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

malpractice

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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!

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.

Guest post by Ken McLeod

On 07 June 2022, we published an article warning readers of the planned visit to the UK of health crank Barbara O’Neill, ‘A residential health programme that poses “a risk to the health and safety of members of the public.” ‘ We referred to the Prohibition Order that the New South Wales Health Care Complaints Commission has imposed on her:

‘The Commission is satisfied that Mrs O’Neill poses a risk to the health and safety of members of the public and therefore makes the following prohibition order:

Mrs O’Neill is permanently prohibited from providing any health services, as defined in s4 Of the Health Care Complaints Act 1993, whether in a paid or voluntary capacity.’

We showed that O’Neill remains undaunted by such mere technicalities and continues to spruik her nostrums and misinformation, such as that planned for Manna House, Stoke-on-Trent.

One reader did a little bit of digging into O’Neill’s lectures and found something that should alarm anyone; her advocacy of asbestosform Yoni Stones for ‘Balancing Your Hormones.’

So what are ‘Yoni Stones?’ and ‘Why should we be worried?’ we hear you ask. Good questions, so here we go.

0. BACKGROUND:

According to promoters in alternative health industries, ‘Yoni stones,’ also known as ‘Yoni Eggs’ are ‘semi – precious stones carved into the shape of eggs that can be inserted into a woman’s womb space for vaginal wall tightening and energetic cleansing. Yoni Eggs have been used for many decades by the most in-tuned women who know that keeping good vaginal wellness is keeping universal wellness. The more in-tuned a woman is in her femininity the better all her relations will be.’ 1

1. PROMOTION AND SALE:

The following are examples of the promotion and sale of Yoni stones and showing how wrong and dangerous they are.

1.1 ‘La Loba’

A Google search found hundreds of retailers selling them, such as ‘La Loba’ 2 whose website does do not give an address, but are located on the Gold Coast Australia. La Loba sells nephrite jade eggs like this:

La Loba claim that ‘GIA certified means that it’s certified by the Gemological institute of America to be that specific stone. So you know it’s a real stone that is high quality.’ La Loba makes several claims of therapeutic benefit, like:

‘Yoni Eggs Physical Benefits Pelvic Floor Health Assists with incontinence Increases lubrication Builds sensitivity Helps improve Libido Can be used to prepare for childbirth and to heal post childbirth Helps to prevent and improve prolapse Balances hormones by increasing blood flow to the Yoni Increases orgasmic pleasure for yourself and your partner Spiritual Benefits Healing properties of the chosen crystal are absorbed Builds connection with your Yoni Helps one work through any trauma/stagnant energy held… ‘

 

Despite the claims of therapeutic benefits, ‘La Loba’ did not display any regulatory approval from the Australian Therapeutic Goods Administration or US Federal Drug Administration, so we can take it as read that Yoni Stones have not been assessed for safety.

1.2 Barbara O’Neill

The most prominent promoter of Yoni Stones is Barbara O’Neill, of Misty Mountain Lifestyle Retreat, of Bellbrook, New South Wales.

The internet, especially YouTube, is alive with hundreds of her videos promoting all sorts of quackery, but today we can limit ourselves to the dozens of videos in which she promotes Yoni Stones, such as the video of Barbara O’Neill conducting a lecture at Living Springs Alabama, USA. This video 5 ‘Balancing Your Hormones’ has been viewed 43,636 times since it was first published on 3 May 2022.

From the video:

In that video, Barbara O’Neill makes claims that are of concern. From the transcript,6 at 00:44:31, she recommends ‘Yoni Stones,’ and at 00:44:44 ‘… ideally, they’re made out of nephrite.’ (See the above screencap of her whiteboard presentation, bottom left-hand corner.) In the transcript she advises that women should insert them daily for several hours at a time over several months, even years. O’Neill describes Yoni Stones at 00:44:35 in the transcript: “The Chinese dynasty developed Yoni stones to help the young concubines be sexually toned for the emperor. But they’re very popular today, and ideally, they’re made out of nephrite. Jade nephrite. Jade is like a green marble. The nephrite jade is heavy and as you’ll see why that’s important in a minute. But it’s also a smooth marble, so there are no crevices.”

There are several falsehoods in this:

1.2.1 There were many dynasties in Imperial China, but none of them were named ‘The Chinese Dynasty.’

1.2.2 No Imperial Chinese dynasty developed Yoni Stones. It’s marketing hype designed to dupe the gullible. Obstetrician -Gynaecologist Dr Jennifer Gunter 7 and archaeologist Professor Sarah Parcak 8 researched that claim by conducting a search of the online databases of four major Chinese art and archaeology collections in the United States. They identified more than 5000 jade objects viewable in online databases. They found that no vaginal jade eggs were identified, and concluded that:

“No evidence was found to support the claim that vaginal jade eggs were used for any indication in ancient Chinese culture.” 9

1.2.3 As for O’Neill’s claim that there are no crevices and are therefore safe, O’Neill says in the transcript at 00:45:13 ‘….There are two holes in the bottom (of the Yoni Stone) so that a woman can insert dental floss for easy extraction….’ So crevices are out but holes are OK?

The Cleveland Health Clinic published an article 10 on July 30, 2021, by Obstetrician – Gynaecologist Dr Suchetha Kshettry, MD, ‘Think Twice Before Putting a Yoni Egg in Your Vagina. She says that ‘Gemstones like jade and onyx are semi-porous, which means there’s space for bacteria to take up residence within them. Semi-porous materials are difficult to fully clean, too, meaning that bacteria may stick around and fester.’ She listed the following hazards:

Ø Persistent bacterial infections;

Ø Irritation, scratches, tears;

Ø Damage to pelvic floor muscles; Ø toxic shock syndrome that can lead to serious health issues and even death.

Dr Kshettry makes it clear that there is no benefit.

That is supported by Obstetrician -Gynaecologist Dr Jennifer Gunter, who has written that Yoni stones do not balance hormones and have all the risks that Dr Kshettry listed above. 11

Further, California officials prosecuted Gwyneth Paltrow and her company Goop for making the same claims as O’Neill. In an out-of-court settlement, Paltrow’s company agreed to pay $US145,000 ($202,000) in civil penalties. 12

1.2.4. More concerning, nephrite jade is notorious as a dangerous asbestiform prismatic tremolite, a mineral composed of microcrystalline tremolite asbestos. Nephrite is a variety of the calcium, magnesium, and iron-rich amphibole minerals tremolite or actinolite, aggregates of which also make up one form of asbestos. The chemical formula for nephrite is Ca2(Mg, Fe)5Si8O22(OH)2. It is one of two different mineral species called jade. In layman’s terms it is ‘asbestos’ and we would think that it is therefore carcinogenic. Strangely enough, while there is plenty of research on the consequences of inhaling asbestos, there seems to be little or no research on the consequences of inserting it into vaginas.

That may be because scientists thought that it was not a productive area of research because they thought nobody would be stupid enough to do that. (How wrong they were.) Nevertheless, in the absence of definitive research showing that inserting asbestos into vaginas is perfectly safe, promoting that is incredibly irresponsible.

All we could find on the subject was the limited research which examined the dangers to people shaping nephrite jade asbestos:

1.2.4.1. Yang HY, Shie RH, Chen PC. Carving of non-asbestiform tremolite and the risk of lung cancer: a follow-up mortality study in a historical nephrite processing cohort. Occup Environ Med. 2013 Dec;70(12):852-7. doi: 10.1136/oemed-2013-101404. Epub 2013 Sep 18. PMID: 24142973; PMCID: PMC3841744. 13

1.2.4.1.1. The researchers found that nephrite processing led to a significantly increased risk of lung cancer.

1.2.4.2. Bailey et al, ‘The Asbestiform and Prismatic Mineral Growth Habit and Their Relationship to Cancer Studies – A Pictorial Presentation.’ 14

If anyone can find research on the effects of inserting asbestos-form Yoni Stones into vaginas, please let us know in the comments.

2. CONCLUSIONS:

2.1 As if the risks of persistent bacterial infections, irritation, scratches, tears, damage to pelvic floor muscles, toxic shock syndrome, serious health issues and death were not bad enough, Barbara O’Neill’s and other health gurus’ and retailers’ recommendations to insert asbestos stones into vaginas for extended lengths of time is reckless and dangerous. And there is no therapeutic benefit in the use of Yoni Stones.

But that’s Standard Operating Procedure in Alt-Med, so that’s all right then.

So what would health regulators make of this? Should they issue a Public Warning to all users, processors, manufacturers, importers and retailers? Watch this space.

1 https://www.yonieggs.com/

2 https://laloba.com.au/collections/yoni-eggs

3 https://laloba.com.au/collections/yoni-eggs/products/nephrite-jade-eggs?_pos=1&_sid=ab4fad37e&_ss=r

4 https://laloba.com.au/blogs/resources

5https://www.youtube.com/watch?v=z7uATPC-7CY. A backup copy is available on request.

6 Transcript is available at https://www.dropbox.com/s/gwdncg5iwx3a31g/Balancing%20Your%20Hormones%20-%20Barbara%20O%27Neill-%203%20May%202022.mp4-transcript%20%281%29.docx?dl=0

7 https://en.wikipedia.org/wiki/Jen_Gunter

8 https://en.wikipedia.org/wiki/Sarah_Parcak

9 “Vaginal Jade Eggs: Ancient Chinese Practice or Modern Marketing Myth?” Gunter, Jennifer MD*; Parcak, Sarah PhD, Female Pelvic Medicine & Reconstructive Surgery: 1/2 2019 – Volume 25 – Issue 1 – p 1-2, published in Urogynecology – Official Journal of the American Urogynecologic Society. https://journals.lww.com/fpmrs/Abstract/2019/01000/Vaginal_Jade_Eggs__Ancient_Chinese_Practice_or.1.aspx

10 https://health.clevelandclinic.org/are-yoni-eggs-safe/

11 https://drjengunter.com/2017/01/17/dear-gwyneth-paltrow-im-a-gyn-and-your-vaginal-jade-eggs-are-a-bad-idea/

12 https://www.smh.com.au/lifestyle/health-and-wellness/goop-settles-lawsuit-over-purported-benefits-of-jade-eggs-20180906-p5021h.html

13 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3841744/

14 Published 2006. Available on request.

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.”

In a previous post, I explained that anthroposophic education was founded by Steiner in 1919 to serve the children of employees of the Waldorf-Astoria cigarette factory in Stuttgart, Germany. Pupils of Waldorf or Steiner schools, as they are also frequently called, are encouraged to develop independent thinking and creativity, social responsibility, respect, and compassion.

Waldorf schools implicitly infuse spiritual and mystic concepts into their curriculum. Like some other alternative healthcare practitioners – for instance, doctors promoting integrative medicine, chiropractors, homeopaths, and naturopaths – doctors of anthroposophic medicine tend to advise against childhood immunizations. For this and other reasons, Waldorf schools have long attracted criticism.

Now it has been reported that the district government of Münster has withdrawn the school permit of a Waldorf school in Rheine, Germany, because of “serious deficiencies in the teaching operation”. For the 71 children, school operation ends with the start of the fall vacations at the beginning of October, as the district government announced on Tuesday. Already since the end of 2020 there had been numerous complaints. The school board had not succeeded in eliminating the deficiencies, a proper operation is currently and prospectively not guaranteed.

The list of problems described by the district government is long: there were repeated violations in the health protection of children. A spokesman for the district government said that there had been massive and repeated violations of Corona’s protective measures. In addition, there was a risk of accidents in the playground. The school board had also been unable to stop the misconduct of individual teachers, the district government criticized. “In addition, there is an insufficient supply of teachers, school organizational deficits and a massively disturbed school peace,” it said.

In the end, the basis of trust required for continued operation of the school was no longer given, so the school permit had to be revoked for the sake of the children. “This is an absolutely exceptional case,” the spokesman said. It is presumably the first case under the jurisdiction of the Münster district government, he added.

 

 

Le Figaro reported that France’s medical appointment booking service ‘Doctolib’ is being accused of promoting so-called alternative medicine (SCAM) on its platform. “Measures will be taken soon. Several options are on the table, we do not exclude anything,” announced Doctolib after declaring during the day on its Twitter account the immediate suspension of some profiles.

Health professionals and patients have been criticizing the platform for allowing its users to make appointments with practitioners claiming to be naturopaths and some offering dangerous quackery. Naturopathy is not recognized in France and is sometimes considered to be linked to charlatanism.

A member of the office for the control of conspiracies, Tristan Mendès France, had found a practitioner promoting urine therapy via Doctolib. “The presence of these individuals on a service that puts patients and health professionals in touch with each other gives them totally unjustified credit and endorsement,” stated a Twitter account aimed at informing “about the dangers of certain pseudo-alternatives in terms of health and nutrition”.

Amongst the questioned profiles were the naturopaths Thierry Casasnovas and Irène Grosjean, two influential personalities in the naturopathic world who are discredited in the health world. “We would like to point out that it is impossible for a patient to make an [appointment] on Doctolib in a practitioner not referenced by the Ministry of Health, without having expressly sought to do so,” Doctolib defended its position stating that it would proceed to checks on practitioners “whose actions would be dangerous or condemnable by law” and who would have been the subject of complaints on social media.

97%” of practitioners signed up with Doctolib are registered with the Ministry of Health,” the company claimed. According to Doctolib, only 3% of its practitioners are therefore from the realm of SCAM: sophrologists, hypnotherapists, naturopaths. In France, these practitioners are not regulated and do not have the status of health professional, but they are nevertheless legal. The appointments made on Doctolib with such practitioners represent “0.3% of the totality” of the volume recorded on the platform.

The CEO of Doctolib, Stanislas Niox-Chateau, said that he was responding to a request from patients and refused to position his site as a simple directory of the Ministry of Health: “The demand is there. It is not up to us to say whether these activities are effective or useful. They are legal, so we have no reason to prevent practitioners from being listed on our site.”

As so often in the realm of SCAM, the dispute seems to be one between ethical/moral responsibilities and commercial interests of the parties involved.

 

Israel’s Health Ministry announced the revocation of Dr. Aryeh Avni’s medical license, after he called to violate the ministry’s COVID guidelines during the pandemic and published defamatory articles against the medical community. The Jerusalem District Court rejected Avni’s appeal following the decision to revoke his medical license. Avni, who was a specialist in general surgery, engaged for years in so-called alternative medicine (SCAM) and had previously been caught forging vaccination certificates. He claimed in court that he operates in the context of freedom of expression and that his objective is to help the public and to rescue patients from the harm caused by medications and vaccines.

About a year and a half ago, the Health Ministry’s disciplinary committee recommended that Avni’s license be suspended for two years, but former Judge Amnon Shtrashnov, who was granted authority by the health minister, rejected the recommendation and ordered the permanent revocation of Avni’s license. In his decision, Shtrashnov called Avni “a charlatan, a clear coronavirus denier and a dangerous trickster, who behaves that way under the aegis of a licensed doctor.” “There must be a distinction between expressing an opinion and incitement, while conducting a smear campaign against medical authorities in order to dissuade the public from acting in accordance with their directive,” District Court Judge Nimrod Flax said in his decision. “A doctor who chooses to conduct a delegitimization campaign of this kind excludes himself, and is behaving in a manner unbefitting a licensed doctor. “And we will say once again – expressing an opinion, absolutely; conducting a campaign of incitement and defamation against his fellow doctors, while attempting to bias public opinion and to prevent the public from acting in accordance with the recommendations of the medical authorities, absolutely not,” added Judge Flax. “In general, criticism of the directives and decisions of the health care system and those who head it is legitimate, but that’s when these things are said in polite language and are based on true facts,” added the judge. “Granting approval to the appellant to continue to possess a medical license, while he continues with his previous practices, and in particular preaches to violate medical directives given by the authorized bodies, cannot accord with the public interest,” added the judge.

__________________________

Dr. Avni has a website where he writes about himself: “During his work in the hospital but also in his private life, Dr. Avni was exposed to the dismal results of conventional cancer treatments, he lost his wife and sister. The difficult events made him think that allopathic medicine is not the only option and he started looking for other solutions. Better, and less dangerous in terms of “do no harm”.
This is how Dr. Avni came in his decades of journey to many methods and treatments that have in common that they treat problems from the root and not only the symptom, they are not harmful, in repairing one disease they do not increase the risk of new disease, they treat the person and do not see only the “disease” And their natural origin.
The more he delved into his research, the more Dr. Avni discovered to his amazement that there were powerful forces trying to silence and obscure vital information about these treatments. In the United States, for example, several dozen doctors died prematurely and for “strange” reasons, these were doctors who opposed vaccines or conventional cancer treatments. In recent years, Dr. Avni has also faced constant persecution by the media and the Ministry of Health, and once his license was suspended. But Dr. Avni did not flinch or fold, this is his life mission and for that we appreciate him and thank him! And we are not the only ones.

____________________________

Personally, I feel that the world is a safer place without anti-vax doctors in clinical practice. Other countries should perhaps follow the example of Israel and be more ready to revoke the licenses of anti-vax charlatans.

England’s record goalscorer Ellen White has revealed she suffered a punctured lung while receiving acupuncture treatment. The injury accelerated her decision to retire. White, 33, said she was still coming to terms with the “traumatic” injury.

Manchester City had sourced a “specialist” – evidently not such an excellent acupuncturist because the complication is avoidable with proper knowledge of anatomy – outside the club to provide her with acupuncture to treat her back problem because of a high number of injuries in the squad at the time. “If you’d said to me two or three years ago that you’re going to retire, I would have said ‘absolutely not’, but I’ve got to a time in my career,” she said. “I had a challenging time last year – coming back from the Olympics, I basically punctured my lung, and it was a lot for me to have to go through and a big reason that accelerated my want to retire.”

The injury happened when she returned to her club with a back spasm last summer. “It punctured my lung which isn’t something that happens normally, obviously,” she said. “It was a really traumatic time for me and something that I’m still figuring out now, still working through. I had to wait for the lung to basically inflate again. I had a needle put into my chest to drag all the air out then hopefully the lung would inflate again – which it has. At the time, I think for me, I just got into a zone of: ‘I need to get back playing. We’ve got these games – I want to be back playing for my club; I want to be back playing for England. I went very tunnel vision,” she said. “It wasn’t until a good two or three months later, it just hit me like a train, what actually happened and how traumatic it was.”

Despite her quick return to goalscoring form, which included becoming the Lionesses record goalscorer in November, the striker says she is still affected by the injury and suffers “phantom pain” where it feels like it is happening again. “It’s important for me now to tell my story, and say it was a big factor in my year and leading up to the decision of wanting to retire. Obviously, there are other factors that come into that as well. I don’t want it to happen to anybody else again is my main thing. I don’t want to walk away from the sport having not told it and not say that I want things in place for it not to happen to anyone else.”

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Pneumothorax is by far the most common of all the serious, potentially fatal complications caused by acupuncture. In thin individuals, several acupuncture points over the upper thorax are just a few centimeters away from the lung. Therefore, it is easily possible to puncture a lung by inserting an acupuncture needle. This is from my 2010 review of the subject:

About 90 deaths after acupuncture have been anecdotally documented in the medical literature. Thus, acupuncture has been associated with more deaths than most other ‘alternative’ therapies except herbal medicine … The fatalities are usually due to an acupuncture needle penetrating a vital organ. This, in turn, can cause pneumothorax, cardiac tamponade, or major haemorrhage. Most instances of this nature are reported in the Asian literature which, for most of us, is not easily accessible.

A 2013 review of ours located 1104 cases that had been reported in the Korean literature alone. However, the truth of the matter is that nobody can be sure of the exact incidence figures. Why? Because there is no monitoring system that would reliably record such incidences.

I would argue that every single case of acupuncture-induced pneumothorax tells us that the acupuncturist was not adequately trained. With proper knowledge of anatomy, such complications should not happen. Therefore, such instances are a rude reminder that so-called alternative medicine (SCAM) is far too often in the hands of “specialists” who are a danger to the public.

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!

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