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Moar Science Plz

Physical activity program leads to better behavior for children with ADHD

This is kind of headline I’m used to seeing when people talk about press about studies of children with ADHD.  There is so much populist pushback against the idea of medicating of children with drugs like Ritalin (or in my case, dexedrine) that it seems you can’t swing a dead cat without coming across the idea that there is some easier non-pharmacological way to improve outcomes.  And then when I look closer, I find that the glowing ideas are somewhat dubious when you look at the actual procedures behind the headlines.  This one is no exception.

When I came across this study, the person promoting it trumpeted it as “no surprise” since everybody knows that the whole problem with ADHD kids is that they can’t sit still and focus, right?  You know what, fuck you.  You’re part of the problem that led to years and years of my misery going undiagnosed (ignorance, confusion and stigma) and untreated (ZOMG, don’t give kids drugs that clearly help them).  But before we get to that, let’s look at the particulars.

  • The study did not include children without ADHD to provide a contrast of neurotypical students (Because this will undoubtedly lead to replacement of other treatment modalities, rather than addition in most cases, you must contrast results of ADHD children with neurotypical children to get some idea of effectiveness as a coping strategy.)
  • They studied exactly ten children and eleven as a control, quite a small sample size (Do I even need to point out why a tiny sample size is problematic in scientific research?)
  • The control group is not particularly well controlled for environmental variables as they were recruited from numerous other schools while the experimental students all attended the same school (Because the results being measured are of a fuzzy social/behavioral aspect, controlling for variables in teaching and environment is key)
  • Girls with ADHD were not well represented in this study, 1 per group (Women are underresearched in medicine to begin with, but I can tell you that as a girl with ADHD, I was basically invisible.  Girls are often underdiagnosed in ADHD, although I hope it’s improved from my childhood, and ignoring their response to treatment modalities as unimportant during behavioral research will continue to produce studies that may not be useful for treating female children and adolescents.)
  • The control group were all taking medication while only 30% of the experimental population was on medication to manage their symptoms (I took dextroamphetamines to treat my ADHD and while it was almost miraculously helpful, it is not without physical effects.  I was terribly underweight at times and remember having to force myself to eat when I wasn’t hungry.   I also had to take medication that aided in sleep since I was taking powerful stimulants.  Given that this treatment is physical and measures changes in fitness/strength/motor skills, medical side effects that could include reduced appetite and weight loss should not be ignored.  Moreover, this is one of many ways in which variables in the study were ignored rather than controlled; comparison between these two groups can’t discount medication as a difference.)
  • Two of the three types of ADHD were represented in the study (Hyperactive-impulsive, and combined); those with inattentive type were described as “not included in the theoretical model of ADHD” (I have a couple of problems with this. For one, it is another variable that’s not well controlled for in the experiment.  For another, this is simply excluding a whole population of those who meet the diagnosis criteria for ADHD as unimportant while attempting to make generalized statements about improvements in children with ADHD without qualification.)
  • Initial evaluations prior to the physical activity program were done with children explicitly not taking their medication, although they were allowed to be on medication during the experiment (Testing conditions prior to the experiment should be the same as those used during and afterward.  Duh.)
  • Behavioral results were tracked by parents and teachers using Achenbach’s Child Behavior Checklist; no self-evaluation or independent evaluation was used (Even during the ages referenced, I was a fairly secretive child and tended to hide depressive symptoms and problems with my homework/other tasks out of frustration and shame.  Without any input from the children themselves, we have no way of being sure of many internal behavioral issues that are being evaluated by parents and teachers.  Moreover, much like the sugar/hyperactivity studies in children, we have a huge problem of confirmation bias where teachers and parents expecting to see change will believe they observe change.)
  • No way to blind the observers involved for control/experimental groups (Again, confirmation bias)
  • Previous evaluation showed the control group had a higher incidence of withdrawn/depressed behavior prior to program and evaluation (Still more methodological problems in getting comparable data between research groups.) 
  • [Personal Note: No attempts are made regarding statistical analysis of task completion such as homework.  It would not have been difficult to track any change in ability to finish and turn in homework as a hard statistical evaluator of task-related behavior improvement.]
  • Study itself acknowledges flaws within both design and recruitment render the positive results reported more or less useless (They try to spin it positively, claiming that the pointless results are “exploratory” and really means that more study should be done on the subject, hopefully more well designed.  I’m not against this kind of research per se, but I do think that it any positive results need to be cautiously described lest they lead more children to go without treatment like I did for much of my childhood.  No one should have to suffer through that frustration, shame and pain.)

So the rosy headline that physical activity improves outcomes for children with ADHD is basically a lie.  The researchers very clearly state that their data collection and other structural flaws cast doubt on the results.  It’s not entirely the fault of the researchers as medical science reporting is notoriously bad.  Not only can reporters and bloggers often not tell good science from bad, they overstate and exaggerate conclusions until they are sometimes unrecognizable.

So I want more science and I want good science and I want good science reporting.  Is that so much to ask?

Using “Therapy” as a Cover for Abuse

Mental illness has long languished behind physical treatment in parity, research and social parity.  Disorders and disabilities that are lifelong and which affect how an individual functions on a daily basis (like autism spectrum disorders or my ADD) are particularly misunderstood by the public at large, and unfortunately, by teachers specifically.

And while most people would agree that schools need to provide education and training, I can’t help but feel like these kinds of programs are some of the first on the chopping block when public budgets begin to feel tightened.

Perhaps I should not have been surprised to hear about an incident two weeks ago in Kentucky where a nine-year old autistic boy was restrained by placing him in a green duffel bag until his mother came to pick him up.  But I was surprised, because I couldn’t imagine any teacher lacking the basic empathy necessary to see how damaging and harmful doing so would be.

Teachers at the school have had no training in how to meet the needs of autistic students, nor any training in any kind of psychological therapy.  Nevertheless, it is apparently a normal thing at this school to restrain students by putting them into a duffel bag and pulling the drawstring tight, with the only consideration to safety having a teacher’s aide stationed near the bag, presumably in case of death or something.

I first heard about this through the petition at Change.org but I am still horrified and angry, two weeks later.  No mother should have to bear the sight of her child bound inside a bag, being greeted with the frighted query,

Momma, is that you?

Just Sell Me The Tea and Shut Up

It’s long been established that I love tea.  Especially properly brewed loose leaf tea.  It’s delicious and soothing and just all around awesome.  When doing our Christmas shopping in the mall a few weeks ago, Thrack and I came across a brick and mortar location for Teavana, so obviously there was no choice but to go in.  We’re having a pretty low key Christmas in terms of gifts, because we’re sleeping on the big gift of the year already.

They had samples which were okay, but so sweetened that I could hardly taste anything.  Ugh.  And the damn sales clerk did something that immediately pressed all my irritation buttons: preached alt med wellness bullshit.  She took me from being happy and predisposed to buying a decent sampling of teas to being annoyed and wanting to get rid of her so I could get my couple of teas and get the fuck out of the store.

I usually love browsing teapots and assorted bits and bobs even though I really don’t have any intention of buying more stuff because I like the aesthetics.  Hell, the look is why I bought my little Japanese cast iron kettle in the first place (although I bought mine in a California import shop rather than a tea shop, I think).

So when the clerk kept trying to sell me on tea because of amorphous health benefits and not so subtly tried to upsell me to one of their cast iron pots (because I already possess the best electric tea makers in existence, made by Breville and Zarafina), I  was ready to yell at her.  I know it’s her job and she probably doesn’t know a goddamned thing about why alt med bullshit is either harmful or pointlessly expensive or both, but you don’t push this kinds of shit on people so hard or you lose sales.  It made me far less inclined to go back as well, even though I was impressed with the quality of the leaves (just the smell is intoxicating).

She tried and interesting tactic on the cast iron pot.  Even though I had told her I already had a cast iron pot (seriously, how many does a person need?) and that I would much rather have tea made to the right temperature for the type of leaf in my Breville, she tried to tell me the cast iron was better for me.  (It’s not, for two reasons I’ll talk about.)

First, you really only get benefits of cooking with cast iron if you’re iron deficient, whether from diet or your body’s processing of iron on a basic level like my Grams.  I don’t have problems with iron saturation in my body, so there is no health benefit supported by evidence.

Secondly, all their fucking iron teapots are enameled inside, so you don’t get any benefit at all, even if you need it.  Strike three, you’re out annoying sales clerk.  So maybe I’ll go back to give them one more chance when it’s not Christmas madness or maybe I’ll stick to getting loose teas from my previous sources where they don’t lie to me about imaginary benefits.  Even if they do think they give some magical benefit, they don’t proselytize and I can live with that.

Lost in My Head

If you follow me on Twitter, you’ll already be aware that my body has recently been trying to reject my skin.  (Being maybe 60% serious here.)  I’ve never had an allergic reaction like this and it has been ongoing for 6 days now.  I’ve had generalized itchiness and hives over basically my entire body and even the smallest scratching would raise the skin up in to red streaks of painful welts.  I didn’t want to have anything or anyone touch me, and even the weight of my own hair on my shoulders was excruciating.

Thankfully on Friday I was able to get in to see a doctor, who gave me a bucketful of good steroids and a jar of steroid cream to apply topically as needed.

It’s finally headed in a positive direction, but I feel like I’m having a bit of relapse today, and I’m really struggling to function, think and interact with other people in a way that makes sense.  Heavy medication is absolutely necessary here to keep me from wanting to remove my skin in strips, but I just don’t feel like myself or even terribly competent in communicating at work.

I was horrified to realize today that Thanksgiving is this week.  As in a handful of days away, and that just can’t be possible.  It feels way too early because I feel like I lost so much time with the early benedryl filled stupor that it just can’t be this late in the month already.  So now I’m thinking about our contributions to Thanksgiving dinner and where to get the freshest and most flavorful pumpkins (oh, I have a blogpost in the brain-hopper about never ever using canned pumpkin again) because apparently it’s a holiday weekend I didn’t even notice.

On Hypochondria and Dangerous Alternative Treatment

I can be clumsy at times, and while I can’t always remember what I specifically did to cause every little bruise or scratch on me, I don’t cause real injury without paying attention.

So when I woke up yesterday morning in too much pain to move my neck even fractional amounts, I was both befuddled and highly concerned.  I spent nearly the whole day flat on my back in bed loaded full of ibuprofen and muscle relaxants with a heating pad mashed around my neck.  The pain was so intense that Thrack made me a bourbon sour for breakfast and held it to the side of my head so I could sip it through a straw.  If we’d had a sippy cup around the house, I don’t doubt that he would have filled it full of whiskey for me.

I also read much more than I should have about meningitis, and worried over probably nothing.  I had been feeling rather crappy last week, but as I had no fever and wasn’t currently feeling barfy, I knew consciously that it was some fluke muscle stiffness that would go away eventually.  But that didn’t stop me from thinking about the horrors of meningitis as I lay flat being bored out of my mind.

Someone on Twitter suggested that I go to a chiropractor if it didn’t improve and it was all I could do not to unleash rashes of links hir way explaining why a chiropractor is where I’d go immediately after I walked through a nuclear reactor without any protective gear, particularly for neck problems.

I wouldn’t go to a chiropractor for neck problems because:

  1. I don’t want to die
  2. I don’t want a stroke
  3. I don’t want arterial damage
  4. I don’t want an aneurysm
  5. I don’t want medically unnecessary x-rays
  6. I don’t want to be paralyzed

I’m constantly baffled why people aren’t more aware of the dangers of chiropractic treatment, specifically with regards to one’s neck.  While I won’t tell someone never to go to a chiropractor if they are suffering from back pain (notoriously difficult to treat completely), I would recommend they compare all options with a risk/benefit/cost analysis first and ensure that the practitioner does not ever touch the neck.

The suburb of Salt Lake I live in has a highly disproportionate number of chiropractic clinic and it makes me highly uncomfortable; who are they treating and are those people forgoing real medical care?  I wonder if we should start making medical data on what is effective and safe part of biology education people receive in high school.  Because how many people actually know what resources are out there to educate themselves?  How much money do people waste and how many risks do people take with their health simply out of ignorance?

I’m showing distinct improvement today, so continuing to take it easy while keeping up with pain medication and muscle relaxants (don’t worry, I’m not driving!) will get me back to normal soon.  But if I needed help, I would go to an actual doctor or physiotherapist to ensure that I was getting evidence supported medicine rather than this pre-germ theory madness.

Framing of HPV Discourse

I don’t think much of Texas governor Rick Perry.  I regard mandating HPV vaccination one of the few good things he accomplished during his tenure, even if he didn’t do it out of understanding of science based medicine and herd immunity.  (It would have been even better if he’d encouraged students of both sexes to get vaccinated as both sexes suffer negative side effects and cancers as a result, but beggars can’t be choosers.)

Now that he’s courting different public image, naturally, doing something good and positive to prevent diseases and cancers in men and women is a bad, bad thing.  Because you mainly transfer human papillomavirus by *gasp* having sex.  And since sex/sexuality is a terrible thing you should hide and hate yourself for until you marry someone of the opposite sex, we should make sure that there are as many negative consequences to it as possible.  Naturally, this means not vaccinating girls against the most common cause of deadly cervical cancer, because only dirty sluts are at risk for it anyway.  Right?

No.

The fact is, the social stigmas for premarital sex are so disproportionate between young men and women that pretending that a woman is safe from HPV infection if she is a “good girl” and stays a virgin until marriage is disingenuous.  Socially as young girls are simultaneously rewarded and punished for virginity (we really have some stupid hangups), young men are lessers if they don’t want and seek sex constantly.  I assume you can see where I’m going with this?  Yep, even the good religiously shamed virgin can very well get HPV from her spouse and die of cervical cancer.  The young child whose uncle or stepfather abuses him can contract it through no fault of his own.  The young woman whose trust is betrayed when a friend rapes her can contract the disease and never know.

The overall statistical infection rate for the  U.S. population seems to hover around 50% of the population.  So it’s hardly a disease contracted just by those who are highly promiscuous.  Why then do we allow the public and media discussions of vaccination to center on sexual morality?

Protecting huge swaths of the population from the small side effects (warts) as well as sometimes life-threatening cancers in genital and oral areas should be an undeniable public good.  Aside from some truly compassion-challenged people who oppose medical interventions on religious grounds, stopping cancer is universally acknowledged as a wonderful thing.  Why can’t we change the way that we talk about HPV infection, and focus on preventing its spread to boys and girls?

Anti-Science Medicine as a Local Industry

Names like Nu Skin, Usana, XanGo, and Tahitian Noni are familiar to me, even if I don’t know exactly what sort of snake-0il supplementation they’re selling, mostly because I see their signs over public music/sports venues or in giant faux-gilded signage from I-15 driving south through Utah County.  But I’ve never really had friends or family that I knew to buy into and use these products, so I guess I simply assumed that most of the people here were more or less in favor of science-based medicine treatment modalities.  I wish I still believed that.

I had an absolutely stunning conversation with a coworker I still want to like the other day when talking about the problems we’ve been having with insurance coverage of Thrack’s colitis.  I knew she was a super-devout neo-con sort of Mormon, but honestly, given my work environment, that doesn’t actually make her stand out overly much in this very conservative office.  So I was resigned to like her (because she’s nice, even if reality doesn’t seem to be high on her list of valued things), and then I made the mistake of telling her I was stressed about our struggle to find affordable treatment.  She wanted to know if we had tried changing his diet or natural remedies because the actual medicine (you know, the stuff that’s been studied a lot, statistically proven effective and safe and approved by safety boards) was too expensive under our ridiculous insurance prescription formulary. (Yes, despite what we’d been told, treatment is still too fucking expensive each month, so we’re looking for alternatives.)

I explained that diet doesn’t have any measurable effect on his inherited non-specific non-ulcerative colitis; he can wake up and drink a sip of water and be triggered just as easily as he can be by any food type.  We’ve tried to keep our diets more low fat, etc. but that hasn’t had any effect on his digestion because his system is just angry and broken.  Thrack has a few autoimmune things going on, and this is just one of them.  As for natural remedies, well, the only thing known be effective is smoking.  Yes, seriously, if he started smoking, it would treat him.  Not really a great option, of course, but it’s the best “natural” option out there.  Of course, when I mentioned this, said coworker was horrified.  (She also seemed to resent that this is the only alternative treatment with any efficacy, probably because it violates what her god says in the Word of Wisdom.)

I mentioned the problem with lots of herbal treatments is that they don’t have the rigorous evidence for efficacy and are more likely to have side effects because of the other compounds in them.  To which she replied that exactly the opposite was true.  Not only did she claim that all “natural” things are better than purified, tested derivatives because they’re natural.  (Guess what else is natural? Nightshade, arsenic, lead, hell all heavy metals, formaldehyde, strychnine, etc. Natural treatment fallacies are just stupid.  Modern pharmacology encompasses all the healthy/beneficial element of traditional modalities in medicine.  Plus traditional medicines can also sustain incredible cruelty, as with bear bile. As a warning, the bear bile link is heartbreaking/stomach turning.)  But on top of insisting that all natural things are better, she insisted the reason that herbs are better is because they’re not purified; heavenly father (yes really) knows better than us and wouldn’t mix things that were bad for us (yes, REALLY).

I tried pointing out that herbal medicines often cause problems for people because they don’t actually understand all the effects of what they’re taking, lacking both a doctor’s guidance and measured/regulated dosing.  I tried to point out that lots of people self-medicate thinking herbal drugs have no effect on other treatments, and end up blocking absorption of their actual medication, like with St. John’s Wort.  No dice.  As a last ditch attempt, I tried to point out examples where synthetic derivatives are more healthy than the old natural derived ones using the example of insulin.  To which she responded that with diet, no one ever needs insulin ever again.  [Information on what’s she’s talking about, the raw/”living” foods hype machine, here.]

Then we got even further down the rabbit hole when she started to tell me that her god created us all to be obedient, thoughtless idiots who should just not even try to figure things out and should throw scientific inquiry away while we were at it.  It’s just better to be grateful for the apparently perfect easy-to-figure-out world of woo and anti-science alternative herbal modalities.

Man doesn’t understand as much as he thinks he does. He tries to figure it out but can’t because he isn’t God.

I really have liked this woman in the past, but when faced with so much willful ignorance about science, medicine and just reality in general, I don’t know how much I can keep that fondness going.  It’s hard to like someone you can’t respect.  (She’s also told me, for example that it was over-regulation that led to our financial downturn.)

And this is just one person.  Here in Utah, we’re currently facing an outbreak of measles because assholes credulously buy into the bad-science fear-mongering about vaccines.  Currently, all of the affected children were themselves unvaccinated, but there is always the possibility of infecting some innocent immune-compromised person who relies on the greater herd immunity to stay healthy and not die.  Within days of the outbreak spreading, my brother in law complained that coworkers were talking about how all them fucking believed the vaccines cause autism spectrum disorders.  Another loss for science and skepticism.

Which brings me back around the companies I mentioned at the start of this post.  Utah has always had a fairly large stake in the supplement industry, which I knew, but I didn’t realize how much our elected representatives catered to the Big Placebo* industry.  I had no idea how strongly our legislators have advocated relaxing what little regulation exists on supplements and the claims they are able to make, and now that I know, I’m more than a little pissed off.  I wonder if there’s any state-wide pushback against the supplement and “nutritionals” makers; I’d like to know that there are some people here that acknowledge the danger in allowing non-medicine to gain legitimacy.

*I may not be terribly pleased with pharmacology manufacturers or the insurance company panels that decide what to cover, but at least the products they produce have to be shown to be effective and worth the risks associated with treatment.  The woo-woo medicine crowd is so fond of demonizing “Big Pharma” but at least their products are helpful.  Alternative medicine treatments have no such guarantee and are a huge and profitable industry.