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

A team from Israel conducted a pragmatic trial to evaluate the impact of So-called Alternative Medicine (SCAM) treatments on postoperative symptoms. Patients ≥ 18 years referred to SCAM treatments by surgical medical staff were allocated to standard of care with SCAM treatment (SCAM group) or without SCAM. Referral criteria were patient preference and practitioner availability. SCAM treatments included Acupuncture, Reflexology, or Guided Imagery. The primary outcome variable was the change from baseline in symptom severity, measured by Visual Analogue Scale (VAS).

A total of 1127 patients were enrolled, 916 undergoing 1214 SCAM treatments and 211 controls. Socio-demographic characteristics were similar in both groups. Patients in the SCAM group had more severe baseline symptoms. Symptom reduction was greater in the SCAM group compared with controls. No significant adverse events were reported with any of the CAM therapies.

The authors concluded that SCAM treatments provide additional relief to Standard Of Care (SOC) for perioperative symptoms. Larger randomized control trial studies with longer follow-ups are needed to confirm these benefits.

Imagine a situation where postoperative patients are being asked “do you want merely our standard care or do you prefer having a lot of extra care, fuss and attention? Few would opt for the former – perhaps just 211 out of a total of 1127, as in the trial above. Now imagine being one of those patients receiving a lot of extra care and attention; would you not feel better, and would your symptoms not improve faster?

I am sure you have long guessed where I am heading. The infamous A+B versus B design has been discussed often enough on this blog. Researchers using it can be certain that they will generate a positive result for their beloved SCAM – even if the SCAM itself is utterly ineffective. The extra care and attention plus the raised expectation will do the trick. If the researchers want to make extra sure that their bogus treatments come out of this study smelling of roses, they can – like our Israeli investigators – omit to randomise patients to the two groups and let them chose according to their preference.

To cut a long story short: this study had zero chance to yield a negative result.

  • As such it was not a test but a promotion of SCAM.
  • As such it was not science but pseudo science.
  • As such it was not ethical but unethical.

WHEN WILL WE FINALLY STOP PUBLISHING SUCH MISLEADING NONSENSE?

13 Responses to Perioperative SCAM – another example of unethical pseudo-research

  • What a shame! Israel has a well deserved reputation for integrity and ethical research programmes. Maybe they did this SCAM treatment just to prove it was indeed a scam?

  • Ee..The extra care and attention plus the raised expectation will do the trick.

    …mean reduction in pain of -2.17 ± 2.4 vs -0.29 ± 2 (P < 0.0001)…

    Extra care, attention and expectation…Seems like an easy way to make patients more comfortable.

  • If A+B is better than A
    And if B is not replacing A
    And B in this set up does not stand alone
    And the auther did not conclude regarding B validity of efficacy as stand alone treatment
    And if the research was conducted properly ( sorry i can not get the full text right now)

    Where is the problem?

    • just think a bit; I explained it simply

      • Thank you for the kind reply and to the point please… IF the end result is a better outcome for the patients that is where we should keep our focus.

        For example Medical Clowning… Very commonly used in paediatric wards in Israel. No one claims this has a direct medical effect but if its proven to reduce percieved pain and stress why not use it???

        • “IF the end result is a better outcome for the patients that is where we should keep our focus.”
          if you are not interested in what exactly was the cause for the better outcome, you will never make progress. your attitude is deeply regressive.

    • A+B may be better than A, however, it is necessary to be honest about B. I have had several surgeries and seen quite a few patients. And few of them just want to get out as quickly as possible. Absolute majority are longing for somebody to hold their hands, telling that they will surely feel better. They should have studied no care vs. CAM. And chosen patients carefully, because there are those with all kind of sensory disorders. Though it may be difficult to assess patient that is to be operated.

  • Why does PubMed index comedy journals such as this? It will be the Beano next.

  • Of course I am, but i believe Patient Centered Care is not conflicting EBM. When the techniques are complimentry and are not instead of common practice i believe we should be more tolerant with the level of evidance we can accept.

    The A+B > A design is for sure not enough to prove a stand alone intervension. But i think that is not the case.

    By the way i believe A+B vs. A+good placebo is a much more realistic “add on therapy” design than the standard RCT.

    • As I already pointed out: you are regressive

    • @Guy Almog

      By the way i believe A+B vs. A+good placebo is a much more realistic “add on therapy” design than the standard RCT.

      A+B vs. A+a good placebo (for B) is the basic design of an RCT!! (Assuming patients are randomized to one of the groups, neither they nor their carers know which group the belong to and the outcome measures are agreed and specified before the trial begins.)

  • It’s published by Elsevier so I can’t read thefull paper. They say the SCAM group had worse baseline pair. Being self selected that makes the groups non comparable. Worse pain at the start gives more room for improvement, even with simple regression to the mean. Those with worse pain tend to get stronger conventional pain treatment, leading to a bigger reduction in psin. So even apart from attention, relaxation, and time-effort investment effects, the difference in reduction of score is unsurprising.

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