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SolveEczema News and Publication

One of the goals when I started to write a book about SolveEczema.org (still in the works!) was to find a way to bring the ideas into a mainstream medical and scientific forum for discussion and validation, including also writing a scientific paper. After years considering how to publish something so different, I published in a new open source platform called The Winnower, which offers post-publication peer review.

You can view the paper at: https://thewinnower.com/papers/3412-abnormal-ampli-fication-observations-from-applying-the-engineering-method-to-solving-eczema-and-atopic-disease

I know this probably sounds very dry to site users, but for anyone who has asked the question “Why didn’t my doctor give me this information?!” (too many to count have emailed me the same question), you may be interested in the scientific validation of this work, because it will mean other children will be spared the same suffering.  Although many doctors have used and referred SolveEczema.org to patients over the years, it will be tough to reach everyone or work on solving related health conditions without the validation of peer review.

I’m having some computer problems lately, so rather than trying to compose a post to explain, here are some edited excerpts from recent letters I wrote:
SolveEczema.org represents the novel application of modern technical problem solving, in particular, the engineering method, to solving a medical condition, eczema and related allergy. The engineering method has been described as “The use of heuristics to cause the best change in a poorly understood situation within the available resources.” (BV Koen, The Bent of Tau Beta Pi, 1985)

When an environmental cause underlies a medical condition, complex environmental and exposure differences can translate to seemingly intractable person-to-person variability. This work involves the unraveling of this seeming complexity by using heuristics that allow individuals to focus on controlling what’s important to problem solve in their own circumstances. The paper presents a number of insights that came about as part of the problem solving process and subsequent research, such as why a key aspect of the solution has been overlooked to date and why a new approach is needed for the validation of heuristic solutions.

A letter to a doctor who expressed an interest in a collaboration:
The article mentions how this perspective could reconcile seemingly contradictory hygiene hypothesis research. For example, for awhile, researchers said owning dogs and cats was protective, then they said it was just dogs, etc. The issue the research didn’t take into account was developments in cleaning equipment (e.g. better, filtered vacs, and more frequent cleaning of pet hair), and the fact that cats use cat litter which is just loaded with detergents that they track through homes. Birth order – anyone with a first child with allergies is going to make changes in the home environment and products, which are bound to be preventive for the later children, also never taken into account. Breastfeeding and allergies, too – the studies used to show a protective effect, then later studies said no.  I think both are probably right (the later studies looked at older children, where detergents were by then probably a more significant influence).

And (same person):

You are spot on about related health issues. I think ultimately this issue is as major an environmental problem as smoking was, in some ways worse because other creatures in the environment are affected. (I think it’s highly likely that frogs, bats, and honeybees, possibly even otters, may be experiencing serious unrecognized harm, but that’s another discussion.) Asthma, allergies, dry skin, and even wrinkles are major related issues. I have been surprised at how much the changes markedly decreased the propensity for sunburn (which could have a major impact downstream on skin cancer). Over the years, I have been thanked on several occasions by doctors specifically over the issue of having good skin despite constant handwashing – perhaps that’s something we could collaborate over. The physician handwashing issue touches on many health problems: hospital-borne infection, possible improving willingness to wash hands over using sanitizers (which is probably healthier for providers who don’t absorb so much through their skin, and reducing infections since washing is better than sanitizers), maintaining a better barrier on providers’ hands to reduce the harboring of microbes, possibly reducing the general need for antimicrobial chemicals in handwashes in some settings if mechanical means are less damaging (reducing development of resistant strains), etc.

I have been thinking a lot lately about whether it would be possible to design a case-control study. Unfortunately, the barrier is that the engineering method relies on heuristics – when an environmental cause underlies a disease, unless it is very simple to remove the cause, there is no way to apply a completely controlled treatment or course of anything. To solve the problem in every individual case, it’s necessary for people to use a heuristic tool to apply the solution in the best way for their individual environmental exposures, health status, genetic profile, etc. Then the concern is how well each person uses the heuristic tool versus how well the tool works for them. Additionally, with the engineering method, it wouldn’t make sense to apply the tool exactly the same for everyone, then judge what percentage were helped – the whole point of it is that if one case isn’t solved 100%, the unresolved case doesn’t become data, it becomes a resource to revise the heuristic tool to encompass new information to achieve the same standard of outcome or solution for that person and everyone.

That isn’t a problem-solving approach currently in use in medicine, and it clashes with normal epidemiological methods. The method itself would have to be the subject of peer review, in the context of a solution like this being peer reviewed. Just yesterday I heard an oncologist (The Death of Cancer) speak on the radio about how “regulations” were keeping him from solving problems for individual cancer patients. The ideal he described, what he really wanted to do, was really the engineering method. I think some doctors are using heuristics in other areas of medicine because they get better outcomes for their patients, and the lack of overt discussion of heuristics is, IMO, causing some of the bigger medical controversies of our time. Finding a way to ethically, with all the right safeguards, incorporate the engineering method into medicine, I believe could result in many currently unsolved disease problems being solved. No new scientific or medical breakthroughs are needed, just problem solving we already know how to do in other technical arenas.

Validating the site work – peer review is a start – would prove eczema and atopy are solvable problems, on an individual and general disease problem level.  That sounds simple, yet it’s an earth-shattering idea.  Believe it or not, the biggest challenge here is overcoming the idea, the really hard-ingrained prejudice, that a major, complex, seemingly intractable medical problem could even possibly be solved.

So, yes, finding a route to peer-review and publication has been challenging (ironically more challenging than solving my child’s severe eczema and helping thousands around the world do the same over the past >10 years).  You can view the paper at: https://thewinnower.com/papers/3412-abnormal-ampli-fication-observations-from-applying-the-engineering-method-to-solving-eczema-and-atopic-disease

 

 

Happy Birthday, Dr. Bronner’s New Non-Detergent Toothpaste

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I’m very happy to report that Dr. Bronner’s released a new non-detergent toothpaste almost a year ago today.  I’m also happy to report that the toothpaste has been a hit in our home.  It’s made of 70% organic ingredients yet fairly economical compared to the other non-detergent toothpastes we use.  The news release contains a list of all the ingredients in the three flavors of Peppermint, Cinnamon, and Anise:

Dr. Bronner’s Releases New Toothpaste

I’m always happy to see good non-detergent options in categories like toothpaste, shampoo, and dishwasher powder, where the commercial choices (or really good, competitive products) are fairly limited.toothpaste-box_anise_front

Sharing

I haven’t had much time to post, but this doesn’t require many words. I’ve been following the progress of a mom, Kathie, from Ireland who used my SolveEczema site and itchybaby.co.uk to alleviate her son’s eczema.   You can read more about her journey on her blog http://therealityofaperfectlife.blogspot.com

I think she’s planning a site just for eczema, with additional information about supportive herbal and dietary steps she took or learned about on her journey.  These before and after photos of her journey say more than I ever could in words (used with permission). It’s staggering to think how many millions of families all over the world are going through this now:

 

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Off Topic: Salman Khan – Khan Academy: Education Reimagined


Salman Khan – Khan Academy: Education Reimagined

I haven’t forgotten loose ends I haven’t had time to tie:  inserting the citations into Letter to a Medical Student [part 1][part 2][part 3][part4], and posting the last installment of How to Get Rid of Ants for Good [part 1][part 2].  The information in the first two parts is no longer enough for people to solve the problem without the 3rd installment.  I’ve drafted it, I just haven’t been able to finish!

I posted that ant series with an agenda:  I have been following the work of microbiologist Bonnie Bassler on bacterial communications, and wonder if there may be an equivalent biological means of thwarting bacteria by manipulating their communications. (Manipulating rather than trying to kill them, which may not even be in our best interests as collateral damage to good bacteria causes other problems.)

I didn’t want to post anything new until I got around to finishing at least those two things, but I couldn’t help posting this amazing talk by Salman Khan of Khan Academy.

Wow.  Anyone who homeschools should see this.  Anyone who schools should see this.  I love his analogy of education being like building a house.  What’s the purpose of having some kids finish 60% of the foundation and 50% of the framing, and then moving on to something else just because everyone else does?  I went to a public school in a small town in South Dakota when I was a girl and it was a work-at-your-own-pace place, with so much enrichment.  I have since met SO many creative and accomplished people who came out of that one small program.

For SolveEczema.org users in particular:   After the talk, my son and I lined up with everyone else to shake Khan’s hand, say Thank You, and to take photos.  In the first part of his lecture, he was so candid about his journey in a way I wish I could be.  What he said rang so, so many bells.  When we got through the line, I said, “If you ever want to mentor someone, I think I’m you, only with medicine, and 7 years ago — at least I hope so.”  (10 years ago?)  I gave him my card, and he said, “That’s interesting, because I have eczema.”

I keep hoping he’ll try the site strategies, because I’m beginning to think this has to be experienced, even by those who don’t have eczema (especially by those who don’t have eczema) for anyone else to understand the broader medical and environmental implications.  To get researchers to understand why there’s almost no way the underlying environmental issues involved as described on SolveEczema aren’t a factor in bat white nose syndrome/bat fungal susceptibility — they almost have to experience the process and transformation themselves, again, even if they don’t have eczema.

Great talk for anyone who cares about education.
Salman Khan – Khan Academy: Education Reimagined

 

Letter to a Medical Student — What % of Cases are From Detergent? — Part 3

I’m afraid I don’t keep track of citations electronically; I will add in citations after the last post.  There will be at least 4 parts.
AJ

[Part 1]  [Part 2]  [Part 4]
Part 3:

So when I say 25-60% of eczema cases result from detergents, I’m really considering the commonality of circumstances under which detergents would likely be the overwhelming factor in the outbreaks. These circumstances vary.

Because adults often have more complicated health pictures, and because they have naturally less permeable membranes, I would expect detergent as the overwhelming influence in a smaller percentage of cases than for infants or children. For infants, with their far more permeable skin and their still-training immune systems, the percentage is far higher.

Although, as I said, sometimes people can resolve the outbreaks by addressing one modulator or another, or all of them at once if relevant — the primary ones being detergents, environmental (or internal) mold/fungal/yeasts (or, for the internal, let us say, significantly imbalanced microbiome and consequences), or (typically certain protein) foods, or even in some cases the state of the immune system or membranes (skin, lung, and/or gut) health, because it’s all related — I think generally it’s possible to estimate how often the different major modulators dominate.

As you know, a number of studies have shown that pregnant women given beneficial bacteria (probiotics) during pregnancy reduced the rate of eczema in their infants by roughly 20%. [1]   It is my belief that these cases are the ones in which an imbalanced microbiome /fungal modulator would dominate had the eczema developed. Probiotics do more than just compete with fungal organisms, Lactibacillus has also been shown to repair the gut barrier. [2] (Also an important tangent I won’t go into, but this relates to the role of bio-surfactants and how environmental syndets interact.) Not that removing external detergents wouldn’t help those who would have developed eczema absent the probiotics— and there is overlap in the environmental strategies, relating to gut/membrane health as well — but for this segment of infants, about 20-30%, I feel the evidence suggests the fungal modulator dominates.

My observation from experience is that those for whom food is the overwhelmingly dominant factor is about 10% of cases. This is not a hard and fast number, it’s just based on experience, and could change based on conditions. As you know, even the rates of eczema around the world continue to change rapidly.

Other studies tangentially suggest roughly the same proportions: “…two-thirds of patients with atopic dermatitis have no measurable allergen-specific IgE. Are we not just measuring the right IgE? Perhaps, but not likely, considering patients with X-linked agammoglobulinemia (a disease in which patients have almost no IgE) commonly develop atopic dermatitis.” [3] (Note: IVIG, at least at the time of this paper, is normally processed with detergents and patients with X-linked agammaglobulinemia, I believe, need regular infusions. Again, not to go into a long discussion, but write back if you don’t see the applicability here.)

Noted Harvard pediatrician Dr. T. Berry Brazelton, whose writings in his book Touchpoints [4] gave me the spark that led to my own solution, observed in his book that he could prevent most cases of childhood eczema by identifying atopic parents and having them implement general allergy-healthy-home practices and avoid using detergents with their infants. I asked him just as you have asked me, on what research he based his recommendations, but he said it was just based on decades of medical practice and observation.

In his day, of course, there were fewer sources of syndets in home environments, and they tended to be less powerful. Given the instructions he gave, he would have been addressing the two most significant modulators. Given that this eliminated most cases of eczema — and considering the environmental differences between then and now — I feel his experience further corroborates my observation that the cases in which a food (usually a protein food from a short list) is the primary modulator and removing it completely resolves full-body eczema as well as fluctuations from various triggers, represents the smallest percentage of cases from these main modulators. (Let me repeat that none of these factors occurs in isolation, the food modulation relates to the state of the gut barrier, which can also relate to detergent ingestion and unhealthy balance of microflora.)

Although my perspective and problem-solving heuristic are novel, there are researchers who have been publishing along similar lines and whose work supports these contentions. The most notable is probably respected dermatologist Dr. Michael Cork in the UK, who has for many years had success when his patients remove all surfactants entirely. He does not make the distinction between soaps and detergents as I do — he writes about not using “soap” because of presumed consequences to the skin, but then goes on to underscore it by saying many “soaps” have detergents in them anyway. [5] I wasn’t aware of his work while we were problem-solving, but I think he has been publishing along the lines of surfactants playing a role in the eczema epidemic for years prior.

So our views are very similar. The main difference and a significant limitation of the no-surfactant approach is that it’s not really very acceptable to most people to refrain from getting clean — Dr. Cork’s assistant said this to me, the trouble is getting people to do it — and in my experience as well as my understanding of the problem, it’s not really necessary to refrain from washing. In fact, many of my site users (including doctors using the site) have commented on how healthy their skin remains even when they engage in frequent hand washing.

The main difference stems from perspectives on how skin is affected by washing. From empirical observation, I have come to see dryness and other impacts from washing as resulting from the residues of highly hydrophilic compounds ON the skin, because of the molecular properties of those residues and how ubiquitous those exposures are in modern environments, rather than the stripping of lipids from the skin by washing, which is the traditional view.

In fact, avoiding the use of traditional soaps with molecular properties that do not cause the kind of increased permeability that most modern syndets do, actually makes it more difficult to get results in typical modern environments. Where most people with uncomplicated histories can see results in as little as a few days to a week with my site strategies, and those with more complicated histories on the order of a few weeks to a few months, these no-surfactant-at-all approaches seem to take on the order of 6 months to 2 years, and the outcomes seem less satisfactory.

In relation to the abnormal influence of modern syndets, in my observation, everyone experiences a change in circumstances because of this environmental influence — degraded skin quality, often dryness that most people believe is inherent, otherwise increased susceptibility to allergic symptoms or amplified symptoms where an allergy already exists, exacerbated asthma — even though not everyone experiences eczema. Anyone under the age of 5 and over the age of 50 especially benefits from minimizing this influence just in skin quality. I believe virtually anyone has the capacity to express eczema under the right conditions, though. Certainly, worldwide eczema and atopy rates continue to rise, seemingly without bound. And in Sweden, which has some of the highest rates, researchers have noted the environmental factor seems related to something in the indoor environment. [6]

In any given situation, removing detergents, or changing another threshold factor (mainly environmental mold or certain protein foods, including via gut barrier health), or both, might bring a given person’s circumstances below the threshold of any potential for triggering the reaction.  If a person’s outbreaks could have resulted because of more than one factor, but that person removed only one of them and stopped reacting because of bringing a threshold up, that person would blame the eczema on that one thing, when they might as easily have achieved the same result, at least in the short-term, by removing the other factor.

I have had the experience with the site that some people will work very hard in their daily lives to remove triggers that cause outbreaks with each exposure — a pet, for example — only to find that when they follow the site strategies and go detergent-free, they can bring the pet back without the same breakouts or other allergic symptoms. (This is simpler with a dog; many cat litters have significant amounts of detergent in them or are otherwise highly hydrophilic compounds, but with the right awareness and choices, that influence too can be avoided.)

 

To be Continued in Part 4:

“To the question of estimating what percentage of the eczema/atopy problem relates to detergents … implies a broad understanding of the problem across the population …”

 

[1] Pelucchi, Claudio, Liliane Chatenoud, Federica Turati, Carlotta Galeone, Lorenzo Moja, Jean-François Bach, and Carlo La Vecchia. “Probiotics Supplementation During Pregnancy or Infancy for the Prevention of Atopic Dermatitis.” Epidemiology 23.3 (2012): 402-14.

[2] Rao, R. K., and G. Samak. “Protection and Restitution of Gut Barrier by Probiotics: Nutritional and Clinical Implications.” Current nutrition and food science 9.2 (2013): 99–107. Print.

[3] Anderson, P. Chris, and James G. Dinulos. “Atopic Dermatitis and Alternative Management Strategies.” Current Opinion in Pediatrics 21.1 (2009): 131-38. Web.

[4]  Brazelton, T. Berry, and Joshua D. Sparrow. Touchpoints: Birth to 3. Cambridge, MA: Da Capo, 2006. Print.

[5] still ISO this paper, I have the print somewhere… It’s an older paper than I am finding easily on Pubmed

[6] Aberg, N., B. Hesselmar, B. Aberg, and B. Eriksson. “Increase of Asthma, Allergic Rhinitis and Eczema in Swedish Schoolchildren between 1979 and 1991.” Clinical Experimental Allergy 25.9 (1995): 815-19. Print.

 

 

This work by A.J. Lumsdaine is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License

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Letter to a Medical Student — What % of Cases Are From Detergent? — Part 1

I appreciate hearing from someone in medical school.  When I first wrote the website, I was doing citizen science before there was a term for it, so I had no framework to do anything but share through our own journey, in order to help as many people as possible until I could write something more traditionally scientific.  I thought the site would appeal mostly to natural practitioners but be ignored by allopathic practitioners until I could do a study and publish in more traditional outlets.

I found almost the opposite.  Don’t get me wrong, I’ve heard my share of positive feedback from naturally-oriented practitioners who found the site useful.  But I’ve actually gotten the most ready acceptance from allopathic practitioners who read the site.  If they just glance at it or page through it and think they know what it says, they may be dismissive, but if they actually read it, they are invariably positive, even enthusiastic.  I’ve heard from many doctors over the years who not only have used the site for their families, but refer patients to it.  I’ve been thanked by many parents who had my site information because a doctor gave it to them.  I’ve heard from doctors who just appreciate being able to wash their hands frequently and still have healthy skin.  My own doctor once told me that she had just commented to a colleague that, “She really has solved eczema!”

I think the reason my site has been surprisingly well-received by allopathic practitioners is that my perspective pulls together so many loose threads from available research, and views the whole through a new lens that is consistent with what is already known.  I’m putting empirical problem-solving into the context of the available research, with which it is absolutely consistent.  Too often people make good empirical observations and then overlay a vague and unscientific framework to explain it (which may or may not be accurate or generalizable, often not).  It’s not surprising then that allopathic physicians don’t accept the empirical observations, no matter how sound.

And, there is a difference between understanding something scientifically and getting people to implement a problem-solving heuristic in order to address an environmental problem affecting their health — my site is mainly a problem-solving heuristic, although I do have to explain enough that people understand why because my perspective is so different.  People still need their doctors in implementing such a heuristic for safety’s sake, for anything medical really, but the site is not a medical treatment per se, so doctors who understand what it’s trying to achieve typically appreciate having that resource available.

The one specialty exception has been dermatologists!  Which is understandable, because what I am saying does in some ways fundamentally conflict with what they learn about the skin.  For example, one of the key stumbling blocks is the accepted traditional idea that skin becomes dry from washing because of lipids stripped from the skin.  I take a different view, that skin becomes dry because of water loss resulting mainly from the molecular properties of residues ON the skin, residues left from washing or absorbed from contact with dust or surfaces.  (See previous blog posts for more — scroll down to links for “Posts on understanding and solving dry skin”.)

My view is really radically different, but if you think about it, the idea that skin is dry because of stripped oils or lipids from washing is more an educated assumption not incontrovertibly proven by thorough scientific study, the way it was assumed in the early days of AIDS that the virus was dormant rather than locked in a fierce battle with the immune system which the immune system eventually loses, as was eventually found.  My view that the water loss results mainly from the interaction of (primarily syndet) residues of certain molecular properties with the skin isn’t yet proven, either, but it’s at least consistent with very basic biological science that every medical student learns.  Most importantly, my view pans out in solving the problems of dry skin from washing and very often, eczema.

So…

You asked how I came up with the statement that detergent-reactive eczema “likely accounts for 25-60% of eczema, depending on the age group and locality, higher if other allergies and an inherited predisposition are factors.”

(I’ll answer that in my next post.)

Best regards,

AJ Lumsdaine

Dogs and Cats Get Eczema Too: Feline and Canine Atopic Dermatitis also on the Rise — How to Make a Healthier Home for Pets

Using SolveEczema.org for dogs and cats with atopic dermatitis:

Scratching Dog

Image courtesy of anankkml / FreeDigitalPhotos.net

Atopic dermatitis is not just a growing problem for people, more and more household pets are suffering as well. Horses can be affected, too. I will deal with this topic a little more in my book, but I felt like I had to write at least something now.  Because dealing with this issue for dogs, cats, and horses is far easier than it is for babies, animals cannot help themselves by telling us how they feel, and these environmental aspects of the problem are addressable and not their fault.

Households that try these environmental strategies may also find that in addition to helping skin, the animals may themselves end up less allergic, and be less allergenic to people.

As I point out on the SolveEczema.org website, these are my own ideas, they are novel;  I am not a health professional and I am certainly not a vet.  The ideas are the result of “citizen science”, consistent with the body of available mainstream research but have not themselves yet been the subject of such research.  The information is supposed to augment the relationship between health professional and patient, not supplant it.  I always strongly suggest people keep their health professionals in the loop, and that’s not just a liability disclaimer, it’s because it’s important.  Your doctor or vet or naturopath knows you, your child, your pet, and if anything else is at issue or something goes wrong, they know what to do to keep you safe.  Having a trusting, working relationship with a good health care provider is like gold.

As I also point out on my website, it’s necessary to read through the information before making any changes, and especially before making assumptions.  People often incorrectly think they know what the site is about, and either take the wrong or inadequate measures, or dismiss it out of hand.

For example, many people believe that because there is a genetic component to the susceptibility, that the problem cannot be primarily environmental in origin.  There are actually fundamental reasons under the circumstances that the problem CAN’T be primarily genetic even when there is a strong genetic component, which I will discuss in the book.  People — and pets — with the atopy, those WITH the genetic susceptibility, are the most likely to be HELPED by these environmental measures.

The fundamental problem for cats and dogs is this:

*The dust in people’s homes, which cats and dogs are more directly affected by even than people, is full of substances that significantly impact the permeability of their skin.  The increased permeability leads to excessive water loss, dry skin, and more allergens crossing the skin barrier.  The disrupted skin is also more susceptible to bacterial and fungal infections, and not just because of the broken skin, but because the substances inactivate important proteins.  These substances also increase healing time of membranes.  Solving this problem involves changing what is in the dust, which is very doable, not having a dust-free home which is impossible.

*The surfaces dogs and cats spend most of theirs days lying on are coated with these same substances, which can be absorbed from contact.

*Many of these substances are in the fertilizer and poison products sprayed around peoples grass and homes outside as well, which dogs and cats also spend a lot of time in contact with.

*Most commercial cat litters are full of these substances.  When a cat grooms herself, she not only ingests them, she also dissolves these substances into the dander, making the dander even more allergenic than otherwise.  When a cat walks around the house, these substances are tracked around the house and added to the dust of the home.

*Most products used to wash dogs, even “natural” ones, contain these substances, and residues left in their coats (and there are ALWAYS residues) cause the same problems described above.

boy and dog

Image courtesy of Ashley Cox / FreeDigitalPhotos.net

Trying the strategies from the website does not have to be a lot of work.  Please be aware that the site is geared to people with infants who have the most permeable skin and greatest susceptibilities, and who need to see the fastest, most dramatic results.  To help animals, you don’t have to sweat the small stuff, just be aware of what measures will have the greatest benefit and impact.

A few things to remember:

*Please only make changes AFTER reading and understanding the website.  Begin with the slideshow overview to understand.  It is 45 minutes long, only 6 slides.  My apologies to everyone, I originally made it for a crowdfunding for the book, I am not a media person, and the video puts even ME to sleep (sorry!).  It is still the most up-to-date summary and worth beginning with:  http://vimeo.com/33522513

*Helping a cat or dog with AD is not as difficult as helping an infant human — the whole house has to get on board, but you won’t have to sweat the small stuff (like makeup or deodorant) — however, the same principles apply.

*Keep your vet in the loop. Treat as recommended by your vet, especially for bacterial or fungal problems that may have developed, as well as flea control.  Where treatment product choices are possible, choose only products that don’t contain detergents as defined on the SolveEczema.org website.  DON’T MAKE ASSUMPTIONS ABOUT WHAT THAT MEANS! (People are almost always wrong when they assume.)

*Treating fungal problems is more of an art, and can sometimes require long-term application.  Treatment fungal problems initially can cause Jarisch-Herxheimer responses, known as “die-off” reactions, which seem to make things worse.  This disruption in the membrane can actually make things worse and stymie results, plus it’s just uncomfortable for the pet patient, so effective antifungal treatment may involve both using a steroid temporarily with the antifungal, followed by longer-term antifungal therapy.  To minimize die-off for a known fungal problem, sometimes it’s necessary to back off the treatment and begin very, very slowly, with very small amounts ramped up to full strength, and to treat for a very long time.  Switch treatments if one no longer seems to work.

*Getting a good well-filtered vacuum is an essential step.

vacuuming

Image courtesy of artur84 / FreeDigitalPhotos.net

*If you have carpeting, especially old carpeting, consider removing it and replacing it with some kind of non-allergic surface like hardwood flooring or Marmoleum/natural lineoleum, perhaps with area rugs as necessary (washed only with non-detergent products).  A friend clued me in to a way to find Marmoleum cheaper:  Talk to the local supplier and ask if you can add square footage to the next really large order they get (provided you like the material).  We know someone who got really high quality Marmoleum for the price of cheap vinyl that way.  Natural linoleum is not as easy to install and it’s better to have an experienced pro do this.

*Can you wash out the cover of your pet’s bed or bedding?  Follow the SolveEczema.org website strategies for superwashing.  If you have hard water, it may take more washing than suggested.  Use one or two washes with just 2 cups of white vinegar in the wash.

*Remember that the dust in your home is mostly made up of your skin cells, hair, and lint, and that your pet spends most of their day in it.  Marketing is powerful —  even if there are better ones out there, people can be very strongly and irrationally attached to their personal care products (especially since there can be worse ones out there).  You’re just changing what you use in order to help your pet, and it does not have to be a compromise, you can find things you like as much or better, but you may find some you like less in the process.  Don’t give up!

*For most good products, the biggest influence on whether new products work well and produce lovely results, in my experience, is not the products themselves but the hardness of the water.  It will be more difficult to find acceptable products for people with hard water.

*If you don’t have time to superwash the laundry, you can take a lower-key approach that may take longer and produce results more slowly over time, but is far less work.  First, switch to a very benign detergent like Planet (the only syndet I feel comfortable recommending) for a few weeks.  Then switch to just using baking soda and/or vinegar in the laundry for a few more weeks.  Then switch to true soap in the laundry, but wash each load twice.  Once with soap, and then once with just water.  Be sure to follow all the directions about washing out the dryer of previous detergent residues, and be sure to clean out all the detergenty lint in the laundry room.

*For cats, investigate non-clumping cat litters, like cedar chips.  Unfortunately, the clumping litters are the ones with significant amounts of detergents or clays that are very hydrophilic and could theoretically cause the same problems.

*Take a look at the ingredients of the products you use in your yard and patio — detergents are very commonly used in all kinds of products like fertilizers and poisons because they reduce surface tension and spread products more evenly.  example link

dog in bowl

Image courtesy of imagerymajestic / FreeDigitalPhotos.net

*In the case of benefiting just the animals, you also don’t have to switch your dishwashing products, but I recommend doing so anyway as a healthy step for the benefit of everyone’s mucous membranes.  Our digestive systems make up a goodly portion of our bodies’ immune systems.  If you don’t take this step, do at least buy non-detergent soaps to wash the water bowls and toys of pets with AD.

*You can’t necessarily use bathing to control exposures of animals as you can children, but you probably won’t need to.  But still, use baths judiciously relative to exposures, as “eczema removal time”, such as when the dog (or cat, IF appropriate) is scratching from spending time in the yard.

*With pet fur, it’s also probably impractical to moisturize.  People who use the site strategies usually find over time that they no longer need to anyway.  Absent these abnormal environmental influences, a pet’s skin should not need moisturizing.  As with humans, the creamy absorbing moisturizers can backfire and cause more water loss later (see SolveEczema.org blog posts about dry skin).

*Most vet sites recommend to control other environmental allergens like mold and dust mites.  I will write more about this contributor to dermatitis for people, too, soon.

*Remember that even people who do not get eczema themselves usually benefit from these steps in the health of their skin and other membranes.  it may not be apparent at the beginning, but a few months into this, pay attention to your own skin — you may find it’s better than you ever remember.  If not, you should find better products, because they exist!

*Although all members of a household usually benefits from the SolveEczema.org strategies, it’s normal for pets to have eczema but not the humans, or vice versa, or for both to have it.  (The reason for that should be evident from reading the site and blog.)

*I know how difficult it can be to change products.  Marketing is very powerful, even when people are aware of it.  I remember what that’s like, but now feel much happier with most of the best products I’ve found.  That said, dogs and cats are likely to see some results even if there is a “holdout” in the household.  If you try the site strategies for your pets with eczema, please let me know how it goes.

I have listed some pet products on my Amazon astore, which is there for people’s convenience, but there are other products out there, and the site discusses how to evaluate them.  When people purchase through those links, I receive a small percentage without increasing the buyer’s price (usually on the order of $15/month, not significant, but I need to say so in case it makes a difference to people one way or another).  The link is:  http://astore.amazon.com/solvsblogastore-20

Use a search engine to learn about “canine atopic dermatitis” — although I don’t necessarily agree with various sites about what to do about it, it’s clear that it’s a growing problem.

If you are helped by these strategies, please consider returning to the website donations page and making a donation — most people don’t (and that’s okay, that’s obviously not why I do this!), but they do help.  People are often willing to pay far more for treatments that don’t work, so if this has been worthwhile to you, please consider a donation, it does help.  Thanks!
A.J. Lumsdaine

http://solveeczema.org/donate.html

 

 

Some Badger Sunscreens Recalled for Contamination

badger sunscreen lotion

Some Badger Kid and Baby sunscreens recalled

Since I recommend this sunscreen as one of the best for SolveEczema.org users, I just wanted to post this voluntary recall information:

“Some Badger sunscreens are being recalled after potentially-dangerous bacteria and fungus were found during testing….”

http://www.cbsnews.com/8301-204_162-57604845/badger-kids-sunscreens-recalled-for-bacteria-fungus/

 And for Canadian users (thanks to Julie for the link!):
Here’s the link directly to the Badger site with the UPC and lot #s:
Please check your sunscreen right away!  I have used this sunscreen for years — love it! — and think they are doing the responsible thing by letting consumers know.
For notices like this in the future, sign up for email notifications of posts, or follow me on Twitter @ solveeczema
(Okay, I still have no idea how Twitter really works, or if saying @solveeczema or #solveeczema even gives the right information to people who want to do so!  I will post the recall link from the Badger site there, but since I just started there and have no followers on Twitter yet, I’m not exactly sure for what purpose…  Kind of pathetic, huh?  Refer to my “I am not a Luddite” missive below…  )

 

 

 

 

Off Topic (sort of): Is the Placebo Effect Real?

In order to help people with my site and blog, I try to stay away from saying anything controversial — aside from my belief that eczema is eminently solvable and understandable, and that there is nothing really wrong with these kids absent these relatively new environmental influences.  I only wish what I have to say in this post weren’t controversial — I don’t know why it is, but it is.  Forgive the lack of photos, I’ll try to remedy that soon.  This post is excerpted from a letter I wrote many years ago, and it highlights the philosophy that led to the way I went about problem solving eczema for my son.  I have posted this opinion anonymously online since, but I may as well come out and say it.  There are critical (unnecessary) barriers to solving intractible health problems, and real people suffer while we all wait for those in ivory towers to break them down.  In the era of distributed knowledge and the Internet, that must change.

When people use the site to problem solve their own children’s eczema, the breakthrough is usually when they can see the eczema outbreaks are not random.  In my experience, when people accept they can solve the problem, they are more than halfway there.  When they see they are in control, they’re there — they may not yet have all the influences or rashes eliminated, but they know they can do it.  I believe the perspective discussed below could help solve other currently-deemed intractable diseases.  I hope the following is helpful to others:

—AJ Lumsdaine, SolveEczema.org

More than ten years ago, Danish researchers Hrobjartsson and Gøtzsche published the watershed study, “Is the placebo powerless?  An analysis of clinical trials comparing placebo with no treatment,” in the New England Journal of Medicine.  The two researchers looked through the history of placebo-controlled clinical trials and found over 100 studies that included three patient groups rather than two:  1) a group given treatment, 2) a group given a placebo intended to mimic treatment, and 3) a group given nothing at all.  The authors decided to compare the groups given nothing to the placebo groups, and found that there is no significant clinical effect associated with placebos.  In other words, the placebo effect – interpreted as improvement resulting from patients’ belief in a treatment – is more myth than reality.

As you might imagine, the study generated quite a firestorm in the medical community.  I remember reading a letter by the head of Harvard Med School, in which he scratched his head at the earth shattering results, but also said he wouldn’t want anyone to give him a placebo.

And after such earth-shattering results, then what happened?

Hrobjartsson and Gøtzsche followed up with another study in 2004:  “Is the placebo powerless?  Update of a systematic review with 52 new randomized trials comparing placebo with no treatment.”  Again they “found no evidence of a generally large effect of placebo interventions.  A possible small effect on patient-reported continuous outcomes, especially pain, could not be clearly distinguished from bias.”

Although these researchers were arguably the first to make a dent in ironclad beliefs about placebos, especially in the media, they are not the first to analyze and refute the concept.

In 1997, researchers Kienle and Kiene wrote, “In 1955, Henry K. Beecher published the classic work entitled “The Powerful Placebo.”  Since that time, 40 years ago, the placebo effect has been considered a scientific fact.  Beecher … claimed that in 15 trials with different diseases, 35% of 1082 patients were satisfactorily relieved by a placebo alone.  This publication is still the most frequently cited placebo reference.  Recently Beecher’s article was reanalyzed with surprising results:  In contrast to his claim, no evidence was found of any placebo effect in any of the studies cited by him.  There were many other factors that could account for the reported improvements in patients in these trials, but most likely there was no placebo effect whatsoever.  False impressions of placebo effects can be produced in various ways. … These factors are still prevalent in modern placebo literature.  The placebo topic seems to invite sloppy methodological thinking.  Therefore awareness of Beecher’s mistakes and misinterpretation is essential for an appropriate interpretation of current placebo literature.”

No one is claiming that placebo-controlled trials are unnecessary.  On the contrary, these studies further emphasize the importance of placebos in clinical trials to eliminate the junk drawer of biases and other effects that needs to be separated from the clinical effect of the drug or treatment under scrutiny.  But the studies also point out how sloppy definitions of the placebo effect have perpetuated false beliefs.

The popular lay understanding of the placebo effect — the myth — is of powerful physical changes that result from an expectation or hope, a belief that good will happen if one is taking a medication (or that bad will happen if one is expecting bad side effects).

On the other side of the spectrum, is the definition of placebo effects as what is attributable to everything else that is not a medication effect – including the natural course of the illness, other effects caused by a placebo, even reporting biases among researchers and patients.  When the definitions are confused, the placebo effect is falsely supported as resulting from belief in treatment.

For a classic example of confusing changes from belief in treatment with other effects caused by a placebo, look no further than a watershed arthroscopic surgery trial from a few years ago, meant to test whether placebo-controlled surgeries are necessary and oft-cited as demonstrating that placebos are powerful.  Unfortunately, the many who wrote about this study as proving the power of placebos, meant placebos-as-causing-physical-effects-from-expectation.  But that’s not how the researchers of the study were using the term.  (This is one reason, especially in this day and age, full medical articles really must be made available to everyone online, not just abstracts.)

Patients were divided into three groups — patients to receive one of two popular arthroscopic surgeries, and a patient group to receive a sham surgery in which they were operated on and closed up without any actual surgical intervention.

Patients in all three groups improved, and this was taken as proof the placebo effect is powerful, and equated to mean the belief in treatment produces powerful effects.

But in fact, if people read the full article, they could see the placebo in this study wasn’t just the surgery.  Patients in all three groups – those given one of two different kinds of common knee surgeries and those in the placebo surgery group – all patients followed a comprehensive regimen of rest, walking aids, gradual exercise, and analgesics, in addition to their surgeries.  So, the placebo in this study was not just a sham surgery, the placebo was a sham surgery AND a comprehensive regimen of rest, walking aids, gradual exercise, and analgesics.  Unfortunately, there was neither a group that got the same regimen of rest and rehabilitation but did not get surgery at all, nor was there a control group that got nothing, to determine whether the observed improvements were from an independent effect of the placebo (i.e., improvements from just the rest and rehabilitation) or the natural course of the disease.

The study authors merely examined whether two common knee surgeries produced better outcomes than a placebo surgery (they did not), the study design in no way supported the existence of real clinical changes stemming from patients’ belief in treatment.  In fact, the study authors made oblique reference to the Hrobjartsson results and suggested themselves that the effects they observed could be the result of the natural course of the disease or related to an independent influence (but not the result of a belief in the treatment).

Despite such serious research supporting the need for a revolution in how we think about the placebo effect, nothing has really changed in over a decade.

Too few studies bother to delve into how the natural course of a disease plays into the picture.   If we know now from definitive research that improvements aren’t from belief in the treatment, but the result of something else, shouldn’t we be acting on this?

I’m sorry to burst one of the happiest bubbles in popular medical mythology, but there is just no good evidence that belief in a treatment alone produces a significant clinical change down the road, only wishful interpretations that it does.

Now, I’m not suggesting there is no mind-body connection, far from it.  I’m only saying that just because we see some obvious mind-body connections, does not mean that the conscious brain has unfettered control of all physiological processes.  Just because you can jump over a box, does not mean you can leap tall buildings in a single bound.

I’m also not saying, believe it or not, that there will never be a role for harnessing hope in medical treatment.  I’m just skeptical that sham treatments are the right vehicle.  If a passenger tries to catch a moving train, for example, a sudden surge of hope might make all the difference in whether she catches it and reaches her destination.  The surge in hope won’t allow her to keep outrunning a train forever, though.  In other words, a short-term belief could affect the long-term outcome in a significant way – but only if the train is real, not a mirage (or a sugar pill).

There is a much more serious issue at stake here than whether we can harness the power (however minor it has proven to be) of belief in treatment.  The popular concept of the placebo effect—as resulting from belief—undermined the crucial role of empiricism in medical practice, which has in turn seriously degraded the scientific authority of clinicians (even within the medical profession, very rigorous and scientific observations by good clinicians of individual patients are typically deemed “anecdotal” by definition).  This has in turn led to an over-reliance on statistical studies in medicine to problem solve for individuals (leading naturally to “one-size-fits-all treatments”), rather than to PROVE solutions found through empirical means.

In the decades since the concept of the placebo effect was first embraced, how many millions of times have doctors come across clinically significant improvements in their patients, even cures, but dismissed what they saw as the probable result of their patients’ beliefs in treatment, the irreproducible products of their patients’ minds?  How many times have clues to cures been left uninvestigated because of how beliefs about placebos lead to handwaving about the “vagaries of the human body”? 

We know now, we have solid proof now, that significant clinical changes are not the result of beliefs but of something else.  Something else — like the rigorous plan of rest and rehabilitation in the arthroscopic surgery study — that could, through empirical problem solving, be discerned and tested and turned into a solution or many solutions.

Every day, the belief that clinically significant improvements in individuals may merely be the result of the placebo effect costs our world opportunities to solve or cure tough diseases.

Catching up … if my computer will cooperate …

Well, when I drop off the face of the earth for awhile, at least relative to my blog, I feel like I should catch up before posting more.  But I’m not someone who writes well about the usual slogs of life, so — my apologies!  I am still wrapping up from the crowdfunding and cleaning up after a particularly long season of computer troubles.   (I didn’t win the Changemakers healthcare competition, by the way — I didn’t expect to — but take a look at the winners who did, and some who didn’t, it’s both eye opening and inspiring.  Links on my last post.)

I heard somewhere that Steve Jobs had an employee whose job was just to take care of all the time-consuming technical hassles so that all Jobs had to do was use his computers for their intended purposes when he wanted.   (I need that guy!!!!!!!)  Barring that, I sure wish the computer industry was paying attention to what the rest of us slog through that keeps us from using our computers the way WE intend to use them…

Anyone at Apple have eczema?  I’m happy to barter some expertise…