Just a couple of months ago I wrote about a report published by the CDC which presented the case of a newborn infant potentially harmed by their mother’s belief in the absurd practice of placentophagy. In that case, it was impossible to firmly conclude that the mother’s consumption of her dehydrated and encapsulated placenta actually caused a serious bacterial infection in the baby. The most reasonable conclusion, in my opinion, is that it increases the risk of such infections without any demonstrable benefit.
The CDC report
Today I’m writing about yet another example of how parental belief in pseudomedicine can harm children, based on another CDC “Notes from the Field” report published last week. In the report, the authors discuss the discovery of lead poisoning in a 9-month-old baby during routine screening last September. This was eventually linked to the use of a “homeopathic magnetic hematite healing bracelet.” In this case, there is a more firmly established causal connection. In fact, I don’t really think the link is even in doubt.
The child was found to have a blood lead level of 41 μg/dL, which based on my calculation is a lot higher than 5 μg/dL, the level generally considered to be abnormal, although we consider any amount of lead in the body of a child to be problematic and actionable. Even trace amounts in the blood require intervention in the form of home investigation, nutritional assessment, and close follow-up to make sure that the level doesn’t increase. Most experts strongly consider chelation at 45 μg/dL even in an asymptomatic child.
We get very few details in the report unfortunately, such as whether or not the child was overtly symptomatic or what happened in the year since the initial diagnosis was made. I can say that the baby was very likely asymptomatic, based on how lead poisoning typically presents in a child, but that doesn’t mean that they didn’t have complications during treatment or that they won’t have challenges down the road. I’ll explain what I mean shortly.
As would be expected, an investigation of the child’s home took place in order to uncover any potential environmental sources of lead. In particular, investigations look for lead paint, which is still commonly found in homes built before 1978 and can be ingested by children in the form of chipped paint or dust particles. Lead can also be found in the home’s water supply and in the surrounding soil, deposited years ago by the exhaust of vehicles burning leaded gasoline. All young children can ingest lead from these environmental sources when present because of normal exploratory behaviors, but at particular risk are children with pica, an eating disorder with myriad etiologies that results in the pathological consumption of non-food items, such as dirt.
Two interior windows were found to have peeling lead-based pain. The home was not felt to have played a role in the child’s elevated lead level, however, because investigators were able to confirm that the child did not have access to the windows and also that the lead levels in the two siblings, aged 3 and 5 years, were normal. Chronic lead exposure, such as that seen in homes with a significant lead burden, results in deposition in the bones where the half-life is measured in decades. So levels would have almost certainly still been elevated in the siblings had they been living in an environment capable of producing a blood level that high in the baby.
This is why prevention and appropriate screening is so important in the management of lead poisoning. Once diagnosed, even with chelation to help quickly lower blood lead levels, the damage to the brain has often already been done in cases of chronic exposure, especially if the child is very young. And because chelation can only bind to lead in the blood, it can do nothing for the long term leaching of lead from the child’s own bones. Treatment with chelating agents can be used to manage some symptoms of severe lead toxicity, such as gastrointestinal distress, irritability, seizures and lead encephalopathy, but nothing has been shown to improve neurocognitive outcomes down the road.
An unexpected revelation
At some point the patient’s mother pointed out that she had purchased a “homeopathic magnetic hematite healing bracelet” at an art fair in the area. Nothing on the bracelet indicated what the various parts were made of or where they were manufactured, and investigators were unable to determine who had crafted and then sold the item to the patient’s mother. When one of the several small spacer beads was tested, it was found to contain 17,000 ppm of lead, which is 16,900 ppm higher than the limit established by the Consumer Product Safety Improvement Act of 2008 for any part of a product made for children. Obviously this law doesn’t protect young children from jewelry.
We are told that the child wore the bracelet only “intermittently” for symptoms related to teething and that the child was seen putting it into their mouth, which could have been assumed based on their age. We are not told when the bracelet was purchased, but teething generally starts at around 7 months. That being said, many parents believe that their child is suffering from teething induced discomfort for many weeks prior to the actual arrival of a tooth, so it is possible that the child had frequent access to the bracelet for weeks to months.
We aren’t told if the child required chelation. If they were asymptomatic, as most children with lead poisoning are, they might not have. They would have undergone testing for comorbid conditions such as renal impairment and iron deficiency, and abdominal imaging to make sure that no flecks of paint or pieces of metals, such as one of those spacer beads, were sitting in the GI tract leaching out lead.
It is possible, although I would say unlikely, that the symptoms being blamed on teething in this case were actually related to lead toxicity. I’ve written about teething on SBM a few times, and even used it as an example of medical folklore in my recent talk at NECSS. Sadly this case is a perfect example of the issues I’ve raised. Not only are caregivers, and sometimes even pediatric medical providers, exposing children to risky interventions for a condition that is considerably more myth than reality, excessive focus on teething symptoms might delay appropriate evaluation when a child is truly ill.
Hopefully the child did well, although as I mentioned earlier there is unfortunately a decent chance that they will ultimately have neurocognitive deficits. This might include impaired learning and memory, language delays, ADHD, cognitive impairment, and speech, language, and hearing problems. This is why we assess for risk factors and screen children. This may have continued for months, and the lead level risen even higher, otherwise.
Homeopathic jewelry?
I think that it goes without saying that there is absolutely no scientific evidence, and zero plausibility, to support the claim that a bracelet such as the one in question would benefit a teething infant or anyone else for that matter. Magnetic hematite is still commonly incorporated into jewelry and promoted by believers for its pain relieving properties. Hematite is apparently also used in Feng Shui for its powerful grounding energy and ability to calm and focus the mind.
What does homeopathy have to do with a bracelet? I tried but was unable to find any explanation. It appears that people selling amber or hematite jewelry just use the “homeopathic” label to give a product more alt med cred, similar to how people sometimes use “quantum” to make something sound scientifically more impressive. Really nothing about this is homeopathic in any sense.
Conclusion: Pseudomedicine isn’t harmless
This wasn’t the first child to be harmed by pseudomedicine. They weren’t even the first to suffer lead poisoning because of a caregiver’s belief in nonsense. And it will certainly happen again. This case demonstrates not only the potential risk of turning to unproven and implausible treatments, but also the harm that can come when medical folklore and cultural inertia combine and result in caregivers treating normal variations in infant behavior, such as teething, as something that requires treatment.