{"id":40,"date":"2008-10-08T13:34:33","date_gmt":"2008-10-08T12:34:33","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/adc-archimedes\/?p=40"},"modified":"2008-10-22T15:08:40","modified_gmt":"2008-10-22T14:08:40","slug":"q-honey-for-neutropenia","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/adc\/2008\/10\/08\/q-honey-for-neutropenia\/","title":{"rendered":"Q: Honey for neutropenia?"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft\" style=\"float: left\" src=\"http:\/\/www.lifemel.co.uk\/img\/right_column\/life-mel-honey-and-spoon.jpg\" alt=\"Life Mel Honey\" width=\"150\" height=\"131\" \/>It&#8217;s my own question, this time, and throws up lots of annoying little things.<\/p>\n<p>The problem is straightforward: I&#8217;m a paediatric oncologist in my spare time, and was asked about the use of LifeMel honey to prevent infections.<\/p>\n<p>Now, being both an EBMer and a Physician, I said I didn&#8217;t know, but didn&#8217;t think it could do, but might cause problems. (Remember we&#8217;re not supposed to give honey to infants &#8217;cause of botulinism? Same concerns.)<\/p>\n<p><!--more-->Running a really simple PubMed search (&#8220;honey&#8221; and &#8220;infection&#8221; and &#8220;cancer&#8221; &#8211; to get rid of the leg ulcers) give 7 hits which are irrelevant. I tried again, &#8217;cause I&#8217;d been told the website cited a real paper published somewhere &#8230; &#8220;life mel honey&#8221; gets <a title=\"Trial of Life Mel Honey\" href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/17303914\">a single hit.<\/a> Looking at the Medline citation, where the index terms are listed, made me think that &#8220;honey&#8221; and &#8220;neutropenia&#8221; might be better &#8211; but still the single study.<\/p>\n<p>The study is a cohort of 30 adult patients who&#8217;d previously had neutropenia. They then got given 5ml honey\/day with the next course of chemo, and about 12 (40%) didn&#8217;t get very badly neutropenic this time, and 8 (27% &#8211; not 36% as quoted in the abstract) thought their quality of life was better.<\/p>\n<p>Now ask yourselves a question &#8211; do you think the honey made a difference?<\/p>\n<p>If it hadn&#8217;t been honey, but <a title=\"Wikipedia GCSF\" href=\"http:\/\/en.wikipedia.org\/wiki\/Granulocyte-colony_stimulating_factor\">GCSF <\/a>that had been given, would your answer be the same?<\/p>\n<p>(I think most people would have a different answer if it&#8217;s honey or G, and the rest of this presumes that as a fact&#8230;)<\/p>\n<p>The interesting points:<\/p>\n<p>Firstly, I think that despite the claim we make to believe RCTs and p-values, most of us are inherently <a title=\"Wikipedia Bayesian\" href=\"http:\/\/en.wikipedia.org\/wiki\/Bayesian_inference\">Bayesian<\/a>: we move forward with new information not from an unbiased position but one of knowledge (or at least assumed knowledge). I come to the question with an assumption that honey might <em>at the best<\/em> have a 5% chance of doing something. And so I am not shifted at all. But is that reasonable, right and scientific?<\/p>\n<p>Second, I am on the whole a &#8220;<a title=\"Science-based Medicine Blog Link\" href=\"http:\/\/www.sciencebasedmedicine.org\/?p=238\">shruggie<\/a>&#8221; when it comes to complementary therapies (as expounded by Val Jones). And I have no hard data for the botulinism argument. But at <a title=\"Life Mel UK site\" href=\"http:\/\/www.lifemel.co.uk\/buy-life-mel.php\">\u00a337.50 for 120ml <\/a>it seems a lot for a family who struggle to afford the transport to hospital to be spending (or guilty about not spending).<\/p>\n<p>Before I go on, I&#8217;d like to note that the UK distributors of Life Mel make no claims of medicinal value for their product on their website, in keeping with UK and EU laws, and I&#8217;m not claiming in any way that their actions are illegal. The references to anything active &#8211; feeling better etc &#8211; are carefully silo&#8217;d into a well-linked sister website.<\/p>\n<p>But back to the point &#8211; the questions I&#8217;d like to hear your answers on:<\/p>\n<ol>\n<li>Can we take a Bayesian approach to treatment like we do with diagnostics?<\/li>\n<li>Should poor quality benefit and harm data cancel each other out? Or how should they be balanced?<\/li>\n<li>Do adult data and customer feedback have any relevance to paediatric oncology patients?<\/li>\n<\/ol>\n<p>Acknowledgements:<\/p>\n<p>Ben Goldacre&#8217;s <a title=\"Bad Science Blog\" href=\"http:\/\/www.badscience.net\">BadScience <\/a>mini-blog for the link to SBM<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>It&#8217;s my own question, this time, and throws up lots of annoying little things. The problem is straightforward: I&#8217;m a paediatric oncologist in my spare time, and was asked about the use of LifeMel honey to prevent infections. Now, being both an EBMer and a Physician, I said I didn&#8217;t know, but didn&#8217;t think it [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/stg-blogs.bmj.com\/adc\/2008\/10\/08\/q-honey-for-neutropenia\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":""},"categories":[504,99,82],"tags":[],"class_list":["post-40","post","type-post","status-publish","format-standard","hentry","category-infection","category-oncology","category-therapy"],"jetpack_featured_media_url":"","jetpack_sharing_enabled":true,"_links":{"self":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts\/40","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/comments?post=40"}],"version-history":[{"count":0,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/posts\/40\/revisions"}],"wp:attachment":[{"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/media?parent=40"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/categories?post=40"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stg-blogs.bmj.com\/adc\/wp-json\/wp\/v2\/tags?post=40"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}