OVERSPECIALIZATION IN MEDICINE

The current treatment model for most chronic pediatric illnesses focuses on the management and suppression of symptoms through pharmaceutical treatments that have side effects or adverse events as a consequence of continued usage. Additionally, many pharmaceutical agents (such as hormone or steroid medications, antibiotics, proton pump inhibitors, antipsychotics, antidepressants, etc.) deplete essential nutrients from the body necessary for energy production, mood stability, brain function, detoxification among other important processes.

Following is a sampling of literature identifying some of the many challenges of the current treatment model.

Amerio A, Galvez JF, Odone A, Dalley SA, Ghaemi SN. Carcinogenicity of psychotropic drugs: A systematic review of US Food and Drug Administration-required preclinical in vivo studies. Aust N Z J Psychiatry. 2015.

Bengmark S. Gut microbiota, immune development and function. Pharmacol Res. 2013;69(1):87-113.

Buehring B, Viswanathan R, Binkley N, Busse W. Glucocorticoid-induced osteoporosis: an update on effects and management. J Allergy Clin Immunol. 2013;132(5):1019-30.

Calarge CA, Zimmerman B, Xie D, Kuperman S, Schlechte JA. A cross-sectional evaluation of the effect of risperidone and selective serotonin reuptake inhibitors on bone mineral density in boys. J Clin Psychiatry. 2010;71(3):338-47.

Chauhan BF, Chartrand C, Ducharme FM. Intermittent versus daily inhaled corticosteroids for persistent asthma in children and adults. Cochrane Database Syst Rev. 2013;2:CD009611.

Correll CU, Kratochvil CJ, March JS. Developments in pediatric psychopharmacology: focus on stimulants, antidepressants, and antipsychotics. J Clin Psychiatry. 2011;72(5):655-70.

Dahl R. Systemic side effects of inhaled corticosteroids in patients with asthma. Respir Med. 2006;100(8):1307-17.

Ducharme FM, Lemire C, Noya FJ, Davis GM, Alos N, Leblond H, et al. Preemptive use of high-dose fluticasone for virus-induced wheezing in young children. N Engl J Med. 2009;360(4):339-53.

Dura-Trave T, Gallinas-Victoriano F. Caloric and nutrient intake in children with attention deficit hyperactivity disorder treated with extended-release methylphenidate: analysis of a cross-sectional nutrition survey. JRSM Open. 2014;5(2):2042533313517690.

Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70(2):338-51.

Gotia S, Rusu T, Badiu I, Murgu A, Rugina A, Ioniuc I. [The effects of inhaled corticoids on bone density in asthmatic children]. Rev Med Chir Soc Med Nat Iasi. 2005;109(1):29-35.

Hamre HJ, Fischer M, Heger M, Riley D, Haidvogl M, Baars E, et al. Anthroposophic vs. conventional therapy of acute respiratory and ear infections: a prospective outcomes study. Wien Klin Wochenschr. 2005;117(7-8):256-68.

Hamre HJ, Glockmann A, Schwarz R, Riley DS, Baars EW, Kiene H, et al. Antibiotic Use in Children with Acute Respiratory or Ear Infections: Prospective Observational Comparison of Anthroposophic and Conventional Treatment under Routine Primary Care Conditions. Evid Based Complement Alternat Med. 2014;2014:243801.

Hetrick SE, McKenzie JE, Cox GR, Simmons MB, Merry SN. Newer generation antidepressants for depressive disorders in children and adolescents. Cochrane Database Syst Rev. 2012;11:CD004851.

Heusser P, Scheffer C, Neumann M, Tauschel D, Edelhauser F. Towards non-reductionistic medical anthropology, medical education and practitioner-patient-interaction: the example of Anthroposophic Medicine. Patient Educ Couns. 2012;89(3):455-60.

Lessa N, Murray ML, Curran S, Wong IC. Asthma and suicide-related adverse events: a review of observational studies. Eur Respir Rev. 2011;20(122):287-92.

Joshi N, Rajeshwari K. Deflazacort. J Postgrad Med. 2009;55(4):296-300.

Karkoulias K, Charokopos N, Kaparianos A, Sampsonas F, Tsiamita M, Spiropoulos K. Aseptic femoral head necrosis in a patient receiving long term courses of inhaled and intranasal corticosteroids. Tuberk Toraks. 2007;55(2):182-5.

Kelly HW, Van Natta ML, Covar RA, Tonascia J, Green RP, Strunk RC, et al. Effect of longterm corticosteroid use on bone mineral density in children: a prospective longitudinal assessment in the childhood Asthma Management Program (CAMP) study. Pediatrics. 2008;122(1):e53-61.

Kienle GS, Glockmann A, Grugel R, Hamre HJ, Kiene H. [Clinical research on anthroposophic medicine: update of a health technology assessment report and status quo]. Forsch Komplementmed. 2011;18(5):269-82.

Kimura G, Kadoyama K, Brown JB, Nakamura T, Miki I, Nisiguchi K, et al. Antipsychotics-associated serious adverse events in children: an analysis of the FAERS database. Int J Med Sci. 2015;12(2):135-40.

Komatsu DE, Thanos PK, Mary MN, Janda HA, John CM, Robison L, et al. Chronic exposure to methylphenidate impairs appendicular bone quality in young rats. Bone. 2012;50(6):1214-22.

Korterink JJ, Rutten JM, Venmans L, Benninga MA, Tabbers MM. Pharmacologic treatment in pediatric functional abdominal pain disorders: a systematic review. J Pediatr. 2015;166(2):424-31 e6.

Levine M, Froberg B, Ruha AM, Burns-Ewald M, Yen M, Claudius IA, et al. Assessing the toxicity and associated costs among pediatric patients admitted with unintentional poisonings of attention-deficit/hyperactivity disorder drugs in the United States. Clin Toxicol (Phila). 2013;51(3):147-50.

Marchac V, Foussier V, Devillier P, Le Bourgeois M, Polak M. [Fluticasone propionate in children and infants with asthma]. Arch Pediatr. 2007;14(4):376-87.

McCarthy S, Cranswick N, Potts L, Taylor E, Wong IC. Mortality associated with attentiondeficit hyperactivity disorder (ADHD) drug treatment: a retrospective cohort study of children, adolescents and young adults using the general practice research database. Drug Saf. 2009;32(11):1089-96.

Pampura AN. Prevalence of atopic diseases and the use of topical corticosteroids. Is there any connection? Med Hypotheses. 2005;64(3):575-8.

Trasande L, Boscarino J, Graber N, Falk R, Schechter C, Galvez M, et al. The environment in pediatric practice: a study of New York pediatricians’ attitudes, beliefs, and practices towards children’s environmental health. J Urban Health. 2006;83(4):760-72.

Weldon D. The effects of corticosteroids on bone growth and bone density. Ann Allergy Asthma Immunol. 2009;103(1):3-11; quiz -3, 50.

Wohlfarth TD, van Zwieten BJ, Lekkerkerker FJ, Gispen-de Wied CC, Ruis JR, Elferink AJ, et al. Antidepressants use in children and adolescents and the risk of suicide. Eur Neuropsychopharmacol. 2006;16(2):79-83.

Zuzak TJ, Zuzak-Siegrist I, Rist L, Staubli G, Simoes-Wust AP. Medicinal systems of complementary and alternative medicine: a cross-sectional survey at a pediatric emergency department. J Altern Complement Med. 2010;16(4):473-9.

 

CRITIQUES OF “EVIDENCE-BASED” MEDICINE

Coming soon! This section is being updated.

 

THE ALTERNATIVE SYSTEMS APPROACH

While specialization in medicine is of extreme importance and can account for remarkably successful treatments, especially with regard to emergency room medicine, surgery, and other highly technical and skilled fields, overspecialization can limit our ability to effectively address illnesses that are complex and affect multiple organ systems. Alternative systems of treatment including traditional Chinese medicine, Ayurveda, Naturopathy and those rooted in functional medicine, systems biology, physiology and other more integrative disciplines are demonstrating improved outcomes in chronic illness. Collaboration across disciplines can also result in improved health outcomes.

Ahmed T, Haque R, Shamsir Ahmed AM, Petri WA, Jr., Cravioto A. Use of metagenomics to understand the genetic basis of malnutrition. Nutr Rev. 2009;67 Suppl 2:S201-6.

Bland J. Systems biology, functional medicine, and folates. Altern Ther Health Med. 2008;14(3):18-20.

Bland J. Functional somatic syndromes, stress pathologies, and epigenetics. Altern Ther Health Med. 2008;14(1):14-6.

Calarge CA, Zimmerman B, Xie D, Kuperman S, Schlechte JA. A cross-sectional evaluation of the effect of risperidone and selective serotonin reuptake inhibitors on bone mineral density in boys. J Clin Psychiatry. 2010 Mar;71(3):338–47.

Erlandsson LK, Carlsson G, Horstmann V, Gard G, Holmstrom E. Health factors in the everyday life and work of public sector employees in Sweden. Work. 2012;42(3):321-30.

Edelman D, Oddone EZ, Liebowitz RS, Yancy WS, Jr., Olsen MK, Jeffreys AS, et al. A multidimensional integrative medicine intervention to improve cardiovascular risk. J Gen Intern Med. 2006;21(7):728-34.

Hansel TT, Johnston SL, Openshaw PJ. Microbes and mucosal immune responses in asthma. Lancet. 2013;381(9869):861-73.

Heusser P, Scheffer C, Neumann M, Tauschel D, Edelhauser F. Towards non-reductionistic medical anthropology, medical education and practitioner-patient-interaction: the example of Anthroposophic Medicine. Patient Educ Couns. 2012;89(3):455-60.

Hamre HJ, Witt CM, Glockmann A, Ziegler R, Willich SN, Kiene H. Anthroposophic medical therapy in chronic disease: a four-year prospective cohort study. BMC Complement Altern Med. 2007;7:10.

Hamre HJ, Witt CM, Kienle GS, Meinecke C, Glockmann A, Willich SN, et al. Anthroposophic therapy for children with chronic disease: a two-year prospective cohort study in routine outpatient settings. BMC Pediatr. 2009;9:39.

Hamre HJ, Witt CM, Kienle GS, Schnurer C, Glockmann A, Ziegler R, et al. Anthroposophic therapy for asthma: A two-year prospective cohort study in routine outpatient settings. J Asthma Allergy. 2009;2:111-28.

Hamre HJ, Kiene H, Ziegler R, Troger W, Meinecke C, Schnurer C, et al. Overview of the Publications From the Anthroposophic Medicine Outcomes Study (AMOS): A Whole System Evaluation Study. Glob Adv Health Med. 2014;3(1):54-70.

Hamre HJ, Witt CM, Kienle GS, Glockmann A, Ziegler R, Rivoir A, et al. Anthroposophic therapy for migraine: a two-year prospective cohort study in routine outpatient settings. Open Neurol J. 2010;4:100-10.

Hamre HJ, Becker-Witt C, Glockmann A, Ziegler R, Willich SN, Kiene H. Anthroposophic therapies in chronic disease: the Anthroposophic Medicine Outcomes Study (AMOS). Eur J Med Res. 2004;9(7):351-60.

Hanaway P. Systems approaches: a global and historical perspective on integrative medicine. Glob Adv Health Med. 2012;1(1):10-1.

Kapka-Skrzypczak L, Niedzwiecka J, Cyranka M, Kruszewski MK, Skrzypczak M, Wojtyla A. [Nutrigenomics – perspectives of personalized nutrition]. Pediatr Endocrinol Diabetes Metab. 2011;17(4):222-6.

Katiraei P, Bultron G. Need for a comprehensive medical approach to the neuro-immunogastroenterology of irritable bowel syndrome. World J Gastroenterol. 2011;17(23):2791-800.

Kienle GS, Glockmann A, Grugel R, Hamre HJ, Kiene H. [Clinical research on anthroposophic medicine: update of a health technology assessment report and status quo]. Forsch Komplementmed. 2011;18(5):269-82.

Lamb J, Bland J. The Heart and Medicine: Exploring the Interconnectedness of Cardiometabolic-related Concerns Through a Systems Biology Approach. Glob Adv Health Med. 2012;1(2):38-45.

Lambert B, Kobliner V. A compromised generation : the epidemic of chronic illness in America’s children [Internet]. 1st Sentient Publications. Boulder, CO: Sentient Publications; 2010. xiv, 358 p. (BOOK)

Leuchter AF, Hunter AM, Krantz DE, Cook IA. Intermediate phenotypes and biomarkers of treatment outcome in major depressive disorder. Dialogues Clin Neurosci. 2014;16(4):525-37.

McCloud E, Papoutsakis C. A medical nutrition therapy primer for childhood asthma: current and emerging perspectives. J Am Diet Assoc. 2011 Jul;111(7):1052–64.

Minich DM, Bland JS. Personalized lifestyle medicine: relevance for nutrition and lifestyle recommendations. ScientificWorldJournal. 2013;2013:129841.

Oken BS, Chamine I, Wakeland W. A systems approach to stress, stressors and resilience in humans. Behav Brain Res. 2015;282:144-54.

Persch AC, Braveman BH, Metzler CA. P4 medicine and pediatric occupational therapy. Am J Occup Ther. 2013;67(4):383-8.

Pizzorno JE, Jr. Clinical decision making-a functional medicine perspective. Glob Adv Health Med. 2012;1(4):8-13.

Sabuncuoglu O. Understanding the relationships between breastfeeding, malocclusion, ADHD, sleep-disordered breathing and traumatic dental injuries. Med Hypotheses. 2013;80(3):315-20.

Schmidt MA, Bland JS. Thyroid gland as sentinel: interface between internal and external environment. Altern Ther Health Med. 1997;3(1):78-81.

Sela DA, Mills DA. The marriage of nutrigenomics with the microbiome: the case of infant-associated bifidobacteria and milk. Am J Clin Nutr. 2014;99(3):697S-703S.

Weiss MD, Gadow K, Wasdell MB. Effectiveness outcomes in attention-deficit/hyperactivity disorder. J Clin Psychiatry. 2006;67 Suppl 8:38-45.

 

TRADITIONS UTILIZING SYSTEMS APPROACH

Aggarwal BB, Ichikawa H, Garodia P, Weerasinghe P, Sethi G, Bhatt ID, et al. From traditional Ayurvedic medicine to modern medicine: identification of therapeutic targets for suppression of inflammation and cancer. Expert Opin Ther Targets. 2006;10(1):87-118.

Banerjee S, Debnath P, Rao PN, Tripathy TB, Adhikari A, Debnath PK. Ayurveda in changing scenario of diabetes management for developing safe and effective treatment choices for the future. J Complement Integr Med. 2015.

Bell IR, Koithan M. Models for the study of whole systems. Integr Cancer Ther. 2006;5(4):293-307.

Bellavite P. Homeopathy and integrative medicine: keeping an open mind. J Med Person. 2015;13(1):1-6.

Boehm K, Raak C, Cramer H, Lauche R, Ostermann T. Homeopathy in the treatment of fibromyalgia–a comprehensive literature-review and meta-analysis. Complement Ther Med. 2014;22(4):731-42.

Deocaris CC, Widodo N, Wadhwa R, Kaul SC. Merger of ayurveda and tissue culture-based functional genomics: inspirations from systems biology. J Transl Med. 2008;6:14.

Gaitonde S, Joshi VR. Non-allopathic systems of medicine–time to reflect and act. J Assoc Physicians India. 2002;50:223-4.

Garodia P, Ichikawa H, Malani N, Sethi G, Aggarwal BB. From ancient medicine to modern medicine: ayurvedic concepts of health and their role in inflammation and cancer. J Soc Integr Oncol. 2007;5(1):25-37.

Hankey A. Ayurvedic physiology and etiology: Ayurvedo Amritanaam. The doshas and their functioning in terms of contemporary biology and physical chemistry. J Altern Complement Med. 2001;7(5):567-74.

Hankey A. Establishing the Scientific Validity of Tridosha part 1: Doshas, Subdoshas and Dosha Prakritis. Anc Sci Life. 2010;29(3):6-18.

Lamson DW. National Institutes of Health discover naturopathic principle. Altern Med Rev. 2010;15(3):186.

Litchy AP. Naturopathic physicians: holistic primary care and integrative medicine specialists. J Diet Suppl. 2011;8(4):369-77.

Lu A, Jiang M, Zhang C, Chan K. An integrative approach of linking traditional Chinese medicine pattern classification and biomedicine diagnosis. J Ethnopharmacol. 2012;141(2):549-56.

Milgrom LR. The vital force “reincarnated”: modeling entelechy as a quantized spinning gyroscopic metaphor for integrated medicine. Adv Exp Med Biol. 2015;821:111-23.

Patwardhan B, Mutalik G. Search of novel model for integrative medicine. Chin J Integr Med. 2014;20(3):170-8.

Rioux J. A complex, nonlinear dynamic systems perspective on Ayurveda and Ayurvedic research. J Altern Complement Med. 2012;18(7):709-18.

Rodriguez-van Lier ME, Simon LM, Gomez RE, Escalante IP. Intergrative health care method based on combined complementary medical practices: rehabilitative acupuncture, homeopathy and chiropractic. Afr J Tradit Complement Altern Med. 2014;11(1):180-6.

Shen ZY. [Application of systems biology and information medicine to integrated traditional Chinese and Western medicine]. Zhong Xi Yi Jie He Xue Bao. 2006;4(2):111-3.

Smith MJ, Logan AC. Naturopathy. Med Clin North Am. 2002;86(1):173-84.

Uzuner H, Bauer R, Fan TP, Guo DA, Dias A, El-Nezami H, et al. Traditional Chinese medicine research in the post-genomic era: good practice, priorities, challenges and opportunities. J Ethnopharmacol. 2012;140(3):458-68.

Varker KA, Ansel A, Aukerman G, Carson WE, 3rd. Review of complementary and alternative medicine and selected nutraceuticals: background for a pilot study on nutrigenomic intervention in patients with advanced cancer. Altern Ther Health Med. 2012;18(2):26-34.

Wilson E, Rampp T, Wen M, Musial F, Dobos GJ. Integrative approach to migraine using traditional European, Indian and chinese medicine: a case report. Forsch Komplementmed. 2011;18(2):84-90.

Zhou X, Liu B, Wu Z, Feng Y. Integrative mining of traditional Chinese medicine literature and MEDLINE for functional gene networks. Artif Intell Med. 2007;41(2):87-104.