Monday, July 30, 2018

A Few Bits From the Summer...

Even if I haven't been posting here in a while I have been writing. Recently I submitted the findings of a research study I performed to a medical journal. I said before that I was going to give my readers here a preview of the findings.

I looked at the data from a couple of years' worth of new patients, but when I did so, I did it by letting chance choose whose chart data to review. This means I didn't get to "cherry pick" all the good ones! As with any medical technique, some people didn't find what they'd hoped for; that is, they didn't get better. But the good news is that two-thirds of people did get better!

One of my goals was simply to try to determine how well homeopathy works in practice, rather than in clinical trials, which themselves are very controlled. I wanted to know: what do the numbers look like in the real world? The answer is, pretty good...and it also makes me glad that I have tended to choose homeopathy as my first choice for health problems.

I also wanted to know something about the kinds of problems people have when they choose homeopathy. The answer? Pretty much anything! And the advanced nature of some of the problems we found in the data may explain why some people who didn't improve much.

Often, people come to homeopathy after they've tried a lot of allopathic medicine approaches, and by the time a homeopath sees them, they're desperate. Nothing's working well. Their disease has advanced.  Could starting with a more natural medicine like homeopathy first, before things have gotten away from us, have a better chance of working while the disease is still minor? While this research doesn't conclusively prove that case, it is something I take away from the results.

And Speaking of Allopathic Medicine

This summer a few interesting research results came in through my email.

One was a video presentation by physician Jamie Koufman on the dangers of using proton pump inhibitors ("PPIs")--these are drugs like Prilosec and Nexium (just 2 randomly chosen brands) and I've discussed these before in a prior post. While I remain of the opinion that most drugs have their place, I also remain of the opinion that drugs are used way too often and for what are often pretty trivial reasons, or out of habit (and here I mean by doctors too).

Dr. Koufman, an expert on reflux (GERD) reports that PPIs are dangerous and often unnecessary. There was some evidence that PPIs could contribute to dementia, but more recent data have cast some confusion and doubt on this connection. However it remains true that lowering stomach acid chronically interferes with the absorption of some vitamins, increases the risks of some infections like pneumonia, lowers magnesium levels, and may reduce bone density. Koufman proposes recommendations that are proven effective and pose way less drug risk:

  • She recommends the use of "alkaline water"--water adjusted to a pH of 8. 
  • Reduce the consumption of red meat and dairy, especially at night.
  • Eat meals early enough in the evening to promote good digestion--too many people apparently eat right before bed!
  • Reduce or eliminate consumption of sodas and acid juices (most fruit juices). Soda especially tends to be manufactured with phosphoric acid, which lowers pH (makes more acid).

If you have to use a drug for an episode of heartburn or reflux, she suggests Gaviscon and similar products containing sodium alginate (basically seaweed), and mild alkalis like calcium carbonate.

"But what if my reflux is bad and hasn't responded to these kinds of things?"

Like I said, sometimes drugs have their place, but as I also said, consider specific lifestyle changes and natural medicine alternatives before you let a doctor just put you on a PPI. I myself have had great success in patients with reducing or eliminating reflux using homeopathy alone.

And a Common Antibiotic's Reputation Gets Worse

Fluoroquinolones (flor-o-QUIN-o-lonez) are a class of antibiotics that were developed to treat infections usually resistant to antibiotics. (Cipro and Levaquin are examples.) However I have observed them being over-used for 20+ years, often for simple urinary tract infections and such. As a result many infections have become resistant to these drugs as well. It's been reported that these drugs are now no longer recommended to treat gonorrhea, a common sexually transmitted disease that has become resistant to more and more antibiotics.

But that's not all. This summer the U.S. Food and Drug Administration issued warning that fluoroquinolones can cause neurological changes in the brain that can result in disturbances in attention, memory impairment, and delirium. Again, these drugs have their place, but perhaps that place is not "every time we think about using an antibiotic for anything"! I still use Cipro, but not as a first choice; rather I use it if a test has shown the infection is resistant to safer antibiotics like amoxicillin, clindamycin, or sulfa (or, if allergies to other antibiotics preclude their use).

Once, drugs like Cipro were famous for "exploding" achillies tendons (I've actually seen not one but two cases of this "rare" condition). We now have data that show that less dramatic side effects can occur, including problems with bones, joints, and muscles. The FDA has added warnings as well about the chance that these drugs can cause low blood sugar. While this may be unsettling to some, it can be fatal to a person with diabetes who is on insulin. Since diabetes is a very common condition, it may be a good idea to try something less hazardous first in people with this problem, to avoid catastrophic low blood sugar.

Drugs are useful, powerful tools. But our cultural tendency in medicine is to treat these agents like they are pretty much harmless. After all, despite accumulated research, PPIs are mostly available without even a prescription! Is this really wise? Or is it just good for drug companies? As a society we need to take a closer look at how drugs are regulated for sale, but as individuals we can at least stay informed and ask questions.

I plan to go in for a routine surgery this fall, and research has shown that a single dose of antibiotic given an hour before surgery significantly reduces the risk of infection. I'm allergic to the usual antibiotic given for this purpose, so I asked the doctor what would be given instead. You guessed it: Cipro! I asked about alternatives and he suggested a drug called Cleocin, which I have had before and done well on. It's a great old drug--and it too has side effects--but long experience has shown they are uncommon and usually not too bad at all. I said, "Let's do that."

The "take-home" message: ask!