I can not believe the way this thread on candida(yeast) has progressed.
Steve Dyer and I have been exchanging words over the same topic in Sci.
Med. Nutrition when he displayed his typical reserve and attacked a women
poster for being treated by a liscenced physician for a disease that did
not exist.  Calling this physician a quack was reprehensible Steve and I
see that you and some of the others are doing it here as well.  

Let me tell you who the quacks really are, these are the physicans who have
no idea how the human body interacts with it's environment and how that
balance can be altered by diet and antibiotics.  These are the physicians
who dismiss their patients with difficult symptomatology and make them go
from doctor to doctor to find relief(like Elaine in Sci. Med. Nutrition) and
then when they find one that solves their problem, the rest start yelling
quack.  Could it just be professional jealousy?  I couldn't help Elaine or Jon
but somebody else did.  Could they know more than Me?  No way, they must be a
quack.  

I've been teaching a human nutrition course for Medical students for over ten
years now and guess who the most receptive students are?  Those that were
raised on farms and saw first-hand the effect of diet on the health of their
farm animals and those students who had made a dramatic diet change prior to
entering medical school(switched to the vegan diet).  Typically, this is
about 1/3 of my class of 90 students.  Those not interested in nutrition
either tune me out or just stop coming to class.  That's okay because I
know that some of what I'm teaching is going to stick and there will be at
least a few "enlightened" physicians practicing in the U.S.  It's really
too bad that most U.S. medical schools don't cover nutrition because if
they did, candida would not be viewed as a non-disease by so many in the
medical profession.

In animal husbandry, an animal is reinnoculated with "good" bacteria after
antibiotics are stopped.  Medicine has decided that since humans do not
have a ruminant stomach, no such reinnoculation with "good" bacteria is
needed after coming off a braod spectrum antibiotic.  Humans have all
kinds of different organisms living in the GI system(mouth, stomach, small
and large intestine), sinuses, {*filter*} and on the skin.  These are
nonpathogenic because they do not cause disease in people unless the immune
system is compromised.  They are also called nonpathogens because unlike
the pathogenic organisms that cause human disease, they do not produce
toxins as they live out their merry existence in and on our body.  But any of
these organisms will be considered pathogenic if it manages to take up
residence within the body.  A poor mucus membrane barrier can let this
happen and vitamin A is mainly responsible for setting up this barrier.
Steve got real upset with Elaine's doctor because he was using anti-fungals
and vitamin A for her GI problems.  If Steve really understoood what
vitamin A does in the body, he would not(or at least should not) be calling
Elaine's doctor a quack.

Here is a brief primer on yeast.  Yeast infections, as they are commonly
called, are not truely caused by yeasts.  The most common organism responsible
for this type of infection is Candida albicans or Monilia which is actually a
yeast-like fungus.  An infection caused by this organism is called candidiasis.
Candidiasis is a very rare occurance because, like an E. Coli infection, it
requires that the host immune system be severly depressed.  

Candida is frequently found on the skin and all of the mucous membranes of
normal healthy people and it rarely becomes a problem unless some predisposing
factor is present such as a high {*filter*} glucose level(diabetes) or an {*filter*}
course of antibiotics has been used.  In diabetics, their secretions contain
much higher amounts of glucose.  Candida, unlike bacteria, is very limited in
it's food(fuel) selection.  Without glucose, it can not grow, it just barely
survives.  If it gets access to a lot of glucose, it blooms and over rides
the other organisms living with it in the sinuses, GI tract or {*filter*}.  In
diabetics, skin lesions can also foster a good bloom site for these little
{*filter*}s.  The bloom is usually just a minor irritant in most people but
some people do really develop a bad inflammatory process at the mucus
membrane or skin bloom site.  Whether this is an allergic like reaction to
the candida or not isn't certain.  When the bloom is in the {*filter*} or on
the skin, it can be easliy seen and some doctors do then try to "treat" it.
If it's internal, only symptoms can be used and these symptoms are pretty
nondiscript.  

Candida is kept in check in most people by the normal bacterial flora in
the sinuses, the GI tract(mouth, stomach and intestines) and in the
{*filter*}l tract which compete with it for food.  The human immune system
ususally does not bother itself with these(nonpathogenic organisms) unless
they broach the mucus membrane "barrier".  If they do, an inflammatory
response will be set up.  Most Americans are not getting enough vitamin A
from their diets.  About 30% of all American's die with less Vitamin A than
they were born with(U.S. autopsy studies).  While this low level of vitamin
A does not cause pathology(blindness) it does impair the mucus membrane
barrier system.  This would then be a predisposing factor for a strong
inflammatory response after a candida bloom.  

While diabetics can suffer from a candida "bloom" the  most common cause of
this type of bloom is the use of broad spectrum antibiotics which
knock down many different kinds of bacteria in the body and remove the main
competition for candida as far as cooking.net">food is concerned.  While {*filter*} are
available to handle candida, many patients find that their doctor will not
use them unless there is evidence of a systemic infection.  The toxicity of
the anti-fungal {*filter*} does warrant some caution.  But if the GI or sinus
inflammation is suspected to be candida(and recent use of a broad spectrum
antibiotic is the smoking gun), then anti-fungal use should be approrpriate
just as the anti-fungal creams are an appropriate treatment for recurring
{*filter*}l yeast infections, in spite of what Mr. Steve Dyer says.

But even in patients being given the anti-fungals, the irritation caused by
the excessive candida bloom in the sinus, GI tract or the {*filter*} tends to
return after drug treatment is discontinued unless the underlying cause of
the problem is addressed(lack of a "good" bacterial flora in the body and/or
poor mucus membrane barrier).  Lactobacillus acidophilus is the most effective
therapy for candida overgrowth.  From it's name, it is an acid loving
organism and it sets up an acidic condition were it grows.  Candida can not
grow very well in an acidic environment.  In the {*filter*}, L. acidophilius is
the predominate bacteria(unless you are hit with broad spectrum
antibiotics).  

In the GI system, the ano-rectal region seems to be a particularly good
reservoir for candida and the use of pantyhose by many women creates a very
favorable environment around the rectum for transfer(through moisture and
humidity) of candida to the {*filter*}l tract.  One of the most effctive ways to
minimmize this transfer is to wear undyed cotton underwear.  

If the bloom occurs in the {*filter*}area, the burning, swelling, pain and even
{*filter*} discharge make many patients think that they have hemorroids.  If the
bloom manages to move further up the GI tract, very diffuse symptomatology
occurs(abdominal discomfort and {*filter*} in the stool).  This positive stool
for occult {*filter*} is what sent Elaine to her family doctor in the first
place.  After extensive testing, he told her that there was nothing wrong
but her gut still hurt.  On to another doctor, and so on.  Richard Kaplan
has told me throiugh e-mail that he considers occult {*filter*} tests in stool
specimens to be a waste of time and money because of the very large number of
false positives(candida blooms guys?).  If my gut hurt me on a constant
basis, I would want it fixed.  Yes it's nice to know that I don't have
colon cancer but what then is causing my distress?  When I finally find a
doctor who treats me and gets me 90% better, Steve Dyer calls him a quack.

Candida prefers a slightly alkaline environment while bacteria
tend to prefer a slightly acidic environment.  The {*filter*} becomes alkaline
during a woman's period and this is often when candida blooms in the {*filter*}.
Vinegar and water douches are the best way of dealing with {*filter*}l
problems.  Many women have also gotten relief from the introduction of
Lactobacillus directly into the {*filter*}l tract(I would want to be sure of
the purity of the product before trying this).  My wife had this {*filter*}
problem after going on birth control pills and searched for over a year
until she found a gynocologist who solved the problem rather than just writting
scripts for anti-fungal creams.  This was a woman gynocologist who had had
the same problem(recurring {*filter*}l yeast infections).  This M.D. did some
digging and came up with an acetic acid and L. Acidophilis douche which she
used in your office to keep it sterile.  After three treatments, sex
returned to our marraige.  I have often wondered what an M.D. with chronic
GI distress or sinus problems would do about the problem that he tells his
patients is a non-existent syndrome.

The nonpathogenic bacteria L. acidophilus is an acid producing bacteria
which is the most common bacteria found in the {*filter*}l tract of healthy women.  
If taken orally, it can also become a major bacteria in the gut.  Through
aresol sprays, it has also been used to innoculate the sinus membranes.
But before this innoculation occurs, the mucus membrane barrier system
needs to be strengthened.  This is accomplished by vitamin A, vitamin C and
some of the B-complex vitamins.  Diet surveys repeatedly
...

read more »

Do you believe that any quacks exist?  How about quack diagnoses?  Is
being a "licensed physician" enough to guarantee that someone is not
a quack, or is it just that even if a licensed physician is a quack,
other people shouldn't say so?  Can you give an example of a
commonly diagnosed ailment that you think is a quack diagnosis,
or have we gotten to the point in civilization where we no longer
need to worry about unscrupulous "healers" taking advantage of
people.
--
David Rind

I don't like the term "quack" being applied to a licensed physician David.
Questionable conduct is more appropriately called unethical(in my opinion).
I'll give you some examples.

        1. Prescribing controlled substances to patients with no
           demonstrated need(other than a drug addition) for the medication.

        2. Prescribing thyroid preps for patients with normal thyroid
           function for the purpose of quick weight loss.

        3. Using laetril to treat cancer patients when such treatment has
           been shown to be ineffective and dangerous(cyanide release) by
           the NCI.

These are errors of commission that competently trained physicians should
not committ but sometimes do.  There are also errors of omission(some of
which result in malpractice suits).  I don't think that using anti-fungal
agents to try to relieve discomfort in a patient who you suspect may be
having a problem with candida(or another fungal growth) is an error of
commission or omission.  Healers have had a long history of trying to
relieve human suffering.  Some have stuck to standard, approved procedures,
others have been willing to try any reasonable treatment if there is a
chance that it will help the patient.  The key has to be tied to the
healer's oath, "I will do no harm".  But you know David that very few
treatments involve no risk to the patient.  The job of the physician is a
very difficult one when risk versus benefit has to be weighed.  Each
physician deals with this risk/benefit paradox a little differently.  Some
are very conservative while others are more agressive.  An agressive
approach may be more costly to the patient and carry more risk but as long
as the motive is improving the patient's health and not an attempt to rake
in lots of money(through some of the schemes that have been uncovered in
the medicare fraud cases), I don't see the need to label these healers as
quacks or even unethical.

What do I reserve the term quack for?  Pseudo-medical professionals.  
These people lurk on the fringes of the health care system waiting for the
frustrated patient to fall into their lair.  Some of these individuals are
really doing a pretty good job of providing "alternative" medicine.  But
many lack any formal training and are in the "business" simply to make a
few fast bucks.   While a patient can be reasonably assured of getting
competent care when a liscenced physician is consulted, this alternative
care area is really a buyer's beware arena.  If you are lucky, you may find
someone who can help you.  If you are unlucky, you can loose a lot of
money and develop severe disease because of the inability of these pseudo-
medical professional to diagnose disease(which is the fortay of the
liscened physicians).

I hope that this clears things up David.

Marty B.

Sure there are quacks. There are quacks who don't treat and quacks who
treat. One's that refuse to diagnose and ones that diagnose improperly.
There are lucky quacks and unlucky quacks. Smart quacks and dumb ones.

There are people ahead of their time, with unprobable or unproven theories
and rationals. There are ill-reasoned, absurd, theorists.

Sometimes it's hard to tell who's who.  

Reading a book of ancient jokes it seems that doctors called other doctors
quacks in Babylon.

Arguments abound when there aren't any firm answers. Plenty of illnesses
aren't, or can't, be diagnosed or treated. But I think it's better to argue
against the theory, as was originally done with postings on candida a month
or so ago. Stating the facts usually works better than simply asserting an
opinion about someone's competency. And you can't convince everybody.

Sometimes a correct diagnosis
takes years for people: they don't run into a doctor who recognizes the
disease, they haven't developed something recognizable yet, or they have
something that no one is going to recognize, because it hasn't been
described yet. Sometimes they get a cure, sometimes the illness wears out,
sometimes they stumble on an improper diagnosis with the right treatment,
sometimes they find it's incurable.  

There is no profit in a patient accepting a hopeless attitude about an
illness. Unless it's a rock solid diagnosis of terminal disease it's is
more like ly that a person will find a cure if they keep looking.

-Jackie-

In an article Jon Noring writes:

If I prescribe itraconazole for a patient's sinusitis neither the AMA,
FDA, State Licensing Board, nor ABFP will be knocking on my door to ask
why.  This is a specious argument.

Among other things, how to evaluate new theories and treatments.

Funny, I thought it meant "one who fraudulently misrepresents his
ability and experience in the diagnosis and treatment of disease or
the effects to be achieved by the treatment he offers" (Dorland's
27th).  Certainly more precision than conveyed by "chronic yeast".

The inability to discriminate between fraudulent or erroneous
representations is far more frightening.  It is fraud to promote a
treatment where the evidence for it is either lacking or against it
and the quacksalver knows so, or error if the honest practitioner
doesn't know so.  Failure to speak out against either bespeaks
incompetency.

May I reply - seriously - that if the practitioners and proponents of
non-scientific medicine have left their minds so open that the parts
of their brains that do critical evaluation have fallen out, they should
learn to edit their newsgroup headers to conform to the existing
hierarchy and divisions.

--
     John Angelo Gnassi                 Lab of Computer Science

     "Eternal Student"                  Boston, Massachusetts, USA
     "The Earth be spanned, connected by a Network" - Walt Whitman

Hmm.  This is certainly among the things I would refer to as quack
therapy and would tend to refer to any practitioner who prescribed
laetrile (whether licensed or not) as a quack.  There are unethical
behaviors (such as ordering unneccessary tests to increase fees)
which I would not lable as quackish, but prescribing known ineffective
therapies seems to me to be one of the hallmarks of a quack.
--
David Rind

One of the responsibilities of a licensed physician is to read the medical
literature to keep up with changes in medical practice.  All the clamor
over laetril resulted in the NCI spending quite a bit of money on clinical
trials which proved(to me anyway) that laetril was ineffective against
cancer.  A physician who continued to use it, when better, more effective,
treatments are available, may deserve to be called a quack.  Anti-fungals
are in a different class.  The big question seems to be is it reasonable to
use them in patients with GI distress or sinus problems that *could* be due
to candida blooms following the use of broad-spectrum antibiotics?  Gorden
Rubenfeld, through e-mail, has assured me that most physicians recognize
the chance of candida blooms occuring after broad-spectrum antibiotic use
and they therefore reinnoculate their patients with *good* bacteria to
restore competetion for candida in the body.  I do not believe that this is
yet a standard part of medical practice.  He deals with critical care
patients where fungal infection(systemic) is a real problem and just
because he tries to keep *good* bacteria in his patients does not mean that
all physicians do this.  I think that aspergillis is more likely to be
found in the sinus mucus membranes than is candida.  Women have been known
for a very long time to suffer from candida blooms in the {*filter*} and a
women is lucky to find a physician who is willing to treat the cause and
not give give her advise to use the OTC anti-fungal creams.  Since candida
colonizes primarily in the ano-rectal area, GI symptoms should be more common
than {*filter*}l problems after broad-spectrum antibiotic use.

The problem we have here David is proof that GI discomfort can be caused by
a candida bloom.  The arguement is that without proof, no action is
warrented.

Medicine has not, and probalby never will be, practiced this way.  There
has always been the use of conventional wisdom.  A very good example is
kidney stones.  Conventional wisdom(because clinical trails have not been
done to come up with an effective prevention), was that restricitng the
intake of calcium and oxalates was the best way to prevent kidney stones
from forming.  Clinical trials focused on {*filter*} or ultrasonic blasts to
breakdown the stone once it formed.  Through the recent New England J of
Medicine article, we now know that conventional wisdom was wrong,
increasing calcium intake is better at preventing stone formation than is
restricting calcium intake.

The conventional wisdom in animal husbandry has been that animals need to
be reinnoculated with *good* bacteria after coming off antibiotic therapy.
If it makes sense for livestock, why doesn't it make sense for humans
David?  We are not talking about a dangerous treatment(unless you consider
yogurt dangerous).  If this were a standard part of medical practice, as
Gordon R. says it is, then the incidence of GI distress and {*filter*}l yeast
infections should decline.

Marty B.

I guess I'm still not clear on what the term "candida bloom" means,
but certainly it is well known that thrush (superficial candidal
infections on mucous membranes) can occur after antibiotic use.
This has nothing to do with systemic yeast syndrome, the "quack"
diagnosis that has been being discussed.

Lucky how?  Since a recent article (randomized controlled trial) of
{*filter*}yogurt on reducing {*filter*}l candidiasis, I've mentioned to a
number of patients with frequent {*filter*}l yeast infections that they
could try eating 6 ounces of yogurt daily.  It turns out most would
rather just use anti-fungal creams when they get yeast infections.

Again, this just isn't what the systemic yeast syndrome is about, and
has nothing to do with the quack therapies that were being discussed.
There is some evidence that attempts to reinoculate the GI tract with
bacteria after antibiotic therapy don't seem to be very helpful in
reducing diarrhea, but I don't think anyone would view this as a
quack therapy.
--
David Rind

  Nor is it mine.  What I tried to explain to Marty was that it is clearly
understood that antibiotic exposure is a risk factor for fungal infections
- which is not the same as saying bacteria prevent fungal infections.
Marty made this sound like a secret  known only to veternarians and
biochemists.  Anyone who has treated a urinary tract infection knowns
this. At some centers pre-op liver transplant patients receive bowel
decontamination directed at retaining "good" anaerobic flora in an attempt
to prevent fungal colonization in this soon-to-be high risk group.  I also
use lactobacillus to treat enteral nutrition associated diarrhea (that may
be in part due to alterations in gut flora).  However, it is NOT part of
my routine practice to "reinnoculate" patients with "good" bacteria after
antibiotics.  I have seen no data on this practice preventing or treating
fungal infections in at risk patients.  Whether or not it is a "logical
extension" from the available observations I'll leave to those of you who
base strong opinions and argue over such speculations in the absence of
clinical trials.
  One place such therapy has been described is in treating particularly
recalcitrant cases of C. difficile colitis (NOT a fungal infection). There
are case reports of using stool (ie someone elses){*filter*}s to repopulate
the patients flora.  Don't try this at home.

  Except that it isn't. At least symptomatically apparent disease.

  Seems like this is an excellent argument for ignoring anecdotal
conventional wisdom (a euphemism for no data) and doing a good clinical
trial, like:

AU   Dismukes-W-E.  Wade-J-S.  Lee-J-Y.  Dockery-B-K.  Hain-J-D.
TI   A randomized, double-blind trial of nystatin therapy for the
     candidiasis hypersensitivity syndrome [see comments]
SO   N-Engl-J-Med.  1990 Dec 20.  323(25).  P 1717-23.
     psychological tests. RESULTS. The three active-treatment regimens
     and the all-placebo regimen
     significantly reduced both {*filter*}l and systemic symptoms (P less than
     0.001), but nystatin did not reduce the systemic symptoms
     significantly more than placebo. [ . . . ]
     CONCLUSIONS. In women with presumed candidiasis
     hypersensitivity syndrome, nystatin does not reduce systemic or
     psychological symptoms significantly more than placebo. Consequently,
     the empirical recommendation of long-term nystatin therapy for such
     women appears to be unwarranted.

  Does this trial address every issue raised here, no.  Jon Noring was not
surprised at this negative trial since they didn't use *Sporanox* (despite
Crook's recommendation for Nystatin).  Maybe they didn't avoid those
carbohydrates . . .

  Marty, you've also changed the terrain of the discussion from empiric
itraconazole for undocumented chronic fungal sinusitis with systemic
hypersensitivity symptoms (Noring syndrome) to the yoghurt and vitamin
therapy of undocumented candida enteritis (Elaine Palmer syndrome) with
systemic symptoms.  There is significant difference between the cost and
risk of these two empiric therapeutic trials.  Are we talking about "real"
candida infections, the whole "yeast connection" hypothesis, the efficacy
of routine bacterial repopulation in humans, or the ability of anecdotally
effective therapies (challenged by a negative randomized trial) to confirm
an etiologic hypothesis (post hoc ergo propter hoc).  We can't seem to
focus in on a disease, a therapy, or a hypothesis under discussion.

                           I'm lost!

Yogurt contains Lactobacillus acidophilus and L. bulgaricus.  L.
acidophilus is the major bacteria in the {*filter*}l tract and is primarily
responsible for keeping the {*filter*}l tract acidic and yeast free.  Most of
the commercial yogurt sold in the U.S. has a very low L. acidophilus and L.
bulgaricus count.  Neither of these bacteria are obligate anaerobes with are
much more important in dealing with the diarrhea problem.  Gordon R. has told
me through e-mail that he gives his patients L. acidophilus and several
different obligate anaerobes(which set-up shop in the colon) but he hasn't
told me which ones yet.  The Lactobacillus genera are mostly facultative
anaerobes and will set-up shop where they have access to oxygen if given a
chance(mouth,{*filter*}, sinus cavity and {*filter*}).  Having these good bacteria
around will greatly decrease the chance of candida blooms in the {*filter*}
region or the {*filter*}.  I have not proposed a systemic action for candida
blooms.  I know that others swear that all kinds of symptoms arise from
the evil yeast blooms in the body.  I'm not ready to buy that yet.  I do
believe that complications at specific sites({*filter*}, {*filter*}and maybe lower
colon, sinus and mouth) can result from antibiotic use which removes the
competing bacteria from these sites and thus lets candida grow unchecked.
Restoring the right bacterial balance is the best way(in my opinion) to get
rid of the problem.  Anti-fungals, a low carbohydrate diet and vitamin A
supplementation may all help to minimize the local irritation until the
good bacteria can take over control of the cooking.net">food supply again and lower the
pH to basically starve the candida out.

Marty B.

Candida can do that to you. :-)  Gordon, I think that the best clinical
trial for candida blooms would involve giving women with chronic {*filter*}l
candida blooms L. Acidophilus orally and see it it can decrease the
frequency and extent of candida blooms in the {*filter*} since most of the
candida seems to be migrating in from the {*filter*}region and L. acidophilus
should be able keep the candida in check if it can make it through the
intestinal tract and colonize in the{*filter*} where it will have access to
oxygen(just like it does in the {*filter*}).  As much stuff as there is in the
lay press about L. acidophilus and {*filter*}l yeast infections, I'm really
amazed that someone has not done a clinical trial yet to check it out.

The calcium and kidney stone story is not a good reason to throw all
conventional wisdom out the window.  Where would medicine be if
conventional wisdom had not been used to develop many of the standard
medical practices that could not be confirmed through clinical trials?
The clinical trial is a very new arrival on the medical scene(and a very
important one).  The lack of proof that reinnoculation with good bacteria
after antibiotic use is important to the health of a patient is no reason
to dismiss it out-of-hand, especially if reinnoculation can be done cleaply
and safely(like it is in animal husbandry).

Marty B.

Point 1:

I'm beginning to see that *part* of the disagreements about the whole
"yeast issue" is on differing perceptions and on differing meanings
of words.  Medical doctors have a very specific and specialized "jargon",
necessary for precise communication within their field (which I'm fully
cognizant of since I, too, speak "jargonese" when with my peers).  For the
situation in sci.med, many times the words or phrases used by doctors can
have a different and more specific meaning than the same word used in the
world at large, causing significant miscommunication.  One example word,
and very relevant to the yeast discussion, is the exact meaning of "systemic".
It is now obvious to me that the meaning of this word is very specific, much
more so than its meaning to a non-doctor.  There is also the observation of
this newsgroup that both doctors and non-doctors come together on essentially
equal terms, which, when combined with the jargon issue, can further fan
the flames.  This is probably the first time that practicing doctors get
really "beat up" by non-doctors for their views on medicine, which they
otherwise don't see much of in their practice except for the occasional
"difficult" patient.

Point 2:

I understand the viewpoint among many practicing doctors that they will not
prescribe any treatments/therapies for their patients unless such treatments
have been shown to be effective and the risks understood from well-constructed
clinical trials (usually double-blind), or that such treatments/therapies are
part of an approved and funded clinical trial.  To these doctors, to do any
differently would, in this belief system, be unethical practice.  And it
follows that any therapy not on the "accepted" list is therefore a non-
therapy - it does not even exist, nor does the underlying hypothesis or
theory have any validity, even if it sounds very plausible by extrapolation
of what is currently known.  Anecdotal evidence has no value, either, from
a treatment point-of-view.

And by and large, as a scientist myself, I am glad that medical practice/
science takes such a rigorous approach to medical treatment.  However, as
also being a human being (last I checked), and having been one of those people
that has been significantly helped by a currently unaccepted treatment, where
"standard" medicine was not able to help me, has caused me to sit back and
wonder if holding such an extreme and rigid "scientific" viewpoint is in
itself unethical from humanitarian considerations.  After all, the underlying
intent of the "scientific" approach to medicine is to protect the health of
the patient by providing the best possible care for the patient, so the
patient should come first when considering treatment.

What we need is a slightly modified approach to treatment that satisfies both
the "scientific" and the "humanitarian" viewpoints.  In an earlier post I
outlined a crazy idea for doing just that.  The gist of it was to give any
physician freedom and encouragement by the medical community to prescribe
alternate, not yet proven therapies (maybe supported by anecdotal evidence)
for patients who *all* avenues of accepted therapies have been exhausted
(and not until then).  The patient would be fully informed that such
therapies/treatments are not supported by the proper clinical trials and that
there are real potential risks with real possibilities of no benefit derived
from them.

This approach satisfies the need for scientific rigor.  It also satisfies
the humanitarian needs of the patient.  And the reality is that many patients
who have reached a dead-end in the treatment of their symptoms using accepted
medicine *will* go outside the orthodox medical community:  either to the
doctors who are brave enough to prescribe such treatments at the risk of losing
their license, or worse, to non-doctors who have not had the proper medical
training.  This approach also recognizes this reality and keeps the control
more within orthodox medicine, with the benefits that the information gleaned
could help focus limited resources towards future clinical trials in the most
productive way.  Everybody wins in this admittedly rose-colored approach - I'm
sure there are real problems with this approach as well - it is presented
more as a strawman to stimulate discussion.

Hopefully what I write here may give the sci.med doctors a better idea as to
why I am "open" to alternative therapies, as well as why I have real
difficulty (read "apparent hostility") with the "coldness" of the 99.9% pure
"scientific" approach to medicine.  I believe the best approach to medical
treatment is one where both the "humanitarian" aspects are balanced with and
by the "scientific" aspects.  Anything else is just not good medicine, imho.
Just my 'NF' leanings, I guess.  :^)

Comments?

Jon Noring

--

Charter Member --->>>  INFJ Club.

If you're dying to know what INFJ means, be brave, e-mail me, I'll send info.
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Who are you?  Read alt.psychology.personality!  That's where the action is.

THE diarrhea problem?  WHAT diarrhea problem?  First, candidal overgrowth is
not a frequent problem during antibiotic therapy, and not all cases of
antibiotic-related diarrhea have anything to do with candida.  But a case
of {*filter*}l candidiasis or {*filter*}thrush after antibiotic therapy isn't going
to surprise anyone either.  That's not what people are disagreeing with.

Oh, really?  Where'd you come up with this?  You know, it's really
appalling to see you try to comment authoritatively on clinical matters
in a bizarre synthesis from reading reports in the literature.
Bobbing for citations in the research literature isn't medicine.
I hope you're not giving the wrong idea to your medical students.

--
Steve Dyer

I've mentioned this study a couple of times now: Ingestion of yogurt
containing Lactobacillus acidophilus as prophylaxis for candidal
vaginitis, Annals of Internal Medicine, 3/1/92 116(5):353-7.  Do you
have a problem with the study because they used yogurt rather than
capsules of lactobacillus (even though it had positive results)?

The study was a crossover trial of daily ingestion of 8 ounces of
yogurt.  There was a marked decrease in infections while women were
ingesting the yogurt.  Problems with the study included very small
numbers (33 patients enrolled) and many protocol violations (only
21 patients were analyzed).  Still, the difference in rates of infection
between the two groups was so large that the study remains fairly
believable.
--
David Rind

David, this study looks like a good one.  Gordon Rubenfeld did a Medline
search and also sent me the same reference through e-mail.  Since
commercial yogurt does not always have a good Lactobacillus a. or
bulgaricus culture, a negative finding would not have been too informative.
This is often the reason why Lactobacillus acidophilus tablets are
recommended rather than yogurt.

I guess the next question is why would this introduction of "good" bacteria
back into the gut decrease the incidence of {*filter*}l candida blooms if the
{*filter*} was not serving as a candida reservoir(a fact that Gordon R. vehementy
denys)?  I see two possible theories.  One, the L. acidophilus, which is a
facultatively anaerobic bacterium, could make it through the gut and
colonize the rectal area to overgrow the candida.  This would not explain
the reoccurance of candida blooms in the {*filter*} after the yogurt ingestion
was stopped though.  The other is that the additional bacteria in the
intestinal tract remove most of the glucose from the feces and candida
looses it's major cooking.net">food source.

Getting Lactobacillus acidophilus to colonize the {*filter*}l tract(where it is
normally found) would have a much better effect on the recurrance of {*filter*}l
yeast blooms though.  An acetic acid, Lactobacillus acidophilus douche has
been used to get this effect but I've not seen any such treatment reported in
the medical literature.  This would be an example of physicians conducting
their own clinical trials to try to come up with treatments that help their
patients.  When this is done in private practice, the results are rarely, if
ever published.  It was the hallmark of medicine until the modern age
emerged with clinical trials.  It really raises a big question.  Does the
medical profession cast out the adventerous few who try new treatments to
help patients or does it look the other way.

This particular issue is really a very simple one since no real dangerous
therapy is involved(even the anti-fungals are not all that dangerous).  But
there are some areas(like EDTA chelation therapy), where the fire is pretty
hot and somebody could get burned.  It's really tough.  Do I follow only
well established protocols and then give up if they don't work that well or
do it try something that looks like it will work but hasn't been proven to
work yet?

My stand is to consider other treatment possibilities, especially if they
involve little or no risk to the patient.  Getting good bacteria back into
the gut after antibiotic treatment is one treatment possibility.  The other
is getting L. acidophilus into the {*filter*}l tract of a woman who is having a
problem with recurring yeast infections.

Marty B.