Tag: alternative medications

Is There Evidence for That Therapy, or No?

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:

  • If her jaundice had been much worse, she would have gotten phototherapy, not sunlight.
    If her jaundice had been much worse, she would have gotten phototherapy, not sunlight. Photo by Vincent Iannelli, MD

    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.”

Steven Novella on Aroma”therapy”

These non-evidence based “therapies” include:

  • acupressure – acupuncture without the needles
  • amber teething necklaces – if your baby’s amber teething necklace doesn’t seem to be doing anything, it isn’t because it’s fake and not made of genuine Baltic amber, it’s because it’s a teething necklace…
  • aromatherapy
  • 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…
  • dry or wet cupping – what’s next, leeches?
  • essential oils – they don’t even smell good a lot of the times…
  • gripe water for colic
  • Oscillococcinum will not prevent flu complications.
    Oscillococcinum will not prevent flu complications.

    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?

  • hyperbaric oxygen therapy – this can actually help treat folks with carbon monoxide poisoning and decompression sickness (divers), but HBOT isn’t going to help your autistic child
  • 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…
  • magnetic field therapy – do your kids still wear one of those magnetic bracelets to “help” their balance?
  • mindfulness – while a nice idea and it may help you relax, it doesn’t have all of the health benefits that folks claim
  • restrictive and fad diets – from gluten-free diets for kids who don’t have Celiac disease to the GAPS and Gluten Free-Casein Free (GFCF) Diet, these diets don’t help, can be difficult and expensive to follow, and can be dangerous if kids don’t get all of the nutrients they need

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?

Do you ever wonder, what’s the harm in using these things that don’t work?

“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

If your pediatrician knows that homeopathic medicines aren’t going to work, but tells you to try them if you want, what are they going to let you try next – black salve, coffee enemas, colloidal silver, dry needling, earthing, faith healing, iridology, psychic surgery, slapping, tapping, or shamanism?

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.

And be many of the folks who pursue and push these types of alternative treatments also push myths and propaganda about vaccines or seek to skip or delay their child’s vaccines, choosing to follow a follow a non-standard, parent-selected, delayed protection vaccine schedule that leaves their kids at risk for vaccine-preventable diseases.

Don’t be fooled.

Learn to be skeptical, stick to the evidence, and stick with medicine that works.

What to Know About Evidence Based Medicine

There is plenty of evidence that alternative therapies don’t work and can do harm. Stick with medicine that works to keep your kids safe and healthy.

More on Evidence Based Medicine

Prescribe These Inexpensive Medications for Kids, Not Tho$e

The Auvi-Q epinephrine injector retails for over $2,500 each.
The Auvi-Q epinephrine injector retails for over $2,500 each, but it is recommended that folks have at least two!

Folks are no longer surprised when outrageous drug prices make the news.

Remember the $600 EpiPens?

We got less expensive alternatives after folks complained and there was a lot of media attention, but many other drugs are still expensive.

Did you know that there is a diaper rash cream on the market that costs over $600? What’s startling, is that the cream, Vusion, is simply made up of three ingredients that are available over the counter – miconazole (an antifungal drug), zinc oxide, and petroleum jelly.

There is also a pill for pinworms, Emverm, that costs $600!

Saving Money on Pediatric Prescriptions

There is one very easy way to save money on your next pediatric prescription.

That’s right, make sure your child really needs it.

No, that doesn’t mean not filling your pediatrician’s prescription, but it can mean simply asking if a prescription medication is really necessary the next time your kids get sick. Unfortunately, many conditions are over-treated, from ear and sinus infections to pink eye and reflux.

Also, when your child does need a prescription, instead of asking for a coupon, ask if a lower cost, generic alternative might be appropriate.

You can also:

  • make sure the medication is covered by your drug plan, if you have one
  • get a 90 day supply if it is a medication that your child uses long-term, like to control asthma
  • ask about optimizing your child’s dose so that they don’t need multiple pills, for example, taking one 30mg capsule is likely less expensive than taking two 15mg capsules each day
  • see if an alternative form of the same medication might be less expensive. For example, a tube of mupirocin (Bactroban) cream is a lot more expensive than a tube of mupirocin ointment, although both forms of the topical antibiotic can be used in the same situations. Similarly, ondansetron (Zofran) syrup is more expensive than ondansetron orally disintegrating tablets, which is often used when kids have nausea and vomiting.

To save money on prescriptions, you might also use a service like GoodRx, to search for the lowest prices at nearby pharmacies. Especially if you have a high deductible or if a medicine isn’t covered by your insurance, it can sometimes be cheaper to use GoodRx, or a similar service with discount cards, than to go through your insurance plan. And remember that some pharmacies, like at Walmart, offer many $4 generic drugs.

Lastly, ask your pediatrician for samples and go through the manufacturer’s patient assistance plan for help paying for your medicines.

Prescribe These Inexpensive Medications, Not Tho$e

Still can’t afford your child’s prescription?

Fortunately, there is almost always an alternative medication that is less expensive, but will work just as well, that you can ask your pediatrician about. It doesn’t do your child any good if your pediatrician prescribes a medication, but you don’t get it because you can’t afford it. Ask about an alternative instead.

In general, if you need a coupon to get the drug, you can expect that it is an expensive medication. And even if the coupon makes it affordable for you, remember that someone is still paying for it, and in the end, that’s likely going to be you in the form of higher insurance rates.

Will any of these alternatives work for your child?

 

Expensive Drug Less Expensive Alternative*
Vusion (diaper rashes) use Lotrimin + Triple Paste
Advair, Dulera, Symbicort (asthma) generic AirDuo1
Moxeza or Vigamox (pink eye) ofloxacin oph drops2
Auvi-Q (epineprine inj) generic Adrenaclick or EpiPen3
Emverm (pinworms) Reese’s Pinworm Medicine (OTC)
Omnaris, QNasl, Veramyst (allergies) generic Flonase (fluticasone propionate) or Nasacort (triamcinolone) (OTC)
Patanase (allergies) azelastine
 Suprax (UTI) trimethoprim/sulfamethoxazole or Cefdinir4
Suprax (ear infection) high dose amoxicillin or Augmentin or Cefdinir
Ciprodex, Cipro HC (ear drops) ofloxacin oph drops5
Vyvanse, Mydayis (ADHD) generic Adderall XR or Adderal6
Aptensio, Cotempla XR-ODT, Daytrana, QuilliChew ER & Quillivant XR (ADHD) generic Concerta or Ritalin6
EpiDuo, Ziana (acne) benzoyl peroxide/clindamycin
or Differin (OTC)
Solodyn, Doryx (acne) minocycline, doxycycline
Sklice, Ulesfia (lice) spinosad (Natroba) or an OTC treatment
Nexium (GERD) lansoprazole (Prevacid)7 OTC
Cutivate, Elocon, Topicort (eczema) triamcinolone 0.1% cream
 Clarinex (allergies) loratadine (Claritin)8 OTC
Xyzal (allergies) cetirizine (Zyrtec)8 OTC
levalbuterol (Xopenex) (asthma) albuterol8
Patanol, Pataday, Pazeo  (allergies) Zaditor9 (OTC)

*To be clear though, these aren’t direct brand name to generic equivalents. Most are less expensive alternative medications that many pediatricians use every day though. Many were once the primary treatment and were found to work well. They were eventually replaced by newer medications, which were thought to work better, even though there are rarely head-to-head studies that actually prove that they work better than older, now less expensive medicines.

  1. AirDuo – this is a generic preventative asthma inhaler, which like Advair, combines fluticasone propionate and salmeterol. The main downside? It can’t be used with a spacer.
  2. Before looking for lower cost antibiotic eye drops to treat pink eye, you should maybe reconsider the need to treat pink eye in the first place. Most experts now think that pink eye is usually a viral infection, and even when it is caused by a bacteria, unless it is severe, it will likely go away without treatment. Most importantly, keep in mind that according to the AAP, “exclusion is no longer required” for kids with pink eye if they are in daycare or school, which is often why many parents seek treatment in the first place.
  3. Epinephrine injectors are lifesaving medicines for kids with food allergies. They were one of the first medicines to expose how drug coupons helped drug prices soar (the $600 EpiPens), while parents got free medicines for their kids – at least if they had insurance and a co-pay to worry about. Those paying cash or who had a high deductible plan were stuck with high priced drugs. Less expensive epinephrine injectors are now available, but one of the most expensive medicines on our list is back – Auvi-Q. Although the manufacturer advertises that it is available for just $0 for commercially insured patients, each injector pack (comes with 2 injectors and a trainer) actually costs up to $2,500! And since it is recommended that kids have multiple injector packs to store in multiple places, the real price is at least $5,000.
  4. Suprax (cefixime) was once a popular antibiotic for UTIs, especially once it became generic. Then, because it was maybe not popular enough, they stopped making it. It came back though, but not with a generic price tag. Some push it as a better choice for kids with persistent ear infections, but keep in mind that when mentioned on the list of antibiotics in the AAP ear infection treatment guide, it is suggested that when multiple antibiotics have failed, “a course of clindamycin may be used, with or without an antibiotic that covers nontypeable H influenzae and M catarrhalis, such as cefdinir, cefixime, or cefuroxime.” There is likely no benefit to using Suprax by itself or over a less expensive antibiotic.
  5. Can you really use ofloxacin ophthalmic drops in a child’s ear? Yes, although it is an off-label treatment. You just can’t use otic (ear) drops in a child’s eyes. While eye drops are sterile, ear drops aren’t. And for some reason, eye drops are less expensive than ear drops.
  6. Most newer, once a day ADHD medicines are expensive. Some aren’t even covered on insurance plans. Generic medicines are going to be less expensive than newer brand name medicines and short acting stimulants, like Adderall and Ritalin, are the cheapest. Your child just has to take a repeat dose around lunch time.
  7. In many ways, we have come a long way in treating infants with reflux. Gone are the days of using medicines with dangerous side effects, like Propulsid (cisapride) and Reglan (Metoclopramide). Now, if they have gastroesophageal reflux disease (GERD), they are usually treated with an antisecretory agent to reduce acid and pain, but not necessary reduce the amount of spitting up. This can include histamine H2 receptor antagonists, like Zantac (ranitidine), and proton pump inhibitors (PPIs). Before Nexium packets for delayed release oral suspension became available, we had Prevacid Solutabs, which are now available OTC. This would be an off-label treatment.
  8. Clarinex and Xyzal are new classes of medications that turn a drug made up of a racemic mixture (Claritin and Zyrtec) into a single enatiomer. Basically, these drugs are made up of two mirror images of themselves. The theory is that if you make a new drug with just one of those mirror images, then it will work better and cause less side effects. For the great majority of people, these new drugs just cost more. Xopenex was one of the first drugs to use this method, as it is just the R-enantiomer or isomer of albuterol = levalbuterol. Does it work better than albuterol? No. Some people do think that it has fewer side effects, so it might be worth a try if your child gets very jittery or gets an elevated heart rate when he takes albuterol.
  9. Why try an over-the-counter medicine when prescription medications are available? Many medicines that are now over-the-counter, from Allegra and Claritin to Flonase and Nasacort, used to only be available with a prescription. Like these and many more medications, Zaditor allergy eye drops was once a prescription drug. It is available for kids who are at least three years old and might be worth a try before you spend money on a more expensive allergy eye drop.

In general, just remember that the “latest and greatest” medication isn’t always the greatest. Sometimes it is just newer and more expensive. Don’t be afraid to ask about an alternative if it is too expensive.

What to Know About Saving Money on Pediatric Prescriptions

Medications can be expensive, but there are things you can do to try and save money the next time your kids get a prescription from their pediatrician.

More on Saving Money on Pediatric Prescriptions