Tag Archives: alternative medicine

What not to do during pregnancy and childbirth

Ben Goldacre – author of Bad Science, scourge of secretive Pharma companies, and champion of evidence-based healthcare – highlighted a great resource on his secondary blog. It is a collection of ‘do not do’ recommendations from the National Institute for Health and Clinical Excellence (pleasingly abbreviated to NICE), which publishes guidelines on best healthcare practices within the UK’s National Health Service.

The ‘do not do’ database holds information on a range of clinical practices that NICE recommend should be stopped or not used routinely, all of which is based on the best available evidence. There is a section on ‘Gynaecology, Pregnancy and Birth’, which contains 174 recommendations. Many are for specific interventions that may be more of interest to health professionals, such as “A serum ferritin test should not routinely be carried out on women with heavy menstrual bleeding (HMB)”. But there are a few nuggets that mothers- and fathers-to-be may like to hear.

There is a range of advice on alternative and complementary therapies, for instance: “Healthcare professionals should inform women that the available evidence does not support herbal supplements, acupuncture, homeopathy, castor oil, for induction of labour”. There is no evidence for hot baths, enemas or sexual intercourse either. For labour pain, transcutaneous electrical nerve stimulation (TENS) should not be offered to women in established labour”, which our midwife obviously had not read (or just ignored!).

As for acupuncture, acupressure and hypnosis, they “should not be provided, but women who wish to use these techniques should not be prevented from doing so”, which seems sensible, although potential side effects should be forgotten. Generally for alt med, it advises that: “Pregnant women should be informed that few complementary therapies have been established as being safe and effective during pregnancy. Women should not assume that such therapies are safe and they should be used as little as possible during pregnancy.” Sound  advice.

There is a mention of supplements during pregnancy – iron supplements shouldn’t be taken routinely (unless a deficiency is identified) – but I would love to see that section expanded to cover other areas of nutrition. More specifically, there is no good evidence that magnesiumfolic acidantioxidants (vitamins C and E), garlicfish oils or algal oils can help prevent disorders related to high blood pressure, such as pre-eclampsia.

A random titbit that’s not really connected with other recommendations, says that if a women wants to breastfeed, then breast examination during pregnancy does not seem to help breastfeeding in the long run.

There are more pieces of intriguing guidance about midwife support during labour (“Team midwifery and active management of labour), psychosocial interventions to reduce the likelihood of developing a mental disorder, and approaches to fertility problems.

All of which can only be good for mums and dads in making informed decisions and for health professionals in providing the best care possible. Happy browsing!

Advertisements

Alternative medicine in parenting – part 1 out now!

Just a quick update to flag that the first instalment of a three-part look at the use of complementary and alternative medicine (CAM) in parenting has been posted at The 21st Floor blog. This post focuses on the many CAM therapies advocated in pregnancy and childbirth, from acupuncture and reiki to improve fertility, enzyme therapy and herbs to prevent miscarriage, through to homeopathy and aromatherapy during labour.

I look at the evidence behind the claims and ask whether it’s so wrong if people want to do it. Part 2 will look at the role that some healthcare professionals play in its promotion (and whether this is OK), plus issues around the regulation of its use. Part 3 will focus on “alt med” care for children and the problems this may cause for the population.

As ever, let me know what you think!

In the meantime, here are a couple of comics about homeopathy. Enjoy!

XKCD: Dilution

Saturday Morning Breakfast Cereal

Natural’s not in it: the problem with homeopathy for babies

I never thought I’d end up writing about homeopathy for babies, but some things just take you by surprise.

For those that are unaware, a homeopathic preparation starts by taking a substance, usually one that would cause an ailment, and dilute it down to such a degree that none of the original substance remains. The belief is that this dilution can then be used to treat the ailment and that the more diluted the preparation, the more effective the ‘remedy’ is. To give an idea of the level of dilution of most standard homeopathic preparations, the Merseyside Skeptics made ‘homeopathic vodka’ and tested it on a few willing volunteers.

The arguments against homeopathy have been made effectively elsewhere, so I won’t re-tread those well-articulated paths too heavily, but will sum it up briefly. To support homeopathy, proponents usually either ‘cherry-pick’ flimsy, uncorroborated evidence to try and prove efficacy, suggest that a placebo effect is still a positive effect (and so what’s the problem?), or simply argue that everyone has a choice to decide what treatments they use. The primary problem for me (for it’s a problem among many) is that patients replace or delay conventional treatment in favour of alternative treatment, often at a serious detriment to their health. This is exacerbated by the decision to make homeopathic treatments available on the NHS – justified by the Government with the patient choice argument – that lends validity to the practice in many people’s minds. The Science and Technology Committee, however, conclude unequivocally that it’s not valid.

So why do I bring this up here?

Well, we’re fairly sure that my little boy’s teething at the moment. This can often be a pretty painful process, as anyone who can remember those first adult teeth poking through or who have been unfortunate enough to gain some wisdom teeth. We would, of course, like to reduce Reuben’s discomfort as much as possible, and so it is with this in mind that my wife bought some teething granules, on the recommendation of some her friends who swear by this particular brand.

Now imagine my surprise when I whipped out the box, in anticipation of riding to my son’s rescue and alleviate his pain, only to discover that these were homeopathic teething granules. First, the surprise that these even exist; and second, the puzzlement that my wife, knowing my somewhat sceptical nature, had actually bought them for our son. On the second point, she assured me that she didn’t realise they were homeopathic (this fact is revealed only on the back of the packet) and was going only on the testimonials of her friends (common ‘evidence’ homeopaths produce). So I’ll give her the benefit of the doubt on that score.

But the first point, that homeopathic pain relief exists for babies, has been troubling me since. The preparation is a 6C dilution of Chamomilla (or camomile). This means that it has been diluted 10-12, or 0.000000000001 of the original substance. In the ‘homeopathic vodka’ preparation, this would have been reached by the 6th cup of water. So a pretty extreme dilution. Leaving aside the pro-homeopathic argument that camomile doesn’t cause teething (‘like with like’ theory), there’s no evidence of this substance’s pain relief qualities (as advertised) nor, as far as I could tell, of its often assumed calming properties (also this). So at a 10-12 dilution, it seems extraordinary that there would be enough active molecules to have an effect (unless one subscribes to the ‘weaker makes it stronger’ argument).

As soon I saw that this was a homeopathic treatment, I convinced my wife that we needed to buy a proper teething pain relief. We bought some teething gel, with some well-tested analgesic and antiseptic compounds in it. And this, to me, demonstrates the crux of the issue: if we’d persisted with the homeopathic treatment, then we would have delayed using the more reliable teething gel and could have caused our son a few nights of needlessly heightened pain.

I guess it may have also subsided independently of the homeopathic treatment and we would now be telling our friends about this wonderful, magical treatment for teething. And the bandwagon would roll on.