Here's the rub: Right for the wrong reasons

MSNBC recently reported that Vick's vaporub may actually be harmful to young children. The case in interest was a grandparent who rubbed Vick's vaborub on their 18 month infant under the nostrils even the instructions say 1) don't put it under the nostrils, and 2)don't use in on infants or children under 24 months of age. I was interviewed for on online news service, Kaboose.com and you can read my comments here.

There are only two things that I don't like about Vick's vaporub. Unfortunately, it's the only two things that make Vick's vaporub Vick's vaporub. First, it's a petroleum based product. Do you really want to be rubbing toxic petroleum derivatives on your body? This stuff may cause cancer. Is that concerning to anyone?

The second thing I don't like is that Vick's vaporub uses three extracts from three essential oils: menthol from peppermint, camphor from camphor essential oil, and eucalyptol from eucalyptus essential oil. These compounds do really decrease cough, break up mucous and kill viruses. There are many, many, many studies that demonstrate that. If you read the case study I published on the use of essential oils in the intensive care unit, I've referenced it there.

When you use a whole essential oil, containing dozens of compounds, some of the compounds act like a partial antidote to the "main ingredient" which reduces harsh side effects when used properly.

Both menthol and eucalyptol--and for that matter peppermint and eucalyptus essential oils are too harsh for babies to tolerate. I have always warned against their use in this age group for the same reason as what happened to that toddler. There is a nerve in the nose--besides the smell nerve--that detects the smell of rotten, acrid or rancid smells--like rotten milk or spoiled meat. It causes the voice box to shutter and the airway to tight and secret mucous to protect itself from harm. Because these two oils are so strong, it stimulates not only the smell nerve, but also the this other nerve (the nasal branch of the trigeminal nerve). This is what caused the ferrets in the experiment and the baby rushed to the hospital to have a bad reaction.

The "expert" in the MSNBC article states:

“When you’re talking about an agent that does no good, your tolerance for harm is very low.”

but in adults, Vicks does improve the removal of mucous. Menthol does activate cold receptors and doesn't narrow airways--but so what? Do these experts think that suffering is better than feeling better because your brain thinks you can breathe easier? It's as if these guys have some type of schadenfreude in seeing people suffer in the real world? Peppermint essential oils, on the other hand does open up the airways, unlike menthol alone. Besides, pine essential oils like pine, spruce and balsam fir are much better and more gentle vasoconstrictors that open up airways.

The reason I made Flugon is because between adverse events from Vics (not to mention the petroleum!!!) and the deaths from over-the-counter cough and cold medications that the FDA overlooked for 50 years. I wanted a gentle but effective combination of essential oils that dissolves mucus, eases coughs, supports the immune system and has proven antiviral and antibacterial properties.

Essential oils--when used whole, in the right amount for the right age are amazingly effective in treating cold and flu symptoms in children and adults. The problem is that every chemical in this world can be a poison or panacea depending on the dose, the route given, the duration given, and the patient it's used on. The MSNBC article and the pseudo-scientific study they cited in ferrets only represents ballyhoo and sensationalism, which affects both media and medicine when there is an axe to grind and an agenda to pursue.

There is no alternative medicine, pt 2

Just before the new year I discussed an article in the Wall Street Journal by Steve Salerno entitled "The touch that does not heal." Perhaps it was meant to be simply an amusing piece because it was published in the "arts and entertainment" section and not the business section or the science section. However, I must say that it turned out to be a comedy of errors.

In my previous post, I discussed the philosophical roots of the two main forms of medicine: the rationalist and empirical schools. Here, I want to discuss some of the other points that the author brings up.

Mr. Salerno says in his article:

...what was once a ragtag assortment of New Age nostrums has metastasized into a multibillion-dollar industry championed by dozens of lobbyists and their congressional sympathizers.

The last time I checked, a noble prize winners Crick, Watson and Pauling, Harvard-educated Andrew Weil, and others are not "ragtag." There are literally thousands of MD's, DO's and others practicing some type of integrative medicine that is beyond the restrictive, reductionist concepts of 17th century Europe.

As for choosing the word "metastasized"? It has taken over 100 years for the concept of nutritional supplementation to treat illnesses to really catch on. Pauling coined the term "orthomolecular medicine" in 1967 but it is only recently that august organizations such as the American Heart Association have actually come to recommend supplementation with omega-3 fatty acids and co-enzyme Q10 for congestive heart disease, lipid problems and other issues. It has taken over 40 years since the first discovery of the "molecules of emotions" until today to simply start to understand the physiology of emotions and its impact on health.

Again, Mr. Salerno writes,

Not by coincidence is CAM most avidly touted by a loose alliance of self-help gurus (Andrew Weil, Deepak Chopra, et al.) and veteran hucksters like erstwhile infomercial king Kevin Trudeau. Mr. Trudeau has been sued for deceptive business practices several times by the Federal Trade Commission. In 2004, the agency deemed his sins so egregious that it barred him from "appearing in, producing, or disseminating future infomercials that advertise any type of product, service, or program to the public.

Dr. Weil, whom I personally spent a month training with as a medical student, works at the University of Arizona and is program is training MD's and DO's in scientific-based integrative medicine. Dr. Chopra is an endocrinologist who runs a private medical center in Encinitas not too far from San Diego, California. I personally worked with the Bravewell collaborative, a group of academic physicians who run integrative medical centers and research projects out of such institutions as Duke University and Scripps Medical Clinic. Not exactly a loose collection of hucksters.

As for Mr. Trudeau, he is not a physician. He is a huckster, and to mention him with Drs. Weil and Chopra is really egregious and duplicitous because on a quick read it sounds like all three have been investigated for questionable dealings.

Finally, I want to point out Mr. Salerno's amusing comments about aromatherapy:

and aromatherapy, which relies on the supposed healing properties of about 40 "essential oils,"

There are over 100 clinical studies and thousands of scientific studies about the healing properties of essential oils. Just go to pubmed, the free database of the US Library of Medicine and type the terms "aromatherapy" or "oils, volatile" and read some of the abstracts yourself. If you want to see the clinical studies, type "AND human." You can also read some full articles here.

It's funny that he puts essential oils in quotation marks. That is, in deed what the organic hydrocarbon compounds are called: essential oils. I've spoken a lot already about essential oils, so, you can view my first post from 2008 to review the evidence.

To your health in the new year.

There is no alternative medicine, pt 1

One Chris Salerno, a self-proclaimed sham watcher, wrote a scathing article in the Wall Street Journal recently. The thrust of the article was that any medicine that does not conform to today's standard's of scientific validity, and which does not have rigorous scientific validation is a sham. This article presents some very interesting biases that have plagued medical schools, hospitals and the National Institute of Health (the single largest investor in medical research in the world) for over 100 years.

Mr. Salerno quotes a former editor of the prestigious Journal of the American Medical Association (JAMA), Dr. Lundberg as saying, "There's no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data."

There is a monumental presumption of arrogance that Dr. Lundberg typifies and which has been falling apart at the seems for quite some time. What Dr. Lundberg, and the author by quoting him are saying is "It ain't medicine until I say it's medicine."

Au contraire, you may say. Surely, there must be some standards, right? Of course, there are standards, but when the people setting the standards used duplicity, the bully pulpit of government and economic sabotage, as the American Medical Association did in the late 1800's and early 1900's to become THE standard bearer of medicine, there is something wrong here.

Since the time of the Greeks, there has been a tug of war between the two schools of medicine: "rationalists" and "empiricists" and this continues even up until today. I will summarize it here, but for those who are really interested in this subject, I highly recommend Harris Coulter's Divided Legacy, volume IV.

Rationalists use deductive reasoning, meaning, they look at a big picture, break it down into its smaller parts, and then treat the parts. This is why we have diagnosis, that relies on symptoms. For example, a person comes to their doctor and says, "I'm depressed." The doctor asks some questions, and finds out that the person doesn't enjoy things they used to like, can't get out of bed, has increased appetite, trouble falling asleep at night, and has lost interest in sex. So, he prescribes an anti-depressant, a diet pill, a sleeping pill, and something for the sex issues. In this approach, depression is depression and once you're labeled as "depressed" you get an anti-depressant. End of discussion. Allopathic ("Western" or "Mainstream") medicine is best described this way.

Empiricists use inductive reasoning. This is where you take individual signs and build it up into a single diagnosis specific for that person. For example, in the case of depression, it is can be viewed as depression with loss of appetite, with increased appetite, with too much sleep or insomnia, etc. Each one is a separate illness and a single treatment may address all the symptoms which are related to each other. Homeopathy best fits this camp.

I was trained by the first school, the rationalist school, as all MD's and DO's are, but in truth, the more material science explores life at the level of hormones, and the vibratory, steiric and electromagnetic levels of receptor-chemical interaction, the more it validates what the empiricists were saying.

So, when Dr. Lundgren said that there is no "alternative medicine" he was right for the wrong reasons. There is only one type of medicine: a medicine that is an enterprise of healing not hurt, of health care not sick care, of prevention in its primacy, but which has answers for emergencies, a medicine that understands anatomy and physiology, but also appreciates the impact of emotions and spirit on the body. There is no alternative to healing and helping. It either works for an individual or it doesn't.

The lack of caring by busy MD's cannot make up for cure. In fact, because of the pressures put on doctors, they are forced to peg people into tidy little diagnoses and just give them some pill and get them out the door. This is why people are seeking "alternatives"--alternatives to factory medicine.

Let me give you a real example. I woman told me she was diagnosed with a thyroid problem and fatigue. She had the thyroid removed, which gave her a new disease: celiac's disease. She was given one drug for her fatigue, which gave her side effects, so they gave her another drug, which gave her side effects, so they prescribed a third drug to deal with the side effects of the second drug. Is this the medicine for which there is no alternative?

In my practice, I spend 60-90 minutes on the first visit because, as Hippocrates said over 2500 years ago, "The person who has the disease is more important than the disease the person has."

As a final note, "alternative" medicine is one of those colonial terms given by the medical establishment, like a dictator calling every dissenting voice "upstarts and rebels."

The term "complimentary" medicine came about by peace makers and medical "diplomats" if you will, who said, "Maybe this stuff isn't so bad. We should at least take a look at it." They thought, "Hey, we can use some zinc and antibiotics for colds, or massage therapy and Prozac when a person is depressed. The one compliments the other," hence "complimentary medicine. This was the uncle Tom approach. The house negro, if you will, the one who was good and compliant and tried to explain all the "alternative" therapies with purely biomechanical explanations that pleased his master at the NIH and prestigious medical schools.

Now, there is "integrative medicine" which was an addage coined by MD's and DO's who were not afraid to admit that they believed in vibrational medicine, acupuncture, and surgery at the same time, and wanted to integrate both approaches--rational and empirical--as two equals in a "power sharing agreement" if you will.

This is a really good start, but it is still not integrative because many of these MD's are still using a organ-based approach and a symptoms based approach and treating every symptom their patient has using a bag full of vitamins, herbs, massage and supplement in place of a bag full of prescription medication. Truly integrative medicine requires the ability to look at the causative factors of disease--the ultimate cause--and take an approach that restores the entire body to equilibrium by crafting a truly individualized plan to treat body, mind and spirit from the cell to the soul.

In part 2, I will take one a few of the more outlandish statements that Mr. Salerno made in his article.

Fresh Air: A report on Asthma Medications

The New York Times reported that the FDA published a warning about the use of combination asthma medication in children. These medications combine a beta-agonist that opens the airways with a steroid, that reduces swelling. Advair and Symbicort are the best selling versions of these drugs.

The FDA has been expressing its concern for some years now (read it here) that children who uses these medications are at risk of dying as a result of it. Other studies have shown that even using "rescue inhalers" like albuterol frequently increases the risk of dying and can actually worsen wheezing.

Over 10 years ago, the FDA expressed concern about the risk of death related to the use of Serevent, its maker, GlaxcoSmithKline did an internal study which is refused to publish the results of. It then took this potentially dangerous product and combined it with a steroid to get Advair now the biggest selling drug in its class. Then, in 2003, years later, it published the report which said that the FDA was right on this.

Aromatherapy can be amazingly effectively for treating mild asthma flare-ups in addition to treating the problems of asthma. For flare-ups, I nebulize the essential oils directly into the lungs. This should be arranged with a doctor experiences in this type of treatment. The convenient thing about aromatherapy is that it is effective inhaled on the skin (rub it on the chest for mild asthma flare ups) and taken internally.

I like to use a medical aromatherapy product called Aroma Aid as a compliment to my total treatment plan for Asthma. It contains lavender essential oil, which reduce histamine release that leads to swelling in the airways. It also has frankincense essential oil, which has a naturally occurring compound (leukotriene inhibitor) similar to medications like Singulair, without the side effects that those medications have. This decreases the cascade of inflammation. To deal with mucous and inflammation, Aroma Aid has peppermint essential oil.

DO NOT STOP ANY TREATMENT BEFORE CONSULTING WITH YOUR DOCTOR. IT IS IMPORTANT TO HAVE A PLAN TO DEAL WITH ASTHMA EMERGENCIES BEFORE STARTING TO DEAL WITH THE ROOT CAUSES OF ASTHMA. Here is a passage from my soon-to-be-published book, "Natural Cures for your child's cold and flu":

Asthma has become a national epidemic in the United States. There are many powerful medications to treat the symptoms of asthma and they can be life saving and give good relief of the discomforts of asthma. If you are interested in trying to reduce the number of asthma attacks your child suffers from go Natural treatments, below. They usually take a few months to reach their peak effects, so, continue with the treatment plan your doctor has worked out with you.

A treatment plan is more than a prescription for medication. It should include a clear, step-by-step treatment plan which includes “peak flows” for kids who are old enough to check how deep a breath they can take. For example, It would say: “If Miguel’s peak flow is less than 200, start giving him albuterol every 4 hours. If his peak flow is less than 180, start steroids and give the albuterol every 3 hours. If his peak flow is less than 150, please call my office, and go to an urgent care center or emergency department immediately.

Ultimately, it's important that the causes of your child's asthma are addressed, not just his or her symptoms. Children who suffer from asthma can have too much inflammation, too much mucous, or tight airways, or, a combination of all three factors. These factors themselves, arise from an imbalance in natural steroids, of a diet high in unhealthy foods, stress, a deficiency in key nutrients, like selenium, magnesium or vitamin C can play a role too.

To ensure that your child gets the best care possible, a pediatrician with experience in integrative medicine, or, a naturopath experienced in the care of children should be consulted to address diet, lifestyle, stress and other issues related to your child's health.

Lecture Update: First Aid with Aromatherapy

It's my passion to educate people on the value and joys of medical aromatherapy. To that end, it's been a busy week, so you'll excuse my delay in posting a blog.

I lectured at PANGEA, 2008 in New York City. I participated in a panel discussion on natural first aid treatments for the family. It was a fantastic panel and I was honored to sit with them. There was Aviva Jill Rohm, an herbalist and midwife of over 20 years experience, now in her final year of medical school at Yale University School of Medicine. She spoke about herbal approaches to first aid. There was Donielle Wilson, a superb naturopath and homeopathy. She spoke about homeoapthy for first aid. There was David Riley, a medical doctor, very fine homeopath and pioneer in integrative medicine (and yoga instructor!). He was the moderator and added some gems about homeopathy...And there was me. I spoke about aromatherapy and first aid.

As life tends to have that literary, ironic hue to it times, my son needed some first aid the night I was preparing for my talk. He got a black eye. It was only 15 minutes after his face was hit with the lid of a garbage can with its own agenda it his eye was swollen and bruised.

I quickly made a cold compress using hydrolats (floral waters). Hydrolats are the water-extract of plants that come from making essential oils ( you could say that essential oils are the oil-based extract left from making hydrolats). Hydrolats are the "other aromatherapy." Rose water is the best known hydrolat.

I took a sturdy paper towel and liberally soaked it with helichrysum and pine hydrolats. I put it on his face and put a bag of ice over his eye. After 20 minutes we took it off and looked at his face. He was so upset! The bruise had completely subsided and the swelling was greatly improved. He said, "Noooooo! I wanted a black eye on Monday to show my friends. Dad, now I won't look like I got hurt!" After the initial compress, we started arnica homeopathic and continued the helichrysum and pine internally--1 tablespoon combined with 4 oz of water twice per day. When I returned from New York 4 days later there was not even a trace of bruising or swelling.

This story is a great example of how medical aromatherapy is an important part but not the ONLY treatment modality to be used. It's just that it's very convenient and easy to easy and incredibly effective, and, with acute injury, it works faster than any other treatment I know.

Medical Quality Essential Oils

Medical aromatherapy is the science of using essential oils for health and healing. Medical aromatherapy has a 5000 year old history going back to the ancient Egyptians. Internal usage of essential oils is a safe and effective means of curing many illnesses and dysfunctions in the body, in children and adults if a safe concentration (1-10%) of the right essential oils is used. But most importantly, the right quality of essential oil must be used--medical quality.

Listen to a short, 3 minute discussion of medical quality essential oils here:



It's really important to know the quality of your essential oils because many companies that use essential oils in their products, including many reputable companies, do not know how to tell a quality essential oil from an adulterated one. You can, though with a sensitive nose.

When you smell an essential oil or a shampoo, soap, etc. that claims to have "pure" essential oils, pay attention to the feeling around your jaw and up the side of your head. If your jaw tightens up, or you feel a slight headache, or like there is a vice around your head, that essential oils has been adulterated--cut with a synthetic version of one of the naturally occurring compounds in that oil to "boost" the scent.

The most common oils they do this too are:

• Lavender
• Jasmine
• Neroli
• Citrus oils (Orange, Grapefruit, Lemon, Lime, Tangerine, Bergamot, etc.)
• Clove

Even more concerning than these cut oils are fragrance oils, sometimes listed:

• fragrance
• parfum
• fragrance oil.

Often times, they contain BPA (bis-phenol A) an endocrine disruptor that can cause damage to the human body in serious ways. Infants and children are the most susceptible to this because they have more surface area of skin relative to their weight. In fact, a recent study in the journal Pediatrics found that when infants, children and adults used lotions and shampoo containing BPA as "fragrance" it was absorbed through their skin, into the blood--just from a few minutes of exposure.

Now, I know that you know that the big guys use this stuff shamelessly in their "kids" lines, but I'm very disappointed to see that many of the "eco" and "green" companies fall trap to the Medusa of fragrance oils--even after they spent money using cheap essential oils.

Caveat emptor. Read your labels carefully and be well.

PS: BPA is in baby bottles, water bottles and lots of other products. Please look for BPA free products whenever possible.

Free at last: a short story about heart transplantation

I am posting this story about a patient I took care of while I was at Stanford University, where heart transplantation was first performed in humans. I am posting this as a follow up to my previous posting about Hannah Jones, the 13 year old girl in England who turned down a heart transplant due to a failing heart from the side effects of chemotherapy (Major minor: children's right to chose).

Free at last

Snip. She cut another paisley triangle, neatly stacking it next to the calico squares. “It keeps me busy,” she explained as I walked in to glance at the monitor. “I’m making a quilt for my first grandchild born just last week. I haven’t seen him yet.” She looked at her son, up at the monitor, then at me. It was almost midnight and I had come in to check on Luke before midnight rounds. His blood pressure was still too low but hadn’t changed in the last few hours. Not better, not worse; stably unstable. This oxymoron made sense in my world. It just did.

The last of eight children, he was the baby, the tall, pale one who always stood next to his mother in family pictures. He needed a heart and double lung transplant to survive. They had come from a small town in Nebraska to free him from a life of illness. When he was transplanted, Luke’s mother was ecstatic. But her joy lay in the sadness of others—she knew what had to happen for her son to have received a “donated” heart—and that troubled her. She saw two teenagers who had received hearts around the same time as Luke leave the ICU after a few days while her son languished here for weeks. Her sadness lay in the joy of others and that troubled her too—but to that she’d never admit.

It had been a rocky course from the beginning for Luke. His kidneys shut down from low blood pressure and infections. He was hooked up to a dialysis machine on his second day back from the operation. He was extubated, re-intubated, re-extubated, and intubated over and over again with a breathing tube because he was not even strong enough to breathe on his own and have his heart pump at the same time. Then he became infected again with God-knows-what. It wasn’t responding to any class of antibiotic we had on hand.

“We want everything done. But we don’t want him to suffer.” His mother would say to me. At this point, they were mutually exclusive requests, but that made sense in her world. It just did.

She and her husband came to learn our lingo and could infer a lot from the monitors and my face without us needing to utter words. They learned the semiotics of a raised eyebrow and stroked beard with and without cocked head. A glance at the vitals flow sheet with a “humph” was the most intolerable and I found a brief commentary to be de rigueur to put them at ease.

With each successive week, we spoke less and less about monitors and medications. Instead, at their request, we started talking basic physiology. I found myself explaining nine years of medical education in 15 minute sermons using metaphors of pipes, pumps and flowers. Then, our conversations became personal. I was seeing them more than my own wife and children and they hadn’t seen their other seven children or parishioners in weeks. We were both working shifts in order to take care of Luke. They alternated six hours on, six hours off at the bedside. As for myself, I was doing thirty hours on, eighteen hours off.

Setting her scissors down, she began to tell me how difficult it had been to raise eight children and be a minister’s wife. It was a life of sacrifice and she was content to live it only because she saw it as God’s will. It was a life lived in denial of comfort or privacy. She could never call her husband her own because he was wedded to his parish too. I laughed and told her that a physician’s wife had it no better.

The whirring of the dialysis machine filled a momentary silence; then she continued.

“I miss my home so badly, doctor. I miss having just one moment of privacy. Once, last week, I just wanted to go somewhere and cry. All the sleep rooms were occupied, someone was in the bathroom, and the family lounge was full of people. My husband came up to me and put a blanket over our heads and said, ‘Here’s our private space.’ And I cried until I couldn’t cry any more.”

Our conversation drifted to religion and she began complaining about those “liberal Christians”. I wondered if she knew or cared that I was Muslim. It didn’t matter to me either way. She was a mother. I was a father. That was commonalty enough for me. Birth has no creed, illness has no dogma, and sorrow is the universal paean of death.

She gathered up the strips of clothe and turned to me like a school girl at penance. “Doctor, I feel that Luke is suffering. I feel that he’s trapped in there. We thought that this transplant would free him from a life of constantly being ill.” I found myself playing minister and counseled her to be patient, saying “It will, it will.”

The next morning, considering Luke’s condition and his parent’s concern for his suffering, the decision was made to de-escalate care, a euphemism for “pulling the plug”. Curtains drawn, the door was closed and the cacophony of the ICU gave way to a heavy silence. One by one the machines were turned off until the whirs and beeps were replaced by whimpers and sighs. The breathing tube was removed. The pressure medicines stopped. Heavily sedated, Luke lay in a state between two states. Like snow drifting in a waning December wind, he laid somewhere between heaven and earth. After 18 years of suffering, 2 weeks of waiting, 3 weeks of struggle and 4 minutes of peace, it was over.

Bereft of clerical counsel, I hugged the reverend, letting the tears fall from his face unto my shoulder. Consoling his mother I said, “The suffering’s over. He’s free. Free at last.”