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Herbal Supplements

Dear Dr. Lanny: A couple of months ago, my 10-year-old daughter seemed to be coming down with a cold, so I gave her echinacea capsules twice a day for four days to boost her immune system. And it worked: She didn’t get a cold. At her next pediatrician’s appointment, I told the doctor about my success with echinacea. The doctor clearly disapproved of herbal supplements and told me they can be very dangerous. I disagree. Do you think I should try to find a pediatrician who is more accepting of alternative medicine?

A: The description of your experience and interaction with your daughter’s doctor actually brings up two different issues that I will try to respond to without getting myself into trouble with any one of several constituencies.

I’ll start with the easiest. Your daughter “seemed to be getting sick.” She took echinacea. She didn’t get sick. You really have no way of telling from this simple set of facts that the echinacea prevented the illness, or that there really was an illness in the first place. It is impossible to draw a conclusion from a single uncontrolled event such as you describe. Echinacea may or may not be a valuable tool, but unless you study it in a controlled scientific way you really can’t determine its efficacy.

Next I’d like to discuss the interaction with your doctor. Several years ago I went to a conference run by Harvard Medical School regarding alternative (also called complementary) medicine. Although I came away unconvinced about a number of alternative specialties, the most important thing I learned was that a large percentage of patients (this was largely directed at adult-medicine providers) were using some form of alternative medicine. Further, I found out if you didn’t inquire about such methods, you were not likely to find out about them. Patients were hesitant to tell the doctor, for fear of exactly the reaction you got from your daughter’s pediatrician.

Whether alternative methods are scientifically proven treatments or not doesn’t matter. Patients use and believe in them; to dismiss them out of hand will only diminish your patient’s trust in you. I have learned that asking, “Are you giving your child any medicines?” gets limited information.

I increasingly ask (and I’m not perfect at this), “Are you using any medications, herbals, supplements or other therapies?” The answer is usually “no,” but not always. I also find that parents do not mind if I express my skepticism about alternative fields so long as I respect their choices and right to seek care however they see fit.

Patients seem increasingly hesitant to simply accept the word of “authorities” and see me more as a knowledgeable resource rather than the keeper of absolute truth. Actually, I’m sympathetic to this perspective because my career has gone on long enough that I find myself contradicting things I said in the past—things that I, in turn, had learned from my “authorities.”

A wonderful example of this flip-flopping is the recommended sleeping position for babies. Not that many years ago I “knew” that babies must not sleep on their backs, because if they threw up they could choke and that would be very bad. Now I “know” that babies must sleep on their backs. This time I’m sure I’m right.

I would like to add that I find many patients, and friends as well, seem to accept alternative medicine treatments and claims—often with little or no support from controlled studies. Such treatments seem “natural” and non-corporate, and therefore they must be OK. I would only ask that patients apply the same degree of skepticism to all claims of knowledge and efficacy, be they from mainstream physicians or alternative medicine practitioners.

Would I suggest you look for a new pediatrician? Based on this one interaction I wouldn’t change. The doctor’s response reflects the hesitance most mainstream practitioners feel about the many unsubstantiated claims or absolute quackery we hear about. Our business has its foibles, but ongoing research and new knowledge are hallmarks of science, and we change as we learn.

I’m not sure the same can be said for all non-mainstream disciplines. The question here is how you are usually treated and listened to. If your history with this doctor is a positive one, surely you can discuss your feeling about this incident and move on together.                                                                               

Dr. Alan Freshman, father of two grown boys, practices at Syracuse Pediatrics. Consult your own physician before making
decisions about your family’s health care. Send e-mail to him at editorial@familytimes.biz.

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