I generally don’t write too much about pseudo-medical woo that often. The main reason is that Orac at Respectful Insolence does it so very well, thus there’s no need for me to peddle an inferior version. But it seems he’ll be at a conference for the next few days, so maybe I’ll try my hand at it. They are kind of fun to write, after all.
What set me off today was something in this article about the rise in precocious puberty rates. The article, which appeared in the Times Magazine, is generally excellent and worth reading for anyone interested in the topic. To summarize the phenomenon briefly, it is becoming increasingly common for girls to show some form of pubertal development at younger and younger ages. To what degree this is problematic varies from patient to patient, and there is no clear answer as to what is causing it.
One of the prevailing theories is that environmental toxins that mimic the effects of estrogen are to blame, though this is far from a settled question. Which brings us to this:
One day last year when her daughter, Ainsley, was 9, Tracee Sioux pulled her out of her elementary school in Fort Collins, Colo., and drove her an hour south, to Longmont, in hopes of finding a satisfying reason that Ainsley began growing pubic hair at age 6. Ainsley was the tallest child in her third-grade class. She had a thick, enviable blond-streaked ponytail and big feet, like a puppy’s. The curves of her Levi’s matched her mother’s.
In the back seat, Ainsley wiggled out of her pink parka and looked in her backpack for her Harry Potter book. Over the past three years, Tracee — pretty and well-put-together, wearing a burnt orange blouse that matched her necklace and her bag — had taken Ainsley to see several doctors. They ordered blood tests and bone-age X-rays and turned up nothing unusual. “The doctors always come back with these blank looks on their faces, and then they start redefining what normal is,” Tracee said as we drove down Interstate 25, a ribbon of asphalt that runs close to where the Great Plains bump up against the Rockies. “And I always just sit there thinking, What are you talking about, normal? Who gets pubic hair in first grade?”
Fed up with mainstream physicians, Tracee began pursuing less conventional options. She tried giving Ainsley diindolylmethane, or DIM, a supplement that may or may not help a body balance its hormones. She also started a blog, the Girl Revolution, with a mission to “revolutionize the way we think about, treat and raise girls,” and the accompanying T.G.R. Body line of sunscreens and lotions marketed to tweens and described by Tracee as “natural, organic, craptastic-free products” containing “no estrogens, phytoestrogens, endocrine disrupters.”
None of this stopped Ainsley’s body from maturing ahead of its time. That afternoon, Tracee and Ainsley visited the office of Jared Allomong, an applied kinesiologist. Applied kinesiology is a “healing art” sort of like chiropractic. Practitioners test muscle strength in order to diagnose health problems; it’s a refuge for those skeptical and weary of mainstream medicine.
I like that “healing art” and “refuge.” They sound much nicer than the sadly more accurate words “chicanery” and “scam.” But sometimes the truth hurts. “Kinesiologists” claim to diagnose sensitivities to certain substances by having the mark (I refuse to call them “patients”) hold a vial of the offending substance, then yanking on the other arm. If the person seems comparatively weak, they are deemed to be sensitive to the substance. It is pure, unadulterated malarkey. It makes reiki look like radiation oncology.
“So, what brings you here today?” Allomong asked mother and daughter. Tracee stroked Ainsley’s arm and said, wistfully, “Precocious puberty.”
Allomong nodded. “What are the symptoms?”
“Have you seen Western doctors for this?” Allomong asked.
Tracee laughed. “Yes, many,” she said. “None suggested any course of action. They left us hanging.” She repeated for Allomong what she told me in the car: “They seem to have changed the definition of ‘normal.’ ”
For many parents of early-developing girls, “normal” is a crazy-making word, especially when uttered by a doctor; it implies that the patient, or patient’s mother, should quit being neurotic and accept that not much can be done. Allomong listened intently. He nodded and took notes, asking Tracee detailed questions about her birth-control history and validating her worst fears by mentioning the “extremely high levels” of estrogen-mimicking chemicals in the food and water supply. After about 20 minutes he asked Ainsley to lie on a table. There he performed a lengthy physical exam that involved testing the strength in Ainsley’s arms and legs while she held small glass vials filled with compounds like cortisol, estrogen and sugar. (Kinesiologists believe that weak muscles indicate illness, and that a patient’s muscles will test as weaker when he or she is holding a substance that contributes to health problems.)
Finally, he asked Ainsley to sit up. “It doesn’t test like it’s her own estrogens,” Allomong reported to Tracee, meaning he didn’t think Ainsley’s ovaries were producing too many hormones on their own. “I think it’s xeno-estrogens, from the environment,” he explained. “And I think it’s stress and insulin and sugar.”
“You can’t be more specific?” Tracee asked, pleading. “Like tell me what crap in my house I can get rid of?” Allomong shook his head. [emphasis added]
And leprechauns! Don’t forget the leprechauns, Mr. Allomong! Shouldn’t she also hold a vial full of fairy dust and rainbows, just to be sure? It would be a shame to miss something.
Look, I understand a mother’s frustration. (My sympathy is a little bit dimmed for this woman, given that she’s apparently formed her own company that will attempt to profit from other parents’ anxieties, but I’ll leave that aside.) I understand that it sucks when your child has a problem, and after an extensive work-up no answer surfaces. I understand that the words “this may just be your child’s ‘normal'” can be profoundly unsatisfying. I really do understand that, and I want to assure everyone that it sucks on our end, too. Medical providers don’t like to leave patients without clear answers.
But sometimes the only honest thing to say is that there is no clear answer. It does not serve any good purpose to fill in that gap with mythology. If I told Ms. Sioux that Vesta, the Roman goddess of the hearth, was triggering precocious puberty because she wanted more virgins for her temples, nobody would take me seriously. Well, I promise you that that answer and Mr. Allomong’s have exactly the same scientific validity. He delivers his answer surrounded by an aura of ersatz legitimacy that he has appropriated from the world of real medicine, and his rituals (which he calls an “exam”) presumably don’t involve kindling a sacred fire. But it’s all mythology just the same.
Sometimes no answer is the only answer. It’s awful, and medical providers need to acknowledge how hard it can be for parents or patients when we can’t give them a solid answer for their questions. “We don’t know” must be delivered with humility, compassion and patience. But sometimes “we don’t know” is the truth, and the truth is better than a lie.