Alternative Medicine 7--Mind-Body Medicine

“Julie, Do you recall our January 3, 2013 posting on the Introduction to Risks and Fears?”

“I do, Curmudge, but what does that have to do with Part 2 of the Mayo Clinic Book of Alternative Medicine? (1)  Hey, you promised that we would discuss that this week.”

“We will.  Just stick with me.”

“I’ve been with you for 6-1/2 years, Old Guy, so I’m not leaving now.  Let’s return to Risks and Fears.  As I recall, at least hypothetically, I came face-to-face with a grizzly bear when we were hiking in the Rockies.  I jumped, and my heart ‘leaped into my mouth.’  It was a virtually instantaneous reaction; no thinking was required.  You described it as my ‘flight or fight’ response, starting in my brain’s thalamus and moving in milliseconds to my amygdala.”

“You’ve got it Julie, as usual.  Now let’s put me in a similar fictitious but illustrative situation.  At one time earlier in my life I believed that I almost died from eating a contaminated strawberry.  As a result of that extremely unlikely experience, I ‘flip out’ whenever I see a strawberry.  I become fearful and have a ‘blue funk’ for the rest of the day.  Dr. Sood at Mayo’s would characterize my ‘blue funk’ as a state of mindlessness in which the threat existing in my mind far exceeds that in the real world.”

“Your experience with the strawberry, Curmudge, resembles mine with the grizzly bear.  The strawberry triggered the ‘flight or fight’ reaction in your brain.  So once again, after over 100 words, what does this have to do with alternative medicine?”

“Here’s the connection, Dear Colleague, quoting Amit Sood, MD, from p. 95 in the Mayo book: ‘Impressive advances in neuroscience research have brought to our attention a startling and exciting discovery—the mind can change the brain.  Software can indeed transform the hardware.  Training our mind using mind-body approaches can soothe the limbic areas of the brain such as the amygdala…’  ‘This literal rewiring of the brain by our recurring thought patterns and experiences is now popularly recognized as neuroplasticity.’ “

“Voila!  That’s the link we need, Professor, to soothe your amygdala and your ‘flight or fight’ reaction when you see a strawberry.  No more blue funk, and we’ll be able to put strawberry shortcake on the menu again.  Of course, I must be careful not to lose my primordial fear of grizzly bears.”

“As an aged-but-still-somewhat-functional scientist, I remain puzzled by how this ‘brain reprogramming’ occurs.  You’ve read the Mayo book too, Julie.  Can you quote or paraphrase more from pages 96 and 104 of the Mayo book that might improve my understanding?”

“Coming at you, Chief.  ‘The system responsible for the flight-or-fight response is the autonomic (involuntary) nervous system.  It regulates many body activities, including heartbeat, perspiration, breathing, and digestion.  The autonomic nervous system is divided into two parts, sympathetic that mobilizes the body into action (flight-or-fight) and parasympathetic that creates a “rest-and-digest” response.  Current research is focused on understanding how meditation and related techniques can reduce the activity of the sympathetic system and increase the activity of the parasympathetic system.’ “

“My interpretation of what you just said, Julie, is that we don’t know exactly how meditation makes that work.  However from other reading one can conclude that it does work.  ‘Positive emotion may be a skill which can be achieved with training similar to learning to ride a bike or play the piano.’  But I bet it’s not really as easy as learning to ride a bike.”

“We don’t have to rely on just the Mayo book and Wikipedia, Old Guy.  For one really interested in this topic, there are several books that go into it more deeply than we can.  Norman  Doidge (2) reviewed the experiments that established the validity of neuroplasticity.  Applying neuroplasticity and meditation to personal problems is described by Sharon Begley (3) and in several books by Jeffrey M. Schwartz (4-6).”

“One can discern the theme and contents of these publications just by reading their reviews on Amazon.com.  An outstanding example is the review of Sharon Begley’s book by Barbara Rose, Ph.D.  You know, Julie, these books look so inspiring that I might try some of that meditation stuff.”          

“Knowing you, Ancient One, you’d probably just fall asleep while meditating.  And then there are people who might just naturally reject meditation or allowing themselves to be hypnotized.  Then what?”

“These people might try tai chi (‘moving meditation’) or qigong and achieve comparable results.  There’s a technique for everyone in mind-body medicine.”   

“What about the other mind-body medicines in the Mayo book?  Although the most space is given to meditation, there are ten other techniques, from biofeedback (alphabetically) to yoga.”

“We can’t talk about all of them in a blog, Julie.  In my own case I wouldn’t be too selective about the technique; I‘d seek the best coach who had the most success with strawberry-phobia.”

“I’m sure you are aware, Old Guy, that Part 2 of the book also has sections on Energy Therapies, Hands-on Therapies, and Other Approaches.”

“We’ll mention some of those in our next posting, Julie.  Don’t go away.”

Kaizen Curmudgeon

(1) Mayo Clinic Book of Alternative Medicine, Second Edition.  (2010, Mayo Foundation for Medical Education and Research).

(2) Doidge, Norman The Brain That Changes Itself (2007).

(3) Begley, Sharon. Train Your Mind, Change Your Brain (2007).

(4) Schwartz, Jeffrey M. and Begley, Sharon  The Mind and the Brain: Neuroplasticity and the Power of Mental Force (2003).

(5) Schwartz, Jeffrey M. and Gladding, Rebecca You Are Not Your Brain (2012)

(6) Schwartz, Jeffrey M. and Beyette, Beverly  Brain Lock: Free Yourself from Obsessive-Compulsive Behavior (1997)  

Link to posting from blog archives: Patient Safety—Epilogue  3/12/09

http://kaizencurmudgeon.blogspot.com/2009/03/patient-safety-epilogue.html

Alternative Medicine 6—Alt. Med. 101

“Did you know, Julie, that learning and blogging are both non-linear processes?”

“It never occurred to me, Curmudge, so I’m going to need some explanation.”

“When one learns a foreign language, he learns to say a few useful phrases, such as ‘hello’ and ‘goodbye,’ before he learns the basics, such as how to conjugate verbs.  When you and I study a new topic and write about it, we learn and discuss aspects of the topic of our current interest.  We don’t start with the basics at square one and blog about the topic as if we were writing a textbook.”

“I think I’ve got it, Old Guy.  When we began blogging on alternative medicine, we jumped right into herbal medicines without laying a foundation for the whole of alternative medicine.  So perhaps the sooner we do that, the better.  Let’s call it Alt. Med. 101.”

“And our text for Alt. Med. 101 will be the Mayo Clinic Book of Alternative Medicine. (1)  It is authoritative and comprehensive; its main sections are Part 1  (Today’s New Medicine), Part 2 (Guide to Alternative Therapies), and Part 3 (Your Action Plan).   Contrary to other publications we have read, Mayo’s authors don’t have major vested interests in their contributions.  They are promoting neither practices nor potions.  Their overall views tend to be conservative, and their conclusion for each dietary supplement and mind-body practice is indicated by a red, yellow, or green ‘traffic light.’ “

“Right from the start, I am impressed by two things: (a) an institution with Mayo‘s stature has a Comprehensive and Integrative Medicine Program, and (b) the book must be so good that a skinflint like you, Curmudge, actually purchased it (at $29.95).”

“Julie, because we’re not going to discuss all of the book, we’d better tell our readers a bit more about its contents.  Part 1 deals with lifestyle issues, from diet, to exercise, to stress.  Part 2 covers herbs and dietary supplements, mind-body medicine, and energy-related therapies.  Part 3 provides a two-page discussion on each of 20 common conditions ranging (alphabetically) from arthritis to vaginal yeast infections.”

Part 1

Compared with traditional ‘diet‘ books, this book has broader lifestyle coverage and fewer diet specifics.

Part 2

“Gosh, Old Man, we have already read a lot about natural products and dietary supplements.  Does the Mayo book tell us much that is new?”

“For each item the book presents a few paragraphs of general discussion, then a two-or-three sentence summary called Our take, and then a research note called What the research says.  And of course, the ‘traffic light.’  They do this for 39 herbs (I wish there were more), 7 vitamins, 5 minerals, and 11 hormones and other compounds.  A common conclusion is that ‘more research is needed.’  But my answer to your question is a qualified ‘yes’ as well as ‘no.’  We learned new stuff, but several natural products of interest weren’t mentioned, including turmeric (curcumin), quercitin, and resveratrol.”

Part 3

“Hey, Curmudge!  How can we move on to Part 3 without discussing Mind-Body Medicine and Energy and Other Therapies in Part 2?”

“We‘re not going to skip those topics, Julie.  They are so important that we are going to defer them and put them in several postings.  But before we leave Part 3 we must mention the Mayo book’s contribution to treatment of its list of 20 common conditions.  For each condition, Mayo mentions the alternative medicine treatments that are available.  I can’t comment on the treatments because I haven’t had hardly any of the conditions except the common cold.  The book says that the Scandinavians use andrographis; that sounds like an interesting recommendation.”

“I consider it your promise, Old Guy, that we’ll be back within the next couple of weeks to talk about the rest of Part 2.”

Kaizen Curmudgeon

(1)  Mayo Clinic Book of Alternative Medicine, Second Edition.  (2010, Mayo Foundation for Medical Education and Research)

Link to posting from blog archives: Patient Safety—Accidents, Trauma, and Luck 3/04/09

http://kaizencurmudgeon.blogspot.com/2009/03/patient-safety-accidents-trauma-and.html

Alternative Medicine 5—It’s Cancer! Now What?

“I presume, Curmudge, that we are just going to play copy-cat and pass along what we have learned in our reading.”

“Right as usual, Julie.  Despite having read good stuff, what might sound like advice is really our perceptions.  So let’s begin.  For most people, a diagnosis of cancer hits like a whack with a wet towel in a locker room.  Their immediate emotion is, ‘Do something!  I want it out!’ “

“Whoa-up there, Partner.  If our patient’s diagnosis is based on a biopsy, she’ll want a second opinion from another pathologist.  Cancer is serious business, and nobody wants an incorrect diagnosis.  She should also read our Evidence-Based Medicine postings back in September and October of 2010.”

 

“Here are some of the things that I have learned that pertain to many cancers.  If they don’t require immediate action, there is time for the patient to learn about the various modes of treatment and to select among them.  When one consults oncologists, the surgeons will want to cut, the clinical oncologists will favor chemotherapy, and the radiation oncologists will propose radiation therapy.  By their very nature, specialists in many fields are parochial in their diagnosis and plan of care.  And irrespective of the initial approach, the cancer may return, its further growth need to be arrested, and it might become something the patient must learn to live with.”

“Hey, that’s more scary than I realized.  To most people, ‘removed’ or ‘in remission’ means ‘goodbye.’ “ 

“Lots of people don’t realize that, Julie, and they also aren’t aware that alternative medicine might play an important role in their plan of care.  So before plunging ahead with surgery, chemotherapy, or radiation, our patient should—if possible—consult with someone who practices integrative or alternate medicine.  Our readings have told us about complementary medicine techniques that can strengthen the patient prior to conventional procedures, mitigate the procedures’ side effects, and hasten the patient’s recovery.  Furthermore, there may be opportunities to skip the conventional procedures altogether.”

“Wow, Curmudge!  I’ll bet those ‘opportunities’ enliven the debate between the allopathic and alternative docs.  Fortunately, if the cancer is growing slowly enough, there might be time to test the alternative meds to see if they shrink the tumor or arrest its growth.”

“Nevertheless, Julie, an alternative med zealot should not bet all of her chips on some herbal concoction without carefully evaluating the oncologist’s proposed conventional plan of care.”

“That’s for sure, Old Guy, but from my search of the Web, it’s not going to be very easy for our cancer patient to find an alternative medicine doc with the training she needs for consultation.  A person with cancer or malfunctioning innards such as liver, lungs, intestines, or whatever needs an herbalist with experience with her particular ailment.”

“That seems to be the case.  Recall the two main categories of alternative medicine mentioned in our first posting on this topic, ‘Alternative medicine includes use of natural products (herbs, vitamins, minerals, and probiotics) as well as mind and body practices (acupuncture, meditation, relaxation techniques, and movement therapies).’  If one specializes in just one or a few of the mind and body practices, less training is needed than for treatment with natural products.”

“I’ve even seen some of the mind and body practice clinics advertising their ‘antiaging’ services, whatever that is.”

“I’m puzzled too, Julie.  To me, antiaging is opposition to growing old, i.e. dying young.  I think we’ll just skip that aspect of alternative medicine.”

“So, Curmudge, back to our patient’s search for a natural products practitioner who can provide the help that she needs.”

“That may require reading the publications of Yance and Blaylock that we mentioned in our posting on nutrition.  The Blaylock Report Archives is a collection of his monthly newsletters on a variety of illnesses.  Another book that discusses a host of conditions has the intimidating title, Miracles from the Vault: Anthology of Underground Cures by Jenny Thompson of the Institute of Health Sciences (see Quackwatch).  She is an excellent writer, but some of her ‘cures’ sound too good to be true (and they may be).”

“Hey, Professor, let’s not forget Suzanne Somers, an actress also cited in Quackwatch.  She has been criticized mostly for promoting bioidentical hormones.  However, she has also written Knockout (1), a book comprised of interviews with ‘doctors who are curing cancer,’ including one whose treatments include coffee enemas (!).    Our cancer patient might wish to follow up with some of her more conventional interviewees, which might require long-distance travel.  But as you and I have said many times, we don’t make recommendations.  Recall also our suggesting that cancer patients may be willing to take somewhat greater—but hopefully intelligent—risks.”

“And that, Curmudge, is about as risky as this posting is going to get.  In future postings, do you intend to discuss any of the so-called mind and body aspects of alternative medicine?”

“I’ll try, Julie, and if we’re lucky we may get some help from a guest author.”

Kaizen Curmudgeon

(1) Somers, Suzanne  Knockout (2009, Random House)

Link to posting from blog archives: Patient Safety—Your Lifestyle 2/26/09

http://kaizencurmudgeon.blogspot.com/2009/02/patient-safety-your-lifestyle.html

Alternative Medicine 4—Illness and Risk

“Julie, do you recall the ‘Tylenol murders’ in 1982?  Seven people died after taking Tylenol capsules laced with potassium cyanide.  As a result, over-the-counter meds now come in tamper-proof bottles.”

“That was before my time, Curmudge, but now when I open a bottle of Bayer aspirin from Walgreen’s I can be confident that each tablet contains 81 mg of 2-acetoxybenzoic acid plus an enteric coating.  However, I would be assuming a bit more risk if I were opening a package of a multi-component mixture of exotic Chinese herbs from an unfamiliar vendor.”

“That’s the point, Julie.  There is the possibility of contamination or adulteration at each step in the product’s chain-of-custody—from picking the herbs to drying, grinding, compounding, bottling, labeling, and selling to the consumer.  These are minimally regulated dietary supplements, and the consumers’ main protection is to buy from trustworthy vendors who, in turn, buy from trustworthy suppliers.  Problems like contamination and mislabeling are apt to get past the cautions that we mentioned in Alternative Medicine 2.”

“In Alternative Medicine 3 we promised to talk about the use of alternative meds by people with a disease or who are likely to contract a disease.  Here is how I see that our discussion above relates to the use of alternative meds and their inherent risks: As the risk of one’s contracting a disease goes up, so does one’s willingness to accept greater risk in avoiding the disease.  Consider these examples: If a woman’s mother died of breast cancer, the woman may regard herself to be at risk.  If a man’s father has prostate cancer, the younger man may consider himself at a higher-than-normal risk of prostate cancer.  In both examples, the younger persons might consider the prophylactic use—and attendant risks—of alternative medications.”

“Wow, Julie!  How perceptive!  That’s our story, so let’s develop it.  The best way to ward off disease, including cancer, is proper diet and a healthy lifestyle including adequate rest and exercise and no tobacco.  Of these, a healthy diet may be the most difficult to achieve unilaterally.  Consider these obstacles: living with a spouse who is an intractable meat-and-potatoes person, living at home with Mom whose cooking is irresistible, or living alone and unwilling to devote more than seven minutes to preparing dinner.  The last example leaves one with a diet high in all the bad stuff in processed food.”

“Other than divorce to solve the intractable spouse problem, dietary supplements may need to be considered for filling the nutrition gaps in one’s current régime.  One could take the supplements when Mom isn’t looking.  Based on your well-known lack of expertise, Curmudge, how would you recommend that one proceed in selecting dietary supplements?”

“You seem to have forgotten, Dear Colleague, that the making of recommendations is above our salary grade (which is zero) as well as our knowledge grade.  My perception, however, is that one should simply compare his diet with those we have referenced, take out the bad stuff if Mom will allow it, and fill in the blanks with over–the-counter multivitamin and multimineral supplements.  Add fruit and fiber at breakfast and raw vegetables and more fruit at lunch.  Up to this point, we have stayed with safe and reliable products from the neighborhood pharmacy and food market and avoided exotic herbal concoctions.”

“Next, Old Guy, what about the person who is fearful that his ancestors have left him with the propensity for contracting a horrible disease?  We assume that this person is already following the dietary program noted above.”

“If this person is really serious, his best move is to find a health care provider with knowledge of integrative, alternative, or holistic medicine or herbalism.  However, those people are pretty scarce, so Plan B is to ask around and read the right literature.  ow per eptIn addition to reading the books on nutrition that we have already cited, become an ‘information hound’ on the issue or ailment of your concern.  If you wonder about something, Google it and you will be amazed at the response (sometimes mostly ads).  If the person’s fear is hereditary cancer, Yance and Blaylock (references in preceding posting) discuss the biochemical pathways involved in carcinogenesis; learn from them what substances have been found to derail those processes.  Some of these substances may have strange-sounding names and come from strange-sounding places.  With these, the risk of adulteration or contamination goes up, especially with multi-component mixtures.  So if one is self-medicating, keep it simple and conservative.”

“That sounds like good advice, Curmudge, especially coming from someone who doesn’t give advice.  I presume that you also have some non-advice for someone who already has cancer?”

“Jaded Julie, the literature on alternative medicine and cancer is metastasizing.  Come back next week and we’ll learn more.”

Kaizen Curmudgeon

Link to posting from blog archives: Patient Safety—Human Factors 2/19/09

http://kaizencurmudgeon.blogspot.com/2009/02/patient-safety-human-factors.html 

Alternative Medicine 3--Nutrition

“In our last posting, Curmudge, you suggested that we had learned a few things about alternative medicine worth sharing.  How do you propose that we proceed?”

“This may be a bit presumptuous, Julie, but we are going to provide a blog’s worth of guidance for a selection of people with various degrees of health.  We’ll start at the healthy end of the spectrum—with young people who are healthy and want to stay that way.  Their simplest path forward is good nutrition.”

“Nutrition!  Here we go again, discussing something about which we know absolutely nothing.”

“As of a few weeks ago, I knew at least a little bit.  Here are my rules of thumb:

(a)  Everything that tastes really good is probably bad for you.

(b)  An apple a day would have kept the doctor away many years ago when doctors made house calls.

(c)  If you are healthy and happy with your diet, don’t change it.

‘If it ain’t broke don’t fix it.’  Of course, you might die tomorrow.

(d)  If you are 79 years old, you must have been eating some of the right foods for the past 79 years.  But don’t make big plans for ten years from now.

(e)  If you are obese and don’t want to stay that way, change your diet and lifestyle.  There are a million sources of advice out there.  If you decide to remain obese, move to Mississippi, the fattest state in the nation.  You’ll have lots of company down there.”

“Curmudge, some of your rules sound rather unkind, but it’s hard to argue against them.  And you suggested that you have learned more about nutrition in the past few weeks.  You must have been reading the right books; it can’t be from your exemplary eating habits.”

“I grew up as a meat-and-potatoes kid.  During the Second World War the meat was sometimes Spam®, and we raised potatoes in our victory garden.  Nationally, every week we celebrated ‘Meatless Tuesday.’  The objective of a meal was to get over the feeling of hunger, and that has continued until recently.  If we look around, we see most people still eating that way; and in the U.S. they eat too much.  Regrettably, in some parts of the world people never get over feeling hungry.”

“In the past many years since your youth, Professor, scientists have learned that the real purpose of eating is to nourish the biochemical systems that run one’s body.  Paraphrasing Blaylock’s comment about nutrition and cancer, ‘New techniques for measuring biochemical events on a molecular level have allowed us to map out the many ways the components of (a proper diet including) fruits and vegetables inhibit cancer formation.’ (1) “

“You’ve got it right as usual, Julie.  That’s the link between the natural products side of alternative medicine and nutrition.  One’s good health can be largely dependent on the specific natural products in the foods that he eats.  That’s why we could say a moment ago that good nutrition is the best path forward for a healthy person who wants to stay healthy.”

“Shall we provide some specific suggestions for that up-to-now healthy person?”

“Sure.  Most people in the U.S. have been eating too much sugar, refined carbohydrates, and the wrong kind of fat.  Instead, they need more fruits and vegetables, especially the cruciferous ones like broccoli, cauliflower, and Brussels sprouts.  There was even an article in the August 2013 National Geographic about how we eat too much sugar, much of it invisible as high-fructose corn syrup.  The average American eats 22.7 teaspoons of sugar per day without touching the sugar bowl.  Among the worst sources are sugar-coated breakfast cereals and carbonated drinks (soda).  We have acquired a taste for poor nutrition.  For example, a can of soup wouldn’t taste right if were not crammed full of salt.”

“Curmudge, I believe everyone knows what you just said, but they seem unwilling to put it into practice.  But suppose our ‘healthy person’ really wants to get serious about his/her diet.  Assuming she has a computer and is willing to learn, what resources should she turn to?”

“I first recommend a change in syntax.  Use the French word régime instead of diet.  Diet connotes ‘fat’ and an effort that is often short, unpleasant, and unsuccessful.  Second, recognize that many of the experts in nutrition are those who have used diet as the foundation for their approach to diseases via alternate medicine.  And finally, you’ll see that many of those diseases are senior citizens’ afflictions that have been the most resistant to conventional medicine, such as cancer.”               

“I suspect that the first nutrition ‘guru’ that you will recommend is Andrew Weil, MD.”

“For him, ‘guru’ is he right term, Julie, and he can certainly provide more authoritative advice than we can.  It‘s spelled out in his anti-inflammatory diet and food pyramid.  Most of the authorities whose books I have read are fairly consistent in their dietary recommendations.  Russell Blaylock MD and Donald Yance, a nutritionist and herbalist (2), describe in detail why certain foods are good or bad for you.  And locally (Green Bay), Terry Lemerond includes diet advice in his Terry’s Traditional Diet.  For the dedicated meat eater, Al Sears MD provides advice on protein. (3)”

“A new find for us, Old Guy, but seemingly not for a lot of other people, is William Davis’s book, Wheat Belly.  I even found a summary of the book on the web, so the price is right for a tightwad like you.  Dr. Davis makes a pretty strong case for a wheat-free diet, although some of his assertions have recently been contested.  Davis’s diet has a lot in common with the well-known Paleo diet.”

“Davis’s results sound impressive, Julie, but adhering to a wheat-free diet would be difficult.  I would have to make toast from rye bread and give up frosted cupcakes and weissbier (beer made from wheat).”  

“But Curmudge, all of these diets are demanding, and it’s hard to get enthusiastic about eating a bunch of vegetables.”

“Try juicing or blenderizing them, Julie.  I haven’t tried that yet, but Doc Mack has.  The first step is to buy a blender, and it’s critical to find one that is easy to clean. (1, p. 28)”

“We can’t leave nutrition without considering smart shopping.  Look for a store that uses the NuVal system for evaluating food nutrition. The system considers 30-plus nutrients and nutrition factors – the good (protein, calcium, vitamins) and the not-so-good (sugar, sodium, cholesterol).  And then it boils it down into an algorithm that gives a score from 1 (bad) to 100 (good) for each food item.  These numbers should be visible for each item in a store that has adopted this fairly new system.  I’ve seen some of these numbers in the local Festival Foods.  So, Professor, we’re at the end of another class.  Do we have a final observation for our readers?”

“When I’m in a restaurant or in the hospital where I volunteer, there seem to be lots of obese people.  But in my apartment complex, where most of the residents are over 80 years old, very few people are obese.  I think I know why.  Bon appétit, Julie.”      

Kaizen Curmudgeon

(1)  Blaylock, Russell L., MD  Natural Strategies for Cancer Patients (2003, Kensington)

(2)  Yance, Donald R.  Herbal Medicine, Healing & Cancer (1999, McGraw-Hill)

(3)  Sears, Al, MD  P.A.C.E. (2010, Wellness Research and Consulting)

Link to posting from blog archives: Patient Safety—Communications 1/22/09

http://kaizencurmudgeon.blogspot.com/2009/01/patient-safety-communications.html

Alternative Medicine 2—Words of Wisdom and Caution

“As I recall, Curmudge, you had an unfortunate brush with alternative medicine 20 years ago.”

“I had almost forgotten, Julie.  I had tendonitis in my arm, and a colleague gave me some capsules containing the Chinese herb, ma huang (ephedra).  Assuming that a billion Chinese can’t be wrong (they were), I took a couple.  My head felt like it was going to blow off; my blood pressure must have gone through the roof.  The effects soon subsided, but not before I trashed the rest of the capsules.  I have since learned that although ephedra is presumably banned in the U.S. due to serious side effects, it is still available for weight loss under appetizing names like ‘Green Stinger’ and ‘Yellow Bullet.’ “

“And more recently, Old Guy, you saw an article on page 1 of the 7/25/13 issue of USA Today telling about the dangers to bodybuilders of questionable supplements…stuff with names like ‘Craze’ and ‘Superdrol’ “

“Believe it or not, Julie, the vendor set up his business from his jail cell.” 

“Now that we have our readers’ attention, Curmudge, what resources are available to guide consumers away from supplements that might be ineffective or dangerous and assist them in finding alternative medicines of potential value?”

“There are a number of databases that are quite comprehensive.  Listed below are some with hyperlinks:

Natural Medicines Comprehensive Database (Professional Version [by subscription]) http://naturaldatabase.therapeuticresearch.com/home.aspx?s=ND&cs=&referer=none&logout=1&logoutcomplete=1

Kaiser Permanente Consumer Information  and Education (Same database as above in which searches are free.)

Kaiser Permanente Database (vitamins, herb, and supplements)

Office of Dietary Supplements  (Nat’l. Institute of Health.  Making Decisions.)

Dietary Supplements: What you need to know to stay safe and avoid fraud.  (From Human Performance Resource Center,  Department of Defense)

Kaiser Permanente  Which websites are reliable?

National Center for Complementary and Alternative Medicine (NCCAM): Herbs at a Glance. How Safe Is This Product or Practice?  These are lists of items that can be searched.”

“You know, Old Guy, there are also extensive lists of questionable associations, institutes, and presumed educational and research organizations in Quackwatch.  The name of the site speaks for itself.  Quackwatch also has a list of doctors that they call Promoters of Questionable Methods or Advice.  Another Quackwatch database is A Message to Cancer Patients Seeking Alternative Treatments.  Of special interest are the treatments and information sources that are absent from their nonrecommended lists.”

“Julie, I wish that I were confident that Quackwatch is accurate and up to date.  A few people and organizations appear to be listed because they were on the wrong side of conventional wisdom.  Examples include Dr. Russell Blaylock, Dr. Mehmet Oz (TV), Suzanne Somers (actress), and NCCAM (database above).  Sometimes I wonder who is watching Quackwatch.”

 

“In any case, Curmudge, after looking at these databases I can see why you are impressed.  If one searches on a substance, the database answers questions like: ‘What is it?’ ‘Is it effective?’ ‘How does it work?’ ‘Are there safety concerns?’ ‘Are there any interactions with herbs and supplements?’ ‘What other names is the product known by?’ “

“Also, Julie, the report from the Department of Defense lists some alerts on product labels.  There are notes of what should be there as well as statements to look out for such as claiming to cure a wide range of diseases.  I was interested in their list of problematic ingredients that included my nemesis, ephedra.”

“Common advice also is, ‘Talk with your health care provider.’ “

“That’s great advice, Julie, but after studying these documents you might know more about the product of interest than the doc does.  To make the conversation more productive, you might give him or her the appropriate documents ahead of time.  Incidentally, this problem has not gone unnoticed by physicians.”

“If we end our Alternative Medicine series right here, Curmudge, we will be leaving our readers pretty much up to their own devices.  You have read quite a bit about alternative medicine.  Despite your total lack of formal qualifications, is there more information on this topic that we can share?”

“I believe the info presented in this posting is a pretty big gulp for our readers, so let’s ring the chapel bell to end the lecture.  But next week we’ll share our further perceptions on Alternative Medicine.”

Kaizen Curmudgeon

Link to posting from blog archives: Patient Safety—Medications 2 1/14/09

http://kaizencurmudgeon.blogspot.com/2009/01/patient-safety-medications-2.html    

Alternative Medicine 1--Introduction

“Here we go again, Curmudge, tackling a topic on which the people with real knowledge of the subject fall into two camps.  Last spring it was low doses of ionizing radiation with the linear no-threshold theory vs. radiation hormesis.  Then we talked about anthropogenic global warming with the consensus vs. the contrarian perspectives.  Now you want to discuss conventional or allopathic medicine vs. alternative or complementary medicine?  So what is this alternative medicine stuff anyway?”   

“ ‘Any therapy that is typically excluded by conventional medicine, and that patients use instead of conventional medicine, is known as alternative medicine.‘  Alternative medicine includes use of natural products (herbs, vitamins, minerals, and probiotics) as well as mind and body practices (acupuncture, meditation, relaxation techniques, and movement therapies).  Julie, if you’d like a detailed discussion of herbal medicine—including history—check out Herbalism in Wikipedia.  You’ll be pleased to know that some alternative therapies are scientifically validated, although some are not.  ‘Integrative medicine combines mainstream medical therapies and alternative therapies for which there is some high-quality scientific evidence of safety and effectiveness.’ “ 

“Wow, that sounds exciting and, thankfully, reassuring.  But tell me how, Old Guy, did you get onto this alternative medicine kick, anyway?  As I recall, back on 9/23/10 we began a five-posting series on Evidence-Based Medicine.  That’s as main stream as medicine can get.”

“Right after we finished that series Mrs. Curmudgeon was diagnosed with an interstitial lung disease.  The pathologists could not agree on whether it was a treatable or terminal form.  Hoping it was treatable, prednisone—with all of its side effects including a lowered resistance to disease—was prescribed.  Then while studying the medical literature, I saw an ad for a purported alternative treatment.  I asked the doc, ‘is this snake oil?’  His reply was, ‘probably.’  At that point I decided that the alternative med might be a viable last resort.”

“I remember, Curmudge, that Mrs. Curmudgeon contracted pneumonia an top of the interstitial lung disease and died within a month.  There wasn’t time to take her to Mayo’s or implement any sort of Plan B.  In retrospect, the alternative med could not have done any less for her than the prednisone.  You were devastated.”

“And I still am.  The thought occasionally crosses my mind, ’we might have saved her.’  So that, Jaded Julie, is why we are talking about alternative medicine.”

“As I suggested earlier, Curmudge, it seems that that we have come upon another of those two-camps issues like global warming.  And members of each camp use extreme examples in describing the ‘other guy,’  The alternative medicine docs accuse the conventional or allopathic docs of being in cahoots with ‘big pharma.’  In reply, conventional physicians accuse natural medicine purveyors of being ‘quacks’ making big profits from gullible patients.  While in reality, all the patient wants is to feel better or be cured irrespective of the source of the medication.”

“Right as usual, Julie.  You and I are learning enough to give our readers a modicum of knowledge of the differences between the two main types of medicine and some guidance on where they can learn more.  That’s about all we can hope to do in a blog.”

“Before we get too deep into this stuff, Old Guy, please briefly tell me more about the differences between allopathic and alternative medicine.”

“Let’s start with allopathic.  A person with an illness goes to her primary care physician—an MD or DO—is diagnosed and given a prescription.  She takes it to a pharmacist who dispenses an FDA-approved medication.  The med is most commonly a synthetic organic compound developed by a major pharmaceutical company based on their knowledge of the cell biology and biochemical pathways impacted by the disease.  If the disease is cancer, the compound (not always synthetic) is called chemotherapy; and it’s in a race to kill or arrest the disease before the side effects of chemotherapy kill the patient.  Our series on The Ordeal  last February described the torments of chemotherapy, but it seems to have cured my friend of his non-Hodgkin’s lymphoma.”

      

“Thank God for that, Old Guy.  So if allopathic meds have FDA approval to attest to their safety and efficacy, what comparable assurance do we have for alternative meds extracted from natural products?”

“That’s one very important issue that we’ll consider in detail later, Julie.  For the moment, we can derive a little bit of confidence from the experience of ancient Greek, Chinese, Arab, and other practitioners over a thousand or more years.  If these ancient healers didn’t achieve some success, they would have become unemployed or possibly burned as witches.”

“Okay, Curmudge, why don’t the formulators of modern alternative medications do the necessary testing of safety and efficacy and obtain FDA approval?  Then their preparations would be designated conventional medicine.”

“More and more testing is being done, Julie.  However, most of the makers of alternative medicine preparations are not major corporations, and Phase I, II, and III clinical trials are very expensive to conduct.  Additionally, for a double-blind study, it may be difficult to design a placebo (sugar pill) that looks exactly like an herbal concoction.  Perhaps the best route for a little guy with a potential blockbuster drug is to be acquired by a major pharmaceutical company.  Of courser, some purveyors of alternative meds are already making sufficient profit that they might consider conducting trials and seeking FDA approval to be not worth the trouble.  And finally, some others feel that if an alternate therapy is not based on a plausible scientific mechanism, a clinical trial is not appropriate.  After all of that, use of an approved ‘miracle drug’ is never a sure cure for an individual patient anyway.”

“I have an idea, Professor.   We’ve talked a lot today, and it’s time for a cool one (glass of water).  Perhaps we should assign Wikipedia’s excellent introduction to Herbalism as a homework assignment for our readers.  Then we’ll move on to searchable databases in our next session.  Also, you neglected to mention the Mayo Clinic’s comprehensive and authoritative Book of Alternative Medicine. (1) ”

“Jaded Julie, what would I do without you?”

Kaizen Curmudgeon

(1) Mayo Clinic Book of Alternative Medicine, 2d ed. (2010, Mayo Foundation for Medical Education and Research)

Link to posting from blog archives: Patient Safety—Medications 1/08/09

http://kaizencurmudgeon.blogspot.com/2009/01/patient-safety-medications.html