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First up, a bit of shameless self-promotion: I was interviewed by Ben Brown for the excellent Tourette’s Podcast and I invite everyone to check it out.

Also of note, the number of measles cases in the Unites States so far this year has now officially topped the 1,000 threshold. We are at 1,022 to be exact. This is likely going to be the new normal folks.

Despite this, celebrities keep coming out of the anti-vaccine closet. Jessica Biel denies being anti-vaccine, of course. She is claiming only to be speaking up for a family friend whose child has a medical vaccine exemption, although if this were true and it wasn’t purchased from an unethical pediatrician (B. Sears for example. No, too obvious. Bob S.), the bill that Biel is speaking against would actually help to protect a child who is unable to be fully immunized. Judging by her character witness, however, she’s anti-vaccine.

Now on to the always frustrating, and sometimes heartbreaking, business of “exploring issues & controversies in science and medicine”. I hope that over the years we have made it clear that the risks of virtually all so-called alternative approaches to healthcare outweigh any potential benefits. Though direct harm is uncommon, there is no such thing as a completely benign unscientific medical intervention. Even less common, although we have documented many examples on the pages of SBM, are deaths directly attributed to quackery. Sadly, here is one more.

This case involves the 2017 death of a 7-year-old Italian child whose parents chose to follow recommendations from a local practitioner of homeopathy when their child had an apparent ear infection. Citing their failure to give the child antibiotics, which according to the judge would have prevented the infection from spreading to the brain, the parents were found guilty of aggravated manslaughter and given suspended sentences of three months in prison. The child’s grandfather has defended the convicted couple, stating that they “resorted to homeopathy” only out of concern over the harmful effects of antibiotics and are not anti-medicine in general.

According to reports from the time of the child’s death, his first signs of illness involved a viral upper respiratory illness with fever. Rather than seeking care from the family pediatrician, they had him evaluated by a local homeopath. Homeopathy is popular in Italy, with about 16% of the population using it regularly, so this isn’t surprising at all. Sadly, but also not surprising, the family received dangerous advice, again according to the child’s grandfather:

He scared them by claiming that the doctors would give medication to Francesco that would make him deaf or would damage his liver. He promised them that Francesco will recover soon.

I found it odd that the conviction appears to be specifically based on the parents choosing not to give an antibiotic, rather than on their failure to seek appropriate medical care for what had to have been an extremely ill-appearing child. I don’t know if early intervention with antibiotics would have prevented a fatal outcome, although it is highly likely. The more recent reporting claims that he developed encephalitis, which was what supposedly killed him. I’m a bit skeptical of this, however.

Encephalitis is the term for inflammation involving the brain, and is almost always caused by a viral infection such as herpes simplex virus, although there can be rare bacterial (Lyme disease for example) or even autoimmune causes. It is not something I think of as a potential complication of an untreated bacterial ear infection, and it is not something that would respond to antibiotics commonly prescribed for them. Earlier reports are more likely to be accurate as they discuss the development of a brain abscess (collection of pus), which is a rare but very possible sequelae of an untreated bacterial ear infection. He likely died from a combination of the abscess and meningitis that resulted in cerebral edema, coma, and ultimately brain death.

When he was finally brought to a local hospital after two weeks of suffering, it was too late. Piecing things together from several reports since 2017, he was already (brain) dead or at least close to it on presentation. Surgical drainage of the brain abscess was attempted but it didn’t help. Support was withdrawn after an EEG showed no brain activity and his parents agreed to organ donation, so at least some other family could find hope in this tragedy.

Up next will be the September trial of the homeopath whose quackery resulted in the death of this child. He is being accused of negligence, naturally, and of “having underestimated the typical clinical picture of a highly serious local infection” in addition to sticking with homeopathic treatments despite clear failure to improve. I hope he is put away for a very long time.

The family may not have been anti-medicine. Some of the recent reports claim that they refused antibiotics, but I don’t think that’s accurate. I think they went to the homeopath and believed what they were told and what they wanted to believe.

Ultimately, I don’t have enough information to determine what was in their hearts. But they did have a worldview that left them vulnerable to dangerous pseudomedical advice and are victims in this as well. I’m begrudgingly okay with them not receiving significant jail time because I think that they are going to suffer enough, although there would need to be special consideration should there be other children in the home. My mind would certainly change should it come to light that they have an attitude similar to the parents of poor Ezekiel Stephan, who have been thoroughly unrepentant. Then they should rot in jail.

I’d like to give thanks to thanks to our good friend Edzard Ernst, whose own post led me to translations of the initial reporting from 2017 which provided the most helpful information.

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Posted by Clay Jones

Clay Jones, M.D. is a pediatrician and a regular contributor to the Science-Based Medicine blog. He primarily cares for healthy newborns and hospitalized children, and devotes his full time to educating pediatric residents and medical students. Dr. Jones first became aware of and interested in the incursion of pseudoscience into his chosen profession while completing his pediatric residency at Vanderbilt Children’s Hospital a decade ago. He has since focused his efforts on teaching the application of critical thinking and scientific skepticism to the practice of pediatric medicine. Dr. Jones has no conflicts of interest to disclose and no ties to the pharmaceutical industry. He can be found on Twitter as @SBMPediatrics and is the co-host of The Prism Podcast with fellow SBM contributor Grant Ritchey. The comments expressed by Dr. Jones are his own and do not represent the views or opinions of Newton-Wellesley Hospital or its administration.