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Edward Siguel, MD PhD |
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PO Box 1269, Brookline MA 02446 Letters to the Editor (Opinions by Siguel) October 18, 1997 COVER LETTER
Dear Editor: Please consider the attached letter for publication. Journals who widely distribute and advertise their articles in news media for consumption for the general public have an ethical and scientific obligation to present their results with a perspective that can be understood by the lay person. The article you published on a new treatment for Crohn's disease received widespread coverage in news media. Even Time magazine had a short reference to this new and allegedly effective treatment for Crohn's disease. Patients with Crohn's are desperately seeking a new treatment, and likely believe that this new research offers an effective therapy. Unfortunately, neither the article nor accompanying editorials discussed likely consequences of the proposed treatment, such as decreased life expectancy and increased incidence of tumors and infections. I know of at least one patient who was successfully treated with anti-inflammatory drugs-- until he developed an abscess whose presence was masked by the drugs and almost died. Another patient on high dose anti-inflammatory drugs died of intestinal cancer. There are many ways to improve a patient's symptoms and make him feel better without relieving the underlying cause of the disease. Aspirin, marijuana, cocaine, heroin, and many other drugs improve the sense of well being. These treatments often cause short-term relief but long term harm. There are several effective existing treatments for Crohn's disease that ought to have been mentioned in the article. Through my research, lectures, and communications regarding my website and book on Crohn's disease, I have spoken with thousands of patients with Crohn's disease who have been treated at leading medical centers. None of the patients I spoke to were informed that elemental diets are a highly effective treatment for Crohn's disease. Drug companies are unlikely to fund studies that prove their drugs are potentially hazardous or less effective than alternative therapies. Thus, journals, researchers and physicians have a duty to be far more candid and explain the potential long-term hazards of drug treatment and available alternatives. We must be careful not to encourage patients to start a treatment that could cause long-term harm before we exhaust other effective alternatives. OPINIONS
Targan et al(1) describe how an intravenous infusion of cA2 dramatically improves the symptoms of Crohn's disease. However, many drugs, such as steroids or aspirin, can also produce dramatic improvements in the symptoms of Crohn's disease. Patients with Crohn's are often very sick, desperately seeking a miracle cure that will improve their well being. Doctors feel pressured to find quick cures, and rely on published studies to do so. Unfortunately, neither doctors nor journals usually take the time to explain alternative therapies or the potential long-term dangers of drug therapy. [Only a few months ago, journals, doctors and patients were touting the benefits of weight loss drugs-- now these drugs have been shown to lead to heart disease and malpractice lawsuits.] Research suggests that Crohn's disease is caused by an infectious agent. Therefore, the immune disorders involved in Crohn's may be a part of the body's defenses against the disease. Reducing inflammation may improve or relieve the disease's symptoms, but could allow the disease to spread. Reducing inflammation also would reduce the body's defenses against cancer (more common in Crohn's disease) and infectious diseases (abscesses are common in Crohn's), and thereby reduce life expectancy. Fortunately, there are other effective but underutilized therapies for Crohn's. Elemental diets are highly effective in treating Crohn's disease (2,3). Patients with Crohn's disease have substantial abnormalities of polyunsaturated fatty acid (PUFA) metabolism (most likely caused by malabsorption and diets low in PUFAs)(4). PUFAs are critical for normal bowel function; abnormalities can cause abnormal immune and inflammatory responses (PUFAs are precursors to eicosanoids, and their balance in body tissues determines eicosanoid production). PUFA supplements, such as w3 fatty acids, can improve Crohn's and the immune system while reducing inflammation. There are no known side effects to therapeutic trials of elemental diets with supplements used to correct PUFA abnormalities. Before starting treatment with powerful anti-inflammatory agents, it is necessary to do more research potential long-term side effects, and further evaluate and exhaust less harmful alternatives. Sincerely yours,
1. Targan, SR, Hanauer, SB, Sander JH et al. "A Short-Term Study of Chimeric monoclonal Antibody cA2 to Tumor Necrosis Factor for Crohn's Disease." NEJM, 1997:337(15):1029-1035. 2. Morain CO, Segal AW, Levy AJ. Treatment with elemental diets is the primary treatment of acute Crohn's disease. Brit Med J. 1984;288:1859-62. 3. Teahon et al 10 years experience with an elemental diet in the management of Crohn's disease. Gut, 1990; 31:1133-1137. 4. Siguel E, Lerman, RH. Fatty Acid Patterns in Patients With chronic intestinal disease. Metabolism. 1996; 45(1):12-23. |
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© 1998 Edward N. Siguel. All rights reserved |
modified 9/16/98 |