The realm of personalized medicine, functional medicine and, of course, integrative medicine remains filled with pseudoscience and dubious claims. Claims are often phrased in scientific terms, as if this were the next step in scientific medicine, just a little ahead of its time. This is especially dangerous, as non-experts will have a hard time analyzing the often complex claims that are made. This is why it is often necessary for expert communities to adjust to ensure a standard of quality – something that has eroded within medicine for decades, under the relentless and successful onslaught of the whole ROOM Community.
One practice that, in my opinion, is a good example of this phenomenon is the in-office autonomic nervous system (ANS) testing offered by some practices. Testing and diagnosing ANS is legitimate in its own right, although it is a very complicated area of neurology. However, “boutique” versions of many legitimate medical practices have cropped up, such as questionable thyroid tests, fake allergy tests, and other questionable practices.
This particular practice was brought to my attention due to recent local news, which was uncritical and essentially free publicity for the practitioner. But before I get into that, let me give a little background on ANS and clinical trials in general.
The ANS is part of the nervous system that regulates our overall nervous system activity in specific ways. The sympathetic nervous system reacts to stress or danger by increasing blood pressure and heart function, dilating the pupils, increasing respiration, and increasing sweating. The parasympathetic nervous system is most active when we are in a calm state and increases the activity of our gastrointestinal system and glandular secretions slowing the heart and reducing blood pressure. These two systems exist in constant equilibrium, adjusting their relative pitch moment-to-moment to, for example, maintain constant blood flow to the brain. It does this by making constant micro-adjustments in response to changes in position, muscle tone, and even the different pressures that come with breathing.
Severe ANS disturbances can result in dramatic symptoms, such as fainting on standing due to insufficient sympathetic activity to raise blood pressure to compensate, or severe constipation to the point where food cannot move through the gastrointestinal tract . But ANS disorders can also produce more subtle symptoms, such as dizziness or lightheadedness, occasional heart palpitations or excessive sweating. Diagnosing ANS disorders can be tricky, especially when they are complex or subtle.
Most medical centers will be able to do basic tests. The most common test is a tilt table test, in which blood pressure and heart rate are measured while the position of the head is altered. For more complex testing there are a few standalone centers in the US (only a few) that can do extensive testing. Even then sometimes the best we can do is document that there is autonomic dysfunction, but may not be able to pinpoint where the problem is coming from. Treatment is mostly symptomatic as most causes of ANS dysfunction are not curable.
If we are going to introduce a new test method for ANS function (or anything else in medicine) we need to answer a few questions. What exactly is it measuring and what is the measured variable an indicator for? What is the sensitivity and specificity of the test? And how useful is the information: does it predict the presence of a specific disease or response to a specific treatment? Research should be done to validate any new test against each condition in which it is used.
With this background I read Dr. Plotnikoff’s report stating that his ANS testing device is a “game changer” for medicine. I could not find any studies published by him or his colleagues on ANS testing. I was not reassured by your clinic which prides itself on personalized, functional and integrative medicine. On his website he specifically states that people with the following symptoms or ailments will benefit from testing:
Dizziness, lightheadedness, fainting, fatigue, exercise intolerance, post-exertional fatigue, chronic pain including fibromyalgia (sic), persistent and unexplained weight gain, sleep disturbances of all types, anxiety, heart palpitations, depressed mood, fogginess brain, brain fatigue, gastrointestinal (GI) symptoms including constipation, nausea, bloating, diarrhea, constipation and randomly alternating symptoms, frequent headaches, falls or near falls, urogenital dysfunction including difficulty urinating and erectile dysfunction, symptoms difficult to diagnose, blood pressure difficult to control, diabetes or hormonal states, long term COVID, diabetes, hypertension, previous cardiac infarction or heart surgery, postural orthostatic tachycardia syndrome (POTS), syncope, anxiety, dysthymia and/or depression, neurological diagnoses including neuropathies, migraine and/or seizures, gastroparesis, traumatic brain injury (TBI), post-concussion syndrome, mast cell activation syndrome (MCAS).
That’s a pretty impressive list, especially without any specific scientific research to back it up. The test itself appears to be just a basic self-test for the poor, with heart monitoring, respiratory monitoring, and blood pressure testing. All of this could be useful as part of a basic medical evaluation, but to say it can diagnose autonomic dysfunction would require some extensive validation testing. The notion that the results of this test would help, for example, guide treatment for distinct, medical entities like diabetes and seizures is a stretch.
In addition to the incredibly exaggerated claims of using this test to guide the customization of medicine, they also claim that it can directly diagnose and treat ANS problems:
For those with low parasympathetic status (rest and digest) or excessive sympathetic status (fight or flight), we provide access to an FDA-cleared parasympathetic system enhancer called GammaCore.
GammaCore is a device used for stimulation of the vagal nerve. This is a legitimate treatment for very specific conditions, but Plotnikoff’s clinic seems to think it’s a panacea for all of the above. Furthermore, they falsely claimed that the device is “FDA approved”. “Approved” when it comes to the FDA specifically means that it has been tested and found to be safe and effective for a specific disease. That doesn’t appear to be true: The GammaCore website just says it’s “FDA-approved,” meaning the device itself is safe, with no claims of efficacy. This may have just been a sloppy mistake on their part, but it has significant implications. Falsely claiming FDA approval is no small feat.
As we can see, they seem to take a kernel of real science and medicine, but then twist it into a streamlined boutique treatment that’s good for just about anything, making wildly exaggerated claims without sufficient evidence, and presenting themselves as the wave of the future. This is the “functional medicine” that markets BS in a nutshell.
#Doubtful #claims #autonomic #nervous #system