Heartburn: Now It's a Problem for Kids?

It's very troubling to have the expansion of heartburn medication to children and even infants.  Especially when we have no evidence that they are effective and we do have evidence that long term use of acid blockers affects bone health.  But without evidence, we're still seeing prescriptions for the medication.  Here's the expert meta-analysis from the Cochrane database.  I've highlighted the relevant sentence. 

Pediatrics. 2011 Apr 4. [Epub ahead of print]


Efficacy of Proton-Pump Inhibitors in Children With Gastroesophageal Reflux Disease: A Systematic Review.

van der Pol RJ, Smits MJ, van Wijk MP, Omari TI, Tabbers MM, Benninga MA.

SourceDepartment of Pediatric Gastroenterology and Nutrition, Emma Children's Hospital AMC, Amsterdam, Netherlands;

Abstract

Introduction: Use of proton-pump inhibitors (PPIs) for the treatment of gastroesophageal reflux disease (GERD) in children has increased enormously. However, effectiveness and safety of PPIs for pediatric GERD are under debate. Objectives: We performed a systematic review to determine effectiveness and safety of PPIs in children with GERD. Methods: We searched PubMed, Embase, and the Cochrane Database of Systematic Reviews for randomized controlled trials and crossover studies investigating efficacy and safety of PPIs in children aged 0 to 18 years with GERD for reduction in GERD symptoms, gastric pH, histologic aberrations, and reported adverse events. Results: Twelve studies were included with data from children aged 0-17 years. For infants, PPIs were more effective in 1 study (compared with hydrolyzed formula), not effective in 2 studies, and equally effective in 2 studies (compared with placebo) for the reduction of GERD symptoms. For children and adolescents, PPIs were equally effective (compared with alginates, ranitidine, or a different PPI dosage). For gastric acidity, in infants and children PPIs were more effective (compared with placebo, alginates, or ranitidine) in 4 studies. For reducing histologic aberrations, PPIs showed no difference (compared with ranitidine or alginates) in 3 studies. Six studies reported no differences in treatment-related adverse events (compared with placebo or a different PPI dosage). Conclusions: PPIs are not effective in reducing GERD symptoms in infants. Placebo-controlled trials in older children are lacking. Although PPIs seem to be well tolerated during short-term use, evidence supporting the safety of PPIs is lacking.

PMID:21464183

So let's all step away from treating colic, which is likely to be associated with overgrowth of bacteria, with acid blockers. 

I have extensive information on options for adults on my website:  http://www.maloneymedical.com/ under What Do I Treat? and GERD. 

How Many of Us Are Dying Because We Go To Our Doctors? (As Opposed To Dying Because We Can't Afford To Go.)

I'm often curious about the denial of the pretty clear reality that our medical system needs serious help.  One of the denial sticking points is the number of deaths directly attributable to medical care.  Let's be clear.  Almost everyone dies under medical care at some point.  But a fair percent of patients are helped on their way unnecessarily and prematurely by the very people who want to preserve their lives. 

We rank poorly (twelfth out of fifteen) in comparison to other industrialized nations' healthcare.  Before you blame the fat Americans, we rank 3rd lowest in smokers and fifth lowest in drinkers.  U.S. men 50-70 have the lowest cholesterol of the group.  So it isn't just that we're less healthy. 

"According to several research studies in the last decade, a total of 225,000 Americans per year have died as a result of their medical treatments:


• 12,000 deaths per year due to unnecessary surgery

• 7000 deaths per year due to medication errors in hospitals
• 20,000 deaths per year due to other errors in hospitals
• 80,000 deaths per year due to infections in hospitals
• 106,000 deaths per year due to negative effects of drugs
Thus, America's healthcare-system-induced deaths are the third leading cause of the death in the U.S., after heart disease and cancer.

Where am I getting all these disturbing statistics?  From the Journal of the American Medical Association, that den of alternative radicalism (seriously, one of the most conservative medical journals on the planet).  Here's the data written out at a radical blog and here's -WAIT-where is that pesky journal article?  Oh, right here on the JAMA website.  Oh, and if you had some concerns about Starfield's credentials, she works at John Hopkins.  So that's where we get our statistics. 

If you'd like a whole book on our chilling reality, check out Money Driven Medicine.

Differentiating between Naturopaths and Naturopathic Physicians.

For anyone not involved in the field, it can be incredibly difficult to differentiate the relative training and authenticity of degrees within alternative medicine.  Let me say that within all of medicine, it matters far more how ethical the person is than what degree they have. We all know stories of top ranked surgeons who have failed to practice ethically, and relative laypeople provide the backbone of much of our hospice and homecare structures.  So the degree doesn't matter in one sense.  But in another sense it really does matter, especially when it becomes the focus. 

Here's the information on Robert Theil.  "He is not a medical doctor, but is registered as a naturopath by the Federal District of Columbia, licensed as a Naturopath by the State of North Carolina, licensed as a Naturopathic Scientist by the State of Alabama and is licensed as a Naturopathic Physician by Bingham County, Idaho." 

Wow!  So if I were anyone other than who I am, I would think this guy is a naturopathic doctor, same as doc maloney.  Well, no.  Every place that he lists happens to not require a four year degree, boards, etc.  So he didn't go to Naturopathic medical school.  It doesn't mean he's a bad person, just that he's not licensed. 

In fact, the organization that Robert Thiel is a major member of, the American Naturopathic Medical Association, is the one fighting licensing and the medicalization of Naturopathy.  That's right, the ANMA is against the licensure of N.D.s  They run a program where you get a correspondence degree when you are board certified by the American Naturopathic Medical Certification and Accreditation Board.  Yep, they are board certified, not licensed.  It's kind of the cart without the horse, and if it seems confusing, it's meant to be.  It is this confusion, and the layering on of degrees without depth, that truly bothers me.  I have one degree, from one state, and it is more comprehensive than I can hope to master in my lifetime.  I can't imagine trying to fully master a variety of degrees from a variety of states. 

So a traditional Naturopath like Robert Thiel is not to be confused with the American Association of Naturopathic Physicians (http://www.naturopathic.org/) which is the professional group advocating for the licensure of N.D.s.  We all get licensed, and practice medicine, which includes diagnosing and treating disease.  In Maine, I do not use the term physician, but the term Naturopathic Doctor.  See http://maloneynd.tripod.com/naturopathicmaine/  But I was trained in Oregon, where we are Naturopathic Physicians. 

Now, I also saw a nice looking book from an English Naturopath, and I have no idea of her relative level of qualification.  It just shows the level of knowledge necessary to differentiate.  But it also matters what people do it their practices.  So, to show that differentiating does not mean discarding, have a look at both their books. 

Why We Get Fat: It's the Carbs or our Genotype?

Gary Taubes has a new book that explains why we get fat.  Guess what?  It has nothing to do with calories.  Well, it does to some extent, but what should be obvious from the title of his previous work is that all calories are not equal.
So Taubes sets out to convince that calories alone do not explain our weight gain.  Then he progresses on to basically say:  meat is good.  Carbs are bad.  The first part is great the second part has yet to be proven (NY Times reviewer agrees.)

Ok, I'm already convinced that calories don't work.  But I'll also say that low carb is effective for only some people.  Yes, it is an answer for a very select subsection of the population.  But the rest of us do not need a blanket prescription for low carb.  We need to look at individual variation in food choices. 

The D'Adamos had at least a little variety, although they based it all on blood type, which is only one factor in individual makeup.  Now Peter D'Adamo has moved on to genotyping the diet, which is really cool and hopefully leads to more options.  But it isn't the genes, it's the histones.  They determine the activation of the genes.  So maybe I'll get a jump on everyone and start promoting the Histone Diet (patent pending).  Watch for it!  

By the way, Taubes Good Calories book does a number on a lot of diet myths.  It just concludes the way he wants it to conclude, because we don't have the perfect diet data yet. 

Naturopathic Medicine: An Admirably Specific Tool.

Modern medicine is often done at the expense of individual.  You may get your own dosage of a medication, but that medication must meet with a very wide audience before it is truly profitable.  The so called "orphan diseases" rarely have researched medications specifically for them because they don't represent enough of a market. 

In the same way that a hammer can be used to open a bottle of wine, modern medicine can be used for any purpose.  But if one wishes to preserve the shape and texture of the human individual involved, Naturopathic medicine provides a far more elegant method of intervention. 

Just as a corkscrew winds its way deeper into the layers of an illness, drawing out the illness bit by bit to its core, so also does Naturopathic medicine wind itself to the heart of the issue and withdraw the entire issue in one go.  It is slower going, and the impatient patient who wishes instant results sees the explosive power of the pharmaceutical drug and is intoxicated.  But after a few years of opening up their illnesses with a hammer, few patients remain as enamored with the side effects of the methods used.  At that point they search out the slower, more specific route to health.  See http://www.naturopathic.org/ for your local licensed N.D.

Desiderata: Correcting the Errata.

I first came across the Desiderata as a poster that gave the date of production as sometime in the 17th century.  But the wording was always far too modern.  It was nicked from Max Ehrmann, a poet who lived at the beginning of the 20th century.  The story I like is that Max wrote the Desiderata as a personal set of notes for himself, and then decided to publish it.  It is different from much of his other work.  I'm reposting the poem here, for personal reference.  You can read more about Max on Wikipedia.  Or maybe even buy his book (the Multnomah county library copy had the Desiderata torn out when I went looking for it years ago).

Go placidly amid the noise and haste,


and remember what peace there may be in silence.



As far as possible without surrender

be on good terms with all persons.

Speak your truth quietly and clearly;

and listen to others,

even the dull and the ignorant;

they too have their story.

Avoid loud and aggressive persons,

they are vexatious to the spirit.



If you compare yourself with others,

you may become vain and bitter;

for always there will be greater and lesser persons than yourself.



Enjoy your achievements as well as your plans.

Keep interested in your own career, however humble;

it is a real possession in the changing fortunes of time.

Exercise caution in your business affairs;

for the world is full of trickery.

But let this not blind you to what virtue there is;

many persons strive for high ideals;

and everywhere life is full of heroism.



Be yourself.

Especially, do not feign affection.

Neither be cynical about love;

for in the face of all aridity and disenchantment

it is as perennial as the grass.



Take kindly the counsel of the years,

gracefully surrendering the things of youth.

Nurture strength of spirit to shield you in sudden misfortune.

But do not distress yourself with dark imaginings.

Many fears are born of fatigue and loneliness.



Beyond a wholesome discipline,

be gentle with yourself.

You are a child of the universe,

no less than the trees and the stars;

you have a right to be here.

And whether or not it is clear to you,

no doubt the universe is unfolding as it should.



Therefore be at peace with God,

whatever you conceive Him to be,

and whatever your labors and aspirations,

in the noisy confusion of life keep peace with your soul.



With all its sham, drudgery, and broken dreams,

it is still a beautiful world.

Be cheerful.

Strive to be happy.

The Most In Depth Discussion of Energy Work.

Despite their age, these are still the two most comprehensive books on energy work.  Preparation, explanation of phenomena, basic patient interactions.  I found the second book much more interesting in terms of depth and concepts.  A great deal of what is said dovetails off of the Course in Miracles.  If you make it through all the text at the beginning of that book, then you've got me.  I just skipped to the lessons (spoiler:  we're all one.) 

Tim Hawkins: A Little Southern Humor

Tim has finally explained to me the fascination with Chick-fil-A.  When we were in State Farm land outside of Chicago, everyone asked us if we'd been to the only Chick-fil-A in Illinois.  We didn't make the pilgrimage, but here's Tim singing a tribute.  Where are our songs about healthy food?  Besides cookie monster's rap, that is. 

Life is fleeting, breathe.

In every breath, a molecule of the air breathed by every fallen hero enters your lungs.  Rather than speculation, this is the simple reality of the recycling of oxygen in our atmosphere.  We are literally connected. 

http://www.youtube.com/watch?v=16MjXSj-Kek

Allergies

The application of sublingual desensitization is a necessary part of any allergy therapy.  We aren't supposed to be allergic to everything.  Check out http://www.maloneymedical.com/ under the What Do I Treat? page.  I just added a page on allergies.

A Naturopath's friend. The old Merck.

Every time they call alternative medicine old fashioned, pull out a copy of the original Merck manual and read about M.D.s dosing patients with arsenic.  We've come so far? Today we use methotrexate to treat RA, a disease caused by a bacteria.