Can clowns ameliorate the effects of botulinum toxin?

And now, from the darkest corner of pediatric medicine comes a recent study that somehow bridges the gap between costumed buffoonery and tainted canned goods.

Danish researchers recently investigated whether or not the presence of a clown mitigated the effects of botulinum treatments for children with cerebral palsy. The paper — "Effect of a clown's presence at botulinum toxin injections in children: a randomized, prospective study," Journal of Pain Research — kicks off with a series of observations about therapeutic harlequinade that oscillate between unusual and chilling:

The presence of a clown seems to have a positive effect on preoperative anxiety, but no effect when the anesthesia mask is introduced [...] The use of clowns is not always easy because of resistance from medical staff. Only a few studies on the effect of clowns have been carried out, and very little is known about the mode of action.

The authors then delve into their methods and the clown's origin, a passage which is a mystery novella unto itself:

The clown came from a hospital in another part of the country. The clown distracted the child, trying to be inferior to the child and making an alliance with the child, thereby allowing the child a superior role to increase its self-esteem. The clown mirrored and amplified the child's reactions, enabled and accepted the child's expressions, and was verbal if appropriate. The clown decided herself on the appropriate way of interacting with the child, according to the child's emotional state. She dressed the same way, with a big skirt, a painted face, and a big red nose at every session.

Good on the researchers for controlling the clown's nasal embellishments. The team then concludes:

No effect of the clown was documented for children being treated for the first time. At repeat treatments, we saw a positive effect of the female clown in relation to girls, and a negative effect on boys younger than 8 years of age.

Honestly, I believe there are too many variables (fake nose diameter, the omission of unrealistically droopy overalls, the potential socioeconomic bias of vagabond clowns, hamburger sponsorship or lack thereof) in play to make this study worthwhile. But hey, I'm speaking as a layman here. I never went clown medical school.

[Via Improbable Research]