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Free radicals: trick or treat?
I am no exception-my department recently cared for an infant who had developed infantile botulism after being given home-grown camomile tea, contaminated with Clostridium botulinum spores, for colic. If one asks physicians what homoeopathic medications are, the response is that these preparations consist of substances in such small amounts that they cannot possibly have any effect. However, this is the very basis of homoeopathyie, that "a substance that can cause certain symptoms when given in large doses to a healthy person is said to cure those same symptoms when given in very small doses to someone who is sick".6 This theory might raise even greater scepticism about the practice of homoeopathy, because the logic underlying the notion that something potentially harmful can be helpful is rather elusive. Nevertheless, the principle that small doses of potentially harmful substances can source.
augment a healthy response is no stranger to accepted medical practices-eg, desensitisation for allergy. The failure to explain how small doses of potentially toxic substances work contributes to the lack of acceptance of these remedies in mainstream medical practice. Yet clinicians are not always aware of the mechanism of action of drugs that they use, and their decision to prescribe is influenced more by proven efficacy. Jacobs et a 1,6 in a small but methodologically sound study, have shown the benefits of homoeopathic preparations in the management of acute diarrhoea in children in Nicaragua. Although their data are convincing as to the efficacy of certain remedies, the authors describe what I believe to be an additional obstacle to the ready acceptance of homoeopathic medications-the complexity of the prescribing process. First, there seem to be at least eight different homoeopathic remedies that can be used to treat diarrhoea. Second, to ascertain which preparation is correct one needs to take an accurate and elaborate history of mental status-eg, "great anxiety and restlessness" versus "weakness of memory"-as well as determine the general condition of the patient and the pattern of defaecation and consistency of stools.’ I tried to remain open-minded as I read the article, but what am I to make of symptoms such as "one cheek red, other pale", or "blue circle under eyes"? What can be the mechanism behind such manifestations? I wonder whether most parents are such observant historians. Despite these barriers to universal acceptance of homoeopathy, physicians should maintain an open mind about potential benefits. Although we have often relied on drugs such as antibiotics to manage disorders such as diarrhoea, the emergence of resistant organisms may necessitate a change in strategies. Home remedies of the past such as rice water have become accepted modalities
702
present. Physicians who choose to prescribe any unproven therapy must be prepared to justify their choice, at the very least they should be confident that the preparation causes no harm. of the
Carol D Berkowitz Department of Pediatrics, Harbor/UCLA
Medical Center, Torrance,
California, USA 1
2
3 4
5
Los Angeles County Department of Health Services. Use of lead tetroxide as a folk remedy for gastrointestinal illness. Public Health Letter 1981; 3(10): 37 Pachtet LM. Culture and clinical care folk illness beliefs and behaviors and their implications for health care delivery. JAMA 1994; 271: 690-94. Palafox N, Warren A, eds. Cross-cultural caring in Hawaii. Honolulu: Transcultural Health Care Forum, 1980. Reilly DT, Taylor MA, McSharry C, Aitchison T. Is homoeopathy a placebo response? Controlled trial of homoeopathic potency, with pollen in hayfever as a model. Lancet 1986; ii: 881-85.
Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States.
6
7
N Engl J Med 1993; 328: 246-52. Jacobs J, Jimenez LM, Gloyd SS, Gale JL, Crothers D. Treatment of acute childhood diarrhea with homeopathic medicine: a randomized clinical trial in Nicaragua. Pediatrics 1994; 93: 719-25. Creticos PS, Norman PS. Immunotherapy with allergens. JAMA 1987; 258: 2874-80.
8
Wapner RA, Litov RE, Zdanowicz MM, et al. Improved water and sodium absorption from oral rehydration: solutions based on rice syrup in a rat model of osmotic diarrhea. J Pediatr 1991; 118: 553-61.
Free radicals: trick
or
treat?
See page 721
"Can’t seem to live with ’em, can’t seem to live without them" might be a casual but encompassing summary of how we interact with free radicals in our bodies and in the environment. Oxygen free-radicals are produced all the time in vivo. Examples include superoxide and the highly reactive hydroxyl radical. Other non-radical oxygenderived molecules (eg, hydrogen peroxide and hypochlorous acid) are also generated. These so-called reactive oxygen species are usually quenched in the body by antioxidant defences. Because some reactive oxygen species have physiologically useful roles (eg, nitric oxide), we walk in danger of overdoing the protection, or underdoing any necessary repairs after oxidative stress. Starting in this issue of The Lancet, we look at the oxidants and antioxidants we make or are exposed to. Our thanks go to Prof Barry Halliwell for leading us out from the departure lounge. With his help, we have assembled a series of other navigators for a radical journey around several human organ systems. David McNamee The Lancet, London, UK
augment a healthy response is no stranger to accepted medical practices-eg, desensitisation for allergy. The failure to explain how small doses of potentially toxic substances work contributes to the lack of acceptance of these remedies in mainstream medical practice. Yet clinicians are not always aware of the mechanism of action of drugs that they use, and their decision to prescribe is influenced more by proven efficacy. Jacobs et a 1,6 in a small but methodologically sound study, have shown the benefits of homoeopathic preparations in the management of acute diarrhoea in children in Nicaragua. Although their data are convincing as to the efficacy of certain remedies, the authors describe what I believe to be an additional obstacle to the ready acceptance of homoeopathic medications-the complexity of the prescribing process. First, there seem to be at least eight different homoeopathic remedies that can be used to treat diarrhoea. Second, to ascertain which preparation is correct one needs to take an accurate and elaborate history of mental status-eg, "great anxiety and restlessness" versus "weakness of memory"-as well as determine the general condition of the patient and the pattern of defaecation and consistency of stools.’ I tried to remain open-minded as I read the article, but what am I to make of symptoms such as "one cheek red, other pale", or "blue circle under eyes"? What can be the mechanism behind such manifestations? I wonder whether most parents are such observant historians. Despite these barriers to universal acceptance of homoeopathy, physicians should maintain an open mind about potential benefits. Although we have often relied on drugs such as antibiotics to manage disorders such as diarrhoea, the emergence of resistant organisms may necessitate a change in strategies. Home remedies of the past such as rice water have become accepted modalities
702
present. Physicians who choose to prescribe any unproven therapy must be prepared to justify their choice, at the very least they should be confident that the preparation causes no harm. of the
Carol D Berkowitz Department of Pediatrics, Harbor/UCLA
Medical Center, Torrance,
California, USA 1
2
3 4
5
Los Angeles County Department of Health Services. Use of lead tetroxide as a folk remedy for gastrointestinal illness. Public Health Letter 1981; 3(10): 37 Pachtet LM. Culture and clinical care folk illness beliefs and behaviors and their implications for health care delivery. JAMA 1994; 271: 690-94. Palafox N, Warren A, eds. Cross-cultural caring in Hawaii. Honolulu: Transcultural Health Care Forum, 1980. Reilly DT, Taylor MA, McSharry C, Aitchison T. Is homoeopathy a placebo response? Controlled trial of homoeopathic potency, with pollen in hayfever as a model. Lancet 1986; ii: 881-85.
Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States.
6
7
N Engl J Med 1993; 328: 246-52. Jacobs J, Jimenez LM, Gloyd SS, Gale JL, Crothers D. Treatment of acute childhood diarrhea with homeopathic medicine: a randomized clinical trial in Nicaragua. Pediatrics 1994; 93: 719-25. Creticos PS, Norman PS. Immunotherapy with allergens. JAMA 1987; 258: 2874-80.
8
Wapner RA, Litov RE, Zdanowicz MM, et al. Improved water and sodium absorption from oral rehydration: solutions based on rice syrup in a rat model of osmotic diarrhea. J Pediatr 1991; 118: 553-61.
Free radicals: trick
or
treat?
See page 721
"Can’t seem to live with ’em, can’t seem to live without them" might be a casual but encompassing summary of how we interact with free radicals in our bodies and in the environment. Oxygen free-radicals are produced all the time in vivo. Examples include superoxide and the highly reactive hydroxyl radical. Other non-radical oxygenderived molecules (eg, hydrogen peroxide and hypochlorous acid) are also generated. These so-called reactive oxygen species are usually quenched in the body by antioxidant defences. Because some reactive oxygen species have physiologically useful roles (eg, nitric oxide), we walk in danger of overdoing the protection, or underdoing any necessary repairs after oxidative stress. Starting in this issue of The Lancet, we look at the oxidants and antioxidants we make or are exposed to. Our thanks go to Prof Barry Halliwell for leading us out from the departure lounge. With his help, we have assembled a series of other navigators for a radical journey around several human organ systems. David McNamee The Lancet, London, UK