Have you heard the news that the FDA has approved the first generic version of the EpiPen?
“The U.S. Food and Drug Administration today approved the first generic version of EpiPen and EpiPen Jr (epinephrine) auto-injector for the emergency treatment of allergic reactions, including those that are life-threatening (anaphylaxis), in adults and pediatric patients who weigh more than 33 pounds.”
FDA Press Announcement on FDA approves first generic version of EpiPen
Is This Really the First Generic Version of EpiPen?
Many remember that we all talk about EpiPens so much because their cost jumped from about $100 in 2006 to over $600 in recent years.
That prompted Mylan, the company that makes the EpiPen 2-Pak and EpiPen Jr 2-Pak, to come out with a half-price authorized generic version last year.
“An authorized generic is made under the brand name’s existing new drug application using the same formulation, process and manufacturing facilities that are used by the brand name manufacturer.”
An authorized generic Adrenaclick injector also became available for a cash price of $109.99 CVS pharmacies. Combined with a $50 coupon, that’s often your best deal on an epinephrine injector if you don’t have insurance.
How Much Will the First Generic Version of EpiPen Cost?
And now we have a true generic version of the EpiPen 2-Pak and EpiPen Jr 2-Pak, from Teva Pharmaceuticals USA.
“The reduction in upfront research costs means that, although generic medicines have the same therapeutic effect as their branded counterparts, they are typically sold at substantially lower costs.”
FDA on Generic Drug Facts
Will it be cheaper than current EpiPens?
“When multiple generic companies market a single approved product, market competition typically results in prices about 85% less than the brand-name.”
FDA on Generic Drug Facts
It should be, but how much cheaper will it be?
“A company spokeswoman declined to say when it would be available, or how much it would cost.”
F.D.A. Approves Generic EpiPen That May Be Cheaper
While most folks would be happy with a $90 EpiPen and a tier 1 generic copay, I wouldn’t count on it. For one thing, we technically don’t have multiple generic EpiPens competing against the TEVA EpiPen yet.
And looking at drug prices of some of TEVA’s other medications, you can get a clue about their pricing plan:
Airduo generic (similar to Advair, but about 1/4 the price) – $98
What does your alternative medicine provider think?
How does he or she heal what ails you?
In other words, what’s really behind the idea or philosophy behind what makes their techniques ‘work?’
“…there’s no such thing as conventional or alternative or complementary or integrative or holistic medicine. There’s only medicine that works and medicine that doesn’t.”
Paul Offit on Do You Believe in Magic?
Does it matter to you that the concept of innate intelligence of chiropractic “is derived directly from the occult practices of another era?”
Does it matter to you that following their bad advice might have deadly consequences?
A Parent’s Guide to Complementary and Integrative Medicine
You may think that it doesn’t matter how something works, as long as it works, right?
Unfortunately, these treatments have not been proven to work and sometimes do real harm to folks, especially when they have serious illnesses and skip using traditional treatments that could have really helped them.
Acupuncture – a practitioner of acupuncture “heals” by inserting needles along specific meridians to unblock your child’s qi (chi) or life force. Can also be done without needles (acupressure), with practitioners applying physical pressure to acupuncture points to clear blockages in specific meridians
Aromatherapy – invented in 1937 by Rene- Maurice Gattefosse, aromatherapy uses essential oils or “naturally extracted aromatic essences from plants to balance, harmonize and promote the health of body, mind and spirit.” How do essential oils work? They help to “unify physiological, psychological and spiritual processes to enhance an individual’s innate healing process.” Is that what you are doing when you use essential oils?
Ayurveda – with origins in ancient India, practitioners believe that imbalances in three elemental substances (which are made up of five classical elements – earth, water, fire, air and ether) can cause disease, as they lead to excess or deficiency in one of three forces – vata, kapha, and pitta.
Traditional Chinese medicine – includes the use of herbal medicines, tai chi, and acupuncture, etc., and is rooted in Taoism and based on keeping yin and yang in harmony, the five elements (water, wood, fire, earth, and metal), and qi – a vital energy that flows through your body.
Chiropractic – chiropractic subluxations interfere with our innate intelligence that works to keep us healthy and our ability to heal ourselves. Daniel David Palmer, a magnetic healer, discovered this when he adjusted and “healed” a partially deaf janitor in Iowa in 1895. It is important to note that these chiropractic subluxations are usually not visible on xray, unlike true spinal subluxations. Like other alternative providers, chiropractors have vertebral subluxation and nerve charts that they think map to specific areas and parts of our bodies.
Craniosacral therapy – has to do with tides, rhythms, and flow of cerebrospinal fluid, which these practitioners think they can feel and manipulate by massaging your head. It was was developed by John Upledger, D.O. in the 1970s.
Cryotherapy – no, we aren’t talking about freezing warts, but rather whole body cryotherapy, the new trend that has hit your local strip-mall and many chiropractic offices.
Cupping – truly an ancient practice, cupping is supposed to draw toxins out of your body. It was once combined with bloodletting.
Dry needling – involves sticking needles into “myofascial trigger points” in your skin to create a local twitch reflex, which is supposed to stop pain. Another ancient practice? Nope. It was invented in the 1940s. Physical therapists often learn how to do dry needling at weekend seminars.
Electromagnetic therapy – do you believe that an imbalance of electromagnetic frequencies or fields of energy in your body is making you sick? Have you ever used a TENS unit for pain?
Faith healing – while there is certainly nothing wrong with praying when your child is sick, there are way too many stories of tragedies when parents rely on prayer alone.
Herbalism – herbalism is a part of many traditional medical traditions, but many practitioners make exaggerated claims about what these herbs can do.
Holistic Dentistry – use homeopathy, ozone therapy, essential oils, and other alternative therapies to take care of your whole body, not just your teeth. Many even have their own meridian tooth charts, thinking that you can map each tooth an organ in the body or a disease. And of course, they are often anti-fluoride and will want to replace any mercury fillings that you have.
Homeopathy – homeopathic medicine was created in Germany by Samuel Hahnemann in 1796. It is based on the concepts that “like cures like” and the “law of the minimum dose.” Homeopathic medicines are diluted so much, in fact, that they are said to only contain a memory of the original substance.
Holistic Pediatricians – likely panders to your fears about vaccines and incorporates many of the alternative therapies on this list, especially acupuncture, the use of essential oils, and homeopathy. Probably doesn’t take insurance, but has found a way to integrate a lot of expensive, non-evidence based testing and treatments into their practice, like meridian testing, Zyto scans, detox testing, and chelation therapy, etc.
Hypnotherapy – while maybe hypnotherapy can distract you during a painful procedure, there is less evidence that it helps treat medical and psychological problems
Iridology – the “science” of the iris of the eyes, a certified iridologist, by consulting an iridology chart, can diagnose your problems “based on the markings, fibers, structures, pigments and color variations in the iris which are located in specific areas”
Naturopathy – in addition to licensed naturopathic physicians that have to complete four years of schooling, there are also unlicensed, traditional naturopaths with much less formal education, which is why you see many using a lot of non-evidence based treatments. Naturopaths combine herbalism, homeopathy, acupuncture, IV therapy, and other alternative therapies.
Phrenology – developed at about the same time as homeopathy, phrenologists thought that they could tell things about a person’s personality by feeling their skull.
Reflexology – although it may have its origins in ancient Egypt, modern reflexology traces itself to Dr. William H. Fitzgerald and Eunice D. Ingham in the early 20th century. Reflexologists believe that they can diagnose and cure diseases by feeling a persons feet or hands, as, the International Institute of Reflexology claims, “there are reflex areas in the feet and hands which correspond to all of the glands, organs and parts of the body.”
Reiki – rei (universal) and ki (life energy) was introduced to Western Cultures from Japan by Hawayo Takata in the 1930s. Reiki practitioners, trained by a Reiki Master, can, according to the The International Center for Reiki Training, get “miraculous results” and Reiki is reportedly “effective in helping virtually every known illness and malady and always creates a beneficial effect.” How? Reiki is “a non-physical healing energy made up of life force energy that is guided by the Higher Intelligence, or spiritually guided life force energy. This is a functional definition as it closely parallels the experience of those who practice Reiki in that Reiki energy seems to have an intelligence of its own flowing where it is needed in the client and creating the healing conditions necessary for the individuals needs.”
Rolfing – invented in the 1920s by Dr. Ida P. Rolf, rolfing is like deep tissue massage, except that it also “aimed at improving body alignment and functioning,” to keep your body’s energy field in alignment with the gravitational field of the Earth.
Sclerology – the belief that a practitioner can diagnose your medical problems by looking at the veins (the red lines) on the sclera (the white part of your eyes), as a sclerology chart shows you that each part of our body is represented in a different part of the sclera.
Shamanism – ancient practices, typically of indigenous people, who invoke spirits and travel to the spirit world to heal people and the community.
Shiatsu – accupressure from Japan
Shonishin – this is pediatric acupuncture, so acupuncture for little kids, but don’t worry, they don’t actually use needles…
When you go to one of these practitioners, do you really think you need help unblocking your qi, an adjustment to help your “Innate Intelligence” get unblocked, or to have your life force energy moved around?
Do their charts and maps really make any sense to you?
But these are ancient treatments, so doesn’t that mean that they must work? Many of these treatments aren’t so ancient, but were invented fairly recently. Even those that are ancient, they have often been replaced by modern medicine in the places where they were discovered.
But many modern medicines are derived from natural substances, so doesn’t that mean herbal therapies and natural treatments can work? Sure and when they do, they become conventional medicines. It doesn’t mean that everything that is natural is a good medicine.
And it certainly does’t mean that you should try the latest fad holistic therapy on your child.
More on Complementary and Integrative Medicine for Kids
By most definitions, a person who is literate is well educated.
So a “Lyme literate” doctor is good thing, right?
What is a Lyme-Literate Doctor?
That you can get Lyme disease after a tick bite is well known by most folks, even if they don’t live in an area with a lot of confirmed cases.
Early symptoms are also well-known, including flu-like symptoms ( fever, chills, headache, fatigue, muscle and joint aches), swollen lymph nodes, and the classic erythma migrans rash.
Later symptoms of Lyme disease, when it isn’t treated right away, can include more rashes, arthritis, heart palpitations or an irregular heart beat, facial palsy, severe headaches and neck stiffness, nerve pain, and problems with short-term memory.
Fortunately, that there are many antibiotic regimens that can effectively treat Lyme disease, including amoxicillin, isn’t a huge secret.
So do you need to see a “Lyme literate” doctor to get diagnosed and treated if you think you have Lyme disease?
That’s actually the last thing you want to do.
The first thing you want to understand is that the term “Lyme literate” doctors is actually kind of ironic. These are not literate doctors, at least not in the sense that they are educated and practice evidence based medicine.
They are often alternative medicine providers who think that you can get Lyme disease anywhere, even if you don’t live in and haven’t traveled to an area with ticks capable of transmitting Lyme disease.
Many also diagnose folks with many different kinds of non-specific symptoms as having Lyme disease, especially because they misuse tests for Lyme disease as screening tests, or simply misinterpret the results. Tests that often lead to false positive results and folks getting misdiagnosed with chronic Lyme disease.
“Once serum antibodies to B. burgdorferi do develop, both IgG and IgM may persist for many years despite adequate treatment and clinical cure of the illness”
Murray et al. on Lyme Disease
They also often think that it is likely that if you have Lyme disease, then you are also likely to have many coinfections, including Bartonella or Mycoplasma. And that the Borrelia burgdorferi bacteria can hide in our bodies, creating persistent infections, even passing through breastmilk or causing congenital Lyme disease.
“You can access a variety of online resources and directories to locate doctors who are specifically trained in identifying and treating tick-borne illnesses. This is particularly important if you suspect that you may have Lyme disease since it is the most frequently misdiagnosed of all tick-borne diseases. Finding a Lyme-literate medical doctor (LLMD)—or a physician who is familiar with the vast range of symptoms that may indicate infection at various stages of the disease, as well as potential coinfections and other complexities—can help ensure that you get the right treatment, right away.”
IGeneX Inc. on How to Find Doctors Who Can Help with Your Tick-Borne Disease
Why does IGeneX Inc. want to help you find a Lyme-literate doctor? Maybe because IGeneX Inc. sells the tests that many Lyme-literate doctors use to diagnose Lyme disease and chronic Lyme disease! Tests that most other doctors don’t recommend doing.
“The controversy is a nice model for many similar controversies: the science doesn’t support the existence of the disease, but a dedicated group of activists, including some scientists and physicians, feel their extensive experiences more than make up for lack of data. What some of us have problems with is not only the lack of data, but also the willingness of people who believe in this to go about trying to prove it in unconventional ways, for example, relying on lab tests that are not validated.”
Lyme disease—who is credible?
Still, not everyone knows about Lyme disease.
And if you don’t mention a history of a tick bite, didn’t notice a tick bite (Lyme ticks are very small), or don’t have the classic erythema migrans rash, then diagnosis might be delayed.
you can prevent Lyme disease by avoiding tick bites and removing ticks as quickly as possible after they bite you, which is why it is important to do use insect repellent and do regular tick checks after spending time outdoors, especially if you were in wooded, overgrown areas or places with tall grass or unmarked trails.
just because you were bitten by a blacklegged tick, it doesn’t mean that you will develop Lyme disease. In general, only 2% of tick bites result in Lyme disease.
in most cases, ticks don’t need to be tested for Lyme disease, after all, even if the tick tested positive, it doesn’t mean that it transmitted the Lyme bacteria during a bite.
Lyme disease isn’t the only tick-borne disease that we are concerned about, so do tick checks even if you aren’t in a Lyme endemic area.
according to the American Lyme Disease Foundation, eight states, including Arizona, Colorado, Idaho, Montana, Nevada, North Dakota, Utah, and Wyoming, don’t have the Ixodes ticks that transmit Lyme disease
And know that in addition to your pediatrician, a pediatric rheumatologist or pediatric infectious disease specialist can help you if you think your child has Lyme disease. Unfortunately, late symptoms of untreated Lyme disease can be serious. That makes early diagnosis and the return of a Lyme disease vaccine important.
What about Lyme-literate doctors who say that they specialize in caring for patients with Lyme disease? Understand that the term “Lyme-literate” is simply a dog whistle for alternative medicine providers and websites who are likely to offer non-evidence based care.
Accidents are the leading cause of death for kids, with drownings, car accidents, fires, shootings, and poisonings at the top of the list.
But that doesn’t mean that you should ignore all of the other less common causes of accidents.
Did you know that riding down a slide with your kid on your lap is a common way to break their ankle or leg?
If you did, would you still ride down with them?
You can see Meadow’s leg breaking (her foot is going in the wrong direction) as she is going down the slide with her mom. Few people know this can happen and we are lucky that Meadow’s mom continues to tell her story, so that we don’t have to worry about unintentionally hurting our kids.
toys with small parts – choking hazard, which makes it important to buy your kids age-appropriate toys
lawn mowers – lawn mowers are dangerous and cause a lot of injuries, often when you run over a younger child that you didn’t know was there. Keep in mind that the AAP recommends minimum ages of 12 years to use a push mower and 16 to use a riding mower.
magnets – can lead to serious intestinal injuries if two or more magnets are swallowed
hoverboards – can overheat while be charged, causing fires
clothing – hood and neck drawstrings are a safety hazard and should be cut from young children’s clothing
balloons – it is important to remember that balloons are a choking hazard for young kids, as they can choke or suffocate on uninflated or broken balloons.
pool, spa, and hot tub drains – faulty drain covers can lead to drownings if a child gets stuck to a hot tub drain. Teach your kids to stay away from drains and make sure drain grates or covers meet the latest safety standards.
liquid nicotine for e-cigarettes – can be ingested by young children if not stored in a secure place
home trampolines – should not be used and can lead to injuries, even when you think you are using them safely
BB guns – non-powder guns can serious injure kids and shouldn’t be used by younger kids or without adult supervision
loud toys – listen to toys before you let your kids play with them, as some toys with sirens, etc., can get very loud, especially if your child holds it up to their ear
windows – install window guards and stops to prevent falls from windows above the first floor because kids can’t fly
digging in the sand – playing in the sand is great fun and still safe, as long your kids don’t try to build deep holes that are deeper than their knees, cave-like structures, or tunnels that they crawl into, as these can suddenly collapse on top of them
cedar chests – kids have suffocated in cedar chests that lock automatically when closed
playgrounds – too little shock-absorbing surface, ropes on playground equipment (strangulation hazard), sharp edges, tripping hazards, and uncoated metal that can get hot and burn in the summer
We have come along way since the old days when kids would ride around without seat belts in the front seat of the car. Or a bunch of kids would ride packed into the back of a station wagon, also without seat belts.
In those early days, kids weren’t necessarily safe even if they were strapped in while in the car…
Anyone remember when cars didn’t even have seat belts? It’s hard to imagine, but three-point seat belts, the lap and shoulder harnesses that we use today, didn’t become standard in cars until 1968. Before that, many cars just had optional two-point lap belts.
Latest Car Seat Recommendations
Do your kids ride safely when they are in the car?
in a rear-facing car safety seats in the back seat until they are 2 years of age or reach the weight or height limits of their car seat
in a forward-facing car safety seat in the back seat for as long as possible and until they reach the weight or height limits of their convertible or forward-facing car seat
in a belt-positioning booster seats in the back seat until they are between 8 to 12 years of age and the car’s lap and shoulder seat belts fit properly
with lap-and-shoulder seat belts in the back seat once they have outgrown their booster seats and until they are at least 13-years-old, when they might be ready to ride in front seat
In addition to these updated recommendations, we have seen many improvements in car seats and booster seats, including higher weight limits for rear facing car seats and car seats with harness straps.
History of Car Seat Recommendations
With all of these improvements, it is easy to remember that it wasn’t that long ago that kids rode without car seats.
Although the first car seats were invented in 1962, it wasn’t until 1968 that we got a car seat that could actually protect a child in a car accident. Before that, kids might ride in homemade car seats, safety harnesses, or leashes.
Better car seats followed once the National Highway Traffic Safety Administration issued the most minimum of car seat safety standards in 1971 and pediatricians began to push for routine car seat use. It would still take more than a decade, until 1985, that all states actually required young kids to ride in car seats.
Then, in 1996, the American Academy of Pediatrics issued their first major recommendations about car seat safety. Those recommendations included that infants should ride rear facing until they are at least 20lb or 1 year of age and that rear-facing car seats should be placed in the back seat if a car had a passenger side air bag.
Why issue recommendations if states had already passed car seat laws?
It was in response to an increasing number of air bag deaths, as more and more cars began to have passenger side airbags in the 1980s and 90s. In fact, by 1998, front side passenger side air bags were required on all new cars and light trucks sold in the United States. As we now know, a car seat in the front seat, up close to the air bag isn’t a good idea if you are in an accident and the air bag deploys.
The 1996 recommendations also called for the use of convertible car seats that could be used forward facing after a child’s first birthday and through about 40 pounds, and then booster seats until seat belts fit properly.
In 2002, we were introduced to the LATCH system, which made installing car seats easier. And the idea that school age kids needed to stay in car seats or booster seats a lot longer than most parents thought necessary was introduced. The AAP also clarified that infants should ride rear facing until they are 20lb and 1 year of age.
And then, in 2011, the AAP published the recommendations that we are still following today.
State car seat laws still haven’t kept up with the latest recommendations from the AAP though. Some still just use age based criteria or have criteria for car seats and booster seats that are far lower than AAP recommendations. And South Dakota still doesn’t even have a booster seat law!
Other Car Safety Recommendations
Of course, car safety isn’t all about car seats and seat belts.
Since the first laws and recommendations about car seats and seat belts, we have also learned:
Despite what some folks believe, most pediatricians are very interested in breastfeeding and learning as much as they can to help their families breastfeeding effectively for as long as they wish.
They are not looking to push baby formula or bottles to sabotage a mom’s chances of breastfeeding her baby.
And they will typically do anything to help the mom breastfeed, as well as make sure the baby is getting enough to eat. At least they will do anything that has some evidence to show that it is effective.
Chiropractic for Breastfeeding Problems
Will they refer their babies to a chiropractor for extra help with breastfeeding?
“Chiropractic manipulation in children who are < age 12 years is considered unproven and not medically necessary as a treatment for any diagnosis as there is insufficient published evidence to assess the safety and/or impact on health outcomes in the pediatric population.”
Chiropractic Spinal Manipulation in Children
Probably not, as there is no real evidence that it would help. Unfortunately, well meaning pediatricians do often refer their patients to lactation consultants who may then recommend further management by a chiropractor.
“Based on their case studies and the volumes of previous research, these researchers concluded that subluxations and the neurological interference they cause play a major role in Hypolactation. The researchers suggest, “Chiropractic evaluation for subluxations would be a key element in the holistic assessment of the failure to establish milk supply in the post partum patient.””
icpa on Chiropractic Helps New Mothers Produce Milk
Maybe it is because they don’t understand that when chiropractors use the term subluxations, they are not referring to something you can see on an xray, but rather something they think they can feel, and when manipulated, unblocks the flow of energy that prevents your body’s innate ability to heal itself.
“DD Palmer, an American magnetic healer, believed that diseases are often caused by subluxations of the vertebrae, which, in turn, lead to an interruption of nervous impulses; and that the correction of these subluxations allows the body to heal itself. This is still a central tenet of chiropractic.”
Chiropractic care for children: Controversies and issues
Is that why your baby is having trouble breastfeeding? An invisible subluxation is blocking the flow of energy in your body?
What about the “research” chiropractors talk about?
They are case studies, which is basically a chiropractor telling a story (glorified anecdote) about what happened to their patient, without any evidence of why it happened or how it could have happened.
“High-quality evidence supporting effectiveness of spinal manipulation for nonmusculoskeletal concerns is lacking, especially in infants and children, for whom the risks of adverse events may be the highest because of immature stability of the spine.”
AAP on Pediatric Integrative Medicine
The American Academy of Pediatrics Section on Integrative Medicine even warns parents about taking their kids to a chiropractor. And that’s saying something, as they promote some other holistic therapies that aren’t actually all that evidence based.
Craniosacral Therapy for Breastfeeding Problems
What about craniosacral therapy?
Similar to chiropractic, it has to do with has to do with tides and rhythms of cerebrospinal fluid, which these practitioners think they can feel and manipulate by massaging your baby’s head.
Is that why your baby isn’t breastfeeding well? The tides and rhythms of his cerebrospinal fluid are off?
“When a baby is unable to nurse or nurses so poorly that he causes pain to his mother, he presents a true challenge. A mother who experiences pain or who perceives that her baby is not breastfeeding effectively is a mother who is at risk of prematurely weaning this baby.
After working through all of the usual avenues of information and resources that can help in this kind of situation, some Leaders have found a new therapy, called CranioSacral Therapy (CST), can be helpful. CST is a light-touch manual therapy used to encourage the body’s self-correcting mechanisms.”
La Leche League on Considering CranioSacral Therapy in Difficult Situations
Not surprisingly, there is no real evidence that craniosacral therapy helps breastfeeding or anything else.
It is very surprising that some parents are willing to pay $600 or more for a few craniosacral therapy sessions.
And it is disappointing that a lactation consultant would refer their patients for this kind of therapy, since there is no evidence that it will work.
What to Know About Chiropractic and Craniosacral Therapy for Breastfeeding Problems
Parents looking for breastfeeding support should view a referral to a chiropractor or to get craniosacral therapy as a red flag and consider getting a second opinion for their breastfeeding problems from someone who uses evidence based therapies that have been proven to work.
More on Chiropractic and Craniosacral Therapy for Breastfeeding Problems
Of course, you should always seek the advice of a physician or other qualified health provider with any questions you may have regarding a medical condition. Still, these answers can be helpful, especially for non-urgent problems.