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  1. CAM for children deserves more skepticism

    Editor,

    The article by Dr. Kathi Kemper entitled 'Complementary and alternative medicine for children: does it work?'[1] is puzzling. The most obvious objection is that the question of whether a practice "works" should be answered by the usual methods of investigation, not by the various nonscientific factors cited in the article's summary.

    Equally perplexing is a theme that runs throughout the article. There is some attention paid to the value of meeting unproven claims with skepticism and caution, particularly with regard to herbal medicines. There is, however, a bland acceptance, amounting to a tacit promotion, of other claims that are both baseless and dangerous.

    Here are two examples:

    1. One of the "goals" of CAM therapy, according to Dr. Kemper, is that of "promoting wellness or resilience and minimizing stress or toxins." "Promoting wellness" is one of the common claims made for "CAM," but it is a nebulous concept. If it is taken to mean lifestyle modifications that lead to a subjective sense of well-being, then it is mundane and uncontroversial. If it is taken to imply actual health promotion, for example, by preventing cancer through "enhancement of the immune system," another common CAM claim, then it is a dubious, although testable, proposition. This is a claim for which there is not now, nor is there likely to be, any evidence forthcoming from the "CAM community." In the absence of such evidence it constitutes a form of consumer fraud, and pediatricians should be counseling this to parents who are asking.

    "Minimizing toxins," when offered by CAM practitioners, is unequivocally fraudulent. The notion of ubiquitous "toxins," as espoused by naturopaths, chiropractors, "clinical ecologists," homeopaths, many other CAM practitioners, and even some medical doctors, is not the stuff of the legitimate field of toxicology. The CAM version of "toxins" is a catchall explanation for virtually any complaint a patient might have. A short list of symptoms, signs, and diagnoses attributable to "toxins," according to one of the bibles of alternative medicine, includes "psoriasis, acne, chronic headaches, inflammatory and auto-immune diseases, chronic fatigue, muscle pains, indigestion, tremors, constipation, anemia, pallor, dizziness, poor coordination, impaired ability to think or concentrate, childhood learning disabilities, depression, tingling in the hands and feet, abnormal nerve reflexes, respiratory tract allergies, increase rates for many cancers, liver diseases, Crohn's disease, ulcerative colitis, thyroid disease, lupus erythematosis, pancreatitis, asthma, myasthenia gravis, and diabetes."[2]

    What are the "toxins?" According to this and other CAM treatises, vaccines, antibiotics and virtually all other medicines prescribed by medical doctors are "toxins." So are a number of other substances that obviously would be toxic if present in the body in large enough quantities, such as heavy metals, cleaning solvents, pesticides, and bacterial endotoxins. In a caricature of environmentalism, these substances are said to be increasingly poisoning us all: "25% of Americans," for example, allegedly suffer from heavy metal poisoning[3] even though the reality is nothing of the sort and the levels of lead in the environment and in children have dropped precipitously in the past 10-20 years. The CAM practitioner typically "diagnoses" the presence of these "toxins" by absurd and/or fraudulent "tests," such as "applied kinesiology," "electrodiagnostic skin testing," or hair analysis.[4] The proposed treatments include sweeping dietary changes, multiple vitamins, antioxidants and other "natural" remedies sold by the CAM practitioner, chelation, fasting, enemas, spinal manipulation, acupuncture, homeopathy, and more.

    Does Dr. Kemper really believe that "minimizing toxins," CAM style, is a "legitimate goal?"

    2. In a reprint of this article recently published in the Western Journal of Medicine[5], a photograph is offered of a chiropractor "[providing] chiropractic care to 9-month-old Alexander Diamond." This photograph should give pause to any pediatrician familiar with chiropractic claims and practices. It shows that the chiropractor's hands are applied to the infant's head, with her right index finger touching the angle of the mandible. There are only a few chiropractic maneuvers that this could represent. The first is an "adjustment" of the cervical spine, said to cure all sorts of ills and promote health because, according to chiropractic dogma, vertebral "subluxations" are the cause of all "dis-ease." It is frequently offered for otitis media, asthma, and many other childhood diseases for which there is not the slightest reason to believe that it would help.

    The maneuver is dangerous; there is not a single indication for it in an infant, nor is there any biological basis for predicting that there ever will be. Dr Samuel Homola, one of a small number of rational chiropractors, points out that the vast majority of cervical spine manipulations, even in adults, is inappropriate and states that "it is the consensus of medical and scientific opinion that chiropractors should not be allowed to treat infants and children."[6] To practice cervical spine manipulation on a baby is a form of child abuse, and this is what pediatricians should tell parents who ask.

    Another possible interpretation of the photo is that the chiropractor is performing "cranial osteopathy," or "craniosacral therapy." These practices are based on the notion that the cranium can be manipulated in such a way as to favorably affect a myriad of problems, e.g. recurrent otitis media (by dilating the Eustachian tubes!), ADHD, learning disabilities, and even hereditary diseases such as Down's Syndrome. Once again, the claims are both ridiculous and dangerous.

    It's entirely possible, of course, that the chiropractor is gently massaging the baby but claiming to be doing something more, such as performing one of the techniques described above. One hopes, for the baby's sake, that this is the case; but if so is it really "chiropractic care?"

    It's worrisome that so much of the information about "CAM" that physicians are likely to read is uncritical. Dr Kemper is correct that many medical schools have courses discussing CAM, but even these are overwhelmingly taught by advocates.[7] The CAM fare in peer-reviewed journals should be an exception.

    (1). Arch Dis Child 2001;84:6-9 ( January )
    (2). Murray M T, and Pizzorno J E. Detoxification. In Encyclopedia of Natural Medicine. Little, Brown & Co. London, 1998. pp.104-125
    (3). Pizzorno J E and Murray M T, eds. Textbook of Natural Medicine. London. Churchill Livingstone, 1999. p.438.
    (4). See: http://www.quackwatch.com/ for discussions of these and other dubious "tests" and practices.
    (5). West J Med 2001; 174: 272-276. Available at: http://www.ewjm.com/cgi/collection/complementary_medicine
    (6). Homola S. Is the chiropractic subluxation theory a threat to public health? Sci Rev Alt Med. 2001; 5(1): 45-53.
    (7). Sampson W. Dancing with a dream: the folly of pursuing alternative medicine. Acad Med. 2001; 76(4):301-303.

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