Posted by: Ticktock | May 25, 2009

Interview With a Skeptic: Mark Mentser

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I met Mark Mentser at the Skepticamp in Columbus, Ohio. He gave an excellent presentation on the pitfalls and dangers of alternative medicine, a subject on which he is fully qualified to speak since he is a pediatric physician at Nationwide Children’s Hospital in Columbus. Mark is the director of the Department of Nephrology.

Dr. Mentser took the time over his Memorial Day holiday to sit down and answer the onslaught of questions that I’ve been saving up for a professional to address.  Here is the Q&A in all it’s unedited glory. My thanks to the good doctor for his wisdom and expertise…

What made you first get involved with skepticism?

As a traditional physician, I always considered myself skeptical of implausible medical claims, but over time I found myself relying too much on my past experiences of over thirty years as a kidney specialist. I am training several pediatricians to also be kidney specialists and they are unwilling to accept my experiences as proof that a treatment works. I started reading more medical literature than ever. I also found a few skeptical blogs and I realized that I was not as critical of medical literature as I thought. I would say that I am now a more critical reader of medical reports; I guess skeptical would also describe this approach.

Have you experienced any patients who mistrust modern medicine or prefer CAM? How did you handle them?

I really haven’t had many patients who really mistrust modern medicine. I think more patients, parents in my case, are asking more good questions to their children’s doctors and expect answers. Very few of my patients report to me that they are using complementary and alternative medicine (CAM), but I have had a few. I make clear that I do not know any plausible reason that the treatment they are tying has any scientific basis for being effective, and I thank them for telling me.

Your area of expertise is Pediatric Nephrology (kidney area). What are the most common illnesses that you treat?

Urinary tract infections, congenital ( born with) kidney disorders, high blood pressure, kidney stones (very common in children in Ohio) and blood in the urine are the most common conditions that I treat. I also take care of children who require dialysis and get a kidney transplant.

What symptoms should alarm parents that something may be wrong with their child’s kidneys?

Symptoms of the common conditions I mentioned are generally similar to adults, and I always remind parents not to get alarmed. The pediatrician is most helped by the parent’s giving their best description of the symptoms since children often have trouble explaining what they feel. Kidneys rarely shut down suddenly. I would also encourage parents to make sure their children have a blood pressure taken at all check-ups since hypertension does occur in children and usually has no symptoms.

You also deal with urinary tract infections. Is it true that bubble baths cause urinary tract infections?

I get asked a lot if bubble baths cause urinary tract infections. I always answer this way. Bacteria cause infections and enter the urinary tract from outside, in through the urethra into the bladder. Bubble baths present two problems, possible bacteria in the soap and irritation to the area around the urethra, both may contribute to increased chances of infection. I recommend that children with more than one UTI avoid bubble baths for awhile to see if they stop having infections. I don’t tell parents not to allow children to take bubble baths as a way to prevent their child from having their first UTI.

Why did my pediatrician warn me not to feed my daughter acidic juice during her U.T.I. when I’ve previously heard that pure cranberry juice is a natural remedy?

There are two parts to the cranberry story. Cranberries contain chemicals called proanthocyanidins (PACS) which prevent E. coli bacteria from adhering to the cells lining the urinary tract. There have been several studies showing that E.Coli cannot stick to the bladder as well when this chemical is present. So there is evidence that taking cranberry juice could have a preventative effect on UTIs, but is not sufficient to treat an infection. This has also been shown for blueberry juice, but no other juices contain this chemical. Claims are made that if an infection is already present; drinking acidic fluids (not only cranberry juice) will make the urine acid and keep the bacteria growing. The pH (acidity) of the urine changes all the time. The prescribed antibiotic will eradicate the infection and frequent bladder emptying helps get ride of the bacteria. So I would recommend the antibiotic, whatever fluids the child will take and remind him/her to urinate often.

Cough and cold medicines for children have been getting a bad rap lately. Do you recommend avoiding those treatments?

One of my teachers (or maybe it was my mother) taught me that if you treat a cold it will last a week, if you don’t it will last 7 days. There is no medicine to treat the cold virus. Antibiotics don’t kill cold viruses. Cold treatments are to alleviate the symptoms, cough, congestion, runny nose and fever. Parents bring their children to the doctor and want something to make their child feel better. When I was a pediatrician-in-training, I prescribed cough medicine and decongestants to children, even infants, knowing that the cold will go away, but treatment made me and the parents feel better. There were no studies of these medicines showing they really helped, but could they hurt? The answer is yes and the FDA recommends the following:

“FDA has completed its review of information about the safety of over-the-counter (OTC) cough and cold medicines in infants and children under 2 years of age.  FDA is recommending that these drugs not be used to treat infants and children under 2 years of age because serious and potentially life-threatening side effects can occur. FDA has not completed its review of information about the safety of OTC cough and cold medicines in children 2 through 11 years of age.  We are aware of reports of serious side effects from cough and cold medicines in children 2 years of age and older.” http://www.fda.gov/Cder/drug/advisory/cough_cold_2008.htm

What is your general advice for treating a child’s cold?

The best treatment is to rest, drink fluids and take something for fever if necessary.

I never know when to take my daughters in to see the doctor when they’re sick. Is there a good rule of thumb for when I should drag her in to be examined by the pediatrician?

This is an easy question. Whenever a parent thinks something is wrong with their child, contact the pediatrician. Usually pediatricians provide parents with “office guidelines” for the common childhood illnesses, simple remedies and when to call. But, if a parent is worried, that’s a reason to call. Pediatricians usually have questions they ask to get a better idea how sick a child is and will error on being too careful, particularly with infants and young children.

I never know what to do when my child is vomiting. My Dad used to have me gargle with salt water – is that a good idea? Should I force her to drink more liquids? Should I give her a spoonful of pepto bismol?

Vomiting is a symptom of an illness. Children will often vomit from nausea with non-intestinal illnesses as part of their not feeling well. They may also have “stomach flu” or something more serious with their GI tract. Giving various “home remedies” may increase nausea, and more vomiting, so I don’t recommend salt water. Continued fluid intake is important to prevent dehydration, but you can’t force children to drink. I recommend various clear liquids, Pedialyte for infants or Gatorade for older children. Avoid adult Peto-Bismol as the main ingredient, bismuth subsalicylate, an aspirin-like compound has been associated with a life-threatening condition in children. If nothing stays down or the child appears dehydrated, see the doctor.

What would you say to someone that told you that they wanted to treat their child’s pink eye with Applied Kinesiology and Chiropractic?

I would explain that pink eye is a mild infection in the eye, easily treated with an antibiotic directly to the site of the infection. Any other treatment has no plausible reason it would work, will delay recovery from the problem and might have other unexpected side-effects.

Too often, we attack CAM without acknowledging problems with western medicine. What reforms would you like to see in your profession, and what do you think doctors can do to bring back people who are turning to CAM?

This is a huge problem, and we physicians have brought some of this on ourselves. The CAM proponents focus a lot on the impersonal, short, uncaring traditional physicians, who appear too busy to listen and simply want to go on to the next patient. CAM doctors are “holistic”, they treat the “whole patient” with “natural” treatments. Unfortunately the perception is often the reality, but not always the truth. This perception should not over shadow the lack of science-based treatments offered by Acupuncture, Chiropractic or Homeopathy. I have belief in the “traditional” physician and so should patients.

What do you think of parents who reference Google searches when they are consulting with their child’s pediatrician?

I often ask parents if they have “googled” the condition for which I see their child. I am always supportive of parents wanting to get as much information as possible, but warn them that their search may not be specific to their child’s condition. I remind them to ask me about any concerning information they have found, particularly if I have not discussed it already with them. Parents should know all they can about treatment for their children, but miss-information will make parents worry needlessly

Many thanks to Dr. Mentser for letting me pick apart his brain. Hopefully, he will be a friend to this blog and pop in from time to time to give us a more professional perspective. I welcome the information and advice from scholars, doctors, and scientists, so please share your expertise, readers.

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Responses

  1. Nice interview and sound advice provided. I recently looked at the use of cough and cold products in pediatric patients as well.

    http://sciencebasedpharmacy.wordpress.com/2009/05/19/cough-and-cold-products-for-children/

  2. Thanks for the information. I referenced the question about cranberry juice when someone mentioned treating a UTI with that and not antibiotics.

  3. Very informative. Thanks for sharing this. This is helpful for parents like me.

  4. hi
    first time visitor.
    i’m from india where the CAM atrocity is rampant. informative post. thank u. will visit often.

  5. My son is a Patient of Dr. Mentser’s…he is as nice in person as he comes across on this interview. Our first visit he spent well over an hour talking with us…when a call to us has been required he makes the call himself…never makes me feel rushed and wants to make sure I have all my questions answered.


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