Shepherd Roee Singer

Herbal medicine and epilepsy: proconvulsive effects and interactions with antiepileptic drugs.

The use of complementary and alternative medicine is on the rise, including among patients with epilepsy. Herbal medicine, one of the most popular forms of CAM, is considered to be both safe and effective by most consumers. Yet many herbs may increase the risk for seizures, through intrinsic proconvulsant properties or contamination by heavy metals, as well as via effects on the cytochrome P450 enzymes and P‐glycoproteins, altering antiepileptic drug (AED) disposition. Herb–drug interactions may be difficult to predict, especially since the quality and quantity of active ingredients are often unknown. Since most patients do not inform their physicians that they are taking herbal medicines, health care professionals must initiate a dialogue in order to prevent complications with the combined regimen. At the same time, further research is required regarding the effect of herbs on seizure activity and interactions with AED treatment.

Effect of Traumeel S on Cytokine Profile in a Cecal Ligation and Puncture (CLP) Sepsis Model in Rats

BACKGROUND Sepsis results in significant morbidity and mortality, with current treatment options limited with respect to efficacy as well as safety. The complex homeopathic remedy Traumeel S has been shown to have both anti-inflammatory and immunostimulatory effects in the in vitro setting. OBJECTIVES The objective was to explore the effects of Traumeel S in an in vivo setting, using a cecal ligation and puncture (CLP) sepsis model in rats, evaluating the effects of the medication on cytokine activity. DESIGN Sepsis was induced in 30 rats using accepted CLP methodology. Following the procedure, rats were randomly allocated to receive an intraperitoneal injection of either Traumeel S (n=15) or normal saline (n=15). At 6 hours post-CLP, serum cytokines (interleukin [IL]-1β, tumor necrosis factor-α, IL-6, and IL-10) were evaluated. RESULTS IL-1β levels were significantly higher in the treatment group (p=0.03) with no significant differences found between the groups with respect to the other cytokines tested. CONCLUSIONS In contrast to in vitro studies, Traumeel significantly increased IL-1β levels in an in vivo model, without influencing other cytokines. IL-1β is a proinflammatory cytokine that has been shown to have a protective effect in the CLP rat model. Further research is warranted to examine this finding, as well as its clinical implications.

Traumeel S® for pain relief following hallux valgus surgery: a randomized controlled trial

BackgroundIn spite of recent advances in post-operative pain relief, pain following orthopedic surgery remains an ongoing challenge for clinicians. We examined whether a well known and frequently prescribed homeopathic preparation could mitigate post-operative pain.MethodWe performed a randomized, double blind, placebo-controlled trial to evaluate the efficacy of the homeopathic preparation Traumeel S® in minimizing post-operative pain and analgesic consumption following surgical correction of hallux valgus. Eighty consecutive patients were randomized to receive either Traumeel tablets or an indistinguishable placebo, and took primary and rescue oral analgesics as needed. Maximum numerical pain scores at rest and consumption of oral analgesics were recorded on day of surgery and for 13 days following surgery.ResultsTraumeel was not found superior to placebo in minimizing pain or analgesic consumption over the 14 days of the trial, however a transient reduction in the daily maximum post-operative pain score favoring the Traumeel arm was observed on the day of surgery, a finding supported by a treatment-time interaction test (p = 0.04).ConclusionsTraumeel was not superior to placebo in minimizing pain or analgesic consumption over the 14 days of the trial. A transient reduction in the daily maximum post-operative pain score on the day of surgery is of questionable clinical importance.Trial RegistrationThis study was registered at ClinicalTrials.gov. # NCT00279513

Homeopathy in emergency medicine.

SummaryBACKGROUND: Use of homeopathy is not frequently reported in critically ill patients. We describe our experience treating such patients homeopathically in the emergency room, on the wards, and in the intensive care unit of conventional hospitals in Austria and Israel. METHODS: We describe a case series of patients treated in the ER for multiple casualty incidents, two case reports of remarkable cures in the ICU, and two RCTs demonstrating the efficacy of homeopathy in septic and intubated patients. RESULTS: A case series documents favorable results in homeopathic treatment of patients in the ER and wards after multiple casualty incidents. Two case reports narrate remarkable homeopathic cures to imminently terminal illnesses. Finally, homeopathy was demonstrated effective as compared with placebo in improving long-term survival in severely ill septic patients and in hastening extubation ICU patients. CONCLUSIONS: Our report suggests that homeopathy may be applicable even for critically ill patients. We discuss the obstacles encountered, including a dearth of tools for successful homeopathic prescription in these situations, suspicion and lack of cooperation by patients and conventional colleagues, and the highly suppressive nature of concomitant conventional therapies. We suggest the development of algorithms and other tools to aid rapid homeopathic prescription in critical care patients and discuss the importance of familiarizing physicians and medical students with homeopathy in order to facilitate communication and cooperation between these complementary branches of medicine.ZusammenfassungGRUNDLAGEN: Die Anwendung der Homöopathie bei kritisch kranken Patienten wird nur selten berichtet. Wir beschreiben unsere Erfahrungen bei der homöopathischen Behandlung solcher Patienten in der Notfallaufnahme, den Bettenstationen und Intensivstationen konventioneller Spitäler in Österreich und Israel. METHODIK: Wir beschreiben eine Serie von Fallberichten von Patienten, die in der Notfallaufnahme wegen Katastrophenfällen behandelt worden sind, zwei Fallberichte bemerkenswerter Heilungen an der Intensivstation, sowie zwei randomisierte klinische Studien, die die Effektivität der Homöopathie bei septischen und intubierten Patienten zeigen. ERGEBNISSE: Eine Fallstudie dokumentiert günstige Ergebnisse bei der homöopathischen Behandlung von Patienten in der Notfallaufnahme- und der Normalstation nach Katastrophenfällen. Weiters beschreiben zwei Fallberichte bemerkenswerte homöopathische Heilungen bei fortgeschrittenen tödlichen Erkrankungen. In zwei randomisierten klinischen Studien zeigte sich die Homöopathie im Vergleich zu Plazebo als effektiver bezüglich der Verbesserung des Langzeitüberlebens von Patienten mit schwerster Sepsis sowie bei der Beschleunigung der Extubation von Intensivpatienten. SCHLUSSFOLGERUNGEN: Unser Bericht lässt vermuten, dass die Homöopathie auch bei kritisch kranken Patienten sinnvoll ist. Wir diskutieren die dabei angetroffenen Hindernisse, einschließlich des Mangels an Werkzeugen für eine erfolgreiche homöopathische Verschreibung bei solchen Situationen, des Misstrauens und der fehlenden Kooperation seitens der Patienten und konventionell tätiger Kollegen sowie der supprimierenden Wirkungsweise begleitender konventioneller Therapien. Wir regen die Entwicklung von Algorithmen und anderer Werkzeuge zur Beschleunigung homöopathischer Verschreibungen bei kritisch kranken Patienten an und diskutieren die Wichtigkeit, Ärzte und Medizinstudenten mit Homöopathie bekannt zu machen, um die Kommunikation und Kooperation zwischen diesen komplementären Zweigen der Medizin zu verbessern.

Apparent life-threatening events in infants and homeopathy: An alternative explanation

Background: A recent report showed increased frequency of apparent life-threatening events (ALTEs) in infants treated with the homeopathic medication GaliCol-Baby (GCB). The premise was that the ALTEs resulted from toxic effects of the drug’s components. We examine an alternative explanation. Method: The toxicological literature was searched for known reactions to the various GCB components, noting doses and reported symptoms. Dosage quantities and severity of reaction to the GCB were ranked independently by two groups of physicians, and a dose–response curve was generated. Reported toxic doses and symptoms were compared with those of the GCB series. The homeopathic literature was searched as well to determine the propensity of the GCB components to cause ALTE symptoms, when given in homeopathic doses to healthy volunteers (proving). Results: Doses ingested in the GCB series were 10–13 orders of magnitude smaller than those reported to cause toxic reactions in humans. There was poor correlation between symptoms with GCB and toxic profiles of the components. A nonsignificant, inverse relationship between dose and severity of reaction was observed. Conversely, four GCB components (in homeopathic doses) had a high propensity to produce at least one of five symptoms which define ALTE, two of which had intermediate to high propensity to produce three symptoms. Conclusions: It is unlikely that the ALTE following ingestion of GCB was a toxic reaction to any of the drug’s component. Homeopathic theory may explain this linkage, though further research is needed to understand the pathogenic effects of highly diluted homeopathic compounds.

Hormesis and homeopathy: Bridge over troubled waters

Homeopathy is an empirical method of treatment. Hormesis, while stemming from within the rationalist tradition, has yet to be explained according to current pharmacological theory. Both share in common sub-threshold doses of toxic substances and an initial semi-toxicological insult followed by a greater compensatory (or healing) response. We question whether the differences between these fields may be amenable to scientific research. We identify five cardinal differences between homeopathy and hormesis: (1) Hormesis is a universal phenomenon, while homeopathy is highly specific; (2) Hormesis uses only measurable quantities of compounds, as opposed to homeopathy, which frequently administers medicines at dilutions far beyond the material range; (3) Preparation of hormetic solutions follows standard laboratory procedure, while homeopathy requires a sequential series of dilutions, each followed by vigorous shaking (‘succussion’); (4) The effects of hormesis are moderate and temporary, while homeopathy claims curative and permanent responses and (5) Hormesis is a lab phenomenon observed primarily in healthy organisms, whereas homeopathy is a mode of treatment administered primarily to ailing individuals. We believe that all five of these differences are amenable to scientific investigation, and suggest comparing succussed to non-succussed diluted solutions as an optimal first evaluation. We conclude that while certain differences exist between hormesis and homeopathy, hormesis may in fact be a subset of homeopathy.

Petroleum: a series of 25 cases

This study is based on 25 well documented reports of cases which responded well to treatment with Petroleum. Materia medica data were compared with results in contemporary clinical practice. Many patients had characteristic skin problems; children often had recurrent or chronic upper respiratory tract problems. The most prominent mental feature is a quiet, withdrawn or stubborn disposition. The mental symptoms may be difficult to recognise. Detailed documentation in daily practice can be helpful for preserving data of the effect of a medicine; confirmation of statements given in materia medica; improving understanding of homeopathic medicines and differentiating the indications for medicines.

Integrative Tumor Board: Metastatic Breast Cancer

History of present illness In December 2000, a routine mammogram showed a large zone of calcification involving the right breast. A sonogram revealed a solid oval mass measuring 0.8 × 1.0 × 0.6 cm in the retroareolar portion of the right breast. A biopsy of this area showed ductal carcinoma in situ (DCIS) with comedo necrosis, nuclear grade 2/3, lymphatic invasion absent. In February 2001, the patient underwent right simple mastectomy with sentinel lymph node biopsy. Pathology revealed extensive DCIS and focal invasive, moderately differentiated ductal carcinoma. The tumor size measured 1.0 cm, and resection margins were free of tumor involvement. Sentinel lymph node was negative for malignancy. Tumor was estrogen and progesterone receptor positive and Her-2/neu negative by fluorescence in situ hybridization (FISH) assay. The patient did not receive adjuvant chemotherapy, but following surgery, she was started on tamoxifen 20 mg daily. The patient continued to have regular menstrual cycles while on tamoxifen. The patient did well until October 2005, when she began to experience postprandial abdominal pain and nausea. In addition, she noted right hip pain and lower back pain. Extensive workup and restaging studies were performed. A computed tomography (CT) scan of the thorax, abdomen, and pelvis revealed small right axillary lymph nodes, mildly prominent lymph nodes in the anterior mediastinum, bibasilar effusions, an 11-mm lesion in the dome of the liver, ascites, multiple thickened loops of small bowel with mild dilation, gallstones, and findings suspicious for an omental cake formation. A bone scan showed diffuse sclerotic metastases involving the spine, ribs, calvarium, pelvis, and left proximal femur. Magnetic resonance imaging (MRI) viously in the reference range. In November 2005, the patient underwent bilateral thoracentesis. Cell block showed malignant metastatic adenocarcinoma, estrogen receptor positive, progesterone receptor negative, Her-2/neu negative by FISH assay. Tamoxifen was discontinued, and the patient was started on Zometa, as well as chemotherapy with Taxol and Avastin every other week. The patient received 2 cycles of chemotherapy with her local oncologist in New York. In December 2005, the patient presented to the Block Center for Integrative Cancer Care for a consultation on integrative cancer treatment. Beginning in January 2006, the patient commuted for treatment from her home in New York. She continued to receive weekly Taxol (day 8 given by local oncologist), Avastin every 2 weeks, and monthly Zometa. The protocol is based on the E2100 protocol. Her baseline serum tumor markers were as follows: CA 15-3 = 1334; CA 27,29 = 1708. In February 2006, tumor markers improved; CA 15-3 = 1035; CA 27,29 = 1081. In March 2006, a repeat staging CT scan of the thorax, abdomen, and pelvis showed a significant decrease in pleural effusions and no significant change in skeletal metastases or abdomen/pelvic findings. In April 2006, serum tumor markers continued to improve: CA 15-3 = 616; CA 27,29 = 712. At this time, the patient developed significant postprandial right upper quadrant abdominal pain. A HIDA scan revealed nonvisualization of the gallbladder, suggesting occlusion of the cystic duct. Avastin was discontinued temporarily because of potential cholecystectomy and increased risk of surgical bleeding. In May 2006, Taxol was placed on hold because of an upcoming cholecystectomy. In late May, the patient