I was informed late yesterday that I must place the post I had originally planned for today, which no doubt was destined for a long overdue Science-Based Medicine Pulitzer, on hold. Why? My post involved discussion of a controversial JAMA Pediatrics publication authored by two colleagues of mine, one of which is the Chair of my department, and I have been asked by my employer to refrain from adding additional commentary for the time being.
Perhaps this is a good thing because waiting until the dust has settled will allow a more comprehensive review, particularly after responses from various involved parties, in particular the AAP, have been published. Still, although I can understand their concern, I feel that I must apologize. In the meantime, Slate did an excellent job covering the publication without the use of any distracting and ultimately unhelpful emotional anecdotes or any of the typical false balance we frequently encounter. Clearly they don’t answer to my hospital’s PR department.
In the place of my intended post, please enjoy the following collection of hastily assembled pseudomedical odds and ends brought to my attention over the past few weeks.
Psychic ear acupuncture for neonatal withdrawal?
You read that correctly, but sadly it isn’t this kind of psychic acupuncture. I mean psychic as in psychological, as opposed to somatic (from the body) or paranormal (from the nutter). Sorry for the confusion but you’ll understand soon enough.
I’ve written about the use of ear acupuncture in the management of neonates and infants at risk for or suffering from opioid withdrawal in the past. In summation, it is a clinically useless and unethical waste of time. But believers in pseudomedical nonsense are not easily swayed and there is no shortage of “evidence-based medicine” for them to cling to.
The Journal of Alternative and Complementary Medicine has a track record of publishing all manner of inanity, and investigations into neonatal ear acupuncture are no exception. In 2010, German researchers at a university teaching hospital published a paper on their use of a stud finder neuronal pen acupuncture point detector to “determine the presence and absence of acupuncture ear points in neonates with neonatal abstinence syndrome (NAS).” To absolutely nobody’s surprise, they found some in each of the 5 withdrawing newborns and concluded that “for the first time it is possible to identify psychic ear acupuncture points in neonates.”
The authors imagined that the “In the future it could be possible to use active ear points in neonates for diagnostic and therapeutic options.” Fast forward six years to earlier this month and some of the same researchers, at the same facility, published data, in the same journal, on 31 more newborns diagnosed with NAS that were found to have the same active acupuncture points using the same acupuncture point detector. They concluded that “The activity of psychic ear acupuncture points may be specific for neonates with NAS.” Of note, one baby was excluded because his mother had been weaned off of narcotics prior to delivery, but just to be safe they checked for acupuncture points anyway and found none.
So is there anything to the use of an acupuncture point locating device to determine if a baby is undergoing withdrawal? I hope so, because NAS can be subtle at first. And while many babies demonstrate tell-tale signs soon after delivery, in the case of maternal use of longer-acting agents for the treatment of opioid addiction, withdrawal can develop days after delivery. So we often have to keep a baby in the hospital under close observation long after their mother has been discharged home. It would be wonderful to have the ability to know which babies to keep in house and which to discharge home with mom.
But in order to accept that these devices work, we would need to make a lot of assumptions. First and foremost we would need to assume that acupuncture points exist in the first place, which already puts us on shaky ground. And if they do exist, we would need to assume that they alter the electrical conductivity in the skin as measured by a simple device, which if true would be surprising considering how meridians and acupuncture points make Bigfoot look gregarious by comparison.
Then we would need to assume that these acupuncture points, once detected, are reliably stable in their location and not just a transient or migratory phenomenon. And if stable, we would need to assume that they could be used to consistently determine the existence of underlying health problems. Once clearly demonstrated to serve as a real, reliable, and valid dashboard warning light for the human body, we would have to figure out if they serve as indications for general health problems or disease in specific organs or regions of the body. Science is hard!
In case you haven’t figured it out already, all these assumptions add up to equal an extremely low prior plausibility. And none of these assumptions has any reasonable evidence supporting them. Furthermore, measuring electrodermal activity is a common component of a variety of pseudoscientific health claims as well as Scientology e-meters and lie detectors. And as Steve Novella discusses in a 2015 post, it is essentially a measurement of how sweaty the skin is and is very prone to influence by a variety of environmental factors as well as the bias of the person doing the testing. Pressing a little harder over the spot one expects to see a change, for example, may be enough to cause the device in question to light up.
Using a device that measures electrodermal activity to detect acupuncture points is no different than using an EMF meter to hunt for ghosts.
Seriously, more cupping nonsense?
Cupping isn’t just for elite Olympic athletes with more medals than neurons. Sadly, this prescientific hickey-inducing therapy is being used on children for virtually every possible health complaint, including some real and potentially very deadly conditions. According to “Dr.” of Chinese Medicine Suzy McCleary on AcuKids.com, we should consider cupping before reaching for “the drugs.”
Cupping is generally recommended for the treatment of pain, gastrointestinal disorders, lung diseases (especially chronic cough and asthma), and paralysis. It is also very helpful for the treatment of headaches and migraines, digestive disorders (constipation, abdominal tension), menstrual disorders (cramps), respiratory problems (cough, allergies), as well as being very beneficial for reducing stress and anxiety, improving energy and helps to calm hyperactive behaviour in children.
McCreary’s website has one of the biggest and most comprehensive disclaimers I’ve ever seen. A simple “I’m full of crap.” would have sufficed. Wait, paralysis?
McCreary is also a proponent of something called Shonishin, a non-invasive form of acupuncture that involves gently massaging a child with little metal instruments. As with cupping, it appears to fix nothing everything, and is particularly effective during a full moon:
Full Moon treatments are given each month on or just before the full moon for general wellness. It is during this time that children are more sensitive to change. Often, symptoms that are hidden during the rest of the month become more apparent during this time. The same way the full moon affects the tides, it affects people too –especially children!
Children often develop fevers, grow taller, or have a tooth break through the gum at this time of the month. It is because of their increased sensitivity that children respond quickly when treated with the building energy of the full moon.
Abdominal complaints appear to be a common focus of kid cuppers. Pediatric cupologists? Here is an example that involves flaming alcohol swabs held inches from a constipated child’s abdomen. And another.
In this case, an 11-year-old child developed severe ulceration and infection after a cupping session for her eczema.
Kinesio tape for newborns?
Kinesio tape (KT) was a prominent feature of the 2008 Beijing and 2012 London Summer Olympics, especially during sports that require less clothing equipment. And although it was overshadowed by cupping in Rio, it is still a popular pseudoscience among athletes despite a lack of much actual benefit beyond that of standard tape. It doesn’t reduce pain, increase strength, improve blood flow or increase lymphatic drainage, and it won’t restart your heart. Okay, that last one was satire.
Despite being nothing more than tape that is a bit stretchier and more colorful, KT is also being used on children for a variety of musculoskeletal conditions:
Infants and children with developmental delays, central nervous system dysfunction, brain injury, movement disorders and more can benefit from the ongoing use of kinesiology tape. Specific conditions that have responded positively to kinesiology taping include toe hypotonia, toe clawing, joint hypermobility, hemiplegia, brachial plexus injury and torticollis. Conditions involving low muscle tone can be taped to activate weak muscles as well as assist with postural control.
There are numerous websites touting anecdotal benefit of KT in pediatric physical and occupational therapy, and several published case reports and series, but no properly blinded controlled studies. Here is one example involving a premature infant with feeding difficulty, a common problem that often improves over a short period of time once a certain level of developmental maturity is reached. Ultimately there is no reason to think that KT would be any more likely to work in children than it is in adults, where there is considerably more available evidence showing its lack of clinical usefulness.
Conclusion: Triple the fun nonsense
There you have it, three examples of so-called soft targets in the fight against pseudoscience in medicine. But two of these can result in very real harm. Children being treated with acupuncture for neonatal abstinence syndrome, something that unfortunately requires subjective assessments of discomfort, may be less likely to receive proven medical treatment if caregivers are biased by a belief in nonsense. Cupping isn’t simply a waste of time but a possible cause of serious injury to a child’s skin and, like acupuncture, a potential cause of delay in seeking real medical care for a child suffering from an asthma exacerbation. Finally, although kinesio taping is silly and unlikely to be used for urgent medical conditions in children, it adds to the growing list of unscientific interventions eroding our societal understanding of and appreciation for science-based medicine.
An Unexpected Miscellany of Medical Malarkey Clay Jones
No comments:
Post a Comment