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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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The Time a Pulitzer Prize Winning Journalist Got Manipulated by a Chiropractor

docbrown

You have WiFi allergy, chronic Lyme, multiple chemical sensitivity, and menopause!

Katherine Ellison won a Pulitzer Prize in 1985, not for science journalism but for coverage of the monetary mayhem perpetrated by Ferdinand and Imelda Marcos on the people of the Philippines. I was nine at the time and have little recollection of the impact of her work, but I will assume that it was meaningful in light of the award. And she went on to win numerous additional accolades for her writing on politics, economics, and human rights.

Her most recent work, “Chiropractic Care Grows, and Gains Acceptance“, will likely not be considered for any journalism awards. The article, published on the New York Times Health and Wellness blog, reveals a terribly flawed understanding of chiropractic practice and philosophy and a preternatural ability to interpret fleecing at the hands of an obvious quack as a positive experience. She displays few if any signs of an ability to think critically when it comes to medicine and gives no indication of having done more than cursory research on the subject of chiropractic.

Sometimes the apple does fall far from the tree

The inspiration for Ellison’s article was a trip to the chiropractor after having injured her tail bone during a spin class. She does this despite having grown up with a surgeon father who apparently did not think highly of “alternative healers,” particularly chiropractors. Right off the bat she brings up the history of the AMA’s stance on the chiropractic profession:

Of course, this was in the 1960s, when the American Medical Association was still waging war on the profession via its Committee on Quackery, which labeled chiropractors as an “unscientific cult.”

And:

The A.M.A.’s Committee on Quackery is long defunct, having gone out of existence after a lawsuit by chiropractors led to a 1987 federal district judge’s ruling that the medical association had tried to destroy the chiropractic profession.

Well, not exactly. The AMA absolutely was vehemently opposed to chiropractic and its practitioners and, as Dr. Harriet Hall describes, they are far from beyond reproach in the methods they used. In fact, I think you would be hard pressed to find anyone that would defend their tactics today. But the Committee on Quackery actually disbanded in 1974, two years prior to the filing of the infamous Wilk v. AMA antitrust lawsuit and at a time when all 50 states were licensing chiropractors. Louisiana, as backwards as my home state can be when it comes to science and medicine, was the last to give in that same year.

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Posted in: Science and Medicine, Science and the Media

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“Magic Socks?” Alternative Medicine’s Obsession With Your Feet.

earthing

Inappropriate earthing technique?

I recently received an email from none other than Jann Bellamy pointing out a particular flavor of naturopathic nonsense that I had missed up until this point: “magic socks.” A quick search revealed that our own Scott Gavura had briefly mentioned this remedy in a 2013 post, but I plan on going into much greater detail. The claim contained in the newsletter attached to Jann’s email involved the use of said magic socks to “alleviate congestion.” Three links were thoughtfully provided for more information and I took the bait. Thanks Jann.

That’s right, magic socks!

The first link took me to the website of Bastyr University, where Britt Hermes matriculated to the tune of $300,000 and a leader in “innovation in natural health education” that offers numerous degrees in “science-based natural medicine.” According to the experts at Bastyr, wet sock treatment, apparently synonymous with “magic socks”, is “a natural method of stimulating the immune system and zapping a cold or flu” that involves forcing a child to don ice-cold socks overnight. They even admit that this is a treatment approach recommended regularly by the naturopathic physicians at Bastyr Center for Natural Health.

According to the chief medical officer at BCNH (seems like there should be an asterisk there or something), we shouldn’t be thrown by how much this sounds like complete and utter nonsense, because it works. He reassures us that magic socks “rally the body’s defenses” using the healing power of nature. And it’s free! All you need is water, socks, a freezer, and some electricity. Okay, so it isn’t free but it’s pretty darn cheap. (more…)

Posted in: Naturopathy, Science and Medicine

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A “Natural Cure” for Eczema Leaves a Young Child in Agony…..

polarbear3

“I swear I had nothing to do with this!”

A short post today, for me at least, but an important one to file away for the next time somebody asks “What’s the harm?” during a discussion on the use of irregular medicine in the care of pediatric (or any) patients.

The case

The September 2015 issue of Pediatrics in Review, the official American Academy of Pediatrics source for continuing medical education, contains a case report that should be of particular interest to readers of Science-Based Medicine. The authors, pediatricians at Children’s Hospital at Albany Medical Center, describe the ordeal of a six-year-old boy, previously healthy except for eczema, suffering with lower extremity pain to the point of crying with attempts to walk or to even bear weight. For those of you who don’t have experience with children of this age, it takes a considerable amount of discomfort or disability to interfere with their determination to remain in a near constant state of motion. Refusal to bear weight is a red flag that we take very seriously as the cause in a young child is often serious, ranging from traumatic injuries and severe infections of the bones or joints to diagnostic dilemmas such as leukemia and juvenile rheumatoid arthritis. (more…)

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New Study on Homeopathic Cough Syrup for Children Reveals a Lack of Effectiveness and Ethics

coughkid

Just say no to homeopathic cough syrup! Actually, avoid all cough syrups.

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…)

Posted in: Ethics, Homeopathy, Science and Medicine

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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!]

SVT

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.
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Posted in: Chiropractic, Science and Medicine

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Separating Fact from Fiction in the Newborn Nursery: Hepatitis B Vaccine for Newborns

hepbincidence

Hmm, what could have happened in the early 90s to explain the significant decrease in incidence of acute hepatitis B? Urkel?

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.
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Posted in: Science and Medicine

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The Windi: Revolutionary Relief for Colic or a Pain in the Butt

windi

Stand back.

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…)

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Chiropractic Manipulation of the Neck Linked to Stroke in a 6-Year-Old Child…

neckjer

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…)

Posted in: Chiropractic, Science and Medicine

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