The honey monster

I kept bees a couple of years ago for one season and harvested a fair crop of honey. We are now down to the last jar.

Unfortunately I lost the colony over the winter and I haven’t yet gotten around to getting some more. Although I am tempted to blame the recent problems with bee losses I suspect the problem was entirely related to the fact that I nicked all of their honey then didn’t feed them enough. Oops. This year I plan to try again.

Bees are fascinating beasts and the health benefits of honey are a popular theme of CAM related goofiness. It ticks a lot of the boxes – it is an ancient remedy and natural. So it must be good…

Well, I could spend the rest of the year and set up a separate blog for the many and varied claims for apitherapy. One angle where honey has shown some promising results is in treating wounds, burns, ulcers etc. Here is one such recent story.

Here is the Cochrane review of the evidence for honey as a topical treatment for wounds.

Main results

19 trials (n=2554) were identified that met the inclusion criteria. In acute wounds, three trials evaluated the effect of honey in acute lacerations, abrasions or minor surgical wounds and nine trials evaluated the effect the honey in burns. In chronic wounds two trials evaluated the effect of honey in venous leg ulcers and one trial in pressure ulcers, infected post-operative wounds, and Fournier’s gangrene respectively. Two trials recruited people with mixed groups of chronic or acute wounds. The poor quality of most of the trial reports means the results should be interpreted with caution, except in venous leg ulcers. In acute wounds, honey may reduce time to healing compared with some conventional dressings in partial thickness burns (WMD -4.68 days, 95%CI -4.28 to -5.09 days). All the included burns trials have originated from a single centre, which may have impact on replicability. In chronic wounds, honey in addition to compression bandaging does not significantly increase healing in venous leg ulcers (RR 1.15, 95%CI 0.96 to 1.38). There is insufficient evidence to determine the effect of honey compared with other treatments for burns or in other acute or chronic wound types.

A digression

An initial glance and you may not be alarmed by this. Put aside for one moment our scholarly appreciation of the therapeutic value of honey for wounds.

On reading this my eyes widened and I think my pupils probably dilated in horror. If you are bloke and you are not alarmed by this paragraph that is because you don’t know what Fournier’s Gangrene is…

Jean Alfred Fournier was a French “Professeur des maladies cutanées et syphilitiques”. So skin and syphilis was his bag. The condition he describes is basically a necrotising fasciitis of the scrotum – a flesh eating bug of the ‘nads. It is, to put it mildly, an emergency. Treatment usually involves surgical debridement, IV antibiotics and there is still a very significant mortality. Spare a thought for the bloke who had this dread condition and some bright spark decided to include him in a trial to try rubbing honey into his tattered scrotum.

You can find some more details of the condition and some utterly gruesome pictures here, here and here. But don’t say I didn’t warn you.

Anyway, I digress and with a shudder I will move on.

Honey and wounds

So Cochrane says honey doesn’t work for venous leg ulcers. It does look promising when honey is compared with standard dressings for treatment of burns but there are some quite serious issues with the trials. There is no blinding and they all seem to come from one centre. There is scope for some major bias issues creeping in. There are also some concerns that they did not go head-to-head with appropriate alternatives. Comparing your treatment with a slightly rubbish one is always a good way to massage the figures.

Bandolier thinks it probably works for burns (here, here and here). This diagram shows healing of burn wounds at 7 days.

Bandolier added this in 2007:

The last two or three years have not brought what we might think of as the “killer” paper, the study that unequivocally demonstrates benefits to patients (in terms of good results in patients with particular problems) or to health services (perhaps with lower costs, or intangible benefits like tackling antibiotic resistant organisms). That being said, the general positive result of honey being effective in infected wounds seems to be maintained. The biggest problem is that the quality of study reporting remains generally poor, and numbers tends to be small, limiting the importance we can put on any findings.

Manuka honey is often cited as a veritable Wonder Honey. Check out manukahoney.co.uk and this mealy statement. 

Here in the United Kingdom we are very restricted about what we can say about the many therapeutic properties of UMF rated Active Manuka Honey. We are, however, able to provide links to third party research. This will provide you with a large resource detailing the research that has been conducted into the honey and its uses as well as the results of various clinical trials.

This raises my hackles a little and it seems to me to raise some interesting legal points. Perhaps they have read Prof David Colquhoun’s post. There is certainly a restriction in the UK on making false claims but I am not sure there is any issue if there is proven benefit. I am also curious about the position of providing ‘links to third party research’ with such a tacit nod and wink. My understanding is that this may be no defence when in comes to such issues as copyright breach or libel. They will direct you to the Waikato Honey Research Unit which is heavily involved with the research.

However, several honey dressings are available on the NHS. From the BNF:

Mesitran®(Unomedical)
Absorbent, semi-permeable dressings impregnated with medical grade honey, 10 cm × 10 cm = £2.46, 10 cm × 17.5 cm = £4.43, 15 cm × 20 cm = £5.12; with adhesive border, 10 cm × 10 cm = £2.56, 15 cm × 13 cm (sacral) = £4.33, 15 cm × 15 cm = £4.53 
Uses: pressure ulcers, diabetic ulcers, fungating wounds, donor sites, surgical wounds, abrasions, and first and second degree burns.

Ultimately honey is a viscous hyperosmolar substance that contains some antimicrobials. There is clear biological plausibility when using it to treat wounds and it is not too much of a leap to think that it could be effective in some topical applications. I have no great problem in accepting  that honey may well be a useful basis for treatment of certain conditions but the evidence could do with some clarification for which conditions it really helps.

Dr*T has commented on a salutory tale of the dangers of inappropriate management of ulcers. Honey for wounds looks like a case where a so-called alternative medicine has been subjected to some trials and then adopted.

It doesn’t automatically mean that honey will be beneficial for all skin problems (though it may be worth investigating) and it certainly does not confer automatic credibility on some of the more outlandish apitherapy options.

The jury is still out on bee venom acupuncture for arthritis…