According to the authors of the latest study claiming to demonstrate effectiveness of homeopathic remedies, colds are common in the pediatric population. They further explain that colds and cough symptoms are a frequent impetus for parents to seek pediatric medical care. Finally, they add that evidence in support of decongestants, antihistamines and cough suppressants for the treatment of pediatric cold symptoms is lacking and that there are significant potential risks with their use in young children.
All of this is true and information I give to medical learners and patient caregivers all the time. I only wish they had quit while they were ahead. Sadly, the authors of “A randomized controlled trial of a homeopathic syrup in the treatment of cold symptoms in young children” continued:
One option for treating cold symptoms in young children is with homeopathy. Because the concentrations of active ingredients in homeopathic medications are extremely dilute, they are generally considered to be safe. However, there is a widely held belief that any efficacy related to use of homeopathic remedies is related to a placebo effect.
Steven Novella recently wrote a post discussing an FDA warning against the use of homeopathic teething products over safety concerns related to the possibility of toxic amounts of belladonna. He goes into the hypocrisy of the FDA regulation of homeopathic products, a topic covered numerous times here on Science-Based Medicine, as well as the misleading initial response from Hyland’s, producers of the most popular homeopathic teething remedies in the United States and Canada. There have been some updates over the past two weeks that I’ll cover in this post. (more…)
The FDA recently put out a consumer warning about homeopathic teething gels and pills. The warning states:
The FDA recommends that consumers stop using these products and dispose of any in their possession.
The warning is not because all homeopathic products are inherently useless. As we have discussed here often, the basic principles of homeopathy are pure pseudoscience. The practice of diluting substances so that almost no or no active ingredient remains means that most homeopathic products are just sugar pills. Further, clinical studies show that homeopathic products don’t work. There isn’t a single homeopathic product that has been shown to be effective for a single condition with rigorous clinical trials.
The FDA acknowledges this, writing in their warning:
Homeopathic teething tablets and gels have not been evaluated or approved by the FDA for safety or efficacy. The agency is also not aware of any proven health benefit of the products, which are labeled to relieve teething symptoms in children.
An infant with a left facial nerve palsy
There are numerous medical conditions that are seemingly designed to allow proponents of “irregular medicine” to proclaim their treatments to be effective. These conditions tend to be chronic and subjective in nature, or to have waxing and waning courses such that a parent or patient might easily be fooled into assigning a causal relationship between a bogus intervention and a clinical improvement. Brief, self-limited maladies are also quite convenient for people with nothing to offer but false information and false hope. After a recent encounter with a patient, I’ve added a new one to the list: idiopathic facial nerve palsy.
What is idiopathic facial nerve palsy?
Although not the first to do so, facial nerve dysfunction resulting in the sudden and unexplained weakness of all muscles on one side of the face was most famously described by Scottish neurophysiologist Sir Charles Bell in 1830. Hence it is commonly, if not always accurately, referred to as “Bell’s palsy.” Since then our understanding of the condition has progressed considerably, thanks to scientific investigation and improved diagnostic testing. In particular, we have learned that many cases are the result of infection, with ear infections, various human herpes viruses, and the spirochete responsible for Lyme disease being the most common culprits in children. (more…)
While social media and news outlets were reacting, or in some cases overreacting, to a new rodent-based medical study on the unlikely link between cell phone use and brain cancer last month, two studies and an accompanying commentary were quietly published in Pediatrics that raised similar concerns. Rather than cell phone use, the proposed potential cause of pediatric cancer in these newly published papers was phototherapy, a common treatment for newborn jaundice that I use regularly and have written about before. My previous post has a full review of jaundice in the newborn, how it can potentially cause permanent brain damage, and why phototherapy is a safe and effective treatment in most cases.
But is phototherapy truly safe? Can exposure to a narrow spectrum of blue light increase the risk of cancer in young children? And if so, what type or types of cancer? This is exactly what the study authors set out to investigate using the power of “Big Data.” Time will eventually tell us if the authors’ conclusions are justified or if they will end up only serving as excellent future examples of the Texas Sharpshooter Fallacy. (more…)
Chiropractor Ian Rossborough shown here mid-rationalization
In January, Melbourne chiropractor Ian Rossborough uploaded a video to YouTube of himself treating a 4-day-old premature infant. The video, one of many that can be found on his “Chiropractic Excellence” channel, is for educational purposes only, intended to teach the world about the miraculous benefits of chiropractic care for a wide variety of conditions. Although the cynical among us may proclaim that his videos are just more examples of chiropractic practice building shenanigans, Rossborough claims that he simply wants to “enable natural healthy living, without resorting to drugs or surgery.”
Australian physicians respond
Well, there are apparently a lot of angry and cynical Australians, particularly journalists and physicians. In late April, the video, which features Rossborough manipulating the newborn’s thoracic spine hard enough to cause a loud cracking sound and a cry of pain went viral after it was featured in a story on Australian Broadcasting Corporation Radio National. Rossborough, and the treatment of children by chiropractors, has since come under intense scrutiny.
According to the Australian press, “doctors have declared war on chiropractors” in response to the realization that newborns and young infants are undergoing unnecessary spinal manipulation for problems such as colic, acid reflux, and excessive crying as well as for nebulous benefits like boosting the immune system and improved growth and development. The Royal Australian College of General Practitioners, the largest medical college in Australia with a membership of over 30,000 rural and urban primary care physicians, has even requested that members refrain from referring patients to chiropractors. They want the federal government and private insurers to stop paying for nonsense such as infant chiropractic.
Frank Jones MD, president of the RACGP, has made the media rounds, describing infant and toddler adjustments as “seemingly almost cruel” and lacking any supporting evidence. He has also called for the Chiropractic Board of Australia to shape up in order to have any chance of being accepted as a legitimate scientific discipline. Jones thinks that chiropractors like Rossborough and his ilk don’t know what they are doing and are putting patients at risk. He reminds the public that a physician’s job is to advocate for patients and to try to reduce exposure to practices where the risk far exceeds any potential benefit. I like this guy.
David and Collet Stephan, parents to the now-deceased Ezekiel Stephan.
This is a very sad and tragic case, and I have great sympathy for the extended family of Ezekiel Stephan, the 19-month-old who died of meningitis four years ago. In my opinion, there are many victims in this case.
The jury, apparently, agreed. Yesterday they returned a guilty verdict for Ezekiel’s parents, David and Collet Stephan, who now face sentencing for failing to provide the basic necessities of life to their son. It is reported that many of the jurors were crying when the verdict was given – clearly this was a difficult and emotional case.
Just the facts
As is often the case, there are different narratives of what happened, depending on your perspective. It is likely the jury had access to more facts than the public, and so their verdict, which was clearly difficult, needs to be taken seriously. Here are the basic facts as being reported:
In March of 2012 Ezekiel became ill with flu-like symptoms. His parents report that they thought this was a normal childhood illness and would pass. His mother reported to police that she thought he had croup. They treated him with natural remedies, mostly supplements. (more…)
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…)
A Japanese girl being screen for thyroid cancer.
One of my favorite topics to blog about for SBM is the topic of overdiagnosis and overtreatment. These are two interrelated phenomena that most people are blissfully unaware of. Unfortunately, I’d also say that the majority of physicians are only marginally more aware than the public about these confounders of screening programs, if even that.
Overdiagnosis has long been appreciated to be a major impediment to translating programs to screen for disease into better outcomes in a number of diseases but has only recently really seeped into the public consciousness, beginning in particular in 2009 when the United States Preventative Services Task Force (USPSTF) issued mammography recommendations that pushed back the recommended age to start screening to 50. Certainly, the concept of overdiagnosis is counterintuitive. After all, why do we screen for disease in asymptomatic people? The reason is simple—and maddeningly intuitive. We screen for disease based on the belief that catching potentially deadly diseases like cancer early, before they produce clinical symptoms, will allow earlier intervention and save lives. It seems blindingly obvious that this should be the case, doesn’t it? Unfortunately, real life biology and pathophysiology aren’t quite so neat and tidy, and the relationship between early detection and improved survival is muddied by phenomena such as lead time bias and the Will Rogers effect, in addition to overdiagnosis.
What is overdiagnosis? In brief, it is the detection of pathology or disease that, if left untreated, would never endanger the life of a patient or even harm him. Note that overdiagnosis is not the same thing as a false positive. A false positive occurs when a test detects disease that isn’t really there; in contrast with overdiagnosis there is definite pathology. The disease being screened for is there, at least in an early form. It’s just that, at the very early stage detected, it’s either not progressive or so indolent that the patient will grow old and die of something else before it would ever cause a problem. Indeed, it’s been estimated that as many as one in three breast cancers detected by mammography in asymptomatic women might be overdiagnosed and that one in five might spontaneously regress. However, because we don’t know which ones are unlikely to cause harm and haven’t worked out a safe method of observing them and intervening if they look as though they are progressing, we are obligated to treat them all when discovered. The problem of overdiagnosis has led to multiple alterations in what once were considered definitive recommendations for screening mammography, first by the USPSTF and most recently by the American Cancer Society.
My article “Pediatric Chiropractic Care: The Subluxation Question and Referral Risk” was published in the 2016 February issue of the journal Bioethics. The abstract summarizes the message of the article:
Chiropractors commonly treat children for a variety of ailments by manipulating the spine to correct a “vertebral subluxation” or a “vertebral subluxation complex” alleged to be a cause of disease. Such treatment might begin soon after a child is born. Both major American chiropractic associations─the International Chiropractic Association and the American Chiropractic Association─support chiropractic care for children, care that includes subluxation correction as a treatment or preventive measure. I do not know of any credible evidence to support chiropractic subluxation theory. Any attempt to manipulate the immature, cartilaginous spine of a neonate or a small child to correct a putative chiropractic subluxation should be regarded as dangerous and unnecessary. Referral of a child to a chiropractor for such treatment should not be considered lest a bad outcome harms the child or leads to a charge of negligence or malpractice.1
The first objection to my article came in a January 30 Facebook posting by Milehighchiro, a subluxation-based group: (more…)