No Science, No Choice: Children’s Vulnerability to CAM and Pseudoscience

Some time ago, Skeptic North reviewed an episode of CBC’s Marketplace that focused on homeopathy. The program featured a parent that opted to use homeopathic vaccines instead of real vaccines. I suspected that the parent was genuinely misinformed about vaccines and homeopathy, and noted in the comments that since as a result of the program, she now knows (or should know) that her children are unvaccinated; not providing her children with the appropriate medical care is tantamount to neglect.

Some disagree with me. Not on the grounds of what legally constitutes neglect, but rather because they believe no one has a right to interfere with the choices of a parent for their child. Here’s what commenter “Anon” contributed:

“Every person on this earth has choices, and that Mom has EVERY right to choose for her child, because it is her child! Not the drug companies child, not your child! Gain some research under your belt before you start trashing a mother who chooses not to put vaccinations in her kids arms”.

Apparently everyone has the right to choices, except the child in this case. I responded that parental choice is in fact limited by child protection laws, that children have independent rights of their own, and are owed a minimum standard of appropriate medical care. On this basis I believe that using homeopathy in substitution for science-based medical care is neglectful.

Commenter “Dr. MOM HD” disagrees with me:

“Thanks for your insight Dianne but you are wrong about the law and child protection has nothing to do with it! In Canada you do not have to get your child vaccinated and only 3 provinces require proof or an affidavit signed that your child is not vaccinated.”

Granted, I’m not a lawyer, and so I’m not qualified to speak about what legally constitutes neglect. Nonetheless, I suggest that substituting homeopathy for standard medical care is neglectful. I think this a reasonable position given the fact that homeopathy is nothing more than water. Dr.MOM HD and I do agree on one point: homeopathy has nothing to do with child protection, though I would say that this is because homeopathy doesn’t protect your child from anything.

Won’t Someone Please, Think of the Children!

What I take away from exchanges like this, is that people easily conflate the ability to make a choice for their children with the nonexistent right to make whatever choice they want. Children are not chattel. The choices that are made by a parent for their children are best described as responsibilities. You have the responsibility to make choices for your children, and these choices are reasonably limited by various laws in place to protect children from the harms that result from bad parental choices, among other things.

What I want to draw attention to here isn’t the irrationality of homeopathy proponents, or even the fear mongering tactics of the anti-vax crowd. Rather, I want to point out just how vulnerable children are to becoming the victims of CAM and pseudoscience. The comments above don’t reject the neglect argument on the grounds of it being erroneous so much as they are suggesting that it’s irrelevant. To them, the right of a parent to choose supersedes the right of the child to appropriate medical treatment. This is disturbing, since children can’t be expected to advocate for themselves when they are ill or unwell in some way, or ever really for that matter.

Seriously, Can We Please Think Rationally About the Children?

Children are vulnerable to the harms associated with CAM and related pseudoscience. A round-up of some common CAM modalities and pseudoscientific ideas should illustrate the point.

Anti-Vaccination Misinformation – Parents are inappropriately counselled against vaccinating their children, which leaves these children vulnerable to dangerous and debilitating disease and also leaves children who can’t be vaccinated at serious risk. Children are disproportionally affected by anti-vax propaganda.

Chelation Therapy – Advocated as a treatment for autistic children who are thought to be “vaccine damaged” through heavy metal poisoning. Chelation is used to remove heavy metals from the child’s system but carries serious risks, including death. You wouldn’t know it though, if you were to come across certain natural pharmacies. It’s just another menu item on the list of available medical interventions that you can choose for your autistic child.

Facilitated Communication – A facilitator aids a child with a disability that allegedly affects full communication by supporting their hand as the child types or points to letters on a board. Even though the technique has been discredited, it continues to be used, and not just on the fringe. Once the “Facilitated Communication Institute” at Syracuse University, the Institute on Communication and Inclusion has rebranded the technique as ‘supported typing’, and continues to promote its use.

Water + Fancy Box = Profits

Homeopathy and Related ‘Natural’ Remedies – I could probably write volumes on the useless and dangerous products that are made specifically for children. Most that I come across are for self-limiting conditions, like teething, coughs, colds and the like. But there are also many products out there that target children with emotional or behavioural issues. Homeopathic manufacturer Boiron makes a product called ‘Nervita’.  The Canadian company Homeocan produces ‘Kids Calm 0-9’ recommended “for agitated, restless children as well as those suffering from occasional nervousness and insomnia”. You should buy it for your agitated child because of the fancy box it comes in. If you’re wondering, Health Canada approves these products as safe, effective, and of high quality (search NPN/DIN-HM numbers 80008739 and 80007900 here).

Dubious Psychotherapies – There are hundreds of different psychotherapy modalities out there with a concomitant amount of institutes, associations and practitioners. Many have been discarded (or are not yet accepted) by science-based psychology in favour of modalities with better scientific support (like cognitive behavioural therapy). Much like the discarded ideas of medicine, they remain promoted on the not so quiet fringe.  Some of these psychotherapies are targeted to children and have a history of being abusive in the extreme. Visit the website of the Ontario Society of Psychotherapists and look at the therapeutic modalities in the drop down menu under “therapist approach”. On the list is attachment therapy, and 28 therapists list it as an approach they use. I want to be very clear here: these therapists probably mean they provide therapy based on attachment theory and not the controversial and clearly abusive “attachment therapy”. Nonetheless, I can’t be sure what they mean since even the diagnosis of “attachment disorder” is unrecognized. It’s worth noting that the use of dubious psychotherapies continues, at least in part, due to the largely unregulated nature of mental health professionals, beyond fully licensed psychiatrists and psychologists. It’s in this climate that help is sought out for a child with an emotional or behavioural disturbance. What kind of safety net is in place for these children who can’t be expected to seek out and evaluate help for themselves?

Where Skepticism Comes In

I don’t see that children are sufficiently protected from being harmed by CAM and pseudoscientific ideas. First, there are plenty of practitioners and manufacturers of alternative medicine out there who market themselves to parents. There are also plenty of parents who are suspicious enough of conventional medicine that they will seek out alternatives. Too often, they seek out CAM in lieu of treatments known to work. Also too often, practitioners and parents will defend their choices insisting that they are the ones with the child’s best interest in mind, and that they have the right to make the choice anyway, evidence notwithstanding. As this is happening, children’s rights and needs are pushed aside.

Who advocates for the child when parents are bombarded by misinformation, are marketed to vigorously, and the agencies charged with protecting consumers are unable or unwilling to intervene? I don’t know, but I’d like to start the conversation. I will suggest that we all begin to pay closer attention to when the pseudoscience we’re dealing with affects children disproportionally. It’s not just about the science, it’s also, and more importantly perhaps, about the victims.

12 Responses to “No Science, No Choice: Children’s Vulnerability to CAM and Pseudoscience”

  1. Composer99 says:

    One thing that jumped out about facilitated communication to me just now (even though I had read about it on Science-Based Medicine discussing the Belgian man who had been subject to it) is that it appears indistinguishable from playing a Ouija board.

  2. Kenneth says:

    Let us not forget the children who suffer and die because their parents “choose” prayer over any medical treatment: Kent Schaible, Ava Worthington, Madeline Kara Neumann, among too many others…

  3. I agree wholeheartedly with this article. Kenneth–I wonder if prosecutions similar to those Kenneth mentions for prayer would help. Someone would need to explain to the Crown Attorneys why it would be abuse. But I guess that’s our role.

    • Dianne Sousa says:

      Prosecutions are important, but there are bound to be more cases where kids are at unacceptable risk that do not meet the criteria for criminal abuse or neglect.

      • My point on the prosecutions is that they would increase awareness of the issues.

        One of the problems of dealing with the concept of kids at risk is that it would include parents who delay a doctor’s visit for their children because in their minds it isn’t serious enough to warrant a visit. How can one separate the idea of a warm bath, a cup of earl gray tea and off to bed from a warm bath and drink of echinacea?

        In some cases there is an easy distinction, in others not so much.

  4. Mr. Empey says:

    Your article got me interested in what Ontario law says about non-immunization of children. I came across a very interesting article (http://www.publichealthpolicy.org/wp-content/uploads/2010/10/WilsonRodal.pdf) which observes that Ontario is the only Canadian province where immunization is required by law. Even more interesting is that non-immunization does constitute neglect in Ontario in certain, albeit rare, situations. I wrote more about it on my blog: http://www.mrempey.com/2011/08/what-does-ontario-law-say-about.html

    • Dianne Sousa says:

      Thanks for the link. I’m going to recommend that everyone take the time to read through it, as it outlines a novel approach to combatting anti-vaccine misinformation.

      Here’s a brief summary for those not interested in reading a 26 page discussion of tort law (really, it’s not that bad). The paper discusses whether parents who don’t immunize their children can be sued for harm caused by vaccine preventable diseases. The analysis concludes that parents can be sued in certain circumstances but that the potential plaintiffs would have a hard time surmounting certain defences to the claim.

      This stems from current immunization policy (like in Ontario) that both requires immunization by law and allows conscietious objections. Parents who choose to not immunize and sign exemption forms may not be aware of the potential harm of breaking herd immunity to both vaccinated children and to children who cannot be immunized.

      The authors suggest that lawsuits would be more successful if immunization policy were standardized across Canada, in addition to either the removal of exemptions, or more complete explanations of the risk to public health on exemption forms. They suggest that succesful lawsuits would evoke a “stigma effect” on parents who choose to not vaccinate and suggest that this could reverse the non-compliance trend.

  5. chip cherry says:

    Agreed. Alt med is often a faith based proposition. Faith will not keep a virus from attacking a young body.

  6. CKinNC says:

    Clearly this author has not had a child with attachment disorder. Her remarks on this subject are ignorant.

    • Kim Hebert says:

      Care to clarify exactly what she got wrong?

    • Dianne Sousa says:

      As I noted above “attachment disorder” isn’t a recognized diagnosis. It is not in either the DSM IV-TR (the diagnostic maunual of the American Psyciatric Association) or the ICD-10 (the diagnotic manual of the World Health Association). Both list “Reactive Attachment Disorder”, but the term “attachment disorder” is used by proponents and defenders of attachment therapy as a diagnosis that may be confused with RAD but is without any valid scientific base.

      Indeed, it is clear that I haven’t had a child with “attachment disorder” because “attachment disorder” doesn’t seem to be a thing. Even if it was determined to be a valid diagnosis, this in no way could be construed as a defence of attachment therapy.

      In case this was in any way not clear in the article, attachment therapy is abuse to a disturbed child, in the guise of a therapeutic intervention.

      From the APSAC (Americam Professional Society on the Abuse of Children – quoted in the wikipedia entry linked to above):

      “A central feature of many of these therapies is the use of psychological, physical, or aggressive means to provoke the child to catharsis, ventilation of rage, or other sorts of acute emotional discharge. To do this, a variety of coercive techniques are used, including scheduled holding, binding, rib cage stimulation (e.g., tickling, pinching, knuckling), and/or licking. Children may be held down, may have several adults lie on top of them, or their faces may be held so they can be forced to engage in prolonged eye contact. Sessions may last from 3 to 5 hours, with some sessions reportedly lasting longer… Similar but less physically coercive approaches may involve holding the child and psychologically encouraging the child to vent anger toward her or his biological parent.”

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  • Dianne Sousa

    Dianne holds a degree from the University of Guelph in criminal justice, public policy and social psychology. She became involved in the skeptical movement after becoming disillusioned with the addictions counselling field. Skeptical topics of interest include alternative medicine and it's regulation in Canada, pseudoscience and the law and skeptical activism. She also crochets extensively and enjoys bad film, usually at the same time. Follow me on twitter: @DianneSousa. All views expressed by Dianne are her personal views alone, and do not represent the opinions of any current, former or future employers, or any organizations or associations that she may be affiliated with.