There is a positive aspect to living around followers of alternative therapies and conspiracies: they are eternal sources of information. Case in point: one of my colleagues asked me if I had ever heard of autohemotherapy – a pseudoscientific practice in which a patient withdraws some blood from a vein and injects it into a muscle. He told me he had joined a Facebook group called “Auto-hemotherapy: my blood heals me”, and that he was tempted to start the sessions, as he had read countless reports of people who had been cured of sinusitis, migraines and muscle pain, problems he had been facing.
Fearing he was doing something dangerous, I asked if any health council recognised the practice. He said he didn’t know, but knew that there were numerous nurses, bio-medics, and doctors who performed the procedure, both in their offices and at home.
Based this initial information conversation with my colleague, I began researching the subject. It became clear that, unlike other pseudosciences that end up making headlines, autohemotherapy is a marginal practice, disseminated through online groups, using a well-known modus operandi: a conspiracy between governments and the pharmaceutical industry to hide the ‘true cure’ from people; the claim that the practice is useful for a multitude of pathologies; the exclusive reliance on personal accounts, rather than scientific evidence; and, of course, the centralisation around a quasi-messianic figure, persecuted by the medical ‘establishment’ for rebelling against the status quo.
Interestingly, while the practice is not as popular as other pseudosciences, it has an extremely famous follower: the singer Madonna. In 2019, she posted on her social media that she was using different alternative therapies, including autohemotherapy and intravenous vitamin infusion, among others, to recover before her tour.
Fortunately (and I say this without sarcasm), Brazilian health councils, represented by the CFM and COFEN, have played an exceptional role in pointing out, since 2007, that the practice is not supported by scientific evidence to corroborate its efficacy and safety. They have also warned of serious health risks to patients, such as infection, and have prohibited professionals from adopting it in their therapeutic arsenal, stipulating severe penalties for those who fail to comply, up to the revocation of professional registration.
In fact, I believe the most enlightening position on the practice was published in 2017 by Anvisa, under the title “TECHNICAL NOTE No. 6/2017/SEI/GSTCO/DIARE/ANVISA: ANVISA’s Position on the Practice of Autohemotherapy“. In the document, the agency emphasised that autohemotherapy is not recognised as a medical procedure and lacks studies proving its effectiveness. Furthermore, the practice also lacks studies that investigate essential aspects to assess its therapeutic viability, such as specific indications, contraindications, safe or ideal dosages, drug interactions, and possible adverse reactions.
Another equally serious point is that the procedure can pose risks to the health of patients in two ways: through the possibility of transmission of infectious diseases, due to the manipulation of biological material; and through unfounded promises of cure, which can distance the patient from proven effective therapeutic treatments.
CFM opinion no. 12/07, issued by the Federal Council of Medicine, indicated that, based on the scientific literature available up to 2007 (the year the opinion was published), there was no reliable evidence in high-quality scientific journals that proved the effectiveness of autohemotherapy for any disease in human beings.
Similarly, COFEN Resolution No. 346/2009, produced by the Federal Nursing Council (COFEN), prohibited the procedure, considering it to be a treatment without technical and scientific consensus, in addition to not having the approval of professional councils in the health area. The Federal Pharmacy Council (CFF) also took a stand against the practice, not recommending it and classifying it as a serious infraction, subject to suspension of three to twelve months for all pharmacists who practice it.
Unfortunately, the warnings weren’t enough to prevent the practice from resurfacing in 2020 during the COVID-19 pandemic. Anvisa (the Brazilian Health Regulatory Agency) once again had to take a strong stance against autohemotherapy. Five years later, the practice continues to be informally recommended and attracting new adherents. Therefore, I believe it’s worth taking a critical look at the few studies that have examined it. But first, a little historical context.
The origin
All the information in this section comes from the doctoral theses “Contribution à l’Étude de l’Auto-hémothérapie en Médecine Vétérinaire“, “L’Auto-hémothérapie en Dermatologie et Particulièrement dans l’Urticaire et les Prurits”, and “Auto-Hemoterapia nas Dermatoses“, published between 1920 and 1930.
The origins of autohemotherapy are intertwined with the first blood transfusion experiments of the 17th century. The current momentum began in 1912, when neurologists Jean Sicard and Ludwig Gutmann conducted a series of studies on the subject, testing autohemotherapy on epileptic patients, without observing any significant incidents. Another physician, Raymond Francis, began recommending the practice as a treatment for tuberculosis patients.
In 1913, the French physician – considered the main exponent of the practice – Paul Ravaut described the technique in detail in an article published in the Annales de Dermatologie et de Syphilographie, in which he defended the use of autohemotherapy for dermatological problems, such as hives and eczema.
The most widely accepted explanation for the practice’s supposed “effectiveness” – and one that persists to this day – arose after studies conducted by Lucien Lamy. He administered the therapy to cancer patients and observed that they experienced an increase in white blood cell counts and temporary improvements in symptoms such as muscle wasting.
Based on these findings, it was theorised that blood therapy could have immune action.
The Brazilian version
In Brazil, autohemotherapy spread through the work of physician and practitioner Luiz Moura, who starred in a DVD on the subject in 2006, the content of which is still cited by enthusiasts as conclusive proof of its effectiveness. Moura says that his father was a staunch supporter of the practice, administering it to all patients undergoing surgery. Moura died in 2016 at the age of 91, having “converted” to autohemotherapy in 1943, while still a medical student.
Behind this adoption was the work of Dr. Jesse Teixeira, who compared the number of patients suffering from postoperative infections among those who received autohemotherapy, and those who did not. According to the video, of the 150 patients treated with the technique, the infection rate was 0%, while the group that did not receive the therapy had a rate of 20%.
The most remarkable part of the entire testimony is the fact that Moura makes no secret of the fact that he neither follows nor respects scientific standards. In the final section, titled “The Mission of Medicine,” the doctor states that, for him, the important thing is to alleviate suffering and, when possible, cure the patient – regardless of scientific evidence. In his worldview, what proves the effectiveness of any treatment is simply whether the patient feels better.
This position ignores the entire logic behind the need for controlled clinical trials: the possibility of confounding factors, such as concomitant treatments or the natural cycle of symptoms; the masking of serious conditions by superficial symptom relief; and the simple possibility that both patient and physician are deluding themselves.
Information about Teixeira’s study is highly conflicted. While Moura claims that Teixeira’s work involved 300 participants (two groups of 150), the version of the study I found online and one cited by the CFM statement mention only a single group, with 150 participants. I believe the second version is the more accurate, and therefore, I will use it to highlight the council’s criticisms.
According to the document, the main problem with Teixeira’s work is that it is not a randomised clinical trial, which could compare the effects of autohemotherapy with standard intervention. Furthermore, since there was no randomisation among the volunteers, it raises the possibility of questioning the suitability of the patients who received autohemotherapy – it is possible that they were selected by Teixeira because they presented better health than other patients, which may have influenced the results.
Similarly, it is noted that, although 150 surgeries were performed to assess postoperative pulmonary complications, the expected number of complications is approximately 3%. In other words, of these 150 patients, only 5 cases were expected. In fact, considering the type of surgery performed, this percentage is even higher. According to the report, of the 150 surgeries, almost all (133, or 88.7%) were performed below the navel, an area known to generate fewer postoperative pulmonary complications.
Last but not least, it’s important to note that Teixeira’s work has never been replicated. Even if it were, it would only demonstrate that the technique could be useful in reducing the incidence of postoperative pulmonary complications. However, all other health claims made by Moura and his followers would require specific evidence – which, to this day, is lacking.
And, to be clear, even if the study involved 300 patients (150 in each comparison group), these criticisms would remain valid.
New evidence
In 2014, a study entitled “A Systematic Review of Autohemotherapy as a Treatment for Urticaria and Eczema” was published. As the name suggests, this was a systematic review that aimed to investigate and summarise the evidence for autohemotherapy as a treatment for chronic spontaneous urticaria and eczema.
To this end, all studies published up to August 2014 (including clinical trials, case studies, and other methodologies) that addressed these outcomes were analysed. The analysis included only randomised clinical trials with designs that allowed researchers to determine the independent effect of the practice on the disease or symptom severity. Of 435 studies identified, only eight remained.
Regarding the results, analysis of the overall efficacy of autohemotherapy revealed that patients who received the intervention reported less severe symptoms of urticaria and eczema at the end of the follow-up period, compared to patients in the control group. On average, this reduction was 19%.
Interestingly, most studies on urticaria also observed a moderate reduction in symptoms in the placebo group. The review has several limitations and makes important reservations about the studies analysed. None of the clinical trials on urticaria provided information on random allocation to treatment groups. Similarly, not all studies reported information on blinding, which casts doubt on the validity of the results.
Another important limitation is that all outcomes in the urticaria studies were based on self-reports, which are known to be unreliable measures. Furthermore, some of the outcomes used in the analysis were manually estimated from graphs of original reports, which may have introduced some error.
It’s also worth noting that, of the eight studies analysed, three reported external funding: two from private foundations (one focused on alternative medicine) and one from a pharmaceutical company. While this isn’t inherently problematic, it’s important to emphasise that funding sources can influence results.
In 2021, another systematic review entitled “Effect of Autohemotherapy in the Treatment of Viral Infections – A Systematic Review” was published, which investigated whether autohemotherapy offers benefits in the case of viral diseases. It included studies published in all languages from 2010 onwards, involving at least five patients, and using different types of autohemotherapy (conventional major and minor autohemotherapy, ozone therapy, or blood treatment with ultraviolet radiation). Case reports, reviews, letters to the editor, and in vitro and animal studies were excluded.
In total, 4,915 articles were identified. After applying quality criteria, only eight remained, covering a total of 431 patients. The included studies demonstrated the benefits of autohemotherapy, in some cases combined with ozone therapy, in combating hepatitis B and C and coronavirus infections. However, all have limitations and other serious problems.
Half of the studies evaluated showed a moderate risk of bias. Furthermore, because the review included different forms of autohemotherapy, such as UV treatment and ozone therapy, it is not possible to state with certainty that the positive results observed are exclusively attributable to this practice.
Of the eight studies analysed, six are case studies. Due to their looser and bias-prone methodologies, these studies create a false impression that the practice would actually be effective. The only two studies that used more rigorous methodologies (randomised clinical trials) yielded conflicting results.
The study, titled “Preliminary Result of Ozone Therapy as a Possible Treatment for Patients with Chronic Hepatitis C“, which evaluated the effects of ozone therapy and autohemotherapy, concluded that the practice was superior to placebo. However, the study’s conduct was questionable, with serious flaws that opened the door to bias – something acknowledged by the authors of the systematic review.
The study, “Ozone as Adjuvant Support in the Treatment of COVID-19: A Preliminary Report of the Probiozovid Trial“, which investigated the effects of ozone therapy in the treatment of COVID-19 and found no superior efficacy to the control (contrary to the results of the other case studies analysed), was considered adequate. However, in my opinion, the sample size of just 28 volunteers was too small to draw any real conclusions.
Furthermore, of the eight articles analysed, four are preliminary studies – initial versions of research that are still subject to change. This gives us a good indication of the fragility of the evidence.
After almost two decades since the release of Dr. Moura’s DVD, the search for evidence seems to have evolved – at least now there are randomised clinical trials and systematic reviews, albeit very few.
However, this does not mean that the quality of the evidence produced has improved. To date, all available information about the practice is extremely fragile and only confirms what we already know: autohemotherapy does not appear to be more effective than a placebo and is certainly not a panacea. The practice’s effectiveness is not supported by any convincing evidence, and, moreover, it may pose health risks.
This story was originally published by Revista Questão de Ciência in Brazil. It is translated and reprinted here with permission.
