MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

The aim of palliative care is to improve quality of life for patients with serious illnesses by treating their symptoms, often in situations where all the possible causative therapeutic options have been exhausted. In many palliative care settings, complementary and alternative medicine (CAM) is used for this purpose. In fact, this is putting it mildly; my impression is that CAM seems to have flooded palliative care. The question is therefore whether this approach is based on sufficiently good evidence.

This review was aimed at evaluating the available evidence on the use of CAM in hospice and palliative care and to summarize their potential benefits. The researchers conducted thorough literature searches and located 4682 studies of which 17 were identified for further evaluation. The therapies considered included:

  • acupressure,
  • acupuncture,
  • aromatherapy massage,
  • breathing,
  • hypnotherapy,
  • massage,
  • meditation,
  • music therapy,
  • reflexology,
  • reiki.

Many studies demonstrated a short-term benefit in symptom improvement from baseline with CAM, although a significant benefit was not found between groups.

The authors concluded that CAM may provide a limited short-term benefit in patients with symptom burden. Additional studies are needed to clarify the potential value of CAM in the hospice or palliative setting.

When reading research articles in CAM, I often have to ask myself: ARE THEY TAKING THE MIKEY?

??? “Many studies demonstrated a short-term benefit in symptom improvement from baseline with CAM, although a significant benefit was not found between groups.” ???

Really?!?!?

Controlled clinical trials are only about comparing the outcomes between the experimental and the control groups (and not about assessing improvements from baseline which can be [and often is] unrelated to any effect caused by the treatment per se). Therefore, within-group changes are irrelevant and should not even deserve a mention in the abstract. Thus the only finding worth reporting in the abstract is this:

No significant benefit was found.

It follows that the above conclusions are totally out of line with the data.

They should, according to what the researchers report in their abstract, read something like this:

CAM HAS NO PROVEN BENEFIT IN PALLIATIVE CARE. ITS USE IN THIS AREA IS THEREFORE HIGHLY PROBLEMATIC.

17 Responses to THE USE OF CAM IN PALLIATIVE CARE IS HIGHLY PROBLEMATIC.

  • It is sad that they target the desperate, but when your objective is to make money then this is probably the best way to go. I once came across some meeting notes where these unethical people make their sinister plans in their smoke-filled dark back rooms of some universities. Why do they target oncology? because “..the press/media would be reluctant to take a negative line on initiatives that are targeted at oncology…” Does the stuff work? who cares, it’s about fooling people and making money !

  • The use of CAM is problematic full stop..

  • Sad, so very sad, and Frank, you’re so cynical – and so right!

    IMHO there really does need to be a distinction between the Type I benefits resulting from patients having a constructive therapeutic relationship with an empathic practitioner (aka: TLC; systemic effects; care, love and attention; effective response expectancies; placebo responses) and the Type II effects of the pummeling, pins, pillules, potions and preternatural powers of the modalities identified and studied – which have no effect whatsoever (or they would not be CAM).

    Conflating type I and II effects allows benefits from type I to be falsely applied to the marketed modality by healthcare prostitutes, unworthily corrupting their talents for personal gain. That is not altruism but ‘advantagism’ – the taking unworthy advantage of the gullible and vulnerable.

    Hypnotherapy, meditation modalities, including yoga, and some massage modalities should not be tarred with the brush of CAM as these practitioners simply say: “Let me help you have an experience which will help you come to terms with your condition, and help you feel better.” Or “I will massage your soft tissues and that will help make you feel more comfortable.”
    That’s honest.

    Saying: “I will generate vital forces by this manipulative maneuver, in these pillules, with these pins, potions or paranormal procedures” is simply dishonest, unethical and fraudulent. And to be deprecated.

    Doctors who refer patients to centres offering these modalities are vicarious medical prostitutes – prostituting their talents to gain, if not financial advantage, then egotistical satisfaction, unworthily.

    • I’ve been there and I’ve seen it, but this room is of course not filled with tobacco smoke but by some sort of evidence based herbal smoke – which clearly works because you need to go on a trip if you can come with such unethical ideas.

      Here is another gem from the very same meeting notes “It was suggested that perhaps NICM should limit its involvement in the Cancer Wellness Centres to good evidence based treatments such as acupuncture. Acupuncture is proven to have zero side effects/adverse interactions with chemotherapy drugs. The Research Committee recommended forging ahead with acupuncture and then introducing the Chinese medicines discussed with oncologists in China.”

  • The therapies considered included: … breathing

    Well, I must admit that is is quite inventive – so now these (S)CAMsters actually charge people money for inhaling and exhaling air?

    “Right, let’s try this. Breathe in … breathe out … breathe in … breathe out … Very good, that’s how it’s done! Now keep going as long as you can! OK, that’ll be EUR 150, thank you very much.”

    This is even better than selling people plain shaken water at extortionate prices…

  • Therapeutic Touch, Massage and Reiki is most practiced (by relatives or volunteers) in nursing homes and also in hospices to people in the terminal phase. In UK it will be organized in another way, I am from NL.

    Relaxation and reduction of anxiety or pain are side effects, which alone are of more than enough value to continue these sort of therapies. After all, the target group are people who are in the most vulnerable stage of life.

    This is often the only affective attention for the people involved, which they may experience; please do not forget this….
    To call these CAM ‘highly problematic’ in palliative care is a good example of –rigid skeptical– thinking for me.

    Affective care, even if it is so limited is of great importance, especially for this group of people. I strongly doubt if one the skeptics here have ever experienced one of those (sessions) in a hospice or nursing home.

    In your report on Peter Fischer’s death, you showed to have some empathy qualities, but now with this “highly problematic” statement you make me doubt.. ;).

    • no doubt, relaxation would be good!
      BUT
      it does not seem to happen.
      why else would the studies not show an effect?
      plus: we do not need woo for relaxing patients; there are actual evidence-based treatments for this!

    • Touch, massage, empathy, attention, care, TLC, love – do indeed help many patients.
      But there is no evidence that any ‘forces’ emanate from practitioners of Reiki or ‘Therapeutic Touch’ as they claim.
      Such claims are nonsense. Such practitioners are quacks and may be frauds. How do we know?

      Please do not conflate massage modalities with those whose practitioners make implausible claims about ‘unidentified forces’ (by whatever name used). Taking advantage of gullible patients when they are at their most vulnerable is to be deprecated and is indeed highly problematic.

      Carry on caring. Avoid false claiming.

  • When my friend was dying from cancer, an acquaitance asked whether she had tried lymphatic drainage because her sister does it. I don’t speak to this imbecile anymore.

  • I have limited experience of other terminal diseasese, but when someone receives a cancer diagnosis, one of the most distressing things is the uncertainty of what will happen and when, and another is the feeling of being out of control. The patient has lost control of their body, of all the plans for their life, of how they can cope for themselves, and indeed how they can organise any sort of normal life around out-patient appointments, biopsies, operations, staging scans, treatment sessions, radiotherapy, chemotherapy… Then their are the symptoms from the cancer itself: pain, loss of appetite, changes in appearance and body image, fatigue, and symtoms from their treatment: post-operative pain, pain from multiple venepuncture, nausea, vomiting, mouth ulcers, diarrhoea, rashes, fatigue…

    In the UK at least, although the NHS does provide good cancer cancer treatment, oncology departments are under a lot of pressure simply to see the patients and ensure that their treatment is delivered correctly and safely, and that doesn’t leave as much time as everybody would wish to give the patient the time and individual attention that they really need, or to help them to understand what is going on and to enable them to feel in control of their lives again.

    The palliative care services do a very good job here, advising on symptom control but many other things, too, such as how to claim benefits and indeed practical advice on how to manage their lives given the constraints of their disease and treatment. One thing that they are much better placed to do is to provide attention and to help the patient feel better about themselves.

    This can include massage of all kinds, reflexology, aromatherapy, music therapy, art therapy. I think there are few who would disagree that these can be pleasant and relaxing.

    Perhaps you could call this a placebo effect, but when we are dealing with distressed people approaching the end of their lives, harnessing the placebo effect to make them feel better is very valuable. The effect is stronger if it is something that they may have a prior belief in (for whatever reason), and that might include something like acupuncture, where we know that the ritual and the needles and the arcane and complicated system behind it ensure that the placebo effect is very strong indeed.

    These are not people who are likely to have an evidence-based epiphany at the end of their lives. They are ordinary people who have probably never had any education and training in scientific thinking or evaluating evidence. They will believe what their friends tell, them or other people that they identify with (such as other patients), not what they are told by experts. Do you really think it is kind, or indeed ethical, to try to educate them in the workings of evidence-based medicine at this point in their lives? Do you even think that it is possible?

    If we deny them this comfort, the services in the NHS don’t have anything to put in their place. At least if we work with a few known SCAM practitioners with close relationships to the palliative care (or oncology) services, then we will know that they won’t be told to stop their proper treatment, to go onto mad diets, or to sell the house to pay for dendritic cell therapy in Germany or blue scorpion venom in Cuba.

    Indeed, if we take evidence-based practice to its logical conclusion, are we suggesting that our patients should abandon their religious faith, shun priests, immams and rabbis, avoid attending Church or whatever their preferred place of worship might be?

    And while evidence-based medicine is something that we all aspire to, in practice we often simply don’t have the evidence to answer the question of how best to treat the patient in front of us, who would have been excluded from the trials by virtue of age, sex, co-morbidity or whatever, or indeed where the relevant trials have never been done. A real-world doctor has to make decisions all the time based on how he can extrapolate from the evidence to the current situation, using his own experience, consulting with colleagues and in discussion with a multi-disciplinary team, and within the constraints of funding, staffing and time.

    It is interesting to see that the patients always prefer the doctor who is kind, who listens and who gives them time, who explains and who does his best to be honest. Arguably none of this matters if he gets the diagnosis wrong, or does not prescribe the right treatment. But of my surgical colleagues, the ones whose technical skills I rate most highly are not the ones I would let loose on my family.

    I am certainly not advocating the many nonsensical cancer treatments that lie in wait for the unwary patient, which are often fraudulent and at the very least very misguided. I am not suggesting that we should turn back the clock on medical knowledge, believe the delusional systems of theosophic medicine, acupuncture etc. or abandon atomic theory. But when we reach the limits of what we are able to do for terminally ill patients with evidence-based medical care, we still have a duty to be kind and to comfort, whatever form that takes.

    • “Perhaps you could call this a placebo effect, but when we are dealing with distressed people approaching the end of their lives, harnessing the placebo effect to make them feel better is very valuable.”
      correct
      but the point is that one can use treatments that are effective beyond placebo for that purpose.
      the result would be that patients benefit from the placebo effect plus the specific effect of the therapy.

    • Thank you for this comprehensive response and agree whole heartedly with what you have said. Let’s not judge those that benefit from a therapeutic relationship through CAM.
      Compassion , empathy, person centred , holistic and unique care can come from CAM. Let’s move forward not go back to calling it all quackery. Embrace the grounded, therapeutic governance based care.

      • “Compassion , empathy, person centred , holistic and unique care can come from CAM”
        YES!
        but it should come from evidence based medicine too and does not require dubious treatments.

  • I wonder if “flooded” is perhaps too strong an adjective. My daughter-in-law is a specialist registrar in palliative care, and doesn’t see anything like a deluge of CAM. Very little is actually provided by the NHS, most treatments being evidence based.

  • I agree that SCAM in palliative care is problematic.

    I am reminded of the case of controversial guru “Master Oh” and his charity Innersound (aka Ki Health aka Qi Wellness aka Jung Shim and a lot of other names) and the sadly now deceased British Army officer Naima Mohamed.

    from coverage in the Mail:

    “Master Oh, Harley Street guru who treats cancer patients with BELCHING: Healer pays back thousands to soldier to opted for bizarre energy ‘cure’ over chemo

    A clinic run by a controversial guru who has treated BBC stars has refunded thousands to a terminal cancer patient who thought she could be healed without chemotherapy.

    Innersound – run by Korean therapist ‘Master Oh’ – offers bizarre treatments which involve belching to release patients’ ‘bad energy’.

    Celebrity clients have included BBC sports presenters Gabby Logan and Clare Balding and actress Rula Lenska.

    Miss Mohamed, 27, was offered treatments at Innersound. But the clinic insists she decided against chemotherapy herself – against its advice.

    Miss Mohamed was diagnosed with breast cancer in 2010 at the age of 25, but stopped NHS treatment in January 2011.

    She said: ‘I came away from Innersound thinking chemotherapy would not benefit me and I shouldn’t have it.

    ‘Master Oh was gentle, knowledgeable and spiritual and Innersound has a reputation as a respectable organisation.’

    Miss Mohamed paid the clinic £16,000 for a series of Oriental ‘energy’ therapies, including meditation and chanting.”

    More here

    http://www.dailymail.co.uk/news/article-2193553/Master-Oh-Harley-Street-guru-treats-cancer-patients-BELCHING.html#

    There is a fascinating and extremely scary and concerning thread about Master Oh and his associates on the Cult Education Forum. It is quite a long read but definitely worth the effort. It is here:
    Is “Ki Health [aka Innersound, Qi Wellness…]run by Criminals”?
    http://forum.culteducation.com/read.php?12,60845,page=1

    I am extremely concerned that this organisation has been providing “Qi wellness” massages, delivered by associates of Master Oh, to people diagnosed with serious, ongoing mental illnesses in Camden, London, as part of the Mind in Camden Phoenix Wellbeing and Recovery service in 2013, 2016 and 2017.

    As far as I can ascertain the various treatments offered as part fo the Phoenix programme are supposed to provide support to and increase the resilience of to some of the most vulnerable people within the community.

    If a highly educated RAF officer can get into serious problems with such a group what hope is there for the vulnerable adults who are offered such interventions?

    Of course one also wonders how such a notorious organisation, that has received so much critical overage from the mainstream UK press and (if even a tiny percentage of the claims on the Cult Education forum are true) bad press internationally, could position itself to be offering services to mentally ill people via one of the UK’s largest and best known mental health charities?

    I am wondering whether this video might possibly suggest an answer?

    https://www.youtube.com/watch?v=W_Ekcgwcj-0

    Master Oh first makes an appearance 35 seconds into the video.

    It would appear that it is not just mentally vulnerable adults from the general population who have been treated by Innersound or whatever they are calling themselves these days, but current and former servicemen and women who suffer from PTSD.

    The organisation connecting mentally vulnerable service men and women with Innersound / Qi Wellness / whatever name they are currently using is called The Warrior Programme

    HRH Prince Charles’ visit to the Warrior Programmes is detailed in an archived page of their website here
    https://web.archive.org/web/20160711185856/http://www.warriorprogramme.org.uk:80/HRH_The_Prince_of_Wales_Visits_The_Warrior_Programme

    Here their archived page from 2010 when they were working with Innersound as it was then known
    https://web.archive.org/web/20100304220309/http://www.warriorprogramme.org.uk:80/index

    Therapies used by them, according to an archived page also from 2010, include:
    NLP (Neuro-Linguistic Programming)
    – time line therapy
    – forgiveness process (Huna)
    – meditation/breathing
    – Tai Chi

    https://web.archive.org/web/20100402223845/http://www.warriorprogramme.org.uk:80/Programme
    Please note that there is no mention of Innersound or any of their AKAs, just “meditation/breathing” and “Tai Chi”.

    The Warrior Project were the subject of an article in the Sun newspaper in September 2016 titled:
    “VET CASH ‘VANISHES’
    Scandal of ‘wasted’ public money meant to help veterans given to charities that did nothing with it”

    according to the article:

    “MILLIONS of pounds of public cash designated to help war veterans has disappeared into unknown charities.

    The firms receiving the money have delivered little or nothing, promoted unproven “voodoo” therapies or vanished.

    The Warrior Programme claims to be able to cure PTSD in three days – but its founder’s only qualification is a dubious online hypnotherapy degree.

    A Sunday Times probe revealed £933,000 from the fund was given to the Warrior Programme.

    The charity gives traumatised ex-solders “time-line therapy” and neurolinguistics programming – methods described by psychiatrists as pseudoscientific, unproven and even dangerous.

    Its lead trainer, David Shephard, claims he can “completely remove” PTSD in “less than three days.”

    He also describes himself as a “doctor” on his Twitter account but later confessed the basis of this claim was an unrecognised internet qualification in “clinical hypnosis.”

    https://www.thesun.co.uk/news/1804237/scandal-of-wasted-public-money-meant-to-help-veterans-given-to-charities-that-did-nothing-with-it/

    The Warrior Programme is, remarkably, still active and still offering “support” to traumatised service men and women and their families. Their website boasts that a new website is being developed.

    I wonder whether it might be helpful, for the sake of various vulnerable people in the community, to keep an eye on developments at The Warrior Programme and at Innersound / Ki Health / Qi Wellness / Jung Shim?

    • I see that a group of charities was registered in 1999 and closed around 2011. I have to ask what on earth the Charity Commission thought it was doing to register these fraudsters. Innersound redirects to Qi Wellness website, which says it is registered as charity 1133398. But this is named Jung Shim, dated 2009. Jung Shim also has its own site. Confused? Join the club. I can’t trace the trustees of the closed charities, but it might be worth an FOI request. If the Commission registered Jung Shim with any trustees of the former charities then it has some questions to answer.

      • Les,

        Yes, there are many questions unanswered. The situation is outrageous.

        Many extremely sinister and questionable “controversial religious movements” are registered in the UK as charities, offering various types of quackery to the vulnerable. Unfortunately there are many similar situations that I am aware of.

        However I would tread extremely carefully around Innersound.

        The cult described in these articles is Innersound.

        https://www.culteducation.com/group/989-innersound-ki-health.html

        It is not some little upstart organisation. It is very well established business operating in multiple territories internationally. It possesses significant assets and, as demonstrated in my links, is skilled at recruiting people of influence to further its agenda.

        One can only imagine what might have occurred for the charity commission to have permitted this to happen.

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