children
As most of us know, the use of so-called alternative medicine (SCAM) can be problematic; its use in children is often most problematic:
- There are hardly any SCAMs that have been shown to work for paediatric conditions.
- Most SCAMs can cause considerable harm to children.
- Some might even amount to child abuse.
- Most SCAM practitioners lack adequate training to treat children.
- Many SCAM providers offer dangerous advice to parents.
- Parents are sometimes unable to differentiate between nonsense and medicine.
- Informed consent can present a trick subject when treating children.
In this context, the statement from the ‘Spanish Association Of Paediatrics Medicines Committee’ is of particular value and importance:
Currently, there are some therapies that are being practiced without adjusting to the available scientific evidence. The terminology is confusing, encompassing terms such as “alternative medicine”, “natural medicine”, “complementary medicine”, “pseudoscience” or “pseudo-therapies”. The Medicines Committee of the Spanish Association of Paediatrics considers that no health professional should recommend treatments not supported by scientific evidence. Also, diagnostic and therapeutic actions should be always based on protocols and clinical practice guidelines. Health authorities and judicial system should regulate and regularize the use of alternative medicines in children, warning parents and prescribers of possible sanctions in those cases in which the clinical evolution is not satisfactory, as well responsibilities are required for the practice of traditional medicine, for health professionals who act without complying with the “lex artis ad hoc”, and for the parents who do not fulfill their duties of custody and protection. In addition, it considers that, as already has happened, Professional Associations should also sanction, or at least reprobate or correct, those health professionals who, under a scientific recognition obtained by a university degree, promote the use of therapies far from the scientific method and current evidence, especially in those cases in which it is recommended to replace conventional treatment with pseudo-therapy, and in any case if said substitution leads to a clinical worsening that could have been avoided.
Of course, not all SCAM professions focus on children. The following, however, treat children regularly:
- acupuncturists
- anthroposophical doctors
- chiropractors
- craniosacral therapists
- energy healers
- herbalists
- homeopaths
- naturopaths
- osteopaths
I believe that all SCAM providers who treat children should consider the above statement very carefully. They must ask themselves whether there is good evidence that their treatments generate more good than harm for their patients. If the answer is not positive, they should stop. If they don’t, they should realise that they behave unethically and quite possibly even illegally.
Treating children is an important income stream for chiropractors and osteopaths. There is plenty of evidence to suspect that their spinal manipulations generate more harm than good; on this blog, we have discussed this problem more often than I care to remember (see for instance here, here, here, here and here). Yet, osteopaths and chiropractors carry on misleading parents to abuse their children with ineffective and dangerous spinal manipulations. A new and thorough assessment of the evidence seems to confirm this suspicion.
This systematic review evaluated the evidence for effectiveness and harms of specific SMT techniques for infants, children and adolescents. Controlled studies, describing primary SMT treatment in infants (<1 year) and children/adolescents (1-18 years), were included to determine effectiveness.
Of the 1,236 identified studies, 26 studies were eligible. Infants and children/adolescents were treated for various (non-)musculoskeletal indications, hypothesized to be related to spinal joint dysfunction. Studies examining the same population, indication and treatment comparison were scarce. The results showed that:
- Due to very low quality evidence, it is uncertain whether gentle, low-velocity mobilizations reduce complaints in infants with colic or torticollis, and whether high-velocity, low-amplitude manipulations reduce complaints in children/adolescents with autism, asthma, nocturnal enuresis, headache or idiopathic scoliosis.
- Five case reports described severe harms after HVLA manipulations in 4 infants and one child. Mild, transient harms were reported after gentle spinal mobilizations in infants and children, and could be interpreted as side effect of treatment.
The authors concluded that due to very low quality of the evidence, the effectiveness of gentle, low-velocity mobilizations in infants and HVLA manipulations in children and/or adolescents is uncertain. Assessments of intermediate outcomes are lacking in current pediatric SMT research. Therefore, the relationship between specific treatment and its effect on the hypothesized spinal dysfunction remains unclear. Gentle, low-velocity spinal mobilizations seem to be a safe treatment technique. Although scarcely reported, HVLA manipulations in infants and young children could lead to severe harms. Severe harms were likely to be associated with unexamined or missed underlying medical pathology. Nevertheless, there is a need for high quality research to increase certainty about effectiveness and safety of specific SMT techniques in infants, children and adolescents. We encourage conduction of controlled studies that focus on the effectiveness of specific SMT techniques on spinal dysfunction, instead of concluding about SMT as a general treatment approach. Large observational studies could be conducted to monitor the course of complaints/symptoms in children and to gain a greater understanding of potential harms.
The situation regarding spinal manipulation for children might be summarised as follows:
- Spinal manipulations are not demonstrably effective for paediatric conditions.
- They can cause serious direct and indirect harm.
- Chiropractors and osteopaths are not usually competent to treat children.
- They nevertheless treat children regularly.
In my view, this is unethical and can amount to child abuse.
In Switzerland, so-called alternative medicine (SCAM) is officially recognised within the healthcare system and mainly practised in conjunction with conventional medicine. So far no research has been published into the attitude towards, training in and offer of SCAM among paediatricians in Switzerland. This survey addresses this gap by investigating these topics with an online survey of paediatricians in Switzerland.
It employed a 19-item, self-reporting questionnaire among all ordinary and junior members of the Swiss Society of Paediatrics (SSP). A comparison of the study sample with the population of all paediatricians registered with the Swiss Medical Association (FMH) allowed an assessment of the survey’s representativeness. The data analysis was performed on the overall group level as well as for predefined subgroups (e.g. sex, age, language, workplace and professional experience).
A total of 1890 paediatricians were approached and 640, from all parts of Switzerland, responded to the survey (response rate 34%). Two thirds of respondents were female, were aged between 35 and 55 years, trained as paediatric generalist and worked in a practice. Apart from young paediatricians in training, the study sample was representative of all Swiss paediatricians.
According to the authors’ statistics, the results suggest that
- 23% had attended training in SCAM, most frequently in phytotherapy, homeopathy, acupuncture/traditional Chinese medicine (TCM) and anthroposophic medicine
- 8% had a federal certificate in one or more SCAM methods.
- 44% did not routinely ask their patients about their use of SCAM.
- 84% did not offer SCAM.
- 65% were interested in SCAM courses and training.
- 16% provided SCAM services to their patients.
- 97% were asked by patients/parents about SCAM therapies.
- More than half of the responding paediatricians use SCAM for themselves or their families.
- 42% were willing to contribute to paediatric SCAM research.
The authors concluded that in a representative sample of paediatricians in Switzerland, the overall attitude towards SCAM was positive, emphasised by great interest in SCAM training, willingness to contribute to SCAM research and, in particular, by the high rate of paediatricians using SCAM for themselves and their families. However, given the strong demand for SCAM for children, the rate of paediatricians offering SCAM is rather low, despite the official recognition of SCAM in Switzerland. Among the various reasons for this, insufficient knowledge and institutional barriers deserve special attention. The paediatricians’ great interest in SCAM training and support for SCAM research offer key elements for the future development of complementary and integrative medicine for children in Switzerland.
SCAM suffers from acute survey mania. I am anxiously waiting for a survey of SCAM use in left-handed, diabetic policemen in retirement from Devon. But every other variation of the theme has been exploited. And why not? It provides the authors with a most welcome addition to their publication list. And, of course, it lends itself very nicely to SCAM-promotion. Sadly, there is not much else that such surveys offer.
Except perhaps for an opportunity to do an alternative evaluation of their results. Here is an assessment the devil’s advocate in me proposes. Based on the reasonable assumption that those 34% of paediatricians who responded did so because they had an interest in SCAM, and the 64% who did not reply couldn’t care less, it is tempting to do an analysis of the entire population of Swiss paediatricians. Here are my findings:
- Hardly anyone had attended training in SCAM.
- Hardly anyone had a federal certificate in one or more SCAM methods.
- Very few did not routinely ask their patients about their use of SCAM.
- Hardly anyone offered SCAM.
- Very few were interested in SCAM courses and training.
- Hardly anyone provided SCAM services to their patients.
- Quite a few were asked by patients/parents about SCAM therapies.
- Very few paediatricians use SCAM for themselves or their families.
- Few were willing to contribute to paediatric SCAM research.
These results might be closer to the truth but they have one very important drawback: they do not lend themselves to drawing the SCAM-promotional conclusions formulated by the authors.
Oh Yes, reality can be a painful thing!
This press-release caught my attention:
Following the publication in Australia earlier this year of a video showing a chiropractor treating a baby, the Health Minster for the state of Victoria called for the prohibition of chiropractic spinal manipulation for children under the age of 12 years. As a result, an independent panel has been appointed by Safer Care Victoria to examine the evidence and provide recommendations for the chiropractic care of children.
The role of the panel is to (a) examine and assess the available evidence, including information from consumers, providers, and other stakeholders, for the use of spinal manipulation by chiropractors on children less than 12 years of age and (b) provide recommendations regarding this practice to the Victorian Minister for Health.
Members of the public and key stakeholders, including the WFC’s member for Australia, the Australia Chiropractors Association (AusCA), were invited to submit observations. The AusCA’s submission can be read here…
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This submission turns out to be lengthy and full of irrelevant platitudes, repetitions and nonsense. In fact, it is hard to find in it any definitive statements at all. Here are two sections (both in bold print) which I found noteworthy:
1. There is no need to restrict parental or patient choice for chiropractic care for children under 12 years of age as there is no evidence of harm. There is however, expressed outcome of benefit by parents70 who actively choose chiropractic care for their children …
No evidence of harm? Really! This is an outright lie. Firstly, one has to stress that there is no monitoring system and that therefore we simply do not learn about adverse effects. Secondly, there is no reason to assume that the adverse effects that have been reported in adults are not also relevant for children. Thirdly, adverse effects in children have been reported; see for instance here. Fourthly, we need to be aware of the fact that any ineffective therapy causes harm by preventing effective therapies from being applied. And fifthly, we need to remember that some chiropractors harm children by advising their parents against vaccination.
2. Three recent systematic reviews have focused on the effectiveness of manual therapy for paediatric conditions. For example, Lanaro et al. assessed osteopathic manipulative treatment for use on preterm infants. This systematic review looked at five clinical trials and found a reduction of length of stay and costs in a large population of preterm infants with no adverse events (96).
Carnes et al.’s 2018 systematic review focused on unsettled, distressed and excessively crying infants following any type of manual therapy. Of the seven clinical trials included, five involved chiropractic manipulative therapy; however, meta-analyses of outcomes were not possible due to the heterogeneity of the clinical trials. The review also analysed an additional 12 observational studies: seven case series, three cohort studies, one service evaluation survey, and one qualitative study. Overall, the systematic review concluded that small benefits were found. Additionally, the reporting of adverse events was low. Interestingly, when a relative risk analysis was done, those who had manual therapy were found to have an 88% reduced risk of having an adverse event compared to those who did not have manual therapy (97).
A third systematic review by Parnell Prevost et al. in 2019 evaluated the effectiveness of any paediatric condition following manual therapy of any type and summarizes the findings of studies of children 18 years of age or younger, as well as all adverse event information. While mostly inconclusive data were found due to lack of high-quality studies, of the 32 clinical trials and 18 observational studies included, favourable outcomes were found for all age groups, including improvements in suboptimal breastfeeding and musculoskeletal conditions. Adverse events were mentioned in only 24 of the included studies with no serious adverse events reported in them (98).
(96) Lanaro D, Ruffini N, Manzotti A, Lista G. Osteopathic manipulative treatment showed reduction of length of stay and costs in preterm infants: A systematic review and meta-analysis. Medicine (Baltimore). 2017; 96(12):e6408 10.1097/MD.0000000000006408.
(97) Carnes D, Plunkett A, Ellwood J, Miles C. Manual therapy for unsettled, distressed and excessively crying infants: a systematic review and meta-analyses. BMJ Open 2018;8:e019040. doi:10.1136/bmjopen-2017-019040.
(98) Parnell Prevost et al. 2019.
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And here are my comments:
(96) Lanaro et al is about osteopathy, not chiropractic (4 of the 5 primary trials were by the same research group).
(97) The review by Carnes et al has been discussed previously on this blog. This is what I wrote about it at the time:
The authors concluded that some small benefits were found, but whether these are meaningful to parents remains unclear as does the mechanisms of action. Manual therapy appears relatively safe.
For several reasons, I find this review, although technically sound, quite odd.
Why review uncontrolled data when RCTs are available?
How can a qualitative study be rated as high quality for assessing the effectiveness of a therapy?
How can the authors categorically conclude that there were benefits when there were only 4 RCTs of high quality?
Why do they not explain the implications of none of the RCTs being placebo-controlled?
How can anyone pool the results of all types of manual therapies which, as most of us know, are highly diverse?
How can the authors conclude about the safety of manual therapies when most trials failed to report on this issue?
Why do they not point out that this is unethical?
My greatest general concern about this review is the overt lack of critical input. A systematic review is not a means of promoting an intervention but of critically assessing its value. This void of critical thinking is palpable throughout the paper. In the discussion section, for instance, the authors state that “previous systematic reviews from 2012 and 2014 concluded there was favourable but inconclusive and weak evidence for manual therapy for infantile colic. They mention two reviews to back up this claim. They conveniently forget my own review of 2009 (the first on this subject). Why? Perhaps because it did not fit their preconceived ideas? Here is my abstract:
Some chiropractors claim that spinal manipulation is an effective treatment for infant colic. This systematic review was aimed at evaluating the evidence for this claim. Four databases were searched and three randomised clinical trials met all the inclusion criteria. The totality of this evidence fails to demonstrate the effectiveness of this treatment. It is concluded that the above claim is not based on convincing data from rigorous clinical trials.
Towards the end of their paper, the authors state that “this was a comprehensive and rigorously conducted review…” I beg to differ; it turned out to be uncritical and biased, in my view. And at the very end of the article, we learn a possible reason for this phenomenon: “CM had financial support from the National Council for Osteopathic Research from crowd-funded donations.”
(98) Parnell et al was easy to find despite the incomplete reference in the submission. This paper has also been discussed previously. Here is my post on it:
This systematic review is an attempt [at] … evaluating the use of manual therapy for clinical conditions in the paediatric population, assessing the methodological quality of the studies found, and synthesizing findings based on health condition.
Of the 3563 articles identified through various literature searches, 165 full articles were screened, and 50 studies (32 RCTs and 18 observational studies) met the inclusion criteria. Only 18 studies were judged to be of high quality. Conditions evaluated were:
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- attention deficit hyperactivity disorder (ADHD),
- autism,
- asthma,
- cerebral palsy,
- clubfoot,
- constipation,
- cranial asymmetry,
- cuboid syndrome,
- headache,
- infantile colic,
- low back pain,
- obstructive apnoea,
- otitis media,
- paediatric dysfunctional voiding,
- paediatric nocturnal enuresis,
- postural asymmetry,
- preterm infants,
- pulled elbow,
- suboptimal infant breastfeeding,
- scoliosis,
- suboptimal infant breastfeeding,
- temporomandibular dysfunction,
- torticollis,
- upper cervical dysfunction.
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Musculoskeletal conditions, including low back pain and headache, were evaluated in seven studies. Only 20 studies reported adverse events.
The authors concluded that fifty studies investigated the clinical effects of manual therapies for a wide variety of pediatric conditions. Moderate-positive overall assessment was found for 3 conditions: low back pain, pulled elbow, and premature infants. Inconclusive unfavorable outcomes were found for 2 conditions: scoliosis (OMT) and torticollis (MT). All other condition’s overall assessments were either inconclusive favorable or unclear. Adverse events were uncommonly reported. More robust clinical trials in this area of healthcare are needed.
There are many things that I find remarkable about this review:
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- The list of indications for which studies have been published confirms the notion that manual therapists – especially chiropractors – regard their approach as a panacea.
- A systematic review evaluating the effectiveness of a therapy that includes observational studies without a control group is, in my view, highly suspect.
- Many of the RCTs included in the review are meaningless; for instance, if a trial compares the effectiveness of two different manual therapies none of which has been shown to work, it cannot generate a meaningful result.
- Again, we find that the majority of trialists fail to report adverse effects. This is unethical to a degree that I lose faith in such studies altogether.
- Only three conditions are, according to the authors, based on evidence. This is hardly enough to sustain an entire speciality of paediatric chiropractors.
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Allow me to have a closer look at these three conditions.
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- Low back pain: the verdict ‘moderate positive’ is based on two RCTs and two observational studies. The latter are irrelevant for evaluating the effectiveness of a therapy. One of the two RCTs should have been excluded because the age of the patients exceeded the age range named by the authors as an inclusion criterion. This leaves us with one single ‘medium quality’ RCT that included a mere 35 patients. In my view, it would be foolish to base a positive verdict on such evidence.
- Pulled elbow: here the verdict is based on one RCT that compared two different approaches of unknown value. In my view, it would be foolish to base a positive verdict on such evidence.
- Preterm: Here we have 4 RCTs; one was a mere pilot study of craniosacral therapy following the infamous A+B vs B design. The other three RCTs were all from the same Italian research group; their findings have never been independently replicated. In my view, it would be foolish to base a positive verdict on such evidence.
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So, what can be concluded from this?
I would say that there is no good evidence for chiropractic, osteopathic or other manual treatments for children suffering from any condition.
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The ACA’s submission ends with the following conclusion:
The Australian Chiropractors Association (ACA) intent is to improve the general health of all Australians and the ACA supports the following attributes to achieve this:
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- The highest standards of ethics and conduct in all areas of research, education and practise
- Chiropractors as the leaders in high quality spinal health and wellbeing
- A commitment to evidence-based practice – the integration of best available research evidence, clinical expertise and patient values
- The profound significance and value of patient-centred chiropractic care in healthcare in Australia.
- Inclusiveness and collaborative relationships within and outside the chiropractic profession…
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After reading through the entire, tedious document, I arrived at the conclusion that
THIS SUBMISSION CAN ONLY BE A CALL FOR THE PROHIBITION OF CHIROPRACTIC SPINAL MANIPULATION FOR CHILDREN.
I am sure this press-release of today will be of interest:
Good Thinking, a charity which aims to promote science and challenge pseudoscience, is bringing the action after the PSA acknowledged that multiple members of the Society of Homeopaths continue to offer CEASE therapy – a purported treatment for autism which is targeted particularly at children and which relies on the false notion that autism is caused by vaccination, and can be cured with homeopathic treatments, high-dosage Vitamin C, and dietary restriction.
The PSA has acknowledged that CEASE therapy is potentially harmful and conflicts with the advice of the NHS in several respects, including with regard to the childhood vaccinations for potentially life-threatening conditions. Nevertheless, the PSA decided on April 1st to approve the Society of Homeopaths’ accreditation for a further year.
Michael Marshall, Project Director of Good Thinking, said: “By being part of the PSA’s Accredited Voluntary Register scheme, the Society of Homeopaths and its members – including those who practice CEASE therapy – can point to the PSA’s logo on their websites and marketing materials as a sign that they are competent, trustworthy and safe. But that badge, and the credibility and legitimacy it confers, only carries any meaning if the PSA takes seriously their duty to protect the public from harmful practices.
“For the PSA to acknowledge that members of the Society of Homeopaths are offering a treatment that the PSA themselves recognise as harmful, and which is targeted at a particularly vulnerable group, and to then reaccredit them all the same makes a mockery of the PSA’s whole accreditation scheme. For PSA accreditation to mean anything at all, the public needs to be confident that when the PSA identify potentially harmful therapies, they take the necessary steps to protect the public, rather than accepting it and, effectively, endorsing it”.
The Society of Homeopaths has been part of the PSA’s Accredited Voluntary Register scheme since 2014. The PSA’s decision to accredit the Society of Homeopaths and its subsequent decisions to re-accredit have been the subject of criticism from both autism rights campaigners and those who support evidence-based medicine.
Marshall said: “The PSA encourage members of the public to choose healthcare practitioners which belong to one of its accredited registers, and even have a tool on their site to find accredited practitioners. That advice is fundamentally undermined by the fact that a patient could, via the PSA’s list of accredited practitioners, find themselves consulting with a homeopath who discourages vaccination and believes they can cure children of autism.”
Good Thinking’s action has drawn support from autism campaigners, such as Emma Dalmayne: “We as autistic people, are bombarded with the discriminatory rhetoric that we are in need of a cure. CEASE is not a cure for our neurological difference, and it is proven to be extremely harmful. The PSA should not endorse the Society of Homeopaths while their members offer this harmful therapy. The Society of
Homeopaths are at present allowing their members to mislead the public, which in turn puts vulnerable autistic children in harm’s way.”
If Good Thinking’s Judicial Review is successful, the PSA will likely be required to revisit their decision to reaccredit the Society of Homeopaths, this time paying proper regard to the need to protect the public and in particular autistic children who are the main targets for CEASE therapy.
As a small charity, Good Thinking have appealed for support in funding their Judicial Review, and are urging supporters to contribute to their crowdfunding campaign, at crowdjustice.com/case/gts-cease-psa/.
Additional Quotes:
· Simon Singh, Science Writer and Chair of Good Thinking: “Only this week we saw Prince Charles become a patron of the Faculty of Homeopathy. We have become accustomed to Prince Charles endorsing dangerous quackery, but we expect more of the PSA. The credibility of the PSA is at stake when it allows the Society of Homeopaths to retain accredited status despite their members offering this clearly harmful therapy.”
· Laura Thomason, Project Manager, Good Thinking: “Since 2017 we have raised concerns with the PSA about Society of Homeopaths members practicing CEASE therapy, and how we felt the actions they took to protect the public were wholly inadequate. We were therefore shocked and dismayed to see the PSA reaccredit the Society of Homeopaths, and believe their decision to do so, in the absence of any real sign from the Society that they are taking the protection of autistic children seriously, to be unlawful.”
· Professor Edzard Ernst: “According to the ‘like cures like’ principle of homeopathy, Dr Tinus Smits, the Dutch homeopath who invented CEASE, claimed that autism must be cured by applying homeopathic doses of the substances which allegedly caused the condition. CEASE therapists thus ‘detoxify’ all assumed causative factors – vaccines, regular medication, environmental toxic exposures, effects of illness, etc. – with homeopathically prepared substances that were administered prior to the onset of autism. The assumptions of CEASE therapy fly in the face of science. There is also no clinical evidence that CEASE therapy is effective in curing autism or alleviating its symptoms. By misleading desperate parents that CEASE therapy works, homeopaths can do untold harm.”
Reiki is a form of energy healing popularised by the Japanese Mikao Usui (1865-1926). ‘Rei’ means universal spirit (sometimes thought of as a supreme being), and ‘ki’ is the assumed universal life energy. Reiki is broadly based on some of the obsolete concepts of Traditional Chinese Medicine. Reiki practitioners believe that they can transfer ‘healing energy’ to a patient which, in turn, stimulates the self-healing properties of the body. They assume that the therapeutic effects of this technique are obtained from a ‘universal life energy’ that provides strength, harmony, and balance to the body and mind.
This study (entitled ‘ The Power of Reiki’) was conducted to pilot testing the feasibility and efficacy of Reiki to provide pain relief among pediatric patients undergoing hematopoietic stem cell transplantation (HSCT). Paediatric patients undergoing HSCT during the inpatient phase in the Stem Cell Transplantation Unit were eligible to participate. Short and medium effects were assessed investigating the increase or decrease of patient’s pain during three specific time periods (“delta”) of the day: morning of the Reiki session versus assessment before Reiki session (within subjects control period), assessment before Reiki session versus assessment after Reiki session (within subjects experimental period) and assessment after Reiki session versus morning the day after Reiki session (within subject follow-up period). The effect of 88 Reiki therapy sessions in nine patients was analysed following a short, medium, and long-term perspective. Repeated-measures analysis of variance revealed a significant difference among the three periods: a decrease of the pain occurred in the experimental period in short and medium term, while in the follow-up period, the pain level remained stable.
The authors concluded that this study demonstrates the feasibility of using Reiki therapy in pediatric cancer patients undergoing HSCT. Furthermore, these findings evidence that trained pediatric oncology nurses can insert Reiki into their clinical practice as a valid instrument for diminishing suffering from cancer in childhood.
This is an unusual conclusion in that it is strictly speaking correct. What is wrong, however, that the abstract reports findings related to the alleged effectiveness of Reiki. A feasibility study is not designed for that purpose. I therefore suggest to ignore all allusions to therapeutic effects.
This, I think, begs the question as to why it is necessary or productive to study Reiki in clinical trials.
- The treatment is not plausible.
- There have been many trials already.
- The ones that are sufficiently rigorous fail to show that it has any effects beyond placebo.
- The medical literature is already highly polluted with Reiki studies reporting false-positive results.
- This can only confuse researchers who attempt to conduct reviews on the subject.
- Reiki studies discredit clinical research.
- They are a waste of valuable resources.
- Arguably, they are even unethical.
If you ask me, it is high time to stop researching such implausible nonsense.
Bleach can be a useful product – but not as a medicine taken by mouth or for injection.
A 39-year-old man with a fracture of the right acetabulum underwent open reduction and internal fixation with a plate under general anaesthesia. At closure, the surgeons injected 0.75% ropivacaine into the subcutaneous tissue of the incision wound for postoperative analgesia. Soon after injection, subcutaneous emphysema at the injection site and a sudden decrease in end-tidal CO2 tension with crude oscillatory ripples during the alveolar plateau phase were observed. Shortly thereafter, it was found that the surgeons had mistakenly injected hydrogen peroxide instead of ropivacaine. Fortunately, the patient recovered to normal status after 10 minutes. After the surgery, the patient was carefully observed for suspected pulmonary embolism and discharged without complications.
A team from Morocco reported the case of a massive embolism after hydrogen peroxide use in the cleaning of infected wound with osteosynthesis material left femoral done under spinal anaesthesia in a young girl of 17 years admitted after to the ICU intubated ventilated. She was placed under mechanical ventilation with vasoactive drugs for ten hours and then extubated without neurological sequelae.
Tunisian doctors reported 2 cases of embolic events with neurological signs. The first, during a pleural cleaning with hydrogen peroxide after cystectomy of a pulmonary hydatic cyst at the right upper lobe. The second case, after a pleural washing during the treatment of hepatitic hydatidosis complicated by a ruptured cyst in the thorax.
Canadian anaesthetists reported a case of suspected oxygen venous embolism during lumbar discectomy in the knee-prone position after use of H2O2. Immediately after irrigation of a discectomy wound with H2O2, a dramatic decrease of the PETCO2, blood pressure and oxygen saturation coincident with ST segment elevation occurred suggesting a coronary gas embolism. Symptomatic treatment was initiated immediately and the patient recovered without any sequelae.
Indian nephrologists reported a case of chlorine dioxide poisoning presenting with acute kidney injury.
A 1-year-old boy presented to the emergency department with vomiting and poor complexion after accidentally ingesting a ClO2-based household product. The patient had profound hypoxia that did not respond to oxygen therapy and required endotracheal intubation to maintain a normal oxygen level. Methemoglobinemia was suspected based on the gap between SpO2 and PaO2, and subsequently increased methemoglobin at 8.0% was detected. The patient was admitted to the paediatric intensive care unit for further management. After supportive treatment, he was discharged without any complications. He had no cognitive or motor dysfunction on follow up 3 months later.
The medical literature is littered with such case-reports. They give us a fairly good idea that the internal use of bleach is not a good idea. In fact, it has caused several deaths. Yet, this is precisely what some SCAM practitioners are advocating.
Now one of them is in court for manslaughter. “If I am such a clear and present danger and a murderer, I should be in jail by now,” said doctor Shortt, who despite a criminal investigation, is still treating patients in his office on the outskirts of Columbia, S.C. Shortt got his medical degree 13 years ago on the Caribbean island of Montserrat. Being a “longevity physician” didn’t seem to bother anyone until one of his patients wound up dead. Shortt gave her an infusion of hydrogen peroxide. Katherine Bibeau, a medical technologist and a mother of two, had been battling multiple sclerosis for two years, and was looking for any treatment that might keep her out of a wheelchair. According to her husband, doctor Shortt said hydrogen peroxide was just the thing. “He had said that there was other people who had been in wheelchairs, and had actually gone through treatment and were now walking again.” It didn’t worry the Bibeaus that Shortt wasn’t affiliated with any hospital or university – and that insurance didn’t cover most of his treatments. “He was a licensed medical doctor in Carolina,” says Bibeau. “So I put my faith in those credentials.” According to Shortt’s own records, the patient subsequently complained of “nausea,” “leg pain,” and later “bruises” with no clear cause. “She went Tuesday, she went Thursday. And by 11 o’clock on Sunday, she died,” says Mr Bibeau. Shortt never told him or his wife about any serious risks. “Even if it wasn’t effective, it should not have been harmful.”
Shortt has been putting hydrogen peroxide in several of his patients’ veins, because he believes it can effectively treat illnesses from AIDS to the common cold. “I think it’s an effective treatment for the flu,” says Shortt, who also believes that it’s effective for multiple sclerosis, Lyme disease, and “as adjunctive therapy” for heart disease. “Things that involve the immune system, viruses, bacteria, sometimes parasites.”
He’s not the only physician using this treatment. Intravenous hydrogen peroxide is a SCAM touted as a cure the medical establishment doesn’t want you to know about. There even is an association that claims to have trained hundreds of doctors how to administer it. The theory is that hydrogen peroxide releases extra oxygen inside the body, killing viruses and bacteria.
Natural News, for instance, tells us that cancer has a rival that destroys it like an M-60 leveling a field of enemy soldiers. It’s called “hydrogen peroxide,” and the “lame-stream,” mainstream media will tell you how “dangerous” it is at 35%, but they won’t tell you that you can drip a couple drops in a glass of water each day and end cancer. Yes, it’s true.
And hydrogen peroxide is not the only bleach that found its way into the realm of SCAM.
Perhaps even worse (if that is possible), the Genesis II Church of Health and Healing promote MMS as a miracle cure. It consists of chlorine dioxide, a powerful bleach that has been banned in several countries around the world for use as a medical treatment. The ‘Church’ claim that MMS cures 95% of all diseases in the world by making adults and children, including infants, drink industrial bleach. The group is inviting members to attend what they call their “effective alternative healing”.
The organizer of the event, Tom Merry, has publicized it by telling people that learning how to consume the bleach “could save your life, or the life of a loved one sent home to die”. The “church” is asking attendants of the meeting to “donate” $450 each, or $800 per couple, in exchange for receiving membership to the organization as well as packages of the bleach, which they call “sacraments”. The chemical is referred to as MMS, or “miracle mineral solution or supplement”, and participants are promised they will acquire “the knowledge to help heal many people of this world’s terrible diseases”.
Fiona O’Leary, a tireless and courageous campaigner for putting an end to a wide variety of mistreatments of children and adults, whose work helped to get MMS banned in Ireland, said she was horrified that the Genesis II Church, which she called a “bleach cult”, was hosting a public event in Washington.
In Fiona’s words: “ Its experimentation and abuse”. I do agree and might just add this: selling bleach for oral or intravenous application, while pretending it is an effective medicine, seems criminal as well.
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?
The purpose of this recently published survey was to obtain the demographic profile and educational background of chiropractors with paediatric patients on a multinational scale.
A multinational online cross-sectional demographic survey was conducted over a 15-day period in July 2010. The survey was electronically administered via chiropractic associations in 17 countries, using SurveyMonkey for data acquisition, transfer, and descriptive analysis.
The response rate was 10.1%, and 1498 responses were received from 17 countries on 6 continents. Of these, 90.4% accepted paediatric cases. The average practitioner was male (61.1%) and 41.4 years old, had 13.6 years in practice, and saw 107 patient visits per week. Regarding educational background, 63.4% had a bachelor’s degree or higher in addition to their chiropractic qualification, and 18.4% had a postgraduate certificate or higher in paediatric chiropractic.
The authors from the Anglo-European College of Chiropractic (AECC), Bournemouth University, United Kingdom, drew the following conclusion: this is the first study about chiropractors who treat children from the United Arab Emirates, Peru, Japan, South Africa, and Spain. Although the response rate was low, the results of this multinational survey suggest that pediatric chiropractic care may be a common component of usual chiropractic practice on a multinational level for these respondents.
A survey with a response rate of 10%?
An investigation published 9 years after it has been conducted?
Who at the AECC is responsible for controlling the quality of the research output?
Or is this paper perhaps an attempt to get the AECC into the ‘Guinness Book of Records’ for outstanding research incompetence?
But let’s just for a minute pretend that this paper is of acceptable quality. If the finding that ~90% of chiropractors tread kids is approximately correct, one has to be very concerned indeed.
I am not aware of any good evidence that chiropractic care is effective for paediatric conditions. On the contrary, it can do quite a bit of direct harm! To this, we sadly also have to add the indirect harm many chiropractors cause, for instance, by advising parents against vaccinating their kids.
This clearly begs the question: is it not time to stop these charlatans?
What do you think?
‘Mom’s Choice Awards’ have just honoured the homeopathic product ‘COLD CALM KIDS’. This remedy has the following ingredients:
- Allium cepa 3C HPUS
- Apis mellifica 15C HPUS
- Eupatorium perfoliatum 3C HPUS
- Gelsemium sempervirens 6C HPUS
- Kali bichromicum 6C HPUS
- Nux vomica 3C HPUS
- Phytolacca decandra 6C HPUS
- Pulsatilla 6C HPUS
3C = a dilution of 1:1000000
6C = a dilution of 1:1000000000000
15C = a dilution of 1:1000000000000000000000000000000
The ingredients are, according to this website, claimed to have the following effects:
- Allium cepa 3C HPUS – Relieves sneezing and runny nose
- Apis mellifica 15C HPUS – Relieves nasal congestion
- Eupatorium perfoliatum 3C HPUS – Relieves aches associated with colds
- Gelsemium sempervirens 6C HPUS – Relieves headaches associated with colds
- Kali bichromicum 6C HPUS – Relieves nasal discharge
- Nux vomica 3C HPUS – Relieves sneezing attacks
- Phytolacca decandra 6C HPUS – Relieves mild fever
- Pulsatilla 6C HPUS – Relieves colds with a loss of taste and smell
The formula could easily make Hahnemann turn in his grave! It goes against most of what he has been teaching. But I found these claims interesting nevertheless.
Are they true? To find out, I did some research. Here is what I found (in case anyone can find more evidence, I’d be most grateful to let me know):
- Allium cepa 3C HPUS – Relieves sneezing and runny nose NO GOOD EVIDENCE FOR THIS CLAIM
- Apis mellifica 15C HPUS – Relieves nasal congestion NO GOOD EVIDENCE FOR THIS CLAIM
- Eupatorium perfoliatum 3C HPUS – Relieves aches associated with colds NO GOOD EVIDENCE FOR THIS CLAIM
- Gelsemium sempervirens 6C HPUS – Relieves headaches associated with colds NO GOOD EVIDENCE FOR THIS CLAIM
- Kali bichromicum 6C HPUS – Relieves nasal discharge NO GOOD EVIDENCE FOR THIS CLAIM
- Nux vomica 3C HPUS – Relieves sneezing attacks NO GOOD EVIDENCE FOR THIS CLAIM
- Phytolacca decandra 6C HPUS – Relieves mild fever NO GOOD EVIDENCE FOR THIS CLAIM
- Pulsatilla 6C HPUS – Relieves colds with a loss of taste and smell NO GOOD EVIDENCE FOR THIS CLAIM
I am confused! If there is no good evidence, how come Boiron, the manufacturer of the product, is allowed to make these claims? And how come the product just was given an award?
The Mom’s Choice Awards® (MCA) evaluates products and services created for children, families and educators. The program is globally recognized for establishing the benchmark of excellence in family-friendly media, products and services. The organization is based in the United States and has reviewed thousands of items from more than 55 countries…
An esteemed panel of evaluators includes education, media and other experts as well as parents, children, librarians, performing artists, producers, medical and business professionals, authors, scientists and others.
MCA evaluators volunteer their time and are bound by a strict code of ethics which ensures expert and objective analysis free from any manufacturer association.
The evaluation process uses a proprietary methodology in which items are scored on a number of elements including production quality, design, educational value, entertainment value, originality, appeal and cost. Each item is judged on its own merit.
MCA evaluators are especially interested in items that help families grow emotionally, physically and spiritually; are morally sound and promote good will; and are inspirational and uplifting…
Now I am even more confused!
A benchmark of excellence?
A strict code of ethics?
Morally sound?
I must have misunderstood something! Or perhaps the award was for achieving a maximum of 8 false claims for one single product!? Can someone please enlighten me?
