MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Exactly 20 years ago, I published a review concluding that the generally high and possibly growing prevalence of complementary/alternative medicine use by children renders this topic an important candidate for rigorous investigation. Since then, many papers have emerged, and most of them are worrying in one way or another. Here is the latest one.

This Canadian survey assessed chiropractic (DC) and naturopathic doctors’ (ND) natural health product (NHP) recommendations for paediatric care. It was developed in collaboration with DC and ND educators, and delivered as an on-line national survey. NHP dose, form of delivery, and indications across paediatric age ranges (from newborn to 16 years) for each practitioner’s top five NHPs were assessed. Data were analysed using descriptive statistics, t-tests, and non-parametric tests.

Of the 421 respondents seeing one or more paediatric patients per week, 172 (41%, 107 DCs, 65 NDs) provided 440 NHP recommendations, categorized as:

  • vitamins and minerals (89 practitioners, 127 recommendations),
  • probiotics (110 practitioners, 110 recommendations),
  • essential fatty acids (EFAs: 72 practitioners, 72 recommendations),
  • homeopathics (56 practitioners, 66 recommendations),
  • botanicals (29 practitioners, 31 recommendations),
  • other NHPs (33 practitioners, 34 recommendations).

Indications for the NHP recommendations were tabulated for NHPs with 10 or more recommendations in any age category:

  • 596 total indications for probiotics,
  • 318 indications for essential fatty acids,
  • 138 indications for vitamin D,
  • 71 indications for multi-vitamins.

Good evidence regarding the efficacy, safety, and dosing for NHP use in children is scarce or even absent. Therefore, the finding that so many DCs and NDs recommend unproven NHPs for use in children is worrying, to say the least. It seems to indicate that, at least in Canada, DCs and NDs are peddling unproven, mostly useless  and potentially harmful children.

In an earlier, similar survey the same group of researchers had disclosed that the majority of Canadian DCs and NDs seem to see infants, children, and youth for a variety of health conditions and issues, while, according to their own admission, not having adequate paediatric training.

Is this a Canadian phenomenon? If you think so, read this abstract:

AIM:

This systematic review is aimed at estimating the prevalence of complementary and alternative medicine (CAM)-use by paediatric populations in the United Kingdom (UK).

METHOD:

AMED, CINAHL, COCHRANE, EMBASE and MEDLINE were searched for English language peer-reviewed surveys published between 01 January 2000 and September 2011. Additionally, relevant book chapters and our own departmental files were searched manually.

RESULTS:

Eleven surveys were included with a total of 17,631 paediatric patients. The majority were of poor methodological quality. Due to significant heterogeneity of the data, a formal meta-analysis was deemed inappropriate. Ten surveys related to CAM in general, while one was specifically on homeopathy. Across all surveys on CAM in general, the average one-year prevalence rate was 34% and the average lifetime prevalence was 42%. In surveys with a sample size of more than 500, the prevalence rates were considerably lower than in surveys with the sample size of lower than 500. Herbal medicine was the most popular CAM modality, followed by homeopathy and aromatherapy.

CONCLUSIONS:

Many paediatric patients in the UK seem to use CAM. Paediatricians should therefore have sufficient knowledge about CAM to issue responsible advice.

This means, I fear, that children are regularly treated by SCAM practitioners who are devoid of the medical competence to do so, and  who prescribe or recommend treatments of unknown value, usually without the children needing them.

Why are regulators not more concerned about this obvious abuse?

16 Responses to Children are regularly (mis)treated by practitioners who do not have adequate competence to do so

  • Law and politics.

    I understand this from the UK perspective of bogus cures/treatments for autism. In particular CEASE therapy. The problem in the UK is that no single regulator has responsibility. This is highlighted by the Westminster Commission on Autism short report “”A Spectrum of Harmful Interventions for Autism” (see https://network.autism.org.uk/content/westminster-commission-autism-reports-harmful-interventions ). It is very clear that although regulators may acknowledge the potential harms it poses, they are not terribly willing to act in a timely way, if at all. It’s not clear why this is but it is enabled by legislation that is no longer fit for purpose. I’ve written on my blog about why quackery is legally permitted in the UK (see https://ukhomeopathyregulation.blogspot.com/2018/11/why-is-quackery-legal-in-uk.html ).

    There seems to be no desire to change the law on the part of politicians. This is possibly because they don’t see a problem. It might also be the case that politicians believe there are votes in CAM. Whilst there are a tiny minority that are extremely vocal, they are hardly likely to vote purely on whether a candidate is proponent of CAM or not. A change to law is what it would take to offer genuine protection not just to children but other vulnerable groups. Other countries have much more restrictive laws on the practice of CAM by medically unqualified lay persons. France totally prohibits it, Norway prohibits advertising and treatment of serious conditions, Sweden prohibits treatment of certain conditions and vulnerable groups.

    It’s been suggested that some politicians and senior civil servants are reluctant to deal with issues relating to CAM because of Prince Charles.

  • “Why are regulators not more concerned about this obvious abuse?”

    I style the issue: “The Mao Gambit”.

    Mao Zedong did not use TCM (by his own admission), but he simply had to provide the vast populace with some sort of healthcare on the time honoured political principle that “something is better than nothing.”
    Hence his bare-foot doctors.
    Additionallly, the market for TCM is in billions, and rising expotentially.

    Ohio has such a problem with opiates that it covers acupuncture care by its Medicaid – even though there is no evidence of clinical (as opposed to emotional or psychological) benefit.

    The Swiss government covers a number of CAMs (including homeopathy) with its state insurance scheme – though I believe those who want such access do have to pay a supplementary premium.

    The NHS will still cover homeopathic remedies for those who would suffer significant psychological distress were they to be denied. And still allows referral for acupuncture and Reiki.

    MPs voted to have a well-known advocate for homeopathy (and astrology) on Parliament’s Health Select Committee.

    All this just to keep the populace quiet – or at any rate, those who are hard of thinking, gullible, vulnerable, quacks, who lobby hardest and shout loudest or whose mother is Head of State (and his sychophants).

    Currently, Secretary of State Matt Hancock is very wound up about the implications of anti-vaccination, but has done nothing to rectify or change the mind-set of those who endorse camistry. And his predecessor Jeremey Hunt was notorious for having endorsed homeopathy, (only later grudgingly indicating he would “follow the science”).

    It was Lenin who opined: “Religion is the opiate of the people.”
    So too, SCAMs.
    Regulators and politicians want an easy life.
    Science is too hard a taskmaster – it requires evidence.

    Apologies for cynicism, but c’est la vie!

  • Pot calling the kettle black?

    Most drugs prescribed for children have not been tested in children. Before the Food and Drug Administration initiated a pediatric program, only about 20 percent of drugs approved by the FDA were labeled for pediatric use. By necessity, doctors have routinely given drugs to children “off label,” which means the drug has not been approved for use in children based on the demonstration of safety and efficacy in adequate, well-controlled clinical trials.

    https://www.fda.gov/Drugs/ResourcesForYou/Consumers/ucm143565.htm

    • @DC

      Have you tried applying the standards you expect from medicine, to chiropractic manipulation? If neck manipulation were a drug, would it still be on the market? What do you think?

      • Bjorn…If neck manipulation were a drug, would it still be on the market?

        Apparently some dont share your benefit risk conclusion

        “Multimodal care Clinicians may consider a maximum of
        six sessions over 8 weeks of multimodal care that includes
        range of motion exercise and manual therapy (manipulation
        or mobilization to the cervical and/or thoracic spine as
        clinically indicated) [16]. This recommendation is based on
        our systematic review [16] that identified 14 low risk of bias
        RCTs examining the effectiveness of multimodal care for
        NAD [46, 49–64]. This body of evidence suggests that the
        effective multimodal programs of care included exercise,
        manual therapy, and education [16]. On average, effective
        multimodal care was achieved within six visits over
        8 weeks [16]. Cost-effectiveness data suggest that exercise
        and manual therapy is more cost-effective than two other
        programs of multimodal care (i.e., a program with exercise,
        traction, soft tissue therapy, and passive physical modalities
        or a program with advice and analgesics) [65].

        https://www.researchgate.net/publication/298907851_Management_of_neck_pain_and_associated_disorders_A_clinical_practice_guideline_from_the_Ontario_Protocol_for_Traffic_Injury_Management_OPTIMa_Collaboration

        • @DC

          Your reply is irrelevant. Why don’t you answer the question?

          • cSMT is not a drug so I can’t answer the question.

          • @DC
            What is the problem? Do you not want to answer the question or hat is it you do not understand??

          • I dont know the drug process.

            But if i were to guess the most they would do is put a label on it…

            “Restricted utilization to highly trained professionals.”

          • I do know what you call ‘the drug process’.
            and I think that spinal manipulation would long have been taken off the market because of lack of efficacy and concerns over safety.

  • DC:
    Tu quoque is a logical fallacy.

  • In order for my question to be classified as a fallacy you would have to show it is a loaded question.

    https://www.fallacyfiles.org/taxonomy.html

    But if it you want to call my question a logical fallacy, i dont care.

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