What?! Homeopathy and acupuncture for symptoms of autism

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Let’s get the American Association for the Advancement of Science (AAAS) to stop publicizing junk studies of acupuncture for symptoms of autism intended to exploit parents NOW.

 

 

Changes are ordered by Advertising Standards Authority for Ireland (ASAI) in the Facebook Page advertising acupuncture for autism.

  • Yet, an enterprising journal editor got the AAAS’s Eurkalert to distribute worldwide a press release for a junk study of acupuncture for autism that his journal published.

  • Some lessons and practice in skills in detecting junk studies.

  • Let’s recognize The Journal of Alternative and Complementary Medicine (JACM) as a Quack! purveyor of junk promotions of discredited and unproved treatments disguised as science.

  • Let’s watch for the next move of the Editor of JACM’s next move in his avowed effort to gain legitimacy and reimbursement for acupuncture.

  • Let’s tell AAAS to stop making excuses.

  • Tell AAAS to get EurekAlert to screen press releases before distributing them. As it stands, EurekAlert is damn confusing to lay persons who consider the AAAS bran attached to anything as indicated a trusted source. [At the end of this blog, I make it easy for you to lodge a protest.]

Ireland’s Advertising Standards Authority investigated a complaint. As a result, the ASA has informed a homeopath not run a Facebook advertisement in its current form.

The homeopath was told by ASAI not to run a Facebook advertisement in its current form again because the page suggests she could treat the symptoms of autism. The ad by Almond Homeopathy stated the homeopath had:

“the great pleasure of meeting and working with many children diagnosed with ASD and the greater pleasure and joy of helping them overcome many of their symptoms that were holding them and their families back from getting the most out of life.”

The Facebook Page also referenced a blog which contained a reference to a child whose “learning, relationships and speech” had improved

The advertiser defended her FB page by declaring  that  she was a qualified homeopath, registered with the Irish Society of Homeopaths.

She said she treated the person, not their condition or disease, and did not claim to be able to cure anything or anyone.  However,

The ASAI’s complaints committee said that, while noting the advertisers’ comments that she was a qualified and licensed homeopath and registered with the Irish Society of Homeopaths, it was aware from a previous case that the Department of Health had confirmed that there was no statutory regulation of complementary therapists.

The committee also said the wording of the post and the heading of the blog post would give readers the impression she could treat the symptoms of autism.

About the same time, EurekAlert’s posted on Twitter a link

New study from KKI shows feasibility of acupuncture in young children with ASD

To the naïve reader, the item appeared to be a story, not  the pasted in press release that it was, but that was not the case. Where one would have expected the name of a journalist, the publisher’s name was listed.

MARY ANN LIEBERT, INC./GENETIC ENGINEERING NEWS

New Rochelle, NY, June 19, 2017-A pilot feasibility study to determine if young children with autism spectrum disorder (ASD) and their parents would tolerate and adhere to an office- and home-based acupuncture/acupressure intervention showed completion of all 16 biweekly sessions and measurements of their effects before, during, and after the protocol. The study design and results, which suggest further controlled studies of this intervention approach in ASD, are published in the Journal of Alternative and Complementary Medicine (JACM), a peer-reviewed publication from Mary Ann Liebert, Inc., publishers. The article is available free on the JACM website until July 19, 2017.

Coauthors Lana Warren, EdD, OT/L and Patricia Rao, PhD, Kennedy Krieger Institute, Baltimore, MD, and David Paton, DAc, LAc, Starting Point Acupuncture and Health Services, Catonsville, MD, identified the most positive outcome of the study as the high compliance rate, with all parents of the children ages 3-10 completing the intervention. The researchers measured the effects of the intervention on factors such as the children’s behavior, ability to pay attention, sleep, and aspects of parenting stress. In the article entitled “A Pilot Observational Study of an Acupressure/Acupuncture Intervention in Children with Autism Spectrum Disorder,” most parents reported that the intervention had a positive impact on their relationship with their child.

The editor of JACM chimed in:

“While a small study, the tolerance and adherence with acupressure this pilot are both hopeful signs for families of those in their care with autism spectrum disorder,” states JACM Editor-in-Chief John Weeks, johnweeks-integrator.com, Seattle, WA.

Before getting to the horrible little study itself, note how the AAAS  denies responsibility for what it posts:

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

Note also that AAAS has said it employs 20 staff to monitor its presence in social media and tweak publicity.

The “pilot study” was:

Warren Lana R., Rao Patricia A., and Paton David C. A Pilot Observational Study of an Acupressure/Acupuncture Intervention in Children with Autism Spectrum Disorder. The Journal of Alternative and Complementary Medicine. May 2017, ahead of print. https://doi.org/10.1089/acm.2016.0257\

The Abstract

Objectives: To determine whether children with autism spectrum disorder (ASD) would tolerate an acupressure/acupuncture intervention and whether parents would adhere to a twice-weekly, 8-week intervention protocol. Second, to further understand best measures to use to capture impact of intervention on behavioral and regulatory functions.

Design: This is an observational pilot study with pre-, mid-, and postintervention measures.

Settings/location: The intervention was carried out in a private practice office in a large metropolitan area.

Subjects: A total of 10 children of ages 3–10 years with ASD and one of their parents participated.

Interventions: A total of 16 biweekly treatment sessions of acupressure and/or acupuncture were carried out by a licensed acupuncturist, and a daily home-based acupressure intervention was carried out by a parent.

Outcome measures: Attendance, tolerance of intervention, parent compliance with home program, and parent compliance in completing daily diary and five standardized measures of behavioral and regulatory functions pre-, mid-, and postintervention were recorded.

Results: The 10 children in this observational study, collectively, tolerated the intervention and parents adhered to the 16 sessions, biweekly protocol, and home protocol, as well as completing daily diary and five standardized measures at three different time intervals. The five measurements appeared to be sensitive to behavioral and regulatory functions that may improve with this type of intervention.

Conclusions: The results of this observational pilot study suggest that acupressure/acupuncture is a feasible intervention for children with ASD that merits rigorous evaluation through a randomized controlled trial.

Probing the article

Keep in mind:

There is no evidence that acupuncture is anything but an elaborate placebo ritual. The ritual involves efforts to communicate hope and acupuncturists are trained to express a sense of progress when patients wince or express discomfort.

There is no specific scientific mechanism by which acupuncture could be expected to affect physical and mental health outcomes.

This is not a randomized trial. Any changes observed  could be chance variation or return to the usual behavior of the patient from the whatever increase in problems motivated seeking health.

Outcomes are not objective, but depend on the subjective ratings from parents who have invested time in repeated traveling to the clinic where treatment is provided. The parents are not blinded, they know their child is receiving a treatment that the clinic communicates is effective. There is no comparison-control group. It is a very different situation than getting the same ratings from teachers who know the children, but do not know if they have received treatment.

A sample of 10 is inadequate (underpowered) for any claims of efficacy or effectiveness. In a randomized trial, a sample of 30 patients per group is needed to detect half the time when the effectiveness of a  treatment that actually has moderate-sized effects. Half the time the effects of the treatment would be missedWhen statistically significant results are found, they are likely to be flukes. Any results that reached significance would have to be a large difference. The literature on psychotherapeutic interventions for mental health problems is littered with unpowered studies claiming significant effects that do not replicated in larger studies.

Why is that? There is a strong confirmation bias in what gets published. Expectable null findings do not get published. The positive effects from small studies that do get published are likely to chance, selective reporting, or the researchers exercising some selection and control of what is reported that they should have.

The ability to detect moderate sized effects drops off quickly as sample size decreases.

A sample of 10 patients would need huge effects. Most statistics do not perform well with such a small sample.  Sampling error or just plain noise affect results: Loss of one patient or adding of another could dramatically affect results. But statistical analyses depend on assumptions being met about the distribution of data. These assumptions are not likely to be met with 10 patients and could not even be tested.

The bottom line: Competent, well-meaning psychotherapy researchers do not even claim any evidence a treatment is effective from a sample  of 10. Authors who make such claims are fools or are trying to fool their readers , or both.

An added bonus guide with helpful tips from a source I trust

Small studies: Be vigilant when writing about them and skeptical when reading about them – HealthNewsReview.org

Nonetheless, the authors make some dubious claims

Unexpectedly, the most robust finding of the current pilot observational study was significant improvement in children’s expressive and receptive social communication after the intervention. These findings are consistent with previous studies reporting significantly improved social communication after acupuncture, including language comprehension and social interaction.14,18 However, they were unexpected because the acupoints selected for intervention in the current study were chosen to target areas of the body corresponding to behavioral and regulatory problems, not areas known to be involved with social communication.

Beware of unexpected robust findings from such little studies. The authors admit that they were not  stimulating the bogus acupuncture points that are supposed to produce such change. They cite crap studies that nonetheless suggest such results should be found.

Although not statistically significant, the current findings indicated some improvement in sleep delay after the intervention, which may be worth further investigation.

Sure, the authors would be better off consulting tea leaves or the children’s horoscopes. They are sorting through lots of measures searching for other significant ones to crow about. When they come up  empty handed, they declare success and call for more research.

Of note, sensory processing concerns associated with ASD, particularly tactile, which had been anticipated to be problematic in AIs, did not manifest in the child participants in this study, with the exception of their general dislike of maintained deep pressure in one location. It should be noted that the initial acupressure strokes administered during the intervention were those that promote calming and quieting per Chinese Medicine theory. response to treatment.

Let’s go back to what the editor of this journal said in the press release:

“While a small study, the tolerance and adherence with acupressure this pilot are both hopeful signs for families of those in their care with autism spectrum disorder,” states JACM Editor-in-Chief John Weeks, johnweeks-integrator.com, Seattle, WA

Quack, Quack,

 

Any journal that would publish such irresponsible stuff deserves a warning to ward off naïve and vulnerable readers. Nija Ezard Ernst says

I only see one solution: completely disregard certain journals that have been identified to regularly publish nonsense. Sadly, the wider medical community is far from having arrived at this point. As far as I can see, the problem has not even been identified yet as a serious issue that needs addressing. For the foreseeable future, we will probably have to live with this type of pollution of our medical literature.

The JACM Editor-in-Chief John Weeks is well known to the skeptical community who watch for quacks. Like the EverReady Bunny, he jumps at opportunities to promote the reimbursement of dubious, unproven treatments. For instance:

The Academic Consortium for Complementary and Alternative Health Care (ACCAHC) is a group of “complementary and alternative medicine” educational organizations representing chiropractors, naturopaths, acupuncturists, homeopaths, ayurvedic practitioners, direct entry midwives and massage therapists. The executive director is John Weeks, a relentless promoter of “integrative medicine,” both on the Integrator Blog website and in the Huffington Post. The ACCAHC is dedicated to ensuring that its members and the practitioners they represent are included in all aspects of health care, such insurance reimbursement, financial resources for education and delivery models. ACCAHC’s stock-in-trade is its practitioners’ supposed expertise is being patient-centered, holistic, taking into account the whole person and such, as well as an alleged emphasis on healthy lifestyles, nutrition, well-being, and the like.

AAAS puts this stuff out there because it makes money. You can tell them to stop. Contact them at their website, go to their Facebook page. Share and Tweet the link to this blog post, tweet to EurekAlert.

EurekAlert is promoting quack treatments to vulnerable parents of children with autism and it must stop. Readers may not notice that distributing through the EurekAlert doies not constitute endorsement by the widely respected Association for the Advancement of Science, despite the disclaimer at the bottom of the page.

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