medical ethics
Here is the abstract of a recent article that I find worrying:
In 2020, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) challenged the world with a global outbreak that led to millions of deaths worldwide. Coronavirus disease 2019 (COVID-19) is the symptomatic manifestation of this virus, which can range from flu-like symptoms to utter clinical complications and even death. Since there was no clear medicine that could tackle this infection or lower its complications with minimal adverse effects on the patients’ health, the world health organization (WHO) developed awareness programs to lower the infection rate and limit the fast spread of this virus. Although vaccines have been developed as preventative tools, people still prefer going back to traditional herbal medicine, which provides remarkable health benefits that can either prevent the viral infection or limit the progression of severe symptoms through different mechanistic pathways with relatively insignificant side effects. This comprehensive review provides scientific evidence elucidating the effect of 10 different plants against SARS-CoV-2, paving the way for further studies to reconsider plant-based extracts, rich in bioactive compounds, into more advanced clinical assessments in order to identify their impact on patients suffering from COVID-19.
The conclusions of this paper read as follows:
…since these 10 herbs hold distinct bioactive compounds with significant properties in vitro and with remarkable benefits to human health, it is possible to prevent SARS-CoV-2 infection and reduce its symptomatic manifestations by consuming any of these 10 plants according to the recommended dose. The diversity in bioactive molecules between the different plants exerts various effects through different mechanisms at once, which makes it more potent than conventional synthetic drugs. Nonetheless, more studies are needed to highlight the clinical efficacy of these extracts and spot their possible side effects on patients, especially those with comorbidities who take multiple conventional drugs.
I should point out that the authors fail to offer a single reliable trial that would prove or even imply that any of the 10 herbal remedies can effectively treat or prevent COVID infections (to the best of my knowledge, no such studies exist). Laguage like “it is possible to prevent SARS-CoV-2 infection and reduce its symptomatic manifestations” is therefore not just misleading but highly dangerous and deeply unethical. Sadly, such evidence-free claims abound in herbal medicine.
I think the journal editor, the peer-reviewer, the authors and their universities ( University of Tripoli in Lebanon, American University of the Middle East, Egaila in Kuwait, University of Balamand, Kalhat, Tripoli in Lebanon, Lebanese University, Tripoli in Lebanon, Aix-Marseille Université in France) should be ashamed to produce such dangerous rubbish.
Traditional herbal medicine (THM) is frequently used in pediatric populations. This is perticularly true in many low-income countries. Yet THM has been associated with a range of adverse events, including liver toxicity, renal failure, and allergic reactions. Despite these concerns, its impact on multi-organ dysfunction syndrome (MODS) risk has so far not been thoroughly investigated.
This study aimed to investigate the incidence and predictors of MODS in a pediatric intensive care unit (PICU) in Ethiopia, with a focus on the association between THM use and the risk of MODS. It was designed as a single-center prospective cohort study conducted at a PICU in the university of Gondar Comprehensive Specialized hospital, Northwest Ethiopia. The researchers enrolled eligible patients aged one month to 18 years admitted to the PICU during the study period. Data on demographic characteristics, medical history, clinical and laboratory data, and outcome measures using standard case record forms, physical examination, and patient document reviews. The predictors of MODS were assessed using Cox proportional hazards models, with a focus on the association between traditional herbal medicine use and the risk of MODS.
A total of 310 patients were included in the final analysis, with a median age of 48 months and a male-to-female ratio of 1.5:1. The proportion and incidence of MODS were 30.96% (95% CI:25.8, 36.6) and 7.71(95% CI: 6.10, 9.40) per 100-person-day observation respectively. Renal failure (17.74%), neurologic failure (15.16%), and heart failure (14.52%) were the leading organ failures identified. Nearly one-third of patients (32.9%) died in the PICU, of which 59.8% had MODS. The rate of mortality was higher in patients with MODS than in those without. The Cox proportional hazards model identified renal disease (AHR = 6.32 (95%CI: 3.17,12.61)), intake of traditional herbal medication (AHR = 2.45, 95% CI:1.29,4.65), modified Pediatric Index of Mortality 2 (mPIM 2) score (AHR = 1.54 (95% CI: 1.38,1.71), and critical illness diagnoses (AHR = 2.68 (95% CI: 1.77,4.07)) as predictors of MODS.
The authors concluded that the incidence of MODS was high. Renal disease, THM use, mPIM 2 scores, and critical illness diagnoses were independent predictors of MODS. A more than twofold increase in the risk of MODS was seen in patients who used TMH. Healthcare providers should be aware of risks associated with THM, and educate caregivers about the potential harms of these products. Future studies with larger sample sizes and more comprehensive outcome measures are needed.
I do fully agree with the authors about the high usage of herbal and other so-called alternative medicines by children. We have shown that, in the UK the average one-year prevalence rate was 34% and the average lifetime prevalence was 42%. We have furthermore shown that the evidence base for these treatments in children is weak, even more so than for general populations. Finally, we can confirm that adverse effects are far from rare and often serious.
It is therefore high time, I think, that national regulators do more to protect children from SCAM practitioners who are at best uncritical about their treatments and at worse outright dangerous.
Jennifer Jacobs started publishing peer-reviewed papers on homeopathy in the early 1990s. This happens to be around the same time as I did. So, we both have about 30 years of research into homeopathy behind us.
Jennifer just authored a paper entitled “Thirty Years of Homeopathic Research – Lessons Learned“. Here is its abstract:
Conducting double-blind randomized controlled trials is difficult, even in the allopathic medical system. Doing so within the paradigm of classical homeopathy is even more challenging. More than thirty years of experience in carrying out such trials has taught me much about the pitfalls to avoid as well as the factors that can lead to success. The initial steps of putting together a research protocol, securing funding, and obtaining human subjects’ approval can be daunting. After that comes developing questionnaires and surveys, hiring study personnel, and recruitment of subjects. The actual implementation of the research comes with its own set of possible missteps. Sample size determination, entry criteria, as well as type, frequency and duration of treatment are all crucial. Finally, statistical analysis must be performed to a high standard and a manuscript prepared to submit for publication. Even then there can be one or more manuscript revisions to make, based on feedback from reviewers, before a study is actually published. The entire process can take at least two years and is usually much longer.
Mistakes at any one of these steps can damage the outcome, as well as the impact of the study. With examples from my body of research, I will discuss some of the things that I wish I had done differently, as well as those that turned out to be correct. Homeopathic research is held to a much higher standard than conventional trials. Any flaws in study design, implementation, and analysis can be used by critics to negate the results. I am hopeful that the next generation of homeopathic researchers will learn from my experiences and carry on with great success.
Jennifer’s example motivated me to follow suit and contribute some very brief thoughts about my 30 years of homeopathy research and the lessons I have learnt:
Conducting double-blind randomized controlled trials is difficult in any area of medicine. Yet these types of studies are by far the best way to find out which treatments work and which don’t. Therefore, they need doing, regardless of the obstacles they may pose.
In homeopathy, we now have a large body of such trials. Sadly, not all of them are reliable. Those that are, according to accepted criteria, tend to fail to show that homeopathy works better than a placebo. Understandably, homeopaths are disappointed with this overall result and have made numerous attempts to invalidate it.
The main problem with research into homeopathy is not the research methodology. It is well established for clinical trials and can be easily modified to fit all the demands made by individualised treatment or other pecularities that may apply to homeopathy. The main problem is the homeopath who finds it impossible to accept the truth, namely that highly diluted homeopathic remedies are pure placebos and any observed benefits of homeopathy are due to non-specific effects such as the empathetic encounter or a placebo response.
The lesson to be learned from the past is that, in medicine, even the most obsessive belief, conviction or wishful thinking will eventually have to give way to the scientific evidence. In the case of homeopathy, this process has taken an extraordinary amount of time and effort but, finally, we are almost there and the writing is on the wall for everyone to see.
Two resumes of 30 years of work, research and experience!
And what a difference between them!
Who do you think gets closer to the truth,
Jennifer or I?
Yes, I often moan about the abundance of poor-quality prevalence surveys that we are confronted with when scanning the literaturee on so-called alternative medicine (SCAM), e.g.:
- The survey mania in so-called alternative medicine prevents progress
- A truly homeopathic survey
- A new survey of CAM-use (or is it a promotion for more nonsense on the NHS?)
- A new chiropractic survey seems to avoid all the potentially embarrassing questions
- Survey-mania in alternative medicine: a fruitless, misleading and counter-productive distraction
Here is another example that recently appeared on my screen and that allows me to explain (yet again) why these surveys are such a waste of space:
The Use of Traditional and Complementary Medicine Among Patients With Multiple Sclerosis in Morocco
Let’s assume the survey is done perfectly (a condition that most are very far from meeting). If the information generated by such a perfect survey were worthwhile, we would also need to consider possible mutations that would be just as relevant:
- We have just over 200 nations (other than Morocco) on the planet.
- I assume there are about 1000 conditions (other than multiple sclerosis) for which SCAM is used.
- There are, I estimate, 100 different definitions of SCAM (other than ‘traditional and complementary medicine’) that all include different modalities.
So, this alone would make 20 000 000 surveys that would be important enough to get published. But that’s not all. The usage and nature of SCAM change fairly quickly. That means we would need these 20 million surveys to be repeated every 2 to 3 years to be up-to-date.
For all this, we would need, I estimate, 200 000 research groups doing the work and about 20 000 SCAM journals to publish their results.
I think we can agree that this would be a nonsensical effort for producing millions of papers reaching dramatic conclusions that read something like this:
Our survey shows that patients suffering from xy living in yz use much SCAM. This level of popularity suggests that SCAM is much appreciated and needs to be made available more widely and free of charge.
I rest my case.
I have been called just about everything during my professional life (not to mention the private one). Yesterday, a new addition arrived: a German psychologist who chose to misunderstand a re-Tweet (or is that re-X these days?), Sebastian Bartoschek, implied I am an anti-Semite.
My re-Tweet quoted without any comment by me a Holocaust survivor stating “The Nazis made me afraid to be a Jew, and the Israelis made me ashamed to be a Jew”.
My re-Tweet was meant to make people reflect critical about the horrendous atrocities that is currently happening in Gaza. However, Bartoschek decided it was anti-semitism and demanded I explain myself. As I had previously had an unpleasantly unproductive encounter over an entirely different matter with him, I did not quite see why I should comply to the wishes of this guy. What followed was a rather ridiculous triade by Bartoschek. It included him alerting DIE WELT that someone who sometimes writes for the paper propagates anti-semitism.
A third party (I don’t know who) must have suggested that this amounts to denunciation. Bartoschek replied: “If asking someone why they share anti-Semitic content is denunciation for you, then so be it.” Eventually he sent me this Tweet:
To EdzardErnst – I’ll wait until 11 a.m. tomorrow, Sunday, for a statement. After that, I’ll write about it without it.
This is why I feel that I am blackmailed. Either I explain what I feel is too obvious to explain, or he will write about the matter in what can be expected to be a defaming way.
Well, I prefer to write about it myself by stating categorically that I am definitely not an anti-semite. What is more, I can prove it. I have since many years published numerous articles (around 30, I guess) that make my position entirely clear; to mention just three:
- The most important paper I ever published
- Killing in the name of healing: the active role of the German medical profession during the Third Reich – PubMed (nih.gov)
- Die grauenhaften Verbrechen des Doktor Karl Brandt – Zeit – derStandard.at › Wissenschaft
So, now it will be great fun to see whether Bartoschek has lost his marbles and what version of the truth he will tell in his own write-up of the story.
WATCH THIS SPACE.
Current interventions for posttraumatic stress disorder (PTSD) are efficacious, yet effectiveness may be limited by adverse effects and high withdrawal rates. Acupuncture is an intervention with some positive preliminary but methodologically flawed data for PTSD. Therefore a new study compared verum acupuncture with sham acupuncture (minimal needling) on clinical and physiological outcomes.
This was a 2-arm, parallel-group, prospective blinded randomized clinical trial hypothesizing superiority of verum to sham acupuncture. The study was conducted at a single outpatient-based site, the Tibor Rubin VA Medical Center in Long Beach, California, with recruitment from April 2018 to May 2022, followed by a 15-week treatment period. Following exclusion for characteristics that are known PTSD treatment confounds, might affect biological assessment, indicate past nonadherence or treatment resistance, or indicate risk of harm, 93 treatment-seeking combat veterans with PTSD aged 18 to 55 years were allocated to group by adaptive randomization and 71 participants completed the intervention protocols.
Verum and sham were provided as 1-hour sessions, twice weekly, and participants were given 15 weeks to complete up to 24 sessions. The primary outcome was pretreatment to posttreatment change in PTSD symptom severity on the Clinician-Administered PTSD Scale-5 (CAPS-5). The secondary outcome was pretreatment to posttreatment change in fear-conditioned extinction, assessed by fear-potentiated startle response. Outcomes were assessed at pretreatment, midtreatment, and posttreatment. General linear models comparing within- and between-group were analyzed in both intention-to-treat (ITT) and treatment-completed models.
A total of 85 male and 8 female veterans (mean [SD] age, 39.2 [8.5] years) were randomized. There was a large treatment effect of verum (Cohen d, 1.17), a moderate effect of sham (d, 0.67), and a moderate between-group effect favoring verum (mean [SD] Δ, 7.1 [11.8]; t90 = 2.87, d, 0.63; P = .005) in the intention-to-treat analysis. The effect pattern was similar in the treatment-completed analysis: verum d, 1.53; sham d, 0.86; between-group mean (SD) Δ, 7.4 (11.7); t69 = 2.64; d, 0.63; P = .01). There was a significant pretreatment to posttreatment reduction of fear-potentiated startle during extinction (ie, better fear extinction) in the verum but not the sham group and a significant correlation (r = 0.31) between symptom reduction and fear extinction. Withdrawal rates were low.
The authors concluded that the acupuncture intervention used in this study was clinically efficacious and favorably affected the psychobiology of PTSD in combat veterans. These data build on extant literature and suggest that clinical implementation of acupuncture for PTSD, along with further research about comparative efficacy, durability, and mechanisms of effects, is warranted.
I am not sure that the authors’ enthusiastic verdict is correct. Its lead author was even quoted stating that his study, which used improved controls, was needed to “definitively” support acupuncture for PTSD. He noted that “acupuncture ought to be considered a potential first-line treatment for PTSD.”
While the study is an improvement on the previous research in this area, it is by no means compelling. My main point of criticism is the nature of the sham acupuncture. Such controls are used to account for placebo effects which, of course, can be considerable in the case of acupuncture.
For this concept to work adequately, the patient and the therapist need to be blinded. In the case of acupuncture, therapist blinding is difficult (but not impossible). In this study, therepists were not blinded. Thus they could have influenced the outcome by verbal and non-verbal clues given to the patient. As acupuncturists inevitably have an interest in the positive result of their study, this effect seems inevitable to me.
More important, however, is the adequate blinding of the patient. In this study, it was attempted by using shallow needling as a sham intervention. Yet, shallow needling can easily distinguished from real acupuncture by the patient. At the very least, patients should be asked what treatment – sham or real – they thought they had received. This did not happen, and we therefore might assume that the effect of patient de-blinding – combined with the confounder described above – was sufficient to bring about the relatively small effect sizes observed by the authors.
One might argue that this does not really matter; all that counts is to alleviate the suffering of the patients, never mind by what mechanism. I think, this would be erroneous. It matters because, if acupuncture itself is ineffective (which I suggest), settling for acupuncture as a first line therapy for PTSD is in nobody’s interest and a disservice to severely suffering patients. It would inhibit meaningful research aimed at finding an optimal therapy (one that works beyond placebo) and be a waste of resources.
A recent post of mine started an interesting discussion about the research of the NCCIH. Richard Rasker made the following comment:
The NCCIH was initially established as the Office for Alternative Medicine (OAM) for mostly the same reason that Edzard’s department at Exeter was founded, i.e. to study alternative modalities, and determine once and for all which ones were effective and which ones weren’t. Unfortunately, OAM and its subsequent incarnations were taken over by SCAM proponents almost right away, with its core mission changed into validating (NOT ‘studying’) SCAM modalities – a small but crucial difference that will all but guarantee that even long-obsolete and totally ineffective quackery will continue to be ‘researched’ and promoted.
So what’s the score now, after more than 30 years and well over 4 billion dollars in taxpayers’ money? How many SCAM modalities have they managed to ‘validate’, i.e. definitively proven to be effective? The answer is: none, for all intents and purposes. Even their research into herbal medicine – one of the most effective (or should I say: least ineffective) SCAMs out there – is best described as woefully lacking. Their list of herbs and plants names just 55 species of plants, and the individual descriptions are mostly to the tune of ‘a lot of research was done, but we can’t say anything definite’.
I think I can contribute meaningfully to this important comment and topic. Several years ago, my Exeter team – together with several other researches – systematically reviewed the NCCIH (formerly NCCAM)-sponsored clinical trials. Specifically, we focussed on 4 different subject areas. Here are the conclusions of our articles reporting the findings:
-
-
- ACUPUNCTURE
-
Seven RCTs had a low risk of bias. Numerous methodological shortcomings were identified. Many NCCAM-funded RCTs of acupuncture have important limitations. These findings might improve future studies of acupuncture and could be considered in the ongoing debate regarding NCCAM-funding. [Focus on Alternative and Complementary Therapies Volume 17(1) March 2012 15–21]
2. HERBAL MEDICINE
This independent assessment revealed a plethora of serious concerns related to NCCAM studies of herbal medicine. [Perfusion 2011; 24: 89-102]
3. ENERGY MEDICINE
In conclusion, the NCCAM-funded RCTs of energy medicine are prime examples of misguided investments into research. In our opinion, NCCAM should not be funding poor-quality studies of implausible practices. The impact of any future studies of energy medicine would be negligible or even detrimental. [Focus on Alternative and Complementary Therapies Volume 16(2) June 2011 106–109 ]
4. CHIROPRACTIC
In conclusion, our review demonstrates that several RCTs of chiropractic have been funded by the NCCAM. It raises numerous concerns in relation to these studies; in particular, it suggests that many of these studies are seriously flawed. [https://www.ncbi.nlm.nih.gov/pubmed/21207089]
The overall conclusion that comes to my mind is this:
The NCCIH has managed to spend more money on SCAM research than any other institution in the world (in the 20 years that I ran the Exeter research unit, we spent around £2 million in total). The NCCIH has wasted precious funds on plenty of dubious studies; arguably, this is unethical. It has misappropriated its role from testing to validating SCAMs. And it has validated none.
PS
As some of the above-cited papers are not easily accessible, I offer to send copies to interested individuals on request.
Guest post by Ken McLeod
This week a Coroner’s Inquest into the death of Jarrad Antonovich resumes [1] in Byron Bay, New South Wales, Australia. Meanwhile, pending the outcome of Inquests and other investigations, the NSW Health Care Complaints Commission has imposed interim prohibition order on Mr Soulore Solaris, ‘….a Counsellor who facilitates Ayahuasca ceremonies.’
Under section 41AA of the Health Care Complaints Act 1993 (Act), Mr Solaris: “….must not under any circumstances provide, or cause to be provided, any health services, either in paid employment or voluntary, to any member of the public.” [2] This applies until 11 March 2024, when the matter will be reconsidered.
So what is all this about? To go back a while, Mr Antonovich died from a perforated oesophagus after consuming ayahuasca and kambo frog toxin in October 2021, at the age of 46, while attending the ‘Dreaming Arts festival’, a six-day retreat at Arcoora near Kyogle in northern New South Wales. At the festival he had consumed ayahuasca and participated in a “Kambo” ceremony, involving secretions harvested from an Amazonian tree frog.
Ayahuasca is a psychedelic substance made from boiling plants that is used in ritualistic ceremonies in the Amazon basin. [3] Ayahuasca contains chemicals of concern, such as N,N-Dimethyltryptamine (DMT), a highly psychedelic substance and a Schedule I drug under the Convention on Psychotropic Substances. Ayahuasca is illegal in many countries, and it is illegal to sell, import, produce and possess it in Australia. [4]
Kambo is made from secretions harvested from an Amazonian tree frog. Kambo is usually used in a group setting, called a Kambo circle or Kambo ceremony. Wikipedia lists a whole smorgasbord of dangerous consequences, including tachycardia, nausea, vomiting, diarrhea, psychosis, SIADH, kidney damage (including acute renal failure), pancreas damage, liver damage including toxic hepatitis, dermatomyositis, esophageal rupture, seizures, and death. [5]
The Australian Therapeutic Goods Administration has listed it as a schedule 10 poison, in the category for “substances of such danger to health as to warrant prohibition of sale, supply and use”. [6]
Earlier in the Inquest we heard that:
- – While Jarrad Antonovich‘s condition worsened there was resistance to calling for an ambulance. An ambulance was finally called at 11.30pm and took an hour to arrive because of the remote location.
- -One ambulance officer reported that a female told them to “move away from Jarrad because it was affecting his aura” and no one told them he had consumed Kambo. [7]
- -The event organiser Soulore “Lore” Solaris described Jarrad Antonovich’s death as ‘beautiful.’ [8]
- -Fred Woller, the site manager at Arcoora, was unaware those running the event did not have any medical training. [9]
- -Soulore “Lore” Solaris said Mr Antonovich ”…. had good support, a couple of kinesiologists with him and they couldn’t find anything wrong,” [10]
- -Mr Antonovich “was surrounded by people who loved him and an Aboriginal elder called Uncle Andrew who was chanting sacred songs and calling the spirit out of his body” and “the koalas were making a special sound that is known to the elders when the land accepts a spirit”.
- -“Mr Solaris has stated that he has plans to leave Australia for Brazil to visit his teachers.” [11]
We will keep you informed.
REFERENCES
- 1 Court Lists http://tinyurl.com/3fzjd6uy
- 2 Health Care Complaints Commission http://tinyurl.com/yh76rzc6
- 3 The Guardian http://tinyurl.com/328manjt
- 4 Wikipedia https://en.wikipedia.org/wiki/Legal_status_of_ayahuasca_by_country
- 5 Wikipedia https://en.wikipedia.org/wiki/Kambo_(drug)
- 6 The Guardian http://tinyurl.com/2s398psy
- 7 The Guardian http://tinyurl.com/328manjt
- 8 ABC http://tinyurl.com/5n7ejydy
- 9 The Guardian http://tinyurl.com/59wa3rmn
- 10 ABC http://tinyurl.com/5n7ejydy
- 11 Byron Bay Echo http://tinyurl.com/44n78s2w
The French ‘National Assembly’ has yesterday adopted a major law aimed at reinforcing the prevention and combat against sectarian aberrations in France. This marks a significant step forward in strengthening the protection of citizens against abuse and manipulation by charlatans, gurus and other sectarian movements.
This bill, the result of particularly fruitful work and debate in both chambers, reflects the Government’s commitment to meeting the expectations of the victims of these sectarian movements.
Some of the key measures voted through by parliamentarians include:
- The enshrinement in law of the powers of MIVILUDES (Interministerial Mission of Vigilance and Combat against Sectarian Aberrations);
- The reinforcement of the penal response with the creation of the offence of placing or maintaining in a state of psychological or physical subjection;
- The creation of an offence of incitement to abandon or refrain from treatment, or to adopt practices which clearly expose the person concerned to a serious health risk;
- Support for victims, with the extension of the categories of associations that can bring civil action;
- Information for the judiciary, with the introduction of an “amicus curiae” role for certain government departments in legal cases relating to cults.
Despite sometimes heated debates, particularly around article 4, fuelled by the opinion of the Conseil d’Etat, the adoption of this law by the National Assembly bears witness to a shared desire to protect the rights and freedoms of individuals while providing better protection for our fellow citizens against sectarian aberrations.
This bill is part of a multi-annual national strategy for 2023-2027 resulting from the conference on sectarian aberrations held in spring 2023. It is a major step towards strengthening the penal arsenal and protecting victims.
_______________
Sabrina Agresti-Roubache, Secretary of State for Citizenship and Urban Affairs, commented:
“Long-awaited by victim support associations, this text aims to strengthen our legal arsenal in the fight against sectarian aberrations. I’m delighted that all the articles have been adopted, particularly Article 4, which creates an offence of incitement to abandon or abstain from treatment. There have been some passionate debates in the Chamber, but I’d like to reiterate the basis of this bill: the State is not fighting against beliefs, opinions or religions, but against all forms of sectarian aberrations, these dangerous behaviors which represent a threat to our social cohesion and put lives at risk.”
_______________
Obviously, we shall have to see how the new law will be applied. But, in any case, it is an important step into the right direction and could put an end to much of so-called alternative medicine that endangers the health of French consumers.
Other nations should consicer following the Franch example.
Millions of US adults use so-called alternative medicine (SCAM). In 2012, 55 million adults spent $28.3 billion on SCAMs, comparable to 9% of total out-of-pocket health care expenditures. A recent analysis conducted by the US National Institutes of Health’s National Center for Complementary and Integrative Health (NCCIH) suggests a substantial increase in the overall use of SCAM by American adults from 2002 to 2022. The paper published in the Journal of the American Medical Association, highlights a surge in the use of SCAM particularly for pain management.
Data from the 2002, 2012, and 2022 National Health Interview Surveys (NHISs) were employed to evaluate changes in the use of 7 SCAMs:
- yoga,
- meditation,
- massage therapy,
- chiropractic,
- acupuncture,
- naturopathy,
- guided imagery/progressive muscle relaxation.
The key findings include:
- The percentage of individuals who reported using at least one of the SCAMs increased from 19.2% in 2002 to 36.7% in 2022.
- The use of yoga, meditation, and massage therapy experienced the most significant growth.
- Use of yoga increased from 5% in 2002 to 16% in 2022.
- Meditation became the most popular SCAM in 2022, with an increase from 7.5% in 2002 to 17.3% in 2022.
- Acupuncture saw an increase from 1% in 2002 to 2.2% in 2022.
- The smallest rise was noted for chiropractic, from 79 to 86%
The analyses also suggested a rise in the proportion of US adults using SCAMs specifically for pain management. Among participants using any SCAM, the percentage reporting use for pain management increased from 42% in 2002 to 49% in 2022.
Limitations of the survey include:
- decreasing NHIS response rates over time,
- possible recall bias,
- cross-sectional data,
- differences in the wording of the surveys.
The NCCIH researchers like such surveys and tend to put a positive spin on them, i.e. SCAM is becoming more and more popular because it is supported by better and better evidence. Therefore, SCAM should be available to everyone who wants is.
But, of course, the spin could also turn in the opposite direction, i.e. the risk/benefit balance for most SCAMs is either negative or uncertain, and their cost-benefit remains unclear – as seen regularly on this blog. Therefore, the fact that SCAM seems to be getting more popular is of increasing concern. In particular, more consideration ought to be given to the indirect risks of SCAM (think, for instance, only of the influence SCAM practitioners have on the vaccination rates) that we often discuss here but that the NCCIH conveniently tends to ignore.
