Pediatricians weigh alternative treatments

Up to two-thirds of children are being treated with complementary therapies, but research on safety and effectiveness is lacking.

By Deborah L. Shelton, amednews staff. March 27, 2000.

Garlic oil drops for a child's ear infection? Echinacea to treat childhood colds? Acupuncture for cerebral palsy?

Parents regularly ask pediatricians if these and other alternative and complementary therapies are safe and effective for their children. Physicians, for the most part, have not had good answers, experts say.

"Right now, there's a lot of anecdotal information about [alternative and complementary medicines], but not much evidence-based research that would support them from a scientific standpoint," said Burris Duncan, MD, professor of pediatrics and public health at the University of Arizona, Tucson.

That could soon change. A recent conference at the university gave pediatricians an opportunity to share information about evidence-based alternative therapies and how to integrate them into conventional pediatric practices.

"The consumer pressures on medicine at the moment are overwhelming," said Andrew Weil, MD, director of the University of Arizona Program in Integrative Medicine. "The market is moving very strongly in a direction that conventional physicians are not trying to provide for."

A study in the Nov. 11, 1998, Journal of the American Medical Association reported that four out of 10 Americans used a complementary or alternative medicine therapy in 1997. The number of visits to alternative medicine practitioners increased 50% between 1990 and 1997, to 629 million visits per year, the study said.

Other studies have found that up to 70% of children with severe, chronic or recurrent illnesses use a complementary or alternative therapy. A recent survey by the American Academy of Pediatrics reported that 93% of pediatricians were queried about such therapies by parents, said Kathi J. Kemper, MD, MPH, associate professor of pediatrics at Harvard Medical School, Boston.

Therapies used to treat common pediatric problems include herbal treatments, touch therapy, acupressure, acupuncture and hypnotism. The conditions for which they're being applied include migraines, asthma, cancer, ear infection, developmental disabilities, chronic and acute pain and attention deficit hyperactivity disorder.

"In my experience, people want doctors who can help them review treatment options and not just promote drugs and surgery as the only way of doing things," Dr. Weil said.

Part of life, medicine

Complementary therapies could potentially lower the costs and toxicities associated with conventional therapies and improve the efficacy of therapeutic outcomes, Dr. Weil told the conference.

But unstudied treatments can cause unexpected complications, said Dr. Kemper, who spoke recently to the Society of Pediatric Anesthesia about herbal remedies that exacerbate bleeding during surgery. Recent studies have shown that St. John's Wort, which is purchased over the counter as an antidepressant, can lower serum levels of protease inhibitors used to treat AIDS and of digoxin, a drug that treats heart failure.

Dr. Kemper chairs a task force that has been working since last year to develop evidence-based information for physicians, pharmacists and patients on some of the most commonly used herbs and supplements.

Dr. Duncan has been looking for ways to help the children with chronic conditions, such as cerebral palsy and spina bifida, whom he treats. "For many years I have been frustrated seeing children with cerebral palsy deteriorate over time and not be able to offer them very much," he said. "About the only thing we can offer are medicines that dull the senses and surgeries that are extremely invasive. For years, I've wondered if there were other things we should be doing."

After reading about the use of hypnosis in children with cerebral palsy, he conducted a small pilot study of four or five children, attaching surface myogram electrical probes to measure muscle rigidity. Hypnosis proved effective in relaxing and straightening their normally stiff bodies, he said.

Since July 1999 he has been working on another clinical trial utilizing acupuncture.

Alternative therapies "are a tremendous adjunct to what we're doing in a more chemical realm with children," said Dr. Duncan, who co-chaired the pediatric integrative medicine conference, the first of its kind. "It's important to look at these modalities and see how effective they are. The goal is to give these children a better chance."

The National Center for Alternative and Complementary Medicine at the National Institutes of Health is funding other studies of this kind. The center conducts and supports basic and applied research and research training and disseminates studies on complementary and alternative practices to health professionals and the public.

"We also need to get mainstream medical research institutions -- academic medical centers -- involved in this work," said Dr. Kemper, director of the Center for Holistic Pediatric Education and Research at Children's Hospital of Boston, the nation's first pediatric alternative medicine center.

Right now, there are only two centers for holistic pediatrics in the countr: the Boston program she heads and the one at the University of Arizona.

In its first year, the Pediatric Center for Complementary and Alternative Medicine at Arizona will initiate three projects investigating the safety and effectiveness of various alternative approaches on recurrent abdominal pain, otitis media and cerebral palsy.

The center also is establishing research methodologies and a pediatric research fellowship in complementary and alternative practices.

"I want to see more well-trained observers out there who are committed to open-minded, skeptical inquiry of phenomena that now are beyond our conventional view," Dr. Weil said.