EBM
Chemotherapy-induced nausea and vomiting (CINV) is a common adverse event in cancer patients and can negatively affect their quality of life (QoL). This randomized phase II cross-over trial aimed to evaluate the clinical efficacy of an electric massage chair (EMC) for the treatment of CINV. It was conducted on solid cancer patients who received moderate (MEC) to high emetogenic chemotherapy (HEC). The participants were randomly assigned to receive their first chemotherapy either on a standard bed (Group A) or in an EMC (Group B) during the infusion. The patients were then crossed over to the next cycle. CINV and QoL questionnaires were collected from the participants.
A total of 59 patients completed the trial protocol and were included in the analysis, with 29 and 30 patients in Groups A and B, respectively. The mean INVR (Index of Nausea, Vomiting, and Retching) score in the 2nd day of the first cycle was higher in Group B (3.63 ± 5.35) than Group A (2.76 ± 4.78), but the difference was not statistically significant (p = 0.5367). The complete response rate showed little difference between the groups. Among the high-emetic risk subgroups, patients who received HEC (p = 0.04595), younger patients (p = 0.0108), and non-colorectal cancer patients (p = 0.0495) presented significantly lower CINV scores when EMC was applied.
The authors concluded that there was no significant difference in INVR scores between standard care and EMC. Applying EMC at the first chemotherapy infusion may help preserve QoL and reduce CINV in high-risk patients.
Receiving chemotherapy for the first time is a very frightening event. In my view, everything should be done by the care team to make it less scary and as agreeable as possible. Patients might chose whether they prefere to lie down or sit, whether they have their own room or are treated in the company of others, with or without music, etc., etc. If an EMC is available, they should be able to try it and decide whether it suits them or not. If it does, I would not care a hoot whether EMC is a proven intervention or not, wether it is placebo or not, etc.
The main thing here is to make patients comfortable – and that, in my view, hardly needs a clinical trial.
The American Society of Clinical Oncology (ASCO) and the Society for Integrative Oncology have collaborated to develop guidelines for the application of integrative approaches in the management of:
- anxiety,
- depression,
- fatigue,
- use of cannabinoids and cannabis in patients with cancer.
These guidelines provide evidence-based recommendations to improve outcomes and quality of life by enhancing conventional cancer treatment with integrative modalities.
All studies that informed the guideline recommendations were reviewed by an Expert Panel which was made up of a patient advocate, an ASCO methodologist, oncology providers, and integrative medicine experts. Panel members reviewed each trial for quality of evidence, determined a grade quality assessment label, and concluded strength of recommendations.
The findings show:
- Strong recommendations for management of cancer fatigue during treatment were given to both in-person or web-based mindfulness-based stress reduction, mindfulness-based cognitive therapy, and tai chi or qigong.
- Strong recommendations for management of cancer fatigue after cancer treatment were given to mindfulness-based programs.
- Clinicians should recommend against using cannabis or cannabinoids as a cancer-directed treatment unless within the context of a clinical trial.
- The recommended modalities for managing anxiety included Mindfulness-Based Interventions (MBIs), yoga, hypnosis, relaxation therapies, music therapy, reflexology, acupuncture, tai chi, and lavender essential oils.
- The strongest recommendation in the guideline is that MBIs should be offered to people with cancer, both during active treatment and post-treatment, to address depression.
The authors concluded that the evidence for integrative interventions in cancer care is growing, with research now supporting benefits of integrative interventions across the cancer care continuum.
I am sorry, but I find these guidelines of poor quality and totally inadequate for the purpose of providing responsible guidance to cancer patients and carers. Here are some of my reasons:
- I know that this is a petty point, particularly for me as a non-native English speaker, but what on earth is an INTEGRATIVE THERAPY? I know integrative care or integrative medicine, but what could possibly be integrative with a therapy?
- I can vouch for the fact that the assertion “all studies that informed the guideline recommendations were reviewed” is NOT true. The authors seem to have selected the studies they wanted. Crucially, they do not reveal their selection criteria. I have the impression that they selected positive studies and omitted those that were negative.
- The panel of experts conducting the research should be mentioned; one can put together a panel to show just about anything simply by choosing the right individuals.
- The authors claim that they assessed the quality of the evidence, yet they fail to tell us what it was. I know that many of the trials are of low quality and their results therefore less than reliable. And guidance based on poor-quality studies is misguidance.
- The guidelines say nothing about the risks of the various treatments. In my view, this would be essential for any decent guideline. I know that some of the mentioned therapies are not free of adverse effects.
- They also say nothing about the absolute and relative effect sizes of the treatments they recommend. Such information would ne necessary for making informed decisions about the optimal therapeutic choices.
- The entire guideline is bar any critical thinking.
Overall, these guidelines provide more an exercise in promotion of dubious therapies than a reliable guide for cancer patients and their carers. The ASCO and the Society for Integrative Oncology should be ashamed to have given their names to such a poor-quality document.
Pharmacists often advise patients on the use of over-the counter (OTC) medications, including homeopathics. Yet, little is known about student pharmacist education about homeopathy. The objectives of this study were to:
- describe homeopathic topics being taught in pharmacy schools,
- evaluate faculty views about pharmacists’ roles in counseling patients about homeopathic products.
An explanatory sequential mixed methods approach was used. Online surveys were distributed to 3,300 pharmacy practice faculty members representing all schools accredited in the US. Frequencies were calculated to describe faculty characteristics and their responses. Moreover, 18 interviews of faculty involved with teaching homeopathy were conducted to learn about homeopathy teaching and expectations about roles of pharmacists in counseling patients.
Survey data were collected from 365 respondents. Over half (84 of 137) of the responding pharmacy schools reported teaching
homeopathy to pharmacy students. In addition, the responses from most of the interviewed faculty were summarized into two themes
which emphasized that pharmacists should be knowledgeable and able to counsel patients effectively to ensure they benefit from
taking homeopathic products.
The authors concluded that over half of US pharmacy schools are teaching students about homeopathy topics. Further, there was support for pharmacists being able to counsel effectively about homeopathic products.
Oh, dear!
The sampling method of “3,300 pharmacy practice faculty members representing all schools accredited in the US” seems nonsensical. It means, if I understand it correctly, that some schools will be represented multiple times, while others are not represented at all. The response rate (~11%) is dismal which means that the data allow no generalisable conclusion whatsoever.
If we forget about these fatal flaws for just a minute and take the findings of the survey seriously, we are perhaps surprised that over half of the schools teach homeopathy. This fact in itself might, however, not necessarily be a bad thing. The students could simply learn that (and why) homeopathy is an obsolete therapy. What makes me shudder is this statement: “pharmacists should be knowledgeable and able to counsel patients effectively to ensure they benefit from taking homeopathic products”.
How can you teach students to counsel patients in such a way that they benefit from an ineffective therapy?, I wonder.
This paper employs a governmentality framework to explore resistance by sceptics to homeopathy’s partial settlement in the public health systems of England and France, resulting in its defunding in both countries in 2018 and 2021, respectively. While partly dependent upon long-standing problematisations – namely, that homeopathy’s ability to heal is unproven, its mechanisms implausible, and its consequences for patients potentially dangerous – the defunding of homeopathy was also driven by the conduct of sceptics towards so-called alternative medicine (SCAM), who undermined homeopathy’s position in strikingly different ways in both contexts. This difference, we suggest, is a consequence of the diverging regulatory arrangements surrounding homeopathy (and SCAMs more generally) in England and France—and the ambivalent effects of SCAM’s regulation. If law and regulation have been a key component of SCAM’s integration and (partial) acceptance over the past four decades, the fortunes of homeopathy in England and France highlight their unpredictability as techniques of governmentality: just as the formal regulatory systems in England and France have helped to normalise homeopathy in different ways, they have also incited and galvanised opposition, providing specific anchor-points for resistance by SCAM sceptics.
The authors state that they approach the sceptics’ actions as a form of resistance to the normalising power of governmentality—a resistance that is also shaped by the possibilities and spaces offered by legal orderings. From a Foucauldian perspective, resistance is immanent to relations of power: the two presuppose one another. If regimes of governmentality have increasingly let SCAMs ‘in’ as a means of normalising them, then this paper attends to some of the resistances the modes of SCAM’s regulation have incited and shaped, and how resistance to SCAM has taken different forms in different regulatory contexts. At times, resistance has emanated from some SCAM healers themselves, who regard their practice as inimical to the standardisation and bureaucratisation required by formal regulation. In the case of homeopathy, much resistance has come from those outside of the SCAM professions. Such resistance seemingly rejects per se the notion that ‘good’ homeopathy (or SCAMs more generally) can be distinguished from ‘bad’—and, hence, the idea that state institutions should grant any form of legitimacy to such practices. By grounding our analysis in a governmentality perspective, we invite a closer consideration of the means by which homeopathy’s regulation (and its conditional acceptance by formal institutions)—a core component of its normalisation—has incited irritations, aggravations and resistances which have paradoxically helped to challenge its place in the national healthcare systems of England and France.
The authors further explain that SCAM sceptics’ initial resistance to homeopathy began to emerge in a coordinated fashion in the mid 2000s, and can best be described as a cumulative build-up of dispersed sceptic activism and campaigning on the part of a loose coalition of prominent non-state, non-official individuals, often, but not always, from outside the medical profession itself. It included high profile scientists and academics such as Edzard Ernst and David Colquhoun, and sceptic campaigning groups, such as Sense About Science (SAS), which was founded in 2002. In other words, the multifaceted nature of their campaigning and the dispersal of their targets appeared to be a reaction to the diffuse, decentred provision and regulation of homeopathy in England and the involvement of a broad range of actors ‘beyond the state’.
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I find this version of events interesting (I encourage you to read the full text of the paper) and somewhat amusing, as I hardly recognise it. The way I experienced and recall this story is roughly as follows:
- In the 1970/80s EBM had become the generally accepted norm and logic in healthcare. It had begun to generate significant, tangible advantages for the fate of suffering patients.
- Thus many areas of medicine came under scrutiny and those that were non-compliant with EBM were rightly criticised.
- From the early 1990s, I and others started to apply the principles of EBM to homeopathy (and other SCAMs).
- This soon made it obvious that homeopathy was lacking convincing evidence of efficacy.
- Now, it was merely a question of time that the regulators had to act accordingly.
- England and France happened to do this first, but, in my view, it is virtually inevitable that other countries will follow – not because of any organised activism but because ethical medicine must always follow the evidence and cannot tolerate quackery.
I disagree with the authors of the above paper; there was no coordinated resistance, cumulative build-up, activism, coalition of individuals, multifacetet campaigning to speak of. The actions that occurred were merely the inevitable consequence of the scientific evidence that emerged from the 1990s onwards. In other words, the principles of EBM were simply taking their course. The defunding is thus not unique to homeopathy but has happened (and will continue to happen) in many other areas of healthcare that do not demonstrably generate more good than harm.
The authors of the above article mention my name repeatedly and seem to imply that I assumed the role of a key activist. Interestingly, they do not cite a single of my papers, presumably because none of them can demonstrate the points they are trying to make. The truth is that, until my retirement from academia in 2012/13, my role was merely that of a researcher. The activism that did happen consisted mostly of diverse and unfunded actions of rationalists who felt that homeopathy was making a mockery of EBM.
Looking back, I am still surprised that these actions were achieved almost entirely by altruistic amateurs. I even feel a little ashamed that the vast majority of doctors seemed to care so little (and were put to shame by the amateurs) about upolding the values of EBM, the best interest of patients and the importance of medical ethics.
The JOURNAL OF BUSINESS ETHICS (I did not even know such a journal existed) recently carried a most interesting article. Here is its abstract:
Consumers spend billions of dollars per year on homeopathic products. But there is powerful evidence that these products don’t work, i.e., they are not medically effective. Should homeopathic products be for sale? I give reason for thinking that the answer is ‘no.’ It has been suggested that the sale of homeopathic products involves deception. This might be so in some cases, but the problem is simpler: it is that these products don’t do what people buy them to do. More precisely, homeopathic products don’t meet the “desire-satisfaction condition,” according to which products for sale in markets should satisfy the desires that people buy them to satisfy. I defend my view against objections, and conclude by acknowledging some of the practical difficulties of banning products people want to buy.
Allow me to introduce you to the logic of the author, Jeffrey Moriarty, in a little more detail. Essentially, he argues as follows:
- There is powerful evidence that homeopathic products don’t work, i.e., they are not medically effective. As we have discussed ad nauseam on my blog, this is certainly true.
- Thus they don’t meet the “desire-satisfaction condition,” according to which the sale of a product should satisfy the desire(s) that people buy it to satisfy. Regulators prohibit retailers from advertising in ways that cause reasonable people to have materially false beliefs. It doesn’t matter to regulators whether advertisers cause false beliefs intentionally, and therefore deceive consumers, or unintentionally, and therefore merely mislead them. The point is to prevent consumers from acting on false information; however, they acquire it.
- If a product doesn’t meet the “desire-satisfaction condition” condition, then there is a presumption against selling it. When people act on false information in markets, they are likely to make themselves worse off. We can understand how this works in terms of the satisfaction of desires. People engage in market exchanges in order to satisfy their desires. When their desires are satisfied as a result of market exchange, they are better off. You want a car that runs and seek to buy one. When you purchase the car, and it does run, you are better off. But when people act on false information, they are likely to frustrate rather than satisfy their desires. As a result, they are likely to be worse off. If the car you purchase doesn’t run, you are worse off. You spent your money on something you didn’t want.
- The products people buy should satisfy the desires they buy them to satisfy. This is the “desire-satisfaction condition” for market exchange. Transactions that reliably don’t result in desire-satisfaction are problematic. Because desires aren’t satisfied, this is evidence that value isn’t being created; the party whose desires are not satisfied is worse off. Since markets should make people better off, there is a presumption against allowing these transactions.
- The author states that his arguments also apply to other medicines and medical treatments that we have powerful reason to believe don’t work.
Jeffrey Moriatry concludes: When people purchase homeopathic products, they act on false information, and in doing so, fail to satisfy their desires. This is a sign that the purchase does not create value for them. Since market transactions should create value, there is a presumption in favor of prohibiting this transaction … we give states broad authority to decide what sorts of products can and can’t be sold, including medicines. This suggests that people generally think that banning the sale of certain products, despite the costs of doing so, is worth it. It also suggests that people think that the state uses its power competently and fairly—or at least that it doesn’t use it so incompetently and unfairly that it is better for the state not to have this power. The state would be doing nothing out of the ordinary in prohibiting the sale of homeopathic products.
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These arguments are interesting and relevant (sorry, if I have not represented them fully; I recommend reading the full article). Personally, I have never argued that the sales of homeopathics should be banned; I felt that good and responsible information is essential and would eventually reduce sales to an insignificant level. Yet, after reading this paper, I have to admit that its arguments make sense.
I’d love to hear what you think about them.
- There is no question that cancer patients deserve measures that improve their QoL.
- There is also no question that essential oils contain active ingredients.
- Yet, it is doubtful that they reach the blood stream in sufficient concentrations to have meaningful health effects.
- Much more likely is the notion that not the oils but the massage during a typical aromatherapy is the effective element of the treatment.
- In addition, we have to think of the placebo effect [which is difficult to control for in clinical trials of aromatherapy].
So, should we use aromatherapy for cancer patients?
If it makes a patient feel better, I would use it. But there are many patients who dislike to be touched/massaged; in such cases, I would not advocate it. In addition, I would try to find out whether there are other measures that are more effective for improving the QoL (e.g. an emapthetic conversation, a cup of tea, a kind gesture, a visit from a friend) of my patient.
In any case, I would not think of aromatherapy as a THERAPY. It is more pamering and TLC than a real therapy that interfers with the disease process; it has more to do with wellness that with cure. And I would certainly caution of the many specific claims made for aromaatherapy by its enthusiasts; they are usually not supported by sound evidence, they may distract from truly effective therapies, and they have nothing to do with any pharmacological effects that the essential oils may or may not have.
When I still worked as a clinician, I have looked after athletes long enough to know that they go for everything that promises to improve their performance. It is thus hardly surprising that Olympians would try all sorts of so-called alternative medicine (SCAM) regardless of whether the therapy is supported by evidence or not. Skeptics are tempted to dismiss all of SCAM for improving fitness. But is that fair? Is it true that no evidence evists for any of them?
The short answer to this question is NO.
Here I have looked at some of the possibilities and show you some of the Medline-listed papers that seem to support SCAM as a means of improving fitness:
Acupuncture
Ashwagandha
Balneology
Cupping
Ginkgo biloba
Ice
Kinesiology tape
Massage guns
Percussion massage
Sports massage
Tai massage
Vibrational massage
Yoga
Please do not mistake this for anything resembling a systematic review of the evidence; it is merely a list to give you a flavour of what is out there. And please don’t assume that the list is complete; I am sure that there is much more.
Looking at the articles that I found, one could get the impression that there is plenty of good evidence to support SCAM for improving fitness. This, however, would be wrong. The evidence for almost every of the above listed therapies is flimsy to say the least. But – as I stated already at the beginning – in my experience, this will not stop athletes to use them.
Yesterday, I was sent this OfS press release and asked to comment:
Approval of proposed new name for AECC University College UKPRN: 10000163
The Office for Students (OfS) has approved the use of the word ‘university’ in the provider’s change of name from ‘AECC University College’ to ‘Health Sciences University’.
The Higher Education and Research Act 2017 amended relevant legislation to give the OfS the power to consent to the use of the word university in a registered higher education provider’s name. In consenting to the inclusion of the word ’university’ in any name, the OfS has regard to the need to avoid names which are, or may be, confusing.1
The OfS has published guidance for registered higher education providers that wish to use either ‘university’ or ‘university college’ title as part of their name. This states that we will consult on a provider’s proposed new name and assess the extent to which the proposed name is, or may be, confusing or misleading.2
AECC University College applied to the OfS for approval to use the word university in its proposed new name ‘Health Sciences University’ in June 2023. We consulted on the provider’s proposed new name and received 98 responses.3 Considering the responses:
• We took the view that the provider’s proposed new name did not appear to be like any other registered English higher education provider’s name because of similarity that could cause potential confusion or be misleading.
• We agreed with some consultation responses which stated that the proposed name could be potentially misleading, for the following reasons:
o Several respondents raised concerns that the proposed name implies a scope of offering that does not match the reality of the provider’s offering.
o Several respondents raised concerns that the proposed name may suggest that the provider is the sole provider of health sciences provision in the region and/or the UK. Respondents stated that the proposed name offers a broader portfolio than the provider has in reality, and therefore the name is anti-competitive, given other providers may offer a broader scope of provision in the relevant disciplines.
• We concluded, however, that issues raised by respondents during the consultation are unlikely to cause any detriment or harm as they could be mitigated by the university’s requirement to comply with its legal obligations under consumer protection law. This means that the university must ensure that students have clear information to enable them to make informed decisions about whether they want to study there. Information would include, for example, what is meant by the term ‘health sciences’ and clear and visible communication regarding the breadth and depth of courses offered.
• Therefore, we decided to approve the proposed new name of ‘Health Sciences University’.
1 See https://www.legislation.gov.uk/ukpga/2017/29/part/1/crossheading/powers-in-relation-to-university title/enacted.
2 See ‘Regulatory Advice 13: How to apply for university college or university title’ available at:
www.officeforstudents.org.uk/publications/regulatory-advice-13-how-to-apply-for-university-college-and university-title/.
3 Available at: www.officeforstudents.org.uk/publications/proposed-new-name-for-aecc-university-college/.
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A few years ago, I was invited to visit the ‘AECC’ and give a lecture to its students. Here is the post I published about this weird experience:
As I said, yesterday, I was asked (by ‘The Times Higher’) to comment on the above press release. Here is the comment I provided; I hope they publish it:
The change from ‘AECC University College’ to ‘Health Sciences University’ is an intriguing construct emphasizing the academic status by using the term ‘university’, while hiding the true content of the institution: AECC stands for ‘Anglo-European College of Chiropractic‘; in other words, the institution is a school of chiropractic, a form of treatment that is as far from science as bungee jumping and has never convincingly demonstrated to generate more good than harm. I wonder what might be next – a ‘Health Science University for Pole Dancing’ perhaps?
Subsequently, the journalist came back to me with two further questions which I answered:
Q1: Do you think it is concerning that the OfS has allowed it to use this title?
A: This title will almost inevitably mislead consumers who might assume that, if they are granted university status, chiropractic must be backed by strong evidence for efficacy and safety.
Q2: What do you worry will be the consequences?
A: Patients who are misled in this way are in danger of wasting their money, of delaying their recovery, or of suffering significant harm.
The aim of this study was to assess the effectiveness of different forms of walking in reducing symptoms of depression and anxiety. A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted assessing the effects of walking on depressive and anxiety symptoms. MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), Embase, PsycINFO, Allied and Complementary Medicine Database (AMED), CINAHL, and Web of Science were searched on April 5, 2022. Two authors independently screened the studies and extracted the data. Random-effects meta-analysis was used to synthesize the data. Results were summarized as standardized mean differences (SMDs) with 95% CIs in forest plots. The risk of bias was assessed by using the Cochrane Risk of Bias tool.
This review included 75 RCTs with 8636 participants; 68 studies reported depressive symptoms, 39 reported anxiety symptoms, and 32 reported both as the outcomes. One study reported the results for adolescents and was not included in the meta-analysis. The pooled results for adults indicated that walking could significantly reduce depressive symptoms (RCTs: n=44; SMD −0.591, 95% CI −0.778 to −0.403; I2=84.8%; τ2=0.3008; P<.001) and anxiety symptoms (RCTs: n=26; SMD −0.446, 95% CI −0.628 to −0.265; I2=81.1%; τ2=0.1530; P<.001) when compared with the inactive controls. Walking could significantly reduce depressive or anxiety symptoms in most subgroups, including different walking frequency, duration, location (indoor or outdoor), and format (group or individual) subgroups (all P values were <.05). Adult participants who were depressed (RCTs: n=5; SMD −1.863, 95% CI −2.764 to −0.962; I2=86.4%; τ2=0.8929) and those who were not depressed (RCTs: n=39; SMD −0.442, 95% CI −0.604 to −0.280; I2=77.5%; τ2=0.1742) could benefit from walking effects on their depressive symptoms, and participants who were depressed could benefit more (P=.002). In addition, there was no significant difference between walking and active controls in reducing depressive symptoms (RCTs: n=17; SMD −0.126, 95% CI −0.343 to 0.092; I2=58%; τ2=0.1058; P=.26) and anxiety symptoms (14 RCTs, SMD −0.053, 95% CI −0.311 to 0.206, I2=67.7%, τ2=0.1421; P=.69).
The authors concluded that various forms of walking can be effective in reducing symptoms of depression and anxiety, and the effects of walking are comparable to active controls. Walking can be adopted as an evidence-based intervention for reducing depression and anxiety. More evidence on the effect of low-intensity walking is needed in the future.
Clinical trials of walking are encounter considerable methodological difficulties: there is no adequate placebo, for instance. Thus, such studies are often conducted against no treatment or against ‘active control’ which means that the control group receives a therapy of known effectiveness.
The former comparison is not very meaningful because it does not allow us to tell whether the effects are truly caused by walking or by some non-specific effect. The latter comparison is more rigorous but also not perfect because the patients cannot be blinded.
This means we have to accept a degree of uncertainty in estimating the benefit of walking. As walking is not expensive, not hazardous, and has many other health benefits, this caveat seems truly minor. In other words, the findings reported here are encouraging and should be accepted in clinical practice.
Yet, there is still one ‘hair in the soup’: depressed people find it often very hard to motivate themselves to do activities such as walking. Thus, compliance with this treatment might often be less than satisfactory. It might be worth researching how this obstacle can be best overcome.
Vaccine hesitancy has been defined as a continuum of attitudes, ranging from accepting vaccines with doubts to rejecting them. For good reasons, the topic has featured regularly on this blog, e.g.:
- Anthroposophic medicine and vaccine hesitancy: are there links?
- Endorsement of so-called alternative medicine (SCAM) and vaccine hesitancy among physicians
- So-called alternative medicine (SCAM) and vaccine hesitancy among physicians: findings from Germany, Finland, Portugal, and France
- Echo chambers of vaccine hesitancy and so-called alternative medicine (SCAM)
- Vaccine hesitancy and so-called alternative medicine (SCAM)
- How to reduce vaccination hesitancy?
- Reasons for parental hesitancy or refusal of childhood vaccination
- Intelligence, Religiosity, SCAM, Vaccination Hesitancy – are there links?
- The American Medical Association take a stand against chiropractors, naturopaths, or homeopaths granting medical exemptions to vaccines
- Attitudes of Vaccination-Hesitant Parents Towards So-Called Alternative Medicine (SCAM)
- Do views about so-called alternative medicine (SCAM), nature and god influence people’s vaccination intentions?
This new study aimed to explore the heterogeneity of a childhood-vaccine-hesitant group by using a person-oriented approach, i.e. latent profile analysis.
A non-representative cross-sectional sample of vaccine-hesitant Slovenians (N = 421, Mage = 35.21, 82.9% women) was used to identify differences based on their
- reliance on personal research (“self” researching instead of relying on science),
- over-confidence in knowledge,
- endorsement of conspiracy theories,
- complementary and alternative medicine,
- trust in the healthcare system.
The analysis revealed three profiles of vaccine-hesitant individuals. The most hesitant profile—vaccine rejecting—expressed the greatest reliance on personal research, expressed the highest endorsement of conspiracy theories and complementary and alternative medicine, showed moderate overconfidence in their knowledge, and expressed the highest levels of distrust in the healthcare system. Furthermore, the researchers found differences in sociodemographic structure and noted that the identified profiles differed in their attitudes regarding MMR, HPV, and Seasonal Influenza vaccinations.
The authors concluded as follows: our findings not only further confirm the heterogeneous nature of vaccine-hesitant groups but also offer critical insights for public health interventions. By acknowledging the existence of distinct profiles within the vaccine-hesitant population, strategies can be tailored to address the nuanced beliefs and attitudes of these subgroups more effectively.
- Skeptics who already express a certain level of trust in healthcare, may be most receptive to messages from medical professionals. Given that skeptics are typically older, higher-educated men, interventions could focus on leveraging their existing trust in healthcare professionals and providing detailed, evidence-based information to address their specific concerns.
- Self-directed researchers, who are characterized by high endorsement of CAM and conspiracy theories and moderate over-confidence, could benefit from interventions involving trusted community figures or CAM medicine experts who can bridge the gap between traditional and CAM perspectives. In addition, reaching out to younger women in this group through online platforms and providing credible information that counteracts misinformation could be effective.
- Conventionalists, who have the highest trust in the healthcare system and tend to include more educated individuals with a left-leaning political orientation, may respond well to public health messages that emphasize the collective benefits of vaccination. Campaigns could focus on reinforcing their positive views on the efficacy, safety, and importance of vaccines while leveraging their trust in physicians and public health institutions.
The effectiveness of targeted interventions for each specific subgroup could then also be examined, employing insights from the present study. For instance, tailored communication strategies could be tested to determine which messages and messengers are the most effective in regard to changing attitudes and behaviors within each profile.
