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

patient choice

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Drip IV is “Australia’s first and leading mobile healthcare company specialising in assisting with nutritional deficiencies”. They claim to provide a mobile IV service that is prescribed and tailored individually to your nutritional needs. Treatment plans and customised infusions are determined by a medical team to suit individual requirements. They deliver vitamins, minerals and amino acids directly to the body via the bloodstream, a method they state allows for optimal bioavailability.

These claims are a little puzzling to me, not least because vitamins, minerals and amino acids tailored individually to the nutritional needs of the vast majority of people would mean administering nothing at all. But I guess that virtually every person who consults the service will get an infusion [and pay dearly for it].

The Australian Therapeutic Goods Administration (TGA) seems to have a similarly dim view on Drip IV. The TGA has just issued 20 infringement notices totalling $159,840 to the company and to one of its executive officers. The reason: unlawful advertising of intravenous infusion products to Australian consumers on a company website and social media. Ten notices totalling $133,200 were issued to the company and ten notices totalling $26,640 were issued to an executive officer. The TGA considers the intravenous infusion products to be therapeutic goods because of the claims made about them, and the advertising to be unlawful because the advertisements allegedly:

  • contained prohibited representations, such as claims regarding cancer.
  • contained restricted representations such as that the products would alleviate fatigue caused by COVID-19, assist in the treatment of Graves’ Disease and Alzheimer’s Disease, and support the treatment of autoimmune diseases such as Multiple Sclerosis. No TGA approval had been given to make such claims.
  • referred to ingredients that are prescription only, such as glutathione. Prescription medicines cannot be advertised directly to the public in Australia.
  • contained a statement or picture suggesting or implying the products were ‘TGA Approved’. Advertising of therapeutic goods cannot include a government endorsement.
  • contained a statement or picture expressing that the goods were ‘miraculous’.

Vitamin infusions have become very popular around the globe. There are now thousands of clinics offering this service, and many of them advertise aggressively with claims that are questionable. Here is just one example from the UK:

Modern life is hectic. If you are looking to boost your wellbeing, increase your energy levels, lift your mood and hydrate your body, Vitamin IV Infusions are ideal. Favoured by celebrities such as Madonna, Simon Cowell and Rihanna, Vitamin IV Infusions are an easy, effective way of delivering vitamins, minerals and amino acids directly into your bloodstream via an IV (intravenous) drip. Vitamins are essential for normal growth and staying healthy – but our bodies can’t produce all of the nutrients we need to function and thrive. That’s why more than one in three people take daily vitamin supplements – often without realising that only 15% of the active nutrients consumed orally actually find their way into their bloodstream. With Vitamin IV Infusions, the nutrients enter your bloodstream directly and immediately, and are delivered straight to your cells. We offer four different Vitamin IV Infusions, so you can choose the best combination for your personal needs, while boosting your general health, energy and wellbeing.

My advice to consumers is a little different and considerably less costly:

  1. to ensure you get enough vitamins, minerals, and amino acids, eat a balanced diet;
  2. to boost your well-being, sit down and calculate the savings you made by NOT using such a service;
  3. to increase your energy levels, take a nap;
  4. to lift your mood, recount the money you saved and think of what nice things you might buy with it;
  5. to hydrate your body drink a glass of water.

Perhaps it is time the authorities in all countries had a look at what these clinics are offering and what health claims they are making. Perhaps it is time they act as the TGA just did.

 

The INDY and many other news outlets reported that the British Tory MP, Andrew Bridgen, has called on prime minister Rishi Sunak to suspend mRNA covid vaccines after alleging they are “not safe, not effective and not necessary”.

During Wednesday’s PMQs (13 December), Bridgen stated that “since the rollout in the UK of the BioNTech-Pfizer mRNA vaccine, we have had almost half a million reports of adverse effects from the public”, a message he later reiterated on Twitter.

Posting a snippet from his debate, Bridgen tweeted: “Almost half a million yellow card reports of adverse effects following administration of the Biotech Pfizer mRNA vaccine in the UK alone! Answers are desperately needed. #completelyunprecedented”.

Bridgen also claimed that a leading figure in the British Heart Foundation is suppressing evidence that the Covid vaccines cause heart damage, even sending non-disclosure agreements to his research team.

Facebook flagged his post with a notice urging users to ensure that they share “reliable information.” It included two links to “continue sharing” or “get vaccine info.”

The scandals Bridgen has been involved in seem too numerous to mention (e.g. violation of parliamentary standards, homophobic remarks, antisemitic statements). Here is just one of the most recent:

Leicestershire MP has been ordered to pay £800,000 and been evicted from his five bedroom home by a judge following a legal dispute involving the family vegetable business. It is currently unknown where Andrew Bridgen, Conservative MP for North West Leicestershire, lives after being given final deadline of August 24 to vacate the premises in Coleorton, near Coalville.

The 57-year-old was branded “dishonest” by a High Court judge in March – who ruled that Bridgen “lied” under oath. Judge Brian Rawlings said he was so dishonest that nothing he said about the dispute with AB Produce, a vegetable and potato supplier based in Measham, could be taken at face value.

Bridgen was also said to have behaved in an “abusive”, “arrogant” and “aggressive” way during the dispute, in which he has spent years suing the firm. A later judgment in June, reported by the Times on Sunday, forced the MP to vacate the £1.5 million-valued property owned by AB Produce that he has lived in since 2015…

For a fact check on Bridgeon’s vaccine claims, see here. And below are a few reactions from Twitter users to Bridgen’s Covid proctophsia:

First a High Court judge says Tory MP, Andrew Bridgen, lied under oath, then he evicts him from his home and orders him to pay £800,000 now Facebook flags his posts as Covid misinformation. How’s your week going?

Andrew Bridgen MP now promoting Dr David Cartland, a man who aligns himself with claims that Freemasons rule the world; that Covid doesn’t exist; and that medical doctors who don’t share his views should be executed (screenshots H/T

Andrew Bridgen MP now promoting Dr David Cartland, a man who aligns himself with claims that Freemasons rule the world; that Covid doesn’t exist; and that medical doctors who don’t share his views should be executed.

This Andrew Bridgen? ‘A Conservative MP lied under oath, behaved in an abusive, arrogant and aggressive way, and was so dishonest that his claims about a multimillion-pound family dispute could not be taken at face value, a high court judge has ruled.’

Proper tinfoil-hat stuff from Andrew Bridgen, suggesting Covid vaccines are unsafe, misrepresenting data, and implying some sort of conspiracy between ‘Big Pharma’ and MHRA.

The American Heart Association has issued a statement outlining research on so-called alternative medicine (SCAM) for heart failure. They found some SCAMs that work, some that don’t work, and some that are harmful.

Alternative therapies that may benefit people with heart failure include:

  • Omega-3 polyunsaturated fatty acids (PUFA, fish oil) have the strongest evidence among complementary and alternative agents for clinical benefit in people with heart failure and may be used safely, in moderation, in consultation with their health care team. Omega-3 PUFA is associated with a lower risk of developing heart failure and, for those who already have heart failure, improvements in the heart’s pumping ability. There appears to be a dose-related increase in atrial fibrillation (an irregular heart rhythm), so doses of 4 grams or more should be avoided.
  • Yoga and Tai Chi, in addition to standard treatment, may help improve exercise tolerance and quality of life and decrease blood pressure.

Meanwhile, some therapies were found to have harmful effects, such as interactions with common heart failure medications and changes in heart contraction, blood pressure, electrolytes and fluid levels:

  • While low blood levels of vitamin D are associated with worse heart failure outcomes, supplementation hasn’t shown benefit and may be harmful when taken with heart failure medications such as digoxin, calcium channel blockers and diuretics.
  • The herbal supplement blue cohosh, from the root of a flowering plant found in hardwood forests, might cause a fast heart rate called tachycardia, high blood pressure, chest pain and may increase blood glucose. It may also decrease the effect of medications taken to treat high blood pressure and Type 2 diabetes.
  • Lily of the valley, the root, stems and flower of which are used in supplements, has long been used in mild heart failure because it contains active chemicals similar to, but less potent than, the heart failure medicine digoxin. It may be harmful when taken with digoxin by causing very low potassium levels, a condition known as hypokalemia. Lily of the valley also may cause irregular heartbeat, confusion and tiredness.

Other therapies have been shown as ineffective based on current data, or have mixed findings, highlighting the importance of patients having a discussion with a health care professional about any non-prescribed treatments:

  • Routine thiamine supplementation isn’t shown to be effective for heart failure treatment unless someone has this specific nutrient deficiency.
  • Research on alcohol varies, with some data showing that drinking low-to-moderate amounts (1 to 2 drinks per day) is associated with preventing heart failure, while habitual drinking or intake of higher amounts is toxic to the heart muscle and known to contribute to heart failure.
  • There are mixed findings about vitamin E. It may have some benefit in reducing the risk of heart failure with preserved ejection fraction, a type of heart failure in which the left ventricle is unable to properly fill with blood between heartbeats. However, it has also been associated with an increased risk of hospitalization in people with heart failure.
  • Co-Q10, or coenzyme Q10, is an antioxidant found in small amounts in organ meats, oily fish and soybean oil, and commonly taken as a dietary supplement. Small studies show it may help improve heart failure class, symptoms and quality of life, however, it may interact with blood pressure lowering and anti-clotting medicines. Larger trials are needed to better understand its effects.
  • Hawthorn, a flowering shrub, has been shown in some studies to increase exercise tolerance and improve heart failure symptoms such as fatigue. Yet it also has the potential to worsen heart failure, and there is conflicting research about whether it interacts with digoxin.

“Overall, more quality research and well-powered randomized controlled trials are needed to better understand the risks and benefits of complementary and alternative medicine therapies for people with heart failure,” said Chow. “This scientific statement provides critical information to health care professionals who treat people with heart failure and may be used as a resource for consumers about the potential benefit and harm associated with complementary and alternative medicine products.”

____________________

No doubt, this assessment is a laudable attempt to inform patients responsibly. Personally, I am always a bit skeptical about such broad statements. SCAM encompasses some 400 different therapies, and I doubt that these can all be assessed in one single overview.

It is not difficult to find SCAMs that seem to have not been considered. Take this systematic review, for instance. It included 24 RCTs (n = 1314 participants) of 9 different mind-body interventions (MBI) types: Tai Chi (n = 7), yoga (n = 4), relaxation (n = 4), meditation (n = 2), acupuncture (n = 2), biofeedback (n = 2), stress management (n = 1), Pilates (n = 1), and reflexology (n = 1). Most (n = 22, 95.8%) reported small-to-moderate improvements in quality of life (14/14 studies), exercise capacity (8/9 studies), depression (5/5 studies), anxiety and fatigue (4/4 studies), blood pressure (3/5 studies), heart rate (5/6 studies), heart rate variability (7/9 studies), and B-type natriuretic peptide (3/4 studies). Studies ranged from 4 minutes to 26 weeks and group sizes ranged from 8 to 65 patients per study arm.

The authors concluded that, although wide variability exists in the types and delivery, RCTs of MBIs have demonstrated small-to-moderate positive effects on HF patients’ objective and subjective outcomes. Future research should examine the mechanisms by which different MBIs exert their effects.

Or take this systematic review of 38 RCTs of oral TCM remedies. The majority of the included trials were assessed to be of high clinical heterogeneity and poor methodological quality. The main results of the meta-analysis showed improvement in total MLHFQ score when oral Chinese herbal medicine plus conventional medical treatment (CMT) compared with CMT with or without placebo [MD = -5.71 (-7.07, -4.36), p < 0.01].

The authors concluded that there is some encouraging evidence of oral Chinese herbal medicine combined with CMT for the improvement of QoL in CHF patients. However, the evidence remains weak due to the small sample size, high clinical heterogeneity, and poor methodological quality of the included trials. Further, large sample size and well-designed trials are needed.

Don’t get me wrong: I am not saying that TCM remedies are a viable option – in fact, I very much doubt it – but I am saying that attempts to provide comprehensive overviews of all SCAMs are problematic, and that incomplete overviews are just that: incomplete.

Onion water seems to be all the rage these days. Advocates claim that it is a natural cold and flu remedy that can help the body heal faster and kick symptoms like coughing and congestion. And many consumers who feel threatened by flu, COVID, and various respiratory infections believe them.

But what on earth is onion water? It is precisely what it sounds like: onion immersed in water. Preparation starts with cutting up raw red or yellow onions, placing them into a bowl, and adding water. The fresh onion and water mixture should then soak for about 12 hours. After that, the onion water is ready for consumption.

Besides being a recipe for bad breath, can onion water actually relieve any symptoms, or help the body heal from infections?

A review of the evidence concluded that “effect of onion and its constituents on oxidative stress, inflammatory and immune system were shown indicating their therapeutic value in treatment of various diseases associated with oxidative stress, inflammation, and immune-dysregulation.”

This may sound encouraging but the review was based mostly on pre-clinical evidence, and the question, therefore, remains: are there any good trial data?

Another recent review included clinical trials (where available) and concluded that “possible bronchodilatory and preventive effects of onion and Qt on asthma and other obstructive respiratory diseases. The effects of the plant and its constituents on lung cancer, lung infections, and allergic disorders were also reported both in experimental and clinical studies. However, before preparing drugs based on A. cepa and its constituents for clinical practice, further standard clinical trials are needed to be performed.”

In other words, compelling trial evidence that preparations from onion are effective against viral infections does not exist.

And what about homeopathy?

Homeopaths frequently use potentised onion as a remedy for conditions that cause eyes to water (because ‘like cures like’). Is there any sound evidence that homeopathic onion remedies are better than a placebo? You probably guessed: the answer is NO!

So, no good evidence for onion, potentised onion, onion water, or any other preparations of onion. My advice, therefore, is to continue using your onions in the kitchen rather than in the medicine cabinet.

The Sunday Times reported yesterday reported that five NHS trusts currently offer moxibustion to women in childbirth for breech babies, i.e. babies presenting upside down. Moxibustion is a form of Traditional Chinese Medicine (TCM) where mugwort is burned close to acupuncture points. The idea is that this procedure would stimulate the acupuncture point similar to the more common way using needle insertion. The fifth toe is viewed as the best traditional acupuncture point for breech presentation, and the treatment is said to turn the baby in the uterus so that it can be delivered more easily.

At least four NHS trusts are offering acupuncture and reflexology with aromatherapy to help women with delayed pregnancies, while 15 NHS trusts offer hypnobirthing classes. Some women are asked to pay fees of up to £140 for it. These treatments are supposed to relax the mother in the hope that this will speed up the process of childbirth.

The Nice guidelines on maternity care say the NHS should not offer acupuncture, acupressure, or hypnosis unless specifically requested by women. The reason for the Nice warning is simple: there is no convincing evidence that these therapies are effective.

Campaigner Catherine Roy who compiled the list of treatments said: “To one degree or another, the Royal College of Midwives, the Care Quality Commission and parts of the NHS support these pseudoscientific treatments.

“They are seen as innocuous but they carry risks, can delay medical help and participate in an anti-medicalisation stance specific to ‘normal birth’ ideology and maternity care. Nice guidelines are clear that they should not be offered by clinicians for treatment. NHS England must ensure that pseudoscience and non-evidence based treatments are removed from NHS maternity care.”

Birte Harlev-Lam, executive director of the Royal College of Midwives (RCM), said: “We want every woman to have as positive an experience during pregnancy, labour, birth and the postnatal period as possible — and, most importantly, we want that experience to be safe. That is why we recommend all maternity services to follow Nice guidance and for midwives to practise in line with the code set out by the Nursing and Midwifery Council.”

A spokeswoman for Nice said it was reviewing its maternity guidelines. NHS national clinical director for maternity and women’s health, Dr Matthew Jolly, said: “All NHS services are expected to offer safe and personalised clinical care and local NHS areas should commission core maternity services using the latest NICE and clinical guidance. NHS trusts are under no obligation to provide complementary or alternative therapies on top of evidence-based clinical care, but where they do in response to the wishes of mothers it is vital that the highest standards of safety are maintained.”

On this blog, we have repeatedly discussed the strange love affair of midwives with so-called alternative medicine (SCAM), for instance, here. In 2012, we published a summary of 19 surveys on the subject. It showed that the prevalence of SCAM use varied but was often close to 100%. Much of it did not seem to be supported by strong evidence for efficacy. We concluded that most midwives seem to use SCAM. As not all SCAMs are without risks, the issue should be debated openly. Today, there is plenty more evidence to show that the advice of midwives regarding SCAM is not just not evidence-based but also often dangerous. This, of course, begs the question: when will the professional organizations of midwifery do something about it?

It has been reported that a Vancouver naturopath has been fined and temporarily suspended after a patient complained he failed to notice a rectal tumor during four months of treatment for hemorrhoids.

Jordan Atkinson will have to pay $5,000 and lose his license for 16 days after signing a consent agreement with the College of Naturopathic Physicians of B.C., according to a public notice posted by the COLLEGE OF NATUROPATHIC PHYSICIANS OF BRITISH COLUMBIA.

A former patient had filed the complaint when another medical professional diagnosed a tumor on the rectum following “several appointments” with Atkinson for hemorrhoid treatment. “The patient complained that Dr. Atkinson failed to detect the tumor because he did not perform a competent examination,” the college notice says.  ‘Doctor’ Atkinson disagreed with that allegation but admitted that he didn’t fully document his appointments with the patient.

The college’s inquiry committee, which investigates complaints, found that “Dr. Atkinson’s treatment of the patient fell short of the standard of practice required of a naturopathic doctor in these circumstances.”  Atkinson who is also the subject of a lawsuit from a patient who alleges he seriously injured her while injecting Botox into her face at the base of her nose, has also agreed to a reprimand and “to make reasonable efforts when a language barrier exists to ensure that his patients understand the treatment plan and provide informed consent.” 

Personally, I find it hard to believe that any health professional can administer a prolonged treatment for hemorrhoids, while the patient is actually suffering from a rectal tumor which might well be malign. I find it even harder to believe that, after a complaint had been filed by a victim, the professional body of this professional suspends his license for just 16 days.

In my view, this suggests that this professional body (like so many in the realm of so-called alternative medicine (SCAM)) is not fit for purpose. That is to say, it does clearly not fulfill its main task adequately which is to protect the public from the malpractice of its members. Rather it seems to prioritize the interests of the member over those of the public. Yet, on its website the COLLEGE OF NATUROPATHIC PHYSICIANS OF BRITISH COLUMBIA state that “the College protects the public interest by ensuring that naturopathic physicians in British Columbia practice safely, ethically, and competently.” As so often in SCAM, what is being stated and what is being done differs dramatically.

At the heart of this and many similar cases, I fear, is that consumers find it difficult to differentiate between well-educated healthcare professionals and poorly trained charlatans. And who could blame them? Calling naturopaths ‘doctors’ cannot be helpful, particularly if the ‘Dr.-title’ is used without a clear qualification that the person who carries it has never seen the inside of a medical school; instead he has learned an abundance of nonsense taught by a quack institution.

In summary one is tempted to conclude that this case yet again confirms that naturopaths are medically incompetent graduates of schools of incompetence protected by organizations of incompetence.

The U.S. Food and Drug Administration issued warning letters to seven companies for illegally selling dietary supplements that claim to cure, treat, mitigate or prevent cardiovascular disease or related conditions, such as atherosclerosis, stroke or heart failure, in violation of the Federal Food, Drug, and Cosmetic Act (FD&C Act). The FDA is urging consumers not to use these or similar products because they have not been evaluated by the FDA to be safe or effective for their intended use and may be harmful.

The warning letters were issued to:

“Given that cardiovascular disease is the leading cause of death in the U.S., it’s important that the FDA protect the public from products and companies that make unlawful claims to treat it. Dietary supplements that claim to cure, treat, mitigate or prevent cardiovascular disease and related conditions could potentially harm consumers who use these products instead of seeking safe and effective FDA-approved treatments from qualified health care providers,” said Cara Welch, Ph.D., director of the Office of Dietary Supplement Programs in the FDA’s Center for Food Safety and Applied Nutrition. “We encourage consumers to remain vigilant when shopping online or in stores to avoid purchasing products that could put their health at risk.”

Under the FD&C Act, products intended to diagnose, cure, treat, mitigate or prevent disease are drugs and are subject to the requirements that apply to drugs, even if they are labeled as dietary supplements. Unlike drugs approved by the FDA, the agency has not evaluated whether the unapproved products subject to the warning letters announced today are effective for their intended use, what the proper dosage might be, how they could interact with FDA-approved drugs or other substances, or whether they have dangerous side effects or other safety concerns.

The FDA advises consumers to talk to their doctor, pharmacist or other health care provider before deciding to purchase or use any dietary supplement or drug. Some supplements might interact with medicines or other supplements. Health care providers will work with patients to determine which treatment is the best option for their condition.

If a consumer thinks that a product might have caused a reaction or an illness, they should immediately stop using the product and contact their health care provider. The FDA encourages health care providers and consumers to report any adverse reactions associated with FDA-regulated products to the agency using MedWatch or the Safety Reporting Portal.

The FDA has requested responses from the companies within 15 working days stating how they will address the issues described in the warning letters or provide their reasoning and supporting information as to why they think the products are not in violation of the law. Failure to correct violations promptly may result in legal action, including product seizure and/or injunction.

Quackery is rife in India. On this blog, I have occasionally reported on this situation, e.g.:

Now the Chief Justice of India (CJI) NV Ramana has pointed out that legislation needs to be brought in to save people “from falling prey to fraudulent practices in the name of treatment”. Speaking at the inaugural National Academy of Medical Sciences on ‘Law and Medicine’, the CJI said: “Quackery is the biggest disease affecting India” and that hospitals are “being run like companies, where profit-making is more important than service to society”. The CJI added, “another side of lack of accessible healthcare is giving space to quacks. Quackery begins where awareness ends. Where there is room for myths, there is room for quackery”. He continued, “Owing to the financial and time constraints, a huge majority of the Indian population approaches these untrained and uncertified doctors. Lack of awareness and knowledge, misplaced belief, and sheer inaccessibility have massive ramifications on the health of the country, particularly the rural and underprivileged Indian … The need of the hour is to bring in legislation to save people from falling prey to fraudulent practices in the name of treatment … Private hospitals are being opened at an exponential rate. This is not necessarily a bad thing, but there is a glaring need for balance. We are seeing hospitals being run like companies, where profit-making is more important than service to society.”

I am sure the CJI is correct; India does have a quackery problem. If nothing else, the fact that one website lists a total of 746 Alternative Medicine Colleges in India, leaves little doubt about it.

In recent weeks, I have been thinking a lot about ‘INTEGRATIVE MEDICINE‘. Skeptics mostly see it as a way of smuggling quackery into conventional healthcare. This is undoubtedly true and important. But it occurred to me that there also is a somewhat different perspective that has so far been neglected. Let me try to explain by recounting a story. It is fictive, of course, but the fiction is based on the observation of many cases during previous decades.

The story is about a doctor – let’s call him George – who, to be frank, is not the most gifted of his colleagues. Already at medical school, he was not as dedicated as his teachers would have hoped. In fact, medicine had not been his first choice at all. Yet he ended up as a general practitioner and eventually became a partner in a practice with 5 GPs.

Over the years, it became clear that George lacked something to be a good doctor. He knew his stuff, alright, got most of the diagnoses correct, and made not too many mistakes. But something was not quite right. One could say that, relative to his colleagues, he lacked kindness, dedication, compassion, and empathy. He often found it unnecessary to respect his patients. Sometimes, he even joked about them and about what he perceived as their stupidity.

If we view medicine as being both a science and an art, one might conclude that George was just about alright with the science but notably deficient in the art of healthcare. Most of his patients were aware that something was amiss; many even avoided him and tried to consult one of his colleagues instead. On more than one occasion, patients had told George that they were disappointed with his attitude. Some had even told him to the face that he lacked kindness. Such conversations made George think. He had to admit to himself that his colleagues were better at building good relationships with their patients. Eventually, George decided that something ought to change.

As it happened, George’s wife had a friend who was a Reiki healer. One day, he asked the healer – let’s call her Liz – whether she would like to try working alongside the GPs in his practice. Liz was delighted and accepted. George did not believe for a minute that Reiki was more than hocus-pocus, but he knew that Liz was kind and had loads of the compassion that he was so obviously lacking.

Hence force George and Liz formed a team: George looked after his patients the best he could and whenever he felt that more empathy and compassion were required, he would send the patient to Liz. This partnership changed everything. The patients were content, George was happy, and Liz was beaming.

As some patients frowned at the idea of Reiki, George soon recruited an aromatherapist as well. After that, a lay homeopath and a reflexologist were employed. George’s GP partners (who made little use of the alternative practitioners) were sure that none of these therapies had any specific effects (incidentally, a belief not shared by the practitioners in question who felt they were doing wonders). But for George, the therapists clearly did supplement his limited interpersonal skills. Patients were delighted and the GP practice began to thrive. As for George, he became an increasingly outspoken and prominent advocate of INTEGRATED MEDICINE. The fact that there was no evidence to support it did hardly matter to him; what counted was that it rendered his own incompetence less visible.

About a year later, George convinced his slightly bewildered partners to rename their practice ‘THE INTEGRATIVE HEALTH CENTRE’.

End of story

In case you did not get my point, let me make it more bluntly: INTEGRATIVE MEDICINE can be a way for some doctors to delegate the art of medicine to quacks. Good doctors don’t need to do this because they are able to show compassion and treat their patients as whole human beings. Less gifted doctors, however, find INTEGRATIVE MEDICINE a practical solution to their own incompetence.

So, is INTEGRATIVE MEDICINE a good compromise then?

No, certainly not!

The last thing we need in healthcare is for doctors to start delegating the art of medicine to others. It would be a serious mistake, nothing less than abandoning the core values of medicine to charlatans.

But what is the solution?

Obviously, it is to make sure all doctors are competent. We need to select medical students adequately, tell them much more about the importance of kindness, compassion, empathy, holism, etc., and teach them how to show and use these qualities. We need to train doctors to be competent in both the science and the art of medicine. This has to begin in medical school and must continue throughout their professional career. We need to make sure that doctors like George understand the message; if they prove to be unable to do so, we should direct them to professions where compassion is not essential.

The worst solution we can possibly envisage is to allow charlatans to cover up the incompetence of people like George and call it INTEGRATED MEDICINE.

 

This study described osteopathic practise activity, scope of practice and the osteopathic patient profile in order to understand the role osteopathy plays within the United Kingdom’s (UK) health system a decade after the authors’ previous survey.

The researchers used a retrospective questionnaire survey design to ask about osteopathic practice and audit patient case notes. All UK-registered osteopaths were invited to participate in the survey. The survey was conducted using a web-based system. Each participating osteopath was asked about themselves, and their practice and asked to randomly select and extract data from up to 8 random new patient health records during 2018. All patient-related data were anonymized.

The survey response rate was 500 osteopaths (9.4% of the profession) who provided information about 395 patients and 2,215 consultations. Most osteopaths were:

  • self-employed (81.1%; 344/424 responses),
  • working alone either exclusively or often (63.9%; 237/371),
  • able to offer 48.6% of patients an appointment within 3 days (184/379).

Patient ages ranged from 1 month to 96 years (mean 44.7 years, Std Dev. 21.5), of these 58.4% (227/389) were female. Infants <1 years old represented 4.8% (18/379) of patients. The majority of patients presented with musculoskeletal complaints (81.0%; 306/378) followed by pediatric conditions (5%). Persistent complaints (present for more than 12 weeks before the appointment) were the most common (67.9%; 256/377) and 41.7% (156/374) of patients had co-existing medical conditions.

The most common treatment approaches used at the first appointment were:

  • soft-tissue techniques (73.9%; 292/395),
  • articulatory techniques (69.4%; 274/395),
  • high-velocity low-amplitude thrust (34.4%; 136/395),
  • cranial techniques (23%).

The mean number of treatments per patient was 7 (mode 4). Osteopaths’ referral to other healthcare practitioners amounted to:

  • GPs 29%
  • Other complementary therapists 21%
  • Other osteopaths 18%

The authors concluded that osteopaths predominantly provide care of musculoskeletal conditions, typically in private practice. To better understand the role of osteopathy in UK health service delivery, the profession needs to do more research with patients in order to understand their needs and their expected outcomes of care, and for this to inform osteopathic practice and education.

What can we conclude from a survey that has a 9% response rate?

Nothing!

If I ignore this fact, do I find anything of interest here?

Not a lot!

Perhaps just three points:

  1. Osteopaths use high-velocity low-amplitude thrusts, the type of manipulation that has most frequently been associated with serious complications, too frequently.
  2. They also employ cranial osteopathy, which is probably the least plausible technique in their repertoire, too often.
  3. They refer patients too frequently to other SCAM practitioners and too rarely to GPs.

To come back to the question asked in the title of this post: What do UK osteopaths do? My answer is

ALMOST NOTHING THAT MIGHT BE USEFUL.

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