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

Autologous whole blood (AWB) therapy is a treatment where a patients blood is first drawn from a vein and then (unmodified or treated in various bizarre ways) reinjected intra-muscularly. This sounds barmy, not least because there is no remotely plausible mode of action. Nonetheless, the therapy is popular in some countries (like Germany, where it is practised by many doctors and Heilpraktikers) and recommended for all sorts of illnesses, particularly for strengthening the immune system and fend off infections.

I have personally used it quite a bit and even conducted the first but very small double-blind, placebo-controlled RCT of AWB therapy which showed promising results. Now two systematic reviews of AWB therapy have become available almost simultaneously.

The first systematic review included our plus 7 more clinical studies. The authors included all prospective controlled trials concerning intra-muscular AWB therapy with the exception of trials using oxygenated, UV radiated or heated blood. Information was extracted on the indication, design, additions to AWB and outcome. Full texts were screened for information about the effector mechanisms.

Eight trials met their inclusion criteria. In three controlled trials with patients suffering from atopic dermatitis and urticaria, AWB therapy showed beneficial effects. In five randomized controlled trials (RCTs), two of which concerned respiratory tract infections, two urticaria and one ankylosing spondylitis, no efficacy could be found. A quantitative assessment was not possible due to the heterogeneity of the included studies. The authors found only 4 controlled trials with sample sizes bigger than 37 individuals per group. Only one study investigated the effector mechanisms of AWB.

The German authors concluded that there is some evidence for efficacy of AWB therapy in urticaria patients and patients with atopic eczema. Firm conclusions can, however, not be drawn. We see a great need for further RCTs with adequate sample sizes and for investigation of the effector mechanisms of AWB therapy.

The second systematic review had a slightly different focus in that it assessed AWB therapy as well as autologous serum therapy (AST) for patients suffering from chronic spontaneous urticaria (CSU). Its authors managed to include 8 clinical trials. AST was not more effective than the placebo treatment in alleviating CSU symptoms at the end of treatment (p = .161), and AWB injection was also not more effective in response rates than the placebo at the end of follow-up (p = .099). Furthermore, the efficacy of AST or AWB injection for CSU and the ASST status were not significantly related. No remarkable adverse events were recorded during therapy.

The Taiwanese authors concluded that their meta-analysis suggested that AWB therapy and AST are not significantly more effective in alleviating CSU symptoms than the placebo treatment.

These somewhat contradictory conclusions will confuse most readers. Personally, I think that caution is well-justified. The trials are mostly flawed, and even our positive study (which received the highest possible quality marks by the authors of the first review) can in no way be definitive, because it was far too small for allowing firm conclusions.

Yet, despite all this, I do think that AWB therapy merits further study.

 

20 Responses to Autologous whole blood therapy, another very surprising SCAM. Does it merit further study?

  • Mr. Dr. Edzard Ernst:
    I did not have access to the trials of these systematic reviews. For this reason, please kindly inform me, if possible, what was used in the control group of these trials? What did they inject into the controls? Did they see what was injected?
    Sincerely,
    Munir Massud

  • The difference in scientific credibility between these two journals seems to be noticeable, right?

  • Science does not admit the contradiction. If two conclusions are mutually exclusive, one must not correspond to the facts. The quality of clinical trials admitted in the two systematic reviews could be reviewed. Apparently these two journals appear to have conflicts of interest (one in favor of dermatology and the other in favor of SCAM). This strange procedure has been used in Brazil for the most diverse diseases, similar to a panacea. Testing all these alleged indications would require thousands of trials and systematic reviews, and thousands of dollars. Medical scientists cannot test everything that delusional minds create from rambunctious theories.
    The absolute lack of high-level studies published in this area in established databases made me advise the Federal Council of Medicine against the use of this therapy by physicians. This same view was adopted by the Federal Councils of other health professions. The reaction of the populace of all degrees of ignorance was very great. Unfortunately, people have a great appreciation for charlatans, although many know that there is a scientific explanation available.
    Grateful for the opportunity.
    Munir Massud

  • Am I reading this right?

    … intra-muscular AWB therapy …

    That is equivalent to giving someone an intramuscular haematoma and hoping that will cure something. Even if you do something with the blood – pray, irradiate, infuse with oxygen etc., you are still only causing an injury and the result will only be a physiological response to injury, which has never been proven beneficial. Anyone who has torn a muscle will tell you it is also painful as h*ll, not the least while the blood is being broken down an re-absorbed into the system by a mechanism of inflamation, repair and results in scarring.
    I would think you get the exact same physiological response/effect by whacking somenone on the thigh with a hammer, and that does not help for exzema or anything else.
    In my mind just another idiotic injury-healing idea.

  • I can’t send a rebuttal because there’s no record of it. Unless it has been rejected.

    Grateful for the attention. However, consider and judge the following:
    Necessary Inference from Conclusion 1: The German authors concluded that there is evidence of the efficacy of AWB therapy in patients with urticaria and patients with atopic eczema.
    Necessary Inference from Conclusion 2: The Taiwanese authors concluded that their meta-analysis suggested that AWB therapy and AST are not significantly more effective in alleviating CSU symptoms than the placebo treatment.
    Suppose these inferences imply a decision by physicians to use or not to use such therapy in patients with urticaria. Would they not be faced with a contradiction?

    • one review [the German] looked at AWB only and considered any condition.
      the 2nd considered 2 different therapies and just one specific condition.
      not hard to see that they might arrive at different conclusions!

  • Unless I am mistaken, urticaria was treated with the use of autologous blood in both trials.
    Treated diseases included urticaria and the autologous blood therapy was used in both trials. Regarding the outcomes related to urticaria were contradictory. This is undeniable. If both trials were methodologically correct, they create for the clinician a conflicting situation about the use of this therapy for the purpose mentioned.

    In his own words:
    AST was not more effective than placebo treatment in alleviating CSU symptoms at the end of treatment (p = .161), and AWB injection was also not more effective in response rates than placebo at the end of follow-up (p =. 099).

    After all, what would you conclude, solely in light of these two studies, about using autologous blood to treat the symptoms of urticaria? Imagine that it is all about relieving symptoms with injections, which conventional therapy does with the use of antihistamine pills.

  • I do not know the mechanism is that quoted by Mr. Björn Geir, but he is sure that this therapy is one more product of fantasy, among many.

  • Data venia, your claim does not alter what I have tried to demonstrate.
    We are dealing with systematic reviews whose findings on the use of autologous blood to treat hives revealed contradictory outcomes. Nothing more clear. It is unbelievable that you do not recognize this!

  • Both systematic reviews included clinical trials that treated patients with autologous blood urticaria. One of them showed improvement of symptoms and another did not. Is this not a contradiction? And am I wrong?

    • I tried to have a look at Edzard’s original paper but the full text is hidden behind a paywall and I no longer have easy access to such journals since retiring. From the abstract it seems that the numbers are very small, and despite the results reaching statistical significance I suspect they were nevertheless a statistical anomaly.

      Conflicting conclusions from apparently well-conducted clinical trials is a well-known and quite common problem in the medical literature. A quick search bring up this, for instance:
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568363/

      Worse than that, many trials are not well-conducted, and they are often analysed using inappropriate statistical methods (which therefore generate meaningless results) by authors who don’t have very much training in statistics. Furthermore, many of the doctors trying to base their practice on evidence don’t understand statistics very well either, which means that they can easily draw the wrong conclusions from what they read.

      This goes right to the top. On the BBC’s radio program “The Life Scientific” (available as a podcast) there is an interview by Jim Al-Khalili of the epidemiologist Richard Peto (who was instrumental in demonstration the causal relationship between cigarette smoking and lung cancer). He recounts the story of a trial he was involved in which looked at the effect of giving aspirin to patients during the acute phase of myocardial infarction (what non-medics might rather vaguely refer to as a coronary or a heart attack). It was a large multicentre trial conducted in the UK, and very roughly it showed that there were 1,000 deaths in the control group but only 800 deaths in the group who had been given aspirin. He submitted his paper to the Lancet, but the editor refused to publish it until he had performed a sub-group analysis. Essentially this involves breaking down the data to see which groups of patients benefit from the intervention and which don’t (such as whether age, sex, diabetes, smoking, other cardiac problems etc. might be relevant). Peto knew that this would generate spurious correlations, and that, since this was going to be a very influential study, it would lead to doctors in future witholding aspirin from some groups of patients, resulting in avoidable deaths.

      Finally he did perform the sub-group analysis, breaking down the results by astrological star sign of the patients. He found that patients born under Pisces or Gemini didn’t benefit from taking aspirin in this situation, but the benefit was double for Capricorn. The Lancet were not amused, but he was finally able to persuade them not to insist on a meaningless and inappropriate statistical analysis and to publish his study as it was.

      • yes, our trial was ‘very small’, as I called it the post

        • The fact that contradiction is not uncommon may be due to studies of misconduct with falsifications and, mainly, to methodological flaws. This is not unknown to anyone. But it must be undone. Dialectics (in Hegel’s sense) has no use in medical research. However, you know that clinical decisions today must be based on methodologically correct randomized clinical trials and, better yet, appropriate systematic reviews of these trials, published in high-level databases and medical specialty guidelines from societies. of specialties. It is a resounding misconception that doctors around the world have enough time and insanity, and the knowledge to review all the trials in a systematic review, and to critique them, and even worse, to perform the statistical critical analysis of the physicians. themselves, on all matters relevant to their practice. The way out, at least for a glorious majority, is to rely on reliable databases and expert analysis of the respective specialties published as guidelines.
          What I have tried to warn is that in the systematic reviews of autologous blood injections by the distinguished professor Edzatd Ernst, which dealt with symptomatic treatment of urticaria, they revealed contradictory results. These contradictory results do not allow a safe position on the therapy under consideration to treat urticaria. No specialty society can make a decision about the value of this therapy for this purpose. This is a fait accompli. It seems possible that the tendency of dermatologists in general would be to rely less on the review by SCAM practitioners published in a journal devoted to articles on SCAM. They should not even know that it exists. Of course, they look for information in magazines of their specialty.
          Who would bother to review all trials included in the on-screen reviews, including the respective statistical analyzes and, subsequently, the methodological quality of the review?
           In any case, I pointed out that the results of the treatments provided conflicting results about symptomatic urticaria therapy and that this does not provide dermatologists and general practitioners with the evidence needed to decide on the use of this therapy.
           The use of autohemotherapy here in Brazil is performed by some doctors, but mainly by a majority of lay people of all levels of ignorance, and as a panacea.

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