babyreflexology
In the fascinating, if not rational, world of so-called complementary and alternative medicine, the age of the patient rarely seems to matter. This stands in stark contrast to the practice of science-based medicine. Sure, there is some physiological overlap across the spectrum of age, but caring for children often requires a vastly-different approach and there are numerous conditions not seen or only seen in kids.

Alternative medicine is more about the underlying belief system rather than the actual physiology, however. Chiropractic is chiropractic whether the subluxation belongs to a neonate or a nonagenarian. In traditional Chinese medicine, the flow of chi is obstructed in youngsters and old fogeys alike. No matter the length of our telomeres in fact, every major form of alternative medicine appears to contain a subset of practitioners that claim unique expertise in maximizing health and wellbeing at any age. But for kids, they simply do the same thing they would do for an older patient.

Newborns appear to be an increasingly-popular target of irregular medical practitioners. Even the unborn baby still in their mother’s womb isn’t safe. A generous interpretation would be that these true believers simply wish to aid in establishing health early in a child’s life, while the cynic in me worries that establishing a lifetime of billing opportunities might be the primary motivating factor.

Chiropractic has perhaps the most well-established professional pediatric focus, although the Pediatric Association of Naturopathic Physicians might disagree. The chiropractic pediatric community has its own organizations, conferences and advanced education, which teaches interested parties the finer points of “Neonatal Abnormals” during an intense two-day session. A lack of evidence has not interfered with efforts to expand their role in pediatric healthcare, nor has plentiful high-quality evidence proving the safety and efficacy of routine childhood vaccines convinced many of them to support their use. The following, found on the website of one chiropractor that specializes in treating children, demonstrates nicely why pediatric chiropractic is problematic:

Chiropractic care for children, and patients of all ages, has repeatedly been shown to be one of the safest forms of health care available. This becomes even more apparent when compared with the “alternative” to chiropractic and wellness care, drugs. Most times drugs are not tested on children (rightfully so) and therefore pediatric doses are the doctor’s ‘best guess’ and often times can lead to dangerous and damaging side effects. That is not the case with chiropractic!

Acupuncture is performed on children, even in world class pediatric academic facilities like Boston Children’s Hospital. In an effort to replace prescientific beliefs with cutting edge science, while not stepping on any toes by outright denying the existence of meridians and mystical life energy, they provide the following “In-Depth” explanation for prospective customers:

Scientific research suggests that needling acupuncture points stimulates the body to release chemicals into the nervous system and into the bloodstream. These chemicals change the experience of pain and trigger the release of other chemicals which influence the body’s internal regulatory systems.

It’s hard to argue with chemicals. Chemicals do everything. I do wish they would be a bit more explicit in their description of how tiny needles in the skin induce the production of chemicals that help children with such varied conditions as post-operative pain, nausea, intestinal inflammation and constipation. At least at Boston Children’s there is an emphasis on proper precautions to prevent the spread of infectious disease via an acupuncture needle and to reduce the risk of traumatic injury. This isn’t always the case.

The use of homeopathy in the pediatric population is extremely common, particularly for self-limited and largely subjective problems like colic, teething and viral upper respiratory infections. Typically homeopathy comes in the form of over-the-counter remedies recommended by friends and family, or endorsed by celebrities and talk show hosts, but it can also be found offered in pediatric practices and even academic medical centers. Homeopathy also has an abysmal track record in regards to evidence of efficacy, and has the distinction of being the least plausible form of alternative medicine because it necessitates the violation of fundamental laws of physics. The competition for this honor was pretty stiff.

There is Reiki for kids, which is kind of like The Force but without the special effects. There are also innumerable herbal remedies recommended for children. The list really does go on and on. In fact, if it exists as a form of alternative medicine, it almost certainly has been used on a child. Even Biodanza, crystal healing, Iridology and urine therapy. Yes, urine therapy:

The easiest internal form of the therapy for children is oral drops of the child’s own fresh urine. As mentioned in the studies, for acute flu, colds, viral infections, measles, mumps, chicken pox, etc., small frequent oral doses of 1-10 drops during illness have been shown to be very effective. For allergies, the research studies indicate that several drops of fresh urine should be given orally before and after meals containing allergenic foods, or when allergic symptoms are present.

Links to “the studies” were unfortunately not provided on Master Mantak’s website.

In 2010, our own Mark Crislip wrote a post about one of the more absurd flavors of alternative medicine, but I first learned about reflexology from a segment on Penn and Teller’s television program on Showtime back in 2003. As Dr. Crislip describes in his post on the subject, plausibility and evidence are lacking. He rightfully questions why clinical trials even exist. Why do clearly nonsensical therapies, with as close to zero plausibility as allowed in science, get to skip the steps required by conventional medicine? Why are valuable resources wasted on seeing if magic and make-believe work? I was inspired to again kick over the rotten woodpile that is reflexology, to see what comes scurrying out, when a follower on Twitter sent me the picture I included at the onset of this post.

Reflexology for babies? It boggles the mind. And this coming from a physician who promotes skin-to-skin contact for babies on a daily basis. But first, just a little background.

What is reflexology?

The reflexologist featured in the Penn and Teller episode on alternative medicine had the following to say about his calling:

Through Reflexology you can get someone to relax, the immune system can then respond to the crisis, and you don’t have to die! It’s way more than just a foot message that makes you feel good. It’s something that triggers the electrical aspect of the body’s self-healing processes.

Boosting the immune system, the concept of a healing crisis, mysterious electrical processes within the body and self-healing are common themes in alternative medicine. And the ability to prevent death is a bold claim, but one we’ve seen before many times. But these claims seem particularly bold considering that to the untrained eye reflexology usually just looks like a foot or hand massage, albeit a fancy one.

Let’s not jump to conclusions. According to proponents, confusing reflexology with a simple massage is a common mistake. While massage, they reveal, is the manipulation of soft tissues to relax muscles, reflexology involves the manipulation of specifically mapped points on the feet (mostly) as well as the hands and ears to trigger healing reflexes in specific zones of the body. Massage involves a variety of techniques that bring about stress reduction from the outside in, while reflexology, again according to believers, works from the inside out by stimulating the body to heal itself.

Reflexology is natural of course. And holistic because it “stimulates the movement of energy along the nerve channels, and helps to restore homeostasis (balance) in the whole body.” And while a good massage typically involves the use of lotion or oil, reflexologists appear to eschew them. Friction is apparently an integral part of the process because it helps to break up the toxic crystals that have accumulated in reflex points and are interfering with the flow of healing energy. Uric acid crystal deposition in the skin seems testable, yet no evidence of this exists.

The maps used by reflexologists to guide their treatment are fairly straightforward. The right foot corresponds to the right half of the body, the left foot with the left half. If the client is having right shoulder problems, for example, you rub an area a bit below the pinky toe on the corresponding foot. There are many versions of these maps, with significant variability in complexity, but they do tend to agree with each other for the most part. Nonsense that is consistent is still nonsense, however. These maps have no basis in reality and serve as yet another testament to the ability of humans to notice patterns that don’t exist or to just make things up. The only thing accurate about them is that the liver area is only on the right foot, and the spleen is only on the left.

Reflexology’s origin story also shares common themes with other forms of alternative medicine. It has a grandiose historical pedigree. It was developed using ancient (prescientific) wisdom and was supposedly practiced thousands of years ago by ancient Egyptian, Chinese and Indian cultures. This belief is based on the finding of old pictures/carvings of feet with symbols on them. Naturally it was also used by some Native American tribes, and even President Garfield rubbed his feet after a long day in the Oval Office. Convinced?

But this ancient and powerful healing technique needed to be “rediscovered” a century ago by Dr. William Fitzgerald, a physician based in Connecticut and the father of reflexology. He noticed that the application of pressure to specific areas using a cotton swab resulted in numbing or relief of minor surgical pain in other areas. He went about mapping ten vertical zones of the body and discovered through trial and error (confirmation bias) what came to be knows as Zone Therapy. Five decades later, after a few other pioneers in this new therapy had the opportunity to tweak it by adding horizontal zones and additional focus on the hands and ears, we have modern day reflexology. When alternative medicine is updated like this, I always imagine a kid who thinks that his pinewood derby car will go faster after he paints some flames on the side.

What can reflexology treat?

Reflexology has pretty much been tried for everything. While tending to avoid claims of efficacy for specific conditions, reflexology is often touted as helpful for vague complaints like stress, fatigue and musculoskeletal pain. Typical structure and function benefits are also commonly cited, like boosting the immune system, increasing energy and improving organ or gland function. There are unfortunately still plenty of practitioners out there who do make specific health claims, such as helping diabetic patients reduce their dependence on insulin. The American Academy of Reflexology provides a detailed list of the largely-subjective proposed benefits, as well as the secrets of building a successful practice in less than a year.

Again I refer to Dr. Crislip’s post on the subject. He breaks down some of the best studies that proponents of reflexology have to offer and it isn’t pretty. There is no evidence to support that rubbing the feet positively impacts any medical conditions, but it might feel good like a massage so there’s that. Placebo effects achieved via reflexology certainly might alter a patient’s perception of their subjective symptoms, but there is no anatomical or magical link between the feet and the rest of the body than can be taken advantage of to improve our health.

The impetus for this post was my discovery that reflexology is now being used on newborn infants, although I’m not sure why this surprised me. As I stated earlier, when a therapy is based on a belief system rather than evidence, there would never be any qualms about using it on a child of any age. If one version is obviously dangerous, or scary to parents (think high-velocity chiropractic neck adjustments), just tweak the belief system a bit and maybe invent some kid friendly technology like the Activator. Although in the case of infants, it’s really being used on the parents. Not through some kind of surrogate therapy as in applied kinesiology, although I was able to find a few examples of that online, but rather via parental placebo.

The conditions for which reflexology is being promoted for newborns and young infants are essentially the same as with chiropractic, acupuncture and every other form of alternative medicine. Vague conditions like colic, gas, teething and trouble falling asleep are a common focus. Blaming birth trauma was also a common theme.

These are all highly-subjective parental complaints and usually a marker more of parental stress than a medical problem. They also wax and wane and tend to resolve spontaneously, a perfect set up for thinking a treatment works when it doesn’t. Thankfully I was unable to find any recommendations for reflexology to be used in truly ill children, and a run through Pubmed yielded no clinical trials involving reflexology and infants.

Conclusion

Our understanding of human physiology is the result of a hard-fought journey of discovery that has taken thousands of years and still isn’t complete. But we have learned a great deal about how the body works and how to change physiology in order to improve health. One aspect of our anatomy and physiology that is frequently encountered during training in pediatric medicine is the fact that children are not just little adults, and babies aren’t just tiny children. It would seem that practitioners of alternative medicine are unaware of this.

Every form of alternative medicine approaches children in the same fundamental way that they approach adults, a result of following belief and personal experience rather than science. And many have infiltrated even our most respected pediatric academic facilities. Reflexology is a perfect example of how irrational and implausible the overwhelming majority of alternative approaches can be, and also of the double standard that exists in medicine today. From acupuncture to quantum healing, if you think that the evidence base for these therapies is weak in adults, research in children is almost always even more pitiful. But as we have witnessed time and time again, scientific evidence only matters if it appears to support the belief system.

 

 

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.