medical ethics
An article in THE TIMES seems worth mentioning. Here are some excerpts:
… Maternity care at Nottingham University Hospitals NHS Trust (NUH) is the subject of an inquiry, prompted by dozens of baby deaths. More than 450 families have now come forward to take part in the review, led by the expert midwife Donna Ockenden. The trust now faces further scrutiny over its use of aromatherapy, after experts branded guidelines at the trust “shocking” and not backed by evidence. Several bereaved families have said they recall aromatherapy being heavily promoted at the trust’s maternity units.
It is being prosecuted over the death of baby Wynter Andrews just 23 minutes after she was born in September 2019. Her mother Sarah Andrews wrote on Twitter that she remembered aromatherapy being seen as “the answer to everything”. Internal guidelines, first highlighted by the maternity commentator Catherine Roy, suggest using essential oils if the placenta does not follow the baby out of the womb quickly enough… the NUH guidelines say aromatherapy can help expel the placenta, and suggest midwives ask women to inhale oils such as clary sage, jasmine, lavender or basil, while applying others as an abdominal compress. They also describe the oils as “extremely effective for the prevention of and, in some cases, the treatment of infection”. The guidelines also suggest essential oils to help women suffering from cystitis, or as a compress on a caesarean section wound. Nice guidelines for those situations do not recommend aromatherapy…
The NUH adds frankincense “may calm hysteria” and is “recommended in situations of maternal panic”. Roy said: “It is shocking that dangerous advice seemed to have been approved by a team of healthcare professionals at NUH. There is a high tolerance for pseudoscience in NHS maternity care … and it needs to stop. Women deserve high quality care, not dangerous quackery.” …
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The journalist who wrote the article also asked me for a comment, and I emailed her this quote: “Aromatherapy is little more than a bit of pampering; no doubt it is enjoyable but it is not an effective therapy for anything. To use it in medical emergencies seems irresponsible to say the least.” The Times evidently decided not to include my thoughts.
Having now read the article, I checked again and failed to find good evidence for aromatherapy for any of the mentioned conditions. However, I did find an article and an announcement both of which are quite worrying, in my view:
Aromatherapy is often misunderstood and consequently somewhat marginalized. Because of a basic misinterpretation, the integration of aromatherapy into UK hospitals is not moving forward as quickly as it might. Aromatherapy in UK is primarily aimed at enhancing patient care or improving patient satisfaction, and it is frequently mixed with massage. Little focus is given to the real clinical potential, except for a few pockets such as the Micap/South Manchester University initiative which led to a Phase 1 clinical trial into the effects of aromatherapy on infection carried out in the Burns Unit of Wythenshawe Hospital. This article discusses the expansion of aromatherapy within the US and follows 10 years of developing protocols and policies that led to pilot studies on radiation burns, chemo-induced nausea, slow-healing wounds, Alzheimers and end-of-life agitation. The article poses two questions: should nursing take aromatherapy more seriously and do nurses really need 60 hours of massage to use aromatherapy as part of nursing practice?
My own views on aromatherapy are expressed in our now not entirely up-to-date review:
Aromatherapy is the therapeutic use of essential oil from herbs, flowers, and other plants. The aim of this overview was to provide an overview of systematic reviews evaluating the effectiveness of aromatherapy. We searched 12 electronic databases and our departmental files without restrictions of time or language. The methodological quality of all systematic reviews was evaluated independently by two authors. Of 201 potentially relevant publications, 10 met our inclusion criteria. Most of the systematic reviews were of poor methodological quality. The clinical subject areas were hypertension, depression, anxiety, pain relief, and dementia. For none of the conditions was the evidence convincing. Several SRs of aromatherapy have recently been published. Due to a number of caveats, the evidence is not sufficiently convincing that aromatherapy is an effective therapy for any condition.
In this context, it might also be worth mentioning that we warned about the frequent usage of quackery in midwifery years ago. Here is our systematic review of 2012 published in a leading midwifery journal:
Background: in recent years, several surveys have suggested that many midwives use some form of complementary/alternative therapy (CAT), often without the knowledge of obstetricians.
Objective: to systematically review all surveys of CAT use by midwives.
Search strategy: six electronic databases were searched using text terms and MeSH for CAT and midwifery.
Selection criteria: surveys were included if they reported quantitative data on the prevalence of CAT use by midwives.
Data collection and analysis: full-text articles of all relevant surveys were obtained. Data were extracted according to pre-defined criteria.
Main results: 19 surveys met the inclusion criteria. Most were recent and from the USA. Prevalence data varied but were usually high, often close to 100%. Much use of CATs does not seem to be supported by strong evidence for efficacy.
Conclusion: most midwives seem to use CATs. As not all CATs are without risks, the issue should be debated openly.
I am tired of saying ‘I TOLD YOU SO!’ but nevertheless find it a pity that our warning remained (yet again) unheeded!
In Austria, even some of the most blatant quackery continues to be supported by the country’s medical association. This has been notorious for a very long time, and many rational doctors have opposed this nonsense. Now my friends and colleagues have courageously sent an open letter to the President of the Austrian Medical Association. In order to support their efforts, I have taken the liberty of translating it:
Dr. Johannes Steinhart
President of the Austrian Medical Association
Weihburggasse 10-12
1010 Vienna
Dear President Steinhart,
In 2014 we founded the “Initiative for Scientific Medicine” with the aim of counteracting the support of pseudo-medicine by medical associations and the Ministry of Health.
We (www.initiative-wissenschaftliche-medizin.at) have been demanding for years that the Austrian Medical Association distance itself from irrational, predominantly esoteric pseudo-medicine and refrain from awarding diplomas in them. We also made these demands on behalf of the supporters of the initiative (currently 1142 supporters, of which 495 are female doctors and 230 natural scientists) during a discussion with the former president Wechselberger in 2015 (unfortunately unsuccessful at the time).
We would like to draw your attention to a resolution of the German Medical Congress 2022 on homeopathy and a court ruling in the first instance in Germany on the subject of bioresonance, which show that our neighbours have obviously begun to treat pseudomedicine for what it is, namely sham medicine.
The 126th German Medical Congress 2022 in Bremen has, among other things, passed a long overdue resolution. The additional title “homeopathy” was deleted from the (model) further training regulations. Prior to this decision, 12 of 17 state medical associations had already taken this decision themselves.
In May 2022 in Reutlingen, two managing directors of a company producing and selling bioresonance devices were sentenced to 2 and 3 years in prison and a fine of 2.5 million euros, and the former sales director to 90 days’ imprisonment for commercial fraud and violation of the Therapeutic Products Advertising Act. The verdict is not yet legally binding. Unfortunately, many Austrian doctors also practice this pseudo-medicine method.
The fact that many colleagues offer esoteric, pseudo-medical “therapies” without proven benefits to their patients and can refer to diplomas and accredited further training courses of the Medical Association/Academy of Physicians is difficult for us to understand, especially in view of the fact that the majority of the accredited further training courses are of high scientific quality. A medical association that argues that such pseudo-medical practices “should better remain in the hands of doctors (as “healers”)” contradicts the principles of evidence-based medicine to which the medical association always refers. The corona pandemic has shown us all the damage potential of science denial.
We believe that the time has also come for the Austrian Medical Association to come clean. We call on the Austrian Medical Association to unreservedly declare its support for scientific medicine, to clearly distance itself from pseudo-medicine, to suspend the awarding of diplomas in pseudo-medicine methods that are far removed from science, and to end the accreditation of pseudo-medicine training courses by the Medical Academy.
We are publishing this open letter on our website and will also publish your reply if you so wish.
With collegial greetings
Dr. Theodor Much, Specialist in Dermatology and Venereology, Baden near Vienna
DDr. Viktor Weisshäupl, retired specialist in anaesthesiology and intensive care medicine, Vienna
Despite considerable doubts about its effectiveness, osteopathic manipulative treatment (OMT) continues to be used for a range of pediatric conditions. Here is just one example of many osteopaths advertising their services:
I qualified as an Osteopath in 2009 after 4 years of intensive training from the British College of Osteopathic medicine, where I received a distinction for my efforts. After having two children I decided to do a 2-year Postgraduate training in Pediatric Osteopathy from the Osteopathic Centre for Children in London. Whilst at the centre I was lucky enough to meet a wide variety of children from premature babies in a Neonate Hospital ward to children with developmental issues and disabilities, children on the Autistic spectrum, to kids doing exams or experiencing high levels of stress. We also saw lots of children with normal coughs, colds, lumps and bumps.
And the ‘Institute of Osteopathy states this:
Parents visit osteopaths for a range of reasons to support their child’s health. Children, like adults, can be affected by general joint and muscle issues, which is one of the reasons people visit an osteopath. Parents will also take their children to visit an osteopath for a variety of other health reasons that may benefit from osteopathic care.
As osteopathic care is based on the individual needs of the patient, it will vary depending on your child’s age and the diagnosis. Osteopaths generally use a wide range of gentle hands-on techniques that focus on releasing tension, improving mobility and optimising function. This is often used together with exercise and helpful advice. Some osteopaths have been trained in very gentle techniques which are particularly suitable to assess and treat very young children, including new-borns. You do not need to consult your GP before you visit an osteopath, although you may wish to do so.
So, how good or bad is osteopathy for kids? Our systematic review wanted to find out. Specifically, the aim of this paper is to update our previous systematic review (SR) initially published in 2013 by critically evaluating the evidence for or against this treatment.
Eleven databases were searched (January 2012 to November 2021). Only randomized clinical trials (RCTs) of OMT in pediatric patients compared with any type of controls were considered. The Cochrane risk-of-bias tool was used. In addition, the quality of the evidence was rated using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria, as recommended by the Cochrane Collaboration.
Thirteen trials met the eligibility criteria, of which four could be subjected to a meta-analysis. The findings show that, in preterm infants, OMT has little or no effect on reducing the length of hospital stay (standardized mean difference (SMD) -0.03; 95% confidence interval (CI) -0.44 to 0.39; very low certainty of the evidence) when compared with usual care alone. Only one study (8.3%) was judged to have a low risk of bias and showed no effects of OMT on improving exclusive breastfeeding at one month. The methodological quality of RCTs published since 2013 has improved. However, adverse effects remain poorly reported.
We concluded that the quality of the primary trials of OMT has improved during recent years. However, the quality of the totality of the evidence remains low or very low. Therefore, the effectiveness of OMT for selected pediatric populations remains unproven.
These days, it is not often that I am the co-author of a systematic review. So, allow me to discuss one of my own papers for a change by making a few very brief points:
- Considering how many osteopaths treat children, the fact that only 13 trials exist is shameful. To me, it suggests that the osteopathic profession has little interest in research.
- The finding that adverse effects are poorly reported is even more shameful, in my view. It suggests that the few osteopaths who do some research don’t mind violating research ethics.
- The fact that overall our review fails to yield good evidence that osteopathy is effective for any pediatric condition is the most shameful finding of them all. It means that osteopaths are either not informed about the evidence for their own approach, or that they are informed but don’t give a hoot and treat kids regardless. In both cases, they behave unethically.
Cannabis use is a frequently-discussed subject, not just in the realm of so-called alternative medicine (SCAM). In general, SCAM advocates view it as an herbal medicine and recommend it for all sorts of conditions. They also often downplay the risks associated with cannabis use. Yet, these risks might be substantial.
Cannabis potency, defined as the concentration of Δ9-tetrahydrocannabinol (THC), has increased internationally, which could increase the risk of adverse health outcomes for cannabis users. The first systematic review of the association of cannabis potency with mental health and addiction was recently published in ‘The Lancet Psychiatry’.
The authors searched Embase, PsycINFO, and MEDLINE (from database inception to Jan 14, 2021). Included studies were observational studies of human participants comparing the association of high-potency cannabis (products with a higher concentration of THC) and low-potency cannabis (products with a lower concentration of THC), as defined by the studies included, with depression, anxiety, psychosis, or cannabis use disorder (CUD).
Of 4171 articles screened, 20 met the eligibility criteria:
- eight studies focused on psychosis,
- eight on anxiety,
- seven on depression,
- and six on CUD.
Overall, higher potency cannabis, relative to lower potency cannabis, was associated with an increased risk of psychosis and CUD. Evidence varied for depression and anxiety. The association of cannabis potency with CUD and psychosis highlights its relevance in healthcare settings, and for public health guidelines and policies on cannabis sales.
The authors concluded that standardisation of exposure measures and longitudinal designs are needed to strengthen the evidence of this association.
The fact that cannabis use increases the risk of psychosis has long been general knowledge. The notion that the risk increases with increased potency of cannabis seems entirely logical and is further supported by this systematic review. Perhaps it is time to educate the public and make cannabis users more aware of these risks, and perhaps it is time that SCAM proponents negate the harm cannabis can do.
It has been reported by several sources that the NHS is advertising for a Reiki healer.
The NHS stated that “the responsibilities of a reiki healer include treating clients using energy principles … and activating the healing process.” The post is paid for by the Sam Buxton Sunflower Healing Trust (SBSHT) which states on its website:
The SBSHT healing therapists, who work within the NHS and other health areas, are proud to be part of a multi-disciplinary team of professionals to provide vital support cancer patients, their relatives and staff. Since 2006, the SBSHT has funded healers to work in NHS, and other health related areas to support cancer patients and their families. A key role of the SBSHT is to increase awareness within the UK of the importance of providing healing support to cancer patients and families. Another vital role is to generate the crucial funds needed to place more healers in NHS, and other health related areas, throughout the country. Complementary therapy (CT) is increasingly demanded and expected by patients undergoing cancer treatments. An increasing amount of research clearly demonstrates that CT is important to support patients through their conventional treatments. SBSHT is committed to providing funds to NHS hospitals and cancer centers to engage the services of a Reiki practitioner or Healer for cancer patients and their families
As a charity we are or have funded healer posts within the centres below.
- University College Hospital, London
- Addenbrookes Hospital, Cambridge
- Princess Alexandra Hospital, Epping
- Queen Elizabeth Hospital, Welwyn Garden City
- Derriford Hospital, Plymouth
- Wigan NHS Trust, Wigan
- St Josephs Hospice, London
- Eden Valley Hospice and Jigsaw Children’s Hospice, Carlisle
- St Mary’s Hospice, Ulverston and Barrow in Furness NHS Trust
- St Johns Hospice, Lancaster
- Kent and Canterbury Hospital, Canterbury
- Bristol Haematology and Oncology Centre, Bristol
- Rowcroft Hospice, Torquay
- The Lister Hospital, Stevenage
- Barnstaple NHS Trust
- Treliske Hospital, Cornwall
- Poole NHS Trust
- St Michaels Hospice, Herefordshire
The SBSHT was co-founded by Angie Buxton-King in memory of her son Sam, who died of Acute Myeloid Leukaemia in 1998 aged 10. She is a member of the ‘College of Psychic Studies’ which is “committed to serving the evolution of consciousness”. The College website states this:
We were founded in 1884 to support and encourage empirical research into the esoteric. Our programme has since broadened and diversified to meet rising demand and increasingly global interests.
However, our core values remain the same. We continue to shine a light on key themes including consciousness, intuition, self-development and meditation. Our courses, workshops, talks and special events provide a safe and inclusive space in which to explore the full spectrum of human potential under the careful guidance of our expert tutors.
The College offers all sorts of courses; I was particularly fascinated by this one: “Alchemise Your Energy Through Dowsing“.
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Now, one could easily claim that there is nothing wrong with reiki healers invading the NHS; after all, they are funded by a charitable trust at no cost to the taxpayer.
Yet, I disagree!
Reiki healing is implausible and ineffective nonsense. As such it is by no means harmless. Employing such healers in the NHS sends out a strong signal that undermines the principles of rational thinking and evidence-based medicine. If the NHS truly does not value these principles, I suggest they also fill the chronic gaps in ambulance services by flying carpets.
DIARALIA is a homeopathic remedy for the symptomatic treatment of acute transient diarrhea. It is produced by Boiron, the world’s largest manufacturer of homeopathic remedies. This is how it is currently advertised:
Instructions DIARALIA
Dosage DIARALIA
Adults and children from 6 years
Lozenge 1, 4 to 6 times a day, for a maximum of three days of treatment.
Discontinue treatment as soon as symptoms disappear.
Method and route of administration DIARALIA
Sublingual (tablet to dissolve under the tongue)
In children 18 months to 6 years: dissolve the tablet in a little water before use, because of the risk of aspiration. As soon as the permitted age, dissolve the tablets under the tongue.
Duration of treatment DIARALIA
The duration of treatment should not exceed one week.
In case of overdose DIARALIA
If you have taken more DIARALIA orodispersible tablets that you don” should have:
Consult your doctor or pharmacist immediately.
In case of failure of one or more doses of DIARALIA
If you miss a dose of DIARALIA orodispersible tablets:
Do not take a double dose to make up for the dose that you forgot to take
Pregnancy and lactation with DIARALIA
Ask your doctor or pharmacist before taking any medicine.
In the absence of experimental and clinical data, and as a precautionary measure, the use of this drug should be avoided during pregnancy and lactation.
Composition DIARALIA
Excipients with known effect: This medicinal product contains lactose,
Active substances:
For a 300 mg tablet
Arsenicum album 9CH 1mg
China rubra 5CH 1mg
Podophyllum peltatum 9 CH 1mg
Excipients: sucrose, lactose monohydrate, magnesium stearate
Cons-indication DIARALIA
N” Never use DIARALIA orodispersible tablets:
· In children under 18 months.
· If you are allergic (hypersensitive) to the active substances or to any of the ingredients in CORYZALIA orodispersible tablets.
Possible interactions with DIARALIA
If you are taking or have recently taken any other medicines, including medicines obtained without a prescription, talk to your doctor or pharmacist.
This medication is to be taken between meals.
Adverse DIARALIA
Like all medicines, DIARALIA orodispersible tablets may cause side effects, although not everybody will not matter.
If you notice any side effects not listed in this leaflet, or if the side effects gets serious, please tell your doctor or pharmacist.
Storage conditions DIARALIA
Store at a temperature not exceeding 30 ° C
Precautions and warnings DIARALIA
This medication should not be used in case of vomiting, high fever, blood in the stool.
Any significant diarrhea exposed to the risk of dehydration requiring appropriate rehydration.
If diarrhea persists beyond 3 days, a medical consultation is necessary.
If your doctor has told you have an intolerance to some sugars, contact your doctor before taking this medicine
Use of this medicine is not recommended in patients with galactose intolerance, a Lapp lactase deficiency or malabsorption syndrome glucose or galactose (rare hereditary diseases).
But is there any evidence that DIARALIA works?
I’m glad you asked!
I looked far and wide but found none (if a reader knows of a clinical trial, please let me know).
Jenifer Jacobs (JJ) published a review of 3 studies – all her own! – and concluded that the results from these studies confirm that individualized homeopathic treatment decreases the duration of acute childhood diarrhea and suggest that larger sample sizes be used in future homeopathic research to ensure adequate statistical power. Homeopathy should be considered for use as an adjunct to oral rehydration for this illness. So, some homeopathy fans might claim there is good evidence. But I dispute that.
- Firstly, there are good reasons to distrust these conclusions.
- Secondly, there are good reasons to doubt that JJ is a reliable researcher.
- Thirdly, JJ used INDIVIDUALIZED homeopathy and not DIARALIA.
We all know, of course, that diarrhea can be a symptom of a range of serious conditions. Thus, one should not joke about it. On the contrary, one should diagnose the reason for the symptom and treat it adequately. And one should certainly not advertise unproven treatments for it; one could even go one step further and claim that anyone who does that is fraudulently endangering the health of the often all too gullible consumer.
Trevor Zierke is a D.C. who published several videos that have gone viral after saying that “literally 99% of my profession” is a scam. “When I say almost all the usual lines chiropractors tell you are lies, I mean almost all of them,” he stated. Zierke then went on to give examples of issues chiropractors allegedly make up, including someone’s spine being “misaligned,” tension on nerves causing health problems, and someone having back pain because their hips are off-center. “Almost all of these aren’t true,” he concluded.
In a follow-up video, he claimed that the reasons most people are told they need to go to a chiropractor are “overblown or just flat out lies proven wrong by research.” He also noted that, while there are many scams, that “doesn’t mean you can’t get help from a chiropractor.”
In a third TikTok video, Zierke offered some valid reasons to see a chiropractor. He said that one can seek help from a chiropractor if one has musculoskeletal pain that has been ongoing for more than one to two days, and that’s about it. He stated that issues that a chiropractor couldn’t really fix include “GI pain, hormonal issues, nutrition,” among others.
In comments, users were largely supportive of Zierke’s message.
One said: “As a physiotherapist, I’ve been trying to tell this but I don’t want to like offend any chiropractor in doing so,” a commenter shared.
“Working in a chiropractic office, this is fair,” a further user wrote. “I have issues that I know an adjustment will help & other pain that would be better stretched/released.”
In an email, Zierke reiterated the intention of his videos: “I would just like to clarify that chiropractors, in general, are not a scam or are inherently scammers (I myself am a practicing chiropractor), but rather a lot of very popular sales tactics, phrases, and wording used to imply patients need treatment, and methods of treatment, have never been proven to be true,” he explained. “When chiropractors say & use these methods stating things that are not factually true—I believe it’s scammy behavior and practices. There are still a lot of very good, honest, and integral chiropractors out there,” he concluded. “They can provide a lot of help and relief to patients. But that’s unfortunately not the majority, and I’ve heard too many stories of people falling victim to some of these scam-like tactics from bad apple chiropractors.”
None of what DC Zierke said can surprise those who have been following my blog. On the contrary, I could add a few recent posts to his criticism of chiropractic, for example:
- Pediatric chiropractic seems to be on the rise
- Catastrophic injuries after chiropractic treatment
- Chiropractic: “a safe form of treatment”?
- Malpractice Litigation Involving Chiropractic Spinal Manipulation
- Best Practices for the Chiropractic Care of Children
- No effect from adding chiropractic manipulations to exercises for neck pain
- Hurray! The new professional standard by the General Chiropractic Council protects UK chiropractors
- Manual therapy (mainly chiropractic and osteopathy) does not have clinically relevant effects on back pain compared with sham treatment
- Chiropractic Paediatric Courses … it is high time to stop this dangerous nonsense
- Chiropractic ‘subluxation’ is by no means a notion of the past
- Another indirect risk of chiropractic
- And again: chiropractic for infant colic
- Chiropractic misinformation during the COVID-19 pandemic
- The lack of chiropractic ethics: “valid consent was not obtained in a single case”
I rest my case.
It has been reported that a recent inspection from the Care Quality Commission (CQC) found that the diagnostic imaging service at AECC University College in Parkwood Road, Bournemouth, requires improvement in three out of four areas – including patient safety. This is surprising not least because the AECC prides itself on being “a leading higher education institution in healthcare disciplines, nationally and internationally recognised for quality and excellence.” 
The unannounced inspection in May this year resulted in several demands for the service to improve upon. For example, the CQC report said staff “did not receive all of the training they needed to keep patients safe” and that patient chaperones “did not receive chaperone training”. Moreover, managers were reported as not always ensuring staff were competent to operate certain equipment. In fact, there was no record of staff competencies which meant inspectors “could not tell if staff had been trained to use equipment”. General cleanliness was also found lacking in relation to certain procedures, namely no sink in any of the site’s nine ultrasound rooms (including those for transvaginal scans) – meaning staff carrying out ultrasound scanning did not have access to a clinical handwashing facility.
The CQC states on its website that it “is the independent regulator of health and adult social care in England. We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve. We monitor, inspect and regulate services. Then we publish what we find, including performance ratings, to help people choose care. Where we find poor care, we will use our powers to take action.”
No doubt, these are laudable aims. What I find, however, disappointing is that the CQC’s inspection of the AECC did not question the nature of some of the courses taught by the AECC. Earlier this year, I reported in a blog post that the AECC has announced a new MSc ‘Musculoskeletal Paediatric Health‘. This motivated me to look into the evidence for such a course. This is what I found with several Medline searches (date of the review on chiropractic for any pediatric conditions, followed by its conclusion + link [so that the reader can look up the evidence]):
2008
I am unable to find convincing evidence for any of the above-named conditions.
2009
Previous research has shown that professional chiropractic organisations ‘make claims for the clinical art of chiropractic that are not currently available scientific evidence…’. The claim to effectively treat otitis seems to
be one of them. It is time now, I think, that chiropractors either produce the evidence or abandon the claim.
2009
The … evidence is neither complete nor, in my view, “substantial.”
2010
2018
What seems to emerge is rather disappointing:
- There are no really new reviews.
- Most of the existing reviews are not on musculoskeletal conditions.
- All of the reviews cast considerable doubt on the notion that chiropractors should go anywhere near children.
But perhaps I was too ambitious. Perhaps there are some new rigorous clinical trials of chiropractic for musculoskeletal conditions. A few further searches found this (again year and conclusion):
2019
2018
I might have missed one or two trials because I only conducted rather ‘rough and ready’ searches, but even if I did: would this amount to convincing evidence? Would it be good science?
No! and No!
So, why does the AECC offer a Master of Science in ‘Musculoskeletal Paediatric Health’?
____________________
Isn’t that a question the CQC should have asked?
Should Acupuncture-Related Therapies be Considered in Prediabetes Control?
No!
If you are pre-diabetic, consult a doctor and follow his/her advice. Do NOT do what acupuncturists or other self-appointed experts tell you. Do NOT become a victim of quackery.
But the authors of a new paper disagree with my view.
So, let’s have a look at the evidence.
Their systematic review was aimed at evaluating the effects and safety of acupuncture-related therapy (AT) interventions on glycemic control for prediabetes. The Chinese researchers searched 14 databases and 5 clinical registry platforms from inception to December 2020. Randomized controlled trials involving AT interventions for managing prediabetes were included.
Of the 855 identified trials, 34 articles were included for qualitative synthesis, 31 of which were included in the final meta-analysis. Compared with usual care, sham intervention, or conventional medicine, AT treatments yielded greater reductions in the primary outcomes, including fasting plasma glucose (FPG) (standard mean difference [SMD] = -0.83; 95% confidence interval [CI], -1.06, -0.61; P < .00001), 2-hour plasma glucose (2hPG) (SMD = -0.88; 95% CI, -1.20, -0.57; P < .00001), and glycated hemoglobin (HbA1c) levels (SMD = -0.91; 95% CI, -1.31, -0.51; P < .00001), as well as a greater decline in the secondary outcome, which is the incidence of prediabetes (RR = 1.43; 95% CI, 1.26, 1.63; P < .00001).
The authors concluded that AT is a potential strategy that can contribute to better glycemic control in the management of prediabetes. Because of the substantial clinical heterogeneity, the effect estimates should be interpreted with caution. More research is required for different ethnic groups and long-term effectiveness.
But this is clearly a positive result!
Why do I not believe it?
There are several reasons:
- There is no conceivable mechanism by which AT prevents diabetes.
- The findings heavily rely on Chinese RCTs which are known to be of poor quality and often even fabricated. To trust such research would be a dangerous mistake.
- Many of the primary studies were designed such that they failed to control for non-specific effects of AT. This means that a causal link between AT and the outcome is doubtful.
- The review was published in a 3rd class journal of no impact. Its peer-review system evidently failed.
So, let’s just forget about this rubbish paper?
If only it were so easy!
Journalists always have a keen interest in exotic treatments that contradict established wisdom. Predictably, they have been reporting about the new review thus confusing or misleading the public. One journalist, for instance, stated:
Acupuncture has been used for thousands of years to treat a variety of illnesses — and now it could also help fight one of the 21st century’s biggest health challenges.
New research from Edith Cowan University has found acupuncture therapy may be a useful tool in avoiding type 2 diabetes.
The team of scientists investigated dozens of studies covering the effects of acupuncture on more than 3600 people with prediabetes. This is a condition marked by higher-than-normal blood glucose levels without being high enough to be diagnosed as diabetes.
According to the findings, acupuncture therapy significantly improved key markers, such as fasting plasma glucose, two-hour plasma glucose, and glycated hemoglobin. Additionally, acupuncture therapy resulted in a greater decline in the incidence of prediabetes.
The review can thus serve as a prime example for demonstrating how irresponsible research has the power to mislead millions. This is why I have often said that poor research is a danger to public health.
And what can be done about this more and more prevalent problem?
The answer is easy: people need to behave more responsibly; this includes:
- trialists,
- review authors,
- editors,
- peer-reviewers,
- journalists.
Yes, the answer is easy in theory – but the practice is far from it!
Warning: Exceptionally, this post is not on so-called alternative medicine but on a different scam.
The current issue of the BMJ carries an editorial that is worth quoting on my blog, I think. I have never made a secret of the fact that I am against Brexit. In fact, I re-took German nationality because of it. Therefore, I am in agreement with Kamran Abbasi, the BMJ editor and author of the editorial. Here are what I consider the two most important paragraphs from his article:
… In the absence of public debate and meaningful data six years after the UK’s Brexit referendum, we asked Richard Vize to examine the effects of Brexit on health and care (doi:10.1136/bmj.o1870).20 The news isn’t all bad, although there isn’t much good. Brexit hasn’t brought about a cut in NHS funding but did fail to deliver the £350m weekly windfall that Boris Johnson and others promised. The European Working Time Directive remains in place, and the predicted “stampede” of European doctors leaving the NHS hasn’t happened. But the impacts on social care and lower paid staff are harming delivery of care in an increasingly multidisciplinary service.
Health technology, life science industries, and research, where integration with Europe was greatest and benefits most obvious, are being damaged. Promises to cut red tape have created new complexities and been tarnished by suspect procurement practices at the height of the pandemic (doi:10.1136/bmj.o1893).21 Perhaps the most damning legacy of Brexit, however, is the state of unreadiness it created for a pandemic that required utmost readiness. Whether or not you agree Brexit was the right decision, you should at least agree that it is a decision worthy of question, analysis, and redoubled effort if the signs are good and possibly even reversal if the damage is too great.
This quote probably makes more sense if one also reads the paper referenced in its 2nd link. So, please allow me to quote from this article as well:
… In a highly critical report, the Commons Public Account Committee accuses the Department of Health and Social Care of “woefully inadequate record keeping” and failing to meet basic requirements to publicly report ministers’ external meetings or deal with potential conflicts of interest when awarding testing contracts to the company.
The committee said that large gaps in the document trail meant it was impossible to say the contracts were awarded properly in the way that would be expected, even allowing for the exceptional circumstances and accelerated processes in place at the time. The first contract, for £132m, was awarded at the height of the covid pandemic in March 2020, when the department had suspended the normal requirements for competition between suppliers in the award of government contracts.
The report noted that officials were aware of contacts between Matt Hancock, the then health and social care secretary, and Owen Paterson, a Conservative MP and paid consultant for Randox, and of hospitality that Hancock received from Randox’s founder Peter Fitzgerald in 2019, but failed to identify any conflicts of interest before awarding the first contract.
The department set up a “VIP lane,” through which suppliers put forward by officials, MPs, ministers, or Number 10 would be given priority. Suppliers coming through priority routes were awarded £6bn out of the total £7.9bn of testing contracts awarded between May 2020 and March 2021, the committee noted…
This is by no means all, and I do encourage you to read these articles in full. Once you have, you might ask yourself as I do:
Has Britain become a banana republic?
