On the pages of SBM we frequently discuss homeopathy, and rightfully so considering its position as one of the most pervasive yet dumbest forms of alternative medicine. Just yesterday our own Scott Gavura, who is neither pervasive nor dumb, wrote an excellent review of some recent improvements in the regulation of these ridiculous remedies in Canada, and I encourage readers to check that out. Sadly, despite numerous high profile setbacks for the practice, including a thorough trouncing by the Australian National Health and Medical Research Council in March, proponents of what is essentially the belief in sympathetic magic continue to clutter the pubmeds and interwebs with worthless studies. (more…)
Neck Adjustment for Newborn Supraventricular Tachycardia: More Chiropractic Manipulation of Reality…..
[Editor’s note: Not enough Clay for one day? Check out this post on homeopathy over at The Scientific Parent!]
It was recently brought to my attention that a chiropractor was promoting his profession on Facebook by claiming to have treated and cured a potentially life-threatening cardiac arrhythmia. The condition in question, supraventricular tachycardia (SVT), can be very serious and even deadly in patients of all ages. Needless to say, the thought of anyone but a well-trained medical professional with access to appropriate medication and equipment to control the heart rate if necessary was unsettling to say the least.
After a deep breath, I followed the link and was sadly not surprised to find that it was true. In fact, after taking a minute for the rage to subside, and a few more to delve deeper into the case, I found that it was in reality much worse that I had initially imagined. The intervention, a stealthy adjustment of the child’s first cervical vertebrae, was performed by her father while she was being treated in a neonatal intensive care unit just hours after being born.
The events in question were posted by the chiropractor on a public account for his practice. Still, I feel hesitant to link to them directly as they reveal not only the name of the child but the identity of the cardiologist and intensive care doctor involved in her care (who naturally cannot respond because of privacy laws). If readers want to go to the trouble of locating the source of my outrage, they certainly can.
I will provide details of the child’s care as described by her father, but first a brief primer on SVT to set the stage a bit.
For those of you new to Science-Based Medicine, I am a pediatric hospitalist and spend the majority of my time caring for newborns. It’s an extremely rewarding experience on most days. The babies are usually healthy, the parents are usually happy and appreciative, and I get to give a lot of good news. I also get to dispel a lot of myths and misconceptions regarding the care of infants, which as you can probably imagine, I take great pleasure in.
Parents ask a lot of questions, which I appreciate and encourage, but they also make a lot of claims about the care of children based on their prior experience, advice from well-meaning friends and family, or their evaluation of the online “literature.” Some of these claims I will challenge, nicely of course, when they are demonstrably wrong or increase the risk for a bad outcome. (“We read that babies should sleep inverted like a bat in order to increase blood flow to the brain.”) Some of these claims I acknowledge as an acceptable approach, even if I don’t agree with them myself, if there is low risk or a lack of available quality evidence to guide me. (“We burped our last baby every five minutes during feeds to prevent colic.”) Sometimes I even learn a thing or two from parents.
We tend to cover some very serious topics here on Science-Based Medicine. In fact, most of our posts are downright depressing. This will hopefully not be one of them.
In just the past few weeks we have written about the public health menace of anti-vaccine pseudoscience, autistic children being subjected to dangerous bleach enemas, and chiropractic-induced stroke in children. Unsurprisingly, there is typically no shortage of rage and heartache on the pages of this blog. But not today. Today will be a reprieve from the misery.
I’ll be discussing two products that were recently brought to my attention by colleagues. The last product I skeptically evaluated was the Buzzy, a device designed to reduce procedural pain in kids that is little more than a clever distraction technique. That product, however, was considerably more complex in concept and design than the ones I’ve chosen for this post. But the NoseFrida and the Windi are marketed to parents using equally dubious claims of efficacy, and use of one of them has an unfavorable risk-benefit analysis in my opinion. At least they’re funny…kind of.
The NoseFrida and the Windi come from the Miami-based FridaBaby LLC. The company website provides a succinct mission statement:
FridaBaby specializes in baby products you actually need! Our products are for the important stuff, you know, like breathing. Instead of using harsh chemicals to relieve your baby of discomfort, we opt for more natural solutions. Our focus on pragmatic and “gross” products (their words, not ours, nothing grosses us out!) that really work has garnered us a cult like following of ENTs, pediatric GIs nurses, doulas, midwives, lactation consultants, bloggers, and parents.
Okay, they help promote a needless anxiety over chemicals in baby products, and yes, that statement contains a straw man implication that all other options require the use of “harsh chemicals”, but they seem like decent enough folks. Who doesn’t like breathing? I do it daily and recommend it to all my patients. (more…)
The risk of suffering a stroke when undergoing aggressive chiropractic manipulation of the neck is not a new concern. We’ve discussed it several times on the pages of Science-Based Medicine over the years, most recently in November of 2014 when Steven Novella covered the death by chiropractor of 30-year-old Jeremy Youngblood, whose fatal brain injury occurred while seeking treatment for a sore neck. For a nice review of cervical manipulation in general, the evidence against its inappropriate use, and an assessment of the literature on this subject, check out prior posts by Dr. Hall and chiropractor Samuel Homola.
I believe that my take on the issue is in line with my fellow SBM authors. There is no role for high velocity, low amplitude (HVLA) thrust-type maneuvers that cause sudden and intense rotation of the neck in any patient, for any reason. It is not effective for neck pain, headache or any other complaint, and it is a proven risk factor for injury to the vertebral arteries and subsequent stroke. Some patients are at higher risk, such as the elderly or those with atherosclerosis or connective tissue disorders, but this type of injury can occur at any age and even in a perfectly healthy individual. (more…)
Every few years, it seems, a new concept emerges as the favorite go-to means of marketing unproven and highly implausible approaches to health care. Explanations of the proposed healing properties of homeopathic remedies incorporating quantum mechanics immediately comes to mind as an example of this phenomenon. Or how proponents of the most absurd treatments will just add “Nano” to anything and claim scientific miracles of healing.
From the Nano SRT website:
Q: What Is Stress Reduction Therapy?
A: SRT is a remarkable new procedure that combines the disciplines of Acupuncture, Biofeedback and Homeopathy with Laser Light technology. A computerized scan or test is done to see what your body is sensitive to, and how it is out of balance, then help it learn not to be.
Q: What does the Nano SRT do?
A: Substance specific frequencies converted to a digital format, and presented in the form of sound and light, are what allow for patient assessment and therapy down to the molecular level. The frequencies are what make it possible to assess thousands of substance sensitivities in mere minutes, then allow the brain and nervous system to record a new association that is positive or neutral instead of the inappropriate ones that were previously stored in memory. This breaks the link between the stimulus and response, makes symptoms unnecessary, creates balance and harmony, from dis-ease and disharmony, and allows the body to function better.
There are few aspects of daily existence, particularly in modern society, that are more pervasive than advice on what we should eat. Everyone, including friends, family, strangers on Twitter and self-proclaimed experts in nutrition and health, seems to have an opinion on how to eat in order to improve and prolong our lives. Even legitimate organizations dedicated to the health and well-being of the population add to the cacophony of recommendations on diet.
Readers of Science-Based Medicine should be well aware of the current popularity of avoiding gluten, even absent the diagnosis of celiac disease or thoughtful evaluation for another related condition. Gluten, we are told by gurus and authors of books like Wheat Belly and Grain Brain, is the one true cause of a host of medical complaints, even autism. Avoid gluten at all costs, they say, and watch the pounds melt away or experience the clearing of your “brain fog.” (more…)
In 2011, psychologist Daryl Bem published a highly controversial series of nine experiments designed to tease out the potential existence of precognition, the ability to experience future events. In order to isolate the potential influence of future events on the present, Bem’s experimental design reversed the standard order of psychological investigations. In one experiment, for example, subjects were allowed to practice with random words after having already taken a memory test comprised of some of them.
Bem’s results were controversial for many reasons, mostly because they were positive. But the question of whether or not they should have even been published in the first place, regardless of the results, was raised by many in the scientific and skeptical community. As history has shown us repeatedly, the risk of falsely legitimizing nonsense by publishing positive but typically poorly-designed studies is very real. And negative studies tend to be ignored by believers and policy makers.
Bem’s experimental design was made available from the beginning of his research in 2002, and he encouraged others to perform their own studies. Unfortunately for Bem, attempts at replicating his findings were largely reported, if not always published, as negative. Apparently this was not enough to discourage the intrepid believer. In fact, he currently has a meta-analysis of 90 experiments using the same protocols as his original research under editorial review.
The conclusions of his new analysis [PDF] are, not surprisingly, supportive of the existence of precognition, and in his manuscript he attempts to address all of the skepticism regarding his findings. He even quotes Feynman and implies that physicists are taking the possibility of quantum-based explanations of psi seriously. It’s an interesting read to say the least.
What does NCAA basketball have to do with the topic of psi research?
A new name in the field of parapsychology research has been making headlines since going public with his efforts on the 1st of the month, and not surprisingly the media coverage is increasing now that his findings have been announced. Dr. Mort Fishman, a psychologist and paranormal researcher out of Tuono di Legno University in Florence, has ingeniously incorporated one of the world’s most popular sporting events, the NCAA Men’s Basketball Tournament, into a study of precognitive abilities. The results, if they are to be believed, may change the minds of even the hardiest psi skeptics.
In anticipation of March Madness each year, millions of basketball fans around the world fill out tournament brackets in an attempt to correctly predict which teams will win, and ultimately who will emerge victorious from the championship game. Many make a contest out of it, with office pools now a nearly ubiquitous aspect of life this time of year. ESPN even holds a Tournament Challenge, the winner of which is given a chance for $20,000 and a trip to Hawaii. It might even be Mitt Romney this year, leading some to regret their vote in the 2012 Presidential election.
The reasons people give for their choices are myriad, ranging from a thorough evaluation of the various teams’ stats to something as primitive and powerful as a gut feeling or how cute the mascot is. Fishman, an avid basketball fan who played three seasons for the European Basketball Federation’s Florence Nightingales, set out at the beginning of the NCAA college basketball season to determine if there might be a precognitive component to these choices. Inspired by Bem’s study designs, he also incorporated a reversal of standard protocols into his research.
The typical approach to filling out a bracket is to do so before the first game of the tournament. In fact, most official contests require it in order to avoid any unfair advantage. Fishman, who had a league record foul-to-rebound ratio of 2.5 during his stint on the Nightingales, instead asked study participants to fill out their bracket after the completion of the championship game, which was won by beloved perennial tournament underdogs, the Duke Blue Devils. According to Fishman, the most challenging aspect of the study was preventing participants from being exposed to any potential contamination with information about the teams during the season.
We went to great expense to protect subjects from potential bias or even outright cheating by basing their bracket picks on outside information. They were sequestered in a reasonably priced hotel, without access to the internet, television, or radio from November 1st of last year through Monday night. They were not allowed to speak to anyone outside of each other and us. No family. No friends. I think there were a few old Reader’s Digests and maybe a Redbook in the room. Progress requires sacrifice.
Once the brackets were completed and turned over to the research team, the real science began. Each subject entered a sensory deprivation tank and was randomly exposed to the results of 25 of the tournament’s 67 total games. The brackets were analyzed using math to see if subject picks were retroactively impacted by knowing the result of games after the fact. Choosing to courageously forego the stifling process of peer review, Fishman announced the positive findings at a press conference held in the parking lot of a Buffalo Wild Wings eight minutes from Lucas Oil Stadium on East Washington Street in Indianapolis.
As believers in Science-Based Medicine, we must have open minds when it comes to fringe or even highly implausible claims because you never know when seemingly-incontrovertible assumptions about the natural world will be proven wrong. Science is imperfect and historically has been very wrong on many occasions. Experts used to believe that the Earth was flat and we still don’t know how Tylenol even works.
Intellectual humility is a key component of scientific skepticism. Sometimes ideas which were ridiculed turn out to be true. Having a closed mind might help prevent any untrue new idea from being accepted, but some of them are pretty interesting and already very popular with the public. Who are we to judge truth from fiction?
Though the existence of psi has now been proven by the Fishman study, it doesn’t mean that more studies aren’t needed. In fact, the hard part lies ahead. We need to figure out how best to harness its potential in order to improve patient outcomes, and only science can lead the way in that regard. But we must not be afraid of the unknown or of different approaches to discovery. As Endocrinologist Dr. Deepak Chopra said, “All great changes are preceded by chaos.”
Separating Fact from Fiction in the Not-So-Normal Newborn Nursery: Chiropractic and Craniosynostosis
Pediatricians, particularly those who spend a significant amount of time caring for newborns, see a lot of babies with unusually-shaped heads. Although to be fair, the fact that the overwhelming majority of vaginally-delivered babies, and quite a few born via Caesarean section, will have a transient and abnormal shape to their heads makes it, well, not unusual. In fact, I rarely make it out of the room without some discussion and reassurance regarding the lumps and bumps of a new arrival’s head.
The potentially lumpy and misshapen head of the newborn occurs for a variety of reasons, some common and some extremely rare. It often is related to the development of the bones of the skull but can also involve the surrounding tissues of the scalp. A vaginal delivery, and some difficult Caesarean births, subject a baby’s head to a lot of pressure. This pressure frequently results in swelling of the scalp that can be quite impressive, but tends to resolve in a day or two.
This same pressure can also cause bleeding, perhaps because of an insufficient amount of vitamin K available to optimally activate clotting, that collects under the top layer of one or more of the bones of the skull. These cephalohematomas can also be impressive and may take weeks to completely resolve. Rarely the trapped blood becomes calcified and requires surgical correction to remove the otherwise-permanent lump and restore a normal contour to the head.
Newborns very frequently have a molded skull. Depending on the timing and severity of the pressure experienced during delivery, the shape and size of the uterus and positioning of the baby in the womb, the newborn can emerge with a variety of head shapes. The most common one that I see is a cone. If you’re thinking of a classic Saturday Night Live sketch right now, you’ve got the correct mental image.
Babies who are breech also have a distinct pattern of molding which involves a flattened and elongated top of the head because of pressure against the uterine wall. Abnormal positioning in the womb can also result in asymmetric molding of the head and facial structures like the jaw, nose and ear. Fortunately these pressure-induced and positional deformities usually resolve without intervention, often within a few days, but some are serious enough to require intervention and even surgical correction.
Why are the cranial bones of newborns so easily molded by the pressure of birth? This is a question I answer frequently for new parents and inexperienced medical students. The answer will segue us into the primary topic of this post, but before I discuss craniosynostosis, and the sadly unsurprising claims of some in the chiropractic community, a review of normal cranial anatomy is in order. (more…)
[Editor’s note: We have two posts today, this post by our regular contributor Dr. Clay Jones, and an excellent guest post by William London about a chiropractor’s dubious neuropathy treatment protocol. Enjoy today or over the weekend!]
As a pediatrician, even one who has spent the majority of his career caring only for hospitalized children, the death of a patient has been a rare occurrence. There are certainly some pediatric specialties, such as intensive care and oncology, that because of the nature of their patient population must develop a more intimate relationship with the end of life. But compared to the adult world, even their exposure pales in comparison. The most common form of pediatric cancer, acute lymphoblastic leukemia, has a cure rate that is over 90% for example – making the unnecessary death of Makayla Sault after some worthless “treatment” at the Hippocrates Health Institute all the more tragic.
A bit more common in pediatrics are the patients that require significant intervention, and who may come close to death, but recover thanks to advances in modern medicine. These patients, however, are dwarfed by the number of children who receive routine hospital care and recover fairly uneventfully. And most children emerge into adulthood having never had more than a few self-limited viral illnesses and maybe a cavity or two. This wasn’t always the case. In 1900, 10% of 1-year-old children would not make it to adulthood. (more…)