P.S. My son is currently a patient at the Univ. of Iowa Hospitals (Center for Digestive Diseases). Do you feel they have an adequate "handle" on IBD? Are you taking new patients?
U of I is well respected. An important question in getting
a handle on the case is to be sure they know your son is on a number of
non-prescribed medications. There is a misconception that many share
that natural remedies are not medications. Consider this: A
drug is a substance which is taken to affect a patient's metabolism in
some desireable way. These natural products really are being used
as medications by many. The trouble doctors have in dealing with
them is that there is in general no safety or efficacy data available to
base any recommendation upon. The drug companies that sell these
materials have lobbied congress and have gotten laws passed that have prohibited
regulation of themselves. They also have a fig leaf of a regulation
that says as long as they just say the magic words "nutritional supplement"
they can market to the public without any regulatory oversight.
There is another misconception that natural substances are safe. There are tragedies in the medical literature of liver failure causing death in several children due to daily administration of certain herbal teas. The teas were known to be hepatotoxic, but the labelling did not include this (didn't have to, it was a nutritional supplement). There are a number of natural substances that are known to be toxic in sufficient doses. Nicotine, caffeine, digitalis, aspirin, strychnine, castor oil, ipecac, poppy juice, to name a few. (The last example is particularly instructive. Poppies are a source of opiates which caused well documented toxicity to Dorothy, Toto, and the Cowardly Lion. The Tin Man and Scarecrow were spared, due to a difference in metabolism.) There are cases of death due to contaminated tryptophan. Just because something comes in pill form does not mean it is as safe as people have come to expect from pills from regulated drug companies.
You may be aware that the risk of drug interactions goes up with the number of drugs taken. With your son being on four different additional medications than prescribed there is the potential of drug interactions.
So, what are the drugs you are giving your child doing? I don't know. Indeed, I know that no one can know. The products described are all complex. Aside from the vitamins, their manufacture is not regulated. Fish oils can be a source of dioxins. I wonder if any of the nonprescription drugs your son is on have been through any regular monitoring of known or likely contaminants. The medical literature also contains articles showing that the unregulated drugs are sometimes misidentified by the manufacturer.
I try to limit my advice to matters for which there is some sort of experience with the substance at hand which can predict how a patient will do. The need for the evidence to be predictive is what patients really want. It is expected that a doctor could explain what the expected effect would be, what the side effects would be, and the chance of either happening. For the majority of unregulated drugs, the evidence for the medicines marketed as nutritional supplements is anecdotal, which does not help one make predictions as to how a patient will respond.
All that said, what can I say about your particular questions? Well, I do not have data on efficacy or side effects of Salmon oil in Crohn's. Thus, prediction of relative effects is not possible. (I even do not know if Purepa is whole fish extract or part fish extract. As a licensed drug, processing must adhere to Italian good manufacturing practices and will therefore be consistent lot to lot.) I also do not know what interactions would develop, if any, with the other medications he is on. As to Purepa, note that the patients in the study were selected with criteria that predicted a high chance of relapse. The single study thus applies to patients with the same clinical features. It is probably generalizable to patients outside Italy, though the fact that Italians eat more olive oil is one reason that studies in other countries would be good. Whether the drug would be beneficial to patients with a lower risk of relapse is not known.
The simple answer, therefore, is "I do not know." The reason for writing all of the above is to explain the underlying concerns that I as a physician have that causes me to say "I do not know". As a fellow prescriber of medications I urge you to consider the risks and benefits of your recommendations. Also, I hope that you are keeping records of clinical response and medications (including dose and regimen and lot/batch number). These records would be valuable for determining likely candidate medications relating to clinical response, good or bad.
I hope for the best in your son's case.
Stephen Holland, M.D.
Section of Clinical Pharmacology
University of Illinois College of Medicine at Peoria
Copyright 1999, Stephen Holland, M.D.