[cobluegirl]

********
"Equating fluid behind the drum with infection requiring treatment ignores
what all pediatricians know, that URI's with swelling of the tonsils and
adenoids produce congestion of the middle ear and temporary hearing loss as
a result. Decades of warfare against the nasopharyngeal bacteria have
culminated in a Vietnam-like strategy of killing everything in the vicinity."
********

Again leaving aside my rather crude prescribing in this case, I want to
point out a few of the methodological issues it poses, issues so obvious
and fundamental as to be easily overlooked. First, equating fluid behind
the eardrum with an ear infection requiring antibiotic treatment ignores
what every pediatrician knows, that most colds or URI's with swelling of
the tonsils or adenoids produce secondary congestion of the middle ear and
temporary hearing loss as a result. The girl in this case was prone mainly
to tonsillitis, and could be said to have ear infections only to the extent
that pneumatic otoscopes can detect even minute amounts of fluid, and that
years of deadly warfare against the nasopharyngeal bacteria have culminated
in a Vietnam-like strategy of killing every living thing in the vicinity.

Second, her longest period of ear involvement followed a DPT shot, a
connection that I have often verified in practice, but is rarely sus-pected
by pediatricians, because vaccines are regarded as sacrosanct and almost
risk-free, except for negligibly rare acute reactions developing within the
first hours or days. [note 7]

Third, like most of my chronic otitis patients, this child seldom ran
fevers during the time she received conventional treatment, and began to do
so only as her general condition improved. Useful both for reassuring the
family and for making a simple prognosis, this humble fact carries a
profound implication for the natural history of the disease and its recent
evolution.

Case 4. L. P., a girl of ten months, had already had four acute ear
infections and received antibiotics for each one. The first began at two
months, when her mother weaned her to go back to work, and the child
developed a rash and unusually cranky behavior on a milk-based formula.
These symptoms were also intensified for the week following her first DPT
shot. A few weeks after that, the ear infection developed suddenly, with
high fever and violent earache, like all the others. With the help of
Calcarea Carb. 1M initially and Chamomilla 30X as needed acutely, she did
quite well, with fewer colds and no acute episodes, but mild symptoms
persisted and were aggravated by teething, when the remedies had to be
repeated. She relapsed the following spring, six months later, with three
acute ear infections and three rounds of antibiotics in the three months
since her father had insisted on her long-overdue MMR shot.

At this point I gave Lycopodium 10M, Sulphur 10M a month later, and almost
a third remedy after that, but I heard that the parents had separated and
were vying angrily over the child. From then on, she did very well on
infrequent doses of Sulphur, despite a violent gastroenteritis following a
DT-polio booster, and a tendency to relapse when she stayed with her
father, who let her eat her fill of dairy products and took her to the
doctor for her regular quota of vaccines and antibiotics. I have continued
to see this child at long intervals for more than nine years, and although
she has long since outgrown her ear infections, her underlying health
issues have not changed very much. Since the acute, vigor-ous responses of
her infancy, her basically strong constitution and maturing immune system
have enabled her to bounce back more quickly when she does fall ill. While
very fond of milk and cheese and somewhat allergic to them as well, she
continues to grow and develop normally in the face of her conflicted
heritage that she can as yet neither understand nor change.

In short, this is a child of strong vitality, representing the opposite
side of the same issues already discussed: 1) an innate ability to respond
acutely and vigorously, and rebound quickly from illness; 2) a tendency to
relapse following vaccination (and milk allergy, often associated with it);
and 3) the classic signs and symptoms of acute otitis media that were the
rule in the pre-vaccine era.

With these representative cases in mind, I will try to summarize my
experience with otitis media in children, giving special emphasis to the
practical issues of diagnosis, treatment, prognosis, and long-term case
management. As with my allopathic colleagues, middle-ear infection is one
of the commonest presenting complaints of children in my practice. In an
average week I will triage several acute episodes over the phone, and see
at least one new and probably two or three established patients with
chronic or recurrent otitis that has been diagnosed and treated on a
long-term basis or repeatedly with antibiotics or tympanostomy or both.


What most of these patients have in common is the absence or paucity of
strong symptoms like high fever or violent earache that would indicate an
acute, vigorous response to their illness. With a few notable exceptions,
like the last case I presented, their symptoms even during acute flareups
are typically vague or nondescript in character, e. g., fussy or cranky
behavior, whining or picking at the ear, congestive hearing loss, poor
appetite, and the like. In quite a few cases, there are no symptoms
whatsoever, and the child behaves and functions normally, but at the
well-baby visit the pediatrician detects fluid in the ear, signs it off as
an "ear infection," and begins or continues the cycle of antibiotics that
often proves so difficult to break.

********
"The most striking and disturbing feature of these cases is precisely their
chronicity, their tendency to develop smoldering or persistent responses to
illness and to relapse more and more easily, resulting in a failure to heal
or resolve them in a clearcut or timely fashion."
*********

Similarly, although the symptoms often recede during treatment, relapse is
common, and even when the child appears clinically well, the presence of
fluid is regularly interpreted as continuing infection and cited as a
mandate for further treatment. In this way, a child who may never have been
that sick never gets entirely well, and continues to relapse until the
doctor recommends antibiotics for months at a time and later surgical
drainage as well, if the condition persists despite these lesser measures,
as indeed it often does. In short, the most striking and dis-turbing
feature of these cases is precisely their chronicity, their tendency to
develop smoldering or persistent responses to illness and to relapse more
and more easily, resulting in a failure to heal or resolve them in a
clearcut or timely fashion.

Breaking this cycle of chronicity proves quite easy if parents and
caregivers can suspend the conventional wisodm that reduces the art of
diagnosis to the specialized detection of abnormalities and the goal of
treatment to the killing of our resident bacteria. As much as finding the
correct remedy, the critical requirement for success in treating these kids
is to re-educate the parents and develop an alternative model that works
and makes sense to everyone.

First, it is necessary to redefine the illness and how best to detect it,
beginning with basic anatomy and the clinical and pathological features of
a URI with ear involvement (congestion, earache, etc.), in contrast with
classic acute otitis media. In my own practice I emphasize the signs and
symptoms that parents themselves are aware of, i. e., how each child feels
and functions in his or her own special world, or what homeopaths like to
call the "totality of symptoms." If they are willing to trust me thus far,
I'll take the next step and propose that we not look in the ear unless the
illness is acute and intense, or hasn't resolved after giving remedies, or
either of us is so panicked that we just have to know. Since any URI can
produce detectable fluid or congestion behind the eardrum, and the
homeopath does not need or even want to treat illness all the way to the
end, the totality of symptoms is what best defines the illness, and the
otoscope is useful primarily to confirm or qualify what the alert observer
already knows.

With significant ear involvement, it is helpful to assure the parents that
antibiotic treatment is no more effective than placebo, [notes 8, 9, 10]
and that it produces more frequent relapses than giving symptomatic
treatment or simply allowing the children to recover on their own. [note
11] At that point it makes sense to offer homeopathic remedies, both as
needed for the acute episodes, and preventively, to minimize their number
and severity.

Finally, it is imperative to take a careful vaccine history, and to look
for familial influences or other factors that may aggravate a pre-existing
chronic state, such as traumatic birth, food allergy, emotional upset, and
the like. Quite often, the first episode can be traced to the time of a
DPT, MMR, or other vaccine, even though no acute or obvious reaction was
noted at the time, [note 12] or an old pattern of chronic or recurrent
otitis is activated by a booster after a long period of remission. [note
13] Such apparent-ly speculative connections have also been verified by the
successful use of homeopathic "nosodes" prepared from the vaccines
themselves in re-solving difficult cases. [note 14] Drawing on these
experiences, I routinely ask parents not to vaccinate their children until
they are cured, and refer them to my various publications on the subject
for further study. While I have also seen chronic otitis in unvaccinated
kids, the crucial importance of vaccines lies in the fact that they are
compulsory for all and regarded as so uniformly safe and beneficial that
the possibility of chronic, long-term problems from them is seldom
investigated or taken seriously. [note 15]

With this educational work in progress, it is appropriate to proceed with
homeopathic remedies. Both the procedure that I follow and the remedies I
use are much the same as would be found in any homeopathic practice
involving children, and I see no need to elaborate on them here. If the
child is not acutely ill at the time of the first visit, I may begin with
one dose of the indicated constitutional remedy, or perhaps three weekly
doses. In addition, it is reassuring to give parents a strategy and a list
of remedies to have on hand for acute flare-ups, and to see the child or at
least coach the parents through these episodes with words of
encourage-ment, changing the remedy as needed. Often these acute remedies
will include the constitutional plus a few others that are complementary to
it.

Once remedies help them through this critical phase of the illness without
antibiotics, the rest of the treatment is likely to proceed very smoothly.
But if the child has never responded so acutely or intensely before, it is
useful to prepare the family for such an eventuality as the underlying
condition improves. By no means cause for discouragement, relapses many
months or even years later are much easier to treat, since precipitating
factors are usually much more obvious after a long period of good health,
and remedies that worked well before will most likely do so again, as the
children often know and will ask for it themselves. Indeed, this uncanny
clarification and ordering of cases over time is a major and predictable
benefit of successful treatment, and the awe and wonder it inspires in
doctor and patient alike are among our highest rewards.

*********
"In the 1960's, otitis media was an acute disease, with high fever and
pain, which subsided dramatically once the eardrum burst and discharged its
contents. It didn't last long, had often taken care of itself before we
could do anything about it, and was unlikely to come back for a long time.
It was just what I have come to recognize as a favorable sign when I see it
today."
**********

What is mysterious and problematic about ear infections in children thus
lies not so much in their treatment, which is not particularly difficult
and involves many of the same remedies as for other chronic ailments, as in
the disturbing fact of that chronicity itself. As a medical student in the
early 1960's, I encountered otitis media promarily as an acute disease,
usually presenting in the Emergency Room with high fever and piercing
screams of pain, both of which subsided dramatically once the eardrum burst
and discharged its infected contents. While certainly not a pleasant
experience for doctor or patient, it didn't last very long, indeed had
often taken care of itself before we had a chance to do anything about it,
and was unlikely to come back for a long time to come. In every way it
close-ly resembles the kind of flare-up which, when I see it in a patient
today, I have learned to recognize as a favorable sign.

***********
"The epidemic of chronic ear disease must be attributed to two colossal
public health blunders: the war on the nasopharyngeal bacteria, fought with
antibiotics, tubes, and the cultivation of fear; and the vaccination of
entire populations against a growing list of diseases with no end in sight,
and no strategy or inclination to consider the long-term consequences."
***********

After 1982, when I moved to Boston, stopped attending births, and limited
my practice to homeopathy, I began to see large numbers of the sort of
chronic otitis patient that I have just described. Why the sporadic acute
infections I knew in medical school had mushroomed into a chronic disease
of colossal proportions was also precisely the question with which I began
this article. Both my clinical experience and the research I have conducted
to try to make sense of it have strongly corroborated my "gut" feeling that
the modern epidemic of chronic ear disease must largely be attributed to
two colossal public health blunders that carry on the same outmoded
militaristic philosophy:

1) the war on the nasopharyngeal bacteria, fought with antibiotics,
tympanostomy tubes, and the systematic cultivation of fear; and

2) the vaccination of entire populations against a growing list of
diseases, with no end in sight, and no inclination or strategy to consider
the possible long-term consequences.

Based on Koch's postulates and their immense predictive power, the war on
bacteria is nevertheless unwinnable even in thought. As the most basic life
form on the planet, bacteria reproduce themselves in about six hours, and
through natural selection rapidly become resistant to even the most lethal
antibiotics. In clinical medicine, some major examples include
hospital-borne epidemics of resistant Staphylococci and E. coli, and the
emergence of infections with L-forms, Mycoplasma, and PPLO organisms, all
lacking cell walls, neat adaptations to penicillin-rich environments. In a
recent Newsweek cover story, the spread of resistant strains made U. S.
hospitals look like centers of germ warfare from which many types of
virulent organisms are disseminated into a general population more or less
helpless to stop them. [note 16]

In the case of childhood ear infections, resistant strains have been
similarly implicated in the weak primary immune responses and high relapse
rates associated with antibiotic treatment. [note 17] Other frequent com-
plications include superinfection with yeast and other common fungi, as
well as the food and environmental allergies that often accompany them.

Furthermore, numerous studies have shown that the supposedly causative
organisms isolated from children with chronic ear infetions are simply the
common pathogens of the tonsils and nasopharynx, such as the
"pneumococcus," or Streptococcus pneumoniae, Group A ß-hemolytic
Streptococcus, Hemophilus influenzae type B, and Staphylococcus aureus, all
of which are regularly found in healthy throats as well. [note 18] In 25%
of children with acute otitis, and in 80% of those with the most prevalent
chronic serous variety, the middle-ear discharges and cultures are sterile
and contain no organisms whatsoever. [notes 19, 20] Once these resident
bacteria are destroyed, the result could have been foreseen by ordinary
common sense: chronic serous otitis, or "glue ear," an important cause of
chronic and even permanent deafness. Thus even more destructive than these
antibacterial weapons themselves is the fanatical strategy of attacking and
killing that makes such imagery seem attractive.

A further application of the same approach has been the develop-ment of the
pneumatic otoscope, its tight seal permitting the detection of even minute
amounts of fluid and thus facilitating both early diagnosis and more minute
surveillance. Yet diagnosing more infection has only unleashed more of the
same firepower, and thus more of the same results already described.
Indeed, with tympanostomy the war against chronic otitis media has reached
its final dead end, since it looks like an obvious mechanical solution to
the problem, yet has itself recently been found to be a major cause of
otosclerosis and permanent hearing loss, the same spectre used to browbeat
reluctant parents into accepting it in the first place. [note 21] Still
more ironic is the fact that it simply makes permanent and structural the
natural perforation and drainage that the acutely infected ear heals so
well by itself and with so few complications.

In any case, it makes little sense to search out and destroy the friendly
bacteria that already live with us and police our bodies so effect-ively
most of the time, or to imagine that making war on them could ever produce
anything but more devastation, more war, and ultimately more resistant and
less friendly bacteria.

Although I have previously written about vaccinations in some detail,
relatively little of my experience with vaccine-related illness is of the
kind that Harris Coulter and Barbara Fisher write about in A Shot in the
Dark, [note 22] or what might be termed the specific effects of a
particular vaccine. While these reactions are apt to be the most severe and
also the most useful in learning how to prescribe the nosodes that
correspond to them, most of the complications I have seen in my practice
have been limited to subtler reactions that I would describe as
non-specific in type. By that I mean that they resemble exacerbations of
the pre-existing chronic state, looking more or less the same in a given
individual, regard-less of which vaccine is given, and are benefited by the
same group of remedies are used to treat chronic illness in the general
population, vaccinated or not. Although such reactions are more difficult
to recognize and verify, they are also much more common, and I suspect much
more important as well.

***********
"Two of four cases suffered relapses of their chronic state after a
vaccine, one suffered identical relapses after two different vaccines, and
all four first developed their complaint during their initial series. In
none were their responses acute enough to be identified as symptoms of the
vaccine. What was repeatable was simply the chronicity of the responses."
**********