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Neurocranial Restructuring and Homeopathy, Neither Complementary nor Alternative

Neurocranial Restructuring and Homeopathy, Neither Complementary nor Alternative The several articles involving "neurocranial restructuring" (NCR) and homeopathy in the April 2003 issue of the ARCHIVES suggest common themes: the folly of licensing practitioners whose methods are irrational, the unethical nature of highly implausible health practices, and the futility of submitting such claims to clinical trials. To begin with, there is more information regarding the case report of a nasal septum fracture caused by NCR.1 The practice has existed for significantly longer than the 8 years reported by the authors, but by a different name. There is also at least 1 other published report of a serious complication. The precursor of NCR is called "bilateral nasal specific" (BNS) and was invented by chiropractor J. Richard Stober.2 Both the endonasal balloon insertions and the panacea claims for BNS are virtually identical to those of NCR. According to the National Council Against Health Fraud, in 1983 a naturopath in Alberta performed BNS on a 20-month-old girl: she died of asphyxiation. A judge called the treatment "outright quackery" but sentenced the naturopath to only a $1000 fine and 1 day in jail.3 According to the course catalog, "bilateral nasal specifics [sic]," "iris analysis," homeopathy, "pulse diagnosis," and numerous other implausible practices are taught at Bastyr University, a naturopathy school near Seattle.4 The inclusion of these techniques in the curriculum of the flagship of naturopathy schools identifies them as standards of practice within the field, and therefore self-regulating boards of naturopathy are unlikely to discipline a practitioner who uses them. Patients injured by them (even if only by having paid for an ineffective treatment) are unlikely to win significant judgments in court. Naturopaths are licensed and given broad scope to portray themselves as primary care physicians in 11 states, including the state of Washington. Health insurers in that state are required to reimburse naturopaths by virtue of the "every category of provider" law. It may come as a surprise to Davis and colleagues1 that the Web site of their own medical school erroneously portrays "naturopathic physicians" as well trained to practice "primary care integrative natural medicine."5 It also states, again falsely, that "naturopathic diagnosis and therapeutics are supported by scientific research drawn from peer-reviewed journals from many disciplines."5 In fact, such statements merely echo those made by naturopaths themselves but do not stand up to scrutiny.6,7 Uncritical endorsements of "complementary and alternative medicine" (CAM) techniques by academic medical centers contribute to a social climate that entices scientifically naive patients to accept treatments such as NCR. The implausibility of this practice raises another issue regarding CAM. Drs Yueh and Piccirillo8 write that many CAM "treatments and procedures are introduced to patients with little scientific evaluation." But ample existing knowledge demonstrates the uselessness of CAM claims such as those under discussion here. Anatomy and neurophysiology tell us that inflating balloons in the nasopharynx to cause a "controlled release of the connective tissue tension to unwind the body and return it toward to its original design"3 is, prima facie, absurd. The facts of nature also refute homeopathy, for reasons that require only a bit more thought.9 Thus, no further scientific evaluation is necessary, and to pursue it is counterproductive and misleading. Put in Bayesian terms, the prior probability of either of these hypotheses being correct is so close to zero that no amount of "positive" clinical evidence can validate them.10 Human studies of claims with infinitesimal prior probabilities—"trifling hypotheses"—are presumed unethical because they exploit subjects and waste resources.11 The practices discussed here are neither complementary nor alternative to modern medicine. They are merely ineffective and, in some cases, dangerous. The time-honored term for them, invoked by the Canadian judge in the case of the toddler's death in 1983,3 is the correct one. References 1. Davis GEMurphy MPYueh BWeymuller EA Jr A complication from neurocranial restructuring: nasal septum fracture. Arch Otolaryngol Head Neck Surg.2003;129:472-474.PubMedGoogle Scholar 2. Butler K A Consumer's Guide to Alternative Medicine. Buffalo, NY: Prometheus Books; 1992:82. 3. Barrett S Be wary of neurocranial restructuring (NCR) [Chirobase Web site]. Available at: http://www.chirobase.org/06DD/ncr.html. Accessed May 3, 2003. 4. Not Available Bastyr University course catalog, 2001. Available at: http://web.archive.org/web/20010423130039/http://bastyr.edu/catalog/courses/default.asp?PID=PM. Accessed May 3, 2003. 5. Not Available Complementary and alternative medicine (CAM): naturopathic medicine [University of Washington School of Medicine, Department of Family Medicine Web site]. Available at: http://www.fammed.washington.edu/predoctoral/CAM/naturmed.html. Accessed May 3, 2003. 6. Atwood KC Naturopathy: a monograph. Available at: http://www.quackwatch.org/01QuackeryRelatedTopics/Naturopathy/opposition.rtf. Accessed August 12, 2003. 7. Atwood KCRyder WJ Minority report of the Massachusetts Special Commission on Complementary and Alternative Medical Practitioners, in opposition to the licensure of naturopaths. Available at: http://www.state.ma.us/reg/current/2002medp/rminor.pdf. Accessed May 3, 2003. 8. Yueh BPiccirillo JF On equivalence trials and alternative medicine. Arch Otolaryngol Head Neck Surg.2003;129:403-404.PubMedGoogle Scholar 9. Atwood KC Homeopathy and critical thinking. Sci Rev Altern Med.2001;5:146-148.Google Scholar 10. Stalker DF Evidence and alternative medicine. Mt Sinai J Med.1995;62:132-143.PubMedGoogle Scholar 11. Emanuel EJWendler DGrady C What makes clinical research ethical? JAMA.2000;283:2701-2711.PubMedGoogle Scholar http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology - Head & Neck Surgery American Medical Association

Neurocranial Restructuring and Homeopathy, Neither Complementary nor Alternative

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References (11)

Publisher
American Medical Association
Copyright
Copyright © 2003 American Medical Association. All Rights Reserved.
ISSN
0886-4470
eISSN
1538-361X
DOI
10.1001/archotol.129.12.1356
Publisher site
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Abstract

The several articles involving "neurocranial restructuring" (NCR) and homeopathy in the April 2003 issue of the ARCHIVES suggest common themes: the folly of licensing practitioners whose methods are irrational, the unethical nature of highly implausible health practices, and the futility of submitting such claims to clinical trials. To begin with, there is more information regarding the case report of a nasal septum fracture caused by NCR.1 The practice has existed for significantly longer than the 8 years reported by the authors, but by a different name. There is also at least 1 other published report of a serious complication. The precursor of NCR is called "bilateral nasal specific" (BNS) and was invented by chiropractor J. Richard Stober.2 Both the endonasal balloon insertions and the panacea claims for BNS are virtually identical to those of NCR. According to the National Council Against Health Fraud, in 1983 a naturopath in Alberta performed BNS on a 20-month-old girl: she died of asphyxiation. A judge called the treatment "outright quackery" but sentenced the naturopath to only a $1000 fine and 1 day in jail.3 According to the course catalog, "bilateral nasal specifics [sic]," "iris analysis," homeopathy, "pulse diagnosis," and numerous other implausible practices are taught at Bastyr University, a naturopathy school near Seattle.4 The inclusion of these techniques in the curriculum of the flagship of naturopathy schools identifies them as standards of practice within the field, and therefore self-regulating boards of naturopathy are unlikely to discipline a practitioner who uses them. Patients injured by them (even if only by having paid for an ineffective treatment) are unlikely to win significant judgments in court. Naturopaths are licensed and given broad scope to portray themselves as primary care physicians in 11 states, including the state of Washington. Health insurers in that state are required to reimburse naturopaths by virtue of the "every category of provider" law. It may come as a surprise to Davis and colleagues1 that the Web site of their own medical school erroneously portrays "naturopathic physicians" as well trained to practice "primary care integrative natural medicine."5 It also states, again falsely, that "naturopathic diagnosis and therapeutics are supported by scientific research drawn from peer-reviewed journals from many disciplines."5 In fact, such statements merely echo those made by naturopaths themselves but do not stand up to scrutiny.6,7 Uncritical endorsements of "complementary and alternative medicine" (CAM) techniques by academic medical centers contribute to a social climate that entices scientifically naive patients to accept treatments such as NCR. The implausibility of this practice raises another issue regarding CAM. Drs Yueh and Piccirillo8 write that many CAM "treatments and procedures are introduced to patients with little scientific evaluation." But ample existing knowledge demonstrates the uselessness of CAM claims such as those under discussion here. Anatomy and neurophysiology tell us that inflating balloons in the nasopharynx to cause a "controlled release of the connective tissue tension to unwind the body and return it toward to its original design"3 is, prima facie, absurd. The facts of nature also refute homeopathy, for reasons that require only a bit more thought.9 Thus, no further scientific evaluation is necessary, and to pursue it is counterproductive and misleading. Put in Bayesian terms, the prior probability of either of these hypotheses being correct is so close to zero that no amount of "positive" clinical evidence can validate them.10 Human studies of claims with infinitesimal prior probabilities—"trifling hypotheses"—are presumed unethical because they exploit subjects and waste resources.11 The practices discussed here are neither complementary nor alternative to modern medicine. They are merely ineffective and, in some cases, dangerous. The time-honored term for them, invoked by the Canadian judge in the case of the toddler's death in 1983,3 is the correct one. References 1. Davis GEMurphy MPYueh BWeymuller EA Jr A complication from neurocranial restructuring: nasal septum fracture. Arch Otolaryngol Head Neck Surg.2003;129:472-474.PubMedGoogle Scholar 2. Butler K A Consumer's Guide to Alternative Medicine. Buffalo, NY: Prometheus Books; 1992:82. 3. Barrett S Be wary of neurocranial restructuring (NCR) [Chirobase Web site]. Available at: http://www.chirobase.org/06DD/ncr.html. Accessed May 3, 2003. 4. Not Available Bastyr University course catalog, 2001. Available at: http://web.archive.org/web/20010423130039/http://bastyr.edu/catalog/courses/default.asp?PID=PM. Accessed May 3, 2003. 5. Not Available Complementary and alternative medicine (CAM): naturopathic medicine [University of Washington School of Medicine, Department of Family Medicine Web site]. Available at: http://www.fammed.washington.edu/predoctoral/CAM/naturmed.html. Accessed May 3, 2003. 6. Atwood KC Naturopathy: a monograph. Available at: http://www.quackwatch.org/01QuackeryRelatedTopics/Naturopathy/opposition.rtf. Accessed August 12, 2003. 7. Atwood KCRyder WJ Minority report of the Massachusetts Special Commission on Complementary and Alternative Medical Practitioners, in opposition to the licensure of naturopaths. Available at: http://www.state.ma.us/reg/current/2002medp/rminor.pdf. Accessed May 3, 2003. 8. Yueh BPiccirillo JF On equivalence trials and alternative medicine. Arch Otolaryngol Head Neck Surg.2003;129:403-404.PubMedGoogle Scholar 9. Atwood KC Homeopathy and critical thinking. Sci Rev Altern Med.2001;5:146-148.Google Scholar 10. Stalker DF Evidence and alternative medicine. Mt Sinai J Med.1995;62:132-143.PubMedGoogle Scholar 11. Emanuel EJWendler DGrady C What makes clinical research ethical? JAMA.2000;283:2701-2711.PubMedGoogle Scholar

Journal

Archives of Otolaryngology - Head & Neck Surgery – American Medical Association

Published: Dec 1, 2003

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