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Brain Balance

A member of Quackwatch’s Healthfraud discussion list recently reported from a health fair:

One booth was a bit of a mystery for me: Brain Balance. “Is your child struggling with ADHD, dyslexia, autism, Asperger’s, Tourette’s, or other related disorders?” A quick glance at their website makes it seem that they may be legitimate.

No, a quick glance at their website makes it seem that they are not legitimate, and a more detailed examination confirms that initial impression.

The Claims

It’s easy to see the attraction of the program. They offer hope: the brain can be changed. They can figure out exactly what is wrong and how to fix it. They offer a package of interventions to improve academic performance, social abilities, cognitive function, sensory and motor skills, visual-spatial organizational skills, improved immunity and nutritional health. Miraculous results are reported (“He spoke for the first time!”), and there are impressive testimonials. But there are a number of red flags indicating that this website might not be a reliable source of health information. They use the word “balance,” a vague term often used in pseudoscience and seldom based on clearly defined scientific realities; they use other buzz words like “holistic,” “without drugs,” and “improves immunity”; they are aggressively selling something (a service, through their own clinics) and you can buy a franchise and they will train you; “Dr. Robert Melillo” is not identified as a chiropractor; and the biggest red flag of all is that a headline on the front page says their program is “clinically proven,” yet they provide only testimonials and one published study (which turns out not to support their claims).

Their website’s list of possible environmental factors which can affect brain development and/or gene expression is decidedly unconventional and highly questionable:

  • sedentary behavior of child or mother (prenatal or postnatal)
  • abnormal sensory motor development caused by birth injury or from lack of sufficient stimuli early on
  • poor diet and nutritional deficiencies and sensitivities prenatal or postnatal
  • exposure to toxins pre or postnatal
  • chronic infection / yeast / bacterial / parasite of mother or child
  • psychological stress prenatal or postnatal
  • sleep deprivation of mother prenatal and of child
  • hypoxia (perinatal, postnatal)

This list is fanciful, even bizarre (“sedentary behavior of child”??!). I suppose anything is “possible,” but most of these are not recognized by mainstream science as probable or as worthy of further investigation, and some of them are ruled out by the known facts.

They claim that ADHD, autism, Tourette’s syndrome, pervasive developmental disorder and dyslexia are no longer considered separate entities but are now considered points on a spectrum of neurobehavioral/developmental disorders. This is their own idiosyncratic interpretation and it directly contradicts the understanding of mainstream science.

The Evidence

Do their treatments work?

To give you a better sense of the outstanding results our clients continue to realize, we have included success stories and findings from a formalized research study initiated by the F.R. Carrick Research Institute.

One formalized research study. Only one. One might be persuasive if it were scientifically rigorous and convincing, but this one certainly isn’t.

The complete study is available online. It was published in the International Journal of Adolescent Medicine and Health. This is an obscure peer-reviewed journal published by the Freund Publishing House in Tel Aviv, Israel; I could find no listing for its impact factor. Only one of the study’s authors is an MD; the rest are chiropractors and MScs. All of them are affiliated with two “Carrick Institutes” named for the last author, Frederick Carrick. Carrick is a chiropractor who teaches chiropractic neurology to post-graduate chiropractic students. He has a PhD, but in education, not science.

I had encountered Dr. Carrick before. A few years ago I wrote about a study he did on blind spot mapping. It found that everyone has an enlarged blind spot in one eye (averaging 50% larger than in the other eye!?) and that this constitutes a “map” of brain function showing abnormalities in the corresponding cortical hemisphere, and that normal hemispheric brain function can be restored by chiropractic manipulation of the proper side of the neck. “Normal function” was essentially defined as a shrinking of the previously enlarged blind spot. If this sounds like nonsense, it is. In an article in The Scientific Review of Alternative Medicine (not available online) I wrote a more complete analysis showing that the study demonstrated logical fallacies, faulty syllogisms, careless writing, poor citations, poor methodology, unwarranted conclusions, and a poor understanding of science, and that its results were not credible. Carrick responded with a diatribe in which he accused me of deception, fraud, and lying and called me delusional and “perhaps psychotic” and much else.

The Brain Balance Study

This new study on brain balance is a pilot study, the kind of study whose results are not intended to guide clinical decisions but only to direct future research. They didn’t even bother to use a control group. They took 122 children with diagnosed ADHD and submitted them to what they call “a hemisphere specific remediation program.” The rationale for the study was flimsy. They speculate that ADHD is related to a “functional dysconnectivity,” hemispheric imbalance, subcortical dysfunction, a lack of temporal coherence, and a difference in arousal level between the hemispheres. They provide no evidence that these are characteristic of ADHD or were present in their subjects, or that their treatments specifically changed any of them. They assumed an underactive right hemisphere (it was not clear why) and they provided interventions that they assumed (without any supporting evidence) ought to remedy the alleged imbalance. They tested for the child’s specific deficits and provided tailored interventions: these included sensory stimulation, motor training, aerobic strength and conditioning, primitive reflex inhibition exercises and academic training. None of these interventions seem to me to be directed at a specific hemisphere, despite their unsupported statement that the treatment “was aimed nominally at exercises thought to principally stimulate the less efficiently performing hemisphere.” (Emphasis added.) Synchronized Metronome Treatment was given, where subjects listened to a metronome beat and matched physical movements to it. This was intended to “improve participants’ timing/rhythmicity by reducing the latency between the onset of the metronome beat and the participant’s expectancy response to the beat.” It is not clear how any of the tested interventions constituted “hemisphere specific training.”

The subjects improved significantly on several measures: parental reports, achievement tests, grade level performance, objective improvement in coordination with the interactive metronome. But what do these results mean? Without a control group, it is impossible to know whether the interventions were responsible for the improvement. In the “Hawthorne effect,” simply being enrolled in a study tends to improve performance. People frequently improve their performance when any test is repeated. In this case, all children were also taking stimulant medication throughout the study: how do we know that alone didn’t account for the improvements?

At any rate, the interventions in this study were not comparable to the Brain Balance program: the program includes dietary manipulations and is “drug-free.” The study participants were all on drugs and their diets were not manipulated.

In the discussion section, the authors themselves admit that this was only a pilot study and that a large scale clinical trial will be needed. So how can Brain Balance justify citing this one uncontrolled pilot study as evidence of the “outstanding results” their clients realize? The authors comment that trials will need to examine the differential effects of medication and hemisphere specific treatment. They also comment out of the blue that they will need to examine the effects of nutritional interventions: where did that come from?!

Conclusion

The one study presented as evidence for the Brain Balance program does not constitute evidence. While some aspects of the program’s interventions are already used in more conventional programs and might prove helpful to individual children, there is no indication that the theoretical concepts of “functional dysconnectivity,” “brain balance,” or “hemisphere specific training” are clinically useful. The Brain Balance program is based on speculation, not on credible evidence.

Posted in: Clinical Trials, Neuroscience/Mental Health

Leave a Comment (50) ↓

50 thoughts on “Brain Balance

  1. Citizen Deux says:

    Brain Balance charges more the $6000 for their “integrated” approach. The clinics are largely run by chiropractors and staffed with a mix of lay people and practitioners. Their results are holy debated in review boards with some parents defending their program vigorously and others crying fraud.

    Given the lack of evidence, one would come to the conclusion that their program does not work and in fact may be fraudulent.

  2. ejwillingham says:

    This bunch just opened a center in our town, which prompted me to do a critique of their claims a month ago:

    http://daisymayfattypants.blogspot.com/2010/08/brain-balance-centers-critique.html

    Their “reference” list alone is reason enough to run away screaming.

    They had the “grand opening” in Austin yesterday, and the Man Himself, “Dr.” Robert Melillo, is speaking here today and tomorrow. No doubt, all the wealthy susceptibles in our area will be in attendance.
    http://austin.bizjournals.com/austin/stories/2010/09/13/daily1.html

    The newly hired director has a degree from…ahem…Walden U.

    If I had the time, I’d do a little correlation analysis between where they locate their franchises–yep, franchised “therapy,” folks–and what the median income is in that area. There’s a reason that a Brain Balance Center just opened up almost literally across the street from where Thoughtful House is…it’s called deep local pockets.

  3. Citizen Deux says:

    Great observation! The locations of these “centers” is not accidental.

    It is, in fact, a business model. The advantage is that almost all of their “therapies” are subjective and thus not covered under normal practitioner ethics. This is a problem in many professionally regulated fields, unqualified “practioners” may put up their shingle and do what they will – the regulating agencies typically shrug their shoulders and cite caveat emptor.

    Until enough parents realize that they have been duped and are spending precsious time, money and energy pursuing unproven treatments, these folks will thrive. Sadly, the children affected have no say in this.

  4. chaos4zap says:

    So this is essentially a pyramid scheme? That is certainly the way it sounds to me. I’m sure the franchise bit is far too great sounding for a Chiropractor not to jump on right away in their desperate attempts to legitimize themselves. Words cannot express how much it bothers me that Chiro’s are able to call themselves “Doctor”. It is blatantly and intentionally misleading. The phrase “I’m not a real doctor, but I play one on T.V.” comes to mind.

  5. rwk says:

    @chaos4zap

    Words cannot express how much it bothers me that Chiro’s are able to call themselves “Doctor”. It is blatantly and intentionally misleading.

    Yeah,I hate that too. It bothers me when PhDs,DVMs,DDs.Hon.Ds,
    Ed.Ds ,DPTs, DNs,NDs,LLDs,ODs and DOs call themselves doctors.

    Everyone knows that Doctor means medical doctor,right?

  6. Harriet Hall says:

    The chiropractors’ own professional organizations have published ethical standards that prohibit advertisements where chiropractors call themselves “doctor” without disclosing that they are chiropractors. Yes, they hold a degree as “doctor of chiropractic” and they can say so. But if they just call themselves “doctor” without further explanation, the average reader will assume that they are medical doctors. I’ve heard of many instances where patients who had seen chiropractors were confused and thought they had seen medical doctors.

  7. windriven says:

    @rwk

    “Everyone knows that Doctor means medical doctor,right?”

    No, everyone does not.

    Everyone knows that medical doctors have earned that honorific. But so have men and women who have earned doctorates in a host of other disciplines.

    As to NDs and others of that ilk, their fields are fraudulent and no honorific can mask the intellectual stink that surrounds them.

  8. RenegadeSynapse says:

    Well, DOs are medical doctors and are legally recognized as such in most (all?) states. They have some questionable things in the curriculum (craniosacral therapy, anyone?) but on the whole their training is equivalent to MD granting schools.

    I understand confusion with the term “doctor” in a hospital and clinic setting, but I certainly wouldn’t remove the title from Ph.D., DVMs, DDS/DMD, etc. They’ve earned that title. Unless I am mistaken, classically the Ph.D.s have more right to the term than MDs do (and I will one day be one, an MD that is).

  9. Scott says:

    Let’s also note that context matters. In a social situation, it’s reasonable and appropriate to address a PhD (say) as Doctor, or for them to introduce themselves as such. But if said PhD is in a hospital visiting a patient, they should absolutely not be addressed as Doctor, or call themselves Doctor.

  10. lizditz says:

    chaos4zap asked:

    So this is essentially a pyramid scheme?

    No, I don’t think so. Franchises can be for everything from fast foods (a lot of them are locally-owned franchises) to “learning centers” like Sylvan & Kaplan. It’s just a business model where the franchiser (like McDonald’s) has worked out what is to be sold and how it is to be sold. The franchisee puts up capital and personnel to provide the goods or services in a given market.

  11. Maz says:

    The term that MDs and DOs may use exclusively is Physician.

    I sure as hell am going to have people call me doctor when I get my PhD.

  12. nitramnaed says:

    We have one of these in the Twin Cities. The DC who runs it claims he’s an expert on the brain because he took some courses at the Carrick Institute. He has a radio show where he spouts nonsense about brain function, that’s not science based and makes little sense.

  13. Joe says:

    Maz on 14 Sep 2010 at 4:59 pm wrote “… I sure as hell am going to have people call me doctor when I get my PhD.”

    Good luck!

  14. “Everyone knows that Doctor means medical doctor,right?”

    Hum, Well my sister has a PhD and is well respected and published in her non-medical field. You could attempt to call her Miss, Ms, Mrs or Ma’am, but I’d bring some sort of ultra-violet shielding device to protect yourself from the glare.

    Sadly the doctors have to share the title. Too bad they didn’t come up with something to differentiate themselves a long time ago. It pays to plan ahead with branding, you know.

  15. ejwillingham says:

    Michele…I used to tell my students that they had to call me “Dr. Willingham” or “Professor Willingham” because I’d worked my ass off for the biological sciences PhD and the honorific. I conceded that in a pinch, they could call me “Ms. Willingham” but never ever to refer to me as “Mrs. Willingham,” as I am not married to myself and the last Mrs. Willingham was my long-deceased great-grandmother.

    Yes…MDs have to share on that one!

  16. Dr. Le Petomane says:

    Not only are there many legitimate types of ‘doctor,’ DOs are legitimate physicians. The difference with MDs is largely anachronistic. DOs get essentially the same education and go on to exactly the same residencies and fellowships. There are plenty of dishonest ways to use the term ‘doctor,’ but a DO can use it just the way an MD can.

  17. JMB says:

    When I was a medical student, I was curious why we had to complete a research paper as a senior project. I was told that in order to maintain some semblance to the academic requirements for a doctorate equivalent degree, we would have to complete a paper similar to a PhD thesis. Well, I don’t think too many of those papers had much semblance to a PhD thesis. Otherwise, completion of a medical school curriculum is reasonably the academic equivalent of a PhD (although the PhD definition has varied). Current licensed physicians have at least 1 year of post doctoral education (post graduate year one medical doctors have restrictions on their practice).

    It is true that in a hospital setting, anybody identifying themselves as a doctor may be presumed by the patient or visitor to be a physician. Anybody insisting on calling themselves a doctor in a hospital setting should be prepared to have questions or comments addressed to them by patients or visitors while they are micturating or defecating in a public bathroom.

  18. What about Ph.D.s in fields such as engineering who then go on to do some postdoc research in medical fields like cardiology and then finally go on to do regular media interviews giving their opinions on health topics as “Dr. So and So”?

    I’ve always felt that was an improper use of the title. Other thoughts?

    :?
    Michael J. McFadden

  19. Tim Kreider says:

    If someone calls me Dr. Kreider, I reply with “that’s my mother’s name.”

    Especially in the hospital I don’t allow that (each rotation another med student inevitably brings it up), because it could mislead patients and staff. What’s the point of an honorific, except to stroke my ego, if my scientific credentials are irrelevant in the given context?

    “That’s ‘Dr. Evil.’ I didn’t go to eight years of evil medical school to be called ‘Mr.’, thank you very much.”

  20. And then there’s always “Dr” Laura… urrgh.

  21. Dawn says:

    I honestly think it depends on the person and location. I would address and write letters to Dr Gorski and Dr Hall with their title of Doctor. For my brother, aunt, and uncle, all PhDs, I use Mr/Ms unless either requested otherwise (my aunt prefers to be addressed as Dr Smith at all times, my uncle is OK with Mr except in his academic role). However, especially in their workplace, I would ask to speak to Dr X Smith, using their hard-earned title. (To be honest, my uncle really prefers Professor over Doctor; my brother doesn’t seem to have a preference)

    I think the confusion that might occur in a medical or office setting is significant and that a PhD in that situation should be willing to point out they are not an MD. Unfortunately, I have known a few who insisted on the title of Doctor which has caused a lot of confusion.

    @Tim Kreider: How about Professor? Or don’t your students use that title? Your credentials are not irrelevant if you are teaching medical students!

  22. Dawn on forms of address: “I would address and write letters to Dr Gorski and Dr Hall with their title of Doctor.”

    I do address them from time to time and I use the nyms they have chosen for themseleves, the same way I use everyone else’s nym. The entity who comments as “Dawn” I address and refer to as “Dawn”; the entity who posts and comments as “David Gorski” I address and refer to as “David Gorski.” If David Gorski and Harriet Hall wished to be addressed as “Dr Gorski” and “Dr Hall” on this blog presumably they would indicate that preference by using those nyms.

    When consulting a medical doctor I am fine using titles to underline the professional nature of the exchange, especially if the nature of the consultation involves fingers probing my body cavities. My doctor is “Dre Nally” and I am “Mme Cummins.” If my doctor were to indicate her preference for a more personal relationship by calling me “Alison” then I would call her “Véronique.” If she walked into her office saying, “Hello Alison, I am Dre Nally” then I would have a problem.

    I can’t remember what we called our professors in university. I remember one being criticized by students for using “Dr” on the nameplate on her door. Not sure why. Maybe because the men didn’t?

    Back in the ooold days when only boys went to school, teachers and students were not on a first-name basis with one another. The teacher was “Mr” or “Dr” and the student was “Cummins” (or whatever) with or without an honorific.

    In hospitals professionals don’t always introduce themselves. When I was hospitalized back in 1980 I remember a couple of doctors (I assumed) trying to figure out if I’d been seen by their ID specialist, so they asked me if I’d been examined by an asian woman (and immediately realized how useless that question was). But clearly they were aware that I would be unlikely to have any idea who the folks traipsing through my room were supposed to be.

  23. Citizen Deux says:

    I didn’t go through four years of evil medical school to be called mister…

  24. Harriet Hall says:

    Then there’s the other problem, when you really are an MD and tell someone you’re a doctor and they don’t hear you. I wore a nametag that said I was a doctor and I made a point of introducing myself to every patient as “Doctor Hall,” but when someone asked them if they had been seen by a doctor yet, they would often say “No, just by some nurse.” One patient I saw on morning Sick Call showed up in the ER that night saying he hadn’t been seen by a doctor yet and demanding to see one, and the ER doc had to inform him that he had already seen a doctor – me.

  25. Zetetic says:

    Patient perception of who’s a “Doctor” and the abuse thereof has always amused but occasionally annoyed me. With a long career as a male in two health care professions traditionally dominated by females (Registered Nurse and Medical Laboratory Technologist), I was often mistakenly referred to as “Doctor” by patients I encountered. One pediatric patient insisted that ALL “Doctors” were males and ALL “Nurses” were females! Whenever I hear someone introduced as “Doctor” out of the health care realm, I am always wary. I used to carpool with two hospital based pharmacists, one who was a “PharmD” and actually had “Dr.” and “Pharacologist” on his hospital name tag. The other pharmacist attended a pharmacy program at a different state’s university that issued an MS to their pharmacy graduates. There were continual barbs about this between them.

  26. ejwillingham says:

    ^^^Those stories are legion. I’ve got so many MD friends who are women who have the same stories…they’re always the nurse. One of my friends looks particularly young, and I think experiences it more than usual.

    Kinda wandered off of Brain Balance Centers, didn’t we?

  27. mikerattlesnake says:

    Conversation got derailed by some doofus ignoring the fact that Chiropractors use “Dr.” to make people trust them as medical professionals while biology professors and the like don’t. Seems like a pretty clear-cut difference to me.

  28. JMB says:

    Getting back closer to the subject, I looked for chiropractic college admission requirements on the web, and found this blog.

    http://www.rebuildyourback.com/chiropractic/students.php

    I believe the honor of being called a doctor was originally based on the extent of education received in a university setting. I am most familiar with the educational requirements of a physician. An average practicing physician has 12 years of education after high school. I think the average PhD has 10 years of education after high school. I think the average chiropractor has 6 years. Requirements for a doctorate degree are set by university committees. They do vary greatly.

    The decision to grant doctorate degrees based on 6 years of education after high school does sound like some organizations are trying to increase the competitiveness of their services. If the curriculum is truly difficult (as with pharmacy), it may be justified. As soon as the curriculum becomes easier, then it becomes much harder to accept the doctorate designation of the shortened educational curricula.

    In the hospital setting, the patient needs to be provided with the information of who has what role in their care, even though many patients will not understand the information because of their prejudices.

    Credibility of claims on a website or health fair is usually based on credentials of the authors or presenters. Since there is such a variation in what is now called a doctor, the most credible authors are those that identify what kind of doctor they are.

  29. Scott says:

    An average practicing physician has 12 years of education after high school. I think the average PhD has 10 years of education after high school.

    While not key to the main point of your post, these numbers don’t sound right to me. For a PhD, while it depends on the field, 9 is the typical minimum (4-year bachelor’s then 5 in a PhD program). But at least in physics (the field I know best), few manage it that fast. Wikipedia suggests that a PhD program averages 7 years in the US (http://en.wikipedia.org/wiki/Doctorate#Research_doctorates_in_the_United_States) which would imply a total somewhat over 11 years (since the bachelor’s often takes 5 years so the average there is more than 4).

    Wikipedia also indicates that a typical MD program takes 4 years after the bachelor’s (http://en.wikipedia.org/wiki/Doctor_of_Medicine#United_States_and_Canada) which would then imply an average of 8 years to the degree. Are you including residency/internship/etc. in your physician figure? If so, then a comparable PhD figure should include postdoc positions and you’re probably talking 15+ years at that point – potentially a lot longer. (Of course, postdoc lengths are often determined by availability of tenure-track positions, which have more of a supply/demand problem, so an exactly analogous number probably isn’t possible.)

  30. Regarding conversation derailment.

    Oh well, I have to admit, I love a tangent, it’s sort of the sculpture of the topic rather than the relief.

    But more on, but kinda off, the brain balance topic, I’d like to make a suggestion for a future topic. I think something on “cranio-sacral” therapy might be informative.

    A friend of mine e-mailed me a while back about her new baby boy asking me who my cranio-sacral therapist for my son was. I replied back wondering if she was asking about our cranio-facial team*? Turns out she was working with a cranio-sacral therapist due to some feeding issues that her son had. Anyone know much about this therapy?

    *My son was born with cleft lip and plate, has a team of surgeons, dentist, therapists, etc.

  31. Chris says:

    Craniosacral therapy is essentially a homeopathic head massage, often done by chiropractors. It is silly:
    http://quackwatch.org/01QuackeryRelatedTopics/cranial.html

  32. Is there a diplomatic way to tell friends things like that, without stepping on toes and sounding like you think they are incompetent. Because I don’t think they are incompetent. I think they are very conscientious, caring parents. And I’m really crummy at stuff conversations like that. It seems I always come off to strong and offend or too weak and it sounds like I’m agreeing.

    But sorry, that is really, really off topic. Perhaps we need a regular social advice column on SBM. Then I could ask that columnist.

  33. Chris says:

    I don’t know. Every time someone suggested I try it with my disabled son I ask them how a head massage is going to repair the seizure damaged Broca’s Area that is about an inch beneath the skull.

    I get a blank stare. Possibly because they don’t know what Broca’s Area is (and I probably have the depth wrong).

    You could ask how a head massage with very little pressure is supposed to work. Or ask if washing the child’s hair would have the same effect.

    Or if the child is an infant if she has tried a lactation expert (usually a nurse).

  34. It helps that they actually went to you for advice, meaning that they value your judgement and (crucially) that anything you say is not unsolicited advice. How about, “My preference is to go with science- and evidence-based treatments. I think cranio-sacral therapy is a little like astrology, so I’ve never used it. Did your doctor recommend it? What does your doctor recommend?”

    I always ask people what their doctor says to do. That usually provides a good starting point for analyzing their options.

    When it’s feeding issues with a newborn, sometimes the answer is “Why would I talk to my doctor? What would a doctor be able to say?” You can reassure them that a doctor can actually help them quite a lot; that newborns are tricky even when the parents are experienced, because they don’t have a “normal for them” yet so you don’t know when they’re “not acting normal” and that a doctor can help figure out what’s behind any issues.

    Cranio-sacral therapy may have been mentioned by someone from the La Leche League, which are often a mix of valuable support and woo. That’s trickier, because you don’t want to poison the well and discount all the really good help and advice the LLL can provide. You need to be able to supply questions that they can ask to help sort out the smart stuff from the woo. When it’s infant care, that can be really tricky. Sometimes all you can do is reassure them that they are good parents, that they will make mistakes, and that their kid will be fine anyway.

  35. “You could ask how a head massage with very little pressure is supposed to work. Or ask if washing the child’s hair would have the same effect.

    Or if the child is an infant if she has tried a lactation expert (usually a nurse).”

    Chris, good suggestions that I hadn’t thought of, Thanks!

  36. JMB says:

    @Scott
    Thanks for your correction. I am aware of postdoctoral positions in academia, having worked with many of them as an undergraduate. What I didn’t know is the percentage of PhDs that go into a postdoctoral position. I was including residency in the education of a physician. I think all states require 1 year of post doctoral training before license to practice as a physician. A minority of physicians have less than two years of postdoctoral training (I’m guessing 10%). Academic physicians tend to be subspecialists, which involve additional education in a “fellowship” (which may be a term used in PhD postdoctoral positions, a research fellow).

    I am aware of the variability in time to receive a PhD. Most MDs/DOs vary only by 1 to 2 years in the length of variation of education for their chosen specialty (I include primary care areas as specialties). In those friends and family of mine who have received PhD’s, much of that variability appeared to be due to length of time of preparation of the PhD thesis. I think the average length of time in preparation of the senior paper in my MD school was about 6 weeks. That’s why our research paper was not the equivalent of a PhD thesis.

    I think educational requirements of physicians and PhDs are reasonably similar, which justifies the shared use of the “doctor title”. There are always individual variations in training programs and individuals. I think the burden of proof that an educational degree represents a doctoral degree depends on comparison to traditional PhD requirements (hence, why we had to complete a senior research paper). That standard is not always followed.

    I give credit to Tim Kreider for his circumspect use of the term. Patients in academic medical centers are often confused as to who really is in charge of their care. Tim is putting the patients’ needs above his concern for recognition.

    Failure to identify qualifications to be called a doctor in popular press or internet websites reduces credibility (trying to get back on track).

  37. ScienceGuru says:

    Wow! Thank you for giving me so many things to address. It disheartens and baffles me to find that there are so many people that support the current medical system, the practicing physicians, and the current school of thought. First I will say this. Not all MDs and PhDs are created equal. I will limit this discussion of PhD’s to those in the biological and physical sciences. My lifelong dream was to become a pediatric heart surgeon. I started working in the hospital setting at 16, working 1 day a week in my job and spending 6 days shadowing physicians in the clinic and in surgery. In efforts to make myself a desirable medical candidate, I elected to study biochemistry during my undergraduate career. Through my low-level science classes, I met many people who also wanted to become physicians.
    Medical schools require the following for admission i) a bachelors degree or greater from an accredited university ii) the MCAT iii) 1 year of each of the following courses a) General Chemistry b) Organic Chemistry c) Physics d) Biology e) Very few schools also require Genetics and even fewer require Calculus. Many medical schools explicitly state on their websites that they are interested in diverse undergraduate studies from incoming applicants. That being said, my early undergrad classes contained students with majors like Literature, Performing Arts, Religion Studies, and many other non-science degree programs. The percentage varies from year to year, but according to the AAMC, on average, these students make u AT LEAST one third of students entering medical school. The remaining 70% of “science” applicants is largely comprised of students in Biology, Botany, and Zoology, to name a few. Once I reached the upper-division Biochemistry classes, they were no longer filled with eager pre-medical students. There were a few, myself being one of them, but we were the exception rather than the rule. This means that the majority of students entering medical school come from a “simple science” or completely unrelated background. For people to cite the number of years in school after high school as some sort of measure of smarts, intelligence, or credibility, is quite flawed as I’m sure everyone reading this has known of the freshman in high school who can already drive or the really big fourth grader.
    Once in medical school, students are subjected to 4 years of constant classes, and weekly exams covering hundreds of pages of text. Medical students spend their days and nights cramming material to regurgitate for their exams only to have to repeat it again the following week. Ultimately, they become professionals at this skill, much like completion eaters, but more like those with eating disorders who binge and purge.
    My academic journey has taken me very deep into research in the fields of biochemistry, molecular genetics, biophysical chemistry, and yes, even medicine. Ultimately, this resulted in a Masters and a Doctorate degree. One of the most profound differences I have observed is that the academic science degrees compared to med school is that academic sciences are predicated upon the idea of questioning the current knowledge base and constantly striving for discovery. There is tremendous emphasis placed on venturing into the unknown, creating novel hypothesis, and conducting research to prove or disprove them. This process is known as research and takes many years to develop within ones self. The rigidity of the medical curriculum and the subsequent standard of care however, require that there is only one answer, which ultimately comes from the current body of knowledge.
    In the academic sciences, it is widely accepted this body of knowledge is continually changing, and evolution of new paradigms is rapidly integrated. The translation of new paradigms, from the academic sciences to the medical field however, is a much more lethargic process. This means that much of what MDs think they know and consider fact is blatantly wrong. Consider this, the average age of practicing physicians across the US is 50 years old. This means that they completed medical school at least 20 years ago and their undergrad programs about 25 years ago. The current CME standards for any specialty do not exceed 50 CME hours per year. Many of these are earned at conferences. Conferences are frequently held in amazing destination locations and frequently large amounts of alcohol are consumed. This sounds more like my early undergrad days rather than an educational workshop that will provide a physician with roughly half of their CME requirements for the year. Additionally, as a result of our technological advances in the last decade, the scientific knowledge base has changed more than in the previous 50 years.
    We live in an interesting society. We know the effects of smoking, yet millions continue to smoke. We know the causes and effects of obesity, yet nearly one third of our population is obese [BMI > 25% (Although 1/3 is really high, the BMI obesity baselines have increased over the last 20 years to artificially keep the obesity rate lower)]
    At the end of the day, I too might have difficulty taking expert advice from a chiro, but who are MDs, still stuck in the science of 20 or 30 years ago, to be casting opinions about things that are not understood. It’s actually quite straightforward; car companies utilize the same techniques to sway consumer opinion. When all is said and done, sick patients, no matter what the illness or disease, mean money for physicians. Any therapy outside of the scope of events that can be reimbursed by physicians is very quickly dismissed and widely criticized. The converse is also true. Physicians also strongly support treatments, which benefit them financially. Many times this is taken to the extreme. Physicians receive financial incentives, aka bribes, from companies to publish research supporting the use of that company’s devices. A report was published this week to that extent:
    http://www.usatoday.com/yourlife/health/2010-09-14-conflict14_ST_N.htm
    To add insult to injury, these bribes are undisclosed. The current system is predicated on the use of expensive devices and drugs and is propagated through research publications.
    There is hope on the horizon however. Do not fear. ICD-9 codes and CPT codes are slowly emerging for alternative therapies. Additionally, the NIH, through the National Center for Complementary and Alternative Medicine (NCCAM), http://nccam.nih.gov/ is working to promote alternative treatment modalities. My grandma does not have a cell phone and my parents just learned to text in 2010. Unfortunately, the same trends are demonstrated in the majority of our physicians, but not for much longer. Over the next few years we can expect to see the “old” physicians along with their closed minds move out of medicine, their positions of power in administration, and into retirement, resulting in a new wave of physicians.

    Stay healthy my friends!

  38. JMB says:

    @ScienceGuru

    The thread of the discussion was not that years of education identifies who is smart, it was about what qualifies for a doctorate degree, and how the variability in definition of a doctorate degree means, that to maintain credibility, an author should identify credentials beyond identification as a doctor. Lack of identification of the nature of a doctorate is a red flag to the reader to be wary of an article. In the articles you have written, have you ever failed to specify what your degrees are, and what your board certification is? Frankly, if I had really been smart, I would have dropped out of college to be a computer programmer. I would already have retired.

    I must admit that my medical school was mostly focused on the current state of medical knowledge, although there was still much training about how to stay abreast of changing concepts. My postdoctoral residency training hammered incessantly on how to stay abreast of changes in medical knowledge. Didn’t your residency have a journal club? I don’t disagree that academic endeavors focus on the cutting edge, but I disagree that practicing physicians are all stuck in out of date medicine. I used to think that doctors in private practice were out of date when I was in academic medicine, but I learned otherwise when I changed to private practice. The focus in academic medicine may be in pushing the envelope of knowledge. The focus in community medicine is on production quality.

    I would also say that drinking to excess is not something I have witnessed at CME meetings. Any licensed physician visibly drunk in public runs the risk of being turned in to a state board of health. Where do you come up with these things?

    If you completed medical school, a residency in surgery, a fellowship in pediatric heart surgery, and a PhD program, you would have been about 37 years old when you finished. Then you would have about 13 years before you become one of those over the hill doctors at age 50. Good luck!

    So how is it that, with all of your science education, you support alternative medicine, when, by definition, we call alternative medicine those procedures without scientific basis?

    By the way, I also have a definition of a science guru, something I never achieved. A science guru is someone who has had an invitation for an expense paid trip overseas with an honorarium to present research at a major meeting, without having submitted a paper for acceptance.

  39. JMB says:

    By the way, in one of our introductory lectures on the first day of my medical school, we were told that 50% of medical knowledge turns over every ten years.

  40. Chris says:

    ScienceGuru = crank.

    (Dude, if you want to be taken seriously: do not reference USA Today!)

  41. Chris says:

    Oh rats! I forgot something:

    Get off my lawn!

  42. Dr Benway says:

    ScienceGuru,

    Wall of text is tl;dr.

    Double-return for paragraph breaks. Try it.

  43. sjb says:

    Let’s get back to the Brain Balance topic.
    I have tremendous respect for the individual accomplishments of MDs and PhDs. I have friends that are PhDs and MDs from MIT and Harvard. However, a degree from a prestigious institution does not make you an expert on all subjects.
    My question to Dr. Hall is how are you qualified as an ER doc to comment on the field learning disabilities? You are not a neurologist or a psychiatrist. Have you read the latest research or been to the conferences or confirmed with researchers in the field? From reading this article you are not aware of much of anything in the field.
    I am also suspicious of anyone whose only focus in their work is one of criticism. This generation calls people this “haters.”
    Your statement that the underlying neurological model that the program is based on “directly contradicts the understanding of mainstream science” is noticeably vague. Do you know what is the understanding of mainstream science for the cause of learning disabilities? You don’t mention it so I presume you don’t know. Martha R. Herbert, MD, PhD, Harvard Medical Professor and neurologist at Mass General Hospital stated regarding a common mechanism in autism, ”some kind of abnormality in brain connectivity-i.e. the structural and/or functional factors related to brain connections and coordination.” Problems with connectivity in the brain is the mainstream scientific model. Other researchers have demonstrated “cortical underconnectivity” in autism and other learning disorders: Just, Koshino, Villalobos, Castelli and Herbert to name a few. Other research findings into ADHD have demonstrated right hemisphere deficits on fMRI and others have theorized a decrease in inhibitory activity as a result of diminished frontal lobe activity.
    Your attack on the website’s list of environmental factors also demonstrates your almost absent knowledge of current studies in this field. There have been recent studies that have drawn a direct connection between watching TV and attention deficit and a more limited vocabulary. One study that found a link between attention deficit and TV involved 2600 toddlers between the ages of one and three. Furthermore, the Academy of American Pediatrics recommends no TV for children under the age of two. Obviously this pertains to sedentary activities and learning difficulties.
    Research into epigenetics using Agouti mice and historical research on behaviors of populations in Sweden have demonstrated that the manifestation of behaviors can be passed onto your offspring for up to four generations. This has obvious implications with regards to our behaviors around the current use of digital technologies. ADHD expert and Harvard psychiatrist, Edward Hallowell, MD has linked the rise in ADHD and the electronic media.
    Furthermore, there is recent conclusive evidence of a link in recent studies between ADHD and pesticides in the diet. Other factors in ADHD and supported by research are smoking and alcohol use by the mother during pregnancy.
    The outcome assessment study which you disparaged demonstrated that the Brain Balance program attained a high success rate in remediating ADHD of the children in the study. The results were based on the Brown’s Attention Deficit Disorder Scale which is an accepted tool for aiding in the diagnosis of ADHD. There results yielded an 82% success rate in remediating the symptoms in ADHD after completion of the Brain Balance program. While you criticize aspects of the study it was accepted by a scientific peer reviewed journal.
    Finally, all the other critics should just look around at the “accepted” treatment for the conditions. All require spending money. You could take drugs but then you have side effects and not all people respond to the drugs. But the benefit of the drug only lasts for a few hours. You have to keep taking it. It doesn’t cure the problem. There are schools that charge up to $80,000 per year for helping children with these disorders.
    I have a daughter who is now 22. But we spent more on a educational consultation than the brain balance program costs. That is not to mention the special school we put her in. And she was not cured of her program.
    Would you call that “fraudulent?”
    You bloggers out there should do some real homework before you spread your negativity about a program that has helped many families.
    And yes I am a chiropractor and an owner of a Brain Balance Center.

  44. Citizen Deux says:

    @sjb – I qould inquire of the following;

    1 – What is the average cost per client for your services?
    2 – What is the training for your staff?
    3 – What is your training?
    4 – What qualifies Dr. Melillo to validate his therapy, as practiced by franchise Brain Balance centers?
    5 – What peer reviewed articles has Dr. Melillo published in this field? What training has he received?

    Your comments are weak and your arguments out of context. You cite studies without reference. Your appeal is to that of emotion, disconnected by verifiable facts. Your posting reads like a shotgun approach listed in the back of every alt-med book and magazine.

    Furthermore,

    Do you support pediatric chelation as a treatment?
    If so, what empirical testing do you use?
    What is YOUR success rate with your clients?

    Please – spare us the rant, in my view, you are a fraud.

  45. Cowy1 says:

    @sjb

    Emotional response to a rational question; not surprising by someone who has a significant financial conflict of interest in the “success” of the program.

    And, to address one of your comments, just being peer-reviewed doesn’t mean a whole lot. JMPT is peer reviewed but you might as well use it for toilet paper considering the shoddy quality of research they publish.

    Since you’re a chiropractor, why don’t you let us all know why ADHD (or pick your disorder) doesn’t respond to a deft bit of back-cracking? You know, de-kink the “hose” and let that innate flow!

  46. Citizen Deux says:

    And finally, via the Quackometer – 3 canards, once you get in to the website

    http://www.quackometer.net/?url=http%3A%2F%2Fwww.brainbalancecenters.com%2Fthe-truth%2F

  47. Chris says:

    sjb, Dr. Hall was a family practice physician. So she would have had experience dealing with families and their children during her time in the Air Force (something she did while stationed in Spain).

  48. Cowy1 says:

    Quackometer, my newest way to waste time and not write a thesis proposal.

    Thanks Citizen Deux.

  49. JMB says:

    @sjb

    There is a fairly standard progression of medical science that is being circumvented by “Brain Balance” purveyors.

    The normal progression could be characterized as follows:

    1. Scholarly study and inspiration.

    2. Basic science/ in vitro studies. These studies establish a scientifically plausible mechanism.

    3. Preliminary in vivo studies. These studies (which include laboratory animal studies) establish a reasonable a estimate of risk and benefit to justify clinical trials. This is what I would classify the pilot study cited by yourself and discussed in the article.

    4. Multiple randomized clinical trials, (unless the initial trial demonstrates significant risks, or no benefit.)

    These numbers do not correlate with the formal designation of stages provided by the FDA.

    While there are many variations on this progression depending on the nature of the intervention, and the disease process, the end result is a careful adherence to scientific principles in an attempt to insure that the risk benefit ratio has been reliably determined.

    A hallmark of pseudoscience is that someone will jump the tracks and offer the treatment before it has completed full scientific assessment. While the FDA generally insures that drugs cannot jump the tracks, many other treatments or interventions are not as regulated. This is part of the reason that CAM relies so heavily on dietary supplements (outside of most of FDA regulation.)

    Some of the methods advocated in Brain Balance have been used in the educational approach to ADHD. There should also be a comparative effectiveness study between the educational approach and Brain Balance approach, if the Brain Balance approach passes #4.

    I would also question the ethics of providing a breakthrough treatment by a franchise business model (assuming it could stand up to the scrutiny of standard randomized clinical trials.)

  50. Shelley.ma says:

    As a parent who has had a child in the Brain Balance Center program, I challenge anyone who is sceptical to put a child through the program before you make comments. Within the first month, my 6 year old daughter not only could read for the first time but was excited about reading and school. She even brought a Dr. Suess book into the center to read to the teacher , that is how proud she was! Before the program, my daughter had no social skills and no friends. She now has girls in her grade coming up to her to be her friend. She was withdrawn and “in a shell”. She is now happy and outgoing, connecting to others for the very first time. I would have spent $100,000 to have a happy, well adjusted child; $6000 seems like the deal of a lifetime!

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