The author of this article is Judith Warner, a frequent contributor to the NY Times who lives in Washington, D.C. Ms. Warner uses this article to gain publicity for her new book, entitled: "We've Got Issues: Children and Parents in the Age of
Medication". The article masquerades as a journalistic investigation of vision therapy, but it's tone mocking parents who believe in vision therapy as gullible is unmistakable.
This will come as no surprise to anyone who reads her book. In it, Ms. Warner relates how she was moved to do this expose by a Washington Post article in 2004 by Cathy Trost, a scathing piece about 'THERAPYLAND" in the Washington DC
area. From p. 12 of Warner's book: Therapyland was largely a place for the wealthy. Who else, after all,
could afford even a portion of the $6000 a month that, according to the Post
piece, one Philadelphia-area family was paying to rent an apartment in the D.C.
area and put their daughter through fifteen hours a week of occupational
therapy, language and reading therapy, vision training, Interactive Metronome therapy, neurobiofeedback, sensory motor gym, nutritional counseling,
homeschooling, ballet, art, horseback riding, swimming, and karate.
"You're tearing my brain apart"! the young girl cried out the day
Trost tagged her, in the course of the second hour of vision therapy.
On pp 222-3 is Ms. Warner's piece de resistance on VT, which I'm quoting
"There should be gatekeepers within our health care system shepherding
parents toward getting the best treatments. There should be protocols for
what these best treatments consist of. There should be safeguards against profiteering and quackery. [My underline added -
you'll see why in a moment.] There should be affordable access. There
should be guidance, and protections in place to make parents feel they can
trust that whatever care their children receive is safe, necessary, and of
proven efficacy. None of this is happening.
Instead, there is nontreatment and sloppily administered drug treatment. There are therapies and interventions on the market of dubious value.
There are entrepreneurs selling extremely expensive brain scans that they claim
'show' the existence of mental disorders, and which brain researchers uniformly
say are interesting, even pretty, but of no actual value in diagnosis or
treatment. There are optometrists claiming they can "cure"
ADHD, learning issues and dyslexia through eye exercises, even though the
American Academy of Pediatrics, among other doctors' groups, has repeatedly
declared that vision problems are not the primary cause of learning
disabilities and that vision therapy is a waste of time and money."
[My underline added]
My intent here is not to "preach to the choir". Dr Appelbaum did a marvelous job influencing Ms. Warner to write anything positive about VT, given the anti-optometric medical pablum she serves in her book. What is more revealing than the article are the reader's comments at the end of the article. There are many comments in that section worthy of discussion. I think it would serve us well to reflect on those comments, both positive and negative (as well as neutral), and to begin a dialogue as to why the public has the perception they do of VT. Equally important, how does one best address those perceptions, beyond the many fine responses that colleagues and patients have posted.
Nate Bonilla-Warford advised me of a different portal to the article, and one that I would suggest you add comments to, as the other portal has become saturated. Optimally, add your comments, or encourage patients bothered by this concocted attack on vision therapy to post their comments, through both portals. The newer portal is:
So let's take a look at a cross-section of reader comments at the end of Judith Warner's deliberately skewed "Concocting a Cure for Kids with Issues", subtitled: "The Fight Over Vision Therapy". How apt that the color of the NY Times Magazine that bears this incendiary story is yellow, as it represents the finest in yellow journalism. Due credit again goes to Dr. Appelbaum for his efforts in helping Ms. Warner to see some light in vision therapy, as the story inside the magazine is titled:"Issues With a Fix For Kids With Issues", a less derogatory description than "Concocting".
There are plenty of positive comments to be sure, and these are well worth noting. There are former patients and parents who feel that although VT was expensive, it was among the best investments they ever made. There are comments about how modern medicine fails to address behavioral issues that do not lend themselves to tidy "evidence based medicine" trials. Readers internally take each other to task in these comments. The nonsense about VT being a Hawthorne effect, because these kids typically have received a host of other therapies prior to have coming to us, and a Hawthorne effect should have resulted in their problems being resolved. The same logic applies to arguments that these children are receiving concomitant therapies aside from VT, so that one cannot be sure improvement is attributable to VT. Obviously if that were an acceptable criticism, the same criticism could be leveled against all the other therapies that Ms. Warner, and her "expert" physicians quoted, accept uncritically.
The question I'd like to see discussed in this forum is whether or not any of the negative comments have merit. That is, do we as a group over-diagnose problems or issues, when either none exist, or the problems are relatively minimal in the grand scheme of things? How many patients are evaluated our practices, for whom VT is not recommended? Are their practices you know of where either everyone needs VT, and/or an Rx, irrespective of the findings?
After all, know that most pediatric ophthalmologists don't need to examine the patient to give a second opinion about VT. The opinion is that VT is bogus, or unproven, or unscientific, or, as one reader put it, the only thing we know for sure about it is that it's expensive. But can the same be said for some ODs? That the evaluation is simply a portal to put the child into VT? Why, I ask, are there comments from colleagues who feel that VT is an embarrassment to their profession? This, despite all the good work that COVD and OEP have done. This, despite all the wonderful Policy Statements and White Papers and CPGs and Tool Kits that the AOA has produced during the past decade.
I raise these issues because I believe that the negative comments are issues we should address, rather than dismiss. If these are perceptions in the field, and I believe they are accurate perceptions though they may not be factually correct, the perceptions must be based on at least some level of encounters that parents have had. But how do YOU feel? Do you think there is something to be gained by having further discussion about these issues, or are we best leaving our heads in the sand?
I'm heading back out to the white sands of Clearwater Beach, because the sun is shining brightly this morning. At my home in NJ a tall spruce tree stands in its original spot no longer. Having been uprooted by the weekend Nor'Easter, it lays against the roof of my house. While the structure is solid and still standing, the landscape has shifted.