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Separating Fact from Fiction in the Not-So-Normal Newborn Nursery: Chiropractic and Brachial Plexus Injury

Thanks to a hot tip from a follower on Twitter, I’ve once again found myself neck deep in chiropractic propaganda involving the care of a pediatric patient. The case as presented involves, among numerous specious assumptions, claims of successfully treating an infant’s paralyzed arm using chiropractic philosophy and spinal adjustment techniques. As I will explain in detail, this “miracle” is just another in a seemingly endless stream of emotional but worthless anecdotes being used for marketing purposes.

I’ll be discussing two videos, uploaded to YouTube by a father who wants to tell the world about the miracle of chiropractic. He uses that word a lot, in fact, assigning the label to no less than four outcomes and clearly setting the bar lower than my own personal threshold. The videos are a few years old, but have over 150,000 views and can still be found linked to on numerous websites and discussed in interviews. If you’re feeling generous, they serve as excellent examples of how the mind of the believer works when facing uncertainty regarding the health of a loved one.

I will provide a general synopsis of the events in question, but I do recommend watching the videos despite the fact that you will never get those 18 minutes back. They contain the details of the case and, particularly in the second video, some great examples of typical chiropractic tactics and buzzwords. (more…)

Posted in: Science and Medicine

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Hiring a Doula for Dental Procedures

complicatedgraph

An inverted quantum matrix proving the myriad benefits of using of a dental doula

Suzy Flanders had always dreamed of having a natural tooth extraction without pain medications, sedation, or local anesthesia, just like in the Bible or on an episode of Keeping Up With Kardashians. “When the day finally came on April 1st 2011, and my dentist recommended the removal of an impacted third molar, I almost couldn’t believe it,” Flanders explained. “After reading everything I could find online and talking to a few trusted friends and family members, the right choice became clear. I had to do what was best for me and for my precious tooth.”

What she found in her research was the consistent recommendation to have someone present during the procedure that had been through the experience themselves. Many proponents of natural dental care endorse this practice because there is evidence that it helps to reduce the need for harmful medications that might prevent a quick return to normal activity. They also argue that a dental procedure is about more than just the removal of an abscessed tooth or the correction of malocclusion, it’s about experiencing what the procedure feels like and discovering what you are capable of achieving. Natural dental care patients learn to manage their pain and remain open to the excitement and exhilaration of the process, and often report feeling higher levels of satisfaction. After all, modern humans have been experiencing the beauty of natural dental pain for 250,000 years.
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Posted in: Humor, Science and Medicine

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Audio Therapy for Postoperative Pediatric Pain: Randomized Controlled Nonsense

For 10/10 pain I recommend two Rihannas and a Captain and Tennille!

For 10/10 pain, I recommend two Rihannas and a Captain and Tennille

In January of 2015, a study on “the effect of audio therapy to treat postoperative pain in children” performed at Lurie Children’s Hospital and published in Pediatric Surgery International made the media rounds. It was the typical story where numerous news outlets further exaggerated already exaggerated claims made in a university press release, in this case Northwestern University in Chicago. Some of the reporting was quite silly.

The study authors, the chair of pediatric anesthesiology at the hospital and his daughter, a biomedical engineering student at Northwestern who is now a fourth year medical student at Johns Hopkins, make some reasonable points in the introduction. Fear of opioid-related side effects, in particular respiratory suppression, does often result in poorly managed postoperative pain in kids. And there isn’t great data on the safety and efficacy of non-opioid medications for this purpose. (more…)

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Ezekiel Stephan: Another Pediatric Death by World View

Ezekiel
Reports of a disturbing chain of events that ended in the likely preventable death of a 19-month-old Canadian child have made the rounds this week. The case was discussed by friend of Science-Based Medicine Orac (who I believe is some kind of a protocol droid) on Respectful Insolence two days ago. But even if you’ve read that excellent post, please continue reading as I have updated information and, I believe, additional insight into this unfortunate outcome.

If this is your first encounter with the story, prepare to be angry and frustrated but don’t presume to know everything that happened. The numerous news reports, beginning back in 2013 when the parents were first charged and the case went public, are not all well-written and there are discrepancies between accounts. Add to that the announcements and fundraising efforts by the family on Facebook and various other crowdfunding websites, and their alleged side of the story as reported by disreputable sources steeped in pro-woo/anti-vaccine bias, and we have one confusing mess of facts and a heap of conspiracy claims to boot. The only aspect of this case that is completely irrefutable is that a child suffered and died, and that he was failed by people who should have known better. (more…)

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Chiropractic and the Newborn Baby

birth subluxation

I had the pleasure of speaking on the topic of chiropractic and the newborn baby earlier this week at a meeting of the Boston Skeptics. There is a video of the talk online for anyone interested in learning more. And if you haven’t yet, please read yesterday’s post on chiropractic and babies by Sam Homola.

My introduction to pediatric chiropractic

Although I was aware of the existence of chiropractic well before beginning my medical training, I was blissfully ignorant of the full scope of what many chiropractors actually do on a daily basis. My belief that they practiced solely as “doctors of the back” was shattered early in my pediatric training at Vanderbilt while on a pulmonary medicine rotation when I was asked to consult on the child of a well-known musician who lived in the area. The patient, perhaps only hours from respiratory failure, had been brought to our emergency department only after chiropractic treatments had failed to manage a severe asthma exacerbation.

That encounter, as well as another around the same time involving a child with a throat abscess being treated with acupuncture, inspired me to dig deeper into the general concept of alternative medicine. I even went so far as to approach a local chiropractor who had set up a table at a Nashville YMCA to promote chiropractic prevention and treatment of the flu. Dr. Fakename happily allowed me to spend a day in his office, and even brought in his own child to demonstrate his approach pediatric care.

Needless to say, Dr. Fakename failed to convince me of the benefits or need for chiropractic involvement in pediatric healthcare. When the discussion turned to routine childhood vaccines, I heard the party line on the subject for the first of many times. Dr. Fakename was not against vaccines, he was in favor of giving families all of the facts. He gave me some reading material, and a book suggestion or two, which provided nothing but potential and unproven risks with no mention of the well-established benefits and proven safety of immunizations. I’ll never forget what his wife, who had brought their child in for the demonstration, whispered to me during a moment of distraction: “Don’t worry, we vaccinate our kids. I make sure.”

By the end of my residency I was a full blown skeptic of a variety of alternative medical modalities in addition to chiropractic, and had built a reputation as someone interested in and knowledgeable on the subject of quackery. I even gave a grand rounds on pediatric CAM with a focus on chiropractic which I’m proud to say drew a standing room only crowd that included folks from the community interested in alternative medicine as well as from the brand new integrative medicine center at Vanderbilt. I had even been asked to serve as a resident representative, however that invitation was quickly rescinded after my skeptical talk. (more…)

Posted in: Chiropractic, Science and Medicine

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Kangaroo Mother Care, Skin-To-Skin Contact, and the Risk of Sudden Unexpected Postnatal Collapse

Skin to skin sleeping baby
In January, a study published in Pediatrics, the American Academy of Pediatrics’ flagship peer-reviewed journal, presented evidence in support of Kangaroo Mother Care (KMC) and its primary intervention: prolonged skin-to-skin contact (SSC) between a mother and her newborn child. I was originally asked to discuss this report at the time by the editors of The Scientific Parent, which is a great resource by the way, but I wanted to expand on my initial thoughts after letting them simmer for a bit over the past few weeks. Please check out the great work done by Leslie and Julia over at TSP after you finish this post.
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Posted in: Science and the Media

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Baby Translating Technology: Revolutionary Parenting Tool or Confirmation Bias Bonanza

stupidbaby
Caring for a young infant, although a potentially rewarding means of producing a labor force for chores and minor home repairs, can be a trying ordeal for both new and experienced parents. The peaks and valleys of parental experience can leave a caregiver both exhilarated and agonizingly frustrated during a single hour of childcare, let alone the first few months. It is not an uncommon experience for a parent to rapidly alternate between extreme states of emotional arousal, one minute gazing down at their sleeping baby with seemingly limitless feelings of joy and love, and the next panicking at the perception that it has been too long since their baby’s last breath.

Babies, especially stupid ones, require near constant attention during the first several weeks of life, and that’s if it is going well. There is no user manual for the care of the newborn human that could possibly describe every situation and how to effectively respond to it in each individual child. A trial and error approach is always necessary to some degree, and it tends to result in a lot of sleepless nights, with many parents finding themselves more exhausted than they ever dreamed possible. So it shouldn’t be surprising that parents are a particularly vulnerable population when it comes to the marketing claims of bogus technology aimed at making their lives even the slightest bit easier. (more…)

Posted in: Science and Medicine

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Science-Based Medicine’s Not-So-Psychic Predictions for 2016

May your epididymitis be treated with acupressure!

“May your epididymitis be treated with acupressure by André the Giant!”

The new year is upon us, and with it comes a unique opportunity for the Science-Based Medicine team to look deep into our crystal balls, to channel our Atlantean spirit guides, and to ride the waves of cosmic consciousness in order to bring to you our predictions for 2016. But before you scoff at our collective powers of prognostication, know that we have never made a prediction that has not come to pass. We’ve also never made any official predictions before, but that’s neither here nor there.

In the process of discussing what will become of this new alternative medicine fad (have you heard of it?) in the coming year, I have discovered that the contributors to SBM are all extremely pessimistic. Sadly, the vast majority of the responses to my request for predictions were focused on the future advances of pseudoscience in medicine and the steady decline of our ability to tell the difference between reality and medical fiction. But I agree with each and every one. (more…)

Posted in: Humor, Science and Medicine

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Hospitals Slow to Adopt Pediatric Pneumonia Guidelines

sick kid

While it is both easy and fun to point out the inadequacies of unscientific modalities such as chiropractic and homeopathy, our goal at Science-Based Medicine is the application of a single standard to all medical practice, even if it stings a bit. We are far from perfect. While I firmly believe that most conventional healthcare professionals are good people who strive to provide the best care possible for their patients, I accept that there is room for improvement and pediatric medicine is certainly no exception.

In fact, one of the characteristics that best distinguishes conventional from so-called alternative medicine is the simple fact that we systematically attempt to recognize and correct our errors on an individual and system wide level. That we evolve in the light of new and better evidence, albeit sluggishly as a rule rather than an exception, allows me to sleep at night. There is no quality control in alternative medicine. There are only shifting trends in the marketing of nonsense to the curious, desperate, and gullible. (more…)

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Separating Fact from Fiction in Pediatric Medicine: Ear Infections

chiroears

Please don’t try chiropractic first, or at all, for any pediatric condition

As discussed numerous times on the pages of Science-Based Medicine, children are increasingly a target of chiropractors, with some even pushing for recognition as primary care practitioners. Despite a thoroughly inadequate training, and a lack of experience with ill pediatric patients, they believe that they have what it takes to recognize and manage common pediatric conditions or refer to an actual pediatric medical professional when they deem it appropriate. While a significant percentage of pediatric illness is self-limited, and thus might appear to respond to chiropractic manipulation, I have seen many deteriorate quickly and with little warning. The idea of an ill child suffering at the hands of a charlatan is terrifying.

Many chiropractors are of course more than happy to see pediatric patients without acting as their PCP. They love to claim that children are at risk of developing misalignment of the bones of the skull and spine, chiropractic subluxations, and numerous other conditions unique to alternative medical reality, particularly during the first few years of life. They tell caregivers that these insults can be subtle, or even silent for years, and that regular maintenance care is required to prevent severe problems, even going so far as to blame SIDS and “shaken baby syndrome” on these fictional entities.

Many chiropractors are also quick to claim that they can prevent or cure some of the most common conditions seen by pediatricians and family healthcare providers, such as viral infections of the upper respiratory tract, asthma, bedwetting, and ear infections to name just a few. By simply improving the function of the nervous system, chiropractors believe that they can “boost” the immune system’s ability to fight infections, improve control over bladder function, and even reduce airway inflammation and bronchoconstriction. If you think that sounds like nonsense, you’re right!

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