Well the move is finally upon us. Friday is our last day in the current office. Next Monday, August 8, we will reopen at the new address (2448 Guerneville Road, Suite 900). For many of you, traveling via Fulton and turning east onto Guerneville Road will work the best (avoiding 101 congestion).

On Friday August 19 from 5:30 to 7:30 we will host an open house so you can visit and get used to the new location. Considering all of the difficulties encountered trying to see patients while the wall at my back shakes and all the other construction excitement, we are VERY eager to move.

Since the last newsletter, there have been a few media health items which demand comment and the trip itself leads me to a couple of topics.

We had a fantastic experience on the trip. The excitement and energy of Live 8 in London alone would have made the trip remarkable but so many other experiences - personal, social, intellectual and spiritual, made it more than the trip of a lifetime I had expected. We feel very lucky also because we returned from London just 24 hours before the first bombings.

However, I am still concerned for colleagues there. Part of our last full day Melanie and I spent visiting the Royal London Homeopathic Hospital which is only a few blocks away from the incredible British Museum and unfortunately, both the bombed Russell Square tube station and Tavistock Square bus bombing site. The building is shared with a pediatrics hospital. Following the tube and bus bombs in those locations, the hospital waiting area was turned into an inpatient treatment area. I took a picture of the floor there because there is a large seal dedicating the Royal London Homeopathic Hospital on the floor.

I always find something to learn from traveling - sometimes quite a lot. This trip was certainly extreme in its many many lessons. We are happy to be back and carry much hope, love and caring from and for the people there.

Best, Michael Carlston, M.D.
www.carlstonmd.com 
707-545-1554

A recent study on Echinacea is very disappointing to me, although not for the reasons you might think. The study was funded through the NIH’s National Center for Complementary and Alternative Medicine (NCCAM). They found that Echinacea did not help prevent or treat experimentally induced colds.

That result is not the reason for my disappointment. My disappointment arises from the poor study design. The dose of Echinacea was far too low. The form of Echinacea was very crudely prepared. Both of these are markedly at odds with the basic care available at any US health food store. Typical American usage of Echinacea involves doses at least 3 times higher and high quality extracts. Consequently, we now know that this study indicates that inadequate doses of poorly prepared Echinacea are ineffective. We do not know if the average American’s use of Echinacea is likely to be helpful. These dubious results were published in the New England Journal of Medicine.

I have worked for this department of the NIH on several occasions. That work has always been challenging, enjoyable and important. I am discouraged though that the NCCAM’s focus on drawing together experienced clinicians and scientific researchers, seems to be getting lost. If experienced clinicians helped design this study, such basic errors would not have occurred.

Studies like this one are a waste of time and money. They also generate misinformation and could be considered unethical by exposing human subjects to research which is not sufficiently well designed to answer the research question. NIH is too often the province of academics who do not have ongoing clinical experience and, even among the MD researchers, some who have not seen a patient since medical school.

As you know, I adore research. I have been involved in clinical research for 25 years and firmly believe it is an excellent tool to help us improve health care. However, studies like this remind us once again, of the cautionary “There are three kinds of lies, lies, damned lies, and statistics”.

Many argue that attention deficit disorder is over diagnosed or dramatically over medicated. It is clear that whenever any patient can be treated as successfully by a means with fewer adverse effects, that alternative should be attempted first. Although two previous studies demonstrated positive effects of homeopathic treatment in this group of patients, neither of those was a randomized, double blind, placebo controlled trial (RDBPCT).

A new study has just been published in electronic form awaiting final print publication. Researchers investigated homeopathic treatment of ADHD patients using the highest research standard - RDBPCT format. The study protocol was to treat each child with a classically selected individual homeopathic remedy after they had been formally diagnosed with ADHD and the severity of symptoms evaluated. Children who responded significantly to treatment (50% improvement by Conner’s Global Index scale) were then split into two groups. Group A received active treatment for 6 weeks and then placebo for 6 weeks. Group B received placebo for 6 weeks and then active treatment for the final 6 weeks.

Measures of cognitive performance (global perception, impulsivity and divided attention) improved quite significantly (p < 0.0001) during the preliminary phase. This improvement was confirmed and persisted in the longer term study.

One way of measuring the worth of a therapy is to consider the benefit to patient relative to the cost of the treatment. When a treatment works better but costs the same or works as well but costs less, the superiority is evident.

German investigators enrolled 493 patients (adults and children) with chronic diseases and divided them evenly into conventional and homeopathic treatment groups following an assessment of their symptom severity (by both patients and physicians). They then compared the patients’ symptoms at baseline, 6 months and 1 year into treatment.

The patients responded quite significantly better to homeopathic than conventional care by their own assessment. Physicians’ assessment of treatment response was also statistically better for the children treated homeopathically. Costs were not significantly different.

The study did not look at adverse effect rates or other long-term health effects. Other studies and clinical experience suggest these two factors would also have favored homeopathic treatment.

This study created a lot of needless fear among many women. It was a large study using old breast biopsy specimens looking for characteristics that were found later to be associated with development of breast cancer years down the road.

Suspicious findings on clinical examination or mammogram often lead to biopsy of the lump. When the biopsy has not been read as cancer, no one thought any more about it. This study attempted a more subtle consideration of the pathology (microscopic tissue analysis) findings.

The study population was over 9,000 women from 1867 to 1991. Investigators learned that there was a statistically significant different rate of breast cancer in women with different, although noncancerous, biopsy findings. The average risk for all American women of the same age over this interval of time is 5%. Women with nonproliferative (slow growing) breast lumps had a 6% likelihood of developing breast cancer within 15 years. Women with proliferative (more rapidly growing appearance on biopsy) breast lumps had a 10% likelihood of developing breast cancer within 15 years. Women with atypical breast lumps (atypical = unusual) had a 19% likelihood of developing breast cancer within 15 years.

Lumpy breasts are common and still should not, of themselves, be a source of anxiety. The overall lifetime breast cancer rate is approximately 11% in the United States. It would be very nice to get as much long-term information as possible from breast biopsies.