Monday, June 29, 2009

Makes No Scents

Several months ago, a good friend asked me for some bar-side medical advice. Why, he wondered, had his sense of smell deserted him. The problem, he said, began with a bout of nasal congestion, but weeks later and snot-free, he was still sniff-impaired. If he leaned over a bowl of onions or buried his face in a lilac, he could pick up the smell, but just faintly. I was somewhat perplexed, but not too concerned – probably the lingering effects of the cold, I told him, and his sense of smell should return eventually.

Weeks later, my friend’s problem persisted. At best, he could smell 15 or 20 percent of normal, and if he got the least bit congested, then he went back to zero. Now concerned, I considered the day-to-day ramifications of his condition (the medical term for which is anosmia); savory meals unappreciated, spring days muted, underarm ripeness untreated and backyard canine bombs unnoticed. And, I contemplated the notion that while modern civilization has diminished the survival importance of a keen sense of smell, there are situations where a working sense of smell can warn of imminent danger; the decayed cabbage of propane, the garlic odor of toxic organophosphate chemicals or the bitter almond of cyanide gas.

As I was just beginning to appreciate the extent of my friend’s loss, I saw a yahoo news headline that offered a clue to its cause: “FDA says Zicam Nasal Spray can cause loss of smell.” The Food and Drug Administration (FDA), based on 130 different complaints, had advised consumers to stop using Zicam’s nasal gel and swab products. I asked my friend about Zicam and yes, he had used their nasal swab many months before. He recalled it clearly in fact, because the product had caused an intense burning sensation in his nose. Thus, he was not surprised when I informed him of the FDA’s notice – he had long suspected that his loss of smell was due to Zicam. But, he was frustrated; Zicam is a homeopathic brand – natural and presumably safe. And, sadly, that is where he and many others had been led astray. As a recent onslaught of news reports (including Dr Elliott’s column in this paper last week) have emphasized, alternative treatments (such as homeopathic preparations) are not guaranteed to be either effective or safe. In fact in some cases they are far riskier than conventional treatments. This I know from my own practice.

As an emergency physician, I treat many patients who are using alternative therapies. This is not surprising; a recent CDC survey study of 32,000 Americans (including 9,400 children) found that 38% of adults and 12% of children had used some sort of alternative medical therapy in the previous year. Rarely, do I see people who seem to clearly benefit from alternative therapies (although I know there are many who do). Rather, I see those people for whom they have gone awry; such as a woman with a devastating vertebral artery dissection after a chiropractic adjustment or a young man with severe gastrointestinal bleeding caused by a Chinese herbal medicine. And I am also aware that most alternative treatments are of no proven benefit. In fact, recent well done studies have rebuffed the therapeutic clams of St. John's Wort, Vitamin E, Selenium and Gingko Biloba. Combine this with the barrage of disingenuous marketing on packaging and T.V. and I’ve become inclined to view with suspicion anything "alternative," "natural," or "homeopathic." On a recent trip to my local, premium-priced natural food store, I encountered one homeopathic medicine of dubious value after another: Bronchial Wellness Herbal Syrup ($19.98 for a plantain-laced elixir), Male Sexual Vitality Tonic ($16.79 based on ginseng’s supposed and unfounded libido stimulation properties) and ChlorOxygen ($17.98 for a “cleansing” product primarily designed to cleanse the wallet).

Traditional medicine is not without its faults, and I have, in sum, seen far more complications from conventional treatments than from alternative therapies. Nonetheless, the basic process by which mainstream medical therapies are evaluated is much more rigorous and safety-consciousness than that of complementary ones. Fortunately, this is starting to change, in large part due to the work of the National Center for Complementary and Alternative Medicine (NCCAM) – the branch of the National Institute of Health (NIH) that recently released its research into Gingko and St. John's Wort. As NCCAM’s work continues, I suspect that the list of discredited alternative therapies will keep growing and entrepreneurs will have to scramble to develop "all natural" treatments to fill the void. And, there will be some treatments added to the now short list of effective alternative therapies – which include fish oil, red yeast rice and melatonin.

So, far be it from me to tell people not to use alternative treatments – for some people these therapies help. What I advise, however, if that before you use a new homeopathic product picked off the shelves of your favorite natural food store is to do some due diligence; take a look at the ingredients, google the product online to search for pending lawsuits or claims of harm, and look it up on quackwatch ( and the NNCAM site ( If everything checks out, use with caution. If not, be prepared to contact your friendly product liability lawyer. Speaking of which, if anyone can recommend one, I have a friend in need.