systematic review
Onion water seems to be all the rage these days. Advocates claim that it is a natural cold and flu remedy that can help the body heal faster and kick symptoms like coughing and congestion. And many consumers who feel threatened by flu, COVID, and various respiratory infections believe them.
But what on earth is onion water? It is precisely what it sounds like: onion immersed in water. Preparation starts with cutting up raw red or yellow onions, placing them into a bowl, and adding water. The fresh onion and water mixture should then soak for about 12 hours. After that, the onion water is ready for consumption. 
Besides being a recipe for bad breath, can onion water actually relieve any symptoms, or help the body heal from infections?
A review of the evidence concluded that “effect of onion and its constituents on oxidative stress, inflammatory and immune system were shown indicating their therapeutic value in treatment of various diseases associated with oxidative stress, inflammation, and immune-dysregulation.”
This may sound encouraging but the review was based mostly on pre-clinical evidence, and the question, therefore, remains: are there any good trial data?
Another recent review included clinical trials (where available) and concluded that “possible bronchodilatory and preventive effects of onion and Qt on asthma and other obstructive respiratory diseases. The effects of the plant and its constituents on lung cancer, lung infections, and allergic disorders were also reported both in experimental and clinical studies. However, before preparing drugs based on A. cepa and its constituents for clinical practice, further standard clinical trials are needed to be performed.”
In other words, compelling trial evidence that preparations from onion are effective against viral infections does not exist.
And what about homeopathy?
Homeopaths frequently use potentised onion as a remedy for conditions that cause eyes to water (because ‘like cures like’). Is there any sound evidence that homeopathic onion remedies are better than a placebo? You probably guessed: the answer is NO!
So, no good evidence for onion, potentised onion, onion water, or any other preparations of onion. My advice, therefore, is to continue using your onions in the kitchen rather than in the medicine cabinet.
Yesterday, the post brought me a nice Christmas present. For many months, I had been working on updating and extending a book of mine. Then there were some delays at the publisher, but now it is out – what a delight!
The previous edition contained my evidence-based assessments of 150 alternative modalities (therapies and diagnostic techniques). This already was by no means an easy task. The new edition has 202 short, easy-to-understand, and fully-referenced chapters, each on a different modality. I am quite proud of the achievement. Let me just show you the foreword to the new edition:
Alternative medicine is full of surprises. For me, a big surprise was that the first edition of this book was so successful that I was invited to do a second one. I do this, of course, with great pleasure.
So, what is new? I have made two main alterations. Firstly, I updated the previous text by adding new evidence where it had emerged. Secondly, I added many more modalities—52, to be exact.
To the best of my knowledge, this renders the new edition of this book the most comprehensive reference text on alternative medicine available to date. It informs you about the nature, proven benefits, and potential risks of 202 different diagnostic methods and therapeutic interventions from the realm of so-called alternative medicine. If you use this information wisely, it could save you a lot of money. One day, it might even save your life.
I hope you enjoy using this book as much as I enjoyed writing it.
Like the first edition, the book is not about promoting so-called alternative medicine (SCAM) nor about the opposite. It is about evaluating SCAM critically but fairly. In other words, each subject had to be researched and the evidence for or against it explained such that a layperson will comprehend it. This proved to be a colossal task.
The end result will not please the many believers in SCAM, I am afraid. Yet, I hope it will suit those who realize that, in healthcare, progress is generated not through belief but through critical evaluation of the evidence.
The Sunday Times reported yesterday reported that five NHS trusts currently offer moxibustion to women in childbirth for breech babies, i.e. babies presenting upside down. Moxibustion is a form of Traditional Chinese Medicine (TCM) where mugwort is burned close to acupuncture points. The idea is that this procedure would stimulate the acupuncture point similar to the more common way using needle insertion. The fifth toe is viewed as the best traditional acupuncture point for breech presentation, and the treatment is said to turn the baby in the uterus so that it can be delivered more easily.
At least four NHS trusts are offering acupuncture and reflexology with aromatherapy to help women with delayed pregnancies, while 15 NHS trusts offer hypnobirthing classes. Some women are asked to pay fees of up to £140 for it. These treatments are supposed to relax the mother in the hope that this will speed up the process of childbirth.
The Nice guidelines on maternity care say the NHS should not offer acupuncture, acupressure, or hypnosis unless specifically requested by women. The reason for the Nice warning is simple: there is no convincing evidence that these therapies are effective.
Campaigner Catherine Roy who compiled the list of treatments said: “To one degree or another, the Royal College of Midwives, the Care Quality Commission and parts of the NHS support these pseudoscientific treatments.
“They are seen as innocuous but they carry risks, can delay medical help and participate in an anti-medicalisation stance specific to ‘normal birth’ ideology and maternity care. Nice guidelines are clear that they should not be offered by clinicians for treatment. NHS England must ensure that pseudoscience and non-evidence based treatments are removed from NHS maternity care.”
Birte Harlev-Lam, executive director of the Royal College of Midwives (RCM), said: “We want every woman to have as positive an experience during pregnancy, labour, birth and the postnatal period as possible — and, most importantly, we want that experience to be safe. That is why we recommend all maternity services to follow Nice guidance and for midwives to practise in line with the code set out by the Nursing and Midwifery Council.”
A spokeswoman for Nice said it was reviewing its maternity guidelines. NHS national clinical director for maternity and women’s health, Dr Matthew Jolly, said: “All NHS services are expected to offer safe and personalised clinical care and local NHS areas should commission core maternity services using the latest NICE and clinical guidance. NHS trusts are under no obligation to provide complementary or alternative therapies on top of evidence-based clinical care, but where they do in response to the wishes of mothers it is vital that the highest standards of safety are maintained.”
On this blog, we have repeatedly discussed the strange love affair of midwives with so-called alternative medicine (SCAM), for instance, here. In 2012, we published a summary of 19 surveys on the subject. It showed that the prevalence of SCAM use varied but was often close to 100%. Much of it did not seem to be supported by strong evidence for efficacy. We concluded that most midwives seem to use SCAM. As not all SCAMs are without risks, the issue should be debated openly. Today, there is plenty more evidence to show that the advice of midwives regarding SCAM is not just not evidence-based but also often dangerous. This, of course, begs the question: when will the professional organizations of midwifery do something about it?
Acupuncture is emerging as a potential therapy for relieving pain, but the effectiveness of acupuncture for relieving low back and/or pelvic pain (LBPP) during pregnancy remains controversial. This meta-analysis aimed to investigate the effects of acupuncture on pain, functional status, and quality of life for women with LBPP pain during pregnancy.
The authors included all RCTs evaluating the effects of acupuncture on LBPP during pregnancy. Data extraction and study quality assessments were independently performed by three reviewers. The mean differences (MDs) with 95% CIs for pooled data were calculated. The primary outcomes were pain, functional status, and quality of life. The secondary outcomes were overall effects (a questionnaire at a post-treatment visit within a week after the last treatment to determine the number of people who received good or excellent help), analgesic consumption, Apgar scores >7 at 5 min, adverse events, gestational age at birth, induction of labor and mode of birth.
Ten studies, reporting on a total of 1040 women, were included. Overall, acupuncture
- relieved pain during pregnancy (MD=1.70, 95% CI: (0.95 to 2.45), p<0.00001, I2=90%),
- improved functional status (MD=12.44, 95% CI: (3.32 to 21.55), p=0.007, I2=94%),
- improved quality of life (MD=−8.89, 95% CI: (−11.90 to –5.88), p<0.00001, I2 = 57%).
There was a significant difference in overall effects (OR=0.13, 95% CI: (0.07 to 0.23), p<0.00001, I2 = 7%). However, there was no significant difference in analgesic consumption during the study period (OR=2.49, 95% CI: (0.08 to 80.25), p=0.61, I2=61%) and Apgar scores of newborns (OR=1.02, 95% CI: (0.37 to 2.83), p=0.97, I2 = 0%). Preterm birth from acupuncture during the study period was reported in two studies. Although preterm contractions were reported in two studies, all infants were in good health at birth. In terms of gestational age at birth, induction of labor, and mode of birth, only one study reported the gestational age at birth (mean gestation 40 weeks).
The authors concluded that acupuncture significantly improved pain, functional status and quality of life in women with LBPP during the pregnancy. Additionally, acupuncture had no observable severe adverse influences on the newborns. More large-scale and well-designed RCTs are still needed to further confirm these results.
What should we make of this paper? 
In case you are in a hurry: NOT A LOT!
In case you need more, here are a few points:
- many trials were of poor quality;
- there was evidence of publication bias;
- there was considerable heterogeneity within the studies.
The most important issue is one studiously avoided in the paper: the treatment of the control groups. One has to dig deep into this paper to find that the control groups could be treated with “other treatments, no intervention, and placebo acupuncture”. Trials comparing acupuncture combined plus other treatments with other treatments were also considered to be eligible. In other words, the analyses included studies that compared acupuncture to no treatment at all as well as studies that followed the infamous ‘A+Bversus B’ design. Seven studies used no intervention or standard of care in the control group thus not controlling for placebo effects.
Nobody can thus be in the slightest surprised that the overall result of the meta-analysis was positive – false positive, that is! And the worst is that this glaring limitation was not discussed as a feature that prevents firm conclusions.
Dishonest researchers?
Biased reviewers?
Incompetent editors?
Truly unbelievable!!!
In consideration of these points, let me rephrase the conclusions:
The well-documented placebo (and other non-specific) effects of aacupuncture improved pain, functional status and quality of life in women with LBPP during the pregnancy. Unsurprisingly, acupuncture had no observable severe adverse influences on the newborns. More large-scale and well-designed RCTs are not needed to further confirm these results.
PS
I find it exasperating to see that more and more (formerly) reputable journals are misleading us with such rubbish!!!
This systematic review, meta-analysis, and meta-regression investigated the effects of individualized interventions, based on exercise alone or combined with psychological treatment, on pain intensity and disability in patients with chronic non-specific low-back pain.
Databases were searched up to January 31, 2022, to retrieve respective randomized clinical trials of individualized and/or personalized and/or stratified exercise interventions with or without psychological treatment compared to any control.
The findings show:
- Fifty-eight studies (n = 10084) were included. At short-term follow-up (12 weeks), low-certainty evidence for pain intensity (SMD -0.28 [95%CI -0.42 to -0.14]) and very low-certainty evidence for disability (-0.17 [-0.31 to -0.02]) indicates superior effects of individualized versus active exercises, and very low-certainty evidence for pain intensity (-0.40; [-0.58 to -0.22])), but not (low-certainty evidence) for disability (-0.18; [-0.22 to 0.01]) compared to passive controls.
- At long-term follow-up (1 year), moderate-certainty evidence for pain intensity (-0.14 [-0.22 to -0.07]) and disability (-0.20 [-0.30 to -0.10]) indicates effects versus passive controls.
Sensitivity analyses indicate that the effects on pain, but not on disability (always short-term and versus active treatments) were robust. Pain reduction caused by individualized exercise treatments in combination with psychological interventions (in particular behavioral-cognitive therapies) (-0.28 [-0.42 to -0.14], low certainty) is of clinical importance.
The certainty of the evidence was downgraded mainly due to evidence of risk of bias, publication bias, and inconsistency that could not be explained. Individualized exercise can treat pain and disability in chronic non-specific low-back pain. The effects in the short term are of clinical importance (relative differences versus active 38% and versus passive interventions 77%), especially in regard to the little extra effort to individualize exercise. Sub-group analysis suggests a combination of individualized exercise (especially motor-control-based treatments) with behavioral therapy interventions to boost effects.
The authors concluded that the relative benefit of individualized exercise therapy on chronic low back pain compared to other active treatments is approximately 38% which is of clinical importance. Still, sustainability of effects (> 12 months) is doubtable. As individualization in exercise therapies is easy to implement, its use should be considered.
Johannes Fleckenstein, the 1st author from the Goethe-University Frankfurt, Institute of Sports Sciences, Department of Sports Medicine and Exercise Physiology, sees in the study “an urgent health policy appeal” to strengthen combined services in care and remuneration. “Compared to other countries, such as the USA, we are in a relatively good position in Germany. For example, we have a lower prescription of strong narcotics such as opiates. But the rate of unnecessary X-ray examinations, which incidentally can also contribute to the chronicity of pain, or inaccurate surgical indications is still very high.”
Personally, I find the findings of this paper rather unsurprising. As a clinician, many years ago, prescribing exercise therapy for low back pain was my daily bread. None of my team would have ever conceived the idea that exercise does not need to be individualized according to the needs and capabilities of each patient. Therefore, I suggest rephrasing the last sentence of the conclusion: As individualization in exercise therapies is easy to implement, its use should be standard procedure.
One of the numerous conditions chiropractors, osteopaths, and other manual therapists claim to treat effectively is tension-type headache (TTH). For this purpose, they (in particular, chiropractors) often use high-velocity, low-amplitude manipulations of the neck. They do so despite the fact that the evidence for these techniques is less than convincing.
This systematic review evaluated the evidence about the effectiveness of manual therapy (MT) on pain intensity, frequency, and impact of pain in individuals with tension-type headache (TTH).
Medline, Embase, Scopus, Web of Science, CENTRAL, and PEDro were searched in June 2020. Randomized clinical trials that applied MT not associated with other interventions for TTH were selected. The level of evidence was synthesized using GRADE, and Standardized Mean Differences (SMD) were calculated for meta-analysis.
Fifteen studies were included with a total sample of 1131 individuals. The analyses show that high-velocity, low-amplitude techniques were not superior to no treatment in reducing pain intensity (SMD = 0.01, low evidence) and frequency (SMD = -0.27, moderate evidence). Soft tissue interventions were superior to no treatment in reducing pain intensity (SMD = -0.86, low evidence) and frequency of pain (SMD = -1.45, low evidence). Dry needling was superior to no treatment in reducing pain intensity (SMD = -5.16, moderate evidence) and frequency (SMD = -2.14, moderate evidence). Soft tissue interventions were not superior to no treatment and other treatments on the impact of headache.
The authors concluded that manual therapy may have positive effects on pain intensity and frequency, but more studies are necessary to strengthen the evidence of the effects of manual therapy on subjects with tension-type headache. Implications for rehabilitation soft tissue interventions and dry needling can be used to improve pain intensity and frequency in patients with tension type headache. High velocity and low amplitude thrust manipulations were not effective for improving pain intensity and frequency in patients with tension type headache. Manual therapy was not effective for improving the impact of headache in patients with tension type headache.
So, this review shows that:
- soft tissue interventions are better than no treatment,
- dry needling is better than no treatment.
These two results fail to impress me. Due to a placebo effect, almost any treatment should be better than no therapy at all.
ALMOST, because high-velocity, low-amplitude techniques were not superior to no treatment in reducing the intensity and frequency of pain. This, I feel, is an important finding that needs an explanation.
As it is only logical that high-velocity, low-amplitude techniques must also produce a positive placebo effect, the finding can only mean that these manipulations also generate a negative effect that is strong enough to cancel the positive response to placebo. (In addition, they can also cause severe complications via arterial dissections, as discussed often on this blog.)
Too complicated?
Perhaps; let me, therefore, put it simply and use the blunt words of a neurologist who once was quoted saying this:
DON’T LET THE BUGGARS TOUCH YOUR NECK!
The authors of this article searched 37 online sources, as well as print libraries, for homeopathy (HOM) and related terms in eight languages (1980 to March 2021). They included studies that compared a homeopathic medicine or intervention with a control regarding the therapeutic or preventive outcome of a disease (classified according to International Classification of Diseases-10). Subsequently, the data were extracted independently by two reviewers and analyzed descriptively.
A total of 636 investigations met the inclusion criteria, of which 541 had a therapeutic and 95 a preventive purpose. Seventy-three percent were randomized controlled trials (n = 463), whereas the rest were non-randomized studies (n = 173). The most frequently employed comparator was placebo (n = 400).
The type of homeopathic intervention was classified as:
- multi-constituent or complex (n = 272),
- classical or individualized (n = 176),
- routine or clinical (n = 161),
- isopathic (n = 19),
- various (n = 8).
The potencies ranged from 1X (dilution of -10,000) to 10 M (100–10.000). The included studies explored the effect of HOM in 223 different medical indications. The authors also present the evidence in an online database.
The authors concluded that this bibliography maps the status quo of clinical research in HOM. The data will serve for future targeted reviews, which may focus on the most studied conditions and/or homeopathic medicines, clinical impact, and the risk of bias of the included studies.
There are still skeptics who claim that no evidence exists for homeopathy. This paper proves them wrong. The number of studies may seem sizable to homeopaths, but compared to most other so-called alternative medicines (SCAMs), it is low. And compared to any conventional field of healthcare, it is truly tiny.
There are also those who claim that no rigorous trials of homeopathy with a positive results have ever emerged. This assumption is also erroneous. There are several such studies, but this paper was not aimed at identifying them. Obviously, the more important question is this: what does the totality of the methodologically sound evidence show? It fails to convincingly demonstrate that homeopathy has effects beyond placebo.
The present review was unquestionably a lot of tedious work, but it does not address these latter questions. It was published by known believers in homeopathy and sponsored by the Tiedemann Foundation for Classical Homeopathy, the Homeopathy Foundation of the Association of Homeopathic Doctors (DZVhÄ), both in Germany, and the Foundation of Homeopathy Pierre Schmidt and the Förderverein komplementärmedizinische Forschung, both in Switzerland.
The dataset established by this article will now almost certainly be used for numerous further analyses. I hope that this work will not be left to enthusiasts of homeopathy who have often demonstrated to be blinded by their own biases and are thus no longer taken seriously outside the realm of homeopathy. It would be much more productive, I feel, if independent scientists could tackle this task.
Bioenergy (or energy healing) therapies are among the popular alternative treatment options for many diseases, including cancer. Many studies deal with the advantages and disadvantages of bioenergy therapies as an addition to established treatments such as chemotherapy, surgery, and radiation in the treatment of cancer. However, a systematic overview of this evidence is thus far lacking. For this reason, German authors reviewed and critically examined the evidence to determine what benefits the treatments have for patients.
In June 2022, a systematic search was conducted searching five electronic databases (Embase, Cochrane, PsychInfo, CINAHL and Medline) to find studies concerning the use, effectiveness, and potential harm of bioenergy therapies including the following modalities:
- Reiki,
- Therapeutic Touch,
- Healing Touch,
- Polarity Therapy.
From all 2477 search results, 21 publications with a total of 1375 patients were included in this systematic review. The patients treated with bioenergy therapies were mainly diagnosed with breast cancer. The main outcomes measured were:
- anxiety,
- depression,
- mood,
- fatigue,
- quality of life (QoL),
- comfort,
- well-being,
- neurotoxicity,
- pain,
- nausea.
The studies were predominantly of moderate quality and, for the most part, found no effect. In terms of QoL, pain, and nausea, there were some positive short-term effects of the interventions, but no long-term differences were detectable. The risk of side effects from bioenergy therapies appears to be relatively small.
The authors concluded that considering the methodical limitations of the included studies, studies with high study quality could not find any difference between bioenergy therapies and active (placebo, massage, RRT, yoga, meditation, relaxation training, companionship, friendly visit) and passive control groups (usual care, resting, education). Only studies with a low study quality were able to show significant effects.
Energy healing is as popular as it is implausible. What these ‘healers’ call ‘energy’ is not how it is defined in physics. It is an undefined, imagined entity that exists only in the imagination of its proponents. So why should it have an effect on cancer or any other condition?
My team conducted 2 RCT of energy healing (pain and warts); both failed to show positive effects. And here is what I stated in my recent book about energy healing for any ailment:
Energy healing is an umbrella term for a range of paranormal healing practices. Their common denominator is the belief in a mystical ‘energy’ that can be used for therapeutic purposes.
- Forms of energy healing have existed in many ancient cultures. The ‘New Age’ movement has brought about a revival of these ideas, and today energy healing systems are amongst the most popular alternative therapies in the US as well as in many other countries. Popular forms of energy healing include those listed above. Each of these are discussed and referenced in separate chapters of this book.
- Energy healing relies on the esoteric belief in some form of ‘energy’ which is distinct from the concept of energy understood in physics and refers to some life force such as chi in Traditional Chinese Medicine, or prana in Ayurvedic medicine.
- Some proponents employ terminology from quantum physics and other ‘cutting-edge’ science to give their treatments a scientific flair which, upon closer scrutiny, turns out to be but a veneer of pseudo-science.
- The ‘energy’ that energy healers refer to is not measurable and lacks biological plausibility.
- Considering its implausibility, energy healing has attracted a surprisingly high level of research activity. Its findings are discussed in the respective chapters of each of the specific forms of energy healing.
- Generally speaking, the methodologically best trials of energy healing fail to demonstrate that it generates effects beyond placebo.
- Even though energy healing is per se harmless, it can do untold damage, not least because it significantly undermines rational thought in our societies.
As you can see, I do not entirely agree with my German friends on the issue of harm. I think energy healing is potentially dangerous and should be discouraged.
I recently came across the ‘Sutherland Cranial College of Osteopathy’.
Sutherland Cranial College of Osteopathy?
Really?
I know what osteopathy is but what exactly is a ‘cranial college’?
Perhaps they mean ‘Sutherland College of Cranial Osteopathy’?
Anyway, they explain on their website that:
Cranial Osteopathy uses the same osteopathic principles that were described by Andrew Taylor Still, the founder of Osteopathy. Cranial osteopaths develop a very highly developed sense of palpation that enables them to feel subtle movements and imbalances in body tissues and to very gently support the body to release and re-balance itself. Treatment is so gentle that often patients are quite unaware that anything is happening. But the results of this subtle treatment can be dramatic, and it can benefit whole body health.
Sounds good?
I am sure you are now keen to become an expert in cranial osteopathy. The good news is that the college offers a course where this can be achieved in just 2 days! Here are the details:
This will be a spacious exploration of the nervous system. Neurological dysfunction and conditions feature greatly in our clinical work and this is especially the case in paediatric practice. The focus of this course is how to approach the nervous system in a fundamental way with reference to both current and historical ideas of neurological function. The following areas will be considered:
-
- Attaining stillness and grounding during palpation of the nervous system. It is within stillness that potency resides and when the treatment happens. The placement of attention.
- The pineal and its relationship to the tent, the pineal shift.
- The relations of the clivus and the central importance of the SBS, How do we assess and treat compression?
- The electromagnetic field and potency.
- The suspension of the cord within the spinal canal, the cervical and lumbar expansions.
- Listening posts for the central autonomic network.
Hawkwood College accommodation
Please be aware that accommodation at Hawkwood will be in shared rooms (single sex). Some single rooms are available on a first-come-first-served basis and will carry a supplement. Requesting a single room is not a guarantee that one will be provided.
£390.00 – £490.00
29 – 30 APRIL 2023 STROUD, UK
This will be a spacious exploration of the nervous system. Neurological dysfunction and conditions feature greatly in our clinical work and this is especially the case in pediatric practice.
_________________________
You see, not even expensive!
Go for it!!!
Oh, I see, you want to know what evidence there is that cranial osteopathy does more good than harm?
Right! Here is what I wrote in my recent book about it:
Craniosacral therapy (or craniosacral osteopathy) is a manual treatment developed by the US osteopath William Sutherland (1873–1953) and further refined by the US osteopath John Upledger (1932–2012) in the 1970s. The treatment consists of gentle touch and palpation of the synarthrodial joints of the skull and sacrum. Practitioners believe that these joints allow enough movement to regulate the pulsation of the cerebrospinal fluid which, in turn, improves what they call ‘primary respiration’. The notion of ‘primary respiration’ is based on the following 5 assumptions:
- inherent motility of the central nervous system
- fluctuation of the cerebrospinal fluid
- mobility of the intracranial and intraspinal dural membranes
- mobility of the cranial bones
- involuntary motion of the sacral bones.
A further assumption is that palpation of the cranium can detect a rhythmic movement of the cranial bones. Gentle pressure is used by the therapist to manipulate the cranial bones to achieve a therapeutic result. The degree of mobility and compliance of the cranial bones is minimal, and therefore, most of these assumptions lack plausibility.
The therapeutic claims made for craniosacral therapy are not supported by sound evidence. A systematic review of all 6 trials of craniosacral therapy concluded that “the notion that CST is associated with more than non‐specific effects is not based on evidence from rigorous RCTs.” Some studies seem to indicate otherwise, but they are of lamentable methodological quality and thus not reliable.
Being such a gentle treatment, craniosacral therapy is particularly popular for infants. But here too, the evidence fails to show effectiveness. A study concluded that “healthy preterm infants undergoing an intervention with craniosacral therapy showed no significant changes in general movements compared to preterm infants without intervention.”
The costs for craniosacral therapy are usually modest but, if the treatment is employed regularly, they can be substantial.
______________________________
As the college states “often patients are quite unaware that anything is happening”. Is it because nothing is happening? According to the evidence, the answer is YES.
So, on second thought, maybe you give the above course a miss?
Lots of people have commented on King Charles’ swollen hands which can be seen in many pictures, not least the one on the cover of my biography of Charles. The king himself repeatedly referred to his ‘sausage fingers’ and has made light of the issue as far back as 1982. When William was born. At that time, he wrote to a friend: “I can’t tell you how excited and proud I am. He really does look surprisingly appetising and has sausage fingers just like mine.”
Now that he is King, we might need to worry; are his ‘sausage fingers’ a sign of a serious underlying disease?
Swollen fingers are normally due to fluid retention which can have many causes, e.g.:
- allergy,
- arthritis,
- bursitis,
- carpal tunnel syndrome,
- diabetes,
- gout,
- heart failure,
- injury,
- infection,
- kidney failure,
- lymphoedema,
- scleroderma,
- sickle cell disease,
- syphilis,
- tendinitis,
- tuberculosis.
The list is long and it contains some worrying diseases. Luckily, we can exclude many of them simply because Charles has had ‘sausage fingers’ for so many years. Thus, plausible options could be diabetes and scleroderma. The former can probably be excluded mainly because we would have long known about it.
But what about scleroderma?
Scleroderma (or systemic sclerosis, as it is also called) is a serious autoimmune condition that may be localized or generalized. The latter form is more serious. In 2020, it was noted that Charles’s feet also seemed to be swollen. In addition, his face often looks flushed (see also the cover of my book).
I know far too little about Charles’s health to make even a tentative diagnosis. Some features of scleroderma fit quite well, while others do not. In any case, I do hope Charles’s swellings have a more benign explanation. But, if scleroderma is the cause, the question obviously arises: is there a so-called alternative medicine (SCAM) for it?
A recent review stated that some study results have shown that vitamins D and E, probiotics, turmeric, l-arginine, essential fatty acids, broccoli, biofeedback, and acupuncture may be beneficial in systemic sclerosis care. However, large randomized clinical trials have not been conducted. In other words, SCAM has no proven benefit for the condition, and I would not recommend it.
Charles does know that, of course. In the past, he regularly made grand proclamations in favor of SCAM but, as soon as he was really ill, he always employed the best conventional healthcare can offer.
