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

conflict of interest

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All healthcare professionals have an ethical obligation to be truthful and act in the best interest of the patient by adhering to the best available evidence. Providing false or misleading information to patients or consumers is thus a breach of medical ethics. In Canada, the authorities have started taking action against nurses that violate these ethical principles.

Now it has been reported that a former registered nurse in West Kelowna has been suspended for four weeks after giving a vulnerable client anti-vaccine information and recommending “alternative pseudoscience” treatments.

According to the terms of a consent agreement posted on the B.C. College of Nurses and Midwives site, Carole Garfield was under investigation for actions that happened in September 2021. The college claims that Garfield contacted the client when she was off duty, using her personal mobile phone and email to give information against the COVID-19 vaccine and recommending so-called alternative medicine (SCAM). The exact nature of the “pseudoscience modalities” Garfield recommended to the client was not listed in the college’s notice.

Garfield’s nursing licence was cancelled back in April, according to the college’s registry. It’s unclear how exactly the four-week suspension will be applied. In addition to her month-long suspension and a public reprimand, Garfield is not allowed to be the sole nurse on duty for six months. She will also be given education about ethics, boundaries, and client confidentiality, as well as the province’s professional nursing standards. “The inquiry committee is satisfied that the terms will protect the public,” read a statement from the college.

In my view, it is high time for professional bodies to act against healthcare professionals who issue misleading information to their patients. In the realm of so-called alternative medicine (SCAM), issuing false or misleading information is extremely common and causes untold harm. Such harm would be largely preventable if the professional bodies in charge would start acting responsibly in the best interest of patients. It is high time that they follow the Canadian example!

The Center for Inquiry (CFI) is a charitable nonprofit organization dedicated to defending science and critical thinking. CFI’s vision is a world in which evidence, science, and compassion—rather than superstition, pseudoscience, or prejudice—guide public policy.

It has been reported that the CFI, through its Office of Consumer Protection from Pseudoscience, warned Amazon.com that the marketing and sale of unapproved homeopathic drugs betrays consumers’ trust and runs afoul of federal law. In a letter sent to the world’s largest online retailer, attorneys for CFI charged that Amazon has legal and moral obligations to end its trade in the prohibited items and urged the company to immediately cease the sale of unapproved drugs marketed as medicine for babies, infants, and children.

In Amazon’s Health Care Products department, a search for “homeopathic” returns more than 10,000 product results–each claiming to treat a host of health issues, ranging from “nerve pain” and “fever” to “surgical wounds” and “fibroids and ovarian cysts.” Marketed with names such as “Boiron RhinAllergy Kids” and “Hyland’s 4Kids Pain Relief,” many items are explicitly sold as medicine for children. However, not one homeopathic drug has been approved by the Food and Drug Administration (FDA) as required by the federal Food, Drug & Cosmetic Act.

“Amazon built its business and public reputation on assurances it prioritizes consumer trust above all else,” says CFI Vice President and General Counsel Nick Little. “It’s impossible to be ‘Earth’s most customer-centric company’ while aggressively promoting thousands of snake oil products to parents. If Amazon truly wants to put its customers first, the company should be protecting them from sellers of sham treatments and faux medicine, not profiting from it.”

The FDA recently issued a warning letter to Amazon over the platform’s prohibited sale of mole and skin tag removal products that lack FDA approval. CFI makes clear that the same prohibitions apply to homeopathic drugs sold on Amazon.com. The letter also highlights deceptive marketing practices used to sell the products, noting that the industry’s own figures found 85 percent of those who purchased a brand of homeopathic product were not aware the item was actually homeopathic.

“Amazon recently announced partnerships to help crack-down on phony wrestling memorabilia,” Little notes. “We think protecting children against harmful homeopathic drugs is a bit more deserving of the company’s attention and hope Amazon accepts our offer to help identify these particularly problematic products for removal.”

You can read CFI’s letter to Amazon here.

The last few days, I spent much of my time answering questions from journalists on the subject of Charles lll. [interestingly, almost exclusively journalists NOT writing for UK newspapers]. Unsurprisingly, they all wanted to know about the way Charles managed to close down my research department at Exeter University some 10 years ago.

The story is old and I am a bit tired of repeating it. So, nowadays I often refer people to Wikipedia where a short paragraph sums it up:

Ernst was accused by Prince Charles’ private secretary of having breached a confidentiality agreement regarding the 2005 Smallwood report. After being subjected to a “very unpleasant” investigation by the University of Exeter, the university “accepted his innocence but continued, in his view, to treat him as ‘persona non grata’. All fundraising for his unit ceased, forcing him to use up its core funding and allow its 15 staff to drift away.”[15] He retired in 2011, two years ahead of his official retirement.[10][25] In July 2011, a Reuters article described his “long-running dispute with the Prince about the merits of alternative therapies” and stated that he “accused Britain’s heir-to-the-throne Prince Charles and other backers of alternative therapies on Monday of being ‘snake-oil salesmen’ who promote products with no scientific basis”, and that the dispute “had cost him his job – a claim Prince Charles’s office denied”.[14][26] Ernst is a republican, and has supported Republic, an organisation which campaigns for the abolition of the British monarchy.[27]

Re-reading it yesterday, I noticed that the text is not entirely correct (a full account can be found here). Let me explain:

  • There never was a formal confidentiality agreement with signature etc. But I did feel bound to keep the contents of the Smallwood report confidential.
  • The investigation by my University was not just ‘very unpleasant’, it was also far too long. It lasted 13 months! I had to take lawyers against my own University!
  • In addition, it was unnecessary, not least because a University should simply establish the facts and, if reasonable, defend its professor from outside attacks. The facts could have been established over a cup of tea with the Vice Chancellor in less than half an hour.
  • When my department had been destroyed in the process, I retired voluntarily and was subsequently re-employed for half a year to help find a successor. In retrospect, I see this move as a smart ploy by the University to keep me sweet and prevent me from going to the press.
  • A successor was never hired; one good candidate was found but he was told that he had to find 100% of the funds to do the job. Nobody of high repute would have found this acceptable, and thus the only good candidate was not even tempted to accept the position.
  • The snake oil salesman story is an entirely separate issue (see here) that happened years later.
  • It is true that Charles’s office denied that Charles knew about his 1st private secretary writing to my Vice Chancellor asking him to investigate my alleged breach of confidence. However, as Sir Michael Peat started his letter with the words “I AM WRITING … AS THE PRINCE OF WALES’ PRIVATE SECRETARY…, I find this exceedingly hard to believe.
  • Even though Charles did a sterling job in trying, I did not become a republican. I do have considerable doubts that Charles will be a good King (his reign might even be the end of the monarchy), and I did help the republican cause on several occasions but I never formally joined any such group (in general, I am not a joiner of parties, clubs or interest groups).

To one of the journalists who recently interviewed me, I explained that I do not in the slightest feel sore, bitter, or angry on a personal level. Going into early retirement suited me perfectly fine, and thanks to that decision I enjoy life to the full. The significance of this story lies elsewhere: Charles’ intervention managed to permanently close the then worldwide-only department that systematically and critically investigated so-called alternative medicine. If you know another, please let me know.

As numerous of my posts have demonstrated, chiropractic manipulations can cause severe adverse effects, including deaths. Several hundred have been documented in the medical literature. When discussing this fact with chiropractors, we either see denial or we hear the argument that such events are but extreme rarities. To the latter, I usually respond that, in the absence of a monitoring system, nobody can tell how often serious adverse events happen. The resply often is this:

You are mistaken because the Royal College of Chiropractors’ UK-based Chiropractic Patient Incident Reporting and Learning System (CPiRLS) monitors such events adequately. 

I have heard this so often that it is time, I feel, to have a look at CPiRLS. Here is what it says on the website:

CPiRLS is a secure website which allows chiropractors to view, submit and comment on patient safety incidents.

Access to CPiRLS

CPiRLS is currently open to all UK-based chiropractors, all ECU members and members of the Chiropractic and Osteopathic College of Australasia. To access the secure area of the CPiRLS website, please click the icon below and insert the relevant CPiRLS username and password when prompted.

In the UK, these can normally be found on your Royal College of Chiropractors’ membership card unless the details are changed mid-year. Alternatively, email admin@rcc-uk.org from your usual email address and we will forward the details.

Alternatively, in the UK and overseas, secure access details can be obtained from your professional association.

National associations and organisations wishing to use CPiRLS, or obtain trial access to the full site for evaluation purposes, should contact The Royal College of Chiropractors at chiefexec@rcc-uk.org

Please click the icon below to visit the CPiRLS site.

Yes, you understood correctly. The public cannot access CPiRLS! When I click on the icon, I get this:

Welcome to CPiRLS

CPiRLS, The Chiropractic Patient Incident Reporting and Learning System – is an online reporting and learning forum that enables chiropractors to share and comment on patient safety incidents.

The essential details of submitted reports are published on this website for all chiropractors to view and add comments. A CPiRLS team identifies trends among submitted reports in order to provide feedback for the profession. Sharing information in this way helps to ensure the whole profession learns from the collective experience in the interests of patients.

All chiropractors are encouraged to adopt incident reporting as part of a blame-free culture of safety, and a routine risk management tool.

CPiRLS is secure and anonymous. There is no known way that anyone reporting can be identified, nor do those running the system seek to identify you. For this security to be effective, you require a password to participate.

Please note that reporting to CPiRLS is NOT a substitute for the reporting of patient safety incidents to your professional association and/or indemnity insurers.

So, how useful is CPiRLS?

Can we get any information from CPiRLS about the incidence of adverse effects?

No!

Do we know how many strokes or deaths have been reported?

No!

Can chiropractors get reliable information from CPiRLS about the incidence of adverse effects?

No, because reporting is not mandatory and the number of reports cannot relate to incidence.

Are chiropractors likely to report adverse effects?

No, because they have no incentive and might even feel that it would give their profession a bad name.

Is CPiRLS transparent?

No!

Is CPiRLS akin to postmarketing surveillance as it exists in conventional medicine?

No!

How useful is CPiRLS?

I think I let my readers answer this question.

 

Earlier this year, I started the ‘WORST PAPER OF 2022 COMPETITION’. As a competition without a prize is no fun, I am offering the winner (that is the lead author of the winning paper) one of my books that best fits his/her subject. I am sure this will overjoy him or her.

And how do we identify the winner? I will continue blogging about nominated papers (I hope to identify about 10 in total), and towards the end of the year, I let my readers decide democratically.

In this spirit of democratic voting, let me suggest to you ENTRY No 8 (it is so impressive that I must show you the unadulterated abstract):

Introduction

Female sexual dysfunction (FSD) seriously affects the quality of life of women. However, most women do not have access to effective treatment.

Aim

This study aimed to determine the feasibility and effectiveness of the use of acupuncture in FSD treatment based on existing clear acupuncture protocol and experience-supported face-to-face therapy.

Methods

A retrospective analysis was performed on 24 patients with FSD who received acupuncture from October 2018 to February 2022. The Chinese version of the female sexual function index , subjective sensation, sexual desire, sexual arousal, vaginal lubrication, orgasm, sexual satisfaction, and dyspareunia scores were compared before and after the treatment in all 24 patients.

Main Outcome Measure

A specific female sexual function index questionnaire was used to assess changes in female sexual function before and after the acupuncture treatment.

Results

In this study, the overall treatment improvement rate of FSD was 100%. The Chinese version of the female sexual function index total score, sexual desire score, sexual arousal score, vaginal lubrication score, orgasm score, sexual satisfaction score, and dyspareunia score during intercourse were significantly different before and after the treatment (P < .05). Consequently, participants reported high levels of satisfaction with acupuncture. This study indicates that acupuncture could be a new and effective technique for treating FSD. The main advantages of this study are its design and efficacy in treating FSD. To the best of our knowledge, this is the first study to evaluate the efficacy of acupuncture in the treatment of FSD using the female sexual function index scale from 6 dimensions. The second advantage is that the method used (ie, the nonpharmacological method) is simple, readily available, highly safe with few side effects, and relatively inexpensive with high patient satisfaction. However, limitations include small sample size and lack of further detailed grouping, pre and post control study of patients, blank control group, and pre and post control study of sex hormones.

Conclusion

Acupuncture can effectively treat FSD from all dimensions with high safety, good satisfaction, and definite curative effect, and thus, it is worthy of promotion and application.

My conclusion is very different: acupuncture can effectively kill any ability for critical thinking.

I hardly need to list the flaws of this paper – they are all too obvious, e.g.:

  • there is no control group; the results might therefore be due to a host of factors that are unrelated to acupuncture,
  • the trial was too small to allow far-reaching conclusions,
  • the study does not tell us anything about the safety of acupuncture.

The authors call their investigation a ‘pilot study’. Does that excuse the flimsiness of their effort? No! A pilot study cannot draw conclusions such as the above.

What’s the harm? you might ask; nobody will ever read such rubbish and nobody will have the bizarre idea to use acupuncture for treating FSD. I’m afraid you would be wrong to argue in this way. The paper already got picked up by THE DAILY MAIL in an article entitled “Flailing libido? Acupuncture could help boost sex drive, scientists say” which was as devoid of critical thinking as the original study. Thus we can expect that hundreds of desperate women are already getting needled and ripped off as we speak. And in any case, offensively poor science is always harmful; it undermines public trust in research (and it renders acupuncture research the laughing stock of serious scientists).

 

There is a broad, growing, international consensus that homeopathy is a placebo therapy. Even the Germans who have been notoriously fond of their homeopathic remedies are now slowly beginning to accept this fact. But now, a dispute has started to smolder in Germany’s southwest about further training for doctors in homeopathy. In July, the representative assembly of the Baden-Württemberg Medical Association decided to remove the additional title of homeopathy from the further training regulations of doctors. However, the local health ministry has legal control over the medical association and must therefore review the decision, and the minister (Manne Lucha), a member of the Green Party, has stated that he considers the deletion to be wrong.

In a further deepening of the conflict, it has been reported that the chairwoman of the Green Party, Lena Schwelling, considers the ongoing controversy over homeopathy to be exaggerated and wants to preserve people’s freedom of choice. She said she agrees with Health Minister Manne Lucha that naturopathy and homeopathy are important issues for many people. “There is freedom of choice of doctor and therapy in this country. And if people want to choose it, I think they should be allowed to do so.” She also said continuing education for homeopathy for physicians should remain.

Schwelling spoke out against omitting homeopathy from the benefits catalog of the statutory health insurance funds, as demanded by the German Liberal Party, for example: “We are talking about about 0.003 percent of the total costs of the statutory health insurance funds, which flow into homeopathic medicines and treatments. If you saw that as a homeopathic medicine, that would also be at the detection limit, that’s how little money it is. It’s so diluted and so little in this overall budget that it’s not worth arguing about. That’s why I’m very surprised at the crusade some are waging against the issue of homeopathy.”

Recently, a dispute has been smoldering in the southwest about continuing education for homeopathy. The representative assembly of the Baden-Württemberg Medical Association decided in July to remove the additional title of homeopathy from the continuing education regulations. The local health minister, Lucha, has legal oversight of the medical association and must review the amendment statute. However, the minister has already stated that he believes the deletion is wrong.

In response, Schwelling stated it is a “normal process” for the ministry to review what the medical association has proposed. He added that it was perfectly clear that “further training in homeopathy is additional training and does not replace medical studies. Of course, homeopathic doctors also prescribe antibiotics when indicated. An important point why homeopathy should remain in the canon is that you then have the established control mechanisms, for example, in further education.”

Osteopathic tradition in the cranial field (OCF) postulates that the primary respiratory mechanism (PRM) relies on the anatomical links between the occiput and sacrum. Few studies investigated this relationship with inconsistent results. No studies investigated the occiput-sacrum connection from a neurophysiological perspective.

This study aims to determine whether the sacral technique (ST), compared to the compression of the fourth ventricle (CV4) technique, can affect brain alpha-band power (AABP) as an indicator of a neurophysiological connection between the occiput and sacrum.

Healthy students, 22-30 years old for men and 20-30 years old for women, were enrolled in the study and randomized into eight intervention groups. Each group received a combination of active techniques (CV4 or ST) and the corresponding sham techniques (sham compression of the fourth ventricle [sCV4] or sham sacral technique [sST] ), organized in two experimental sessions divided by a 4 h washout period. AABP was continuously recorded by electroencephalogram (EEG) of the occipital area in the first 10 min of resting state, during each intervention (active technique time) and after 10 min (post-active technique time), for a total of approximately 50 min per session. Analysis was carried out utilizing a repeated-measure ANOVA within the linear general model framework, consisting of a within-subject factor of time and a within-subject factor of treatment (CV4/ST).

Forty healthy volunteers (mean age ± SD, 23.73±1.43 years; range, 21-26 years; 16 male and 24 female) were enrolled in the study and completed the study protocol. ANOVA revealed a time × treatment interaction effect statistically significant (F=791.4; p<0.001). A particularly high increase in mean AABP magnitude was recorded during the 10 min post-CV4, compared to both the CV4 and post-sCV4 application (p<0.001). During all the times analyzed for ST and sST application, no statistically significant differences were registered with respect to the resting state.

The authors concluded that the ST does not produce immediate changes on occipital AABP brain activity. CV4, as previous evidence supported, generates immediate effects, suggesting that a different biological basis for OCF therapy’s connection between the head and sacrum should be explored.

Why on earth should a different biological mechanism be explored? Why not conclude that OCF and its assumptions are pure nonsense?

The answer to these questions is not difficult to find: the authors are from the ‘Istituto Superiore di Osteopatia, Milan, Italy’! One can understand that, at this institution, people are unlikely to agree with my conclusion that OCF is based on absurd concepts and does not merit further research.

According to the authors of this study, research is lacking regarding osteopathic approaches in treating polycystic ovary syndrome (PCOS), one of the prevailing endocrine abnormalities in reproductive-aged women. Limited movement of pelvic organs can result in functional and structural deficits, which can be resolved by applying visceral manipulation (VM). Already with these two introductory sentences, I have problems. But for the moment, we can leave this aside and have a look at their trial.

The study was aimed at analyzing the effect of VM on dysmenorrhea, irregular, delayed, and/or absent menses, and premenstrual symptoms in PCOS patients.

Thirty Egyptian women with PCOS, with menstruation-related complaints and free from systematic diseases and/or adrenal gland abnormalities, prospectively participated in a single-blinded, randomized controlled trial. They were recruited from the women’s health outpatient clinic in the faculty of physical therapy at Cairo University, with an age of 20-34 years, and a body mass index (BMI) ≥25, <30 kg/m2. Patients were randomly allocated into two equal groups (15 patients); the control group received a low-calorie diet for 3 months, and the study group received the same hypocaloric diet plus VM to the pelvic organs and their related structures, according to assessment findings, for eight sessions over 3 months. Evaluations for body weight, BMI, and menstrual problems were done by weight-height scale, and menstruation-domain of Polycystic Ovary Syndrome Health-Related Quality of Life Questionnaire (PCOSQ), respectively, at baseline and after 3 months of treatments.

A total of 30 patients were included, with baseline mean age, weight, BMI, and menstruation domain score of 27.5 ± 2.2 years, 77.7 ± 4.3 kg, 28.6 ± 0.7 kg/m2, and 3.4 ± 1.0, respectively, for the control group, and 26.2 ± 4.7 years, 74.6 ± 3.5 kg, 28.2 ± 1.1 kg/m2, and 2.9 ± 1.0, respectively, for the study group. Of the 15 patients in the study group, uterine adhesions were found in 14 patients (93.3%), followed by restricted uterine mobility in 13 patients (86.7%), restricted ovarian/broad ligament mobility (9, 60%), and restricted motility (6, 40%). At baseline, there was no significant difference (p>0.05) in any of the demographics (age, height), or dependent variables (weight, BMI, menstruation domain score) among both groups. Post-study, there was a statistically significant reduction (p=0.000) in weight, and BMI mean values for the diet group (71.2 ± 4.2 kg, and 26.4 ± 0.8 kg/m2, respectively) and the diet + VM group (69.2 ± 3.7 kg; 26.1 ± 0.9 kg/m2, respectively). For the improvement in the menstrual complaints, a significant increase (p<0.05) in the menstruation domain mean score was shown in the diet group (3.9 ± 1.0), and the diet + VM group (4.6 ± 0.5). On comparing both groups post-study, there was a statistically significant improvement (p=0.024) in the severity of menstruation-related problems in favor of the diet + VM group.

The authors concluded that VM yielded greater improvement in menstrual pain, irregularities, and premenstrual symptoms in PCOS patients when added to caloric restriction than utilizing the low-calorie diet alone in treating that condition.

VM involves the manual manipulation by a therapist of internal organs, blood vessels and nerves (the viscera) mostly from outside the body, but sometimes, the therapist also puts his/her fingers into the patient’s vagina. It was developed by the osteopath Jean-Piere Barral. He stated that through his clinical work with thousands of patients, he created this modality based on organ-specific fascial mobilization. And through work in a dissection lab, he was able to experiment with visceral manipulation techniques and see the internal effects of the manipulations. According to its proponents, visceral manipulation is based on the specific placement of soft manual forces looking to encourage the normal mobility, tone, and motion of the viscera and their connective tissues. The idea is that these gentle manipulations may potentially improve the functioning of individual organs, the systems the organs function within, and the structural integrity of the entire body.

I don’t see any reason to believe the concepts of VM are plausible. Thus I find the hypothesis of this trial extremely far-fetched. The results are equally unconvincing. As we have often discussed, the ‘A+B vs B’ design cannot prove a causal relationship between the intervention and the outcome.

The most likely explanation for the findings is that the patients receiving VM experienced or merely reported improvements because the extra attention of mildly invasive treatments produced a powerful placebo effect. To put it bluntly: this is a poor, arguably unethical study where over-enthusiastic researchers reach a conclusion that is not supported by the data.

An article in THE TIMES seems worth mentioning. Here are some excerpts:

… Maternity care at Nottingham University Hospitals NHS Trust (NUH) is the subject of an inquiry, prompted by dozens of baby deaths. More than 450 families have now come forward to take part in the review, led by the expert midwife Donna Ockenden. The trust now faces further scrutiny over its use of aromatherapy, after experts branded guidelines at the trust “shocking” and not backed by evidence. Several bereaved families have said they recall aromatherapy being heavily promoted at the trust’s maternity units.

It is being prosecuted over the death of baby Wynter Andrews just 23 minutes after she was born in September 2019. Her mother Sarah Andrews wrote on Twitter that she remembered aromatherapy being seen as “the answer to everything”. Internal guidelines, first highlighted by the maternity commentator Catherine Roy, suggest using essential oils if the placenta does not follow the baby out of the womb quickly enough…  the NUH guidelines say aromatherapy can help expel the placenta, and suggest midwives ask women to inhale oils such as clary sage, jasmine, lavender or basil, while applying others as an abdominal compress. They also describe the oils as “extremely effective for the prevention of and, in some cases, the treatment of infection”. The guidelines also suggest essential oils to help women suffering from cystitis, or as a compress on a caesarean section wound. Nice guidelines for those situations do not recommend aromatherapy…

The NUH adds frankincense “may calm hysteria” and is “recommended in situations of maternal panic”. Roy said: “It is shocking that dangerous advice seemed to have been approved by a team of healthcare professionals at NUH. There is a high tolerance for pseudoscience in NHS maternity care … and it needs to stop. Women deserve high quality care, not dangerous quackery.” …

________________________________

The journalist who wrote the article also asked me for a comment, and I emailed her this quote: “Aromatherapy is little more than a bit of pampering; no doubt it is enjoyable but it is not an effective therapy for anything. To use it in medical emergencies seems irresponsible to say the least.” The Times evidently decided not to include my thoughts.

Having now read the article, I checked again and failed to find good evidence for aromatherapy for any of the mentioned conditions. However, I did find an article and an announcement both of which are quite worrying, in my view:

Aromatherapy is often misunderstood and consequently somewhat marginalized. Because of a basic misinterpretation, the integration of aromatherapy into UK hospitals is not moving forward as quickly as it might. Aromatherapy in UK is primarily aimed at enhancing patient care or improving patient satisfaction, and it is frequently mixed with massage. Little focus is given to the real clinical potential, except for a few pockets such as the Micap/South Manchester University initiative which led to a Phase 1 clinical trial into the effects of aromatherapy on infection carried out in the Burns Unit of Wythenshawe Hospital. This article discusses the expansion of aromatherapy within the US and follows 10 years of developing protocols and policies that led to pilot studies on radiation burns, chemo-induced nausea, slow-healing wounds, Alzheimers and end-of-life agitation. The article poses two questions: should nursing take aromatherapy more seriously and do nurses really need 60 hours of massage to use aromatherapy as part of nursing practice?

My own views on aromatherapy are expressed in our now not entirely up-to-date review:

Aromatherapy is the therapeutic use of essential oil from herbs, flowers, and other plants. The aim of this overview was to provide an overview of systematic reviews evaluating the effectiveness of aromatherapy. We searched 12 electronic databases and our departmental files without restrictions of time or language. The methodological quality of all systematic reviews was evaluated independently by two authors. Of 201 potentially relevant publications, 10 met our inclusion criteria. Most of the systematic reviews were of poor methodological quality. The clinical subject areas were hypertension, depression, anxiety, pain relief, and dementia. For none of the conditions was the evidence convincing. Several SRs of aromatherapy have recently been published. Due to a number of caveats, the evidence is not sufficiently convincing that aromatherapy is an effective therapy for any condition.

In this context, it might also be worth mentioning that we warned about the frequent usage of quackery in midwifery years ago. Here is our systematic review of 2012 published in a leading midwifery journal:

Background: in recent years, several surveys have suggested that many midwives use some form of complementary/alternative therapy (CAT), often without the knowledge of obstetricians.

Objective: to systematically review all surveys of CAT use by midwives.

Search strategy: six electronic databases were searched using text terms and MeSH for CAT and midwifery.

Selection criteria: surveys were included if they reported quantitative data on the prevalence of CAT use by midwives.

Data collection and analysis: full-text articles of all relevant surveys were obtained. Data were extracted according to pre-defined criteria.

Main results: 19 surveys met the inclusion criteria. Most were recent and from the USA. Prevalence data varied but were usually high, often close to 100%. Much use of CATs does not seem to be supported by strong evidence for efficacy.

Conclusion: most midwives seem to use CATs. As not all CATs are without risks, the issue should be debated openly.

I am tired of saying ‘I TOLD YOU SO!’ but nevertheless find it a pity that our warning remained (yet again) unheeded!

Despite considerable doubts about its effectiveness, osteopathic manipulative treatment (OMT) continues to be used for a range of pediatric conditions. Here is just one example of many osteopaths advertising their services:

I qualified as an Osteopath in 2009 after 4 years of intensive training from the British College of Osteopathic medicine, where I received a distinction for my efforts. After having two children I decided to do a 2-year Postgraduate training in Pediatric Osteopathy from the Osteopathic Centre for Children in London. Whilst at the centre I was lucky enough to meet a wide variety of children from premature babies in a Neonate Hospital ward to children with developmental issues and disabilities, children on the Autistic spectrum, to kids doing exams or experiencing high levels of stress. We also saw lots of children with normal coughs, colds, lumps and bumps.

And the ‘Institute of Osteopathy states this:

Parents visit osteopaths for a range of reasons to support their child’s health. Children, like adults, can be affected by general joint and muscle issues, which is one of the reasons people visit an osteopath. Parents will also take their children to visit an osteopath for a variety of other health reasons that may benefit from osteopathic care.

As osteopathic care is based on the individual needs of the patient, it will vary depending on your child’s age and the diagnosis. Osteopaths generally use a wide range of gentle hands-on techniques that focus on releasing tension, improving mobility and optimising function. This is often used together with exercise and helpful advice. Some osteopaths have been trained in very gentle techniques which are particularly suitable to assess and treat very young children, including new-borns. You do not need to consult your GP before you visit an osteopath, although you may wish to do so.

So, how good or bad is osteopathy for kids? Our systematic review wanted to find out. Specifically, the aim of this paper is to update our previous systematic review (SR) initially published in 2013 by critically evaluating the evidence for or against this treatment.

Eleven databases were searched (January 2012 to November 2021). Only randomized clinical trials (RCTs) of OMT in pediatric patients compared with any type of controls were considered. The Cochrane risk-of-bias tool was used. In addition, the quality of the evidence was rated using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria, as recommended by the Cochrane Collaboration.

Thirteen trials met the eligibility criteria, of which four could be subjected to a meta-analysis. The findings show that, in preterm infants, OMT has little or no effect on reducing the length of hospital stay (standardized mean difference (SMD) -0.03; 95% confidence interval (CI) -0.44 to 0.39; very low certainty of the evidence) when compared with usual care alone. Only one study (8.3%) was judged to have a low risk of bias and showed no effects of OMT on improving exclusive breastfeeding at one month. The methodological quality of RCTs published since 2013 has improved. However, adverse effects remain poorly reported.

We concluded that the quality of the primary trials of OMT has improved during recent years. However, the quality of the totality of the evidence remains low or very low. Therefore, the effectiveness of OMT for selected pediatric populations remains unproven.

These days, it is not often that I am the co-author of a systematic review. So, allow me to discuss one of my own papers for a change by making a few very brief points:

  • Considering how many osteopaths treat children, the fact that only 13 trials exist is shameful. To me, it suggests that the osteopathic profession has little interest in research.
  • The finding that adverse effects are poorly reported is even more shameful, in my view. It suggests that the few osteopaths who do some research don’t mind violating research ethics.
  • The fact that overall our review fails to yield good evidence that osteopathy is effective for any pediatric condition is the most shameful finding of them all. It means that osteopaths are either not informed about the evidence for their own approach, or that they are informed but don’t give a hoot and treat kids regardless. In both cases, they behave unethically.
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