Tag: evidence based medicine

What to Know About the Acute Flaccid Myelitis Investigations

Although you may just now be hearing about acute flaccid myelitis, it is important to understand that it isn’t new.

The rise in AFM cases began in 2014 and seem to occur every other year.
The rise in AFM cases began in 2014 and seem to occur every other year.

It wasn’t even new when we started to see an increased number of cases a few years ago.

What is new, is that we are seeing an increased number of cases.

Acute Flaccid Myelitis Timeline

AFM refers to acute (sudden onset) flaccid (droopy or loose muscles) myelitis (inflammation of the spinal cord) and it is a subtype of acute flaccid paralysis.

If that explanation doesn’t really help you, it might help to understand that paralytic polio, like AFM, is another subtype of acute flaccid paralysis.

“In August 2012, the California Department of Public Health (CDPH) was contacted by a San Francisco Bay area clinician who requested poliovirus testing for an unvaccinated man aged 29 years with acute flaccid paralysis (AFP) associated with anterior myelitis (i.e., evidence of inflammation of the spinal cord involving the grey matter including anterior horn cell bodies) and no history of international travel during the month before symptom onset. Within 2 weeks, CDPH had received reports of two additional cases of AFP with anterior myelitis of unknown etiology.”

Acute Flaccid Paralysis with Anterior Myelitis — California, June 2012–June 2014

That seems to be about when this started, in 2012.

Unfortunately, they didn’t figure out what was causing the paralysis in these three patients, despite extensive testing and more cases followed.

“To identify other cases of AFP with anterior myelitis and elucidate possible common etiologies, CDPH posted alerts in official communications for California local health departments during December 2012, July 2013, and February 2014.”

Among 23 cases, California health officials found that the median age of the patients was 10 years old, only two tested positive for EV-D68, although most did have a recent “an upper respiratory or gastrointestinal prodrome.”

“Acute flaccid paralysis (AFP) with anterior myelitis is not a reportable condition, and baseline rates of disease are unknown but are likely quite low. Data from 1992–1998 on children aged <15 years in California indicated an incidence of 1.4 AFP cases per 100,000 children per year and did not identify a single case of AFP with anterior myelitis.”

California wasn’t the only state with cases.

In 2014, there were at least 12 cases in Colorado and 11 in Utah.

“In response to the CDPH and CHCO reports, the CDC established a case definition for enhanced nationwide surveillance of AFM, which included individuals less than 21 years of age with acute flaccid limb weakness and MRI involvement of predominantly the gray matter of the spinal cord without identified etiology presenting after August 1, 2014.”

Messacar et al on Acute Flaccid Myelitis: A Clinical Review of US Cases 2012–2015

All together though, in 2014, once  the CDC began actively investigating cases, at least 120 cases were discovered in 34 states. The cases were associated with a large outbreak of EV-D68-associated respiratory illness, although they weren’t able to conclusively link those respiratory illnesses to the AFM cases.

Is there any evidence that there were a lot of cases before 2012?

Or that the CDC has dropped the ball and hasn’t been doing enough to investigate cases?

Not if you look at the timeline.

The CDC was involved very early, called for all cases to be reported, and is actively investigating those cases.

CDC activities include… using multiple research methods to further explore the potential association of AFM with possible causes as well as risk factors for AFM. This includes collaborating with experts to review MRI scans of people from the past 10 years to determine how many AFM cases occurred before 2014, updating treatment and management protocols, and engaging with several academic centers to conduct active surveillance simultaneously for both AFM and respiratory viruses.

CDC on the AFM Investigation

And if the first cases in California and Colorado triggered so much attention, isn’t it likely that any cases anywhere else would have done the same thing?

That makes it very unlikely that many cases were missed in earlier years.

  • EV-D68 first identified as a cause of respiratory tract infections – 1962
  • the first reports that EV-D68 could cause severe, even fatal respiratory disease – 2008
  • first AFM cases are discovered in California – August 2012
  • the Colorado Department of Public Health and Environment notifies the CDC about a cluster of AFM cases at Children’s Hospital Colorado and a joint investigation begins between the CDPH, CDC, and the physicians caring for the patients  – September 2014
  • the CDC issues a health advisory on Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children and calls on local and state health departments to report patients to the CDC – September 2014
  • the CDC conducts a conference call on Neurologic Illness with Limb Weakness in Children, so that clinicians could learn about the latest situation, surveillance, and CDC clinical guidance for AFM testing, patient evaluation and case reporting – October 2014
  • the CDC posts Interim Considerations for Clinical Management – November 2014
  • 120 AFM cases in 34 states – 2014
  • Council of State and Territorial Epidemiologists AFM case definition adopted – June 2015
  • 22 AFM cases in 17 states – 2015
  • 149 AFM cases in 39 states – 2016
  • Council of State and Territorial Epidemiologists AFM case definition updated, which once again, recommends against adding AFM to the Nationally Notifiable Disease List – June 2017
  • 33 AFM cases in 16 states, including one death – 2017
  • CDC Telebriefing on Acute Flaccid Myelitis in the US with Dr. Nancy Messonnier, director of CDC’s National Center for Immunization and Respiratory Diseases – August 2018
  • 158 AFM cases confirmed in 36 states among 311 reported cases that are being investigated – 2018

The other issue that concerns many parents is why a definitive cause hasn’t yet been identified. And why don’t we have treatments or a cure yet?

“To date, no pathogen (germ) has been consistently detected in the patients’ spinal fluid; a pathogen detected in the spinal fluid would be good evidence to indicate the cause of AFM since this condition affects the spinal cord.”

CDC on AFM Investigation

Although enteroviruses can be difficult to detect in spinal fluid, it is important to keep in mind that isn’t the only thing that is keeping experts from declaring the investigation over and naming a cause, such as EV-D68.

“Among 41 patients whose upper respiratory tract samples were available for enterovirus/rhinovirus testing at CDC, 17 (41%) tested positive: eight (20%) for EV-D68 and nine (22%) for eight other enterovirus/rhinovirus types.”

Eyal Leshem on Notes from the Field: Acute Flaccid Myelitis Among Persons Aged ≤21 Years — United States, August 1–November 13, 2014

Another big issue is that EV-D68 has not been detected in every, or even most AMF patients, and many others have been found to have other enteroviral infections, including EV-A71.

Could it be a coincidence that investigators are finding these enteroviruses simply because it is the season for them to appear? That would mean something else is causing these kids to have AFM.

“During September–November 2016, 10 confirmed cases of AFM were reported in Washington. No common etiology or source of exposure was identified. Enterovirus-A71 was detected in one patient and EV-D68 in two patients, one of whom also tested positive for adenovirus.”

Acute Flaccid Myelitis Among Children — Washington, September–November 2016

While the focus is on EV-D68 as a cause and everyone wants an answer, no one wants the CDC or other investigators to be wrong.

That doesn’t mean that they should be overly cautious and waste time or resources once an answer is evident, but just that they should follow sound epidemiological principles, get the right answer, and help stop kids from getting AFM.

What’s Next for AFM?

There are still a lot of unknowns about AFM, but this is likely what we can expect in the coming months:

  • the CDC will continue to investigate all unconfirmed cases that have occurred this year, which can take about four weeks after a case is reported and all necessary information is sent in. Keep in mind that since we don’t know if the CDC has already received all of the information on the cases they are investigating, we don’t know when they will finish investigating any pending cases.
  • local or state health departments will likely reach out to treating physicians to get followup about AFM patients about two months after they developed limb weakness and then report this short-term follow-up data to the CDC. In general, the CDC does not seem to contact patients directly.

From the current investigation, information from outbreaks and cases over the previous years, and cases in other countries, we will hopefully get the answers we need soon to prevent and treat AFM.

During the COCA Call, the AFM Surveillance Team will discuss the activities CDC is conducting as part of its AFM investigation.
The AFM Surveillance Team will participate in a COCA Call in mid-November.

Maybe some of those answers will come during a Clinician Outreach and Communication Activity (COCA) Call on November 13, when members from the CDC Acute Flaccid Myelitis Surveillance Team discuss the “activities the CDC is conducting as part of its investigation into AFM.”

The fact that the CDC has an Acute Flaccid Myelitis Surveillance Team will be news and is hopefully reassuring to some folks…

This is also probably a good time to remind folks that funding for public health has been declining in recent years, even as we expect our public health officials to respond to more things and react more quickly to keep us all safe and healthy. Let’s make sure we fund our public health programs, including the CDC and NIH, so that they have all of the resources they need to address all of today’s public health challenges.

More on the Acute Flaccid Myelitis Timeline

Updated on December 10, 2018

What is a Lyme-Literate Doctor?

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.

The majority of Lyme disease cases, about 95% of confirmed cases, are reported in just 14 states.
The majority of Lyme disease cases, about 95% of confirmed cases, are reported in just 14 states.

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.

Quest Diagnostics says that they have detected Lyme in all 50 states, even Arizona and Colorado, even though they are among the 8 states that don't have any of the Ixodes ticks that transmit Lyme... Are those really the states "where people are being infected?"
Quest Diagnostics says that they have detected Lyme in all 50 states, even Arizona and Colorado, even though they are among the eight states that don’t have any of the Ixodes ticks that transmit Lyme… Are those really the states “where people are being infected?”

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.

Tips from Lyme Disease Country

So what should you know to be literate about Lyme disease and be prepared if a tick ever bites your child?

  • 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.
  • except in very specific cases in high risk areas, people shouldn’t usually be treated with antibiotics after a tick bite, just in case they might develop symptoms of Lyme disease
  • 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.

More on Lyme Disease and Lyme-Literate Doctors

Chiropractic and Craniosacral Therapy for Breastfeeding Problems

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.

It can help you breastfeed if you get ongoing support.
Your pediatrician should give you ongoing support to help you breastfeed effectively.

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.

Why?

“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?

Or is that why your baby has reflux or colic?

I doubled checked my copy of Gray's Anatomy, and our nervous system and the things it supplies don't look like this. The gall bladder, for example, is supplied by the vagus nerve (Cranial Nerve X) and the phrenic nerve (cervical nerves 3 to 5) and is not associated with the T4 vertebrae.
I doubled checked my copy of Gray’s Anatomy, and our nervous system and the things it supplies does’t look like this. The gall bladder, for example, is supplied by the vagus nerve (Cranial Nerve X) and the phrenic nerve (cervical nerves 3 to 5) and is not associated with the T4 vertebrae.

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

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