A brief and somewhat incoherent post today, written during breaks from preparing for my upcoming NECSS talk and patient care duties.

There are countless examples of the failures of so-called “complementary and integrative health” documented in the pages of Science-Based Medicine. Essentially, whenever judged by the same standards as commonly applied to conventional medicine, many popular pseudomedical entities such as acupuncture, homeopathy, and chiropractic are revealed to offer little more than theatrical placebo. At best, patients may experience a transient and minor improvement in subjective complaints.

Rarely do potential benefits outweigh the risk of harm to patients. And when a physician is involved, the deception required to materialize these meager potential benefits results in a sacrifice of patient autonomy that is ethically questionable. But it gets worse.

Sadly, these concerns have failed to prevent a growing public acceptance of blatant quackery. It has failed even to prevent acceptance by major academic institutions, or at least the acceptance by their administrators who are choosing profits over ethical patient care. Yet there are always credentialed believers at the ready to helm department after integrative medical department while rank and file healthcare providers simply shrug.

And taxpayer dollars in the millions are spent to help fortify this house of cards every year through the efforts of organizations like the National Center for Complementary and Integrative Health. There are days, many in fact as of late, where I find myself imagining a life where I had never been exposed to the realities of newborn chiropractic or homeopathic options for pertussis and drowning:

Drowning is a life-threatening emergency. Call an ambulance immediately if someone is drowning so they may be assessed by an emergency professional. After you call an ambulance, you may administer the remedy below.

Or you could just perform CPR. Reiki CPR, which can be performed secretly while compressing the chest or at a safe distance from the dying stranger, is apparently also an option.

Won’t somebody please think of the children???

My daughter, who just wrapped up a portrayal of Carl Sagan for a Living History project at her school, told me about a classroom discussion occurring one recent afternoon. Another student told the class about a session of acupuncture that they had undergone for some irrelevant reason. Several other students, as well as the teacher, then took turns relating their own positive experiences with acupuncture. My child, who is prone to outbursts of a skeptical nature, wisely held her tongue.

Granted there may be some degree of selection bias at play, considering that I do live in a town with more alternative medicine clinics than Starbucks and Dunkin’ Donuts combined. But I was surprised to hear that so many children in the class, all around 12 years old, had been to an acupuncturist. We know that children are exposed to a variety of pseudomedical entities, particularly when they are suffering from chronic illness or cancer, but most of this comes in the form of dietary interventions and herbal supplements. Only a small percentage tend to end up being treated by a practitioner of irregular medicine.

This isn’t because of a lack of effort.

Give me the child and I will give you the loyal, long term customer

There are many examples of alternative medical practitioners turning their focus on children. After all, if you convince a parent that their child’s spine requires regular chiropractic maintenance or that their chakras require balancing, you may have found a customer for life. At least some of them recognize that children are not just little adults:

Kids develop chakras at different stages of life. Not all of these will be intact until later, but it is good to get the conversation going.

The same can be said about the stages of puberty, and the paranasal sinuses. I recommend that parents sit down with their kids to discuss the paranasal sinuses at a young age, and to maintain an open and non-judgmental channel of communication throughout adolescence. You don’t want to find out about their neti pot use because of a brain-eating amoeba infection.

I did a bit of online research into kids and acupuncture. According to Robin Green L.Ac at KidsLoveAcupuncture.com, acupuncture offers “a safe, natural and effective approach to pediatric care.” In keeping with numerous other practice website marketing shtick, Green claims that acupuncture allows the body to harness its own healing and resilience, and that their treatment plans, unlike those from Western medicine, are customized holistically to each individual child:

Sometimes generic western treatments may not be able to adequately address the challenges faced by a child and parents may be told they’ll just “grow out of it.” No parent wants to accept such a fatalistic view when their child is suffering!

And they accuse us of bias against them. My wife, a pediatric palliative care physician, cares for suffering patients. I do sometimes as well. We both do everything we can to prevent and relieve suffering. If a child’s suffering can be alleviated by acupuncture, or is something that a child may outgrow, we may have to agree to disagree on what the word actually means. Honestly, I’m not even sure what she could mean by that last sentence.

Similar to the way chiropractors market their brand of pseudoscience to potentially nervous parents, pediatric acupuncture can be fundamentally changed to suit the population without concern of a loss of effectiveness. If Timmy is a little nervous about needles being shoved into his skin, or if he has trouble sitting still for a long session, he conveniently has little to fear:

For young children a rapid needling technique is used, where the needle is inserted and immediately taken out. Babies and children do not have to sit still for more than a few seconds at a time.

And:

A child is never forced to have acupuncture treatment and there are several other non-needle treatment techniques that your acupuncturist may use. They are easy, painless and have a similar therapeutic effect to acupuncture.

I doubt that ancient Chinese acupuncturists devoted much time to studying the effectiveness of various acupuncture techniques in infants and toddlers. But I am confident that the therapeutic effects of kid-friendly pediatric acupuncture are similar to acupuncture performed on adults, and even turtles.

All pediatric acupuncturists really want to do is address deficiencies, be they in the flow of mystical energy or the care of conventional pediatric providers:

Most acupuncturists offer well visits where they can address health issues before they become a major issue. Well visits allows the practitioner to address some of the deficiencies of conventional pediatric care such as nutritional counseling, attention to environmental toxins, emotional health and more. After the birth of a baby, guidance is provided for parents on all aspects of the baby’s care such as decisions regarding sleeping arrangements, support for breastfeeding mothers, treatment of common problems like colic and reflux.

At the Center for Advanced Acupuncture Pediatrics, the online practice building/training resource division of the Robin Green L.Ac pediatric acupuncture empire, you can learn about pediatric health in order to “grow a thriving practice.” During her $575 Pediatric Essentials course, reading a kid’s body language, herbs for babies, chronic low immunity, leaky guts, and more through the use of case studies and without having to actually be around children. According to one satisfied recent course graduate, “This course content is not provided in textbooks.”

If you are looking for an illustrated book to teach young children about homeopathy, look no further than Jackie Jormp-Jomp’s Rhymes for Remedies. Homeopathy is an amazing healing art that can simultaneously be both too individualized to be effectively studied by Western scientific methods and simple enough to be taught using nursery rhymes. Or you can find a remedy with “just 3 taps” using Boiron’s free smartphone app.

Hail to the king, baby

The undisputed king of marketing aimed at ensuring future customers is chiropractic. It just isn’t a state fair or neighborhood festival without one offering free spinal screens for the kids. And they put out an endless stream of stickers, coloring books, and juvenile fiction in the name of practice-building. Plus it’s so easy a toddler can do it. Okay, even I have to admit that one was pretty adorable. There may be hope for me yet.

Posted by Clay Jones

Clay Jones, M.D. is a pediatrician practicing at Newton-Wellesley Hospital in Newton, MA, 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 @skepticpedi and is the co-host of The Prism Podcast with fellow SBM contributor Grant Ritchey.