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

experience

1 2 3 13

When I first heard about it, I thought it was a hoax – nobody can be that daft, I felt. Then I did a bit of research and found that I had been wrong: some people evidently can be that daft and are trying to promote a new SCAM.

Yes, I am speaking of SPERM SMOOTHIES.

And it’s not even a new thing. One sperm smoothie fan boasted 2 years ago: “My immune system is far stronger than it’s ever been. I no longer catch colds or the flu — even when my children get sick from school! I have such high energy levels, feel positive and enthusiastic and have focus and clarity throughout my day whilst most parents feel tired, crave junk food and struggle with forgetfulness.”

In 2021, THE SUN reported this :

Tracy Kiss, 33, from Buckinghamshire, previously told how she put a spoonful of her best friend’s donated semen into her drink every morning in a bid to boost her immunity.

The personal trainer, who is mum to Millie and Gabrille,  has previously advocated using sperm as a facial ointment.

She spoke as celebrity facialist Chelsee Lewis claimed it actually worked to reduce wrinkles.

On her bizarre beverage concoction, Tracy said: “I’d been feeling run down and had no energy, but now I’m full of beans and my mood has improved.

“It can taste really good – depending on what my friend has been eating. My other mates think I’m strange, but I don’t give a toss.”

Tracy, who is a vegan, roped her single pal into giving her his semen. She previously told how he pops round with a fresh tub three times a week.

“I know he’s healthy, doesn’t smoke, drink or do drugs and I made him have an STI check,” she said.

“When I first approached him, he was concerned I’d use it to impregnate myself.

“But once I’d convinced him it was for my beauty regime he agreed – after all, he has a regular supply at hand!”

Tracy, a qualified nutritional adviser and personal trainer, told how she kept it in her fridge.

She mixes the semen with fruit, seeds, coconut or almond milk – but is also happy to drink it on its own.

“Every batch tastes different, depending on what he’s been eating,” she said.

“If he’s been drinking alcohol or eaten something particularly pungent like asparagus, I ask him to give me a heads up so I know not to drink it neat.

“Things like pineapple and peppermint make it taste better, but I’ll happily take it straight off a spoon usually.”

Tracy has filmed a YouTube video where she talks through her unusual remedy and explains what it tastes like.

“We look at its smoothness and texture, discuss its benefits and then I show people who I use a teaspoon to eat the sperm,” she said.

“Sperm is an awesome product and we should stop being so ridiculous about it – the health benefits have been well researched and more women and men should take advantage of it particularly as its made by our own bodies and doesn’t contain e-numbers and chemicals.”

________________________________

The question I ask myself is this: are sperm smoothies really a new SCAM or are they just a way for some strange people to get their 5 minutes of fame? I sincerely hope it is the latter.

It is not often that I publish a paper with a philosopher in a leading journal of philosophy. In fact, it is the first time, and I am rather proud of it – so much so that I must show my readers (the article is freely available via the link below and I encourage everyone to read the full text) the abstract of our article entitled WHY HOMOEOPATHY IS PSEUDOSCIENCE (Synthese (2022) 200:394):

Homoeopathy is commonly recognised as pseudoscience. However, there is, to date, no systematic discussion that seeks to establish this view. In this paper, we try to fill this gap. We explain the nature of homoeopathy, discuss the notion of pseudoscience, and provide illustrative examples from the literature indicating why homoeopathy fits the
bill. Our argument contains a conceptual and an empirical part.

In the conceptual part, we introduce the premise that a doctrine qualifies as a pseudoscience if, firstly, its proponents claim scientific standing for it and, secondly, if they produce bullshit to defend it, such that, unlike science, it cannot be viewed as the most reliable knowledge on its topic. In the empirical part, we provide evidence that homoeopathy fulfils both criteria. The first is quickly established since homoeopaths often explicitly claim scientificity.

To establish the second, we dive into the pseudo-academic literature on homoeopathy to provide evidence of bullshit in the arguments of homoeopaths. Specifically, we show that they make bizarre ontological claims incompatible with natural science, illegitimately shift the burden of proof to sceptics, and mischaracterise, cherry-pick, and misreport the evidence. Furthermore, we demonstrate that they reject essential parts of established scientific methodology and use epistemically unfair strategies to immunise their doctrine against recalcitrant evidence.

And here is our conclusion:

At the beginning of the paper, we noted that homoeopathy is commonly named one of the prototypical pseudosciences. However, there has been, to date, no comprehensive discussion as to what makes it a pseudoscience. Moreover, the problem is not trivial since the most well-known and influential demarcation criteria, such as Popper’s falsifiability criterion and Kuhn’s problem-solving criterion, cannot account for it, as we have shown. We have tried to fill this research gap using a novel bullshitology-based approach to the demarcation problem. Following this approach, we have argued that homoeopathy should be regarded as pseudoscience because its proponents claim scientific standing for it and produce argumentative bullshit to defend it, thus violating important epistemic standards central to science.

The tales of Kate Moss’s excesses are legendary. Sex and drugs and rock ‘n’ roll have always been an integral part of the supermodel’s life. Stories of wild behavior, random sexual encounters, and copious drug use seemed endless. Now, it seems she is adding a new element to her tumultuous career:

Quackery.

The supermodel is the latest in the long line of VIPs jumping on the quackery bandwagon by marketing her very own brand of over-priced nonsense. She was reported to have worked with Victoria Young, a homeopath and “spiritual guide”, on the products. There’s a Dawn Tea at £20 for 25 tea bags, “inspired by Kate’s English garden” – “With ingredients like hibiscus, rosemary, and nettle leaf, this first step of the Dawn Ritual gently energizes and strengthens the body”. There’s also a Dusk Tea.

There is also a 100ml bottle called Sacred Mist for £120. It is described as “a unique eau de parfum blended with essential oils for the body and surroundings.” There’s a 30ml bottle for £105 called Golden Nectar, which is pro-collagen. CBD oil drops to “holistically support body, mind, and soul”. A 50ml face cream for £95. A 100ml face cleanser for £52.

The website of Moss’ new enterprise claims that “COSMOSS draws on the extraordinary life experience of Kate Moss — someone whose career and image has touched on and influenced so many others and yet has taken her own, rich journey of transformation gradually and privately. COSMOSS is a celebration of every day exactly as it is, with all its imperfections. Each product has been meticulously crafted with wellbeing in mind, using potent, natural substances. Each ritual opens a door to balance, restoration, and love; each fragrance and infusion recentres and completes. COSMOSS is self-care created for life’s modern journeys to make them beautiful, mesmerising and magical.”

In a far cry from her past, Moss explained: “I’ve been meditating, doing yoga, just being much healthier. All the stuff that can make you feel more grounded and balanced.”

Personally, I am glad to hear that Kate is off cocaine and now into other, less harmful ‘natural substances’. Her customers wellbeing might not improve, but I suspect her bank account might.

Anyone who has followed this blog for a while will know that advocates of so-called alternative medicine (SCAM) are either in complete denial about the risks of SCAM or they do anything to trivialize them. Here is a dialogue between a SCAM proponent (P) and a scientist (S) that is aimed at depicting this situation. The conversation is fictitious, of course, but it is nevertheless based on years of experience in discussing these issues with practitioners of various types of SCAM. As we shall see, the arguments turn out to be perfectly circular.

P: My therapy is virtually free of risks.

S: How can you be so sure?

P: I am practicing it for decades and have never seen a single problem.

S: That could have several reasons; perhaps the patients who experience problems did simply not come back.

P: I find this unlikely.

S: I don’t, and I know of reports where patients had serious complications after the type of SCAM you practice.

P: These are isolated case reports. They do not amount to evidence.

S: How do you know they are isolated?

P: They must be isolated because, in the many clinical trials of my therapy available to date, you will not find any evidence of serious adverse effects.

S: That is true, but it has been repeatedly shown that these trials regularly fail to mention side effects altogether.

P: That’s because there aren’t any.

S: Not quite, clinical trials should always mention adverse effects, and if there were none, they should mention this too.

P: So, you admit that you have no evidence that my therapy causes adverse effects.

S: The thing is, I don’t need such evidence. It is you, the practitioners of this therapy, who should provide evidence that your treatments are safe.

P: We did! The complete absence of reports of side effects constitutes that evidence.

S: Except, there is some evidence. I already told you that there are several case reports of serious problems.

P: But case reports are anecdotes; they are no evidence.

S: Look, here is a systematic review of all the case reports. You cannot possibly deny that this is a concern.

P: It’s still merely a bunch of anecdotes, nothing more.

S: Only because your profession does nothing about it.

P: What do you think we need to do about it?

S: Like other professions, you need to systematically record adverse effects.

P: How would that help?

S: It would give us a rough indication of the size and severity of the problem.

P: This sounds expensive and complicated to organize.

S: Perhaps, but it is necessary if you want to be sure that your therapy is safe.

P: But we are sure already!

S: No, you believe it, but you don’t know it.

P: You are getting on my nerves with your obsession. Don’t you know that the true danger in healthcare is the adverse effects of pharmaceutical drugs?

S: But these drugs are also effective.

P: Are you saying my therapy isn’t?

S: What I am saying is that the drugs you claim to be dangerous do more good than harm, while this is not at all clear with your SCAM.

P: To me, that is very clear. My therapy helps many and harms nobody!

S: How do you know that it harms nobody?

 

 

… At this point, we have gone full circle and we can re-start this conversation from its beginning.

 

 

There are many patients in general practice with health complaints that cannot be medically explained. Some of these patients attribute their problems to dental amalgam.

This study examined the cost-effectiveness of the removal of amalgam fillings in patients with medically unexplained physical symptoms (MUPS) attributed to amalgam compared to usual care, based on a prospective cohort study in Norway.

Costs were determined using a micro-costing approach at the individual level. Health outcomes were documented at baseline and approximately two years later for both the intervention and the usual care using EQ-5D-5L. Quality-adjusted life year (QALY) was used as the main outcome measure. A decision analytical model was developed to estimate the incremental cost-effectiveness of the intervention. Both probabilistic and one-way sensitivity analyses were conducted to assess the impact of uncertainty on costs and effectiveness.

In patients who attributed health complaints to dental amalgam and fulfilled the inclusion and exclusion criteria, amalgam removal was associated with a modest increase in costs at the societal level as well as improved health outcomes. In the base-case analysis, the mean incremental cost per patient in the amalgam group was NOK 19 416 compared to the MUPS group, while the mean incremental QALY was 0.119 with a time horizon of two years. Thus, the incremental costs per QALY of the intervention were NOK 162 680, which is usually considered to be cost-effective in Norway. The estimated incremental cost per QALY decreased with increasing time horizons, and amalgam removal was found to be cost-saving over both 5 and 10 years.

The authors concluded that this study provides insight into the costs and health outcomes associated with the removal of amalgam restorations in patients who attribute health complaints to dental amalgam fillings, which are appropriate instruments to inform health care priorities.

The group sizes were 32 and 28 respectively. This study was thus almost laughably small and therefore cannot lead to firm conclusions of any type. In this contest, a recent systematic review might be relevant; it concluded as follows:

On the basis of the available RCTs, amalgam restorations, if compared with resin-based fillings, do not show an increased risk for systemic diseases. There is still insufficient evidence to exclude or demonstrate any direct influence on general health. The removal of old amalgam restorations and their substitution with more modern adhesive restorations should be performed only when clinically necessary and not just for material concerns. In order to better evaluate the safety of dental amalgam compared to other more modern restorative materials, further RCTs that consider important parameters such as long and uniform follow up periods, number of restorations per patient, and sample populations representative of chronic or degenerative diseases are needed.

Similarly, a review of the evidence might be informative:

Since more than 100 years amalgam is successfully used for the functional restoration of decayed teeth. During the early 1990s the use of amalgam has been discredited by a not very objective discussion about small amounts of quicksilver that can evaporate from the material. Recent studies and reviews, however, found little to no correlation between systemic or local diseases and amalgam restorations in man. Allergic reactions are extremely rare. Most quicksilver evaporates during placement and removal of amalgam restorations. Hence it is not recommended to make extensive rehabilitations with amalgam in pregnant or nursing women. To date, there is no dental material, which can fully substitute amalgam as a restorative material. According to present scientific evidence the use of amalgam is not a health hazard.

Furthermore, there is evidence that the removal of amalgam fillings is not such a good idea. One study, for instance, showed that the mercury released by the physical action of the drill, the replacement material and especially the final destination of the amalgam waste can increase contamination levels that can be a risk for human and environment health.

As dental amalgam removal does not seem risk-free, it is perhaps unwise to remove these fillings at all. Patients who are convinced that their amalgam fillings make them ill might simply benefit from assurance. After all, we also do not re-lay electric cables because some people feel they are the cause of their ill-health.

What motivates a doctor to work as an integrative medical practitioner? This is a question I asked myself often. Despite trying to find answers through several methods, I was not very successful. The question does not seem well-researched at all. Here is what I found so far:

Our own 1996 survey of GPs participating in a course at Exeter that was aimed at familiarizing them with so-called alternative medicine (SCAM) found that the main perceived advantage of SCAM, apart from the potential intrinsic value of the techniques themselves, was the time available for establishing a good therapeutic relationship with the patient.

A UK survey from 2001 suggested that doctors are motivated by issues ranging from feeling a responsibility to respond to their patients’ interests and needs to developing “another string to their bow.” Some are attracted to its study in its own right, others by a wish to focus some of their energy away from conventional medical practice, which they may find stressful and unfulfilling. Doctors studying complementary and alternative medicine often call on different personality traits and report a variety of positive benefits from training, including welcoming the opportunity to engage their feelings, trust their intuition, and enjoy therapeutic touch. Comments from attendees at one homoeopathic course were “I started to enjoy seeing patients again,” “Training had improved my conventional history taking,” and “Having another approach made treating heart-sink patients easier.”

A German focus group in 2008 with 17 GP suggested that scientific evidence and patient preference were the main criteria used by these doctors in deciding whether to apply a SCAM or not.

An interview study published in 2011 with Australian doctors provided some details. The researchers invited 43 doctors to participate. Twenty-three agreed to take part in either a face-to-face (n = 7) or telephone (n = 16) interviews. Here is the passage entitled “Motivations to work as an integrative medical practitioner” from their paper:

‘Family of origin health beliefs and practices’ were an important influence on the doctors’ philosophical approach and their decisions to work as an integrative medical practitioner.

…When I grew up it was not uncommon that I would see my aunties and uncles preparing all sorts of things. My auntie laying me on her lap and putting breast milk in my ear and drinking chamomile tea for a sore belly…there was lots of things that influenced me. (Female, 23 years in practice)

…There is a long tradition in [country of origin] of using a herbalist. I heard things from my mum and my grandma and those ideas were there. (Male, 16 years in practice)

The ‘personal or close family illness experiences’ reported by doctors were also influential in motivating them to practice integrative medicine. These experiences included non-conventional approaches to health and illness and the use of CAM as treatment modalities.

…I had my own illness – depression and a very bad back. I’d been on medication for years and I got sick of taking medications and I was given a prognosis of chronic illness with relapses and I really didn’t like it. So I started to look elsewhere and that took me in to the world of mind-body medicine. (Female, 24 years in practice)

Other doctors cited ‘professional experiences’, often early in their careers, of different theoretical approaches to medicine as being a powerful stimulus to practice integrative medicine. These included being inspired by a medical lecturer, an interesting, usually non-conventional experience during a placement as a medical student, and professional experiences of CAM modalities during their residency or early medical career.

…We had this subject Medical Studies 3, where there was a discussion of the French fur trapper in the Yukon who had shot himself in the stomach and the local doctor who was experimenting with various emotional states. There was just that sort of moment, of thinking, that’s the sort of area that I want to work in. (Male, 26 years in practice)

…I found myself doing a clinical attachment at a hospital in Switzerland that used integrated medicine, they had a course and I thought I’ll just do this for interest. I came in contact with an Indian person who did homeopathy and I found his stories quite interesting. (Male, 22 years in practice)

‘Dissatisfaction with the conventional approach to medicine’, which was perceived to be too illness focused or commercialized, was also cited by some doctors as a precursor to adopting an integrative approach to medical practice.

…More and more I’m realising that medicine is a personalised thing. We need to learn the art of treating people individually rather than en masse as a sick lung or a sick toe or a sick whatever because it doesn’t work like that. (Male, 22 years in practice)

…Medicine was hijacked by the market; i.e.: big pharmaceutical companies. And they have seduced the government, the colleges, the universities, general practice, everybody. GPs, in my opinion, have been deskilled. (Female, 19 years in practice).

An Australian survey from 2021 suggested that GPs were attracted to SCAM because they thought it to be relatively safe and effective, offering additional, holistic benefits to patients.

___________________________

Collectively these investigations suggest that doctors’ motivation to work as integrated medical practitioners vary greatly. They seem to include:

  • positive evidence for SCAM’s safety and efficacy,
  • having the time to establish a good therapeutic relationship,
  • wanting to use all therapeutic options,
  • dissatisfaction with conventional medicine,
  • patient preferences,
  • wanting to practice in a more human and holistic way,
  • personal and professional experiences.

But surely, there are other factors as well (from my personal experience in dealing with doctors of integrative medicine, I could list a few that are less than flattering). In any case, I would be most interested to hear your thought and read more published evidence that you might know about.

This systematic review and meta-analysis of clinical trials were performed to summarize the evidence of the effects of Urtica dioica (UD) consumption on metabolic profiles in patients with type 2 diabetes mellitus (T2DM).

Eligible studies were retrieved from searches of PubMed, Embase, Scopus, Web of Science, Cochrane Library, and Google Scholar databases until December 2019. Cochran (Q) and I-square statistics were used to examine heterogeneity across included clinical trials. Data were pooled using a fixed-effect or random-effects model and expressed as weighted mean difference (WMD) and 95% confidence interval (CI).

Among 1485 citations, thirteen clinical trials were found to be eligible for the current metaanalysis. UD consumption significantly decreased levels of fasting blood glucose (FBG) (WMD = – 17.17 mg/dl, 95% CI: -26.60, -7.73, I2 = 93.2%), hemoglobin A1c (HbA1c) (WMD = -0.93, 95% CI: – 1.66, -0.17, I2 = 75.0%), C-reactive protein (CRP) (WMD = -1.09 mg/dl, 95% CI: -1.64, -0.53, I2 = 0.0%), triglycerides (WMD = -26.94 mg/dl, 95 % CI = [-52.07, -1.82], P = 0.03, I2 = 90.0%), systolic blood pressure (SBP) (WMD = -5.03 mmHg, 95% CI = -8.15, -1.91, I2 = 0.0%) in comparison to the control groups. UD consumption did not significantly change serum levels of insulin (WMD = 1.07 μU/ml, 95% CI: -1.59, 3.73, I2 = 63.5%), total-cholesterol (WMD = -6.39 mg/dl, 95% CI: -13.84, 1.05, I2 = 0.0%), LDL-cholesterol (LDL-C) (WMD = -1.30 mg/dl, 95% CI: -9.95, 7.35, I2 = 66.1%), HDL-cholesterol (HDL-C) (WMD = 6.95 mg/dl, 95% CI: -0.14, 14.03, I2 = 95.4%), body max index (BMI) (WMD = -0.16 kg/m2, 95% CI: -1.77, 1.44, I2 = 0.0%), and diastolic blood pressure (DBP) (WMD = -1.35 mmHg, 95% CI: -2.86, 0.17, I2= 0.0%) among patients with T2DM.

The authors concluded that UD consumption may result in an improvement in levels of FBS, HbA1c, CRP, triglycerides, and SBP, but did not affect levels of insulin, total-, LDL-, and HDL-cholesterol, BMI, and DBP in patients with T2DM.

Several plants have been reported to affect the parameters of diabetes. Whenever I read such results, I cannot stop wondering whether this is a good or a bad thing. It seems to be positive at first glance, yet I can imagine at least two scenarios where such effects might be detrimental:

  • A patient reads about the antidiabetic effects and decides to swap his medication for the herbal remedy which is far less effective. Consequently, the patient’s metabolic control is insufficient.
  • A patient adds the herbal remedy to his therapy. Consequently, his blood sugar drops too far and he suffers a hypoglycemic episode.

My advice to diabetics is therefore this: if you want to try herbal antidiabetic treatments, please think twice. And if you persist, do it only under the close supervision of your doctor.

WARNING: SATIRE

This is going to be a very short post. Yet, I am sure you agree that my ‘golden rules’ encapsulate the collective wisdom of so-called alternative medicine (SCAM):

  1. Conventional treatments are dangerous
  2. Conventional doctors are ignorant
  3. Natural remedies are by definition good
  4. Ancient wisdom knows best
  5. SCAM tackles the roots of all health problems
  6. Experience trumps evidence
  7. People vote with their feet (SCAM’s popularity and patients’ satisfaction prove SCAM’s effectiveness)
  8. Science is barking up the wrong tree (what we need is a paradigm shift)
  9. Even Nobel laureates and other VIPs support SCAM
  10. Only SCAM practitioners care about the whole individual (mind, body, and soul)
  11. Science is not yet sufficiently advanced to understand how SCAM works (the mode of action has not been discovered)
  12. SCAM even works for animals (and thus cannot be a placebo)
  13. There is reliable evidence to support SCAM
  14. If a study of SCAM happens to yield a negative result, it is false-negative (e.g. because SCAM was not correctly applied)
  15. SCAM is patient-centered
  16. Conventional medicine is money-orientated
  17. The establishment is forced to suppress SCAM because otherwise, they would go out of business
  18. SCAM is reliable, constant, and unwavering (whereas conventional medicine changes its views all the time)
  19. SCAM does not need a monitoring system for adverse effects because it is inherently safe
  20. SCAM treatments are individualized (they treat the patient and not just a diagnostic label like conventional medicine)
  21. SCAM could save us all a lot of money
  22. There is no health problem that SCAM cannot cure
  23. Practitioners of conventional medicine have misunderstood the deeper reasons why people fall ill and should learn from SCAM

QED

I am sure that I have forgotten several important rules. If you can think of any, please post them in the comments section.

This paper is an evaluation of the relationship between chiropractic spinal manipulation and medical malpractice. The legal database VerdictSearch was queried using the terms “chiropractor” OR “spinal manipulation” under the classification of “Medical Malpractice” between 1988 and 2018. Cases with chiropractors as defendants were identified. Relevant medicolegal characteristics were obtained, including legal outcome (plaintiff/defense verdict, settlement), payment amount, nature of plaintiff claim, and type and location of the alleged injury.

Forty-eight cases involving chiropractic management in the US were reported. Of these, 93.8% (n = 45) featured allegations involving spinal manipulation. The defense (practitioner) was victorious in 70.8% (n = 34) of cases, with a plaintiff (patient) victory in 20.8% (n = 10) (mean payment $658,487 ± $697,045) and settlement in 8.3% (n = 4) (mean payment $596,667 ± $402,534).

Over-aggressive manipulation was the most frequent allegation (33.3%; 16 cases). A majority of cases alleged neurological injury of the spine as the reason for litigation (66.7%, 32 cases) with 87.5% (28/32) requiring surgery. C5-C6 disc herniation was the most frequently alleged injury (32.4%, 11/34, 83.3% requiring surgery) followed by C6-C7 herniation (26.5%, 9/34, 88.9% requiring surgery). Claims also alleged 7 cases of stroke (14.6%) and 2 rib fractures (4.2%) from manipulation therapy.

The authors concluded that litigation claims following chiropractic care predominately alleged neurological injury with consequent surgical management. Plaintiffs primarily alleged overaggressive treatment, though a majority of trials ended in defensive verdicts. Ongoing analysis of malpractice provides a unique lens through which to view this complicated topic.

The fact that the majority of trials ended in defensive verdicts does not surprise me. I once served as an expert witness in a trial against a UK chiropractor. Therefore, I know how difficult it is to demonstrate that the chiropractic intervention – and not anything else – caused the problem. Even cases that seem medically clear-cut, often allow reasonable doubt vis a vis the law.

Apologists will be quick and keen to point out that, in the US, there are many more successful cases brought against real doctors (healthcare professionals who have studied medicine). They are, of course, correct. But, at the same time, they miss the point. Real doctors treat real diseases where the outcomes are sadly often not as hoped. Litigation is then common, particularly in a litigious society like the US. Chiropractors predominantly treat symptoms like back troubles that are essentially benign. To create a fair comparison of litigations against doctors and chiros, one would therefore need to account for the type and severity of the conditions. Such a comparison has – to the best of my knowledge – not been done.

What has been done, however – and I did previously report about it – are comparisons between chiros, osteos, and physios (which seems to be a more level playing field). They show that complaints against chiros top the bill.

Horticultural therapy (HT)?

What on earth is that?

Don’t worry, it was new to me too and I first thought of the treatment of plants.

HT is said to be a “time-proven practice. The therapeutic benefits of garden environments have been documented since ancient times. In the 19th century, Dr. Benjamin Rush, a signer of the Declaration of Independence and recognized as the “Father of American Psychiatry,” was first to document the positive effect working in the garden had on individuals with mental illness. In the 1940s and 1950s, rehabilitative care of hospitalized war veterans significantly expanded acceptance of the practice. No longer limited to treating mental illness, horticultural therapy practice gained in credibility and was embraced for a much wider range of diagnoses and therapeutic options. Today, horticultural therapy is accepted as a beneficial and effective therapeutic modality. It is widely used within a broad range of rehabilitative, vocational, and community settings. Horticultural therapy techniques are employed to assist participants to learn new skills or regain those that are lost. Horticultural therapy helps improve memory, cognitive abilities, task initiation, language skills, and socialization. In physical rehabilitation, horticultural therapy can help strengthen muscles and improve coordination, balance, and endurance. In vocational horticultural therapy settings, people learn to work independently, problem solve, and follow directions. Horticultural therapists are professionals with specific education, training, and credentials in the use of horticulture for therapy and rehabilitation. Read the formal definition of the role of horticultural therapists.”

As always, the question is DOES IT WORK?

This systematic review and meta-analysis aimed to evaluate HT for general health in older adults. Electronic databases as well as grey literature databases, and clinical trials registers were searched from inception to March 2021. Randomized controlled trials (RCTs), quasi-RCTs (QRCTs), and cohort studies about HT for adults aged over 60 were included in this review. Outcome measures were physical function, quality of life, BMI, mood tested by self-reported questionnaire and the expression of the immune cells.

Fifteen studies (thirteen RCTs and two cohort studies) involving 1046 older participants were included. Meta-analysis showed that HT resulted in better quality of life (MD 2.09, 95% CI [1.33, 2.85], P<0. 01) and physical function (SMD 0.82, 95% [0.36, 1.29], P<0.01) compared with no-gardener; the similar findings showed in BMI (SMD -0.30, 95% [-0.57, -0.04], P = 0.02) and mood tested by self-reported questionnaire (SMD 2.80, 95% CI [1.82, 3.79], P<0. 01). And HT might be beneficial for blood pressure and immunity, while all the evidence was moderate-quality judged by GRADE.

The authors concluded that HT may improve physical function and quality of life in older adults, reduce BMI and enhance positive mood. A suitable duration of HT may be between 60 to 120 minutes per week lasting 1.5 to 12 months. However, it remains unclear as to what constitutes an optimal recommendation.

I have considerable problems with this review and its conclusion:

  • It is simply untrue that there were 13 RCTs; several of these studies were clearly not randomized.
  • Most of the studies are of very poor quality. For instance, they often did not make the slightest attempt to control for non-specific effects, yet they concluded that the observed outcome was a specific effect of HT.

My biggest problem does, however, not relate to methodological issues. My main issue with this paper is one of definition. What is a ‘therapy’ and what not? If we call a bit of gardening a ‘therapy’ are we not descending to the level of those who call a bit of shopping ‘retail therapy’? To put it differently, is HT superior to retail therapy? And do we need RCTs to answer this question?

What is wrong with encouraging people who like gardening to just do it? I, for instance, like drumming; but I do not believe we need a few RCTs to prove that it is healthy. Not every past-time or hobby that makes you feel good is a therapy and needs to be scrutinized as such.

 

 

1 2 3 13
Subscribe to new posts

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted but you must tick the box: “Save my name, email, and website in this browser for the next time I comment.”

The most recent comments from all posts can be seen here.

Archives
Categories