Experts in traditional Chinese medicine are warning patients to avoid unlicensed acupuncture practitioners after an apparent case of spontaneous human combustion.
Baton Rouge, LA-When investigators climbed from out of the smoldering debris that was the home of Hank Thomas, the looks on their faces told the gathering crowd what these hardened veterans of the Baton Rouge Fire Department couldn’t put into words. Thomas, a yoga instructor and avid fisherman who had lived in Baton Rouge his entire life, had exploded. And as the grisly details slowly emerge, people are asking questions about what might be to blame and how they can prevent being the next Baton Rougian to erupt into a massive fireball of body parts and Tony Chachere’s Creole Seasoning.
Some local medical professionals have proposed a controversial theory. Based on reports that Thomas has undergone acupuncture treatments for sciatica several times in the weeks preceding his untimely fulmination, a group of local experts are speaking out. They are warning the community to beware of discount acupuncture clinics.
“We aren’t saying that every incidence of spontaneous human combustion is linked to the incorrect placement of acupuncture needles,” Kuang Zhu LAC, Chief of Pragmatic Acupuncture in the Health and Wellness division of Vic’s Day Spa and Pet Grooming Center, explained during a recent press conference. “But in some cases, there is a relationship that is hard to explain otherwise.”
“For every complex problem there is an answer that is clear, simple, and wrong.”
-H. L. Mencken
This approach is not endorsed by the American Academy of Pediatrics.
As I sit in an apartment full of unpacked boxes and grumpy children, only a few days removed from driving 1,600 miles to a 3rd floor walk-up and a better life just outside of Boston, I find the task of writing a post somewhat daunting. But I must admit that this new town is not without the potential for inspiring future musings. In fact, I find myself surrounded by irregular medicine of all shapes, sizes and dilutions.
Next door is a chiropractor who cures Tourette’s syndrome and, according to the pamphlet available outside the clinic entrance, only uses the in-house x-ray machine on select patients who truly need it. A few buildings down from me is an acupuncturist that treats athletic injuries with ear acupuncture and Kinesio-tape while liberally sprinkling references to his practice of “sports medicine” and “orthopedics” throughout the clinic’s promotional material. But at least I was reassured that acupuncture is completely harmless because it is a natural medicine. Finally, a block further down the road, completing my welcome committee of woo is a clinic that uses homeopathy to treat just about every real and fictional condition under the sun. I checked out their website and it’s a good thing that the walls are well insulated or my neighbors would have surely been forced to ignore the sound of my forehead pounding a wooden desk like a flagellant monk hoping for divine intervention.
Carl Sagan supposedly once said that randomness is clumpy. Those three words have become one of my favorite go-to quotes, particularly when teaching residents and medical students who are often overly impressed with improbable runs of similar diagnoses or exam findings. I love this quote because it is so simple and yet reveals so much about our experience with observing the natural world. Sagan’s ability to offer up insightful nuggets of rational thought, even if he didn’t actually produce this gem, was unmatched and his efforts to bring science and reason to the public have been sorely missed. If you haven’t read any of Sagan’s works, I highly recommend The Demon-Haunted World: Science as a Candle in the Dark.
If you have a coin, and a few hours to kill, record the results of a long run of flips and you’ll see what Sagan meant about the nature of randomness. You will inevitably observe clusters of heads or tails that might seem improbable, but eventually the outcomes will average out to about half of the flips being heads and half resulting in tails. The more trials that you perform, the closer the outcomes will approach 50% for each possible result, assuming you aren’t gaming the system by using a trick coin.
I don’t think that very many people would argue with the fact that on average a coin flip is random chance, although there are still people out there who think that the Earth is flat and that Justin Bieber is a reptilian humanoid. But because of a deeply rooted cognitive bias, the gambler’s fallacy, we frequently fail at recognizing that randomness is clumpy. We accept the established overall odds, but our acceptance wavers in the face of short runs that go against our expectations. This error in logic can lead to the belief, for instance, that after five heads in a row there is a higher than 50% chance that the next flip with land on tails as if to magically even things out.
In my line of work as a pediatric hospitalist, I frequently experience other healthcare professionals making this mistake in a variety of circumstances. There is a known likelihood of bacteremia when an infant less than 28 days of life is evaluated for fever, for example. Despite this, it is common for physicians and nurses to lament, upon seeing fever as the triage chief complaint, that they are due for this life threatening infection after a number of recent febrile neonates have had negative blood cultures. (more…)
It’s now officially summertime, but people have been hitting the pools and beaches for weeks in many parts of the nation. In fact it has been well into the 90’s for over two month here in Baton Rouge, which is what I blame for the early exit of LSU from the College World Series. Our boys just weren’t used to that cold and dry northern weather.
Not surprisingly, the media has already been busy reporting on some of the many tragic drowning incidents that have occurred thus far, and Facebook profiles have been full of commentary from worried parents. And, as usual, there are businesses offering infant and toddler swimming lessons costing hundreds and even thousands of dollars per course, some of which come with claims of decreasing the risk of drowning in the young participants.
At what age can a child begin swimming lessons? According to Jan Emler of Emler Swim School, teaching a child to swim can start “As soon as the umbilical cord falls off.” Emler, like more reputable proponents of infant and toddler swimming programs, doesn’t actually put newborns into swimming pools for lessons (I’ll leave water birthing enthusiasts out of this discussion). For the most part these programs only cover bath time activities to help younger babies grow comfortable being in the water. Truly teaching infants and toddlers behaviors aimed at reducing the likelihood of drowning in the event of falling into a body of water doesn’t usually start until 6 months of age. There are exceptions.
But when should these lessons start, are they safe and do they work? Or do they actually put children at risk of injury and the parent at risk of having a false sense of security? Until their updated 2010 policy statement on the prevention of drowning, the American Academy of Pediatrics came down firmly against initiating swimming lessons in children less than 4 years of age for a number of very good reasons. Why did they soften their stance and does their change of opinion support the claims that are being made by infant and toddler swimming programs? First some background information.
The following article is entirely made up. It’s satire. I am making fun of treatment modalities which are claimed by proponents to cure everything, from real medical ailments to fictional entities like “adrenal fatigue”. I am also poking fun at the state of medical reporting these days. If the concepts discussed seem similar to actual alternative medical practice, it is because a great deal of what goes on out there in the real world really isn’t distinguishable from purposefully outlandish fictional treatments made up by someone with a doctoral degree in Feng Shui from Thunderwood College. (more…)
A concept that has been well-recognized in pediatric medicine, at least since it was first described in 1964, is that of vulnerable child syndrome (VCS). Classically VCS occurs when a currently healthy child is felt to be at increased risk for behavioral, developmental, or medical problems by a primary caregiver, usually a parent, and typically follows a serious illness. It can lead to some pretty serious behavioral complications in the parent, and subsequently the child, and severely impact entire families.
In the past, I have mistakenly thought of this entity more as “sick child syndrome” but that is problematic. It implies that it only occurs in the aftermath of true illness or injury. As I will explain in detail, there is much more to the development of VCS and it is the concern of VCS in children without true medical problems that led me to amend my understanding and make the connection with alternative medicine.
Is VCS Really a Problem?
Every parent (well, most parents – I’ve seen some things), worries about the well-being of their children. The desire to protect our personal genetic repositories is hardwired. And as with many behaviors, there is a point where parental worry becomes pathologic and interferes with normal functioning. In the case of VCS, the relationship between the parent and child can be severely impacted and the consequences can be disastrous.
As a pediatrician caring for hospitalized children, I deal with fear on a daily basis. My day is saturated with it. I encounter fear in a variety of presentations, with parental fear the most obvious but probably least impactful on my management decisions. I do spend a lot of time and mental energy calming the fears of others but more managing my own, both struggling to prevent it from biasing my thought process and harnessing it as a productive motivational force. I devote a significant amount of effort towards teaching residents and students the practice of inpatient pediatric medicine and fear can be a valuable teaching tool when used appropriately.
So I admit that I take advantage of fear to a certain extent in my practice. Most pediatricians do. Maybe we all do. Proper informed consent, for instance, must include potential poor health outcomes related to medical intervention or the refusal of them. I accept that fear is an impetus for seeking medical care. Parents should be afraid of poor health outcomes from vaccine-preventable illnesses, for example. They should be made aware of the repercussions of poor adherence to home asthma management or of not placing their child in a proper car seat every time they put them in a car. Fear can serve the greater good.
But there is a difference between these unavoidable aspects of science-based medical care and the abuse of fear by practitioners of irregular medicine.
Fever is a mighty engine which Nature brings into the world for conquest of her enemies.”
— Thomas Sydenham
The occasional abnormal elevation in body temperature associated with infection is as much a part of the human condition as abstract thought or the desire to lose weight without exercise or cutting calories. Commonly known as fever, this powerful yet misunderstood physiologic response has been documented in a variety of animal species including fish, reptiles and of course humans. We have all had fever at least once in our lives, and probably several times. And many of us have undoubtedly spent a few anxious nights cradling febrile little ones, afraid more of the repercussions of the fever itself than the potential sequelae of the underlying cause.
Along those lines, fever is one of the most common reasons for parents to seek medical care for their children, with roughly a third of pediatric acute care visits related to it, as well as a frequent impetus for late night nursing calls to sleepy hospitalists. Actually only about half of after-hours calls are about fever but who’s counting. Unfortunately most medical professionals, including many pediatricians, have a poor understanding of the pathophysiology of fever, and their panicked approach to its management in many children involves unnecessary laboratory tests, imaging studies, and doses of broad spectrum antibiotics. It also adds to parental anxiety and helps to establish a vicious cycle as patients of over worried caregivers tend to undergo more aggressive evaluation and treatment.
I can think of few conditions with clinical features more ideal for establishing a pattern of abuse at the hands of practitioners of so-called alternative medicine than Tourette syndrome. Tourette syndrome (TS), which first manifests itself in early childhood in the overwhelming majority of patients, is a neurological disorder with infamous motor and vocal manifestations and a troubled past. Historically the condition was blamed on everything from emotional disturbances to outright faking to demon possession. But over the past few decades it has increasingly been recognized as a primarily organic disorder caused by negative genetic and environmental influences on areas in the brain which control movement and behavior.
I have a particular interest in Tourette syndrome, not just because I am a pediatrician but because I was diagnosed with the disorder at the age of seven. I have been lucky in that my symptoms, after a few rocky years in middle school and early high school, have been fairly mild. It is obvious to most people that I have a movement disorder, but it has never impacted my ability to function in society and succeed in my chosen profession of pediatric medicine. In fact, I often think of my Tourette’s as a positive aspect of my life, believing that it helped shape who I am as a person. I feel that it has helped instill in me positive personality attributes that are beneficial in the practice of medicine, such as empathy and compassion.
Patients that would have been institutionalized a hundred years ago, or worse as you go farther back in time, are now treated based on scientific advances in neuroscience and pharmacology, typically very successfully — that is if they manage to avoid involvement with quacks and charlatans. A 2009 survey of TS patients, or parents of patients with TS, revealed that nearly two thirds partake in alternative therapies with no proven benefit.