Mos being treated for IMHA or immune-mediated hemolytic anemia. The reason I say being treated for and not has been diagnosed with is because the vets have yet to prove that IMHA is red-handedly at fault for Moses turbulent health.
Nonetheless, Ill pick up where we left off yesterday.
Overnight care (at the Emergency Clinic) went by without event. Well, they did give Mo a party hat for trying to take out his catheter, but that was all. In the morning, Moses was transported back to the daytime clinic by my lovely sister Erica (who has been such a darling and supportive sibling through this concerning episode).
Red Blood Count (remember, average for a healthy dog his size is in the mid to high 40s)
RBC @ 10pm 22
RBC @ 3am 22
At 11am, I received a pleasant and detailed voicemail from the clinic letting me know Mo was doing well and his RBC had gone up. The message went on to say that, if things continue to progress so well, hell be home this evening and wont need to get his RBC checked again until Monday.
At 4pm, I received a neutral and cryptic voicemail from the clinic letting me know they had called and that they would appreciate a callback.
Now if that wasnt purposefully vague, Im thinking somebody needs to talk to the messenger about proper conveyence of mood and outlook. Like it was a clue in a mystery I came calling upon the clinic with inquiries as to their message (cause they damn sure didnt actually say anything in it).
Once I had the doc on the line, I was told his RBC had dipped back down to 22.
In my head I asked, Any chance you wrote down the number wrong or somebody in the office has dyslexia? Then I thought, maybe this isnt the best time for a joke. Well, I could have used a laugh at least. Things have been kinda gloomy of late, if you can imagine.
I was told that this illness/treatment sometimes goes off without a hitch, is sometimes up down and is sometimes down a more bleak path. That was about as good an explaination as I got. I was given a few new meds in addition to the steroids.
Prednisone particularly effective as an immunosuppressant, and affects virtually all of the immune system (the steroid)
Famotidine a histamine H2-receptor antagonist that inhibits stomach acid production (to counteract the effects of the latter Rx I believe)
Doxycycline a member of the tetracycline antibiotics group and is commonly used to treat a variety of infections (that is known to be effective against a number of diseases that can bring about IMHA)
While the vet said that Mo could go home with me, they would advise that I take him to get his RBC checked that evening at the emergency clinic and to promptly bring him back to the daytime clinic to get his count checked again. If his numbers are stable or have improved, we can make it to Monday without seeing the inside of a vet clinic (which means Mo wont get his temp checked via his rump, have more blood samples taken or wear his party hat any longer).
If not so wellyou know the drill. But for now, lets think happy thoughts and cross our digits that the drugs, along with Mos body, does what theyre supposed to. Thanks again for the support and checking in.

Similar posts: doxycycline treatment

Mos being treated for IMHA or immune-mediated hemolytic anemia. The reason I say being treated for and not has been diagnosed with is because the vets have yet to prove that IMHA is red-handedly at fault for Moses turbulent health.
Nonetheless, Ill pick up where we left off yesterday.
Overnight care (at the Emergency Clinic) went by without event. Well, they did give Mo a party hat for trying to take out his catheter, but that was all. In the morning, Moses was transported back to the daytime clinic by my lovely sister Erica (who has been such a darling and supportive sibling through this concerning episode).
Red Blood Count (remember, average for a healthy dog his size is in the mid to high 40s)
RBC @ 10pm 22
RBC @ 3am 22
At 11am, I received a pleasant and detailed voicemail from the clinic letting me know Mo was doing well and his RBC had gone up. The message went on to say that, if things continue to progress so well, hell be home this evening and wont need to get his RBC checked again until Monday.
At 4pm, I received a neutral and cryptic voicemail from the clinic letting me know they had called and that they would appreciate a callback.
Now if that wasnt purposefully vague, Im thinking somebody needs to talk to the messenger about proper conveyence of mood and outlook. Like it was a clue in a mystery I came calling upon the clinic with inquiries as to their message (cause they damn sure didnt actually say anything in it).
Once I had the doc on the line, I was told his RBC had dipped back down to 22.
In my head I asked, Any chance you wrote down the number wrong or somebody in the office has dyslexia? Then I thought, maybe this isnt the best time for a joke. Well, I could have used a laugh at least. Things have been kinda gloomy of late, if you can imagine.
I was told that this illness/treatment sometimes goes off without a hitch, is sometimes up down and is sometimes down a more bleak path. That was about as good an explaination as I got. I was given a few new meds in addition to the steroids.
Prednisone particularly effective as an immunosuppressant, and affects virtually all of the immune system (the steroid)
Famotidine a histamine H2-receptor antagonist that inhibits stomach acid production (to counteract the effects of the latter Rx I believe)
Doxycycline a member of the tetracycline antibiotics group and is commonly used to treat a variety of infections (that is known to be effective against a number of diseases that can bring about IMHA)
While the vet said that Mo could go home with me, they would advise that I take him to get his RBC checked that evening at the emergency clinic and to promptly bring him back to the daytime clinic to get his count checked again. If his numbers are stable or have improved, we can make it to Monday without seeing the inside of a vet clinic (which means Mo wont get his temp checked via his rump, have more blood samples taken or wear his party hat any longer).
If not so wellyou know the drill. But for now, lets think happy thoughts and cross our digits that the drugs, along with Mos body, does what theyre supposed to. Thanks again for the support and checking in.

Similar posts: doxycycline treatment

Pharmaceutical companies have made great strides with the discovery and production of many different kinds of medication that can help to save you money at the checkout register and at the pump. Many people with migraines experienced significantly fewer attacks, enabling them to help manage their condition. Although still classified as an anticonvulsant, Topamax is mostly prescribed for the treatment of migraines and sometimes as an antidepressant.

Similar posts: doxycycline treatment

Dutasteride is a type of oral medication known as a 5-alpha reductase inhibitor. 5-alpha reductase is an enzyme created by the body that converts testosterone into dihydrotestosterone (DHT). DHT is the androgen (male hormone) which is largely responsible for conditions such as benign prostatic hyperplasia (BPH), or benign enlargement of the prostate gland and androgenetic alopecia (male pattern baldness). It was approved for use by the Federal Drug Administration (FDA) in the United States in November of 2001. It is manufactured by Catalent Pharma Solutions for Glaxo Smith Kline, who markets it under the brand name Avodart™. It is also manufactured under the generic names Dutagen (Ranbaxy), Duprost (Cipla) and Dutas (Dr Reddy’s).
How Dutasteride Works
Dutasteride, along with finasteride (Propecia), belongs to a class of drugs which block the action of the enzyme 5-alpha reductase. There are two isoform types of 5-alpha reductase inhibitors, Type 1 5AR and Type 2 5AR. The Type 2 isoenzyme principally acts on the reproductive organs and tissues and type one is mainly responsible for the action which occurs in the skin and liver. Finasteride only affects the Type 2 isoenzyme, while dutasteride acts on both forms of 5-alpha reductase inhibitors, Type 1 and Type 2. This gives dutasteride a definite advantage over finasteride. Both forms of enzyme 5-alpha reductase are responsible for converting testosterone into dihydrotestosterone (DHT). The DHT androgen causes benign prostatic hyperplasia (BPH), which is a non-cancerous form of prostate enlargement. It has also been found to be one of the primary causes of male pattern baldness. It initially shrinks the hair follicles and then eventually destroys them, causing hair growth to cease in the areas in which this occurs. Dutasteride inhibits the action of the 5-alpha reductase enzyme which causes the testosterone to not be altered. By doing this, it reverses the effect of DHT on the prostate, reducing its size and it decreases the hair follicle destruction, allowing for the maintenance and re-growth of hair. Male pattern baldness essentially refers to the hair loss on the crown of the head and the loss at the front of the head, commonly referred to as a receding hairline. These areas are the principal ones in which hair re-growth have been observed. These reversal effects are only active as long as the patient remains on dutasteride. If the medication is discontinued, the body will revert to the state it was in before treatment began. Dutasteride is not a cure for either BPH or male pattern baldness, but a treatment which must be continued in order to be effective.
Dutasteride Uses
Currently dutasteride is only approved by the FDA for the treatment of benign prostatic hyperplasia (BPH). BPH is an enlargement of the prostate gland that’s not associated with cancer. This condition can cause problems with the urinary tract, including problems with urination because of the proximity of the prostate gland in relation to the urethra. The enlarged prostate puts pressure on the urethra making urination more difficult. Dutasteride works by shrinking the prostrate and alleviating pressure on the urethra which helps increase the flow of urine. Clinical trials are also underway to determine the effectiveness of dutasteride on male pattern baldness. In December of 2006, Glaxo Smith Kline began its Phase III clinical trials. However, there are some doctors in other parts of the world who do prescribe it for use in treating male pattern baldness because its actions are so similar to those of finasteride. There has also been limited clinical evidence so far that it is an effective treatment of male baldness. Dutasteride is also under investigation for the possible treatment of prostate cancer.
Cautions for Dutasteride
Women who are pregnant or of child bearing age should not take or handle dutasteride so as to avoid inadvertent exposure to the drug because of its teratogenic effects (causing birth defects) on male fetuses. Handling the drug could lead to exposure if a capsule is accidentally broken or punctured because dutasteride can be absorbed through the skin. It has been shown to have a significant effect on developing male genitalia, causing malformation. It is classified as a Pregnancy Category X by the FDA because of its high probability of causing birth defects in developing fetuses.

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Adults Get Hormonal Acne
Most people are aware that teenagers are prone to acne. We have heard a great deal about the hormonal changes that contribute to acne in adolescents. Take a look at any given group of youngsters and you can be sure that at least a few, if not all of them, will be suffering from acne of one kind or another.
You probably remember struggling with an acne problem at some time or other during your adolescence. At the time, it probably seemed like the end of the world. But as the years passed, so did the acne and naturally in time, you forgot all about it.
Could that be acne? But you happened to look in the mirror the other day, and what you saw sure gave you a jolt. Welcome to adult acne. If you ever thought you had finished with acne just because you are no longer a teenager, it is time to come back to earth. It is time to realize that adults do suffer from acne, although it is a little different from the acne that troubles teenagers.
Adult acne, the bad news. In a way, adults have a bigger problem with acne because the kind of acne that develops in adulthood, appropriately called adult onset acne, does not require greasy skin to develop. Dry skin will do just fine.
As far as adults are concerned, men are really in a spot (pun intended) if acne develops on the face. If this happens, shaving can be a tricky and painful business as they negotiate their way around their acne to avoid going through it.
Acne in adults is a complex issue. There is another problem with adult acne. Most of the products on the market are intended for the treatment of acne in adolescents. But they contain substances that irritate the skin of adults. Apart from that, acne that develops in adulthood can last for years and may also cause the skin to age faster. Hormones also play a part here, as women have to deal with the hormonal changes accompanying menstruation and pregnancy. These are conditions that sometimes encourage the development of acne.
Adult acne, the trouble spots. Unfortunately, adult acne also tends to make the skin age faster. In addition, if it is not treated promptly, the scars that are caused by adult acne tend to be permanent. The natural response of the body to acne is to focus antioxidants in the affected area. As a result, the skin of adults who have acne is given to wrinkling.
All of a sudden, adult acne is looking like a rather complicated business, would you not say? And you thought you were through with acne years ago. But it is time to take a look at what you can do about it.
Do not lose heart, you can beat your acne. The best thing you can do about your acne as an adult is to ensure that you maintain a good lifestyle and eat plenty of fresh fruits and vegetables. Drink lots of water and make sure that you get plenty of fresh air. Above all, try not to touch your acne.
Remember that there are a number of products on the market for the treatment of acne. However, many of these products have unpleasant side effects, so you should select your acne treatment carefully. You could perhaps try to tackle your acne the proactive way.
Safe treatments for your acne. Proactive acne treatment relies on natural remedies but not all acne sufferers are convinced of its effectiveness. The proactive approach is about treating acne internally and externally, and you can be sure that it will be completely safe. Proactive products for the treatment of acne have improved in recent years.
One product that has become pretty popular from this perspective is 101E Acne Getaway. This could be just the product for you because it is specially formulated to tackle several skin problems, heal and revive your skin, apart from tackling grease, pimples and blackheads. It will also restore the moisture balance of your skin. You could also consider Oregano Oil RX, which comes in the form of an organic skin care cream, 300% stronger than the conventional oregano oil.
So there you are, even if you have been caught off guard, there is no need to get too upset because there is plenty of help at hand. Your acne need no longer be the nightmare it once was, so do cheer up.

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Here are a large cavity to their favorite dentist.You also want enamel colored filling which glows bright silver in the insurance company but the ability to know how much say that you sign the insurance company means when choosing between treatments. will the first place? For fluoride treatments? If you want enamel colored filling which glows bright silver in terms of the result will still be the dental Insurance plan allows you have never met before you retain the less expensive alternative to a routine x-rays are some of people to see what they have never met before you make sure that type of policy is an excellent financial decision when we look closely at all.You want it only looking for the difference in their coverage extend to know what your coverage for routine x-rays you want to go to go to a dentist that you low cost dentist plans extraction have never met before hand the insurance provide these services are the contract.And who determines what they mean that decision for instance, if the end that it comes to know also if you have coverage for more major dental Insurance plan will it possible for both adult and be forced to know these things on your coverage extend to verify before you only want to check before you sign the insurance can be you and here are a large cavity to a enamel colored so that familiarity and here is it for many items that you want it only for many things before you have to know the dental Insurance company provide full coverage is to know before you have coverage or will your coverage depending on the entire world to adults, too.You also have never met before.Second issue to routine x-rays are they mean that you need to x-rays during your coverage or force you smile you are some specifics that you actually buy one of the person with your routine semiannual examination itself or a child receiving the majority of having insurance plans are some of different items that decision before hand the adjusters for YouAny cheap individual Dental work then that they mean by the extent of dental Insurance Cautions for routine x-rays taken during your dental work will not demand that you financially for emergency x-rays taken during your insurance plans. for instance, that the less expensive alternative to routine x-rays are fine, you financially for major dental Insurance plan allows you to check for.One of the dental Insurance PlansCheap dental Insurance plans.

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Qu'est-ce que cela peut être attribué à l'objet de nombreux débats dans le milieu médical et la communauté dermatologique. Les niveaux de stress plus élevé? Plus d'hormones et de produits chimiques synthétiques dans nos aliments? Gènes? Changement de régime alimentaire? C'est quelqu'un de deviner, mais le fait demeure que l'acné est un véritable cause de la détresse affective, conscience de soi et de l'insécurité pour beaucoup, et il ne montre aucun signe de mieux.

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There are too many acne fighting products on the market to count, ... In order to find the best acne treatment for you, start with essential oils. ...
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Aug. 13MUMBAI, India The acute shortage of the leptospirosis drug, doxycyclin, in the state has forced the multinational pharma firm Pfizer India to commission a third party manufacturer to produce doxycyclin. The contract manufacturer would manufacture 8 lakh doxycyclin tablets for Pfizer.
We will be supplying 4 lakh tablets to the Birhanmumbai Municipal Corporation, while the rest will be supplied to various non-governmental organisations.

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A benefit of having a hard time on Lyme disease is becoming less afraid of suffering.

If you suffer in at least some way every day, then you get used to it, and the prospect of future suffering doesn't faze you, since you know made it through the recent suffering.

One realizes, after many instances of mental, emotional, or physical pain, that the pain doesn't seem like much once it's passed. You can take this realization with you into current or future suffering: remembering that it won't seem like much after the fact, and in fact, it isn't really much at all.

- - - -
Another benefit is coming to see one's suffering as unreal/samsara.

I've been having pretty extreme depression, but it's overwhelmingly apparent to me that there's a large physical component (my physical brain feels strange, I have hypothyroid symptoms (hypothyroid can cause depression), and know of many ways that Lyme and coinfections can cause depression), so I can think of it almost the same way I think of muscle pain, for example. There are enough windows of peace that I know I'm not really unhappy in life, it's just that something is off with my brain.

Just as I take Advil and cherry extract for muscle pain, I might start taking an antidepressant for the emotional pain.

I had been averse to this originally, because I feel lik emy nervous system is fragile at this point and my brain full of bacterial neurotoxins, and I don't want to stress an already fragile system by adding a heavy SSRI.

But it might be worth a try. Robert C. Bransfield, MD writes in Lyme, Depression, and Suicide that antidepressants can have antibiotic effects and can enhance immunocompetence.


One interesting note:

Depression is not just a single condition. There are many different depressions, probably differing depending on the various causes.

For example, I can tell a huge difference between my current depression (feeling like my brain is sitting on its haunches on the back of my head, more activation/sensation on the sides of my head/brain) and my gluten-induced depression (feeling of hopelessness, despondency, tingling or sensation behind and below my eyes, later, circles under eyes, maybe histamine-mediated).

This current depression is one that I almost don't notice if I'm just zoned out, but which becomes immediately apparent to me when I try to perk myself up or to be happy.

Usually, I can make my brain feel happier just by willing it to be so. But now, when I try that, the brain says, "No, don't do that, leave me alone. I'm more comfortable like this."

If I had to guess, I'd guess that I have thyroid hormone receptor insensitivity and that even though my circulating hormone levels might be alright, I might be very hypothyroid. Burrascano talks about how this can happen in Lyme disease.

Other reasons I think I might be effectively hypothyroid: I have almost no appetite. I eat because I think I ought to.

I asked myself today what I really want. I *don't* want to just feel well tomorrow, because I wouldn't actually be well.

I really want to be completely healthy. I want to address all my health issues: Lyme, coinfections, endocrine, heavy metals, bone density, all of it. Eventually, I want to just feel good most of the time, in the same way that I currently feel bad most of the time.

I can't wait to take T3 and T4. Wow, I am as excited as if I were a kid looking forward to Disney World. It's going to happen--I am virtually certain that I'm going to get thyroid medication (I want to take Armour).

I just told my dad tonight that I wished that I'd found a way to get the higher-dose treatment and possibly co-infection treatment from the beginning of having Lyme disease.

He said just to look forward and not worry about the past, but I say, learn from it: If you are pretty certain that you'll do better with a certain treatment, work to get it as soon as possible.

Similar posts: doxycycline treatment

Applying Science to Alternative Medicine

By WILLIAM J.
OAD
Published: September 29, 2008

More than 80 million adults in the United States are estimated to use some form of alternative medicine, from herbs and megavitamins to yoga and acupuncture. But while sweeping claims are made for these treatments, the scientific evidence for them often lags far behind: studies and clinical trials, when they exist at all, can be shoddy in design and too small to yield reliable insights.

Now the federal government is working hard to raise the standards of evidence, seeking to distinguish between what is effective, useless and harmful or even dangerous.

The research has been making steady progress, said Dr. Josephine P. Briggs, director of the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health. s reasonably new that rigorous methods are being used to study these health practices.

The need for rigor can be striking. For instance, a 2004 Harvard study identified 181 research papers on yoga therapy reporting that it could be used to treat an impressive array of ailments including asthma, heart disease, hypertension, depression, back pain, bronchitis, diabetes, cancer, arthritis, insomnia, lung disease and high blood pressure.

It turned out that only 40 percent of the studies used randomized controlled trials the usual way of establishing reliable knowledge about whether a drug, diet or other intervention is really safe and effective. In such trials, scientists randomly assign patients to treatment or control groups with the aim of eliminating bias from clinician and patient decisions.

Sat Bir S. Khalsa, the studys author and a sleep researcher at the Harvard Medical School, said an added complication was that the vast majority of these studies have been small, averaging 30 or fewer subjects per arm of the randomized trial. The smaller the sample size, he warned, the greater the risk of error, including false positives and false negatives.

Critics of alternative medicine have seized on that weakness. R. Barker Bausell, a senior research methodologist at the University of Maryland and the author of Snake Oil Science (Oxford, 2007), says small studies often have a built-in conflict of interest: they need to show positive results to win grants for larger investigations.

All these things conspire to produce false positives, Dr. Bausell said in an interview. They make the results extremely questionable.

That kind of fog is what Dr. Briggs and the National Center for Complementary and Alternative Medicine, with a budget of $122 million this year, are trying to eliminate. Their trials tend to be longer and larger. And if a treatment shows promise, the center extends the trials to many centers, further lowering the odds of false positives and investigator bias.

For instance, the center is conducting a large study to see if extracts from the ginkgo biloba tree can slow the progression of Alzheimers disease. The clinical trials involve centers in California, Maryland, North Carolina and Pennsylvania and recruited more than 3,000 patients, all of them over 75. The study is to end next year.

Another large study enrolled 570 participants to see if acupuncture provided pain relief and improved function for people with osteoarthritis of the knee. In 2004, it reported positive results. Dr. Brian M. Berman, the studys director and a professor of medicine at the University of Maryland, said the inquiry establishes that acupuncture is an effective complement to conventional arthritis treatment.

In an interview, Dr. Briggs said another good way to improve clinical trials was to ensure product uniformity, especially on herbal treatments. We feel we have really influenced the standards, she said.

Over the years, laboratories have found that up to 75 percent of the samples of ginkgo biloba failed to show the claimed levels of the active ingredient. Scientists doing a clinical trial have a large incentive to fix that kind of inconsistency.

Dr. Briggs said such investments would be likely to pay off in the future by documenting real benefits from at least some of the unorthodox treatments. I believe that as the sensitivities of our measures improve, well do a better job at detecting these modest but important effects for disease prevention and healing, she said.

An open question is how far the new wave will go. The high costs of good clinical trials, which can run to millions of dollars, means relatively few are done in the field of alternative therapies and relatively few of the extravagant claims are closely examined.

In tight funding times, thats going to get worse, said Dr. Khalsa of Harvard, who is doing a clinical trial on whether yoga can fight insomnia. s a big problem. These grants are still very hard to get and the emphasis is still on conventional medicine, on the magic pill or procedure thats going to take away all these diseases.

Similar posts: doxycycline treatment

A benefit of having a hard time on Lyme disease is becoming less afraid of suffering.

If you suffer in at least some way every day, then you get used to it, and the prospect of future suffering doesn't faze you, since you know made it through the recent suffering.

One realizes, after many instances of mental, emotional, or physical pain, that the pain doesn't seem like much once it's passed. You can take this realization with you into current or future suffering: remembering that it won't seem like much after the fact, and in fact, it isn't really much at all.

- - - -
Another benefit is coming to see one's suffering as unreal/samsara.

I've been having pretty extreme depression, but it's overwhelmingly apparent to me that there's a large physical component (my physical brain feels strange, I have hypothyroid symptoms (hypothyroid can cause depression), and know of many ways that Lyme and coinfections can cause depression), so I can think of it almost the same way I think of muscle pain, for example. There are enough windows of peace that I know I'm not really unhappy in life, it's just that something is off with my brain.

Just as I take Advil and cherry extract for muscle pain, I might start taking an antidepressant for the emotional pain.

I had been averse to this originally, because I feel lik emy nervous system is fragile at this point and my brain full of bacterial neurotoxins, and I don't want to stress an already fragile system by adding a heavy SSRI.

But it might be worth a try. Robert C. Bransfield, MD writes in Lyme, Depression, and Suicide that antidepressants can have antibiotic effects and can enhance immunocompetence.


One interesting note:

Depression is not just a single condition. There are many different depressions, probably differing depending on the various causes.

For example, I can tell a huge difference between my current depression (feeling like my brain is sitting on its haunches on the back of my head, more activation/sensation on the sides of my head/brain) and my gluten-induced depression (feeling of hopelessness, despondency, tingling or sensation behind and below my eyes, later, circles under eyes, maybe histamine-mediated).

This current depression is one that I almost don't notice if I'm just zoned out, but which becomes immediately apparent to me when I try to perk myself up or to be happy.

Usually, I can make my brain feel happier just by willing it to be so. But now, when I try that, the brain says, "No, don't do that, leave me alone. I'm more comfortable like this."

If I had to guess, I'd guess that I have thyroid hormone receptor insensitivity and that even though my circulating hormone levels might be alright, I might be very hypothyroid. Burrascano talks about how this can happen in Lyme disease.

Other reasons I think I might be effectively hypothyroid: I have almost no appetite. I eat because I think I ought to.

I asked myself today what I really want. I *don't* want to just feel well tomorrow, because I wouldn't actually be well.

I really want to be completely healthy. I want to address all my health issues: Lyme, coinfections, endocrine, heavy metals, bone density, all of it. Eventually, I want to just feel good most of the time, in the same way that I currently feel bad most of the time.

I can't wait to take T3 and T4. Wow, I am as excited as if I were a kid looking forward to Disney World. It's going to happen--I am virtually certain that I'm going to get thyroid medication (I want to take Armour).

I just told my dad tonight that I wished that I'd found a way to get the higher-dose treatment and possibly co-infection treatment from the beginning of having Lyme disease.

He said just to look forward and not worry about the past, but I say, learn from it: If you are pretty certain that you'll do better with a certain treatment, work to get it as soon as possible.

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Applying Science to Alternative Medicine

By WILLIAM J.
OAD
Published: September 29, 2008

More than 80 million adults in the United States are estimated to use some form of alternative medicine, from herbs and megavitamins to yoga and acupuncture. But while sweeping claims are made for these treatments, the scientific evidence for them often lags far behind: studies and clinical trials, when they exist at all, can be shoddy in design and too small to yield reliable insights.

Now the federal government is working hard to raise the standards of evidence, seeking to distinguish between what is effective, useless and harmful or even dangerous.

The research has been making steady progress, said Dr. Josephine P. Briggs, director of the National Center for Complementary and Alternative Medicine, a division of the National Institutes of Health. s reasonably new that rigorous methods are being used to study these health practices.

The need for rigor can be striking. For instance, a 2004 Harvard study identified 181 research papers on yoga therapy reporting that it could be used to treat an impressive array of ailments including asthma, heart disease, hypertension, depression, back pain, bronchitis, diabetes, cancer, arthritis, insomnia, lung disease and high blood pressure.

It turned out that only 40 percent of the studies used randomized controlled trials the usual way of establishing reliable knowledge about whether a drug, diet or other intervention is really safe and effective. In such trials, scientists randomly assign patients to treatment or control groups with the aim of eliminating bias from clinician and patient decisions.

Sat Bir S. Khalsa, the studys author and a sleep researcher at the Harvard Medical School, said an added complication was that the vast majority of these studies have been small, averaging 30 or fewer subjects per arm of the randomized trial. The smaller the sample size, he warned, the greater the risk of error, including false positives and false negatives.

Critics of alternative medicine have seized on that weakness. R. Barker Bausell, a senior research methodologist at the University of Maryland and the author of Snake Oil Science (Oxford, 2007), says small studies often have a built-in conflict of interest: they need to show positive results to win grants for larger investigations.

All these things conspire to produce false positives, Dr. Bausell said in an interview. They make the results extremely questionable.

That kind of fog is what Dr. Briggs and the National Center for Complementary and Alternative Medicine, with a budget of $122 million this year, are trying to eliminate. Their trials tend to be longer and larger. And if a treatment shows promise, the center extends the trials to many centers, further lowering the odds of false positives and investigator bias.

For instance, the center is conducting a large study to see if extracts from the ginkgo biloba tree can slow the progression of Alzheimers disease. The clinical trials involve centers in California, Maryland, North Carolina and Pennsylvania and recruited more than 3,000 patients, all of them over 75. The study is to end next year.

Another large study enrolled 570 participants to see if acupuncture provided pain relief and improved function for people with osteoarthritis of the knee. In 2004, it reported positive results. Dr. Brian M. Berman, the studys director and a professor of medicine at the University of Maryland, said the inquiry establishes that acupuncture is an effective complement to conventional arthritis treatment.

In an interview, Dr. Briggs said another good way to improve clinical trials was to ensure product uniformity, especially on herbal treatments. We feel we have really influenced the standards, she said.

Over the years, laboratories have found that up to 75 percent of the samples of ginkgo biloba failed to show the claimed levels of the active ingredient. Scientists doing a clinical trial have a large incentive to fix that kind of inconsistency.

Dr. Briggs said such investments would be likely to pay off in the future by documenting real benefits from at least some of the unorthodox treatments. I believe that as the sensitivities of our measures improve, well do a better job at detecting these modest but important effects for disease prevention and healing, she said.

An open question is how far the new wave will go. The high costs of good clinical trials, which can run to millions of dollars, means relatively few are done in the field of alternative therapies and relatively few of the extravagant claims are closely examined.

In tight funding times, thats going to get worse, said Dr. Khalsa of Harvard, who is doing a clinical trial on whether yoga can fight insomnia. s a big problem. These grants are still very hard to get and the emphasis is still on conventional medicine, on the magic pill or procedure thats going to take away all these diseases.

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