I wrote this this morning and am just getting it posted, so I know others have already made some similar comments, but, here goes:


I am not in any way opposed to science, to research or to evidence. I am opposed to reliance on a term that has come to mean all the wrong things. I am opposed to blind acceptance of a model of evaluation that may never be very useful and of dismissal of models that may appear less scientific while being far more useful in practice. 


For example, if we are going to ride the EBM bandwagon, I want to know where the evidence is for the practices we currently accept?


For example, bactroban is generally considered safe for use on nipples. Where is the evidence that this is true?


Bactroban contains polyethylene glycol 400 and polyethylene glycol 3350, the first listed by the Environmental Working Group as 5-8--high hazard, which means this ingredient creates a risk for cancer, developmental and reproductive toxicity, has risk of being contaminated with other toxins, non-reproductive organ system toxicity and skin, eye or lung irritation, the second as a moderate 4-6 hazard. Some mothers use this product for weeks or longer. Is this evidence-based medicine? 


Have babies been evaluated long-term for such risk? Has anyone even thought to ask the questions? 



When I am asked where the evidence is that coconut oil is safe to use on nipples, I am blown away. As compared to what? Human milk--less safe. Bactroban--far safer. And, IMO more effective most of the time. 


Where is the evidence that the best treatment for mastitis is abx? If first do no harm actually means anything, then it is not. It might work (although I have my doubts in many cases), but so would cutting off the mother's breast. (That may sound like a vile comparison, but how many body parts are cut out in allopathy when they can be healed in other models?) What is the degree of harm. If we want to practice based upon evidence, we are going to have to challenge some accepted practices, not fall in behind them. Homeopathy and castor oil are 100% safe methods of treating mastitis. How can we justify referring for abx if we know that abx exposure before the age of 6 mos increases risk of asthma in the infant, causes gut damage in mother and infant (hence the asthma) and increases the risk of thrush, food allergies and suppressed immunity? 


In the past ten years, I have not had a single mother in my practice need to use abx for mastitis. One mom who came to see me on abx (her second script) was told by her OB that I would use homeopathy instead. I had her call the OB and get permission to stop the abx, which she did. The remedies work. When moms have weakened immune systems, we may need to rebuild them so as not to have recurrences, but that is easily done. BTW, that OB did not feel bashed by me--she used the tools she knew how to use and gave the mother another option, bc she did not want the mom on course after course of abx. 


It is not bashing anyone to offer a better option. Larry Kotlow just published a follow-up protocol for post-tongue revision. He said--I know many of you (the LCs who refer) use homeopathy and I am fine with that, but as I do not know enough yet, this is what I am offering. I am fine with that. I trust Larry--he is smart guy and he will learn bc he is open-minded. 



The term evidence-based medicine has been co-opted by the allopathic model as a way of throwing aside any medicine that carries long traditions, such as Chinese, Native American, Indian or even western herbalism. And certainly homeopathy. It cannot even hope to address nutrition when one considers that the isolation of one nutrient exclusive of its cofactors makes it essentially useless. 


The concept of evidence-based medicine initially gave equal weight to clinical experience, yet we have blindly plodded along as if the only evidence takes place under lab conditions and is published in journals. For one thing, a lot of good evidence is never published anywhere (read the second article below written by a doctor who has had this experience) and most of what is published is not good evidence. 


That leaves us in the awkward position of having to figure out for ourselves what is really best practice. We can always cling to the "evidence-based" ideal and in doing so, blindly ignore the fact that often there is no evidence! Look at the practice of obstetrics. Most of us who have to work with drugged and hurting mommas and babies know that obstetric practices interfere with breastfeeding most of the time. Yet, there is little evidence to support the majority of obstetrics as practiced in western hospitals. 


Lack of evidence-based medicine in a spiral towards what? More lack of evidence-based medicine? 


Most of us have seen astonishing results when a tongue-tied baby has a revision and goes back to breast. We refer babies for revision all the time. Where is the evidence? I have personally observed about 200 revisions. I have the clinical experience. I have seen some of the evidence that my colleagues and I have gathered. There will never be a double-blind controlled study. Is my practice evidence-based? Am I covered because I am referring to physicians? Is what I do okay only when a physician says it is? Most of the time, my clients' peds do not think it is ok. Moms do it anyway. Really, I am getting the approval of only a small group of self-educated docs. How do I decide? 


For me, the decision often comes from asking myself which is the least likely to cause harm. If I have no evidence (meaning reproducible scientific studies) on say coconut oil vs bactroban, I am going to encourage the least likely to cause harm--the food rather than the toxic chemical. If a mom has thrush, I am going to do the same--coconut oil over gentian violet every time. I do not only want to know that something has an outcome--I want to know the risk of that outcome. In science, risk is often the least properly assessed and reported. How widely reported are the risks of artificial feeding? 


I have a friend who is a family practice doc--she teaches integrative medicine--she said that the worst thing, in her opinion, that has happened to medicine in the past 10 years has been "EBM". Like me, she sees it as an excuse to narrow possibilities and exercise control over non-allopathic practices, even though that was never its intention. There are many, many MDs crying foul on this issue, too. 


If we were to reframe evidence-based medicine as something other than an excuse for not doing certain things (usually those that have very old traditions, are less harmful and have the "alternative" moniker pinned to them), then I am certainly interested. But, so far, that has not been my experience. 


Articles addressing the issue of EBM:



http://www.cancerdecisions.com/051108.html


http://www.whale.to/a/saputo.html




To specifically address Deborah's post, since it was directed to me:


I do not think evidence should ever mean only "research", but that is my point--it gets narrowed down to that, doesn't it? As Melissa said--there are many valid forms of evidence--the reason to dismiss others is that most traditional medicine has never been tested by it (and I agree--allopathy is not traditional--it is very new medicine). It is a way of making something less than something else--albeit with no evidence!


I use research insofar as it raises questions and offers possibilities. Do I consider it useful enough to override common sense and experience? No. There is research that concludes that breastfed babies are at greater risk of allergies. It definitely raises questions for me--I do not dismiss it out of hand--I want to know why. Will it cause me to suggest moms wean and AF? Nope. 


I consider it odd at best that anyone can see how deeply flawed current research is and still argue that it is our best tool. Best tool for what? How can you pick and choose which you will use? I view it all in the same way--it is a piece of the picture, but defines nothing. 


My son is 22 today. When he was 5, he faced a life-threatening condition that was treated with highly invasive medical procedures that saved his life. When we discussed follow-up, the doctors wanted to use drugs that were considered the best choice, based upon the evidence. I read all the evidence and I came to conclusion that they were right--it was the best choice they could offer based upon their evidence. But, I was not limited like them. I could access any modality I wanted. My son never took the drugs and we never subjected him to the years of follow-up invasive procedures they recommended. We used homeopathy, herbs, energy medicine, acupuncture and bodywork. We saw the doc once a year for 5 more years, had one diagnostic ultrasound and we were done. In the last year that we saw the doc, he told me that I had done the right thing--that they no longer recommended the drug they wanted my son to take--that it caused secondary problems that were just as severe as the condition it treated. 


Yes, this is one experience. But, he is my child and I am no slouch when it comes to digging deep into every avenue for my child. What I learned was not to bash the doctors--I continued to see a doctor for 5 years and we were never at odds. I told him what I was doing--he said my son was doing great and on we went. He knew what I did worked better than what he had offered, but never once did he want to learn about it for other children. He practiced evidence-based medicine and I found a way to ensure first that my son would simply live and then that he would thrive. I am not angry at him. I have learned so much from the doctors I have worked with and I have immense respect for them. I do not have to save the life of a kid who is bleeding to death in the middle of the night. If anyone thinks I do not have enormous respect for that, they are very wrong. But, it also has helped me to understand just how stuck in our own paradigms we can be. I got knocked out of mine, when my son needed emergency medicine. But, then it expanded vastly when the real healing had to happen. 


In his healing, we did the least harm possible, first and foremost. In my mind, that should always happen. I start there. I can tell you one thing--I do not believe in absolutes. I think that is a very dangerous concept. The earth was once absolutely flat and the sun revolved around it. 


And I would urge caution in assuming how anyone came to the beliefs they have. While I am grateful that holistic medicine is a first language for my children is is not native for me and I have had to stumble through for 25 years to get a good handle on it. I was a heavily medicated person in my early twenties. 


As to being provocative--it is usually a straw man argument and a waste of time to address. Everything is provocative at some point. 





Jennifer Tow, IBCLC, Toulouse, FR
Intuitive Parenting Network, LLC








 

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