[Editor’s note: We have two posts today, this post by our regular contributor Dr. Clay Jones, and an excellent guest post by William London about a chiropractor’s dubious neuropathy treatment protocol. Enjoy today or over the weekend!]
As a pediatrician, even one who has spent the majority of his career caring only for hospitalized children, the death of a patient has been a rare occurrence. There are certainly some pediatric specialties, such as intensive care and oncology, that because of the nature of their patient population must develop a more intimate relationship with the end of life. But compared to the adult world, even their exposure pales in comparison. The most common form of pediatric cancer, acute lymphoblastic leukemia, has a cure rate that is over 90% for example – making the unnecessary death of Makayla Sault after some worthless “treatment” at the Hippocrates Health Institute all the more tragic.
A bit more common in pediatrics are the patients that require significant intervention, and who may come close to death, but recover thanks to advances in modern medicine. These patients, however, are dwarfed by the number of children who receive routine hospital care and recover fairly uneventfully. And most children emerge into adulthood having never had more than a few self-limited viral illnesses and maybe a cavity or two. This wasn’t always the case. In 1900, 10% of 1-year-old children would not make it to adulthood. (more…)
Belvidere, NE- Bref Albright was taking an unfamiliar route home from work because of a stalled 18-wheeler when he passed by the cell phone tower. As the electromagnetic field washed over him, symptoms of his sensitivity quickly set in. He first noticed a tingling sensation throughout his body and an odd dryness in his mouth and throat. Then nausea and headache. Once the palpitations and difficulty concentrating on the road began, he knew he had to pull over in order to avoid an accident.
An elderly woman, shown here about to be strangled by a conventional doctor and/or pharmaceutical industry representative, is wearing an EmergenQi pendant
“Getting off the road was the right thing to do,” Albright explained. “I couldn’t risk injuring somebody else if I lost control of my truck, but it left me vulnerable. I was a sitting duck!” As expected, Albright’s condition worsened because of continued exposure to the deadly yet fundamental force of nature. Despite blurry vision and difficulty remembering his wife’s cell phone number, he managed to place a call. No answer. His wife, home brewing kombucha, had left her phone in another room.
Albright, a 53-year-old taxidermist for the Belvidere Parks Commission, then pressed the red button that activated his alternative medical emergency alert system. Within seconds, a satellite had pinpointed the location of Albright’s pendant and a team of emergency alternative medicine experts was soon on its way. While on route, a member of the team was even able to contact Albright’s wife Norleen and ask a few questions about Bref’s alternative medical history.
Last week an article published by the New York Times entitled “Scrutiny for Laxatives as a Childhood Remedy” made the rounds. The article raised the question of a possible link between the use of a popular over-the-counter laxative, PEG (polyethylene glycol) 3350, and neurological or psychiatric problems in children. This wasn’t the first time this particular journalist wrote a piece on this topic, however. In 2012, she wrote about the popularity of the treatment among pediatricians despite a lack of FDA approval for use by children, a fact which applies to many if not most of the drugs commonly prescribed by pediatricians. (more…)
Like acupuncture, Weebles wobble, but they don’t fall down.
The practice of medicine, particularly our pharmaceutical and surgical interventions, involves a constant struggle between risk and benefit. If the physiology or anatomy of the human body is altered, even with the best of intentions, there is always a potential downside. There are certainly instances where the risk to benefit ratio is extremely favorable or unfavorable and the right recommendation is obvious, and unfortunately there are times when it isn’t entirely obvious what the next step should be. But there has been a trend of steady progress in regards to improved safety and efficacy over the past several decades.
The treatment of pain has of late been one of those areas where the picture is becoming a bit less cloudy. We are learning more and more about the potential negative outcomes related to the long term use of opioid medications, such as physical dependence, addiction and even chronic pain. The way that these drugs have been prescribed in many patients has caused more harm than expected, and in some instances more hurt than help. Doctors generally strive to alleviate pain and suffering but, once again, good intentions don’t decrease risk.
In the neonatal and young infant population, the management of pain has had a rocky history. I’ve written about pediatric pain in the past, in particular the potential difficulties in managing acute pain. I won’t go into detail (read my prior post), but we have truly come a long way since the days of performing major surgery on newborns without any analgesia at all. There are areas where we need to do better, however. Children are still less likely than adults to be adequately treated for pain.
But things have improved. And as more children receive appropriate management for pain, the side effects of that management must increasingly be dealt with by healthcare professionals, the patients and their families. One of the issues that is typically observed and managed in neonatal and pediatric intensive care units is physical dependence and the subsequent occurrence of withdrawal symptoms.
In the fascinating, if not rational, world of so-called complementary and alternative medicine, the age of the patient rarely seems to matter. This stands in stark contrast to the practice of science-based medicine. Sure, there is some physiological overlap across the spectrum of age, but caring for children often requires a vastly-different approach and there are numerous conditions not seen or only seen in kids.
Alternative medicine is more about the underlying belief system rather than the actual physiology, however. Chiropractic is chiropractic whether the subluxation belongs to a neonate or a nonagenarian. In traditional Chinese medicine, the flow of chi is obstructed in youngsters and old fogeys alike. No matter the length of our telomeres in fact, every major form of alternative medicine appears to contain a subset of practitioners that claim unique expertise in maximizing health and wellbeing at any age. But for kids, they simply do the same thing they would do for an older patient.
Newborns appear to be an increasingly-popular target of irregular medical practitioners. Even the unborn baby still in their mother’s womb isn’t safe. A generous interpretation would be that these true believers simply wish to aid in establishing health early in a child’s life, while the cynic in me worries that establishing a lifetime of billing opportunities might be the primary motivating factor. (more…)
There are many mental pitfalls and logical stumbling blocks faced by healthcare professionals when attempting to untangle the complex web of patient history and physical exam findings. They can impede our ability to practice high quality medicine at every step in the process, interfering with our ability to establish an accurate diagnosis and to provide comfort or cure. And we are all susceptible, even the most intelligent and experienced among us. In fact, having more intelligence and experience may even enlarge our bias blind spots.
Steven Novella discussed the complexities of clinical decision making in early 2013, specifically tackling some of the more common ways that physicians can come to a faulty conclusion in the third installment of the series. One cognitive bias yet to be specifically addressed on the pages of Science-Based Medicine, and it is one that I encounter regularly in practice, is outcome bias. Simply put, outcome bias in medicine occurs when the assessment of the quality of a clinical decision, such as the ordering of a particular test or treatment, is affected by knowledge of the outcome of that decision. We are prone to assigning more positive significance to a decision when the outcome is positive, and we often react more harshly when the outcome is negative. This bias is particularly obvious when the result of a decision largely comes down to chance.
I see outcome bias rear its ugly head in two contexts for the most part: the Lucky Catch and the Bad Call.
This is not for kids?
Last month I wrote a post on the causes of poor sleep in adolescents, as well as the myriad problems that can result in this high-risk population. Fortunately there is a system-wide public health measure proven to work, and now groups like the American Academy of Pediatrics are fully endorsing it. In that post, I briefly mentioned the increasing popularity of energy drinks and shots as caffeine delivery devices, and their role as both a potential cause of sleep deprivation and a means of temporarily ameliorating the effects.
I have been planning on addressing in greater detail the intentional, and unfortunately often accidental, ingestion of energy drinks in the pediatric population and the various associated risks for quite a while. What finally motivated me to get to work on this topic was the recent spate of media coverage regarding the results of a study presented this week at the American Heart Association’s Scientific Sessions 2014. The research, which involved the analysis of data obtained from the National Poison Data System for October 2010 through September 2013, supports concerns that pediatricians and other pediatric healthcare professionals have had for a very long time. Energy drinks are dangerous, particularly in young children, and a large part of the blame falls on the shoulders of manufacturers as well as the 1994 Dietary Supplement Health and Education Act (DSHEA) so frequently discussed on SBM.
Before I break down the scary numbers from the study, first a little background on energy drinks. (more…)
Unsafe playtime activity?
During my first clinical rotation in medical school, I found myself at the pediatric nurse station one afternoon waiting for a patient to arrive from the emergency department. An adorable older infant was there sitting in a bouncy chair, smiling and drooling as babies tend to do, and looking rather well for an inpatient. The nurse watching her explained that she had come a long way since first being transported to the facility by ambulance after being admittedly shaken (and almost certainly also beaten) by her mother’s new boyfriend one evening when she wouldn’t stop crying.
Now, cortically blind and facing a lifetime of disability, the child was awaiting placement by social services. I had experienced my first exposure to child abuse, a scourge of pediatric medicine that I hadn’t thought of at that point despite having decided on a career in pediatrics well before being accepted into medical school. I’ve since had many more opportunities to care for abused children, some of which involved considerably more visually disturbing findings and a couple that resulted in a child’s death. But I will never forget her and the feeling of utter revulsion I felt that day.
Child abuse is common and it comes in many forms that can involve physical abuse as well as neglect. Children under the age of 4 years are the most frequently affected, but children under a year tend to suffer the most severe manifestations. Head injuries make up the bulk of physical abuse in this age group, and they are often fatal. Roughly 40% of child abuse-related deaths occur in the first year of life and there is frequently both a history of abuse prior to the fatal event as well as missed opportunities for medical professionals to have intervened.
The head injuries that children suffer at the hands of abusive caregivers, if not fatal, are frequently still devastating. It is not uncommon for these children to suffer permanent neurologic injury which can include persistently altered mental status, cognitive impairment, cerebral palsy, blindness and recurring seizures. In addition to the child’s injuries, the psychosocial impact on the family can also be quite severe. I’ve seen families torn apart because of guilt and anger. (more…)
In August of this year, a new policy statement from the American Academy of Pediatrics was published which tackled the widespread problem of insufficient sleep in our adolescent population. They even went so far as to label insufficient sleep as “one of the most common, important, and potentially remediable health risks in children.” The statement, which gave a number of recommendations on how to address the problem, made the news rounds primarily because of the call for schools to delay start times until at least 8:30 AM.
I wrote about pediatric sleep in March for a post on the potential link between some sleep disorders in children, specifically nightmares and night terrors, and the development of psychosis. Those claims are suspect but please read that post for a review of what sleep is, why we need it, and what can go wrong with it in children of all ages. For this post, my focus will be on adolescent sleep specifically, and on the role of delaying school start times in improving a variety of health parameters.
What are the common adolescent sleep challenges?
The typical modern teenager faces a variety of challenges to consistently obtaining a full night’s sleep, which is considered by most sleep experts to be in the 8.5 to 9.5 hours per night range. This doesn’t mean that every teenager will fall apart if they only get 7 hours of sleep each night, but sub-optimal sleep can adversely affect school performance in many, and even lead to long-term health problems in some children who establish such a pattern during these pivotal years. Hold that thought for now, however.
One obvious reason for insufficient sleep in teenagers, at least it is likely obvious if you have one of your own or have ever spent more than two minutes near one, is technology. Most older children have electronic media in their rooms, if not attached to their bodies in the form of a smart phone. 24-7 access to the internet and social media is a commonly-cited impediment to sleep onset. The increasing availability and popularity of energy drinks containing absurd amounts of caffeine among adolescents likely also plays a role as both a coping strategy for daytime fatigue resulting from insufficient sleep, and as a cause of it. In fact, I think I’ve just come up with the topic for my next post.