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Cranial Manipulation and Tooth Fairy Science

Tooth Fairy Science is science that studies a phenomenon that doesn’t exist. You can do studies on the Tooth Fairy; for instance, comparing how much money she leaves to kids in different socioeconomic groups. You can do studies on the memory of homeopathic water. You can do studies on the therapeutic effects of smoothing out wrinkles in the imaginary human energy field with therapeutic touch. Or you can do studies of craniosacral therapy. “Therapeutic Effects of Cranial Osteopathic Manipulative Medicine: A Systematic Review,” by Jakel and Hauenschild, was published 2011 in the Journal of the American Osteopathic Medical Association. It is a perfect example of Tooth Fairy Science.

In the 1930s, William G. Sutherland, DO looked at a disarticulated skull and noticed that the sutures were beveled, like the gills of a fish. He concluded that this indicated articular mobility for a respiratory mechanism. He invented cranial osteopathic manipulation to allegedly move the bones of the skull relative to each other for therapeutic benefit.

In the 1970s, John E. Upledger developed this idea further, inventing craniosacral therapy (CST). It postulates rhythmic fluctuations of the cerebrospinal fluid (CSF), mobility of the cranial bones and dural membranes, and involuntary motion of the sacrum. The CST practitioner palpates the skull, senses pulsations transmitted to the skull by the CSF, gently moves the skull bones relative to each other, and thereby releases restrictions to the flow of CSF, which somehow restores health in an astounding variety of human illnesses.

The thinking of CST practitioners is illustrated by this statement quoted by Edzard Ernst:

When a self-development issue is linked to the illness, it is enough for that issue to be acknowledged by the client (without any further discussion unless the client desires it) for the body to release the memory of that issue – sensed by the therapist as tightness, tension, inertia within the body’s systems – so that the healing can proceed.

Several treatment sessions may still be needed, especially if the condition is a long lasting one. Our bodies’ self-healing mechanisms rely on a combination of the various fluid systems of the body (blood and lymph flow and the fluid nature of the cells making up all the organs and systems within our bodies) and the body’s energy fields. Our hearts generate their own electrical signal independently of the control of our brains. Such signals travel around the body through the blood and other fluid systems. Blood is an excellent conductor of electricity and, when electricity flows through a conductor, magnetic fields are created. It is with these fields that the craniosacral therapist works.

These same fields store the memory of the events of our life – rather like the hard disk on a computer – but these memories can only be accessed when the underlying Body intelligence ‘decides’ it is needed as part of the healing process. There is absolutely no danger, therefore, of more being revealed than is strictly necessary to encourage the client back onto their self development route and to enable healing to take place.

Upledger’s odyssey

I first became aware of Dr. Upledger in 2003, when he was the subject of the first article I ever published, in Skeptical Inquirer. The text of that article is available online. You might enjoy reading the full article. In it, I described Dr. Upledger’s epiphany as he reported it: he was assisting a neurosurgeon by holding the dura (membrane surrounding the brain and spinal cord) steady while the surgeon removed a calcified plaque. He wasn’t doing a very good job of holding still. The surgeon complained. Most of us would have thought our own muscles were at fault; however, Upledger observed that the dura was fluctuating up and down at about ten cycles per minute, overcoming his attempts to hold it still. Nobody had ever observed this before, not even neurosurgeons.

He tried mobilizing the cranial bones through hands-on manipulation and convinced himself he could feel the bones move one-sixteenth of an inch or more. Patients with autism, seizures, cerebral palsy, headaches, dyslexia, colic, asthma, and other diseases reported dramatic improvement. He found that well people treated with monthly adjustments reported more energy, felt happier, and were sick less often.

That was bad enough, but then he really got carried away. He discovered energy cysts, sound therapy, healing energy that he could transmit from one hand to the other through the patient’s body, dolphin therapy where dolphins touched the therapist and the therapist touched the patient, and the patient’s “Inner Physician,” one of which appeared to the patient in the form of a seagull and asked to be introduced as “Mermaid.”

I got the title of my article “Wired to the Kitchen Sink” from Upledger’s treatment of a patient who had “excess energy.” He grounded her big toe to a drainpipe with copper wire to remove the energy, and it worked to relieve her chronic pain. So he had her husband connect her to the kitchen sink with a thirty-foot length of copper grounding wire so she could get around the house.

The JAOA systematic review

The authors of the review assume their Tooth Fairy is real. They assert that osteopathic manipulation affects the primary CSF respiratory mechanism though techniques that accomplish things like compressing the fourth ventricle. They say that research so far has focused on the reliability of palpation. They cite osteopathic books and articles, including a 1939 book by Sutherland, none of which actually support the reliability of palpation. And they do not mention the several studies showing that palpation is unreliable.

Bypassing the question of whether CSF fluctuations exist, and bypassing the subject of reliability, they forge ahead to review randomized controlled trials and observational data to describe the clinical benefit of cranial OMM (osteopathic manipulative medicine) in patients with a variety of pathologic conditions. Note: they want to describe the clinical benefit, not to ask whether there is a real clinical benefit.

Starting with 159 studies, they excluded those that failed to meet the inclusion criteria and ended up with 8 studies: 7 randomized controlled trials (RCTs) and one observational study. The number of subjects ranged from 9 patients to 142 patients. Four studies did not mention the manual techniques used. Treatment duration ranged from 1 minute to 30 minutes, from a single treatment to 6 months. Four studies were in healthy subjects; four used patients with different ages and a variety of conditions, from infants with colic to adults with myopia.

The most common finding was improvement in sleeping patterns. For pain, there was a positive outcome for adults with tension headaches but not for children with cerebral palsy. One study showed reduction of crying and “required parental attention” in infants with colic. Three studies did not have meaningful clinical endpoints (for instance a study of the effect of CV-4 technique on blood velocity).

They actually admit that the available evidence is heterogeneous and insufficient to draw definitive conclusions, but they nevertheless remain convinced that OMM is an effective and clinically beneficial treatment modality for patients of all ages. Their bias is glaringly obvious, and of course they end by calling for further research.

The SRAM analysis

Jakel and Hauenschild do not mention the incisive 2002 study “Interexaminer Reliability and Cranial Osteopathy” published in the Scientific Review of Alternative Medicine (full text available online). It showed that claims of inherent rhythmic motility of the brain and spinal cord are scientifically groundless, that the only fluctuations in CSF are reflections of the patient’s respiration and heart rhythms, and that the skull bones are fused together in adults and cannot move relative to one another. Inter-examiner reliability was non-existent: different examiners reported different “cranial rhythms” for the same subject and each single examiner tended to report very similar rates for every subject examined. So the reported rhythms obviously depended on the examiner and had nothing to do with the patient. They rejected the results of a study by Upledger that allegedly showed interexaminer reliability, offering more likely explanations his apparent success and saying that his study shows extraordinary evidence of careless and poor design.

They comment:

Without careful scientific controls, weaknesses of perception and interpretation can fool both practitioners and patients into believing that a treatment is effective when it is not. We believe that these and other natural human psychosocial influences help to explain how cranial osteopathy has achieve the 21st century without scientific support of any kind.

A Later, More Skeptical Systematic Review

A 2012 review by Edzard Ernst found that low quality studies with a high risk of bias suggested positive effects, while the highest quality trial failed to demonstrate effectiveness. He concluded: “The notion that CST is associated with more than non-specific effects is not based on evidence from rigorous RCTs.”

Is it safe?

In most cases it probably is safe. The manipulations are gentle and the treatment may have a relaxing effect. But at least two deaths have been reported, one in an epileptic woman who was treated with cranial therapy and was told to stop her seizure medication, and one in a 2 day old infant who was treated with cranial manipulation in lieu of conventional treatment for a high fever (a life-threatening medical emergency in a child of that age). The cause of death was a subdural hematoma likely due to the manipulations.

Conclusion

Stephen Barrett was right: cranial therapy is silly. Its underlying theory is false, it has no therapeutic value, and its safety is questionable. Systematic reviews like the one by Jakel and Hauenschild are unfortunate because they lend an aura of scientific respectability to nonsensical treatments and encourage wasting money on Tooth Fairy Science.

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84 thoughts on “Cranial Manipulation and Tooth Fairy Science

  1. Kathy says:

    “(he) noticed that the sutures were beveled, like the gills of a fish. He concluded that this indicated articular mobility for a respiratory mechanism.”

    I’m a bit puzzled by this. I’m a biologist by training, not a medic, but I’d have thought the edges of skull bones were beveled in order to PREVENT movement of those bones w.r.t. each other, especially when they get a sudden hard blow at an angle. One sees something similar along the edges of (old, well-made) furniture like dressers and wardrobes … it’s a much sturdier way of preventing the edges parting company than merely gluing them.

    Maybe someone who has done engineering or made furniture could comment?

  2. Agashem says:

    Thank you for this. Craniosacral therapy is flogged for physical therapists as well. How any one with the slightest knowledge of anatomy and physiology could buy this malarkey is beyond me. My husband pointed out that if this so-called therapy actually worked, then wearing a tight cap on your head should cure you of all your ills (let it be pointed out that on the Upledger Institute page they claim the pressure of equivalent to the weight of a nickel is sufficient for therapeutic effect!)

    1. windriven says:

      Any relation to Samuel Shem?

      I love the tight cap idea. If I could just shed my sense of ethics I’d market some elastic skull caps as craniosacral therapy supports – available in a range of colors to accessorize any wardrobe. The Windriven line of craniosacral therapy sustentation system products is intended to augment and reinforce the normal flow and rhythm of your cerebrospinal fluid (precious bodily fluids???). Also available is the swimming cap guaranteed to let you dive deeper, stay down longer and come up drier!

      Hmmm … I feel my sense of ethics fading…….

  3. Miriam says:

    Dear Harriet,

    I would like to ask you how do you view Staffan Lindeberg’s Kitava research? As well as the work of Jeff Volek and Stephen Phinney and their low carb advocacy? If you could review their books?

    I just have an extremely hard time believing that calories does not matter and that it’s good to eat all that fat, however I’m not sure what is the best. What book would you recommend?

    Thank you for your knowledge and no bs approach! Appreciate it immensely.

  4. windriven says:

    “Bypassing the question of whether CSF fluctuations exist,”

    As I read Dr. Hall’s post I kept wondering what the presumed mechanism driving the CSF might be. There are, as I understand it, about 125ml of CSF in the average body. Some force must act on the CSF to move it rhythmically at 6 cycles per minute, some CSF pump. I do not claim proficiency as a human anatomist but I don’t recall every learning about the human CSF pump. Moreover, a pump capable of displacing fused bone plates by 1.5mm or more is going to be a pretty sporty pump! What happens when the human CSF pump fails? What happens when it overpumps? Are there dural aneurysms? Dural hemorrhages?

    If this is tooth fairy science, the tooth fairy must have gotten into the magic mushrooms.

  5. It’s amazing how the woo peddlers totally get science wrong. You don’t have a hypothesis and then go out and find data to support your hypothesis (hello confirmation bias). Also, are these practitioners confusing the cranial bones for tectonic plates??!!?? So I guess in some of the older Kung Foo movies I have watched, the fighters are just performing CST, and not implode their heads. Another excellent article Dr. Hall.

  6. Calli Arcale says:

    Cranial manipulation always struck me as baloney. I mean, in chiropractic, at least you get that satisfying cracking sound; with this, you get nothing perceptible at all besides perhaps a nice scalp massage. (And that does feel good, but is probably cheaper at your local hairdresser, and then you come away with a new hairdo as well. Hmmm….it occurs to me that the hairdresser likely has more stringent licensing requirements as well, so you’re probably in safer hands there.)

    It’s definitely a case of a guy noticing something weird, idly wondering if it was happening on its own, getting excited, and then turning into a runaway freight train from that point.

    Sidenote:
    “You can do studies on the Tooth Fairy; for instance, comparing how much money she leaves to kids in different socioeconomic groups.”

    Funnily enough, today my daughter lost a tooth. This will be her first opportunity for the Tooth Fairy, as she managed to mislay her last two lost teeth within a matter of hours. ;-) So the Tooth Fairy will be visiting tonight, as we have secured the tooth in a large container that even she shouldn’t be able to mislay. (We hope. She is a classic case of ADHD.)

    It occurs to me that there could actually be value in comparing how much money the Tooth Fairy leaves kids in different socioeconomic groups. This is on my mind as I have to decide how much the Tooth Fairy will leave tonight. ;-) I imagine there are a number of social and economic factors that drive those decisions in households everywhere. But then, that ironically wouldn’t be tooth fairy science, since it would be acknowledging the reality of the situation.

    1. Newcoaster says:

      If you ever watch the TV show “Modern Family”, there was an episode in the last season that dealt with the topic. The gay parents (Cam and Mitchell) accidently left a $100 bill instead of the $1 bill they intended when their adopted Vietnamese daughter lost her first tooth. Hilarity ensues…yada yada

  7. I’m a test comment, ignore me!

  8. Tsu Dho Nimh says:

    primary CSF respiratory mechanism

    Has this been shown to exist? Or are we into the nutritional quality of unicorn farts territory?

  9. Harriet Hall says:

    To those wondering about the logic of beveling, CSF respiratory mechanism, and the pump rationale, don’t strain your brain. Logic has nothing to do with it; it’s all magical thinking, self-delusion, and unicorn fart territory.

    1. windriven says:

      Ahhh, I love the smell of unicorn farts in the morning! (Apologies to Robert Duvall).

      1. PNG says:

        I once worked in a lab with a guy who claimed to be researching bee farts. I grew suspicious when I noticed that he made a weekly trip to the slaughterhouse.

    2. vadaisy says:

      Is this the same as the CSF pulse, rather than a respiratory mechanism? It seems that the quacks usually take a bit of the truth and mix it up with their own version of reality. As I understand it, there is some sort of CSF pulse, but it is not a respiration like breathing. Just call me ‘Easily Confused’.

      1. Harriet Hall says:

        The CSF “pulse” is due to transmitted cardiovascular pulsations and variations with respiration.

  10. Newcoaster says:

    This was an ongoing topic of skeptics vs wackadoodles when I used to hang out at Yahoo Answers a few years ago, and I did quite a bit of reading on it at the time. As usual in woo-land, nothing much seems to have changed since I last heard about this topic. Upledger is revered as a demi-god by osteopaths, and others who practice CSM.

    In my neck of the woods (BC Canada) it is mostly chiropractors, osteopaths, and the occasional naturopath that use this. I know in the US osteopaths are often considered equivalent to GP’s, but in Canada, most are still British trained, and most are still quacks.

    1. Patricia says:

      Upledger is not revered by all osteopaths, nor is cranio-sacral ‘therapy’ modality believed or used by most osteopaths. Please don’t define a whole profession by a few vocal practitioners of this practice.

  11. erickttr says:

    A few subsections of this book (e.g. in Ch 6) called “Cerebral Circulation” available for free from the National Library of Medicine explain a little bit about CSF circulation (if you can call it that, it’s more like a stream). It is similar to lymph in that there is no pump. The CSF is produced by the choroid plexus; it normally is acellular; the ventricles & space in the spine are innervated and the CSF “drains” through semipermeable spaces into the blood. Some of it is circulated, I think into the subarachnoid space via cranial arteries, which is a layer between the brain and the skull. Measuring any “pulse” is purely a result of the mechanical transfer of energy/motion from interaction with the vasculature. (I just HAPPENED to be brushing up on this for an educational project last weekend — it turns out that Intro Neuroscience textbooks are horrible at describing CSF & ventricular system and I was looking for reading material). http://www.ncbi.nlm.nih.gov/books/NBK53084/

  12. erickttr says:

    i wrote innervated and I meant vascularized.

  13. cphickie says:

    Thank you for this review. As a pediatrician, I have had some families take their infant for this “therapy” in the vain attempt to correct positional plagiocephaly, which is basically a flattening of a normally rounded portion of an infant’s skull. This classically occurs because the infant is spending more time resting on one area of the skull than others. It can become severe enough to cause misalignment of the ear canals and/or ocular orbits, which can affect hearing and/or vision (in addition to giving you an unusually shaped head). Unless you have one of the rather rarer causes of this (such as premature fusion of one or more of your cranial sutures), treatment is nonsurgical and involves helping the infant to stay off the flat spot and/or fitting them with what is called a plagiocephaly helmet. The helmet is for more severe flattening and actually helps–over a period of weeks to month– reshape the skull into a more normal rounded position. I bring this up because I never saw CST do anything to correct the flattening of the skull in the infants who received it. I didn’t oppose CST, though, because I was under the impression CST had little to no risk. Given the reference above to the dentist who killed an infant using CST, I will remember to cite this risk in the future to any parent considering CST on their child.

    1. mho says:

      The risk is in the parents going under the spell of quacks who sell “healing.” Those parents will hear a lot of nonsense about vaccines, diet, qi gong, chiropractic, acupunture,etc. etc. etc. –all of it worthless and potentially harmful to that child.

      That baby will have to live with those parents for the next eighteen years without the ability to make his/her own choices.

      You have an opportunity to steer them in another direction. Please do.

      1. cphickie says:

        Believe me, I try. But I keep seeing more and more people who can’t tell the difference between science and magic, and more and more that magic seems to sway them over anything I can say.

      2. TJ says:

        What kind of un-scientific moron would think DIET could have an influence on your health?!

        1. WilliamLawrenceUtridge says:

          A healthy, well-balanced diet high in unrefined foods, particularly fruits and vegetables, is a mainstream recommendation that has been in place for decades. You can pretend that the USDA food guide is made up of candy and cigarettes, but that merely shows that you are delusional or a liar. It is quite well-recognized that diet has a powerful effect on long-term health. It’s just not medicine.

  14. Anne Cooper says:

    “(he) noticed that the sutures were beveled, like the gills of a fish. He concluded that this indicated articular mobility for a respiratory mechanism.”

    The Sydney Harbour Bridge has joints that resemble what Sutherland noted. They allow for expansion and contraction due to heat. As I am sure the human skull does. Does that mean the Sydney Harbour Bridge breathes?
    I am an osteopath. I love and revere my job. It makes sense – structure/architecture determines function, increased pressure reduces fluid/gas flow. I wont go into it. But the anatomical and physiological explanation for so called ‘cranial’ is asinine, and I wonder if its related somehow to the Lord of the Rings? Same era…

  15. David Aston says:

    It is positive that osteopaths are reviewing their “own” treatments. Will lack of evidence for some treatment eventually mean that course curriculum will change? Many theoretical models within manual therapy and not only osteopathy are not scientifically proven and the treatment effect is debatable from an evidence based perspective. But if one would remove cranial and visceral osteopathy from osteopathic manual medicine then there is really not that much difference from manual physiotherapy.

  16. Anne Cooper says:

    That is simply not true. PT comes fromandiffernet history and operates from a vastly differing philosophy.

    1. David Aston says:

      I do not agree with you. Freddy Kaltenborn is both a physiotherapist and an osteopath and Alan Stoddard was an osteopath and a physician. Many techniques in examination and treatment are the same or similar. The philosophy can be different but this could also be true for different physiotherapists.

      1. windriven says:

        Could you clarify your point? Are you suggesting that chiros and PTs share the same philosophical underpinnings? Whether they use similar techniques is immaterial; it isn’t just the technique but when it is used and why it is used.

        I do not believe that PTs are taught subluxation theology. Please correct me if I’m mistaken.

        1. David Aston says:

          All chiropractors do not believe in the conservative model of subluxation. All osteopaths do not use cranial or visceral manipulation. There are schools and individual therapists that are more or less conservative. But this is the same within our physiotherapy community. Some use treatment models with no science or evidence. If you read some better textbooks in chiropractic or osteopathy you will see the subluxation or osteopathic lesion/dysfunction is discussed in a more critical way. In Sweden many chiropractors use their techniques for restoring joint motion and not for repositioning joints or curing internal disease.

          1. WilliamLawrenceUtridge says:

            Considering there’s no evidence for subluxations, even “more critical” discussions seems to be falling rather short. Do any textbooks say “Palmer made up subluxations and there’s no evidence behind it”? Because that would be my standard.

            That being said, there are good and bad physios, good and bad osteopaths, and more and less evidence-based practices. Unfortunately the only thing that really distinguishes chiros from physios, aside from blatant, lunatic quackery, appears to be the subluxation theory. The less batshit-crazy chiros should just become physiotherapists.

  17. WilliamLawrenceUtridge says:

    One must be quite careful when discussing osteopaths, since there are two very different flavours (American and everywhere else), and both continue to practice. If ever someone bashes or praises an osteopath, one might consider asking them in which country they practice. Possibly where they were trained. You might be discussing an MD who knows a bit more about the bones and muscles than the average GP, or you might be talking about a total lunatic who believes in faeries.

  18. Anne Cooper says:

    That’s not quite true. Many us trained DOs practice cranial. Most trained for example in Australia, are structural. so, there are two general types- structural and cranial which includes bio dynamic. Dontgetmestarted.

  19. lilady says:

    (The things I do for science)

    It takes a strong stomach to wade into the muck and mire at the Ho-Po, but when an article appears that touts craniosacral therapy for newborn babies…I do don my hip boots to comment:

    http://www.huffingtonpost.com/juliet-linley/craniosacral-therapy-for-_b_827495.html

    I really don’t care that gullible adults subject themselves to this quackery, but I strongly object to parents who subject their infants and their disabled kids to this risky “therapy”.

    Take a look at how this quack “practitioner” asks an infant for permission to perform craniosacral therapy:

    https://www.craniosacraltherapy.org/Babies.htm

    “…..The infant needs to be fully informed of the purpose of his or her visit with the therapist. The craniosacral therapist must speak in the first person to the infant. “Do you know what I do?” The therapist explains to the infant what they do and who they are. Infants are quite capable of responding to this information except with certain kinds of shock. They often shake their head knowingly from side to side to indicate “no”. So the therapist carefully observes the infant for their communication style. Infants will use their whole body to speak in response to a question or comment. They will also verbally talk to the therapist. The conversation skills are emotionally based and developed in the body ego i.e. skin, muscles, vocal tones, micro movements, macro movements, etc. It may take a session or two for the therapist to intuit the infants unique style of communication. It is equally important to state questions and comments to the infant simply in a way that only require yes and no answers. The infant just went through a very intense experience and wants to tell the story. Someone needs to listen and the infant needs to know it’s being heard for healing to occur.

    As the therapist discusses his or her intentions with the infant they begin to pay close attention to the infants physical movement patterns. The goal of tracking these movements is to see where the infant’s personal space extends via the amount of extension the infant is capable of making with their arms. Spastic, jerky and uncoordinated movements are often signs of shock. When the therapist has a clear picture of the physical space the infant inhabits then contact is negotiated at that point in space. The therapist asks for permission to touch the infant. Often an infant will say no at first with a definitive movement of their head, their body or a vocalization. Follow the infants lead and talk to them a little more about why touch is important. Here is a key: Its important for the therapist to give up any intention of being clinical with their hands in the early sessions of craniosacral therapy. The actual intention is to establish safety and trust with the infant so that the physical contact is contained in loving kindness rather than the lifting of a frontal bone, etc. Structural work comes later; evaluation of shock, trauma and the bonding sequence is first. The therapy is playful rather than clinical….”

    Cripes, I despise how credulous parents subject their children to dangerous quack treatments.

  20. Anne Cooper, Osteopath says:

    Dear is a owerful tool. all medicine, science climatology, and especially politicians use it. Why expect any aspect of health care to not use it?
    People have come to think that illness and death is an aberration.

  21. Anne Cooper, osteopath says:

    Having expressed my disdain, however, I cannot accept that the 2 deaths were due to cst or cranial osteopathy. They were both essentially crimes of omission. Both failed to get appropriate care. That’s not cst. Both offered other treatments incl cst, and failed to facilitate the right ones. A sub duralumin a 2 day old child following a traumatic birth is more likely to be related to trauma, probably the birth, not the pressure of a ‘nickel’.
    Barrett is a psychiatrist. When it comes to loopy diagnoses and treatment, they can too often stand alongside the cranials.

    1. Harriet Hall says:

      Isn’t it a crime of “commission” to manipulate the cranial bones in a newborn with a subdural hematoma?

    2. Chris says:

      Alice Cooper:

      Having expressed my disdain, however, I cannot accept that the 2 deaths were due to cst or cranial osteopathy.

      Possibly perhaps as it is normally practiced it is best described as a “homeopathic massage.” This is because the pressure applied to the scalp is not supposed be more than putting a small coin (like a nickel) on someone’s head. Apparently the “energy” of the practitioner’s hand is supposed to cure all.

      The problem is that my kid had cerebral bleeding and seizures from an area at least an inch away beneath the skull not long after his birth. Plus more seizures from a now vaccine preventable disease. How is it supposed to cure damage to both Broca’s and Wernicke’s areas of the brain, and then miraculously not need speech therapy for his severe speech/language disorder? I need more than anecdotes.

      Obviously the practitioners who killed kids did not get the “no more pressure than a nickel” message, and decided to actually move those bones! Sure, you can claim they were not “real” practitioners, but their unskilled hands would never had come close to a baby’s head if the parents knew the reality of “cranial manipulation.”

    3. WilliamLawrenceUtridge says:

      If you have a criticism of Dr. Barrett’s reasoning – criticize that. Don’t bother criticizing him with “he’s a psychiatrist”. An argument or fact stands or falls irrespective who makes it.

  22. lilady says:

    Isn’t a crime of commission to bend a healthy infant’s spinal column with such force and have the infant die during the craniosacral “treatment”?

    http://anaximperator.wordpress.com/2009/05/07/infant-dies-after-craniosacral-therapy/

    “….Case history

    Patient A was a three-month-old, healthy girl. Because their child exhibited mild motor unrest, the parents contacted a so-called “craniosacral” therapist who, after a short introductory interview, started administering the craniosacral therapy. He placed the child on her back on a changing mat, after which he palpated the neck and the skull. The patient cried vehemently at this. Then she was turned to her right side and a deep bending of the vertebral column was applied at Figure 1which the chin touched the chest, as shown in figure 1. After the vertebral column was bent deeply in this manner during several minutes, the child lost faeces and several loud intakes of breath were clearly audible. The therapist interpreted this as a deep sleep, which he said was normal during the treatment. After about 10 minutes the girl was placed on her back and blue discolouration of the lips was apparent. The child was limp now and did not react to touching. The father started mouth-to-mouth resuscitation. Alerted ambulance personnel on arrival saw a deceased infant with asystolia….”

    Dangerous quackery…when performed by any medical doctor, osteopath, “certified” (or uncertified), so-called craniosacral therapists.

  23. Anne Cooper says:

    I cant see how one can manipulate the bones of a newborn, unless you knock it on the head, or squeeze them like forceps do (and thats not a bad thing when it is at risk.) Cranial whatever does not use pressure. It uses the weight of a 20 cent piece. Subdurals are slow and hard to diagnose without a scan… so to blame it on the ‘cranial’ treatment, or the fatally mismanaged epileptic, is stretching someones agenda. If it was a traumatic birth, one would need to know exactly what that involved becasue a kiddy’s soft head gets squashed in a difficult birth, as you know. There is no need for the detractors of cranial and loopy medicine in general to be as bad as them. And no need to get overly self righteous. I am an RN and an osteopath, and I assure you, stupidity, hubris, arrogance, neglect indeed criminality occur on both sides of this artificial divide. If we waited for ‘evidence’ then nothing new would ever be attempted. Would Robin Warren and Barry Marshall’s work stand up to scrutiny? and ‘evidence’ is a wobbly concept. I am a proficient spinal manipulator of 25 years (and the only ones who have ended a hospital after seeing me have been having a baby), and my skill cannot be compared to a 3rd year PT or osteopathy students in the lab. And I assure you, my personality is not so compelling that patients give me money for my gentle ministrations and sympathetic ear. They pay and recommend me and my colleagues because they had pain and it went immediately during or after treatment. The rules of physics apply to all systems in the universe. There is no real or alternative medicine, there is only good and bad medicine, and thats a moveable feast. Ask Dr Barrett.
    Nevertheless the poor child should have been referred.
    Look up Viola Frymann, an american DO. Another case of omission. Many of these people are mad christians, doing gods work. They don’t need the imprimatur of humankind.

    1. Chris says:

      You are still not going to reverse the damage done by seizures to Broca’s or Wernicke’s area of the brain. Show us the achievements you have had in the absence of intensive speech therapy.

      Speech therapy is not perfect, but the kid could not even speak at age three, and can now hold a slow conversation. Can you document that kind of progress with only cranial manipulation?

      Give us your unbiased peer reviewed PubMed indexed evidence. Especially when you cannot master the use of a basic paragraph.

      Really, why should we believe you?

    2. WilliamLawrenceUtridge says:

      If we waited for ‘evidence’ then nothing new would ever be attempted.

      That’s nigh the most short-sighted comment I’ve ever seen used to rationalize CAM. Using Robin Warren and Barry Marshall as examples makes it worse. Warren & Marshall developed their theory and turned it into proof in a relatively short amount of time considering they were competing with an existing safe and effective (short-term) treatment. The reason why Warren and Marshall’s work was taken seriously, that it stood up to scrutiny, was that it was rigorous and replicated.

      The issue is – truly effective treatment can be demonstrated and adopted in a relatively short period of time if rigorous trials are done that support the intervention. No such trials have been done for CST, it’s nonsense from beginning to end. Generally harmless, but not necessarily so when you’re dealing with a baby’s skull.

    3. Chris says:

      Actually, Ms. Cooper, could you tell us why the authors of this paper are wrong:
      http://www.quackwatch.com/01QuackeryRelatedTopics/cst.pdf

      And for the record that is also this paper, the copy above is because BC Health kept changing its URL:
      http://www.ncbi.nlm.nih.gov/pubmed/10709302

  24. Anne Cooper says:

    yep.

  25. Anne Cooper says:

    Thats not CST thats spinal manipulation and that is NEVER OK in a child. WIth CST they just sit there with their hands on the cranium and under the sacrum, feeling The Tide.

  26. Anne Cooper says:

    I completely agree.

    1. lilady says:

      I’ve got to ask. Is commenter Anne Cooper a licensed osteopath physician in the United States?

      http://en.wikipedia.org/wiki/Osteopathy

        1. lilady says:

          Thanks, Woo Fighter. That link explains a lot.

          1. Woo Fighter says:

            That website is a veritable treasure trove of quackery and woo.

            Check out some of the ridiculous claims her shop makes for the “powers” of TCM and acupuncture and the list of ailments they can cure. And while she admirably dismisses subluxations as an old-fashioned concept, the acupuncture page is full of references to “Qi.”

            I’m surprised they don’t offer homeopathy to complete the quack “holy trinity” alongside chiro and acupuncture. And maybe some reiki or energy healing too.

            In an article she wrote on alternate ways to deal with the flu, she recommends eating Vietnamese pho (soup) instead of Tamiflu, as they both contain star anise. Yeah, I’d rather depend on an unknown and variable dose of star anise which depends on how much the chef threw into the batch of broth over a controlled, regulated consistent dose in Tamiflu.

            Of course for the flu she specifies chicken pho over beef because chicken soup “boosts the immune system.” She also suggests warm milk at bedtime which does the same thing.

            And you’ll love her references to massage therapy for premature babies.

  27. Andrey Pavlov says:

    It’s got to be my bias talking – you know the “I studied science and biology and physiology and chemistry and physics and so on for two solid decades” bias – but doesn’t:

    WIth CST they just sit there with their hands on the cranium and under the sacrum, feeling The Tide

    Just sound ridiculous? I mean these sorts of statements are just viscerally silly to me. I’ve even been joking around at th ehospital with friends some time and “suggest” homeopathy or energy healing or “feeling The Tide” or whatever and I can’t manage to deadpan. After a couple back-and-forths we just end up laughing and trying to see who can top whom in making $hit up. Sadly, I nearly always win. Not because I can make stuff up better, but because I know more actual CAM practices and modalities. The only friends who give me a run for the money are those equally well versed in sCAMs.

    Truth, they say, is stranger than fiction.

  28. Chris Hickie says:

    @Lilady #22–that figure 1 on that web site looks like a extreme variant of the positioning sometimes used to perform a lumbar spinal tap on an infant (such as when there is a concern for meningitis). Whenever an infant is positioned like that, they are closely monitored for their cardiorespiratory status and the position is held for as little time as needed (typically a minute). To do what was described for 10 minutes until “deep sleep” occurred is criminal.

  29. lilady says:

    Yes, I know how infants are positioned for lumbar punctures.

    “…..After the vertebral column was bent deeply in this manner during several minutes, the child lost faeces and several loud intakes of breath were clearly audible. The therapist interpreted this as a deep sleep, which he said was normal during the treatment….”

    It appears that those clearly audible loud intakes of breath were agonal gasps.

  30. another harriet h not Dr. hall says:

    Thanks so much for this article. I am a community member of an encephalitis forum and it has just been overwhelmed with woo. People are desperately seeking answers for a serious condition and they want hope. Chronic headaches are common post encephalitis and are quite debilitating so people will latch on to anything that offers them hope of relief. One of the admins of the forum offers up this little gem from her chiropractor “It was explained to me that often the skull plates do not settle back into place properly after the inflammation of encephalitis.” I usually post after that it is ineffective but don’t ask her about the apparent plate tectonics. I try to keep it friendly but we are attracting so many anti-vaxxers and I am getting sick of posting -no you can not get encephalitis from the flu vaccine – no mmr does not cause autism- no autism is not encephalitis- no – no – no. F-ing NO. Now what I need is more info on autoimmune encephalitis after vaccination.

    1. lilady says:

      You should really consider leaving that forum if you have been invaded by anti-vaxxers.

      There is one persistent troll that I do post back at, when I encounter her on science blogs, where she claims her daughter’s autism was caused by the hepatitis B birth dose.

      She and her sockies (she’s been banned by at least one science blogger), claim that the birth dose of hepatitis B vaccine was given without her permission. She then proceeds to describe her infant’s “encephalitic cry” (colic), which led to “vaccine-induced encephalitis” then a diagnosis of autism at a later date.

      I keep asking her if she took her baby to an emergency room for evaluation by a pediatric infectious doctor or pediatric neurologist…she didn’t. She, who is a lawyer, made the diagnosis.

      I also ask her what extensive life-saving treatment her infant received, provided in a pediatric intensive care unit for this emerging life-threatening condition…following the IDSA (Infectious Disease Society of America) Clinical Treatment Guidelines:

      http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Encephalitis.pdf

      She despises me, because I call her out every time she posts her b.s. about her child’s “encephalitis” and because I call her out about her ludicrous claim that her multiple sclerosis was caused by a Td booster vaccine that she received at age 21.

      P.S. If I have correctly identified “Parker” as the troll you have encountered and you want to p!ss her off, tell her lilady says hello. :-)

      1. another harriet h not Dr. hall says:

        I like to point out that when I deteriorated neurologically “right before my (parents) eyes” My parents rushed me to the emergency. My intake form says “Measles?” I guess they don’t love their children as much as my parents loved me

        1. Chris says:

          Trust me, we have asked that particular lawyer person many times why she did not call 911 or take her child to a doctor.

          When my kid was a toddler he had seizures after a a couple of weeks of diarrhea. The neurologist did tell me that there is an infectious form of it that causes seizures. This was before there was a rotavirus vaccine.

          I really do not understand those who do not call 911 when their child is having seizures, or the the symptoms of stroke. The last time we called 911 was when our son could speak coherently, the 911 operator recognized that his speech was abnormal over the phone. Help was sent immediately (it turned out to be a complex migraine, but it was severe enough to keep him in the hospital for three days).

  31. r mater says:

    Thank you for your article. I have been a craniosacral therapist for 15 years. I specialise in the treatment of concussions and TMJ dysfunction. I receive referrals from many mds and physiotherapists in my area who know of my work and the results that can be obtained with craniosacral facilitation.

    1. Chris says:

      Okay, give me the PubMed indexed citations that it can cure oral motor dyspraxia due to bleeding in the frontal lobes and seizures, especially near Broca’s and Wernicke’s areas of the brain.

      And I do not want anecdotes, I want real verifiable studies that kids who could not form more than a dozen unintelligible single syllabic word approximations at age three can speak perfectly clear after a year of CST therapy, in the absence of any speech therapy.

      Basically I want you to prove you can repair neurological damage to both the speech and language center of the brain. This is a claim I have heard for several years, and most recently from someone who claimed to be a “neurologist” (but turned out to be a chiropractor). I want actual scientific proof that a homeopathic massage can repair that kind of neurological damage that was still not fixed by over ten years of speech therapy and lots of special education supports.

      Come on! Prove to us that BC Health was wrong in 1999.

  32. WilliamLawrenceUtridge says:

    Thank you for your article. I have been a craniosacral therapist for 15 years. I specialise in the treatment of concussions and TMJ dysfunction. I receive referrals from many mds and physiotherapists in my area who know of my work and the results that can be obtained with craniosacral facilitation.

    The exact same thing could be said by bloodletters, priests of the Egyptian god Thoth, Hermes Trismegistus, homeopaths, practitioners of recovered memory therapy, exorcists, trepanators, and the list goes on. Human experience is deceptive, horribly so. Memory is not a video camera, it is a slave to ego, and it exists to justify our actions – not record them.

  33. This is correct. The problem is that at least a simple majority seem to believe in it and the overseeing professional bodies of chiropractic certainly do. Furthermore, the curriculum for all DC schools investigated by Jann, myself, and others here all have the mythical subluxation as part of the curriculum. Lastly, the licensing exam for DC requires knowledge of precisely the mythical subluxation (I use this term to differentiate from an actual orthopedic subluxation which is often used interchangeably by chiros to obfuscate the discussion) as it is tested on the exam.

    The only rebut I have ever heard is “Well, not everyone believes in that magical joo-joo and besides, it is a really small part of our curriculum and licensing.”

    Well, why would any of the curriculum or licensing require knowledge of disproven magical ideas? I can tell you exactly how much of my licensing exams is based on magical thinking and thoroughly disproven ideas. Zero.

  34. TJ says:

    Cranioscaral therapists are baby killers. Got it. Thanks scientists.

  35. WilliamLawrenceUtridge says:

    Craniosacral therapists have killed babies. It is a real risk that is unrecognized by their profession. However, you seem to be missing the real problem – craniosacral therapy has no reason to work, is not proven to work, and ultimately seems to be a complete waste of time and money. The fact a craniosacral practitioner has in fact killed a baby through their allegedly “safe” practice is an unfortunate tragedy that is the very opposite, in every way, of the icing on the cake.

    You appear to have turned the most tragic aspect of the post into a reason to disengage with it completely and miss its overall point.

  36. TJ says:

    I’m agreeing with you, Mr Super Smart Scientist. The pile of dead babies must be the reason cranio sacral therapists have to pay such high rates for their liability insurance. $218/year for a two million dollar policy.

    1. WilliamLawrenceUtridge says:

      TJ, personally I think one baby dying due to an intervention with no prior probability or proof of efficacy is too many.

      But perhaps your standards are different.

  37. Tj says:

    And I’m glad to see that scientists have finally realized what politicians and advertising executives have always known. When your argument is weak, resort to an emotional plea to protect children. ;)

    1. windriven says:

      “Craniosacral therapists are baby killers. Got it. Thanks scientists.”

      No. Craniosacral therapists are frauds. They may occasionally kill a baby as a result of perpetrating their fraud. But the the killing is incidental to the primary activity.

      It is kind of like bank robbers. Sometimes some stupid teller or bank customer gets in the way of a bullet. The dumb-asses shouldn’t have been in the bank anyway, right? But look, the thing is to rob the bank. The dead people are just collateral damage.

    2. WilliamLawrenceUtridge says:

      If there were any facts about CST, I wouldn’t have to resort to such a plea, I could merely refer to them. Oh, hold on, there are facts – upon testing, there is no indication CST has any specific effects. Despite this, two deaths have been associated with it – one a baby, the second a woman who ceased her seizure medication. The argument isn’t weak, the evidence is.

      I note that none of your comments show any reference to the astonishingly poor evidence base for CST that Dr. Hall refers to. Is there a reason why?

  38. TJ says:

    Okay, okay, this is my last comment. I don’t object to your feelings about cranio sacral therapy. My problem is that there are so many feelings. Why not stick to the facts? If the site took a more scientific approach to its deconstruction of a non-scientific treatment it might draw some people who could argue the other side of the issue. Because something’s going on with CST, and it’s not the same as “wearing a hat”. Try it for yourself some time.

    That’s all for me.

    Peace!

    1. Chris says:

      “Why not stick to the facts?”

      What facts? That is does nothing?

    2. WilliamLawrenceUtridge says:

      Your reply is a standard hand-waving tactic used by CAM and pseudoscience apologists everywhere – why not try it?

      My response is – if CST is so effective, why don’t the results show up when tested scientifically?

      And for CST specifically – why not test it before trying it on, say, babies, whose skulls are soft enough to deform even from just lying on their backs too long?

  39. TJ says:

    I’m in a weird position because I experienced CST many times before I knew there was no scientific evidence supporting its claims. I liked it so much I even took a couple of classes. But I will look at the study you reference and any others I can find and try to figure out why my experience with CST is so different than what the people posting comments say it should be.

    Meanwhile, I apologize for being a dick in previous comments. And I hope that all sides can be a little more civil going forward (unless you really got a good knock like the guy who invented the CST hat. That was pretty funny).

    I’ll get back to you. :)

  40. WilliamLawrenceUtridge says:

    TJ, perhaps you are misattributing your improvements. I have had CST. My experience was it was time spent in a relaxing setting, without moving. I ended up having a nap. I won’t argue it wasn’t relaxing (again, nap), but it’s simply not possible for the forces involved to change the shape of the skull, or even influence it in any way. Spending time with compassionate people who asking you questions about your health in a caring manner is immensely soothing, and is often accompanied by reassurance that your health is good (or can be improved).

    It’s quite possible your experience with CST is at odds with the studies because good studies look for objective improvements rather than self-reports (which often consist of “did you enjoy it”). This is a perennial problem within medical research, and there are many confounds – regression to the mean, the Hawthorne effect, expectancy, release of endogenous opioids, and more. An interesting comparison study could simply involve conventional gentle massage, or even just holding someone’s hand in a quiet room.

    If you are certain, absolutely convinced, that CST is a powerful and effective treatment, and nothing you read will change your mind – you aren’t doing science. You don’t care about science. You don’t understand science. And that’s a shame, because science is absolutely fantastic at revealing truths about the world and challenging our preconceptions. Science is all about beating at ideas like pinatas until the truth falls out. If your idea is so frail and fragile that it can’t pass a few simple tests, chances are it wasn’t true in the first place.

  41. TJ says:

    William, my guarding angels tell me you might be right, haha.

    I’m not married to cranio. I don’t do it for a living or anything. It’s really just a hobby. I’m also reasonable enough to recognize the importance of science (I’m typing this thing on a tiny glass typewriter/telephone/radio/TV afterall). I will try to approach the topic again and read the studies and challenge the ideas. I don’t want to defend something that claims to work in a way that it doesn’t. And if cranio turns out to be nothing but a bunch of super-awesome nap inducing holds, then I’ll offer my friends who might benifit from it super-awesome nap inducing holds.
    Thanks for your answer.

    1. Chris says:

      You just try getting a nice head massage from a friend.

      I find that when I go to the salon for a haircut, the shampoo I get from the stylist is feels very good and relaxing.

  42. WilliamLawrenceUtridge says:

    Your first point of investigation should be what a “suture” is. Then contemplate whether the weight of a nickel is sufficient to move them.

    Massages are a much better use of time and money.

  43. TJ says:

    Very true!

  44. TJ says:

    Yeah I’m going to look at my class notes and the book to see what exactly I was told about movement in cranial bones. Like I said, I’m no expert in CST but maybe that’s to my advantage here.

    I actually got my massage license just for kicks (cranio wasn’t part of the curriculum). I never imagined I would do anything with a massage license, but now when my workload is light on my regular job I work weekends at a massage place. And I absolutely love it! Giving someone a massage is almost as satisfying as getting one. If it actually paid more I’d be happy to do it full time.

    1. WilliamLawrenceUtridge says:

      Why not go to an actual reliable source, that doesn’t require a fact to be true to justify its existence, to confirm the facts? Like an anatomy textbook. While your CST textbooks may claim as a fundamental dogma that the sutures of the skull move, that doesn’t mean it is true. While your textbooks may claim there is a pulse to the cerebrospinal fluids, that doesn’t mean it is true. And when tested, CS therapists give wildly different estimates of the frequency of the alleged pulse. Some other independent critical sources include Quackwatch, , Quackwatch again, Ben Goldacre, skepdic, a SBM article by Mark Crislip, Save Yourself by Paul Ingraham (a contributor and moderator here at SBM) and the American Cancer Society.

      Most CAM approaches violate one or more fundamental aspects of anatomy, biology, chemistry or physics. There are no anatomical structures that support the existence of acupuncture points, for instance. There is no basis for serial dilutions making homeopathic medications more powerful, and for homeopathy to work, essentially all of chemistry and physics would have to have gaping, glaring, astounding holes (despite being among the best-tested and empirically supported sciences that exist). The human energy field alleged to be manipulated by therapeutic touch practitioners can not be identified under controlled conditions. And for CST – there’s no reason to believe that the sutures of the skull are mobile short of catastrophic injury, there’s no reason to believe that pressure equal to that of a nickel could move them, and there’s no reason to believe that moving them would influence the pulsations of cerebrospinal fluid (or that such pulsations exist).

  45. TJ says:

    Good article by Crislip.

    Yesterday I read “The Cerebral Circulation” Chapter 6 Barriers of the CNS

    http://www.ncbi.nlm.nih.gov/books/NBK53084/

    And printed out this link from quack watch: A SYSTEMATIC REVIEW AND CRITICAL APPRAISAL OF THE SCIENTIFIC EVIDENCE ON CRANIOSACRAL THERAPY BCOHTA 99:1J May 1999

    I do have Netter and several other good anatomy text books, which I love more than words can describe.

    I have plenty to read on the topic for today, but I appreciate all the links you provide and I will look at all of them.

    I like what you said yesterday about Science being about beating at ideas like pinatas until the truth falls out. Because when I can manage it financially I will probably work as a massage therapist full time for as long as I’m able. And being a MT is already such a low status job I want to make sure I can speak in a way that ads credibility to the profession.

    As far as moving bones of the cranium with 20 grams of force…Well that’s certainly not happening. But I’m not ready to throw the dead baby out with the bath water yet. I want to take what works from CST, understand what is really happening and why it’s woking so I can apply it when I think it will help someone.

    And so you don’t think I’m getting too far out of my training level, my goal with a client is usually to get them into a parasympathetic dominant state so their body can repair and recover itself.

  46. WilliamLawrenceUtridge says:

    Two points:

    1) There may not be anything that “works” from CST, it may be a complete waste of time, or an expensive nap. But who cares about that? As a massage therapist, you provide a valuable and skilled service that relaxes people, relieves tension, and addresses the largest organ system in the body, the muscles. Why do you need to move beyond that when it’s already an important and valuable skill? You’ve got the steak, why bother trying to add magic pixie dust as sizzle? There is tremendous benefit to saying what you can honestly – I can’t promise a magic cure, but massage has many benefits including the relief of chronic pain.

    2) Paul Ingraham, at saveyourself.ca, is a former massage therapist who has done a lot of reading and thinking about massage, health and science in general. He had a successful practice for over a decade in Vancouver before retiring to dedicate himself full-time to writing about skepticism. I would suggest reading up on his website.

    If you’ve never read up on the process of science and medical investigation, it would be good background reading. Part of the problem with CAM claims, and particularly with how they deal with scientific evidence, is that it’s just…bad. Practitioners cherry-pick studies, ignore dissenting information, and don’t understand the importance of proper scientific control. The standard recommendations are:

    #Snake Oil Science by R. Barker Bausell
    #Bad Science by Ben Goldacre
    #Trick or Treatment by Edzard Ernst and Simon Singh, and I would also recommend
    #Mistakes Were Made (but not by me) by Carol Tavris and another guy whose name I always forget. Aaron something. Something Aaron.

    Also, ever, ever recommend or use homeopathy. It’s nonsense.

  47. TJ says:

    Thanks, William. You’re turning out to be a very valuable resource. I’m glad I came storming thru here.

    I’ll report back soon.

    1. Chris says:

      Thank you for having an open mind.

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