“Here, let me kiss it and make it better.”

— moms from time immemorial

In a recent post on wellness and woo, a commenter pointed me to one of the most interesting articles I’ve ever read about medicine: Placebos Are Getting More Effective. Drugmakers Are Desperate to Know Why. The most interesting part of the article (for me) was the idea that — rather than dismissing the placebo response as gullibility and a nuisance to research — it’s an effect that scientists can research, to benefit patients.

One finding was that the health-care practitioner’s empathy can give the placebo response a huge boost:

Volunteers in the third group got the same sham treatment from a clinician who asked them questions about symptoms, outlined the causes of IBS, and displayed optimism about their condition. Not surprisingly, the health of those in the third group improved most. In fact, just by participating in the trial, volunteers in this high-interaction group got as much relief as did people taking the two leading prescription drugs for IBS. And the benefits of their bogus treatment persisted for weeks afterward, contrary to the belief—widespread in the pharmaceutical industry—that the placebo response is short-lived.

That immediately reminded me of this cartoon discussion of Homeopathy. Despite being just a cartoon, it’s correct that people derive benefit merely from talking to a practitioner about their symptoms.

There’s one big obstacle to using the placebo response in a clinical setting: by definition, the patient has to believe that s/he is getting a real treatment in order for it to work. If the practitioner is intentionally lying, that raises real ethical questions. And if the practitioner is not lying (and believes the bogus treatment is real), that’s even more dangerous. The intentional liar (like the mom who kisses the boo-boo), knows to get a real doctor if the condition is serious. As outlined in the cartoon above, a Homeopath will often continue to recommend only placebos, even in cases (eg. cancer, vaccines) where that advice is totally inappropriate.

Even aside from the danger, there’s the ethical question of selling goods and services through deception and fraud. Here’s a personal example of what I mean:

A couple of years ago, one of my kids came down with pink-eye (conjunctivitis). So I went to a local pharmacy (here in Zürich) and asked the pharmacist to recommend a treatment. I bought the one she recommended. When I brought it home to my husband, he pointed out something I hadn’t noticed — the product was marked “Homéopathie” — and he told me that means it’s just a placebo.

Now, I consider myself to be a relatively well-informed and well-educated person. But a couple years ago (when I bought this product), I had no idea what “Homeopathy” was. As soon as my husband told me it was a placebo, my immediate reaction was that that can’t be. A professional pharmacist isn’t going to recommend me a placebo when I ask for a medicine for my sick child, right? Homeopathy sounds so homey — I figured it must just be another word for “home remedies.” You know, like herbal tea, which might potentially have a physical effect (even if it’s not the same as medicine).

Nope. Homeopathy is not “home remedies.” I later learned that Homeopathy is water. It is placebo pills whose active ingredient is water. (For details, see this earlier post on Homeopathic teething remedies.)

Once I found this out, it pissed me off that the pharmacist would take advantage of my ignorance like that. I know that I’m not an expert on medicines, which is why I went to a professional — and I expected ethical, professional advice. I won’t call it fraud because I’m not 100% certain she didn’t say the word “Homeopathy” at some point when she was pulling this choice off the shelf for me. But since I had no idea what Homeopathy was, the word would have gone right past me without my notice. She certainly didn’t make it clear that she was suggesting an “alternative” or “complementary” medicine. If pharmacists’ professional organizations don’t have guidelines about this sort of unethical behavior, they should.

So the question remains: Is it possible to use the placebo response ethically and responsibly? It’s quite effective and useful in a lot of cases — it seems a shame not to use it. Based on the findings in the above-linked article, I think the following would work:

Create a class of medical practitioners who have enough medical training to dispense basic advice and (important!) who know how to identify symptoms that are serious enough to require referral to a doctor. This practitioner would listen carefully to the patient’s symptoms and offer appropriate suggestions. For example: “Take an aspirin, and if the fever doesn’t go down in a few hours, call a doctor,” or “If you get plenty of rest, your condition should go away in a week or so — come see me again in a few days, and we’ll see how it’s progressing.”

Logically, this should yield the benefits of the placebo effect without the disadvantages. It wouldn’t give any money to “big pharma” — or to the big business of Homeopathy — but it might help some patients. Thoughts?

One of the things that has been recommended to me many times are homeopathic teething tablets or drops such as Hyland’s.  People swear  it is the ONLY thing that worked for their kid.  They say that they are “all natural” and “completely safe” so there is no harm in trying them! Well, I’ve done some research on homeopathy and yes, homeopathic remedies are completely safe, but it is doubtful that they actually work.

Homeopathic products often get lumped in with natural or herbal products. This confusion is completely understandable. Homeopathic products are marketed that way and are sold next to herbal products and vitamins on store shelves, but homeopathy is a distinct and specific form of alternative medicine.

What is Homeopathy?

Homeopathy was developed in the late 1700s or early 1800s by Samuel Hahnemann and is based on two main principals:

The law of similars or “like cures like”

The law of infinitesimals or minimal dose

The law of similars states that a disease can be cured by administering a substance that causes similar symptoms in a healthy person.

The National Center for Complementary and Alternative Medicine (NCCAM) explains it like this:

The principle of similars (or “like cures like”) states that a disease can be cured by a substance that produces similar symptoms in healthy people. This idea, which can be traced back to Hippocrates, was further developed by Hahnemann after he repeatedly ingested cinchona bark, a popular treatment for malaria, and found that he developed the symptoms of the disease. Hahnemann theorized that if a substance could cause disease symptoms in a healthy person, small amounts could cure a sick person who had similar symptoms.

Abchomeopathy.com uses this example:

For example, if the symptoms of your cold are similar to poisoning by mercury, then mercury would be your homeopathic remedy.

By that logic, if I’m having trouble sleeping I should drink a very small dose of caffeine. I’m just sayin’.

In Hahnemann’s defense, he developed his principal at a time when the predominate medical theory was to “balance the body’s humors” by treating a disease with its opposite which included letting out the offensive matter causing the illness by bloodletting, purging or enemas. His law of similars was at least partly a reaction to these horrifying and harmful practices. The thing is that when people got more information about how the body and the world work, bloodletting was abandoned in favor of a more effective and provable system.  But homeopathy continues to use the law of similars even though there is no conclusive evidence that it is effective or even plausible.

The law of infinitesimals states that the smaller the dose of the medication, the more effective it will be.

Again NCCAM explains it like this:

The principle of dilutions (or “law of minimum dose”) states that the lower the dose of the medication, the greater its effectiveness. In homeopathy, substances are diluted in a stepwise fashion and shaken vigorously between each dilution. This process, referred to as “potentization,” is believed to transmit some form of information or energy from the original substance to the final diluted remedy. Most homeopathic remedies are so dilute that no molecules of the healing substance remain; however, in homeopathy, it is believed that the substance has left its imprint or “essence,” which stimulates the body to heal itself (this theory is called the “memory of water”).

ABC Homeopathy explains it like this:

Minimal Dose
The remedy is taken in an extremely dilute form; normally one part of the remedy to around 1,000,000,000,000 parts of water.

That’s a trillion! That’s a whole lot. That is so much that the likelihood of there even being one molecule of the substance left in the remedy in your bottle is next to zero.

The “law of minimal dose” contradicts the laws of chemistry, physics (yes, even quantum physics) and, in my opinion, common sense. By this logic, the less alcohol you drink, the more drunk you should feel. (This isn’t an actual claim made by homeopaths, but I’m using it to illustrate the point.)

As NCCAM states above, homeopaths believe that the healing substance leaves its imprint or essence in the water and that the water has a memory of the substance. As of now there is no plausible explanation of how this can happen.  Even if water does have a memory, how does the water know to keep the memory of that particular substance and not all the other stuff (urine, fish spawn, etc.) that has been in it before?  Let’s say that homeopaths have a way to purify or flush the memory of the water, how does the water know not to remember the essence of the container that they shake it up in?

Even the NCCAM acknowledges that homeopathy is inconsistent with established laws of science:

Homeopathy is a controversial area of CAM because a number of its key concepts are not consistent with established laws of science (particularly chemistry and physics). Critics think it is implausible that a remedy containing a miniscule amount of an active ingredient (sometimes not a single molecule of the original compound) can have any biological effect—beneficial or otherwise.

I agree that if a remedy is truly homeopathic then it is safe and will have no harmful side effects. The problem is that it will have no positive effect either. Or at least no effect beyond that of a placebo.

From NCCAM:

Most analyses of the research on homeopathy have concluded that there is little evidence to support homeopathy as an effective treatment for any specific condition, and that many of the studies have been flawed. However, there are some individual observational studies, randomized placebo-controlled trials, and laboratory research that report positive effects or unique physical and chemical properties of homeopathic remedies.

From Wikipedia:

Health organizations such as the UK’s National Health Service,[121] the American Medical Association,[11] and the FASEB[103] have issued statements of their conclusion that there is no convincing scientific evidence to support the use of homeopathic treatments in medicine.

From Pub Med:

CONCLUSIONS: The findings of currently available Cochrane reviews of studies of homeopathy do not show that homeopathic medicines have effects beyond placebo.

Teething

Whenever Duncan seems to be in a lot of pain from teething I give him some infant Tylenol or Motrin and that seems to help, but if you are looking to avoid these medications there are plenty of other things you can try.

Remedies seem to fall into two broad categories: 1) cold things to chew on and 2) various textures to chew on.

In the first category there are any number of teething rings that you can put in the freezer.  I’ve also heard of people freezing bagels, carrots and pieces of fruit for the little ones to chew on. I know it sounds a little gross, but my son likes to chew on an ice cube wrapped in a clean washcloth.

In the second category, my son loves the Wee Play Hand and Foot Teether. You can also try plush toys or wooden teething rings.

Teething is no fun and all we can do is try and help our babies be more comfortable as they go through it. If you still have some of those homeopathic teething drops in your medicine cabinet, I recommend freezing them into an ice cube, wrapping a washcloth around it and letting your kid chew on it. That is the best use of a homeopathic remedy.

If you would like to learn more about homeopathy, here are some good articles and videos:

http://video.google.ca/videoplay?docid=2785985155605802136&q=James+Randi#

http://www.acsh.org/healthissues/newsID.632/healthissue_detail.asp

http://www.skepdic.com/homeo.html#why

The therapies often go beyond harmless New Age folly, the investigation found. Many are unproven and risky, based on flawed, preliminary or misconstrued scientific research.

Lab tests used to justify therapies are often misleading and misinterpreted. And though some parents fervently believe their children have benefited, the investigation found a trail of disappointing results from the few clinical trials conducted to evaluate the treatments objectively.

It is easy to understand the eagerness with which parents of afflicted children desire a cure. With one in one hundred U.S. children diagnosed on the autism spectrum by the age of 8, there are a lot of people searching for answers. As we’ve discussed on this site, the heartbreaking reality is that there are no answers at this point. No one knows what causes autism or what can best treat (or possibly reverse) the condition. This means there is rampant speculation and anecdotal evidence being spread amongst parents and others in the medical field, which can lead to a child participating in unproven and possibly dangerous treatments.

The article gives a few examples of the risky treatments being performed:

The investigation found children undergoing day-long infusions of a blood product that carries the risk of kidney failure and anaphylactic shock. Researchers in the field emphatically warn that the therapy should not be used to treat autism.

Children are repeatedly encased in pressurized oxygen chambers normally used after scuba diving accidents. This unproven therapy is meant to reduce inflammation that experts say is little understood and may even be beneficial.

Children undergo rounds of chelation therapy to leach heavy metals from the body, though most toxicologists say the test commonly used to measure the metals is meaningless and the treatment potentially harmful.

It is worrisome that there are vulnerable children being subjected to these sorts of alternative procedures without scientific evidence of their benefit. At best, some of these methods would do nothing; at worst, there could be serious health consequences. There is an example cited in the article of a 5-year old autistic child who died in 2005 while undergoing a chelation treatment in a doctor’s office.

Obviously, more scientific research is needed, quickly, to help stop the misinformation. Parents need treatment options that are backed by solid evidence and hold up in clinical trials. Only then can we be sure we’re not doing more harm than good.

I’ve been hearing a lot about Baltic Amber Teething Necklaces, and here’s a little photo of one from this site, which is just one place you can buy them.  The idea is that the succinic acid in the amber is released by the warmth of the baby’s skin and is a natural analgesic.

I couldn’t find any studies about this at all and I think I’ll stick to Infant Tylenol.  The obvious drawbacks of a baby wearing a necklace seem to have been noticed on this particular site, which states in a disclaimer:

Although we have never had any any incidents that have resulted in harm to infants, there is always a chance they will break the necklace apart and perhaps swallow one of the beads.

Um, duh.

If anyone does have any reliable information about how this necklace might actually work, I’m curious to read it. But since many of the sites selling these things also claim that the necklace will align my baby’s energy, I just have to be extremely skeptical about this one.

acupuncture doesn’t work as claimed, because people who seek an acupuncturist may need actual medicine, and treating with placebo is unethical because deception must occur for the response to be most effective. As for the endorphins, those aren’t anything special. You can get the same response by pinching your skin, running a mile, or having sex.

Get all your questions about acupuncture answered in one handy article.

By the time she died, she was the weight of an average three-month-old, her body was covered with angry blotches and her once black hair had turned completely white. [...] Any improvements in her condition after homeopathic treatment were short-lived, and the rest of the time she was irritable and in pain, crying whenever she was moved and taking refuge only on her mother’s breast.

Surely, these parents loved their daughter and wanted her to live. But they blatantly disregarded the advice of all the professionals consulted–even those in their homeland of India, where homeopathic medicine is an accepted equivalent to mainstream medicine. So, it’s important they be held accountable for the torture their daughter had to endure in her short life.

It’s such a shame, and hopefully this case will shed more light on the danger of homeopathy. It can kill.

One viewer went online to ask McCarthy what she would do if she could do it all over again. “If I had another child,” McCarthy answered, “I would not vaccinate.” A mother wrote in to say that she had decided not to give her child the MMR vaccine because of fears of autism. McCarthy was delighted. “I’m so proud you followed your mommy instinct,” she wrote. A year later, McCarthy was back on the show for an episode about “Warrior Moms,” which gave her another opportunity to expand on her claims about vaccines and autism. Oprah must have liked what she heard. McCarthy became a semiregular guest on the show, and in May, Oprah announced that her production company had signed McCarthy for a talk show of her own.

The article discusses Oprah’s fascination with The Secret, and this little story cracked me up:

I couldn’t imagine what a homeopathic vaccination could be. Homeopathy is well known quackery. That’s just the Wikipedia link, by the way, which says,

“Claims to the efficacy of homeopathic treatment beyond the placebo effect are unsupported by the collective weight of scientific and clinical evidence.”

If Wikipedia’s all over it, why does anyone believe this stuff would work? Science Based Medicine has several articles on the inefficacy of homeopathy, and here’s just one. Homeopathy claims to work on the “law of similars.” If you give a substance to an ill person that mimics the symptoms of the condition, that’s the best treatment for the problem. It’s…silly. And as it turns out, homeopathic preparations are so diluted that there’s just hardly anything of the “cure” in there anyway.

But I remember back before I knew all that, and just the word “homeopathic” sounded so reassuring, natural, and nice. So I guess I can see why people turn to it. They just don’t know any better. But come on, if Wikipedia knows, you should know by now.

So what could a homeopathic vaccination even be?

The only answers on my support group were about a homeopathic flu shot, and the name that kept coming up was Dr. Lauren Feder. And a quick search turned up her website. It looks like she is offering not actually homeopathic flu shots, but homeopathic flu treatments with an oral dosage.

But her website was alarming to me in terms of its overall stance on vaccinations. For example, she has an article entitled, “Vaccines: Pros and Cons.” Just the title gave me a sinking feeling in my stomach. What could the cons be? First of all, the list of cons is about six times as long as the only pro:

Most healthcare professionals believe that vaccinations are very effective. There is a widespread belief that vaccinations are responsible for the vast decline in many of our infectious and childhood illnesses. In comparison to the risks of the illnesses, it is commonly felt that vaccines are relatively harmless and pose very little risk.

The way this is stated is so absurd. “A widespread belief?” No, vaccinations ARE responsible for the decline of those diseases. It’s like she’s equivocating on this touchy issue, when really it’s just plain fact. “It is commonly felt” that vaccines are less harmful than the disease? What do you mean “commonly?” Just the use of the word common implies that those in the know–the uncommon–must feel that the vaccines are not harmless. What is going on here? This language is so wrong and misleading.

And then there are the cons, which just go on and on. Here’s one:

There are benefits from having an illness like chickenpox, measles mumps or rubella in that there is lifelong immunity following infection.

*Sigh.* That’s a hell of an experience to have in order to gain the benefit of immunity, especially since those diseases are potentially fatal. Is this doctor seriously advocating that children get the diseases rather than the vaccinations? I found an article linking the MMR with autism on her website. This article is not by Dr. Feder herself, and it’s from 2002. But the message is clearly that Dr. Feder believes vaccinations are risky. If you decide you’d like her as your pediatrician, she assures you that,

“We also have thimerosal (mercury) free vaccines for families who choose to vaccinate.”

Wait, “families who choose to vaccinate?” I remember when I asked my pediatrician about just an alternative vaccine schedule (before I did some reading and realized there’s no reason to do any alternative vaccine schedule). Our doctor must have to deal with these questions a lot, because she right away said, “When families tell me they don’t want to vaccinate, I tell them I can’t be their doctor, because I consider myself an advocate for the child.” We loved hearing that, and we reassured her that we were in no way anti-vaxxers. How can a doctor like Dr. Feder in good conscience respect the “choice” not to vaccinate and consider herself an advocate for kids?

It turns out Dr. Feder is “nationally recognized” and has appeared on TV and radio. So maybe some other bloggers or some of our readers have heard of her already. I didn’t know anything about her. She conducts workshops on “Vaccine Safety” in LA. I almost want to go to one, just to see what it would be like, but I’m afraid it would be too upsetting.

It doesn’t look like she actually has homeopathic vaccinations, but she has a whole bunch of other strange stuff on her website. There’s the page on “Non-toxic Environment and Feng Shui.” Really?

So this is where LA people are getting their odd ideas about what actually works. From doctors. Disheartening.

It happened again recently that I ran into an acquaintance who was doing acupuncture to help fertility. This happens all the time in LA, really, where many people believe in acupuncture, and where many, many women (at least in my circle) have put off having children until their late 30s or early 40s. I admit that I tried acupuncture myself, at a time when I was diagnosed with serious fertility problems. I spent a couple hundred dollars on sessions with needles and some pills with herbs. I never did take the pills, because I started some actual, medical fertility treatments and didn’t want to combine the medicine I was taking with an unknown element. And then, I decided the acupuncture was silly, so I stopped going.

My travails with infertility pretty much sealed the deal on my becoming a skeptic (or you could say a critical thinker, rational mom, or what have you), because I was embittered by my encounter with alternative medicine and supplements. I was, at one point, imbibing a two-ounce “shot” of wheatgrass every day, because I heard that this was supposed to help fertility. In fact, I heard that wheatgrass was supposed to contain all of the nutrients in a full pound of vegetables. All it took to prove the falseness of this claim was a quick glance at the back of a package of frozen wheatgrass, where the nutritional information is listed. Two ounces of wheatgrass really doesn’t contain the nutrients of even one vegetable, let alone a whole pound—of anything.

Steven Novella does a great job of breaking down the reasons to be skeptical of acupuncture here.

Essentially, it just doesn’t work, and there’s really no evidence that it’s ever worked. Yet, I know plenty of well-educated, well-spoken, intelligent people who will say, without any irony, “Oh, acupuncture is supposed to be great for fertility!” So how do smart people fall for this stuff? What’s the hook, and why do some of us bite? Why do we drink wheatgrass, take supplements, do yoga for fertility, or any number of other “treatments” whose efficacy is unproven?

Here are some thoughts.

1. My friends don’t lie. Word of mouth is powerful. I have no reason to doubt that my friends are honest people who mean well. If someone tells me she’s heard wheatgrass is effective, why would I think she’s offering a bogus waste of money?

2. I’m no doctor. I have only the smallest inkling of how ibuprofen works, but I know that it does. The explanation of chi and meridians might sound a little mystical, because we can’t see those things. But we can’t see germs, either. For those of us who are not doctors or scientists, a lot of things can sound plausible.

3. Desperation is a big motivator. I remember when I was singing the praises of wheatgrass, my mother, a medical professional, said something that fell on somewhat deaf ears: “Anecdotal evidence doesn’t really count.” In truth, there’s really not even good anecdotal evidence that wheatgrass helps fertility. But I read about it in a Chinese medicine book I bought. (So add that to the total money I wasted on Chinese medicine.) Wheatgrass is also discussed in Julia Indichnova’s book Inconceivable. She tries the entire spectrum of “natural” cures—juicing, yoga, acupuncture, wheatgrass, colon cleansing. Eventually, in spite of high FSH diagnosis (this was my diagnosis, and it’s not an easy one), she conceives naturally, and she attributes this conception to her change in lifestyle. So many women I know with high FSH read this book like it’s the Bible. It’s a lifeline for them. When you are desperate, anecdotal evidence is hope, and it’s tough to hear otherwise.

4. The proponents are louder than the critics. When I’ve come clean with friends, or on discussion boards, about my skepticism regarding acupuncture, it’s like people come out of the woodwork to agree. But it takes a lot to get out on that skeptic dance floor alone and start the party. People who don’t believe in this stuff know better than to join the conversation. People who are embarrassed that they spent a lot of money tend to keep quiet. The default position, in polite conversation, is to nod and smile.

5. Fertility clinics pair up with acupuncture clinics. There are often brochures for local acupuncture and Chinese medicine clinics in reputable fertility clinics. This gives the impression that doctors endorse these treatments. And actually, some doctors do endorse them, which I find problematic and misleading. The fact that many women who are seeking alternative treatment are simultaneously using assisted reproductive technology just confuses the issue. A typical word of mouth endorsement from the louder proponents goes something along the lines of, “I tried three rounds of IVF, but the one with the acupuncture took!”

I actually have been tinkering with this post for a while, and in the meantime, I found Stephen Barrett’s list of reasons that people may become vulnerable to “quackery.” It looks pretty similar to mine.

He also has a nice article on “Why Quakery Persists.”

Steven Novella recently wrote a great piece on how Evidence Based Medicine is losing the battle against complementary and alternative medicine.

These two and others have been writing about skepticism for much longer than I have, and well, they’re doctors. I feel that my place in this whole affair is as a regular person, not a scientist, just trying to get the word out to other parents. It may be that quackery persists all over the country and the world, but somehow, living in Los Angeles, I just feel surrounded by it. I can’t go to any gathering of friends without hearing about some pseudoscientific treatment and having to simply be as polite as I can about it.

Often friends couch the suggestion to try alternative treatments in terms of thinking positively, implying that skepticism about acupuncture is tantamount to a lack of effort or open mindedness. And really, one could ask, what’s the harm of trying wheatgrass or acupuncture? They might not work, but could they hurt? And aren’t we all free to do what we like? If these things make us feel good, then what’s the problem?

If these treatments take the place of actual treatment, the big problem is that patients who are desperate to have children are actually doing nothing to further that goal. That is tragic, considering that often for women, fertility is a time sensitive issue, and time wasted on ineffective treatments means less time available for effective ones.

If women seek actual treatment in tandem with alternative treatments, the main problem is that they are wasting money that could be better spent on college funds, car payments, or even new wardrobes.

The most pernicious effect may simply be the continued persistence of the prevalence of these kinds of treatments, in spite of much evidence that they do not work. Because I believe that I wasted my money, I now speak up on the subject of acupuncture or wheatgrass, or many other alternative infertility treatments. It takes a gentle touch to do this, when talking about infertility, which is emotional issue for those enduring it. However, I sincerely believe that in addition to dealing with the hardship of infertility, women should not have to deal with the hardship of an empty bank account.

As it turned out, I conceived naturally and went on to have the world’s most perfect baby. It may have been that my brush with infertility was the result of a misdiagnosis. (I’ll try to cover this in another post.) Still, I was an older mom, and I got very lucky. I certainly have a continued empathy for anyone who is facing problems conceiving, which is why I believe it’s important to let women know that acupuncture and wheatgrass, along with many other supposed cures, are just a waste of time and cash.