Monday, October 26, 2009

Do your homework before using alternative treatments (Marin IJ)

A FRIEND asked me this year for medical advice about an affliction that was puzzling and disturbing him.

Why, he wondered, had his sense of smell deserted him. The condition began with a bout of the sniffles, but weeks later and snot-free, it persisted. He could faintly pick up some scents, but only with great effort - such as if he leaned over a bowl of onions or buried his face in a lilac bush.

I was perplexed, but not overly concerned. I told him that it was probably the lingering, but temporary, effects of a cold.

A month went by and my friend's problem persisted. At best, he could smell 15 to 20 percent of normal and if he got the least bit congested, that sent him back to zero.

Now concerned, I considered the day-to-day ramifications of his condition; 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 smell can warn of imminent danger; as with the decayed cabbage of a propane leak, the garlic odor of toxic organophosphate chemicals or the bitter almond of cyanide gas on the loose.

This past June, as I was just beginning to appreciate the extent of my friend's loss, I saw a news headline that offered a clue to its cause: "FDA says Zicam Nasal Spray can cause loss of smell."

The Food and Drug Administration, based on 130 different complaints,
was advising 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. And he recalled it quite clearly because the product had caused an immediate and intense burning sensation. Thus, he was not surprised to learn of the FDA's notice - he had long suspected that his loss of smell was due to Zicam. But, he was frustrated; Zicam was 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 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 use alternative therapies. This is not surprising; a CDC survey study of 32,000 Americans found that 38 percent of adults and 12 percent of children had used some sort of alternative medical therapy in the previous year.

Rarely do I encounter people who 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 the woman with a devastating vertebral artery dissection after a chiropractic adjustment or the young man with gastrointestinal bleeding caused by a Chinese herbal medicine.

And I am also aware that most alternative treatments are of no proven benefit.

There are exceptions, such as fish oil and melatonin, but these are rare. In fact, recent studies have rebuffed the therapeutic clams of St. John's Wort, Vitamin E, and Gingko Biloba. This evidence, coupled with the often-disingenuous marketing of alternative products has made me inclined to view anything labeled "natural," or "homeopathic" with suspicion.

For example, during a recent foray 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). Ironically, some of the folks who purchase these aggressively priced products are the same ones who consider childhood vaccines a moneymaking scam.

Traditional medicine is far from perfect, and I have, in sum, seen far more complications from conventional treatments than from alternative therapies. Pharmaceutical companies and medical device makers use disingenuous marketing and some physicians prescribe medications of dubious value. But nonetheless, the basic process by which mainstream medical therapies are evaluated is much more rigorous, evidence-based and safety-conscious than that of alternative 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 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 grow and entrepreneurs will have to scramble to develop a new line of "miraculous and all natural" treatments to fill the void and empty the wallet.

So, far be it from me to tell people not to use unproven alternative treatments - for some these therapies help.

What I advise, however, if that before you use a new homeopathic product picked off the shelves of your local vitamin emporium is to exercise 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. Otherwise, you should be prepared to contact your friendly product liability lawyer. Speaking of which, if anyone has a recommendation, I have a friend in need.