patient choice
It has been reported that a father accused of withholding insulin from his eight-year-old diabetic daughter and relying on the healing power of God has been committed to stand trial for her alleged murder.
Jason Richard Struhs, his wife Kerrie, and 12 others from a fringe religious group have been charged over the death of type 1 diabetic Elizabeth Rose Struhs. Police alleged she had gone days without insulin and then died. The police prosecutor detailed statements from witnesses and experts, including pediatric consultant Dr. Catherine Skellern, who said Elizabeth’s death “would have been painful and was over a prolonged period of days”.
“There is [also] body-worn camera footage at the scene … where Jason Struhs has recounted the events of the week leading up to the death of Elizabeth,” said the prosecutor. “This details the decision that Jason Struhs has made to stop the administration of insulin, and he stated that he knew the consequences, and he stated in that recording that he will ‘probably go to jail like they put Kerrie in jail’.”
During the hearing, Struhs, who appeared from jail by videolink, mainly sat with his head bowed and hands clasped against his forehead as magistrate Clare Kelly described the evidence against him. “It is said that Mr. Struhs, his wife Kerrie Struhs, and their children, including Elizabeth, were members of a religious community… The religious beliefs held by the members of the community include the healing power of God and the shunning of medical intervention in human life.” She also described a statement from Skellern suggesting Elizabeth would have spent her final days suffering from “insatiable thirst, weakness and lethargy, abdominal pain, incontinence, and the onset of impaired levels of consciousness”. The evidence read into court was an attempt by prosecutors to firm up an additional charge of torture. She said a post-mortem found Elizabeth’s cause of death was diabetic ketoacidosis, caused by a lack of insulin. “It is a life-threatening condition, which requires urgent medical treatment,” Kelly said.
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Cases like these are tragic, all the more so because they might have been preventable with more information and critical thinking. They make me desperately sad, of course, but they also convince me that my work with this blog should continue.
Advocates of so-called alternative medicine (SCAM) often sound like a broken record to me. They bring up the same ‘arguments’ over and over again, no matter whether they happen to be defending acupuncture, energy healing, homeopathy, or any other form of SCAM. Here are some of the most popular of these generic ‘arguments’:
1. It helped me
The supporters of SCAM regularly cite their own good experiences with their particular form of treatment and think that this is proof enough. However, they forget that any symptomatic improvement they may have felt can be the result of several factors that are unrelated to the SCAM in question. To mention just a few:
- Placebo
- Regression towards the mean
- Natural history of the disease
2. My SCAM is without risk
Since homeopathic remedies, for instance, are highly diluted, it makes sense to assume that they cannot cause side effects. Several other forms of SCAM are equally unlikely to cause adverse effects. So, the notion is seemingly correct. However, this ‘argument’ ignores the fact that it is not the therapy itself that can pose a risk, but the SCAM practitioner. For example, it is well documented – and, on this blog, we have discussed it often – that many of them advise against vaccination, which can undoubtedly cause serious harm.
3. SCAM has stood the test of time
It is true that many SCAMs have survived for hundreds or even thousands of years. It is also true that millions still use it even today. This, according to enthusiasts, is sufficient proof of SCAM’s efficacy. But they forget that many therapies have survived for centuries, only to be proved useless in the end. Just think of bloodletting or mercury preparations from past times.
4 The evidence is not nearly as negative as skeptics pretend
Yes, there are plenty of positive studies on some SCAMs This is not surprising. Firstly, from a purely statistical point of view, if we have, for instance, 1 000 studies of a particular SCAM, it is to be expected that, at the 5% level of statistical significance, about 50 of them will produce a significantly positive result. Secondly, this number becomes considerably larger if we factor in the fact that most of the studies are methodologically poor and were conducted by SCAM enthusiasts with a corresponding bias (see my ALTERNATIVE MEDICINE HALL OF FAME on this blog). However, if we base our judgment on the totality of the most robust studies, the bottom line is almost invariably that there is no overall convincingly positive result.
5. The pharmaceutical industry is suppressing SCAM
SCAM is said to be so amazingly effective that the pharmaceutical industry would simply go bust if this fact became common knowledge. Therefore Big Pharma is using its considerable resources to destroy SCAM. This argument is fallacious because:
- there is no evidence to support it,
- far from opposing SCAM, the pharmaceutical industry is heavily involved in SCAM (for example, by manufacturing homeopathic remedies, dietary supplements, etc.)
6 SCAM could save a lot of money
It is true that SCAMs are on average much cheaper than conventional medicines. However, one must also bear in mind that price alone can never be the decisive factor. We also need to consider other issues such as the risk/benefit balance. And a reduction in healthcare costs can never be achieved by ineffective therapies. Without effectiveness, there can be no cost-effectiveness.
7 Many conventional medicines are also not evidence-based
Sure, there are some treatments in conventional medicine that are not solidly supported by evidence. So why do we insist on solid evidence for SCAM? The answer is simple: in all areas of healthcare, intensive work is going on aimed at filling the gaps and improving the situation. As soon as a significant deficit is identified, studies are initiated to establish a reliable basis. Depending on the results, appropriate measures are eventually taken. In the case of negative findings, the appropriate measure is to exclude treatments from routine healthcare, regardless of whether the treatment in question is conventional or alternative. In other words, this is work in progress. SCAM enthusiasts should ask themselves how many treatments they have discarded so far. The answer, I think, is zero.
8 SCAM cannot be forced into the straitjacket of a clinical trial
This ‘argument’ surprisingly popular. It supposes that SCAM is so individualized, holistic, subtle, etc., that it defies science. The ‘argument’ is false, and SCAM advocates know it, not least because they regularly and enthusiastically cite those scientific papers that seemingly support their pet therapy.
9 SCAM is holistic
This may or may not be true, but the claim of holism is not a monopoly of SCAM. All good medicine is holistic, and in order to care for our patients holistically, we certainly do not need SCAM.
1o SCAM complements conventional medicine
This argument might be true: SCAM is often used as an adjunct to conventional treatments. Yet, there is no good reason why a complementary treatment should not be shown to be worth the effort and expense to add it to another therapy. If, for instance, you pay for an upgrade on a flight, you also want to make sure that it is worth the extra expenditure.
11 In Switzerland it works, too
That’s right, in Switzerland, a small range of SCAMs was included in basic health care by referendum. However, it has been reported that the consequences of this decision are far from positive. It brought no discernible benefit and only caused very considerable costs.
I am sure there are many more such ‘arguments’. Feel free to post your favorites!
My point here is this:
the ‘arguments’ used in defense of SCAM are not truly arguments; they are fallacies, misunderstandings, and sometimes even outright lies.
The problems for homeopathy in Germany do not seem to stop. Recently, the German health minister announced that he will look at the issue of reimbursement of homeopathy. Now, an article in the Deutsche Apotheker Zeitung (German Journal for Pharmacists) critically discussed the question of the place of homeopathy in German pharmacies. At present, pharmacies are the only places that are allowed to sell homeopathic preparations. This undoubtedly gives them a veneer of respectability; many consumers seem to feel that, if homeopathic preparations are only available in pharmacies, they must be well-tested and effective.
But recently, more and more German pharmacists have been pointing out that homeopathy is ineffective nonsense. A journalist who had listened to the advanced training “Homeopathy Highlights” of the Westphalia-Lippe Chamber of Pharmacists, he subsequently confronted the Chamber with the controversial contents of this advanced training event. The Chamber then declared that it would “no longer offer any refresher seminars on the subject of homeopathy with immediate effect” and that the speaker would also no longer work for it.
And now, the Berlin Chamber of Pharmacists wants the pharmacy community to distance itself from homeopathy as a scientifically recognized and evidence-based drug therapy. With its motion, the Chamber wants to achieve that the title “Naturopathic Medicine and Homeopathy” of the training regulations is replaced by the title “Phytopharmacy and Naturopathy”. The justification states: “The permission to use the title ‘pharmacist for naturopathic treatment and homeopathy’ by the state chambers of pharmacists suggests that homeopathy is a scientifically recognized and evidence-based drug therapy”.
I think it is time that German pharmacists remind themselves that they are more than shopkeepers; they are healthcare professionals who have an ethical duty. I have discussed this issue often enough. If you are interested, here are a few of my posts on this subject:
- Pharmacists must advise customers that homeopathic remedies lack evidence
- “Pharmacists should not sell or dispense homeopathic products”
- German pharmacists fail their customers when advising them on homeopathy
- Pharmacists put themselves at risk by selling homeopathic remedies
- Pro and Contra: should UK community pharmacists sell homeopathic remedies?
- Pharmacists’ responsibilities vis a vis alternative medicine: the violation of healthcare ethics continues.
- It is “disappointing that some pharmacists are still stocking homeopathy products”
- Pharmacists: to sell quackery means you are quacks – or have I got that wrong?
- Pharmacists must use their professional judgement to prevent the supply of homeopathic remedies
It is high time that German pharmacists do the right thing!
One of my previous posts was about a press release announcing a ‘WORLDWIDE DECLARATION’, and I promised to comment about the actual declaration. This post firstly reproduces this document and secondly provides a few comments on it. Here is the document:
DEFINITIONS
Traditional, complementary and integrative healthcare (TCIH) refers to the respectful collaboration between various systems of healthcare and their health professionals with the aim of offering a person-centred and holistic approach to health.
ABOUT US
We represent a worldwide community of users and health professionals of TCIH with a large diversity of backgrounds and experiences with a common commitment to the advancement and
promotion of TCIH.
THE HEALTHCARE WE DESIRE
• Focuses on the whole person, including physical, mental, social and spiritual dimensions
• Is patient-centred and supports self-healing and health creation
• Is participative and respects individual choices
• Is evidence-based by integrating clinical experience and patient values with the best available research information
• Respects cultural diversity and regional differences
• Is an integral part of community and planetary health
• Uses natural and sustainable resources that are respectful of the health of our planet
• Integrates traditional, complementary and biomedical practices in a supportive and collaborative manner
We appreciate the benefits of conventional / biomedicine. At the same time we recognize its limitations, including:
• The insufficient therapeutic options that biomedicine provides, especially for chronic / non-communicable diseases (NCDs)
• Frequent side effects of biomedical treatments and rising antimicrobial resistance
• Fragmentation of care from increased specialization and the limits of a disease-based model
We are inspired by countries that are successfully integrating TCIH into their healthcare systems. However, we are concerned about:
• Countries that prevent, limit or undervalue the practice of TCIH
• Uninformed or unbalanced media reporting of TCIH
• Insufficient public funding of TCIH research
• Risk of reduced availability of TCIH and unregulated practices in some countries
OUR CALL TO ACTION
All countries
• Ensure full access to TCIH as part of the right to health for all
• Include TCIH into national health systems
• Provide accreditation of TCIH healthcare professionals in accordance with international training standards to ensure high quality care
• Ensure access and safety of TCIH medicines through specific regulatory pathways
• Fund research on TCIH and disseminate reliable information on TCIH to the public
All healthcare professionals
• Foster respectful collaboration between all healthcare professions towards achieving a person-centred and holistic approach to healthcare
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And here are my comments.
- “TCIH”: in the realm of so-called alternative medicine it seems popular to create a new name for the subject at hand; this one is yet another one in a long line of innovations – sadly, it is as nonsensical as most of the previous ones.
- Person-centred and holistic approach to health: all good healthcare has these qualities.
- We represent a worldwide community: really? Who exactly are you then, and what is your ligitimization?
- Whole person, including physical, mental, social and spiritual dimensions: all good healthcare has these qualities.
- Patient-centred and supports self-healing and health creation: all good healthcare has these qualities.
- Respects individual choices: all good healthcare has these qualities.
- Evidence-based: either they do not know what this term means or they are deliberately misleading the public.
- Integral part of community and planetary health: all good healthcare has these qualities.
- Natural and sustainable resources that are respectful of the health of our planet: like Rhino horn and similar ingredients of TCM products?
- Insufficient therapeutic options that biomedicine provides: yes, conventional medicine is far from perfect, but adding something even less perfect to it cannot improve it.
- Frequent side effects of biomedical treatments and rising antimicrobial resistance: yes, conventional medicine is far from perfect, but adding something even less perfect to it cannot improve it.
- Full access to TCIH as part of the right to health for all: the ‘right to health for all’ means the right to the most effective therapies not the right to the most bizarre quackery.
- Accreditation of TCIH healthcare professionals: giving respectability to every quack would not render healthcare better or safer but worse and more dangerous.
- Access and safety of TCIH medicines through specific regulatory pathways: regulating access to unproven treatments is nothing less than a recipe for disaster.
- Research on TCIH: yes in some areas, research might be worthwhile, but it must be rigorously testing TCIH and not promoting it uncritically.
- Disseminate reliable information on TCIH to the public: thank you! This is my main aim in writing the ~2500 posts on this blog. Yet I do often get the impression that this gets disappointingly little support – and frequently the exact opposite – from enthusiasts of TCIH.
I reported about the activities of Eurocam before (see here) and I was distinctly underwhelmed with this quackery lobby group. Now they have published a press release about a ‘worldwide declaration’ in favor of integrated medicine. Here is my translation of the press release (I will comment on the actual declaration at a later stage):
With a declaration, Eurocam and the European Federation of Homeopathic Patient’s Association, among others, call for an open scientific discourse, more research funds, and more promotion of young researchers in the field of integrative medicine. The declaration is supported by the German Central Association of Homeopathic Physicians and the Homeopathy Research Institute (HRI), among others. Integrative medicine combines conventional and complementary elements in health care for the benefit of patients. The goal is patient-centred and holistic health care. Already 130 organisations have committed themselves to these goals in the medical care of the population in the Declaration.
Integrative medicine integrates complementary and conventional methods
In addition, the Declaration advocates health care that takes the whole person into account in its psychological, mental, social and spiritual dimensions. Integrative medicine in the sense of the Declaration is patient-centred and supports the body’s own regulatory abilities. In addition, it is participatory and respects individual decisions with regard to medical care. It is committed to the evidence of medical procedures, which is based on experience, patient preferences and research findings. It incorporates cultural diversity and regional differences as well as the concepts of community health and planetary health. Integrative medicine uses natural and sustainable resources and integrates complementary and conventional medical procedures.
Integrative medicine: Opportunities especially for chronic diseases and side effects
The supporters of the Declaration see opportunities for integrative medicine above all in chronic and non-communicable diseases, as well as in the frequent side effects of conventional therapies and increasing antibiotic resistance. Conventional medicine is characterised by fragmentation and divisional thinking within medical care, as well as by the increasing specialisation of the health professions. The holistic view of the patient is thus left out. Against this backdrop, the Declaration advocates anchoring integrative medicine as a legal entitlement in health care and integrating it into national health care systems. International training standards should be adapted with integrative medicine in mind, and research projects should be promoted. At the same time, balanced and high-quality patient information is needed.
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This press release requires a few short comments, in my view:
- “Integrative medicine combines conventional and complementary elements in health care for the benefit of patients.” Anyone who cares to research for longer than 10 minutes will find that very often the complementary elements are unproven and disproven treatments.
- “The goal is patient-centred and holistic health care.” By integrating unproven and disproven treatments into routine care, medicine cannot become more patient-centred but must get less effective and more expensive.
- “The Declaration advocates health care that takes the whole person into account in its psychological, mental, social and spiritual dimensions.” Any good healthcare aims at doing this.
- “Individual decisions with regard to medical care” are respected in all forms of healthcare.
- “Side effects of conventional therapies and increasing antibiotic resistance” are regrettable phenomena and much research is going on to minimize them. So-called alternative medicine (SCAM) has not yet been shown to offer a single solution to these problems.
- “The holistic view of the patient is left out” in conventional medicine. One of the most popular fallacies with SCAM advocates is the strawman fallacy.
I find the text almost comical. It reveals thought processes that lack even the most fundamental rules of logic. One really does get the impression that it had been written by people who are deplorably naive, misinformed, and quite frankly stupid.
When I first heard about it, I thought it was a hoax – nobody can be that daft, I felt. Then I did a bit of research and found that I had been wrong: some people evidently can be that daft and are trying to promote a new SCAM.
Yes, I am speaking of SPERM SMOOTHIES.
And it’s not even a new thing. One sperm smoothie fan boasted 2 years ago: “My immune system is far stronger than it’s ever been. I no longer catch colds or the flu — even when my children get sick from school! I have such high energy levels, feel positive and enthusiastic and have focus and clarity throughout my day whilst most parents feel tired, crave junk food and struggle with forgetfulness.”
In 2021, THE SUN reported this :
Tracy Kiss, 33, from Buckinghamshire, previously told how she put a spoonful of her best friend’s donated semen into her drink every morning in a bid to boost her immunity.
The personal trainer, who is mum to Millie and Gabrille, has previously advocated using sperm as a facial ointment.
She spoke as celebrity facialist Chelsee Lewis claimed it actually worked to reduce wrinkles.
On her bizarre beverage concoction, Tracy said: “I’d been feeling run down and had no energy, but now I’m full of beans and my mood has improved.
“It can taste really good – depending on what my friend has been eating. My other mates think I’m strange, but I don’t give a toss.”
Tracy, who is a vegan, roped her single pal into giving her his semen. She previously told how he pops round with a fresh tub three times a week.
“I know he’s healthy, doesn’t smoke, drink or do drugs and I made him have an STI check,” she said.
“When I first approached him, he was concerned I’d use it to impregnate myself.
“But once I’d convinced him it was for my beauty regime he agreed – after all, he has a regular supply at hand!”
Tracy, a qualified nutritional adviser and personal trainer, told how she kept it in her fridge.
She mixes the semen with fruit, seeds, coconut or almond milk – but is also happy to drink it on its own.
“Every batch tastes different, depending on what he’s been eating,” she said.
“If he’s been drinking alcohol or eaten something particularly pungent like asparagus, I ask him to give me a heads up so I know not to drink it neat.
“Things like pineapple and peppermint make it taste better, but I’ll happily take it straight off a spoon usually.”
Tracy has filmed a YouTube video where she talks through her unusual remedy and explains what it tastes like.
“We look at its smoothness and texture, discuss its benefits and then I show people who I use a teaspoon to eat the sperm,” she said.
“Sperm is an awesome product and we should stop being so ridiculous about it – the health benefits have been well researched and more women and men should take advantage of it particularly as its made by our own bodies and doesn’t contain e-numbers and chemicals.”
________________________________
The question I ask myself is this: are sperm smoothies really a new SCAM or are they just a way for some strange people to get their 5 minutes of fame? I sincerely hope it is the latter.
There is a broad, growing, international consensus that homeopathy is a placebo therapy. Even the Germans who have been notoriously fond of their homeopathic remedies are now slowly beginning to accept this fact. But now, a dispute has started to smolder in Germany’s southwest about further training for doctors in homeopathy. In July, the representative assembly of the Baden-Württemberg Medical Association decided to remove the additional title of homeopathy from the further training regulations of doctors. However, the local health ministry has legal control over the medical association and must therefore review the decision, and the minister (Manne Lucha), a member of the Green Party, has stated that he considers the deletion to be wrong.
In a further deepening of the conflict, it has been reported that the chairwoman of the Green Party, Lena Schwelling, considers the ongoing controversy over homeopathy to be exaggerated and wants to preserve people’s freedom of choice. She said she agrees with Health Minister Manne Lucha that naturopathy and homeopathy are important issues for many people. “There is freedom of choice of doctor and therapy in this country. And if people want to choose it, I think they should be allowed to do so.” She also said continuing education for homeopathy for physicians should remain.
Schwelling spoke out against omitting homeopathy from the benefits catalog of the statutory health insurance funds, as demanded by the German Liberal Party, for example: “We are talking about about 0.003 percent of the total costs of the statutory health insurance funds, which flow into homeopathic medicines and treatments. If you saw that as a homeopathic medicine, that would also be at the detection limit, that’s how little money it is. It’s so diluted and so little in this overall budget that it’s not worth arguing about. That’s why I’m very surprised at the crusade some are waging against the issue of homeopathy.”
Recently, a dispute has been smoldering in the southwest about continuing education for homeopathy. The representative assembly of the Baden-Württemberg Medical Association decided in July to remove the additional title of homeopathy from the continuing education regulations. The local health minister, Lucha, has legal oversight of the medical association and must review the amendment statute. However, the minister has already stated that he believes the deletion is wrong.
In response, Schwelling stated it is a “normal process” for the ministry to review what the medical association has proposed. He added that it was perfectly clear that “further training in homeopathy is additional training and does not replace medical studies. Of course, homeopathic doctors also prescribe antibiotics when indicated. An important point why homeopathy should remain in the canon is that you then have the established control mechanisms, for example, in further education.”
While still at Exeter, we had a whole program examining so-called alternative medicines (SCAMs) for weight reduction. I thus can assure you of one thing: there are plenty out there! We also published many papers on the subject. The results can be summarized quite easily:
NONE OF THEM WORK CONVINCINGLY AND MANY ARE OUTRIGHT FRAUDULENT.
So I thought I had seen them all … until I saw this advertisement:
Hourglass S-line Waist Slimming Patch ingredients directly transfers them to your skin which then stimulates your body, kickstarts your metabolism and increases calorific burn. This process tones your skin, busts fat cells giving you a slimmer appearance with radiant looking skin.
Consist of 3 Key Ingredient For Hourglass S-line Waist Slimming Patch:
- Ay Tsao
- Wormwood
- Mint
Ay Tsao is a flowering plant that is mostly cultivated for its root, it decreases inflammation, stimulates digestion, and suppresses your appetite. These properties are effective ways promote weight loss. Experts says that this plant plays a huge role in providing a person with health benefits, determining decongestion and improving blood circulation.
Wormwood is regarded as a useful remedy for liver and gallbladder problems. Wormwood contains strong bitter agents known as absinthin and anabsinthin, which stimulate digestive and gallbladder function. Wormwood is believed to stimulate digestion and relieve spasms in the intestinal tract
Mint play an essential role in losing weight in a healthy way. Mint leaves promote digestion and boost metabolism to help in losing weight. Mint tea is a great refreshing calorie-free beverage to promote weight loss.
This is why Hourglass S-line Waist Slimming Patch is special
- Effectively prevent forming a waist fat.
- Accelerate the burning of fat.
- Maintaining a perfect body continuously.
- Extracting the essence from pure, safe, and healthy natural plants.
- Better sleep;
- Safe for daily use.
- Relieves gas and bloating.
- Slim down, and increase your energy levels for a better, healthier life.
- Made of high-quality material, with good breathability and adhesion.
Natalie’s Hourglass S-line Waist Slimming Patch report
Natalie Having trouble wearing dress because of her weight. She wanted a body that will make a dress look good for her. She gladly found this product online.
Here is the result…
Week 1
“Having a sexy body is always what I wanted. But what I can only do is light exercise. So I decided to use this Hourglass S-line Waist Slimming Patch. In just a week my body felt light. I still have a medium-sized belly but I’ll keep trying. Improvement is important and I see it with this product.”
Week 4
“I’m on day 30 of using this product. I love it. I combined its use with diet and light exercise. This is a good treatment for my muscles because Hourglass S-line Waist Slimming Patch also helps with muscle cramps or pain. I never feel my waist muscles working as well as they do when I’m using this product. I love feeling my body muscles actually moving in there. I literally KNOW this product is working my muscles for me. It’s incredible.”
Week 6
“After a month and a half, the result is great. I am amazed that the product is just as described. It will surely achieve the body that you want!! A must try for everyone, this patch is restrengthening muscles, or to add an extra kick in the gut for your exercise, this is it!”
Natalie Lopez — Toronto, Canada
This Patch saves you tons of money!
Hourglass S-line Waist Slimming Patch all natural ingredients are carefully made to make a huge impact not only to your skin but also saves you tons of money in the long run.
With this product you can avoid expensive sessions, time consuming appointments and you can use this patch at your home that can save transportations fare.
How to Use:
- Make sure your waist is dry and clean.
- Take 2 pcs patch and tear of the back then stick it to your both side waist.
- Remove after 3 – 8 hours a day.
______________________________________
I find it hard to believe that there are people who actually fall for such an advertisement. And the more I think about it, the sadder I feel. There are quite obviously some who believe such nonsense and get ripped off by irresponsible snake-oil salesmen. Not only does the product not work, but some of the ingredients are also potentially toxic.
I hope that my posing this will prevent a few people from wasting their hard-earned money on outright quackery:
None of the claims made in this advertisement is backed by evidence!
Traditional, complementary, and alternative medicine (TCAM) – as most of my readers know, I prefer the abbreviation SCAM for so-called alternative medicine – refers to a broad range of health practices and products typically not part of the ‘conventional medicine’ system. Its use is substantial among the general population. TCAM products and therapies may be used in addition to, or instead of, conventional medicine approaches, and some have been associated with adverse reactions or other harms.
The aims of this systematic review were to identify and examine recently published national studies globally on the prevalence of TCAM use in the general population, to review the research methods used in these studies, and to propose best practices for future studies exploring the prevalence of use of TCAM.
MEDLINE, Embase, CINAHL, PsycINFO, and AMED were searched to identify relevant studies published since 2010. Reports describing the prevalence of TCAM use in a national study among the general population were included. The quality of included studies was assessed using a risk of bias tool developed by Hoy et al. Relevant data were extracted and summarised.
Forty studies from 14 countries, comprising 21 national surveys and one cross-national survey, were included. Studies explored the use of TCAM products (e.g. herbal medicines), TCAM practitioners/therapies, or both. Included studies used different TCAM definitions, prevalence time frames and data collection tools, methods and analyses, thereby limiting comparability across studies. The reported prevalence of use of TCAM (products and/or practitioners/therapies) over the previous 12 months was 24–71.3%.
The authors concluded that the reported prevalence of use of TCAM (products and/or practitioners/therapies) is high, but may underestimate use. Published prevalence data varied considerably, at least in part because studies utilise different data collection tools, methods and operational definitions, limiting cross-study comparisons and study reproducibility. For best practice, comprehensive, detailed data on TCAM exposures are needed, and studies should report an operational definition (including the context of TCAM use, products/practices/therapies included and excluded), publish survey questions and describe the data-coding criteria and analysis approach used.
[Trends in prevalence of TCAM use by country for countries with at least two data collection waves from a nationally representative study. For data collected over several years (e.g. 2007–2009), the prevalence data are plotted at the end of the data collection period (e.g. 2009). Solid and perforated lines between consecutive points are for illustrative purposes only and are not intended to represent linearity. NHANES National Health and Nutrition Examination Survey, NHIS National Health and Interview Survey, SLAN Survey of Lifestyle, Attitudes and Nutrition.]
The review discloses that the prevalence reported across countries ranges from 24 to 71%. This huge variability is not very surprising; some of the many reasons for this phenomenon include:
- different TCAM definitions,
- different prevalence time frames,
- different data collection tools,
- different methods of analyzing the data.
Despite these problems, the information summarized in the review is fascinating in several respects. For me, the most interesting message here is this: the plethora of claims that SCAM use is increasing are not supported by sound evidence.
An article in THE TIMES seems worth mentioning. Here are some excerpts:
… Maternity care at Nottingham University Hospitals NHS Trust (NUH) is the subject of an inquiry, prompted by dozens of baby deaths. More than 450 families have now come forward to take part in the review, led by the expert midwife Donna Ockenden. The trust now faces further scrutiny over its use of aromatherapy, after experts branded guidelines at the trust “shocking” and not backed by evidence. Several bereaved families have said they recall aromatherapy being heavily promoted at the trust’s maternity units.
It is being prosecuted over the death of baby Wynter Andrews just 23 minutes after she was born in September 2019. Her mother Sarah Andrews wrote on Twitter that she remembered aromatherapy being seen as “the answer to everything”. Internal guidelines, first highlighted by the maternity commentator Catherine Roy, suggest using essential oils if the placenta does not follow the baby out of the womb quickly enough… the NUH guidelines say aromatherapy can help expel the placenta, and suggest midwives ask women to inhale oils such as clary sage, jasmine, lavender or basil, while applying others as an abdominal compress. They also describe the oils as “extremely effective for the prevention of and, in some cases, the treatment of infection”. The guidelines also suggest essential oils to help women suffering from cystitis, or as a compress on a caesarean section wound. Nice guidelines for those situations do not recommend aromatherapy…
The NUH adds frankincense “may calm hysteria” and is “recommended in situations of maternal panic”. Roy said: “It is shocking that dangerous advice seemed to have been approved by a team of healthcare professionals at NUH. There is a high tolerance for pseudoscience in NHS maternity care … and it needs to stop. Women deserve high quality care, not dangerous quackery.” …
________________________________
The journalist who wrote the article also asked me for a comment, and I emailed her this quote: “Aromatherapy is little more than a bit of pampering; no doubt it is enjoyable but it is not an effective therapy for anything. To use it in medical emergencies seems irresponsible to say the least.” The Times evidently decided not to include my thoughts.
Having now read the article, I checked again and failed to find good evidence for aromatherapy for any of the mentioned conditions. However, I did find an article and an announcement both of which are quite worrying, in my view:
Aromatherapy is often misunderstood and consequently somewhat marginalized. Because of a basic misinterpretation, the integration of aromatherapy into UK hospitals is not moving forward as quickly as it might. Aromatherapy in UK is primarily aimed at enhancing patient care or improving patient satisfaction, and it is frequently mixed with massage. Little focus is given to the real clinical potential, except for a few pockets such as the Micap/South Manchester University initiative which led to a Phase 1 clinical trial into the effects of aromatherapy on infection carried out in the Burns Unit of Wythenshawe Hospital. This article discusses the expansion of aromatherapy within the US and follows 10 years of developing protocols and policies that led to pilot studies on radiation burns, chemo-induced nausea, slow-healing wounds, Alzheimers and end-of-life agitation. The article poses two questions: should nursing take aromatherapy more seriously and do nurses really need 60 hours of massage to use aromatherapy as part of nursing practice?
My own views on aromatherapy are expressed in our now not entirely up-to-date review:
Aromatherapy is the therapeutic use of essential oil from herbs, flowers, and other plants. The aim of this overview was to provide an overview of systematic reviews evaluating the effectiveness of aromatherapy. We searched 12 electronic databases and our departmental files without restrictions of time or language. The methodological quality of all systematic reviews was evaluated independently by two authors. Of 201 potentially relevant publications, 10 met our inclusion criteria. Most of the systematic reviews were of poor methodological quality. The clinical subject areas were hypertension, depression, anxiety, pain relief, and dementia. For none of the conditions was the evidence convincing. Several SRs of aromatherapy have recently been published. Due to a number of caveats, the evidence is not sufficiently convincing that aromatherapy is an effective therapy for any condition.
In this context, it might also be worth mentioning that we warned about the frequent usage of quackery in midwifery years ago. Here is our systematic review of 2012 published in a leading midwifery journal:
Background: in recent years, several surveys have suggested that many midwives use some form of complementary/alternative therapy (CAT), often without the knowledge of obstetricians.
Objective: to systematically review all surveys of CAT use by midwives.
Search strategy: six electronic databases were searched using text terms and MeSH for CAT and midwifery.
Selection criteria: surveys were included if they reported quantitative data on the prevalence of CAT use by midwives.
Data collection and analysis: full-text articles of all relevant surveys were obtained. Data were extracted according to pre-defined criteria.
Main results: 19 surveys met the inclusion criteria. Most were recent and from the USA. Prevalence data varied but were usually high, often close to 100%. Much use of CATs does not seem to be supported by strong evidence for efficacy.
Conclusion: most midwives seem to use CATs. As not all CATs are without risks, the issue should be debated openly.
I am tired of saying ‘I TOLD YOU SO!’ but nevertheless find it a pity that our warning remained (yet again) unheeded!
