Monthly Archives: July 2015

Look Below: Another Conspiracy Theory Sinks

There’s a quote often attributed to comic John Cleese that always makes me laugh: “The Spanish are all excited to see their new submarines ready to deploy. These beautifully designed subs have glass bottoms so the new Spanish navy can get a really good look at the old Spanish navy.” This hilarious imagery exactly describes how anyone taking any conspiracy theory “ship” under consideration should constantly look below, acutely aware of the possibility that it actually sank in a magnificent battle long ago.

Many of you may be aware of a new conspiracy theory making the rounds of social media. The most updated version of the theory is that the recent alleged rash of deaths and disappearances of physicians who practice alternative medicine and died or disappeared in Florida is a sign of something more sinister. The implication is that it has something to do with the FDA and, ostensibly, Big Pharma.

8-doctors-dead

The Free Thought Project reported, “Another Florida Doctor Murdered, Bringing Total to 8 Dead & 5 Missing in Just the Last Month”

From the first article I read on the topic, I was put in mind of the recent alleged rash of black church burnings. That conspiracy theory referred to seven predominately African American churches that had been burned within a week, claiming these alleged hate crimes as evidence of racism in America. However, this article explained that two of those churches were struck by lightning (one of which was a predominately Caucasian church), one was due to an electrical failure, and in one case, it was actually the church van that burned, not the church itself, leaving only three black church burnings considered to be deliberate—i.e., arson. Furthermore, it goes on to explain that there are an average of 1,600 church fires per year in the U.S., which averages out to 31 fires per week. Therefore, the “rash” of 7 church burnings is in no way unusual. In fact, it comes out to less than a quarter of what is expected for any given week. I’m sure there were other church fires that went unreported, but the point is that this was not an unusual circumstance.

The logical fallacy that would apply to this is the fallacy of incomplete evidence, a.k.a. cherry-picking, where one selects and reports only those facts which support his/her theory, ignoring those which do not support his/her theory.

However, in my opinion, this is more likely an example of the availability heuristic (at least, as regards its spread on social media). This cognitive shortcut applied to media takes the form of the viewer/reader believing something to be more common, more likely, or increasing in incidence because he/she is seeing/hearing more news stories about the topic. For example, I read a story about how the media reported several assaults on elderly women in New York, which led to a rash of starvation deaths among elderly women because they were afraid to leave their homes, thinking assaults on elderly women were becoming more common. A hypothetical example would be that when the media reports several shark attack deaths, people consider dying of a shark attack to be more common than dying from being hit by falling airplane parts, when in reality the reverse is true. Another hypothetical would be that, during the Disneyland measles outbreak, people heard far more about measles on the media than they did about lightning strikes and came to believe that death is a significantly high risk factor for measles; however, in reality, Americans are more likely to die of a lightning strike than from the measles. Similarly, people heard a series of news reports on black black church burningchurch burnings and came to believe that these represented an unusually high incidence and, therefore, sinister intent—specifically, racism—when in reality, the majority of the fires were accidental, not all of them were directed against black churches, and the number was well within the expected range for a given week.

I wondered whether the same was true of these alternative medicine doctors–i.e., whether it’s a combination of (A) people hearing of the death of one conspicuous alternative medicine physician and then subconsciously taking greater note of all following physician deaths, and (B) clickbaiters consciously cherry-picking the data to convince their readers that there is an epidemic of alternative physician deaths by homicide. But, typically, I was too occupied with other things to look it up.

Finally, as the tally kept rising and people were sharing these stories more and more on Facebook, I eventually got sick of it and decided to look it up. By then, Snopes had published an article about it. It was a thoroughly-researched article and answered all of my questions, and all of the links they provided checked out. (In fact, even the conspiracy theorists conceded some of Snopes’ points.) The only issue I take with it is the random snide comment that mainstream doctors are “science-based,” implying that anyone who practices alternative medicine is not science-based. Perhaps I’m more accepting of alternative medicine because I’m a midwife, which is considered alternative in the U.S. but mainstream just about everywhere else. Furthermore, I live in Japan, where the vast majority (probably close to 100%) of the physicians believe in the power of acupuncture, traditional Chinese medicine, and other practices deemed “alternative” in the U.S., yet in spite of this “anti-science” opinion, Japan has a lower infant mortality rate, longer life expectancy, and overall better health than does the U.S. The spiteful comment about alternative health practitioners smacks of bigotry and ethnocentrism.

At any rate, back to the topic on hand. The short of it is that (1) they weren’t all murders, (2) they weren’t all alternative medicine doctors who died in Florida, and (3) the number of murders is within the expected range for a given month.

  1. First, like the “black church burnings” which turned out to be mostly accidental fires, the “murdered” physicians were not all murdered. In the last alternative media article I found on the topic, the tally stood at 8 “murders” and 5 disappearances. Of the five disappearances, three were Mexican doctors who lived and practiced in Mexico and were found dead in Mexico; only two of the disappearances were American doctors living and practicing in America. Of those two, one, Dr. Whiteside, has been found dead, so we’ll add him to the eight “murdered” physicians. Of the eight—now nine—“murdered” physicians, four are known to be a homicide, one was ruled a suicide but is being further investigated by private detectives hired by the family, two died of natural causes, two have pending autopsies and are therefore unknown at this time, and one is unknown as the cause does not appear to have been reported anywhere.
  2. Second, like the “black church burnings” which turned out not to be all black churches, not all of the physicians were alternative medicine doctors living or working in Florida. Of the eleven doctors, five were alternative medicine doctors and six were mainstream (or, at least, there is no evidence that they practiced alternatively, or even that they espoused alternative beliefs); significantly, of the four homicides, three were mainstream physicians. Furthermore, five died in Florida while six died elsewhere; and only one of those who died outside of Florida lived and worked in Florida, but he also lived and worked in two other states.
  3. Third, like the “black church burnings” which turned out to be within the expected range, the number of murders is also completely within the expected range. As Snopes reports, statistically speaking, approximately 6,500-8,200 physicians die every year, adding up to approximately 700 in one month—so these 11 are WELL within the range of expected physician deaths. However, I’d like to further address the argument that these physicians all had connections to Florida. In reality, as discussed above, about half of them did not. Nevertheless, based on the differences in population of various states, we could expect approximately 13 of those 700 monthly physician deaths to occur in Florida. Therefore, even the five who specifically died in Florida (or six with Florida connections) fall within the expected number for any given month.

Here’s a tabulated breakdown:

Name Cause of Death Type of Physician State
Bradstreet, M.D. suicide or homicide [1] alternative NC (died);FL, GA, AZ (worked)
Hedendal, D.C. natural causes alternative FL
Holt, D.C. unknown—autopsy pending alternative FL
Fitzpatrick, M.D. (missing) mainstream ND
Sievers, M.D. homicide alternative FL
Whiteside, M.D. unknown—autopsy pending mainstream WI
Riley, D.O. homicide mainstream [2] GA
Schwartz, M.D. homicide mainstream FL
Crews, M.D. homicide mainstream CA
Castellano, D.D. unknown—not reported mainstream FL
Gonzalez, M.D. natural causes alternative NY

M.D. = Medical Doctor. D.C. = Doctor of Chiropractic. D.O. = Doctor of Osteopathic Medicine. D.D. = Doctor of Dentistry [3].

(I want to note here that D.O.’s can be very mainstream—in fact, in the ER, I worked with several—but are more likely than M.D.’s to be alternative. D.O.’s learn both mainstream medicine and chiropractic medicine, but may or may not practice chiropractic medicine.)

  1. Dr. Bradstreet was found with a gunshot wound to the chest. Local authorities ruled it a suicide. His family has hired several private detectives to investigate the possibility of homicide.
  2. Dr. Riley was a D.O., and many D.O.’s are alternative practitioners. However, they are also very often mainstream. Dr. Riley was an ER doctor, and there’s no evidence that she was an alternative practitioner or even that she held any “controversial” views, so it’s generally believed she was a mainstream physician.
  3. There are several abbreviations for dentists; I’m not sure which one applies to Dr. Castellano.

 

Conspiracy theories do occasionally turn out to be true, so it’s prudent to give thought to the facts of any given case. For example, although racist killings of minority individuals by white cops are exceptionally rare, it’s prudent to look into the possible motives of any such killing just to be sure. Of course, in the same way that we should give up any theory of bias on the part of the cop when a preponderance of evidence demonstrates that the crime was not related to racism, we should also give up any conspiracy theory when evidence pokes so many holes in its hull that it can no longer stay afloat. And this particular conspiracy theory is one that seems to have sunk long ago. It’s time to stop looking for it on the horizon and realize that it’s below us.

 

じゃあまたね!

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A Brief History of Pertussis Vaccines

Previously, I wrote about the dangers of attempting to protect an infant by cocooning (vaccinating all of his adult contacts against whooping cough), demonstrating how doing so actually increases the risk to the infant rather than decreasing it. I discussed how I’ve never been a fan of influenza or HPV vaccination, but how, due to research published primarily in the last couple years, I’ve come to feel similarly about pertussis vaccination.

Whooping cough deaths and cases dropped dramatically prior to introduction of the vaccine. They continued to drop after the introduction of the vaccine, decreasing by about 99% between the mid-1940s and 1970. Vaccination rates fell in concert with rising concerns about the safety of the DTP vaccine in the 1970s-1990s. However, vaccination rates have steadily risen since then and are now at an all-time high. Nevertheless, since the 1980s, the incidence has steadily increased in spite of simultaneously increasing rates of pertussis vaccination.

As I was reading studies and articles about the many possible explanations for this paradoxical increase, I came across what was to me a fascinating and detailed (and apparently award-winning) article authored by Dr. Geier, a former researcher at the National Institutes of Health (NIH) and advisor to the Centers for Disease Control and Prevention (CDC), about the history of pertussis vaccines. After reading it, I’m amazed at how much disinformation abounds on the internet about this topic! You may not be as fascinated by the topic as am I—in which case, you can skip this one and wait for my next blog post—but I found it so interesting that I summarized the article and filled in the few blanks from a few other sources. So without further ado, I present to you a brief history of pertussis vaccination.

 

And So It Starts

In 1906, researchers Bordet and Gengou developed a technique to grow B. pertussis in a laboratory, which paved the way for the creation of a pertussis vaccine. The first whole cell pertussis (wP) vaccine was produced by Bordet and Gengou in 1912 and by 1914, there were six U.S. manufacturers of pertussis vaccines. Pertussis vaccines sans formal testing were used sporadically between 1914 and 1925. The first clinical trials of wP vaccines were published in 1925 and 1933, with the 1933 study reporting serious adverse effects for the first time in its listing of two deaths that occurred within 48 hours of vaccination. The first modern wP vaccine, which was combined with diphtheria and tetanus toxoids, was created in 1942 by Dr. Pearl Kendrick. Because the wP vaccine does not inactivate endotoxin or pertussis toxin, it may be associated with some or all the side effects of pertussis infection from fever to seizures, shock, and death. Evidence of the dangerous side effects of the wP vaccine as compared to the aP vaccine were reported as early as the 1930s and considered conclusive by the 1950s, with the first deaths reported in 1933 and the first published reports of irreversible brain damage appearing in 1947 and 1948. By 1948, there were a dozen manufacturers of DPT. The “mouse toxicity test,” which essentially determined the toxicity of the vaccine by seeing how many mice died from it, was introduced to ensure licensure of safer vaccines; however, researchers concluded in 1963 that there was no correlation between mouse safety and human safety. From the late 1940s to the early 1960s, physicians continued to use wP vaccines because they had no other choice on the market and because manufacturers hid the presence of endotoxin in the vaccine and its associated risk. Vaccine manufacturers began a successful lobbying campaign of pediatric societies and state legislators in the 1940s, ultimately resulting in legislation requiring DTP vaccination prior to school entry in most states by the mid-1960s. However, with such widespread vaccination came the first published reports of irreversible brain damage and deaths resulting from the vaccine, with these reports being published almost every year from the early 1950s through the early 2000s, with additional published reports coming out of other countries. This causal relationship was deemed definite by a report from the National Institutes of Health (NIH) in 1963. Criticism of the wP vaccine due to its high rate of adverse effects, cited at 93% in a 1984 study, increased through the 1970s and peaked in the 1980s.

 

A Better Option?

The first aP vaccine was created in the 1920s and it was obvious from at least the 1930s that it was associated with fewer adverse events than the wP vaccine. Lederle Laboratories patented a new aP vaccine in 1937, which was shown clinically to be 94% protective against disease, making it significantly more effective than the wP vaccine, and was used widely in the 1940s. However, new federal laws were passed which would require expensive and labor-intensive efficacy testing of aP vaccines, and so Lederle ceased production of its more expensive but more effective and less reactogenic aP vaccine in 1948 and began producing a wP vaccine instead. Another aP vaccine was produced in 1954 but never licensed or marketed in the U.S. due to the higher cost of production and increased clinical trial requirements. Eli Lilly Company created an aP vaccine and named it Tri-Solgen. Tri-Solgen was associated with significantly fewer adverse reactions compared to wP vaccines and was sold widely from 1962-1977, at one point capturing up to 65% of the U.S. market for pertussis vaccines. Merck Sharp & Dohme produced another aP vaccine in 1960 which was found to be both safer and more effective than the wP vaccines, but ceased production by 1963 due to the cost. The following year, 1964, Merck also removed all wP vaccines from the market citing a fear of lawsuits due to damages caused by its wP vaccine because they had a safer and more effective aP product that didn’t sell. Many other aP vaccines were produced but never marketed due to their cost and to similar concerns about legal liability due to having a safer and more effective product (the aP vaccine) but continuing to sell the more dangerous and less effective product (the wP vaccine). Due to these concerns, the market severely contracted and only four manufacturers were still producing DTP vaccines by the 1970s. Lilly ceased production of all biologic products in 1975 and sold the rights to its high quality aP vaccine Tri-Solgen to Wyeth. However, the yield was low and when Wyeth reformulated it to increase its yield, the government required new safety and efficacy trials. Wyeth determined the cost, both financial and legally, wasn’t worth it and ceased production of Tri-Solgen; specifically, Wyeth’s concerns were the same as Merck’s had been—that the studies would show the aP Tri-Solgen to be safer and more effective than Wyeth’s wP vaccine, making them legally liable for continuing to market an inferior product. Hence, the only aP vaccine on the market became unavailable after 1977. By 1984, Wyeth also completely stopped production of pertussis vaccines, again due to concerns of legal liability from its failure to produce its safer product. The end result was that only two pertussis vaccine manufacturers remained in the U.S., and both produced only the wP vaccine.

 

Trouble in Paradise

In 1975, two babies in Japan died from DPT vaccination, and these were two of 37 SIDS deaths linked to vaccination; in response, the Japanese government initially banned the DTP vaccine, but later in the year resumed vaccination in children over age 2. The following year, 1976, the government sent Dr. Sato to the NIH to study aP vaccine production. His aP vaccine was tested between 1978 and 1981 and found to be nearly 100% effective and significantly less reactogenic, and so the Japanese government mandated switching to aP vaccination in 1981. During this period, infant deaths plummeted, bringing Japan from a high 17th place in world comparison of infant mortality rates to 1st place with the lowest infant mortality rate in the world. (Coincidentally, when they reintroduced vaccinations in children as young as 3 months of age in 1988, their SIDS rate quadrupled.)

Also in the 1970s, rising awareness of vaccine adverse effects led to a reduction in the pertussis vaccine compliance rate. Pertussis is an epidemic disease–i.e., there are periodic outbreaks every 3.3 years with low disease rates in the interepidemic periods–but the interepidemic period that correlated to the lowest pertussis vaccine compliance rates was an unusually long interepidemic period with the lowest whooping cough incidence on record. In the 1970s, the U.K. determined that the benefits of continued use of wP vaccination outweighed its risks, while Sweden determined the opposite, pointing out that no one had died from pertussis since 1970 and that the causal relationship between wP vaccines and encephalopathies was too great to ignore, and banned the wP vaccine. Most studies of efficacy look only at the ability of the vaccine to produce an antibody response—termed by some “research efficacy.” However, because the presence of antibodies does not necessarily correlate to immunity, a study of actual disease rates may be used to determine the ability of the vaccine to prevent disease—termed by some “clinical efficacy.” The wP vaccines were determined to be 45-48% clinically effective while the Japanese aP vaccines when tested in Sweden were found to be 55-69% clinically effective. Even when the Swedish scientists compared a two-dose regimen of aP vaccines to a five-dose regimen of wP vaccines, the aP vaccines were found to be more effective.

In the 1970s and 1980s in the U.S., several factors contributed to consideration of abandoning wP vaccination, including: the relative absence of whooping cough in the population; improvements in medical treatment of whooping cough; the serious adverse effects of the wP vaccine, which led to health clinics requiring parents to sign an informed consent prior to receiving a wP vaccine; several SIDS deaths in 1979 which the CDC deemed to be caused by a particular lot of the wP vaccine, causing the FDA to order a recall of the defective lot, followed by a reversal of the recall and efforts by manufacturers to prevent future recalls (e.g., Wyeth began spreading lots out across the country rather than sending an entire lot to one area so that adverse effects of any one lot would not be noticed as quickly in the future); and numerous lawsuits beginning in 1981 which were ironically successful because it was argued that the manufacturers had known how to produce a safer aP product but chose not to. (Unsuccessful lawsuits had been filed previously.) In 1982, a television program about the adverse effects of DPT vaccination raised parental awareness so much that attorneys trying the cases were flooded with hundreds of requests for representation. The vaccine manufacturers attempted to stop the cases by harassing the expert witnesses, leading at least one to file a suit against them. Nevertheless, by 1985, 219 such lawsuits had been filed. Pressure from parents and especially from a group formed in 1982 called Dissatisfied Parents Together led the American Academy of Pediatrics (AAP) to conduct over 8 months of hearings to develop recommendations for the creation of a federal compensation program for vaccine-injured children. Due to the AAP’s recommendations and to the large-scale civil litigation against vaccine manufacturers, Congress introduced the National Compensation Act in 1983, which sought to limit liability for vaccine injuries. One manufacturer agreed to settle out of court for $26 million and then cite its case as an example of why the act was needed. In 1986, the U.S. Congress passed the National Vaccine Injury Act, which established, among other things, the National Vaccine Injury Compensation Program (NVICP) and essentially ended litigation against vaccine manufacturers. However, with the threat of litigation gone, manufacturers were no longer under pressure to produce a safer aP vaccine. Foreseeing that this would happen, the Congress also stipulated in the Act that the IOM hold hearings and make recommendations for improving vaccines in general and the pertussis vaccine specifically.

 

Safety Wins

As previously stated, the causal link between DPT and neurological sequelae was deemed definite by the NIH in 1963. However, after receiving several generous donations from vaccine manufacturers and being staffed and/or headed by former and current employees of vaccine manufacturers, the AAP and the Pediatric Neurology Society “mysteriously” reported in 1992 that there was no such link. This was followed by several heavily manufacturer-funded researchers publishing articles that also attempted to deny the link. Backing up a few years, we’ll examine what the government saw. In 1985, the Institute of Medicine (IOM) published a report stating, among other things, that in spite of its initially higher costs, the aP vaccine saves on overall medical costs as compared to the wP vaccine, and the United States would save millions of dollars if the wP vaccine was replaced by the aP vaccine due to the high rate of adverse reactions; it advised that the highest priority should be given to making the switch. However, this recommendation was put on the back shelf and when another IOM committee convened in 1990, only five years later, they were surprised to learn that data presented in the meeting came from their own archives. Nevertheless, the evidence against the wP vaccine was so overwhelming that, regardless of the opinions of those bought by the manufacturers, the IOM determined that the causal link between wP vaccination and encephalitis was definite. The IOM convened a third time in 1993 to again discuss the DTP vaccine and determined that it definitely causes permanent brain damage. Even the AAP failed to argue the point, instead merely notifying its members of the IOM’s position. In 1992, the FDA approved the use of aP for the boosters given at 18 months and 6 years of age. In 1996, the FDA approved the use of aP for the entire schedule. Finally, by the beginning of 2001, the wP vaccine had been removed from the U.S. market, though American manufacturers continue to produce the cheaper (in every sense of the word) wP vaccines for sale in the third world.

 

“The development and acceptance of acellular pertussis vaccine in the United States demonstrates that scientific evidence alone is not always enough to change harmful medical practices. Given the powerful resistance to change demonstrated by the pharmaceutical industry, it took years of litigation, consumer advocacy, international scientific development, and congressional action to create a new norm for childhood immunization. It would seem that open discussion of vaccine problems in the scientific and medical communities, along with policies that preclude those with a conflict of interest from determining vaccine policy, might help to prevent similar difficulties in the future in the rapidly expanding vaccination field.” (Geier & Geier, 2002, p. 284]

 

 

References

Centers for Disease Control and Prevention (1997). “Vaccination: Use of acellular pertussis vaccines among infants and young children recommendations of the Advisory Committee on Immunization Practices (ACIP).” Morbidity and Mortality Weekly Report, 46(RR-7):1-25. Retrieved from <http://www.cdc.gov/mmwr/preview/mmwrhtml/00048610.htm >.

Fine, P.E.M., & Clarkson, J.A. (1982). “The recurrence of whooping cough: Possible implications for assessment of vaccine efficacy.” The Lancet, 319(8273):666-669. doi: 10.1016/S0140-6736(82)92214-0.

Geier, D., & Geier, M. (2002). “The true story of pertussis vaccination: A sordid legacy?” Journal of the History of Medicine, 57:249-284. Retrieved from <http://www.researchgate.net/publication/11177062_The_true_story_of_pertussis_vaccination_A_sordid_legacy >.

Hieb, L. (2015). “How vaccine hysteria could spark totalitarian nightmare.” WND. Retrieved from <http://www.wnd.com/2015/02/how-vaccine-hysteria-could-spark-totalitarian-nightmare/ >.

Howson, C.P., Howe, C.J., Fineberg, H.V., eds. (1991). “B pertussis and rubella vaccines: A brief chronology.” In Adverse Effects of Pertussis and Rubella Vaccines: A Report of the Committee to Review the Adverse Consequences of Pertussis and Rubella Vaccines. Institute of Medicine Committee to Review the Adverse Consequences of Pertussis and Rubella Vaccines. Retrieved from <http://www.ncbi.nlm.nih.gov/books/NBK234365/ >.

 

Of Toddlers and Hairstyles and Pinterest Parenting

I finally got tired of my daughter sometimes looking like a boy and always having plain jane hair. These days, with so many parents letting their toddler boys’ hair grow long and dressing their daughters in gender-neutral clothing (guilty), you can’t tell the child’s sex by length of hair or type of clothing alone. However, if the toddler in question has pigtails, it’s probably a girl.

So I did my research. As a midwife and nurse, I research the heck out of everything. So should it come as a surprise that I ended up with nine pages of toddler hairstyles pinned to my “Kids” Pinterest board? I found pages like this and this and this and this and this and this and this and this and this.

Ada pigtailsSo I decided to start simple. On July 4, I put her hair in simple pigtails. Isn’t she so cute?! And it only took an hour for her to pull them out! Then three days later, figuring the problem was inadequate hair length, I pulled the front half into pigtails and pulled those into back half pigtails. Those lasted a whole two hours!

It seems every other day I read something (usually satirical but sometimes serious) about how the purpose of Pinterest seems to be to make you hate your life. But seriously… there MUST be a way to keep toddler hair put up!! I’ve SEEN it… like, in REAL LIFE!!

Anyone?

…Bueller?

じゃあまたね!

EOs and Bad Advice

DISCLAIMER: I am an ER nurse, but I’m also a midwife. As such, I straddle both “conventional” and “alternative” medicine. I use and recommend alternative pharmaceuticals (e.g., herbs, essential oils, homeopathic remedies, etc.), but I’m not above using conventional pharmaceuticals (e.g., antibiotics, lidocaine for stitches, etc.). I treat all pharmaceuticals, be they conventional or alternative, with the same pause, consideration, and concern. Please note this is not aimed at anyone in particular but rather at everyone who uses or is considering using essential oils. I do not pretend to be an expert on essential oils; I am just beginning my research. I merely hope to open some eyes to potential dangers with improper use and encourage people to begin doing their own research independently of any rep’s advice.

COMMENTS: People tend to get a little… uptight… dare I say defensive?… when discussing essential oils. Please see my About page for my comments policy.

Long story short, I’ve recently come to learn some specific things about proper use of essential oils (EOs) that most people don’t seem to know and the bad advice flying around has always bothered me, but it’s gotten much more bothersome lately. Maybe it’s because I’ve learned more about EO safety over the past couple months. Maybe it’s because I was recently given bad advice for treatment of my mastitis that could have harmed my newborn if I didn’t know better, which really brought home to me the risks people undergo just by having friends they trust who use EOs. I’ve also always been deeply irritated by people who claim or pretend to know more than they do and use their fake expertise or credentials to influence people who don’t know better. For example, during the Ebola “epidemic” in America, a couple of acquaintances of a friend were using their position in a hospital (which, coincidentally, did not involve any medical training whatsoever, but rather health insurance training, and zero patient contact, facts which no one who works outside of a hospital would know unless they specifically looked it up) tothis is why doves cry convince people that they knew what they were talking about when they said Ebola was more contagious than the flu or measles. (#facepalm #thisiswhydovescry) Similarly, many MLM EO reps who have little to no training (and what they do have is provided by others with little or no training or experience) use their fake credentials to convince clients that they know what they’re talking about when they say X use of X oil is safe in X person for X ailment, but they’re often wrong, putting others at risk with their bad advice, and never seem to be willing to admit they’re wrong, even arguing with aromatherapists (those who actually have undergone in-depth, unbiased training on essential oil use). There is also a much larger subset of people who have taken bad advice from others and, through no fault of their own, pass on that bad advice simply because they don’t know better and because they trust the person who gave it to them. It’s been said that the most dangerous place to be is where you have just enough knowledge to give you confidence in your practice but not enough to recognize when your practice is dangerous. So maybe I’m writing this because I resent it when those with little or no education use their dangerous level of knowledge to influence others to do dangerous things—and then argue with those who actually have the education to know the truth. At any rate, whatever my reason for writing this blog post, consider this a PSA.

(As a side note, this risk of bad advice and potential harm is true of virtually any alternative medicine. I’ve had pregnant clients receive recommendations for herbs that I knew to be abortifacient. Luckily, being a midwife and having taught classes on birth control, which includes abortifacients, I knew better and could advise against it, but many people wouldn’t know better and would blindly take those herbs while pregnant and potentially miscarry.)

I know this post is going to tick off a bunch of people (mostly MLM EO reps), but I’m an ER nurse and, as such, am not afraid to tell someone, “You’re being unwise with certain aspects of your healthcare and may seriously harm yourself or your child with some of these uninformed decisions.” (Of course, in the ER, it was often more along the lines of, “Dear God, you’re such an incomparable moron. How are you still living?” Slightly different situation. But the point is that I learned a little bit about bravery in regards to telling people the truth about their health.) Some of this may seem overly cautious, but if you don’t know all the cautions, then you can’t make a truly informed decision. It may seem overly cautious to tell someone who has been taking narcotics daily for decades that they’re not supposed to drive while on narcotics, but if I as an ER nurse didn’t offer that education, that would be considered bad practice, and if that person then got into a car accident, I would be liable in a malpractice suit. Ditto the failure to educate a patient taking an antifungal pill regarding potential liver damage from drinking alcohol while taking the drug, or any other number of potential risks with conventional medicine. What you do with the education provided here is up to you. But at least my conscience will be clear and your eyes, hopefully, will be opened to the potential dangers of the extremely potent alternative medicine known as essential oils and you will gain a new respect for this potentially harmful and potentially beneficial “wonder drug.”

 

What is It?

EOs have been used for thousands of years in humans to treat a variety of conditions. As such, it’s difficult to patent and therefore difficult to obtain research grants because of the risk of no return on investment. It also means many of the EO remedies have been tested by time. On the other hand, it has sometimes taken thousands of years to abandon bad medical practices from the past, so just because a practice is very old doesn’t mean it’s good.
antibiotic-history-58-728Nevertheless, in this case, there’s plenty of scientific evidence indicating that EOs are beneficial for the treatment of various conditions when used correctly (however, remember to take all studies on any topic by any author with a grain of salt, understanding that it’s extremely easy to publish fraudulent studies and that most published research is false [1]). For example, the University of Minnesota has an article [2] on EO research wherein it asserts that EOs have shown “positive effects for a variety of health concerns including infections, pain, anxiety, depression, tumors, premenstrual syndrome, nausea, and many others” and then lists 75 published research studies for a brief glance at the literature on the topic. The book Essential Oil Safety by Robert Tisserand reportedly lists over 4,000 studies.

Ok… But what **are** they? Basically, EOs are super-concentrated herbs in oil form. EOs are far more potent than dried herbs. In fact, one ounce of EO may have literal tons of plant matter and be over 100x the strength of its herbal version. EOs are extremely potent, then, and pose a high risk of chemical reactions if used incorrectly or unwisely. Which brings us to the next topic…

 

EO Dangers and Sensitization

EOs pose similar risks to those you’d expect from any highly concentrated substance. For example, dermatologists sometimes recommend a bath with half a capful of bleach to treat childhood eczema, but touching undiluted bleach can give you a chemical burn. As another example, vitamin C is relatively harmless, but it’s still an acid—in fact, I once burned the roof of my mouth by sucking on a low-dose (500 mg) vitamin C tablet. EOs are similar. A given EO may be harmless at a certain dilution but cause serious harm if undiluted.

Sensitization-is-described-as-“aPerhaps the most commonly discussed risk with EOs is “sensitization.” The West Coast Institute of Aromatherapy [3] and aromatherapist Lea Harris of LearningAboutEOs.com [4] explain what this is. Basically, many EOs can cause skin irritation, and this typically occurs on the first use. However, sensitization is basically an allergic reaction. Like all allergic reactions, it’s typically *not* the first use that causes a visible reaction (in fact, I had taken Vicodin off and on for years for various ailments before I first developed an allergic reaction to it; sometimes it takes one use, but other times it takes years to develop an allergic response). Sensitization is more likely in those with sensitive skin (e.g., eczema, infants, etc.) and is typically associated with undiluted (“neat”) use or overuse (e.g., lavender is considered one of the safest EOs, but aromatherapists most often become sensitized to lavender because they use it with their clients so frequently). This is why undiluted use is rarely recommended, and why it’s recommended you don’t use the same EO daily for a long period of time. Furthermore, if you are in a profession or have a career or side job that involves frequently handling essential oils (e.g., aromatherapist, massage therapist, seller of essential oil-infused soaps or lotions or other care products, etc.), you should strongly consider wearing gloves when handling oils so as to prevent sensitization to any oils, which may hamper or prematurely end your career, as it has for others (e.g., 14). Sensitization may occur with any EO and brand is irrelevant in the same way that if you’re allergic to peanuts, you’ll be allergic to all brands of peanut butter.

There are also some side effects associated with each EO that should be taken into consideration. For example, “thieves”-type blends typically contain cinnamon bark and clove, both of which are blood thinners; rosemary and eucalyptus, both of which can inhibit the respiratory drive in children (Footnote 1); and lemon and bitter orange, both of which are phototoxic (note that sweet orange, sometimes used instead of bitter orange, is not phototoxic) [5]. Therefore, these additive—or even synergistic—effects make thieves blends unsuitable for people prone to bleeding (e.g., people taking blood-thinners), children under age 10, and people at risk of sunburn (e.g., fair-skinned people planning to be out in the sun for a significant length of time). Knowing about these side effects can help people avoid using an EO that might be fine for most but harmful for them.

What I’m trying to say is that EOs, like any medicine, must be treated with the respect they deserve. They are powerful medicinals and may indeed be that magic cure you’ve sought, but when used unwisely, they may do you serious harm.

 

General Guidelines

There are some general guidelines for proper, safe use of EOs. You certainly have the right and ability to violate these guidelines, but you do so at your own (or your child’s) risk. My hope is only that you would be informed so that, at the least, you’re aware of the guidelines and know that what you’re doing is potentially dangerous—basically, that if something goes wrong, it won’t be because you were uninformed and your response won’t be that ever-heartbreaking “I didn’t know.”

Dilution and Mixing

EOs are most often diffused into the air and inhaled, but may be used topically (put directly on the skin). Some people also ingest EOs.

Diffusion is the safest way to use EOs, so it’s generally the first recommendation. However, topical application is generally safe when done correctly.

dilute dilute diluteWhat is the correct way to use EOs topically? Generally speaking, the correct way to use them topically is to dilute them first in a carrier oil such as coconut oil. The term “neat” refers to undiluted topical application—i.e., putting the oil directly on your skin without first diluting it by mixing it in a carrier oil. Directly applying any undiluted, concentrated substance is rarely recommended, regardless of whether you’re cooking, cleaning, or formulating/administering medications as a nurse working in a hospital setting, and the same is true of EOs. Neat application is a particularly predictive risk factor for sensitization, as mentioned above, so should be avoided if at all possible. properly dilutingNeat application is NEVER recommended for children, whose skin is far more sensitive and absorbent than that of adults and who therefore are at significantly increased risk of having reactions to topical EOs, including sensitization. Neat application is almost never indicated for adults, either. Furthermore, EOs are actually spread and absorbed better when diluted in a carrier oil, and many carrier oils have additive or synergistic effects due to their own therapeutic properties (for example, coconut oil is antiinflammatory). Therefore, EOs are generally more effective when diluted prior to topical application and are more likely to cause problems if not diluted before topical use [6,7,8,10].

lowest dilution possibleHow much should they be diluted? That depends on the age of the patient and the purpose of the treatment, but the concentration of the oil ranges from 0.25% (1 drop EO to 4 tsp carrier oil) to 2% (2 drops per tsp). For very short-term use in adults, 3% concentration or even 25% concentration may be used. Exceptionally rarely, an EO may be used neat in adults. Check out Lea Harris’s article for more information on dilution [8].

ingestioncautionNow, as for ingestion… The mucous membranes of your mouth, throat, etc., allow absorption much more readily and are much more sensitive to bad side effects of EOs. When used topically, you absorb about 10% of the dose, but when swallowed, you absorb about 95%, which goes straight to (and can accumulate in) your liver, so there’s also a risk of what amounts to overdose with ingestion. Remember that essential oils are extremely potent. Swallowing a drop of EO is NOT the same as swallowing an herbal pill or two. One drop of EO is FAR more potent than a couple pills of herbs.

Aromatherapist Lea Harris warns, “Physical contact of essential oils on the mucous membranes can cause immediate irritation, or even burns. Long-term consequences of allowing essential oils to physically touch this delicate skin can lead to permanent damage, including scarring and ulcers, as well as liver and/or kidney damage, and the potential for cancer.”

EO and waterAromatherapists will very rarely agree that ingestion is safe or preferable. If you wish to ingest it, though, you should do so only under the guidance of a certified aromatherapist and you should first dilute it in a carrier oil and put it in a capsule so that when you swallow the pill, the EO bypasses your most sensitive tissues and will be diluted when it does contact your mucous membranes.

oil and waterEOs should NEVER be added to water and drunk. Oil and water does not mix. In other words, the oil is being placed directly against your sensitive mucous membranes—you might as well have swallowed the EO directly without adding it to your water because it has the same undiluted effect. An EO added to water is NOT diluted because oil and water do not mix.

Again, brand doesn’t matter—ALL EOs are highly concentrated and therefore pose a risk of chemical irritation and sensitization. [9]

Age Restrictions

3 mo

There are also lots of oils that should not be used in children of certain ages. As a general rule:

  • Under 3 months: NO EO use in any form (Footnote 2)
  • Under 2 years: preferably no EO use, with hydrosols and herbs preferred over EOs due to greater risks with EOs; generally only diffusion permitted (if used at all), though the extremely rare topical use may be recommended (e.g., for treatment of bug bites)
  • Under 6 years: very limited EO use; diffusion and topical permitted
  • Under 10 years: diffusion and topical permitted

EO poisoningThere are many EOs that are not safe for use in any form in children of certain ages. For a list of EOs not recommended for each age, here’s a quick, reader-friendly cheat sheet.

As with drugs, children are more sensitive to the effects of EOs, are at higher risk of overdose, metabolize EOs differently, and absorb more of a topically applied dose as compared to adults. Their skin is also more sensitive (consider, for example, how many infants react to various laundry detergents as compared to older children and adults), and so are at higher risk of skin irritation and reactions—including sensitization—than adults, even if the EO is used correctly, which demonstrates the importance of very judicious use of EOs in children, especially young children and infants. You wouldn’t give a 2-year-old 800 mg of ibuprofen. Similarly, I hope you would think twice about using EOs on your small child—and preferably choose the less concentrated and therefore safer hydrosols or herbs instead. [10,11]

Pregnancy/Breastfeeding Restrictions

Some EOs, like the herbs from which they come, may cause birth defects or miscarriage, and some may enter the breastmilk. Like drugs, most EOs have unknown safety profiles in pregnancy or breastfeeding and so should generally be avoided in pregnancy unless absolutely necessary and used with caution while breastfeeding. Neat (undiluted) and internal (swallowed) use in pregnancy and breastfeeding is never recommended. [12]

pregnancy lactationJust because it’s “natural” doesn’t mean it’s safe. Remember that some herbs can cause miscarriages and birth defects and that EOs are super-concentrated herbs that are over 100x more powerful. Therefore, the risk for untoward effects on the unborn baby is great.

Furthermore, something most people don’t seem to talk about is that an EO may be safe for an adult but not safe for an infant, and so a woman who is breastfeeding shouldn’t use such an EO topically in an area where her nursing infant might breathe or touch. For example, a friend recommended I use two EOs topically on my armpits when I had mastitis. However, my baby was only a couple weeks old at that point—far younger than the minimum age for EO inhalation of 3 months and EO topical use of 2 years—and if I did as recommended, there was a risk that my newborn would both inhale and potentially touch the EOs on my skin. Luckily, I knew enough to seek advice from an aromatherapist before following my friend’s advice, but most people wouldn’t know better and would put their newborns at risk. The same friend recommended putting a blend on my feet to treat the mastitis. Though the effectiveness of such a use is in question, my newborn wouldn’t be smelling or touching my feet, so that would be a safe use as regards my baby (assuming all the oils in the blend are otherwise considered safe when breastfeeding—which, coincidentally, they were not).

For a list of EOs not recommended in pregnancy and breastfeeding, there’s another quick, reader-friendly cheat sheet on the same page as the children’s cheat sheet.

 

Conclusion

If you’re the type of person to blindly swallow whatever pills any doctor prescribes you, no one (well, very few people, anyway) would think you a hypocrite for blindly following the advice of friends more knowledgeable than yourself as regards EO use. However, if you are the kind of person to avoid overuse of conventional medicine (e.g., antibiotics for every infection, antipyretics for fevers, etc.), to use natural or alternative medicine due to a belief that it is safer, to think twice before adding a new prescription to your list, to research drug reactions before agreeing to a new drug, or at the very least to hesitate when given a pharmaceutical recommendation from a healthcare professional, but you don’t hesitate when given an essential oil recommendation by a friend, even a very knowledgeable friend, then you are practicing alternative medicine dangerously. As with all alternative medicine, educate yourself prior to use, generally avoid use if not needed, and don’t blindly follow ANY advice. I always recommend that you err on the side of caution. YOU (or your child) are the one who will have to live with the consequences of bad advice followed blindly.

 

じゃあまたね!

 

Footnotes

Footnote 1: Eucalyptus and Rosemary Inhibit Respiratory Drive in Children. This is widely agreed upon among aromatherapists and written in basically every aromatherapy textbook. However, there are some who disagree with this. See here for more information if interested.

Footnote 2: No EO Use in Infants Under 3 Months of Age. It’s unknown what age is actually safe for EO use. However, Robert Tisserand talks about how infants reach a developmental milestone as regards skin permeability and sensitivity to EOs around 3 months of age. For this reason, many don’t recommend use under age 3 months, but consider 3+ months to be “probably safe” for very limited, properly diluted use (e.g., 13).

 

References

  1. Ioannidis, J.P.A. (2005). “Why most published research findings are false.” PLoS Med, 2(8):e124. doi: 10.1371/journal.pmed.0020124. Retrieved from <http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124>
  2. Halcón, L. (N.d.) “What does the research say about essential oils?” University of Minnesota. Retrieved from <http://www.takingcharge.csh.umn.edu/explore-healing-practices/aromatherapy/what-does-research-say-about-essential-oils>
  3. West Coast Institute of Aromatherapy (N.d.) “Essential Oil Safety–Skin Sensitization.” Retrieved from <http://www.westcoastaromatherapy.com/free-information/articles-archive/essential-oil-safety-skin-sensitization/>
  4. Harris, L. (2014). “A Word on Sensitization.” LearningAboutEOs.com. Retrieved from <http://www.learningabouteos.com/index.php/2014/03/12/a-word-on-sensitization/>
  5. Harris, L. (2014). “Thieves & OnGuard essential oil blends – what you must know before using thieves-type blends.” LearningAboutEOs.com. Retrieved from <http://www.learningabouteos.com/index.php/2014/08/17/thieves-onguard-essential-oil-blends-what-you-must-know-before-using-thieves-type-blends/>
  6. Harris, L. (N.d.). “Undiluted Essential Oils For Babies: Busted Essential Oil Myth #3.” Food Renegade. Retrieved from <http://www.foodrenegade.com/undiluted-essential-oils-for-babies-busted-essential-oil-myth-3/>
  7. Harris, L. (2014). “Neat Babies – Are there consequences to using essential oils “neat” on your children?” LearningAboutEOs.com. Retrieved from <http://www.learningabouteos.com/index.php/2014/10/02/neat-babies/>
  8. Harris, L. (2013). “Properly Diluting Essential Oils.” LearningAboutEOs.com. Retrieved from <http://www.learningabouteos.com/index.php/2013/08/07/properly-diluting-essential-oils/>
  9. Harris, L. (2013). “Ingesting Essential Oils.” LearningAboutEOs.com. Retrieved from <http://www.learningabouteos.com/index.php/2013/08/06/ingesting-essential-oils/>
  10. Harris, L. (2014). “Safely Using Essential Oils for Children.” Herbal Academy of New England. Retrieved from <http://herbalacademyofne.com/2014/08/using-essential-oils-for-children/>
  11. Harris, L. (2014). “Essential Oils and Children.” LearningAboutEOs.com. Retrieved from <http://www.learningabouteos.com/index.php/2014/02/07/essential-oils-and-children/>
  12. Harris, L. (2013). “Essential Oil Safety During Pregnancy.” LearningAboutEOs.com. Retrieved from <http://www.learningabouteos.com/index.php/2013/08/06/essential-oil-safety-during-pregnancy/>
  13. Anthis, C. (2014). “Safe Essential Oil Use with Babies & Children.” The Hippy Homemaker. Retrieved from <http://www.thehippyhomemaker.com/essential-oil-safety-babies-children/>
  14. The Untamed Alchemist (2015). “Put Essential Oils in ALL the Things! (Yeah, NO.)” Retrieved from <http://theuntamedalchemist.com/2015/02/15/put-essential-oils-in-all-the-things-yeah-no/>

Knitting Rhymes and Mnemonics

childknittingIn a recent discussion on a Facebook knitting group I’m in, someone who is teaching knitting to a child asked what rhymes or mnemonics she can use to help the child remember the technique, noting that her mother taught her a rhyme but she’s since forgotten it. The answers were so awesome I just had to share. Here they are…

 

For the Knit Stitch:

  • Up, Round, Under, and Off
    • Or: In, Round, Through, and Out
    • Or: In, Around, Out, Off
    • Or: Up to make x round the top of T and pull off
  • Bottom up, left to right and around, slide the needle down, scoop, pull and off! (This one came with a comment about teaching this to kids of unspecified age at church: “It’s funny, alot [sic] of them think of knitting as ‘off’ and casting on as ‘over’. [T]eaching the right words is almost more trouble than it’s worth at this age.”)
  • In thru the front door / Go round back / Out thru the window / Jump off, Jack
    • Or: In through the front door / Run around the back / Out through the window / Off jumps Jack
  • Run in the front door, grab your scarf, run back out again before the cat throws up
    • Or: In through the door, wrap up, out the door, down the sidewalk
    • Or: In through the front door / Grab your scarf / Back out the front door / Before you barf
  • Stab him, strangle him, pull his guts out and throw him off the cliff. (This one came with a disclaimer: “I learnt a pretty gruesome one from Ravelry that I used to teach children at school to knit, they loved it!” I suppose sometimes it’s the really horrid/odd/gruesome things kids remember, like how they can’t remember the family patriarch/matriarch’s name—my daughter calls both of my husband’s parents “Grandpa”—no matter how many times you tell it to them, but the one time you cuss, they remember that word forever.)

 

For the Purl Stitch:

  • Dive down for pearls
  • Jack goes in / Puts on his scarf / Comes back out / And takes it off
  • Under the fence / Catch the sheep / Back we come / Off we leap!
  • Down the little bunny hole / Around the big tree / Up pops bunny / And away runs he
    • Or: In through the bunny hole / And round the big tree / And out through the bunny hole / And off goes she
  • In through the back way / Then rope the hog / Back out the gate / And jump off the log!

 

For the Standard Bind Off:

  • you have Pete and Repeat sitting on a log and Pete jumps over Repeat who’s left

 

Others recommended Kids Knitting by Melanie Fallick and Auntie Suzanne Blogs it All (http://auntiesuzanne.blogspot.jp/2006/10/knitting-rhymesold-and-new.html) as additional sources for rhymes.

 

じゃあまたね!