Weak Recomendations

Weak Recomendations

Today Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis was published on the web. I assume this will be a topic for Dr. Novella over at SBM. It makes for an interesting read, since apparently the authors have no interest in issues like anantomy, physiology, prior probability, or have considered the issues raised by my favorite paper of all time, Why Most Published Research Findings Are False.

I thought it would be fun to list the three big whoppers in the paper:

1) Reflexology is possibly effective for reducing MS-associated paresthesia over 11 weeks (MS type unspecified, 1 Class IIe20). Data are inadequate to support or refute the use of reflexology for pain, HRQOL, disability, spasticity, fatigue, cognition, bowel/bladder function, depression, anxiety, or insomnia in MS.

Reflexology practice recommendation.

Clinicians might counsel patients with MS that reflexology is possibly effective for reducing paresthesia (Level C).

2) Bee sting therapy is possibly ineffective for reducing MS-related relapses, disability, fatigue, total MRI lesion burden, new gadolinium-enhancing lesion volume, or HRQOL (RRMS, SPMS; 1 Class II).e26

Bee venom practice recommendation.

Clinicians might counsel patients with MS that bee sting therapy is possibly ineffective for reducing relapses, disability, fatigue, total MRI lesion burden, new gadolinium-enhancing lesion volume, or HRQOL (Level C).

3) Magnetic therapy is probably effective for reducing fatigue in RRMS (1 Class I,e31 1 Class IIIe34) and probably ineffective for reducing depression in RRMS over 15 weeks (1 Class Ie31).

Data are inadequate to support or refute the effect of magnetic therapy on reducing MS-related disability (1 Class Ie31 with insensitive outcome measure; 1 underpowered Class IIe32), bladder control problems, or spasticity, or on improving cognition, mobility, sensation, or vision (1 underpowered Class II,e32 3 underpowered/inconsistent Class IIIe34-e36).

Magnetic therapy practice recommendation.

Clinicians might counsel patients with MS that magnetic therapy is probably effective for reducing fatigue (Level B) and probably ineffective for reducing depression (Level B).

As they say at the end:

This review has several limitations.

Understated much?

Reflexology, magnet therapy, and bee venom therapy are all nonsense with no reason in this reality to work. But who needs to consider anatomy and physiology in CAM interventions? Not the editors of Neurology.

They note on the patient page that

They also found that ginkgo biloba, reflexology, and magnetic therapy may be effective against some MS symptoms.

To suggest, even with the weasel words 'might' and 'possible' and 'probably,' that patients spend their time, money and hope on pseudo-medical interventions, all with the weakest of data to support the interventions, only does a disservice to patients. They do note that naturopathy, acupuncture and electroacupuncture, among 22 other interventions,

have insufficient evidence to support a specific practice recommendation

keeping a door open as if some day such data may be forthcoming. Unlikely given they are not reality based.

I would probably have suggested a stronger, less shruggie, recommendation: save your time, money and hope for reality based therapies.  I know it is hopelessly paternalistic, but isn't our knowledge of medicine supposed to be used to help patients make good decisions and avoid bad decisions?  I guess that is not a guiding idea for the paper.  They do recognize that

Some approaches may have little potential for harm (but are totally worthless. Ed.), but others may have side effects, significant risks, steep financial costs, or dangerous interactions with conventional medications.

but fail to mention which CAM interventions fit the bill to help patients make decisions.

Overall a unsatisfactory review, typical of the equivocating found in most journals. I doubt they will ask Jimmy Wales to write the next version, although he at least can recognize lunatic charlatans, unlike the writers of this review.

Points of Interest: 3/28/2014
Points of Interest 3/27/2014