Thursday, November 12, 2009
The Epidemic of "Medical Child Abuse"...and what can be done
The primary purpose of this article is to encourage a stronger commitment from doctors and parents to consider using safer medical care for infants and children FIRST before resorting to more dangerous treatments.
One would hope and assume that doctors and parents would have a natural inclination to place the safety of these young human souls as significant and sincere priority, but sadly, the power and propaganda of Big Pharma has inappropriately turned this equation around and has made it seem that doctors and parents are putting their children at risk if they don’t prescribe powerful drugs first. I personally disagree with this assumption and sincerely hope that people consider this health issue to be of primary importance today.
I certainly realize that the evidence that I present below on the epidemic proportions of “medical child abuse” is somewhat inflammatory, but due to the fact that this issue is presently being ignored by so many doctors and parents, a little “inflammation” may be a necessary symptom that will lead to great attention to this problem and perhaps to some concrete solutions to it.
Although many people consider American health care to be “the best in the world,” the World Health Organization has ranked the United States to be the 37th (!) in the world in the “performance of the overall health system” and 72nd (!!) in “overall level of health” (of the 191 member countries). American health care may be the most expensive, but there is no evidence to prove that increased expense leads to improved health status.
When one looks at the countries where health status and overall health scores the highest, they are countries in which there are a significant number of physicians and other health care practitioners who use herbal medicines, homeopathic remedies, acupuncture, and nutritional treatments. Perhaps American doctors and patients would benefit from a significant change in health care practices that are not only considerably safer than modern medical treatments but that also seem to create better health care status.
A newly published review of the six leading medical journals uncovered a truly shocking observation: “No information on severe adverse events and withdrawal of patients owing to an adverse event was given in 27.1% and 47.4% of articles, respectively.”  When one considers that this review only analyzed the “best” medical journals, we can and should seriously worry about the safety of many drugs that are used today, and we should express real indignation when doctors prescribe two or more together (unless they were formally tested together) or when doctors prescribe them for conditions for which they have not been tested (called “off-label”).
Ultimately, although physicians assume that they are practicing “scientific medicine,” most drugs today are not tested on infants or children, and most children and adults are prescribed more than one drug at a time (and drugs are very rarely tested for efficacy or safety when used in combination with other drugs). These common practices lead one to assume that modern medicine is not adequately scientific, and these practices may be part of the explanation for the poor health status of Americans.
The Very Real Problem…
We all know people who have children who have benefited from conventional medical care, but sadly, we all also know people whose children have been harmed by it. The most famous words of the father of medicine, Hippocrates, are “First, do no harm.” This dictum was directed at doctors, but it is as appropriate for parents as it is for doctors. Sadly, however, our children are being put in front of harm’s way with our present almost callous overuse of powerful drugs for our young ones.
The bottom line is that too many physicians and parents are giving drugs to children that have not been proven to be either safe or effective for them. It is important for parents to know and to remind doctors that it is widely acknowledged that drugs act differently on the bodies of infants and children than on adults. And yet, it is extremely common for doctors to prescribe powerful drugs to infants and children and even prescribe more than one drug at a time, despite the fact that drugs are very rarely evaluated scientifically in combination with other drugs.
The FDA recently withdrew from the marketplace many popular cold and cough drugs that were marketed for infants and children, but the problem of doctors over-prescribing unproven drugs for children and the inappropriate and overuse of over-the-counter drugs in children by parents is a very significant health problem. One must wonder if the increase in psychiatric disorders, immune dysfunction, autism, and various other chronic diseases result from the use of the drugs that have not yet been proven to be either safe or effective for our infants and children.
Most consumers do not know that many drugs commonly prescribed for children today are not tested on them.  A 2002 survey in the British Medical Journal (BMJ) found that almost one-half of children were prescribed a drug that was “unlicensed” or “off-label” prescriptions for children.  A 2007 study of over 350,000 children found that a shocking 78.7% of children in hospitals are prescribed drugs that the FDA has not approved for use in children.  If this isn’t shocking enough, it is seriously problematic to report that a survey in England found that 90% of infants were prescribed drugs that were not tested for safety or efficacy in infants. 
If the off-label use for drugs was not found to be dangerous, it would not be a problem. However, the use of off-label drug use is significantly associated with adverse drug reactions. In fact, there is almost a 350% increase in adverse drug reactions in children prescribed an off-label drug than children who were prescribed a drug that had been tested for safety and efficacy.  The use of drugs for infants and children that have not been proven to be safe constitutes a type of “medical child abuse.”
Despite some significant gaps in research and knowledge about the safety and efficacy of drugs for children, the number of drugs prescribed for children has jumped significantly in recent years. In the U.S., the number of prescription drugs for children with asthma increased 46.5% from 2002 to 2005. In this same time, the number of prescription drugs for children with ADD/ADHD increased 40.5%, and even the number of prescription drugs for lowering cholesterol in children increased by 15%. 
In 2007, the Journal of the American Medical Association (JAMA) reported significant increases in childhood chronic diseases.  Since 1960, there has been a 280% (!) increase in the “limitation of activity due to a health condition of more than 3 months’ duration.” This article also noted a shadow side of increased vaccination that usually ignored by physicians and the media: “decreased exposure to viral infections in early childhood… may provide less and less normal stimulation of the immune system with more susceptibility to allergies in later years.”
What can be done and what is being done…
First and foremost, physicians have to STOP prescribing as many drugs as they are prescribing, and they absolutely have to significantly reduce the number of off-label prescribing of drugs for infants and children. I am not suggesting that they stop the use of all off-label prescribing but that they work to significantly reduce these more risky prescriptions.
Because doctors sometimes feel pressured by patients who want drugs (or something!) to help their infant or child, doctors need to warn parents that many drugs have not yet been adequately tested for safety and efficacy for children. Doctors need to become better educators so that parents can better decide which risks they wish to take either with conventional drugs or various safer alternatives.
Doctors also need to begin learning about safer treatment methods. Although some “alternative” methods may not yet be adequately tested for efficacy (usually because Big Pharma cannot make as much money making and selling these treatments), natural therapies certainly have a much better safety profile, and there is a body of experience historically and internationally to suggest that many (not all) natural treatments can aid in the healing of many pediatric ailments. In honor of the Hippocratic dictum, “first, do no harm,” doctors need to explore and even exhaust safer methods before resorting to the highly risky treatment modalities.
Because the FDA recently withdrew from the marketplace many popular cold and cough medicines, more parents and physicians should explore safer homeopathic and botanical alternatives. One of the books that I co-authored with Stephen Cummings, MD, Everybody’s Guide to Homeopathic Medicines, has been the most popular guidebook to using homeopathic medicine. Besides explaining how to choose a homeopathic medicine that fits the sick person’s unique syndrome of symptoms, this book is also widely appreciated because it provides detailed guidelines that define when it is medically safe to use some type of safer alternative treatment or when medical supervision is recommended.
Another useful, though more technical, resource was just published by Oxford University Press (OUP), one of the highly respected publishers of medical textbooks and medical journals. OUP has begun to publish a series of textbooks on “integrative medicine,” which is the emerging field of utilizing the best of the various natural treatment modalities and the best of conventional medicine. OUP just published an Integrative Pediatrics (edited by two pediatricians, Timothy Culbert, MD, and Karen Olness, MD).
Nowadays, virtually every leading conventional medical school in America has a course in “integrative medicine” (or alternative and complementary medicine). Although these courses are generally just an overview and introduction to the various “alternative therapies,” they provide good seeds for the medical students to determine which treatments should be a part of the medical care they will later provide. One way to predict the future of medicine is to ask medical students about what they are interested. Clearly, integrative medicine is the medicine of the future. In 2008, the American Academy of Pediatrics (AAP) published a position paper acknowledging the widespread use of alternative and complementary therapies for children and encouraging doctors to discuss options with parents.  An AAP survey found that 54% of pediatricians in the US agreed that “pediatricians should consider the use of all potential therapies, not just those of mainstream medicine.”
Doctors, however, need to understand that alternative therapies are not just a different “treatment,” but also a different approach to understanding and treating whole person healthcare. Acupuncture, ayurveda, and homeopathic medicines provide time-tested and historically verified benefits that deserve the investigation of doctors and parents everywhere who want to use safer methods before resorting to more risky treatments. And there is a small but significant (and growing) body of research to confirm the efficacy of these systems of medicine, despite the strong tendency for skeptics to ignore this body of evidence.
Parents have to START asking their doctors if the drugs they are prescribing for their children have formally been found to be safe for them. If more than one drug is recommended, parents should ask for the evidence that these two drugs, taken together, are safe and effective. Parents will benefit from learning when some type of medical treatment is truly necessary because many common ailments do not require medical attention, and therefore, safer home treatment methods can and should be considered.
The bottom line is that there is increasing interested in alternative and complementary treatments for children. A survey in Canada that published in Pediatrics (2007) found that more than half of the children who visited a university-affiliated hospital had received alternative and complementary medicines.  Homeopathic medicine was by far the most popular treatment, used by 39% of the families.
In 2002, the British Medical Journal (BMJ) reported that 75% of Germans have used complementary or natural medicine.  They also reported that 5,700 doctors received specialized training in natural medicine, with this number doubling to 10,800 by 2000. Homeopathic medicine is practiced by 4,500 medical doctors in German, almost twice as many as did so in 1994. The German government conducted this survey, and it also discovered that there was a 33% reduction in sick days if people used natural therapies, especially homeopathy or acupuncture.
Although homeopathic medicine is not well known in the US anymore, homeopathy has maintained a unique international presence that has included appreciation and advocacy for many of the most respected cultural heroes of the past 200 years, including 11 U.S. Presidents and scores of world leaders (ranging from Gandhi to Tony Blair), 6 popes, numerous European royalty, literary greats, sports superstars, corporate leaders, as well as a wide range of first class physicians and scientists. 
In reference to homeopathy, it is common for skeptics of homeopathy to purposefully misinform others that “there is no research that proves that homeopathy works.” Such misinformation is typical of Big Pharma shills and closed-minded skeptics who revel in confusing the public.
In fact, one of the most serious public health problems in the world today that affects children in the Third World is diarrhea, a condition for which several million kids die every year as a result of dehydration. Three double-blind and placebo controlled trials have shown efficacy of treatment from homeopathic care.  he number one reason that children in the US seek medical treatment is for ear infection, and the American Academy of Pediatrics has sought to discourage doctors from prescribing antibiotics due to their questionable efficacy and potential problems. And yet, there is some good evidence that homeopathic medicines are effective for this common ailment.  There have also been several trials showing efficacy of homeopathic treatment for children with ADD/ADHD. 
Ultimately, both doctors and parents need to educate themselves more about safer methods of treatment for the short-term as well as long-term health of our blessed young ones.
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