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

Monthly Archives: February 2023

Wellness seems to be everywhere these days – I mean of course the term, not the state or condition. On Medline, we find in excess of 500 000 articles on wellness, just for the year 2022! Wellness is en vogue, sexy, politically correct, etc. It looks good to talk and write about it. Most importantly it is good business. A report by the Global Wellness Institute stated that in 2020 the wellness industry was valued at $4.5 trillion and continues to grow at a frightening rate.

Having studied some of the recent literature on the subject, I get the impression that, for many, wellness is foremost an excuse for waffling utter nonsense. Let me, therefore, today ask just 5 simple questions about wellness that are likely to reduce the wellness of the ‘wellness brigade’:

1.What is wellness?

It is quite evidently a sector that is unable to define itself. Here are just a few of the definitions that have been suggested. Wellness is:

A 2018 review revealed that there is a lack of a uniform definition of wellness and showed that there is insufficient evidence to support the clinical utility of a single particular wellness instrument.

2. How do we measure wellness? 

The short answer to this question is: nobody is quite sure. There simply is no generally accepted, well-validated measure. A few domains come to mind:

  • physical functioning,
  • somatic symptoms, e.g. pain,
  • psychological symptoms,
  • social functioning,
  • needs and satisfaction.

But there is no simple means to quantify wellness. If you think that I am exaggerating, consider this recent review: 79 mental wellness instruments were identified. Most studies did not provide a definition for mental wellness. We identified thirteen mental wellness concepts from 97 studies, namely: life satisfaction, mental wellbeing [general], resilience, self-efficacy, self- esteem, connectedness, coping, self-control, mindfulness/spiritual, hope, sense of coherence, happiness, and life purpose.

3. What affects wellness?

The short answer is: potentially everything. My very own wellness, for instance, deteriorates sharply, if I have to read yet another nonsensical article about it.

4. Which interventions improve wellness?

As we have seen in my previous post, this is where so-called alternative medicine (SCAM) comes in. Since there is no measure to quantify wellness, we just have to take the word of SCAM proponents for it: SCAM improves wellness!!!

It’s obvious!

Which specific SCAM?

Can I see the evidence?

Sorry, no questions allowed!

And if you dare to insist on evidence, the ‘wellness brigade’ would just give you a pitiful smile and say: wellness has to be experienced, not measured.

5. Are there risks?

Yes, of course! Here are just some of them:

  • The treatments advocated for wellness almost invariably cost money.
  • The treatments advocated for wellness almost invariably cause direct and indirect harm, as discussed in many of my previous posts.
  • Wellness treatments tend to give the impression that one can buy wellness like an expensive piece of clothing without putting in any real effort oneself.

Considering all this, I’d like to offer my very own definition of the sector:

Wellness is a fashionable paradise for charlatans in which they are protected from scientific scrutiny and feel at liberty to bullshit to their hearts’ content. 

 

The All-Party Parliamentary Group (APPG) on Beauty and Wellbeing, UK, has undertaken an investigation into the ‘complementary therapies sector’, to consider how the sector can support everyone’s physical health, mental health, and well-being and take pressure off the NHS. In their recent document, they state:

The complementary therapies industry is an integral part of the Personal Care sector, which includes beauty, wellbeing, and alternative therapies. These therapies can be key to supporting everyone’s health and mental wellbeing…

To ensure complementary therapies can adequately support the NHS, we need to attract more talent into the sector and ensure all therapists receive the right training to become highly skilled professionals.

We also need to enhance the perception of the professionalism within the sector, so that it is no longer seen as ‘frivolous and fluffy’ and non-essential. Building awareness and understanding of its value in supporting our nation’s health is one step. However, it also important to crack down on any bad practice and the ‘underground market’ of poor treatment…

The committee makes the following recommendations:

1. The Government must work with NHS England to better promote the benefits of social prescribing with GPs, nurses and other health and care professionals, and how they can refer people to non-clinical complementary therapy services.
2. The Personal Care sector team in the Department for Business, Energy, Industry and Strategy must work with officials within the Department for Health and Social Care responsible for social prescribing to better integrate complementary therapy services into the NHS, and produce guidance to support health professionals and therapists in doing so.
3. The Department for Health and Social Care must undertake or fund research studies to demonstrate the value of integrating complementary therapy services into the NHS through social prescribing.
4. The Department for Education must revisit the gap between the apprentice wage and minimum wage for apprentices aged 19+, and provide financial incentives for employers to take on learners on any ‘job ready ‘qualification.
5. The Government must give Environmental health officers (EHOs) greater powers to act quickly to deal with bad practice and lead a crack-down on tax evading businesses that are driving down prices and undermining legitimate businesses under pressure.

Conclusions
The evidence that we have received during this investigation clearly demonstrate that greater support
and recognition is needed for the complementary therapies sector to ensure that they are able support
everyone’s physical health, mental health and wellbeing and take pressure off the NHS.
We hope the Government will review our recommendations in order to support the complementary
therapies sector and ensure they have adequate funding and acknowledgement.

In case you are wondering what therapies they refer to, here is their complete list of the treatments (including links to what they seem to think about them):

Alexander technique

Aromatherapy

Body massage

Bowen technique

Cranio sacral therapy

Healing

Homeopathy

Hypnotherapy

Kinesiology

Microsystems acupuncture

Naturopathy

Nutritional therapy

Reflexology

Reiki

Shiatsu

Sports massage

Sports therapy

Yoga therapy

This could have made me laugh, had it not been so serious. The committee is composed of MPs who might be full of goodwill. Yet, they seem utterly clueless regarding the ‘complementary therapies sector’. For instance, they seem to be unaware of the evidence for some of the treatments they want to promote, e.g. craniosacral therapy, aromatherapy, Reiki, shiatsu, energy healing, or reflexology (which is far less positive than they seem to assume); and they aim at enhancing the “perception of the professionalism” instead of improving the PROFESSIONALISM of the therapists (which obviously would include adherence to evidence-based practice). And perhaps the committee might have given some thought to the question of whether it is ethical to push dubious therapies onto the unsuspecting public.

I could go on, but the perplexing wooliness of the document speaks for itself, I think.

And in case you are wondering who the MP members of the committee are, here is the list of its members:

• Carolyn Harris MP – Co-Chair
• Judith Cummins MP – Co-Chair
• Jessica Morden MP – Vice-Chair
• Jackie Doyle-Price MP – Vice-Chair
• Peter Dowd MP – Treasurer
• Nick Smith MP – Secretary
• Caroline Nokes MP – Member
• Sarah Champion MP – Member
• Alex Davies-Jones MP – Member
• Kate Osamor MP – Member
• John McNally MP – Member
• Kevan Jones MP – Member
• Gagan Mohindra MP- Member

The Secretariat for this APPG is Dentons Global Advisors with support from the National Hair and Beauty Federation, the Federation of Holistic Therapists and spabreaks.com.

 

PS

Two hours after having posted this, I begin to feel bad about being so dismissive. Let me thus try to do something constructive: I herewith offer to give one or more lectures to the committee about the evidence as it pertains to the therapies they included in their report.

In one of my last posts, I was rather dismissive of veterinary chiropractic.

Was I too harsh?

I did ask readers who disagree with my judgment to send me their evidence.

Sadly, none arrived!

Therefore, I did several further literature searches and found a recent review of the topic. It included 14 studies; 13 were equine and one was a canine study. Seven of these were cohort studies and seven were randomized controlled clinical trials. . Study quality was low (n = 4), moderate (n = 7), and high (n = 3) and included a wide array of outcome parameters with varying levels of efficacy and duration of therapeutic effects, which prevented further meta-analysis. The authors concluded that it was difficult to draw firm conclusions despite all studies reporting positive effects. Optimal technique indications and dosages need to be determined to improve the standardization of these treatment options.

This, I think, can hardly be called good evidence. But I also found this more recent paper:

Chiropractic care is a common treatment modality used in equine practice to manage back pain and stiffness but has limited evidence for treating lameness. The objective of this blinded, controlled clinical trial was to evaluate the effect of chiropractic treatment on chronic lameness and concurrent axial skeleton pain and dysfunction. Two groups of horses with multiple limb lameness (polo) or isolated hind limb lameness (Quarter Horses) were enrolled. Outcome measures included subjective and objective measures of lameness, spinal pain and stiffness, epaxial muscle hypertonicity, and mechanical nociceptive thresholds collected on days 0, 14, and 28. Chiropractic treatment was applied on days 0, 7, 14, and 21. No treatment was applied to control horses. Data was analyzed by a mixed model fit separately for each response variable (p < 0.05) and was examined within each group of horses individually. Significant treatment effects were noted in subjective measures of hind limb and whole-body lameness scores and vertebral stiffness. Limited or inconsistent therapeutic effects were noted in objective lameness scores and other measures of axial skeleton pain and dysfunction. The lack of pathoanatomical diagnoses, multilimb lameness, and lack of validated outcome measures likely had negative impacts on the results.

Great! So, we finally have an RCT of chiropractic for horses. Unfortunately, the study is less than convincing:

  • It included just 20 polo horses plus 18 horses active in ridden or competitive work all suffering from lameness.
  • The authors state that ‘horses were numerically randomized to treatment and control groups’; yet I am not sure what this means.
  • Treatment consisted of high-velocity, low-amplitude, manually applied thrusts to sites of perceived pain or stiffness with the axial and appendicular articulations. Treatment was applied on days 0, 7, 14, and 21 by a single examiner. The control group received no treatment and was restrained quietly for 15 min to simulate the time required for chiropractic treatment. In other words, no placebo controls were used.
  • The validity of the many outcome measures is unknown.
  • The statistical analyses seem odd to me.
  • No correction for multiple statistical tests was done.
  • Most of the outcomes show no significant effect.
  • Overall, there were some small positive treatment effects based on subjective assessment of lameness, but no measurable treatment effects on objective measures of limb lameness.
  • The polo horses began their competition season at the beginning of the study which would have confounded the outcomes.

What does all this tell us about veterinary chiropractic?

Not a lot.

All we can safely say, I think, is that veterinary chiropractic is not evidence-based and that claims to the contrary are certainly ill-informed and most probably of a promotional nature.

Konjac glucomannan (KGM), also just called ‘glucomannan’, is a dietary fiber hydro colloidal polysaccharide isolated from the tubers of Amorphophallus konjac. It is used as a food, a food additive, as well as a dietary supplement in many countries. KGM is claimed to reduce the levels of glucose, cholesterol, triglycerides, and blood pressure.

The objective of this study was to evaluate the effect of the consumption of gummy candy enriched with KGM on appetite and to evaluate anthropometric data, biochemical, and oxidative stress markers in overweight individuals. Forty-two participants aged 18 to 45 years completed this randomized, double-blind, placebo-controlled clinical trial. Participants were randomly assigned to consume for 14 days, 2 candies per day, containing 250 mg of KGM or identical-looking placebo candy with 250 mg of flaxseed meal, shortly after breakfast and dinner. As a result, we observed that there was a reduction in waist circumference and in the intensity of hunger of the participants who consumed KGM. The authors believe that a longer consumption time as well as an increased dose of KGM would contribute to even more satisfactory body results.

These findings seem promising, yet somehow I am not convinced. The study was small and short-term; moreover, the authors seem uncritical and, instead of a conclusion, they offer speculations.

Our own review of 2014 included 9 clinical studies. There was a variation in the reporting quality of the included RCTs. A meta-analysis (random effect model) of 8 RCTs revealed no significant difference in weight loss between glucomannan and placebo (mean difference [MD]: -0.22 kg; 95% confidence interval [CI], -0.62, 0.19; I(2) = 65%). Adverse events included abdominal discomfort, diarrhea, and constipation. We concluded that the evidence from available RCTs does not show that glucomannan intake generates statistically significant weight loss. Future trials should be more rigorous and better reported.

Rigorous trials are required to change my mind, and I am not sure that the new study falls into this category.

About 10 years ago, I published this little post about ‘MY HOLISTIC HEALTH CENTRE’:

Where I live, some of the old-fashioned, privately-owned shops that used to dominate our high streets have survived the onslaught of the supermarkets. Our bakery is such a quaint remnant from the past. Surprisingly, it also is more holistic and more therapeutic than any alternative health centre I have come across.

The first thing that strikes anyone who enters the premises is the irresistible smell. Customers’ well-being hits the ceiling, and the local aromatherapists are in danger of going out of business. The intense stimulation of the customers’ olfactory system relaxes their minds and puts them into a meditative state as they patiently wait to be served. Everyone in the queue has a little word with the baker’s wife, and progress is therefore slow – but we don’t mind: the chat is holistic counseling at its best, and our slow movements toward the counter are healthier than tai chi.

“You are looking well today,” says the baker’s wife, thereby gently arousing me from my aroma-induced meditation and indicating that she is about to focus her shaman healing energy on me. Her diagnosis is spot on; the alternative therapies I enjoyed while waiting have re-balanced my chakras and got my qi flowing nicely – no wonder I am looking well!

The whole-wheat scones are finely balanced and nutritious; so I order three—one for the walk home and two for tea later. Prices have gone up a bit but, as with all holistic therapies, the more you pay, the more it’s worth. “Here you are,” she says, handing me her dietary delights. As I pay, our hands touch ever so briefly, just long enough for me to experience the instant transfer of healing energy that is so characteristic of Therapeutic Touch.

“Take care now, and God bless”, she says. As I walk out of her aura, I contemplate her words full of empathetic spiritual guidance and ancient wisdom. “That was expensive”, my wife mutters back home. I beg to differ: not only did I get the most wholesome food for my physical body, but I received holistic and patient-centered aromatherapy, counseling, meditation, tai chi, and energy healing for my emotional, psychological, and spiritual needs.

If only our Health Secretary knew about this traditional, yet integrated and therefore cutting-edge approach to cost-effective health and holistic well-being. We could all have it for free, and it might even save the NHS from its current crisis!

Since I wrote these lines, the healthcare crises have deepened and, in some countries, privatization is considered a possible solution. If that moment arrives, it will be the day of so-called alternative medicine (SCAM) clinics. They will pop up like mushrooms and prosper like gold mines. In preparation for this glorious development, I have been trying to think of a few names that would be best for attracting needy consumers to my new alternative health clinics:

  • An establishment specializing in SCAM for grieving individuals: GOOD GRIEF
  • A clinic for traditional acupuncture: WHAT’S THE POINT?
  • A body purification center: CHUCKY’S DETOX TINCTURES
  • An institute specializing in SCAM for erectile dysfunction: SOMETHING MIGHT COME UP
  • A clinic for talking therapies: THE HOT AIR SALOON
  • Osteopathy school: STILL FOR ALL ILLS
  • An institute for veterinary homeopathy: NOTHING IS BETTER
  • A center specializing in SCAM for premature ejaculation: COMING LATER
  • SCAM diagnostic clinic: SECOND BEST OPINION
  • Chiropractic clinic: SUBLUXOURIOUS LUXATIONS
  • Energy healing institute: TOO GOOD TO BE TRUE
  • Clinic specializing in SCAM for intestinal pain: GONE WITH A WIND
  • Essential oils clinic: I CAN’T BELIEVE IT’S NOT BUTTER
  • Coffee enema clinic: STARBUCKS
  • Spiritual healing: CREED AND GREED
  • Clinic for Oriental medicine: EAST OF EDEN
  • Body reshaping center: WASTE WATCHERS
  • Leech therapy clinic: BORN TO SUCK
  • Mind-body institute: NEVER MIND
  • Alternative computer skills: NEUROLINGUISTIC PROGRAMMING
  • Vibrational medicine clinic: SATISFACTION GUARANTEED
  • Homeopathic health clinic: A LOT TO DO ABOUT NOTHING
  • Clinic specializing in SCAM for Benign Prostate Hypertrophy: TO PEE OR NOT TO PEE

I am sure many of you have much better ideas than I can think of – please, do not hesitate to let me know.

The concept of ultra-processed food (UPF) was initially developed and the term coined by the Brazilian nutrition researcher Carlos Monteiro, with his team at the Center for Epidemiological Research in Nutrition and Health (NUPENS) at the University of São Paulo, Brazil. They argue that “the issue is not food, nor nutrients, so much as processing,” and “from the point of view of human health, at present, the most salient division of food and drinks is in terms of their type, degree, and purpose of processing.”

Examples of UPF include:

Ultra-processed food is bad for our health! This message is clear and has been voiced so many times – not least by proponents of so-called alternative medicine (SCAM) – that most people should now understand it.

But how bad?

And what diseases does UPF promote?

How strong is the evidence?

I did a quick Medline search and was overwhelmed by the amount of research on this subject. In 2022 alone, there were more than 2000 publications! Here are the conclusions from just a few recent studies on the subject:

Don’t get me wrong: this is not a systematic review of the subject. I am merely trying to give a rough impression of the research that is emerging. A few thoughts seem nonetheless appropriate.

  1. The research on this subject is intense.
  2. Even though most studies disclose associations and not causal links, there is in my view no question that UPF aggravates many diseases.
  3. The findings of the current research are highly consistent and point to harm done to most organs.
  4. Even though this is a subject on which advocates of SCAM are exceedingly keen, none of the research I saw was conducted by SCAM researchers.
  5. The view of many SCAM proponents that conventional medicine does not care about nutrition is clearly not correct.
  6. Considering how unhealthy UPF is, there seems to be a lack of effective education and action aimed at preventing the harm UPF does to us.

Drip IV is “Australia’s first and leading mobile healthcare company specialising in assisting with nutritional deficiencies”. They claim to provide a mobile IV service that is prescribed and tailored individually to your nutritional needs. Treatment plans and customised infusions are determined by a medical team to suit individual requirements. They deliver vitamins, minerals and amino acids directly to the body via the bloodstream, a method they state allows for optimal bioavailability.

These claims are a little puzzling to me, not least because vitamins, minerals and amino acids tailored individually to the nutritional needs of the vast majority of people would mean administering nothing at all. But I guess that virtually every person who consults the service will get an infusion [and pay dearly for it].

The Australian Therapeutic Goods Administration (TGA) seems to have a similarly dim view on Drip IV. The TGA has just issued 20 infringement notices totalling $159,840 to the company and to one of its executive officers. The reason: unlawful advertising of intravenous infusion products to Australian consumers on a company website and social media. Ten notices totalling $133,200 were issued to the company and ten notices totalling $26,640 were issued to an executive officer. The TGA considers the intravenous infusion products to be therapeutic goods because of the claims made about them, and the advertising to be unlawful because the advertisements allegedly:

  • contained prohibited representations, such as claims regarding cancer.
  • contained restricted representations such as that the products would alleviate fatigue caused by COVID-19, assist in the treatment of Graves’ Disease and Alzheimer’s Disease, and support the treatment of autoimmune diseases such as Multiple Sclerosis. No TGA approval had been given to make such claims.
  • referred to ingredients that are prescription only, such as glutathione. Prescription medicines cannot be advertised directly to the public in Australia.
  • contained a statement or picture suggesting or implying the products were ‘TGA Approved’. Advertising of therapeutic goods cannot include a government endorsement.
  • contained a statement or picture expressing that the goods were ‘miraculous’.

Vitamin infusions have become very popular around the globe. There are now thousands of clinics offering this service, and many of them advertise aggressively with claims that are questionable. Here is just one example from the UK:

Modern life is hectic. If you are looking to boost your wellbeing, increase your energy levels, lift your mood and hydrate your body, Vitamin IV Infusions are ideal. Favoured by celebrities such as Madonna, Simon Cowell and Rihanna, Vitamin IV Infusions are an easy, effective way of delivering vitamins, minerals and amino acids directly into your bloodstream via an IV (intravenous) drip. Vitamins are essential for normal growth and staying healthy – but our bodies can’t produce all of the nutrients we need to function and thrive. That’s why more than one in three people take daily vitamin supplements – often without realising that only 15% of the active nutrients consumed orally actually find their way into their bloodstream. With Vitamin IV Infusions, the nutrients enter your bloodstream directly and immediately, and are delivered straight to your cells. We offer four different Vitamin IV Infusions, so you can choose the best combination for your personal needs, while boosting your general health, energy and wellbeing.

My advice to consumers is a little different and considerably less costly:

  1. to ensure you get enough vitamins, minerals, and amino acids, eat a balanced diet;
  2. to boost your well-being, sit down and calculate the savings you made by NOT using such a service;
  3. to increase your energy levels, take a nap;
  4. to lift your mood, recount the money you saved and think of what nice things you might buy with it;
  5. to hydrate your body drink a glass of water.

Perhaps it is time the authorities in all countries had a look at what these clinics are offering and what health claims they are making. Perhaps it is time they act as the TGA just did.

 

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