"Natural" does not necessarily mean "good for you"

You can generally separate eczema bloggers and tweeters into three groups. In increasing size of their representation on the web:

• Those (e.g., me) who believe that Western science and medicine have good solutions to offer
• People who believe that Western medicine is a conspiracy designed solely to funnel money into the pockets of big pharma (generally, wackos, although they may have a point)
• Those who won't go as far as the second group, but who favor "natural" products and therapies instead of refined, "artificial' pharmaceuticals

I had an experience on the weekend that gave me a new look at the "natural" versus "artificial" debate. The idea that because something is part of a fresh or recently harvested plant (think Chinese herbs here) it's somehow kinder, softer, less likely to mess you up.

This is utterly wrong.

So, I found this cluster of healthy, clean-looking weeds outside my back gate. It looked like Italian parsley. It smelled like parsley. Did it taste like parsley? Whoa--let's not taste it right now, I thought.

And I'm a fan of wild mushrooms. I pick them and taste them raw. There is no mushroom that will kill you if you spit it out. Something just told me not to taste this plant.

I called my father-in-law, a biologist and naturalist, and he brought over a pile of books to help identify my weed. We narrowed it down to a few candidates that grow in our region.

• Actual feral parsley
• Water hemlock
• Poison hemlock

Poison hemlock, according to our books, is the same herb the ancient Greeks used to kill Socrates. Next to the entry for poison hemlock, one of the books noted: "FATAL TO TASTE."

It also said that since so many plants in the parsley family are extremely poisonous, you shouldn't eat them unless you have absolutely, positively, identified them.

I don't know what this stuff is, but even though it's all-natural, I won't be using it to garnish my pasta.

And, by contrast, the same night I quite happily popped a few pills of ibuprofen to reduce my back pain. They worked just fine, like they always do. I don't mind paying big pharma for ibuprofen.

I know the comparison between poison hemlock and ibuprofen is hardly a fair one, and that most practitioners of Chinese medicine know what they're handling, but it did starkly illustrate the point that "natural" plants can produce some of the most evil toxins we know.

Which alternative therapies for eczema are worth considering?

The recent issue of The Advocate, the newsletter of the National Eczema Association, features two positive articles on alternative therapies for eczema--an account of an acupressure study conducted by Peter Lio of Northwestern University in Chicago, and a review of alternative, complementary, and integrative medicine that Lio seems to have had a hand in editing.

The review is well done, and mentions a new center set up at the NIH to study these therapies, but my initial reaction was one of dismay. There is nothing physical that operates outside the rules of Western science. I'm 100% for evidence-based medicine and I think most alternative treatments offer nothing more than a placebo effect.

But I like to treat people fairly, so I had a look at the Wikipedia page for traditional Chinese medicine. My opinion was reinforced. The theories--what a load of hogwash. It's like going back to medieval days, when doctors believed illnesses were caused by an imbalance in the four Hippocratic humours--blood, phlegm, black bile and yellow bile--and treated nearly everything with leeches.

But, as I keep reminding myself that this blog has a POSITIVE outlook on eczema research and therapies, and that the point is not to get caught up in criticizing quack medicine or poor studies, as much fun as that may be, I decided to map out for myself whether I could get enthusiastic about any alternative therapies at all.

I drew a plot of where common alternative therapies for eczema lie on two axes: how probable it is that they will do what the people promoting them say they will, and how probable it is that they could cause harm to a patient in some way. Here's my plot. For comparison, I included two standard treatments for eczema: straight-up moisturizing, with something like Eucerin or Aveeno; and low-potency steroids such as 1% hydrocortisone.

I found it illuminating to do this. Let me elaborate my thoughts:

• Homeopathy, the practice of ultra-diluting reagents, has zero chance of working. You're just drinking water.
• NAET, in which practitioners claim to diagnose allergies by "applied kinesiology," not only has zero chance of working, but could actually harm patients if they take the practitioner's word that they aren't allergic to a substance that they really are.
• Acupressure and acupuncture might counteract the itch stimulus with pressure or pain. But based on the mediocre results from small-group studies I've read, I don't really think they do anything. And with acupuncture you are poking holes in your skin, which is never a good idea.
• Vitamin D is a fad, but it seems true that many people have levels below the recommended 30 ng/ml. Taking vitamin D to boost your levels to normal makes sense. Taking more does not. You could poison yourself if you took too much.
• Probiotics--consuming foods that contain live, benign microbes to normalize your gut flora--make a lot of sense (especially since more links between gut flora and systemic inflammation are emerging) but I haven't seen any knock-'em-dead studies that really show they significantly relieve eczema.
• Herbal Chinese medicine does hold promise for eczema therapies. (Tiger penis and rhino horn, not so much.) There are real drugs hiding in there. Artemisinin, for example, is a scientifically verified antimalarial isolated from a traditional Chinese herb. But I won't believe in the efficacy or safety of any Chinese therapy until it has been verified by the full spectrum of clinical trials. In short--when it's not alternative anymore, but mainstream. And if a drug works, it is going to have side effects and interactions with other medications. So there's definitely the potential for Chinese herbs to produce some good therapies in the future--the pharma company Glaxo Smith Kline now has a traditional Chinese medicine division. There are also other storeholds of incredible biodiversity, such as marine compounds from the Malaysian coastline. But it could be decades before we see any drugs hit the market from these sources.

My plot is too simple to make clear that I think it's possible that some drugs isolated from Chinese herbs might be more effective than low-potency steroids such as hydrocortisone. They could be better. But on average I'd be surprised if they were. And if it's true (according to Wikipedia) that a typical herbal treatment from a traditional Chinese practitioner is decocted from 9-18 herbs, I have to wonder what exactly the active ingredients are and how sure the practitioner is of the dose and proportions.

I also worry that we just don't know what some of these herbal compounds are doing. What are the side effects? And where were the herbs harvested? Do they contain arsenic and heavy metals? China's not famous for its environmental policies.

The Chinese multi-component treatment does have a parallel with Western pharma approaches such as the "triple cocktail" antiretroviral for HIV, or combination chemotherapy. The Chinese herbal compounds just haven't been rigorously identified, categorized, and tested in the way that they need to be.

I clearly find Chinese herbal medicine intriguing. You can expect me to investigate Chinese herbal eczema therapies in this blog. I'll also consider vitamin D and probiotics, although from what I've seen, they do not promise anything but slight improvement for the average patient.

A venture capital fund for eczema companies

Today I had a crazy idea about something to do to get us closer to a cure for eczema.

What if we created a venture capital fund devoted exclusively to investing in startup companies developing eczema therapies? Therapies could include new drugs (oral, topical); new barrier creams; new itch-inhibiting devices, etc.

Venture capital firms invest in small-to-medium size companies that look like they have the potential to grow big in a hurry. Venture capitalists accept a fair amount of risk; perhaps 9/10 of their investments will prove failures, but that tenth one will go off like a bomb and multiply their money a hundredfold.

Small companies need venture capital to build value to the point where they can get acquired by a larger company or hold an initial public offering of stock.

The conventional wisdom that you need to diversify your portfolio, so my idea may come across as foolish. I haven't heard of a specialized one-disease fund before. There could well be some out there and I'd like you to tell me if you know of any. Despite  conventional wisdom, my naive experience with investing over the past few years has taught me that the whole market goes up or down in unison like a herd of lemmings. The only exception to this is gold, which goes the opposite way to everything else. So I don't think an all-eczema investment fund is necessarily a losing proposition.

It could be structured as one big investment (say from a philanthropist) or lots of smaller ones. For a first fund, I'd aim for $10 million, and it would probably be best to have 10 investors at $1 million apiece so you don't have one big boss dictating what you do.

The fund would aim to invest about $500,000 in 20 different startup companies across the U.S.

(My model for this idea is a small fund called Mission Bay Capital, the operations of which I am familiar with.)

The key to getting started, to being able to pitch successfully to investors, is to have a solid business advisory board. I expect I could convince some of the National Eczema Association's scientific board to back this fund as advisors, but this is not what I'm talking about--I mean seasoned venture capitalists from Silicon Valley. If you had $1 million to lend out, who would you give it to: a scientist, or a successful businessperson? Face it, you only lend money to people you feel comfortable with--people who know how to make a profit.

And the fund would be for profit. It would exist to make money for its investors. You'd have to pay the manager a fee too. But the plan, in the end (after, perhaps, launching a second fund of $100 million) would be to return a certain fraction of the profit to the NEA to support eczema research.

An eczema venture capital fund could make money and help produce needed therapies for us all.

Am I nuts or what? I'm going to think this through some more. It's absolutely necessary to connect to one or more successful people in Silicon Valley who have personal experience with eczema.

Gil Yosipovitch on alternative therapies for itch

The basic problem with treating chronic itch is that there is no cure for most conditions, including eczema. But several approaches reduce the severity by a significant amount. Some of these approaches are “Western” medicine, which I take to mean they are based on refined drugs manufactured by a pharma company. Some are “alternative,” which includes acupuncture, probiotics, “Chinese medicine” (that is, herbs that probably contain active ingredients that have not been isolated and refined into “Western” drugs), and others. Gil Yosipovitch, a world expert on itch, combines both in his approach, without overt prejudice--as long as the alternative component is not patently ridiculous.

Psychology plays a large part in Y’s method. “There are a lot of issues involved in the suffering that are beyond dermatology,” he says. “We use a lot of meds that come from psychology.”

He works with an acupuncturist. He collaborates with a practitioner of healing touch.

Here’s an aside: my own mother practices healing touch, and in past years I have mocked her for it, because there is no way that waving your hands over someone’s body is going to cause physiological changes through the medium of some imaginary “energy field” that has no connection with the laws of physics. But here’s the rub: if the patient believes there is such a connection, then I acknowledge that it is possible that undergoing healing touch could relax the patient and, via psychological paths, relieve itch or pain. Won’t work for me, though; I don’t believe in it!

“I’m a physician--I’m OK with the placebo effect,” Y says. Y doesn’t care, as long as the patient feels better. He found out that his acupuncturist has expertise in itch, and his patients who undergo acupuncture see their symptoms relieved by 20-30%. That’s better than he sees with most drugs. “Why should I prescribe drugs with side effects?” he asks. “We don’t know everything.” One of his patients was taking “enough meds for an elephant,” but they didn’t do much, and it was healing touch that appeared to improve his condition.

This holds, he says, only for chronic itch. Acute itch, that is caused by something like poison ivy or insect bite, likely has a well-defined treatment. And in any case, why worry about acute itch? It will go away. (That’s my opinion, not his.)

Probiotics: he’s not super-keen on them, but he sees a lot of people asking about them. “We have to address the issue,” he says. Again, if it works, it works, so why not try eating yogurt if it seems like a good idea.

But sometimes he sees ads for less legitimate treatments such as garlic pills or suppositories. “That’s not what I want my patients to try,” he says.

I’m confused. It seems hard to draw any sort of boundary between valid and invalid therapies, if you’re OK with healing touch. Perhaps with healing touch, or yoga, if you are “treated” or practice it regularly, there is a rhythmic relaxation effect, whereas garlic pills or their ilk are unlikely to produce anything but a weak, transitory placebo effect. However, Y knows what he sees, and he sees that healing touch has a practical, beneficial outcome.

Also, it could be that genuine caring human contact reduces anxiety. A theory occurs to me: maybe the apparent increase in incidence of eczema in developed countries is partly related to social alienation in modern life. We spend so much time dealing with machines instead of people, and so much time with strangers instead of friends and family. Can we improve our eczema symptoms by spending more time with family?

I doubt it, unfortunately. Ask any mother of a young child with eczema. It’s not that the mother doesn’t care, or isn’t doing her best to try to calm her child.

In this blog I intend mostly to pursue Western therapy as a means of treating eczema or relieving itch. I’m open-minded, though, and I hope not to bad-mouth any therapies without good reason. So, within reason, I’ll try anything myself and see if it works. That includes vitamin D. In the near future I will try a course of 4000 IU vitamin D per day, and we’ll see what happens.

With itch medicine, Y says, “large studies are a problem” because itch has so many potential causes and pathways that it’s hard to find a large identical test population. “You can’t give just one antibody for itch. That’s a simplistic approach.” And so personalized medicine, a customized approach for each of us, is our future. The responsibility lies with us. But we already knew that.