Michael Carlston, M.D. - Family Practice & Complementary Medicine

Carlston, M.D.
Family Practice and Complementary Medicine

www.carlstonmd.com

October 23, 2007

Dear Patients,

This newsletter includes my most recent blog for Veria. The first topic was specifically requested by one of you. I hope you find something useful and interesting.

Please tell any of your friends who are also my patients with Yahoo email addresses that I cannot send them the newsletter. Yahoo thinks I have too many patients. However, they can always go to my website to read it.

Best
Michael Carlston, MD
www.carlstonmd.com

Newsletter topics

Cold Medicines and Kids
Emotions and Cancer
The Rising Rate of Double Mastectomy
Veria TV

Other recent Veria Blog topics

Breast Cancer Risk Factors
Healthy Bacteria
Antibacterial Resistance

http://www.veria.com

Cold Medicines and Kids
There are a number of ways to look at the FDA recommendation not to give cold medications to children under age 6. I am very happy with the attention that this announcement has generated. Hopefully it will lead to further discussion about the overuse of medication as that is the underlying issue.

Upper respiratory infections are extremely common in children. The great majority of these illnesses are what are commonly called “colds”. They are annoying for sure, but they go away on their own over a couple of weeks time. Some children with poor health can develop more serious illnesses such as pneumonia or ear infections following a cold. This is especially likely if the child does not get enough water to replace the fluid lost in the mucous his or her body creates to flush away the virus.

The viruses that cause colds are common and easily transmitted from one person to another, even easier if those persons sneeze and drool on each other as little children tend to do. With the passage of time, our bodies develop immunity (and we slobber less on each other) so the rate of these infections drops.

No parent wants his or her child to suffer so medications for these minor illnesses, are among the most commonly purchased in the US representing half a billion in sales annually. Physicians also play our part in this overmedication story with some studies finding close to 50% of children with colds getting prescriptions for antibiotics. As many as 1/3 of parents incorrectly believe that antibiotics are effective against cold viruses. Physicians are supposed to know better.

The evidence is that the various conventional cold medicines in common usage, do little if anything to relieve symptoms in adults. The FDA panel nearly recommended that children under 12 not use these medications. The majority of studies show that these medicines actually prolong the illness, possibly by suppressing the body’s immune response. There is no evidence that taking these medicines decreases the likelihood of more serious problems developing. Why use a medication which is ineffective, carries the risk of significant adverse effects and may lead to worse consequences?

Conjunctivitis (pink eye) as an illness that many children get with upper respiratory infections. Nearly all of the 10-15% of children who get conjunctivitis in an average year, receive antibiotics. Again, the evidence is very strong that antibiotics simply do not help the cast majority of cases of conjunctivitis.

The decision to prescribe antibiotics seems to be either ignorant or political. By “political” I don’t mean Red or Blue state. I mean that a physician might prescribe antibiotics because of a perception that he/she must do so to keep the parent happy. The parent might demand antibiotics because the parent knows that if her/his child does not take antibiotics, the parents of other children in the school or day care center will blame that child (and parent) for the spread of the pink eye to other children. Ignorance seems to be a less important factor as children of physicians and pharmacists are less likely to receive antibiotics for colds than other children.

What can you do instead? The answer is a lot. Vitamin C, Zinc lozenges and Echinacea all have research support. Vitamin D levels plummet at the same time cold rates rise and vitamin D reduces risk of developing influenza and supports the immune system. Keeping well hydrated can be helpful as a preventive as well as therapeutically. Saline nose spray is available in many forms and I have had patients as young as 4 learn to comfortably perform saltwater nose rinses. Speaking of water, simple hand washing with plain soap and water decreases the spread of all infections. The usual health foundations of getting enough sleep and eating properly are always important. Self-prescribed homeopathic remedies can be helpful as can professional application of homeopathy and other forms of alternative medicine.

Emotion and Cancer
Even 6 weeks before a study is to be published it has already hit the headlines. This is very frustrating because it is impossible to comment in detail on the study design strengths and weaknesses. In other words, it is very difficult to determine if these headlines are real or not.

This is not customary. Usually there is an embargo on publicizing research before it is published. When I conducted the first study on alternative medicine education in US medical schools and family practice residency programs in 1995, for example, I had to refuse a request to appear on Good Morning America with C Everett Koop, MD the former US Surgeon General because the study had not yet appeared in print. If I had, the medical journal would have dropped my article.

The net effect (pun intended) is that the headlines will now become accepted reality as we cannot uncover or discuss any flaws until the Dec 1, 2007 issue comes out.

The most prominent researcher on the topic of cancer and attitudes, David Speigel, MD of Stanford Medical School has seen more of the article than I can find available anywhere and issued a highly critical statement. I suspect that Dr. Spiegel was asked to comment for the medical journal and so has been able to see an advance copy of the study. Among his criticisms were that this study only used four items from a 27 item questionnaire and that the response rate was only 62%. (We usually want to see a response rate of over 70% for any meaningful data interpretation).

I will make a couple of comments. First, we have copious evidence that how we think and feel is intimately connected to our physiology and disease outcomes. As the brain resides in the body and every thought involves chemical processes, how could there not be a connection. Secondly, there can be a horrible tendency for those who believe in a connection between thoughts/emotions and disease to blame themselves (or others) when they get sick. Again this is foolish and counterproductive. We all need to be working constantly to better ourselves, including our emotional wellbeing. Disease should simply be an encouragement to do so. Even if a better attitude does not give you a single additional day of life, more importantly it certainly will help you lead a better and more fulfilling life during the time remaining to you.

Rising Rate of Double Mastectomy
In my last blog I wrote that one of the stronger risks for breast cancer is breast cancer in the opposite breast. As many women learn of this risk, the rate of double mastectomy, in hopes of preventing breast caner, has been rising rapidly.

Surgeons at the University of Minnesota noticed an apparent increase in requests to have the healthy breast removed from women undergoing surgery for breast cancer. Reviewing national data, they learned that, regardless of the severity of cancer, women with breast cancer in 2003 were nearly three times as likely to opt for double mastectomy than only five years before. Women with earlier cancers were somewhat more likely to have their breasts removed than women with widespread cancer.

This intervention is highly aggressive. Although the risk of cancer is increased in the other breast, the likelihood is still small and unlikely to significantly impact the risk of death from breast cancer. Breast cancer is often emotionally even more upsetting than other cancers. I have seen women who feel very strongly that they only want to go through this trauma once. As we perform more genetic testing, women learn about their long-term risk so this information might also be having an impact.

Further investigation of this finding is needed to better understand the reasons behind it and better address the needs of women with breast cancer.

Veria TV
I want to extend my compliments to Veria TV. In the weeks since the channel debuted I have watched a number of programs. I do not watch much television (except soccer games that is) as I am too busy living my life and most of it is boring. Health programming is an even harder “sell” to me because I have spent so much time over so many years studying health. I usually have to dig deeply to find information that is new and interesting to me. Entertaining my health-jaded eyes is even more difficult.

The Veria TV programs I watched have been interesting and entertaining. The commercials were funny or beautifully relaxing. Homeopathy can be difficult to explain. As the editor and principle author of a homeopathic textbook and studying it for 35 years, I know the subject well. The GENESIS OF HEALING program on homeopathy was very well done. It was entertaining. Seeing the places Hahnemann lived was interesting. I was pleasantly surprised when one of the practitioners in the program mentioned one of the cases I treated.

If the quality in the programs I have watched is typical, Veria has a great deal to be proud of. Check it out (9575 and 281 on Dish network) and tell your friends.

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October 23, 2007

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