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Monthly Archives: August 2022
We dont need EU! UK firms handed Brexit boost through new US and Australia links – Express
Posted: August 27, 2022 at 11:54 am
Over the past few years, the UK has pressed on with building its space industry, from purchasing the OneWeb satellite constellation to opening the new spaceport Cornwall later this year. While Britain was hit with some setbacks, like being forced out of the EUs Galileo satellite constellation, it may become an exciting place for space companies to establish a space industry.
Speaking toExpress.co.uk, Bryan Dean, the co-founder of Dragonfly Aerospace hailed Brexit as an opportunity for the UK to work closer with other non-EU countries like the US and Australia.
Dragonfly is a satellite imaging systems company based in South Africa that makes optical cameras for space, along with satellites that use the technology.
His firm is looking to use satellites and satellite data to combat climate change, to help industries such as agriculture flourish, and to use data to help avoid or overcome humanitarian disasters.
He said: When you look in a pre Brexit context, Europe was clearly Britain's primary trading partner.
He admitted that while he wasn't supportive of Brexit when it happened, "from an economic point of view, international point of view, it marks a transition towards international bilateral collaborations and things like that.
I think that probably will be positive, so that's the one side on the economic level in terms of the trade Britain does.
Obviously from a space industry point of view, it marks a transition towards national priorities and nationalism.
Again, personally, I'm a bit proponent of globalism, but from the point of view of our company, UK internally focused means there's an opportunity for us to be a part of that.
READ MORE:US Navy hands Britain huge 480m contract for satellite tech
So that's our major development there, developing the radar capabilities in the UK makes sense to us.
In 2021, Britains space industry was already valued at 16.4billion, and the Government now has a goal of capturing about 10 percent of the global market, which is at $400billion (331.3billion).
Mr Dean noted that Brexit allowed the Government to focus on international trade, which even on a country-level, would eventually benefit space companies.
He said: In terms of bilateral trade agreements, the obvious one is between the US and the UK.
The US has traditionally been a strong trading partner for the UK and it seems to me that Brexit is a realigning of Britain's focus.
But it also opens up opportunities for trade agreements with other parties like Australia, and Japan, where a little bit of independence from Europe is actually a positive thing.
These country-level trade agreements broadly feed into the space industry as well.
As we see bigger trade deals with international partners, we also see space projects, agreements and collaborations increase well.
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We dont need EU! UK firms handed Brexit boost through new US and Australia links - Express
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‘Prove all the naysayers wrong!’ Next PM must take Brexit by horns’ to transform UK – Express
Posted: at 11:54 am
Dale Wood has spent the past 22 years investing in a huge variety of firms from technology, real estate to healthcare in countries ranging from East Asia to South America. The owner and CEO of Dale Ventures Group believes that Brexit has presented a fantastic opportunity for Britain, but warned that if it is not handled well it could backfire.
Speaking to Express.co.uk as Rishi Sunak and Liz Truss battle it out to replace Boris Johnson, he warned that people on all sides of the debate are unhappy with certain aspects of the current Brexit trade deal.
The global investor - who has invested in firms across Europe, Latin America, the Far East and the Middle East - added: Just like with any business, governments need to take the right approach.
Boris Johnson got Brexit done but there are clearly kinks in his deal - you can see that by the fact that people on all sides are unhappy with certain aspects of it.
That doesnt mean it cant be amended and I would hope that his successor makes that their top priority when they take office next month.
The UKs prime minister will no doubt be aware of that but whether they act upon it remains to be seen.
Mr Wood believes that Ms Trusss plans to cut taxes to boost economic growth could achieve their ambition as long as public services are still properly funded.
And the former Chancellors pledge to tame inflation - which rose to a 40-year high of 10.1 percent in July, is equally key, he said.
He said: There is no easy way to steady the UKs economy and both candidates have good ideas.
My libertarian streak leans towards Liz Truss because she wants to reduce the tax burden from its 70-year high.
But I am also mindful that the huge debts racked up during the pandemic need to be repaid and overheating the economy will not control inflation.
It is a difficult situation to be in and there is no doubt that something needs to be done to remedy it.
Whoever wins needs to be acutely aware of that and press ahead with making the most of Brexit on day one.
I know politicians love to talk about their plans for the first 100 days but this is more urgent than that.
The minute their foot is through the door the number one focus needs to be on tackling the cost-of-living crisis and delivering a truly Global Britain that will attract investment from across the globe.
Thats what we want to see at Dale Ventures and we believe it is possible whoever wins the race.
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'Prove all the naysayers wrong!' Next PM must take Brexit by horns' to transform UK - Express
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1.44bn boost to Scotlands exports in spite of Brexit woe – Yahoo News UK
Posted: at 11:54 am
Adrian Gillespie
By Ian McConnell
Business Editor
More than 1.4 billion of additional export sales are anticipated over the next three years by companies north of the Border on the back of support from taxpayer-funded Scottish Development International in the year to March.
Scottish firms were supported to enter 208 new markets over the 12 months, with a focus on opportunities in the US, China, Germany, Spain and France. As part of this, 176 new products and services left Scotland for these new markets, SDI noted yesterday as it published its annual results.
Overall, 467 companies trade efforts were supported by SDI in the year to March.
READ MORE:Bewildering Tory detachment as grim winter looms: Ian McConnell
The anticipated additional export sales total of 1.44bn is up sharply on the 1.16bn projected on a three-year view from support that was provided by SDI in the 2020/21 financial year.
Asked how the distinction was made between export sales that companies would have had anyway and those arising from the support, a spokesman for SDI replied: The international sales figures are additional export sales forecast to be achieved from the activities we have supported. The estimated additional international exports are validated by the company at that stage.
The results combine company projects supported by SDI, and Scottish Enterprise and its sister agencies Highlands and Islands Enterprise and South of Scotland Enterprise.
The spokesman noted that SDI is pan-Scotland so these results [cover] all the agencies (SE, SoSE and HIE).
Adrian Gillespie, chief executive of Scottish Enterprise, said: These are very positive results and show that, despite a difficult environment for exporters, Scotlands goods and services continue to be incredibly attractive to global markets and buyers.
READ MORE:Ian McConnell: EU deal with New Zealand shows how desperate Tories failed UK farmers
Scottish exporters have demonstrated enormous resilience over the past year to adjust to the challenges they have faced due to Covid-19, Brexit and now the conflict in Ukraine. Our SDI trade colleagues have been there to support companies every step of the way, providing knowledge, skills and access to our international networks, enabling hundreds of firms to enter new markets overseas.
Story continues
He added: Supporting innovative Scottish companies scale up and grow through exports is a priority for us. Not only is this a major contributor to Scotlands economy, an international focus plays a vital role in encouraging the innovation and competitiveness that are essential to our future economy. With markets fully opening up and our exporters taking advantage of additional routes to overseas customers, we are positive about future trade opportunities for Scottish exporters.
HIE chief executive Stuart Black said: It has been an extremely challenging few years for Highlands and Islands businesses that trade internationally, so these results from SDI are particularly encouraging.
"Our regions businesses contribute significantly to the value of Scotlands exports, which are dominated by sectors such as energy, aquaculture and whisky sectors where the Highlands and Islands high-quality products are internationally recognised.
Firms supported by SDI in the year to March included agritech innovator Intelligent Growth Solutions, marine energy management and storage technologies company Verlume, and Boe Gin.
Scottish Government trade minister Ivan McKee said: These results are extremely positive, and they highlight the demand for Scotlands goods and services across the globe. Trade and investment plays an integral role to help us create new, sustainable jobs and grow our economy.
He flagged the resilience of Scottish businesses over the last few years, noting export success had been achieved "despite the complications of the Covid-19 pandemic and the consequences of Brexit".
South of Scotland Enterprise chairman Russel Griggs said: These are fantastic results which show, despite the pandemic, trade is a significant part of the Scottish economy. We are already seeing a result of this in the number of inward investment enquiries we are getting in the south of Scotland.
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1.44bn boost to Scotlands exports in spite of Brexit woe - Yahoo News UK
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Emily Maitlis Has A Brutal Message For The BBC Over Its Brexit Coverage – HuffPost UK
Posted: at 11:54 am
Emily Maitlis has criticised the BBC for both-sideism in its coverage of Brexit suggesting its attempts to hear both sides of the argument led to superficial balance.
The former BBC journalist also argued the BBC and other media outlets are failing to tackle the impact of leaving the EU today, saying that sidestepping the issue feels like a conspiracy against the British people.
Maitlis, who left the broadcaster this year for rival media group Global, was addressing the annual MacTaggart Lecture at the Edinburgh TV Festival on Wednesday.
In one striking passage that won praise on social media, Maitlis said: It might take our producers five minutes to find 60 economists who feared Brexit and five hours to find a sole voice who espoused it.
But by the time we went on air we simply had one of each; we presented this unequal effort to our audience as balance. It wasnt.
She added: Id later learn that the ungainly name for this myopic style of journalism: both-sideism, which talks to the way it reaches a superficial balance while obscuring a deeper truth.
Not everyone agreed.
The broadcaster suggested the problems continue, and outlets including the BBC adopt an automatic crouch position whenever the Brexit issue looms large.
She said: Many broadcasters fear discussing the obvious economic cause of major change in this country in case they get labelled pessimistic, anti-populist, or worse still, as above: unpatriotic.
And yet every day that we sidestep these issues with glaring omissions feels like a conspiracy against the British people.
Maitlis joined the BBC in 2001 and presented Newsnight from 2006.
In February, she and Jon Sopel announced they were leaving the BBC to join Global, where they are hosting a new podcast, titled The News Agents, and a radio show together on LBC.
In her speech, Maitlis also said the BBCs board includes an active agent of the Conservative party as she issued a warning about her former employers impartiality.
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Emily Maitlis Has A Brutal Message For The BBC Over Its Brexit Coverage - HuffPost UK
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Brexit shake-up essential to save the City of London, stock exchange warns – The Telegraph
Posted: at 11:54 am
London will lose its status as a global financial hub and be downgraded to a middling regional market without a post-Brexit overhaul of City rules, the chairman of the London Stock Exchange has warned.
Michael Findlay, who also chairs an influential advisory group to the City watchdog, issued a stark warning, saying officials must tear up decades-old orthodoxies and water down a host of stock market rules if the Square Mile is to remain competitivewith the likes of New York, Shanghai, Tokyo and even Amsterdam.
In a submission to the Financial Conduct Authority (FCA)s primary markets review, Mr Findlay said the UK has a once-in-a-generation opportunity to implement radical reforms to ensure London remains a relevant destination for flotations and capital raisings.
He added that without this essential modernisation, Londons status as a global market runs a material risk of diminishing to that of a regional exchange and that the size of Britain's public capital markets will continue to shrink.
The warning is the strongest indication yet that the Government and City regulators could be pushed to axe swathes of red tape in the financial services industry amid fears London is falling further behind rival cities.
It also comes as tensions continue to grow between ministers and watchdogs over the pace of post-Brexit regulatory reform, with Liz Truss weighing a potential merger of the Citys main regulators in a bid to put growth and competitiveness at the heart of post-Brexit regulation.
Mr Findlays submission, authored with Mark Austin, a partner at law firm Freshfields and chairman of another advisory panel to the FCA, argued that regulators must quickly do away with excessive rules, which are acting as a competitive disadvantage to the UK.
It said: We are in a foot race with our competitors, and we cannot afford to be ignorant of that or complacent about what we need to do if we want to stay relevant.
It means that we as a jurisdiction cannot and should not continue to assume that the gold plating that we currently have in place in regulatory terms is necessarily fit for purpose for our markets if we want to keep them relevant in the coming years.It was relevant in the past couple of decades, but it is unlikely to be in the coming two decades unless we are satisfied with slipping gently into being a relatively mid-market, regional capital market.The submission proposed abandoning the restrictive philosophy that governs the current listings regime in favour of a disclosure-led approach that was previously adopted by the Financial Services Authority, the FCAs predecessor.It also advocated a radical simplification of the current listings regime, including scrapping the current premium and standard segments and creating a genuine single segment with less stringent rules. In May, the FCA also proposed scrapping the current premium and standard regime to lure tech companies to the UK, with additional mandatory and supplementary obligations that public companies would have to meet.However, Mr Findlay and Mr Austin said this would in effect maintain a two tier regime, adding: "The FCAs current proposed criteria remain in some respects onerous and could operate as a competitive disadvantage when put side by side with other listing venues with which the UK competes." At present, only companies with a premium listing are eligible to be included in the FTSE indexes, meaning that scrapping the current regime would mark one of the most significant overhauls of Londons stock market rules since the 1980s.Londons capital markets ground to a halt this year following Russias invasion of Ukraine and the outlook remains bleak as a recession looms. In the first six months of the year, only 13 listings took place in the capital, raising proceeds of just under $150m, mammoth declines of 71pc and 99pc respectively on the previous year.Last year, the FCA reformed Londons listings rules to allow dual class share structures and lower free float requirements in a bid to boost the market, but the intervention from Mr Findlay suggests that the reforms do not go far enough.He warned that London is no longer the default European venue for listings and equity raises, adding that even cities such as Warsaw have shown an ability to host initial public offerings at attractive valuations with the participation of global investors.The submission also proposed relaxing the current sponsor regime, which requires a third party to provide oversight and assurances to the FCA about listed companies in a bid to protect investors.Mr Findlay was writing in capacity as chairman of the Markets Practitioner Panel, while Mr Austin chairs the FCAs Joint Listing Authority Advisory Panel.A spokesman for the FCA said: We are currently seeing feedback from the industry on potential changes to the listing regime in an aim to attract more high quality, growth companies to list in the UK. We are pleased to see the degree of debate it has provoked, and we welcome the panels' contribution.
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Brexit shake-up essential to save the City of London, stock exchange warns - The Telegraph
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It wasn’t Brexit or capitalism that got us into this mess – but try telling that to the new Puritans – The Telegraph
Posted: at 11:54 am
On any given week, I do a number of things that, increasingly, put me on the naughty step. Just yesterday I had high carbon-emitting agricultural produce for dinner (steak), and on Monday Im making a transatlantic flight back to Blighty, with another low-cost hop to France coming hot on its heels. Beyond generally chucking things in the right bin, I give as little thought to recycling as possible. I love to blast air conditioning, if available, when its truly boiling outside, and to blast the heating, equally, when its freezing. And, to make it all worse for the armies of cultural puritans finger-wagging everywhere from government to activism to the highest echelons of celebrity culture and the royal family, I dont feel bad about any of it. In fact, I regard flying, and advanced forms of consumption, from Amazons next-day deliveries of completely random stuff to the ability, following Ubers implosion, to summon a black cab in two minutes on an app, as nothing short of marvellous and just as it should be.
No, what I feel bad about is the fact that all that nice stuff good meat, flights and holidays, not having to overthink heating ones home or cooking or keeping lights on has already become extremely difficult for millions, and is only going to get worse when the mercury plummets. I feel bad about the fact not, as some seem to censoriously suggest, that we consumed, polluted and, with Brexit, voted ourselves into a brutal cost of living crisis, but rather that a grisly storm of silly priorities by the government, unavoidably outlandish spending during Covid, a muddled, under-used work force, a broken energy sector and the egregious Russian invasion of Ukraine has landed us here.
Its clear that Britain is hitting the skids, and, thanks to the added seasoning of relentless mass transport strikes, has already slid back to a 1970s-style economic and infrastructural mess. What is needed are solutions, not the further embrace of punitive finger-wagging.
We face several years, perhaps, of miserable drear and grind as costs and prices soar, and the inflation rate, currently at over 10 per cent, poisons economic stability. But those seizing on this perilous situation to blame capitalism, Brexit, and to lecture about climate change, are missing the point. The point is not that we got ourselves into this, that we spend too much, enjoy too much cheap travel and variety at the supermarket, got the energy market wrong, and had the audacity to want to break free of the EU. The point is that we need better thinking about markets, and better technology to reduce carbon emissions, fix the energy sector, water shortages, and the problems caused by long-distance food haulage. We need to creatively embrace the possibilities afforded by Brexit, not go down in the mire, ideological and practical, of a poorly-managed transition. The point, in short, is not just desserts, but making sure we can keep enjoying lots of delicious desserts, or, put in safer metaphorical terms, the fruits of modernity thoroughly and securely.
The working and middle classes are due a break. For years we have been berated about everything from plastic bag use to sugar consumption, slapped with eye-watering congestion charges, and disrupted by malodorous environmental and anti-capitalist protesters as we simply tried to commute to work. Covids universal cats cradle of nonsensical rules further entrenched the sense of being fatally and perpetually constrained.
If a break is not forthcoming in the present mess, we are at the very least due a bit of encouragement, a bit of hope. And yet there is no let-up. Last week, responding to the most recent heat wave, the focus was back on how we need to do and eat less of what we fancy. Henry Dimbleby, adviser on the governments food policy, and founder of Leon, the food chain, said that the only way for Britain to meet its biodiversity and climate targets was for the consumption of meat to be drastically curtailed, including through penalties. Meanwhile, despite the present government being one of the most aggressive pursuants of net zero on earth today, researchers are complaining that its not doing enough to heckle people into lifestyle changes. Yougov polling showed the July heatwave caused some panic and reflection about climate change among the public, but understandably not enough to make people want to change their lifestyles by forking out for an electric car, eating less red meat, and giving up flying.
To green-heads in policy and research, this is a shame; in their view, the little people should bite the bullet while the government should be less focused on innovation. It should stay mum about the possibilities of electric planes, for instance, and instead focus on making it harder for people to heat their homes or go on holiday. And while few would publicly clap their hands with glee while arguing that Brexit is causing millions to struggle to feed their families there is, nonetheless, a whiff of cackling Remainiac told-you-so-ism about the present moment too. Much was made in the usual quarters of a study earlier this summer on the effects of Brexit on Britains economic outlook. Put out by the Resolution Foundation, a thinktank, in partnership with the LSE, it was surprise surprise a celebration of all the allegedly grim outcomes Remainers warned of. The cost of living crisis, an apparent plummeting in both openness and competitiveness and all the rest of it was explored in fairly one-sided detail.
Brexit has certainly caused some economic constriction, but next to sensible embrace of the broader picture, there is no reason it should not be relatively short-term. Its the same for the rest of the current horror show. Indeed, the main thing about the present mess is not that we deserve it, but that we deserve to get out of it as quickly as possible.
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Liz Truss’ Brexit prediction has aged terribly in just seven months – indy100
Posted: at 11:54 am
One of the things Liz Truss said about Brexit earlier this year already looks pretty ridiculous.
In January, the now Tory leadership contender said Brexit had been fine and had not led to "Armageddon" with "huge queues at Dover" but this is absolutely not true.
She told the Andrew Marr Show on BBC One: There were all kinds of predictions of Armageddon, that wed have huge queues at Dover, it would all be very difficult. In fact, many businesses have succeeded in undergoing those new processes, continuing their exports, we havent seen those predictions of Armageddon come true.
At the time, it was called out for being a bit ridiculous given there was already evidence of queues in Dover which industry groups blamed Brexit for.
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And months on, it has just appeared even less of a credible take as these queues have become more of a regular occurrence. As recently as last month. Some Tories have tried to blame the French for the problems, but have been shut down.
Regardless of the ins and outs of how they have happened, it is clear that queues in Dover have indeed started since Brexit.
Great prediction, Liz.
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Liz Truss' Brexit prediction has aged terribly in just seven months - indy100
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‘Liz Truss is nearest thing we’ve got to Margaret Thatcher’ – The London Economic
Posted: at 11:54 am
The Government can look forward to a post-Brexit windfall worth 135 billion after the UK leaves the European Union, a report claimed in 2017.
The Economists for Free Trade (EFT) group said Brexit will be overwhelmingly positive for the British economy provided the Government adopts the right policies.
The EFT headed by Professor Patrick Minford says the priority for the Government should be to bring down trade barriers with the rest of the world once Britain has left the EU while reducing the burden of regulation and taxation on firms and individuals.
Yes it is that Patrick Minford who is calling Truss the new Thatcher,
Back in July BBCs Nick Robinson interviewed Liz Truss.
He asked: Will borrowing billions of pounds, you say over 30billion increase or decrease inflation?
Ms Truss replied My tax cuts will decrease inflation.
Mr Robinson interjected: Really? You dont point to a single Chancellor or a single Governor of the Bank of England, a single leading economist who thinks that cutting taxes with borrowed money does anything other than increase inflation.
Ms Truss hit back: Patrick Minford. Hes written an article about it this weekend.
In 1981 over 300 economists wrote a letter criticising Margaret Thatchers disastrous economic policies, Minford defended the government and received a letter from Thatcher congratulating him for his efforts.
John Spiers wrote on Twitter: Liz Truss just told Radio 4 that she wants to follow the advice of Patrick Minford, a fringe economist who said that for Brexit to succeed economically we would have to get rid of farming and manufacturing and live with much bigger wage inequality.
Now he has told the Times that Liz Truss is the nearest thing we have to Margaret Thatcher.
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Related: Boris Johnson will run the country from Chequers and people arent having it
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'Liz Truss is nearest thing we've got to Margaret Thatcher' - The London Economic
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Brexit red tape sees battle re-enactment societies at risk of having weapons confiscated – Express
Posted: at 11:54 am
According to members of the UKs leading Napoleonic re-enactment society, the customs red tape fails to account for their firearms. As a result, they are at risk of having their weapons confiscated as they head to the central Spanish-Portuguese border for an event. Members say they may have to wield pitchforks as Portuguese peasants, instead of being British soldiers armed with muskets and rifles.
Chair of the Napoleonic Association Lisa Stanhope said: "What you cant risk is having your beautiful, historically accurate and expensive weapon taken off you by a customs officer who doesnt know the rules.
They are heading to the border this week for a re-enactment for the 1810 Siege of Almeida.Prior to the UK leaving the EU, re-enactors could get a free European licence alongside their shotgun licence. The European licence is used for old-fashioned long arms, allowing them to travel freely with the weapons.
But it seems that for this niche activity, no Brexit provisions exist to guarantee they will be able to continue their re-enactments. Ms Stanhope said she had received conflicting advice from officials at HMRC. She had spoken to four different people who she says could not provide clear guidance.
Ms Stanhope added that she had been told by both French and Spanish officials as well as ferry operators that their community were being held back by UK rules, not EU ones. The rules require them to fill out complex and expensive forms to continue post-Brexit.
Re-enactment societies are already an expensive activity, with outfits costing over 1,000.
They say that the cost and uncertainty of the situation is putting them off it entirely. Re-enactor Richard Cocker, meanwhile, took a swipe at the priorities of the Brexit deal.
READ MORE:'Pay with your liberty' Macron gives chilling ultimatum to French[REVEAL]
He said: "Were not rich guys going off on a hunting holiday, which seems to be totally catered for."
An HMRC spokesman said they were working to provide clearer guidance for those affected, adding that it was the EUs remit to decide on the process.
They said: "The EU determines what is required to import goods into member states. We are working on providing clearer guidance that addresses the requirements on temporarily moving items to the EU."
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Brexit red tape sees battle re-enactment societies at risk of having weapons confiscated - Express
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The Impact of Complementary and Alternative Medicine on Insomnia: A Systematic Review – Cureus
Posted: at 11:51 am
Insomnia is identified by difficulty in maintaining sleep and early morning awakenings [1]. Consequently, it further causes workplace absenteeism, accidents, and a declinein productivity which imparts tremendous societal and economic impact [2]. One-third of the general population encounter insomnia symptoms across their lifespan [3]. Insomnia should not be confused with sleep deprivation, the former being the inability to sleep adequately, either in length or quality[4]. Most studies suggested predominance rates of insomnia disorder from 5% to 15% [5-7]. Insomnia could be a persistent issue in 31% to 75% of patients, with more than two-thirds revealing side effects for at least one year [6-8]. Due to the increasing work pressure and social challenges in an advanced society, most of the masses cannot get adequate sleep and suffer from sleep disturbance [9-12]. A detailed study shows that around 30% of adults suffer from sleep disturbance [7]. It mainly affects females and is increasing with advancing age [8]. Insomnia may be acute or chronic, and primary or secondary [1]. Primary insomnia can be defined as an individual experiencing a sleep disorder due to stress or emotions, while secondary insomnia can be due to co-morbid conditions or prior illness [1]. Insomnia has been associated with many comorbidities such as hypertension, cardiovascular disease, depression, obesity, and diabetes [2]. It can also lead to alterations in attention with episodic memory, and these cognitive impairments are clinically significant [1,2].Hence, to maintain an individual's overall health, the treatment of insomnia is necessary [9, 10]. Conventional methods of treatinginsomnia generally involve either pharmacotherapies or psychological interventions [11]. The use of such kinds ofdrugs can cause serious adverse effects such as cognitive impairment, oversedation, daytime drowsiness,rebound discontinuation,and psychomotor disturbance [12].In recent years, benzodiazepines (diazepam and related drugs) or nonbenzodiazepine hypnotics (zolpidem or zopiclone} have been chosen over older barbiturates which can cause death in cases of overdose. In older patients, sedating antipsychotics, e.g., olanzapine or quetiapine, and sedating anti-depressants with older tricyclic drugs, are generally regarded as "off label" [11, 12]. The new treatment guidelines evolved for benzodiazepine include low doses of sedating antipsychotics, antidepressants, and mood stabilizers [11].Although pharmacotherapiesand psychological interventions remain essential for conventional treatment, due to various motivational factors, interest in using alternative therapies and products for insomnia has developed over the last two decades.
One common treatment group used by patients with insomnia is complementary and alternative medicine (CAM) [5-7]. Research on adult insomnia patients hasfound that 4.5% of them practised CAM to treat their condition [9]. CAM use can be seen extensively among patients with mental disorders, commonly for managing depression or insomnia. CAM generally includes extensive therapies based on different geographical regions from various schools of thought [8]. Common CAM therapies for insomnia include herbal and nutritional medicine, acupuncture, acupressure, yoga, tai chi, and mind-body practices [10]. Mind-body interventions such as yoga help manage stress and anxiety, improving sleep quality[10].Protein source herbal supplement L-tryptophan is also usedfor the treatment of insomnia [11]. Acupuncture and acupressure have been found to restore the normal sleep-wake process. They can also be employed to increase the -amino butyric acid content, enhancing sleep quality [12, 13]. Considering the growing public interest in CAM, these therapies and products have been researched over the past two decades to treat sleep disorders. Although few systematic reviews have been conducted on the use of acupuncture and valerian in treating insomnia, butcomprehensive study on all primary CAM treatments has not been conducted. The present systematic review comprehensively explored the effects of CAM on improving sleep quality to guide evidence-based clinical decision-making and inform future research. We have systematically searched and evaluated the evidence for the impact of CAM on insomnia.
Data Sources
Several electronic databases such as MEDLINE, PubMed, Scopus, EMBASE, Clinical key, Cochrane, and Research gate were explored to search the relevant articles. The references to the articles were also examined. The search strategy was only restricted to research studies in English.
The PubMed search strategy was :(((((((((((INSOMNIA) OR (insomnia[MeSH Terms])) AND (complementary medicine[MeSH Terms])) OR (alternative medicine[MeSH Terms]))) OR (complementary and alternative medicine[MeSH Terms]))) OR Natural practicesOR Manual practices OR Mind-body intervention practices OR Acupuncture ORAcupressure OR Yoga OR Tai ChiAND (The Pittsburgh Sleep Quality Index[MeSH Terms])) OR (PSQI[MeSH Terms])) OR (sleep quality[MeSH Terms])) OR (sleep latency[MeSH Terms])) OR (adjustment sleep disorder[MeSH Terms]) (((("insomnia s"[All Fields] OR "sleep initiation and maintenance disorders"[MeSH Terms] OR ("sleep"[All Fields] AND "initiation"[All Fields] AND "maintenance"[All Fields] AND "disorders"[All Fields]) OR "sleep initiation and maintenance disorders"[All Fields] OR "insomnia"[All Fields] OR "insomnias"[All Fields] OR "sleep initiation and maintenance disorders"[MeSH Terms]) AND "complementary therapies"[MeSH Terms]) OR "complementary therapies"[MeSH Terms] OR (("complementaries"[All Fields] OR "complementary"[All Fields]) AND "complementary therapies"[MeSH Terms])) AND (("Pittsburgh"[All Fields] AND ("sleep quality"[MeSH Terms] OR ("sleep"[All Fields] AND "quality"[All Fields]) OR "sleep quality"[All Fields])) AND OR "sleep quality"[MeSH Terms] OR "sleep latency"[MeSH Terms] OR "dyssomnias"[MeSH Terms]
Eligibility Criteria
Eligibility criteria have been described with the PICO framework. Inclusion and exclusion criteria for participants, intervention, comparison, and outcomes have been mentioned separately in other sections of the article.
Study Design
Randomized controlled trials reporting outcomes of the effects of CAM on insomnia and sleep quality were identified and included. Observational studies, case reports, case series, case presentations, and case-control studies were not included.
Study Participants
Regardless of health issues, adults (18 years or older) were included in the study, except for those working shifts and time zone travellers.
Interventions
For the systematic review, we have included CAM studies, classified under "manual practices," "natural practices," and "mind-body practices." All psychological and psycho-educational interventions were excluded from the review, e.g., cognitive behavioural therapy, relaxation therapy, or mindfulness (regarded as mainstream therapies). Bright-light treatment, exercise, music therapy, sensory art therapies, and aromatherapy were excluded from the study (as these therapies were not considered classical CAM interventions). Melatonin, too, was excluded from the review as the substance is a hormone, not an exogenous natural medicine. A total of eight CAM intervention RCTs met the inclusion criteria.
Comparison
For comparison, we have compared the intervention with a non-active placebo or control.
Outcome Measures
Subjective and objective sleep outcomes were evaluated, including, but not limited to, sleep quality, duration, and latency. The Pittsburgh Sleep Quality Index (PSQI) and Insomnia severity index (ISI) were used as the outcome measure in most of the studies. Duration of intervention should be 1 week.
Study Eligibility
The authors KVand AS independently screened all titles and abstracts per the inclusion and exclusion criteria. Only full-text articles that were published in English are included. Any discrepancy was resolved with discussion among other authors. The searched files were imported to the Zotero library after removing duplicate items and were freely available, and Rayyan (https:// rayyan.qcri.org), a free web-based software, was used to review articles. From the selected eligible articles, required data, including administration of intervention and control, author, year of publication, study design, follow-up, sample size, outcome measures, results, effect size and quality rating, and primary outcomes, were extracted from eligible studies.
Data Extraction
KV and AS prepared a narrative synthesis for relevant research articles, including their outcomes, variations on intervention, types, and outcomes measurement. The methodological quality assessment of the RCTs was performed using the modified Jadad scale, a scientific quality index of 5/10 (on the augmented Jadad scale) [14].
KV and DSsystematically searched the articles through different search engines, but as per inclusion and exclusion criteria mentioned previously, we have reviewed the articles through Rayyan (https:// rayyan.qcri.org), free web-based softwareto be more precise for the inclusion and exclusion criteria.As mentioned in the flow chart, among 621 identified potential studies in the field of CAM and insomnia. A total of 96 studies were removed, due to small sample size (5), different study design (7), insufficient reporting (7), only protocol/meeting abstract available (22), non-adequate control (11), different outcomes (17), non-English (19), short duration (8). This left 35 clinical trials for inclusion, primarily comprising adult samples (except for the tai chi and yoga studies, which used an older population). These CAM studies were grouped under "manual practices," "mind-body," and "natural practices." Eight CAM interventions had RCTs that met the inclusion criteria. DS and KV calculated and reported effect sizes (Cohens d) in all placebo-controlled studies with the available data(Figure 1).
Manual Practices
The systematic review revealed 11 RCTs with manual practice intervention [15-25]. These studies involved acupuncture (inserting fine needles to stimulate "acupoints") and acupressure (using digital or blunt pressure on "acupoints"). The trials were between two and 12 weeks, with an average sample size of 70 participants. Seven of the 11 studies measured the outcomes in the Pittsburgh sleep quality index (PSQI). The insomnia severity index (ISI) was adequate for the outcome measure in three of the 11 studies. The average quality score was 6.8 out of 10[15-18]. Out of the four acupressure studies, they all revealed positive results on the PSQI scale with large effect sizes ranging from 1.42 to 2.12 when measured on various PSQI subscales [15-18].
Among these four acupuncture studies, one was negative, equivalent to either placebo acupuncture or basic sleep hygiene. At the same time, one was positive, equal to the positive control (clonazepam), or more effective than placebo acupuncture or positive control (estazolam). Yin et al. stated a large effect size d = 1.14 on sleep quality outcomes [19-25](Table 1).
Mind-Body Practices
There were 12 mind-body intervention RCTs of sufficient methodological rigour in this review[26-37]. The trial length was between four and 24 weeks, with an average sample size of 90 participants. Five out of the seven studies used PSQI as the outcome measure. The average rating of the quality of the studies was eight out of 10. The yoga intervention studies revealed a positive effect on wait-list control. Manjunathet al. and Mustianet al.studies found large effect sizes (d = 1.52) and d = 2.56 on sleep quality outcome measures [31, 32]. One study (Ward et al.) found no significant difference between yoga and control groups [30].
All five tai chi trials were positive on various PSQI outcome measures compared with health education or low-impact exercise [33-37]. Large effect sizes prevailed in sleep duration d = 2.15 and sleep quality d = 1.05 in Li et al. [35]. At the same time, a marked divergence was observed in Irwin et al. with a large effect size on sleep severity (global score) d = 1.57 compared to small effect sizes on sleep duration d = 0.22, and sleep quality d = 0.44 [37] (Table 2).
Natural medicine practices
The review identified 12 RCTs of sufficient methodological rigour [38-48]. Three studies included kava and valerian interventions. Six studies included valerian intervention [38-40]. Three studies included tryptophan intervention [13,47,48]. The trials were from two to eight weeks (commonly two to four weeks) with an average sample size of 150 participants. The herbal medicine kava met the inclusion criteria compared to the placebo. The analysis of Lehrl et al.'s study showed a benefit for kava over placebo on the quality of sleep outcome [40]. The valerian studies exhibited diversified results, with three positive (more effective than placebo and equivalent to oxazepam) and three negative results (equal to placebo) [41-46]. For most of the studies, effect size calculations could not be available. For L-tryptophan trials, the average quality rating was seven out of 10, while herbal medicines studies showed a higher rating of 8 out of 10. Among the three L-tryptophan studies, two were positive on several outcomes. Hudson et al., in their analysis, mentioned a large effect size on increased sleep duration d = 1.16, and a small effect size on sleep quality d = 0.28 [13] (Table 3).
A review of all quality studies suggested that CAM may have the potential to improve sleep quality in a variety of patient populations. Although evidence is limited, this systematic review, which includes studies published till Jan. 2022, provides evidence that CAM may be useful for the treatment of both uncomplicated insomnias as well as insomnia co-morbid conditions.
Despite the substantial clinical trial literature, several studies were excluded due to methodological shortcomings. Only35 English language RCTs met the inclusion criteria. In various RCTs of herbal medicine, mostly involving valerian, researchers employed a short study duration and small sample size, restricting the study's statistical power. Moreover, several acupuncture studies had an 'active' control group, mostly involving another type of acupuncture.
Many studies could not calculate the effect size due to negative results or insufficient data (e.g., no standard deviation). As a result, the effect sizes noted in the positive studies (in natural medicine and manual practices) should be tempered concerning the negative studies. Quality grading of RCTs has been displayed in respective tables of manual, mind body and natural medicine practice. The majority of RCTs for manual practice scored 7/10 for quality of grading. Most RCTs for mind-body practices scored 6/10 while assessing quality grading. Mostly, RCTs with natural medicine practice scored 8/10 score for quality grading.
Findings revealed that the evidence for natural medicine practices in treating insomnia was also conflicting. Valerian was one of the most studied soporific natural medicines for its rich folkloric tradition of use in conditions of restlessness, hysteria, headache, nervousness, and mental depression. As detailed in Table 3, the evidence regarding valerian was quite mixed and did not support its use in treating insomnia. These results follow thesystematic reviews and meta-analyses done byBent et al. and Taibi et al. [49, 50]. The study of Bent et al., which included 16 eligible RCTs on valerian and valerian in combination with other herbal medicines, suggests that nine out of 16 studies did not have positive outcomes concerning the improvement of sleep quality [49]. The Taibi et al. review, which included 29 controlled studies, consistently stated that most studies lacked any significant difference between valerian and placebo. Valerian, combined withhopsor kava, did not seem to support the available data. Kava may provide a prospective alternative for managing insomnia [50]. However, Lehrl's studies had a different opinion, and presently as kava is withdrawn in several jurisdictions, further studies about its safety and efficacy are much needed [40].
L-tryptophan, an exogenous amino acid converted into serotonin, has been widely studied in treating insomnia and depression [51].However, the results were encouraging but varied concerning different sleep outcomes. The studies on various animals and humans consistently suggest that L-tryptophan increases sleepiness and decreases sleep latency [51, 52]. It has been observed that the best results seem to occur in cases of mild insomnia with long sleep latency and the absence of any medical or psychiatric comorbidity [51, 52]. A study by Hudson et al. determined a large effect size on increased sleep duration and a negligible effect on sleep quality [13]. A survey by Irwin et al.consistently revealed a substantial effect size for tai chi in reducing insomnia severity. In contrast, sleep duration and quality effects had poor clinical outcomes [37]. The heterogeneous nature of samples throughout the studies made these effect size differences [37].
Acupuncture and acupressure seem to contribute to treating insomnia, probably by the neurochemical modulatory activity of serotonin, dopamine, and endogenous opioids [53]. The review by Cheuk et al.concluded with seven rigorous methodological trials that acupuncture and acupressure help improve sleep quality scores. Still, the evidence for acupuncture as a hypnotic intervention was inconsistent. Compared to control or no treatment, the efficacy of acupuncture and its variants was inconsistent among studies, including many sleep parameters, such as sleep onset latency, time to wake after sleep onset, and total sleep duration [53]. Further, Yeung et al. revealed that definitive conclusions could not be derived on acupuncture's efficacy for insomnia. This conclusion was reached due to the methodological quality of RCTs as the limitations of the study designs hampered studies. For instance, publications of such studies have also provided limited information about inclusion/exclusion criteria, outcomes measured, missing baseline data, randomization methods, and the specific acupuncture approach [54].
Mind-body practices such as yoga and tai chi in insomnia and different sleep disorders are enhancing popularity, particularly in the ageing population who might prefer low-effect exercises [35]. Comparatively, findings supported the benefits of exercise in improving sleep quality and reducing the severity of insomnia in older people. However, a Li et al. study compared tai chi to low-effect exercise and found it superior to low-effect exercises in all outcomes [35]. While Manjunath et al., the yoga study included older participants with sleep issues and noted yoga was superior to both wait-list and herbal medicine on sleep latency and total sleep [31]. Mind-body practices comprise multicomponent interventions, considered to give rise to similar physiological processes to traditional relaxation methods, which have been investigated as treatment options for insomnia [26-37]. Mechanistically, yoga acutely affects the activity of the autonomic nervous system and may decrease the gamma-aminobutyric acid levels and inflammatory markers. Probably by neurobiological pathways, yoga may improve sleep quality [28, 29]. Data from small RCTs suggested that yoga improves subjective and objective sleep quality, reducing insomnia symptoms in adults with chronic medical conditions [26, 28, 29, 31]. One of the largest RCTs of Yoga illustrated reduced hypnotic medication use in cancer survivors with sleep disturbance by 21% in the yoga group compared with 5% in the control group [32]. However, several emerging clinical trials on yoga found that most participants faced a general sleep disturbance. Moreover, yoga studies includingpranayama, breathing exercises, gentle hatha, restorative yoga asanas, and meditationassessing sleep outcomes showed common methodological limitations of sample sizes and limited use of objective outcome measures [27-32]. Further studies on yoga are encouraged with participants with a confirmed diagnosis of insomnia using validated sleep assessment scales.
Similarly, in studies for tai chi intervention, the focus was more on sleep quality rather than insomnia. Several RCTs suggested improvement in reported sleep quality, with tai chi intervention, particularly among older adults. Therefore,tai chimay improve sleep quality in different populations, specifically older adults [33-37]. Its impact on objective measures in chronic insomnia needs further explained.
In reference to data from the United States National Health Interview Survey, 17.4% of adults (n= 93 386) reported insomnia or regular sleep disturbance, and 4.5% used CAM therapies to improve their sleep quality. 56% of the individuals said that CAM was essential to maintaining their overall health and well-being, while 72% observed that CAM improved insomnia disorders significantly. Younger and highly qualified persons believe in CAM to improve insomnia symptoms [55]. It has been noticed that traditional Indo-Asian therapies such as acupuncture, acupressure, and yoga were morewidely studied compared to standard Western CAM therapies. The broadly researched herbal medicine is valerian in the form of monotherapy or combination with hops or kava [13, 15-48]. Future research in other herbal medications or Western CAM therapies with potential hypnotic effects is recommended as current research in these areas is insufficient.
The strengths of this systematic review included the search and synthesis of all relevant studies across several databases, the rigorous methodological inclusion criteria, and a quality assessment of all clinical trials with calculations of the effect size of studies.
This review also had some limitations. These were language constraints, as we excluded non-English publications; several valerian studies were published in German, and acupuncture studies were published in Chinese. Secondly, it lacks appropriate clinical trials with methodological weakness, for instance, adequate sample sizes. While reporting complete data, the long-term efficacy and safety of CAM interventions should have been employed.
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The Impact of Complementary and Alternative Medicine on Insomnia: A Systematic Review - Cureus
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