Category Archives: Health

California Baby and sodium benzoate

There’s a bit of a kerfuffle about California Baby, a longtime champion of “natural” baby products, adding the preservative sodium benzoate to some of their shampoos and bubble baths.

According to California Baby, sodium benzoate is actually certified for use in organic products.  And in fact it’s approved for use in foods and beverages, never mind shampoo and bubble bath.  Now, some people are saying that it’s a carcinogen, but I’ve seen no evidence of that at all.  Others have mentioned that sodium benzoate can produce benzene when combined with ascorbic acid, especially when heated.  At first I thought that might be hysteria too, but it is actually true.  Wikipedia has a good rundown of sodium benzoate, benzene, and the old standby, “solely the dose makes the poison” in their article on sodium benzoate in soft drinks.  Basically, sodium benzoate can produce small amounts of benzene when it’s combined with ascorbic acid.  The effect is greater when the combination is exposed to heat.  But regardless, the vast majority of soft drinks that form benzene develop only tiny amounts that are probably not a health risk, and pale in comparison to the amount you inhale while you’re filling your car with gas or walking along a busy road.

So that’s the story on benzene in drinks.  In this case, people are concerned that sodium benzoate might be forming benzene in shampoos and bubble baths.  So right off the bat, the risk is much lower because babies won’t be swigging the bottle of bubble bath (well, not in most cases).  Even if California Baby’s products contained ascorbic acid (as far as I can tell they don’t), and might therefore contain traces of benzene, it would be in a product that’s briefly in contact with skin, then rinsed away.  But let me reiterate: California Baby’s products don’t appear to include ascorbic acid, so there’s no possibility of the chemical reaction that would convert sodium benzoate to benzene.

Now, some parents are reporting skin irritation with the new formulas, and that is more plausible.  According to this European Union report, sodium benzoate might cause mild skin irritation in some people.  However, if irritation is a concern, consumers should avoid California Baby products with lavender oil, which is a well known irritant, before worrying about sodium benzoate.  Luckily California Baby does offer fragrance free formulations without essential oils, which can be a rare find in a cosmetics industry that loves to market fragrant (but potentially irritating) products.

The bottom line is that California Baby shampoos and bubble baths are generally safe.  It is possible that a few children could develop skin irritation when exposed to sodium benzoate.  Of course, kids with sensitive skin probably shouldn’t be soaking in bubble baths anyway, so the only issue is the shampoo.  For any parents who are seeing this problem, or noticing irritation with other CB products (which don’t have sodium benzoate), my advice is to first check for any essential oils in the ingredient list.  Since California Baby has tweaked a lot of their stuff, it may be that your favorite formulation suddenly has more lavender oil or clary sage oil (which can sometimes cause skin sensitization).  Even calendula, which is typically used as a soothing ingredient, can cause sensitization and allergic reaction, and CB did just reformulate their calendula, so that could be the culprit.  Unfortunately, I’m having trouble finding any shampoos that are free of both sodium benzoate and essential oils, so if you have a child with very sensitive skin that reacts to sodium benzoate, it appears your choices are very limited.

To recap:  No benzene.  Probably safe for the vast majority of babies, and the essential oils are at least as problematic as the sodium benzoate.  And one tangential musing: it’s ironic that crunchy parents are worried about exposing their kids to benzene.  Sure it’s a carcinogen, but it’s completely natural, and more than that, it’s organic!

The Quest for the Zero-Risk Option

“Sleep training might be harming your child’s brain – why would you take that risk?”

“Drugs have so many side effects!  I’d rather use natural remedies.”

“Parabens are hormone disruptors.  I always use preservative-free cosmetics.”

“I’ve researched the risks of vaccines, and I just can’t expose my child to all that danger.”

This is a theme I’ve noticed in the reasoning of “natural family living” devotees.  Usually these folks are just genuinely concerned about exposing themselves and their families to unnecessary risks.  But they’re missing something very important – there is no such thing as a risk-free option.  Every choice we make is a choice between two different sets of benefits and drawbacks.  I can hardly think of a life decision that will have no downside.  (Perhaps the decision not to smoke.)  Even most benign choices that are generally recommended for our health do have drawbacks.  Exercise is almost always a good decision, but it’s not risk-free.  Exercise brings the risk of injury, as well as frequently involving monetary and opportunity costs.  A healthy diet full of unprocessed fruits and vegetables is of course highly recommended by just about everyone, but again, this can be expensive and time-consuming compared to processed starch and fat obtained at the drive-through window.  Maybe that’s not a significant drawback to most people, but it is a drawback.

With this in mind, let me revisit those quotes, with a more balanced look at the relative risks:

Sleep training can involve babies crying for minutes or even hours.  We know that cortisol levels rise when babies cry, and that in other circumstances continuously elevated cortisol levels can cause serious health effects.  On the other hand, adequate sleep is vital for the health of both babies and parents, and continued sleep deprivation can cause serious health effects.

Medications often have potential side effects, some of which are bad enough to make taking the drugs unhelpful for a particular person.  On the other hand, any remedy that can have a positive effect can have a negative side effect, whether it’s a capsule or an herb, and of course most natural remedies are not proven to ameliorate any health condition, so relying on them involves a greater risk of leaving the original condition untreated.

There are indications that parabens do get into our systems through cosmetics, and it’s possible they have endocrine-like effects.  On the other hand, parabens are used to prevent bacterial growth in cosmetics, and it’s not clear that their actual presence in human tissues or their hypothetical contribution to breast cancer is more dangerous than the potential for smearing a happily thriving colony of staphylococcus on your face every morning.

Vaccines have risks.  Frequent side effects include soreness at the injection site and fever.  More serious health problems are rare, but possible.  On the other hand, vaccine-preventable diseases (VPDs) are even more risky.  Moreover, a child is at greater risk of injury when you drive them to Whole Foods to pick up some Oscillococcinum than they would be if you get them a flu shot.  (Seriously, more people die in car crashes each year than the total number of people who have even claimed to be injured by any vaccine over the course of 23 years of the National Vaccine Injury Compensation Program.)

When you unpack the assumption that there’s a zero-risk option, suddenly it’s clear that the “natural” option in each case isn’t as superior as it first appears.  Of course, it’s easier to make a buck or get publicity by scaring the pants off people about toxins, “Western medicine,” and vaccine injuries if you don’t include all that pesky factual nuance.  Not only do we consumers have to do some research and hard work to find out about the relative risks of our options, but we have to tolerate the notion that there is no perfectly safe choice, and we will have to expose ourselves to one risk or another.  That’s not a mental place many people want to be, so they turn off their skepticism and simply embrace the notion that “natural is safe and good!”

Why I gave my children homeopathic cold pills

The placebo effect is real and powerful.  For many conditions that won’t cause harm if left untreated, it would be perfectly reasonable to give the patient a placebo to help them cope.  The problem is ethics: doctors cannot give a patient a medication and lie about what it contains.  That would prevent informed consent and would be a serious breach of trust and professional responsibility.

However, as a mom I can give placebos with a pretty clear conscience.  It’s my job to take care of my children’s health without their informed consent.  Of course as they mature, I will solicit more and more input from them, but right now I basically run their healthcare.

My older daughter in particular has inspired me to explore placebos.  She has extreme sensitivity to flavors and textures, and is largely unable to take children’s medications.  Of course if she has a high fever or needs antibiotics, I work with her to make sure the medicine goes down.  But it’s not worth cajoling, finagling, and risking  some spectacular reverse peristalsis to get some cough and cold medicine into her when she’s uncomfortable at bed time.  I offer, sure, but she always declines.

So I started to think about placebos.  I was sure if I could give her something and tell her it would make her feel more comfortable, she would be more relaxed and less likely to obsess about her symptoms, and could go to sleep.  My first thought was Tic Tacs, but I knew she’d catch on.  She’s 8, and she’s already familiar with them.  The telltale shape and flavor would surely tip her off.

Then I thought of homeopathy.  It’s just water!  Hyland’s makes tablets that dissolve immediately.  Perfect.  Well, the one drawback I thought of at the time was, of course, putting money in the pockets of scam artists.  But my immediate need overrode my boycott circuits, and I grabbed some Hyland’s C-plus.

It worked really well.  I have since used it several times for cold symptoms, and once with my three year old for boo boo pain drama.  I never actually said they would cure anything – I told them that the pills would make them feel better, or make it easier to deal with being sick.  (But yeah, I essentially lied.  I’m going to just assume that our Santa honesty balances it out.)

But when I did a little more research on the C-Plus tablets, I discovered they contain Yellow Jessamine at a mere 3X dilution.  I started to think about whether 3X means that there could be some actual molecules of this poisonous plant in the tablets, but I only got as far as a vague notion that it would involve molarity and Avogadro’s number before I had to go lie down.  So I decided to just function on the supposition that there could be a trace of actual factual poison in these things.  Between that and the issue of supporting snake oil, no more homeopathic remedies for us.

I will however seek out a more ethical and safer placebo for those times when my kids can’t stop focusing on their snotty noses and can’t sleep, or when there’s much wailing and gnashing of teeth over a small scrape.  I’m open to suggestions – they must get by a fairly sharp 8yo, as well as being easy to take.

(And yes, I will be filling them in on the ruse at some point before they go off into the world and might try to buy such remedies for themselves or their children.)

Kills germs on surfaces – so we should definitely drink it!

“If it’s not accepted as medicine, it will cure you!”

This seems to be the mentality of many folk who extol the virtues of bizarre home remedies.  These people are the most confusing to me.  I can kind of understand where you’re coming from if you want to avoid pharmaceuticals, pesticides, toxic cleansers, and so on.  Many people are trying to live a “natural” life, and while that may be a  fantasy in some ways, it does make sense to eat whole foods, avoid unnecessary drugs, limit exposure to pesticides, plasticizers, and other chemicals that may cause problems for our bodies or our environment, and even to use home-grown herbs to treat the symptoms of mild, self-limiting diseases.  Hell, I can even understand the use of homeopathy to an extent – it’s billed as a mild, side-effect-free to make sure the body is working at its best.  It was specifically formulated as an alternative to toxic and dangerous treatments used in the 18th century.  People like to think that there’s something more natural, that won’t cause bad side effects, that they can use to cure themselves.  That’s understandable.

But then there’s this subset of people who seem to latch on to a particular cure which isn’t herbal or natural in any way.  It may be the product of standard industrial processes or pharmaceutical research.  But the key to this woo is that the substance not be used as intended by mainstream science.

The most extreme case I can think of is bleach.  Bleach is a very mainstream product.  It’s manufactured by big companies.  It’s corrosive.  It’s a substance often avoided by crunchy people due to its potential to harm humans and the environment.  Bleach has been shown to be very effective at killing microbes on surfaces however.  It’s recommended for cleaning in the home for HIV patients because it kills bugs so well.  Bleach disinfection is even promoted as a stopgap method of killing HIV in heroin syringes if no clean needles can be obtained.

Somehow people have extrapolated all that microbe-killing power to a notion that ingesting bleach can cure diseases in the body.  “If bleach kills HIV in a syringe, it will kill HIV in my bloodstream” is how the thinking goes.  It almost makes sense, if you ignore the fact that drinking bleach will cause major burns in your esophagus, stomach, and intestines, and will kill you long before it would provide any theoretical benefit.

Similarly, silver can be used as an antiseptic and is used in topical application to prevent infection.  Some cranks have made the “if it’s good topically, it must be great ingested” leap and advocate ingestion of colloidal silver to cure, well, everything.  However, there’s no evidence showing ingestion of colloidal silver treats any disease or condition.  It’s probably not as bad as drinking bleach as far as immediate injury, but colloidal silver can cause kidney damage and seizures.  Far more entertaining is its celebrated, non-toxic side effect, argyria.  It turns your skin and mucous membranes gray-blue.  So if you want to get no benefits whatsoever, risk major organ damage, and wind up looking like a sick smurf, colloidal silver is for you!

Here’s a quick list of other products of good old toxin-laden, money-driven, factory-produced technology, that are hailed as cures for things that science doesn’t use them for:

Dichloroacetate, allegedly a cure-all for cancer, in reality a substance that might fight cancer, but may be too toxic for use in the body.

Laetrile, another cancer “cure.”

F***ing Magnets, how do they work?  They don’t.

Vicks on your feet to stop a cough.

Tagamet for warts.

Aspirin dissolved on a sore tooth, rather than ingested.

Milk of Magnesia for acne.

Listerine for everything.

I won’t pretend to understand all the psychology underlying this behavior of off-label use as alternative medicine.  But it seems to me that a large part is just desperation – when the doctor only has difficult, complex, or slow-working answers, these remedies can make people feel like they’re fixing the problem.  And certainly the idea of getting one over on The Man is appealing.  The medical-industrial complex may want to charge you a lot of money for a treatment that might or might not work, but you can show them up by just rubbing Listerine on [body part] and fixing yourself!  That sense of control is really appealing.

And ultimately, I think Mark Crislip has a large part of the answer:

As I have discussed before, users of alternative therapies are not comfortable with nuance and subtlety, and,  I think, prefer black and white binary approaches.  Mercury in one form is toxic, so all forms of mercury are toxic.  Some forms of silver are beneficial, so all forms of silver of benefit, including colloidal silver. The inability to deal with shades of gray is a hallmark of many forms of alternative therapy.

The Cynical O.B.

I was really excited to see a blog called “The Skeptical O.B.”  Having read The Thinking Woman’s Guide to a Better Birth, I knew that standard O.B. practices are often more about intuition and tradition than evidence-based medicine.  I thought it would be so cool to see an actual O.B. looking at the risk/benefit analysis on interventions like induction, epidural, and c-section.

Whoops!  Boy is my face red.  The blog could better be named, “The Hidebound Ideologue Against Natural Birth.”  Now, I am interested in skepticism of natural birth practices as well as hospital practices.  You don’t automatically get a pass from me because you’re doing something crunchy.  But god damn, Amy Tuteur is so vituperative, condescending, and obnoxious in her approach, and so obviously devoted to propping up standard hospital practices, that I can’t read her blog even if it might offer some interesting info on homebirth safety or midwifery guilds run amok.

Amy typically storms into each post with a haughty and self-assured stance, declaring her position to be self-evidently correct and everyone else to be feeble-minded.  Most recently, she announced “The largest, most comprehensive study ever done of homebirth has released its results and there’s nothing left to argue about: homebirth increases the risk of perinatal death.”  The study she’s citing though, states almost the opposite take-home message in its Conclusions:

The results support a policy of offering healthy women with low risk pregnancies a choice of birth setting. Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes. For nulliparous women, planned home births also have fewer interventions but have poorer perinatal outcomes.

In my experience of her work, this is representative.  She is the opposite of a skeptic – she decides on her position, and then twists and cherry-picks evidence to support it.  It also doesn’t help matters that she is absolutely vile and superior to any commenter who dares to question her pronouncements and offer counter-evidence.  In other circumstances, I’d be very interested in her information about the Midwives Alliance of North America keeping their statistics on births secret, and appearing to require almost a loyalty oath before giving someone access to it.  But a.) I don’t trust her to give me all the information, and b.) I don’t want to don a bile-proof jumpsuit to wade through her excoriating commenters who offer other perspectives.

This was such a wasted opportunity.  In my opinion, all birth practices need a good review based on the most recent evidence available.  Honestly, I probably agree with Dr. Amy on a lot of things.  I think unassisted childbirth is a terrifying new trend that exposes mothers and babies to too much risk.  But I think that it’s useful to look at the hospital practices and insurance structure that drive women to birth without any attendant whatsoever, and try to reform our institutions so mothers can feel safe and secure in a hospital, or have access to a well-trained, licensed midwife.  Dr. Amy thinks the answer is to sneer and call these mothers fools.

Vaccine Avoidance and The Trolley Problem

Mention the vaccine debate to a skeptic, and their blood pressure will rise precipitously.  Vaccine opponents like Jenny McCarthy leap to mind – people who are loud and aggressively irrational, who cling to discredited theories and practitioners and invoke tinfoil-hat level conspiracy theories to explain why the evidence is against them.  It’s no wonder that vaccine supporters distrust and even revile anyone labeled as “anti-vax.”

But it’s not just a belief in Wakefield and his faked data about autism that motivates vaccine-cautious parents.  Between those who adhere to the CDC schedule and those who hyperventilate about Congress forcibly turning children into “mercury-laced vaccinated guinea pigs”  there are a lot of parents who are just worried about their kids’ health.

To be honest, I think a lot of their motivation originates in emotion rather than reason, but that doesn’t make them fringe loonies.  They hear that a doctor wants to stick needles in their tiny, vulnerable baby and inject, well, stuff.  Not only are they being injected with dead viruses and such, but there is some mystery about what else is floating in that syringe.  Moms who scrupulously avoid pesticides, preservatives, dyes, and even sugar are told that the doc is going to deliver an industrially-produced cocktail of substances directly into their infants’ muscles.  You have to admit, that’s kind of scary.  And most people don’t emulate Mr. Spock and dispassionately weigh the relative risks of each decision.  They are guided by their gut reactions.  And in this case, their gut says, “that seems bad.”  Humans aren’t really built to look at statistics and risk in a logical way – we react, then interpret evidence in light of that initial emotional reaction.

Humans are also really, really prone to the post hoc ergo propter hoc fallacy.  Even if someone intellectually knows that one event closely following another doesn’t imply causation, the emotional impact of watching a child have a serious health problem shortly after a vaccination can’t be underestimated.  And of course, some children really do have serious reactions that are related to vaccines.  It’s quite natural and prudent for parents to withhold future vaccines from such children if there is an elevated risk of further reactions.

Generally, the reluctance about vaccinating on schedule  is not due to parental neglect, but quite the opposite: parents who avoid vaccines tend to be extremely cautious about their children’s health.  As alluded to above, many of the alternatively- or non-vaxing parents I know are exceedingly careful about birth interventions, breastfeeding, sleeping safety, car seat safety, nutrition, and every variable they can control in the slightest to maximize their children’s well-being.

Now, to some extent this caution may be misplaced.  Parents may think that the risk of not vaccinating is lower than the risk of vaccinating.  If vaccine inserts had a well-founded comparison chart that laid out the relative risk, maybe some of these parents would feel more comfortable vaccinating.  The vaccine information statement I just got for the flu vax just states, “The risk of a vaccine causing serious harm, or death, is extremely small.”  Well, the risk of my kid getting serious harm or dying of the flu is “extremely small” too, right?    The statement goes on to warn that the vaccine could very rarely cause life-threatening allergic reactions.  But veryvery cautious parents are going to read that and have serious harm . . . death . . . life-threatening jump out and stick in their memory, then compare that to the time they had the flu and felt a bit unwell for a week, and they will conclude that there is no way the risk is worth it.  If the information statement had a table showing “Risk of death from vaccine = .000001” and “Risk of death from the flu = .000005” maybe people would have the data to make better decisions.  (I totally and completely made up those numbers, just to demonstrate what I’m saying, by the way. I also realize that some may look at the research and conclude that the risk of death from a vaccine is actually higher than the risk from the disease.  Personally I’d like some expert statisticians to analyze the data for parents.)

I also think that the vaccination decision is related to the ethical reasoning displayed in The Trolley Problem and its related hypothesis, The Fat Man.  In those hypotheses, people are pretty willing to divert a train from a track that has five potential victims tied to it, even if that will accidentally cause the death of a single person.  But people are generally reluctant to agree that they would push a fat man off an overpass to derail the train as it is about to hit five people.  In both cases, the number of people saved compared to the number sacrificed is the same.  But people are not willing to take deliberate action to harm someone, even in situations where they are willing to take an action they know will probably cause the same harm as an unintended consequence.

I think that parents who don’t vaccinate on the CDC schedule are functioning according to this pattern.  They will risk their children happening to encounter a serious vaccine-preventable disease and being harmed.  But they can’t accept the possibility that they might choose to inject shit right into their kid’s bodies and thereby cause them harm.  That might not be a logical reaction.  It might be frustrating to vaccine proponents and public health officials.  But it is a profoundly human reaction.

Nipple Yeast, Part 2 – Alternative Treatments and What’s in Them

OK, this is what you’ve been waiting for – “natural” and alternative remedies for candidiasis! (Part 1 is background and doctor-style remedies.)

First up, gentian violet.  This is renowned for its quick-acting slaughter of all things fungal, and it’s often recommended in crunchy circles.  Whereas most yeast treatments take at least two weeks, this takes about three days.  The one big drawback is that this stuff is seriously PURPLE and stains everything it touches. (That’s my daughter with a purple mouth, purple thumb, and slightly purple pajamas thanks to GV.)

Want to guess where gentian violet comes from?  Nope, it’s not extracted from organically grown violets.  Nor from gentian flowers.  It’s an extract of coal tar.  It was first used as a dye, but then users noticed when they used it for gram staining microscope slides, it killed all the wee beasties they were trying to look at.  (And yes, I find it a bit hilarious that there are people who decry mineral oil use on the skin, but who happily slather the insides of their infants’ mouths with extract of coal tar.)

The other potential risks of gentian violet are mouth ulcers and a possible increased risk of cancer.  But that’s based on a study of ingestion of large amounts by mice.  Honestly, if I had it to do again, I would still use gentian violet for nipple yeast.

Next big natural cure: grapefruit seed extract (GSE).  Again, this seems to be a pretty powerful antimicrobial agent.  There is research showing that its efficacy is comparable to that of bleach in killing microorganisms.  And because it’s derived from grapefruit, a lot of moms feel more comfortable using it on their nipples and in their infants’ mouths.  But that’s where we need to back up the truck – the reason this stuff is so powerful is that it is either contaminated with or nearly chemically identical to well-known antimicrobial chemicals Triclosan, benzethonium chloride, and benzalkonium chloride.  The latter are often referred to simply as BAC.  One study found some commercial GSE preparations contained Triclosan.  The others typically find the spectrometry is pinging for BAC.

The main manufacturer of GSE, Nutriteam, Inc., maintains that their product is not contaminated with BAC.  They say their GSE is just similar to BAC, so it confuses the spectrometer.  And well, I kind of believe them.  My conclusion is that their product isn’t contaminated.  It’s just that it is for all intents and purposes BAC.  I don’t know how BAC is typically manufactured, but I suspect you can make it using grapefruit as a raw material.  And Nutriteam themselves call GSE a “quaternary compound” (just like BAC is), and describe a manufacturing process that sounds pretty industrial and non-crunchy.  It sounds like they’re doing pretty typical chemical synthesis to me.  And they wind up with a substance that tests and works just like BAC, only they call it a dietary supplement so they don’t really have to comply with any regulations, and they slap a label on it that makes it sound like something natural, not a “chemical” or gods forbid, a “toxin.”

Now, BAC isn’t actually evil, necessarily.  It’s used as a preservative in cosmetics and in anti-bacterial wipes.  Hell, if you’ve ever given a urine sample, you have probably smeared BAC all over your naughty bits.  And since many people have used GSE without ill effects (beyond a bitter taste and the possibility of dry, peely skin), I wouldn’t be averse to using it myself if I ever got nipple yeast again.  I really don’t like that the manufacturers are getting away with fooling people, but look at my previous yeast post – it feels like rubbing your nipples with broken glass.  For me, I’d hold my nose and use GSE since it makes that go away – quickly, for both me and my nursling, without having to get a prescription and explain to the doctor why Nystatin doesn’t work and how much Fluconazole you really need to prescribe, and so on.  But I do think moms deserve to know the real story before they decide whether to use it.

So there you go, two wildly popular crunchy alternative yeast treatments, that aren’t really that crunchy.  But I’d still use them!

Skeptical Quickies

I had important things to do today like physical therapy, and shopping, and going out to lunch.  I just got to sit down in front of the computer, and my kid has to get ready for a sleepover, so here are some links of interest.  Monday we’ll do alternative yeast therapies, I promise!

Self-help guru gets 6 years in sweat lodge deaths – a newage self-help guru basically roasted a bunch of people alive, in the name of enlightenment.

FDA revokes Avastin’s approval for breast cancer treatment – but you can still get it prescribed off-label.

Science fights fluoridation – do modern opponents have some real science on their side?

American Pain Foundation creates informational website for CAM – it does talk about some of the risks of CAM treatments, but not comprehensively (aortic dissection isn’t mentioned in regards to spinal manipulation, for instance), and seems quite dewy-eyed and trusting when it comes to efficacy.

Canadian Medical Association Journal: natural health products should be subject to the same regulations as pharmaceutical drugs – “it is a near-universal truth that any substance that exerts a beneficial effect on a biological system will also have the potential for adverse effects.”