Crystal Healing

It was a text for the course in CAM that I took. It does need to be taken with more then a grain of salt and does clearly reside in the camp of CAMs. But it is a good start off point in at least understanding what the therapies are and giving you a start. I just listed it because I have read and used it.

The two more serious, and better researched, texts are the ones I can't find at the moment. No, I am not trying to imply that all nursing professionals agree, merely that many of the effects have been well documented and are in text books. We both know that despite any amount of evidence there are people who will ignore new research because its just not the way they were taught. I am not calling older nurses hidebound per se, but let's face it- there are a lot of older women out there doing some shoddy work. And I don't know that UK and USA nursing courses are exactly similar. I can't figure out your system for the life of me. I do know that non Baccalaureate prepared nurses rarely go into the research here in the US.

And I am saying that allowing the treatments to continue reduces stress, promotes healing and increases sensitivity to pain medication. Therefore, it is good nursing practice to allow them.

 

To be a bit clearer on the position I'm taking and how it is not a fringe position that no-one has heard of here are some quotes from reputable figures who I strongly agree with:

1. Edzard Ernst-
Left a lucrative position (chair in Physical Medicine and Rehabilitation) at an extremely well regarded medical university to establish a center exploring the evidence for complementary and alternative medicine and is the editor of two journals on the subject. Advocates 'complementary' therapies that are proven to work based on evidence:

"They say you can't squeeze a holistic, individualised approach like homeopathy or spiritual healing into the straitjacket of RCTs - not that it is the only research tool, but it is a good one. The argument surfaces on a daily basis. It is as frequent as it is wrong."

[in a letter to Prince Charles published in the Times]
"There have been well over 4,000 research studies into alternative medicine since 2000, and in our new book, Trick or Treatment? Alternative Medicine on Trial, which is published next week, we have evaluated this evidence rigorously and fairly. A few treatments seem to work. However, the majority of alternative therapies appear to be clinically ineffective, and many are downright dangerous."

2. Marcia Angell
Physician and Editor of New England Journal of Medicine.

"It is time for the scientific community to stop giving alternative medicine a free ride... There cannot be two kinds of medicine — conventional and alternative. There is only medicine that has been adequately tested and medicine that has not, medicine that works and medicine that may or may not work. Once a treatment has been tested rigorously, it no longer matters whether it was considered alternative at the outset. If it is found to be reasonably safe and effective, it will be accepted."

3. Fontanarosa and Lundberg
Editors of the Journal of the American Medical Association.

"There is no alternative medicine. There is only scientifically proven, evidence-based medicine supported by solid data or unproven medicine, for which scientific evidence is lacking. Whether a therapeutic practice is "Eastern" or "Western," is unconventional or mainstream, or involves mind-body techniques or molecular genetics is largely irrelevant except for historical purposes and cultural interest."

And now I have to get back to work... on the whole from what I can find 'evidence based integrative medicine' seems to be the kind of position I'm advocating. I can also find quite alot on evidence based nursing sites and more general evidence based medicine sites that promote the position I'm advocating I'll get back with links later.

 

This might have more resonence for people in the UK due to our national health service.
If people want to spend their own (or insurers) money on placebo treatments then I'm less inclined to feel aggrieved. I don't like it and feel we as a species should be better than that but I'm not directly involved.
Snake oil therapies should be exposed wherever possible but there will always be idiots with cash to spare.

However knowing we have an NHS funded school of homeopathy in the UK makes my blood boil. That's MY money they are spending there. They should not be free to spend it in that way.
Millions of pounds spent on looking into whether water or alcohol can "cure" things if at one point in their past they had some substance or other in them!?!?
Ridiculous.

 

Why not stick to proven treatments which do the same thing (i.e. ones that reduce stress, promotes healing and increases sensitivity to pain medication)?

I don't think the fact an unproven treatment can have a positive effect is a justification for its provision. Perhaps the case could be made if no proven treatments had such outcomes, but the fact these outcomes are not unique to CAM means their use is entirely unnecessary.

 

Oh ok... I thought I made myself clear when I said "the hospital should not promote such treatments since they have never been proven to work but if the patient wants to bring in an alternative medicine practitioner then as always the person should be free to do so".

To rephrase then 'No' ideally a nurse as a representative of the hospital should not be administering or advocating treatments with no evidence such as waving a carrot over someone. The nurse does not however have any obligation to PREVENT access to carrot therapy or anything else if that is what the patient wants and it won't harm them.

 

And that nurse would be violating one of our basic tenets of nursing- to do no harm. Because, quite clearly, an argument can be made that preventing someone from having access to such promotes healing. So you could actually create a situation in which the nurse is charged with malpractice because the research clearly indicates that allowing such procedures (which we all know are phony) to be conducted.

 

I wouldn't say it's not relevant. If you give people a sugar pill and tell them it is a new super pill it will result in 'swifter healing' for some patients. Yet doctors are not allowed to do this because it's deemed unethical to mislead the patient and prescribe something that you know can't have any possible effect besides the placebo. I don't think it's any less unethical just because you label a treatment 'alternative' or 'complimentary' if the evidence isn't there you shouldn't lie to a patient.

Are wry's textbooks more respected than the Cochrane group? Or the center ran by Edzard Ernst that spends ALL of its time and money researching the evidence for CAM treatments? More respected than JAMA? I don't tink so. I made a post earlier to highlight that the position I'm advocating is not simply held by me and is in fact supported by a wide variety of practitioners and groups in medicine worldwide so what you should actually ask is something like...

Why are wry's claims that alternative therapies have been proven effective not echoed by the groups dedicated to promoting evidence based medicine? If she's right then they should be. Here's the link to the Cochrane website (the gold standard in evidence based medicine) which provide summaries of the best evidence for the efficacy of treatments and whether or not there is enough evidence to recommend them...

http://www.cochrane.org/reviews/en/index_list_a_reviews.html

Knock yourself out looking through the various summaries. Here's the bottom line from just some of the acupuncture reviews it doesn't paint the picture of proven effective treatments that wry is suggesting:

Acupuncture and dry-needling for low back pain
" There is insufficient evidence to make any recommendations about acupuncture or dry-needling for acute low-back pain... Acupuncture is not more effective than other conventional and "alternative" treatments. When acupuncture is added to other conventional therapies, it relieves pain and improves function better than the conventional therapies alone. However, effects are only small."

Acupuncture and electroacupuncture for the treatment of rheumatoid arthritis
"From the little evidence that there is, acupuncture does not appear to improve the symptoms of rheumatoid arthritis."

Acupuncture and related interventions for smoking cessation
"The review did not find consistent evidence that active acupuncture or related techniques increased the number of people who could successfully quit smoking. However, acupuncture may be better than doing nothing, at least in the short term; and there is not enough evidence to dismiss the possibility that acupuncture might have an effect greater than placebo."

Acupuncture for acute stroke
"The review showed no clear effect of acupuncture on either outcome. Serious adverse effects were uncommon, and occurred in about one in every hundred patients treated."

Acupuncture for facial paralysis
"The quality of the included trials was inadequate to allow any conclusion about the efficacy of acupuncture. More research with high quality trials is needed."

Acupuncture for chronic asthma
"Current evidence has not shown an effect in favour of acupuncture compared with control treatment for asthma and more research is required."

Acupuncture for depression
"Based on the findings from seven trials of low quality, there is insufficient evidence to determine whether acupuncture is effective in the management of depression."

Acupuncture for epilepsy
"...despite numerous experimental studies and observational studies in humans, acupuncture has not yet been proven to be effective and safe for treating people with epilepsy."

Acupuncture for glaucoma
"At this point, the effectiveness of acupuncture as a therapeutic modality for glaucoma could not be established."

And the list goes on... as I say knock yourself out. In the few cases where there is evidence they recommend using the treatment which again is a position I would also advocate.

 

You are getting medical science confused with nursing research. You are right and I have never tried to argue that CAMs have a high efficacy rate. Some have higher then others, some are just totally nuts.

Which is COMPLETELY BESIDE THE POINT.

If it can be shown, and it has, that providing access aids in healing- despite the actual efficacy of the therapy involved- then it is beneficial to the patient. Nursing text books, nursing care plans and nursing research have all proved that allowing the patients to have access to CAMs helps speed healing and decrease pain (which is self reported as their is no scientific way to measure pain) then that is what the nurse should do. Now, if when someone is well, you want to try to teach them about how silly, say, homeopathy is or crystal healing- well then, knock yourself out. And I agree that they needed to be tested for efficacy and should be employed when proven to have positive effects. Such as massage ought to be a part of every hospital stay for anyone whose injuries or condition do not contraindicate it. But its hidebound adherence to drug therapies that prevents it.

 

You're still begging the question that there are not proven treatments that can do the same thing, and then you're using that begged question as a justification for the provision of alternative treatments.

Furthermore, you still seem to think we're preventing them from getting CAMs despite the fact we've stated I think in every single post that this is not what we're doing.

 

Perhaps you misunderstand. He is not presupposing that they don't help, he is saying that irrespective of whether they aid healing in any way, it is not ethical to prescribe such a treatment or in any way validate a treatment if it cannot be shown to be anything other than a placebo effect.

No treatment that is purely a placebo effect should be provided to a patient since it constitutes lying to the patient. Would you like to be lied to by your doctor, aikiMac?

Perhaps you should read his post (for the first time):

"To rephrase then 'No' ideally a nurse as a representative of the hospital should not be administering or advocating treatments with no evidence such as waving a carrot over someone."

This is exactly the same as what he originally said:

""the hospital should not promote such treatments since they have never been proven to work"


I'll again reiterate that no one is preventing people from what ever treatment they want, however in a hospital the only treatments that should ever be provided are those that have been demonstrated to work. A placebo is NOT a demonstration of efficacy and so should not be provided, even if they aid healing. As I said, such healing is not unique to CAM so just use evidence-based treatments that aid healing or treatments that do not carry impossible, unscientific and unnecessary baggage.

 

The thing is I'm not. I even said in the example of sugar pills "it will result in 'swifter healing' for some patients" but this is due to the placebo effect. I don't know if your simply not reading the replies properly but I strongly suggest taking the time to work out what people are saying before arguing with them. Discussions can't progress when you don't read what the other person is saying.

I can try it as fast or slow as you like but I've already provided the answer to this several times over. I'm not sure where the trouble in understanding my point is coming from though so I'll try and repeat my main points as simply as possible.

- Ethically doctors are not allowed to prescribe treatments that rely solely on the placebo effect even though it will result in a 'swifter treatment' for some patients.
- Clinical evidence plus scientific understanding proves that crystal therapy and a number of other alternative therapies are not working through anything but the placebo effect (or at least is indistinguishable from it).
- Hence ethically doctors/nurses IMO and the opinion of the people I've mentioned several times over now should not be promoting therapies even when the placebo effect would lead to 'swifter healing'.
- BECAUSE even 'swifter healing' will occur when a therapy PROVEN to be effective is used because the therapy will have REAL effects + benefit from PLACEBO effects rather than having JUST THE PLACEBO EFFECTS.
- Again this does not involve prohibiting alternative treatments without evidence it just involves not advocating them. There are complementary treatments and mainstream treatments that DO have evidence so why not just use them?

I'm afraid I can't be any clearer aiki. As Topher pointed out I did in fact begin the 2nd response with your desired yes/no answer. I even put hyphens round the no to make it clear. Reading 3 or 4 lines of text where the answer is clearly stated and explained is not really something I would consider too much to ask. Most worthwhile answers require more than a one liner and this is a complex topic.

 

Is it? So you would advocate a mainstream treatment that had been shown to have a dismal efficacy rate and to operate on nothing more than the placebo? I was under the impression that medical staff aren't allowed to do that due to requirements that they be open and honest about the treatments being received by a patient?

No-one has argued for preventing access. Please consider the following repeated statements.

At this point the horse is no longer just flogged and dead it has been buried, uneartheed, dismembered, took part in a seance, had it's funeral, been beaten once again and then been reburied.

I totally agree with this 100%. As I say I'm not against therapeutic treatments such as say massage, meditation, various forms of exercise and so on. I think in many cases such treatments will aid recovery as well if not better than drugs. My point simply is that hospitals should promote those therapeutic treatments proven to be effective.

 

Here's an article on CAMs and malpractice liability:

Potential Physician Malpractice Liability Associated with Complementary and Integrative Medical Therapies

http://www.annals.org/cgi/content/abstract/136/8/596

Full article: http://www.annals.org/cgi/reprint/136/8/596.pdf

Which suggests they should not just do what the patient wants. In fact, with regards to lack of safety and efficiency it states that:

From a liability standpoint, by pursuing a therapy for which evidence indicates either inefficacy or serious risk, the physician is not only deviating from conventional standards of care but also causing patient injury; thus, the physician is probably liable. This scenario may trigger concerns about professional conduct and competence, creating the additional possibility of a professional disciplinary proceeding and revocation of licensure (1). Clinical examples include the injection (intravenous or intramuscular) of unapproved substances; the use of herbs known to be directly toxic (for example, chaparral [36] and Aristolochia fangchi [37]); substances proven ineffective in randomized, controlled trials (such as laetrile) (38, 39); clinical use of herbs known to be associated with clinically significant drug–herb interactions (32–34); or knowing use of a CAM therapy that delays treatment for a potentially curable condition—for example, delay of recommended lumpectomy and radiation therapy in favor of adopting a macrobiotic diet for a patient with stage I breast cancer. The physician should avoid and actively discourage pursuit of such treatments. If the patient insists on pursuing the treatment, the physician should document the discussion, including his or her disclosure to the patient of evidence regarding documented or potential dangers and any proven lack of efficacy, if such data exist.

Which is inline with what we are saying: don't just give into the patients demand, rather inform them about the evidence and ensure they are well aware of the risks and benefits. The more evidence for efficacy and safety there are, the more acceptable it would be to use them. It states this explicitly here:

"3. Provide adequate informed consent by engaging in a clear discussion of the risks and benefits of using the CAM therapy. Whenever possible, provide a discussion of the known risks and benefits of the CAM therapy, together with a discussion of what is not known or cannot be evaluated, as part of the obligation of informed consent (7). Arguably, informed consent also should encompass the risks and benefits of combining conventional care with CAM therapies versus providing conventional care alone (45). Document this disclosure in writing, where appropriate (for example, when the patient is competent and wishes to pursue a CAM therapy associated with documented or potential risk) (45), and especially when the patient elects to proceed with the CAM therapy against medical advice."

With respects to evaluating safety and efficacy, "the physician should review the available scientific and medical literature regarding the proposed CAM therapy. Present medical consensus provides a basis for decision making in the clinical scenarios outlined above. Continually emerging research, however, makes conclusive judgments difficult and renders even the above choices amenable to interpretation by individual clinicians. One possibility is to fashion evaluative criteria for safety and efficacy based on requirements such as 1) the existence of sufficient (quantity and quality of) randomized, controlled trials (either alone or in combination with a meta-analysis) supporting efficacy (or lack thereof) and 2) the existence (or lack thereof) of documented, major (for example, life-threatening or permanently disabling) adverse events associated with the therapy or obvious, theoretical potential (or lack thereof) for major adverse events occurring in association with the therapy."

 

Here's another:

Ethical Considerations of Complementary and Alternative Medical Therapies in Conventional Medical Settings

Full article: http://www.annals.org/cgi/reprint/137/8/660.pdf

"There are currently many situations for which no reliable evidence about CAM therapies exists but patients nonetheless request these treatments; in such cases, physicians must counsel and advise in the absence of evidence. When there is no evidence either for or against a particular therapy, physicians can choose to tolerate and monitor or actively discourage use of CAM treatments. The risk–benefit framework presented in the Table is helpful in counseling because the unknown CAM therapy can be compared with what is known about the competing conventional treatment and the relative risk of choosing the CAM therapy can be assessed. If, for example, the conventional treatment is effective and the risk for not treating is great, a patient would be ill-advised to pursue an unproven CAM therapy, and the physician should actively discourage such a decision. If, however, the standard conventional therapy is ineffective, even an unproven CAM therapy could be tolerated, because the patient has few, if any, good alternatives. An unproven therapy may have unknown toxicities, and patients should be clearly informed about the lack of information on the safety of untested CAM therapies, particularly if the condition being treated is minor."

In a case like this where there there is inconclusive evidence for or against the treatment I would consider a) plausibility/mechanism, b) the status of the patients health and c) conventional treatment. If the patients condition is incurable/terminal then it would be okay to allow treatment with minimal/no evidence (and even if it showed some risks the risk-benefit for a terminal patient would probably be worthwhile). I wouldn't bother for instance with homeopathy at all as it's just expensive water whereas something like herbal treatment (which doesn't conflict with their main medication) or acupuncture is chemically/physically doing something to the body, so could be useful. But for someone with a curable treatment where conventional evidence-based medicine is available, just use that.

 

To be fair aiki, my second answer was simply a rephrasing of my first answer. If you consider the meaning they are the exact same. Plus you didn't acknowledge that I had answered in post #212 you even specifically say "That's twice today I asked a yes/no question and you did not answer "yes" or "no." ... When the question is a yes/no question, why can't "yes" or "no" appear in the first sentence of the answer?"

Which clearly ignores that I did begin the 2nd answer as you asked with 'no'. Nto to mention that you can answer yes/no questions clearly without needing to say yes/no. Example:
Q: Do you like potatoes yes/no?
A: I don't really like potatoes.

The answer is still clear even though I haven't said...

A: No. I don't like potatoes.

I'm willing to move on as well but just didn't think your cirticism of Topher was fair hence this reply.

 

You did not acknowledge his answer in fact you specifically stated he did not answer yes or no (despite the fact that he did)!
Why lie?