Vol. 11 •Issue 5 • Page 13
Allergy & Asthma
Asthma Patients Should Use Caution When Considering Alternative Medicine
For centuries, some cultures have soothed their aches and pains with herbal remedies. But only recently has the popularity of these approaches taken hold in the United States.
Approximately half of the American public has used complementary and alternative medicine (CAM), according to a recent study.1 It’s likely that this trend will continue, as access to CAM expands. Health food stores and pharmacies have shelves filled with bottles whose labels promise fast, natural relief of symptoms.
“As Americans we want quick fixes, and everything needs to be short and easy,” said Kathy Garrett, RRT, asthma center administrator at Long Island College Hospital, Brooklyn, N.Y. “We want to be able to go to the store and buy something with the bottom line to make ourselves healthy.”
However, she warned that asthma patients who experiment with herbal supplements could be doing their bodies more harm than good. For example, ginseng (taken to stimulate mucous secretions) and licorice (taken to reduce serum IgE)2 can prolong the action of steroids in the body. Licorice also can increase blood pressure. Echinacea (taken to raise white blood cell counts to fight germs) is a cousin to the ragweed plant and can precipitate asthma attacks and allergic reactions in some individuals.
“Most people like herbal remedies because they are natural, and they believe this is good,” said Lyndon Mansfield, MD. “Rattlesnakes are also natural, but they’re still dangerous, as are many natural things. ‘Natural’ does not mean good for human beings.”
Dr. Mansfield, medical consultant for Esoterix Allergy and Asthma, Brentwood, Tenn., has observed cases of bee pollen anaphylaxis and allergy. In addition, he noted that several herbs on the market contain mercury, silver and arsenic — ingredients rarely listed on packaging, but which can cause permanent toxic damage to the liver, kidneys and brain.
Ma huang (Ephedra sinica) is possibly the best herbal choice for asthma symptom relief, but not for long-term asthma control, Dr. Mansfield said. Used as a bronchodilator, ma huang is a central ingredient of Chinese and Japanese herbal preparations for asthma and allergic rhinitis. L-ephedrine is the primary constituent of ma huang, and it was once used in Western medicine as a bronchodilator to treat asthma before the advent of inhaled beta2-agonists.2 However, the risk/benefits ratio for beta2-agonists are much more favorable compared to ephedrine.2 Taken in large doses, ma huang can cause insomnia and cardiac and anxiety problems, Dr. Mansfield said.
ON THE SAME PAGE
Although some clinical studies have found some CAM are safer than others when taken for asthma, the U.S. Food and Drug Administration doesn’t recognize alternative medicine as an accepted form of treatment. It’s important for patients to recognize that these types of products aren’t regulated by the FDA and therefore aren’t subject to the same scrutiny as their prescription medications are under.
Currently, as long as an herbal preparation doesn’t make an outrageous claim (for example, “This product will cure your asthma.”), it’s legal for a product to be labeled as good for one’s respiratory care. Such statements often mislead consumers to believe the products are completely safe.
“You can walk into a health food store and the staff will be more than happy to tell you what to take for your asthma,” said Esther Langmack, MD, associate professor of medicine at National Jewish Medical and Research Center, Denver. “I don’t consider that to be the opinion of an informed medical practitioner, but lots of folks derive their information this way.”
In Dr. Mansfield’s experience, almost 100 percent of patients will discuss side effects of prescription drugs with their doctors, and two-thirds of patients will discuss effects of over-the-counter drugs with their doctors. However, less than one-third of patients will discuss effects from herbal remedies with their physician.
That’s why it’s imperative for physicians to ask their asthma patients to list all the types of health supplements that they use. “If someone is doing something alternative for their asthma, whether it be herbal medicines, yoga or acupuncture, doctors need to know how that individual is tackling his or her illness so everyone’s on the same page,” Dr. Langmack said. “As doctors, we need to be able to weigh the benefits and adverse effects of these therapies.”
MIND AND BODY
In addition to herbal supplements, patients are turning to holistic medicine. Mind-body relaxation techniques are considered the safest form of the CAM medicines available, and they may help to lower the body’s cortisol count to healthier levels. Cortisol is a stress hormone that the body needs in balanced amounts. When cortisol levels rise, the body can become hyperreactive to the environment, food and stress, explained James Rouse, ND, a naturopathic physician practicing in Denver. This reaction is typical in some asthma and allergy patients.
Therapies focusing on mind-body connection have been advocated for use in helping asthma symptoms. Of these, yoga and hypnosis have been evaluated more often in clinical studies, where in some cases, patients have experienced decreased bronchial reactivity to inhaled histamines.2
However, some practitioners believe relaxation techniques simply alter patient perception and promote tolerance to asthma’s warning signs, Dr. Langmack said. She encourages patients who are using CAM as part of their asthma management to track their peak flows and symptoms for two to three months. At that point, they should determine whether or not the modalities are improving their heath.
“If there’s no benefit for a patient either objectively or subjectively, then perhaps it’s time for him or her to move on rather than continue something that’s not working,” Dr. Langmack said.
Most people will have to pay out of pocket for CAM. Depending on what therapy interests a patient, that person could pay anywhere from a few dollars for herbal supplements to $50 to $100 for yoga classes. The alternative medicine practitioner should be credentialed in whatever technique he or she practices, and practitioners shouldn’t make extraordinary claims that CAM alone will cure a client’s asthma problems.
Most importantly, a reasonable CAM practitioner should require clients to consult with their physicians, and the practitioner should never tell patients to end their prescribed regimens.
1. Bielory L. Adverse reactions to complementary and alternative medicine: ragweed’s cousin, the coneflower (Echinacea), is a “problem more than a sneeze.” Annals of Allergy, Asthma, & Immunology. 2002;88:7-9. Accessed via: http://allergy.edoc.com/server-java/Propub/acaai/ao-v88n1p7fulltext.
2. Langmack E. Complementary and Alternative Therapies for Asthma. In: Szefler S, Leung D, editors. Severe Asthma: Pathogenesis and Clinical Management. 2nd ed. New York: Marcel Dekker Inc; 2001.
Debra Yemenijian is editorial assistant of ADVANCE.
Doctor Learns that U.S. Modern Medicine Doesn’t Have All the Answers
When Bhaswati Bhattacharya, MD, MPH, MA, first volunteered abroad, she was confident she knew the basis for good medicine. After all, she had studied at universities that were considered the Mecca of U.S. modern medicine.
But then she traveled to ancient Tibet, where doctors use their hands, rather than complex machinery, to determine diagnoses, and where pain is treated with drugs that are locked in plant roots instead of test tubes. So with no EKGs or wonder pills, Dr. Bhattacharya watched doctors heal patient after patient. And she realized that maybe they knew something she didn’t.
Although her Tibetan experience occurred years ago, it made an indelible mark on her life, freeing her mind from preconceived notions about medicine. Her subsequent travels to China, El Salvador, Brazil, Nigeria and India taught her “the realities of pluralistic medicine,” said Dr. Bhattacharya. Today, she incorporates this knowledge into her work as a public health and preventive medicine-trained holistic physician/scientist.
Many doctors don’t think about observing the human body without running tests, she said, because they were never really trained to do so in medical school. “Instead of looking or listening to the heart, they will run an echo,” she said. “Or instead of feeling a patient’s abdomen, they will order a CT.”
But in countries such as India and Africa, it’s common for doctors to listen to patients’ hearts at length, for instance, to make accurate diagnoses. If physicians learn this skill abroad, they will become better doctors at home. “When students are put in emergency situations where they don’t have labs and scans, they learn to be more perceptive and can perform much better as doctors here in the United States,” she said.
Besides improving physical exam and diagnostic skills, doctors who volunteer abroad learn that multiple medical practices can coexist. India, for example, is a country of ancient and modern practices. “It contains some of the leading cardiac surgeons who practice in modern hospitals and some of the world’s ancient sages,” she described.
India recognizes six medical models in its system, forcing specialists who practice there to recognize that other forms of medicine, beside their own, might be useful. For instance, modern medicine specialists might recognize that acupuncture is the best treatment for back pain, not only because it eradicates pain, but also because it won’t suppress the immune system like certain drugs can. “Our education doesn’t train us to be open to these possibilities,” she added.
The United States only recently has begun to acknowledge the importance of other practices besides modern medicine. Part of the problem, said Dr. Bhattacharya, is that the government hasn’t funded many studies on these different practices. “Research is just beginning to emerge in our country, and those who do research have no incentive to study procedures or common herbs that can’t be patented,” she said. “At the same time, many scientific studies conducted on complementary therapies in other countries are still not honored as valid in the United States.”
Despite her criticisms, Dr. Bhattacharya acknowledges her passion for modern medicine. “I love knowing what is happening on a molecular level,” she said. What she doesn’t like is doctors who apply their biomolecular knowledge myopically to patients. She bristles when doctors tell her to look at the “kidney” in Room 4. “Yes, the patient is a correlation of biochemical molecules, but the patient is also a human being with a mind, a body and a spirit,” she said.
Learning from other medical practices is the best way to stay in tune with this humanistic side of medicine, Dr. Bhattacharya said. It also keeps her humble. Before Tibet, she never considered how different therapies could be practiced side by side. She knew how “we” in the United States practice medicine and was trained that “they” were doing it all wrong.
But modern medicine is young compared to the practices of indigenous people, who’ve healed for thousands of years. Maybe — just maybe — the grandfathers of the bush could teach her something all our modern tests and drugs couldn’t. After all, they both had the same goal — to heal. And when Dr. Bhattacharya realized this, her notion of “they” simply became “we.”
Tisha Nickenig is assistant editor of ADVANCE for Directors of Rehabilitation.