The Rule of Too/Two is an easy way to discover possible risks of genetic conditions in your family medical history.
Have you ever heard of the Rule of Two?
No, this isn’t about Star Wars…
What is the Rule of Two/Too?
If you didn’t know about the Rule of Two/Too, you will likely be very surprised to know that there are more than one of these rules!
The Rules of Two is a quick and easy way to figure our if your child’s asthma is out of control.
Remember that one now?
What about this other one?
The rule of Two/Too.
The Rule of Too/Two can help you figure out if you might have a genetic condition in your family!
After all, filling out your family medical history is pretty easy for most people. Knowing what to do with all of that information, especially how it might translate into a risk for a genetic condition is the tricky part…
“Family health history questions that result in answers using the descriptors “too” or “two”may indicate a genetic condition.”
A Toolkit to Improve Care for Pediatric Patients with Genetic Conditions in Primary Care
And that’s where the Rule of Too/Two comes in!
It reviews many of the red flags for genetic conditions and can help you figure out if you or your kids should undergo any kind of genetic screening.
The Rule of Too/Two includes:
being TOO tall as compared to their genetic potential for height
being TOO short as compared to their genetic potential for height
getting sick at TOO early/TOO young an age – extreme early onset cardiovascular disease, cancer, or renal failure, etc., and developing adult disorders in childhood can be a sign of a genetic cause
TOO many people in a family having the same condition
having an unusual or extreme presentation of a common condition that is TOO different than usual, like breast cancer in a male family member
a family member having TWO different types of tumors
a condition in TWO generations of family members
a condition that affects TWO people in the family
a family member with TWO or more birth defects or congenital anomalies
To get the most accurate results and avoid false positive and false negative results, you want to use the right test for the right patient, and then know how to interpret the results correctly.
There are a lot of good reasons that most doctors should do fewer lab tests.
For one thing, many are simply unnecessary.
And few tests are inexpensive.
Another reason, one that you likely haven’t thought of, is that sometimes lab tests are misinterpreted, leading to unnecessary treatments.
Lab Tests That Are Often Misinterpreted
In addition to false positive and false negative test results, which are an inherent risk with almost any test, you sometimes run the risk that your doctor doesn’t truly understand how to interpret the results of the test they ordered.
How is that possible?
Consider Lyme disease testing.
Unless you live in or visited an area with ticks that cause Lyme disease and you have symptoms of Lyme disease, then you don’t need to be tested for Lyme disease. If you do get tested, you doctor should use two-tiered testing – an EIA or IFA test first, and if positive, Western blot testing.
How do you know if your Western Blot test is positive?
A positive IgM Western blot for Lyme disease requires at least two of the following bands of the test to be positive:
24 kDa (OspC)
39 kDa (BmpA)
41 kDa (Fla)
And a positive IgG Western blot for Lyme disease requires at least five of the following bands of the test to be positive:
21 kDa (OspC)
39 kDa (BmpA)
41 kDa (Fla)
58 kDa (not GroEL)
93 kDa (2)
What happens if someone only sees one of the IgM bands or four of the IgG bands? Are they going to know it is a negative test or are they going to wonder if they have Lyme disease?
Still, that doesn’t mean that you should never test patients for Lyme disease. You just want to use the right test for the right patient, and then know how to interpret the results correctly.
What other tests are often misused or can be easily misinterpreted?
blood allergy tests – Ever been told you’re child is allergic to everything? That’s likely because instead of a simple positive or negative result, blood allergy tests are prone to false positive results
rapid strep tests – prone to false positive results, picking up strep carriers, especially if you test kids who do not have classic symptoms of strep throat
rapid flu tests – prone to false positive results if you test when flu activity is low
thyroid function tests
monospot test – this is a non-specific test, so is not just for mono and most experts recommend that it no longer be used
EBV titers – titers of Epstein-Barr virus (EBV) antigens, including viral capsid antigen (VCA), Early antigen (EA), and EBV nuclear antigen (EBNA) can all appear at different points in your infection, from early on to years after you have recovered. Many persist for the rest of your life after you have had mono, which some folks confuse as a new infection or a relapse.
ANA – while your anti-nuclear antibody test should typically be negative and a positive ANA can be a sign of arthritis, it is also very common for kids without any problems to have a positive or elevated ANA
vitamin D levels
Why are these tests so easily misinterpreted?
False Positive Test Results
For one thing, many people underestimate the risk of false positive test results.
That’s why it is important to remember that a positive test doesn’t necessarily mean 100% that you have any specific disease or condition. It just means that you have a positive test.
“EEG will be negative in a large portion of patients with epilepsy, and may be positive in patients without epilepsy. False positive EEG findings commonly lead to unnecessary use of antiepileptic drugs and may delay the syncope diagnosis and treatment. EEGs are most helpful in specific situations when there is high pre-test probability for epilepsy based on history and exam, and clinical presentation.”
Do not routinely order electroencephalogram (EEG) as part of initial syncope work-up.
The fact that you can actually have a false positive EEG test should help you understand this whole issue a little better.
So how do you reduce the chance that you will have a false positive test result – or a false negative for that matter?
“A given test will have a higher positive predictive value in those patients with a higher prior probability of disease.”
Sensitivity, Specificity, and Predictive Values of Diagnostic and Screening Tests
You have to understand the sensitivity, specificity, and predictive values of the tests you use. And the things that influence them.
“The positive and negative predictive values vary considerably depending upon the prevalence of influenza (level of influenza activity) in the patient population being tested.”
Rapid Diagnostic Testing for Influenza: Information for Clinical Laboratory Directors
For example, when no one has the flu and disease prevalence is low, you are more likely to have false-positive rapid antigen test results. So that positive flu test this year, when no one has the flu might not actually mean that you have the flu either. It is probably a false positive, which makes you wonder why the test was done in the first place…
And know that you can’t just test everyone for everything…
Jennifer Gunter may be best known for calling out Gwyneth Paltrow’s Goop and her jade vaginal eggs, vaginal steaming, and other quackery. Active on Twitter, she also has a column in the New York Times, has a new book coming out, The Vagina Bible (pre-order it now!), and she is getting her own TV show!!!
She is another doctor you should be following, as she is doing a great job of calling out non-evidence based treatments.
And then there are these folks you should be reading and following (no, they are not all doctors…):
That they all don’t have millions of followers is one of the reasons that folks fall for medical misinformation so easily.
It’s the reason that you might go to a chiropractor when you are having problems breastfeeding, even though you don’t really understand how chiropractic works.
And why you buy homeopathic “medicines” when your kids have colic or a runny nose, not understanding that you don’t get any active medicine when you buy something with homeopathy on the label.
From misinformation about vaccines to every type of alternative medicine scam out there, these folks have been writing and warning us about them for a long time.
Surprised when someone “breaks a story” about celebrity anti-vaxxers or the “latest” alternative medicine fad that is hurting folks? You wouldn’t be if you were following these folks fighting medical misinformation.
More on Social Media Doctors Fighting Medical Misinformation
While you may want to seek medical attention, depending on your child’s age and how sick they are, believe it or not, you don’t need a flu test to get diagnosed with the flu.
“If your doctor needs to know for sure whether you have the flu, there are laboratory tests that can be done.”
CDC on Diagnosing Flu
A flu test is an option though.
Is it a good option?
A necessary option?
“Most people with flu symptoms are not tested because the test results usually do not change how you are treated.”
CDC on Diagnosing Flu
While a diagnosis of the flu can be made clinically, based on your symptoms, a flu test can be a good idea:
to help determine the cause of an outbreak (mostly if there aren’t already a lot of flu cases in your area)
if someone is at high risk for flu complications
In general though, most people do not need a flu test, especially during the active part of flu season.
What’s the problem with doing a flu test?
“In January 2017, the FDA reclassified antigen-based RIDT systems into class II. This reclassification was to help improve the overall quality of flu testing. The reclassification was prompted, in part, by recognition that the poor sensitivity of some of antigen-based RIDTs resulted in misdiagnosed cases, and, according to anecdotal reports, even death.”
FDA on CLIA-Waived Rapid Flu Test Facts
Mostly, they are neither as accurate nor as easy to interpret as most folks think, even the newer versions of these tests.
Have you ever heard someone say that they tested positive for both flu A and flu B?
When a flu tests is positive for both A and B flu strains, it invalidates the test. They may have had either flu A or flu B or neither, but they almost certainly didn’t have both.
The antigen-based rapid flu tests that most doctors and clinics use, which give results in 10 or 15 minutes, are also prone to both false positive (you don’t really have the flu, even though your test was positive), and more commonly, false negative (you actually do have the flu, even though your test was negative) results, depending if flu is active at the time.
Other flu tests are available, but are more expensive and take longer to get results, so aren’t used as often. These include “rapid” nucleic acid detection based tests that can be done in a doctor’s office, rapid nucleic acid detection based tests and rapid influenza diagnostic tests that are done in a central lab, PCR tests, and viral cultures.
So why do so many people rush to the doctor to get a flu test?
Many think that if they are positive, then they can take Tamiflu or another flu medicine and get better faster.
The problem with thinking like that is that few people actually need to take Tamiflu, as at best, it only helps you get better about a day quicker than if you didn’t take it. That’s why the recommendations for Tamiflu say to reserve it for children under two to five years of age and others who might be at high risk for flu complications.
Since most other people don’t need to take Tamiflu, they don’t necessarily need a flu test or a definitive diagnosis of the flu. Again, even if they did need Tamiflu, the diagnosis of the flu could be made clinically.
And even more importantly, a negative flu test doesn’t necessarily mean that you don’t really have the flu, especially if you have classic flu symptoms in the middle of flu season. Again, a negative flu test could be a false negative.
“RIDTs may be used to help with diagnostic and treatment decisions for patients in clinical settings, such as whether to prescribe antiviral medications. However, due to the limited sensitivities and predictive values of RIDTs , negative results of RIDTs do not exclude influenza virus infection in patients with signs and symptoms suggestive of influenza. Therefore, antiviral treatment should not be withheld from patients with suspected influenza, even if they test negative.”
CDC on Guidance for Clinicians on the Use of Rapid Influenza Diagnostic Tests
Have you ever had a negative flu test and the doctor still gave you Tamiflu? Then why did they do the test?
Diagnosing the Flu Without a Flu Test
If the results of flu testing aren’t going to change how you are treated, then you probably don’t need to have the flu test done in the first place.
Plus it saves you from having a swab stuck up your nose.
But kids should have flu tests, right?
Although rapid flu tests might be a little more accurate in kids than adults, it is not by much, so you are left with the same issues.
A positive test might reassure you that it really is the flu, but your child could still have the flu if their test is negative. A diagnosis and treatment decision can be made clinically, without a flu test, remembering that most older, healthy kids don’t need to be treated with Tamiflu.
We can’t skip flu season (although we sure can try if we get vaccinated and protected), but we can try and skip flu testing season.
“Acute flaccid myelitis (AFM) is not nationally notifiable; CDC relies on clinician recognition and health department reporting of patients under investigation (PUIs) for AFM to learn more about AFM and what causes it.”
But could there be more cases?
The Case for Making AFM Reporting Mandatory
Although AFM isn’t yet a nationally notifiable disease, 120 other diseases are, from Anthrax and Botulism to Vibriosis and Zika virus disease.
Who picks them?
The Council of State and Territorial Epidemiologists.
“Although AFP surveillance is commonly conducted in many countries currently still at risk for ongoing transmission of poliovirus, AFP is not a reportable condition in any U.S. state and routine surveillance and assessment for AFP is not performed. Therefore, understanding the baseline incidence and epidemiology of AFM and its public health impact in the United States is significantly limited.”
Revision to the Standardized Surveillance and Case Definition for Acute Flaccid Myelitis
While many people would like AFM to be added to the the Nationally Notifiable Condition List, the CSTE has instead recommended that we:
Utilize standard sources (e.g. reporting to a local or state public health department) for case ascertainment for acute flaccid myelitis (AFM), including clinician and laboratory reporting, reporting by hospitals, hospital discharge notes, neurology or infectious disease consult notes, MRI reports and images, outpatient records, and extracts from electronic medical records, etc.
Utilize standardized criteria for case identification and classification for acute flaccid myelitis (AFM) but do not add AFM to the Nationally Notifiable Condition List . If requested by CDC, jurisdictions (e.g. States and Territories) conducting surveillance according to these methods may submit case information to CDC.
Report cases as soon as possible and continue surveillance.
Share data to “measure the burden of acute flaccid myelitis (AFM).”
And the CDC has agreed.
“CDC concurs with this position statement. We look forward to continuing to work with our jurisdictional partners to address this important public health issue. This standardized case definition provides an opportunity to better define the spectrum of illness seen with AFM and to determine baseline rates of AFM in the United States. During review of the position statement, a few minor edits were identified as necessary for clarification, and we are working with the author to make these changes.”
What would be the difference if AFM was added to the Nationally Notifiable Condition List?
For one thing, because the list of reportable conditions varies from state to state, it would provide a uniform case surveillance and case definition.
But we already have that in the CSTE Position Statement on Acute Flaccid Myelitis.
The big issue is that there is no federal law that actually mandates reporting for the diseases on the list! Or even to report them to the CDC.
“Each state has laws requiring certain diseases be reported at the state level, but it is voluntary for states to provide information or notifications to CDC at the federal level.”
CDC on Data Collection and Reporting
It is up to state laws – in each and every state.
“The legal basis for disease reporting is found at the state level, where inconsistent laws may differ in terms of which conditions are reportable and their reporting process.”
Brian Labus on Differences In Disease Reporting: An Analysis Of State Reportable Conditions And Their Relationship To The Nationally Notifiable Conditions List
So even if the Council of State and Territorial Epidemiologists added AFM to the Nationally Notifiable Condition List, you would then need each state to pass a law adding AFM to their lists of notifiable diseases.
“Currently AFM is not a reportable condition in Texas.”
TxDSHS on Acute Flaccid Myelitis
How long would that take?
Zika is on the Nationally Notifiable Condition List, but guess what, like AFM, it isn’t on the reportable condition list in many states…
Want to get more cases of AFM reported to the CDC?
Let’s raise awareness about AFM and educate parents and health professionals to get all cases diagnosed, as they can then get reported to local and state health departments, who will then report them to the CDC.
Making AFM reporting mandatory might sound like a big deal, but will it really make any difference in getting kids diagnosed and treated?
“Ultimately, we would have to decide what the purpose of making something nationally notifiable is. We can investigate it just as well without that designation, and keeping things at the state level (for now) allows a lot more flexibility in how we define and investigate it. It might seem frustrating because it isn’t on the nationally-notifiable list, but that honestly doesn’t matter in terms of how we investigate things.”
Brian Labus, PhD, MPH
Cases still get investigated without being on the Nationally Notifiable Condition List.
Cases still get reported without being on the Nationally Notifiable Condition List.
And that’s good, because adding AFM to the Nationally Notifiable Condition List is not something that would happen overnight.
The CSTE would probably discuss it at their next meeting (next summer), and if approved, it would take effect at the beginning of the new year – January 2020. But then, then CDC has to get approval from the Office of Management and Budget (OMB) to actually get permission to start collecting the data on AFM for the Nationally Notifiable Condition List. All of that likely means that the earliest we would see “national” reporting for AFM would be sometime in 2022.
Does that mean we should jump on it now if it is going to take so long, or should we wait to figure out a definitive cause, and then put that on the Nationally Notifiable Condition List?
Whatever we do, remember that it still wouldn’t be mandated reporting unless each and every state actually passes a law mandating reporting of AFM cases to the CDC. Again, being on the Nationally Notifiable Condition List simply means that states are strongly encouraged to report their cases, as they do now. There are several diseases on the Nationally Notifiable Condition List that states never add to their own notifiable conditions list.
“It is voluntary that notifiable disease cases be reported to CDC by state and territorial jurisdictions (without direct personal identifiers) for nationwide aggregation and monitoring of disease data. Regular, frequent, timely information on individual cases is considered necessary to monitor disease trends, identify populations or geographic areas at high risk, formulate and assess prevention and control strategies, and formulate public health policies. The list of notifiable diseases varies over time and by state. The list of national notifiable diseases is reviewed and modified annually by the CSTE and CDC. Every national notifiable disease is not necessarily reportable in each state. In addition, not every state reportable condition is national notifiable.”
CDC on Data Collection and Reporting
Mostly, folks should understand that simply being on the Nationally Notifiable Condition List may not mean as much as they think it does.
“Although disease and condition reporting is mandated at the state, territory, and local levels by legislation or regulation, state and territory notification to CDC is voluntary. All U.S. state health departments, five territorial health departments, and two local health departments (New York City and District of Columbia) voluntarily notify CDC about national notifiable diseases and conditions that are reportable in their jurisdictions; the data in the case notifications that CDC receives are collected by staff working on reportable disease and condition surveillance systems in local, state, and territorial health departments.”
CDC on Data Collection and Reporting
And that epidemiologists at the local, state, and national level are working hard to identify all cases of AFM, which will hopefully help them figure out what is causing these cases, how to treat kids who are already affected, and how to prevent new cases.
They are identifying more and more cases of AFM even though few states have mandatory reporting, AFM isn’t on the Nationally Notifiable Condition List, and reporting of cases to the CDC is voluntary.
Interested in complementary or integrative medicine for your child? Going to see a holistic pediatrician? Learn about some of the most common treatments they might offer, from acupuncture and homeopathy to craniosacary therapy and using essential oils.
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
Is there any evidence that your favoriate therapy for when your kids are sick actually works?
What do you think of when you think of alternative medicine?
“…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. And the best way to sort it out is by carefully evaluating scientific studies – not by visiting Internet chat rooms, reading magazine articles, or talking to friends.”
Paul Offit, MD on Do You Believe in Magic
Do you think of acupuncture, Ayurveda, homeopathy, Reiki, or reflexology?
And do you wonder if they really work?
Evidence Based Medicine, or No?
Unfortunately, there are many things that parents do for which there is absolutely no evidence that they can actually help their kids.
Some parents are even encouraged to do them by well meaning pediatricians, who may not know the latest evidence about:
exposing jaundiced babies to sunlight – not only does it not work, unless they were in the sun all day long (this is done in some parts of the world, but under tinted windows to block UV and infrared light), it isn’t very practical and the AAP advises against it
changing your child’s toothbrush after they have strep throat – a study has shown it is not necessary
alternating Tylenol and Motrin – it isn’t necessary, promotes fever phobia, and can be dangerous if you mix up the times or dosages
putting kids on a BRAT diet when they have diarrhea – not necessary and doesn’t help kids get better any faster
For other therapies, your pediatrician isn’t likely to recommend them unless they are a so-called integrative or holistic pediatrician.
“Attaching the word “therapy” to the back end of an activity is an attempt to give it a status it may not deserve – and that status is subsequently used to garner insurance coverage, hospital resources, consumer patronage, and research dollars. It is also used to constrain how we think about an intervention – implying that perhaps there is some specific mechanism as work, when none need exist.”
chiropractic care of newborns and infants – understand that chiropractors don’t adjust real dislocations or misalignments in your spine, but instead manipulate what they think are subluxations that block the flow of energy that prevent your body’s innate ability to heal itself from working. Since these subluxations can’t be seen on xray, it makes you wonder why they chiropractors do so many xrays, doesn’t it?
craniosacral therapy (osteopathy) – has to do with tides and rhythms of cerebrospinal fluid, which these practitioners think they can feel and manipulate…
homeopathic “medicines” for teething, colic, gas, and the flu, etc. – do you know what’s in Oscillococcinum, the homeopathic flu medicine? It’s a mix of the pancreatic juice, liver, and heart of a duck, although it is diluted so many times, it is only the memory of those substances that remain in the little pills you take. How does that help treat your flu symptoms?
hypnosis and hypnotherapy for pain, anxiety, and insomnia – hypnosis might work as a distraction technique, but there is no good evidence beyond that
magic socks – please don’t make your kids wear ice-cold socks at night, either with or without first covering them with Vicks VapoRub. It’s as helpful as putting a raw, cut onion in their socks, which your shouldn’t do either…
Have you tried any of these therapies on your kids?
If you have, do you understand that they “work” by way of meridians (acupuncture), the memory of water, like cures like, and law of the minimum dose (homeopathy), energy and spinal fluid tides (craniosacral therapy), manipulating energy fields in your hands or feet (reflexology), and spiritual energy (Reiki)?
What’s the Harm of Trying Alternative Treatments?
But even if you don’t go to a holistic pediatrician that recommends any of these therapies that don’t work, does your pediatrician discourage you from trying them?
If they do, how strongly?
Do they say it isn’t going to work, so don’t do it, or do they use more permissive phrasing?
The American Academy of Pediatrics, for example, tells parents that amber teething necklaces don’t work and pose a risk for strangulation and choking, but then gives advice for “parents who choose to use these necklaces.”
Since they don’t work, why not just tell them to save their money and not use them?
“Rather than getting distracted by alluring rituals and elaborate pseudoscientific explanations for how they work, we should focus on maximizing the non-specific elements of the therapeutic interaction, and adding that to physiological or psychological interventions that have specific efficacy.”
Steven Novella on EMDR and Acupuncture – Selling Non-specific Effects
In addition to kids actually being harmed by many of these alternative therapies and by missing out on real medicine that could have helped them, putting so much focus on these non-evidence based “treatments” is a waste of time and money that could go towards really helping people.
Some even want to skip getting the antibiotic ointment that is placed on their baby’s eyes that can help prevent ophthalmia neonatorum, which can lead to blindness.
Since we don’t usually think of pink eye (conjunctivitis) as a serious disease, it is likely hard to imagine that neonatal conjunctivitis (ophthalmia neonatorum) could lead to blindness. It does though – or did.
The main cause was Neisseria gonorrhoeae, a sexually transmitted infection that could be passed to a baby when they were born. Similarly, Chlamydia trachomatis can cause ophthalmia neonatorum.
That ophthalmia neonatorum could be prevented was first discovered by a German gynecologist in 1881. Dr. Carl Siegmund Franz Credé instilled a drop of silver nitrate into a newborn’s eyes immediately after they were born and this greatly decreased the rates of infections in babies born in his hospital.
Today, erythromycin ophthalmic ointment and povidone-iodine have largely replaced the use of silver nitrate for preventing ophthalmia neonatorum, but it works on the same principle – killing any bacteria that might cause neonatal conjunctivitis, especially those that cause blindness.
Can You Skip Your Newborn Baby’s Eye Ointment?
Why skip a treatment that can prevent your baby from getting an infection that can lead to blindness?
Since ophthalmia neonatorum is generally caused by gonorrhoea and chlamydia, most parents who think about skipping their baby’s eye ointment are likely fairly confident that they don’t have one of these sexually transmitted infections. And most of them will likely be right.
In fact, some countries, including Australia, the UK, Norway, Denmark, and Sweden, have stopped routine ophthalmia neonatorum prophylaxis. Some just treat those babies who are at high risk for infections, especially if they didn’t receive prenatal care or have a maternal history of STIs, etc.
In the United States, routine use of erythromycin 0.5% ophthalmic ointment within 24 hours of a baby’s birth for the prevention of ophthalmia neonatorum is still the standard of care. In fact, it is required by law in many states.
What are some of the issues to consider when thinking about skipping your baby’s eye ointment?
the incidence of gonorrhoea and chlamydia have been increasing in recent years and it is very possible to have these STDs without obvious symptoms
up to 30 to 50% of babies born to a mother with gonorrhoea or chlamydia will get neonatal conjunctivitis, even if they had a cesarean section
not all pregnant women are routinely tested for gonorrhoea and chlamydia
ophthalmia neonatorum caused by gonorrhoea or chlamydia can very quickly lead to permanent scarring and blindness
ophthalmia neonatorum caused by gonorrhoea or chlamydia is not as easy to treat as routine pink eye, often requiring hospitalization and systemic antibiotics
gonorrhoea and chlamydia aren’t the only bacteria that can cause severe neonatal conjunctivitis
Most importantly, if you are thinking about skipping your baby’s eye ointment, know that places that routinely stopped using eye ointment to prevent ophthalmia neonatorum often saw an increased incidence of gonococcal ophthalmia, while rates remain very low in the United States.
“The annual figures for ON reported during the study period, under statutory health protection regulations, underestimated the actual occurrence of this disease by a very substantial amount.”
Dharmasena on Time trends in ophthalmia neonatorum and dacryocystitis of the newborn in England, 2000–2011: database study
And you are likely to get worried every time your baby has a little eye discharge or redness, just like parents who skip vaccines worry when their child has a fever or cough.
Since the eye ointment that is used is safe (erythromycin doesn’t cause the irritation that silver nitrate used to in the old days), why take the risk of an infection that can lead to blindness?
What to Know About Skipping Your Baby’s Eye Ointment
The use of erythromycin eye ointment after your baby is born can help to prevent a serious infection that can lead to blindness. Don’t skip it.
After increasing for several years, autism rates seem to be unchanged, but that hasn’t kept anti-vaccine folks from trying to get parents to panic about changes in prevalence rates that are not statistically significant.
A new report on autism prevalence rates isn’t generating many headlines.
“There was not a statistically significant change in the prevalence of children ever diagnosed with autism spectrum disorder from 2014 to 2016.”
Zablotsky et al on Estimated Prevalence of Children With Diagnosed Developmental Disabilities in the United States, 2014–2016
While the rate seemed to increase on paper, from 2.24 to 2.76%, it was not a statistically significant change. If it had been a statistically significant change, then you could think autism rates really were increasing and the report would have made headlines beyond anti-vaccine websites.
“By trying to say that there is no significant increase, is the government hoping to reassure people that autism isn’t a significant problem? That the rising number of children with autism isn’t something that anyone has to worry about? Are they trying to avoid a panic?”
Dr. Bob Sears
As most people likely understand, the term significant is used in the report as a statistical term.
When something is found to be statistically significant, then you can be fairly confident that it wasn’t caused by chance alone.
“Significance is a statistical term that tells how sure you are that a difference or relationship exists.”
So by stating that “there was not a statistically significant change in the prevalence of children ever diagnosed with autism spectrum disorder,” they were not “trying to avoid a panic.” There is no conspiracy.
Another thing to keep in mind as you think about this report – there are multiple reports about autism prevalence rates that come out every few years.
The latest report uses National Health Interview Survey data that was collected by the National Center for Health Statistics.
Unlike the autism prevalence reports from the Autism and Developmental Disabilities Monitoring (ADDM) Network that we are used to, which reported a rate of 1 in 68 children in 2016, the NCHS reports:
rely on parent reports during a telephone survey – one of the questions that they are asked is if a health professional has ever told them that their child has autism, but that diagnosis is not confirmed by looking at medical or school records
are prone to recall bias – parents might not accurately recall what doctors have told them in the past about their child
have questions that have changed over the years, for example, when PDD was added in 2014, it was thought that it might have confused some parents who didn’t know that a pervasive developmental disorder is different than a developmental disorder
look at lifetime prevalence
And not surprisingly, over the years, the NHIS has typically reported higher autism rates than the Autism and Developmental Disabilities Monitoring Network.
So what does this new report on autism prevalence mean?
It means the same thing that all of the other recent reports have been saying, that autism prevalence rates seem to be unchanged.
What to Know About Autism Rates
After increasing for several years, autism rates seem to be unchanged, but that hasn’t kept anti-vaccine folks from trying to get parents to panic about changes in prevalence rates that are not statistically significant.
Oral immunotherapy and some other treatments are providing new options to help kids with severe food allergies avoid life-threatening reactions.
Many parents likely got excited recently when they read about a possible cure for peanut allergies.
Peanut allergy could be cured with probiotics
Medical News Today
While these types of treatments are called cures by some people, what they do is desensitize you to peanuts, so that if you have a reaction, it is less severe. Some don’t have reactions anymore though. Probiotics were just part of the ‘cure’ though. They were paired with oral immunotherapy.
Is There a Cure for Peanut Allergies?
So is there really is a cure for peanut allergies?
I’m guessing it doesn’t matter if you call it a cure or a treatment if you have a child with a severe peanut allergy, you really just want to know if it is available for your child, right?
And again, there isn’t a simple answer.
Although it does seem like they are being used more and more, many of these treatments are still being tested, so they likely aren’t available everywhere, or in some cases, anywhere outside of a trial.
Among the treatments for peanut allergies, besides avoidance and treating anaphylactic reactions with epinephrine, you some day soon might be able to get your child with peanut allergies:
a wearable skin patch to provide epicutaneous immunotherapy (EPIT) – in phase III studies
a pill to provide orally administered biologic immunotherapy – in phase III studies
oral immunotherapy with Xolair (FASTX) – in phase II studies
a combination of probiotics with peanut oral immunotherapy (PPOIT)
sublingual immunotherapy (SLIT) – in phase III studies
The patch is the easiest to explain. Kids simply apply a new patch that contains peanut protein on their skin each day.
Oral immunotherapy is similar, kids are exposed to peanut protein, but unlike the patch, the dose is steadily increased each day, until you read a maintenance dose, that you continue eating each day. Most of these treatments use some variation of the characterized oral desensitization immunotherapy (CODIT) method to control and maintain desensitization.
And these treatments are not just for peanuts. Similar studies are being done for eggs and milk. And theoretically, they can be done for anything that can trigger an IgE-mediated allergic reaction, from foods and medicines to environmental allergens.
The downside? In addition to side effects, in most cases, you have to continue eating the thing you are allergic to every day, otherwise your allergy might return.
So, Is There a Cure for Peanut Allergies?
While many of these treatments are promising, they are not ready for regular use in every doctor’s office.
“The aim of OIT is to administer a food allergen slowly, in small but steadily increasing doses, until the patient stops reacting to the food (termed becoming desensitized to the food). OIT studies have shown promising results, though adverse reactions are frequent and may cause significant side effects like abdominal pain, wheezing and/or diarrhea. Published data from placebo-controlled trials have shown that only 50 to 70 percent of patients attempting OIT complete desensitization, with the failures primarily due to side effects. Also, there currently are no standardized protocols or foods used in OIT and no FDA approved approach that could allow insurance to reimburse for this therapy. Thus, there are challenges with the current practice of OIT.”
FARE Statement on Oral Immunotherapy for Food Allergies
That doesn’t mean that you can’t get some of these treatments right now or overcome those challenges.
Just keep in mind that “An allergist doing OIT for patients in a private practice develops his/her own individualized protocols and uses his/her unique food preparation.”
If your child’s food allergy has led to severe stress and anxiety for your family, that might not matter though. You probably don’t want to wait anymore if there is a chance at reducing your child’s chance of having a severe, life-threatening allergic reaction.
On the other hand, if you are fine refilling your child’s epi-pens every year and working hard to avoid peanuts, then maybe wait until the jury comes in and we get an official recommendation and more standardized treatments become more widely available.
What Else Should You Be Doing About Food Allergies?
If you don’t do private practice OIT, then in addition to strictly avoiding the things to which your child is allergic and making sure that an epi-pen is always readily available, the latest guidelines recommend that your child have:
annual testing if they have a milk, egg, soy, or wheat allergy
testing every two to three years if they have a peanut, tree nut, fish, or shellfish allergy
Kids do sometimes outgrow their allergies, especially if the allergy isn’t to peanuts or tree nuts. And even for peanuts, about 20% of kids have a chance of outgrowing their allergy.
Also remember that it is now recommended that infants at high risk for peanut allergies, especially those with eczema, have an early introduction of peanut proteins, sometimes as early as four months of age.
Hopefully that will help decrease the number of kids who need these kinds of treatments in the future.
What to Know About Treating Peanut Allergies
Oral immunotherapy and some other treatments are providing new options to help kids with severe food allergies avoid life-threatening reactions.
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