I make no secret of that fact that I like editorial cartoonists. Maybe it's that they make their living from observing the world instead of making up stories, and have the court-jester's licence to mock instead of the journalist's assumed responsibility to be unbiased and non-editorial, but some of them (and I am particularly fond of Kudelka and Michael Leunig here) are so much more entertaining than regular cartoonists who just have a cool idea for a story. I have been keeping an eye on Matt Bors for my dose of fear-and-loathing-at-a-distance American news, and then he drops this gem:
Placebo Effect. Click on the image for the full size cartoon.
Wednesday, 21 May 2008
Mainstream medical news makes me go AAAAAGGGGH!
First, the background: Somebody once made the observation that in people with ADHD and other attention-style disorders (let's not get into an argument about the validity of ADHD as a diagnosis or definition), the Cerebellum, which sits at the base of the brain, handles coordination and is structurally different to the rest of the brain, being much denser and, in evolutionary terms, older, is about 4% smaller than in their peers.
Valid hypothesis one was: The cerebellum is linked to control of attentional processing in the prefrontal lobes.
Completely off-base kooky assumption one was: If we make someone with ADHD perform coordination exercises, we are stressing the cerebellum, so it'll get bigger, and because it's linked to attentional processing, their ADHD will improve! Yay! And we'll call it the Dore program, and charge people $5,000 for the privilege!
I don't have the mental strength to get into everything that's wrong with the Dore program and how it operates, but let's start with the fact that none of their scientific claims have been validated. None of them: "The scientific evidence to support the claims of the Dore program has not yet been established," the Macquarie University authors wrote. "There are two flawed studies, both carried out by the same group who were not independent of the Dore program."
In fact, if memory serves, the editor of one particular paediatric journal was forced to resign in disgrace after allowing one of those studies to be published. The possible explanations for observed effectiveness of the Dore program start with the Placebo effect, move through the fact that children are being given structured, regimented exercises at all, regardless of what they are and what they are for, and even include the possibility of children growing out of it during the 12-month duration of the program.
Now, don't you think that for $5000 and 12 months you'd want the improvements to be really good and for the premises to be proven as vital? I mean, $5,000 would pay for your child to attend Karate lessons for several years. In fact, I want to see a study done on rates of ADHD among children who attend a structured physical discipline such as a martial art, gymnastics, dance or good-quality sports coaching (Christ, don't tell me that the annoying little pick-tutu wearing female human larvae that jump up and down on the wooden floor across the road every fucking weekend might be doing some good).
That quote above comes from this article, and it has the latest subtle cock-up headline to make me see red:
Medics blast Dore program that gets results for ADHD (Courier Mail)
"Gets results"? Gets results? See above about placebo effect, etc. In fact, read the article, where somebody actually says that. The article itself isn't too bad: Not much analysis, not much actual journalism, a couple of quotes, but have a look at that headline again: Notice the sly suggestion that not only does Dore work, but that "medics" somehow don't like it despite the "fact" that it works? With the implication being that if it's not drugs, then mainstream medicine doesn't want to know? Would this be the same mainstream medicine that embraces physiotherapy?
And see the end of the article: "We're not trying to "cure", we're trying to "improve" ". I'm sorry, what? "It's pretty difficult to scientifically prove exactly what happens." No it isn't, you ignorant fuck. If you're trying to change sensory paths to and from the cerebellum, then use the scanning techniques you started with. Use fMRI scans to show brain activity. Use blind reassessment of program children and control children who got enrolled for a couple of sessions of bare-foot kata in white pyjamas each week instead. We use drugs because drugs, in the majority of cases, get results. You can't show results. Shut up and go away, please, before you do real damage to the fragile hopes of a family who don't have much left.
Valid hypothesis one was: The cerebellum is linked to control of attentional processing in the prefrontal lobes.
Completely off-base kooky assumption one was: If we make someone with ADHD perform coordination exercises, we are stressing the cerebellum, so it'll get bigger, and because it's linked to attentional processing, their ADHD will improve! Yay! And we'll call it the Dore program, and charge people $5,000 for the privilege!
I don't have the mental strength to get into everything that's wrong with the Dore program and how it operates, but let's start with the fact that none of their scientific claims have been validated. None of them: "The scientific evidence to support the claims of the Dore program has not yet been established," the Macquarie University authors wrote. "There are two flawed studies, both carried out by the same group who were not independent of the Dore program."
In fact, if memory serves, the editor of one particular paediatric journal was forced to resign in disgrace after allowing one of those studies to be published. The possible explanations for observed effectiveness of the Dore program start with the Placebo effect, move through the fact that children are being given structured, regimented exercises at all, regardless of what they are and what they are for, and even include the possibility of children growing out of it during the 12-month duration of the program.
Now, don't you think that for $5000 and 12 months you'd want the improvements to be really good and for the premises to be proven as vital? I mean, $5,000 would pay for your child to attend Karate lessons for several years. In fact, I want to see a study done on rates of ADHD among children who attend a structured physical discipline such as a martial art, gymnastics, dance or good-quality sports coaching (Christ, don't tell me that the annoying little pick-tutu wearing female human larvae that jump up and down on the wooden floor across the road every fucking weekend might be doing some good).
That quote above comes from this article, and it has the latest subtle cock-up headline to make me see red:
Medics blast Dore program that gets results for ADHD (Courier Mail)
"Gets results"? Gets results? See above about placebo effect, etc. In fact, read the article, where somebody actually says that. The article itself isn't too bad: Not much analysis, not much actual journalism, a couple of quotes, but have a look at that headline again: Notice the sly suggestion that not only does Dore work, but that "medics" somehow don't like it despite the "fact" that it works? With the implication being that if it's not drugs, then mainstream medicine doesn't want to know? Would this be the same mainstream medicine that embraces physiotherapy?
And see the end of the article: "We're not trying to "cure", we're trying to "improve" ". I'm sorry, what? "It's pretty difficult to scientifically prove exactly what happens." No it isn't, you ignorant fuck. If you're trying to change sensory paths to and from the cerebellum, then use the scanning techniques you started with. Use fMRI scans to show brain activity. Use blind reassessment of program children and control children who got enrolled for a couple of sessions of bare-foot kata in white pyjamas each week instead. We use drugs because drugs, in the majority of cases, get results. You can't show results. Shut up and go away, please, before you do real damage to the fragile hopes of a family who don't have much left.
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