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

nurses

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!

Look what I found on Facebook:

Learn how to offer the healing energy of Reiki to yourself, people, and animals while enhancing your animal connection skills!

From daily support for health or challenges during times of crisis, Reiki helps restore balance on physical, emotional, spiritual, and mental levels for all living beings, enabling the body to do what it does best—heal itself. These benefits extend to other people, animals, trees/plants, and self-healing.

Reiki offers so many benefits for animals and for their human caregivers that I call it the gift that keeps on giving!

Reiki also enables students to connect and communicate more deeply with animals. If you think animals like you now, wait until they discover you’ve got Reiki—you’ll become an animal magnet!

For 25+ years Reiki has blessed me, my animal companions, students, and as a teacher I love sharing those benefits with as many people and animals as possible.

AVAILABLE WORLDWIDE

For many years I’ve taught a LIVE personally-mentored 6-week audio class where students learn all the basic skills needed by a beginning Reiki practitioner in addition to foundational principles of energy healing. And you don’t even need to leave the comfort of your home!

TAKEN REIKI BEFORE but don’t feel confident? Students who have retaken Reiki with me share that the weekly calls, opportunities to practice, online community, and opportunity to ask questions and receive guidance have helped them make Reiki a part of their daily lives and feel confident in offering it to loved ones.

REIKI LEVEL 1 CLASS SERIES

August 3 – September 7, 2022

LIVE WEEKLY CALLS and PERSONAL MENTORING

Every Wednesday at 6:00 p.m. Pacific for six weeks. Each call will be recorded and available for replay for students, including those in other time zones/countries. You do not have to attend live to take this class.

In addition to the 60-90 minute weekly calls, each student receives handouts and personal guidance for practice sessions.

When the class concludes, and all requirements have been fulfilled, each student receives a Reiki Level 1 certificate.

To learn more or register:

AND NOW FOR THE IMPORTANT BIT:

Choose one payment for all six classes. Payment is available with Visa, MC, or PayPal (choose PayPal credit card option for payment with Amex or Discover). PayPal also offers a payment plan option. Confirmation will be sent after registration along with instructions on how to join the first call. If you were unable to register in time to attend the first class live you can very easily catch up with the replay. Final deadline for registration is the day of the second class.

Single Pay Plan: $249.00

____________________________

This seems like a good little earner to me!

Congratulations to whoever invented it.

Yet I do feel that something has been forgotten:

the evidence.

If you search for Reiki on Pubmed, you find a baffling array of papers many of which arrive at positive conclusions. If you then check out the primary studies, you realize that most of them are of extremely poor quality, published by members of the Reiki cult (often in 3rd class journals for the nursing professions). If you search for independent systematic reviews that adequately account for the quality of the primary studies, you discover that, in fact, the evidence does not support the notion that Reiki is effective for anything. Here are a few examples:

And what about Reiki for animals?

As far as I can see, there is no good evidence at all.

So, does this render the above and similar courses fraudulent?

I let you answer this question for yourselves.

Given the high prevalence of burdensome symptoms in palliative care (PC) and the increasing use of so-called alternative medicine (SCAM) therapies, research is needed to determine how often and what types of SCAM therapies providers recommend to manage symptoms in PC.

This survey documented recommendation rates of SCAM for target symptoms and assessed if, SCAM use varies by provider characteristics. The investigators conducted US nationwide surveys of MDs, DOs, physician assistants, and nurse practitioners working in PC.

Participants (N = 404) were mostly female (71.3%), MDs/DOs (74.9%), and cared for adults (90.4%). Providers recommended SCAM an average of 6.8 times per month (95% CI: 6.0-7.6) and used an average of 5.1 (95% CI: 4.9-5.3) out of 10 listed SCAM modalities. Respondents recommended mostly:

  • mind-body medicines (e.g., meditation, biofeedback),
  • massage,
  • acupuncture/acupressure.

The most targeted symptoms included:

  • pain,
  • anxiety,
  • mood disturbances,
  • distress.

Recommendation frequencies for specific modality-for-symptom combinations ranged from little use (e.g. aromatherapy for constipation) to occasional use (e.g. mind-body interventions for psychiatric symptoms). Finally, recommendation rates increased as a function of pediatric practice, noninpatient practice setting, provider age, and proportion of effort spent delivering palliative care.

The authors concluded that to the best of our knowledge, this is the first national survey to characterize PC providers’ SCAM recommendation behaviors and assess specific therapies and common target symptoms. Providers recommended a broad range of SCAM but do so less frequently than patients report using SCAM. These findings should be of interest to any provider caring for patients with serious illness.

Initially, one might feel encouraged by these data. Mind-body therapies are indeed supported by reasonably sound evidence for the symptoms listed. The evidence is, however, not convincing for many other forms of SCAM, in particular massage or acupuncture/acupressure. So encouragement is quickly followed by disappointment.

Some people might say that in PC one must not insist on good evidence: if the patient wants it, why not? But the point is that there are several forms of SCAMs that are backed by good evidence for use in PC. So, why not follow the evidence and use those? It seems to me that it is not in the patients’ best interest to disregard the evidence in medicine – and this, of course, includes PC.

Bach Flower Remedies are often mistaken for homeopathy. Yet they are quite different. They were invented about 100 years ago by Dr. Edward Bach (1886–1936), a doctor homeopath who had previously worked in the London Homeopathic Hospital. His remedies are clearly inspired by homeopathy; however, they are by no means the same because they do not follow the ‘like cures like’ principle and neither are they potentised. They are manufactured by placing freshly picked specific flowers or parts of plants in water which is subsequently mixed with alcohol, bottled, and sold. Like most homeopathic remedies, they are highly dilute and thus do not contain therapeutic concentrations of the plant printed on the bottle. In other words, flower remedies (or essences) are placebos. This does not stop enthusiasts to continue submitting them to clinical trials.

This study tested the effects of flower essence bouquets on the signs and symptoms of stress in nursing students. The study was designed as a randomized clinical trial, triple blind, with two groups (flower essence group and placebo group), carried out with 101 nursing students. Bach’s flower essences Cerato (Ceratostigma wilimottianum)Cherry Plum (Prunus cerasifera)Elm (Ulmus procera)Impatients (Impatiens glandulifera), Larch (Larix decidua), Olive (Olea europaea) and White Chestnut (Aesculus hippocastanum) were selected by the researcher based on the experience of attending nursing students on flower essence therapy. The formulas were prepared in a 30 ml amber glass bottle with a perforated cap with a white seal and bulbs, and labeled according to randomization (Group 1 or Group 2). The groups applied the treatments for 60 days at a dosage of 4 drops 4 times a day. The outcome was evaluated using the Baccaro Test and the Perceived Stress Scale applied at the beginning and at the end of the intervention.

The results demonstrated no significant difference between the groups in stress reduction (p > 0.05). Both groups showed a reduction in scale scores (p < 0.001) with a large effect size. There was an influence of the COVID-19 pandemic in the reduction of Baccaro Test scores.

The authors (who seem to have been advocates of Bach Flower Remedies) concluded that the intervention with flower essence therapy was not more effective than placebo in reducing stress signs and symptoms.

Is anyone surprised?

I am not!

For my last post of the year 2021, I take the liberty to borrow parts of a BMJ editorial entitled A NEW YEAR’S RESOLUTION OF HEALTH WORKERS:

The prospect of a return to normality seems within reach. But what will that normality look like? We believe that health workers, who have been at the frontline of the pandemic, must offer a vision of a healthier future. We must not let the terrible events of this year recast the pre-pandemic world in a glowing light. The normality we departed from at the onset of the pandemic was unjust, unsustainable, and shaped the evolution of, and responses to, the pandemic with devastating consequences, particularly for the most deprived and vulnerable.

The start of a new year offers an opportunity to question old ways of working and to ask how we can create a better future for everyone. It is a cliché to say that you should never waste a crisis. Just as in wartime and in the global financial crisis, many have profited greatly from the pandemic, whether as providers of online services or by taking advantage of the rush to procure essential goods such as personal protective equipment.

But many were far less fortunate, living in circumstances that rendered them vulnerable to an infection that spread especially rapidly through communities where successive generations had been living ever more precarious lives. As the recovery begins, the powerful groups who benefited from the social and economic systems that created those conditions will, once again, seek to shape the world to their advantage. Health workers cannot remain silent. They must offer a compelling vision of how we should reconfigure the world so that it produces and sustains health for all, resilient in the face of future threats…

A country navigating the pandemic is like a ship navigating treacherous and unpredictable waters in a storm. If the ship, its crew, and its passengers are to come through the experience unscathed it needs three things. First, it needs an experienced captain who understands the ship and commands the trust of the crew. Unfortunately, in some of the countries worst affected, captains were either away from the bridge, denied there was a storm, or had lost the trust of those on whom they depended.

Second, it needs a crew that is adequate for the size of the ship, that is well trained, and that is working as a team to achieve the same goal. Yet in too many countries, skeleton crews were working in health systems that were highly fragmented. Dissenting voices who raise the alarm about the integrity of the ship, the working of the team, or its leadership must not be silenced or lives can be lost. It also needs passengers who are as seaworthy as possible so that they can withstand the storm. One of the sentinel challenges of covid-19 was finding large segments of the population weighted by a disproportionate burden of preventable disease that predisposed them to severe covid-19 once infected.

Third, we need a ship that is securely constructed. Yet in many of the countries that have fared worst, we have been working in vessels that are full of holes. Social safety nets have been ripped asunder, allowing too many people to fall through the holes. We have made many demands on our people—to stay at home, to face loss of income—and we have added greater uncertainty to what were already difficult situations, particularly for certain racially and economically marginalised groups. The disproportionate exposure to covid-19 of many in these groups—a consequence of precarious jobs and social circumstances that denied them the luxury of social distancing—drove, in large part, the high burden of covid-19 among minority and marginalised groups worldwide.

As we look to the prospect of a covid-19 secure future, with effective vaccines, new treatments, and continued countermeasures as necessary, we must ask how we can strengthen the foundations of our societies, coming together to repair the torn safety nets. We must never be afraid to challenge our political leaders when they are going in the wrong direction, and we must insist that they really are guided by the science, and not just those bits that support their beliefs. And we must ensure that our fellow citizens are as healthy as possible so they can withstand the inevitable storms that lie ahead. We must insist that our health systems and other public systems are adequately staffed, with the tools needed to do the job, with teams that are working together, pulling in the same direction. If we do all this, then we, and the populations we serve, can be confident that we can weather any future storms.

___________________________

The editorial was written by 4 authors:

  1. Martin McKee, professor of European public health
  2. May C I van Schalkwyk, NIHR doctoral research fellow
  3. Nason Maani, assistant professor in public health evaluation
  4. Sandro Galea, dean

I think it is most sensible and thought-provoking and I suspect many of us agree with its sentiments. If it did not make you think, perhaps this information will do so:

The editorial was published one year ago in the Christmas issue of the BMJ

2020!

Yes, 2021 has disappointed many of our hopes and turned out to be a difficult year.

I wish us all that 2022 will be better, much better.

Therapeutic touch (TT) is a form of paranormal or energy healing developed by Dora Kunz (1904-1999), a psychic and alternative practitioner, in collaboration with Dolores Krieger, a professor of nursing. TT is popular and practised predominantly by US nurses; it is currently being taught in more than 80 colleges and universities in the U.S., and in more than seventy countries. According to one TT-organisation, TT is a holistic, evidence-based therapy that incorporates the intentional and compassionate use of universal energy to promote balance and well-being. It is a consciously directed process of energy exchange during which the practitioner uses the hands as a focus to facilitate the process.

The question is: does TT work beyond a placebo effect?

This review synthesized recent (January 2009–June 2020) investigations on the effectiveness and safety of therapeutic touch  (TT) as a therapy in clinical health applications. A rapid evidence assessment (REA) approach was used to review recent TT research adopting PRISMA 2009 guidelines. CINAHL, PubMed, MEDLINE, Cochrane databases, Web of Science, PsychINFO, and Google Scholar were screened between January 2009-March 2020 for studies exploring TT therapies as an intervention. The main outcome measures were for pain, anxiety, sleep, nausea, and functional improvement.

Twenty-one studies covering a range of clinical issues were identified, including 15 randomized controlled trials, four quasi-experimental studies, one chart review study, and one mixed-methods study including 1,302 patients. Eighteen of the studies reported positive outcomes. Only four exhibited a low risk of bias. All others had serious methodological flaws, bias issues, were statistically underpowered, and scored as low-quality studies. Over 70% of the included studies scored the lowest score possible on the GSRS weight of evidence scale. No high-quality evidence was found for any of the benefits claimed.

The authors drew the following conclusions:

After 45 years of study, scientific evidence of the value of TT as a complementary intervention in the management of any condition still remains immature and inconclusive:

  • Given the mixed result, lack of replication, overall research quality and significant issues of bias identified, there currently exists no good quality evidence that supports the implementation of TT as an evidence‐based clinical intervention in any context.
  • Research over the past decade exhibits the same issues as earlier work, with highly diverse poor quality unreplicated studies mainly published in alternative health media.
  • As the nature of human biofield energy remains undemonstrated, and that no quality scientific work has established any clinically significant effect, more plausible explanations of the reported benefits are from wishful thinking and use of an elaborate theatrical placebo.

TT turns out to be a prime example of a so-called alternative medicine (SCAM) that enthusiastic amateurs, who wanted to prove TT’s effectiveness, have submitted to multiple trials. Thus the literature is littered with positive but unreliable studies. This phenomenon can create the impression – particularly to TT fans – that the treatment works.

This course of events shows in an exemplary fashion that research is not always something that creates progress. In fact, poor research often has the opposite effect. Eventually, a proper scientific analysis is required to put the record straight (the findings of which enthusiasts are unlikely to accept).

In view of all this, and considering the utter implausibility of TT, it seems an unethical waste of resources to continue researching the subject. Similarly, continuing to use TT in clinical settings is unethical and potentially dangerous.

The aim of this paper was to synthesize the most recent evidence investigating the effectiveness and safety of therapeutic touch as a complementary therapy in clinical health applications.
A rapid evidence assessment (REA) approach was used to review recent TT research adopting PRISMA 2009 guidelines. CINAHL, PubMed, MEDLINE, Cochrane databases, Web of Science, PsychINFO and Google Scholar were screened between January 2009–March 2020 for studies exploring TT therapies as an intervention. The main outcome measures were for pain, anxiety, sleep, nausea and functional improvement.
Twenty‐one studies covering a range of clinical issues were identified, including 15 randomized trials, four quasi‐experimental studies, one chart review study, and one mixed-methods study including 1,302 patients. Eighteen of the studies reported positive outcomes. Only four exhibited a low risk of bias. All others had serious methodological flaws, bias issues, were statistically underpowered, and scored as low‐quality studies. No high‐quality evidence was found for any of the benefits claimed.

 The authors offer the following conclusions:

After 45 years of study, scientific evidence of the value of TT as a complementary intervention in the management of any condition still remains immature and inconclusive:

  • Given the mixed result, lack of replication, overall research quality, and significant issues of bias identified, there currently exists no good-quality evidence that supports the implementation of TT as an evidence‐based clinical intervention in any context.
  • Research over the past decade exhibits the same issues as earlier work, with highly diverse poor quality unreplicated studies mainly published in alternative health media.
  • As the nature of human biofield energy remains undemonstrated, and that no quality scientific work has established any clinically significant effect, more plausible explanations of the reported benefits are from wishful thinking and use of an elaborate theatrical placebo.

These are clear and much-needed words addressed at nurses (the paper was published in a nursing journal). Nurses have been oddly fond of TT. Therefore, it seems important to send evidence-based information in their direction. In my recent book, I arrived at similar conclusions about TT:

  1. The assumptions that form the basis for TT are not biologically plausible.
  2. Several trials and reviews of TT have emerged. However, many of them are by ardent proponents of TT, seriously flawed, and thus less than reliable. e.g.[1],[2]
  3. One rigorous pre-clinical study, co-designed by a 9-year-old girl, found that experienced TT practitioners were unable to detect the investigator’s “energy field.” Their failure to substantiate TT’s most fundamental claim is unrefuted evidence that the claims of TT are groundless and that further professional use is unjustified. [3]
  4. There are no reasons to assume that TT causes direct harm. One could, however, argue that, like all forms of paranormal healing, it undermines rational thinking.

[1] https://www.ncbi.nlm.nih.gov/pubmed/19299529

[2] https://www.ncbi.nlm.nih.gov/pubmed/27194823

[3] https://www.ncbi.nlm.nih.gov/pubmed/?term=rosa+e%2C+therapeutic+touch%2C+jama

An intercessory prayer (IP) is an intervention characterized by one or more individuals praying for the well-being or a positive outcome of another person. There have been several trials of IP, but the evidence is far from clear-cut. Perhaps this new study will bring clarity?

The goal of this double-blind RCT was to assess the effects of intercessory prayer on psychological, spiritual and biological scores of breast 31 cancer patients who were undergoing radiotherapy (RT). The experimental group was prayed for, while the controla group received no such treatment. The intercessory prayer was performed by a group of six Christians, who prayed daily during 1 h while participant where under RT. The prayers asked for calm, peace, harmony and recovery of health and spiritual well-being of all participants. Data collection was performed in three time points (T0, T1 and T2).

Significant changes were noted in the intra-group analysis, concerning the decrease in spiritual distress score; negative religious/spiritual coping prevailed, while the total religious/spiritual coping increased between the posttest T2 to T0.

The authors concluded that begging a higher being for health recovery is a common practice among people, regardless of their spirituality and religiosity. In this study, this practice was performed through intercessory prayer, which promoted positive health effects, since spiritual distress and negative spiritual coping have reduced. Also, spiritual coping has increased, which means that participants facing difficult situations developed strategies to better cope and solve the problems. Given the results related to the use of intercession prayer, as a complementary therapeutic intervention, holistic nursing care should integrate this intervention, which is included in the Nursing Interventions Classification. Additionally, further evidence and research is needed about the effect of this nursing spiritual intervention in other cultures, in different clinical settings and with larger samples.

The write-up of this study is very poor and most confusing – so much so that I find it hard to make sense of the data provided. If I understand it correctly, the positive findings relate to changes within the experimental group. As RCTs are about compating one group to another, these changes are irrelevant. Therefore (and for several other methodological flaws as well), the conclusion that IP generates positive effects is not warranted by these new findings.

Like all other forms of paranormal healing, IP is implausible and lacks support of clinical effectiveness.

After a previous post about aromatherapy, someone recently commented:

I love essential oils and use them daily. Essential oils became a part of my life! I do feel better with it! Why I need clinical trials so?

The answer is probably: you don’t need clinical trials for a little pampering that makes you feel good.

But, if someone claims that aromatherapy (or indeed any other treatment) is effective for this or that medical condition, we need proof in the form of a clinical trial. By proof, we usually mean a clinical trial.

One like this new study, perhaps?

The aim of this study was to evaluate the use of a lavender aromatherapy skin patch on anxiety and vital sign variability during the preoperative period in female patients scheduled for breast surgery. Participants received an aromatherapy patch in addition to standard preoperative care. Anxiety levels were assessed with a 10-cm visual analogue scale (VAS) at baseline and then every 15 minutes after patch placement. Vital sign measurements were recorded at the same interval. There was a statistically significant decrease (P = .03) in the anxiety VAS measurements from baseline to final scores.

The authors concluded that the findings from this study suggest the use of aromatherapy is beneficial in reducing anxiety experienced by females undergoing breast surgery. Further research is needed to address the experience of preoperative anxiety, aromatherapy use, and the challenges of managing preoperative anxiety.

No, not one like this study!

This study – its called it a ‘pilot study’ – tells us nothing of value.

Why?

  1. It was not a pilot study because it did not pilot anything; its aim was to evaluate aromatherapy.
  2. But it could not evaluate aromatherapy because it had no control group. This means the reduction in anxiety was almost certainly not a specific effect of the therapy, but a non-specific effect due to the extra attention, expectation, etc.
  3. This means that the conclusion (the use of aromatherapy is beneficial) is not justified.
  4. In turn, this means that the paper is not helpful in any way. All it can possibly do is to mislead the public.

In summary: another fine example of pseudo-research that, I believe, is worse than no research at all.

This randomized controlled trial was aimed to investigate the effect of aromatherapy massage on anxiety, depression, and physiologic parameters in older patients with acute coronary syndrome. It was conducted on 90 older women with acute coronary syndrome. The participants were randomly assigned into the intervention and control groups. The intervention group received reflexology with lavender essential oil plus routine care and the control group only received routine care. Physiologic parameters, the levels of anxiety and depression in the hospital were evaluated using a checklist and the Hospital’s Anxiety and Depression Scale, respectively, before and immediately after the intervention.

Significant differences in the levels of anxiety and depression were reported between the groups after the intervention. The analysis of physiological parameters revealed a statistically significant reduction in systolic blood pressure, diastolic blood pressure, mean arterial pressure, and heart rate. However, no significant difference was observed in the respiratory rate.

The authors concluded that aromatherapy massage can be considered by clinical nurses an efficient therapy for alleviating psychological and physiological responses among older women suffering from acute coronary syndrome.

WRONG!

This trial does not show remotely what the authors think. It demonstrates that A+B is always more than B. We have discussed this phenomenon so often that I hesitate to mention it again. Any study with the ‘A+B versus B’ design can only produce a positive result. The danger that this result is false-positive is so high that it is best to forget about such investigations altogether.

Ethics committees should not accept such protocols.

Researchers should stop running such studies.

Reviewers should not pass them for publication.

Editors should not publish such trials.

THEY MISLEAD ALL OF US AND GIVE CLINICAL RESEARCH A BAD NAME.

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