence exists to support the claim that a hospital is the safest place for women to have normal births.”

Safety Begins at Home

There are several reasons why midwife-attended home births are safer than hospital births for most women. The first is that birth is a natural bodily process that works best without interference. A home birth with a midwife attending assures you that risky medical intervention will be kept to a minimum. (For example, Pitocin and epidural anesthesia, routinely administered in hospitals, introduce significant risks to both mother and baby.) Most problems that arise at home can be corrected with position changes or by providing the mother with food or better hydration— safe and helpful tools which are, ironically, often forbidden in many hospitals.

The second reason that home birth is safer is that the infection rate at home births is less than half that of hospital births. There are several reasons for this. First, the baby is born with the mother’s antibodies, passed through the placenta. These include immunity to the family’s household germs. Hospitals are notoriously germ-infested, and a mother isn’t able to offer herself or her baby the same degree of immunity from that environment. Second, homebirth midwives know not to wash off the protective, antibacterial vernix covering the baby’s skin. Third, because mothers and babies are never separated, the baby’s immature immune system is able to function optimally, without the stress and disruption of the baby being taken from its mother. Furthermore, the continuous mother-baby interaction fosters successful breastfeeding, which is the baby’s best protection against infection from the moment of birth. Midwives provide continuity of care and comprehensive mother/baby care at a level impossible in the assembly-line nature of hospitals.

Many women wonder whether they’ll be able to give birth at home without drugs; in fact, most women do just fine. Many women who have had babies both at home and in the hospital assert that birthing is much less painful at home, in familiar surroundings, with birth attendants who could cater to every need.

Childbirth classes teach about the fear-tension-pain cycle, whereby fear increases tension, causing the cervix to constrict rather than dilate, which in turn increases pain. It’s a process that’s counterproductive to birthing. When fear is absent from the birthing environment, the opposite cycle can play out: confidence-relaxation-comfort. That is, the more confident you are, the better able you are to relax, and the more comfortable you’ll be. This allows your body to secrete endorphins, which are the natural pain relief intended by nature for the mother’s body during natural childbirth.

As a laboring woman’s body produces more oxytocin to increase the effectiveness of her contractions, she also produces an equivalent level of endorphins for pain relief. (These endorphins aren’t produced if the mother is under stress or feeling afraid.) It is not uncommon for women to become increasingly relaxed as labor progresses, due to their endorphin levels climbing as the intensity increases. It’s easy to imagine how being in your own home can increase your confidence and ability to relax. A birthing tub provides even greater comfort, immersing the mother in the warm weightlessness of water.

Water birthing offers the woman the option of laboring and birthing in a tub. When a baby is born in water, the baby continues to receive all of its oxygen through the placenta until it is above water and using its lungs successfully. Thus, there is no risk of drowning, even if the baby crowns slowly over several contractions. The buoyancy provided by the water seems to help the mother and baby find the optimal position for birthing. In addition, the warm water increases blood flow to the uterus, which not only provides the necessary oxygen to the baby, but facilitates cervical dilation and reduces pain. Babies born in water are usually in excellent condition, and they are easily comforted by the familiarity of warm water.

The experience of birth for the baby at home is usually very gentle. We know that babies recognize voices during late pregnancy, so it is believed that the baby recognizes the midwife’s voice as someone nonthreatening and familiar. Homebirth midwives don’t use any devices that go inside the uterus or might be uncomfortable for the baby, and women are encouraged to birth in a position they choose. Positions chosen by the mother, such as an upright position, or on her hands and knees, tend to minimize stress on the baby and facilitate an easier birth.

Many homebirth couples choose to catch their own baby, and the assessment of baby’s well-being right at birth can be easily done with the baby still in the mother’s arms. Some midwives don’t ever hold the baby until the mother feels ready to have the baby weighed. Most parts of the newborn exam can be performed with the baby in the arms of the mom or dad. And because there is no rush to cut the cord, the baby receives all of its nutrient-rich cord blood, as nature intends.

Families who already have a little one at home appreciate how much easier it is for the older sibling to adjust to a new baby when their mom doesn’t mysteriously disappear for a few days. It may be wise to have a special family friend or a professional child doula there to care for the older child during the birth, but many siblings happily participate during the birth or sleep right through the excitement.

Easier Than You Think

The logistics of planning a home birth are often not as complex as couples assume. Babies born at home get a birth certificate and social security number, just like hospital born babies. (Your midwife can provide the necessary paperwork.) Birth kits with disposable supplies can be easily purchased online. Even larger items, such as birthing tubs, can be affordably purchased or rented.

Home birth provides an opportunity for a safe and satisfying birth experience, putting the needs of the baby first. She’s the most important person during the event: Shouldn’t she be treated like it?

Article originally posted at ICPA.org.

Antibiotics and the Aware Parent

by Claudia Anrig, D.C. – ICPA.org:

Acute Otitis Media is the most common upper respiratory condition treated in pediatric offices and the treatment of this condition continues to be the most controversial in the medical community.

The majority of children suffering from Acute Otitis Media will automatically be placed on antibiotics despite growing evidence that suggests there’s only a marginal benefit from this form of care.

The pediatric community is being confronted primarily by mounting evidence that the standard use of antibiotics may be an outdated practice with little value and what appears to be greater risk to the child.

When prescribing antibiotics for your child your pediatrician should be willing to answer the question, “Does this case warrant a prescription”?

Let’s consider an observation published recently by the American Academy of Pediatrics and the American Academy of Family Physicians:

“Each course of antibiotics given to a child can make future infections more difficult to treat. The result is an increase in the use of a larger range of—and generally more expensive— antibiotics. In addition, the benefit of antibiotics for Acute Otitis Media is small on average and must be balanced against potential harm of therapy. About 15 percent of children who take antibiotics suffer from diarrhea or vomiting and up to 5 percent have allergic reactions, which can be serious or life threatening. The average preschooler carries around 1 to 2 pounds of bacteria – about 5 percent of his or her body weight. These bacteria have 3.5 billion years of experience in resisting and surviving environmental challenges. Resistant bacteria in a child can be passed to siblings, other family members, neighbors, and peers in group-care or school settings.”

Scientific Evidence

Scientific evidence puts forth the following information:

• Children with high temperature or vomiting improved after an average of three days.

• Children with high temperature or vomiting were likely to benefit from antibiotics, although it’s still reasonable to wait 24 to 48 hours since many children will improve when left to their body’s own natural defenses.

• Children without high temperature or vomiting were not expected to benefit from immediate antibiotics.

Considering this information it’s best to take an option to observe stance since 80 percent of children with Acute Otitis Media get better without antibiotics within 48 to 72 hours.

With this scientific evidence mounting, ask yourself a few questions:

Will my pediatrician continue to prescribe antibiotics to my child based on his or her old programming and habits despite growing evidence that suggests antibiotics make little difference?

Does my pediatrician continue to have concerns that there’s a risk for dangerous complications, such as Acute Mastoiditis, despite the fact that it’s documented as a “rare occurrence”

As a parent, what do you need to know?

• That there is mounting evidence from the research community that the use of antibiotics has very little effect on Acute Otitis Media.

• That your doctor may be prescribing antibiotics based on old habits or the concern of developing acute mastoiditis, which has proven to be rare.

• That when delaying the use of antibiotics for 72 hours, even if your child is suffering from fever and vomiting, 50 percent of all children improve within that time period.

• That children with Acute Otitis Media but without fever and vomiting receive very little benefit from the use of antibiotics (this child should not begin antibiotics unless their condition worsens).

• It’s your child and you can take the initiative by asking your pediatrician to consider waiting 72 hours before introducing the antibiotic.

Prevention is the Key

New guidelines set forth by the American Academy of Pediatrics and the American Academy of Family Physicians recommend that the clinician take an active role in preventing Acute Otitis Media. A few suggestions included:

• Altering child care center attendance • Breastfeeding for the first 6 months • Avoid supine bottle-feeding (bottle propping) • Reduce or eliminate pacifier in the second six months of life • Eliminate exposure to passive smoke

A Healthy Alternative

Take the common sense approach to otitis media and consider chiropractic care. The Fallon study with 332 participating children suggests that chiropractic care may be more effective than drug therapy.

Be aware that your chiropractor is not opposed to antibiotics when necessary, but the chiropractic profession acknowledges that over usage is prevalent in our country and that the habits of medical doctors may not have caught up with the latest research.

A Final Thought

For the overall wellness of your child, participate in all decisions when it comes to the usage of antibiotics and seek other non-invasive forms of care. Remember, it’s your child and you have a say in his or her care. Most importantly, initiate healthy lifestyle choices for your family and include regular chiropractic care as part of your family’s achievement towards wellness.

Article originally posted at ICPA.org.

Children May Not Need Antibiotics for Acute Infective Conjunctivitis

by Pathways Magazine – ICPA.org:

Antibiotics are not necessary for most children with acute infective conjunctivitis, according to the results of a randomized, double-blind trial published in the June 22 Early Online Publication issue of The Lancet.

“We have shown that symptoms resolve without antibiotics in most children with acute infective conjunctivitis,” lead author Peter W. Rose, from the University of Oxford, England, said in a news release. “The health economic argument against antibiotic prescription for acute conjunctivitis is compelling.”

The authors note that each year, one in eight schoolchildren has an episode of acute infective conjunctivitis annually, and that standard clinical practice is to prescribe a topical antibiotic. However, there is little evidence to support this practice.

“Parents should be encouraged to cleanse their children’s eyes if an antibiotic is not prescribed,” the authors conclude. “Parents should be encouraged to treat children themselves without medical consultation, unless their child develops unusual symptoms or the symptoms persist for more than a week.”

1 in 8 schoolchildren has an episode of acute infective conjunctivitis annually, and that standard clinical practice is to prescribe a topical antibiotic. However, there is little evidence to support this practice.

Article originally posted at ICPA.org.

Treating an Ear Infection

by Joseph Mercola, DO – ICPA.org:

I know antibiotics are not good for my baby, but what do I do if he gets an ear infection?

Avoid dairy. Identify food allergens. Try this safe, economical solution!

The treatment of ear infections in this country is a huge problem. Most of the chronically sick children I see were given antibiotics frequently for recurrent ear infections. The sad tragedy is that nearly all of these are preventable by simply changing the diet. Avoiding milk and dairy is the single largest issue, but clearly other food allergens contribute.

Even with the best diets though a child may get an ear infection. This does not mean that the child needs antibiotics. The simple solution is to put a few drops of breast milk in the ear canal every few hours. This usually works to clear up the infection within 24–48 hours and is far safer, less expensive and a better solution than putting the child on antibiotics. If the mother is not breastfeeding, it is likely she knows someone who is. All that is required for the treatment is about one half ounce of breast milk, so obtaining that from a friend will work just as well.

If you know someone who has a child with ear infections please share this article. You may make a huge impact on the future health of that child.

Article originally posted at ICPA.org.

The Wait and See Prescription – Avoiding Antibiotics

by Darrel Crain, DC – ICPA.org:

Earaches bring more unhappy children to emergency rooms and pediatric offices each year than just about any other health disorder. Antibiotics remain the most popular medical treatment for earache, with doctors reportedly writing 15 million prescriptions per year in the United States alone. It is estimated that at least half of the prescriptions are unnecessary and ineffective for helping this problem.

Due to the widespread overuse of antibiotics, drug-resistant germs have been reproducing as fast as frolicking rabbits, constantly evolving new levels of drug resistance. For over a decade our health leaders have been sounding the alarm to doctors to stop writing so many prescriptions for antibiotics because of growing drug resistance as well as serious health risks to the user.

“The risks of antibiotics, including gastrointestinal symptoms, allergic reactions, and accelerated resistance to bacterial pathogens must be weighed against their benefits for an illness that, for the most part, is self-limited,” according to the authors of a study about earache published in the Journal of the American Medical Association (JAMA) in September 2006.

Antibiotics are weapons of mass destruction intended to assassinate select gangs of bad-boy bacteria. Unfortunately, most of the hardworking, honest bacteria in the body get murdered at the same time, wiping out the body’s mighty microbes that normally do important work such as digesting food and making vitamins.

The earache study published in JAMA was a test of something called the “wait-and-see prescription” to help kids with earaches. This method has apparently been tried previously, but never before in an emergency room.

Half of the 283 children in the study diagnosed with acute otitis media (AOM) were sent home with a standard prescription, the other half with the wait-and-see prescription (WASP). The only difference between the two groups was that the parents in the WASP group were told to wait at least 48 hours before filling the antibiotic prescription.

“Everything comes if a man will only wait,” Benjamin Disraeli pointed out more than 150 years ago.

An unbelievable two out of three children avoided antibiotics with this innovative wait and- see strategy. “The WASP approach substantially reduced unnecessary use of antibiotics in children with AOM seen in an emergency department and may be an alternative to routine use of antimicrobials for treatment of such children,” according to the study.

The WASP concept may well be one of the greatest advances in medical science since the discovery of hand washing. The immediate benefit will be in the fight against two very pressing medical problems, microbial drug resistance caused by widespread antibiotic use, and antibiotic-induced chronic disease. But I can imagine applications throughout the medical profession. How about “wait-and-see surgery” for example?

The WASP study is sure to be criticized because it was only an observational study, not a clinical randomized trial (CRT). The CRT is considered the gold standard in medical science, so if the only thing you have is observational and anecdotal evidence to support your clinical practice, you might as well just use the paper to line your birdcage.

Which brings us to children who visit the chiropractor’s office for their earaches… Critics of chiropractic complain that there just isn’t any science to verify the ability of the chiropractic adjustment to enhance natural healing of the ears. The fact is, a significant number of studies have been published that describe the neurology and verify the benefits of chiropractic care for children, but alas, no clinical randomized trials.

And that reminds me of the famous parachute study, published in the British Medical Journal in December of 2003. The authors of this study write, “parachutes are widely used to prevent death and major injury after gravitational challenge,” yet the placebo-controlled, randomized clinical trials have never been done. I’m thinking that at this point it may be difficult to find people willing to jump from an airplane wearing a placebo parachute. It looks and feels like the real thing when you put it on, but when you pull the cord nothing happens.

“The perception that parachutes are a successful intervention is based largely on anecdotal evidence… As with many interventions intended to prevent ill health, the effectiveness of parachutes has not been subjected to rigorous evaluation by using randomized controlled trials,” write the authors.

Now I may be wrong, but it seems to me that people seeking good health are mostly interested in getting well as quickly as they can with having to worry about additional health risks. The wait-and-see prescription is not a recommendation to just ignore health problems and hope they go away, it is simply more evidence that the watchword for medical interventions is “less is more.”

Common sense suggests that if you need to jump out of a plane while still up in the air, you might want to strap on a real parachute without waiting for the double blind studies. I agree with the authors of the JAMA study who conclude, “Individuals who insist that all interventions need to be validated by a randomized controlled trial need to come down to earth with a bump.”

Article originally posted at ICPA.org.

Whose Prescription Is It, Anyway?

by Author Howard Markel, MD, PhD – ICPA.org:

Attention Deficit Disorder and Ritalin

The boy is 14 years old and has one of the most severe cases of attention deficit disorder (ADD) that I have seen as a pediatrician. He fidgets; there are nonstop hand gestures, leg swinging and tapping. More troubling, he simply will not pay attention to any adult attempting to engage him in conversation, placing him in great jeopardy of flunking out of school.

During his first office visit, the boy explained his predicament to me: “It’s like I’m in a room with 20 big screen HDTVs blaring away in surround-sound. And on them are all the newest videos from MTV. The problem is that I can’t decide which one to watch, so I try to watch them all.”

His mother is less focused on her son’s perpetual motion than on his angry outbursts and what she sees as his refusal to listen to her. The day we met, she had already decided what she wanted to do. I was being told to write a prescription for Ritalin.

As every pediatrician knows, stimulant drugs like methylphenidate (Ritalin) cause most people to speed up their actions and thoughts. But for those with ADD (with or without hyperactivity), these drugs can slow them down, reduce overactivity, increase attention span, and can even improve relationships between a child and parents or other family members. There are, however, some nagging problems: none of us is exactly certain how these drugs work or what their long-term benefits and risks might be. Sometimes, they cause intolerable side effects such as tics and sleep disturbances.

The young man was clearly unhappy with his mother’s decision and let it be known with a slew of scowls and outcries of “Shut up!!” I asked him why he would prefer not being able to pay attention to his schoolwork, to which he replied: “You just don’t get it. I’m a lot more fun when I don’t take Ritalin. I crack great jokes in class and my friends think I am really cool. But when I take that stuff, I’m zoned out. I’m like a log. Ritalin ruins my life.”

This description went a long way in explaining why many teachers (and not a few parents) of kids with ADD prefer their charges to be medicated and why many children resist such attempts. Left untreated, however, many of these kids create problems with disruptive behaviors and can destroy the normal dynamics of a classroom and at home.

Here was my dilemma: The boy’s mother, and not the young man, wanted the prescription. The law defines a 14-year-old as a minor, but given that his condition was hardly fatal and essentially a behavioral issue, to whom should I have listened? The mother, who wants a more controllable child, or the boy, who simply wants to be what he perceives to be his true self? After all, the essence of adolescence is finding out who you are and figuring out who you want to be. As a pediatrician, I am supposed to be assisting youngsters in this difficult process.

That day, I listened to the parent and wrote the standard prescription for 40 mg of Ritalin a day. Like millions of youngsters with ADD, he takes 20 mg before going to school in the morning and another 20 mg at lunch.

Every month, I see the boy to renew his prescription for Ritalin and to make sure that there are no serious side effects. At each visit, he greets me with a deep-rooted but quiet anger. His fidgeting and outbursts seem to have diminished, but there has been little improvement in his schoolwork. Last year, he barely passed the eighth grade and his mother admitted that 2 of his teachers simply elected to pass him to avoid a repeat year with him. Nevertheless, she is delighted with the results.

When the boy is on vacation from school, I have noticed a definite change in his demeanor. Typically, when school is out, pediatricians give children with ADD a “drug holiday.” When he does not take his medication, his fidgeting and inattention are back in full force but he beams with joy, at least when I see him, and tells me that without Ritalin he can again enjoy cutting up in front of his friends.

But in his mother’s defense, I don’t live with him and have no real idea how disruptive his ADD behaviors can be at home. In cases like these, I have to listen to the parent that does live with him. I remain terribly conflicted about pharmacologically altering this young man against his will. Using potent pills to treat a disorder we do not completely understand flies in the face of prudent medical practice, and yet we pediatricians do this all the time with our ADD patients. More than a century ago, the great physician Sir William Osler observed that “the desire to take medicine is one feature which distinguishes man, the animal, from the rest of his fellow creatures.” In the practice of pediatrics, we are often compelled to include the parent’s desire in that rubric.

But still, I wonder, am I doing the right thing?

Article originally posted at ICPA.org.

Nutritional Considerations for ADHD

by Pathways Magazine – ICPA.org:

Early Use of ADHD Drug Alters Brain

Ritalin use in preteen children may lead to depression later in life. Ritalin and cocaine have different effects on humans. But their effects on the brain are very similar. When given to preteen rats, both drugs cause long-term changes in behavior.

One of the changes seems good. Early exposure to Ritalin makes rats less responsive to the rewarding effects of cocaine. But that’s not all good. It might mean that the drug short-circuits the brain’s reward system. That would make it difficult to experience pleasure—a “hallmark symptom of depression,” Carlezon and colleagues note.

The other change seems all bad. Early exposure to Ritalin increases rats’ depressive-like responses in a stress test. “These experiments suggest that preadolescent exposure to [Ritalin] in rats causes numerous complex behavioral adaptations, each of which endures into adulthood,” Carlezon and colleagues conclude. “This work highlights the importance of a more thorough understanding of the enduring neurobiological effects of juvenile exposure to psychotropic drugs.”

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Consider Fish Oil Over Ritalin

Children with attention-deficit hyperactivity disorder (ADHD) have problems paying attention, listening to instructions, and completing tasks; they also fidget and squirm, are hyperactive, blurt out answers, and interrupt others.

It is conservatively estimated that 3-5% of the schoolage population has ADHD. Although drugs, such as Ritalin, are frequently used to treat ADHD, they are fraught with complications. Disadvantages include possible side effects, including decreased appetite and growth, insomnia, increased irritability, and rebound hyperactivity when the drug wears off.

One would not expect to find that a single cause or even a handful of factors could explain why ADHD appears to be so rampant in our society. Because it is accepted that both genetic and environmental factors play a role in ADHD, many other factors—both intrinsic and extrinsic— could influence an individual’s fatty acid status.

Inefficient Conversion of ALA (Flax Oil) To EPA And DHA

A possible cause for the low fish oil status of the ADHD children may be impaired conversion of the fatty acid precursors LA and ALA to their longer and more highly unsaturated products, such as EPA and DHA (fish oil fats).

It appears that children with ADHD just are not able to chemically convert the plant omega-3, ALA to fish oil very well. The problem is further worsened when omega-6 fats are consumed and the ideal omega-6:3 ratio of 1:1, progresses to the typical standard American ratio of 15:1. Many of these children have ratios which are even worse and can be as high as 50:1.

This study provides the research evidence supporting the use of the omega-3 fats found in fish oils to effectively address the underlying deficiency that is present in most of these children and appears to be contributing to the ADHD.

Two books worth having for your lending libraries:

Smart Fats: How Dietary Fats and Oils Affect Mental, Physical and Emotional Intelligence
by Michael A. Schmidt

Omega 3 Connection
by Dr. Stoll

Article originally posted at ICPA.org.

ADHD and Non-Medical Care

by Pathways Magazine – ICPA.org:

Parents seeking treatment for their child with ADHD (attention deficit hyperactivity disorder) often pursue alternative treatments to those offered by conventional medicine. A study conducted in Australia investigated how many parents with ADHD children did seek some form of alternative to stimulant medication. This study published in the January 2005 issue of the Journal of Paediatric Child Health revealed that over two-thirds of families with an ADHD child sought alternative care. Families of 50 children out of 75 respondents attending the Royal Children’s Hospital in Victoria reported using at least one form of alternative treatment for ADHD.

Diet modification was the most common form of alternative treatment pursued by these parents (66 percent of those who tried alternatives). Other treatments that parents had tried included vitamins and minerals (32 percent), aromatherapy (24 percent), dietary supplements (24 percent), chiropractic (20 percent), naturopathic therapy (16 percent), herbal therapy (14 percent), and neurofeedback and behavioral optometry (10 percent each).

Parents were also asked their goals in seeking alternative treatment, and 89 percent wanted to minimize their child’s symptoms. Avoiding side effects of prescribed medications was rated as important by 67 percent of families.

Most importantly, nearly 60 percent of families rated at least one type of alternative treatment helpful for their child.

This study shows the frustration and general dissatisfaction among parents with the pharmaceutical approach to children’s attention problems. Parents are seeking a holistic approach to these children’s problems, and this study shows the perceived benefit that parents experience from these holistic methods of treatment.