There is no such thing as alternative medicine. There is only medicine that works and medicine that doesn't. - Richard Dawkins. There is no such thing as alternative medicine, just alternatives to medicine. If a treatment works, it becomes part of mainstream medicine. There is only "medicine that works" and "useless or dangerous stuff". Any "alternative" practice that actually works is rapidly absorbed into the standard medical canon.
What does it mean to be "part of mainstream medicine" or "absorbed into the standard medical canon"? It means if you go to a doctor, s/he will recommend it as a treatment. Especially if you go to a specialist in the field. It turns out that relying upon this is every bit as dangerous to your health as uncritically accepting unsubstantiated nostrums. As we shall see, there is no substitute for doing the research. It is your body and your health and you cannot depend on a doctor or anyone else to do it for you. When I say this people always ask, "How can I know what to trust?" For evaluating herbal and alternative remedies, studies published in medical journals can be relied upon. They are easily found using Google Scholar. For those of us who are not medical doctors, myself included, there will be terms we do not understand. Google them. After a while everything else will pale by comparison. What not to trust? Unsubstantiated claims, whether by people that stand to benefit from your business or people who are simply believers.
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Descent Into Medical Hell
It started some time ago with the seemingly minor annoyance of an itchy scalp. I got myself to the dermatologist. She took a look, found some flakes, and diagnosed, correctly, a fungal cause. The official name for the condition is tinea capitis. She prescribed Nizoral shampoo. I tried that for a couple of weeks and got no relief. I proceeded to try a variety of other antifungal shampoos and topical remedies, all to no effect. I finally got around to researching the medical literature and found that topical treatments do not get at the root of the problem - the hair root. To completely eradicate tinea capitis it is necessary to also use an oral antifungal to address the problem from inside out. Perhaps some others haven't needed this, but clearly I did. So I got started trying oral antifungals.
Meanwhile the fungus was not standing still. Over time it progressed to my sinuses - I started having discomfort there - something we have no words for but I can only describe as a "smoky" sensation. Then it started affecting the pitch of my voice. Finally I started having asthma symptoms. Asthma is a condition I had previously suffered from. It had been in remission for some time, but no longer. On the treatment front, griseofulvin is the standard of care for tinea capitis, so I tried that first. Unfortunately it aggravated my pre-existing tinnitus to the point of becoming intolerable, so that wouldn't work. A doctor I worked with had had good experiences with oral terbinafine, a/k/a Lamisil, so I gave that a try for a month. I tolerated it fine but it had no effect. Finally I got around to itraconazole last fall. It completely relieved my asthma symptoms, at least at the time. So it seemed I was on the right track. I got an itraconazole nasal spray from a compounding pharmacy and this relieved my sinus symptoms too, at the time. It takes some time for oral itraconazole to penetrate and accumulate in the skin get to rid of the scalp problem, but I now had reason to believe that would happen as well.
I need to mention that my asthma symptoms have manifested two different ways. One is a stable, steady discomfort, controllable with a fixed regimen of medication. The other, an out-of-control attack occasioned by a big exposure to an allergen. Come the beginning of December, we had our first rains, followed by a bloom of mold spores. Many people experienced allergy symptoms. I had an asthma attack. All the usual asthma meds, oral and inhaled, were insufficient to relieve the constriction in my chest. I had what only can be described as a feeling of impending doom. In this situation there is only one thing to do - a massive dose of prednisone, known as a "burst and taper". (If you go to the ER they will do essentially the same thing, with an IM shot). Get it under control, and taper off the prednisone dosage during the ensuing days. Well, that worked and I got back to normal. Until...
A week or two later the winds kicked up I had another attack, but even worse. I needed even higher doses of prednisone, and for longer, to get it under control. And after I tapered off the prednisone I could not say I was breathing comfortably with the other meds. During the course of all this I consulted with a couple of different pulmonologists. The official diagnosis for the condition is ABPA - allergic bronchopulmonary aspergillosis (although many different fungi can cause this result). It is a superficial fungal colonization of the lungs that is harmless in and of itself, but for the immune response, exacerbated by additional mold spores in the air. The standard of care for this condition is itraconazole plus prednisone as required. Short term, prednisone is literally a life saver. Long term it has many deleterious effects. So what was the prognosis at this point?
Allergic bronchopulmonary aspergillosis. Natural history and classification of early disease: ....The largest percentage of patients were in the stage IV (corticosteroid-dependent asthma stage) group. The next largest percentage were in the stage V (fibrotic, end-stage lung disease) group. Of the latter 24 patients, eight had died [during the observation period].
Death due to lung fibrosis is a really ugly way to go, and "stage IV" corticosteroid-dependent is pretty awful too.
Before we continue it is important to note that the wrong bacteria can do exactly the same thing - colonize the lung, with the only symptom being exacerbation of asthma, and asthma attack upon exposure to the wrong allergen. There are a vast variety of bacteria out there - the mouth alone has about 400 different species of bacteria, and around 40% of these have never even been cultured. Anyway, many years ago I had an exacerbation of asthma culminating in a visit to the ER and an overnight hospital stay. (I wasn't knowledgeable about prednisone at the time). None of the several doctors involved thought to do a CBC, complete blood count. After the dust settled I arranged for this on my own initiative. I had an elevated white blood cell count. On that basis I asked for and received a prescription for antibiotics, and lo and behold, the asthma exacerbation resolved. This condition was not so easily cured. With the kind of prognosis I now had it was time to have a look around.
Return to Health
What I found was this:
Efficacy and tolerability of antiasthma herbal medicine intervention in adult patients with moderate-severe allergic asthma
Pharmacology and immunological actions of an herbal medicine ASHMI on allergic asthma
This study was undertaken to compare the efficacy, safety, and immunomodulatory effects of ASHMI treatment in patients with moderate-severe, persistent asthma with prednisone therapy. Methods: In a double-blind trial, 91 subjects underwent randomization. Forty-five subjects received oral ASHMI capsules and prednisone placebo tablets (ASHMI group) and 46 subjects received oral prednisone tablets and ASHMI placebo capsules (prednisone group) for 4 weeks.
ASHMI is a combination of three Chinese herbs. In this study neither the patients nor the investigators knew who was getting which medication. They compared ASHMI to prednisone, the gold standard of asthma treatment. They had a sufficient number of subjects to get highly statistically significant results, as we shall see. This was published in the Journal of Allergy and Clinical Immunology:
With an impact factor of 12.047, the journal ranks 1st of 23 in the Allergy category and 7th of 135 in the Immunology category in the 2013 Journal Citation Reports
So this study was top quality by any standard. Let's see what they found:
By week 4 (the last week of treatment), symptom scores (median) were reduced in patients treated with ASHMI (5.0 to 2.0 P < .001; Fig 1, A) and patients treated with prednisone (5.0 to 2.0 ; P < .001; Fig 1, B). Improvement in symptom scores was similar between the treatment groups (P = .47; Table II). [edit: range values removed to improve readability]
P<.001 means the treatment effects were highly significant in both arms of the study. P=.47 means the differences between the two arms were insignificant. So from the patients' perspective both treatments has the same effect.
FEV1 [Forced Expiratory Volume = lung capacity] values showed significant improvement after treatment with ASHMI (64.9 to 84.2 ; P < .001) and prednisone (65.2 to 88.4 ; P < .001; Fig 2, A). PEF [Peak Expiratory Flow] values in both treatment groups also showed significant increases (ASHMI, 64.6 to 84.8 P < .001; prednisone, 65.0 to 88.1 , P < .001; Fig 2, B). Increases in FEV1 and PEF were significantly greater in the prednisone group than in the ASHMI group (P = .02 and .04, respectively; Table II).[edits: here and below I removed standard deviation values to improve readability]
So the prednisone group did a bit better on this measure, but both treatments registered a highly significant improvement. Of course, there is a downside to prednisone:
In this study, pretreatment cortisol levels were slightly below normal ... in both groups... After treatment, subjects in the prednisone treatment group showed a significant reduction in serum cortisol levels after treatment (5.1to 3.7 mg/dL; P < .001). In contrast, patients in the ASHMI treatment group showed increased levels of serum cortisol (5.4 to 7.7 mg/dL; P < .001; Fig 4), which were within the normal range. The difference between groups was statistically significant (P < .001).
So ASHMI patients got back to normal range and prednisone patients got worse. How about safety?
Treatment with ASHMI and prednisone was well tolerated. Neither group showed abnormal findings in hematology, serum chemistry tests, or electrocardiograms. No serious adverse effects were observed in either group. Both groups showed an increase in weight (2.8 kg for prednisone group and 0.8 kg for ASHMI group), and the difference between the groups was statistically significant (P < .001). Of patients receiving ASHMI, 5.08% (3 of 45) had gastric discomfort, whereas 15.51% (9 of 46) patients in the prednisone group reported gastric discomfort.
Note: Weight gain is a known side effect of prednisone treatment. Also, if you ever need to take prednisone, eat something first. Otherwise it tends to damage the stomach lining. Very well. Now, how to get this treatment? If this were a new drug we would have to wait for completion of Phase 1, 2 and 3 trials, a new drug application, an advisory committee meeting, and an FDA decision, a process which takes many years. Then be prepared to pay the big bucks: Xolair costs $860 a vial and requires injection of a number of vials per month. However, this treatment is herbal. Nutricology sells it as "Phytocort" on Amazon for $25 for a supply which lasts 2-4 weeks depending on dosage. Any downside? Traces of lead were at one time detected in some Nutricology products prompting a prop 65 notification from the company. What the company says about this:
"We have placed those labels as a requirement of The Environmental Research Center (ERC) for foods and supplements that contain levels of naturally occurring lead in the food ingredients that compose them. We believe ERC's claims to be without merit, as our products comply with all federal Food, Drug and Cosmetic Act and California's Sherman Food and Drug Act requirements, and contain naturally occurring levels of lead in low levels, which is allowable even under California Proposition 65. We are currently resolving this matter, but until we are able to do so, we are including the prophylactic warning on some of our products. Compared with many common foods, our supplements do not contain an unusually high amount of lead. A serving contains less than 1% of the normal daily intake of lead from food in the United States (Kehoe RA, 1964). A serving of supplements contains significantly less lead than a serving of most food in North America (Schroeder and Balassa, 1961). As always, we continue to evaluate our ingredient sources toward the end of finding even purer ingredients for our complex formulas."
I took my chances with this issue an did not hesitate to start Phytocort, back in mid-January. Within a week I was off all asthma meds except for an occasional puff off albuterol. Since then, with the spring pollen there was a period of three days in early March when I needed moderate doses of prednisone. Otherwise, no prednisone, and on many days no oral meds at all. Not ideal, but manageable, versus frightening with a grim prognosis. And, back to my daily exercise routine almost every day, including running up hills.
Note to commenters:
This diary is on the subject of supplement effectiveness. For those who wish to discuss supplement authenticity and purity we have republished an earlier diary entitled Can You Trust Your Supplements? Yes! Schneiderman Erred! which covers this subject thoroughly. Please comment on supplement authenticity there, so we can have the relevant information, including some very knowledgeable prior comments, right in front of us. Thanks!